S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
     S. 1507                                                  A. 2007
 
                       S E N A T E - A S S E M B L Y
 
                             January 18, 2019
                                ___________
 
 IN  SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
   cle seven of the Constitution -- read twice and ordered  printed,  and
   when printed to be committed to the Committee on Finance
 
 IN  ASSEMBLY  --  A  BUDGET  BILL, submitted by the Governor pursuant to
   article seven of the Constitution -- read once  and  referred  to  the
   Committee on Ways and Means

 AN ACT to amend the social services law, in relation to reimbursement of
   transportation   costs,   reimbursement  of  emergency  transportation
   services and  supplemental  transportation  payments;  and  to  repeal
   certain provisions of such law relating thereto (Part A); to amend the
   social services law and the public health law, in relation to updating
   copayments;  to  amend the public health law, in relation to extending
   and enhancing the Medicaid drug cap and to reduce unnecessary pharmacy
   benefit manager costs to the Medicaid program; and to  repeal  certain
   provisions  of  the  social services law relating thereto (Part B); to
   amend the social  services  law,  in  relation  to  extension  of  the
   National  Diabetes  Prevention Program and in relation to supplemental
   medicaid managed care payments (Part C); to amend chapter  59  of  the
   laws of 2011 amending the public health law and other laws relating to
   known  and projected department of health state fund medicaid expendi-
   tures, in relation to extending the medicaid global cap (Part  D);  to
   amend  chapter 505 of the laws of 1995, amending the public health law
   relating to the operation  of  department  of  health  facilities,  in
   relation  to  extending the provisions thereof; to amend chapter 56 of
   the laws of the laws of 2013, amending the social services law  relat-
   ing to eligibility conditions, in relation to extending the provisions
   thereof; to amend chapter 884 of the laws of 1990, amending the public
   health  law  relating  to authorizing bad debt and charity care allow-
   ances for certified home health agencies, in relation to extending the
   provisions thereof; to amend chapter 303 of the laws of 1999, amending
   the New York state medical care facilities finance agency act relating
   to financing health facilities, in relation to the effectiveness ther-
   eof; to amend chapter 109 of the laws of  2010,  amending  the  social
   services  law  relating  to  transportation  costs, in relation to the
   effectiveness thereof; to amend chapter 58 of the laws of 2009, amend-
   ing the public health law relating to payment by governmental agencies
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD12571-01-9

 S. 1507                             2                            A. 2007
 
   for general hospital inpatient services, in relation to the effective-
   ness thereof; to amend chapter 56 of the laws of  2013,  amending  the
   public  health law relating to the general public health work program,
   in  relation  to the effectiveness thereof; to amend chapter 59 of the
   laws of 2011, amending the public health law and other  laws  relating
   to known and projected department of health state fund medical expend-
   itures,  in relation to extending the provisions thereof; to amend the
   public health law, in relation to hospital assessments; to amend chap-
   ter 474 of the laws of 1996, amending the education law and other laws
   relating to rates for residential health care facilities, in  relation
   to the effectiveness thereof; to amend chapter 58 of the laws of 2007,
   amending  the  social services law and other laws relating to enacting
   the major components of legislation necessary to implement the  health
   and  mental  hygiene  budget  for  the 2007-2008 state fiscal year, in
   relation to delay of certain administrative costs; to amend chapter 81
   of the laws of 1995, amending the public health  law  and  other  laws
   relating  to  medical reimbursement and welfare reform, in relation to
   the effectiveness thereof; to amend chapter 56 of the  laws  of  2013,
   amending chapter 59 of the laws of 2011 amending the public health law
   and  other  laws relating to general hospital reimbursement for annual
   rates, in relation to rates of payments; to amend  the  public  health
   law,  in  relation  to reimbursement rate promulgation for residential
   health care facilities; to amend the public health law, in relation to
   residential health care facility, and  certified  home  health  agency
   services  payments;  to amend chapter 81 of the laws of 1995, amending
   the public health law and other laws relating to medical reimbursement
   and welfare reform, in relation to the effectiveness thereof; to amend
   chapter 56 of the laws of 2013 amending chapter 59 of the laws of 2011
   amending the public health law and  other  laws  relating  to  general
   hospital  reimbursement  for  annual  rates,  in relation to extending
   government rates for behavioral services  and  adding  an  alternative
   payment  methodology  requirement; to amend chapter 111 of the laws of
   2010 relating to increasing Medicaid  payments  to  providers  through
   managed  care  organizations  and providing equivalent fees through an
   ambulatory patient group methodology, in relation to extending govern-
   ment rates for behavioral services and adding an  alternative  payment
   methodology  requirement;  to amend section 2 of part H of chapter 111
   of the laws of 2010,  relating  to  increasing  Medicaid  payments  to
   providers  through managed care organizations and providing equivalent
   fees through an ambulatory patient group methodology, in  relation  to
   transfer  of funds and the effectiveness thereof; and to amend chapter
   649 of the laws of 1996, amending the public health  law,  the  mental
   hygiene  law  and  the social services law relating to authorizing the
   establishment of special needs plans, in relation to the effectiveness
   thereof (Part E); to amend chapter 266 of the laws of  1986,  amending
   the  civil  practice law and rules and other laws relating to malprac-
   tice and professional medical conduct,  in  relation  to  apportioning
   premium  for  certain  policies;  to amend part J of chapter 63 of the
   laws of 2001 amending chapter 266 of the laws of  1986,  amending  the
   civil  practice  law  and rules and other laws relating to malpractice
   and professional medical conduct, relating  to  the  effectiveness  of
   certain  provisions  of such chapter, in relation to extending certain
   provisions concerning the hospital excess liability pool; and to amend
   part H of chapter 57 of the laws of 2017, amending the New York Health
   Care Reform Act of 1996 and other laws relating to  extending  certain
   provisions  relating  thereto,  in  relation  to  extending provisions

 S. 1507                             3                            A. 2007
 
   relating to excess coverage (Part F); to  amend  the  social  services
   law,  in  relation  to  eliminating the ability of legally responsible
   spouses to refuse to support non-institutionalized spouses; to  create
   a state fiscal intermediary for the consumer directed personal assist-
   ance  program;  and  to repeal certain provisions of such law relating
   thereto (Part G); to amend the public health law, in relation to waiv-
   er of certain regulations; to amend the public health law in  relation
   to  certain  rates  and  payment  methodologies; and to repeal certain
   provisions of such law relating thereto (Part H); to amend the  insur-
   ance  law, in relation to registration and licensing of pharmacy bene-
   fit managers (Part I); to amend  the  insurance  law  and  the  public
   health  law,  in  relation  to  guaranteed  availability, pre-existing
   conditions  and  employee  welfare  funds;  and  to   repeal   certain
   provisions of the insurance law relating thereto (Subpart A); to amend
   the  insurance  law,  in  relation to actuarial value requirements and
   essential health benefits (Subpart B); to amend the insurance law,  in
   relation to coverage for medically necessary abortions, and exceptions
   thereto  (Subpart  C);  to  amend  the  insurance  law, in relation to
   prescription drug coverage (Subpart D); to amend the insurance law, in
   relation to discrimination based on sex and gender  identity  (Subpart
   E);  and  to amend the insurance law, in relation to insurance certif-
   icate delivery (Subpart F) (Part J); to amend the public  health  law,
   in relation to the medical indemnity fund; and to amend chapter 517 of
   the  laws  of 2016 amending the public health law relating to payments
   from the New York state medical indemnity fund,  in  relation  to  the
   effectiveness  thereof  (Part  K);  to  amend  the  insurance  law, in
   relation to in-vitro fertilization (Part L); to  amend  the  insurance
   law  and  the  social  services  law,  in relation to requiring health
   insurance policies to include coverage of all FDA-approved  contracep-
   tive  drugs, devices, and products, as well as voluntary sterilization
   procedures, contraceptive education and counseling, and related follow
   up services and prohibiting a health insurance  policy  from  imposing
   any  cost-sharing  requirements  or  other restrictions or delays with
   respect to this coverage (Part M); to  establish  a  universal  access
   commission  to  consider the options for achieving universal access to
   health care (Part N); to amend the public health law, in  relation  to
   the  general  public health work program (Part O); to amend the public
   health law, in relation to lead levels in residential  rental  proper-
   ties  (Part  P);  to  amend  the public health law, in relation to the
   healthcare facility transformation program state III authorizing addi-
   tional awards for statewide II applications (Part  Q);  to  amend  the
   public health law, in relation to maternal mortality review boards and
   the  maternal  mortality  and  morbidity advisory council (Part R); to
   amend the public health law, in relation to enacting the  reproductive
   health act and revising existing provisions of law regarding abortion;
   to amend the penal law, the criminal procedure law, the county law and
   the  judiciary  law,  in  relation  to  abortion;  to  repeal  certain
   provisions of the public health law relating to  abortion;  to  repeal
   certain  provisions  of  the  education  law  relating  to the sale of
   contraceptives; and to repeal certain  provisions  of  the  penal  law
   relating  to  abortion  (Part  S);  to amend the public health law, in
   relation to codifying the creation of NY State of Health, the official
   Health Plan Marketplace within the department of health (Part  T);  to
   amend  the elder law, in relation to the private pay program (Part U);
   to amend the social services law, in relation to compliance of managed
   care organizations and providers participating in the Medicaid program

 S. 1507                             4                            A. 2007
 
   (Part V); to amend part D of chapter 111 of the laws of 2010  relating
   to  the  recovery  of exempt income by the office of mental health for
   community residences and family-based treatment programs, in  relation
   to the effectiveness thereof (Part W); to amend the criminal procedure
   law,  in  relation  to  authorizing  restorations to competency within
   correctional facility based residential settings;  and  providing  for
   the  repeal  of  such  provisions upon expiration thereof (Part X); to
   amend part C of chapter 57 of the laws of 2006, relating to establish-
   ing  a  cost  of  living  adjustment  for  designated  human  services
   programs, in relation to the inclusion and development of certain cost
   of living adjustments (Part Y); to amend the public health law and the
   mental  hygiene  law,  in relation to integrated services (Part Z); to
   amend the social services law, in relation  to  the  definition  of  a
   facility  or  a  provider agency (Part AA); and to amend the insurance
   law, in relation to mental health and substance  use  disorder  health
   insurance  parity;  to  amend  the  public  health law, in relation to
   health maintenance organizations; and to repeal certain provisions  of
   the  insurance  law  relating thereto (Subpart A); to amend the public
   health law, in relation to general hospital policies for substance use
   disorder treatment (Subpart B); to repeal subparagraph  (v)  of  para-
   graph  (a) of subdivision 2 of section 3343-a of the public health law
   relating to general hospital prescription drug monitoring (Subpart C);
   to amend the  social  services  law,  in  relation  to  court  ordered
   substance  use disorder treatment (Subpart D); and to amend the public
   health law, in relation to including fentanyl  analogs  as  controlled
   substances (Subpart E)(Part BB)
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act enacts into law major  components  of  legislation
 which are necessary to implement the state fiscal plan for the 2019-2020
 state  fiscal  year.  Each  component  is wholly contained within a Part
 identified as Parts A through BB. The effective date for each particular
 provision contained within such Part is set forth in the last section of
 such Part. Any provision in any section contained within a Part, includ-
 ing the effective date of the Part, which makes a reference to a section
 "of this act", when used in connection with that  particular  component,
 shall  be  deemed  to mean and refer to the corresponding section of the
 Part in which it is found. Section three of  this  act  sets  forth  the
 general effective date of this act.
 
                                  PART A
 
   Section  1. Subdivision 4 of section 365-h of the social services law,
 as separately amended by section 50 of part B and section 24 of  part  D
 of chapter 57 of the laws of 2015, is amended to read as follows:
   4.  The  commissioner of health is authorized to assume responsibility
 from a local social services official for the provision  and  reimburse-
 ment  of  transportation  costs  under this section. If the commissioner
 elects to assume such responsibility, the commissioner shall notify  the
 local  social  services official in writing as to the election, the date
 upon which the election shall be effective and such  information  as  to
 transition  of  responsibilities  as the commissioner deems prudent. The
 commissioner is authorized to contract with a transportation manager  or

 S. 1507                             5                            A. 2007
 
 managers  to manage transportation services in any local social services
 district, other than transportation services provided  or  arranged  for
 enrollees  of  [managed  long  term  care  plans  issued certificates of
 authority  under section forty-four hundred three-f of the public health
 law] A PROGRAM DESIGNATED AS A PROGRAM OF  ALL-INCLUSIVE  CARE  FOR  THE
 ELDERLY (PACE) AS AUTHORIZED BY FEDERAL PUBLIC LAW 105-33, SUBTITLE I OF
 TITLE IV OF THE BALANCED BUDGET ACT OF 1997.  Any transportation manager
 or  managers  selected  by  the  commissioner  to  manage transportation
 services shall have proven  experience  in  coordinating  transportation
 services in a geographic and demographic area similar to the area in New
 York  state  within  which  the contractor would manage the provision of
 services under this section. Such a contract or  contracts  may  include
 responsibility  for:  review,  approval and processing of transportation
 orders; management of the appropriate level of transportation  based  on
 documented  patient  medical  need;  and development of new technologies
 leading to efficient transportation services. If the commissioner elects
 to assume such responsibility from a local social services district, the
 commissioner shall examine and, if appropriate, adopt quality  assurance
 measures  that  may  include, but are not limited to, global positioning
 tracking system reporting requirements and  service  verification  mech-
 anisms.  Any  and  all  reimbursement  rates developed by transportation
 managers under this subdivision shall  be  subject  to  the  review  and
 approval of the commissioner.
   §  2.  The  opening  paragraph  of  subdivision 1 and subdivision 3 of
 section 367-s of the social services law, as amended by  section  53  of
 part  B  of  chapter  57  of  the  laws  of 2015, are amended to read as
 follows:
   Notwithstanding any provision of law to the contrary,  a  supplemental
 medical assistance payment shall be made on an annual basis to providers
 of  emergency medical transportation services in an aggregate amount not
 to exceed four million dollars for two thousand six, six million dollars
 for two thousand seven, six million dollars for two thousand eight,  six
 million  dollars for the period May first, two thousand fourteen through
 March thirty-first, two thousand fifteen, and six million dollars [annu-
 ally beginning with] ON AN ANNUAL BASIS FOR the period April first,  two
 thousand  fifteen  through  March  thirty-first,  two thousand [sixteen]
 NINETEEN pursuant to the following methodology:
   3. If all necessary approvals under federal law and regulation are not
 obtained to receive federal  financial  participation  in  the  payments
 authorized by this section, payments under this section shall be made in
 an  aggregate  amount not to exceed two million dollars for two thousand
 six, three million dollars for two thousand seven, three million dollars
 for two thousand eight, three million dollars for the period May  first,
 two  thousand fourteen through March thirty-first, two thousand fifteen,
 and three million dollars [annually beginning with] ON AN  ANNUAL  BASIS
 FOR  the  period April first, two thousand fifteen through March thirty-
 first, two thousand [sixteen] NINETEEN.   In such case,  the  multiplier
 set  forth  in paragraph (b) of subdivision one of this section shall be
 deemed to be two million dollars or three million dollars as  applicable
 to the annual period.
   §  3.  Subdivision  5  of  section 365-h of the social services law is
 REPEALED.
   § 4. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that section one of this act shall take effect October 1, 2019;
 provided,  further that the amendments to subdivision 4 of section 365-h

 S. 1507                             6                            A. 2007
 
 of the social services law made by section one of  this  act  shall  not
 affect  the  repeal  of  such  section  and  shall  expire and be deemed
 repealed therewith.
 
                                  PART B
 
   Section  1.  Paragraph  (a)  of  subdivision 4 of section 365-a of the
 social services law, as amended by chapter 493 of the laws of  2010,  is
 amended to read as follows:
   (a) drugs which may be dispensed without a prescription as required by
 section sixty-eight hundred ten of the education law; provided, however,
 that  the state commissioner of health may by regulation specify certain
 of such drugs which may be reimbursed as an item of  medical  assistance
 in  accordance with the price schedule established by such commissioner.
 Notwithstanding any other provision of law, [additions] MODIFICATIONS to
 the list of drugs reimbursable under this  paragraph  may  be  filed  as
 regulations  by  the  commissioner  of  health  without prior notice and
 comment;
   § 2. Paragraph (c) of subdivision 6 of section  367-a  of  the  social
 services  law  is  amended  by  adding a new subparagraph (v) to read as
 follows:
   (V) NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, CO-PAYMENTS
 CHARGED FOR DRUGS  DISPENSED  WITHOUT  A  PRESCRIPTION  AS  REQUIRED  BY
 SECTION SIXTY-EIGHT HUNDRED TEN OF THE EDUCATION LAW BUT WHICH ARE REIM-
 BURSED  AS  AN  ITEM  OF MEDICAL ASSISTANCE PURSUANT TO PARAGRAPH (A) OF
 SUBDIVISION FOUR OF SECTION THREE HUNDRED  SIXTY-FIVE-A  OF  THIS  TITLE
 SHALL BE ONE DOLLAR.
   §  3.  Paragraph  (b)  of  subdivision  3 of section 273 of the public
 health law, as added by section 10 of part C of chapter 58 of  the  laws
 of 2005, is amended to read as follows:
   (b)  In the event that the patient does not meet the criteria in para-
 graph (a) of this subdivision, the  prescriber  may  provide  additional
 information  to  the  program  to justify the use of a prescription drug
 that is not on the preferred drug list.  The  program  shall  provide  a
 reasonable opportunity for a prescriber to reasonably present his or her
 justification  of  prior authorization. [If, after consultation with the
 program, the prescriber, in his or her reasonable professional judgment,
 determines that the use of a  prescription  drug  that  is  not  on  the
 preferred  drug  list is warranted, the prescriber's determination shall
 be final.] THE PROGRAM WILL CONSIDER THE ADDITIONAL INFORMATION AND  THE
 JUSTIFICATION  PRESENTED  TO DETERMINE WHETHER THE USE OF A PRESCRIPTION
 DRUG THAT IS NOT ON THE PREFERRED DRUG LIST IS WARRANTED.
   § 4. Subdivisions 25 and 25-a of section 364-j of the social  services
 law are REPEALED.
   §  5.  Paragraphs  (b)  and (c) of subdivision 2 of section 280 of the
 public health law, paragraph (b) as amended and paragraph (c)  as  added
 by  section  8  of part D of chapter 57 of the laws of 2018, are amended
 and a new paragraph (d) is added to read as follows:
   (b) for state fiscal year two thousand  eighteen--two  thousand  nine-
 teen,  be  limited to the ten-year rolling average of the medical compo-
 nent of the consumer price index plus four percent and minus a  pharmacy
 savings target of eighty-five million dollars; [and]
   (c)  for state fiscal year two thousand nineteen--two thousand twenty,
 be limited to the ten-year rolling average of the medical  component  of
 the  consumer price index plus four percent and minus a pharmacy savings
 target of eighty-five million dollars[.]; AND

 S. 1507                             7                            A. 2007
 
   (D) FOR STATE FISCAL YEAR TWO THOUSAND  TWENTY--TWO  THOUSAND  TWENTY-
 ONE, BE LIMITED TO THE TEN-YEAR ROLLING AVERAGE OF THE MEDICAL COMPONENT
 OF  THE  CONSUMER  PRICE  INDEX  PLUS  FOUR PERCENT AND MINUS A PHARMACY
 SAVINGS TARGET OF EIGHTY-FIVE MILLION DOLLARS.
   § 6. Subdivision 3 of section 280 of the public health law, as amended
 by  section 8 of part D of chapter 57 of the laws of 2018, is amended to
 read as follows:
   3. The department and the division of the budget  shall  assess  on  a
 quarterly basis the projected total amount to be expended in the year on
 a  cash  basis  by the Medicaid program for each drug, and the projected
 annual amount of state funds Medicaid drug expenditures on a cash  basis
 for all drugs, which shall be a component of the projected department of
 health  state  funds  Medicaid  expenditures  calculated for purposes of
 sections ninety-one and ninety-two of part H of  chapter  fifty-nine  of
 the  laws  of  two  thousand eleven. For purposes of this section, state
 funds Medicaid drug expenditures include amounts expended for  drugs  in
 both  the  Medicaid  fee-for-service  program  and Medicaid managed care
 programs, minus the amount of any  drug  rebates  or  supplemental  drug
 rebates received by the department, including rebates pursuant to subdi-
 vision five of this section with respect to rebate targets. [The depart-
 ment  and  the division of the budget shall report quarterly to the drug
 utilization review board the projected state funds Medicaid drug expend-
 itures including the amounts, in aggregate thereof, attributable to  the
 net cost of: changes in the utilization of drugs by Medicaid recipients;
 changes  in  the  number  of Medicaid recipients; changes to the cost of
 brand name drugs and changes to the cost of generic drugs. The  informa-
 tion  contained in the report shall not be publicly released in a manner
 that allows for the identification of an individual drug or manufacturer
 or that is likely to compromise the financial competitive,  or  proprie-
 tary nature of the information.]
   (a) In the event the director of the budget determines, based on Medi-
 caid drug expenditures for the previous quarter or other relevant infor-
 mation,  that  the  total department of health state funds Medicaid drug
 expenditure is projected to exceed the annual growth limitation  imposed
 by  subdivision  two  of this section, the commissioner may identify and
 refer drugs to the drug utilization review board established by  section
 three hundred sixty-nine-bb of the social services law for a recommenda-
 tion  as to whether a target supplemental Medicaid rebate should be paid
 by the manufacturer of the drug to the department and the target  amount
 of the rebate.
   (b)  If the department intends to refer a drug to the drug utilization
 review board pursuant to paragraph (a) of this subdivision, the  depart-
 ment  shall  notify  the  manufacturer of such drug and shall attempt to
 reach agreement with the manufacturer on a rebate for the drug prior  to
 referring  the  drug  to  the  drug utilization review board for review.
 SUCH REBATE MAY BE BASED ON EVIDENCE-BASED RESEARCH, INCLUDING, BUT  NOT
 LIMITED  TO,  SUCH  RESEARCH OPERATED OR CONDUCTED BY OR FOR OTHER STATE
 GOVERNMENTS, THE FEDERAL GOVERNMENT, THE GOVERNMENTS OF  OTHER  NATIONS,
 AND THIRD PARTY PAYERS OR MULTI-STATE COALITIONS.
   (c)  [In  the  event  that  the commissioner and the manufacturer have
 previously agreed to a supplemental rebate for a drug pursuant to  para-
 graph  (b)  of this subdivision or paragraph (e) of subdivision seven of
 section three hundred sixty-seven-a of the social services law, the drug
 shall not be referred to the  drug  utilization  review  board  for  any
 further  supplemental  rebate  for  the  duration of the previous rebate
 agreement.

 S. 1507                             8                            A. 2007

   (d)] The department shall consider a drug's actual cost to the  state,
 including  current rebate amounts, prior to seeking an additional rebate
 pursuant to paragraph (b) [or (c)] of this subdivision [and  shall  take
 into  consideration  whether  the  manufacturer of the drug is providing
 significant  discounts  relative  to other drugs covered by the Medicaid
 program].
   [(e)] (D) The commissioner shall be authorized  to  take  the  actions
 described  in  this section only so long as total Medicaid drug expendi-
 tures are projected to exceed the annual growth  limitation  imposed  by
 subdivision two of this section.
   §  7.  Paragraph  (a)  of  subdivision  5 of section 280 of the public
 health law, as amended by section 8 of part D of chapter 57 of the  laws
 of 2018, is amended to read as follows:
   (a)  If  the  drug utilization review board recommends a target rebate
 amount on a drug referred by the commissioner, the  [commissioner  shall
 require]  DEPARTMENT  SHALL NEGOTIATE WITH THE DRUG'S MANUFACTURER FOR a
 supplemental rebate to be paid by the [drug's] manufacturer in an amount
 not to exceed such target rebate amount. [With respect to  a]  A  rebate
 [required  in  state  fiscal  year  two thousand seventeen--two thousand
 eighteen, the rebate] requirement shall apply beginning with the  [month
 of  April,  two  thousand seventeen,] FIRST DAY OF THE STATE FISCAL YEAR
 DURING WHICH THE REBATE WAS REQUIRED without  regard  to  the  date  the
 department enters into the rebate agreement with the manufacturer.
   §  8.  Paragraph  (a)  of  subdivision  7 of section 280 of the public
 health law, as amended by section 8 of part D of chapter 57 of the  laws
 of 2018, is amended to read as follows:
   (a) If, after taking into account all rebates and supplemental rebates
 received  by the department, including rebates received to date pursuant
 to this section, total Medicaid drug expenditures are still projected to
 exceed the annual growth limitation imposed by subdivision two  of  this
 section,  the  commissioner  may:  subject  any  drug  of a manufacturer
 referred to the drug utilization review  board  under  this  section  to
 prior approval in accordance with existing processes and procedures when
 such  manufacturer  has not entered into a supplemental rebate agreement
 as required by this section; [directing] DIRECT managed  care  plans  to
 remove  from their Medicaid formularies those drugs that the drug utili-
 zation review board recommends  a  target  rebate  amount  for  and  the
 manufacturer  has  failed  to  enter into a rebate agreement required by
 this section; [promoting] PROMOTE the use of cost  effective  and  clin-
 ically  appropriate  drugs  other than those of a manufacturer who has a
 drug that the drug utilization review board recommends a  target  rebate
 amount  and the manufacturer has failed to enter into a rebate agreement
 required by this section; [allowing] ALLOW manufacturers  to  accelerate
 rebate  payments under existing rebate contracts; and such other actions
 as authorized by law.  The commissioner shall provide written notice  to
 the  legislature  thirty  days  prior  to taking action pursuant to this
 paragraph, unless action is necessary in the fourth quarter of a  fiscal
 year  to  prevent  total  Medicaid  drug expenditures from exceeding the
 limitation imposed by subdivision two of this  section,  in  which  case
 such notice to the legislature may be less than thirty days.
   §  9.  Subdivision 8 of section 280 of the public health law, as added
 by section 8 of part D of chapter 57 of the laws of 2018, is amended  to
 read as follows:
   8.  The commissioner shall report by [February] JULY first annually to
 the drug utilization review board on savings achieved through  the  drug
 cap  in  the  last  FISCAL  year. Such report shall provide data on what

 S. 1507                             9                            A. 2007
 
 savings were achieved through actions pursuant  to  subdivisions  three,
 five  and  seven  of  this  section, respectively, and what savings were
 achieved through other means and how such savings  were  calculated  and
 implemented.
   §  10.  Section 4406-c of the public health law is amended by adding a
 new subdivision 10 to read as follows:
   10. (A) ANY CONTRACT OR OTHER ARRANGEMENT ENTERED  INTO  BY  A  HEALTH
 CARE PLAN FOR PHARMACY BENEFIT MANAGEMENT SERVICES ON BEHALF OF INDIVID-
 UALS  ENROLLED  IN  A  MANAGED CARE PROVIDER AS DEFINED IN SECTION THREE
 HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW SHALL INCLUDE PROVISIONS
 THAT ENSURE THE FOLLOWING:
   (I) PAYMENT TO THE  PHARMACY  BENEFIT  MANAGER  FOR  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  IS  LIMITED  TO  THE  ACTUAL  INGREDIENT  COSTS, A
 DISPENSING FEE, AND AN ADMINISTRATIVE FEE FOR EACH CLAIM PROCESSED.  THE
 DEPARTMENT OF HEALTH MAY ESTABLISH A MAXIMUM ADMINISTRATIVE FEE;
   (II)  THE  PHARMACY  BENEFIT  MANAGER IDENTIFIES ALL SOURCES OF INCOME
 RELATED TO THE PROVISION OF  PHARMACY  BENEFIT  MANAGEMENT  SERVICES  ON
 BEHALF  OF  THE  HEALTH  CARE  PLAN,  INCLUDING, BUT NOT LIMITED TO, ANY
 DISCOUNTS OR SUPPLEMENTAL REBATES, AND THAT ANY PORTION OF  SUCH  INCOME
 IS  PASSED THROUGH TO THE HEALTH CARE PLAN IN FULL TO REDUCE THE REPORT-
 ABLE INGREDIENT COST; AND
   (III) THE PHARMACY BENEFIT MANAGER SHALL NOT  RETAIN  ANY  PORTION  OF
 SPREAD  PRICING. FOR PURPOSES OF THIS SUBDIVISION "SPREAD PRICING" MEANS
 ANY AMOUNT CHARGED OR CLAIMED BY THE PHARMACY BENEFIT MANAGER IN  EXCESS
 OF  THE AMOUNT PAID TO PHARMACIES ON BEHALF OF THE HEALTH CARE PLAN LESS
 AN ADMINISTRATIVE FEE AS DESCRIBED IN THIS PARAGRAPH.  ANY  SUCH  EXCESS
 AMOUNT SHALL BE REMITTED TO THE HEALTH CARE PLAN ON A QUARTERLY BASIS.
   (B) THE COMMISSIONER MAY PROMULGATE REGULATIONS AS NECESSARY TO ESTAB-
 LISH ADDITIONAL STANDARDS FOR CONTRACTS OR OTHER ARRANGEMENTS RELATED TO
 THE SERVICES DESCRIBED IN THIS SUBDIVISION.
   § 11. Health care plans subject to subdivision 10 of section 4406-c of
 the  public  health  law,  as  added  by  section ten of this act, shall
 provide evidence of compliance with such section to  the  department  of
 health, and in a manner and form determined by the department of health,
 within  90  days and again within 180 days of the effective date of this
 act. The department of health shall  take  no  enforcement  action  with
 regards  to  the requirements of subdivision 10 of section 4406-c of the
 public health law, as added by section ten of this  act,  prior  to  the
 passage  of  180  days  from  the  effective date of this act, nor shall
 enforcement action be taken  related  to  any  non-compliance  occurring
 prior to the passage of the same 180 days.
   §  12.  This  act shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that sections one and two of this act shall take effect July 1,
 2019; and provided further, however, that the  amendments  to  paragraph
 (c) of subdivision 6 of section 367-a of the social services law made by
 section  two  of  this act shall not affect the repeal of such paragraph
 and shall be deemed repealed therewith.
 
                                  PART C
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (ff) to read as follows:
   (FF)  EVIDENCE-BASED PREVENTION AND SUPPORT SERVICES RECOGNIZED BY THE
 FEDERAL CENTERS FOR DISEASE CONTROL (CDC), PROVIDED BY A COMMUNITY-BASED

 S. 1507                            10                            A. 2007
 
 ORGANIZATION, AND DESIGNED TO PREVENT INDIVIDUALS AT RISK OF  DEVELOPING
 DIABETES FROM DEVELOPING TYPE 2 DIABETES.
   §  2.  Subparagraph  (ii) of paragraph (d) of subdivision 1 of section
 367-a of the social services law, as amended by section 1 of part J1  of
 chapter 63 of the laws of 2003, is amended to read as follows:
   (ii) Amounts payable under this title for medical assistance for items
 and  services  provided  to  eligible persons who are also beneficiaries
 under part B of title XVIII of the federal social security act and items
 and services provided to qualified medicare beneficiaries under  part  B
 of  title  XVIII  of  the federal social security act shall not [be less
 than the amount of any deductible liability of such eligible persons  or
 for which such eligible persons or such qualified medicare beneficiaries
 would  be  liable  under  federal law were they not eligible for medical
 assistance or  were  they  not  qualified  medicare  beneficiaries  with
 respect  to  such  benefits  under such part B.]  EXCEED THE AMOUNT THAT
 OTHERWISE WOULD BE MADE UNDER THIS TITLE  IF  PROVIDED  TO  AN  ELIGIBLE
 PERSON  OTHER THAN A PERSON WHO IS ALSO A BENEFICIARY UNDER PART B OR IS
 A QUALIFIED MEDICARE BENEFICIARY MINUS THE AMOUNT PAYABLE UNDER PART B.
   § 3. Subparagraph (iii) of paragraph (d) of subdivision 1  of  section
 367-a  of the social services law, as amended by section 31 of part B of
 chapter 57 of the laws of 2015, is amended to read as follows:
   (iii) With respect to items and services provided to eligible  persons
 who  are  also  beneficiaries under part B of title XVIII of the federal
 social security act and items and services provided to  qualified  medi-
 care  beneficiaries  under  part  B of title XVIII of the federal social
 security act, the amount payable for services covered under  this  title
 shall  be  the  amount  of  any  co-insurance liability of such eligible
 persons pursuant to federal law  were  they  not  eligible  for  medical
 assistance  or  were  they  not  qualified  medicare  beneficiaries with
 respect to such benefits under such part B, but  shall  not  exceed  the
 amount  that  otherwise would be made under this title if provided to an
 eligible person other than a person who is also a beneficiary under part
 B or is a qualified medicare beneficiary minus the amount payable  under
 part  B;  provided,  however, amounts payable under this title for items
 and services provided to eligible persons  who  are  also  beneficiaries
 under  part  B  or  to qualified medicare beneficiaries by [an ambulance
 service under the authority of an operating certificate issued  pursuant
 to  article  thirty  of  the  public health law, a psychologist licensed
 under article one hundred fifty-three of the education law, or] a facil-
 ity under the authority of an operating certificate issued  pursuant  to
 article  sixteen, thirty-one or thirty-two of the mental hygiene law and
 with respect to  outpatient  hospital  and  clinic  items  and  services
 provided  by  a facility under the authority of an operating certificate
 issued pursuant to article twenty-eight of the public health law,  shall
 not be less than the amount of any co-insurance liability of such eligi-
 ble  persons or such qualified medicare beneficiaries, or for which such
 eligible persons or  such  qualified  medicare  beneficiaries  would  be
 liable  under  federal law were they not eligible for medical assistance
 or were they not qualified medicare beneficiaries with respect  to  such
 benefits under part B.
   § 4. This act shall take effect July 1, 2019.
 
                                  PART D
 
   Section  1. Subdivision 1 of section 92 of part H of chapter 59 of the
 laws of 2011, amending the public health law and other laws relating  to

 S. 1507                            11                            A. 2007
 
 known  and  projected  department of health state fund medicaid expendi-
 tures, as amended by section 2 of part K of chapter 57 of  the  laws  of
 2018, is amended to read as follows:
   1.  For  state  fiscal  years 2011-12 through [2019-20] 2020-2021, the
 director of the budget, in consultation with the commissioner of  health
 referenced  as "commissioner" for purposes of this section, shall assess
 on a monthly basis, as reflected in monthly reports pursuant to subdivi-
 sion five of this section known and projected department of health state
 funds medicaid expenditures by category of  service  and  by  geographic
 regions,  as  defined  by  the  commissioner, and if the director of the
 budget determines that such expenditures are expected to cause  medicaid
 disbursements  for  such  period  to  exceed the projected department of
 health medicaid state funds disbursements in the enacted  budget  finan-
 cial  plan  pursuant to subdivision 3 of section 23 of the state finance
 law, the commissioner of health, in consultation with  the  director  of
 the  budget,  shall  develop a medicaid savings allocation plan to limit
 such spending to the aggregate limit  level  specified  in  the  enacted
 budget  financial  plan,  provided,  however,  such  projections  may be
 adjusted by the director of the budget to account for any changes in the
 New York state federal medical assistance percentage amount  established
 pursuant  to the federal social security act, changes in provider reven-
 ues, reductions to local social  services  district  medical  assistance
 administration,  minimum wage increases, and beginning April 1, 2012 the
 operational costs of the New York state medical indemnity fund and state
 costs or savings from the basic health plan.   Such projections  may  be
 adjusted by the director of the budget to account for increased or expe-
 dited department of health state funds medicaid expenditures as a result
 of  a natural or other type of disaster, including a governmental decla-
 ration of emergency.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART E

   Section  1. Section 4 of chapter 505 of the laws of 1995, amending the
 public health law relating to the  operation  of  department  of  health
 facilities, as amended by section 27 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   §  4.  This act shall take effect immediately; provided, however, that
 the provisions of paragraph (b) of subdivision 4 of section 409-c of the
 public health law, as added by section three of  this  act,  shall  take
 effect  January 1, 1996 and shall expire and be deemed repealed [twenty-
 four] TWENTY-NINE years from the effective date thereof.
   § 2. Subdivision p of section 76 of part D of chapter 56 of  the  laws
 of 2013, amending the social services law relating to eligibility condi-
 tions, is amended to read as follows:
   p.  the  amendments [made] to subparagraph [(7)] 7 of paragraph (b) of
 subdivision 1 of section 366 of the social services law made by  section
 one  of  this  act shall expire and be deemed repealed October 1, [2019]
 2024.
   § 3. Section 11 of chapter 884 of  the  laws  of  1990,  amending  the
 public  health  law  relating  to  authorizing bad debt and charity care
 allowances for certified home health agencies, as amended by  section  1
 of  part  I  of  chapter  57  of the laws of 2017, is amended to read as
 follows:
   § 11. This act shall take effect immediately and:

 S. 1507                            12                            A. 2007
 
   (a) sections one and three shall expire on December 31, 1996,
   (b)  sections  four  through ten shall expire on June 30, [2019] 2024,
 and
   (c) provided that the amendment to section 2807-b of the public health
 law by section two of this act shall not affect the expiration  of  such
 section  2807-b  as  otherwise  provided  by  law and shall be deemed to
 expire therewith.
   § 4. Section 3 of chapter 303 of the laws of 1999,  amending  the  New
 York  state  medical  care  facilities  finance  agency  act relating to
 financing health facilities, as amended by section 16 of part D of chap-
 ter 57 of the laws of 2015, is amended to read as follows:
   § 3. This act shall take effect immediately, provided,  however,  that
 subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of
 1973,  as  added  by section one of this act, shall expire and be deemed
 repealed June 30, [2019] 2024; and provided further, however,  that  the
 expiration  and  repeal  of  such  subdivision  15-a shall not affect or
 impair in any manner any health facilities bonds issued, or any lease or
 purchase of a health facility executed,  pursuant  to  such  subdivision
 15-a  prior  to  its expiration and repeal and that, with respect to any
 such bonds issued and outstanding  as  of  June  30,  [2019]  2024,  the
 provisions of such subdivision 15-a as they existed immediately prior to
 such  expiration  and  repeal shall continue to apply through the latest
 maturity date of any such bonds, or their earlier retirement or  redemp-
 tion,  for  the  sole  purpose  of authorizing the issuance of refunding
 bonds to refund bonds previously issued pursuant thereto.
   § 5. Subdivision (a) of section 40 of part B of  chapter  109  of  the
 laws  of  2010, amending the social services law relating to transporta-
 tion costs, as amended by section 8 of part I of chapter 57 of the  laws
 of 2017, is amended to read as follows:
   (a)  sections  two, three, three-a, three-b, three-c, three-d, three-e
 and twenty-one of this act shall take  effect  July  1,  2010;  sections
 fifteen,  sixteen,  seventeen,  eighteen  and nineteen of this act shall
 take effect January 1, 2011; and provided further that section twenty of
 this act shall be deemed repealed [eight] THIRTEEN years after the  date
 the  contract  entered  into  pursuant  to  section  365-h of the social
 services law, as amended by section twenty of  this  act,  is  executed;
 provided  that  the  commissioner of health shall notify the legislative
 bill drafting commission upon the execution of the contract entered into
 pursuant to section 367-h of the social services law in order  that  the
 commission  may  maintain  an accurate and timely effective data base of
 the official text of the laws of the state of New York in furtherance of
 effectuating the provisions of section 44 of  the  legislative  law  and
 section 70-b of the public officers law;
   §  6.  Subdivision  (f)  of section 129 of part C of chapter 58 of the
 laws of 2009, amending the public health  law  relating  to  payment  by
 governmental  agencies  for  general  hospital  inpatient  services,  as
 amended by section 4 of part D of chapter 59 of the  laws  of  2016,  is
 amended to read as follows:
   (f)  section  twenty-five  of  this  act  shall  expire  and be deemed
 repealed April 1, [2019] 2024;
   § 7. Subdivision (c) of section 122 of part E of  chapter  56  of  the
 laws  of  2013  amending  the  public health law relating to the general
 public health work program, as amended by section 5 of part D of chapter
 59 of the laws of 2016, is amended to read as follows:
   (c) section fifty of this act shall take effect immediately [and shall
 expire six years after it becomes law];

 S. 1507                            13                            A. 2007
 
   § 8. Subdivision (i) of section 111 of part H of  chapter  59  of  the
 laws  of 2011, amending the public health law and other laws relating to
 known and projected department of health  state  fund  medical  expendi-
 tures,  as  amended by section 19 of part D of chapter 57 of the laws of
 2015, is amended to read as follows:
   (i)  the amendments to paragraph (b) and subparagraph (i) of paragraph
 (g) of subdivision 7 of section 4403-f of the public health law made  by
 section  forty-one-b  of  this act shall expire and be repealed April 1,
 [2019] 2024;
   § 9. Subparagraph (vi) of paragraph (b) of subdivision  2  of  section
 2807-d  of  the  public health law, as amended by section 3 of part I of
 chapter 57 of the laws of 2017, is amended to read as follows:
   (vi) Notwithstanding any contrary provision of this paragraph  or  any
 other  provision  of  law or regulation to the contrary, for residential
 health care facilities the assessment shall be six percent of each resi-
 dential health care facility's gross receipts received from all  patient
 care  services and other operating income on a cash basis for the period
 April first, two thousand two through March thirty-first,  two  thousand
 three  for  hospital  or  health-related  services,  including adult day
 services; provided, however, that residential  health  care  facilities'
 gross receipts attributable to payments received pursuant to title XVIII
 of the federal social security act (medicare) shall be excluded from the
 assessment; provided, however, that for all such gross receipts received
 on  or after April first, two thousand three through March thirty-first,
 two thousand five, such assessment shall be five  percent,  and  further
 provided  that  for  all  such gross receipts received on or after April
 first, two thousand five through March thirty-first, two thousand  nine,
 and  on  or  after  April first, two thousand nine through March thirty-
 first, two thousand eleven such assessment shall  be  six  percent,  and
 further  provided  that for all such gross receipts received on or after
 April first, two thousand eleven through March thirty-first,  two  thou-
 sand thirteen such assessment shall be six percent, and further provided
 that  for  all such gross receipts received on or after April first, two
 thousand thirteen through March thirty-first, two thousand fifteen  such
 assessment  shall be six percent, and further provided that for all such
 gross receipts received on or after April first,  two  thousand  fifteen
 through March thirty-first, two thousand seventeen such assessment shall
 be  six  percent,  and further provided that for all such gross receipts
 received on or after April first, two thousand seventeen  through  March
 thirty-first,  two  thousand  nineteen  such  assessment  shall  be  six
 percent, AND FURTHER PROVIDED THAT FOR ALL SUCH GROSS RECEIPTS  RECEIVED
 ON  OR  AFTER  APRIL  FIRST, TWO THOUSAND NINETEEN THROUGH MARCH THIRTY-
 FIRST, TWO THOUSAND TWENTY-FOUR SUCH ASSESSMENT SHALL BE SIX PERCENT.
   § 10. Subdivision 1 of section 194 of chapter 474 of the laws of 1996,
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, as amended by section 4 of part I of  chap-
 ter 57 of the laws of 2017, is amended to read as follows:
   1.  Notwithstanding  any  inconsistent provision of law or regulation,
 the trend factors used to project reimbursable operating  costs  to  the
 rate  period  for  purposes  of determining rates of payment pursuant to
 article 28 of the public health law for residential health care  facili-
 ties for reimbursement of inpatient services provided to patients eligi-
 ble  for payments made by state governmental agencies on and after April
 1, 1996 through March 31, 1999 and for payments made on and  after  July
 1,  1999  through  March 31, 2000 and on and after April 1, 2000 through
 March 31, 2003 and on and after April 1, 2003 through March 31, 2007 and

 S. 1507                            14                            A. 2007
 
 on and after April 1, 2007 through March 31, 2009 and on and after April
 1, 2009 through March 31, 2011 and on and after April  1,  2011  through
 March  31,  2013  and on and after April 1, 2013 through March 31, 2015,
 and  on and after April 1, 2015 through March 31, 2017, and on and after
 April 1, 2017 through March 31, 2019, AND ON AND  AFTER  APRIL  1,  2019
 THROUGH  MARCH  31,  2024  shall  reflect no trend factor projections or
 adjustments for the period April 1, 1996, through March 31, 1997.
   § 11. Subdivision 1 of section 89-a of part C of  chapter  58  of  the
 laws  of  2007, amending the social services law and other laws relating
 to enacting the major components of legislation necessary  to  implement
 the  health  and  mental  hygiene  budget for the 2007-2008 state fiscal
 year, as amended by section 5 of part I of chapter 57  of  the  laws  of
 2017, is amended to read as follows:
   1.  Notwithstanding  paragraph (c) of subdivision 10 of section 2807-c
 of the public health law and section 21 of chapter  1  of  the  laws  of
 1999,  as  amended, and any other inconsistent provision of law or regu-
 lation to the contrary,  in  determining  rates  of  payments  by  state
 governmental agencies effective for services provided beginning April 1,
 2006,  through  March  31,  2009, and on and after April 1, 2009 through
 March 31, 2011, and on and after April 1, 2011 through March  31,  2013,
 and  on and after April 1, 2013 through March 31, 2015, and on and after
 April 1, 2015 through March 31, 2017, and on and  after  April  1,  2017
 through March 31, 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31,
 2024 for inpatient and outpatient services provided by general hospitals
 and for inpatient services and outpatient adult day health care services
 provided by residential health care facilities pursuant to article 28 of
 the  public  health  law, the commissioner of health shall apply a trend
 factor projection of two and twenty-five hundredths percent attributable
 to the period January 1, 2006 through December  31,  2006,  and  on  and
 after January 1, 2007, provided, however, that on reconciliation of such
 trend  factor  for  the period January 1, 2006 through December 31, 2006
 pursuant to paragraph (c) of subdivision 10 of  section  2807-c  of  the
 public  health  law,  such  trend  factor shall be the final US Consumer
 Price Index (CPI) for all  urban  consumers,  as  published  by  the  US
 Department  of  Labor,  Bureau  of  Labor  Statistics  less  twenty-five
 hundredths of a percentage point.
   § 12. Subdivision 5-a of section 246 of chapter  81  of  the  laws  of
 1995,  amending the public health law and other laws relating to medical
 reimbursement and welfare reform, as amended by section 6 of part  I  of
 chapter 57 of the laws of 2017, is amended to read as follows:
   5-a.  Section sixty-four-a of this act shall be deemed to have been in
 full force and effect on and after April 1, 1995 through March 31,  1999
 and  on  and  after July 1, 1999 through March 31, 2000 and on and after
 April 1, 2000 through March 31, 2003 and on  and  after  April  1,  2003
 through March 31, 2007, and on and after April 1, 2007 through March 31,
 2009,  and on and after April 1, 2009 through March 31, 2011, and on and
 after April 1, 2011 through March 31, 2013, and on and  after  April  1,
 2013  through  March  31,  2015,  and on and after April 1, 2015 through
 March 31, 2017 and on and after April 1, 2017 through  March  31,  2019,
 AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024;
   §  13.  Section  64-b  of chapter 81 of the laws of 1995, amending the
 public health law and other laws relating to medical  reimbursement  and
 welfare  reform,  as amended by section 7 of part I of chapter 57 of the
 laws of 2017, is amended to read as follows:
   §  64-b.  Notwithstanding  any  inconsistent  provision  of  law,  the
 provisions of subdivision 7 of section 3614 of the public health law, as

 S. 1507                            15                            A. 2007
 
 amended,  shall  remain and be in full force and effect on April 1, 1995
 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
 and after April 1, 2000 through March 31, 2003 and on and after April 1,
 2003  through  March  31,  2007,  and on and after April 1, 2007 through
 March 31, 2009, and on and after April 1, 2009 through March  31,  2011,
 and  on and after April 1, 2011 through March 31, 2013, and on and after
 April 1, 2013 through March 31, 2015, and on and  after  April  1,  2015
 through  March 31, 2017 and on and after April 1, 2017 through March 31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024.
   § 14. Section 4-a of part A of chapter 56 of the laws of 2013,  amend-
 ing  chapter  59  of the laws of 2011 amending the public health law and
 other laws relating to general hospital reimbursement for annual  rates,
 as  amended by section 5 of part T of chapter 57 of the laws of 2018, is
 amended to read as follows:
   § 4-a. Notwithstanding paragraph (c)  of  subdivision  10  of  section
 2807-c  of the public health law, section 21 of chapter 1 of the laws of
 1999, or any other contrary provision of law, in  determining  rates  of
 payments  by state governmental agencies effective for services provided
 on and after January 1, 2017 through March 31, [2019]  2024,  for  inpa-
 tient  and  outpatient services provided by general hospitals, for inpa-
 tient services and adult day health care outpatient services provided by
 residential health care facilities pursuant to article 28 of the  public
 health  law,  except  for residential health care facilities or units of
 such facilities providing services primarily to children  under  twenty-
 one  years  of  age,  for home health care services provided pursuant to
 article 36 of the public health law by certified home  health  agencies,
 long term home health care programs and AIDS home care programs, and for
 personal  care services provided pursuant to section 365-a of the social
 services law, the commissioner of health shall  apply  no  greater  than
 zero  trend  factors  attributable  to the 2017, 2018, [and] 2019, 2020,
 2021, 2022, AND 2023 calendar years in accordance with paragraph (c)  of
 subdivision  10  of  section  2807-c of the public health law, provided,
 however, that such no greater than zero trend  factors  attributable  to
 such  2017,  2018, [and] 2019, 2020, 2021, 2022, AND 2023 calendar years
 shall also be applied to rates of payment provided on and after  January
 1,  2017  through  March  31,  [2019]  2024  for  personal care services
 provided in those local social services districts,  including  New  York
 city,  whose  rates of payment for such services are established by such
 local social services districts pursuant  to  a  rate-setting  exemption
 issued  by  the  commissioner  of  health  to such local social services
 districts  in  accordance  with  applicable  regulations;  and  provided
 further,  however, that for rates of payment for assisted living program
 services provided on and after January 1, 2017 through March 31,  [2019]
 2024,  such  trend  factors  attributable to the 2017, 2018, [and] 2019,
 2020, 2021, 2022, AND 2023 calendar years shall  be  established  at  no
 greater than zero percent.
   §  15.  Paragraph  (b) of subdivision 17 of section 2808 of the public
 health law, as amended by section 21 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (b) Notwithstanding any inconsistent provision of law or regulation to
 the contrary, for the state fiscal  years  beginning  April  first,  two
 thousand  ten  and  ending  March  thirty-first, two thousand [nineteen]
 TWENTY-FOUR, the commissioner shall not be required to revise  certified
 rates  of  payment established pursuant to this article for rate periods
 prior to April first, two  thousand  [nineteen]  TWENTY-FOUR,  based  on
 consideration  of  rate appeals filed by residential health care facili-

 S. 1507                            16                            A. 2007
 
 ties or based upon adjustments to capital cost reimbursement as a result
 of approval by the commissioner of an application for construction under
 section twenty-eight hundred two of this article, in excess of an aggre-
 gate  annual amount of eighty million dollars for each such state fiscal
 year provided, however, that for the period April  first,  two  thousand
 eleven  through  March  thirty-first, two thousand twelve such aggregate
 annual amount shall be fifty million dollars.  In  revising  such  rates
 within  such  fiscal limit, the commissioner shall, in prioritizing such
 rate appeals, include consideration of which facilities the commissioner
 determines are facing significant financial hardship  as  well  as  such
 other considerations as the commissioner deems appropriate and, further,
 the commissioner is authorized to enter into agreements with such facil-
 ities  or  any  other  facility to resolve multiple pending rate appeals
 based upon a negotiated aggregate amount and may offset such  negotiated
 aggregate  amounts  against  any  amounts  owed  by  the facility to the
 department, including, but not limited  to,  amounts  owed  pursuant  to
 section twenty-eight hundred seven-d of this article; provided, however,
 that the commissioner's authority to negotiate such agreements resolving
 multiple  pending  rate appeals as hereinbefore described shall continue
 on and after April first,  two  thousand  [nineteen]  TWENTY-FOUR.  Rate
 adjustments  made  pursuant  to  this  paragraph remain fully subject to
 approval by the director of the budget in accordance with the provisions
 of subdivision two of section twenty-eight hundred seven of  this  arti-
 cle.
   §  16.  Paragraph  (a) of subdivision 13 of section 3614 of the public
 health law, as amended by section 22 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (a) Notwithstanding any inconsistent provision of  law  or  regulation
 and  subject  to  the  availability  of federal financial participation,
 effective April first, two thousand twelve through  March  thirty-first,
 two thousand [nineteen] TWENTY-FOUR, payments by government agencies for
 services  provided  by  certified  home health agencies, except for such
 services provided to children under eighteen  years  of  age  and  other
 discreet  groups  as  may  be determined by the commissioner pursuant to
 regulations, shall be based on episodic payments. In  establishing  such
 payments, a statewide base price shall be established for each sixty day
 episode  of  care  and  adjusted  by a regional wage index factor and an
 individual patient case mix index. Such episodic payments may be further
 adjusted for low utilization cases and to reflect a  percentage  limita-
 tion  of the cost for high-utilization cases that exceed outlier thresh-
 olds of such payments.
   § 17. Subdivision 2 of section 246 of chapter 81 of the laws of  1995,
 amending  the  public  health  law  and  other  laws relating to medical
 reimbursement and welfare reform, as amended by section 18 of part I  of
 chapter 57 of the laws of 2017, is amended to read as follows:
   2.  Sections  five,  seven  through nine, twelve through fourteen, and
 eighteen of this act shall be deemed to have  been  in  full  force  and
 effect  on  and  after  April  1, 1995 through March 31, 1999 and on and
 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
 through March 31, 2003 and on and after April 1, 2003 through March  31,
 2006  and  on  and after April 1, 2006 through March 31, 2007 and on and
 after April 1, 2007 through March 31, 2009 and on  and  after  April  1,
 2009  through  March 31, 2011 and sections twelve, thirteen and fourteen
 of this act shall be deemed to be in full force and effect on and  after
 April  1,  2011  through  March  31, 2015 and on and after April 1, 2015

 S. 1507                            17                            A. 2007
 
 through March 31, 2017 and on and after April 1, 2017 through March  31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024;
   §  18. Section 48-a of part A of chapter 56 of the laws of 2013 amend-
 ing chapter 59 of the laws of 2011 amending the public  health  law  and
 other  laws relating to general hospital reimbursement for annual rates,
 as amended by section 1 of part P of chapter 57 of the laws of 2017,  is
 amended to read as follows:
   §  48-a. 1. Notwithstanding any contrary provision of law, the commis-
 sioners of the office of alcoholism and substance abuse services and the
 office of mental health are authorized, subject to the approval  of  the
 director  of the budget, to transfer to the commissioner of health state
 funds to be utilized as the state share for the  purpose  of  increasing
 payments  under  the  medicaid  program  to  managed  care organizations
 licensed under article 44 of the public health law or under  article  43
 of the insurance law. Such managed care organizations shall utilize such
 funds  for  the  purpose  of  reimbursing providers licensed pursuant to
 article 28 of the public health law or article 31 or 32  of  the  mental
 hygiene  law for ambulatory behavioral health services, as determined by
 the commissioner of health, in consultation  with  the  commissioner  of
 alcoholism  and  substance  abuse  services  and the commissioner of the
 office of mental health, provided to medicaid enrolled  outpatients  and
 for  all  other  behavioral health services except inpatient included in
 New York state's Medicaid redesign waiver approved by  the  centers  for
 medicare  and  Medicaid services (CMS).   Such reimbursement shall be in
 the form of fees for such services which are equivalent to the  payments
 established  for  such services under the ambulatory patient group (APG)
 rate-setting methodology as utilized by the department  of  health,  the
 office  of  alcoholism  and  substance  abuse services, or the office of
 mental health for rate-setting purposes or any such other fees  pursuant
 to  the Medicaid state plan or otherwise approved by CMS in the Medicaid
 redesign waiver; provided, however, that the increase to such fees  that
 shall  result  from  the  provisions  of  this section shall not, in the
 aggregate and as determined by the commissioner of health, in  consulta-
 tion  with  the  commissioner of alcoholism and substance abuse services
 and the commissioner of the office of mental health, be greater than the
 increased funds made available pursuant to this section.   The  increase
 of  such  ambulatory behavioral health fees to providers available under
 this section shall be for all rate periods on and  after  the  effective
 date  of  section [29] 1 of part [B] P of chapter [59] 57 of the laws of
 [2016] 2017 through March 31, [2020] 2022 for patients in  the  city  of
 New  York,  for  all  rate  periods  on  and after the effective date of
 section [29] 1 of part [B] P of chapter [59] 57 of the  laws  of  [2016]
 2017  through  [March  31, 2020] MARCH 31, 2022 for patients outside the
 city of New York, and for all rate periods on and  after  the  effective
 date  of  such  chapter  through [March 31, 2020] MARCH 31, 2022 for all
 services provided to persons under  the  age  of  twenty-one;  provided,
 however,  the  commissioner  of health, in consultation with the commis-
 sioner of alcoholism and substance abuse services and  the  commissioner
 of  mental health, may require, as a condition of approval of such ambu-
 latory behavioral health fees, that aggregate managed care  expenditures
 to  eligible providers meet the alternative payment methodology require-
 ments as set forth in attachment  I  of  the  New  York  state  medicaid
 section  one  thousand one hundred fifteen medicaid redesign team waiver
 as approved by the centers  for  medicare  and  medicaid  services.  The
 commissioner  of  health shall, in consultation with the commissioner of
 alcoholism and substance abuse services and the commissioner  of  mental

 S. 1507                            18                            A. 2007
 
 health,  waive  such  conditions if a sufficient number of providers, as
 determined by the commissioner, suffer a financial hardship as a  conse-
 quence of such alternative payment methodology requirements, or if he or
 she  shall determine that such alternative payment methodologies signif-
 icantly threaten individuals  access  to  ambulatory  behavioral  health
 services.  Such waiver may be applied on a provider specific or industry
 wide  basis. Further, such conditions may be waived, as the commissioner
 determines necessary,  to  comply  with  federal  rules  or  regulations
 governing  these  payment methodologies.   Nothing in this section shall
 prohibit managed  care  organizations  and  providers  from  negotiating
 different  rates  and  methods  of payment during such periods described
 above, subject to the approval of the department of health. The  depart-
 ment of health shall consult with the office of alcoholism and substance
 abuse  services  and  the office of mental health in determining whether
 such alternative rates shall be approved.  The  commissioner  of  health
 may,  in  consultation with the commissioner of alcoholism and substance
 abuse services and the commissioner of  the  office  of  mental  health,
 promulgate  regulations,  including  emergency  regulations  promulgated
 prior to October 1, 2015 to establish rates  for  ambulatory  behavioral
 health  services,  as  are necessary to implement the provisions of this
 section. Rates promulgated under this section shall be included  in  the
 report required under section 45-c of part A of this chapter.
   2.  Notwithstanding  any  contrary  provision of law, the fees paid by
 managed care organizations licensed  under  article  44  of  the  public
 health  law  or  under  article  43  of  the insurance law, to providers
 licensed pursuant to article 28 of the public health law or  article  31
 or  32  of  the  mental  hygiene  law,  for ambulatory behavioral health
 services provided to patients enrolled in  the  child  health  insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to  the  payments  established  for  such  services under the ambulatory
 patient group (APG) rate-setting methodology  or  any  such  other  fees
 established  pursuant  to  the  Medicaid state plan. The commissioner of
 health shall consult with the commissioner of alcoholism  and  substance
 abuse  services  and  the commissioner of the office of mental health in
 determining such services and establishing such  fees.  Such  ambulatory
 behavioral  health  fees to providers available under this section shall
 be for all rate periods on and after the effective date of this  chapter
 through [March 31, 2020] MARCH 31, 2022, provided, however, that managed
 care organizations and providers may negotiate different rates and meth-
 ods  of  payment  during  such  periods  described above, subject to the
 approval of the department of health.   The department of  health  shall
 consult  with  the office of alcoholism and substance abuse services and
 the office of mental health  in  determining  whether  such  alternative
 rates shall be approved.  The report required under section 16-a of part
 C of chapter 60 of the laws of 2014 shall also include the population of
 patients  enrolled  in  the  child  health insurance program pursuant to
 title [one-A] 1-A of article 25 of the public health law in its examina-
 tion on the transition of behavioral health services into managed care.
   § 19. Section 1 of part H of chapter 111 of the laws of 2010  relating
 to increasing Medicaid payments to providers through managed care organ-
 izations  and  providing  equivalent  fees through an ambulatory patient
 group methodology, as amended by section 2 of part P of  chapter  57  of
 the laws of 2017, is amended to read as follows:
   Section  1.  a.  Notwithstanding  any  contrary  provision of law, the
 commissioners of  mental  health  and  alcoholism  and  substance  abuse

 S. 1507                            19                            A. 2007
 
 services  are authorized, subject to the approval of the director of the
 budget, to transfer to the commissioner of  health  state  funds  to  be
 utilized as the state share for the purpose of increasing payments under
 the  medicaid program to managed care organizations licensed under arti-
 cle 44 of the public health law or under article  43  of  the  insurance
 law.  Such  managed  care organizations shall utilize such funds for the
 purpose of reimbursing providers licensed pursuant to article 28 of  the
 public health law, or pursuant to article 31 or article 32 of the mental
 hygiene  law for ambulatory behavioral health services, as determined by
 the commissioner of health in  consultation  with  the  commissioner  of
 mental  health  and  commissioner  of  alcoholism  and  substance  abuse
 services, provided to medicaid enrolled outpatients and  for  all  other
 behavioral health services except inpatient included in New York state's
 Medicaid  redesign waiver approved by the centers for medicare and Medi-
 caid services (CMS). Such reimbursement shall be in the form of fees for
 such services which are equivalent to the payments established for  such
 services under the ambulatory patient group (APG) rate-setting methodol-
 ogy  as  utilized by the department of health or by the office of mental
 health or office of alcoholism and substance abuse  services  for  rate-
 setting  purposes  or any such other fees pursuant to the Medicaid state
 plan or otherwise approved by  CMS  in  the  Medicaid  redesign  waiver;
 provided, however, that the increase to such fees that shall result from
 the provisions of this section shall not, in the aggregate and as deter-
 mined by the commissioner of health in consultation with the commission-
 ers  of  mental  health  and alcoholism and substance abuse services, be
 greater than  the  increased  funds  made  available  pursuant  to  this
 section. The increase of such behavioral health fees to providers avail-
 able  under  this section shall be for all rate periods on and after the
 effective date of section [30] 2 of part [B] P of chapter [59] 57 of the
 laws of [2016] 2017 through March 31, [2020] 2022 for  patients  in  the
 city  of  New York, for all rate periods on and after the effective date
 of section [30] 2 of part [B] P of chapter [59] 57 of the laws of [2016]
 2017 through March 31, [2020] 2022 for patients outside the city of  New
 York,  and  for  all  rate  periods  on  and after the effective date of
 section [30] 2 of part [B] P of chapter [59] 57 of the  laws  of  [2016]
 2017  through March 31, [2020] 2022 for all services provided to persons
 under the age of twenty-one;  provided,  however,  the  commissioner  of
 health,   in  consultation  with  the  commissioner  of  alcoholism  and
 substance abuse services and the  commissioner  of  mental  health,  may
 require, as a condition of approval of such ambulatory behavioral health
 fees,  that  aggregate  managed  care expenditures to eligible providers
 meet the alternative payment methodology requirements as  set  forth  in
 attachment  I  of  the  New York state medicaid section one thousand one
 hundred fifteen medicaid redesign team waiver as approved by the centers
 for medicare and medicaid services. The commissioner of health shall, in
 consultation with the commissioner of  alcoholism  and  substance  abuse
 services and the commissioner of mental health, waive such conditions if
 a  sufficient  number  of  providers, as determined by the commissioner,
 suffer a financial hardship as a consequence of such alternative payment
 methodology requirements, or if he or  she  shall  determine  that  such
 alternative  payment  methodologies  significantly  threaten individuals
 access to ambulatory behavioral health services.   Such  waiver  may  be
 applied  on  a  provider  specific or industry wide basis. Further, such
 conditions may be waived, as the commissioner determines  necessary,  to
 comply with federal rules or regulations governing these payment method-
 ologies.  Nothing  in this section shall prohibit managed care organiza-

 S. 1507                            20                            A. 2007
 
 tions and providers from negotiating  different  rates  and  methods  of
 payment  during  such  periods described, subject to the approval of the
 department of health. The department of health shall  consult  with  the
 office  of  alcoholism  and  substance  abuse services and the office of
 mental health in determining whether such  alternative  rates  shall  be
 approved.  The  commissioner  of  health  may,  in consultation with the
 commissioners of  mental  health  and  alcoholism  and  substance  abuse
 services,   promulgate   regulations,  including  emergency  regulations
 promulgated prior to October 1, 2013 that establish rates for behavioral
 health services, as are necessary to implement the  provisions  of  this
 section.  Rates  promulgated under this section shall be included in the
 report required under section 45-c of part A of chapter 56 of  the  laws
 of 2013.
   b.  Notwithstanding  any  contrary  provision of law, the fees paid by
 managed care organizations licensed  under  article  44  of  the  public
 health  law  or  under  article  43  of  the insurance law, to providers
 licensed pursuant to article 28 of the public health law or  article  31
 or  32  of  the  mental  hygiene  law,  for ambulatory behavioral health
 services provided to patients enrolled in  the  child  health  insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to  the  payments  established  for  such  services under the ambulatory
 patient group (APG) rate-setting methodology. The commissioner of health
 shall consult with the commissioner of alcoholism  and  substance  abuse
 services  and  the commissioner of the office of mental health in deter-
 mining such services and establishing such fees. Such ambulatory  behav-
 ioral health fees to providers available under this section shall be for
 all rate periods on and after the effective date of this chapter through
 March  31,  [2020]  2022, provided, however, that managed care organiza-
 tions and providers may negotiate different rates and methods of payment
 during such periods described above, subject  to  the  approval  of  the
 department  of  health.  The department of health shall consult with the
 office of alcoholism and substance abuse  services  and  the  office  of
 mental  health  in  determining  whether such alternative rates shall be
 approved.  The report required under section 16-a of part C  of  chapter
 60  of  the  laws  of 2014 shall also include the population of patients
 enrolled in the child health insurance program pursuant to title [one-A]
 1-A of article 25 of the public health law in  its  examination  on  the
 transition of behavioral health services into managed care.
   § 20. Section 2 of part H of chapter 111 of the laws of 2010, relating
 to increasing Medicaid payments to providers through managed care organ-
 izations  and  providing  equivalent  fees through an ambulatory patient
 group methodology, as amended by section 16 of part C of chapter  60  of
 the laws of 2014, is amended to read as follows:
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2010, and shall
 expire on [January 1, 2018] MARCH 31, 2022.
   § 21. Section 10 of chapter 649 of the  laws  of  1996,  amending  the
 public  health  law,  the mental hygiene law and the social services law
 relating to authorizing the establishment of  special  needs  plans,  as
 amended  by  section  2  of part D of chapter 59 of the laws of 2016, is
 amended to read as follows:
   § 10. This act shall take effect immediately and shall  be  deemed  to
 have  been in full force and effect on and after July 1, 1996; provided,
 however, that sections one, two and three of this act shall  expire  and
 be  deemed  repealed on March 31, [2020] 2025 provided, however that the

 S. 1507                            21                            A. 2007
 
 amendments to section 364-j of the social services law made  by  section
 four  of  this  act  shall not affect the expiration of such section and
 shall be deemed to expire therewith  and  provided,  further,  that  the
 provisions  of  subdivisions  8,  9 and 10 of section 4401 of the public
 health law, as added by section one of this act; section 4403-d  of  the
 public health law as added by section two of this act and the provisions
 of  section seven of this act, except for the provisions relating to the
 establishment of no more than twelve  comprehensive  HIV  special  needs
 plans, shall expire and be deemed repealed on July 1, 2000.
   §  22. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
 the laws of 1996, amending the education law and other laws relating  to
 rates  for residential healthcare facilities, as amended by section 1 of
 part D of chapter 59 of the laws of 2016, is amended to read as follows:
   (a) Notwithstanding any inconsistent provision of law or regulation to
 the contrary, effective beginning August 1, 1996, for the  period  April
 1,  1997  through  March 31, 1998, April 1, 1998 for the period April 1,
 1998 through March 31, 1999, August 1, 1999, for  the  period  April  1,
 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
 through  March  31,  2001,  April  1, 2001, for the period April 1, 2001
 through March 31, 2002, April 1, 2002, for  the  period  April  1,  2002
 through March 31, 2003, and for the state fiscal year beginning April 1,
 2005  through  March  31,  2006, and for the state fiscal year beginning
 April 1, 2006 through March 31, 2007, and  for  the  state  fiscal  year
 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
 year  beginning  April 1, 2008 through March 31, 2009, and for the state
 fiscal year beginning April 1, 2009 through March 31, 2010, and for  the
 state  fiscal  year  beginning April 1, 2010 through March 31, 2016, and
 for the state fiscal year beginning April 1, 2016 through March 31, 2019
 AND ANNUALLY THEREAFTER, the department of health is authorized  to  pay
 public  general  hospitals, as defined in subdivision 10 of section 2801
 of the public health law, operated by the state of New York  or  by  the
 state  university  of New York or by a county, which shall not include a
 city with a population of over one million, of the state  of  New  York,
 and those public general hospitals located in the county of Westchester,
 the  county  of  Erie  or  the county of Nassau, additional payments for
 inpatient hospital services as medical assistance payments  pursuant  to
 title  11  of article 5 of the social services law for patients eligible
 for federal financial participation  under  title  XIX  of  the  federal
 social  security  act in medical assistance pursuant to the federal laws
 and regulations governing disproportionate share payments  to  hospitals
 up to one hundred percent of each such public general hospital's medical
 assistance  and uninsured patient losses after all other medical assist-
 ance, including disproportionate share payments to such  public  general
 hospital  for  1996,  1997,  1998, and 1999, based initially for 1996 on
 reported 1994 reconciled data as further reconciled to  actual  reported
 1996  reconciled  data,  and  for  1997 based initially on reported 1995
 reconciled data as further reconciled to actual reported 1997 reconciled
 data, for 1998 based initially  on  reported  1995  reconciled  data  as
 further  reconciled  to  actual  reported 1998 reconciled data, for 1999
 based initially on reported 1995 reconciled data as  further  reconciled
 to  actual  reported  1999  reconciled data, for 2000 based initially on
 reported 1995 reconciled data as further reconciled to  actual  reported
 2000  data, for 2001 based initially on reported 1995 reconciled data as
 further reconciled to actual reported 2001 data, for 2002 based initial-
 ly on reported 2000 reconciled data  as  further  reconciled  to  actual
 reported  2002  data,  and  for state fiscal years beginning on April 1,

 S. 1507                            22                            A. 2007
 
 2005, based initially on reported 2000 reconciled data as further recon-
 ciled to actual reported data for  2005,  and  for  state  fiscal  years
 beginning  on April 1, 2006, based initially on reported 2000 reconciled
 data  as  further reconciled to actual reported data for 2006, for state
 fiscal years beginning on and after April  1,  2007  through  March  31,
 2009, based initially on reported 2000 reconciled data as further recon-
 ciled to actual reported data for 2007 and 2008, respectively, for state
 fiscal  years  beginning  on and after April 1, 2009, based initially on
 reported 2007 reconciled data, adjusted  for  authorized  Medicaid  rate
 changes  applicable  to the state fiscal year, and as further reconciled
 to actual reported data for 2009, for state fiscal  years  beginning  on
 and  after  April  1,  2010, based initially on reported reconciled data
 from the base year two years prior to the  payment  year,  adjusted  for
 authorized  Medicaid  rate  changes applicable to the state fiscal year,
 and further reconciled to actual reported data from such  payment  year,
 and  to  actual  reported data for each respective succeeding year.  The
 payments may be added to rates of payment or made as aggregate  payments
 to an eligible public general hospital.
   § 23. This act shall take effect immediately; provided that the amend-
 ments  to section 1 of part H of chapter 111 of the laws of 2010 made by
 section nineteen of this act shall not affect  the  expiration  of  such
 section  and  shall  expire therewith; and provided further that section
 twenty of this act shall be deemed to have been in full force and effect
 on and after January 1, 2018.
 
                                  PART F
 
   Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266
 of the laws of 1986, amending the civil practice law and rules and other
 laws relating  to  malpractice  and  professional  medical  conduct,  as
 amended  by  section  1  of part M of chapter 57 of the laws of 2018, is
 amended to read as follows:
   (a) The superintendent of financial services and the  commissioner  of
 health  or  their  designee  shall, from funds available in the hospital
 excess liability pool created pursuant to subdivision 5 of this section,
 purchase a policy or policies for excess insurance coverage, as  author-
 ized  by  paragraph 1 of subsection (e) of section 5502 of the insurance
 law; or from an insurer, other than an insurer described in section 5502
 of the insurance law, duly authorized to write such coverage and actual-
 ly writing  medical  malpractice  insurance  in  this  state;  or  shall
 purchase equivalent excess coverage in a form previously approved by the
 superintendent  of  financial  services for purposes of providing equiv-
 alent excess coverage in accordance with section 19 of  chapter  294  of
 the  laws of 1985, for medical or dental malpractice occurrences between
 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30,  1988,
 between  July  1,  1988 and June 30, 1989, between July 1, 1989 and June
 30, 1990, between July 1, 1990 and June 30, 1991, between July  1,  1991
 and  June 30, 1992, between July 1, 1992 and June 30, 1993, between July
 1, 1993 and June 30, 1994, between July  1,  1994  and  June  30,  1995,
 between  July  1,  1995 and June 30, 1996, between July 1, 1996 and June
 30, 1997, between July 1, 1997 and June 30, 1998, between July  1,  1998
 and  June 30, 1999, between July 1, 1999 and June 30, 2000, between July
 1, 2000 and June 30, 2001, between July  1,  2001  and  June  30,  2002,
 between  July  1,  2002 and June 30, 2003, between July 1, 2003 and June
 30, 2004, between July 1, 2004 and June 30, 2005, between July  1,  2005
 and  June 30, 2006, between July 1, 2006 and June 30, 2007, between July

 S. 1507                            23                            A. 2007
 
 1, 2007 and June 30, 2008, between July  1,  2008  and  June  30,  2009,
 between  July  1,  2009 and June 30, 2010, between July 1, 2010 and June
 30, 2011, between July 1, 2011 and June 30, 2012, between July  1,  2012
 and  June 30, 2013, between July 1, 2013 and June 30, 2014, between July
 1, 2014 and June 30, 2015, between July  1,  2015  and  June  30,  2016,
 between  July  1,  2016 and June 30, 2017, between July 1, 2017 and June
 30, 2018, [and] between July 1, 2018 and June 30, 2019, AND BETWEEN JULY
 1, 2019 AND JUNE 30, 2020 or reimburse the hospital where  the  hospital
 purchases  equivalent  excess coverage as defined in subparagraph (i) of
 paragraph (a) of subdivision 1-a of this section for medical  or  dental
 malpractice  occurrences between July 1, 1987 and June 30, 1988, between
 July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30,  1990,
 between  July  1,  1990 and June 30, 1991, between July 1, 1991 and June
 30, 1992, between July 1, 1992 and June 30, 1993, between July  1,  1993
 and  June 30, 1994, between July 1, 1994 and June 30, 1995, between July
 1, 1995 and June 30, 1996, between July  1,  1996  and  June  30,  1997,
 between  July  1,  1997 and June 30, 1998, between July 1, 1998 and June
 30, 1999, between July 1, 1999 and June 30, 2000, between July  1,  2000
 and  June 30, 2001, between July 1, 2001 and June 30, 2002, between July
 1, 2002 and June 30, 2003, between July  1,  2003  and  June  30,  2004,
 between  July  1,  2004 and June 30, 2005, between July 1, 2005 and June
 30, 2006, between July 1, 2006 and June 30, 2007, between July  1,  2007
 and  June 30, 2008, between July 1, 2008 and June 30, 2009, between July
 1, 2009 and June 30, 2010, between July  1,  2010  and  June  30,  2011,
 between  July  1,  2011 and June 30, 2012, between July 1, 2012 and June
 30, 2013, between July 1, 2013 and June 30, 2014, between July  1,  2014
 and  June 30, 2015, between July 1, 2015 and June 30, 2016, between July
 1, 2016 and June 30, 2017, between July 1, 2017 and June 30, 2018, [and]
 between July 1, 2018 and June 30, 2019, AND BETWEEN  JULY  1,  2019  AND
 JUNE  30, 2020 for physicians or dentists certified as eligible for each
 such period or periods pursuant to subdivision 2 of this  section  by  a
 general  hospital  licensed  pursuant to article 28 of the public health
 law; provided that no single insurer shall write more than fifty percent
 of the total excess premium for  a  given  policy  year;  and  provided,
 however, that such eligible physicians or dentists must have in force an
 individual  policy,  from  an  insurer licensed in this state of primary
 malpractice insurance coverage in amounts of no less  than  one  million
 three  hundred thousand dollars for each claimant and three million nine
 hundred thousand dollars for all claimants under that policy during  the
 period  of  such  excess coverage for such occurrences or be endorsed as
 additional insureds under a hospital professional liability policy which
 is  offered  through  a  voluntary  attending  physician  ("channeling")
 program previously permitted by the superintendent of financial services
 during  the  period of such excess coverage for such occurrences. During
 such period, such policy for excess coverage or such  equivalent  excess
 coverage  shall, when combined with the physician's or dentist's primary
 malpractice insurance coverage or coverage provided through a  voluntary
 attending  physician ("channeling") program, total an aggregate level of
 two million three hundred thousand dollars for  each  claimant  and  six
 million  nine  hundred  thousand dollars for all claimants from all such
 policies with respect to occurrences in each  of  such  years  provided,
 however, if the cost of primary malpractice insurance coverage in excess
 of  one million dollars, but below the excess medical malpractice insur-
 ance coverage provided pursuant to this act, exceeds the  rate  of  nine
 percent per annum, then the required level of primary malpractice insur-
 ance  coverage  in excess of one million dollars for each claimant shall

 S. 1507                            24                            A. 2007
 
 be in an amount of not less than the  dollar  amount  of  such  coverage
 available at nine percent per annum; the required level of such coverage
 for  all claimants under that policy shall be in an amount not less than
 three  times the dollar amount of coverage for each claimant; and excess
 coverage, when combined with such primary malpractice  insurance  cover-
 age, shall increase the aggregate level for each claimant by one million
 dollars  and  three  million  dollars  for  all  claimants; and provided
 further, that, with respect to policies of primary  medical  malpractice
 coverage  that  include  occurrences  between April 1, 2002 and June 30,
 2002, such requirement that coverage be in  amounts  no  less  than  one
 million  three  hundred  thousand  dollars  for  each claimant and three
 million nine hundred thousand dollars for all claimants for such  occur-
 rences shall be effective April 1, 2002.
   §  2.  Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
 amending the civil practice law and rules and  other  laws  relating  to
 malpractice and professional medical conduct, as amended by section 2 of
 part M of chapter 57 of the laws of 2018, is amended to read as follows:
   (3)(a)  The  superintendent  of financial services shall determine and
 certify to each general hospital and to the commissioner of  health  the
 cost  of  excess malpractice insurance for medical or dental malpractice
 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988
 and June 30, 1989, between July 1, 1989 and June 30, 1990, between  July
 1,  1990  and  June  30,  1991,  between July 1, 1991 and June 30, 1992,
 between July 1, 1992 and June 30, 1993, between July 1,  1993  and  June
 30,  1994,  between July 1, 1994 and June 30, 1995, between July 1, 1995
 and June 30, 1996, between July 1, 1996 and June 30, 1997, between  July
 1,  1997  and  June  30,  1998,  between July 1, 1998 and June 30, 1999,
 between July 1, 1999 and June 30, 2000, between July 1,  2000  and  June
 30,  2001,  between July 1, 2001 and June 30, 2002, between July 1, 2002
 and June 30, 2003, between July 1, 2003 and June 30, 2004, between  July
 1,  2004  and  June  30,  2005,  between July 1, 2005 and June 30, 2006,
 between July 1, 2006 and June 30, 2007, between July 1,  2007  and  June
 30,  2008,  between July 1, 2008 and June 30, 2009, between July 1, 2009
 and June 30, 2010, between July 1, 2010 and June 30, 2011, between  July
 1,  2011  and June 30, 2012, between July 1, 2012 and June 30, 2013, and
 between July 1, 2013 and June 30, 2014, between July 1,  2014  and  June
 30,  2015,  between  July 1, 2015 and June 30, 2016, and between July 1,
 2016 and June 30, 2017, between July 1, 2017 and June  30,  2018,  [and]
 between  July  1,  2018  and June 30, 2019, AND BETWEEN JULY 1, 2019 AND
 JUNE 30, 2020 allocable to  each  general  hospital  for  physicians  or
 dentists  certified  as  eligible  for  purchase  of a policy for excess
 insurance coverage by such general hospital in accordance with  subdivi-
 sion  2  of  this  section, and may amend such determination and certif-
 ication as necessary.
   (b) The superintendent  of  financial  services  shall  determine  and
 certify  to  each general hospital and to the commissioner of health the
 cost of excess malpractice insurance or equivalent excess  coverage  for
 medical  or dental malpractice occurrences between July 1, 1987 and June
 30, 1988, between July 1, 1988 and June 30, 1989, between July  1,  1989
 and  June 30, 1990, between July 1, 1990 and June 30, 1991, between July
 1, 1991 and June 30, 1992, between July  1,  1992  and  June  30,  1993,
 between  July  1,  1993 and June 30, 1994, between July 1, 1994 and June
 30, 1995, between July 1, 1995 and June 30, 1996, between July  1,  1996
 and  June 30, 1997, between July 1, 1997 and June 30, 1998, between July
 1, 1998 and June 30, 1999, between July  1,  1999  and  June  30,  2000,
 between  July  1,  2000 and June 30, 2001, between July 1, 2001 and June

 S. 1507                            25                            A. 2007
 
 30, 2002, between July 1, 2002 and June 30, 2003, between July  1,  2003
 and  June 30, 2004, between July 1, 2004 and June 30, 2005, between July
 1, 2005 and June 30, 2006, between July  1,  2006  and  June  30,  2007,
 between  July  1,  2007 and June 30, 2008, between July 1, 2008 and June
 30, 2009, between July 1, 2009 and June 30, 2010, between July  1,  2010
 and  June 30, 2011, between July 1, 2011 and June 30, 2012, between July
 1, 2012 and June 30, 2013, between July  1,  2013  and  June  30,  2014,
 between  July  1,  2014 and June 30, 2015, between July 1, 2015 and June
 30, 2016, between July 1, 2016 and June 30, 2017, between July  1,  2017
 and  June  30,  2018,  [and] between July 1, 2018 and June 30, 2019, AND
 BETWEEN JULY 1, 2019 AND JUNE 30, 2020 allocable to each general  hospi-
 tal  for  physicians or dentists certified as eligible for purchase of a
 policy for excess insurance coverage or equivalent  excess  coverage  by
 such  general hospital in accordance with subdivision 2 of this section,
 and may amend such determination and  certification  as  necessary.  The
 superintendent of financial services shall determine and certify to each
 general  hospital and to the commissioner of health the ratable share of
 such cost allocable to the period July 1, 1987 to December 31, 1987,  to
 the  period January 1, 1988 to June 30, 1988, to the period July 1, 1988
 to December 31, 1988, to the period January 1, 1989 to June 30, 1989, to
 the period July 1, 1989 to December 31, 1989, to the period  January  1,
 1990  to June 30, 1990, to the period July 1, 1990 to December 31, 1990,
 to the period January 1, 1991 to June 30, 1991, to the  period  July  1,
 1991  to  December  31,  1991, to the period January 1, 1992 to June 30,
 1992, to the period July 1, 1992 to December 31,  1992,  to  the  period
 January 1, 1993 to June 30, 1993, to the period July 1, 1993 to December
 31,  1993, to the period January 1, 1994 to June 30, 1994, to the period
 July 1, 1994 to December 31, 1994, to the period January 1, 1995 to June
 30, 1995, to the period July 1, 1995 to December 31, 1995, to the period
 January 1, 1996 to June 30, 1996, to the period July 1, 1996 to December
 31, 1996, to the period January 1, 1997 to June 30, 1997, to the  period
 July 1, 1997 to December 31, 1997, to the period January 1, 1998 to June
 30, 1998, to the period July 1, 1998 to December 31, 1998, to the period
 January 1, 1999 to June 30, 1999, to the period July 1, 1999 to December
 31,  1999, to the period January 1, 2000 to June 30, 2000, to the period
 July 1, 2000 to December 31, 2000, to the period January 1, 2001 to June
 30, 2001, to the period July 1, 2001 to June 30,  2002,  to  the  period
 July  1,  2002  to June 30, 2003, to the period July 1, 2003 to June 30,
 2004, to the period July 1, 2004 to June 30, 2005, to the period July 1,
 2005 and June 30, 2006, to the period July 1, 2006 and June 30, 2007, to
 the period July 1, 2007 and June 30, 2008, to the period  July  1,  2008
 and  June 30, 2009, to the period July 1, 2009 and June 30, 2010, to the
 period July 1, 2010 and June 30, 2011, to the period July  1,  2011  and
 June  30,  2012,  to  the  period July 1, 2012 and June 30, 2013, to the
 period July 1, 2013 and June 30, 2014, to the period July  1,  2014  and
 June  30,  2015,  to  the  period  July  1, 2015 and June 30, 2016, [and
 between] TO THE PERIOD July 1, 2016 and June  30,  2017,  [and]  to  the
 period  July  1, 2017 to June 30, 2018, [and] to the period July 1, 2018
 to June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE 30, 2020.
   § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section
 18 of chapter 266 of the laws of 1986, amending the civil  practice  law
 and  rules  and  other  laws  relating  to  malpractice and professional
 medical conduct, as amended by section 3 of part M of chapter 57 of  the
 laws of 2018, are amended to read as follows:
   (a)  To  the  extent  funds available to the hospital excess liability
 pool pursuant to subdivision 5 of this section as amended, and  pursuant

 S. 1507                            26                            A. 2007
 
 to  section  6  of part J of chapter 63 of the laws of 2001, as may from
 time to time be amended, which amended this  subdivision,  are  insuffi-
 cient  to  meet  the  costs  of  excess insurance coverage or equivalent
 excess  coverage  for coverage periods during the period July 1, 1992 to
 June 30, 1993, during the period July 1, 1993 to June 30,  1994,  during
 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
 to  June  30,  1996,  during  the  period July 1, 1996 to June 30, 1997,
 during the period July 1, 1997 to June 30, 1998, during the period  July
 1,  1998  to  June  30, 1999, during the period July 1, 1999 to June 30,
 2000, during the period July 1, 2000 to June 30, 2001, during the period
 July 1, 2001 to October 29, 2001, during the period  April  1,  2002  to
 June  30,  2002, during the period July 1, 2002 to June 30, 2003, during
 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
 to June 30, 2005, during the period July  1,  2005  to  June  30,  2006,
 during  the period July 1, 2006 to June 30, 2007, during the period July
 1, 2007 to June 30, 2008, during the period July 1,  2008  to  June  30,
 2009, during the period July 1, 2009 to June 30, 2010, during the period
 July  1,  2010  to June 30, 2011, during the period July 1, 2011 to June
 30, 2012, during the period July 1, 2012 to June 30,  2013,  during  the
 period  July 1, 2013 to June 30, 2014, during the period July 1, 2014 to
 June 30, 2015, during the period July 1, 2015 to June 30,  2016,  during
 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017
 to June 30, 2018, [and] during the period July 1, 2018 to June 30, 2019,
 AND DURING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 allocated or reallo-
 cated  in  accordance  with  paragraph  (a)  of  subdivision 4-a of this
 section to rates of payment applicable to state  governmental  agencies,
 each  physician or dentist for whom a policy for excess insurance cover-
 age or equivalent excess coverage is purchased for such period shall  be
 responsible  for payment to the provider of excess insurance coverage or
 equivalent excess coverage of an allocable share of such  insufficiency,
 based on the ratio of the total cost of such coverage for such physician
 to the sum of the total cost of such coverage for all physicians applied
 to such insufficiency.
   (b)  Each  provider  of excess insurance coverage or equivalent excess
 coverage covering the period July 1, 1992 to June 30, 1993, or  covering
 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
 1994  to  June 30, 1995, or covering the period July 1, 1995 to June 30,
 1996, or covering the period July 1, 1996 to June 30, 1997, or  covering
 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
 1998  to  June 30, 1999, or covering the period July 1, 1999 to June 30,
 2000, or covering the period July 1, 2000 to June 30, 2001, or  covering
 the  period  July  1,  2001  to October 29, 2001, or covering the period
 April 1, 2002 to June 30, 2002, or covering the period July 1,  2002  to
 June  30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008,  or
 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
 June  30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
 covering the period July 1, 2012 to June 30, 2013, or covering the peri-
 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to
 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016,  or
 covering the period July 1, 2016 to June 30, 2017, or covering the peri-
 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to
 June  30,  2019,  OR  COVERING  THE PERIOD JULY 1, 2019 TO JUNE 30, 2020

 S. 1507                            27                            A. 2007
 
 shall notify a covered physician or  dentist  by  mail,  mailed  to  the
 address  shown  on the last application for excess insurance coverage or
 equivalent excess coverage, of the amount due to such provider from such
 physician  or  dentist for such coverage period determined in accordance
 with paragraph (a) of this subdivision. Such amount shall  be  due  from
 such  physician or dentist to such provider of excess insurance coverage
 or equivalent excess coverage in a time and  manner  determined  by  the
 superintendent of financial services.
   (c)  If  a physician or dentist liable for payment of a portion of the
 costs of excess insurance coverage or equivalent excess coverage  cover-
 ing  the  period  July  1, 1992 to June 30, 1993, or covering the period
 July 1, 1993 to June 30, 1994, or covering the period July  1,  1994  to
 June  30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000,  or
 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
 od  July  1,  2001  to October 29, 2001, or covering the period April 1,
 2002 to June 30, 2002, or covering the period July 1, 2002 to  June  30,
 2003,  or covering the period July 1, 2003 to June 30, 2004, or covering
 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
 2005 to June 30, 2006, or covering the period July 1, 2006 to  June  30,
 2007,  or covering the period July 1, 2007 to June 30, 2008, or covering
 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
 2009 to June 30, 2010, or covering the period July 1, 2010 to  June  30,
 2011,  or covering the period July 1, 2011 to June 30, 2012, or covering
 the period July 1, 2012 to June 30, 2013, or covering the period July 1,
 2013 to June 30, 2014, or covering the period July 1, 2014 to  June  30,
 2015,  or covering the period July 1, 2015 to June 30, 2016, or covering
 the period July 1, 2016 to June 30, 2017, or covering the period July 1,
 2017 to June 30, 2018, or covering the period July 1, 2018 to  June  30,
 2019, OR COVERING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 determined in
 accordance  with  paragraph  (a)  of  this subdivision fails, refuses or
 neglects to make payment to the provider of excess insurance coverage or
 equivalent excess coverage in such time and manner as determined by  the
 superintendent  of  financial services pursuant to paragraph (b) of this
 subdivision, excess insurance coverage  or  equivalent  excess  coverage
 purchased  for such physician or dentist in accordance with this section
 for such coverage period shall be cancelled and shall be null  and  void
 as  of  the  first  day  on or after the commencement of a policy period
 where the liability for payment pursuant to  this  subdivision  has  not
 been met.
   (d)  Each  provider  of excess insurance coverage or equivalent excess
 coverage shall notify the superintendent of financial services  and  the
 commissioner  of  health or their designee of each physician and dentist
 eligible for purchase of a  policy  for  excess  insurance  coverage  or
 equivalent  excess coverage covering the period July 1, 1992 to June 30,
 1993, or covering the period July 1, 1993 to June 30, 1994, or  covering
 the period July 1, 1994 to June 30, 1995, or covering the period July 1,
 1995  to  June 30, 1996, or covering the period July 1, 1996 to June 30,
 1997, or covering the period July 1, 1997 to June 30, 1998, or  covering
 the period July 1, 1998 to June 30, 1999, or covering the period July 1,
 1999  to  June 30, 2000, or covering the period July 1, 2000 to June 30,
 2001, or covering the period July 1, 2001 to October 29, 2001, or cover-
 ing the period April 1, 2002 to June 30, 2002, or  covering  the  period
 July  1,  2002  to June 30, 2003, or covering the period July 1, 2003 to

 S. 1507                            28                            A. 2007
 
 June 30, 2004, or covering the period July 1, 2004 to June 30, 2005,  or
 covering the period July 1, 2005 to June 30, 2006, or covering the peri-
 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to
 June  30, 2008, or covering the period July 1, 2008 to June 30, 2009, or
 covering the period July 1, 2009 to June 30, 2010, or covering the peri-
 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to
 June 30, 2012, or covering the period July 1, 2012 to June 30, 2013,  or
 covering the period July 1, 2013 to June 30, 2014, or covering the peri-
 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to
 June  30, 2016, or covering the period July 1, 2016 to June 30, 2017, or
 covering the period July 1, 2017 to June 30, 2018, or covering the peri-
 od July 1, 2018 to June 30, 2019, OR COVERING THE PERIOD JULY 1, 2019 TO
 JUNE 30, 2020 that has made payment to such provider of excess insurance
 coverage or equivalent excess coverage in accordance with paragraph  (b)
 of  this  subdivision  and of each physician and dentist who has failed,
 refused or neglected to make such payment.
   (e) A provider of  excess  insurance  coverage  or  equivalent  excess
 coverage  shall  refund to the hospital excess liability pool any amount
 allocable to the period July 1, 1992 to June 30, 1993, and to the period
 July 1, 1993 to June 30, 1994, and to the period July 1,  1994  to  June
 30,  1995,  and  to the period July 1, 1995 to June 30, 1996, and to the
 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997  to
 June  30,  1998, and to the period July 1, 1998 to June 30, 1999, and to
 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
 to June 30, 2001, and to the period July 1, 2001 to  October  29,  2001,
 and to the period April 1, 2002 to June 30, 2002, and to the period July
 1,  2002  to  June  30, 2003, and to the period July 1, 2003 to June 30,
 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
 July 1, 2005 to June 30, 2006, and to the period July 1,  2006  to  June
 30,  2007,  and  to the period July 1, 2007 to June 30, 2008, and to the
 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009  to
 June  30,  2010, and to the period July 1, 2010 to June 30, 2011, and to
 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
 to June 30, 2013, and to the period July 1, 2013 to June 30,  2014,  and
 to  the  period July 1, 2014 to June 30, 2015, and to the period July 1,
 2015 to June 30, 2016, to the period July 1, 2016 to June 30, 2017,  and
 to  the  period July 1, 2017 to June 30, 2018, and to the period July 1,
 2018 to June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE  30,  2020
 received  from the hospital excess liability pool for purchase of excess
 insurance coverage or equivalent excess  coverage  covering  the  period
 July  1,  1992 to June 30, 1993, and covering the period July 1, 1993 to
 June 30, 1994, and covering the period July 1, 1994 to  June  30,  1995,
 and  covering the period July 1, 1995 to June 30, 1996, and covering the
 period July 1, 1996 to June 30, 1997, and covering the  period  July  1,
 1997  to June 30, 1998, and covering the period July 1, 1998 to June 30,
 1999, and covering the period July 1, 1999 to June 30, 2000, and  cover-
 ing  the  period  July 1, 2000 to June 30, 2001, and covering the period
 July 1, 2001 to October 29, 2001, and covering the period April 1,  2002
 to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003,
 and  covering the period July 1, 2003 to June 30, 2004, and covering the
 period July 1, 2004 to June 30, 2005, and covering the  period  July  1,
 2005  to June 30, 2006, and covering the period July 1, 2006 to June 30,
 2007, and covering the period July 1, 2007 to June 30, 2008, and  cover-
 ing  the  period  July 1, 2008 to June 30, 2009, and covering the period
 July 1, 2009 to June 30, 2010, and covering the period July 1,  2010  to
 June  30,  2011,  and covering the period July 1, 2011 to June 30, 2012,

 S. 1507                            29                            A. 2007
 
 and covering the period July 1, 2012 to June 30, 2013, and covering  the
 period  July  1,  2013 to June 30, 2014, and covering the period July 1,
 2014 to June 30, 2015, and covering the period July 1, 2015 to June  30,
 2016,  and covering the period July 1, 2016 to June 30, 2017, and cover-
 ing the period July 1, 2017 to June 30, 2018, and  covering  the  period
 July  1,  2018 to June 30, 2019, AND COVERING THE PERIOD JULY 1, 2019 TO
 JUNE 30, 2020 for a physician or dentist  where  such  excess  insurance
 coverage  or  equivalent excess coverage is cancelled in accordance with
 paragraph (c) of this subdivision.
   § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil
 practice law and rules  and  other  laws  relating  to  malpractice  and
 professional medical conduct, as amended by section 4 of part M of chap-
 ter 57 of the laws of 2018, is amended to read as follows:
   §  40.  The superintendent of financial services shall establish rates
 for policies providing coverage  for  physicians  and  surgeons  medical
 malpractice  for the periods commencing July 1, 1985 and ending June 30,
 [2019;]  2020;  provided,  however,  that  notwithstanding   any   other
 provision  of law, the superintendent shall not establish or approve any
 increase in rates for the period commencing July 1, 2009 and ending June
 30, 2010. The superintendent shall direct insurers to  establish  segre-
 gated  accounts  for  premiums, payments, reserves and investment income
 attributable to such premium periods and shall require periodic  reports
 by the insurers regarding claims and expenses attributable to such peri-
 ods to monitor whether such accounts will be sufficient to meet incurred
 claims  and expenses. On or after July 1, 1989, the superintendent shall
 impose a surcharge on premiums to satisfy a projected deficiency that is
 attributable to the premium levels established pursuant to this  section
 for  such  periods;  provided, however, that such annual surcharge shall
 not exceed eight percent of the established rate until July  1,  [2019,]
 2020, at which time and thereafter such surcharge shall not exceed twen-
 ty-five  percent  of  the  approved  adequate rate, and that such annual
 surcharges shall continue for such period of time as shall be sufficient
 to satisfy such deficiency. The superintendent  shall  not  impose  such
 surcharge  during the period commencing July 1, 2009 and ending June 30,
 2010. On and after July  1,  1989,  the  surcharge  prescribed  by  this
 section  shall  be  retained by insurers to the extent that they insured
 physicians and surgeons during the July 1, 1985 through June 30,  [2019]
 2020  policy  periods;  in  the  event  and to the extent physicians and
 surgeons were insured by another insurer during such periods, all  or  a
 pro  rata  share of the surcharge, as the case may be, shall be remitted
 to such other insurer in accordance with rules  and  regulations  to  be
 promulgated by the superintendent.  Surcharges collected from physicians
 and  surgeons  who  were not insured during such policy periods shall be
 apportioned among all insurers in proportion to the premium  written  by
 each  insurer  during such policy periods; if a physician or surgeon was
 insured by an insurer subject to rates established by the superintendent
 during such policy periods, and  at  any  time  thereafter  a  hospital,
 health  maintenance organization, employer or institution is responsible
 for responding in damages for liability arising out of such  physician's
 or  surgeon's  practice  of medicine, such responsible entity shall also
 remit to such prior insurer the equivalent amount  that  would  then  be
 collected  as  a  surcharge if the physician or surgeon had continued to
 remain insured by such prior insurer. In  the  event  any  insurer  that
 provided  coverage  during  such  policy  periods is in liquidation, the
 property/casualty insurance security fund shall receive the  portion  of
 surcharges to which the insurer in liquidation would have been entitled.

 S. 1507                            30                            A. 2007
 
 The surcharges authorized herein shall be deemed to be income earned for
 the  purposes of section 2303 of the insurance law.  The superintendent,
 in establishing adequate rates and in determining  any  projected  defi-
 ciency  pursuant  to  the requirements of this section and the insurance
 law, shall give substantial weight, determined  in  his  discretion  and
 judgment,  to  the  prospective  anticipated  effect  of any regulations
 promulgated and laws enacted and the  public  benefit  of    stabilizing
 malpractice rates and minimizing rate level fluctuation during the peri-
 od  of  time  necessary for the development of more reliable statistical
 experience as to the efficacy of such  laws  and  regulations  affecting
 medical, dental or podiatric malpractice enacted or promulgated in 1985,
 1986,  by this act and at any other time.  Notwithstanding any provision
 of the insurance law, rates already established and to be established by
 the superintendent pursuant to this section are deemed adequate if  such
 rates  would be adequate when taken together with the maximum authorized
 annual surcharges to be imposed for a reasonable period of time  whether
 or  not  any  such  annual surcharge has been actually imposed as of the
 establishment of such rates.
   § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J  of
 chapter  63  of  the  laws  of 2001, amending chapter 266 of the laws of
 1986, amending the civil practice law and rules and other laws  relating
 to  malpractice and professional medical conduct, relating to the effec-
 tiveness of certain provisions of such chapter, as amended by section  5
 of  part  M  of  chapter  57 of the laws of 2018, are amended to read as
 follows:
   § 5. The superintendent of financial services and the commissioner  of
 health shall determine, no later than June 15, 2002, June 15, 2003, June
 15,  2004,  June  15, 2005, June 15, 2006, June 15, 2007, June 15, 2008,
 June 15, 2009, June 15, 2010, June 15, 2011, June  15,  2012,  June  15,
 2013,  June  15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June
 15, 2018, [and] June 15, 2019, AND JUNE 15, 2020  the  amount  of  funds
 available  in  the  hospital  excess liability pool, created pursuant to
 section 18 of chapter 266 of the laws of 1986, and  whether  such  funds
 are  sufficient for purposes of purchasing excess insurance coverage for
 eligible participating physicians and dentists during the period July 1,
 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003
 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,  2005  to
 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June
 30,  2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
 2010, or July 1, 2010 to June 30, 2011, or July  1,  2011  to  June  30,
 2012,  or  July  1,  2012  to June 30, 2013, or July 1, 2013 to June 30,
 2014, or July 1, 2014 to June 30, 2015, or July  1,  2015  to  June  30,
 2016,  or  July  1,  2016  to June 30, 2017, or July 1, 2017 to June 30,
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (a) This section shall be effective only upon a determination,  pursu-
 ant  to  section  five  of  this act, by the superintendent of financial
 services and the commissioner of health, and  a  certification  of  such
 determination  to  the  state  director  of the budget, the chair of the
 senate committee on finance and the chair of the assembly  committee  on
 ways  and means, that the amount of funds in the hospital excess liabil-
 ity pool, created pursuant to section 18 of chapter 266 of the  laws  of
 1986, is insufficient for purposes of purchasing excess insurance cover-
 age for eligible participating physicians and dentists during the period
 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July
 1,  2003  to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,

 S. 1507                            31                            A. 2007
 
 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007
 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1,  2009  to
 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June
 30,  2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
 2014, or July 1, 2014 to June 30, 2015, or July  1,  2015  to  June  30,
 2016,  or  July  1,  2016  to June 30, 2017, or July 1, 2017 to June 30,
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (e) The commissioner of health  shall  transfer  for  deposit  to  the
 hospital excess liability pool created pursuant to section 18 of chapter
 266  of  the laws of 1986 such amounts as directed by the superintendent
 of financial services for the purchase  of  excess  liability  insurance
 coverage  for  eligible  participating  physicians  and dentists for the
 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to  June  30,
 2003,  or  July  1,  2003  to June 30, 2004, or July 1, 2004 to June 30,
 2005, or July 1, 2005 to June 30, 2006, or July  1,  2006  to  June  30,
 2007,  as  applicable, and the cost of administering the hospital excess
 liability pool for such applicable policy year,  pursuant to the program
 established in chapter 266 of the laws of 1986,  as  amended,  no  later
 than  June  15,  2002, June 15, 2003, June 15, 2004, June 15, 2005, June
 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009,  June  15,  2010,
 June  15,  2011,  June  15, 2012, June 15, 2013, June 15, 2014, June 15,
 2015, June 15, 2016, June 15, 2017, June 15, 2018, [and] June 15,  2019,
 AND JUNE 15, 2020 as applicable.
   §  6. Section 20 of part H of chapter 57 of the laws of 2017, amending
 the New York Health Care Reform Act of 1996 and other laws  relating  to
 extending  certain provisions thereto, as amended by section 6 of part M
 of chapter 57 of the laws of 2018, is amended to read as follows:
   § 20. Notwithstanding any law, rule or  regulation  to  the  contrary,
 only  physicians  or dentists who were eligible, and for whom the super-
 intendent of financial services and the commissioner of health, or their
 designee, purchased, with funds available in the hospital excess liabil-
 ity pool, a full or partial policy for  excess  coverage  or  equivalent
 excess  coverage  for  the coverage period ending the thirtieth of June,
 two thousand [eighteen,] NINETEEN, shall be eligible to apply  for  such
 coverage  for the coverage period beginning the first of July, two thou-
 sand [eighteen;] NINETEEN; provided, however, if  the  total  number  of
 physicians  or  dentists  for  whom  such  excess coverage or equivalent
 excess coverage was purchased for the policy year ending  the  thirtieth
 of  June,  two  thousand [eighteen] NINETEEN exceeds the total number of
 physicians or dentists certified as eligible  for  the  coverage  period
 beginning the first of July, two thousand [eighteen,] NINETEEN, then the
 general hospitals may certify additional eligible physicians or dentists
 in  a  number equal to such general hospital's proportional share of the
 total number of physicians or  dentists  for  whom  excess  coverage  or
 equivalent  excess  coverage  was  purchased with funds available in the
 hospital excess liability pool as of the thirtieth of June, two thousand
 [eighteen,] NINETEEN, as applied to the difference between the number of
 eligible physicians or dentists for whom a policy for excess coverage or
 equivalent excess coverage was purchased for the coverage period  ending
 the  thirtieth  of June, two thousand [eighteen] NINETEEN and the number
 of such eligible physicians or dentists  who  have  applied  for  excess
 coverage or equivalent excess coverage for the coverage period beginning
 the first of July, two thousand [eighteen] NINETEEN.
   §  7.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019.

 S. 1507                            32                            A. 2007
 
                                  PART G
 
   Section 1. Paragraph (a) of subdivision 3 of section 366 of the social
 services  law  is  REPEALED  and a new paragraph (a) is added to read as
 follows:
   (A) MEDICAL ASSISTANCE SHALL BE FURNISHED WITHOUT CONSIDERATION OF THE
 INCOME AND RESOURCES OF AN APPLICANT'S LEGALLY RESPONSIBLE  RELATIVE  IF
 THE  APPLICANT'S  ELIGIBILITY  WOULD NORMALLY BE DETERMINED BY COMPARING
 THE AMOUNT OF  AVAILABLE  INCOME  AND/OR  RESOURCES  OF  THE  APPLICANT,
 INCLUDING AMOUNTS DEEMED AVAILABLE TO THE APPLICANT FROM LEGALLY RESPON-
 SIBLE RELATIVES, TO AN APPLICABLE ELIGIBILITY STANDARD, AND:
   (1)  (I)  THE  LEGALLY  RESPONSIBLE RELATIVE IS A COMMUNITY SPOUSE, AS
 DEFINED IN SECTION THREE HUNDRED SIXTY-SIX-C OF THIS TITLE;
   (II) SUCH RELATIVE IS REFUSING  TO  MAKE  HIS  OR  HER  INCOME  AND/OR
 RESOURCES  AVAILABLE  TO  MEET  THE  COST  OF  NECESSARY  MEDICAL  CARE,
 SERVICES, AND SUPPLIES; AND
   (III) THE APPLICANT EXECUTES AN ASSIGNMENT OF SUPPORT FROM THE  COMMU-
 NITY SPOUSE IN FAVOR OF THE SOCIAL SERVICES DISTRICT AND THE DEPARTMENT,
 UNLESS  THE  APPLICANT IS UNABLE TO EXECUTE SUCH ASSIGNMENT DUE TO PHYS-
 ICAL OR MENTAL IMPAIRMENT OR TO DENY ASSISTANCE WOULD  CREATE  AN  UNDUE
 HARDSHIP, AS DEFINED BY THE COMMISSIONER; OR
   (2)  THE  LEGALLY  RESPONSIBLE RELATIVE IS ABSENT FROM THE APPLICANT'S
 HOUSEHOLD, AND FAILS OR  REFUSES  TO  MAKE  HIS  OR  HER  INCOME  AND/OR
 RESOURCES  AVAILABLE  TO  MEET  THE  COST  OF  NECESSARY  MEDICAL  CARE,
 SERVICES, AND SUPPLIES.
   IN SUCH CASES, HOWEVER, THE FURNISHING OF SUCH ASSISTANCE SHALL CREATE
 AN IMPLIED CONTRACT WITH SUCH RELATIVE, AND  THE  COST  THEREOF  MAY  BE
 RECOVERED  FROM  SUCH  RELATIVE  IN ACCORDANCE WITH TITLE SIX OF ARTICLE
 THREE OF THIS CHAPTER AND OTHER APPLICABLE PROVISIONS OF LAW.
   § 2. Paragraphs (b), (c), (d), (e), (f), (g), and (h)  of  subdivision
 4-a and subdivisions 4-b and 4-c of section 365-f of the social services
 law  are  REPEALED,  and  paragraph (i) of subdivision 4-a is relettered
 paragraph (b).
   § 3. Section 365-f of the social services law is REPEALED, and  a  new
 section 365-f is added to read as follows:
   § 365-F. CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAM. 1. PURPOSE AND
 INTENT. THE CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAM IS INTENDED TO
 PERMIT  CHRONICALLY ILL AND/OR PHYSICALLY DISABLED INDIVIDUALS RECEIVING
 HOME CARE SERVICES UNDER THE MEDICAL ASSISTANCE PROGRAM  GREATER  FLEXI-
 BILITY  AND FREEDOM OF CHOICE IN OBTAINING SUCH SERVICES. THE DEPARTMENT
 SHALL REGULARLY MONITOR DISTRICT PARTICIPATION IN THE PROGRAM BY REVIEW-
 ING THE IMPLEMENTATION PLANS SUBMITTED PURSUANT TO THIS  SECTION.    THE
 DEPARTMENT SHALL PROVIDE GUIDANCE TO THE DISTRICTS TO IMPROVE COMPLIANCE
 WITH   IMPLEMENTATION  PLANS  AND  PROMOTE  CONSISTENCY  AMONG  COUNTIES
 REGARDING APPROVED SERVICE LEVELS BASED ON THE ASSESSMENTS  REQUIRED  BY
 THIS  SECTION.  IN  ADDITION,  THE  DEPARTMENT  SHALL  PROVIDE TECHNICAL
 ASSISTANCE AND SUCH OTHER ASSISTANCE AS MAY BE NECESSARY TO ASSIST  SUCH
 DISTRICTS IN ASSURING ACCESS TO THE PROGRAM FOR ELIGIBLE INDIVIDUALS.
   2.  ELIGIBILITY. ALL ELIGIBLE INDIVIDUALS RECEIVING HOME CARE SHALL BE
 PROVIDED NOTICE  OF  THE  AVAILABILITY  OF  THE  PROGRAM,  AND  NO  LESS
 FREQUENTLY  THAN  ANNUALLY THEREAFTER, AND SHALL HAVE THE OPPORTUNITY TO
 APPLY FOR PARTICIPATION IN THE PROGRAM. EACH  SOCIAL  SERVICES  DISTRICT
 SHALL  FILE AN  IMPLEMENTATION PLAN WITH THE COMMISSIONER OF THE DEPART-
 MENT OF HEALTH, WHICH SHALL BE UPDATED ANNUALLY. SUCH UPDATES  SHALL  BE
 SUBMITTED  NO  LATER THAN NOVEMBER THIRTIETH OF EACH YEAR. THE PLANS AND
 UPDATES SUBMITTED BY DISTRICTS SHALL REQUIRE THE APPROVAL OF THE DEPART-

 S. 1507                            33                            A. 2007
 
 MENT. IMPLEMENTATION PLANS SHALL INCLUDE  DISTRICT  ENROLLMENT  TARGETS,
 DESCRIBE  METHODS  FOR  THE PROVISION OF NOTICE AND ASSISTANCE TO INTER-
 ESTED INDIVIDUALS ELIGIBLE FOR ENROLLMENT  IN  THE  PROGRAM,  AND  SHALL
 CONTAIN  SUCH OTHER INFORMATION AS, SHALL BE REQUIRED BY THE DEPARTMENT.
 AN "ELIGIBLE INDIVIDUAL", FOR PURPOSES OF THIS SECTION IS A PERSON WHO:
   (A) IS ELIGIBLE FOR LONG TERM CARE AND SERVICES PROVIDED BY  A  CERTI-
 FIED HOME HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR AIDS HOME
 CARE  PROGRAM  AUTHORIZED  PURSUANT  TO ARTICLE THIRTY-SIX OF THE PUBLIC
 HEALTH LAW, OR IS ELIGIBLE FOR PERSONAL CARE SERVICES PROVIDED  PURSUANT
 TO THIS ARTICLE;
   (B) IS ELIGIBLE FOR MEDICAL ASSISTANCE;
   (C)  HAS  BEEN DETERMINED BY THE SOCIAL SERVICES DISTRICT OR AN ENTITY
 CERTIFIED UNDER ARTICLE  FORTY-FOUR OF THE PUBLIC HEALTH  LAW,  PURSUANT
 TO  AN  ASSESSMENT  OF  THE  PERSON'S  APPROPRIATENESS  FOR THE PROGRAM,
 CONDUCTED WITH AN APPROPRIATE LONG TERM  HOME  HEALTH  CARE  PROGRAM,  A
 CERTIFIED  HOME  HEALTH AGENCY, OR AN AIDS HOME CARE PROGRAM OR PURSUANT
 TO THE PERSONAL CARE PROGRAM, AS BEING IN NEED OF HOME CARE SERVICES  OR
 PRIVATE  DUTY NURSING AND IS ABLE AND WILLING OR HAS A DESIGNATED REPRE-
 SENTATIVE, INCLUDING A LEGAL GUARDIAN ABLE AND WILLING TO MAKE  INFORMED
 CHOICES, OR A DESIGNATED RELATIVE OR OTHER ADULT WHO IS ABLE AND WILLING
 TO  ASSIST  IN  MAKING INFORMED   CHOICES, AS TO THE TYPE AND QUALITY OF
 SERVICES, INCLUDING BUT NOT LIMITED TO SUCH SERVICES  AS  NURSING  CARE,
 PERSONAL CARE, TRANSPORTATION AND RESPITE SERVICES; AND
   (D)  MEETS  SUCH  OTHER CRITERIA, AS MAY BE ESTABLISHED BY THE COMMIS-
 SIONER, WHICH ARE NECESSARY TO EFFECTIVELY IMPLEMENT THE  OBJECTIVES  OF
 THIS SECTION.
   3. ELIGIBLE INDIVIDUALS. ELIGIBLE INDIVIDUALS WHO ELECT TO PARTICIPATE
 IN  THE  PROGRAM    ASSUME  THE  RESPONSIBILITY  FOR SERVICES UNDER SUCH
 PROGRAM AS MUTUALLY AGREED TO BY THE ELIGIBLE  INDIVIDUAL  AND  PROVIDER
 AND  AS  DOCUMENTED  IN THE ELIGIBLE INDIVIDUAL'S RECORD, INCLUDING, BUT
 NOT LIMITED  TO,  RECRUITING,  HIRING  AND  SUPERVISING  THEIR  PERSONAL
 ASSISTANTS.  FOR THE PURPOSES OF THIS  SECTION, PERSONAL ASSISTANT SHALL
 MEAN  AN  ADULT WHO PROVIDES SERVICES UNDER THIS SECTION TO THE ELIGIBLE
 INDIVIDUAL UNDER THE ELIGIBLE INDIVIDUAL'S INSTRUCTION, SUPERVISION  AND
 DIRECTION  OR  UNDER  THE  INSTRUCTION, SUPERVISION AND DIRECTION OF THE
 ELIGIBLE INDIVIDUAL'S DESIGNATED REPRESENTATIVE, PROVIDED THAT A  PERSON
 LEGALLY  RESPONSIBLE  FOR  AN ELIGIBLE INDIVIDUAL'S CARE AND SUPPORT, AN
 ELIGIBLE INDIVIDUAL'S SPOUSE OR DESIGNATED REPRESENTATIVE MAY NOT BE THE
 PERSONAL ASSISTANT FOR THE  ELIGIBLE  INDIVIDUAL;  HOWEVER,  A  PERSONAL
 ASSISTANT  MAY INCLUDE ANY OTHER ADULT RELATIVE OF THE ELIGIBLE INDIVID-
 UAL, PROVIDED, HOWEVER, THAT THE PROGRAM DETERMINES  THAT  THE  SERVICES
 PROVIDED  BY  SUCH  RELATIVE ARE CONSISTENT WITH AN INDIVIDUAL'S PLAN OF
 CARE AND THAT THE AGGREGATE COST FOR SUCH  SERVICES DOES NOT EXCEED  THE
 AGGREGATE  COSTS  FOR  EQUIVALENT  SERVICES  PROVIDED  BY A NON-RELATIVE
 PERSONAL ASSISTANT. SUCH INDIVIDUALS SHALL BE  ASSISTED  AS  APPROPRIATE
 WITH  SERVICE  COVERAGE, SUPERVISION, ADVOCACY AND MANAGEMENT. PROVIDERS
 SHALL NOT BE LIABLE FOR FULFILLMENT OF  RESPONSIBILITIES  AGREED  TO  BE
 UNDERTAKEN BY THE ELIGIBLE INDIVIDUAL. THIS SUBDIVISION, HOWEVER,  SHALL
 NOT DIMINISH THE PARTICIPATING PROVIDER'S LIABILITY FOR FAILURE TO EXER-
 CISE  REASONABLE  CARE  IN    PROPERLY CARRYING OUT ITS RESPONSIBILITIES
 UNDER THIS PROGRAM, WHICH SHALL  INCLUDE  MONITORING  SUCH  INDIVIDUAL'S
 CONTINUING  ABILITY  TO FULFILL THOSE RESPONSIBILITIES DOCUMENTED IN HIS
 OR HER RECORDS.   FAILURE OF THE INDIVIDUAL TO  CARRY  OUT  HIS  OR  HER
 AGREED  TO  RESPONSIBILITIES MAY BE CONSIDERED IN DETERMINING SUCH INDI-
 VIDUAL'S CONTINUED APPROPRIATENESS FOR THE PROGRAM.

 S. 1507                            34                            A. 2007
 
   4. PARTICIPATING PROVIDERS. ALL AGENCIES OR INDIVIDUALS WHO  MEET  THE
 QUALIFICATIONS TO PROVIDE HOME HEALTH, PERSONAL CARE OR NURSING SERVICES
 AND  WHO  ELECT  TO  PROVIDE SUCH SERVICES TO  PERSONS RECEIVING MEDICAL
 ASSISTANCE MAY PARTICIPATE IN THE PROGRAM.  ANY  AGENCY  OR  INDIVIDUALS
 PROVIDING  SERVICES UNDER A PATIENT MANAGED HOME CARE PROGRAM AUTHORIZED
 UNDER THE FORMER SECTION THIRTY-SIX HUNDRED  TWENTY-TWO  OF  THE  PUBLIC
 HEALTH  LAW  OR  THE  FORMER  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS
 CHAPTER MAY CONTINUE TO PROVIDE SUCH SERVICES UNDER THIS SECTION.
   5. FISCAL INTERMEDIARIES. (A) FOR THE PURPOSES OF THIS SECTION "FISCAL
 INTERMEDIARY" MEANS:
   (I) AN ENTITY THAT HAS A CONTRACT WITH THE  DEPARTMENT  OF  HEALTH  TO
 PROVIDE  FISCAL  INTERMEDIARY SERVICES PURSUANT TO PARAGRAPH (E) OF THIS
 SUBDIVISION; OR
   (II) AN ENTITY AUTHORIZED BY THE COMMISSIONER UPON APPLICATION WITH  A
 HISTORY OF PROVIDING FISCAL INTERMEDIARY SERVICES THAT:
   (A) IS A SERVICE CENTER FOR INDEPENDENT LIVING UNDER SECTION ONE THOU-
 SAND ONE HUNDRED TWENTY-ONE OF THE EDUCATION LAW; OR
   (B)  HAS EXPERIENCE PROVIDING FISCAL INTERMEDIARY SERVICES FOR PERSONS
 WITH DISABILITIES, IN ACCORDANCE WITH SUCH CRITERIA  AS  THE  DEPARTMENT
 MAY  DEVELOP, AS DEMONSTRATED BY HAVING A CONTINUOUS HISTORY OF ARRANGE-
 MENTS WITH LOCAL DEPARTMENTS OF SOCIAL SERVICES BEGINNING NO LATER  THAN
 JANUARY FIRST, TWO THOUSAND TWELVE.
   (B)  AN  APPLICATION  FOR AUTHORIZATION AS A FISCAL INTERMEDIARY UNDER
 SUBPARAGRAPH (II) OF PARAGRAPH (A) OF THIS SUBDIVISION  SHALL  BE  FILED
 WITH THE COMMISSIONER, TOGETHER WITH SUCH OTHER FORMS AND INFORMATION AS
 SHALL BE PRESCRIBED BY, OR ACCEPTABLE TO THE COMMISSIONER.
   (C) FISCAL INTERMEDIARY SERVICES SHALL INCLUDE THE FOLLOWING SERVICES,
 PERFORMED ON BEHALF OF THE CONSUMER TO FACILITATE HIS OR HER ROLE AS THE
 EMPLOYER:
   (I) WAGE AND BENEFIT PROCESSING FOR CONSUMER DIRECTED PERSONAL ASSIST-
 ANTS;
   (II) PROCESSING ALL INCOME TAX AND OTHER REQUIRED WAGE WITHHOLDINGS;
   (III)  COMPLYING  WITH WORKERS' COMPENSATION, DISABILITY AND UNEMPLOY-
 MENT REQUIREMENTS;
   (IV) MAINTAINING PERSONNEL RECORDS FOR EACH CONSUMER DIRECTED PERSONAL
 ASSISTANTS INCLUDING TIME SHEETS  AND  OTHER  DOCUMENTATION  NEEDED  FOR
 WAGES  AND  BENEFIT  PROCESSING  AND A COPY OF THE MEDICAL DOCUMENTATION
 REQUIRED PURSUANT TO REGULATIONS ESTABLISHED BY THE  COMMISSIONER;
   (V) ENSURING THAT THE HEALTH STATUS OF EACH CONSUMER DIRECTED PERSONAL
 ASSISTANT IS ASSESSED PRIOR TO SERVICE DELIVERY PURSUANT TO  REGULATIONS
 ISSUED BY THE COMMISSIONER;
   (VI)  MAINTAINING  RECORDS  OF  SERVICE  AUTHORIZATIONS  OR REAUTHORI-
 ZATIONS;
   (VII) MONITORING THE CONSUMER'S  OR,  IF  APPLICABLE,  THE  DESIGNATED
 REPRESENTATIVE'S  CONTINUING ABILITY TO FULFILL THE CONSUMER'S RESPONSI-
 BILITIES UNDER THE PROGRAM AND PROMPTLY NOTIFYING THE AUTHORIZING ENTITY
 OF ANY CIRCUMSTANCE THAT MAY AFFECT THE CONSUMER'S  OR,  IF  APPLICABLE,
 THE  DESIGNATED  REPRESENTATIVE'S  ABILITY  TO FULFILL SUCH RESPONSIBIL-
 ITIES;
   (VIII) COMPLYING WITH  REGULATIONS  ESTABLISHED  BY  THE  COMMISSIONER
 SPECIFYING  THE  RESPONSIBILITIES  OF  FISCAL  INTERMEDIARIES  PROVIDING
 SERVICES UNDER THIS TITLE; AND
   (IX) ENTERING INTO A DEPARTMENT APPROVED MEMORANDUM  OF  UNDERSTANDING
 WITH  THE  CONSUMER  THAT  DESCRIBES THE PARTIES' RESPONSIBILITIES UNDER
 THIS PROGRAM.

 S. 1507                            35                            A. 2007
 
   (D) FISCAL INTERMEDIARIES ARE NOT RESPONSIBLE FOR, AND FISCAL INTERME-
 DIARY SERVICES SHALL NOT INCLUDE, FULFILLMENT OF THE RESPONSIBILITIES OF
 THE CONSUMER OR, IF APPLICABLE, THE CONSUMER'S DESIGNATED REPRESENTATIVE
 AS ESTABLISHED BY THE COMMISSIONER. A FISCAL INTERMEDIARY'S RESPONSIBIL-
 ITIES  SHALL NOT INCLUDE, AND A FISCAL INTERMEDIARY SHALL NOT ENGAGE IN:
 MANAGING THE PLAN OF CARE INCLUDING RECRUITING AND HIRING  A  SUFFICIENT
 NUMBER  OF  INDIVIDUALS  WHO  MEET  THE  DEFINITION OF CONSUMER DIRECTED
 PERSONAL ASSISTANT, AS SUCH TERM IS  DEFINED  BY  THE  COMMISSIONER,  TO
 PROVIDE  AUTHORIZED SERVICES THAT ARE INCLUDED ON THE CONSUMER'S PLAN OF
 CARE;  TRAINING,  SUPERVISING  AND  SCHEDULING  EACH  CONSUMER  DIRECTED
 PERSONAL  ASSISTANT;  TERMINATING THE CONSUMER DIRECTED PERSONAL ASSIST-
 ANT'S EMPLOYMENT; OR  ASSURING  THAT  EACH  CONSUMER  DIRECTED  PERSONAL
 ASSISTANT  COMPETENTLY  AND  SAFELY PERFORMS THE PERSONAL CARE SERVICES,
 HOME HEALTH AIDE SERVICES  AND SKILLED NURSING TASKS THAT  ARE  INCLUDED
 ON  THE  CONSUMER'S  PLAN  OF CARE. A FISCAL INTERMEDIARY SHALL EXERCISE
 REASONABLE CARE IN PROPERLY CARRYING OUT ITS RESPONSIBILITIES UNDER  THE
 PROGRAM.
   (E) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
 TWELVE  AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
 ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW,
 THE COMMISSIONER IS AUTHORIZED TO ENTER INTO  A  CONTRACT  OR  CONTRACTS
 UNDER  THIS SUBDIVISION WITH AN ENTITY OR ENTITIES WITHOUT A COMPETITIVE
 BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
   (I) THE DEPARTMENT SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO  LESS
 THAN THIRTY DAYS:
   (A)  A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
 THE CONTRACT OR CONTRACTS;
   (B) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
   (C) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY  SEEK
 SELECTION,  WHICH  SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
 TION IS FIRST POSTED ON THE WEBSITE; AND
   (D) THE MANNER  BY  WHICH  A  PROSPECTIVE  CONTRACTOR  MAY  SEEK  SUCH
 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
   (II)  ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
 PROSPECTIVE CONTRACTORS IN A TIMELY FASHION SHALL  BE  REVIEWED  BY  THE
 COMMISSIONER; AND
   (III)  THE  COMMISSIONER  SHALL  SELECT SUCH CONTRACTOR OR CONTRACTORS
 THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF
 THIS SECTION.
   6. ACTIONS INVOLVING THE AUTHORIZATION OF A FISCAL INTERMEDIARY. (A) A
 FISCAL INTERMEDIARY'S AUTHORIZATION UNDER SUBPARAGRAPH (II) OF PARAGRAPH
 (A) OF SUBDIVISION FIVE OF  THIS  SECTION  MAY  BE  REVOKED,  SUSPENDED,
 LIMITED  OR  ANNULLED  UPON  THIRTY  DAYS'  WRITTEN NOTICE TO THE FISCAL
 INTERMEDIARY, IF THE COMMISSIONER FINDS THAT THE FISCAL INTERMEDIARY HAS
 FAILED TO COMPLY WITH THE PROVISIONS OF THIS SUBDIVISION OR  REGULATIONS
 PROMULGATED  HEREUNDER.  NOTWITHSTANDING THE FOREGOING, UPON DETERMINING
 THAT THE PUBLIC HEALTH OR SAFETY WOULD BE IMMINENTLY ENDANGERED  BY  THE
 CONTINUED AUTHORIZATION OF THE FISCAL INTERMEDIARY, THE COMMISSIONER MAY
 REVOKE,  SUSPEND, LIMIT OR ANNUL THE FISCAL INTERMEDIARY'S AUTHORIZATION
 IMMEDIATELY.
   (B) ALL ORDERS OR  DETERMINATIONS  UNDER  THIS  SUBDIVISION  SHALL  BE
 SUBJECT  TO  REVIEW  AS  PROVIDED  IN ARTICLE SEVENTY-EIGHT OF THE CIVIL
 PRACTICE LAW AND RULES.
   7. WAIVERS, REGULATIONS AND EFFECTIVENESS. (A) THE  COMMISSIONER  MAY,
 SUBJECT TO THE APPROVAL OF THE DIRECTOR OF BUDGET, FILE FOR SUCH FEDERAL
 WAIVERS AS MAY BE NEEDED FOR THE IMPLEMENTATION OF THE PROGRAM.

 S. 1507                            36                            A. 2007

   (B)  NOTWITHSTANDING  ANY  OTHER PROVISION OF LAW, THE COMMISSIONER IS
 AUTHORIZED TO WAIVE ANY PROVISION OF SECTION THREE HUNDRED SIXTY-SEVEN-B
 OF THIS TITLE RELATED TO PAYMENT AND MAY PROMULGATE  REGULATIONS  NECES-
 SARY  TO CARRY OUT THE OBJECTIVES OF THE PROGRAM, AND WHICH DESCRIBE THE
 RESPONSIBILITIES OF THE ELIGIBLE INDIVIDUALS IN ARRANGING AND PAYING FOR
 SERVICES AND THE PROTECTIONS ASSURED SUCH INDIVIDUALS IF THEY ARE UNABLE
 OR NO LONGER DESIRE TO CONTINUE IN THE PROGRAM.
   8.  NOTWITHSTANDING  ANY INCONSISTENT PROVISION OF THIS SECTION OR ANY
 OTHER CONTRARY PROVISION  OF  LAW,  MANAGED  CARE  PROGRAMS  ESTABLISHED
 PURSUANT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE AND MANAGED
 LONG  TERM  CARE  PLANS  AND  OTHER CARE COORDINATION MODELS ESTABLISHED
 PURSUANT TO SECTION FOUR THOUSAND FOUR HUNDRED  THREE-F  OF  THE  PUBLIC
 HEALTH LAW SHALL OFFER CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAMS TO
 ENROLLEES.
   9.   NOTWITHSTANDING ANY PROVISION OF THIS SECTION OR ANY OTHER LAW TO
 THE CONTRARY, THE PROVISIONS PERTAINING TO  CONSUMER  DIRECTED  PERSONAL
 ASSISTANCE  SERVICES  AND FISCAL INTERMEDIARIES PURSUANT TO THIS SECTION
 SHALL ONLY BE AVAILABLE IF THE COMMISSIONER OF  HEALTH  DETERMINES  THAT
 THERE  IS ADEQUATE FEDERAL FINANCIAL PARTICIPATION TO FUND SUCH PROGRAMS
 AND/OR ENTITIES.
   10. SUBJECT TO THE AVAILABILITY OF  FEDERAL  FINANCIAL  PARTICIPATION,
 THE  PROVISIONS  OF  THIS   SECTION GOVERNING CONSUMER DIRECTED PERSONAL
 ASSISTANCE SERVICES SHALL ALSO APPLY TO SUCH SERVICES WHEN OFFERED UNDER
 THE HOME AND COMMUNITY-BASED ATTENDANT SERVICES AND SUPPORTS STATE  PLAN
 OPTION, COMMUNITY FIRST CHOICE, PURSUANT TO 42 U.S.C. § 1396N(K).
   §  4.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019;  provided
 however,  that  section  three  of this act shall take effect January 1,
 2020.
 
                                  PART H
 
   Section 1. Subparagraph (v) of paragraph (b)  of  subdivision  5-b  of
 section 2807-k of the public health law is REPEALED.
   §  2. Section 2807 of the public health law is amended by adding a new
 subdivision 20-a to read as follows:
   20-A. NOTWITHSTANDING ANY  PROVISION  OF  LAW  TO  THE  CONTRARY,  THE
 COMMISSIONERS  OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH,
 THE OFFICE OF PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE  OF
 ALCOHOLISM  AND  SUBSTANCE  ABUSE  SERVICES  ARE AUTHORIZED TO WAIVE ANY
 REGULATORY REQUIREMENTS AS ARE  NECESSARY,  CONSISTENT  WITH  APPLICABLE
 LAW,  TO  ALLOW  PROVIDERS THAT ARE INVOLVED IN DSRIP PROJECTS OR REPLI-
 CATION AND SCALING ACTIVITIES, AS APPROVED BY  THE  AUTHORIZING  COMMIS-
 SIONER,  TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE EFFICIENT
 SCALING AND REPLICATION OF DSRIP PROMISING PRACTICES, AS  DETERMINED  BY
 THE   AUTHORIZING   COMMISSIONER;  PROVIDED  HOWEVER,  THAT  REGULATIONS
 PERTAINING TO PATIENT SAFETY MAY NOT BE  WAIVED,  NOR  SHALL  ANY  REGU-
 LATIONS BE WAIVED IF SUCH WAIVER WOULD RISK PATIENT SAFETY.
   §  3.  Subparagraph (i) of paragraph (e-1) of subdivision 4 of section
 2807-c of the public health law, as amended by section 29 of part  C  of
 chapter 60 of the laws of 2014, is amended to read as follows:
   (i)  For  rate periods on and after April first, two thousand ten, the
 commissioner, in consultation with the commissioner  of  the  office  of
 mental health, shall promulgate regulations, and may promulgate emergen-
 cy regulations, establishing methodologies for determining the operating
 cost  components  of  rates  of  payments for services described in this

 S. 1507                            37                            A. 2007

 paragraph. Such regulations shall utilize two  thousand  five  operating
 costs  as  submitted to the department prior to July first, two thousand
 nine and [shall] MAY provide for  methodologies  establishing  per  diem
 inpatient  rates that utilize case mix adjustment mechanisms. Such regu-
 lations [shall] MAY contain criteria for adjustments based on length  of
 stay  and  may  also  provide for a base year update, provided, however,
 that such base year update shall  take  effect  no  earlier  than  April
 first,  two  thousand  fifteen,  and provided further, however, that the
 commissioner may make such adjustments to such utilization  and  to  the
 methodology  for  computing  such  rates  as  is necessary to achieve no
 aggregate, net growth in overall Medicaid expenditures related  to  such
 rates,  as  compared to such aggregate expenditures from the prior year.
 In determining the updated base year to be  utilized  pursuant  to  this
 subparagraph,  the  commissioner  shall  take into account the base year
 determined in accordance with paragraph (c) of  subdivision  thirty-five
 of this section.
   §  4.  Paragraph (b) of subdivision 35 of section 2807-c of the public
 health law is amended by adding a new  subparagraph  (xiv)  to  read  as
 follows:
   (XIV)  SUCH  RATES AND PAYMENT METHODOLOGIES MAY INCORPORATE METHODOL-
 OGIES TO REDUCE PAYMENTS TO  FACILITIES  WITH  A  HIGHER  PERCENTAGE  OF
 POTENTIALLY  AVOIDABLE INPATIENT SERVICES BY INSTITUTING LOWER INPATIENT
 PAYMENT RATES FOR BOTH FEE-FOR-SERVICE AND MANAGED CARE  TO  INCENTIVIZE
 THE  PROVISION  OF  PREVENTATIVE  CARE  TO REDUCE PREVENTABLE EVENTS AND
 OVERALL INPATIENT COSTS. A PORTION OF  SUCH  SAVINGS  DERIVED  FROM  THE
 IMPLEMENTATION  OF  SUCH  PAYMENT  METHODOLOGIES  SHALL BE REINVESTED IN
 INITIATIVES TO INCENTIVIZE THE PROVISION OF PREVENTATIVE CARE, MATERNITY
 SERVICES, AND OTHER  AMBULATORY  CARE  SERVICES  TO  REDUCE  PREVENTABLE
 HEALTH CARE COSTS.
   § 5. This act shall take effect immediately.
 
                                  PART I
 
   Section  1. The insurance law is amended by adding a new article 29 to
 read as follows:
                                ARTICLE 29
                         PHARMACY BENEFIT MANAGERS
 SECTION 2901. DEFINITIONS.
         2902. ACTING WITHOUT A REGISTRATION.
         2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2905. ACTING WITHOUT A LICENSE.
         2906. LICENSING OF A PHARMACY BENEFIT MANAGER.
         2907. REVOCATION OR SUSPENSION OF A REGISTRATION OR LICENSE OF A
                 PHARMACY BENEFIT MANAGER.
         2908. PENALTIES FOR VIOLATIONS.
         2909. STAY OR SUSPENSION OF SUPERINTENDENT'S DETERMINATION.
         2910. REVOKED REGISTRATION OR LICENSES.
         2911. CHANGE OF ADDRESS.
         2912. APPLICABILITY OF OTHER LAWS.
         2913. ASSESSMENTS.
   § 2901. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE:
   (A) "CONTROLLING PERSON" IS ANY PERSON OR OTHER ENTITY  WHO  OR  WHICH
 DIRECTLY  OR  INDIRECTLY HAS THE POWER TO DIRECT OR CAUSE TO BE DIRECTED
 THE MANAGEMENT, CONTROL OR ACTIVITIES OF A PHARMACY BENEFIT MANAGER.

 S. 1507                            38                            A. 2007
 
   (B) "HEALTH INSURER" MEANS AN INSURANCE  COMPANY  AUTHORIZED  IN  THIS
 STATE TO WRITE ACCIDENT AND HEALTH INSURANCE, A COMPANY ORGANIZED PURSU-
 ANT  TO  ARTICLE  FORTY-THREE  OF  THIS CHAPTER, A MUNICIPAL COOPERATIVE
 HEALTH BENEFIT PLAN ESTABLISHED PURSUANT TO ARTICLE FORTY-SEVEN OF  THIS
 CHAPTER, AN ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
 PUBLIC HEALTH LAW, AN INSTITUTION OF HIGHER EDUCATION CERTIFIED PURSUANT
 TO  SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, OR THE
 NEW YORK STATE HEALTH INSURANCE PLAN ESTABLISHED UNDER ARTICLE ELEVEN OF
 THE CIVIL SERVICE LAW.
   (C) "PHARMACY BENEFIT MANAGEMENT SERVICES" MEANS DIRECTLY  OR  THROUGH
 AN  INTERMEDIARY,  MANAGING THE PRESCRIPTION DRUG COVERAGE PROVIDED BY A
 HEALTH INSURER UNDER A CONTRACT OR POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY  IN  THIS  STATE  OR  A  PLAN  SUBJECT  TO  SECTION  THREE   HUNDRED
 SIXTY-FOUR-J  OF  THE  SOCIAL SERVICES LAW, INCLUDING THE PROCESSING AND
 PAYMENT OF CLAIMS FOR PRESCRIPTION DRUGS, THE PERFORMANCE OF DRUG UTILI-
 ZATION REVIEW, THE PROCESSING OF DRUG PRIOR AUTHORIZATION REQUESTS,  THE
 ADJUDICATION  OF  APPEALS  OR  GRIEVANCES  RELATED  TO PRESCRIPTION DRUG
 COVERAGE, CONTRACTING WITH NETWORK PHARMACIES, AND CONTROLLING THE  COST
 OF COVERED PRESCRIPTION DRUGS.
   (D)  "PHARMACY  BENEFIT  MANAGER"  MEANS  A PERSON, FIRM, ASSOCIATION,
 CORPORATION OR OTHER ENTITY THAT, PURSUANT TO A CONTRACT WITH  A  HEALTH
 INSURER  PROVIDES PHARMACY BENEFIT MANAGEMENT SERVICES, EXCEPT THAT TERM
 SHALL NOT INCLUDE:
   (1) AN OFFICER OR EMPLOYEE OF A REGISTERED OR LICENSED PHARMACY  BENE-
 FIT MANAGER; OR
   (2) A HEALTH INSURER, OR ANY MANAGER THEREOF, INDIVIDUAL OR CORPORATE,
 OR ANY OFFICER, DIRECTOR OR REGULAR SALARIED EMPLOYEE THEREOF, PROVIDING
 PHARMACY  BENEFIT  MANAGEMENT SERVICES UNDER A POLICY OR CONTRACT ISSUED
 BY THE HEALTH INSURER.
   § 2902. ACTING WITHOUT A REGISTRATION. (A) NO  PERSON,  FIRM,  ASSOCI-
 ATION, CORPORATION OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFITS MANAG-
 ER  PRIOR  TO  JANUARY FIRST, TWO THOUSAND TWENTY WITHOUT HAVING A VALID
 REGISTRATION AS A PHARMACY BENEFIT MANAGER FILED WITH THE SUPERINTENDENT
 IN ACCORDANCE WITH THIS ARTICLE AND ANY REGULATIONS  PROMULGATED  THERE-
 UNDER.
   (B) PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY, NO HEALTH INSURER MAY
 PAY  ANY  FEE  OR  OTHER  COMPENSATION TO ANY PERSON, FIRM, ASSOCIATION,
 CORPORATION OR OTHER ENTITY FOR PERFORMING PHARMACY  BENEFIT  MANAGEMENT
 SERVICES  UNLESS  THE  PERSON,  FIRM,  ASSOCIATION, CORPORATION OR OTHER
 ENTITY IS REGISTERED AS A PHARMACY BENEFIT MANAGER  IN  ACCORDANCE  WITH
 THIS ARTICLE.
   (C)  ANY  PERSON,  FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY THAT
 VIOLATES THIS SECTION SHALL, IN ADDITION TO ANY OTHER  PENALTY  PROVIDED
 BY  LAW,  BE  LIABLE FOR RESTITUTION TO ANY INSURER OR INSURED HARMED BY
 THE VIOLATION AND SHALL ALSO BE SUBJECT TO A PENALTY OF THE  GREATER  OF
 (1)  ONE  THOUSAND DOLLARS FOR THE FIRST VIOLATION AND TWO THOUSAND FIVE
 HUNDRED DOLLARS FOR EACH  SUBSEQUENT  VIOLATION  OR  (2)  THE  AGGREGATE
 ECONOMIC GROSS RECEIPTS ATTRIBUTABLE TO ALL VIOLATIONS.
   §  2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.  (A)
 EVERY PHARMACY BENEFIT MANAGER THAT PERFORMS PHARMACY BENEFIT MANAGEMENT
 SERVICES PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY-ONE SHALL  REGISTER
 WITH  THE  SUPERINTENDENT  IN A MANNER ACCEPTABLE TO THE SUPERINTENDENT,
 AND SHALL PAY A FEE OF ONE THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF
 A YEAR IN WHICH THE REGISTRATION SHALL BE VALID. THE SUPERINTENDENT,  IN
 CONSULTATION  WITH  THE  COMMISSIONER OF HEALTH, MAY ESTABLISH, BY REGU-
 LATION, MINIMUM REGISTRATION STANDARDS REQUIRED FOR A  PHARMACY  BENEFIT

 S. 1507                            39                            A. 2007
 
 MANAGER.  THE SUPERINTENDENT CAN REJECT A REGISTRATION APPLICATION FILED
 BY A PHARMACY BENEFIT MANAGER THAT FAILS  TO  COMPLY  WITH  THE  MINIMUM
 REGISTRATION STANDARDS.
   (B)  FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR OR
 DIRECTORS NAMED IN THE APPLICATION SHALL BE DESIGNATED  RESPONSIBLE  FOR
 THE  BUSINESS ENTITY'S COMPLIANCE WITH THE FINANCIAL SERVICES AND INSUR-
 ANCE LAWS, RULES AND REGULATIONS OF THIS STATE.
   (C) EVERY REGISTRATION WILL EXPIRE ON DECEMBER THIRTY-FIRST, TWO THOU-
 SAND TWENTY REGARDLESS OF WHEN REGISTRATION WAS FIRST MADE.
   (D) EVERY PHARMACY BENEFIT  MANAGER  THAT  PERFORMS  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  AT  ANY  TIME  BETWEEN JANUARY FIRST, TWO THOUSAND
 NINETEEN AND JUNE FIRST, TWO THOUSAND NINETEEN, SHALL MAKE THE REGISTRA-
 TION AND FEE PAYMENT REQUIRED BY SUBSECTION (A) OF THIS  SECTION  ON  OR
 BEFORE  JUNE  FIRST,  TWO  THOUSAND NINETEEN. ANY OTHER PHARMACY BENEFIT
 MANAGER  SHALL  MAKE  THE  REGISTRATION  AND  FEE  PAYMENT  REQUIRED  BY
 SUBSECTION  (A)  OF  THIS  SECTION  PRIOR TO PERFORMING PHARMACY BENEFIT
 MANAGEMENT SERVICES.
   (E) REGISTRANTS UNDER THIS SECTION SHALL BE SUBJECT TO EXAMINATION  BY
 THE SUPERINTENDENT AS OFTEN AS THE SUPERINTENDENT MAY DEEM IT NECESSARY.
 THE  SUPERINTENDENT  MAY PROMULGATE REGULATIONS ESTABLISHING METHODS AND
 PROCEDURES FOR FACILITATING AND VERIFYING COMPLIANCE WITH  THE  REQUIRE-
 MENTS OF THIS ARTICLE AND SUCH OTHER REGULATIONS AS NECESSARY TO ENFORCE
 THE PROVISIONS OF THIS ARTICLE.
   §  2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.  (A)(1)
 ON OR BEFORE JULY FIRST OF EACH YEAR, BEGINNING IN TWO THOUSAND  TWENTY,
 EVERY  PHARMACY BENEFIT MANAGER SHALL REPORT TO THE SUPERINTENDENT, IN A
 STATEMENT SUBSCRIBED AND AFFIRMED AS TRUE UNDER  PENALTIES  OF  PERJURY,
 THE INFORMATION REQUESTED BY THE SUPERINTENDENT INCLUDING, WITHOUT LIMI-
 TATION,  DISCLOSURE  OF ANY FINANCIAL INCENTIVE OR BENEFIT FOR PROMOTING
 THE USE OF CERTAIN DRUGS  AND  OTHER  FINANCIAL  ARRANGEMENTS  AFFECTING
 HEALTH  INSURERS  OR THEIR POLICYHOLDERS OR INSUREDS AND ANY INFORMATION
 RELATING TO THE BUSINESS, FINANCIAL CONDITION, OR MARKET CONDUCT OF  THE
 PHARMACY BENEFIT MANAGER. THE SUPERINTENDENT ALSO MAY REQUIRE THE FILING
 OF  QUARTERLY OR OTHER STATEMENTS, WHICH SHALL BE IN SUCH FORM AND SHALL
 CONTAIN SUCH MATTERS AS THE SUPERINTENDENT SHALL PRESCRIBE.
   (2) THE SUPERINTENDENT ALSO MAY ADDRESS TO ANY PHARMACY BENEFIT MANAG-
 ER OR ITS OFFICERS ANY INQUIRY IN RELATION TO ITS PROVISION OF  PHARMACY
 BENEFIT  MANAGEMENT  SERVICES  OR ANY MATTER CONNECTED THEREWITH.  EVERY
 PHARMACY BENEFIT MANAGER OR PERSON SO ADDRESSED SHALL REPLY  IN  WRITING
 TO  SUCH  INQUIRY  PROMPTLY  AND TRUTHFULLY, AND SUCH REPLY SHALL BE, IF
 REQUIRED BY THE SUPERINTENDENT, SUBSCRIBED BY  SUCH  INDIVIDUAL,  OR  BY
 SUCH  OFFICER OR OFFICERS OF THE PHARMACY BENEFIT MANAGER, AS THE SUPER-
 INTENDENT SHALL DESIGNATE, AND AFFIRMED BY THEM AS TRUE UNDER THE PENAL-
 TIES OF PERJURY.
   (B) IN THE EVENT ANY PHARMACY  BENEFIT  MANAGER  OR  PERSON  DOES  NOT
 SUBMIT  THE  REPORT  REQUIRED BY PARAGRAPH ONE OF SUBSECTION (A) OF THIS
 SECTION OR DOES NOT PROVIDE A GOOD FAITH RESPONSE TO AN INQUIRY FROM THE
 SUPERINTENDENT PURSUANT TO PARAGRAPH  TWO  OF  SUBSECTION  (A)  OF  THIS
 SECTION WITHIN A TIME PERIOD SPECIFIED BY THE SUPERINTENDENT OF NOT LESS
 THAN  FIFTEEN  BUSINESS DAYS, THE SUPERINTENDENT IS AUTHORIZED TO LEVY A
 CIVIL PENALTY, AFTER NOTICE AND HEARING, AGAINST SUCH  PHARMACY  BENEFIT
 MANAGER  OR  PERSON  NOT TO EXCEED FIVE HUNDRED DOLLARS PER DAY FOR EACH
 DAY BEYOND THE DATE THE REPORT IS DUE  OR  THE  DATE  SPECIFIED  BY  THE
 SUPERINTENDENT FOR RESPONSE TO THE INQUIRY.
   (C)  ALL  INFORMATION DISCLOSED BY A PHARMACY BENEFIT MANAGER SHALL BE
 DEEMED CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE UNLESS THE SUPERINTEN-

 S. 1507                            40                            A. 2007
 
 DENT DETERMINES THAT SUCH DISCLOSURE IS IN THE PUBLIC  INTEREST,  OR  IS
 NECESSARY  TO  CARRY  OUT  THIS  ARTICLE  OR  TO ALLOW THE DEPARTMENT TO
 PERFORM EXAMINATIONS OR INVESTIGATIONS AUTHORIZED BY LAW.
   §  2905.  ACTING  WITHOUT A LICENSE. (A) NO PERSON, FIRM, ASSOCIATION,
 CORPORATION OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFIT MANAGER ON  OR
 AFTER JANUARY FIRST, TWO THOUSAND TWENTY-ONE WITHOUT HAVING AUTHORITY TO
 DO  SO BY VIRTUE OF A LICENSE ISSUED IN FORCE PURSUANT TO THE PROVISIONS
 OF THIS ARTICLE.
   (B) NO HEALTH INSURER MAY PAY ANY FEE OR  OTHER  COMPENSATION  TO  ANY
 PERSON,  FIRM,  ASSOCIATION,  CORPORATION OR OTHER ENTITY FOR PERFORMING
 PHARMACY BENEFIT MANAGEMENT SERVICES ON  OR  AFTER  JANUARY  FIRST,  TWO
 THOUSAND TWENTY-ONE UNLESS THE PERSON, FIRM, ASSOCIATION, CORPORATION OR
 OTHER  ENTITY  IS  LICENSED  AS A PHARMACY BENEFIT MANAGER IN ACCORDANCE
 WITH THIS ARTICLE.
   (C) ANY PERSON, FIRM, ASSOCIATION, CORPORATION OR  OTHER  ENTITY  THAT
 VIOLATES  THIS  SECTION SHALL, IN ADDITION TO ANY OTHER PENALTY PROVIDED
 BY LAW, BE SUBJECT TO A PENALTY OF  THE  GREATER  OF  (1)  ONE  THOUSAND
 DOLLARS  FOR  THE  FIRST VIOLATION AND TWO THOUSAND FIVE HUNDRED DOLLARS
 FOR EACH SUBSEQUENT  VIOLATION  OR  (2)  THE  AGGREGATE  GROSS  RECEIPTS
 ATTRIBUTABLE TO ALL VIOLATIONS.
   §  2906.  LICENSING OF A PHARMACY BENEFIT MANAGER. (A) THE SUPERINTEN-
 DENT MAY ISSUE A PHARMACY BENEFIT MANAGER'S LICENSE TO ANY PERSON, FIRM,
 ASSOCIATION OR CORPORATION WHO OR THAT HAS COMPLIED  WITH  THE  REQUIRE-
 MENTS  OF  THIS ARTICLE, INCLUDING REGULATIONS PROMULGATED BY THE SUPER-
 INTENDENT. THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONER  OF
 HEALTH, MAY ESTABLISH, BY REGULATION, MINIMUM STANDARDS FOR THE ISSUANCE
 OF A LICENSE TO A PHARMACY BENEFIT MANAGER.
   (B)  THE  MINIMUM  STANDARDS  ESTABLISHED  UNDER  THIS  SUBSECTION MAY
 ADDRESS, WITHOUT LIMITATION:
   (1) CONFLICTS OF INTEREST BETWEEN PHARMACY BENEFIT MANAGERS AND HEALTH
 INSURERS;
   (2) DECEPTIVE PRACTICES IN CONNECTION WITH THE PERFORMANCE OF PHARMACY
 BENEFIT MANAGEMENT SERVICES;
   (3) ANTI-COMPETITIVE PRACTICES IN CONNECTION WITH THE  PERFORMANCE  OF
 PHARMACY BENEFIT MANAGEMENT SERVICES;
   (4)  UNFAIR  CLAIMS  PRACTICES  IN  CONNECTION WITH THE PERFORMANCE OF
 PHARMACY BENEFIT MANAGEMENT SERVICES; AND
   (5) PROTECTION OF CONSUMERS.
   (C)(1) ANY SUCH LICENSE ISSUED TO A FIRM OR ASSOCIATION SHALL  AUTHOR-
 IZE  ALL  OF  THE  MEMBERS OF THE FIRM OR ASSOCIATION AND ANY DESIGNATED
 EMPLOYEES TO ACT AS PHARMACY BENEFIT MANAGERS UNDER THE LICENSE, AND ALL
 SUCH PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (2) ANY SUCH LICENSE ISSUED TO A CORPORATION SHALL  AUTHORIZE  ALL  OF
 THE  OFFICERS  AND ANY DESIGNATED EMPLOYEES AND DIRECTORS THEREOF TO ACT
 AS PHARMACY BENEFIT MANAGERS ON BEHALF OF SUCH CORPORATION, AND ALL SUCH
 PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (3) FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR  OR
 DIRECTORS  NAMED  IN THE APPLICATION SHALL BE DESIGNATED RESPONSIBLE FOR
 THE BUSINESS ENTITY'S COMPLIANCE WITH  THE  INSURANCE  LAWS,  RULES  AND
 REGULATIONS OF THIS STATE.
   (D)(1)  BEFORE A PHARMACY BENEFIT MANAGER'S LICENSE SHALL BE ISSUED OR
 RENEWED, THE PROSPECTIVE LICENSEE SHALL PROPERLY FILE IN THE  OFFICE  OF
 THE  SUPERINTENDENT A WRITTEN APPLICATION THEREFOR IN SUCH FORM OR FORMS
 AND SUPPLEMENTS THERETO AS THE SUPERINTENDENT PRESCRIBES, AND PAY A  FEE
 OF  ONE  THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF A YEAR IN WHICH A
 LICENSE SHALL BE VALID.

 S. 1507                            41                            A. 2007
 
   (2) EVERY PHARMACY BENEFIT MANAGER'S  LICENSE  ISSUED  TO  A  BUSINESS
 ENTITY  PURSUANT  TO  THIS  SECTION SHALL EXPIRE ON THE THIRTIETH DAY OF
 NOVEMBER OF EVEN-NUMBERED YEARS. EVERY LICENSE ISSUED PURSUANT  TO  THIS
 SECTION  TO  AN  INDIVIDUAL  PHARMACY BENEFIT MANAGER WHO WAS BORN IN AN
 ODD-NUMBERED  YEAR,  SHALL  EXPIRE  ON THE INDIVIDUAL'S BIRTHDAY IN EACH
 ODD-NUMBERED YEAR. EVERY LICENSE ISSUED PURSUANT TO THIS SECTION  TO  AN
 INDIVIDUAL  PHARMACY  BENEFIT  MANAGER  WHO WAS BORN IN AN EVEN-NUMBERED
 YEAR, SHALL EXPIRE ON THE INDIVIDUAL'S BIRTHDAY  IN  EACH  EVEN-NUMBERED
 YEAR.   EVERY LICENSE ISSUED PURSUANT TO THIS SECTION MAY BE RENEWED FOR
 THE ENSUING PERIOD OF TWENTY-FOUR MONTHS UPON THE FILING OF AN  APPLICA-
 TION IN CONFORMITY WITH THIS SUBSECTION.
   (E)(1)  IF  AN APPLICATION FOR A RENEWAL LICENSE SHALL HAVE BEEN FILED
 WITH THE SUPERINTENDENT BEFORE OCTOBER FIRST OF THE YEAR OF  EXPIRATION,
 THEN  THE  LICENSE SOUGHT TO BE RENEWED SHALL CONTINUE IN FULL FORCE AND
 EFFECT EITHER UNTIL THE ISSUANCE BY THE SUPERINTENDENT  OF  THE  RENEWAL
 LICENSE  APPLIED  FOR  OR UNTIL FIVE DAYS AFTER THE SUPERINTENDENT SHALL
 HAVE REFUSED TO ISSUE SUCH RENEWAL LICENSE  AND  GIVEN  NOTICE  OF  SUCH
 REFUSAL TO THE APPLICANT.
   (2)  BEFORE REFUSING TO RENEW ANY LICENSE PURSUANT TO THIS SECTION FOR
 WHICH A RENEWAL APPLICATION HAS BEEN FILED PURSUANT TO PARAGRAPH ONE  OF
 THIS  SUBSECTION,  THE  SUPERINTENDENT SHALL NOTIFY THE APPLICANT OF THE
 SUPERINTENDENT'S INTENTION TO DO SO AND  SHALL  GIVE  SUCH  APPLICANT  A
 HEARING.
   (F)  THE  SUPERINTENDENT MAY REFUSE TO ISSUE A PHARMACY BENEFIT MANAG-
 ER'S LICENSE IF, IN THE SUPERINTENDENT'S JUDGMENT, THE APPLICANT OR  ANY
 MEMBER,  PRINCIPAL,  OFFICER OR DIRECTOR OF THE APPLICANT, IS NOT TRUST-
 WORTHY AND COMPETENT TO ACT AS OR IN CONNECTION WITH A PHARMACY  BENEFIT
 MANAGER,  OR THAT ANY OF THE FOREGOING HAS GIVEN CAUSE FOR REVOCATION OR
 SUSPENSION OF SUCH LICENSE, OR HAS FAILED TO COMPLY WITH  ANY  PREREQUI-
 SITE FOR THE ISSUANCE OF SUCH LICENSE.
   (G) LICENSEES AND APPLICANTS FOR A LICENSE UNDER THIS SECTION SHALL BE
 SUBJECT TO EXAMINATION BY THE SUPERINTENDENT AS OFTEN AS THE SUPERINTEN-
 DENT  MAY  DEEM  IT  EXPEDIENT.  THE SUPERINTENDENT MAY PROMULGATE REGU-
 LATIONS ESTABLISHING METHODS AND PROCEDURES FOR FACILITATING AND VERIFY-
 ING COMPLIANCE WITH THE REQUIREMENTS OF  THIS  SECTION  AND  SUCH  OTHER
 REGULATIONS AS NECESSARY.
   (H)  THE  SUPERINTENDENT  MAY  ISSUE  A  REPLACEMENT  FOR  A CURRENTLY
 IN-FORCE LICENSE THAT HAS BEEN LOST OR DESTROYED. BEFORE THE REPLACEMENT
 LICENSE SHALL BE ISSUED, THERE SHALL BE ON FILE IN  THE  OFFICE  OF  THE
 SUPERINTENDENT  A  WRITTEN  APPLICATION  FOR  THE  REPLACEMENT  LICENSE,
 AFFIRMING UNDER PENALTY OF PERJURY THAT THE ORIGINAL  LICENSE  HAS  BEEN
 LOST OR DESTROYED, TOGETHER WITH A FEE OF ONE HUNDRED DOLLARS.
   §  2907.  REVOCATION  OR  SUSPENSION OF A REGISTRATION OR LICENSE OF A
 PHARMACY BENEFIT MANAGER. (A) THE SUPERINTENDENT MAY  REFUSE  TO  RENEW,
 MAY  REVOKE,  OR  MAY SUSPEND FOR A PERIOD THE SUPERINTENDENT DETERMINES
 THE REGISTRATION OR LICENSE OF ANY PHARMACY BENEFIT  MANAGER  IF,  AFTER
 NOTICE AND HEARING, THE SUPERINTENDENT DETERMINES THAT THE REGISTRANT OR
 LICENSEE  OR  ANY  MEMBER,  PRINCIPAL, OFFICER, DIRECTOR, OR CONTROLLING
 PERSON OF THE REGISTRANT OR LICENSEE, HAS:
   (1) VIOLATED ANY INSURANCE LAWS, OR VIOLATED ANY REGULATION,  SUBPOENA
 OR  ORDER  OF THE SUPERINTENDENT OR OF ANOTHER STATE'S INSURANCE COMMIS-
 SIONER, OR HAS VIOLATED ANY LAW IN THE COURSE OF HIS OR HER DEALINGS  IN
 SUCH CAPACITY;
   (2)  PROVIDED  MATERIALLY INCORRECT, MATERIALLY MISLEADING, MATERIALLY
 INCOMPLETE OR MATERIALLY  UNTRUE  INFORMATION  IN  THE  REGISTRATION  OR
 LICENSE APPLICATION;

 S. 1507                            42                            A. 2007
 
   (3)  OBTAINED OR ATTEMPTED TO OBTAIN A REGISTRATION OR LICENSE THROUGH
 MISREPRESENTATION OR FRAUD;
   (4)(A) USED FRAUDULENT, COERCIVE OR DISHONEST PRACTICES;
   (B) DEMONSTRATED INCOMPETENCE;
   (C) DEMONSTRATED UNTRUSTWORTHINESS; OR
   (D) DEMONSTRATED FINANCIAL IRRESPONSIBILITY IN THE CONDUCT OF BUSINESS
 IN THIS STATE OR ELSEWHERE;
   (5)  IMPROPERLY  WITHHELD,  MISAPPROPRIATED OR CONVERTED ANY MONIES OR
 PROPERTIES RECEIVED IN THE COURSE OF BUSINESS IN  THIS  STATE  OR  ELSE-
 WHERE;
   (6)  INTENTIONALLY  MISREPRESENTED  THE TERMS OF AN ACTUAL OR PROPOSED
 INSURANCE CONTRACT;
   (7) BEEN CONVICTED OF A FELONY;
   (8) ADMITTED OR BEEN FOUND TO  HAVE  COMMITTED  ANY  INSURANCE  UNFAIR
 TRADE PRACTICE OR FRAUD;
   (9)  HAD  A  PHARMACY  BENEFIT MANAGER REGISTRATION OR LICENSE, OR ITS
 EQUIVALENT, DENIED, SUSPENDED OR REVOKED IN ANY OTHER  STATE,  PROVINCE,
 DISTRICT OR TERRITORY;
   (10)  FAILED TO PAY STATE INCOME TAX OR COMPLY WITH ANY ADMINISTRATIVE
 OR COURT ORDER DIRECTING PAYMENT OF STATE INCOME TAX; OR
   (11) CEASED TO MEET THE REQUIREMENTS  FOR  REGISTRATION  OR  LICENSURE
 UNDER THIS ARTICLE.
   (B)  BEFORE  REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE OF ANY
 PHARMACY BENEFIT MANAGER PURSUANT TO THE PROVISIONS OF THIS ARTICLE, THE
 SUPERINTENDENT SHALL GIVE NOTICE TO THE REGISTRANT OR  LICENSEE  AND  TO
 EVERY  SUB-LICENSEE  AND  SHALL HOLD, OR CAUSE TO BE HELD, A HEARING NOT
 LESS THAN TEN DAYS AFTER THE GIVING OF SUCH NOTICE.
   (C) IF A REGISTRATION OR LICENSE PURSUANT TO THE  PROVISIONS  OF  THIS
 ARTICLE  IS  REVOKED OR SUSPENDED BY THE SUPERINTENDENT, THEN THE SUPER-
 INTENDENT SHALL FORTHWITH GIVE NOTICE TO THE REGISTRANT OR LICENSEE.
   (D) THE REVOCATION OR SUSPENSION OF ANY REGISTRATION OR LICENSE PURSU-
 ANT TO THE PROVISIONS OF THIS ARTICLE  SHALL  TERMINATE  FORTHWITH  SUCH
 REGISTRATION  OR  LICENSE  AND  THE AUTHORITY CONFERRED THEREBY UPON ALL
 SUB-LICENSEES. FOR GOOD CAUSE SHOWN, THE SUPERINTENDENT  MAY  DELAY  THE
 EFFECTIVE DATE OF A REVOCATION OR SUSPENSION TO PERMIT THE REGISTRANT OR
 LICENSEE  TO  SATISFY  SOME  OR  ALL  OF  ITS CONTRACTUAL OBLIGATIONS TO
 PERFORM PHARMACY BENEFIT MANAGEMENT SERVICES IN THE STATE.
   (E)(1) NO INDIVIDUAL, CORPORATION, FIRM OR ASSOCIATION WHOSE REGISTRA-
 TION OR LICENSE AS A PHARMACY BENEFIT MANAGER HAS BEEN REVOKED  PURSUANT
 TO  SUBSECTION  (A) OF THIS SECTION, AND NO FIRM OR ASSOCIATION OF WHICH
 SUCH INDIVIDUAL IS A MEMBER, AND NO CORPORATION OF WHICH SUCH INDIVIDUAL
 IS AN OFFICER OR DIRECTOR, AND NO CONTROLLING PERSON OF  THE  REGISTRANT
 OR  LICENSEE  SHALL  BE  ENTITLED  TO OBTAIN ANY REGISTRATION OR LICENSE
 UNDER THE PROVISIONS OF THIS ARTICLE FOR A PERIOD OF ONE YEAR AFTER SUCH
 REVOCATION, OR, IF SUCH REVOCATION BE JUDICIALLY REVIEWED, FOR ONE  YEAR
 AFTER THE FINAL DETERMINATION THEREOF AFFIRMING THE ACTION OF THE SUPER-
 INTENDENT IN REVOKING SUCH LICENSE.
   (2) IF ANY SUCH REGISTRATION OR LICENSE HELD BY A FIRM, ASSOCIATION OR
 CORPORATION  BE  REVOKED,  NO  MEMBER OF SUCH FIRM OR ASSOCIATION AND NO
 OFFICER OR DIRECTOR OF SUCH CORPORATION OR ANY CONTROLLING PERSON OF THE
 REGISTRANT OR LICENSEE SHALL BE ENTITLED TO OBTAIN ANY  REGISTRATION  OR
 LICENSE,  OR  TO  BE  NAMED AS A SUB-LICENSEE IN ANY SUCH LICENSE, UNDER
 THIS ARTICLE FOR THE SAME PERIOD  OF  TIME,  UNLESS  THE  SUPERINTENDENT
 DETERMINES,  AFTER  NOTICE  AND  HEARING,  THAT  SUCH MEMBER, OFFICER OR
 DIRECTOR WAS NOT PERSONALLY AT FAULT IN THE MATTER ON ACCOUNT  OF  WHICH
 SUCH REGISTRATION OR LICENSE WAS REVOKED.

 S. 1507                            43                            A. 2007
 
   (F)  IF  ANY  REGISTERED  OR  LICENSED PHARMACY BENEFIT MANAGER OR ANY
 PERSON AGGRIEVED SHALL FILE WITH THE SUPERINTENDENT A VERIFIED COMPLAINT
 SETTING FORTH FACTS TENDING TO SHOW SUFFICIENT GROUND FOR THE REVOCATION
 OR SUSPENSION OF ANY PHARMACY BENEFIT MANAGER'S REGISTRATION OR LICENSE,
 THEN  THE  SUPERINTENDENT  SHALL,  AFTER NOTICE AND A HEARING, DETERMINE
 WHETHER SUCH REGISTRATION OR LICENSE SHALL BE SUSPENDED OR REVOKED.
   (G) THE SUPERINTENDENT SHALL  RETAIN  THE  AUTHORITY  TO  ENFORCE  THE
 PROVISIONS  OF AND IMPOSE ANY PENALTY OR REMEDY AUTHORIZED BY THIS CHAP-
 TER AGAINST ANY PERSON OR ENTITY  WHO  IS  UNDER  INVESTIGATION  FOR  OR
 CHARGED  WITH A VIOLATION OF THIS CHAPTER, EVEN IF THE PERSON'S OR ENTI-
 TY'S REGISTRATION OR LICENSE HAS BEEN SURRENDERED, OR HAS EXPIRED OR HAS
 LAPSED BY OPERATION OF LAW.
   (H) A REGISTRANT OR LICENSEE SUBJECT TO THIS ARTICLE SHALL  REPORT  TO
 THE  SUPERINTENDENT  ANY  ADMINISTRATIVE ACTION TAKEN AGAINST THE REGIS-
 TRANT OR LICENSEE IN ANOTHER JURISDICTION  OR  BY  ANOTHER  GOVERNMENTAL
 AGENCY  IN THIS STATE WITHIN THIRTY DAYS OF THE FINAL DISPOSITION OF THE
 MATTER.  THIS REPORT SHALL INCLUDE A COPY OF THE ORDER, CONSENT TO ORDER
 OR OTHER RELEVANT LEGAL DOCUMENTS.
   (I) WITHIN THIRTY DAYS OF THE INITIAL PRETRIAL HEARING DATE, A  REGIS-
 TRANT  OR  LICENSEE  SUBJECT  TO THIS ARTICLE SHALL REPORT TO THE SUPER-
 INTENDENT ANY CRIMINAL PROSECUTION OF THE REGISTRANT OR  LICENSEE  TAKEN
 IN  ANY  JURISDICTION.  THE  REPORT  SHALL INCLUDE A COPY OF THE INITIAL
 COMPLAINT FILED, THE ORDER RESULTING FROM  THE  HEARING  AND  ANY  OTHER
 RELEVANT LEGAL DOCUMENTS.
   §  2908.  PENALTIES FOR VIOLATIONS. (A) THE SUPERINTENDENT, IN LIEU OF
 REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE OF  A  REGISTRANT  OR
 LICENSEE  IN  ACCORDANCE WITH THE PROVISIONS OF THIS ARTICLE, MAY IN ANY
 ONE PROCEEDING BY ORDER, REQUIRE THE REGISTRANT OR LICENSEE  TO  PAY  TO
 THE PEOPLE OF THIS STATE A PENALTY IN A SUM NOT EXCEEDING THE GREATER OF
 (1)  ONE THOUSAND DOLLARS FOR EACH OFFENSE AND TWO THOUSAND FIVE HUNDRED
 DOLLARS FOR  EACH  SUBSEQUENT  VIOLATION  OR  (2)  THE  AGGREGATE  GROSS
 RECEIPTS ATTRIBUTABLE TO ALL OFFENSES.
   (B)  UPON  THE  FAILURE  OF  SUCH  A REGISTRANT OR LICENSEE TO PAY THE
 PENALTY ORDERED PURSUANT TO SUBSECTION (A) OF THIS SECTION WITHIN TWENTY
 DAYS AFTER THE MAILING OF THE ORDER, POSTAGE  PREPAID,  REGISTERED,  AND
 ADDRESSED  TO  THE  LAST KNOWN PLACE OF BUSINESS OF THE LICENSEE, UNLESS
 THE ORDER IS STAYED BY AN ORDER OF A COURT  OF  COMPETENT  JURISDICTION,
 THE  SUPERINTENDENT MAY REVOKE THE REGISTRATION OR LICENSE OF THE REGIS-
 TRANT OR LICENSEE OR MAY SUSPEND THE SAME FOR SUCH PERIOD AS THE  SUPER-
 INTENDENT DETERMINES.
   §  2909.  STAY  OR  SUSPENSION  OF SUPERINTENDENT'S DETERMINATION. THE
 COMMENCEMENT OF A PROCEEDING UNDER ARTICLE SEVENTY-EIGHT  OF  THE  CIVIL
 PRACTICE  LAW  AND  RULES, TO REVIEW THE ACTION OF THE SUPERINTENDENT IN
 SUSPENDING OR REVOKING OR REFUSING TO RENEW ANY CERTIFICATE  UNDER  THIS
 ARTICLE,  SHALL  STAY  SUCH ACTION OF THE SUPERINTENDENT FOR A PERIOD OF
 THIRTY DAYS. SUCH STAY SHALL NOT BE EXTENDED FOR A LONGER PERIOD  UNLESS
 THE  COURT  SHALL  DETERMINE,  AFTER  A PRELIMINARY HEARING OF WHICH THE
 SUPERINTENDENT IS NOTIFIED FORTY-EIGHT HOURS IN ADVANCE, THAT A STAY  OF
 THE  SUPERINTENDENT'S  ACTION PENDING THE FINAL DETERMINATION OR FURTHER
 ORDER OF THE COURT WILL NOT UNDULY INJURE THE INTERESTS OF THE PEOPLE OF
 THE STATE.
   § 2910. REVOKED REGISTRATIONS OR LICENSES.  (A)(1)  NO  PERSON,  FIRM,
 ASSOCIATION,  CORPORATION  OR  OTHER ENTITY SUBJECT TO THE PROVISIONS OF
 THIS ARTICLE WHOSE REGISTRATION OR LICENSE UNDER THIS ARTICLE  HAS  BEEN
 REVOKED,  OR  WHOSE REGISTRATION OR LICENSE TO ENGAGE IN THE BUSINESS OF
 PHARMACY BENEFIT MANAGEMENT IN ANY CAPACITY  HAS  BEEN  REVOKED  BY  ANY

 S. 1507                            44                            A. 2007

 OTHER  STATE  OR TERRITORY OF THE UNITED STATES SHALL BECOME EMPLOYED OR
 APPOINTED BY A PHARMACY BENEFIT MANAGER AS AN OFFICER, DIRECTOR,  MANAG-
 ER,  CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE PRIOR WRITTEN
 APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE FOR MAINTENANCE
 OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (2)  NO PERSON, FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY SUBJECT
 TO THE PROVISIONS OF THIS ARTICLE SHALL KNOWINGLY EMPLOY OR APPOINT  ANY
 PERSON OR ENTITY WHOSE REGISTRATION OR LICENSE ISSUED UNDER THIS ARTICLE
 HAS  BEEN  REVOKED,  OR  WHOSE  REGISTRATION OR LICENSE TO ENGAGE IN THE
 BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY CAPACITY HAS BEEN REVOKED
 BY ANY OTHER STATE OR TERRITORY OF THE UNITED  STATES,  AS  AN  OFFICER,
 DIRECTOR, MANAGER, CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE
 PRIOR  WRITTEN  APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE
 FOR MAINTENANCE OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (3) NO CORPORATION OR PARTNERSHIP SUBJECT TO THE  PROVISIONS  OF  THIS
 ARTICLE  SHALL KNOWINGLY PERMIT ANY PERSON WHOSE REGISTRATION OR LICENSE
 ISSUED UNDER THIS ARTICLE HAS BEEN REVOKED,  OR  WHOSE  REGISTRATION  OR
 LICENSE  TO ENGAGE IN THE BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY
 CAPACITY HAS BEEN REVOKED BY ANY OTHER STATE, OR TERRITORY OF THE UNITED
 STATES, TO BE A SHAREHOLDER OR HAVE AN INTEREST IN SUCH  CORPORATION  OR
 PARTNERSHIP,  NOR  SHALL ANY SUCH PERSON BECOME A SHAREHOLDER OR PARTNER
 IN SUCH CORPORATION OR PARTNERSHIP, WITHOUT THE PRIOR  WRITTEN  APPROVAL
 OF THE SUPERINTENDENT.
   (B)  THE  SUPERINTENDENT  MAY  APPROVE  THE EMPLOYMENT, APPOINTMENT OR
 PARTICIPATION OF ANY SUCH PERSON WHOSE REGISTRATION OR LICENSE HAS  BEEN
 REVOKED:
   (1)  IF THE SUPERINTENDENT DETERMINES THAT THE DUTIES AND RESPONSIBIL-
 ITIES OF SUCH PERSON ARE SUBJECT TO  APPROPRIATE  SUPERVISION  AND  THAT
 SUCH  DUTIES  AND  RESPONSIBILITIES WILL NOT HAVE AN ADVERSE EFFECT UPON
 THE PUBLIC, OTHER REGISTRANTS OR LICENSEES, OR THE REGISTRANT OR  LICEN-
 SEE PROPOSING EMPLOYMENT OR APPOINTMENT OF SUCH PERSON; OR
   (2)  IF  SUCH  PERSON  HAS  FILED AN APPLICATION FOR REREGISTRATION OR
 RELICENSING PURSUANT TO THIS ARTICLE AND THE APPLICATION FOR REREGISTRA-
 TION OR RELICENSING HAS NOT BEEN APPROVED OR DENIED WITHIN  ONE  HUNDRED
 TWENTY  DAYS  FOLLOWING  THE  FILING  THEREOF, UNLESS THE SUPERINTENDENT
 DETERMINES WITHIN THE SAID TIME THAT EMPLOYMENT OR APPOINTMENT  OF  SUCH
 PERSON  BY A REGISTRANT OR LICENSEE IN THE CONDUCT OF A PHARMACY BENEFIT
 MANAGEMENT BUSINESS WOULD NOT BE IN THE PUBLIC INTEREST.
   (C) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO THE OWNERSHIP OF
 SHARES OF ANY CORPORATION REGISTERED OR LICENSED PURSUANT TO THIS  ARTI-
 CLE  IF  THE  SHARES OF SUCH CORPORATION ARE PUBLICLY HELD AND TRADED IN
 THE OVER-THE-COUNTER MARKET OR UPON ANY NATIONAL OR REGIONAL  SECURITIES
 EXCHANGE.
   § 2911. CHANGE OF ADDRESS. A REGISTRANT OR LICENSEE UNDER THIS ARTICLE
 SHALL INFORM THE SUPERINTENDENT BY A MEANS ACCEPTABLE TO THE SUPERINTEN-
 DENT OF A CHANGE OF ADDRESS WITHIN THIRTY DAYS OF THE CHANGE.
   §  2912. APPLICABILITY OF OTHER LAWS. NOTHING IN THIS ARTICLE SHALL BE
 CONSTRUED TO EXEMPT A PHARMACY BENEFIT MANAGER FROM COMPLYING  WITH  THE
 PROVISIONS  OF  ARTICLES  TWENTY-ONE  AND FORTY-NINE OF THIS CHAPTER AND
 ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW OR ANY  OTHER  PROVISION  OF
 THIS CHAPTER OR THE FINANCIAL SERVICES LAW.
   §  2913.  ASSESSMENTS. PHARMACY BENEFIT MANAGERS THAT FILE A REGISTRA-
 TION WITH THE DEPARTMENT OR ARE LICENSED  BY  THE  DEPARTMENT  SHALL  BE
 ASSESSED BY THE SUPERINTENDENT FOR THE OPERATING EXPENSES OF THE DEPART-
 MENT  THAT  ARE  SOLELY ATTRIBUTABLE TO REGULATING SUCH PHARMACY BENEFIT

 S. 1507                            45                            A. 2007
 
 MANAGERS IN SUCH PROPORTIONS AS THE SUPERINTENDENT SHALL DEEM  JUST  AND
 REASONABLE.
   §  2.  Subsection (b) of section 2402 of the insurance law, as amended
 by section 71 of part A of chapter 62 of the laws of 2011, is amended to
 read as follows:
   (b) "Defined violation" means the commission by a  person  of  an  act
 prohibited  by:  subsection (a) of section one thousand one hundred two,
 section one thousand two hundred  fourteen,  one  thousand  two  hundred
 seventeen,  one  thousand two hundred twenty, one thousand three hundred
 thirteen, subparagraph (B) of paragraph two of subsection (i) of section
 one thousand three hundred twenty-two, subparagraph (B) of paragraph two
 of subsection (i) of section one thousand three hundred twenty-four, two
 thousand one hundred two, two thousand one hundred seventeen, two  thou-
 sand  one  hundred  twenty-two,  two  thousand one hundred twenty-three,
 subsection (p) of section two thousand three hundred  thirteen,  section
 two  thousand  three hundred twenty-four, two thousand five hundred two,
 two thousand five hundred three, two thousand  five  hundred  four,  two
 thousand six hundred one, two thousand six hundred two, two thousand six
 hundred  three,  two thousand six hundred four, two thousand six hundred
 six, two thousand seven hundred three, TWO THOUSAND  NINE  HUNDRED  TWO,
 TWO  THOUSAND  NINE HUNDRED FIVE, three thousand one hundred nine, three
 thousand two hundred twenty-four-a, three thousand four hundred  twenty-
 nine,  three  thousand  four  hundred  thirty-three,  paragraph seven of
 subsection (e) of section three thousand four hundred  twenty-six,  four
 thousand two hundred twenty-four, four thousand two hundred twenty-five,
 four thousand two hundred twenty-six, seven thousand eight hundred nine,
 seven  thousand  eight hundred ten, seven thousand eight hundred eleven,
 seven thousand eight hundred  thirteen,  seven  thousand  eight  hundred
 fourteen  and  seven  thousand eight hundred fifteen of this chapter; or
 section 135.60, 135.65,  175.05,  175.45,  or  190.20,  or  article  one
 hundred five of the penal law.
   §  3.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART J
 
   Section 1. This Part enacts into law major components  of  legislation
 which are necessary to protect health care consumers; increase access to
 more  affordable  quality  health  insurance  coverage; and preserve and
 foster New York's health insurance markets.   Each component  is  wholly
 contained  within  a  Subpart  identified  as  Subparts A through F. The
 effective date for  each  particular  provision  contained  within  such
 Subpart  is set forth in the last section of such Subpart. Any provision
 in any section contained within a Subpart, including the effective  date
 of the Subpart, which makes a reference to a section "of this act," when
 used  in  connection  with that particular component, shall be deemed to
 mean and refer to the corresponding section of the Subpart in  which  it
 is  found.  Section  five  of this Part sets forth the general effective
 date of this Part.
 
                                 SUBPART A
 
   Section 1. Section 3221 of the insurance law is amended  by  adding  a
 new subsection (t) to read as follows:
   (T) (1) ANY INSURER THAT DELIVERS OR ISSUES FOR DELIVERY IN THIS STATE
 HOSPITAL,  SURGICAL OR MEDICAL EXPENSE GROUP POLICIES IN THE SMALL GROUP

 S. 1507                            46                            A. 2007
 
 OR LARGE GROUP MARKET SHALL OFFER TO ANY EMPLOYER IN THIS STATE ALL SUCH
 POLICIES IN THE  APPLICABLE  MARKET,  AND  SHALL  ACCEPT  AT  ALL  TIMES
 THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES FOR ANY OF THOSE POLICIES.
   (2)  THE  REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION SHALL APPLY
 WITH RESPECT TO AN EMPLOYER THAT APPLIES FOR  COVERAGE  EITHER  DIRECTLY
 FROM THE INSURER OR THROUGH AN ASSOCIATION OR TRUST TO WHICH THE INSURER
 HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.
   §  2.  Paragraph  1 of subsection (g) of section 3231 of the insurance
 law, as amended by section 70 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (1)  This  section  shall  also  apply  to  policies issued to a group
 defined in subsection (c) of section four thousand two  hundred  thirty-
 five, including but not limited to an association or trust of employers,
 if  the  group  includes  one  or  more member employers or other member
 groups which have [fifty] ONE HUNDRED  or  fewer  employees  or  members
 exclusive  of  spouses and dependents. For policies issued or renewed on
 or after January first, two thousand fourteen, if the group includes one
 or more member small group employers eligible for  coverage  subject  to
 this  section,  then  such member employers shall be classified as small
 groups for rating purposes and the  remaining  members  shall  be  rated
 consistent  with  the  rating rules applicable to such remaining members
 pursuant to paragraph two of this subsection.
   § 3. Subsections (h) and (i) of section 3232 of the insurance law  are
 REPEALED.
   §  4. Subsections (f) and (g) of section 3232 of the insurance law, as
 added by chapter 219 of the  laws  of  2011,  are  amended  to  read  as
 follows:
   (f)  [With respect to an individual under age nineteen, an insurer may
 not impose any pre-existing condition  exclusion  in  an  individual  or
 group policy of hospital, medical, surgical or prescription drug expense
 insurance  pursuant  to  the  requirements of section 2704 of the Public
 Health Service Act, 42 U.S.C. § 300gg-3, as made  effective  by  section
 1255(2)  of  the Affordable Care Act, except for an individual under age
 nineteen covered under an individual policy of hospital, medical, surgi-
 cal or prescription drug  expense  insurance  that  is  a  grandfathered
 health plan.
   (g)  Beginning  January  first,  two  thousand  fourteen,  pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3,  an]
 AN  insurer  [may] SHALL not impose any pre-existing condition exclusion
 in an individual or group  policy  of  hospital,  medical,  surgical  or
 prescription drug expense insurance [except in an individual policy that
 is a grandfathered health plan].
   § 5. Subparagraph (A) of paragraph 1 of subsection (c) of section 4235
 of  the insurance law, as amended by chapter 515 of the laws of 2010, is
 amended to read as follows:
   (A) A policy issued to an employer or to a trustee or  trustees  of  a
 fund  established  by an employer, which employer or trustee or trustees
 shall be deemed the policyholder, insuring with or without  evidence  of
 insurability  satisfactory  to  the insurer, employees of such employer,
 and insuring, except as hereinafter provided, all of such  employees  or
 all  of any class or classes thereof determined by conditions pertaining
 to the employment or a combination of  such  conditions  and  conditions
 pertaining  to the family status of the employee, for insurance coverage
 on each person insured based upon some plan [which] THAT  will  preclude
 individual  selection.  However, such a plan may permit a limited number
 of selections by employees if the selections offered utilize  consistent

 S. 1507                            47                            A. 2007
 
 plans  of  coverage  for  individual group members so that the resulting
 plans of coverage are reasonable. The premium for the  policy  shall  be
 paid  by  the  policyholder,  either  from the employer's funds, or from
 funds  contributed  by  the insured employees, or from funds contributed
 jointly by the employer and employees. If all or part of the premium  is
 to  be  derived  from  funds  contributed by the insured employees, then
 [such] THE INSURER ISSUING THE policy [must insure not less  than  fifty
 percent of such eligible employees or, if less, fifty or more] SHALL NOT
 REQUIRE  A  MINIMUM  NUMBER  OR  MINIMUM PERCENTAGE of such employees BE
 INSURED when [such] THE policy is providing coverage for group hospital,
 medical, major medical or similar comprehensive types of  expense  reim-
 bursed  insurance  and, for all other types of group accident and health
 insurance, [must] THE POLICY SHALL insure a minimum of fifty percent  or
 five of such eligible employees, whichever is fewer.
   §  6.  Section  4305  of  the insurance law is amended by adding a new
 subsection (n) to read as follows:
   (N) (1) ANY CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 ISSUES HOSPITAL, SURGICAL OR MEDICAL  EXPENSE  CONTRACTS  IN  THE  SMALL
 GROUP OR LARGE GROUP MARKET IN THIS STATE SHALL OFFER TO ANY EMPLOYER IN
 THIS STATE ALL SUCH CONTRACTS IN THE APPLICABLE MARKET, AND SHALL ACCEPT
 AT  ALL  TIMES  THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES FOR ANY OF
 THOSE CONTRACTS.
   (2) THE REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION  SHALL  APPLY
 WITH  RESPECT  TO  AN EMPLOYER THAT APPLIES FOR COVERAGE EITHER DIRECTLY
 FROM THE CORPORATION OR THROUGH AN ASSOCIATION OR  TRUST  TO  WHICH  THE
 CORPORATION HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.
   §  7.  Paragraph  1 of subsection (d) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (1)  This  section  shall  also  apply to a contract issued to a group
 defined in subsection (c) of section four thousand two  hundred  thirty-
 five  of  this  chapter,  including but not limited to an association or
 trust of employers, if the group includes one or more  member  employers
 or other member groups which have [fifty] ONE HUNDRED or fewer employees
 or  members exclusive of spouses and dependents. For contracts issued or
 renewed on or after January first, two thousand fourteen, if  the  group
 includes  one or more member small group employers eligible for coverage
 subject to this section, then such member employers shall be  classified
 as  small  groups for rating purposes and the remaining members shall be
 rated consistent with the rating  rules  applicable  to  such  remaining
 members pursuant to paragraph two of this subsection.
   §  8. Subsections (h) and (i) of section 4318 of the insurance law are
 REPEALED.
   § 9. Subsections (f) and (g) of section 4318 of the insurance law,  as
 added  by  chapter  219  of  the  laws  of  2011, are amended to read as
 follows:
   (f) [With respect to an individual under age nineteen,  a  corporation
 may  not impose any pre-existing condition exclusion in an individual or
 group contract of  hospital,  medical,  surgical  or  prescription  drug
 expense  insurance  pursuant  to the requirements of section 2704 of the
 Public Health Service Act, 42 U.S.C. § 300gg-3,  as  made  effective  by
 section  1255(2)  of  the  Affordable Care Act, except for an individual
 under age nineteen covered under an  individual  contract  of  hospital,
 medical,  surgical  or  prescription  drug  expense  insurance that is a
 grandfathered health plan.

 S. 1507                            48                            A. 2007

   (g) Beginning  January  first,  two  thousand  fourteen,  pursuant  to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation  [may] SHALL not impose any pre-existing condition exclusion
 in an individual or group contract of  hospital,  medical,  surgical  or
 prescription  drug  expense  insurance [except in an individual contract
 that is a grandfathered health plan].
   § 10. Section 4413 of the insurance law is amended  by  adding  a  new
 subsection (h) to read as follows:
   (H)  (1)  ON  OR  AFTER JUNE FIRST, TWO THOUSAND NINETEEN, AN EMPLOYEE
 WELFARE FUND  REGISTERED  WITH  THE  SUPERINTENDENT  SHALL  NOT  PROVIDE
 MEDICAL,  SURGICAL OR HOSPITAL CARE OR BENEFITS IN THE EVENT OF SICKNESS
 OR INJURY FOR EMPLOYEES OR THEIR FAMILIES OR DEPENDENTS,  OR  FOR  BOTH,
 UNLESS PROVIDED UNDER A GROUP COMPREHENSIVE-TYPE HEALTH INSURANCE POLICY
 OR  CONTRACT  IN  ACCORDANCE  WITH  THE REQUIREMENTS OF THIS CHAPTER AND
 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE BY AN AUTHORIZED  INSURER
 OR  A  HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIFICATE OF AUTHORITY
 UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
   (2) NOTWITHSTANDING PARAGRAPH ONE  OF  THIS  SUBSECTION,  AN  EMPLOYEE
 WELFARE FUND REGISTERED WITH THE SUPERINTENDENT PRIOR TO JUNE FIRST, TWO
 THOUSAND  NINETEEN,  WHICH,  AS OF FEBRUARY FIRST, TWO THOUSAND NINETEEN
 DIRECTLY PROVIDED MEDICAL, SURGICAL OR HOSPITAL CARE OR BENEFITS IN  THE
 EVENT  OF  SICKNESS  OR INJURY FOR EMPLOYEES OR THEIR FAMILIES OR DEPEN-
 DENTS, OR FOR BOTH, MAY CONTINUE  TO  PROVIDE  THOSE  BENEFITS  DIRECTLY
 RATHER  THAN UNDER A GROUP COMPREHENSIVE-TYPE HEALTH INSURANCE POLICY OR
 CONTRACT DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE BY AN AUTHORIZED
 INSURER OR A HEALTH MAINTENANCE ORGANIZATION  ISSUED  A  CERTIFICATE  OF
 AUTHORITY  UNDER  ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW; PROVIDED,
 HOWEVER, THAT, IF THE EMPLOYEE WELFARE FUND CEASES OFFERING THE BENEFITS
 DIRECTLY, IT MAY NOT RESUME PROVIDING THE BENEFITS DIRECTLY.
   § 11. Subdivision 1 of section 4406  of  the  public  health  law,  as
 amended  by section 46-a of part D of chapter 56 of the laws of 2013, is
 amended to read as follows:
   1. The contract between  a  health  maintenance  organization  and  an
 enrollee  shall  be subject to regulation by the superintendent as if it
 were a health insurance subscriber contract, and shall include, but  not
 be  limited to, all mandated benefits required by article forty-three of
 the insurance law. Such contract shall fully and clearly state the bene-
 fits and limitations therein provided or imposed, so  as  to  facilitate
 understanding  and  comparisons,  and to exclude provisions which may be
 misleading or unreasonably confusing. Such contract shall be  issued  to
 any  individual  and  dependents  of  such  individual  and any group of
 [fifty] ONE HUNDRED or fewer employees or members, exclusive of  spouses
 and  dependents,  or  TO  any employee or member of the group, including
 dependents, applying for such contract at any time throughout the year[,
 and may include a pre-existing condition provision as  provided  for  in
 section  four  thousand  three  hundred  eighteen  of the insurance law,
 provided, however, that, the]. AN  INDIVIDUAL  DIRECT  PAYMENT  CONTRACT
 SHALL  BE  ISSUED  ONLY  IN  ACCORDANCE WITH SECTION FOUR THOUSAND THREE
 HUNDRED TWENTY-EIGHT OF THE INSURANCE LAW. THE superintendent may, after
 giving consideration to the public interest, exempt a health maintenance
 organization from the requirements of this section provided that another
 health insurer or health  maintenance  organization  within  the  health
 maintenance  organization's  same  holding company system, as defined in
 article fifteen of the insurance law,  including  a  health  maintenance
 organization  operated  as a line of business of a health service corpo-
 ration licensed under article forty-three of the insurance  law,  offers

 S. 1507                            49                            A. 2007
 
 coverage that, at a minimum, complies with this section and provides all
 of  the consumer protections required to be provided by a health mainte-
 nance organization pursuant to this chapter and  regulations,  including
 those  consumer  protections  contained  in  sections four thousand four
 hundred three and four thousand four hundred eight-a  of  this  chapter.
 The  requirements  shall  not apply to a health maintenance organization
 exclusively serving individuals enrolled pursuant  to  title  eleven  of
 article  five of the social services law, title eleven-D of article five
 of the social services law, title one-A of article twenty-five  of  [the
 public  health law] THIS CHAPTER or title eighteen of the federal Social
 Security Act, and, further provided, that such health maintenance organ-
 ization shall not discontinue a contract  for  an  individual  receiving
 comprehensive-type  coverage in effect prior to January first, two thou-
 sand four who is ineligible to purchase policies offered after such date
 pursuant to this section or section four thousand three  hundred  [twen-
 ty-two  of  this  article]  TWENTY-EIGHT OF THE INSURANCE LAW due to the
 provision of 42 U.S.C. 1395ss in effect  prior  to  January  first,  two
 thousand  four.    [Subject  to  the creditable coverage requirements of
 subsection (a) of section four thousand three hundred  eighteen  of  the
 insurance  law,  the organization may, as an alternative to the use of a
 pre-existing condition provision, elect to  offer  contracts  without  a
 pre-existing  condition  provision  to  such groups but may require that
 coverage shall not become effective until after a specified  affiliation
 period of not more than sixty days after the application for coverage is
 submitted.    The  organization  is  not required to provide health care
 services or benefits during such period and no premium shall be  charged
 for  any  coverage  during  the  period.  After  January first, nineteen
 hundred ninety-six, all individual direct  payment  contracts  shall  be
 issued  only pursuant to sections four thousand three hundred twenty-one
 and four thousand three hundred twenty-two of the  insurance  law.  Such
 contracts may not, with respect to an eligible individual (as defined in
 section  2741(b)  of  the federal Public Health Service Act, 42 U.S.C. §
 300gg-41(b), impose any pre-existing condition exclusion.]
   § 12. This act shall take effect immediately, provided that:
   (1) sections one, three, four, five, six, eight and nine of  this  act
 shall  apply  to  all  policies and contracts issued, renewed, modified,
 altered or amended on or after January 1, 2020; and
   (2) sections two and seven of this act shall take effect on  the  same
 date  as  the reversion of paragraph 1 of subsection (g) of section 3231
 and paragraph 1 of subsection (d) of section 4317 of the insurance  law,
 as provided in section 5 of chapter 588 of the laws of 2015, as amended.
 
                                 SUBPART B
 
   Section  1.  Subparagraph  (A)  of  paragraph  5  of subsection (c) of
 section 3216 of the insurance law, as amended by chapter 388 of the laws
 of 2014, is amended to read as follows:
   (A) Any family policy providing hospital or surgical expense insurance
 (but not including such insurance against accidental injury only)  shall
 provide  that, in the event such insurance on any person, other than the
 policyholder, is terminated because the person is no longer  within  the
 definition  of  the  family  as  set forth in the policy but before such
 person has attained the limiting age, if any,  for  coverage  of  adults
 specified in the policy, such person shall be entitled to have issued to
 that  person  by  the  insurer,  without  evidence of insurability, upon
 application therefor and payment of the first premium, within sixty days

 S. 1507                            50                            A. 2007
 
 after such insurance shall have  terminated,  an  individual  conversion
 policy  that contains the ESSENTIAL HEALTH benefits PACKAGE described in
 paragraph [one] THREE of subsection [(b)] (F) of section [four  thousand
 three  hundred twenty-eight of this chapter. The insurer shall offer one
 policy at each level of coverage as defined in section  1302(d)  of  the
 affordable  care  act, 42 U.S.C. § 18022(d).] THREE THOUSAND TWO HUNDRED
 SEVENTEEN-I OF THIS ARTICLE. THE INSURER SHALL OFFER ONE POLICY AT  EACH
 LEVEL OF COVERAGE AS DEFINED IN SUBSECTION (C) OF SECTION THREE THOUSAND
 TWO  HUNDRED  SEVENTEEN-I OF THIS ARTICLE. The individual may choose any
 such policy offered by the insurer. Provided, however,  the  superinten-
 dent may, after giving due consideration to the public interest, approve
 a request made by an insurer for the insurer to satisfy the requirements
 of  this  subparagraph through the offering of policies that comply with
 this subparagraph by another insurer, corporation or health  maintenance
 organization  within the insurer's holding company system, as defined in
 article fifteen of this chapter. The conversion privilege afforded here-
 in shall also be available upon the divorce or annulment of the marriage
 of the policyholder to the former spouse of such policyholder.
   § 2. Subparagraph (E) of paragraph 2 of subsection (g) of section 3216
 of the insurance law, as added by chapter 388 of the laws  of  2014,  is
 amended to read as follows:
   (E)  The  superintendent  may,  after  giving due consideration to the
 public interest, approve a request made by an insurer for the insurer to
 satisfy the requirements of subparagraph (C) of this  paragraph  through
 the  offering  of  policies  at  each  level  of  coverage as defined in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 § 18022(d)] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE  that
 contains  the  ESSENTIAL  HEALTH benefits PACKAGE described in paragraph
 [one] THREE of subsection [(b)] (F)  of  section  [four  thousand  three
 hundred  twenty-eight of this chapter] THREE THOUSAND TWO HUNDRED SEVEN-
 TEEN-I OF THIS ARTICLE by another insurer, corporation or health mainte-
 nance organization within the insurer's same holding company system,  as
 defined in article fifteen of this chapter.
   §  3.  Items  (i)  and  (ii)  of  subparagraph  (D) of paragraph 11 of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended, and a new item (iii) is  added  to
 read as follows:
   (i)  evidence-based  items  or  services  for mammography that have in
 effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
 United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for mammography not described in item (i)  of  this  subpara-
 graph  and  as provided for in comprehensive guidelines supported by the
 health resources and services administration[.]; AND
   (III) ANY OTHER PREVENTIVE  CARE  AND  SCREENINGS  DESIGNATED  BY  THE
 SUPERINTENDENT  IN  A  REGULATION  THAT  ARE  CONSISTENT WITH CURRENT OR
 PREVIOUS RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND  (II)
 OF THIS SUBPARAGRAPH.
   §  4.  Items  (i)  and  (ii)  of  subparagraph  (D) of paragraph 15 of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended, and a new item (iii) is  added  to
 read as follows:
   (i)  evidence-based  items or services for cervical cytology that have
 in effect a rating of 'A' or 'B' in the current recommendations  of  the
 United States preventive services task force; [and]

 S. 1507                            51                            A. 2007

   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for cervical cytology not  described  in  item  (i)  of  this
 subparagraph  and  as provided for in comprehensive guidelines supported
 by the health resources and services administration[.]; AND
   (III)  ANY  OTHER  PREVENTIVE  CARE  AND  SCREENINGS DESIGNATED BY THE
 SUPERINTENDENT IN A REGULATION  THAT  ARE  CONSISTENT  WITH  CURRENT  OR
 PREVIOUS  RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND (II)
 OF THIS SUBPARAGRAPH.
   § 5. Items (iii) and (iv) of  subparagraph  (E)  of  paragraph  17  of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (v) is added to read
 as follows:
   (iii)  with  respect  to  children, including infants and adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (iv) with respect  to  women,  such  additional  preventive  care  and
 screenings  not  described  in  item  (i)  of  this  subparagraph and as
 provided  for  in  comprehensive  guidelines  supported  by  the  health
 resources and services administration[.]; AND
   (V)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS  OR  GUIDELINES  IDENTIFIED IN ITEMS (I) THROUGH (IV) OF
 THIS SUBPARAGRAPH.
   § 6. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
 law,  as  amended by chapter 469 of the laws of 2018, is amended to read
 as follows:
   (21) Every policy [which]  THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein  [or  which],
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve
 months for any insured individual shall not  exceed  two  thousand  five
 hundred dollars].

 S. 1507                            52                            A. 2007
 
   §  7.  Paragraph 30 of subsection (i) of section 3216 of the insurance
 law, as amended by chapter 377 of the laws of 2014, is amended  to  read
 as follows:
   (30) Every policy [which] THAT provides medical coverage that includes
 coverage for physician services in a physician's office and every policy
 [which] THAT provides major medical or similar comprehensive-type cover-
 age  shall  include  coverage  for  equipment  and supplies used for the
 treatment of ostomies, if prescribed by a physician  or  other  licensed
 health  care  provider legally authorized to prescribe under title eight
 of the education law. Such coverage shall be subject to  annual  deduct-
 ibles  and  coinsurance as deemed appropriate by the superintendent. The
 coverage required by this paragraph shall be identical to, and shall not
 enhance or increase the coverage required as part  of  essential  health
 benefits  as [required pursuant to] DEFINED IN SUBSECTION (A) OF section
 [2707 (a) of the public health services act 42 U.S.C. 300 gg-6(a)] THREE
 THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   § 8. Subsection (l) of section 3216 of the insurance law, as added  by
 section  42  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (l) [On and after October first, two thousand thirteen, an] AN insurer
 shall not offer individual hospital, medical or surgical expense  insur-
 ance  policies  unless  the policies meet the requirements of subsection
 (b) of section four thousand three hundred twenty-eight of this chapter.
 Such policies that are offered within the health benefit exchange estab-
 lished [pursuant to section 1311 of the affordable care act, 42 U.S.C. §
 18031, or any regulations promulgated thereunder,] BY  THIS  STATE  also
 shall meet any requirements established by the health benefit exchange.
   §  9. Subsection (m) of section 3216 of the insurance law, as added by
 section 53 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (m)  An  insurer  shall  not be required to offer the policyholder any
 benefits that must be made available pursuant to  this  section  if  the
 benefits  must  be  covered as essential health benefits. For any policy
 issued within the  health  benefit  exchange  established  [pursuant  to
 section  1311  of  the  affordable  care act, 42 U.S.C. § 18031] BY THIS
 STATE, an insurer shall not be required to offer  the  policyholder  any
 benefits  that  must  be  made  available  pursuant to this section. For
 purposes of this subsection, "essential health benefits" shall have  the
 meaning  set forth in SUBSECTION (A) OF section [1302(b) of the afforda-
 ble care act, 42 U.S.C. § 18022(b)] THREE THOUSAND  TWO  HUNDRED  SEVEN-
 TEEN-I OF THIS ARTICLE.
   §  10.  The insurance law is amended by adding a new section 3217-i to
 read as follows:
   § 3217-I. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;
   (5) MENTAL HEALTH  AND  SUBSTANCE  USE  DISORDER  SERVICES,  INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;

 S. 1507                            53                            A. 2007
 
   (9)  PREVENTIVE  AND WELLNESS SERVICES AND CHRONIC DISEASE MANAGEMENT;
 AND
   (10) PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.
   (B)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, MAY SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF  PLANS  THAT
 TOGETHER  CONTAIN  ESSENTIAL  HEALTH  BENEFITS,  IN ACCORDANCE WITH THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP ACCIDENT AND HEALTH INSURANCE
 POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND
 IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE
 ACTUARIAL REQUIREMENTS OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:
   (A) BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE  BENEFITS
 PROVIDED UNDER THE PLAN;
   (B)  SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO  SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C) GOLD LEVEL. A PLAN IN THE GOLD LEVEL  SHALL  PROVIDE  A  LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF COVERAGE THAT IS DESIGNED TO PROVIDE BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2)  THE  SUPERINTENDENT  MAY PROVIDE FOR A VARIATION IN THE ACTUARIAL
 VALUES USED IN DETERMINING THE LEVEL OF COVERAGE OF A  PLAN  TO  ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3)  EVERY  STUDENT ACCIDENT AND HEALTH INSURANCE POLICY SHALL PROVIDE
 COVERAGE THAT MEETS AT LEAST SIXTY PERCENT OF THE FULL  ACTUARIAL  VALUE
 OF  THE  BENEFITS  PROVIDED  UNDER  THE POLICY. THE POLICY'S SCHEDULE OF
 BENEFITS SHALL INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE  OF  THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D)  EVERY  INDIVIDUAL  OR  GROUP ACCIDENT AND HEALTH INSURANCE POLICY
 THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT
 A GRANDFATHERED HEALTH PLAN,  AND  EVERY  STUDENT  ACCIDENT  AND  HEALTH
 INSURANCE  POLICY  SHALL LIMIT THE INSURED'S COST-SHARING FOR IN-NETWORK
 SERVICES IN A POLICY YEAR TO NOT MORE  THAN  THE  MAXIMUM  OUT-OF-POCKET
 AMOUNT DETERMINED BY THE SUPERINTENDENT FOR ALL POLICIES SUBJECT TO THIS
 SECTION.  SUCH AMOUNT SHALL NOT EXCEED ANY ANNUAL OUT-OF-POCKET LIMIT ON
 COST-SHARING SET BY THE UNITED STATES  SECRETARY  OF  HEALTH  AND  HUMAN
 SERVICES, IF AVAILABLE.
   (E)  THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE DESCRIB-
 ING THE COVERAGE REQUIREMENTS FOR  ANY  ACCIDENT  AND  HEALTH  INSURANCE
 POLICY FORM THAT IS SUBJECT TO THE SUPERINTENDENT'S APPROVAL PURSUANT TO
 SECTION THREE THOUSAND TWO HUNDRED ONE OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1)  "ACTUARIAL  VALUE"  MEANS  THE  PERCENTAGE  OF THE TOTAL EXPECTED
 PAYMENTS BY THE INSURER FOR BENEFITS PROVIDED TO A STANDARD  POPULATION,
 WITHOUT  REGARD  TO THE POPULATION TO WHOM THE INSURER ACTUALLY PROVIDES
 BENEFITS;
   (2) "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE,  COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:

 S. 1507                            54                            A. 2007
 
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)   LIMITS   COST-SHARING  FOR  SUCH  COVERAGE  IN  ACCORDANCE  WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4) "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED BY AN  INSURER
 IN  WHICH AN INDIVIDUAL WAS ENROLLED ON MARCH TWENTY-THIRD, TWO THOUSAND
 TEN FOR AS LONG  AS  THE  COVERAGE  MAINTAINS  GRANDFATHERED  STATUS  IN
 ACCORDANCE  WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C. §
 18011(E);
   (5) "SMALL GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER  EMPLOYEES  OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF
 THIS ARTICLE.
   § 11. Subsection (g) of section 3221 of the insurance law, as  amended
 by chapter 388 of the laws of 2014, is amended to read as follows:
   (g) For conversion purposes, an insurer shall offer to the employee or
 member  a  policy at each level of coverage as defined in SUBSECTION (C)
 OF section [1302(d) of the affordable care act, 42  U.S.C.  §  18022(d)]
 THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE that contains the
 ESSENTIAL  HEALTH benefits PACKAGE described in paragraph [one] THREE of
 subsection [(b)] (F) of section [four  thousand  three  hundred  twenty-
 eight  of  this  chapter] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS
 ARTICLE. Provided, however, the superintendent  may,  after  giving  due
 consideration  to  the  public  interest,  approve  a request made by an
 insurer for the insurer to satisfy the requirements of  this  subsection
 and  subsections  (e)  and  (f)  of this section through the offering of
 policies that comply with this subsection  by  another  insurer,  corpo-
 ration  or  health maintenance organization within the insurer's holding
 company system, as defined in article fifteen of this chapter.
   § 12. Subsection (h) of section 3221 of the insurance law, as added by
 section 54 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (h)  Every small group policy or association group policy delivered or
 issued for delivery in this state that provides coverage  for  hospital,
 medical  or surgical expense insurance and is not a grandfathered health
 plan shall provide coverage for the essential health [benefit]  BENEFITS
 package  [as  required  in  section 2707(a) of the public health service
 act, 42 U.S.C.  § 300gg-6(a)]. For purposes of this subsection:
   (1) "essential health benefits package" shall  have  the  meaning  set
 forth  in  PARAGRAPH  THREE OF SUBSECTION (F) OF section [1302(a) of the
 affordable care act, 42 U.S.C. § 18022(a)] THREE  THOUSAND  TWO  HUNDRED
 SEVENTEEN-I OF THIS ARTICLE;
   (2)  "grandfathered health plan" means coverage provided by an insurer
 in which an individual was enrolled on March twenty-third, two  thousand
 ten  for  as  long  as  the  coverage  maintains grandfathered status in
 accordance with section 1251(e) of the affordable care act, 42 U.S.C.  §
 18011(e);
   (3)  "small  group"  means  a  group  of  [fifty or fewer employees or
 members exclusive of spouses and  dependents;  provided,  however,  that
 beginning  January  first,  two  thousand sixteen, "small group" means a
 group of] one hundred or fewer employees or members exclusive of spouses
 and dependents; and

 S. 1507                            55                            A. 2007
 
   (4) "association group" means a group defined  in  subparagraphs  (B),
 (D),  (H), (K), (L) or (M) of paragraph one of subsection (c) of section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B)  the  group  includes one or more member employers or other member
 groups that are small groups.
   § 13. Subsection (i) of section 3221 of the insurance law, as added by
 section 54 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (i)  An  insurer  shall  not be required to offer the policyholder any
 benefits that must be made available pursuant to  this  section  if  the
 benefits must be covered pursuant to subsection (h) of this section. For
 any policy issued within the health benefit exchange established [pursu-
 ant  to  section  1311 of the affordable care act, 42 U.S.C. § 18031] BY
 THIS STATE, an insurer shall not be required to offer  the  policyholder
 any benefits that must be made available pursuant to this section.
   §  14. Paragraph 11 of subsection (k) of section 3221 of the insurance
 law, as amended by chapter 469 of the laws of 2018, is amended  to  read
 as follows:
   (11)  Every  policy  [which]  THAT  provides coverage for prescription
 drugs shall include coverage for the cost of enteral formulas  for  home
 use, whether administered orally or via tube feeding, for which a physi-
 cian  or  other  licensed  health  care  provider  legally authorized to
 prescribe under title eight of the education law has  issued  a  written
 order. Such written order shall state that the enteral formula is clear-
 ly  medically  necessary and has been proven effective as a disease-spe-
 cific treatment regimen.  Specific  diseases  and  disorders  for  which
 enteral  formulas  have been proven effective shall include, but are not
 limited to, inherited diseases of amino-acid or organic acid metabolism;
 Crohn's Disease; gastroesophageal reflux; disorders of  gastrointestinal
 motility  such  as  chronic intestinal pseudo-obstruction; and multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders  and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein  [or  which],
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve
 months for any insured individual shall not  exceed  two  thousand  five
 hundred dollars].
   §  15.  Items  (i)  and  (ii)  of  subparagraph (D) of paragraph 13 of
 subsection (k) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (iii)  is  added  to
 read as follows:
   (i)  evidence-based  items  or  services for bone mineral density that
 have in effect a rating of 'A' or 'B' in the current recommendations  of
 the United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for bone mineral density not described in item  (i)  of  this

 S. 1507                            56                            A. 2007
 
 subparagraph  and  as provided for in comprehensive guidelines supported
 by the health resources and services administration[.]; AND
   (III)  ANY  OTHER  PREVENTIVE  CARE  AND  SCREENINGS DESIGNATED BY THE
 SUPERINTENDENT IN A REGULATION  THAT  ARE  CONSISTENT  WITH  CURRENT  OR
 PREVIOUS  RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND (II)
 OF THIS SUBPARAGRAPH.
   § 16. Paragraph 19 of subsection (k) of section 3221 of the  insurance
 law,  as  amended by chapter 377 of the laws of 2014, is amended to read
 as follows:
   (19) Every group or  blanket  accident  and  health  insurance  policy
 delivered  or  issued  for  delivery in this state [which] THAT provides
 medical coverage that includes coverage  for  physician  services  in  a
 physician's  office and every policy [which] THAT provides major medical
 or similar comprehensive-type coverage shall include coverage for equip-
 ment and supplies used for the treatment of ostomies, if prescribed by a
 physician or other licensed health care provider legally  authorized  to
 prescribe under title eight of the education law. Such coverage shall be
 subject  to  annual deductibles and coinsurance as deemed appropriate by
 the superintendent. The coverage required by  this  paragraph  shall  be
 identical to, and shall not enhance or increase the coverage required as
 part  of  essential health benefits as [required pursuant to] DEFINED IN
 SUBSECTION (A) OF section [2707 (a) of the public health services act 42
 U.S.C.   300 gg-6(a)] THREE THOUSAND TWO  HUNDRED  SEVENTEEN-I  OF  THIS
 ARTICLE.
   §  17.  Items  (iii)  and  (iv)  of subparagraph (E) of paragraph 8 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (v) is added to read
 as follows:
   (iii) with respect to children,  including  infants  and  adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (iv)  with  respect  to  women,  such  additional  preventive care and
 screenings not described  in  item  (i)  of  this  subparagraph  and  as
 provided  for  in  comprehensive  guidelines  supported  by  the  health
 resources and services administration[.]; AND
   (V) ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE  SUPER-
 INTENDENT  IN  A REGULATION THAT ARE CONSISTENT WITH CURRENT OR PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I)  THROUGH  (IV)  OF
 THIS SUBPARAGRAPH.
   §  18.  Items  (i)  and  (ii)  of  subparagraph (D) of paragraph 11 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (iii)  is  added  to
 read as follows:
   (i)  evidence-based  items  or  services  for mammography that have in
 effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
 United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for mammography not described in item (i)  of  this  subpara-
 graph  and  as provided for in comprehensive guidelines supported by the
 health resources and services administration[.]; AND
   (III) ANY OTHER PREVENTIVE  CARE  AND  SCREENINGS  DESIGNATED  BY  THE
 SUPERINTENDENT  IN  A  REGULATION  THAT  ARE  CONSISTENT WITH CURRENT OR
 PREVIOUS RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND  (II)
 OF THIS SUBPARAGRAPH.

 S. 1507                            57                            A. 2007

   §  19.  Items  (i)  and  (ii)  of  subparagraph (D) of paragraph 14 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (iii)  is  added  to
 read as follows:
   (i)  evidence-based  items or services for cervical cytology that have
 in effect a rating of 'A' or 'B' in the current recommendations  of  the
 United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for cervical cytology not  described  in  item  (i)  of  this
 subparagraph  and  as provided for in comprehensive guidelines supported
 by the health resources and services administration[.]; AND
   (III) ANY OTHER PREVENTIVE  CARE  AND  SCREENINGS  DESIGNATED  BY  THE
 SUPERINTENDENT  IN  A  REGULATION  THAT  ARE  CONSISTENT WITH CURRENT OR
 PREVIOUS RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND  (II)
 OF THIS SUBPARAGRAPH.
   §  20.  Paragraph 4 of subsection (a) of section 3231 of the insurance
 law, as amended by section 69 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology  in  which  the  premium for all persons covered by a policy
 form is the same based on the experience of the entire pool of risks  of
 all individuals or small groups covered by the insurer without regard to
 age,  sex,  health  status, tobacco usage or occupation, excluding those
 individuals or small groups covered by medicare supplemental  insurance.
 For  medicare supplemental insurance coverage, "community rated" means a
 rating methodology in which the premiums for all persons  covered  by  a
 policy  or  contract  form  is  the  same based on the experience of the
 entire pool of risks covered by that policy  or  contract  form  without
 regard  to  age,  sex,  health  status,  tobacco  usage  or  occupation.
 [Catastrophic health  insurance  policies  issued  pursuant  to  section
 1302(e) of the affordable care act, 42 U.S.C. § 18022(e), shall be clas-
 sified in a distinct community rating pool.]
   § 21. Subsection (d) of section 3240 of the insurance law, as added by
 section  41  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (d) A student accident and health insurance policy or  contract  shall
 provide  coverage for essential health benefits as defined in SUBSECTION
 (A) OF section  [1302(b)  of  the  affordable  care  act,  42  U.S.C.  §
 18022(b)]  THREE  THOUSAND  TWO HUNDRED SEVENTEEN-I OR SUBSECTION (A) OF
 SECTION  FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS   CHAPTER,   AS
 APPLICABLE.
   §  22.  Subparagraph  (A)  of paragraph 3 of subsection (d) of section
 4235 of the insurance law, as added by section 60 of part D  of  chapter
 56 of the laws of 2013, is amended to read as follows:
   (A)  "employee"  shall  have the meaning set forth in [section 2791 of
 the public health service act, 42 U.S.C. § 300gg-91(d)(5) or  any  regu-
 lations  promulgated thereunder] THE EMPLOYEE RETIREMENT INCOME SECURITY
 ACT OF 1974, 29 U.S.C. § 1002(6); and
   § 23. Subparagraphs (C) and (D) of paragraph 3 of  subsection  (j)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (E)  is  added  to  read  as
 follows:
   (C)  with  respect  to  children,  including  infants and adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]

 S. 1507                            58                            A. 2007
 
   (D) with respect to women, such additional preventive care and screen-
 ings not described in subparagraph (A) of this paragraph and as provided
 for in comprehensive guidelines supported by the  health  resources  and
 services administration[.]; AND
   (E)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS  OR  GUIDELINES  IDENTIFIED IN SUBPARAGRAPHS (A) THROUGH
 (D) OF THIS PARAGRAPH.
   § 24. Subparagraphs (A) and (B) of paragraph 3 of  subsection  (p)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (C)  is  added  to  read  as
 follows:
   (A)  evidence-based  items  or  services  for mammography that have in
 effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
 United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings for mammography not described in subparagraph (A) of this paragraph
 and  as provided for in comprehensive guidelines supported by the health
 resources and services administration[.]; AND
   (C) ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE  SUPER-
 INTENDENT  IN  A REGULATION THAT ARE CONSISTENT WITH CURRENT OR PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   § 25. Subparagraphs (A) and (B) of paragraph 3 of  subsection  (t)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (C)  is  added  to  read  as
 follows:
   (A)  evidence-based  items or services for cervical cytology that have
 in effect a rating of 'A' or 'B' in the current recommendations  of  the
 United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings  for  cervical  cytology  not described in subparagraph (A) of this
 paragraph and as provided for in comprehensive guidelines  supported  by
 the health resources and services administration[.]; AND
   (C)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   §  26.  Subsection  (u-1)  of  section  4303  of the insurance law, as
 amended by chapter 377 of the laws  of  2014,  is  amended  to  read  as
 follows:
   (u-1)  A  medical  expense  indemnity  corporation or a health service
 corporation which provides medical coverage that includes  coverage  for
 physician  services  in  a  physician's  office  and  every policy which
 provides major medical  or  similar  comprehensive-type  coverage  shall
 include  coverage  for  equipment and supplies used for the treatment of
 ostomies, if prescribed by a physician or  other  licensed  health  care
 provider legally authorized to prescribe under title eight of the educa-
 tion law. Such coverage shall be subject to annual deductibles and coin-
 surance  as  deemed  appropriate  by  the  superintendent.  The coverage
 required by this subsection shall be identical to, and shall not enhance
 or increase the coverage required as part of essential  health  benefits
 as  [required pursuant to] DEFINED IN SUBSECTION (A) OF section [2707(a)
 of the public health services act 42 U.S.C. 300 gg-6(a)]  FOUR  THOUSAND
 THREE HUNDRED SIX-H OF THIS ARTICLE.

 S. 1507                            59                            A. 2007
 
   §  27. Subsection (y) of section 4303 of the insurance law, as amended
 by chapter 469 of the laws of 2018, is amended to read as follows:
   (y)  Every  contract  [which]  THAT provides coverage for prescription
 drugs shall include coverage for the cost of enteral formulas  for  home
 use, whether administered orally or via tube feeding, for which a physi-
 cian  or  other  licensed  health  care  provider  legally authorized to
 prescribe under title eight of the education law has  issued  a  written
 order. Such written order shall state that the enteral formula is clear-
 ly  medically  necessary and has been proven effective as a disease-spe-
 cific treatment regimen.  Specific  diseases  and  disorders  for  which
 enteral  formulas  have been proven effective shall include, but are not
 limited to, inherited diseases of amino-acid or organic acid metabolism;
 Crohn's Disease; gastroesophageal reflux; disorders of  gastrointestinal
 motility  such  as  chronic intestinal pseudo-obstruction; and multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired absorption of  nutrients  caused  by  disorders  affecting  the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal  tract.  Enteral  formulas  [which] THAT are medically necessary and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic acid metabolism as well as severe protein allergic  conditions  shall
 include  modified  solid  food products that are low protein, [or which]
 contain modified protein, or are  amino  acid  based  [which]  THAT  are
 medically  necessary[,  and  such  coverage for such modified solid food
 products for any calendar year or for any continuous  period  of  twelve
 months  for  any  insured  individual shall not exceed two thousand five
 hundred dollars].
   § 28. Subparagraphs (A) and (B) of paragraph 4 of subsection  (bb)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (C)  is  added  to  read  as
 follows:
   (A)  evidence-based  items  or  services for bone mineral density that
 have in effect a rating of 'A' or 'B' in the current recommendations  of
 the United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings  for bone mineral density not described in subparagraph (A) of this
 paragraph and as provided for in comprehensive guidelines  supported  by
 the health resources and services administration[.]; AND
   (C)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   §  29.  Subsection (ll) of section 4303 of the insurance law, as added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (ll) Every small group contract or association group contract  [deliv-
 ered  or  issued  for  delivery  in  this state] ISSUED BY A CORPORATION
 SUBJECT TO THE PROVISIONS OF THIS ARTICLE  that  provides  coverage  for
 hospital,  medical  or  surgical expense insurance and is not a grandfa-
 thered health plan shall  provide  coverage  for  the  essential  health
 [benefit] BENEFITS package [as required in section 2707(a) of the public
 health  service  act,  42  U.S.C.  §  300gg-6(a)].  For purposes of this
 subsection:

 S. 1507                            60                            A. 2007
 
   (1) "essential health benefits package" shall  have  the  meaning  set
 forth  in  PARAGRAPH THREE OF SUBSECTION (F)  OF section [1302(a) of the
 affordable care act, 42 U.S.C. § 18022(a)] FOUR THOUSAND  THREE  HUNDRED
 SIX-H OF THIS ARTICLE;
   (2)  "grandfathered  health  plan" means coverage provided by a corpo-
 ration in which an individual was enrolled on  March  twenty-third,  two
 thousand  ten for as long as the coverage maintains grandfathered status
 in accordance with section 1251(e) of the affordable care act, 42 U.S.C.
 § 18011(e); and
   (3) "small group" means a  group  of  [fifty  or  fewer  employees  or
 members  exclusive  of  spouses and dependents. Beginning January first,
 two thousand sixteen, "small group" means a group  of]  one  hundred  or
 fewer employees or members exclusive of spouses and dependents; and
   (4)  "association  group"  means a group defined in subparagraphs (B),
 (D), (H), (K), (L) or (M) of paragraph one of subsection (c) of  section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B)  the  group  includes one or more member employers or other member
 groups that are small groups.
   § 30. Subsection (mm) of section 4303 of the insurance law,  as  added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (mm)  A corporation shall not be required to offer the contract holder
 any benefits that must be made available pursuant  to  this  section  if
 such  benefits  must  be  covered  pursuant  to  subsection (kk) of this
 section. For any contract issued  within  the  health  benefit  exchange
 established  [pursuant  to  section  1311 of the affordable care act, 42
 U.S.C. § 18031] BY THIS STATE, a corporation shall not  be  required  to
 offer  the  contract  holder  any  benefits  that must be made available
 pursuant to this section.
   § 31. Item (i) of subparagraph (C) of paragraph 2 of subsection (c) of
 section 4304 of the insurance law, as amended by chapter 317 of the laws
 of 2017, is amended to read as follows:
   (i) Discontinuance of a class of contract upon not  less  than  ninety
 days'  prior  written  notice.  In  exercising the option to discontinue
 coverage pursuant to this item, the corporation must act uniformly with-
 out regard to any health status-related factor of  enrolled  individuals
 or  individuals who may become eligible for such coverage and must offer
 to subscribers or group remitting agents, as  may  be  appropriate,  the
 option  to  purchase  all  other  individual  health  insurance coverage
 currently being offered by the corporation to applicants in that market.
 Provided, however, the superintendent may, after  giving  due  consider-
 ation  to  the  public interest, approve a request made by a corporation
 for the corporation to satisfy the requirements of this item through the
 offering of contracts at each level of coverage as defined in SUBSECTION
 (C) OF section  [1302(d)  of  the  affordable  care  act,  42  U.S.C.  §
 18022(d)]  FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE that
 contains the ESSENTIAL HEALTH benefits PACKAGE  described  in  paragraph
 [one]  THREE  of  subsection  [(b)]  (F)  of section four thousand three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE by another corpo-
 ration, insurer or health maintenance  organization  within  the  corpo-
 ration's  same  holding company system, as defined in article fifteen of
 this chapter.
   § 32. Paragraph 1 of subsection (e) of section 4304 of  the  insurance
 law,  as  amended by chapter 388 of the laws of 2014, is amended to read
 as follows:

 S. 1507                            61                            A. 2007
 
   (1) (A) If any such contract is  terminated  in  accordance  with  the
 provisions  of  paragraph  one of subsection (c) of this section, or any
 such contract is terminated because of a default by the remitting  agent
 in  the  payment  of  premiums not cured within the grace period and the
 remitting  agent  has not replaced the contract with similar and contin-
 uous coverage for the same group whether insured or self-insured, or any
 such contract is terminated in accordance with the provisions of subpar-
 agraph (E) of paragraph two of subsection (c) of this section, or if  an
 individual  other  than the contract holder is no longer covered under a
 "family contract" because the individual is no longer within  the  defi-
 nition set forth in the contract, or a spouse is no longer covered under
 the contract because of divorce from the contract holder or annulment of
 the marriage, or any such contract is terminated because of the death of
 the contract holder, then such individual, former spouse, or in the case
 of the death of the contract holder the surviving spouse or other depen-
 dents of the deceased contract holder covered under the contract, as the
 case  may  be, shall be entitled to convert, without evidence of insura-
 bility, upon application therefor and the making of  the  first  payment
 thereunder  within  sixty  days  after  the  date of termination of such
 contract, to a contract that  contains  the  ESSENTIAL  HEALTH  benefits
 PACKAGE  described  in  paragraph [one] THREE of subsection [(b)] (F) of
 section four thousand three hundred [twenty-eight] SIX-H of this  [chap-
 ter] ARTICLE.
   (B) The corporation shall offer one contract at each level of coverage
 as  defined in SUBSECTION (C) OF section [1302(d) of the affordable care
 act, 42 U.S.C. § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS
 ARTICLE.  The  individual  may  choose  any such contract offered by the
 corporation. Provided, however, the superintendent may, after giving due
 consideration to the public interest, approve a request made by a corpo-
 ration for the corporation to satisfy the requirements of this paragraph
 through the offering of contracts that comply  with  this  paragraph  by
 another  corporation,  insurer or health maintenance organization within
 the corporation's same holding company system,  as  defined  in  article
 fifteen of this chapter.
   (C)  The  effective  date  of  the  coverage provided by the converted
 direct payment contract shall be the date of the termination of coverage
 under the contract from which conversion was made.
   § 33. Subsection (l) of section 4304 of the insurance law, as added by
 section 43 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (l)  [On  and  after October first, two thousand thirteen, a] A corpo-
 ration shall not offer individual hospital, medical, or surgical expense
 insurance contracts  unless  the  contracts  meet  the  requirements  of
 subsection  (b)  of  section four thousand three hundred twenty-eight of
 this article. Such contracts that are offered within the health  benefit
 exchange  established  [pursuant  to section 1311 of the affordable care
 act, 42 U.S.C. § 18031, or any regulations promulgated  thereunder,]  BY
 THIS  STATE  also  shall meet any requirements established by the health
 benefit exchange.  To the extent that a  holder  of  a  special  purpose
 certificate  of  authority issued pursuant to section four thousand four
 hundred three-a of the public health  law  offers  individual  hospital,
 medical,  or  surgical  expense insurance contracts, the contracts shall
 meet the requirements of subsection (b) of section four  thousand  three
 hundred twenty-eight of this article.

 S. 1507                            62                            A. 2007
 
   §  34.  Subparagraph  (A)  of paragraph 1 of subsection (d) of section
 4305 of the insurance law, as amended by chapter  388  of  the  laws  of
 2014, is amended to read as follows:
   (A)  A  group contract issued pursuant to this section shall contain a
 provision to the effect that in case of a termination of coverage  under
 such  contract of any member of the group because of (i) termination for
 any reason whatsoever of the member's employment or membership, or  (ii)
 termination  for  any  reason  whatsoever  of  the group contract itself
 unless the group contract holder has replaced the  group  contract  with
 similar  and  continuous  coverage for the same group whether insured or
 self-insured, the member shall be entitled to have issued to the  member
 by  the  corporation, without evidence of insurability, upon application
 therefor and payment of the first premium made to the corporation within
 sixty days after termination  of  the  coverage,  an  individual  direct
 payment  contract, covering such member and the member's eligible depen-
 dents who were covered by the group contract,  which  provides  coverage
 that  contains  the ESSENTIAL HEALTH benefits PACKAGE described in para-
 graph [one] THREE of subsection [(b)] (F) of section four thousand three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE. The  corporation
 shall  offer  one  contract  at  each  level  of  coverage as defined in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE.  The
 member  may  choose  any  such  contract  offered  by  the  corporation.
 Provided, however, the superintendent may, after  giving  due  consider-
 ation  to  the  public interest, approve a request made by a corporation
 for the corporation to satisfy the  requirements  of  this  subparagraph
 through  the offering of contracts that comply with this subparagraph by
 another corporation, insurer or health maintenance  organization  within
 the  corporation's  same  holding  company system, as defined in article
 fifteen of this chapter.
   § 35. The insurance law is amended by adding a new section  4306-h  to
 read as follows:
   § 4306-H. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;
   (5)  MENTAL  HEALTH  AND  SUBSTANCE  USE  DISORDER SERVICES, INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;
   (9) PREVENTIVE AND WELLNESS SERVICES AND CHRONIC  DISEASE  MANAGEMENT;
 AND
   (10) PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.
   (B)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, MAY SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF  PLANS  THAT
 TOGETHER  CONTAIN  ESSENTIAL  HEALTH  BENEFITS,  IN ACCORDANCE WITH THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP CONTRACT THAT PROVIDES HOSPI-
 TAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS  NOT  A  GRANDFATHERED
 HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE ACTUARIAL REQUIREMENTS
 OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:

 S. 1507                            63                            A. 2007
 
   (A)  BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN;
   (B)  SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO  SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C) GOLD LEVEL. A PLAN IN THE GOLD LEVEL  SHALL  PROVIDE  A  LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF COVERAGE THAT IS DESIGNED TO PROVIDE BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2)  THE  SUPERINTENDENT  MAY PROVIDE FOR A VARIATION IN THE ACTUARIAL
 VALUES USED IN DETERMINING THE LEVEL OF COVERAGE OF A  PLAN  TO  ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3) EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL PROVIDE
 COVERAGE  THAT  MEETS AT LEAST SIXTY PERCENT OF THE FULL ACTUARIAL VALUE
 OF THE BENEFITS PROVIDED UNDER THE CONTRACT.  THE CONTRACT'S SCHEDULE OF
 BENEFITS SHALL INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE  OF  THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D)  EVERY INDIVIDUAL OR GROUP CONTRACT THAT PROVIDES HOSPITAL, SURGI-
 CAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT A GRANDFATHERED HEALTH PLAN,
 AND EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL LIMIT THE
 INSURED'S COST-SHARING FOR IN-NETWORK SERVICES IN A CONTRACT YEAR TO NOT
 MORE THAN THE MAXIMUM OUT-OF-POCKET AMOUNT DETERMINED BY THE SUPERINTEN-
 DENT FOR ALL CONTRACTS SUBJECT TO THIS SECTION. SUCH  AMOUNT  SHALL  NOT
 EXCEED  ANY ANNUAL OUT-OF-POCKET LIMIT ON COST-SHARING SET BY THE UNITED
 STATES SECRETARY OF HEALTH AND HUMAN SERVICES, IF AVAILABLE.
   (E) THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE  DESCRIB-
 ING  THE  COVERAGE  REQUIREMENTS  FOR  ANY  FORM  THAT IS SUBJECT TO THE
 APPROVAL OF THE SUPERINTENDENT PURSUANT TO SECTION FOUR  THOUSAND  THREE
 HUNDRED EIGHT OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1)  "ACTUARIAL  VALUE"  MEANS  THE  PERCENTAGE  OF THE TOTAL EXPECTED
 PAYMENTS BY THE CORPORATION FOR BENEFITS PROVIDED TO  A  STANDARD  POPU-
 LATION, WITHOUT REGARD TO THE POPULATION TO WHOM THE CORPORATION ACTUAL-
 LY PROVIDES BENEFITS;
   (2)  "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE, COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)  LIMITS  COST-SHARING  FOR  SUCH  COVERAGE  IN   ACCORDANCE   WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4)  "GRANDFATHERED  HEALTH  PLAN" MEANS COVERAGE PROVIDED BY A CORPO-
 RATION IN WHICH AN INDIVIDUAL WAS ENROLLED ON  MARCH  TWENTY-THIRD,  TWO
 THOUSAND  TEN FOR AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED STATUS
 IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
 § 18011(E);
   (5) "SMALL GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER  EMPLOYEES  OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND

 S. 1507                            64                            A. 2007
 
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF
 THIS CHAPTER.
   §  36.  Paragraph 4 of subsection (a) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology  in which the premium for all persons covered by a policy or
 contract form is the same, based on the experience of the entire pool of
 risks of all individuals or small  groups  covered  by  the  corporation
 without  regard  to age, sex, health status, tobacco usage or occupation
 excluding those individuals of small groups covered by Medicare  supple-
 mental  insurance. For medicare supplemental insurance coverage, "commu-
 nity rated" means a rating methodology in which  the  premiums  for  all
 persons  covered  by  a policy or contract form is the same based on the
 experience of the entire  pool  of  risks  covered  by  that  policy  or
 contract  form  without regard to age, sex, health status, tobacco usage
 or occupation. [Catastrophic health insurance contracts issued  pursuant
 to  section  1302(e)  of  the affordable care act, 42 U.S.C. § 18022(e),
 shall be classified in a distinct community rating pool.]
   § 37. Subsections (d), (e) and (j) of section 4326  of  the  insurance
 law,  as  amended  by  section 56 of part D of chapter 56 of the laws of
 2013, are amended to read as follows:
   (d) A qualifying group health insurance contract shall provide  cover-
 age for the essential health [benefit] BENEFITS package as [required in]
 DEFINED  IN PARAGRAPH THREE OF SUBSECTION (F) OF section [2707(a) of the
 public health service act, 42 U.S.C. § 300gg-6(a). For purposes of  this
 subsection  "essential  health  benefits package" shall have the meaning
 set forth in section 1302(a) of the affordable care  act,  42  U.S.C.  §
 18022(a)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE.
   (e) A qualifying group health insurance contract [issued to a qualify-
 ing  small  employer  prior to January first, two thousand fourteen that
 does not include all essential  health  benefits  required  pursuant  to
 section   2707(a)  of  the  public  health  service  act,  42  U.S.C.  §
 300gg-6(a), shall be discontinued, including grandfathered health plans.
 For the purposes of this paragraph, "grandfathered health  plans"  means
 coverage  provided  by a corporation to individuals who were enrolled on
 March twenty-third, two thousand ten for as long as the  coverage  main-
 tains  grandfathered  status  in  accordance with section 1251(e) of the
 affordable care act, 42 U.S.C. § 18011(e). A qualifying  small  employer
 shall  be  transitioned  to  a  plan that provides: (1)] SHALL PROVIDE a
 level of coverage that is designed to provide benefits that are actuari-
 ally equivalent to eighty percent of the full  actuarial  value  of  the
 benefits  provided  under  the plan[; and (2) coverage for the essential
 health benefit package as required in  section  2707(a)  of  the  public
 health  service  act,  42 U.S.C. § 300gg-6(a)]. The superintendent shall
 standardize the benefit package and cost sharing requirements of  quali-
 fied  group  health insurance contracts consistent with coverage offered
 through the health benefit exchange  established  [pursuant  to  section
 1311 of the affordable care act, 42 U.S.C. § 18031] BY THIS STATE.
   (j)  [Beginning  January  first,  two  thousand  fourteen, pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation shall not impose any pre-existing condition limitation in  a
 qualifying group health insurance contract.

 S. 1507                            65                            A. 2007
 
   §  38.  Subsection  (m-1)  of  section  4327  of the insurance law, as
 amended by section 58 of part D of chapter 56 of the laws  of  2013,  is
 amended to read as follows:
   (m-1)  In the event that the superintendent suspends the enrollment of
 new individuals for qualifying group  health  insurance  contracts,  the
 superintendent  shall ensure that small employers seeking to enroll in a
 qualified group health insurance contract  pursuant  to  section  forty-
 three hundred twenty-six of this article are provided information on and
 directed  to  coverage  options  available  through  the  health benefit
 exchange established [pursuant to section 1311 of  the  affordable  care
 act, 42 U.S.C. § 18031] BY THIS STATE.
   §  39.  Paragraphs 1, 2 and 3 of subsection (b) of section 4328 of the
 insurance law, as added by section 46 of part D of  chapter  56  of  the
 laws of 2013, are amended to read as follows:
   (1)  The  individual enrollee direct payment contract offered pursuant
 to this section shall provide coverage for the essential  health  [bene-
 fit]  BENEFITS  package  as  [required in] DEFINED IN PARAGRAPH THREE OF
 SUBSECTION (F) OF section [2707(a) of the public health service act,  42
 U.S.C.  §  300gg-6(a). For purposes of this paragraph, "essential health
 benefits package" shall have the meaning set forth in section 1302(a) of
 the affordable care act, 42  U.S.C.  §  18022(a)]  FOUR  THOUSAND  THREE
 HUNDRED SIX-H OF THIS ARTICLE.
   (2)  A  health maintenance organization shall offer at least one indi-
 vidual enrollee direct payment contract at each  level  of  coverage  as
 defined  in  SUBSECTION  (C)  OF section [1302(d) of the affordable care
 act, 42 U.S.C. § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS
 ARTICLE.  A  health maintenance organization also shall offer one child-
 only plan, AS REQUIRED BY SECTION 1302(F) OF THE AFFORDABLE CARE ACT, 42
 U.S.C. § 18022(F), at each level of coverage  [as  required  in  section
 2707(c) of the public health service act, 42 U.S.C. § 300gg-6(c)].
   (3)  Within  the  health  benefit  exchange  established  [pursuant to
 section 1311 of the affordable care act, 42  U.S.C.  §  18031]  BY  THIS
 STATE,  a health maintenance organization may offer an individual enrol-
 lee direct payment contract  that  is  a  catastrophic  health  plan  as
 defined  in  section  1302(e)  of  the  affordable care act, 42 U.S.C. §
 18022(e), or any regulations promulgated thereunder.
   § 40. Subparagraph (A) of paragraph 4 of  subsection  (b)  of  section
 4328  of  the insurance law, as added by chapter 11 of the laws of 2016,
 is amended to read as follows:
   (A) The individual enrollee direct payment contract  offered  pursuant
 to  this  section  shall  have  the  same  enrollment periods, including
 special enrollment periods, as required for an individual direct payment
 contract offered within the health benefit exchange established  [pursu-
 ant  to  section  1311 of the affordable care act, 42 U.S.C. § 18031, or
 any regulations promulgated thereunder] BY THIS STATE.
   § 41. Subsection (c) of section 4328 of the insurance law, as added by
 section 46 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (c)  In  addition  to  or  in  lieu  of the individual enrollee direct
 payment contracts required under this section,  all  health  maintenance
 organizations issued a certificate of authority under article forty-four
 of  the public health law or licensed under this article may offer indi-
 vidual enrollee direct  payment  contracts  within  the  health  benefit
 exchange  established  [pursuant  to section 1311 of the affordable care
 act, 42 U.S.C. § 18031, or any regulations  promulgated  thereunder]  BY
 THIS  STATE, subject to any requirements established by the health bene-

 S. 1507                            66                            A. 2007
 
 fit exchange.   If  a  health  maintenance  organization  satisfies  the
 requirements  of  subsection  (a) of this section by offering individual
 enrollee direct  payment  contracts,  only  within  the  health  benefit
 exchange, the health maintenance organization, not including a holder of
 a  special  purpose  certificate of authority issued pursuant to section
 four thousand four hundred three-a of the public health law, shall  also
 offer  at  least one individual enrollee direct payment contract at each
 level of coverage as defined in SUBSECTION (C) section [1302 (d) of  the
 affordable  care act, 42 U.S.C. § 18022 (d)] FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE, outside the health benefit exchange.
   § 42. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.

                                 SUBPART C
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 35 to read as follows:
   (35)  NO  POLICY  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT  OR
 EXCLUDE  COVERAGE  FOR  ABORTIONS THAT ARE MEDICALLY NECESSARY. COVERAGE
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE  POLICY
 IS  A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF THE
 INTERNAL REVENUE CODE OF 1986; IN  WHICH  CASE  COVERAGE  FOR  MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21) (A) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES  HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT OR
 EXCLUDE COVERAGE FOR ABORTIONS THAT ARE  MEDICALLY  NECESSARY.  COVERAGE
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL  DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE POLICY
 IS A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF  THE
 INTERNAL  REVENUE  CODE  OF  1986;  IN WHICH CASE COVERAGE FOR MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   (B) NOTWITHSTANDING ANY OTHER PROVISION, A GROUP POLICY THAT  PROVIDES
 HOSPITAL,  SURGICAL, OR MEDICAL EXPENSE COVERAGE DELIVERED OR ISSUED FOR
 DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER, AS DEFINED IN  PARAGRAPH
 SIXTEEN OF THIS SUBSECTION, MAY EXCLUDE COVERAGE FOR MEDICALLY NECESSARY
 ABORTIONS ONLY IF THE INSURER:
   (I)  OBTAINS  AN ANNUAL CERTIFICATION FROM THE GROUP POLICYHOLDER THAT
 THE POLICYHOLDER IS A RELIGIOUS EMPLOYER AND THAT THE RELIGIOUS EMPLOYER
 REQUESTS A POLICY WITHOUT COVERAGE FOR MEDICALLY NECESSARY ABORTIONS;
   (II) ISSUES A RIDER TO EACH CERTIFICATEHOLDER  AT  NO  PREMIUM  TO  BE
 CHARGED  TO  THE  CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER FOR THE RIDER,
 THAT PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO  THE
 SAME  RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF TREATMENT
 IN THE POLICY ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER SHALL  CLEARLY
 AND  CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT ADMINIS-
 TER MEDICALLY NECESSARY ABORTION BENEFITS, BUT THAT THE INSURER IS ISSU-
 ING A RIDER FOR COVERAGE OF MEDICALLY  NECESSARY  ABORTIONS,  AND  SHALL
 PROVIDE THE INSURER'S CONTACT INFORMATION FOR QUESTIONS; AND
   (III)  PROVIDES  NOTICE OF THE ISSUANCE OF THE POLICY AND RIDER TO THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.

 S. 1507                            67                            A. 2007
 
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ss) to read as follows:
   (SS) (1) NO CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS
 OF  THIS  ARTICLE  THAT  PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE
 COVERAGE  SHALL  LIMIT  OR  EXCLUDE  COVERAGE  FOR  ABORTIONS  THAT  ARE
 MEDICALLY NECESSARY. COVERAGE FOR ABORTIONS THAT ARE MEDICALLY NECESSARY
 SHALL  NOT  BE  SUBJECT  TO ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING
 CO-PAYMENTS, UNLESS THE CONTRACT IS A HIGH  DEDUCTIBLE  HEALTH  PLAN  AS
 DEFINED  IN  SECTION  223(C)(2)  OF THE INTERNAL REVENUE CODE OF 1986 IN
 WHICH CASE COVERAGE FOR MEDICALLY NECESSARY ABORTIONS MAY BE SUBJECT  TO
 THE CONTRACT'S ANNUAL DEDUCTIBLE.
   (2)  NOTWITHSTANDING  ANY  OTHER  PROVISION,  A  GROUP  CONTRACT  THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE  COVERAGE  DELIVERED  OR
 ISSUED  FOR DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER AS DEFINED IN
 SUBSECTION (CC) OF THIS  SECTION  MAY  EXCLUDE  COVERAGE  FOR  MEDICALLY
 NECESSARY ABORTIONS ONLY IF THE CORPORATION:
   (A) OBTAINS AN ANNUAL CERTIFICATION FROM THE GROUP CONTRACTHOLDER THAT
 THE  CONTRACTHOLDER  IS  A  RELIGIOUS  EMPLOYER  AND  THAT THE RELIGIOUS
 EMPLOYER REQUESTS A CONTRACT WITHOUT COVERAGE  FOR  MEDICALLY  NECESSARY
 ABORTIONS;
   (B)  ISSUES  A  RIDER  TO  EACH  CERTIFICATEHOLDER AT NO PREMIUM TO BE
 CHARGED TO THE CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER  FOR  THE  RIDER,
 THAT  PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO THE
 SAME RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF  TREATMENT
 IN THE CONTRACT ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER MUST CLEARLY
 AND  CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT ADMINIS-
 TER MEDICALLY NECESSARY ABORTION BENEFITS, BUT THAT THE  CORPORATION  IS
 ISSUING A RIDER FOR COVERAGE OF MEDICALLY NECESSARY ABORTIONS, AND SHALL
 PROVIDE THE CORPORATION'S CONTACT INFORMATION FOR QUESTIONS; AND
   (C)  PROVIDES  NOTICE OF THE ISSUANCE OF THE CONTRACT AND RIDER TO THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART D

   Section  1.  The insurance law is amended by adding a new section 3242
 to read as follows:
   § 3242. PRESCRIPTION DRUG COVERAGE.  (A) EVERY INSURER  THAT  DELIVERS
 OR ISSUES FOR DELIVERY IN THIS STATE A POLICY THAT PROVIDES COVERAGE FOR
 PRESCRIPTION  DRUGS  SHALL, WITH RESPECT TO THE PRESCRIPTION DRUG COVER-
 AGE, PUBLISH AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF  ALL  COVERED
 PRESCRIPTION  DRUGS  ON  ITS  FORMULARY DRUG LIST, INCLUDING ANY TIERING
 STRUCTURE THAT IT HAS ADOPTED AND ANY  RESTRICTIONS  ON  THE  MANNER  IN
 WHICH  A  PRESCRIPTION  DRUG MAY BE OBTAINED, IN A MANNER THAT IS EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B) (1) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY  IN  THIS  STATE
 THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL INCLUDE IN THE POLI-
 CY  A  PROCESS  THAT  ALLOWS  AN INSURED, THE INSURED'S DESIGNEE, OR THE
 INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A FORMULARY EXCEP-
 TION.  WITH RESPECT TO THE PROCESS FOR SUCH A  FORMULARY  EXCEPTION,  AN
 INSURER  SHALL  FOLLOW  THE  PROCESS AND PROCEDURES SPECIFIED IN ARTICLE

 S. 1507                            68                            A. 2007
 
 FORTY-NINE OF THIS CHAPTER AND ARTICLE FORTY-NINE OF THE  PUBLIC  HEALTH
 LAW,  EXCEPT  AS  OTHERWISE  PROVIDED IN PARAGRAPHS TWO, THREE, FOUR AND
 FIVE OF THIS SUBSECTION.
   (2)  (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE INSURED'S
 DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A
 STANDARD REVIEW THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES OF  A  FORMU-
 LARY  EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE POLI-
 CY.
   (B) AN INSURER SHALL MAKE A  DETERMINATION  ON  A  STANDARD  EXCEPTION
 REQUEST  THAT  IS  NOT  BASED  ON  EXIGENT  CIRCUMSTANCES AND NOTIFY THE
 INSURED OR THE INSURED'S DESIGNEE AND THE INSURED'S  PRESCRIBING  HEALTH
 CARE  PROVIDER  BY TELEPHONE OF ITS COVERAGE DETERMINATION NO LATER THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C) AN INSURER THAT GRANTS A STANDARD EXCEPTION REQUEST  THAT  IS  NOT
 BASED  ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE NON-FORMU-
 LARY PRESCRIPTION DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING
 REFILLS.
   (D)  FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES" MEANS
 WHEN AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY  SERIOUSLY
 JEOPARDIZE  THE  INSURED'S  LIFE,  HEALTH,  OR ABILITY TO REGAIN MAXIMUM
 FUNCTION OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF  TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3)  (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE INSURED'S
 DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  TO  REQUEST
 AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF A FORMULARY EXCEP-
 TION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE POLICY.
   (B)  AN  INSURER  SHALL  MAKE  A  DETERMINATION ON AN EXPEDITED REVIEW
 REQUEST BASED ON EXIGENT CIRCUMSTANCES AND NOTIFY  THE  INSURED  OR  THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE  OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR HOURS
 FOLLOWING RECEIPT OF THE REQUEST.
   (C) AN INSURER THAT GRANTS AN EXCEPTION BASED ON EXIGENT CIRCUMSTANCES
 SHALL PROVIDE COVERAGE OF THE NON-FORMULARY PRESCRIPTION  DRUG  FOR  THE
 DURATION OF THE EXIGENT CIRCUMSTANCES.
   (4) AN INSURER THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO OR
 THREE  OF  THIS  SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE DETERMINATION UNDER SECTION FOUR THOUSAND NINE HUNDRED  FOUR  OF
 THIS  CHAPTER  OR  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THE PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY APPROPRIATE PRESCRIPTION DRUGS COVERED BY THE  INSURER  TO  TREAT
 THE INSURED.
   (5)  (A)  IF  AN INSURER DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  SHALL  HAVE  THE
 RIGHT  TO  REQUEST  THAT  SUCH  DENIAL BE REVIEWED BY AN EXTERNAL APPEAL
 AGENT CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR  THOUSAND
 NINE  HUNDRED  ELEVEN  OF THIS CHAPTER IN ACCORDANCE WITH ARTICLE FORTY-
 NINE OF THIS CHAPTER OR ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B) AN EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION  ON  THE
 EXTERNAL  APPEAL  AND  NOTIFY  THE INSURER, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST

 S. 1507                            69                            A. 2007
 
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE EXTERNAL APPEAL AGENT SHALL NOTIFY THE INSURER, THE INSURED  OR  THE
 INSURED'S  DESIGNEE,  AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER
 IN WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN TWO BUSINESS DAYS
 OF RENDERING SUCH DETERMINATION.
   (C)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE INSURER, THE  INSURED  OR  THE  INSURED'S
 DESIGNEE,  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL  REQUEST
 WAS  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF THIS
 SUBSECTION AND THE INSURED'S PRESCRIBING HEALTH  CARE  PROVIDER  ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE  INSURER,  THE  INSURED OR THE INSURED'S DESIGNEE, AND THE INSURED'S
 PRESCRIBING HEALTH CARE PROVIDER  IN  WRITING  OF  THE  EXTERNAL  APPEAL
 DETERMINATION  WITHIN  SEVENTY-TWO  HOURS OF THE EXTERNAL APPEAL AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D) AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN  ACCORDANCE
 WITH  SUBPARAGRAPH  (A)  OF  PARAGRAPH FOUR OF SUBSECTION (B) OF SECTION
 FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER OR SUBPARAGRAPH  (A)
 OF  PARAGRAPH  (D)  OF  SUBDIVISION  TWO  OF  SECTION FOUR THOUSAND NINE
 HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A  DETERMINATION,
 THE   EXTERNAL   APPEAL  AGENT  SHALL  CONSIDER  WHETHER  THE  FORMULARY
 PRESCRIPTION DRUG COVERED BY THE INSURER WILL BE OR  HAS  BEEN  INEFFEC-
 TIVE,  WOULD NOT BE AS EFFECTIVE AS THE NON-FORMULARY PRESCRIPTION DRUG,
 OR WOULD HAVE ADVERSE EFFECTS.
   (E) IF AN EXTERNAL APPEAL AGENT OVERTURNS THE INSURER'S  DENIAL  OF  A
 STANDARD  EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION, THEN
 THE INSURER SHALL PROVIDE COVERAGE  OF  THE  NON-FORMULARY  PRESCRIPTION
 DRUG  FOR  THE  DURATION  OF  THE PRESCRIPTION, INCLUDING REFILLS. IF AN
 EXTERNAL APPEAL AGENT OVERTURNS THE INSURER'S  DENIAL  OF  AN  EXPEDITED
 EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE OF THIS SUBSECTION, THEN THE
 INSURER SHALL PROVIDE COVERAGE OF THE  NON-FORMULARY  PRESCRIPTION  DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   § 2. The insurance law is amended by adding a new section 4329 to read
 as follows:
   §  4329. PRESCRIPTION DRUG COVERAGE.  (A) EVERY CORPORATION SUBJECT TO
 THE PROVISIONS OF THIS ARTICLE THAT  ISSUES  A  CONTRACT  THAT  PROVIDES
 COVERAGE  FOR PRESCRIPTION DRUGS SHALL, WITH RESPECT TO THE PRESCRIPTION
 DRUG COVERAGE, PUBLISH AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF ALL
 COVERED PRESCRIPTION DRUGS ON ITS FORMULARY  DRUG  LIST,  INCLUDING  ANY
 TIERING STRUCTURE THAT IT HAS ADOPTED AND ANY RESTRICTIONS ON THE MANNER
 IN WHICH A PRESCRIPTION DRUG MAY BE OBTAINED, IN A MANNER THAT IS EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B)  (1)  EVERY  CONTRACT  ISSUED  BY  A  CORPORATION  SUBJECT  TO THE
 PROVISIONS OF THIS ARTICLE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
 SHALL INCLUDE IN THE CONTRACT A PROCESS  THAT  ALLOWS  AN  INSURED,  THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST  A  FORMULARY  EXCEPTION. WITH RESPECT TO THE PROCESS FOR SUCH A
 FORMULARY EXCEPTION, A CORPORATION SHALL FOLLOW THE PROCESS  AND  PROCE-
 DURES  SPECIFIED  IN  ARTICLE  FORTY-NINE  OF  THIS  CHAPTER AND ARTICLE
 FORTY-NINE OF THE PUBLIC HEALTH LAW, EXCEPT  AS  OTHERWISE  PROVIDED  IN
 PARAGRAPHS TWO, THREE, FOUR AND FIVE OF THIS SUBSECTION.

 S. 1507                            70                            A. 2007
 
   (2)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST A STANDARD REVIEW THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES  OF
 A FORMULARY EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE
 CONTRACT.
   (B)  A  CORPORATION SHALL MAKE A DETERMINATION ON A STANDARD EXCEPTION
 REQUEST THAT IS NOT  BASED  ON  EXIGENT  CIRCUMSTANCES  AND  NOTIFY  THE
 INSURED  OR  THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH
 CARE PROVIDER BY TELEPHONE OF ITS COVERAGE DETERMINATION NO  LATER  THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS A STANDARD EXCEPTION REQUEST THAT IS NOT
 BASED  ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE NON-FORMU-
 LARY PRESCRIPTION DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING
 REFILLS.
   (D)  FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES" MEANS
 WHEN AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY  SERIOUSLY
 JEOPARDIZE  THE  INSURED'S  LIFE,  HEALTH,  OR ABILITY TO REGAIN MAXIMUM
 FUNCTION OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF  TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF  A  FORMU-
 LARY EXCEPTION FOR A PRESCRIPTION DRUG IS NOT COVERED BY THE CONTRACT.
   (B)  A  CORPORATION  SHALL MAKE A DETERMINATION ON AN EXPEDITED REVIEW
 REQUEST BASED ON EXIGENT CIRCUMSTANCES AND NOTIFY  THE  INSURED  OR  THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE  OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR HOURS
 FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS AN EXCEPTION BASED  ON  EXIGENT  CIRCUM-
 STANCES  SHALL  PROVIDE  COVERAGE OF THE NON-FORMULARY PRESCRIPTION DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   (4) A CORPORATION THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO
 OR THREE OF THIS SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE DETERMINATION UNDER SECTION FOUR THOUSAND NINE HUNDRED  FOUR  OF
 THIS  CHAPTER  OR  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THE PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY APPROPRIATE PRESCRIPTION DRUGS  COVERED  BY  THE  CORPORATION  TO
 TREAT THE INSURED.
   (5) (A) IF A CORPORATION DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE,  OR  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER SHALL HAVE THE
 RIGHT TO REQUEST THAT SUCH DENIAL BE  REVIEWED  BY  AN  EXTERNAL  APPEAL
 AGENT  CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR THOUSAND
 NINE HUNDRED ELEVEN OF THIS CHAPTER IN ACCORDANCE  WITH  ARTICLE  FORTY-
 NINE OF THIS CHAPTER AND ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE EXTERNAL APPEAL AGENT SHALL NOTIFY THE CORPORATION, THE  INSURED  OR
 THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVID-

 S. 1507                            71                            A. 2007
 
 ER  IN  WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN TWO BUSINESS
 DAYS OF RENDERING SUCH DETERMINATION.
   (C)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE CORPORATION, THE INSURED OR THE INSURED'S DESIGNEE AND THE INSURED'S
 PRESCRIBING HEALTH CARE PROVIDER  IN  WRITING  OF  THE  EXTERNAL  APPEAL
 DETERMINATION  WITHIN  SEVENTY-TWO  HOURS OF THE EXTERNAL APPEAL AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D) AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN  ACCORDANCE
 WITH  SUBPARAGRAPH  (A)  OF  PARAGRAPH FOUR OF SUBSECTION (B) OF SECTION
 FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER AND SUBPARAGRAPH (A)
 OF PARAGRAPH (D) OF  SUBDIVISION  TWO  OF  SECTION  FOUR  THOUSAND  NINE
 HUNDRED  FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A DETERMINATION,
 THE  EXTERNAL  APPEAL  AGENT  SHALL  CONSIDER  WHETHER   THE   FORMULARY
 PRESCRIPTION  DRUG  COVERED BY THE CORPORATION WILL BE OR HAS BEEN INEF-
 FECTIVE, WOULD NOT BE AS EFFECTIVE  AS  THE  NON-FORMULARY  PRESCRIPTION
 DRUG, OR WOULD HAVE ADVERSE EFFECTS.
   (E)  IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S DENIAL OF
 A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH  TWO  OF  THIS  SUBSECTION,
 THEN  THE  CORPORATION  SHALL  PROVIDE  COVERAGE  OF  THE  NON-FORMULARY
 PRESCRIPTION DRUG  FOR  THE  DURATION  OF  THE  PRESCRIPTION,  INCLUDING
 REFILLS.  IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S DENIAL
 OF  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION,  THEN THE CORPORATION SHALL PROVIDE COVERAGE OF THE NON-FOR-
 MULARY PRESCRIPTION DRUG FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   § 3. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART E
 
   Section  1.  Section  2607  of the insurance law is amended to read as
 follows:
   § 2607. Discrimination because of sex or marital status.  (A) No indi-
 vidual or entity shall refuse to  issue  any  policy  of  insurance,  or
 cancel or decline to renew [such] THE policy because of the sex or mari-
 tal  status  of the applicant or policyholder OR ENGAGE IN SEXUAL STERE-
 OTYPING.
   (B) FOR THE PURPOSES OF  THIS  SECTION,  "SEX"  SHALL  INCLUDE  SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 2. The insurance law is amended by adding a new section 3243 to read
 as follows:
   §  3243.  DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS IN HOSPITAL,
 SURGICAL OR MEDICAL EXPENSE INSURANCE.  (A) WITH REGARD TO  AN  ACCIDENT
 AND HEALTH INSURANCE POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 EXPENSE  COVERAGE  OR A POLICY OF STUDENT ACCIDENT AND HEALTH INSURANCE,
 AS DEFINED IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY
 OF THIS ARTICLE, DELIVERED OR ISSUED FOR  DELIVERY  IN  THIS  STATE,  NO
 INSURER  SHALL  BECAUSE  OF  SEX,  MARITAL STATUS OR BASED ON PREGNANCY,

 S. 1507                            72                            A. 2007
 
 FALSE PREGNANCY, TERMINATION OF PREGNANCY, OR RECOVERY THEREFROM, CHILD-
 BIRTH OR RELATED MEDICAL CONDITIONS:
   (1)  MAKE  ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS TO THE
 PREMIUMS OR RATES CHARGED FOR THE POLICY OR IN ANY OTHER MANNER  WHATEV-
 ER;
   (2)  DEMAND  OR  REQUIRE  A  GREATER  PREMIUM  FROM ANY PERSON THAN IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3) MAKE OR REQUIRE ANY REBATE, DISCRIMINATION OR  DISCOUNT  UPON  THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY POLICY;
   (4)  INSERT  IN  THE  POLICY  ANY  CONDITION, OR MAKE ANY STIPULATION,
 WHEREBY THE INSURED BINDS HIS OR HERSELF, OR HIS OR  HER  HEIRS,  EXECU-
 TORS,  ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS THAN
 THE FULL VALUE OR AMOUNT OF SUCH POLICY  IN  CASE  OF  A  CLAIM  THEREON
 EXCEPT  SUCH  CONDITIONS  AND STIPULATIONS AS ARE IMPOSED UPON OTHERS IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A POLICY ISSUED OR SOLD BY IT;
   (6) CANCEL OR REFUSE TO ISSUE, RENEW OR SELL SUCH POLICY AFTER  APPRO-
 PRIATE APPLICATION THEREFOR;
   (7)  FIX  ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR COMMISSIONS OF
 INSURANCE AGENTS OR INSURANCE BROKERS FOR WRITING  OR  RENEWING  SUCH  A
 POLICY; OR
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B)  FOR  THE  PURPOSES  OF  THIS  SECTION, "SEX" SHALL INCLUDE SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 3. The insurance law is amended by adding a new section 4330 to read
 as follows:
   § 4330. DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS  IN  HOSPITAL,
 SURGICAL  OR  MEDICAL EXPENSE INSURANCE.   (A) WITH REGARD TO A CONTRACT
 ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS OF THIS  ARTICLE  THAT
 PROVIDES  HOSPITAL,  SURGICAL, OR MEDICAL EXPENSE COVERAGE OR A CONTRACT
 OF STUDENT ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN  SUBSECTION  (A)
 OF  SECTION  THREE THOUSAND TWO HUNDRED FORTY OF THIS CHAPTER, NO CORPO-
 RATION SHALL BECAUSE OF SEX, MARITAL STATUS OR BASED ON PREGNANCY, FALSE
 PREGNANCY, TERMINATION OF PREGNANCY, OR RECOVERY  THEREFROM,  CHILDBIRTH
 OR RELATED MEDICAL CONDITIONS:
   (1)  MAKE  ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS TO THE
 PREMIUMS OR RATES CHARGED FOR THE CONTRACT OR IN ANY OTHER MANNER  WHAT-
 EVER;
   (2)  DEMAND  OR  REQUIRE  A  GREATER  PREMIUM  FROM ANY PERSON THAN IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3) MAKE OR REQUIRE ANY REBATE, DISCRIMINATION OR  DISCOUNT  UPON  THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY CONTRACT;
   (4)  INSERT  IN  THE  CONTRACT ANY CONDITION, OR MAKE ANY STIPULATION,
 WHEREBY THE INSURED BINDS HIS OR HERSELF, OR HIS OR  HER  HEIRS,  EXECU-
 TORS,  ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS THAN
 THE FULL VALUE OR AMOUNT OF SUCH CONTRACT IN CASE  OF  A  CLAIM  THEREON
 EXCEPT  SUCH  CONDITIONS  AND STIPULATIONS AS ARE IMPOSED UPON OTHERS IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A CONTRACT ISSUED OR SOLD BY IT;
   (6) CANCEL OR REFUSE TO ISSUE,  RENEW  OR  SELL  SUCH  CONTRACT  AFTER
 APPROPRIATE APPLICATION THEREFOR;
   (7)  FIX  ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR COMMISSIONS OF
 INSURANCE AGENTS OR INSURANCE BROKERS FOR WRITING  OR  RENEWING  SUCH  A
 CONTRACT; OR

 S. 1507                            73                            A. 2007
 
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B)  FOR  PURPOSES  OF THIS SECTION, "SEX" SHALL INCLUDE SEXUAL ORIEN-
 TATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART F
 
   Section  1.  Subparagraph  (B)  of  paragraph  2  of subsection (b) of
 section 1101 of the insurance law, as amended by chapter 369 of the laws
 of 1985, is amended to read as follows:
   (B) transactions with respect to  group  life,  group  annuity,  group
 accident and health or blanket accident and health insurance (other than
 any  transaction  with respect to a group annuity contract funding indi-
 vidual  retirement  accounts  or  individual  retirement  annuities,  as
 defined  in  section  four  hundred  eight of the Internal Revenue Code,
 funding annuities in accordance with subdivision  (b)  of  section  four
 hundred  three  of such code or providing a plan of retirement annuities
 under which the payments are derived wholly from  funds  contributed  by
 the persons covered):
   (i)  where  such  groups  conform  to  the  definitions of eligibility
 contained in[;]:
   (I) the following paragraphs of subsection (b) of section  four  thou-
 sand two hundred sixteen of this chapter:
   (aa) paragraph (1) or (2);
   (bb)  paragraph  (3),  if,  with  respect to those credit transactions
 entered into in this state, the policy fully conforms with the  require-
 ments  of  sections  three  thousand two hundred one, three thousand two
 hundred twenty and four thousand two hundred sixteen of this chapter; OR
   (cc) paragraphs (4), (5), (6), (7), (8), (9) [and] OR (10)[.];
   (II) the following subparagraphs of paragraph (1) of subsection (c) of
 section four thousand two hundred thirty-five of this chapter:
   (aa) subparagraph (A), (B), (C) or (D), (EXCEPT THAT  WITH  REGARD  TO
 SUBPARAGRAPHS (A), (B), AND (D), TRANSACTIONS WITH RESPECT TO AN EMPLOY-
 ER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO INSURE EMPLOYEES OF
 AN  EMPLOYER  OR  AN EMPLOYER TO WHOM THE POLICY IS ISSUED, WHERE: (AAA)
 THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS STATE; OR (BBB)
 THE LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES WORK  IN  THIS  STATE  OR
 TWENTY-FIVE OR MORE EMPLOYERS WORK IN THIS STATE);
   (bb)  subparagraph  (E), if, with respect to those credit transactions
 entered into in this state, the policy fully conforms with the  require-
 ments  of  sections  three  thousand two hundred one, three thousand two
 hundred twenty-one and four thousand two  hundred  thirty-five  of  this
 chapter;
   (cc) subparagraphs (F)[,] AND (G) [and (H).];
   (III)  section four thousand two hundred thirty-seven (except subpara-
 graph (B) FOR TRANSACTIONS WITH RESPECT TO AN EMPLOYER TO WHOM THE POLI-
 CY IS ISSUED WHERE THE EMPLOYER HAS ITS PRINCIPAL PLACE OF  BUSINESS  IN
 THIS  STATE  OR  THE  LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES WORK IN
 THIS STATE OR TWENTY-FIVE OR MORE EMPLOYEES WORK  IN  THIS  STATE,  (C),
 (E),  OR (F) of paragraph three of subsection (a) thereof) or four thou-
 sand two hundred  thirty-eight  (except  paragraphs  six  and  seven  of
 subsection (b) thereof) of this chapter; and

 S. 1507                            74                            A. 2007
 
   (ii) where the master policies or contracts were lawfully issued with-
 out  this state in a jurisdiction where the insurer was authorized to do
 an insurance business;
   §  2.  Items  (ii)  and  (iii)  of  subparagraph (A) of paragraph 8 of
 subsection (b) of section 1101 of the insurance law, as added by chapter
 449 of the laws of 2014, are amended to read as follows:
   (ii) subparagraph (A), (B), (C), or (D) [(with  respect  to  a  policy
 issued to a trustee or trustees of a fund established or participated in
 by  two  or  more employers, one or more labor unions, or by one or more
 employers or labor unions, provided that all  such  employers  or  labor
 unions  are in the same industry)] of paragraph one of subsection (c) of
 section four thousand two hundred thirty-five of  this  chapter  (EXCEPT
 THAT  WITH  REGARD TO SUBPARAGRAPHS (A), (B), AND (D), TRANSACTIONS WITH
 RESPECT TO AN EMPLOYER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO
 INSURE EMPLOYEES OF AN EMPLOYER OR AN EMPLOYER TO  WHOM  THE  POLICY  IS
 ISSUED,  WHERE:  (I) THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN
 THIS STATE; OR (II) THE LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES  WORK
 IN THIS STATE OR TWENTY-FIVE OR MORE EMPLOYEES WORK IN THIS STATE); or
   (iii)  paragraphs one, two, three or four of subsection (b) of section
 four thousand two hundred thirty-eight of this chapter, but not  includ-
 ing a group annuity contract: (I) funding individual retirement accounts
 or  individual  retirement annuities, as defined in section four hundred
 eight of the Internal Revenue Code; (II) funding annuities in accordance
 with subdivision (b) of section four hundred  three  of  such  code;  or
 (III)  providing a plan of retirement annuities under which the payments
 are derived wholly from funds contributed by the persons covered[.];
   § 3. Subsection (b) of section 1101 of the insurance law is amended by
 adding a new paragraph 9 to read as follows:
   (9) FOR PURPOSES OF THIS SUBSECTION,  "PRINCIPAL  PLACE  OF  BUSINESS"
 SHALL  MEAN  THE  PLACE  WHERE AN EMPLOYER MAINTAINS ITS HEADQUARTERS OR
 WHERE THE EMPLOYER'S HIGH-LEVEL OFFICERS DIRECT, CONTROL, AND COORDINATE
 THE BUSINESS ACTIVITIES.
   § 4. Paragraph 1 of subsection (b) of section 3201  of  the  insurance
 law,  as  amended by chapter 369 of the laws of 1985, is amended to read
 as follows:
   (1) (A) No policy form shall be delivered or issued  for  delivery  in
 this state unless it has been filed with and approved by the superinten-
 dent  as  conforming  to the requirements of this chapter and not incon-
 sistent with law.
   (B) A group life, group accident, group  health,  group  accident  and
 health, BLANKET ACCIDENT, BLANKET HEALTH, or blanket accident and health
 insurance  certificate  evidencing  insurance  coverage on a resident of
 this state shall be deemed to have been delivered in this state, regard-
 less of the place of actual delivery[, unless the insured group] OR  THE
 TYPE  OF  GROUP  TO  WHICH  THE  GROUP  OR BLANKET POLICY OR CONTRACT IS
 ISSUED.
   (C) NOTWITHSTANDING SUBPARAGRAPH (B) OF THIS PARAGRAPH, A  CERTIFICATE
 SHALL  NOT  BE DEEMED TO HAVE BEEN DELIVERED IN THIS STATE WHEN: (I) THE
 CERTIFICATE IS NOT ACTUALLY DELIVERED IN THIS STATE;  (II)  THE  INSURED
 GROUP  is  of  the  type  described  in[: (A)] section four thousand two
 hundred sixteen OF THIS CHAPTER, except paragraph four where  the  group
 policy  is  issued  to  a  trustee  or trustees of a fund established or
 participated in by two or more employers not in the same  industry  with
 respect  to  an employer principally located within the state, paragraph
 twelve, thirteen or fourteen of subsection (b) thereof;  AND  (III)  THE
 MASTER  POLICY  OR  CONTRACT  IS LAWFULLY ISSUED WITHOUT THIS STATE IN A

 S. 1507                            75                            A. 2007
 
 JURISDICTION WHERE THE INSURER IS AUTHORIZED TO DO  AN  INSURANCE  BUSI-
 NESS.
   (D)  NOTWITHSTANDING  SUBPARAGRAPH  (B)  OF  THIS PARAGRAPH, WHERE THE
 MASTER POLICY OR CONTRACT IS LAWFULLY ISSUED WITHOUT  THIS  STATE  IN  A
 JURISDICTION  WHERE  THE  INSURER IS AUTHORIZED TO DO AN INSURANCE BUSI-
 NESS, A CERTIFICATE SHALL NOT BE DEEMED TO HAVE BEEN DELIVERED  IN  THIS
 STATE  EVEN  IF  IT IS ACTUALLY DELIVERED IN THIS STATE WHEN THE INSURED
 GROUP IS OF THE TYPE DESCRIBED IN:
   [(B)] (I) section four thousand two hundred thirty-five OF THIS  CHAP-
 TER,  except  [subparagraph]:  (I) SUBPARAGRAPHS (A), (B) AND (D) [where
 the group policy is issued to a trustee or trustees  of  a  fund  estab-
 lished  or  participated  in  by  two  or more employers not in the same
 industry with respect to an  employer  principally  located  within  the
 state,  subparagraph]  OF  PARAGRAPH ONE OF SUBSECTION (C) THEREOF, WITH
 RESPECT TO AN EMPLOYER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO
 INSURE EMPLOYEES OF AN EMPLOYER OR AN EMPLOYER TO  WHOM  THE  POLICY  IS
 ISSUED,  WHERE  THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS
 STATE OR THE LESSER OF TWENTY-FIVE PERCENT OF  EMPLOYEES  WORK  IN  THIS
 STATE  OR  TWENTY-FIVE  OR  MORE  EMPLOYEES  WORK IN THIS STATE; OR (II)
 SUBPARAGRAPHS (H), (K), (L) or (M) of paragraph one  of  subsection  (c)
 thereof; or
   [(C)]  (II) section four thousand two hundred thirty-seven [(] OF THIS
 CHAPTER, except subparagraph (B) WITH RESPECT TO AN EMPLOYER TO WHOM THE
 POLICY IS ISSUED WHERE THE EMPLOYER HAS ITS PRINCIPAL PLACE OF  BUSINESS
 IN  THIS STATE OR THE LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES WORK IN
 THIS STATE OR TWENTY-FIVE OR MORE EMPLOYEES WORK IN THIS STATE, (C), (E)
 OR (F) of paragraph three of subsection (a) thereof[; of  this  chapter;
 and  where the master policies or contracts were lawfully issued without
 this state in a jurisdiction where the insurer was authorized to  do  an
 insurance business].
   (E)(I)  With  regard to any GROUP LIFE INSURANCE certificate deemed to
 have been delivered in this state by virtue of SUBPARAGRAPH (B)  OR  (C)
 OF  this paragraph, the superintendent shall [(i)]: (I) require that the
 premiums charged be reasonable in relation  to  the  benefits  provided,
 except  in  cases where the policyholder pays the entire premium; [(ii)]
 (II) have power to issue regulations prescribing the required,  optional
 and prohibited provisions in such certificates; [(iii)] AND (III) estab-
 lish  an accelerated certificate form approval procedure available to an
 insurer [which] THAT includes a statement in its policy form  submission
 letter  that  it  is  the company's opinion that the certificate form or
 forms comply with applicable New York law and regulations.   The  super-
 intendent, upon receipt of such a filing letter, shall grant conditional
 approval  of such certificate form or forms in reliance on the aforemen-
 tioned statement by the company upon the condition that the company will
 retroactively modify such certificate  form  or  forms,  to  the  extent
 necessary,  if  it  is  found by the superintendent that the certificate
 form fails to comply with applicable New York laws and regulations[.];
   (II) The superintendent may, with regard to the approval of any  GROUP
 LIFE  INSURANCE  certificate deemed to have been delivered in this state
 by virtue of SUBPARAGRAPH (B) OR (C) OF  this  paragraph,  approve  such
 certificate  if  the  superintendent  finds that the certificate affords
 insureds protections substantially similar to those  [which]  THAT  have
 been provided by certificates delivered in this state[.]; AND
   (III)  Any  regulations  issued by the superintendent pursuant to this
 [paragraph] SUBPARAGRAPH may not impose stricter requirements than those

 S. 1507                            76                            A. 2007
 
 applicable to similar policies and certificates  actually  delivered  in
 this state.
   (F)(I)  A  GROUP  ACCIDENT,  GROUP  HEALTH, GROUP ACCIDENT AND HEALTH,
 BLANKET ACCIDENT, BLANKET HEALTH, OR BLANKET ACCIDENT AND HEALTH  INSUR-
 ANCE CERTIFICATE DEEMED TO HAVE BEEN DELIVERED IN THIS STATE PURSUANT TO
 SUBPARAGRAPH  (B) OR (D) OF THIS PARAGRAPH, SHALL BE SUBJECT TO THE SAME
 PROVISIONS OF THIS CHAPTER AS A CERTIFICATE ACTUALLY DELIVERED OR ISSUED
 FOR DELIVERY IN THIS STATE.
   (II) AN INSURER SHALL ISSUE TO THE GROUP OR PERSON IN WHOSE  NAME  THE
 POLICY OR CONTRACT IS ISSUED, FOR DELIVERY TO EACH MEMBER OF THE INSURED
 GROUP,  A  CERTIFICATE  SETTING FORTH IN SUMMARY FORM A STATEMENT OF THE
 ESSENTIAL FEATURES OF THE INSURANCE COVERAGE.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "INSTITUTION OF HIGHER EDUCATION" SHALL HAVE THE MEANING SET FORTH
 IN PARAGRAPH TWO OF SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED
 FORTY OF THIS ARTICLE;
   (II) "PRINCIPAL PLACE OF BUSINESS"  SHALL  MEAN  THE  PLACE  WHERE  AN
 EMPLOYER  MAINTAINS  ITS HEADQUARTERS OR WHERE THE EMPLOYER'S HIGH-LEVEL
 OFFICERS DIRECT, CONTROL, AND COORDINATE THE BUSINESS ACTIVITIES; AND
   (III) "RESIDENT OF THIS STATE" SHALL INCLUDE A STUDENT WHO IS ENROLLED
 IN AN INSTITUTION OF HIGHER EDUCATION IN THIS STATE THAT OFFERS COVERAGE
 TO THE STUDENT THROUGH A GROUP OR BLANKET POLICY OR CONTRACT.
   § 5. Subparagraph (E) of paragraph 3 of subsection (a) of section 4237
 of the insurance law is amended to read as follows:
   (E) Under a policy or contract issued to  [and  in  the  name  of]  an
 [incorporated or unincorporated] association [of persons having a common
 interest or calling, which association shall be deemed the policyholder,
 having  not  less  than  fifty members, covering all the members of such
 association or if part or all of] OR THE TRUSTEE OR TRUSTEES OF A  TRUST
 ESTABLISHED,  OR PARTICIPATED IN, BY ONE OR MORE ASSOCIATIONS, TO INSURE
 ASSOCIATION MEMBERS, SUBJECT TO THE FOLLOWING:
   (I) EACH ASSOCIATION SHALL HAVE:
   (I) A MINIMUM OF TWO HUNDRED INSURED  INDIVIDUALS  AT  THE  POLICY  OR
 CONTRACT'S DATE OF ISSUE;
   (II)  BEEN ORGANIZED AND MAINTAINED IN GOOD FAITH FOR PURPOSES PRINCI-
 PALLY OTHER THAN THAT OF OBTAINING INSURANCE;
   (III) BEEN IN ACTIVE EXISTENCE FOR AT LEAST TWO YEARS; AND
   (IV) A CONSTITUTION AND BY-LAWS THAT PROVIDE THAT:
   (AA) THE ASSOCIATION HOLD REGULAR MEETINGS NOT LESS THAN  ANNUALLY  TO
 FURTHER THE PURPOSES OF THE ASSOCIATION;
   (BB)  THE  ASSOCIATION  COLLECT  DUES  OR  SOLICIT  CONTRIBUTIONS FROM
 MEMBERS; AND
   (CC) THE MEMBERS HAVE VOTING  PRIVILEGES  AND  REPRESENTATION  ON  THE
 GOVERNING BOARD AND COMMITTEES;
   (II)  the  premium [is to be derived] FOR THE POLICY OR CONTRACT SHALL
 BE PAID BY THE ASSOCIATION OR THE  TRUSTEES  EITHER  WHOLLY  from  funds
 contributed  by  the  ASSOCIATION  OR BY THE insured [members and if the
 opportunity to take such insurance is offered to all eligible]  INDIVID-
 UALS,  OR  FROM FUNDS CONTRIBUTED JOINTLY BY THE ASSOCIATION AND INSURED
 [members, then such] INDIVIDUALS. A policy [must  cover  not  less  than
 seventy-five  percent  of  any class or classes of members determined by
 conditions pertaining to membership in the association] OR  CONTRACT  ON
 WHICH  NO PART OF THE PREMIUM IS TO BE DERIVED FROM FUNDS CONTRIBUTED BY
 THE INSURED INDIVIDUALS SPECIFICALLY FOR THEIR  INSURANCE  SHALL  INSURE
 ALL  ELIGIBLE INDIVIDUALS, EXCLUDING ANY AS TO WHOM EVIDENCE OF INDIVID-

 S. 1507                            77                            A. 2007

 UAL INSURABILITY IS NOT  SATISFACTORY  TO  THE  INSURER  TO  THE  EXTENT
 PERMITTED BY LAW;
   (III)  THE  AMOUNT  OF INSURANCE UNDER THE POLICY OR CONTRACT SHALL BE
 BASED UPON SOME PLAN  PRECLUDING  INDIVIDUAL  SELECTION  EITHER  BY  THE
 INSURED  INDIVIDUALS  OR BY THE ASSOCIATION. HOWEVER, WITH RESPECT TO AN
 ASSOCIATION, SUCH A PLAN MAY PERMIT A NUMBER OF SELECTIONS BY THE  ASSO-
 CIATION  IF THE SELECTIONS OFFERED UTILIZE CONSISTENT PLANS OF INSURANCE
 SO THAT THE RESULTING PLANS OF  COVERAGE  ARE  REASONABLE.  FURTHERMORE,
 SUCH  A  PLAN MAY PERMIT A LIMITED NUMBER OF SELECTIONS BY INSURED INDI-
 VIDUALS IF THE SELECTIONS OFFERED UTILIZE CONSISTENT PLANS OF  INSURANCE
 FOR  INSURED  INDIVIDUALS  SO  THAT  THE RESULTING PLANS OF COVERAGE ARE
 REASONABLE.
   (IV) EXCEPT AS PROVIDED IN SUBSECTION (B) OF THIS SECTION, SUCH POLICY
 OR CONTRACT SHALL PROVIDE FOR THE PAYMENT  OF  BENEFITS  TO  THE  PERSON
 INSURED  OR  TO SOME BENEFICIARY OR BENEFICIARIES OTHER THAN THE ASSOCI-
 ATION OR ANY OFFICIALS, REPRESENTATIVES, TRUSTEES OR AGENTS THEREOF  AND
 SHALL  PROVIDE  FOR THE ISSUANCE OF A CERTIFICATE TO THE ASSOCIATION FOR
 DELIVERY TO THE INSURED INDIVIDUAL OR SUCH BENEFICIARY, AS  EVIDENCE  OF
 SUCH INSURANCE.
   (V)  THE PREMIUMS CHARGED SHALL BE REASONABLE IN RELATION TO THE BENE-
 FITS PROVIDED.
   § 6. Subsection (d) of section 4237-a of the insurance law, as amended
 by chapter 599 of the laws of 2003, is amended to read as follows:
   (d) No stop-loss insurance contract shall be DELIVERED OR  issued  [or
 renewed]  FOR  DELIVERY IN OR OUTSIDE THIS STATE BY AN INSURER OR HEALTH
 SERVICE CORPORATION:
   (1) TO A NEW YORK  EMPLOYER  WITH  ONE  HUNDRED  OR  FEWER  EMPLOYEES,
 PROVIDED  THAT  "NEW  YORK  EMPLOYER"  SHALL MEAN AN EMPLOYER WHO HAS AT
 LEAST ONE EMPLOYEE THAT WORKS IN THIS STATE; OR
   (2) if issuance of the policy would be prohibited by section two thou-
 sand six hundred thirteen, three thousand two hundred  thirty-one,  four
 thousand  three  hundred seventeen or four thousand three hundred twenty
 of this chapter.
   § 7. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply to all policies and contracts
 issued, renewed, modified, altered, or amended on or  after  such  date.
 Effective immediately:
   (1)  the superintendent of financial services may promulgate any rules
 or regulations necessary for the implementation  of  the  provisions  of
 this act on its effective date; and
   (2)  insurers  may submit to the superintendent and the superintendent
 may approve filings necessary to comply with the provisions of this  act
 on its effective date.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or subpart of this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or  subpart  thereof  directly involved in the controversy in which such
 judgment shall have been rendered. It  is  hereby  declared  to  be  the
 intent  of the legislature that this act would have been enacted even if
 such invalid provisions had not been included herein.
   § 3. Interpretations by  the  superintendent.  The  superintendent  of
 financial  services  has  special  expertise and experience in the regu-
 lation of insurance in this state. As such his or her interpretations of
 the insurance law shall be afforded the highest level of deference.

 S. 1507                            78                            A. 2007
 
   § 4. Legislative intent. It is hereby declared to be the intent of the
 legislature in enacting this act, that the laws of  this  state  provide
 consumer  and  market  protections at least as robust as those under the
 federal Patient Protection and Affordable Care Act, public law  111-148,
 as that law existed and was interpreted on January 19, 2017. In addition
 to  any  other  power  conferred by law, the superintendent of financial
 services is hereby  specifically  empowered  to  promulgate  regulations
 under,  and  issue  interpretations  of, this act as necessary to ensure
 that the intent of the legislature as expressed in this section is real-
 ized.
   § 5. This act shall take effect immediately  provided,  however,  that
 the  applicable effective date of Subparts A through F of this act shall
 be as specifically set forth in the last section of such Subparts.
 
                                  PART K
 
   Section 1. Subdivisions 4 and 5 of section 2999-h of the public health
 law, as added by section 52 of part H of chapter 59 of the laws of 2011,
 are amended to read as follows:
   4. "Qualified plaintiff" means every plaintiff or claimant who (i) has
 been found by a jury or court to have sustained a  birth-related  neuro-
 logical  injury  as  the  result  of  medical  malpractice,  or (ii) has
 sustained a birth-related neurological injury as the result  of  alleged
 medical  malpractice, and has settled his or her lawsuit or claim there-
 for; AND (III) HAS BEEN ORDERED TO BE ENROLLED IN THE FUND BY A COURT IN
 NEW YORK STATE.
   [5. Any reference to the "department of financial  services"  and  the
 "superintendent  of  financial services" in this title shall mean, prior
 to October third, two thousand eleven, respectively, the "department  of
 insurance" and "superintendent of insurance."]
   §  2.  Section 2999-i of the public health law, as added by section 52
 of part H of chapter 59 of the laws of 2011, subdivision 1 as amended by
 section 29 of part D of chapter 56 of the laws of 2012,  is  amended  to
 read as follows:
   §  2999-i. Custody and administration of the fund.  1. (a) The commis-
 sioner of taxation and finance shall be the custodian of  the  fund  and
 the special account established pursuant to section ninety-nine-t of the
 state  finance  law.  All  payments  from  the fund shall be made by the
 commissioner of taxation and finance upon  certificates  signed  by  the
 [superintendent  of  financial  services]  COMMISSIONER,  or  his or her
 designee, as hereinafter provided. The fund shall be separate and  apart
 from  any other fund and from all other state monies; provided, however,
 that monies of the fund may be invested as set forth in paragraph (b) of
 this subdivision. No monies from the fund shall be  transferred  to  any
 other  fund,  nor  shall any such monies be applied to the making of any
 payment for any purpose other than the purpose set forth in this title.
   (b) Any monies of the fund not required for immediate use may, at  the
 discretion  of  the commissioner [of financial services] in consultation
 with [the commissioner of health and] the director  of  the  budget,  be
 invested  by  the commissioner of taxation and finance in obligations of
 the United States or the state or obligations the principal and interest
 of which are guaranteed by the United States or the state. The  proceeds
 of  any  such  investment  shall be retained by the fund as assets to be
 used for the purposes of the fund.

 S. 1507                            79                            A. 2007
 
   2. (a) The fund shall be administered by the [superintendent of finan-
 cial services] COMMISSIONER or his or her designee  in  accordance  with
 the provisions of this article.
   (b) The [superintendent of financial services] COMMISSIONER shall have
 all powers necessary and proper to carry out the purposes of the fund.
   (c)  Notwithstanding  any contrary provision of this section, sections
 one hundred twelve and one hundred sixty-three of the state finance  law
 or  any other contrary provision of law, the superintendent of financial
 services is authorized to [enter into a contract or contracts without  a
 competitive bid or request for proposal process for purposes of adminis-
 tering  the  fund for the first year of its operation and in preparation
 therefor] ASSIGN AND THE COMMISSIONER IS AUTHORIZED TO  RECEIVE  ASSIGN-
 MENT  OF  ANY  AND  ALL  CONTRACTS ENTERED INTO BY THE SUPERINTENDENT OF
 FINANCIAL SERVICES TO ADMINISTER THE FUND FOR PERIODS PRIOR  TO  OCTOBER
 FIRST, TWO THOUSAND NINETEEN.
   (d)  The  department  [of financial services and the department] shall
 post on [their websites] ITS WEBSITE information about the fund[, eligi-
 bility for enrollment in the fund,] and the process  for  enrollment  in
 the fund.
   3.  The  expense  of  administering  the fund[, including the expenses
 incurred by the department,] shall be paid from the fund.
   4. Monies for the fund will be provided pursuant to this chapter.
   5. For the state fiscal year beginning April first, two thousand elev-
 en and ending March thirty-first, two thousand twelve, the state  fiscal
 year  beginning  April first, two thousand twelve and ending March thir-
 ty-first, two thousand thirteen, and the  state  fiscal  year  beginning
 April  first,  two  thousand thirteen and ending March thirty-first, two
 thousand fourteen, the superintendent of financial services shall  cause
 to  be  deposited  into  the  fund  for each such fiscal year the amount
 appropriated for such purpose. Beginning April first, two thousand four-
 teen and annually thereafter, the superintendent of  financial  services
 OR  THE COMMISSIONER, WHOEVER IS ADMINISTERING THE FUND FOR THE APPLICA-
 BLE PERIOD shall cause to be deposited into the fund, subject to  avail-
 able  appropriations,  an  amount  equal  to  the difference between the
 amount appropriated to  the  fund  in  the  preceding  fiscal  year,  as
 increased  by the adjustment factor defined in subdivision seven of this
 section, and the assets of the fund at the  conclusion  of  that  fiscal
 year.
   6.  (a)  Following  the deposit referenced in subdivision five of this
 section, the [superintendent of financial services]  COMMISSIONER  shall
 conduct  an  actuarial  calculation  of the estimated liabilities of the
 fund for  the  coming  year  resulting  from  the  qualified  plaintiffs
 enrolled  in  the fund. The administrator shall from time to time adjust
 such calculation IN ACCORDANCE WITH SUBDIVISION SEVEN OF  THIS  SECTION.
 If  the  total of all estimates of current liabilities equals or exceeds
 eighty percent of the fund's assets, then the fund shall not accept  any
 new  enrollments  until a new deposit has been made pursuant to subdivi-
 sion five of this section. When, as a result of such  new  deposit,  the
 fund's liabilities no longer exceed eighty percent of the fund's assets,
 the  fund  administrator  shall  enroll  new qualified plaintiffs in the
 order that an application for enrollment has been submitted  in  accord-
 ance with subdivision seven of section twenty-nine hundred ninety-nine-j
 of this title.
   (b) Whenever enrollment is suspended pursuant to paragraph (a) of this
 subdivision  and  until such time as enrollment resumes pursuant to such
 paragraph: (i) notice of such suspension shall be promptly posted on the

 S. 1507                            80                            A. 2007
 
 department's website [and on the website of the department of  financial
 services];  (ii)  the fund administrator shall deny each application for
 enrollment that had been received but not accepted prior to the date  of
 suspension  and  each application for enrollment received after the date
 of such suspension; and (iii) notification of each such denial shall  be
 made to the plaintiff or claimant or persons authorized to act on behalf
 of  such  plaintiff  or  claimant  and  all defendants in regard to such
 plaintiff or claimant, to the extent they are known to the fund adminis-
 trator. Judgments and settlements for plaintiffs or claimants  for  whom
 applications are denied under this paragraph or who are not eligible for
 enrollment  due to suspension pursuant to paragraph (a) of this subdivi-
 sion shall be satisfied as if this title had not been enacted.
   (c) Following a suspension, whenever enrollment  resumes  pursuant  to
 paragraph  (a)  of  this subdivision, notice that enrollment has resumed
 shall be promptly posted on the department's website [and on the website
 of the department of financial services].
   (d) The suspension of enrollment pursuant to  paragraph  (a)  of  this
 subdivision  shall  not  impact payment under the fund for any qualified
 plaintiffs already enrolled in the fund.
   7. For purposes of this section, the adjustment factor  referenced  in
 this  section shall be the ten year rolling average medical component of
 the consumer price index as published by the United States department of
 labor, bureau of labor statistics, for the preceding ten years.
   § 3. Subdivisions 2, 5, 6, 7, 9, 11, 12, 15 and 16 of  section  2999-j
 of the public health law, subdivision 2 as amended by chapter 517 of the
 laws  of 2016, paragraph (c) of subdivision 2 as amended by chapter 4 of
 the laws of 2017, and subdivisions 5, 6, 7, 9, 11,  12,  15  and  16  as
 added  by  section  52  of part H of chapter 59 of the laws of 2011, are
 amended to read as follows:
   2. The provision of qualifying health care costs to  qualified  plain-
 tiffs  shall  not be subject to prior authorization, except as described
 by the commissioner in regulation; provided, however:
   (a) such  regulation  shall  not  prevent  qualified  plaintiffs  from
 receiving  care  or  assistance  that would, at a minimum, be authorized
 under the medicaid program;
   (b) if any prior authorization is required  by  such  regulation,  the
 regulation  shall require that requests for prior authorization be proc-
 essed within a reasonably prompt period of time  and[,  subject  to  the
 provisions of subdivision two-a of this section,] shall identify a proc-
 ess  for  prompt  administrative  review  of any denial of a request for
 prior authorization; and
   (c) such regulations shall not prohibit qualifying health  care  costs
 on  the  grounds  that  the qualifying health care cost may incidentally
 benefit other members of the household, provided that whether the quali-
 fying health care cost primarily benefits the patient may be considered.
   5. Claims for the payment or reimbursement from the fund of qualifying
 health care costs shall be made upon forms prescribed and  furnished  by
 the  fund  administrator  [in consultation with the commissioner and] in
 conjunction with regulations establishing a mechanism for submission  of
 claims by health care providers directly to the fund, where practicable.
   6.  (a)  Every  settlement  agreement  for  claims  arising  out  of a
 plaintiff's or claimant's birth related neurological injury  subject  to
 this title, and that provides for the payment of future medical expenses
 for  the  plaintiff  or  claimant,  shall provide that [in the event the
 administrator of the fund determines that the plaintiff or claimant is a
 qualified plaintiff,] all payments for future medical expenses shall  be

 S. 1507                            81                            A. 2007
 
 paid  in  accordance  with  this title[,] in lieu of that portion of the
 settlement agreement that provides for payment  of  such  expenses.  The
 plaintiff's  or  claimant's  future  medical  expenses  shall be paid in
 accordance with this title. When such a settlement agreement does not so
 provide,  the  court  shall  direct the modification of the agreement to
 include such term as a condition of court approval.
   (b) In any case where the jury or court has made an award  for  future
 medical expenses arising out of a birth related neurological injury, any
 party to such action or person authorized to act on behalf of such party
 may  make  application  to  the court that the judgment reflect that, in
 lieu of that portion of the award that  provides  for  payment  of  such
 expenses,  [and  upon a determination by the fund administrator that the
 plaintiff is a qualified plaintiff,] the future medical expenses of  the
 plaintiff  shall  be paid out of the fund in accordance with this title.
 Upon a finding by the court that the applicant has made  a  prima  facie
 showing  that  the  plaintiff  is a qualified plaintiff, the court shall
 ensure that the judgment so provides.
   7. A qualified plaintiff shall be enrolled when (a) such plaintiff  or
 person  authorized  to  act on behalf of such person, upon notice to all
 defendants, or any of the defendants in regard to the plaintiff's claim,
 upon notice to such plaintiff, makes an application  for  enrollment  by
 providing  the  fund administrator with a certified copy of the judgment
 or of the court approved settlement agreement; and (b) the fund adminis-
 trator determines [upon the basis of such judgment or settlement  agree-
 ment  and  any  additional  information  the  fund  administrator  shall
 request] that the relevant provisions of subdivision six of this section
 have been met  [and  that  the  plaintiff  is  a  qualified  plaintiff];
 provided  that  no  enrollment  shall  occur  when the fund is closed to
 enrollment pursuant to subdivision six of  section  twenty-nine  hundred
 ninety-nine-i of this title.
   9.  Payments  from the fund shall be made by the commissioner of taxa-
 tion and finance on the  said  certificate  of  the  [superintendent  of
 financial  services]  COMMISSIONER.    No  payment  shall be made by the
 commissioner of taxation and finance in excess of the amount  certified.
 Promptly  upon receipt of the said certificate of the [superintendent of
 financial services]  COMMISSIONER,  the  commissioner  of  taxation  and
 finance  shall  pay  the  qualified  plaintiff's health care provider or
 reimburse the qualified plaintiff the amount so certified for payment.
   11. All health care providers shall accept from qualified  plaintiff's
 or  persons  authorized to act on behalf of such plaintiff's assignments
 of the right to receive payments from the  fund  for  qualifying  health
 care  costs.  SUCH  PAYMENTS  SHALL  CONSTITUTE  PAYMENT IN FULL FOR ANY
 SERVICES PROVIDED TO A QUALIFIED PLAINTIFF IN ACCORDANCE WITH THIS ARTI-
 CLE.
   12. Health insurers (other than medicare and Medicaid)  shall  be  the
 primary  payers of qualifying health care costs of qualified plaintiffs.
 Such costs shall be paid from the fund only to the  extent  that  health
 insurers  or other collateral sources or other persons are not otherwise
 obligated to make payments therefor. Health insurers that make  payments
 for qualifying health care costs to or on behalf of qualified plaintiffs
 shall  have no right of recovery against and shall have no lien upon the
 fund or any person or entity nor shall the fund constitute an additional
 payment source to offset the payments otherwise  contractually  required
 to  be  made  by  such  health insurers. The superintendent of financial
 services shall have the authority to  enforce  the  provisions  of  this
 subdivision UPON THE REFERRAL OF THE COMMISSIONER.

 S. 1507                            82                            A. 2007
 
   15.  The  commissioner[,  in  consultation  with the superintendent of
 financial services,] shall promulgate, amend and enforce all  rules  and
 regulations  necessary  for  the  proper  administration  of the fund in
 accordance with the provisions  of  this  section,  including,  but  not
 limited  to,  those  concerning the payment of claims and concerning the
 actuarial calculations  necessary  to  determine,  annually,  the  total
 amount  to  be  paid  into the fund as provided herein, and as otherwise
 needed to implement this title.
   [16. The commissioner shall convene a consumer advisory committee  for
 the  purpose of providing information, as requested by the commissioner,
 in the development of the regulations authorized by subdivision  fifteen
 of this section.]
   § 4. Section 5 of chapter 517 of the laws of 2016, amending the public
 health  law  relating to payments from the New York state medical indem-
 nity fund, as amended by chapter 4 of the laws of 2017,  is  amended  to
 read as follows:
   §  5. This act shall take effect on the forty-fifth day after it shall
 have become a law, provided that the  amendments  to  subdivision  4  of
 section  2999-j of the public health law made by section two of this act
 shall take effect on June 30,  2017  and  shall  expire  and  be  deemed
 repealed December 31, [2019] 2020.
   §  5.  Section 99-t of the state finance law, as added by section 52-e
 of part H of chapter 59 of the laws of  2011,  is  amended  to  read  as
 follows:
   §  99-t.  New  York  state medical indemnity fund account. 1. There is
 hereby established in the custody of the commissioner  of  taxation  and
 finance  a  special  account  to be known as the "New York state medical
 indemnity fund account".
   2. All moneys received by the New York state  medical  indemnity  fund
 pursuant to title four of article twenty-nine-D of the public health law
 from  whatever source derived shall be deposited to the exclusive credit
 of such fund account. Said moneys shall be kept separate and  shall  not
 be  commingled  with any other moneys in the custody of the commissioner
 of taxation and finance.
   3. The moneys in said account shall be retained by the fund and  shall
 be  released  by  the  commissioner  of  taxation  and finance only upon
 certificates signed by the [superintendent of financial services or  the
 head of any successor agency to the department of insurance] COMMISSION-
 ER  OF HEALTH or his or her designee and only for the purposes set forth
 in title four of article twenty-nine-D of the public health law.
   § 6. This act shall take effect October 1, 2019; provided however,  on
 and  after  April 1, 2019, the commissioner of health may take any steps
 necessary to implement this act on its effective date; and notwithstand-
 ing any inconsistent provision of the state administrative procedure act
 or any other provision of law, rule or regulation, the  commissioner  of
 health  is  authorized  to  adopt or amend or promulgate on an emergency
 basis any regulation he or she determines  necessary  to  implement  any
 provision of this act on its effective date.
 
                                  PART L
 
   Section  1.  Subparagraph  (C)  of  paragraph  6  of subsection (k) of
 section 3221 of the insurance law, as amended by section 1 of part K  of
 chapter 82 of the laws of 2002, is amended to read as follows:
   (C)   Coverage  of  diagnostic  and  treatment  procedures,  including
 prescription drugs, used in the diagnosis and treatment  of  infertility

 S. 1507                            83                            A. 2007

 as  required  by  subparagraphs  (A)  and (B) of this paragraph shall be
 provided in accordance with the provisions of this subparagraph.
   (i)  [Coverage]  EXCEPT  AS  PROVIDED  IN ITEMS (VI) AND (VII) OF THIS
 SUBPARAGRAPH, COVERAGE shall be provided for persons  whose  ages  range
 from  twenty-one  through forty-four years, provided that nothing herein
 shall preclude the provision of coverage to persons whose age  is  below
 or above such range.
   (ii)  Diagnosis  and  treatment  of infertility shall be prescribed as
 part of a physician's overall plan  of  care  and  consistent  with  the
 guidelines for coverage as referenced in this subparagraph.
   (iii)  Coverage may be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (iv) [Coverage shall be limited to those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided  that for the purposes of this subparagraph "period of
 not less than twelve months" shall be  determined  by  calculating  such
 time from either the date the insured was first covered under the exist-
 ing policy or from the date the insured was first covered by a previous-
 ly in-force converted policy, whichever is earlier.
   (v)  Coverage]  EXCEPT  AS  PROVIDED  IN  ITEMS (VI) AND (VII) OF THIS
 SUBPARAGRAPH, COVERAGE shall not be required to  include  the  diagnosis
 and treatment of infertility in connection with: (I) in vitro fertiliza-
 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
 transfers;  (II)  the  reversal  of  elective  sterilizations; (III) sex
 change procedures; (IV) cloning; or (V) medical or surgical services  or
 procedures  that  are deemed to be experimental in accordance with clin-
 ical guidelines referenced in [clause (vi)] ITEM (V)  of  this  subpara-
 graph.
   [(vi)]  (V)  The superintendent, in consultation with the commissioner
 of health, shall promulgate regulations which shall stipulate the guide-
 lines and standards which shall be used in carrying out  the  provisions
 of this subparagraph, which shall include:
   (I)  The  determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine INCLUDING "IATROGENIC INFERTILITY", WHICH MEANS AN IMPAIR-
 MENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHERAPY OR  OTHER  MEDICAL
 TREATMENT AFFECTING REPRODUCTIVE ORGANS OR PROCESSES;
   (II)  The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   (III) The identification of  the  required  training,  experience  and
 other  standards  for  health care providers for the provision of proce-
 dures and treatments for the  diagnosis  and  treatment  of  infertility
 determined  in  accordance with the standards and guidelines established
 and adopted by the American College of Obstetricians  and  Gynecologists
 and the American Society for Reproductive Medicine; and
   (IV) The determination of appropriate medical candidates by the treat-
 ing  physician  in  accordance  with the standards and guidelines estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.

 S. 1507                            84                            A. 2007
 
   (VI) COVERAGE  SHALL  ALSO  INCLUDE  STANDARD  FERTILITY  PRESERVATION
 SERVICES  WHEN  A  MEDICAL  TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE
 IATROGENIC INFERTILITY TO AN INSURED. COVERAGE MAY BE SUBJECT TO  ANNUAL
 DEDUCTIBLES  AND  COINSURANCE,  INCLUDING  COPAYMENTS,  AS MAY BE DEEMED
 APPROPRIATE  BY  THE  SUPERINTENDENT  AND  AS  ARE CONSISTENT WITH THOSE
 ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   (VII) EVERY LARGE GROUP POLICY DELIVERED OR  ISSUED  FOR  DELIVERY  IN
 THIS  STATE  THAT  PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHEN-
 SIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR THREE CYCLES  OF  IN-VITRO
 FERTILIZATION  USED IN THE TREATMENT OF INFERTILITY AS DEFINED IN CLAUSE
 (I) OF ITEM (V) OF THIS SUBPARAGRAPH. COVERAGE MAY BE SUBJECT TO  ANNUAL
 DEDUCTIBLES  AND  COINSURANCE,  INCLUDING  COPAYMENTS,  AS MAY BE DEEMED
 APPROPRIATE BY THE SUPERINTENDENT  AND  AS  ARE  CONSISTENT  WITH  THOSE
 ESTABLISHED  FOR  OTHER  BENEFITS WITHIN A GIVEN POLICY. FOR PURPOSES OF
 THIS ITEM, A "CYCLE" IS DEFINED AS  EITHER  ALL  TREATMENT  THAT  STARTS
 WHEN:   PREPARATORY MEDICATIONS ARE ADMINISTERED FOR OVARIAN STIMULATION
 FOR OOCYTE RETRIEVAL WITH THE INTENT OF UNDERGOING  IN-VITRO  FERTILIZA-
 TION  USING A FRESH EMBRYO TRANSFER; OR MEDICATIONS ARE ADMINISTERED FOR
 ENDOMETRIAL PREPARATION WITH THE INTENT OF UNDERGOING IN-VITRO  FERTILI-
 ZATION  USING  A  FROZEN  EMBRYO TRANSFER. NO INSURER PROVIDING COVERAGE
 UNDER THIS ITEM OR ITEM (VI) OF  THIS  SUBPARAGRAPH  SHALL  DISCRIMINATE
 BASED  ON  AN  INSURED'S  EXPECTED  LENGTH OF LIFE, PRESENT OF PREDICTED
 DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF LIFE,  OR
 OTHER  HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS, INCLUD-
 ING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTITY.
   § 2. Paragraph 3 of subsection (s) of section 4303  of  the  insurance
 law,  as  amended  by  section  2 of part K of chapter 82 of the laws of
 2002, is amended to read as follows:
   (3)  Coverage  of  diagnostic  and  treatment  procedures,   including
 prescription drugs used in the diagnosis and treatment of infertility as
 required  by paragraphs one and two of this subsection shall be provided
 in accordance with this paragraph.
   (A) [Coverage] EXCEPT AS PROVIDED IN SUBPARAGRAPHS (F) AND (G) OF THIS
 PARAGRAPH, COVERAGE shall be provided for persons whose ages range  from
 twenty-one  through forty-four years, provided that nothing herein shall
 preclude the provision of coverage to persons  whose  age  is  below  or
 above such range.
   (B) Diagnosis and treatment of infertility shall be prescribed as part
 of a physician's overall plan of care and consistent with the guidelines
 for coverage as referenced in this paragraph.
   (C)  Coverage  may  be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (D) [Coverage shall be limited to  those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided that for the purposes of this paragraph "period of not
 less than twelve months" shall be determined by  calculating  such  time
 from  either  the  date the insured was first covered under the existing
 policy or from the date the insured was first covered  by  a  previously
 in-force converted policy, whichever is earlier.
   (E)  Coverage] EXCEPT AS PROVIDED IN SUBPARAGRAPHS (F) AND (G) OF THIS
 PARAGRAPH, COVERAGE shall not be required to include the  diagnosis  and
 treatment of infertility in connection with: (i) in vitro fertilization,
 gamete  intrafallopian  tube  transfers  or  zygote  intrafallopian tube
 transfers; (ii) the  reversal  of  elective  sterilizations;  (iii)  sex

 S. 1507                            85                            A. 2007

 change  procedures; (iv) cloning; or (v) medical or surgical services or
 procedures that are deemed to be experimental in accordance  with  clin-
 ical guidelines referenced in subparagraph [(F)] (E) of this paragraph.
   [(F)] (E) The superintendent, in consultation with the commissioner of
 health,  shall  promulgate  regulations which shall stipulate the guide-
 lines and standards which shall be used in carrying out  the  provisions
 of this paragraph, which shall include:
   (i)  The  determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine;
   (ii) The identification of experimental procedures and treatments  not
 covered  for  the  diagnosis  and treatment of infertility determined in
 accordance with the standards and guidelines established and adopted  by
 the American College of Obstetricians and Gynecologists and the American
 Society  for  Reproductive  Medicine INCLUDING "IATROGENIC INFERTILITY",
 WHICH MEANS AN IMPAIRMENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHER-
 APY OR OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE  ORGANS  OR  PROC-
 ESSES;
   (iii)  The  identification  of  the  required training, experience and
 other standards for health care providers for the  provision  of  proce-
 dures  and  treatments  for  the  diagnosis and treatment of infertility
 determined in accordance with the standards and  guidelines  established
 and  adopted  by the American College of Obstetricians and Gynecologists
 and the American Society for Reproductive Medicine; and
   (iv) The determination of appropriate medical candidates by the treat-
 ing physician in accordance with the  standards  and  guidelines  estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.
   (F)  COVERAGE  SHALL  ALSO  INCLUDE  STANDARD  FERTILITY  PRESERVATION
 SERVICES WHEN A MEDICAL  TREATMENT  MAY  DIRECTLY  OR  INDIRECTLY  CAUSE
 IATROGENIC  INFERTILITY TO AN INSURED. COVERAGE MAY BE SUBJECT TO ANNUAL
 DEDUCTIBLES AND COINSURANCE, INCLUDING  COPAYMENTS,  AS  MAY  BE  DEEMED
 APPROPRIATE  BY  THE  SUPERINTENDENT  AND  AS  ARE CONSISTENT WITH THOSE
 ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN CONTRACT.
   (G) EVERY LARGE GROUP CONTRACT THAT PROVIDES MEDICAL, MAJOR MEDICAL OR
 SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL  PROVIDE  COVERAGE  FOR  THREE
 CYCLES OF IN-VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY AS
 DEFINED  IN ITEM (I) OF SUBPARAGRAPH (E) OF THIS PARAGRAPH. COVERAGE MAY
 BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE, INCLUDING  COPAYMENTS,
 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
 WITH  THOSE  ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN CONTRACT. FOR
 PURPOSES OF THIS SUBPARAGRAPH, A "CYCLE" IS DEFINED AS EITHER ALL TREAT-
 MENT THAT STARTS WHEN:   PREPARATORY MEDICATIONS  ARE  ADMINISTERED  FOR
 OVARIAN  STIMULATION  FOR OOCYTE RETRIEVAL WITH THE INTENT OF UNDERGOING
 IN-VITRO FERTILIZATION USING A FRESH EMBRYO TRANSFER; OR MEDICATIONS ARE
 ADMINISTERED FOR ENDOMETRIAL PREPARATION WITH THE INTENT  OF  UNDERGOING
 IN-VITRO  FERTILIZATION  USING  A FROZEN EMBRYO TRANSFER. NO CORPORATION
 PROVIDING COVERAGE UNDER SUBPARAGRAPHS (F)  OR  (G)  OF  THIS  PARAGRAPH
 SHALL  DISCRIMINATE BASED ON AN INSURED'S EXPECTED LENGTH OF LIFE, PRES-
 ENT OR PREDICTED DISABILITY, DEGREE  OF  MEDICAL  DEPENDENCY,  PERCEIVED
 QUALITY OF LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHAR-
 ACTERISTICS,  INCLUDING  AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR
 GENDER IDENTITY.
   § 3. Paragraph 13 of subsection (i) of section 3216 of  the  insurance
 law is amended by adding a new subparagraph (C) to read as follows:

 S. 1507                            86                            A. 2007
 
   (C)  EVERY  POLICY  THAT  PROVIDES  MEDICAL,  MAJOR MEDICAL OR SIMILAR
 COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR STANDARD FERTILI-
 TY PRESERVATION SERVICES WHEN A MEDICAL TREATMENT MAY DIRECTLY OR  INDI-
 RECTLY  CAUSE  IATROGENIC  INFERTILITY  TO  AN  INSURED. COVERAGE MAY BE
 SUBJECT  TO ANNUAL DEDUCTIBLES AND COINSURANCE, INCLUDING COPAYMENTS, AS
 MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND  AS  ARE  CONSISTENT
 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   (I)  FOR PURPOSES OF THIS SUBPARAGRAPH, "IATROGENIC INFERTILITY" MEANS
 AN IMPAIRMENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHERAPY OR  OTHER
 MEDICAL TREATMENT AFFECTING REPRODUCTIVE ORGANS OR PROCESSES.
   (II) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIM-
 INATE  BASED  ON  AN  INSURED'S  EXPECTED  LENGTH  OF  LIFE,  PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   § 4. This act shall take effect January 1, 2020  and  shall  apply  to
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                  PART M
 
   Section 1. This act shall be known and may be cited as the "comprehen-
 sive contraception coverage act".
   § 2. Paragraph 16 of subsection (l) of section 3221 of  the  insurance
 law,  as added by chapter 554 of the laws of 2002, is amended to read as
 follows:
   (16) (A) Every group or blanket policy which  [provides  coverage  for
 prescription  drugs shall include coverage for the cost of contraceptive
 drugs or devices approved by the federal food and drug administration or
 generic equivalents approved as substitutes by such food and drug admin-
 istration under the prescription  of  a  health  care  provider  legally
 authorized  to  prescribe  under  title  eight of the education law. The
 coverage required by this section shall  be  included  in  policies  and
 certificates only through the addition of a rider.
   (A)]  PROVIDES  MEDICAL,  MAJOR  MEDICAL OR SIMILAR COMPREHENSIVE-TYPE
 COVERAGE SHALL PROVIDE COVERAGE FOR ALL OF THE  FOLLOWING  SERVICES  AND
 CONTRACEPTIVE METHODS:
   (I) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS  INCLUDES  ALL  FDA-APPROVED  OVER-THE-COUNTER CONTRACEPTIVE DRUGS,
 DEVICES, AND PRODUCTS AS PRESCRIBED OR  AS  OTHERWISE  AUTHORIZED  UNDER
 STATE  OR FEDERAL LAW.  NOTWITHSTANDING THIS PARAGRAPH, AN INSURER SHALL
 NOT BE REQUIRED TO PROVIDE COVERAGE OF  MALE  CONDOMS.    THE  FOLLOWING
 APPLIES TO THIS COVERAGE:
   (I)  WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND PHARMACEU-
 TICAL EQUIVALENT, AS DEFINED BY THE FDA,  VERSIONS  OF  A  CONTRACEPTIVE
 DRUG, DEVICE, OR PRODUCT, AN INSURER IS NOT REQUIRED TO INCLUDE ALL SUCH
 THERAPEUTIC  AND PHARMACEUTICAL EQUIVALENT VERSIONS IN ITS FORMULARY, SO
 LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING AND IN
 ACCORDANCE WITH THIS PARAGRAPH;
   (II) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED  MEDICALLY
 INADVISABLE,  THE INSURER SHALL PROVIDE COVERAGE FOR AN ALTERNATE THERA-
 PEUTIC AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE  DRUG,
 DEVICE,  OR  PRODUCT WITHOUT COST-SHARING UPON THE RECOMMENDATION OF THE
 INSURED'S ATTENDING HEALTH CARE PROVIDER. AN INSURER SHALL DEFER TO  THE

 S. 1507                            87                            A. 2007
 
 ATTENDING  HEALTH  CARE  PROVIDER'S  DETERMINATION OF MEDICAL NECESSITY.
 THE  SUPERINTENDENT  MAY  DEVELOP  A  STANDARD   EXCEPTION   FORM   WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A  PARTICULAR CONTRACEPTIVE DRUG, DEVICE, OR PRODUCT BASED UPON A DETER-
 MINATION OF MEDICAL NECESSITY FOR AN INSURED. THE INSURER  SHALL  ACCEPT
 THE  STANDARD EXCEPTION FORM SUBMITTED BY THE INSURED'S ATTENDING HEALTH
 CARE PROVIDER;
   (III) THIS COVERAGE  SHALL  INCLUDE  EMERGENCY  CONTRACEPTION  WITHOUT
 COST-SHARING WHEN PROVIDED PURSUANT TO PRESCRIPTION, ORDER UNDER SECTION
 SIXTY-EIGHT  HUNDRED  THIRTY-ONE OF THE EDUCATION LAW, OVER-THE-COUNTER,
 OR  WHEN  OTHERWISE  LAWFULLY  PROVIDED  OTHER  THAN   PURSUANT   TO   A
 PRESCRIPTION; AND
   (IV)  THIS  COVERAGE  SHALL ALLOW FOR THE DISPENSING OF TWELVE MONTHS-
 WORTH OF A CONTRACEPTIVE AT ONE TIME;
   (II) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (III) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (IV) FOLLOW-UP SERVICES RELATED TO THE DRUGS, DEVICES,  PRODUCTS,  AND
 PROCEDURES  COVERED UNDER THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO,
 MANAGEMENT OF SIDE EFFECTS,  COUNSELING  FOR  CONTINUED  ADHERENCE,  AND
 DEVICE INSERTION AND REMOVAL.
   (B)  AN  INSURER  SUBJECT TO THIS PARAGRAPH SHALL NOT IMPOSE A DEDUCT-
 IBLE, COINSURANCE, COPAYMENT OR ANY OTHER  COST-SHARING  REQUIREMENT  ON
 THE COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH.
   (C)  EXCEPT  AS  OTHERWISE AUTHORIZED UNDER THIS PARAGRAPH, AN INSURER
 SHALL NOT IMPOSE ANY RESTRICTIONS OR DELAYS  ON  THE  COVERAGE  REQUIRED
 UNDER THIS PARAGRAPH.
   (D)  Notwithstanding  any  other provision of this subsection, a reli-
 gious employer may request a contract without coverage for federal  food
 and drug administration approved contraceptive methods that are contrary
 to  the  religious  employer's  religious  tenets. If so requested, such
 contract shall be provided without coverage for  contraceptive  methods.
 This  paragraph  shall not be construed to deny an enrollee coverage of,
 and timely access to, contraceptive methods.
   (1) For purposes of this subsection,  a  "religious  employer"  is  an
 entity for which each of the following is true:
   (a) The inculcation of religious values is the purpose of the entity.
   (b)  The  entity  primarily  employs  persons  who share the religious
 tenets of the entity.
   (c) The entity serves primarily persons who share the religious tenets
 of the entity.
   (d) The entity is a nonprofit organization  as  described  in  Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
   (2) Every religious employer that invokes the exemption provided under
 this  paragraph  shall  provide  written notice to prospective enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(B) (i)] (E) (1) Where a group policyholder makes an election not  to
 purchase  coverage for contraceptive drugs or devices in accordance with
 subparagraph [(A)] (D) of this paragraph each certificateholder  covered
 under  the policy issued to that group policyholder shall have the right
 to directly purchase the rider  required  by  this  paragraph  from  the
 insurer  which  issued  the  group  policy at the prevailing small group
 community rate for such rider whether or not the employee is part  of  a
 small group.
   [(ii)]  (2)  Where  a  group  policyholder  makes  an  election not to
 purchase coverage for contraceptive drugs or devices in accordance  with

 S. 1507                            88                            A. 2007
 
 subparagraph [(A)] (D) of this paragraph, the insurer that provides such
 coverage shall provide written notice to certificateholders upon enroll-
 ment  with  the  insurer of their right to directly purchase a rider for
 coverage  for  the  cost  of  contraceptive drugs or devices. The notice
 shall also advise the certificateholders of the additional  premium  for
 such coverage.
   [(C)]  (F) Nothing in this paragraph shall be construed as authorizing
 a group or blanket policy which provides coverage for prescription drugs
 to exclude coverage for prescription drugs prescribed for reasons  other
 than contraceptive purposes.
   [(D) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   § 3. Subsection (cc) of section 4303 of the insurance law, as added by
 chapter 554 of the laws of 2002, is amended to read as follows:
   (cc) (1) Every contract  [which  provides  coverage  for  prescription
 drugs  shall  include  coverage  for  the cost of contraceptive drugs or
 devices approved by the federal food and drug administration or  generic
 equivalents approved as substitutes by such food and drug administration
 under  the  prescription of a health care provider legally authorized to
 prescribe under title eight of the education law. The coverage  required
 by  this  section  shall  be included in contracts and certificates only
 through the addition of a rider.
   (1)] WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR  COMPREHENSIVE-
 TYPE  COVERAGE  SHALL PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES
 AND CONTRACEPTIVE METHODS:
   (A) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS INCLUDES ALL  FDA-APPROVED  OVER-THE-COUNTER  CONTRACEPTIVE  DRUGS,
 DEVICES,  AND  PRODUCTS  AS  PRESCRIBED OR AS OTHERWISE AUTHORIZED UNDER
 STATE OR FEDERAL LAW.   NOTWITHSTANDING THIS  PARAGRAPH,  A  CORPORATION
 SHALL  NOT BE REQUIRED TO PROVIDE COVERAGE OF MALE CONDOMS.  THE FOLLOW-
 ING APPLIES TO THIS COVERAGE:
   (I) WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND  PHARMACEU-
 TICAL  EQUIVALENT,  AS  DEFINED  BY THE FDA, VERSIONS OF A CONTRACEPTIVE
 DRUG, DEVICE, OR PRODUCT, A CORPORATION IS NOT REQUIRED TO  INCLUDE  ALL
 SUCH  THERAPEUTIC  AND  PHARMACEUTICAL EQUIVALENT VERSIONS IN ITS FORMU-
 LARY, SO LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHAR-
 ING AND IN ACCORDANCE WITH THIS SUBSECTION;
   (II) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED  MEDICALLY
 INADVISABLE, A CORPORATION SHALL PROVIDE COVERAGE FOR AN ALTERNATE THER-
 APEUTIC AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE DRUG,
 DEVICE,  OR  PRODUCT WITHOUT COST-SHARING UPON THE RECOMMENDATION OF THE
 INSURED'S ATTENDING HEALTH CARE PROVIDER. A CORPORATION SHALL  DEFER  TO
 THE ATTENDING HEALTH CARE PROVIDER'S DETERMINATION OF MEDICAL NECESSITY.
 THE   SUPERINTENDENT   MAY   DEVELOP  A  STANDARD  EXCEPTION  FORM  WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A PARTICULAR CONTRACEPTIVE DRUG, DEVICE, OR PRODUCT BASED UPON A  DETER-
 MINATION  OF  MEDICAL NECESSITY FOR AN INSURED. THE INSURER SHALL ACCEPT
 THE STANDARD EXCEPTION FORM SUBMITTED BY THE INSURED'S ATTENDING  HEALTH
 CARE PROVIDER;
   (III)  THIS  COVERAGE  SHALL  INCLUDE  EMERGENCY CONTRACEPTION WITHOUT
 COST-SHARING WHEN PROVIDED  PURSUANT  TO  A  PRESCRIPTION,  ORDER  UNDER
 SECTION  SIXTY-EIGHT  HUNDRED THIRTY-ONE OF THE EDUCATION LAW, OVER-THE-

 S. 1507                            89                            A. 2007

 COUNTER, OR WHEN  OTHERWISE  LAWFULLY  PROVIDED  OTHER  THAN  THROUGH  A
 PRESCRIPTION; AND
   (IV)  THIS  COVERAGE  SHALL  ALLOW FOR THE DISPENSING OF TWELVE MONTHS
 WORTH OF A CONTRACEPTIVE AT ONE TIME;
   (B) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (C) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (D) FOLLOW-UP SERVICES RELATED TO THE DRUGS,  DEVICES,  PRODUCTS,  AND
 PROCEDURES COVERED UNDER THIS SUBSECTION, INCLUDING, BUT NOT LIMITED TO,
 MANAGEMENT  OF  SIDE  EFFECTS,  COUNSELING  FOR CONTINUED ADHERENCE, AND
 DEVICE INSERTION AND REMOVAL.
   (2) A CORPORATION SUBJECT TO THIS PARAGRAPH SHALL NOT IMPOSE A DEDUCT-
 IBLE, COINSURANCE, COPAYMENT OR ANY OTHER  COST-SHARING  REQUIREMENT  ON
 THE COVERAGE PROVIDED PURSUANT TO THIS SUBSECTION.
   (3)  EXCEPT  AS  OTHERWISE  AUTHORIZED UNDER THIS SUBSECTION, A CORPO-
 RATION SHALL NOT IMPOSE ANY  RESTRICTIONS  OR  DELAYS  ON  THE  COVERAGE
 REQUIRED UNDER THIS SUBSECTION.
   (4)  Notwithstanding  any  other provision of this subsection, a reli-
 gious employer may request a contract without coverage for federal  food
 and drug administration approved contraceptive methods that are contrary
 to  the  religious  employer's  religious  tenets. If so requested, such
 contract shall be provided without coverage for  contraceptive  methods.
 This  paragraph  shall not be construed to deny an enrollee coverage of,
 and timely access to, contraceptive methods.
   (A) For purposes of this subsection,  a  "religious  employer"  is  an
 entity for which each of the following is true:
   (i) The inculcation of religious values is the purpose of the entity.
   (ii)  The  entity  primarily  employs  persons who share the religious
 tenets of the entity.
   (iii) The entity serves primarily  persons  who  share  the  religious
 tenets of the entity.
   (iv)  The  entity  is a nonprofit organization as described in Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
   (B) Every religious employer that invokes the exemption provided under
 this paragraph shall provide written  notice  to  prospective  enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(2)](5)  (A)  Where  a  group contractholder makes an election not to
 purchase coverage for contraceptive drugs or devices in accordance  with
 paragraph [one] FOUR of this subsection, each enrollee covered under the
 contract  issued  to  that  group contractholder shall have the right to
 directly purchase the rider required by this subsection from the insurer
 or health maintenance organization which issued the  group  contract  at
 the  prevailing small group community rate for such rider whether or not
 the employee is part of a small group.
   (B) Where a group contractholder makes an  election  not  to  purchase
 coverage for contraceptive drugs or devices in accordance with paragraph
 [one]  FOUR of this subsection, the insurer or health maintenance organ-
 ization that provides such coverage  shall  provide  written  notice  to
 enrollees  upon enrollment with the insurer or health maintenance organ-
 ization of their right to directly purchase a rider for coverage for the
 cost of contraceptive drugs or devices. The notice shall also advise the
 enrollees of the additional premium for such coverage.
   [(3)](6) Nothing in this subsection shall be construed as  authorizing
 a  contract  which  provides  coverage for prescription drugs to exclude
 coverage for  prescription  drugs  prescribed  for  reasons  other  than
 contraceptive purposes.

 S. 1507                            90                            A. 2007
 
   [(4) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   §  4.  Paragraph 17 of subsection (i) of section 3216 of the insurance
 law is amended by adding a new subparagraph (G) to read as follows:
   (G)(I) IN ADDITION TO SUBPARAGRAPHS (A), (B), (C), (D), OR (E) OF THIS
 PARAGRAPH, EVERY POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL OR  SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  ALL  OF THE
 FOLLOWING SERVICES AND CONTRACEPTIVE METHODS:
   (I) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS INCLUDES ALL  FDA-APPROVED  OVER-THE-COUNTER  CONTRACEPTIVE  DRUGS,
 DEVICES,  AND  PRODUCTS  AS  PRESCRIBED OR AS OTHERWISE AUTHORIZED UNDER
 STATE OR FEDERAL LAW.  NOTWITHSTANDING  THIS  SUBPARAGRAPH,  AN  INSURER
 SHALL NOT BE REQUIRED TO PROVIDE COVERAGE OF MALE CONDOMS. THE FOLLOWING
 APPLIES TO THIS COVERAGE:
   (AA) WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND PHARMACEU-
 TICAL  EQUIVALENT,  AS  DEFINED  BY THE FDA, VERSIONS OF A CONTRACEPTIVE
 DRUG, DEVICE, OR PRODUCT, AN INSURER IS NOT REQUIRED TO INCLUDE ALL SUCH
 THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS IN ITS FORMULARY,  SO
 LONG  AS  AT  LEAST  ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING IN
 ACCORDANCE WITH THIS SUBPARAGRAPH;
   (BB) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED  MEDICALLY
 INADVISABLE,  THE INSURER SHALL PROVIDE COVERAGE FOR AN ALTERNATE THERA-
 PEUTIC AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE  DRUG,
 DEVICE,  OR  PRODUCT WITHOUT COST-SHARING. AN INSURER SHALL DEFER TO THE
 ATTENDING HEALTH CARE PROVIDER'S  DETERMINATION  OF  MEDICAL  NECESSITY.
 THE   SUPERINTENDENT   MAY   DEVELOP  A  STANDARD  EXCEPTION  FORM  WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A PARTICULAR CONTRACEPTIVE DRUG, DEVICE, PROCEDURE, SERVICE, OR  PRODUCT
 BASED  UPON  A  DETERMINATION  OF  MEDICAL NECESSITY FOR AN INSURED. THE
 INSURER SHALL ACCEPT  THE  STANDARD  EXCEPTION  FORM  SUBMITTED  BY  THE
 INSURED'S ATTENDING HEALTH CARE PROVIDER;
   (CC) THIS COVERAGE SHALL INCLUDE EMERGENCY CONTRACEPTION WITHOUT COST-
 SHARING  WHEN  PROVIDED  PURSUANT TO A PRESCRIPTION, ORDER UNDER SECTION
 SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION  LAW,  OVER-THE-COUNTER,
 OR   WHEN   OTHERWISE   LAWFULLY  PROVIDED  OTHER  THAN  PURSUANT  TO  A
 PRESCRIPTION; AND
   (DD) THIS COVERAGE SHALL ALLOW FOR THE DISPENSING  OF  TWELVE  MONTHS-
 WORTH OF A CONTRACEPTIVE AT ONE TIME:
   (II) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (III) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (IV)  FOLLOW-UP  SERVICES RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
 PROCEDURES COVERED UNDER THIS SUBPARAGRAPH, INCLUDING MANAGEMENT OF SIDE
 EFFECTS, COUNSELING FOR CONTINUED ADHERENCE, AND  DEVICE  INSERTION  AND
 REMOVAL.
   (II) AN INSURER SUBJECT TO THIS SUBPARAGRAPH SHALL NOT IMPOSE A DEDUC-
 TIBLE,  COINSURANCE,  COPAYMENT OR ANY OTHER COST-SHARING REQUIREMENT ON
 THE COVERAGE PROVIDED PURSUANT TO THIS SUBPARAGRAPH.
   (III) EXCEPT AS  OTHERWISE  AUTHORIZED  UNDER  THIS  SUBPARAGRAPH,  AN
 INSURER  SHALL  NOT  IMPOSE  ANY  RESTRICTIONS OR DELAYS ON THE COVERAGE
 REQUIRED UNDER THIS SUBPARAGRAPH.
   § 5. Paragraph (d) of subdivision 3 of section  365-a  of  the  social
 services  law,  as  amended  by  chapter  909 of the laws of 1974 and as

 S. 1507                            91                            A. 2007
 
 relettered by chapter 82 of the laws of 1995,  is  amended  to  read  as
 follows:
   (d)  family  planning  services  and  supplies for eligible persons of
 childbearing age, including children under twenty-one years of  age  who
 can  be  considered  sexually  active,  who  desire  such  services  and
 supplies, in accordance with the requirements of federal law  and  regu-
 lations  and the regulations of the department.  PRESCRIPTION CONTRACEP-
 TIVES, WHEN PRESCRIBED BASED ON GENERALLY ACCEPTED MEDICAL PRACTICE, MAY
 BE DISPENSED AT ONE TIME OR UP TO TWELVE TIMES WITHIN ONE YEAR FROM  THE
 DATE  OF  THE  PRESCRIPTION.  No person shall be compelled or coerced to
 accept such services or supplies.
   § 6. This act  shall  take  effect  January  1,  2020;  provided  that
 sections  two,  three  and  four of this act shall apply to policies and
 contracts issued, renewed, modified, altered or  amended  on  and  after
 such date.
 
                                  PART N
 
   Section  1.  Universal access commission. 1. There is hereby created a
 universal access commission, which shall consider and advise the commis-
 sioner of health and the superintendent of financial services on options
 for achieving universal access to health care in New York State.
   2. The universal access commission shall consist of independent health
 policy and insurance experts appointed by the  commissioner  and  super-
 intendent.  The commission shall consult with the legislature and stake-
 holder groups and convene at least one meeting for members of the public
 to review and discuss options for achieving universal access to care.
   3. The commissioner and superintendent shall select the chair  of  the
 commission from among the members of such commission and shall designate
 at  least  one employee from each department to assist the commission in
 the performance of its duties under this section. The  commissioner  and
 superintendent  shall  adopt rules for the governance of the commission,
 which shall meet as frequently as its business may require and  at  such
 other  times  as determined by the commissioner and superintendent to be
 necessary.
   4. Members of the commission  shall  serve  without  compensation  for
 their  services  as members, but each shall be allowed the necessary and
 actual expenses incurred in the performance of his or her  duties  under
 this section.
   5.  The  commission  shall  provide  a  report  to the Governor on the
 options for achieving universal access to health care in New York  State
 by December 1, 2019.
   § 2. This act shall take effect immediately.
 
                                  PART O
 
   Section  1.  Subdivision 2 of section 605 of the public health law, as
 amended by section 20 of part E of chapter 56 of the laws  of  2013,  is
 amended to read as follows:
   2.  State  aid  reimbursement for public health services provided by a
 municipality under this title, shall be  made  if  the  municipality  is
 providing  some  or all of the core public health services identified in
 section six hundred two of this title, pursuant to an approved  applica-
 tion  for  state  aid,  at a rate of no less than thirty-six per centum,
 EXCEPT FOR THE CITY OF NEW YORK WHICH SHALL RECEIVE NO LESS THAN  TWENTY
 PER  CENTUM,  of the difference between the amount of moneys expended by

 S. 1507                            92                            A. 2007
 
 the municipality for public health  services  required  by  section  six
 hundred  two  of  this  title  during the fiscal year and the base grant
 provided pursuant to subdivision one of this section. No such reimburse-
 ment  shall be provided for services that are not eligible for state aid
 pursuant to this article.
   § 2. Subdivision 1 of section 616 of the public health law, as amended
 by section 27 of part E of chapter 56 of the laws of 2013, is amended to
 read as follows:
   1. The total amount of state aid provided  pursuant  to  this  article
 shall  be  limited to the amount of the annual appropriation made by the
 legislature. In no event, however, shall such state aid be less than  an
 amount  to  provide  the  full  base grant and, as otherwise provided by
 [paragraph (a) of] subdivision two of section six hundred five  of  this
 article,  [at  least] NO LESS THAN thirty-six per centum, EXCEPT FOR THE
 CITY OF NEW YORK WHICH SHALL RECEIVE NO LESS THAN TWENTY PER CENTUM,  of
 the difference between the amount of moneys expended by the municipality
 for  eligible public health services pursuant to an approved application
 for state aid during the fiscal year and the base grant provided  pursu-
 ant to subdivision one of section six hundred five of this article.
   § 3. This act shall take effect July 1, 2019.
 
                                  PART P
 
   Section 1.  Subdivision 6 of section 1370 of the public health law, as
 amended by chapter 485 of the laws of 1992, is amended as follows:
   6.  "Elevated  lead  levels"  means a blood lead level greater than or
 equal to [ten] FIVE micrograms of lead per deciliter of whole  blood  or
 such  LOWER  blood  lead  level  as may be established by the department
 pursuant to rule or regulation.
   § 2. The public health law is amended by adding a new  section  1370-f
 to read as follows:
   §  1370-F.  LEAD  SAFE RESIDENTIAL RENTAL PROPERTIES. 1.  DEFINITIONS.
 FOR THE PURPOSES OF THIS SECTION:
   (A) "RESIDENTIAL RENTAL PROPERTY"  SHALL  MEAN  A  DWELLING  WHICH  IS
 EITHER  RENTED, LEASED, LET OR HIRED OUT, TO BE OCCUPIED, OR IS OCCUPIED
 AS THE HOME,  RESIDENCE OR SLEEPING PLACE OF ONE OR MORE  PERSONS  OTHER
 THAN  THE OWNER'S  FAMILY. RESIDENTIAL RENTAL PROPERTY SHALL NOT INCLUDE
 SHORT TERM RENTAL  PROPERTIES DURING WHICH GUESTS DO NOT STAY IN  EXCESS
 OF TWENTY-EIGHT DAYS.
   (B) "LEAD SAFE" SHALL MEAN ANY RESIDENTIAL RENTAL PROPERTY THAT:
   (I)   HAS  BEEN  DETERMINED  THROUGH  A  LEAD-BASED  PAINT  INSPECTION
 CONDUCTED IN ACCORDANCE WITH  APPROPRIATE  FEDERAL  REGULATIONS  NOT  TO
 CONTAIN LEAD-BASED  PAINT; OR
   (II)  MEETS THE MINIMUM STANDARDS SET FORTH IN REGULATIONS PROMULGATED
 BY THE COMMISSIONER PURSUANT TO THIS SECTION.
   2. THE COMMISSIONER SHALL PROMULGATE RULES AND REGULATIONS  ESTABLISH-
 ING  MINIMUM  STANDARDS  FOR  THE  MAINTENANCE  OF LEAD SAFE RESIDENTIAL
 RENTAL PROPERTIES. SUCH RULES AND REGULATIONS SHALL INCLUDE:
   (A) MINIMUM STANDARDS FOR MAINTAINING INTERNAL  AND  EXTERNAL  PAINTED
 SURFACES THAT CONTAIN LEAD-BASED PAINT; AND
   (B)  A  SCHEDULE  BY  WHICH OWNERS OF RESIDENTIAL RENTAL PROPERTY MUST
 IMPLEMENT AND COMPLY WITH SUCH MINIMUM STANDARDS.
   3. IT SHALL BE THE RESPONSIBILITY  OF  AN  OWNER  OF  ANY  RESIDENTIAL
 RENTAL  PROPERTY  TO  MAINTAIN SUCH PROPERTY IN A LEAD SAFE CONDITION IN
 ACCORDANCE WITH  RULES AND REGULATIONS PROMULGATED BY  THE  COMMISSIONER
 PURSUANT TO THIS SECTION.

 S. 1507                            93                            A. 2007
 
   4.  ALL PAINT ON ANY RESIDENTIAL RENTAL PROPERTY ON WHICH THE ORIGINAL
 CONSTRUCTION WAS COMPLETED PRIOR  TO  JANUARY  FIRST,  NINETEEN  HUNDRED
 SEVENTY-EIGHT,  SHALL  BE PRESUMED TO BE LEAD-BASED PAINT. THIS PRESUMP-
 TION MAY BE  OVERCOME BY A CERTIFICATION ISSUED BY A FEDERALLY CERTIFIED
 LEAD-BASED  PAINT  INSPECTOR OR RISK ASSESSOR THAT THE PROPERTY HAS BEEN
 DETERMINED NOT TO CONTAIN LEAD-BASED PAINT, OR BY SUCH  OTHER  MEANS  AS
 MAY  BE  PRESCRIBED BY THE RULES AND  REGULATIONS ADOPTED BY THE COMMIS-
 SIONER PURSUANT TO THIS SECTION.
   5. THE COMMISSIONER, LOCAL HEALTH OFFICER OF A COUNTY AND, IN THE CITY
 OF NEW YORK, THE COMMISSIONER OF THE  NEW YORK CITY DEPARTMENT OF HEALTH
 AND MENTAL HYGIENE, MAY ENTER INTO  AN  AGREEMENT  OR  CONTRACT  WITH  A
 MUNICIPAL    GOVERNMENT  REGARDING  INSPECTION OF THE LEAD CONDITIONS IN
 RESIDENTIAL RENTAL  PROPERTIES AND SUCH HEALTH DEPARTMENT MAY  DESIGNATE
 THE  LOCAL  HOUSING    MAINTENANCE  CODE ENFORCEMENT AGENCY IN WHICH THE
 RESIDENTIAL RENTAL PROPERTY IS   LOCATED  AS  AN  AGENCY  AUTHORIZED  TO
 ADMINISTER  AND  ENSURE  COMPLIANCE WITH THE  PROVISIONS OF THIS SECTION
 AND SUBSEQUENT REGULATIONS PURSUANT TO SUBDIVISION  ONE OF SECTION THIR-
 TEEN HUNDRED SEVENTY-FIVE OF THIS TITLE.
   6. IF THE COMMISSIONER, OR OTHER OFFICER HAVING  JURISDICTION,  DETER-
 MINES  THAT  AN  OWNER OF RESIDENTIAL RENTAL PROPERTY IS IN VIOLATION OF
 THIS SECTION OR  ANY RULES OR REGULATIONS PROMULGATED PURSUANT  TO  THIS
 SECTION,  THE  COMMISSIONER   OR OTHER OFFICER HAVING JURISDICTION SHALL
 HAVE THE AUTHORITY TO ORDER THE  ABATEMENT OF ANY LEAD CONDITION PRESENT
 AT THE RESIDENTIAL RENTAL PROPERTY AND  ASSESS FINES NOT TO  EXCEED  TWO
 THOUSAND DOLLARS FOR EACH VIOLATION.
   § 3. This act shall take effect immediately.
 
                                  PART Q
 
   Section  1.  Section  2825-f  of  the  public health law is amended by
 adding two new subdivisions 4-a and 4-b to read as follows:
   4-A. NOTWITHSTANDING SUBDIVISION TWO OF THIS SECTION OR ANY INCONSIST-
 ENT PROVISION OF LAW TO THE CONTRARY, AND UPON APPROVAL OF THE  DIRECTOR
 OF  THE  BUDGET,  THE  COMMISSIONER  MAY, SUBJECT TO THE AVAILABILITY OF
 LAWFUL APPROPRIATION, AWARD UP TO THREE HUNDRED MILLION DOLLARS  OF  THE
 FUNDS  MADE  AVAILABLE  PURSUANT  TO  THIS  SECTION FOR UNFUNDED PROJECT
 APPLICATIONS SUBMITTED IN  RESPONSE  TO  THE  REQUEST  FOR  APPLICATIONS
 NUMBER  17648  ISSUED  BY THE DEPARTMENT ON JANUARY EIGHTH, TWO THOUSAND
 EIGHTEEN PURSUANT TO SECTION TWENTY-EIGHT HUNDRED TWENTY-FIVE-E OF  THIS
 ARTICLE,  PROVIDED HOWEVER THAT THE PROVISIONS OF SUBDIVISIONS THREE AND
 FOUR OF THIS SECTION SHALL APPLY.
   4-B. AUTHORIZED AMOUNTS TO BE AWARDED PURSUANT TO APPLICATIONS SUBMIT-
 TED IN RESPONSE TO THE REQUEST FOR APPLICATION  NUMBER  17648  SHALL  BE
 AWARDED NO LATER THAN MAY FIRST, TWO THOUSAND NINETEEN.
   § 2. This act shall take effect immediately.
 
                                  PART R
 
   Section 1. Legislative findings and intent. The legislature finds that
 maternal  mortality and morbidity is a serious public health concern and
 has a serious family and societal impact. New York state has  among  the
 highest  maternal  mortality rates in the country and racial disparities
 remain significant. The U.S. Centers for Disease Control and  Prevention
 has  determined that a regular process for professional, multi-discipli-
 nary, confidential review of all maternal deaths can help  identify  the
 causes  of  maternal  mortality, and those findings can lead to clinical

 S. 1507                            94                            A. 2007
 
 and social change that can help prevent maternal mortality. The same  is
 true  for  severe  maternal  morbidity.  Confidentiality is important to
 ensure that full information is made available in the review process  to
 maximize protection of maternal health.
   Section  3  of  article  17  of  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." The
 legislature finds that the creation of a state maternal mortality review
 board, and recognition and protection of any maternal  mortality  review
 board,  including a New York city maternal mortality review board, are a
 matter of state concern and an important exercise of  the  legislature's
 constitutional mandate to protect the public health.
   §  2. The public health law is amended by adding a new section 2509 to
 read as follows:
   § 2509. MATERNAL MORTALITY REVIEW BOARD. 1. (A) THERE IS HEREBY ESTAB-
 LISHED IN THE DEPARTMENT THE MATERNAL MORTALITY  REVIEW  BOARD  FOR  THE
 PURPOSE  OF  REVIEWING MATERNAL DEATHS AND SEVERE MATERNAL MORBIDITY AND
 DEVELOPING FINDINGS, RECOMMENDATIONS, AND BEST PRACTICES TO THE  COMMIS-
 SIONER  TO CONTRIBUTE TO THE PREVENTION OF MATERNAL MORTALITY AND SEVERE
 MATERNAL MORBIDITY.  THE BOARD SHALL ASSESS THE CAUSE OF DEATH,  FACTORS
 LEADING  TO  DEATH  AND  PREVENTABILITY FOR EACH MATERNAL DEATH REVIEWED
 AND, AT THE DISCRETION OF THE BOARD, CASES OF SEVERE MATERNAL MORBIDITY,
 AND SHALL DEVELOP STRATEGIES FOR REDUCING THE RISK OF MATERNAL MORTALITY
 AND SEVERE MATERNAL MORBIDITY, WHERE CASES OF SEVERE MATERNAL  MORBIDITY
 WERE  REVIEWED, TAKING INTO ACCOUNT FACTORS SUCH AS RACIAL, ECONOMIC, OR
 OTHER DISPARITIES. THE BOARDS' FINDINGS, RECOMMENDATIONS AND BEST  PRAC-
 TICES SHALL BE GIVEN TO THE COMMISSIONER FOR DISSEMINATION.
   (B)  ANY  MATERNAL  MORALITY  REVIEW  BOARD, INCLUDING A NEW YORK CITY
 MATERNAL MORTALITY REVIEW BOARD, SHALL PROVIDE TO THE  COMMISSIONER  THE
 RESULTS  AND  THE FINDINGS OF ITS REVIEWS, INCLUDING RECOMMENDATIONS AND
 BEST PRACTICES AND UPON REQUEST INFORMATION  AND  DATA,  INCLUDING  CASE
 SUMMARIES, TO SUPPORT STATEWIDE SURVEILLANCE AND ENFORCEMENT.
   2. AS USED IN THIS SECTION:
   (A)  "ADVISORY  COUNCIL"  AND  "COUNCIL"  MEAN THE ADVISORY COUNCIL ON
 MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY, ESTABLISHED UNDER THIS
 SECTION.
   (B) "BOARD" MEANS A MATERNAL MORTALITY  REVIEW  BOARD  ESTABLISHED  BY
 THIS  SECTION,  REFERRED TO IN THIS SECTION AS THE "STATE BOARD", OR ANY
 BOARD OPERATING, INCLUDING A NEW YORK  CITY  MATERNAL  MORTALITY  REVIEW
 BOARD, UNDER THIS SECTION.
   (C)  "MATERNAL  DEATH"  MEANS THE DEATH OF A WOMAN DURING PREGNANCY OR
 WITHIN A YEAR FROM THE END OF PREGNANCY.
   (D) "SEVERE MATERNAL MORBIDITY" MEANS UNEXPECTED OUTCOMES OF  PREGNAN-
 CY,  LABOR,  OR  DELIVERY THAT RESULT IN SIGNIFICANT SHORT- OR LONG-TERM
 CONSEQUENCES TO A WOMAN'S HEALTH.
   3. (A) THE MEMBERS OF THE STATE BOARD SHALL BE COMPRISED OF  MULTIDIS-
 CIPLINARY EXPERTS IN THE FIELD OF MATERNAL MORTALITY, WOMEN'S HEALTH AND
 PUBLIC  HEALTH,  AND  SHALL  INCLUDE HEALTH CARE PROFESSIONALS AND OTHER
 EXPERTS WHO SERVE AND ARE REPRESENTATIVE OF THE RACIAL AND ETHNIC DIVER-
 SITY OF THE WOMEN AND MOTHERS OF THE STATE.
   (B) THE STATE BOARD SHALL BE COMPOSED OF AT LEAST FIFTEEN MEMBERS, ALL
 OF WHOM SHALL BE APPOINTED BY THE COMMISSIONER.

 S. 1507                            95                            A. 2007
 
   (C) THE TERMS OF THE STATE BOARD MEMBERS SHALL  BE  THREE  YEARS.  THE
 COMMISSIONER  MAY  CHOOSE TO REAPPOINT STATE BOARD MEMBERS TO ADDITIONAL
 THREE YEAR TERMS.
   (D) A MAJORITY OF THE APPOINTED MEMBERSHIP OF THE STATE BOARD, NO LESS
 THAN THREE, SHALL CONSTITUTE A QUORUM.
   (E)  WHEN  ANY MEMBER OF THE STATE BOARD FAILS TO ATTEND THREE CONSEC-
 UTIVE REGULAR MEETINGS, UNLESS SUCH ABSENCE  IS  FOR  GOOD  CAUSE,  THAT
 MEMBERSHIP  MAY  BE  DEEMED  VACANT FOR PURPOSES OF THE APPOINTMENT OF A
 SUCCESSOR.
   (F) MEETINGS OF THE STATE BOARD SHALL BE HELD AT LEAST  TWICE  A  YEAR
 BUT  MAY BE HELD MORE FREQUENTLY AS DEEMED NECESSARY, SUBJECT TO REQUEST
 OF THE DEPARTMENT.
   (G) MEMBERS OF THE STATE BOARD  SHALL  BE  INDEMNIFIED  UNDER  SECTION
 SEVENTEEN OF THE PUBLIC OFFICERS LAW.
   (H)  MEMBERS  OF  THE  STATE  BOARD SHALL NOT BE COMPENSATED FOR THEIR
 PARTICIPATION ON THE BOARD BUT MAY RECEIVE REIMBURSEMENT FOR THEIR ORDI-
 NARY AND NECESSARY EXPENSES OF PARTICIPATION.
   (I) MEMBERSHIP ON A BOARD SHALL NOT DISQUALIFY ANY PERSON FROM HOLDING
 ANY PUBLIC OFFICE OR EMPLOYMENT.
   (J) THE BOARD IS NOT SUBJECT TO THE OPEN MEETINGS LAW.
   4. (A) THE COMMISSIONER SHALL RECEIVE UPON REQUEST  FROM  ANY  DEPART-
 MENT,  DIVISION,  BOARD, BUREAU, COMMISSION, LOCAL HEALTH DEPARTMENTS OR
 OTHER AGENCY OF THE STATE OR POLITICAL SUBDIVISION THEREOF OR ANY PUBLIC
 AUTHORITY, AS WELL AS HOSPITALS ESTABLISHED PURSUANT TO ARTICLE  TWENTY-
 EIGHT  OF THIS CHAPTER, BIRTHING FACILITIES, MEDICAL EXAMINERS, CORONERS
 AND CORONER PHYSICIANS AND ANY OTHER FACILITY PROVIDING SERVICES ASSOCI-
 ATED WITH MATERNAL  MORTALITY,  SUCH  INFORMATION,  INCLUDING,  BUT  NOT
 LIMITED  TO, DEATH RECORDS, MEDICAL RECORDS, AUTOPSY REPORTS, TOXICOLOGY
 REPORTS, HOSPITAL DISCHARGE RECORDS, BIRTH RECORDS AND ANY OTHER  INFOR-
 MATION.
   (B)  THE  COMMISSIONER  SHALL  RECEIVE  INFORMATION, INCLUDING ORAL OR
 WRITTEN STATEMENTS, RELATING TO ANY MATERNAL DEATH AND  CASE  OF  SEVERE
 MATERNAL  MORBIDITY,  FROM  ANY  FAMILY MEMBER OR OTHER INTERESTED PARTY
 (INCLUDING THE PATIENT IN A CASE OF SEVERE MATERNAL MORBIDITY)  RELATING
 TO  ANY  CASE  THAT  MAY COME BEFORE THE BOARD. ORAL STATEMENTS RECEIVED
 UNDER THIS PARAGRAPH SHALL BE TRANSCRIBED OR SUMMARIZED IN WRITING.  THE
 COMMISSIONER  AND  THE CITY COMMISSIONER SHALL TRANSMIT THAT INFORMATION
 TO THE BOARD CONSIDERING THE CASE.
   (C) BEFORE TRANSMITTING ANY INFORMATION TO THE BOARD, THE  COMMISSION-
 ER,  OR  THE  CITY  COMMISSIONER,  SHALL REMOVE ALL PERSONAL IDENTIFYING
 INFORMATION OF THE WOMAN, HEALTH CARE PRACTITIONER OR  PRACTITIONERS  OR
 ANYONE  ELSE  INDIVIDUALLY  NAMED  IN  SUCH  INFORMATION, AS WELL AS THE
 HOSPITAL OR FACILITY THAT TREATED THE WOMAN, AND ANY  OTHER  INFORMATION
 SUCH  AS  GEOGRAPHIC LOCATION THAT MAY INADVERTENTLY IDENTIFY THE WOMAN,
 PRACTITIONER OR FACILITY.  THIS PARAGRAPH SHALL NOT PRECLUDE THE  TRANS-
 MITTING  OF  INFORMATION  TO  THE  BOARD THAT IS REASONABLY NECESSARY TO
 ENABLE THE BOARD TO PERFORM AN APPROPRIATE REVIEW UNDER THIS SECTION.
   5. EACH BOARD:
   (A) SHALL MAKE AND REPORT FINDINGS, RECOMMENDATIONS AND BEST PRACTICES
 TO THE COMMISSIONER REGARDING THE CAUSE OF  DEATH,  FACTORS  LEADING  TO
 DEATH,  AND PREVENTABILITY OF EACH MATERNAL DEATH CASE, AND EACH CASE OF
 SEVERE MATERNAL MORBIDITY REVIEWED BY THE BOARD, BY  REVIEWING  RELEVANT
 INFORMATION FOR EACH CASE AND CONSULTING WITH EXPERTS AS NEEDED TO EVAL-
 UATE  THE  INFORMATION FOR EACH DEATH; AND SHALL PROVIDE SUCH DE-IDENTI-
 FIED FINDINGS AND RECOMMENDATIONS, INCLUDING BEST PRACTICES AND  STRATE-
 GIES  FOR  REDUCING  THE  RISK OF MATERNAL MORTALITY AND SEVERE MATERNAL

 S. 1507                            96                            A. 2007
 
 MORBIDITY, TO THE ADVISORY COUNCIL; PROVIDED THAT MATERIAL  PROVIDED  TO
 THE  ADVISORY  COUNCIL  SHALL  NOT INCLUDE ANY INFORMATION THAT WOULD BE
 CONFIDENTIAL UNDER THIS SECTION;
   (B)  SHALL  DEVELOP  RECOMMENDATIONS  TO THE COMMISSIONER FOR AREAS OF
 FOCUS, INCLUDING ISSUES OF  SEVERE  MATERNAL  MORBIDITY  AND  ISSUES  OF
 RACIAL, ECONOMIC OR OTHER DISPARITIES IN MATERNAL OUTCOMES;
   (C)  MAY, IN ADDITION TO THE FINDINGS, RECOMMENDATIONS, AND BEST PRAC-
 TICES MADE UNDER THIS SUBDIVISION, AND CONSISTENT  WITH  ALL  APPLICABLE
 CONFIDENTIALITY  PROTECTIONS,  BRING ANY PARTICULAR MATTER TO THE ATTEN-
 TION OF THE COMMISSIONER;
   (D) THE STATE BOARD SHALL ISSUE A  REPORT  EVERY  OTHER  YEAR  TO  THE
 COMMISSIONER  ON  ITS FINDINGS, RECOMMENDATIONS, AND BEST PRACTICES, AND
 IT SHALL BE A PUBLIC DOCUMENT.
   6. THE COMMISSIONER AND BOARDS SHALL EACH KEEP CONFIDENTIAL ANY INFOR-
 MATION COLLECTED OR RECEIVED UNDER THIS SECTION THAT  INCLUDES  PERSONAL
 IDENTIFYING  INFORMATION OF THE WOMAN, HEALTH CARE PRACTITIONER OR PRAC-
 TITIONERS OR ANYONE ELSE INDIVIDUALLY NAMED IN SUCH INFORMATION, AS WELL
 AS THE HOSPITAL OR FACILITY THAT TREATED THE WOMAN, AND ANY OTHER INFOR-
 MATION SUCH AS GEOGRAPHIC LOCATION THAT MAY INADVERTENTLY  IDENTIFY  THE
 WOMAN,  PRACTITIONER OR FACILITY, AND SHALL USE THE INFORMATION PROVIDED
 OR RECEIVED UNDER THIS SECTION SOLELY FOR THE PURPOSES OF IMPROVEMENT OF
 THE QUALITY OF HEALTH CARE OF WOMEN AND TO  PREVENT  MATERNAL  MORTALITY
 AND  SEVERE MATERNAL MORBIDITY.  THIS SUBDIVISION SHALL NOT PRECLUDE THE
 TRANSMITTING OF INFORMATION TO THE BOARD THAT IS REASONABLY NECESSARY TO
 ENABLE THE BOARD TO PERFORM AN APPROPRIATE REVIEW  UNDER  THIS  SECTION.
 ALL  INFORMATION  AND  RECORDS RECEIVED, MEETINGS CONDUCTED, REPORTS AND
 RECORDS MADE AND MAINTAINED AND ALL BOOKS AND  PAPERS  OBTAINED  BY  THE
 COMMISSIONER AS WELL AS THE BOARD SHALL BE CONFIDENTIAL AND SHALL NOT BE
 MADE  OPEN OR AVAILABLE, INCLUDING UNDER ARTICLE SIX OF THE PUBLIC OFFI-
 CERS LAW, AND SHALL BE LIMITED TO BOARD MEMBERS AS WELL AS THOSE AUTHOR-
 IZED BY THE COMMISSIONER.  SUCH INFORMATION SHALL NOT BE DISCOVERABLE OR
 ADMISSIBLE AS EVIDENCE IN ANY ACTION IN ANY COURT OR  BEFORE  ANY  OTHER
 TRIBUNAL, BOARD, AGENCY OR PERSON.
   7. (A) THERE IS HEREBY ESTABLISHED IN THE DEPARTMENT AN ADVISORY COUN-
 CIL ON MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY.
   (B) THE ADVISORY COUNCIL:
   (I) MAY REVIEW THE FINDINGS, RECOMMENDATIONS AND BEST PRACTICES OF THE
 BOARDS;
   (II)  MAY  USE THE BOARDS FINDINGS, RECOMMENDATIONS AND BEST PRACTICES
 TO DEVELOP RECOMMENDATIONS ON POLICIES, BEST PRACTICES,  AND  STRATEGIES
 TO PREVENT MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY;
   (III) MAY HOLD PUBLIC HEARINGS ON THOSE MATTERS; AND
   (IV)  MAY MAKE FINDINGS AND ISSUE REPORTS, INCLUDING AN ANNUAL REPORT,
 ON SUCH MATTERS;
   (C) THE ADVISORY COUNCIL SHALL CONSIST OF  AT  LEAST  TWENTY  MEMBERS,
 REPRESENTATIVE OF THE RACIAL AND ETHNIC DIVERSITY OF THE WOMEN AND MOTH-
 ERS  OF  THE  STATE  TO  BE DETERMINED BY THE COMMISSIONER.   TEN OF THE
 MEMBERS OF THE COUNCIL SHALL BE REPRESENTATIVE  OF  THE  POPULATION  AND
 HEALTH  CARE  SYSTEM  OF  THE CITY OF NEW YORK.   THE COMMISSIONER SHALL
 APPOINT THE CHAIR OF THE COUNCIL.
   (D) THE MEMBERS OF THE COUNCIL SHALL BE COMPRISED OF MULTIDISCIPLINARY
 EXPERTS AND LAY PERSONS KNOWLEDGEABLE IN THE FIELD OF  MATERNAL  MORTAL-
 ITY,  WOMEN'S  HEALTH  AND  PUBLIC  HEALTH AND SHALL INCLUDE MEMBERS WHO
 SERVE AND ARE REPRESENTATIVE OF THE DIVERSITY OF THE WOMEN  AND  MOTHERS
 IN  MEDICALLY  UNDERSERVED AREAS OF THE STATE OR AREAS OF THE STATE WITH

 S. 1507                            97                            A. 2007
 
 DISPROPORTIONATELY HIGH OCCURRENCES  OF  MATERNAL  MORTALITY  OR  SEVERE
 MATERNAL MORBIDITY.
   (E) THE TERMS OF THE COUNCIL MEMBERS SHALL BE THREE YEARS. THE COMMIS-
 SIONER  MAY CHOOSE TO REAPPOINT COUNCIL MEMBERS TO ADDITIONAL THREE-YEAR
 TERMS. VACANCIES ON THE COUNCIL SHALL BE FILLED BY  APPOINTMENT  BY  THE
 COMMISSIONER.    A  MAJORITY  OF THE APPOINTED MEMBERSHIP OF THE COUNCIL
 SHALL CONSTITUTE A QUORUM. WHEN ANY  MEMBER  OF  THE  COUNCIL  FAILS  TO
 ATTEND  THREE  CONSECUTIVE  REGULAR MEETINGS, UNLESS SUCH ABSENCE IS FOR
 GOOD CAUSE, THAT MEMBERSHIP MAY BE DEEMED VACANT  FOR  PURPOSES  OF  THE
 APPOINTMENT OF A SUCCESSOR.
   (F) MEETINGS OF THE COUNCIL SHALL BE HELD AT LEAST TWICE A YEAR.
   (G)  MEMBERS  OF THE COUNCIL SHALL BE INDEMNIFIED UNDER SECTION SEVEN-
 TEEN OF THE PUBLIC OFFICERS LAW. MEMBERS OF THE  COUNCIL  SHALL  NOT  BE
 COMPENSATED  FOR  THEIR  PARTICIPATION  ON THE COUNCIL BUT SHALL RECEIVE
 REIMBURSEMENT FOR THEIR  ORDINARY  AND  NECESSARY  EXPENSES  OF  PARTIC-
 IPATION.  MEMBERSHIP ON THE COUNCIL SHALL NOT DISQUALIFY ANY PERSON FROM
 HOLDING ANY PUBLIC OFFICE OR EMPLOYMENT.
   § 3. This act shall take effect immediately.
 
                                  PART S
 
   Section 1. Legislative intent. The legislature finds  that  comprehen-
 sive  reproductive health care, including contraception and abortion, is
 a fundamental component of a woman's health, privacy and  equality.  The
 New  York  Constitution and United States Constitution protect a woman's
 fundamental right to access safe, legal abortion, courts have repeatedly
 reaffirmed this right and further emphasized that states may  not  place
 undue burdens on women seeking to access such right.
   Moreover, the legislature finds, as with other medical procedures, the
 safety  of  abortion  is furthered by evidence-based practices developed
 and supported by medical professionals. Abortion is one  of  the  safest
 medical  procedures  performed in the United States; the goal of medical
 regulation should be to improve the quality and availability  of  health
 care services.
   Furthermore,  the legislature declares that it is the public policy of
 New York State that every individual possesses a  fundamental  right  of
 privacy  and  equality with respect to their personal reproductive deci-
 sions and should be able to safely effectuate those decisions, including
 by seeking and obtaining abortion care, free from discrimination in  the
 provision of health care.
   Therefore, it is the intent of the legislature to prevent the enforce-
 ment  of laws or regulations that are not in furtherance of a legitimate
 state interest in protecting  a  woman's  health  that  burden  abortion
 access.
   §  2. The public health law is amended by adding a new article 25-A to
 read as follows:
                               ARTICLE 25-A
                          REPRODUCTIVE HEALTH ACT
 SECTION 2599-AA. POLICY AND PURPOSE.
         2599-BB. ABORTION.
   § 2599-AA. POLICY AND PURPOSE. THE LEGISLATURE FINDS  THAT  COMPREHEN-
 SIVE  REPRODUCTIVE HEALTH CARE IS A FUNDAMENTAL COMPONENT OF EVERY INDI-
 VIDUAL'S HEALTH, PRIVACY AND EQUALITY. THEREFORE, IT IS  THE  POLICY  OF
 THE STATE THAT:
   1.  EVERY  INDIVIDUAL  HAS  THE  FUNDAMENTAL RIGHT TO CHOOSE OR REFUSE
 CONTRACEPTION OR STERILIZATION.

 S. 1507                            98                            A. 2007

   2. EVERY INDIVIDUAL WHO BECOMES PREGNANT HAS THE FUNDAMENTAL RIGHT  TO
 CHOOSE  TO  CARRY THE PREGNANCY TO TERM, TO GIVE BIRTH TO A CHILD, OR TO
 HAVE AN ABORTION, PURSUANT TO THIS ARTICLE.
   3.  THE  STATE SHALL NOT DISCRIMINATE AGAINST, DENY, OR INTERFERE WITH
 THE EXERCISE OF THE RIGHTS SET FORTH IN THIS SECTION IN  THE  REGULATION
 OR PROVISION OF BENEFITS, FACILITIES, SERVICES OR INFORMATION.
   § 2599-BB. ABORTION.  1.  A  HEALTH CARE PRACTITIONER LICENSED, CERTI-
 FIED, OR AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW, ACTING WITH-
 IN HIS OR HER LAWFUL SCOPE OF PRACTICE, MAY PERFORM  AN  ABORTION  WHEN,
 ACCORDING  TO  THE PRACTITIONER'S REASONABLE AND GOOD FAITH PROFESSIONAL
 JUDGMENT BASED ON THE FACTS OF THE PATIENT'S CASE: THE PATIENT IS WITHIN
 TWENTY-FOUR WEEKS FROM THE COMMENCEMENT OF PREGNANCY,  OR  THERE  IS  AN
 ABSENCE  OF FETAL VIABILITY, OR THE ABORTION IS NECESSARY TO PROTECT THE
 PATIENT'S LIFE OR HEALTH.
   2. THIS ARTICLE SHALL BE CONSTRUED AND  APPLIED  CONSISTENT  WITH  AND
 SUBJECT  TO  APPLICABLE  LAWS  AND APPLICABLE AND AUTHORIZED REGULATIONS
 GOVERNING HEALTH CARE PROCEDURES.
   § 3. Section 4164 of the public health law is REPEALED.
   § 4. Subdivision 8 of section 6811 of the education law is REPEALED.
   § 5. Sections 125.40, 125.45, 125.50, 125.55 and 125.60 of  the  penal
 law  are  REPEALED,  and the article heading of article 125 of the penal
 law is amended to read as follows:
                 HOMICIDE[, ABORTION] AND RELATED OFFENSES
   § 6. Section 125.00 of the penal law is amended to read as follows:
 § 125.00 Homicide defined.
   Homicide means conduct which causes the  death  of  a  person  [or  an
 unborn  child  with which a female has been pregnant for more than twen-
 ty-four weeks] under circumstances constituting murder, manslaughter  in
 the  first  degree,  manslaughter  in  the  second degree, OR criminally
 negligent homicide[, abortion in the first degree  or  self-abortion  in
 the first degree].
   §  7.  The  section  heading,  opening  paragraph and subdivision 1 of
 section 125.05 of the penal law are amended to read as follows:
   Homicide[, abortion] and  related  offenses;  [definitions  of  terms]
 DEFINITION.
   The following [definitions are] DEFINITION IS applicable to this arti-
 cle:
   [1.]  "Person,"  when  referring  to the victim of a homicide, means a
 human being who has been born and is alive.
   § 7-a. Subdivisions 2 and 3 of section 125.05 of  the  penal  law  are
 REPEALED.
   § 8. Subdivision 2 of section 125.15 of the penal law is REPEALED.
   § 9. Subdivision 3 of section 125.20 of the penal law is REPEALED.
   § 10. Paragraph (b) of subdivision 8 of section 700.05 of the criminal
 procedure law, as amended by chapter 189 of the laws of 2018, is amended
 to read as follows:
   (b)  Any  of  the  following felonies: assault in the second degree as
 defined in section 120.05 of the penal law, assault in the first  degree
 as  defined in section 120.10 of the penal law, reckless endangerment in
 the first degree as defined in section 120.25 of the penal law,  promot-
 ing  a  suicide  attempt  as defined in section 120.30 of the penal law,
 strangulation in the second degree as defined in section 121.12  of  the
 penal  law,  strangulation  in  the  first  degree as defined in section
 121.13 of the penal law, criminally negligent  homicide  as  defined  in
 section  125.10  of  the penal law, manslaughter in the second degree as
 defined in section 125.15 of the penal law, manslaughter  in  the  first

 S. 1507                            99                            A. 2007
 
 degree  as  defined  in  section  125.20 of the penal law, murder in the
 second degree as defined in section 125.25 of the penal law,  murder  in
 the  first  degree  as  defined  in  section  125.27  of  the penal law,
 [abortion in the second degree as defined in section 125.40 of the penal
 law,  abortion  in  the first degree as defined in section 125.45 of the
 penal law,] rape in the third degree as defined in section 130.25 of the
 penal law, rape in the second degree as defined in section 130.30 of the
 penal law, rape in the first degree as defined in section 130.35 of  the
 penal law, criminal sexual act in the third degree as defined in section
 130.40  of  the  penal  law, criminal sexual act in the second degree as
 defined in section 130.45 of the penal law, criminal sexual act  in  the
 first degree as defined in section 130.50 of the penal law, sexual abuse
 in  the  first  degree  as  defined  in section 130.65 of the penal law,
 unlawful imprisonment in the first degree as defined in  section  135.10
 of  the penal law, kidnapping in the second degree as defined in section
 135.20 of the penal law, kidnapping in the first degree  as  defined  in
 section 135.25 of the penal law, labor trafficking as defined in section
 135.35  of  the  penal  law,  aggravated labor trafficking as defined in
 section 135.37 of the penal law, custodial  interference  in  the  first
 degree  as  defined  in section 135.50 of the penal law, coercion in the
 first degree as defined in section 135.65 of  the  penal  law,  criminal
 trespass  in  the first degree as defined in section 140.17 of the penal
 law, burglary in the third degree as defined in section  140.20  of  the
 penal law, burglary in the second degree as defined in section 140.25 of
 the penal law, burglary in the first degree as defined in section 140.30
 of  the  penal  law, criminal mischief in the third degree as defined in
 section 145.05 of the penal law, criminal mischief in the second  degree
 as  defined in section 145.10 of the penal law, criminal mischief in the
 first degree as defined in section 145.12 of  the  penal  law,  criminal
 tampering  in the first degree as defined in section 145.20 of the penal
 law, arson in the fourth degree as defined  in  section  150.05  of  the
 penal law, arson in the third degree as defined in section 150.10 of the
 penal  law,  arson  in the second degree as defined in section 150.15 of
 the penal law, arson in the first degree as defined in section 150.20 of
 the penal law, grand larceny in the fourth degree as defined in  section
 155.30 of the penal law, grand larceny in the third degree as defined in
 section  155.35  of the penal law, grand larceny in the second degree as
 defined in section 155.40 of the penal law, grand larceny in  the  first
 degree  as defined in section 155.42 of the penal law, health care fraud
 in the fourth degree as defined in section  177.10  of  the  penal  law,
 health  care  fraud  in the third degree as defined in section 177.15 of
 the penal law, health care fraud in the  second  degree  as  defined  in
 section  177.20  of the penal law, health care fraud in the first degree
 as defined in section 177.25 of the penal  law,  robbery  in  the  third
 degree  as  defined  in  section 160.05 of the penal law, robbery in the
 second degree as defined in section 160.10 of the penal law, robbery  in
 the first degree as defined in section 160.15 of the penal law, unlawful
 use  of  secret  scientific material as defined in section 165.07 of the
 penal law, criminal possession of stolen property in the  fourth  degree
 as  defined  in  section 165.45 of the penal law, criminal possession of
 stolen property in the third degree as defined in section 165.50 of  the
 penal  law,  criminal possession of stolen property in the second degree
 as defined by section 165.52 of the penal law,  criminal  possession  of
 stolen  property in the first degree as defined by section 165.54 of the
 penal law, trademark counterfeiting in the second degree as  defined  in
 section  165.72  of the penal law, trademark counterfeiting in the first

 S. 1507                            100                           A. 2007
 
 degree as defined in section 165.73 of the penal  law,  forgery  in  the
 second  degree as defined in section 170.10 of the penal law, forgery in
 the first degree as defined in section 170.15 of the penal law, criminal
 possession  of  a  forged  instrument in the second degree as defined in
 section 170.25 of the penal law, criminal possession of a forged instru-
 ment in the first degree as defined in section 170.30 of the penal  law,
 criminal  possession  of forgery devices as defined in section 170.40 of
 the penal law, falsifying  business  records  in  the  first  degree  as
 defined  in  section  175.10  of  the  penal  law, tampering with public
 records in the first degree as defined in section 175.25  of  the  penal
 law,  offering  a  false  instrument  for  filing in the first degree as
 defined in section 175.35 of the penal law, issuing a false  certificate
 as  defined  in  section  175.40 of the penal law, criminal diversion of
 prescription medications and  prescriptions  in  the  second  degree  as
 defined  in  section  178.20  of  the  penal  law, criminal diversion of
 prescription medications  and  prescriptions  in  the  first  degree  as
 defined  in  section 178.25 of the penal law, residential mortgage fraud
 in the fourth degree as defined in section  187.10  of  the  penal  law,
 residential  mortgage  fraud  in  the third degree as defined in section
 187.15 of the penal law, residential mortgage fraud in the second degree
 as defined in section 187.20 of  the  penal  law,  residential  mortgage
 fraud in the first degree as defined in section 187.25 of the penal law,
 escape  in  the  second degree as defined in section 205.10 of the penal
 law, escape in the first degree as defined  in  section  205.15  of  the
 penal  law,  absconding  from  temporary  release in the first degree as
 defined in section 205.17 of the penal law, promoting prison  contraband
 in  the  first  degree  as  defined  in section 205.25 of the penal law,
 hindering prosecution in the second degree as defined in section  205.60
 of  the  penal law, hindering prosecution in the first degree as defined
 in section 205.65 of the  penal  law,  sex  trafficking  as  defined  in
 section  230.34  of the penal law, sex trafficking of a child as defined
 in section 230.34-a of the penal law, criminal possession of a weapon in
 the third degree as defined in  subdivisions  two,  three  and  five  of
 section  265.02 of the penal law, criminal possession of a weapon in the
 second degree as defined in section 265.03 of the  penal  law,  criminal
 possession  of a weapon in the first degree as defined in section 265.04
 of the penal law, manufacture, transport, disposition and defacement  of
 weapons  and dangerous instruments and appliances defined as felonies in
 subdivisions one, two, and three of section 265.10  of  the  penal  law,
 sections  265.11,  265.12 and 265.13 of the penal law, or prohibited use
 of weapons as defined in subdivision two of section 265.35 of the  penal
 law,  relating  to  firearms  and other dangerous weapons, or failure to
 disclose the origin of a recording in the first  degree  as  defined  in
 section 275.40 of the penal law;
   §  11.  Subdivision  1  of  section 673 of the county law, as added by
 chapter 545 of the laws of 1965, is amended to read as follows:
   1. A coroner or medical examiner has  jurisdiction  and  authority  to
 investigate  the death of every person dying within his county, or whose
 body is found within the county, which is or appears to be:
   (a) A violent death, whether by criminal violence, suicide or  casual-
 ty;
   (b) A death caused by unlawful act or criminal neglect;
   (c) A death occurring in a suspicious, unusual or unexplained manner;
   (d) [A death caused by suspected criminal abortion;
   (e)] A death while unattended by a physician, so far as can be discov-
 ered,  or  where  no  physician  able  to  certify the cause of death as

 S. 1507                            101                           A. 2007
 
 provided in the public health law and  in  form  as  prescribed  by  the
 commissioner of health can be found;
   [(f)]  (E)  A death of a person confined in a public institution other
 than a hospital, infirmary or nursing home.
   § 12. Section 4 of the judiciary law, as amended by chapter 264 of the
 laws of 2003, is amended to read as follows:
   § 4. Sittings of courts to be public.  The  sittings  of  every  court
 within  this  state shall be public, and every citizen may freely attend
 the same, except that  in  all  proceedings  and  trials  in  cases  for
 divorce,  seduction,  [abortion,]  rape,  assault  with intent to commit
 rape, criminal sexual act, bastardy or filiation, the court may, in  its
 discretion,  exclude  therefrom  all persons who are not directly inter-
 ested therein, excepting jurors, witnesses, and officers of the court.
   § 13. Severability. If any provision of this act, or  any  application
 of  any  provision  of  this  act, is held to be invalid, that shall not
 affect the validity or effectiveness of any other provision of this act,
 or of any other application of any provision of this act, which  can  be
 given effect without that provision or application; and to that end, the
 provisions and applications of this act are severable.
   § 14. This act shall take effect immediately.
 
                                  PART T
 
   Section  1.  This act shall be known and may be cited as the "NY State
 of Health, The Official Health Plan Marketplace Act".
   § 2. Article 2 of the public health law is amended  by  adding  a  new
 title VII to read as follows:
                                 TITLE VII
                             NY STATE OF HEALTH
 SECTION 268. STATEMENT OF POLICY AND PURPOSES.
         268-A. DEFINITIONS.
         268-B. ESTABLISHMENT  OF NY STATE OF HEALTH, THE OFFICIAL HEALTH
                PLAN MARKETPLACE.
         268-C. FUNCTIONS OF THE MARKETPLACE.
         268-D. SPECIAL FUNCTIONS OF THE MARKETPLACE  RELATED  TO  HEALTH
                PLAN CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
         268-E. APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW.
         268-F. MARKETPLACE ADVISORY COMMITTEE.
         268-G. FUNDING OF THE MARKETPLACE.
         268-H. CONSTRUCTION.
   §  268. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS TITLE IS
 TO CODIFY THE ESTABLISHMENT OF THE HEALTH BENEFIT EXCHANGE IN NEW  YORK,
 KNOWN  AS  NY  STATE  OF  HEALTH,  THE  OFFICIAL HEALTH PLAN MARKETPLACE
 (MARKETPLACE), IN CONFORMANCE WITH EXECUTIVE  ORDER  42  (CUOMO)  ISSUED
 APRIL  12,  2012.  THE MARKETPLACE SHALL CONTINUE TO PERFORM ELIGIBILITY
 DETERMINATIONS FOR FEDERAL AND STATE  INSURANCE  AFFORDABILITY  PROGRAMS
 INCLUDING  MEDICAL  ASSISTANCE  IN ACCORDANCE WITH SECTION THREE HUNDRED
 SIXTY-SIX OF THE SOCIAL SERVICES LAW, CHILD HEALTH  PLUS  IN  ACCORDANCE
 WITH  SECTION  TWENTY-FIVE  HUNDRED  ELEVEN  OF  THIS CHAPTER, THE BASIC
 HEALTH PROGRAM IN ACCORDANCE WITH SECTION THREE HUNDRED SIXTY-NINE-GG OF
 THE SOCIAL SERVICES  LAW,  AND  PREMIUM  TAX  CREDITS  AND  COST-SHARING
 REDUCTIONS,  TOGETHER  WITH  PERFORMING  ELIGIBILITY  DETERMINATIONS FOR
 QUALIFIED HEALTH PLANS AND  SUCH  OTHER  HEALTH  INSURANCE  PROGRAMS  AS
 DETERMINED  BY  THE  COMMISSIONER. THE MARKETPLACE SHALL ALSO FACILITATE
 ENROLLMENT IN INSURANCE AFFORDABILITY PROGRAMS, QUALIFIED  HEALTH  PLANS
 AND  OTHER  HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER,

 S. 1507                            102                           A. 2007

 THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS AND/OR  OTHER  OR  ADDI-
 TIONAL HEALTH PLANS CERTIFIED BY THE MARKETPLACE PURSUANT TO THIS TITLE,
 AND  SHALL  CONTINUE  TO  HAVE THE AUTHORITY TO OPERATE A SMALL BUSINESS
 HEALTH  OPTIONS  PROGRAM  ("SHOP") TO ASSIST ELIGIBLE SMALL EMPLOYERS IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR PURPOSES OF SMALL EMPLOYER TAX CREDITS. IT  IS  THE  INTENT  OF  THE
 LEGISLATURE,  BY CODIFYING THE MARKETPLACE IN STATE STATUTE, TO CONTINUE
 TO PROMOTE QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE,  REDUCE  THE
 NUMBER  OF UNINSURED PERSONS, PROVIDE A TRANSPARENT MARKETPLACE, EDUCATE
 CONSUMERS AND  ASSIST  INDIVIDUALS  WITH  ACCESS  TO  COVERAGE,  PREMIUM
 ASSISTANCE  TAX  CREDITS  AND  COST-SHARING REDUCTIONS. IN ADDITION, THE
 LEGISLATURE DECLARES THE INTENT THAT  THE  MARKETPLACE  CONTINUE  TO  BE
 PROPERLY  INTEGRATED  WITH  INSURANCE  AFFORDABILITY PROGRAMS, INCLUDING
 MEDICAID, CHILD HEALTH PLUS AND THE BASIC HEALTH PROGRAM, AND SUCH OTHER
 HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER.
   § 268-A. DEFINITIONS. FOR PURPOSES OF THIS TITLE, THE FOLLOWING  DEFI-
 NITIONS SHALL APPLY:
   1. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH OF THE STATE OF NEW
 YORK.
   2.  "MARKETPLACE"  MEANS  THE "NY STATE OF HEALTH, THE OFFICIAL HEALTH
 PLAN MARKETPLACE" OR  "MARKETPLACE"  ESTABLISHED  AS  A  HEALTH  BENEFIT
 EXCHANGE  OR  "MARKETPLACE"  WITHIN THE DEPARTMENT OF HEALTH PURSUANT TO
 EXECUTIVE ORDER 42 (CUOMO) ISSUED APRIL 12, 2012 AND THIS TITLE.
   3. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT,
 PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE AND  EDUCATION  RECON-
 CILIATION  ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR GUID-
 ANCE ISSUED THEREUNDER.
   4. "HEALTH PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE,  OFFERED  OR
 ISSUED  BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR REIM-
 BURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. HEALTH  PLAN  SHALL  NOT
 INCLUDE THE FOLLOWING:
   (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
 TION THEREOF;
   (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
   (C)  LIABILITY  INSURANCE,  INCLUDING  GENERAL LIABILITY INSURANCE AND
 AUTOMOBILE LIABILITY INSURANCE;
   (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
   (E) AUTOMOBILE NO-FAULT INSURANCE;
   (F) CREDIT INSURANCE;
   (G) OTHER SIMILAR INSURANCE COVERAGE, AS SPECIFIED  IN  FEDERAL  REGU-
 LATIONS,  UNDER  WHICH  BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI-
 DENTAL TO OTHER INSURANCE BENEFITS;
   (H) LIMITED SCOPE DENTAL OR VISION BENEFITS,  BENEFITS  FOR  LONG-TERM
 CARE  INSURANCE,  NURSING  HOME  INSURANCE,  HOME CARE INSURANCE, OR ANY
 COMBINATION THEREOF, OR SUCH  OTHER  SIMILAR,  LIMITED  BENEFITS  HEALTH
 INSURANCE  AS  SPECIFIED  IN  FEDERAL  REGULATIONS,  IF THE BENEFITS ARE
 PROVIDED UNDER A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE
 OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
   (I)  COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL INDEM-
 NITY, OR OTHER FIXED INDEMNITY COVERAGE;
   (J) MEDICARE SUPPLEMENTAL INSURANCE AS DEFINED IN  SECTION  1882(G)(1)
 OF  THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE COVER-
 AGE PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE,  OR
 SIMILAR  SUPPLEMENTAL  COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN IF IT

 S. 1507                            103                           A. 2007
 
 IS OFFERED AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE;
 OR
   (K)  THE NEW YORK STATE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO
 TITLE FOUR OF ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
   5. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO  ARTICLE  FORTY-TWO
 OR A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR
 A  HEALTH  MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-
 FOUR OF THE PUBLIC HEALTH LAW THAT CONTRACTS OR OFFERS  TO  CONTRACT  TO
 PROVIDE,  DELIVER,  ARRANGE, PAY OR REIMBURSE ANY OF THE COSTS OF HEALTH
 CARE SERVICES.
   6. "STAND-ALONE DENTAL PLAN" MEANS A DENTAL  SERVICES  PLAN  THAT  HAS
 BEEN  ISSUED PURSUANT TO APPLICABLE LAW AND CERTIFIED BY THE MARKETPLACE
 IN ACCORDANCE WITH SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE.
   7. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED PURSUANT
 TO APPLICABLE LAW AND CERTIFIED BY THE MARKETPLACE  IN  ACCORDANCE  WITH
 SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE, INCLUDING A STAND-ALONE
 DENTAL PLAN.
   8.  "INSURANCE  AFFORDABILITY  PROGRAM"  MEANS  MEDICAID, CHILD HEALTH
 PLUS, THE BASIC HEALTH PROGRAM AND ANY OTHER  HEALTH  INSURANCE  SUBSIDY
 PROGRAM DESIGNATED AS SUCH BY THE COMMISSIONER.
   9.  "ELIGIBLE  INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A MINOR, WHO
 IS ELIGIBLE TO ENROLL IN AN INSURANCE  AFFORDABILITY  PROGRAM  OR  OTHER
 HEALTH INSURANCE PROGRAM AS DETERMINED BY THE COMMISSIONER.
   10.  "QUALIFIED  INDIVIDUAL"  MEANS,  WITH RESPECT TO QUALIFIED HEALTH
 PLANS, AN INDIVIDUAL, INCLUDING A MINOR, WHO:
   (A) IS ELIGIBLE TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO  INDI-
 VIDUALS THROUGH THE MARKETPLACE;
   (B) RESIDES IN THIS STATE;
   (C)  AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR-
 CERATION PENDING THE DISPOSITION OF CHARGES; AND
   (D) IS, AND IS REASONABLY EXPECTED TO BE, FOR THE  ENTIRE  PERIOD  FOR
 WHICH  ENROLLMENT  IS SOUGHT, A CITIZEN OR NATIONAL OF THE UNITED STATES
 OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
   11. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF
 HEALTH AND HUMAN SERVICES.
   12. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM OPERATED BY
 THE MARKETPLACE TO ASSIST ELIGIBLE SMALL  EMPLOYERS  IN  THIS  STATE  IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR PURPOSES OF SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH APPLICABLE
 FEDERAL AND STATE LAWS AND REGULATIONS.
   13. "SMALL EMPLOYER" MEANS AN EMPLOYER WHICH OFFERS COVERAGE WHERE THE
 COVERAGE  SUCH  EMPLOYER OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE
 UNDER THE INSURANCE LAW AND REGULATIONS PROMULGATED THEREUNDER, PROVIDED
 THAT IT IS NOT OTHERWISE PROHIBITED UNDER THE FEDERAL ACT.
   14. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
 INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON  BEHALF  OF  THEMSELVES
 AND  THEIR  DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL
 EMPLOYER.
   15. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
   16. "ESSENTIAL HEALTH BENEFITS" SHALL MEAN THE CATEGORIES OF  BENEFITS
 DEFINED  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED SEVEN-
 TEEN-I AND SUBSECTION (A) OF SECTION FOUR THOUSAND THREE  HUNDRED  SIX-H
 OF THE INSURANCE LAW.
   § 268-B. ESTABLISHMENT OF NY STATE OF HEALTH, THE OFFICIAL HEALTH PLAN
 MARKETPLACE. 1. THERE IS HEREBY ESTABLISHED AN OFFICE WITHIN THE DEPART-

 S. 1507                            104                           A. 2007
 
 MENT  OF  HEALTH  TO  BE  KNOWN AS THE "NY STATE OF HEALTH, THE OFFICIAL
 HEALTH PLAN MARKETPLACE".
   2.  THE  PURPOSE  OF  THE  MARKETPLACE  IS TO FACILITATE ENROLLMENT IN
 HEALTH COVERAGE AND THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS  AND
 OTHER  HEALTH  PLANS CERTIFIED BY THE MARKETPLACE; ENROLL INDIVIDUALS IN
 COVERAGE FOR WHICH THEY ARE ELIGIBLE  IN  ACCORDANCE  WITH  FEDERAL  AND
 STATE  LAW;  ENABLE ELIGIBLE INDIVIDUALS TO RECEIVE PREMIUM TAX CREDITS,
 COST-SHARING REDUCTIONS, AND TO ACCESS INSURANCE AFFORDABILITY  PROGRAMS
 AND  OTHER  HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER;
 ASSIST ELIGIBLE SMALL EMPLOYERS  IN  SELECTING  QUALIFIED  HEALTH  PLANS
 AND/OR  OTHER,  OR  ADDITIONAL HEALTH PLANS CERTIFIED BY THE MARKETPLACE
 AND TO QUALIFY FOR SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH  APPLI-
 CABLE LAW; AND TO CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS TITLE.
   § 268-C. FUNCTIONS OF THE MARKETPLACE. THE MARKETPLACE SHALL:
   1. (A) PERFORM ELIGIBILITY DETERMINATIONS FOR FEDERAL AND STATE INSUR-
 ANCE  AFFORDABILITY  PROGRAMS INCLUDING MEDICAL ASSISTANCE IN ACCORDANCE
 WITH SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES  LAW,  CHILD
 HEALTH  PLUS  IN  ACCORDANCE  WITH SECTION TWENTY-FIVE HUNDRED ELEVEN OF
 THIS CHAPTER, THE BASIC HEALTH PROGRAM IN ACCORDANCE WITH SECTION  THREE
 HUNDRED  SIXTY-NINE-GG  OF  THE SOCIAL SERVICES LAW, PREMIUM TAX CREDITS
 AND COST-SHARING REDUCTIONS AND QUALIFIED  HEALTH  PLANS  IN  ACCORDANCE
 WITH APPLICABLE LAW AND OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED BY
 THE COMMISSIONER;
   (B)  CERTIFY  AND  MAKE  AVAILABLE TO QUALIFIED INDIVIDUALS, QUALIFIED
 HEALTH PLANS, INCLUDING  DENTAL  PLANS,  CERTIFIED  BY  THE  MARKETPLACE
 PURSUANT  TO  APPLICABLE  LAW,  PROVIDED  THAT COVERAGE UNDER SUCH PLANS
 SHALL NOT BECOME EFFECTIVE PRIOR TO CERTIFICATION  BY  THE  MARKETPLACE;
 AND
   (C)  CERTIFY  AND/OR  MAKE  AVAILABLE  TO ELIGIBLE INDIVIDUALS, HEALTH
 PLANS CERTIFIED BY THE MARKETPLACE PURSUANT TO  APPLICABLE  LAW,  AND/OR
 PARTICIPATING IN AN INSURANCE AFFORDABILITY PROGRAM PURSUANT TO APPLICA-
 BLE LAW, PROVIDED THAT COVERAGE UNDER SUCH PLANS SHALL NOT BECOME EFFEC-
 TIVE  PRIOR  TO CERTIFICATION BY THE MARKETPLACE, AND/OR APPROVAL BY THE
 COMMISSIONER.
   2. ASSIGN AN  ACTUARIAL  VALUE  TO  EACH  MARKETPLACE  CERTIFIED  PLAN
 OFFERED  THROUGH  THE MARKETPLACE IN ACCORDANCE WITH THE CRITERIA DEVEL-
 OPED BY THE SECRETARY PURSUANT TO  FEDERAL  LAW  OR  THE  SUPERINTENDENT
 PURSUANT  TO  THE  INSURANCE  LAW  AND/OR  REQUIREMENTS DEVELOPED BY THE
 MARKETPLACE, AND DETERMINE EACH  HEALTH  PLAN'S  LEVEL  OF  COVERAGE  IN
 ACCORDANCE  WITH REGULATIONS ISSUED BY THE SECRETARY PURSUANT TO FEDERAL
 LAW OR THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW.
   3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
 IN THE MARKETPLACE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
 ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE  ACT
 OR THE INSURANCE LAW.
   4.  STANDARDIZE THE BENEFITS AVAILABLE THROUGH THE MARKETPLACE AT EACH
 LEVEL OF COVERAGE DEFINED BY THE SUPERINTENDENT IN THE INSURANCE LAW.
   5. MAINTAIN ENROLLMENT PERIODS IN THE BEST INTEREST OF QUALIFIED INDI-
 VIDUALS CONSISTENT WITH FEDERAL AND STATE LAW.
   6. IMPLEMENT PROCEDURES FOR  THE  CERTIFICATION,  RECERTIFICATION  AND
 DECERTIFICATION  OF  HEALTH  PLANS  AS  QUALIFIED HEALTH PLANS OR HEALTH
 PLANS APPROVED FOR SALE BY  THE  DEPARTMENT  OF  FINANCIAL  SERVICES  OR
 DEPARTMENT  OF  HEALTH AND CERTIFIED BY THE MARKETPLACE, CONSISTENT WITH
 GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C) OF THE
 FEDERAL ACT AND REQUIREMENTS DEVELOPED BY THE MARKETPLACE.

 S. 1507                            105                           A. 2007
 
   7. CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO QUALIFIED  INDIVIDUALS
 THROUGH  THE  MARKETPLACE,  AND IN DOING SO SHALL SEEK TO PROVIDE HEALTH
 CARE COVERAGE CHOICES THAT OFFER  THE  OPTIMAL  COMBINATION  OF  CHOICE,
 VALUE, QUALITY, AND SERVICE.
   8. CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO CERTAIN ELIGIBLE INDI-
 VIDUALS  THROUGH  THE MARKETPLACE, PURSUANT TO HEALTH INSURANCE PROGRAMS
 AS DETERMINED BY THE COMMISSIONER, AND IN DOING SO SHALL SEEK TO PROVIDE
 HEALTH CARE COVERAGE CHOICES  THAT  OFFER  THE  OPTIMAL  COMBINATION  OF
 CHOICE, VALUE, QUALITY, AND SERVICE;
   9.  PROVIDE  THE MINIMUM REQUIREMENTS AN INSURER SHALL MEET TO PARTIC-
 IPATE IN THE MARKETPLACE, IN THE BEST INTEREST OF QUALIFIED  INDIVIDUALS
 OR ELIGIBLE INDIVIDUALS;
   10. REQUIRE QUALIFIED HEALTH PLANS AND/OR OTHER HEALTH PLANS CERTIFIED
 BY  THE  MARKETPLACE  TO OFFER THOSE BENEFITS DETERMINED TO BE ESSENTIAL
 HEALTH BENEFITS PURSUANT TO STATE LAW OR AS REQUIRED BY THE MARKETPLACE.
   11. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE MARKETPLACE
 DO NOT CHARGE AN INDIVIDUAL ENROLLEE A FEE OR PENALTY FOR TERMINATION OF
 COVERAGE.
   12. PROVIDE FOR THE OPERATION OF  A  TOLL-FREE  TELEPHONE  HOTLINE  TO
 RESPOND TO REQUESTS FOR ASSISTANCE.
   13.  MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND PROSPEC-
 TIVE ENROLLEES OF QUALIFIED HEALTH PLANS AND HEALTH PLANS  CERTIFIED  BY
 THE  MARKETPLACE MAY OBTAIN STANDARDIZED COMPARATIVE INFORMATION ON SUCH
 PLANS AND INSURANCE AFFORDABILITY PROGRAMS.
   14. MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO  DETERMINE  THE
 ACTUAL  COST OF COVERAGE AFTER THE APPLICATION OF ANY PREMIUM TAX CREDIT
 UNDER SECTION 36B OF THE INTERNAL REVENUE CODE  OF  1986  OR  APPLICABLE
 STATE  LAW  AND  ANY  COST-SHARING REDUCTION UNDER FEDERAL OR APPLICABLE
 STATE LAW.
   15. OPERATE A PROGRAM UNDER WHICH THE  MARKETPLACE  AWARDS  GRANTS  TO
 ENTITIES  TO  SERVE  AS NAVIGATORS IN ACCORDANCE WITH APPLICABLE FEDERAL
 LAW AND REGULATIONS ADOPTED THEREUNDER, AND/OR A PROGRAM UNDER WHICH THE
 MARKETPLACE AWARDS GRANTS TO ENTITIES TO PROVIDE COMMUNITY BASED ENROLL-
 MENT ASSISTANCE IN ACCORDANCE WITH REQUIREMENTS DEVELOPED BY THE MARKET-
 PLACE; AND/OR A PROGRAM UNDER WHICH THE MARKETPLACE CERTIFIES  NEW  YORK
 STATE  LICENSED  PRODUCERS TO PROVIDE ASSISTANCE TO ELIGIBLE INDIVIDUALS
 AND/OR SMALL EMPLOYERS PURSUANT TO FEDERAL OR STATE LAW.
   16. IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAW, INFORM  INDI-
 VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE
 XIX  OF  THE  SOCIAL SECURITY ACT AND THE SOCIAL SERVICES LAW, THE CHIL-
 DREN'S HEALTH INSURANCE PROGRAM (CHIP) UNDER TITLE  XXI  OF  THE  SOCIAL
 SECURITY  ACT  AND  THIS CHAPTER, THE BASIC HEALTH PROGRAM UNDER SECTION
 THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW, OR ANY  APPLICA-
 BLE  STATE  OR  LOCAL  PUBLIC  HEALTH  INSURANCE PROGRAM AND IF, THROUGH
 SCREENING OF THE APPLICATION BY THE MARKETPLACE, THE MARKETPLACE  DETER-
 MINES  THAT  SUCH  INDIVIDUALS ARE ELIGIBLE FOR ANY SUCH PROGRAM, ENROLL
 SUCH INDIVIDUALS IN SUCH PROGRAM.
   17. GRANT A CERTIFICATION  THAT  AN  INDIVIDUAL  IS  EXEMPT  FROM  THE
 REQUIREMENT  TO  MAINTAIN MINIMUM ESSENTIAL COVERAGE PURSUANT TO FEDERAL
 OR STATE LAW  AND  FROM  ANY  PENALTIES  IMPOSED  BY  SUCH  REQUIREMENTS
 BECAUSE:
   (A) THERE IS NO AFFORDABLE HEALTH PLAN AVAILABLE COVERING THE INDIVID-
 UAL, AS DEFINED BY APPLICABLE LAW; OR
   (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
 FROM  THE  REQUIREMENT  TO MAINTAIN MINIMUM ESSENTIAL COVERAGE OR TO PAY
 THE PENALTY PURSUANT TO APPLICABLE FEDERAL OR STATE LAW.

 S. 1507                            106                           A. 2007
 
   18. OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP")  PURSUANT
 TO  SECTION  1311  OF  THE FEDERAL ACT AND APPLICABLE STATE LAW, THROUGH
 WHICH ELIGIBLE SMALL EMPLOYERS MAY SELECT  MARKETPLACE-CERTIFIED  QUALI-
 FIED  HEALTH  PLANS OFFERED IN THE SMALL GROUP MARKET, AND THROUGH WHICH
 ELIGIBLE  SMALL EMPLOYERS MAY RECEIVE ASSISTANCE IN QUALIFYING FOR SMALL
 BUSINESS TAX CREDITS AVAILABLE PURSUANT TO FEDERAL AND STATE LAW.
   19. ENTER INTO AGREEMENTS AS NECESSARY WITH FEDERAL AND STATE AGENCIES
 AND OTHER STATE MARKETPLACES TO CARRY  OUT  ITS  RESPONSIBILITIES  UNDER
 THIS  TITLE,  PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE PROTECTIONS WITH
 RESPECT TO THE CONFIDENTIALITY OF  ANY  INFORMATION  TO  BE  SHARED  AND
 COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS.
   20.  PERFORM  DUTIES  REQUIRED  BY THE SECRETARY, THE SECRETARY OF THE
 UNITED STATES DEPARTMENT OF THE TREASURY OR THE COMMISSIONER RELATED  TO
 DETERMINING  ELIGIBILITY FOR PREMIUM TAX CREDITS OR REDUCED COST-SHARING
 UNDER APPLICABLE FEDERAL OR STATE LAW.
   21. MEET PROGRAM INTEGRITY REQUIREMENTS UNDER APPLICABLE LAW,  INCLUD-
 ING  KEEPING  AN  ACCURATE  ACCOUNTING  OF RECEIPTS AND EXPENDITURES AND
 PROVIDING REPORTS TO THE SECRETARY REGARDING MARKETPLACE RELATED  ACTIV-
 ITIES IN ACCORDANCE WITH APPLICABLE LAW.
   22.  SUBMIT INFORMATION PROVIDED BY MARKETPLACE APPLICANTS FOR VERIFI-
 CATION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT AND  APPLICABLE
 STATE LAW.
   23.  ESTABLISH  RULES  AND  REGULATIONS  THAT  DO NOT CONFLICT WITH OR
 PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY THE SECRETARY.
   24. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE  OPPORTUNITIES
 FOR  APPEAL  AND  REDETERMINATION IN ACCORDANCE WITH THE REQUIREMENTS OF
 FEDERAL AND STATE LAW.
   § 268-D. SPECIAL FUNCTIONS OF THE MARKETPLACE RELATED TO  HEALTH  PLAN
 CERTIFICATION  AND  QUALIFIED  HEALTH  PLAN  OVERSIGHT.  1. HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE SHALL MEET THE FOLLOWING REQUIREMENTS:
   (A) THE INSURER OFFERING THE HEALTH PLAN:
   (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER, IN
 GOOD STANDING TO OFFER HEALTH INSURANCE  COVERAGE  IN  THIS  STATE,  AND
 MEETS THE REQUIREMENTS ESTABLISHED BY THE MARKETPLACE;
   (II)  OFFERS  AT LEAST ONE QUALIFIED HEALTH PLAN AND/OR OTHER OR ADDI-
 TIONAL HEALTH PLANS AUTHORIZED FOR SALE BY THE DEPARTMENT  OF  FINANCIAL
 SERVICES  OR  THE  DEPARTMENT  IN  EACH OF THE SILVER AND GOLD LEVELS AS
 REQUIRED BY STATE LAW,  PROVIDED,  HOWEVER,  THAT  THE  MARKETPLACE  MAY
 REQUIRE  ADDITIONAL BENEFIT LEVELS TO BE OFFERED BY ALL INSURERS PARTIC-
 IPATING IN THE MARKETPLACE;
   (III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT  OF
 ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
 LAW AND/OR THIS CHAPTER;
   (IV)  DOES  NOT  CHARGE  ANY CANCELLATION FEES OR PENALTIES FOR TERMI-
 NATION OF COVERAGE IN VIOLATION OF APPLICABLE LAW; AND
   (V) COMPLIES WITH THE REGULATIONS DEVELOPED  BY  THE  SECRETARY  UNDER
 SECTION  1311(C)  OF  THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE
 MARKETPLACE MAY ESTABLISH.
   (B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS  PACK-
 AGE  DESCRIBED  IN STATE LAW OR REQUIRED BY THE MARKETPLACE AND INCLUDES
 SUCH ADDITIONAL BENEFITS AS ARE MANDATED BY STATE LAW, EXCEPT  THAT  THE
 HEALTH  PLAN  SHALL  NOT  BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT
 DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF:
   (A) THE MARKETPLACE HAS DETERMINED THAT AT LEAST ONE QUALIFIED  DENTAL
 PLAN  OR DENTAL PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL SERVICES OR

 S. 1507                            107                           A. 2007
 
 THE DEPARTMENT IS AVAILABLE TO SUPPLEMENT THE  HEALTH  PLAN'S  COVERAGE;
 AND
   (B)  THE  INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
 HEALTH PLAN, IN A FORM APPROVED BY THE MARKETPLACE, THAT THE  PLAN  DOES
 NOT  PROVIDE  THE  FULL  RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT
 QUALIFIED DENTAL PLANS OR DENTAL PLANS APPROVED  BY  THE  DEPARTMENT  OF
 FINANCIAL  SERVICES OR DEPARTMENT OF HEALTH PROVIDING THOSE BENEFITS AND
 OTHER DENTAL BENEFITS NOT COVERED BY THE PLAN ARE  OFFERED  THROUGH  THE
 MARKETPLACE;
   (II)  PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE AS DEFINED BY STATE
 LAW, UNLESS THE PLAN IS CERTIFIED AS A QUALIFIED CATASTROPHIC  PLAN,  AS
 DEFINED IN SECTION 1302(E) OF THE FEDERAL ACT AND THE INSURANCE LAW, AND
 SHALL ONLY BE OFFERED TO INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE;
   (III)  HAS  COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
 NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF  THE  FEDERAL
 ACT, STATE LAW AND ANY REQUIREMENTS OF THE MARKETPLACE;
   (IV)  COMPLIES  WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT
 TO SECTION 1311(C) OF THE FEDERAL ACT AND APPLICABLE  STATE  LAW,  WHICH
 INCLUDE  MINIMUM  STANDARDS IN THE AREAS OF MARKETING PRACTICES, NETWORK
 ADEQUACY, ESSENTIAL COMMUNITY PROVIDERS IN UNDERSERVED  AREAS,  ACCREDI-
 TATION,  QUALITY  IMPROVEMENT, UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS
 OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH BENEFIT  PLAN
 PERFORMANCE;
   (V)  MEETS  STANDARDS  SPECIFIED  AND  DETERMINED  BY THE MARKETPLACE,
 PROVIDED THAT THE STANDARDS DO NOT CONFLICT WITH OR PREVENT THE APPLICA-
 TION OF FEDERAL REQUIREMENTS; AND
   (VI) COMPLIES WITH THE INSURANCE LAW  AND  THIS  CHAPTER  REQUIREMENTS
 APPLICABLE  TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGULATIONS
 PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH  OR  PREVENT  THE
 APPLICATION OF FEDERAL REQUIREMENTS; AND
   (C)  THE  MARKETPLACE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE
 THROUGH THE MARKETPLACE IS IN THE INTEREST OF QUALIFIED  INDIVIDUALS  IN
 THIS STATE.
   2. THE MARKETPLACE SHALL NOT EXCLUDE A HEALTH PLAN:
   (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
   (B)  THROUGH  THE  IMPOSITION OF PREMIUM PRICE CONTROLS BY THE MARKET-
 PLACE; OR
   (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
 PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE MARKETPLACE DETERMINES ARE
 INAPPROPRIATE OR TOO COSTLY.
   3. THE MARKETPLACE SHALL REQUIRE EACH  INSURER  CERTIFIED  OR  SEEKING
 CERTIFICATION  OF  A  HEALTH  PLAN  AS  A  QUALIFIED HEALTH PLAN OR PLAN
 APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL SERVICES OR THE DEPART-
 MENT TO:
   (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE PURSUANT TO APPLI-
 CABLE LAW PRIOR TO IMPLEMENTATION OF SUCH INCREASE.  THE  INSURER  SHALL
 PROMINENTLY  POST  THE  INFORMATION  ON ITS INTERNET WEBSITE.  SUCH RATE
 INCREASES SHALL BE SUBJECT TO THE PRIOR APPROVAL OF  THE  SUPERINTENDENT
 PURSUANT TO THE INSURANCE LAW;
   (B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE MARKETPLACE, THE
 SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
   (A) CLAIMS PAYMENT POLICIES AND PRACTICES;
   (B) PERIODIC FINANCIAL DISCLOSURES;
   (C) DATA ON ENROLLMENT AND DISENROLLMENT;
   (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
   (E) DATA ON RATING PRACTICES;

 S. 1507                            108                           A. 2007
 
   (F)  INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT-
 OF-NETWORK COVERAGE;
   (G)  INFORMATION  ON  ENROLLEE AND PARTICIPANT RIGHTS UNDER TITLE I OF
 THE FEDERAL ACT; AND
   (H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY  THE  SECRETARY  OR
 OTHERWISE REQUIRED BY THE MARKETPLACE;
   (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM
 IS  DEFINED  IN  SECTION 1311(E)(3)(B) OF THE FEDERAL ACT AND STATE LAW,
 AND IN GUIDANCE JOINTLY ISSUED  THEREUNDER  BY  THE  SECRETARY  AND  THE
 FEDERAL SECRETARY OF LABOR; AND
   (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
 INDIVIDUAL,  THE  AMOUNT  OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY-
 MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN  OR  COVERAGE
 THAT  THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE
 FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
 A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE  TO  THE  INDIVIDUAL
 THROUGH  AN  INTERNET  WEBSITE  AND  THROUGH OTHER MEANS FOR INDIVIDUALS
 WITHOUT ACCESS TO THE INTERNET.
   4. THE MARKETPLACE SHALL NOT EXEMPT ANY INSURER SEEKING  CERTIFICATION
 OF  A  HEALTH  PLAN, REGARDLESS OF THE TYPE OR SIZE OF THE INSURER, FROM
 LICENSING OR SOLVENCY REQUIREMENTS UNDER THE INSURANCE LAW OR THIS CHAP-
 TER, AND SHALL APPLY THE CRITERIA OF  THIS  SECTION  IN  A  MANNER  THAT
 ENSURES  A LEVEL PLAYING FIELD FOR INSURERS PARTICIPATING IN THE MARKET-
 PLACE.
   5. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO  QUALIFIED  HEALTH
 PLANS  AND  PLANS  APPROVED  FOR  SALE  BY  THE  DEPARTMENT OF FINANCIAL
 SERVICES AND THE DEPARTMENT ALSO SHALL APPLY TO THE EXTENT  RELEVANT  TO
 QUALIFIED  DENTAL PLANS APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT, EXCEPT AS MODIFIED IN  ACCORDANCE  WITH  THE
 PROVISIONS  OF  PARAGRAPHS  (B) AND (C) OF THIS SUBDIVISION OR OTHERWISE
 REQUIRED BY THE MARKETPLACE.
   (B) THE QUALIFIED DENTAL PLAN OR DENTAL PLAN APPROVED FOR SALE BY  THE
 DEPARTMENT  OF FINANCIAL SERVICES AND/OR THE DEPARTMENT SHALL BE LIMITED
 TO DENTAL AND ORAL HEALTH BENEFITS,  WITHOUT  SUBSTANTIALLY  DUPLICATING
 THE  BENEFITS  TYPICALLY  OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL
 COVERAGE, AND SHALL INCLUDE,  AT  A  MINIMUM,  THE  ESSENTIAL  PEDIATRIC
 DENTAL   BENEFITS  PRESCRIBED  BY  THE  SECRETARY  PURSUANT  TO  SECTION
 1302(B)(1)(J) OF THE FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS  THE
 MARKETPLACE OR SECRETARY MAY SPECIFY IN REGULATIONS.
   (C)  INSURERS  MAY  JOINTLY  OFFER  A  COMPREHENSIVE  PLAN THROUGH THE
 MARKETPLACE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS  THROUGH  A
 QUALIFIED  DENTAL  PLAN  OR PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT AND AN INSURER PROVIDES  THE  OTHER  BENEFITS
 THROUGH  A  QUALIFIED  HEALTH  PLAN,  PROVIDED THAT THE PLANS ARE PRICED
 SEPARATELY AND ALSO ARE MADE AVAILABLE FOR PURCHASE  SEPARATELY  AT  THE
 SAME PRICE.
   §  268-E.  APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW. 1. ANY APPLI-
 CANT OR ENROLLEE, OR ANY INDIVIDUAL AUTHORIZED TO ACT ON BEHALF  OF  ANY
 SUCH  APPLICANT  OR ENROLLEE, MAY APPEAL TO THE DEPARTMENT FROM DETERMI-
 NATIONS OF DEPARTMENT OFFICIALS OR FAILURES TO MAKE DETERMINATIONS  UPON
 GROUNDS  SPECIFIED  IN  SUBDIVISION FOUR OF THIS SECTION. THE DEPARTMENT
 MUST REVIEW THE APPEAL DE NOVO AND GIVE SUCH PERSON AN  OPPORTUNITY  FOR
 AN  APPEAL HEARING.   THE DEPARTMENT MAY ALSO, ON ITS OWN MOTION, REVIEW
 ANY DECISION MADE OR ANY CASE IN WHICH A DECISION HAS NOT BEEN  MADE  BY
 THE  MARKETPLACE OR A SOCIAL SERVICES OFFICIAL WITHIN THE TIME SPECIFIED
 BY LAW OR REGULATIONS OF THE DEPARTMENT. THE DEPARTMENT  MAY  MAKE  SUCH

 S. 1507                            109                           A. 2007
 
 ADDITIONAL  INVESTIGATION AS IT MAY DEEM NECESSARY, AND THE COMMISSIONER
 MUST MAKE SUCH DETERMINATION AS IS  JUSTIFIED  AND  IN  ACCORDANCE  WITH
 APPLICABLE LAW.
   2.  REGARDING  ANY APPEAL PURSUANT TO THIS SECTION, WITH OR WITHOUT AN
 APPEAL HEARING, THE COMMISSIONER MAY DESIGNATE AND AUTHORIZE ONE OR MORE
 APPROPRIATE MEMBERS OF HIS STAFF TO CONSIDER AND  DECIDE  SUCH  APPEALS.
 ANY  STAFF  MEMBER  SO  DESIGNATED AND AUTHORIZED WILL HAVE AUTHORITY TO
 DECIDE SUCH APPEALS ON BEHALF OF THE COMMISSIONER WITH  THE  SAME  FORCE
 AND  EFFECT  AS IF THE COMMISSIONER HAD MADE THE DECISIONS. APPEAL HEAR-
 INGS MUST BE HELD ON BEHALF OF THE COMMISSIONER BY MEMBERS OF HIS  STAFF
 WHO  ARE  EMPLOYED  FOR  SUCH  PURPOSES  OR WHO HAVE BEEN DESIGNATED AND
 AUTHORIZED BY THE COMMISSIONER.
   3. PERSONS ENTITLED TO APPEAL  TO  THE  DEPARTMENT  PURSUANT  TO  THIS
 SECTION MUST INCLUDE:
   (A)  APPLICANTS  FOR  OR ENROLLEES IN INSURANCE AFFORDABILITY PROGRAMS
 AND QUALIFIED HEALTH PLANS; AND
   (B) OTHER PERSONS ENTITLED TO AN OPPORTUNITY FOR AN APPEAL HEARING  AS
 DIRECTED BY THE COMMISSIONER.
   4.  AN  APPLICANT  OR  ENROLLEE  HAS  THE RIGHT TO APPEAL AT LEAST THE
 FOLLOWING ISSUES:
   (A) AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH THIS  ARTICLE
 AND APPLICABLE LAW, INCLUDING:
   (I) AN INITIAL DETERMINATION OF ELIGIBILITY, INCLUDING:
   (A) ELIGIBILITY TO ENROLL IN A QUALIFIED HEALTH PLAN;
   (B) ELIGIBILITY FOR MEDICAID;
   (C) ELIGIBILITY FOR CHILD HEALTH PLUS;
   (D) ELIGIBILITY FOR THE BASIC HEALTH PROGRAM;
   (E) THE AMOUNT OF ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND LEVEL
 OF COST-SHARING REDUCTIONS;
   (F)  THE  AMOUNT OF ANY OTHER SUBSIDY THAT MAY BE AVAILABLE UNDER LAW;
 AND
   (G) ELIGIBILITY FOR SUCH OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED
 BY THE COMMISSIONER; AND
   (II) A RE-DETERMINATION OF ELIGIBILITY  OF  THE  PROGRAMS  UNDER  THIS
 SUBDIVISION.
   (B)  AN  ELIGIBILITY DETERMINATION FOR AN EXEMPTION FOR ANY MANDATE TO
 PURCHASE HEALTH INSURANCE.
   (C) A FAILURE BY NY STATE OF HEALTH TO PROVIDE TIMELY  WRITTEN  NOTICE
 OF AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH APPLICABLE LAW.
   5.  THE DEPARTMENT MAY, SUBJECT TO THE DISCRETION OF THE COMMISSIONER,
 PROMULGATE SUCH REGULATIONS, CONSISTENT WITH FEDERAL OR  STATE  LAW,  AS
 MAY BE NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
   6. REGARDING EVERY DECISION OF AN APPEAL PURSUANT TO THIS SECTION, THE
 DEPARTMENT  MUST  INFORM  EVERY PARTY, AND HIS OR HER REPRESENTATIVE, IF
 ANY, OF THE AVAILABILITY OF JUDICIAL REVIEW AND THE TIME  LIMITATION  TO
 PURSUE FUTURE REVIEW.
   7. APPLICANTS AND ENROLLEES OF QUALIFIED HEALTH PLANS, WITH OR WITHOUT
 ADVANCE  PAYMENTS OF THE PREMIUM TAX CREDIT AND COST-SHARING REDUCTIONS,
 ALSO HAVE THE RIGHT TO APPEAL TO THE UNITED STATES DEPARTMENT OF  HEALTH
 AND HUMAN SERVICES APPEAL ENTITY:
   (A) APPEALS DECISIONS ISSUED BY NY STATE OF HEALTH UPON THE EXHAUSTION
 OF THE NY STATE OF HEALTH APPEALS PROCESS; AND
   (B)  A  DENIAL OF A REQUEST TO VACATE A DISMISSAL MADE BY THE NY STATE
 OF HEALTH APPEALS ENTITY.
   8. THE DEPARTMENT MUST INCLUDE  NOTICE  OF  THE  RIGHT  TO  APPEAL  AS
 PROVIDED  BY SUBDIVISION FOUR OF THIS SECTION AND INSTRUCTIONS REGARDING

 S. 1507                            110                           A. 2007
 
 HOW TO FILE AN APPEAL IN ANY ELIGIBILITY  DETERMINATION  ISSUED  TO  THE
 APPLICANT  OR  ENROLLEE  IN  ACCORDANCE WITH APPLICABLE LAW. SUCH NOTICE
 SHALL INCLUDE:
   (A) AN EXPLANATION OF THE APPLICANT OR ENROLLEE'S APPEAL RIGHTS;
   (B) A DESCRIPTION OF THE PROCEDURES BY WHICH THE APPLICANT OR ENROLLEE
 MAY REQUEST AN APPEAL;
   (C)  INFORMATION  ON  THE  APPLICANT  OR ENROLLEE'S RIGHT TO REPRESENT
 HIMSELF OR HERSELF, OR TO BE REPRESENTED BY  LEGAL  COUNSEL  OR  ANOTHER
 REPRESENTATIVE;
   (D)  AN  EXPLANATION  OF THE CIRCUMSTANCES UNDER WHICH THE APPELLANT'S
 ELIGIBILITY MAY BE MAINTAINED OR REINSTATED PENDING AN APPEAL  DECISION;
 AND
   (E)  AN  EXPLANATION  THAT AN APPEAL DECISION FOR ONE HOUSEHOLD MEMBER
 MAY RESULT IN A CHANGE IN ELIGIBILITY FOR OTHER  HOUSEHOLD  MEMBERS  AND
 THAT  SUCH  A CHANGE WILL BE HANDLED AS A REDETERMINATION OF ELIGIBILITY
 FOR ALL HOUSEHOLD MEMBERS IN ACCORDANCE WITH THE STANDARDS SPECIFIED  IN
 APPLICABLE LAW.
   §  268-F.  MARKETPLACE  ADVISORY COMMITTEE. 1. THERE IS HEREBY CREATED
 THE MARKETPLACE ADVISORY COMMITTEE, WHICH SHALL CONSIDER AND ADVISE  THE
 DEPARTMENT  AND  COMMISSIONER  ON  MATTERS  CONCERNING  THE PROVISION OF
 HEALTH CARE COVERAGE THROUGH THE NY STATE OF HEALTH OR MARKETPLACE.
   2. THE MARKETPLACE ADVISORY COMMITTEE SHALL CONSIST OF UP  TO  TWENTY-
 EIGHT  MEMBERS  APPOINTED  BY  THE  COMMISSIONER, REPRESENTATIVE OF EACH
 GEOGRAPHIC AREA OF THE STATE AND INCLUDING:
   (A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT  MORE  THAN
 SIX FROM ANY SINGLE CATEGORY:
   (I) HEALTH PLAN CONSUMER ADVOCATES;
   (II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
   (III) HEALTH CARE PROVIDER REPRESENTATIVES;
   (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
   (B)  REPRESENTATIVES  FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
 TWO FROM EITHER CATEGORY:
   (I) LICENSED INSURANCE PRODUCERS; AND
   (II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
   3. THE MARKETPLACE SHALL SELECT THE CHAIR OF  THE  ADVISORY  COMMITTEE
 FROM  AMONG THE MEMBERS OF SUCH COMMITTEE AND SHALL DESIGNATE AN OFFICER
 OR EMPLOYEE OF THE DEPARTMENT TO ASSIST THE MARKETPLACE ADVISORY COMMIT-
 TEE IN THE PERFORMANCE OF ITS DUTIES UNDER THIS SECTION. THE MARKETPLACE
 SHALL ADOPT RULES FOR THE GOVERNANCE OF THE  ADVISORY  COMMITTEE,  WHICH
 SHALL  MEET  AS FREQUENTLY AS ITS BUSINESS MAY REQUIRE AND AT SUCH OTHER
 TIMES AS DETERMINED BY THE MARKETPLACE TO BE NECESSARY.
   4. MEMBERS OF THE ADVISORY COMMITTEE SHALL SERVE WITHOUT  COMPENSATION
 FOR  THEIR  SERVICES AS MEMBERS, BUT EACH SHALL BE ALLOWED THE NECESSARY
 AND ACTUAL EXPENSES INCURRED IN THE PERFORMANCE OF  HIS  OR  HER  DUTIES
 UNDER THIS SECTION.
   § 268-G. FUNDING OF THE MARKETPLACE. 1. THE MARKETPLACE SHALL BE FUND-
 ED BY STATE AND FEDERAL SOURCES AS AUTHORIZED BY APPLICABLE LAW, INCLUD-
 ING  BUT NOT LIMITED TO APPLICABLE LAW AUTHORIZING THE RESPECTIVE INSUR-
 ANCE AFFORDABILITY PROGRAMS AVAILABLE THROUGH THE MARKETPLACE.
   2. THE ACCOUNTS OF THE MARKETPLACE SHALL BE SUBJECT TO SUPERVISION  OF
 THE  COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS, EXPENDITURES,
 CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
 MARKETPLACE.
   3. NOTWITHSTANDING ANY LAW TO THE CONTRARY,  AND  IN  ACCORDANCE  WITH
 SECTION  FOUR  OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
 THE BUDGET, IN CONSULTATION WITH THE  COMMISSIONER,  THE  SUPERINTENDENT

 S. 1507                            111                           A. 2007
 
 AND THE EXECUTIVE DIRECTOR OF THE MARKETPLACE, THE COMPTROLLER IS HEREBY
 AUTHORIZED  AND  DIRECTED  TO  SUB-ALLOCATE  OR TRANSFER SPECIAL REVENUE
 FEDERAL FUNDS APPROPRIATED TO THE DEPARTMENT FOR PLANNING AND IMPLEMENT-
 ING  VARIOUS  HEALTHCARE  AND INSURANCE REFORM INITIATIVES AUTHORIZED BY
 APPLICABLE LAW.  MARKETPLACE MONEYS SUB-ALLOCATED OR TRANSFERRED  PURSU-
 ANT TO THIS SECTION SHALL BE PAID OUT OF THE FUND UPON AUDIT AND WARRANT
 OF  THE  STATE  COMPTROLLER  ON  VOUCHERS  CERTIFIED  OR APPROVED BY THE
 MARKETPLACE.
   § 268-H. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
 THE MARKETPLACE PURSUANT HERETO, SHALL BE CONSTRUED TO:
   1. PREEMPT OR SUPERSEDE THE AUTHORITY OF  THE  SUPERINTENDENT  OR  THE
 COMMISSIONER; OR
   2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
 THIS CHAPTER OR THE INSURANCE LAW AND ANY REGULATIONS PROMULGATED THERE-
 UNDER.
   §  3.  Severability. If any provision of this article, or the applica-
 tion thereof to any person or circumstances is held invalid or unconsti-
 tutional, that invalidity or unconstitutionality shall not affect  other
 provisions  or  applications  of  this  article that can be given effect
 without the invalid or unconstitutional provision or application, and to
 this end the provisions and application of this article are severable.
   § 4. This act shall take effect immediately.
 
                                  PART U
 
   Section 1. Section 203 of the elder law is amended  by  adding  a  new
 subdivision 12 to read as follows:
   12.  THE DIRECTOR IS HEREBY AUTHORIZED TO IMPLEMENT PRIVATE PAY PROTO-
 COLS FOR ALL PROGRAMS ADMINISTERED BY THE OFFICE. THESE PROTOCOLS MAY BE
 IMPLEMENTED BY AREA AGENCIES ON AGING AT THEIR OPTION AND SUCH PROTOCOLS
 MAY NOT BE APPLIED TO CLIENTS WHOSE SERVICES ARE PAID FOR  WITH  FEDERAL
 FUNDS  OR  FUNDS  DESIGNATED  AS  FEDERAL  MATCH.  ALL  PRIVATE PAYMENTS
 RECEIVED DIRECTLY BY AN AREA AGENCY ON AGING OR INDIRECTLY BY ONE OF ITS
 CONTRACTORS SHALL BE USED TO SUPPLEMENT, NOT SUPPLANT, FUNDS  BY  STATE,
 FEDERAL,  OR  COUNTY APPROPRIATIONS. PRIVATE PAY PAYMENTS RECEIVED UNDER
 THIS SUBDIVISION SHALL BE USED BY THE AREA AGENCY ON  AGING  TO  SUPPORT
 AND  ENHANCE  SERVICES OR PROGRAMS PROVIDED BY THE AREA AGENCY ON AGING.
 PARTICIPANT PAYMENTS UNDER THIS SUBDIVISION SHALL  NOT  BE  REQUIRED  OF
 INDIVIDUALS  WITH  INCOMES  BELOW  FOUR  HUNDRED  PERCENT OF THE FEDERAL
 POVERTY LEVEL. NO PARTICIPANT, REGARDLESS OF INCOME, SHALL  BE  REQUIRED
 TO  PAY FOR ANY SERVICE THAT THEY ARE RECEIVING AT THE TIME THESE PROTO-
 COLS ARE IMPLEMENTED BY THE AREA AGENCY ON AGING. THIS SUBDIVISION SHALL
 NOT PREVENT COST  SHARING  FOR  THE  PROGRAMS  ESTABLISHED  PURSUANT  TO
 SECTION  TWO  HUNDRED  FOURTEEN OF THIS TITLE FOR INDIVIDUALS BELOW FOUR
 HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL.
   § 2. This act shall take effect immediately.
 
                                  PART V
 
   Section 1. Paragraph (d) of subdivision 32 of  section  364-j  of  the
 social services law, as amended by section 15 of part B of chapter 59 of
 the laws of 2016, is amended to read as follows:
   (d) (I) Penalties under this subdivision may be applied to any and all
 circumstances  described  in paragraph (b) of this subdivision until the
 managed care organization complies with the requirements for  submission
 of encounter data.

 S. 1507                            112                           A. 2007
 
   (II)  No  penalties  for late, incomplete or inaccurate encounter data
 shall be assessed against managed  care  organizations  in  addition  to
 those  provided for in this subdivision, PROVIDED, HOWEVER, THAT NOTHING
 IN THIS PARAGRAPH SHALL PROHIBIT THE IMPOSITION OF PENALTIES,  IN  CASES
 OF FRAUD OR ABUSE, OTHERWISE AUTHORIZED BY LAW.
   §  2.  Section 364-j of the social services law is amended by adding a
 new subdivision 34 read as follows:
   34. ANY PAYMENT MADE PURSUANT TO THE  STATE'S  MANAGED  CARE  PROGRAM,
 INCLUDING PAYMENTS MADE BY MANAGED LONG TERM CARE PLANS, SHALL BE DEEMED
 A PAYMENT BY THE STATE'S MEDICAL ASSISTANCE PROGRAM.
   §  3.  Section 364-j of the social services law is amended by adding a
 new subdivision 36 to read as follows:
   36. MEDICAID PROGRAM INTEGRITY  REVIEWS.  (A)  FOR  PURPOSES  OF  THIS
 SUBDIVISION,  MANAGED CARE PROVIDER SHALL ALSO INCLUDE MANAGED LONG TERM
 CARE PLANS.
   (B) THE MEDICAID INSPECTOR GENERAL SHALL CONDUCT PERIODIC  REVIEWS  OF
 THE  CONTRACTUAL PERFORMANCE OF EACH MANAGED CARE PROVIDER AS IT RELATES
 TO THE MANAGED CARE PROVIDER'S PROGRAM INTEGRITY OBLIGATIONS  UNDER  ITS
 CONTRACT WITH THE DEPARTMENT. THE MEDICAID INSPECTOR GENERAL, IN CONSUL-
 TATION  WITH THE COMMISSIONER, SHALL PUBLISH A LIST OF THOSE CONTRACTUAL
 OBLIGATIONS WHICH MAY BE SUBJECT TO REVIEW AND HOW THEY SHALL BE  EVALU-
 ATED, INCLUDING BENCHMARKS, PRIOR TO COMMENCING ANY REVIEW.
   (C)  IF,  AS  A  RESULT  OF  HIS OR HER REVIEW, THE MEDICAID INSPECTOR
 GENERAL DETERMINES THAT A MANAGED  CARE  PROVIDER  IS  NOT  MEETING  ITS
 PROGRAM  INTEGRITY  OBLIGATIONS,  THE  MEDICAID  INSPECTOR  GENERAL  MAY
 RECOVER FROM THE MANAGED CARE PROVIDER UP TO TWO PERCENT OF THE MEDICAID
 PREMIUMS PAID TO THE MANAGED CARE PROVIDER FOR THE PERIOD UNDER  REVIEW.
 ANY PREMIUM RECOVERY UNDER THIS SUBDIVISION SHALL BE A PERCENTAGE OF THE
 ADMINISTRATIVE  COMPONENT  OF  THE  MEDICAID  PREMIUM  CALCULATED BY THE
 DEPARTMENT AND MAY BE RECOVERED BY THE DEPARTMENT IN THE SAME MANNER  IT
 RECOVERS OVERPAYMENTS.
   (D)  THE  MANAGED  CARE  PROVIDER SHALL BE ENTITLED TO RECEIVE A DRAFT
 AUDIT REPORT AND FINAL AUDIT REPORT CONTAINING THE RESULTS OF THE  MEDI-
 CAID  INSPECTOR  GENERAL'S  REVIEW.  IF  THE  MEDICAID INSPECTOR GENERAL
 DETERMINES TO RECOVER A PERCENTAGE OF THE PREMIUM AS DESCRIBED IN  PARA-
 GRAPH  (C)  OF THIS SUBDIVISION, THE MANAGED CARE PROVIDER SHALL HAVE AN
 OPPORTUNITY TO BE HEARD IN ACCORDANCE WITH SECTION  TWENTY-TWO  OF  THIS
 CHAPTER.
   §  4.  Subdivision  3  of section 363-d of the social services law, as
 amended by section 44 of part C of chapter 58 of the laws  of  2007,  is
 amended to read as follows:
   3. Upon enrollment in the medical assistance program, a provider shall
 certify  to  the  department  that the provider satisfactorily meets the
 requirements of this section. Additionally, the commissioner  of  health
 and  Medicaid inspector general shall have the authority to determine at
 any time if a provider has  a  compliance  program  that  satisfactorily
 meets the requirements of this section.
   (a) A compliance program that is accepted by the federal department of
 health  and  human  services  office of inspector general and remains in
 compliance with the standards promulgated by such office shall be deemed
 in compliance with the provisions of this section, so long as such plans
 adequately address medical assistance program risk areas and  compliance
 issues.
   (b)  A  COMPLIANCE PROGRAM THAT MEETS FEDERAL REQUIREMENTS FOR MANAGED
 CARE PROVIDER COMPLIANCE PROGRAMS,  AS  SPECIFIED  IN  THE  CONTRACT  OR
 CONTRACTS  BETWEEN THE DEPARTMENT AND THE MEDICAID MANAGED CARE PROVIDER

 S. 1507                            113                           A. 2007
 
 SHALL BE DEEMED IN COMPLIANCE WITH THE PROVISIONS IN  THIS  SECTION,  SO
 LONG AS SUCH PROGRAMS ADEQUATELY ADDRESS MEDICAL ASSISTANCE PROGRAM RISK
 AREAS  AND  COMPLIANCE  ISSUES.  FOR PURPOSES OF THIS SECTION, A MANAGED
 CARE  PROVIDER  IS  AS  DEFINED  IN  PARAGRAPH (C) OF SUBDIVISION ONE OF
 SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS CHAPTER, AND INCLUDES MANAGED
 LONG TERM CARE PLANS.
   (C) In the event that the  commissioner  of  health  or  the  Medicaid
 inspector  general  finds that the provider does not have a satisfactory
 program within ninety days after the effective date of  the  regulations
 issued pursuant to subdivision four of this section, the provider may be
 subject to any sanctions or penalties permitted by federal or state laws
 and  regulations,  including  revocation  of the provider's agreement to
 participate in the medical assistance program.
   § 5. Section 3613 of the public health law is amended by adding a  new
 subdivision 1-a to read as follows:
   1-A.  EACH  HOME  CARE  SERVICES  WORKER  SHALL  OBTAIN  AN INDIVIDUAL
 NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER  FROM  THE  NATIONAL  PROVIDER
 PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES).
   §  6.  Section 364-j of the social services law is amended by adding a
 new subdivision 35 to read as follows:
   35. RECOVERY OF OVERPAYMENTS FROM NETWORK  PROVIDERS.  (A)  WHERE  THE
 MEDICAID INSPECTOR GENERAL DURING THE COURSE OF AN AUDIT, INVESTIGATION,
 OR REVIEW, OR THE DEPUTY ATTORNEY GENERAL FOR THE MEDICAID FRAUD CONTROL
 UNIT  DURING  THE COURSE OF AN INVESTIGATION OR PROSECUTION FOR MEDICAID
 FRAUD, IDENTIFIES MEDICAL ASSISTANCE OVERPAYMENTS MADE BY A MANAGED CARE
 PROVIDER OR MANAGED LONG TERM CARE PLAN TO ITS SUBCONTRACTOR OR  SUBCON-
 TRACTORS  OR  PROVIDER  OR  PROVIDERS, THE STATE SHALL HAVE THE RIGHT TO
 RECOVER  THE  OVERPAYMENT  FROM  THE  SUBCONTRACTOR  OR  SUBCONTRACTORS,
 PROVIDER OR PROVIDERS, OR THE MANAGED CARE PROVIDER OR MANAGED LONG TERM
 CARE PLAN.
   (B)  WHERE THE STATE IS UNSUCCESSFUL IN RECOVERING AN OVERPAYMENT FROM
 THE SUBCONTRACTOR OR SUBCONTRACTORS OR PROVIDER OR PROVIDERS, THE  MEDI-
 CAID  INSPECTOR GENERAL MAY REQUIRE THE MANAGED CARE PROVIDER OR MANAGED
 LONG TERM CARE PLAN TO RECOVER THE MEDICAL ASSISTANCE OVERPAYMENT  IDEN-
 TIFIED  IN PARAGRAPH (A) OF THIS SUBDIVISION ON BEHALF OF THE STATE. THE
 MANAGED CARE PROVIDER OR MANAGED LONG TERM CARE PLAN SHALL REMIT TO  THE
 STATE  THE  FULL  AMOUNT OF THE IDENTIFIED OVERPAYMENT NO LATER THAN SIX
 MONTHS AFTER RECEIVING NOTICE OF THE OVERPAYMENT FROM THE STATE.
   § 7. This act shall take effect immediately; provided,  however,  that
 the  amendments  to  section  364-j  of  the social services law made by
 sections one, two, three, and six of  this  act  shall  not  affect  the
 repeal  of such section and shall be deemed repealed therewith; provided
 further, that section three of this act shall apply  to  a  contract  or
 contracts  in  effect  as  of  January  1, 2015 and any review period in
 section three of this act shall not begin before January 1, 2018.
 
                                  PART W
 
   Section 1. Section 1 of part D of chapter 111  of  the  laws  of  2010
 relating to the recovery of exempt income by the office of mental health
 for community residences and family-based treatment programs, as amended
 by  section 1 of part H of chapter 59 of the laws of 2016, is amended to
 read as follows:
   Section 1. The office of mental health is authorized to recover  fund-
 ing  from  community  residences  and  family-based  treatment providers
 licensed by the office of mental  health,  consistent  with  contractual

 S. 1507                            114                           A. 2007
 
 obligations  of such providers, and notwithstanding any other inconsist-
 ent provision of law to the contrary, in an amount equal to  50  percent
 of  the income received by such providers which exceeds the fixed amount
 of  annual  Medicaid  revenue limitations, as established by the commis-
 sioner of mental health. Recovery of such excess income shall be for the
 following fiscal periods: for programs in counties  located  outside  of
 the  city of New York, the applicable fiscal periods shall be January 1,
 2003 through December 31, 2009 and January 1, 2011 through December  31,
 [2019]  2022;  and for programs located within the city of New York, the
 applicable fiscal periods shall be July 1, 2003 through  June  30,  2010
 and July 1, 2011 through June 30, [2019] 2022.
   § 2. This act shall take effect immediately.
 
                                  PART X
 
   Section  1.  Subdivision 9 of section 730.10 of the criminal procedure
 law, as added by section 1 of part Q of chapter 56 of the laws of  2012,
 is amended to read as follows:
   9.  "Appropriate  institution"  means:  (a) a hospital operated by the
 office of mental health or a developmental center operated by the office
 for people with developmental disabilities; [or] (b) a hospital licensed
 by the department of health which operates a psychiatric  unit  licensed
 by  the  office  of  mental  health,  as  determined by the commissioner
 provided, however, that any such hospital that is not  operated  by  the
 state shall qualify as an "appropriate institution" only pursuant to the
 terms  of an agreement between the commissioner and the hospital; OR (C)
 A MENTAL HEALTH UNIT OPERATING  WITHIN  A  LOCAL  CORRECTIONAL  FACILITY
 EXCEPT  THOSE  LOCATED WITHIN A CITY WITH A POPULATION OF ONE MILLION OR
 MORE; PROVIDED HOWEVER, THAT ANY SUCH MENTAL HEALTH UNIT OPERATING WITH-
 IN A LOCAL CORRECTIONAL FACILITY SHALL QUALIFY AS AN "APPROPRIATE INSTI-
 TUTION" ONLY PURSUANT TO THE TERMS OF AN AGREEMENT BETWEEN  THE  COMMIS-
 SIONER  OF MENTAL HEALTH, DIRECTOR OF COMMUNITY SERVICES AND THE SHERIFF
 FOR THE RESPECTIVE LOCALITY.  Nothing in this article shall be construed
 as requiring a hospital OR LOCAL CORRECTIONAL  FACILITY  to  consent  to
 providing care and treatment to an incapacitated person at such hospital
 OR  LOCAL CORRECTIONAL FACILITY. THE COMMISSIONER OF MENTAL HEALTH SHALL
 PROMULGATE REGULATIONS FOR DEMONSTRATION PROGRAMS AT NO  MORE  THAN  TWO
 COUNTIES  TO  IMPLEMENT RESTORATION TO COMPETENCY WITHIN A LOCAL CORREC-
 TIONAL FACILITY. SUBJECT TO ANNUAL APPROPRIATION,  THE  COMMISSIONER  OF
 MENTAL  HEALTH MAY, AT SUCH COMMISSIONER'S DISCRETION, MAKE FUNDS AVAIL-
 ABLE FOR STATE AID GRANTS TO ANY COUNTY THAT  DEVELOPS  AND  OPERATES  A
 MENTAL HEALTH UNIT WITHIN A LOCAL CORRECTIONAL FACILITY PURSUANT TO THIS
 SECTION.  NOTHING  IN  THIS  ARTICLE  SHALL  BE CONSTRUED AS REQUIRING A
 HOSPITAL OR LOCAL CORRECTIONAL FACILITY TO CONSENT TO PROVIDING CARE AND
 TREATMENT TO AN INCAPACITATED PERSON AT SUCH HOSPITAL OR  LOCAL  CORREC-
 TIONAL FACILITY.
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that this act shall expire and be  deemed  repealed  March  31,
 2024;  effective  immediately,  the addition, amendment and/or repeal of
 any rule or regulation necessary for the implementation of this  act  on
 its  effective date are authorized to be made and completed on or before
 such effective date.
 
                                  PART Y

 S. 1507                            115                           A. 2007
 
   Section 1. Subdivisions 3-b and 3-c of section 1 of part C of  chapter
 57  of  the  laws  of  2006,  relating  to establishing a cost of living
 adjustment for designated human services programs, as amended by section
 1 of part AA of chapter 57 of the laws of 2018, are amended to  read  as
 follows:
   3-b.  Notwithstanding  any  inconsistent  provision  of law, beginning
 April 1, 2009 and ending March 31, 2016 and beginning April 1, 2017  and
 ending March 31, [2019] 2020, the commissioners shall not include a COLA
 for  the  purpose  of  establishing  rates of payments, contracts or any
 other form of reimbursement[, provided that  the  commissioners  of  the
 office  for people with developmental disabilities, the office of mental
 health, and the office of alcoholism and substance abuse services  shall
 not include a COLA beginning April 1, 2017 and ending March 31, 2019].
   3-c.  Notwithstanding  any  inconsistent  provision  of law, beginning
 April 1, [2019] 2020 and ending March 31, [2022] 2023, the commissioners
 shall develop the COLA under this section using the actual U.S. consumer
 price index for all urban consumers  (CPI-U)  published  by  the  United
 States  department  of  labor, bureau of labor statistics for the twelve
 month period ending in July of the  budget  year  prior  to  such  state
 fiscal  year,  for  the  purpose  of  establishing  rates  of  payments,
 contracts or any other form of reimbursement.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that the amendments to section 1 of part C of chapter 57 of the
 laws of 2006 made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith.
 
                                  PART Z
 
   Section  1. Subdivision 1 of section 2801 of the public health law, as
 amended by section 1 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follows:
   1. "Hospital" means a facility or institution engaged  principally  in
 providing services by or under the supervision of a physician or, in the
 case  of  a dental clinic or dental dispensary, of a dentist, or, in the
 case of a midwifery birth center, of  a  midwife,  for  the  prevention,
 diagnosis  or  treatment  of  human  disease, pain, injury, deformity or
 physical condition, including, but not limited to, a  general  hospital,
 public  health center, diagnostic center, treatment center, dental clin-
 ic, dental dispensary, rehabilitation center other than a facility  used
 solely  for vocational rehabilitation, nursing home, tuberculosis hospi-
 tal, chronic  disease  hospital,  maternity  hospital,  midwifery  birth
 center,  lying-in-asylum,  out-patient  department,  out-patient  lodge,
 dispensary and a laboratory or central service facility serving  one  or
 more  such  institutions,  but  the  term  hospital shall not include an
 institution, sanitarium or other facility engaged principally in provid-
 ing services for the prevention, diagnosis or treatment of mental  disa-
 bility  and  which  is subject to the powers of visitation, examination,
 inspection and investigation of the department of mental hygiene  except
 for  those  distinct  parts  of  such  a facility which provide hospital
 service. The provisions of this article shall not apply to a facility or
 institution engaged principally in providing services by  or  under  the
 supervision of the bona fide members and adherents of a recognized reli-
 gious  organization  whose teachings include reliance on spiritual means
 through prayer alone for healing in the practice of the religion of such
 organization and where services are provided in  accordance  with  those

 S. 1507                            116                           A. 2007
 
 teachings.  No  provision  of this article or any other provision of law
 shall be construed to: (a) limit  the  volume  of  mental  health  [or],
 substance  use  disorder  services  OR DEVELOPMENTAL DISABILITY SERVICES
 that  can  be  provided  by a provider of primary care services licensed
 under this article and authorized  to  provide  integrated  services  in
 accordance  with  regulations issued by the commissioner in consultation
 with the commissioner of the office of mental health [and], the  commis-
 sioner  of the office of alcoholism and substance abuse services AND THE
 COMMISSIONER OF THE OFFICE FOR PEOPLE WITH  DEVELOPMENTAL  DISABILITIES,
 including  regulations  issued  pursuant to subdivision seven of section
 three hundred sixty-five-l of the social services law or part L of chap-
 ter fifty-six of the laws of two thousand twelve; (b) require a provider
 licensed pursuant to article thirty-one of the  mental  hygiene  law  or
 certified  pursuant  to  ARTICLE  SIXTEEN  OR  article thirty-two of the
 mental hygiene law to obtain an operating certificate from  the  depart-
 ment if such provider has been authorized to provide integrated services
 in  accordance  with regulations issued by the commissioner in consulta-
 tion with the commissioner of the office of  mental  health  [and],  the
 commissioner  of  the  office of alcoholism and substance abuse services
 AND THE COMMISSIONER OF THE OFFICE FOR PEOPLE WITH  DEVELOPMENTAL  DISA-
 BILITIES,  including regulations issued pursuant to subdivision seven of
 section three hundred sixty-five-l of the social services law or part  L
 of chapter fifty-six of the laws of two thousand twelve.
   §  2.  Subdivision  (f) of section 31.02 of the mental hygiene law, as
 added by section 2 of subpart B of part S of chapter 57 of the  laws  of
 2018, is amended to read as follows:
   (f)  No  provision of this article or any other provision of law shall
 be construed to require a provider licensed pursuant to article  twenty-
 eight  of the public health law or certified pursuant to ARTICLE SIXTEEN
 OR article thirty-two of this chapter to obtain an operating certificate
 from the office of mental health if such provider has been authorized to
 provide integrated services in accordance with regulations issued by the
 commissioner of the office of mental health  in  consultation  with  the
 commissioner  of the department of health [and], the commissioner of the
 office of alcoholism and substance abuse services AND  THE  COMMISSIONER
 OF  THE  OFFICE  FOR  PEOPLE  WITH DEVELOPMENTAL DISABILITIES, including
 regulations issued  pursuant  to  subdivision  seven  of  section  three
 hundred  sixty-five-l  of  the  social services law or part L of chapter
 fifty-six of the laws of two thousand twelve.
   § 3. Subdivision (b) of section 32.05 of the mental  hygiene  law,  as
 amended by section 3 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follow:
   (b)  (i)  Methadone,  or such other controlled substance designated by
 the commissioner of health as appropriate for such use, may be  adminis-
 tered  to  an  addict, as defined in section thirty-three hundred two of
 the public health law, by individual physicians,  groups  of  physicians
 and  public  or private medical facilities certified pursuant to article
 twenty-eight or thirty-three of the public health law as part of a chem-
 ical dependence program which has been issued an  operating  certificate
 by the commissioner pursuant to subdivision (b) of section 32.09 of this
 article,  provided,  however,  that  such administration must be done in
 accordance with all applicable federal and state laws  and  regulations.
 Individual physicians or groups of physicians who have obtained authori-
 zation  from  the  federal  government  to  administer  buprenorphine to
 addicts may do so without obtaining an operating  certificate  from  the
 commissioner.  (ii)  No provision of this article or any other provision

 S. 1507                            117                           A. 2007
 
 of law shall be construed to require a  provider  licensed  pursuant  to
 article  twenty-eight  of the public health law or article thirty-one of
 this chapter to obtain an operating certificate from the office of alco-
 holism and substance abuse services if such provider has been authorized
 to  provide integrated services in accordance with regulations issued by
 the commissioner of alcoholism and substance abuse services in consulta-
 tion with the commissioner  of  the  department  of  health  [and],  the
 commissioner  of the office of mental health AND THE COMMISSIONER OF THE
 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, including regulations
 issued pursuant to subdivision seven of  section  three  hundred  sixty-
 five-l  of the social services law or part L of chapter fifty-six of the
 laws of two thousand twelve.
   § 4. Section 16.03 of the mental hygiene law is amended  by  adding  a
 new subdivision (g) to read as follows:
   (G)  NO  PROVISION OF THIS ARTICLE OR ANY OTHER PROVISION OF LAW SHALL
 BE CONSTRUED TO REQUIRE A PROVIDER LICENSED PURSUANT TO ARTICLE  TWENTY-
 EIGHT  OF THE PUBLIC HEALTH LAW OR CERTIFIED PURSUANT TO ARTICLE THIRTY-
 ONE OR THIRTY-TWO OF THIS CHAPTER TO  OBTAIN  AN  OPERATING  CERTIFICATE
 FROM  THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL DISABILITIES IF SUCH
 PROVIDER HAS BEEN AUTHORIZED TO PROVIDE INTEGRATED SERVICES  IN  ACCORD-
 ANCE  WITH  REGULATIONS  ISSUED  BY  THE  COMMISSIONER OF THE OFFICE FOR
 PEOPLE WITH DEVELOPMENTAL DISABILITIES, IN CONSULTATION WITH THE COMMIS-
 SIONER OF THE DEPARTMENT OF HEALTH, THE COMMISSIONER AND THE COMMISSION-
 ER OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE  SERVICES,  INCLUDING
 REGULATIONS  ISSUED  PURSUANT  TO  SUBDIVISION  SEVEN  OF  SECTION THREE
 HUNDRED SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW OR  PART  L  OF  CHAPTER
 FIFTY-SIX OF THE LAWS OF TWO THOUSAND TWELVE.
   §  5.  This  act shall take effect October 1, 2019; provided, however,
 that the commissioner of the department of health, the  commissioner  of
 the  office of mental health, the commissioner of the office of alcohol-
 ism and substance abuse services, and the commissioner of the office for
 people with developmental disabilities are authorized to issue any  rule
 or  regulation necessary for the implementation of this act on or before
 its effective date.
 
                                  PART AA
 
   Section 1. Paragraph (a) of subdivision 4 of section 488 of the social
 services law, as amended by section 2 of part MM of chapter  58  of  the
 laws of 2015, is amended to read as follows:
   (a)  a facility or program in which services are provided and which is
 operated, licensed or certified by the  office  of  mental  health,  the
 office for people with developmental disabilities or the office of alco-
 holism  and  substance  abuse  services,  including  but  not limited to
 psychiatric centers, [inpatient psychiatric units of  a  general  hospi-
 tal,]  developmental  centers,  intermediate  care facilities, community
 residences, group homes and family care homes, provided,  however,  that
 such  term  shall  not include a secure treatment facility as defined in
 section 10.03 of the mental hygiene law, services  defined  in  subpara-
 graph  four  of  subdivision  (a) of section 16.03 of the mental hygiene
 law, [or] services provided in programs or facilities that are  operated
 by the office of mental health and located in state correctional facili-
 ties  under the jurisdiction of the department of corrections and commu-
 nity supervision OR SERVICES PROVIDED  IN  A  UNIT  OF  A  HOSPITAL,  AS
 DEFINED  IN  SUBDIVISION  ONE OF SECTION TWENTY-EIGHT HUNDRED ONE OF THE

 S. 1507                            118                           A. 2007
 
 PUBLIC HEALTH LAW THAT IS LICENSED OR CERTIFIED BY THE OFFICE OF  MENTAL
 HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES;
   §  2.  Paragraphs  (c), (d) and (e) of subdivision 4 of section 488 of
 the social services law, as added by section 1 of part B of chapter  501
 of the laws of 2012, paragraph (d) as amended by chapter 126 of the laws
 of 2014, and paragraph (e) as amended by chapter 83 of the laws of 2013,
 are amended to read as follows:
   (c)  adult  care  facilities, which shall mean adult homes or enriched
 housing programs licensed pursuant to article seven of this chapter: (i)
 (A) that have a licensed capacity of eighty or more  beds;  and  (B)  in
 which  at  least  twenty-five  percent of the residents are persons with
 serious mental illness as defined by subdivision  fifty-two  of  section
 1.03  of the mental hygiene law; (ii) but not including an adult home or
 enriched housing program  which  is  authorized  to  operate  fifty-five
 percent  or  more  of  its  total  licensed capacity of beds as assisted
 living program beds pursuant to section four hundred sixty-one-l of this
 chapter; OR
   (d) [any overnight, summer day and  traveling  summer  day  camps  for
 children  with  developmental  disabilities  as  defined  in regulations
 promulgated by the commissioner of health; or
   (e)] the New York state school for the blind and the  New  York  state
 school for the deaf, which operate pursuant to articles eighty-seven and
 eighty-eight of the education law; an institution for the instruction of
 the  deaf and the blind which has a residential component and is subject
 to the visitation of the commissioner of education pursuant  to  article
 eighty-five of the education law with respect to its day and residential
 components; special act school districts serving students with disabili-
 ties;  or  in-state  private  schools  which  have  been approved by the
 commissioner of education for special education  services  or  programs,
 and which have a residential program.
   §  3.  This  act  shall  take effect August 1, 2019 and shall apply to
 reports of abuse or neglect made on or after such date;  provided  that,
 any  reports of abuse or neglect reported to the justice center prior to
 the effective date of this act shall be completed by the justice center.
 
                                  PART BB
 
   Section 1. This part enacts into law major components  of  legislation
 which  are  necessary to effectuate provisions relating to mental health
 and  substance  use  disorder  treatment.    Each  component  is  wholly
 contained  within  a  Subpart  identified  as  Subparts A through E. The
 effective date for  each  particular  provision  contained  within  such
 Subpart  is set forth in the last section of such Subpart. Any provision
 in any section contained within a Subpart, including the effective  date
 of the Subpart, which makes a reference to a section "of this act", when
 used  in  connection  with that particular component, shall be deemed to
 mean and refer to the corresponding section of the Subpart in  which  it
 is  found.  Section  three of this Part sets forth the general effective
 date of this Part.
 
                                 SUBPART A
 
   Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
 ance law is amended to read as follows:
   (4) If a policy provides for reimbursement for psychiatric or  psycho-
 logical  services  or for diagnosis and treatment of mental[,nervous, or

 S. 1507                            119                           A. 2007

 emotional disorders or ailments,] HEALTH CONDITIONS however  defined  in
 the  policy,  the  insured  shall  be entitled to reimbursement for such
 services, diagnosis or  treatment  whether  performed  by  a  physician,
 psychiatrist  [or],  a certified and registered psychologist, OR A NURSE
 PRACTITIONER when the services rendered are within the lawful  scope  of
 their practice.
   §  2.  Subparagraph  (B)  of paragraph 25 of subsection (i) of section
 3216 of the insurance law, as amended by section 38 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B) Every policy that  provides  physician  services,  medical,  major
 medical  or  similar  comprehensive-type coverage shall provide coverage
 for the screening, diagnosis and treatment of autism  spectrum  disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered by the policy because the individual is  diagnosed  with  autism
 spectrum  disorder.  Such coverage may be subject to annual deductibles,
 copayments and coinsurance as may be deemed appropriate  by  the  super-
 intendent  and  shall be consistent with those imposed on other benefits
 under the policy. [Coverage  for  applied  behavior  analysis  shall  be
 subject  to  a  maximum benefit of six hundred eighty hours of treatment
 per policy or calendar year  per  covered  individual.]  This  paragraph
 shall  not  be  construed  as  limiting  the benefits that are otherwise
 available to an individual under the policy, provided however that  such
 policy  shall  not  contain  any  limitations  on visits that are solely
 applied to the treatment of autism spectrum disorder. No  insurer  shall
 terminate  coverage or refuse to deliver, execute, issue, amend, adjust,
 or renew coverage to an individual  solely  because  the  individual  is
 diagnosed  with  autism  spectrum disorder or has received treatment for
 autism spectrum disorder.  Coverage  shall  be  subject  to  utilization
 review  and external appeals of health care services pursuant to article
 forty-nine of this chapter as well as[,] case  management[,]  and  other
 managed care provisions.
   §  3.  Items  (i)  and  (iii)  of  subparagraph (C) of paragraph 25 of
 subsection (i) of section 3216 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant  to  the behavior analyst certification board] PERSON LICENSED,
 CERTIFIED OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED BEHAVIOR  ANALYSIS,
 that  are  necessary  to  develop,  maintain, or restore, to the maximum
 extent practicable, the functioning of an individual. [Individuals  that
 provide behavioral health treatment under the supervision of a certified
 behavior  analyst  pursuant to this paragraph shall be subject to stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations promulgated by the superintendent in consultation  with  the
 commissioners of health and education.]
   §  4.  Paragraph 25 of subsection (i) of section 3216 of the insurance
 law is amended by adding four new subparagraphs (H), (I), (J),  and  (K)
 to read as follows:

 S. 1507                            120                           A. 2007
 
   (H)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE  RESTRICTIVE THAN THE PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED  BY THE POLICY.
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT  TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE AVAIL-
 ABLE BY THE  INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR  IN-NETWORK
 PROVIDER UPON REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED ON MEDICAL  NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR  PROVIDER ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES;  METHODS FOR DETER-
 MINING USUAL, CUSTOMARY, AND REASONABLE CHARGES;  FAIL-FIRST  OR    STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.
   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  5.  Paragraph 30 of subsection (i) of section 3216 of the insurance
 law, as amended by section 1 of part B of chapter  71  of  the  laws  of
 2016, is amended to read as follows:
   (30)(A)  Every policy that provides hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  policy.  [Further,  such  coverage  shall  be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage  provided under this paragraph may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  CERTI-
 FIED  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence  treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.

 S. 1507                            121                           A. 2007

   (C) Coverage provided under this paragraph may be  subject  to  annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and  that  are  consistent with those imposed on other benefits within a
 given policy.
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services that are  participating  in  the  insurer's
 provider  network.  Coverage  provided under this paragraph shall not be
 subject to preauthorization.  Coverage  provided  under  this  paragraph
 shall  also  not  be subject to concurrent utilization review during the
 first [fourteen] TWENTY-ONE days of  the  inpatient  admission  provided
 that  the  facility  notifies  the insurer of both the admission and the
 initial treatment plan within [forty-eight hours] TWO BUSINESS  DAYS  of
 the  admission.  The facility shall perform daily clinical review of the
 patient, including the periodic consultation with the insurer to  ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism  and  substance  abuse services and appropriate to the age of
 the patient, to ensure that the inpatient treatment is medically  neces-
 sary for the patient. Any utilization review of treatment provided under
 this  subparagraph  may include a review of all services provided during
 such inpatient treatment, including all  services  provided  during  the
 first  [fourteen] TWENTY-ONE days of such inpatient treatment. Provided,
 however, the insurer shall only deny coverage for  any  portion  of  the
 initial  [fourteen] TWENTY-ONE day inpatient treatment on the basis that
 such treatment was not medically necessary if such  inpatient  treatment
 was  contrary  to  the  evidence-based and peer reviewed clinical review
 tool utilized by the insurer which is designated by the office of  alco-
 holism  and  substance  abuse  services.  An  insured shall not have any
 financial obligation to  the  facility  for  any  treatment  under  this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E)  AN  INSURER  SHALL  MAKE  AVAILABLE  TO  ANY INSURED, PROSPECTIVE
 INSURED, OR IN-NETWORK PROVIDER, UPON REQUEST, THE CRITERIA FOR  MEDICAL
 NECESSITY  DETERMINATIONS  UNDER  THE  POLICY  WITH RESPECT TO INPATIENT
 SUBSTANCE USE DISORDER BENEFITS.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND

 S. 1507                            122                           A. 2007
 
   (IV) "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN  THE
 MOST  RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
 DISORDERS OR THE MOST RECENT EDITION  OF  ANOTHER  GENERALLY  RECOGNIZED
 INDEPENDENT  STANDARD  OF CURRENT MEDICAL PRACTICE, SUCH AS THE INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  6.  Paragraph 31 of subsection (i) of section 3216 of the insurance
 law, as added by chapter 41 of the laws of 2014 and subparagraph (E)  as
 added  by  section  3  of  part MM of chapter 57 of the laws of 2018, is
 amended to read as follows:
   (31) (A) Every policy that provides medical, major medical or  similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication  and  rehabilitation  services.  Such  coverage shall not apply
 financial requirements or treatment limitations to outpatient  substance
 use  disorder  benefits  that  are more restrictive than the predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the policy.    [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B) Coverage under this paragraph may be limited to facilities in  New
 York state [certified] THAT ARE LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED  by  the  office  of  alcoholism  and  substance abuse services [or
 licensed by such office as outpatient clinics  or  medically  supervised
 ambulatory]  TO PROVIDE OUTPATIENT substance [abuse programs] USE DISOR-
 DER SERVICES and, in other states, to those which are accredited by  the
 joint  commission  as  alcoholism or chemical dependence substance abuse
 treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED,  OR  OTHERWISE
 AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (C)  Coverage  provided  under this paragraph may be subject to annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and that are consistent with those imposed on other  benefits  within  a
 given policy.
   (D)  A  policy  providing coverage for substance use disorder services
 pursuant to this paragraph shall provide up to twenty outpatient  visits
 per  policy  or  calendar  year  to  an individual who identifies him or
 herself as a family member of a  person  suffering  from  substance  use
 disorder  and  who  seeks  treatment as a family member who is otherwise
 covered by the applicable policy pursuant to this paragraph. The  cover-
 age  required  by  this  paragraph  shall  include treatment as a family
 member pursuant to such family member's own policy provided such  family
 member:
   (i)  does not exceed the allowable number of family visits provided by
 the applicable policy pursuant to this paragraph; and
   (ii) is otherwise entitled to coverage pursuant to this paragraph  and
 such family member's applicable policy.
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services for the provision of outpatient,  intensive
 outpatient,  outpatient  rehabilitation  and  opioid  treatment that are
 participating in the insurer's provider network. Coverage provided under
 this paragraph  shall  not  be  subject  to  preauthorization.  Coverage
 provided  under this paragraph shall not be subject to concurrent review

 S. 1507                            123                           A. 2007
 
 for the first [two] THREE weeks of continuous treatment, not  to  exceed
 [fourteen] TWENTY-ONE visits, provided the facility notifies the insurer
 of  both  the  start  of treatment and the initial treatment plan within
 [forty-eight  hours] TWO BUSINESS DAYS. The facility shall perform clin-
 ical assessment of the patient at each  visit,  including  the  periodic
 consultation  with  the insurer to ensure that the facility is using the
 evidence-based and peer reviewed clinical review tool  utilized  by  the
 insurer  which  is  designated by the office of alcoholism and substance
 abuse services and appropriate to the age of the patient, to ensure that
 the outpatient treatment is medically necessary  for  the  patient.  Any
 utilization review of the treatment provided under this subparagraph may
 include  a review of all services provided during such outpatient treat-
 ment, including all services provided during the first [two] THREE weeks
 of continuous treatment, not to exceed [fourteen] TWENTY-ONE visits,  of
 such  outpatient  treatment.  Provided,  however, the insurer shall only
 deny coverage for any portion  of  the  initial  [two]  THREE  weeks  of
 continuous  treatment,  not  to exceed [fourteen] TWENTY-ONE visits, for
 outpatient treatment on the basis that such treatment was not  medically
 necessary  if  such  outpatient  treatment was contrary to the evidence-
 based and peer reviewed clinical review tool  utilized  by  the  insurer
 which  is  designated  by  the  office of alcoholism and substance abuse
 services. An insured shall not have  any  financial  obligation  to  the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).

 S. 1507                            124                           A. 2007

   § 7. Paragraph 31-a of subsection (i) of section 3216 of the insurance
 law,  as added by section 1 of part B of chapter 69 of the laws of 2016,
 is amended to read as follows:
   (31-a)  [(A)]  Every  policy  that  provides medical, major medical or
 similar  comprehensive-type   coverage   and   provides   coverage   for
 prescription  drugs  for medication for the treatment of a substance use
 disorder shall include immediate access, without prior authorization, to
 [a five day emergency supply] THE FORMULARY FORMS of prescribed  medica-
 tions covered under the policy for the treatment of substance use disor-
 der  [where  an emergency condition exists], including a prescribed drug
 or medication associated with the management of opioid withdrawal and/or
 stabilization, except where otherwise prohibited by law. Further, cover-
 age [of an emergency supply] WITHOUT PRIOR AUTHORIZATION  shall  include
 FORMULARY  FORMS  OF  medication  for opioid overdose reversal otherwise
 covered under the  policy  prescribed  OR  DISPENSED  to  an  individual
 covered by the policy.
   [(B)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in clause (i), (ii), or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (C) Coverage provided under this paragraph may be  subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty day supply of the same medication in the same thirty  day  period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the  initial  emergency  supply  of medication in an amount that is less
 than the copayment or coinsurance otherwise applicable to a  thirty  day
 supply of such medication, provided that the total sum of the copayments
 or  coinsurance  for  an entire thirty day supply of the medication does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   § 8. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 35 to read as follows:
   (35) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE
 THAT  PROVIDES  COVERAGE  FOR  INPATIENT  HOSPITAL  CARE OR COVERAGE FOR
 PHYSICIAN SERVICES SHALL PROVIDE COVERAGE FOR THE DIAGNOSIS  AND  TREAT-
 MENT OF MENTAL HEALTH CONDITIONS AS FOLLOWS:
   (I)  WHERE  THE  POLICY PROVIDES COVERAGE FOR INPATIENT HOSPITAL CARE,
 BENEFITS FOR INPATIENT CARE IN A HOSPITAL AS DEFINED BY SUBDIVISION  TEN
 OF  SECTION  1.03  OF THE MENTAL HYGIENE LAW AND BENEFITS FOR OUTPATIENT
 CARE PROVIDED IN A FACILITY  ISSUED  AN  OPERATING  CERTIFICATE  BY  THE
 COMMISSIONER  OF  MENTAL  HEALTH  PURSUANT  TO THE PROVISIONS OF ARTICLE
 THIRTY-ONE OF THE MENTAL HYGIENE LAW, OR IN A FACILITY OPERATED  BY  THE

 S. 1507                            125                           A. 2007
 
 OFFICE OF MENTAL HEALTH, OR, FOR CARE PROVIDED IN OTHER STATES, TO SIMI-
 LARLY LICENSED OR CERTIFIED HOSPITALS OR FACILITIES; AND
   (II)  WHERE THE POLICY PROVIDES COVERAGE FOR PHYSICIAN SERVICES, BENE-
 FITS FOR OUTPATIENT CARE PROVIDED  BY  A  PSYCHIATRIST  OR  PSYCHOLOGIST
 LICENSED  TO  PRACTICE  IN THIS STATE, A LICENSED CLINICAL SOCIAL WORKER
 WHO MEETS THE REQUIREMENTS OF SUBPARAGRAPH  (D)  OF  PARAGRAPH  FOUR  OF
 SUBSECTION  (1) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS
 ARTICLE, A NURSE PRACTITIONER LICENSED TO PRACTICE IN THIS STATE,  OR  A
 PROFESSIONAL  CORPORATION  OR  UNIVERSITY  FACULTY  PRACTICE CORPORATION
 THEREOF.
   (B) COVERAGE REQUIRED BY THIS  PARAGRAPH  MAY  BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES,  COPAYMENTS AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY
 THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH THOSE IMPOSED  ON  OTHER
 BENEFITS UNDER THE POLICY.
   (C)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT  ARE  MORE
 RESTRICTIVE  THAN  THE  PREDOMINANT FINANCIAL REQUIREMENTS AND TREATMENT
 LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND  SURGICAL  BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT  TO  MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE BY THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS:  MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "MENTAL  HEALTH  CONDITION"  MEANS ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL  OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G) THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT  ARE
 LICENSED  BY  THE  OFFICE OF MENTAL HEALTH THAT ARE PARTICIPATING IN THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
 TIENT HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A  HOSPITAL
 AS  DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE LAW
 PROVIDED TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN  SHALL

 S. 1507                            126                           A. 2007
 
 NOT  BE  SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER THIS PARA-
 GRAPH SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW  DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY  NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL TREATMENT
 PLAN WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY  CLINICAL
 REVIEW  OF  THE  PATIENT, AND PARTICIPATES IN PERIODIC CONSULTATION WITH
 THE INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED  AND
 PEER  REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH IS
 APPROVED BY THE OFFICE OF MENTAL HEALTH AND APPROPRIATE TO  THE  AGE  OF
 THE  PATIENT,  TO  ENSURE THAT THE INPATIENT CARE IS MEDICALLY NECESSARY
 FOR THE PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH  MAY  BE
 REVIEWED  RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY, AN
 INSURED SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR  ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   § 9. Paragraphs 17, 19 and 20 of subsection 2 of section 3217-a of the
 insurance law, paragraph 17 as amended and paragraphs 19 and 20 as added
 by  section  1  of part H of chapter 60 of the laws of 2014, are amended
 and a new paragraph 21 is added to read as follows:
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate document that is updated annually, of the name, address, and  tele-
 phone  number of all participating providers, including facilities, AND:
 (A) WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (B) IN THE  CASE  OF
 MENTAL  HEALTH  OR SUBSTANCE USE DISORDER SERVICES PROVIDERS, ANY AFFIL-
 IATIONS WITH PARTICIPATING FACILITIES CERTIFIED  OR  AUTHORIZED  BY  THE
 OFFICE  OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
 SERVICES, AND ANY RESTRICTIONS REGARDING THE AVAILABILITY OF  THE  INDI-
 VIDUAL PROVIDER'S SERVICES; and [in addition,] (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  insur-
 er's  website  and  the  insurer shall update the website within fifteen
 days of the addition or termination of a  provider  from  the  insurer's
 network or a change in a physician's hospital affiliation;
   (19) with respect to out-of-network coverage:
   (A)  a  clear  description  of  the methodology used by the insurer to
 determine reimbursement for out-of-network health care services;
   (B) the amount that the insurer will reimburse under  the  methodology
 for out-of-network health care services set forth as a percentage of the
 usual and customary cost for out-of-network health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (20) information in writing  and  through  an  internet  website  that
 reasonably  permits  an  insured  or prospective insured to estimate the
 anticipated out-of-pocket cost for out-of-network health  care  services
 in  a  geographical  area  or zip code based upon the difference between
 what the insurer will reimburse for out-of-network health care  services
 and  the  usual  and  customary  cost  for  out-of-network  health  care
 services[.]; AND
   (21) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE INSURER  TO
 ASSESS THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE PAUL
 WELLSTONE  AND  PETE  DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY
 ACT OF 2008, 42 U.S.C. 18031(J), AND  ANY  AMENDMENTS  TO,  AND  FEDERAL
 GUIDANCE OR REGULATIONS ISSUED UNDER THOSE ACTS.
   §  10. Subsection (b) of section 3217-b of the insurance law, as added
 by chapter 705 of the laws of 1996, is amended to read as follows:

 S. 1507                            127                           A. 2007
 
   (b) No insurer subject to this  article  shall  by  contract,  written
 policy  [or],  written  procedure  OR  PRACTICE prohibit or restrict any
 health care provider  from  filing  a  complaint,  making  a  report  or
 commenting to an appropriate governmental body regarding the policies or
 practices  of  such  insurer  which the provider believes may negatively
 impact upon the quality of, or access to, patient care.   NOR  SHALL  AN
 INSURER  SUBJECT  TO THIS ARTICLE TAKE ANY ADVERSE ACTION, INCLUDING BUT
 NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR AGREEMENT WITH
 A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVIDER FOR
 FILING A COMPLAINT, MAKING A REPORT  OR  COMMENTING  TO  AN  APPROPRIATE
 GOVERNMENTAL  BODY REGARDING POLICIES OR PRACTICES OF SUCH INSURER WHICH
 MAY VIOLATE THIS CHAPTER INCLUDING PARAGRAPHS THIRTY, AS ADDED BY  CHAP-
 TER  FORTY-ONE OF THE LAWS OF 2014, THIRTY-ONE, THIRTY-ONE-A AND THIRTY-
 FIVE OF SUBSECTION (I) OF SECTION THIRTY-TWO HUNDRED SIXTEEN  AND  PARA-
 GRAPHS  FIVE,  SIX,  SEVEN,  SEVEN-A  AND  SEVEN-B  OF SUBSECTION (L) OF
 SECTION THIRTY-TWO HUNDRED TWENTY-ONE OF THIS ARTICLE.
   § 11. Subparagraph (A) of paragraph 4 of  subsection  (l)  of  section
 3221  of  the  insurance  law,  as amended by chapter 230 of the laws of
 2004, is amended to read as follows:
   (A) Every insurer delivering a group policy or issuing a group  policy
 for  delivery,  in  this  state, [which] THAT provides reimbursement for
 psychiatric or psychological services or for the diagnosis and treatment
 of mental[, nervous or emotional disorders and ailments]  HEALTH  CONDI-
 TIONS,  however  defined in such policy, by physicians, psychiatrists or
 psychologists, [must] SHALL make available and if requested by the poli-
 cyholder provide the same coverage to insureds for  such  services  when
 performed  by a licensed clinical social worker, within the lawful scope
 of his or her practice, who is licensed pursuant to article one  hundred
 fifty-four  of  the education law. Written notice of the availability of
 such coverage shall be delivered to the policyholder prior to  inception
 of  such  group  policy and annually thereafter, except that this notice
 shall not be required where a policy covers two hundred or more  employ-
 ees  or  where  the  benefit  structure  was  the  subject of collective
 bargaining affecting persons who are employed in more than one state.
   § 12. Subparagraph (D) of paragraph 4 of  subsection  (l)  of  section
 3221 of the insurance law, as amended by section 50 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (D)  In addition to the requirements of subparagraph (A) of this para-
 graph, every insurer issuing a group policy for delivery in  this  state
 where  the  policy provides reimbursement to insureds for psychiatric or
 psychological services or for the diagnosis and  treatment  of  mental[,
 nervous  or emotional disorders and ailments] HEALTH CONDITIONS, however
 defined in such policy, by physicians, psychiatrists  or  psychologists,
 shall  provide  the  same  coverage  to  insureds for such services when
 performed by a licensed clinical social worker, within the lawful  scope
 of  his  or her practice, who is licensed pursuant to subdivision two of
 section seven thousand seven hundred four of the education  law  and  in
 addition  shall  have either: (i) three or more additional years experi-
 ence in psychotherapy, which for the purposes of this subparagraph shall
 mean the use of verbal methods in interpersonal relationships  with  the
 intent of assisting a person or persons to modify attitudes and behavior
 that  are  intellectually,  socially  or  emotionally maladaptive, under
 supervision, satisfactory to the state  board  for  social  work,  in  a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental
 department, providing services for diagnosis or  treatment  of  mental[,
 nervous  or  emotional  disorders  or  ailments] HEALTH CONDITIONS; (ii)

 S. 1507                            128                           A. 2007
 
 three or more additional years experience  in  psychotherapy  under  the
 supervision,  satisfactory  to  the  state  board  for social work, of a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical  social  worker  qualified for reimbursement pursuant to subsection
 (e) of this section, or (iii) a combination of the experience  specified
 in  items (i) and (ii) of this subparagraph totaling three years, satis-
 factory to the state board for social work.
   § 13. Subparagraphs (A) and (B) of paragraph 5 of  subsection  (l)  of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, are amended to read as follows:
   (A) Every insurer delivering a group or school blanket policy or issu-
 ing  a group or school blanket policy for delivery, in this state, which
 provides coverage for inpatient hospital care or coverage for  physician
 services shall provide [as part of such policy broad-based] coverage for
 the  diagnosis  and treatment of mental[, nervous or emotional disorders
 or ailments, however defined in such  policy,  at  least  equal  to  the
 coverage provided for other] health conditions and:
   (i)  where  the  policy provides coverage for inpatient hospital care,
 benefits for inpatient care in a hospital as defined by subdivision  ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed  to  not  less  than  thirty days of active treatment in any contract
 year, plan year or calendar year,]  and  benefits  for  outpatient  care
 provided  in  a  facility issued an operating certificate by the commis-
 sioner of mental health pursuant to the provisions of article thirty-one
 of the mental hygiene law, or in a facility operated by  the  office  of
 mental  health[,  which  benefits may be limited to not less than twenty
 visits in any contract year, plan year or calendar  year.  Benefits  for
 partial  hospitalization program services shall be provided as an offset
 to covered inpatient days at a  ratio  of  two  partial  hospitalization
 visits  to  one  inpatient  day  of treatment.] OR, FOR CARE PROVIDED IN
 OTHER STATES, TO SIMILARLY LICENSED OR CERTIFIED  HOSPITALS  OR  FACILI-
 TIES; AND
   (ii)  where  the  policy  provides coverage for physician services, it
 shall include benefits for outpatient care provided by a psychiatrist or
 psychologist licensed to practice in this  state,  a  licensed  clinical
 social  worker  who  meets the requirements of subparagraph (D) of para-
 graph four of this subsection, A NURSE PRACTITIONER LICENSED TO PRACTICE
 IN THIS STATE, or a professional corporation or university faculty prac-
 tice corporation thereof. [Such benefits may be limited to not less than
 twenty visits in any contract year, plan year, or calendar year.]
   [(iii)] (B) Coverage required by this paragraph may be [provided on  a
 contract  year, plan year or calendar year basis and shall be consistent
 with the provision of other benefits under the policy. Such coverage may
 be] subject to annual deductibles, co-pays and  coinsurance  as  may  be
 deemed  appropriate  by  the superintendent and shall be consistent with
 those imposed on other benefits under the policy. [In the event  that  a
 policy  provides coverage for both inpatient hospital care and physician
 services, the aggregate of the benefits  for  outpatient  care  obtained
 under  this  paragraph  may be limited to not less than twenty visits in
 any contract year, plan year or calendar year.
   (iv) In this paragraph, "active treatment" means  treatment  furnished
 in  conjunction  with  inpatient  confinement  for  mental,  nervous  or
 emotional disorders or ailments that meet standards prescribed  pursuant
 to the regulations of the commissioner of mental health.
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy for delivery,  in  this  state,

 S. 1507                            129                           A. 2007

 which  provides  coverage  for  inpatient  hospital care or coverage for
 physician services, shall provide comparable  coverage  for  adults  and
 children  with  biologically  based  mental illness. Such group policies
 issued  or  delivered  in  this state shall also provide such comparable
 coverage for children with serious emotional disturbances. Such coverage
 shall be provided under the terms and  conditions  otherwise  applicable
 under  the  policy,  including network limitations or variations, exclu-
 sions, co-pays, coinsurance, deductibles or other specific cost  sharing
 mechanisms.  Provided  further,  where a policy provides both in-network
 and  out-of-network  benefits,  the  out-of-network  benefits  may  have
 different  coinsurance,  co-pays,  or  deductibles,  than the in-network
 benefits, regardless of whether the policy is written under one  license
 or two licenses.
   (ii)  For  purposes  of  this  paragraph, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive compulsive disorders, bulimia, and anorexia.] PROVIDED THAT NO
 COPAYMENT  OR  COINSURANCE IMPOSED FOR OUTPATIENT MENTAL HEALTH SERVICES
 PROVIDED IN A FACILITY LICENSED, CERTIFIED OR  OTHERWISE  AUTHORIZED  BY
 THE  OFFICE  OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS OR COINSURANCE
 IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE POLICY.
   § 14. Subparagraphs (C), (D) and (E) of paragraph 5 of subsection  (l)
 of  section 3221 of the insurance law are REPEALED and five new subpara-
 graphs (C), (D), (E), (F) and (G) are added to read as follows:
   (C) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS  OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE MORE
 RESTRICTIVE THAN THE PREDOMINANT FINANCIAL  REQUIREMENTS  AND  TREATMENT
 LIMITATIONS  APPLIED  TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE  AVAILABLE  BY  THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND

 S. 1507                            130                           A. 2007
 
   (IV)  "MENTAL  HEALTH  CONDITION"  MEANS ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL  OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G)  THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT ARE
 LICENSED BY THE OFFICE OF MENTAL HEALTH THAT ARE  PARTICIPATING  IN  THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
 TIENT  HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A HOSPITAL
 AS DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE  LAW
 PROVIDED  TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN SHALL
 NOT BE SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER  THIS  PARA-
 GRAPH  SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL  TREATMENT
 PLAN  WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY CLINICAL
 REVIEW OF THE PATIENT, AND PARTICIPATES IN  PERIODIC  CONSULTATION  WITH
 THE  INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED AND
 PEER REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH  IS
 APPROVED  BY  THE  OFFICE OF MENTAL HEALTH AND APPROPRIATE TO THE AGE OF
 THE PATIENT, TO ENSURE THAT THE INPATIENT CARE  IS  MEDICALLY  NECESSARY
 FOR  THE  PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH MAY BE
 REVIEWED RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY,  AN
 INSURED  SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   § 15. Subparagraphs (A), (B) and (D) of paragraph 6 of subsection  (l)
 of  section 3221 of the insurance law, as amended by section 2 of part B
 of chapter 71 of the laws of 2016, are amended and  three  new  subpara-
 graphs (E), (F) and (G) are added to read as follows:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  policy.  [Further,  such  coverage  shall  be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage  provided under this paragraph may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  certi-
 fied  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the  joint commission as alcoholism, substance abuse or chemical depend-
 ence treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED, OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.

 S. 1507                            131                           A. 2007
 
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance  abuse  services  that are participating in the insurer's
 provider network. Coverage provided under this paragraph  shall  not  be
 subject  to  preauthorization.  Coverage  provided  under this paragraph
 shall also not be subject to concurrent utilization  review  during  the
 first  [fourteen]  TWENTY-ONE  days  of the inpatient admission provided
 that the facility notifies the insurer of both  the  admission  and  the
 initial  treatment  plan within [forty-eight hours] TWO BUSINESS DAYS of
 the admission. The facility shall perform daily clinical review  of  the
 patient,  including the periodic consultation with the insurer to ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism and substance abuse services and appropriate to  the  age  of
 the  patient, to ensure that the inpatient treatment is medically neces-
 sary for the patient. Any utilization review of treatment provided under
 this subparagraph may include a review of all services  provided  during
 such  inpatient  treatment,  including  all services provided during the
 first [fourteen] TWENTY-ONE days of such inpatient treatment.  Provided,
 however,  the  insurer  shall  only deny coverage for any portion of the
 initial [fourteen] TWENTY-ONE day inpatient treatment on the basis  that
 such  treatment  was not medically necessary if such inpatient treatment
 was contrary to the evidence-based and  peer  reviewed  clinical  review
 tool  utilized by the insurer which is designated by the office of alco-
 holism and substance abuse services.  An  insured  shall  not  have  any
 financial  obligation  to  the  facility  for  any  treatment under this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO INPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE  MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.

 S. 1507                            132                           A. 2007
 
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  16.  Subparagraphs  (A) and (B) of paragraph 7 of subsection (l) of
 section 3221 of the insurance law, as amended by chapter 41 of the  laws
 of  2014,  are  amended and a new subparagraph (C-1) is added to read as
 follows:
   (A) Every policy that  provides  medical,  major  medical  or  similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication  and  rehabilitation  services.  Such  coverage shall not apply
 financial requirements or treatment limitations to outpatient  substance
 use  disorder  benefits  that  are more restrictive than the predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the policy.    [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B) Coverage under this paragraph may be limited to facilities in  New
 York  state  THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED by the
 office of alcoholism and substance abuse services [or licensed  by  such
 office   as   outpatient  clinics  or  medically  supervised  ambulatory
 substance abuse programs] TO PROVIDE OUTPATIENT SUBSTANCE  USE  DISORDER
 SERVICES  and,  in  other  states,  to those which are accredited by the
 joint commission as alcoholism or chemical dependence treatment programs
 AND SIMILARLY LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED IN  THE  STATE
 IN WHICH THE FACILITY IS LOCATED.
   (C-1) A LARGE GROUP POLICY THAT PROVIDES COVERAGE UNDER THIS PARAGRAPH
 MAY  NOT  IMPOSE  COPAYMENTS OR COINSURANCE FOR OUTPATIENT SUBSTANCE USE
 DISORDER SERVICES THAT EXCEEDS THE COPAYMENT OR COINSURANCE IMPOSED  FOR
 A  PRIMARY  CARE OFFICE VISIT. PROVIDED THAT ONLY ONE SUCH COPAYMENT MAY
 BE IMPOSED FOR ALL SERVICES PROVIDED IN  A  SINGLE  DAY  BY  A  FACILITY
 LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED BY THE OFFICE OF ALCOHOLISM
 AND SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT SUBSTANCE USE  DISOR-
 DER SERVICES.
   §  17.  Subparagraph  (E)  of paragraph 7 of subsection (l) of section
 3221 of the insurance law, as added by section 4 of part MM  of  chapter
 57  of the laws of 2018, is amended and three new subparagraphs (F), (G)
 and (H) are added to read as follows:
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance abuse services for the provision of outpatient, intensive
 outpatient, outpatient rehabilitation  and  opioid  treatment  that  are
 participating in the insurer's provider network. Coverage provided under
 this  paragraph  shall  not  be  subject  to  preauthorization. Coverage
 provided under this paragraph shall not be subject to concurrent  review
 for  the  first [two] THREE weeks of continuous treatment, not to exceed
 [fourteen] TWENTY-ONE visits, provided the facility notifies the insurer
 of both the start of treatment and the  initial  treatment  plan  within
 [forty-eight hours] TWO BUSINESS DAYS.  The facility shall perform clin-
 ical  assessment  of  the  patient at each visit, including the periodic
 consultation with the insurer to ensure that the facility is  using  the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 insurer which is designated by the office of  alcoholism  and  substance
 abuse services and appropriate to the age of the patient, to ensure that
 the  outpatient  treatment  is  medically necessary for the patient. Any

 S. 1507                            133                           A. 2007
 
 utilization review of the treatment provided under this subparagraph may
 include a review of all services provided during such outpatient  treat-
 ment, including all services provided during the first [two] THREE weeks
 of  continuous treatment, not to exceed [fourteen] TWENTY-ONE visits, of
 such outpatient treatment. Provided, however,  the  insurer  shall  only
 deny  coverage  for  any  portion  of  the  initial [two] THREE weeks of
 continuous treatment, not to exceed [fourteen]  TWENTY-ONE  visits,  for
 outpatient  treatment on the basis that such treatment was not medically
 necessary if such outpatient treatment was  contrary  to  the  evidence-
 based  and  peer  reviewed  clinical review tool utilized by the insurer
 which is designated by the office  of  alcoholism  and  substance  abuse
 services.  An  insured  shall  not  have any financial obligation to the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV) "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN  THE
 MOST  RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
 DISORDERS OR THE MOST RECENT EDITION  OF  ANOTHER  GENERALLY  RECOGNIZED
 INDEPENDENT  STANDARD  OF  CURRENT MEDICAL PRACTICE SUCH AS THE INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 18. Paragraph 7-b of subsection (l) of section 3221 of the insurance
 law, as added by section 2 of part B of chapter 69 of the laws of  2016,
 is amended to read as follows:
   (7-b) [(A)] Every policy that provides medical, major medical or simi-
 lar  comprehensive-type  coverage and provides coverage for prescription
 drugs for medication for the treatment of a substance use disorder shall
 include immediate access, without prior authorization, [to  a  five  day
 emergency  supply]  TO  THE  FORMULARY  FORMS  of prescribed medications
 covered under the policy for the treatment  of  substance  use  disorder
 [where  an  emergency  condition exists], including a prescribed drug or
 medication associated with the management of  opioid  withdrawal  and/or

 S. 1507                            134                           A. 2007
 
 stabilization, except where otherwise prohibited by law. Further, cover-
 age  [of  an emergency supply] WITHOUT PRIOR AUTHORIZATION shall include
 FORMULARY  FORMS  medication  for  opioid  overdose  reversal  otherwise
 covered  under  the  policy  prescribed  OR  DISPENSED  to an individual
 covered by the policy.
   [(B) For purposes of this paragraph, an "emergency condition" means  a
 substance use disorder condition that manifests itself by acute symptoms
 of  sufficient  severity,  including  severe  pain or the expectation of
 severe pain, such that a prudent layperson, possessing an average  know-
 ledge  of  medicine  and  health, could reasonably expect the absence of
 immediate medical attention to result in:
   (i) placing the health of the person afflicted with such condition  in
 serious  jeopardy, or in the case of a behavioral condition, placing the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v) a condition described in clause (i), (ii),  or  (iii)  of  section
 1867(e)(1)(A) of the Social Security Act.
   (C)  Coverage  provided  under this paragraph may be subject to copay-
 ments, coinsurance, and annual  deductibles  that  are  consistent  with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty  day  supply of the same medication in the same thirty day period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the initial emergency supply of medication in an  amount  that  is  less
 than  the  copayment or coinsurance otherwise applicable to a thirty day
 supply of such medication, provided that the total sum of the copayments
 or coinsurance for an entire thirty day supply of  the  medication  does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   §  19.  Subparagraph  (B) of paragraph 17 of subsection (l) of section
 3221 of the insurance law, as amended by section 39 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B) Every group or blanket policy that  provides  physician  services,
 medical,  major  medical  or  similar  comprehensive-type coverage shall
 provide coverage for the screening, diagnosis and  treatment  of  autism
 spectrum  disorder  in  accordance  with  this  paragraph  and shall not
 exclude coverage for the screening, diagnosis or  treatment  of  medical
 conditions  otherwise  covered  by  the policy because the individual is
 diagnosed with autism spectrum disorder. Such coverage may be subject to
 annual deductibles, copayments and coinsurance as may be  deemed  appro-
 priate  by the superintendent and shall be consistent with those imposed
 on other benefits under the  group  or  blanket  policy.  [Coverage  for
 applied  behavior  analysis shall be subject to a maximum benefit of six
 hundred eighty hours of  treatment  per  policy  or  calendar  year  per
 covered  individual.]  This paragraph shall not be construed as limiting
 the benefits that are otherwise available to  an  individual  under  the
 group  or  blanket  policy,  provided however that such policy shall not
 contain any limitations on visits that are solely applied to the  treat-
 ment of autism spectrum disorder. No insurer shall terminate coverage or
 refuse  to  deliver, execute, issue, amend, adjust, or renew coverage to
 an individual solely because the individual  is  diagnosed  with  autism
 spectrum  disorder  or has received treatment for autism spectrum disor-

 S. 1507                            135                           A. 2007

 der. Coverage shall  be  subject  to  utilization  review  and  external
 appeals  of  health care services pursuant to article forty-nine of this
 chapter  as  well  as[,]  case  management[,]  and  other  managed  care
 provisions.
   §  20.  Items  (i)  and  (iii)  of subparagraph (C) of paragraph 17 of
 subsection (l) of section 3221 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis,  when  provided [or supervised] by a [behavior analyst] PERSON
 LICENSED, certified [pursuant  to  the  behavior  analyst  certification
 board,]  OR  OTHERWISE  AUTHORIZED TO PROVIDE APPLIED BEHAVIOR ANALYSIS,
 that are necessary to develop, maintain,  or  restore,  to  the  maximum
 extent  practicable, the functioning of an individual. [Individuals that
 provide behavioral health treatment under the supervision of a certified
 behavior analyst pursuant to this paragraph shall be subject  to  stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations  promulgated  by the superintendent in consultation with the
 commissioners of health and education.]
   § 21. Paragraph 17 of subsection (l) of section 3221 of the  insurance
 law is amended by adding four new subparagraphs (H), (I), (J) and (K) to
 read as follows:
   (H)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE  RESTRICTIVE THAN THE PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH    RESPECT  TO  OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE
 MADE AVAILABLE BY THE INSURER TO ANY INSURED,  PROSPECTIVE  INSURED,  OR
 IN-NETWORK PROVIDER UPON  REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS    THE  MOST  COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT,  NUMBER    OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON
 THE SCOPE OR DURATION OF  TREATMENT AND INCLUDES NONQUANTITATIVE  TREAT-
 MENT  LIMITATIONS  SUCH  AS:  MEDICAL   MANAGEMENT STANDARDS LIMITING OR
 EXCLUDING BENEFITS BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER  THE
 TREATMENT  IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY   DESIGN FOR
 PRESCRIPTION DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER   ADMIS-
 SION TO PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS
 FOR  DETERMINING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR
 STEP THERAPY PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE
 OF TREATMENT; AND RESTRICTIONS BASED ON  GEOGRAPHIC  LOCATION,  FACILITY
 TYPE,  PROVIDER  SPECIALTY,  AND  OTHER CRITERIA THAT LIMIT THE SCOPE OR
 DURATION OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.

 S. 1507                            136                           A. 2007

   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  22. Paragraphs 1, 2, and 3 of subsection (g) of section 4303 of the
 insurance law, as amended by chapter  502  of  the  laws  of  2007,  are
 amended to read as follows:
   [(1)] A MEDICAL EXPENSE INDEMNITY CORPORATION, hospital service corpo-
 ration  or  a  health  service corporation, [which] THAT provides group,
 group remittance or  school  blanket  coverage  for  inpatient  hospital
 care[,]  OR COVERAGE FOR PHYSICIAN SERVICES shall provide as part of its
 contract [broad-based] coverage  for  the  diagnosis  and  treatment  of
 mental[,  nervous or emotional disorders or ailments, however defined in
 such contract, at least equal to the coverage provided for other] health
 conditions and [shall include]:
   [(A)]
   (1) WHERE THE CONTRACT PROVIDES COVERAGE FOR INPATIENT HOSPITAL  CARE,
 benefits for in-patient care in a hospital as defined by subdivision ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed  to  not  less  than  thirty days of active treatment in any contract
 year, plan year or calendar year.
   (B)] OR FOR INPATIENT CARE PROVIDED  IN  OTHER  STATES,  TO  SIMILARLY
 LICENSED  HOSPITALS,  AND  benefits  for  out-patient care provided in a
 facility issued an operating certificate by the commissioner  of  mental
 health  pursuant  to  the provisions of article thirty-one of the mental
 hygiene law or in a facility operated by the office of  mental  health[,
 which  benefits  may  be  limited  to not less than twenty visits in any
 contract year, plan year or calendar year. Benefits for  partial  hospi-
 talization  program  services  shall be provided as an offset to covered
 inpatient days at a ratio of two partial hospitalization visits  to  one
 inpatient day of treatment.
   (C)  Such  coverage  may  be provided on a contract year, plan year or
 calendar year basis and shall be consistent with the provision of  other
 benefits  under the contract.] OR FOR OUT-PATIENT CARE PROVIDED IN OTHER
 STATES, TO SIMILARLY CERTIFIED FACILITIES; AND
   (2) WHERE THE CONTRACT PROVIDES COVERAGE FOR PHYSICIAN SERVICES  BENE-
 FITS  FOR  OUTPATIENT  CARE  PROVIDED  BY A PSYCHIATRIST OR PSYCHOLOGIST
 LICENSED TO PRACTICE IN THIS STATE, A LICENSED  CLINICAL  SOCIAL  WORKER
 WHO  MEETS  THE  REQUIREMENTS OF SUBSECTION (N) OF THIS SECTION, A NURSE
 PRACTITIONER LICENSED TO PRACTICE ON THIS STATE, OR PROFESSIONAL  CORPO-
 RATION OR UNIVERSITY FACULTY PRACTICE CORPORATION THEREOF.
   (3)  Such  coverage  may be subject to annual deductibles, co-pays and
 coinsurance as may be deemed appropriate by the superintendent and shall
 be consistent with those imposed on other benefits under  the  contract.
 PROVIDED  THAT NO COPAYMENT OR COINSURANCE IMPOSED FOR OUTPATIENT MENTAL
 HEALTH SERVICES PROVIDED IN A FACILITY LICENSED, CERTIFIED OR  OTHERWISE
 AUTHORIZED BY THE OFFICE OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS OR
 COINSURANCE IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE CONTRACT.
   [(D)  For  the  purpose  of  this subsection, "active treatment" means
 treatment furnished  in  conjunction  with  in-patient  confinement  for
 mental, nervous or emotional disorders or ailments that meet such stand-
 ards  as  shall be prescribed pursuant to the regulations of the commis-
 sioner of mental health.
   (E) In the event the group remittance  group  or  contract  holder  is
 provided  coverage  under  this  subsection  and  under paragraph one of
 subsection (h) of this section from the same health service corporation,
 or under a contract that is jointly underwritten by two  health  service

 S. 1507                            137                           A. 2007

 corporations  or  by  a health service corporation and a medical expense
 indemnity corporation, the aggregate of the benefits for outpatient care
 obtained under subparagraph (B) of this paragraph and paragraph  one  of
 subsection  (h)  of  this section may be limited to not less than twenty
 visits in any contract year, plan year or calendar year.
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness. Such hospi-
 tal service corporation or health service corporation shall also provide
 such comparable coverage for children with  serious  emotional  disturb-
 ances.  Such  coverage  shall be provided under the terms and conditions
 otherwise applicable under the contract, including  network  limitations
 or  variations,  exclusions,  co-pays, coinsurance, deductibles or other
 specific cost sharing mechanisms. Provided  further,  where  a  contract
 provides both in-network and out-of-network benefits, the out-of-network
 benefits  may  have different coinsurance, co-pays, or deductibles, than
 the in-network benefits, regardless of whether the contract  is  written
 under one license or two licenses.
   (B)  For  purposes  of  this  subsection, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive compulsive disorders, anorexia, and bulimia.
   (3)  For  purposes of this subsection, the term "children with serious
 emotional disturbances" means persons under the age  of  eighteen  years
 who  have  diagnoses of attention deficit disorders, disruptive behavior
 disorders, or pervasive development disorders, and where there  are  one
 or more of the following:
   (A)  serious suicidal symptoms or other life-threatening self-destruc-
 tive behaviors;
   (B) significant psychotic symptoms (hallucinations, delusion,  bizarre
 behaviors);
   (C) behavior caused by emotional disturbances that placed the child at
 risk of causing personal injury or significant property damage; or
   (D) behavior caused by emotional disturbances that placed the child at
 substantial risk of removal from the household.]
   §  23.  Paragraphs  4  and  5 of subsection (g) of section 4303 of the
 insurance law are REPEALED and five new paragraphs 4, 5, 6, 7 and 8  are
 added to read as follows:
   (4)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE  MORE
 RESTRICTIVE  THAN   THE PREDOMINANT FINANCIAL REQUIREMENTS AND TREATMENT
 LIMITATIONS APPLIED TO  SUBSTANTIALLY ALL MEDICAL AND SURGICAL  BENEFITS
 COVERED BY THE CONTRACT.
   (5)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH  RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE
 BY THE CORPORATION TO  ANY INSURED, PROSPECTIVE INSURED,  OR  IN-NETWORK
 PROVIDER UPON REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;

 S. 1507                            138                           A. 2007
 
   (B) "PREDOMINANT" MEANS THAT  A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS    THE  MOST  COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER  OF    VISITS,  DAYS  OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF  TREATMENT AND INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY   DESIGN FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS  FOR DETER-
 MINING USUAL, CUSTOMARY, AND  REASONABLE  CHARGES;  FAIL-FIRST  OR  STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "MENTAL  HEALTH  CONDITION"  MEANS  ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE  MOST RECENT EDITION OF THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL OF MENTAL DISORDERS  OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (7)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM,  CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND  PETE  DOMENICI
 MENTAL  HEALTH    PARITY  AND  ADDICTION EQUITY ACT OF 2008 (29 U.S.C. §
 1185A).
   (8) THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT  ARE
 LICENSED  BY  THE  OFFICE OF MENTAL HEALTH THAT ARE PARTICIPATING IN THE
 CORPORATION'S PROVIDER NETWORK. WHERE THE CONTRACT PROVIDES COVERAGE FOR
 INPATIENT HOSPITAL CARE, BENEFITS  FOR  INPATIENT  HOSPITAL  CARE  IN  A
 HOSPITAL  AS    DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL
 HYGIENE LAW PROVIDED TO INDIVIDUALS WHO HAVE NOT  ATTAINED  THE  AGE  OF
 EIGHTEEN  SHALL  NOT  BE  SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED
 UNDER THIS PARAGRAPH SHALL ALSO NOT BE  SUBJECT TO  CONCURRENT  UTILIZA-
 TION  REVIEW  DURING THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION,
 PROVIDED THE FACILITY NOTIFIES THE CORPORATION OF BOTH THE ADMISSION AND
 THE INITIAL TREATMENT PLAN WITHIN TWO BUSINESS DAYS  OF  THE  ADMISSION,
 PERFORMS DAILY CLINICAL REVIEW OF THE PATIENT, AND PARTICIPATES IN PERI-
 ODIC  CONSULTATION  WITH  THE CORPORATION TO ENSURE THAT THE FACILITY IS
 USING THE EVIDENCE-BASED AND  PEER  REVIEWED  CLINICAL  REVIEW  CRITERIA
 UTILIZED  BY  THE  CORPORATION WHICH IS APPROVED BY THE OFFICE OF MENTAL
 HEALTH AND APPROPRIATE TO THE AGE OF THE PATIENT,  TO  ENSURE  THAT  THE
 INPATIENT  CARE  IS  MEDICALLY  NECESSARY FOR THE PATIENT. ALL TREATMENT
 PROVIDED UNDER THIS SUBPARAGRAPH MAY BE REVIEWED RETROSPECTIVELY.  WHERE
 CARE  IS DENIED RETROSPECTIVELY, AN INSURED SHALL NOT HAVE ANY FINANCIAL
 OBLIGATION TO THE FACILITY FOR ANY  TREATMENT  UNDER  THIS  SUBPARAGRAPH
 OTHER  THAN ANY COPAYMENT, COINSURANCE, OR DEDUCTIBLE OTHERWISE REQUIRED
 UNDER THE CONTRACT.
   § 24. Subsection (h) of section 4303 of the insurance law is REPEALED.
   § 25. Subsection (i) of section 4303 of the insurance law, as  amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (i)  A  medical expense indemnity corporation or health service corpo-
 ration [which] THAT provides coverage for physicians,  psychiatrists  or
 psychologists for psychiatric or psychological services or for the diag-
 nosis  and  treatment  of  [mental,  nervous  or emotional disorders and
 ailments] MENTAL HEALTH CONDITIONS, however defined  in  such  contract,
 [must]  SHALL  make  available  and  if requested by all persons holding

 S. 1507                            139                           A. 2007
 
 individual contracts in a group whose premiums are paid by  a  remitting
 agent  or  by the contract holder in the case of a group contract issued
 pursuant to section four thousand three hundred five  of  this  article,
 provide the same coverage for such services when performed by a licensed
 clinical  social worker, within the lawful scope of his or her practice,
 who is licensed pursuant to article one hundred fifty-four of the educa-
 tion law. The state board for social work shall maintain a list  of  all
 licensed  clinical social workers qualified for reimbursement under this
 subsection. Such coverage shall be made available at  the  inception  of
 all new contracts and, with respect to all other contracts, at any anni-
 versary  date subject to evidence of insurability. Written notice of the
 availability of such coverage shall be delivered to the group  remitting
 agent  or  group contract holder prior to inception of such contract and
 annually thereafter, except that this notice shall not be required where
 a [policy] CONTRACT covers two hundred or more employees  or  where  the
 benefit  structure  was  the  subject of collective bargaining affecting
 persons who are employed in more than one state.
   § 26. Subsection (k) of section 4303 of the insurance law, as  amended
 by  section 3 of part B of chapter 71 of the laws of 2016, is amended to
 read as follows:
   (k)(1) Every contract that provides hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  contract.  [Further,  such  coverage shall be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (2)  Coverage provided under this subsection may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  CERTI-
 FIED  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence  treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (3) Coverage provided under this subsection may be subject  to  annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and  that  are  consistent with those imposed on other benefits within a
 given contract.
   (4) This paragraph shall apply to facilities in this state [certified]
 THAT ARE LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED by  the  office  of
 alcoholism  and  substance  abuse services that are participating in the
 corporation's provider network. Coverage provided under this  subsection
 shall  not  be subject to preauthorization. Coverage provided under this
 subsection shall also not be subject to  concurrent  utilization  review
 during  the  first [fourteen] TWENTY-ONE days of the inpatient admission
 provided that the facility notifies the corporation of both  the  admis-
 sion and the initial treatment plan within [forty-eight hours] TWO BUSI-
 NESS  DAYS  of  the admission. The facility shall perform daily clinical

 S. 1507                            140                           A. 2007
 
 review of the patient, including  the  periodic  consultation  with  the
 corporation  to ensure that the facility is using the evidence-based and
 peer reviewed clinical review tool utilized by the corporation which  is
 designated  by the office of alcoholism and substance abuse services and
 appropriate to the age of the patient,  to  ensure  that  the  inpatient
 treatment is medically necessary for the patient. Any utilization review
 of  treatment  provided under this paragraph may include a review of all
 services  provided  during  such  inpatient  treatment,  including   all
 services  provided  during  the first [fourteen] TWENTY-ONE days of such
 inpatient treatment.  Provided, however, the corporation shall only deny
 coverage for any portion of the initial [fourteen] TWENTY-ONE day  inpa-
 tient  treatment  on  the  basis  that  such treatment was not medically
 necessary if such inpatient treatment was contrary to the evidence-based
 and peer reviewed clinical review tool utilized by the corporation which
 is designated by the office of alcoholism and substance abuse  services.
 An  insured  shall not have any financial obligation to the facility for
 any treatment under this paragraph other  than  any  copayment,  coinsu-
 rance, or deductible otherwise required under the contract.
   (5)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH   RESPECT TO INPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED OR IN-NETWORK PROVIDER UPON  REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER  OF    VISITS,  DAYS  OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF  TREATMENT AND INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY   DESIGN FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS  FOR DETER-
 MINING USUAL, CUSTOMARY, AND  REASONABLE  CHARGES;  FAIL-FIRST  OR  STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF  MENTAL
 DISORDERS  OR  THE MOST   RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT  MEDICAL PRACTICE SUCH AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (7)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM,  CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND  PETE  DOMENICI
 MENTAL  HEALTH    PARITY  AND  ADDICTION EQUITY ACT OF 2008 (29 U.S.C. §
 1185A).
   § 27. Paragraphs 1 and 2 of subsection (l)  of  section  4303  of  the
 insurance law, as amended by chapter 41 of the laws of 2014, are amended
 and a new paragraph 3-a is added to read as follows:
   (1)  Every  contract  that  provides medical, major medical or similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-

 S. 1507                            141                           A. 2007
 
 fication and rehabilitation services.  Such  coverage  shall  not  apply
 financial  requirements or treatment limitations to outpatient substance
 use disorder benefits that are more  restrictive  than  the  predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the contract.  [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (2) Coverage under this subsection may be limited to facilities in New
 York state THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED  by  the
 office  of  alcoholism and substance abuse services [or licensed by such
 office as outpatient clinics  or  medically  supervised  ambulatory]  TO
 PROVIDE OUTPATIENT substance [abuse programs] USE DISORDER SERVICES and,
 in  other  states, to those which are accredited by the joint commission
 as alcoholism or chemical dependence substance abuse treatment  programs
 AND  ARE  SIMILARLY  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED IN THE
 STATE IN WHICH THE FACILITY IS LOCATED.
   (3-A) A CONTRACT THAT PROVIDES  LARGE  GROUP  COVERAGE  THAT  PROVIDES
 COVERAGE  FOR  OUTPATIENT  SUBSTANCE  USE  DISORDER  SERVICES UNDER THIS
 SUBSECTION MAY NOT  IMPOSE  COPAYMENTS  OR  COINSURANCE  FOR  OUTPATIENT
 SUBSTANCE USE DISORDER SERVICES THAT EXCEED THE COPAYMENT OR COINSURANCE
 IMPOSED  FOR  A  PRIMARY  CARE OFFICE VISIT. PROVIDED THAT ONLY ONE SUCH
 COPAYMENT MAY BE IMPOSED FOR ALL SERVICES PROVIDED IN A SINGLE DAY BY  A
 FACILITY  LICENSED,  CERTIFIED  OR OTHERWISE AUTHORIZED BY THE OFFICE OF
 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT  SUBSTANCE
 USE DISORDER SERVICES.
   §  28.  Paragraph 5 of subsection (l) of section 4303 of the insurance
 law, as added by section 5 of part MM of chapter 57 of the laws of 2018,
 is amended and three new paragraphs 6, 7 and 8  are  added  to  read  as
 follows:
   (5) This paragraph shall apply to facilities in this state [certified]
 THAT  ARE  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED by the office of
 alcoholism and substance abuse services for the provision of outpatient,
 intensive outpatient, outpatient  rehabilitation  and  opioid  treatment
 that  are  participating in the corporation's provider network. Coverage
 provided under this subsection shall not be subject to preauthorization.
 Coverage provided under this subsection shall not be subject to  concur-
 rent review for the first [two] THREE weeks of continuous treatment, not
 to  exceed  [fourteen] TWENTY-ONE visits, provided the facility notifies
 the corporation of both the start of treatment and the initial treatment
 plan within [forty-eight hours] TWO BUSINESS DAYS.  The  facility  shall
 perform  clinical assessment of the patient at each visit, including the
 periodic consultation with the corporation to ensure that  the  facility
 is  using  the  evidence-based  and  peer  reviewed clinical review tool
 utilized by the corporation which is designated by the office  of  alco-
 holism  and  substance  abuse services and appropriate to the age of the
 patient, to ensure that the outpatient treatment is medically  necessary
 for  the patient. Any utilization review of the treatment provided under
 this paragraph may include a review of all services provided during such
 outpatient treatment, including all services provided during  the  first
 [two]  THREE  weeks  of  continuous  treatment, not to exceed [fourteen]
 TWENTY-ONE visits, of such outpatient treatment. Provided, however,  the
 corporation  shall  only  deny  coverage  for any portion of the initial
 [two] THREE weeks of continuous  treatment,  not  to  exceed  [fourteen]
 TWENTY-ONE  visits,  for  outpatient  treatment  on  the basis that such
 treatment was not medically necessary if such outpatient  treatment  was

 S. 1507                            142                           A. 2007
 
 contrary  to  the  evidence-based and peer reviewed clinical review tool
 utilized by the corporation which is designated by the office  of  alco-
 holism  and  substance  abuse  services. A subscriber shall not have any
 financial  obligation to the facility for any treatment under this para-
 graph other than any copayment,  coinsurance,  or  deductible  otherwise
 required under the contract.
   (6)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH RESPECT TO  OUTPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED, OR IN-NETWORK PROVIDER UPON REQUEST.
   (7) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT.
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR  DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT LIMITA-
 TIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING  BENE-
 FITS  BASED  ON  MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (8)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE  AND  PETE  DOMENICI
 MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY  ACT OF 2008 (29 U.S.C. §
 1185A).
   § 29. Subsection (l-2) of section 4303 of the insurance law, as  added
 by  section 3 of part B of chapter 69 of the laws of 2016, is amended to
 read as follows:
   (l-2) [(1)] Every contract that provides  medical,  major  medical  or
 similar   comprehensive-type   coverage   and   provides   coverage  for
 prescription drugs for medication for the treatment of a  substance  use
 disorder shall include immediate access, without prior authorization, to
 [a  five day emergency supply] THE FORMULARY FORMS of prescribed medica-
 tions covered under the contract for  the  treatment  of  substance  use
 disorder  [where  an emergency condition exists], including a prescribed
 drug or medication associated with the management of  opioid  withdrawal
 and/or stabilization, except where otherwise prohibited by law. Further,
 coverage  [of  an  emergency  supply]  WITHOUT PRIOR AUTHORIZATION shall
 include FORMULARY FORMS  OF  medication  for  opioid  overdose  reversal
 otherwise covered under the contract prescribed OR DISPENSED to an indi-
 vidual covered by the contract.
   [(2)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms

 S. 1507                            143                           A. 2007

 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in  clause (i), (ii) or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (3) Coverage provided under this subsection may be subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the contract; provided,  however,
 no  contract  shall  impose an additional copayment or coinsurance on an
 insured who received an emergency supply of medication and then received
 up to a thirty day supply of the same medication in the same thirty  day
 period  in  which the emergency supply of medication was dispensed. This
 paragraph shall not preclude the imposition of a  copayment  or  coinsu-
 rance  on  the initial limited supply of medication in an amount that is
 less than the copayment or coinsurance otherwise applicable to a  thirty
 day supply of such medication, provided that the total sum of the copay-
 ments  or  coinsurance for an entire thirty day supply of the medication
 does not exceed the copayment or coinsurance otherwise applicable  to  a
 thirty day supply of such medication.]
   §  30. Subsection (n) of section 4303 of the insurance law, as amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (n) In addition to the requirements of subsection (i) of this section,
 every health service or medical expense indemnity corporation issuing  a
 group  contract  pursuant to this section or a group remittance contract
 for delivery in this state  which  contract  provides  reimbursement  to
 subscribers  or physicians, psychiatrists or psychologists for psychiat-
 ric or psychological services or for  the  diagnosis  and  treatment  of
 [mental,  nervous  or  emotional  disorders and ailments,] MENTAL HEALTH
 CONDITIONS, however defined in such  contract,  must  provide  the  same
 coverage  to  persons covered under the group contract for such services
 when performed by a licensed clinical social worker, within  the  lawful
 scope  of  his  or her practice, who is licensed pursuant to subdivision
 two of section seven thousand seven hundred four of  the  education  law
 and  in  addition  shall  have either (i) three or more additional years
 experience in psychotherapy, which for the purposes of  this  subsection
 shall mean the use of verbal methods in interpersonal relationships with
 the  intent  of  assisting  a  person or persons to modify attitudes and
 behavior which are intellectually, socially or emotionally  maladaptive,
 under supervision, satisfactory to the state board for social work, in a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental
 department, providing services for diagnosis or  treatment  of  [mental,
 nervous  or  emotional disorders or ailments,] MENTAL HEALTH CONDITIONS,
 or (ii) three or more additional years experience in psychotherapy under
 the supervision, satisfactory to the state board for social work,  of  a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical  social  worker  qualified for reimbursement pursuant to subsection
 (i) of this section, or (iii) a combination of the experience  specified
 in  paragraphs  (i)  and  (ii) totaling three years, satisfactory to the
 state board for social work.   The state board  for  social  work  shall

 S. 1507                            144                           A. 2007
 
 maintain  a  list  of all licensed clinical social workers qualified for
 reimbursement under this subsection.
   §  31. Paragraph 2 of subsection (ee) of section 4303 of the insurance
 law, as amended by section 40 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (2)  Every  contract  that provides physician services, medical, major
 medical or similar comprehensive-type coverage  shall  provide  coverage
 for  the  screening, diagnosis and treatment of autism spectrum disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered  by the contract because the individual is diagnosed with autism
 spectrum disorder. Such coverage may be subject to  annual  deductibles,
 copayments  and  coinsurance  as may be deemed appropriate by the super-
 intendent and shall be consistent with those imposed on  other  benefits
 under  the  contract.  [Coverage  for applied behavior analysis shall be
 subject to a maximum benefit of six hundred eighty  hours  of  treatment
 per  contract  or  calendar year per covered individual.] This paragraph
 shall not be construed as  limiting  the  benefits  that  are  otherwise
 available  to  an  individual  under the contract, provided however that
 such contract shall not contain any limitations on visits that are sole-
 ly applied to the treatment of  autism  spectrum  disorder.  No  insurer
 shall  terminate  coverage  or refuse to deliver, execute, issue, amend,
 adjust, or renew coverage to an individual solely because the individual
 is diagnosed with autism spectrum disorder or has received treatment for
 autism spectrum disorder.  Coverage  shall  be  subject  to  utilization
 review  and external appeals of health care services pursuant to article
 forty-nine of this chapter as well as[,] case  management[,]  and  other
 managed care provisions.
   §  32.  Subparagraphs (A) and (C) of paragraph 3 of subsection (ee) of
 section 4303 of the insurance law, as amended by chapter 596 of the laws
 of 2011, are amended to read as follows:
   (A) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (C)  "behavioral  health  treatment"  means  counseling  and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant  to  the  behavior  analyst certification board] PERSON THAT IS
 LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED  BEHAVIOR
 ANALYSIS,  that  are  necessary to develop, maintain, or restore, to the
 maximum extent practicable, the functioning of an individual.  [Individ-
 uals that provide behavioral health treatment under the supervision of a
 certified  behavior analyst pursuant to this subsection shall be subject
 to standards of professionalism,  supervision  and  relevant  experience
 pursuant  to  regulations promulgated by the superintendent in consulta-
 tion with the commissioners of health and education.]
   § 33. Subsection (ee) of section 4303 of the insurance law is  amended
 by adding four new paragraphs 8, 9, 10, and 11 to read as follows:
   (8)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE RESTRICTIVE THAN THE  PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.

 S. 1507                            145                           A. 2007
 
   (9) THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER  THE
 CONTRACT WITH RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE
 AVAILABLE  BY  THE  CORPORATION  TO ANY INSURED, PROSPECTIVE INSURED, OR
 IN-NETWORK PROVIDER UPON REQUEST.
   (10) FOR PURPOSES OF THIS SUBSECTION:
   (A)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B) "PREDOMINANT" MEANS THAT  A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT  LIMITA-
 TIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING BENE-
 FITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT  IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT.
   (11) A CORPORATION SHALL PROVIDE COVERAGE UNDER THIS SUBSECTION, AT  A
 MINIMUM,  CONSISTENT  WITH  THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI
 MENTAL HEALTH PARITY AND ADDICTION EQUITY  ACT  OF  2008  (29  U.S.C.  §
 1185A).
   §  34.  Paragraphs  17, 20 and 21 of subsection (a) of section 4324 of
 the insurance law, paragraph 17 as amended and paragraphs 20 and  21  as
 added  by  section  8  of  part H of chapter 60 of the laws of 2014, are
 amended and a new paragraph 22 is added to read as follows:
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate document that is updated annually, of the name, address, and  tele-
 phone  number of all participating providers, including facilities, [and
 in addition,] AND: (A) WHETHER THE PROVIDER IS ACCEPTING  NEW  PATIENTS;
 (B)  IN  THE  CASE  OF  MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES
 PROVIDERS, ANY AFFILIATIONS WITH PARTICIPATING FACILITIES  CERTIFIED  OR
 AUTHORIZED  BY  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM
 AND SUBSTANCE ABUSE SERVICES, AND ANY RESTRICTIONS REGARDING THE  AVAIL-
 ABILITY OF THE INDIVIDUAL PROVIDER'S SERVICES; (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  corpo-
 ration's  website  and  the  corporation shall update the website within
 fifteen days of the addition or  termination  of  a  provider  from  the
 corporation's network or a change in a physician's hospital affiliation;
   (20) with respect to out-of-network coverage:
   (A)  a clear description of the methodology used by the corporation to
 determine reimbursement for out-of-network health care services;
   (B) a description of the amount that the  corporation  will  reimburse
 under  the methodology for out-of-network health care services set forth
 as a percentage of the  usual  and  customary  cost  for  out-of-network
 health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (21) information in writing  and  through  an  internet  website  that
 reasonably  permits  a  subscriber or prospective subscriber to estimate

 S. 1507                            146                           A. 2007
 
 the  anticipated  out-of-pocket  cost  for  out-of-network  health  care
 services  in  a  geographical area or zip code based upon the difference
 between what the corporation will reimburse  for  out-of-network  health
 care services and the usual and customary cost for out-of-network health
 care services[.]; AND
   (22) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE CORPORATION
 TO  ASSESS  THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE
 PAUL WELLSTONE AND PETE DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION
 EQUITY  ACT  OF  2008,  42  U.S.C. 18031 (J), AND ANY AMENDMENTS TO, AND
 FEDERAL GUIDANCE OR REGULATIONS ISSUED UNDER, THOSE ACTS.
   § 35. Subsection (b) of section 4325 of the insurance law, as added by
 chapter 705 of the laws of 1996, is amended to read as follows:
   (b) No corporation organized under this  article  shall  by  contract,
 written  policy [or], written procedure OR PRACTICE prohibit or restrict
 any health care provider from filing a complaint,  making  a  report  or
 commenting to an appropriate governmental body regarding the policies or
 practices of such corporation which the provider believes may negatively
 impact upon the quality of or access to patient care. NOR SHALL A CORPO-
 RATION  ORGANIZED  UNDER THIS ARTICLE TAKE ANY ADVERSE ACTION, INCLUDING
 BUT NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR  AGREEMENT
 WITH A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVID-
 ER FOR FILING A COMPLAINT, MAKING A REPORT OR COMMENTING TO AN APPROPRI-
 ATE  GOVERNMENTAL  BODY  REGARDING  POLICIES OR PRACTICES OF SUCH CORPO-
 RATION WHICH MAY VIOLATE THIS CHAPTER  INCLUDING  SUBSECTION  (G),  (K),
 (1),  (1-1)  OR (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THIS ARTI-
 CLE.
   § 36. Subparagraph (C) of paragraph 1 of  subsection  (b)  of  section
 4900  of  the insurance law, as added by chapter 41 of the laws of 2014,
 is amended and a new subparagraph (D) is added to read as follows:
   (C) for purposes of a determination involving substance  use  disorder
 treatment:
   (i)  a  physician  who  possesses  a  current and valid non-restricted
 license to practice medicine and who specializes  in  behavioral  health
 and  has experience in the delivery of substance use disorder courses of
 treatment; or
   (ii) a health care professional other than a  licensed  physician  who
 specializes  in  behavioral health and has experience in the delivery of
 substance use disorder  courses  of  treatment  and,  where  applicable,
 possesses  a  current  and  valid non-restricted license, certificate or
 registration or, where no provision for a license, certificate or regis-
 tration exists, is credentialed by the national accrediting body  appro-
 priate to the profession; [and] OR
   (D)  FOR  PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR A MENTAL
 HEALTH CONDITION:
   (I) A PHYSICIAN WHO  POSSESSES  A  CURRENT  AND  VALID  NON-RESTRICTED
 LICENSE  TO  PRACTICE  MEDICINE AND WHO SPECIALIZES IN BEHAVIORAL HEALTH
 AND HAS EXPERIENCE IN THE DELIVERY OF MENTAL HEALTH  COURSES  OR  TREAT-
 MENT; OR
   (II)  A  HEALTH  CARE PROFESSIONAL OTHER THAN A LICENSED PHYSICIAN WHO
 SPECIALIZES IN BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE  DELIVERY  OF
 MENTAL  HEALTH  COURSES  OF TREATMENT AND, WHERE APPLICABLE, POSSESSES A
 CURRENT AND VALID NON-RESTRICTED LICENSE, CERTIFICATE,  OR  REGISTRATION
 OR,  WHERE  NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE OR REGISTRATION
 EXISTS, IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE  TO
 THE PROFESSION; AND

 S. 1507                            147                           A. 2007
 
   §  37.  Paragraph 9 of subsection (a) of section 4902 of the insurance
 law, as amended by section 1 of part A of chapter  69  of  the  laws  of
 2016, is amended to read as follows:
   (9)  When  conducting  utilization  review for purposes of determining
 health care coverage for substance use disorder treatment, a utilization
 review agent shall utilize AN evidence-based and peer reviewed  clinical
 review [tools designated by the office of alcoholism and substance abuse
 services  that  are appropriate to the age of the patient and consistent
 with the treatment service levels within the office  of  alcoholism  and
 substance  abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE OF
 THE PATIENT. WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW  FOR  TREATMENT
 PROVIDED  IN  THIS  STATE,  A  UTILIZATION REVIEW AGENT SHALL UTILIZE AN
 EVIDENCE-BASED AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE  OFFICE
 OF  ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT WITH THE
 TREATMENT SERVICE LEVELS WITHIN THE OFFICE OF ALCOHOLISM  AND  SUBSTANCE
 ABUSE  SERVICES  SYSTEM. All approved tools shall have inter rater reli-
 ability  testing  completed  by  December  thirty-first,  two   thousand
 sixteen.
   §  38.  Subsection (a) of section 4902 of the insurance law is amended
 by adding a new paragraph 12 to read as follows:
   (12) WHEN CONDUCTING UTILIZATION REVIEW FOR  PURPOSES  OF  DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT  SHALL  UTILIZE  EVIDENCE-BASED  AND PEER REVIEWED CLINICAL REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW AGENT SHALL USE CLINICAL REVIEW CRITERIA DEEMED  APPROPRIATE  AND
 APPROVED  FOR  SUCH  USE  BY  THE  COMMISSIONER  OF THE OFFICE OF MENTAL
 HEALTH, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH AND  THE  SUPER-
 INTENDENT.  APPROVED  CLINICAL  REVIEW  CRITERIA  SHALL HAVE INTER RATER
 RELIABILITY TESTING COMPLETED BY  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND
 NINETEEN.
   §  39.  Paragraph  (b)  of  subsection 5 of section 4403 of the public
 health law, as added by chapter 705 of the laws of 1996, is  amended  to
 read as follows:
   (b)  The following criteria shall be considered by the commissioner at
 the time of a review: (i) the availability  of  appropriate  and  timely
 care  that  is  provided in compliance with the standards of the Federal
 Americans with Disability Act to assure access to health  care  for  the
 enrollee  population;  (ii)  the network's ability to provide culturally
 and linguistically competent care to meet  the  needs  of  the  enrollee
 population;  [and] (iii) THE AVAILABILITY OF APPROPRIATE AND TIMELY CARE
 THAT IS IN COMPLIANCE WITH THE STANDARDS OF THE PAUL WELLSTONE AND  PETE
 DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY ACT OF 2008, 42
 U.S.C.  18031(J), AND ANY AMENDMENTS TO, AND FEDERAL GUIDANCE AND  REGU-
 LATIONS  ISSUED UNDER THOSE ACTS, WHICH SHALL INCLUDE AN ANALYSIS OF THE
 RATE  OF  OUT-OF-NETWORK  UTILIZATION  FOR  COVERED  MENTAL  HEALTH  AND
 SUBSTANCE  USE  DISORDER SERVICES AS COMPARED TO THE RATE OF OUT-OF-NET-
 WORK UTILIZATION FOR THE RESPECTIVE CATEGORY OF  MEDICAL  SERVICES;  AND
 (IV)  with  the exception of initial licensure, the number of grievances
 filed by enrollees relating to waiting times for appointments, appropri-
 ateness of referrals and other indicators of plan capacity.
   § 40. Subdivision 3 of section 4406-c of the  public  health  law,  as
 added by chapter 705 of the laws of 1996, is amended to read as follows:
   3. No health care plan shall by contract, written policy [or], written
 procedure OR PRACTICE prohibit or restrict any health care provider from
 filing  a  complaint,  making  a  report or commenting to an appropriate
 governmental body regarding the policies or  practices  of  such  health

 S. 1507                            148                           A. 2007
 
 care  plan  which  the  provider believes may negatively impact upon the
 quality of, or access to, patient care. NOR SHALL  A  HEALTH  CARE  PLAN
 TAKE  ANY ADVERSE ACTION, INCLUDING BUT NOT LIMITED TO REFUSING TO RENEW
 OR EXECUTE A CONTRACT OR AGREEMENT WITH A HEALTH CARE PROVIDER AS RETAL-
 IATION  AGAINST  A HEALTH CARE PROVIDER FOR FILING A COMPLAINT, MAKING A
 REPORT OR COMMENTING TO AN APPROPRIATE GOVERNMENTAL BODY REGARDING POLI-
 CIES OR PRACTICES OF SUCH HEALTH CARE PLAN WHICH MAY VIOLATE THIS  CHAP-
 TER  OR  THE  INSURANCE LAW INCLUDING SUBSECTION (G), (K), (L), (L-1) OR
 (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THE INSURANCE LAW.
   § 41. Paragraphs (r), (t) and (u) of subdivision 1 of section 4408  of
 the  public  health law, paragraph (r) as amended and paragraphs (t) and
 (u) as added by section 18 of part H of chapter 60 of the laws of  2014,
 are amended and a new paragraph (v) is added to read as follows:
   (r)  a  listing by specialty, which may be in a separate document that
 is updated annually, of the name, address and telephone  number  of  all
 participating  providers, including facilities, [and, in addition,] AND:
 (I) WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (II) IN THE CASE  OF
 MENTAL  HEALTH  OR SUBSTANCE USE DISORDER SERVICES PROVIDERS, ANY AFFIL-
 IATIONS WITH PARTICIPATING FACILITIES CERTIFIED  OR  AUTHORIZED  BY  THE
 OFFICE  OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
 SERVICES, AND ANY RESTRICTIONS REGARDING THE AVAILABILITY OF  THE  INDI-
 VIDUAL  PROVIDER'S  SERVICES; AND (III) in the case of physicians, board
 certification, languages spoken and any affiliations with  participating
 hospitals.  The  listing  shall also be posted on the health maintenance
 organization's website and the  health  maintenance  organization  shall
 update the website within fifteen days of the addition or termination of
 a  provider  from  the  health  maintenance  organization's network or a
 change in a physician's hospital affiliation;
   (t) with respect to out-of-network coverage:
   (i) a clear description of the methodology used by the health  mainte-
 nance  organization to determine reimbursement for out-of-network health
 care services;
   (ii) the amount that the health maintenance  organization  will  reim-
 burse  under the methodology for out-of-network health care services set
 forth as a percentage of the usual and customary cost for out-of-network
 health care services;
   (iii) examples  of  anticipated  out-of-pocket  costs  for  frequently
 billed out-of-network health care services; [and]
   (u)  information  in  writing  and  through  an  internet website that
 reasonably permits an enrollee or prospective enrollee to  estimate  the
 anticipated  out-of-pocket  cost for out-of-network health care services
 in a geographical area or zip code based  upon  the  difference  between
 what  the health maintenance organization will reimburse for out-of-net-
 work health care services and the usual and customary cost  for  out-of-
 network health care services[.]; AND
   (V) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE HEALTH MAIN-
 TENANCE  ORGANIZATION TO ASSESS THE PROVISION OF ITS COVERED SERVICES IN
 ACCORDANCE WITH THE PAUL WELLSTONE AND PETE DOMINICI MENTAL HEALTH PARI-
 TY AND ADDICTION EQUITY ACT OF 2008, 42 U.S.C. 18031(J) AND  ANY  AMEND-
 MENTS TO, AND FEDERAL GUIDANCE AND REGULATIONS ISSUED UNDER, THOSE ACTS.
   §  42. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
 4900  of the public health law, as added by chapter 41 of  the  laws  of
 2014,  is  amended  and  a  new  subparagraph  (iv)  is added to read as
 follows:
   (iii) for purposes of a determination involving substance use disorder
 treatment:

 S. 1507                            149                           A. 2007
 
   (A) a physician who  possesses  a  current  and  valid  non-restricted
 license  to  practice  medicine and who specializes in behavioral health
 and has experience in the delivery of substance use disorder courses  of
 treatment; or
   (B)  a  health  care  professional other than a licensed physician who
 specializes in behavioral health and has experience in the  delivery  of
 substance  use  disorder  courses  of  treatment  and, where applicable,
 possesses a current and valid  non-restricted  license,  certificate  or
 registration or, where no provision for a license, certificate or regis-
 tration  exists, is credentialed by the national accrediting body appro-
 priate to the profession; [and] OR
   (IV) FOR PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR A  MENTAL
 HEALTH CONDITION:
   (A)  A  PHYSICIAN  WHO  POSSESSES  A  CURRENT AND VALID NON-RESTRICTED
 LICENSE TO PRACTICE MEDICINE AND WHO SPECIALIZES  IN  BEHAVIORAL  HEALTH
 AND  HAS  EXPERIENCE  IN THE DELIVERY OF MENTAL HEALTH COURSES OF TREAT-
 MENT; OR
   (B) A HEALTH CARE PROFESSIONAL OTHER THAN  A  LICENSED  PHYSICIAN  WHO
 SPECIALIZES IN BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE DELIVERY OF A
 MENTAL  HEALTH  COURSES  OF TREATMENT AND, WHERE APPLICABLE, POSSESSES A
 CURRENT AND VALID NON-RESTRICTED LICENSE, CERTIFICATE,  OR  REGISTRATION
 OR,  WHERE  NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE OR REGISTRATION
 EXISTS, IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE  TO
 THE PROFESSION; AND
   §  43.  Paragraph  (i)  of subdivision 1 of section 4902 of the public
 health law, as amended by section 2 of part A of chapter 69 of the  laws
 of 2016, is amended and a new paragraph (j) is added to read as follows:
   (i)  When  conducting  utilization  review for purposes of determining
 health care coverage for substance use disorder treatment, a utilization
 review agent shall utilize AN evidence-based and peer reviewed  clinical
 review [tools designated by the office of alcoholism and substance abuse
 services  that  are appropriate to the age of the patient and consistent
 with the treatment service levels within the office  of  alcoholism  and
 substance  abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE OF
 THE PATIENT. WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW  FOR  TREATMENT
 PROVIDED  IN  THIS  STATE,  A  UTILIZATION REVIEW AGENT SHALL UTILIZE AN
 EVIDENCE-BASED AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE  OFFICE
 OF  ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT WITH THE
 TREATMENT SERVICE LEVELS WITHIN THE OFFICE OF ALCOHOLISM  AND  SUBSTANCE
 ABUSE  SERVICES  SYSTEM. All approved tools shall have inter rater reli-
 ability  testing  completed  by  December  thirty-first,  two   thousand
 sixteen.
   (J)  WHEN  CONDUCTING  UTILIZATION  REVIEW FOR PURPOSES OF DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT SHALL UTILIZE EVIDENCE-BASED AND  PEER  REVIEWED  CLINICAL  REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW  AGENT  SHALL USE CLINICAL REVIEW CRITERIA DEEMED APPROPRIATE AND
 APPROVED FOR SUCH USE BY  THE  COMMISSIONER  OF  THE  OFFICE  OF  MENTAL
 HEALTH,  IN CONSULTATION WITH THE COMMISSIONER AND THE SUPERINTENDENT OF
 FINANCIAL SERVICES.  APPROVED CLINICAL REVIEW CRITERIA SHALL HAVE  INTER
 RATER  RELIABILITY TESTING COMPLETED BY DECEMBER THIRTY-FIRST, TWO THOU-
 SAND NINETEEN.
   § 44. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date; provided, however, notwithstanding any provision  of

 S. 1507                            150                           A. 2007
 
 law to the contrary, nothing in this act shall limit the rights accruing
 to  employees  pursuant  to  a  collective bargaining agreement with any
 state or local government employer for the unexpired term of such agree-
 ment where such agreement is in effect on the effective date of this act
 and so long as such agreement remains in effect thereafter or the eligi-
 bility of any member of an employee organization to join a health insur-
 ance  plan open to him or her pursuant to such a collectively negotiated
 agreement.
 
                                 SUBPART B
 
   Section 1. Subdivision 1 of section 2803-u of the public  health  law,
 as  added  by  section 1 of part C of chapter 70 of the laws of 2016, is
 amended to read as follows:
   1. The office of alcoholism and substance abuse services, in consulta-
 tion with the department, shall develop or utilize existing  educational
 materials to be provided to general hospitals to disseminate to individ-
 uals  with  a documented substance use disorder or who appear to have or
 be at risk for a substance use disorder during discharge planning pursu-
 ant to section twenty-eight hundred three-i of this  [chapter]  ARTICLE.
 Such  materials shall include information regarding the various types of
 treatment and recovery services, including but not limited  to:    inpa-
 tient,  outpatient,  and medication-assisted treatment; how to recognize
 the need for treatment services; information for individuals  to  deter-
 mine  what  type  and  level  of  treatment is most appropriate and what
 resources are available to them; and any other information  the  commis-
 sioner deems appropriate. GENERAL HOSPITALS SHALL INCLUDE IN THEIR POLI-
 CIES  AND PROCEDURES TREATMENT PROTOCOLS, CONSISTENT WITH MEDICAL STAND-
 ARDS, TO BE UTILIZED BY THE EMERGENCY DEPARTMENTS IN  GENERAL  HOSPITALS
 FOR  THE  APPROPRIATE  USE  OF  MEDICATION-ASSISTED TREATMENT, INCLUDING
 BUPRENORPHINE, PRIOR TO DISCHARGE, OR REFERRAL PROTOCOLS FOR  EVALUATION
 OF MEDICATION-ASSISTED TREATMENT WHEN INITIATION IN AN EMERGENCY DEPART-
 MENT OF A GENERAL HOSPITAL IS NOT FEASIBLE.
   § 2. This act shall take effect immediately.
 
                                 SUBPART C
 
   Section  1.  Subparagraph  (v)  of  paragraph  (a) of subdivision 2 of
 section 3343-a of the public health law is  REPEALED  and  subparagraphs
 (vi),  (vii),  (viii),  (ix)  and  (x) are renumbered subparagraphs (v),
 (vi), (vii), (viii) and (ix).
   § 2. This act shall take effect immediately.
 
                                 SUBPART D

   Section 1. Paragraph (r) of subdivision 4  of  section  364-j  of  the
 social services law, as amended by section 39 of part A of chapter 56 of
 the laws of 2013, is amended to read as follows:
   (r)  A  managed  care  provider shall provide services to participants
 pursuant to an order of a  court  of  competent  jurisdiction,  provided
 however,  that  such  services shall be within such provider's or plan's
 benefit package and are reimbursable under  title  xix  of  the  federal
 social security act, PROVIDED THAT SERVICES FOR A SUBSTANCE USE DISORDER
 SHALL  BE PROVIDED BY A PROGRAM LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.

 S. 1507                            151                           A. 2007

   § 2. This act shall take effect immediately;  provided,  however  that
 the amendments to paragraph (r) of subdivision 4 of section 364-j of the
 social services law made by section one of this act shall not affect the
 repeal of such section and shall be deemed to be repealed therewith.
 
                                 SUBPART E
 
   Section 1. Subdivision (b) of schedule I of section 3306 of the public
 health  law is amended by adding nineteen new paragraphs 58, 59, 60, 61,
 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 and 76 to read as
 follows:
   (58) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLBUTYRAMIDE.    OTHER  NAME:
 BUTYRYL FENTANYL.
   (59) N-[1-[2-hydroxy-2-(thiophen-2-yl)ethyl]PIPERIDIN-4-Y1]-N-PHENYLPRO-
 PIONAMIDE.  OTHER NAME: BETA-HYDROXYTHIOFENTANYL.
   (60) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLFURAN-2-CARBOXAMIDE.  OTHER
 NAME: FURANYL FENTANYL.
   (61) 3,4-DICHLORO-N-[2-(dimethylamino)cyclohexyl]-N-METHYLBENZAMIDE.
 OTHER NAME: U-47700.
   (62) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACRYLAMIDE.  OTHER   NAMES:
 ACRYL FENTANYL OR ACRYLOYLFENTANYL.
   (63) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER  NAMES:  4-FLUOROISOBUTYRYL FENTANYL, PARA-FLUOROISOBUTYRYL FENTA-
 NYL.
   (64) N-(2-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)PROPIONAMIDE.
 OTHER NAMES: ORTHO-FLUOROFENTANYL OR 2-FLUOROFENTANYL.
   (65) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLTETRAHYDROFURAN-2-CARBOXAMIDE.
 OTHER NAME: TETRAHYDROFURANYL FENTANYL.
   (66) 2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACETAMIDE.  OTHER
 NAME: METHOXYACETYL FENTANYL.
   (67) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPROPANECARBOXAMIDE.
 OTHER NAME: CYCLOPROPYL FENTANYL.
   (68) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLPENTANAMIDE.   OTHER  NAME:
 VALERYL FENTANYL.
   (69) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE. OTHER
 NAME: PARA-FLUOROBUTYRYLFENTANYL.
   (70) N-(4-METHOXYPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE.
 OTHER NAME: PARA-METHOXYBUTYRYL FENTANYL.
   (71) N-(4-CHLOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER NAME: PARA-CHLOROISOBUTYRYL FENTANYL.
   (72) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLISOBUTYRAMIDE. OTHER  NAME:
 ISOBUTYRYL FENTANYL.
   (73) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPENTANECARBOXAMIDE.
 OTHER NAME: CYCLOPENTYL FENTANYL.
   (74) N-(2-FLUOROPHENY1)-2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-YL)
 ACETAMIDE. OTHER NAME: OCFENTANIL.
   (75) 1-CYCLOHEXY1-4-(1,2-DIPHENYLETHYL)PIPERAZINE. OTHER NAME: MT-45.
   (76) FENTANYL-RELATED SUBSTANCES, THEIR ISOMERS, ESTERS, ETHERS, SALTS
 AND SALTS OF ISOMERS, ESTERS AND ETHERS.
   (I) FENTANYL-RELATED SUBSTANCE MEANS ANY SUBSTANCE NOT OTHERWISE LIST-
 ED  IN  THIS SECTION, THAT IS STRUCTURALLY RELATED TO FENTANYL BY ONE OR
 MORE OF THE FOLLOWING MODIFICATIONS:
   (A) REPLACEMENT OF THE PHENYL PORTION OF THE PHENETHYL  GROUP  BY  ANY
 MONOCYCLE, WHETHER OR NOT FURTHER SUBSTITUTED IN OR ON THE MONOCYCLE;
   (B) SUBSTITUTION  IN  OR  ON  THE PHENETHYL GROUP WITH ALKYL, ALKENYL,
 ALKOXYL, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;

 S. 1507                            152                           A. 2007
 
   (C) SUBSTITUTION IN OR ON THE PIPERIDINE  RING  WITH  ALKYL,  ALKENYL,
 ALKOXYL, ESTER, ETHER, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;
   (D) REPLACEMENT OF THE ANILINE RING WITH ANY AROMATIC MONOCYCLE WHETH-
 ER OR NOT FURTHER SUBSTITUTED IN OR ON THE AROMATIC MONOCYCLE; AND/OR
   (E) REPLACEMENT OF THE N-PROPIONYL GROUP BY ANOTHER ACYL GROUP.
   §  2. Section 3308 of the public health law is amended by adding a new
 subdivision 7 to read as follows:
   7. THE COMMISSIONER MAY, BY  REGULATION,  CLASSIFY  AS  A  SCHEDULE  I
 CONTROLLED SUBSTANCE IN SECTION THREE THOUSAND THREE HUNDRED SIX OF THIS
 ARTICLE  ANY  SUBSTANCE LISTED IN SCHEDULE I OF THE FEDERAL SCHEDULES OF
 CONTROLLED SUBSTANCES IN 21 USC §812 OR 21 CFR §1308.11.
   § 3. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment  shall  have been rendered. It has hereby declared to be the intent
 of the legislature that this act would have been enacted  even  if  such
 invalid provisions had not been included herein.
   §  3.  This  act shall take effect immediately provided, however, that
 the applicable effective date of Subparts A through E of this act  shall
 be as specifically set forth in the last section of such Subparts.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 3. This act shall take effect immediately  provided,  however,  that
 the applicable effective date of Parts A through BB of this act shall be
 as specifically set forth in the last section of such Parts.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
     S. 1507--A                                            A. 2007--A
 
                       S E N A T E - A S S E M B L Y
 
                             January 18, 2019
                                ___________
 
 IN  SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
   cle seven of the Constitution -- read twice and ordered  printed,  and
   when  printed to be committed to the Committee on Finance -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 IN ASSEMBLY -- A BUDGET BILL, submitted  by  the  Governor  pursuant  to
   article  seven  of  the  Constitution -- read once and referred to the
   Committee on Ways and Means --  committee  discharged,  bill  amended,
   ordered reprinted as amended and recommitted to said committee
 
 AN ACT to amend the social services law, in relation to reimbursement of
   transportation   costs,   reimbursement  of  emergency  transportation
   services and  supplemental  transportation  payments;  and  to  repeal
   certain provisions of such law relating thereto (Part A); to amend the
   social services law and the public health law, in relation to updating
   copayments;  to  amend the public health law, in relation to extending
   and enhancing the Medicaid drug cap and to reduce unnecessary pharmacy
   benefit manager costs to the Medicaid program; and to  repeal  certain
   provisions  of  the  social services law relating thereto (Part B); to
   amend the social  services  law,  in  relation  to  extension  of  the
   National  Diabetes  Prevention Program and in relation to supplemental
   medicaid managed care payments (Part C); to amend chapter  59  of  the
   laws of 2011 amending the public health law and other laws relating to
   known  and projected department of health state fund medicaid expendi-
   tures, in relation to extending the medicaid global cap (Part  D);  to
   amend  chapter 505 of the laws of 1995, amending the public health law
   relating to the operation  of  department  of  health  facilities,  in
   relation  to  extending the provisions thereof; to amend chapter 56 of
   the laws of the laws of 2013, amending the social services law  relat-
   ing to eligibility conditions, in relation to extending the provisions
   thereof; to amend chapter 884 of the laws of 1990, amending the public
   health  law  relating  to authorizing bad debt and charity care allow-
   ances for certified home health agencies, in relation to extending the
   provisions thereof; to amend chapter 303 of the laws of 1999, amending
   the New York state medical care facilities finance agency act relating
   to financing health facilities, in relation to the effectiveness ther-
   eof; to amend chapter 109 of the laws of  2010,  amending  the  social
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD12571-02-9

 S. 1507--A                          2                         A. 2007--A
 
   services  law  relating  to  transportation  costs, in relation to the
   effectiveness thereof; to amend chapter 58 of the laws of 2009, amend-
   ing the public health law relating to payment by governmental agencies
   for general hospital inpatient services, in relation to the effective-
   ness  thereof;  to  amend chapter 56 of the laws of 2013, amending the
   public health law relating to the general public health work  program,
   in  relation  to the effectiveness thereof; to amend chapter 59 of the
   laws of 2011, amending the public health law and other  laws  relating
   to known and projected department of health state fund medical expend-
   itures,  in relation to extending the provisions thereof; to amend the
   public health law, in relation to hospital assessments; to amend chap-
   ter 474 of the laws of 1996, amending the education law and other laws
   relating to rates for residential health care facilities, in  relation
   to the effectiveness thereof; to amend chapter 58 of the laws of 2007,
   amending  the  social services law and other laws relating to enacting
   the major components of legislation necessary to implement the  health
   and  mental  hygiene  budget  for  the 2007-2008 state fiscal year, in
   relation to delay of certain administrative costs; to amend chapter 81
   of the laws of 1995, amending the public health  law  and  other  laws
   relating  to  medical reimbursement and welfare reform, in relation to
   the effectiveness thereof; to amend chapter 56 of the  laws  of  2013,
   amending chapter 59 of the laws of 2011 amending the public health law
   and  other  laws relating to general hospital reimbursement for annual
   rates, in relation to rates of payments; to amend  the  public  health
   law,  in  relation  to reimbursement rate promulgation for residential
   health care facilities; to amend the public health law, in relation to
   residential health care facility, and  certified  home  health  agency
   services  payments;  to amend chapter 81 of the laws of 1995, amending
   the public health law and other laws relating to medical reimbursement
   and welfare reform, in relation to the effectiveness thereof; to amend
   chapter 56 of the laws of 2013 amending chapter 59 of the laws of 2011
   amending the public health law and  other  laws  relating  to  general
   hospital  reimbursement  for  annual  rates,  in relation to extending
   government rates for behavioral services  and  adding  an  alternative
   payment  methodology  requirement; to amend chapter 111 of the laws of
   2010 relating to increasing Medicaid  payments  to  providers  through
   managed  care  organizations  and providing equivalent fees through an
   ambulatory patient group methodology, in relation to extending govern-
   ment rates for behavioral services and adding an  alternative  payment
   methodology  requirement;  to amend section 2 of part H of chapter 111
   of the laws of 2010,  relating  to  increasing  Medicaid  payments  to
   providers  through managed care organizations and providing equivalent
   fees through an ambulatory patient group methodology, in  relation  to
   transfer  of funds and the effectiveness thereof; and to amend chapter
   649 of the laws of 1996, amending the public health  law,  the  mental
   hygiene  law  and  the social services law relating to authorizing the
   establishment of special needs plans, in relation to the effectiveness
   thereof (Part E); to amend chapter 266 of the laws of  1986,  amending
   the  civil  practice law and rules and other laws relating to malprac-
   tice and professional medical conduct,  in  relation  to  apportioning
   premium  for  certain  policies;  to amend part J of chapter 63 of the
   laws of 2001 amending chapter 266 of the laws of  1986,  amending  the
   civil  practice  law  and rules and other laws relating to malpractice
   and professional medical conduct, relating  to  the  effectiveness  of
   certain  provisions  of such chapter, in relation to extending certain
   provisions concerning the hospital excess liability pool; and to amend

 S. 1507--A                          3                         A. 2007--A
 
   part H of chapter 57 of the laws of 2017, amending the New York Health
   Care Reform Act of 1996 and other laws relating to  extending  certain
   provisions  relating  thereto,  in  relation  to  extending provisions
   relating  to  excess  coverage  (Part F); to amend the social services
   law, in relation to eliminating the  ability  of  legally  responsible
   spouses  to refuse to support non-institutionalized spouses; to create
   a state fiscal intermediary for the consumer directed personal assist-
   ance program; and to repeal certain provisions of  such  law  relating
   thereto (Part G); to amend the public health law, in relation to waiv-
   er  of certain regulations; to amend the public health law in relation
   to certain rates and payment  methodologies;  and  to  repeal  certain
   provisions  of such law relating thereto (Part H); to amend the insur-
   ance law, in relation to registration and licensing of pharmacy  bene-
   fit  managers  (Part  I);  to  amend  the insurance law and the public
   health law,  in  relation  to  guaranteed  availability,  pre-existing
   conditions   and   employee  welfare  funds;  and  to  repeal  certain
   provisions of the insurance law relating thereto (Subpart A); to amend
   the insurance law, in relation to  actuarial  value  requirements  and
   essential  health benefits (Subpart B); to amend the insurance law, in
   relation to coverage for medically necessary abortions, and exceptions
   thereto (Subpart C); to  amend  the  insurance  law,  in  relation  to
   prescription drug coverage (Subpart D); to amend the insurance law, in
   relation  to  discrimination based on sex and gender identity (Subpart
   E); and to amend the insurance law, in relation to  insurance  certif-
   icate  delivery  (Subpart F) (Part J); to amend the public health law,
   in relation to the medical indemnity fund; and to amend chapter 517 of
   the laws of 2016 amending the public health law relating  to  payments
   from  the  New  York  state medical indemnity fund, in relation to the
   effectiveness thereof  (Part  K);  to  amend  the  insurance  law,  in
   relation  to  in-vitro  fertilization (Part L); to amend the insurance
   law and the social services  law,  in  relation  to  requiring  health
   insurance  policies to include coverage of all FDA-approved contracep-
   tive drugs, devices, and products, as well as voluntary  sterilization
   procedures, contraceptive education and counseling, and related follow
   up  services  and  prohibiting a health insurance policy from imposing
   any cost-sharing requirements or other  restrictions  or  delays  with
   respect  to  this  coverage  (Part M); to establish a universal access
   commission to consider the options for achieving universal  access  to
   health  care  (Part N); to amend the public health law, in relation to
   the general public health work program (Part O); to amend  the  public
   health  law,  in relation to lead levels in residential rental proper-
   ties (Part P); to amend the public health  law,  in  relation  to  the
   healthcare facility transformation program state III authorizing addi-
   tional  awards  for  statewide  II applications (Part Q); to amend the
   public health law, in relation to maternal mortality review boards and
   the maternal mortality and morbidity advisory  council  (Part  R);  to
   amend  the public health law, in relation to enacting the reproductive
   health act and revising existing provisions of law regarding abortion;
   to amend the penal law, the criminal procedure law, the county law and
   the  judiciary  law,  in  relation  to  abortion;  to  repeal  certain
   provisions  of  the  public health law relating to abortion; to repeal
   certain provisions of the  education  law  relating  to  the  sale  of
   contraceptives;  and  to  repeal  certain  provisions of the penal law
   relating to abortion (Part S); to amend  the  public  health  law,  in
   relation to codifying the creation of NY State of Health, the official
   Health  Plan  Marketplace within the department of health (Part T); to

 S. 1507--A                          4                         A. 2007--A
 
   amend the elder law, in relation to the private pay program (Part  U);
   to amend the social services law, in relation to compliance of managed
   care organizations and providers participating in the Medicaid program
   (Part  V); to amend part D of chapter 111 of the laws of 2010 relating
   to the recovery of exempt income by the office of  mental  health  for
   community  residences and family-based treatment programs, in relation
   to the effectiveness thereof (Part W); to amend the criminal procedure
   law, in relation to  authorizing  restorations  to  competency  within
   correctional  facility  based  residential settings; and providing for
   the repeal of such provisions upon expiration  thereof  (Part  X);  to
   amend part C of chapter 57 of the laws of 2006, relating to establish-
   ing  a  cost  of  living  adjustment  for  designated  human  services
   programs, in relation to the inclusion and development of certain cost
   of living adjustments (Part Y); to amend the public health law and the
   mental hygiene law, in relation to integrated services  (Part  Z);  to
   amend  the  social  services  law,  in relation to the definition of a
   facility or a provider agency (Part AA); to amend the  insurance  law,
   in  relation to mental health and substance use disorder health insur-
   ance parity; to amend the public health law,  in  relation  to  health
   maintenance  organizations;  and  to  repeal certain provisions of the
   insurance law relating thereto (Subpart A); to amend the public health
   law, in relation to general hospital policies for substance use disor-
   der treatment (Subpart B); to repeal subparagraph (v) of paragraph (a)
   of subdivision 2 of section 3343-a of the public health  law  relating
   to general hospital prescription drug monitoring (Subpart C); to amend
   the  social  services  law, in relation to court ordered substance use
   disorder treatment (Subpart D); and to amend the public health law, in
   relation  to  including  fentanyl  analogs  as  controlled  substances
   (Subpart  E)(Part  BB); to amend the public health law, in relation to
   prescriber assistance in allowing unlicensed certified pharmacy  tech-
   nicians to assist in dispensing of drugs (Part CC); and to authorize a
   uniform  across  the board reduction to the Department of Health Medi-
   caid claims (Part DD)
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  This  act enacts into law major components of legislation
 which are necessary to implement the state fiscal plan for the 2019-2020
 state fiscal year. Each component is  wholly  contained  within  a  Part
 identified as Parts A through DD. The effective date for each particular
 provision contained within such Part is set forth in the last section of
 such Part. Any provision in any section contained within a Part, includ-
 ing the effective date of the Part, which makes a reference to a section
 "of  this  act", when used in connection with that particular component,
 shall be deemed to mean and refer to the corresponding  section  of  the
 Part  in  which  it  is  found. Section three of this act sets forth the
 general effective date of this act.
 
                                  PART A
 
   Section 1. Subdivision 4 of section 365-h of the social services  law,
 as  separately  amended by section 50 of part B and section 24 of part D
 of chapter 57 of the laws of 2015, is amended to read as follows:

 S. 1507--A                          5                         A. 2007--A
 
   4. The commissioner of health is authorized to  assume  responsibility
 from  a  local social services official for the provision and reimburse-
 ment of transportation costs under this  section.  If  the  commissioner
 elects  to assume such responsibility, the commissioner shall notify the
 local  social  services official in writing as to the election, the date
 upon which the election shall be effective and such  information  as  to
 transition  of  responsibilities  as the commissioner deems prudent. The
 commissioner is authorized to contract with a transportation manager  or
 managers  to manage transportation services in any local social services
 district, other than transportation services provided  or  arranged  for
 enrollees  of  [managed  long  term  care  plans  issued certificates of
 authority under section forty-four hundred three-f of the public  health
 law]  A  PROGRAM  DESIGNATED  AS A PROGRAM OF ALL-INCLUSIVE CARE FOR THE
 ELDERLY (PACE) AS AUTHORIZED BY FEDERAL PUBLIC LAW 105-33, SUBTITLE I OF
 TITLE IV OF THE BALANCED BUDGET ACT OF 1997.  Any transportation manager
 or managers  selected  by  the  commissioner  to  manage  transportation
 services  shall  have  proven  experience in coordinating transportation
 services in a geographic and demographic area similar to the area in New
 York state within which the contractor would  manage  the  provision  of
 services  under  this  section. Such a contract or contracts may include
 responsibility for: review, approval and  processing  of  transportation
 orders;  management  of the appropriate level of transportation based on
 documented patient medical need; and  development  of  new  technologies
 leading to efficient transportation services. If the commissioner elects
 to assume such responsibility from a local social services district, the
 commissioner  shall examine and, if appropriate, adopt quality assurance
 measures that may include, but are not limited  to,  global  positioning
 tracking  system  reporting  requirements and service verification mech-
 anisms. Any and all  reimbursement  rates  developed  by  transportation
 managers  under  this  subdivision  shall  be  subject to the review and
 approval of the commissioner.
   § 2. The opening paragraph of  subdivision  1  and  subdivision  3  of
 section  367-s  of  the social services law, as amended by section 53 of
 part B of chapter 57 of the  laws  of  2015,  are  amended  to  read  as
 follows:
   Notwithstanding  any  provision of law to the contrary, a supplemental
 medical assistance payment shall be made on an annual basis to providers
 of emergency medical transportation services in an aggregate amount  not
 to exceed four million dollars for two thousand six, six million dollars
 for  two thousand seven, six million dollars for two thousand eight, six
 million dollars for the period May first, two thousand fourteen  through
 March thirty-first, two thousand fifteen, and six million dollars [annu-
 ally  beginning with] ON AN ANNUAL BASIS FOR the period April first, two
 thousand fifteen through  March  thirty-first,  two  thousand  [sixteen]
 NINETEEN pursuant to the following methodology:
   3. If all necessary approvals under federal law and regulation are not
 obtained  to  receive  federal  financial  participation in the payments
 authorized by this section, payments under this section shall be made in
 an aggregate amount not to exceed two million dollars for  two  thousand
 six, three million dollars for two thousand seven, three million dollars
 for  two thousand eight, three million dollars for the period May first,
 two thousand fourteen through March thirty-first, two thousand  fifteen,
 and  three  million dollars [annually beginning with] ON AN ANNUAL BASIS
 FOR the period April first, two thousand fifteen through  March  thirty-
 first,  two  thousand [sixteen] NINETEEN.   In such case, the multiplier
 set forth in paragraph (b) of subdivision one of this section  shall  be

 S. 1507--A                          6                         A. 2007--A
 
 deemed  to be two million dollars or three million dollars as applicable
 to the annual period.
   §  3.  Subdivision  5  of  section 365-h of the social services law is
 REPEALED.
   § 4. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that section one of this act shall take effect October 1, 2019;
 provided,  further that the amendments to subdivision 4 of section 365-h
 of the social services law made by section one of  this  act  shall  not
 affect  the  repeal  of  such  section  and  shall  expire and be deemed
 repealed therewith.
 
                                  PART B
 
   Section 1. Paragraph (a) of subdivision 4  of  section  365-a  of  the
 social  services  law, as amended by chapter 493 of the laws of 2010, is
 amended to read as follows:
   (a) drugs which may be dispensed without a prescription as required by
 section sixty-eight hundred ten of the education law; provided, however,
 that the state commissioner of health may by regulation specify  certain
 of  such  drugs which may be reimbursed as an item of medical assistance
 in accordance with the price schedule established by such  commissioner.
 Notwithstanding any other provision of law, [additions] MODIFICATIONS to
 the  list  of  drugs  reimbursable  under this paragraph may be filed as
 regulations by the commissioner  of  health  without  prior  notice  and
 comment;
   §  2.  Paragraph  (c)  of subdivision 6 of section 367-a of the social
 services law is amended by adding a new  subparagraph  (v)  to  read  as
 follows:
   (V) NOTWITHSTANDING ANY OTHER PROVISION OF THIS PARAGRAPH, CO-PAYMENTS
 CHARGED  FOR  DRUGS  DISPENSED  WITHOUT  A  PRESCRIPTION  AS REQUIRED BY
 SECTION SIXTY-EIGHT HUNDRED TEN OF THE EDUCATION LAW BUT WHICH ARE REIM-
 BURSED AS AN ITEM OF MEDICAL ASSISTANCE PURSUANT  TO  PARAGRAPH  (A)  OF
 SUBDIVISION  FOUR  OF  SECTION  THREE HUNDRED SIXTY-FIVE-A OF THIS TITLE
 SHALL BE ONE DOLLAR.
   § 3. Paragraph (b) of subdivision 3  of  section  273  of  the  public
 health  law,  as added by section 10 of part C of chapter 58 of the laws
 of 2005, is amended to read as follows:
   (b) In the event that the patient does not meet the criteria in  para-
 graph  (a)  of  this  subdivision, the prescriber may provide additional
 information to the program to justify the use  of  a  prescription  drug
 that  is  not  on  the  preferred drug list. The program shall provide a
 reasonable opportunity for a prescriber to reasonably present his or her
 justification of prior authorization. [If, after consultation  with  the
 program, the prescriber, in his or her reasonable professional judgment,
 determines  that  the  use  of  a  prescription  drug that is not on the
 preferred drug list is warranted, the prescriber's  determination  shall
 be  final.] THE PROGRAM WILL CONSIDER THE ADDITIONAL INFORMATION AND THE
 JUSTIFICATION PRESENTED TO DETERMINE WHETHER THE USE OF  A  PRESCRIPTION
 DRUG THAT IS NOT ON THE PREFERRED DRUG LIST IS WARRANTED.
   §  4. Subdivisions 25 and 25-a of section 364-j of the social services
 law are REPEALED.
   § 5. Paragraphs (b) and (c) of subdivision 2 of  section  280  of  the
 public  health  law, paragraph (b) as amended and paragraph (c) as added
 by section 8 of part D of chapter 57 of the laws of  2018,  are  amended
 and a new paragraph (d) is added to read as follows:

 S. 1507--A                          7                         A. 2007--A
 
   (b)  for  state  fiscal year two thousand eighteen--two thousand nine-
 teen, be limited to the ten-year rolling average of the  medical  compo-
 nent  of the consumer price index plus four percent and minus a pharmacy
 savings target of eighty-five million dollars; [and]
   (c)  for state fiscal year two thousand nineteen--two thousand twenty,
 be limited to the ten-year rolling average of the medical  component  of
 the  consumer price index plus four percent and minus a pharmacy savings
 target of eighty-five million dollars[.]; AND
   (D) FOR STATE FISCAL YEAR TWO THOUSAND  TWENTY--TWO  THOUSAND  TWENTY-
 ONE, BE LIMITED TO THE TEN-YEAR ROLLING AVERAGE OF THE MEDICAL COMPONENT
 OF  THE  CONSUMER  PRICE  INDEX  PLUS  FOUR PERCENT AND MINUS A PHARMACY
 SAVINGS TARGET OF EIGHTY-FIVE MILLION DOLLARS.
   § 6. Subdivision 3 of section 280 of the public health law, as amended
 by section 8 of part D of chapter 57 of the laws of 2018, is amended  to
 read as follows:
   3.  The  department  and  the division of the budget shall assess on a
 quarterly basis the projected total amount to be expended in the year on
 a cash basis by the Medicaid program for each drug,  and  the  projected
 annual  amount of state funds Medicaid drug expenditures on a cash basis
 for all drugs, which shall be a component of the projected department of
 health state funds Medicaid  expenditures  calculated  for  purposes  of
 sections  ninety-one  and  ninety-two of part H of chapter fifty-nine of
 the laws of two thousand eleven. For purposes  of  this  section,  state
 funds  Medicaid  drug expenditures include amounts expended for drugs in
 both the Medicaid fee-for-service  program  and  Medicaid  managed  care
 programs,  minus  the  amount  of  any drug rebates or supplemental drug
 rebates received by the department, including rebates pursuant to subdi-
 vision five of this section with respect to rebate targets. [The depart-
 ment and the division of the budget shall report quarterly to  the  drug
 utilization review board the projected state funds Medicaid drug expend-
 itures  including the amounts, in aggregate thereof, attributable to the
 net cost of: changes in the utilization of drugs by Medicaid recipients;
 changes in the number of Medicaid recipients; changes  to  the  cost  of
 brand  name drugs and changes to the cost of generic drugs. The informa-
 tion contained in the report shall not be publicly released in a  manner
 that allows for the identification of an individual drug or manufacturer
 or  that  is likely to compromise the financial competitive, or proprie-
 tary nature of the information.]
   (a) In the event the director of the budget determines, based on Medi-
 caid drug expenditures for the previous quarter or other relevant infor-
 mation, that the total department of health state  funds  Medicaid  drug
 expenditure  is projected to exceed the annual growth limitation imposed
 by subdivision two of this section, the commissioner  may  identify  and
 refer  drugs to the drug utilization review board established by section
 three hundred sixty-nine-bb of the social services law for a recommenda-
 tion as to whether a target supplemental Medicaid rebate should be  paid
 by  the manufacturer of the drug to the department and the target amount
 of the rebate.
   (b) If the department intends to refer a drug to the drug  utilization
 review  board pursuant to paragraph (a) of this subdivision, the depart-
 ment shall notify the manufacturer of such drug  and  shall  attempt  to
 reach  agreement with the manufacturer on a rebate for the drug prior to
 referring the drug to the drug  utilization  review  board  for  review.
 SUCH  REBATE MAY BE BASED ON EVIDENCE-BASED RESEARCH, INCLUDING, BUT NOT
 LIMITED TO, SUCH RESEARCH OPERATED OR CONDUCTED BY OR  FOR  OTHER  STATE

 S. 1507--A                          8                         A. 2007--A

 GOVERNMENTS,  THE  FEDERAL GOVERNMENT, THE GOVERNMENTS OF OTHER NATIONS,
 AND THIRD PARTY PAYERS OR MULTI-STATE COALITIONS.
   (c)  [In  the  event  that  the commissioner and the manufacturer have
 previously agreed to a supplemental rebate for a drug pursuant to  para-
 graph  (b)  of this subdivision or paragraph (e) of subdivision seven of
 section three hundred sixty-seven-a of the social services law, the drug
 shall not be referred to the  drug  utilization  review  board  for  any
 further  supplemental  rebate  for  the  duration of the previous rebate
 agreement.
   (d)] The department shall consider a drug's actual cost to the  state,
 including  current rebate amounts, prior to seeking an additional rebate
 pursuant to paragraph (b) [or (c)] of this subdivision [and  shall  take
 into  consideration  whether  the  manufacturer of the drug is providing
 significant discounts relative to other drugs covered  by  the  Medicaid
 program].
   [(e)]  (D)  The  commissioner  shall be authorized to take the actions
 described in this section only so long as total Medicaid  drug  expendi-
 tures  are  projected  to exceed the annual growth limitation imposed by
 subdivision two of this section.
   § 7. Paragraph (a) of subdivision 5  of  section  280  of  the  public
 health  law, as amended by section 8 of part D of chapter 57 of the laws
 of 2018, is amended to read as follows:
   (a) If the drug utilization review board recommends  a  target  rebate
 amount  on  a drug referred by the commissioner, the [commissioner shall
 require] DEPARTMENT SHALL NEGOTIATE WITH THE DRUG'S MANUFACTURER  FOR  a
 supplemental rebate to be paid by the [drug's] manufacturer in an amount
 not  to  exceed  such target rebate amount. [With respect to a] A rebate
 [required in state fiscal  year  two  thousand  seventeen--two  thousand
 eighteen,  the rebate] requirement shall apply beginning with the [month
 of April, two thousand seventeen,] FIRST DAY OF THE  STATE  FISCAL  YEAR
 DURING  WHICH  THE  REBATE  WAS  REQUIRED without regard to the date the
 department enters into the rebate agreement with the manufacturer.
   § 8. Paragraph (a) of subdivision 7  of  section  280  of  the  public
 health  law, as amended by section 8 of part D of chapter 57 of the laws
 of 2018, is amended to read as follows:
   (a) If, after taking into account all rebates and supplemental rebates
 received by the department, including rebates received to date  pursuant
 to this section, total Medicaid drug expenditures are still projected to
 exceed  the  annual growth limitation imposed by subdivision two of this
 section, the commissioner  may:  subject  any  drug  of  a  manufacturer
 referred  to  the  drug  utilization  review board under this section to
 prior approval in accordance with existing processes and procedures when
 such manufacturer has not entered into a supplemental  rebate  agreement
 as  required  by  this section; [directing] DIRECT managed care plans to
 remove from their Medicaid formularies those drugs that the drug  utili-
 zation  review  board  recommends  a  target  rebate  amount for and the
 manufacturer has failed to enter into a  rebate  agreement  required  by
 this  section;  [promoting]  PROMOTE the use of cost effective and clin-
 ically appropriate drugs other than those of a manufacturer  who  has  a
 drug  that  the drug utilization review board recommends a target rebate
 amount and the manufacturer has failed to enter into a rebate  agreement
 required  by  this section; [allowing] ALLOW manufacturers to accelerate
 rebate payments under existing rebate contracts; and such other  actions
 as  authorized by law.  The commissioner shall provide written notice to
 the legislature thirty days prior to  taking  action  pursuant  to  this
 paragraph,  unless action is necessary in the fourth quarter of a fiscal

 S. 1507--A                          9                         A. 2007--A
 
 year to prevent total Medicaid  drug  expenditures  from  exceeding  the
 limitation  imposed  by  subdivision  two of this section, in which case
 such notice to the legislature may be less than thirty days.
   §  9.  Subdivision 8 of section 280 of the public health law, as added
 by section 8 of part D of chapter 57 of the laws of 2018, is amended  to
 read as follows:
   8.  The commissioner shall report by [February] JULY first annually to
 the drug utilization review board on savings achieved through  the  drug
 cap  in  the  last  FISCAL  year. Such report shall provide data on what
 savings were achieved through actions pursuant  to  subdivisions  three,
 five  and  seven  of  this  section, respectively, and what savings were
 achieved through other means and how such savings  were  calculated  and
 implemented.
   §  10.  Section 4406-c of the public health law is amended by adding a
 new subdivision 10 to read as follows:
   10. (A) ANY CONTRACT OR OTHER ARRANGEMENT ENTERED  INTO  BY  A  HEALTH
 CARE PLAN FOR PHARMACY BENEFIT MANAGEMENT SERVICES ON BEHALF OF INDIVID-
 UALS  ENROLLED  IN  A  MANAGED CARE PROVIDER AS DEFINED IN SECTION THREE
 HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW SHALL INCLUDE PROVISIONS
 THAT ENSURE THE FOLLOWING:
   (I) PAYMENT TO THE  PHARMACY  BENEFIT  MANAGER  FOR  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  IS  LIMITED  TO  THE  ACTUAL  INGREDIENT  COSTS, A
 DISPENSING FEE, AND AN ADMINISTRATIVE FEE FOR EACH CLAIM PROCESSED.  THE
 DEPARTMENT OF HEALTH MAY ESTABLISH A MAXIMUM ADMINISTRATIVE FEE;
   (II)  THE  PHARMACY  BENEFIT  MANAGER IDENTIFIES ALL SOURCES OF INCOME
 RELATED TO THE PROVISION OF  PHARMACY  BENEFIT  MANAGEMENT  SERVICES  ON
 BEHALF  OF  THE  HEALTH  CARE  PLAN,  INCLUDING, BUT NOT LIMITED TO, ANY
 DISCOUNTS OR SUPPLEMENTAL REBATES, AND THAT ANY PORTION OF  SUCH  INCOME
 IS  PASSED THROUGH TO THE HEALTH CARE PLAN IN FULL TO REDUCE THE REPORT-
 ABLE INGREDIENT COST; AND
   (III) THE PHARMACY BENEFIT MANAGER SHALL NOT  RETAIN  ANY  PORTION  OF
 SPREAD  PRICING. FOR PURPOSES OF THIS SUBDIVISION "SPREAD PRICING" MEANS
 ANY AMOUNT CHARGED OR CLAIMED BY THE PHARMACY BENEFIT MANAGER IN  EXCESS
 OF  THE AMOUNT PAID TO PHARMACIES ON BEHALF OF THE HEALTH CARE PLAN LESS
 AN ADMINISTRATIVE FEE AS DESCRIBED IN THIS PARAGRAPH.  ANY  SUCH  EXCESS
 AMOUNT SHALL BE REMITTED TO THE HEALTH CARE PLAN ON A QUARTERLY BASIS.
   (B) THE COMMISSIONER MAY PROMULGATE REGULATIONS AS NECESSARY TO ESTAB-
 LISH ADDITIONAL STANDARDS FOR CONTRACTS OR OTHER ARRANGEMENTS RELATED TO
 THE SERVICES DESCRIBED IN THIS SUBDIVISION.
   § 11. Health care plans subject to subdivision 10 of section 4406-c of
 the  public  health  law,  as  added  by  section ten of this act, shall
 provide evidence of compliance with such section to  the  department  of
 health, and in a manner and form determined by the department of health,
 within  90  days and again within 180 days of the effective date of this
 act. The department of health shall  take  no  enforcement  action  with
 regards  to  the requirements of subdivision 10 of section 4406-c of the
 public health law, as added by section ten of this  act,  prior  to  the
 passage  of  180  days  from  the  effective date of this act, nor shall
 enforcement action be taken  related  to  any  non-compliance  occurring
 prior to the passage of the same 180 days.
   §  12.  This  act shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that sections one and two of this act shall take effect July 1,
 2019; and provided further, however, that the  amendments  to  paragraph
 (c) of subdivision 6 of section 367-a of the social services law made by

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 section  two  of  this act shall not affect the repeal of such paragraph
 and shall be deemed repealed therewith.
 
                                  PART C
 
   Section  1.  Subdivision 2 of section 365-a of the social services law
 is amended by adding a new paragraph (ff) to read as follows:
   (FF) EVIDENCE-BASED PREVENTION AND SUPPORT SERVICES RECOGNIZED BY  THE
 FEDERAL CENTERS FOR DISEASE CONTROL (CDC), PROVIDED BY A COMMUNITY-BASED
 ORGANIZATION,  AND DESIGNED TO PREVENT INDIVIDUALS AT RISK OF DEVELOPING
 DIABETES FROM DEVELOPING TYPE 2 DIABETES.
   § 2. Subparagraph (ii) of paragraph (d) of subdivision  1  of  section
 367-a  of the social services law, as amended by section 1 of part J1 of
 chapter 63 of the laws of 2003, is amended to read as follows:
   (ii) Amounts payable under this title for medical assistance for items
 and services provided to eligible persons  who  are  also  beneficiaries
 under part B of title XVIII of the federal social security act and items
 and  services  provided to qualified medicare beneficiaries under part B
 of title XVIII of the federal social security act  shall  not  [be  less
 than  the amount of any deductible liability of such eligible persons or
 for which such eligible persons or such qualified medicare beneficiaries
 would be liable under federal law were they  not  eligible  for  medical
 assistance  or  were  they  not  qualified  medicare  beneficiaries with
 respect to such benefits under such part B.]   EXCEED  THE  AMOUNT  THAT
 OTHERWISE  WOULD  BE  MADE  UNDER  THIS TITLE IF PROVIDED TO AN ELIGIBLE
 PERSON OTHER THAN A PERSON WHO IS ALSO A BENEFICIARY UNDER PART B OR  IS
 A QUALIFIED MEDICARE BENEFICIARY MINUS THE AMOUNT PAYABLE UNDER PART B.
   §  3.  Subparagraph (iii) of paragraph (d) of subdivision 1 of section
 367-a of the social services law, as amended by section 31 of part B  of
 chapter 57 of the laws of 2015, is amended to read as follows:
   (iii)  With respect to items and services provided to eligible persons
 who are also beneficiaries under part B of title XVIII  of  the  federal
 social  security  act and items and services provided to qualified medi-
 care beneficiaries under part B of title XVIII  of  the  federal  social
 security  act,  the amount payable for services covered under this title
 shall be the amount of  any  co-insurance  liability  of  such  eligible
 persons  pursuant  to  federal  law  were  they not eligible for medical
 assistance or  were  they  not  qualified  medicare  beneficiaries  with
 respect  to  such  benefits  under such part B, but shall not exceed the
 amount that otherwise would be made under this title if provided  to  an
 eligible person other than a person who is also a beneficiary under part
 B  or is a qualified medicare beneficiary minus the amount payable under
 part B; provided, however, amounts payable under this  title  for  items
 and  services  provided  to  eligible persons who are also beneficiaries
 under part B or to qualified medicare  beneficiaries  by  [an  ambulance
 service  under the authority of an operating certificate issued pursuant
 to article thirty of the public  health  law,  a  psychologist  licensed
 under article one hundred fifty-three of the education law, or] a facil-
 ity  under  the authority of an operating certificate issued pursuant to
 article sixteen, thirty-one or thirty-two of the mental hygiene law  and
 with  respect  to  outpatient  hospital  and  clinic  items and services
 provided by a facility under the authority of an  operating  certificate
 issued  pursuant to article twenty-eight of the public health law, shall
 not be less than the amount of any co-insurance liability of such eligi-
 ble persons or such qualified medicare beneficiaries, or for which  such
 eligible  persons  or  such  qualified  medicare  beneficiaries would be

 S. 1507--A                         11                         A. 2007--A
 
 liable under federal law were they not eligible for  medical  assistance
 or  were  they not qualified medicare beneficiaries with respect to such
 benefits under part B.
   § 4. This act shall take effect July 1, 2019.
 
                                  PART D

   Section  1. Subdivision 1 of section 92 of part H of chapter 59 of the
 laws of 2011, amending the public health law and other laws relating  to
 known  and  projected  department of health state fund medicaid expendi-
 tures, as amended by section 2 of part K of chapter 57 of  the  laws  of
 2018, is amended to read as follows:
   1.  For  state  fiscal  years 2011-12 through [2019-20] 2020-2021, the
 director of the budget, in consultation with the commissioner of  health
 referenced  as "commissioner" for purposes of this section, shall assess
 on a monthly basis, as reflected in monthly reports pursuant to subdivi-
 sion five of this section known and projected department of health state
 funds medicaid expenditures by category of  service  and  by  geographic
 regions,  as  defined  by  the  commissioner, and if the director of the
 budget determines that such expenditures are expected to cause  medicaid
 disbursements  for  such  period  to  exceed the projected department of
 health medicaid state funds disbursements in the enacted  budget  finan-
 cial  plan  pursuant to subdivision 3 of section 23 of the state finance
 law, the commissioner of health, in consultation with  the  director  of
 the  budget,  shall  develop a medicaid savings allocation plan to limit
 such spending to the aggregate limit  level  specified  in  the  enacted
 budget  financial  plan,  provided,  however,  such  projections  may be
 adjusted by the director of the budget to account for any changes in the
 New York state federal medical assistance percentage amount  established
 pursuant  to the federal social security act, changes in provider reven-
 ues, reductions to local social  services  district  medical  assistance
 administration,  minimum wage increases, and beginning April 1, 2012 the
 operational costs of the New York state medical indemnity fund and state
 costs or savings from the basic health plan.   Such projections  may  be
 adjusted by the director of the budget to account for increased or expe-
 dited department of health state funds medicaid expenditures as a result
 of  a natural or other type of disaster, including a governmental decla-
 ration of emergency.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART E
 
   Section  1. Section 4 of chapter 505 of the laws of 1995, amending the
 public health law relating to the  operation  of  department  of  health
 facilities, as amended by section 27 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   §  4.  This act shall take effect immediately; provided, however, that
 the provisions of paragraph (b) of subdivision 4 of section 409-c of the
 public health law, as added by section three of  this  act,  shall  take
 effect  January 1, 1996 and shall expire and be deemed repealed [twenty-
 four] TWENTY-NINE years from the effective date thereof.
   § 2. Subdivision p of section 76 of part D of chapter 56 of  the  laws
 of 2013, amending the social services law relating to eligibility condi-
 tions, is amended to read as follows:

 S. 1507--A                         12                         A. 2007--A
 
   p.  the  amendments [made] to subparagraph [(7)] 7 of paragraph (b) of
 subdivision 1 of section 366 of the social services law made by  section
 one  of  this  act shall expire and be deemed repealed October 1, [2019]
 2024.
   §  3.  Section  11  of  chapter  884 of the laws of 1990, amending the
 public health law relating to authorizing  bad  debt  and  charity  care
 allowances  for  certified home health agencies, as amended by section 1
 of part I of chapter 57 of the laws of  2017,  is  amended  to  read  as
 follows:
   § 11. This act shall take effect immediately and:
   (a) sections one and three shall expire on December 31, 1996,
   (b)  sections  four  through ten shall expire on June 30, [2019] 2024,
 and
   (c) provided that the amendment to section 2807-b of the public health
 law by section two of this act shall not affect the expiration  of  such
 section  2807-b  as  otherwise  provided  by  law and shall be deemed to
 expire therewith.
   § 4. Section 3 of chapter 303 of the laws of 1999,  amending  the  New
 York  state  medical  care  facilities  finance  agency  act relating to
 financing health facilities, as amended by section 16 of part D of chap-
 ter 57 of the laws of 2015, is amended to read as follows:
   § 3. This act shall take effect immediately, provided,  however,  that
 subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of
 1973,  as  added  by section one of this act, shall expire and be deemed
 repealed June 30, [2019] 2024; and provided further, however,  that  the
 expiration  and  repeal  of  such  subdivision  15-a shall not affect or
 impair in any manner any health facilities bonds issued, or any lease or
 purchase of a health facility executed,  pursuant  to  such  subdivision
 15-a  prior  to  its expiration and repeal and that, with respect to any
 such bonds issued and outstanding  as  of  June  30,  [2019]  2024,  the
 provisions of such subdivision 15-a as they existed immediately prior to
 such  expiration  and  repeal shall continue to apply through the latest
 maturity date of any such bonds, or their earlier retirement or  redemp-
 tion,  for  the  sole  purpose  of authorizing the issuance of refunding
 bonds to refund bonds previously issued pursuant thereto.
   § 5. Subdivision (a) of section 40 of part B of  chapter  109  of  the
 laws  of  2010, amending the social services law relating to transporta-
 tion costs, as amended by section 8 of part I of chapter 57 of the  laws
 of 2017, is amended to read as follows:
   (a)  sections  two, three, three-a, three-b, three-c, three-d, three-e
 and twenty-one of this act shall take  effect  July  1,  2010;  sections
 fifteen,  sixteen,  seventeen,  eighteen  and nineteen of this act shall
 take effect January 1, 2011; and provided further that section twenty of
 this act shall be deemed repealed [eight] THIRTEEN years after the  date
 the  contract  entered  into  pursuant  to  section  365-h of the social
 services law, as amended by section twenty of  this  act,  is  executed;
 provided  that  the  commissioner of health shall notify the legislative
 bill drafting commission upon the execution of the contract entered into
 pursuant to section 367-h of the social services law in order  that  the
 commission  may  maintain  an accurate and timely effective data base of
 the official text of the laws of the state of New York in furtherance of
 effectuating the provisions of section 44 of  the  legislative  law  and
 section 70-b of the public officers law;
   §  6.  Subdivision  (f)  of section 129 of part C of chapter 58 of the
 laws of 2009, amending the public health  law  relating  to  payment  by
 governmental  agencies  for  general  hospital  inpatient  services,  as

 S. 1507--A                         13                         A. 2007--A
 
 amended by section 4 of part D of chapter 59 of the  laws  of  2016,  is
 amended to read as follows:
   (f)  section  twenty-five  of  this  act  shall  expire  and be deemed
 repealed April 1, [2019] 2024;
   § 7. Subdivision (c) of section 122 of part E of  chapter  56  of  the
 laws  of  2013  amending  the  public health law relating to the general
 public health work program, as amended by section 5 of part D of chapter
 59 of the laws of 2016, is amended to read as follows:
   (c) section fifty of this act shall take effect immediately [and shall
 expire six years after it becomes law];
   § 8. Subdivision (i) of section 111 of part H of  chapter  59  of  the
 laws  of 2011, amending the public health law and other laws relating to
 known and projected department of health  state  fund  medical  expendi-
 tures,  as  amended by section 19 of part D of chapter 57 of the laws of
 2015, is amended to read as follows:
   (i) the amendments to paragraph (b) and subparagraph (i) of  paragraph
 (g)  of subdivision 7 of section 4403-f of the public health law made by
 section forty-one-b of this act shall expire and be  repealed  April  1,
 [2019] 2024;
   §  9.  Subparagraph  (vi) of paragraph (b) of subdivision 2 of section
 2807-d of the public health law, as amended by section 3 of  part  I  of
 chapter 57 of the laws of 2017, is amended to read as follows:
   (vi)  Notwithstanding  any contrary provision of this paragraph or any
 other provision of law or regulation to the  contrary,  for  residential
 health care facilities the assessment shall be six percent of each resi-
 dential  health care facility's gross receipts received from all patient
 care services and other operating income on a cash basis for the  period
 April  first,  two thousand two through March thirty-first, two thousand
 three for hospital  or  health-related  services,  including  adult  day
 services;  provided,  however,  that residential health care facilities'
 gross receipts attributable to payments received pursuant to title XVIII
 of the federal social security act (medicare) shall be excluded from the
 assessment; provided, however, that for all such gross receipts received
 on or after April first, two thousand three through March  thirty-first,
 two  thousand  five,  such assessment shall be five percent, and further
 provided that for all such gross receipts received  on  or  after  April
 first,  two thousand five through March thirty-first, two thousand nine,
 and on or after April first, two thousand  nine  through  March  thirty-
 first,  two  thousand  eleven  such assessment shall be six percent, and
 further provided that for all such gross receipts received on  or  after
 April  first,  two thousand eleven through March thirty-first, two thou-
 sand thirteen such assessment shall be six percent, and further provided
 that for all such gross receipts received on or after April  first,  two
 thousand  thirteen through March thirty-first, two thousand fifteen such
 assessment shall be six percent, and further provided that for all  such
 gross  receipts  received  on or after April first, two thousand fifteen
 through March thirty-first, two thousand seventeen such assessment shall
 be six percent, and further provided that for all  such  gross  receipts
 received  on  or after April first, two thousand seventeen through March
 thirty-first,  two  thousand  nineteen  such  assessment  shall  be  six
 percent,  AND FURTHER PROVIDED THAT FOR ALL SUCH GROSS RECEIPTS RECEIVED
 ON OR AFTER APRIL FIRST, TWO THOUSAND  NINETEEN  THROUGH  MARCH  THIRTY-
 FIRST, TWO THOUSAND TWENTY-FOUR SUCH ASSESSMENT SHALL BE SIX PERCENT.
   § 10. Subdivision 1 of section 194 of chapter 474 of the laws of 1996,
 amending the education law and other laws relating to rates for residen-

 S. 1507--A                         14                         A. 2007--A
 
 tial  health care facilities, as amended by section 4 of part I of chap-
 ter 57 of the laws of 2017, is amended to read as follows:
   1.  Notwithstanding  any  inconsistent provision of law or regulation,
 the trend factors used to project reimbursable operating  costs  to  the
 rate  period  for  purposes  of determining rates of payment pursuant to
 article 28 of the public health law for residential health care  facili-
 ties for reimbursement of inpatient services provided to patients eligi-
 ble  for payments made by state governmental agencies on and after April
 1, 1996 through March 31, 1999 and for payments made on and  after  July
 1,  1999  through  March 31, 2000 and on and after April 1, 2000 through
 March 31, 2003 and on and after April 1, 2003 through March 31, 2007 and
 on and after April 1, 2007 through March 31, 2009 and on and after April
 1, 2009 through March 31, 2011 and on and after April  1,  2011  through
 March  31,  2013  and on and after April 1, 2013 through March 31, 2015,
 and on and after April 1, 2015 through March 31, 2017, and on and  after
 April  1,  2017  through  March 31, 2019, AND ON AND AFTER APRIL 1, 2019
 THROUGH MARCH 31, 2024 shall reflect  no  trend  factor  projections  or
 adjustments for the period April 1, 1996, through March 31, 1997.
   §  11.  Subdivision  1  of section 89-a of part C of chapter 58 of the
 laws of 2007, amending the social services law and other  laws  relating
 to  enacting  the major components of legislation necessary to implement
 the health and mental hygiene budget  for  the  2007-2008  state  fiscal
 year,  as  amended  by  section 5 of part I of chapter 57 of the laws of
 2017, is amended to read as follows:
   1. Notwithstanding paragraph (c) of subdivision 10 of  section  2807-c
 of  the  public  health  law  and section 21 of chapter 1 of the laws of
 1999, as amended, and any other inconsistent provision of law  or  regu-
 lation  to  the  contrary,  in  determining  rates  of payments by state
 governmental agencies effective for services provided beginning April 1,
 2006, through March 31, 2009, and on and after  April  1,  2009  through
 March  31,  2011, and on and after April 1, 2011 through March 31, 2013,
 and on and after April 1, 2013 through March 31, 2015, and on and  after
 April  1,  2015  through  March 31, 2017, and on and after April 1, 2017
 through March 31, 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31,
 2024 for inpatient and outpatient services provided by general hospitals
 and for inpatient services and outpatient adult day health care services
 provided by residential health care facilities pursuant to article 28 of
 the public health law, the commissioner of health shall  apply  a  trend
 factor projection of two and twenty-five hundredths percent attributable
 to  the  period  January  1,  2006 through December 31, 2006, and on and
 after January 1, 2007, provided, however, that on reconciliation of such
 trend factor for the period January 1, 2006 through  December  31,  2006
 pursuant  to  paragraph  (c)  of subdivision 10 of section 2807-c of the
 public health law, such trend factor shall  be  the  final  US  Consumer
 Price  Index  (CPI)  for  all  urban  consumers,  as published by the US
 Department  of  Labor,  Bureau  of  Labor  Statistics  less  twenty-five
 hundredths of a percentage point.
   §  12.  Subdivision  5-a  of  section 246 of chapter 81 of the laws of
 1995, amending the public health law and other laws relating to  medical
 reimbursement  and  welfare reform, as amended by section 6 of part I of
 chapter 57 of the laws of 2017, is amended to read as follows:
   5-a. Section sixty-four-a of this act shall be deemed to have been  in
 full  force and effect on and after April 1, 1995 through March 31, 1999
 and on and after July 1, 1999 through March 31, 2000 and  on  and  after
 April  1,  2000  through  March  31, 2003 and on and after April 1, 2003
 through March 31, 2007, and on and after April 1, 2007 through March 31,

 S. 1507--A                         15                         A. 2007--A
 
 2009, and on and after April 1, 2009 through March 31, 2011, and on  and
 after  April  1,  2011 through March 31, 2013, and on and after April 1,
 2013 through March 31, 2015, and on and  after  April  1,  2015  through
 March  31,  2017  and on and after April 1, 2017 through March 31, 2019,
 AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024;
   § 13. Section 64-b of chapter 81 of the laws  of  1995,  amending  the
 public  health  law and other laws relating to medical reimbursement and
 welfare reform, as amended by section 7 of part I of chapter 57  of  the
 laws of 2017, is amended to read as follows:
   §  64-b.  Notwithstanding  any  inconsistent  provision  of  law,  the
 provisions of subdivision 7 of section 3614 of the public health law, as
 amended, shall remain and be in full force and effect on April  1,  1995
 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
 and after April 1, 2000 through March 31, 2003 and on and after April 1,
 2003  through  March  31,  2007,  and on and after April 1, 2007 through
 March 31, 2009, and on and after April 1, 2009 through March  31,  2011,
 and  on and after April 1, 2011 through March 31, 2013, and on and after
 April 1, 2013 through March 31, 2015, and on and  after  April  1,  2015
 through  March 31, 2017 and on and after April 1, 2017 through March 31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024.
   § 14. Section 4-a of part A of chapter 56 of the laws of 2013,  amend-
 ing  chapter  59  of the laws of 2011 amending the public health law and
 other laws relating to general hospital reimbursement for annual  rates,
 as  amended by section 5 of part T of chapter 57 of the laws of 2018, is
 amended to read as follows:
   § 4-a. Notwithstanding paragraph (c)  of  subdivision  10  of  section
 2807-c  of the public health law, section 21 of chapter 1 of the laws of
 1999, or any other contrary provision of law, in  determining  rates  of
 payments  by state governmental agencies effective for services provided
 on and after January 1, 2017 through March 31, [2019]  2024,  for  inpa-
 tient  and  outpatient services provided by general hospitals, for inpa-
 tient services and adult day health care outpatient services provided by
 residential health care facilities pursuant to article 28 of the  public
 health  law,  except  for residential health care facilities or units of
 such facilities providing services primarily to children  under  twenty-
 one  years  of  age,  for home health care services provided pursuant to
 article 36 of the public health law by certified home  health  agencies,
 long term home health care programs and AIDS home care programs, and for
 personal  care services provided pursuant to section 365-a of the social
 services law, the commissioner of health shall  apply  no  greater  than
 zero  trend  factors  attributable  to the 2017, 2018, [and] 2019, 2020,
 2021, 2022, AND 2023 calendar years in accordance with paragraph (c)  of
 subdivision  10  of  section  2807-c of the public health law, provided,
 however, that such no greater than zero trend  factors  attributable  to
 such  2017,  2018, [and] 2019, 2020, 2021, 2022, AND 2023 calendar years
 shall also be applied to rates of payment provided on and after  January
 1,  2017  through  March  31,  [2019]  2024  for  personal care services
 provided in those local social services districts,  including  New  York
 city,  whose  rates of payment for such services are established by such
 local social services districts pursuant  to  a  rate-setting  exemption
 issued  by  the  commissioner  of  health  to such local social services
 districts  in  accordance  with  applicable  regulations;  and  provided
 further,  however, that for rates of payment for assisted living program
 services provided on and after January 1, 2017 through March 31,  [2019]
 2024,  such  trend  factors  attributable to the 2017, 2018, [and] 2019,

 S. 1507--A                         16                         A. 2007--A
 
 2020, 2021, 2022, AND 2023 calendar years shall  be  established  at  no
 greater than zero percent.
   §  15.  Paragraph  (b) of subdivision 17 of section 2808 of the public
 health law, as amended by section 21 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (b) Notwithstanding any inconsistent provision of law or regulation to
 the contrary, for the state fiscal  years  beginning  April  first,  two
 thousand  ten  and  ending  March  thirty-first, two thousand [nineteen]
 TWENTY-FOUR, the commissioner shall not be required to revise  certified
 rates  of  payment established pursuant to this article for rate periods
 prior to April first, two  thousand  [nineteen]  TWENTY-FOUR,  based  on
 consideration  of  rate appeals filed by residential health care facili-
 ties or based upon adjustments to capital cost reimbursement as a result
 of approval by the commissioner of an application for construction under
 section twenty-eight hundred two of this article, in excess of an aggre-
 gate annual amount of eighty million dollars for each such state  fiscal
 year  provided,  however,  that for the period April first, two thousand
 eleven through March thirty-first, two thousand  twelve  such  aggregate
 annual  amount  shall  be  fifty million dollars. In revising such rates
 within such fiscal limit, the commissioner shall, in  prioritizing  such
 rate appeals, include consideration of which facilities the commissioner
 determines  are  facing  significant  financial hardship as well as such
 other considerations as the commissioner deems appropriate and, further,
 the commissioner is authorized to enter into agreements with such facil-
 ities or any other facility to resolve  multiple  pending  rate  appeals
 based  upon a negotiated aggregate amount and may offset such negotiated
 aggregate amounts against any  amounts  owed  by  the  facility  to  the
 department,  including,  but  not  limited  to, amounts owed pursuant to
 section twenty-eight hundred seven-d of this article; provided, however,
 that the commissioner's authority to negotiate such agreements resolving
 multiple pending rate appeals as hereinbefore described  shall  continue
 on  and  after  April  first,  two thousand [nineteen] TWENTY-FOUR. Rate
 adjustments made pursuant to this  paragraph  remain  fully  subject  to
 approval by the director of the budget in accordance with the provisions
 of  subdivision  two of section twenty-eight hundred seven of this arti-
 cle.
   § 16. Paragraph (a) of subdivision 13 of section 3614  of  the  public
 health law, as amended by section 22 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (a)  Notwithstanding  any  inconsistent provision of law or regulation
 and subject to the  availability  of  federal  financial  participation,
 effective  April  first, two thousand twelve through March thirty-first,
 two thousand [nineteen] TWENTY-FOUR, payments by government agencies for
 services provided by certified home health  agencies,  except  for  such
 services  provided  to  children  under  eighteen years of age and other
 discreet groups as may be determined by  the  commissioner  pursuant  to
 regulations,  shall  be based on episodic payments. In establishing such
 payments, a statewide base price shall be established for each sixty day
 episode of care and adjusted by a regional  wage  index  factor  and  an
 individual patient case mix index. Such episodic payments may be further
 adjusted  for  low utilization cases and to reflect a percentage limita-
 tion of the cost for high-utilization cases that exceed outlier  thresh-
 olds of such payments.
   §  17. Subdivision 2 of section 246 of chapter 81 of the laws of 1995,
 amending the public health  law  and  other  laws  relating  to  medical

 S. 1507--A                         17                         A. 2007--A
 
 reimbursement  and welfare reform, as amended by section 18 of part I of
 chapter 57 of the laws of 2017, is amended to read as follows:
   2.  Sections  five,  seven  through nine, twelve through fourteen, and
 eighteen of this act shall be deemed to have  been  in  full  force  and
 effect  on  and  after  April  1, 1995 through March 31, 1999 and on and
 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
 through March 31, 2003 and on and after April 1, 2003 through March  31,
 2006  and  on  and after April 1, 2006 through March 31, 2007 and on and
 after April 1, 2007 through March 31, 2009 and on  and  after  April  1,
 2009  through  March 31, 2011 and sections twelve, thirteen and fourteen
 of this act shall be deemed to be in full force and effect on and  after
 April  1,  2011  through  March  31, 2015 and on and after April 1, 2015
 through March 31, 2017 and on and after April 1, 2017 through March  31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2024;
   §  18. Section 48-a of part A of chapter 56 of the laws of 2013 amend-
 ing chapter 59 of the laws of 2011 amending the public  health  law  and
 other  laws relating to general hospital reimbursement for annual rates,
 as amended by section 1 of part P of chapter 57 of the laws of 2017,  is
 amended to read as follows:
   §  48-a. 1. Notwithstanding any contrary provision of law, the commis-
 sioners of the office of alcoholism and substance abuse services and the
 office of mental health are authorized, subject to the approval  of  the
 director  of the budget, to transfer to the commissioner of health state
 funds to be utilized as the state share for the  purpose  of  increasing
 payments  under  the  medicaid  program  to  managed  care organizations
 licensed under article 44 of the public health law or under  article  43
 of the insurance law. Such managed care organizations shall utilize such
 funds  for  the  purpose  of  reimbursing providers licensed pursuant to
 article 28 of the public health law or article 31 or 32  of  the  mental
 hygiene  law for ambulatory behavioral health services, as determined by
 the commissioner of health, in consultation  with  the  commissioner  of
 alcoholism  and  substance  abuse  services  and the commissioner of the
 office of mental health, provided to medicaid enrolled  outpatients  and
 for  all  other  behavioral health services except inpatient included in
 New York state's Medicaid redesign waiver approved by  the  centers  for
 medicare  and  Medicaid services (CMS).   Such reimbursement shall be in
 the form of fees for such services which are equivalent to the  payments
 established  for  such services under the ambulatory patient group (APG)
 rate-setting methodology as utilized by the department  of  health,  the
 office  of  alcoholism  and  substance  abuse services, or the office of
 mental health for rate-setting purposes or any such other fees  pursuant
 to  the Medicaid state plan or otherwise approved by CMS in the Medicaid
 redesign waiver; provided, however, that the increase to such fees  that
 shall  result  from  the  provisions  of  this section shall not, in the
 aggregate and as determined by the commissioner of health, in  consulta-
 tion  with  the  commissioner of alcoholism and substance abuse services
 and the commissioner of the office of mental health, be greater than the
 increased funds made available pursuant to this section.   The  increase
 of  such  ambulatory behavioral health fees to providers available under
 this section shall be for all rate periods on and  after  the  effective
 date  of  section [29] 1 of part [B] P of chapter [59] 57 of the laws of
 [2016] 2017 through March 31, [2020] 2022 for patients in  the  city  of
 New  York,  for  all  rate  periods  on  and after the effective date of
 section [29] 1 of part [B] P of chapter [59] 57 of the  laws  of  [2016]
 2017  through  [March  31, 2020] MARCH 31, 2022 for patients outside the
 city of New York, and for all rate periods on and  after  the  effective

 S. 1507--A                         18                         A. 2007--A
 
 date  of  such  chapter  through [March 31, 2020] MARCH 31, 2022 for all
 services provided to persons under  the  age  of  twenty-one;  provided,
 however,  the  commissioner  of health, in consultation with the commis-
 sioner  of  alcoholism and substance abuse services and the commissioner
 of mental health, may require, as a condition of approval of such  ambu-
 latory  behavioral health fees, that aggregate managed care expenditures
 to eligible providers meet the alternative payment methodology  require-
 ments  as  set  forth  in  attachment  I  of the New York state medicaid
 section one thousand one hundred fifteen medicaid redesign  team  waiver
 as  approved  by  the  centers  for  medicare and medicaid services. The
 commissioner of health shall, in consultation with the  commissioner  of
 alcoholism  and  substance abuse services and the commissioner of mental
 health, waive such conditions if a sufficient number  of  providers,  as
 determined  by the commissioner, suffer a financial hardship as a conse-
 quence of such alternative payment methodology requirements, or if he or
 she shall determine that such alternative payment methodologies  signif-
 icantly  threaten  individuals  access  to  ambulatory behavioral health
 services.  Such waiver may be applied on a provider specific or industry
 wide basis. Further, such conditions may be waived, as the  commissioner
 determines  necessary,  to  comply  with  federal  rules  or regulations
 governing these payment methodologies.   Nothing in this  section  shall
 prohibit  managed  care  organizations  and  providers  from negotiating
 different rates and methods of payment  during  such  periods  described
 above,  subject to the approval of the department of health. The depart-
 ment of health shall consult with the office of alcoholism and substance
 abuse services and the office of mental health  in  determining  whether
 such  alternative  rates  shall  be approved. The commissioner of health
 may, in consultation with the commissioner of alcoholism  and  substance
 abuse  services  and  the  commissioner  of the office of mental health,
 promulgate  regulations,  including  emergency  regulations  promulgated
 prior  to  October  1, 2015 to establish rates for ambulatory behavioral
 health services, as are necessary to implement the  provisions  of  this
 section.  Rates  promulgated under this section shall be included in the
 report required under section 45-c of part A of this chapter.
   2. Notwithstanding any contrary provision of law,  the  fees  paid  by
 managed  care  organizations  licensed  under  article  44 of the public
 health law or under article  43  of  the  insurance  law,  to  providers
 licensed  pursuant  to article 28 of the public health law or article 31
 or 32 of the  mental  hygiene  law,  for  ambulatory  behavioral  health
 services  provided  to  patients  enrolled in the child health insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to the payments established  for  such  services  under  the  ambulatory
 patient  group  (APG)  rate-setting  methodology  or any such other fees
 established pursuant to the Medicaid state  plan.  The  commissioner  of
 health  shall  consult with the commissioner of alcoholism and substance
 abuse services and the commissioner of the office of  mental  health  in
 determining  such  services  and establishing such fees. Such ambulatory
 behavioral health fees to providers available under this  section  shall
 be  for all rate periods on and after the effective date of this chapter
 through [March 31, 2020] MARCH 31, 2022, provided, however, that managed
 care organizations and providers may negotiate different rates and meth-
 ods of payment during such  periods  described  above,  subject  to  the
 approval  of  the  department of health.  The department of health shall
 consult with the office of alcoholism and substance abuse  services  and
 the  office  of  mental  health  in determining whether such alternative

 S. 1507--A                         19                         A. 2007--A
 
 rates shall be approved.  The report required under section 16-a of part
 C of chapter 60 of the laws of 2014 shall also include the population of
 patients enrolled in the child  health  insurance  program  pursuant  to
 title [one-A] 1-A of article 25 of the public health law in its examina-
 tion on the transition of behavioral health services into managed care.
   §  19. Section 1 of part H of chapter 111 of the laws of 2010 relating
 to increasing Medicaid payments to providers through managed care organ-
 izations and providing equivalent fees  through  an  ambulatory  patient
 group  methodology,  as  amended by section 2 of part P of chapter 57 of
 the laws of 2017, is amended to read as follows:
   Section 1. a. Notwithstanding  any  contrary  provision  of  law,  the
 commissioners  of  mental  health  and  alcoholism  and  substance abuse
 services are authorized, subject to the approval of the director of  the
 budget,  to  transfer  to  the  commissioner of health state funds to be
 utilized as the state share for the purpose of increasing payments under
 the medicaid program to managed care organizations licensed under  arti-
 cle  44  of  the  public health law or under article 43 of the insurance
 law. Such managed care organizations shall utilize such  funds  for  the
 purpose  of reimbursing providers licensed pursuant to article 28 of the
 public health law, or pursuant to article 31 or article 32 of the mental
 hygiene law for ambulatory behavioral health services, as determined  by
 the  commissioner  of  health  in  consultation with the commissioner of
 mental  health  and  commissioner  of  alcoholism  and  substance  abuse
 services,  provided  to  medicaid enrolled outpatients and for all other
 behavioral health services except inpatient included in New York state's
 Medicaid redesign waiver approved by the centers for medicare and  Medi-
 caid services (CMS). Such reimbursement shall be in the form of fees for
 such  services which are equivalent to the payments established for such
 services under the ambulatory patient group (APG) rate-setting methodol-
 ogy as utilized by the department of health or by the office  of  mental
 health  or  office  of alcoholism and substance abuse services for rate-
 setting purposes or any such other fees pursuant to the  Medicaid  state
 plan  or  otherwise  approved  by  CMS  in the Medicaid redesign waiver;
 provided, however, that the increase to such fees that shall result from
 the provisions of this section shall not, in the aggregate and as deter-
 mined by the commissioner of health in consultation with the commission-
 ers of mental health and alcoholism and  substance  abuse  services,  be
 greater  than  the  increased  funds  made  available  pursuant  to this
 section. The increase of such behavioral health fees to providers avail-
 able under this section shall be for all rate periods on and  after  the
 effective date of section [30] 2 of part [B] P of chapter [59] 57 of the
 laws  of  [2016]  2017 through March 31, [2020] 2022 for patients in the
 city of New York, for all rate periods on and after the  effective  date
 of section [30] 2 of part [B] P of chapter [59] 57 of the laws of [2016]
 2017  through March 31, [2020] 2022 for patients outside the city of New
 York, and for all rate periods  on  and  after  the  effective  date  of
 section  [30]  2  of part [B] P of chapter [59] 57 of the laws of [2016]
 2017 through March 31, [2020] 2022 for all services provided to  persons
 under  the  age  of  twenty-one;  provided, however, the commissioner of
 health,  in  consultation  with  the  commissioner  of  alcoholism   and
 substance  abuse  services  and  the  commissioner of mental health, may
 require, as a condition of approval of such ambulatory behavioral health
 fees, that aggregate managed care  expenditures  to  eligible  providers
 meet  the  alternative  payment methodology requirements as set forth in
 attachment I of the New York state medicaid  section  one  thousand  one
 hundred fifteen medicaid redesign team waiver as approved by the centers

 S. 1507--A                         20                         A. 2007--A
 
 for medicare and medicaid services. The commissioner of health shall, in
 consultation  with  the  commissioner  of alcoholism and substance abuse
 services and the commissioner of mental health, waive such conditions if
 a  sufficient  number  of  providers, as determined by the commissioner,
 suffer a financial hardship as a consequence of such alternative payment
 methodology requirements, or if he or  she  shall  determine  that  such
 alternative  payment  methodologies  significantly  threaten individuals
 access to ambulatory behavioral health services.   Such  waiver  may  be
 applied  on  a  provider  specific or industry wide basis. Further, such
 conditions may be waived, as the commissioner determines  necessary,  to
 comply with federal rules or regulations governing these payment method-
 ologies.  Nothing  in this section shall prohibit managed care organiza-
 tions and providers from negotiating  different  rates  and  methods  of
 payment  during  such  periods described, subject to the approval of the
 department of health. The department of health shall  consult  with  the
 office  of  alcoholism  and  substance  abuse services and the office of
 mental health in determining whether such  alternative  rates  shall  be
 approved.  The  commissioner  of  health  may,  in consultation with the
 commissioners of  mental  health  and  alcoholism  and  substance  abuse
 services,   promulgate   regulations,  including  emergency  regulations
 promulgated prior to October 1, 2013 that establish rates for behavioral
 health services, as are necessary to implement the  provisions  of  this
 section.  Rates  promulgated under this section shall be included in the
 report required under section 45-c of part A of chapter 56 of  the  laws
 of 2013.
   b.  Notwithstanding  any  contrary  provision of law, the fees paid by
 managed care organizations licensed  under  article  44  of  the  public
 health  law  or  under  article  43  of  the insurance law, to providers
 licensed pursuant to article 28 of the public health law or  article  31
 or  32  of  the  mental  hygiene  law,  for ambulatory behavioral health
 services provided to patients enrolled in  the  child  health  insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to  the  payments  established  for  such  services under the ambulatory
 patient group (APG) rate-setting methodology. The commissioner of health
 shall consult with the commissioner of alcoholism  and  substance  abuse
 services  and  the commissioner of the office of mental health in deter-
 mining such services and establishing such fees. Such ambulatory  behav-
 ioral health fees to providers available under this section shall be for
 all rate periods on and after the effective date of this chapter through
 March  31,  [2020]  2022, provided, however, that managed care organiza-
 tions and providers may negotiate different rates and methods of payment
 during such periods described above, subject  to  the  approval  of  the
 department  of  health.  The department of health shall consult with the
 office of alcoholism and substance abuse  services  and  the  office  of
 mental  health  in  determining  whether such alternative rates shall be
 approved.  The report required under section 16-a of part C  of  chapter
 60  of  the  laws  of 2014 shall also include the population of patients
 enrolled in the child health insurance program pursuant to title [one-A]
 1-A of article 25 of the public health law in  its  examination  on  the
 transition of behavioral health services into managed care.
   § 20. Section 2 of part H of chapter 111 of the laws of 2010, relating
 to increasing Medicaid payments to providers through managed care organ-
 izations  and  providing  equivalent  fees through an ambulatory patient
 group methodology, as amended by section 16 of part C of chapter  60  of
 the laws of 2014, is amended to read as follows:

 S. 1507--A                         21                         A. 2007--A
 
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2010, and shall
 expire on [January 1, 2018] MARCH 31, 2022.
   §  21.  Section  10  of  chapter 649 of the laws of 1996, amending the
 public health law, the mental hygiene law and the  social  services  law
 relating  to  authorizing  the  establishment of special needs plans, as
 amended by section 2 of part D of chapter 59 of the  laws  of  2016,  is
 amended to read as follows:
   §  10.  This  act shall take effect immediately and shall be deemed to
 have been in full force and effect on and after July 1, 1996;  provided,
 however,  that  sections one, two and three of this act shall expire and
 be deemed repealed on March 31, [2020] 2025 provided, however  that  the
 amendments  to  section 364-j of the social services law made by section
 four of this act shall not affect the expiration  of  such  section  and
 shall  be  deemed  to  expire  therewith and provided, further, that the
 provisions of subdivisions 8, 9 and 10 of section  4401  of  the  public
 health  law,  as added by section one of this act; section 4403-d of the
 public health law as added by section two of this act and the provisions
 of section seven of this act, except for the provisions relating to  the
 establishment  of  no  more  than twelve comprehensive HIV special needs
 plans, shall expire and be deemed repealed on July 1, 2000.
   § 22. Paragraph (a) of subdivision 1 of section 212 of chapter 474  of
 the  laws of 1996, amending the education law and other laws relating to
 rates for residential healthcare facilities, as amended by section 1  of
 part D of chapter 59 of the laws of 2016, is amended to read as follows:
   (a) Notwithstanding any inconsistent provision of law or regulation to
 the  contrary,  effective beginning August 1, 1996, for the period April
 1, 1997 through March 31, 1998, April 1, 1998 for the  period  April  1,
 1998  through  March  31,  1999, August 1, 1999, for the period April 1,
 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
 through March 31, 2001, April 1, 2001, for  the  period  April  1,  2001
 through  March  31,  2002,  April  1, 2002, for the period April 1, 2002
 through March 31, 2003, and for the state fiscal year beginning April 1,
 2005 through March 31, 2006, and for the  state  fiscal  year  beginning
 April  1,  2006  through  March  31, 2007, and for the state fiscal year
 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
 year beginning April 1, 2008 through March 31, 2009, and for  the  state
 fiscal  year beginning April 1, 2009 through March 31, 2010, and for the
 state fiscal year beginning April 1, 2010 through March  31,  2016,  and
 for the state fiscal year beginning April 1, 2016 through March 31, 2019
 AND  ANNUALLY  THEREAFTER, the department of health is authorized to pay
 public general hospitals, as defined in subdivision 10 of  section  2801
 of  the  public  health law, operated by the state of New York or by the
 state university of New York or by a county, which shall not  include  a
 city  with  a  population of over one million, of the state of New York,
 and those public general hospitals located in the county of Westchester,
 the county of Erie or the county  of  Nassau,  additional  payments  for
 inpatient  hospital  services as medical assistance payments pursuant to
 title 11 of article 5 of the social services law for  patients  eligible
 for  federal  financial  participation  under  title  XIX of the federal
 social security act in medical assistance pursuant to the  federal  laws
 and  regulations  governing disproportionate share payments to hospitals
 up to one hundred percent of each such public general hospital's medical
 assistance and uninsured patient losses after all other medical  assist-
 ance,  including  disproportionate share payments to such public general
 hospital for 1996, 1997, 1998, and 1999, based  initially  for  1996  on

 S. 1507--A                         22                         A. 2007--A
 
 reported  1994  reconciled data as further reconciled to actual reported
 1996 reconciled data, and for 1997  based  initially  on  reported  1995
 reconciled data as further reconciled to actual reported 1997 reconciled
 data,  for  1998  based  initially  on  reported 1995 reconciled data as
 further reconciled to actual reported 1998  reconciled  data,  for  1999
 based  initially  on reported 1995 reconciled data as further reconciled
 to actual reported 1999 reconciled data, for  2000  based  initially  on
 reported  1995  reconciled data as further reconciled to actual reported
 2000 data, for 2001 based initially on reported 1995 reconciled data  as
 further reconciled to actual reported 2001 data, for 2002 based initial-
 ly  on  reported  2000  reconciled  data as further reconciled to actual
 reported 2002 data, and for state fiscal years  beginning  on  April  1,
 2005, based initially on reported 2000 reconciled data as further recon-
 ciled  to  actual  reported  data  for  2005, and for state fiscal years
 beginning on April 1, 2006, based initially on reported 2000  reconciled
 data  as  further reconciled to actual reported data for 2006, for state
 fiscal years beginning on and after April  1,  2007  through  March  31,
 2009, based initially on reported 2000 reconciled data as further recon-
 ciled to actual reported data for 2007 and 2008, respectively, for state
 fiscal  years  beginning  on and after April 1, 2009, based initially on
 reported 2007 reconciled data, adjusted  for  authorized  Medicaid  rate
 changes  applicable  to the state fiscal year, and as further reconciled
 to actual reported data for 2009, for state fiscal  years  beginning  on
 and  after  April  1,  2010, based initially on reported reconciled data
 from the base year two years prior to the  payment  year,  adjusted  for
 authorized  Medicaid  rate  changes applicable to the state fiscal year,
 and further reconciled to actual reported data from such  payment  year,
 and  to  actual  reported data for each respective succeeding year.  The
 payments may be added to rates of payment or made as aggregate  payments
 to an eligible public general hospital.
   § 23. This act shall take effect immediately; provided that the amend-
 ments  to section 1 of part H of chapter 111 of the laws of 2010 made by
 section nineteen of this act shall not affect  the  expiration  of  such
 section  and  shall  expire therewith; and provided further that section
 twenty of this act shall be deemed to have been in full force and effect
 on and after January 1, 2018.
 
                                  PART F
 
   Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266
 of the laws of 1986, amending the civil practice law and rules and other
 laws relating  to  malpractice  and  professional  medical  conduct,  as
 amended  by  section  1  of part M of chapter 57 of the laws of 2018, is
 amended to read as follows:
   (a) The superintendent of financial services and the  commissioner  of
 health  or  their  designee  shall, from funds available in the hospital
 excess liability pool created pursuant to subdivision 5 of this section,
 purchase a policy or policies for excess insurance coverage, as  author-
 ized  by  paragraph 1 of subsection (e) of section 5502 of the insurance
 law; or from an insurer, other than an insurer described in section 5502
 of the insurance law, duly authorized to write such coverage and actual-
 ly writing  medical  malpractice  insurance  in  this  state;  or  shall
 purchase equivalent excess coverage in a form previously approved by the
 superintendent  of  financial  services for purposes of providing equiv-
 alent excess coverage in accordance with section 19 of  chapter  294  of
 the  laws of 1985, for medical or dental malpractice occurrences between

 S. 1507--A                         23                         A. 2007--A

 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30,  1988,
 between  July  1,  1988 and June 30, 1989, between July 1, 1989 and June
 30, 1990, between July 1, 1990 and June 30, 1991, between July  1,  1991
 and  June 30, 1992, between July 1, 1992 and June 30, 1993, between July
 1, 1993 and June 30, 1994, between July  1,  1994  and  June  30,  1995,
 between  July  1,  1995 and June 30, 1996, between July 1, 1996 and June
 30, 1997, between July 1, 1997 and June 30, 1998, between July  1,  1998
 and  June 30, 1999, between July 1, 1999 and June 30, 2000, between July
 1, 2000 and June 30, 2001, between July  1,  2001  and  June  30,  2002,
 between  July  1,  2002 and June 30, 2003, between July 1, 2003 and June
 30, 2004, between July 1, 2004 and June 30, 2005, between July  1,  2005
 and  June 30, 2006, between July 1, 2006 and June 30, 2007, between July
 1, 2007 and June 30, 2008, between July  1,  2008  and  June  30,  2009,
 between  July  1,  2009 and June 30, 2010, between July 1, 2010 and June
 30, 2011, between July 1, 2011 and June 30, 2012, between July  1,  2012
 and  June 30, 2013, between July 1, 2013 and June 30, 2014, between July
 1, 2014 and June 30, 2015, between July  1,  2015  and  June  30,  2016,
 between  July  1,  2016 and June 30, 2017, between July 1, 2017 and June
 30, 2018, [and] between July 1, 2018 and June 30, 2019, AND BETWEEN JULY
 1, 2019 AND JUNE 30, 2020 or reimburse the hospital where  the  hospital
 purchases  equivalent  excess coverage as defined in subparagraph (i) of
 paragraph (a) of subdivision 1-a of this section for medical  or  dental
 malpractice  occurrences between July 1, 1987 and June 30, 1988, between
 July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30,  1990,
 between  July  1,  1990 and June 30, 1991, between July 1, 1991 and June
 30, 1992, between July 1, 1992 and June 30, 1993, between July  1,  1993
 and  June 30, 1994, between July 1, 1994 and June 30, 1995, between July
 1, 1995 and June 30, 1996, between July  1,  1996  and  June  30,  1997,
 between  July  1,  1997 and June 30, 1998, between July 1, 1998 and June
 30, 1999, between July 1, 1999 and June 30, 2000, between July  1,  2000
 and  June 30, 2001, between July 1, 2001 and June 30, 2002, between July
 1, 2002 and June 30, 2003, between July  1,  2003  and  June  30,  2004,
 between  July  1,  2004 and June 30, 2005, between July 1, 2005 and June
 30, 2006, between July 1, 2006 and June 30, 2007, between July  1,  2007
 and  June 30, 2008, between July 1, 2008 and June 30, 2009, between July
 1, 2009 and June 30, 2010, between July  1,  2010  and  June  30,  2011,
 between  July  1,  2011 and June 30, 2012, between July 1, 2012 and June
 30, 2013, between July 1, 2013 and June 30, 2014, between July  1,  2014
 and  June 30, 2015, between July 1, 2015 and June 30, 2016, between July
 1, 2016 and June 30, 2017, between July 1, 2017 and June 30, 2018, [and]
 between July 1, 2018 and June 30, 2019, AND BETWEEN  JULY  1,  2019  AND
 JUNE  30, 2020 for physicians or dentists certified as eligible for each
 such period or periods pursuant to subdivision 2 of this  section  by  a
 general  hospital  licensed  pursuant to article 28 of the public health
 law; provided that no single insurer shall write more than fifty percent
 of the total excess premium for  a  given  policy  year;  and  provided,
 however, that such eligible physicians or dentists must have in force an
 individual  policy,  from  an  insurer licensed in this state of primary
 malpractice insurance coverage in amounts of no less  than  one  million
 three  hundred thousand dollars for each claimant and three million nine
 hundred thousand dollars for all claimants under that policy during  the
 period  of  such  excess coverage for such occurrences or be endorsed as
 additional insureds under a hospital professional liability policy which
 is  offered  through  a  voluntary  attending  physician  ("channeling")
 program previously permitted by the superintendent of financial services
 during  the  period of such excess coverage for such occurrences. During

 S. 1507--A                         24                         A. 2007--A

 such period, such policy for excess coverage or such  equivalent  excess
 coverage  shall, when combined with the physician's or dentist's primary
 malpractice insurance coverage or coverage provided through a  voluntary
 attending  physician ("channeling") program, total an aggregate level of
 two million three hundred thousand dollars for  each  claimant  and  six
 million  nine  hundred  thousand dollars for all claimants from all such
 policies with respect to occurrences in each  of  such  years  provided,
 however, if the cost of primary malpractice insurance coverage in excess
 of  one million dollars, but below the excess medical malpractice insur-
 ance coverage provided pursuant to this act, exceeds the  rate  of  nine
 percent per annum, then the required level of primary malpractice insur-
 ance  coverage  in excess of one million dollars for each claimant shall
 be in an amount of not less than the  dollar  amount  of  such  coverage
 available at nine percent per annum; the required level of such coverage
 for  all claimants under that policy shall be in an amount not less than
 three times the dollar amount of coverage for each claimant; and  excess
 coverage,  when  combined with such primary malpractice insurance cover-
 age, shall increase the aggregate level for each claimant by one million
 dollars and three  million  dollars  for  all  claimants;  and  provided
 further,  that,  with respect to policies of primary medical malpractice
 coverage that include occurrences between April 1,  2002  and  June  30,
 2002,  such  requirement  that  coverage  be in amounts no less than one
 million three hundred thousand  dollars  for  each  claimant  and  three
 million  nine hundred thousand dollars for all claimants for such occur-
 rences shall be effective April 1, 2002.
   § 2. Subdivision 3 of section 18 of chapter 266 of the laws  of  1986,
 amending  the  civil  practice  law and rules and other laws relating to
 malpractice and professional medical conduct, as amended by section 2 of
 part M of chapter 57 of the laws of 2018, is amended to read as follows:
   (3)(a) The superintendent of financial services  shall  determine  and
 certify  to  each general hospital and to the commissioner of health the
 cost of excess malpractice insurance for medical or  dental  malpractice
 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988
 and  June 30, 1989, between July 1, 1989 and June 30, 1990, between July
 1, 1990 and June 30, 1991, between July  1,  1991  and  June  30,  1992,
 between  July  1,  1992 and June 30, 1993, between July 1, 1993 and June
 30, 1994, between July 1, 1994 and June 30, 1995, between July  1,  1995
 and  June 30, 1996, between July 1, 1996 and June 30, 1997, between July
 1, 1997 and June 30, 1998, between July  1,  1998  and  June  30,  1999,
 between  July  1,  1999 and June 30, 2000, between July 1, 2000 and June
 30, 2001, between July 1, 2001 and June 30, 2002, between July  1,  2002
 and  June 30, 2003, between July 1, 2003 and June 30, 2004, between July
 1, 2004 and June 30, 2005, between July  1,  2005  and  June  30,  2006,
 between  July  1,  2006 and June 30, 2007, between July 1, 2007 and June
 30, 2008, between July 1, 2008 and June 30, 2009, between July  1,  2009
 and  June 30, 2010, between July 1, 2010 and June 30, 2011, between July
 1, 2011 and June 30, 2012, between July 1, 2012 and June 30,  2013,  and
 between  July  1,  2013 and June 30, 2014, between July 1, 2014 and June
 30, 2015, between July 1, 2015 and June 30, 2016, and  between  July  1,
 2016  and  June  30, 2017, between July 1, 2017 and June 30, 2018, [and]
 between July 1, 2018 and June 30, 2019, AND BETWEEN  JULY  1,  2019  AND
 JUNE  30,  2020  allocable  to  each  general hospital for physicians or
 dentists certified as eligible for  purchase  of  a  policy  for  excess
 insurance  coverage by such general hospital in accordance with subdivi-
 sion 2 of this section, and may amend  such  determination  and  certif-
 ication as necessary.

 S. 1507--A                         25                         A. 2007--A
 
   (b)  The  superintendent  of  financial  services  shall determine and
 certify to each general hospital and to the commissioner of  health  the
 cost  of  excess malpractice insurance or equivalent excess coverage for
 medical or dental malpractice occurrences between July 1, 1987 and  June
 30,  1988,  between July 1, 1988 and June 30, 1989, between July 1, 1989
 and June 30, 1990, between July 1, 1990 and June 30, 1991, between  July
 1,  1991  and  June  30,  1992,  between July 1, 1992 and June 30, 1993,
 between July 1, 1993 and June 30, 1994, between July 1,  1994  and  June
 30,  1995,  between July 1, 1995 and June 30, 1996, between July 1, 1996
 and June 30, 1997, between July 1, 1997 and June 30, 1998, between  July
 1,  1998  and  June  30,  1999,  between July 1, 1999 and June 30, 2000,
 between July 1, 2000 and June 30, 2001, between July 1,  2001  and  June
 30,  2002,  between July 1, 2002 and June 30, 2003, between July 1, 2003
 and June 30, 2004, between July 1, 2004 and June 30, 2005, between  July
 1,  2005  and  June  30,  2006,  between July 1, 2006 and June 30, 2007,
 between July 1, 2007 and June 30, 2008, between July 1,  2008  and  June
 30,  2009,  between July 1, 2009 and June 30, 2010, between July 1, 2010
 and June 30, 2011, between July 1, 2011 and June 30, 2012, between  July
 1,  2012  and  June  30,  2013,  between July 1, 2013 and June 30, 2014,
 between July 1, 2014 and June 30, 2015, between July 1,  2015  and  June
 30,  2016,  between July 1, 2016 and June 30, 2017, between July 1, 2017
 and June 30, 2018, [and] between July 1, 2018 and  June  30,  2019,  AND
 BETWEEN  JULY 1, 2019 AND JUNE 30, 2020 allocable to each general hospi-
 tal for physicians or dentists certified as eligible for purchase  of  a
 policy  for  excess  insurance coverage or equivalent excess coverage by
 such general hospital in accordance with subdivision 2 of this  section,
 and  may  amend  such  determination and certification as necessary. The
 superintendent of financial services shall determine and certify to each
 general hospital and to the commissioner of health the ratable share  of
 such  cost allocable to the period July 1, 1987 to December 31, 1987, to
 the period January 1, 1988 to June 30, 1988, to the period July 1,  1988
 to December 31, 1988, to the period January 1, 1989 to June 30, 1989, to
 the  period  July 1, 1989 to December 31, 1989, to the period January 1,
 1990 to June 30, 1990, to the period July 1, 1990 to December 31,  1990,
 to  the  period  January 1, 1991 to June 30, 1991, to the period July 1,
 1991 to December 31, 1991, to the period January 1,  1992  to  June  30,
 1992,  to  the  period  July 1, 1992 to December 31, 1992, to the period
 January 1, 1993 to June 30, 1993, to the period July 1, 1993 to December
 31, 1993, to the period January 1, 1994 to June 30, 1994, to the  period
 July 1, 1994 to December 31, 1994, to the period January 1, 1995 to June
 30, 1995, to the period July 1, 1995 to December 31, 1995, to the period
 January 1, 1996 to June 30, 1996, to the period July 1, 1996 to December
 31,  1996, to the period January 1, 1997 to June 30, 1997, to the period
 July 1, 1997 to December 31, 1997, to the period January 1, 1998 to June
 30, 1998, to the period July 1, 1998 to December 31, 1998, to the period
 January 1, 1999 to June 30, 1999, to the period July 1, 1999 to December
 31, 1999, to the period January 1, 2000 to June 30, 2000, to the  period
 July 1, 2000 to December 31, 2000, to the period January 1, 2001 to June
 30,  2001,  to  the  period July 1, 2001 to June 30, 2002, to the period
 July 1, 2002 to June 30, 2003, to the period July 1, 2003  to  June  30,
 2004, to the period July 1, 2004 to June 30, 2005, to the period July 1,
 2005 and June 30, 2006, to the period July 1, 2006 and June 30, 2007, to
 the  period  July  1, 2007 and June 30, 2008, to the period July 1, 2008
 and June 30, 2009, to the period July 1, 2009 and June 30, 2010, to  the
 period  July  1,  2010 and June 30, 2011, to the period July 1, 2011 and
 June 30, 2012, to the period July 1, 2012 and  June  30,  2013,  to  the

 S. 1507--A                         26                         A. 2007--A
 
 period  July  1,  2013 and June 30, 2014, to the period July 1, 2014 and
 June 30, 2015, to the period July  1,  2015  and  June  30,  2016,  [and
 between]  TO  THE  PERIOD  July  1, 2016 and June 30, 2017, [and] to the
 period  July  1, 2017 to June 30, 2018, [and] to the period July 1, 2018
 to June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE 30, 2020.
   § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section
 18 of chapter 266 of the laws of 1986, amending the civil  practice  law
 and  rules  and  other  laws  relating  to  malpractice and professional
 medical conduct, as amended by section 3 of part M of chapter 57 of  the
 laws of 2018, are amended to read as follows:
   (a)  To  the  extent  funds available to the hospital excess liability
 pool pursuant to subdivision 5 of this section as amended, and  pursuant
 to  section  6  of part J of chapter 63 of the laws of 2001, as may from
 time to time be amended, which amended this  subdivision,  are  insuffi-
 cient  to  meet  the  costs  of  excess insurance coverage or equivalent
 excess coverage for coverage periods during the period July 1,  1992  to
 June  30,  1993, during the period July 1, 1993 to June 30, 1994, during
 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
 to June 30, 1996, during the period July  1,  1996  to  June  30,  1997,
 during  the period July 1, 1997 to June 30, 1998, during the period July
 1, 1998 to June 30, 1999, during the period July 1,  1999  to  June  30,
 2000, during the period July 1, 2000 to June 30, 2001, during the period
 July  1,  2001  to  October 29, 2001, during the period April 1, 2002 to
 June 30, 2002, during the period July 1, 2002 to June 30,  2003,  during
 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
 to  June  30,  2005,  during  the  period July 1, 2005 to June 30, 2006,
 during the period July 1, 2006 to June 30, 2007, during the period  July
 1,  2007  to  June  30, 2008, during the period July 1, 2008 to June 30,
 2009, during the period July 1, 2009 to June 30, 2010, during the period
 July 1, 2010 to June 30, 2011, during the period July 1,  2011  to  June
 30,  2012,  during  the period July 1, 2012 to June 30, 2013, during the
 period July 1, 2013 to June 30, 2014, during the period July 1, 2014  to
 June  30,  2015, during the period July 1, 2015 to June 30, 2016, during
 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017
 to June 30, 2018, [and] during the period July 1, 2018 to June 30, 2019,
 AND DURING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 allocated or reallo-
 cated in accordance with  paragraph  (a)  of  subdivision  4-a  of  this
 section  to  rates of payment applicable to state governmental agencies,
 each physician or dentist for whom a policy for excess insurance  cover-
 age  or equivalent excess coverage is purchased for such period shall be
 responsible for payment to the provider of excess insurance coverage  or
 equivalent  excess coverage of an allocable share of such insufficiency,
 based on the ratio of the total cost of such coverage for such physician
 to the sum of the total cost of such coverage for all physicians applied
 to such insufficiency.
   (b) Each provider of excess insurance coverage  or  equivalent  excess
 coverage  covering the period July 1, 1992 to June 30, 1993, or covering
 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
 1994 to June 30, 1995, or covering the period July 1, 1995 to  June  30,
 1996,  or covering the period July 1, 1996 to June 30, 1997, or covering
 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
 1998 to June 30, 1999, or covering the period July 1, 1999 to  June  30,
 2000,  or covering the period July 1, 2000 to June 30, 2001, or covering
 the period July 1, 2001 to October 29,  2001,  or  covering  the  period
 April  1,  2002 to June 30, 2002, or covering the period July 1, 2002 to
 June 30, 2003, or covering the period July 1, 2003 to June 30, 2004,  or

 S. 1507--A                         27                         A. 2007--A
 
 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
 June  30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
 June  30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
 covering the period July 1, 2012 to June 30, 2013, or covering the peri-
 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to
 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016,  or
 covering the period July 1, 2016 to June 30, 2017, or covering the peri-
 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to
 June  30,  2019,  OR  COVERING  THE PERIOD JULY 1, 2019 TO JUNE 30, 2020
 shall notify a covered physician or  dentist  by  mail,  mailed  to  the
 address  shown  on the last application for excess insurance coverage or
 equivalent excess coverage, of the amount due to such provider from such
 physician or dentist for such coverage period determined  in  accordance
 with  paragraph  (a)  of this subdivision. Such amount shall be due from
 such physician or dentist to such provider of excess insurance  coverage
 or  equivalent  excess  coverage  in a time and manner determined by the
 superintendent of financial services.
   (c) If a physician or dentist liable for payment of a portion  of  the
 costs  of excess insurance coverage or equivalent excess coverage cover-
 ing the period July 1, 1992 to June 30, 1993,  or  covering  the  period
 July  1,  1993  to June 30, 1994, or covering the period July 1, 1994 to
 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996,  or
 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
 June  30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
 od July 1, 2001 to October 29, 2001, or covering  the  period  April  1,
 2002  to  June 30, 2002, or covering the period July 1, 2002 to June 30,
 2003, or covering the period July 1, 2003 to June 30, 2004, or  covering
 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
 2005  to  June 30, 2006, or covering the period July 1, 2006 to June 30,
 2007, or covering the period July 1, 2007 to June 30, 2008, or  covering
 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
 2009  to  June 30, 2010, or covering the period July 1, 2010 to June 30,
 2011, or covering the period July 1, 2011 to June 30, 2012, or  covering
 the period July 1, 2012 to June 30, 2013, or covering the period July 1,
 2013  to  June 30, 2014, or covering the period July 1, 2014 to June 30,
 2015, or covering the period July 1, 2015 to June 30, 2016, or  covering
 the period July 1, 2016 to June 30, 2017, or covering the period July 1,
 2017  to  June 30, 2018, or covering the period July 1, 2018 to June 30,
 2019, OR COVERING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 determined in
 accordance with paragraph (a) of  this  subdivision  fails,  refuses  or
 neglects to make payment to the provider of excess insurance coverage or
 equivalent  excess coverage in such time and manner as determined by the
 superintendent of financial services pursuant to paragraph (b)  of  this
 subdivision,  excess  insurance  coverage  or equivalent excess coverage
 purchased for such physician or dentist in accordance with this  section
 for  such  coverage period shall be cancelled and shall be null and void
 as of the first day on or after the  commencement  of  a  policy  period
 where  the  liability  for  payment pursuant to this subdivision has not
 been met.
   (d) Each provider of excess insurance coverage  or  equivalent  excess
 coverage  shall  notify the superintendent of financial services and the

 S. 1507--A                         28                         A. 2007--A
 
 commissioner of health or their designee of each physician  and  dentist
 eligible  for  purchase  of  a  policy  for excess insurance coverage or
 equivalent excess coverage covering the period July 1, 1992 to June  30,
 1993,  or covering the period July 1, 1993 to June 30, 1994, or covering
 the period July 1, 1994 to June 30, 1995, or covering the period July 1,
 1995 to June 30, 1996, or covering the period July 1, 1996 to  June  30,
 1997,  or covering the period July 1, 1997 to June 30, 1998, or covering
 the period July 1, 1998 to June 30, 1999, or covering the period July 1,
 1999 to June 30, 2000, or covering the period July 1, 2000 to  June  30,
 2001, or covering the period July 1, 2001 to October 29, 2001, or cover-
 ing  the  period  April 1, 2002 to June 30, 2002, or covering the period
 July 1, 2002 to June 30, 2003, or covering the period July  1,  2003  to
 June  30, 2004, or covering the period July 1, 2004 to June 30, 2005, or
 covering the period July 1, 2005 to June 30, 2006, or covering the peri-
 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to
 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009,  or
 covering the period July 1, 2009 to June 30, 2010, or covering the peri-
 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to
 June  30, 2012, or covering the period July 1, 2012 to June 30, 2013, or
 covering the period July 1, 2013 to June 30, 2014, or covering the peri-
 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to
 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017,  or
 covering the period July 1, 2017 to June 30, 2018, or covering the peri-
 od July 1, 2018 to June 30, 2019, OR COVERING THE PERIOD JULY 1, 2019 TO
 JUNE 30, 2020 that has made payment to such provider of excess insurance
 coverage  or equivalent excess coverage in accordance with paragraph (b)
 of this subdivision and of each physician and dentist  who  has  failed,
 refused or neglected to make such payment.
   (e)  A  provider  of  excess  insurance  coverage or equivalent excess
 coverage shall refund to the hospital excess liability pool  any  amount
 allocable to the period July 1, 1992 to June 30, 1993, and to the period
 July  1,  1993  to June 30, 1994, and to the period July 1, 1994 to June
 30, 1995, and to the period July 1, 1995 to June 30, 1996,  and  to  the
 period  July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
 June 30, 1998, and to the period July 1, 1998 to June 30, 1999,  and  to
 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
 to  June  30,  2001, and to the period July 1, 2001 to October 29, 2001,
 and to the period April 1, 2002 to June 30, 2002, and to the period July
 1, 2002 to June 30, 2003, and to the period July 1,  2003  to  June  30,
 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
 July  1,  2005  to June 30, 2006, and to the period July 1, 2006 to June
 30, 2007, and to the period July 1, 2007 to June 30, 2008,  and  to  the
 period  July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
 June 30, 2010, and to the period July 1, 2010 to June 30, 2011,  and  to
 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
 to  June  30, 2013, and to the period July 1, 2013 to June 30, 2014, and
 to the period July 1, 2014 to June 30, 2015, and to the period  July  1,
 2015  to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and
 to the period July 1, 2017 to June 30, 2018, and to the period  July  1,
 2018  to  June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE 30, 2020
 received from the hospital excess liability pool for purchase of  excess
 insurance  coverage  or  equivalent  excess coverage covering the period
 July 1, 1992 to June 30, 1993, and covering the period July 1,  1993  to
 June  30,  1994,  and covering the period July 1, 1994 to June 30, 1995,
 and covering the period July 1, 1995 to June 30, 1996, and covering  the
 period  July  1,  1996 to June 30, 1997, and covering the period July 1,

 S. 1507--A                         29                         A. 2007--A
 
 1997 to June 30, 1998, and covering the period July 1, 1998 to June  30,
 1999,  and covering the period July 1, 1999 to June 30, 2000, and cover-
 ing the period July 1, 2000 to June 30, 2001, and  covering  the  period
 July  1, 2001 to October 29, 2001, and covering the period April 1, 2002
 to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003,
 and covering the period July 1, 2003 to June 30, 2004, and covering  the
 period  July  1,  2004 to June 30, 2005, and covering the period July 1,
 2005 to June 30, 2006, and covering the period July 1, 2006 to June  30,
 2007,  and covering the period July 1, 2007 to June 30, 2008, and cover-
 ing the period July 1, 2008 to June 30, 2009, and  covering  the  period
 July  1,  2009 to June 30, 2010, and covering the period July 1, 2010 to
 June 30, 2011, and covering the period July 1, 2011 to  June  30,  2012,
 and  covering the period July 1, 2012 to June 30, 2013, and covering the
 period July 1, 2013 to June 30, 2014, and covering the  period  July  1,
 2014  to June 30, 2015, and covering the period July 1, 2015 to June 30,
 2016, and covering the period July 1, 2016 to June 30, 2017, and  cover-
 ing  the  period  July 1, 2017 to June 30, 2018, and covering the period
 July 1, 2018 to June 30, 2019, AND COVERING THE PERIOD JULY 1,  2019  TO
 JUNE  30,  2020  for  a physician or dentist where such excess insurance
 coverage or equivalent excess coverage is cancelled in  accordance  with
 paragraph (c) of this subdivision.
   § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil
 practice  law  and  rules  and  other  laws  relating to malpractice and
 professional medical conduct, as amended by section 4 of part M of chap-
 ter 57 of the laws of 2018, is amended to read as follows:
   § 40. The superintendent of financial services shall  establish  rates
 for  policies  providing  coverage  for  physicians and surgeons medical
 malpractice for the periods commencing July 1, 1985 and ending June  30,
 [2019;]   2020;   provided,  however,  that  notwithstanding  any  other
 provision of law, the superintendent shall not establish or approve  any
 increase in rates for the period commencing July 1, 2009 and ending June
 30,  2010.  The superintendent shall direct insurers to establish segre-
 gated accounts for premiums, payments, reserves  and  investment  income
 attributable  to such premium periods and shall require periodic reports
 by the insurers regarding claims and expenses attributable to such peri-
 ods to monitor whether such accounts will be sufficient to meet incurred
 claims and expenses. On or after July 1, 1989, the superintendent  shall
 impose a surcharge on premiums to satisfy a projected deficiency that is
 attributable  to the premium levels established pursuant to this section
 for such periods; provided, however, that such  annual  surcharge  shall
 not  exceed  eight percent of the established rate until July 1, [2019,]
 2020, at which time and thereafter such surcharge shall not exceed twen-
 ty-five percent of the approved adequate  rate,  and  that  such  annual
 surcharges shall continue for such period of time as shall be sufficient
 to  satisfy  such  deficiency.  The superintendent shall not impose such
 surcharge during the period commencing July 1, 2009 and ending June  30,
 2010.  On  and  after  July  1,  1989,  the surcharge prescribed by this
 section shall be retained by insurers to the extent  that  they  insured
 physicians  and surgeons during the July 1, 1985 through June 30, [2019]
 2020 policy periods; in the event  and  to  the  extent  physicians  and
 surgeons  were  insured by another insurer during such periods, all or a
 pro rata share of the surcharge, as the case may be, shall  be  remitted
 to  such  other  insurer  in accordance with rules and regulations to be
 promulgated by the superintendent.  Surcharges collected from physicians
 and surgeons who were not insured during such policy  periods  shall  be
 apportioned  among  all insurers in proportion to the premium written by

 S. 1507--A                         30                         A. 2007--A
 
 each insurer during such policy periods; if a physician or  surgeon  was
 insured by an insurer subject to rates established by the superintendent
 during  such  policy  periods,  and  at  any time thereafter a hospital,
 health  maintenance organization, employer or institution is responsible
 for responding in damages for liability arising out of such  physician's
 or  surgeon's  practice  of medicine, such responsible entity shall also
 remit to such prior insurer the equivalent amount  that  would  then  be
 collected  as  a  surcharge if the physician or surgeon had continued to
 remain insured by such prior insurer. In  the  event  any  insurer  that
 provided  coverage  during  such  policy  periods is in liquidation, the
 property/casualty insurance security fund shall receive the  portion  of
 surcharges to which the insurer in liquidation would have been entitled.
 The surcharges authorized herein shall be deemed to be income earned for
 the  purposes of section 2303 of the insurance law.  The superintendent,
 in establishing adequate rates and in determining  any  projected  defi-
 ciency  pursuant  to  the requirements of this section and the insurance
 law, shall give substantial weight, determined  in  his  discretion  and
 judgment,  to  the  prospective  anticipated  effect  of any regulations
 promulgated and laws enacted and the  public  benefit  of    stabilizing
 malpractice rates and minimizing rate level fluctuation during the peri-
 od  of  time  necessary for the development of more reliable statistical
 experience as to the efficacy of such  laws  and  regulations  affecting
 medical, dental or podiatric malpractice enacted or promulgated in 1985,
 1986,  by this act and at any other time.  Notwithstanding any provision
 of the insurance law, rates already established and to be established by
 the superintendent pursuant to this section are deemed adequate if  such
 rates  would be adequate when taken together with the maximum authorized
 annual surcharges to be imposed for a reasonable period of time  whether
 or  not  any  such  annual surcharge has been actually imposed as of the
 establishment of such rates.
   § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J  of
 chapter  63  of  the  laws  of 2001, amending chapter 266 of the laws of
 1986, amending the civil practice law and rules and other laws  relating
 to  malpractice and professional medical conduct, relating to the effec-
 tiveness of certain provisions of such chapter, as amended by section  5
 of  part  M  of  chapter  57 of the laws of 2018, are amended to read as
 follows:
   § 5. The superintendent of financial services and the commissioner  of
 health shall determine, no later than June 15, 2002, June 15, 2003, June
 15,  2004,  June  15, 2005, June 15, 2006, June 15, 2007, June 15, 2008,
 June 15, 2009, June 15, 2010, June 15, 2011, June  15,  2012,  June  15,
 2013,  June  15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June
 15, 2018, [and] June 15, 2019, AND JUNE 15, 2020  the  amount  of  funds
 available  in  the  hospital  excess liability pool, created pursuant to
 section 18 of chapter 266 of the laws of 1986, and  whether  such  funds
 are  sufficient for purposes of purchasing excess insurance coverage for
 eligible participating physicians and dentists during the period July 1,
 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003
 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,  2005  to
 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June
 30,  2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
 2010, or July 1, 2010 to June 30, 2011, or July  1,  2011  to  June  30,
 2012,  or  July  1,  2012  to June 30, 2013, or July 1, 2013 to June 30,
 2014, or July 1, 2014 to June 30, 2015, or July  1,  2015  to  June  30,
 2016,  or  July  1,  2016  to June 30, 2017, or July 1, 2017 to June 30,

 S. 1507--A                         31                         A. 2007--A
 
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (a)  This section shall be effective only upon a determination, pursu-
 ant to section five of this act,  by  the  superintendent  of  financial
 services  and  the  commissioner  of health, and a certification of such
 determination to the state director of the  budget,  the  chair  of  the
 senate  committee  on finance and the chair of the assembly committee on
 ways and means, that the amount of funds in the hospital excess  liabil-
 ity  pool,  created pursuant to section 18 of chapter 266 of the laws of
 1986, is insufficient for purposes of purchasing excess insurance cover-
 age for eligible participating physicians and dentists during the period
 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July
 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or  July  1,
 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007
 to  June  30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to
 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June
 30, 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June  30,
 2014,  or  July  1,  2014  to June 30, 2015, or July 1, 2015 to June 30,
 2016, or July 1, 2016 to June 30, 2017, or July  1,  2017  to  June  30,
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (e)  The  commissioner  of  health  shall  transfer for deposit to the
 hospital excess liability pool created pursuant to section 18 of chapter
 266 of the laws of 1986 such amounts as directed by  the  superintendent
 of  financial  services  for  the purchase of excess liability insurance
 coverage for eligible participating  physicians  and  dentists  for  the
 policy  year  July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30,
 2003, or July 1, 2003 to June 30, 2004, or July  1,  2004  to  June  30,
 2005,  or  July  1,  2005  to June 30, 2006, or July 1, 2006 to June 30,
 2007, as applicable, and the cost of administering the  hospital  excess
 liability pool for such applicable policy year,  pursuant to the program
 established  in  chapter  266  of the laws of 1986, as amended, no later
 than June 15, 2002, June 15, 2003, June 15, 2004, June  15,  2005,  June
 15,  2006,  June  15, 2007, June 15, 2008, June 15, 2009, June 15, 2010,
 June 15, 2011, June 15, 2012, June 15, 2013, June  15,  2014,  June  15,
 2015,  June 15, 2016, June 15, 2017, June 15, 2018, [and] June 15, 2019,
 AND JUNE 15, 2020 as applicable.
   § 6. Section 20 of part H of chapter 57 of the laws of 2017,  amending
 the  New  York Health Care Reform Act of 1996 and other laws relating to
 extending certain provisions thereto, as amended by section 6 of part  M
 of chapter 57 of the laws of 2018, is amended to read as follows:
   §  20.  Notwithstanding  any  law, rule or regulation to the contrary,
 only physicians or dentists who were eligible, and for whom  the  super-
 intendent of financial services and the commissioner of health, or their
 designee, purchased, with funds available in the hospital excess liabil-
 ity  pool,  a  full  or partial policy for excess coverage or equivalent
 excess coverage for the coverage period ending the  thirtieth  of  June,
 two  thousand  [eighteen,] NINETEEN, shall be eligible to apply for such
 coverage for the coverage period beginning the first of July, two  thou-
 sand  [eighteen;]  NINETEEN;  provided,  however, if the total number of
 physicians or dentists for  whom  such  excess  coverage  or  equivalent
 excess  coverage  was purchased for the policy year ending the thirtieth
 of June, two thousand [eighteen] NINETEEN exceeds the  total  number  of
 physicians  or  dentists  certified  as eligible for the coverage period
 beginning the first of July, two thousand [eighteen,] NINETEEN, then the
 general hospitals may certify additional eligible physicians or dentists

 S. 1507--A                         32                         A. 2007--A
 
 in a number equal to such general hospital's proportional share  of  the
 total  number  of  physicians  or  dentists  for whom excess coverage or
 equivalent excess coverage was purchased with  funds  available  in  the
 hospital excess liability pool as of the thirtieth of June, two thousand
 [eighteen,] NINETEEN, as applied to the difference between the number of
 eligible physicians or dentists for whom a policy for excess coverage or
 equivalent  excess coverage was purchased for the coverage period ending
 the thirtieth of June, two thousand [eighteen] NINETEEN and  the  number
 of  such  eligible  physicians  or  dentists who have applied for excess
 coverage or equivalent excess coverage for the coverage period beginning
 the first of July, two thousand [eighteen] NINETEEN.
   § 7. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART G
 
   Section 1. Paragraph (a) of subdivision 3 of section 366 of the social
 services  law  is  REPEALED  and a new paragraph (a) is added to read as
 follows:
   (A) MEDICAL ASSISTANCE SHALL BE FURNISHED WITHOUT CONSIDERATION OF THE
 INCOME AND RESOURCES OF AN APPLICANT'S LEGALLY RESPONSIBLE  RELATIVE  IF
 THE  APPLICANT'S  ELIGIBILITY  WOULD NORMALLY BE DETERMINED BY COMPARING
 THE AMOUNT OF  AVAILABLE  INCOME  AND/OR  RESOURCES  OF  THE  APPLICANT,
 INCLUDING AMOUNTS DEEMED AVAILABLE TO THE APPLICANT FROM LEGALLY RESPON-
 SIBLE RELATIVES, TO AN APPLICABLE ELIGIBILITY STANDARD, AND:
   (1)  (I)  THE  LEGALLY  RESPONSIBLE RELATIVE IS A COMMUNITY SPOUSE, AS
 DEFINED IN SECTION THREE HUNDRED SIXTY-SIX-C OF THIS TITLE;
   (II) SUCH RELATIVE IS REFUSING  TO  MAKE  HIS  OR  HER  INCOME  AND/OR
 RESOURCES  AVAILABLE  TO  MEET  THE  COST  OF  NECESSARY  MEDICAL  CARE,
 SERVICES, AND SUPPLIES; AND
   (III) THE APPLICANT EXECUTES AN ASSIGNMENT OF SUPPORT FROM THE  COMMU-
 NITY SPOUSE IN FAVOR OF THE SOCIAL SERVICES DISTRICT AND THE DEPARTMENT,
 UNLESS  THE  APPLICANT IS UNABLE TO EXECUTE SUCH ASSIGNMENT DUE TO PHYS-
 ICAL OR MENTAL IMPAIRMENT OR TO DENY ASSISTANCE WOULD  CREATE  AN  UNDUE
 HARDSHIP, AS DEFINED BY THE COMMISSIONER; OR
   (2)  THE  LEGALLY  RESPONSIBLE RELATIVE IS ABSENT FROM THE APPLICANT'S
 HOUSEHOLD, AND FAILS OR  REFUSES  TO  MAKE  HIS  OR  HER  INCOME  AND/OR
 RESOURCES  AVAILABLE  TO  MEET  THE  COST  OF  NECESSARY  MEDICAL  CARE,
 SERVICES, AND SUPPLIES.
   IN SUCH CASES, HOWEVER, THE FURNISHING OF SUCH ASSISTANCE SHALL CREATE
 AN IMPLIED CONTRACT WITH SUCH RELATIVE, AND  THE  COST  THEREOF  MAY  BE
 RECOVERED  FROM  SUCH  RELATIVE  IN ACCORDANCE WITH TITLE SIX OF ARTICLE
 THREE OF THIS CHAPTER AND OTHER APPLICABLE PROVISIONS OF LAW.
   § 2. Paragraphs (c), (d), (e), (f), (g), and (h)  of  subdivision  4-a
 and  subdivision  4-c  of  section  365-f of the social services law are
 REPEALED, and paragraph (i) of subdivision 4-a is  relettered  paragraph
 (c).
   Section 3. Subdivision 4-a of section 365-f of the social services law
 is  redesignated as subdivision 5, and subparagraph (i) of paragraph (a)
 of such subdivision is amended as follows:
   [4-a] 5.  Fiscal intermediary services. (a) For the purposes  of  this
 section:
   (i)  "Fiscal intermediary" means an entity that provides fiscal inter-
 mediary services and has a contract for providing such services with[:
   (A) a local department of social services;

 S. 1507--A                         33                         A. 2007--A

   (B) an organization licensed under article forty-four  of  the  public
 health law; or
   (C)  an  accountable care organization certified under article twenty-
 nine-E of the  public  health  law  or  an  integrated  delivery  system
 composed primarily of health care providers recognized by the department
 as  a performing provider system under the delivery system reform incen-
 tive payment program] THE DEPARTMENT OF HEALTH AND IS  SELECTED  THROUGH
 THE  PROCUREMENT PROCESS DESCRIBED IN PARAGRAPH (B) OF THIS SUBDIVISION,
 OR BY AUTHORIZATION UPON APPLICATION IN ACCORDANCE WITH SUCH CRITERIA AS
 THE DEPARTMENT MAY DEVELOP TOGETHER WITH SUCH OTHER FORMS  AND  INFORMA-
 TION  PRESCRIBED BY, OR ACCEPTABLE TO, THE COMMISSIONER. ELIGIBLE APPLI-
 CANTS FOR AUTHORIZATION UNDER THIS PARAGRAPH  ARE  LIMITED  TO  ENTITIES
 THAT:
   (A)  ARE  A  SERVICE  CENTER  FOR INDEPENDENT LIVING UNDER SECTION ONE
 THOUSAND ONE HUNDRED TWENTY-ONE OF THE EDUCATION LAW; OR
   (B) HAVE A HISTORY  OF  PROVIDING  FISCAL  INTERMEDIARY  SERVICES  FOR
 PERSONS WITH DISABILITIES, AS DEMONSTRATED BY HAVING A CONTINUOUS HISTO-
 RY  OF  ARRANGEMENTS WITH LOCAL DEPARTMENTS OF SOCIAL SERVICES BEGINNING
 NO LATER THAN JANUARY FIRST, TWO THOUSAND TWELVE.
   § 4. Paragraph (b) of subdivision 4-a, redesignated as  subdivision  5
 pursuant  to  section  3  of  this  Part, of section 365-f of the social
 services law is amended as follows:
   (b) [No entity shall provide, directly  or  through  contract,  fiscal
 intermediary  services without an authorization as a fiscal intermediary
 issued by the commissioner in accordance with this subdivision] NOTWITH-
 STANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED  TWELVE  AND
 ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION ONE HUNDRED
 FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW, THE COMMIS-
 SIONER  IS  AUTHORIZED  TO ENTER INTO A CONTRACT OR CONTRACTS UNDER THIS
 SUBDIVISION WITH AN ENTITY OR ENTITIES  WITHOUT  A  COMPETITIVE  BID  OR
 REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
   (I)  THE DEPARTMENT SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS
 THAN THIRTY DAYS:
   (A) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT  TO
 THE CONTRACT OR CONTRACTS;
   (B) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
   (C)  THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
 SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER  SUCH  INFORMA-
 TION IS FIRST POSTED ON THE WEBSITE; AND
   (D)  THE  MANNER  BY  WHICH  A  PROSPECTIVE  CONTRACTOR  MAY SEEK SUCH
 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
   (II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED  FROM
 PROSPECTIVE  CONTRACTORS  IN  TIMELY  FASHION  SHALL  BE REVIEWED BY THE
 COMMISSIONER; AND
   (III) THE COMMISSIONER SHALL SELECT  SUCH  CONTRACTOR  OR  CONTRACTORS
 THAT,  IN  THE  COMMISSIONER'S  DISCRETION, ARE BEST SUITED TO SERVE THE
 PURPOSES OF THIS SECTION.
   § 5. Subdivision 4-b of section 365-f of the social  services  law  is
 REPEALED  and  current  subdivisions  5, 6, 7, 8 and 9 are redesigned as
 subdivisions 6, 7, 8, 9, and 10.
   § 6. This act shall take effect immediately and  shall  be  deemed  to
 have  been in full force and effect on and after April 1, 2019; provided
 however, that sections three, four, and five  of  this  act  shall  take
 effect January 1, 2020.

                                  PART H

 S. 1507--A                         34                         A. 2007--A
 
   Section  1.  Subparagraph  (v)  of paragraph (b) of subdivision 5-b of
 section 2807-k of the public health law is REPEALED.
   §  2. Section 2807 of the public health law is amended by adding a new
 subdivision 20-a to read as follows:
   20-A. NOTWITHSTANDING ANY  PROVISION  OF  LAW  TO  THE  CONTRARY,  THE
 COMMISSIONERS  OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH,
 THE OFFICE OF PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE  OF
 ALCOHOLISM  AND  SUBSTANCE  ABUSE  SERVICES  ARE AUTHORIZED TO WAIVE ANY
 REGULATORY REQUIREMENTS AS ARE  NECESSARY,  CONSISTENT  WITH  APPLICABLE
 LAW,  TO  ALLOW  PROVIDERS THAT ARE INVOLVED IN DSRIP PROJECTS OR REPLI-
 CATION AND SCALING ACTIVITIES, AS APPROVED BY  THE  AUTHORIZING  COMMIS-
 SIONER,  TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE EFFICIENT
 SCALING AND REPLICATION OF DSRIP PROMISING PRACTICES, AS  DETERMINED  BY
 THE   AUTHORIZING   COMMISSIONER;  PROVIDED  HOWEVER,  THAT  REGULATIONS
 PERTAINING TO PATIENT SAFETY MAY NOT BE  WAIVED,  NOR  SHALL  ANY  REGU-
 LATIONS BE WAIVED IF SUCH WAIVER WOULD RISK PATIENT SAFETY.
   §  3.  Subparagraph (i) of paragraph (e-1) of subdivision 4 of section
 2807-c of the public health law, as amended by section 29 of part  C  of
 chapter 60 of the laws of 2014, is amended to read as follows:
   (i)  For  rate periods on and after April first, two thousand ten, the
 commissioner, in consultation with the commissioner  of  the  office  of
 mental health, shall promulgate regulations, and may promulgate emergen-
 cy regulations, establishing methodologies for determining the operating
 cost  components  of  rates  of  payments for services described in this
 paragraph. Such regulations shall utilize two  thousand  five  operating
 costs  as  submitted to the department prior to July first, two thousand
 nine and [shall] MAY provide for  methodologies  establishing  per  diem
 inpatient  rates that utilize case mix adjustment mechanisms. Such regu-
 lations [shall] MAY contain criteria for adjustments based on length  of
 stay  and  may  also  provide for a base year update, provided, however,
 that such base year update shall  take  effect  no  earlier  than  April
 first,  two  thousand  fifteen,  and provided further, however, that the
 commissioner may make such adjustments to such utilization  and  to  the
 methodology  for  computing  such  rates  as  is necessary to achieve no
 aggregate, net growth in overall Medicaid expenditures related  to  such
 rates,  as  compared to such aggregate expenditures from the prior year.
 In determining the updated base year to be  utilized  pursuant  to  this
 subparagraph,  the  commissioner  shall  take into account the base year
 determined in accordance with paragraph (c) of  subdivision  thirty-five
 of this section.
   §  4.  Subdivision  35  of  section 2807-c of the public health law is
 amended by adding a new paragraph (k) to read as follows:
   (K) NOTWITHSTANDING ANY CONTRARY PROVISION OF  LAW,  THE  COMMISSIONER
 MAY MAKE SUCH ADJUSTMENTS TO GENERAL HOSPITAL INPATIENT RATES AND TO THE
 METHODOLOGY  FOR COMPUTING SUCH RATES AS IS NECESSARY TO REDUCE PAYMENTS
 TO FACILITIES WITH A HIGHER PERCENTAGE OF  POTENTIALLY  AVOIDABLE  INPA-
 TIENT  SERVICES  BY  INSTITUTING  LOWER INPATIENT PAYMENT RATES FOR BOTH
 FEE-FOR-SERVICE AND MANAGED CARE TO INCENTIVIZE THE PROVISION OF PREVEN-
 TATIVE CARE TO REDUCE PREVENTABLE EVENTS AND OVERALL INPATIENT COSTS.  A
 PORTION  OF SUCH SAVINGS DERIVED FROM THE IMPLEMENTATION OF SUCH PAYMENT
 METHODOLOGIES SHALL BE REINVESTED  IN  INITIATIVES  TO  INCENTIVIZE  THE
 PROVISION OF PREVENTATIVE CARE, MATERNITY SERVICES, AND OTHER AMBULATORY
 CARE SERVICES TO REDUCE PREVENTABLE HEALTH CARE COSTS.
   § 5. Social Services Law section 367-u, as amended by chapter 6 of the
 laws of 2015, is amended to read as follows:

 S. 1507--A                         35                         A. 2007--A
 
   §  367-u.  Payment  for  home  telehealth  services. 1. Subject to the
 approval of the state director  of  the  budget,  the  commissioner  may
 authorize  the  payment  of  medical  assistance funds for demonstration
 rates or fees established for home telehealth services provided pursuant
 to  subdivision  three-c  of  section thirty-six hundred fourteen of the
 public health law.
   2. Subject to federal financial participation and the approval of  the
 director  of  the  budget,  the  commissioner shall not exclude from the
 payment of medical assistance funds the delivery of health care services
 through telehealth, as defined in subdivision four of section two  thou-
 sand  nine  hundred  ninety-nine-cc  of the public health law; PROVIDED,
 HOWEVER, FOR TELEHEALTH SERVICES PROVIDED TO INDIVIDUALS DUALLY ENROLLED
 IN MEDICAID AND MEDICARE, THE COMMISSIONER IS AUTHORIZED  TO  PROMULGATE
 REGULATIONS  GOVERNING  MEDICAID  COVERAGE  AND  REIMBURSEMENT  OF  SUCH
 SERVICES, INCLUDING DEVELOPMENT OF A COVERED SERVICES LIST WHICH MAY  BE
 LIMITED  TO HIGHER PRIORITY SERVICES AND PROCEDURES. Such services shall
 meet the requirements of federal law,  rules  and  regulations  for  the
 provision of medical assistance pursuant to this title.
   §  6.  Subdivision  5-d of section 2807-k of the public health law, as
 amended by chapter 57 of the laws of 28, is amended to read as follows.
   5-d. (a) Notwithstanding any inconsistent provision of  this  section,
 section  twenty-eight  hundred  seven-w  of  this  article  or any other
 contrary provision of law, and subject to the  availability  of  federal
 financial  participation,  for  periods  on and after January first, two
 thousand thirteen, through March  thirty-first,  two  thousand  [twenty]
 TWENTY-ONE,  all  funds  available  for  distribution  pursuant  to this
 section, except for funds distributed pursuant to  subparagraph  (v)  of
 paragraph  (b)  of  subdivision  five-b  of  this section, and all funds
 available for distribution  pursuant  to  section  twenty-eight  hundred
 seven-w of this article, shall be reserved and set aside and distributed
 in accordance with the provisions of this subdivision.
   (b)  The commissioner shall promulgate regulations, and may promulgate
 emergency regulations, establishing methodologies for  the  distribution
 of  funds  as  described  in  paragraph (a) of this subdivision and such
 regulations shall include, but not be limited to, the following:
   (i) Such regulations shall  establish  methodologies  for  determining
 each  facility's  relative uncompensated care need amount based on unin-
 sured inpatient and outpatient units of service from the cost  reporting
 year  two years prior to the distribution year, multiplied by the appli-
 cable medicaid rates in effect January first of the  distribution  year,
 as summed and adjusted by a statewide cost adjustment factor and reduced
 by  the  sum  of  all  payment  amounts  collected  from  such uninsured
 patients, and as further adjusted  by  application  of  a  nominal  need
 computation  that shall take into account each facility's medicaid inpa-
 tient share.
   (ii) Annual distributions pursuant to such  regulations  for  the  two
 thousand  thirteen through two thousand [nineteen] TWENTY calendar years
 shall be in accord with the following:
   (A) one hundred thirty-nine  million  four  hundred  thousand  dollars
 shall be distributed as Medicaid Disproportionate Share Hospital ("DSH")
 payments to major public general hospitals; and
   (B)  [nine  hundred ninety-four] SEVEN HUNDRED NINETEEN million [nine]
 FOUR hundred thousand dollars  as  Medicaid  DSH  payments  to  eligible
 general hospitals, other than major public general hospitals; and
   (C) PROVIDED, HOWEVER, THAT NOTWITHSTANDING ANY INCONSISTENT PROVISION
 OF  THIS SECTION, FOR ALL CALENDAR YEARS BEGINNING ON JANUARY FIRST, TWO

 S. 1507--A                         36                         A. 2007--A
 
 THOUSAND TWENTY, GENERAL HOSPITALS LOCATED IN A CITY WITH  A  POPULATION
 OF  MORE THAN ONE MILLION PERSONS AND/OR IN THE COUNTIES OF WESTCHESTER,
 SUFFOLK AND NASSAU, THAT HAVE, OR THAT THAT ARE  PART  OF  A  SYSTEM  OF
 CO-ESTABLISHED  GENERAL  HOSPITALS  THAT  COLLECTIVELY  HAS, AND AVERAGE
 OPERATING MARGIN GREATER THAN 2.98 WHERE  AVERAGE  OPERATING  MARGIN  IS
 CALCULATED  BY SUBTRACTING TOTAL OPERATING EXPENSES FROM TOTAL OPERATING
 REVENUE AND DIVIDING THE RESULT BY THE TOTAL OPERATING REVENUE, AND THAT
 ALSO HAVE, OR THAT THAT ARE PART OF A SYSTEM OF  CO-ESTABLISHED  GENERAL
 HOSPITALS  THAT  COLLECTIVELY  HAS,  A NET OPERATING INCOME OF MORE THAN
 SIXTY-EIGHT MILLION DOLLARS, BOTH AS DETERMINED BY THE DEPARTMENT PURSU-
 ANT TO THE HOSPITAL INSTITUTIONAL COST REPORTS  FOR  YEAR  TWO  THOUSAND
 SEVENTEEN,  SHALL  ONLY BE ELIGIBLE FOR INDIGENT CARE POOL PAYMENTS OF A
 MAXIMUM OF TEN THOUSAND DOLLARS.
   (iii)(A) Such regulations shall establish  transition  adjustments  to
 the  distributions  made pursuant to clauses (A) and (B) of subparagraph
 (ii) of this paragraph such that no facility experiences a reduction  in
 indigent care pool payments pursuant to this subdivision that is greater
 than the percentages, as specified in clause (C) of this subparagraph as
 compared  to  the  average distribution that each such facility received
 for the three calendar years prior to two thousand thirteen pursuant  to
 this section and section twenty-eight hundred seven-w of this article.
   (B)  Such  regulations  shall  also establish adjustments limiting the
 increases in indigent  care  pool  payments  experienced  by  facilities
 pursuant to this subdivision by an amount that will be, as determined by
 the  commissioner  and  in conjunction with such other funding as may be
 available for this purpose, sufficient to ensure full  funding  for  the
 transition adjustment payments authorized by clause (A) of this subpara-
 graph.
   (C)  No  facility  shall  experience a reduction in indigent care pool
 payments pursuant to this subdivision that: for the calendar year begin-
 ning January first, two thousand thirteen, is greater than two and  one-
 half  percent;  for the calendar year beginning January first, two thou-
 sand fourteen, is greater than five percent; and, for the calendar  year
 beginning  on January first, two thousand fifteen; is greater than seven
 and one-half percent, and for the calendar  year  beginning  on  January
 first,  two  thousand  sixteen, is greater than ten percent; and for the
 calendar year beginning on January first,  two  thousand  seventeen,  is
 greater  than  twelve  and  one-half  percent; and for the calendar year
 beginning on January first,  two  thousand  eighteen,  is  greater  than
 fifteen  percent;  and for the calendar year beginning on January first,
 two thousand nineteen, is greater than seventeen and one-half percent.
   (iv) Such regulations shall reserve one percent of the funds available
 for distribution in the two thousand fourteen and two  thousand  fifteen
 calendar  years,  and  for  calendar  years thereafter, pursuant to this
 subdivision, subdivision  fourteen-f  of  section  twenty-eight  hundred
 seven-c of this article, and sections two hundred eleven and two hundred
 twelve  of  chapter  four  hundred  seventy-four of the laws of nineteen
 hundred ninety-six, in a  "financial  assistance  compliance  pool"  and
 shall establish methodologies for the distribution of such pool funds to
 facilities  based  on  their  level  of compliance, as determined by the
 commissioner, with the provisions of subdivision nine-a of this section.
   (c) The commissioner shall annually report to  the  governor  and  the
 legislature  on the distribution of funds under this subdivision includ-
 ing, but not limited to:
   (i) the impact on safety net providers, including community providers,
 rural general hospitals and major public general hospitals;

 S. 1507--A                         37                         A. 2007--A
 
   (ii) the provision of indigent care by units  of  services  and  funds
 distributed by general hospitals; and
   (iii) the extent to which access to care has been enhanced.
   § 7. This act shall take effect immediately.
 
                                  PART I
 
   Section  1. The insurance law is amended by adding a new article 29 to
 read as follows:
                                ARTICLE 29
                         PHARMACY BENEFIT MANAGERS
 SECTION 2901. DEFINITIONS.
         2902. ACTING WITHOUT A REGISTRATION.
         2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2905. ACTING WITHOUT A LICENSE.
         2906. LICENSING OF A PHARMACY BENEFIT MANAGER.
         2907. REVOCATION OR SUSPENSION OF A REGISTRATION OR LICENSE OF A
                 PHARMACY BENEFIT MANAGER.
         2908. PENALTIES FOR VIOLATIONS.
         2909. STAY OR SUSPENSION OF SUPERINTENDENT'S DETERMINATION.
         2910. REVOKED REGISTRATION OR LICENSES.
         2911. CHANGE OF ADDRESS.
         2912. APPLICABILITY OF OTHER LAWS.
         2913. ASSESSMENTS.
   § 2901. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE:
   (A) "CONTROLLING PERSON" IS ANY PERSON OR OTHER ENTITY  WHO  OR  WHICH
 DIRECTLY  OR  INDIRECTLY HAS THE POWER TO DIRECT OR CAUSE TO BE DIRECTED
 THE MANAGEMENT, CONTROL OR ACTIVITIES OF A PHARMACY BENEFIT MANAGER.
   (B) "HEALTH INSURER" MEANS AN INSURANCE  COMPANY  AUTHORIZED  IN  THIS
 STATE TO WRITE ACCIDENT AND HEALTH INSURANCE, A COMPANY ORGANIZED PURSU-
 ANT  TO  ARTICLE  FORTY-THREE  OF  THIS CHAPTER, A MUNICIPAL COOPERATIVE
 HEALTH BENEFIT PLAN ESTABLISHED PURSUANT TO ARTICLE FORTY-SEVEN OF  THIS
 CHAPTER, AN ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
 PUBLIC HEALTH LAW, AN INSTITUTION OF HIGHER EDUCATION CERTIFIED PURSUANT
 TO  SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, OR THE
 NEW YORK STATE HEALTH INSURANCE PLAN ESTABLISHED UNDER ARTICLE ELEVEN OF
 THE CIVIL SERVICE LAW.
   (C) "PHARMACY BENEFIT MANAGEMENT SERVICES" MEANS DIRECTLY  OR  THROUGH
 AN  INTERMEDIARY,  MANAGING THE PRESCRIPTION DRUG COVERAGE PROVIDED BY A
 HEALTH INSURER UNDER A CONTRACT OR POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY  IN  THIS  STATE  OR  A  PLAN  SUBJECT  TO  SECTION  THREE   HUNDRED
 SIXTY-FOUR-J  OF  THE  SOCIAL SERVICES LAW, INCLUDING THE PROCESSING AND
 PAYMENT OF CLAIMS FOR PRESCRIPTION DRUGS, THE PERFORMANCE OF DRUG UTILI-
 ZATION REVIEW, THE PROCESSING OF DRUG PRIOR AUTHORIZATION REQUESTS,  THE
 ADJUDICATION  OF  APPEALS  OR  GRIEVANCES  RELATED  TO PRESCRIPTION DRUG
 COVERAGE, CONTRACTING WITH NETWORK PHARMACIES, NEGOTIATION  OF  REBATES,
 AND CONTROLLING THE COST OF COVERED PRESCRIPTION DRUGS.
   (D)  "PHARMACY  BENEFIT  MANAGER"  MEANS  A PERSON, FIRM, ASSOCIATION,
 CORPORATION OR OTHER ENTITY THAT, PURSUANT TO A CONTRACT WITH  A  HEALTH
 INSURER  PROVIDES PHARMACY BENEFIT MANAGEMENT SERVICES, EXCEPT THAT TERM
 SHALL NOT INCLUDE:
   (1) AN OFFICER OR EMPLOYEE OF A REGISTERED OR LICENSED PHARMACY  BENE-
 FIT MANAGER; OR
   (2) A HEALTH INSURER, OR ANY MANAGER THEREOF, INDIVIDUAL OR CORPORATE,
 OR ANY OFFICER, DIRECTOR OR REGULAR SALARIED EMPLOYEE THEREOF, PROVIDING

 S. 1507--A                         38                         A. 2007--A
 
 PHARMACY  BENEFIT  MANAGEMENT SERVICES UNDER A POLICY OR CONTRACT ISSUED
 BY THE HEALTH INSURER.
   §  2902.  ACTING  WITHOUT A REGISTRATION. (A) NO PERSON, FIRM, ASSOCI-
 ATION, CORPORATION OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFITS MANAG-
 ER PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY WITHOUT  HAVING  A  VALID
 REGISTRATION AS A PHARMACY BENEFIT MANAGER FILED WITH THE SUPERINTENDENT
 IN  ACCORDANCE  WITH THIS ARTICLE AND ANY REGULATIONS PROMULGATED THERE-
 UNDER.
   (B) PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY, NO HEALTH INSURER MAY
 PAY ANY FEE OR OTHER COMPENSATION  TO  ANY  PERSON,  FIRM,  ASSOCIATION,
 CORPORATION  OR  OTHER ENTITY FOR PERFORMING PHARMACY BENEFIT MANAGEMENT
 SERVICES UNLESS THE PERSON,  FIRM,  ASSOCIATION,  CORPORATION  OR  OTHER
 ENTITY  IS  REGISTERED  AS A PHARMACY BENEFIT MANAGER IN ACCORDANCE WITH
 THIS ARTICLE.
   (C) ANY PERSON, FIRM, ASSOCIATION, CORPORATION OR  OTHER  ENTITY  THAT
 VIOLATES  THIS  SECTION SHALL, IN ADDITION TO ANY OTHER PENALTY PROVIDED
 BY LAW, BE LIABLE FOR RESTITUTION TO ANY INSURER OR  INSURED  HARMED  BY
 THE  VIOLATION  AND SHALL ALSO BE SUBJECT TO A PENALTY OF THE GREATER OF
 (1) ONE THOUSAND DOLLARS FOR THE FIRST VIOLATION AND TWO  THOUSAND  FIVE
 HUNDRED  DOLLARS  FOR  EACH  SUBSEQUENT  VIOLATION  OR (2) THE AGGREGATE
 ECONOMIC GROSS RECEIPTS ATTRIBUTABLE TO ALL VIOLATIONS.
   § 2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.   (A)
 EVERY PHARMACY BENEFIT MANAGER THAT PERFORMS PHARMACY BENEFIT MANAGEMENT
 SERVICES  PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY-ONE SHALL REGISTER
 WITH THE SUPERINTENDENT IN A MANNER ACCEPTABLE  TO  THE  SUPERINTENDENT,
 AND SHALL PAY A FEE OF ONE THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF
 A  YEAR IN WHICH THE REGISTRATION SHALL BE VALID. THE SUPERINTENDENT, IN
 CONSULTATION WITH THE COMMISSIONER OF HEALTH, MAY  ESTABLISH,  BY  REGU-
 LATION,  MINIMUM  REGISTRATION STANDARDS REQUIRED FOR A PHARMACY BENEFIT
 MANAGER. THE SUPERINTENDENT CAN REJECT A REGISTRATION APPLICATION  FILED
 BY  A  PHARMACY  BENEFIT  MANAGER  THAT FAILS TO COMPLY WITH THE MINIMUM
 REGISTRATION STANDARDS.
   (B) FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR  OR
 DIRECTORS  NAMED  IN THE APPLICATION SHALL BE DESIGNATED RESPONSIBLE FOR
 THE BUSINESS ENTITY'S COMPLIANCE WITH THE FINANCIAL SERVICES AND  INSUR-
 ANCE LAWS, RULES AND REGULATIONS OF THIS STATE.
   (C) EVERY REGISTRATION WILL EXPIRE ON DECEMBER THIRTY-FIRST, TWO THOU-
 SAND TWENTY REGARDLESS OF WHEN REGISTRATION WAS FIRST MADE.
   (D)  EVERY  PHARMACY  BENEFIT  MANAGER  THAT PERFORMS PHARMACY BENEFIT
 MANAGEMENT SERVICES AT ANY TIME  BETWEEN  JANUARY  FIRST,  TWO  THOUSAND
 NINETEEN AND JUNE FIRST, TWO THOUSAND NINETEEN, SHALL MAKE THE REGISTRA-
 TION  AND  FEE  PAYMENT REQUIRED BY SUBSECTION (A) OF THIS SECTION ON OR
 BEFORE JUNE FIRST, TWO THOUSAND NINETEEN.  ANY  OTHER  PHARMACY  BENEFIT
 MANAGER  SHALL  MAKE  THE  REGISTRATION  AND  FEE  PAYMENT  REQUIRED  BY
 SUBSECTION (A) OF THIS SECTION  PRIOR  TO  PERFORMING  PHARMACY  BENEFIT
 MANAGEMENT SERVICES.
   (E)  REGISTRANTS UNDER THIS SECTION SHALL BE SUBJECT TO EXAMINATION BY
 THE SUPERINTENDENT AS OFTEN AS THE SUPERINTENDENT MAY DEEM IT NECESSARY.
 THE SUPERINTENDENT MAY PROMULGATE REGULATIONS ESTABLISHING  METHODS  AND
 PROCEDURES  FOR  FACILITATING AND VERIFYING COMPLIANCE WITH THE REQUIRE-
 MENTS OF THIS ARTICLE AND SUCH OTHER REGULATIONS AS NECESSARY TO ENFORCE
 THE PROVISIONS OF THIS ARTICLE.
   § 2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.   (A)(1)
 ON  OR BEFORE JULY FIRST OF EACH YEAR, BEGINNING IN TWO THOUSAND TWENTY,
 EVERY PHARMACY BENEFIT MANAGER SHALL REPORT TO THE SUPERINTENDENT, IN  A
 STATEMENT  SUBSCRIBED  AND  AFFIRMED AS TRUE UNDER PENALTIES OF PERJURY,

 S. 1507--A                         39                         A. 2007--A
 
 THE INFORMATION REQUESTED BY THE SUPERINTENDENT INCLUDING, WITHOUT LIMI-
 TATION, DISCLOSURE OF ANY FINANCIAL INCENTIVE OR BENEFIT  FOR  PROMOTING
 THE  USE  OF  CERTAIN  DRUGS  AND OTHER FINANCIAL ARRANGEMENTS AFFECTING
 HEALTH  INSURERS  OR THEIR POLICYHOLDERS OR INSUREDS AND ANY INFORMATION
 RELATING TO THE BUSINESS, FINANCIAL CONDITION, OR MARKET CONDUCT OF  THE
 PHARMACY BENEFIT MANAGER. THE SUPERINTENDENT ALSO MAY REQUIRE THE FILING
 OF  QUARTERLY OR OTHER STATEMENTS, WHICH SHALL BE IN SUCH FORM AND SHALL
 CONTAIN SUCH MATTERS AS THE SUPERINTENDENT SHALL PRESCRIBE.
   (2) THE SUPERINTENDENT ALSO MAY ADDRESS TO ANY PHARMACY BENEFIT MANAG-
 ER OR ITS OFFICERS ANY INQUIRY IN RELATION TO ITS PROVISION OF  PHARMACY
 BENEFIT  MANAGEMENT  SERVICES  OR ANY MATTER CONNECTED THEREWITH.  EVERY
 PHARMACY BENEFIT MANAGER OR PERSON SO ADDRESSED SHALL REPLY  IN  WRITING
 TO  SUCH  INQUIRY  PROMPTLY  AND TRUTHFULLY, AND SUCH REPLY SHALL BE, IF
 REQUIRED BY THE SUPERINTENDENT, SUBSCRIBED BY  SUCH  INDIVIDUAL,  OR  BY
 SUCH  OFFICER OR OFFICERS OF THE PHARMACY BENEFIT MANAGER, AS THE SUPER-
 INTENDENT SHALL DESIGNATE, AND AFFIRMED BY THEM AS TRUE UNDER THE PENAL-
 TIES OF PERJURY.
   (B) IN THE EVENT ANY PHARMACY  BENEFIT  MANAGER  OR  PERSON  DOES  NOT
 SUBMIT  THE  REPORT  REQUIRED BY PARAGRAPH ONE OF SUBSECTION (A) OF THIS
 SECTION OR DOES NOT PROVIDE A GOOD FAITH RESPONSE TO AN INQUIRY FROM THE
 SUPERINTENDENT PURSUANT TO PARAGRAPH  TWO  OF  SUBSECTION  (A)  OF  THIS
 SECTION WITHIN A TIME PERIOD SPECIFIED BY THE SUPERINTENDENT OF NOT LESS
 THAN  FIFTEEN  BUSINESS DAYS, THE SUPERINTENDENT IS AUTHORIZED TO LEVY A
 CIVIL PENALTY, AFTER NOTICE AND HEARING, AGAINST SUCH  PHARMACY  BENEFIT
 MANAGER  OR  PERSON  NOT TO EXCEED FIVE HUNDRED DOLLARS PER DAY FOR EACH
 DAY BEYOND THE DATE THE REPORT IS DUE  OR  THE  DATE  SPECIFIED  BY  THE
 SUPERINTENDENT FOR RESPONSE TO THE INQUIRY.
   (C)  ALL  INFORMATION DISCLOSED BY A PHARMACY BENEFIT MANAGER SHALL BE
 DEEMED CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE UNLESS THE SUPERINTEN-
 DENT DETERMINES THAT SUCH DISCLOSURE IS IN THE PUBLIC  INTEREST,  OR  IS
 NECESSARY  TO  CARRY  OUT  THIS  ARTICLE  OR  TO ALLOW THE DEPARTMENT TO
 PERFORM EXAMINATIONS OR INVESTIGATIONS AUTHORIZED BY LAW.
   § 2905. ACTING WITHOUT A LICENSE. (A) NO  PERSON,  FIRM,  ASSOCIATION,
 CORPORATION  OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFIT MANAGER ON OR
 AFTER JANUARY FIRST, TWO THOUSAND TWENTY-ONE WITHOUT HAVING AUTHORITY TO
 DO SO BY VIRTUE OF A LICENSE ISSUED IN FORCE PURSUANT TO THE  PROVISIONS
 OF THIS ARTICLE.
   (B)  NO  HEALTH  INSURER  MAY PAY ANY FEE OR OTHER COMPENSATION TO ANY
 PERSON, FIRM, ASSOCIATION, CORPORATION OR OTHER  ENTITY  FOR  PERFORMING
 PHARMACY  BENEFIT  MANAGEMENT  SERVICES  ON  OR AFTER JANUARY FIRST, TWO
 THOUSAND TWENTY-ONE UNLESS THE PERSON, FIRM, ASSOCIATION, CORPORATION OR
 OTHER ENTITY IS LICENSED AS A PHARMACY  BENEFIT  MANAGER  IN  ACCORDANCE
 WITH THIS ARTICLE.
   (C)  ANY  PERSON,  FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY THAT
 VIOLATES THIS SECTION SHALL, IN ADDITION TO ANY OTHER  PENALTY  PROVIDED
 BY  LAW,  BE  SUBJECT  TO  A  PENALTY OF THE GREATER OF (1) ONE THOUSAND
 DOLLARS FOR THE FIRST VIOLATION AND TWO THOUSAND  FIVE  HUNDRED  DOLLARS
 FOR  EACH  SUBSEQUENT  VIOLATION  OR  (2)  THE  AGGREGATE GROSS RECEIPTS
 ATTRIBUTABLE TO ALL VIOLATIONS.
   § 2906. LICENSING OF A PHARMACY BENEFIT MANAGER. (A)  THE  SUPERINTEN-
 DENT MAY ISSUE A PHARMACY BENEFIT MANAGER'S LICENSE TO ANY PERSON, FIRM,
 ASSOCIATION  OR  CORPORATION  WHO OR THAT HAS COMPLIED WITH THE REQUIRE-
 MENTS OF THIS ARTICLE, INCLUDING REGULATIONS PROMULGATED BY  THE  SUPER-
 INTENDENT.  THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONER OF
 HEALTH, MAY ESTABLISH, BY REGULATION, MINIMUM STANDARDS FOR THE ISSUANCE
 OF A LICENSE TO A PHARMACY BENEFIT MANAGER.

 S. 1507--A                         40                         A. 2007--A
 
   (B) THE  MINIMUM  STANDARDS  ESTABLISHED  UNDER  THIS  SUBSECTION  MAY
 ADDRESS, WITHOUT LIMITATION:
   (1) CONFLICTS OF INTEREST BETWEEN PHARMACY BENEFIT MANAGERS AND HEALTH
 INSURERS;
   (2) DECEPTIVE PRACTICES IN CONNECTION WITH THE PERFORMANCE OF PHARMACY
 BENEFIT MANAGEMENT SERVICES;
   (3)  ANTI-COMPETITIVE  PRACTICES IN CONNECTION WITH THE PERFORMANCE OF
 PHARMACY BENEFIT MANAGEMENT SERVICES;
   (4) UNFAIR CLAIMS PRACTICES IN  CONNECTION  WITH  THE  PERFORMANCE  OF
 PHARMACY BENEFIT MANAGEMENT SERVICES; AND
   (5) PROTECTION OF CONSUMERS.
   (C)(1)  ANY SUCH LICENSE ISSUED TO A FIRM OR ASSOCIATION SHALL AUTHOR-
 IZE ALL OF THE MEMBERS OF THE FIRM OR  ASSOCIATION  AND  ANY  DESIGNATED
 EMPLOYEES TO ACT AS PHARMACY BENEFIT MANAGERS UNDER THE LICENSE, AND ALL
 SUCH PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (2)  ANY  SUCH  LICENSE ISSUED TO A CORPORATION SHALL AUTHORIZE ALL OF
 THE OFFICERS AND ANY DESIGNATED EMPLOYEES AND DIRECTORS THEREOF  TO  ACT
 AS PHARMACY BENEFIT MANAGERS ON BEHALF OF SUCH CORPORATION, AND ALL SUCH
 PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (3)  FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR OR
 DIRECTORS NAMED IN THE APPLICATION SHALL BE DESIGNATED  RESPONSIBLE  FOR
 THE  BUSINESS  ENTITY'S  COMPLIANCE  WITH  THE INSURANCE LAWS, RULES AND
 REGULATIONS OF THIS STATE.
   (D)(1) BEFORE A PHARMACY BENEFIT MANAGER'S LICENSE SHALL BE ISSUED  OR
 RENEWED,  THE  PROSPECTIVE LICENSEE SHALL PROPERLY FILE IN THE OFFICE OF
 THE SUPERINTENDENT A WRITTEN APPLICATION THEREFOR IN SUCH FORM OR  FORMS
 AND  SUPPLEMENTS THERETO AS THE SUPERINTENDENT PRESCRIBES, AND PAY A FEE
 OF ONE THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF A YEAR IN  WHICH  A
 LICENSE SHALL BE VALID.
   (2)  EVERY  PHARMACY  BENEFIT  MANAGER'S  LICENSE ISSUED TO A BUSINESS
 ENTITY PURSUANT TO THIS SECTION SHALL EXPIRE ON  THE  THIRTIETH  DAY  OF
 NOVEMBER  OF  EVEN-NUMBERED YEARS. EVERY LICENSE ISSUED PURSUANT TO THIS
 SECTION TO AN INDIVIDUAL PHARMACY BENEFIT MANAGER WHO  WAS  BORN  IN  AN
 ODD-NUMBERED  YEAR,  SHALL  EXPIRE  ON THE INDIVIDUAL'S BIRTHDAY IN EACH
 ODD-NUMBERED YEAR. EVERY LICENSE ISSUED PURSUANT TO THIS SECTION  TO  AN
 INDIVIDUAL  PHARMACY  BENEFIT  MANAGER  WHO WAS BORN IN AN EVEN-NUMBERED
 YEAR, SHALL EXPIRE ON THE INDIVIDUAL'S BIRTHDAY  IN  EACH  EVEN-NUMBERED
 YEAR.   EVERY LICENSE ISSUED PURSUANT TO THIS SECTION MAY BE RENEWED FOR
 THE ENSUING PERIOD OF TWENTY-FOUR MONTHS UPON THE FILING OF AN  APPLICA-
 TION IN CONFORMITY WITH THIS SUBSECTION.
   (E)(1)  IF  AN APPLICATION FOR A RENEWAL LICENSE SHALL HAVE BEEN FILED
 WITH THE SUPERINTENDENT BEFORE OCTOBER FIRST OF THE YEAR OF  EXPIRATION,
 THEN  THE  LICENSE SOUGHT TO BE RENEWED SHALL CONTINUE IN FULL FORCE AND
 EFFECT EITHER UNTIL THE ISSUANCE BY THE SUPERINTENDENT  OF  THE  RENEWAL
 LICENSE  APPLIED  FOR  OR UNTIL FIVE DAYS AFTER THE SUPERINTENDENT SHALL
 HAVE REFUSED TO ISSUE SUCH RENEWAL LICENSE  AND  GIVEN  NOTICE  OF  SUCH
 REFUSAL TO THE APPLICANT.
   (2)  BEFORE REFUSING TO RENEW ANY LICENSE PURSUANT TO THIS SECTION FOR
 WHICH A RENEWAL APPLICATION HAS BEEN FILED PURSUANT TO PARAGRAPH ONE  OF
 THIS  SUBSECTION,  THE  SUPERINTENDENT SHALL NOTIFY THE APPLICANT OF THE
 SUPERINTENDENT'S INTENTION TO DO SO AND  SHALL  GIVE  SUCH  APPLICANT  A
 HEARING.
   (F)  THE  SUPERINTENDENT MAY REFUSE TO ISSUE A PHARMACY BENEFIT MANAG-
 ER'S LICENSE IF, IN THE SUPERINTENDENT'S JUDGMENT, THE APPLICANT OR  ANY
 MEMBER,  PRINCIPAL,  OFFICER OR DIRECTOR OF THE APPLICANT, IS NOT TRUST-
 WORTHY AND COMPETENT TO ACT AS OR IN CONNECTION WITH A PHARMACY  BENEFIT

 S. 1507--A                         41                         A. 2007--A
 
 MANAGER,  OR THAT ANY OF THE FOREGOING HAS GIVEN CAUSE FOR REVOCATION OR
 SUSPENSION OF SUCH LICENSE, OR HAS FAILED TO COMPLY WITH  ANY  PREREQUI-
 SITE FOR THE ISSUANCE OF SUCH LICENSE.
   (G) LICENSEES AND APPLICANTS FOR A LICENSE UNDER THIS SECTION SHALL BE
 SUBJECT TO EXAMINATION BY THE SUPERINTENDENT AS OFTEN AS THE SUPERINTEN-
 DENT  MAY  DEEM  IT  EXPEDIENT.  THE SUPERINTENDENT MAY PROMULGATE REGU-
 LATIONS ESTABLISHING METHODS AND PROCEDURES FOR FACILITATING AND VERIFY-
 ING COMPLIANCE WITH THE REQUIREMENTS OF  THIS  SECTION  AND  SUCH  OTHER
 REGULATIONS AS NECESSARY.
   (H)  THE  SUPERINTENDENT  MAY  ISSUE  A  REPLACEMENT  FOR  A CURRENTLY
 IN-FORCE LICENSE THAT HAS BEEN LOST OR DESTROYED. BEFORE THE REPLACEMENT
 LICENSE SHALL BE ISSUED, THERE SHALL BE ON FILE IN  THE  OFFICE  OF  THE
 SUPERINTENDENT  A  WRITTEN  APPLICATION  FOR  THE  REPLACEMENT  LICENSE,
 AFFIRMING UNDER PENALTY OF PERJURY THAT THE ORIGINAL  LICENSE  HAS  BEEN
 LOST OR DESTROYED, TOGETHER WITH A FEE OF ONE HUNDRED DOLLARS.
   §  2907.  REVOCATION  OR  SUSPENSION OF A REGISTRATION OR LICENSE OF A
 PHARMACY BENEFIT MANAGER. (A) THE SUPERINTENDENT MAY  REFUSE  TO  RENEW,
 MAY  REVOKE,  OR  MAY SUSPEND FOR A PERIOD THE SUPERINTENDENT DETERMINES
 THE REGISTRATION OR LICENSE OF ANY PHARMACY BENEFIT  MANAGER  IF,  AFTER
 NOTICE AND HEARING, THE SUPERINTENDENT DETERMINES THAT THE REGISTRANT OR
 LICENSEE  OR  ANY  MEMBER,  PRINCIPAL, OFFICER, DIRECTOR, OR CONTROLLING
 PERSON OF THE REGISTRANT OR LICENSEE, HAS:
   (1) VIOLATED ANY INSURANCE LAWS, OR VIOLATED ANY REGULATION,  SUBPOENA
 OR  ORDER  OF THE SUPERINTENDENT OR OF ANOTHER STATE'S INSURANCE COMMIS-
 SIONER, OR HAS VIOLATED ANY LAW IN THE COURSE OF HIS OR HER DEALINGS  IN
 SUCH CAPACITY;
   (2)  PROVIDED  MATERIALLY INCORRECT, MATERIALLY MISLEADING, MATERIALLY
 INCOMPLETE OR MATERIALLY  UNTRUE  INFORMATION  IN  THE  REGISTRATION  OR
 LICENSE APPLICATION;
   (3)  OBTAINED OR ATTEMPTED TO OBTAIN A REGISTRATION OR LICENSE THROUGH
 MISREPRESENTATION OR FRAUD;
   (4)(A) USED FRAUDULENT, COERCIVE OR DISHONEST PRACTICES;
   (B) DEMONSTRATED INCOMPETENCE;
   (C) DEMONSTRATED UNTRUSTWORTHINESS; OR
   (D) DEMONSTRATED FINANCIAL IRRESPONSIBILITY IN THE CONDUCT OF BUSINESS
 IN THIS STATE OR ELSEWHERE;
   (5) IMPROPERLY WITHHELD, MISAPPROPRIATED OR CONVERTED  ANY  MONIES  OR
 PROPERTIES  RECEIVED  IN  THE  COURSE OF BUSINESS IN THIS STATE OR ELSE-
 WHERE;
   (6) INTENTIONALLY MISREPRESENTED THE TERMS OF AN  ACTUAL  OR  PROPOSED
 INSURANCE CONTRACT;
   (7) BEEN CONVICTED OF A FELONY;
   (8)  ADMITTED  OR  BEEN  FOUND  TO HAVE COMMITTED ANY INSURANCE UNFAIR
 TRADE PRACTICE OR FRAUD;
   (9) HAD A PHARMACY BENEFIT MANAGER REGISTRATION  OR  LICENSE,  OR  ITS
 EQUIVALENT,  DENIED,  SUSPENDED OR REVOKED IN ANY OTHER STATE, PROVINCE,
 DISTRICT OR TERRITORY;
   (10) FAILED TO PAY STATE INCOME TAX OR COMPLY WITH ANY  ADMINISTRATIVE
 OR COURT ORDER DIRECTING PAYMENT OF STATE INCOME TAX; OR
   (11)  CEASED  TO  MEET  THE REQUIREMENTS FOR REGISTRATION OR LICENSURE
 UNDER THIS ARTICLE.
   (B) BEFORE REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE  OF  ANY
 PHARMACY BENEFIT MANAGER PURSUANT TO THE PROVISIONS OF THIS ARTICLE, THE
 SUPERINTENDENT  SHALL  GIVE  NOTICE TO THE REGISTRANT OR LICENSEE AND TO
 EVERY SUB-LICENSEE AND SHALL HOLD, OR CAUSE TO BE HELD,  A  HEARING  NOT
 LESS THAN TEN DAYS AFTER THE GIVING OF SUCH NOTICE.

 S. 1507--A                         42                         A. 2007--A
 
   (C)  IF  A  REGISTRATION OR LICENSE PURSUANT TO THE PROVISIONS OF THIS
 ARTICLE IS REVOKED OR SUSPENDED BY THE SUPERINTENDENT, THEN  THE  SUPER-
 INTENDENT SHALL FORTHWITH GIVE NOTICE TO THE REGISTRANT OR LICENSEE.
   (D) THE REVOCATION OR SUSPENSION OF ANY REGISTRATION OR LICENSE PURSU-
 ANT  TO  THE  PROVISIONS  OF THIS ARTICLE SHALL TERMINATE FORTHWITH SUCH
 REGISTRATION OR LICENSE AND THE AUTHORITY  CONFERRED  THEREBY  UPON  ALL
 SUB-LICENSEES.  FOR  GOOD  CAUSE SHOWN, THE SUPERINTENDENT MAY DELAY THE
 EFFECTIVE DATE OF A REVOCATION OR SUSPENSION TO PERMIT THE REGISTRANT OR
 LICENSEE TO SATISFY SOME  OR  ALL  OF  ITS  CONTRACTUAL  OBLIGATIONS  TO
 PERFORM PHARMACY BENEFIT MANAGEMENT SERVICES IN THE STATE.
   (E)(1) NO INDIVIDUAL, CORPORATION, FIRM OR ASSOCIATION WHOSE REGISTRA-
 TION  OR LICENSE AS A PHARMACY BENEFIT MANAGER HAS BEEN REVOKED PURSUANT
 TO SUBSECTION (A) OF THIS SECTION, AND NO FIRM OR ASSOCIATION  OF  WHICH
 SUCH INDIVIDUAL IS A MEMBER, AND NO CORPORATION OF WHICH SUCH INDIVIDUAL
 IS  AN  OFFICER OR DIRECTOR, AND NO CONTROLLING PERSON OF THE REGISTRANT
 OR LICENSEE SHALL BE ENTITLED TO  OBTAIN  ANY  REGISTRATION  OR  LICENSE
 UNDER THE PROVISIONS OF THIS ARTICLE FOR A PERIOD OF ONE YEAR AFTER SUCH
 REVOCATION,  OR, IF SUCH REVOCATION BE JUDICIALLY REVIEWED, FOR ONE YEAR
 AFTER THE FINAL DETERMINATION THEREOF AFFIRMING THE ACTION OF THE SUPER-
 INTENDENT IN REVOKING SUCH LICENSE.
   (2) IF ANY SUCH REGISTRATION OR LICENSE HELD BY A FIRM, ASSOCIATION OR
 CORPORATION BE REVOKED, NO MEMBER OF SUCH FIRM  OR  ASSOCIATION  AND  NO
 OFFICER OR DIRECTOR OF SUCH CORPORATION OR ANY CONTROLLING PERSON OF THE
 REGISTRANT  OR  LICENSEE SHALL BE ENTITLED TO OBTAIN ANY REGISTRATION OR
 LICENSE, OR TO BE NAMED AS A SUB-LICENSEE IN  ANY  SUCH  LICENSE,  UNDER
 THIS  ARTICLE  FOR  THE  SAME  PERIOD OF TIME, UNLESS THE SUPERINTENDENT
 DETERMINES, AFTER NOTICE AND  HEARING,  THAT  SUCH  MEMBER,  OFFICER  OR
 DIRECTOR  WAS  NOT PERSONALLY AT FAULT IN THE MATTER ON ACCOUNT OF WHICH
 SUCH REGISTRATION OR LICENSE WAS REVOKED.
   (F) IF ANY REGISTERED OR LICENSED  PHARMACY  BENEFIT  MANAGER  OR  ANY
 PERSON AGGRIEVED SHALL FILE WITH THE SUPERINTENDENT A VERIFIED COMPLAINT
 SETTING FORTH FACTS TENDING TO SHOW SUFFICIENT GROUND FOR THE REVOCATION
 OR SUSPENSION OF ANY PHARMACY BENEFIT MANAGER'S REGISTRATION OR LICENSE,
 THEN  THE  SUPERINTENDENT  SHALL,  AFTER NOTICE AND A HEARING, DETERMINE
 WHETHER SUCH REGISTRATION OR LICENSE SHALL BE SUSPENDED OR REVOKED.
   (G) THE SUPERINTENDENT SHALL  RETAIN  THE  AUTHORITY  TO  ENFORCE  THE
 PROVISIONS  OF AND IMPOSE ANY PENALTY OR REMEDY AUTHORIZED BY THIS CHAP-
 TER AGAINST ANY PERSON OR ENTITY  WHO  IS  UNDER  INVESTIGATION  FOR  OR
 CHARGED  WITH A VIOLATION OF THIS CHAPTER, EVEN IF THE PERSON'S OR ENTI-
 TY'S REGISTRATION OR LICENSE HAS BEEN SURRENDERED, OR HAS EXPIRED OR HAS
 LAPSED BY OPERATION OF LAW.
   (H) A REGISTRANT OR LICENSEE SUBJECT TO THIS ARTICLE SHALL  REPORT  TO
 THE  SUPERINTENDENT  ANY  ADMINISTRATIVE ACTION TAKEN AGAINST THE REGIS-
 TRANT OR LICENSEE IN ANOTHER JURISDICTION  OR  BY  ANOTHER  GOVERNMENTAL
 AGENCY  IN THIS STATE WITHIN THIRTY DAYS OF THE FINAL DISPOSITION OF THE
 MATTER.  THIS REPORT SHALL INCLUDE A COPY OF THE ORDER, CONSENT TO ORDER
 OR OTHER RELEVANT LEGAL DOCUMENTS.
   (I) WITHIN THIRTY DAYS OF THE INITIAL PRETRIAL HEARING DATE, A  REGIS-
 TRANT  OR  LICENSEE  SUBJECT  TO THIS ARTICLE SHALL REPORT TO THE SUPER-
 INTENDENT ANY CRIMINAL PROSECUTION OF THE REGISTRANT OR  LICENSEE  TAKEN
 IN  ANY  JURISDICTION.  THE  REPORT  SHALL INCLUDE A COPY OF THE INITIAL
 COMPLAINT FILED, THE ORDER RESULTING FROM  THE  HEARING  AND  ANY  OTHER
 RELEVANT LEGAL DOCUMENTS.
   §  2908.  PENALTIES FOR VIOLATIONS. (A) THE SUPERINTENDENT, IN LIEU OF
 REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE OF  A  REGISTRANT  OR
 LICENSEE  IN  ACCORDANCE WITH THE PROVISIONS OF THIS ARTICLE, MAY IN ANY

 S. 1507--A                         43                         A. 2007--A

 ONE PROCEEDING BY ORDER, REQUIRE THE REGISTRANT OR LICENSEE  TO  PAY  TO
 THE PEOPLE OF THIS STATE A PENALTY IN A SUM NOT EXCEEDING THE GREATER OF
 (1)  ONE THOUSAND DOLLARS FOR EACH OFFENSE AND TWO THOUSAND FIVE HUNDRED
 DOLLARS  FOR  EACH  SUBSEQUENT  VIOLATION  OR  (2)  THE  AGGREGATE GROSS
 RECEIPTS ATTRIBUTABLE TO ALL OFFENSES.
   (B) UPON THE FAILURE OF SUCH A  REGISTRANT  OR  LICENSEE  TO  PAY  THE
 PENALTY ORDERED PURSUANT TO SUBSECTION (A) OF THIS SECTION WITHIN TWENTY
 DAYS  AFTER  THE  MAILING OF THE ORDER, POSTAGE PREPAID, REGISTERED, AND
 ADDRESSED TO THE LAST KNOWN PLACE OF BUSINESS OF  THE  LICENSEE,  UNLESS
 THE  ORDER  IS  STAYED BY AN ORDER OF A COURT OF COMPETENT JURISDICTION,
 THE SUPERINTENDENT MAY REVOKE THE REGISTRATION OR LICENSE OF THE  REGIS-
 TRANT  OR LICENSEE OR MAY SUSPEND THE SAME FOR SUCH PERIOD AS THE SUPER-
 INTENDENT DETERMINES.
   § 2909. STAY OR  SUSPENSION  OF  SUPERINTENDENT'S  DETERMINATION.  THE
 COMMENCEMENT  OF  A  PROCEEDING UNDER ARTICLE SEVENTY-EIGHT OF THE CIVIL
 PRACTICE LAW AND RULES, TO REVIEW THE ACTION OF  THE  SUPERINTENDENT  IN
 SUSPENDING  OR  REVOKING OR REFUSING TO RENEW ANY CERTIFICATE UNDER THIS
 ARTICLE, SHALL STAY SUCH ACTION OF THE SUPERINTENDENT FOR  A  PERIOD  OF
 THIRTY  DAYS. SUCH STAY SHALL NOT BE EXTENDED FOR A LONGER PERIOD UNLESS
 THE COURT SHALL DETERMINE, AFTER A  PRELIMINARY  HEARING  OF  WHICH  THE
 SUPERINTENDENT  IS NOTIFIED FORTY-EIGHT HOURS IN ADVANCE, THAT A STAY OF
 THE SUPERINTENDENT'S ACTION PENDING THE FINAL DETERMINATION  OR  FURTHER
 ORDER OF THE COURT WILL NOT UNDULY INJURE THE INTERESTS OF THE PEOPLE OF
 THE STATE.
   §  2910.  REVOKED  REGISTRATIONS  OR LICENSES. (A)(1) NO PERSON, FIRM,
 ASSOCIATION, CORPORATION OR OTHER ENTITY SUBJECT TO  THE  PROVISIONS  OF
 THIS  ARTICLE  WHOSE REGISTRATION OR LICENSE UNDER THIS ARTICLE HAS BEEN
 REVOKED, OR WHOSE REGISTRATION OR LICENSE TO ENGAGE IN THE  BUSINESS  OF
 PHARMACY  BENEFIT  MANAGEMENT  IN  ANY  CAPACITY HAS BEEN REVOKED BY ANY
 OTHER STATE OR TERRITORY OF THE UNITED STATES SHALL BECOME  EMPLOYED  OR
 APPOINTED  BY A PHARMACY BENEFIT MANAGER AS AN OFFICER, DIRECTOR, MANAG-
 ER, CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE PRIOR  WRITTEN
 APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE FOR MAINTENANCE
 OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (2)  NO PERSON, FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY SUBJECT
 TO THE PROVISIONS OF THIS ARTICLE SHALL KNOWINGLY EMPLOY OR APPOINT  ANY
 PERSON OR ENTITY WHOSE REGISTRATION OR LICENSE ISSUED UNDER THIS ARTICLE
 HAS  BEEN  REVOKED,  OR  WHOSE  REGISTRATION OR LICENSE TO ENGAGE IN THE
 BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY CAPACITY HAS BEEN REVOKED
 BY ANY OTHER STATE OR TERRITORY OF THE UNITED  STATES,  AS  AN  OFFICER,
 DIRECTOR, MANAGER, CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE
 PRIOR  WRITTEN  APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE
 FOR MAINTENANCE OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (3) NO CORPORATION OR PARTNERSHIP SUBJECT TO THE  PROVISIONS  OF  THIS
 ARTICLE  SHALL KNOWINGLY PERMIT ANY PERSON WHOSE REGISTRATION OR LICENSE
 ISSUED UNDER THIS ARTICLE HAS BEEN REVOKED,  OR  WHOSE  REGISTRATION  OR
 LICENSE  TO ENGAGE IN THE BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY
 CAPACITY HAS BEEN REVOKED BY ANY OTHER STATE, OR TERRITORY OF THE UNITED
 STATES, TO BE A SHAREHOLDER OR HAVE AN INTEREST IN SUCH  CORPORATION  OR
 PARTNERSHIP,  NOR  SHALL ANY SUCH PERSON BECOME A SHAREHOLDER OR PARTNER
 IN SUCH CORPORATION OR PARTNERSHIP, WITHOUT THE PRIOR  WRITTEN  APPROVAL
 OF THE SUPERINTENDENT.
   (B)  THE  SUPERINTENDENT  MAY  APPROVE  THE EMPLOYMENT, APPOINTMENT OR
 PARTICIPATION OF ANY SUCH PERSON WHOSE REGISTRATION OR LICENSE HAS  BEEN
 REVOKED:

 S. 1507--A                         44                         A. 2007--A
 
   (1)  IF THE SUPERINTENDENT DETERMINES THAT THE DUTIES AND RESPONSIBIL-
 ITIES OF SUCH PERSON ARE SUBJECT TO  APPROPRIATE  SUPERVISION  AND  THAT
 SUCH  DUTIES  AND  RESPONSIBILITIES WILL NOT HAVE AN ADVERSE EFFECT UPON
 THE PUBLIC, OTHER REGISTRANTS OR LICENSEES, OR THE REGISTRANT OR  LICEN-
 SEE PROPOSING EMPLOYMENT OR APPOINTMENT OF SUCH PERSON; OR
   (2)  IF  SUCH  PERSON  HAS  FILED AN APPLICATION FOR REREGISTRATION OR
 RELICENSING PURSUANT TO THIS ARTICLE AND THE APPLICATION FOR REREGISTRA-
 TION OR RELICENSING HAS NOT BEEN APPROVED OR DENIED WITHIN  ONE  HUNDRED
 TWENTY  DAYS  FOLLOWING  THE  FILING  THEREOF, UNLESS THE SUPERINTENDENT
 DETERMINES WITHIN THE SAID TIME THAT EMPLOYMENT OR APPOINTMENT  OF  SUCH
 PERSON  BY A REGISTRANT OR LICENSEE IN THE CONDUCT OF A PHARMACY BENEFIT
 MANAGEMENT BUSINESS WOULD NOT BE IN THE PUBLIC INTEREST.
   (C) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO THE OWNERSHIP OF
 SHARES OF ANY CORPORATION REGISTERED OR LICENSED PURSUANT TO THIS  ARTI-
 CLE  IF  THE  SHARES OF SUCH CORPORATION ARE PUBLICLY HELD AND TRADED IN
 THE OVER-THE-COUNTER MARKET OR UPON ANY NATIONAL OR REGIONAL  SECURITIES
 EXCHANGE.
   § 2911. CHANGE OF ADDRESS. A REGISTRANT OR LICENSEE UNDER THIS ARTICLE
 SHALL INFORM THE SUPERINTENDENT BY A MEANS ACCEPTABLE TO THE SUPERINTEN-
 DENT OF A CHANGE OF ADDRESS WITHIN THIRTY DAYS OF THE CHANGE.
   §  2912. APPLICABILITY OF OTHER LAWS. NOTHING IN THIS ARTICLE SHALL BE
 CONSTRUED TO EXEMPT A PHARMACY BENEFIT MANAGER FROM COMPLYING  WITH  THE
 PROVISIONS  OF  ARTICLES  TWENTY-ONE  AND FORTY-NINE OF THIS CHAPTER AND
 ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW OR ANY  OTHER  PROVISION  OF
 THIS CHAPTER OR THE FINANCIAL SERVICES LAW.
   §  2913.  ASSESSMENTS. PHARMACY BENEFIT MANAGERS THAT FILE A REGISTRA-
 TION WITH THE DEPARTMENT OR ARE LICENSED  BY  THE  DEPARTMENT  SHALL  BE
 ASSESSED BY THE SUPERINTENDENT FOR THE OPERATING EXPENSES OF THE DEPART-
 MENT  THAT  ARE  SOLELY ATTRIBUTABLE TO REGULATING SUCH PHARMACY BENEFIT
 MANAGERS IN SUCH PROPORTIONS AS THE SUPERINTENDENT SHALL DEEM  JUST  AND
 REASONABLE.
   §  2.  Subsection (b) of section 2402 of the insurance law, as amended
 by section 71 of part A of chapter 62 of the laws of 2011, is amended to
 read as follows:
   (b) "Defined violation" means the commission by a  person  of  an  act
 prohibited  by:  subsection (a) of section one thousand one hundred two,
 section one thousand two hundred  fourteen,  one  thousand  two  hundred
 seventeen,  one  thousand two hundred twenty, one thousand three hundred
 thirteen, subparagraph (B) of paragraph two of subsection (i) of section
 one thousand three hundred twenty-two, subparagraph (B) of paragraph two
 of subsection (i) of section one thousand three hundred twenty-four, two
 thousand one hundred two, two thousand one hundred seventeen, two  thou-
 sand  one  hundred  twenty-two,  two  thousand one hundred twenty-three,
 subsection (p) of section two thousand three hundred  thirteen,  section
 two  thousand  three hundred twenty-four, two thousand five hundred two,
 two thousand five hundred three, two thousand  five  hundred  four,  two
 thousand six hundred one, two thousand six hundred two, two thousand six
 hundred  three,  two thousand six hundred four, two thousand six hundred
 six, two thousand seven hundred three, TWO THOUSAND  NINE  HUNDRED  TWO,
 TWO  THOUSAND  NINE HUNDRED FIVE, three thousand one hundred nine, three
 thousand two hundred twenty-four-a, three thousand four hundred  twenty-
 nine,  three  thousand  four  hundred  thirty-three,  paragraph seven of
 subsection (e) of section three thousand four hundred  twenty-six,  four
 thousand two hundred twenty-four, four thousand two hundred twenty-five,
 four thousand two hundred twenty-six, seven thousand eight hundred nine,
 seven  thousand  eight hundred ten, seven thousand eight hundred eleven,

 S. 1507--A                         45                         A. 2007--A
 
 seven thousand eight hundred  thirteen,  seven  thousand  eight  hundred
 fourteen  and  seven  thousand eight hundred fifteen of this chapter; or
 section 135.60, 135.65,  175.05,  175.45,  or  190.20,  or  article  one
 hundred five of the penal law.
   §  3.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART J
 
   Section 1. This Part enacts into law major components  of  legislation
 which are necessary to protect health care consumers; increase access to
 more  affordable  quality  health  insurance  coverage; and preserve and
 foster New York's health insurance markets.   Each component  is  wholly
 contained  within  a  Subpart  identified  as  Subparts A through F. The
 effective date for  each  particular  provision  contained  within  such
 Subpart  is set forth in the last section of such Subpart. Any provision
 in any section contained within a Subpart, including the effective  date
 of the Subpart, which makes a reference to a section "of this act," when
 used  in  connection  with that particular component, shall be deemed to
 mean and refer to the corresponding section of the Subpart in  which  it
 is  found.  Section  five  of this Part sets forth the general effective
 date of this Part.
 
                                 SUBPART A
 
   Section 1. Section 3221 of the insurance law is amended  by  adding  a
 new subsection (t) to read as follows:
   (T) (1) ANY INSURER THAT DELIVERS OR ISSUES FOR DELIVERY IN THIS STATE
 HOSPITAL,  SURGICAL OR MEDICAL EXPENSE GROUP POLICIES IN THE SMALL GROUP
 OR LARGE GROUP MARKET SHALL OFFER TO ANY EMPLOYER IN THIS STATE ALL SUCH
 POLICIES IN THE  APPLICABLE  MARKET,  AND  SHALL  ACCEPT  AT  ALL  TIMES
 THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES FOR ANY OF THOSE POLICIES.
   (2)  THE  REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION SHALL APPLY
 WITH RESPECT TO AN EMPLOYER THAT APPLIES FOR  COVERAGE  EITHER  DIRECTLY
 FROM THE INSURER OR THROUGH AN ASSOCIATION OR TRUST TO WHICH THE INSURER
 HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.
   §  2.  Paragraph  1 of subsection (g) of section 3231 of the insurance
 law, as amended by section 70 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (1)  This  section  shall  also  apply  to  policies issued to a group
 defined in subsection (c) of section four thousand two  hundred  thirty-
 five, including but not limited to an association or trust of employers,
 if  the  group  includes  one  or  more member employers or other member
 groups which have [fifty] ONE HUNDRED  or  fewer  employees  or  members
 exclusive  of  spouses and dependents. For policies issued or renewed on
 or after January first, two thousand fourteen, if the group includes one
 or more member small group employers eligible for  coverage  subject  to
 this  section,  then  such member employers shall be classified as small
 groups for rating purposes and the  remaining  members  shall  be  rated
 consistent  with  the  rating rules applicable to such remaining members
 pursuant to paragraph two of this subsection.
   § 3. Subsections (h) and (i) of section 3232 of the insurance law  are
 REPEALED.
   §  4. Subsections (f) and (g) of section 3232 of the insurance law, as
 added by chapter 219 of the  laws  of  2011,  are  amended  to  read  as
 follows:

 S. 1507--A                         46                         A. 2007--A
 
   (f)  [With respect to an individual under age nineteen, an insurer may
 not impose any pre-existing condition  exclusion  in  an  individual  or
 group policy of hospital, medical, surgical or prescription drug expense
 insurance  pursuant  to  the  requirements of section 2704 of the Public
 Health  Service  Act,  42 U.S.C. § 300gg-3, as made effective by section
 1255(2) of the Affordable Care Act, except for an individual  under  age
 nineteen covered under an individual policy of hospital, medical, surgi-
 cal  or  prescription  drug  expense  insurance  that is a grandfathered
 health plan.
   (g) Beginning  January  first,  two  thousand  fourteen,  pursuant  to
 section  2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, an]
 AN insurer [may] SHALL not impose any pre-existing  condition  exclusion
 in  an  individual  or  group  policy  of hospital, medical, surgical or
 prescription drug expense insurance [except in an individual policy that
 is a grandfathered health plan].
   § 5. Subparagraph (A) of paragraph 1 of subsection (c) of section 4235
 of the insurance law, as amended by chapter 515 of the laws of 2010,  is
 amended to read as follows:
   (A)  A  policy  issued to an employer or to a trustee or trustees of a
 fund established by an employer, which employer or trustee  or  trustees
 shall  be  deemed the policyholder, insuring with or without evidence of
 insurability satisfactory to the insurer, employees  of  such  employer,
 and  insuring,  except as hereinafter provided, all of such employees or
 all of any class or classes thereof determined by conditions  pertaining
 to  the  employment  or  a combination of such conditions and conditions
 pertaining to the family status of the employee, for insurance  coverage
 on  each  person insured based upon some plan [which] THAT will preclude
 individual selection. However, such a plan may permit a  limited  number
 of  selections by employees if the selections offered utilize consistent
 plans of coverage for individual group members  so  that  the  resulting
 plans  of  coverage  are reasonable. The premium for the policy shall be
 paid by the policyholder, either from  the  employer's  funds,  or  from
 funds  contributed  by  the insured employees, or from funds contributed
 jointly by the employer and employees. If all or part of the premium  is
 to  be  derived  from  funds  contributed by the insured employees, then
 [such] THE INSURER ISSUING THE policy [must insure not less  than  fifty
 percent of such eligible employees or, if less, fifty or more] SHALL NOT
 REQUIRE  A  MINIMUM  NUMBER  OR  MINIMUM PERCENTAGE of such employees BE
 INSURED when [such] THE policy is providing coverage for group hospital,
 medical, major medical or similar comprehensive types of  expense  reim-
 bursed  insurance  and, for all other types of group accident and health
 insurance, [must] THE POLICY SHALL insure a minimum of fifty percent  or
 five of such eligible employees, whichever is fewer.
   §  6.  Section  4305  of  the insurance law is amended by adding a new
 subsection (n) to read as follows:
   (N) (1) ANY CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 ISSUES HOSPITAL, SURGICAL OR MEDICAL  EXPENSE  CONTRACTS  IN  THE  SMALL
 GROUP OR LARGE GROUP MARKET IN THIS STATE SHALL OFFER TO ANY EMPLOYER IN
 THIS STATE ALL SUCH CONTRACTS IN THE APPLICABLE MARKET, AND SHALL ACCEPT
 AT  ALL  TIMES  THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES FOR ANY OF
 THOSE CONTRACTS.
   (2) THE REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION  SHALL  APPLY
 WITH  RESPECT  TO  AN EMPLOYER THAT APPLIES FOR COVERAGE EITHER DIRECTLY
 FROM THE CORPORATION OR THROUGH AN ASSOCIATION OR  TRUST  TO  WHICH  THE
 CORPORATION HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.

 S. 1507--A                         47                         A. 2007--A
 
   §  7.  Paragraph  1 of subsection (d) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (1)  This  section  shall  also  apply to a contract issued to a group
 defined in subsection (c) of section four thousand two  hundred  thirty-
 five  of  this  chapter,  including but not limited to an association or
 trust of employers, if the group includes one or more  member  employers
 or other member groups which have [fifty] ONE HUNDRED or fewer employees
 or  members exclusive of spouses and dependents. For contracts issued or
 renewed on or after January first, two thousand fourteen, if  the  group
 includes  one or more member small group employers eligible for coverage
 subject to this section, then such member employers shall be  classified
 as  small  groups for rating purposes and the remaining members shall be
 rated consistent with the rating  rules  applicable  to  such  remaining
 members pursuant to paragraph two of this subsection.
   §  8. Subsections (h) and (i) of section 4318 of the insurance law are
 REPEALED.
   § 9. Subsections (f) and (g) of section 4318 of the insurance law,  as
 added  by  chapter  219  of  the  laws  of  2011, are amended to read as
 follows:
   (f) [With respect to an individual under age nineteen,  a  corporation
 may  not impose any pre-existing condition exclusion in an individual or
 group contract of  hospital,  medical,  surgical  or  prescription  drug
 expense  insurance  pursuant  to the requirements of section 2704 of the
 Public Health Service Act, 42 U.S.C. § 300gg-3,  as  made  effective  by
 section  1255(2)  of  the  Affordable Care Act, except for an individual
 under age nineteen covered under an  individual  contract  of  hospital,
 medical,  surgical  or  prescription  drug  expense  insurance that is a
 grandfathered health plan.
   (g) Beginning  January  first,  two  thousand  fourteen,  pursuant  to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation  [may] SHALL not impose any pre-existing condition exclusion
 in an individual or group contract of  hospital,  medical,  surgical  or
 prescription  drug  expense  insurance [except in an individual contract
 that is a grandfathered health plan].
   § 10. Section 4413 of the insurance law is amended  by  adding  a  new
 subsection (h) to read as follows:
   (H)  (1)  ON  OR  AFTER JUNE FIRST, TWO THOUSAND NINETEEN, AN EMPLOYEE
 WELFARE FUND  REGISTERED  WITH  THE  SUPERINTENDENT  SHALL  NOT  PROVIDE
 MEDICAL,  SURGICAL OR HOSPITAL CARE OR BENEFITS IN THE EVENT OF SICKNESS
 OR INJURY FOR EMPLOYEES OR THEIR FAMILIES OR DEPENDENTS,  OR  FOR  BOTH,
 UNLESS PROVIDED UNDER A GROUP COMPREHENSIVE-TYPE HEALTH INSURANCE POLICY
 OR  CONTRACT  IN  ACCORDANCE  WITH  THE REQUIREMENTS OF THIS CHAPTER AND
 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE BY AN AUTHORIZED  INSURER
 OR  A  HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIFICATE OF AUTHORITY
 UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
   (2) NOTWITHSTANDING PARAGRAPH ONE  OF  THIS  SUBSECTION,  AN  EMPLOYEE
 WELFARE FUND REGISTERED WITH THE SUPERINTENDENT PRIOR TO JUNE FIRST, TWO
 THOUSAND  NINETEEN,  WHICH,  AS OF FEBRUARY FIRST, TWO THOUSAND NINETEEN
 DIRECTLY PROVIDED MEDICAL, SURGICAL OR HOSPITAL CARE OR BENEFITS IN  THE
 EVENT  OF  SICKNESS  OR INJURY FOR EMPLOYEES OR THEIR FAMILIES OR DEPEN-
 DENTS, OR FOR BOTH, MAY CONTINUE  TO  PROVIDE  THOSE  BENEFITS  DIRECTLY
 RATHER  THAN UNDER A GROUP COMPREHENSIVE-TYPE HEALTH INSURANCE POLICY OR
 CONTRACT DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE BY AN AUTHORIZED
 INSURER OR A HEALTH MAINTENANCE ORGANIZATION  ISSUED  A  CERTIFICATE  OF
 AUTHORITY  UNDER  ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW; PROVIDED,

 S. 1507--A                         48                         A. 2007--A
 
 HOWEVER, THAT, IF THE EMPLOYEE WELFARE FUND CEASES OFFERING THE BENEFITS
 DIRECTLY, IT MAY NOT RESUME PROVIDING THE BENEFITS DIRECTLY.
   §  11.  Subdivision  1  of  section  4406 of the public health law, as
 amended by section 46-a of part D of chapter 56 of the laws of 2013,  is
 amended to read as follows:
   1.  The  contract  between  a  health  maintenance organization and an
 enrollee shall be subject to regulation by the superintendent as  if  it
 were  a health insurance subscriber contract, and shall include, but not
 be limited to, all mandated benefits required by article forty-three  of
 the insurance law. Such contract shall fully and clearly state the bene-
 fits  and  limitations  therein provided or imposed, so as to facilitate
 understanding and comparisons, and to exclude provisions  which  may  be
 misleading  or  unreasonably confusing. Such contract shall be issued to
 any individual and dependents  of  such  individual  and  any  group  of
 [fifty]  ONE HUNDRED or fewer employees or members, exclusive of spouses
 and dependents, or TO any employee or member  of  the  group,  including
 dependents, applying for such contract at any time throughout the year[,
 and  may  include  a pre-existing condition provision as provided for in
 section four thousand three  hundred  eighteen  of  the  insurance  law,
 provided,  however,  that,  the].  AN INDIVIDUAL DIRECT PAYMENT CONTRACT
 SHALL BE ISSUED ONLY IN ACCORDANCE  WITH  SECTION  FOUR  THOUSAND  THREE
 HUNDRED TWENTY-EIGHT OF THE INSURANCE LAW. THE superintendent may, after
 giving consideration to the public interest, exempt a health maintenance
 organization from the requirements of this section provided that another
 health  insurer  or  health  maintenance  organization within the health
 maintenance organization's same holding company system,  as  defined  in
 article  fifteen  of  the  insurance law, including a health maintenance
 organization operated as a line of business of a health  service  corpo-
 ration  licensed  under article forty-three of the insurance law, offers
 coverage that, at a minimum, complies with this section and provides all
 of the consumer protections required to be provided by a health  mainte-
 nance  organization  pursuant to this chapter and regulations, including
 those consumer protections contained  in  sections  four  thousand  four
 hundred  three  and  four thousand four hundred eight-a of this chapter.
 The requirements shall not apply to a  health  maintenance  organization
 exclusively  serving  individuals  enrolled  pursuant to title eleven of
 article five of the social services law, title eleven-D of article  five
 of  the  social services law, title one-A of article twenty-five of [the
 public health law] THIS CHAPTER or title eighteen of the federal  Social
 Security Act, and, further provided, that such health maintenance organ-
 ization  shall  not  discontinue  a contract for an individual receiving
 comprehensive-type coverage in effect prior to January first, two  thou-
 sand four who is ineligible to purchase policies offered after such date
 pursuant  to  this section or section four thousand three hundred [twen-
 ty-two of this article] TWENTY-EIGHT OF THE INSURANCE  LAW  due  to  the
 provision  of  42  U.S.C.  1395ss  in effect prior to January first, two
 thousand four.   [Subject to the  creditable  coverage  requirements  of
 subsection  (a)  of  section four thousand three hundred eighteen of the
 insurance law, the organization may, as an alternative to the use  of  a
 pre-existing  condition  provision,  elect  to offer contracts without a
 pre-existing condition provision to such groups  but  may  require  that
 coverage  shall not become effective until after a specified affiliation
 period of not more than sixty days after the application for coverage is
 submitted.   The organization is not required  to  provide  health  care
 services  or benefits during such period and no premium shall be charged
 for any coverage  during  the  period.  After  January  first,  nineteen

 S. 1507--A                         49                         A. 2007--A

 hundred  ninety-six,  all  individual  direct payment contracts shall be
 issued only pursuant to sections four thousand three hundred  twenty-one
 and  four  thousand  three hundred twenty-two of the insurance law. Such
 contracts may not, with respect to an eligible individual (as defined in
 section  2741(b)  of  the federal Public Health Service Act, 42 U.S.C. §
 300gg-41(b), impose any pre-existing condition exclusion.]
   § 12. This act shall take effect immediately, provided that:
   (1) sections one, three, four, five, six, eight and nine of  this  act
 shall  apply  to  all  policies and contracts issued, renewed, modified,
 altered or amended on or after January 1, 2020; and
   (2) sections two and seven of this act shall take effect on  the  same
 date  as  the reversion of paragraph 1 of subsection (g) of section 3231
 and paragraph 1 of subsection (d) of section 4317 of the insurance  law,
 as provided in section 5 of chapter 588 of the laws of 2015, as amended.
 
                                 SUBPART B
 
   Section  1.  Subparagraph  (A)  of  paragraph  5  of subsection (c) of
 section 3216 of the insurance law, as amended by chapter 388 of the laws
 of 2014, is amended to read as follows:
   (A) Any family policy providing hospital or surgical expense insurance
 (but not including such insurance against accidental injury only)  shall
 provide  that, in the event such insurance on any person, other than the
 policyholder, is terminated because the person is no longer  within  the
 definition  of  the  family  as  set forth in the policy but before such
 person has attained the limiting age, if any,  for  coverage  of  adults
 specified in the policy, such person shall be entitled to have issued to
 that  person  by  the  insurer,  without  evidence of insurability, upon
 application therefor and payment of the first premium, within sixty days
 after such insurance shall have  terminated,  an  individual  conversion
 policy  that contains the ESSENTIAL HEALTH benefits PACKAGE described in
 paragraph [one] THREE of subsection [(b)] (F) of section [four  thousand
 three  hundred twenty-eight of this chapter. The insurer shall offer one
 policy at each level of coverage as defined in section  1302(d)  of  the
 affordable  care  act, 42 U.S.C. § 18022(d).] THREE THOUSAND TWO HUNDRED
 SEVENTEEN-I OF THIS ARTICLE. THE INSURER SHALL OFFER ONE POLICY AT  EACH
 LEVEL OF COVERAGE AS DEFINED IN SUBSECTION (C) OF SECTION THREE THOUSAND
 TWO  HUNDRED  SEVENTEEN-I OF THIS ARTICLE. The individual may choose any
 such policy offered by the insurer. Provided, however,  the  superinten-
 dent may, after giving due consideration to the public interest, approve
 a request made by an insurer for the insurer to satisfy the requirements
 of  this  subparagraph through the offering of policies that comply with
 this subparagraph by another insurer, corporation or health  maintenance
 organization  within the insurer's holding company system, as defined in
 article fifteen of this chapter. The conversion privilege afforded here-
 in shall also be available upon the divorce or annulment of the marriage
 of the policyholder to the former spouse of such policyholder.
   § 2. Subparagraph (E) of paragraph 2 of subsection (g) of section 3216
 of the insurance law, as added by chapter 388 of the laws  of  2014,  is
 amended to read as follows:
   (E)  The  superintendent  may,  after  giving due consideration to the
 public interest, approve a request made by an insurer for the insurer to
 satisfy the requirements of subparagraph (C) of this  paragraph  through
 the  offering  of  policies  at  each  level  of  coverage as defined in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 § 18022(d)] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE  that

 S. 1507--A                         50                         A. 2007--A
 
 contains  the  ESSENTIAL  HEALTH benefits PACKAGE described in paragraph
 [one] THREE of subsection [(b)] (F)  of  section  [four  thousand  three
 hundred  twenty-eight of this chapter] THREE THOUSAND TWO HUNDRED SEVEN-
 TEEN-I OF THIS ARTICLE by another insurer, corporation or health mainte-
 nance  organization within the insurer's same holding company system, as
 defined in article fifteen of this chapter.
   § 3. Items (i) and  (ii)  of  subparagraph  (D)  of  paragraph  11  of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219  of  the laws of 2011, are amended, and a new item (iii) is added to
 read as follows:
   (i) evidence-based items or services  for  mammography  that  have  in
 effect  a  rating  of  'A'  or 'B' in the current recommendations of the
 United States preventive services task force; [and]
   (ii) with respect  to  women,  such  additional  preventive  care  and
 screenings  for  mammography  not described in item (i) of this subpara-
 graph and as provided for in comprehensive guidelines supported  by  the
 health resources and services administration[.]; AND
   (III)  ANY  OTHER  PREVENTIVE  CARE  AND  SCREENINGS DESIGNATED BY THE
 SUPERINTENDENT IN A REGULATION  THAT  ARE  CONSISTENT  WITH  CURRENT  OR
 PREVIOUS  RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND (II)
 OF THIS SUBPARAGRAPH.
   § 4. Items (i) and  (ii)  of  subparagraph  (D)  of  paragraph  15  of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219  of  the laws of 2011, are amended, and a new item (iii) is added to
 read as follows:
   (i) evidence-based items or services for cervical cytology  that  have
 in  effect  a rating of 'A' or 'B' in the current recommendations of the
 United States preventive services task force; [and]
   (ii) with respect  to  women,  such  additional  preventive  care  and
 screenings  for  cervical  cytology  not  described  in item (i) of this
 subparagraph and as provided for in comprehensive  guidelines  supported
 by the health resources and services administration[.]; AND
   (III)  ANY  OTHER  PREVENTIVE  CARE  AND  SCREENINGS DESIGNATED BY THE
 SUPERINTENDENT IN A REGULATION  THAT  ARE  CONSISTENT  WITH  CURRENT  OR
 PREVIOUS  RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND (II)
 OF THIS SUBPARAGRAPH.
   § 5. Items (iii) and (iv) of  subparagraph  (E)  of  paragraph  17  of
 subsection (i) of section 3216 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (v) is added to read
 as follows:
   (iii)  with  respect  to  children, including infants and adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (iv) with respect  to  women,  such  additional  preventive  care  and
 screenings  not  described  in  item  (i)  of  this  subparagraph and as
 provided  for  in  comprehensive  guidelines  supported  by  the  health
 resources and services administration[.]; AND
   (V)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS  OR  GUIDELINES  IDENTIFIED IN ITEMS (I) THROUGH (IV) OF
 THIS SUBPARAGRAPH.
   § 6. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
 law,  as  amended by chapter 469 of the laws of 2018, is amended to read
 as follows:

 S. 1507--A                         51                         A. 2007--A
 
   (21) Every policy [which]  THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein  [or  which],
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve
 months for any insured individual shall not  exceed  two  thousand  five
 hundred dollars].
   §  7.  Paragraph 30 of subsection (i) of section 3216 of the insurance
 law, as amended by chapter 377 of the laws of 2014, is amended  to  read
 as follows:
   (30) Every policy [which] THAT provides medical coverage that includes
 coverage for physician services in a physician's office and every policy
 [which] THAT provides major medical or similar comprehensive-type cover-
 age  shall  include  coverage  for  equipment  and supplies used for the
 treatment of ostomies, if prescribed by a physician  or  other  licensed
 health  care  provider legally authorized to prescribe under title eight
 of the education law. Such coverage shall be subject to  annual  deduct-
 ibles  and  coinsurance as deemed appropriate by the superintendent. The
 coverage required by this paragraph shall be identical to, and shall not
 enhance or increase the coverage required as part  of  essential  health
 benefits  as [required pursuant to] DEFINED IN SUBSECTION (A) OF section
 [2707 (a) of the public health services act 42 U.S.C. 300 gg-6(a)] THREE
 THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   § 8. Subsection (l) of section 3216 of the insurance law, as added  by
 section  42  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (l) [On and after October first, two thousand thirteen, an] AN insurer
 shall not offer individual hospital, medical or surgical expense  insur-
 ance  policies  unless  the policies meet the requirements of subsection
 (b) of section four thousand three hundred twenty-eight of this chapter.
 Such policies that are offered within the health benefit exchange estab-
 lished [pursuant to section 1311 of the affordable care act, 42 U.S.C. §
 18031, or any regulations promulgated thereunder,] BY  THIS  STATE  also
 shall meet any requirements established by the health benefit exchange.

 S. 1507--A                         52                         A. 2007--A
 
   §  9. Subsection (m) of section 3216 of the insurance law, as added by
 section 53 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (m)  An  insurer  shall  not be required to offer the policyholder any
 benefits that must be made available pursuant to  this  section  if  the
 benefits  must  be  covered as essential health benefits. For any policy
 issued within the  health  benefit  exchange  established  [pursuant  to
 section  1311  of  the  affordable  care act, 42 U.S.C. § 18031] BY THIS
 STATE, an insurer shall not be required to offer  the  policyholder  any
 benefits  that  must  be  made  available  pursuant to this section. For
 purposes of this subsection, "essential health benefits" shall have  the
 meaning  set forth in SUBSECTION (A) OF section [1302(b) of the afforda-
 ble care act, 42 U.S.C. § 18022(b)] THREE THOUSAND  TWO  HUNDRED  SEVEN-
 TEEN-I OF THIS ARTICLE.
   §  10.  The insurance law is amended by adding a new section 3217-i to
 read as follows:
   § 3217-I. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;
   (5) MENTAL HEALTH  AND  SUBSTANCE  USE  DISORDER  SERVICES,  INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;
   (9)  PREVENTIVE  AND WELLNESS SERVICES AND CHRONIC DISEASE MANAGEMENT;
 AND
   (10) PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.
   (B) THE SUPERINTENDENT,  IN  CONSULTATION  WITH  THE  COMMISSIONER  OF
 HEALTH,  MAY  SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF PLANS THAT
 TOGETHER CONTAIN ESSENTIAL HEALTH  BENEFITS,  IN  ACCORDANCE  WITH  THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP ACCIDENT AND HEALTH INSURANCE
 POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND
 IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE
 ACTUARIAL REQUIREMENTS OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:
   (A)  BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN;
   (B) SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF  THE  BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C)  GOLD  LEVEL.  A  PLAN  IN THE GOLD LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF  COVERAGE  THAT  IS DESIGNED TO PROVIDE BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.

 S. 1507--A                         53                         A. 2007--A
 
   (2) THE SUPERINTENDENT MAY PROVIDE FOR A VARIATION  IN  THE  ACTUARIAL
 VALUES  USED  IN  DETERMINING THE LEVEL OF COVERAGE OF A PLAN TO ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3)  EVERY  STUDENT ACCIDENT AND HEALTH INSURANCE POLICY SHALL PROVIDE
 COVERAGE THAT MEETS AT LEAST SIXTY PERCENT OF THE FULL  ACTUARIAL  VALUE
 OF  THE  BENEFITS  PROVIDED  UNDER  THE POLICY. THE POLICY'S SCHEDULE OF
 BENEFITS SHALL INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE  OF  THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D)  EVERY  INDIVIDUAL  OR  GROUP ACCIDENT AND HEALTH INSURANCE POLICY
 THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT
 A GRANDFATHERED HEALTH PLAN,  AND  EVERY  STUDENT  ACCIDENT  AND  HEALTH
 INSURANCE  POLICY  SHALL LIMIT THE INSURED'S COST-SHARING FOR IN-NETWORK
 SERVICES IN A POLICY YEAR TO NOT MORE  THAN  THE  MAXIMUM  OUT-OF-POCKET
 AMOUNT DETERMINED BY THE SUPERINTENDENT FOR ALL POLICIES SUBJECT TO THIS
 SECTION.  SUCH AMOUNT SHALL NOT EXCEED ANY ANNUAL OUT-OF-POCKET LIMIT ON
 COST-SHARING SET BY THE UNITED STATES  SECRETARY  OF  HEALTH  AND  HUMAN
 SERVICES, IF AVAILABLE.
   (E)  THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE DESCRIB-
 ING THE COVERAGE REQUIREMENTS FOR  ANY  ACCIDENT  AND  HEALTH  INSURANCE
 POLICY FORM THAT IS SUBJECT TO THE SUPERINTENDENT'S APPROVAL PURSUANT TO
 SECTION THREE THOUSAND TWO HUNDRED ONE OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1)  "ACTUARIAL  VALUE"  MEANS  THE  PERCENTAGE  OF THE TOTAL EXPECTED
 PAYMENTS BY THE INSURER FOR BENEFITS PROVIDED TO A STANDARD  POPULATION,
 WITHOUT  REGARD  TO THE POPULATION TO WHOM THE INSURER ACTUALLY PROVIDES
 BENEFITS;
   (2) "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE,  COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)   LIMITS   COST-SHARING  FOR  SUCH  COVERAGE  IN  ACCORDANCE  WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4) "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED BY AN  INSURER
 IN  WHICH AN INDIVIDUAL WAS ENROLLED ON MARCH TWENTY-THIRD, TWO THOUSAND
 TEN FOR AS LONG  AS  THE  COVERAGE  MAINTAINS  GRANDFATHERED  STATUS  IN
 ACCORDANCE  WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C. §
 18011(E);
   (5) "SMALL GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER  EMPLOYEES  OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF
 THIS ARTICLE.
   § 11. Subsection (g) of section 3221 of the insurance law, as  amended
 by chapter 388 of the laws of 2014, is amended to read as follows:
   (g) For conversion purposes, an insurer shall offer to the employee or
 member  a  policy at each level of coverage as defined in SUBSECTION (C)
 OF section [1302(d) of the affordable care act, 42  U.S.C.  §  18022(d)]
 THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE that contains the
 ESSENTIAL  HEALTH benefits PACKAGE described in paragraph [one] THREE of
 subsection [(b)] (F) of section [four  thousand  three  hundred  twenty-
 eight  of  this  chapter] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS
 ARTICLE. Provided, however, the superintendent  may,  after  giving  due
 consideration  to  the  public  interest,  approve  a request made by an
 insurer for the insurer to satisfy the requirements of  this  subsection

 S. 1507--A                         54                         A. 2007--A
 
 and  subsections  (e)  and  (f)  of this section through the offering of
 policies that comply with this subsection  by  another  insurer,  corpo-
 ration  or  health maintenance organization within the insurer's holding
 company system, as defined in article fifteen of this chapter.
   § 12. Subsection (h) of section 3221 of the insurance law, as added by
 section  54  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (h) Every small group policy or association group policy delivered  or
 issued  for  delivery in this state that provides coverage for hospital,
 medical or surgical expense insurance and is not a grandfathered  health
 plan  shall provide coverage for the essential health [benefit] BENEFITS
 package [as required in section 2707(a) of  the  public  health  service
 act, 42 U.S.C.  § 300gg-6(a)]. For purposes of this subsection:
   (1)  "essential  health  benefits  package" shall have the meaning set
 forth in PARAGRAPH THREE OF SUBSECTION (F) OF section  [1302(a)  of  the
 affordable  care  act,  42 U.S.C. § 18022(a)] THREE THOUSAND TWO HUNDRED
 SEVENTEEN-I OF THIS ARTICLE;
   (2) "grandfathered health plan" means coverage provided by an  insurer
 in  which an individual was enrolled on March twenty-third, two thousand
 ten for as long  as  the  coverage  maintains  grandfathered  status  in
 accordance  with section 1251(e) of the affordable care act, 42 U.S.C. §
 18011(e);
   (3) "small group" means a  group  of  [fifty  or  fewer  employees  or
 members  exclusive  of  spouses  and dependents; provided, however, that
 beginning January first, two thousand sixteen,  "small  group"  means  a
 group of] one hundred or fewer employees or members exclusive of spouses
 and dependents; and
   (4)  "association  group"  means a group defined in subparagraphs (B),
 (D), (H), (K), (L) or (M) of paragraph one of subsection (c) of  section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B)  the  group  includes one or more member employers or other member
 groups that are small groups.
   § 13. Subsection (i) of section 3221 of the insurance law, as added by
 section 54 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (i)  An  insurer  shall  not be required to offer the policyholder any
 benefits that must be made available pursuant to  this  section  if  the
 benefits must be covered pursuant to subsection (h) of this section. For
 any policy issued within the health benefit exchange established [pursu-
 ant  to  section  1311 of the affordable care act, 42 U.S.C. § 18031] BY
 THIS STATE, an insurer shall not be required to offer  the  policyholder
 any benefits that must be made available pursuant to this section.
   §  14. Paragraph 11 of subsection (k) of section 3221 of the insurance
 law, as amended by chapter 469 of the laws of 2018, is amended  to  read
 as follows:
   (11)  Every  policy  [which]  THAT  provides coverage for prescription
 drugs shall include coverage for the cost of enteral formulas  for  home
 use, whether administered orally or via tube feeding, for which a physi-
 cian  or  other  licensed  health  care  provider  legally authorized to
 prescribe under title eight of the education law has  issued  a  written
 order. Such written order shall state that the enteral formula is clear-
 ly  medically  necessary and has been proven effective as a disease-spe-
 cific treatment regimen.  Specific  diseases  and  disorders  for  which
 enteral  formulas  have been proven effective shall include, but are not
 limited to, inherited diseases of amino-acid or organic acid metabolism;

 S. 1507--A                         55                         A. 2007--A

 Crohn's Disease; gastroesophageal reflux; disorders of  gastrointestinal
 motility  such  as  chronic intestinal pseudo-obstruction; and multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food  protein induced enterocolitis syndrome; eosinophilic disorders and
 impaired absorption of  nutrients  caused  by  disorders  affecting  the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal  tract.  Enteral  formulas  [which] THAT are medically necessary and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic acid metabolism as well as severe protein allergic  conditions  shall
 include  modified  solid  food products that are low protein [or which],
 contain modified protein, or are  amino  acid  based  [which]  THAT  are
 medically  necessary[,  and  such  coverage for such modified solid food
 products for any calendar year or for any continuous  period  of  twelve
 months  for  any  insured  individual shall not exceed two thousand five
 hundred dollars].
   § 15. Items (i) and (ii)  of  subparagraph  (D)  of  paragraph  13  of
 subsection (k) of section 3221 of the insurance law, as added by chapter
 219  of  the  laws of 2011, are amended and a new item (iii) is added to
 read as follows:
   (i) evidence-based items or services for  bone  mineral  density  that
 have  in effect a rating of 'A' or 'B' in the current recommendations of
 the United States preventive services task force; [and]
   (ii) with respect  to  women,  such  additional  preventive  care  and
 screenings  for  bone  mineral density not described in item (i) of this
 subparagraph and as provided for in comprehensive  guidelines  supported
 by the health resources and services administration[.]; AND
   (III)  ANY  OTHER  PREVENTIVE  CARE  AND  SCREENINGS DESIGNATED BY THE
 SUPERINTENDENT IN A REGULATION  THAT  ARE  CONSISTENT  WITH  CURRENT  OR
 PREVIOUS  RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND (II)
 OF THIS SUBPARAGRAPH.
   § 16. Paragraph 19 of subsection (k) of section 3221 of the  insurance
 law,  as  amended by chapter 377 of the laws of 2014, is amended to read
 as follows:
   (19) Every group or  blanket  accident  and  health  insurance  policy
 delivered  or  issued  for  delivery in this state [which] THAT provides
 medical coverage that includes coverage  for  physician  services  in  a
 physician's  office and every policy [which] THAT provides major medical
 or similar comprehensive-type coverage shall include coverage for equip-
 ment and supplies used for the treatment of ostomies, if prescribed by a
 physician or other licensed health care provider legally  authorized  to
 prescribe under title eight of the education law. Such coverage shall be
 subject  to  annual deductibles and coinsurance as deemed appropriate by
 the superintendent. The coverage required by  this  paragraph  shall  be
 identical to, and shall not enhance or increase the coverage required as
 part  of  essential health benefits as [required pursuant to] DEFINED IN
 SUBSECTION (A) OF section [2707 (a) of the public health services act 42
 U.S.C.   300 gg-6(a)] THREE THOUSAND TWO  HUNDRED  SEVENTEEN-I  OF  THIS
 ARTICLE.
   §  17.  Items  (iii)  and  (iv)  of subparagraph (E) of paragraph 8 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (v) is added to read
 as follows:

 S. 1507--A                         56                         A. 2007--A
 
   (iii) with respect to children,  including  infants  and  adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (iv)  with  respect  to  women,  such  additional  preventive care and
 screenings not described  in  item  (i)  of  this  subparagraph  and  as
 provided  for  in  comprehensive  guidelines  supported  by  the  health
 resources and services administration[.]; AND
   (V) ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE  SUPER-
 INTENDENT  IN  A REGULATION THAT ARE CONSISTENT WITH CURRENT OR PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I)  THROUGH  (IV)  OF
 THIS SUBPARAGRAPH.
   §  18.  Items  (i)  and  (ii)  of  subparagraph (D) of paragraph 11 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (iii)  is  added  to
 read as follows:
   (i)  evidence-based  items  or  services  for mammography that have in
 effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
 United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for mammography not described in item (i)  of  this  subpara-
 graph  and  as provided for in comprehensive guidelines supported by the
 health resources and services administration[.]; AND
   (III) ANY OTHER PREVENTIVE  CARE  AND  SCREENINGS  DESIGNATED  BY  THE
 SUPERINTENDENT  IN  A  REGULATION  THAT  ARE  CONSISTENT WITH CURRENT OR
 PREVIOUS RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND  (II)
 OF THIS SUBPARAGRAPH.
   §  19.  Items  (i)  and  (ii)  of  subparagraph (D) of paragraph 14 of
 subsection (l) of section 3221 of the insurance law, as added by chapter
 219 of the laws of 2011, are amended and a new item (iii)  is  added  to
 read as follows:
   (i)  evidence-based  items or services for cervical cytology that have
 in effect a rating of 'A' or 'B' in the current recommendations  of  the
 United States preventive services task force; [and]
   (ii)  with  respect  to  women,  such  additional  preventive care and
 screenings for cervical cytology not  described  in  item  (i)  of  this
 subparagraph  and  as provided for in comprehensive guidelines supported
 by the health resources and services administration[.]; AND
   (III) ANY OTHER PREVENTIVE  CARE  AND  SCREENINGS  DESIGNATED  BY  THE
 SUPERINTENDENT  IN  A  REGULATION  THAT  ARE  CONSISTENT WITH CURRENT OR
 PREVIOUS RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN ITEMS (I) AND  (II)
 OF THIS SUBPARAGRAPH.
   §  20.  Paragraph 4 of subsection (a) of section 3231 of the insurance
 law, as amended by section 69 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology  in  which  the  premium for all persons covered by a policy
 form is the same based on the experience of the entire pool of risks  of
 all individuals or small groups covered by the insurer without regard to
 age,  sex,  health  status, tobacco usage or occupation, excluding those
 individuals or small groups covered by medicare supplemental  insurance.
 For  medicare supplemental insurance coverage, "community rated" means a
 rating methodology in which the premiums for all persons  covered  by  a
 policy  or  contract  form  is  the  same based on the experience of the
 entire pool of risks covered by that policy  or  contract  form  without
 regard  to  age,  sex,  health  status,  tobacco  usage  or  occupation.

 S. 1507--A                         57                         A. 2007--A
 
 [Catastrophic health  insurance  policies  issued  pursuant  to  section
 1302(e) of the affordable care act, 42 U.S.C. § 18022(e), shall be clas-
 sified in a distinct community rating pool.]
   § 21. Subsection (d) of section 3240 of the insurance law, as added by
 section  41  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (d) A student accident and health insurance policy or  contract  shall
 provide  coverage for essential health benefits as defined in SUBSECTION
 (A) OF section  [1302(b)  of  the  affordable  care  act,  42  U.S.C.  §
 18022(b)]  THREE  THOUSAND  TWO HUNDRED SEVENTEEN-I OR SUBSECTION (A) OF
 SECTION  FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS   CHAPTER,   AS
 APPLICABLE.
   §  22.  Subparagraph  (A)  of paragraph 3 of subsection (d) of section
 4235 of the insurance law, as added by section 60 of part D  of  chapter
 56 of the laws of 2013, is amended to read as follows:
   (A)  "employee"  shall  have the meaning set forth in [section 2791 of
 the public health service act, 42 U.S.C. § 300gg-91(d)(5) or  any  regu-
 lations  promulgated thereunder] THE EMPLOYEE RETIREMENT INCOME SECURITY
 ACT OF 1974, 29 U.S.C. § 1002(6); and
   § 23. Subparagraphs (C) and (D) of paragraph 3 of  subsection  (j)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (E)  is  added  to  read  as
 follows:
   (C)  with  respect  to  children,  including  infants and adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (D) with respect to women, such additional preventive care and screen-
 ings not described in subparagraph (A) of this paragraph and as provided
 for in comprehensive guidelines supported by the  health  resources  and
 services administration[.]; AND
   (E)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS  OR  GUIDELINES  IDENTIFIED IN SUBPARAGRAPHS (A) THROUGH
 (D) OF THIS PARAGRAPH.
   § 24. Subparagraphs (A) and (B) of paragraph 3 of  subsection  (p)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (C)  is  added  to  read  as
 follows:
   (A)  evidence-based  items  or  services  for mammography that have in
 effect a rating of 'A' or 'B' in  the  current  recommendations  of  the
 United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings for mammography not described in subparagraph (A) of this paragraph
 and  as provided for in comprehensive guidelines supported by the health
 resources and services administration[.]; AND
   (C) ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE  SUPER-
 INTENDENT  IN  A REGULATION THAT ARE CONSISTENT WITH CURRENT OR PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   § 25. Subparagraphs (A) and (B) of paragraph 3 of  subsection  (t)  of
 section  4303  of the insurance law, as added by chapter 219 of the laws
 of 2011, are amended and a new subparagraph (C)  is  added  to  read  as
 follows:

 S. 1507--A                         58                         A. 2007--A
 
   (A)  evidence-based  items or services for cervical cytology that have
 in effect a rating of 'A' or 'B' in the current recommendations  of  the
 United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings  for  cervical  cytology  not described in subparagraph (A) of this
 paragraph and as provided for in comprehensive guidelines  supported  by
 the health resources and services administration[.]; AND
   (C)  ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE SUPER-
 INTENDENT IN A REGULATION THAT ARE CONSISTENT WITH CURRENT  OR  PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   §  26.  Subsection  (u-1)  of  section  4303  of the insurance law, as
 amended by chapter 377 of the laws  of  2014,  is  amended  to  read  as
 follows:
   (u-1)  A  medical  expense  indemnity  corporation or a health service
 corporation which provides medical coverage that includes  coverage  for
 physician  services  in  a  physician's  office  and  every policy which
 provides major medical  or  similar  comprehensive-type  coverage  shall
 include  coverage  for  equipment and supplies used for the treatment of
 ostomies, if prescribed by a physician or  other  licensed  health  care
 provider legally authorized to prescribe under title eight of the educa-
 tion law. Such coverage shall be subject to annual deductibles and coin-
 surance  as  deemed  appropriate  by  the  superintendent.  The coverage
 required by this subsection shall be identical to, and shall not enhance
 or increase the coverage required as part of essential  health  benefits
 as  [required pursuant to] DEFINED IN SUBSECTION (A) OF section [2707(a)
 of the public health services act 42 U.S.C. 300 gg-6(a)]  FOUR  THOUSAND
 THREE HUNDRED SIX-H OF THIS ARTICLE.
   §  27. Subsection (y) of section 4303 of the insurance law, as amended
 by chapter 469 of the laws of 2018, is amended to read as follows:
   (y) Every contract [which] THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino-acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein,  [or  which]
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve

 S. 1507--A                         59                         A. 2007--A

 months for any insured individual shall not  exceed  two  thousand  five
 hundred dollars].
   §  28.  Subparagraphs (A) and (B) of paragraph 4 of subsection (bb) of
 section 4303 of the insurance law, as added by chapter 219 of  the  laws
 of  2011,  are  amended  and  a new subparagraph (C) is added to read as
 follows:
   (A) evidence-based items or services for  bone  mineral  density  that
 have  in effect a rating of 'A' or 'B' in the current recommendations of
 the United States preventive services task force; [and]
   (B) with respect to women, such additional preventive care and screen-
 ings for bone mineral density not described in subparagraph (A) of  this
 paragraph  and  as provided for in comprehensive guidelines supported by
 the health resources and services administration[.]; AND
   (C) ANY OTHER PREVENTIVE CARE AND SCREENINGS DESIGNATED BY THE  SUPER-
 INTENDENT  IN  A REGULATION THAT ARE CONSISTENT WITH CURRENT OR PREVIOUS
 RECOMMENDATIONS OR GUIDELINES IDENTIFIED IN SUBPARAGRAPHS (A) AND (B) OF
 THIS PARAGRAPH.
   § 29. Subsection (ll) of section 4303 of the insurance law,  as  added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (ll)  Every small group contract or association group contract [deliv-
 ered or issued for delivery in  this  state]  ISSUED  BY  A  CORPORATION
 SUBJECT  TO  THE  PROVISIONS  OF THIS ARTICLE that provides coverage for
 hospital, medical or surgical expense insurance and is  not  a  grandfa-
 thered  health  plan  shall  provide  coverage  for the essential health
 [benefit] BENEFITS package [as required in section 2707(a) of the public
 health service act, 42  U.S.C.  §  300gg-6(a)].  For  purposes  of  this
 subsection:
   (1)  "essential  health  benefits  package" shall have the meaning set
 forth in PARAGRAPH THREE OF SUBSECTION (F)  OF section [1302(a)  of  the
 affordable  care  act, 42 U.S.C. § 18022(a)] FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE;
   (2) "grandfathered health plan" means coverage provided  by  a  corpo-
 ration  in  which  an individual was enrolled on March twenty-third, two
 thousand ten for as long as the coverage maintains grandfathered  status
 in accordance with section 1251(e) of the affordable care act, 42 U.S.C.
 § 18011(e); and
   (3)  "small  group"  means  a  group  of  [fifty or fewer employees or
 members exclusive of spouses and dependents.  Beginning  January  first,
 two  thousand  sixteen,  "small  group" means a group of] one hundred or
 fewer employees or members exclusive of spouses and dependents; and
   (4) "association group" means a group defined  in  subparagraphs  (B),
 (D),  (H), (K), (L) or (M) of paragraph one of subsection (c) of section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B) the group includes one or more member employers  or  other  member
 groups that are small groups.
   §  30.  Subsection (mm) of section 4303 of the insurance law, as added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (mm) A corporation shall not be required to offer the contract  holder
 any  benefits  that  must  be made available pursuant to this section if
 such benefits must be  covered  pursuant  to  subsection  (kk)  of  this
 section.  For  any  contract  issued  within the health benefit exchange
 established [pursuant to section 1311 of the  affordable  care  act,  42
 U.S.C.  §  18031]  BY THIS STATE, a corporation shall not be required to

 S. 1507--A                         60                         A. 2007--A
 
 offer the contract holder any  benefits  that  must  be  made  available
 pursuant to this section.
   § 31. Item (i) of subparagraph (C) of paragraph 2 of subsection (c) of
 section 4304 of the insurance law, as amended by chapter 317 of the laws
 of 2017, is amended to read as follows:
   (i)  Discontinuance  of  a class of contract upon not less than ninety
 days' prior written notice. In  exercising  the  option  to  discontinue
 coverage pursuant to this item, the corporation must act uniformly with-
 out  regard  to any health status-related factor of enrolled individuals
 or individuals who may become eligible for such coverage and must  offer
 to  subscribers  or  group  remitting agents, as may be appropriate, the
 option to  purchase  all  other  individual  health  insurance  coverage
 currently being offered by the corporation to applicants in that market.
 Provided,  however,  the  superintendent may, after giving due consider-
 ation to the public interest, approve a request made  by  a  corporation
 for the corporation to satisfy the requirements of this item through the
 offering of contracts at each level of coverage as defined in SUBSECTION
 (C)  OF  section  [1302(d)  of  the  affordable  care  act,  42 U.S.C. §
 18022(d)] FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE  that
 contains  the  ESSENTIAL  HEALTH benefits PACKAGE described in paragraph
 [one] THREE of subsection [(b)]  (F)  of  section  four  thousand  three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE by another corpo-
 ration,  insurer  or  health  maintenance organization within the corpo-
 ration's same holding company system, as defined in article  fifteen  of
 this chapter.
   §  32.  Paragraph 1 of subsection (e) of section 4304 of the insurance
 law, as amended by chapter 388 of the laws of 2014, is amended  to  read
 as follows:
   (1)  (A)  If  any  such  contract is terminated in accordance with the
 provisions of paragraph one of subsection (c) of this  section,  or  any
 such  contract is terminated because of a default by the remitting agent
 in the payment of premiums not cured within the  grace  period  and  the
 remitting  agent  has not replaced the contract with similar and contin-
 uous coverage for the same group whether insured or self-insured, or any
 such contract is terminated in accordance with the provisions of subpar-
 agraph (E) of paragraph two of subsection (c) of this section, or if  an
 individual  other  than the contract holder is no longer covered under a
 "family contract" because the individual is no longer within  the  defi-
 nition set forth in the contract, or a spouse is no longer covered under
 the contract because of divorce from the contract holder or annulment of
 the marriage, or any such contract is terminated because of the death of
 the contract holder, then such individual, former spouse, or in the case
 of the death of the contract holder the surviving spouse or other depen-
 dents of the deceased contract holder covered under the contract, as the
 case  may  be, shall be entitled to convert, without evidence of insura-
 bility, upon application therefor and the making of  the  first  payment
 thereunder  within  sixty  days  after  the  date of termination of such
 contract, to a contract that  contains  the  ESSENTIAL  HEALTH  benefits
 PACKAGE  described  in  paragraph [one] THREE of subsection [(b)] (F) of
 section four thousand three hundred [twenty-eight] SIX-H of this  [chap-
 ter] ARTICLE.
   (B) The corporation shall offer one contract at each level of coverage
 as  defined in SUBSECTION (C) OF section [1302(d) of the affordable care
 act, 42 U.S.C. § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS
 ARTICLE.  The  individual  may  choose  any such contract offered by the
 corporation. Provided, however, the superintendent may, after giving due

 S. 1507--A                         61                         A. 2007--A
 
 consideration to the public interest, approve a request made by a corpo-
 ration for the corporation to satisfy the requirements of this paragraph
 through the offering of contracts that comply  with  this  paragraph  by
 another  corporation,  insurer or health maintenance organization within
 the corporation's same holding company system,  as  defined  in  article
 fifteen of this chapter.
   (C)  The  effective  date  of  the  coverage provided by the converted
 direct payment contract shall be the date of the termination of coverage
 under the contract from which conversion was made.
   § 33. Subsection (l) of section 4304 of the insurance law, as added by
 section 43 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (l)  [On  and  after October first, two thousand thirteen, a] A corpo-
 ration shall not offer individual hospital, medical, or surgical expense
 insurance contracts  unless  the  contracts  meet  the  requirements  of
 subsection  (b)  of  section four thousand three hundred twenty-eight of
 this article. Such contracts that are offered within the health  benefit
 exchange  established  [pursuant  to section 1311 of the affordable care
 act, 42 U.S.C. § 18031, or any regulations promulgated  thereunder,]  BY
 THIS  STATE  also  shall meet any requirements established by the health
 benefit exchange.  To the extent that a  holder  of  a  special  purpose
 certificate  of  authority issued pursuant to section four thousand four
 hundred three-a of the public health  law  offers  individual  hospital,
 medical,  or  surgical  expense insurance contracts, the contracts shall
 meet the requirements of subsection (b) of section four  thousand  three
 hundred twenty-eight of this article.
   §  34.  Subparagraph  (A)  of paragraph 1 of subsection (d) of section
 4305 of the insurance law, as amended by chapter  388  of  the  laws  of
 2014, is amended to read as follows:
   (A)  A  group contract issued pursuant to this section shall contain a
 provision to the effect that in case of a termination of coverage  under
 such  contract of any member of the group because of (i) termination for
 any reason whatsoever of the member's employment or membership, or  (ii)
 termination  for  any  reason  whatsoever  of  the group contract itself
 unless the group contract holder has replaced the  group  contract  with
 similar  and  continuous  coverage for the same group whether insured or
 self-insured, the member shall be entitled to have issued to the  member
 by  the  corporation, without evidence of insurability, upon application
 therefor and payment of the first premium made to the corporation within
 sixty days after termination  of  the  coverage,  an  individual  direct
 payment  contract, covering such member and the member's eligible depen-
 dents who were covered by the group contract,  which  provides  coverage
 that  contains  the ESSENTIAL HEALTH benefits PACKAGE described in para-
 graph [one] THREE of subsection [(b)] (F) of section four thousand three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE. The  corporation
 shall  offer  one  contract  at  each  level  of  coverage as defined in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE.  The
 member  may  choose  any  such  contract  offered  by  the  corporation.
 Provided, however, the superintendent may, after  giving  due  consider-
 ation  to  the  public interest, approve a request made by a corporation
 for the corporation to satisfy the  requirements  of  this  subparagraph
 through  the offering of contracts that comply with this subparagraph by
 another corporation, insurer or health maintenance  organization  within
 the  corporation's  same  holding  company system, as defined in article
 fifteen of this chapter.

 S. 1507--A                         62                         A. 2007--A
 
   § 35. The insurance law is amended by adding a new section  4306-h  to
 read as follows:
   § 4306-H. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;
   (5)  MENTAL  HEALTH  AND  SUBSTANCE  USE  DISORDER SERVICES, INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;
   (9) PREVENTIVE AND WELLNESS SERVICES AND CHRONIC  DISEASE  MANAGEMENT;
 AND
   (10) PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.
   (B)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, MAY SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF  PLANS  THAT
 TOGETHER  CONTAIN  ESSENTIAL  HEALTH  BENEFITS,  IN ACCORDANCE WITH THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP CONTRACT THAT PROVIDES HOSPI-
 TAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS  NOT  A  GRANDFATHERED
 HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE ACTUARIAL REQUIREMENTS
 OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:
   (A)  BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN;
   (B) SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF  THE  BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C)  GOLD  LEVEL.  A  PLAN  IN THE GOLD LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF  COVERAGE  THAT  IS DESIGNED TO PROVIDE BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2) THE SUPERINTENDENT MAY PROVIDE FOR A VARIATION  IN  THE  ACTUARIAL
 VALUES  USED  IN  DETERMINING THE LEVEL OF COVERAGE OF A PLAN TO ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3) EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL PROVIDE
 COVERAGE THAT MEETS AT LEAST SIXTY PERCENT OF THE FULL  ACTUARIAL  VALUE
 OF THE BENEFITS PROVIDED UNDER THE CONTRACT.  THE CONTRACT'S SCHEDULE OF
 BENEFITS  SHALL  INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE OF THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D) EVERY INDIVIDUAL OR GROUP CONTRACT THAT PROVIDES HOSPITAL,  SURGI-
 CAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT A GRANDFATHERED HEALTH PLAN,
 AND EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL LIMIT THE
 INSURED'S COST-SHARING FOR IN-NETWORK SERVICES IN A CONTRACT YEAR TO NOT
 MORE THAN THE MAXIMUM OUT-OF-POCKET AMOUNT DETERMINED BY THE SUPERINTEN-
 DENT  FOR  ALL  CONTRACTS SUBJECT TO THIS SECTION. SUCH AMOUNT SHALL NOT

 S. 1507--A                         63                         A. 2007--A
 
 EXCEED ANY ANNUAL OUT-OF-POCKET LIMIT ON COST-SHARING SET BY THE  UNITED
 STATES SECRETARY OF HEALTH AND HUMAN SERVICES, IF AVAILABLE.
   (E)  THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE DESCRIB-
 ING THE COVERAGE REQUIREMENTS FOR  ANY  FORM  THAT  IS  SUBJECT  TO  THE
 APPROVAL  OF  THE SUPERINTENDENT PURSUANT TO SECTION FOUR THOUSAND THREE
 HUNDRED EIGHT OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1) "ACTUARIAL VALUE" MEANS  THE  PERCENTAGE  OF  THE  TOTAL  EXPECTED
 PAYMENTS  BY  THE  CORPORATION FOR BENEFITS PROVIDED TO A STANDARD POPU-
 LATION, WITHOUT REGARD TO THE POPULATION TO WHOM THE CORPORATION ACTUAL-
 LY PROVIDES BENEFITS;
   (2) "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE,  COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)   LIMITS   COST-SHARING  FOR  SUCH  COVERAGE  IN  ACCORDANCE  WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4) "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED  BY  A  CORPO-
 RATION  IN  WHICH  AN INDIVIDUAL WAS ENROLLED ON MARCH TWENTY-THIRD, TWO
 THOUSAND TEN FOR AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED  STATUS
 IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
 § 18011(E);
   (5)  "SMALL  GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER EMPLOYEES OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED  FORTY  OF
 THIS CHAPTER.
   §  36.  Paragraph 4 of subsection (a) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology  in which the premium for all persons covered by a policy or
 contract form is the same, based on the experience of the entire pool of
 risks of all individuals or small  groups  covered  by  the  corporation
 without  regard  to age, sex, health status, tobacco usage or occupation
 excluding those individuals of small groups covered by Medicare  supple-
 mental  insurance. For medicare supplemental insurance coverage, "commu-
 nity rated" means a rating methodology in which  the  premiums  for  all
 persons  covered  by  a policy or contract form is the same based on the
 experience of the entire  pool  of  risks  covered  by  that  policy  or
 contract  form  without regard to age, sex, health status, tobacco usage
 or occupation. [Catastrophic health insurance contracts issued  pursuant
 to  section  1302(e)  of  the affordable care act, 42 U.S.C. § 18022(e),
 shall be classified in a distinct community rating pool.]
   § 37. Subsections (d), (e) and (j) of section 4326  of  the  insurance
 law,  as  amended  by  section 56 of part D of chapter 56 of the laws of
 2013, are amended to read as follows:
   (d) A qualifying group health insurance contract shall provide  cover-
 age for the essential health [benefit] BENEFITS package as [required in]
 DEFINED  IN PARAGRAPH THREE OF SUBSECTION (F) OF section [2707(a) of the
 public health service act, 42 U.S.C. § 300gg-6(a). For purposes of  this
 subsection  "essential  health  benefits package" shall have the meaning
 set forth in section 1302(a) of the affordable care  act,  42  U.S.C.  §
 18022(a)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE.

 S. 1507--A                         64                         A. 2007--A
 
   (e) A qualifying group health insurance contract [issued to a qualify-
 ing  small  employer  prior to January first, two thousand fourteen that
 does not include all essential  health  benefits  required  pursuant  to
 section   2707(a)  of  the  public  health  service  act,  42  U.S.C.  §
 300gg-6(a), shall be discontinued, including grandfathered health plans.
 For  the  purposes of this paragraph, "grandfathered health plans" means
 coverage provided by a corporation to individuals who were  enrolled  on
 March  twenty-third,  two thousand ten for as long as the coverage main-
 tains grandfathered status in accordance with  section  1251(e)  of  the
 affordable  care  act, 42 U.S.C. § 18011(e). A qualifying small employer
 shall be transitioned to a plan that  provides:  (1)]  SHALL  PROVIDE  a
 level of coverage that is designed to provide benefits that are actuari-
 ally  equivalent  to  eighty  percent of the full actuarial value of the
 benefits provided under the plan[; and (2) coverage  for  the  essential
 health  benefit  package  as  required  in section 2707(a) of the public
 health service act, 42 U.S.C. § 300gg-6(a)].  The  superintendent  shall
 standardize  the benefit package and cost sharing requirements of quali-
 fied group health insurance contracts consistent with  coverage  offered
 through  the  health  benefit  exchange established [pursuant to section
 1311 of the affordable care act, 42 U.S.C. § 18031] BY THIS STATE.
   (j) [Beginning January  first,  two  thousand  fourteen,  pursuant  to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation  shall not impose any pre-existing condition limitation in a
 qualifying group health insurance contract.
   § 38. Subsection (m-1) of  section  4327  of  the  insurance  law,  as
 amended  by  section  58 of part D of chapter 56 of the laws of 2013, is
 amended to read as follows:
   (m-1) In the event that the superintendent suspends the enrollment  of
 new  individuals  for  qualifying  group health insurance contracts, the
 superintendent shall ensure that small employers seeking to enroll in  a
 qualified  group  health  insurance  contract pursuant to section forty-
 three hundred twenty-six of this article are provided information on and
 directed to  coverage  options  available  through  the  health  benefit
 exchange  established  [pursuant  to section 1311 of the affordable care
 act, 42 U.S.C. § 18031] BY THIS STATE.
   § 39. Paragraphs 1, 2 and 3 of subsection (b) of section 4328  of  the
 insurance  law,  as  added  by section 46 of part D of chapter 56 of the
 laws of 2013, are amended to read as follows:
   (1) The individual enrollee direct payment contract  offered  pursuant
 to  this  section shall provide coverage for the essential health [bene-
 fit] BENEFITS package as [required in] DEFINED  IN  PARAGRAPH  THREE  OF
 SUBSECTION  (F) OF section [2707(a) of the public health service act, 42
 U.S.C. § 300gg-6(a). For purposes of this paragraph,  "essential  health
 benefits package" shall have the meaning set forth in section 1302(a) of
 the  affordable  care  act,  42  U.S.C.  § 18022(a)] FOUR THOUSAND THREE
 HUNDRED SIX-H OF THIS ARTICLE.
   (2) A health maintenance organization shall offer at least  one  indi-
 vidual  enrollee  direct  payment  contract at each level of coverage as
 defined in SUBSECTION (C) OF section [1302(d)  of  the  affordable  care
 act,  42  U.S.C.  §  18022(d)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS
 ARTICLE. A health maintenance organization also shall offer  one  child-
 only plan, AS REQUIRED BY SECTION 1302(F) OF THE AFFORDABLE CARE ACT, 42
 U.S.C.  §  18022(F),  at  each level of coverage [as required in section
 2707(c) of the public health service act, 42 U.S.C. § 300gg-6(c)].
   (3) Within  the  health  benefit  exchange  established  [pursuant  to
 section  1311  of  the  affordable  care act, 42 U.S.C. § 18031] BY THIS

 S. 1507--A                         65                         A. 2007--A
 
 STATE, a health maintenance organization may offer an individual  enrol-
 lee  direct  payment  contract  that  is  a  catastrophic health plan as
 defined in section 1302(e) of the  affordable  care  act,  42  U.S.C.  §
 18022(e), or any regulations promulgated thereunder.
   §  40.  Subparagraph  (A)  of paragraph 4 of subsection (b) of section
 4328 of the insurance law, as added by chapter 11 of the laws  of  2016,
 is amended to read as follows:
   (A)  The  individual enrollee direct payment contract offered pursuant
 to this section  shall  have  the  same  enrollment  periods,  including
 special enrollment periods, as required for an individual direct payment
 contract  offered within the health benefit exchange established [pursu-
 ant to section 1311 of the affordable care act, 42 U.S.C.  §  18031,  or
 any regulations promulgated thereunder] BY THIS STATE.
   § 41. Subsection (c) of section 4328 of the insurance law, as added by
 section  46  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (c) In addition to or  in  lieu  of  the  individual  enrollee  direct
 payment  contracts  required  under this section, all health maintenance
 organizations issued a certificate of authority under article forty-four
 of the public health law or licensed under this article may offer  indi-
 vidual  enrollee  direct  payment  contracts  within  the health benefit
 exchange established [pursuant to section 1311 of  the  affordable  care
 act,  42  U.S.C.  § 18031, or any regulations promulgated thereunder] BY
 THIS STATE, subject to any requirements established by the health  bene-
 fit  exchange.    If  a  health  maintenance  organization satisfies the
 requirements of subsection (a) of this section  by  offering  individual
 enrollee  direct  payment  contracts,  only  within  the  health benefit
 exchange, the health maintenance organization, not including a holder of
 a special purpose certificate of authority issued  pursuant  to  section
 four  thousand four hundred three-a of the public health law, shall also
 offer at least one individual enrollee direct payment contract  at  each
 level  of coverage as defined in SUBSECTION (C) section [1302 (d) of the
 affordable care act, 42 U.S.C. § 18022 (d)] FOUR THOUSAND THREE  HUNDRED
 SIX-H OF THIS ARTICLE, outside the health benefit exchange.
   § 42. This act shall take effect on the first of January next succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART C

   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 35 to read as follows:
   (35) NO POLICY DELIVERED OR ISSUED FOR DELIVERY  IN  THIS  STATE  THAT
 PROVIDES  HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT OR
 EXCLUDE COVERAGE FOR ABORTIONS THAT ARE  MEDICALLY  NECESSARY.  COVERAGE
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL  DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE POLICY
 IS A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF  THE
 INTERNAL  REVENUE  CODE  OF  1986;  IN WHICH CASE COVERAGE FOR MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21) (A) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT  OR
 EXCLUDE  COVERAGE  FOR  ABORTIONS THAT ARE MEDICALLY NECESSARY. COVERAGE

 S. 1507--A                         66                         A. 2007--A
 
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE  POLICY
 IS  A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF THE
 INTERNAL  REVENUE  CODE  OF  1986;  IN WHICH CASE COVERAGE FOR MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   (B) NOTWITHSTANDING ANY OTHER PROVISION, A GROUP POLICY THAT  PROVIDES
 HOSPITAL,  SURGICAL, OR MEDICAL EXPENSE COVERAGE DELIVERED OR ISSUED FOR
 DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER, AS DEFINED IN  PARAGRAPH
 SIXTEEN OF THIS SUBSECTION, MAY EXCLUDE COVERAGE FOR MEDICALLY NECESSARY
 ABORTIONS ONLY IF THE INSURER:
   (I)  OBTAINS  AN ANNUAL CERTIFICATION FROM THE GROUP POLICYHOLDER THAT
 THE POLICYHOLDER IS A RELIGIOUS EMPLOYER AND THAT THE RELIGIOUS EMPLOYER
 REQUESTS A POLICY WITHOUT COVERAGE FOR MEDICALLY NECESSARY ABORTIONS;
   (II) ISSUES A RIDER TO EACH CERTIFICATEHOLDER  AT  NO  PREMIUM  TO  BE
 CHARGED  TO  THE  CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER FOR THE RIDER,
 THAT PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO  THE
 SAME  RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF TREATMENT
 IN THE POLICY ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER SHALL  CLEARLY
 AND  CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT ADMINIS-
 TER MEDICALLY NECESSARY ABORTION BENEFITS, BUT THAT THE INSURER IS ISSU-
 ING A RIDER FOR COVERAGE OF MEDICALLY  NECESSARY  ABORTIONS,  AND  SHALL
 PROVIDE THE INSURER'S CONTACT INFORMATION FOR QUESTIONS; AND
   (III)  PROVIDES  NOTICE OF THE ISSUANCE OF THE POLICY AND RIDER TO THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ss) to read as follows:
   (SS) (1) NO CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS
 OF  THIS  ARTICLE  THAT  PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE
 COVERAGE  SHALL  LIMIT  OR  EXCLUDE  COVERAGE  FOR  ABORTIONS  THAT  ARE
 MEDICALLY NECESSARY. COVERAGE FOR ABORTIONS THAT ARE MEDICALLY NECESSARY
 SHALL  NOT  BE  SUBJECT  TO ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING
 CO-PAYMENTS, UNLESS THE CONTRACT IS A HIGH  DEDUCTIBLE  HEALTH  PLAN  AS
 DEFINED  IN  SECTION  223(C)(2)  OF THE INTERNAL REVENUE CODE OF 1986 IN
 WHICH CASE COVERAGE FOR MEDICALLY NECESSARY ABORTIONS MAY BE SUBJECT  TO
 THE CONTRACT'S ANNUAL DEDUCTIBLE.
   (2)  NOTWITHSTANDING  ANY  OTHER  PROVISION,  A  GROUP  CONTRACT  THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE  COVERAGE  DELIVERED  OR
 ISSUED  FOR DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER AS DEFINED IN
 SUBSECTION (CC) OF THIS  SECTION  MAY  EXCLUDE  COVERAGE  FOR  MEDICALLY
 NECESSARY ABORTIONS ONLY IF THE CORPORATION:
   (A) OBTAINS AN ANNUAL CERTIFICATION FROM THE GROUP CONTRACTHOLDER THAT
 THE  CONTRACTHOLDER  IS  A  RELIGIOUS  EMPLOYER  AND  THAT THE RELIGIOUS
 EMPLOYER REQUESTS A CONTRACT WITHOUT COVERAGE  FOR  MEDICALLY  NECESSARY
 ABORTIONS;
   (B)  ISSUES  A  RIDER  TO  EACH  CERTIFICATEHOLDER AT NO PREMIUM TO BE
 CHARGED TO THE CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER  FOR  THE  RIDER,
 THAT  PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO THE
 SAME RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF  TREATMENT
 IN THE CONTRACT ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER MUST CLEARLY
 AND  CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT ADMINIS-
 TER MEDICALLY NECESSARY ABORTION BENEFITS, BUT THAT THE  CORPORATION  IS
 ISSUING A RIDER FOR COVERAGE OF MEDICALLY NECESSARY ABORTIONS, AND SHALL
 PROVIDE THE CORPORATION'S CONTACT INFORMATION FOR QUESTIONS; AND
   (C)  PROVIDES  NOTICE OF THE ISSUANCE OF THE CONTRACT AND RIDER TO THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.

 S. 1507--A                         67                         A. 2007--A
 
   § 4. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART D
 
   Section  1.  The insurance law is amended by adding a new section 3242
 to read as follows:
   § 3242. PRESCRIPTION DRUG COVERAGE.  (A) EVERY INSURER  THAT  DELIVERS
 OR ISSUES FOR DELIVERY IN THIS STATE A POLICY THAT PROVIDES COVERAGE FOR
 PRESCRIPTION  DRUGS  SHALL, WITH RESPECT TO THE PRESCRIPTION DRUG COVER-
 AGE, PUBLISH AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF  ALL  COVERED
 PRESCRIPTION  DRUGS  ON  ITS  FORMULARY DRUG LIST, INCLUDING ANY TIERING
 STRUCTURE THAT IT HAS ADOPTED AND ANY  RESTRICTIONS  ON  THE  MANNER  IN
 WHICH  A  PRESCRIPTION  DRUG MAY BE OBTAINED, IN A MANNER THAT IS EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B) (1) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY  IN  THIS  STATE
 THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL INCLUDE IN THE POLI-
 CY  A  PROCESS  THAT  ALLOWS  AN INSURED, THE INSURED'S DESIGNEE, OR THE
 INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A FORMULARY EXCEP-
 TION.  WITH RESPECT TO THE PROCESS FOR SUCH A  FORMULARY  EXCEPTION,  AN
 INSURER  SHALL  FOLLOW  THE  PROCESS AND PROCEDURES SPECIFIED IN ARTICLE
 FORTY-NINE OF THIS CHAPTER AND ARTICLE FORTY-NINE OF THE  PUBLIC  HEALTH
 LAW,  EXCEPT  AS  OTHERWISE  PROVIDED IN PARAGRAPHS TWO, THREE, FOUR AND
 FIVE OF THIS SUBSECTION.
   (2) (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE  INSURED'S
 DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A
 STANDARD  REVIEW  THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES OF A FORMU-
 LARY EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE  POLI-
 CY.
   (B)  AN  INSURER  SHALL  MAKE  A DETERMINATION ON A STANDARD EXCEPTION
 REQUEST THAT IS NOT  BASED  ON  EXIGENT  CIRCUMSTANCES  AND  NOTIFY  THE
 INSURED  OR  THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH
 CARE PROVIDER BY TELEPHONE OF ITS COVERAGE DETERMINATION NO  LATER  THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C)  AN  INSURER  THAT GRANTS A STANDARD EXCEPTION REQUEST THAT IS NOT
 BASED ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE  NON-FORMU-
 LARY  PRESCRIPTION  DRUG FOR THE DURATION OF THE PRESCRIPTION, INCLUDING
 REFILLS.
   (D) FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES"  MEANS
 WHEN  AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY SERIOUSLY
 JEOPARDIZE THE INSURED'S LIFE, HEALTH,  OR  ABILITY  TO  REGAIN  MAXIMUM
 FUNCTION  OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3) (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE  INSURED'S
 DESIGNEE,  OR  THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST
 AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF A FORMULARY EXCEP-
 TION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE POLICY.
   (B) AN INSURER SHALL MAKE  A  DETERMINATION  ON  AN  EXPEDITED  REVIEW
 REQUEST  BASED  ON  EXIGENT  CIRCUMSTANCES AND NOTIFY THE INSURED OR THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR  HOURS
 FOLLOWING RECEIPT OF THE REQUEST.

 S. 1507--A                         68                         A. 2007--A
 
   (C) AN INSURER THAT GRANTS AN EXCEPTION BASED ON EXIGENT CIRCUMSTANCES
 SHALL  PROVIDE  COVERAGE  OF THE NON-FORMULARY PRESCRIPTION DRUG FOR THE
 DURATION OF THE EXIGENT CIRCUMSTANCES.
   (4) AN INSURER THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO OR
 THREE  OF  THIS  SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE DETERMINATION UNDER SECTION FOUR THOUSAND NINE HUNDRED  FOUR  OF
 THIS  CHAPTER  OR  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THE PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY APPROPRIATE PRESCRIPTION DRUGS COVERED BY THE  INSURER  TO  TREAT
 THE INSURED.
   (5)  (A)  IF  AN INSURER DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  SHALL  HAVE  THE
 RIGHT  TO  REQUEST  THAT  SUCH  DENIAL BE REVIEWED BY AN EXTERNAL APPEAL
 AGENT CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR  THOUSAND
 NINE  HUNDRED  ELEVEN  OF THIS CHAPTER IN ACCORDANCE WITH ARTICLE FORTY-
 NINE OF THIS CHAPTER OR ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B) AN EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION  ON  THE
 EXTERNAL  APPEAL  AND  NOTIFY  THE INSURER, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE EXTERNAL APPEAL AGENT SHALL NOTIFY THE INSURER, THE INSURED  OR  THE
 INSURED'S  DESIGNEE,  AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER
 IN WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN TWO BUSINESS DAYS
 OF RENDERING SUCH DETERMINATION.
   (C) AN EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION  ON  THE
 EXTERNAL  APPEAL  AND  NOTIFY  THE INSURER, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE INSURER, THE INSURED OR THE INSURED'S DESIGNEE,  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE  PROVIDER  IN  WRITING  OF THE EXTERNAL APPEAL
 DETERMINATION WITHIN SEVENTY-TWO HOURS OF THE  EXTERNAL  APPEAL  AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D)  AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN ACCORDANCE
 WITH SUBPARAGRAPH (A) OF PARAGRAPH FOUR OF  SUBSECTION  (B)  OF  SECTION
 FOUR  THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER OR SUBPARAGRAPH (A)
 OF PARAGRAPH (D) OF  SUBDIVISION  TWO  OF  SECTION  FOUR  THOUSAND  NINE
 HUNDRED  FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A DETERMINATION,
 THE  EXTERNAL  APPEAL  AGENT  SHALL  CONSIDER  WHETHER   THE   FORMULARY
 PRESCRIPTION  DRUG  COVERED  BY THE INSURER WILL BE OR HAS BEEN INEFFEC-
 TIVE, WOULD NOT BE AS EFFECTIVE AS THE NON-FORMULARY PRESCRIPTION  DRUG,
 OR WOULD HAVE ADVERSE EFFECTS.
   (E)  IF  AN  EXTERNAL APPEAL AGENT OVERTURNS THE INSURER'S DENIAL OF A
 STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION,  THEN
 THE  INSURER  SHALL  PROVIDE  COVERAGE OF THE NON-FORMULARY PRESCRIPTION
 DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING  REFILLS.  IF  AN
 EXTERNAL  APPEAL  AGENT  OVERTURNS  THE INSURER'S DENIAL OF AN EXPEDITED

 S. 1507--A                         69                         A. 2007--A
 
 EXCEPTION REQUEST UNDER PARAGRAPH THREE OF  THIS  SUBSECTION,  THEN  THE
 INSURER  SHALL  PROVIDE  COVERAGE OF THE NON-FORMULARY PRESCRIPTION DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   § 2. The insurance law is amended by adding a new section 4329 to read
 as follows:
   §  4329. PRESCRIPTION DRUG COVERAGE.  (A) EVERY CORPORATION SUBJECT TO
 THE PROVISIONS OF THIS ARTICLE THAT  ISSUES  A  CONTRACT  THAT  PROVIDES
 COVERAGE  FOR PRESCRIPTION DRUGS SHALL, WITH RESPECT TO THE PRESCRIPTION
 DRUG COVERAGE, PUBLISH AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF ALL
 COVERED PRESCRIPTION DRUGS ON ITS FORMULARY  DRUG  LIST,  INCLUDING  ANY
 TIERING STRUCTURE THAT IT HAS ADOPTED AND ANY RESTRICTIONS ON THE MANNER
 IN WHICH A PRESCRIPTION DRUG MAY BE OBTAINED, IN A MANNER THAT IS EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B)  (1)  EVERY  CONTRACT  ISSUED  BY  A  CORPORATION  SUBJECT  TO THE
 PROVISIONS OF THIS ARTICLE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
 SHALL INCLUDE IN THE CONTRACT A PROCESS  THAT  ALLOWS  AN  INSURED,  THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST  A  FORMULARY  EXCEPTION. WITH RESPECT TO THE PROCESS FOR SUCH A
 FORMULARY EXCEPTION, A CORPORATION SHALL FOLLOW THE PROCESS  AND  PROCE-
 DURES  SPECIFIED  IN  ARTICLE  FORTY-NINE  OF  THIS  CHAPTER AND ARTICLE
 FORTY-NINE OF THE PUBLIC HEALTH LAW, EXCEPT  AS  OTHERWISE  PROVIDED  IN
 PARAGRAPHS TWO, THREE, FOUR AND FIVE OF THIS SUBSECTION.
   (2)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST A STANDARD REVIEW THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES  OF
 A FORMULARY EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE
 CONTRACT.
   (B)  A  CORPORATION SHALL MAKE A DETERMINATION ON A STANDARD EXCEPTION
 REQUEST THAT IS NOT  BASED  ON  EXIGENT  CIRCUMSTANCES  AND  NOTIFY  THE
 INSURED  OR  THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH
 CARE PROVIDER BY TELEPHONE OF ITS COVERAGE DETERMINATION NO  LATER  THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS A STANDARD EXCEPTION REQUEST THAT IS NOT
 BASED  ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE NON-FORMU-
 LARY PRESCRIPTION DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING
 REFILLS.
   (D)  FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES" MEANS
 WHEN AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY  SERIOUSLY
 JEOPARDIZE  THE  INSURED'S  LIFE,  HEALTH,  OR ABILITY TO REGAIN MAXIMUM
 FUNCTION OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF  TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF  A  FORMU-
 LARY EXCEPTION FOR A PRESCRIPTION DRUG IS NOT COVERED BY THE CONTRACT.
   (B)  A  CORPORATION  SHALL MAKE A DETERMINATION ON AN EXPEDITED REVIEW
 REQUEST BASED ON EXIGENT CIRCUMSTANCES AND NOTIFY  THE  INSURED  OR  THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE  OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR HOURS
 FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS AN EXCEPTION BASED  ON  EXIGENT  CIRCUM-
 STANCES  SHALL  PROVIDE  COVERAGE OF THE NON-FORMULARY PRESCRIPTION DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.

 S. 1507--A                         70                         A. 2007--A
 
   (4) A CORPORATION THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO
 OR THREE OF THIS SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE  DETERMINATION  UNDER SECTION FOUR THOUSAND NINE HUNDRED FOUR OF
 THIS CHAPTER OR SECTION FOUR THOUSAND NINE HUNDRED FOUR  OF  THE  PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY  APPROPRIATE  PRESCRIPTION  DRUGS  COVERED  BY THE CORPORATION TO
 TREAT THE INSURED.
   (5) (A) IF A CORPORATION DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  SHALL  HAVE  THE
 RIGHT  TO  REQUEST  THAT  SUCH  DENIAL BE REVIEWED BY AN EXTERNAL APPEAL
 AGENT CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR  THOUSAND
 NINE  HUNDRED  ELEVEN  OF THIS CHAPTER IN ACCORDANCE WITH ARTICLE FORTY-
 NINE OF THIS CHAPTER AND ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B) AN EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION  ON  THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE,  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL  REQUEST
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE  EXTERNAL  APPEAL AGENT SHALL NOTIFY THE CORPORATION, THE INSURED OR
 THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVID-
 ER IN WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN  TWO  BUSINESS
 DAYS OF RENDERING SUCH DETERMINATION.
   (C)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE CORPORATION, THE INSURED OR THE INSURED'S DESIGNEE AND THE INSURED'S
 PRESCRIBING HEALTH CARE PROVIDER  IN  WRITING  OF  THE  EXTERNAL  APPEAL
 DETERMINATION  WITHIN  SEVENTY-TWO  HOURS OF THE EXTERNAL APPEAL AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D) AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN  ACCORDANCE
 WITH  SUBPARAGRAPH  (A)  OF  PARAGRAPH FOUR OF SUBSECTION (B) OF SECTION
 FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER AND SUBPARAGRAPH (A)
 OF PARAGRAPH (D) OF  SUBDIVISION  TWO  OF  SECTION  FOUR  THOUSAND  NINE
 HUNDRED  FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A DETERMINATION,
 THE  EXTERNAL  APPEAL  AGENT  SHALL  CONSIDER  WHETHER   THE   FORMULARY
 PRESCRIPTION  DRUG  COVERED BY THE CORPORATION WILL BE OR HAS BEEN INEF-
 FECTIVE, WOULD NOT BE AS EFFECTIVE  AS  THE  NON-FORMULARY  PRESCRIPTION
 DRUG, OR WOULD HAVE ADVERSE EFFECTS.
   (E)  IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S DENIAL OF
 A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH  TWO  OF  THIS  SUBSECTION,
 THEN  THE  CORPORATION  SHALL  PROVIDE  COVERAGE  OF  THE  NON-FORMULARY
 PRESCRIPTION DRUG  FOR  THE  DURATION  OF  THE  PRESCRIPTION,  INCLUDING
 REFILLS.  IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S DENIAL
 OF  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION,  THEN THE CORPORATION SHALL PROVIDE COVERAGE OF THE NON-FOR-
 MULARY PRESCRIPTION DRUG FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.

 S. 1507--A                         71                         A. 2007--A
 
   § 3. This act shall take effect on the first of January next  succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.
 
                                 SUBPART E
 
   Section  1.  Section  2607  of the insurance law is amended to read as
 follows:
   § 2607. Discrimination because of sex or marital status.  (A) No indi-
 vidual or entity shall refuse to  issue  any  policy  of  insurance,  or
 cancel or decline to renew [such] THE policy because of the sex or mari-
 tal  status  of the applicant or policyholder OR ENGAGE IN SEXUAL STERE-
 OTYPING.
   (B) FOR THE PURPOSES OF  THIS  SECTION,  "SEX"  SHALL  INCLUDE  SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 2. The insurance law is amended by adding a new section 3243 to read
 as follows:
   §  3243.  DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS IN HOSPITAL,
 SURGICAL OR MEDICAL EXPENSE INSURANCE.  (A) WITH REGARD TO  AN  ACCIDENT
 AND HEALTH INSURANCE POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 EXPENSE  COVERAGE  OR A POLICY OF STUDENT ACCIDENT AND HEALTH INSURANCE,
 AS DEFINED IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY
 OF THIS ARTICLE, DELIVERED OR ISSUED FOR  DELIVERY  IN  THIS  STATE,  NO
 INSURER  SHALL  BECAUSE  OF  SEX,  MARITAL STATUS OR BASED ON PREGNANCY,
 FALSE PREGNANCY, TERMINATION OF PREGNANCY, OR RECOVERY THEREFROM, CHILD-
 BIRTH OR RELATED MEDICAL CONDITIONS:
   (1) MAKE ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS  TO  THE
 PREMIUMS  OR RATES CHARGED FOR THE POLICY OR IN ANY OTHER MANNER WHATEV-
 ER;
   (2) DEMAND OR REQUIRE A  GREATER  PREMIUM  FROM  ANY  PERSON  THAN  IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3)  MAKE  OR  REQUIRE ANY REBATE, DISCRIMINATION OR DISCOUNT UPON THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY POLICY;
   (4) INSERT IN THE POLICY  ANY  CONDITION,  OR  MAKE  ANY  STIPULATION,
 WHEREBY  THE  INSURED  BINDS HIS OR HERSELF, OR HIS OR HER HEIRS, EXECU-
 TORS, ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS  THAN
 THE  FULL  VALUE  OR  AMOUNT  OF  SUCH POLICY IN CASE OF A CLAIM THEREON
 EXCEPT SUCH CONDITIONS AND STIPULATIONS AS ARE IMPOSED  UPON  OTHERS  IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A POLICY ISSUED OR SOLD BY IT;
   (6)  CANCEL OR REFUSE TO ISSUE, RENEW OR SELL SUCH POLICY AFTER APPRO-
 PRIATE APPLICATION THEREFOR;
   (7) FIX ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR  COMMISSIONS  OF
 INSURANCE  AGENTS  OR  INSURANCE  BROKERS FOR WRITING OR RENEWING SUCH A
 POLICY; OR
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B) FOR THE PURPOSES OF  THIS  SECTION,  "SEX"  SHALL  INCLUDE  SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 3. The insurance law is amended by adding a new section 4330 to read
 as follows:
   §  4330.  DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS IN HOSPITAL,
 SURGICAL OR MEDICAL EXPENSE INSURANCE.  (A) WITH REGARD  TO  A  CONTRACT
 ISSUED  BY  A CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE OR  A  CONTRACT

 S. 1507--A                         72                         A. 2007--A
 
 OF  STUDENT  ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN SUBSECTION (A)
 OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF THIS CHAPTER,  NO  CORPO-
 RATION SHALL BECAUSE OF SEX, MARITAL STATUS OR BASED ON PREGNANCY, FALSE
 PREGNANCY,  TERMINATION  OF PREGNANCY, OR RECOVERY THEREFROM, CHILDBIRTH
 OR RELATED MEDICAL CONDITIONS:
   (1) MAKE ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS  TO  THE
 PREMIUMS  OR RATES CHARGED FOR THE CONTRACT OR IN ANY OTHER MANNER WHAT-
 EVER;
   (2) DEMAND OR REQUIRE A  GREATER  PREMIUM  FROM  ANY  PERSON  THAN  IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3)  MAKE  OR  REQUIRE ANY REBATE, DISCRIMINATION OR DISCOUNT UPON THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY CONTRACT;
   (4) INSERT IN THE CONTRACT ANY CONDITION,  OR  MAKE  ANY  STIPULATION,
 WHEREBY  THE  INSURED  BINDS HIS OR HERSELF, OR HIS OR HER HEIRS, EXECU-
 TORS, ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS  THAN
 THE  FULL  VALUE  OR  AMOUNT OF SUCH CONTRACT IN CASE OF A CLAIM THEREON
 EXCEPT SUCH CONDITIONS AND STIPULATIONS AS ARE IMPOSED  UPON  OTHERS  IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A CONTRACT ISSUED OR SOLD BY IT;
   (6)  CANCEL  OR  REFUSE  TO  ISSUE,  RENEW OR SELL SUCH CONTRACT AFTER
 APPROPRIATE APPLICATION THEREFOR;
   (7) FIX ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR  COMMISSIONS  OF
 INSURANCE  AGENTS  OR  INSURANCE  BROKERS FOR WRITING OR RENEWING SUCH A
 CONTRACT; OR
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B) FOR PURPOSES OF THIS SECTION, "SEX" SHALL  INCLUDE  SEXUAL  ORIEN-
 TATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                 SUBPART F
 
   Section 1. Subparagraph (B)  of  paragraph  2  of  subsection  (b)  of
 section 1101 of the insurance law, as amended by chapter 369 of the laws
 of 1985, is amended to read as follows:
   (B)  transactions  with  respect  to  group life, group annuity, group
 accident and health or blanket accident and health insurance (other than
 any transaction with respect to a group annuity contract  funding  indi-
 vidual  retirement  accounts  or  individual  retirement  annuities,  as
 defined in section four hundred eight  of  the  Internal  Revenue  Code,
 funding  annuities  in  accordance  with subdivision (b) of section four
 hundred three of such code or providing a plan of  retirement  annuities
 under  which  the  payments are derived wholly from funds contributed by
 the persons covered):
   (i) where such  groups  conform  to  the  definitions  of  eligibility
 contained in[;]:
   (I)  the  following paragraphs of subsection (b) of section four thou-
 sand two hundred sixteen of this chapter:
   (aa) paragraph (1) or (2);
   (bb) paragraph (3), if, with  respect  to  those  credit  transactions
 entered  into in this state, the policy fully conforms with the require-
 ments of sections three thousand two hundred  one,  three  thousand  two
 hundred twenty and four thousand two hundred sixteen of this chapter; OR

 S. 1507--A                         73                         A. 2007--A
 
   (cc) paragraphs (4), (5), (6), (7), (8), (9) [and] OR (10)[.];
   (II) the following subparagraphs of paragraph (1) of subsection (c) of
 section four thousand two hundred thirty-five of this chapter:
   (aa)  subparagraph  (A),  (B), (C) or (D), (EXCEPT THAT WITH REGARD TO
 SUBPARAGRAPHS (A), (B), AND (D), TRANSACTIONS WITH RESPECT TO AN EMPLOY-
 ER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO INSURE EMPLOYEES OF
 AN EMPLOYER OR AN EMPLOYER TO WHOM THE POLICY IS  ISSUED,  WHERE:  (AAA)
 THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS STATE; OR (BBB)
 THE  LESSER  OF  TWENTY-FIVE  PERCENT OF EMPLOYEES WORK IN THIS STATE OR
 TWENTY-FIVE OR MORE EMPLOYERS WORK IN THIS STATE);
   (bb) subparagraph (E), if, with respect to those  credit  transactions
 entered  into in this state, the policy fully conforms with the require-
 ments of sections three thousand two hundred  one,  three  thousand  two
 hundred  twenty-one  and  four  thousand two hundred thirty-five of this
 chapter;
   (cc) subparagraphs (F)[,] AND (G) [and (H).];
   (III) section four thousand two hundred thirty-seven (except  subpara-
 graph (B) FOR TRANSACTIONS WITH RESPECT TO AN EMPLOYER TO WHOM THE POLI-
 CY  IS  ISSUED WHERE THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN
 THIS STATE OR THE LESSER OF TWENTY-FIVE PERCENT  OF  EMPLOYEES  WORK  IN
 THIS  STATE  OR  TWENTY-FIVE  OR MORE EMPLOYEES WORK IN THIS STATE, (C),
 (E), OR (F) of paragraph three of subsection (a) thereof) or four  thou-
 sand  two  hundred  thirty-eight  (except  paragraphs  six  and seven of
 subsection (b) thereof) of this chapter; and
   (ii) where the master policies or contracts were lawfully issued with-
 out this state in a jurisdiction where the insurer was authorized to  do
 an insurance business;
   §  2.  Items  (ii)  and  (iii)  of  subparagraph (A) of paragraph 8 of
 subsection (b) of section 1101 of the insurance law, as added by chapter
 449 of the laws of 2014, are amended to read as follows:
   (ii) subparagraph (A), (B), (C), or (D) [(with  respect  to  a  policy
 issued to a trustee or trustees of a fund established or participated in
 by  two  or  more employers, one or more labor unions, or by one or more
 employers or labor unions, provided that all  such  employers  or  labor
 unions  are in the same industry)] of paragraph one of subsection (c) of
 section four thousand two hundred thirty-five of  this  chapter  (EXCEPT
 THAT  WITH  REGARD TO SUBPARAGRAPHS (A), (B), AND (D), TRANSACTIONS WITH
 RESPECT TO AN EMPLOYER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO
 INSURE EMPLOYEES OF AN EMPLOYER OR AN EMPLOYER TO  WHOM  THE  POLICY  IS
 ISSUED,  WHERE:  (I) THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS IN
 THIS STATE; OR (II) THE LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES  WORK
 IN THIS STATE OR TWENTY-FIVE OR MORE EMPLOYEES WORK IN THIS STATE); or
   (iii)  paragraphs one, two, three or four of subsection (b) of section
 four thousand two hundred thirty-eight of this chapter, but not  includ-
 ing a group annuity contract: (I) funding individual retirement accounts
 or  individual  retirement annuities, as defined in section four hundred
 eight of the Internal Revenue Code; (II) funding annuities in accordance
 with subdivision (b) of section four hundred  three  of  such  code;  or
 (III)  providing a plan of retirement annuities under which the payments
 are derived wholly from funds contributed by the persons covered[.];
   § 3. Subsection (b) of section 1101 of the insurance law is amended by
 adding a new paragraph 9 to read as follows:
   (9) FOR PURPOSES OF THIS SUBSECTION,  "PRINCIPAL  PLACE  OF  BUSINESS"
 SHALL  MEAN  THE  PLACE  WHERE AN EMPLOYER MAINTAINS ITS HEADQUARTERS OR
 WHERE THE EMPLOYER'S HIGH-LEVEL OFFICERS DIRECT, CONTROL, AND COORDINATE
 THE BUSINESS ACTIVITIES.

 S. 1507--A                         74                         A. 2007--A
 
   § 4. Paragraph 1 of subsection (b) of section 3201  of  the  insurance
 law,  as  amended by chapter 369 of the laws of 1985, is amended to read
 as follows:
   (1)  (A)  No  policy form shall be delivered or issued for delivery in
 this state unless it has been filed with and approved by the superinten-
 dent as conforming to the requirements of this chapter  and  not  incon-
 sistent with law.
   (B)  A  group  life,  group accident, group health, group accident and
 health, BLANKET ACCIDENT, BLANKET HEALTH, or blanket accident and health
 insurance certificate evidencing insurance coverage  on  a  resident  of
 this state shall be deemed to have been delivered in this state, regard-
 less  of the place of actual delivery[, unless the insured group] OR THE
 TYPE OF GROUP TO WHICH THE  GROUP  OR  BLANKET  POLICY  OR  CONTRACT  IS
 ISSUED.
   (C)  NOTWITHSTANDING SUBPARAGRAPH (B) OF THIS PARAGRAPH, A CERTIFICATE
 SHALL NOT BE DEEMED TO HAVE BEEN DELIVERED IN THIS STATE WHEN:  (I)  THE
 CERTIFICATE  IS  NOT  ACTUALLY DELIVERED IN THIS STATE; (II) THE INSURED
 GROUP is of the type described  in[:  (A)]  section  four  thousand  two
 hundred  sixteen  OF THIS CHAPTER, except paragraph four where the group
 policy is issued to a trustee or  trustees  of  a  fund  established  or
 participated  in  by two or more employers not in the same industry with
 respect to an employer principally located within the  state,  paragraph
 twelve,  thirteen  or  fourteen of subsection (b) thereof; AND (III) THE
 MASTER POLICY OR CONTRACT IS LAWFULLY ISSUED WITHOUT  THIS  STATE  IN  A
 JURISDICTION  WHERE  THE  INSURER IS AUTHORIZED TO DO AN INSURANCE BUSI-
 NESS.
   (D) NOTWITHSTANDING SUBPARAGRAPH (B)  OF  THIS  PARAGRAPH,  WHERE  THE
 MASTER  POLICY  OR  CONTRACT  IS LAWFULLY ISSUED WITHOUT THIS STATE IN A
 JURISDICTION WHERE THE INSURER IS AUTHORIZED TO DO  AN  INSURANCE  BUSI-
 NESS,  A  CERTIFICATE SHALL NOT BE DEEMED TO HAVE BEEN DELIVERED IN THIS
 STATE EVEN IF IT IS ACTUALLY DELIVERED IN THIS STATE  WHEN  THE  INSURED
 GROUP IS OF THE TYPE DESCRIBED IN:
   [(B)]  (I) section four thousand two hundred thirty-five OF THIS CHAP-
 TER, except [subparagraph]: (I) SUBPARAGRAPHS (A), (B)  AND  (D)  [where
 the  group  policy  is  issued to a trustee or trustees of a fund estab-
 lished or participated in by two or  more  employers  not  in  the  same
 industry  with  respect  to  an  employer principally located within the
 state, subparagraph] OF PARAGRAPH ONE OF SUBSECTION  (C)  THEREOF,  WITH
 RESPECT TO AN EMPLOYER THAT HAS ESTABLISHED OR PARTICIPATES IN A FUND TO
 INSURE  EMPLOYEES  OF  AN  EMPLOYER OR AN EMPLOYER TO WHOM THE POLICY IS
 ISSUED, WHERE THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS  IN  THIS
 STATE  OR  THE  LESSER  OF TWENTY-FIVE PERCENT OF EMPLOYEES WORK IN THIS
 STATE OR TWENTY-FIVE OR MORE EMPLOYEES  WORK  IN  THIS  STATE;  OR  (II)
 SUBPARAGRAPHS  (H),  (K),  (L) or (M) of paragraph one of subsection (c)
 thereof; or
   [(C)] (II) section four thousand two hundred thirty-seven [(] OF  THIS
 CHAPTER, except subparagraph (B) WITH RESPECT TO AN EMPLOYER TO WHOM THE
 POLICY  IS ISSUED WHERE THE EMPLOYER HAS ITS PRINCIPAL PLACE OF BUSINESS
 IN THIS STATE OR THE LESSER OF TWENTY-FIVE PERCENT OF EMPLOYEES WORK  IN
 THIS STATE OR TWENTY-FIVE OR MORE EMPLOYEES WORK IN THIS STATE, (C), (E)
 OR  (F)  of paragraph three of subsection (a) thereof[; of this chapter;
 and where the master policies or contracts were lawfully issued  without
 this  state  in a jurisdiction where the insurer was authorized to do an
 insurance business].
   (E)(I) With regard to any GROUP LIFE INSURANCE certificate  deemed  to
 have  been  delivered in this state by virtue of SUBPARAGRAPH (B) OR (C)

 S. 1507--A                         75                         A. 2007--A
 
 OF this paragraph, the superintendent shall [(i)]: (I) require that  the
 premiums  charged  be  reasonable  in relation to the benefits provided,
 except in cases where the policyholder pays the entire  premium;  [(ii)]
 (II)  have power to issue regulations prescribing the required, optional
 and prohibited provisions in such certificates; [(iii)] AND (III) estab-
 lish an accelerated certificate form approval procedure available to  an
 insurer  [which] THAT includes a statement in its policy form submission
 letter that it is the company's opinion that  the  certificate  form  or
 forms  comply  with applicable New York law and regulations.  The super-
 intendent, upon receipt of such a filing letter, shall grant conditional
 approval of such certificate form or forms in reliance on the  aforemen-
 tioned statement by the company upon the condition that the company will
 retroactively  modify  such  certificate  form  or  forms, to the extent
 necessary, if it is found by the  superintendent  that  the  certificate
 form fails to comply with applicable New York laws and regulations[.];
   (II)  The superintendent may, with regard to the approval of any GROUP
 LIFE INSURANCE certificate deemed to have been delivered in  this  state
 by  virtue  of  SUBPARAGRAPH  (B) OR (C) OF this paragraph, approve such
 certificate if the superintendent finds  that  the  certificate  affords
 insureds  protections  substantially  similar to those [which] THAT have
 been provided by certificates delivered in this state[.]; AND
   (III) Any regulations issued by the superintendent  pursuant  to  this
 [paragraph] SUBPARAGRAPH may not impose stricter requirements than those
 applicable  to  similar  policies and certificates actually delivered in
 this state.
   (F)(I) A GROUP ACCIDENT, GROUP  HEALTH,  GROUP  ACCIDENT  AND  HEALTH,
 BLANKET  ACCIDENT, BLANKET HEALTH, OR BLANKET ACCIDENT AND HEALTH INSUR-
 ANCE CERTIFICATE DEEMED TO HAVE BEEN DELIVERED IN THIS STATE PURSUANT TO
 SUBPARAGRAPH (B) OR (D) OF THIS PARAGRAPH, SHALL BE SUBJECT TO THE  SAME
 PROVISIONS OF THIS CHAPTER AS A CERTIFICATE ACTUALLY DELIVERED OR ISSUED
 FOR DELIVERY IN THIS STATE.
   (II)  AN  INSURER SHALL ISSUE TO THE GROUP OR PERSON IN WHOSE NAME THE
 POLICY OR CONTRACT IS ISSUED, FOR DELIVERY TO EACH MEMBER OF THE INSURED
 GROUP, A CERTIFICATE SETTING FORTH IN SUMMARY FORM A  STATEMENT  OF  THE
 ESSENTIAL FEATURES OF THE INSURANCE COVERAGE.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "INSTITUTION OF HIGHER EDUCATION" SHALL HAVE THE MEANING SET FORTH
 IN PARAGRAPH TWO OF SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED
 FORTY OF THIS ARTICLE;
   (II)  "PRINCIPAL  PLACE  OF  BUSINESS"  SHALL  MEAN THE PLACE WHERE AN
 EMPLOYER MAINTAINS ITS HEADQUARTERS OR WHERE THE  EMPLOYER'S  HIGH-LEVEL
 OFFICERS DIRECT, CONTROL, AND COORDINATE THE BUSINESS ACTIVITIES; AND
   (III) "RESIDENT OF THIS STATE" SHALL INCLUDE A STUDENT WHO IS ENROLLED
 IN AN INSTITUTION OF HIGHER EDUCATION IN THIS STATE THAT OFFERS COVERAGE
 TO THE STUDENT THROUGH A GROUP OR BLANKET POLICY OR CONTRACT.
   § 5. Subparagraph (E) of paragraph 3 of subsection (a) of section 4237
 of the insurance law is amended to read as follows:
   (E)  Under  a  policy  or  contract  issued to [and in the name of] an
 [incorporated or unincorporated] association [of persons having a common
 interest or calling, which association shall be deemed the policyholder,
 having not less than fifty members, covering all  the  members  of  such
 association  or if part or all of] OR THE TRUSTEE OR TRUSTEES OF A TRUST
 ESTABLISHED, OR PARTICIPATED IN, BY ONE OR MORE ASSOCIATIONS, TO  INSURE
 ASSOCIATION MEMBERS, SUBJECT TO THE FOLLOWING:
   (I) EACH ASSOCIATION SHALL HAVE:

 S. 1507--A                         76                         A. 2007--A
 
   (I)  A  MINIMUM  OF  TWO  HUNDRED INSURED INDIVIDUALS AT THE POLICY OR
 CONTRACT'S DATE OF ISSUE;
   (II)  BEEN ORGANIZED AND MAINTAINED IN GOOD FAITH FOR PURPOSES PRINCI-
 PALLY OTHER THAN THAT OF OBTAINING INSURANCE;
   (III) BEEN IN ACTIVE EXISTENCE FOR AT LEAST TWO YEARS; AND
   (IV) A CONSTITUTION AND BY-LAWS THAT PROVIDE THAT:
   (AA) THE ASSOCIATION HOLD REGULAR MEETINGS NOT LESS THAN  ANNUALLY  TO
 FURTHER THE PURPOSES OF THE ASSOCIATION;
   (BB)  THE  ASSOCIATION  COLLECT  DUES  OR  SOLICIT  CONTRIBUTIONS FROM
 MEMBERS; AND
   (CC) THE MEMBERS HAVE VOTING  PRIVILEGES  AND  REPRESENTATION  ON  THE
 GOVERNING BOARD AND COMMITTEES;
   (II)  the  premium [is to be derived] FOR THE POLICY OR CONTRACT SHALL
 BE PAID BY THE ASSOCIATION OR THE  TRUSTEES  EITHER  WHOLLY  from  funds
 contributed  by  the  ASSOCIATION  OR BY THE insured [members and if the
 opportunity to take such insurance is offered to all eligible]  INDIVID-
 UALS,  OR  FROM FUNDS CONTRIBUTED JOINTLY BY THE ASSOCIATION AND INSURED
 [members, then such] INDIVIDUALS. A policy [must  cover  not  less  than
 seventy-five  percent  of  any class or classes of members determined by
 conditions pertaining to membership in the association] OR  CONTRACT  ON
 WHICH  NO PART OF THE PREMIUM IS TO BE DERIVED FROM FUNDS CONTRIBUTED BY
 THE INSURED INDIVIDUALS SPECIFICALLY FOR THEIR  INSURANCE  SHALL  INSURE
 ALL  ELIGIBLE INDIVIDUALS, EXCLUDING ANY AS TO WHOM EVIDENCE OF INDIVID-
 UAL INSURABILITY IS NOT  SATISFACTORY  TO  THE  INSURER  TO  THE  EXTENT
 PERMITTED BY LAW;
   (III)  THE  AMOUNT  OF INSURANCE UNDER THE POLICY OR CONTRACT SHALL BE
 BASED UPON SOME PLAN  PRECLUDING  INDIVIDUAL  SELECTION  EITHER  BY  THE
 INSURED  INDIVIDUALS  OR BY THE ASSOCIATION. HOWEVER, WITH RESPECT TO AN
 ASSOCIATION, SUCH A PLAN MAY PERMIT A NUMBER OF SELECTIONS BY THE  ASSO-
 CIATION  IF THE SELECTIONS OFFERED UTILIZE CONSISTENT PLANS OF INSURANCE
 SO THAT THE RESULTING PLANS OF  COVERAGE  ARE  REASONABLE.  FURTHERMORE,
 SUCH  A  PLAN MAY PERMIT A LIMITED NUMBER OF SELECTIONS BY INSURED INDI-
 VIDUALS IF THE SELECTIONS OFFERED UTILIZE CONSISTENT PLANS OF  INSURANCE
 FOR  INSURED  INDIVIDUALS  SO  THAT  THE RESULTING PLANS OF COVERAGE ARE
 REASONABLE.
   (IV) EXCEPT AS PROVIDED IN SUBSECTION (B) OF THIS SECTION, SUCH POLICY
 OR CONTRACT SHALL PROVIDE FOR THE PAYMENT  OF  BENEFITS  TO  THE  PERSON
 INSURED  OR  TO SOME BENEFICIARY OR BENEFICIARIES OTHER THAN THE ASSOCI-
 ATION OR ANY OFFICIALS, REPRESENTATIVES, TRUSTEES OR AGENTS THEREOF  AND
 SHALL  PROVIDE  FOR THE ISSUANCE OF A CERTIFICATE TO THE ASSOCIATION FOR
 DELIVERY TO THE INSURED INDIVIDUAL OR SUCH BENEFICIARY, AS  EVIDENCE  OF
 SUCH INSURANCE.
   (V)  THE PREMIUMS CHARGED SHALL BE REASONABLE IN RELATION TO THE BENE-
 FITS PROVIDED.
   § 6. Subsection (d) of section 4237-a of the insurance law, as amended
 by chapter 599 of the laws of 2003, is amended to read as follows:
   (d) No stop-loss insurance contract shall be DELIVERED OR  issued  [or
 renewed]  FOR  DELIVERY IN OR OUTSIDE THIS STATE BY AN INSURER OR HEALTH
 SERVICE CORPORATION:
   (1) TO A NEW YORK  EMPLOYER  WITH  ONE  HUNDRED  OR  FEWER  EMPLOYEES,
 PROVIDED  THAT  "NEW  YORK  EMPLOYER"  SHALL MEAN AN EMPLOYER WHO HAS AT
 LEAST ONE EMPLOYEE THAT WORKS IN THIS STATE; OR
   (2) if issuance of the policy would be prohibited by section two thou-
 sand six hundred thirteen, three thousand two hundred  thirty-one,  four
 thousand  three  hundred seventeen or four thousand three hundred twenty
 of this chapter.

 S. 1507--A                         77                         A. 2007--A
 
   § 7. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply to all policies and contracts
 issued, renewed, modified, altered, or amended on or  after  such  date.
 Effective immediately:
   (1)  the superintendent of financial services may promulgate any rules
 or regulations necessary for the implementation  of  the  provisions  of
 this act on its effective date; and
   (2)  insurers  may submit to the superintendent and the superintendent
 may approve filings necessary to comply with the provisions of this  act
 on its effective date.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or subpart of this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or  subpart  thereof  directly involved in the controversy in which such
 judgment shall have been rendered. It  is  hereby  declared  to  be  the
 intent  of the legislature that this act would have been enacted even if
 such invalid provisions had not been included herein.
   § 3. Interpretations by  the  superintendent.  The  superintendent  of
 financial  services  has  special  expertise and experience in the regu-
 lation of insurance in this state. As such his or her interpretations of
 the insurance law shall be afforded the highest level of deference.
   § 4. Legislative intent. It is hereby declared to be the intent of the
 legislature in enacting this act, that the laws of  this  state  provide
 consumer  and  market  protections at least as robust as those under the
 federal Patient Protection and Affordable Care Act, public law  111-148,
 as that law existed and was interpreted on January 19, 2017. In addition
 to  any  other  power  conferred by law, the superintendent of financial
 services is hereby  specifically  empowered  to  promulgate  regulations
 under,  and  issue  interpretations  of, this act as necessary to ensure
 that the intent of the legislature as expressed in this section is real-
 ized.
   § 5. This act shall take effect immediately  provided,  however,  that
 the  applicable effective date of Subparts A through F of this act shall
 be as specifically set forth in the last section of such Subparts.
 
                                  PART K

   Section 1. Subdivisions 4 and 5 of section 2999-h of the public health
 law, as added by section 52 of part H of chapter 59 of the laws of 2011,
 are amended to read as follows:
   4. "Qualified plaintiff" means every plaintiff or claimant who (i) has
 been found by a jury or court to have sustained a  birth-related  neuro-
 logical  injury  as  the  result  of  medical  malpractice,  or (ii) has
 sustained a birth-related neurological injury as the result  of  alleged
 medical  malpractice, and has settled his or her lawsuit or claim there-
 for; AND (III) HAS BEEN ORDERED TO BE ENROLLED IN THE FUND BY A COURT IN
 NEW YORK STATE.
   [5. Any reference to the "department of financial  services"  and  the
 "superintendent  of  financial services" in this title shall mean, prior
 to October third, two thousand eleven, respectively, the "department  of
 insurance" and "superintendent of insurance."]
   §  2.  Section 2999-i of the public health law, as added by section 52
 of part H of chapter 59 of the laws of 2011, subdivision 1 as amended by

 S. 1507--A                         78                         A. 2007--A
 
 section 29 of part D of chapter 56 of the laws of 2012,  is  amended  to
 read as follows:
   §  2999-i. Custody and administration of the fund.  1. (a) The commis-
 sioner of taxation and finance shall be the custodian of  the  fund  and
 the special account established pursuant to section ninety-nine-t of the
 state  finance  law.  All  payments  from  the fund shall be made by the
 commissioner of taxation and finance upon  certificates  signed  by  the
 [superintendent  of  financial  services]  COMMISSIONER,  or  his or her
 designee, as hereinafter provided. The fund shall be separate and  apart
 from  any other fund and from all other state monies; provided, however,
 that monies of the fund may be invested as set forth in paragraph (b) of
 this subdivision. No monies from the fund shall be  transferred  to  any
 other  fund,  nor  shall any such monies be applied to the making of any
 payment for any purpose other than the purpose set forth in this title.
   (b) Any monies of the fund not required for immediate use may, at  the
 discretion  of  the commissioner [of financial services] in consultation
 with [the commissioner of health and] the director  of  the  budget,  be
 invested  by  the commissioner of taxation and finance in obligations of
 the United States or the state or obligations the principal and interest
 of which are guaranteed by the United States or the state. The  proceeds
 of  any  such  investment  shall be retained by the fund as assets to be
 used for the purposes of the fund.
   2. (a) The fund shall be administered by the [superintendent of finan-
 cial services] COMMISSIONER or his or her designee  in  accordance  with
 the provisions of this article.
   (b) The [superintendent of financial services] COMMISSIONER shall have
 all powers necessary and proper to carry out the purposes of the fund.
   (c)  Notwithstanding  any contrary provision of this section, sections
 one hundred twelve and one hundred sixty-three of the state finance  law
 or  any other contrary provision of law, the superintendent of financial
 services is authorized to [enter into a contract or contracts without  a
 competitive bid or request for proposal process for purposes of adminis-
 tering  the  fund for the first year of its operation and in preparation
 therefor] ASSIGN AND THE COMMISSIONER IS AUTHORIZED TO  RECEIVE  ASSIGN-
 MENT  OF  ANY  AND  ALL  CONTRACTS ENTERED INTO BY THE SUPERINTENDENT OF
 FINANCIAL SERVICES TO ADMINISTER THE FUND FOR PERIODS PRIOR  TO  OCTOBER
 FIRST, TWO THOUSAND NINETEEN.
   (d)  The  department  [of financial services and the department] shall
 post on [their websites] ITS WEBSITE information about the fund[, eligi-
 bility for enrollment in the fund,] and the process  for  enrollment  in
 the fund.
   3.  The  expense  of  administering  the fund[, including the expenses
 incurred by the department,] shall be paid from the fund.
   4. Monies for the fund will be provided pursuant to this chapter.
   5. For the state fiscal year beginning April first, two thousand elev-
 en and ending March thirty-first, two thousand twelve, the state  fiscal
 year  beginning  April first, two thousand twelve and ending March thir-
 ty-first, two thousand thirteen, and the  state  fiscal  year  beginning
 April  first,  two  thousand thirteen and ending March thirty-first, two
 thousand fourteen, the superintendent of financial services shall  cause
 to  be  deposited  into  the  fund  for each such fiscal year the amount
 appropriated for such purpose. Beginning April first, two thousand four-
 teen and annually thereafter, the superintendent of  financial  services
 OR  THE COMMISSIONER, WHOEVER IS ADMINISTERING THE FUND FOR THE APPLICA-
 BLE PERIOD shall cause to be deposited into the fund, subject to  avail-
 able  appropriations,  an  amount  equal  to  the difference between the

 S. 1507--A                         79                         A. 2007--A
 
 amount appropriated to  the  fund  in  the  preceding  fiscal  year,  as
 increased  by the adjustment factor defined in subdivision seven of this
 section, and the assets of the fund at the  conclusion  of  that  fiscal
 year.
   6.  (a)  Following  the deposit referenced in subdivision five of this
 section, the [superintendent of financial services]  COMMISSIONER  shall
 conduct  an  actuarial  calculation  of the estimated liabilities of the
 fund for  the  coming  year  resulting  from  the  qualified  plaintiffs
 enrolled  in  the fund. The administrator shall from time to time adjust
 such calculation IN ACCORDANCE WITH SUBDIVISION SEVEN OF  THIS  SECTION.
 If  the  total of all estimates of current liabilities equals or exceeds
 eighty percent of the fund's assets, then the fund shall not accept  any
 new  enrollments  until a new deposit has been made pursuant to subdivi-
 sion five of this section. When, as a result of such  new  deposit,  the
 fund's liabilities no longer exceed eighty percent of the fund's assets,
 the  fund  administrator  shall  enroll  new qualified plaintiffs in the
 order that an application for enrollment has been submitted  in  accord-
 ance with subdivision seven of section twenty-nine hundred ninety-nine-j
 of this title.
   (b) Whenever enrollment is suspended pursuant to paragraph (a) of this
 subdivision  and  until such time as enrollment resumes pursuant to such
 paragraph: (i) notice of such suspension shall be promptly posted on the
 department's website [and on the website of the department of  financial
 services];  (ii)  the fund administrator shall deny each application for
 enrollment that had been received but not accepted prior to the date  of
 suspension  and  each application for enrollment received after the date
 of such suspension; and (iii) notification of each such denial shall  be
 made to the plaintiff or claimant or persons authorized to act on behalf
 of  such  plaintiff  or  claimant  and  all defendants in regard to such
 plaintiff or claimant, to the extent they are known to the fund adminis-
 trator. Judgments and settlements for plaintiffs or claimants  for  whom
 applications are denied under this paragraph or who are not eligible for
 enrollment  due to suspension pursuant to paragraph (a) of this subdivi-
 sion shall be satisfied as if this title had not been enacted.
   (c) Following a suspension, whenever enrollment  resumes  pursuant  to
 paragraph  (a)  of  this subdivision, notice that enrollment has resumed
 shall be promptly posted on the department's website [and on the website
 of the department of financial services].
   (d) The suspension of enrollment pursuant to  paragraph  (a)  of  this
 subdivision  shall  not  impact payment under the fund for any qualified
 plaintiffs already enrolled in the fund.
   7. For purposes of this section, the adjustment factor  referenced  in
 this  section shall be the ten year rolling average medical component of
 the consumer price index as published by the United States department of
 labor, bureau of labor statistics, for the preceding ten years.
   § 3. Subdivisions 2, 5, 6, 7, 9, 11, 12, 15 and 16 of  section  2999-j
 of the public health law, subdivision 2 as amended by chapter 517 of the
 laws  of 2016, paragraph (c) of subdivision 2 as amended by chapter 4 of
 the laws of 2017, and subdivisions 5, 6, 7, 9, 11,  12,  15  and  16  as
 added  by  section  52  of part H of chapter 59 of the laws of 2011, are
 amended to read as follows:
   2. The provision of qualifying health care costs to  qualified  plain-
 tiffs  shall  not be subject to prior authorization, except as described
 by the commissioner in regulation; provided, however:

 S. 1507--A                         80                         A. 2007--A

   (a) such  regulation  shall  not  prevent  qualified  plaintiffs  from
 receiving  care  or  assistance  that would, at a minimum, be authorized
 under the medicaid program;
   (b)  if  any  prior  authorization is required by such regulation, the
 regulation shall require that requests for prior authorization be  proc-
 essed  within  a  reasonably  prompt period of time and[, subject to the
 provisions of subdivision two-a of this section,] shall identify a proc-
 ess for prompt administrative review of any  denial  of  a  request  for
 prior authorization; and
   (c)  such  regulations shall not prohibit qualifying health care costs
 on the grounds that the qualifying health  care  cost  may  incidentally
 benefit other members of the household, provided that whether the quali-
 fying health care cost primarily benefits the patient may be considered.
   5. Claims for the payment or reimbursement from the fund of qualifying
 health  care  costs shall be made upon forms prescribed and furnished by
 the fund administrator [in consultation with the  commissioner  and]  in
 conjunction  with regulations establishing a mechanism for submission of
 claims by health care providers directly to the fund, where practicable.
   6. (a)  Every  settlement  agreement  for  claims  arising  out  of  a
 plaintiff's  or  claimant's birth related neurological injury subject to
 this title, and that provides for the payment of future medical expenses
 for the plaintiff or claimant, shall provide  that  [in  the  event  the
 administrator of the fund determines that the plaintiff or claimant is a
 qualified  plaintiff,] all payments for future medical expenses shall be
 paid in accordance with this title[,] in lieu of  that  portion  of  the
 settlement  agreement  that  provides  for payment of such expenses. The
 plaintiff's or claimant's future  medical  expenses  shall  be  paid  in
 accordance with this title. When such a settlement agreement does not so
 provide,  the  court  shall  direct the modification of the agreement to
 include such term as a condition of court approval.
   (b) In any case where the jury or court has made an award  for  future
 medical expenses arising out of a birth related neurological injury, any
 party to such action or person authorized to act on behalf of such party
 may  make  application  to  the court that the judgment reflect that, in
 lieu of that portion of the award that  provides  for  payment  of  such
 expenses,  [and  upon a determination by the fund administrator that the
 plaintiff is a qualified plaintiff,] the future medical expenses of  the
 plaintiff  shall  be paid out of the fund in accordance with this title.
 Upon a finding by the court that the applicant has made  a  prima  facie
 showing  that  the  plaintiff  is a qualified plaintiff, the court shall
 ensure that the judgment so provides.
   7. A qualified plaintiff shall be enrolled when (a) such plaintiff  or
 person  authorized  to  act on behalf of such person, upon notice to all
 defendants, or any of the defendants in regard to the plaintiff's claim,
 upon notice to such plaintiff, makes an application  for  enrollment  by
 providing  the  fund administrator with a certified copy of the judgment
 or of the court approved settlement agreement; and (b) the fund adminis-
 trator determines [upon the basis of such judgment or settlement  agree-
 ment  and  any  additional  information  the  fund  administrator  shall
 request] that the relevant provisions of subdivision six of this section
 have been met  [and  that  the  plaintiff  is  a  qualified  plaintiff];
 provided  that  no  enrollment  shall  occur  when the fund is closed to
 enrollment pursuant to subdivision six of  section  twenty-nine  hundred
 ninety-nine-i of this title.
   9.  Payments  from the fund shall be made by the commissioner of taxa-
 tion and finance on the  said  certificate  of  the  [superintendent  of

 S. 1507--A                         81                         A. 2007--A

 financial  services]  COMMISSIONER.    No  payment  shall be made by the
 commissioner of taxation and finance in excess of the amount  certified.
 Promptly  upon receipt of the said certificate of the [superintendent of
 financial  services]  COMMISSIONER,  the  commissioner  of  taxation and
 finance shall pay the qualified  plaintiff's  health  care  provider  or
 reimburse the qualified plaintiff the amount so certified for payment.
   11.  All health care providers shall accept from qualified plaintiff's
 or persons authorized to act on behalf of such  plaintiff's  assignments
 of  the  right  to  receive payments from the fund for qualifying health
 care costs. SUCH PAYMENTS SHALL  CONSTITUTE  PAYMENT  IN  FULL  FOR  ANY
 SERVICES PROVIDED TO A QUALIFIED PLAINTIFF IN ACCORDANCE WITH THIS ARTI-
 CLE.
   12.  Health  insurers  (other than medicare and Medicaid) shall be the
 primary payers of qualifying health care costs of qualified  plaintiffs.
 Such  costs  shall  be paid from the fund only to the extent that health
 insurers or other collateral sources or other persons are not  otherwise
 obligated  to make payments therefor. Health insurers that make payments
 for qualifying health care costs to or on behalf of qualified plaintiffs
 shall have no right of recovery against and shall have no lien upon  the
 fund or any person or entity nor shall the fund constitute an additional
 payment  source  to offset the payments otherwise contractually required
 to be made by such health  insurers.  The  superintendent  of  financial
 services  shall  have  the  authority  to enforce the provisions of this
 subdivision UPON THE REFERRAL OF THE COMMISSIONER.
   15. The commissioner[, in  consultation  with  the  superintendent  of
 financial  services,]  shall promulgate, amend and enforce all rules and
 regulations necessary for the  proper  administration  of  the  fund  in
 accordance  with  the  provisions  of  this  section, including, but not
 limited to, those concerning the payment of claims  and  concerning  the
 actuarial  calculations  necessary  to  determine,  annually,  the total
 amount to be paid into the fund as provided  herein,  and  as  otherwise
 needed to implement this title.
   [16.  The commissioner shall convene a consumer advisory committee for
 the purpose of providing information, as requested by the  commissioner,
 in  the development of the regulations authorized by subdivision fifteen
 of this section.]
   § 4. Section 5 of chapter 517 of the laws of 2016, amending the public
 health law relating to payments from the New York state  medical  indem-
 nity  fund,  as  amended by chapter 4 of the laws of 2017, is amended to
 read as follows:
   § 5. This act shall take effect on the forty-fifth day after it  shall
 have  become  a  law,  provided  that the amendments to subdivision 4 of
 section 2999-j of the public health law made by section two of this  act
 shall  take  effect  on  June  30,  2017  and shall expire and be deemed
 repealed December 31, [2019] 2020.
   § 5. Section 99-t of the state finance law, as added by  section  52-e
 of  part  H  of  chapter  59  of the laws of 2011, is amended to read as
 follows:
   § 99-t. New York state medical indemnity fund  account.  1.  There  is
 hereby  established  in  the custody of the commissioner of taxation and
 finance a special account to be known as the  "New  York  state  medical
 indemnity fund account".
   2.  All  moneys  received by the New York state medical indemnity fund
 pursuant to title four of article twenty-nine-D of the public health law
 from whatever source derived shall be deposited to the exclusive  credit
 of  such  fund account. Said moneys shall be kept separate and shall not

 S. 1507--A                         82                         A. 2007--A
 
 be commingled with any other moneys in the custody of  the  commissioner
 of taxation and finance.
   3.  The moneys in said account shall be retained by the fund and shall
 be released by the  commissioner  of  taxation  and  finance  only  upon
 certificates  signed by the [superintendent of financial services or the
 head of any successor agency to the department of insurance] COMMISSION-
 ER OF HEALTH or his or her designee and only for the purposes set  forth
 in title four of article twenty-nine-D of the public health law.
   §  6. This act shall take effect October 1, 2019; provided however, on
 and after April 1, 2019, the commissioner of health may take  any  steps
 necessary to implement this act on its effective date; and notwithstand-
 ing any inconsistent provision of the state administrative procedure act
 or  any  other provision of law, rule or regulation, the commissioner of
 health is authorized to adopt or amend or  promulgate  on  an  emergency
 basis  any  regulation  he  or she determines necessary to implement any
 provision of this act on its effective date.
 
                                  PART L
 
   Section 1. Subparagraph (C)  of  paragraph  6  of  subsection  (k)  of
 section  3221 of the insurance law, as amended by section 1 of part K of
 chapter 82 of the laws of 2002, is amended to read as follows:
   (C)  Coverage  of  diagnostic  and  treatment  procedures,   including
 prescription  drugs,  used in the diagnosis and treatment of infertility
 as required by subparagraphs (A) and (B)  of  this  paragraph  shall  be
 provided in accordance with the provisions of this subparagraph.
   (i)  [Coverage]  EXCEPT  AS  PROVIDED  IN ITEMS (VI) AND (VII) OF THIS
 SUBPARAGRAPH, COVERAGE shall be provided for persons  whose  ages  range
 from  twenty-one  through forty-four years, provided that nothing herein
 shall preclude the provision of coverage to persons whose age  is  below
 or above such range.
   (ii)  Diagnosis  and  treatment  of infertility shall be prescribed as
 part of a physician's overall plan  of  care  and  consistent  with  the
 guidelines for coverage as referenced in this subparagraph.
   (iii)  Coverage may be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (iv) [Coverage shall be limited to those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided  that for the purposes of this subparagraph "period of
 not less than twelve months" shall be  determined  by  calculating  such
 time from either the date the insured was first covered under the exist-
 ing policy or from the date the insured was first covered by a previous-
 ly in-force converted policy, whichever is earlier.
   (v)  Coverage]  EXCEPT  AS  PROVIDED  IN  ITEMS (VI) AND (VII) OF THIS
 SUBPARAGRAPH, COVERAGE shall not be required to  include  the  diagnosis
 and treatment of infertility in connection with: (I) in vitro fertiliza-
 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
 transfers;  (II)  the  reversal  of  elective  sterilizations; (III) sex
 change procedures; (IV) cloning; or (V) medical or surgical services  or
 procedures  that  are deemed to be experimental in accordance with clin-
 ical guidelines referenced in [clause (vi)] ITEM (V)  of  this  subpara-
 graph.
   [(vi)]  (V)  The superintendent, in consultation with the commissioner
 of health, shall promulgate regulations which shall stipulate the guide-

 S. 1507--A                         83                         A. 2007--A
 
 lines and standards which shall be used in carrying out  the  provisions
 of this subparagraph, which shall include:
   (I)  The  determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine INCLUDING "IATROGENIC INFERTILITY", WHICH MEANS AN IMPAIR-
 MENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHERAPY OR  OTHER  MEDICAL
 TREATMENT AFFECTING REPRODUCTIVE ORGANS OR PROCESSES;
   (II)  The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   (III) The identification of  the  required  training,  experience  and
 other  standards  for  health care providers for the provision of proce-
 dures and treatments for the  diagnosis  and  treatment  of  infertility
 determined  in  accordance with the standards and guidelines established
 and adopted by the American College of Obstetricians  and  Gynecologists
 and the American Society for Reproductive Medicine; and
   (IV) The determination of appropriate medical candidates by the treat-
 ing  physician  in  accordance  with the standards and guidelines estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.
   (VI) COVERAGE  SHALL  ALSO  INCLUDE  STANDARD  FERTILITY  PRESERVATION
 SERVICES  WHEN  A  MEDICAL  TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE
 IATROGENIC INFERTILITY TO AN INSURED. COVERAGE MAY BE SUBJECT TO  ANNUAL
 DEDUCTIBLES  AND  COINSURANCE,  INCLUDING  COPAYMENTS,  AS MAY BE DEEMED
 APPROPRIATE BY THE SUPERINTENDENT  AND  AS  ARE  CONSISTENT  WITH  THOSE
 ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   (VII)  EVERY  LARGE  GROUP  POLICY DELIVERED OR ISSUED FOR DELIVERY IN
 THIS STATE THAT PROVIDES MEDICAL, MAJOR MEDICAL  OR  SIMILAR  COMPREHEN-
 SIVE-TYPE  COVERAGE  SHALL PROVIDE COVERAGE FOR THREE CYCLES OF IN-VITRO
 FERTILIZATION USED IN THE TREATMENT OF INFERTILITY AS DEFINED IN  CLAUSE
 (I)  OF ITEM (V) OF THIS SUBPARAGRAPH. COVERAGE MAY BE SUBJECT TO ANNUAL
 DEDUCTIBLES AND COINSURANCE, INCLUDING  COPAYMENTS,  AS  MAY  BE  DEEMED
 APPROPRIATE  BY  THE  SUPERINTENDENT  AND  AS  ARE CONSISTENT WITH THOSE
 ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.  FOR  PURPOSES  OF
 THIS  ITEM,  A  "CYCLE"  IS  DEFINED AS EITHER ALL TREATMENT THAT STARTS
 WHEN:  PREPARATORY MEDICATIONS ARE ADMINISTERED FOR OVARIAN  STIMULATION
 FOR  OOCYTE  RETRIEVAL WITH THE INTENT OF UNDERGOING IN-VITRO FERTILIZA-
 TION USING A FRESH EMBRYO TRANSFER; OR MEDICATIONS ARE ADMINISTERED  FOR
 ENDOMETRIAL  PREPARATION WITH THE INTENT OF UNDERGOING IN-VITRO FERTILI-
 ZATION USING A FROZEN EMBRYO TRANSFER.  NO  INSURER  PROVIDING  COVERAGE
 UNDER  THIS  ITEM  OR  ITEM (VI) OF THIS SUBPARAGRAPH SHALL DISCRIMINATE
 BASED ON AN INSURED'S EXPECTED LENGTH  OF  LIFE,  PRESENT  OF  PREDICTED
 DISABILITY,  DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF LIFE, OR
 OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,  INCLUD-
 ING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTITY.
   §  2.  Paragraph  3 of subsection (s) of section 4303 of the insurance
 law, as amended by section 2 of part K of chapter  82  of  the  laws  of
 2002, is amended to read as follows:
   (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
 prescription drugs used in the diagnosis and treatment of infertility as
 required by paragraphs one and two of this subsection shall be  provided
 in accordance with this paragraph.

 S. 1507--A                         84                         A. 2007--A
 
   (A) [Coverage] EXCEPT AS PROVIDED IN SUBPARAGRAPHS (F) AND (G) OF THIS
 PARAGRAPH,  COVERAGE shall be provided for persons whose ages range from
 twenty-one through forty-four years, provided that nothing herein  shall
 preclude  the  provision  of  coverage  to persons whose age is below or
 above such range.
   (B) Diagnosis and treatment of infertility shall be prescribed as part
 of a physician's overall plan of care and consistent with the guidelines
 for coverage as referenced in this paragraph.
   (C)  Coverage  may  be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (D) [Coverage shall be limited to  those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided that for the purposes of this paragraph "period of not
 less than twelve months" shall be determined by  calculating  such  time
 from  either  the  date the insured was first covered under the existing
 policy or from the date the insured was first covered  by  a  previously
 in-force converted policy, whichever is earlier.
   (E)  Coverage] EXCEPT AS PROVIDED IN SUBPARAGRAPHS (F) AND (G) OF THIS
 PARAGRAPH, COVERAGE shall not be required to include the  diagnosis  and
 treatment of infertility in connection with: (i) in vitro fertilization,
 gamete  intrafallopian  tube  transfers  or  zygote  intrafallopian tube
 transfers; (ii) the  reversal  of  elective  sterilizations;  (iii)  sex
 change  procedures; (iv) cloning; or (v) medical or surgical services or
 procedures that are deemed to be experimental in accordance  with  clin-
 ical guidelines referenced in subparagraph [(F)] (E) of this paragraph.
   [(F)] (E) The superintendent, in consultation with the commissioner of
 health,  shall  promulgate  regulations which shall stipulate the guide-
 lines and standards which shall be used in carrying out  the  provisions
 of this paragraph, which shall include:
   (i)  The  determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine;
   (ii) The identification of experimental procedures and treatments  not
 covered  for  the  diagnosis  and treatment of infertility determined in
 accordance with the standards and guidelines established and adopted  by
 the American College of Obstetricians and Gynecologists and the American
 Society  for  Reproductive  Medicine INCLUDING "IATROGENIC INFERTILITY",
 WHICH MEANS AN IMPAIRMENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHER-
 APY OR OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE  ORGANS  OR  PROC-
 ESSES;
   (iii)  The  identification  of  the  required training, experience and
 other standards for health care providers for the  provision  of  proce-
 dures  and  treatments  for  the  diagnosis and treatment of infertility
 determined in accordance with the standards and  guidelines  established
 and  adopted  by the American College of Obstetricians and Gynecologists
 and the American Society for Reproductive Medicine; and
   (iv) The determination of appropriate medical candidates by the treat-
 ing physician in accordance with the  standards  and  guidelines  estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.
   (F)  COVERAGE  SHALL  ALSO  INCLUDE  STANDARD  FERTILITY  PRESERVATION
 SERVICES WHEN A MEDICAL  TREATMENT  MAY  DIRECTLY  OR  INDIRECTLY  CAUSE
 IATROGENIC  INFERTILITY TO AN INSURED. COVERAGE MAY BE SUBJECT TO ANNUAL

 S. 1507--A                         85                         A. 2007--A
 
 DEDUCTIBLES AND COINSURANCE, INCLUDING  COPAYMENTS,  AS  MAY  BE  DEEMED
 APPROPRIATE  BY  THE  SUPERINTENDENT  AND  AS  ARE CONSISTENT WITH THOSE
 ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN CONTRACT.
   (G) EVERY LARGE GROUP CONTRACT THAT PROVIDES MEDICAL, MAJOR MEDICAL OR
 SIMILAR  COMPREHENSIVE-TYPE  COVERAGE  SHALL  PROVIDE COVERAGE FOR THREE
 CYCLES OF IN-VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY AS
 DEFINED IN ITEM (I) OF SUBPARAGRAPH (E) OF THIS PARAGRAPH. COVERAGE  MAY
 BE  SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE, INCLUDING COPAYMENTS,
 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN  CONTRACT.  FOR
 PURPOSES OF THIS SUBPARAGRAPH, A "CYCLE" IS DEFINED AS EITHER ALL TREAT-
 MENT  THAT  STARTS  WHEN:   PREPARATORY MEDICATIONS ARE ADMINISTERED FOR
 OVARIAN STIMULATION FOR OOCYTE RETRIEVAL WITH THE INTENT  OF  UNDERGOING
 IN-VITRO FERTILIZATION USING A FRESH EMBRYO TRANSFER; OR MEDICATIONS ARE
 ADMINISTERED  FOR  ENDOMETRIAL PREPARATION WITH THE INTENT OF UNDERGOING
 IN-VITRO FERTILIZATION USING A FROZEN EMBRYO  TRANSFER.  NO  CORPORATION
 PROVIDING  COVERAGE  UNDER  SUBPARAGRAPHS  (F)  OR (G) OF THIS PARAGRAPH
 SHALL DISCRIMINATE BASED ON AN INSURED'S EXPECTED LENGTH OF LIFE,  PRES-
 ENT  OR  PREDICTED  DISABILITY,  DEGREE OF MEDICAL DEPENDENCY, PERCEIVED
 QUALITY OF LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHAR-
 ACTERISTICS, INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL  STATUS  OR
 GENDER IDENTITY.
   §  3.  Paragraph 13 of subsection (i) of section 3216 of the insurance
 law is amended by adding a new subparagraph (C) to read as follows:
   (C) EVERY POLICY THAT  PROVIDES  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
 COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR STANDARD FERTILI-
 TY  PRESERVATION SERVICES WHEN A MEDICAL TREATMENT MAY DIRECTLY OR INDI-
 RECTLY CAUSE IATROGENIC INFERTILITY  TO  AN  INSURED.  COVERAGE  MAY  BE
 SUBJECT  TO ANNUAL DEDUCTIBLES AND COINSURANCE, INCLUDING COPAYMENTS, AS
 MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND  AS  ARE  CONSISTENT
 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   (I)  FOR PURPOSES OF THIS SUBPARAGRAPH, "IATROGENIC INFERTILITY" MEANS
 AN IMPAIRMENT OF FERTILITY BY SURGERY, RADIATION, CHEMOTHERAPY OR  OTHER
 MEDICAL TREATMENT AFFECTING REPRODUCTIVE ORGANS OR PROCESSES.
   (II) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIM-
 INATE  BASED  ON  AN  INSURED'S  EXPECTED  LENGTH  OF  LIFE,  PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   § 4. This act shall take effect January 1, 2020  and  shall  apply  to
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                  PART M

   Section 1. This act shall be known and may be cited as the "comprehen-
 sive contraception coverage act".
   § 2. Paragraph 16 of subsection (l) of section 3221 of  the  insurance
 law,  as added by chapter 554 of the laws of 2002, is amended to read as
 follows:
   (16) (A) Every group or blanket policy which  [provides  coverage  for
 prescription  drugs shall include coverage for the cost of contraceptive
 drugs or devices approved by the federal food and drug administration or
 generic equivalents approved as substitutes by such food and drug admin-
 istration under the prescription  of  a  health  care  provider  legally

 S. 1507--A                         86                         A. 2007--A

 authorized  to  prescribe  under  title  eight of the education law. The
 coverage required by this section shall  be  included  in  policies  and
 certificates only through the addition of a rider.
   (A)]  PROVIDES  MEDICAL,  MAJOR  MEDICAL OR SIMILAR COMPREHENSIVE-TYPE
 COVERAGE SHALL PROVIDE COVERAGE FOR ALL OF THE  FOLLOWING  SERVICES  AND
 CONTRACEPTIVE METHODS:
   (I) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS  INCLUDES  ALL  FDA-APPROVED  OVER-THE-COUNTER CONTRACEPTIVE DRUGS,
 DEVICES, AND PRODUCTS AS PRESCRIBED OR  AS  OTHERWISE  AUTHORIZED  UNDER
 STATE  OR FEDERAL LAW.  NOTWITHSTANDING THIS PARAGRAPH, AN INSURER SHALL
 NOT BE REQUIRED TO PROVIDE COVERAGE OF  MALE  CONDOMS.    THE  FOLLOWING
 APPLIES TO THIS COVERAGE:
   (I)  WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND PHARMACEU-
 TICAL EQUIVALENT, AS DEFINED BY THE FDA,  VERSIONS  OF  A  CONTRACEPTIVE
 DRUG, DEVICE, OR PRODUCT, AN INSURER IS NOT REQUIRED TO INCLUDE ALL SUCH
 THERAPEUTIC  AND PHARMACEUTICAL EQUIVALENT VERSIONS IN ITS FORMULARY, SO
 LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING AND IN
 ACCORDANCE WITH THIS PARAGRAPH;
   (II) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED  MEDICALLY
 INADVISABLE,  THE INSURER SHALL PROVIDE COVERAGE FOR AN ALTERNATE THERA-
 PEUTIC AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE  DRUG,
 DEVICE,  OR  PRODUCT WITHOUT COST-SHARING UPON THE RECOMMENDATION OF THE
 INSURED'S ATTENDING HEALTH CARE PROVIDER. AN INSURER SHALL DEFER TO  THE
 ATTENDING  HEALTH  CARE  PROVIDER'S  DETERMINATION OF MEDICAL NECESSITY.
 THE  SUPERINTENDENT  MAY  DEVELOP  A  STANDARD   EXCEPTION   FORM   WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A  PARTICULAR CONTRACEPTIVE DRUG, DEVICE, OR PRODUCT BASED UPON A DETER-
 MINATION OF MEDICAL NECESSITY FOR AN INSURED. THE INSURER  SHALL  ACCEPT
 THE  STANDARD EXCEPTION FORM SUBMITTED BY THE INSURED'S ATTENDING HEALTH
 CARE PROVIDER;
   (III) THIS COVERAGE  SHALL  INCLUDE  EMERGENCY  CONTRACEPTION  WITHOUT
 COST-SHARING WHEN PROVIDED PURSUANT TO PRESCRIPTION, ORDER UNDER SECTION
 SIXTY-EIGHT  HUNDRED  THIRTY-ONE OF THE EDUCATION LAW, OVER-THE-COUNTER,
 OR  WHEN  OTHERWISE  LAWFULLY  PROVIDED  OTHER  THAN   PURSUANT   TO   A
 PRESCRIPTION; AND
   (IV)  THIS  COVERAGE  SHALL ALLOW FOR THE DISPENSING OF TWELVE MONTHS-
 WORTH OF A CONTRACEPTIVE AT ONE TIME;
   (II) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (III) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (IV) FOLLOW-UP SERVICES RELATED TO THE DRUGS, DEVICES,  PRODUCTS,  AND
 PROCEDURES  COVERED UNDER THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO,
 MANAGEMENT OF SIDE EFFECTS,  COUNSELING  FOR  CONTINUED  ADHERENCE,  AND
 DEVICE INSERTION AND REMOVAL.
   (B)  AN  INSURER  SUBJECT TO THIS PARAGRAPH SHALL NOT IMPOSE A DEDUCT-
 IBLE, COINSURANCE, COPAYMENT OR ANY OTHER  COST-SHARING  REQUIREMENT  ON
 THE COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH.
   (C)  EXCEPT  AS  OTHERWISE AUTHORIZED UNDER THIS PARAGRAPH, AN INSURER
 SHALL NOT IMPOSE ANY RESTRICTIONS OR DELAYS  ON  THE  COVERAGE  REQUIRED
 UNDER THIS PARAGRAPH.
   (D)  Notwithstanding  any  other provision of this subsection, a reli-
 gious employer may request a contract without coverage for federal  food
 and drug administration approved contraceptive methods that are contrary
 to  the  religious  employer's  religious  tenets. If so requested, such
 contract shall be provided without coverage for  contraceptive  methods.

 S. 1507--A                         87                         A. 2007--A

 This  paragraph  shall not be construed to deny an enrollee coverage of,
 and timely access to, contraceptive methods.
   (1)  For  purposes  of  this  subsection, a "religious employer" is an
 entity for which each of the following is true:
   (a) The inculcation of religious values is the purpose of the entity.
   (b) The entity primarily  employs  persons  who  share  the  religious
 tenets of the entity.
   (c) The entity serves primarily persons who share the religious tenets
 of the entity.
   (d)  The  entity  is  a nonprofit organization as described in Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
   (2) Every religious employer that invokes the exemption provided under
 this paragraph shall provide written  notice  to  prospective  enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(B)  (i)] (E) (1) Where a group policyholder makes an election not to
 purchase coverage for contraceptive drugs or devices in accordance  with
 subparagraph  [(A)] (D) of this paragraph each certificateholder covered
 under the policy issued to that group policyholder shall have the  right
 to  directly  purchase  the  rider  required  by this paragraph from the
 insurer which issued the group policy  at  the  prevailing  small  group
 community  rate  for such rider whether or not the employee is part of a
 small group.
   [(ii)] (2) Where  a  group  policyholder  makes  an  election  not  to
 purchase  coverage for contraceptive drugs or devices in accordance with
 subparagraph [(A)] (D) of this paragraph, the insurer that provides such
 coverage shall provide written notice to certificateholders upon enroll-
 ment with the insurer of their right to directly purchase  a  rider  for
 coverage  for  the  cost  of  contraceptive drugs or devices. The notice
 shall also advise the certificateholders of the additional  premium  for
 such coverage.
   [(C)]  (F) Nothing in this paragraph shall be construed as authorizing
 a group or blanket policy which provides coverage for prescription drugs
 to exclude coverage for prescription drugs prescribed for reasons  other
 than contraceptive purposes.
   [(D) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   § 3. Subsection (cc) of section 4303 of the insurance law, as added by
 chapter 554 of the laws of 2002, is amended to read as follows:
   (cc) (1) Every contract  [which  provides  coverage  for  prescription
 drugs  shall  include  coverage  for  the cost of contraceptive drugs or
 devices approved by the federal food and drug administration or  generic
 equivalents approved as substitutes by such food and drug administration
 under  the  prescription of a health care provider legally authorized to
 prescribe under title eight of the education law. The coverage  required
 by  this  section  shall  be included in contracts and certificates only
 through the addition of a rider.
   (1)] WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR  COMPREHENSIVE-
 TYPE  COVERAGE  SHALL PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES
 AND CONTRACEPTIVE METHODS:
   (A) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS INCLUDES ALL  FDA-APPROVED  OVER-THE-COUNTER  CONTRACEPTIVE  DRUGS,
 DEVICES,  AND  PRODUCTS  AS  PRESCRIBED OR AS OTHERWISE AUTHORIZED UNDER
 STATE OR FEDERAL LAW.   NOTWITHSTANDING THIS  PARAGRAPH,  A  CORPORATION

 S. 1507--A                         88                         A. 2007--A
 
 SHALL  NOT BE REQUIRED TO PROVIDE COVERAGE OF MALE CONDOMS.  THE FOLLOW-
 ING APPLIES TO THIS COVERAGE:
   (I)  WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND PHARMACEU-
 TICAL EQUIVALENT, AS DEFINED BY THE FDA,  VERSIONS  OF  A  CONTRACEPTIVE
 DRUG,  DEVICE,  OR PRODUCT, A CORPORATION IS NOT REQUIRED TO INCLUDE ALL
 SUCH THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS  IN  ITS  FORMU-
 LARY, SO LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHAR-
 ING AND IN ACCORDANCE WITH THIS SUBSECTION;
   (II) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF  A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED MEDICALLY
 INADVISABLE, A CORPORATION SHALL PROVIDE COVERAGE FOR AN ALTERNATE THER-
 APEUTIC AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE DRUG,
 DEVICE, OR PRODUCT WITHOUT COST-SHARING UPON THE RECOMMENDATION  OF  THE
 INSURED'S  ATTENDING  HEALTH CARE PROVIDER. A CORPORATION SHALL DEFER TO
 THE ATTENDING HEALTH CARE PROVIDER'S DETERMINATION OF MEDICAL NECESSITY.
 THE  SUPERINTENDENT  MAY  DEVELOP  A  STANDARD   EXCEPTION   FORM   WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A  PARTICULAR CONTRACEPTIVE DRUG, DEVICE, OR PRODUCT BASED UPON A DETER-
 MINATION OF MEDICAL NECESSITY FOR AN INSURED. THE INSURER  SHALL  ACCEPT
 THE  STANDARD EXCEPTION FORM SUBMITTED BY THE INSURED'S ATTENDING HEALTH
 CARE PROVIDER;
   (III) THIS COVERAGE  SHALL  INCLUDE  EMERGENCY  CONTRACEPTION  WITHOUT
 COST-SHARING  WHEN  PROVIDED  PURSUANT  TO  A  PRESCRIPTION, ORDER UNDER
 SECTION SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION  LAW,  OVER-THE-
 COUNTER,  OR  WHEN  OTHERWISE  LAWFULLY  PROVIDED  OTHER  THAN THROUGH A
 PRESCRIPTION; AND
   (IV) THIS COVERAGE SHALL ALLOW FOR THE  DISPENSING  OF  TWELVE  MONTHS
 WORTH OF A CONTRACEPTIVE AT ONE TIME;
   (B) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (C) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (D)  FOLLOW-UP  SERVICES  RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
 PROCEDURES COVERED UNDER THIS SUBSECTION, INCLUDING, BUT NOT LIMITED TO,
 MANAGEMENT OF SIDE EFFECTS,  COUNSELING  FOR  CONTINUED  ADHERENCE,  AND
 DEVICE INSERTION AND REMOVAL.
   (2) A CORPORATION SUBJECT TO THIS PARAGRAPH SHALL NOT IMPOSE A DEDUCT-
 IBLE,  COINSURANCE,  COPAYMENT  OR ANY OTHER COST-SHARING REQUIREMENT ON
 THE COVERAGE PROVIDED PURSUANT TO THIS SUBSECTION.
   (3) EXCEPT AS OTHERWISE AUTHORIZED UNDER  THIS  SUBSECTION,  A  CORPO-
 RATION  SHALL  NOT  IMPOSE  ANY  RESTRICTIONS  OR DELAYS ON THE COVERAGE
 REQUIRED UNDER THIS SUBSECTION.
   (4) Notwithstanding any other provision of this  subsection,  a  reli-
 gious  employer may request a contract without coverage for federal food
 and drug administration approved contraceptive methods that are contrary
 to the religious employer's religious  tenets.  If  so  requested,  such
 contract  shall  be provided without coverage for contraceptive methods.
 This paragraph shall not be construed to deny an enrollee  coverage  of,
 and timely access to, contraceptive methods.
   (A)  For  purposes  of  this  subsection, a "religious employer" is an
 entity for which each of the following is true:
   (i) The inculcation of religious values is the purpose of the entity.
   (ii) The entity primarily employs  persons  who  share  the  religious
 tenets of the entity.
   (iii)  The  entity  serves  primarily  persons who share the religious
 tenets of the entity.
   (iv) The entity is a nonprofit organization as  described  in  Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.

 S. 1507--A                         89                         A. 2007--A
 
   (B) Every religious employer that invokes the exemption provided under
 this  paragraph  shall  provide  written notice to prospective enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(2)](5)  (A)  Where  a  group contractholder makes an election not to
 purchase coverage for contraceptive drugs or devices in accordance  with
 paragraph [one] FOUR of this subsection, each enrollee covered under the
 contract  issued  to  that  group contractholder shall have the right to
 directly purchase the rider required by this subsection from the insurer
 or health maintenance organization which issued the  group  contract  at
 the  prevailing small group community rate for such rider whether or not
 the employee is part of a small group.
   (B) Where a group contractholder makes an  election  not  to  purchase
 coverage for contraceptive drugs or devices in accordance with paragraph
 [one]  FOUR of this subsection, the insurer or health maintenance organ-
 ization that provides such coverage  shall  provide  written  notice  to
 enrollees  upon enrollment with the insurer or health maintenance organ-
 ization of their right to directly purchase a rider for coverage for the
 cost of contraceptive drugs or devices. The notice shall also advise the
 enrollees of the additional premium for such coverage.
   [(3)](6) Nothing in this subsection shall be construed as  authorizing
 a  contract  which  provides  coverage for prescription drugs to exclude
 coverage for  prescription  drugs  prescribed  for  reasons  other  than
 contraceptive purposes.
   [(4) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   § 4. Paragraph 17 of subsection (i) of section 3216 of  the  insurance
 law is amended by adding a new subparagraph (G) to read as follows:
   (G)(I) IN ADDITION TO SUBPARAGRAPHS (A), (B), (C), (D), OR (E) OF THIS
 PARAGRAPH,  EVERY POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL OR SIMILAR
 COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  ALL  OF  THE
 FOLLOWING SERVICES AND CONTRACEPTIVE METHODS:
   (I) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS.
 THIS  INCLUDES  ALL  FDA-APPROVED  OVER-THE-COUNTER CONTRACEPTIVE DRUGS,
 DEVICES, AND PRODUCTS AS PRESCRIBED OR  AS  OTHERWISE  AUTHORIZED  UNDER
 STATE  OR  FEDERAL  LAW.  NOTWITHSTANDING  THIS SUBPARAGRAPH, AN INSURER
 SHALL NOT BE REQUIRED TO PROVIDE COVERAGE OF MALE CONDOMS. THE FOLLOWING
 APPLIES TO THIS COVERAGE:
   (AA) WHERE THE FDA HAS APPROVED ONE OR MORE THERAPEUTIC AND PHARMACEU-
 TICAL EQUIVALENT, AS DEFINED BY THE FDA,  VERSIONS  OF  A  CONTRACEPTIVE
 DRUG, DEVICE, OR PRODUCT, AN INSURER IS NOT REQUIRED TO INCLUDE ALL SUCH
 THERAPEUTIC  AND PHARMACEUTICAL EQUIVALENT VERSIONS IN ITS FORMULARY, SO
 LONG AS AT LEAST ONE IS INCLUDED AND  COVERED  WITHOUT  COST-SHARING  IN
 ACCORDANCE WITH THIS SUBPARAGRAPH;
   (BB) IF THE COVERED THERAPEUTIC AND PHARMACEUTICAL EQUIVALENT VERSIONS
 OF  A DRUG, DEVICE, OR PRODUCT ARE NOT AVAILABLE OR ARE DEEMED MEDICALLY
 INADVISABLE, THE INSURER SHALL PROVIDE COVERAGE FOR AN ALTERNATE  THERA-
 PEUTIC  AND PHARMACEUTICAL EQUIVALENT VERSION OF THE CONTRACEPTIVE DRUG,
 DEVICE, OR PRODUCT WITHOUT COST-SHARING. AN INSURER SHALL DEFER  TO  THE
 ATTENDING  HEALTH  CARE  PROVIDER'S  DETERMINATION OF MEDICAL NECESSITY.
 THE  SUPERINTENDENT  MAY  DEVELOP  A  STANDARD   EXCEPTION   FORM   WITH
 INSTRUCTIONS THAT AN ATTENDING HEALTH CARE PROVIDER MAY USE TO RECOMMEND
 A  PARTICULAR CONTRACEPTIVE DRUG, DEVICE, PROCEDURE, SERVICE, OR PRODUCT
 BASED UPON A DETERMINATION OF MEDICAL  NECESSITY  FOR  AN  INSURED.  THE

 S. 1507--A                         90                         A. 2007--A
 
 INSURER  SHALL  ACCEPT  THE  STANDARD  EXCEPTION  FORM  SUBMITTED BY THE
 INSURED'S ATTENDING HEALTH CARE PROVIDER;
   (CC) THIS COVERAGE SHALL INCLUDE EMERGENCY CONTRACEPTION WITHOUT COST-
 SHARING  WHEN  PROVIDED  PURSUANT TO A PRESCRIPTION, ORDER UNDER SECTION
 SIXTY-EIGHT HUNDRED THIRTY-ONE OF THE EDUCATION  LAW,  OVER-THE-COUNTER,
 OR   WHEN   OTHERWISE   LAWFULLY  PROVIDED  OTHER  THAN  PURSUANT  TO  A
 PRESCRIPTION; AND
   (DD) THIS COVERAGE SHALL ALLOW FOR THE DISPENSING  OF  TWELVE  MONTHS-
 WORTH OF A CONTRACEPTIVE AT ONE TIME:
   (II) VOLUNTARY STERILIZATION PROCEDURES FOR WOMEN;
   (III) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION; AND
   (IV)  FOLLOW-UP  SERVICES RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
 PROCEDURES COVERED UNDER THIS SUBPARAGRAPH, INCLUDING MANAGEMENT OF SIDE
 EFFECTS, COUNSELING FOR CONTINUED ADHERENCE, AND  DEVICE  INSERTION  AND
 REMOVAL.
   (II) AN INSURER SUBJECT TO THIS SUBPARAGRAPH SHALL NOT IMPOSE A DEDUC-
 TIBLE,  COINSURANCE,  COPAYMENT OR ANY OTHER COST-SHARING REQUIREMENT ON
 THE COVERAGE PROVIDED PURSUANT TO THIS SUBPARAGRAPH.
   (III) EXCEPT AS  OTHERWISE  AUTHORIZED  UNDER  THIS  SUBPARAGRAPH,  AN
 INSURER  SHALL  NOT  IMPOSE  ANY  RESTRICTIONS OR DELAYS ON THE COVERAGE
 REQUIRED UNDER THIS SUBPARAGRAPH.
   § 5. Paragraph (d) of subdivision 3 of section  365-a  of  the  social
 services  law,  as  amended  by  chapter  909 of the laws of 1974 and as
 relettered by chapter 82 of the laws of 1995,  is  amended  to  read  as
 follows:
   (d)  family  planning  services  and  supplies for eligible persons of
 childbearing age, including children under twenty-one years of  age  who
 can  be  considered  sexually  active,  who  desire  such  services  and
 supplies, in accordance with the requirements of federal law  and  regu-
 lations  and the regulations of the department.  PRESCRIPTION CONTRACEP-
 TIVES, WHEN PRESCRIBED BASED ON GENERALLY ACCEPTED MEDICAL PRACTICE, MAY
 BE DISPENSED AT ONE TIME OR UP TO TWELVE TIMES WITHIN ONE YEAR FROM  THE
 DATE  OF  THE  PRESCRIPTION.  No person shall be compelled or coerced to
 accept such services or supplies.
   § 6. This act  shall  take  effect  January  1,  2020;  provided  that
 sections  two,  three  and  four of this act shall apply to policies and
 contracts issued, renewed, modified, altered or  amended  on  and  after
 such date.
 
                                  PART N

   Section  1.  Universal access commission. 1. There is hereby created a
 universal access commission, which shall consider and advise the commis-
 sioner of health and the superintendent of financial services on options
 for achieving universal access to health care in New York State.
   2. The universal access commission shall consist of independent health
 policy and insurance experts appointed by the  commissioner  and  super-
 intendent.  The commission shall consult with the legislature and stake-
 holder groups and convene at least one meeting for members of the public
 to review and discuss options for achieving universal access to care.
   3. The commissioner and superintendent shall select the chair  of  the
 commission from among the members of such commission and shall designate
 at  least  one employee from each department to assist the commission in
 the performance of its duties under this section. The  commissioner  and
 superintendent  shall  adopt rules for the governance of the commission,
 which shall meet as frequently as its business may require and  at  such

 S. 1507--A                         91                         A. 2007--A
 
 other  times  as determined by the commissioner and superintendent to be
 necessary.
   4.  Members  of  the  commission  shall serve without compensation for
 their services as members, but each shall be allowed the  necessary  and
 actual  expenses  incurred in the performance of his or her duties under
 this section.
   5. The commission shall provide  a  report  to  the  Governor  on  the
 options  for achieving universal access to health care in New York State
 by December 1, 2019.
   § 2. This act shall take effect immediately.

                                  PART O
 
   Section 1. Subdivision 2 of section 605 of the public health  law,  as
 amended  by  section  20 of part E of chapter 56 of the laws of 2013, is
 amended to read as follows:
   2. State aid reimbursement for public health services  provided  by  a
 municipality  under  this  title,  shall  be made if the municipality is
 providing some or all of the core public health services  identified  in
 section  six hundred two of this title, pursuant to an approved applica-
 tion for state aid, at a rate of no less  than  thirty-six  per  centum,
 EXCEPT  FOR THE CITY OF NEW YORK WHICH SHALL RECEIVE NO LESS THAN TWENTY
 PER CENTUM, of the difference between the amount of moneys  expended  by
 the  municipality  for  public  health  services required by section six
 hundred two of this title during the fiscal  year  and  the  base  grant
 provided pursuant to subdivision one of this section. No such reimburse-
 ment  shall be provided for services that are not eligible for state aid
 pursuant to this article.
   § 2. Subdivision 1 of section 616 of the public health law, as amended
 by section 27 of part E of chapter 56 of the laws of 2013, is amended to
 read as follows:
   1. The total amount of state aid provided  pursuant  to  this  article
 shall  be  limited to the amount of the annual appropriation made by the
 legislature. In no event, however, shall such state aid be less than  an
 amount  to  provide  the  full  base grant and, as otherwise provided by
 [paragraph (a) of] subdivision two of section six hundred five  of  this
 article,  [at  least] NO LESS THAN thirty-six per centum, EXCEPT FOR THE
 CITY OF NEW YORK WHICH SHALL RECEIVE NO LESS THAN TWENTY PER CENTUM,  of
 the difference between the amount of moneys expended by the municipality
 for  eligible public health services pursuant to an approved application
 for state aid during the fiscal year and the base grant provided  pursu-
 ant to subdivision one of section six hundred five of this article.
   § 3. This act shall take effect July 1, 2019.
 
                                  PART P
 
   Section 1.  Subdivision 6 of section 1370 of the public health law, as
 amended by chapter 485 of the laws of 1992, is amended as follows:
   6.  "Elevated  lead  levels"  means a blood lead level greater than or
 equal to [ten] FIVE micrograms of lead per deciliter of whole  blood  or
 such  LOWER  blood  lead  level  as may be established by the department
 pursuant to rule or regulation.
   § 2. The public health law is amended by adding a new  section  1370-f
 to read as follows:
   §  1370-F.  LEAD  SAFE RESIDENTIAL RENTAL PROPERTIES. 1.  DEFINITIONS.
 FOR THE PURPOSES OF THIS SECTION:

 S. 1507--A                         92                         A. 2007--A
 
   (A) "RESIDENTIAL RENTAL PROPERTY"  SHALL  MEAN  A  DWELLING  WHICH  IS
 EITHER  RENTED, LEASED, LET OR HIRED OUT, TO BE OCCUPIED, OR IS OCCUPIED
 AS THE HOME,  RESIDENCE OR SLEEPING PLACE OF ONE OR MORE  PERSONS  OTHER
 THAN  THE OWNER'S  FAMILY. RESIDENTIAL RENTAL PROPERTY SHALL NOT INCLUDE
 SHORT  TERM RENTAL  PROPERTIES DURING WHICH GUESTS DO NOT STAY IN EXCESS
 OF TWENTY-EIGHT DAYS.
   (B) "LEAD SAFE" SHALL MEAN ANY RESIDENTIAL RENTAL PROPERTY THAT:
   (I)  HAS  BEEN  DETERMINED  THROUGH  A  LEAD-BASED  PAINT   INSPECTION
 CONDUCTED  IN  ACCORDANCE  WITH  APPROPRIATE  FEDERAL REGULATIONS NOT TO
 CONTAIN LEAD-BASED  PAINT; OR
   (II) MEETS THE MINIMUM STANDARDS SET FORTH IN REGULATIONS  PROMULGATED
 BY THE COMMISSIONER PURSUANT TO THIS SECTION.
   2.  THE COMMISSIONER SHALL PROMULGATE RULES AND REGULATIONS ESTABLISH-
 ING MINIMUM STANDARDS FOR  THE  MAINTENANCE  OF  LEAD  SAFE  RESIDENTIAL
 RENTAL PROPERTIES. SUCH RULES AND REGULATIONS SHALL INCLUDE:
   (A)  MINIMUM  STANDARDS  FOR MAINTAINING INTERNAL AND EXTERNAL PAINTED
 SURFACES THAT CONTAIN LEAD-BASED PAINT; AND
   (B) A SCHEDULE BY WHICH OWNERS OF  RESIDENTIAL  RENTAL  PROPERTY  MUST
 IMPLEMENT AND COMPLY WITH SUCH MINIMUM STANDARDS.
   3.  IT  SHALL  BE  THE  RESPONSIBILITY  OF AN OWNER OF ANY RESIDENTIAL
 RENTAL PROPERTY TO MAINTAIN SUCH PROPERTY IN A LEAD  SAFE  CONDITION  IN
 ACCORDANCE  WITH   RULES AND REGULATIONS PROMULGATED BY THE COMMISSIONER
 PURSUANT TO THIS SECTION.
   4. ALL PAINT ON ANY RESIDENTIAL RENTAL PROPERTY ON WHICH THE  ORIGINAL
 CONSTRUCTION  WAS  COMPLETED  PRIOR  TO  JANUARY FIRST, NINETEEN HUNDRED
 SEVENTY-EIGHT, SHALL BE PRESUMED TO BE LEAD-BASED PAINT.  THIS  PRESUMP-
 TION MAY BE  OVERCOME BY A CERTIFICATION ISSUED BY A FEDERALLY CERTIFIED
 LEAD-BASED  PAINT  INSPECTOR OR RISK ASSESSOR THAT THE PROPERTY HAS BEEN
 DETERMINED NOT TO CONTAIN LEAD-BASED PAINT, OR BY SUCH  OTHER  MEANS  AS
 MAY  BE  PRESCRIBED BY THE RULES AND  REGULATIONS ADOPTED BY THE COMMIS-
 SIONER PURSUANT TO THIS SECTION.
   5. THE COMMISSIONER, LOCAL HEALTH OFFICER OF A COUNTY AND, IN THE CITY
 OF NEW YORK, THE COMMISSIONER OF THE  NEW YORK CITY DEPARTMENT OF HEALTH
 AND MENTAL HYGIENE, MAY ENTER INTO  AN  AGREEMENT  OR  CONTRACT  WITH  A
 MUNICIPAL    GOVERNMENT  REGARDING  INSPECTION OF THE LEAD CONDITIONS IN
 RESIDENTIAL RENTAL  PROPERTIES AND SUCH HEALTH DEPARTMENT MAY  DESIGNATE
 THE  LOCAL  HOUSING    MAINTENANCE  CODE ENFORCEMENT AGENCY IN WHICH THE
 RESIDENTIAL RENTAL PROPERTY IS   LOCATED  AS  AN  AGENCY  AUTHORIZED  TO
 ADMINISTER  AND  ENSURE  COMPLIANCE WITH THE  PROVISIONS OF THIS SECTION
 AND SUBSEQUENT REGULATIONS PURSUANT TO SUBDIVISION  ONE OF SECTION THIR-
 TEEN HUNDRED SEVENTY-FIVE OF THIS TITLE.
   6. IF THE COMMISSIONER, OR OTHER OFFICER HAVING  JURISDICTION,  DETER-
 MINES  THAT  AN  OWNER OF RESIDENTIAL RENTAL PROPERTY IS IN VIOLATION OF
 THIS SECTION OR  ANY RULES OR REGULATIONS PROMULGATED PURSUANT  TO  THIS
 SECTION,  THE  COMMISSIONER   OR OTHER OFFICER HAVING JURISDICTION SHALL
 HAVE THE AUTHORITY TO ORDER THE  ABATEMENT OF ANY LEAD CONDITION PRESENT
 AT THE RESIDENTIAL RENTAL PROPERTY AND  ASSESS FINES NOT TO  EXCEED  TWO
 THOUSAND DOLLARS FOR EACH VIOLATION.
   §  3.  Subdivision  one  of  section three hundred eighty-three of the
 executive law, as added by chapter 707 of the laws of 1984, paragraph  c
 as  amended  by  chapter 772 of the laws of 1986, is amended by adding a
 new paragraph d, to read as follows:
   D. THE REGULATIONS PROMULGATED BY THE COMMISSIONER OF HEALTH  PURSUANT
 TO  SUBDIVISION  TWO OF SECTION THIRTEEN HUNDRED SEVENTY-F OF THE PUBLIC
 HEALTH LAW

 S. 1507--A                         93                         A. 2007--A
 
   (I) SHALL NOT BE SUPERSEDED BY THE PROVISIONS OF THIS ARTICLE, BY  THE
 PROVISIONS  OF  THE UNIFORM FIRE PREVENTION AND BUILDING CODE, OR BY THE
 PROVISIONS OF THE BUILDING AND FIRE PREVENTION CODES IN EFFECT IN A CITY
 WITH A POPULATION OF OVER ONE MILLION;
   (II)  SHALL  BE APPLICABLE IN ADDITION TO, AND NOT IN SUBSTITUTION FOR
 OR LIMITATION OF, THE PROVISIONS OF  THE  UNIFORM  FIRE  PREVENTION  AND
 BUILDING  CODE  AND THE PROVISIONS OF BUILDING AND FIRE PREVENTION CODES
 IN EFFECT IN CITIES WITH A POPULATION OF OVER ONE MILLION; AND
   (III) SHALL BE ADMINISTERED AND ENFORCED BY  COMMISSIONER  OF  HEALTH,
 THE  LOCAL  HEALTH OFFICER OF A COUNTY, THE COMMISSIONER OF THE NEW YORK
 CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, OR A MUNICIPAL  GOVERNMENT
 ENTERING INTO AN AGREEMENT OR CONTRACT AUTHORIZED BY SUBDIVISION FIVE OF
 SECTION  THIRTEEN  HUNDRED  SEVENTY-F  OF  THE PUBLIC HEALTH LAW, IN THE
 MANNER PROVIDED IN SAID SUBDIVISION.
   § 4. This act shall take effect immediately.

                                  PART Q
 
   Section 1. Section 2825-f of the  public  health  law  is  amended  by
 adding two new subdivisions 4-a and 4-b to read as follows:
   4-A. NOTWITHSTANDING SUBDIVISION TWO OF THIS SECTION OR ANY INCONSIST-
 ENT  PROVISION OF LAW TO THE CONTRARY, AND UPON APPROVAL OF THE DIRECTOR
 OF THE BUDGET, THE COMMISSIONER MAY,  SUBJECT  TO  THE  AVAILABILITY  OF
 LAWFUL  APPROPRIATION,  AWARD UP TO THREE HUNDRED MILLION DOLLARS OF THE
 FUNDS MADE AVAILABLE PURSUANT  TO  THIS  SECTION  FOR  UNFUNDED  PROJECT
 APPLICATIONS  SUBMITTED  IN  RESPONSE  TO  THE  REQUEST FOR APPLICATIONS
 NUMBER 17648 ISSUED BY THE DEPARTMENT ON JANUARY  EIGHTH,  TWO  THOUSAND
 EIGHTEEN  PURSUANT TO SECTION TWENTY-EIGHT HUNDRED TWENTY-FIVE-E OF THIS
 ARTICLE, PROVIDED HOWEVER THAT THE PROVISIONS OF SUBDIVISIONS THREE  AND
 FOUR OF THIS SECTION SHALL APPLY.
   4-B. AUTHORIZED AMOUNTS TO BE AWARDED PURSUANT TO APPLICATIONS SUBMIT-
 TED  IN  RESPONSE  TO  THE REQUEST FOR APPLICATION NUMBER 17648 SHALL BE
 AWARDED NO LATER THAN MAY FIRST, TWO THOUSAND NINETEEN.
   § 2. This act shall take effect immediately.
 
                                  PART R
 
   Section 1. Legislative findings and intent. The legislature finds that
 maternal mortality and morbidity is a serious public health concern  and
 has  a  serious family and societal impact. New York state has among the
 highest maternal mortality rates in the country and  racial  disparities
 remain  significant. The U.S. Centers for Disease Control and Prevention
 has determined that a regular process for professional,  multi-discipli-
 nary,  confidential  review of all maternal deaths can help identify the
 causes of maternal mortality, and those findings can  lead  to  clinical
 and  social change that can help prevent maternal mortality. The same is
 true for severe maternal  morbidity.  Confidentiality  is  important  to
 ensure  that full information is made available in the review process to
 maximize protection of maternal health.
   Section 3 of  article  17  of  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."  The
 legislature finds that the creation of a state maternal mortality review
 board,  and  recognition and protection of any maternal mortality review

 S. 1507--A                         94                         A. 2007--A
 
 board, including a New York city maternal mortality review board, are  a
 matter  of  state concern and an important exercise of the legislature's
 constitutional mandate to protect the public health.
   §  2. The public health law is amended by adding a new section 2509 to
 read as follows:
   § 2509. MATERNAL MORTALITY REVIEW BOARD. 1. (A) THERE IS HEREBY ESTAB-
 LISHED IN THE DEPARTMENT THE MATERNAL MORTALITY  REVIEW  BOARD  FOR  THE
 PURPOSE  OF  REVIEWING MATERNAL DEATHS AND SEVERE MATERNAL MORBIDITY AND
 DEVELOPING FINDINGS, RECOMMENDATIONS, AND BEST PRACTICES TO THE  COMMIS-
 SIONER  TO CONTRIBUTE TO THE PREVENTION OF MATERNAL MORTALITY AND SEVERE
 MATERNAL MORBIDITY.  THE BOARD SHALL ASSESS THE CAUSE OF DEATH,  FACTORS
 LEADING  TO  DEATH  AND  PREVENTABILITY FOR EACH MATERNAL DEATH REVIEWED
 AND, AT THE DISCRETION OF THE BOARD, CASES OF SEVERE MATERNAL MORBIDITY,
 AND SHALL DEVELOP STRATEGIES FOR REDUCING THE RISK OF MATERNAL MORTALITY
 AND SEVERE MATERNAL MORBIDITY, WHERE CASES OF SEVERE MATERNAL  MORBIDITY
 WERE  REVIEWED, TAKING INTO ACCOUNT FACTORS SUCH AS RACIAL, ECONOMIC, OR
 OTHER DISPARITIES. THE BOARDS' FINDINGS, RECOMMENDATIONS AND BEST  PRAC-
 TICES SHALL BE GIVEN TO THE COMMISSIONER FOR DISSEMINATION.
   (B)  ANY  MATERNAL  MORTALITY  REVIEW BOARD, INCLUDING A NEW YORK CITY
 MATERNAL MORTALITY REVIEW BOARD, SHALL PROVIDE TO THE  COMMISSIONER  THE
 RESULTS  AND  THE FINDINGS OF ITS REVIEWS, INCLUDING RECOMMENDATIONS AND
 BEST PRACTICES AND UPON REQUEST INFORMATION  AND  DATA,  INCLUDING  CASE
 SUMMARIES, TO SUPPORT STATEWIDE SURVEILLANCE AND ENFORCEMENT.
   2. AS USED IN THIS SECTION:
   (A)  "ADVISORY  COUNCIL"  AND  "COUNCIL"  MEAN THE ADVISORY COUNCIL ON
 MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY, ESTABLISHED UNDER THIS
 SECTION.
   (B) "BOARD" MEANS A MATERNAL MORTALITY  REVIEW  BOARD  ESTABLISHED  BY
 THIS  SECTION,  REFERRED TO IN THIS SECTION AS THE "STATE BOARD", OR ANY
 BOARD OPERATING, INCLUDING A NEW YORK  CITY  MATERNAL  MORTALITY  REVIEW
 BOARD, UNDER THIS SECTION.
   (C)  "MATERNAL  DEATH"  MEANS THE DEATH OF A WOMAN DURING PREGNANCY OR
 WITHIN A YEAR FROM THE END OF PREGNANCY.
   (D) "SEVERE MATERNAL MORBIDITY" MEANS UNEXPECTED OUTCOMES OF  PREGNAN-
 CY,  LABOR,  OR  DELIVERY THAT RESULT IN SIGNIFICANT SHORT- OR LONG-TERM
 CONSEQUENCES TO A WOMAN'S HEALTH.
   3. (A) THE MEMBERS OF THE STATE BOARD SHALL BE COMPRISED OF  MULTIDIS-
 CIPLINARY EXPERTS IN THE FIELD OF MATERNAL MORTALITY, WOMEN'S HEALTH AND
 PUBLIC  HEALTH,  AND  SHALL  INCLUDE HEALTH CARE PROFESSIONALS AND OTHER
 EXPERTS WHO SERVE AND ARE REPRESENTATIVE OF THE RACIAL AND ETHNIC DIVER-
 SITY OF THE WOMEN AND MOTHERS OF THE STATE.
   (B) THE STATE BOARD SHALL BE COMPOSED OF AT LEAST FIFTEEN MEMBERS, ALL
 OF WHOM SHALL BE APPOINTED BY THE COMMISSIONER.
   (C) THE TERMS OF THE STATE BOARD MEMBERS SHALL  BE  THREE  YEARS.  THE
 COMMISSIONER  MAY  CHOOSE TO REAPPOINT STATE BOARD MEMBERS TO ADDITIONAL
 THREE YEAR TERMS.
   (D) A MAJORITY OF THE APPOINTED MEMBERSHIP OF THE STATE BOARD, NO LESS
 THAN THREE, SHALL CONSTITUTE A QUORUM.
   (E) WHEN ANY MEMBER OF THE STATE BOARD FAILS TO ATTEND  THREE  CONSEC-
 UTIVE  REGULAR  MEETINGS,  UNLESS  SUCH  ABSENCE IS FOR GOOD CAUSE, THAT
 MEMBERSHIP MAY BE DEEMED VACANT FOR PURPOSES OF  THE  APPOINTMENT  OF  A
 SUCCESSOR.
   (F)  MEETINGS  OF  THE STATE BOARD SHALL BE HELD AT LEAST TWICE A YEAR
 BUT MAY BE HELD MORE FREQUENTLY AS DEEMED NECESSARY, SUBJECT TO  REQUEST
 OF THE DEPARTMENT.

 S. 1507--A                         95                         A. 2007--A
 
   (G)  MEMBERS  OF  THE  STATE  BOARD SHALL BE INDEMNIFIED UNDER SECTION
 SEVENTEEN OF THE PUBLIC OFFICERS LAW.
   (H)  MEMBERS  OF  THE  STATE  BOARD SHALL NOT BE COMPENSATED FOR THEIR
 PARTICIPATION ON THE BOARD BUT MAY RECEIVE REIMBURSEMENT FOR THEIR ORDI-
 NARY AND NECESSARY EXPENSES OF PARTICIPATION.
   (I) MEMBERSHIP ON A BOARD SHALL NOT DISQUALIFY ANY PERSON FROM HOLDING
 ANY PUBLIC OFFICE OR EMPLOYMENT.
   (J) THE BOARD IS NOT SUBJECT TO ARTICLE 7 OF THE PUBLIC OFFICERS LAW.
   4. (A) THE COMMISSIONER SHALL RECEIVE UPON REQUEST  FROM  ANY  DEPART-
 MENT,  DIVISION,  BOARD, BUREAU, COMMISSION, LOCAL HEALTH DEPARTMENTS OR
 OTHER AGENCY OF THE STATE OR POLITICAL SUBDIVISION THEREOF OR ANY PUBLIC
 AUTHORITY, AS WELL AS HOSPITALS ESTABLISHED PURSUANT TO ARTICLE  TWENTY-
 EIGHT  OF THIS CHAPTER, BIRTHING FACILITIES, MEDICAL EXAMINERS, CORONERS
 AND CORONER PHYSICIANS AND ANY OTHER FACILITY PROVIDING SERVICES ASSOCI-
 ATED WITH MATERNAL  MORTALITY,  SUCH  INFORMATION,  INCLUDING,  BUT  NOT
 LIMITED  TO, DEATH RECORDS, MEDICAL RECORDS, AUTOPSY REPORTS, TOXICOLOGY
 REPORTS, HOSPITAL DISCHARGE RECORDS, BIRTH RECORDS AND ANY OTHER  INFOR-
 MATION.
   (B)  THE  COMMISSIONER  SHALL  RECEIVE  INFORMATION, INCLUDING ORAL OR
 WRITTEN STATEMENTS, RELATING TO ANY MATERNAL DEATH AND  CASE  OF  SEVERE
 MATERNAL  MORBIDITY,  FROM  ANY  FAMILY MEMBER OR OTHER INTERESTED PARTY
 (INCLUDING THE PATIENT IN A CASE OF SEVERE MATERNAL MORBIDITY)  RELATING
 TO  ANY  CASE  THAT  MAY COME BEFORE THE BOARD. ORAL STATEMENTS RECEIVED
 UNDER THIS PARAGRAPH SHALL BE TRANSCRIBED OR SUMMARIZED IN WRITING.  THE
 COMMISSIONER  AND  THE CITY COMMISSIONER SHALL TRANSMIT THAT INFORMATION
 TO THE BOARD CONSIDERING THE CASE.
   (C) BEFORE TRANSMITTING ANY INFORMATION TO THE BOARD, THE COMMISSIONER
 SHALL REMOVE ALL PERSONAL IDENTIFYING INFORMATION OF THE  WOMAN,  HEALTH
 CARE  PRACTITIONER OR PRACTITIONERS OR ANYONE ELSE INDIVIDUALLY NAMED IN
 SUCH INFORMATION, AS WELL AS THE HOSPITAL OR FACILITY THAT  TREATED  THE
 WOMAN,  AND  ANY  OTHER INFORMATION SUCH AS GEOGRAPHIC LOCATION THAT MAY
 INADVERTENTLY IDENTIFY THE WOMAN, PRACTITIONER OR FACILITY.  THIS  PARA-
 GRAPH  SHALL  NOT  PRECLUDE THE TRANSMITTING OF INFORMATION TO THE BOARD
 THAT IS REASONABLY NECESSARY TO ENABLE THE BOARD TO PERFORM AN APPROPRI-
 ATE REVIEW UNDER THIS SECTION.
   5. EACH BOARD:
   (A) SHALL MAKE AND REPORT FINDINGS, RECOMMENDATIONS AND BEST PRACTICES
 TO THE COMMISSIONER REGARDING THE CAUSE OF  DEATH,  FACTORS  LEADING  TO
 DEATH,  AND PREVENTABILITY OF EACH MATERNAL DEATH CASE, AND EACH CASE OF
 SEVERE MATERNAL MORBIDITY REVIEWED BY THE BOARD, BY  REVIEWING  RELEVANT
 INFORMATION FOR EACH CASE AND CONSULTING WITH EXPERTS AS NEEDED TO EVAL-
 UATE  THE  INFORMATION FOR EACH DEATH; AND SHALL PROVIDE SUCH DE-IDENTI-
 FIED FINDINGS AND RECOMMENDATIONS, INCLUDING BEST PRACTICES AND  STRATE-
 GIES  FOR  REDUCING  THE  RISK OF MATERNAL MORTALITY AND SEVERE MATERNAL
 MORBIDITY, TO THE ADVISORY COUNCIL; PROVIDED THAT MATERIAL  PROVIDED  TO
 THE  ADVISORY  COUNCIL  SHALL  NOT INCLUDE ANY INFORMATION THAT WOULD BE
 CONFIDENTIAL UNDER THIS SECTION;
   (B) SHALL DEVELOP RECOMMENDATIONS TO THE  COMMISSIONER  FOR  AREAS  OF
 FOCUS,  INCLUDING  ISSUES  OF  SEVERE  MATERNAL  MORBIDITY AND ISSUES OF
 RACIAL, ECONOMIC OR OTHER DISPARITIES IN MATERNAL OUTCOMES;
   (C) MAY, IN ADDITION TO THE FINDINGS, RECOMMENDATIONS, AND BEST  PRAC-
 TICES  MADE  UNDER  THIS SUBDIVISION, AND CONSISTENT WITH ALL APPLICABLE
 CONFIDENTIALITY PROTECTIONS, BRING ANY PARTICULAR MATTER TO  THE  ATTEN-
 TION OF THE COMMISSIONER;

 S. 1507--A                         96                         A. 2007--A
 
   (D)  THE  STATE  BOARD  SHALL  ISSUE  A REPORT EVERY OTHER YEAR TO THE
 COMMISSIONER ON ITS FINDINGS, RECOMMENDATIONS, AND BEST  PRACTICES,  AND
 IT SHALL BE A PUBLIC DOCUMENT.
   6. THE COMMISSIONER AND BOARDS SHALL EACH KEEP CONFIDENTIAL ANY INFOR-
 MATION  COLLECTED  OR RECEIVED UNDER THIS SECTION THAT INCLUDES PERSONAL
 IDENTIFYING INFORMATION OF THE WOMAN, HEALTH CARE PRACTITIONER OR  PRAC-
 TITIONERS OR ANYONE ELSE INDIVIDUALLY NAMED IN SUCH INFORMATION, AS WELL
 AS THE HOSPITAL OR FACILITY THAT TREATED THE WOMAN, AND ANY OTHER INFOR-
 MATION  SUCH  AS GEOGRAPHIC LOCATION THAT MAY INADVERTENTLY IDENTIFY THE
 WOMAN, PRACTITIONER OR FACILITY, AND SHALL USE THE INFORMATION  PROVIDED
 OR RECEIVED UNDER THIS SECTION SOLELY FOR THE PURPOSES OF IMPROVEMENT OF
 THE  QUALITY  OF  HEALTH CARE OF WOMEN AND TO PREVENT MATERNAL MORTALITY
 AND SEVERE MATERNAL MORBIDITY.  THIS SUBDIVISION SHALL NOT PRECLUDE  THE
 TRANSMITTING OF INFORMATION TO THE BOARD THAT IS REASONABLY NECESSARY TO
 ENABLE  THE  BOARD  TO PERFORM AN APPROPRIATE REVIEW UNDER THIS SECTION.
 ALL INFORMATION AND RECORDS RECEIVED, MEETINGS  CONDUCTED,  REPORTS  AND
 RECORDS  MADE  AND  MAINTAINED  AND ALL BOOKS AND PAPERS OBTAINED BY THE
 COMMISSIONER AS WELL AS THE BOARD SHALL BE CONFIDENTIAL AND SHALL NOT BE
 MADE OPEN OR AVAILABLE, INCLUDING UNDER ARTICLE SIX OF THE PUBLIC  OFFI-
 CERS LAW, AND SHALL BE LIMITED TO BOARD MEMBERS AS WELL AS THOSE AUTHOR-
 IZED BY THE COMMISSIONER.  SUCH INFORMATION SHALL NOT BE DISCOVERABLE OR
 ADMISSIBLE  AS  EVIDENCE  IN ANY ACTION IN ANY COURT OR BEFORE ANY OTHER
 TRIBUNAL, BOARD, AGENCY OR PERSON.
   7. (A) THERE IS HEREBY ESTABLISHED IN THE DEPARTMENT AN ADVISORY COUN-
 CIL ON MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY.
   (B) THE ADVISORY COUNCIL:
   (I) MAY REVIEW THE FINDINGS, RECOMMENDATIONS AND BEST PRACTICES OF THE
 BOARDS;
   (II) MAY USE THE BOARDS FINDINGS, RECOMMENDATIONS AND  BEST  PRACTICES
 TO  DEVELOP  RECOMMENDATIONS ON POLICIES, BEST PRACTICES, AND STRATEGIES
 TO PREVENT MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY;
   (III) MAY HOLD PUBLIC HEARINGS ON THOSE MATTERS; AND
   (IV) MAY MAKE FINDINGS AND ISSUE REPORTS, INCLUDING AN ANNUAL  REPORT,
 ON SUCH MATTERS;
   (C)  THE  ADVISORY  COUNCIL  SHALL CONSIST OF AT LEAST TWENTY MEMBERS,
 REPRESENTATIVE OF THE RACIAL AND ETHNIC DIVERSITY OF THE WOMEN AND MOTH-
 ERS OF THE STATE TO BE DETERMINED BY  THE  COMMISSIONER.    TEN  OF  THE
 MEMBERS  OF  THE  COUNCIL  SHALL BE REPRESENTATIVE OF THE POPULATION AND
 HEALTH CARE SYSTEM OF THE CITY OF NEW  YORK.    THE  COMMISSIONER  SHALL
 APPOINT THE CHAIR OF THE COUNCIL.
   (D) THE MEMBERS OF THE COUNCIL SHALL BE COMPRISED OF MULTIDISCIPLINARY
 EXPERTS  AND  LAY PERSONS KNOWLEDGEABLE IN THE FIELD OF MATERNAL MORTAL-
 ITY, WOMEN'S HEALTH AND PUBLIC HEALTH  AND  SHALL  INCLUDE  MEMBERS  WHO
 SERVE  AND  ARE REPRESENTATIVE OF THE DIVERSITY OF THE WOMEN AND MOTHERS
 IN MEDICALLY UNDERSERVED AREAS OF THE STATE OR AREAS OF THE  STATE  WITH
 DISPROPORTIONATELY  HIGH  OCCURRENCES  OF  MATERNAL  MORTALITY OR SEVERE
 MATERNAL MORBIDITY.
   (E) THE TERMS OF THE COUNCIL MEMBERS SHALL BE THREE YEARS. THE COMMIS-
 SIONER MAY CHOOSE TO REAPPOINT COUNCIL MEMBERS TO ADDITIONAL  THREE-YEAR
 TERMS.  VACANCIES  ON  THE COUNCIL SHALL BE FILLED BY APPOINTMENT BY THE
 COMMISSIONER.  A MAJORITY OF THE APPOINTED  MEMBERSHIP  OF  THE  COUNCIL
 SHALL  CONSTITUTE  A  QUORUM.  WHEN  ANY  MEMBER OF THE COUNCIL FAILS TO
 ATTEND THREE CONSECUTIVE REGULAR MEETINGS, UNLESS SUCH  ABSENCE  IS  FOR
 GOOD  CAUSE,  THAT  MEMBERSHIP  MAY BE DEEMED VACANT FOR PURPOSES OF THE
 APPOINTMENT OF A SUCCESSOR.
   (F) MEETINGS OF THE COUNCIL SHALL BE HELD AT LEAST TWICE A YEAR.

 S. 1507--A                         97                         A. 2007--A
 
   (G) MEMBERS OF THE COUNCIL SHALL BE INDEMNIFIED UNDER  SECTION  SEVEN-
 TEEN  OF  THE  PUBLIC  OFFICERS LAW. MEMBERS OF THE COUNCIL SHALL NOT BE
 COMPENSATED FOR THEIR PARTICIPATION ON THE  COUNCIL  BUT  SHALL  RECEIVE
 REIMBURSEMENT  FOR  THEIR  ORDINARY  AND  NECESSARY  EXPENSES OF PARTIC-
 IPATION.  MEMBERSHIP ON THE COUNCIL SHALL NOT DISQUALIFY ANY PERSON FROM
 HOLDING ANY PUBLIC OFFICE OR EMPLOYMENT.
   § 3. This act shall take effect immediately.
 
                                  PART S
 
   Section 1. Legislative intent. The legislature finds  that  comprehen-
 sive  reproductive health care, including contraception and abortion, is
 a fundamental component of a woman's health, privacy and  equality.  The
 New  York  Constitution and United States Constitution protect a woman's
 fundamental right to access safe, legal abortion, courts have repeatedly
 reaffirmed this right and further emphasized that states may  not  place
 undue burdens on women seeking to access such right.
   Moreover, the legislature finds, as with other medical procedures, the
 safety  of  abortion  is furthered by evidence-based practices developed
 and supported by medical professionals. Abortion is one  of  the  safest
 medical  procedures  performed in the United States; the goal of medical
 regulation should be to improve the quality and availability  of  health
 care services.
   Furthermore,  the legislature declares that it is the public policy of
 New York State that every individual possesses a  fundamental  right  of
 privacy  and  equality with respect to their personal reproductive deci-
 sions and should be able to safely effectuate those decisions, including
 by seeking and obtaining abortion care, free from discrimination in  the
 provision of health care.
   Therefore, it is the intent of the legislature to prevent the enforce-
 ment  of laws or regulations that are not in furtherance of a legitimate
 state interest in protecting  a  woman's  health  that  burden  abortion
 access.
   §  2. The public health law is amended by adding a new article 25-A to
 read as follows:
                               ARTICLE 25-A
                          REPRODUCTIVE HEALTH ACT
 SECTION 2599-AA. POLICY AND PURPOSE.
         2599-BB. ABORTION.
   § 2599-AA. POLICY AND PURPOSE. THE LEGISLATURE FINDS  THAT  COMPREHEN-
 SIVE  REPRODUCTIVE HEALTH CARE IS A FUNDAMENTAL COMPONENT OF EVERY INDI-
 VIDUAL'S HEALTH, PRIVACY AND EQUALITY. THEREFORE, IT IS  THE  POLICY  OF
 THE STATE THAT:
   1.  EVERY  INDIVIDUAL  HAS  THE  FUNDAMENTAL RIGHT TO CHOOSE OR REFUSE
 CONTRACEPTION OR STERILIZATION.
   2. EVERY INDIVIDUAL WHO BECOMES PREGNANT HAS THE FUNDAMENTAL RIGHT  TO
 CHOOSE  TO  CARRY THE PREGNANCY TO TERM, TO GIVE BIRTH TO A CHILD, OR TO
 HAVE AN ABORTION, PURSUANT TO THIS ARTICLE.
   3. THE STATE SHALL NOT DISCRIMINATE AGAINST, DENY, OR  INTERFERE  WITH
 THE  EXERCISE  OF THE RIGHTS SET FORTH IN THIS SECTION IN THE REGULATION
 OR PROVISION OF BENEFITS, FACILITIES, SERVICES OR INFORMATION.
   § 2599-BB. ABORTION. 1. A HEALTH CARE  PRACTITIONER  LICENSED,  CERTI-
 FIED, OR AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW, ACTING WITH-
 IN  HIS  OR  HER LAWFUL SCOPE OF PRACTICE, MAY PERFORM AN ABORTION WHEN,
 ACCORDING TO THE PRACTITIONER'S REASONABLE AND GOOD  FAITH  PROFESSIONAL
 JUDGMENT BASED ON THE FACTS OF THE PATIENT'S CASE: THE PATIENT IS WITHIN

 S. 1507--A                         98                         A. 2007--A
 
 TWENTY-FOUR  WEEKS  FROM  THE  COMMENCEMENT OF PREGNANCY, OR THERE IS AN
 ABSENCE OF FETAL VIABILITY, OR THE ABORTION IS NECESSARY TO PROTECT  THE
 PATIENT'S LIFE OR HEALTH.
   2.  THIS  ARTICLE  SHALL  BE CONSTRUED AND APPLIED CONSISTENT WITH AND
 SUBJECT TO APPLICABLE LAWS AND  APPLICABLE  AND  AUTHORIZED  REGULATIONS
 GOVERNING HEALTH CARE PROCEDURES.
   § 3. Section 4164 of the public health law is REPEALED.
   § 4. Subdivision 8 of section 6811 of the education law is REPEALED.
   §  5.  Sections 125.40, 125.45, 125.50, 125.55 and 125.60 of the penal
 law are REPEALED, and the article heading of article 125  of  the  penal
 law is amended to read as follows:
                 HOMICIDE[, ABORTION] AND RELATED OFFENSES
   § 6. Section 125.00 of the penal law is amended to read as follows:
 § 125.00 Homicide defined.
   Homicide  means  conduct  which  causes  the  death of a person [or an
 unborn child with which a female has been pregnant for more  than  twen-
 ty-four  weeks] under circumstances constituting murder, manslaughter in
 the first degree, manslaughter  in  the  second  degree,  OR  criminally
 negligent  homicide[,  abortion  in the first degree or self-abortion in
 the first degree].
   § 7. The section heading,  opening  paragraph  and  subdivision  1  of
 section 125.05 of the penal law are amended to read as follows:
   Homicide[,  abortion]  and  related  offenses;  [definitions of terms]
 DEFINITION.
   The following [definitions are] DEFINITION IS applicable to this arti-
 cle:
   [1.] "Person," when referring to the victim of  a  homicide,  means  a
 human being who has been born and is alive.
   §  7-a.  Subdivisions  2  and 3 of section 125.05 of the penal law are
 REPEALED.
   § 8. Subdivision 2 of section 125.15 of the penal law is REPEALED.
   § 9. Subdivision 3 of section 125.20 of the penal law is REPEALED.
   § 10. Paragraph (b) of subdivision 8 of section 700.05 of the criminal
 procedure law, as amended by chapter 189 of the laws of 2018, is amended
 to read as follows:
   (b) Any of the following felonies: assault in  the  second  degree  as
 defined  in section 120.05 of the penal law, assault in the first degree
 as defined in section 120.10 of the penal law, reckless endangerment  in
 the  first degree as defined in section 120.25 of the penal law, promot-
 ing a suicide attempt as defined in section 120.30  of  the  penal  law,
 strangulation  in  the second degree as defined in section 121.12 of the
 penal law, strangulation in the  first  degree  as  defined  in  section
 121.13  of  the  penal  law, criminally negligent homicide as defined in
 section 125.10 of the penal law, manslaughter in the  second  degree  as
 defined  in  section  125.15 of the penal law, manslaughter in the first
 degree as defined in section 125.20 of the  penal  law,  murder  in  the
 second  degree  as defined in section 125.25 of the penal law, murder in
 the first degree  as  defined  in  section  125.27  of  the  penal  law,
 [abortion in the second degree as defined in section 125.40 of the penal
 law,  abortion  in  the first degree as defined in section 125.45 of the
 penal law,] rape in the third degree as defined in section 130.25 of the
 penal law, rape in the second degree as defined in section 130.30 of the
 penal law, rape in the first degree as defined in section 130.35 of  the
 penal law, criminal sexual act in the third degree as defined in section
 130.40  of  the  penal  law, criminal sexual act in the second degree as
 defined in section 130.45 of the penal law, criminal sexual act  in  the

 S. 1507--A                         99                         A. 2007--A
 
 first degree as defined in section 130.50 of the penal law, sexual abuse
 in  the  first  degree  as  defined  in section 130.65 of the penal law,
 unlawful imprisonment in the first degree as defined in  section  135.10
 of  the penal law, kidnapping in the second degree as defined in section
 135.20 of the penal law, kidnapping in the first degree  as  defined  in
 section 135.25 of the penal law, labor trafficking as defined in section
 135.35  of  the  penal  law,  aggravated labor trafficking as defined in
 section 135.37 of the penal law, custodial  interference  in  the  first
 degree  as  defined  in section 135.50 of the penal law, coercion in the
 first degree as defined in section 135.65 of  the  penal  law,  criminal
 trespass  in  the first degree as defined in section 140.17 of the penal
 law, burglary in the third degree as defined in section  140.20  of  the
 penal law, burglary in the second degree as defined in section 140.25 of
 the penal law, burglary in the first degree as defined in section 140.30
 of  the  penal  law, criminal mischief in the third degree as defined in
 section 145.05 of the penal law, criminal mischief in the second  degree
 as  defined in section 145.10 of the penal law, criminal mischief in the
 first degree as defined in section 145.12 of  the  penal  law,  criminal
 tampering  in the first degree as defined in section 145.20 of the penal
 law, arson in the fourth degree as defined  in  section  150.05  of  the
 penal law, arson in the third degree as defined in section 150.10 of the
 penal  law,  arson  in the second degree as defined in section 150.15 of
 the penal law, arson in the first degree as defined in section 150.20 of
 the penal law, grand larceny in the fourth degree as defined in  section
 155.30 of the penal law, grand larceny in the third degree as defined in
 section  155.35  of the penal law, grand larceny in the second degree as
 defined in section 155.40 of the penal law, grand larceny in  the  first
 degree  as defined in section 155.42 of the penal law, health care fraud
 in the fourth degree as defined in section  177.10  of  the  penal  law,
 health  care  fraud  in the third degree as defined in section 177.15 of
 the penal law, health care fraud in the  second  degree  as  defined  in
 section  177.20  of the penal law, health care fraud in the first degree
 as defined in section 177.25 of the penal  law,  robbery  in  the  third
 degree  as  defined  in  section 160.05 of the penal law, robbery in the
 second degree as defined in section 160.10 of the penal law, robbery  in
 the first degree as defined in section 160.15 of the penal law, unlawful
 use  of  secret  scientific material as defined in section 165.07 of the
 penal law, criminal possession of stolen property in the  fourth  degree
 as  defined  in  section 165.45 of the penal law, criminal possession of
 stolen property in the third degree as defined in section 165.50 of  the
 penal  law,  criminal possession of stolen property in the second degree
 as defined by section 165.52 of the penal law,  criminal  possession  of
 stolen  property in the first degree as defined by section 165.54 of the
 penal law, trademark counterfeiting in the second degree as  defined  in
 section  165.72  of the penal law, trademark counterfeiting in the first
 degree as defined in section 165.73 of the penal  law,  forgery  in  the
 second  degree as defined in section 170.10 of the penal law, forgery in
 the first degree as defined in section 170.15 of the penal law, criminal
 possession of a forged instrument in the second  degree  as  defined  in
 section 170.25 of the penal law, criminal possession of a forged instru-
 ment  in the first degree as defined in section 170.30 of the penal law,
 criminal possession of forgery devices as defined in section  170.40  of
 the  penal  law,  falsifying  business  records  in  the first degree as
 defined in section 175.10  of  the  penal  law,  tampering  with  public
 records  in  the  first degree as defined in section 175.25 of the penal
 law, offering a false instrument for  filing  in  the  first  degree  as

 S. 1507--A                         100                        A. 2007--A
 
 defined  in section 175.35 of the penal law, issuing a false certificate
 as defined in section 175.40 of the penal  law,  criminal  diversion  of
 prescription  medications  and  prescriptions  in  the  second degree as
 defined  in  section  178.20  of  the  penal  law, criminal diversion of
 prescription medications  and  prescriptions  in  the  first  degree  as
 defined  in  section 178.25 of the penal law, residential mortgage fraud
 in the fourth degree as defined in section  187.10  of  the  penal  law,
 residential  mortgage  fraud  in  the third degree as defined in section
 187.15 of the penal law, residential mortgage fraud in the second degree
 as defined in section 187.20 of  the  penal  law,  residential  mortgage
 fraud in the first degree as defined in section 187.25 of the penal law,
 escape  in  the  second degree as defined in section 205.10 of the penal
 law, escape in the first degree as defined  in  section  205.15  of  the
 penal  law,  absconding  from  temporary  release in the first degree as
 defined in section 205.17 of the penal law, promoting prison  contraband
 in  the  first  degree  as  defined  in section 205.25 of the penal law,
 hindering prosecution in the second degree as defined in section  205.60
 of  the  penal law, hindering prosecution in the first degree as defined
 in section 205.65 of the  penal  law,  sex  trafficking  as  defined  in
 section  230.34  of the penal law, sex trafficking of a child as defined
 in section 230.34-a of the penal law, criminal possession of a weapon in
 the third degree as defined in  subdivisions  two,  three  and  five  of
 section  265.02 of the penal law, criminal possession of a weapon in the
 second degree as defined in section 265.03 of the  penal  law,  criminal
 possession  of a weapon in the first degree as defined in section 265.04
 of the penal law, manufacture, transport, disposition and defacement  of
 weapons  and dangerous instruments and appliances defined as felonies in
 subdivisions one, two, and three of section 265.10  of  the  penal  law,
 sections  265.11,  265.12 and 265.13 of the penal law, or prohibited use
 of weapons as defined in subdivision two of section 265.35 of the  penal
 law,  relating  to  firearms  and other dangerous weapons, or failure to
 disclose the origin of a recording in the first  degree  as  defined  in
 section 275.40 of the penal law;
   §  11.  Subdivision  1  of  section 673 of the county law, as added by
 chapter 545 of the laws of 1965, is amended to read as follows:
   1. A coroner or medical examiner has  jurisdiction  and  authority  to
 investigate  the death of every person dying within his county, or whose
 body is found within the county, which is or appears to be:
   (a) A violent death, whether by criminal violence, suicide or  casual-
 ty;
   (b) A death caused by unlawful act or criminal neglect;
   (c) A death occurring in a suspicious, unusual or unexplained manner;
   (d) [A death caused by suspected criminal abortion;
   (e)] A death while unattended by a physician, so far as can be discov-
 ered,  or  where  no  physician  able  to  certify the cause of death as
 provided in the public health law and  in  form  as  prescribed  by  the
 commissioner of health can be found;
   [(f)]  (E)  A death of a person confined in a public institution other
 than a hospital, infirmary or nursing home.
   § 12. Section 4 of the judiciary law, as amended by chapter 264 of the
 laws of 2003, is amended to read as follows:
   § 4. Sittings of courts to be public.  The  sittings  of  every  court
 within  this  state shall be public, and every citizen may freely attend
 the same, except that  in  all  proceedings  and  trials  in  cases  for
 divorce,  seduction,  [abortion,]  rape,  assault  with intent to commit
 rape, criminal sexual act, bastardy or filiation, the court may, in  its

 S. 1507--A                         101                        A. 2007--A
 
 discretion,  exclude  therefrom  all persons who are not directly inter-
 ested therein, excepting jurors, witnesses, and officers of the court.
   §  13.  Severability. If any provision of this act, or any application
 of any provision of this act, is held to  be  invalid,  that  shall  not
 affect the validity or effectiveness of any other provision of this act,
 or  of  any other application of any provision of this act, which can be
 given effect without that provision or application; and to that end, the
 provisions and applications of this act are severable.
   § 14. This act shall take effect immediately.
 
                                  PART T

   Section 1. This act shall be known and may be cited as the  "NY  State
 of Health, The Official Health Plan Marketplace Act".
   §  2.  Article  2  of the public health law is amended by adding a new
 title VII to read as follows:
                                 TITLE VII
                             NY STATE OF HEALTH
 SECTION 268. STATEMENT OF POLICY AND PURPOSES.
         268-A. DEFINITIONS.
         268-B. ESTABLISHMENT OF NY STATE OF HEALTH, THE OFFICIAL  HEALTH
                PLAN MARKETPLACE.
         268-C. FUNCTIONS OF THE MARKETPLACE.
         268-D. SPECIAL  FUNCTIONS  OF  THE MARKETPLACE RELATED TO HEALTH
                PLAN CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
         268-E. APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW.
         268-F. MARKETPLACE ADVISORY COMMITTEE.
         268-G. FUNDING OF THE MARKETPLACE.
         268-H. CONSTRUCTION.
   § 268. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS TITLE  IS
 TO  CODIFY THE ESTABLISHMENT OF THE HEALTH BENEFIT EXCHANGE IN NEW YORK,
 KNOWN AS NY STATE  OF  HEALTH,  THE  OFFICIAL  HEALTH  PLAN  MARKETPLACE
 (MARKETPLACE),  IN  CONFORMANCE  WITH  EXECUTIVE ORDER 42 (CUOMO) ISSUED
 APRIL 12, 2012. THE MARKETPLACE SHALL CONTINUE  TO  PERFORM  ELIGIBILITY
 DETERMINATIONS  FOR  FEDERAL  AND STATE INSURANCE AFFORDABILITY PROGRAMS
 INCLUDING MEDICAL ASSISTANCE IN ACCORDANCE WITH  SECTION  THREE  HUNDRED
 SIXTY-SIX  OF  THE  SOCIAL SERVICES LAW, CHILD HEALTH PLUS IN ACCORDANCE
 WITH SECTION TWENTY-FIVE HUNDRED  ELEVEN  OF  THIS  CHAPTER,  THE  BASIC
 HEALTH PROGRAM IN ACCORDANCE WITH SECTION THREE HUNDRED SIXTY-NINE-GG OF
 THE  SOCIAL  SERVICES  LAW,  AND  PREMIUM  TAX  CREDITS AND COST-SHARING
 REDUCTIONS, TOGETHER  WITH  PERFORMING  ELIGIBILITY  DETERMINATIONS  FOR
 QUALIFIED  HEALTH  PLANS  AND  SUCH  OTHER  HEALTH INSURANCE PROGRAMS AS
 DETERMINED BY THE COMMISSIONER. THE MARKETPLACE  SHALL  ALSO  FACILITATE
 ENROLLMENT  IN  INSURANCE AFFORDABILITY PROGRAMS, QUALIFIED HEALTH PLANS
 AND OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED BY  THE  COMMISSIONER,
 THE  PURCHASE  AND  SALE OF QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDI-
 TIONAL HEALTH PLANS CERTIFIED BY THE MARKETPLACE PURSUANT TO THIS TITLE,
 AND SHALL CONTINUE TO HAVE THE AUTHORITY TO  OPERATE  A  SMALL  BUSINESS
 HEALTH  OPTIONS  PROGRAM  ("SHOP") TO ASSIST ELIGIBLE SMALL EMPLOYERS IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR PURPOSES OF SMALL EMPLOYER TAX CREDITS. IT  IS  THE  INTENT  OF  THE
 LEGISLATURE,  BY CODIFYING THE MARKETPLACE IN STATE STATUTE, TO CONTINUE
 TO PROMOTE QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE,  REDUCE  THE
 NUMBER  OF UNINSURED PERSONS, PROVIDE A TRANSPARENT MARKETPLACE, EDUCATE
 CONSUMERS AND  ASSIST  INDIVIDUALS  WITH  ACCESS  TO  COVERAGE,  PREMIUM

 S. 1507--A                         102                        A. 2007--A
 
 ASSISTANCE  TAX  CREDITS  AND  COST-SHARING REDUCTIONS. IN ADDITION, THE
 LEGISLATURE DECLARES THE INTENT THAT  THE  MARKETPLACE  CONTINUE  TO  BE
 PROPERLY  INTEGRATED  WITH  INSURANCE  AFFORDABILITY PROGRAMS, INCLUDING
 MEDICAID, CHILD HEALTH PLUS AND THE BASIC HEALTH PROGRAM, AND SUCH OTHER
 HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER.
   §  268-A. DEFINITIONS. FOR PURPOSES OF THIS TITLE, THE FOLLOWING DEFI-
 NITIONS SHALL APPLY:
   1. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH OF THE STATE OF NEW
 YORK.
   2. "MARKETPLACE" MEANS THE "NY STATE OF HEALTH,  THE  OFFICIAL  HEALTH
 PLAN  MARKETPLACE"  OR  "MARKETPLACE"  ESTABLISHED  AS  A HEALTH BENEFIT
 EXCHANGE OR "MARKETPLACE" WITHIN THE DEPARTMENT OF  HEALTH  PURSUANT  TO
 EXECUTIVE ORDER 42 (CUOMO) ISSUED APRIL 12, 2012 AND THIS TITLE.
   3. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT,
 PUBLIC  LAW  111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON-
 CILIATION ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR  GUID-
 ANCE ISSUED THEREUNDER.
   4.  "HEALTH  PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR
 ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR  REIM-
 BURSE  ANY  OF  THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT
 INCLUDE THE FOLLOWING:
   (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
 TION THEREOF;
   (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
   (C) LIABILITY INSURANCE, INCLUDING  GENERAL  LIABILITY  INSURANCE  AND
 AUTOMOBILE LIABILITY INSURANCE;
   (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
   (E) AUTOMOBILE NO-FAULT INSURANCE;
   (F) CREDIT INSURANCE;
   (G)  OTHER  SIMILAR  INSURANCE COVERAGE, AS SPECIFIED IN FEDERAL REGU-
 LATIONS, UNDER WHICH BENEFITS FOR MEDICAL CARE ARE  SECONDARY  OR  INCI-
 DENTAL TO OTHER INSURANCE BENEFITS;
   (H)  LIMITED  SCOPE  DENTAL OR VISION BENEFITS, BENEFITS FOR LONG-TERM
 CARE INSURANCE, NURSING HOME INSURANCE,  HOME  CARE  INSURANCE,  OR  ANY
 COMBINATION  THEREOF,  OR  SUCH  OTHER  SIMILAR, LIMITED BENEFITS HEALTH
 INSURANCE AS SPECIFIED IN  FEDERAL  REGULATIONS,  IF  THE  BENEFITS  ARE
 PROVIDED  UNDER  A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE
 OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
   (I) COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL  INDEM-
 NITY, OR OTHER FIXED INDEMNITY COVERAGE;
   (J)  MEDICARE  SUPPLEMENTAL INSURANCE AS DEFINED IN SECTION 1882(G)(1)
 OF THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE  COVER-
 AGE  PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE, OR
 SIMILAR SUPPLEMENTAL COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN  IF  IT
 IS  OFFERED  AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE;
 OR
   (K) THE NEW YORK STATE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT  TO
 TITLE FOUR OF ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
   5.  "INSURER"  MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE FORTY-TWO
 OR A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR
 A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO  ARTICLE  FORTY-
 FOUR  OF  THE  PUBLIC HEALTH LAW THAT CONTRACTS OR OFFERS TO CONTRACT TO
 PROVIDE, DELIVER, ARRANGE, PAY OR REIMBURSE ANY OF THE COSTS  OF  HEALTH
 CARE SERVICES.

 S. 1507--A                         103                        A. 2007--A
 
   6.  "STAND-ALONE  DENTAL  PLAN"  MEANS A DENTAL SERVICES PLAN THAT HAS
 BEEN ISSUED PURSUANT TO APPLICABLE LAW AND CERTIFIED BY THE  MARKETPLACE
 IN ACCORDANCE WITH SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE.
   7. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED PURSUANT
 TO  APPLICABLE  LAW  AND CERTIFIED BY THE MARKETPLACE IN ACCORDANCE WITH
 SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE, INCLUDING A STAND-ALONE
 DENTAL PLAN.
   8. "INSURANCE AFFORDABILITY  PROGRAM"  MEANS  MEDICAID,  CHILD  HEALTH
 PLUS,  THE  BASIC  HEALTH PROGRAM AND ANY OTHER HEALTH INSURANCE SUBSIDY
 PROGRAM DESIGNATED AS SUCH BY THE COMMISSIONER.
   9. "ELIGIBLE INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A  MINOR,  WHO
 IS  ELIGIBLE  TO  ENROLL  IN AN INSURANCE AFFORDABILITY PROGRAM OR OTHER
 HEALTH INSURANCE PROGRAM AS DETERMINED BY THE COMMISSIONER.
   10. "QUALIFIED INDIVIDUAL" MEANS, WITH  RESPECT  TO  QUALIFIED  HEALTH
 PLANS, AN INDIVIDUAL, INCLUDING A MINOR, WHO:
   (A)  IS ELIGIBLE TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO INDI-
 VIDUALS THROUGH THE MARKETPLACE;
   (B) RESIDES IN THIS STATE;
   (C) AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN  INCAR-
 CERATION PENDING THE DISPOSITION OF CHARGES; AND
   (D)  IS,  AND  IS REASONABLY EXPECTED TO BE, FOR THE ENTIRE PERIOD FOR
 WHICH ENROLLMENT IS SOUGHT, A CITIZEN OR NATIONAL OF THE  UNITED  STATES
 OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
   11. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF
 HEALTH AND HUMAN SERVICES.
   12. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM OPERATED BY
 THE  MARKETPLACE  TO  ASSIST  ELIGIBLE  SMALL EMPLOYERS IN THIS STATE IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR PURPOSES OF SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH APPLICABLE
 FEDERAL AND STATE LAWS AND REGULATIONS.
   13. "SMALL EMPLOYER" MEANS AN EMPLOYER WHICH OFFERS COVERAGE WHERE THE
 COVERAGE SUCH EMPLOYER OFFERS WOULD BE CONSIDERED SMALL  GROUP  COVERAGE
 UNDER THE INSURANCE LAW AND REGULATIONS PROMULGATED THEREUNDER, PROVIDED
 THAT IT IS NOT OTHERWISE PROHIBITED UNDER THE FEDERAL ACT.
   14. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
 INDIVIDUALS  RECEIVE  HEALTH  INSURANCE COVERAGE ON BEHALF OF THEMSELVES
 AND THEIR DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY  A  SMALL
 EMPLOYER.
   15. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
   16.  "ESSENTIAL HEALTH BENEFITS" SHALL MEAN THE CATEGORIES OF BENEFITS
 DEFINED IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO  HUNDRED  SEVEN-
 TEEN-I  AND  SUBSECTION (A) OF SECTION FOUR THOUSAND THREE HUNDRED SIX-H
 OF THE INSURANCE LAW.
   § 268-B. ESTABLISHMENT OF NY STATE OF HEALTH, THE OFFICIAL HEALTH PLAN
 MARKETPLACE. 1. THERE IS HEREBY ESTABLISHED AN OFFICE WITHIN THE DEPART-
 MENT OF HEALTH TO BE KNOWN AS THE "NY  STATE  OF  HEALTH,  THE  OFFICIAL
 HEALTH PLAN MARKETPLACE".
   2.  THE  PURPOSE  OF  THE  MARKETPLACE  IS TO FACILITATE ENROLLMENT IN
 HEALTH COVERAGE AND THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS  AND
 OTHER  HEALTH  PLANS CERTIFIED BY THE MARKETPLACE; ENROLL INDIVIDUALS IN
 COVERAGE FOR WHICH THEY ARE ELIGIBLE  IN  ACCORDANCE  WITH  FEDERAL  AND
 STATE  LAW;  ENABLE ELIGIBLE INDIVIDUALS TO RECEIVE PREMIUM TAX CREDITS,
 COST-SHARING REDUCTIONS, AND TO ACCESS INSURANCE AFFORDABILITY  PROGRAMS
 AND  OTHER  HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER;
 ASSIST ELIGIBLE SMALL EMPLOYERS  IN  SELECTING  QUALIFIED  HEALTH  PLANS

 S. 1507--A                         104                        A. 2007--A
 
 AND/OR  OTHER,  OR  ADDITIONAL HEALTH PLANS CERTIFIED BY THE MARKETPLACE
 AND TO QUALIFY FOR SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH  APPLI-
 CABLE LAW; AND TO CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS TITLE.
   § 268-C. FUNCTIONS OF THE MARKETPLACE. THE MARKETPLACE SHALL:
   1. (A) PERFORM ELIGIBILITY DETERMINATIONS FOR FEDERAL AND STATE INSUR-
 ANCE  AFFORDABILITY  PROGRAMS INCLUDING MEDICAL ASSISTANCE IN ACCORDANCE
 WITH SECTION THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES  LAW,  CHILD
 HEALTH  PLUS  IN  ACCORDANCE  WITH SECTION TWENTY-FIVE HUNDRED ELEVEN OF
 THIS CHAPTER, THE BASIC HEALTH PROGRAM IN ACCORDANCE WITH SECTION  THREE
 HUNDRED  SIXTY-NINE-GG  OF  THE SOCIAL SERVICES LAW, PREMIUM TAX CREDITS
 AND COST-SHARING REDUCTIONS AND QUALIFIED  HEALTH  PLANS  IN  ACCORDANCE
 WITH APPLICABLE LAW AND OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED BY
 THE COMMISSIONER;
   (B)  CERTIFY  AND  MAKE  AVAILABLE TO QUALIFIED INDIVIDUALS, QUALIFIED
 HEALTH PLANS, INCLUDING  DENTAL  PLANS,  CERTIFIED  BY  THE  MARKETPLACE
 PURSUANT  TO  APPLICABLE  LAW,  PROVIDED  THAT COVERAGE UNDER SUCH PLANS
 SHALL NOT BECOME EFFECTIVE PRIOR TO CERTIFICATION  BY  THE  MARKETPLACE;
 AND
   (C)  CERTIFY  AND/OR  MAKE  AVAILABLE  TO ELIGIBLE INDIVIDUALS, HEALTH
 PLANS CERTIFIED BY THE MARKETPLACE PURSUANT TO  APPLICABLE  LAW,  AND/OR
 PARTICIPATING IN AN INSURANCE AFFORDABILITY PROGRAM PURSUANT TO APPLICA-
 BLE LAW, PROVIDED THAT COVERAGE UNDER SUCH PLANS SHALL NOT BECOME EFFEC-
 TIVE  PRIOR  TO CERTIFICATION BY THE MARKETPLACE, AND/OR APPROVAL BY THE
 COMMISSIONER.
   2. ASSIGN AN  ACTUARIAL  VALUE  TO  EACH  MARKETPLACE  CERTIFIED  PLAN
 OFFERED  THROUGH  THE MARKETPLACE IN ACCORDANCE WITH THE CRITERIA DEVEL-
 OPED BY THE SECRETARY PURSUANT TO  FEDERAL  LAW  OR  THE  SUPERINTENDENT
 PURSUANT  TO  THE  INSURANCE  LAW  AND/OR  REQUIREMENTS DEVELOPED BY THE
 MARKETPLACE, AND DETERMINE EACH  HEALTH  PLAN'S  LEVEL  OF  COVERAGE  IN
 ACCORDANCE  WITH REGULATIONS ISSUED BY THE SECRETARY PURSUANT TO FEDERAL
 LAW OR THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW.
   3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
 IN THE MARKETPLACE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
 ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE  ACT
 OR THE INSURANCE LAW.
   4.  STANDARDIZE THE BENEFITS AVAILABLE THROUGH THE MARKETPLACE AT EACH
 LEVEL OF COVERAGE DEFINED BY THE SUPERINTENDENT IN THE INSURANCE LAW.
   5. MAINTAIN ENROLLMENT PERIODS IN THE BEST INTEREST OF QUALIFIED INDI-
 VIDUALS CONSISTENT WITH FEDERAL AND STATE LAW.
   6. IMPLEMENT PROCEDURES FOR  THE  CERTIFICATION,  RECERTIFICATION  AND
 DECERTIFICATION  OF  HEALTH  PLANS  AS  QUALIFIED HEALTH PLANS OR HEALTH
 PLANS APPROVED FOR SALE BY  THE  DEPARTMENT  OF  FINANCIAL  SERVICES  OR
 DEPARTMENT  OF  HEALTH AND CERTIFIED BY THE MARKETPLACE, CONSISTENT WITH
 GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C) OF THE
 FEDERAL ACT AND REQUIREMENTS DEVELOPED BY THE MARKETPLACE.
   7. CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO QUALIFIED  INDIVIDUALS
 THROUGH  THE  MARKETPLACE,  AND IN DOING SO SHALL SEEK TO PROVIDE HEALTH
 CARE COVERAGE CHOICES THAT OFFER  THE  OPTIMAL  COMBINATION  OF  CHOICE,
 VALUE, QUALITY, AND SERVICE.
   8. CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO CERTAIN ELIGIBLE INDI-
 VIDUALS  THROUGH  THE MARKETPLACE, PURSUANT TO HEALTH INSURANCE PROGRAMS
 AS DETERMINED BY THE COMMISSIONER, AND IN DOING SO SHALL SEEK TO PROVIDE
 HEALTH CARE COVERAGE CHOICES  THAT  OFFER  THE  OPTIMAL  COMBINATION  OF
 CHOICE, VALUE, QUALITY, AND SERVICE;

 S. 1507--A                         105                        A. 2007--A
 
   9.  PROVIDE  THE MINIMUM REQUIREMENTS AN INSURER SHALL MEET TO PARTIC-
 IPATE IN THE MARKETPLACE, IN THE BEST INTEREST OF QUALIFIED  INDIVIDUALS
 OR ELIGIBLE INDIVIDUALS;
   10. REQUIRE QUALIFIED HEALTH PLANS AND/OR OTHER HEALTH PLANS CERTIFIED
 BY  THE  MARKETPLACE  TO OFFER THOSE BENEFITS DETERMINED TO BE ESSENTIAL
 HEALTH BENEFITS PURSUANT TO STATE LAW OR AS REQUIRED BY THE MARKETPLACE.
   11. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE MARKETPLACE
 DO NOT CHARGE AN INDIVIDUAL ENROLLEE A FEE OR PENALTY FOR TERMINATION OF
 COVERAGE.
   12. PROVIDE FOR THE OPERATION OF  A  TOLL-FREE  TELEPHONE  HOTLINE  TO
 RESPOND TO REQUESTS FOR ASSISTANCE.
   13.  MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND PROSPEC-
 TIVE ENROLLEES OF QUALIFIED HEALTH PLANS AND HEALTH PLANS  CERTIFIED  BY
 THE  MARKETPLACE MAY OBTAIN STANDARDIZED COMPARATIVE INFORMATION ON SUCH
 PLANS AND INSURANCE AFFORDABILITY PROGRAMS.
   14. MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO  DETERMINE  THE
 ACTUAL  COST OF COVERAGE AFTER THE APPLICATION OF ANY PREMIUM TAX CREDIT
 UNDER SECTION 36B OF THE INTERNAL REVENUE CODE  OF  1986  OR  APPLICABLE
 STATE  LAW  AND  ANY  COST-SHARING REDUCTION UNDER FEDERAL OR APPLICABLE
 STATE LAW.
   15. OPERATE A PROGRAM UNDER WHICH THE  MARKETPLACE  AWARDS  GRANTS  TO
 ENTITIES  TO  SERVE  AS NAVIGATORS IN ACCORDANCE WITH APPLICABLE FEDERAL
 LAW AND REGULATIONS ADOPTED THEREUNDER, AND/OR A PROGRAM UNDER WHICH THE
 MARKETPLACE AWARDS GRANTS TO ENTITIES TO PROVIDE COMMUNITY BASED ENROLL-
 MENT ASSISTANCE IN ACCORDANCE WITH REQUIREMENTS DEVELOPED BY THE MARKET-
 PLACE; AND/OR A PROGRAM UNDER WHICH THE MARKETPLACE CERTIFIES  NEW  YORK
 STATE  LICENSED  PRODUCERS TO PROVIDE ASSISTANCE TO ELIGIBLE INDIVIDUALS
 AND/OR SMALL EMPLOYERS PURSUANT TO FEDERAL OR STATE LAW.
   16. IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAW, INFORM  INDI-
 VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE
 XIX  OF  THE  SOCIAL SECURITY ACT AND THE SOCIAL SERVICES LAW, THE CHIL-
 DREN'S HEALTH INSURANCE PROGRAM (CHIP) UNDER TITLE  XXI  OF  THE  SOCIAL
 SECURITY  ACT  AND  THIS CHAPTER, THE BASIC HEALTH PROGRAM UNDER SECTION
 THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW, OR ANY  APPLICA-
 BLE  STATE  OR  LOCAL  PUBLIC  HEALTH  INSURANCE PROGRAM AND IF, THROUGH
 SCREENING OF THE APPLICATION BY THE MARKETPLACE, THE MARKETPLACE  DETER-
 MINES  THAT  SUCH  INDIVIDUALS ARE ELIGIBLE FOR ANY SUCH PROGRAM, ENROLL
 SUCH INDIVIDUALS IN SUCH PROGRAM.
   17. GRANT A CERTIFICATION  THAT  AN  INDIVIDUAL  IS  EXEMPT  FROM  THE
 REQUIREMENT  TO  MAINTAIN MINIMUM ESSENTIAL COVERAGE PURSUANT TO FEDERAL
 OR STATE LAW  AND  FROM  ANY  PENALTIES  IMPOSED  BY  SUCH  REQUIREMENTS
 BECAUSE:
   (A) THERE IS NO AFFORDABLE HEALTH PLAN AVAILABLE COVERING THE INDIVID-
 UAL, AS DEFINED BY APPLICABLE LAW; OR
   (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
 FROM  THE  REQUIREMENT  TO MAINTAIN MINIMUM ESSENTIAL COVERAGE OR TO PAY
 THE PENALTY PURSUANT TO APPLICABLE FEDERAL OR STATE LAW.
   18. OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP")  PURSUANT
 TO  SECTION  1311  OF  THE FEDERAL ACT AND APPLICABLE STATE LAW, THROUGH
 WHICH ELIGIBLE SMALL EMPLOYERS MAY SELECT  MARKETPLACE-CERTIFIED  QUALI-
 FIED  HEALTH  PLANS OFFERED IN THE SMALL GROUP MARKET, AND THROUGH WHICH
 ELIGIBLE SMALL EMPLOYERS MAY RECEIVE ASSISTANCE IN QUALIFYING FOR  SMALL
 BUSINESS TAX CREDITS AVAILABLE PURSUANT TO FEDERAL AND STATE LAW.
   19. ENTER INTO AGREEMENTS AS NECESSARY WITH FEDERAL AND STATE AGENCIES
 AND  OTHER  STATE  MARKETPLACES  TO CARRY OUT ITS RESPONSIBILITIES UNDER
 THIS TITLE, PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE  PROTECTIONS  WITH

 S. 1507--A                         106                        A. 2007--A
 
 RESPECT  TO  THE  CONFIDENTIALITY  OF  ANY  INFORMATION TO BE SHARED AND
 COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS.
   20.  PERFORM  DUTIES  REQUIRED  BY THE SECRETARY, THE SECRETARY OF THE
 UNITED STATES DEPARTMENT OF THE TREASURY OR THE COMMISSIONER RELATED  TO
 DETERMINING  ELIGIBILITY FOR PREMIUM TAX CREDITS OR REDUCED COST-SHARING
 UNDER APPLICABLE FEDERAL OR STATE LAW.
   21. MEET PROGRAM INTEGRITY REQUIREMENTS UNDER APPLICABLE LAW,  INCLUD-
 ING  KEEPING  AN  ACCURATE  ACCOUNTING  OF RECEIPTS AND EXPENDITURES AND
 PROVIDING REPORTS TO THE SECRETARY REGARDING MARKETPLACE RELATED  ACTIV-
 ITIES IN ACCORDANCE WITH APPLICABLE LAW.
   22.  SUBMIT INFORMATION PROVIDED BY MARKETPLACE APPLICANTS FOR VERIFI-
 CATION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT AND  APPLICABLE
 STATE LAW.
   23.  ESTABLISH  RULES  AND  REGULATIONS  THAT  DO NOT CONFLICT WITH OR
 PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY THE SECRETARY.
   24. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE  OPPORTUNITIES
 FOR  APPEAL  AND  REDETERMINATION IN ACCORDANCE WITH THE REQUIREMENTS OF
 FEDERAL AND STATE LAW.
   § 268-D. SPECIAL FUNCTIONS OF THE MARKETPLACE RELATED TO  HEALTH  PLAN
 CERTIFICATION  AND  QUALIFIED  HEALTH  PLAN  OVERSIGHT.  1. HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE SHALL MEET THE FOLLOWING REQUIREMENTS:
   (A) THE INSURER OFFERING THE HEALTH PLAN:
   (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER, IN
 GOOD STANDING TO OFFER HEALTH INSURANCE  COVERAGE  IN  THIS  STATE,  AND
 MEETS THE REQUIREMENTS ESTABLISHED BY THE MARKETPLACE;
   (II)  OFFERS  AT LEAST ONE QUALIFIED HEALTH PLAN AND/OR OTHER OR ADDI-
 TIONAL HEALTH PLANS AUTHORIZED FOR SALE BY THE DEPARTMENT  OF  FINANCIAL
 SERVICES  OR  THE  DEPARTMENT  IN  EACH OF THE SILVER AND GOLD LEVELS AS
 REQUIRED BY STATE LAW,  PROVIDED,  HOWEVER,  THAT  THE  MARKETPLACE  MAY
 REQUIRE  ADDITIONAL BENEFIT LEVELS TO BE OFFERED BY ALL INSURERS PARTIC-
 IPATING IN THE MARKETPLACE;
   (III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT  OF
 ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
 LAW AND/OR THIS CHAPTER;
   (IV)  DOES  NOT  CHARGE  ANY CANCELLATION FEES OR PENALTIES FOR TERMI-
 NATION OF COVERAGE IN VIOLATION OF APPLICABLE LAW; AND
   (V) COMPLIES WITH THE REGULATIONS DEVELOPED  BY  THE  SECRETARY  UNDER
 SECTION  1311(C)  OF  THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE
 MARKETPLACE MAY ESTABLISH.
   (B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS  PACK-
 AGE  DESCRIBED  IN STATE LAW OR REQUIRED BY THE MARKETPLACE AND INCLUDES
 SUCH ADDITIONAL BENEFITS AS ARE MANDATED BY STATE LAW, EXCEPT  THAT  THE
 HEALTH  PLAN  SHALL  NOT  BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT
 DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF:
   (A) THE MARKETPLACE HAS DETERMINED THAT AT LEAST ONE QUALIFIED  DENTAL
 PLAN  OR DENTAL PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL SERVICES OR
 THE DEPARTMENT IS AVAILABLE TO SUPPLEMENT THE  HEALTH  PLAN'S  COVERAGE;
 AND
   (B)  THE  INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
 HEALTH PLAN, IN A FORM APPROVED BY THE MARKETPLACE, THAT THE  PLAN  DOES
 NOT  PROVIDE  THE  FULL  RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT
 QUALIFIED DENTAL PLANS OR DENTAL PLANS APPROVED  BY  THE  DEPARTMENT  OF
 FINANCIAL  SERVICES OR DEPARTMENT OF HEALTH PROVIDING THOSE BENEFITS AND
 OTHER DENTAL BENEFITS NOT COVERED BY THE PLAN ARE  OFFERED  THROUGH  THE
 MARKETPLACE;

 S. 1507--A                         107                        A. 2007--A
 
   (II)  PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE AS DEFINED BY STATE
 LAW, UNLESS THE PLAN IS CERTIFIED AS A QUALIFIED CATASTROPHIC  PLAN,  AS
 DEFINED IN SECTION 1302(E) OF THE FEDERAL ACT AND THE INSURANCE LAW, AND
 SHALL ONLY BE OFFERED TO INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE;
   (III)  HAS  COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
 NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF  THE  FEDERAL
 ACT, STATE LAW AND ANY REQUIREMENTS OF THE MARKETPLACE;
   (IV)  COMPLIES  WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT
 TO SECTION 1311(C) OF THE FEDERAL ACT AND APPLICABLE  STATE  LAW,  WHICH
 INCLUDE  MINIMUM  STANDARDS IN THE AREAS OF MARKETING PRACTICES, NETWORK
 ADEQUACY, ESSENTIAL COMMUNITY PROVIDERS IN UNDERSERVED  AREAS,  ACCREDI-
 TATION,  QUALITY  IMPROVEMENT, UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS
 OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH BENEFIT  PLAN
 PERFORMANCE;
   (V)  MEETS  STANDARDS  SPECIFIED  AND  DETERMINED  BY THE MARKETPLACE,
 PROVIDED THAT THE STANDARDS DO NOT CONFLICT WITH OR PREVENT THE APPLICA-
 TION OF FEDERAL REQUIREMENTS; AND
   (VI) COMPLIES WITH THE INSURANCE LAW  AND  THIS  CHAPTER  REQUIREMENTS
 APPLICABLE  TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGULATIONS
 PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH  OR  PREVENT  THE
 APPLICATION OF FEDERAL REQUIREMENTS; AND
   (C)  THE  MARKETPLACE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE
 THROUGH THE MARKETPLACE IS IN THE INTEREST OF QUALIFIED  INDIVIDUALS  IN
 THIS STATE.
   2. THE MARKETPLACE SHALL NOT EXCLUDE A HEALTH PLAN:
   (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
   (B)  THROUGH  THE  IMPOSITION OF PREMIUM PRICE CONTROLS BY THE MARKET-
 PLACE; OR
   (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
 PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE MARKETPLACE DETERMINES ARE
 INAPPROPRIATE OR TOO COSTLY.
   3. THE MARKETPLACE SHALL REQUIRE EACH  INSURER  CERTIFIED  OR  SEEKING
 CERTIFICATION  OF  A  HEALTH  PLAN  AS  A  QUALIFIED HEALTH PLAN OR PLAN
 APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL SERVICES OR THE DEPART-
 MENT TO:
   (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE PURSUANT TO APPLI-
 CABLE LAW PRIOR TO IMPLEMENTATION OF SUCH INCREASE.  THE  INSURER  SHALL
 PROMINENTLY  POST  THE  INFORMATION  ON ITS INTERNET WEBSITE.  SUCH RATE
 INCREASES SHALL BE SUBJECT TO THE PRIOR APPROVAL OF  THE  SUPERINTENDENT
 PURSUANT TO THE INSURANCE LAW;
   (B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE MARKETPLACE, THE
 SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
   (A) CLAIMS PAYMENT POLICIES AND PRACTICES;
   (B) PERIODIC FINANCIAL DISCLOSURES;
   (C) DATA ON ENROLLMENT AND DISENROLLMENT;
   (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
   (E) DATA ON RATING PRACTICES;
   (F)  INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT-
 OF-NETWORK COVERAGE;
   (G) INFORMATION ON ENROLLEE AND PARTICIPANT RIGHTS UNDER  TITLE  I  OF
 THE FEDERAL ACT; AND
   (H)  OTHER  INFORMATION  AS DETERMINED APPROPRIATE BY THE SECRETARY OR
 OTHERWISE REQUIRED BY THE MARKETPLACE;
   (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM
 IS DEFINED IN SECTION 1311(E)(3)(B) OF THE FEDERAL ACT  AND  STATE  LAW,

 S. 1507--A                         108                        A. 2007--A
 
 AND  IN  GUIDANCE  JOINTLY  ISSUED  THEREUNDER  BY THE SECRETARY AND THE
 FEDERAL SECRETARY OF LABOR; AND
   (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
 INDIVIDUAL,  THE  AMOUNT  OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY-
 MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN  OR  COVERAGE
 THAT  THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE
 FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
 A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE  TO  THE  INDIVIDUAL
 THROUGH  AN  INTERNET  WEBSITE  AND  THROUGH OTHER MEANS FOR INDIVIDUALS
 WITHOUT ACCESS TO THE INTERNET.
   4. THE MARKETPLACE SHALL NOT EXEMPT ANY INSURER SEEKING  CERTIFICATION
 OF  A  HEALTH  PLAN, REGARDLESS OF THE TYPE OR SIZE OF THE INSURER, FROM
 LICENSING OR SOLVENCY REQUIREMENTS UNDER THE INSURANCE LAW OR THIS CHAP-
 TER, AND SHALL APPLY THE CRITERIA OF  THIS  SECTION  IN  A  MANNER  THAT
 ENSURES  A LEVEL PLAYING FIELD FOR INSURERS PARTICIPATING IN THE MARKET-
 PLACE.
   5. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO  QUALIFIED  HEALTH
 PLANS  AND  PLANS  APPROVED  FOR  SALE  BY  THE  DEPARTMENT OF FINANCIAL
 SERVICES AND THE DEPARTMENT ALSO SHALL APPLY TO THE EXTENT  RELEVANT  TO
 QUALIFIED  DENTAL PLANS APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT, EXCEPT AS MODIFIED IN  ACCORDANCE  WITH  THE
 PROVISIONS  OF  PARAGRAPHS  (B) AND (C) OF THIS SUBDIVISION OR OTHERWISE
 REQUIRED BY THE MARKETPLACE.
   (B) THE QUALIFIED DENTAL PLAN OR DENTAL PLAN APPROVED FOR SALE BY  THE
 DEPARTMENT  OF FINANCIAL SERVICES AND/OR THE DEPARTMENT SHALL BE LIMITED
 TO DENTAL AND ORAL HEALTH BENEFITS,  WITHOUT  SUBSTANTIALLY  DUPLICATING
 THE  BENEFITS  TYPICALLY  OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL
 COVERAGE, AND SHALL INCLUDE,  AT  A  MINIMUM,  THE  ESSENTIAL  PEDIATRIC
 DENTAL   BENEFITS  PRESCRIBED  BY  THE  SECRETARY  PURSUANT  TO  SECTION
 1302(B)(1)(J) OF THE FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS  THE
 MARKETPLACE OR SECRETARY MAY SPECIFY IN REGULATIONS.
   (C)  INSURERS  MAY  JOINTLY  OFFER  A  COMPREHENSIVE  PLAN THROUGH THE
 MARKETPLACE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS  THROUGH  A
 QUALIFIED  DENTAL  PLAN  OR PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT AND AN INSURER PROVIDES  THE  OTHER  BENEFITS
 THROUGH  A  QUALIFIED  HEALTH  PLAN,  PROVIDED THAT THE PLANS ARE PRICED
 SEPARATELY AND ALSO ARE MADE AVAILABLE FOR PURCHASE  SEPARATELY  AT  THE
 SAME PRICE.
   §  268-E.  APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW. 1. ANY APPLI-
 CANT OR ENROLLEE, OR ANY INDIVIDUAL AUTHORIZED TO ACT ON BEHALF  OF  ANY
 SUCH  APPLICANT  OR ENROLLEE, MAY APPEAL TO THE DEPARTMENT FROM DETERMI-
 NATIONS OF DEPARTMENT OFFICIALS OR FAILURES TO MAKE DETERMINATIONS  UPON
 GROUNDS  SPECIFIED  IN  SUBDIVISION FOUR OF THIS SECTION. THE DEPARTMENT
 MUST REVIEW THE APPEAL DE NOVO AND GIVE SUCH PERSON AN  OPPORTUNITY  FOR
 AN  APPEAL HEARING.   THE DEPARTMENT MAY ALSO, ON ITS OWN MOTION, REVIEW
 ANY DECISION MADE OR ANY CASE IN WHICH A DECISION HAS NOT BEEN  MADE  BY
 THE  MARKETPLACE OR A SOCIAL SERVICES OFFICIAL WITHIN THE TIME SPECIFIED
 BY LAW OR REGULATIONS OF THE DEPARTMENT. THE DEPARTMENT  MAY  MAKE  SUCH
 ADDITIONAL  INVESTIGATION AS IT MAY DEEM NECESSARY, AND THE COMMISSIONER
 MUST MAKE SUCH DETERMINATION AS IS  JUSTIFIED  AND  IN  ACCORDANCE  WITH
 APPLICABLE LAW.
   2.  REGARDING  ANY APPEAL PURSUANT TO THIS SECTION, WITH OR WITHOUT AN
 APPEAL HEARING, THE COMMISSIONER MAY DESIGNATE AND AUTHORIZE ONE OR MORE
 APPROPRIATE MEMBERS OF HIS STAFF TO CONSIDER AND  DECIDE  SUCH  APPEALS.
 ANY  STAFF  MEMBER  SO  DESIGNATED AND AUTHORIZED WILL HAVE AUTHORITY TO
 DECIDE SUCH APPEALS ON BEHALF OF THE COMMISSIONER WITH  THE  SAME  FORCE

 S. 1507--A                         109                        A. 2007--A
 
 AND  EFFECT  AS IF THE COMMISSIONER HAD MADE THE DECISIONS. APPEAL HEAR-
 INGS MUST BE HELD ON BEHALF OF THE COMMISSIONER BY MEMBERS OF HIS  STAFF
 WHO  ARE  EMPLOYED  FOR  SUCH  PURPOSES  OR WHO HAVE BEEN DESIGNATED AND
 AUTHORIZED BY THE COMMISSIONER.
   3.  PERSONS  ENTITLED  TO  APPEAL  TO  THE DEPARTMENT PURSUANT TO THIS
 SECTION MUST INCLUDE:
   (A) APPLICANTS FOR OR ENROLLEES IN  INSURANCE  AFFORDABILITY  PROGRAMS
 AND QUALIFIED HEALTH PLANS; AND
   (B)  OTHER PERSONS ENTITLED TO AN OPPORTUNITY FOR AN APPEAL HEARING AS
 DIRECTED BY THE COMMISSIONER.
   4. AN APPLICANT OR ENROLLEE HAS THE  RIGHT  TO  APPEAL  AT  LEAST  THE
 FOLLOWING ISSUES:
   (A)  AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH THIS ARTICLE
 AND APPLICABLE LAW, INCLUDING:
   (I) AN INITIAL DETERMINATION OF ELIGIBILITY, INCLUDING:
   (A) ELIGIBILITY TO ENROLL IN A QUALIFIED HEALTH PLAN;
   (B) ELIGIBILITY FOR MEDICAID;
   (C) ELIGIBILITY FOR CHILD HEALTH PLUS;
   (D) ELIGIBILITY FOR THE BASIC HEALTH PROGRAM;
   (E) THE AMOUNT OF ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND LEVEL
 OF COST-SHARING REDUCTIONS;
   (F) THE AMOUNT OF ANY OTHER SUBSIDY THAT MAY BE AVAILABLE  UNDER  LAW;
 AND
   (G) ELIGIBILITY FOR SUCH OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED
 BY THE COMMISSIONER; AND
   (II)  A  RE-DETERMINATION  OF  ELIGIBILITY  OF THE PROGRAMS UNDER THIS
 SUBDIVISION.
   (B) AN ELIGIBILITY DETERMINATION FOR AN EXEMPTION FOR ANY  MANDATE  TO
 PURCHASE HEALTH INSURANCE.
   (C)  A  FAILURE BY NY STATE OF HEALTH TO PROVIDE TIMELY WRITTEN NOTICE
 OF AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH APPLICABLE LAW.
   5. THE DEPARTMENT MAY, SUBJECT TO THE DISCRETION OF THE  COMMISSIONER,
 PROMULGATE  SUCH  REGULATIONS,  CONSISTENT WITH FEDERAL OR STATE LAW, AS
 MAY BE NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
   6. REGARDING EVERY DECISION OF AN APPEAL PURSUANT TO THIS SECTION, THE
 DEPARTMENT MUST INFORM EVERY PARTY, AND HIS OR  HER  REPRESENTATIVE,  IF
 ANY,  OF  THE AVAILABILITY OF JUDICIAL REVIEW AND THE TIME LIMITATION TO
 PURSUE FUTURE REVIEW.
   7. APPLICANTS AND ENROLLEES OF QUALIFIED HEALTH PLANS, WITH OR WITHOUT
 ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND COST-SHARING  REDUCTIONS,
 ALSO  HAVE THE RIGHT TO APPEAL TO THE UNITED STATES DEPARTMENT OF HEALTH
 AND HUMAN SERVICES APPEAL ENTITY:
   (A) APPEALS DECISIONS ISSUED BY NY STATE OF HEALTH UPON THE EXHAUSTION
 OF THE NY STATE OF HEALTH APPEALS PROCESS; AND
   (B) A DENIAL OF A REQUEST TO VACATE A DISMISSAL MADE BY THE  NY  STATE
 OF HEALTH APPEALS ENTITY.
   8.  THE  DEPARTMENT  MUST  INCLUDE  NOTICE  OF  THE RIGHT TO APPEAL AS
 PROVIDED BY SUBDIVISION FOUR OF THIS SECTION AND INSTRUCTIONS  REGARDING
 HOW  TO  FILE  AN  APPEAL IN ANY ELIGIBILITY DETERMINATION ISSUED TO THE
 APPLICANT OR ENROLLEE IN ACCORDANCE WITH  APPLICABLE  LAW.  SUCH  NOTICE
 SHALL INCLUDE:
   (A) AN EXPLANATION OF THE APPLICANT OR ENROLLEE'S APPEAL RIGHTS;
   (B) A DESCRIPTION OF THE PROCEDURES BY WHICH THE APPLICANT OR ENROLLEE
 MAY REQUEST AN APPEAL;

 S. 1507--A                         110                        A. 2007--A
 
   (C)  INFORMATION  ON  THE  APPLICANT  OR ENROLLEE'S RIGHT TO REPRESENT
 HIMSELF OR HERSELF, OR TO BE REPRESENTED BY  LEGAL  COUNSEL  OR  ANOTHER
 REPRESENTATIVE;
   (D)  AN  EXPLANATION  OF THE CIRCUMSTANCES UNDER WHICH THE APPELLANT'S
 ELIGIBILITY MAY BE MAINTAINED OR REINSTATED PENDING AN APPEAL  DECISION;
 AND
   (E)  AN  EXPLANATION  THAT AN APPEAL DECISION FOR ONE HOUSEHOLD MEMBER
 MAY RESULT IN A CHANGE IN ELIGIBILITY FOR OTHER  HOUSEHOLD  MEMBERS  AND
 THAT  SUCH  A CHANGE WILL BE HANDLED AS A REDETERMINATION OF ELIGIBILITY
 FOR ALL HOUSEHOLD MEMBERS IN ACCORDANCE WITH THE STANDARDS SPECIFIED  IN
 APPLICABLE LAW.
   §  268-F.  MARKETPLACE  ADVISORY COMMITTEE. 1. THERE IS HEREBY CREATED
 THE MARKETPLACE ADVISORY COMMITTEE, WHICH SHALL CONSIDER AND ADVISE  THE
 DEPARTMENT  AND  COMMISSIONER  ON  MATTERS  CONCERNING  THE PROVISION OF
 HEALTH CARE COVERAGE THROUGH THE NY STATE OF HEALTH OR MARKETPLACE.
   2. THE MARKETPLACE ADVISORY COMMITTEE SHALL CONSIST OF UP  TO  TWENTY-
 EIGHT  MEMBERS  APPOINTED  BY  THE  COMMISSIONER, REPRESENTATIVE OF EACH
 GEOGRAPHIC AREA OF THE STATE AND INCLUDING:
   (A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT  MORE  THAN
 SIX FROM ANY SINGLE CATEGORY:
   (I) HEALTH PLAN CONSUMER ADVOCATES;
   (II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
   (III) HEALTH CARE PROVIDER REPRESENTATIVES;
   (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
   (B)  REPRESENTATIVES  FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
 TWO FROM EITHER CATEGORY:
   (I) LICENSED INSURANCE PRODUCERS; AND
   (II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
   3. THE MARKETPLACE SHALL SELECT THE CHAIR OF  THE  ADVISORY  COMMITTEE
 FROM  AMONG THE MEMBERS OF SUCH COMMITTEE AND SHALL DESIGNATE AN OFFICER
 OR EMPLOYEE OF THE DEPARTMENT TO ASSIST THE MARKETPLACE ADVISORY COMMIT-
 TEE IN THE PERFORMANCE OF ITS DUTIES UNDER THIS SECTION. THE MARKETPLACE
 SHALL ADOPT RULES FOR THE GOVERNANCE OF THE  ADVISORY  COMMITTEE,  WHICH
 SHALL  MEET  AS FREQUENTLY AS ITS BUSINESS MAY REQUIRE AND AT SUCH OTHER
 TIMES AS DETERMINED BY THE MARKETPLACE TO BE NECESSARY.
   4. MEMBERS OF THE ADVISORY COMMITTEE SHALL SERVE WITHOUT  COMPENSATION
 FOR  THEIR  SERVICES AS MEMBERS, BUT EACH SHALL BE ALLOWED THE NECESSARY
 AND ACTUAL EXPENSES INCURRED IN THE PERFORMANCE OF  HIS  OR  HER  DUTIES
 UNDER THIS SECTION.
   § 268-G. FUNDING OF THE MARKETPLACE. 1. THE MARKETPLACE SHALL BE FUND-
 ED BY STATE AND FEDERAL SOURCES AS AUTHORIZED BY APPLICABLE LAW, INCLUD-
 ING  BUT NOT LIMITED TO APPLICABLE LAW AUTHORIZING THE RESPECTIVE INSUR-
 ANCE AFFORDABILITY PROGRAMS AVAILABLE THROUGH THE MARKETPLACE.
   2. THE ACCOUNTS OF THE MARKETPLACE SHALL BE SUBJECT TO SUPERVISION  OF
 THE  COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS, EXPENDITURES,
 CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
 MARKETPLACE.
   3. NOTWITHSTANDING ANY LAW TO THE CONTRARY,  AND  IN  ACCORDANCE  WITH
 SECTION  FOUR  OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
 THE BUDGET, IN CONSULTATION WITH THE  COMMISSIONER,  THE  SUPERINTENDENT
 AND THE EXECUTIVE DIRECTOR OF THE MARKETPLACE, THE COMPTROLLER IS HEREBY
 AUTHORIZED  AND  DIRECTED  TO  SUB-ALLOCATE  OR TRANSFER SPECIAL REVENUE
 FEDERAL FUNDS APPROPRIATED TO THE DEPARTMENT FOR PLANNING AND IMPLEMENT-
 ING VARIOUS HEALTHCARE AND INSURANCE REFORM  INITIATIVES  AUTHORIZED  BY
 APPLICABLE  LAW.  MARKETPLACE MONEYS SUB-ALLOCATED OR TRANSFERRED PURSU-
 ANT TO THIS SECTION SHALL BE PAID OUT OF THE FUND UPON AUDIT AND WARRANT

 S. 1507--A                         111                        A. 2007--A
 
 OF THE STATE COMPTROLLER  ON  VOUCHERS  CERTIFIED  OR  APPROVED  BY  THE
 MARKETPLACE.
   § 268-H. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
 THE MARKETPLACE PURSUANT HERETO, SHALL BE CONSTRUED TO:
   1.  PREEMPT  OR  SUPERSEDE  THE AUTHORITY OF THE SUPERINTENDENT OR THE
 COMMISSIONER; OR
   2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
 THIS CHAPTER OR THE INSURANCE LAW AND ANY REGULATIONS PROMULGATED THERE-
 UNDER.
   § 3. Severability. If any provision of this article, or  the  applica-
 tion thereof to any person or circumstances is held invalid or unconsti-
 tutional,  that invalidity or unconstitutionality shall not affect other
 provisions or applications of this article  that  can  be  given  effect
 without the invalid or unconstitutional provision or application, and to
 this end the provisions and application of this article are severable.
   § 4. This act shall take effect immediately.
 
                                  PART U
 
   Section  1.  Section  203  of the elder law is amended by adding a new
 subdivision 12 to read as follows:
   12. THE DIRECTOR IS HEREBY AUTHORIZED TO IMPLEMENT PRIVATE PAY  PROTO-
 COLS FOR ALL PROGRAMS ADMINISTERED BY THE OFFICE. THESE PROTOCOLS MAY BE
 IMPLEMENTED BY AREA AGENCIES ON AGING AT THEIR OPTION AND SUCH PROTOCOLS
 MAY  NOT  BE APPLIED TO CLIENTS WHOSE SERVICES ARE PAID FOR WITH FEDERAL
 FUNDS OR  FUNDS  DESIGNATED  AS  FEDERAL  MATCH.  ALL  PRIVATE  PAYMENTS
 RECEIVED DIRECTLY BY AN AREA AGENCY ON AGING OR INDIRECTLY BY ONE OF ITS
 CONTRACTORS  SHALL  BE USED TO SUPPLEMENT, NOT SUPPLANT, FUNDS BY STATE,
 FEDERAL, OR COUNTY APPROPRIATIONS. PRIVATE PAY PAYMENTS  RECEIVED  UNDER
 THIS  SUBDIVISION  SHALL  BE USED BY THE AREA AGENCY ON AGING TO SUPPORT
 AND ENHANCE SERVICES OR PROGRAMS PROVIDED BY THE AREA AGENCY  ON  AGING.
 PARTICIPANT  PAYMENTS  UNDER  THIS  SUBDIVISION SHALL NOT BE REQUIRED OF
 INDIVIDUALS WITH INCOMES BELOW  FOUR  HUNDRED  PERCENT  OF  THE  FEDERAL
 POVERTY  LEVEL.  NO PARTICIPANT, REGARDLESS OF INCOME, SHALL BE REQUIRED
 TO PAY FOR ANY SERVICE THAT THEY ARE RECEIVING AT THE TIME THESE  PROTO-
 COLS ARE IMPLEMENTED BY THE AREA AGENCY ON AGING. THIS SUBDIVISION SHALL
 NOT  PREVENT  COST  SHARING  FOR  THE  PROGRAMS  ESTABLISHED PURSUANT TO
 SECTION TWO HUNDRED FOURTEEN OF THIS TITLE FOR  INDIVIDUALS  BELOW  FOUR
 HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL.
   § 2. This act shall take effect immediately.
 
                                  PART V
 
   Section  1.  Paragraph  (d)  of subdivision 32 of section 364-j of the
 social services law, as amended by section 15 of part B of chapter 59 of
 the laws of 2016, is amended to read as follows:
   (d) (I) Penalties under this subdivision may be applied to any and all
 circumstances described in paragraph (b) of this subdivision  until  the
 managed  care organization complies with the requirements for submission
 of encounter data.
   (II) No penalties for late, incomplete or  inaccurate  encounter  data
 shall  be  assessed  against  managed  care organizations in addition to
 those provided for in this subdivision, PROVIDED, HOWEVER, THAT  NOTHING
 IN  THIS  PARAGRAPH SHALL PROHIBIT THE IMPOSITION OF PENALTIES, IN CASES
 OF FRAUD OR ABUSE, OTHERWISE AUTHORIZED BY LAW.

 S. 1507--A                         112                        A. 2007--A

   § 2. Section 364-j of the social services law is amended by  adding  a
 new subdivision 34 read as follows:
   34.  ANY  PAYMENT  MADE  PURSUANT TO THE STATE'S MANAGED CARE PROGRAM,
 INCLUDING PAYMENTS MADE BY MANAGED LONG TERM CARE PLANS, SHALL BE DEEMED
 A PAYMENT BY THE STATE'S MEDICAL ASSISTANCE PROGRAM.
   § 3. Section 364-j of the social services law is amended by  adding  a
 new subdivision 36 to read as follows:
   36.  MEDICAID  PROGRAM  INTEGRITY  REVIEWS.  (A)  FOR PURPOSES OF THIS
 SUBDIVISION, MANAGED CARE PROVIDER SHALL ALSO INCLUDE MANAGED LONG  TERM
 CARE PLANS.
   (B)  THE  MEDICAID INSPECTOR GENERAL SHALL CONDUCT PERIODIC REVIEWS OF
 THE CONTRACTUAL PERFORMANCE OF EACH MANAGED CARE PROVIDER AS IT  RELATES
 TO  THE  MANAGED CARE PROVIDER'S PROGRAM INTEGRITY OBLIGATIONS UNDER ITS
 CONTRACT WITH THE DEPARTMENT. THE MEDICAID INSPECTOR GENERAL, IN CONSUL-
 TATION WITH THE COMMISSIONER, SHALL PUBLISH A LIST OF THOSE  CONTRACTUAL
 OBLIGATIONS  WHICH MAY BE SUBJECT TO REVIEW AND HOW THEY SHALL BE EVALU-
 ATED, INCLUDING BENCHMARKS, PRIOR TO COMMENCING ANY REVIEW.
   (C) IF, AS A RESULT OF HIS  OR  HER  REVIEW,  THE  MEDICAID  INSPECTOR
 GENERAL  DETERMINES  THAT  A  MANAGED  CARE  PROVIDER IS NOT MEETING ITS
 PROGRAM  INTEGRITY  OBLIGATIONS,  THE  MEDICAID  INSPECTOR  GENERAL  MAY
 RECOVER FROM THE MANAGED CARE PROVIDER UP TO TWO PERCENT OF THE MEDICAID
 PREMIUMS  PAID TO THE MANAGED CARE PROVIDER FOR THE PERIOD UNDER REVIEW.
 ANY PREMIUM RECOVERY UNDER THIS SUBDIVISION SHALL BE A PERCENTAGE OF THE
 ADMINISTRATIVE COMPONENT OF  THE  MEDICAID  PREMIUM  CALCULATED  BY  THE
 DEPARTMENT  AND MAY BE RECOVERED BY THE DEPARTMENT IN THE SAME MANNER IT
 RECOVERS OVERPAYMENTS.
   (D) THE MANAGED CARE PROVIDER SHALL BE ENTITLED  TO  RECEIVE  A  DRAFT
 AUDIT  REPORT AND FINAL AUDIT REPORT CONTAINING THE RESULTS OF THE MEDI-
 CAID INSPECTOR GENERAL'S  REVIEW.  IF  THE  MEDICAID  INSPECTOR  GENERAL
 DETERMINES  TO RECOVER A PERCENTAGE OF THE PREMIUM AS DESCRIBED IN PARA-
 GRAPH (C) OF THIS SUBDIVISION, THE MANAGED CARE PROVIDER SHALL  HAVE  AN
 OPPORTUNITY  TO  BE  HEARD IN ACCORDANCE WITH SECTION TWENTY-TWO OF THIS
 CHAPTER.
   § 4. Subdivision 3 of section 363-d of the  social  services  law,  as
 amended  by  section  44 of part C of chapter 58 of the laws of 2007, is
 amended to read as follows:
   3. Upon enrollment in the medical assistance program, a provider shall
 certify to the department that the  provider  satisfactorily  meets  the
 requirements  of  this section. Additionally, the commissioner of health
 and Medicaid inspector general shall have the authority to determine  at
 any  time  if  a  provider  has a compliance program that satisfactorily
 meets the requirements of this section.
   (a) A compliance program that is accepted by the federal department of
 health and human services office of inspector  general  and  remains  in
 compliance with the standards promulgated by such office shall be deemed
 in compliance with the provisions of this section, so long as such plans
 adequately  address medical assistance program risk areas and compliance
 issues.
   (b) A COMPLIANCE PROGRAM THAT MEETS FEDERAL REQUIREMENTS  FOR  MANAGED
 CARE  PROVIDER  COMPLIANCE  PROGRAMS,  AS  SPECIFIED  IN THE CONTRACT OR
 CONTRACTS BETWEEN THE DEPARTMENT AND THE MEDICAID MANAGED CARE  PROVIDER
 SHALL  BE  DEEMED  IN COMPLIANCE WITH THE PROVISIONS IN THIS SECTION, SO
 LONG AS SUCH PROGRAMS ADEQUATELY ADDRESS MEDICAL ASSISTANCE PROGRAM RISK
 AREAS AND COMPLIANCE ISSUES. FOR PURPOSES OF  THIS  SECTION,  A  MANAGED
 CARE  PROVIDER  IS  AS  DEFINED  IN  PARAGRAPH (C) OF SUBDIVISION ONE OF

 S. 1507--A                         113                        A. 2007--A
 
 SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS CHAPTER, AND INCLUDES MANAGED
 LONG TERM CARE PLANS.
   (C)  In  the  event  that  the  commissioner of health or the Medicaid
 inspector general finds that the provider does not have  a  satisfactory
 program  within  ninety days after the effective date of the regulations
 issued pursuant to subdivision four of this section, the provider may be
 subject to any sanctions or penalties permitted by federal or state laws
 and regulations, including revocation of  the  provider's  agreement  to
 participate in the medical assistance program.
   §  5. Section 3613 of the public health law is amended by adding a new
 subdivision 1-a to read as follows:
   1-A. EACH  HOME  CARE  SERVICES  WORKER  SHALL  OBTAIN  AN  INDIVIDUAL
 NATIONAL  PROVIDER  IDENTIFIER  (NPI)  NUMBER FROM THE NATIONAL PROVIDER
 PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES).
   § 6. Section 364-j of the social services law is amended by  adding  a
 new subdivision 35 to read as follows:
   35.  RECOVERY  OF  OVERPAYMENTS  FROM NETWORK PROVIDERS. (A) WHERE THE
 MEDICAID INSPECTOR GENERAL DURING THE COURSE OF AN AUDIT, INVESTIGATION,
 OR REVIEW, OR THE DEPUTY ATTORNEY GENERAL FOR THE MEDICAID FRAUD CONTROL
 UNIT DURING THE COURSE OF AN INVESTIGATION OR PROSECUTION  FOR  MEDICAID
 FRAUD, IDENTIFIES MEDICAL ASSISTANCE OVERPAYMENTS MADE BY A MANAGED CARE
 PROVIDER  OR MANAGED LONG TERM CARE PLAN TO ITS SUBCONTRACTOR OR SUBCON-
 TRACTORS OR PROVIDER OR PROVIDERS, THE STATE SHALL  HAVE  THE  RIGHT  TO
 RECOVER  THE  OVERPAYMENT  FROM  THE  SUBCONTRACTOR  OR  SUBCONTRACTORS,
 PROVIDER OR PROVIDERS, OR THE MANAGED CARE PROVIDER OR MANAGED LONG TERM
 CARE PLAN.
   (B) WHERE THE STATE IS UNSUCCESSFUL IN RECOVERING AN OVERPAYMENT  FROM
 THE  SUBCONTRACTOR OR SUBCONTRACTORS OR PROVIDER OR PROVIDERS, THE MEDI-
 CAID INSPECTOR GENERAL MAY REQUIRE THE MANAGED CARE PROVIDER OR  MANAGED
 LONG  TERM CARE PLAN TO RECOVER THE MEDICAL ASSISTANCE OVERPAYMENT IDEN-
 TIFIED IN PARAGRAPH (A) OF THIS SUBDIVISION ON BEHALF OF THE STATE.  THE
 MANAGED  CARE PROVIDER OR MANAGED LONG TERM CARE PLAN SHALL REMIT TO THE
 STATE THE FULL AMOUNT OF THE IDENTIFIED OVERPAYMENT NO  LATER  THAN  SIX
 MONTHS AFTER RECEIVING NOTICE OF THE OVERPAYMENT FROM THE STATE.
   §  7.  This act shall take effect immediately; provided, however, that
 the amendments to section 364-j of  the  social  services  law  made  by
 sections  one,  two,  three,  and  six  of this act shall not affect the
 repeal of such section and shall be deemed repealed therewith;  provided
 further,  that  section  three  of this act shall apply to a contract or
 contracts in effect as of January 1,  2015  and  any  review  period  in
 section three of this act shall not begin before January 1, 2018.
 
                                  PART W
 
   Section  1.  Section  1  of  part D of chapter 111 of the laws of 2010
 relating to the recovery of exempt income by the office of mental health
 for community residences and family-based treatment programs, as amended
 by section 1 of part H of chapter 59 of the laws of 2016, is amended  to
 read as follows:
   Section  1. The office of mental health is authorized to recover fund-
 ing from  community  residences  and  family-based  treatment  providers
 licensed  by  the  office  of mental health, consistent with contractual
 obligations of such providers, and notwithstanding any other  inconsist-
 ent  provision  of law to the contrary, in an amount equal to 50 percent
 of the income received by such providers which exceeds the fixed  amount
 of  annual  Medicaid  revenue limitations, as established by the commis-

 S. 1507--A                         114                        A. 2007--A
 
 sioner of mental health. Recovery of such excess income shall be for the
 following fiscal periods: for programs in counties  located  outside  of
 the  city of New York, the applicable fiscal periods shall be January 1,
 2003  through December 31, 2009 and January 1, 2011 through December 31,
 [2019] 2022; and for programs located within the city of New  York,  the
 applicable  fiscal  periods  shall be July 1, 2003 through June 30, 2010
 and July 1, 2011 through June 30, [2019] 2022.
   § 2. This act shall take effect immediately.
 
                                  PART X
 
   Section 1. Subdivision 9 of section 730.10 of the  criminal  procedure
 law,  as added by section 1 of part Q of chapter 56 of the laws of 2012,
 is amended to read as follows:
   9. "Appropriate institution" means: (a) a  hospital  operated  by  the
 office of mental health or a developmental center operated by the office
 for people with developmental disabilities; [or] (b) a hospital licensed
 by  the  department of health which operates a psychiatric unit licensed
 by the office of  mental  health,  as  determined  by  the  commissioner
 provided,  however,  that  any such hospital that is not operated by the
 state shall qualify as an "appropriate institution" only pursuant to the
 terms of an agreement between the commissioner and the hospital; OR  (C)
 A  MENTAL  HEALTH  UNIT  OPERATING  WITHIN A LOCAL CORRECTIONAL FACILITY
 EXCEPT THOSE LOCATED WITHIN A CITY WITH A POPULATION OF ONE  MILLION  OR
 MORE; PROVIDED HOWEVER, THAT ANY SUCH MENTAL HEALTH UNIT OPERATING WITH-
 IN A LOCAL CORRECTIONAL FACILITY SHALL QUALIFY AS AN "APPROPRIATE INSTI-
 TUTION"  ONLY  PURSUANT TO THE TERMS OF AN AGREEMENT BETWEEN THE COMMIS-
 SIONER OF MENTAL HEALTH, DIRECTOR OF COMMUNITY SERVICES AND THE  SHERIFF
 FOR THE RESPECTIVE LOCALITY.  Nothing in this article shall be construed
 as  requiring  a  hospital  OR LOCAL CORRECTIONAL FACILITY to consent to
 providing care and treatment to an incapacitated person at such hospital
 OR LOCAL CORRECTIONAL FACILITY. THE COMMISSIONER OF MENTAL HEALTH  SHALL
 PROMULGATE  REGULATIONS  FOR  DEMONSTRATION PROGRAMS AT NO MORE THAN TWO
 COUNTIES TO IMPLEMENT RESTORATION TO COMPETENCY WITHIN A  LOCAL  CORREC-
 TIONAL  FACILITY.  SUBJECT  TO ANNUAL APPROPRIATION, THE COMMISSIONER OF
 MENTAL HEALTH MAY, AT SUCH COMMISSIONER'S DISCRETION, MAKE FUNDS  AVAIL-
 ABLE  FOR  STATE  AID  GRANTS TO ANY COUNTY THAT DEVELOPS AND OPERATES A
 MENTAL HEALTH UNIT WITHIN A LOCAL CORRECTIONAL FACILITY PURSUANT TO THIS
 SECTION. NOTHING IN THIS ARTICLE  SHALL  BE  CONSTRUED  AS  REQUIRING  A
 HOSPITAL OR LOCAL CORRECTIONAL FACILITY TO CONSENT TO PROVIDING CARE AND
 TREATMENT  TO  AN INCAPACITATED PERSON AT SUCH HOSPITAL OR LOCAL CORREC-
 TIONAL FACILITY.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however,  that  this  act  shall expire and be deemed repealed March 31,
 2024; effective immediately, the addition, amendment  and/or  repeal  of
 any  rule  or regulation necessary for the implementation of this act on
 its effective date are authorized to be made and completed on or  before
 such effective date.
 
                                  PART Y
 
   Section  1. Subdivisions 3-b and 3-c of section 1 of part C of chapter
 57 of the laws of 2006,  relating  to  establishing  a  cost  of  living
 adjustment for designated human services programs, as amended by section

 S. 1507--A                         115                        A. 2007--A
 
 1  of  part AA of chapter 57 of the laws of 2018, are amended to read as
 follows:
   3-b.  Notwithstanding  any  inconsistent  provision  of law, beginning
 April 1, 2009 and ending March 31, 2016 and beginning April 1, 2017  and
 ending March 31, [2019] 2020, the commissioners shall not include a COLA
 for  the  purpose  of  establishing  rates of payments, contracts or any
 other form of reimbursement[, provided that  the  commissioners  of  the
 office  for people with developmental disabilities, the office of mental
 health, and the office of alcoholism and substance abuse services  shall
 not include a COLA beginning April 1, 2017 and ending March 31, 2019].
   3-c.  Notwithstanding  any  inconsistent  provision  of law, beginning
 April 1, [2019] 2020 and ending March 31, [2022] 2023, the commissioners
 shall develop the COLA under this section using the actual U.S. consumer
 price index for all urban consumers  (CPI-U)  published  by  the  United
 States  department  of  labor, bureau of labor statistics for the twelve
 month period ending in July of the  budget  year  prior  to  such  state
 fiscal  year,  for  the  purpose  of  establishing  rates  of  payments,
 contracts or any other form of reimbursement.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that the amendments to section 1 of part C of chapter 57 of the
 laws of 2006 made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith.

                                  PART Z
 
   Section  1. Subdivision 1 of section 2801 of the public health law, as
 amended by section 1 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follows:
   1. "Hospital" means a facility or institution engaged  principally  in
 providing services by or under the supervision of a physician or, in the
 case  of  a dental clinic or dental dispensary, of a dentist, or, in the
 case of a midwifery birth center, of  a  midwife,  for  the  prevention,
 diagnosis  or  treatment  of  human  disease, pain, injury, deformity or
 physical condition, including, but not limited to, a  general  hospital,
 public  health center, diagnostic center, treatment center, dental clin-
 ic, dental dispensary, rehabilitation center other than a facility  used
 solely  for vocational rehabilitation, nursing home, tuberculosis hospi-
 tal, chronic  disease  hospital,  maternity  hospital,  midwifery  birth
 center,  lying-in-asylum,  out-patient  department,  out-patient  lodge,
 dispensary and a laboratory or central service facility serving  one  or
 more  such  institutions,  but  the  term  hospital shall not include an
 institution, sanitarium or other facility engaged principally in provid-
 ing services for the prevention, diagnosis or treatment of mental  disa-
 bility  and  which  is subject to the powers of visitation, examination,
 inspection and investigation of the department of mental hygiene  except
 for  those  distinct  parts  of  such  a facility which provide hospital
 service. The provisions of this article shall not apply to a facility or
 institution engaged principally in providing services by  or  under  the
 supervision of the bona fide members and adherents of a recognized reli-
 gious  organization  whose teachings include reliance on spiritual means
 through prayer alone for healing in the practice of the religion of such
 organization and where services are provided in  accordance  with  those
 teachings.  No  provision  of this article or any other provision of law
 shall be construed to: (a) limit  the  volume  of  mental  health  [or],
 substance  use  disorder  services  OR DEVELOPMENTAL DISABILITY SERVICES

 S. 1507--A                         116                        A. 2007--A
 
 that can be provided by a provider of  primary  care  services  licensed
 under  this  article  and  authorized  to provide integrated services in
 accordance with regulations issued by the commissioner  in  consultation
 with  the commissioner of the office of mental health [and], the commis-
 sioner of the office of alcoholism and substance abuse services AND  THE
 COMMISSIONER  OF  THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES,
 including regulations issued pursuant to subdivision  seven  of  section
 three hundred sixty-five-l of the social services law or part L of chap-
 ter fifty-six of the laws of two thousand twelve; (b) require a provider
 licensed  pursuant  to  article  thirty-one of the mental hygiene law or
 certified pursuant to ARTICLE  SIXTEEN  OR  article  thirty-two  of  the
 mental  hygiene  law to obtain an operating certificate from the depart-
 ment if such provider has been authorized to provide integrated services
 in accordance with regulations issued by the commissioner  in  consulta-
 tion  with  the  commissioner  of the office of mental health [and], the
 commissioner of the office of alcoholism and  substance  abuse  services
 AND  THE  COMMISSIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISA-
 BILITIES, including regulations issued pursuant to subdivision seven  of
 section  three hundred sixty-five-l of the social services law or part L
 of chapter fifty-six of the laws of two thousand twelve.
   § 2. Subdivision (f) of section 31.02 of the mental  hygiene  law,  as
 added  by  section 2 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follows:
   (f) No provision of this article or any other provision of  law  shall
 be  construed to require a provider licensed pursuant to article twenty-
 eight of the public health law or certified pursuant to ARTICLE  SIXTEEN
 OR article thirty-two of this chapter to obtain an operating certificate
 from the office of mental health if such provider has been authorized to
 provide integrated services in accordance with regulations issued by the
 commissioner  of  the  office  of mental health in consultation with the
 commissioner of the department of health [and], the commissioner of  the
 office  of  alcoholism and substance abuse services AND THE COMMISSIONER
 OF THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES,  including
 regulations  issued  pursuant  to  subdivision  seven  of  section three
 hundred sixty-five-l of the social services law or  part  L  of  chapter
 fifty-six of the laws of two thousand twelve.
   §  3.  Subdivision  (b) of section 32.05 of the mental hygiene law, as
 amended by section 3 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follow:
   (b) (i) Methadone, or such other controlled  substance  designated  by
 the  commissioner of health as appropriate for such use, may be adminis-
 tered to an addict, as defined in section thirty-three  hundred  two  of
 the  public  health  law, by individual physicians, groups of physicians
 and public or private medical facilities certified pursuant  to  article
 twenty-eight or thirty-three of the public health law as part of a chem-
 ical  dependence  program which has been issued an operating certificate
 by the commissioner pursuant to subdivision (b) of section 32.09 of this
 article, provided, however, that such administration  must  be  done  in
 accordance  with  all applicable federal and state laws and regulations.
 Individual physicians or groups of physicians who have obtained authori-
 zation from  the  federal  government  to  administer  buprenorphine  to
 addicts  may  do  so without obtaining an operating certificate from the
 commissioner. (ii) No provision of this article or any  other  provision
 of  law  shall  be  construed to require a provider licensed pursuant to
 article twenty-eight of the public health law or article  thirty-one  of
 this chapter to obtain an operating certificate from the office of alco-

 S. 1507--A                         117                        A. 2007--A
 
 holism and substance abuse services if such provider has been authorized
 to  provide integrated services in accordance with regulations issued by
 the commissioner of alcoholism and substance abuse services in consulta-
 tion  with  the  commissioner  of  the  department  of health [and], the
 commissioner of the office of mental health AND THE COMMISSIONER OF  THE
 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, including regulations
 issued  pursuant  to  subdivision  seven of section three hundred sixty-
 five-l of the social services law or part L of chapter fifty-six of  the
 laws of two thousand twelve.
   §  4.  Section  16.03 of the mental hygiene law is amended by adding a
 new subdivision (g) to read as follows:
   (G) NO PROVISION OF THIS ARTICLE OR ANY OTHER PROVISION OF  LAW  SHALL
 BE  CONSTRUED TO REQUIRE A PROVIDER LICENSED PURSUANT TO ARTICLE TWENTY-
 EIGHT OF THE PUBLIC HEALTH LAW OR CERTIFIED PURSUANT TO ARTICLE  THIRTY-
 ONE  OR  THIRTY-TWO  OF  THIS CHAPTER TO OBTAIN AN OPERATING CERTIFICATE
 FROM THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES  IF  SUCH
 PROVIDER  HAS  BEEN AUTHORIZED TO PROVIDE INTEGRATED SERVICES IN ACCORD-
 ANCE WITH REGULATIONS ISSUED BY  THE  COMMISSIONER  OF  THE  OFFICE  FOR
 PEOPLE WITH DEVELOPMENTAL DISABILITIES, IN CONSULTATION WITH THE COMMIS-
 SIONER OF THE DEPARTMENT OF HEALTH, THE COMMISSIONER AND THE COMMISSION-
 ER  OF  THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, INCLUDING
 REGULATIONS ISSUED  PURSUANT  TO  SUBDIVISION  SEVEN  OF  SECTION  THREE
 HUNDRED  SIXTY-FIVE-L  OF  THE  SOCIAL SERVICES LAW OR PART L OF CHAPTER
 FIFTY-SIX OF THE LAWS OF TWO THOUSAND TWELVE.
   § 5. This act shall take effect October 1,  2019;  provided,  however,
 that  the  commissioner of the department of health, the commissioner of
 the office of mental health, the commissioner of the office of  alcohol-
 ism and substance abuse services, and the commissioner of the office for
 people  with developmental disabilities are authorized to issue any rule
 or regulation necessary for the implementation of this act on or  before
 its effective date.
 
                                  PART AA
 
   Section 1. Paragraph (a) of subdivision 4 of section 488 of the social
 services  law,  as  amended by section 2 of part MM of chapter 58 of the
 laws of 2015, is amended to read as follows:
   (a) a facility or program in which services are provided and which  is
 operated,  licensed  or  certified  by  the office of mental health, the
 office for people with developmental disabilities or the office of alco-
 holism and substance  abuse  services,  including  but  not  limited  to
 psychiatric  centers,  [inpatient  psychiatric units of a general hospi-
 tal,] developmental centers,  intermediate  care  facilities,  community
 residences,  group  homes and family care homes, provided, however, that
 such term shall not include a secure treatment facility  as  defined  in
 section  10.03  of  the mental hygiene law, services defined in subpara-
 graph four of subdivision (a) of section 16.03  of  the  mental  hygiene
 law,  [or] services provided in programs or facilities that are operated
 by the office of mental health and located in state correctional facili-
 ties under the jurisdiction of the department of corrections and  commu-
 nity  supervision  OR  SERVICES  PROVIDED  IN  A  UNIT OF A HOSPITAL, AS
 DEFINED IN SUBDIVISION ONE OF SECTION TWENTY-EIGHT HUNDRED  ONE  OF  THE
 PUBLIC  HEALTH LAW THAT IS LICENSED OR CERTIFIED BY THE OFFICE OF MENTAL
 HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES;
   § 2. Paragraphs (c), (d) and (e) of subdivision 4 of  section  488  of
 the  social services law, as added by section 1 of part B of chapter 501

 S. 1507--A                         118                        A. 2007--A
 
 of the laws of 2012, paragraph (d) as amended by chapter 126 of the laws
 of 2014, and paragraph (e) as amended by chapter 83 of the laws of 2013,
 are amended to read as follows:
   (c)  adult  care  facilities, which shall mean adult homes or enriched
 housing programs licensed pursuant to article seven of this chapter: (i)
 (A) that have a licensed capacity of eighty or more  beds;  and  (B)  in
 which  at  least  twenty-five  percent of the residents are persons with
 serious mental illness as defined by subdivision  fifty-two  of  section
 1.03  of the mental hygiene law; (ii) but not including an adult home or
 enriched housing program  which  is  authorized  to  operate  fifty-five
 percent  or  more  of  its  total  licensed capacity of beds as assisted
 living program beds pursuant to section four hundred sixty-one-l of this
 chapter; OR
   (d) [any overnight, summer day and  traveling  summer  day  camps  for
 children  with  developmental  disabilities  as  defined  in regulations
 promulgated by the commissioner of health; or
   (e)] the New York state school for the blind and the  New  York  state
 school for the deaf, which operate pursuant to articles eighty-seven and
 eighty-eight of the education law; an institution for the instruction of
 the  deaf and the blind which has a residential component and is subject
 to the visitation of the commissioner of education pursuant  to  article
 eighty-five of the education law with respect to its day and residential
 components; special act school districts serving students with disabili-
 ties;  or  in-state  private  schools  which  have  been approved by the
 commissioner of education for special education  services  or  programs,
 and which have a residential program.
   §  3.  This  act  shall  take effect August 1, 2019 and shall apply to
 reports of abuse or neglect made on or after such date;  provided  that,
 any  reports of abuse or neglect reported to the justice center prior to
 the effective date of this act shall be completed by the justice center.
 
                                  PART BB
 
   Section 1. This part enacts into law major components  of  legislation
 which  are  necessary to effectuate provisions relating to mental health
 and  substance  use  disorder  treatment.    Each  component  is  wholly
 contained  within  a  Subpart  identified  as  Subparts A through E. The
 effective date for  each  particular  provision  contained  within  such
 Subpart  is set forth in the last section of such Subpart. Any provision
 in any section contained within a Subpart, including the effective  date
 of the Subpart, which makes a reference to a section "of this act", when
 used  in  connection  with that particular component, shall be deemed to
 mean and refer to the corresponding section of the Subpart in  which  it
 is  found.  Section  three of this Part sets forth the general effective
 date of this Part.
 
                                 SUBPART A
 
   Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
 ance law is amended to read as follows:
   (4) If a policy provides for reimbursement for psychiatric or  psycho-
 logical  services  or for diagnosis and treatment of mental[,nervous, or
 emotional disorders or ailments,] HEALTH CONDITIONS however  defined  in
 the  policy,  the  insured  shall  be entitled to reimbursement for such
 services, diagnosis or  treatment  whether  performed  by  a  physician,
 psychiatrist  [or],  a certified and registered psychologist, OR A NURSE

 S. 1507--A                         119                        A. 2007--A
 
 PRACTITIONER when the services rendered are within the lawful  scope  of
 their practice.
   §  2.  Subparagraph  (B)  of paragraph 25 of subsection (i) of section
 3216 of the insurance law, as amended by section 38 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B) Every policy that  provides  physician  services,  medical,  major
 medical  or  similar  comprehensive-type coverage shall provide coverage
 for the screening, diagnosis and treatment of autism  spectrum  disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered by the policy because the individual is  diagnosed  with  autism
 spectrum  disorder.  Such coverage may be subject to annual deductibles,
 copayments and coinsurance as may be deemed appropriate  by  the  super-
 intendent  and  shall be consistent with those imposed on other benefits
 under the policy. [Coverage  for  applied  behavior  analysis  shall  be
 subject  to  a  maximum benefit of six hundred eighty hours of treatment
 per policy or calendar year  per  covered  individual.]  This  paragraph
 shall  not  be  construed  as  limiting  the benefits that are otherwise
 available to an individual under the policy, provided however that  such
 policy  shall  not  contain  any  limitations  on visits that are solely
 applied to the treatment of autism spectrum disorder. No  insurer  shall
 terminate  coverage or refuse to deliver, execute, issue, amend, adjust,
 or renew coverage to an individual  solely  because  the  individual  is
 diagnosed  with  autism  spectrum disorder or has received treatment for
 autism spectrum disorder.  Coverage  shall  be  subject  to  utilization
 review  and external appeals of health care services pursuant to article
 forty-nine of this chapter as well as[,] case  management[,]  and  other
 managed care provisions.
   §  3.  Items  (i)  and  (iii)  of  subparagraph (C) of paragraph 25 of
 subsection (i) of section 3216 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant  to  the behavior analyst certification board] PERSON LICENSED,
 CERTIFIED OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED BEHAVIOR  ANALYSIS,
 that  are  necessary  to  develop,  maintain, or restore, to the maximum
 extent practicable, the functioning of an individual. [Individuals  that
 provide behavioral health treatment under the supervision of a certified
 behavior  analyst  pursuant to this paragraph shall be subject to stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations promulgated by the superintendent in consultation  with  the
 commissioners of health and education.]
   §  4.  Paragraph 25 of subsection (i) of section 3216 of the insurance
 law is amended by adding four new subparagraphs (H), (I), (J),  and  (K)
 to read as follows:
   (H)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE  RESTRICTIVE THAN THE PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED  BY THE POLICY.

 S. 1507--A                         120                        A. 2007--A
 
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT  TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE AVAIL-
 ABLE BY THE  INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR  IN-NETWORK
 PROVIDER UPON REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED ON MEDICAL  NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR  PROVIDER ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES;  METHODS FOR DETER-
 MINING USUAL, CUSTOMARY, AND REASONABLE CHARGES;  FAIL-FIRST  OR    STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.
   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  5.  Paragraph 30 of subsection (i) of section 3216 of the insurance
 law, as amended by section 1 of part B of chapter  71  of  the  laws  of
 2016, is amended to read as follows:
   (30)(A)  Every policy that provides hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  policy.  [Further,  such  coverage  shall  be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage  provided under this paragraph may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  CERTI-
 FIED  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence  treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (C) Coverage provided under this paragraph may be  subject  to  annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and  that  are  consistent with those imposed on other benefits within a
 given policy.

 S. 1507--A                         121                        A. 2007--A
 
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance  abuse  services  that are participating in the insurer's
 provider network. Coverage provided under this paragraph  shall  not  be
 subject  to  preauthorization.  Coverage  provided  under this paragraph
 shall also not be subject to concurrent utilization  review  during  the
 first  [fourteen]  TWENTY-ONE  days  of the inpatient admission provided
 that the facility notifies the insurer of both  the  admission  and  the
 initial  treatment  plan within [forty-eight hours] TWO BUSINESS DAYS of
 the admission. The facility shall perform daily clinical review  of  the
 patient,  including the periodic consultation with the insurer to ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism and substance abuse services and appropriate to  the  age  of
 the  patient, to ensure that the inpatient treatment is medically neces-
 sary for the patient. Any utilization review of treatment provided under
 this subparagraph may include a review of all services  provided  during
 such  inpatient  treatment,  including  all services provided during the
 first [fourteen] TWENTY-ONE days of such inpatient treatment.  Provided,
 however,  the  insurer  shall  only deny coverage for any portion of the
 initial [fourteen] TWENTY-ONE day inpatient treatment on the basis  that
 such  treatment  was not medically necessary if such inpatient treatment
 was contrary to the evidence-based and  peer  reviewed  clinical  review
 tool  utilized by the insurer which is designated by the office of alco-
 holism and substance abuse services.  An  insured  shall  not  have  any
 financial  obligation  to  the  facility  for  any  treatment under this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E) AN INSURER  SHALL  MAKE  AVAILABLE  TO  ANY  INSURED,  PROSPECTIVE
 INSURED,  OR IN-NETWORK PROVIDER, UPON REQUEST, THE CRITERIA FOR MEDICAL
 NECESSITY DETERMINATIONS UNDER THE  POLICY  WITH  RESPECT  TO  INPATIENT
 SUBSTANCE USE DISORDER BENEFITS.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE, SUCH AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.

 S. 1507--A                         122                        A. 2007--A
 
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  6.  Paragraph 31 of subsection (i) of section 3216 of the insurance
 law, as added by chapter 41 of the laws of 2014 and subparagraph (E)  as
 added  by  section  3  of  part MM of chapter 57 of the laws of 2018, is
 amended to read as follows:
   (31) (A) Every policy that provides medical, major medical or  similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication  and  rehabilitation  services.  Such  coverage shall not apply
 financial requirements or treatment limitations to outpatient  substance
 use  disorder  benefits  that  are more restrictive than the predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the policy.    [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B) Coverage under this paragraph may be limited to facilities in  New
 York state [certified] THAT ARE LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED  by  the  office  of  alcoholism  and  substance abuse services [or
 licensed by such office as outpatient clinics  or  medically  supervised
 ambulatory]  TO PROVIDE OUTPATIENT substance [abuse programs] USE DISOR-
 DER SERVICES and, in other states, to those which are accredited by  the
 joint  commission  as  alcoholism or chemical dependence substance abuse
 treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED,  OR  OTHERWISE
 AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (C)  Coverage  provided  under this paragraph may be subject to annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and that are consistent with those imposed on other  benefits  within  a
 given policy.
   (D)  A  policy  providing coverage for substance use disorder services
 pursuant to this paragraph shall provide up to twenty outpatient  visits
 per  policy  or  calendar  year  to  an individual who identifies him or
 herself as a family member of a  person  suffering  from  substance  use
 disorder  and  who  seeks  treatment as a family member who is otherwise
 covered by the applicable policy pursuant to this paragraph. The  cover-
 age  required  by  this  paragraph  shall  include treatment as a family
 member pursuant to such family member's own policy provided such  family
 member:
   (i)  does not exceed the allowable number of family visits provided by
 the applicable policy pursuant to this paragraph; and
   (ii) is otherwise entitled to coverage pursuant to this paragraph  and
 such family member's applicable policy.
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services for the provision of outpatient,  intensive
 outpatient,  outpatient  rehabilitation  and  opioid  treatment that are
 participating in the insurer's provider network. Coverage provided under
 this paragraph  shall  not  be  subject  to  preauthorization.  Coverage
 provided  under this paragraph shall not be subject to concurrent review
 for the first [two] THREE weeks of continuous treatment, not  to  exceed
 [fourteen] TWENTY-ONE visits, provided the facility notifies the insurer
 of  both  the  start  of treatment and the initial treatment plan within
 [forty-eight hours] TWO BUSINESS DAYS. The facility shall perform  clin-
 ical  assessment  of  the  patient at each visit, including the periodic

 S. 1507--A                         123                        A. 2007--A
 
 consultation with the insurer to ensure that the facility is  using  the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 insurer which is designated by the office of  alcoholism  and  substance
 abuse services and appropriate to the age of the patient, to ensure that
 the  outpatient  treatment  is  medically necessary for the patient. Any
 utilization review of the treatment provided under this subparagraph may
 include a review of all services provided during such outpatient  treat-
 ment, including all services provided during the first [two] THREE weeks
 of  continuous treatment, not to exceed [fourteen] TWENTY-ONE visits, of
 such outpatient treatment. Provided, however,  the  insurer  shall  only
 deny  coverage  for  any  portion  of  the  initial [two] THREE weeks of
 continuous treatment, not to exceed [fourteen]  TWENTY-ONE  visits,  for
 outpatient  treatment on the basis that such treatment was not medically
 necessary if such outpatient treatment was  contrary  to  the  evidence-
 based  and  peer  reviewed  clinical review tool utilized by the insurer
 which is designated by the office  of  alcoholism  and  substance  abuse
 services.  An  insured  shall  not  have any financial obligation to the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV) "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN  THE
 MOST  RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
 DISORDERS OR THE MOST RECENT EDITION  OF  ANOTHER  GENERALLY  RECOGNIZED
 INDEPENDENT  STANDARD  OF  CURRENT MEDICAL PRACTICE SUCH AS THE INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 7. Paragraph 31-a of subsection (i) of section 3216 of the insurance
 law, as added by section 1 of part B of chapter 69 of the laws of  2016,
 is amended to read as follows:
   (31-a)  [(A)]  Every  policy  that  provides medical, major medical or
 similar  comprehensive-type   coverage   and   provides   coverage   for
 prescription  drugs  for medication for the treatment of a substance use

 S. 1507--A                         124                        A. 2007--A
 
 disorder shall include immediate access, without prior authorization, to
 [a five day emergency supply] THE FORMULARY FORMS of prescribed  medica-
 tions covered under the policy for the treatment of substance use disor-
 der  [where  an emergency condition exists], including a prescribed drug
 or medication associated with the management of opioid withdrawal and/or
 stabilization, except where otherwise prohibited by law. Further, cover-
 age [of an emergency supply] WITHOUT PRIOR AUTHORIZATION  shall  include
 FORMULARY  FORMS  OF  medication  for opioid overdose reversal otherwise
 covered under the  policy  prescribed  OR  DISPENSED  to  an  individual
 covered by the policy.
   [(B)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in clause (i), (ii), or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (C) Coverage provided under this paragraph may be  subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty day supply of the same medication in the same thirty  day  period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the  initial  emergency  supply  of medication in an amount that is less
 than the copayment or coinsurance otherwise applicable to a  thirty  day
 supply of such medication, provided that the total sum of the copayments
 or  coinsurance  for  an entire thirty day supply of the medication does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   § 8. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 35 to read as follows:
   (35) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE
 THAT  PROVIDES  COVERAGE  FOR  INPATIENT  HOSPITAL  CARE OR COVERAGE FOR
 PHYSICIAN SERVICES SHALL PROVIDE COVERAGE FOR THE DIAGNOSIS  AND  TREAT-
 MENT OF MENTAL HEALTH CONDITIONS AS FOLLOWS:
   (I)  WHERE  THE  POLICY PROVIDES COVERAGE FOR INPATIENT HOSPITAL CARE,
 BENEFITS FOR INPATIENT CARE IN A HOSPITAL AS DEFINED BY SUBDIVISION  TEN
 OF  SECTION  1.03  OF THE MENTAL HYGIENE LAW AND BENEFITS FOR OUTPATIENT
 CARE PROVIDED IN A FACILITY  ISSUED  AN  OPERATING  CERTIFICATE  BY  THE
 COMMISSIONER  OF  MENTAL  HEALTH  PURSUANT  TO THE PROVISIONS OF ARTICLE
 THIRTY-ONE OF THE MENTAL HYGIENE LAW, OR IN A FACILITY OPERATED  BY  THE
 OFFICE OF MENTAL HEALTH, OR, FOR CARE PROVIDED IN OTHER STATES, TO SIMI-
 LARLY LICENSED OR CERTIFIED HOSPITALS OR FACILITIES; AND
   (II)  WHERE THE POLICY PROVIDES COVERAGE FOR PHYSICIAN SERVICES, BENE-
 FITS FOR OUTPATIENT CARE PROVIDED  BY  A  PSYCHIATRIST  OR  PSYCHOLOGIST
 LICENSED  TO  PRACTICE  IN THIS STATE, A LICENSED CLINICAL SOCIAL WORKER
 WHO MEETS THE REQUIREMENTS OF SUBPARAGRAPH  (D)  OF  PARAGRAPH  FOUR  OF

 S. 1507--A                         125                        A. 2007--A
 
 SUBSECTION  (1) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS
 ARTICLE, A NURSE PRACTITIONER LICENSED TO PRACTICE IN THIS STATE,  OR  A
 PROFESSIONAL  CORPORATION  OR  UNIVERSITY  FACULTY  PRACTICE CORPORATION
 THEREOF.
   (B)  COVERAGE  REQUIRED  BY  THIS  PARAGRAPH  MAY BE SUBJECT TO ANNUAL
 DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE DEEMED APPROPRIATE  BY
 THE  SUPERINTENDENT  AND SHALL BE CONSISTENT WITH THOSE IMPOSED ON OTHER
 BENEFITS UNDER THE POLICY.
   (C) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS  OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE MORE
 RESTRICTIVE THAN THE PREDOMINANT FINANCIAL  REQUIREMENTS  AND  TREATMENT
 LIMITATIONS  APPLIED  TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE  AVAILABLE  BY  THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS:  MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV) "MENTAL HEALTH CONDITION" MEANS ANY  MENTAL  HEALTH  DISORDER  AS
 DEFINED  IN  THE  MOST  RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL
 MANUAL OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER  GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G)  THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT ARE
 LICENSED BY THE OFFICE OF MENTAL HEALTH THAT ARE  PARTICIPATING  IN  THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
 TIENT  HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A HOSPITAL
 AS DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE  LAW
 PROVIDED  TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN SHALL
 NOT BE SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER  THIS  PARA-
 GRAPH  SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL  TREATMENT
 PLAN  WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY CLINICAL
 REVIEW OF THE PATIENT, AND PARTICIPATES IN  PERIODIC  CONSULTATION  WITH

 S. 1507--A                         126                        A. 2007--A

 THE  INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED AND
 PEER REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH  IS
 APPROVED  BY  THE  OFFICE OF MENTAL HEALTH AND APPROPRIATE TO THE AGE OF
 THE  PATIENT,  TO  ENSURE THAT THE INPATIENT CARE IS MEDICALLY NECESSARY
 FOR THE PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH  MAY  BE
 REVIEWED  RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY, AN
 INSURED SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR  ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   § 9. Paragraphs 17, 19 and 20 of subsection 2 of section 3217-a of the
 insurance law, paragraph 17 as amended and paragraphs 19 and 20 as added
 by  section  1  of part H of chapter 60 of the laws of 2014, are amended
 and a new paragraph 21 is added to read as follows:
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate document that is updated annually, of the name, address, and  tele-
 phone  number of all participating providers, including facilities, AND:
 (A) WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (B) IN THE  CASE  OF
 MENTAL  HEALTH  OR SUBSTANCE USE DISORDER SERVICES PROVIDERS, ANY AFFIL-
 IATIONS WITH PARTICIPATING FACILITIES CERTIFIED  OR  AUTHORIZED  BY  THE
 OFFICE  OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
 SERVICES, AND ANY RESTRICTIONS REGARDING THE AVAILABILITY OF  THE  INDI-
 VIDUAL PROVIDER'S SERVICES; and [in addition,] (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  insur-
 er's  website  and  the  insurer shall update the website within fifteen
 days of the addition or termination of a  provider  from  the  insurer's
 network or a change in a physician's hospital affiliation;
   (19) with respect to out-of-network coverage:
   (A)  a  clear  description  of  the methodology used by the insurer to
 determine reimbursement for out-of-network health care services;
   (B) the amount that the insurer will reimburse under  the  methodology
 for out-of-network health care services set forth as a percentage of the
 usual and customary cost for out-of-network health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (20) information in writing  and  through  an  internet  website  that
 reasonably  permits  an  insured  or prospective insured to estimate the
 anticipated out-of-pocket cost for out-of-network health  care  services
 in  a  geographical  area  or zip code based upon the difference between
 what the insurer will reimburse for out-of-network health care  services
 and  the  usual  and  customary  cost  for  out-of-network  health  care
 services[.]; AND
   (21) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE INSURER  TO
 ASSESS THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE PAUL
 WELLSTONE  AND  PETE  DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY
 ACT OF 2008, 42 U.S.C. 18031(J), AND  ANY  AMENDMENTS  TO,  AND  FEDERAL
 GUIDANCE OR REGULATIONS ISSUED UNDER THOSE ACTS.
   §  10. Subsection (b) of section 3217-b of the insurance law, as added
 by chapter 705 of the laws of 1996, is amended to read as follows:
   (b) No insurer subject to this  article  shall  by  contract,  written
 policy  [or],  written  procedure  OR  PRACTICE prohibit or restrict any
 health care provider  from  filing  a  complaint,  making  a  report  or
 commenting to an appropriate governmental body regarding the policies or
 practices  of  such  insurer  which the provider believes may negatively
 impact upon the quality of, or access to, patient care.   NOR  SHALL  AN
 INSURER  SUBJECT  TO THIS ARTICLE TAKE ANY ADVERSE ACTION, INCLUDING BUT

 S. 1507--A                         127                        A. 2007--A

 NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR AGREEMENT WITH
 A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVIDER FOR
 FILING A COMPLAINT, MAKING A REPORT  OR  COMMENTING  TO  AN  APPROPRIATE
 GOVERNMENTAL  BODY REGARDING POLICIES OR PRACTICES OF SUCH INSURER WHICH
 MAY VIOLATE THIS CHAPTER INCLUDING PARAGRAPHS THIRTY, AS ADDED BY  CHAP-
 TER  FORTY-ONE OF THE LAWS OF 2014, THIRTY-ONE, THIRTY-ONE-A AND THIRTY-
 FIVE OF SUBSECTION (I) OF SECTION THIRTY-TWO HUNDRED SIXTEEN  AND  PARA-
 GRAPHS  FIVE,  SIX,  SEVEN,  SEVEN-A  AND  SEVEN-B  OF SUBSECTION (L) OF
 SECTION THIRTY-TWO HUNDRED TWENTY-ONE OF THIS ARTICLE.
   § 11. Subparagraph (A) of paragraph 4 of  subsection  (l)  of  section
 3221  of  the  insurance  law,  as amended by chapter 230 of the laws of
 2004, is amended to read as follows:
   (A) Every insurer delivering a group policy or issuing a group  policy
 for  delivery,  in  this  state, [which] THAT provides reimbursement for
 psychiatric or psychological services or for the diagnosis and treatment
 of mental[, nervous or emotional disorders and ailments]  HEALTH  CONDI-
 TIONS,  however  defined in such policy, by physicians, psychiatrists or
 psychologists, [must] SHALL make available and if requested by the poli-
 cyholder provide the same coverage to insureds for  such  services  when
 performed  by a licensed clinical social worker, within the lawful scope
 of his or her practice, who is licensed pursuant to article one  hundred
 fifty-four  of  the education law. Written notice of the availability of
 such coverage shall be delivered to the policyholder prior to  inception
 of  such  group  policy and annually thereafter, except that this notice
 shall not be required where a policy covers two hundred or more  employ-
 ees  or  where  the  benefit  structure  was  the  subject of collective
 bargaining affecting persons who are employed in more than one state.
   § 12. Subparagraph (D) of paragraph 4 of  subsection  (l)  of  section
 3221 of the insurance law, as amended by section 50 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (D)  In addition to the requirements of subparagraph (A) of this para-
 graph, every insurer issuing a group policy for delivery in  this  state
 where  the  policy provides reimbursement to insureds for psychiatric or
 psychological services or for the diagnosis and  treatment  of  mental[,
 nervous  or emotional disorders and ailments] HEALTH CONDITIONS, however
 defined in such policy, by physicians, psychiatrists  or  psychologists,
 shall  provide  the  same  coverage  to  insureds for such services when
 performed by a licensed clinical social worker, within the lawful  scope
 of  his  or her practice, who is licensed pursuant to subdivision two of
 section seven thousand seven hundred four of the education  law  and  in
 addition  shall  have either: (i) three or more additional years experi-
 ence in psychotherapy, which for the purposes of this subparagraph shall
 mean the use of verbal methods in interpersonal relationships  with  the
 intent of assisting a person or persons to modify attitudes and behavior
 that  are  intellectually,  socially  or  emotionally maladaptive, under
 supervision, satisfactory to the state  board  for  social  work,  in  a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental
 department, providing services for diagnosis or  treatment  of  mental[,
 nervous  or  emotional  disorders  or  ailments] HEALTH CONDITIONS; (ii)
 three or more additional years experience  in  psychotherapy  under  the
 supervision,  satisfactory  to  the  state  board  for social work, of a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical social worker qualified for reimbursement  pursuant  to  subsection
 (e)  of this section, or (iii) a combination of the experience specified
 in items (i) and (ii) of this subparagraph totaling three years,  satis-
 factory to the state board for social work.

 S. 1507--A                         128                        A. 2007--A
 
   §  13.  Subparagraphs  (A) and (B) of paragraph 5 of subsection (l) of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, are amended to read as follows:
   (A) Every insurer delivering a group or school blanket policy or issu-
 ing  a group or school blanket policy for delivery, in this state, which
 provides coverage for inpatient hospital care or coverage for  physician
 services shall provide [as part of such policy broad-based] coverage for
 the  diagnosis  and treatment of mental[, nervous or emotional disorders
 or ailments, however defined in such  policy,  at  least  equal  to  the
 coverage provided for other] health conditions and:
   (i)  where  the  policy provides coverage for inpatient hospital care,
 benefits for inpatient care in a hospital as defined by subdivision  ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed  to  not  less  than  thirty days of active treatment in any contract
 year, plan year or calendar year,]  and  benefits  for  outpatient  care
 provided  in  a  facility issued an operating certificate by the commis-
 sioner of mental health pursuant to the provisions of article thirty-one
 of the mental hygiene law, or in a facility operated by  the  office  of
 mental  health[,  which  benefits may be limited to not less than twenty
 visits in any contract year, plan year or calendar  year.  Benefits  for
 partial  hospitalization program services shall be provided as an offset
 to covered inpatient days at a  ratio  of  two  partial  hospitalization
 visits  to  one  inpatient  day  of treatment.] OR, FOR CARE PROVIDED IN
 OTHER STATES, TO SIMILARLY LICENSED OR CERTIFIED  HOSPITALS  OR  FACILI-
 TIES; AND
   (ii)  where  the  policy  provides coverage for physician services, it
 shall include benefits for outpatient care provided by a psychiatrist or
 psychologist licensed to practice in this  state,  a  licensed  clinical
 social  worker  who  meets the requirements of subparagraph (D) of para-
 graph four of this subsection, A NURSE PRACTITIONER LICENSED TO PRACTICE
 IN THIS STATE, or a professional corporation or university faculty prac-
 tice corporation thereof. [Such benefits may be limited to not less than
 twenty visits in any contract year, plan year, or calendar year.]
   [(iii)] (B) Coverage required by this paragraph may be [provided on  a
 contract  year, plan year or calendar year basis and shall be consistent
 with the provision of other benefits under the policy. Such coverage may
 be] subject to annual deductibles, co-pays and  coinsurance  as  may  be
 deemed  appropriate  by  the superintendent and shall be consistent with
 those imposed on other benefits under the policy. [In the event  that  a
 policy  provides coverage for both inpatient hospital care and physician
 services, the aggregate of the benefits  for  outpatient  care  obtained
 under  this  paragraph  may be limited to not less than twenty visits in
 any contract year, plan year or calendar year.
   (iv) In this paragraph, "active treatment" means  treatment  furnished
 in  conjunction  with  inpatient  confinement  for  mental,  nervous  or
 emotional disorders or ailments that meet standards prescribed  pursuant
 to the regulations of the commissioner of mental health.
   (B)  (i)  Every insurer delivering a group or school blanket policy or
 issuing a group or school blanket policy for delivery,  in  this  state,
 which  provides  coverage  for  inpatient  hospital care or coverage for
 physician services, shall provide comparable  coverage  for  adults  and
 children  with  biologically  based  mental illness. Such group policies
 issued or delivered in this state shall  also  provide  such  comparable
 coverage for children with serious emotional disturbances. Such coverage
 shall  be  provided  under the terms and conditions otherwise applicable
 under the policy, including network limitations  or  variations,  exclu-

 S. 1507--A                         129                        A. 2007--A

 sions,  co-pays, coinsurance, deductibles or other specific cost sharing
 mechanisms. Provided further, where a policy  provides  both  in-network
 and  out-of-network  benefits,  the  out-of-network  benefits  may  have
 different  coinsurance,  co-pays,  or  deductibles,  than the in-network
 benefits, regardless of whether the policy is written under one  license
 or two licenses.
   (ii)  For  purposes  of  this  paragraph, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive compulsive disorders, bulimia, and anorexia.] PROVIDED THAT NO
 COPAYMENT  OR  COINSURANCE IMPOSED FOR OUTPATIENT MENTAL HEALTH SERVICES
 PROVIDED IN A FACILITY LICENSED, CERTIFIED OR  OTHERWISE  AUTHORIZED  BY
 THE  OFFICE  OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS OR COINSURANCE
 IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE POLICY.
   § 14. Subparagraphs (C), (D) and (E) of paragraph 5 of subsection  (l)
 of  section 3221 of the insurance law are REPEALED and five new subpara-
 graphs (C), (D), (E), (F) and (G) are added to read as follows:
   (C) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS  OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE MORE
 RESTRICTIVE THAN THE PREDOMINANT FINANCIAL  REQUIREMENTS  AND  TREATMENT
 LIMITATIONS  APPLIED  TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE  AVAILABLE  BY  THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "MENTAL  HEALTH  CONDITION"  MEANS ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL  OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.

 S. 1507--A                         130                        A. 2007--A
 
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G)  THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT ARE
 LICENSED BY THE OFFICE OF MENTAL HEALTH THAT ARE  PARTICIPATING  IN  THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
 TIENT  HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A HOSPITAL
 AS DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE  LAW
 PROVIDED  TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN SHALL
 NOT BE SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER  THIS  PARA-
 GRAPH  SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL  TREATMENT
 PLAN  WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY CLINICAL
 REVIEW OF THE PATIENT, AND PARTICIPATES IN  PERIODIC  CONSULTATION  WITH
 THE  INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED AND
 PEER REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH  IS
 APPROVED  BY  THE  OFFICE OF MENTAL HEALTH AND APPROPRIATE TO THE AGE OF
 THE PATIENT, TO ENSURE THAT THE INPATIENT CARE  IS  MEDICALLY  NECESSARY
 FOR  THE  PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH MAY BE
 REVIEWED RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY,  AN
 INSURED  SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   § 15. Subparagraphs (A), (B) and (D) of paragraph 6 of subsection  (l)
 of  section 3221 of the insurance law, as amended by section 2 of part B
 of chapter 71 of the laws of 2016, are amended and  three  new  subpara-
 graphs (E), (F) and (G) are added to read as follows:
   (A)  Every  policy  that  provides  hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  policy.  [Further,  such  coverage  shall  be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage  provided under this paragraph may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  certi-
 fied  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the  joint commission as alcoholism, substance abuse or chemical depend-
 ence treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED, OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance  abuse  services  that are participating in the insurer's
 provider network. Coverage provided under this paragraph  shall  not  be
 subject  to  preauthorization.  Coverage  provided  under this paragraph
 shall also not be subject to concurrent utilization  review  during  the

 S. 1507--A                         131                        A. 2007--A
 
 first  [fourteen]  TWENTY-ONE  days  of the inpatient admission provided
 that the facility notifies the insurer of both  the  admission  and  the
 initial  treatment  plan within [forty-eight hours] TWO BUSINESS DAYS of
 the  admission.  The facility shall perform daily clinical review of the
 patient, including the periodic consultation with the insurer to  ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism  and  substance  abuse services and appropriate to the age of
 the patient, to ensure that the inpatient treatment is medically  neces-
 sary for the patient. Any utilization review of treatment provided under
 this  subparagraph  may include a review of all services provided during
 such inpatient treatment, including all  services  provided  during  the
 first  [fourteen] TWENTY-ONE days of such inpatient treatment. Provided,
 however, the insurer shall only deny coverage for  any  portion  of  the
 initial  [fourteen] TWENTY-ONE day inpatient treatment on the basis that
 such treatment was not medically necessary if such  inpatient  treatment
 was  contrary  to  the  evidence-based and peer reviewed clinical review
 tool utilized by the insurer which is designated by the office of  alco-
 holism  and  substance  abuse  services.  An  insured shall not have any
 financial obligation to  the  facility  for  any  treatment  under  this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT TO INPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV) "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN  THE
 MOST  RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
 DISORDERS OR THE MOST RECENT EDITION  OF  ANOTHER  GENERALLY  RECOGNIZED
 INDEPENDENT  STANDARD  OF  CURRENT MEDICAL PRACTICE SUCH AS THE INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 16. Subparagraphs (A) and (B) of paragraph 7 of  subsection  (l)  of
 section  3221 of the insurance law, as amended by chapter 41 of the laws

 S. 1507--A                         132                        A. 2007--A
 
 of 2014, are amended and a new subparagraph (C-1) is added  to  read  as
 follows:
   (A)  Every  policy  that  provides  medical,  major medical or similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication and rehabilitation services.  Such  coverage  shall  not  apply
 financial  requirements or treatment limitations to outpatient substance
 use disorder benefits that are more  restrictive  than  the  predominant
 financial requirements and treatment limitations applied to substantial-
 ly  all  medical and surgical benefits covered by the policy.  [Further,
 such coverage shall be provided consistent with the federal  Paul  Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage under this paragraph may be limited to facilities in New
 York state THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED  by  the
 office  of  alcoholism and substance abuse services [or licensed by such
 office  as  outpatient  clinics  or  medically   supervised   ambulatory
 substance  abuse  programs] TO PROVIDE OUTPATIENT SUBSTANCE USE DISORDER
 SERVICES and, in other states, to those  which  are  accredited  by  the
 joint commission as alcoholism or chemical dependence treatment programs
 AND  SIMILARLY  LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED IN THE STATE
 IN WHICH THE FACILITY IS LOCATED.
   (C-1) A LARGE GROUP POLICY THAT PROVIDES COVERAGE UNDER THIS PARAGRAPH
 MAY NOT IMPOSE COPAYMENTS OR COINSURANCE FOR  OUTPATIENT  SUBSTANCE  USE
 DISORDER  SERVICES THAT EXCEEDS THE COPAYMENT OR COINSURANCE IMPOSED FOR
 A PRIMARY CARE OFFICE VISIT. PROVIDED THAT ONLY ONE SUCH  COPAYMENT  MAY
 BE  IMPOSED  FOR  ALL  SERVICES  PROVIDED  IN A SINGLE DAY BY A FACILITY
 LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED BY THE OFFICE OF  ALCOHOLISM
 AND  SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT SUBSTANCE USE DISOR-
 DER SERVICES.
   § 17. Subparagraph (E) of paragraph 7 of  subsection  (l)  of  section
 3221  of  the insurance law, as added by section 4 of part MM of chapter
 57 of the laws of 2018, is amended and three new subparagraphs (F),  (G)
 and (H) are added to read as follows:
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services for the provision of outpatient,  intensive
 outpatient,  outpatient  rehabilitation  and  opioid  treatment that are
 participating in the insurer's provider network. Coverage provided under
 this paragraph  shall  not  be  subject  to  preauthorization.  Coverage
 provided  under this paragraph shall not be subject to concurrent review
 for the first [two] THREE weeks of continuous treatment, not  to  exceed
 [fourteen] TWENTY-ONE visits, provided the facility notifies the insurer
 of  both  the  start  of treatment and the initial treatment plan within
 [forty-eight hours] TWO BUSINESS DAYS.  The facility shall perform clin-
 ical assessment of the patient at each  visit,  including  the  periodic
 consultation  with  the insurer to ensure that the facility is using the
 evidence-based and peer reviewed clinical review tool  utilized  by  the
 insurer  which  is  designated by the office of alcoholism and substance
 abuse services and appropriate to the age of the patient, to ensure that
 the outpatient treatment is medically necessary  for  the  patient.  Any
 utilization review of the treatment provided under this subparagraph may
 include  a review of all services provided during such outpatient treat-
 ment, including all services provided during the first [two] THREE weeks
 of continuous treatment, not to exceed [fourteen] TWENTY-ONE visits,  of
 such  outpatient  treatment.  Provided,  however, the insurer shall only

 S. 1507--A                         133                        A. 2007--A
 
 deny coverage for any portion  of  the  initial  [two]  THREE  weeks  of
 continuous  treatment,  not  to exceed [fourteen] TWENTY-ONE visits, for
 outpatient treatment on the basis that such treatment was not  medically
 necessary  if  such  outpatient  treatment was contrary to the evidence-
 based and peer reviewed clinical review tool  utilized  by  the  insurer
 which  is  designated  by  the  office of alcoholism and substance abuse
 services. An insured shall not have  any  financial  obligation  to  the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 18. Paragraph 7-b of subsection (l) of section 3221 of the insurance
 law,  as added by section 2 of part B of chapter 69 of the laws of 2016,
 is amended to read as follows:
   (7-b) [(A)] Every policy that provides medical, major medical or simi-
 lar comprehensive-type coverage and provides coverage  for  prescription
 drugs for medication for the treatment of a substance use disorder shall
 include  immediate  access,  without prior authorization, [to a five day
 emergency supply] TO  THE  FORMULARY  FORMS  of  prescribed  medications
 covered  under  the  policy  for the treatment of substance use disorder
 [where an emergency condition exists], including a  prescribed  drug  or
 medication  associated  with  the management of opioid withdrawal and/or
 stabilization, except where otherwise prohibited by law. Further, cover-
 age [of an emergency supply] WITHOUT PRIOR AUTHORIZATION  shall  include
 FORMULARY  FORMS  medication  for  opioid  overdose  reversal  otherwise
 covered under the  policy  prescribed  OR  DISPENSED  to  an  individual
 covered by the policy.

 S. 1507--A                         134                        A. 2007--A
 
   [(B)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge  of  medicine  and  health, could reasonably expect the absence of
 immediate medical attention to result in:
   (i) placing the health of the person afflicted with such condition  in
 serious  jeopardy, or in the case of a behavioral condition, placing the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v) a condition described in clause (i), (ii),  or  (iii)  of  section
 1867(e)(1)(A) of the Social Security Act.
   (C)  Coverage  provided  under this paragraph may be subject to copay-
 ments, coinsurance, and annual  deductibles  that  are  consistent  with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty  day  supply of the same medication in the same thirty day period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the initial emergency supply of medication in an  amount  that  is  less
 than  the  copayment or coinsurance otherwise applicable to a thirty day
 supply of such medication, provided that the total sum of the copayments
 or coinsurance for an entire thirty day supply of  the  medication  does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   §  19.  Subparagraph  (B) of paragraph 17 of subsection (l) of section
 3221 of the insurance law, as amended by section 39 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B) Every group or blanket policy that  provides  physician  services,
 medical,  major  medical  or  similar  comprehensive-type coverage shall
 provide coverage for the screening, diagnosis and  treatment  of  autism
 spectrum  disorder  in  accordance  with  this  paragraph  and shall not
 exclude coverage for the screening, diagnosis or  treatment  of  medical
 conditions  otherwise  covered  by  the policy because the individual is
 diagnosed with autism spectrum disorder. Such coverage may be subject to
 annual deductibles, copayments and coinsurance as may be  deemed  appro-
 priate  by the superintendent and shall be consistent with those imposed
 on other benefits under the  group  or  blanket  policy.  [Coverage  for
 applied  behavior  analysis shall be subject to a maximum benefit of six
 hundred eighty hours of  treatment  per  policy  or  calendar  year  per
 covered  individual.]  This paragraph shall not be construed as limiting
 the benefits that are otherwise available to  an  individual  under  the
 group  or  blanket  policy,  provided however that such policy shall not
 contain any limitations on visits that are solely applied to the  treat-
 ment of autism spectrum disorder. No insurer shall terminate coverage or
 refuse  to  deliver, execute, issue, amend, adjust, or renew coverage to
 an individual solely because the individual  is  diagnosed  with  autism
 spectrum  disorder  or has received treatment for autism spectrum disor-
 der. Coverage shall  be  subject  to  utilization  review  and  external
 appeals  of  health care services pursuant to article forty-nine of this
 chapter  as  well  as[,]  case  management[,]  and  other  managed  care
 provisions.

 S. 1507--A                         135                        A. 2007--A
 
   §  20.  Items  (i)  and  (iii)  of subparagraph (C) of paragraph 17 of
 subsection (l) of section 3221 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental disorders[, including autistic disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  when  provided  by  a licensed provider, and applied behavior
 analysis, when provided [or supervised] by a [behavior  analyst]  PERSON
 LICENSED,  certified  [pursuant  to  the  behavior analyst certification
 board,] OR OTHERWISE AUTHORIZED TO PROVIDE  APPLIED  BEHAVIOR  ANALYSIS,
 that  are  necessary  to  develop,  maintain, or restore, to the maximum
 extent practicable, the functioning of an individual. [Individuals  that
 provide behavioral health treatment under the supervision of a certified
 behavior  analyst  pursuant to this paragraph shall be subject to stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations promulgated by the superintendent in consultation  with  the
 commissioners of health and education.]
   §  21. Paragraph 17 of subsection (l) of section 3221 of the insurance
 law is amended by adding four new subparagraphs (H), (I), (J) and (K) to
 read as follows:
   (H) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE  MORE    RESTRICTIVE THAN THE PREDOMINANT FINANCIAL REQUIREMENTS AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE  AVAIL-
 ABLE  BY  THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK
 PROVIDER UPON  REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT; AND
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER  OF VISITS, DAYS OF COVERAGE, OR OTHER  SIMILAR  LIMITS  ON
 THE  SCOPE OR DURATION OF  TREATMENT AND INCLUDES NONQUANTITATIVE TREAT-
 MENT LIMITATIONS SUCH AS: MEDICAL    MANAGEMENT  STANDARDS  LIMITING  OR
 EXCLUDING  BENEFITS BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE
 TREATMENT IS EXPERIMENTAL OR  INVESTIGATIONAL;  FORMULARY    DESIGN  FOR
 PRESCRIPTION  DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMIS-
 SION TO PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS
 FOR DETERMINING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST  OR
 STEP THERAPY PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE
 OF  TREATMENT;  AND  RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY
 TYPE, PROVIDER SPECIALTY, AND OTHER CRITERIA THAT  LIMIT  THE  SCOPE  OR
 DURATION OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.
   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).

 S. 1507--A                         136                        A. 2007--A
 
   §  22. Paragraphs 1, 2, and 3 of subsection (g) of section 4303 of the
 insurance law, as amended by chapter  502  of  the  laws  of  2007,  are
 amended to read as follows:
   [(1)] A MEDICAL EXPENSE INDEMNITY CORPORATION, hospital service corpo-
 ration  or  a  health  service corporation, [which] THAT provides group,
 group remittance or  school  blanket  coverage  for  inpatient  hospital
 care[,]  OR COVERAGE FOR PHYSICIAN SERVICES shall provide as part of its
 contract [broad-based] coverage  for  the  diagnosis  and  treatment  of
 mental[,  nervous or emotional disorders or ailments, however defined in
 such contract, at least equal to the coverage provided for other] health
 conditions and [shall include]:
   [(A)]
   (1) WHERE THE CONTRACT PROVIDES COVERAGE FOR INPATIENT HOSPITAL  CARE,
 benefits for in-patient care in a hospital as defined by subdivision ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed  to  not  less  than  thirty days of active treatment in any contract
 year, plan year or calendar year.
   (B)] OR FOR INPATIENT CARE PROVIDED  IN  OTHER  STATES,  TO  SIMILARLY
 LICENSED  HOSPITALS,  AND  benefits  for  out-patient care provided in a
 facility issued an operating certificate by the commissioner  of  mental
 health  pursuant  to  the provisions of article thirty-one of the mental
 hygiene law or in a facility operated by the office of  mental  health[,
 which  benefits  may  be  limited  to not less than twenty visits in any
 contract year, plan year or calendar year. Benefits for  partial  hospi-
 talization  program  services  shall be provided as an offset to covered
 inpatient days at a ratio of two partial hospitalization visits  to  one
 inpatient day of treatment.
   (C)  Such  coverage  may  be provided on a contract year, plan year or
 calendar year basis and shall be consistent with the provision of  other
 benefits  under the contract.] OR FOR OUT-PATIENT CARE PROVIDED IN OTHER
 STATES, TO SIMILARLY CERTIFIED FACILITIES; AND
   (2) WHERE THE CONTRACT PROVIDES COVERAGE FOR PHYSICIAN SERVICES  BENE-
 FITS  FOR  OUTPATIENT  CARE  PROVIDED  BY A PSYCHIATRIST OR PSYCHOLOGIST
 LICENSED TO PRACTICE IN THIS STATE, A LICENSED  CLINICAL  SOCIAL  WORKER
 WHO  MEETS  THE  REQUIREMENTS OF SUBSECTION (N) OF THIS SECTION, A NURSE
 PRACTITIONER LICENSED TO PRACTICE ON THIS STATE, OR PROFESSIONAL  CORPO-
 RATION OR UNIVERSITY FACULTY PRACTICE CORPORATION THEREOF.
   (3)  Such  coverage  may be subject to annual deductibles, co-pays and
 coinsurance as may be deemed appropriate by the superintendent and shall
 be consistent with those imposed on other benefits under  the  contract.
 PROVIDED  THAT NO COPAYMENT OR COINSURANCE IMPOSED FOR OUTPATIENT MENTAL
 HEALTH SERVICES PROVIDED IN A FACILITY LICENSED, CERTIFIED OR  OTHERWISE
 AUTHORIZED BY THE OFFICE OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS OR
 COINSURANCE IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE CONTRACT.
   [(D)  For  the  purpose  of  this subsection, "active treatment" means
 treatment furnished  in  conjunction  with  in-patient  confinement  for
 mental, nervous or emotional disorders or ailments that meet such stand-
 ards  as  shall be prescribed pursuant to the regulations of the commis-
 sioner of mental health.
   (E) In the event the group remittance  group  or  contract  holder  is
 provided  coverage  under  this  subsection  and  under paragraph one of
 subsection (h) of this section from the same health service corporation,
 or under a contract that is jointly underwritten by two  health  service
 corporations  or  by  a health service corporation and a medical expense
 indemnity corporation, the aggregate of the benefits for outpatient care
 obtained under subparagraph (B) of this paragraph and paragraph  one  of

 S. 1507--A                         137                        A. 2007--A

 subsection  (h)  of  this section may be limited to not less than twenty
 visits in any contract year, plan year or calendar year.
   (2)  (A)  A  hospital  service  corporation or a health service corpo-
 ration, which provides group, group remittance or school blanket  cover-
 age  for  inpatient hospital care, shall provide comparable coverage for
 adults and children with biologically based mental illness. Such  hospi-
 tal service corporation or health service corporation shall also provide
 such  comparable  coverage  for children with serious emotional disturb-
 ances. Such coverage shall be provided under the  terms  and  conditions
 otherwise  applicable  under the contract, including network limitations
 or variations, exclusions, co-pays, coinsurance,  deductibles  or  other
 specific  cost  sharing  mechanisms.  Provided further, where a contract
 provides both in-network and out-of-network benefits, the out-of-network
 benefits may have different coinsurance, co-pays, or  deductibles,  than
 the  in-network  benefits, regardless of whether the contract is written
 under one license or two licenses.
   (B) For purposes of this  subsection,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders, anorexia, and bulimia.
   (3) For purposes of this subsection, the term "children  with  serious
 emotional  disturbances"  means  persons under the age of eighteen years
 who have diagnoses of attention deficit disorders,  disruptive  behavior
 disorders,  or  pervasive development disorders, and where there are one
 or more of the following:
   (A) serious suicidal symptoms or other life-threatening  self-destruc-
 tive behaviors;
   (B)  significant psychotic symptoms (hallucinations, delusion, bizarre
 behaviors);
   (C) behavior caused by emotional disturbances that placed the child at
 risk of causing personal injury or significant property damage; or
   (D) behavior caused by emotional disturbances that placed the child at
 substantial risk of removal from the household.]
   § 23. Paragraphs 4 and 5 of subsection (g)  of  section  4303  of  the
 insurance  law are REPEALED and five new paragraphs 4, 5, 6, 7 and 8 are
 added to read as follows:
   (4) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS  OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE MORE
 RESTRICTIVE THAN  THE PREDOMINANT FINANCIAL REQUIREMENTS  AND  TREATMENT
 LIMITATIONS  APPLIED TO  SUBSTANTIALLY ALL MEDICAL AND SURGICAL BENEFITS
 COVERED BY THE CONTRACT.
   (5) THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER  THE
 CONTRACT WITH  RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE
 BY  THE  CORPORATION TO  ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK
 PROVIDER UPON REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;

 S. 1507--A                         138                        A. 2007--A
 
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER  OF    VISITS,  DAYS  OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF  TREATMENT AND INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY   DESIGN FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS  FOR DETER-
 MINING USUAL, CUSTOMARY, AND  REASONABLE  CHARGES;  FAIL-FIRST  OR  STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "MENTAL  HEALTH  CONDITION"  MEANS  ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE  MOST RECENT EDITION OF THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL OF MENTAL DISORDERS  OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (7)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM,  CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND  PETE  DOMENICI
 MENTAL  HEALTH    PARITY  AND  ADDICTION EQUITY ACT OF 2008 (29 U.S.C. §
 1185A).
   (8) THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT  ARE
 LICENSED  BY  THE  OFFICE OF MENTAL HEALTH THAT ARE PARTICIPATING IN THE
 CORPORATION'S PROVIDER NETWORK. WHERE THE CONTRACT PROVIDES COVERAGE FOR
 INPATIENT HOSPITAL CARE, BENEFITS  FOR  INPATIENT  HOSPITAL  CARE  IN  A
 HOSPITAL  AS    DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL
 HYGIENE LAW PROVIDED TO INDIVIDUALS WHO HAVE NOT  ATTAINED  THE  AGE  OF
 EIGHTEEN  SHALL  NOT  BE  SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED
 UNDER THIS PARAGRAPH SHALL ALSO NOT BE  SUBJECT TO  CONCURRENT  UTILIZA-
 TION  REVIEW  DURING THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION,
 PROVIDED THE FACILITY NOTIFIES THE CORPORATION OF BOTH THE ADMISSION AND
 THE INITIAL TREATMENT PLAN WITHIN TWO BUSINESS DAYS  OF  THE  ADMISSION,
 PERFORMS DAILY CLINICAL REVIEW OF THE PATIENT, AND PARTICIPATES IN PERI-
 ODIC  CONSULTATION  WITH  THE CORPORATION TO ENSURE THAT THE FACILITY IS
 USING THE EVIDENCE-BASED AND  PEER  REVIEWED  CLINICAL  REVIEW  CRITERIA
 UTILIZED  BY  THE  CORPORATION WHICH IS APPROVED BY THE OFFICE OF MENTAL
 HEALTH AND APPROPRIATE TO THE AGE OF THE PATIENT,  TO  ENSURE  THAT  THE
 INPATIENT  CARE  IS  MEDICALLY  NECESSARY FOR THE PATIENT. ALL TREATMENT
 PROVIDED UNDER THIS SUBPARAGRAPH MAY BE REVIEWED RETROSPECTIVELY.  WHERE
 CARE  IS DENIED RETROSPECTIVELY, AN INSURED SHALL NOT HAVE ANY FINANCIAL
 OBLIGATION TO THE FACILITY FOR ANY  TREATMENT  UNDER  THIS  SUBPARAGRAPH
 OTHER  THAN ANY COPAYMENT, COINSURANCE, OR DEDUCTIBLE OTHERWISE REQUIRED
 UNDER THE CONTRACT.
   § 24. Subsection (h) of section 4303 of the insurance law is REPEALED.
   § 25. Subsection (i) of section 4303 of the insurance law, as  amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (i)  A  medical expense indemnity corporation or health service corpo-
 ration [which] THAT provides coverage for physicians,  psychiatrists  or
 psychologists for psychiatric or psychological services or for the diag-
 nosis  and  treatment  of  [mental,  nervous  or emotional disorders and
 ailments] MENTAL HEALTH CONDITIONS, however defined  in  such  contract,
 [must]  SHALL  make  available  and  if requested by all persons holding
 individual contracts in a group whose premiums are paid by  a  remitting
 agent  or  by the contract holder in the case of a group contract issued
 pursuant to section four thousand three hundred five  of  this  article,

 S. 1507--A                         139                        A. 2007--A
 
 provide the same coverage for such services when performed by a licensed
 clinical  social worker, within the lawful scope of his or her practice,
 who is licensed pursuant to article one hundred fifty-four of the educa-
 tion  law.  The state board for social work shall maintain a list of all
 licensed clinical social workers qualified for reimbursement under  this
 subsection.  Such  coverage  shall be made available at the inception of
 all new contracts and, with respect to all other contracts, at any anni-
 versary date subject to evidence of insurability. Written notice of  the
 availability  of such coverage shall be delivered to the group remitting
 agent or group contract holder prior to inception of such  contract  and
 annually thereafter, except that this notice shall not be required where
 a  [policy]  CONTRACT  covers two hundred or more employees or where the
 benefit structure was the subject  of  collective  bargaining  affecting
 persons who are employed in more than one state.
   §  26. Subsection (k) of section 4303 of the insurance law, as amended
 by section 3 of part B of chapter 71 of the laws of 2016, is amended  to
 read as follows:
   (k)(1) Every contract that provides hospital, major medical or similar
 comprehensive  coverage  [must] SHALL provide inpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion and rehabilitation services. Such inpatient coverage shall  include
 unlimited  medically  necessary  treatment  for  substance  use disorder
 treatment services provided in residential settings [as required by  the
 Mental  Health  Parity  and  Addiction  Equity  Act of 2008 (29 U.S.C. §
 1185a)].  Further, such inpatient coverage  shall  not  apply  financial
 requirements  or  treatment  limitations,  including  utilization review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive than the predominant financial  requirements  and  treatment
 limitations  applied  to substantially all medical and surgical benefits
 covered by the contract.  [Further,  such  coverage  shall  be  provided
 consistent  with  the  federal  Paul  Wellstone and Pete Domenici Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (2) Coverage provided under this subsection may be limited to  facili-
 ties  in  New York state [which are certified] THAT ARE LICENSED, CERTI-
 FIED OR OTHERWISE AUTHORIZED by the office of alcoholism  and  substance
 abuse  services  and,  in other states, to those which are accredited by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR  OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (3)  Coverage  provided under this subsection may be subject to annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and that are consistent with those imposed on other  benefits  within  a
 given contract.
   (4) This paragraph shall apply to facilities in this state [certified]
 THAT  ARE  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED by the office of
 alcoholism and substance abuse services that are  participating  in  the
 corporation's  provider network. Coverage provided under this subsection
 shall not be subject to preauthorization. Coverage provided  under  this
 subsection  shall  also  not be subject to concurrent utilization review
 during the first [fourteen] TWENTY-ONE days of the  inpatient  admission
 provided  that  the facility notifies the corporation of both the admis-
 sion and the initial treatment plan within [forty-eight hours] TWO BUSI-
 NESS DAYS of the admission. The facility shall  perform  daily  clinical
 review  of  the  patient,  including  the periodic consultation with the
 corporation to ensure that the facility is using the evidence-based  and
 peer  reviewed clinical review tool utilized by the corporation which is

 S. 1507--A                         140                        A. 2007--A
 
 designated by the office of alcoholism and substance abuse services  and
 appropriate  to  the  age  of  the patient, to ensure that the inpatient
 treatment is medically necessary for the patient. Any utilization review
 of  treatment  provided under this paragraph may include a review of all
 services  provided  during  such  inpatient  treatment,  including   all
 services  provided  during  the first [fourteen] TWENTY-ONE days of such
 inpatient treatment.  Provided, however, the corporation shall only deny
 coverage for any portion of the initial [fourteen] TWENTY-ONE day  inpa-
 tient  treatment  on  the  basis  that  such treatment was not medically
 necessary if such inpatient treatment was contrary to the evidence-based
 and peer reviewed clinical review tool utilized by the corporation which
 is designated by the office of alcoholism and substance abuse  services.
 An  insured  shall not have any financial obligation to the facility for
 any treatment under this paragraph other  than  any  copayment,  coinsu-
 rance, or deductible otherwise required under the contract.
   (5)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH   RESPECT TO INPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED OR IN-NETWORK PROVIDER UPON  REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER  OF    VISITS,  DAYS  OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF  TREATMENT AND INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY   DESIGN FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS  FOR DETER-
 MINING USUAL, CUSTOMARY, AND  REASONABLE  CHARGES;  FAIL-FIRST  OR  STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF  MENTAL
 DISORDERS  OR  THE MOST   RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT  MEDICAL PRACTICE SUCH AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (7)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM,  CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND  PETE  DOMENICI
 MENTAL  HEALTH    PARITY  AND  ADDICTION EQUITY ACT OF 2008 (29 U.S.C. §
 1185A).
   § 27. Paragraphs 1 and 2 of subsection (l)  of  section  4303  of  the
 insurance law, as amended by chapter 41 of the laws of 2014, are amended
 and a new paragraph 3-a is added to read as follows:
   (1)  Every  contract  that  provides medical, major medical or similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication and rehabilitation services.  Such  coverage  shall  not  apply
 financial  requirements or treatment limitations to outpatient substance
 use disorder benefits that are more  restrictive  than  the  predominant

 S. 1507--A                         141                        A. 2007--A
 
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the contract.  [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (2) Coverage under this subsection may be limited to facilities in New
 York  state  THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED by the
 office of alcoholism and substance abuse services [or licensed  by  such
 office  as  outpatient  clinics  or  medically supervised ambulatory] TO
 PROVIDE OUTPATIENT substance [abuse programs] USE DISORDER SERVICES and,
 in other states, to those which are accredited by the  joint  commission
 as  alcoholism or chemical dependence substance abuse treatment programs
 AND ARE SIMILARLY LICENSED, CERTIFIED OR  OTHERWISE  AUTHORIZED  IN  THE
 STATE IN WHICH THE FACILITY IS LOCATED.
   (3-A)  A  CONTRACT  THAT  PROVIDES  LARGE GROUP COVERAGE THAT PROVIDES
 COVERAGE FOR OUTPATIENT  SUBSTANCE  USE  DISORDER  SERVICES  UNDER  THIS
 SUBSECTION  MAY  NOT  IMPOSE  COPAYMENTS  OR  COINSURANCE FOR OUTPATIENT
 SUBSTANCE USE DISORDER SERVICES THAT EXCEED THE COPAYMENT OR COINSURANCE
 IMPOSED FOR A PRIMARY CARE OFFICE VISIT. PROVIDED  THAT  ONLY  ONE  SUCH
 COPAYMENT  MAY BE IMPOSED FOR ALL SERVICES PROVIDED IN A SINGLE DAY BY A
 FACILITY LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED BY  THE  OFFICE  OF
 ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT SUBSTANCE
 USE DISORDER SERVICES.
   § 28. Paragraph 5 of subsection (l) of section 4303 of  the  insurance
 law, as added by section 5 of part MM of chapter 57 of the laws of 2018,
 is  amended  and  three  new  paragraphs 6, 7 and 8 are added to read as
 follows:
   (5) This paragraph shall apply to facilities in this state [certified]
 THAT ARE LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED by  the  office  of
 alcoholism and substance abuse services for the provision of outpatient,
 intensive  outpatient,  outpatient  rehabilitation  and opioid treatment
 that are participating in the corporation's provider  network.  Coverage
 provided under this subsection shall not be subject to preauthorization.
 Coverage  provided under this subsection shall not be subject to concur-
 rent review for the first [two] THREE weeks of continuous treatment, not
 to exceed [fourteen] TWENTY-ONE visits, provided the  facility  notifies
 the corporation of both the start of treatment and the initial treatment
 plan  within  [forty-eight  hours] TWO BUSINESS DAYS. The facility shall
 perform clinical assessment of the patient at each visit, including  the
 periodic  consultation  with the corporation to ensure that the facility
 is using the evidence-based  and  peer  reviewed  clinical  review  tool
 utilized  by  the corporation which is designated by the office of alco-
 holism and substance abuse services and appropriate to the  age  of  the
 patient,  to ensure that the outpatient treatment is medically necessary
 for the patient. Any utilization review of the treatment provided  under
 this paragraph may include a review of all services provided during such
 outpatient  treatment,  including all services provided during the first
 [two] THREE weeks of continuous  treatment,  not  to  exceed  [fourteen]
 TWENTY-ONE  visits, of such outpatient treatment. Provided, however, the
 corporation shall only deny coverage for  any  portion  of  the  initial
 [two]  THREE  weeks  of  continuous  treatment, not to exceed [fourteen]
 TWENTY-ONE visits, for outpatient  treatment  on  the  basis  that  such
 treatment  was  not medically necessary if such outpatient treatment was
 contrary to the evidence-based and peer reviewed  clinical  review  tool
 utilized  by  the corporation which is designated by the office of alco-
 holism and substance abuse services. A subscriber  shall  not  have  any

 S. 1507--A                         142                        A. 2007--A
 
 financial  obligation to the facility for any treatment under this para-
 graph other than any copayment,  coinsurance,  or  deductible  otherwise
 required under the contract.
   (6)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH RESPECT TO  OUTPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED, OR IN-NETWORK PROVIDER UPON REQUEST.
   (7) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT.
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR  DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT LIMITA-
 TIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING  BENE-
 FITS  BASED  ON  MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (8)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE  AND  PETE  DOMENICI
 MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY  ACT OF 2008 (29 U.S.C. §
 1185A).
   § 29. Subsection (l-2) of section 4303 of the insurance law, as  added
 by  section 3 of part B of chapter 69 of the laws of 2016, is amended to
 read as follows:
   (l-2) [(1)] Every contract that provides  medical,  major  medical  or
 similar   comprehensive-type   coverage   and   provides   coverage  for
 prescription drugs for medication for the treatment of a  substance  use
 disorder shall include immediate access, without prior authorization, to
 [a  five day emergency supply] THE FORMULARY FORMS of prescribed medica-
 tions covered under the contract for  the  treatment  of  substance  use
 disorder  [where  an emergency condition exists], including a prescribed
 drug or medication associated with the management of  opioid  withdrawal
 and/or stabilization, except where otherwise prohibited by law. Further,
 coverage  [of  an  emergency  supply]  WITHOUT PRIOR AUTHORIZATION shall
 include FORMULARY FORMS  OF  medication  for  opioid  overdose  reversal
 otherwise covered under the contract prescribed OR DISPENSED to an indi-
 vidual covered by the contract.
   [(2)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-

 S. 1507--A                         143                        A. 2007--A

 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in  clause (i), (ii) or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (3) Coverage provided under this subsection may be subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the contract; provided,  however,
 no  contract  shall  impose an additional copayment or coinsurance on an
 insured who received an emergency supply of medication and then received
 up to a thirty day supply of the same medication in the same thirty  day
 period  in  which the emergency supply of medication was dispensed. This
 paragraph shall not preclude the imposition of a  copayment  or  coinsu-
 rance  on  the initial limited supply of medication in an amount that is
 less than the copayment or coinsurance otherwise applicable to a  thirty
 day supply of such medication, provided that the total sum of the copay-
 ments  or  coinsurance for an entire thirty day supply of the medication
 does not exceed the copayment or coinsurance otherwise applicable  to  a
 thirty day supply of such medication.]
   §  30. Subsection (n) of section 4303 of the insurance law, as amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (n) In addition to the requirements of subsection (i) of this section,
 every health service or medical expense indemnity corporation issuing  a
 group  contract  pursuant to this section or a group remittance contract
 for delivery in this state  which  contract  provides  reimbursement  to
 subscribers  or physicians, psychiatrists or psychologists for psychiat-
 ric or psychological services or for  the  diagnosis  and  treatment  of
 [mental,  nervous  or  emotional  disorders and ailments,] MENTAL HEALTH
 CONDITIONS, however defined in such  contract,  must  provide  the  same
 coverage  to  persons covered under the group contract for such services
 when performed by a licensed clinical social worker, within  the  lawful
 scope  of  his  or her practice, who is licensed pursuant to subdivision
 two of section seven thousand seven hundred four of  the  education  law
 and  in  addition  shall  have either (i) three or more additional years
 experience in psychotherapy, which for the purposes of  this  subsection
 shall mean the use of verbal methods in interpersonal relationships with
 the  intent  of  assisting  a  person or persons to modify attitudes and
 behavior which are intellectually, socially or emotionally  maladaptive,
 under supervision, satisfactory to the state board for social work, in a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental
 department, providing services for diagnosis or  treatment  of  [mental,
 nervous  or  emotional disorders or ailments,] MENTAL HEALTH CONDITIONS,
 or (ii) three or more additional years experience in psychotherapy under
 the supervision, satisfactory to the state board for social work,  of  a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical  social  worker  qualified for reimbursement pursuant to subsection
 (i) of this section, or (iii) a combination of the experience  specified
 in  paragraphs  (i)  and  (ii) totaling three years, satisfactory to the
 state board for social work.   The state board  for  social  work  shall
 maintain  a  list  of all licensed clinical social workers qualified for
 reimbursement under this subsection.

 S. 1507--A                         144                        A. 2007--A
 
   § 31. Paragraph 2 of subsection (ee) of section 4303 of the  insurance
 law,  as  amended  by  section 40 of part D of chapter 56 of the laws of
 2013, is amended to read as follows:
   (2)  Every  contract  that provides physician services, medical, major
 medical or similar comprehensive-type coverage  shall  provide  coverage
 for  the  screening, diagnosis and treatment of autism spectrum disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered  by the contract because the individual is diagnosed with autism
 spectrum disorder. Such coverage may be subject to  annual  deductibles,
 copayments  and  coinsurance  as may be deemed appropriate by the super-
 intendent and shall be consistent with those imposed on  other  benefits
 under  the  contract.  [Coverage  for applied behavior analysis shall be
 subject to a maximum benefit of six hundred eighty  hours  of  treatment
 per  contract  or  calendar year per covered individual.] This paragraph
 shall not be construed as  limiting  the  benefits  that  are  otherwise
 available  to  an  individual  under the contract, provided however that
 such contract shall not contain any limitations on visits that are sole-
 ly applied to the treatment of  autism  spectrum  disorder.  No  insurer
 shall  terminate  coverage  or refuse to deliver, execute, issue, amend,
 adjust, or renew coverage to an individual solely because the individual
 is diagnosed with autism spectrum disorder or has received treatment for
 autism spectrum disorder.  Coverage  shall  be  subject  to  utilization
 review  and external appeals of health care services pursuant to article
 forty-nine of this chapter as well as[,] case  management[,]  and  other
 managed care provisions.
   §  32.  Subparagraphs (A) and (C) of paragraph 3 of subsection (ee) of
 section 4303 of the insurance law, as amended by chapter 596 of the laws
 of 2011, are amended to read as follows:
   (A) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (C)  "behavioral  health  treatment"  means  counseling  and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant  to  the  behavior  analyst certification board] PERSON THAT IS
 LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED  BEHAVIOR
 ANALYSIS,  that  are  necessary to develop, maintain, or restore, to the
 maximum extent practicable, the functioning of an individual.  [Individ-
 uals that provide behavioral health treatment under the supervision of a
 certified  behavior analyst pursuant to this subsection shall be subject
 to standards of professionalism,  supervision  and  relevant  experience
 pursuant  to  regulations promulgated by the superintendent in consulta-
 tion with the commissioners of health and education.]
   § 33. Subsection (ee) of section 4303 of the insurance law is  amended
 by adding four new paragraphs 8, 9, 10, and 11 to read as follows:
   (8)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE RESTRICTIVE THAN THE  PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.
   (9) THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER  THE
 CONTRACT WITH RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE

 S. 1507--A                         145                        A. 2007--A
 
 AVAILABLE  BY  THE  CORPORATION  TO ANY INSURED, PROSPECTIVE INSURED, OR
 IN-NETWORK PROVIDER UPON REQUEST.
   (10) FOR PURPOSES OF THIS SUBSECTION:
   (A)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B) "PREDOMINANT" MEANS THAT  A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT  LIMITA-
 TIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING BENE-
 FITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT  IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT.
   (11) A CORPORATION SHALL PROVIDE COVERAGE UNDER THIS SUBSECTION, AT  A
 MINIMUM,  CONSISTENT  WITH  THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI
 MENTAL HEALTH PARITY AND ADDICTION EQUITY  ACT  OF  2008  (29  U.S.C.  §
 1185A).
   §  34.  Paragraphs  17, 20 and 21 of subsection (a) of section 4324 of
 the insurance law, paragraph 17 as amended and paragraphs 20 and  21  as
 added  by  section  8  of  part H of chapter 60 of the laws of 2014, are
 amended and a new paragraph 22 is added to read as follows:
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate document that is updated annually, of the name, address, and  tele-
 phone  number of all participating providers, including facilities, [and
 in addition,] AND: (A) WHETHER THE PROVIDER IS ACCEPTING  NEW  PATIENTS;
 (B)  IN  THE  CASE  OF  MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES
 PROVIDERS, ANY AFFILIATIONS WITH PARTICIPATING FACILITIES  CERTIFIED  OR
 AUTHORIZED  BY  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM
 AND SUBSTANCE ABUSE SERVICES, AND ANY RESTRICTIONS REGARDING THE  AVAIL-
 ABILITY OF THE INDIVIDUAL PROVIDER'S SERVICES; (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  corpo-
 ration's  website  and  the  corporation shall update the website within
 fifteen days of the addition or  termination  of  a  provider  from  the
 corporation's network or a change in a physician's hospital affiliation;
   (20) with respect to out-of-network coverage:
   (A)  a clear description of the methodology used by the corporation to
 determine reimbursement for out-of-network health care services;
   (B) a description of the amount that the  corporation  will  reimburse
 under  the methodology for out-of-network health care services set forth
 as a percentage of the  usual  and  customary  cost  for  out-of-network
 health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (21) information in writing  and  through  an  internet  website  that
 reasonably  permits  a  subscriber or prospective subscriber to estimate
 the  anticipated  out-of-pocket  cost  for  out-of-network  health  care
 services  in  a  geographical area or zip code based upon the difference

 S. 1507--A                         146                        A. 2007--A
 
 between what the corporation will reimburse  for  out-of-network  health
 care services and the usual and customary cost for out-of-network health
 care services[.]; AND
   (22) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE CORPORATION
 TO  ASSESS  THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE
 PAUL WELLSTONE AND PETE DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION
 EQUITY  ACT  OF  2008,  42  U.S.C. 18031 (J), AND ANY AMENDMENTS TO, AND
 FEDERAL GUIDANCE OR REGULATIONS ISSUED UNDER, THOSE ACTS.
   § 35. Subsection (b) of section 4325 of the insurance law, as added by
 chapter 705 of the laws of 1996, is amended to read as follows:
   (b) No corporation organized under this  article  shall  by  contract,
 written  policy [or], written procedure OR PRACTICE prohibit or restrict
 any health care provider from filing a complaint,  making  a  report  or
 commenting to an appropriate governmental body regarding the policies or
 practices of such corporation which the provider believes may negatively
 impact upon the quality of or access to patient care. NOR SHALL A CORPO-
 RATION  ORGANIZED  UNDER THIS ARTICLE TAKE ANY ADVERSE ACTION, INCLUDING
 BUT NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR  AGREEMENT
 WITH A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVID-
 ER FOR FILING A COMPLAINT, MAKING A REPORT OR COMMENTING TO AN APPROPRI-
 ATE  GOVERNMENTAL  BODY  REGARDING  POLICIES OR PRACTICES OF SUCH CORPO-
 RATION WHICH MAY VIOLATE THIS CHAPTER  INCLUDING  SUBSECTION  (G),  (K),
 (1),  (1-1)  OR (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THIS ARTI-
 CLE.
   § 36. Subparagraph (C) of paragraph 1 of  subsection  (b)  of  section
 4900  of  the insurance law, as added by chapter 41 of the laws of 2014,
 is amended and a new subparagraph (D) is added to read as follows:
   (C) for purposes of a determination involving substance  use  disorder
 treatment:
   (i)  a  physician  who  possesses  a  current and valid non-restricted
 license to practice medicine and who specializes  in  behavioral  health
 and  has experience in the delivery of substance use disorder courses of
 treatment; or
   (ii) a health care professional other than a  licensed  physician  who
 specializes  in  behavioral health and has experience in the delivery of
 substance use disorder  courses  of  treatment  and,  where  applicable,
 possesses  a  current  and  valid non-restricted license, certificate or
 registration or, where no provision for a license, certificate or regis-
 tration exists, is credentialed by the national accrediting body  appro-
 priate to the profession; [and] OR
   (D)  FOR  PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR A MENTAL
 HEALTH CONDITION:
   (I) A PHYSICIAN WHO  POSSESSES  A  CURRENT  AND  VALID  NON-RESTRICTED
 LICENSE  TO  PRACTICE  MEDICINE AND WHO SPECIALIZES IN BEHAVIORAL HEALTH
 AND HAS EXPERIENCE IN THE DELIVERY OF MENTAL HEALTH  COURSES  OR  TREAT-
 MENT; OR
   (II)  A  HEALTH  CARE PROFESSIONAL OTHER THAN A LICENSED PHYSICIAN WHO
 SPECIALIZES IN BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE  DELIVERY  OF
 MENTAL  HEALTH  COURSES  OF TREATMENT AND, WHERE APPLICABLE, POSSESSES A
 CURRENT AND VALID NON-RESTRICTED LICENSE, CERTIFICATE,  OR  REGISTRATION
 OR,  WHERE  NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE OR REGISTRATION
 EXISTS, IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE  TO
 THE PROFESSION; AND
   §  37.  Paragraph 9 of subsection (a) of section 4902 of the insurance
 law, as amended by section 1 of part A of chapter  69  of  the  laws  of
 2016, is amended to read as follows:

 S. 1507--A                         147                        A. 2007--A

   (9)  When  conducting  utilization  review for purposes of determining
 health care coverage for substance use disorder treatment, a utilization
 review agent shall utilize AN evidence-based and peer reviewed  clinical
 review [tools designated by the office of alcoholism and substance abuse
 services  that  are appropriate to the age of the patient and consistent
 with the treatment service levels within the office  of  alcoholism  and
 substance  abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE OF
 THE PATIENT. WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW  FOR  TREATMENT
 PROVIDED  IN  THIS  STATE,  A  UTILIZATION REVIEW AGENT SHALL UTILIZE AN
 EVIDENCE-BASED AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE  OFFICE
 OF  ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT WITH THE
 TREATMENT SERVICE LEVELS WITHIN THE OFFICE OF ALCOHOLISM  AND  SUBSTANCE
 ABUSE  SERVICES  SYSTEM. All approved tools shall have inter rater reli-
 ability  testing  completed  by  December  thirty-first,  two   thousand
 sixteen.
   §  38.  Subsection (a) of section 4902 of the insurance law is amended
 by adding a new paragraph 12 to read as follows:
   (12) WHEN CONDUCTING UTILIZATION REVIEW FOR  PURPOSES  OF  DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT  SHALL  UTILIZE  EVIDENCE-BASED  AND PEER REVIEWED CLINICAL REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW AGENT SHALL USE CLINICAL REVIEW CRITERIA DEEMED  APPROPRIATE  AND
 APPROVED  FOR  SUCH  USE  BY  THE  COMMISSIONER  OF THE OFFICE OF MENTAL
 HEALTH, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH AND  THE  SUPER-
 INTENDENT.  APPROVED  CLINICAL  REVIEW  CRITERIA  SHALL HAVE INTER RATER
 RELIABILITY TESTING COMPLETED BY  DECEMBER  THIRTY-FIRST,  TWO  THOUSAND
 NINETEEN.
   §  39.  Paragraph  (b)  of  subsection 5 of section 4403 of the public
 health law, as added by chapter 705 of the laws of 1996, is  amended  to
 read as follows:
   (b)  The following criteria shall be considered by the commissioner at
 the time of a review: (i) the availability  of  appropriate  and  timely
 care  that  is  provided in compliance with the standards of the Federal
 Americans with Disability Act to assure access to health  care  for  the
 enrollee  population;  (ii)  the network's ability to provide culturally
 and linguistically competent care to meet  the  needs  of  the  enrollee
 population;  [and] (iii) THE AVAILABILITY OF APPROPRIATE AND TIMELY CARE
 THAT IS IN COMPLIANCE WITH THE STANDARDS OF THE PAUL WELLSTONE AND  PETE
 DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY ACT OF 2008, 42
 U.S.C.  18031(J), AND ANY AMENDMENTS TO, AND FEDERAL GUIDANCE AND  REGU-
 LATIONS  ISSUED UNDER THOSE ACTS, WHICH SHALL INCLUDE AN ANALYSIS OF THE
 RATE  OF  OUT-OF-NETWORK  UTILIZATION  FOR  COVERED  MENTAL  HEALTH  AND
 SUBSTANCE  USE  DISORDER SERVICES AS COMPARED TO THE RATE OF OUT-OF-NET-
 WORK UTILIZATION FOR THE RESPECTIVE CATEGORY OF  MEDICAL  SERVICES;  AND
 (IV)  with  the exception of initial licensure, the number of grievances
 filed by enrollees relating to waiting times for appointments, appropri-
 ateness of referrals and other indicators of plan capacity.
   § 40. Subdivision 3 of section 4406-c of the  public  health  law,  as
 added by chapter 705 of the laws of 1996, is amended to read as follows:
   3. No health care plan shall by contract, written policy [or], written
 procedure OR PRACTICE prohibit or restrict any health care provider from
 filing  a  complaint,  making  a  report or commenting to an appropriate
 governmental body regarding the policies or  practices  of  such  health
 care  plan  which  the  provider believes may negatively impact upon the
 quality of, or access to, patient care. NOR SHALL  A  HEALTH  CARE  PLAN
 TAKE  ANY ADVERSE ACTION, INCLUDING BUT NOT LIMITED TO REFUSING TO RENEW

 S. 1507--A                         148                        A. 2007--A
 
 OR EXECUTE A CONTRACT OR AGREEMENT WITH A HEALTH CARE PROVIDER AS RETAL-
 IATION AGAINST A HEALTH CARE PROVIDER FOR FILING A COMPLAINT,  MAKING  A
 REPORT OR COMMENTING TO AN APPROPRIATE GOVERNMENTAL BODY REGARDING POLI-
 CIES  OR PRACTICES OF SUCH HEALTH CARE PLAN WHICH MAY VIOLATE THIS CHAP-
 TER OR THE INSURANCE LAW INCLUDING SUBSECTION (G), (K),  (L),  (L-1)  OR
 (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THE INSURANCE LAW.
   §  41. Paragraphs (r), (t) and (u) of subdivision 1 of section 4408 of
 the public health law, paragraph (r) as amended and paragraphs  (t)  and
 (u)  as added by section 18 of part H of chapter 60 of the laws of 2014,
 are amended and a new paragraph (v) is added to read as follows:
   (r) a listing by specialty, which may be in a separate  document  that
 is  updated  annually,  of the name, address and telephone number of all
 participating providers, including facilities, [and, in addition,]  AND:
 (I)  WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (II) IN THE CASE OF
 MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES PROVIDERS,  ANY  AFFIL-
 IATIONS  WITH  PARTICIPATING  FACILITIES  CERTIFIED OR AUTHORIZED BY THE
 OFFICE OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE
 SERVICES,  AND  ANY RESTRICTIONS REGARDING THE AVAILABILITY OF THE INDI-
 VIDUAL PROVIDER'S SERVICES; AND (III) in the case of  physicians,  board
 certification,  languages spoken and any affiliations with participating
 hospitals. The listing shall also be posted on  the  health  maintenance
 organization's  website  and  the  health maintenance organization shall
 update the website within fifteen days of the addition or termination of
 a provider from the  health  maintenance  organization's  network  or  a
 change in a physician's hospital affiliation;
   (t) with respect to out-of-network coverage:
   (i)  a clear description of the methodology used by the health mainte-
 nance organization to determine reimbursement for out-of-network  health
 care services;
   (ii)  the  amount  that the health maintenance organization will reim-
 burse under the methodology for out-of-network health care services  set
 forth as a percentage of the usual and customary cost for out-of-network
 health care services;
   (iii)  examples  of  anticipated  out-of-pocket  costs  for frequently
 billed out-of-network health care services; [and]
   (u) information in  writing  and  through  an  internet  website  that
 reasonably  permits  an enrollee or prospective enrollee to estimate the
 anticipated out-of-pocket cost for out-of-network health  care  services
 in  a  geographical  area  or zip code based upon the difference between
 what the health maintenance organization will reimburse for  out-of-net-
 work  health  care services and the usual and customary cost for out-of-
 network health care services[.]; AND
   (V) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE HEALTH MAIN-
 TENANCE ORGANIZATION TO ASSESS THE PROVISION OF ITS COVERED SERVICES  IN
 ACCORDANCE WITH THE PAUL WELLSTONE AND PETE DOMINICI MENTAL HEALTH PARI-
 TY  AND  ADDICTION EQUITY ACT OF 2008, 42 U.S.C. 18031(J) AND ANY AMEND-
 MENTS TO, AND FEDERAL GUIDANCE AND REGULATIONS ISSUED UNDER, THOSE ACTS.
   § 42. Subparagraph (iii) of paragraph (a) of subdivision 2 of  section
 4900    of  the public health law, as added by chapter 41 of the laws of
 2014, is amended and a  new  subparagraph  (iv)  is  added  to  read  as
 follows:
   (iii) for purposes of a determination involving substance use disorder
 treatment:
   (A)  a  physician  who  possesses  a  current and valid non-restricted
 license to practice medicine and who specializes  in  behavioral  health

 S. 1507--A                         149                        A. 2007--A
 
 and  has experience in the delivery of substance use disorder courses of
 treatment; or
   (B)  a  health  care  professional other than a licensed physician who
 specializes in behavioral health and has experience in the  delivery  of
 substance  use  disorder  courses  of  treatment  and, where applicable,
 possesses a current and valid  non-restricted  license,  certificate  or
 registration or, where no provision for a license, certificate or regis-
 tration  exists, is credentialed by the national accrediting body appro-
 priate to the profession; [and] OR
   (IV) FOR PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR A  MENTAL
 HEALTH CONDITION:
   (A)  A  PHYSICIAN  WHO  POSSESSES  A  CURRENT AND VALID NON-RESTRICTED
 LICENSE TO PRACTICE MEDICINE AND WHO SPECIALIZES  IN  BEHAVIORAL  HEALTH
 AND  HAS  EXPERIENCE  IN THE DELIVERY OF MENTAL HEALTH COURSES OF TREAT-
 MENT; OR
   (B) A HEALTH CARE PROFESSIONAL OTHER THAN  A  LICENSED  PHYSICIAN  WHO
 SPECIALIZES IN BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE DELIVERY OF A
 MENTAL  HEALTH  COURSES  OF TREATMENT AND, WHERE APPLICABLE, POSSESSES A
 CURRENT AND VALID NON-RESTRICTED LICENSE, CERTIFICATE,  OR  REGISTRATION
 OR,  WHERE  NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE OR REGISTRATION
 EXISTS, IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE  TO
 THE PROFESSION; AND
   §  43.  Paragraph  (i)  of subdivision 1 of section 4902 of the public
 health law, as amended by section 2 of part A of chapter 69 of the  laws
 of 2016, is amended and a new paragraph (j) is added to read as follows:
   (i)  When  conducting  utilization  review for purposes of determining
 health care coverage for substance use disorder treatment, a utilization
 review agent shall utilize AN evidence-based and peer reviewed  clinical
 review [tools designated by the office of alcoholism and substance abuse
 services  that  are appropriate to the age of the patient and consistent
 with the treatment service levels within the office  of  alcoholism  and
 substance  abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE OF
 THE PATIENT. WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW  FOR  TREATMENT
 PROVIDED  IN  THIS  STATE,  A  UTILIZATION REVIEW AGENT SHALL UTILIZE AN
 EVIDENCE-BASED AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE  OFFICE
 OF  ALCOHOLISM  AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT WITH THE
 TREATMENT SERVICE LEVELS WITHIN THE OFFICE OF ALCOHOLISM  AND  SUBSTANCE
 ABUSE  SERVICES  SYSTEM. All approved tools shall have inter rater reli-
 ability  testing  completed  by  December  thirty-first,  two   thousand
 sixteen.
   (J)  WHEN  CONDUCTING  UTILIZATION  REVIEW FOR PURPOSES OF DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT SHALL UTILIZE EVIDENCE-BASED AND  PEER  REVIEWED  CLINICAL  REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW  AGENT  SHALL USE CLINICAL REVIEW CRITERIA DEEMED APPROPRIATE AND
 APPROVED FOR SUCH USE BY  THE  COMMISSIONER  OF  THE  OFFICE  OF  MENTAL
 HEALTH,  IN CONSULTATION WITH THE COMMISSIONER AND THE SUPERINTENDENT OF
 FINANCIAL SERVICES.  APPROVED CLINICAL REVIEW CRITERIA SHALL HAVE  INTER
 RATER  RELIABILITY TESTING COMPLETED BY DECEMBER THIRTY-FIRST, TWO THOU-
 SAND NINETEEN.
   § 44. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date; provided, however, notwithstanding any provision  of
 law to the contrary, nothing in this act shall limit the rights accruing
 to  employees  pursuant  to  a  collective bargaining agreement with any

 S. 1507--A                         150                        A. 2007--A
 
 state or local government employer for the unexpired term of such agree-
 ment where such agreement is in effect on the effective date of this act
 and so long as such agreement remains in effect thereafter or the eligi-
 bility of any member of an employee organization to join a health insur-
 ance  plan open to him or her pursuant to such a collectively negotiated
 agreement.
 
                                 SUBPART B
 
   Section 1. Subdivision 1 of section 2803-u of the public  health  law,
 as  added  by  section 1 of part C of chapter 70 of the laws of 2016, is
 amended to read as follows:
   1. The office of alcoholism and substance abuse services, in consulta-
 tion with the department, shall develop or utilize existing  educational
 materials to be provided to general hospitals to disseminate to individ-
 uals  with  a documented substance use disorder or who appear to have or
 be at risk for a substance use disorder during discharge planning pursu-
 ant to section twenty-eight hundred three-i of this  [chapter]  ARTICLE.
 Such  materials shall include information regarding the various types of
 treatment and recovery services, including but not limited  to:    inpa-
 tient,  outpatient,  and medication-assisted treatment; how to recognize
 the need for treatment services; information for individuals  to  deter-
 mine  what  type  and  level  of  treatment is most appropriate and what
 resources are available to them; and any other information  the  commis-
 sioner deems appropriate. GENERAL HOSPITALS SHALL INCLUDE IN THEIR POLI-
 CIES  AND PROCEDURES TREATMENT PROTOCOLS, CONSISTENT WITH MEDICAL STAND-
 ARDS, TO BE UTILIZED BY THE EMERGENCY DEPARTMENTS IN  GENERAL  HOSPITALS
 FOR  THE  APPROPRIATE  USE  OF  MEDICATION-ASSISTED TREATMENT, INCLUDING
 BUPRENORPHINE, PRIOR TO DISCHARGE, OR REFERRAL PROTOCOLS FOR  EVALUATION
 OF MEDICATION-ASSISTED TREATMENT WHEN INITIATION IN AN EMERGENCY DEPART-
 MENT OF A GENERAL HOSPITAL IS NOT FEASIBLE.
   § 2. This act shall take effect immediately.
 
                                 SUBPART C
 
   Section  1.  Subparagraph  (v)  of  paragraph  (a) of subdivision 2 of
 section 3343-a of the public health law is  REPEALED  and  subparagraphs
 (vi),  (vii),  (viii),  (ix)  and  (x) are renumbered subparagraphs (v),
 (vi), (vii), (viii) and (ix).
   § 2. This act shall take effect immediately.
 
                                 SUBPART D
 
   Section 1. Paragraph (r) of subdivision 4  of  section  364-j  of  the
 social services law, as amended by section 39 of part A of chapter 56 of
 the laws of 2013, is amended to read as follows:
   (r)  A  managed  care  provider shall provide services to participants
 pursuant to an order of a  court  of  competent  jurisdiction,  provided
 however,  that  such  services shall be within such provider's or plan's
 benefit package and are reimbursable under  title  xix  of  the  federal
 social security act, PROVIDED THAT SERVICES FOR A SUBSTANCE USE DISORDER
 SHALL  BE PROVIDED BY A PROGRAM LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
   § 2. This act shall take effect immediately;  provided,  however  that
 the amendments to paragraph (r) of subdivision 4 of section 364-j of the

 S. 1507--A                         151                        A. 2007--A
 
 social services law made by section one of this act shall not affect the
 repeal of such section and shall be deemed to be repealed therewith.
 
                                 SUBPART E
 
   Section 1. Subdivision (b) of schedule I of section 3306 of the public
 health  law is amended by adding nineteen new paragraphs 58, 59, 60, 61,
 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 and 76 to read as
 follows:
   (58) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLBUTYRAMIDE.    OTHER  NAME:
 BUTYRYL FENTANYL.
   (59) N-[1-[2-hydroxy-2-(thiophen-2-yl)ethyl]PIPERIDIN-4-Y1]-N-PHENYLPRO-
 PIONAMIDE.  OTHER NAME: BETA-HYDROXYTHIOFENTANYL.
   (60) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLFURAN-2-CARBOXAMIDE.  OTHER
 NAME: FURANYL FENTANYL.
   (61) 3,4-DICHLORO-N-[2-(dimethylamino)cyclohexyl]-N-METHYLBENZAMIDE.
 OTHER NAME: U-47700.
   (62) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACRYLAMIDE.  OTHER   NAMES:
 ACRYL FENTANYL OR ACRYLOYLFENTANYL.
   (63) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER  NAMES:  4-FLUOROISOBUTYRYL FENTANYL, PARA-FLUOROISOBUTYRYL FENTA-
 NYL.
   (64) N-(2-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)PROPIONAMIDE.
 OTHER NAMES: ORTHO-FLUOROFENTANYL OR 2-FLUOROFENTANYL.
   (65) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLTETRAHYDROFURAN-2-CARBOXAMIDE.
 OTHER NAME: TETRAHYDROFURANYL FENTANYL.
   (66) 2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACETAMIDE.  OTHER
 NAME: METHOXYACETYL FENTANYL.
   (67) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPROPANECARBOXAMIDE.
 OTHER NAME: CYCLOPROPYL FENTANYL.
   (68) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLPENTANAMIDE.   OTHER  NAME:
 VALERYL FENTANYL.
   (69) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE. OTHER
 NAME: PARA-FLUOROBUTYRYLFENTANYL.
   (70) N-(4-METHOXYPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE.
 OTHER NAME: PARA-METHOXYBUTYRYL FENTANYL.
   (71) N-(4-CHLOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER NAME: PARA-CHLOROISOBUTYRYL FENTANYL.
   (72) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLISOBUTYRAMIDE. OTHER  NAME:
 ISOBUTYRYL FENTANYL.
   (73) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPENTANECARBOXAMIDE.
 OTHER NAME: CYCLOPENTYL FENTANYL.
   (74) N-(2-FLUOROPHENY1)-2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-YL)
 ACETAMIDE. OTHER NAME: OCFENTANIL.
   (75) 1-CYCLOHEXY1-4-(1,2-DIPHENYLETHYL)PIPERAZINE. OTHER NAME: MT-45.
   (76) FENTANYL-RELATED SUBSTANCES, THEIR ISOMERS, ESTERS, ETHERS, SALTS
 AND SALTS OF ISOMERS, ESTERS AND ETHERS.
   (I) FENTANYL-RELATED SUBSTANCE MEANS ANY SUBSTANCE NOT OTHERWISE LIST-
 ED  IN  THIS SECTION, THAT IS STRUCTURALLY RELATED TO FENTANYL BY ONE OR
 MORE OF THE FOLLOWING MODIFICATIONS:
   (A) REPLACEMENT OF THE PHENYL PORTION OF THE PHENETHYL  GROUP  BY  ANY
 MONOCYCLE, WHETHER OR NOT FURTHER SUBSTITUTED IN OR ON THE MONOCYCLE;
   (B) SUBSTITUTION  IN  OR  ON  THE PHENETHYL GROUP WITH ALKYL, ALKENYL,
 ALKOXYL, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;
   (C) SUBSTITUTION IN OR ON THE PIPERIDINE  RING  WITH  ALKYL,  ALKENYL,
 ALKOXYL, ESTER, ETHER, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;

 S. 1507--A                         152                        A. 2007--A
 
   (D) REPLACEMENT OF THE ANILINE RING WITH ANY AROMATIC MONOCYCLE WHETH-
 ER OR NOT FURTHER SUBSTITUTED IN OR ON THE AROMATIC MONOCYCLE; AND/OR
   (E) REPLACEMENT OF THE N-PROPIONYL GROUP BY ANOTHER ACYL GROUP.
   §  2. Section 3308 of the public health law is amended by adding a new
 subdivision 7 to read as follows:
   7. THE COMMISSIONER MAY, BY  REGULATION,  CLASSIFY  AS  A  SCHEDULE  I
 CONTROLLED SUBSTANCE IN SECTION THREE THOUSAND THREE HUNDRED SIX OF THIS
 ARTICLE  ANY  SUBSTANCE LISTED IN SCHEDULE I OF THE FEDERAL SCHEDULES OF
 CONTROLLED SUBSTANCES IN 21 USC §812 OR 21 CFR §1308.11.
   § 3. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment  shall  have been rendered. It has hereby declared to be the intent
 of the legislature that this act would have been enacted  even  if  such
 invalid provisions had not been included herein.
   §  3.  This  act shall take effect immediately provided, however, that
 the applicable effective date of Subparts A through E of this act  shall
 be as specifically set forth in the last section of such Subparts.
 
                                  PART CC
 
   Section  1.  The  public health law is amended by adding a new section
 280-d to read as follows:
   § 280-D.  PRESCRIBER  ASSISTANCE.  1.  UNLICENSED  ASSISTANTS  MAY  BE
 EMPLOYED  IN LICENSED PHARMACIES FOR PURPOSES OTHER THAN THE PRACTICE OF
 PHARMACY, INCLUDING AT LEAST TWO UNLICENSED PERSONS  PER  PHARMACIST  TO
 ASSIST  IN THE DISPENSING OF DRUGS, PROVIDED, HOWEVER, THAT A PHARMACIST
 MAY OBTAIN THE ASSISTANCE OF UP TO FOUR  ADDITIONAL  UNLICENSED  PERSONS
 WHERE SUCH ADDITIONAL UNLICENSED PERSONS ARE CERTIFIED AS PHARMACY TECH-
 NICIANS  BY  A  NATIONALLY  ACCREDITED PHARMACY TECHNICIAN CERTIFICATION
 PROGRAM. PROOF OF CERTIFICATION FOR SUCH INDIVIDUALS EMPLOYED BY A PHAR-
 MACY SHALL BE MAINTAINED BY THE PHARMACY AND PROVIDED TO STATE  AGENCIES
 UPON  REQUEST. THE DEPARTMENT AND STATE BOARD OF PHARMACY SHALL CONSIDER
 AND MAY ESTABLISH REGULATIONS PERMITTING  A  PHARMACIST  TO  OBTAIN  THE
 ASSISTANCE OF A GREATER NUMBER OF UNLICENSED PERSONS.
   2. (A) THE COMPOUNDING, PREPARATION, LABELING, OR DISPENSING OF DRUGS,
 IN  ACCORDANCE  WITH  ARTICLE  ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION
 LAW, IN FACILITIES LICENSED IN ACCORDANCE WITH ARTICLE  TWENTY-EIGHT  OF
 THIS  CHAPTER  SHALL  BE  PERFORMED  BY:  (I)  A LICENSED PHARMACIST, AS
 DEFINED IN ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW; (II) A
 PHARMACY INTERN, UNDER THE DIRECT SUPERVISION OF A  LICENSED  PHARMACIST
 AS  DEFINED IN ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW; OR
 (III) UNDER THE DIRECT SUPERVISION OF A LICENSED PHARMACIST AN  INDIVID-
 UAL WHO HAS RECEIVED CERTIFICATION FROM A NATIONALLY ACCREDITED PHARMACY
 TECHNICIAN  CERTIFICATION  PROGRAM  MAY  ASSIST  IN  THE PREPARATION AND
 DISPENSING OF DRUGS INCLUDING WEIGHING, MIXING, AND MEASURING WHEN PROP-
 ERLY TRAINED. PROOF OF CERTIFICATION AND TRAINING FOR  SUCH  INDIVIDUALS
 EMPLOYED  BY A FACILITY SHALL BE MAINTAINED BY THE FACILITY AND PROVIDED
 TO STATE AGENCIES UPON REQUEST.
   (B) A PERSON EMPLOYED IN A FACILITY LICENSED IN ACCORDANCE WITH  ARTI-
 CLE  TWENTY-EIGHT  OF THIS CHAPTER WHO DIRECTLY ASSISTS LICENSED PHARMA-

 S. 1507--A                         153                        A. 2007--A
 
 CISTS TO DISPENSE PRESCRIPTIONS IN SUCH FACILITY ON THE  EFFECTIVE  DATE
 OF  THIS  SECTION  SHALL BE EXEMPT FROM THE CERTIFICATION REQUIREMENT IN
 PARAGRAPH (A) OF THIS SUBDIVISION IF HE OR SHE SUBMITS EVIDENCE TO,  AND
 VERIFIED  BY,  HIS  OR  HER  EMPLOYER, OF A MINIMUM OF FIVE (5) YEARS OF
 EMPLOYMENT IN GOOD STANDING IN A PHARMACY WITHIN THE PREVIOUS EIGHT  (8)
 YEARS,  INCLUDING  EIGHTEEN  CONSECUTIVE  MONTHS WITH A SINGLE EMPLOYER.
 SUCH EVIDENCE AND VERIFICATION SHALL BE DOCUMENTED AND MAINTAINED BY THE
 FACILITY AND PROVIDED TO STATE AGENCIES UPON  REQUEST.  SUCH  INDIVIDUAL
 SHALL NOT BE PERMITTED TO ASSIST IN THE COMPOUNDING OF MEDICATIONS.
   § 2. This act shall take effect immediately.
 
                                  PART DD
 
   Section  1.    (a)  Notwithstanding  any other provision of law to the
 contrary, for the state fiscal years beginning April 1, 2019 and  ending
 on  March  31, 2021, all Medicaid payments made for services provided on
 and after April 1, 2019,  shall,  except  as  hereinafter  provided,  be
 subject  to  a uniform reduction and such reduction shall be applied, to
 the extent  practicable,  in  equal  amounts  during  the  fiscal  year,
 provided,  however,  that an alternative method may be considered at the
 discretion of the commissioner of health and the director of the  budget
 based  upon consultation with the health care industry including but not
 limited to, a uniform reduction in Medicaid rates of payments  or  other
 reductions provided that any method selected achieves up to $190,200,000
 in Medicaid state share savings in state fiscal year 2019-2020 and up to
 $190,200,000  in  state  fiscal  year  2020-2021,  except as hereinafter
 provided, for services provided on and after April 1, 2019 through March
 31, 2021. Any alternative methods  to  achieve  the  reduction  must  be
 provided in writing and shall be filed with the senate finance committee
 and  the  assembly  ways  and  means committee not less than thirty days
 before the date on which implementation is expected to begin. Nothing in
 this section shall be deemed to prevent all or part of such  alternative
 reduction plan from taking effect retroactively, to the extent permitted
 by the federal centers for medicare and Medicaid services.
   (b)  The  following  types  of  appropriations  shall  be  exempt from
 reductions pursuant to this section:
   (i) any reductions that would violate federal law including,  but  not
 limited to, payments required pursuant to the federal medicare program;
   (ii) any reductions related to direct payments pursuant to article 32,
 article 31 and article 16 of the mental hygiene law;
   (iii) payments the state is obligated to make pursuant to court orders
 or judgments;
   (iv)  payments  for  which  the non-federal share does not reflect any
 state funding; and
   (v) at the discretion of the commissioner of health and  the  director
 of  the  budget,  payments  with regard to which it is determined by the
 commissioner of health and the director of the budget  that  application
 of  reductions  pursuant  to  this section would result, by operation of
 federal law, in a lower federal medical assistance percentage applicable
 to such payments.
   (c) Reductions to Medicaid payments or Medicaid rates of payments made
 pursuant to this section shall be subject to the receipt of  all  neces-
 sary federal approvals.
   § 2. This act shall take effect immediately.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of

 S. 1507--A                         154                        A. 2007--A
 
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 3. This act shall take effect immediately  provided,  however,  that
 the applicable effective date of Parts A through DD of this act shall be
 as specifically set forth in the last section of such Parts.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1507--B
 
                             I N  S E N A T E
 
                             January 18, 2019
                                ___________
 
 A  BUDGET  BILL,  submitted by the Governor pursuant to article seven of
   the Constitution -- read twice and ordered printed, and  when  printed
   to  be  committed to the Committee on Finance -- committee discharged,
   bill amended, ordered reprinted as amended  and  recommitted  to  said
   committee  -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee

 AN ACT to amend the social services law, in relation to reimbursement of
   transportation  costs,  reimbursement  of   emergency   transportation
   services  and  supplemental transportation payments (Part A); to amend
   the public health law, in relation  to  extending  and  enhancing  the
   Medicaid  drug  cap and to reduce unnecessary pharmacy benefit manager
   costs to the Medicaid program (Part B); to amend the  social  services
   law,  in relation to the extension of the National Diabetes Prevention
   Program and the inclusion in standard coverage of  medically  tailored
   meals  and  medical  nutrition therapy for certain persons and applied
   behavioral analysis treatment for those with autism spectrum  disorder
   (Part  C); to amend chapter 59 of the laws of 2011 amending the public
   health law and other laws relating to known and  projected  department
   of  health  state fund medicaid expenditures, in relation to extending
   the medicaid global cap (Part D); to amend chapter 505 of the laws  of
   1995,  amending  the  public  health  law relating to the operation of
   department  of  health  facilities,  in  relation  to  extending   the
   provisions  thereof; to amend chapter 56 of the laws of 2013, amending
   the  social  services  law  relating  to  eligibility  conditions,  in
   relation  to extending the provisions thereof; to amend chapter 884 of
   the laws of 1990, amending the public health law relating to authoriz-
   ing bad debt and charity care allowances  for  certified  home  health
   agencies,  in  relation  to extending the provisions thereof; to amend
   chapter 303 of the laws of 1999, amending the New York  state  medical
   care facilities finance agency act relating to financing health facil-
   ities,  in relation to the effectiveness thereof; to amend chapter 109
   of the laws of 2010, amending the  social  services  law  relating  to
   transportation  costs,  in  relation  to the effectiveness thereof; to
   amend chapter 58 of the laws of 2009, amending the public  health  law
   relating  to  payment  by  governmental  agencies for general hospital
   inpatient services, in relation to the effectiveness thereof; to amend
   chapter 56 of the laws of 2013, amending the public health law  relat-
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD12571-04-9

 S. 1507--B                          2
 
   ing  to  the  general  public  health work program, in relation to the
   effectiveness thereof; to amend chapter 59 of the laws of 2011, amend-
   ing the public health  law  and  other  laws  relating  to  known  and
   projected  department  of  health  state fund medical expenditures, in
   relation to extending the provisions  thereof;  to  amend  the  public
   health  law, in relation to hospital assessments; to amend chapter 474
   of the laws of 1996, amending the education law and other laws  relat-
   ing  to  rates  for residential health care facilities, in relation to
   the effectiveness thereof; to amend chapter 58 of the  laws  of  2007,
   amending  the  social services law and other laws relating to enacting
   the major components of legislation necessary to implement the  health
   and  mental  hygiene  budget  for  the 2007-2008 state fiscal year, in
   relation to delay of certain administrative costs; to amend chapter 81
   of the laws of 1995, amending the public health  law  and  other  laws
   relating  to  medical reimbursement and welfare reform, in relation to
   the effectiveness thereof; to amend chapter 56 of the  laws  of  2013,
   amending chapter 59 of the laws of 2011 amending the public health law
   and  other  laws relating to general hospital reimbursement for annual
   rates, in relation to rates of payments; to amend  the  public  health
   law,  in  relation  to reimbursement rate promulgation for residential
   health care facilities; to amend the public health law, in relation to
   residential health care facility, and  certified  home  health  agency
   services  payments;  to amend chapter 81 of the laws of 1995, amending
   the public health law and other laws relating to medical reimbursement
   and welfare reform, in relation to the effectiveness thereof; to amend
   chapter 56 of the laws of 2013 amending chapter 59 of the laws of 2011
   amending the public health law and  other  laws  relating  to  general
   hospital  reimbursement  for  annual  rates,  in relation to extending
   government rates for behavioral services  and  adding  an  alternative
   payment  methodology  requirement; to amend chapter 111 of the laws of
   2010 relating to increasing Medicaid  payments  to  providers  through
   managed  care  organizations  and providing equivalent fees through an
   ambulatory patient group methodology, in relation to extending govern-
   ment rates for behavioral services and adding an  alternative  payment
   methodology  requirement;  to amend section 2 of part H of chapter 111
   of the laws of 2010,  relating  to  increasing  Medicaid  payments  to
   providers  through managed care organizations and providing equivalent
   fees through an ambulatory patient group methodology, in  relation  to
   transfer  of funds and the effectiveness thereof; and to amend chapter
   649 of the laws of 1996, amending the public health  law,  the  mental
   hygiene  law  and  the social services law relating to authorizing the
   establishment of special needs plans, in relation to the effectiveness
   thereof (Part E); to amend chapter 266 of the laws of  1986,  amending
   the  civil  practice law and rules and other laws relating to malprac-
   tice and professional medical conduct,  in  relation  to  apportioning
   premium  for  certain  policies;  to amend part J of chapter 63 of the
   laws of 2001 amending chapter 266 of the laws of  1986,  amending  the
   civil  practice  law  and rules and other laws relating to malpractice
   and professional medical conduct, relating  to  the  effectiveness  of
   certain  provisions  of such chapter, in relation to extending certain
   provisions concerning the hospital excess liability pool; and to amend
   part H of chapter 57 of the laws of 2017, amending the New York Health
   Care Reform Act of 1996 and other laws relating to  extending  certain
   provisions  relating  thereto,  in  relation  to  extending provisions
   relating to excess coverage (Part F); to amend the public  health  law
   and  the  social  services law, in relation to the payment of rates to

 S. 1507--B                          3
 
   managed care plans and the service providers of such  plans  for  long
   term care services; and requires the commissioner of health to convene
   a workgroup on case mix adjustments for residential health care facil-
   ities  (Part G); to amend the public health law, in relation to waiver
   of certain regulations; and to repeal certain provisions of  such  law
   relating  thereto  (Part H); to amend the insurance law and the public
   health law, in relation to  registration  and  licensing  of  pharmacy
   benefit  managers  (Part I); to amend the insurance law and the public
   health law,  in  relation  to  guaranteed  availability,  pre-existing
   conditions   and   employee  welfare  funds;  and  to  repeal  certain
   provisions of the insurance law relating thereto (Subpart A); to amend
   the insurance law, in relation to  actuarial  value  requirements  and
   essential  health benefits (Subpart B); to amend the insurance law, in
   relation to coverage for medically necessary abortions, and exceptions
   thereto (Subpart C); to  amend  the  insurance  law,  in  relation  to
   prescription drug coverage (Subpart D); to amend the insurance law, in
   relation  to  discrimination based on sex and gender identity (Subpart
   E); and intentionally omitted (Subpart F) (Part J); to  amend  chapter
   517  of  the  laws  of 2016 amending the public health law relating to
   payments from the New York state medical indemnity fund,  in  relation
   to  the effectiveness thereof (Part K); to amend the insurance law, in
   relation to insurance coverage of in  vitro  fertilization  and  other
   fertility  preservation  treatments  (Part  L);  intentionally omitted
   (Part M); intentionally omitted (Part N); intentionally omitted  (Part
   O);  to amend the public health law and the executive law, in relation
   to elevated blood lead levels and testing for lead (Part P); to  amend
   the  public  health law, in relation to the healthcare facility trans-
   formation program state III mandating certain awards  and  authorizing
   additional awards for statewide II applications (Part Q); to amend the
   public health law, in relation to maternal mortality review boards and
   the maternal mortality and morbidity advisory council (Part R); inten-
   tionally omitted (Part S); to amend the public health law, in relation
   to  codifying  the creation of NY State of Health, the official Health
   Plan Marketplace within the department of health (Part  T);  to  amend
   the elder law, in relation to the private pay program (Part U); inten-
   tionally  omitted (Part V); to amend part D of chapter 111 of the laws
   of 2010 relating to the recovery of exempt income  by  the  office  of
   mental  health  for  community  residences  and family-based treatment
   programs, in relation to the effectiveness thereof (Part W); to  amend
   the criminal procedure law, in relation to authorizing restorations to
   competency  within  correctional  facility based residential settings;
   and providing for the repeal of such provisions upon expiration there-
   of (Part X); to amend part C of chapter 57 of the laws of 2006, relat-
   ing to establishing a cost of living adjustment for  designated  human
   services  programs,  in  relation  to the inclusion and development of
   certain cost of living adjustments  (Part  Y);  to  amend  the  public
   health  law  and  the  mental  hygiene  law, in relation to integrated
   services (Part Z); intentionally  omitted  (Part  AA);  to  amend  the
   insurance law, in relation to mental health and substance use disorder
   health  insurance  parity; to amend the public health law, in relation
   to health maintenance organizations; and to repeal certain  provisions
   of the insurance law relating thereto (Subpart A); to amend the public
   health law, in relation to general hospital policies for substance use
   disorder  treatment  (Subpart  B); to repeal subparagraph (v) of para-
   graph (a) of subdivision 2 of section 3343-a of the public health  law
   relating to general hospital prescription drug monitoring (Subpart C);

 S. 1507--B                          4
 
   to  amend  the  social  services  law,  in  relation  to court ordered
   substance use disorder treatment (Subpart D); and to amend the  public
   health  law,  in  relation to including fentanyl analogs as controlled
   substances  (Subpart  E)  (Part  BB);  amend the public health law, in
   relation to prescriber assistance  in  allowing  unlicensed  certified
   pharmacy  technicians  to  assist  in  dispensing  of drugs (Part CC);
   intentionally omitted (Part DD); to amend the social services law,  in
   relation  to  denial  of  a claim based on lack of prior authorization
   (Part EE); to amend the social services law, in relation to establish-
   ing the home care asthma management program (Part FF);  directing  the
   department  of health to submit a Medicaid state plan amendment to the
   centers for Medicare and Medicaid service to request authorization  to
   establish   and  administer  a  methodology  to  provide  supplemental
   reimbursement to certain eligible ground emergency medical transporta-
   tion providers (Part GG); in relation to establishing the primary  and
   preventive  reproductive  health care program; and making an appropri-
   ation therefor (Part HH); to amend the public health law, in  relation
   to   funding  early  intervention  services;  and  to  repeal  certain
   provisions of the public health law and  the  insurance  law  relating
   thereto  (Part  II);  to  amend  the public health law, in relation to
   expanding health department review  of  correctional  health  services
   (Part  JJ);  to amend the elder law, in relation to grants awarded for
   classic NORC programs (Part KK); to amend the mental hygiene  law,  in
   relation  to  establishing  a  credentialing  pilot program for direct
   support professionals (Part  LL);  to  amend  the  executive  law,  in
   relation  to  establishing  the office of the advocate for people with
   disabilities (Part MM); and to amend the elder law, in relation to the
   program for elderly pharmaceutical insurance coverage (Part NN)
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  This  act enacts into law major components of legislation
 which are necessary to implement the state fiscal plan for the 2019-2020
 state fiscal year. Each component is  wholly  contained  within  a  Part
 identified as Parts A through NN. The effective date for each particular
 provision contained within such Part is set forth in the last section of
 such  Part.    Any  provision  in  any  section contained within a Part,
 including the effective date of the Part, which makes a reference  to  a
 section  "of  this  act",  when  used in connection with that particular
 component, shall be deemed  to  mean  and  refer  to  the  corresponding
 section of the Part in which it is found. Section three of this act sets
 forth the general effective date of this act.
 
                                  PART A
 
   Section  1. Subdivision 4 of section 365-h of the social services law,
 as separately amended by section 50 of part B and section 24 of  part  D
 of chapter 57 of the laws of 2015, is amended to read as follows:
   4.  The  commissioner of health is authorized to assume responsibility
 from a local social services official for the provision  and  reimburse-
 ment  of  transportation  costs  under this section. If the commissioner
 elects to assume such responsibility, the commissioner shall notify  the
 local  social  services official in writing as to the election, the date
 upon which the election shall be effective and such  information  as  to

 S. 1507--B                          5
 
 transition  of  responsibilities  as the commissioner deems prudent. The
 commissioner is authorized to contract with a transportation manager  or
 managers  to manage transportation services in any local social services
 district,  other  than  transportation services provided or arranged for
 [enrollees of managed  long  term  care  plans  issued  certificates  of
 authority  under section forty-four hundred three-f of the public health
 law]: ADULT DAY HEALTH CARE PROGRAMS LOCATED AT A  LICENSED  RESIDENTIAL
 HEALTH  CARE  FACILITY AS DEFINED BY SECTION TWENTY-EIGHT HUNDRED ONE OF
 THE PUBLIC HEALTH LAW OR ANY APPROVED EXTENSION  SITE  THEREOF;  PARTIC-
 IPANTS  OF  A  PROGRAM DESIGNATED AS A PROGRAM OF ALL-INCLUSIVE CARE FOR
 THE ELDERLY (PACE) AS AUTHORIZED BY FEDERAL PUBLIC LAW 105-33,  SUBTITLE
 I  OF  TITLE  IV  OF THE BALANCED BUDGET ACT OF 1997; AND ENROLLEES OF A
 MANAGED LONG TERM CARE PLAN ISSUED  A  CERTIFICATE  OF  AUTHORITY  UNDER
 SECTION  FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW THAT ELECTS
 TO PROVIDE OR ARRANGE FOR TRANSPORTATION SERVICES DIRECTLY. THE  COMMIS-
 SIONER  SHALL  OFFER MANAGED LONG TERM CARE PLANS OTHER THAN PROGRAMS OF
 ALL-INCLUSIVE CARE FOR THE ELDERLY, AND ADULT DAY HEALTH  CARE  PROGRAMS
 THE  OPTION  TO ARRANGE TRANSPORTATION DIRECTLY OR UTILIZE A TRANSPORTA-
 TION MANAGER OR MANAGERS SELECTED BY THE COMMISSIONER.  Any  transporta-
 tion  manager  or managers selected by the commissioner to manage trans-
 portation  services  shall  have  proven  experience   in   coordinating
 transportation  services in a geographic and demographic area similar to
 the area in New York state within which the contractor would manage  the
 provision  of  services under this section. Such a contract or contracts
 may include responsibility  for:  review,  approval  and  processing  of
 transportation  orders; management of the appropriate level of transpor-
 tation based on documented patient medical need; and development of  new
 technologies  leading  to  efficient  transportation  services.  If  the
 commissioner elects to assume such responsibility from  a  local  social
 services  district,  the commissioner shall examine and, if appropriate,
 adopt quality assurance measures that may include, but are  not  limited
 to,  global  positioning  tracking  system  reporting  requirements  and
 service verification mechanisms. Any and all reimbursement rates  devel-
 oped  by transportation managers under this subdivision shall be subject
 to the review and approval of the commissioner.
   § 2. Intentionally omitted.
   § 3. Intentionally omitted.
   § 4. This act shall take effect immediately.
 
                                  PART B

   Section 1. Intentionally omitted.
   § 2. Intentionally omitted.
   § 3. Intentionally omitted.
   § 4. Intentionally omitted.
   § 5. Paragraphs (b) and (c) of subdivision 2 of  section  280  of  the
 public  health  law, paragraph (b) as amended and paragraph (c) as added
 by section 8 of part D of chapter 57 of the laws of  2018,  are  amended
 and a new paragraph (d) is added to read as follows:
   (b)  for  state  fiscal year two thousand eighteen--two thousand nine-
 teen, be limited to the ten-year rolling average of the  medical  compo-
 nent  of the consumer price index plus four percent and minus a pharmacy
 savings target of eighty-five million dollars; [and]
   (c) for state fiscal year two thousand nineteen--two thousand  twenty,
 be  limited  to the ten-year rolling average of the medical component of

 S. 1507--B                          6
 
 the consumer price index plus four percent and minus a pharmacy  savings
 target of eighty-five million dollars[.]; AND
   (D)  FOR  STATE  FISCAL YEAR TWO THOUSAND TWENTY--TWO THOUSAND TWENTY-
 ONE, BE LIMITED TO THE TEN-YEAR ROLLING AVERAGE OF THE MEDICAL COMPONENT
 OF THE CONSUMER PRICE INDEX PLUS  FOUR  PERCENT  AND  MINUS  A  PHARMACY
 SAVINGS TARGET OF EIGHTY-FIVE MILLION DOLLARS.
   § 6. Subdivision 3 of section 280 of the public health law, as amended
 by  section 8 of part D of chapter 57 of the laws of 2018, is amended to
 read as follows:
   3. The department and the division of the budget  shall  assess  on  a
 quarterly basis the projected total amount to be expended in the year on
 a  cash  basis  by the Medicaid program for each drug, and the projected
 annual amount of state funds Medicaid drug expenditures on a cash  basis
 for all drugs, which shall be a component of the projected department of
 health  state  funds  Medicaid  expenditures  calculated for purposes of
 sections ninety-one and ninety-two of part H of  chapter  fifty-nine  of
 the  laws  of  two  thousand eleven. For purposes of this section, state
 funds Medicaid drug expenditures include amounts expended for  drugs  in
 both  the  Medicaid  fee-for-service  program  and Medicaid managed care
 programs, minus the amount of any  drug  rebates  or  supplemental  drug
 rebates received by the department, including rebates pursuant to subdi-
 vision  five of this section with respect to rebate targets. The depart-
 ment and the division of the budget shall report quarterly to  the  drug
 utilization review board the projected state funds Medicaid drug expend-
 itures  including the amounts, in aggregate thereof, attributable to the
 net cost of: changes in the utilization of drugs by Medicaid recipients;
 changes in the number of Medicaid recipients; changes  to  the  cost  of
 brand  name drugs and changes to the cost of generic drugs. The informa-
 tion contained in the report shall not be publicly released in a  manner
 that allows for the identification of an individual drug or manufacturer
 or  that  is likely to compromise the financial competitive, or proprie-
 tary nature of the information.
   (a) In the event the director of the budget determines, based on Medi-
 caid drug expenditures for the previous quarter or other relevant infor-
 mation, that the total department of health state  funds  Medicaid  drug
 expenditure  is projected to exceed the annual growth limitation imposed
 by subdivision two of this section, the commissioner  may  identify  and
 refer  drugs to the drug utilization review board established by section
 three hundred sixty-nine-bb of the social services law for a recommenda-
 tion as to whether a target supplemental Medicaid rebate should be  paid
 by  the manufacturer of the drug to the department and the target amount
 of the rebate.
   (b) If the department intends to refer a drug to the drug  utilization
 review  board pursuant to paragraph (a) of this subdivision, the depart-
 ment shall notify the manufacturer of such drug  and  shall  attempt  to
 reach  agreement with the manufacturer on a rebate for the drug prior to
 referring the drug to the drug  utilization  review  board  for  review.
 SUCH  REBATE MAY BE BASED ON EVIDENCE-BASED RESEARCH, INCLUDING, BUT NOT
 LIMITED TO, SUCH RESEARCH OPERATED OR CONDUCTED BY OR  FOR  OTHER  STATE
 GOVERNMENTS,  THE  FEDERAL GOVERNMENT, THE GOVERNMENTS OF OTHER NATIONS,
 AND THIRD PARTY PAYERS OR MULTI-STATE COALITIONS.
   (c) [In the event that the  commissioner  and  the  manufacturer  have
 previously  agreed to a supplemental rebate for a drug pursuant to para-
 graph (b) of this subdivision or paragraph (e) of subdivision  seven  of
 section three hundred sixty-seven-a of the social services law, the drug
 shall  not  be  referred  to  the  drug utilization review board for any

 S. 1507--B                          7

 further supplemental rebate for the  duration  of  the  previous  rebate
 agreement.
   (d)]  The department shall consider a drug's actual cost to the state,
 including current rebate amounts, prior to seeking an additional  rebate
 pursuant  to  paragraph (b) [or (c)] of this subdivision [and shall take
 into consideration whether the manufacturer of  the  drug  is  providing
 significant  discounts  relative  to other drugs covered by the Medicaid
 program].
   [(e)] (D) The commissioner shall be authorized  to  take  the  actions
 described  in  this section only so long as total Medicaid drug expendi-
 tures are projected to exceed the annual growth  limitation  imposed  by
 subdivision two of this section.
   §  6-a.  Subdivision  4  of  section  280 of the public health law, as
 amended by section 8 of part D of chapter 57 of the  laws  of  2018,  is
 amended to read as follows:
   4.  In  determining  whether to recommend a target supplemental rebate
 for a drug, the drug utilization review board shall consider the  actual
 cost  of  the  drug to the Medicaid program, including federal and state
 rebates, and may consider, among other things:
   (a) the drug's impact on the Medicaid drug spending growth target  and
 the  adequacy of capitation rates of participating Medicaid managed care
 plans, and the drug's affordability and value to the  Medicaid  program;
 or
   (b) significant and unjustified increases in the price of the drug; or
   (c) whether the drug may be priced disproportionately to its therapeu-
 tic benefits, HOWEVER, THE DRUG UTILIZATION REVIEW BOARD MAY NOT RELY ON
 ASSESSMENTS  THAT  UTILIZE  A MEASURE THAT DISCOUNTS THE VALUE OF A LIFE
 BECAUSE OF AN INDIVIDUAL'S DISABILITY OR AGE WHEN RECOMMENDING A  TARGET
 SUPPLEMENTAL VALUE.
   §  6-b.  Subdivision  5  of  section  280 of the public health law, as
 amended by section 8 of part D of chapter 57 of the  laws  of  2018,  is
 amended to read as follows:
   5. (a) If the drug utilization review board recommends a target rebate
 amount  on  a  drug referred by the commissioner, the commissioner shall
 require a supplemental rebate to be paid by the drug's  manufacturer  in
 an  amount  not  to  exceed such target rebate amount. With respect to a
 rebate required in state fiscal year two thousand  seventeen--two  thou-
 sand  eighteen,  the  rebate  requirement shall apply beginning with the
 month of April, two thousand seventeen, without regard to the  date  the
 department enters into the rebate agreement with the manufacturer.
   (b) The supplemental rebate required by paragraph (a) of this subdivi-
 sion shall apply to drugs dispensed to enrollees of managed care provid-
 ers  pursuant  to  section  three  hundred  sixty-four-j  of  the social
 services law and to drugs dispensed to Medicaid recipients who  are  not
 enrollees of such providers.
   (c)  If  the  drug utilization review board recommends a target rebate
 amount for a drug and the department is unable  to  negotiate  a  rebate
 from the manufacturer in an amount that is at least seventy-five percent
 of the target rebate amount, the commissioner is authorized to waive the
 provisions  of paragraph (b) of subdivision three of section two hundred
 seventy-three of this article and the provisions of  subdivisions  twen-
 ty-five  and  twenty-five-a of section three hundred sixty-four-j of the
 social services law with respect to  such  drug;  however,  this  waiver
 shall  not be implemented in situations where it would prevent access by
 a Medicaid recipient to a drug which is the only treatment for a partic-
 ular disease or condition. Under no circumstances shall the commissioner

 S. 1507--B                          8
 
 be authorized to waive such provisions with respect  to  more  than  two
 drugs in a given time.
   (d) Where the department and a manufacturer enter into a rebate agree-
 ment  pursuant  to  this  section,  which may be in addition to existing
 rebate agreements entered into by the manufacturer with respect  to  the
 same  drug,  no  additional  rebates shall be required to be paid by the
 manufacturer to a managed care provider or any of a managed care provid-
 er's agents, including but not limited to any pharmacy benefit  manager,
 while the department is collecting the rebate pursuant to this section.
   (e)  In formulating a recommendation concerning a target rebate amount
 for a drug, the drug utilization review board may consider:
   (i) publicly available information relevant  to  the  pricing  of  the
 drug;
   (ii) information supplied by the department relevant to the pricing of
 the drug SO LONG AS ANY THIRD PARTY SUPPLYING INFORMATION TO THE DEPART-
 MENT  OR  THE  BOARD  DOES  NOT  RECEIVE FUNDING FROM THE PHARMACEUTICAL
 INDUSTRY OR HEALTH INSURANCE INDUSTRY AND DID NOT RECEIVE SUCH  INFORMA-
 TION  FROM  A  THIRD PARTY THAT RECEIVES FUNDING FROM THE PHARMACEUTICAL
 INDUSTRY OR HEALTH INSURANCE INDUSTRY;
   (iii) information relating  to  value-based  pricing  HOWEVER  IF  THE
 DEPARTMENT OR THE BOARD RELY UPON ANY THIRD PARTY TO PROVIDE COST-EFFEC-
 TIVENESS ANALYSIS OR RESEARCH RELATED TO VALUE-BASED PRICING, SUCH ANAL-
 YSIS  OR  RESEARCH  MUST: (A) BE MADE AVAILABLE TO THE PUBLIC, INCLUDING
 ANY UNDERLYING METHODOLOGIES AND MODELS; (B) DISCLOSE ANY ASSUMPTIONS OR
 LIMITATIONS OF RESEARCH FINDINGS IN  THE  CONTEXT  OF  THE  ANALYSIS  OR
 RESEARCH;  AND  (C) PRESENT RESULTS IN A WAY THAT REFLECTS ANY DIFFERENT
 OUTCOMES FOR AFFECTED SUBPOPULATIONS;
   (iv) the seriousness and prevalence of the disease or  condition  that
 is treated by the drug;
   (v) the extent of utilization of the drug;
   (vi)  the  effectiveness  of  the  drug in treating the conditions for
 which it is prescribed, or in improving a patient's health,  quality  of
 life, or overall health outcomes;
   (vii)  the  likelihood  that  use of the drug will reduce the need for
 other medical care, including hospitalization;
   (viii) the average wholesale price, wholesale acquisition cost, retail
 price of the drug, and the cost of the  drug  to  the  Medicaid  program
 minus rebates received by the state;
   (ix)  in  the  case  of  generic  drugs,  the number of pharmaceutical
 manufacturers that produce the drug;
   (x) whether there are pharmaceutical equivalents to the drug; and
   (xi) information supplied by the manufacturer, if any, explaining  the
 relationship between the pricing of the drug and the cost of development
 of  the  drug  and/or  the  therapeutic  benefit of the drug, or that is
 otherwise pertinent to the manufacturer's  pricing  decision;  any  such
 information  provided  shall be considered confidential and shall not be
 disclosed by the drug utilization review board in a form that identifies
 a specific manufacturer or prices charged for drugs by such  manufactur-
 er.
   § 7. Intentionally omitted.
   §  8.  Paragraph  (a)  of  subdivision  7 of section 280 of the public
 health law, as amended by section 8 of part D of chapter 57 of the  laws
 of 2018, is amended to read as follows:
   (a) If, after taking into account all rebates and supplemental rebates
 received  by the department, including rebates received to date pursuant
 to this section, total Medicaid drug expenditures are still projected to

 S. 1507--B                          9
 
 exceed the annual growth limitation imposed by subdivision two  of  this
 section,  the  commissioner  may:  subject  any  drug  of a manufacturer
 referred to the drug utilization review  board  under  this  section  to
 prior approval in accordance with existing processes and procedures when
 such  manufacturer  has not entered into a supplemental rebate agreement
 as required by this section; [directing] DIRECT managed  care  plans  to
 remove  from their Medicaid formularies those drugs that the drug utili-
 zation review board recommends  a  target  rebate  amount  for  and  the
 manufacturer  has  failed  to  enter into a rebate agreement required by
 this section; [promoting] PROMOTE the use of cost  effective  and  clin-
 ically  appropriate  drugs  other than those of a manufacturer who has a
 drug that the drug utilization review board recommends a  target  rebate
 amount  and the manufacturer has failed to enter into a rebate agreement
 required by this section; [allowing] ALLOW manufacturers  to  accelerate
 rebate  payments under existing rebate contracts; and such other actions
 as authorized by law.  The commissioner shall provide written notice  to
 the  legislature  thirty  days  prior  to taking action pursuant to this
 paragraph, unless action is necessary in the fourth quarter of a  fiscal
 year  to  prevent  total  Medicaid  drug expenditures from exceeding the
 limitation imposed by subdivision two of this  section,  in  which  case
 such notice to the legislature may be less than thirty days.
   §  9.  Subdivision 8 of section 280 of the public health law, as added
 by section 8 of part D of chapter 57 of the laws of 2018, is amended  to
 read as follows:
   8.  The commissioner shall report by [February] JULY first annually to
 the drug utilization review board on savings achieved through  the  drug
 cap  in  the  last  FISCAL  year. Such report shall provide data on what
 savings were achieved through actions pursuant  to  subdivisions  three,
 five  and  seven  of  this  section, respectively, and what savings were
 achieved through other means and how such savings  were  calculated  and
 implemented.
   §  10.  Section 4406-c of the public health law is amended by adding a
 new subdivision 10 to read as follows:
   10. (A) ANY CONTRACT, CONTRACT RENEWAL, OR OTHER  ARRANGEMENT  ENTERED
 INTO  BY  A HEALTH CARE PLAN FOR PHARMACY BENEFIT MANAGEMENT SERVICES ON
 BEHALF OF INDIVIDUALS ENROLLED IN A MANAGED CARE PROVIDER AS DEFINED  IN
 SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW SUBSEQUENT
 TO  THE EFFECTIVE DATE OF THIS SUBDIVISION SHALL INCLUDE PROVISIONS THAT
 ENSURE THE FOLLOWING:
   (I) PAYMENT TO THE  PHARMACY  BENEFIT  MANAGER  FOR  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  IS  LIMITED  TO  THE  ACTUAL  INGREDIENT  COSTS, A
 DISPENSING FEE, AND AN ADMINISTRATIVE FEE FOR EACH CLAIM PROCESSED.  THE
 DEPARTMENT OF HEALTH MAY ESTABLISH A MAXIMUM ADMINISTRATIVE FEE;
   (II)  THE  PHARMACY  BENEFIT  MANAGER IDENTIFIES ALL SOURCES OF INCOME
 RELATED TO THE PROVISION OF  PHARMACY  BENEFIT  MANAGEMENT  SERVICES  ON
 BEHALF  OF  THE  HEALTH  CARE  PLAN,  INCLUDING, BUT NOT LIMITED TO, ANY
 DISCOUNTS OR SUPPLEMENTAL REBATES, AND THAT ANY PORTION OF  SUCH  INCOME
 IS  PASSED THROUGH TO THE HEALTH CARE PLAN IN FULL TO REDUCE THE REPORT-
 ABLE INGREDIENT COST; AND
   (III) THE PHARMACY BENEFIT MANAGER SHALL NOT  RETAIN  ANY  PORTION  OF
 SPREAD  PRICING. FOR PURPOSES OF THIS SUBDIVISION "SPREAD PRICING" MEANS
 ANY AMOUNT CHARGED OR CLAIMED BY THE PHARMACY BENEFIT MANAGER IN  EXCESS
 OF  THE AMOUNT PAID TO PHARMACIES ON BEHALF OF THE HEALTH CARE PLAN LESS
 AN ADMINISTRATIVE FEE AS DESCRIBED IN THIS PARAGRAPH.  ANY  SUCH  EXCESS
 AMOUNT SHALL BE REMITTED TO THE HEALTH CARE PLAN ON A QUARTERLY BASIS.

 S. 1507--B                         10
 
   (B) UPON ENTRANCE INTO A NEW CONTRACT, ARRANGEMENT, OR AMENDMENT OF AN
 EXISTING  PHARMACY BENEFIT MANAGER CONTRACT, EACH HEALTH CARE PLAN SHALL
 REPORT ON A QUARTERLY BASIS TO THE DEPARTMENT ANY  NET  SAVINGS  TO  THE
 HEALTH  CARE  PLAN WHICH ACCRUE BASED ON THE PROVISIONS OF THIS SUBDIVI-
 SION.  THE  DEPARTMENT  SHALL  NOT  ADJUST PREMIUMS TO HEALTH CARE PLANS
 UNTIL AFTER SUCH PLANS SUBMIT REPORTS TO THE DEPARTMENT PURSUANT TO THIS
 PARAGRAPH AND THE DEPARTMENT SHALL NOT MAKE ANY SUCH PREMIUM ADJUSTMENTS
 UNLESS SUCH CHANGES ARE DEEMED APPROPRIATE BY ITS  ACTUARY.    ANY  SUCH
 PREMIUM ADJUSTMENTS SHALL BE BASED ON THE REPORTED NET SAVINGS BY HEALTH
 CARE  PLANS  RESULTING FROM THE PHARMACY BENEFIT MANAGER CONTRACT AMEND-
 MENTS MADE IN COMPLIANCE WITH THIS SUBDIVISION.
   (C) HEALTH CARE PLANS SHALL NOTIFY THE  DEPARTMENT  OF  THE  EFFECTIVE
 DATE  OF  CONTRACTS,  CONTRACT RENEWALS OR OTHER ARRANGEMENTS RELATED TO
 SERVICES SUBJECT TO THE PROVISIONS OF PARAGRAPH (A) OF THIS  SUBDIVISION
 AT  LEAST  FIFTEEN  DAYS  PRIOR TO ENTERING INTO SUCH CONTRACT, CONTRACT
 RENEWAL OR OTHER ARRANGEMENT. THE DEPARTMENT SHALL NOT  ADJUST  PREMIUMS
 TO  HEALTH CARE PLANS UNTIL SUCH PLANS NOTIFY THE DEPARTMENT PURSUANT TO
 THIS PARAGRAPH.
   (D) THE COMMISSIONER MAY PROMULGATE REGULATIONS AS NECESSARY TO IMPLE-
 MENT THE REQUIREMENTS OF THIS SUBDIVISION, PROVIDED, HOWEVER,  THAT  ANY
 SUCH  REGULATIONS  SHALL APPLY TO CONTRACTS, CONTRACT RENEWALS, OR OTHER
 ARRANGEMENTS ENTERED INTO SUBSEQUENT TO THE EFFECTIVE DATE OF SUCH REGU-
 LATION.
   § 11.  The department of health shall take no enforcement action  with
 regards  to  the requirements of subdivision 10 of section 4406-c of the
 public health law, as added by section ten of this  act,  prior  to  the
 passage  of  180  days  from  the  effective date of this act, nor shall
 enforcement action be taken  related  to  any  non-compliance  occurring
 prior to the passage of the same 180 days.
   §  12.  This  act shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART C
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (ff) to read as follows:
   (FF)  EVIDENCE-BASED PREVENTION AND SUPPORT SERVICES RECOGNIZED BY THE
 FEDERAL CENTERS FOR DISEASE CONTROL (CDC), PROVIDED BY A COMMUNITY-BASED
 ORGANIZATION, AND DESIGNED TO PREVENT INDIVIDUALS AT RISK OF  DEVELOPING
 DIABETES FROM DEVELOPING TYPE 2 DIABETES.
   § 2. Intentionally omitted.
   § 3. Intentionally omitted.
   §  4.  Subdivision  2  of  section 365-a of the social services law is
 amended by adding a new paragraph (gg) to read as follows:
   (GG) MEDICALLY TAILORED MEALS AND MEDICAL NUTRITION THERAPY.  AS  USED
 IN THIS PARAGRAPH, "MEDICALLY TAILORED MEALS AND MEDICAL NUTRITION THER-
 APY"  MEANS NUTRITIONAL ASSESSMENT, NUTRITIONAL THERAPY, AND NUTRITIONAL
 COUNSELING PROVIDED BY A CERTIFIED DIETICIAN NUTRITIONIST, INCLUDING THE
 PROVISION OF ANY FOOD INDICATED BY THE NUTRITIONAL  ASSESSMENT  AND  THE
 DELIVERY  OF  SUCH  FOOD,  ORDERED  BY A HEALTH CARE PROFESSIONAL ACTING
 WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE  UNDER  TITLE  EIGHT  OF  THE
 EDUCATION  LAW,  FOR  THE PURPOSE OF TREATING ONE OR MORE CHRONIC CONDI-
 TIONS FOR AN INDIVIDUAL WHO IS LIMITED IN HIS OR HER DAILY ACTIVITIES OF
 DAILY LIVING; AND PROVIDED THAT THERE IS FEDERAL FINANCIAL PARTICIPATION
 IN THE COSTS OF SERVICES PROVIDED UNDER THIS PARAGRAPH.

 S. 1507--B                         11
 
   § 5. Subdivision 2 of section 365-a of  the  social  services  law  is
 amended by adding a new paragraph (hh) to read as follows:
   (HH)  APPLIED  BEHAVIOR  ANALYSIS,  AS DEFINED IN SECTION EIGHTY-EIGHT
 HUNDRED ONE OF THE EDUCATION LAW, WHERE SUCH SERVICE IS  PROVIDED  BY  A
 LICENSED  BEHAVIOR  ANALYST  OR  CERTIFIED  BEHAVIOR  ANALYST ASSISTANT,
 LICENSED OR CERTIFIED UNDER  ARTICLE  ONE  HUNDRED  SIXTY-SEVEN  OF  THE
 EDUCATION LAW, FOR THE TREATMENT OF AUTISM SPECTRUM DISORDER.
   § 6. This act shall take effect July 1, 2019.
 
                                  PART D
 
   Section  1. Subdivision 1 of section 92 of part H of chapter 59 of the
 laws of 2011, amending the public health law and other laws relating  to
 known  and  projected  department of health state fund medicaid expendi-
 tures, as amended by section 2 of part K of chapter 57 of  the  laws  of
 2018, is amended to read as follows:
   1.  For  state  fiscal  years  2011-12  through [2019-20,] 2020-21 the
 director of the budget, in consultation with the commissioner of  health
 referenced  as  "commissioner"  for  purposes  of  this section, AND THE
 CHAIRS OF THE SENATE FINANCE AND ASSEMBLY  WAYS  AND  MEANS  COMMITTEES,
 shall  assess on a monthly basis, as reflected in monthly reports pursu-
 ant to subdivision five of this section known and  projected  department
 of  health  state funds medicaid expenditures by category of service and
 by geographic regions, as defined by the commissioner, and if the direc-
 tor of the budget [determines] AND THE CHAIRS OF THE SENATE FINANCE  AND
 ASSEMBLY  WAYS AND MEANS COMMITTEES DETERMINE that such expenditures are
 expected to cause medicaid disbursements for such period to  exceed  the
 projected department of health medicaid state funds disbursements in the
 enacted budget financial plan pursuant to subdivision 3 of section 23 of
 the  state finance law, the commissioner of health, in consultation with
 the director of the budget, shall develop a medicaid savings  allocation
 plan  to  limit  such spending to the aggregate limit level specified in
 the enacted budget financial plan, provided, however,  such  projections
 may be adjusted by the director of the budget to account for any changes
 in  the  New  York  state  federal  medical assistance percentage amount
 established pursuant to the federal  social  security  act,  changes  in
 provider  revenues, reductions to local social services district medical
 assistance administration, minimum wage increases, and  beginning  April
 1,  2012  the  operational costs of the New York state medical indemnity
 fund and state costs or savings  from  the  basic  health  plan.    Such
 projections may be adjusted by the director of the budget to account for
 increased or expedited department of health state funds medicaid expend-
 itures  as  a result of a natural or other type of disaster, including a
 governmental declaration of emergency.
   § 2. Subdivision 3 of section 92 of part H of chapter 59 of  the  laws
 of 2011, amending the public health law and other laws relating to known
 and  projected department of health state fund medicaid expenditures, is
 amended by adding a new paragraph (e) to read as follows:
   (E) THE MEDICAID SAVINGS ALLOCATION PLAN SHALL  BE  SUBMITTED  TO  THE
 LEGISLATURE FOR THEIR CONSIDERATION AND APPROVAL PRIOR TO IMPLEMENTATION
 OF THIS PLAN.
   §  3.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART E

 S. 1507--B                         12
 
   Section 1. Section 4 of chapter 505 of the laws of 1995, amending  the
 public  health  law  relating  to  the operation of department of health
 facilities, as amended by section 27 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   §  4.  This act shall take effect immediately; provided, however, that
 the provisions of paragraph (b) of subdivision 4 of section 409-c of the
 public health law, as added by section three of  this  act,  shall  take
 effect  January 1, 1996 and shall expire and be deemed repealed [twenty-
 four] TWENTY-SIX years from the effective date thereof.
   § 2. Subdivision p of section 76 of part D of chapter 56 of  the  laws
 of 2013, amending the social services law relating to eligibility condi-
 tions, is amended to read as follows:
   p.  the  amendments [made] to subparagraph [(7)] 7 of paragraph (b) of
 subdivision 1 of section 366 of the social services law made by  section
 one  of  this  act shall expire and be deemed repealed October 1, [2019]
 2021.
   § 3. Section 11 of chapter 884 of  the  laws  of  1990,  amending  the
 public  health  law  relating  to  authorizing bad debt and charity care
 allowances for certified home health agencies, as amended by  section  1
 of  part  I  of  chapter  57  of the laws of 2017, is amended to read as
 follows:
   § 11. This act shall take effect immediately and:
   (a) sections one and three shall expire on December 31, 1996,
   (b) sections four through ten shall expire on June  30,  [2019]  2021,
 and
   (c) provided that the amendment to section 2807-b of the public health
 law  by  section two of this act shall not affect the expiration of such
 section 2807-b as otherwise provided by  law  and  shall  be  deemed  to
 expire therewith.
   §  4.  Section  3 of chapter 303 of the laws of 1999, amending the New
 York state medical  care  facilities  finance  agency  act  relating  to
 financing health facilities, as amended by section 16 of part D of chap-
 ter 57 of the laws of 2015, is amended to read as follows:
   §  3.  This act shall take effect immediately, provided, however, that
 subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of
 1973, as added by section one of this act, shall expire  and  be  deemed
 repealed  June  30, [2019] 2021; and provided further, however, that the
 expiration and repeal of such  subdivision  15-a  shall  not  affect  or
 impair in any manner any health facilities bonds issued, or any lease or
 purchase  of  a  health  facility executed, pursuant to such subdivision
 15-a prior to its expiration and repeal and that, with  respect  to  any
 such  bonds  issued  and  outstanding  as  of  June 30, [2019] 2021, the
 provisions of such subdivision 15-a as they existed immediately prior to
 such expiration and repeal shall continue to apply  through  the  latest
 maturity  date of any such bonds, or their earlier retirement or redemp-
 tion, for the sole purpose of  authorizing  the  issuance  of  refunding
 bonds to refund bonds previously issued pursuant thereto.
   §  5.  Subdivision  (a)  of section 40 of part B of chapter 109 of the
 laws of 2010, amending the social services law relating  to  transporta-
 tion  costs, as amended by section 8 of part I of chapter 57 of the laws
 of 2017, is amended to read as follows:
   (a) sections two, three, three-a, three-b, three-c,  three-d,  three-e
 and  twenty-one  of  this  act  shall take effect July 1, 2010; sections
 fifteen, sixteen, seventeen, eighteen and nineteen  of  this  act  shall
 take effect January 1, 2011; and provided further that section twenty of
 this  act  shall be deemed repealed [eight] TEN years after the date the

 S. 1507--B                         13
 
 contract entered into pursuant to section 365-h of the  social  services
 law,  as  amended  by  section twenty of this act, is executed; provided
 that the commissioner of health shall notify the legislative bill draft-
 ing  commission upon the execution of the contract entered into pursuant
 to section 367-h of the social services law in order that the commission
 may maintain an accurate and timely effective data base of the  official
 text of the laws of the state of New York in furtherance of effectuating
 the  provisions of section 44 of the legislative law and section 70-b of
 the public officers law;
   § 6. Subdivision (f) of section 129 of part C of  chapter  58  of  the
 laws  of  2009,  amending  the  public health law relating to payment by
 governmental  agencies  for  general  hospital  inpatient  services,  as
 amended  by  section  4  of part D of chapter 59 of the laws of 2016, is
 amended to read as follows:
   (f) section twenty-five  of  this  act  shall  expire  and  be  deemed
 repealed April 1, [2019] 2021;
   §  7.  Subdivision  (c)  of section 122 of part E of chapter 56 of the
 laws of 2013 amending the public health  law  relating  to  the  general
 public health work program, as amended by section 5 of part D of chapter
 59 of the laws of 2016, is amended to read as follows:
   (c)  section fifty of this act shall take effect immediately and shall
 expire [six] EIGHT years after it becomes law;
   § 8. Subdivision (i) of section 111 of part H of  chapter  59  of  the
 laws  of 2011, amending the public health law and other laws relating to
 known and projected department of health  state  fund  medical  expendi-
 tures,  as  amended by section 19 of part D of chapter 57 of the laws of
 2015, is amended to read as follows:
   (i) the amendments to paragraph (b) and subparagraph (i) of  paragraph
 (g)  of subdivision 7 of section 4403-f of the public health law made by
 section forty-one-b of this act shall expire and be  repealed  April  1,
 [2019] 2021;
   §  9.  Subparagraph  (vi) of paragraph (b) of subdivision 2 of section
 2807-d of the public health law, as amended by section 3 of  part  I  of
 chapter 57 of the laws of 2017, is amended to read as follows:
   (vi)  Notwithstanding  any contrary provision of this paragraph or any
 other provision of law or regulation to the  contrary,  for  residential
 health care facilities the assessment shall be six percent of each resi-
 dential  health care facility's gross receipts received from all patient
 care services and other operating income on a cash basis for the  period
 April  first,  two thousand two through March thirty-first, two thousand
 three for hospital  or  health-related  services,  including  adult  day
 services;  provided,  however,  that residential health care facilities'
 gross receipts attributable to payments received pursuant to title XVIII
 of the federal social security act (medicare) shall be excluded from the
 assessment; provided, however, that for all such gross receipts received
 on or after April first, two thousand three through March  thirty-first,
 two  thousand  five,  such assessment shall be five percent, and further
 provided that for all such gross receipts received  on  or  after  April
 first,  two thousand five through March thirty-first, two thousand nine,
 and on or after April first, two thousand  nine  through  March  thirty-
 first,  two  thousand  eleven  such assessment shall be six percent, and
 further provided that for all such gross receipts received on  or  after
 April  first,  two thousand eleven through March thirty-first, two thou-
 sand thirteen such assessment shall be six percent, and further provided
 that for all such gross receipts received on or after April  first,  two
 thousand  thirteen through March thirty-first, two thousand fifteen such

 S. 1507--B                         14
 
 assessment shall be six percent, and further provided that for all  such
 gross  receipts  received  on or after April first, two thousand fifteen
 through March thirty-first, two thousand seventeen such assessment shall
 be  six  percent,  and further provided that for all such gross receipts
 received on or after April first, two thousand seventeen  through  March
 thirty-first,  two  thousand  nineteen  such  assessment  shall  be  six
 percent, AND FURTHER PROVIDED THAT FOR ALL SUCH GROSS RECEIPTS  RECEIVED
 ON  OR  AFTER  APRIL  FIRST, TWO THOUSAND NINETEEN THROUGH MARCH THIRTY-
 FIRST, TWO THOUSAND TWENTY-ONE SUCH ASSESSMENT SHALL BE SIX PERCENT.
   § 10. Subdivision 1 of section 194 of chapter 474 of the laws of 1996,
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, as amended by section 4 of part I of  chap-
 ter 57 of the laws of 2017, is amended to read as follows:
   1.  Notwithstanding  any  inconsistent provision of law or regulation,
 the trend factors used to project reimbursable operating  costs  to  the
 rate  period  for  purposes  of determining rates of payment pursuant to
 article 28 of the public health law for residential health care  facili-
 ties for reimbursement of inpatient services provided to patients eligi-
 ble  for payments made by state governmental agencies on and after April
 1, 1996 through March 31, 1999 and for payments made on and  after  July
 1,  1999  through  March 31, 2000 and on and after April 1, 2000 through
 March 31, 2003 and on and after April 1, 2003 through March 31, 2007 and
 on and after April 1, 2007 through March 31, 2009 and on and after April
 1, 2009 through March 31, 2011 and on and after April  1,  2011  through
 March  31,  2013  and on and after April 1, 2013 through March 31, 2015,
 and on and after April 1, 2015 through March 31, 2017, and on and  after
 April  1,  2017  through  March 31, 2019, AND ON AND AFTER APRIL 1, 2019
 THROUGH MARCH 31, 2021 shall reflect  no  trend  factor  projections  or
 adjustments for the period April 1, 1996, through March 31, 1997.
   §  11.  Subdivision  1  of section 89-a of part C of chapter 58 of the
 laws of 2007, amending the social services law and other  laws  relating
 to  enacting  the major components of legislation necessary to implement
 the health and mental hygiene budget  for  the  2007-2008  state  fiscal
 year,  as  amended  by  section 5 of part I of chapter 57 of the laws of
 2017, is amended to read as follows:
   1. Notwithstanding paragraph (c) of subdivision 10 of  section  2807-c
 of  the  public  health  law  and section 21 of chapter 1 of the laws of
 1999, as amended, and any other inconsistent provision of law  or  regu-
 lation  to  the  contrary,  in  determining  rates  of payments by state
 governmental agencies effective for services provided beginning April 1,
 2006, through March 31, 2009, and on and after  April  1,  2009  through
 March  31,  2011, and on and after April 1, 2011 through March 31, 2013,
 and on and after April 1, 2013 through March 31, 2015, and on and  after
 April  1,  2015  through  March 31, 2017, and on and after April 1, 2017
 through March 31, 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31,
 2021 for inpatient and outpatient services provided by general hospitals
 and for inpatient services and outpatient adult day health care services
 provided by residential health care facilities pursuant to article 28 of
 the public health law, the commissioner of health shall  apply  a  trend
 factor projection of two and twenty-five hundredths percent attributable
 to  the  period  January  1,  2006 through December 31, 2006, and on and
 after January 1, 2007, provided, however, that on reconciliation of such
 trend factor for the period January 1, 2006 through  December  31,  2006
 pursuant  to  paragraph  (c)  of subdivision 10 of section 2807-c of the
 public health law, such trend factor shall  be  the  final  US  Consumer
 Price  Index  (CPI)  for  all  urban  consumers,  as published by the US

 S. 1507--B                         15
 
 Department  of  Labor,  Bureau  of  Labor  Statistics  less  twenty-five
 hundredths of a percentage point.
   §  12.  Subdivision  5-a  of  section 246 of chapter 81 of the laws of
 1995, amending the public health law and other laws relating to  medical
 reimbursement  and  welfare reform, as amended by section 6 of part I of
 chapter 57 of the laws of 2017, is amended to read as follows:
   5-a. Section sixty-four-a of this act shall be deemed to have been  in
 full  force and effect on and after April 1, 1995 through March 31, 1999
 and on and after July 1, 1999 through March 31, 2000 and  on  and  after
 April  1,  2000  through  March  31, 2003 and on and after April 1, 2003
 through March 31, 2007, and on and after April 1, 2007 through March 31,
 2009, and on and after April 1, 2009 through March 31, 2011, and on  and
 after  April  1,  2011 through March 31, 2013, and on and after April 1,
 2013 through March 31, 2015, and on and  after  April  1,  2015  through
 March  31,  2017  and on and after April 1, 2017 through March 31, 2019,
 AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2021;
   § 13. Section 64-b of chapter 81 of the laws  of  1995,  amending  the
 public  health  law and other laws relating to medical reimbursement and
 welfare reform, as amended by section 7 of part I of chapter 57  of  the
 laws of 2017, is amended to read as follows:
   §  64-b.  Notwithstanding  any  inconsistent  provision  of  law,  the
 provisions of subdivision 7 of section 3614 of the public health law, as
 amended, shall remain and be in full force and effect on April  1,  1995
 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
 and after April 1, 2000 through March 31, 2003 and on and after April 1,
 2003  through  March  31,  2007,  and on and after April 1, 2007 through
 March 31, 2009, and on and after April 1, 2009 through March  31,  2011,
 and  on and after April 1, 2011 through March 31, 2013, and on and after
 April 1, 2013 through March 31, 2015, and on and  after  April  1,  2015
 through  March 31, 2017 and on and after April 1, 2017 through March 31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2021.
   § 14. Section 4-a of part A of chapter 56 of the laws of 2013,  amend-
 ing  chapter  59  of the laws of 2011 amending the public health law and
 other laws relating to general hospital reimbursement for annual  rates,
 as  amended by section 5 of part T of chapter 57 of the laws of 2018, is
 amended to read as follows:
   § 4-a. Notwithstanding paragraph (c)  of  subdivision  10  of  section
 2807-c  of the public health law, section 21 of chapter 1 of the laws of
 1999, or any other contrary provision of law, in  determining  rates  of
 payments  by state governmental agencies effective for services provided
 on and after January 1, 2017 through March 31, [2019]  2021,  for  inpa-
 tient  and  outpatient services provided by general hospitals, for inpa-
 tient services and adult day health care outpatient services provided by
 residential health care facilities pursuant to article 28 of the  public
 health  law,  except  for residential health care facilities or units of
 such facilities providing services primarily to children  under  twenty-
 one  years  of  age,  for home health care services provided pursuant to
 article 36 of the public health law by certified home  health  agencies,
 long term home health care programs and AIDS home care programs, and for
 personal  care services provided pursuant to section 365-a of the social
 services law, the commissioner of health shall  apply  no  greater  than
 zero trend factors attributable to the 2017, 2018, [and] 2019, 2020, AND
 2021  calendar  years in accordance with paragraph (c) of subdivision 10
 of section 2807-c of the public health law, provided, however, that such
 no greater than zero trend factors  attributable  to  such  2017,  2018,
 [and] 2019, 2020, AND 2021 calendar years shall also be applied to rates

 S. 1507--B                         16

 of  payment  provided  on  and  after  January 1, 2017 through March 31,
 [2019] 2021 for personal care services provided in  those  local  social
 services  districts, including New York city, whose rates of payment for
 such  services  are  established by such local social services districts
 pursuant to a rate-setting  exemption  issued  by  the  commissioner  of
 health to such local social services districts in accordance with appli-
 cable  regulations;  and  provided  further,  however, that for rates of
 payment for assisted living program services provided on and after Janu-
 ary 1, 2017 through March 31, [2019] 2021, such trend factors  attribut-
 able  to the 2017, 2018, [and] 2019, 2020, AND 2021 calendar years shall
 be established at no greater than zero percent.
   § 15. Paragraph (b) of subdivision 17 of section 2808  of  the  public
 health law, as amended by section 21 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (b) Notwithstanding any inconsistent provision of law or regulation to
 the  contrary,  for  the  state  fiscal years beginning April first, two
 thousand ten and ending  March  thirty-first,  two  thousand  [nineteen]
 TWENTY-ONE,  the  commissioner shall not be required to revise certified
 rates of payment established pursuant to this article for  rate  periods
 prior  to  April  first,  two  thousand  [nineteen] TWENTY-ONE, based on
 consideration of rate appeals filed by residential health  care  facili-
 ties or based upon adjustments to capital cost reimbursement as a result
 of approval by the commissioner of an application for construction under
 section twenty-eight hundred two of this article, in excess of an aggre-
 gate  annual amount of eighty million dollars for each such state fiscal
 year provided, however, that for the period April  first,  two  thousand
 eleven  through  March  thirty-first, two thousand twelve such aggregate
 annual amount shall be fifty million dollars.  In  revising  such  rates
 within  such  fiscal limit, the commissioner shall, in prioritizing such
 rate appeals, include consideration of which facilities the commissioner
 determines are facing significant financial hardship  as  well  as  such
 other considerations as the commissioner deems appropriate and, further,
 the commissioner is authorized to enter into agreements with such facil-
 ities  or  any  other  facility to resolve multiple pending rate appeals
 based upon a negotiated aggregate amount and may offset such  negotiated
 aggregate  amounts  against  any  amounts  owed  by  the facility to the
 department, including, but not limited  to,  amounts  owed  pursuant  to
 section twenty-eight hundred seven-d of this article; provided, however,
 that the commissioner's authority to negotiate such agreements resolving
 multiple  pending  rate appeals as hereinbefore described shall continue
 on and after April  first,  two  thousand  [nineteen]  TWENTY-ONE.  Rate
 adjustments  made  pursuant  to  this  paragraph remain fully subject to
 approval by the director of the budget in accordance with the provisions
 of subdivision two of section twenty-eight hundred seven of  this  arti-
 cle.
   §  16.  Paragraph  (a) of subdivision 13 of section 3614 of the public
 health law, as amended by section 22 of part D of chapter 57 of the laws
 of 2015, is amended to read as follows:
   (a) Notwithstanding any inconsistent provision of  law  or  regulation
 and  subject  to  the  availability  of federal financial participation,
 effective April first, two thousand twelve through  March  thirty-first,
 two  thousand [nineteen] TWENTY-ONE, payments by government agencies for
 services provided by certified home health  agencies,  except  for  such
 services  provided  to  children  under  eighteen years of age and other
 discreet groups as may be determined by  the  commissioner  pursuant  to
 regulations,  shall  be based on episodic payments. In establishing such

 S. 1507--B                         17
 
 payments, a statewide base price shall be established for each sixty day
 episode of care and adjusted by a regional  wage  index  factor  and  an
 individual patient case mix index. Such episodic payments may be further
 adjusted  for  low utilization cases and to reflect a percentage limita-
 tion of the cost for high-utilization cases that exceed outlier  thresh-
 olds of such payments.
   §  17. Subdivision 2 of section 246 of chapter 81 of the laws of 1995,
 amending the public health  law  and  other  laws  relating  to  medical
 reimbursement  and welfare reform, as amended by section 18 of part I of
 chapter 57 of the laws of 2017, is amended to read as follows:
   2. Sections five, seven through nine,  twelve  through  fourteen,  and
 eighteen  of  this  act  shall  be deemed to have been in full force and
 effect on and after April 1, 1995 through March  31,  1999  and  on  and
 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
 through  March 31, 2003 and on and after April 1, 2003 through March 31,
 2006 and on and after April 1, 2006 through March 31, 2007  and  on  and
 after  April  1,  2007  through March 31, 2009 and on and after April 1,
 2009 through March 31, 2011 and sections twelve, thirteen  and  fourteen
 of  this act shall be deemed to be in full force and effect on and after
 April 1, 2011 through March 31, 2015 and on  and  after  April  1,  2015
 through  March 31, 2017 and on and after April 1, 2017 through March 31,
 2019, AND ON AND AFTER APRIL 1, 2019 THROUGH MARCH 31, 2021;
   § 18. Section 48-a of part A of chapter 56 of the laws of 2013  amend-
 ing  chapter  59  of the laws of 2011 amending the public health law and
 other laws relating to general hospital reimbursement for annual  rates,
 as  amended by section 1 of part P of chapter 57 of the laws of 2017, is
 amended to read as follows:
   § 48-a. 1. Notwithstanding any contrary provision of law, the  commis-
 sioners of the office of alcoholism and substance abuse services and the
 office  of  mental health are authorized, subject to the approval of the
 director of the budget, to transfer to the commissioner of health  state
 funds  to  be  utilized as the state share for the purpose of increasing
 payments under  the  medicaid  program  to  managed  care  organizations
 licensed  under  article 44 of the public health law or under article 43
 of the insurance law. Such managed care organizations shall utilize such
 funds for the purpose of  reimbursing  providers  licensed  pursuant  to
 article  28  of  the public health law or article 31 or 32 of the mental
 hygiene law for ambulatory behavioral health services, as determined  by
 the  commissioner  of  health,  in consultation with the commissioner of
 alcoholism and substance abuse services  and  the  commissioner  of  the
 office  of  mental health, provided to medicaid enrolled outpatients and
 for all other behavioral health services except  inpatient  included  in
 New  York  state's  Medicaid redesign waiver approved by the centers for
 medicare and Medicaid services (CMS).   Such reimbursement shall  be  in
 the  form of fees for such services which are equivalent to the payments
 established for such services under the ambulatory patient  group  (APG)
 rate-setting  methodology  as  utilized by the department of health, the
 office of alcoholism and substance abuse  services,  or  the  office  of
 mental  health for rate-setting purposes or any such other fees pursuant
 to the Medicaid state plan or otherwise approved by CMS in the  Medicaid
 redesign  waiver; provided, however, that the increase to such fees that
 shall result from the provisions of  this  section  shall  not,  in  the
 aggregate  and as determined by the commissioner of health, in consulta-
 tion with the commissioner of alcoholism and  substance  abuse  services
 and the commissioner of the office of mental health, be greater than the
 increased  funds  made available pursuant to this section.  The increase

 S. 1507--B                         18
 
 of such ambulatory behavioral health fees to providers  available  under
 this  section  shall  be for all rate periods on and after the effective
 date of section [29] 1 of part [B] P of chapter [59] 57 of the  laws  of
 [2016]  2017  through  March 31, [2020] 2021 for patients in the city of
 New York, for all rate periods  on  and  after  the  effective  date  of
 section  [29]  1  of part [B] P of chapter [59] 57 of the laws of [2016]
 2017 through [March 31, 2020] MARCH 31, 2021 for  patients  outside  the
 city  of  New  York, and for all rate periods on and after the effective
 date of such chapter through [March 31, 2020] MARCH 31,  2021,  for  all
 services  provided  to  persons  under  the age of twenty-one; provided,
 however, the commissioner of health, in consultation  with  the  commis-
 sioner  of  alcoholism and substance abuse services and the commissioner
 of mental health, may require, as a condition of approval of such  ambu-
 latory  behavioral health fees, that aggregate managed care expenditures
 to eligible providers meet the alternative payment methodology  require-
 ments  as  set  forth  in  attachment  I  of the New York state medicaid
 section one thousand one hundred fifteen medicaid redesign  team  waiver
 as  approved  by  the  centers  for  medicare and medicaid services. The
 commissioner of health shall, in consultation with the  commissioner  of
 alcoholism  and  substance abuse services and the commissioner of mental
 health, waive such conditions if a sufficient number  of  providers,  as
 determined  by the commissioner, suffer a financial hardship as a conse-
 quence of such alternative payment methodology requirements, or if he or
 she shall determine that such alternative payment methodologies  signif-
 icantly  threaten  individuals  access  to  ambulatory behavioral health
 services.  Such waiver may be applied on a provider specific or industry
 wide basis. Further, such conditions may be waived, as the  commissioner
 determines  necessary,  to  comply  with  federal  rules  or regulations
 governing these payment methodologies.   Nothing in this  section  shall
 prohibit  managed  care  organizations  and  providers  from negotiating
 different rates and methods of payment  during  such  periods  described
 above,  subject to the approval of the department of health. The depart-
 ment of health shall consult with the office of alcoholism and substance
 abuse services and the office of mental health  in  determining  whether
 such  alternative  rates  shall  be approved. The commissioner of health
 may, in consultation with the commissioner of alcoholism  and  substance
 abuse  services  and  the  commissioner  of the office of mental health,
 promulgate  regulations,  including  emergency  regulations  promulgated
 prior  to  October  1, 2015 to establish rates for ambulatory behavioral
 health services, as are necessary to implement the  provisions  of  this
 section.  Rates  promulgated under this section shall be included in the
 report required under section 45-c of part A of this chapter.
   2. Notwithstanding any contrary provision of law,  the  fees  paid  by
 managed  care  organizations  licensed  under  article  44 of the public
 health law or under article  43  of  the  insurance  law,  to  providers
 licensed  pursuant  to article 28 of the public health law or article 31
 or 32 of the  mental  hygiene  law,  for  ambulatory  behavioral  health
 services  provided  to  patients  enrolled in the child health insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to the payments established  for  such  services  under  the  ambulatory
 patient  group  (APG)  rate-setting  methodology  or any such other fees
 established pursuant to the Medicaid state  plan.  The  commissioner  of
 health  shall  consult with the commissioner of alcoholism and substance
 abuse services and the commissioner of the office of  mental  health  in
 determining  such  services  and establishing such fees. Such ambulatory

 S. 1507--B                         19
 
 behavioral health fees to providers available under this  section  shall
 be  for all rate periods on and after the effective date of this chapter
 through [March 31, 2020] MARCH 31, 2021, provided, however, that managed
 care organizations and providers may negotiate different rates and meth-
 ods  of  payment  during  such  periods  described above, subject to the
 approval of the department of health.   The department of  health  shall
 consult  with  the office of alcoholism and substance abuse services and
 the office of mental health  in  determining  whether  such  alternative
 rates shall be approved.  The report required under section 16-a of part
 C of chapter 60 of the laws of 2014 shall also include the population of
 patients  enrolled  in  the  child  health insurance program pursuant to
 title [one-A] 1-A of article 25 of the public health law in its examina-
 tion on the transition of behavioral health services into managed care.
   § 19. Section 1 of part H of chapter 111 of the laws of 2010  relating
 to increasing Medicaid payments to providers through managed care organ-
 izations  and  providing  equivalent  fees through an ambulatory patient
 group methodology, as amended by section 2 of part P of  chapter  57  of
 the laws of 2017, is amended to read as follows:
   Section  1.  a.  Notwithstanding  any  contrary  provision of law, the
 commissioners of  mental  health  and  alcoholism  and  substance  abuse
 services  are authorized, subject to the approval of the director of the
 budget, to transfer to the commissioner of  health  state  funds  to  be
 utilized as the state share for the purpose of increasing payments under
 the  medicaid program to managed care organizations licensed under arti-
 cle 44 of the public health law or under article  43  of  the  insurance
 law.  Such  managed  care organizations shall utilize such funds for the
 purpose of reimbursing providers licensed pursuant to article 28 of  the
 public health law, or pursuant to article 31 or article 32 of the mental
 hygiene  law for ambulatory behavioral health services, as determined by
 the commissioner of health in  consultation  with  the  commissioner  of
 mental  health  and  commissioner  of  alcoholism  and  substance  abuse
 services, provided to medicaid enrolled outpatients and  for  all  other
 behavioral health services except inpatient included in New York state's
 Medicaid  redesign waiver approved by the centers for medicare and Medi-
 caid services (CMS). Such reimbursement shall be in the form of fees for
 such services which are equivalent to the payments established for  such
 services under the ambulatory patient group (APG) rate-setting methodol-
 ogy  as  utilized by the department of health or by the office of mental
 health or office of alcoholism and substance abuse  services  for  rate-
 setting  purposes  or any such other fees pursuant to the Medicaid state
 plan or otherwise approved by  CMS  in  the  Medicaid  redesign  waiver;
 provided, however, that the increase to such fees that shall result from
 the provisions of this section shall not, in the aggregate and as deter-
 mined by the commissioner of health in consultation with the commission-
 ers  of  mental  health  and alcoholism and substance abuse services, be
 greater than  the  increased  funds  made  available  pursuant  to  this
 section. The increase of such behavioral health fees to providers avail-
 able  under  this section shall be for all rate periods on and after the
 effective date of section [30] 2 of part [B] P of chapter [59] 57 of the
 laws of [2016] 2017 through March 31, [2020] 2021 for  patients  in  the
 city  of  New York, for all rate periods on and after the effective date
 of section [30] 2 of part [B] P of chapter [59] 57 of the laws of [2016]
 2017 through March 31, [2020] 2021 for patients outside the city of  New
 York,  and  for  all  rate  periods  on  and after the effective date of
 section [30] 2 of part [B] P of chapter [59] 57 of the  laws  of  [2016]
 2017  through March 31, [2020] 2021 for all services provided to persons

 S. 1507--B                         20

 under the age of twenty-one;  provided,  however,  the  commissioner  of
 health,   in  consultation  with  the  commissioner  of  alcoholism  and
 substance abuse services and the  commissioner  of  mental  health,  may
 require, as a condition of approval of such ambulatory behavioral health
 fees,  that  aggregate  managed  care expenditures to eligible providers
 meet the alternative payment methodology requirements as  set  forth  in
 attachment  I  of  the  New York state medicaid section one thousand one
 hundred fifteen medicaid redesign team waiver as approved by the centers
 for medicare and medicaid services. The commissioner of health shall, in
 consultation with the commissioner of  alcoholism  and  substance  abuse
 services and the commissioner of mental health, waive such conditions if
 a  sufficient  number  of  providers, as determined by the commissioner,
 suffer a financial hardship as a consequence of such alternative payment
 methodology requirements, or if he or  she  shall  determine  that  such
 alternative  payment  methodologies  significantly  threaten individuals
 access to ambulatory behavioral health services.   Such  waiver  may  be
 applied  on  a  provider  specific or industry wide basis. Further, such
 conditions may be waived, as the commissioner determines  necessary,  to
 comply with federal rules or regulations governing these payment method-
 ologies.  Nothing  in this section shall prohibit managed care organiza-
 tions and providers from negotiating  different  rates  and  methods  of
 payment  during  such  periods described, subject to the approval of the
 department of health. The department of health shall  consult  with  the
 office  of  alcoholism  and  substance  abuse services and the office of
 mental health in determining whether such  alternative  rates  shall  be
 approved.  The  commissioner  of  health  may,  in consultation with the
 commissioners of  mental  health  and  alcoholism  and  substance  abuse
 services,   promulgate   regulations,  including  emergency  regulations
 promulgated prior to October 1, 2013 that establish rates for behavioral
 health services, as are necessary to implement the  provisions  of  this
 section.  Rates  promulgated under this section shall be included in the
 report required under section 45-c of part A of chapter 56 of  the  laws
 of 2013.
   b.  Notwithstanding  any  contrary  provision of law, the fees paid by
 managed care organizations licensed  under  article  44  of  the  public
 health  law  or  under  article  43  of  the insurance law, to providers
 licensed pursuant to article 28 of the public health law or  article  31
 or  32  of  the  mental  hygiene  law,  for ambulatory behavioral health
 services provided to patients enrolled in  the  child  health  insurance
 program pursuant to title [one-A] 1-A of article 25 of the public health
 law, shall be in the form of fees for such services which are equivalent
 to  the  payments  established  for  such  services under the ambulatory
 patient group (APG) rate-setting methodology. The commissioner of health
 shall consult with the commissioner of alcoholism  and  substance  abuse
 services  and  the commissioner of the office of mental health in deter-
 mining such services and establishing such fees. Such ambulatory  behav-
 ioral health fees to providers available under this section shall be for
 all rate periods on and after the effective date of this chapter through
 March  31,  [2020]  2021, provided, however, that managed care organiza-
 tions and providers may negotiate different rates and methods of payment
 during such periods described above, subject  to  the  approval  of  the
 department  of  health.  The department of health shall consult with the
 office of alcoholism and substance abuse  services  and  the  office  of
 mental  health  in  determining  whether such alternative rates shall be
 approved.  The report required under section 16-a of part C  of  chapter
 60  of  the  laws  of 2014 shall also include the population of patients

 S. 1507--B                         21
 
 enrolled in the child health insurance program pursuant to title [one-A]
 1-A of article 25 of the public health law in  its  examination  on  the
 transition of behavioral health services into managed care.
   § 20. Section 2 of part H of chapter 111 of the laws of 2010, relating
 to increasing Medicaid payments to providers through managed care organ-
 izations  and  providing  equivalent  fees through an ambulatory patient
 group methodology, as amended by section 16 of part C of chapter  60  of
 the laws of 2014, is amended to read as follows:
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2010, and shall
 expire on [January 1, 2018] MARCH 31, 2021.
   § 21. Section 10 of chapter 649 of the  laws  of  1996,  amending  the
 public  health  law,  the mental hygiene law and the social services law
 relating to authorizing the establishment of  special  needs  plans,  as
 amended  by  section  2  of part D of chapter 59 of the laws of 2016, is
 amended to read as follows:
   § 10. This act shall take effect immediately and shall  be  deemed  to
 have  been in full force and effect on and after July 1, 1996; provided,
 however, that sections one, two and three of this act shall  expire  and
 be  deemed  repealed on March 31, [2020] 2021 provided, however that the
 amendments to section 364-j of the social services law made  by  section
 four  of  this  act  shall not affect the expiration of such section and
 shall be deemed to expire therewith  and  provided,  further,  that  the
 provisions  of  subdivisions  8,  9 and 10 of section 4401 of the public
 health law, as added by section one of this act; section 4403-d  of  the
 public health law as added by section two of this act and the provisions
 of  section seven of this act, except for the provisions relating to the
 establishment of no more than twelve  comprehensive  HIV  special  needs
 plans, shall expire and be deemed repealed on July 1, 2000.
   §  22. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
 the laws of 1996, amending the education law and other laws relating  to
 rates  for residential healthcare facilities, as amended by section 1 of
 part D of chapter 59 of the laws of 2016, is amended to read as follows:
   (a) Notwithstanding any inconsistent provision of law or regulation to
 the contrary, effective beginning August 1, 1996, for the  period  April
 1,  1997  through  March 31, 1998, April 1, 1998 for the period April 1,
 1998 through March 31, 1999, August 1, 1999, for  the  period  April  1,
 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
 through  March  31,  2001,  April  1, 2001, for the period April 1, 2001
 through March 31, 2002, April 1, 2002, for  the  period  April  1,  2002
 through March 31, 2003, and for the state fiscal year beginning April 1,
 2005  through  March  31,  2006, and for the state fiscal year beginning
 April 1, 2006 through March 31, 2007, and  for  the  state  fiscal  year
 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
 year  beginning  April 1, 2008 through March 31, 2009, and for the state
 fiscal year beginning April 1, 2009 through March 31, 2010, and for  the
 state  fiscal  year  beginning April 1, 2010 through March 31, 2016, and
 for the state fiscal year beginning April  1,  2016  through  March  31,
 2019,  AND  FOR  THE  STATE  FISCAL YEAR BEGINNING APRIL 1, 2019 THROUGH
 MARCH 31, 2021, the department of health is  authorized  to  pay  public
 general  hospitals,  as defined in subdivision 10 of section 2801 of the
 public health law, operated by the state of New York  or  by  the  state
 university  of  New  York or by a county, which shall not include a city
 with a population of over one million, of the state  of  New  York,  and
 those public general hospitals located in the county of Westchester, the
 county  of  Erie  or the county of Nassau, additional payments for inpa-

 S. 1507--B                         22
 
 tient hospital services as medical assistance payments pursuant to title
 11 of article 5 of the social services law  for  patients  eligible  for
 federal  financial  participation  under title XIX of the federal social
 security  act  in  medical  assistance  pursuant to the federal laws and
 regulations governing disproportionate share payments to hospitals up to
 one hundred percent of  each  such  public  general  hospital's  medical
 assistance  and uninsured patient losses after all other medical assist-
 ance, including disproportionate share payments to such  public  general
 hospital  for  1996,  1997,  1998, and 1999, based initially for 1996 on
 reported 1994 reconciled data as further reconciled to  actual  reported
 1996  reconciled  data,  and  for  1997 based initially on reported 1995
 reconciled data as further reconciled to actual reported 1997 reconciled
 data, for 1998 based initially  on  reported  1995  reconciled  data  as
 further  reconciled  to  actual  reported 1998 reconciled data, for 1999
 based initially on reported 1995 reconciled data as  further  reconciled
 to  actual  reported  1999  reconciled data, for 2000 based initially on
 reported 1995 reconciled data as further reconciled to  actual  reported
 2000  data, for 2001 based initially on reported 1995 reconciled data as
 further reconciled to actual reported 2001 data, for 2002 based initial-
 ly on reported 2000 reconciled data  as  further  reconciled  to  actual
 reported  2002  data,  and  for state fiscal years beginning on April 1,
 2005, based initially on reported 2000 reconciled data as further recon-
 ciled to actual reported data for  2005,  and  for  state  fiscal  years
 beginning  on April 1, 2006, based initially on reported 2000 reconciled
 data as further reconciled to actual reported data for 2006,  for  state
 fiscal  years  beginning  on  and  after April 1, 2007 through March 31,
 2009, based initially on reported 2000 reconciled data as further recon-
 ciled to actual reported data for 2007 and 2008, respectively, for state
 fiscal years beginning on and after April 1, 2009,  based  initially  on
 reported  2007  reconciled  data,  adjusted for authorized Medicaid rate
 changes applicable to the state fiscal year, and as  further  reconciled
 to  actual  reported  data for 2009, for state fiscal years beginning on
 and after April 1, 2010, based initially  on  reported  reconciled  data
 from  the  base  year  two years prior to the payment year, adjusted for
 authorized Medicaid rate changes applicable to the  state  fiscal  year,
 and  further  reconciled to actual reported data from such payment year,
 and to actual reported data for each respective succeeding  year.    The
 payments  may be added to rates of payment or made as aggregate payments
 to an eligible public general hospital.
   § 23. This act shall take effect immediately; provided that the amend-
 ments to section 1 of part H of chapter 111 of the laws of 2010 made  by
 section  nineteen  of  this  act shall not affect the expiration of such
 section and shall expire therewith; and provided  further  that  section
 twenty of this act shall be deemed to have been in full force and effect
 on and after January 1, 2018.
 
                                  PART F
 
   Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266
 of the laws of 1986, amending the civil practice law and rules and other
 laws  relating  to  malpractice  and  professional  medical  conduct, as
 amended by section 1 of part M of chapter 57 of the  laws  of  2018,  is
 amended to read as follows:
   (a)  The  superintendent of financial services and the commissioner of
 health or their designee shall, from funds  available  in  the  hospital
 excess liability pool created pursuant to subdivision 5 of this section,

 S. 1507--B                         23
 
 purchase  a policy or policies for excess insurance coverage, as author-
 ized by paragraph 1 of subsection (e) of section 5502 of  the  insurance
 law; or from an insurer, other than an insurer described in section 5502
 of the insurance law, duly authorized to write such coverage and actual-
 ly  writing  medical  malpractice  insurance  in  this  state;  or shall
 purchase equivalent excess coverage in a form previously approved by the
 superintendent of financial services for purposes  of  providing  equiv-
 alent  excess  coverage  in accordance with section 19 of chapter 294 of
 the laws of 1985, for medical or dental malpractice occurrences  between
 July  1, 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988,
 between July 1, 1988 and June 30, 1989, between July 1,  1989  and  June
 30,  1990,  between July 1, 1990 and June 30, 1991, between July 1, 1991
 and June 30, 1992, between July 1, 1992 and June 30, 1993, between  July
 1,  1993  and  June  30,  1994,  between July 1, 1994 and June 30, 1995,
 between July 1, 1995 and June 30, 1996, between July 1,  1996  and  June
 30,  1997,  between July 1, 1997 and June 30, 1998, between July 1, 1998
 and June 30, 1999, between July 1, 1999 and June 30, 2000, between  July
 1,  2000  and  June  30,  2001,  between July 1, 2001 and June 30, 2002,
 between July 1, 2002 and June 30, 2003, between July 1,  2003  and  June
 30,  2004,  between July 1, 2004 and June 30, 2005, between July 1, 2005
 and June 30, 2006, between July 1, 2006 and June 30, 2007, between  July
 1,  2007  and  June  30,  2008,  between July 1, 2008 and June 30, 2009,
 between July 1, 2009 and June 30, 2010, between July 1,  2010  and  June
 30,  2011,  between July 1, 2011 and June 30, 2012, between July 1, 2012
 and June 30, 2013, between July 1, 2013 and June 30, 2014, between  July
 1,  2014  and  June  30,  2015,  between July 1, 2015 and June 30, 2016,
 between July 1, 2016 and June 30, 2017, between July 1,  2017  and  June
 30, 2018, [and] between July 1, 2018 and June 30, 2019, AND BETWEEN JULY
 1,  2019  AND JUNE 30, 2020 or reimburse the hospital where the hospital
 purchases equivalent excess coverage as defined in subparagraph  (i)  of
 paragraph  (a)  of subdivision 1-a of this section for medical or dental
 malpractice occurrences between July 1, 1987 and June 30, 1988,  between
 July  1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990,
 between July 1, 1990 and June 30, 1991, between July 1,  1991  and  June
 30,  1992,  between July 1, 1992 and June 30, 1993, between July 1, 1993
 and June 30, 1994, between July 1, 1994 and June 30, 1995, between  July
 1,  1995  and  June  30,  1996,  between July 1, 1996 and June 30, 1997,
 between July 1, 1997 and June 30, 1998, between July 1,  1998  and  June
 30,  1999,  between July 1, 1999 and June 30, 2000, between July 1, 2000
 and June 30, 2001, between July 1, 2001 and June 30, 2002, between  July
 1,  2002  and  June  30,  2003,  between July 1, 2003 and June 30, 2004,
 between July 1, 2004 and June 30, 2005, between July 1,  2005  and  June
 30,  2006,  between July 1, 2006 and June 30, 2007, between July 1, 2007
 and June 30, 2008, between July 1, 2008 and June 30, 2009, between  July
 1,  2009  and  June  30,  2010,  between July 1, 2010 and June 30, 2011,
 between July 1, 2011 and June 30, 2012, between July 1,  2012  and  June
 30,  2013,  between July 1, 2013 and June 30, 2014, between July 1, 2014
 and June 30, 2015, between July 1, 2015 and June 30, 2016, between  July
 1, 2016 and June 30, 2017, between July 1, 2017 and June 30, 2018, [and]
 between  July  1,  2018  and June 30, 2019, AND BETWEEN JULY 1, 2019 AND
 JUNE 30, 2020 for physicians or dentists certified as eligible for  each
 such  period  or  periods pursuant to subdivision 2 of this section by a
 general hospital licensed pursuant to article 28 of  the  public  health
 law; provided that no single insurer shall write more than fifty percent
 of  the  total  excess  premium  for  a given policy year; and provided,
 however, that such eligible physicians or dentists must have in force an

 S. 1507--B                         24

 individual policy, from an insurer licensed in  this  state  of  primary
 malpractice  insurance  coverage  in amounts of no less than one million
 three hundred thousand dollars for each claimant and three million  nine
 hundred  thousand dollars for all claimants under that policy during the
 period of such excess coverage for such occurrences or  be  endorsed  as
 additional insureds under a hospital professional liability policy which
 is  offered  through  a  voluntary  attending  physician  ("channeling")
 program previously permitted by the superintendent of financial services
 during the period of such excess coverage for such  occurrences.  During
 such  period,  such policy for excess coverage or such equivalent excess
 coverage shall, when combined with the physician's or dentist's  primary
 malpractice  insurance coverage or coverage provided through a voluntary
 attending physician ("channeling") program, total an aggregate level  of
 two  million  three  hundred  thousand dollars for each claimant and six
 million nine hundred thousand dollars for all claimants  from  all  such
 policies  with  respect  to  occurrences in each of such years provided,
 however, if the cost of primary malpractice insurance coverage in excess
 of one million dollars, but below the excess medical malpractice  insur-
 ance  coverage  provided  pursuant to this act, exceeds the rate of nine
 percent per annum, then the required level of primary malpractice insur-
 ance coverage in excess of one million dollars for each  claimant  shall
 be  in  an  amount  of  not less than the dollar amount of such coverage
 available at nine percent per annum; the required level of such coverage
 for all claimants under that policy shall be in an amount not less  than
 three  times the dollar amount of coverage for each claimant; and excess
 coverage, when combined with such primary malpractice  insurance  cover-
 age, shall increase the aggregate level for each claimant by one million
 dollars  and  three  million  dollars  for  all  claimants; and provided
 further, that, with respect to policies of primary  medical  malpractice
 coverage  that  include  occurrences  between April 1, 2002 and June 30,
 2002, such requirement that coverage be in  amounts  no  less  than  one
 million  three  hundred  thousand  dollars  for  each claimant and three
 million nine hundred thousand dollars for all claimants for such  occur-
 rences shall be effective April 1, 2002.
   §  2.  Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
 amending the civil practice law and rules and  other  laws  relating  to
 malpractice and professional medical conduct, as amended by section 2 of
 part M of chapter 57 of the laws of 2018, is amended to read as follows:
   (3)(a)  The  superintendent  of financial services shall determine and
 certify to each general hospital and to the commissioner of  health  the
 cost  of  excess malpractice insurance for medical or dental malpractice
 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988
 and June 30, 1989, between July 1, 1989 and June 30, 1990, between  July
 1,  1990  and  June  30,  1991,  between July 1, 1991 and June 30, 1992,
 between July 1, 1992 and June 30, 1993, between July 1,  1993  and  June
 30,  1994,  between July 1, 1994 and June 30, 1995, between July 1, 1995
 and June 30, 1996, between July 1, 1996 and June 30, 1997, between  July
 1,  1997  and  June  30,  1998,  between July 1, 1998 and June 30, 1999,
 between July 1, 1999 and June 30, 2000, between July 1,  2000  and  June
 30,  2001,  between July 1, 2001 and June 30, 2002, between July 1, 2002
 and June 30, 2003, between July 1, 2003 and June 30, 2004, between  July
 1,  2004  and  June  30,  2005,  between July 1, 2005 and June 30, 2006,
 between July 1, 2006 and June 30, 2007, between July 1,  2007  and  June
 30,  2008,  between July 1, 2008 and June 30, 2009, between July 1, 2009
 and June 30, 2010, between July 1, 2010 and June 30, 2011, between  July
 1,  2011  and June 30, 2012, between July 1, 2012 and June 30, 2013, and

 S. 1507--B                         25
 
 between July 1, 2013 and June 30, 2014, between July 1,  2014  and  June
 30,  2015,  between  July 1, 2015 and June 30, 2016, and between July 1,
 2016 and June 30, 2017, between July 1, 2017 and June  30,  2018,  [and]
 between  July  1,  2018  and June 30, 2019, AND BETWEEN JULY 1, 2019 AND
 JUNE 30, 2020 allocable to  each  general  hospital  for  physicians  or
 dentists  certified  as  eligible  for  purchase  of a policy for excess
 insurance coverage by such general hospital in accordance with  subdivi-
 sion  2  of  this  section, and may amend such determination and certif-
 ication as necessary.
   (b) The superintendent  of  financial  services  shall  determine  and
 certify  to  each general hospital and to the commissioner of health the
 cost of excess malpractice insurance or equivalent excess  coverage  for
 medical  or dental malpractice occurrences between July 1, 1987 and June
 30, 1988, between July 1, 1988 and June 30, 1989, between July  1,  1989
 and  June 30, 1990, between July 1, 1990 and June 30, 1991, between July
 1, 1991 and June 30, 1992, between July  1,  1992  and  June  30,  1993,
 between  July  1,  1993 and June 30, 1994, between July 1, 1994 and June
 30, 1995, between July 1, 1995 and June 30, 1996, between July  1,  1996
 and  June 30, 1997, between July 1, 1997 and June 30, 1998, between July
 1, 1998 and June 30, 1999, between July  1,  1999  and  June  30,  2000,
 between  July  1,  2000 and June 30, 2001, between July 1, 2001 and June
 30, 2002, between July 1, 2002 and June 30, 2003, between July  1,  2003
 and  June 30, 2004, between July 1, 2004 and June 30, 2005, between July
 1, 2005 and June 30, 2006, between July  1,  2006  and  June  30,  2007,
 between  July  1,  2007 and June 30, 2008, between July 1, 2008 and June
 30, 2009, between July 1, 2009 and June 30, 2010, between July  1,  2010
 and  June 30, 2011, between July 1, 2011 and June 30, 2012, between July
 1, 2012 and June 30, 2013, between July  1,  2013  and  June  30,  2014,
 between  July  1,  2014 and June 30, 2015, between July 1, 2015 and June
 30, 2016, between July 1, 2016 and June 30, 2017, between July  1,  2017
 and  June  30,  2018,  [and] between July 1, 2018 and June 30, 2019, AND
 BETWEEN JULY 1, 2019 AND JUNE 30, 2020 allocable to each general  hospi-
 tal  for  physicians or dentists certified as eligible for purchase of a
 policy for excess insurance coverage or equivalent  excess  coverage  by
 such  general hospital in accordance with subdivision 2 of this section,
 and may amend such determination and  certification  as  necessary.  The
 superintendent of financial services shall determine and certify to each
 general  hospital and to the commissioner of health the ratable share of
 such cost allocable to the period July 1, 1987 to December 31, 1987,  to
 the  period January 1, 1988 to June 30, 1988, to the period July 1, 1988
 to December 31, 1988, to the period January 1, 1989 to June 30, 1989, to
 the period July 1, 1989 to December 31, 1989, to the period  January  1,
 1990  to June 30, 1990, to the period July 1, 1990 to December 31, 1990,
 to the period January 1, 1991 to June 30, 1991, to the  period  July  1,
 1991  to  December  31,  1991, to the period January 1, 1992 to June 30,
 1992, to the period July 1, 1992 to December 31,  1992,  to  the  period
 January 1, 1993 to June 30, 1993, to the period July 1, 1993 to December
 31,  1993, to the period January 1, 1994 to June 30, 1994, to the period
 July 1, 1994 to December 31, 1994, to the period January 1, 1995 to June
 30, 1995, to the period July 1, 1995 to December 31, 1995, to the period
 January 1, 1996 to June 30, 1996, to the period July 1, 1996 to December
 31, 1996, to the period January 1, 1997 to June 30, 1997, to the  period
 July 1, 1997 to December 31, 1997, to the period January 1, 1998 to June
 30, 1998, to the period July 1, 1998 to December 31, 1998, to the period
 January 1, 1999 to June 30, 1999, to the period July 1, 1999 to December
 31,  1999, to the period January 1, 2000 to June 30, 2000, to the period

 S. 1507--B                         26
 
 July 1, 2000 to December 31, 2000, to the period January 1, 2001 to June
 30, 2001, to the period July 1, 2001 to June 30,  2002,  to  the  period
 July  1,  2002  to June 30, 2003, to the period July 1, 2003 to June 30,
 2004, to the period July 1, 2004 to June 30, 2005, to the period July 1,
 2005 and June 30, 2006, to the period July 1, 2006 and June 30, 2007, to
 the  period  July  1, 2007 and June 30, 2008, to the period July 1, 2008
 and June 30, 2009, to the period July 1, 2009 and June 30, 2010, to  the
 period  July  1,  2010 and June 30, 2011, to the period July 1, 2011 and
 June 30, 2012, to the period July 1, 2012 and  June  30,  2013,  to  the
 period  July  1,  2013 and June 30, 2014, to the period July 1, 2014 and
 June 30, 2015, to the period July  1,  2015  and  June  30,  2016,  [and
 between]  TO  THE  PERIOD  July  1, 2016 and June 30, 2017, [and] to the
 period July 1, 2017 to June 30, 2018, [and] to the period July  1,  2018
 to June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE 30, 2020.
   § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section
 18  of  chapter 266 of the laws of 1986, amending the civil practice law
 and rules and  other  laws  relating  to  malpractice  and  professional
 medical  conduct, as amended by section 3 of part M of chapter 57 of the
 laws of 2018, are amended to read as follows:
   (a) To the extent funds available to  the  hospital  excess  liability
 pool  pursuant to subdivision 5 of this section as amended, and pursuant
 to section 6 of part J of chapter 63 of the laws of 2001,  as  may  from
 time  to  time  be amended, which amended this subdivision, are insuffi-
 cient to meet the costs  of  excess  insurance  coverage  or  equivalent
 excess  coverage  for coverage periods during the period July 1, 1992 to
 June 30, 1993, during the period July 1, 1993 to June 30,  1994,  during
 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
 to  June  30,  1996,  during  the  period July 1, 1996 to June 30, 1997,
 during the period July 1, 1997 to June 30, 1998, during the period  July
 1,  1998  to  June  30, 1999, during the period July 1, 1999 to June 30,
 2000, during the period July 1, 2000 to June 30, 2001, during the period
 July 1, 2001 to October 29, 2001, during the period  April  1,  2002  to
 June  30,  2002, during the period July 1, 2002 to June 30, 2003, during
 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
 to June 30, 2005, during the period July  1,  2005  to  June  30,  2006,
 during  the period July 1, 2006 to June 30, 2007, during the period July
 1, 2007 to June 30, 2008, during the period July 1,  2008  to  June  30,
 2009, during the period July 1, 2009 to June 30, 2010, during the period
 July  1,  2010  to June 30, 2011, during the period July 1, 2011 to June
 30, 2012, during the period July 1, 2012 to June 30,  2013,  during  the
 period  July 1, 2013 to June 30, 2014, during the period July 1, 2014 to
 June 30, 2015, during the period July 1, 2015 to June 30,  2016,  during
 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017
 to June 30, 2018, [and] during the period July 1, 2018 to June 30, 2019,
 AND DURING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 allocated or reallo-
 cated  in  accordance  with  paragraph  (a)  of  subdivision 4-a of this
 section to rates of payment applicable to state  governmental  agencies,
 each  physician or dentist for whom a policy for excess insurance cover-
 age or equivalent excess coverage is purchased for such period shall  be
 responsible  for payment to the provider of excess insurance coverage or
 equivalent excess coverage of an allocable share of such  insufficiency,
 based on the ratio of the total cost of such coverage for such physician
 to the sum of the total cost of such coverage for all physicians applied
 to such insufficiency.
   (b)  Each  provider  of excess insurance coverage or equivalent excess
 coverage covering the period July 1, 1992 to June 30, 1993, or  covering

 S. 1507--B                         27
 
 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
 1994  to  June 30, 1995, or covering the period July 1, 1995 to June 30,
 1996, or covering the period July 1, 1996 to June 30, 1997, or  covering
 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
 1998  to  June 30, 1999, or covering the period July 1, 1999 to June 30,
 2000, or covering the period July 1, 2000 to June 30, 2001, or  covering
 the  period  July  1,  2001  to October 29, 2001, or covering the period
 April 1, 2002 to June 30, 2002, or covering the period July 1,  2002  to
 June  30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008,  or
 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
 June  30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
 covering the period July 1, 2012 to June 30, 2013, or covering the peri-
 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to
 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016,  or
 covering the period July 1, 2016 to June 30, 2017, or covering the peri-
 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to
 June  30,  2019,  OR  COVERING  THE PERIOD JULY 1, 2019 TO JUNE 30, 2020
 shall notify a covered physician or  dentist  by  mail,  mailed  to  the
 address  shown  on the last application for excess insurance coverage or
 equivalent excess coverage, of the amount due to such provider from such
 physician or dentist for such coverage period determined  in  accordance
 with  paragraph  (a)  of this subdivision. Such amount shall be due from
 such physician or dentist to such provider of excess insurance  coverage
 or  equivalent  excess  coverage  in a time and manner determined by the
 superintendent of financial services.
   (c) If a physician or dentist liable for payment of a portion  of  the
 costs  of excess insurance coverage or equivalent excess coverage cover-
 ing the period July 1, 1992 to June 30, 1993,  or  covering  the  period
 July  1,  1993  to June 30, 1994, or covering the period July 1, 1994 to
 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996,  or
 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
 June  30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
 od July 1, 2001 to October 29, 2001, or covering  the  period  April  1,
 2002  to  June 30, 2002, or covering the period July 1, 2002 to June 30,
 2003, or covering the period July 1, 2003 to June 30, 2004, or  covering
 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
 2005  to  June 30, 2006, or covering the period July 1, 2006 to June 30,
 2007, or covering the period July 1, 2007 to June 30, 2008, or  covering
 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
 2009  to  June 30, 2010, or covering the period July 1, 2010 to June 30,
 2011, or covering the period July 1, 2011 to June 30, 2012, or  covering
 the period July 1, 2012 to June 30, 2013, or covering the period July 1,
 2013  to  June 30, 2014, or covering the period July 1, 2014 to June 30,
 2015, or covering the period July 1, 2015 to June 30, 2016, or  covering
 the period July 1, 2016 to June 30, 2017, or covering the period July 1,
 2017  to  June 30, 2018, or covering the period July 1, 2018 to June 30,
 2019, OR COVERING THE PERIOD JULY 1, 2019 TO JUNE 30, 2020 determined in
 accordance with paragraph (a) of  this  subdivision  fails,  refuses  or
 neglects to make payment to the provider of excess insurance coverage or
 equivalent  excess coverage in such time and manner as determined by the

 S. 1507--B                         28
 
 superintendent of financial services pursuant to paragraph (b)  of  this
 subdivision,  excess  insurance  coverage  or equivalent excess coverage
 purchased for such physician or dentist in accordance with this  section
 for  such  coverage period shall be cancelled and shall be null and void
 as of the first day on or after the  commencement  of  a  policy  period
 where  the  liability  for  payment pursuant to this subdivision has not
 been met.
   (d) Each provider of excess insurance coverage  or  equivalent  excess
 coverage  shall  notify the superintendent of financial services and the
 commissioner of health or their designee of each physician  and  dentist
 eligible  for  purchase  of  a  policy  for excess insurance coverage or
 equivalent excess coverage covering the period July 1, 1992 to June  30,
 1993,  or covering the period July 1, 1993 to June 30, 1994, or covering
 the period July 1, 1994 to June 30, 1995, or covering the period July 1,
 1995 to June 30, 1996, or covering the period July 1, 1996 to  June  30,
 1997,  or covering the period July 1, 1997 to June 30, 1998, or covering
 the period July 1, 1998 to June 30, 1999, or covering the period July 1,
 1999 to June 30, 2000, or covering the period July 1, 2000 to  June  30,
 2001, or covering the period July 1, 2001 to October 29, 2001, or cover-
 ing  the  period  April 1, 2002 to June 30, 2002, or covering the period
 July 1, 2002 to June 30, 2003, or covering the period July  1,  2003  to
 June  30, 2004, or covering the period July 1, 2004 to June 30, 2005, or
 covering the period July 1, 2005 to June 30, 2006, or covering the peri-
 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to
 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009,  or
 covering the period July 1, 2009 to June 30, 2010, or covering the peri-
 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to
 June  30, 2012, or covering the period July 1, 2012 to June 30, 2013, or
 covering the period July 1, 2013 to June 30, 2014, or covering the peri-
 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to
 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017,  or
 covering the period July 1, 2017 to June 30, 2018, or covering the peri-
 od July 1, 2018 to June 30, 2019, OR COVERING THE PERIOD JULY 1, 2019 TO
 JUNE 30, 2020 that has made payment to such provider of excess insurance
 coverage  or equivalent excess coverage in accordance with paragraph (b)
 of this subdivision and of each physician and dentist  who  has  failed,
 refused or neglected to make such payment.
   (e)  A  provider  of  excess  insurance  coverage or equivalent excess
 coverage shall refund to the hospital excess liability pool  any  amount
 allocable to the period July 1, 1992 to June 30, 1993, and to the period
 July  1,  1993  to June 30, 1994, and to the period July 1, 1994 to June
 30, 1995, and to the period July 1, 1995 to June 30, 1996,  and  to  the
 period  July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
 June 30, 1998, and to the period July 1, 1998 to June 30, 1999,  and  to
 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
 to  June  30,  2001, and to the period July 1, 2001 to October 29, 2001,
 and to the period April 1, 2002 to June 30, 2002, and to the period July
 1, 2002 to June 30, 2003, and to the period July 1,  2003  to  June  30,
 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
 July  1,  2005  to June 30, 2006, and to the period July 1, 2006 to June
 30, 2007, and to the period July 1, 2007 to June 30, 2008,  and  to  the
 period  July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
 June 30, 2010, and to the period July 1, 2010 to June 30, 2011,  and  to
 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
 to  June  30, 2013, and to the period July 1, 2013 to June 30, 2014, and
 to the period July 1, 2014 to June 30, 2015, and to the period  July  1,

 S. 1507--B                         29
 
 2015  to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and
 to the period July 1, 2017 to June 30, 2018, and to the period  July  1,
 2018  to  June 30, 2019, AND TO THE PERIOD JULY 1, 2019 TO JUNE 30, 2020
 received  from the hospital excess liability pool for purchase of excess
 insurance coverage or equivalent excess  coverage  covering  the  period
 July  1,  1992 to June 30, 1993, and covering the period July 1, 1993 to
 June 30, 1994, and covering the period July 1, 1994 to  June  30,  1995,
 and  covering the period July 1, 1995 to June 30, 1996, and covering the
 period July 1, 1996 to June 30, 1997, and covering the  period  July  1,
 1997  to June 30, 1998, and covering the period July 1, 1998 to June 30,
 1999, and covering the period July 1, 1999 to June 30, 2000, and  cover-
 ing  the  period  July 1, 2000 to June 30, 2001, and covering the period
 July 1, 2001 to October 29, 2001, and covering the period April 1,  2002
 to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003,
 and  covering the period July 1, 2003 to June 30, 2004, and covering the
 period July 1, 2004 to June 30, 2005, and covering the  period  July  1,
 2005  to June 30, 2006, and covering the period July 1, 2006 to June 30,
 2007, and covering the period July 1, 2007 to June 30, 2008, and  cover-
 ing  the  period  July 1, 2008 to June 30, 2009, and covering the period
 July 1, 2009 to June 30, 2010, and covering the period July 1,  2010  to
 June  30,  2011,  and covering the period July 1, 2011 to June 30, 2012,
 and covering the period July 1, 2012 to June 30, 2013, and covering  the
 period  July  1,  2013 to June 30, 2014, and covering the period July 1,
 2014 to June 30, 2015, and covering the period July 1, 2015 to June  30,
 2016,  and covering the period July 1, 2016 to June 30, 2017, and cover-
 ing the period July 1, 2017 to June 30, 2018, and  covering  the  period
 July  1,  2018 to June 30, 2019, AND COVERING THE PERIOD JULY 1, 2019 TO
 JUNE 30, 2020 for a physician or dentist  where  such  excess  insurance
 coverage  or  equivalent excess coverage is cancelled in accordance with
 paragraph (c) of this subdivision.
   § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil
 practice law and rules  and  other  laws  relating  to  malpractice  and
 professional medical conduct, as amended by section 4 of part M of chap-
 ter 57 of the laws of 2018, is amended to read as follows:
   §  40.  The superintendent of financial services shall establish rates
 for policies providing coverage  for  physicians  and  surgeons  medical
 malpractice  for the periods commencing July 1, 1985 and ending June 30,
 [2019;]  2020;  provided,  however,  that  notwithstanding   any   other
 provision  of law, the superintendent shall not establish or approve any
 increase in rates for the period commencing July 1, 2009 and ending June
 30, 2010. The superintendent shall direct insurers to  establish  segre-
 gated  accounts  for  premiums, payments, reserves and investment income
 attributable to such premium periods and shall require periodic  reports
 by the insurers regarding claims and expenses attributable to such peri-
 ods to monitor whether such accounts will be sufficient to meet incurred
 claims  and expenses. On or after July 1, 1989, the superintendent shall
 impose a surcharge on premiums to satisfy a projected deficiency that is
 attributable to the premium levels established pursuant to this  section
 for  such  periods;  provided, however, that such annual surcharge shall
 not exceed eight percent of the established rate until July  1,  [2019,]
 2020, at which time and thereafter such surcharge shall not exceed twen-
 ty-five  percent  of  the  approved  adequate rate, and that such annual
 surcharges shall continue for such period of time as shall be sufficient
 to satisfy such deficiency. The superintendent  shall  not  impose  such
 surcharge  during the period commencing July 1, 2009 and ending June 30,
 2010. On and after July  1,  1989,  the  surcharge  prescribed  by  this

 S. 1507--B                         30
 
 section  shall  be  retained by insurers to the extent that they insured
 physicians and surgeons during the July 1, 1985 through June 30,  [2019]
 2020  policy  periods;  in  the  event  and to the extent physicians and
 surgeons  were  insured by another insurer during such periods, all or a
 pro rata share of the surcharge, as the case may be, shall  be  remitted
 to  such  other  insurer  in accordance with rules and regulations to be
 promulgated by the superintendent.  Surcharges collected from physicians
 and surgeons who were not insured during such policy  periods  shall  be
 apportioned  among  all insurers in proportion to the premium written by
 each insurer during such policy periods; if a physician or  surgeon  was
 insured by an insurer subject to rates established by the superintendent
 during  such  policy  periods,  and  at  any time thereafter a hospital,
 health maintenance organization, employer or institution is  responsible
 for  responding in damages for liability arising out of such physician's
 or surgeon's practice of medicine, such responsible  entity  shall  also
 remit  to  such  prior  insurer the equivalent amount that would then be
 collected as a surcharge if the physician or surgeon  had  continued  to
 remain  insured  by  such  prior  insurer. In the event any insurer that
 provided coverage during such policy  periods  is  in  liquidation,  the
 property/casualty  insurance  security fund shall receive the portion of
 surcharges to which the insurer in liquidation would have been entitled.
 The surcharges authorized herein shall be deemed to be income earned for
 the purposes of section 2303 of the insurance law.  The  superintendent,
 in  establishing  adequate  rates and in determining any projected defi-
 ciency pursuant to the requirements of this section  and  the  insurance
 law,  shall  give  substantial  weight, determined in his discretion and
 judgment, to the  prospective  anticipated  effect  of  any  regulations
 promulgated  and  laws  enacted  and the public benefit of   stabilizing
 malpractice rates and minimizing rate level fluctuation during the peri-
 od of time necessary for the development of  more  reliable  statistical
 experience  as  to  the  efficacy of such laws and regulations affecting
 medical, dental or podiatric malpractice enacted or promulgated in 1985,
 1986, by this act and at any other time.  Notwithstanding any  provision
 of the insurance law, rates already established and to be established by
 the  superintendent pursuant to this section are deemed adequate if such
 rates would be adequate when taken together with the maximum  authorized
 annual  surcharges to be imposed for a reasonable period of time whether
 or not any such annual surcharge has been actually  imposed  as  of  the
 establishment of such rates.
   §  5. Section 5 and subdivisions (a) and (e) of section 6 of part J of
 chapter 63 of the laws of 2001, amending chapter  266  of  the  laws  of
 1986,  amending the civil practice law and rules and other laws relating
 to malpractice and professional medical conduct, relating to the  effec-
 tiveness  of certain provisions of such chapter, as amended by section 5
 of part M of chapter 57 of the laws of 2018,  are  amended  to  read  as
 follows:
   §  5. The superintendent of financial services and the commissioner of
 health shall determine, no later than June 15, 2002, June 15, 2003, June
 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007,  June  15,  2008,
 June  15,  2009,  June  15, 2010, June 15, 2011, June 15, 2012, June 15,
 2013, June 15, 2014, June 15, 2015, June 15, 2016, June 15,  2017,  June
 15,  2018,  [and]  June  15, 2019, AND JUNE 15, 2020 the amount of funds
 available in the hospital excess liability  pool,  created  pursuant  to
 section  18  of  chapter 266 of the laws of 1986, and whether such funds
 are sufficient for purposes of purchasing excess insurance coverage  for
 eligible participating physicians and dentists during the period July 1,

 S. 1507--B                         31
 
 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003
 to  June  30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to
 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June
 30,  2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
 2010, or July 1, 2010 to June 30, 2011, or July  1,  2011  to  June  30,
 2012,  or  July  1,  2012  to June 30, 2013, or July 1, 2013 to June 30,
 2014, or July 1, 2014 to June 30, 2015, or July  1,  2015  to  June  30,
 2016,  or  July  1,  2016  to June 30, 2017, or July 1, 2017 to June 30,
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (a) This section shall be effective only upon a determination,  pursu-
 ant  to  section  five  of  this act, by the superintendent of financial
 services and the commissioner of health, and  a  certification  of  such
 determination  to  the  state  director  of the budget, the chair of the
 senate committee on finance and the chair of the assembly  committee  on
 ways  and means, that the amount of funds in the hospital excess liabil-
 ity pool, created pursuant to section 18 of chapter 266 of the  laws  of
 1986, is insufficient for purposes of purchasing excess insurance cover-
 age for eligible participating physicians and dentists during the period
 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July
 1,  2003  to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,
 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007
 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1,  2009  to
 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June
 30,  2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
 2014, or July 1, 2014 to June 30, 2015, or July  1,  2015  to  June  30,
 2016,  or  July  1,  2016  to June 30, 2017, or July 1, 2017 to June 30,
 2018, or July 1, 2018 to June 30, 2019, OR JULY 1, 2019 TO JUNE 30, 2020
 as applicable.
   (e) The commissioner of health  shall  transfer  for  deposit  to  the
 hospital excess liability pool created pursuant to section 18 of chapter
 266  of  the laws of 1986 such amounts as directed by the superintendent
 of financial services for the purchase  of  excess  liability  insurance
 coverage  for  eligible  participating  physicians  and dentists for the
 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to  June  30,
 2003,  or  July  1,  2003  to June 30, 2004, or July 1, 2004 to June 30,
 2005, or July 1, 2005 to June 30, 2006, or July  1,  2006  to  June  30,
 2007,  as  applicable, and the cost of administering the hospital excess
 liability pool for such applicable policy year,  pursuant to the program
 established in chapter 266 of the laws of 1986,  as  amended,  no  later
 than  June  15,  2002, June 15, 2003, June 15, 2004, June 15, 2005, June
 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009,  June  15,  2010,
 June  15,  2011,  June  15, 2012, June 15, 2013, June 15, 2014, June 15,
 2015, June 15, 2016, June 15, 2017, June 15, 2018, [and] June 15,  2019,
 AND JUNE 15, 2020 as applicable.
   §  6. Section 20 of part H of chapter 57 of the laws of 2017, amending
 the New York Health Care Reform Act of 1996 and other laws  relating  to
 extending  certain provisions thereto, as amended by section 6 of part M
 of chapter 57 of the laws of 2018, is amended to read as follows:
   § 20. Notwithstanding any law, rule or  regulation  to  the  contrary,
 only  physicians  or dentists who were eligible, and for whom the super-
 intendent of financial services and the commissioner of health, or their
 designee, purchased, with funds available in the hospital excess liabil-
 ity pool, a full or partial policy for  excess  coverage  or  equivalent
 excess  coverage  for  the coverage period ending the thirtieth of June,
 two thousand [eighteen,] NINETEEN, shall be eligible to apply  for  such

 S. 1507--B                         32
 
 coverage  for the coverage period beginning the first of July, two thou-
 sand [eighteen;] NINETEEN; provided, however, if  the  total  number  of
 physicians  or  dentists  for  whom  such  excess coverage or equivalent
 excess  coverage  was purchased for the policy year ending the thirtieth
 of June, two thousand [eighteen] NINETEEN exceeds the  total  number  of
 physicians  or  dentists  certified  as eligible for the coverage period
 beginning the first of July, two thousand [eighteen,] NINETEEN, then the
 general hospitals may certify additional eligible physicians or dentists
 in a number equal to such general hospital's proportional share  of  the
 total  number  of  physicians  or  dentists  for whom excess coverage or
 equivalent excess coverage was purchased with  funds  available  in  the
 hospital excess liability pool as of the thirtieth of June, two thousand
 [eighteen,] NINETEEN, as applied to the difference between the number of
 eligible physicians or dentists for whom a policy for excess coverage or
 equivalent  excess coverage was purchased for the coverage period ending
 the thirtieth of June, two thousand [eighteen] NINETEEN and  the  number
 of  such  eligible  physicians  or  dentists who have applied for excess
 coverage or equivalent excess coverage for the coverage period beginning
 the first of July, two thousand [eighteen] NINETEEN.
   § 7. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART G
 
   Section 1. Intentionally omitted.
   § 2. Intentionally omitted.
   § 3. Intentionally omitted.
   § 4. Intentionally omitted.
   § 5. Intentionally omitted.
   §  5-a.  Subdivision  8 of section 4403-f of the public health law, as
 amended by section 21 of part B of chapter 59 of the laws  of  2016,  is
 amended to read as follows:
   8.  Payment  rates  for managed long term care plan enrollees eligible
 for medical assistance. The commissioner shall establish  payment  rates
 for  services  provided  to  enrollees  eligible  under title XIX of the
 federal social security act. Such payment  rates  shall  be  subject  to
 approval by the director of the division of the budget and shall reflect
 savings to both state and local governments when compared to costs which
 would  be incurred by such program if enrollees were to receive compara-
 ble health and long term care services on a fee-for-service basis in the
 geographic region in which such services are proposed  to  be  provided.
 Payment rates shall be risk-adjusted to take into account the character-
 istics  of  enrollees, or proposed enrollees, including, but not limited
 to:   frailty, disability level,  health  and  functional  status,  age,
 gender,  the  nature  of  services provided to such enrollees, and other
 factors as determined by the commissioner. The  risk  adjusted  premiums
 may  also  be  combined  with  disincentives or requirements designed to
 mitigate any incentives to obtain higher payment categories. In  setting
 such  payment  rates, the commissioner shall consider costs borne by the
 managed care program to ensure actuarially sound and adequate  rates  of
 payment  to ensure quality of care shall comply with all applicable laws
 and regulations, state and federal, including regulations as to actuari-
 al soundness for medicaid managed care.  PRIOR TO EACH ANNUAL RATE PERI-
 OD AND, TO THE EXTENT PRACTICABLE PRIOR TO THE  EFFECTIVE  DATE  OF  ANY
 CHANGE  IN  LAW,  REGULATION OR OTHER STATE OR FEDERAL MANDATE IMPACTING
 THE COST OF THE MANAGED CARE  PLANS'  OPERATIONS  OR  OF  THE  PROVIDERS

 S. 1507--B                         33

 SERVICES,  THE COMMISSIONER SHALL PROVIDE AN ACCOUNTING OF THE COMPONENT
 COST (INCLUDING WAGE AND  RELATED  LABOR  COMPLIANCE)  AND  TOTAL  COSTS
 FACTORED  INTO  THE  MANAGED  LONG  TERM CARE PLAN RATES, ALONG WITH THE
 COMMISSIONER'S  AND THE INDEPENDENT ACTUARY'S DETERMINATION OF THE ACTU-
 ARIAL SOUNDNESS AND ADEQUACY OF SUCH RATES.   SUCH ACCOUNTING  SHALL  BE
 PROVIDED  TO  MANAGED  LONG TERM CARE PLANS AT LEAST SIXTY DAYS PRIOR TO
 THE START OF THE RATE PERIOD AND, FOR ANY CHANGES DURING THE RATE  PERI-
 OD,  AT  LEAST  SIXTY DAYS PRIOR TO THE EFFECTIVENESS OF SUCH CHANGE, AS
 PRACTICABLE. THE DETERMINATIONS OF ACTUARIAL SOUNDNESS AND  ADEQUACY  OF
 THE  RATES  SHALL BE FURTHER AVAILABLE TO THE PLANS' CONTRACTING PROVID-
 ERS. THE COMMISSIONER SHALL PROVIDE FOR A STREAMLINED AND TIMELY PROCESS
 TO PAY ADJUSTED RATES TO MANAGED CARE  PLANS,  AND  THE  PLANS'  SERVICE
 PROVIDERS,  INCLUDING  INCREASES  FOR  WORKER  WAGES  AND  RELATED LABOR
 COMPLIANCE;  PROVIDED,  HOWEVER,  THAT  TO  THE  EXTENT  NOT   EXPRESSLY
 PRECLUDED BY LAW, ANY NEW STATE REQUIREMENT UPON SUCH PLAN OR THE PLANS'
 SERVICE  PROVIDERS  WHICH IMPOSES NEW COSTS SHALL BE IMPLEMENTED ONLY ON
 OR AFTER THE DETERMINATION MADE IN THIS SECTION THAT SUCH  RATES  COMPLY
 WITH ACTUARIAL SOUNDNESS AND ADEQUACY.
   § 5-b. The public health law is amended by adding a new section 3614-f
 to read as follows:
   §  3614-F.  PAYMENTS  FOR  HOME  AND  COMMUNITY  BASED  LONG TERM CARE
 SERVICES. THE PAYMENT OF CLAIMS SUBMITTED UNDER CONTRACTS OR  AGREEMENTS
 WITH INSURERS UNDER THE MEDICAL ASSISTANCE PROGRAM FOR HOME AND COMMUNI-
 TY  BASED  LONG  TERM  CARE  SERVICES  PROVIDED UNDER THIS ARTICLE OR BY
 FISCAL  INTERMEDIARIES  OPERATING  PURSUANT  TO  SECTION  THREE  HUNDRED
 SIXTY-FIVE-F  OF  THE  SOCIAL  SERVICES LAW SHALL PROVIDE THAT ANY FUNDS
 APPROPRIATED TO COMPENSATE FOR MINIMUM  WAGE  PURSUANT  TO  SECTION  SIX
 HUNDRED  FIFTY-TWO  OF  THE  LABOR  LAW SHALL BE PROVIDED BY INSURERS IN
 AMENDMENTS TO EXISTING CONTRACTS WITH HOME AND COMMUNITY BASED LONG TERM
 CARE SERVICES PROVIDERS UNDER THIS ARTICLE AND TO FISCAL  INTERMEDIARIES
 OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL
 SERVICES LAW AT LEAST NINETY DAYS PRIOR TO THE  EFFECTIVE  DATE  OF  ANY
 SUCH  LAW  OR  REGULATION  IMPACTING  WAGES. INSURERS SHALL PROVIDE SUCH
 FUNDS IN AN AMOUNT THAT SUPPLEMENTS ANY CURRENT CONTRACTS OR  AGREEMENTS
 AND  SHALL NOT USE SUCH FUNDS TO SUPPLANT PAYMENTS FOR EXISTING SERVICES
 UNDER THE MEDICAID PROGRAM. SUCH  INSURERS  SHALL  INCLUDE  BUT  NOT  BE
 LIMITED  TO  MEDICAID  MANAGED CARE PLANS AND MEDICAID MANAGED LONG TERM
 CARE PLANS.
   § 5-c. Paragraph (b) of subdivision 10 of section 3614 of  the  public
 health law, as amended by section 5 of part C of chapter 109 of the laws
 of 2006, is amended and a new paragraph (e) is added to read as follows:
   (b) Programs which have their rates adjusted pursuant to this subdivi-
 sion shall use such funds solely for the purposes of recruitment, train-
 ing and retention of non-supervisory home care services workers or other
 personnel  with  direct  patient care responsibility. Such purpose shall
 include the recruitment, training and retention of non-supervisory  home
 care  services  workers or any worker with direct patient care responsi-
 bility employed in licensed home care services agencies  under  contract
 with  such  agencies.  Such agencies are prohibited from using such fund
 for any other purpose. For purposes of the long term  home  health  care
 program,  such payment shall be treated as supplemental payments and not
 effect any current cost cap requirement. FOR  PURPOSES  OF  THE  MANAGED
 LONG  TERM  CARE  PROGRAM,  PLANS  SHALL  DISTRIBUTE SUCH FUNDS IN THEIR
 ENTIRETY USING A REASONABLE METHODOLOGY. SUCH PAYMENTS SHALL BE  SUPPLE-
 MENTAL TO REIMBURSEMENT RATES, AND PLANS SHALL PROVIDE WRITTEN NOTIFICA-
 TION  TO EACH CONTRACTED AGENCY INDICATING THE AMOUNT OF FUNDS DISBURSED

 S. 1507--B                         34
 
 FOR THE PURPOSE OF RECRUITMENT, TRAINING AND RETENTION OF NON-SUPERVISO-
 RY HOME CARE SERVICES WORKERS OR ANY PERSONNEL WITH DIRECT PATIENT  CARE
 RESPONSIBILITY. Each such agency shall submit, at a time and in a manner
 determined  by  the commissioner, a written certification attesting that
 such funds will be used solely for the purpose of recruitment,  training
 and retention of non-supervisory home health aides or any personnel with
 direct  patient care responsibility. WHEN SUBMITTING ATTESTATIONS TO THE
 DEPARTMENT, MANAGED LONG TERM CARE PLANS SHALL INCLUDE  THE  METHODOLOGY
 UTILIZED IN THE DISBURSEMENT OF FUNDS. The commissioner is authorized to
 audit  each such agency or program to ensure compliance with the written
 certification required by this subdivision and shall  recoup  any  funds
 determined  to  have  been  used for purposes other than recruitment and
 retention of non-supervisory home health aides or other  personnel  with
 direct patient care responsibility. Such recoupment shall be in addition
 to any other penalties provided by law.
   (E)  THE DEPARTMENT SHALL PROVIDE A REPORT TO THE CHAIRS OF THE SENATE
 FINANCE COMMITTEE, ASSEMBLY WAYS AND MEANS COMMITTEE, AND SENATE  HEALTH
 AND  ASSEMBLY  HEALTH COMMITTEES.   SUCH REPORT SHALL BE SUBMITTED ON OR
 BEFORE JANUARY FIRST, TWO THOUSAND TWENTY AND SHALL INCLUDE THE DISTRIB-
 UTION OF MONIES BY PLAN AND PROVIDER OF THE  FUNDS  SET  FORTH  IN  THIS
 SUBDIVISION.
   §  5-d. Subdivision 12 of section 366-a of the social services law, as
 added by section 36-c of part B of chapter 57 of the laws  of  2015,  is
 amended to read as follows:
   12.  The commissioner shall develop expedited procedures for determin-
 ing medical assistance eligibility for any medical assistance  applicant
 with  an  immediate need for personal care or consumer directed personal
 assistance services pursuant to paragraph  (e)  of  subdivision  two  of
 section  three  hundred  sixty-five-a  of  this  title  or section three
 hundred sixty-five-f of this  title,  respectively,  AND  HOSPICE.  Such
 procedures  shall require that a final eligibility determination be made
 within seven days of the date of a complete medical assistance  applica-
 tion.
   §  5-e. Subdivision 31 of section 364-j of the social services law, as
 added by section 36-b of part B of chapter 57 of the laws  of  2015,  is
 amended to read as follows:
   31.  (a)  The  commissioner shall require managed care providers under
 this section, managed long-term  care  plans  under  section  forty-four
 hundred  three-f  the  public health law and other appropriate long-term
 service programs to adopt expedited procedures  for  approving  personal
 care  services for a medical assistance recipient who requires immediate
 personal care or consumer directed personal assistance services pursuant
 to  paragraph  (e)  of  subdivision  two  of   section   three   hundred
 sixty-five-a of this title or section three hundred sixty-five-f of this
 title,  respectively,  or  other  long-term  care,  WHICH  SHALL INCLUDE
 HOSPICE, and provide such  care  or  services  as  appropriate,  pending
 approval by such provider or program.
   §  5-f. Subparagraph (ii) of paragraph (k) of subdivision 3 of section
 461-l of the social services law, as added by section 2  of  part  B  of
 chapter 57 of the laws of 2018, is amended to read as follows:
   (ii)  Existing assisted living program providers licensed on or before
 April first, two thousand eighteen may submit  applications  under  this
 paragraph  beginning no later than June thirtieth, two thousand eighteen
 and until a deadline to be  determined  by  the  department  of  health.
 Existing  assisted  living program providers licensed on or before April
 first, two thousand  [twenty]  NINETEEN  may  submit  such  applications

 S. 1507--B                         35
 
 beginning  no  later than June thirtieth, two thousand [twenty] NINETEEN
 and until a deadline to be determined by the department of health.
   §  5-g.  Paragraph (m) of subdivision 3 of section 461-l of the social
 services law, as added by section 2 of part B of chapter 57 of the  laws
 of 2018, is amended to read as follows:
   (m)  Beginning April first, two thousand [twenty-three,] TWENTY, addi-
 tional assisted living program beds shall be approved on a case by  case
 basis  whenever the commissioner of health is satisfied that public need
 exists at the time and place and under  circumstances  proposed  by  the
 applicant.
   §  5-h.  Workgroup on case mix adjustments for residential health care
 facilities. The commissioner of health shall convene and chair  a  work-
 group  on case mix adjustments to Medicaid rates of payment for residen-
 tial health care facilities. The workgroup shall be comprised  of  resi-
 dential  health care facilities or representatives from such facilities,
 representatives from the statewide associations and other  such  experts
 on  case mix as required by the commissioner. The workgroup shall review
 recent case mix data and related analyses conducted by  the  department,
 the  department's  Minimum  Data Set (MDS) census collection process and
 case mix adjustments authorized under subdivision 2-c of  section  twen-
 ty-eight  hundred eight of the public health law. Such review shall seek
 to promote a higher degree of accuracy in the  MDS  data,  reduce  audit
 findings and target abuses. The workgroup shall offer recommendations on
 how  to  improve  accuracy  in the MDS census collection process, reduce
 audit findings and reduce or eliminate abusive practices. In  developing
 its   recommendations,  the  workgroup  shall  ensure  that  the  census
 collection process and case mix adjustment continues  to  recognize  the
 need  to  adjust rates for residential health care facilities that serve
 high-need residents. The workgroup shall also consider  any  changes  in
 federal  law  and  regulations  relating  to nursing home reimbursement,
 including adoption of the patient driven payment model, and  administra-
 tive  complexity in revising the census collection and rate promulgation
 processes. The commissioner and department of health shall be prohibited
 from reducing or recouping case mix adjustments for periods prior to the
 implementation of the workgroup recommendations; provided, such  limita-
 tion  shall  not apply to audits by the Office of the Medicaid Inspector
 General, audits conducted by the department of health, or  in  cases  of
 fraud  or abuse. The workgroup shall report its recommendations no later
 than July first, two thousand nineteen. Such  recommendations  shall  be
 adopted  by  the commissioner on a prospective basis and rely on assess-
 ment data submitted no earlier than such  adoption;  however,  any  rate
 adjustments  based  on  the  recommendations  of  the workgroup shall be
 implemented only after such adjustments are approved by  an  independent
 actuary, and in no event shall such adjustments result in a reduction in
 rates of over $122 million in state-share funds.
   §  5-i.  Subdivision 31 of section 364-j of the social services law is
 amended by adding a new paragraph (b) to read as follows:
   (B) PRIOR TO ANY MANAGED LONG-TERM CARE PAYMENT REDUCTION  RELATED  TO
 PERSONAL  CARE  SERVICES,  THE COMMISSIONER SHALL PROMULGATE REGULATIONS
 ALLOWING UTILIZATION MANAGEMENT OF PERSONAL CARE SERVICES IN  ACCORDANCE
 WITH  A  RECIPIENT'S  PLAN  OF TREATMENT THAT WILL REALIZE CORRESPONDING
 COST REDUCTIONS IN PERSONAL CARE SERVICES. THE REGULATIONS SHALL NOT  BE
 ADOPTED, NOR SHALL A RELATED PAYMENT REDUCTION OCCUR, UNTIL IT IS DETER-
 MINED  BY  AN INDEPENDENT ACTUARY THAT THE REGULATIONS WILL ACHIEVE COST
 REDUCTIONS EQUAL TO THE MANAGED LONG-TERM CARE PAYMENT REDUCTION.

 S. 1507--B                         36
 
   § 6. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however,  that  the amendments to subdivision 8 of section 4403-f of the
 public health law made by section five-a of this act  shall  not  affect
 the repeal of such subdivision and shall be deemed to be repealed there-
 with;  and provided further, however, that the amendments to subdivision
 31 of section 364-j of the social services law made by  sections  five-e
 and  five-i  of this act shall not affect the repeal of such section and
 shall be deemed repealed therewith.
 
                                  PART H
 
   Section 1. Subparagraph (v) of paragraph (b)  of  subdivision  5-b  of
 section 2807-k of the public health law is REPEALED.
   §  2. Section 2807 of the public health law is amended by adding a new
 subdivision 20-a to read as follows:
   20-A. NOTWITHSTANDING ANY  PROVISION  OF  LAW  TO  THE  CONTRARY,  THE
 COMMISSIONERS  OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH,
 THE OFFICE OF PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE  OF
 ALCOHOLISM  AND  SUBSTANCE  ABUSE  SERVICES  ARE AUTHORIZED TO WAIVE ANY
 REGULATORY REQUIREMENTS AS ARE  NECESSARY,  CONSISTENT  WITH  APPLICABLE
 LAW,  TO  ALLOW  PROVIDERS THAT ARE INVOLVED IN DSRIP PROJECTS OR REPLI-
 CATION AND SCALING ACTIVITIES, AS APPROVED BY  THE  AUTHORIZING  COMMIS-
 SIONER,  TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE EFFICIENT
 SCALING AND REPLICATION OF DSRIP PROMISING PRACTICES, AS  DETERMINED  BY
 THE   AUTHORIZING   COMMISSIONER;  PROVIDED  HOWEVER,  THAT  REGULATIONS
 PERTAINING TO PATIENT SAFETY MAY NOT BE  WAIVED,  NOR  SHALL  ANY  REGU-
 LATIONS BE WAIVED IF SUCH WAIVER WOULD RISK PATIENT SAFETY.
   § 3. Intentionally omitted.
   § 4. Intentionally omitted.
   § 5. Intentionally omitted.
   § 6. Intentionally omitted.
   § 7. This act shall take effect immediately.
 
                                  PART I
 
   Section  1. The insurance law is amended by adding a new article 29 to
 read as follows:
                                ARTICLE 29
                         PHARMACY BENEFIT MANAGERS
 SECTION 2901. DEFINITIONS.
         2902. ACTING WITHOUT A REGISTRATION.
         2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.
         2905. ACTING WITHOUT A LICENSE.
         2906. LICENSING OF A PHARMACY BENEFIT MANAGER.
         2907. REVOCATION OR SUSPENSION OF A REGISTRATION OR LICENSE OF A
                 PHARMACY BENEFIT MANAGER.
         2908. PENALTIES FOR VIOLATIONS.
         2909. STAY OR SUSPENSION OF SUPERINTENDENT'S DETERMINATION.
         2910. REVOKED REGISTRATIONS OR LICENSES.
         2911. CHANGE OF ADDRESS.
         2912. APPLICABILITY OF OTHER LAWS.
         2913. ASSESSMENTS.
         2914. DUTY, ACCOUNTABILITY AND TRANSPARENCY.
   § 2901. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE:

 S. 1507--B                         37
 
   (A) "CONTROLLING PERSON" IS ANY PERSON OR OTHER ENTITY  WHO  OR  WHICH
 DIRECTLY  OR  INDIRECTLY HAS THE POWER TO DIRECT OR CAUSE TO BE DIRECTED
 THE MANAGEMENT, CONTROL OR ACTIVITIES OF A PHARMACY BENEFIT MANAGER.
   (B)  "HEALTH  INSURER"  MEANS  AN INSURANCE COMPANY AUTHORIZED IN THIS
 STATE TO WRITE ACCIDENT AND HEALTH INSURANCE, A COMPANY ORGANIZED PURSU-
 ANT TO ARTICLE FORTY-THREE OF  THIS  CHAPTER,  A  MUNICIPAL  COOPERATIVE
 HEALTH  BENEFIT PLAN ESTABLISHED PURSUANT TO ARTICLE FORTY-SEVEN OF THIS
 CHAPTER, AN ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THE
 PUBLIC HEALTH LAW, AN INSTITUTION OF HIGHER EDUCATION CERTIFIED PURSUANT
 TO SECTION ONE THOUSAND ONE HUNDRED TWENTY-FOUR OF THIS CHAPTER, OR  THE
 NEW YORK STATE HEALTH INSURANCE PLAN ESTABLISHED UNDER ARTICLE ELEVEN OF
 THE CIVIL SERVICE LAW.
   (C)  "PHARMACY  BENEFIT MANAGEMENT SERVICES" MEANS DIRECTLY OR THROUGH
 AN INTERMEDIARY, MANAGING THE PRESCRIPTION DRUG COVERAGE PROVIDED  BY  A
 HEALTH INSURER UNDER A CONTRACT OR POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY   IN  THIS  STATE  OR  A  PLAN  SUBJECT  TO  SECTION  THREE  HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, INCLUDING  THE  PROCESSING  AND
 PAYMENT OF CLAIMS FOR PRESCRIPTION DRUGS, THE PERFORMANCE OF DRUG UTILI-
 ZATION  REVIEW, THE PROCESSING OF DRUG PRIOR AUTHORIZATION REQUESTS, THE
 ADJUDICATION OF APPEALS  OR  GRIEVANCES  RELATED  TO  PRESCRIPTION  DRUG
 COVERAGE,  CONTRACTING  WITH NETWORK PHARMACIES, NEGOTIATION OF REBATES,
 AND CONTROLLING THE COST OF COVERED PRESCRIPTION DRUGS.
   (D) "PHARMACY BENEFIT MANAGER"  MEANS  A  PERSON,  FIRM,  ASSOCIATION,
 CORPORATION  OR  OTHER ENTITY THAT, PURSUANT TO A CONTRACT WITH A HEALTH
 INSURER PROVIDES PHARMACY BENEFIT MANAGEMENT SERVICES, EXCEPT THAT  TERM
 SHALL NOT INCLUDE:
   (1)  AN OFFICER OR EMPLOYEE OF A REGISTERED OR LICENSED PHARMACY BENE-
 FIT MANAGER; OR
   (2) A HEALTH INSURER, OR ANY MANAGER THEREOF, INDIVIDUAL OR CORPORATE,
 OR ANY OFFICER, DIRECTOR OR REGULAR SALARIED EMPLOYEE THEREOF, PROVIDING
 PHARMACY BENEFIT MANAGEMENT SERVICES UNDER A POLICY OR  CONTRACT  ISSUED
 BY THE HEALTH INSURER.
   §  2902.  ACTING  WITHOUT A REGISTRATION. (A) NO PERSON, FIRM, ASSOCI-
 ATION, CORPORATION OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFITS MANAG-
 ER PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY WITHOUT  HAVING  A  VALID
 REGISTRATION AS A PHARMACY BENEFIT MANAGER FILED WITH THE SUPERINTENDENT
 IN  ACCORDANCE  WITH THIS ARTICLE AND ANY REGULATIONS PROMULGATED THERE-
 UNDER.
   (B) PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY, NO HEALTH INSURER MAY
 PAY ANY FEE OR OTHER COMPENSATION  TO  ANY  PERSON,  FIRM,  ASSOCIATION,
 CORPORATION  OR  OTHER ENTITY FOR PERFORMING PHARMACY BENEFIT MANAGEMENT
 SERVICES UNLESS THE PERSON,  FIRM,  ASSOCIATION,  CORPORATION  OR  OTHER
 ENTITY  IS  REGISTERED  AS A PHARMACY BENEFIT MANAGER IN ACCORDANCE WITH
 THIS ARTICLE.
   (C) ANY PERSON, FIRM, ASSOCIATION, CORPORATION OR  OTHER  ENTITY  THAT
 VIOLATES  THIS  SECTION SHALL, IN ADDITION TO ANY OTHER PENALTY PROVIDED
 BY LAW, BE LIABLE FOR RESTITUTION TO ANY INSURER OR  INSURED  HARMED  BY
 THE  VIOLATION  AND SHALL ALSO BE SUBJECT TO A PENALTY OF THE GREATER OF
 (1) TWO THOUSAND DOLLARS FOR  THE  FIRST  VIOLATION  AND  FIVE  THOUSAND
 DOLLARS  FOR  EACH  SUBSEQUENT  VIOLATION  OR (2) THE AGGREGATE ECONOMIC
 GROSS RECEIPTS ATTRIBUTABLE TO ALL VIOLATIONS.
   § 2903. REGISTRATION REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.   (A)
 EVERY PHARMACY BENEFIT MANAGER THAT PERFORMS PHARMACY BENEFIT MANAGEMENT
 SERVICES  PRIOR TO JANUARY FIRST, TWO THOUSAND TWENTY-ONE SHALL REGISTER
 WITH THE SUPERINTENDENT IN A MANNER ACCEPTABLE  TO  THE  SUPERINTENDENT,
 AND SHALL PAY A FEE OF TWO THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF

 S. 1507--B                         38
 
 A  YEAR IN WHICH THE REGISTRATION SHALL BE VALID. THE SUPERINTENDENT, IN
 CONSULTATION WITH THE COMMISSIONER OF HEALTH, MAY  ESTABLISH,  BY  REGU-
 LATION,  MINIMUM  REGISTRATION STANDARDS REQUIRED FOR A PHARMACY BENEFIT
 MANAGER.  THE SUPERINTENDENT CAN REJECT A REGISTRATION APPLICATION FILED
 BY A PHARMACY BENEFIT MANAGER THAT FAILS  TO  COMPLY  WITH  THE  MINIMUM
 REGISTRATION STANDARDS.
   (B)  FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR OR
 DIRECTORS NAMED IN THE APPLICATION SHALL BE DESIGNATED  RESPONSIBLE  FOR
 THE  BUSINESS ENTITY'S COMPLIANCE WITH THE FINANCIAL SERVICES AND INSUR-
 ANCE LAWS, RULES AND REGULATIONS OF THIS STATE.
   (C) EVERY REGISTRATION WILL EXPIRE ON DECEMBER THIRTY-FIRST, TWO THOU-
 SAND TWENTY REGARDLESS OF WHEN REGISTRATION WAS FIRST MADE.
   (D) EVERY PHARMACY BENEFIT  MANAGER  THAT  PERFORMS  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  AT  ANY  TIME  BETWEEN JANUARY FIRST, TWO THOUSAND
 NINETEEN AND JUNE FIRST, TWO THOUSAND NINETEEN, SHALL MAKE THE REGISTRA-
 TION AND FEE PAYMENT REQUIRED BY SUBSECTION (A) OF THIS  SECTION  ON  OR
 BEFORE  JUNE  FIRST,  TWO  THOUSAND NINETEEN. ANY OTHER PHARMACY BENEFIT
 MANAGER  SHALL  MAKE  THE  REGISTRATION  AND  FEE  PAYMENT  REQUIRED  BY
 SUBSECTION  (A)  OF  THIS  SECTION  PRIOR TO PERFORMING PHARMACY BENEFIT
 MANAGEMENT SERVICES.
   (E) REGISTRANTS UNDER THIS SECTION SHALL BE SUBJECT TO EXAMINATION  BY
 THE SUPERINTENDENT AS OFTEN AS THE SUPERINTENDENT MAY DEEM IT NECESSARY.
 THE  SUPERINTENDENT  MAY PROMULGATE REGULATIONS ESTABLISHING METHODS AND
 PROCEDURES FOR FACILITATING AND VERIFYING COMPLIANCE WITH  THE  REQUIRE-
 MENTS OF THIS ARTICLE AND SUCH OTHER REGULATIONS AS NECESSARY TO ENFORCE
 THE PROVISIONS OF THIS ARTICLE.
   §  2904. REPORTING REQUIREMENTS FOR PHARMACY BENEFIT MANAGERS.  (A)(1)
 ON OR BEFORE JULY FIRST OF EACH YEAR, BEGINNING IN TWO THOUSAND  TWENTY,
 EVERY  PHARMACY BENEFIT MANAGER SHALL REPORT TO THE SUPERINTENDENT, IN A
 STATEMENT SUBSCRIBED AND AFFIRMED AS TRUE UNDER  PENALTIES  OF  PERJURY,
 THE INFORMATION REQUESTED BY THE SUPERINTENDENT INCLUDING, WITHOUT LIMI-
 TATION,  DISCLOSURE  OF ANY FINANCIAL INCENTIVE OR BENEFIT FOR PROMOTING
 THE USE OF CERTAIN DRUGS  AND  OTHER  FINANCIAL  ARRANGEMENTS  AFFECTING
 HEALTH  INSURERS  OR THEIR POLICYHOLDERS OR INSUREDS AND ANY INFORMATION
 RELATING TO THE BUSINESS, FINANCIAL CONDITION, OR MARKET CONDUCT OF  THE
 PHARMACY BENEFIT MANAGER. THE SUPERINTENDENT ALSO MAY REQUIRE THE FILING
 OF  QUARTERLY OR OTHER STATEMENTS, WHICH SHALL BE IN SUCH FORM AND SHALL
 CONTAIN SUCH MATTERS AS THE SUPERINTENDENT SHALL PRESCRIBE.
   (2) THE SUPERINTENDENT ALSO MAY ADDRESS TO ANY PHARMACY BENEFIT MANAG-
 ER OR ITS OFFICERS ANY INQUIRY IN RELATION TO ITS PROVISION OF  PHARMACY
 BENEFIT  MANAGEMENT  SERVICES  OR ANY MATTER CONNECTED THEREWITH.  EVERY
 PHARMACY BENEFIT MANAGER OR PERSON SO ADDRESSED SHALL REPLY  IN  WRITING
 TO  SUCH  INQUIRY  PROMPTLY  AND TRUTHFULLY, AND SUCH REPLY SHALL BE, IF
 REQUIRED BY THE SUPERINTENDENT, SUBSCRIBED BY  SUCH  INDIVIDUAL,  OR  BY
 SUCH  OFFICER OR OFFICERS OF THE PHARMACY BENEFIT MANAGER, AS THE SUPER-
 INTENDENT SHALL DESIGNATE, AND AFFIRMED BY THEM AS TRUE UNDER THE PENAL-
 TIES OF PERJURY.
   (B) IN THE EVENT ANY PHARMACY  BENEFIT  MANAGER  OR  PERSON  DOES  NOT
 SUBMIT  THE  REPORT  REQUIRED BY PARAGRAPH ONE OF SUBSECTION (A) OF THIS
 SECTION OR DOES NOT PROVIDE A GOOD FAITH RESPONSE TO AN INQUIRY FROM THE
 SUPERINTENDENT PURSUANT TO PARAGRAPH  TWO  OF  SUBSECTION  (A)  OF  THIS
 SECTION WITHIN A TIME PERIOD SPECIFIED BY THE SUPERINTENDENT OF NOT LESS
 THAN  FIFTEEN  BUSINESS DAYS, THE SUPERINTENDENT IS AUTHORIZED TO LEVY A
 CIVIL PENALTY, AFTER NOTICE AND HEARING, AGAINST SUCH  PHARMACY  BENEFIT
 MANAGER  OR  PERSON  NOT TO EXCEED ONE THOUSAND DOLLARS PER DAY FOR EACH

 S. 1507--B                         39
 
 DAY BEYOND THE DATE THE REPORT IS DUE  OR  THE  DATE  SPECIFIED  BY  THE
 SUPERINTENDENT FOR RESPONSE TO THE INQUIRY.
   (C)  ALL  INFORMATION DISCLOSED BY A PHARMACY BENEFIT MANAGER SHALL BE
 DEEMED CONFIDENTIAL AND NOT SUBJECT TO DISCLOSURE UNLESS THE SUPERINTEN-
 DENT DETERMINES THAT SUCH DISCLOSURE IS IN THE PUBLIC  INTEREST,  OR  IS
 NECESSARY  TO  CARRY  OUT  THIS  ARTICLE  OR  TO ALLOW THE DEPARTMENT TO
 PERFORM EXAMINATIONS OR INVESTIGATIONS AUTHORIZED BY LAW.
   § 2905. ACTING WITHOUT A LICENSE. (A) NO  PERSON,  FIRM,  ASSOCIATION,
 CORPORATION  OR OTHER ENTITY MAY ACT AS A PHARMACY BENEFIT MANAGER ON OR
 AFTER JANUARY FIRST, TWO THOUSAND TWENTY-ONE WITHOUT HAVING AUTHORITY TO
 DO SO BY VIRTUE OF A LICENSE ISSUED IN FORCE PURSUANT TO THE  PROVISIONS
 OF THIS ARTICLE.
   (B)  NO  HEALTH  INSURER  MAY PAY ANY FEE OR OTHER COMPENSATION TO ANY
 PERSON, FIRM, ASSOCIATION, CORPORATION OR OTHER  ENTITY  FOR  PERFORMING
 PHARMACY  BENEFIT  MANAGEMENT  SERVICES  ON  OR AFTER JANUARY FIRST, TWO
 THOUSAND TWENTY-ONE UNLESS THE PERSON, FIRM, ASSOCIATION, CORPORATION OR
 OTHER ENTITY IS LICENSED AS A PHARMACY  BENEFIT  MANAGER  IN  ACCORDANCE
 WITH THIS ARTICLE.
   (C)  ANY  PERSON,  FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY THAT
 VIOLATES THIS SECTION SHALL, IN ADDITION TO ANY OTHER  PENALTY  PROVIDED
 BY  LAW,  BE  SUBJECT  TO  A  PENALTY OF THE GREATER OF (1) TWO THOUSAND
 DOLLARS FOR THE FIRST VIOLATION  AND  FIVE  THOUSAND  DOLLARS  FOR  EACH
 SUBSEQUENT VIOLATION OR (2) THE AGGREGATE GROSS RECEIPTS ATTRIBUTABLE TO
 ALL VIOLATIONS.
   §  2906.  LICENSING OF A PHARMACY BENEFIT MANAGER. (A) THE SUPERINTEN-
 DENT MAY ISSUE A PHARMACY BENEFIT MANAGER'S LICENSE TO ANY PERSON, FIRM,
 ASSOCIATION OR CORPORATION WHO OR THAT HAS COMPLIED  WITH  THE  REQUIRE-
 MENTS  OF  THIS ARTICLE, INCLUDING REGULATIONS PROMULGATED BY THE SUPER-
 INTENDENT. THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONER  OF
 HEALTH, MAY ESTABLISH, BY REGULATION, MINIMUM STANDARDS FOR THE ISSUANCE
 OF A LICENSE TO A PHARMACY BENEFIT MANAGER.
   (B)  THE  MINIMUM  STANDARDS  ESTABLISHED  UNDER  THIS  SUBSECTION MAY
 ADDRESS, WITHOUT LIMITATION:
   (1) CONFLICTS OF INTEREST BETWEEN PHARMACY BENEFIT MANAGERS AND HEALTH
 INSURERS;
   (2) DECEPTIVE PRACTICES IN CONNECTION WITH THE PERFORMANCE OF PHARMACY
 BENEFIT MANAGEMENT SERVICES;
   (3) ANTI-COMPETITIVE PRACTICES IN CONNECTION WITH THE  PERFORMANCE  OF
 PHARMACY BENEFIT MANAGEMENT SERVICES;
   (4)  UNFAIR  CLAIMS  PRACTICES  IN  CONNECTION WITH THE PERFORMANCE OF
 PHARMACY BENEFIT MANAGEMENT SERVICES; AND
   (5) PROTECTION OF CONSUMERS.
   (C)(1) ANY SUCH LICENSE ISSUED TO A FIRM OR ASSOCIATION SHALL  AUTHOR-
 IZE  ALL  OF  THE  MEMBERS OF THE FIRM OR ASSOCIATION AND ANY DESIGNATED
 EMPLOYEES TO ACT AS PHARMACY BENEFIT MANAGERS UNDER THE LICENSE, AND ALL
 SUCH PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (2) ANY SUCH LICENSE ISSUED TO A CORPORATION SHALL  AUTHORIZE  ALL  OF
 THE  OFFICERS  AND ANY DESIGNATED EMPLOYEES AND DIRECTORS THEREOF TO ACT
 AS PHARMACY BENEFIT MANAGERS ON BEHALF OF SUCH CORPORATION, AND ALL SUCH
 PERSONS SHALL BE NAMED IN THE APPLICATION AND SUPPLEMENTS THERETO.
   (3) FOR EACH BUSINESS ENTITY, THE OFFICER OR OFFICERS AND DIRECTOR  OR
 DIRECTORS  NAMED  IN THE APPLICATION SHALL BE DESIGNATED RESPONSIBLE FOR
 THE BUSINESS ENTITY'S COMPLIANCE WITH  THE  INSURANCE  LAWS,  RULES  AND
 REGULATIONS OF THIS STATE.
   (D)(1)  BEFORE A PHARMACY BENEFIT MANAGER'S LICENSE SHALL BE ISSUED OR
 RENEWED, THE PROSPECTIVE LICENSEE SHALL PROPERLY FILE IN THE  OFFICE  OF

 S. 1507--B                         40
 
 THE  SUPERINTENDENT A WRITTEN APPLICATION THEREFOR IN SUCH FORM OR FORMS
 AND SUPPLEMENTS THERETO AS THE SUPERINTENDENT PRESCRIBES, AND PAY A  FEE
 OF  TWO  THOUSAND DOLLARS FOR EACH YEAR OR FRACTION OF A YEAR IN WHICH A
 LICENSE SHALL BE VALID.
   (2)  EVERY  PHARMACY  BENEFIT  MANAGER'S  LICENSE ISSUED TO A BUSINESS
 ENTITY PURSUANT TO THIS SECTION SHALL EXPIRE ON  THE  THIRTIETH  DAY  OF
 NOVEMBER  OF  EVEN-NUMBERED YEARS. EVERY LICENSE ISSUED PURSUANT TO THIS
 SECTION TO AN INDIVIDUAL PHARMACY BENEFIT MANAGER WHO  WAS  BORN  IN  AN
 ODD-NUMBERED  YEAR,  SHALL  EXPIRE  ON THE INDIVIDUAL'S BIRTHDAY IN EACH
 ODD-NUMBERED YEAR. EVERY LICENSE ISSUED PURSUANT TO THIS SECTION  TO  AN
 INDIVIDUAL  PHARMACY  BENEFIT  MANAGER  WHO WAS BORN IN AN EVEN-NUMBERED
 YEAR, SHALL EXPIRE ON THE INDIVIDUAL'S BIRTHDAY  IN  EACH  EVEN-NUMBERED
 YEAR.   EVERY LICENSE ISSUED PURSUANT TO THIS SECTION MAY BE RENEWED FOR
 THE ENSUING PERIOD OF TWENTY-FOUR MONTHS UPON THE FILING OF AN  APPLICA-
 TION IN CONFORMITY WITH THIS SUBSECTION.
   (E)(1)  IF  AN APPLICATION FOR A RENEWAL LICENSE SHALL HAVE BEEN FILED
 WITH THE SUPERINTENDENT BEFORE OCTOBER FIRST OF THE YEAR OF  EXPIRATION,
 THEN  THE  LICENSE SOUGHT TO BE RENEWED SHALL CONTINUE IN FULL FORCE AND
 EFFECT EITHER UNTIL THE ISSUANCE BY THE SUPERINTENDENT  OF  THE  RENEWAL
 LICENSE  APPLIED  FOR  OR UNTIL FIVE DAYS AFTER THE SUPERINTENDENT SHALL
 HAVE REFUSED TO ISSUE SUCH RENEWAL LICENSE  AND  GIVEN  NOTICE  OF  SUCH
 REFUSAL TO THE APPLICANT.
   (2)  BEFORE REFUSING TO RENEW ANY LICENSE PURSUANT TO THIS SECTION FOR
 WHICH A RENEWAL APPLICATION HAS BEEN FILED PURSUANT TO PARAGRAPH ONE  OF
 THIS  SUBSECTION,  THE  SUPERINTENDENT SHALL NOTIFY THE APPLICANT OF THE
 SUPERINTENDENT'S INTENTION TO DO SO AND  SHALL  GIVE  SUCH  APPLICANT  A
 HEARING.
   (F)  THE  SUPERINTENDENT MAY REFUSE TO ISSUE A PHARMACY BENEFIT MANAG-
 ER'S LICENSE IF, IN THE SUPERINTENDENT'S JUDGMENT, THE APPLICANT OR  ANY
 MEMBER,  PRINCIPAL,  OFFICER OR DIRECTOR OF THE APPLICANT, IS NOT TRUST-
 WORTHY AND COMPETENT TO ACT AS OR IN CONNECTION WITH A PHARMACY  BENEFIT
 MANAGER,  OR THAT ANY OF THE FOREGOING HAS GIVEN CAUSE FOR REVOCATION OR
 SUSPENSION OF SUCH LICENSE, OR HAS FAILED TO COMPLY WITH  ANY  PREREQUI-
 SITE FOR THE ISSUANCE OF SUCH LICENSE.
   (G) LICENSEES AND APPLICANTS FOR A LICENSE UNDER THIS SECTION SHALL BE
 SUBJECT TO EXAMINATION BY THE SUPERINTENDENT AS OFTEN AS THE SUPERINTEN-
 DENT  MAY  DEEM  IT  EXPEDIENT.  THE SUPERINTENDENT MAY PROMULGATE REGU-
 LATIONS ESTABLISHING METHODS AND PROCEDURES FOR FACILITATING AND VERIFY-
 ING COMPLIANCE WITH THE REQUIREMENTS OF  THIS  SECTION  AND  SUCH  OTHER
 REGULATIONS AS NECESSARY.
   (H)  THE  SUPERINTENDENT  MAY  ISSUE  A  REPLACEMENT  FOR  A CURRENTLY
 IN-FORCE LICENSE THAT HAS BEEN LOST OR DESTROYED. BEFORE THE REPLACEMENT
 LICENSE SHALL BE ISSUED, THERE SHALL BE ON FILE IN  THE  OFFICE  OF  THE
 SUPERINTENDENT  A  WRITTEN  APPLICATION  FOR  THE  REPLACEMENT  LICENSE,
 AFFIRMING UNDER PENALTY OF PERJURY THAT THE ORIGINAL  LICENSE  HAS  BEEN
 LOST OR DESTROYED, TOGETHER WITH A FEE OF TWO HUNDRED DOLLARS.
   §  2907.  REVOCATION  OR  SUSPENSION OF A REGISTRATION OR LICENSE OF A
 PHARMACY BENEFIT MANAGER. (A) THE SUPERINTENDENT MAY  REFUSE  TO  RENEW,
 MAY  REVOKE,  OR  MAY SUSPEND FOR A PERIOD THE SUPERINTENDENT DETERMINES
 THE REGISTRATION OR LICENSE OF ANY PHARMACY BENEFIT  MANAGER  IF,  AFTER
 NOTICE AND HEARING, THE SUPERINTENDENT DETERMINES THAT THE REGISTRANT OR
 LICENSEE  OR  ANY  MEMBER,  PRINCIPAL, OFFICER, DIRECTOR, OR CONTROLLING
 PERSON OF THE REGISTRANT OR LICENSEE, HAS:
   (1) VIOLATED ANY INSURANCE LAWS, SECTION TWO HUNDRED EIGHTY-A  OF  THE
 PUBLIC  HEALTH LAW, OR VIOLATED ANY REGULATION, SUBPOENA OR ORDER OF THE

 S. 1507--B                         41
 
 SUPERINTENDENT OR OF ANOTHER  STATE'S  INSURANCE  COMMISSIONER,  OR  HAS
 VIOLATED ANY LAW IN THE COURSE OF HIS OR HER DEALINGS IN SUCH CAPACITY;
   (2)  PROVIDED  MATERIALLY INCORRECT, MATERIALLY MISLEADING, MATERIALLY
 INCOMPLETE OR MATERIALLY  UNTRUE  INFORMATION  IN  THE  REGISTRATION  OR
 LICENSE APPLICATION;
   (3)  OBTAINED OR ATTEMPTED TO OBTAIN A REGISTRATION OR LICENSE THROUGH
 MISREPRESENTATION OR FRAUD;
   (4)(A) USED FRAUDULENT, COERCIVE OR DISHONEST PRACTICES;
   (B) DEMONSTRATED INCOMPETENCE;
   (C) DEMONSTRATED UNTRUSTWORTHINESS; OR
   (D) DEMONSTRATED FINANCIAL IRRESPONSIBILITY IN THE CONDUCT OF BUSINESS
 IN THIS STATE OR ELSEWHERE;
   (5) IMPROPERLY WITHHELD, MISAPPROPRIATED OR CONVERTED  ANY  MONIES  OR
 PROPERTIES  RECEIVED  IN  THE  COURSE OF BUSINESS IN THIS STATE OR ELSE-
 WHERE;
   (6) INTENTIONALLY MISREPRESENTED THE TERMS OF AN  ACTUAL  OR  PROPOSED
 INSURANCE CONTRACT;
   (7) BEEN CONVICTED OF A FELONY;
   (8)  ADMITTED  OR  BEEN  FOUND  TO HAVE COMMITTED ANY INSURANCE UNFAIR
 TRADE PRACTICE OR FRAUD;
   (9) HAD A PHARMACY BENEFIT MANAGER REGISTRATION  OR  LICENSE,  OR  ITS
 EQUIVALENT,  DENIED,  SUSPENDED OR REVOKED IN ANY OTHER STATE, PROVINCE,
 DISTRICT OR TERRITORY;
   (10) FAILED TO PAY STATE INCOME TAX OR COMPLY WITH ANY  ADMINISTRATIVE
 OR COURT ORDER DIRECTING PAYMENT OF STATE INCOME TAX; OR
   (11)  CEASED  TO  MEET  THE REQUIREMENTS FOR REGISTRATION OR LICENSURE
 UNDER THIS ARTICLE.
   (B) BEFORE REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE  OF  ANY
 PHARMACY BENEFIT MANAGER PURSUANT TO THE PROVISIONS OF THIS ARTICLE, THE
 SUPERINTENDENT  SHALL  GIVE  NOTICE TO THE REGISTRANT OR LICENSEE AND TO
 EVERY SUB-LICENSEE AND SHALL HOLD, OR CAUSE TO BE HELD,  A  HEARING  NOT
 LESS THAN TEN DAYS AFTER THE GIVING OF SUCH NOTICE.
   (C)  IF  A  REGISTRATION OR LICENSE PURSUANT TO THE PROVISIONS OF THIS
 ARTICLE IS REVOKED OR SUSPENDED BY THE SUPERINTENDENT, THEN  THE  SUPER-
 INTENDENT SHALL FORTHWITH GIVE NOTICE TO THE REGISTRANT OR LICENSEE.
   (D) THE REVOCATION OR SUSPENSION OF ANY REGISTRATION OR LICENSE PURSU-
 ANT  TO  THE  PROVISIONS  OF THIS ARTICLE SHALL TERMINATE FORTHWITH SUCH
 REGISTRATION OR LICENSE AND THE AUTHORITY  CONFERRED  THEREBY  UPON  ALL
 SUB-LICENSEES.  FOR  GOOD  CAUSE SHOWN, THE SUPERINTENDENT MAY DELAY THE
 EFFECTIVE DATE OF A REVOCATION OR SUSPENSION TO PERMIT THE REGISTRANT OR
 LICENSEE TO SATISFY SOME  OR  ALL  OF  ITS  CONTRACTUAL  OBLIGATIONS  TO
 PERFORM PHARMACY BENEFIT MANAGEMENT SERVICES IN THE STATE.
   (E)(1) NO INDIVIDUAL, CORPORATION, FIRM OR ASSOCIATION WHOSE REGISTRA-
 TION  OR LICENSE AS A PHARMACY BENEFIT MANAGER HAS BEEN REVOKED PURSUANT
 TO SUBSECTION (A) OF THIS SECTION, AND NO FIRM OR ASSOCIATION  OF  WHICH
 SUCH INDIVIDUAL IS A MEMBER, AND NO CORPORATION OF WHICH SUCH INDIVIDUAL
 IS  AN  OFFICER OR DIRECTOR, AND NO CONTROLLING PERSON OF THE REGISTRANT
 OR LICENSEE SHALL BE ENTITLED TO  OBTAIN  ANY  REGISTRATION  OR  LICENSE
 UNDER THE PROVISIONS OF THIS ARTICLE FOR A PERIOD OF ONE YEAR AFTER SUCH
 REVOCATION,  OR, IF SUCH REVOCATION BE JUDICIALLY REVIEWED, FOR ONE YEAR
 AFTER THE FINAL DETERMINATION THEREOF AFFIRMING THE ACTION OF THE SUPER-
 INTENDENT IN REVOKING SUCH LICENSE.
   (2) IF ANY SUCH REGISTRATION OR LICENSE HELD BY A FIRM, ASSOCIATION OR
 CORPORATION BE REVOKED, NO MEMBER OF SUCH FIRM  OR  ASSOCIATION  AND  NO
 OFFICER OR DIRECTOR OF SUCH CORPORATION OR ANY CONTROLLING PERSON OF THE
 REGISTRANT  OR  LICENSEE SHALL BE ENTITLED TO OBTAIN ANY REGISTRATION OR

 S. 1507--B                         42
 
 LICENSE, OR TO BE NAMED AS A SUB-LICENSEE IN  ANY  SUCH  LICENSE,  UNDER
 THIS  ARTICLE  FOR  THE  SAME  PERIOD OF TIME, UNLESS THE SUPERINTENDENT
 DETERMINES, AFTER NOTICE AND  HEARING,  THAT  SUCH  MEMBER,  OFFICER  OR
 DIRECTOR  WAS  NOT PERSONALLY AT FAULT IN THE MATTER ON ACCOUNT OF WHICH
 SUCH REGISTRATION OR LICENSE WAS REVOKED.
   (F) IF ANY REGISTERED OR LICENSED  PHARMACY  BENEFIT  MANAGER  OR  ANY
 PERSON AGGRIEVED SHALL FILE WITH THE SUPERINTENDENT A VERIFIED COMPLAINT
 SETTING FORTH FACTS TENDING TO SHOW SUFFICIENT GROUND FOR THE REVOCATION
 OR SUSPENSION OF ANY PHARMACY BENEFIT MANAGER'S REGISTRATION OR LICENSE,
 THEN  THE  SUPERINTENDENT  SHALL,  AFTER NOTICE AND A HEARING, DETERMINE
 WHETHER SUCH REGISTRATION OR LICENSE SHALL BE SUSPENDED OR REVOKED.
   (G) THE SUPERINTENDENT SHALL  RETAIN  THE  AUTHORITY  TO  ENFORCE  THE
 PROVISIONS  OF AND IMPOSE ANY PENALTY OR REMEDY AUTHORIZED BY THIS CHAP-
 TER AGAINST ANY PERSON OR ENTITY  WHO  IS  UNDER  INVESTIGATION  FOR  OR
 CHARGED  WITH A VIOLATION OF THIS CHAPTER, EVEN IF THE PERSON'S OR ENTI-
 TY'S REGISTRATION OR LICENSE HAS BEEN SURRENDERED, OR HAS EXPIRED OR HAS
 LAPSED BY OPERATION OF LAW.
   (H) A REGISTRANT OR LICENSEE SUBJECT TO THIS ARTICLE SHALL  REPORT  TO
 THE  SUPERINTENDENT  ANY  ADMINISTRATIVE ACTION TAKEN AGAINST THE REGIS-
 TRANT OR LICENSEE IN ANOTHER JURISDICTION  OR  BY  ANOTHER  GOVERNMENTAL
 AGENCY  IN THIS STATE WITHIN THIRTY DAYS OF THE FINAL DISPOSITION OF THE
 MATTER.  THIS REPORT SHALL INCLUDE A COPY OF THE ORDER, CONSENT TO ORDER
 OR OTHER RELEVANT LEGAL DOCUMENTS.
   (I) WITHIN THIRTY DAYS OF THE INITIAL PRETRIAL HEARING DATE, A  REGIS-
 TRANT  OR  LICENSEE  SUBJECT  TO THIS ARTICLE SHALL REPORT TO THE SUPER-
 INTENDENT ANY CRIMINAL PROSECUTION OF THE REGISTRANT OR  LICENSEE  TAKEN
 IN  ANY  JURISDICTION.  THE  REPORT  SHALL INCLUDE A COPY OF THE INITIAL
 COMPLAINT FILED, THE ORDER RESULTING FROM  THE  HEARING  AND  ANY  OTHER
 RELEVANT LEGAL DOCUMENTS.
   §  2908.  PENALTIES FOR VIOLATIONS. (A) THE SUPERINTENDENT, IN LIEU OF
 REVOKING OR SUSPENDING THE REGISTRATION OR LICENSE OF  A  REGISTRANT  OR
 LICENSEE  IN  ACCORDANCE WITH THE PROVISIONS OF THIS ARTICLE, MAY IN ANY
 ONE PROCEEDING BY ORDER, REQUIRE THE REGISTRANT OR LICENSEE  TO  PAY  TO
 THE PEOPLE OF THIS STATE A PENALTY IN A SUM NOT EXCEEDING THE GREATER OF
 (1)  TWO THOUSAND DOLLARS FOR EACH OFFENSE AND FIVE THOUSAND DOLLARS FOR
 EACH SUBSEQUENT VIOLATION OR (2) THE AGGREGATE GROSS RECEIPTS  ATTRIBUT-
 ABLE TO ALL OFFENSES.
   (B)  UPON  THE  FAILURE  OF  SUCH  A REGISTRANT OR LICENSEE TO PAY THE
 PENALTY ORDERED PURSUANT TO SUBSECTION (A) OF THIS SECTION WITHIN TWENTY
 DAYS AFTER THE MAILING OF THE ORDER, POSTAGE  PREPAID,  REGISTERED,  AND
 ADDRESSED  TO  THE  LAST KNOWN PLACE OF BUSINESS OF THE LICENSEE, UNLESS
 THE ORDER IS STAYED BY AN ORDER OF A COURT  OF  COMPETENT  JURISDICTION,
 THE  SUPERINTENDENT MAY REVOKE THE REGISTRATION OR LICENSE OF THE REGIS-
 TRANT OR LICENSEE OR MAY SUSPEND THE SAME FOR SUCH PERIOD AS THE  SUPER-
 INTENDENT DETERMINES.
   §  2909.  STAY  OR  SUSPENSION  OF SUPERINTENDENT'S DETERMINATION. THE
 COMMENCEMENT OF A PROCEEDING UNDER ARTICLE SEVENTY-EIGHT  OF  THE  CIVIL
 PRACTICE  LAW  AND  RULES, TO REVIEW THE ACTION OF THE SUPERINTENDENT IN
 SUSPENDING OR REVOKING OR REFUSING TO RENEW ANY CERTIFICATE  UNDER  THIS
 ARTICLE,  SHALL  STAY  SUCH ACTION OF THE SUPERINTENDENT FOR A PERIOD OF
 THIRTY DAYS. SUCH STAY SHALL NOT BE EXTENDED FOR A LONGER PERIOD  UNLESS
 THE  COURT  SHALL  DETERMINE,  AFTER  A PRELIMINARY HEARING OF WHICH THE
 SUPERINTENDENT IS NOTIFIED FORTY-EIGHT HOURS IN ADVANCE, THAT A STAY  OF
 THE  SUPERINTENDENT'S  ACTION PENDING THE FINAL DETERMINATION OR FURTHER
 ORDER OF THE COURT WILL NOT UNDULY INJURE THE INTERESTS OF THE PEOPLE OF
 THE STATE.

 S. 1507--B                         43
 
   § 2910. REVOKED REGISTRATIONS OR LICENSES.  (A)(1)  NO  PERSON,  FIRM,
 ASSOCIATION,  CORPORATION  OR  OTHER ENTITY SUBJECT TO THE PROVISIONS OF
 THIS ARTICLE WHOSE REGISTRATION OR LICENSE UNDER THIS ARTICLE  HAS  BEEN
 REVOKED,  OR  WHOSE REGISTRATION OR LICENSE TO ENGAGE IN THE BUSINESS OF
 PHARMACY  BENEFIT  MANAGEMENT  IN  ANY  CAPACITY HAS BEEN REVOKED BY ANY
 OTHER STATE OR TERRITORY OF THE UNITED STATES SHALL BECOME  EMPLOYED  OR
 APPOINTED  BY A PHARMACY BENEFIT MANAGER AS AN OFFICER, DIRECTOR, MANAG-
 ER, CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE PRIOR  WRITTEN
 APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE FOR MAINTENANCE
 OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (2)  NO PERSON, FIRM, ASSOCIATION, CORPORATION OR OTHER ENTITY SUBJECT
 TO THE PROVISIONS OF THIS ARTICLE SHALL KNOWINGLY EMPLOY OR APPOINT  ANY
 PERSON OR ENTITY WHOSE REGISTRATION OR LICENSE ISSUED UNDER THIS ARTICLE
 HAS  BEEN  REVOKED,  OR  WHOSE  REGISTRATION OR LICENSE TO ENGAGE IN THE
 BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY CAPACITY HAS BEEN REVOKED
 BY ANY OTHER STATE OR TERRITORY OF THE UNITED  STATES,  AS  AN  OFFICER,
 DIRECTOR, MANAGER, CONTROLLING PERSON OR FOR OTHER SERVICES, WITHOUT THE
 PRIOR  WRITTEN  APPROVAL OF THE SUPERINTENDENT, UNLESS SUCH SERVICES ARE
 FOR MAINTENANCE OR ARE CLERICAL OR MINISTERIAL IN NATURE.
   (3) NO CORPORATION OR PARTNERSHIP SUBJECT TO THE  PROVISIONS  OF  THIS
 ARTICLE  SHALL KNOWINGLY PERMIT ANY PERSON WHOSE REGISTRATION OR LICENSE
 ISSUED UNDER THIS ARTICLE HAS BEEN REVOKED,  OR  WHOSE  REGISTRATION  OR
 LICENSE  TO ENGAGE IN THE BUSINESS OF PHARMACY BENEFIT MANAGEMENT IN ANY
 CAPACITY HAS BEEN REVOKED BY ANY OTHER STATE, OR TERRITORY OF THE UNITED
 STATES, TO BE A SHAREHOLDER OR HAVE AN INTEREST IN SUCH  CORPORATION  OR
 PARTNERSHIP,  NOR  SHALL ANY SUCH PERSON BECOME A SHAREHOLDER OR PARTNER
 IN SUCH CORPORATION OR PARTNERSHIP, WITHOUT THE PRIOR  WRITTEN  APPROVAL
 OF THE SUPERINTENDENT.
   (B)  THE  SUPERINTENDENT  MAY  APPROVE  THE EMPLOYMENT, APPOINTMENT OR
 PARTICIPATION OF ANY SUCH PERSON WHOSE REGISTRATION OR LICENSE HAS  BEEN
 REVOKED:
   (1)  IF THE SUPERINTENDENT DETERMINES THAT THE DUTIES AND RESPONSIBIL-
 ITIES OF SUCH PERSON ARE SUBJECT TO  APPROPRIATE  SUPERVISION  AND  THAT
 SUCH  DUTIES  AND  RESPONSIBILITIES WILL NOT HAVE AN ADVERSE EFFECT UPON
 THE PUBLIC, OTHER REGISTRANTS OR LICENSEES, OR THE REGISTRANT OR  LICEN-
 SEE PROPOSING EMPLOYMENT OR APPOINTMENT OF SUCH PERSON; OR
   (2)  IF  SUCH  PERSON  HAS  FILED AN APPLICATION FOR REREGISTRATION OR
 RELICENSING PURSUANT TO THIS ARTICLE AND THE APPLICATION FOR REREGISTRA-
 TION OR RELICENSING HAS NOT BEEN APPROVED OR DENIED WITHIN  ONE  HUNDRED
 TWENTY  DAYS  FOLLOWING  THE  FILING  THEREOF, UNLESS THE SUPERINTENDENT
 DETERMINES WITHIN THE SAID TIME THAT EMPLOYMENT OR APPOINTMENT  OF  SUCH
 PERSON  BY A REGISTRANT OR LICENSEE IN THE CONDUCT OF A PHARMACY BENEFIT
 MANAGEMENT BUSINESS WOULD NOT BE IN THE PUBLIC INTEREST.
   (C) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO THE OWNERSHIP OF
 SHARES OF ANY CORPORATION REGISTERED OR LICENSED PURSUANT TO THIS  ARTI-
 CLE  IF  THE  SHARES OF SUCH CORPORATION ARE PUBLICLY HELD AND TRADED IN
 THE OVER-THE-COUNTER MARKET OR UPON ANY NATIONAL OR REGIONAL  SECURITIES
 EXCHANGE.
   § 2911. CHANGE OF ADDRESS. A REGISTRANT OR LICENSEE UNDER THIS ARTICLE
 SHALL INFORM THE SUPERINTENDENT BY A MEANS ACCEPTABLE TO THE SUPERINTEN-
 DENT OF A CHANGE OF ADDRESS WITHIN THIRTY DAYS OF THE CHANGE.
   §  2912. APPLICABILITY OF OTHER LAWS. NOTHING IN THIS ARTICLE SHALL BE
 CONSTRUED TO EXEMPT A PHARMACY BENEFIT MANAGER FROM COMPLYING  WITH  THE
 PROVISIONS  OF  ARTICLES  TWENTY-ONE  AND FORTY-NINE OF THIS CHAPTER AND
 ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW OR ANY  OTHER  PROVISION  OF
 THIS CHAPTER OR THE FINANCIAL SERVICES LAW.

 S. 1507--B                         44
 
   §  2913.  ASSESSMENTS. PHARMACY BENEFIT MANAGERS THAT FILE A REGISTRA-
 TION WITH THE DEPARTMENT OR ARE LICENSED  BY  THE  DEPARTMENT  SHALL  BE
 ASSESSED BY THE SUPERINTENDENT FOR THE OPERATING EXPENSES OF THE DEPART-
 MENT  THAT  ARE  SOLELY ATTRIBUTABLE TO REGULATING SUCH PHARMACY BENEFIT
 MANAGERS  IN  SUCH PROPORTIONS AS THE SUPERINTENDENT SHALL DEEM JUST AND
 REASONABLE.
   § 2914. DUTY, ACCOUNTABILITY AND TRANSPARENCY. (A) THE PHARMACY  BENE-
 FIT  MANAGER  SHALL HAVE A FIDUCIARY RELATIONSHIP WITH AND OBLIGATION TO
 THE  HEALTH  INSURER  AND  SHALL  PERFORM  PHARMACY  BENEFIT  MANAGEMENT
 SERVICES WITH CARE, SKILL, PRUDENCE, DILIGENCE, AND PROFESSIONALISM.
   (B)  ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT MANAGER IN RELATION TO
 PROVIDING PHARMACY BENEFIT MANAGEMENT SERVICES SHALL BE RECEIVED BY  THE
 PHARMACY  BENEFIT MANAGER IN TRUST FOR THE HEALTH PLAN AND SHALL BE USED
 OR DISTRIBUTED ONLY PURSUANT TO THE PHARMACY BENEFIT MANAGER'S CONTRACT,
 OR OTHER TERMS IN THE ABSENCE OF A CONTRACT, WITH THE HEALTH INSURER  OR
 APPLICABLE  LAW;  EXCEPT FOR ANY ADMINISTRATIVE FEE OR PAYMENT EXPRESSLY
 PROVIDED FOR IN THE CONTRACT,  OR  OTHER  TERMS  IN  THE  ABSENCE  OF  A
 CONTRACT, BETWEEN THE PHARMACY BENEFIT MANAGER AND THE HEALTH INSURER OR
 PROVIDER TO COMPENSATE THE PHARMACY BENEFIT MANAGER FOR ITS SERVICES.
   (C)  THE  PHARMACY  BENEFIT  MANAGER SHALL PERIODICALLY ACCOUNT TO THE
 HEALTH INSURER FOR ALL FUNDS RECEIVED BY THE PHARMACY  BENEFIT  MANAGER.
 THE  HEALTH  PLAN  OR  PROVIDER  SHALL  HAVE ACCESS TO ALL FINANCIAL AND
 UTILIZATION INFORMATION OF THE PHARMACY BENEFIT MANAGER IN  RELATION  TO
 PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
   (D)  THE  PHARMACY  BENEFIT  MANAGER  SHALL DISCLOSE IN WRITING TO THE
 HEALTH INSURER THE TERMS AND CONDITIONS OF ANY CONTRACT  OR  ARRANGEMENT
 BETWEEN  THE PHARMACY BENEFIT MANAGER AND ANY PARTY RELATING TO PHARMACY
 BENEFIT MANAGEMENT SERVICES PROVIDED TO THE HEALTH INSURER.
   (E) THE PHARMACY BENEFIT MANAGER SHALL  DISCLOSE  IN  WRITING  TO  THE
 HEALTH  INSURER  ANY ACTIVITY, POLICY, PRACTICE, CONTRACT OR ARRANGEMENT
 OF THE PHARMACY BENEFIT MANAGER THAT DIRECTLY OR INDIRECTLY PRESENTS ANY
 CONFLICT OF INTEREST WITH THE PHARMACY  BENEFIT  MANAGER'S  RELATIONSHIP
 WITH OR OBLIGATION TO THE HEALTH INSURER.
   (F)  ANY  INFORMATION  REQUIRED  TO BE DISCLOSED BY A PHARMACY BENEFIT
 MANAGER TO A HEALTH INSURER UNDER THIS SECTION THAT IS REASONABLE DESIG-
 NATED BY THE PHARMACY BENEFIT MANAGER AS  PROPRIETARY  OR  TRADE  SECRET
 INFORMATION  SHALL BE KEPT CONFIDENTIAL BY THE HEALTH INSURER, EXCEPT AS
 REQUIRED OR PERMITTED BY LAW, INCLUDING DISCLOSURE NECESSARY  TO  PROSE-
 CUTE OR DEFEND ANY LEGITIMATE LEGAL CLAIM OR CAUSE OF ACTION.
   (G)  THE SUPERINTENDENT SHALL ESTABLISH, BY REGULATION, MINIMUM STAND-
 ARDS FOR PHARMACY BENEFIT MANAGEMENT SERVICES WHICH  SHALL  ADDRESS  THE
 ELIMINATION  OF  CONFLICTS OF INTEREST BETWEEN PHARMACY BENEFIT MANAGERS
 AND HEALTH INSURERS; AND THE ELIMINATION OF DECEPTIVE  PRACTICES,  ANTI-
 COMPETITIVE PRACTICES, AND UNFAIR CLAIMS PRACTICES.
   § 2. Section 280-a of the public health law is amended by adding a new
 subdivision 5 to read as follows:
   5.  A PHARMACY BENEFIT MANAGER MAY NOT SUBSTITUTE OR CAUSE THE SUBSTI-
 TUTING OF ONE PRESCRIPTION DRUG FOR ANOTHER IN DISPENSING A PRESCRIPTION
 OR ALTER OR CAUSE THE ALTERING OF THE TERM  OF  A  PRESCRIPTION,  EXCEPT
 WITH  APPROVAL  OF THE PRESCRIBER OR AS EXPLICITLY REQUIRED OR PERMITTED
 BY LAW.
   § 3. Subsection (b) of section 2402 of the insurance law,  as  amended
 by section 71 of part A of chapter 62 of the laws of 2011, is amended to
 read as follows:
   (b)  "Defined  violation"  means  the commission by a person of an act
 prohibited by: subsection (a) of section one thousand one  hundred  two,

 S. 1507--B                         45
 
 section  one  thousand  two  hundred  fourteen, one thousand two hundred
 seventeen, one thousand two hundred twenty, one thousand  three  hundred
 thirteen, subparagraph (B) of paragraph two of subsection (i) of section
 one thousand three hundred twenty-two, subparagraph (B) of paragraph two
 of subsection (i) of section one thousand three hundred twenty-four, two
 thousand  one hundred two, two thousand one hundred seventeen, two thou-
 sand one hundred twenty-two,  two  thousand  one  hundred  twenty-three,
 subsection  (p)  of section two thousand three hundred thirteen, section
 two thousand three hundred twenty-four, two thousand five  hundred  two,
 two  thousand  five  hundred  three, two thousand five hundred four, two
 thousand six hundred one, two thousand six hundred two, two thousand six
 hundred three, two thousand six hundred four, two thousand  six  hundred
 six,  two  thousand  seven hundred three, TWO THOUSAND NINE HUNDRED TWO,
 TWO THOUSAND NINE HUNDRED FIVE, three thousand one hundred  nine,  three
 thousand  two hundred twenty-four-a, three thousand four hundred twenty-
 nine, three thousand  four  hundred  thirty-three,  paragraph  seven  of
 subsection  (e)  of section three thousand four hundred twenty-six, four
 thousand two hundred twenty-four, four thousand two hundred twenty-five,
 four thousand two hundred twenty-six, seven thousand eight hundred nine,
 seven thousand eight hundred ten, seven thousand eight  hundred  eleven,
 seven  thousand  eight  hundred  thirteen,  seven thousand eight hundred
 fourteen and seven thousand eight hundred fifteen of  this  chapter;  or
 section  135.60,  135.65,  175.05,  175.45,  or  190.20,  or article one
 hundred five of the penal law.
   § 4. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019.
 
                                  PART J
 
   Section  1.  This Part enacts into law major components of legislation
 which are necessary to protect health care consumers; increase access to
 more affordable quality health  insurance  coverage;  and  preserve  and
 foster  New  York's  health insurance markets.  Each component is wholly
 contained within a Subpart identified  as  Subparts  A  through  F.  The
 effective  date  for  each  particular  provision  contained within such
 Subpart is set forth in the last section of such Subpart. Any  provision
 in  any section contained within a Subpart, including the effective date
 of the Subpart, which makes a reference to a section "of this act," when
 used in connection with that particular component, shall  be  deemed  to
 mean  and  refer to the corresponding section of the Subpart in which it
 is found. Section five of this Part sets  forth  the  general  effective
 date of this Part.
 
                                 SUBPART A
 
   Section  1.  Section  3221 of the insurance law is amended by adding a
 new subsection (t) to read as follows:
   (T) (1) ANY INSURER THAT DELIVERS OR ISSUES FOR DELIVERY IN THIS STATE
 HOSPITAL, SURGICAL OR MEDICAL EXPENSE GROUP POLICIES IN THE SMALL  GROUP
 OR LARGE GROUP MARKET SHALL OFFER TO ANY EMPLOYER IN THIS STATE ALL SUCH
 POLICIES  IN  THE  APPLICABLE  MARKET,  AND  SHALL  ACCEPT  AT ALL TIMES
 THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES FOR ANY OF THOSE POLICIES.
   (2) THE REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION  SHALL  APPLY
 WITH  RESPECT  TO  AN EMPLOYER THAT APPLIES FOR COVERAGE EITHER DIRECTLY
 FROM THE INSURER OR THROUGH AN ASSOCIATION OR TRUST TO WHICH THE INSURER
 HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.

 S. 1507--B                         46

   § 2. Paragraph 1 of subsection (g) of section 3231  of  the  insurance
 law,  as  amended  by  section 70 of part D of chapter 56 of the laws of
 2013, is amended to read as follows:
   (1)  This  section  shall  also  apply  to  policies issued to a group
 defined in subsection (c) of section four thousand two  hundred  thirty-
 five, including but not limited to an association or trust of employers,
 if  the  group  includes  one  or  more member employers or other member
 groups which have [fifty] ONE HUNDRED  or  fewer  employees  or  members
 exclusive  of  spouses and dependents. For policies issued or renewed on
 or after January first, two thousand fourteen, if the group includes one
 or more member small group employers eligible for  coverage  subject  to
 this  section,  then  such member employers shall be classified as small
 groups for rating purposes and the  remaining  members  shall  be  rated
 consistent  with  the  rating rules applicable to such remaining members
 pursuant to paragraph two of this subsection.
   § 3. Subsections (h) and (i) of section 3232 of the insurance law  are
 REPEALED.
   §  4. Subsections (f) and (g) of section 3232 of the insurance law, as
 added by chapter 219 of the  laws  of  2011,  are  amended  to  read  as
 follows:
   (f)  [With respect to an individual under age nineteen, an insurer may
 not impose any pre-existing condition  exclusion  in  an  individual  or
 group policy of hospital, medical, surgical or prescription drug expense
 insurance  pursuant  to  the  requirements of section 2704 of the Public
 Health Service Act, 42 U.S.C. § 300gg-3, as made  effective  by  section
 1255(2)  of  the Affordable Care Act, except for an individual under age
 nineteen covered under an individual policy of hospital, medical, surgi-
 cal or prescription drug  expense  insurance  that  is  a  grandfathered
 health plan.
   (g)  Beginning  January  first,  two  thousand  fourteen,  pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3,  an]
 AN  insurer  [may] SHALL not impose any pre-existing condition exclusion
 in an individual or group  policy  of  hospital,  medical,  surgical  or
 prescription drug expense insurance [except in an individual policy that
 is a grandfathered health plan].
   § 5. Subparagraph (A) of paragraph 1 of subsection (c) of section 4235
 of  the insurance law, as amended by chapter 515 of the laws of 2010, is
 amended to read as follows:
   (A) A policy issued to an employer or to a trustee or  trustees  of  a
 fund  established  by an employer, which employer or trustee or trustees
 shall be deemed the policyholder, insuring with or without  evidence  of
 insurability  satisfactory  to  the insurer, employees of such employer,
 and insuring, except as hereinafter provided, all of such  employees  or
 all  of any class or classes thereof determined by conditions pertaining
 to the employment or a combination of  such  conditions  and  conditions
 pertaining  to the family status of the employee, for insurance coverage
 on each person insured based upon some plan [which] THAT  will  preclude
 individual  selection.  However, such a plan may permit a limited number
 of selections by employees if the selections offered utilize  consistent
 plans  of  coverage  for  individual group members so that the resulting
 plans of coverage are reasonable. The premium for the  policy  shall  be
 paid  by  the  policyholder,  either  from the employer's funds, or from
 funds contributed by the insured employees, or  from  funds  contributed
 jointly  by the employer and employees. If all or part of the premium is
 to be derived from funds contributed  by  the  insured  employees,  then
 [such]  THE  INSURER ISSUING THE policy [must insure not less than fifty

 S. 1507--B                         47

 percent of such eligible employees or, if less, fifty or more] SHALL NOT
 REQUIRE A MINIMUM NUMBER OR MINIMUM  PERCENTAGE  of  such  employees  BE
 INSURED when [such] THE policy is providing coverage for group hospital,
 medical,  major  medical or similar comprehensive types of expense reim-
 bursed insurance and, for all other types of group accident  and  health
 insurance,  [must] THE POLICY SHALL insure a minimum of fifty percent or
 five of such eligible employees, whichever is fewer.
   § 6. Section 4305 of the insurance law is  amended  by  adding  a  new
 subsection (n) to read as follows:
   (N) (1) ANY CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 ISSUES  HOSPITAL,  SURGICAL  OR  MEDICAL  EXPENSE CONTRACTS IN THE SMALL
 GROUP OR LARGE GROUP MARKET IN THIS STATE SHALL OFFER TO ANY EMPLOYER IN
 THIS STATE ALL SUCH CONTRACTS IN THE APPLICABLE MARKET, AND SHALL ACCEPT
 AT ALL TIMES THROUGHOUT THE YEAR ANY EMPLOYER THAT APPLIES  FOR  ANY  OF
 THOSE CONTRACTS.
   (2)  THE  REQUIREMENTS OF PARAGRAPH ONE OF THIS SUBSECTION SHALL APPLY
 WITH RESPECT TO AN EMPLOYER THAT APPLIES FOR  COVERAGE  EITHER  DIRECTLY
 FROM  THE  CORPORATION  OR  THROUGH AN ASSOCIATION OR TRUST TO WHICH THE
 CORPORATION HAS ISSUED COVERAGE AND IN WHICH THE EMPLOYER PARTICIPATES.
   § 7. Paragraph 1 of subsection (d) of section 4317  of  the  insurance
 law,  as  amended  by  section 72 of part D of chapter 56 of the laws of
 2013, is amended to read as follows:
   (1) This section shall also apply to a  contract  issued  to  a  group
 defined  in  subsection (c) of section four thousand two hundred thirty-
 five of this chapter, including but not limited  to  an  association  or
 trust  of  employers, if the group includes one or more member employers
 or other member groups which have [fifty] ONE HUNDRED or fewer employees
 or members exclusive of spouses and dependents. For contracts issued  or
 renewed  on  or after January first, two thousand fourteen, if the group
 includes one or more member small group employers eligible for  coverage
 subject  to this section, then such member employers shall be classified
 as small groups for rating purposes and the remaining members  shall  be
 rated  consistent  with  the  rating  rules applicable to such remaining
 members pursuant to paragraph two of this subsection.
   § 8. Subsections (h) and (i) of section 4318 of the insurance law  are
 REPEALED.
   §  9. Subsections (f) and (g) of section 4318 of the insurance law, as
 added by chapter 219 of the  laws  of  2011,  are  amended  to  read  as
 follows:
   (f)  [With  respect to an individual under age nineteen, a corporation
 may not impose any pre-existing condition exclusion in an individual  or
 group  contract  of  hospital,  medical,  surgical  or prescription drug
 expense insurance pursuant to the requirements of section  2704  of  the
 Public  Health  Service  Act,  42 U.S.C. § 300gg-3, as made effective by
 section 1255(2) of the Affordable Care Act,  except  for  an  individual
 under  age  nineteen  covered  under an individual contract of hospital,
 medical, surgical or prescription  drug  expense  insurance  that  is  a
 grandfathered health plan.
   (g)  Beginning  January  first,  two  thousand  fourteen,  pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation [may] SHALL not impose any pre-existing condition  exclusion
 in  an  individual  or  group contract of hospital, medical, surgical or
 prescription drug expense insurance [except in  an  individual  contract
 that is a grandfathered health plan].
   §  10.  Section  4413  of the insurance law is amended by adding a new
 subsection (h) to read as follows:

 S. 1507--B                         48
 
   (H) (1) ON OR AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND  NINETEEN,  AN
 EMPLOYEE  WELFARE  FUND  REGISTERED  WITH  THE  SUPERINTENDENT SHALL NOT
 PROVIDE MEDICAL, SURGICAL OR HOSPITAL CARE OR BENEFITS IN THE  EVENT  OF
 SICKNESS OR INJURY FOR EMPLOYEES OR THEIR FAMILIES OR DEPENDENTS, OR FOR
 BOTH,  UNLESS PROVIDED UNDER A GROUP COMPREHENSIVE-TYPE HEALTH INSURANCE
 POLICY OR CONTRACT IN ACCORDANCE WITH THE REQUIREMENTS OF  THIS  CHAPTER
 AND  DELIVERED  OR  ISSUED  FOR  DELIVERY IN THIS STATE BY AN AUTHORIZED
 INSURER OR A HEALTH MAINTENANCE ORGANIZATION  ISSUED  A  CERTIFICATE  OF
 AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.
   (2)  NOTWITHSTANDING  PARAGRAPH  ONE  OF  THIS SUBSECTION, AN EMPLOYEE
 WELFARE FUND REGISTERED WITH THE SUPERINTENDENT PRIOR TO DECEMBER  THIR-
 TY-FIRST,  TWO THOUSAND NINETEEN, WHICH, AS OF FEBRUARY FIRST, TWO THOU-
 SAND NINETEEN DIRECTLY PROVIDED MEDICAL, SURGICAL OR  HOSPITAL  CARE  OR
 BENEFITS IN THE EVENT OF SICKNESS OR INJURY FOR EMPLOYEES OR THEIR FAMI-
 LIES  OR DEPENDENTS, OR FOR BOTH, MAY CONTINUE TO PROVIDE THOSE BENEFITS
 DIRECTLY RATHER THAN UNDER A GROUP COMPREHENSIVE-TYPE  HEALTH  INSURANCE
 POLICY  OR CONTRACT DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE BY AN
 AUTHORIZED INSURER OR A HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIF-
 ICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH  LAW;
 PROVIDED,  HOWEVER,  THAT,  IF THE EMPLOYEE WELFARE FUND CEASES OFFERING
 THE BENEFITS DIRECTLY, IT MAY NOT RESUME PROVIDING THE BENEFITS  DIRECT-
 LY.
   §  11.  Subdivision  1  of  section  4406 of the public health law, as
 amended by section 46-a of part D of chapter 56 of the laws of 2013,  is
 amended to read as follows:
   1.  The  contract  between  a  health  maintenance organization and an
 enrollee shall be subject to regulation by the superintendent as  if  it
 were  a health insurance subscriber contract, and shall include, but not
 be limited to, all mandated benefits required by article forty-three  of
 the insurance law. Such contract shall fully and clearly state the bene-
 fits  and  limitations  therein provided or imposed, so as to facilitate
 understanding and comparisons, and to exclude provisions  which  may  be
 misleading  or  unreasonably confusing. Such contract shall be issued to
 any individual and dependents  of  such  individual  and  any  group  of
 [fifty]  ONE HUNDRED or fewer employees or members, exclusive of spouses
 and dependents, or TO any employee or member  of  the  group,  including
 dependents, applying for such contract at any time throughout the year[,
 and  may  include  a pre-existing condition provision as provided for in
 section four thousand three  hundred  eighteen  of  the  insurance  law,
 provided,  however,  that,  the].  AN INDIVIDUAL DIRECT PAYMENT CONTRACT
 SHALL BE ISSUED ONLY IN ACCORDANCE  WITH  SECTION  FOUR  THOUSAND  THREE
 HUNDRED TWENTY-EIGHT OF THE INSURANCE LAW. THE superintendent may, after
 giving consideration to the public interest, exempt a health maintenance
 organization from the requirements of this section provided that another
 health  insurer  or  health  maintenance  organization within the health
 maintenance organization's same holding company system,  as  defined  in
 article  fifteen  of  the  insurance law, including a health maintenance
 organization operated as a line of business of a health  service  corpo-
 ration  licensed  under article forty-three of the insurance law, offers
 coverage that, at a minimum, complies with this section and provides all
 of the consumer protections required to be provided by a health  mainte-
 nance  organization  pursuant to this chapter and regulations, including
 those consumer protections contained  in  sections  four  thousand  four
 hundred  three  and  four thousand four hundred eight-a of this chapter.
 The requirements shall not apply to a  health  maintenance  organization
 exclusively  serving  individuals  enrolled  pursuant to title eleven of

 S. 1507--B                         49

 article five of the social services law, title eleven-D of article  five
 of  the  social services law, title one-A of article twenty-five of [the
 public health law] THIS CHAPTER or title eighteen of the federal  Social
 Security Act, and, further provided, that such health maintenance organ-
 ization  shall  not  discontinue  a contract for an individual receiving
 comprehensive-type coverage in effect prior to January first, two  thou-
 sand four who is ineligible to purchase policies offered after such date
 pursuant  to  this section or section four thousand three hundred [twen-
 ty-two of this article] TWENTY-EIGHT OF THE INSURANCE  LAW  due  to  the
 provision  of  42  U.S.C.  1395ss  in effect prior to January first, two
 thousand four.   [Subject to the  creditable  coverage  requirements  of
 subsection  (a)  of  section four thousand three hundred eighteen of the
 insurance law, the organization may, as an alternative to the use  of  a
 pre-existing  condition  provision,  elect  to offer contracts without a
 pre-existing condition provision to such groups  but  may  require  that
 coverage  shall not become effective until after a specified affiliation
 period of not more than sixty days after the application for coverage is
 submitted.   The organization is not required  to  provide  health  care
 services  or benefits during such period and no premium shall be charged
 for any coverage  during  the  period.  After  January  first,  nineteen
 hundred  ninety-six,  all  individual  direct payment contracts shall be
 issued only pursuant to sections four thousand three hundred  twenty-one
 and  four  thousand  three hundred twenty-two of the insurance law. Such
 contracts may not, with respect to an eligible individual (as defined in
 section 2741(b) of the federal Public Health Service Act,  42  U.S.C.  §
 300gg-41(b), impose any pre-existing condition exclusion.]
   § 12. This act shall take effect immediately, provided that:
   (1)  sections  one, three, four, five, six, eight and nine of this act
 shall apply to all policies and  contracts  issued,  renewed,  modified,
 altered or amended on or after January 1, 2020; and
   (2)  sections  two and seven of this act shall take effect on the same
 date as the reversion of paragraph (1) of subsection (g) of section 3231
 and paragraph (1) of subsection (d) of section  4317  of  the  insurance
 law,  as  provided  in  section 5 of chapter 588 of the laws of 2015, as
 amended.
 
                                 SUBPART B
 
   Section 1. Subparagraph (A)  of  paragraph  5  of  subsection  (c)  of
 section 3216 of the insurance law, as amended by chapter 388 of the laws
 of 2014, is amended to read as follows:
   (A) Any family policy providing hospital or surgical expense insurance
 (but  not including such insurance against accidental injury only) shall
 provide that, in the event such insurance on any person, other than  the
 policyholder,  is  terminated because the person is no longer within the
 definition of the family as set forth in  the  policy  but  before  such
 person  has  attained  the  limiting age, if any, for coverage of adults
 specified in the policy, such person shall be entitled to have issued to
 that person by the  insurer,  without  evidence  of  insurability,  upon
 application therefor and payment of the first premium, within sixty days
 after  such  insurance  shall  have terminated, an individual conversion
 policy that contains the ESSENTIAL HEALTH benefits PACKAGE described  in
 paragraph  [one] THREE of subsection [(b)] (F) of section [four thousand
 three hundred twenty-eight of this chapter. The insurer shall offer  one
 policy  at  each  level of coverage as defined in section 1302(d) of the
 affordable care act, 42 U.S.C. § 18022(d).] THREE THOUSAND  TWO  HUNDRED

 S. 1507--B                         50

 SEVENTEEN-I  OF THIS ARTICLE. THE INSURER SHALL OFFER ONE POLICY AT EACH
 LEVEL OF COVERAGE AS DEFINED IN SUBSECTION (C) OF SECTION THREE THOUSAND
 TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE. The individual may  choose  any
 such  policy  offered by the insurer. Provided, however, the superinten-
 dent may, after giving due consideration to the public interest, approve
 a request made by an insurer for the insurer to satisfy the requirements
 of this subparagraph through the offering of policies that  comply  with
 this  subparagraph by another insurer, corporation or health maintenance
 organization within the insurer's holding company system, as defined  in
 article fifteen of this chapter. The conversion privilege afforded here-
 in shall also be available upon the divorce or annulment of the marriage
 of the policyholder to the former spouse of such policyholder.
   § 2. Subparagraph (E) of paragraph 2 of subsection (g) of section 3216
 of  the  insurance  law, as added by chapter 388 of the laws of 2014, is
 amended to read as follows:
   (E) The superintendent may, after  giving  due  consideration  to  the
 public interest, approve a request made by an insurer for the insurer to
 satisfy  the  requirements of subparagraph (C) of this paragraph through
 the offering of policies  at  each  level  of  coverage  as  defined  in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 §  18022(d)] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE that
 contains the ESSENTIAL HEALTH benefits PACKAGE  described  in  paragraph
 [one]  THREE  of  subsection  [(b)]  (F) of section [four thousand three
 hundred twenty-eight of this chapter] THREE THOUSAND TWO HUNDRED  SEVEN-
 TEEN-I OF THIS ARTICLE by another insurer, corporation or health mainte-
 nance  organization within the insurer's same holding company system, as
 defined in article fifteen of this chapter.
   § 3. Intentionally omitted.
   § 4. Intentionally omitted.
   § 5. Intentionally omitted.
   § 6. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
 law,  as  amended by chapter 469 of the laws of 2018, is amended to read
 as follows:
   (21) Every policy [which]  THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein  [or  which],

 S. 1507--B                         51
 
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve
 months  for  any  insured  individual shall not exceed two thousand five
 hundred dollars].
   § 7. Paragraph 30 of subsection (i) of section 3216 of  the  insurance
 law,  as  amended by chapter 377 of the laws of 2014, is amended to read
 as follows:
   (30) Every policy [which] THAT provides medical coverage that includes
 coverage for physician services in a physician's office and every policy
 [which] THAT provides major medical or similar comprehensive-type cover-
 age shall include coverage for  equipment  and  supplies  used  for  the
 treatment  of  ostomies,  if prescribed by a physician or other licensed
 health care provider legally authorized to prescribe under  title  eight
 of  the  education law. Such coverage shall be subject to annual deduct-
 ibles and coinsurance as deemed appropriate by the  superintendent.  The
 coverage required by this paragraph shall be identical to, and shall not
 enhance  or  increase  the coverage required as part of essential health
 benefits as [required pursuant to] DEFINED IN SUBSECTION (A) OF  section
 [2707 (a) of the public health services act 42 U.S.C. 300 gg-6(a)] THREE
 THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   §  8. Subsection (l) of section 3216 of the insurance law, as added by
 section 42 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (l) [On and after October first, two thousand thirteen, an] AN insurer
 shall  not offer individual hospital, medical or surgical expense insur-
 ance policies unless the policies meet the  requirements  of  subsection
 (b) of section four thousand three hundred twenty-eight of this chapter.
 Such policies that are offered within the health benefit exchange estab-
 lished [pursuant to section 1311 of the affordable care act, 42 U.S.C. §
 18031,  or  any  regulations promulgated thereunder,] BY THIS STATE also
 shall meet any requirements established by the health benefit exchange.
   § 9. Subsection (m) of section 3216 of the insurance law, as added  by
 section  53  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (m) An insurer shall not be required to  offer  the  policyholder  any
 benefits  that  must  be  made available pursuant to this section if the
 benefits must be covered as essential health benefits.  For  any  policy
 issued  within  the  health  benefit  exchange  established [pursuant to
 section 1311 of the affordable care act, 42  U.S.C.  §  18031]  BY  THIS
 STATE,  an  insurer  shall not be required to offer the policyholder any
 benefits that must be made  available  pursuant  to  this  section.  For
 purposes  of this subsection, "essential health benefits" shall have the
 meaning set forth in SUBSECTION (A) OF section [1302(b) of the  afforda-
 ble  care  act,  42 U.S.C. § 18022(b)] THREE THOUSAND TWO HUNDRED SEVEN-
 TEEN-I OF THIS ARTICLE.
   § 10. The insurance law is amended by adding a new section  3217-i  to
 read as follows:
   § 3217-I. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;

 S. 1507--B                         52
 
   (5)  MENTAL  HEALTH  AND  SUBSTANCE  USE  DISORDER SERVICES, INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;
   (9)  PREVENTIVE  AND WELLNESS SERVICES AND CHRONIC DISEASE MANAGEMENT;
 AND
   (10) PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.  IF A  STAND-
 ALONE DENTAL BENEFIT PLAN OFFERED THROUGH THE HEALTH BENEFIT EXCHANGE OR
 OUTSIDE  OF THE HEALTH BENEFIT EXCHANGE IN THE INDIVIDUAL OR SMALL GROUP
 MARKET HAS CERTIFIED TO THE STATE THAT THE PLAN INCLUDES DENTAL BENEFITS
 MEETING THE REQUIREMENTS OF THE BENCHMARK PLAN, A HEALTH PLAN SHALL  NOT
 FAIL  TO MEET THE REQUIREMENTS OF THIS SECTION SOLELY BECAUSE THE HEALTH
 PLAN DOES  NOT  INCLUDE  PEDIATRIC  DENTAL  BENEFITS  OTHERWISE  OFFERED
 THROUGH THE STAND-ALONE DENTAL PLAN.
   (B)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, MAY SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF  PLANS  THAT
 TOGETHER  CONTAIN  ESSENTIAL  HEALTH  BENEFITS,  IN ACCORDANCE WITH THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP ACCIDENT AND HEALTH INSURANCE
 POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND
 IS NOT A GRANDFATHERED HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE
 ACTUARIAL REQUIREMENTS OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:
   (A) BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE  BENEFITS
 PROVIDED UNDER THE PLAN;
   (B)  SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO  SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C) GOLD LEVEL. A PLAN IN THE GOLD LEVEL  SHALL  PROVIDE  A  LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF COVERAGE THAT IS DESIGNED TO PROVIDE BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2)  THE  SUPERINTENDENT  MAY PROVIDE FOR A VARIATION IN THE ACTUARIAL
 VALUES USED IN DETERMINING THE LEVEL OF COVERAGE OF A  PLAN  TO  ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3)  EVERY  STUDENT ACCIDENT AND HEALTH INSURANCE POLICY SHALL PROVIDE
 COVERAGE THAT MEETS AT LEAST SIXTY PERCENT OF THE FULL  ACTUARIAL  VALUE
 OF  THE  BENEFITS  PROVIDED  UNDER  THE POLICY. THE POLICY'S SCHEDULE OF
 BENEFITS SHALL INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE  OF  THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D)  EVERY  INDIVIDUAL  OR  GROUP ACCIDENT AND HEALTH INSURANCE POLICY
 THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT
 A GRANDFATHERED HEALTH PLAN,  AND  EVERY  STUDENT  ACCIDENT  AND  HEALTH
 INSURANCE  POLICY  SHALL LIMIT THE INSURED'S COST-SHARING FOR IN-NETWORK
 SERVICES IN A POLICY YEAR TO NOT MORE  THAN  THE  MAXIMUM  OUT-OF-POCKET
 AMOUNT DETERMINED BY THE SUPERINTENDENT FOR ALL POLICIES SUBJECT TO THIS
 SECTION.  SUCH AMOUNT SHALL NOT EXCEED ANY ANNUAL OUT-OF-POCKET LIMIT ON
 COST-SHARING SET BY THE UNITED STATES  SECRETARY  OF  HEALTH  AND  HUMAN
 SERVICES, IF AVAILABLE.

 S. 1507--B                         53
 
   (E)  THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE DESCRIB-
 ING THE COVERAGE REQUIREMENTS FOR  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
 COMPREHENSIVE  TYPE  COVERAGE INSURANCE POLICY FORMS THAT ARE SUBJECT TO
 THE SUPERINTENDENT'S APPROVAL PURSUANT TO  SECTION  THREE  THOUSAND  TWO
 HUNDRED ONE OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1)  "ACTUARIAL  VALUE"  MEANS  THE  PERCENTAGE  OF THE TOTAL EXPECTED
 PAYMENTS BY THE INSURER FOR BENEFITS PROVIDED TO A STANDARD  POPULATION,
 WITHOUT  REGARD  TO THE POPULATION TO WHOM THE INSURER ACTUALLY PROVIDES
 BENEFITS;
   (2) "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE,  COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)   LIMITS   COST-SHARING  FOR  SUCH  COVERAGE  IN  ACCORDANCE  WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4) "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED BY AN  INSURER
 IN  WHICH AN INDIVIDUAL WAS ENROLLED ON MARCH TWENTY-THIRD, TWO THOUSAND
 TEN FOR AS LONG  AS  THE  COVERAGE  MAINTAINS  GRANDFATHERED  STATUS  IN
 ACCORDANCE  WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C. §
 18011(E);
   (5) "SMALL GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER  EMPLOYEES  OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF
 THIS ARTICLE.
   § 11. Subsection (g) of section 3221 of the insurance law, as  amended
 by chapter 388 of the laws of 2014, is amended to read as follows:
   (g) For conversion purposes, an insurer shall offer to the employee or
 member  a  policy at each level of coverage as defined in SUBSECTION (C)
 OF section [1302(d) of the affordable care act, 42  U.S.C.  §  18022(d)]
 THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE that contains the
 ESSENTIAL  HEALTH benefits PACKAGE described in paragraph [one] THREE of
 subsection [(b)] (F) of section [four  thousand  three  hundred  twenty-
 eight  of  this  chapter] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS
 ARTICLE. Provided, however, the superintendent  may,  after  giving  due
 consideration  to  the  public  interest,  approve  a request made by an
 insurer for the insurer to satisfy the requirements of  this  subsection
 and  subsections  (e)  and  (f)  of this section through the offering of
 policies that comply with this subsection  by  another  insurer,  corpo-
 ration  or  health maintenance organization within the insurer's holding
 company system, as defined in article fifteen of this chapter.
   § 12. Subsection (h) of section 3221 of the insurance law, as added by
 section 54 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (h)  Every small group policy or association group policy delivered or
 issued for delivery in this state that provides coverage  for  hospital,
 medical  or surgical expense insurance and is not a grandfathered health
 plan shall provide coverage for the essential health [benefit]  BENEFITS
 package  [as  required  in  section 2707(a) of the public health service
 act, 42 U.S.C.  § 300gg-6(a)]. For purposes of this subsection:
   (1) "essential health benefits package" shall  have  the  meaning  set
 forth  in  PARAGRAPH  THREE OF SUBSECTION (F) OF section [1302(a) of the

 S. 1507--B                         54

 affordable care act, 42 U.S.C. § 18022(a)] THREE  THOUSAND  TWO  HUNDRED
 SEVENTEEN-I OF THIS ARTICLE;
   (2)  "grandfathered health plan" means coverage provided by an insurer
 in which an individual was enrolled on March twenty-third, two  thousand
 ten  for  as  long  as  the  coverage  maintains grandfathered status in
 accordance with section 1251(e) of the affordable care act, 42 U.S.C.  §
 18011(e);
   (3)  "small  group"  means  a  group  of  [fifty or fewer employees or
 members exclusive of spouses and  dependents;  provided,  however,  that
 beginning  January  first,  two  thousand sixteen, "small group" means a
 group of] one hundred or fewer employees or members exclusive of spouses
 and dependents; and
   (4) "association group" means a group defined  in  subparagraphs  (B),
 (D),  (H), (K), (L) or (M) of paragraph one of subsection (c) of section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B) the group includes one or more member employers  or  other  member
 groups that are small groups.
   § 13. Subsection (i) of section 3221 of the insurance law, as added by
 section  54  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (i) An insurer shall not be required to  offer  the  policyholder  any
 benefits  that  must  be  made available pursuant to this section if the
 benefits must be covered pursuant to subsection (h) of this section. For
 any policy issued within the health benefit exchange established [pursu-
 ant to section 1311 of the affordable care act, 42 U.S.C.  §  18031]  BY
 THIS  STATE,  an insurer shall not be required to offer the policyholder
 any benefits that must be made available pursuant to this section.
   § 14. Paragraph 11 of subsection (k) of section 3221 of the  insurance
 law,  as  amended by chapter 469 of the laws of 2018, is amended to read
 as follows:
   (11) Every policy [which]  THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino-acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food  protein induced enterocolitis syndrome; eosinophilic disorders and
 impaired absorption of  nutrients  caused  by  disorders  affecting  the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal  tract.  Enteral  formulas  [which] THAT are medically necessary and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic acid metabolism as well as severe protein allergic  conditions  shall
 include  modified  solid  food products that are low protein [or which],
 contain modified protein, or are  amino  acid  based  [which]  THAT  are
 medically  necessary[,  and  such  coverage for such modified solid food

 S. 1507--B                         55

 products for any calendar year or for any continuous  period  of  twelve
 months  for  any  insured  individual shall not exceed two thousand five
 hundred dollars].
   § 15. Intentionally omitted.
   §  16. Paragraph 19 of subsection (k) of section 3221 of the insurance
 law, as amended by chapter 377 of the laws of 2014, is amended  to  read
 as follows:
   (19)  Every  group  or  blanket  accident  and health insurance policy
 delivered or issued for delivery in this  state  [which]  THAT  provides
 medical  coverage  that  includes  coverage  for physician services in a
 physician's office and every policy [which] THAT provides major  medical
 or similar comprehensive-type coverage shall include coverage for equip-
 ment and supplies used for the treatment of ostomies, if prescribed by a
 physician  or  other licensed health care provider legally authorized to
 prescribe under title eight of the education law. Such coverage shall be
 subject to annual deductibles and coinsurance as deemed  appropriate  by
 the  superintendent.  The  coverage  required by this paragraph shall be
 identical to, and shall not enhance or increase the coverage required as
 part of essential health benefits as [required pursuant to]  DEFINED  IN
 SUBSECTION (A) OF section [2707 (a) of the public health services act 42
 U.S.C.    300  gg-6(a)]  THREE  THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS
 ARTICLE.
   § 17. Intentionally omitted.
   § 18. Intentionally omitted.
   § 19. Intentionally omitted.
   § 20. Paragraph 4 of subsection (a) of section 3231 of  the  insurance
 law,  as  amended  by  section 69 of part D of chapter 56 of the laws of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology in which the premium for all persons  covered  by  a  policy
 form  is the same based on the experience of the entire pool of risks of
 all individuals or small groups covered by the insurer without regard to
 age, sex, health status, tobacco usage or  occupation,  excluding  those
 individuals  or small groups covered by medicare supplemental insurance.
 For medicare supplemental insurance coverage, "community rated" means  a
 rating  methodology  in  which the premiums for all persons covered by a
 policy or contract form is the same  based  on  the  experience  of  the
 entire  pool  of  risks  covered by that policy or contract form without
 regard  to  age,  sex,  health  status,  tobacco  usage  or  occupation.
 [Catastrophic  health  insurance  policies  issued  pursuant  to section
 1302(e) of the affordable care act, 42 U.S.C. § 18022(e), shall be clas-
 sified in a distinct community rating pool.]
   § 21. Subsection (d) of section 3240 of the insurance law, as added by
 section 41 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (d)  A  student accident and health insurance policy or contract shall
 provide coverage for essential health benefits as defined in  SUBSECTION
 (A)  OF  section  [1302(b)  of  the  affordable  care  act,  42 U.S.C. §
 18022(b)] THREE THOUSAND TWO HUNDRED SEVENTEEN-I OR  SUBSECTION  (A)  OF
 SECTION   FOUR   THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS  CHAPTER,  AS
 APPLICABLE.
   § 22. Subparagraph (A) of paragraph 3 of  subsection  (d)  of  section
 4235  of  the insurance law, as added by section 60 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (A) "employee" shall have the meaning set forth in  [section  2791  of
 the  public  health service act, 42 U.S.C. § 300gg-91(d)(5) or any regu-

 S. 1507--B                         56

 lations promulgated thereunder] THE EMPLOYEE RETIREMENT INCOME  SECURITY
 ACT OF 1974, 29 U.S.C. § 1002(6); and
   § 23. Intentionally omitted.
   § 24. Intentionally omitted.
   § 25. Intentionally omitted.
   §  26.  Subsection  (u-1)  of  section  4303  of the insurance law, as
 amended by chapter 377 of the laws  of  2014,  is  amended  to  read  as
 follows:
   (u-1)  A  medical  expense  indemnity  corporation or a health service
 corporation which provides medical coverage that includes  coverage  for
 physician  services  in  a  physician's  office  and  every policy which
 provides major medical  or  similar  comprehensive-type  coverage  shall
 include  coverage  for  equipment and supplies used for the treatment of
 ostomies, if prescribed by a physician or  other  licensed  health  care
 provider legally authorized to prescribe under title eight of the educa-
 tion law. Such coverage shall be subject to annual deductibles and coin-
 surance  as  deemed  appropriate  by  the  superintendent.  The coverage
 required by this subsection shall be identical to, and shall not enhance
 or increase the coverage required as part of essential  health  benefits
 as  [required pursuant to] DEFINED IN SUBSECTION (A) OF section [2707(a)
 of the public health services act 42 U.S.C. 300 gg-6(a)]  FOUR  THOUSAND
 THREE HUNDRED SIX-H OF THIS ARTICLE.
   §  27. Subsection (y) of section 4303 of the insurance law, as amended
 by chapter 469 of the laws of 2018, is amended to read as follows:
   (y) Every contract [which] THAT  provides  coverage  for  prescription
 drugs  shall  include coverage for the cost of enteral formulas for home
 use, whether administered orally or via tube feeding, for which a physi-
 cian or other  licensed  health  care  provider  legally  authorized  to
 prescribe  under  title  eight of the education law has issued a written
 order. Such written order shall state that the enteral formula is clear-
 ly medically necessary and has been proven effective as  a  disease-spe-
 cific  treatment  regimen.  Specific  diseases  and  disorders for which
 enteral formulas have been proven effective shall include, but  are  not
 limited to, inherited diseases of amino-acid or organic acid metabolism;
 Crohn's  Disease; gastroesophageal reflux; disorders of gastrointestinal
 motility such as chronic intestinal  pseudo-obstruction;  and  multiple,
 severe food allergies including, but not limited to immunoglobulin E and
 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe
 food protein induced enterocolitis syndrome; eosinophilic disorders; and
 impaired  absorption  of  nutrients  caused  by  disorders affecting the
 absorptive surface, function, length, and motility of the gastrointesti-
 nal tract. Enteral formulas [which] THAT  are  medically  necessary  and
 taken under written order from a physician for the treatment of specific
 diseases shall be distinguished from nutritional supplements taken elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 ic  acid  metabolism as well as severe protein allergic conditions shall
 include modified solid food products that are low  protein,  [or  which]
 contain  modified  protein,  or  are  amino  acid based [which] THAT are
 medically necessary[, and such coverage for  such  modified  solid  food
 products  for  any  calendar year or for any continuous period of twelve
 months for any insured individual shall not  exceed  two  thousand  five
 hundred dollars].
   § 28. Intentionally omitted.
   §  29.  Subsection (ll) of section 4303 of the insurance law, as added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:

 S. 1507--B                         57
 
   (ll) Every small group contract or association group contract  [deliv-
 ered  or  issued  for  delivery  in  this state] ISSUED BY A CORPORATION
 SUBJECT TO THE PROVISIONS OF THIS ARTICLE  that  provides  coverage  for
 hospital,  medical  or  surgical expense insurance and is not a grandfa-
 thered  health  plan  shall  provide  coverage  for the essential health
 [benefit] BENEFITS package [as required in section 2707(a) of the public
 health service act, 42  U.S.C.  §  300gg-6(a)].  For  purposes  of  this
 subsection:
   (1)  "essential  health  benefits  package" shall have the meaning set
 forth in PARAGRAPH THREE OF SUBSECTION (F)  OF section [1302(a)  of  the
 affordable  care  act, 42 U.S.C. § 18022(a)] FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE;
   (2) "grandfathered health plan" means coverage provided  by  a  corpo-
 ration  in  which  an individual was enrolled on March twenty-third, two
 thousand ten for as long as the coverage maintains grandfathered  status
 in accordance with section 1251(e) of the affordable care act, 42 U.S.C.
 § 18011(e); and
   (3)  "small  group"  means  a  group  of  [fifty or fewer employees or
 members exclusive of spouses and dependents.  Beginning  January  first,
 two  thousand  sixteen,  "small  group" means a group of] one hundred or
 fewer employees or members exclusive of spouses and dependents; and
   (4) "association group" means a group defined  in  subparagraphs  (B),
 (D),  (H), (K), (L) or (M) of paragraph one of subsection (c) of section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B) the group includes one or more member employers  or  other  member
 groups that are small groups.
   §  30.  Subsection (mm) of section 4303 of the insurance law, as added
 by section 55 of part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (mm) A corporation shall not be required to offer the contract  holder
 any  benefits  that  must  be made available pursuant to this section if
 such benefits must be  covered  pursuant  to  subsection  (kk)  of  this
 section.  For  any  contract  issued  within the health benefit exchange
 established [pursuant to section 1311 of the  affordable  care  act,  42
 U.S.C.  §  18031]  BY THIS STATE, a corporation shall not be required to
 offer the contract holder any  benefits  that  must  be  made  available
 pursuant to this section.
   § 31. Item (i) of subparagraph (C) of paragraph 2 of subsection (c) of
 section 4304 of the insurance law, as amended by chapter 317 of the laws
 of 2017, is amended to read as follows:
   (i)  Discontinuance  of  a class of contract upon not less than ninety
 days' prior written notice. In  exercising  the  option  to  discontinue
 coverage pursuant to this item, the corporation must act uniformly with-
 out  regard  to any health status-related factor of enrolled individuals
 or individuals who may become eligible for such coverage and must  offer
 to  subscribers  or  group  remitting agents, as may be appropriate, the
 option to  purchase  all  other  individual  health  insurance  coverage
 currently being offered by the corporation to applicants in that market.
 Provided,  however,  the  superintendent may, after giving due consider-
 ation to the public interest, approve a request made  by  a  corporation
 for the corporation to satisfy the requirements of this item through the
 offering of contracts at each level of coverage as defined in SUBSECTION
 (C)  OF  section  [1302(d)  of  the  affordable  care  act,  42 U.S.C. §
 18022(d)] FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE  that
 contains  the  ESSENTIAL  HEALTH benefits PACKAGE described in paragraph

 S. 1507--B                         58
 
 [one] THREE of subsection [(b)]  (F)  of  section  four  thousand  three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE by another corpo-
 ration,  insurer  or  health  maintenance organization within the corpo-
 ration's  same  holding company system, as defined in article fifteen of
 this chapter.
   § 32. Paragraph 1 of subsection (e) of section 4304 of  the  insurance
 law,  as  amended by chapter 388 of the laws of 2014, is amended to read
 as follows:
   (1) (A) If any such contract is  terminated  in  accordance  with  the
 provisions  of  paragraph  one of subsection (c) of this section, or any
 such contract is terminated because of a default by the remitting  agent
 in  the  payment  of  premiums not cured within the grace period and the
 remitting agent has not replaced the contract with similar  and  contin-
 uous coverage for the same group whether insured or self-insured, or any
 such contract is terminated in accordance with the provisions of subpar-
 agraph  (E) of paragraph two of subsection (c) of this section, or if an
 individual other than the contract holder is no longer covered  under  a
 "family  contract"  because the individual is no longer within the defi-
 nition set forth in the contract, or a spouse is no longer covered under
 the contract because of divorce from the contract holder or annulment of
 the marriage, or any such contract is terminated because of the death of
 the contract holder, then such individual, former spouse, or in the case
 of the death of the contract holder the surviving spouse or other depen-
 dents of the deceased contract holder covered under the contract, as the
 case may be, shall be entitled to convert, without evidence  of  insura-
 bility,  upon  application  therefor and the making of the first payment
 thereunder within sixty days after  the  date  of  termination  of  such
 contract,  to  a  contract  that  contains the ESSENTIAL HEALTH benefits
 PACKAGE described in paragraph [one] THREE of subsection  [(b)]  (F)  of
 section  four thousand three hundred [twenty-eight] SIX-H of this [chap-
 ter] ARTICLE.
   (B) The corporation shall offer one contract at each level of coverage
 as defined in SUBSECTION (C) OF section [1302(d) of the affordable  care
 act,  42  U.S.C.  §  18022(d)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS
 ARTICLE. The individual may choose any  such  contract  offered  by  the
 corporation. Provided, however, the superintendent may, after giving due
 consideration to the public interest, approve a request made by a corpo-
 ration for the corporation to satisfy the requirements of this paragraph
 through  the  offering  of  contracts that comply with this paragraph by
 another corporation, insurer or health maintenance  organization  within
 the  corporation's  same  holding  company system, as defined in article
 fifteen of this chapter.
   (C) The effective date of  the  coverage  provided  by  the  converted
 direct payment contract shall be the date of the termination of coverage
 under the contract from which conversion was made.
   § 33. Subsection (l) of section 4304 of the insurance law, as added by
 section  43  of  part D of chapter 56 of the laws of 2013, is amended to
 read as follows:
   (l) [On and after October first, two thousand thirteen,  a]  A  corpo-
 ration shall not offer individual hospital, medical, or surgical expense
 insurance  contracts  unless  the  contracts  meet  the  requirements of
 subsection (b) of section four thousand three  hundred  twenty-eight  of
 this  article. Such contracts that are offered within the health benefit
 exchange established [pursuant to section 1311 of  the  affordable  care
 act,  42  U.S.C. § 18031, or any regulations promulgated thereunder,] BY
 THIS STATE also shall meet any requirements established  by  the  health

 S. 1507--B                         59
 
 benefit  exchange.    To  the  extent that a holder of a special purpose
 certificate of authority issued pursuant to section four  thousand  four
 hundred  three-a  of  the  public health law offers individual hospital,
 medical,  or  surgical  expense insurance contracts, the contracts shall
 meet the requirements of subsection (b) of section four  thousand  three
 hundred twenty-eight of this article.
   §  34.  Subparagraph  (A)  of paragraph 1 of subsection (d) of section
 4305 of the insurance law, as amended by chapter  388  of  the  laws  of
 2014, is amended to read as follows:
   (A)  A  group contract issued pursuant to this section shall contain a
 provision to the effect that in case of a termination of coverage  under
 such  contract of any member of the group because of (i) termination for
 any reason whatsoever of the member's employment or membership, or  (ii)
 termination  for  any  reason  whatsoever  of  the group contract itself
 unless the group contract holder has replaced the  group  contract  with
 similar  and  continuous  coverage for the same group whether insured or
 self-insured, the member shall be entitled to have issued to the  member
 by  the  corporation, without evidence of insurability, upon application
 therefor and payment of the first premium made to the corporation within
 sixty days after termination  of  the  coverage,  an  individual  direct
 payment  contract, covering such member and the member's eligible depen-
 dents who were covered by the group contract,  which  provides  coverage
 that  contains  the ESSENTIAL HEALTH benefits PACKAGE described in para-
 graph [one] THREE of subsection [(b)] (F) of section four thousand three
 hundred [twenty-eight] SIX-H of this [chapter] ARTICLE. The  corporation
 shall  offer  one  contract  at  each  level  of  coverage as defined in
 SUBSECTION (C) OF section [1302(d) of the affordable care act, 42 U.S.C.
 § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS  ARTICLE.  The
 member  may  choose  any  such  contract  offered  by  the  corporation.
 Provided, however, the superintendent may, after  giving  due  consider-
 ation  to  the  public interest, approve a request made by a corporation
 for the corporation to satisfy the  requirements  of  this  subparagraph
 through  the offering of contracts that comply with this subparagraph by
 another corporation, insurer or health maintenance  organization  within
 the  corporation's  same  holding  company system, as defined in article
 fifteen of this chapter.
   § 35. The insurance law is amended by adding a new section  4306-h  to
 read as follows:
   § 4306-H. ESSENTIAL HEALTH BENEFITS PACKAGE AND LIMIT ON COST-SHARING.
 (A) FOR PURPOSES OF THIS ARTICLE, "ESSENTIAL HEALTH BENEFITS" SHALL MEAN
 THE FOLLOWING CATEGORIES OF BENEFITS:
   (1) AMBULATORY PATIENT SERVICES;
   (2) EMERGENCY SERVICES;
   (3) HOSPITALIZATION;
   (4) MATERNITY AND NEWBORN CARE;
   (5)  MENTAL  HEALTH  AND  SUBSTANCE  USE  DISORDER SERVICES, INCLUDING
 BEHAVIORAL HEALTH TREATMENT;
   (6) PRESCRIPTION DRUGS;
   (7) REHABILITATIVE AND HABILITATIVE SERVICES AND DEVICES;
   (8) LABORATORY SERVICES;
   (9) PREVENTIVE AND WELLNESS SERVICES AND CHRONIC  DISEASE  MANAGEMENT;
 AND
   (10)  PEDIATRIC SERVICES, INCLUDING ORAL AND VISION CARE.  IF A STAND-
 ALONE DENTAL BENEFIT PLAN OFFERED THROUGH THE HEALTH BENEFIT EXCHANGE OR
 OUTSIDE OF THE HEALTH BENEFIT EXCHANGE IN THE INDIVIDUAL OR SMALL  GROUP
 MARKET HAS CERTIFIED TO THE STATE THAT THE PLAN INCLUDES DENTAL BENEFITS

 S. 1507--B                         60
 
 MEETING  THE REQUIREMENTS OF THE BENCHMARK PLAN, A HEALTH PLAN SHALL NOT
 FAIL TO MEET THE REQUIREMENTS OF THIS SECTION SOLELY BECAUSE THE  HEALTH
 PLAN  DOES  NOT  INCLUDE  PEDIATRIC  DENTAL  BENEFITS  OTHERWISE OFFERED
 THROUGH THE STAND-ALONE DENTAL PLAN.
   (B)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, MAY SELECT AS A BENCHMARK, A PLAN OR COMBINATION OF  PLANS  THAT
 TOGETHER  CONTAIN  ESSENTIAL  HEALTH  BENEFITS,  IN ACCORDANCE WITH THIS
 SECTION AND ANY APPLICABLE FEDERAL REGULATION.
   (C) (1) EVERY INDIVIDUAL AND SMALL GROUP CONTRACT THAT PROVIDES HOSPI-
 TAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE AND IS  NOT  A  GRANDFATHERED
 HEALTH PLAN SHALL PROVIDE COVERAGE THAT MEETS THE ACTUARIAL REQUIREMENTS
 OF ONE OF THE FOLLOWING LEVELS OF COVERAGE:
   (A)  BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN;
   (B) SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF  THE  BENE-
 FITS PROVIDED UNDER THE PLAN;
   (C)  GOLD  LEVEL.  A  PLAN  IN THE GOLD LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN; OR
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF  COVERAGE  THAT  IS DESIGNED TO PROVIDE BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2) THE SUPERINTENDENT MAY PROVIDE FOR A VARIATION  IN  THE  ACTUARIAL
 VALUES  USED  IN  DETERMINING THE LEVEL OF COVERAGE OF A PLAN TO ACCOUNT
 FOR THE DIFFERENCES IN ACTUARIAL ESTIMATES.
   (3) EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL PROVIDE
 COVERAGE THAT MEETS AT LEAST SIXTY PERCENT OF THE FULL  ACTUARIAL  VALUE
 OF THE BENEFITS PROVIDED UNDER THE CONTRACT.  THE CONTRACT'S SCHEDULE OF
 BENEFITS  SHALL  INCLUDE THE LEVEL AS DESCRIBED IN PARAGRAPH ONE OF THIS
 SUBSECTION NEAREST TO, BUT BELOW THE ACTUAL ACTUARIAL VALUE.
   (D) EVERY INDIVIDUAL OR GROUP CONTRACT THAT PROVIDES HOSPITAL,  SURGI-
 CAL, OR MEDICAL EXPENSE COVERAGE AND IS NOT A GRANDFATHERED HEALTH PLAN,
 AND EVERY STUDENT ACCIDENT AND HEALTH INSURANCE CONTRACT SHALL LIMIT THE
 INSURED'S COST-SHARING FOR IN-NETWORK SERVICES IN A CONTRACT YEAR TO NOT
 MORE THAN THE MAXIMUM OUT-OF-POCKET AMOUNT DETERMINED BY THE SUPERINTEN-
 DENT  FOR  ALL  CONTRACTS SUBJECT TO THIS SECTION. SUCH AMOUNT SHALL NOT
 EXCEED ANY ANNUAL OUT-OF-POCKET LIMIT ON COST-SHARING SET BY THE  UNITED
 STATES SECRETARY OF HEALTH AND HUMAN SERVICES, IF AVAILABLE.
   (E)  THE SUPERINTENDENT MAY REQUIRE THE USE OF MODEL LANGUAGE DESCRIB-
 ING THE COVERAGE REQUIREMENTS FOR  ANY  FORM  THAT  IS  SUBJECT  TO  THE
 APPROVAL  OF  THE SUPERINTENDENT PURSUANT TO SECTION FOUR THOUSAND THREE
 HUNDRED EIGHT OF THIS ARTICLE.
   (F) FOR PURPOSES OF THIS SECTION:
   (1) "ACTUARIAL VALUE" MEANS  THE  PERCENTAGE  OF  THE  TOTAL  EXPECTED
 PAYMENTS  BY  THE  CORPORATION FOR BENEFITS PROVIDED TO A STANDARD POPU-
 LATION, WITHOUT REGARD TO THE POPULATION TO WHOM THE CORPORATION ACTUAL-
 LY PROVIDES BENEFITS;
   (2) "COST-SHARING" MEANS ANNUAL DEDUCTIBLES, COINSURANCE,  COPAYMENTS,
 OR SIMILAR CHARGES, FOR COVERED SERVICES;
   (3) "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS COVERAGE THAT:

 S. 1507--B                         61
 
   (A) PROVIDES FOR ESSENTIAL HEALTH BENEFITS;
   (B)   LIMITS   COST-SHARING  FOR  SUCH  COVERAGE  IN  ACCORDANCE  WITH
 SUBSECTION (D) OF THIS SECTION; AND
   (C) PROVIDES ONE OF THE LEVELS OF COVERAGE DESCRIBED IN SUBSECTION (C)
 OF THIS SECTION;
   (4) "GRANDFATHERED HEALTH PLAN" MEANS COVERAGE PROVIDED  BY  A  CORPO-
 RATION  IN  WHICH  AN INDIVIDUAL WAS ENROLLED ON MARCH TWENTY-THIRD, TWO
 THOUSAND TEN FOR AS LONG AS THE COVERAGE MAINTAINS GRANDFATHERED  STATUS
 IN ACCORDANCE WITH SECTION 1251(E) OF THE AFFORDABLE CARE ACT, 42 U.S.C.
 § 18011(E);
   (5)  "SMALL  GROUP" MEANS A GROUP OF ONE HUNDRED OR FEWER EMPLOYEES OR
 MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS; AND
   (6) "STUDENT ACCIDENT AND HEALTH INSURANCE" SHALL HAVE THE MEANING SET
 FORTH IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED  FORTY  OF
 THIS CHAPTER.
   §  36.  Paragraph 4 of subsection (a) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (4) For the purposes of this section, "community rated" means a rating
 methodology  in which the premium for all persons covered by a policy or
 contract form is the same, based on the experience of the entire pool of
 risks of all individuals or small  groups  covered  by  the  corporation
 without  regard  to age, sex, health status, tobacco usage or occupation
 excluding those individuals of small groups covered by Medicare  supple-
 mental  insurance. For medicare supplemental insurance coverage, "commu-
 nity rated" means a rating methodology in which  the  premiums  for  all
 persons  covered  by  a policy or contract form is the same based on the
 experience of the entire  pool  of  risks  covered  by  that  policy  or
 contract  form  without regard to age, sex, health status, tobacco usage
 or occupation. [Catastrophic health insurance contracts issued  pursuant
 to  section  1302(e)  of  the affordable care act, 42 U.S.C. § 18022(e),
 shall be classified in a distinct community rating pool.]
   § 37. Subsections (d), (e) and (j) of section 4326  of  the  insurance
 law,  as  amended  by  section 56 of part D of chapter 56 of the laws of
 2013, are amended to read as follows:
   (d) A qualifying group health insurance contract shall provide  cover-
 age for the essential health [benefit] BENEFITS package as [required in]
 DEFINED  IN PARAGRAPH THREE OF SUBSECTION (F) OF section [2707(a) of the
 public health service act, 42 U.S.C. § 300gg-6(a). For purposes of  this
 subsection  "essential  health  benefits package" shall have the meaning
 set forth in section 1302(a) of the affordable care  act,  42  U.S.C.  §
 18022(a)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE.
   (e) A qualifying group health insurance contract [issued to a qualify-
 ing  small  employer  prior to January first, two thousand fourteen that
 does not include all essential  health  benefits  required  pursuant  to
 section   2707(a)  of  the  public  health  service  act,  42  U.S.C.  §
 300gg-6(a), shall be discontinued, including grandfathered health plans.
 For the purposes of this paragraph, "grandfathered health  plans"  means
 coverage  provided  by a corporation to individuals who were enrolled on
 March twenty-third, two thousand ten for as long as the  coverage  main-
 tains  grandfathered  status  in  accordance with section 1251(e) of the
 affordable care act, 42 U.S.C. § 18011(e). A qualifying  small  employer
 shall  be  transitioned  to  a  plan that provides: (1)] SHALL PROVIDE a
 level of coverage that is designed to provide benefits that are actuari-
 ally equivalent to eighty percent of the full  actuarial  value  of  the
 benefits  provided  under  the plan[; and (2) coverage for the essential

 S. 1507--B                         62

 health benefit package as required in  section  2707(a)  of  the  public
 health  service  act,  42 U.S.C. § 300gg-6(a)]. The superintendent shall
 standardize the benefit package and cost sharing requirements of  quali-
 fied  group  health insurance contracts consistent with coverage offered
 through the health benefit exchange  established  [pursuant  to  section
 1311 of the affordable care act, 42 U.S.C. § 18031] BY THIS STATE.
   (j)  [Beginning  January  first,  two  thousand  fourteen, pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A
 corporation shall not impose any pre-existing condition limitation in  a
 qualifying group health insurance contract.
   §  38.  Subsection  (m-1)  of  section  4327  of the insurance law, as
 amended by section 58 of part D of chapter 56 of the laws  of  2013,  is
 amended to read as follows:
   (m-1)  In the event that the superintendent suspends the enrollment of
 new individuals for qualifying group  health  insurance  contracts,  the
 superintendent  shall ensure that small employers seeking to enroll in a
 qualified group health insurance contract  pursuant  to  section  forty-
 three hundred twenty-six of this article are provided information on and
 directed  to  coverage  options  available  through  the  health benefit
 exchange established [pursuant to section 1311 of  the  affordable  care
 act, 42 U.S.C. § 18031] BY THIS STATE.
   §  39.  Paragraphs 1, 2 and 3 of subsection (b) of section 4328 of the
 insurance law, as added by section 46 of part D of  chapter  56  of  the
 laws of 2013, are amended to read as follows:
   (1)  The  individual enrollee direct payment contract offered pursuant
 to this section shall provide coverage for the essential  health  [bene-
 fit]  BENEFITS  package  as  [required in] DEFINED IN PARAGRAPH THREE OF
 SUBSECTION (F) OF section [2707(a) of the public health service act,  42
 U.S.C.  §  300gg-6(a). For purposes of this paragraph, "essential health
 benefits package" shall have the meaning set forth in section 1302(a) of
 the affordable care act, 42  U.S.C.  §  18022(a)]  FOUR  THOUSAND  THREE
 HUNDRED SIX-H OF THIS ARTICLE.
   (2)  A  health maintenance organization shall offer at least one indi-
 vidual enrollee direct payment contract at each  level  of  coverage  as
 defined  in  SUBSECTION  (C)  OF section [1302(d) of the affordable care
 act, 42 U.S.C. § 18022(d)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS
 ARTICLE.  A  health maintenance organization also shall offer one child-
 only plan, AS REQUIRED BY SECTION 1302(F) OF THE AFFORDABLE CARE ACT, 42
 U.S.C. § 18022(F), at each level of coverage  [as  required  in  section
 2707(c) of the public health service act, 42 U.S.C. § 300gg-6(c)].
   (3)  Within  the  health  benefit  exchange  established  [pursuant to
 section 1311 of the affordable care act, 42  U.S.C.  §  18031]  BY  THIS
 STATE,  a health maintenance organization may offer an individual enrol-
 lee direct payment contract  that  is  a  catastrophic  health  plan  as
 defined  in  section  1302(e)  of  the  affordable care act, 42 U.S.C. §
 18022(e), or any regulations promulgated thereunder.
   § 40. Subparagraph (A) of paragraph 4 of  subsection  (b)  of  section
 4328  of  the insurance law, as added by chapter 11 of the laws of 2016,
 is amended to read as follows:
   (A) The individual enrollee direct payment contract  offered  pursuant
 to  this  section  shall  have  the  same  enrollment periods, including
 special enrollment periods, as required for an individual direct payment
 contract offered within the health benefit exchange established  [pursu-
 ant  to  section  1311 of the affordable care act, 42 U.S.C. § 18031, or
 any regulations promulgated thereunder] BY THIS STATE.

 S. 1507--B                         63
 
   § 41. Subsection (c) of section 4328 of the insurance law, as added by
 section 46 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (c)  In  addition  to  or  in  lieu  of the individual enrollee direct
 payment contracts required under this section,  all  health  maintenance
 organizations issued a certificate of authority under article forty-four
 of  the public health law or licensed under this article may offer indi-
 vidual enrollee direct  payment  contracts  within  the  health  benefit
 exchange  established  [pursuant  to section 1311 of the affordable care
 act, 42 U.S.C. § 18031, or any regulations  promulgated  thereunder]  BY
 THIS  STATE, subject to any requirements established by the health bene-
 fit exchange.   If  a  health  maintenance  organization  satisfies  the
 requirements  of  subsection  (a) of this section by offering individual
 enrollee direct  payment  contracts,  only  within  the  health  benefit
 exchange, the health maintenance organization, not including a holder of
 a  special  purpose  certificate of authority issued pursuant to section
 four thousand four hundred three-a of the public health law, shall  also
 offer  at  least one individual enrollee direct payment contract at each
 level of coverage as defined in SUBSECTION (C) section [1302 (d) of  the
 affordable  care act, 42 U.S.C. § 18022 (d)] FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE, outside the health benefit exchange.
   § 42. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                 SUBPART C
 
   Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
 amended by adding a new paragraph 35 to read as follows:
   (35)  NO  POLICY  DELIVERED  OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT  OR
 EXCLUDE  COVERAGE  FOR  ABORTIONS THAT ARE MEDICALLY NECESSARY. COVERAGE
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE  POLICY
 IS  A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF THE
 INTERNAL REVENUE CODE OF 1986; IN  WHICH  CASE  COVERAGE  FOR  MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 21 to read as follows:
   (21) (A) NO POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES  HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE SHALL LIMIT OR
 EXCLUDE COVERAGE FOR ABORTIONS THAT ARE  MEDICALLY  NECESSARY.  COVERAGE
 FOR ABORTIONS THAT ARE MEDICALLY NECESSARY SHALL NOT BE SUBJECT TO ANNU-
 AL  DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS, UNLESS THE POLICY
 IS A HIGH DEDUCTIBLE HEALTH PLAN AS DEFINED IN SECTION 223(C)(2) OF  THE
 INTERNAL  REVENUE  CODE  OF  1986;  IN WHICH CASE COVERAGE FOR MEDICALLY
 NECESSARY ABORTIONS MAY BE SUBJECT TO THE PLAN'S ANNUAL DEDUCTIBLE.
   (B) NOTWITHSTANDING ANY OTHER PROVISION, A GROUP POLICY THAT  PROVIDES
 HOSPITAL,  SURGICAL, OR MEDICAL EXPENSE COVERAGE DELIVERED OR ISSUED FOR
 DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER, AS DEFINED IN  PARAGRAPH
 SIXTEEN OF THIS SUBSECTION, MAY EXCLUDE COVERAGE FOR MEDICALLY NECESSARY
 ABORTIONS ONLY IF THE INSURER:
   (I)  OBTAINS  AN ANNUAL CERTIFICATION FROM THE GROUP POLICYHOLDER THAT
 THE POLICYHOLDER IS A RELIGIOUS EMPLOYER AND THAT THE RELIGIOUS EMPLOYER
 REQUESTS A POLICY WITHOUT COVERAGE FOR MEDICALLY NECESSARY ABORTIONS;

 S. 1507--B                         64
 
   (II) ISSUES A RIDER TO EACH CERTIFICATEHOLDER  AT  NO  PREMIUM  TO  BE
 CHARGED  TO  THE  CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER FOR THE RIDER,
 THAT PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO  THE
 SAME  RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF TREATMENT
 IN  THE POLICY ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER SHALL CLEARLY
 AND CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT  ADMINIS-
 TER MEDICALLY NECESSARY ABORTION BENEFITS, BUT THAT THE INSURER IS ISSU-
 ING  A  RIDER  FOR  COVERAGE OF MEDICALLY NECESSARY ABORTIONS, AND SHALL
 PROVIDE THE INSURER'S CONTACT INFORMATION FOR QUESTIONS; AND
   (III) PROVIDES NOTICE OF THE ISSUANCE OF THE POLICY AND RIDER  TO  THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.
   §  3.  Section  4303  of  the insurance law is amended by adding a new
 subsection (ss) to read as follows:
   (SS) (1) NO CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS
 OF THIS ARTICLE THAT PROVIDES HOSPITAL,  SURGICAL,  OR  MEDICAL  EXPENSE
 COVERAGE  SHALL  LIMIT  OR  EXCLUDE  COVERAGE  FOR  ABORTIONS  THAT  ARE
 MEDICALLY NECESSARY. COVERAGE FOR ABORTIONS THAT ARE MEDICALLY NECESSARY
 SHALL NOT BE SUBJECT TO ANNUAL  DEDUCTIBLES  OR  COINSURANCE,  INCLUDING
 CO-PAYMENTS,  UNLESS  THE  CONTRACT  IS A HIGH DEDUCTIBLE HEALTH PLAN AS
 DEFINED IN SECTION 223(C)(2) OF THE INTERNAL REVENUE  CODE  OF  1986  IN
 WHICH  CASE COVERAGE FOR MEDICALLY NECESSARY ABORTIONS MAY BE SUBJECT TO
 THE CONTRACT'S ANNUAL DEDUCTIBLE.
   (2)  NOTWITHSTANDING  ANY  OTHER  PROVISION,  A  GROUP  CONTRACT  THAT
 PROVIDES  HOSPITAL,  SURGICAL,  OR MEDICAL EXPENSE COVERAGE DELIVERED OR
 ISSUED FOR DELIVERY IN THIS STATE TO A RELIGIOUS EMPLOYER AS DEFINED  IN
 SUBSECTION  (CC)  OF  THIS  SECTION  MAY  EXCLUDE COVERAGE FOR MEDICALLY
 NECESSARY ABORTIONS ONLY IF THE CORPORATION:
   (A) OBTAINS AN ANNUAL CERTIFICATION FROM THE GROUP CONTRACTHOLDER THAT
 THE CONTRACTHOLDER IS  A  RELIGIOUS  EMPLOYER  AND  THAT  THE  RELIGIOUS
 EMPLOYER  REQUESTS  A  CONTRACT WITHOUT COVERAGE FOR MEDICALLY NECESSARY
 ABORTIONS;
   (B) ISSUES A RIDER TO EACH  CERTIFICATEHOLDER  AT  NO  PREMIUM  TO  BE
 CHARGED  TO  THE  CERTIFICATEHOLDER OR RELIGIOUS EMPLOYER FOR THE RIDER,
 THAT PROVIDES COVERAGE FOR MEDICALLY NECESSARY ABORTIONS SUBJECT TO  THE
 SAME  RULES AS WOULD HAVE BEEN APPLIED TO THE SAME CATEGORY OF TREATMENT
 IN THE CONTRACT ISSUED TO THE RELIGIOUS EMPLOYER. THE RIDER MUST CLEARLY
 AND CONSPICUOUSLY SPECIFY THAT THE RELIGIOUS EMPLOYER DOES NOT  ADMINIS-
 TER  MEDICALLY  NECESSARY ABORTION BENEFITS, BUT THAT THE CORPORATION IS
 ISSUING A RIDER FOR COVERAGE OF MEDICALLY NECESSARY ABORTIONS, AND SHALL
 PROVIDE THE CORPORATION'S CONTACT INFORMATION FOR QUESTIONS; AND
   (C) PROVIDES NOTICE OF THE ISSUANCE OF THE CONTRACT AND RIDER  TO  THE
 SUPERINTENDENT IN A FORM AND MANNER ACCEPTABLE TO THE SUPERINTENDENT.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                 SUBPART D
 
   Section 1. The insurance law is amended by adding a new  section  3242
 to read as follows:
   §  3242.  PRESCRIPTION DRUG COVERAGE.  (A) EVERY INSURER THAT DELIVERS
 OR ISSUES FOR DELIVERY IN THIS STATE A POLICY THAT PROVIDES COVERAGE FOR
 PRESCRIPTION DRUGS SHALL, WITH RESPECT TO THE PRESCRIPTION  DRUG  COVER-
 AGE,  PUBLISH  AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF ALL COVERED
 PRESCRIPTION DRUGS ON ITS FORMULARY DRUG  LIST,  INCLUDING  ANY  TIERING

 S. 1507--B                         65
 
 STRUCTURE  THAT  IT  HAS  ADOPTED  AND ANY RESTRICTIONS ON THE MANNER IN
 WHICH A PRESCRIPTION DRUG MAY BE OBTAINED, IN A MANNER  THAT  IS  EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B)  (1)  EVERY  POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS SHALL INCLUDE IN THE POLI-
 CY A PROCESS THAT ALLOWS AN INSURED,  THE  INSURED'S  DESIGNEE,  OR  THE
 INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A FORMULARY EXCEP-
 TION.    WITH  RESPECT TO THE PROCESS FOR SUCH A FORMULARY EXCEPTION, AN
 INSURER SHALL FOLLOW THE PROCESS AND  PROCEDURES  SPECIFIED  IN  ARTICLE
 FORTY-NINE  OF  THIS CHAPTER AND ARTICLE FORTY-NINE OF THE PUBLIC HEALTH
 LAW, EXCEPT AS OTHERWISE PROVIDED IN PARAGRAPHS  TWO,  THREE,  FOUR  AND
 FIVE OF THIS SUBSECTION.
   (2)  (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE INSURED'S
 DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO REQUEST A
 STANDARD REVIEW THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES OF  A  FORMU-
 LARY  EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE POLI-
 CY.
   (B) AN INSURER SHALL MAKE A  DETERMINATION  ON  A  STANDARD  EXCEPTION
 REQUEST  THAT  IS  NOT  BASED  ON  EXIGENT  CIRCUMSTANCES AND NOTIFY THE
 INSURED OR THE INSURED'S DESIGNEE AND THE INSURED'S  PRESCRIBING  HEALTH
 CARE  PROVIDER  BY TELEPHONE OF ITS COVERAGE DETERMINATION NO LATER THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C) AN INSURER THAT GRANTS A STANDARD EXCEPTION REQUEST  THAT  IS  NOT
 BASED  ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE NON-FORMU-
 LARY PRESCRIPTION DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING
 REFILLS.
   (D)  FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES" MEANS
 WHEN AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY  SERIOUSLY
 JEOPARDIZE  THE  INSURED'S  LIFE,  HEALTH,  OR ABILITY TO REGAIN MAXIMUM
 FUNCTION OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF  TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3)  (A) AN INSURER SHALL HAVE A PROCESS FOR AN INSURED, THE INSURED'S
 DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  TO  REQUEST
 AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF A FORMULARY EXCEP-
 TION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE POLICY.
   (B)  AN  INSURER  SHALL  MAKE  A  DETERMINATION ON AN EXPEDITED REVIEW
 REQUEST BASED ON EXIGENT CIRCUMSTANCES AND NOTIFY  THE  INSURED  OR  THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE  OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR HOURS
 FOLLOWING RECEIPT OF THE REQUEST.
   (C) AN INSURER THAT GRANTS AN EXCEPTION BASED ON EXIGENT CIRCUMSTANCES
 SHALL PROVIDE COVERAGE OF THE NON-FORMULARY PRESCRIPTION  DRUG  FOR  THE
 DURATION OF THE EXIGENT CIRCUMSTANCES.
   (4) AN INSURER THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO OR
 THREE  OF  THIS  SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE DETERMINATION UNDER SECTION FOUR THOUSAND NINE HUNDRED  FOUR  OF
 THIS  CHAPTER  OR  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THE PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY APPROPRIATE PRESCRIPTION DRUGS COVERED BY THE  INSURER  TO  TREAT
 THE INSURED.

 S. 1507--B                         66
 
   (5)  (A)  IF  AN INSURER DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER  SHALL  HAVE  THE
 RIGHT  TO  REQUEST  THAT  SUCH  DENIAL BE REVIEWED BY AN EXTERNAL APPEAL
 AGENT  CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR THOUSAND
 NINE HUNDRED ELEVEN OF THIS CHAPTER IN ACCORDANCE  WITH  ARTICLE  FORTY-
 NINE OF THIS CHAPTER OR ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE INSURER, THE  INSURED  OR  THE  INSURED'S
 DESIGNEE,  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL  REQUEST
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE  EXTERNAL  APPEAL AGENT SHALL NOTIFY THE INSURER, THE INSURED OR THE
 INSURED'S DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH  CARE  PROVIDER
 IN WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN TWO BUSINESS DAYS
 OF RENDERING SUCH DETERMINATION.
   (C)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE INSURER, THE  INSURED  OR  THE  INSURED'S
 DESIGNEE,  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL  REQUEST
 WAS  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF THIS
 SUBSECTION AND THE INSURED'S PRESCRIBING HEALTH  CARE  PROVIDER  ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE  INSURER,  THE  INSURED OR THE INSURED'S DESIGNEE, AND THE INSURED'S
 PRESCRIBING HEALTH CARE PROVIDER  IN  WRITING  OF  THE  EXTERNAL  APPEAL
 DETERMINATION  WITHIN  SEVENTY-TWO  HOURS OF THE EXTERNAL APPEAL AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D) AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN  ACCORDANCE
 WITH  SUBPARAGRAPH  (A)  OF  PARAGRAPH FOUR OF SUBSECTION (B) OF SECTION
 FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER OR SUBPARAGRAPH  (A)
 OF  PARAGRAPH  (D)  OF  SUBDIVISION  TWO  OF  SECTION FOUR THOUSAND NINE
 HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A  DETERMINATION,
 THE   EXTERNAL   APPEAL  AGENT  SHALL  CONSIDER  WHETHER  THE  FORMULARY
 PRESCRIPTION DRUG COVERED BY THE INSURER WILL BE OR  HAS  BEEN  INEFFEC-
 TIVE,  WOULD NOT BE AS EFFECTIVE AS THE NON-FORMULARY PRESCRIPTION DRUG,
 OR WOULD HAVE ADVERSE EFFECTS.
   (E) IF AN EXTERNAL APPEAL AGENT OVERTURNS THE INSURER'S  DENIAL  OF  A
 STANDARD  EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION, THEN
 THE INSURER SHALL PROVIDE COVERAGE  OF  THE  NON-FORMULARY  PRESCRIPTION
 DRUG  FOR  THE  DURATION  OF  THE PRESCRIPTION, INCLUDING REFILLS. IF AN
 EXTERNAL APPEAL AGENT OVERTURNS THE INSURER'S  DENIAL  OF  AN  EXPEDITED
 EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE OF THIS SUBSECTION, THEN THE
 INSURER SHALL PROVIDE COVERAGE OF THE  NON-FORMULARY  PRESCRIPTION  DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   § 2. The insurance law is amended by adding a new section 4329 to read
 as follows:
   §  4329. PRESCRIPTION DRUG COVERAGE.  (A) EVERY CORPORATION SUBJECT TO
 THE PROVISIONS OF THIS ARTICLE THAT  ISSUES  A  CONTRACT  THAT  PROVIDES
 COVERAGE  FOR PRESCRIPTION DRUGS SHALL, WITH RESPECT TO THE PRESCRIPTION
 DRUG COVERAGE, PUBLISH AN UP-TO-DATE, ACCURATE, AND COMPLETE LIST OF ALL
 COVERED PRESCRIPTION DRUGS ON ITS FORMULARY  DRUG  LIST,  INCLUDING  ANY
 TIERING STRUCTURE THAT IT HAS ADOPTED AND ANY RESTRICTIONS ON THE MANNER
 IN WHICH A PRESCRIPTION DRUG MAY BE OBTAINED, IN A MANNER THAT IS EASILY
 ACCESSIBLE TO INSUREDS AND PROSPECTIVE INSUREDS. THE FORMULARY DRUG LIST

 S. 1507--B                         67
 
 SHALL CLEARLY IDENTIFY THE PREVENTIVE PRESCRIPTION DRUGS THAT ARE AVAIL-
 ABLE WITHOUT ANNUAL DEDUCTIBLES OR COINSURANCE, INCLUDING CO-PAYMENTS.
   (B)  (1)  EVERY  CONTRACT  ISSUED  BY  A  CORPORATION  SUBJECT  TO THE
 PROVISIONS OF THIS ARTICLE THAT PROVIDES COVERAGE FOR PRESCRIPTION DRUGS
 SHALL INCLUDE IN THE CONTRACT A PROCESS  THAT  ALLOWS  AN  INSURED,  THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST  A  FORMULARY  EXCEPTION. WITH RESPECT TO THE PROCESS FOR SUCH A
 FORMULARY EXCEPTION, A CORPORATION SHALL FOLLOW THE PROCESS  AND  PROCE-
 DURES  SPECIFIED  IN  ARTICLE  FORTY-NINE  OF  THIS  CHAPTER AND ARTICLE
 FORTY-NINE OF THE PUBLIC HEALTH LAW, EXCEPT  AS  OTHERWISE  PROVIDED  IN
 PARAGRAPHS TWO, THREE, FOUR AND FIVE OF THIS SUBSECTION.
   (2)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST A STANDARD REVIEW THAT IS NOT BASED ON EXIGENT CIRCUMSTANCES  OF
 A FORMULARY EXCEPTION FOR A PRESCRIPTION DRUG THAT IS NOT COVERED BY THE
 CONTRACT.
   (B)  A  CORPORATION SHALL MAKE A DETERMINATION ON A STANDARD EXCEPTION
 REQUEST THAT IS NOT  BASED  ON  EXIGENT  CIRCUMSTANCES  AND  NOTIFY  THE
 INSURED  OR  THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH
 CARE PROVIDER BY TELEPHONE OF ITS COVERAGE DETERMINATION NO  LATER  THAN
 SEVENTY-TWO HOURS FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS A STANDARD EXCEPTION REQUEST THAT IS NOT
 BASED  ON EXIGENT CIRCUMSTANCES SHALL PROVIDE COVERAGE OF THE NON-FORMU-
 LARY PRESCRIPTION DRUG FOR THE DURATION OF THE  PRESCRIPTION,  INCLUDING
 REFILLS.
   (D)  FOR THE PURPOSE OF THIS SUBSECTION, "EXIGENT CIRCUMSTANCES" MEANS
 WHEN AN INSURED IS SUFFERING FROM A HEALTH CONDITION THAT MAY  SERIOUSLY
 JEOPARDIZE  THE  INSURED'S  LIFE,  HEALTH,  OR ABILITY TO REGAIN MAXIMUM
 FUNCTION OR WHEN AN INSURED IS UNDERGOING A CURRENT COURSE OF  TREATMENT
 USING A NON-FORMULARY PRESCRIPTION DRUG.
   (3)  (A)  A  CORPORATION  SHALL  HAVE  A  PROCESS  FOR AN INSURED, THE
 INSURED'S DESIGNEE, OR THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER TO
 REQUEST AN EXPEDITED REVIEW BASED ON EXIGENT CIRCUMSTANCES OF  A  FORMU-
 LARY EXCEPTION FOR A PRESCRIPTION DRUG IS NOT COVERED BY THE CONTRACT.
   (B)  A  CORPORATION  SHALL MAKE A DETERMINATION ON AN EXPEDITED REVIEW
 REQUEST BASED ON EXIGENT CIRCUMSTANCES AND NOTIFY  THE  INSURED  OR  THE
 INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY
 TELEPHONE  OF ITS COVERAGE DETERMINATION NO LATER THAN TWENTY-FOUR HOURS
 FOLLOWING RECEIPT OF THE REQUEST.
   (C) A CORPORATION THAT GRANTS AN EXCEPTION BASED  ON  EXIGENT  CIRCUM-
 STANCES  SHALL  PROVIDE  COVERAGE OF THE NON-FORMULARY PRESCRIPTION DRUG
 FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   (4) A CORPORATION THAT DENIES AN EXCEPTION REQUEST UNDER PARAGRAPH TWO
 OR THREE OF THIS SUBSECTION SHALL PROVIDE WRITTEN NOTICE OF ITS DETERMI-
 NATION TO THE INSURED  OR  THE  INSURED'S  DESIGNEE  AND  THE  INSURED'S
 PRESCRIBING  HEALTH  CARE PROVIDER WITHIN THREE BUSINESS DAYS OF RECEIPT
 OF THE EXCEPTION REQUEST. THE WRITTEN NOTICE SHALL BE CONSIDERED A FINAL
 ADVERSE DETERMINATION UNDER SECTION FOUR THOUSAND NINE HUNDRED  FOUR  OF
 THIS  CHAPTER  OR  SECTION FOUR THOUSAND NINE HUNDRED FOUR OF THE PUBLIC
 HEALTH LAW. WRITTEN NOTICE SHALL ALSO INCLUDE THE NAME OR NAMES OF CLIN-
 ICALLY APPROPRIATE PRESCRIPTION DRUGS  COVERED  BY  THE  CORPORATION  TO
 TREAT THE INSURED.
   (5) (A) IF A CORPORATION DENIES A REQUEST FOR AN EXCEPTION UNDER PARA-
 GRAPH TWO OR THREE OF THIS SUBSECTION, THE INSURED, THE INSURED'S DESIG-
 NEE,  OR  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER SHALL HAVE THE
 RIGHT TO REQUEST THAT SUCH DENIAL BE  REVIEWED  BY  AN  EXTERNAL  APPEAL

 S. 1507--B                         68
 
 AGENT  CERTIFIED BY THE SUPERINTENDENT PURSUANT TO SECTION FOUR THOUSAND
 NINE HUNDRED ELEVEN OF THIS CHAPTER IN ACCORDANCE  WITH  ARTICLE  FORTY-
 NINE OF THIS CHAPTER AND ARTICLE FORTY-NINE OF THE PUBLIC HEALTH LAW.
   (B)  AN  EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION ON THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE, AND THE INSURED'S PRESCRIBING HEALTH CARE  PROVIDER  BY  TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN SEVENTY-TWO HOURS FOLLOWING THE
 EXTERNAL  APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL REQUEST
 WAS A STANDARD EXCEPTION REQUEST UNDER PARAGRAPH TWO OF THIS SUBSECTION.
 THE EXTERNAL APPEAL AGENT SHALL NOTIFY THE CORPORATION, THE  INSURED  OR
 THE INSURED'S DESIGNEE AND THE INSURED'S PRESCRIBING HEALTH CARE PROVID-
 ER  IN  WRITING OF THE EXTERNAL APPEAL DETERMINATION WITHIN TWO BUSINESS
 DAYS OF RENDERING SUCH DETERMINATION.
   (C) AN EXTERNAL  APPEAL  AGENT  SHALL  MAKE  A  DETERMINATION  ON  THE
 EXTERNAL APPEAL AND NOTIFY THE CORPORATION, THE INSURED OR THE INSURED'S
 DESIGNEE,  AND  THE  INSURED'S PRESCRIBING HEALTH CARE PROVIDER BY TELE-
 PHONE OF ITS DETERMINATION NO LATER THAN TWENTY-FOUR HOURS FOLLOWING THE
 EXTERNAL APPEAL AGENT'S RECEIPT OF THE REQUEST, IF THE ORIGINAL  REQUEST
 WAS  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF THIS
 SUBSECTION AND THE INSURED'S PRESCRIBING HEALTH  CARE  PROVIDER  ATTESTS
 THAT EXIGENT CIRCUMSTANCES EXIST. THE EXTERNAL APPEAL AGENT SHALL NOTIFY
 THE CORPORATION, THE INSURED OR THE INSURED'S DESIGNEE AND THE INSURED'S
 PRESCRIBING  HEALTH  CARE  PROVIDER  IN  WRITING  OF THE EXTERNAL APPEAL
 DETERMINATION WITHIN SEVENTY-TWO HOURS OF THE  EXTERNAL  APPEAL  AGENT'S
 RECEIPT OF THE EXTERNAL APPEAL.
   (D)  AN EXTERNAL APPEAL AGENT SHALL MAKE A DETERMINATION IN ACCORDANCE
 WITH SUBPARAGRAPH (A) OF PARAGRAPH FOUR OF  SUBSECTION  (B)  OF  SECTION
 FOUR THOUSAND NINE HUNDRED FOURTEEN OF THIS CHAPTER AND SUBPARAGRAPH (A)
 OF  PARAGRAPH  (D)  OF  SUBDIVISION  TWO  OF  SECTION FOUR THOUSAND NINE
 HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. WHEN MAKING A  DETERMINATION,
 THE   EXTERNAL   APPEAL  AGENT  SHALL  CONSIDER  WHETHER  THE  FORMULARY
 PRESCRIPTION DRUG COVERED BY THE CORPORATION WILL BE OR HAS  BEEN  INEF-
 FECTIVE,  WOULD  NOT  BE  AS EFFECTIVE AS THE NON-FORMULARY PRESCRIPTION
 DRUG, OR WOULD HAVE ADVERSE EFFECTS.
   (E) IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S DENIAL  OF
 A  STANDARD  EXCEPTION  REQUEST  UNDER PARAGRAPH TWO OF THIS SUBSECTION,
 THEN  THE  CORPORATION  SHALL  PROVIDE  COVERAGE  OF  THE  NON-FORMULARY
 PRESCRIPTION  DRUG  FOR  THE  DURATION  OF  THE  PRESCRIPTION, INCLUDING
 REFILLS. IF AN EXTERNAL APPEAL AGENT OVERTURNS THE CORPORATION'S  DENIAL
 OF  AN  EXPEDITED  EXCEPTION  REQUEST  UNDER  PARAGRAPH  THREE  OF  THIS
 SUBSECTION, THEN THE CORPORATION SHALL PROVIDE COVERAGE OF THE  NON-FOR-
 MULARY PRESCRIPTION DRUG FOR THE DURATION OF THE EXIGENT CIRCUMSTANCES.
   §  3. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.
 
                                 SUBPART E

   Section 1. Section 2607 of the insurance law is  amended  to  read  as
 follows:
   § 2607. Discrimination because of sex or marital status.  (A) No indi-
 vidual  or  entity  shall  refuse  to  issue any policy of insurance, or
 cancel or decline to renew [such] THE policy because of the sex or mari-
 tal status of the applicant or policyholder OR ENGAGE IN  SEXUAL  STERE-
 OTYPING.

 S. 1507--B                         69
 
   (B)  FOR  THE  PURPOSES  OF  THIS  SECTION, "SEX" SHALL INCLUDE SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 2. The insurance law is amended by adding a new section 3243 to read
 as follows:
   §  3243.  DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS IN HOSPITAL,
 SURGICAL OR MEDICAL EXPENSE INSURANCE.  (A) WITH REGARD TO  AN  ACCIDENT
 AND HEALTH INSURANCE POLICY THAT PROVIDES HOSPITAL, SURGICAL, OR MEDICAL
 EXPENSE  COVERAGE  OR A POLICY OF STUDENT ACCIDENT AND HEALTH INSURANCE,
 AS DEFINED IN SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED FORTY
 OF THIS ARTICLE, DELIVERED OR ISSUED FOR  DELIVERY  IN  THIS  STATE,  NO
 INSURER  SHALL  BECAUSE  OF  SEX,  MARITAL STATUS OR BASED ON PREGNANCY,
 FALSE PREGNANCY, TERMINATION OF PREGNANCY, OR RECOVERY THEREFROM, CHILD-
 BIRTH OR RELATED MEDICAL CONDITIONS:
   (1) MAKE ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS  TO  THE
 PREMIUMS  OR RATES CHARGED FOR THE POLICY OR IN ANY OTHER MANNER WHATEV-
 ER;
   (2) DEMAND OR REQUIRE A  GREATER  PREMIUM  FROM  ANY  PERSON  THAN  IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3)  MAKE  OR  REQUIRE ANY REBATE, DISCRIMINATION OR DISCOUNT UPON THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY POLICY;
   (4) INSERT IN THE POLICY  ANY  CONDITION,  OR  MAKE  ANY  STIPULATION,
 WHEREBY  THE  INSURED  BINDS HIS OR HERSELF, OR HIS OR HER HEIRS, EXECU-
 TORS, ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS  THAN
 THE  FULL  VALUE  OR  AMOUNT  OF  SUCH POLICY IN CASE OF A CLAIM THEREON
 EXCEPT SUCH CONDITIONS AND STIPULATIONS AS ARE IMPOSED  UPON  OTHERS  IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A POLICY ISSUED OR SOLD BY IT;
   (6)  CANCEL OR REFUSE TO ISSUE, RENEW OR SELL SUCH POLICY AFTER APPRO-
 PRIATE APPLICATION THEREFOR;
   (7) FIX ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR  COMMISSIONS  OF
 INSURANCE  AGENTS  OR  INSURANCE  BROKERS FOR WRITING OR RENEWING SUCH A
 POLICY; OR
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B) FOR THE PURPOSES OF  THIS  SECTION,  "SEX"  SHALL  INCLUDE  SEXUAL
 ORIENTATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   § 3. The insurance law is amended by adding a new section 4330 to read
 as follows:
   §  4330.  DISCRIMINATION BECAUSE OF SEX OR MARITAL STATUS IN HOSPITAL,
 SURGICAL OR MEDICAL EXPENSE INSURANCE.  (A) WITH REGARD  TO  A  CONTRACT
 ISSUED  BY  A CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE THAT
 PROVIDES HOSPITAL, SURGICAL, OR MEDICAL EXPENSE COVERAGE OR  A  CONTRACT
 OF  STUDENT  ACCIDENT AND HEALTH INSURANCE, AS DEFINED IN SUBSECTION (A)
 OF SECTION THREE THOUSAND TWO HUNDRED FORTY OF THIS CHAPTER,  NO  CORPO-
 RATION SHALL BECAUSE OF SEX, MARITAL STATUS OR BASED ON PREGNANCY, FALSE
 PREGNANCY,  TERMINATION  OF PREGNANCY, OR RECOVERY THEREFROM, CHILDBIRTH
 OR RELATED MEDICAL CONDITIONS:
   (1) MAKE ANY DISTINCTION OR DISCRIMINATION BETWEEN PERSONS AS  TO  THE
 PREMIUMS  OR RATES CHARGED FOR THE CONTRACT OR IN ANY OTHER MANNER WHAT-
 EVER;
   (2) DEMAND OR REQUIRE A  GREATER  PREMIUM  FROM  ANY  PERSON  THAN  IT
 REQUIRES AT THAT TIME FROM OTHERS IN SIMILAR CASES;
   (3)  MAKE  OR  REQUIRE ANY REBATE, DISCRIMINATION OR DISCOUNT UPON THE
 AMOUNT TO BE PAID OR THE SERVICE TO BE RENDERED ON ANY CONTRACT;
   (4) INSERT IN THE CONTRACT ANY CONDITION,  OR  MAKE  ANY  STIPULATION,
 WHEREBY  THE  INSURED  BINDS HIS OR HERSELF, OR HIS OR HER HEIRS, EXECU-

 S. 1507--B                         70
 
 TORS, ADMINISTRATORS OR ASSIGNS, TO ACCEPT ANY SUM OR SERVICE LESS  THAN
 THE  FULL  VALUE  OR  AMOUNT OF SUCH CONTRACT IN CASE OF A CLAIM THEREON
 EXCEPT SUCH CONDITIONS AND STIPULATIONS AS ARE IMPOSED  UPON  OTHERS  IN
 SIMILAR CASES; AND ANY SUCH STIPULATION OR CONDITION SO MADE OR INSERTED
 SHALL BE VOID;
   (5) REJECT ANY APPLICATION FOR A CONTRACT ISSUED OR SOLD BY IT;
   (6)  CANCEL  OR  REFUSE  TO  ISSUE,  RENEW OR SELL SUCH CONTRACT AFTER
 APPROPRIATE APPLICATION THEREFOR;
   (7) FIX ANY LOWER RATE OR DISCRIMINATE IN THE FEES OR  COMMISSIONS  OF
 INSURANCE  AGENTS  OR  INSURANCE  BROKERS FOR WRITING OR RENEWING SUCH A
 CONTRACT; OR
   (8) ENGAGE IN SEXUAL STEREOTYPING.
   (B) FOR PURPOSES OF THIS SECTION, "SEX" SHALL  INCLUDE  SEXUAL  ORIEN-
 TATION, GENDER IDENTITY OR EXPRESSION, AND TRANSGENDER STATUS.
   §  4. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law and shall apply to  all
 policies  and contracts issued, renewed, modified, altered or amended on
 or after such date.

                                 SUBPART F
 
                           Intentionally Omitted
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion, section or subpart of this act shall be adjudged by any  court  of
 competent  jurisdiction  to  be invalid, such judgment shall not affect,
 impair, or invalidate the remainder thereof, but shall  be  confined  in
 its  operation  to the clause, sentence, paragraph, subdivision, section
 or subpart thereof directly involved in the controversy  in  which  such
 judgment  shall  have  been  rendered.  It  is hereby declared to be the
 intent of the legislature that this act would have been enacted even  if
 such invalid provisions had not been included herein.
   § 3. Intentionally omitted.
   § 4. Legislative intent. It is hereby declared to be the intent of the
 legislature  in  enacting  this act, that the laws of this state provide
 consumer and market protections at least as robust as  those  under  the
 federal  Patient Protection and Affordable Care Act, public law 111-148,
 as that law existed and was interpreted on January 19, 2017. In addition
 to any other power conferred by law,  the  superintendent  of  financial
 services  is  hereby  specifically  empowered  to promulgate regulations
 under, and issue interpretations of, this act  as  necessary  to  ensure
 that the intent of the legislature as expressed in this section is real-
 ized.
   §  5.  This  act shall take effect immediately provided, however, that
 the applicable effective date of Subparts A through F of this act  shall
 be as specifically set forth in the last section of such Subparts.
 
                                  PART K
 
   Section 1. Intentionally omitted.
   § 2. Intentionally omitted.
   § 3. Intentionally omitted.
   § 4. Section 5 of chapter 517 of the laws of 2016, amending the public
 health  law  relating to payments from the New York state medical indem-
 nity fund, as amended by chapter 4 of the laws of 2017,  is  amended  to
 read as follows:

 S. 1507--B                         71
 
   §  5. This act shall take effect on the forty-fifth day after it shall
 have become a law, provided that the  amendments  to  subdivision  4  of
 section  2999-j of the public health law made by section two of this act
 shall take effect on June 30,  2017  and  shall  expire  and  be  deemed
 repealed December 31, [2019] 2020.
   § 5. Intentionally omitted.
   § 6. This act shall take effect immediately.
 
                                  PART L

   Section  1.  Paragraph  13  of  subsection  (i) of section 3216 of the
 insurance law is amended by adding three new subparagraphs (C), (D)  and
 (E) to read as follows:
   (C)  EVERY  POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE  SHALL  PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (D) (I) FOR THE  PURPOSES  OF  SUBPARAGRAPH  (C)  OF  THIS  PARAGRAPH,
 "INFERTILITY" MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPAC-
 ITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II) BY THE FAILURE TO  ESTABLISH  A  CLINICAL  PREGNANCY  AFTER  TWELVE
 MONTHS  OF  REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.
   (II) FOR THE PURPOSES OF SUBPARAGRAPH (C) OF THIS  PARAGRAPH,  "IATRO-
 GENIC  INFERTILITY"  MEANS  AN IMPAIRMENT OF FERTILITY BY SURGERY, RADI-
 ATION, CHEMOTHERAPY OR OTHER MEDICAL  TREATMENT  AFFECTING  REPRODUCTIVE
 ORGANS OR PROCESSES.
   (E) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   §  2.  Paragraph  6 of subsection (k) of section 3221 of the insurance
 law is amended by adding three new subparagraphs (E),  (F)  and  (G)  to
 read as follows:
   (E)  EVERY GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES HOSPITAL,  SURGICAL  OR  MEDICAL  COVERAGE  SHALL  PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (F) (I) FOR THE  PURPOSES  OF  SUBPARAGRAPH  (E)  OF  THIS  PARAGRAPH,
 "INFERTILITY" MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPAC-
 ITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II) BY THE FAILURE TO  ESTABLISH  A  CLINICAL  PREGNANCY  AFTER  TWELVE
 MONTHS  OF  REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.

 S. 1507--B                         72
 
   (II) FOR THE PURPOSES OF SUBPARAGRAPH (E) OF THIS  PARAGRAPH,  "IATRO-
 GENIC  INFERTILITY"  MEANS  AN IMPAIRMENT OF FERTILITY BY SURGERY, RADI-
 ATION, CHEMOTHERAPY OR OTHER MEDICAL  TREATMENT  AFFECTING  REPRODUCTIVE
 ORGANS OR PROCESSES.
   (G) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   §  3.  Subsection (s) of section 4303 of the insurance law, as amended
 by section 2 of part K of chapter 82 of the laws of 2002, is amended  by
 adding three new paragraphs 5, 6 and 7 to read as follows:
   (5)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
 HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION FOR  DELIVERY
 IN THIS STATE THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
 PROVIDE COVERAGE FOR:
   (A) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (B)  STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (6) (A) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "INFER-
 TILITY"  MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPACITY TO
 IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETERMINED (I)
 BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR  (II)  BY
 THE  FAILURE  TO  ESTABLISH  A CLINICAL PREGNANCY AFTER TWELVE MONTHS OF
 REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS OF REGULAR,
 UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIRTY-FIVE YEARS
 OF AGE OR OLDER.
   (B) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "IATROGENIC
 INFERTILITY" MEANS AN IMPAIRMENT OF  FERTILITY  BY  SURGERY,  RADIATION,
 CHEMOTHERAPY OR OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE ORGANS OR
 PROCESSES.
   (7)  NO MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE CORPO-
 RATION OR HEALTH  SERVICE  CORPORATION  PROVIDING  COVERAGE  UNDER  THIS
 SUBSECTION  SHALL  DISCRIMINATE BASED ON A COVERED INDIVIDUAL'S EXPECTED
 LENGTH OF LIFE, PRESENT  OR  PREDICTED  DISABILITY,  DEGREE  OF  MEDICAL
 DEPENDENCY,  PERCEIVED  QUALITY OF LIFE, OR OTHER HEALTH CONDITIONS, NOR
 BASED ON PERSONAL CHARACTERISTICS, INCLUDING  AGE,  SEX,  SEXUAL  ORIEN-
 TATION, MARITAL STATUS OR GENDER IDENTITY.
   § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221
 of the insurance law, as amended by section 1 of part K of chapter 82 of
 the laws of 2002, is amended to read as follows:
   (C)   Coverage  of  diagnostic  and  treatment  procedures,  including
 prescription drugs, used in the diagnosis and treatment  of  infertility
 as  required  by  subparagraphs  (A)  and (B) of this paragraph shall be
 provided in accordance with the provisions of this subparagraph.
   (i) [Coverage shall be provided for  persons  whose  ages  range  from
 twenty-one  through forty-four years, provided that nothing herein shall
 preclude the provision of coverage to persons  whose  age  is  below  or
 above such range.
   (ii)]  Diagnosis  and  treatment of infertility shall be prescribed as
 part of a physician's overall plan  of  care  and  consistent  with  the
 guidelines for coverage as referenced in this subparagraph.
   [(iii)]  (II)  Coverage may be subject to co-payments, coinsurance and
 deductibles as may be deemed appropriate by the  superintendent  and  as

 S. 1507--B                         73

 are  consistent with those established for other benefits within a given
 policy.
   [(iv)  Coverage  shall  be  limited to those individuals who have been
 previously covered under the policy for a period of not less than twelve
 months, provided that for the purposes of this subparagraph  "period  of
 not  less  than  twelve  months" shall be determined by calculating such
 time from either the date the insured was first covered under the exist-
 ing policy or from the date the insured was first covered by a previous-
 ly in-force converted policy, whichever is earlier.
   (v)] (III) Coverage shall not be required to include the diagnosis and
 treatment of infertility in connection with: (I)  [in  vitro  fertiliza-
 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
 transfers;  (II)]  the reversal of elective sterilizations; [(III)] (II)
 sex change procedures; [(IV)] (III) cloning; or [(V)]  (IV)  medical  or
 surgical  services  or  procedures that are deemed to be experimental in
 accordance with clinical guidelines referenced in clause [(vi)] (IV)  of
 this subparagraph.
   [(vi)]  (IV) The superintendent, in consultation with the commissioner
 of health, shall promulgate regulations which shall stipulate the guide-
 lines and standards which shall be used in carrying out  the  provisions
 of this subparagraph, which shall include:
   (I)  [The determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine;
   (II)] The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   [(III)] (II) The identification of the required  training,  experience
 and  other  standards  for  health  care  providers for the provision of
 procedures and treatments for the diagnosis and treatment of infertility
 determined in accordance with the standards and  guidelines  established
 and  adopted  by the American College of Obstetricians and Gynecologists
 and the American Society for Reproductive Medicine; and
   [(IV)] (III) The determination of appropriate  medical  candidates  by
 the  treating  physician in accordance with the standards and guidelines
 established and adopted by the American  College  of  Obstetricians  and
 Gynecologists and/or the American Society for Reproductive Medicine.
   §  5.  Paragraph  3 of subsection (s) of section 4303 of the insurance
 law, as amended by section 2 of part K of chapter  82  of  the  laws  of
 2002, is amended to read as follows:
   (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
 prescription drugs used in the diagnosis and treatment of infertility as
 required by paragraphs one and two of this subsection shall be  provided
 in accordance with this paragraph.
   (A)  [Coverage  shall  be  provided  for persons whose ages range from
 twenty-one through forty-four years, provided that nothing herein  shall
 preclude  the  provision  of  coverage  to persons whose age is below or
 above such range.
   (B)] Diagnosis and treatment of infertility  shall  be  prescribed  as
 part  of  a  physician's  overall  plan  of care and consistent with the
 guidelines for coverage as referenced in this paragraph.
   [(C)] (B) Coverage may be  subject  to  co-payments,  coinsurance  and
 deductibles  as  may  be deemed appropriate by the superintendent and as

 S. 1507--B                         74
 
 are consistent with those established for other benefits within a  given
 policy.
   [(D)  Coverage  shall  be  limited  to those individuals who have been
 previously covered under the policy for a period of not less than twelve
 months, provided that for the purposes of this paragraph "period of  not
 less  than  twelve  months" shall be determined by calculating such time
 from either the date the insured was first covered  under  the  existing
 policy  or  from  the date the insured was first covered by a previously
 in-force converted policy, whichever is earlier.
   (E)] (C) Coverage shall not be required to include the  diagnosis  and
 treatment  of  infertility  in connection with: (i) [in vitro fertiliza-
 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
 transfers; (ii)] the reversal of elective sterilizations;  [(iii)]  (II)
 sex  change  procedures;  [(iv)] (III) cloning; or [(v)] (IV) medical or
 surgical services or procedures that are deemed to  be  experimental  in
 accordance with clinical guidelines referenced in subparagraph [(F)] (D)
 of this paragraph.
   [(F)] (D) The superintendent, in consultation with the commissioner of
 health,  shall  promulgate  regulations which shall stipulate the guide-
 lines and standards which shall be used in carrying out  the  provisions
 of this paragraph, which shall include:
   (i)  [The determination of "infertility" in accordance with the stand-
 ards and guidelines established and adopted by the American  College  of
 Obstetricians  and  Gynecologists and the American Society for Reproduc-
 tive Medicine;
   (ii)] The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   [(iii)] (II) The identification of the required  training,  experience
 and  other  standards  for  health  care  providers for the provision of
 procedures and treatments for the diagnosis and treatment of infertility
 determined in accordance with the standards and  guidelines  established
 and  adopted  by the American College of Obstetricians and Gynecologists
 and the American Society for Reproductive Medicine; and
   [(iv)] (III) The determination of appropriate  medical  candidates  by
 the  treating  physician in accordance with the standards and guidelines
 established and adopted by the American  College  of  Obstetricians  and
 Gynecologists and/or the American Society for Reproductive Medicine.
   §  6.  This  act  shall  take  effect on the first day of January next
 succeeding the date on which it shall have become a law and shall  apply
 to  all  policies  issued, renewed, altered or modified on or after such
 date.
 
                                  PART M
 
                           Intentionally Omitted
 
                                  PART N
 
                           Intentionally Omitted
 
                                  PART O
 
                           Intentionally Omitted

 S. 1507--B                         75
 
                                  PART P
 
   Section 1.  Subdivision 6 of section 1370 of the public health law, as
 amended  by  chapter  485  of  the  laws  of 1992, is amended to read as
 follows:
   6. "Elevated lead levels" means a blood lead  level  greater  than  or
 equal  to  [ten] FIVE micrograms of lead per deciliter of whole blood or
 such LOWER blood lead level as may  be  established  by  the  department
 pursuant to rule or regulation.
   §  1-a.  (a)  Within  90  days  after the date on which this act takes
 effect, the department of health shall adopt all  necessary  regulations
 to define "elevated lead levels" to mean a blood lead level greater than
 or  equal  to  5  micrograms per deciliter of whole blood, or such lower
 blood lead level as the department may establish, to be utilized in  its
 lead  poisoning  prevention program.  The department shall be authorized
 to promulgate  regulations  on  an  emergency  basis  to  implement  the
 provisions of this act.
   (b)  Within 6 months after the date on which the federal department of
 health and human services has published guidance  recommending  a  lower
 concentration of lead in blood than the concentration established pursu-
 ant  to section one of this act as the reference level for conducting an
 environmental intervention, the department of  health  shall  publish  a
 notice  of proposed rule making and incorporating such guidance into its
 regulations.
   § 2. The public health law is amended by adding a new  section  1370-f
 to read as follows:
   §  1370-F.  LEAD  SAFE RESIDENTIAL RENTAL PROPERTIES. 1.  DEFINITIONS.
 FOR THE PURPOSES OF THIS SECTION:
   (A) "RESIDENTIAL RENTAL PROPERTY"  SHALL  MEAN  A  DWELLING  WHICH  IS
 EITHER  RENTED, LEASED, LET OR HIRED OUT, TO BE OCCUPIED, OR IS OCCUPIED
 AS THE HOME,  RESIDENCE OR SLEEPING PLACE OF ONE OR MORE  PERSONS  OTHER
 THAN  THE OWNER'S  FAMILY. RESIDENTIAL RENTAL PROPERTY SHALL NOT INCLUDE
 SHORT TERM RENTAL  PROPERTIES DURING WHICH GUESTS DO NOT STAY IN  EXCESS
 OF TWENTY-EIGHT DAYS.
   (B) "LEAD SAFE" SHALL MEAN ANY RESIDENTIAL RENTAL PROPERTY THAT:
   (I)   HAS  BEEN  DETERMINED  THROUGH  A  LEAD-BASED  PAINT  INSPECTION
 CONDUCTED IN ACCORDANCE WITH  APPROPRIATE  FEDERAL  REGULATIONS  NOT  TO
 CONTAIN LEAD-BASED  PAINT; OR
   (II)  MEETS THE MINIMUM STANDARDS SET FORTH IN REGULATIONS PROMULGATED
 BY THE COMMISSIONER PURSUANT TO THIS SECTION.
   2. THE COMMISSIONER SHALL PROMULGATE RULES AND REGULATIONS  ESTABLISH-
 ING  MINIMUM  STANDARDS  FOR  THE  MAINTENANCE  OF LEAD SAFE RESIDENTIAL
 RENTAL PROPERTIES. SUCH RULES AND REGULATIONS SHALL INCLUDE:
   (A) MINIMUM STANDARDS FOR MAINTAINING INTERNAL  AND  EXTERNAL  PAINTED
 SURFACES THAT CONTAIN LEAD-BASED PAINT; AND
   (B)  A  SCHEDULE  BY  WHICH OWNERS OF RESIDENTIAL RENTAL PROPERTY MUST
 IMPLEMENT AND COMPLY WITH SUCH MINIMUM STANDARDS.
   3. IT SHALL BE THE RESPONSIBILITY  OF  AN  OWNER  OF  ANY  RESIDENTIAL
 RENTAL  PROPERTY  TO  MAINTAIN SUCH PROPERTY IN A LEAD SAFE CONDITION IN
 ACCORDANCE WITH  RULES AND REGULATIONS PROMULGATED BY  THE  COMMISSIONER
 PURSUANT TO THIS SECTION.
   4.  ALL PAINT ON ANY RESIDENTIAL RENTAL PROPERTY ON WHICH THE ORIGINAL
 CONSTRUCTION WAS COMPLETED PRIOR  TO  JANUARY  FIRST,  NINETEEN  HUNDRED
 SEVENTY-EIGHT,  SHALL  BE PRESUMED TO BE LEAD-BASED PAINT. THIS PRESUMP-
 TION MAY BE  OVERCOME BY A CERTIFICATION ISSUED BY A FEDERALLY CERTIFIED
 LEAD-BASED PAINT  INSPECTOR OR RISK ASSESSOR THAT THE PROPERTY HAS  BEEN

 S. 1507--B                         76
 
 DETERMINED  NOT  TO  CONTAIN LEAD-BASED PAINT, OR BY SUCH OTHER MEANS AS
 MAY BE PRESCRIBED BY THE RULES AND  REGULATIONS ADOPTED BY  THE  COMMIS-
 SIONER PURSUANT TO THIS SECTION.
   5. THE COMMISSIONER, LOCAL HEALTH OFFICER OF A COUNTY AND, IN THE CITY
 OF NEW YORK, THE COMMISSIONER OF THE  NEW YORK CITY DEPARTMENT OF HEALTH
 AND  MENTAL  HYGIENE,  MAY  ENTER  INTO  AN AGREEMENT OR CONTRACT WITH A
 MUNICIPAL  GOVERNMENT REGARDING INSPECTION OF  THE  LEAD  CONDITIONS  IN
 RESIDENTIAL  RENTAL  PROPERTIES AND SUCH HEALTH DEPARTMENT MAY DESIGNATE
 THE LOCAL HOUSING   MAINTENANCE CODE ENFORCEMENT  AGENCY  IN  WHICH  THE
 RESIDENTIAL  RENTAL  PROPERTY  IS    LOCATED  AS AN AGENCY AUTHORIZED TO
 ADMINISTER AND ENSURE COMPLIANCE WITH THE   PROVISIONS OF  THIS  SECTION
 AND SUBSEQUENT REGULATIONS PURSUANT TO SUBDIVISION  ONE OF SECTION THIR-
 TEEN HUNDRED SEVENTY-FIVE OF THIS TITLE.
   6.  IF  THE COMMISSIONER, OR OTHER OFFICER HAVING JURISDICTION, DETER-
 MINES THAT AN OWNER OF RESIDENTIAL RENTAL PROPERTY IS  IN  VIOLATION  OF
 THIS  SECTION OR   ANY RULES OR REGULATIONS PROMULGATED PURSUANT TO THIS
 SECTION, THE COMMISSIONER  OR OTHER OFFICER  HAVING  JURISDICTION  SHALL
 HAVE THE AUTHORITY TO ORDER THE  ABATEMENT OF ANY LEAD CONDITION PRESENT
 AT  THE  RESIDENTIAL RENTAL PROPERTY AND  ASSESS FINES NOT TO EXCEED TWO
 THOUSAND DOLLARS FOR EACH VIOLATION.
   § 3. Subdivision 1 of section 383 of the executive law is  amended  by
 adding a new paragraph d to read as follows:
   D.  THE REGULATIONS PROMULGATED BY THE COMMISSIONER OF HEALTH PURSUANT
 TO SUBDIVISION TWO OF SECTION THIRTEEN HUNDRED SEVENTY-F OF  THE  PUBLIC
 HEALTH LAW
   (I)  SHALL NOT BE SUPERSEDED BY THE PROVISIONS OF THIS ARTICLE, BY THE
 PROVISIONS OF THE UNIFORM FIRE PREVENTION AND BUILDING CODE, OR  BY  THE
 PROVISIONS OF THE BUILDING AND FIRE PREVENTION CODES IN EFFECT IN A CITY
 WITH A POPULATION OF OVER ONE MILLION;
   (II)  SHALL  BE APPLICABLE IN ADDITION TO, AND NOT IN SUBSTITUTION FOR
 OR LIMITATION OF, THE PROVISIONS OF  THE  UNIFORM  FIRE  PREVENTION  AND
 BUILDING  CODE  AND THE PROVISIONS OF BUILDING AND FIRE PREVENTION CODES
 IN EFFECT IN CITIES WITH A POPULATION OF OVER ONE MILLION; AND
   (III) SHALL BE ADMINISTERED AND ENFORCED BY  COMMISSIONER  OF  HEALTH,
 THE  LOCAL  HEALTH OFFICER OF A COUNTY, THE COMMISSIONER OF THE NEW YORK
 CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, OR A MUNICIPAL  GOVERNMENT
 ENTERING INTO AN AGREEMENT OR CONTRACT AUTHORIZED BY SUBDIVISION FIVE OF
 SECTION  THIRTEEN  HUNDRED  SEVENTY-F  OF  THE PUBLIC HEALTH LAW, IN THE
 MANNER PROVIDED IN SAID SUBDIVISION.
   § 4. Section 1151 of the public health law is amended by adding a  new
 subdivision 9 to read as follows:
   9.  INFORMATION  REGARDING  THE NUMBER, LENGTHS, AGES AND LOCATIONS OF
 ALL THE LEAD PIPES LOCATED WITHIN THE WATER  SYSTEM,  AS  THAT  TERM  IS
 DEFINED  IN  SUBDIVISION TWENTY-SIX OF SECTION TWO OF THE PUBLIC SERVICE
 LAW.
   § 5. Section 1110 of the public health law, as added by chapter 296 of
 the laws of 2016, is amended to read as follows:
   § 1110. School AND DAY CARE potable water testing  and  standards.  1.
 FOR  THE  PURPOSES  OF  THIS SECTION, "DAY CARE FACILITIES" SHALL MEAN A
 CHILD DAY CARE CENTER, GROUP FAMILY DAY CARE HOME, OR A FAMILY DAY  CARE
 HOME  LICENSED  OR  REGISTERED  WITH  THE  OFFICE OF CHILDREN AND FAMILY
 SERVICES.  THE PROVISIONS OF THIS SECTION DO NOT APPLY TO CHILD DAY CARE
 CENTERS, GROUP FAMILY DAY CARE HOMES, FAMILY DAY CARE HOMES,  SCHOOL-AGE
 CHILD CARE PROGRAMS AND SMALL DAY CARE CENTERS THAT HOLD A PERMIT ISSUED
 BY THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE.

 S. 1507--B                         77
 
   2.  In  addition  to  school  districts already classified as a public
 water system under parts 141 and 142 of title 40 of the code of  federal
 regulations,  as  such  regulations  may, from time to time, be amended,
 every school district [and], board of cooperative educational  services,
 AND  DAY CARE FACILITY shall conduct periodic first-drawn tap testing of
 potable water systems to monitor for lead contamination in each occupied
 school building  under  its  jurisdiction  as  required  by  regulations
 promulgated pursuant to this section. The testing shall be conducted and
 the  results  analyzed  by an entity or entities approved by the commis-
 sioner. SUCH PERIODIC FIRST-DRAWN TESTING SHALL OCCUR ONCE  EVERY  THREE
 YEARS.
   [2.]  3.  Where  a finding of lead contamination is made, the affected
 school district OR DAY CARE FACILITY shall: (a) continue first-drawn tap
 water testing pursuant  to  regulations  promulgated  pursuant  to  this
 section; (b) provide [school] occupants with an adequate supply of safe,
 potable  water  for drinking as required by rules and regulations of the
 department until future tests indicate lead  levels  pursuant  to  regu-
 lations promulgated pursuant to this section; and (c) provide parents or
 persons  in  parental  relation  to a child attending said school OR DAY
 CARE FACILITY with written notification of test results as well as post-
 ing such test results on the school  district's  website;  AND  NOTWITH-
 STANDING  ANY PROVISION OF LAW TO THE CONTRARY, ABATE SUCH CONTAMINATION
 WITHIN NINETY DAYS.
   [3.] 4. First-drawn tap testing shall not be required  for  school  OR
 DAY CARE FACILITY buildings that have been deemed "lead-free" as defined
 by section 1417 of the federal safe drinking water act.
   [4.]  5.  The  commissioner,  in consultation with the commissioner of
 education AND THE COMMISSIONER OF CHILDREN AND  FAMILY  SERVICES,  shall
 promulgate  regulations  to  carry  out  the provisions of this section.
 Notwithstanding any other provision of law to the  contrary,  the  regu-
 lations  promulgated with regard to lead levels shall be consistent with
 the requirements for those school districts OR DAY CARE FACILITIES clas-
 sified as a public water system under parts 141 and 142 of title  40  of
 the  code  of  federal regulations as such regulations may, from time to
 time, be amended.
   [5.] 6. The commissioner IN  CONSULTATION  WITH  THE  COMMISSIONER  OF
 CHILDREN  AND  FAMILY  SERVICES,  may  grant  a  waiver from the testing
 requirements of this section  for  certain  school  buildings,  provided
 that,  the  school  district  OR  DAY  CARE  FACILITY  has substantially
 complied with the testing requirements and has been found  to  be  below
 lead  levels  as  determined by regulations promulgated pursuant to this
 section for such buildings.
   [6.] 7. Each school district [and], board of  cooperative  educational
 services,  AND DAY CARE FACILITY conducting testing pursuant to subdivi-
 sion one of this section and each school district classified as a public
 water system under parts 141 and 142 of title 40 of the code of  federal
 regulations,  as  such  regulations  may, from time to time, be amended,
 shall make a copy of the results of all such testing and any lead  reme-
 diation  plans available to the public on its website and any additional
 means as chosen by such SCHOOL district OR DAY CARE FACILITY. A copy  of
 the  results of all testing shall also be immediately transmitted to the
 department [and], state education department, AND OFFICE OF CHILDREN AND
 FAMILY SERVICES in a format to be determined by the commissioner and  to
 the  county department of health in the local jurisdiction of the school
 building. The commissioner of education AND THE COMMISSIONER OF CHILDREN
 AND FAMILY SERVICES, in conjunction with the commissioner, shall publish

 S. 1507--B                         78

 a report biennially based on the findings from  the  tap  water  testing
 conducted according to the provisions of this section. Such report shall
 be  sent  to  the commissioner, the governor, the temporary president of
 the  senate, and the speaker of the assembly and shall be made available
 on the department's [and], state education department's  AND  OFFICE  OF
 CHILDREN AND FAMILY SERVICES' websites.
   8.  SUBJECT  TO  APPROPRIATION, THE COMMISSIONER MAY PROVIDE FINANCIAL
 ASSISTANCE TO ASSIST DAY  CARE  FACILITIES  WITH  COMPLIANCE  WITH  THIS
 SECTION  WHEN SUCH COMPLIANCE IMPOSES AN UNREASONABLE FINANCIAL HARDSHIP
 ON THE DAY CARE FACILITY AND SUCH DAY CARE FACILITIES ARE  NOT  ELIGIBLE
 FOR BUILDING AID UNDER SECTIONS NINETEEN FIFTY OR THIRTY-SIX HUNDRED TWO
 OF THE EDUCATION LAW.
   §  6.  The public health law is amended by adding a new section 1110-a
 to read as follows:
   § 1110-A. PARK POTABLE WATER TESTING AND  STANDARDS.  1.  THE  PERSON,
 OFFICER,  BOARD  OR  COMMISSION HAVING THE MANAGEMENT AND CONTROL OF THE
 POTABLE WATER SUPPLY OF ANY PARK SHALL CONDUCT PERIODIC FIRST-DRAWN  TAP
 TESTING  OF  POTABLE  WATER SYSTEMS TO MONITOR FOR LEAD CONTAMINATION IN
 EACH PARK UNDER HIS OR  HER  JURISDICTION  AS  REQUIRED  BY  REGULATIONS
 PROMULGATED PURSUANT TO THIS SECTION. THE TESTING SHALL BE CONDUCTED AND
 THE  RESULTS  ANALYZED  BY AN ENTITY OR ENTITIES APPROVED BY THE COMMIS-
 SIONER.  SUCH PERIODIC FIRST-DRAWN TAP TESTING SHALL OCCUR AT LEAST ONCE
 EVERY THREE YEARS.
   2. WHERE A FINDING OF LEAD CONTAMINATION IS MADE, THE PERSON, OFFICER,
 BOARD OR COMMISSION HAVING THE MANAGEMENT AND  CONTROL  OF  THE  POTABLE
 WATER  SUPPLY  OF  SUCH  PARK  SHALL: (A) CONTINUE FIRST-DRAWN TAP WATER
 TESTING PURSUANT TO REGULATIONS PROMULGATED PURSUANT  TO  THIS  SECTION;
 (B) PROVIDE PARK VISITORS WITH AN ADEQUATE SUPPLY OF SAFE, POTABLE WATER
 FOR  DRINKING  AS  REQUIRED  BY  RULES AND REGULATIONS OF THE DEPARTMENT
 UNTIL FUTURE TESTS INDICATE LEAD LEVELS PURSUANT TO REGULATIONS  PROMUL-
 GATED  PURSUANT TO THIS SECTION; (C) CONSPICUOUSLY POST WARNINGS TO PARK
 VISITORS THE FORM AND CONTENT OF SUCH WARNINGS TO BE PROMULGATED BY  THE
 COMMISSIONER,  AS  WELL AS POSTING SUCH WARNINGS AND TEST RESULTS ON THE
 PARK'S WEBSITE; (D) NOTWITHSTANDING ANY PROVISION OF LAW TO THE  CONTRA-
 RY,  ABATE  SUCH  CONTAMINATION  WITHIN NINETY DAYS; AND (E) IMMEDIATELY
 TRANSMIT A COPY OF THE RESULTS OF ALL SUCH TESTING AND ANY LEAD  REMEDI-
 ATION  PLANS TO THE COMMISSIONER OF PARKS, RECREATION AND HISTORIC PRES-
 ERVATION IN A FORMAT TO BE DETERMINED BY SUCH COMMISSIONER.
   3. THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER  OF  PARKS,
 RECREATION  AND  HISTORIC  PRESERVATION, SHALL PROMULGATE REGULATIONS TO
 CARRY OUT THE PROVISIONS OF THIS SECTION.
   4. THE COMMISSIONER OF PARKS,  RECREATION  AND  HISTORIC  PRESERVATION
 SHALL  MAKE A COPY OF THE RESULTS OF ALL SUCH TESTING AND ANY LEAD REME-
 DIATION PLANS AVAILABLE TO THE PUBLIC ON THE OFFICE OF PARKS, RECREATION
 AND HISTORIC PRESERVATION'S WEBSITE AND ANY ADDITIONAL MEANS  AS  CHOSEN
 BY SUCH COMMISSIONER. A COPY OF THE RESULTS OF ALL TESTING SHALL ALSO BE
 IMMEDIATELY  TRANSMITTED  TO THE DEPARTMENT IN A FORMAT TO BE DETERMINED
 BY THE COMMISSIONER. THE COMMISSIONER OF PARKS, RECREATION AND  HISTORIC
 PRESERVATION,  IN  CONJUNCTION  WITH  THE  COMMISSIONER, SHALL PUBLISH A
 REPORT BIENNIALLY BASED ON THE  FINDINGS  FROM  THE  TAP  WATER  TESTING
 CONDUCTED ACCORDING TO THE PROVISIONS OF THIS SECTION. SUCH REPORT SHALL
 BE  SENT  TO  THE COMMISSIONER, THE GOVERNOR, THE TEMPORARY PRESIDENT OF
 THE SENATE, AND THE SPEAKER OF THE ASSEMBLY AND SHALL BE MADE  AVAILABLE
 ON THE DEPARTMENT'S AND OFFICE OF PARKS, RECREATION AND HISTORIC PRESER-
 VATION'S WEBSITES.

 S. 1507--B                         79
 
   §  7.  This act shall take effect immediately; provided, however, that
 sections four, five and six of this act shall take  effect  on  the  one
 hundred eightieth day after it shall have become a law.  Effective imme-
 diately, the addition, amendment and/or repeal of any rule or regulation
 necessary  for  the implementation of this act on its effective date are
 authorized to be made and completed on or before such effective date.
 
                                  PART Q
 
   Section 1. Subdivision 4 of section 2825-f of the public  health  law,
 as  added  by  section 1 of part Q of chapter 57 of the laws of 2018, is
 amended and three new subdivisions 4-a, 4-b and 4-c are added to read as
 follows:
   4. Notwithstanding any inconsistent subdivision of this section or any
 other provision of law to  the  contrary,  the  commissioner,  with  the
 approval of the director of the budget, [may expend up to] SHALL AWARD A
 MINIMUM  OF  twenty  million  dollars of the funds appropriated for this
 program pursuant to subdivision three of  this  section,  not  including
 funds  dedicated  for  community-based health care providers under para-
 graph (a) of such subdivision or for residential health care  facilities
 under  paragraph  (b)  of  such subdivision, for awards made pursuant to
 paragraph (l) of subdivision three of section four  hundred  sixty-one-l
 of  the  social services law, provided that funding shall be prioritized
 for awards made pursuant to subparagraph (i)  of  such  paragraph,  with
 remaining  funding  available  for awards made pursuant to subparagraphs
 (ii) and (iii) of such paragraph.
   4-A. NOTWITHSTANDING SUBDIVISION TWO OF THIS SECTION OR ANY INCONSIST-
 ENT PROVISION OF LAW TO THE CONTRARY, AND UPON APPROVAL OF THE  DIRECTOR
 OF  THE  BUDGET,  THE  COMMISSIONER  MAY, SUBJECT TO THE AVAILABILITY OF
 LAWFUL APPROPRIATION, AWARD UP TO THREE HUNDRED MILLION DOLLARS  OF  THE
 FUNDS  MADE  AVAILABLE  PURSUANT  TO  THIS  SECTION FOR UNFUNDED PROJECT
 APPLICATIONS SUBMITTED IN RESPONSE TO THE REQUEST FOR APPLICATION NUMBER
 17648 ISSUED BY THE DEPARTMENT ON JANUARY EIGHTH, TWO THOUSAND  EIGHTEEN
 PURSUANT  TO SECTION TWENTY-EIGHT HUNDRED TWENTY-FIVE-E OF THIS ARTICLE,
 WITH A MINIMUM OF THIRTY  MILLION  DOLLARS  AWARDED  TO  COMMUNITY-BASED
 HEALTHCARE  PROVIDERS AS DEFINED IN SUBDIVISION THREE OF SECTION TWENTY-
 EIGHT HUNDRED TWENTY-FIVE-E OF THIS TITLE.   PROVIDED HOWEVER  THAT  THE
 PROVISIONS OF SUBDIVISIONS THREE AND FOUR OF THIS SECTION SHALL APPLY.
   4-B. AUTHORIZED AMOUNTS TO BE AWARDED PURSUANT TO APPLICATIONS SUBMIT-
 TED  IN  RESPONSE  TO  THE REQUEST FOR APPLICATION NUMBER 17648 SHALL BE
 AWARDED NO LATER THAN MAY FIRST, TWO THOUSAND NINETEEN.
   4-C. THE COMMISSIONER SHALL RELEASE THE REQUEST FOR  APPLICATIONS  FOR
 THE REMAINING FUNDS MADE AVAILABLE UNDER THIS SECTION BY JULY FIRST, TWO
 THOUSAND NINETEEN AND SHALL AWARD SUCH FUNDS NO LATER THAN JANUARY THIR-
 TY-FIRST, TWO THOUSAND TWENTY.
   § 2. This act shall take effect immediately.
 
                                  PART R
 
   Section 1. Legislative findings and intent. The legislature finds that
 maternal  mortality and morbidity is a serious public health concern and
 has a serious family and societal impact. New York state has  among  the
 highest  maternal  mortality rates in the country and racial disparities
 remain significant. The U.S. Centers for Disease Control and  Prevention
 has  determined that a regular process for professional, multi-discipli-
 nary, confidential review of all maternal deaths can help  identify  the

 S. 1507--B                         80
 
 causes  of  maternal  mortality, and those findings can lead to clinical
 and social change that can help prevent maternal mortality. The same  is
 true  for  severe  maternal  morbidity.  Confidentiality is important to
 ensure  that full information is made available in the review process to
 maximize protection of maternal health.
   Section 3 of  article  17  of  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."  The
 legislature finds that the creation of a state maternal mortality review
 board,  and  recognition  and  protection of a city of New York maternal
 mortality review board, are a matter of state concern and  an  important
 exercise  of  the  legislature's  constitutional  mandate to protect the
 public health.
   § 2. The public health law is amended by adding a new section 2509  to
 read as follows:
   § 2509. MATERNAL MORTALITY REVIEW BOARD. 1. (A) THERE IS HEREBY ESTAB-
 LISHED  IN  THE  DEPARTMENT  THE MATERNAL MORTALITY REVIEW BOARD FOR THE
 PURPOSE OF REVIEWING MATERNAL DEATHS AND MATERNAL MORBIDITY AND DEVELOP-
 ING AND DISSEMINATING FINDINGS, RECOMMENDATIONS, AND BEST  PRACTICES  TO
 CONTRIBUTE  TO  THE PREVENTION OF MATERNAL MORTALITY AND MORBIDITY.  THE
 BOARD SHALL ASSESS THE CAUSE OF DEATH,  FACTORS  LEADING  TO  DEATH  AND
 PREVENTABILITY  FOR  EACH MATERNAL DEATH REVIEWED AND, IN THE DISCRETION
 OF THE BOARD, CASES OF SEVERE MATERNAL MORBIDITY, AND SHALL DEVELOP  AND
 DISSEMINATE  STRATEGIES  FOR REDUCING THE RISK OF MATERNAL MORTALITY AND
 MORBIDITY, INCLUDING RISK RESULTING  FROM  RACIAL,  ECONOMIC,  OR  OTHER
 DISPARITIES.    THE  COMMISSIONER  MAY DELEGATE THE AUTHORITY TO CONDUCT
 MATERNAL MORTALITY REVIEWS.
   (B) THE COMMISSIONER MAY ENTER INTO AN AGREEMENT WITH THE CITY OF  NEW
 YORK PROVIDING:
   (I)  THAT THE FUNCTIONS OF THE STATE BOARD RELATING TO MATERNAL DEATHS
 AND SEVERE MATERNAL MORBIDITY OCCURRING WITHIN  THE  CITY  OF  NEW  YORK
 SHALL BE CONDUCTED BY THE CITY BOARD;
   (II)  THE  CITY  BOARD SHALL PROVIDE TO THE STATE BOARD THE RESULTS OF
 ITS REVIEWS, RELEVANT INFORMATION IN THE POSSESSION OF THE  CITY  BOARD,
 AND THE RECOMMENDATIONS OF THE CITY BOARD; AND
   (III) THE DEPARTMENT AND THE STATE BOARD SHALL PROVIDE INFORMATION AND
 ASSISTANCE TO THE CITY BOARD FOR THE PERFORMANCE OF ITS FUNCTIONS.
   (C)  NOTHING  IN  THIS SECTION SHALL PREVENT THE CITY OF NEW YORK FROM
 ESTABLISHING, WITHOUT AN AGREEMENT WITH THE COMMISSIONER, A BOARD RELAT-
 ING TO MATERNAL DEATHS AND SEVERE MATERNAL  MORBIDITY  OCCURRING  WITHIN
 THE CITY OF NEW YORK.
   2. AS USED IN THIS SECTION, UNLESS THE CONTEXT REQUIRES OTHERWISE:
   (A)  "ADVISORY  COUNCIL"  AND  "COUNCIL"  MEAN THE ADVISORY COUNCIL ON
 MATERNAL MORTALITY AND MORBIDITY, ESTABLISHED UNDER THIS SECTION.
   (B) "BOARD" MEANS A MATERNAL MORTALITY  REVIEW  BOARD  ESTABLISHED  BY
 THIS  SECTION,  REFERRED  TO  IN THIS SECTION AS THE "STATE BOARD", OR A
 BOARD OPERATING UNDER THIS SECTION ESTABLISHED BY THE CITY OF NEW  YORK,
 WITH  OR WITHOUT AN AGREEMENT WITH THE COMMISSIONER, REFERRED TO IN THIS
 SECTION AS THE "CITY BOARD".
   (C) "MATERNAL DEATH" MEANS THE DEATH OF A WOMAN  DURING  PREGNANCY  OR
 WITHIN A YEAR FROM THE END OF PREGNANCY.
   (D)  "SEVERE MATERNAL MORBIDITY" MEANS UNEXPECTED OUTCOMES OF PREGNAN-
 CY, LABOR, OR DELIVERY THAT RESULT IN SIGNIFICANT  SHORT-  OR  LONG-TERM
 CONSEQUENCES TO A WOMAN'S HEALTH.

 S. 1507--B                         81
 
   (E)  "CITY  COMMISSIONER"  MEANS THE COMMISSIONER OF THE NEW YORK CITY
 DEPARTMENT OF HEALTH AND MENTAL HYGIENE.
   3.  (A) THE MEMBERS OF THE STATE BOARD SHALL BE COMPRISED OF MULTIDIS-
 CIPLINARY EXPERTS IN THE FIELD OF MATERNAL MORTALITY, WOMEN'S HEALTH AND
 PUBLIC HEALTH, AND SHALL INCLUDE  HEALTH  CARE  PROFESSIONALS  OR  OTHER
 EXPERTS  WHO  SERVE AND ARE REPRESENTATIVE OF THE DIVERSITY OF THE WOMEN
 AND MOTHERS IN MEDICALLY UNDERSERVED AREAS OF THE STATE OR AREAS OF  THE
 STATE  WITH DISPROPORTIONATELY HIGH OCCURRENCES OF MATERNAL MORTALITY OR
 MORBIDITY.
   (B) THE STATE BOARD SHALL BE COMPOSED OF AT LEAST FIFTEEN MEMBERS, ALL
 OF WHOM SHALL BE APPOINTED BY THE COMMISSIONER.
   (C) THE TERMS OF THE STATE BOARD MEMBERS SHALL  BE  THREE  YEARS.  THE
 COMMISSIONER  MAY  CHOOSE TO REAPPOINT STATE BOARD MEMBERS TO ADDITIONAL
 THREE YEAR TERMS.
   (D) A MAJORITY OF THE APPOINTED MEMBERSHIP OF THE STATE BOARD, NO LESS
 THAN THREE, SHALL CONSTITUTE A QUORUM.
   (E) WHEN ANY MEMBER OF THE STATE BOARD FAILS TO ATTEND  THREE  CONSEC-
 UTIVE  REGULAR  MEETINGS,  UNLESS  SUCH  ABSENCE IS FOR GOOD CAUSE, THAT
 MEMBERSHIP MAY BE DEEMED VACANT FOR PURPOSES OF  THE  APPOINTMENT  OF  A
 SUCCESSOR.
   (F)  MEETINGS  OF  THE STATE BOARD SHALL BE HELD AT LEAST TWICE A YEAR
 BUT MAY BE HELD MORE FREQUENTLY AS DEEMED NECESSARY, SUBJECT TO  REQUEST
 OF THE DEPARTMENT.
   (G)  MEMBERS  OF  THE STATE AND CITY BOARDS SHALL BE INDEMNIFIED UNDER
 SECTION SEVENTEEN OF THE PUBLIC OFFICERS LAW OR SECTION FIFTY-K  OF  THE
 GENERAL MUNICIPAL LAW, AS THE CASE MAY BE.
   (H)  MEMBERS  OF  THE  STATE  BOARD SHALL NOT BE COMPENSATED FOR THEIR
 PARTICIPATION ON THE BOARD BUT SHALL  RECEIVE  REIMBURSEMENT  FOR  THEIR
 ORDINARY AND NECESSARY EXPENSES OF PARTICIPATION.
   (I) MEMBERSHIP ON A BOARD SHALL NOT DISQUALIFY ANY PERSON FROM HOLDING
 ANY PUBLIC OFFICE OR EMPLOYMENT.
   4. (A) THE COMMISSIONER AND THE CITY COMMISSIONER, AS THE CASE MAY BE,
 MAY  REQUEST  AND  SHALL RECEIVE UPON REQUEST FROM ANY DEPARTMENT, DIVI-
 SION, BOARD, BUREAU, COMMISSION, LOCAL HEALTH DEPARTMENTS OR OTHER AGEN-
 CY OF THE STATE OR POLITICAL SUBDIVISION THEREOF OR ANY PUBLIC  AUTHORI-
 TY, AS WELL AS HOSPITALS ESTABLISHED PURSUANT TO ARTICLE TWENTY-EIGHT OF
 THIS  CHAPTER,  BIRTHING  FACILITIES,  MEDICAL  EXAMINERS,  CORONERS AND
 CORONER PHYSICIANS AND ANY OTHER FACILITY PROVIDING SERVICES  ASSOCIATED
 WITH  MATERNAL  MORTALITY,  SUCH INFORMATION, INCLUDING, BUT NOT LIMITED
 TO, DEATH RECORDS, MEDICAL RECORDS, AUTOPSY REPORTS, TOXICOLOGY REPORTS,
 HOSPITAL DISCHARGE RECORDS, BIRTH RECORDS AND ANY OTHER INFORMATION THAT
 WILL HELP THE DEPARTMENT UNDER THIS SECTION TO PROPERLY  CARRY  OUT  ITS
 FUNCTIONS, POWERS AND DUTIES.
   (B)  THE  COMMISSIONER AND THE CITY COMMISSIONER SHALL RECEIVE AND MAY
 SOLICIT VOLUNTARY INFORMATION, INCLUDING  ORAL  OR  WRITTEN  STATEMENTS,
 RELATING  TO  ANY  MATERNAL DEATH AND CASE OF SEVERE MATERNAL MORBIDITY,
 FROM ANY FAMILY MEMBER OR OTHER INTERESTED PARTY (INCLUDING THE  PATIENT
 IN  A  CASE  OF SEVERE MATERNAL MORBIDITY) RELATING TO ANY CASE THAT MAY
 COME BEFORE THE BOARD. ORAL STATEMENTS  RECEIVED  UNDER  THIS  PARAGRAPH
 SHALL  BE TRANSCRIBED OR SUMMARIZED IN WRITING. THE COMMISSIONER AND THE
 CITY COMMISSIONER SHALL TRANSMIT THAT INFORMATION TO THE BOARD CONSIDER-
 ING THE CASE.
   (C) BEFORE TRANSMITTING ANY INFORMATION TO THE BOARD, THE COMMISSIONER
 OR THE CITY COMMISSIONER SHALL REMOVE ALL PERSONAL IDENTIFYING  INFORMA-
 TION  OF  THE WOMAN, HEALTH CARE PRACTITIONER OR PRACTITIONERS OR ANYONE
 ELSE INDIVIDUALLY NAMED IN SUCH INFORMATION, AS WELL AS THE HOSPITAL  OR

 S. 1507--B                         82
 
 FACILITY  THAT  TREATED  THE  WOMAN,  AND  ANY OTHER INFORMATION SUCH AS
 GEOGRAPHIC LOCATION THAT MAY INADVERTENTLY IDENTIFY THE  WOMAN,  PRACTI-
 TIONER  OR FACILITY.  THIS PARAGRAPH SHALL NOT PRECLUDE THE TRANSMITTING
 OF  INFORMATION  TO THE BOARD THAT IS REASONABLY NECESSARY TO ENABLE THE
 BOARD TO PERFORM AN APPROPRIATE REVIEW UNDER THIS SECTION.
   5. EACH BOARD:
   (A) SHALL MAKE AND REPORT FINDINGS AND RECOMMENDATIONS TO THE  COMMIS-
 SIONER  OR CITY COMMISSIONER, AS THE CASE MAY BE, REGARDING THE CAUSE OF
 DEATH, FACTORS LEADING TO DEATH, AND  PREVENTABILITY  OF  EACH  MATERNAL
 DEATH  CASE,  AND EACH CASE OF SEVERE MATERNAL MORBIDITY REVIEWED BY THE
 BOARD, BY REVIEWING RELEVANT INFORMATION FOR EACH CASE IN THE  STATE  OR
 THE CITY OF NEW YORK, AS THE CASE MAY BE, AND CONSULTING WITH EXPERTS AS
 NEEDED  TO  EVALUATE  THE  INFORMATION FOR EACH DEATH; AND SHALL PROVIDE
 SUCH FINDINGS AND RECOMMENDATIONS, INCLUDING BEST PRACTICES AND  STRATE-
 GIES  FOR  REDUCING THE RISK OF MATERNAL MORTALITY AND MORBIDITY, TO THE
 ADVISORY COUNCIL; PROVIDED THAT MATERIAL PROVIDED TO THE ADVISORY  COUN-
 CIL  SHALL  NOT INCLUDE ANY INFORMATION THAT WOULD BE CONFIDENTIAL UNDER
 THIS SECTION;
   (B) SHALL DEVELOP RECOMMENDATIONS TO THE COMMISSIONER OR CITY  COMMIS-
 SIONER,  AS  THE  CASE  MAY  BE, FOR AREAS OF FOCUS, INCLUDING ISSUES OF
 SEVERE MATERNAL MORBIDITY  AND  ISSUES  OF  RACIAL,  ECONOMIC  OR  OTHER
 DISPARITIES IN MATERNAL OUTCOMES;
   (C)  MAY,  IN  ADDITION TO THE FINDINGS AND RECOMMENDATIONS MADE UNDER
 THIS SUBDIVISION, AND CONSISTENT  WITH  ALL  APPLICABLE  CONFIDENTIALITY
 PROTECTIONS, BRING ANY PARTICULAR MATTER TO THE ATTENTION OF THE COMMIS-
 SIONER OR THE CITY COMMISSIONER;
   (D) SHALL ISSUE A REPORT ON ITS FINDINGS AND RECOMMENDATIONS EVERY TWO
 YEARS,  AND MAY ALSO ISSUE REPORTS MORE FREQUENTLY. THE REPORTS SHALL BE
 PUBLIC DOCUMENTS; AND
   (E) MAY REQUEST AND SHALL RECEIVE THE ASSISTANCE OF  THE  COMMISSIONER
 AND THE CITY COMMISSIONER IN CARRYING OUT ITS FUNCTIONS.
   6.  THE  COMMISSIONER AND THE CITY COMMISSIONER AND THE STATE AND CITY
 BOARDS  SHALL  EACH  KEEP  CONFIDENTIAL  ANY  INFORMATION  COLLECTED  OR
 RECEIVED  UNDER THIS SECTION THAT INCLUDES PERSONAL IDENTIFYING INFORMA-
 TION OF THE WOMAN, HEALTH CARE PRACTITIONER OR PRACTITIONERS  OR  ANYONE
 ELSE  INDIVIDUALLY NAMED IN SUCH INFORMATION, AS WELL AS THE HOSPITAL OR
 FACILITY THAT TREATED THE WOMAN,  AND  ANY  OTHER  INFORMATION  SUCH  AS
 GEOGRAPHIC  LOCATION  THAT MAY INADVERTENTLY IDENTIFY THE WOMAN, PRACTI-
 TIONER OR FACILITY, AND SHALL USE THE INFORMATION PROVIDED  OR  RECEIVED
 UNDER THIS SECTION SOLELY FOR THE PURPOSES OF IMPROVEMENT OF THE QUALITY
 OF HEALTH CARE OF WOMEN AND TO PREVENT MATERNAL MORTALITY AND MORBIDITY.
 THIS  SUBDIVISION  SHALL NOT PRECLUDE THE TRANSMITTING OF INFORMATION TO
 THE BOARD THAT IS REASONABLY NECESSARY TO ENABLE THE BOARD TO PERFORM AN
 APPROPRIATE REVIEW UNDER THIS SECTION.  ALL RECORDS  RECEIVED,  MEETINGS
 CONDUCTED,  REPORTS  AND  RECORDS  MADE AND MAINTAINED AND ALL BOOKS AND
 PAPERS OBTAINED BY THE BOARD SHALL BE CONFIDENTIAL AND SHALL NOT BE MADE
 OPEN OR AVAILABLE, INCLUDING UNDER ARTICLE SIX OF  THE  PUBLIC  OFFICERS
 LAW,  AND  SHALL BE LIMITED TO BOARD MEMBERS AS WELL AS THOSE AUTHORIZED
 BY THE COMMISSIONER OR CITY COMMISSIONER.  SUCH INFORMATION SHALL NOT BE
 DISCOVERABLE OR ADMISSIBLE AS EVIDENCE IN ANY ACTION  IN  ANY  COURT  OR
 BEFORE ANY OTHER TRIBUNAL, BOARD, AGENCY OR PERSON.
   7. THE COMMISSIONER AND THE CITY COMMISSIONER, WITHIN THEIR RESPECTIVE
 LEGAL  AUTHORITY, MAY USE THE RECOMMENDATIONS AND FINDINGS OF THE BOARDS
 TO DEVELOP GUIDANCE AND OTHER ACTIONS RELATING TO  BEST  PRACTICES,  AND
 SHALL  DISSEMINATE  INFORMATION  RELATING  TO  THAT  GUIDANCE  AND OTHER
 ACTIONS TO APPROPRIATE HEALTH CARE PROVIDERS.

 S. 1507--B                         83

   8. (A) THERE IS HEREBY ESTABLISHED IN THE DEPARTMENT AN ADVISORY COUN-
 CIL ON MATERNAL MORTALITY AND MORBIDITY.
   (B) THE ADVISORY COUNCIL:
   (I) MAY REVIEW THE FINDINGS OF THE BOARDS;
   (II)  MAY  DEVELOP  RECOMMENDATIONS  ON  POLICIES, BEST PRACTICES, AND
 STRATEGIES TO PREVENT MATERNAL MORTALITY AND MORBIDITY;
   (III) MAY HOLD PUBLIC HEARINGS ON THOSE MATTERS;
   (IV) MAY MAKE FINDINGS AND ISSUE REPORTS, INCLUDING AN ANNUAL  REPORT,
 ON SUCH MATTERS; AND
   (V)  MAY REQUEST AND SHALL RECEIVE THE ASSISTANCE OF THE COMMISSIONER,
 THE CITY COMMISSIONER, AND THE BOARDS IN CARRYING OUT ITS FUNCTIONS.
   (C) THE ADVISORY COUNCIL SHALL CONSIST OF AT LEAST TWENTY MEMBERS,  TO
 BE DETERMINED BY THE COMMISSIONER. THE COMMISSIONER AND THE CITY COMMIS-
 SIONER  SHALL  EACH  APPOINT  HALF  OF  THE  MEMBERS OF THE COUNCIL. THE
 COMMISSIONER SHALL APPOINT THE CHAIR OF THE COUNCIL.
   (D) THE MEMBERS OF THE COUNCIL SHALL BE COMPRISED OF MULTIDISCIPLINARY
 EXPERTS AND LAY PERSONS KNOWLEDGEABLE IN THE FIELD OF  MATERNAL  MORTAL-
 ITY,  WOMEN'S  HEALTH  AND  PUBLIC  HEALTH AND SHALL INCLUDE MEMBERS WHO
 SERVE AND ARE REPRESENTATIVE OF THE DIVERSITY OF THE WOMEN  AND  MOTHERS
 IN  MEDICALLY  UNDERSERVED AREAS OF THE STATE OR AREAS OF THE STATE WITH
 DISPROPORTIONATELY HIGH OCCURRENCES OF MATERNAL MORTALITY OR MORBIDITY.
   (E) THE TERMS OF  THE  COUNCIL  MEMBERS  SHALL  BE  THREE  YEARS.  THE
 APPOINTING  OFFICIAL  MAY  CHOOSE  TO REAPPOINT COUNCIL MEMBERS TO ADDI-
 TIONAL THREE-YEAR TERMS. VACANCIES ON THE COUNCIL  SHALL  BE  FILLED  BY
 APPOINTMENT  BY  THE  APPOINTING OFFICIAL.   A MAJORITY OF THE APPOINTED
 MEMBERSHIP OF THE COUNCIL SHALL CONSTITUTE A QUORUM. WHEN ANY MEMBER  OF
 THE  COUNCIL  FAILS TO ATTEND THREE CONSECUTIVE REGULAR MEETINGS, UNLESS
 SUCH ABSENCE IS FOR GOOD CAUSE, THAT MEMBERSHIP MAY BE DEEMED VACANT FOR
 PURPOSES OF THE APPOINTMENT OF A SUCCESSOR.
   (F) MEETINGS OF THE COUNCIL SHALL BE HELD AT LEAST TWICE A YEAR.
   (G) MEMBERS OF THE COUNCIL SHALL BE INDEMNIFIED UNDER  SECTION  SEVEN-
 TEEN  OF  THE  PUBLIC  OFFICERS LAW. MEMBERS OF THE COUNCIL SHALL NOT BE
 COMPENSATED FOR THEIR PARTICIPATION ON THE  COUNCIL  BUT  SHALL  RECEIVE
 REIMBURSEMENT  FOR  THEIR  ORDINARY  AND  NECESSARY  EXPENSES OF PARTIC-
 IPATION. MEMBERSHIP ON THE COUNCIL SHALL NOT DISQUALIFY ANY PERSON  FROM
 HOLDING ANY PUBLIC OFFICE OR EMPLOYMENT.
   § 3. This act shall take effect immediately.
 
                                  PART S
 
                           Intentionally Omitted
 
                                  PART T
 
   Section  1.  This act shall be known and may be cited as the "NY State
 of Health, The Official Health Plan Marketplace Act".
   § 2. Article 2 of the public health law is amended  by  adding  a  new
 title VII to read as follows:
                                 TITLE VII
                             NY STATE OF HEALTH
 SECTION 268. STATEMENT OF POLICY AND PURPOSES.
         268-A. DEFINITIONS.
         268-B. ESTABLISHMENT  OF NY STATE OF HEALTH, THE OFFICIAL HEALTH
                PLAN MARKETPLACE.
         268-C. FUNCTIONS OF THE MARKETPLACE.

 S. 1507--B                         84
 
         268-D. SPECIAL FUNCTIONS OF THE MARKETPLACE  RELATED  TO  HEALTH
                PLAN CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
         268-E. APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW.
         268-F. MARKETPLACE ADVISORY COMMITTEE.
         268-G. FUNDING OF THE MARKETPLACE.
         268-H. CONSTRUCTION.
   §  268. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS TITLE IS
 TO CODIFY THE ESTABLISHMENT OF THE HEALTH BENEFIT EXCHANGE IN NEW  YORK,
 KNOWN  AS  NY  STATE  OF  HEALTH,  THE  OFFICIAL HEALTH PLAN MARKETPLACE
 (MARKETPLACE), IN CONFORMANCE WITH EXECUTIVE  ORDER  42  (CUOMO)  ISSUED
 APRIL  12,  2012.  THE MARKETPLACE SHALL CONTINUE TO PERFORM ELIGIBILITY
 DETERMINATIONS FOR FEDERAL AND STATE  INSURANCE  AFFORDABILITY  PROGRAMS
 INCLUDING  MEDICAL  ASSISTANCE  IN ACCORDANCE WITH SECTION THREE HUNDRED
 SIXTY-SIX OF THE SOCIAL SERVICES LAW, CHILD HEALTH  PLUS  IN  ACCORDANCE
 WITH  SECTION  TWENTY-FIVE  HUNDRED  ELEVEN  OF  THIS CHAPTER, THE BASIC
 HEALTH PROGRAM IN ACCORDANCE WITH SECTION THREE HUNDRED SIXTY-NINE-GG OF
 THE SOCIAL SERVICES  LAW,  AND  PREMIUM  TAX  CREDITS  AND  COST-SHARING
 REDUCTIONS,  TOGETHER  WITH  PERFORMING  ELIGIBILITY  DETERMINATIONS FOR
 QUALIFIED HEALTH PLANS AND  SUCH  OTHER  HEALTH  INSURANCE  PROGRAMS  AS
 DETERMINED  BY  THE  COMMISSIONER. THE MARKETPLACE SHALL ALSO FACILITATE
 ENROLLMENT IN INSURANCE AFFORDABILITY PROGRAMS, QUALIFIED  HEALTH  PLANS
 AND  OTHER  HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER,
 THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS AND/OR  OTHER  OR  ADDI-
 TIONAL HEALTH PLANS CERTIFIED BY THE MARKETPLACE PURSUANT TO THIS TITLE,
 AND  SHALL  CONTINUE  TO  HAVE THE AUTHORITY TO OPERATE A SMALL BUSINESS
 HEALTH OPTIONS PROGRAM ("SHOP") TO ASSIST ELIGIBLE  SMALL  EMPLOYERS  IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR  PURPOSES  OF  SMALL  EMPLOYER  TAX CREDITS. IT IS THE INTENT OF THE
 LEGISLATURE, BY CODIFYING THE MARKETPLACE IN STATE STATUTE, TO  CONTINUE
 TO  PROMOTE  QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE, REDUCE THE
 NUMBER OF UNINSURED PERSONS, PROVIDE A TRANSPARENT MARKETPLACE,  EDUCATE
 CONSUMERS  AND  ASSIST  INDIVIDUALS  WITH  ACCESS  TO  COVERAGE, PREMIUM
 ASSISTANCE TAX CREDITS AND COST-SHARING  REDUCTIONS.  IN  ADDITION,  THE
 LEGISLATURE  DECLARES  THE  INTENT  THAT  THE MARKETPLACE CONTINUE TO BE
 PROPERLY INTEGRATED WITH  INSURANCE  AFFORDABILITY  PROGRAMS,  INCLUDING
 MEDICAID, CHILD HEALTH PLUS AND THE BASIC HEALTH PROGRAM, AND SUCH OTHER
 HEALTH INSURANCE PROGRAMS AS DETERMINED BY THE COMMISSIONER.
   §  268-A. DEFINITIONS. FOR PURPOSES OF THIS TITLE, THE FOLLOWING DEFI-
 NITIONS SHALL APPLY:
   1. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH OF THE STATE OF NEW
 YORK.
   2. "MARKETPLACE" MEANS THE "NY STATE OF HEALTH,  THE  OFFICIAL  HEALTH
 PLAN  MARKETPLACE"  OR  "MARKETPLACE"  ESTABLISHED  AS  A HEALTH BENEFIT
 EXCHANGE OR "MARKETPLACE" WITHIN THE DEPARTMENT OF  HEALTH  PURSUANT  TO
 EXECUTIVE ORDER 42 (CUOMO) ISSUED APRIL 12, 2012 AND THIS TITLE.
   3. "FEDERAL ACT" MEANS THE PATIENT PROTECTION AND AFFORDABLE CARE ACT,
 PUBLIC  LAW  111-148, AS AMENDED BY THE HEALTH CARE AND EDUCATION RECON-
 CILIATION ACT OF 2010, PUBLIC LAW 111-152, AND ANY REGULATIONS OR  GUID-
 ANCE ISSUED THEREUNDER.
   4.  "HEALTH  PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR
 ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR  REIM-
 BURSE  ANY  OF  THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT
 INCLUDE THE FOLLOWING:
   (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
 TION THEREOF;

 S. 1507--B                         85
 
   (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
   (C)  LIABILITY  INSURANCE,  INCLUDING  GENERAL LIABILITY INSURANCE AND
 AUTOMOBILE LIABILITY INSURANCE;
   (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
   (E) AUTOMOBILE NO-FAULT INSURANCE;
   (F) CREDIT INSURANCE;
   (G) OTHER SIMILAR INSURANCE COVERAGE, AS SPECIFIED  IN  FEDERAL  REGU-
 LATIONS,  UNDER  WHICH  BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI-
 DENTAL TO OTHER INSURANCE BENEFITS;
   (H) LIMITED SCOPE DENTAL OR VISION BENEFITS,  BENEFITS  FOR  LONG-TERM
 CARE  INSURANCE,  NURSING  HOME  INSURANCE,  HOME CARE INSURANCE, OR ANY
 COMBINATION THEREOF, OR SUCH  OTHER  SIMILAR,  LIMITED  BENEFITS  HEALTH
 INSURANCE  AS  SPECIFIED  IN  FEDERAL  REGULATIONS,  IF THE BENEFITS ARE
 PROVIDED UNDER A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE
 OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
   (I)  COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL INDEM-
 NITY, OR OTHER FIXED INDEMNITY COVERAGE;
   (J) MEDICARE SUPPLEMENTAL INSURANCE AS DEFINED IN  SECTION  1882(G)(1)
 OF  THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE COVER-
 AGE PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE,  OR
 SIMILAR  SUPPLEMENTAL  COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN IF IT
 IS OFFERED AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT  OF  INSURANCE;
 OR
   (K)  THE NEW YORK STATE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO
 TITLE FOUR OF ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
   5. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO  ARTICLE  FORTY-TWO
 OR A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR
 A  HEALTH  MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-
 FOUR OF THE PUBLIC HEALTH LAW THAT CONTRACTS OR OFFERS  TO  CONTRACT  TO
 PROVIDE,  DELIVER,  ARRANGE, PAY OR REIMBURSE ANY OF THE COSTS OF HEALTH
 CARE SERVICES.
   6. "STAND-ALONE DENTAL PLAN" MEANS A DENTAL  SERVICES  PLAN  THAT  HAS
 BEEN  ISSUED PURSUANT TO APPLICABLE LAW AND CERTIFIED BY THE MARKETPLACE
 IN ACCORDANCE WITH SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE.
   7. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED PURSUANT
 TO APPLICABLE LAW AND CERTIFIED BY THE MARKETPLACE  IN  ACCORDANCE  WITH
 SECTION TWO HUNDRED SIXTY-EIGHT-D OF THIS TITLE, INCLUDING A STAND-ALONE
 DENTAL PLAN.
   8.  "INSURANCE  AFFORDABILITY  PROGRAM"  MEANS  MEDICAID, CHILD HEALTH
 PLUS, THE BASIC HEALTH PROGRAM AND ANY OTHER  HEALTH  INSURANCE  SUBSIDY
 PROGRAM DESIGNATED AS SUCH BY THE COMMISSIONER.
   9.  "ELIGIBLE  INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A MINOR, WHO
 IS ELIGIBLE TO ENROLL IN AN INSURANCE  AFFORDABILITY  PROGRAM  OR  OTHER
 HEALTH INSURANCE PROGRAM AS DETERMINED BY THE COMMISSIONER.
   10.  "QUALIFIED  INDIVIDUAL"  MEANS,  WITH RESPECT TO QUALIFIED HEALTH
 PLANS, AN INDIVIDUAL, INCLUDING A MINOR, WHO:
   (A) IS ELIGIBLE TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO  INDI-
 VIDUALS THROUGH THE MARKETPLACE;
   (B) RESIDES IN THIS STATE;
   (C)  AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR-
 CERATION PENDING THE DISPOSITION OF CHARGES; AND
   (D) IS, AND IS REASONABLY EXPECTED TO BE, FOR THE  ENTIRE  PERIOD  FOR
 WHICH  ENROLLMENT  IS SOUGHT, A CITIZEN OR NATIONAL OF THE UNITED STATES
 OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
   11. "SECRETARY" MEANS THE SECRETARY OF THE UNITED STATES DEPARTMENT OF
 HEALTH AND HUMAN SERVICES.

 S. 1507--B                         86
 
   12. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM OPERATED BY
 THE MARKETPLACE TO ASSIST ELIGIBLE SMALL  EMPLOYERS  IN  THIS  STATE  IN
 SELECTING QUALIFIED HEALTH PLANS AND/OR OTHER OR ADDITIONAL HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE AND TO DETERMINE SMALL EMPLOYER ELIGIBILITY
 FOR PURPOSES OF SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH APPLICABLE
 FEDERAL AND STATE LAWS AND REGULATIONS.
   13. "SMALL EMPLOYER" MEANS AN EMPLOYER WHICH OFFERS COVERAGE WHERE THE
 COVERAGE  SUCH  EMPLOYER OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE
 UNDER THE INSURANCE LAW AND REGULATIONS PROMULGATED THEREUNDER, PROVIDED
 THAT IT IS NOT OTHERWISE PROHIBITED UNDER THE FEDERAL ACT.
   14. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
 INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON  BEHALF  OF  THEMSELVES
 AND  THEIR  DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL
 EMPLOYER.
   15. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
   16. "ESSENTIAL HEALTH BENEFITS" SHALL MEAN THE CATEGORIES OF  BENEFITS
 DEFINED  IN  SUBSECTION (A) OF SECTION THREE THOUSAND TWO HUNDRED SEVEN-
 TEEN-I AND SUBSECTION (A) OF SECTION FOUR THOUSAND THREE  HUNDRED  SIX-H
 OF THE INSURANCE LAW.
   § 268-B. ESTABLISHMENT OF NY STATE OF HEALTH, THE OFFICIAL HEALTH PLAN
 MARKETPLACE. 1. THERE IS HEREBY ESTABLISHED AN OFFICE WITHIN THE DEPART-
 MENT  OF  HEALTH  TO  BE  KNOWN AS THE "NY STATE OF HEALTH, THE OFFICIAL
 HEALTH PLAN MARKETPLACE".
   2. THE PURPOSE OF THE  MARKETPLACE  IS  TO  FACILITATE  ENROLLMENT  IN
 HEALTH  COVERAGE AND THE PURCHASE AND SALE OF QUALIFIED HEALTH PLANS AND
 OTHER HEALTH PLANS CERTIFIED BY THE MARKETPLACE; ENROLL  INDIVIDUALS  IN
 COVERAGE  FOR  WHICH  THEY  ARE  ELIGIBLE IN ACCORDANCE WITH FEDERAL AND
 STATE LAW; ENABLE ELIGIBLE INDIVIDUALS TO RECEIVE PREMIUM  TAX  CREDITS,
 COST-SHARING  REDUCTIONS, AND TO ACCESS INSURANCE AFFORDABILITY PROGRAMS
 AND OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED BY  THE  COMMISSIONER;
 ASSIST  ELIGIBLE  SMALL  EMPLOYERS  IN  SELECTING QUALIFIED HEALTH PLANS
 AND/OR OTHER, OR ADDITIONAL HEALTH PLANS CERTIFIED  BY  THE  MARKETPLACE
 AND  TO QUALIFY FOR SMALL EMPLOYER TAX CREDITS IN ACCORDANCE WITH APPLI-
 CABLE LAW; AND TO CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS TITLE.
   § 268-C. FUNCTIONS OF THE MARKETPLACE. THE MARKETPLACE SHALL:
   1. (A) PERFORM ELIGIBILITY DETERMINATIONS FOR FEDERAL AND STATE INSUR-
 ANCE AFFORDABILITY PROGRAMS INCLUDING MEDICAL ASSISTANCE  IN  ACCORDANCE
 WITH  SECTION  THREE HUNDRED SIXTY-SIX OF THE SOCIAL SERVICES LAW, CHILD
 HEALTH PLUS IN ACCORDANCE WITH SECTION  TWENTY-FIVE  HUNDRED  ELEVEN  OF
 THIS  CHAPTER, THE BASIC HEALTH PROGRAM IN ACCORDANCE WITH SECTION THREE
 HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW,  PREMIUM  TAX  CREDITS
 AND  COST-SHARING  REDUCTIONS  AND  QUALIFIED HEALTH PLANS IN ACCORDANCE
 WITH APPLICABLE LAW AND OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED BY
 THE COMMISSIONER;
   (B) CERTIFY AND MAKE AVAILABLE  TO  QUALIFIED  INDIVIDUALS,  QUALIFIED
 HEALTH  PLANS,  INCLUDING  DENTAL  PLANS,  CERTIFIED  BY THE MARKETPLACE
 PURSUANT TO APPLICABLE LAW, PROVIDED  THAT  COVERAGE  UNDER  SUCH  PLANS
 SHALL  NOT  BECOME  EFFECTIVE PRIOR TO CERTIFICATION BY THE MARKETPLACE;
 AND
   (C) CERTIFY AND/OR MAKE  AVAILABLE  TO  ELIGIBLE  INDIVIDUALS,  HEALTH
 PLANS  CERTIFIED  BY  THE MARKETPLACE PURSUANT TO APPLICABLE LAW, AND/OR
 PARTICIPATING IN AN INSURANCE AFFORDABILITY PROGRAM PURSUANT TO APPLICA-
 BLE LAW, PROVIDED THAT COVERAGE UNDER SUCH PLANS SHALL NOT BECOME EFFEC-
 TIVE PRIOR TO CERTIFICATION BY THE MARKETPLACE, AND/OR APPROVAL  BY  THE
 COMMISSIONER.

 S. 1507--B                         87
 
   2.  ASSIGN  AN  ACTUARIAL  VALUE  TO  EACH  MARKETPLACE CERTIFIED PLAN
 OFFERED THROUGH THE MARKETPLACE IN ACCORDANCE WITH THE  CRITERIA  DEVEL-
 OPED  BY  THE  SECRETARY  PURSUANT  TO FEDERAL LAW OR THE SUPERINTENDENT
 PURSUANT TO THE INSURANCE  LAW  AND/OR  REQUIREMENTS  DEVELOPED  BY  THE
 MARKETPLACE,  AND  DETERMINE  EACH  HEALTH  PLAN'S  LEVEL OF COVERAGE IN
 ACCORDANCE WITH REGULATIONS ISSUED BY THE SECRETARY PURSUANT TO  FEDERAL
 LAW OR THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW.
   3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
 IN THE MARKETPLACE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
 ESTABLISHED  UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT
 OR THE INSURANCE LAW.
   4. STANDARDIZE THE BENEFITS AVAILABLE THROUGH THE MARKETPLACE AT  EACH
 LEVEL OF COVERAGE DEFINED BY THE SUPERINTENDENT IN THE INSURANCE LAW.
   5. MAINTAIN ENROLLMENT PERIODS IN THE BEST INTEREST OF QUALIFIED INDI-
 VIDUALS CONSISTENT WITH FEDERAL AND STATE LAW.
   6.  IMPLEMENT  PROCEDURES  FOR  THE CERTIFICATION, RECERTIFICATION AND
 DECERTIFICATION OF HEALTH PLANS AS  QUALIFIED  HEALTH  PLANS  OR  HEALTH
 PLANS  APPROVED  FOR  SALE  BY  THE  DEPARTMENT OF FINANCIAL SERVICES OR
 DEPARTMENT OF HEALTH AND CERTIFIED BY THE MARKETPLACE,  CONSISTENT  WITH
 GUIDELINES DEVELOPED BY THE SECRETARY PURSUANT TO SECTION 1311(C) OF THE
 FEDERAL ACT AND REQUIREMENTS DEVELOPED BY THE MARKETPLACE.
   7.  CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO QUALIFIED INDIVIDUALS
 THROUGH THE MARKETPLACE, AND IN DOING SO SHALL SEEK  TO  PROVIDE  HEALTH
 CARE  COVERAGE  CHOICES  THAT  OFFER  THE OPTIMAL COMBINATION OF CHOICE,
 VALUE, QUALITY, AND SERVICE.
   8. CONTRACT FOR HEALTH CARE COVERAGE OFFERED TO CERTAIN ELIGIBLE INDI-
 VIDUALS THROUGH THE MARKETPLACE, PURSUANT TO HEALTH  INSURANCE  PROGRAMS
 AS DETERMINED BY THE COMMISSIONER, AND IN DOING SO SHALL SEEK TO PROVIDE
 HEALTH  CARE  COVERAGE  CHOICES  THAT  OFFER  THE OPTIMAL COMBINATION OF
 CHOICE, VALUE, QUALITY, AND SERVICE;
   9. PROVIDE THE MINIMUM REQUIREMENTS AN INSURER SHALL MEET  TO  PARTIC-
 IPATE  IN THE MARKETPLACE, IN THE BEST INTEREST OF QUALIFIED INDIVIDUALS
 OR ELIGIBLE INDIVIDUALS;
   10. REQUIRE QUALIFIED HEALTH PLANS AND/OR OTHER HEALTH PLANS CERTIFIED
 BY THE MARKETPLACE TO OFFER THOSE BENEFITS DETERMINED  TO  BE  ESSENTIAL
 HEALTH BENEFITS PURSUANT TO STATE LAW OR AS REQUIRED BY THE MARKETPLACE.
   11. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE MARKETPLACE
 DO NOT CHARGE AN INDIVIDUAL ENROLLEE A FEE OR PENALTY FOR TERMINATION OF
 COVERAGE.
   12.  PROVIDE  FOR  THE  OPERATION  OF A TOLL-FREE TELEPHONE HOTLINE TO
 RESPOND TO REQUESTS FOR ASSISTANCE.
   13. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND  PROSPEC-
 TIVE  ENROLLEES  OF QUALIFIED HEALTH PLANS AND HEALTH PLANS CERTIFIED BY
 THE MARKETPLACE MAY OBTAIN STANDARDIZED COMPARATIVE INFORMATION ON  SUCH
 PLANS AND INSURANCE AFFORDABILITY PROGRAMS.
   14.  MAKE  AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO DETERMINE THE
 ACTUAL COST OF COVERAGE AFTER THE APPLICATION OF ANY PREMIUM TAX  CREDIT
 UNDER  SECTION  36B  OF  THE INTERNAL REVENUE CODE OF 1986 OR APPLICABLE
 STATE LAW AND ANY COST-SHARING REDUCTION  UNDER  FEDERAL  OR  APPLICABLE
 STATE LAW.
   15.  OPERATE  A  PROGRAM  UNDER WHICH THE MARKETPLACE AWARDS GRANTS TO
 ENTITIES TO SERVE AS NAVIGATORS IN ACCORDANCE  WITH  APPLICABLE  FEDERAL
 LAW AND REGULATIONS ADOPTED THEREUNDER, AND/OR A PROGRAM UNDER WHICH THE
 MARKETPLACE AWARDS GRANTS TO ENTITIES TO PROVIDE COMMUNITY BASED ENROLL-
 MENT ASSISTANCE IN ACCORDANCE WITH REQUIREMENTS DEVELOPED BY THE MARKET-
 PLACE;  AND/OR  A PROGRAM UNDER WHICH THE MARKETPLACE CERTIFIES NEW YORK

 S. 1507--B                         88
 
 STATE LICENSED PRODUCERS TO PROVIDE ASSISTANCE TO  ELIGIBLE  INDIVIDUALS
 AND/OR SMALL EMPLOYERS PURSUANT TO FEDERAL OR STATE LAW.
   16.  IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAW, INFORM INDI-
 VIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID PROGRAM UNDER TITLE
 XIX OF THE SOCIAL SECURITY ACT AND THE SOCIAL SERVICES  LAW,  THE  CHIL-
 DREN'S  HEALTH  INSURANCE  PROGRAM  (CHIP) UNDER TITLE XXI OF THE SOCIAL
 SECURITY ACT AND THIS CHAPTER, THE BASIC HEALTH  PROGRAM  UNDER  SECTION
 THREE  HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW, OR ANY APPLICA-
 BLE STATE OR LOCAL PUBLIC  HEALTH  INSURANCE  PROGRAM  AND  IF,  THROUGH
 SCREENING  OF THE APPLICATION BY THE MARKETPLACE, THE MARKETPLACE DETER-
 MINES THAT SUCH INDIVIDUALS ARE ELIGIBLE FOR ANY  SUCH  PROGRAM,  ENROLL
 SUCH INDIVIDUALS IN SUCH PROGRAM.
   17.  GRANT  A  CERTIFICATION  THAT  AN  INDIVIDUAL  IS EXEMPT FROM THE
 REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE PURSUANT  TO  FEDERAL
 OR  STATE  LAW  AND  FROM  ANY  PENALTIES  IMPOSED  BY SUCH REQUIREMENTS
 BECAUSE:
   (A) THERE IS NO AFFORDABLE HEALTH PLAN AVAILABLE COVERING THE INDIVID-
 UAL, AS DEFINED BY APPLICABLE LAW; OR
   (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
 FROM THE REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE  OR  TO  PAY
 THE PENALTY PURSUANT TO APPLICABLE FEDERAL OR STATE LAW.
   18.  OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") PURSUANT
 TO SECTION 1311 OF THE FEDERAL ACT AND  APPLICABLE  STATE  LAW,  THROUGH
 WHICH  ELIGIBLE  SMALL EMPLOYERS MAY SELECT MARKETPLACE-CERTIFIED QUALI-
 FIED HEALTH PLANS OFFERED IN THE SMALL GROUP MARKET, AND  THROUGH  WHICH
 ELIGIBLE  SMALL EMPLOYERS MAY RECEIVE ASSISTANCE IN QUALIFYING FOR SMALL
 BUSINESS TAX CREDITS AVAILABLE PURSUANT TO FEDERAL AND STATE LAW.
   19. ENTER INTO AGREEMENTS AS NECESSARY WITH FEDERAL AND STATE AGENCIES
 AND OTHER STATE MARKETPLACES TO CARRY  OUT  ITS  RESPONSIBILITIES  UNDER
 THIS  TITLE,  PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE PROTECTIONS WITH
 RESPECT TO THE CONFIDENTIALITY OF  ANY  INFORMATION  TO  BE  SHARED  AND
 COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS.
   20.  PERFORM  DUTIES  REQUIRED  BY THE SECRETARY, THE SECRETARY OF THE
 UNITED STATES DEPARTMENT OF THE TREASURY OR THE COMMISSIONER RELATED  TO
 DETERMINING  ELIGIBILITY FOR PREMIUM TAX CREDITS OR REDUCED COST-SHARING
 UNDER APPLICABLE FEDERAL OR STATE LAW.
   21. MEET PROGRAM INTEGRITY REQUIREMENTS UNDER APPLICABLE LAW,  INCLUD-
 ING  KEEPING  AN  ACCURATE  ACCOUNTING  OF RECEIPTS AND EXPENDITURES AND
 PROVIDING REPORTS TO THE SECRETARY REGARDING MARKETPLACE RELATED  ACTIV-
 ITIES IN ACCORDANCE WITH APPLICABLE LAW.
   22.  SUBMIT INFORMATION PROVIDED BY MARKETPLACE APPLICANTS FOR VERIFI-
 CATION AS REQUIRED BY SECTION 1411(C) OF THE FEDERAL ACT AND  APPLICABLE
 STATE LAW.
   23.  ESTABLISH  RULES  AND  REGULATIONS  THAT  DO NOT CONFLICT WITH OR
 PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY THE SECRETARY.
   24. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE  OPPORTUNITIES
 FOR  APPEAL  AND  REDETERMINATION IN ACCORDANCE WITH THE REQUIREMENTS OF
 FEDERAL AND STATE LAW.
   § 268-D. SPECIAL FUNCTIONS OF THE MARKETPLACE RELATED TO  HEALTH  PLAN
 CERTIFICATION  AND  QUALIFIED  HEALTH  PLAN  OVERSIGHT.  1. HEALTH PLANS
 CERTIFIED BY THE MARKETPLACE SHALL MEET THE FOLLOWING REQUIREMENTS:
   (A) THE INSURER OFFERING THE HEALTH PLAN:
   (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER, IN
 GOOD STANDING TO OFFER HEALTH INSURANCE  COVERAGE  IN  THIS  STATE,  AND
 MEETS THE REQUIREMENTS ESTABLISHED BY THE MARKETPLACE;

 S. 1507--B                         89
 
   (II)  OFFERS  AT LEAST ONE QUALIFIED HEALTH PLAN AND/OR OTHER OR ADDI-
 TIONAL HEALTH PLANS AUTHORIZED FOR SALE BY THE DEPARTMENT  OF  FINANCIAL
 SERVICES  OR  THE  DEPARTMENT  IN  EACH OF THE SILVER AND GOLD LEVELS AS
 REQUIRED BY STATE LAW,  PROVIDED,  HOWEVER,  THAT  THE  MARKETPLACE  MAY
 REQUIRE  ADDITIONAL BENEFIT LEVELS TO BE OFFERED BY ALL INSURERS PARTIC-
 IPATING IN THE MARKETPLACE;
   (III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT  OF
 ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
 LAW AND/OR THIS CHAPTER;
   (IV)  DOES  NOT  CHARGE  ANY CANCELLATION FEES OR PENALTIES FOR TERMI-
 NATION OF COVERAGE IN VIOLATION OF APPLICABLE LAW; AND
   (V) COMPLIES WITH THE REGULATIONS DEVELOPED  BY  THE  SECRETARY  UNDER
 SECTION  1311(C)  OF  THE FEDERAL ACT AND SUCH OTHER REQUIREMENTS AS THE
 MARKETPLACE MAY ESTABLISH.
   (B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS  PACK-
 AGE  DESCRIBED  IN STATE LAW OR REQUIRED BY THE MARKETPLACE AND INCLUDES
 SUCH ADDITIONAL BENEFITS AS ARE MANDATED BY STATE LAW, EXCEPT  THAT  THE
 HEALTH  PLAN  SHALL  NOT  BE REQUIRED TO PROVIDE ESSENTIAL BENEFITS THAT
 DUPLICATE THE MINIMUM BENEFITS OF QUALIFIED DENTAL PLANS IF:
   (A) THE MARKETPLACE HAS DETERMINED THAT AT LEAST ONE QUALIFIED  DENTAL
 PLAN  OR DENTAL PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL SERVICES OR
 THE DEPARTMENT IS AVAILABLE TO SUPPLEMENT THE  HEALTH  PLAN'S  COVERAGE;
 AND
   (B)  THE  INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
 HEALTH PLAN, IN A FORM APPROVED BY THE MARKETPLACE, THAT THE  PLAN  DOES
 NOT  PROVIDE  THE  FULL  RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT
 QUALIFIED DENTAL PLANS OR DENTAL PLANS APPROVED  BY  THE  DEPARTMENT  OF
 FINANCIAL  SERVICES OR DEPARTMENT OF HEALTH PROVIDING THOSE BENEFITS AND
 OTHER DENTAL BENEFITS NOT COVERED BY THE PLAN ARE  OFFERED  THROUGH  THE
 MARKETPLACE;
   (II)  PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE AS DEFINED BY STATE
 LAW, UNLESS THE PLAN IS CERTIFIED AS A QUALIFIED CATASTROPHIC  PLAN,  AS
 DEFINED IN SECTION 1302(E) OF THE FEDERAL ACT AND THE INSURANCE LAW, AND
 SHALL ONLY BE OFFERED TO INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE;
   (III)  HAS  COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
 NOT EXCEED THE LIMITS ESTABLISHED UNDER SECTION 1302(C) OF  THE  FEDERAL
 ACT, STATE LAW AND ANY REQUIREMENTS OF THE MARKETPLACE;
   (IV)  COMPLIES  WITH REGULATIONS PROMULGATED BY THE SECRETARY PURSUANT
 TO SECTION 1311(C) OF THE FEDERAL ACT AND APPLICABLE  STATE  LAW,  WHICH
 INCLUDE  MINIMUM  STANDARDS IN THE AREAS OF MARKETING PRACTICES, NETWORK
 ADEQUACY, ESSENTIAL COMMUNITY PROVIDERS IN UNDERSERVED  AREAS,  ACCREDI-
 TATION,  QUALITY  IMPROVEMENT, UNIFORM ENROLLMENT FORMS AND DESCRIPTIONS
 OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH BENEFIT  PLAN
 PERFORMANCE;
   (V)  MEETS  STANDARDS  SPECIFIED  AND  DETERMINED  BY THE MARKETPLACE,
 PROVIDED THAT THE STANDARDS DO NOT CONFLICT WITH OR PREVENT THE APPLICA-
 TION OF FEDERAL REQUIREMENTS; AND
   (VI) COMPLIES WITH THE INSURANCE LAW  AND  THIS  CHAPTER  REQUIREMENTS
 APPLICABLE  TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGULATIONS
 PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH  OR  PREVENT  THE
 APPLICATION OF FEDERAL REQUIREMENTS; AND
   (C)  THE  MARKETPLACE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE
 THROUGH THE MARKETPLACE IS IN THE INTEREST OF QUALIFIED  INDIVIDUALS  IN
 THIS STATE.
   2. THE MARKETPLACE SHALL NOT EXCLUDE A HEALTH PLAN:
   (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;

 S. 1507--B                         90
 
   (B)  THROUGH  THE  IMPOSITION OF PREMIUM PRICE CONTROLS BY THE MARKET-
 PLACE; OR
   (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
 PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE MARKETPLACE DETERMINES ARE
 INAPPROPRIATE OR TOO COSTLY.
   3.  THE  MARKETPLACE  SHALL  REQUIRE EACH INSURER CERTIFIED OR SEEKING
 CERTIFICATION OF A HEALTH PLAN  AS  A  QUALIFIED  HEALTH  PLAN  OR  PLAN
 APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL SERVICES OR THE DEPART-
 MENT TO:
   (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE PURSUANT TO APPLI-
 CABLE  LAW  PRIOR  TO IMPLEMENTATION OF SUCH INCREASE. THE INSURER SHALL
 PROMINENTLY POST THE INFORMATION ON ITS INTERNET  WEBSITE.    SUCH  RATE
 INCREASES  SHALL  BE SUBJECT TO THE PRIOR APPROVAL OF THE SUPERINTENDENT
 PURSUANT TO THE INSURANCE LAW;
   (B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE MARKETPLACE, THE
 SECRETARY AND THE SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
   (A) CLAIMS PAYMENT POLICIES AND PRACTICES;
   (B) PERIODIC FINANCIAL DISCLOSURES;
   (C) DATA ON ENROLLMENT AND DISENROLLMENT;
   (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
   (E) DATA ON RATING PRACTICES;
   (F) INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY  OUT-
 OF-NETWORK COVERAGE;
   (G)  INFORMATION  ON  ENROLLEE AND PARTICIPANT RIGHTS UNDER TITLE I OF
 THE FEDERAL ACT; AND
   (H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY  THE  SECRETARY  OR
 OTHERWISE REQUIRED BY THE MARKETPLACE;
   (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE, AS THAT TERM
 IS  DEFINED  IN  SECTION 1311(E)(3)(B) OF THE FEDERAL ACT AND STATE LAW,
 AND IN GUIDANCE JOINTLY ISSUED  THEREUNDER  BY  THE  SECRETARY  AND  THE
 FEDERAL SECRETARY OF LABOR; AND
   (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
 INDIVIDUAL,  THE  AMOUNT  OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY-
 MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN  OR  COVERAGE
 THAT  THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE
 FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
 A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE  TO  THE  INDIVIDUAL
 THROUGH  AN  INTERNET  WEBSITE  AND  THROUGH OTHER MEANS FOR INDIVIDUALS
 WITHOUT ACCESS TO THE INTERNET.
   4. THE MARKETPLACE SHALL NOT EXEMPT ANY INSURER SEEKING  CERTIFICATION
 OF  A  HEALTH  PLAN, REGARDLESS OF THE TYPE OR SIZE OF THE INSURER, FROM
 LICENSING OR SOLVENCY REQUIREMENTS UNDER THE INSURANCE LAW OR THIS CHAP-
 TER, AND SHALL APPLY THE CRITERIA OF  THIS  SECTION  IN  A  MANNER  THAT
 ENSURES  A LEVEL PLAYING FIELD FOR INSURERS PARTICIPATING IN THE MARKET-
 PLACE.
   5. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO  QUALIFIED  HEALTH
 PLANS  AND  PLANS  APPROVED  FOR  SALE  BY  THE  DEPARTMENT OF FINANCIAL
 SERVICES AND THE DEPARTMENT ALSO SHALL APPLY TO THE EXTENT  RELEVANT  TO
 QUALIFIED  DENTAL PLANS APPROVED FOR SALE BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT, EXCEPT AS MODIFIED IN  ACCORDANCE  WITH  THE
 PROVISIONS  OF  PARAGRAPHS  (B) AND (C) OF THIS SUBDIVISION OR OTHERWISE
 REQUIRED BY THE MARKETPLACE.
   (B) THE QUALIFIED DENTAL PLAN OR DENTAL PLAN APPROVED FOR SALE BY  THE
 DEPARTMENT  OF FINANCIAL SERVICES AND/OR THE DEPARTMENT SHALL BE LIMITED
 TO DENTAL AND ORAL HEALTH BENEFITS,  WITHOUT  SUBSTANTIALLY  DUPLICATING
 THE  BENEFITS  TYPICALLY  OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL

 S. 1507--B                         91
 
 COVERAGE, AND SHALL INCLUDE,  AT  A  MINIMUM,  THE  ESSENTIAL  PEDIATRIC
 DENTAL   BENEFITS  PRESCRIBED  BY  THE  SECRETARY  PURSUANT  TO  SECTION
 1302(B)(1)(J) OF THE FEDERAL ACT, AND SUCH OTHER DENTAL BENEFITS AS  THE
 MARKETPLACE OR SECRETARY MAY SPECIFY IN REGULATIONS.
   (C)  INSURERS  MAY  JOINTLY  OFFER  A  COMPREHENSIVE  PLAN THROUGH THE
 MARKETPLACE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS  THROUGH  A
 QUALIFIED  DENTAL  PLAN  OR PLAN APPROVED BY THE DEPARTMENT OF FINANCIAL
 SERVICES OR THE DEPARTMENT AND AN INSURER PROVIDES  THE  OTHER  BENEFITS
 THROUGH  A  QUALIFIED  HEALTH  PLAN,  PROVIDED THAT THE PLANS ARE PRICED
 SEPARATELY AND ALSO ARE MADE AVAILABLE FOR PURCHASE  SEPARATELY  AT  THE
 SAME PRICE.
   §  268-E.  APPEALS AND APPEAL HEARINGS; JUDICIAL REVIEW. 1. ANY APPLI-
 CANT OR ENROLLEE, OR ANY INDIVIDUAL AUTHORIZED TO ACT ON BEHALF  OF  ANY
 SUCH  APPLICANT  OR ENROLLEE, MAY APPEAL TO THE DEPARTMENT FROM DETERMI-
 NATIONS OF DEPARTMENT OFFICIALS OR FAILURES TO MAKE DETERMINATIONS  UPON
 GROUNDS  SPECIFIED  IN  SUBDIVISION FOUR OF THIS SECTION. THE DEPARTMENT
 MUST REVIEW THE APPEAL DE NOVO AND GIVE SUCH PERSON AN  OPPORTUNITY  FOR
 AN  APPEAL HEARING.   THE DEPARTMENT MAY ALSO, ON ITS OWN MOTION, REVIEW
 ANY DECISION MADE OR ANY CASE IN WHICH A DECISION HAS NOT BEEN  MADE  BY
 THE  MARKETPLACE OR A SOCIAL SERVICES OFFICIAL WITHIN THE TIME SPECIFIED
 BY LAW OR REGULATIONS OF THE DEPARTMENT. THE DEPARTMENT  MAY  MAKE  SUCH
 ADDITIONAL  INVESTIGATION AS IT MAY DEEM NECESSARY, AND THE COMMISSIONER
 MUST MAKE SUCH DETERMINATION AS IS  JUSTIFIED  AND  IN  ACCORDANCE  WITH
 APPLICABLE LAW.
   2.  REGARDING  ANY APPEAL PURSUANT TO THIS SECTION, WITH OR WITHOUT AN
 APPEAL HEARING, THE COMMISSIONER MAY DESIGNATE AND AUTHORIZE ONE OR MORE
 APPROPRIATE MEMBERS OF HIS STAFF TO CONSIDER AND  DECIDE  SUCH  APPEALS.
 ANY  STAFF  MEMBER  SO  DESIGNATED AND AUTHORIZED WILL HAVE AUTHORITY TO
 DECIDE SUCH APPEALS ON BEHALF OF THE COMMISSIONER WITH  THE  SAME  FORCE
 AND  EFFECT  AS IF THE COMMISSIONER HAD MADE THE DECISIONS. APPEAL HEAR-
 INGS MUST BE HELD ON BEHALF OF THE COMMISSIONER BY MEMBERS OF HIS  STAFF
 WHO  ARE  EMPLOYED  FOR  SUCH  PURPOSES  OR WHO HAVE BEEN DESIGNATED AND
 AUTHORIZED BY THE COMMISSIONER.
   3. PERSONS ENTITLED TO APPEAL  TO  THE  DEPARTMENT  PURSUANT  TO  THIS
 SECTION MUST INCLUDE:
   (A)  APPLICANTS  FOR  OR ENROLLEES IN INSURANCE AFFORDABILITY PROGRAMS
 AND QUALIFIED HEALTH PLANS; AND
   (B) OTHER PERSONS ENTITLED TO AN OPPORTUNITY FOR AN APPEAL HEARING  AS
 DIRECTED BY THE COMMISSIONER.
   4.  AN  APPLICANT  OR  ENROLLEE  HAS  THE RIGHT TO APPEAL AT LEAST THE
 FOLLOWING ISSUES:
   (A) AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH THIS  ARTICLE
 AND APPLICABLE LAW, INCLUDING:
   (I) AN INITIAL DETERMINATION OF ELIGIBILITY, INCLUDING:
   (A) ELIGIBILITY TO ENROLL IN A QUALIFIED HEALTH PLAN;
   (B) ELIGIBILITY FOR MEDICAID;
   (C) ELIGIBILITY FOR CHILD HEALTH PLUS;
   (D) ELIGIBILITY FOR THE BASIC HEALTH PROGRAM;
   (E) THE AMOUNT OF ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND LEVEL
 OF COST-SHARING REDUCTIONS;
   (F)  THE  AMOUNT OF ANY OTHER SUBSIDY THAT MAY BE AVAILABLE UNDER LAW;
 AND
   (G) ELIGIBILITY FOR SUCH OTHER HEALTH INSURANCE PROGRAMS AS DETERMINED
 BY THE COMMISSIONER; AND
   (II) A RE-DETERMINATION OF ELIGIBILITY  OF  THE  PROGRAMS  UNDER  THIS
 SUBDIVISION.

 S. 1507--B                         92
 
   (B)  AN  ELIGIBILITY DETERMINATION FOR AN EXEMPTION FOR ANY MANDATE TO
 PURCHASE HEALTH INSURANCE.
   (C)  A  FAILURE BY NY STATE OF HEALTH TO PROVIDE TIMELY WRITTEN NOTICE
 OF AN ELIGIBILITY DETERMINATION MADE IN ACCORDANCE WITH APPLICABLE LAW.
   5. THE DEPARTMENT MAY, SUBJECT TO THE DISCRETION OF THE  COMMISSIONER,
 PROMULGATE  SUCH  REGULATIONS,  CONSISTENT WITH FEDERAL OR STATE LAW, AS
 MAY BE NECESSARY TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
   6. REGARDING EVERY DECISION OF AN APPEAL PURSUANT TO THIS SECTION, THE
 DEPARTMENT MUST INFORM EVERY PARTY, AND HIS OR  HER  REPRESENTATIVE,  IF
 ANY,  OF  THE AVAILABILITY OF JUDICIAL REVIEW AND THE TIME LIMITATION TO
 PURSUE FUTURE REVIEW.
   7. APPLICANTS AND ENROLLEES OF QUALIFIED HEALTH PLANS, WITH OR WITHOUT
 ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND COST-SHARING  REDUCTIONS,
 ALSO  HAVE THE RIGHT TO APPEAL TO THE UNITED STATES DEPARTMENT OF HEALTH
 AND HUMAN SERVICES APPEAL ENTITY:
   (A) APPEALS DECISIONS ISSUED BY NY STATE OF HEALTH UPON THE EXHAUSTION
 OF THE NY STATE OF HEALTH APPEALS PROCESS; AND
   (B) A DENIAL OF A REQUEST TO VACATE A DISMISSAL MADE BY THE  NY  STATE
 OF HEALTH APPEALS ENTITY.
   8.  THE  DEPARTMENT  MUST  INCLUDE  NOTICE  OF  THE RIGHT TO APPEAL AS
 PROVIDED BY SUBDIVISION FOUR OF THIS SECTION AND INSTRUCTIONS  REGARDING
 HOW  TO  FILE  AN  APPEAL IN ANY ELIGIBILITY DETERMINATION ISSUED TO THE
 APPLICANT OR ENROLLEE IN ACCORDANCE WITH  APPLICABLE  LAW.  SUCH  NOTICE
 SHALL INCLUDE:
   (A) AN EXPLANATION OF THE APPLICANT OR ENROLLEE'S APPEAL RIGHTS;
   (B) A DESCRIPTION OF THE PROCEDURES BY WHICH THE APPLICANT OR ENROLLEE
 MAY REQUEST AN APPEAL;
   (C)  INFORMATION  ON  THE  APPLICANT  OR ENROLLEE'S RIGHT TO REPRESENT
 HIMSELF OR HERSELF, OR TO BE REPRESENTED BY  LEGAL  COUNSEL  OR  ANOTHER
 REPRESENTATIVE;
   (D)  AN  EXPLANATION  OF THE CIRCUMSTANCES UNDER WHICH THE APPELLANT'S
 ELIGIBILITY MAY BE MAINTAINED OR REINSTATED PENDING AN APPEAL  DECISION;
 AND
   (E)  AN  EXPLANATION  THAT AN APPEAL DECISION FOR ONE HOUSEHOLD MEMBER
 MAY RESULT IN A CHANGE IN ELIGIBILITY FOR OTHER  HOUSEHOLD  MEMBERS  AND
 THAT  SUCH  A CHANGE WILL BE HANDLED AS A REDETERMINATION OF ELIGIBILITY
 FOR ALL HOUSEHOLD MEMBERS IN ACCORDANCE WITH THE STANDARDS SPECIFIED  IN
 APPLICABLE LAW.
   §  268-F.  MARKETPLACE  ADVISORY COMMITTEE. 1. THERE IS HEREBY CREATED
 THE MARKETPLACE ADVISORY COMMITTEE, WHICH SHALL CONSIDER AND ADVISE  THE
 DEPARTMENT  AND  COMMISSIONER  ON  MATTERS  CONCERNING  THE PROVISION OF
 HEALTH CARE COVERAGE THROUGH THE NY STATE OF HEALTH OR MARKETPLACE.
   2. THE MARKETPLACE ADVISORY COMMITTEE SHALL CONSIST OF UP  TO  TWENTY-
 EIGHT  MEMBERS  APPOINTED  BY  THE  COMMISSIONER, REPRESENTATIVE OF EACH
 GEOGRAPHIC AREA OF THE STATE AND INCLUDING:
   (A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT  MORE  THAN
 SIX FROM ANY SINGLE CATEGORY:
   (I) HEALTH PLAN CONSUMER ADVOCATES;
   (II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
   (III) HEALTH CARE PROVIDER REPRESENTATIVES;
   (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
   (B)  REPRESENTATIVES  FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
 TWO FROM EITHER CATEGORY:
   (I) LICENSED INSURANCE PRODUCERS; AND
   (II) REPRESENTATIVES OF LABOR ORGANIZATIONS.

 S. 1507--B                         93
 
   3. THE MARKETPLACE SHALL SELECT THE CHAIR OF  THE  ADVISORY  COMMITTEE
 FROM  AMONG THE MEMBERS OF SUCH COMMITTEE AND SHALL DESIGNATE AN OFFICER
 OR EMPLOYEE OF THE DEPARTMENT TO ASSIST THE MARKETPLACE ADVISORY COMMIT-
 TEE IN THE PERFORMANCE OF ITS DUTIES UNDER THIS SECTION. THE MARKETPLACE
 SHALL  ADOPT  RULES  FOR THE GOVERNANCE OF THE ADVISORY COMMITTEE, WHICH
 SHALL MEET AS FREQUENTLY AS ITS BUSINESS MAY REQUIRE AND AT  SUCH  OTHER
 TIMES AS DETERMINED BY THE MARKETPLACE TO BE NECESSARY.
   4.  MEMBERS OF THE ADVISORY COMMITTEE SHALL SERVE WITHOUT COMPENSATION
 FOR THEIR SERVICES AS MEMBERS, BUT EACH SHALL BE ALLOWED  THE  NECESSARY
 AND  ACTUAL  EXPENSES  INCURRED  IN THE PERFORMANCE OF HIS OR HER DUTIES
 UNDER THIS SECTION.
   § 268-G. FUNDING OF THE MARKETPLACE. 1. THE MARKETPLACE SHALL BE FUND-
 ED BY STATE AND FEDERAL SOURCES AS AUTHORIZED BY APPLICABLE LAW, INCLUD-
 ING BUT NOT LIMITED TO APPLICABLE LAW AUTHORIZING THE RESPECTIVE  INSUR-
 ANCE AFFORDABILITY PROGRAMS AVAILABLE THROUGH THE MARKETPLACE.
   2.  THE ACCOUNTS OF THE MARKETPLACE SHALL BE SUBJECT TO SUPERVISION OF
 THE COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS,  EXPENDITURES,
 CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
 MARKETPLACE.
   3.  NOTWITHSTANDING  ANY  LAW  TO THE CONTRARY, AND IN ACCORDANCE WITH
 SECTION FOUR OF THE STATE FINANCE LAW, UPON REQUEST OF THE  DIRECTOR  OF
 THE  BUDGET,  IN  CONSULTATION WITH THE COMMISSIONER, THE SUPERINTENDENT
 AND THE EXECUTIVE DIRECTOR OF THE MARKETPLACE, THE COMPTROLLER IS HEREBY
 AUTHORIZED AND DIRECTED TO  SUB-ALLOCATE  OR  TRANSFER  SPECIAL  REVENUE
 FEDERAL FUNDS APPROPRIATED TO THE DEPARTMENT FOR PLANNING AND IMPLEMENT-
 ING  VARIOUS  HEALTHCARE  AND INSURANCE REFORM INITIATIVES AUTHORIZED BY
 APPLICABLE LAW.  MARKETPLACE MONEYS SUB-ALLOCATED OR TRANSFERRED  PURSU-
 ANT TO THIS SECTION SHALL BE PAID OUT OF THE FUND UPON AUDIT AND WARRANT
 OF  THE  STATE  COMPTROLLER  ON  VOUCHERS  CERTIFIED  OR APPROVED BY THE
 MARKETPLACE.
   § 268-H. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
 THE MARKETPLACE PURSUANT HERETO, SHALL BE CONSTRUED TO:
   1. PREEMPT OR SUPERSEDE THE AUTHORITY OF  THE  SUPERINTENDENT  OR  THE
 COMMISSIONER; OR
   2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
 THIS CHAPTER OR THE INSURANCE LAW AND ANY REGULATIONS PROMULGATED THERE-
 UNDER.
   §  3.  Severability. If any provision of this article, or the applica-
 tion thereof to any person or circumstances is held invalid or unconsti-
 tutional, that invalidity or unconstitutionality shall not affect  other
 provisions  or  applications  of  this  article that can be given effect
 without the invalid or unconstitutional provision or application, and to
 this end the provisions and application of this article are severable.
   § 4. This act shall take effect immediately.
 
                                  PART U
 
   Section 1. Section 203 of the elder law is amended  by  adding  a  new
 subdivision 12 to read as follows:
   12.  THE DIRECTOR IS HEREBY AUTHORIZED TO IMPLEMENT PRIVATE PAY PROTO-
 COLS FOR ALL PROGRAMS ADMINISTERED BY THE OFFICE. THESE PROTOCOLS MAY BE
 IMPLEMENTED BY AREA AGENCIES ON AGING AT THEIR OPTION AND SUCH PROTOCOLS
 MAY NOT BE APPLIED TO CLIENTS WHOSE SERVICES ARE PAID FOR  WITH  FEDERAL
 FUNDS  OR  FUNDS  DESIGNATED  AS  FEDERAL  MATCH.  ALL  PRIVATE PAYMENTS
 RECEIVED DIRECTLY BY AN AREA AGENCY ON AGING OR INDIRECTLY BY ONE OF ITS
 CONTRACTORS SHALL BE USED TO SUPPLEMENT, NOT SUPPLANT, FUNDS  BY  STATE,

 S. 1507--B                         94
 
 FEDERAL,  OR  COUNTY  APPROPRIATIONS. SUCH PRIVATE PAY PAYMENTS SHALL BE
 SET AT A COST TO THE FINAL RECIPIENT OF NOT  MORE  THAN  TWENTY  PERCENT
 ABOVE  EITHER  THE  AMOUNT  THAT  THE  AREA  AGENCY ON AGING PAYS TO ITS
 CONTRACTOR  TO  RENDER THE SERVICE OR PRODUCT, OR THE PER UNIT WHOLESALE
 COST TO THE AREA AGENCY ON AGING IF SUCH AREA AGENCY  ON  AGING  RENDERS
 THE  SERVICE  OR  PRODUCT  DIRECTLY  TO THE FINAL RECIPIENT. PRIVATE PAY
 PAYMENTS RECEIVED UNDER THIS SUBDIVISION SHALL BE USED BY THE AREA AGEN-
 CY ON AGING TO SUPPORT AND ENHANCE SERVICES OR PROGRAMS PROVIDED BY  THE
 AREA  AGENCY ON AGING. PARTICIPANT PAYMENTS UNDER THIS SUBDIVISION SHALL
 NOT BE REQUIRED OF INDIVIDUALS WITH INCOMES BELOW FOUR  HUNDRED  PERCENT
 OF  THE  FEDERAL  POVERTY  LEVEL.  NO PARTICIPANT, REGARDLESS OF INCOME,
 SHALL BE REQUIRED TO PAY FOR ANY SERVICE THAT THEY ARE RECEIVING AT  THE
 TIME  THESE  PROTOCOLS ARE IMPLEMENTED BY THE AREA AGENCY ON AGING. THIS
 SUBDIVISION SHALL NOT PREVENT COST SHARING FOR THE PROGRAMS  ESTABLISHED
 PURSUANT  TO  SECTION TWO HUNDRED FOURTEEN OF THIS TITLE FOR INDIVIDUALS
 BELOW FOUR HUNDRED PERCENT OF THE  FEDERAL  POVERTY  LEVEL.  INDIVIDUALS
 WITH  INCOMES  BELOW  FOUR  HUNDRED PERCENT OF THE FEDERAL POVERTY LEVEL
 SHALL REMAIN THE HIGHEST PRIORITY  FOR  RECEIPT  OF  SERVICES  FROM  THE
 OFFICE  AND  LOCAL  AREA AGENCIES ON AGING AND THEIR CONTRACTORS; IN THE
 EVENT THAT RESOURCES  AND  SERVICES  ARE  LIMITED,  SUCH  RESOURCES  AND
 SERVICES  MAY  NOT  BE  REDIRECTED  FROM  RECIPIENTS  UNDER FOUR HUNDRED
 PERCENT OF THE FEDERAL POVERTY LEVEL TO THOSE PAYING FOR SERVICES PURSU-
 ANT TO THE PRIVATE PAY PROTOCOLS AUTHORIZED BY THIS SUBDIVISION.
   § 2. This act shall take effect immediately.
 
                                  PART V
 
                           Intentionally Omitted
 
                                  PART W
 
   Section 1. Section 1 of part D of chapter 111  of  the  laws  of  2010
 relating to the recovery of exempt income by the office of mental health
 for community residences and family-based treatment programs, as amended
 by  section 1 of part H of chapter 59 of the laws of 2016, is amended to
 read as follows:
   Section 1. The office of mental health is authorized to recover  fund-
 ing  from  community  residences  and  family-based  treatment providers
 licensed by the office of mental  health,  consistent  with  contractual
 obligations  of such providers, and notwithstanding any other inconsist-
 ent provision of law to the contrary, in an amount equal to  50  percent
 of  the income received by such providers which exceeds the fixed amount
 of annual Medicaid revenue limitations, as established  by  the  commis-
 sioner of mental health. Recovery of such excess income shall be for the
 following  fiscal  periods:  for programs in counties located outside of
 the city of New York, the applicable fiscal periods shall be January  1,
 2003  through December 31, 2009 and January 1, 2011 through December 31,
 [2019] 2022; and for programs located within the city of New  York,  the
 applicable  fiscal  periods  shall be July 1, 2003 through June 30, 2010
 and July 1, 2011 through June 30, [2019] 2022.
   § 2. This act shall take effect immediately.
 
                                  PART X

 S. 1507--B                         95
 
   Section 1. Subdivision 9 of section 730.10 of the  criminal  procedure
 law,  as added by section 1 of part Q of chapter 56 of the laws of 2012,
 is amended to read as follows:
   9.  "Appropriate  institution"  means:  (a) a hospital operated by the
 office of mental health or a developmental center operated by the office
 for people with developmental disabilities; [or] (b) a hospital licensed
 by the department of health which operates a psychiatric  unit  licensed
 by  the  office  of  mental  health,  as  determined by the commissioner
 provided, however, that any such hospital that is not  operated  by  the
 state shall qualify as an "appropriate institution" only pursuant to the
 terms  of an agreement between the commissioner and the hospital; OR (C)
 A MENTAL HEALTH UNIT OPERATING  WITHIN  A  LOCAL  CORRECTIONAL  FACILITY
 EXCEPT  THOSE  LOCATED WITHIN A CITY WITH A POPULATION OF ONE MILLION OR
 MORE; PROVIDED HOWEVER, THAT ANY SUCH MENTAL HEALTH UNIT OPERATING WITH-
 IN A LOCAL CORRECTIONAL FACILITY SHALL QUALIFY AS AN "APPROPRIATE INSTI-
 TUTION" ONLY PURSUANT TO THE TERMS OF AN AGREEMENT BETWEEN  THE  COMMIS-
 SIONER  OF MENTAL HEALTH, DIRECTOR OF COMMUNITY SERVICES AND THE SHERIFF
 FOR THE RESPECTIVE LOCALITY.  Nothing in this article shall be construed
 as requiring a hospital OR LOCAL CORRECTIONAL  FACILITY  to  consent  to
 providing care and treatment to an incapacitated person at such hospital
 OR  LOCAL CORRECTIONAL FACILITY. THE COMMISSIONER OF MENTAL HEALTH SHALL
 PROMULGATE REGULATIONS FOR DEMONSTRATION PROGRAMS AT NO  MORE  THAN  TWO
 COUNTIES  TO  IMPLEMENT RESTORATION TO COMPETENCY WITHIN A LOCAL CORREC-
 TIONAL FACILITY. SUBJECT TO ANNUAL APPROPRIATION,  THE  COMMISSIONER  OF
 MENTAL  HEALTH MAY, AT SUCH COMMISSIONER'S DISCRETION, MAKE FUNDS AVAIL-
 ABLE FOR STATE AID GRANTS TO ANY COUNTY THAT  DEVELOPS  AND  OPERATES  A
 MENTAL HEALTH UNIT WITHIN A LOCAL CORRECTIONAL FACILITY PURSUANT TO THIS
 SECTION.  NOTHING  IN  THIS  ARTICLE  SHALL  BE CONSTRUED AS REQUIRING A
 HOSPITAL OR LOCAL CORRECTIONAL FACILITY TO CONSENT TO PROVIDING CARE AND
 TREATMENT TO AN INCAPACITATED PERSON AT SUCH HOSPITAL OR  LOCAL  CORREC-
 TIONAL FACILITY.
   §  2.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that this act shall expire and be  deemed  repealed  March  31,
 2024;  effective  immediately,  the addition, amendment and/or repeal of
 any rule or regulation necessary for the implementation of this  act  on
 its  effective date are authorized to be made and completed on or before
 such effective date.
 
                                  PART Y
 
   Section 1. Subdivisions 3-b and 3-c of section 1 of part C of  chapter
 57  of  the  laws  of  2006,  relating  to establishing a cost of living
 adjustment for designated human services programs, as amended by section
 1 of part AA of chapter 57 of the laws of 2018, are amended to  read  as
 follows:
   3-b.  Notwithstanding  any  inconsistent  provision  of law, beginning
 April 1, 2009 and ending March 31, 2016 and beginning April 1, 2017  and
 ending  [March  31, 2019] DECEMBER 31, 2019, the commissioners shall not
 include a COLA for  the  purpose  of  establishing  rates  of  payments,
 contracts or any other form of reimbursement[, provided that the commis-
 sioners  of  the  office for people with developmental disabilities, the
 office of mental health, and the  office  of  alcoholism  and  substance
 abuse  services  shall  not  include  a COLA beginning April 1, 2017 and
 ending March 31, 2019].

 S. 1507--B                         96
 
   3-c. Notwithstanding any  inconsistent  provision  of  law,  beginning
 [April  1]  JANUARY 1, [2019] 2020 and ending March 31, [2022] 2023, the
 commissioners shall develop the COLA under this section using the actual
 U.S. consumer price index for all urban consumers (CPI-U)  published  by
 the  United  States  department of labor, bureau of labor statistics for
 the twelve month period ending in July of the budget year prior to  such
 state  fiscal  year,  for the purpose of establishing rates of payments,
 contracts or any other form of reimbursement.
   § 2. This act shall take effect immediately and  shall  be  deemed  to
 have been in full force and effect on and after April 1, 2019; provided,
 however, that the amendments to section 1 of part C of chapter 57 of the
 laws of 2006 made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith.
 
                                  PART Z
 
   Section  1. Subdivision 1 of section 2801 of the public health law, as
 amended by section 1 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follows:
   1. "Hospital" means a facility or institution engaged  principally  in
 providing services by or under the supervision of a physician or, in the
 case  of  a dental clinic or dental dispensary, of a dentist, or, in the
 case of a midwifery birth center, of  a  midwife,  for  the  prevention,
 diagnosis  or  treatment  of  human  disease, pain, injury, deformity or
 physical condition, including, but not limited to, a  general  hospital,
 public  health center, diagnostic center, treatment center, dental clin-
 ic, dental dispensary, rehabilitation center other than a facility  used
 solely  for vocational rehabilitation, nursing home, tuberculosis hospi-
 tal, chronic  disease  hospital,  maternity  hospital,  midwifery  birth
 center,  lying-in-asylum,  out-patient  department,  out-patient  lodge,
 dispensary and a laboratory or central service facility serving  one  or
 more  such  institutions,  but  the  term  hospital shall not include an
 institution, sanitarium or other facility engaged principally in provid-
 ing services for the prevention, diagnosis or treatment of mental  disa-
 bility  and  which  is subject to the powers of visitation, examination,
 inspection and investigation of the department of mental hygiene  except
 for  those  distinct  parts  of  such  a facility which provide hospital
 service. The provisions of this article shall not apply to a facility or
 institution engaged principally in providing services by  or  under  the
 supervision of the bona fide members and adherents of a recognized reli-
 gious  organization  whose teachings include reliance on spiritual means
 through prayer alone for healing in the practice of the religion of such
 organization and where services are provided in  accordance  with  those
 teachings.  No  provision  of this article or any other provision of law
 shall be construed to: (a) limit  the  volume  of  mental  health  [or],
 substance  use  disorder  services  OR DEVELOPMENTAL DISABILITY SERVICES
 that can be provided by a provider of  primary  care  services  licensed
 under  this  article  and  authorized  to provide integrated services in
 accordance with regulations issued by the commissioner  in  consultation
 with  the commissioner of the office of mental health [and], the commis-
 sioner of the office of alcoholism and substance abuse services AND  THE
 COMMISSIONER  OF  THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES,
 including regulations issued pursuant to subdivision  seven  of  section
 three hundred sixty-five-l of the social services law or part L of chap-
 ter fifty-six of the laws of two thousand twelve; (b) require a provider
 licensed  pursuant  to  article  thirty-one of the mental hygiene law or

 S. 1507--B                         97
 
 certified pursuant to ARTICLE  SIXTEEN  OR  article  thirty-two  of  the
 mental  hygiene  law to obtain an operating certificate from the depart-
 ment if such provider has been authorized to provide integrated services
 in  accordance  with regulations issued by the commissioner in consulta-
 tion with the commissioner of the office of  mental  health  [and],  the
 commissioner  of  the  office of alcoholism and substance abuse services
 AND THE COMMISSIONER OF THE OFFICE FOR PEOPLE WITH  DEVELOPMENTAL  DISA-
 BILITIES,  including regulations issued pursuant to subdivision seven of
 section three hundred sixty-five-l of the social services law or part  L
 of chapter fifty-six of the laws of two thousand twelve.
   §  2.  Subdivision  (f) of section 31.02 of the mental hygiene law, as
 added by section 2 of subpart B of part S of chapter 57 of the  laws  of
 2018, is amended to read as follows:
   (f)  No  provision of this article or any other provision of law shall
 be construed to require a provider licensed pursuant to article  twenty-
 eight  of the public health law or certified pursuant to ARTICLE SIXTEEN
 OR article thirty-two of this chapter to obtain an operating certificate
 from the office of mental health if such provider has been authorized to
 provide integrated services in accordance with regulations issued by the
 commissioner of the office of mental health  in  consultation  with  the
 commissioner  of the department of health [and], the commissioner of the
 office of alcoholism and substance abuse services AND  THE  COMMISSIONER
 OF  THE  OFFICE  FOR  PEOPLE  WITH DEVELOPMENTAL DISABILITIES, including
 regulations issued  pursuant  to  subdivision  seven  of  section  three
 hundred  sixty-five-l  of  the  social services law or part L of chapter
 fifty-six of the laws of two thousand twelve.
   § 3. Subdivision (b) of section 32.05 of the mental  hygiene  law,  as
 amended by section 3 of subpart B of part S of chapter 57 of the laws of
 2018, is amended to read as follow:
   (b)  (i)  Methadone,  or such other controlled substance designated by
 the commissioner of health as appropriate for such use, may be  adminis-
 tered  to  an  addict, as defined in section thirty-three hundred two of
 the public health law, by individual physicians,  groups  of  physicians
 and  public  or private medical facilities certified pursuant to article
 twenty-eight or thirty-three of the public health law as part of a chem-
 ical dependence program which has been issued an  operating  certificate
 by the commissioner pursuant to subdivision (b) of section 32.09 of this
 article,  provided,  however,  that  such administration must be done in
 accordance with all applicable federal and state laws  and  regulations.
 Individual physicians or groups of physicians who have obtained authori-
 zation  from  the  federal  government  to  administer  buprenorphine to
 addicts may do so without obtaining an operating  certificate  from  the
 commissioner.  (ii)  No provision of this article or any other provision
 of law shall be construed to require a  provider  licensed  pursuant  to
 article  twenty-eight  of the public health law or article thirty-one of
 this chapter to obtain an operating certificate from the office of alco-
 holism and substance abuse services if such provider has been authorized
 to provide integrated services in accordance with regulations issued  by
 the commissioner of alcoholism and substance abuse services in consulta-
 tion  with  the  commissioner  of  the  department  of health [and], the
 commissioner of the office of mental health AND THE COMMISSIONER OF  THE
 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, including regulations
 issued  pursuant  to  subdivision  seven of section three hundred sixty-
 five-l of the social services law or part L of chapter fifty-six of  the
 laws of two thousand twelve.

 S. 1507--B                         98
 
   §  4.  Section  16.03 of the mental hygiene law is amended by adding a
 new subdivision (g) to read as follows:
   (G)  NO  PROVISION OF THIS ARTICLE OR ANY OTHER PROVISION OF LAW SHALL
 BE CONSTRUED TO REQUIRE A PROVIDER LICENSED PURSUANT TO ARTICLE  TWENTY-
 EIGHT  OF THE PUBLIC HEALTH LAW OR CERTIFIED PURSUANT TO ARTICLE THIRTY-
 ONE OR THIRTY-TWO OF THIS CHAPTER TO  OBTAIN  AN  OPERATING  CERTIFICATE
 FROM  THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL DISABILITIES IF SUCH
 PROVIDER HAS BEEN AUTHORIZED TO PROVIDE INTEGRATED SERVICES  IN  ACCORD-
 ANCE  WITH  REGULATIONS  ISSUED  BY  THE  COMMISSIONER OF THE OFFICE FOR
 PEOPLE WITH DEVELOPMENTAL DISABILITIES, IN CONSULTATION WITH THE COMMIS-
 SIONER OF THE DEPARTMENT OF HEALTH, THE COMMISSIONER AND THE COMMISSION-
 ER OF THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE  SERVICES,  INCLUDING
 REGULATIONS  ISSUED  PURSUANT  TO  SUBDIVISION  SEVEN  OF  SECTION THREE
 HUNDRED SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW OR  PART  L  OF  CHAPTER
 FIFTY-SIX OF THE LAWS OF TWO THOUSAND TWELVE.
   §  5.  This  act shall take effect October 1, 2019; provided, however,
 that the commissioner of the department of health, the  commissioner  of
 the  office of mental health, the commissioner of the office of alcohol-
 ism and substance abuse services, and the commissioner of the office for
 people with developmental disabilities are authorized to issue any  rule
 or  regulation necessary for the implementation of this act on or before
 its effective date.
 
                                  PART AA
 
                           Intentionally Omitted
 
                                  PART BB
 
   Section 1. This part enacts into law major components  of  legislation
 which  are  necessary to effectuate provisions relating to mental health
 and  substance  use  disorder  treatment.    Each  component  is  wholly
 contained  within  a  Subpart  identified  as  Subparts A through E. The
 effective date for  each  particular  provision  contained  within  such
 Subpart  is set forth in the last section of such Subpart. Any provision
 in any section contained within a Subpart, including the effective  date
 of the Subpart, which makes a reference to a section "of this act", when
 used  in  connection  with that particular component, shall be deemed to
 mean and refer to the corresponding section of the Subpart in  which  it
 is  found.  Section  three of this Part sets forth the general effective
 date of this Part.
 
                                 SUBPART A
 
   Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur-
 ance law is amended to read as follows:
   (4) If a policy provides for reimbursement for psychiatric or  psycho-
 logical  services  or for diagnosis and treatment of mental[,nervous, or
 emotional disorders or ailments,] HEALTH CONDITIONS however  defined  in
 the  policy,  the  insured  shall  be entitled to reimbursement for such
 services, diagnosis or  treatment  whether  performed  by  a  physician,
 psychiatrist  [or],  a certified and registered psychologist, OR A NURSE
 PRACTITIONER when the services rendered are within the lawful  scope  of
 their practice.

 S. 1507--B                         99
 
   §  2.  Subparagraph  (B)  of paragraph 25 of subsection (i) of section
 3216 of the insurance law, as amended by section 38 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B)  Every  policy  that  provides  physician services, medical, major
 medical or similar comprehensive-type coverage  shall  provide  coverage
 for  the  screening, diagnosis and treatment of autism spectrum disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered  by  the  policy because the individual is diagnosed with autism
 spectrum disorder. Such coverage may be subject to  annual  deductibles,
 copayments  and  coinsurance  as may be deemed appropriate by the super-
 intendent and shall be consistent with those imposed on  other  benefits
 under  the  policy.  [Coverage  for  applied  behavior analysis shall be
 subject to a maximum benefit of six hundred eighty  hours  of  treatment
 per  policy  or  calendar  year  per covered individual.] This paragraph
 shall not be construed as  limiting  the  benefits  that  are  otherwise
 available  to an individual under the policy, provided however that such
 policy shall not contain any  limitations  on  visits  that  are  solely
 applied  to  the treatment of autism spectrum disorder. No insurer shall
 terminate coverage or refuse to deliver, execute, issue, amend,  adjust,
 or  renew  coverage  to  an  individual solely because the individual is
 diagnosed with autism spectrum disorder or has  received  treatment  for
 autism  spectrum  disorder.  Coverage  shall  be  subject to utilization
 review and external appeals of health care services pursuant to  article
 forty-nine  of  this  chapter as well as[,] case management[,] and other
 managed care provisions.
   § 3. Items (i) and (iii)  of  subparagraph  (C)  of  paragraph  25  of
 subsection (i) of section 3216 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental disorders[, including autistic disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  when  provided  by  a licensed provider, and applied behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant to the behavior analyst certification board]  PERSON  LICENSED,
 CERTIFIED  OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED BEHAVIOR ANALYSIS,
 that are necessary to develop, maintain,  or  restore,  to  the  maximum
 extent  practicable, the functioning of an individual. [Individuals that
 provide behavioral health treatment under the supervision of a certified
 behavior analyst pursuant to this paragraph shall be subject  to  stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations  promulgated  by the superintendent in consultation with the
 commissioners of health and education.]
   § 4. Paragraph 25 of subsection (i) of section 3216 of  the  insurance
 law  is  amended by adding four new subparagraphs (H), (I), (J), and (K)
 to read as follows:
   (H) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE  MORE    RESTRICTIVE THAN THE PREDOMINANT FINANCIAL REQUIREMENTS AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED  BY THE POLICY.
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE  MADE  AVAIL-

 S. 1507--B                         100
 
 ABLE  BY THE  INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK
 PROVIDER UPON REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT; AND
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED ON MEDICAL  NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR  PROVIDER ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES;  METHODS FOR DETER-
 MINING USUAL, CUSTOMARY, AND REASONABLE CHARGES;  FAIL-FIRST  OR    STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.
   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  5.  Paragraph 30 of subsection (i) of section 3216 of the insurance
 law, as amended by section 1 of part B of chapter  71  of  the  laws  of
 2016, is amended to read as follows:
   (30)(A)  Every policy that provides hospital, major medical or similar
 comprehensive coverage [must] SHALL provide inpatient coverage  for  the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion  and rehabilitation services. Such inpatient coverage shall include
 unlimited medically  necessary  treatment  for  substance  use  disorder
 treatment  services provided in residential settings [as required by the
 Mental Health Parity and Addiction Equity  Act  of  2008  (29  U.S.C.  §
 1185a)].    Further,  such  inpatient coverage shall not apply financial
 requirements or  treatment  limitations,  including  utilization  review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive  than  the  predominant financial requirements and treatment
 limitations applied to substantially all medical and  surgical  benefits
 covered  by  the  policy.  [Further,  such  coverage  shall  be provided
 consistent with the federal Paul  Wellstone  and  Pete  Domenici  Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B)  Coverage  provided under this paragraph may be limited to facili-
 ties in New York state [which are certified] THAT ARE  LICENSED,  CERTI-
 FIED  OR  OTHERWISE AUTHORIZED by the office of alcoholism and substance
 abuse services and, in other states, to those which  are  accredited  by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence  treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (C) Coverage provided under this paragraph may be  subject  to  annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and  that  are  consistent with those imposed on other benefits within a
 given policy.
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance  abuse  services  that are participating in the insurer's

 S. 1507--B                         101
 
 provider network. Coverage provided under this paragraph  shall  not  be
 subject  to  preauthorization.  Coverage  provided  under this paragraph
 shall also not be subject to concurrent utilization  review  during  the
 first  [fourteen]  TWENTY-EIGHT days of the inpatient admission provided
 that the facility notifies the insurer of both  the  admission  and  the
 initial  treatment  plan within [forty-eight hours] TWO BUSINESS DAYS of
 the admission. The facility shall perform daily clinical review  of  the
 patient,  including  [the]  periodic consultation with the insurer AT OR
 JUST PRIOR TO THE FOURTEENTH DAY OF THE INPATIENT  ADMISSION  to  ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism  and  substance  abuse services and appropriate to the age of
 the patient, to ensure that the inpatient treatment is medically  neces-
 sary  for  the patient.   PRIOR TO DISCHARGE, THE FACILITY SHALL PROVIDE
 THE PATIENT AND THE INSURER WITH A WRITTEN DISCHARGE  PLAN  WHICH  SHALL
 DESCRIBE ARRANGEMENTS FOR ADDITIONAL SERVICES NEEDED FOLLOWING DISCHARGE
 FROM  THE  INPATIENT FACILITY AS DETERMINED USING THE EVIDENCE-BASED AND
 PEER-REVIEWED CLINICAL REVIEW TOOL UTILIZED  BY  THE  INSURER  WHICH  IS
 DESIGNATED  BY  THE  OFFICE  OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
 PRIOR TO DISCHARGE, THE FACILITY SHALL INDICATE TO THE  INSURER  WHETHER
 SERVICES  INCLUDED IN THE DISCHARGE PLAN ARE SECURED OR DETERMINED TO BE
 REASONABLY AVAILABLE. Any utilization review of treatment provided under
 this subparagraph may include a review of all services  provided  during
 such  inpatient  treatment,  including  all services provided during the
 first  [fourteen]  TWENTY-EIGHT  days  of  such   inpatient   treatment.
 Provided,  however, the insurer shall only deny coverage for any portion
 of the initial [fourteen] TWENTY-EIGHT day inpatient  treatment  on  the
 basis  that such treatment was not medically necessary if such inpatient
 treatment was contrary to the evidence-based and peer reviewed  clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism  and  substance abuse services. An insured shall not have any
 financial obligation to  the  facility  for  any  treatment  under  this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E)  AN  INSURER  SHALL  MAKE  AVAILABLE  TO  ANY INSURED, PROSPECTIVE
 INSURED, OR IN-NETWORK PROVIDER, UPON REQUEST, THE CRITERIA FOR  MEDICAL
 NECESSITY  DETERMINATIONS  UNDER  THE  POLICY  WITH RESPECT TO INPATIENT
 SUBSTANCE USE DISORDER BENEFITS.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,

 S. 1507--B                         102
 
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE, SUCH AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  6.  Paragraph 31 of subsection (i) of section 3216 of the insurance
 law, as added by chapter 41 of the laws of 2014 and subparagraph (E)  as
 added  by  section  3  of  part MM of chapter 57 of the laws of 2018, is
 amended to read as follows:
   (31) (A) Every policy that provides medical, major medical or  similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication  and  rehabilitation  services.  Such  coverage shall not apply
 financial requirements or treatment limitations to outpatient  substance
 use  disorder  benefits  that  are more restrictive than the predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the policy.    [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B) Coverage under this paragraph may be limited to facilities in  New
 York state [certified] THAT ARE LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED  by  the  office  of  alcoholism  and  substance abuse services [or
 licensed by such office as outpatient clinics  or  medically  supervised
 ambulatory]  TO PROVIDE OUTPATIENT substance [abuse programs] USE DISOR-
 DER SERVICES and, in other states, to those which are accredited by  the
 joint  commission  as  alcoholism or chemical dependence substance abuse
 treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED,  OR  OTHERWISE
 AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (C)  Coverage  provided  under this paragraph may be subject to annual
 deductibles and co-insurance as deemed appropriate by the superintendent
 and that are consistent with those imposed on other  benefits  within  a
 given policy.
   (D)  A  policy  providing coverage for substance use disorder services
 pursuant to this paragraph shall provide up to twenty outpatient  visits
 per  policy  or  calendar  year  to  an individual who identifies him or
 herself as a family member of a  person  suffering  from  substance  use
 disorder  and  who  seeks  treatment as a family member who is otherwise
 covered by the applicable policy pursuant to this paragraph. The  cover-
 age  required  by  this  paragraph  shall  include treatment as a family
 member pursuant to such family member's own policy provided such  family
 member:
   (i)  does not exceed the allowable number of family visits provided by
 the applicable policy pursuant to this paragraph; and
   (ii) is otherwise entitled to coverage pursuant to this paragraph  and
 such family member's applicable policy.
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services for the provision of outpatient,  intensive
 outpatient,  outpatient  rehabilitation  and  opioid  treatment that are
 participating in the insurer's provider network. Coverage provided under

 S. 1507--B                         103
 
 this paragraph  shall  not  be  subject  to  preauthorization.  Coverage
 provided  under this paragraph shall not be subject to concurrent review
 for the first [two] FOUR weeks of continuous treatment,  not  to  exceed
 [fourteen]  TWENTY-EIGHT  visits,  provided  the  facility  notifies the
 insurer of both the start of treatment and the  initial  treatment  plan
 within [forty-eight hours] TWO BUSINESS DAYS. The facility shall perform
 clinical  assessment of the patient at each visit, including [the] peri-
 odic consultation with the insurer AT OR JUST PRIOR  TO  THE  FOURTEENTH
 DAY OF TREATMENT to ensure that the facility is using the evidence-based
 and  peer reviewed clinical review tool utilized by the insurer which is
 designated by the office of alcoholism and substance abuse services  and
 appropriate  to  the  age  of the patient, to ensure that the outpatient
 treatment is medically necessary  for  the  patient.    Any  utilization
 review  of  the treatment provided under this subparagraph may include a
 review of  all  services  provided  during  such  outpatient  treatment,
 including  all  services  provided  during the first [two] FOUR weeks of
 continuous treatment, not to exceed [fourteen] TWENTY-EIGHT  visits,  of
 such  outpatient  treatment.  Provided,  however, the insurer shall only
 deny coverage for any portion of the initial [two] FOUR weeks of contin-
 uous treatment, not to exceed [fourteen] TWENTY-EIGHT visits, for outpa-
 tient treatment on the basis  that  such  treatment  was  not  medically
 necessary  if  such  outpatient  treatment was contrary to the evidence-
 based and peer reviewed clinical review tool  utilized  by  the  insurer
 which  is  designated  by  the  office of alcoholism and substance abuse
 services. An insured shall not have  any  financial  obligation  to  the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.

 S. 1507--B                         104
 
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 7. Paragraph 31-a of subsection (i) of section 3216 of the insurance
 law,  as added by section 1 of part B of chapter 69 of the laws of 2016,
 is amended to read as follows:
   (31-a) [(A)] Every policy that  provides  medical,  major  medical  or
 similar   comprehensive-type   coverage   and   provides   coverage  for
 prescription drugs for medication for the treatment of a  substance  use
 disorder shall include immediate access, without prior authorization, to
 [a  five day emergency supply] THE FORMULARY FORMS of prescribed medica-
 tions covered under the policy for the treatment of substance use disor-
 der [where an emergency condition exists], including a  prescribed  drug
 or medication associated with the management of opioid withdrawal and/or
 stabilization, except where otherwise prohibited by law. Further, cover-
 age  [of  an emergency supply] WITHOUT PRIOR AUTHORIZATION shall include
 FORMULARY FORMS OF medication for  opioid  overdose  reversal  otherwise
 covered  under  the  policy  prescribed  OR  DISPENSED  to an individual
 covered by the policy.
   [(B) For purposes of this paragraph, an "emergency condition" means  a
 substance use disorder condition that manifests itself by acute symptoms
 of  sufficient  severity,  including  severe  pain or the expectation of
 severe pain, such that a prudent layperson, possessing an average  know-
 ledge  of  medicine  and  health, could reasonably expect the absence of
 immediate medical attention to result in:
   (i) placing the health of the person afflicted with such condition  in
 serious  jeopardy, or in the case of a behavioral condition, placing the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v) a condition described in clause (i), (ii),  or  (iii)  of  section
 1867(e)(1)(A) of the Social Security Act.
   (C)  Coverage  provided  under this paragraph may be subject to copay-
 ments, coinsurance, and annual  deductibles  that  are  consistent  with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty  day  supply of the same medication in the same thirty day period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the initial emergency supply of medication in an  amount  that  is  less
 than  the  copayment or coinsurance otherwise applicable to a thirty day
 supply of such medication, provided that the total sum of the copayments
 or coinsurance for an entire thirty day supply of  the  medication  does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   § 8. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 35 to read as follows:
   (35)  (A)  EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES COVERAGE FOR  INPATIENT  HOSPITAL  CARE  OR  COVERAGE  FOR
 PHYSICIAN  SERVICES  SHALL PROVIDE COVERAGE FOR THE DIAGNOSIS AND TREAT-
 MENT OF MENTAL HEALTH CONDITIONS AS FOLLOWS:
   (I) WHERE THE POLICY PROVIDES COVERAGE FOR  INPATIENT  HOSPITAL  CARE,
 BENEFITS  FOR INPATIENT CARE IN A HOSPITAL AS DEFINED BY SUBDIVISION TEN
 OF SECTION 1.03 OF THE MENTAL HYGIENE LAW AND  BENEFITS  FOR  OUTPATIENT

 S. 1507--B                         105
 
 CARE  PROVIDED  IN  A  FACILITY  ISSUED  AN OPERATING CERTIFICATE BY THE
 COMMISSIONER OF MENTAL HEALTH PURSUANT  TO  THE  PROVISIONS  OF  ARTICLE
 THIRTY-ONE  OF  THE MENTAL HYGIENE LAW, OR IN A FACILITY OPERATED BY THE
 OFFICE OF MENTAL HEALTH, OR, FOR CARE PROVIDED IN OTHER STATES, TO SIMI-
 LARLY LICENSED OR CERTIFIED HOSPITALS OR FACILITIES; AND
   (II)  WHERE THE POLICY PROVIDES COVERAGE FOR PHYSICIAN SERVICES, BENE-
 FITS FOR OUTPATIENT CARE PROVIDED  BY  A  PSYCHIATRIST  OR  PSYCHOLOGIST
 LICENSED  TO  PRACTICE  IN THIS STATE, A LICENSED CLINICAL SOCIAL WORKER
 WHO MEETS THE REQUIREMENTS OF SUBPARAGRAPH  (D)  OF  PARAGRAPH  FOUR  OF
 SUBSECTION  (1) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS
 ARTICLE, A NURSE PRACTITIONER LICENSED TO PRACTICE IN THIS STATE,  OR  A
 PROFESSIONAL  CORPORATION  OR  UNIVERSITY  FACULTY  PRACTICE CORPORATION
 THEREOF.
   (B) COVERAGE REQUIRED BY THIS  PARAGRAPH  MAY  BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES,  COPAYMENTS AND COINSURANCE AS MAY BE DEEMED APPROPRIATE BY
 THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH THOSE IMPOSED  ON  OTHER
 BENEFITS UNDER THE POLICY.
   (C)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT  ARE  MORE
 RESTRICTIVE  THAN  THE  PREDOMINANT FINANCIAL REQUIREMENTS AND TREATMENT
 LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND  SURGICAL  BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT  TO  MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE BY THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS:  MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "MENTAL  HEALTH  CONDITION"  MEANS ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL  OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G) THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT  ARE
 LICENSED  BY  THE  OFFICE OF MENTAL HEALTH THAT ARE PARTICIPATING IN THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-

 S. 1507--B                         106
 
 TIENT HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A  HOSPITAL
 AS  DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE LAW
 PROVIDED TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN  SHALL
 NOT  BE  SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER THIS PARA-
 GRAPH SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW  DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY  NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL TREATMENT
 PLAN WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY  CLINICAL
 REVIEW  OF  THE  PATIENT, AND PARTICIPATES IN PERIODIC CONSULTATION WITH
 THE INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED  AND
 PEER  REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH IS
 APPROVED BY THE OFFICE OF MENTAL HEALTH AND APPROPRIATE TO  THE  AGE  OF
 THE  PATIENT,  TO  ENSURE THAT THE INPATIENT CARE IS MEDICALLY NECESSARY
 FOR THE PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH  MAY  BE
 REVIEWED  RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY, AN
 INSURED SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR  ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   §  9.  Paragraphs 17, 19 and 20 of subsection (a) of section 3217-a of
 the insurance law, paragraph 17 as amended and paragraphs 19 and  20  as
 added  by  section  1  of  part H of chapter 60 of the laws of 2014, are
 amended and a new paragraph 21 is added to read as follows:
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate document that is updated annually, of the name, address, and  tele-
 phone  number of all participating providers, including facilities, AND:
 (A) WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (B) IN THE  CASE  OF
 MENTAL  HEALTH  OR SUBSTANCE USE DISORDER SERVICES PROVIDERS, ANY AFFIL-
 IATIONS WITH PARTICIPATING FACILITIES CERTIFIED  OR  AUTHORIZED  BY  THE
 OFFICE  OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
 SERVICES, AND ANY RESTRICTIONS REGARDING THE AVAILABILITY OF  THE  INDI-
 VIDUAL PROVIDER'S SERVICES; and [in addition,] (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  insur-
 er's  website  and  the  insurer shall update the website within fifteen
 days of the addition or termination of a  provider  from  the  insurer's
 network or a change in a physician's hospital affiliation;
   (19) with respect to out-of-network coverage:
   (A)  a  clear  description  of  the methodology used by the insurer to
 determine reimbursement for out-of-network health care services;
   (B) the amount that the insurer will reimburse under  the  methodology
 for out-of-network health care services set forth as a percentage of the
 usual and customary cost for out-of-network health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (20) information in writing  and  through  an  internet  website  that
 reasonably  permits  an  insured  or prospective insured to estimate the
 anticipated out-of-pocket cost for out-of-network health  care  services
 in  a  geographical  area  or zip code based upon the difference between
 what the insurer will reimburse for out-of-network health care  services
 and  the  usual  and  customary  cost  for  out-of-network  health  care
 services[.]; AND
   (21) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE INSURER  TO
 ASSESS THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE PAUL
 WELLSTONE  AND  PETE  DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY
 ACT OF 2008, 42 U.S.C. 18031(J), AND  ANY  AMENDMENTS  TO,  AND  FEDERAL
 GUIDANCE OR REGULATIONS ISSUED UNDER THOSE ACTS.

 S. 1507--B                         107
 
   §  10. Subsection (b) of section 3217-b of the insurance law, as added
 by chapter 705 of the laws of 1996, is amended to read as follows:
   (b)  No  insurer  subject  to  this article shall by contract, written
 policy [or], written procedure OR  PRACTICE  prohibit  or  restrict  any
 health  care  provider  from  filing  a  complaint,  making  a report or
 commenting to an appropriate governmental body regarding the policies or
 practices of such insurer which the  provider  believes  may  negatively
 impact  upon  the  quality of, or access to, patient care.  NOR SHALL AN
 INSURER SUBJECT TO THIS ARTICLE TAKE ANY ADVERSE ACTION,  INCLUDING  BUT
 NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR AGREEMENT WITH
 A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVIDER FOR
 FILING  A  COMPLAINT,  MAKING  A  REPORT OR COMMENTING TO AN APPROPRIATE
 GOVERNMENTAL BODY REGARDING POLICIES OR PRACTICES OF SUCH INSURER  WHICH
 MAY  VIOLATE THIS CHAPTER INCLUDING PARAGRAPHS THIRTY, AS ADDED BY CHAP-
 TER FORTY-ONE OF THE LAWS OF 2014, THIRTY-ONE, THIRTY-ONE-A AND  THIRTY-
 FIVE  OF  SUBSECTION (I) OF SECTION THIRTY-TWO HUNDRED SIXTEEN AND PARA-
 GRAPHS FIVE, SIX, SEVEN,  SEVEN-A  AND  SEVEN-B  OF  SUBSECTION  (L)  OF
 SECTION THIRTY-TWO HUNDRED TWENTY-ONE OF THIS ARTICLE.
   §  11.  Subparagraph  (A)  of paragraph 4 of subsection (l) of section
 3221 of the insurance law, as amended by chapter  230  of  the  laws  of
 2004, is amended to read as follows:
   (A)  Every insurer delivering a group policy or issuing a group policy
 for delivery, in this state, [which]  THAT  provides  reimbursement  for
 psychiatric or psychological services or for the diagnosis and treatment
 of  mental[,  nervous or emotional disorders and ailments] HEALTH CONDI-
 TIONS, however defined in such policy, by physicians,  psychiatrists  or
 psychologists, [must] SHALL make available and if requested by the poli-
 cyholder  provide  the  same coverage to insureds for such services when
 performed by a licensed clinical social worker, within the lawful  scope
 of  his or her practice, who is licensed pursuant to article one hundred
 fifty-four of the education law. Written notice of the  availability  of
 such  coverage shall be delivered to the policyholder prior to inception
 of such group policy and annually thereafter, except  that  this  notice
 shall  not be required where a policy covers two hundred or more employ-
 ees or where  the  benefit  structure  was  the  subject  of  collective
 bargaining affecting persons who are employed in more than one state.
   §  12.  Subparagraph  (D)  of paragraph 4 of subsection (l) of section
 3221 of the insurance law, as amended by section 50 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (D) In addition to the requirements of subparagraph (A) of this  para-
 graph,  every  insurer issuing a group policy for delivery in this state
 where the policy provides reimbursement to insureds for  psychiatric  or
 psychological  services  or  for the diagnosis and treatment of mental[,
 nervous or emotional disorders and ailments] HEALTH CONDITIONS,  however
 defined  in  such policy, by physicians, psychiatrists or psychologists,
 shall provide the same coverage  to  insureds  for  such  services  when
 performed  by a licensed clinical social worker, within the lawful scope
 of his or her practice, who is licensed pursuant to subdivision  two  of
 section  seven  thousand  seven hundred four of the education law and in
 addition shall have either: (i) three or more additional  years  experi-
 ence in psychotherapy, which for the purposes of this subparagraph shall
 mean  the  use of verbal methods in interpersonal relationships with the
 intent of assisting a person or persons to modify attitudes and behavior
 that are intellectually,  socially  or  emotionally  maladaptive,  under
 supervision,  satisfactory  to  the  state  board  for social work, in a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental

 S. 1507--B                         108
 
 department,  providing  services  for diagnosis or treatment of mental[,
 nervous or emotional disorders  or  ailments]  HEALTH  CONDITIONS;  (ii)
 three  or  more  additional  years experience in psychotherapy under the
 supervision,  satisfactory  to  the  state  board  for social work, of a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical social worker qualified for reimbursement  pursuant  to  subsection
 (e)  of this section, or (iii) a combination of the experience specified
 in items (i) and (ii) of this subparagraph totaling three years,  satis-
 factory to the state board for social work.
   §  13.  Subparagraphs  (A) and (B) of paragraph 5 of subsection (l) of
 section 3221 of the insurance law, as amended by chapter 502 of the laws
 of 2007, are amended to read as follows:
   (A) Every insurer delivering a group or school blanket policy or issu-
 ing a group or school blanket policy for delivery, in this state,  which
 provides  coverage for inpatient hospital care or coverage for physician
 services shall provide [as part of such policy broad-based] coverage for
 the diagnosis and treatment of mental[, nervous or  emotional  disorders
 or  ailments,  however  defined  in  such  policy, at least equal to the
 coverage provided for other] health conditions and:
   (i) where the policy provides coverage for  inpatient  hospital  care,
 benefits  for inpatient care in a hospital as defined by subdivision ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed to not less than thirty days of  active  treatment  in  any  contract
 year,  plan  year  or  calendar  year,] and benefits for outpatient care
 provided in a facility issued an operating certificate  by  the  commis-
 sioner of mental health pursuant to the provisions of article thirty-one
 of  the  mental  hygiene law, or in a facility operated by the office of
 mental health[, which benefits may be limited to not  less  than  twenty
 visits  in  any  contract year, plan year or calendar year. Benefits for
 partial hospitalization program services shall be provided as an  offset
 to  covered  inpatient  days  at  a ratio of two partial hospitalization
 visits to one inpatient day of treatment.]  OR,  FOR  CARE  PROVIDED  IN
 OTHER  STATES,  TO  SIMILARLY LICENSED OR CERTIFIED HOSPITALS OR FACILI-
 TIES; AND
   (ii) where the policy provides coverage  for  physician  services,  it
 shall include benefits for outpatient care provided by a psychiatrist or
 psychologist  licensed  to  practice  in this state, a licensed clinical
 social worker who meets the requirements of subparagraph  (D)  of  para-
 graph four of this subsection, A NURSE PRACTITIONER LICENSED TO PRACTICE
 IN THIS STATE, or a professional corporation or university faculty prac-
 tice corporation thereof. [Such benefits may be limited to not less than
 twenty visits in any contract year, plan year, or calendar year.]
   [(iii)]  (B) Coverage required by this paragraph may be [provided on a
 contract year, plan year or calendar year basis and shall be  consistent
 with the provision of other benefits under the policy. Such coverage may
 be]  subject  to  annual  deductibles, co-pays and coinsurance as may be
 deemed appropriate by the superintendent and shall  be  consistent  with
 those  imposed  on other benefits under the policy. [In the event that a
 policy provides coverage for both inpatient hospital care and  physician
 services,  the  aggregate  of  the benefits for outpatient care obtained
 under this paragraph may be limited to not less than  twenty  visits  in
 any contract year, plan year or calendar year.
   (iv)  In  this paragraph, "active treatment" means treatment furnished
 in  conjunction  with  inpatient  confinement  for  mental,  nervous  or
 emotional  disorders or ailments that meet standards prescribed pursuant
 to the regulations of the commissioner of mental health.

 S. 1507--B                         109

   (B) (i) Every insurer delivering a group or school blanket  policy  or
 issuing  a  group  or school blanket policy for delivery, in this state,
 which provides coverage for inpatient  hospital  care  or  coverage  for
 physician  services,  shall  provide  comparable coverage for adults and
 children  with  biologically  based  mental illness. Such group policies
 issued or delivered in this state shall  also  provide  such  comparable
 coverage for children with serious emotional disturbances. Such coverage
 shall  be  provided  under the terms and conditions otherwise applicable
 under the policy, including network limitations  or  variations,  exclu-
 sions,  co-pays, coinsurance, deductibles or other specific cost sharing
 mechanisms. Provided further, where a policy  provides  both  in-network
 and  out-of-network  benefits,  the  out-of-network  benefits  may  have
 different coinsurance, co-pays,  or  deductibles,  than  the  in-network
 benefits,  regardless of whether the policy is written under one license
 or two licenses.
   (ii) For purposes of this  paragraph,  the  term  "biologically  based
 mental  illness" means a mental, nervous, or emotional condition that is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the functioning of the person with the illness. Such biologically  based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression,  bipolar  disorder,  delusional  disorders,  panic disorder,
 obsessive compulsive disorders, bulimia, and anorexia.] PROVIDED THAT NO
 COPAYMENT OR COINSURANCE IMPOSED FOR OUTPATIENT MENTAL  HEALTH  SERVICES
 PROVIDED  IN  A  FACILITY LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED BY
 THE OFFICE OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS  OR  COINSURANCE
 IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE POLICY.
   §  14. Subparagraphs (C), (D) and (E) of paragraph 5 of subsection (l)
 of section 3221 of the insurance law are REPEALED and five new  subpara-
 graphs (C), (D), (E), (F) and (G) are added to read as follows:
   (C)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT  ARE  MORE
 RESTRICTIVE  THAN  THE  PREDOMINANT FINANCIAL REQUIREMENTS AND TREATMENT
 LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND  SURGICAL  BENEFITS
 COVERED BY THE POLICY.
   (D) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT  TO  MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE BY THE
 INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK PROVIDER UPON
 REQUEST.
   (E) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,

 S. 1507--B                         110
 
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "MENTAL  HEALTH  CONDITION"  MEANS ANY MENTAL HEALTH DISORDER AS
 DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
 MANUAL  OF MENTAL DISORDERS OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (F) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   (G) THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT  ARE
 LICENSED  BY  THE  OFFICE OF MENTAL HEALTH THAT ARE PARTICIPATING IN THE
 INSURER'S PROVIDER NETWORK. WHERE THE POLICY PROVIDES COVERAGE FOR INPA-
 TIENT HOSPITAL CARE, BENEFITS FOR INPATIENT HOSPITAL CARE IN A  HOSPITAL
 AS  DEFINED BY SUBDIVISION TEN OF SECTION 1.03 OF THE MENTAL HYGIENE LAW
 PROVIDED TO INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF EIGHTEEN  SHALL
 NOT  BE  SUBJECT TO PREAUTHORIZATION. COVERAGE PROVIDED UNDER THIS PARA-
 GRAPH SHALL ALSO NOT BE SUBJECT TO CONCURRENT UTILIZATION REVIEW  DURING
 THE FIRST FOURTEEN DAYS OF THE INPATIENT ADMISSION, PROVIDED THE FACILI-
 TY  NOTIFIES THE INSURER OF BOTH THE ADMISSION AND THE INITIAL TREATMENT
 PLAN WITHIN TWO BUSINESS DAYS OF THE ADMISSION, PERFORMS DAILY  CLINICAL
 REVIEW  OF  THE  PATIENT, AND PARTICIPATES IN PERIODIC CONSULTATION WITH
 THE INSURER TO ENSURE THAT THE FACILITY IS USING THE EVIDENCE-BASED  AND
 PEER  REVIEWED CLINICAL REVIEW CRITERIA UTILIZED BY THE INSURER WHICH IS
 APPROVED BY THE OFFICE OF MENTAL HEALTH AND APPROPRIATE TO  THE  AGE  OF
 THE  PATIENT,  TO  ENSURE THAT THE INPATIENT CARE IS MEDICALLY NECESSARY
 FOR THE PATIENT. ALL TREATMENT PROVIDED UNDER THIS SUBPARAGRAPH  MAY  BE
 REVIEWED  RETROSPECTIVELY.  WHERE  CARE  IS  DENIED  RETROSPECTIVELY, AN
 INSURED SHALL NOT HAVE ANY FINANCIAL OBLIGATION TO THE FACILITY FOR  ANY
 TREATMENT UNDER THIS SUBPARAGRAPH OTHER THAN ANY COPAYMENT, COINSURANCE,
 OR DEDUCTIBLE OTHERWISE REQUIRED UNDER THE POLICY.
   §  15. Subparagraphs (A), (B) and (D) of paragraph 6 of subsection (l)
 of section 3221 of the insurance law, as amended by section 2 of part  B
 of  chapter  71  of the laws of 2016, are amended and three new subpara-
 graphs (E), (F) and (G) are added to read as follows:
   (A) Every policy that provides  hospital,  major  medical  or  similar
 comprehensive  coverage  [must] SHALL provide inpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion and rehabilitation services. Such inpatient coverage shall  include
 unlimited  medically  necessary  treatment  for  substance  use disorder
 treatment services provided in residential settings [as required by  the
 Mental  Health  Parity  and  Addiction  Equity  Act of 2008 (29 U.S.C. §
 1185a)].  Further, such inpatient coverage  shall  not  apply  financial
 requirements  or  treatment  limitations,  including  utilization review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive than the predominant financial  requirements  and  treatment
 limitations  applied  to substantially all medical and surgical benefits
 covered by  the  policy.  [Further,  such  coverage  shall  be  provided
 consistent  with  the  federal  Paul  Wellstone and Pete Domenici Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (B) Coverage provided under this paragraph may be limited  to  facili-
 ties  in  New York state [which are certified] THAT ARE LICENSED, certi-
 fied OR OTHERWISE AUTHORIZED by the office of alcoholism  and  substance
 abuse  services  and,  in other states, to those which are accredited by
 the joint commission as alcoholism, substance abuse or chemical  depend-

 S. 1507--B                         111
 
 ence treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED, OR OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (D) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED,  certified OR OTHERWISE AUTHORIZED by the office of alcoholism
 and substance abuse services that are  participating  in  the  insurer's
 provider  network.  Coverage  provided under this paragraph shall not be
 subject to preauthorization.  Coverage  provided  under  this  paragraph
 shall  also  not  be subject to concurrent utilization review during the
 first [fourteen] TWENTY-EIGHT days of the inpatient  admission  provided
 that  the  facility  notifies  the insurer of both the admission and the
 initial treatment plan within [forty-eight hours] TWO BUSINESS  DAYS  of
 the  admission.  The facility shall perform daily clinical review of the
 patient, including [the] periodic consultation with the  insurer  AT  OR
 JUST  PRIOR  TO  THE FOURTEENTH DAY OF THE INPATIENT ADMISSION to ensure
 that the facility is using the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism and substance abuse services and appropriate to  the  age  of
 the  patient, to ensure that the inpatient treatment is medically neces-
 sary for the patient.  PRIOR TO DISCHARGE, THE  FACILITY  SHALL  PROVIDE
 THE  PATIENT  AND  THE INSURER WITH A WRITTEN DISCHARGE PLAN WHICH SHALL
 DESCRIBE ARRANGEMENTS FOR ADDITIONAL SERVICES NEEDED FOLLOWING DISCHARGE
 FROM THE INPATIENT FACILITY AS DETERMINED USING THE  EVIDENCE-BASED  AND
 PEER-REVIEWED  CLINICAL  REVIEW  TOOL  UTILIZED  BY THE INSURER WHICH IS
 DESIGNATED BY THE OFFICE OF ALCOHOLISM  AND  SUBSTANCE  ABUSE  SERVICES.
 PRIOR  TO  DISCHARGE, THE FACILITY SHALL INDICATE TO THE INSURER WHETHER
 SERVICES INCLUDED IN THE DISCHARGE PLAN ARE SECURED OR DETERMINED TO  BE
 REASONABLY AVAILABLE. Any utilization review of treatment provided under
 this  subparagraph  may include a review of all services provided during
 such inpatient treatment, including all  services  provided  during  the
 first   [fourteen]   TWENTY-EIGHT  days  of  such  inpatient  treatment.
 Provided, however, the insurer shall only deny coverage for any  portion
 of  the  initial  [fourteen] TWENTY-EIGHT day inpatient treatment on the
 basis that such treatment was not medically necessary if such  inpatient
 treatment  was contrary to the evidence-based and peer reviewed clinical
 review tool utilized by the insurer which is designated by the office of
 alcoholism and substance abuse services. An insured shall not  have  any
 financial  obligation  to  the  facility  for  any  treatment under this
 subparagraph other than any copayment, coinsurance, or deductible other-
 wise required under the policy.
   (E) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO INPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE  MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (F) FOR PURPOSES OF THIS PARAGRAPH:
   (I)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II) "PREDOMINANT" MEANS THAT A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS  THE  MOST  COMMON  OR  FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY  OF  TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE  OR  DURATION  OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR  EXCLUDING
 BENEFITS  BASED  ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-

 S. 1507--B                         112
 
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV)  "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (G) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  16.  Subparagraphs  (A) and (B) of paragraph 7 of subsection (l) of
 section 3221 of the insurance law, as amended by chapter 41 of the  laws
 of  2014,  are  amended and a new subparagraph (C-1) is added to read as
 follows:
   (A) Every policy that  provides  medical,  major  medical  or  similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication  and  rehabilitation  services.  Such  coverage shall not apply
 financial requirements or treatment limitations to outpatient  substance
 use  disorder  benefits  that  are more restrictive than the predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the policy.    [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (B) Coverage under this paragraph may be limited to facilities in  New
 York  state  THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED by the
 office of alcoholism and substance abuse services [or licensed  by  such
 office   as   outpatient  clinics  or  medically  supervised  ambulatory
 substance abuse programs] TO PROVIDE OUTPATIENT SUBSTANCE  USE  DISORDER
 SERVICES  and,  in  other  states,  to those which are accredited by the
 joint commission as alcoholism or chemical dependence treatment programs
 AND SIMILARLY LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED IN  THE  STATE
 IN WHICH THE FACILITY IS LOCATED.
   (C-1) A LARGE GROUP POLICY THAT PROVIDES COVERAGE UNDER THIS PARAGRAPH
 MAY  NOT  IMPOSE  COPAYMENTS OR COINSURANCE FOR OUTPATIENT SUBSTANCE USE
 DISORDER SERVICES THAT EXCEEDS THE COPAYMENT OR COINSURANCE IMPOSED  FOR
 A  PRIMARY  CARE OFFICE VISIT. PROVIDED THAT ONLY ONE SUCH COPAYMENT MAY
 BE IMPOSED FOR ALL SERVICES PROVIDED IN  A  SINGLE  DAY  BY  A  FACILITY
 LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED BY THE OFFICE OF ALCOHOLISM
 AND SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT SUBSTANCE USE  DISOR-
 DER SERVICES.
   §  17.  Subparagraph  (E)  of paragraph 7 of subsection (l) of section
 3221 of the insurance law, as added by section 4 of part MM  of  chapter
 57  of the laws of 2018, is amended and three new subparagraphs (F), (G)
 and (H) are added to read as follows:
   (E) This subparagraph shall apply to facilities in this state THAT ARE
 LICENSED, certified OR OTHERWISE AUTHORIZED by the office of  alcoholism
 and  substance abuse services for the provision of outpatient, intensive
 outpatient, outpatient rehabilitation  and  opioid  treatment  that  are
 participating in the insurer's provider network. Coverage provided under
 this  paragraph  shall  not  be  subject  to  preauthorization. Coverage

 S. 1507--B                         113
 
 provided under this paragraph shall not be subject to concurrent  review
 for  the  first  [two] FOUR weeks of continuous treatment, not to exceed
 [fourteen] TWENTY-EIGHT  visits,  provided  the  facility  notifies  the
 insurer  of  both  the start of treatment and the initial treatment plan
 within [forty-eight hours]  TWO  BUSINESS  DAYS.    The  facility  shall
 perform  clinical  assessment  of  the  patient at each visit, including
 [the] periodic consultation with the insurer AT OR  JUST  PRIOR  TO  THE
 FOURTEENTH  DAY  OF  TREATMENT  to ensure that the facility is using the
 evidence-based and peer reviewed clinical review tool  utilized  by  the
 insurer  which  is  designated by the office of alcoholism and substance
 abuse services and appropriate to the age of the patient, to ensure that
 the outpatient treatment is medically necessary for the  patient.    Any
 utilization review of the treatment provided under this subparagraph may
 include  a review of all services provided during such outpatient treat-
 ment, including all services provided during the first [two] FOUR  weeks
 of  continuous  treatment, not to exceed [fourteen] TWENTY-EIGHT visits,
 of such outpatient treatment. Provided, however, the insurer shall  only
 deny coverage for any portion of the initial [two] FOUR weeks of contin-
 uous treatment, not to exceed [fourteen] TWENTY-EIGHT visits, for outpa-
 tient  treatment  on  the  basis  that  such treatment was not medically
 necessary if such outpatient treatment was  contrary  to  the  evidence-
 based  and  peer  reviewed  clinical review tool utilized by the insurer
 which is designated by the office  of  alcoholism  and  substance  abuse
 services.  An  insured  shall  not  have any financial obligation to the
 facility for any treatment under this subparagraph other than any copay-
 ment, coinsurance, or deductible otherwise required under the policy.
   (F) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH RESPECT TO OUTPATIENT SUBSTANCE USE DISORDER BENEFITS SHALL BE MADE
 AVAILABLE BY THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NET-
 WORK PROVIDER UPON REQUEST.
   (G) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF TREATMENT AND  INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS  SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER  THE  TREATMENT
 IS  EXPERIMENTAL  OR  INVESTIGATIONAL; FORMULARY DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO  PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS;  EXCLUSIONS  BASED  ON FAILURE TO COMPLETE A COURSE OF TREAT-
 MENT; AND RESTRICTIONS BASED  ON  GEOGRAPHIC  LOCATION,  FACILITY  TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY; AND
   (IV) "SUBSTANCE USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN  THE
 MOST  RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
 DISORDERS OR THE MOST RECENT EDITION  OF  ANOTHER  GENERALLY  RECOGNIZED
 INDEPENDENT  STANDARD  OF  CURRENT MEDICAL PRACTICE SUCH AS THE INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.

 S. 1507--B                         114
 
   (H) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   § 18. Paragraph 7-b of subsection (l) of section 3221 of the insurance
 law,  as added by section 2 of part B of chapter 69 of the laws of 2016,
 is amended to read as follows:
   (7-b) [(A)] Every policy that provides medical, major medical or simi-
 lar comprehensive-type coverage and provides coverage  for  prescription
 drugs for medication for the treatment of a substance use disorder shall
 include  immediate  access,  without prior authorization, [to a five day
 emergency supply] TO  THE  FORMULARY  FORMS  of  prescribed  medications
 covered  under  the  policy  for the treatment of substance use disorder
 [where an emergency condition exists], including a  prescribed  drug  or
 medication  associated  with  the management of opioid withdrawal and/or
 stabilization, except where otherwise prohibited by law. Further, cover-
 age [of an emergency supply] WITHOUT PRIOR AUTHORIZATION  shall  include
 FORMULARY  FORMS  medication  for  opioid  overdose  reversal  otherwise
 covered under the  policy  prescribed  OR  DISPENSED  to  an  individual
 covered by the policy.
   [(B)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in clause (i), (ii), or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (C) Coverage provided under this paragraph may be  subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the policy; provided, however, no
 policy shall impose an additional copayment or coinsurance on an insured
 who received an emergency supply of medication and then received up to a
 thirty day supply of the same medication in the same thirty  day  period
 in which the emergency supply of medication was dispensed. This subpara-
 graph shall not preclude the imposition of a copayment or coinsurance on
 the  initial  emergency  supply  of medication in an amount that is less
 than the copayment or coinsurance otherwise applicable to a  thirty  day
 supply of such medication, provided that the total sum of the copayments
 or  coinsurance  for  an entire thirty day supply of the medication does
 not exceed the copayment or coinsurance otherwise applicable to a thirty
 day supply of such medication.]
   § 19. Subparagraph (B) of paragraph 17 of subsection  (l)  of  section
 3221 of the insurance law, as amended by section 39 of part D of chapter
 56 of the laws of 2013, is amended to read as follows:
   (B)  Every  group  or blanket policy that provides physician services,
 medical, major medical  or  similar  comprehensive-type  coverage  shall
 provide  coverage  for  the screening, diagnosis and treatment of autism
 spectrum disorder in  accordance  with  this  paragraph  and  shall  not
 exclude  coverage  for  the screening, diagnosis or treatment of medical
 conditions otherwise covered by the policy  because  the  individual  is

 S. 1507--B                         115
 
 diagnosed with autism spectrum disorder. Such coverage may be subject to
 annual  deductibles,  copayments and coinsurance as may be deemed appro-
 priate by the superintendent and shall be consistent with those  imposed
 on  other  benefits  under  the  group  or blanket policy. [Coverage for
 applied behavior analysis shall be subject to a maximum benefit  of  six
 hundred  eighty  hours  of  treatment  per  policy  or calendar year per
 covered individual.] This paragraph shall not be construed  as  limiting
 the  benefits  that  are  otherwise available to an individual under the
 group or blanket policy, provided however that  such  policy  shall  not
 contain  any limitations on visits that are solely applied to the treat-
 ment of autism spectrum disorder. No insurer shall terminate coverage or
 refuse to deliver, execute, issue, amend, adjust, or renew  coverage  to
 an  individual  solely  because  the individual is diagnosed with autism
 spectrum disorder or has received treatment for autism  spectrum  disor-
 der.  Coverage  shall  be  subject  to  utilization  review and external
 appeals of health care services pursuant to article forty-nine  of  this
 chapter  as  well  as[,]  case  management[,]  and  other  managed  care
 provisions.
   § 20. Items (i) and (iii) of  subparagraph  (C)  of  paragraph  17  of
 subsection (l) of section 3221 of the insurance law, as amended by chap-
 ter 596 of the laws of 2011, are amended to read as follows:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental disorders[, including autistic disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  when  provided  by  a licensed provider, and applied behavior
 analysis, when provided [or supervised] by a [behavior  analyst]  PERSON
 LICENSED,  certified  [pursuant  to  the  behavior analyst certification
 board,] OR OTHERWISE AUTHORIZED TO PROVIDE  APPLIED  BEHAVIOR  ANALYSIS,
 that  are  necessary  to  develop,  maintain, or restore, to the maximum
 extent practicable, the functioning of an individual. [Individuals  that
 provide behavioral health treatment under the supervision of a certified
 behavior  analyst  pursuant to this paragraph shall be subject to stand-
 ards of professionalism, supervision and relevant experience pursuant to
 regulations promulgated by the superintendent in consultation  with  the
 commissioners of health and education.]
   §  21. Paragraph 17 of subsection (l) of section 3221 of the insurance
 law is amended by adding four new subparagraphs (H), (I), (J) and (K) to
 read as follows:
   (H) COVERAGE UNDER THIS PARAGRAPH SHALL NOT APPLY  FINANCIAL  REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE  MORE    RESTRICTIVE THAN THE PREDOMINANT FINANCIAL REQUIREMENTS AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.
   (I) THE CRITERIA FOR MEDICAL NECESSITY DETERMINATIONS UNDER THE POLICY
 WITH  RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE  AVAIL-
 ABLE  BY  THE INSURER TO ANY INSURED, PROSPECTIVE INSURED, OR IN-NETWORK
 PROVIDER UPON  REQUEST.
   (J) FOR PURPOSES OF THIS PARAGRAPH:
   (I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (II)  "PREDOMINANT"  MEANS  THAT  A FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT; AND

 S. 1507--B                         116
 
   (III)  "TREATMENT  LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
 MENT, NUMBER  OF VISITS, DAYS OF COVERAGE, OR OTHER  SIMILAR  LIMITS  ON
 THE  SCOPE OR DURATION OF  TREATMENT AND INCLUDES NONQUANTITATIVE TREAT-
 MENT LIMITATIONS SUCH AS: MEDICAL    MANAGEMENT  STANDARDS  LIMITING  OR
 EXCLUDING  BENEFITS BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE
 TREATMENT IS EXPERIMENTAL OR  INVESTIGATIONAL;  FORMULARY    DESIGN  FOR
 PRESCRIPTION  DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMIS-
 SION TO PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS
 FOR DETERMINING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST  OR
 STEP THERAPY PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE
 OF  TREATMENT;  AND  RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY
 TYPE, PROVIDER SPECIALTY, AND OTHER CRITERIA THAT  LIMIT  THE  SCOPE  OR
 DURATION OF  BENEFITS FOR SERVICES PROVIDED UNDER THE POLICY.
   (K) AN INSURER SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A MINI-
 MUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI MENTAL
 HEALTH  PARITY AND ADDICTION EQUITY ACT OF 2008 (29 U.S.C. § 1185A).
   §  22. Paragraphs 1, 2, and 3 of subsection (g) of section 4303 of the
 insurance law, as amended by chapter  502  of  the  laws  of  2007,  are
 amended to read as follows:
   [(1)] A MEDICAL EXPENSE INDEMNITY CORPORATION, hospital service corpo-
 ration  or  a  health  service corporation, [which] THAT provides group,
 group remittance or  school  blanket  coverage  for  inpatient  hospital
 care[,]  OR COVERAGE FOR PHYSICIAN SERVICES shall provide as part of its
 contract [broad-based] coverage  for  the  diagnosis  and  treatment  of
 mental[,  nervous or emotional disorders or ailments, however defined in
 such contract, at least equal to the coverage provided for other] health
 conditions and [shall include]:
   [(A)]
   (1) WHERE THE CONTRACT PROVIDES COVERAGE FOR INPATIENT HOSPITAL  CARE,
 benefits for in-patient care in a hospital as defined by subdivision ten
 of section 1.03 of the mental hygiene law[, which benefits may be limit-
 ed  to  not  less  than  thirty days of active treatment in any contract
 year, plan year or calendar year.
   (B)] OR FOR INPATIENT CARE PROVIDED  IN  OTHER  STATES,  TO  SIMILARLY
 LICENSED  HOSPITALS,  AND  benefits  for  out-patient care provided in a
 facility issued an operating certificate by the commissioner  of  mental
 health  pursuant  to  the provisions of article thirty-one of the mental
 hygiene law or in a facility operated by the office of  mental  health[,
 which  benefits  may  be  limited  to not less than twenty visits in any
 contract year, plan year or calendar year. Benefits for  partial  hospi-
 talization  program  services  shall be provided as an offset to covered
 inpatient days at a ratio of two partial hospitalization visits  to  one
 inpatient day of treatment.
   (C)  Such  coverage  may  be provided on a contract year, plan year or
 calendar year basis and shall be consistent with the provision of  other
 benefits  under the contract.] OR FOR OUT-PATIENT CARE PROVIDED IN OTHER
 STATES, TO SIMILARLY CERTIFIED FACILITIES; AND
   (2) WHERE THE CONTRACT PROVIDES COVERAGE FOR PHYSICIAN SERVICES  BENE-
 FITS  FOR  OUTPATIENT  CARE  PROVIDED  BY A PSYCHIATRIST OR PSYCHOLOGIST
 LICENSED TO PRACTICE IN THIS STATE, A LICENSED  CLINICAL  SOCIAL  WORKER
 WHO  MEETS  THE  REQUIREMENTS OF SUBSECTION (N) OF THIS SECTION, A NURSE
 PRACTITIONER LICENSED TO PRACTICE ON THIS STATE, OR PROFESSIONAL  CORPO-
 RATION OR UNIVERSITY FACULTY PRACTICE CORPORATION THEREOF.
   (3)  Such  coverage  may be subject to annual deductibles, co-pays and
 coinsurance as may be deemed appropriate by the superintendent and shall
 be consistent with those imposed on other benefits under  the  contract.

 S. 1507--B                         117
 
 PROVIDED  THAT NO COPAYMENT OR COINSURANCE IMPOSED FOR OUTPATIENT MENTAL
 HEALTH SERVICES PROVIDED IN A FACILITY LICENSED, CERTIFIED OR  OTHERWISE
 AUTHORIZED BY THE OFFICE OF MENTAL HEALTH SHALL EXCEED THE COPAYMENTS OR
 COINSURANCE IMPOSED FOR A PRIMARY CARE OFFICE VISIT UNDER THE CONTRACT.
   [(D)  For  the  purpose  of  this subsection, "active treatment" means
 treatment furnished  in  conjunction  with  in-patient  confinement  for
 mental, nervous or emotional disorders or ailments that meet such stand-
 ards  as  shall be prescribed pursuant to the regulations of the commis-
 sioner of mental health.
   (E) In the event the group remittance  group  or  contract  holder  is
 provided  coverage  under  this  subsection  and  under paragraph one of
 subsection (h) of this section from the same health service corporation,
 or under a contract that is jointly underwritten by two  health  service
 corporations  or  by  a health service corporation and a medical expense
 indemnity corporation, the aggregate of the benefits for outpatient care
 obtained under subparagraph (B) of this paragraph and paragraph  one  of
 subsection  (h)  of  this section may be limited to not less than twenty
 visits in any contract year, plan year or calendar year.
   (2) (A) A hospital service corporation  or  a  health  service  corpo-
 ration,  which provides group, group remittance or school blanket cover-
 age for inpatient hospital care, shall provide comparable  coverage  for
 adults  and children with biologically based mental illness. Such hospi-
 tal service corporation or health service corporation shall also provide
 such comparable coverage for children with  serious  emotional  disturb-
 ances.  Such  coverage  shall be provided under the terms and conditions
 otherwise applicable under the contract, including  network  limitations
 or  variations,  exclusions,  co-pays, coinsurance, deductibles or other
 specific cost sharing mechanisms. Provided  further,  where  a  contract
 provides both in-network and out-of-network benefits, the out-of-network
 benefits  may  have different coinsurance, co-pays, or deductibles, than
 the in-network benefits, regardless of whether the contract  is  written
 under one license or two licenses.
   (B)  For  purposes  of  this  subsection, the term "biologically based
 mental illness" means a mental, nervous, or emotional condition that  is
 caused by a biological disorder of the brain and results in a clinically
 significant, psychological syndrome or pattern that substantially limits
 the  functioning of the person with the illness. Such biologically based
 mental illnesses are defined as schizophrenia/psychotic disorders, major
 depression, bipolar  disorder,  delusional  disorders,  panic  disorder,
 obsessive compulsive disorders, anorexia, and bulimia.
   (3)  For  purposes of this subsection, the term "children with serious
 emotional disturbances" means persons under the age  of  eighteen  years
 who  have  diagnoses of attention deficit disorders, disruptive behavior
 disorders, or pervasive development disorders, and where there  are  one
 or more of the following:
   (A)  serious suicidal symptoms or other life-threatening self-destruc-
 tive behaviors;
   (B) significant psychotic symptoms (hallucinations, delusion,  bizarre
 behaviors);
   (C) behavior caused by emotional disturbances that placed the child at
 risk of causing personal injury or significant property damage; or
   (D) behavior caused by emotional disturbances that placed the child at
 substantial risk of removal from the household.]
   §  23.  Paragraphs  4  and  5 of subsection (g) of section 4303 of the
 insurance law are REPEALED and five new paragraphs 4, 5, 6, 7 and 8  are
 added to read as follows:

 S. 1507--B                         118
 
   (4)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR  TREATMENT LIMITATIONS TO MENTAL HEALTH BENEFITS THAT ARE  MORE
 RESTRICTIVE  THAN   THE PREDOMINANT FINANCIAL REQUIREMENTS AND TREATMENT
 LIMITATIONS APPLIED TO  SUBSTANTIALLY ALL MEDICAL AND SURGICAL  BENEFITS
 COVERED BY THE CONTRACT.
   (5)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH  RESPECT TO MENTAL HEALTH BENEFITS SHALL BE MADE AVAILABLE
 BY THE CORPORATION TO  ANY INSURED, PROSPECTIVE INSURED,  OR  IN-NETWORK
 PROVIDER UPON REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A)  "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS, COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B) "PREDOMINANT" MEANS THAT  A  FINANCIAL  REQUIREMENT  OR  TREATMENT
 LIMITATION  IS    THE  MOST  COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
 REQUIREMENT;
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF  VISITS, DAYS OF COVERAGE, OR  OTHER  SIMILAR  LIMITS  ON  THE
 SCOPE  OR  DURATION OF  TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE  TREATMENT
 IS  EXPERIMENTAL  OR INVESTIGATIONAL; FORMULARY  DESIGN FOR PRESCRIPTION
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS   FOR  DETER-
 MINING  USUAL,  CUSTOMARY,  AND  REASONABLE  CHARGES; FAIL-FIRST OR STEP
 THERAPY PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER  SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D) "MENTAL HEALTH CONDITION" MEANS  ANY  MENTAL  HEALTH  DISORDER  AS
 DEFINED  IN  THE   MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL
 MANUAL OF MENTAL DISORDERS  OR THE MOST RECENT EDITION OF ANOTHER GENER-
 ALLY RECOGNIZED INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH AS
 THE INTERNATIONAL CLASSIFICATION OF DISEASES.
   (7) A CORPORATION SHALL PROVIDE COVERAGE UNDER THIS  PARAGRAPH,  AT  A
 MINIMUM,    CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND PETE DOMENICI
 MENTAL HEALTH  PARITY AND ADDICTION EQUITY ACT  OF  2008  (29  U.S.C.  §
 1185A).
   (8)  THIS SUBPARAGRAPH SHALL APPLY TO HOSPITALS IN THIS STATE THAT ARE
 LICENSED BY THE OFFICE OF MENTAL HEALTH THAT ARE  PARTICIPATING  IN  THE
 CORPORATION'S PROVIDER NETWORK. WHERE THE CONTRACT PROVIDES COVERAGE FOR
 INPATIENT  HOSPITAL  CARE,  BENEFITS  FOR  INPATIENT  HOSPITAL CARE IN A
 HOSPITAL AS  DEFINED BY SUBDIVISION TEN OF SECTION 1.03  OF  THE  MENTAL
 HYGIENE  LAW  PROVIDED  TO  INDIVIDUALS WHO HAVE NOT ATTAINED THE AGE OF
 EIGHTEEN SHALL NOT BE SUBJECT  TO  PREAUTHORIZATION.  COVERAGE  PROVIDED
 UNDER  THIS  PARAGRAPH SHALL ALSO NOT BE  SUBJECT TO CONCURRENT UTILIZA-
 TION REVIEW DURING THE FIRST FOURTEEN DAYS OF THE  INPATIENT  ADMISSION,
 PROVIDED THE FACILITY NOTIFIES THE CORPORATION OF BOTH THE ADMISSION AND
 THE  INITIAL  TREATMENT  PLAN WITHIN TWO BUSINESS DAYS OF THE ADMISSION,
 PERFORMS DAILY CLINICAL REVIEW OF THE PATIENT, AND PARTICIPATES IN PERI-
 ODIC CONSULTATION WITH THE CORPORATION TO ENSURE THAT  THE  FACILITY  IS
 USING  THE  EVIDENCE-BASED  AND  PEER  REVIEWED CLINICAL REVIEW CRITERIA
 UTILIZED BY THE CORPORATION WHICH IS APPROVED BY THE  OFFICE  OF  MENTAL
 HEALTH  AND  APPROPRIATE  TO  THE AGE OF THE PATIENT, TO ENSURE THAT THE
 INPATIENT CARE IS MEDICALLY NECESSARY FOR  THE  PATIENT.  ALL  TREATMENT
 PROVIDED  UNDER THIS SUBPARAGRAPH MAY BE REVIEWED RETROSPECTIVELY. WHERE
 CARE IS DENIED RETROSPECTIVELY, AN INSURED SHALL NOT HAVE ANY  FINANCIAL

 S. 1507--B                         119
 
 OBLIGATION  TO  THE  FACILITY  FOR ANY TREATMENT UNDER THIS SUBPARAGRAPH
 OTHER THAN ANY COPAYMENT, COINSURANCE, OR DEDUCTIBLE OTHERWISE  REQUIRED
 UNDER THE CONTRACT.
   § 24. Subsection (h) of section 4303 of the insurance law is REPEALED.
   §  25. Subsection (i) of section 4303 of the insurance law, as amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (i) A medical expense indemnity corporation or health  service  corpo-
 ration  [which]  THAT provides coverage for physicians, psychiatrists or
 psychologists for psychiatric or psychological services or for the diag-
 nosis and treatment of  [mental,  nervous  or  emotional  disorders  and
 ailments]  MENTAL  HEALTH  CONDITIONS, however defined in such contract,
 [must] SHALL make available and if  requested  by  all  persons  holding
 individual  contracts  in a group whose premiums are paid by a remitting
 agent or by the contract holder in the case of a group  contract  issued
 pursuant  to  section  four thousand three hundred five of this article,
 provide the same coverage for such services when performed by a licensed
 clinical social worker, within the lawful scope of his or her  practice,
 who is licensed pursuant to article one hundred fifty-four of the educa-
 tion  law.  The state board for social work shall maintain a list of all
 licensed clinical social workers qualified for reimbursement under  this
 subsection.  Such  coverage  shall be made available at the inception of
 all new contracts and, with respect to all other contracts, at any anni-
 versary date subject to evidence of insurability. Written notice of  the
 availability  of such coverage shall be delivered to the group remitting
 agent or group contract holder prior to inception of such  contract  and
 annually thereafter, except that this notice shall not be required where
 a  [policy]  CONTRACT  covers two hundred or more employees or where the
 benefit structure was the subject  of  collective  bargaining  affecting
 persons who are employed in more than one state.
   §  26. Subsection (k) of section 4303 of the insurance law, as amended
 by section 3 of part B of chapter 71 of the laws of 2016, is amended  to
 read as follows:
   (k)(1) Every contract that provides hospital, major medical or similar
 comprehensive  coverage  [must] SHALL provide inpatient coverage for the
 diagnosis and treatment of substance use disorder, including detoxifica-
 tion and rehabilitation services. Such inpatient coverage shall  include
 unlimited  medically  necessary  treatment  for  substance  use disorder
 treatment services provided in residential settings [as required by  the
 Mental  Health  Parity  and  Addiction  Equity  Act of 2008 (29 U.S.C. §
 1185a)].  Further, such inpatient coverage  shall  not  apply  financial
 requirements  or  treatment  limitations,  including  utilization review
 requirements, to inpatient substance use disorder benefits that are more
 restrictive than the predominant financial  requirements  and  treatment
 limitations  applied  to substantially all medical and surgical benefits
 covered by the contract.  [Further,  such  coverage  shall  be  provided
 consistent  with  the  federal  Paul  Wellstone and Pete Domenici Mental
 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).]
   (2) Coverage provided under this subsection may be limited to  facili-
 ties  in  New York state [which are certified] THAT ARE LICENSED, CERTI-
 FIED OR OTHERWISE AUTHORIZED by the office of alcoholism  and  substance
 abuse  services  and,  in other states, to those which are accredited by
 the joint commission as alcoholism, substance abuse, or chemical depend-
 ence treatment programs AND ARE SIMILARLY LICENSED, CERTIFIED OR  OTHER-
 WISE AUTHORIZED IN THE STATE IN WHICH THE FACILITY IS LOCATED.
   (3)  Coverage  provided under this subsection may be subject to annual
 deductibles and co-insurance as deemed appropriate by the superintendent

 S. 1507--B                         120
 
 and that are consistent with those imposed on other  benefits  within  a
 given contract.
   (4) This paragraph shall apply to facilities in this state [certified]
 THAT  ARE  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED by the office of
 alcoholism and substance abuse services that are  participating  in  the
 corporation's  provider network. Coverage provided under this subsection
 shall not be subject to preauthorization. Coverage provided  under  this
 subsection  shall  also  not be subject to concurrent utilization review
 during the first [fourteen] TWENTY-EIGHT days of the inpatient admission
 provided that the facility notifies the corporation of both  the  admis-
 sion and the initial treatment plan within [forty-eight hours] TWO BUSI-
 NESS  DAYS  of  the admission. The facility shall perform daily clinical
 review of the patient, including [the] periodic  consultation  with  the
 corporation  AT  OR  JUST  PRIOR  TO THE FOURTEENTH DAY OF THE INPATIENT
 ADMISSION to ensure that the facility is using  the  evidence-based  and
 peer  reviewed clinical review tool utilized by the corporation which is
 designated by the office of alcoholism and substance abuse services  and
 appropriate  to  the  age  of  the patient, to ensure that the inpatient
 treatment is medically necessary for the patient.   PRIOR TO  DISCHARGE,
 THE  FACILITY SHALL PROVIDE THE PATIENT AND THE CORPORATION WITH A WRIT-
 TEN DISCHARGE PLAN WHICH  SHALL  DESCRIBE  ARRANGEMENTS  FOR  ADDITIONAL
 SERVICES  NEEDED  FOLLOWING  DISCHARGE  FROM  THE  INPATIENT FACILITY AS
 DETERMINED USING THE EVIDENCE-BASED AND  PEER-REVIEWED  CLINICAL  REVIEW
 TOOL  UTILIZED  BY  THE CORPORATION WHICH IS DESIGNATED BY THE OFFICE OF
 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES. PRIOR TO DISCHARGE, THE FACILI-
 TY SHALL INDICATE TO THE CORPORATION WHETHER SERVICES  INCLUDED  IN  THE
 DISCHARGE PLAN ARE SECURED OR DETERMINED TO BE REASONABLY AVAILABLE. Any
 utilization  review  of  treatment  provided  under  this  paragraph may
 include a review of all services provided during such  inpatient  treat-
 ment,  including all services provided during the first [fourteen] TWEN-
 TY-EIGHT days of such  inpatient  treatment.    Provided,  however,  the
 corporation  shall  only  deny  coverage  for any portion of the initial
 [fourteen] TWENTY-EIGHT day inpatient treatment on the basis  that  such
 treatment  was  not  medically necessary if such inpatient treatment was
 contrary to the evidence-based and peer reviewed  clinical  review  tool
 utilized  by  the corporation which is designated by the office of alco-
 holism and substance abuse services.  An  insured  shall  not  have  any
 financial  obligation to the facility for any treatment under this para-
 graph other than any copayment,  coinsurance,  or  deductible  otherwise
 required under the contract.
   (5)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH   RESPECT TO INPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED OR IN-NETWORK PROVIDER UPON  REQUEST.
   (6) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS  THE MOST COMMON OR FREQUENT OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT;
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER  OF    VISITS,  DAYS  OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
 SCOPE OR DURATION OF  TREATMENT AND INCLUDES  NONQUANTITATIVE  TREATMENT
 LIMITATIONS SUCH AS: MEDICAL  MANAGEMENT STANDARDS LIMITING OR EXCLUDING
 BENEFITS  BASED ON MEDICAL NECESSITY,  OR BASED ON WHETHER THE TREATMENT
 IS EXPERIMENTAL OR INVESTIGATIONAL; FORMULARY   DESIGN FOR  PRESCRIPTION

 S. 1507--B                         121
 
 DRUGS; NETWORK TIER DESIGN; STANDARDS FOR PROVIDER  ADMISSION TO PARTIC-
 IPATE  IN  A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS  FOR DETER-
 MINING USUAL, CUSTOMARY, AND  REASONABLE  CHARGES;  FAIL-FIRST  OR  STEP
 THERAPY  PROTOCOLS;  EXCLUSIONS BASED ON FAILURE TO COMPLETE A COURSE OF
 TREATMENT; AND RESTRICTIONS BASED ON GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF  BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT  EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF  MENTAL
 DISORDERS  OR  THE MOST   RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED
 INDEPENDENT STANDARD OF CURRENT  MEDICAL PRACTICE SUCH AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (7)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM,  CONSISTENT WITH THE FEDERAL PAUL WELLSTONE AND  PETE  DOMENICI
 MENTAL  HEALTH    PARITY  AND  ADDICTION EQUITY ACT OF 2008 (29 U.S.C. §
 1185A).
   § 27. Paragraphs 1 and 2 of subsection (l)  of  section  4303  of  the
 insurance law, as amended by chapter 41 of the laws of 2014, are amended
 and a new paragraph 3-a is added to read as follows:
   (1)  Every  contract  that  provides medical, major medical or similar
 comprehensive-type coverage [must] SHALL provide outpatient coverage for
 the diagnosis and treatment of substance use disorder, including detoxi-
 fication and rehabilitation services.  Such  coverage  shall  not  apply
 financial  requirements or treatment limitations to outpatient substance
 use disorder benefits that are more  restrictive  than  the  predominant
 financial requirements and treatment limitations applied to substantial-
 ly all medical and surgical benefits covered by the contract.  [Further,
 such  coverage  shall be provided consistent with the federal Paul Well-
 stone and Pete Domenici Mental Health Parity and Addiction Equity Act of
 2008 (29 U.S.C. § 1185a).]
   (2) Coverage under this subsection may be limited to facilities in New
 York state THAT ARE LICENSED, certified OR OTHERWISE AUTHORIZED  by  the
 office  of  alcoholism and substance abuse services [or licensed by such
 office as outpatient clinics  or  medically  supervised  ambulatory]  TO
 PROVIDE OUTPATIENT substance [abuse programs] USE DISORDER SERVICES and,
 in  other  states, to those which are accredited by the joint commission
 as alcoholism or chemical dependence substance abuse treatment  programs
 AND  ARE  SIMILARLY  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED IN THE
 STATE IN WHICH THE FACILITY IS LOCATED.
   (3-A) A CONTRACT THAT PROVIDES  LARGE  GROUP  COVERAGE  THAT  PROVIDES
 COVERAGE  FOR  OUTPATIENT  SUBSTANCE  USE  DISORDER  SERVICES UNDER THIS
 SUBSECTION MAY NOT  IMPOSE  COPAYMENTS  OR  COINSURANCE  FOR  OUTPATIENT
 SUBSTANCE USE DISORDER SERVICES THAT EXCEED THE COPAYMENT OR COINSURANCE
 IMPOSED  FOR  A  PRIMARY  CARE OFFICE VISIT. PROVIDED THAT ONLY ONE SUCH
 COPAYMENT MAY BE IMPOSED FOR ALL SERVICES PROVIDED IN A SINGLE DAY BY  A
 FACILITY  LICENSED,  CERTIFIED  OR OTHERWISE AUTHORIZED BY THE OFFICE OF
 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES TO PROVIDE OUTPATIENT  SUBSTANCE
 USE DISORDER SERVICES.
   §  28.  Paragraph 5 of subsection (l) of section 4303 of the insurance
 law, as added by section 5 of part MM of chapter 57 of the laws of 2018,
 is amended and three new paragraphs 6, 7 and 8  are  added  to  read  as
 follows:
   (5) This paragraph shall apply to facilities in this state [certified]
 THAT  ARE  LICENSED,  CERTIFIED OR OTHERWISE AUTHORIZED by the office of
 alcoholism and substance abuse services for the provision of outpatient,
 intensive outpatient, outpatient  rehabilitation  and  opioid  treatment

 S. 1507--B                         122
 
 that  are  participating in the corporation's provider network. Coverage
 provided under this subsection shall not be subject to preauthorization.
 Coverage provided under this subsection shall not be subject to  concur-
 rent  review for the first [two] FOUR weeks of continuous treatment, not
 to exceed [fourteen] TWENTY-EIGHT visits, provided the facility notifies
 the corporation of both the start of treatment and the initial treatment
 plan within [forty-eight hours] TWO BUSINESS DAYS.  The  facility  shall
 perform  clinical  assessment  of  the  patient at each visit, including
 [the] periodic consultation with the corporation AT OR JUST PRIOR TO THE
 FOURTEENTH DAY OF TREATMENT to ensure that the  facility  is  using  the
 evidence-based  and  peer  reviewed clinical review tool utilized by the
 corporation  which  is  designated  by  the  office  of  alcoholism  and
 substance  abuse  services and appropriate to the age of the patient, to
 ensure that the outpatient treatment  is  medically  necessary  for  the
 patient.    Any  utilization review of the treatment provided under this
 paragraph may include a review of  all  services  provided  during  such
 outpatient  treatment,  including all services provided during the first
 [two] FOUR weeks of continuous treatment, not to exceed [fourteen] TWEN-
 TY-EIGHT visits, of such outpatient treatment.  Provided,  however,  the
 corporation  shall  only  deny  coverage  for any portion of the initial
 [two] FOUR weeks of continuous treatment, not to exceed [fourteen] TWEN-
 TY-EIGHT visits, for outpatient treatment on the basis that such  treat-
 ment  was  not  medically  necessary  if  such  outpatient treatment was
 contrary to the evidence-based and peer reviewed  clinical  review  tool
 utilized  by  the corporation which is designated by the office of alco-
 holism and substance abuse services. A subscriber  shall  not  have  any
 financial  obligation to the facility for any treatment under this para-
 graph other than any copayment,  coinsurance,  or  deductible  otherwise
 required under the contract.
   (6)  THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER THE
 CONTRACT WITH RESPECT TO  OUTPATIENT  SUBSTANCE  USE  DISORDER  BENEFITS
 SHALL  BE  MADE AVAILABLE BY THE CORPORATION TO ANY INSURED, PROSPECTIVE
 INSURED, OR IN-NETWORK PROVIDER UPON REQUEST.
   (7) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT.
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR  DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT LIMITA-
 TIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING  BENE-
 FITS  BASED  ON  MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT; AND
   (D)  "SUBSTANCE  USE DISORDER" SHALL HAVE THE MEANING SET FORTH IN THE
 MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL  OF  MENTAL
 DISORDERS  OR  THE  MOST  RECENT EDITION OF ANOTHER GENERALLY RECOGNIZED

 S. 1507--B                         123
 
 INDEPENDENT STANDARD OF CURRENT MEDICAL PRACTICE SUCH  AS  THE  INTERNA-
 TIONAL CLASSIFICATION OF DISEASES.
   (8)  A  CORPORATION  SHALL PROVIDE COVERAGE UNDER THIS PARAGRAPH, AT A
 MINIMUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE  AND  PETE  DOMENICI
 MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY  ACT OF 2008 (29 U.S.C. §
 1185A).
   § 29. Subsection (l-2) of section 4303 of the insurance law, as  added
 by  section 3 of part B of chapter 69 of the laws of 2016, is amended to
 read as follows:
   (l-2) [(1)] Every contract that provides  medical,  major  medical  or
 similar   comprehensive-type   coverage   and   provides   coverage  for
 prescription drugs for medication for the treatment of a  substance  use
 disorder shall include immediate access, without prior authorization, to
 [a  five day emergency supply] THE FORMULARY FORMS of prescribed medica-
 tions covered under the contract for  the  treatment  of  substance  use
 disorder  [where  an emergency condition exists], including a prescribed
 drug or medication associated with the management of  opioid  withdrawal
 and/or stabilization, except where otherwise prohibited by law. Further,
 coverage  [of  an  emergency  supply]  WITHOUT PRIOR AUTHORIZATION shall
 include FORMULARY FORMS  OF  medication  for  opioid  overdose  reversal
 otherwise covered under the contract prescribed OR DISPENSED to an indi-
 vidual covered by the contract.
   [(2)  For purposes of this paragraph, an "emergency condition" means a
 substance use disorder condition that manifests itself by acute symptoms
 of sufficient severity, including severe  pain  or  the  expectation  of
 severe  pain, such that a prudent layperson, possessing an average know-
 ledge of medicine and health, could reasonably  expect  the  absence  of
 immediate medical attention to result in:
   (i)  placing the health of the person afflicted with such condition in
 serious jeopardy, or in the case of a behavioral condition, placing  the
 health of such person or others in serious jeopardy;
   (ii) serious impairment to such person's bodily functions;
   (iii) serious dysfunction of any bodily organ or part of such person;
   (iv) serious disfigurement of such person; or
   (v)  a  condition  described  in  clause (i), (ii) or (iii) of section
 1867(e)(1)(A) of the Social Security Act.
   (3) Coverage provided under this subsection may be subject  to  copay-
 ments,  coinsurance,  and  annual  deductibles  that are consistent with
 those imposed on other benefits within the contract; provided,  however,
 no  contract  shall  impose an additional copayment or coinsurance on an
 insured who received an emergency supply of medication and then received
 up to a thirty day supply of the same medication in the same thirty  day
 period  in  which the emergency supply of medication was dispensed. This
 paragraph shall not preclude the imposition of a  copayment  or  coinsu-
 rance  on  the initial limited supply of medication in an amount that is
 less than the copayment or coinsurance otherwise applicable to a  thirty
 day supply of such medication, provided that the total sum of the copay-
 ments  or  coinsurance for an entire thirty day supply of the medication
 does not exceed the copayment or coinsurance otherwise applicable  to  a
 thirty day supply of such medication.]
   §  30. Subsection (n) of section 4303 of the insurance law, as amended
 by chapter 230 of the laws of 2004, is amended to read as follows:
   (n) In addition to the requirements of subsection (i) of this section,
 every health service or medical expense indemnity corporation issuing  a
 group  contract  pursuant to this section or a group remittance contract
 for delivery in this state  which  contract  provides  reimbursement  to

 S. 1507--B                         124
 
 subscribers  or physicians, psychiatrists or psychologists for psychiat-
 ric or psychological services or for  the  diagnosis  and  treatment  of
 [mental,  nervous  or  emotional  disorders and ailments,] MENTAL HEALTH
 CONDITIONS,  however  defined  in  such  contract, must provide the same
 coverage to persons covered under the group contract for  such  services
 when  performed  by a licensed clinical social worker, within the lawful
 scope of his or her practice, who is licensed  pursuant  to  subdivision
 two  of  section  seven thousand seven hundred four of the education law
 and in addition shall have either (i) three  or  more  additional  years
 experience  in  psychotherapy, which for the purposes of this subsection
 shall mean the use of verbal methods in interpersonal relationships with
 the intent of assisting a person or  persons  to  modify  attitudes  and
 behavior  which are intellectually, socially or emotionally maladaptive,
 under supervision, satisfactory to the state board for social work, in a
 facility,  licensed  or  incorporated  by  an  appropriate  governmental
 department,  providing  services  for diagnosis or treatment of [mental,
 nervous or emotional disorders or ailments,] MENTAL  HEALTH  CONDITIONS,
 or (ii) three or more additional years experience in psychotherapy under
 the  supervision,  satisfactory to the state board for social work, of a
 psychiatrist, a licensed and registered psychologist or a licensed clin-
 ical social worker qualified for reimbursement  pursuant  to  subsection
 (i)  of this section, or (iii) a combination of the experience specified
 in paragraphs (i) and (ii) totaling three  years,  satisfactory  to  the
 state  board  for  social  work.   The state board for social work shall
 maintain a list of all licensed clinical social  workers  qualified  for
 reimbursement under this subsection.
   §  31. Paragraph 2 of subsection (ee) of section 4303 of the insurance
 law, as amended by section 40 of part D of chapter 56  of  the  laws  of
 2013, is amended to read as follows:
   (2)  Every  contract  that provides physician services, medical, major
 medical or similar comprehensive-type coverage  shall  provide  coverage
 for  the  screening, diagnosis and treatment of autism spectrum disorder
 in accordance with this paragraph and shall not exclude coverage for the
 screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
 covered  by the contract because the individual is diagnosed with autism
 spectrum disorder. Such coverage may be subject to  annual  deductibles,
 copayments  and  coinsurance  as may be deemed appropriate by the super-
 intendent and shall be consistent with those imposed on  other  benefits
 under  the  contract.  [Coverage  for applied behavior analysis shall be
 subject to a maximum benefit of six hundred eighty  hours  of  treatment
 per  contract  or  calendar year per covered individual.] This paragraph
 shall not be construed as  limiting  the  benefits  that  are  otherwise
 available  to  an  individual  under the contract, provided however that
 such contract shall not contain any limitations on visits that are sole-
 ly applied to the treatment of  autism  spectrum  disorder.  No  insurer
 shall  terminate  coverage  or refuse to deliver, execute, issue, amend,
 adjust, or renew coverage to an individual solely because the individual
 is diagnosed with autism spectrum disorder or has received treatment for
 autism spectrum disorder.  Coverage  shall  be  subject  to  utilization
 review  and external appeals of health care services pursuant to article
 forty-nine of this chapter as well as[,] case  management[,]  and  other
 managed care provisions.
   §  32.  Subparagraphs (A) and (C) of paragraph 3 of subsection (ee) of
 section 4303 of the insurance law, as amended by chapter 596 of the laws
 of 2011, are amended to read as follows:

 S. 1507--B                         125
 
   (A) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders[,  including  autistic  disorder,
 Asperger's disorder, Rett's disorder, childhood disintegrative disorder,
 or pervasive developmental disorder not otherwise specified (PDD-NOS)].
   (C)  "behavioral  health  treatment"  means  counseling  and treatment
 programs, when provided by a licensed  provider,  and  applied  behavior
 analysis, when provided [or supervised] by a [behavior analyst certified
 pursuant  to  the  behavior  analyst certification board] PERSON THAT IS
 LICENSED, CERTIFIED OR OTHERWISE AUTHORIZED TO PROVIDE APPLIED  BEHAVIOR
 ANALYSIS,  that  are  necessary to develop, maintain, or restore, to the
 maximum extent practicable, the functioning of an individual.  [Individ-
 uals that provide behavioral health treatment under the supervision of a
 certified  behavior analyst pursuant to this subsection shall be subject
 to standards of professionalism,  supervision  and  relevant  experience
 pursuant  to  regulations promulgated by the superintendent in consulta-
 tion with the commissioners of health and education.]
   § 33. Subsection (ee) of section 4303 of the insurance law is  amended
 by adding four new paragraphs 8, 9, 10, and 11 to read as follows:
   (8)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT APPLY FINANCIAL REQUIRE-
 MENTS OR TREATMENT LIMITATIONS TO AUTISM SPECTRUM DISORDER BENEFITS THAT
 ARE MORE RESTRICTIVE THAN THE  PREDOMINANT  FINANCIAL  REQUIREMENTS  AND
 TREATMENT  LIMITATIONS APPLIED TO SUBSTANTIALLY ALL MEDICAL AND SURGICAL
 BENEFITS COVERED BY THE POLICY.
   (9) THE  CRITERIA  FOR  MEDICAL  NECESSITY  DETERMINATIONS  UNDER  THE
 CONTRACT WITH RESPECT TO AUTISM SPECTRUM DISORDER BENEFITS SHALL BE MADE
 AVAILABLE  BY  THE  CORPORATION  TO ANY INSURED, PROSPECTIVE INSURED, OR
 IN-NETWORK PROVIDER UPON REQUEST.
   (10) FOR PURPOSES OF THIS SUBSECTION:
   (A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, COPAYMENTS,  COINSURANCE
 AND OUT-OF-POCKET EXPENSES;
   (B)  "PREDOMINANT"  MEANS  THAT  A  FINANCIAL REQUIREMENT OR TREATMENT
 LIMITATION IS THE MOST COMMON OR FREQUENT  OF  SUCH  TYPE  OF  LIMIT  OR
 REQUIREMENT; AND
   (C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
 NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
 OR  DURATION OF TREATMENT AND INCLUDES NONQUANTITATIVE TREATMENT LIMITA-
 TIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING  BENE-
 FITS  BASED  ON  MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT IS
 EXPERIMENTAL  OR  INVESTIGATIONAL;  FORMULARY  DESIGN  FOR  PRESCRIPTION
 DRUGS;  NETWORK TIER DESIGN; STANDARDS FOR PROVIDER ADMISSION TO PARTIC-
 IPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR DETERMIN-
 ING USUAL, CUSTOMARY, AND REASONABLE CHARGES; FAIL-FIRST OR STEP THERAPY
 PROTOCOLS; EXCLUSIONS BASED ON FAILURE TO COMPLETE A  COURSE  OF  TREAT-
 MENT;  AND  RESTRICTIONS  BASED  ON  GEOGRAPHIC LOCATION, FACILITY TYPE,
 PROVIDER SPECIALTY, AND OTHER CRITERIA THAT LIMIT THE SCOPE OR  DURATION
 OF BENEFITS FOR SERVICES PROVIDED UNDER THE CONTRACT.
   (11)  A CORPORATION SHALL PROVIDE COVERAGE UNDER THIS SUBSECTION, AT A
 MINIMUM, CONSISTENT WITH THE FEDERAL PAUL WELLSTONE  AND  PETE  DOMENICI
 MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY  ACT OF 2008 (29 U.S.C. §
 1185A).
   § 34. Paragraphs 17, 20 and 21 of subsection (a) of  section  4324  of
 the  insurance  law, paragraph 17 as amended and paragraphs 20 and 21 as
 added by section 8 of part H of chapter 60 of  the  laws  of  2014,  are
 amended and a new paragraph 22 is added to read as follows:

 S. 1507--B                         126
 
   (17) where applicable, a listing by specialty, which may be in a sepa-
 rate  document that is updated annually, of the name, address, and tele-
 phone number of all participating providers, including facilities,  [and
 in  addition,]  AND: (A) WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS;
 (B)  IN  THE  CASE  OF  MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES
 PROVIDERS, ANY AFFILIATIONS WITH PARTICIPATING FACILITIES  CERTIFIED  OR
 AUTHORIZED  BY  THE  OFFICE OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM
 AND SUBSTANCE ABUSE SERVICES, AND ANY RESTRICTIONS REGARDING THE  AVAIL-
 ABILITY OF THE INDIVIDUAL PROVIDER'S SERVICES; (C) in the case of physi-
 cians,  board  certification, languages spoken and any affiliations with
 participating hospitals. The listing shall also be posted on the  corpo-
 ration's  website  and  the  corporation shall update the website within
 fifteen days of the addition or  termination  of  a  provider  from  the
 corporation's network or a change in a physician's hospital affiliation;
   (20) with respect to out-of-network coverage:
   (A)  a clear description of the methodology used by the corporation to
 determine reimbursement for out-of-network health care services;
   (B) a description of the amount that the  corporation  will  reimburse
 under  the methodology for out-of-network health care services set forth
 as a percentage of the  usual  and  customary  cost  for  out-of-network
 health care services; and
   (C)  examples of anticipated out-of-pocket costs for frequently billed
 out-of-network health care services; [and]
   (21) information in writing  and  through  an  internet  website  that
 reasonably  permits  a  subscriber or prospective subscriber to estimate
 the  anticipated  out-of-pocket  cost  for  out-of-network  health  care
 services  in  a  geographical area or zip code based upon the difference
 between what the corporation will reimburse  for  out-of-network  health
 care services and the usual and customary cost for out-of-network health
 care services[.]; AND
   (22) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE CORPORATION
 TO  ASSESS  THE PROVISION OF ITS COVERED SERVICES IN ACCORDANCE WITH THE
 PAUL WELLSTONE AND PETE DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION
 EQUITY  ACT  OF  2008,  42  U.S.C. 18031 (J), AND ANY AMENDMENTS TO, AND
 FEDERAL GUIDANCE OR REGULATIONS ISSUED UNDER, THOSE ACTS.
   § 35. Subsection (b) of section 4325 of the insurance law, as added by
 chapter 705 of the laws of 1996, is amended to read as follows:
   (b) No corporation organized under this  article  shall  by  contract,
 written  policy [or], written procedure OR PRACTICE prohibit or restrict
 any health care provider from filing a complaint,  making  a  report  or
 commenting to an appropriate governmental body regarding the policies or
 practices of such corporation which the provider believes may negatively
 impact upon the quality of or access to patient care. NOR SHALL A CORPO-
 RATION  ORGANIZED  UNDER THIS ARTICLE TAKE ANY ADVERSE ACTION, INCLUDING
 BUT NOT LIMITED TO REFUSING TO RENEW OR EXECUTE A CONTRACT OR  AGREEMENT
 WITH A HEALTH CARE PROVIDER AS RETALIATION AGAINST A HEALTH CARE PROVID-
 ER FOR FILING A COMPLAINT, MAKING A REPORT OR COMMENTING TO AN APPROPRI-
 ATE  GOVERNMENTAL  BODY  REGARDING  POLICIES OR PRACTICES OF SUCH CORPO-
 RATION WHICH MAY VIOLATE THIS CHAPTER  INCLUDING  SUBSECTION  (G),  (K),
 (1),  (1-1)  OR (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THIS ARTI-
 CLE.
   § 36. Subparagraph (C) of paragraph 1 of  subsection  (b)  of  section
 4900  of  the insurance law, as added by chapter 41 of the laws of 2014,
 is amended and a new subparagraph (D) is added to read as follows:
   (C) for purposes of a determination involving substance  use  disorder
 treatment:

 S. 1507--B                         127
 
   (i)  a  physician  who  possesses  a  current and valid non-restricted
 license to practice medicine and who specializes  in  behavioral  health
 and  has experience in the delivery of substance use disorder courses of
 treatment; or
   (ii)  a  health  care professional other than a licensed physician who
 specializes in behavioral health and has experience in the  delivery  of
 substance  use  disorder  courses  of  treatment  and, where applicable,
 possesses a current and valid  non-restricted  license,  certificate  or
 registration or, where no provision for a license, certificate or regis-
 tration  exists, is credentialed by the national accrediting body appro-
 priate to the profession; [and] OR
   (D) FOR PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR  A  MENTAL
 HEALTH CONDITION:
   (I)  A  PHYSICIAN  WHO  POSSESSES  A  CURRENT AND VALID NON-RESTRICTED
 LICENSE TO PRACTICE MEDICINE AND WHO SPECIALIZES  IN  BEHAVIORAL  HEALTH
 AND  HAS  EXPERIENCE  IN THE DELIVERY OF MENTAL HEALTH COURSES OR TREAT-
 MENT; OR
   (II) A HEALTH CARE PROFESSIONAL OTHER THAN A  LICENSED  PHYSICIAN  WHO
 SPECIALIZES  IN  BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE DELIVERY OF
 MENTAL HEALTH COURSES OF TREATMENT AND, WHERE  APPLICABLE,  POSSESSES  A
 CURRENT  AND  VALID NON-RESTRICTED LICENSE, CERTIFICATE, OR REGISTRATION
 OR, WHERE NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE  OR  REGISTRATION
 EXISTS,  IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE TO
 THE PROFESSION; AND
   § 37. Paragraph 9 of subsection (a) of section 4902 of  the  insurance
 law,  as  amended  by  section  1 of part A of chapter 69 of the laws of
 2016, is amended to read as follows:
   (9) When conducting utilization review  for  purposes  of  determining
 health care coverage for substance use disorder treatment, a utilization
 review  agent shall utilize AN evidence-based and peer reviewed clinical
 review [tools designated by the office of alcoholism and substance abuse
 services that are appropriate to the age of the patient  and  consistent
 with  the  treatment  service levels within the office of alcoholism and
 substance abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE  OF
 THE  PATIENT.  WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW FOR TREATMENT
 PROVIDED IN THIS STATE, A UTILIZATION  REVIEW  AGENT  SHALL  UTILIZE  AN
 EVIDENCE-BASED  AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE OFFICE
 OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT  WITH  THE
 TREATMENT  SERVICE  LEVELS WITHIN THE OFFICE OF ALCOHOLISM AND SUBSTANCE
 ABUSE SERVICES SYSTEM. All approved tools shall have inter  rater  reli-
 ability   testing  completed  by  December  thirty-first,  two  thousand
 sixteen.
   § 38. Subsection (a) of section 4902 of the insurance law  is  amended
 by adding a new paragraph 12 to read as follows:
   (12)  WHEN  CONDUCTING  UTILIZATION REVIEW FOR PURPOSES OF DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT SHALL UTILIZE EVIDENCE-BASED AND  PEER  REVIEWED  CLINICAL  REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW  AGENT  SHALL USE CLINICAL REVIEW CRITERIA DEEMED APPROPRIATE AND
 APPROVED FOR SUCH USE BY  THE  COMMISSIONER  OF  THE  OFFICE  OF  MENTAL
 HEALTH,  IN  CONSULTATION WITH THE COMMISSIONER OF HEALTH AND THE SUPER-
 INTENDENT. APPROVED CLINICAL REVIEW  CRITERIA  SHALL  HAVE  INTER  RATER
 RELIABILITY  TESTING  COMPLETED  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND
 NINETEEN.

 S. 1507--B                         128
 
   § 39. Paragraph (b) of subdivision 5 of section  4403  of  the  public
 health  law,  as added by chapter 705 of the laws of 1996, is amended to
 read as follows:
   (b)  The following criteria shall be considered by the commissioner at
 the time of a review: (i) the availability  of  appropriate  and  timely
 care  that  is  provided in compliance with the standards of the Federal
 Americans with Disability Act to assure access to health  care  for  the
 enrollee  population;  (ii)  the network's ability to provide culturally
 and linguistically competent care to meet  the  needs  of  the  enrollee
 population;  [and] (iii) THE AVAILABILITY OF APPROPRIATE AND TIMELY CARE
 THAT IS IN COMPLIANCE WITH THE STANDARDS OF THE PAUL WELLSTONE AND  PETE
 DOMENICI  MENTAL  HEALTH  PARITY  AND  ADDICTION  EQUITY ACT OF 2008, 42
 U.S.C.  18031(J), AND ANY AMENDMENTS TO, AND FEDERAL GUIDANCE AND  REGU-
 LATIONS  ISSUED UNDER THOSE ACTS, WHICH SHALL INCLUDE AN ANALYSIS OF THE
 RATE  OF  OUT-OF-NETWORK  UTILIZATION  FOR  COVERED  MENTAL  HEALTH  AND
 SUBSTANCE  USE  DISORDER SERVICES AS COMPARED TO THE RATE OF OUT-OF-NET-
 WORK UTILIZATION FOR THE RESPECTIVE CATEGORY OF  MEDICAL  SERVICES;  AND
 (IV)  with  the exception of initial licensure, the number of grievances
 filed by enrollees relating to waiting times for appointments, appropri-
 ateness of referrals and other indicators of plan capacity.
   § 40. Subdivision 3 of section 4406-c of the  public  health  law,  as
 added by chapter 705 of the laws of 1996, is amended to read as follows:
   3. No health care plan shall by contract, written policy [or], written
 procedure OR PRACTICE prohibit or restrict any health care provider from
 filing  a  complaint,  making  a  report or commenting to an appropriate
 governmental body regarding the policies or  practices  of  such  health
 care  plan  which  the  provider believes may negatively impact upon the
 quality of, or access to, patient care. NOR SHALL  A  HEALTH  CARE  PLAN
 TAKE  ANY ADVERSE ACTION, INCLUDING BUT NOT LIMITED TO REFUSING TO RENEW
 OR EXECUTE A CONTRACT OR AGREEMENT WITH A HEALTH CARE PROVIDER AS RETAL-
 IATION AGAINST A HEALTH CARE PROVIDER FOR FILING A COMPLAINT,  MAKING  A
 REPORT OR COMMENTING TO AN APPROPRIATE GOVERNMENTAL BODY REGARDING POLI-
 CIES  OR PRACTICES OF SUCH HEALTH CARE PLAN WHICH MAY VIOLATE THIS CHAP-
 TER OR THE INSURANCE LAW INCLUDING SUBSECTION (G), (K),  (L),  (L-1)  OR
 (1-2) OF SECTION FORTY-THREE HUNDRED THREE OF THE INSURANCE LAW.
   §  41. Paragraphs (r), (t) and (u) of subdivision 1 of section 4408 of
 the public health law, paragraph (r) as amended and paragraphs  (t)  and
 (u)  as added by section 18 of part H of chapter 60 of the laws of 2014,
 are amended and a new paragraph (v) is added to read as follows:
   (r) a listing by specialty, which may be in a separate  document  that
 is  updated  annually,  of the name, address and telephone number of all
 participating providers, including facilities, [and, in addition,]  AND:
 (I)  WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS; (II) IN THE CASE OF
 MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES PROVIDERS,  ANY  AFFIL-
 IATIONS  WITH  PARTICIPATING  FACILITIES  CERTIFIED OR AUTHORIZED BY THE
 OFFICE OF MENTAL HEALTH OR THE OFFICE OF ALCOHOLISM AND SUBSTANCE  ABUSE
 SERVICES,  AND  ANY RESTRICTIONS REGARDING THE AVAILABILITY OF THE INDI-
 VIDUAL PROVIDER'S SERVICES; AND (III) in the case of  physicians,  board
 certification,  languages spoken and any affiliations with participating
 hospitals. The listing shall also be posted on  the  health  maintenance
 organization's  website  and  the  health maintenance organization shall
 update the website within fifteen days of the addition or termination of
 a provider from the  health  maintenance  organization's  network  or  a
 change in a physician's hospital affiliation;
   (t) with respect to out-of-network coverage:

 S. 1507--B                         129
 
   (i)  a clear description of the methodology used by the health mainte-
 nance organization to determine reimbursement for out-of-network  health
 care services;
   (ii)  the  amount  that the health maintenance organization will reim-
 burse under the methodology for out-of-network health care services  set
 forth as a percentage of the usual and customary cost for out-of-network
 health care services;
   (iii)  examples  of  anticipated  out-of-pocket  costs  for frequently
 billed out-of-network health care services; [and]
   (u) information in  writing  and  through  an  internet  website  that
 reasonably  permits  an enrollee or prospective enrollee to estimate the
 anticipated out-of-pocket cost for out-of-network health  care  services
 in  a  geographical  area  or zip code based upon the difference between
 what the health maintenance organization will reimburse for  out-of-net-
 work  health  care services and the usual and customary cost for out-of-
 network health care services[.]; AND
   (V) THE MOST RECENT COMPARATIVE ANALYSIS PERFORMED BY THE HEALTH MAIN-
 TENANCE ORGANIZATION TO ASSESS THE PROVISION OF ITS COVERED SERVICES  IN
 ACCORDANCE WITH THE PAUL WELLSTONE AND PETE DOMINICI MENTAL HEALTH PARI-
 TY  AND  ADDICTION EQUITY ACT OF 2008, 42 U.S.C. 18031(J) AND ANY AMEND-
 MENTS TO, AND FEDERAL GUIDANCE AND REGULATIONS ISSUED UNDER, THOSE ACTS.
   § 42. Subparagraph (iii) of paragraph (a) of subdivision 2 of  section
 4900    of  the public health law, as added by chapter 41 of the laws of
 2014, is amended and a  new  subparagraph  (iv)  is  added  to  read  as
 follows:
   (iii) for purposes of a determination involving substance use disorder
 treatment:
   (A)  a  physician  who  possesses  a  current and valid non-restricted
 license to practice medicine and who specializes  in  behavioral  health
 and  has experience in the delivery of substance use disorder courses of
 treatment; or
   (B) a health care professional other than  a  licensed  physician  who
 specializes  in  behavioral health and has experience in the delivery of
 substance use disorder  courses  of  treatment  and,  where  applicable,
 possesses  a  current  and  valid non-restricted license, certificate or
 registration or, where no provision for a license, certificate or regis-
 tration exists, is credentialed by the national accrediting body  appro-
 priate to the profession; [and] OR
   (IV)  FOR PURPOSES OF A DETERMINATION INVOLVING TREATMENT FOR A MENTAL
 HEALTH CONDITION:
   (A) A PHYSICIAN WHO  POSSESSES  A  CURRENT  AND  VALID  NON-RESTRICTED
 LICENSE  TO  PRACTICE  MEDICINE AND WHO SPECIALIZES IN BEHAVIORAL HEALTH
 AND HAS EXPERIENCE IN THE DELIVERY OF MENTAL HEALTH  COURSES  OF  TREAT-
 MENT; OR
   (B)  A  HEALTH  CARE  PROFESSIONAL OTHER THAN A LICENSED PHYSICIAN WHO
 SPECIALIZES IN BEHAVIORAL HEALTH AND HAS EXPERIENCE IN THE DELIVERY OF A
 MENTAL HEALTH COURSES OF TREATMENT AND, WHERE  APPLICABLE,  POSSESSES  A
 CURRENT  AND  VALID NON-RESTRICTED LICENSE, CERTIFICATE, OR REGISTRATION
 OR, WHERE NO  PROVISION  FOR  A  LICENSE,  CERTIFICATE  OR  REGISTRATION
 EXISTS,  IS CREDENTIALED BY THE NATIONAL ACCREDITING BODY APPROPRIATE TO
 THE PROFESSION; AND
   § 43. Paragraph (i) of subdivision 1 of section  4902  of  the  public
 health  law, as amended by section 2 of part A of chapter 69 of the laws
 of 2016, is amended and a new paragraph (j) is added to read as follows:
   (i) When conducting utilization review  for  purposes  of  determining
 health care coverage for substance use disorder treatment, a utilization

 S. 1507--B                         130
 
 review  agent shall utilize AN evidence-based and peer reviewed clinical
 review [tools designated by the office of alcoholism and substance abuse
 services that are appropriate to the age of the patient  and  consistent
 with  the  treatment  service levels within the office of alcoholism and
 substance abuse services system] TOOL THAT IS APPROPRIATE TO THE AGE  OF
 THE  PATIENT.  WHEN  CONDUCTING  SUCH  UTILIZATION  REVIEW FOR TREATMENT
 PROVIDED IN THIS STATE, A UTILIZATION  REVIEW  AGENT  SHALL  UTILIZE  AN
 EVIDENCE-BASED  AND PEER REVIEWED CLINICAL TOOL DESIGNATED BY THE OFFICE
 OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES THAT IS CONSISTENT  WITH  THE
 TREATMENT  SERVICE  LEVELS WITHIN THE OFFICE OF ALCOHOLISM AND SUBSTANCE
 ABUSE SERVICES SYSTEM. All approved tools shall have inter  rater  reli-
 ability   testing  completed  by  December  thirty-first,  two  thousand
 sixteen.
   (J) WHEN CONDUCTING UTILIZATION REVIEW  FOR  PURPOSES  OF  DETERMINING
 HEALTH CARE COVERAGE FOR A MENTAL HEALTH CONDITION, A UTILIZATION REVIEW
 AGENT  SHALL  UTILIZE  EVIDENCE-BASED  AND PEER REVIEWED CLINICAL REVIEW
 CRITERIA THAT IS APPROPRIATE TO THE AGE OF THE PATIENT.  THE UTILIZATION
 REVIEW AGENT SHALL USE CLINICAL REVIEW CRITERIA DEEMED  APPROPRIATE  AND
 APPROVED  FOR  SUCH  USE  BY  THE  COMMISSIONER  OF THE OFFICE OF MENTAL
 HEALTH, IN CONSULTATION WITH THE COMMISSIONER AND THE SUPERINTENDENT  OF
 FINANCIAL  SERVICES.  APPROVED CLINICAL REVIEW CRITERIA SHALL HAVE INTER
 RATER RELIABILITY TESTING COMPLETED BY DECEMBER THIRTY-FIRST, TWO  THOU-
 SAND NINETEEN.
   § 44. This act shall take effect on the first of January next succeed-
 ing  the date on which it shall have become a law and shall apply to all
 policies and contracts issued, renewed, modified, altered or amended  on
 or  after such date; provided, however, notwithstanding any provision of
 law to the contrary, nothing in this act shall limit the rights accruing
 to employees pursuant to a  collective  bargaining  agreement  with  any
 state or local government employer for the unexpired term of such agree-
 ment where such agreement is in effect on the effective date of this act
 and so long as such agreement remains in effect thereafter or the eligi-
 bility of any member of an employee organization to join a health insur-
 ance  plan open to him or her pursuant to such a collectively negotiated
 agreement.
 
                                 SUBPART B
 
   Section 1. Subdivision 1 of section 2803-u of the public  health  law,
 as  added  by  section 1 of part C of chapter 70 of the laws of 2016, is
 amended to read as follows:
   1. The office of alcoholism and substance abuse services, in consulta-
 tion with the department, shall develop or utilize existing  educational
 materials to be provided to general hospitals to disseminate to individ-
 uals  with  a documented substance use disorder or who appear to have or
 be at risk for a substance use disorder during discharge planning pursu-
 ant to section twenty-eight hundred three-i of this  [chapter]  ARTICLE.
 Such  materials shall include information regarding the various types of
 treatment and recovery services, including but not limited  to:    inpa-
 tient,  outpatient,  and medication-assisted treatment; how to recognize
 the need for treatment services; information for individuals  to  deter-
 mine  what  type  and  level  of  treatment is most appropriate and what
 resources are available to them; and any other information  the  commis-
 sioner deems appropriate. GENERAL HOSPITALS SHALL INCLUDE IN THEIR POLI-
 CIES  AND PROCEDURES TREATMENT PROTOCOLS, CONSISTENT WITH MEDICAL STAND-
 ARDS, TO BE UTILIZED BY THE EMERGENCY DEPARTMENTS IN  GENERAL  HOSPITALS

 S. 1507--B                         131
 
 FOR  THE  APPROPRIATE  USE  OF  MEDICATION-ASSISTED TREATMENT, INCLUDING
 BUPRENORPHINE, PRIOR TO DISCHARGE, OR REFERRAL PROTOCOLS FOR  EVALUATION
 OF MEDICATION-ASSISTED TREATMENT WHEN INITIATION IN AN EMERGENCY DEPART-
 MENT OF A GENERAL HOSPITAL IS NOT FEASIBLE.
   § 2. This act shall take effect immediately.
 
                                 SUBPART C
 
   Section  1.  Subparagraph  (v)  of  paragraph  (a) of subdivision 2 of
 section 3343-a of the public health law is  REPEALED  and  subparagraphs
 (vi),  (vii),  (viii),  (ix)  and  (x) are renumbered subparagraphs (v),
 (vi), (vii), (viii) and (ix).
   § 2. This act shall take  effect  only  upon  certification  from  the
 commissioner  of health that all emergency departments in general hospi-
 tals can access the prescription  monitoring  program  registry  through
 their electronic health record software. Such commissioner is authorized
 to  apply  for  any  federal  grants  to assist emergency departments in
 updating their electronic health record software to interface  with  the
 prescription monitoring program registry; provided that the commissioner
 of health shall notify the legislative bill drafting commission upon the
 occurrence  of  the enactment of the legislation provided for in section
 one of this act in order that the commission may  maintain  an  accurate
 and  timely  effective data base of the official text of the laws of the
 state of New York in  furtherance  of  effectuating  the  provisions  of
 section  44  of the legislative law and section 70-b of the public offi-
 cers law.
 
                                 SUBPART D
 
   Section 1. Paragraph (r) of subdivision 4  of  section  364-j  of  the
 social services law, as amended by section 39 of part A of chapter 56 of
 the laws of 2013, is amended to read as follows:
   (r)  A  managed  care  provider shall provide services to participants
 pursuant to an order of a  court  of  competent  jurisdiction,  provided
 however,  that  such  services shall be within such provider's or plan's
 benefit package and are reimbursable under  title  xix  of  the  federal
 social security act, PROVIDED THAT SERVICES FOR A SUBSTANCE USE DISORDER
 SHALL  BE PROVIDED BY A PROGRAM LICENSED, CERTIFIED OR OTHERWISE AUTHOR-
 IZED BY THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES.
   § 2. This act shall take effect immediately;  provided,  however  that
 the amendments to paragraph (r) of subdivision 4 of section 364-j of the
 social services law made by section one of this act shall not affect the
 repeal of such section and shall be deemed to be repealed therewith.

                                 SUBPART E
 
   Section 1. Subdivision (b) of schedule I of section 3306 of the public
 health  law is amended by adding nineteen new paragraphs 58, 59, 60, 61,
 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 and 76 to read as
 follows:
   (58) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLBUTYRAMIDE.    OTHER  NAME:
 BUTYRYL FENTANYL.
   (59) N-[1-[2-hydroxy-2-(thiophen-2-yl)ethyl]PIPERIDIN-4-Y1]-N-PHENYLPRO-
 PIONAMIDE.  OTHER NAME: BETA-HYDROXYTHIOFENTANYL.
   (60) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLFURAN-2-CARBOXAMIDE.  OTHER
 NAME: FURANYL FENTANYL.

 S. 1507--B                         132
 
   (61) 3,4-DICHLORO-N-[2-(dimethylamino)cyclohexyl]-N-METHYLBENZAMIDE.
 OTHER NAME: U-47700.
   (62) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACRYLAMIDE.   OTHER  NAMES:
 ACRYL FENTANYL OR ACRYLOYLFENTANYL.
   (63) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER NAMES: 4-FLUOROISOBUTYRYL FENTANYL,  PARA-FLUOROISOBUTYRYL  FENTA-
 NYL.
   (64) N-(2-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)PROPIONAMIDE.
 OTHER NAMES: ORTHO-FLUOROFENTANYL OR 2-FLUOROFENTANYL.
   (65) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLTETRAHYDROFURAN-2-CARBOXAMIDE.
 OTHER NAME: TETRAHYDROFURANYL FENTANYL.
   (66) 2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLACETAMIDE.  OTHER
 NAME: METHOXYACETYL FENTANYL.
   (67) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPROPANECARBOXAMIDE.
 OTHER NAME: CYCLOPROPYL FENTANYL.
   (68) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLPENTANAMIDE.  OTHER   NAME:
 VALERYL FENTANYL.
   (69) N-(4-FLUOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE. OTHER
 NAME: PARA-FLUOROBUTYRYLFENTANYL.
   (70) N-(4-METHOXYPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)BUTYRAMIDE.
 OTHER NAME: PARA-METHOXYBUTYRYL FENTANYL.
   (71) N-(4-CHLOROPHENY1)-N-(1-PHENETHYLPIPERIDIN-4-YL)ISOBUTYRAMIDE.
 OTHER NAME: PARA-CHLOROISOBUTYRYL FENTANYL.
   (72) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLISOBUTYRAMIDE.  OTHER NAME:
 ISOBUTYRYL FENTANYL.
   (73) N-(1-PHENETHYLPIPERIDIN-4-Y1)-N-PHENYLCYCLOPENTANECARBOXAMIDE.
 OTHER NAME: CYCLOPENTYL FENTANYL.
   (74) N-(2-FLUOROPHENY1)-2-METHOXY-N-(1-PHENETHYLPIPERIDIN-4-YL)
 ACETAMIDE. OTHER NAME: OCFENTANIL.
   (75) 1-CYCLOHEXY1-4-(1,2-DIPHENYLETHYL)PIPERAZINE. OTHER NAME: MT-45.
   (76) FENTANYL-RELATED SUBSTANCES, THEIR ISOMERS, ESTERS, ETHERS, SALTS
 AND SALTS OF ISOMERS, ESTERS AND ETHERS.
   (I) FENTANYL-RELATED SUBSTANCE MEANS ANY SUBSTANCE NOT OTHERWISE LIST-
 ED IN THIS SECTION, THAT IS STRUCTURALLY RELATED TO FENTANYL BY  ONE  OR
 MORE OF THE FOLLOWING MODIFICATIONS:
   (A) REPLACEMENT  OF  THE  PHENYL PORTION OF THE PHENETHYL GROUP BY ANY
 MONOCYCLE, WHETHER OR NOT FURTHER SUBSTITUTED IN OR ON THE MONOCYCLE;
   (B) SUBSTITUTION IN OR ON THE PHENETHYL  GROUP  WITH  ALKYL,  ALKENYL,
 ALKOXYL, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;
   (C) SUBSTITUTION  IN  OR  ON  THE PIPERIDINE RING WITH ALKYL, ALKENYL,
 ALKOXYL, ESTER, ETHER, HYDROXYL, HALO, HALOALKYL, AMINO OR NITRO GROUPS;
   (D) REPLACEMENT OF THE ANILINE RING WITH ANY AROMATIC MONOCYCLE WHETH-
 ER OR NOT FURTHER SUBSTITUTED IN OR ON THE AROMATIC MONOCYCLE; AND/OR
   (E) REPLACEMENT OF THE N-PROPIONYL GROUP BY ANOTHER ACYL GROUP.
   § 2. Intentionally omitted.
   § 3. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment  shall  have been rendered. It has hereby declared to be the intent
 of the legislature that this act would have been enacted  even  if  such
 invalid provisions had not been included herein.

 S. 1507--B                         133
 
   §  3.  This  act shall take effect immediately provided, however, that
 the applicable effective date of Subparts A through E of this act  shall
 be as specifically set forth in the last section of such Subparts.
 
                                  PART CC
 
   Section  1.  The  public health law is amended by adding a new section
 280-d to read as follows:
   § 280-D.  PRESCRIBER  ASSISTANCE.  1.  UNLICENSED  ASSISTANTS  MAY  BE
 EMPLOYED  IN LICENSED PHARMACIES FOR PURPOSES OTHER THAN THE PRACTICE OF
 PHARMACY, INCLUDING AT LEAST TWO UNLICENSED PERSONS  PER  PHARMACIST  TO
 ASSIST  IN THE DISPENSING OF DRUGS, PROVIDED, HOWEVER, THAT A PHARMACIST
 MAY OBTAIN THE ASSISTANCE OF UP TO FOUR  ADDITIONAL  UNLICENSED  PERSONS
 WHERE SUCH ADDITIONAL UNLICENSED PERSONS ARE CERTIFIED AS PHARMACY TECH-
 NICIANS  BY  A  NATIONALLY  ACCREDITED PHARMACY TECHNICIAN CERTIFICATION
 PROGRAM. PROOF OF CERTIFICATION FOR SUCH INDIVIDUALS EMPLOYED BY A PHAR-
 MACY SHALL BE MAINTAINED BY THE PHARMACY AND PROVIDED TO STATE  AGENCIES
 UPON  REQUEST. THE DEPARTMENT AND STATE BOARD OF PHARMACY SHALL CONSIDER
 AND MAY ESTABLISH REGULATIONS PERMITTING  A  PHARMACIST  TO  OBTAIN  THE
 ASSISTANCE OF A GREATER NUMBER OF UNLICENSED PERSONS.
   2. (A) THE COMPOUNDING, PREPARATION, LABELING, OR DISPENSING OF DRUGS,
 IN  ACCORDANCE  WITH  ARTICLE  ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION
 LAW, IN FACILITIES LICENSED IN ACCORDANCE WITH ARTICLE  TWENTY-EIGHT  OF
 THIS  CHAPTER  SHALL  BE  PERFORMED  BY:  (I)  A LICENSED PHARMACIST, AS
 DEFINED IN ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW; (II) A
 PHARMACY INTERN, UNDER THE DIRECT SUPERVISION OF A  LICENSED  PHARMACIST
 AS  DEFINED IN ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW; OR
 (III) UNDER THE DIRECT SUPERVISION OF A LICENSED PHARMACIST AN  INDIVID-
 UAL WHO HAS RECEIVED CERTIFICATION FROM A NATIONALLY ACCREDITED PHARMACY
 TECHNICIAN  CERTIFICATION  PROGRAM  MAY  ASSIST  IN  THE PREPARATION AND
 DISPENSING OF DRUGS INCLUDING WEIGHING, MIXING, AND MEASURING WHEN PROP-
 ERLY TRAINED. PROOF OF CERTIFICATION AND TRAINING FOR  SUCH  INDIVIDUALS
 EMPLOYED  BY A FACILITY SHALL BE MAINTAINED BY THE FACILITY AND PROVIDED
 TO STATE AGENCIES UPON REQUEST.
   (B) A PERSON EMPLOYED IN A FACILITY LICENSED IN ACCORDANCE WITH  ARTI-
 CLE  TWENTY-EIGHT  OF THIS CHAPTER WHO DIRECTLY ASSISTS LICENSED PHARMA-
 CISTS TO DISPENSE PRESCRIPTIONS IN SUCH FACILITY ON THE  EFFECTIVE  DATE
 OF  THIS  SECTION  SHALL BE EXEMPT FROM THE CERTIFICATION REQUIREMENT IN
 PARAGRAPH (A) OF THIS SUBDIVISION IF HE OR SHE SUBMITS EVIDENCE TO,  AND
 VERIFIED  BY,  HIS  OR  HER  EMPLOYER, OF A MINIMUM OF FIVE (5) YEARS OF
 EMPLOYMENT IN GOOD STANDING IN A PHARMACY WITHIN THE PREVIOUS EIGHT  (8)
 YEARS,  INCLUDING  EIGHTEEN  CONSECUTIVE  MONTHS WITH A SINGLE EMPLOYER.
 SUCH EVIDENCE AND VERIFICATION SHALL BE DOCUMENTED AND MAINTAINED BY THE
 FACILITY AND PROVIDED TO STATE AGENCIES UPON  REQUEST.  SUCH  INDIVIDUAL
 SHALL NOT BE PERMITTED TO ASSIST IN THE COMPOUNDING OF MEDICATIONS.
   § 2. This act shall take effect immediately.
 
                                  PART DD
 
                           Intentionally Omitted
 
                                  PART EE
 
   Section  1.  Paragraph  (b)  of  subdivision 2 of section 367-a of the
 social services law, as amended by section 116 of part C of  chapter  58
 of the laws of 2009, is amended to read as follows:

 S. 1507--B                         134
 
   (b)  Any  inconsistent provision of this chapter or other law notwith-
 standing, upon furnishing assistance under this title to  any  applicant
 or  recipient  of medical assistance, the local social services district
 or the department shall be subrogated, to the extent of the expenditures
 by such district or department for medical care furnished, to any rights
 such  person  may  have  to medical support or reimbursement from liable
 third parties, including but not limited to  health  insurers,  self-in-
 sured  plans,  group  health  plans, service benefit plans, managed care
 organizations, pharmacy benefit managers, or other parties that are,  by
 statute,  contract,  or  agreement, legally responsible for payment of a
 claim for a health care item or service. For purposes of  this  section,
 the  term  medical  support shall mean the right to support specified as
 support for the purpose of medical care by  a  court  or  administrative
 order.  The  right  of subrogation does not attach to insurance benefits
 paid or provided under any health insurance policy prior to the  receipt
 of  written  notice of the exercise of subrogation rights by the carrier
 issuing such insurance, nor shall such right of  subrogation  attach  to
 any  benefits  which may be claimed by a social services official or the
 department, by agreement or other established procedure,  directly  from
 an  insurance  carrier.  No  right  of subrogation to insurance benefits
 available under any health insurance policy shall be enforceable  unless
 written  notice of the exercise of such subrogation right is received by
 the carrier within three years from the date services for which benefits
 are provided under the policy or contract  are  rendered.  Liable  third
 parties shall not deny a claim made by a social services official or the
 department in conformance with this paragraph solely on the basis of the
 date  of  submission of the claim, the type or format of the claim form,
 LACK OF PRIOR AUTHORIZATION, or a failure to present  proper  documenta-
 tion  at  the  point-of-sale  that  is the basis of the claim. The local
 social services district or the department shall also notify the carrier
 when the exercise of subrogation rights has terminated because a  person
 is  no  longer receiving assistance under this title. Such carrier shall
 establish mechanisms to maintain the confidentiality of all individually
 identifiable information or records. Such carrier shall limit the use of
 such information or record  to  the  specific  purpose  for  which  such
 disclosure  is  made, and shall not further disclose such information or
 records.
   § 2. This act shall take effect immediately.
 
                                  PART FF
 
   Section 1. Subdivision 2 of section 365-a of the social  services  law
 is amended by adding a new paragraph (r-1) to read as follows:
   (R-1)  ASTHMA  MANAGEMENT  SERVICES FURNISHED BY A HOME CARE AGENCY IN
 ACCORDANCE WITH THE PROGRAM REQUIREMENTS ESTABLISHED PURSUANT TO SECTION
 THREE HUNDRED SIXTY-FIVE-O OF THIS TITLE, PROVIDED,  HOWEVER,  THAT  THE
 PROVISIONS  OF  THIS PARAGRAPH SHALL NOT TAKE EFFECT UNTIL ALL NECESSARY
 APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN OBTAINED TO RECEIVE
 FEDERAL FINANCIAL  PARTICIPATION  IN  THE  COSTS  OF  ASTHMA  MANAGEMENT
 SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH.
   §  2. The social services law is amended by adding a new section 365-o
 to read as follows:
   § 365-O. HOME CARE ASTHMA MANAGEMENT PROGRAM. 1. PURPOSE  AND  INTENT.
 THE  HOME  CARE  ASTHMA  MANAGEMENT PROGRAM IS INTENDED TO TARGET ASTHMA
 MANAGEMENT, HEALTH MAINTENANCE AND PROMOTION, PREVENTION OF HOSPITALIZA-
 TIONS AND EMERGENCY EPISODES,  AND  COORDINATION  AND  COLLABORATION  OF

 S. 1507--B                         135
 
 SERVICES  AND  PROVIDERS.  IN  IMPLEMENTING SUCH PROGRAM, THE DEPARTMENT
 SHALL CONSIDER THE ADVICE OF EXPERTS IN ASTHMA MANAGEMENT, HOME CARE AND
 OTHER RELEVANT SECTORS IN THE CONTINUUM OF CARE.
   2.  ELIGIBILITY.  THE  DEPARTMENT SHALL PROVIDE NOTICE TO ALL ELIGIBLE
 INDIVIDUALS OF THE AVAILABILITY  OF  THE  HOME  CARE  ASTHMA  MANAGEMENT
 PROGRAM,  AND  SHALL  HAVE THE OPPORTUNITY TO APPLY FOR PARTICIPATION IN
 THE PROGRAM. FOR THE PURPOSES OF THIS SECTION, AN "ELIGIBLE  INDIVIDUAL"
 IS  A  PERSON  WHO  HAS  BEEN  DIAGNOSED WITH ASTHMA AND IS ELIGIBLE FOR
 MEDICAL ASSISTANCE.
   3. PARTICIPATING  PROVIDERS.  ALL  HOME  CARE  AGENCIES  CERTIFIED  OR
 LICENSED  UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW WHO ELECT TO
 PROVIDE SERVICES AS DESCRIBED IN SUBDIVISION FOUR  OF  THIS  SECTION  TO
 ELIGIBLE INDIVIDUALS MAY PARTICIPATE IN THE PROGRAM.
   4.  DEPARTMENT  GUIDELINES. THE DEPARTMENT SHALL PROMULGATE GUIDELINES
 FOR REFERRAL OF INDIVIDUALS DIAGNOSED WITH ASTHMA TO HOME CARE  AGENCIES
 CERTIFIED  OR LICENSED UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW
 AND PARTICIPATING  IN  THE  HOME  CARE  ASTHMA  MANAGEMENT  PROGRAM  FOR
 FOLLOW-UP SERVICES, INCLUDING BUT NOT LIMITED TO:
   (I) A HOME-BASED HEALTH ASSESSMENT OF THE INDIVIDUAL AND HOME ENVIRON-
 MENT FOR ASTHMA TRIGGER REDUCTION;
   (II)  USE OF AVAILABLE TELEHEALTH AND CLINICAL TECHNOLOGY TO ASSIST IN
 ASTHMA MANAGEMENT;
   (III) PATIENT AND FAMILY EDUCATION AND TRAINING IN ASTHMA SELF-MANAGE-
 MENT; SUCH ASTHMA SELF-MANAGEMENT EDUCATION WOULD  INCLUDE  BUT  NOT  BE
 LIMITED  TO BASIC FACTS ABOUT ASTHMA, PROPER MEDICATION USE, IDENTIFICA-
 TION AND AVOIDANCE OF ENVIRONMENTAL EXPOSURES THAT WORSEN ASTHMA,  SELF-
 MONITORING  OF ASTHMA SYMPTOMS, ASTHMA CONTROL, AND USING WRITTEN ASTHMA
 ACTION PLANS;
   (IV) PERIODIC FOLLOW-UP SERVICES, IN PARTICULAR AFTER  EMERGENCY  ROOM
 OR  HOSPITAL  VISITS  OCCUR, PROVIDING PATIENTS WITH ROOT CAUSE ANALYSIS
 AND STEPS FOR PREVENTION OF FUTURE EPISODES; AND
   (V) COORDINATION  OF  HOME  AND  COMMUNITY-BASED  SERVICES,  INCLUDING
 COLLABORATION WITH THE PATIENT'S PRIMARY CARE, MANAGED CARE, HEALTH HOME
 AND SPECIALTY PROVIDERS, AS APPLICABLE.
   5.  ADJUSTMENT  OF  RATES.  THE COMMISSIONER SHALL ADJUST THE RATES OF
 PAYMENT TO HOME CARE AGENCIES CERTIFIED UNDER ARTICLE THIRTY-SIX OF  THE
 PUBLIC  HEALTH  LAW  THAT PARTICIPATE IN THE HOME CARE ASTHMA MANAGEMENT
 PROGRAM.
   6. EFFECTIVENESS. THE PROVISIONS OF THIS SECTION SHALL NOT TAKE EFFECT
 UNTIL ALL NECESSARY APPROVALS UNDER FEDERAL LAW AND REGULATION HAVE BEEN
 OBTAINED TO RECEIVE FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF  THE
 HOME CARE ASTHMA MANAGEMENT PROGRAM PROVIDED PURSUANT TO THIS SECTION.
   § 3. This act shall take effect immediately; provided that the depart-
 ment  of  social  services  shall  notify  the legislative bill drafting
 commission upon the occurrence  of  the  enactment  of  the  legislation
 provided  for  in  sections  one  and  two of this act in order that the
 commission may maintain an accurate and timely effective  data  base  of
 the official text of the laws of the state of New York in furtherance of
 effectuating  the  provisions  of  section 44 of the legislative law and
 section 70-b of the public officers law.
 
                                  PART GG
 
   Section 1. The department of health shall submit a Medicaid state plan
 amendment to the centers for  Medicare  and  Medicaid  services  of  the
 United States department of health and human services to request author-

 S. 1507--B                         136
 
 ization  to  establish  and  administer a methodology to provide supple-
 mental reimbursement to eligible ground emergency medical transportation
 providers that provide ground emergency medical transportation  services
 to  Medicaid  beneficiaries. For the purposes of this section, "eligible
 ground emergency medical transportation provider" means a  provider  who
 provides  ground  emergency  medical transportation services to Medicaid
 beneficiaries and is enrolled as a Medicaid provider during  the  period
 being claimed.
   § 2. This act shall take effect immediately.
 
                                  PART HH
 
   Section  1.  Primary  and preventive reproductive health care program.
 Notwithstanding any other provision of law to the contrary, the  commis-
 sioner  of  health  shall  ensure  the availability of the full range of
 reproductive services through a primary and preventive care reproductive
 health program. The program shall provide  sixteen  million  dollars  in
 grants  to  not-for-profit  organizations  with  demonstrated experience
 providing primary and preventive  reproductive  health  care,  including
 organizations  that  have  at least thirty-five years of family planning
 experience and demonstrated expertise in contracting and grants  manage-
 ment.  Notwithstanding  section  112  or 163 of the state finance law or
 contrary provisions of law, such distributions shall be made  without  a
 competitive  bid  or  request  for proposal process. Notwithstanding any
 inconsistent provision of law, the department of health may provide such
 grants by interchange, suballocation or transfer from any appropriation,
 fund or account with the approval of the director of the budget.
   § 2. This act shall take effect upon a determination  by  the  commis-
 sioner of health that there is a need to establish a primary and preven-
 tive reproductive health care program; provided that the commissioner of
 health  shall  notify  the legislative bill drafting commission upon the
 occurrence of the enactment of the legislation provided for  in  section
 one  of  this  act in order that the commission may maintain an accurate
 and timely effective data base of the official text of the laws  of  New
 York  in  further  of  effectuating  the provisions of section 44 of the
 legislative law and section 70-b of the public officers law.
 
                                  PART II
 
   Section 1. The public health law is amended by adding  a  new  section
 2807-o to read as follows:
   §  2807-O.  EARLY  INTERVENTION  SERVICES  POOL.  1.  DEFINITIONS. THE
 FOLLOWING WORDS OR PHRASES AS  USED  IN  THIS  SECTION  SHALL  HAVE  THE
 FOLLOWING MEANINGS:
   (A)  "EARLY INTERVENTION SERVICES" SHALL MEAN SERVICES DELIVERED TO AN
 ELIGIBLE CHILD, PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN  UNDER
 THE EARLY INTERVENTION PROGRAM.
   (B)  "EARLY  INTERVENTION  PROGRAM"  SHALL MEAN THE EARLY INTERVENTION
 PROGRAM FOR TODDLERS WITH DISABILITIES AND THEIR FAMILIES AS CREATED  BY
 TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
   (C)  "MUNICIPALITY"  SHALL  MEAN ANY COUNTY OUTSIDE OF THE CITY OF NEW
 YORK OR THE CITY OF NEW YORK.
   2. PAYMENTS FOR EARLY  INTERVENTION  SERVICES.  (A)  THE  COMMISSIONER
 SHALL,  FROM  FUNDS  ALLOCATED  FOR  SUCH PURPOSE UNDER PARAGRAPH (G) OF
 SUBDIVISION SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-S OF THIS ARTICLE,

 S. 1507--B                         137
 
 MAKE PAYMENTS TO MUNICIPALITIES AND THE STATE FOR THE DELIVERY OF  EARLY
 INTERVENTION SERVICES.
   (B)  PAYMENTS  UNDER  THIS SUBDIVISION SHALL BE MADE TO MUNICIPALITIES
 AND THE STATE BY THE COMMISSIONER. EACH MUNICIPALITY AND  THE  STATE  OF
 NEW  YORK  SHALL  RECEIVE  A SHARE OF SUCH PAYMENTS EQUAL TO ITS PROPOR-
 TIONATE SHARE OF THE TOTAL APPROVED STATEWIDE DOLLARS  NOT  REIMBURSABLE
 BY  THE  MEDICAL  ASSISTANCE  PROGRAM  PAID TO PROVIDERS OF EARLY INTER-
 VENTION SERVICES BY THE STATE AND MUNICIPALITIES  ON  ACCOUNT  OF  EARLY
 INTERVENTION  SERVICES  IN THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH
 SUCH DATA IS AVAILABLE.
   § 2. Subdivision 6 of section 2807-s  of  the  public  health  law  is
 amended by adding two new paragraphs (g) and (h) to read as follows:
   (G)  A  FURTHER  GROSS  STATEWIDE AMOUNT FOR THE STATE FISCAL YEAR TWO
 THOUSAND TWENTY AND EACH STATE FISCAL YEAR THEREAFTER SHALL  BE  FIFTEEN
 MILLION DOLLARS.
   (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
 ALLOCATED  UNDER  SECTION  TWENTY-EIGHT  HUNDRED SEVEN-O OF THIS ARTICLE
 AMONG THE MUNICIPALITIES AND THE STATE OF NEW YORK BASED ON EACH MUNICI-
 PALITY'S SHARE AND THE  STATE'S  SHARE  OF  EARLY  INTERVENTION  PROGRAM
 EXPENDITURES  NOT REIMBURSABLE BY THE MEDICAL ASSISTANCE PROGRAM FOR THE
 LATEST TWELVE MONTH PERIOD FOR WHICH SUCH DATA IS AVAILABLE.
   § 3. Subdivision 7 of section 2807-s  of  the  public  health  law  is
 amended by adding a new paragraph (d) to read as follows:
   (D)  FUNDS  SHALL  BE ADDED TO THE FUNDS COLLECTED BY THE COMMISSIONER
 FOR DISTRIBUTION IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-O
 OF THIS ARTICLE, IN THE FOLLOWING AMOUNT: FIFTEEN  MILLION  DOLLARS  FOR
 THE  PERIOD  BEGINNING  APRIL FIRST, TWO THOUSAND TWENTY, AND CONTINUING
 EACH STATE FISCAL YEAR THEREAFTER.
   § 4. Subdivision 1 of section  2557  of  the  public  health  law,  as
 amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
 amended to read as follows:
   1. The approved costs for an eligible child who receives an evaluation
 and early intervention services pursuant to this title shall be a charge
 upon the municipality wherein the eligible child resides or,  where  the
 services  are covered by the medical assistance program, upon the social
 services district of fiscal responsibility with respect to those  eligi-
 ble  children who are also eligible for medical assistance. All approved
 costs shall be paid in the first instance and at least quarterly by  the
 appropriate  governing body or officer of the municipality upon vouchers
 presented and audited in the same manner as the  case  of  other  claims
 against  the  municipality.  Notwithstanding  the insurance law or regu-
 lations thereunder relating to the permissible exclusion of payments for
 services under governmental programs, no such exclusion shall apply with
 respect to payments made pursuant to  this  title.  Notwithstanding  the
 insurance  law  or  any other law or agreement to the contrary, benefits
 under this title shall be considered secondary to [any plan of insurance
 or state government benefit] THE MEDICAL ASSISTANCE program under  which
 an  eligible  child  may  have  coverage. [Nothing in this section shall
 increase or enhance coverages provided for within an insurance  contract
 subject to the provisions of this title.]
   §  5.  Subdivision  2  of  section  2557  of the public health law, as
 amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
 amended to read as follows:
   2. The department shall reimburse the approved costs paid by a munici-
 pality  for the purposes of this title, other than those reimbursable by
 the medical assistance program [or by third party payors], in an  amount

 S. 1507--B                         138
 
 of fifty percent of the amount expended in accordance with the rules and
 regulations   of  the  commissioner;  provided,  however,  that  in  the
 discretion of the department and with the approval of  the  director  of
 the  division of the budget, the department may reimburse municipalities
 in an amount greater than fifty percent of  the  amount  expended.  Such
 state reimbursement to the municipality shall not be paid prior to April
 first  of  the  year in which the approved costs are paid by the munici-
 pality, provided, however that, subject to the approval of the  director
 of  the  budget,  the department may pay such state aid reimbursement to
 the municipality prior to such date.
   § 6. The section heading of section 2559 of the public health law,  as
 added by chapter 428 of the laws of 1992, is amended to read as follows:
   [Third   party  insurance  and  medical]  MEDICAL  assistance  program
 payments.
   § 7. Subdivision 3 of section 2559 of the public health law, as  added
 by  chapter  428  of  the  laws  of 1992, paragraphs (a), (c) and (d) as
 amended by section 11 of part A of chapter 56 of the laws  of  2012  and
 paragraph  (b) as further amended by section 104 of part A of chapter 62
 of the laws of 2011, is amended to read as follows:
   3. (a) [Providers of  evaluations  and  early  intervention  services,
 hereinafter  collectively  referred to in this subdivision as "provider"
 or "providers", shall in the first instance and where  applicable,  seek
 payment  from  all  third  party  payors including governmental agencies
 prior to claiming payment from  a  given  municipality  for  evaluations
 conducted  under the program and for services rendered to eligible chil-
 dren, provided that, the obligation to seek payment shall not apply to a
 payment from a third party payor who is  not  prohibited  from  applying
 such  payment,  and  will  apply  such payment, to an annual or lifetime
 limit specified in the insured's policy.
   (i) Parents shall provide the  municipality  and  service  coordinator
 information  on  any  insurance  policy, plan or contract under which an
 eligible child has coverage.
   (ii)] Parents shall provide the municipality and the service coordina-
 tor with a written referral from a primary care provider  as  documenta-
 tion,  for  eligible  children, of the medical necessity of early inter-
 vention services.
   [(iii) providers] (B) PROVIDERS shall utilize the department's  fiscal
 agent  and data system for claiming payment for evaluations and services
 rendered under the early intervention program.
   [(b) The commissioner, in consultation with the director of budget and
 the superintendent of financial services, shall  promulgate  regulations
 providing  public reimbursement for deductibles and copayments which are
 imposed under an insurance policy or health benefit plan to  the  extent
 that  such  deductibles  and  copayments  are applicable to early inter-
 vention services.
   (c) Payments made for early intervention services under  an  insurance
 policy  or  health  benefit plan, including payments made by the medical
 assistance program or other governmental third party  payor,  which  are
 provided  as  part  of  an  IFSP pursuant to section twenty-five hundred
 forty-five of this title shall not be applied by  the  insurer  or  plan
 administrator against any maximum lifetime or annual limits specified in
 the  policy  or  health benefits plan, pursuant to section eleven of the
 chapter of the laws of nineteen  hundred  ninety-two  which  added  this
 title.
   (d)]  (C)  A  municipality,  or  its designee, and a provider shall be
 subrogated, to the extent of the expenditures by  such  municipality  or

 S. 1507--B                         139
 
 for  early intervention services furnished to persons eligible for bene-
 fits under this title, to any rights such person may have or be entitled
 to from [third party reimbursement] THE MEDICAL ASSISTANCE PROGRAM.  The
 provider shall submit notice to the insurer or plan administrator of his
 or her exercise of such right of subrogation upon the provider's assign-
 ment as the early intervention service provider for the child. The right
 of  subrogation  does not attach to benefits paid or provided [under any
 health insurance policy or health benefits plan]  prior  to  receipt  of
 written  notice of the exercise of subrogation rights [by the insurer or
 plan administrator providing such benefits]. NOTWITHSTANDING ANY  INCON-
 SISTENT PROVISION OF THIS TITLE, EXCEPT AS PROVIDED FOR HEREIN, NO THIRD
 PARTY  PAYOR OTHER THAN THE MEDICAL ASSISTANCE PROGRAM SHALL BE REQUIRED
 TO REIMBURSE FOR EARLY INTERVENTION SERVICES PROVIDED UNDER THIS TITLE.
   § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
 REPEALED.
   § 9. Section 3235-a of the insurance law is REPEALED.
   §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
 3216 of the insurance law is REPEALED.
   § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
 3221 of the insurance law is REPEALED.
   §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
 law is REPEALED.
   § 13. This act shall take effect January 1, 2020;  provided,  however,
 that  the  amendments to section 2807-s of the public health law made by
 sections two and three of this act shall not affect  the  expiration  of
 such  section  and  shall be deemed to expire therewith. Effective imme-
 diately, the addition, amendment and/or repeal of any rule or regulation
 necessary for the implementation of this act on its effective  date  are
 authorized to be made and completed by the commissioner of health, on or
 before such effective date.
 
                                  PART JJ
 
   Section  1. Subdivision 26 of section 206 of the public health law, as
 amended by section 127-t of subpart B of part C of  chapter  62  of  the
 laws  of 2011, is amended and a new subdivision 26-a is added to read as
 follows:
   26. (A) The commissioner [is hereby authorized and  directed  to],  IN
 CONSULTATION  WITH  THE  COMMISSIONER  OF  ALCOHOLISM  AND SUBSTANCE USE
 SERVICES IN RELATION TO SUBPARAGRAPH (VIII)  OF  THIS  PARAGRAPH,  SHALL
 review  any  policy or practice instituted in facilities operated by the
 department of corrections and community supervision, and  in  all  local
 correctional  facilities,  as  defined in subdivision sixteen of section
 two of the correction law, regarding:
   (I) human immunodeficiency virus (HIV)[,] AND acquired immunodeficien-
 cy syndrome (AIDS), [and] INCLUDING THE PREVENTION AND  TRANSMISSION  OF
 HIV AND THE TREATMENT OF AIDS;
   (II) hepatitis C (HCV) including the prevention of the transmission of
 [HIV and HCV and the treatment of AIDS, HIV and] HCV [among inmates];
   (III) WOMEN'S HEALTH;
   (IV) TRANSGENDER HEALTH;
   (V)  CHRONIC  HEALTH  CONDITIONS  INCLUDING BUT NOT LIMITED TO ASTHMA,
 DIABETES, AND HEART DISEASE;
   (VI) HEALTH CARE SERVICES FOR INDIVIDUALS FIFTY YEARS OF AGE OR OLDER;

 S. 1507--B                         140
 
   (VII) DISCHARGE PLANNING OF HEALTH CARE  SERVICES  INCLUDING  PLANNING
 FOR   DISCHARGES  REQUIRING  RESIDENTIAL  PLACEMENT  OR  LONG-TERM  CARE
 SERVICES; AND
   (VIII) SUBSTANCE USE DISORDERS.
   (B)  Such [review] REVIEWS shall be performed annually and shall focus
 on whether such [HIV, AIDS or HCV  policy]  POLICIES  or  [practice  is]
 PRACTICES ARE consistent with current, generally accepted medical stand-
 ards and procedures [used to prevent the transmission of HIV and HCV and
 to treat AIDS, HIV and HCV among the general public]. In performing such
 reviews,  in  order  to  determine  the quality and adequacy of care and
 treatment provided, department personnel are authorized to enter correc-
 tional facilities and inspect policy and procedure manuals  and  medical
 protocols,  interview  health  services  providers  and inmate-patients,
 review medical  grievances,  and  inspect  a  representative  sample  of
 medical records of inmates [known to be infected with HIV or HCV or have
 AIDS].  Prior  to  initiating  a  review  of  a correctional system, the
 commissioner shall inform the public, including patients, their families
 and patient advocates, of  the  scheduled  review  and  invite  them  to
 provide the commissioner with relevant information.
   (C) Upon the completion of such review, the department shall, in writ-
 ing,  approve  such policy or practice as instituted in facilities oper-
 ated by the department of corrections and community supervision, and  in
 any  local  correctional facility, or, based on specific, written recom-
 mendations, direct the department of corrections  and  community  super-
 vision,  or  the authority responsible for the provision of medical care
 to inmates in local correctional facilities to prepare and  implement  a
 corrective  plan  to  address deficiencies in areas where such policy or
 practice fails to conform to current, generally accepted medical  stand-
 ards  and procedures.  The commissioner shall monitor the implementation
 of such corrective plans and shall conduct such further reviews  as  the
 commissioner  deems  necessary to ensure that identified deficiencies in
 [HIV, AIDS and HCV] policies and practices are  corrected.  All  written
 reports pertaining to reviews provided for in this subdivision SHALL NOT
 CONTAIN  INDIVIDUAL  PATIENT IDENTIFYING INFORMATION AND shall be [main-
 tained, under such conditions as the commissioner shall  prescribe,  as]
 public information [available for public inspection] AND SHALL BE POSTED
 ON THE DEPARTMENT'S WEBSITE.
   26-A.  (A)  THE  DEPARTMENT,  IN  CONSULTATION  WITH THE DEPARTMENT OF
 CORRECTIONS AND COMMUNITY SUPERVISION,  SHALL  BIENNIALLY  STUDY  HEALTH
 CARE  STAFFING  IN  FACILITIES OPERATED BY THE DEPARTMENT OF CORRECTIONS
 AND COMMUNITY  SUPERVISION  AND  IN  LOCAL  CORRECTIONAL  FACILITIES  AS
 DEFINED IN SUBDIVISION SIXTEEN OF SECTION TWO OF THE CORRECTION LAW. THE
 STUDY SHALL EXAMINE:
   (I)  ADEQUACY  OF  STAFFING, INCLUDING IN SPECIALTIES SUCH AS WOMEN'S,
 TRANSGENDER, AND GERIATRIC HEALTH CARE;
   (II) POTENTIAL  CHALLENGES  SUCH  AS  SALARY  ADEQUACY  OR  GEOGRAPHIC
 FACTORS; AND
   (III) IMPACT OF STAFFING LEVELS ON AVAILABILITY OF SERVICES.
   (B)  THE  FIRST  SUCH  STUDY  SHALL  BE COMPLETED AND SUBMITTED TO THE
 GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE SPEAKER OF  THE
 ASSEMBLY  NO LATER THAN ONE YEAR AFTER THE EFFECTIVE DATE OF THIS SUBDI-
 VISION.
   § 2. This act shall take effect immediately.
 
                                  PART KK

 S. 1507--B                         141
 
   Section 1. Subdivision 5 of section 209 of the elder law,  as  amended
 by  section 1 of part S of chapter 59 of the laws of 2016, is amended to
 read as follows:
   5.  Within  amounts  specifically appropriated therefor and consistent
 with the criteria developed and required pursuant to  this  section  the
 director  shall approve grants to eligible applicants. Individual grants
 awarded for classic NORC programs shall be  in  amounts  not  to  exceed
 [two]  THREE  hundred  thousand  ([$200,000]  $300,000)  dollars and for
 neighborhood NORCs not less than sixty thousand ($60,000) dollars in any
 twelve month period.
   § 2. This act shall take effect immediately.
 
                                  PART LL
 
   Section 1. The mental hygiene law is amended by adding a  new  section
 13.44 to read as follows:
 § 13.44 DIRECT SUPPORT PROFESSIONAL CREDENTIAL PILOT PROGRAM.
   (A)  SUBJECT  TO  APPROPRIATIONS, THE OFFICE SHALL IMPLEMENT A PROFES-
 SIONAL CREDENTIALING PILOT PROGRAM TO ASSIST AND ENHANCE  THE  FIELD  OF
 DIRECT CARE SUPPORT.
   (B)  THE  PILOT  PROGRAM PARTICIPANTS SHALL BE SELECTED BY THE COMMIS-
 SIONER, IN CONSULTATION WITH THE  REGIONAL  OFFICES  UNDER  HIS  OR  HER
 JURISDICTION AND THE REGIONAL CENTERS FOR WORKFORCE TRANSFORMATION. SUCH
 PILOT  PROGRAM PARTICIPANTS SHALL INCLUDE INDIVIDUALS EMPLOYED BY STATE-
 OPERATED FACILITIES UNDER THE AUSPICES OF THE OFFICE AND  NOT-FOR-PROFIT
 PROVIDERS LICENSED AND/OR CERTIFIED BY THE OFFICE. PILOT PROGRAM PARTIC-
 IPANTS  SHALL  BE  GEOGRAPHICALLY DISBURSED THROUGHOUT THE STATE, AND AS
 DETERMINED BY THE COMMISSIONER, IN REGIONS OF THE STATE WITH THE  GREAT-
 EST NEED.
   (C) (1) WHEN IMPLEMENTING THE PILOT PROGRAM, THE OFFICE SHALL FOCUS ON
 ASSISTING INDIVIDUALS IN THE FIELD OF DIRECT SUPPORT BY ADVANCING INITI-
 ATIVES  THAT:  (I) PROMOTE DIRECT SUPPORT WORK AS A CAREER, WITH A FOCUS
 ON CREATING OPPORTUNITIES FOR CAREER ADVANCEMENT WITHIN THE  PROFESSION,
 (II) FURTHER PROFESSIONALIZE THE FIELD BY DEVELOPING ADVANCED SKILLS AND
 COMPETENCIES,  (III)  PROMOTE  THE  HEALTH, SAFETY AND WELL-BEING OF THE
 PEOPLE  BEING  SERVED,  AND  (IV)  ENHANCE  WORKFORCE  RECRUITMENT   AND
 RETENTION  EFFORTS,  WITH  A  FOCUS ON DIRECT SUPPORT PROFESSIONAL POSI-
 TIONS.
   (2) SUCH INITIATIVES SHALL INCLUDE BUT NOT BE LIMITED TO:
   (I) A CREDENTIALING AND EDUCATION PROGRAM FOR DIRECT  SUPPORT  PROFES-
 SIONALS  WHICH SHALL UTILIZE BEST PRACTICES INCLUDING BUT NOT LIMITED TO
 NEW YORK STATE DIRECT SUPPORT PROFESSIONAL  COMPETENCIES,  CERTIFICATION
 PROGRAMS  OFFERED BY INSTITUTIONS OF HIGHER LEARNING, AND DIRECT SUPPORT
 PROFESSIONAL CREDENTIALING AND EDUCATION INITIATIVES  IN  OTHER  STATES;
 AND
   (II) A COMPREHENSIVE TRAINING PROGRAM WHICH MAY INCLUDE ON-LINE TRAIN-
 ING,  MENTORSHIPS, AND SUPPORT GROUP COMPONENTS. TO DEVELOP THE TRAINING
 PROGRAM, THE PILOT MAY  UTILIZE  NATIONAL  DIRECT  SUPPORT  PROFESSIONAL
 COMPETENCY PROGRAMS OR CREDENTIALING STANDARDS AND TRAININGS.
   (D)  (1)  THERE  IS  HEREBY  ESTABLISHED WITHIN THE OFFICE AN ADVISORY
 COUNCIL FOR  DIRECT  SUPPORT  PROFESSIONAL  CREDENTIALING,  WHICH  SHALL
 ADVISE,  OVERSEE AND ASSIST WITH THE IMPLEMENTATION OF THE PILOT PROGRAM
 ESTABLISHED PURSUANT TO THIS SECTION.
   (2) (I) THE COUNCIL SHALL CONSIST OF THE COMMISSIONER OR  HIS  OR  HER
 DESIGNEE, WHO SHALL CHAIR THE COUNCIL AND TWENTY-ONE ADDITIONAL MEMBERS.
 SEVEN  MEMBERS SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE COMMIS-

 S. 1507--B                         142
 
 SIONER, SEVEN MEMBERS SHALL BE APPOINTED UPON THE RECOMMENDATION OF  THE
 TEMPORARY  PRESIDENT  OF THE SENATE AND SEVEN MEMBERS SHALL BE APPOINTED
 UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY. (II) THE  COMPO-
 SITION OF THE COUNCIL SHALL BE AS FOLLOWS:
   (A)  FIVE  INDIVIDUALS FROM THE DIRECT SUPPORT PROFESSIONAL CREDENTIAL
 TECHNICAL REPORT ADVISORY GROUP, AT LEAST TWO OF WHOM SHALL BE  NOT-FOR-
 PROFIT PROVIDERS OF SERVICES;
   (B)  FIVE  INDIVIDUALS FROM THE DIRECT SUPPORT PROFESSIONAL CREDENTIAL
 TECHNICAL REPORT ADVISORY GROUP PROJECT STAFF IDENTIFIED BY THE  COMMIS-
 SIONER, AT LEAST ONE OF WHOM IS FROM AN INSTITUTE OF HIGHER LEARNING;
   (C)  SIX  INDIVIDUALS  FROM THE OFFICE'S REGIONAL CENTER FOR WORKFORCE
 TRANSFORMATION; EACH INDIVIDUAL SHALL REPRESENT ONE OF THE  SIX  REGIONS
 COVERED BY THE REGIONAL CENTER FOR WORKFORCE TRANSFORMATION;
   (D)  FOUR  DIRECT  SUPPORT PROFESSIONALS, OF WHOM TWO SHALL BE CREDEN-
 TIALED DIRECT SUPPORT PROFESSIONALS; AND
   (E) A SELF-ADVOCATE OR A REPRESENTATIVE OF A SELF-ADVOCACY ASSOCIATION
 FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES.
   (3) MEMBERS OF THE TASKFORCE SHALL SERVE WITHOUT COMPENSATION, BUT MAY
 BE REIMBURSED FOR ACTUAL COSTS INCURRED FOR PARTICIPATION ON SUCH  TASK-
 FORCE.
   (4)  THE  COUNCIL SHALL MEET AT LEAST FOUR TIMES IN EACH FULL CALENDAR
 YEAR OR AT THE REQUEST OF THE CHAIR OR COMMISSIONER.
   (5) THE COUNCIL MAY ESTABLISH COMMITTEES  AS  IT  DEEMS  NECESSARY  TO
 PARTICULAR  SUBJECTS  OF IMPORTANCE RELATED TO THE IMPLEMENTATION OF THE
 PILOT PROGRAM.
   (6) THE COUNCIL  MAY  CONSIDER  ANY  MATTER  RELATING  TO  INITIATIVES
 ADVANCED  AS  PART  OF  THE  PILOT  PROGRAM AND SHALL ADVISE AND PROVIDE
 RECOMMENDATIONS TO THE OFFICE ON ANY SUCH  MATTER,  INCLUDING,  BUT  NOT
 LIMITED TO:
   (I)  ENSURING  THE  PROGRAM IS PERSON-CENTERED, ACCESSIBLE, APPLICABLE
 AND RELEVANT FOR PEOPLE AND FAMILIES WHO RESIDE  IN  THE  STATE  OF  NEW
 YORK; AND
   (II)  PROVIDING  RECOMMENDATIONS AND ASSISTANCE TO THE OFFICE TO:  (A)
 SEEK APPROVAL  FROM  THE  FEDERAL  CENTERS  FOR  MEDICARE  AND  MEDICAID
 SERVICES  FOR  THE STATEWIDE CREDENTIALING PROGRAM TO BE INCLUDED IN THE
 STATE'S 1115 DEMONSTRATION WAIVER, AS APPROVED BY THE COMMISSIONER;  (B)
 COLLABORATE  WITH  MANAGED  CARE  ORGANIZATIONS  TO ENSURE THE STATEWIDE
 CREDENTIALING PROGRAM IS INCORPORATED INTO MANAGED  CARE  CONTRACTS  FOR
 LONG  TERM  SERVICES  AND  SUPPORTS; AND (C) DEVELOP THE REPORT REQUIRED
 PURSUANT TO SUBDIVISION (E) OF THIS SECTION.
   (E) THE OFFICE IN CONSULTATION WITH  THE  PARTICIPANTS  OF  THE  PILOT
 PROGRAM  AND  THE ADVISORY COUNCIL ESTABLISHED PURSUANT TO THIS SECTION,
 SHALL ISSUE A REPORT NO LATER  THAN  NOVEMBER  FIFTEENTH,  TWO  THOUSAND
 TWENTY-TWO  TO  THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE
 SPEAKER OF THE ASSEMBLY, THE ASSEMBLY CHAIR OF THE COMMITTEE  ON  MENTAL
 HEALTH,  AND  THE  SENATE  CHAIR  OF  THE COMMITTEE ON MENTAL HEALTH AND
 DEVELOPMENTAL DISABILITIES, DETAILING THE PROGRESS OF THE PILOT PROGRAM,
 ALL RELEVANT DATA AND INFORMATION TAKING INTO CONSIDERATION ANY  PRIVACY
 CONCERNS  OR  CONFIDENTIAL  RESTRICTIONS  TO SHARE SUCH INFORMATION, AND
 RECOMMENDATIONS WHICH SHALL INCLUDE BUT NOT BE LIMITED TO:
   (1) RATE OF RECRUITMENT AND RETENTION FOR DIRECT SUPPORT PROFESSIONALS
 OF PROVIDERS PARTICIPATING IN THE PILOT PROGRAM COMPARED TO THE RATE FOR
 NON-PARTICIPATING PROVIDERS;
   (2) NUMBER OF DIRECT SUPPORT PROFESSIONALS CREDENTIALED;
   (3) ENHANCEMENT OF QUALITY SUPPORTS AND SERVICES TO  INDIVIDUALS  WITH
 DEVELOPMENTAL DISABILITIES;

 S. 1507--B                         143
 
   (4)  CORRELATION  BETWEEN HOW WAGE INCREASES FOR CREDENTIALED INDIVID-
 UALS DEMONSTRATES COMMITMENT TO THE  PROFESSION,  LEADERSHIP  QUALITIES,
 RETENTION  IN  THE FIELD, IMPROVED SUPPORTS AND SERVICES, AND FAMILY AND
 INDIVIDUAL SATISFACTION;
   (5) IDENTIFIED BARRIERS TO MEETING THE PILOT PROGRAMS GOALS AND OBJEC-
 TIVES AND RECOMMENDATIONS ON HOW TO ELIMINATE SUCH BARRIERS; AND
   (6)  ANY  RECOMMENDATION RELATED TO ACHIEVING A SUCCESSFUL IMPLEMENTA-
 TION OF A STATEWIDE CREDENTIALING PROGRAM INCLUDING BUT NOT  LIMITED  TO
 CONTINUING  AND/OR  EXPANDING  THE  OPERATION OF THE CREDENTIALING PILOT
 PROGRAM OR ADDITIONAL INVESTMENT OF RESOURCES REQUIRED BY THE STATE.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law. Effective immediately, the addition,  amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation  of  this act on its effective date are authorized to be made and
 completed on or before such effective date.
 
                                  PART MM
 
   Section 1. The executive law is amended by adding a new  article  19-E
 to read as follows:
                               ARTICLE 19-E
            OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES
 SECTION 460. LEGISLATIVE INTENT.
         461. DEFINITIONS.
         462. OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES.
         463. DIRECTOR; GENERAL RESPONSIBILITIES.
   § 460. LEGISLATIVE INTENT.  PERSONS WITH DISABILITIES COMPRISE A MAJOR
 SEGMENT OF THE STATE OF NEW YORK'S POPULATION AND THEIR PARTICULAR NEEDS
 AND  CONCERNS MUST BE CONSIDERED AS AN INTEGRAL PART OF THE PLANNING AND
 IMPLEMENTATION OF ALL STATE PROGRAMS AND SERVICES AFFECTING THEIR  LIVES
 AND  WELL-BEING. THE OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES
 SHALL ADVOCATE ON BEHALF OF PERSONS WITH DISABILITIES  AND  ASSURE  THAT
 PERSONS  WITH  DISABILITIES ARE AFFORDED THE OPPORTUNITY TO EXERCISE ALL
 OF THE RIGHTS AND RESPONSIBILITIES ACCORDED TO CITIZENS OF THIS STATE.
   § 461. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE:
   (A) "PERSONS WITH DISABILITIES" SHALL MEAN ANY PERSON WHO HAS A  DISA-
 BILITY AS DEFINED IN SUBDIVISION TWENTY-ONE OF SECTION TWO HUNDRED NINE-
 TY-TWO OF THIS CHAPTER.
   (B)  "STATE  AGENCY"  OR "STATE AGENCIES" SHALL MEAN ANY STATE DEPART-
 MENT, BOARD, BUREAU, DIVISION, COMMISSION, COMMITTEE, PUBLIC  AUTHORITY,
 PUBLIC   CORPORATION,  COUNCIL,  OFFICE  OR  OTHER  GOVERNMENTAL  ENTITY
 PERFORMING A GOVERNMENTAL OR PROPRIETARY FUNCTION FOR THE STATE,  EXCEPT
 THE JUDICIARY OR THE STATE LEGISLATURE.
   §  462. OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES. (A) THERE
 IS HEREBY ESTABLISHED WITHIN THE DEPARTMENT OF THE STATE, AN  OFFICE  OF
 THE  ADVOCATE  FOR  PEOPLE WITH DISABILITIES. THE OFFICE OF THE ADVOCATE
 FOR PEOPLE WITH DISABILITIES SHALL ADVISE AND ASSIST STATE  AGENCIES  IN
 DEVELOPING  POLICIES  DESIGNED  TO  HELP  MEET THE NEEDS OF PERSONS WITH
 DISABILITIES.
   (B) THE OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES SHALL: (I)
 BE THE STATE'S COORDINATOR FOR THE IMPLEMENTATION OF THE AMERICANS  WITH
 DISABILITIES  ACT; (II) COORDINATE STATE ACTIVITIES TO ENSURE THAT STATE
 PROGRAMS DO NOT DISCRIMINATE AGAINST AND ARE ACCESSIBLE TO PERSONS  WITH
 DISABILITIES;  (III) ENSURE THAT SUCH PROGRAMS PROVIDE SERVICES TO INDI-
 VIDUALS WITH DISABILITIES IN THE MOST INTEGRATED SETTING APPROPRIATE  TO
 THEIR  NEEDS;  AND  (IV) WORK WITH STATE AGENCIES TO DEVELOP LEGISLATION

 S. 1507--B                         144
 
 AND POTENTIAL REGULATORY CHANGES  TO  HELP  EFFECTUATE  THE  DUTIES  AND
 RESPONSIBILITIES  REQUIRED  IN  THIS ARTICLE, AND ANY OTHER CHANGES THAT
 MAY SIGNIFICANTLY AFFECT THE LIVES OF PERSONS WITH DISABILITIES  IN  THE
 STATE.
   (C)  THE OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES SHALL, TO
 THE EXTENT PRACTICABLE, REVIEW AND REPORT TO THE GOVERNOR UPON  PROPOSED
 LEGISLATION  AND REGULATIONS. THE OFFICE OF THE ADVOCATE FOR PEOPLE WITH
 DISABILITIES SHALL SUBMIT COMMENTS,  WHERE  APPROPRIATE,  TO  THE  STATE
 AGENCY WHICH REFERRED SUCH PROPOSED LEGISLATION AND REGULATIONS EVALUAT-
 ING:  (I)  THE  IMPACT  OF  THE  PROPOSED LEGISLATION OR REGULATION UPON
 PERSONS WITH DISABILITIES; (II) THE  RELATIONSHIP  AND  IMPACT  OF  SUCH
 PROPOSED  LEGISLATION  OR  REGULATION  ON  EXISTING  PROGRAMS  AFFECTING
 PERSONS WITH DISABILITIES; AND (III) ANY MODIFICATIONS THAT  WOULD  HELP
 PERSONS  WITH  DISABILITIES  OR  AID  IN  THE  IMPLEMENTATION OF THE NEW
 PROPOSAL.  ALL STATE AGENCIES SHALL COOPERATE WITH  THE  OFFICE  OF  THE
 ADVOCATE  FOR PEOPLE WITH DISABILITIES TO ENSURE THAT THE OFFICE IS ABLE
 TO FULFILL THE REQUIREMENTS UNDER THIS ARTICLE.
   § 463. DIRECTOR; GENERAL RESPONSIBILITIES. THE HEAD OF THE  OFFICE  OF
 THE  ADVOCATE  FOR  PEOPLE  WITH DISABILITIES SHALL BE THE DIRECTOR, WHO
 SHALL BE APPOINTED BY THE GOVERNOR AND RECEIVE A SALARY TO BE  FIXED  BY
 THE  GOVERNOR  WITHIN  THE  AMOUNTS APPROPRIATED THEREFOR. THE DIRECTOR,
 SUBJECT TO RULES PRESCRIBED BY THE GOVERNOR, MAY  APPOINT  AND  FIX  THE
 COMPENSATION  OF EMPLOYEES OF THE OFFICE WITHIN THE AMOUNTS APPROPRIATED
 THEREFOR.
   § 2.  Subdivisions 1 and 2 of section 702 of  the  executive  law,  as
 added  by  chapter  551  of  the  laws  of  2002, are amended to read as
 follows:
   1.  The most integrated setting coordinating council is hereby created
 within the executive department to  have  and  exercise  the  functions,
 powers  and  duties  provided  by the provisions of this article and any
 other provision of law. The council shall be comprised  of  the  commis-
 sioners  of:  the department of health, the office of mental retardation
 and developmental disabilities, the office of mental health, the depart-
 ment of transportation, the office of children and family services,  the
 office of alcohol and substance abuse services, the department of educa-
 tion,  and  the  division of housing and community renewal. In addition,
 the council shall consist of the director of the office for  the  aging,
 [a  representative  from] THE DIRECTOR OF the office of the advocate for
 [persons] PEOPLE with disabilities, [a representative from  the  commis-
 sion  on  quality of care for the mentally disabled,] three consumers of
 services for individuals with disabilities, one to be appointed  by  the
 governor,  one to be appointed by the temporary president of the senate,
 and one to be appointed by the speaker of the assembly,  three  individ-
 uals with expertise in the field of community services for people of all
 ages  with  disabilities, one to be appointed by the governor, one to be
 appointed by the temporary president  of  the  senate,  and  one  to  be
 appointed  by  the  speaker  of the assembly, and three individuals with
 expertise in or recipients of services available to senior citizens with
 disabilities, one to be appointed by the governor, one to  be  appointed
 by the temporary president of the senate, and one to be appointed by the
 speaker of the assembly.
   2.  The  [commissioners  of  the  department  of health, the office of
 mental health, the office of mental retardation and developmental  disa-
 bilities,  and the director of the office for the aging] DIRECTOR OF THE
 OFFICE OF THE ADVOCATE FOR PEOPLE WITH DISABILITIES shall [rotate] SERVE
 as chairperson of the council [on a quarterly basis].

 S. 1507--B                         145
 
   § 3. This act shall take effect April 1, 2020.
 
                                  PART NN
 
   Section  1.  Subdivision 2 of section 242 of the elder law, as amended
 by section 12 of part A of chapter 60 of the laws of 2014, is amended to
 read as follows:
   2. Persons  eligible  for  catastrophic  coverage  under  section  two
 hundred forty-eight of this title shall include:
   (a) any unmarried resident who is at least sixty-five years of age and
 whose  income  for the calendar year immediately preceding the effective
 date of the annual coverage period beginning on or after January  first,
 two thousand one, is more than twenty thousand and less than or equal to
 [seventy-five  thousand]  ONE  HUNDRED  ONE  THOUSAND  TWO HUNDRED FIFTY
 dollars. After the initial determination of eligibility,  each  eligible
 individual  must  be  redetermined  eligible  at least every twenty-four
 months; and
   (b) any married resident who is at least sixty-five years of  age  and
 whose  income  for the calendar year immediately preceding the effective
 date of the annual coverage period when combined with the income in  the
 same calendar year of such married person's spouse beginning on or after
 January  first,  two  thousand  one,  is  more  than twenty-six thousand
 dollars and less than or  equal  to  one  hundred  THIRTY-FIVE  thousand
 dollars.  After  the initial determination of eligibility, each eligible
 individual must be redetermined  eligible  at  least  every  twenty-four
 months.
   § 2. This act shall take effect immediately.
   § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or  invalidate  the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 3. This act shall take effect immediately  provided,  however,  that
 the applicable effective date of Parts A through NN of this act shall be
 as specifically set forth in the last section of such Parts.