S T A T E O F N E W Y O R K
________________________________________________________________________
5422
2021-2022 Regular Sessions
I N A S S E M B L Y
February 16, 2021
___________
Introduced by M. of A. KIM -- read once and referred to the Committee on
Aging
AN ACT to amend the elder law, in relation to improving and expanding
the pharmaceutical insurance coverage program for certain medicare
enrollees
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 240 of the elder law, is amended to read as
follows:
§ 240. Short title. This title shall be known and may be cited as the
"program for [elderly] EXPANDED pharmaceutical insurance coverage".
§ 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
8 as added by section 2 of part A of chapter 59 of the laws of 2011 and
as renumbered by section 3 of part T of chapter 56 of the laws of 2012,
are amended to read as follows:
3. "Income" shall mean "household gross income" as defined in the real
property tax circuit breaker credit program, pursuant to subparagraph
(C) of paragraph one of subsection (e) of section six hundred six of the
tax law, but only shall include the income of program applicants and
spouses and shall exclude the income of other members of the household,
BUT SHALL NOT INCLUDE ANY INCREASE IN INCOME DERIVED FROM SOCIAL SECURI-
TY INCOME OR PENSION BENEFITS THAT INCREASE OVER THE PREVIOUS YEAR DUE
SOLELY TO A COST OF LIVING ADJUSTMENT PROVIDED BY THE PROGRAM ADMINIS-
TRATORS.
8. "Medicare part D excluded drug classes" shall mean any drugs or
classes of drugs, or their medical uses, which are described in section
1927(d)(2) or 1927(d)(3) of the federal social security act, with the
exception of smoking cessation agents AND MEDICAL MARIJUANA DISPENSED IN
THE STATE OF NEW YORK.
§ 3. The elder law is amended by adding a new section 242-a to read as
follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08041-01-1
A. 5422 2
§ 242-A. EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL. 1. THERE
IS HEREBY ESTABLISHED WITHIN THE EXECUTIVE DEPARTMENT, A PANEL TO BE
KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
PURPOSES OF THIS SECTION, THE TERM "THE PANEL" SHALL MEAN THE EXPANDED
PHARMACEUTICAL INSURANCE COVERAGE PANEL.
2. THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS OF
EDUCATION AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF FINANCIAL
SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
OF THE BUDGET. EACH PANEL MEMBER MAY DESIGNATE AN OFFICER OF HIS OR HER
RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
THE POWERS OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL FROM WHICH
SUCH PANEL MEMBER MAY BE ABSENT.
3. THE DIRECTOR OF THE OFFICE FOR THE AGING AND THE COMMISSIONER OF
HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
4. THE PANEL SHALL MEET AT SUCH TIMES AS MAY BE REQUESTED BY THE
CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
5. THE PANEL SHALL:
(A) SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, PROMULGATE
PROGRAM REGULATIONS PURSUANT TO SECTION TWO HUNDRED FORTY-SIX OF THIS
TITLE;
(B) DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES OF
ELIGIBLE PROGRAM PARTICIPANTS PURSUANT TO SECTIONS TWO HUNDRED FORTY-
SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
(C) ENTER INTO CONTRACTS PURSUANT TO SECTION TWO HUNDRED FORTY-THREE
OF THIS TITLE;
(D) RECOMMEND AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS FOR THE
EFFICIENT AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH THE
PROVISIONS OF THIS TITLE WITH THE ADVICE OF THE ADVISORY COMMITTEE AS
DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
(E) DEVELOP AND IMPLEMENT, IN COOPERATION WITH AREA OFFICES FOR THE
AGING, AN OUTREACH PROGRAM TO INFORM ELIGIBLE APPLICANTS OF BENEFITS
THEY MAY BE ENTITLED TO PURSUANT TO THIS TITLE, AND TO MAKE AVAILABLE
INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
COVERAGE AND BENEFITS TO WHICH THEY MAY BE ENTITLED THROUGH A
PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
(F) PREPARE AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO THE GOVERNOR,
THE TEMPORARY PRESIDENT OF THE SENATE, AND THE SPEAKER OF THE ASSEMBLY
NO LATER THAN THE FIRST DAY OF JANUARY OF EACH YEAR. THE PANEL SHALL
INCLUDE IN SUCH REPORT, AT A MINIMUM, ANNUAL STATISTICAL INFORMATION
REGARDING THE NUMBER OF PERSONS ENROLLED IN THE PROGRAM BY MARITAL
STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
RECEIVE AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE FEDERAL
SOCIAL SECURITY ACT, AND THE NUMBER THAT SO QUALIFY THROUGH THEIR
ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
ADMINISTRATIVE COST CONTAINMENT INITIATIVES COMPLETED DURING THE YEAR,
PROJECTIONS OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN EVALU-
ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
6. THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES
AS PANEL MEMBERS.
7. THERE SHALL BE AN ADVISORY COMMITTEE TO THE PANEL COMPRISED OF
TWELVE PERSONS. FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR, THREE
MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
MEMBER SHALL BE APPOINTED BY THE MINORITY LEADER OF THE SENATE, THREE
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MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
SHALL BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY. THE COMMIT-
TEE MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS, PHARMA-
CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
SIXTY PERCENT OF THE COMMITTEE MEMBERSHIP SHALL REPRESENT CONSUMERS.
COMMITTEE MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES BUT
SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE
PERFORMANCE OF THEIR DUTIES.
§ 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
1 as amended by section 4 of part T of chapter 56 of the laws of 2012,
and subdivision 2 as amended by section 12 of part A of chapter 60 of
the laws of 2014, are amended to read as follows:
1. Persons eligible for comprehensive coverage under section two
hundred forty-seven of this title shall include:
(a) any unmarried resident who is ENROLLED IN MEDICARE AND at least
sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE YEAR
TWO THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS OF AGE, DURING
THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
LEAST EIGHTEEN 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 five, is less than or
equal to twenty thousand 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 ENROLLED IN MEDICARE AND is at least
sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE YEAR
TWO THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS OF AGE, DURING
THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
LEAST EIGHTEEN 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 less than or equal to twenty-six thousand dollars. After the initial
determination of eligibility, each eligible individual must be redeter-
mined eligible at least every twenty-four months.
2. Persons eligible for catastrophic coverage under section two
hundred forty-eight of this title shall include:
(a) any unmarried resident who is ENROLLED IN MEDICARE AND at least
sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE YEAR
TWO THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS OF AGE, DURING
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THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
LEAST EIGHTEEN 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 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 ENROLLED IN MEDICARE AND at least
sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE YEAR
TWO THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS OF AGE, DURING
THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
LEAST EIGHTEEN 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 thousand dollars. After the initial determination of eligibil-
ity, each eligible individual must be redetermined eligible at least
every twenty-four months.
§ 5. Paragraphs (e) and (f) of subdivision 3 of section 242 of the
elder law, paragraph (e) as amended by section 3-d of part A of chapter
59 of the laws of 2011, and paragraph (f) as amended by section 1 of
part T of chapter 56 of the laws of 2012, are amended to read as
follows:
(e) As a condition of eligibility for benefits under this title, if a
program participant's income indicates that the participant could be
eligible for an income-related subsidy under section 1860D-14 of the
federal social security act by either applying for such subsidy or by
enrolling in a medicare savings program as a qualified medicare benefi-
ciary (QMB), a specified low-income medicare beneficiary (SLMB), or a
qualifying individual (QI), a program participant is required to
provide, and to authorize the [elderly] EXPANDED pharmaceutical insur-
ance coverage program to obtain, any information or documentation
required to establish the participant's eligibility for such subsidy,
and to authorize the [elderly] EXPANDED pharmaceutical insurance cover-
age program to apply on behalf of the participant for the subsidy or the
medicare savings program. [The elderly] UPON RECEIPT OF AN ENROLLMENT
APPLICATION, OR AT ANY TIME AFTER ENROLLMENT WHEN THE PROGRAM HAS INFOR-
MATION THAT INDICATES AN ENROLLEE IS ELIGIBLE FOR A SUBSIDY UNDER
SECTION 1860D-14 OF THE FEDERAL SOCIAL SECURITY ACT OR IN A MEDICARE
SAVINGS PROGRAM, THE EXPANDED pharmaceutical insurance coverage program
shall make a reasonable effort to notify the program participant of his
or her need to provide any of the above required information. After a
reasonable effort has been made to contact the participant, a partic-
A. 5422 5
ipant shall be notified in writing that he or she has sixty days to
provide such required information. If such information is not provided
within the sixty day period, the participant's coverage may be termi-
nated. A PROGRAM PARTICIPANT WHO IS ELIGIBLE TO ENROLL IN THE MEDICARE
SAVINGS PROGRAM SHALL BE ASSISTED TO DO SO, AND THEIR EXPANDED PHARMA-
CEUTICAL INSURANCE COVERAGE PROGRAM ENROLLMENT SHALL BE IN PLACE
THROUGHOUT THE MEDICARE SAVINGS PROGRAM APPLICATION PROCESS.
(f) As a condition of eligibility for benefits under this title, a
program participant is required to be enrolled in Medicare part D and to
maintain such enrollment. For unmarried participants with individual
annual income less than or equal to twenty-three thousand dollars and
married participants with joint annual income less than or equal to
twenty-nine thousand dollars, the [elderly] EXPANDED pharmaceutical
insurance coverage program shall pay for the portion of the part D
monthly premium, AND ANY LATE ENROLLMENT PENALTY THAT MAY HAVE BEEN
ASSESSED, that is the responsibility of the participant. Such TOTAL
payment shall be limited to the low-income benchmark premium amount
established by the federal centers for medicare and medicaid services
and any other amount which such agency establishes under its de minimus
premium policy.
§ 6. Subdivision 3 of section 250 of the elder law is amended by
adding a new paragraph (f) to read as follows:
(F) THE EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PROGRAM SHALL POST
TO ITS WEBSITE THE NAMES OF MANUFACTURERS THAT HAVE A REBATE PROGRAM AND
LIST THE DRUGS THAT ARE COVERED BY SUCH REBATE PROGRAM IN A MANNER THAT
PROVIDES ENROLLEES WITH ACCESS TO SUCH INFORMATION PRIOR TO THE ANNUAL
MEDICARE OPEN ENROLLMENT PERIOD.
§ 7. This act shall take effect immediately.