The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6058
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 8, 2021
                                ___________
 
 Introduced  by  M. of A. GOTTFRIED, ABINANTI, ANDERSON, BARRETT, BARRON,
   BENEDETTO,  BICHOTTE HERMELYN,  BRONSON,  BURDICK,  CAHILL,   CARROLL,
   CLARK,  COLTON,  COOK,  CRUZ,  CYMBROWITZ, DE LA ROSA, DICKENS, DILAN,
   DINOWITZ, ENGLEBRIGHT, EPSTEIN, FALL, FERNANDEZ,  FRONTUS,  GALLAGHER,
   GONZALEZ-ROJAS, HUNTER, HYNDMAN, JACKSON, JEAN-PIERRE, JOYNER, KELLES,
   KIM,  LAVINE,  LUNSFORD,  LUPARDO,  MAMDANI,  MEEKS,  MITAYNES,  NIOU,
   PAULIN,  PEOPLES-STOKES,  PERRY,  PHEFFER AMATO,  PICHARDO,  RAJKUMAR,
   RAMOS,  REYES, RICHARDSON, J. RIVERA, RODRIGUEZ, L. ROSENTHAL, SAYEGH,
   SEAWRIGHT, SILLITTI, SIMON, SOLAGES, FORREST, STECK,  STIRPE,  TAYLOR,
   THIELE, VANEL, WALKER, WALLACE, WEPRIN, WILLIAMS -- Multi-Sponsored by
   --  M.  of A.  AUBRY, DAVILA, FAHY, GALEF, GLICK, GUNTHER, MAGNARELLI,
   O'DONNELL, PRETLOW,  QUART,  D. ROSENTHAL,  ROZIC  --  read  once  and
   referred to the Committee on Health
 
 AN  ACT  to  amend  the  public health law and the state finance law, in
   relation to enacting the "New York health act"  and  establishing  New
   York Health
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Short title. This act shall be known and may  be  cited  as
 the "New York health act".
   §  2.  Legislative  findings  and  intent.  1.  The state constitution
 states: "The protection and promotion of the health of  the  inhabitants
 of  the state are matters of public concern and provision therefor shall
 be made by the state and by such of its subdivisions and in such manner,
 and by such means as the legislature shall from time to time determine."
 (Article XVII, §3.) The legislature finds and declares  that  all  resi-
 dents  of  the  state  have the right to health care.  While the federal
 Affordable Care Act brought many improvements in health care and  health
 coverage,  it  still  leaves  many  New Yorkers without coverage or with
 inadequate coverage.  Millions of New Yorkers do not get the health care
 they need or face financial obstacles and hardships to get it.  That  is
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00273-03-1

 A. 6058                             2
 
 not  acceptable.    There  is no plan other than the New York health act
 that will enable New York state to meet that need.   New  Yorkers  -  as
 individuals,  employers,  and taxpayers - have experienced a rise in the
 cost  of  health  care  and  coverage  in recent years, including rising
 premiums, deductibles and co-pays, restricted provider networks and high
 out-of-network charges.  Many New Yorkers go without health care because
 they cannot afford it or suffer financial hardship to  get  it.    Busi-
 nesses have also experienced increases in the costs of health care bene-
 fits for their employees, and many employers are shifting a larger share
 of  the cost of coverage to their employees or dropping coverage entire-
 ly.  Including long-term services and supports (LTSS) in New York Health
 is a major step forward for older adults, people with disabilities,  and
 their  families.  Older adults and people with disabilities often cannot
 receive the services necessary to stay in the community or  other  LTSS.
 Even  when older adults and people with disabilities receive LTSS, espe-
 cially services in the community, it is often at the cost  of  unreason-
 able  demands on unpaid family caregivers, depleting their own or family
 resources, or impoverishing themselves to qualify for  public  coverage.
 Health care providers are also affected by inadequate health coverage in
 New  York  state. A large portion of hospitals, health centers and other
 providers now experience substantial losses due to the provision of care
 that is uncompensated.  Medicaid and Medicare often  do  not  pay  rates
 that  are reasonably related to the cost of efficiently providing health
 care services and sufficient to assure an adequate and accessible supply
 of health care services, as guaranteed under the New  York  Health  Act.
 Individuals  often  find  that  they are deprived of affordable care and
 choice because of decisions by health plans guided by the plan's econom-
 ic interests rather than the individual's health care needs. To  address
 the  fiscal  crisis  facing  the health care system and the state and to
 assure New Yorkers can exercise their right to health  care,  affordable
 and  comprehensive  health  coverage  must  be provided. Pursuant to the
 state constitution's charge to the legislature to provide for the health
 of New Yorkers, this legislation is an enactment of  state  concern  for
 the  purpose of establishing a comprehensive universal guaranteed health
 care coverage program and a health care  cost  control  system  for  the
 benefit of all residents of the state of New York.
   2.  (a)  It  is  the  intent of the Legislature to create the New York
 Health program to provide a universal single payer health plan for every
 New Yorker, funded by broad-based revenue based on ability to pay.   The
 legislature  intends  that federal waivers and approvals be sought where
 they will improve the administration of the New York Health program, but
 the legislature intends that the program  be  implemented  even  in  the
 absence  of  such  waivers or approvals.  The state shall work to obtain
 waivers and other approvals relating to  Medicaid,  Child  Health  Plus,
 Medicare,  the  Affordable  Care  Act, and any other appropriate federal
 programs, under which federal  funds  and  other  subsidies  that  would
 otherwise  be  paid  to  New  York  State,  New Yorkers, and health care
 providers for health coverage that will be equaled or  exceeded  by  New
 York Health will be paid by the federal government to New York State and
 deposited  in  the  New  York  Health trust fund, or paid to health care
 providers and individuals in combination with New York Health trust fund
 payments, and for other program modifications (including elimination  of
 cost sharing and insurance premiums).  Under such waivers and approvals,
 health  coverage under those programs will, to the maximum extent possi-
 ble, be replaced and merged into New York Health, which will operate  as
 a true single-payer program.

 A. 6058                             3
 
   (b)  If  any  necessary  waiver or approval is not obtained, the state
 shall use state plan amendments and seek waivers and approvals to  maxi-
 mize,  and  make  as  seamless as possible, the use of federally-matched
 health programs and federal health programs in New York Health.    Thus,
 even where other programs such as Medicaid or Medicare may contribute to
 paying  for  care,  it is the goal of this legislation that the coverage
 will be delivered by New York Health  and,  as  much  as  possible,  the
 multiple  sources  of  funding will be pooled with other New York Health
 funds and not be apparent to New York Health  members  or  participating
 providers.
   (c)  This  program  will  promote  movement  away from fee-for-service
 payment, which tends to reward quantity and requires excessive  adminis-
 trative  expense,  and  towards alternate payment methodologies, such as
 global or capitated payments to providers or health care  organizations,
 that  promote  quality, efficiency, investment in primary and preventive
 care, and innovation and integration in the organizing of health care.
   (d) The program shall promote the use of clinical data to improve  the
 quality  of health care and public health, consistent with protection of
 patient confidentiality. The program shall maximize patient autonomy  in
 choice  of  health care providers and health care decision making.  Care
 coordination within the program shall ensure management and coordination
 among a patient's health care services, consistent with patient autonomy
 and person-centered service planning, rather than acting as a gatekeeper
 to needed services.
   (e) The program shall operate with care, skill,  prudence,  diligence,
 and professionalism, and for the best interests primarily of the members
 and health care providers.
   3.  This  act  does  not create or relate to any employment benefit or
 employment benefit plan, nor does it require,  prohibit,  or  limit  the
 providing of any employment benefit or employment benefit plan.
   4. In order to promote improved quality of, and access to, health care
 services and promote improved clinical outcomes, it is the policy of the
 state  to  encourage cooperative, collaborative and integrative arrange-
 ments among health care providers who might  otherwise  be  competitors,
 under  the  active  supervision of the commissioner of health. It is the
 intent of the state to supplant competition with such  arrangements  and
 regulation  only  to  the extent necessary to accomplish the purposes of
 this act, and to provide state  action  immunity  under  the  state  and
 federal  antitrust  laws  to  health  care  providers, particularly with
 respect to their relations with the single-payer New  York  Health  plan
 created by this act.
   5.  There  have  been numerous professional economic analyses of state
 and national single-payer  health  proposals,  including  the  New  York
 Health Act, by noted consulting firms and academic economists. They have
 almost  all  come  to  similar conclusions of net savings in the cost of
 health coverage and health care. These savings are driven by (a)  elimi-
 nating  the  administrative  bureaucracy costs, marketing, and profit of
 multiple health plans and replacing that  with  the  dramatically  lower
 costs  of  running a single-payer system; (b) substantially reducing the
 administrative costs borne by health care providers dealing  with  those
 health  plans; and (c) using the negotiating power of 20 million consum-
 ers to achieve lower drug prices. These savings will  more  than  offset
 costs primarily from (a) relieving patients of deductibles, co-pays, and
 out-of-network  charges;  (b)  covering  the  uninsured;  (c) increasing
 provider payment rates  above  Medicare  and  Medicaid  rates;  and  (d)
 replacing uncompensated home health care with paid care. Unlike premiums

 A. 6058                             4
 
 and out-of-pocket spending, the New York Health Act tax will be progres-
 sively  graduated  based  on  ability to pay.   The vast majority of New
 Yorkers today spend dramatically more in premiums, deductibles and other
 out-of-pocket  costs  than they will in New York Health Act taxes.  They
 will have broader coverage (including  long-term  care),  no  restricted
 provider  networks  or  out-of-network  charges,  and  no deductibles or
 co-pays.
   § 3. Article 50 and sections 5000, 5001, 5002 and 5003 of  the  public
 health  law  are renumbered article 80 and sections 8000, 8001, 8002 and
 8003, respectively, and a new article 51 is added to read as follows:
                                ARTICLE 51
                              NEW YORK HEALTH
 SECTION 5100. DEFINITIONS.
         5101. PROGRAM CREATED.
         5102. BOARD OF TRUSTEES.
         5103. ELIGIBILITY AND ENROLLMENT.
         5104. BENEFITS.
         5105. HEALTH CARE PROVIDERS; CARE COORDINATION; PAYMENT  METHOD-
                 OLOGIES.
         5106. HEALTH CARE ORGANIZATIONS.
         5107. PROGRAM STANDARDS.
         5108. REGULATIONS.
         5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS.
         5110. ADDITIONAL PROVISIONS.
         5111. REGIONAL ADVISORY COUNCILS.
   §  5100.  DEFINITIONS.  AS  USED  IN THIS ARTICLE, THE FOLLOWING TERMS
 SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT  CLEARLY  REQUIRES
 OTHERWISE:
   1.  "BOARD" MEANS THE BOARD OF TRUSTEES OF THE NEW YORK HEALTH PROGRAM
 CREATED BY SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE, AND  "TRUSTEE"
 MEANS A TRUSTEE OF THE BOARD.
   2.  "CARE COORDINATION" MEANS, BUT IS NOT LIMITED TO, MANAGING, REFER-
 RING TO, LOCATING, COORDINATING, AND MONITORING HEALTH CARE SERVICES FOR
 THE MEMBER TO ASSURE THAT ALL MEDICALLY NECESSARY HEALTH  CARE  SERVICES
 ARE MADE AVAILABLE TO AND ARE EFFECTIVELY USED BY THE MEMBER IN A TIMELY
 MANNER,  CONSISTENT  WITH  PATIENT  AUTONOMY. CARE COORDINATION DOES NOT
 INCLUDE A REQUIREMENT FOR PRIOR AUTHORIZATION FOR HEALTH  CARE  SERVICES
 OR FOR REFERRAL FOR A MEMBER TO RECEIVE A HEALTH CARE SERVICE.
   3.  "CARE  COORDINATOR"  MEANS  AN  INDIVIDUAL  OR  ENTITY APPROVED TO
 PROVIDE CARE COORDINATION UNDER SUBDIVISION  TWO  OF  SECTION  FIFTY-ONE
 HUNDRED FIVE OF THIS ARTICLE.
   4. "FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM" MEANS THE MEDICAL ASSIST-
 ANCE  PROGRAM  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
 LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-NINE-GG
 OF  THE  SOCIAL  SERVICES  LAW,  AND THE CHILD HEALTH PLUS PROGRAM UNDER
 TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
   5. "HEALTH CARE ORGANIZATION" MEANS AN ENTITY THAT IS APPROVED BY  THE
 COMMISSIONER  UNDER  SECTION  FIFTY-ONE  HUNDRED  SIX OF THIS ARTICLE TO
 PROVIDE HEALTH CARE SERVICES TO MEMBERS UNDER THE PROGRAM.
   6. "HEALTH CARE PROVIDER"  MEANS  ANY  INDIVIDUAL  OR  ENTITY  LEGALLY
 AUTHORIZED  TO  PROVIDE A HEALTH CARE SERVICE UNDER MEDICAID OR MEDICARE
 OR THIS ARTICLE. "HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROVIDER
 THAT IS AN  INDIVIDUAL  LICENSED,  CERTIFIED,  REGISTERED  OR  OTHERWISE
 AUTHORIZED TO PRACTICE UNDER TITLE EIGHT OF THE EDUCATION LAW TO PROVIDE
 SUCH HEALTH CARE SERVICE, ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRAC-
 TICE.

 A. 6058                             5
 
   7. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
 COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
   8. "IMPLEMENTATION PERIOD" MEANS THE PERIOD UNDER SUBDIVISION THREE OF
 SECTION  FIFTY-ONE  HUNDRED ONE OF THIS ARTICLE DURING WHICH THE PROGRAM
 WILL BE SUBJECT TO SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT
 IS FULLY IMPLEMENTED UNDER THAT SECTION.
   9. "MEDICAID" OR "MEDICAL ASSISTANCE" MEANS TITLE  ELEVEN  OF  ARTICLE
 FIVE  OF  THE  SOCIAL  SERVICES  LAW AND THE PROGRAM THEREUNDER.  "CHILD
 HEALTH PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE  OF  THIS  CHAPTER
 AND  THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF THE FEDERAL
 SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.  "AFFORDABLE CARE  ACT"
 MEANS THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT, PUBLIC LAW
 111-148,  AS AMENDED BY THE HEALTH CARE AND EDUCATION RECONCILIATION ACT
 OF 2010, PUBLIC LAW 111-152, AND AS  OTHERWISE  AMENDED  AND  ANY  REGU-
 LATIONS  OR  GUIDANCE  ISSUED THEREUNDER.   "BASIC HEALTH PROGRAM" MEANS
 SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW  AND  THE
 PROGRAM THEREUNDER.
   10. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.
   11.  "NEW  YORK HEALTH", "NEW YORK HEALTH PROGRAM", AND "PROGRAM" MEAN
 THE NEW YORK HEALTH PROGRAM CREATED BY SECTION FIFTY-ONE HUNDRED ONE  OF
 THIS ARTICLE.
   12.  "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST FUND
 ESTABLISHED UNDER SECTION EIGHTY-NINE-J OF THE STATE FINANCE LAW.
   13. "OUT-OF-STATE HEALTH CARE SERVICE" MEANS  A  HEALTH  CARE  SERVICE
 PROVIDED  TO  A  MEMBER WHILE THE MEMBER IS TEMPORARILY OUT OF THE STATE
 AND (A) IT IS MEDICALLY  NECESSARY  THAT  THE  HEALTH  CARE  SERVICE  BE
 PROVIDED  WHILE  THE MEMBER IS OUT OF THE STATE, OR (B) IT IS CLINICALLY
 APPROPRIATE THAT THE HEALTH CARE SERVICE BE  PROVIDED  BY  A  PARTICULAR
 HEALTH  CARE PROVIDER LOCATED OUT OF THE STATE RATHER THAN IN THE STATE.
 HOWEVER, ANY HEALTH CARE SERVICE PROVIDED TO A NEW YORK HEALTH  ENROLLEE
 BY  A  HEALTH CARE PROVIDER QUALIFIED UNDER PARAGRAPH (A) OF SUBDIVISION
 THREE OF SECTION FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE THAT IS  LOCATED
 OUTSIDE  THE  STATE  SHALL NOT BE CONSIDERED AN OUT-OF-STATE SERVICE AND
 SHALL BE COVERED AS OTHERWISE PROVIDED IN THIS ARTICLE.
   14. "PARTICIPATING PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS  A
 HEALTH  CARE  PROVIDER  QUALIFIED  UNDER  SUBDIVISION  THREE  OF SECTION
 FIFTY-ONE HUNDRED  FIVE  OF  THIS  ARTICLE  THAT  PROVIDES  HEALTH  CARE
 SERVICES TO MEMBERS UNDER THE PROGRAM, OR A HEALTH CARE ORGANIZATION.
   15.  "PERSON"  MEANS ANY INDIVIDUAL OR NATURAL PERSON, TRUST, PARTNER-
 SHIP, ASSOCIATION,  UNINCORPORATED  ASSOCIATION,  CORPORATION,  COMPANY,
 LIMITED  LIABILITY  COMPANY,  PROPRIETORSHIP, JOINT VENTURE, FIRM, JOINT
 STOCK ASSOCIATION, DEPARTMENT, AGENCY, AUTHORITY, OR OTHER LEGAL ENTITY,
 WHETHER FOR-PROFIT, NOT-FOR-PROFIT OR GOVERNMENTAL.
   16. "PRESCRIPTION AND NON-PRESCRIPTION DRUGS" MEANS PRESCRIPTION DRUGS
 AS DEFINED IN SECTION TWO HUNDRED SEVENTY OF THIS CHAPTER, AND NON-PRES-
 CRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
   17. "RESIDENT" MEANS AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE IS  IN
 THE  STATE OR, IN THE CASE OF AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE
 IS NOT IN THE STATE, WHO IS EMPLOYED OR SELF-EMPLOYED FULL-TIME  IN  THE
 STATE,  WITHOUT REGARD TO THE INDIVIDUAL'S IMMIGRATION STATUS, AS DETER-
 MINED ACCORDING TO REGULATIONS OF THE COMMISSIONER.    SUCH  REGULATIONS
 SHALL INCLUDE A PROCESS FOR APPEALING DENIALS OF RESIDENCY.
   §  5101.  PROGRAM  CREATED.  1.  THE NEW YORK HEALTH PROGRAM IS HEREBY
 CREATED IN THE DEPARTMENT. THE COMMISSIONER SHALL ESTABLISH  AND  IMPLE-
 MENT  THE  PROGRAM UNDER THIS ARTICLE. THE PROGRAM SHALL PROVIDE COMPRE-
 HENSIVE HEALTH COVERAGE TO EVERY RESIDENT WHO ENROLLS IN THE PROGRAM.

 A. 6058                             6
 
   2. THE COMMISSIONER SHALL, TO THE MAXIMUM EXTENT  POSSIBLE,  ORGANIZE,
 ADMINISTER AND MARKET THE PROGRAM AND SERVICES AS A SINGLE PROGRAM UNDER
 THE  NAME "NEW YORK HEALTH" OR SUCH OTHER NAME AS THE COMMISSIONER SHALL
 DETERMINE, REGARDLESS OF UNDER WHICH LAW OR SOURCE THE DEFINITION  OF  A
 BENEFIT  IS  FOUND INCLUDING (ON A VOLUNTARY BASIS) RETIREE HEALTH BENE-
 FITS. IN IMPLEMENTING THIS ARTICLE, THE COMMISSIONER SHALL  AVOID  JEOP-
 ARDIZING  FEDERAL  FINANCIAL  PARTICIPATION  IN THESE PROGRAMS AND SHALL
 TAKE CARE TO PROMOTE PUBLIC UNDERSTANDING  AND  AWARENESS  OF  AVAILABLE
 BENEFITS AND PROGRAMS.
   3. THE COMMISSIONER SHALL DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLL-
 ING IN THE PROGRAM. THERE SHALL BE AN IMPLEMENTATION PERIOD, WHICH SHALL
 BEGIN  ON  THE  DATE THAT INDIVIDUALS MAY BEGIN ENROLLING IN THE PROGRAM
 AND SHALL END AS DETERMINED BY THE COMMISSIONER.   INDIVIDUALS  MAY  NOT
 ENROLL  IN THE NEW YORK HEALTH PROGRAM UNTIL THE LEGISLATURE HAS ENACTED
 THE REVENUE PROPOSAL, AS AMENDED, AND AS THE LEGISLATURE  SHALL  FURTHER
 PROVIDE.
   4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE PURSUANT TO THE INSURANCE
 LAW  OR  A  HEALTH MAINTENANCE ORGANIZATION CERTIFIED UNDER THIS CHAPTER
 MAY, IF OTHERWISE AUTHORIZED, OFFER  BENEFITS  THAT  DO  NOT  COVER  ANY
 SERVICE  FOR WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER THE PROGRAM,
 BUT MAY NOT OFFER BENEFITS THAT COVER ANY SERVICE FOR WHICH COVERAGE  IS
 OFFERED  TO  INDIVIDUALS UNDER THE PROGRAM. PROVIDED, HOWEVER, THAT THIS
 SUBDIVISION SHALL NOT PROHIBIT (A) THE OFFERING OF ANY  BENEFITS  TO  OR
 FOR  INDIVIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR SELF-EM-
 PLOYED IN THE STATE BUT WHO ARE NOT RESIDENTS OF THE STATE, OR  (B)  THE
 OFFERING OF BENEFITS DURING THE IMPLEMENTATION PERIOD TO INDIVIDUALS WHO
 ENROLLED OR MAY ENROLL AS MEMBERS OF THE PROGRAM, OR (C) THE OFFERING OF
 RETIREE HEALTH BENEFITS.
   5.  A  COLLEGE, UNIVERSITY OR OTHER INSTITUTION OF HIGHER EDUCATION IN
 THE STATE MAY PURCHASE COVERAGE UNDER THE PROGRAM FOR  ANY  STUDENT,  OR
 STUDENT'S DEPENDENT, WHO IS NOT A RESIDENT OF THE STATE.
   6.  TO  THE  EXTENT ANY PROVISION OF THIS CHAPTER, THE SOCIAL SERVICES
 LAW, THE INSURANCE LAW OR THE ELDER LAW:
   (A) IS INCONSISTENT WITH ANY PROVISION OF THIS ARTICLE OR THE LEGISLA-
 TIVE INTENT OF THE NEW YORK HEALTH ACT, THIS  ARTICLE  SHALL  APPLY  AND
 PREVAIL,  EXCEPT WHERE EXPLICITLY PROVIDED OTHERWISE BY THIS ARTICLE; OR
 EXPLICITLY REQUIRED BY APPLICABLE FEDERAL LAW OR REGULATIONS AND
   (B) IS CONSISTENT WITH THE PROVISIONS OF THIS ARTICLE AND THE LEGISLA-
 TIVE INTENT OF THE NEW YORK HEALTH ACT, THE PROVISION OF THAT LAW  SHALL
 APPLY.
   7.    (A) (I) THE PROGRAM SHALL BE DEEMED TO BE A HEALTH CARE PLAN FOR
 PURPOSES OF EXTERNAL APPEAL UNDER ARTICLE  FORTY-NINE  OF  THIS  CHAPTER
 (REFERRED  TO  IN  THIS SUBDIVISION AS "ARTICLE FORTY-NINE"), SUBJECT TO
 THIS SUBDIVISION AND ANY OTHER APPLICABLE PROVISION OF THIS ARTICLE.
   (II)  AN EXTERNAL APPEAL SHALL NOT REQUIRE UTILIZATION  REVIEW  OR  AN
 ADVERSE  DETERMINATION  UNDER  TITLE  ONE  OF ARTICLE FORTY-NINE OF THIS
 CHAPTER.  ANY REFERENCE IN ARTICLE FORTY-NINE TO UTILIZATION REVIEW OR A
 UNIVERSAL REVIEW AGENT SHALL MEAN THE PROGRAM.  WHERE THE PROGRAM  MAKES
 AN  ADVERSE  DETERMINATION, AN EXTERNAL APPEAL SHALL BE AUTOMATIC UNLESS
 SPECIFICALLY WAIVED OR WITHDRAWN BY THE MEMBER OR THE MEMBER'S DESIGNEE.
 SERVICES, INCLUDING SERVICES PROVIDED  FOR  A  CHRONIC  CONDITION,  WILL
 CONTINUE  UNCHANGED UNTIL THE OUTCOME OF THE EXTERNAL APPEAL DECISION IS
 ISSUED. WHERE  AN  EXTERNAL  APPEAL  IS  INITIATED  OR  PURSUED  BY  THE
 PATIENT'S  HEALTH CARE PROVIDER, THE PROVIDER SHALL NOTIFY THE MEMBER OR
 THE MEMBER'S DESIGNEE, AND IT  SHALL  BE  SUBJECT  TO  THE  MEMBER'S  OR
 MEMBER'S  DESIGNEE'S RIGHT TO WAIVE OR WITHDRAW THE EXTERNAL APPEAL.  NO

 A. 6058                             7
 
 FEE SHALL BE REQUIRED TO BE PAID BY ANY PARTY  TO  AN  EXTERNAL  APPEAL,
 INCLUDING THE MEMBER'S HEALTH CARE PROVIDER.
   (III)    WHERE AN EXTERNAL APPEAL IS DENIED, THE EXTERNAL APPEAL AGENT
 SHALL NOTIFY THE MEMBER OR THE MEMBER'S DESIGNEE AND, WHERE APPROPRIATE,
 THE MEMBER'S HEALTH CARE PROVIDER,  WITHIN  TWO  BUSINESS  DAYS  OF  THE
 DETERMINATION.    THE  NOTICE SHALL INCLUDE A STATEMENT THAT THE MEMBER,
 MEMBER'S DESIGNEE OR HEALTH CARE PROVIDER HAS THE RIGHT  TO  APPEAL  THE
 DETERMINATION TO A FAIR HEARING UNDER THIS SUBDIVISION AND SEEK JUDICIAL
 REVIEW.
   (IV)  AN ENROLLEE MAY DESIGNATE A PERSON OR ENTITY, INCLUDING, BUT NOT
 LIMITED  TO,  THE  ENROLLEE'S  FAMILY MEMBER, CARE COORDINATOR, A HEALTH
 CARE ORGANIZATION PROVIDING THE SERVICE UNDER REVIEW  OR  APPEAL,  OR  A
 LABOR UNION OR AN ENTITY AFFILIATED WITH AND DESIGNATED BY A LABOR UNION
 OF  WHICH THE ENROLLEE OR ENROLLEE'S FAMILY MEMBER IS A MEMBER, TO SERVE
 AS THE ENROLLEE'S DESIGNEE FOR PURPOSES OF THAT ARTICLE, IF  THE  PERSON
 OR ENTITY AGREES TO BE THE DESIGNEE.
   (B)  (I)  THIS PARAGRAPH APPLIES WHERE AN EXTERNAL APPEAL IS DENIED IN
 WHOLE OR IN PART; OR THE PROGRAM  DENIES  COVERAGE  FOR  A  HEALTH  CARE
 SERVICE  ON  ANY  GROUNDS  OTHER  THAN  UNDER ARTICLE FORTY-NINE; OR THE
 PROGRAM MAKES ANY OTHER DETERMINATION AS TO A MEMBER OR INDIVIDUAL SEEK-
 ING TO BECOME A MEMBER, CONTRARY TO THE INTEREST OF THE MEMBER OR  INDI-
 VIDUAL (INCLUDING BUT NOT LIMITED TO A DENIAL OF ELIGIBILITY FOR LACK OF
 RESIDENCE).
   (II)  THE  PROGRAM  SHALL  NOTIFY  THE  MEMBER OR INDIVIDUAL, MEMBER'S
 DESIGNEE OR HEALTH CARE PROVIDER, AS APPROPRIATE, THAT  THE  PERSON  HAS
 THE  RIGHT  TO  APPEAL  THE  DETERMINATION  TO A FAIR HEARING UNDER THIS
 SUBDIVISION OR SEEK JUDICIAL REVIEW.
   (III)  THE COMMISSIONER SHALL ESTABLISH BY REGULATION  A  PROCESS  FOR
 FAIR  HEARINGS  UNDER THIS SUBDIVISION.   THE PROCESS SHALL AT A MINIMUM
 CONFORM TO THE STANDARDS FOR FAIR HEARINGS UNDER SECTION  TWENTY-TWO  OF
 THE SOCIAL SERVICES LAW.
   (C)    ARTICLE SEVENTY-EIGHT OF THE CIVIL PRACTICE LAW AND RULES SHALL
 APPLY TO ANY MATTER UNDER THIS ARTICLE.
   8. (A) NO MEMBER SHALL BE REQUIRED TO RECEIVE ANY HEALTH CARE  SERVICE
 THROUGH  ANY  ENTITY  ORGANIZED, CERTIFIED OR OPERATING UNDER GUIDELINES
 UNDER ARTICLE FORTY-FOUR OF THIS CHAPTER,  OR  SPECIFIED  UNDER  SECTION
 THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, THE INSURANCE LAW
 OR  THE  ELDER LAW. NO SUCH ENTITY SHALL RECEIVE PAYMENT FOR HEALTH CARE
 SERVICES (OTHER THAN CARE COORDINATION) FROM THE PROGRAM.
   (B) HOWEVER, THIS SUBDIVISION SHALL NOT PRECLUDE THE USE OF A MEDICARE
 MANAGED CARE ("MEDICARE ADVANTAGE") ENTITY OR OTHER ENTITY CREATED BY OR
 UNDER THE DIRECTION OF THE PROGRAM WHERE REASONABLY NECESSARY  TO  MAXI-
 MIZE  FEDERAL FINANCIAL PARTICIPATION OR OTHER FEDERAL FINANCIAL SUPPORT
 UNDER ANY FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM,  MEDICARE  OR  THE
 AFFORDABLE CARE ACT. ANY ENTITY UNDER THIS PARAGRAPH SHALL, TO THE MAXI-
 MUM  EXTENT  FEASIBLE,  OPERATE  IN THE BACKGROUND, WITHOUT BURDEN ON OR
 INTERFERENCE WITH THE MEMBER AND HEALTH CARE PROVIDER, WITHOUT DEPRIVING
 THE MEMBER OR HEALTH CARE PROVIDER OF ANY RIGHT  OR  BENEFIT  UNDER  THE
 PROGRAM AND OTHERWISE CONSISTENT WITH THIS ARTICLE.
   9.  THE  PROGRAM  SHALL  INCLUDE PROVISIONS FOR AN APPROPRIATE RESERVE
 FUND.
   10. (A) THIS SUBDIVISION APPLIES TO EVERY PERSON WHO IS A RETIREE OF A
 PUBLIC EMPLOYER, AS DEFINED IN SECTION TWO  HUNDRED  ONE  OF  THE  CIVIL
 SERVICE LAW, AND ANY PERSON WHO IS A BENEFICIARY OF THE RETIREE'S PUBLIC
 EMPLOYEE RETIREE HEALTH BENEFIT. ANY REFERENCE TO THE RETIREE SHALL MEAN
 AND  INCLUDE  ANY  BENEFICIARY OF THE RETIREE. THIS SUBDIVISION DOES NOT

 A. 6058                             8
 
 CREATE OR INCREASE ANY  ELIGIBILITY  FOR  ANY  PUBLIC  EMPLOYEE  RETIREE
 HEALTH  BENEFIT THAT WOULD NOT OTHERWISE EXIST AND DOES NOT DIMINISH ANY
 PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT.
   (B)  THIS  PARAGRAPH APPLIES TO THE RETIREE WHILE HE OR SHE IS A RESI-
 DENT OF NEW YORK STATE. THE RETIREE SHALL ENROLL IN THE PROGRAM.  IF, BY
 THE IMPLEMENTATION DATE, THE RETIREE HAS NOT ENROLLED  IN  THE  PROGRAM,
 THE  APPROPRIATE  PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT PROGRAM AND THE
 COMMISSIONER SHALL ENROLL THE RETIREE IN THE NEW YORK HEALTH PROGRAM. IF
 THE RETIREE'S  PUBLIC  EMPLOYEE  RETIREE  HEALTH  BENEFIT  INCLUDES  ANY
 SERVICE  FOR  WHICH  COVERAGE  IS  NOT OFFERED UNDER THE NEW YORK HEALTH
 PROGRAM, THE RETIREE SHALL CONTINUE TO RECEIVE  THAT  BENEFIT  FROM  THE
 APPROPRIATE PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT PROGRAM.
   (C)  FOR  EVERY RETIREE, WHILE HE OR SHE IS NOT A RESIDENT OF NEW YORK
 STATE, THE APPROPRIATE PUBLIC EMPLOYEE RETIREE  HEALTH  BENEFIT  PROGRAM
 SHALL  MAINTAIN  THE RETIREE'S PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT AS
 IF THIS ARTICLE HAD NOT BEEN ENACTED.
   § 5102. BOARD OF TRUSTEES. 1. THE NEW YORK HEALTH BOARD OF TRUSTEES IS
 HEREBY CREATED IN THE DEPARTMENT. THE BOARD OF TRUSTEES  SHALL,  AT  THE
 REQUEST  OF  THE  COMMISSIONER,  CONSIDER  ANY  MATTER TO EFFECTUATE THE
 PROVISIONS AND PURPOSES OF THIS ARTICLE, AND MAY ADVISE THE COMMISSIONER
 THEREON; AND IT MAY, FROM TIME TO TIME, SUBMIT TO THE  COMMISSIONER  ANY
 RECOMMENDATIONS  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTI-
 CLE. THE COMMISSIONER MAY PROPOSE REGULATIONS  UNDER  THIS  ARTICLE  AND
 AMENDMENTS THERETO FOR CONSIDERATION BY THE BOARD. THE BOARD OF TRUSTEES
 SHALL  HAVE  NO EXECUTIVE, ADMINISTRATIVE OR APPOINTIVE DUTIES EXCEPT AS
 OTHERWISE PROVIDED BY LAW. THE BOARD OF TRUSTEES  SHALL  HAVE  POWER  TO
 ESTABLISH,  AND  FROM  TIME TO TIME, AMEND REGULATIONS TO EFFECTUATE THE
 PROVISIONS AND PURPOSES OF THIS ARTICLE,  SUBJECT  TO  APPROVAL  BY  THE
 COMMISSIONER.
   2. THE BOARD SHALL BE COMPOSED OF:
   (A)  THE  COMMISSIONER,  THE SUPERINTENDENT OF FINANCIAL SERVICES, AND
 THE DIRECTOR OF THE BUDGET, OR THEIR DESIGNEES, AS EX OFFICIO MEMBERS:
   (B) THIRTY-ONE TRUSTEES APPOINTED BY THE GOVERNOR;
   (I) SIX OF WHOM SHALL BE REPRESENTATIVES OF HEALTH CARE CONSUMER ADVO-
 CACY ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY,  WHO
 HAVE  BEEN  INVOLVED  IN  ISSUES OF INTEREST TO LOW- AND MODERATE-INCOME
 INDIVIDUALS, OLDER ADULTS, AND PEOPLE WITH DISABILITIES; AT LEAST  THREE
 OF WHOM SHALL REPRESENT ORGANIZATIONS LED BY CONSUMERS IN THOSE GROUPS;
   (II)  THREE OF WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL ORGANIZA-
 TIONS REPRESENTING PHYSICIANS;
   (III) FIVE OF WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL  ORGANIZA-
 TIONS  REPRESENTING  LICENSED  OR  REGISTERED  HEALTH CARE PROFESSIONALS
 OTHER THAN PHYSICIANS;
   (IV) THREE OF WHOM SHALL BE REPRESENTATIVES OF GENERAL HOSPITALS,  ONE
 OF WHOM SHALL BE A REPRESENTATIVE OF PUBLIC GENERAL HOSPITALS;
   (V) ONE OF WHOM SHALL BE A REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
   (VI)  TWO  OF  WHOM SHALL BE REPRESENTATIVES OF REHABILITATION OR HOME
 CARE PROVIDERS;
   (VII) TWO OF WHOM SHALL BE REPRESENTATIVES  OF  BEHAVIORAL  OR  MENTAL
 HEALTH OR DISABILITY SERVICE PROVIDERS;
   (VIII)  TWO  OF WHOM SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
 TIONS;
   (IX) THREE OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
   (X) TWO OF WHOM SHALL  HAVE  DEMONSTRATED  EXPERTISE  IN  HEALTH  CARE
 FINANCE; AND

 A. 6058                             9
 
   (XI)  TWO  OF  WHOM SHALL BE EMPLOYERS OR REPRESENTATIVES OF EMPLOYERS
 WHO PAY THE PAYROLL TAX UNDER THIS ARTICLE, OR, PRIOR TO THE TAX  BECOM-
 ING EFFECTIVE, WILL PAY THE TAX; AND
   (C)  FOURTEEN  TRUSTEES  APPOINTED BY THE GOVERNOR; FIVE OF WHOM TO BE
 APPOINTED ON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; FIVE  OF
 WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
 THE  SENATE;  TWO  OF  WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE
 MINORITY LEADER OF THE ASSEMBLY; AND TWO OF WHOM TO BE APPOINTED ON  THE
 RECOMMENDATION OF THE MINORITY LEADER OF THE SENATE.
   3.  (A) AFTER THE END OF THE IMPLEMENTATION PERIOD, NO PERSON SHALL BE
 A TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM.
   (B) EACH TRUSTEE SHALL SERVE AT THE PLEASURE OF THE  APPOINTING  OFFI-
 CER, EXCEPT THE EX OFFICIO TRUSTEES.
   4.  THE  CHAIR  OF THE BOARD SHALL BE APPOINTED, AND MAY BE REMOVED AS
 CHAIR, BY THE GOVERNOR FROM AMONG THE TRUSTEES. THE BOARD SHALL MEET  AT
 LEAST  FOUR  TIMES  EACH  CALENDAR YEAR. MEETINGS SHALL BE HELD UPON THE
 CALL OF THE CHAIR AND AS PROVIDED  BY  THE  BOARD.  A  MAJORITY  OF  THE
 APPOINTED  TRUSTEES  SHALL BE A QUORUM OF THE BOARD, AND THE AFFIRMATIVE
 VOTE OF A MAJORITY OF THE TRUSTEES VOTING, BUT  NOT  LESS  THAN  TWELVE,
 SHALL  BE  NECESSARY  FOR ANY ACTION TO BE TAKEN BY THE BOARD. THE BOARD
 MAY ESTABLISH AN EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR DUTIES OF
 THE BOARD AS IT MAY PROVIDE, AND OTHER COMMITTEES TO ASSIST THE BOARD OR
 THE EXECUTIVE COMMITTEE. THE CHAIR OF THE BOARD SHALL CHAIR  THE  EXECU-
 TIVE  COMMITTEE  AND  SHALL  APPOINT  THE CHAIR AND MEMBERS OF ALL OTHER
 COMMITTEES. THE BOARD OF TRUSTEES  MAY  APPOINT  ONE  OR  MORE  ADVISORY
 COMMITTEES.  MEMBERS  OF  ADVISORY COMMITTEES NEED NOT BE MEMBERS OF THE
 BOARD OF TRUSTEES.
   5. TRUSTEES SHALL SERVE WITHOUT COMPENSATION BUT SHALL  BE  REIMBURSED
 FOR  THEIR  NECESSARY  AND ACTUAL EXPENSES INCURRED WHILE ENGAGED IN THE
 BUSINESS OF THE BOARD.  HOWEVER, THE BOARD MAY PROVIDE FOR  COMPENSATION
 IN CASES WHERE A LACK OF COMPENSATION WOULD LIMIT THE ABILITY OF A TRUS-
 TEE OR REPRESENTED ORGANIZATION TO PARTICIPATE IN BOARD BUSINESS.
   6. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, NO OFFICER OR
 EMPLOYEE OF THE STATE OR ANY LOCAL GOVERNMENT SHALL FORFEIT OR BE DEEMED
 TO  HAVE  FORFEITED HIS OR HER OFFICE OR EMPLOYMENT BY REASON OF BEING A
 TRUSTEE.
   7. THE BOARD AND ITS COMMITTEES AND ADVISORY  COMMITTEES  MAY  REQUEST
 AND  RECEIVE  THE  ASSISTANCE  OF  THE DEPARTMENT AND ANY OTHER STATE OR
 LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
   8. NO LATER THAN TWO YEARS AFTER THE EFFECTIVE DATE OF THIS ARTICLE:
   (A) THE BOARD SHALL DEVELOP PROPOSALS FOR: (I)  INCORPORATING  RETIREE
 HEALTH  BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER RETI-
 REE HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK  HEALTH
 BUT  LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING EMPLOYER
 RETIREE HEALTH BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED  SUCH  BENEFITS
 WHILE  RESIDING  IN  THE  STATE  PRIOR TO THE IMPLEMENTATION OF NEW YORK
 HEALTH AND LIVE AS RETIREES OUT OF THE STATE.  THE BOARD  SHALL  PRESENT
 ITS PROPOSALS TO THE GOVERNOR AND THE LEGISLATURE.
   (B) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK HEALTH COVERAGE OF
 HEALTH  CARE  SERVICES  COVERED  UNDER  THE  WORKERS'  COMPENSATION LAW,
 INCLUDING WHETHER AND HOW TO CONTINUE FUNDING FOR THOSE  SERVICES  UNDER
 THAT  LAW  AND  WHETHER  AND HOW TO INCORPORATE AN ELEMENT OF EXPERIENCE
 RATING.
   (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK  HEALTH  COVERAGE,
 FOR  MEMBERS,  OF  HEALTH  CARE  SERVICES COVERED UNDER PARAGRAPH ONE OF
 SUBSECTION (A) OF SECTION FIFTY-ONE HUNDRED TWO  OF  THE  INSURANCE  LAW

 A. 6058                            10
 
 RELATING  TO  MOTOR VEHICLE INSURANCE REPARATIONS, INCLUDING WHETHER AND
 HOW TO CONTINUE FUNDING FOR THOSE SERVICES.
   (D)  THE  BOARD  SHALL  DEVELOP  A PROPOSAL FOR INTEGRATION OF FEDERAL
 VETERANS HEALTH ADMINISTRATION PROGRAMS WITH NEW YORK HEALTH COVERAGE OF
 HEALTH CARE SERVICES; PROVIDED HOWEVER THAT ENROLLMENT IN OR ELIGIBILITY
 FOR FEDERAL VETERANS HEALTH ADMINISTRATION PROGRAMS SHALL NOT  AFFECT  A
 RESIDENT'S ELIGIBILITY FOR NEW YORK HEALTH COVERAGE.
   §  5103.  ELIGIBILITY  AND  ENROLLMENT. 1. EVERY RESIDENT OF THE STATE
 SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
   2. NO INDIVIDUAL SHALL BE REQUIRED TO PAY ANY PREMIUM OR OTHER  CHARGE
 FOR ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.
   3.  A  NEWBORN  CHILD  SHALL BE ENROLLED AS OF THE DATE OF THE CHILD'S
 BIRTH IF ENROLLMENT IS DONE PRIOR TO THE CHILD'S BIRTH OR  WITHIN  SIXTY
 DAYS AFTER THE CHILD'S BIRTH.
   §  5104.  BENEFITS.  1. THE PROGRAM SHALL PROVIDE COMPREHENSIVE HEALTH
 COVERAGE TO EVERY MEMBER, WHICH SHALL INCLUDE ALL HEALTH  CARE  SERVICES
 REQUIRED  TO  BE  COVERED  UNDER ANY OF THE FOLLOWING, WITHOUT REGARD TO
 WHETHER THE MEMBER WOULD OTHERWISE BE ELIGIBLE FOR  OR  COVERED  BY  THE
 PROGRAM OR SOURCE REFERRED TO:
   (A) CHILD HEALTH PLUS;
   (B)  MEDICAID,  INCLUDING  BUT  NOT LIMITED TO SERVICES PROVIDED UNDER
 MEDICAID WAIVER PROGRAMS, INCLUDING BUT NOT  LIMITED  TO  THOSE  GRANTED
 UNDER  SECTION  1915  OF THE FEDERAL SOCIAL SECURITY ACT TO PERSONS WITH
 TRAUMATIC BRAIN INJURIES OR QUALIFYING FOR NURSING  HOME  DIVERSION  AND
 TRANSITION SERVICES;
   (C) MEDICARE;
   (D)  ARTICLE  FORTY-FOUR  OF  THIS  CHAPTER  OR  ARTICLE THIRTY-TWO OR
 FORTY-THREE OF THE INSURANCE LAW;
   (E) ARTICLE ELEVEN OF THE CIVIL SERVICE LAW, AS OF THE DATE  ONE  YEAR
 BEFORE THE BEGINNING OF THE IMPLEMENTATION PERIOD;
   (F)  ANY  COST  INCURRED DEFINED IN PARAGRAPH ONE OF SUBSECTION (A) OF
 SECTION FIFTY-ONE HUNDRED TWO OF THE INSURANCE LAW, PROVIDED  THAT  THIS
 COVERAGE  SHALL  NOT  REPLACE  COVERAGE  UNDER  ARTICLE FIFTY-ONE OF THE
 INSURANCE LAW;
   (G) ANY ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED  TO  THE
 PROGRAM'S BENEFITS BY THE PROGRAM; AND
   (H)  PROVIDED  THAT  WHERE  ANY STATE LAW OR REGULATION RELATED TO ANY
 FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM STATES THAT A BENEFIT IS CONTIN-
 GENT ON FEDERAL FINANCIAL PARTICIPATION, OR WORDS TO  THAT  EFFECT,  THE
 BENEFIT  SHALL  BE  INCLUDED  UNDER  THE NEW YORK HEALTH PROGRAM WITHOUT
 REGARD TO FEDERAL FINANCIAL PARTICIPATION.
   2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM, DEDUCTIBLE, CO-PAY-
 MENT OR CO-INSURANCE UNDER THE PROGRAM.
   3. THE PROGRAM SHALL PROVIDE FOR PAYMENT UNDER THE PROGRAM FOR:
   (A) EMERGENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO A  MEMBER
 OR  INDIVIDUAL  ENTITLED TO BECOME A MEMBER WHO HAS NOT HAD A REASONABLE
 OPPORTUNITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR; AND
   (B) HEALTH CARE SERVICES PROVIDED IN AN EMERGENCY TO AN INDIVIDUAL WHO
 IS ENTITLED TO BECOME A MEMBER OR  ENROLLED  WITH  A  CARE  COORDINATOR,
 REGARDLESS OF HAVING HAD AN OPPORTUNITY TO DO SO.
   §  5105.  HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHODOL-
 OGIES.  1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE  PROVIDER
 QUALIFIED  TO  PARTICIPATE  UNDER  THIS  SECTION MAY PROVIDE HEALTH CARE
 SERVICES UNDER THE PROGRAM, PROVIDED THAT THE HEALTH  CARE  PROVIDER  IS
 OTHERWISE  LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR THE
 INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.

 A. 6058                            11
 
   (B) A MEMBER MAY CHOOSE TO RECEIVE  HEALTH  CARE  SERVICES  UNDER  THE
 PROGRAM  FROM  ANY PARTICIPATING PROVIDER, CONSISTENT WITH PROVISIONS OF
 THIS ARTICLE RELATING TO CARE COORDINATION  AND  HEALTH  CARE  ORGANIZA-
 TIONS,  THE  WILLINGNESS  OR  AVAILABILITY  OF  THE PROVIDER (SUBJECT TO
 PROVISIONS  OF  THIS ARTICLE RELATING TO DISCRIMINATION), AND THE APPRO-
 PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
   2. CARE COORDINATION. (A) A CARE COORDINATOR MAY BE AN  INDIVIDUAL  OR
 ENTITY THAT IS APPROVED BY THE PROGRAM THAT IS:
   (I)  A  HEALTH CARE PRACTITIONER WHO IS: (A) THE MEMBER'S PRIMARY CARE
 PRACTITIONER; (B) AT THE OPTION OF A FEMALE MEMBER, THE MEMBER'S PROVID-
 ER OF PRIMARY GYNECOLOGICAL CARE; OR (C) AT THE OPTION OF A  MEMBER  WHO
 HAS  A  CHRONIC  CONDITION  THAT  REQUIRES  SPECIALTY CARE, A SPECIALIST
 HEALTH CARE PRACTITIONER WHO REGULARLY AND CONTINUALLY  PROVIDES  TREAT-
 MENT FOR THAT CONDITION TO THE MEMBER;
   (II)  AN ENTITY LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR
 CERTIFIED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER, OR, WITH RESPECT  TO
 A  MEMBER  WHO  RECEIVES  CHRONIC MENTAL HEALTH CARE SERVICES, AN ENTITY
 LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL  HYGIENE  LAW  OR  OTHER
 ENTITY APPROVED BY THE COMMISSIONER IN CONSULTATION WITH THE COMMISSION-
 ER OF MENTAL HEALTH;
   (III) A HEALTH CARE ORGANIZATION;
   (IV)  A  LABOR  UNION OR AN ENTITY AFFILIATED WITH AND DESIGNATED BY A
 LABOR UNION OF WHICH THE ENROLLEE  OR  ENROLLEE'S  FAMILY  MEMBER  IS  A
 MEMBER,  WITH  RESPECT TO ITS MEMBERS AND THEIR FAMILY MEMBERS; PROVIDED
 THAT THIS PROVISION SHALL NOT PRECLUDE SUCH AN ENTITY  FROM  BECOMING  A
 CARE  COORDINATOR  UNDER  SUBPARAGRAPH (V) OF THIS PARAGRAPH OR A HEALTH
 CARE ORGANIZATION UNDER SECTION FIFTY-ONE HUNDRED SIX OF  THIS  ARTICLE;
 OR
   (V) ANY NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY APPROVED BY THE PROGRAM.
   (B)(I)  EVERY  MEMBER SHALL ENROLL WITH A CARE COORDINATOR THAT AGREES
 TO PROVIDE CARE COORDINATION TO THE MEMBER  PRIOR  TO  RECEIVING  HEALTH
 CARE  SERVICES  TO  BE PAID FOR UNDER THE PROGRAM.  HEALTH CARE SERVICES
 PROVIDED TO A MEMBER SHALL NOT BE SUBJECT TO PAYMENT UNDER  THE  PROGRAM
 UNLESS  THE  MEMBER  IS ENROLLED WITH A CARE COORDINATOR AT THE TIME THE
 HEALTH CARE SERVICE IS PROVIDED.
   (II) THIS PARAGRAPH SHALL NOT APPLY TO HEALTH CARE  SERVICES  PROVIDED
 UNDER  SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR OF THIS ARTI-
 CLE (CERTAIN EMERGENCY OR TEMPORARY SERVICES).
   (III) THE MEMBER SHALL REMAIN  ENROLLED  WITH  THAT  CARE  COORDINATOR
 UNTIL  THE  MEMBER BECOMES ENROLLED WITH A DIFFERENT CARE COORDINATOR OR
 CEASES TO BE A MEMBER. MEMBERS HAVE THE RIGHT TO CHANGE THEIR CARE COOR-
 DINATOR ON TERMS AT LEAST AS PERMISSIVE AS  THE  PROVISIONS  OF  SECTION
 THREE  HUNDRED  SIXTY-FOUR-J  OF  THE SOCIAL SERVICES LAW RELATING TO AN
 INDIVIDUAL CHANGING HIS OR HER PRIMARY CARE  PROVIDER  OR  MANAGED  CARE
 PROVIDER.
   (C)  CARE COORDINATION SHALL BE PROVIDED TO THE MEMBER BY THE MEMBER'S
 CARE COORDINATOR.  A CARE COORDINATOR MAY EMPLOY OR UTILIZE THE SERVICES
 OF OTHER INDIVIDUALS OR ENTITIES TO ASSIST  IN  PROVIDING  CARE  COORDI-
 NATION FOR THE MEMBER, CONSISTENT WITH REGULATIONS OF THE COMMISSIONER.
   (D)  A  HEALTH  CARE ORGANIZATION MAY ESTABLISH RULES RELATING TO CARE
 COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
 THIS SUBDIVISION BUT OTHERWISE CONSISTENT WITH THIS  ARTICLE  AND  OTHER
 APPLICABLE LAWS.
   (E) THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT PROCEDURES AND STAND-
 ARDS FOR AN INDIVIDUAL OR ENTITY TO BE APPROVED TO BE A CARE COORDINATOR
 IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS

 A. 6058                            12
 
 RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
 APPROVAL  ON A DETERMINATION THAT THE INDIVIDUAL OR ENTITY IS NOT QUALI-
 FIED OR COMPETENT TO BE A CARE COORDINATOR OR HAS EXHIBITED A COURSE  OF
 CONDUCT  WHICH  IS  EITHER INCONSISTENT WITH PROGRAM STANDARDS AND REGU-
 LATIONS OR WHICH EXHIBITS AN UNWILLINGNESS TO MEET  SUCH  STANDARDS  AND
 REGULATIONS,  OR  IS  A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY.
 SUCH PROCEDURES AND STANDARDS SHALL NOT LIMIT  APPROVAL  TO  BE  A  CARE
 COORDINATOR  IN  THE  PROGRAM  FOR  CRITERIA OTHER THAN THOSE UNDER THIS
 SECTION AND SHALL BE CONSISTENT  WITH  GOOD  PROFESSIONAL  PRACTICE.  IN
 DEVELOPING  THE  PROCEDURES  AND  STANDARDS, THE COMMISSIONER SHALL: (I)
 CONSIDER  EXISTING  STANDARDS  DEVELOPED  BY  NATIONAL  ACCREDITING  AND
 PROFESSIONAL  ORGANIZATIONS;  AND  (II)  CONSULT WITH NATIONAL AND LOCAL
 ORGANIZATIONS WORKING ON CARE COORDINATION OR SIMILAR MODELS,  INCLUDING
 HEALTH  CARE PRACTITIONERS, HOSPITALS, CLINICS, BIRTH CENTERS, LONG-TERM
 SUPPORTS AND SERVICE PROVIDERS, CONSUMERS AND THEIR REPRESENTATIVES, AND
 LABOR ORGANIZATIONS REPRESENTING HEALTH CARE  WORKERS.  WHEN  DEVELOPING
 AND IMPLEMENTING STANDARDS OF APPROVAL OF CARE COORDINATORS FOR INDIVID-
 UALS  RECEIVING  CHRONIC  MENTAL  HEALTH CARE SERVICES, THE COMMISSIONER
 SHALL CONSULT WITH THE COMMISSIONER OF MENTAL HEALTH. AN  INDIVIDUAL  OR
 ENTITY  MAY  NOT  BE  A CARE COORDINATOR UNLESS THE SERVICES INCLUDED IN
 CARE COORDINATION ARE WITHIN  THE  INDIVIDUAL'S  PROFESSIONAL  SCOPE  OF
 PRACTICE OR THE ENTITY'S LEGAL AUTHORITY.
   (F)  TO  MAINTAIN APPROVAL UNDER THE PROGRAM, A CARE COORDINATOR MUST:
 (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSIONER;  AND
 (II)  PROVIDE  DATA TO THE DEPARTMENT AS REQUIRED BY THE COMMISSIONER TO
 ENABLE THE COMMISSIONER TO EVALUATE THE IMPACT OF CARE  COORDINATORS  ON
 QUALITY, OUTCOMES, COST, AND PATIENT AND PROVIDER SATISFACTION.
   (G)  NOTHING  IN  THIS  SUBDIVISION  SHALL AUTHORIZE ANY INDIVIDUAL TO
 ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION LAW.
   3. HEALTH CARE PROVIDERS. (A) THE  COMMISSIONER  SHALL  ESTABLISH  AND
 MAINTAIN PROCEDURES AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE QUALI-
 FIED  TO PARTICIPATE IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO PROCE-
 DURES AND STANDARDS RELATING TO THE REVOCATION, SUSPENSION,  LIMITATION,
 OR ANNULMENT OF QUALIFICATION TO PARTICIPATE ON A DETERMINATION THAT THE
 HEALTH  CARE  PROVIDER IS NOT QUALIFIED OR COMPETENT TO BE A PROVIDER OF
 SPECIFIC HEALTH CARE SERVICES OR HAS EXHIBITED A COURSE OF CONDUCT WHICH
 IS EITHER INCONSISTENT WITH PROGRAM STANDARDS AND REGULATIONS  OR  WHICH
 EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
 A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
 STANDARDS  SHALL  NOT  LIMIT  HEALTH  CARE PROVIDER PARTICIPATION IN THE
 PROGRAM FOR CRITERIA OTHER THAN THOSE UNDER THIS SECTION  AND  SHALL  BE
 CONSISTENT  WITH GOOD PROFESSIONAL PRACTICE.  SUCH PROCEDURES AND STAND-
 ARDS MAY BE DIFFERENT FOR DIFFERENT TYPES OF HEALTH CARE  PROVIDERS  AND
 HEALTH  CARE  PROFESSIONALS.    THE COMMISSIONER MAY REQUIRE THAT HEALTH
 CARE PROVIDERS AND HEALTH CARE PROFESSIONALS  PARTICIPATE  IN  MEDICAID,
 CHILD HEALTH PLUS, OR MEDICARE TO QUALIFY TO PARTICIPATE IN THE PROGRAM.
 ANY  HEALTH  CARE  PROVIDER THAT IS QUALIFIED TO PARTICIPATE UNDER MEDI-
 CAID, CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE  QUALIFIED  TO
 PARTICIPATE  IN  THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION,
 SUSPENSION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE  IN
 ANY  OF  THOSE PROGRAMS SHALL APPLY TO THE HEALTH CARE PROVIDER'S QUALI-
 FICATION TO PARTICIPATE IN THE PROGRAM;  PROVIDED  THAT  A  HEALTH  CARE
 PROVIDER  QUALIFIED  UNDER  THIS SENTENCE SHALL FOLLOW THE PROCEDURES TO
 BECOME QUALIFIED UNDER THE PROGRAM BY  THE  END  OF  THE  IMPLEMENTATION
 PERIOD.

 A. 6058                            13
 
   (B) THE COMMISSIONER SHALL ESTABLISH AND MAINTAIN PROCEDURES AND STAN-
 DARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR
 PURPOSES OF PROVIDING COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH
 CARE SERVICES.
   (C)  PROCEDURES  AND  STANDARDS  UNDER  THIS SUBDIVISION SHALL INCLUDE
 PROVISIONS FOR EXPEDITED TEMPORARY QUALIFICATION TO PARTICIPATE  IN  THE
 PROGRAM FOR HEALTH CARE PROFESSIONALS WHO ARE (I) TEMPORARILY AUTHORIZED
 TO  PRACTICE  IN  THE STATE OR (II) ARE RECENTLY ARRIVED IN THE STATE OR
 RECENTLY AUTHORIZED TO PRACTICE IN THE STATE.
   4. PAYMENT FOR HEALTH CARE SERVICES.  (A)  (I)  THE  COMMISSIONER  MAY
 ESTABLISH  BY  REGULATION PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES
 AND CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM  BY  PARTIC-
 IPATING  PROVIDERS,  CARE  COORDINATORS,  AND HEALTH CARE ORGANIZATIONS.
 THERE MAY BE A VARIETY OF  DIFFERENT  PAYMENT  METHODOLOGIES,  INCLUDING
 THOSE ESTABLISHED ON A DEMONSTRATION BASIS.
   (II)  ALL  PAYMENT  METHODOLOGIES AND RATES UNDER THE PROGRAM SHALL BE
 REASONABLE AND REASONABLY RELATED TO THE COST OF  EFFICIENTLY  PROVIDING
 THE  HEALTH  CARE SERVICE AND ASSURING AN ADEQUATE AND ACCESSIBLE SUPPLY
 OF THE HEALTH CARE SERVICE.
   (III) IN DETERMINING SUCH PAYMENT METHODOLOGIES AND RATES, THE COMMIS-
 SIONER SHALL CONSIDER FACTORS INCLUDING USUAL AND CUSTOMARY RATES  IMME-
 DIATELY PRIOR TO THE IMPLEMENTATION OF THE PROGRAM, REPORTED IN A BENCH-
 MARKING DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE
 SUPERINTENDENT OF FINANCIAL SERVICES, UNDER SECTION SIX HUNDRED THREE OF
 THE  FINANCIAL SERVICES LAW; THE LEVEL OF TRAINING, EDUCATION, AND EXPE-
 RIENCE OF THE HEALTH CARE PROVIDER OR PROVIDERS INVOLVED; AND THE  SCOPE
 OF  SERVICES, COMPLEXITY, AND CIRCUMSTANCES OF CARE INCLUDING GEOGRAPHIC
 FACTORS. UNTIL AND UNLESS OTHER  APPLICABLE  PAYMENT  METHODOLOGIES  ARE
 ESTABLISHED,  HEALTH CARE SERVICES PROVIDED TO MEMBERS UNDER THE PROGRAM
 SHALL BE PAID FOR ON A FEE-FOR-SERVICE BASIS, EXCEPT  FOR  CARE  COORDI-
 NATION.
   (B)  THE  PROGRAM  SHALL ENGAGE IN GOOD FAITH NEGOTIATIONS WITH HEALTH
 CARE PROVIDERS' REPRESENTATIVES UNDER TITLE III OF ARTICLE FORTY-NINE OF
 THIS CHAPTER, INCLUDING, BUT NOT LIMITED TO, IN  RELATION  TO  RATES  OF
 PAYMENT AND PAYMENT METHODOLOGIES.
   (C) (I) PRESCRIPTION DRUGS ELIGIBLE FOR REIMBURSEMENT UNDER THIS ARTI-
 CLE AND DISPENSED BY A PHARMACY SHALL BE PROVIDED AND PAID FOR UNDER THE
 PREFERRED  DRUG PROGRAM AND THE CLINICAL DRUG REVIEW PROGRAM UNDER TITLE
 ONE OF ARTICLE TWO-A OF THIS CHAPTER, EXCEPT AS  OTHERWISE  PROVIDED  IN
 THIS  PARAGRAPH.    AS  USED  IN THIS PARAGRAPH, "MANAGED CARE PROVIDER"
 MEANS AN ENTITY UNDER PARAGRAPH (B)  OF  SUBDIVISION  EIGHT  OF  SECTION
 FIFTY-ONE  HUNDRED  ONE OF THIS ARTICLE THAT QUALIFIES UNDER THE FEDERAL
 PUBLIC HEALTH SERVICES ACT (THE "340B PROGRAM").
   (II) WHERE THE MEMBER IS ENROLLED IN A MANAGED  CARE  PROVIDER  AND  A
 PRESCRIPTION  FOR  THE  MEMBER IS MADE UNDER SECTION 340B OF THE FEDERAL
 PUBLIC HEALTH SERVICE ACT (THE "340B PROGRAM") AND UNDER A MEMORANDUM OF
 UNDERSTANDING RELATING TO THE 340B PROGRAM BETWEEN THE NEW  YORK  HEALTH
 PROGRAM  AND  THE RELEVANT 340B PROGRAM COVERED ENTITY, THE MANAGED CARE
 PROVIDER SHALL PURCHASE, PAY FOR AND PROVIDE FOR  THE  DRUGS  UNDER  THE
 340B  PROGRAM. HOWEVER, THE PRESCRIPTION SHALL BE SUBJECT TO SECTION TWO
 HUNDRED SEVENTY-THREE (PREFERRED DRUG PROGRAM PRIOR  AUTHORIZATION)  AND
 SECTION  TWO HUNDRED SEVENTY-FOUR (CLINICAL DRUG REVIEW PROGRAM) OF THIS
 CHAPTER.
   (III) THE NEW YORK HEALTH PROGRAM SHALL  ENTER  INTO  AND  MAINTAIN  A
 MEMORANDUM  OF UNDERSTANDING RELATING TO THE 340B PROGRAM WITH EACH 340B
 COVERED ENTITY IN THE STATE THAT AGREES TO DO SO.

 A. 6058                            14
 
   (IV) WHERE PRESCRIPTION DRUGS ARE NOT DISPENSED  THROUGH  A  PHARMACY,
 PAYMENT  SHALL  BE MADE AS OTHERWISE PROVIDED IN THIS ARTICLE, INCLUDING
 USE OF THE 340B PROGRAM AS APPROPRIATE.
   (D)  PAYMENT  FOR  HEALTH CARE SERVICES ESTABLISHED UNDER THIS ARTICLE
 SHALL BE CONSIDERED PAYMENT IN FULL. A PARTICIPATING PROVIDER SHALL  NOT
 CHARGE  ANY RATE IN EXCESS OF THE PAYMENT ESTABLISHED UNDER THIS ARTICLE
 FOR ANY HEALTH CARE SERVICE PROVIDED UNDER THE  PROGRAM  AND  SHALL  NOT
 SOLICIT  OR  ACCEPT  PAYMENT FROM ANY MEMBER OR THIRD PARTY FOR ANY SUCH
 SERVICE EXCEPT AS PROVIDED UNDER SECTION FIFTY-ONE HUNDRED NINE OF  THIS
 ARTICLE.    HOWEVER,  THIS PARAGRAPH SHALL NOT PRECLUDE THE PROGRAM FROM
 ACTING AS A PRIMARY OR  SECONDARY  PAYER  IN  CONJUNCTION  WITH  ANOTHER
 THIRD-PARTY  PAYER  WHERE PERMITTED UNDER SECTION FIFTY-ONE HUNDRED NINE
 OF THIS ARTICLE.
   (E) THE PROGRAM MAY PROVIDE IN PAYMENT METHODOLOGIES FOR  PAYMENT  FOR
 CAPITAL  RELATED  EXPENSES  FOR SPECIFICALLY IDENTIFIED CAPITAL EXPENDI-
 TURES INCURRED BY  NOT-FOR-PROFIT  OR  GOVERNMENTAL  ENTITIES  CERTIFIED
 UNDER  ARTICLE TWENTY-EIGHT OF THIS CHAPTER. ANY CAPITAL RELATED EXPENSE
 GENERATED BY A CAPITAL EXPENDITURE THAT REQUIRES  OR  REQUIRED  APPROVAL
 UNDER  ARTICLE  TWENTY-EIGHT  OF  THIS  CHAPTER  MUST HAVE RECEIVED THAT
 APPROVAL FOR THE CAPITAL RELATED  EXPENSE  TO  BE  PAID  FOR  UNDER  THE
 PROGRAM.
   (F) PAYMENT METHODOLOGIES AND RATES SHALL INCLUDE A DISTINCT COMPONENT
 OF  REIMBURSEMENT  FOR DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION AS
 DEFINED, CALCULATED AND IMPLEMENTED  PURSUANT  TO  SECTION  TWENTY-EIGHT
 HUNDRED SEVEN-C OF THIS CHAPTER.
   (G)  THE COMMISSIONER SHALL PROVIDE BY  REGULATION FOR PAYMENT METHOD-
 OLOGIES AND PROCEDURES FOR PAYING FOR OUT-OF-STATE HEALTH CARE SERVICES.
   5. PRIOR AUTHORIZATION. THE PROGRAM SHALL NOT REQUIRE  PRIOR  AUTHORI-
 ZATION  FOR  ANY  HEALTH  CARE SERVICE IN ANY MANNER MORE RESTRICTIVE OF
 ACCESS TO OR PAYMENT FOR THE SERVICE THAN  WOULD  BE  REQUIRED  FOR  THE
 SERVICE  UNDER  MEDICARE  PART  A  OR  PART  B.  PRIOR AUTHORIZATION FOR
 PRESCRIPTION DRUGS PROVIDED BY PHARMACIES UNDER  THE  PROGRAM  SHALL  BE
 UNDER TITLE ONE OF ARTICLE TWO-A OF THIS CHAPTER.
   §  5106.  HEALTH  CARE ORGANIZATIONS. 1. A MEMBER MAY CHOOSE TO ENROLL
 WITH AND RECEIVE HEALTH CARE SERVICES UNDER THE PROGRAM  FROM  A  HEALTH
 CARE ORGANIZATION.
   2.  A  HEALTH  CARE  ORGANIZATION SHALL BE A NOT-FOR-PROFIT OR GOVERN-
 MENTAL ENTITY THAT IS APPROVED BY THE COMMISSIONER THAT IS:
   (A) AN ACCOUNTABLE CARE ORGANIZATION UNDER  ARTICLE  TWENTY-NINE-E  OF
 THIS CHAPTER; OR
   (B)  A  LABOR  UNION  OR AN ENTITY AFFILIATED WITH AND DESIGNATED BY A
 LABOR UNION OF WHICH THE ENROLLEE  OR  ENROLLEE'S  FAMILY  MEMBER  IS  A
 MEMBER  (I)  WITH  RESPECT  TO ITS MEMBERS AND THEIR FAMILY MEMBERS, AND
 (II) IF ALLOWED BY APPLICABLE LAW AND APPROVED BY THE COMMISSIONER,  FOR
 OTHER MEMBERS OF THE PROGRAM.
   3.  A HEALTH CARE ORGANIZATION MAY BE RESPONSIBLE FOR PROVIDING ALL OR
 PART OF THE HEALTH CARE SERVICES TO WHICH ITS MEMBERS ARE ENTITLED UNDER
 THE PROGRAM, CONSISTENT WITH THE TERMS OF ITS APPROVAL  BY  THE  COMMIS-
 SIONER.
   4.  (A)  THE  COMMISSIONER  SHALL DEVELOP AND IMPLEMENT PROCEDURES AND
 STANDARDS FOR AN ENTITY TO BE APPROVED TO BE A HEALTH CARE  ORGANIZATION
 IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS
 RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
 APPROVAL  ON  A  DETERMINATION  THAT THE ENTITY IS NOT COMPETENT TO BE A
 HEALTH CARE ORGANIZATION OR HAS EXHIBITED A COURSE OF CONDUCT  WHICH  IS
 EITHER  INCONSISTENT  WITH  PROGRAM  STANDARDS  AND REGULATIONS OR WHICH

 A. 6058                            15
 
 EXHIBITS AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR  IS
 A  POTENTIAL  THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND
 STANDARDS SHALL NOT LIMIT APPROVAL TO BE A HEALTH CARE  ORGANIZATION  IN
 THE  PROGRAM  FOR CRITERIA OTHER THAN THOSE UNDER THIS SECTION AND SHALL
 BE CONSISTENT WITH GOOD PROFESSIONAL PRACTICE. IN DEVELOPING THE  PROCE-
 DURES AND STANDARDS, THE COMMISSIONER SHALL: (I) CONSIDER EXISTING STAN-
 DARDS  DEVELOPED BY NATIONAL ACCREDITING AND PROFESSIONAL ORGANIZATIONS;
 AND (II) CONSULT WITH NATIONAL AND LOCAL ORGANIZATIONS  WORKING  IN  THE
 FIELD OF HEALTH CARE ORGANIZATIONS, INCLUDING HEALTH CARE PRACTITIONERS,
 HOSPITALS,  CLINICS,  BIRTH  CENTERS,  LONG-TERM  SUPPORTS  AND  SERVICE
 PROVIDERS, CONSUMERS AND THEIR REPRESENTATIVES AND  LABOR  ORGANIZATIONS
 REPRESENTING HEALTH CARE WORKERS. WHEN DEVELOPING AND IMPLEMENTING STAN-
 DARDS  OF  APPROVAL OF HEALTH CARE ORGANIZATIONS, THE COMMISSIONER SHALL
 CONSULT WITH THE COMMISSIONER OF  MENTAL  HEALTH,  THE  COMMISSIONER  OF
 DEVELOPMENTAL  DISABILITIES,  THE  DIRECTOR  OF THE STATE OFFICE FOR THE
 AGING,  THE  COMMISSIONER  OF  THE  OFFICE  OF  ADDICTION  SERVICES  AND
 SUPPORTS, AND THE COMMISSIONER OF THE DIVISION OF HUMAN RIGHTS.
   (B) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A HEALTH CARE ORGANIZATION
 MUST:  (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSION-
 ER; AND (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY  THE  COMMIS-
 SIONER  TO ENABLE THE COMMISSIONER TO EVALUATE THE HEALTH CARE ORGANIZA-
 TION IN RELATION  TO  QUALITY  OF  HEALTH  CARE  SERVICES,  HEALTH  CARE
 OUTCOMES, COST, AND PATIENT AND PROVIDER SATISFACTION.
   5.  THE  COMMISSIONER  SHALL  MAKE REGULATIONS RELATING TO HEALTH CARE
 ORGANIZATIONS CONSISTENT WITH AND TO ENSURE COMPLIANCE WITH  THIS  ARTI-
 CLE.
   6.  THE  PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY A
 HEALTH CARE ORGANIZATION THROUGH HEALTH  CARE  PROVIDERS  SHALL  NOT  BE
 CONSIDERED  THE PRACTICE OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCA-
 TION LAW BY THE HEALTH CARE ORGANIZATION.
   §  5107.  PROGRAM  STANDARDS.  1.  THE  COMMISSIONER  SHALL  ESTABLISH
 REQUIREMENTS AND STANDARDS FOR THE PROGRAM AND FOR HEALTH CARE ORGANIZA-
 TIONS,  CARE  COORDINATORS,  AND  HEALTH CARE PROVIDERS, CONSISTENT WITH
 THIS ARTICLE, INCLUDING REQUIREMENTS AND STANDARDS FOR, AS APPLICABLE:
   (A) THE SCOPE, QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES;
   (B) RELATIONS BETWEEN HEALTH CARE ORGANIZATIONS OR HEALTH CARE PROVID-
 ERS AND MEMBERS; AND
   (C) RELATIONS  BETWEEN  HEALTH  CARE  ORGANIZATIONS  AND  HEALTH  CARE
 PROVIDERS,  INCLUDING  (I) CREDENTIALING AND PARTICIPATION IN THE HEALTH
 CARE ORGANIZATION; AND (II) TERMS, METHODS AND RATES OF PAYMENT.
   2. REQUIREMENTS AND STANDARDS UNDER THE PROGRAM SHALL INCLUDE, BUT NOT
 BE LIMITED TO, PROVISIONS TO PROMOTE THE FOLLOWING:
   (A) SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS  IN  HEALTH
 CARE  PROVIDER  CREDENTIALING AND PARTICIPATION IN HEALTH CARE ORGANIZA-
 TION NETWORKS, REFERRALS, PAYMENT PROCEDURES AND RATES, CLAIMS  PROCESS-
 ING, AND APPROVAL OF HEALTH CARE SERVICES, AS APPLICABLE;
   (B)  PRIMARY  AND  PREVENTIVE  CARE,  CARE COORDINATION, EFFICIENT AND
 EFFECTIVE HEALTH CARE  SERVICES,  QUALITY  ASSURANCE,  COORDINATION  AND
 INTEGRATION  OF HEALTH CARE SERVICES, INCLUDING USE OF APPROPRIATE TECH-
 NOLOGY, AND PROMOTION OF PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL HEALTH;
   (C) ELIMINATION OF HEALTH CARE DISPARITIES;
   (D) NON-DISCRIMINATION WITH RESPECT TO MEMBERS AND HEALTH CARE PROVID-
 ERS ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, DISABIL-
 ITY, AGE, SEX, SEXUAL ORIENTATION, GENDER  IDENTITY  OR  EXPRESSION,  OR
 ECONOMIC  CIRCUMSTANCES;  PROVIDED  THAT  HEALTH  CARE SERVICES PROVIDED

 A. 6058                            16
 
 UNDER THE PROGRAM SHALL BE APPROPRIATE TO THE PATIENT'S CLINICALLY-RELE-
 VANT CIRCUMSTANCES;
   (E)  ACCESSIBILITY  OF  CARE  COORDINATION,  HEALTH  CARE ORGANIZATION
 SERVICES AND HEALTH CARE SERVICES, INCLUDING  ACCESSIBILITY  FOR  PEOPLE
 WITH DISABILITIES AND PEOPLE WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND
 ENGLISH,  AND  THE PROVIDING OF CARE COORDINATION, HEALTH CARE ORGANIZA-
 TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER;
 AND
   (F) ESPECIALLY IN RELATION TO LONG-TERM  SUPPORTS  AND  SERVICES,  THE
 MAXIMIZATION  AND  PRIORITIZATION OF THE MOST INTEGRATED COMMUNITY-BASED
 SUPPORTS AND SERVICES.
   3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
 A FOR-PROFIT ENTITY (OTHER THAN A PROFESSIONAL PRACTICE OF ONE  OR  MORE
 HEALTH  CARE  PROFESSIONALS) SHALL BE REQUIRED TO MEET THE SAME REQUIRE-
 MENTS AND STANDARDS AS ENTITIES ORGANIZED  AS  NOT-FOR-PROFIT  ENTITIES,
 AND PAYMENTS UNDER THE PROGRAM PAID TO SUCH ENTITIES SHALL NOT BE CALCU-
 LATED  TO  ACCOMMODATE THE GENERATION OF PROFIT OR REVENUE FOR DIVIDENDS
 OR OTHER RETURN ON INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT  BE
 PAID BY A NOT-FOR-PROFIT ENTITY.
   4.  EVERY  PARTICIPATING  PROVIDER  SHALL  FURNISH TO THE PROGRAM SUCH
 INFORMATION TO, AND PERMIT EXAMINATION OF ITS RECORDS BY,  THE  PROGRAM,
 AS  MAY  BE  REASONABLY REQUIRED FOR PURPOSES OF REVIEWING ACCESSIBILITY
 AND UTILIZATION OF HEALTH CARE SERVICES,  QUALITY  ASSURANCE,  PROMOTING
 IMPROVED  PATIENT OUTCOMES AND COST CONTAINMENT, THE MAKING OF PAYMENTS,
 AND STATISTICAL OR OTHER STUDIES OF THE OPERATION OF THE PROGRAM OR  FOR
 PROTECTION  AND  PROMOTION  OF  PUBLIC,  ENVIRONMENTAL  AND OCCUPATIONAL
 HEALTH.
   5. IN DEVELOPING REQUIREMENTS AND STANDARDS AND  MAKING  OTHER  POLICY
 DETERMINATIONS  UNDER  THIS ARTICLE, THE COMMISSIONER SHALL CONSULT WITH
 THE COMMISSIONER OF MENTAL HEALTH,  THE  COMMISSIONER  OF  DEVELOPMENTAL
 DISABILITIES,  THE  DIRECTOR  OF  THE  STATE  OFFICE  FOR THE AGING, THE
 COMMISSIONER OF THE OFFICE  OF  ADDICTION  SERVICES  AND  SUPPORTS,  THE
 COMMISSIONER  OF  THE  DIVISION  OF  HUMAN  RIGHTS,  REPRESENTATIVES  OF
 MEMBERS, HEALTH CARE PROVIDERS, CARE COORDINATORS, HEALTH CARE ORGANIZA-
 TIONS  EMPLOYERS, ORGANIZED LABOR INCLUDING  REPRESENTATIVES  OF  HEALTH
 CARE WORKERS, AND OTHER INTERESTED PARTIES.
   6.  THE PROGRAM SHALL MAINTAIN THE SECURITY AND CONFIDENTIALITY OF ALL
 DATA AND OTHER INFORMATION COLLECTED UNDER THE PROGRAM  WHEN  SUCH  DATA
 WOULD  BE NORMALLY CONSIDERED CONFIDENTIAL PATIENT DATA.  AGGREGATE DATA
 OF THE PROGRAM WHICH IS DERIVED FROM  CONFIDENTIAL  DATA  BUT  DOES  NOT
 VIOLATE  PATIENT  CONFIDENTIALITY  SHALL BE PUBLIC INFORMATION INCLUDING
 FOR PURPOSES OF ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
   § 5108. REGULATIONS. THE COMMISSIONER  SHALL  MAKE  REGULATIONS  UNDER
 THIS  ARTICLE  BY  APPROVING  REGULATIONS  AND AMENDMENTS THERETO, UNDER
 SUBDIVISION ONE OF SECTION FIFTY-ONE HUNDRED TWO OF  THIS  ARTICLE.  THE
 COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS THERETO UNDER THIS ARTI-
 CLE  ON  AN  EMERGENCY  BASIS UNDER SECTION TWO HUNDRED TWO OF THE STATE
 ADMINISTRATIVE PROCEDURE ACT, PROVIDED THAT SUCH REGULATIONS  OR  AMEND-
 MENTS SHALL NOT BECOME PERMANENT UNLESS ADOPTED UNDER SUBDIVISION ONE OF
 SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE.
   § 5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS. 1. THE COMMIS-
 SIONER  SHALL  SEEK  ALL FEDERAL WAIVERS AND OTHER FEDERAL APPROVALS AND
 ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS NECESSARY TO  OPERATE  THE
 PROGRAM CONSISTENT WITH THIS ARTICLE TO THE MAXIMUM EXTENT POSSIBLE.  NO
 PROVISION OF THIS ARTICLE AND NO ACTION UNDER THE PROGRAM SHALL DIMINISH

 A. 6058                            17
 
 ANY  RIGHT OR BENEFIT THE MEMBER WOULD OTHERWISE HAVE UNDER ANY FEDERAL-
 LY-MATCHED PROGRAM OR MEDICARE.
   2.  (A)  THE  COMMISSIONER  SHALL APPLY TO THE SECRETARY OF HEALTH AND
 HUMAN SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS  OF
 REQUIREMENTS,  AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERAL-
 LY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER
 FEDERAL PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH  CARE
 SERVICES,  THAT  ARE  NECESSARY TO ENABLE ALL NEW YORK HEALTH MEMBERS TO
 RECEIVE ALL BENEFITS UNDER THE PROGRAM THROUGH THE PROGRAM TO ENABLE THE
 STATE TO IMPLEMENT THIS ARTICLE AND TO RECEIVE AND DEPOSIT  ALL  FEDERAL
 PAYMENTS  UNDER  THOSE PROGRAMS (INCLUDING FUNDS THAT MAY BE PROVIDED IN
 LIEU OF PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES, AND SMALL  BUSINESS
 TAX  CREDITS) IN THE STATE TREASURY TO THE CREDIT OF THE NEW YORK HEALTH
 TRUST FUND AND TO USE THOSE FUNDS FOR THE NEW YORK  HEALTH  PROGRAM  AND
 OTHER PROVISIONS UNDER THIS ARTICLE. TO THE EXTENT POSSIBLE, THE COMMIS-
 SIONER SHALL NEGOTIATE ARRANGEMENTS WITH THE FEDERAL GOVERNMENT IN WHICH
 BULK  OR  LUMP-SUM FEDERAL PAYMENTS ARE PAID TO NEW YORK HEALTH IN PLACE
 OF  FEDERAL  SPENDING  OR  TAX  BENEFITS  FOR  FEDERALLY-MATCHED  HEALTH
 PROGRAMS  OR  FEDERAL  HEALTH  PROGRAMS.    THE  COMMISSIONER SHALL TAKE
 ACTIONS UNDER PARAGRAPH (B) OF SUBDIVISION EIGHT  OF  SECTION  FIFTY-ONE
 HUNDRED ONE OF THIS ARTICLE AS REASONABLY NECESSARY.
   (B)  THE  COMMISSIONER MAY REQUIRE MEMBERS OR APPLICANTS TO BE MEMBERS
 TO PROVIDE INFORMATION NECESSARY FOR THE  PROGRAM  TO  COMPLY  WITH  ANY
 WAIVER OR ARRANGEMENT UNDER THIS SUBDIVISION.
   3.  (A) THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS ARTICLE
 TO ENABLE NEW YORK HEALTH TO ADMINISTER MEDICARE IN NEW YORK  STATE,  TO
 CREATE  A  MEDICARE  MANAGED CARE PLAN ("MEDICARE ADVANTAGE") THAT WOULD
 OPERATE CONSISTENT WITH THIS ARTICLE, AND  TO  BE  A  PROVIDER  OF  DRUG
 COVERAGE UNDER MEDICARE PART D FOR ELIGIBLE MEMBERS OF NEW YORK HEALTH.
   (B)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
 PROVISIONS OF THIS SECTION  RELATING  TO  ANY  FEDERALLY-MATCHED  PUBLIC
 HEALTH  PROGRAM  OR  MEDICARE  AS  NECESSARY  TO IMPLEMENT ANY WAIVER OR
 ARRANGEMENT UNDER THIS SECTION OR TO MAXIMIZE THE  BENEFIT  TO  THE  NEW
 YORK  HEALTH PROGRAM UNDER THIS SECTION, PROVIDED THAT THE COMMISSIONER,
 IN CONSULTATION WITH THE DIRECTOR OF THE BUDGET,  SHALL  DETERMINE  THAT
 SUCH  WAIVER  OR  MODIFICATION  IS  IN THE BEST INTERESTS OF THE MEMBERS
 AFFECTED BY THE ACTION AND THE  STATE,  AND  PROVIDED  FURTHER  THAT  NO
 ACTION  UNDER  THIS  PARAGRAPH  SHALL  DIMINISH ANY RIGHT OR BENEFIT THE
 MEMBER WOULD OTHERWISE HAVE UNDER THE PROGRAM OR  ANY  FEDERALLY-MATCHED
 PUBLIC HEALTH PROGRAM OR MEDICARE.
   (C)  THE  COMMISSIONER  MAY  APPLY  FOR  COVERAGE UNDER ANY FEDERALLY-
 MATCHED PUBLIC HEALTH PROGRAM ON BEHALF OF ANY  MEMBER  AND  ENROLL  THE
 MEMBER IN THE FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE IF THE
 MEMBER  IS  ELIGIBLE  FOR IT.   ENROLLMENT IN A FEDERALLY-MATCHED PUBLIC
 HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE ANY MEMBER TO LOSE ANY HEALTH
 CARE SERVICE PROVIDED BY THE PROGRAM OR DIMINISH ANY  RIGHT  OR  BENEFIT
 THE MEMBER WOULD OTHERWISE HAVE.
   (D) THE COMMISSIONER SHALL BY REGULATION INCREASE THE INCOME ELIGIBIL-
 ITY  LEVEL,  INCREASE  OR  ELIMINATE  THE RESOURCE TEST FOR ELIGIBILITY,
 SIMPLIFY ANY PROCEDURAL OR DOCUMENTATION REQUIREMENT FOR ENROLLMENT, AND
 INCREASE THE BENEFITS FOR ANY FEDERALLY-MATCHED PUBLIC  HEALTH  PROGRAM,
 AND  FOR ANY PROGRAM TO REDUCE OR ELIMINATE AN INDIVIDUAL'S COINSURANCE,
 COST-SHARING OR PREMIUM OBLIGATIONS OR INCREASE AN  INDIVIDUAL'S  ELIGI-
 BILITY  FOR  ANY  FEDERAL  FINANCIAL  SUPPORT RELATED TO MEDICARE OR THE
 AFFORDABLE CARE ACT NOTWITHSTANDING ANY LAW OR REGULATION TO THE CONTRA-
 RY. THE COMMISSIONER MAY  ACT  UNDER  THIS  PARAGRAPH  UPON  A  FINDING,

 A. 6058                            18
 
 APPROVED BY THE DIRECTOR OF THE BUDGET, THAT THE ACTION (I) WILL HELP TO
 INCREASE  THE  NUMBER  OF  MEMBERS  WHO ARE ELIGIBLE FOR AND ENROLLED IN
 FEDERALLY-MATCHED PUBLIC HEALTH PROGRAMS, OR FOR ANY PROGRAM  TO  REDUCE
 OR  ELIMINATE AN INDIVIDUAL'S COINSURANCE, COST-SHARING OR PREMIUM OBLI-
 GATIONS OR INCREASE AN INDIVIDUAL'S ELIGIBILITY FOR ANY  FEDERAL  FINAN-
 CIAL  SUPPORT  RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT; (II) WILL
 NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY HEALTH CARE SERVICE, BENEFIT
 OR RIGHT THE INDIVIDUAL WOULD OTHERWISE HAVE; (III) IS IN  THE  INTEREST
 OF  THE PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS RECEIVED ANY NECESSARY
 FEDERAL WAIVERS OR APPROVALS TO ENSURE FEDERAL FINANCIAL PARTICIPATION.
   (E) TO ENABLE THE COMMISSIONER TO  APPLY  FOR  COVERAGE  OR  FINANCIAL
 SUPPORT  UNDER ANY FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDA-
 BLE CARE ACT, OR MEDICARE ON BEHALF OF ANY MEMBER AND ENROLL THE  MEMBER
 IN ANY SUCH PROGRAM, INCLUDING AN ENTITY UNDER PARAGRAPH (B) OF SUBDIVI-
 SION  EIGHT  OF  SECTION  FIFTY-ONE  HUNDRED  ONE OF THIS ARTICLE IF THE
 MEMBER IS ELIGIBLE FOR IT,  THE  COMMISSIONER  MAY  REQUIRE  THAT  EVERY
 MEMBER  OR  APPLICANT TO BE A MEMBER SHALL PROVIDE INFORMATION TO ENABLE
 THE COMMISSIONER TO DETERMINE WHETHER THE APPLICANT IS ELIGIBLE FOR SUCH
 PROGRAM.  THE PROGRAM SHALL MAKE A REASONABLE EFFORT TO  NOTIFY  MEMBERS
 OF THEIR OBLIGATIONS UNDER THIS PARAGRAPH. AFTER A REASONABLE EFFORT HAS
 BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
 THAT  HE  OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED INFORMATION. IF
 SUCH INFORMATION IS NOT  PROVIDED  WITHIN  THE  SIXTY  DAY  PERIOD,  THE
 MEMBER'S COVERAGE UNDER THE PROGRAM MAY BE TERMINATED. UPON THE MEMBER'S
 SATISFACTORY  PROVISION  OF THE INFORMATION, THE MEMBER'S COVERAGE UNDER
 THE PROGRAM SHALL BE REINSTATED RETROACTIVE TO THE DATE UPON  WHICH  THE
 COVERAGE WAS TERMINATED.
   (F)  TO THE EXTENT NECESSARY FOR PURPOSES OF THIS SECTION, AS A CONDI-
 TION OF  CONTINUED  ELIGIBILITY  FOR  HEALTH  CARE  SERVICES  UNDER  THE
 PROGRAM,  A  MEMBER  WHO  IS  ELIGIBLE FOR BENEFITS UNDER MEDICARE SHALL
 ENROLL IN MEDICARE, INCLUDING PARTS A, B AND D.
   (G) THE PROGRAM SHALL  PROVIDE  PREMIUM  ASSISTANCE  FOR  ALL  MEMBERS
 ENROLLING  IN  A  MEDICARE  PART  D DRUG COVERAGE UNDER SECTION 1860D OF
 TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT LIMITED TO THE LOW-INCOME
 BENCHMARK PREMIUM AMOUNT ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE
 AND MEDICAID SERVICES AND ANY OTHER AMOUNT WHICH SUCH AGENCY ESTABLISHES
 UNDER ITS DE MINIMIS PREMIUM POLICY, EXCEPT THAT SUCH PAYMENTS  MADE  ON
 BEHALF  OF  MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY EXCEED THE
 LOW-INCOME BENCHMARK PREMIUM AMOUNT IF DETERMINED TO BE  COST  EFFECTIVE
 TO THE PROGRAM.
   (H)  IF  THE  COMMISSIONER  HAS  REASONABLE  GROUNDS TO BELIEVE THAT A
 MEMBER COULD BE ELIGIBLE FOR AN  INCOME-RELATED  SUBSIDY  UNDER  SECTION
 1860D-14  OF  TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT, THE MEMBER
 SHALL PROVIDE, AND AUTHORIZE THE PROGRAM TO OBTAIN, ANY  INFORMATION  OR
 DOCUMENTATION  REQUIRED  TO  ESTABLISH THE MEMBER'S ELIGIBILITY FOR SUCH
 SUBSIDY, PROVIDED THAT THE COMMISSIONER SHALL ATTEMPT TO OBTAIN AS  MUCH
 OF  THE  INFORMATION AND DOCUMENTATION AS POSSIBLE FROM RECORDS THAT ARE
 AVAILABLE TO HIM OR HER.
   (I) THE PROGRAM SHALL MAKE A REASONABLE EFFORT TO  NOTIFY  MEMBERS  OF
 THEIR  OBLIGATIONS UNDER THIS SUBDIVISION. AFTER A REASONABLE EFFORT HAS
 BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
 THAT HE OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED  INFORMATION.  IF
 SUCH  INFORMATION  IS  NOT  PROVIDED  WITHIN  THE  SIXTY DAY PERIOD, THE
 MEMBER'S COVERAGE UNDER  THE  PROGRAM  MAY  BE  TERMINATED.    UPON  THE
 MEMBER'S  SATISFACTORY PROVISION OF THE INFORMATION, THE MEMBER'S COVER-

 A. 6058                            19
 
 AGE UNDER THE PROGRAM SHALL BE REINSTATED RETROACTIVE TO THE  DATE  UPON
 WHICH THE COVERAGE WAS TERMINATED.
   §  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
 WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
   (A) CONSUMER ASSISTANCE TO INDIVIDUALS WITH RESPECT TO  SELECTION  AND
 CHANGING  SELECTION  OF  A CARE COORDINATOR OR HEALTH CARE ORGANIZATION,
 ENROLLING, OBTAINING HEALTH CARE SERVICES, AND OTHER MATTERS RELATING TO
 THE PROGRAM;
   (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
 AND SEEKING OR CONSIDERING WHETHER  TO  PROVIDE,  HEALTH  CARE  SERVICES
 UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
 IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
   (C)  CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES PROVIDING
 AND SEEKING OR CONSIDERING WHETHER  TO  PROVIDE,  CARE  COORDINATION  TO
 MEMBERS.
   2.  THE  COMMISSIONER  SHALL PROVIDE GRANTS FROM FUNDS IN THE NEW YORK
 HEALTH TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO  HEALTH
 SYSTEMS  AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS CHAP-
 TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
   3. RETRAINING AND RE-EMPLOYMENT OF IMPACTED EMPLOYEES. (A) AS USED  IN
 THIS SUBDIVISION:
   (I)  "THIRD  PARTY  PAYER"  HAS  ITS ORDINARY MEANING AND INCLUDES ANY
 ENTITY THAT PROVIDES OR ARRANGES REIMBURSEMENT IN WHOLE OR IN  PART  FOR
 THE PURCHASE OF HEALTH CARE SERVICES.
   (II)  "HEALTH CARE PROVIDER ADMINISTRATIVE EMPLOYEE" MEANS AN EMPLOYEE
 OF A HEALTH CARE PROVIDER PRIMARILY ENGAGED  IN  RELATIONS  OR  DEALINGS
 WITH  THIRD  PARTY PAYERS OR SEEKING PAYMENT OR REIMBURSEMENT FOR HEALTH
 CARE SERVICES FROM THIRD PARTY PAYERS.
   (III) "IMPACTED EMPLOYEE" MEANS AN INDIVIDUAL WHO, AT  ANY  TIME  FROM
 THE DATE THIS SECTION BECOMES A LAW UNTIL TWO YEARS AFTER THE END OF THE
 IMPLEMENTATION PERIOD, IS EMPLOYED BY A THIRD PARTY PAYER OR IS A HEALTH
 CARE  PROVIDER  ADMINISTRATIVE EMPLOYEE, AND WHOSE EMPLOYMENT ENDS OR IS
 REASONABLY ANTICIPATED TO END AS A RESULT OF THE IMPLEMENTATION  OF  THE
 NEW YORK HEALTH PROGRAM.
   (B)  WITHIN  NINETY  DAYS  AFTER  THIS SECTION SHALL BECOME A LAW, THE
 COMMISSIONER OF LABOR SHALL CONVENE A RETRAINING AND RE-EMPLOYMENT  TASK
 FORCE  INCLUDING  BUT  NOT  LIMITED  TO:  REPRESENTATIVES  OF  POTENTIAL
 IMPACTED EMPLOYEES, HUMAN RESOURCE DEPARTMENTS OF THIRD PARTY PAYERS AND
 HEALTH CARE PROVIDERS, INDIVIDUALS  WITH  EXPERIENCE  AND  EXPERTISE  IN
 RETRAINING  AND  RE-EMPLOYMENT PROGRAMS RELEVANT TO THE CIRCUMSTANCES OF
 IMPACTED EMPLOYEES, AND REPRESENTATIVES OF THE  COMMISSIONER  OF  LABOR.
 THE COMMISSIONER OF LABOR AND THE TASK FORCE SHALL REVIEW AND PROVIDE:
   (I)  ANALYSIS  OF  POTENTIAL  IMPACTED  EMPLOYEES  BY  JOB  TITLE  AND
 GEOGRAPHY;
   (II) COMPETENCY MAPPING AND LABOR MARKET ANALYSIS OF IMPACTED EMPLOYEE
 OCCUPATIONS WITH JOB OPENINGS; AND
   (III) ESTABLISHMENT OF REGIONAL RETRAINING AND RE-EMPLOYMENT  SYSTEMS,
 INCLUDING  BUT  NOT  LIMITED  TO  JOB BOARDS, OUTPLACEMENT SERVICES, JOB
 SEARCH SERVICES, CAREER ADVISEMENT SERVICES, AND RETRAINING  ADVISEMENT,
 TO  BE COORDINATED WITH THE REGIONAL ADVISORY COUNCILS ESTABLISHED UNDER
 SECTION FIFTY-ONE HUNDRED ELEVEN OF THIS ARTICLE.
   (C) (I) THREE OR MORE IMPACTED EMPLOYEES, A RECOGNIZED UNION OF  WORK-
 ERS  INCLUDING  IMPACTED EMPLOYEES, OR AN EMPLOYER OF IMPACTED EMPLOYEES
 MAY FILE A PETITION WITH THE  COMMISSIONER  OF  LABOR  TO  CERTIFY  SUCH
 EMPLOYEES AS BEING IMPACTED EMPLOYEES.
   (II) IMPACTED EMPLOYEES SHALL BE ELIGIBLE FOR:

 A. 6058                            20
 
   (A) UP TO TWO YEARS OF RETRAINING AT ANY TRAINING PROVIDER APPROVED BY
 THE COMMISSIONER OF LABOR; AND
   (B)  UP  TO  TWO  YEARS  OF  UNEMPLOYMENT  BENEFITS, PROVIDED THAT THE
 IMPACTED EMPLOYEE IS ENROLLED IN A DEPARTMENT OF LABOR APPROVED TRAINING
 PROGRAM, IS ACTIVELY SEEKING EMPLOYMENT, AND IS NOT  CURRENTLY  EMPLOYED
 FULL  TIME;  PROVIDED, HOWEVER, THAT SUCH IMPACTED EMPLOYEE MAY MAINTAIN
 UNEMPLOYMENT BENEFITS FOR UP TO TWO YEARS EVEN IF HE  OR  SHE  DOES  NOT
 MEET  THE  CRITERIA SET FORTH IN THIS CLAUSE BUT IS SIXTY-THREE YEARS OF
 AGE OR OLDER AT THE TIME OF LOSS OF EMPLOYMENT AS AN IMPACTED EMPLOYEE.
   (D) THE COMMISSIONER SHALL PROVIDE FUNDS  FROM  THE  NEW  YORK  HEALTH
 TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSION-
 ER  OF  LABOR  FOR  RETRAINING  AND  RE-EMPLOYMENT PROGRAMS FOR IMPACTED
 EMPLOYEES UNDER THIS SUBDIVISION.
   (E) THE COMMISSIONER OF LABOR SHALL MAKE REGULATIONS  AND  TAKE  OTHER
 ACTIONS  REASONABLY NECESSARY TO IMPLEMENT THIS SUBDIVISION. THIS SUBDI-
 VISION SHALL BE IMPLEMENTED CONSISTENT WITH  APPLICABLE  LAW  AND  REGU-
 LATIONS.
   4. THE COMMISSIONER SHALL, DIRECTLY AND THROUGH GRANTS TO NOT-FOR-PRO-
 FIT ENTITIES, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH THE NEW YORK
 HEALTH  PROGRAM,  TO  PROMOTE  AND  PROTECT  THE  QUALITY OF HEALTH CARE
 SERVICES, PATIENT OUTCOMES, AND PUBLIC, ENVIRONMENTAL  AND  OCCUPATIONAL
 HEALTH,  INCLUDING  COOPERATION  WITH OTHER DATA COLLECTION AND RESEARCH
 PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH THIS ARTICLE, THE PROTECTION
 OF THE SECURITY AND CONFIDENTIALITY OF INDIVIDUALLY IDENTIFIABLE PATIENT
 INFORMATION, AND OTHERWISE APPLICABLE LAW.
   5. SETTLEMENTS AND  JUDGMENTS.  THIS  SUBDIVISION  APPLIES  WHERE  ANY
 SETTLEMENT,  JUDGMENT  OR  ORDER  IN  THE  COURSE  OF LITIGATION, OR ANY
 CONTRACT OR AGREEMENT MADE AS AN  ALTERNATIVE  TO  LITIGATION,  PROVIDES
 THAT  ONE PARTY SHALL PAY FOR HEALTH CARE COVERAGE FOR ANOTHER PARTY WHO
 IS ENTITLED TO ENROLL IN THE PROGRAM. ANY PARTY TO THE SETTLEMENT, JUDG-
 MENT, ORDER, CONTRACT OR AGREEMENT MAY APPLY TO AN APPROPRIATE COURT FOR
 MODIFICATION OF THE JUDGMENT, ORDER, CONTRACT OR AGREEMENT. THE  MODIFI-
 CATION  MAY  PROVIDE THAT THE PAYING PARTY, INSTEAD OF PAYING FOR HEALTH
 CARE COVERAGE, SHALL PAY ALL OR PART OF THE NEW YORK HEALTH TAX THAT  IS
 OWED  BY  THE  OTHER PARTY, AND MAY INCLUDE OTHER OR FURTHER PROVISIONS.
 THE MODIFICATIONS SHALL BE APPROPRIATE, CONSISTENT WITH THE PROGRAM, AND
 IN THE INTEREST OF JUSTICE. AS  USED  IN  THIS  SUBDIVISION,  "NEW  YORK
 HEALTH TAX" MEANS THE TAX OR TAXES ENACTED BY THE LEGISLATURE AS PART OF
 THE REVENUE PROPOSAL, AS AMENDED, TO FUND THE PROGRAM.
   §  5111.  REGIONAL ADVISORY COUNCILS.  1. THE NEW YORK HEALTH REGIONAL
 ADVISORY COUNCILS (EACH REFERRED TO IN THIS ARTICLE AS A "REGIONAL ADVI-
 SORY COUNCIL") ARE HEREBY CREATED IN THE DEPARTMENT.
   2. THERE SHALL BE A REGIONAL ADVISORY COUNCIL ESTABLISHED IN  EACH  OF
 THE FOLLOWING REGIONS:
   (A) LONG ISLAND, CONSISTING OF NASSAU AND SUFFOLK COUNTIES;
   (B) NEW YORK CITY;
   (C)  HUDSON  VALLEY, CONSISTING OF DELAWARE, DUTCHESS, ORANGE, PUTNAM,
 ROCKLAND, SULLIVAN, ULSTER, WESTCHESTER COUNTIES;
   (D) NORTHERN, CONSISTING OF ALBANY, CLINTON, COLUMBIA,  ESSEX,  FRANK-
 LIN,  FULTON,  GREENE, HAMILTON, HERKIMER, JEFFERSON, LEWIS, MONTGOMERY,
 OTSEGO, RENSSELAER,  SARATOGA,  SCHENECTADY,  SCHOHARIE,  ST.  LAWRENCE,
 WARREN, WASHINGTON COUNTIES;
   (E)  CENTRAL,  CONSISTING  OF BROOME, CAYUGA, CHEMUNG, CHENANGO, CORT-
 LAND, LIVINGSTON, MADISON, MONROE, ONEIDA,  ONONDAGA,  ONTARIO,  OSWEGO,
 SCHUYLER, SENECA, STEUBEN, TIOGA, TOMPKINS, WAYNE, YATES COUNTIES; AND

 A. 6058                            21
 
   (F)  WESTERN,  CONSISTING  OF ALLEGANY, CATTARAUGUS, CHAUTAUQUA, ERIE,
 GENESEE, NIAGARA, ORLEANS, WYOMING COUNTIES.
   3.  EACH REGIONAL ADVISORY COUNCIL SHALL BE COMPOSED OF NOT FEWER THAN
 TWENTY-SEVEN MEMBERS, AS DETERMINED BY THE COMMISSIONER AND  THE  BOARD,
 AS  NECESSARY  TO APPROPRIATELY REPRESENT THE DIVERSE NEEDS AND CONCERNS
 OF THE REGION. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE RESIDENTS
 OF OR HAVE THEIR PRINCIPAL PLACE OF BUSINESS IN THE REGION SERVED BY THE
 REGIONAL ADVISORY COUNCIL.
   4. APPOINTMENT OF MEMBERS OF THE REGIONAL ADVISORY COUNCILS.
   (A) THE TWENTY-SEVEN MEMBERS SHALL BE APPOINTED AS FOLLOWS:
   (I) NINE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR;
   (II) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMENDA-
 TION OF THE SPEAKER OF THE ASSEMBLY;
   (III) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE  RECOMMEN-
 DATION OF THE TEMPORARY PRESIDENT OF THE SENATE;
   (IV) THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
 DATION OF THE MINORITY LEADER OF THE ASSEMBLY; AND
   (V)  THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
 DATION OF THE MINORITY LEADER OF THE SENATE.
   WHERE A REGIONAL ADVISORY COUNCIL HAS MORE THAN TWENTY-SEVEN  MEMBERS,
 ADDITIONAL MEMBERS SHALL BE APPOINTED AND RECOMMENDED BY THESE OFFICIALS
 IN THE SAME PROPORTION AS THE TWENTY-SEVEN MEMBERS.
   (B)  REGIONAL  ADVISORY  COUNCIL  MEMBERSHIP  SHALL INCLUDE BUT NOT BE
 LIMITED TO:
   (I) REPRESENTATIVES OF ORGANIZATIONS WITH A REGIONAL CONSTITUENCY THAT
 ADVOCATE FOR HEALTH CARE CONSUMERS, OLDER ADULTS, AND PEOPLE WITH  DISA-
 BILITIES  INCLUDING  ORGANIZATIONS  LED  BY MEMBERS OF THOSE GROUPS, WHO
 SHALL CONSTITUTE AT LEAST ONE THIRD OF THE MEMBERSHIP OF  EACH  REGIONAL
 COUNCIL;
   (II) REPRESENTATIVES OF PROFESSIONAL ORGANIZATIONS REPRESENTING PHYSI-
 CIANS;
   (III)   REPRESENTATIVES  OF  PROFESSIONAL  ORGANIZATIONS  REPRESENTING
 HEALTH CARE PROFESSIONALS OTHER THAN PHYSICIANS;
   (IV) REPRESENTATIVES OF GENERAL HOSPITALS, INCLUDING PUBLIC HOSPITALS;
   (V) REPRESENTATIVES OF COMMUNITY HEALTH CENTERS;
   (VI) REPRESENTATIVES OF MENTAL HEALTH,  BEHAVIORAL  HEALTH  (INCLUDING
 SUBSTANCE USE), PHYSICAL DISABILITY, DEVELOPMENTAL DISABILITY, REHABILI-
 TATION, HOME CARE AND OTHER SERVICE PROVIDERS;
   (VII) REPRESENTATIVES OF WOMEN'S HEALTH SERVICE PROVIDERS;
   (VIII)  REPRESENTATIVES  OF  HEALTH SERVICE PROVIDERS SERVING LESBIAN,
 GAY,  BISEXUAL,  TRANSGENDER,  GENDER  NON-CONFORMING,   AND   NONBINARY
 PATIENTS;
   (IX) REPRESENTATIVES OF HEALTH CARE ORGANIZATIONS;
   (X)  REPRESENTATIVES  OF  ORGANIZED LABOR INCLUDING REPRESENTATIVES OF
 HEALTH CARE WORKERS;
   (XI) REPRESENTATIVES OF EMPLOYERS; AND
   (XII) REPRESENTATIVES OF MUNICIPAL AND COUNTY GOVERNMENT.
   5. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE APPOINTED FOR TERMS
 OF THREE YEARS PROVIDED, HOWEVER, THAT OF THE MEMBERS  FIRST  APPOINTED,
 ONE-THIRD  SHALL  BE APPOINTED FOR ONE YEAR TERMS AND ONE-THIRD SHALL BE
 APPOINTED FOR TWO YEAR TERMS. VACANCIES SHALL  BE  FILLED  IN  THE  SAME
 MANNER AS ORIGINAL APPOINTMENTS FOR THE REMAINDER OF ANY UNEXPIRED TERM.
 NO PERSON SHALL BE A MEMBER OF A REGIONAL ADVISORY COUNCIL FOR MORE THAN
 SIX YEARS IN ANY PERIOD OF TWELVE CONSECUTIVE YEARS.
   6.  MEMBERS  OF  THE  REGIONAL  ADVISORY  COUNCILS SHALL SERVE WITHOUT
 COMPENSATION BUT SHALL BE REIMBURSED  FOR  THEIR  NECESSARY  AND  ACTUAL

 A. 6058                            22
 
 EXPENSES  INCURRED  WHILE  ENGAGED IN THE BUSINESS OF THE ADVISORY COUN-
 CILS. THE PROGRAM SHALL PROVIDE FINANCIAL SUPPORT FOR SUCH EXPENSES  AND
 OTHER EXPENSES OF THE REGIONAL ADVISORY COUNCILS. HOWEVER, THE BOARD MAY
 PROVIDE  FOR  COMPENSATION  IN  CASES WHERE A LACK OF COMPENSATION WOULD
 LIMIT THE ABILITY OF A TRUSTEE OR REPRESENTED  ORGANIZATION  TO  PARTIC-
 IPATE IN COUNCIL BUSINESS.
   7.  EACH REGIONAL ADVISORY COUNCIL SHALL MEET AT LEAST QUARTERLY. EACH
 REGIONAL ADVISORY COUNCIL MAY FORM COMMITTEES TO ASSIST IT IN ITS  WORK.
 MEMBERS  OF  A  COMMITTEE  NEED  NOT BE MEMBERS OF THE REGIONAL ADVISORY
 COUNCIL.   THE NEW YORK CITY REGIONAL  ADVISORY  COUNCIL  SHALL  FORM  A
 COMMITTEE  FOR  EACH  BOROUGH  OF  NEW YORK CITY, TO ASSIST THE REGIONAL
 ADVISORY COUNCIL IN ITS WORK AS IT RELATES PARTICULARLY TO THAT BOROUGH.
   8. EACH REGIONAL ADVISORY COUNCIL SHALL ADVISE THE  COMMISSIONER,  THE
 BOARD,  THE  GOVERNOR AND THE LEGISLATURE ON ALL MATTERS RELATING TO THE
 DEVELOPMENT AND IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM.
   9. EACH REGIONAL ADVISORY COUNCIL SHALL ADOPT, AND FROM TIME  TO  TIME
 REVISE,  A  COMMUNITY  HEALTH  IMPROVEMENT  PLAN  FOR ITS REGION FOR THE
 PURPOSE OF:
   (A) PROMOTING THE DELIVERY OF HEALTH  CARE  SERVICES  IN  THE  REGION,
 IMPROVING  THE  QUALITY  AND  ACCESSIBILITY  OF CARE, INCLUDING CULTURAL
 COMPETENCY, CLINICAL  INTEGRATION  OF  CARE  BETWEEN  SERVICE  PROVIDERS
 INCLUDING  BUT  NOT  LIMITED TO PHYSICAL, MENTAL, AND BEHAVIORAL HEALTH,
 PHYSICAL AND DEVELOPMENTAL DISABILITY SERVICES, AND  LONG-TERM  SUPPORTS
 AND SERVICES;
   (B) FACILITY AND HEALTH SERVICES PLANNING IN THE REGION;
   (C) IDENTIFYING GAPS IN REGIONAL HEALTH CARE SERVICES;
   (D)  PROMOTING INCREASED PUBLIC KNOWLEDGE AND RESPONSIBILITY REGARDING
 THE AVAILABILITY AND APPROPRIATE UTILIZATION OF  HEALTH  CARE  SERVICES.
 EACH COMMUNITY HEALTH IMPROVEMENT PLAN SHALL BE SUBMITTED TO THE COMMIS-
 SIONER AND THE BOARD AND SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE;
   (E)  IDENTIFYING  NEEDS IN PROFESSIONAL AND SERVICE PERSONNEL REQUIRED
 TO DELIVER HEALTH CARE SERVICES; AND
   (F) COORDINATING REGIONAL IMPLEMENTATION OF RETRAINING AND  RE-EMPLOY-
 MENT  PROGRAMS FOR IMPACTED EMPLOYEES UNDER SUBDIVISION THREE OF SECTION
 FIFTY-ONE HUNDRED TEN OF THIS ARTICLE.
   10. EACH REGIONAL ADVISORY COUNCIL SHALL HOLD  AT  LEAST  FOUR  PUBLIC
 HEARINGS ANNUALLY ON MATTERS RELATING TO THE NEW YORK HEALTH PROGRAM AND
 THE  DEVELOPMENT  AND IMPLEMENTATION OF THE COMMUNITY HEALTH IMPROVEMENT
 PLAN.
   11. EACH REGIONAL ADVISORY COUNCIL SHALL PUBLISH AN ANNUAL  REPORT  TO
 THE  COMMISSIONER  AND THE BOARD ON THE PROGRESS OF THE COMMUNITY HEALTH
 IMPROVEMENT PLAN. THESE REPORTS SHALL  BE  POSTED  ON  THE  DEPARTMENT'S
 WEBSITE.
   12.  ALL  MEETINGS  OF  THE  REGIONAL ADVISORY COUNCILS AND COMMITTEES
 SHALL BE SUBJECT TO ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
   § 4. Financing of New York Health. 1.  (a) As used  in  this  section,
 unless the context clearly requires otherwise:
   (i)  "New  York  Health  program"  and the "program" mean the New York
 Health program, as created by article 51 of the public  health  law  and
 all provisions of that article.
   (ii)  "Revenue proposal" means the revenue plan and legislative bills,
 as proposed and enacted under  this  section,  to  provide  the  revenue
 necessary to finance the New York Health program.
   (iii)  "Tax"  means  the  payroll tax or non-payroll tax to be enacted
 under the revenue proposal. "Payroll  tax"  means  the  tax  on  payroll
 income  and  self-employed  income  subject  to the Medicare Part A tax,

 A. 6058                            23
 
 provided for in subdivision two of this section. "Non-payroll tax" means
 the tax on taxable income (such  as  interest,  dividends,  and  capital
 gains)  not  subject to the payroll tax, provided for in subdivision two
 of this section.
   (b)  The  governor shall submit to the legislature a revenue proposal.
 The revenue proposal shall be submitted to the legislature  as  part  of
 the  executive  budget  under article VII of the state constitution, for
 the fiscal year commencing on the first day of  April  in  the  calendar
 year  after  this  act  shall  become  a  law. In developing the revenue
 proposal, the governor shall consult with appropriate officials  of  the
 executive  branch; the temporary president of the senate; the speaker of
 the assembly; the chairs of the fiscal  and  health  committees  of  the
 senate  and  assembly; and representatives of business, labor, consumers
 and local government.
   2. (a) Basic structure. The basic structure of  the  revenue  proposal
 shall  be as follows: Revenue for the program shall come from two taxes.
 First, there shall be a progressively graduated tax on all  payroll  and
 self-employed  income,  paid  by  employers, employees and self-employed
 individuals.  Second, there shall be a progressively  graduated  tax  on
 taxable  income  (such  as  interest,  dividends, and capital gains) not
 subject to the payroll tax.   Income in the  bracket  below  twenty-five
 thousand  dollars per year shall be exempt from the taxes; provided that
 for individuals enrolled in Medicare as defined in the  program,  income
 in  the  bracket  below  fifty thousand dollars per year shall be exempt
 from the taxes.  Higher brackets of income subject to the taxes shall be
 assessed at a higher marginal rate than lower brackets.  The taxes shall
 be set at levels anticipated to produce sufficient  revenue  to  finance
 the  program, to be scaled up as enrollment grows, taking into consider-
 ation anticipated federal revenue available for the  program.  Provision
 shall  be  made  for  state residents who are employed out-of-state, and
 non-residents who are employed in the state  (including  those  employed
 less than full-time).
   (b)  Payroll tax. The income to be subject to the payroll tax shall be
 all income subject to the Medicare Part A tax. The payroll tax shall  be
 set  at a percentage of that income, which shall be progressively gradu-
 ated, so the percentage is higher on  higher  brackets  of  income.  For
 employed  individuals,  the  employer  shall  pay  eighty percent of the
 payroll tax and the employee shall pay twenty percent of the tax, except
 that an employer may agree to pay all or part of the  employee's  share.
 A self-employed individual shall pay the full tax.
   (c)  Non-payroll  income  tax.  There shall be a tax on income that is
 subject to the personal income tax under article 22 of the tax  law  and
 is  not  subject  to the payroll tax. It shall be set at a percentage of
 that income, which shall be progressively graduated, so  the  percentage
 is higher on higher brackets of income.
   (d) Phased-in rates. Early in the program, when enrollment is growing,
 the  amount  of the taxes shall be at an appropriate level, and shall be
 changed as anticipated enrollment grows, to cover the actual cost of the
 program. The revenue proposal shall include a mechanism for  determining
 the rates of the taxes.
   (e) Cross-border employees. (i) State residents employed out-of-state.
 If an individual is employed out-of-state by an employer that is subject
 to  New  York  state law, the employer and employee shall be required to
 pay the payroll tax as to that employee as if the employment were in the
 state. If an individual is employed out-of-state by an employer that  is
 not  subject to New York state law, either (A) the employer and employee

 A. 6058                            24
 
 shall voluntarily comply with the tax or (B) the employee shall pay  the
 tax as if he or she were self-employed.
   (ii)  Out-of-state  residents  employed in the state.  The payroll tax
 shall apply to any out-of-state resident who  is  employed  or  self-em-
 ployed in the state.  Such individual and individual's employer shall be
 able to take a credit against the payroll taxes each would otherwise pay
 as  to  that  individual  for  amounts they spend respectively on health
 benefits (A) for the individual, if the individual is not eligible to be
 a member of the program, and (B) for  any  member  of  the  individual's
 immediate  family.    For  the  employer,  the credit shall be available
 regardless of the form of the health benefit (e.g., health insurance,  a
 self-insured  plan,  direct services, or reimbursement for services), to
 make sure that the revenue proposal does not relate to employment  bene-
 fits  in violation of any federal law. For non-employment-based spending
 by the individual, the credit shall be  available  for  and  limited  to
 spending  for  health  coverage (not out-of-pocket health spending). The
 credit shall be available without regard to how little is spent  or  how
 sparse  the  benefit.  The  credit may only be taken against the payroll
 tax. Any excess amount may not be applied to other  tax  liability.  The
 credit  shall  be  distributed  between the employer and employee in the
 same proportion as the spending by each  for  the  benefit  and  may  be
 applied to their respective portion of the tax. If any provision of this
 subparagraph  or any application of it shall be ruled to violate federal
 law, the provision or the application of it shall be null and  void  and
 the  ruling  shall not affect any other provision or application of this
 section or the act that enacted it.
   3. (a) The revenue proposal  shall  include  a  plan  and  legislative
 provisions   for  ending  the  requirement  for  local  social  services
 districts to pay part of  the  cost  of  Medicaid  and  replacing  those
 payments with revenue from the taxes under the revenue proposal.
   (b)  The  taxes  under this section shall not supplant the spending of
 other state revenue to pay for the Medicaid program as it exists  as  of
 the  enactment  of  the  revenue proposal as amended, unless the revenue
 proposal as amended provides otherwise.
   4. To the extent that the revenue proposal differs from the  terms  of
 subdivision  two  or paragraph (b) of subdivision three of this section,
 the revenue proposal shall state how it differs  from  those  terms  and
 reasons for and the effects of the differences.
   5.  All  revenue  from  the  taxes  shall be deposited in the New York
 Health trust fund account under section 89-j of the state finance law.
   § 5.  Article 49 of the public health law is amended by adding  a  new
 title 3 to read as follows:
                                 TITLE III
           COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
                              NEW YORK HEALTH
 SECTION 4920. DEFINITIONS.
         4921. COLLECTIVE NEGOTIATION AUTHORIZED.
         4922. COLLECTIVE NEGOTIATION REQUIREMENTS.
         4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
         4924. MEDIATION.
         4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
         4926. FEES.
         4927. CONFIDENTIALITY.
         4928. SEVERABILITY AND CONSTRUCTION.
   § 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:

 A. 6058                            25
 
   1. "NEW YORK HEALTH" MEANS THE PROGRAM UNDER ARTICLE FIFTY-ONE OF THIS
 CHAPTER.
   2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
 OTHER LEGAL ENTITY.
   3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY THAT IS
 AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON  THEIR  BEHALF  WITH
 NEW  YORK  HEALTH  OVER TERMS AND CONDITIONS AFFECTING THOSE HEALTH CARE
 PROVIDERS.
   4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
 RECT, BY A BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS  MADE  ON  AN
 EMPLOYER.
   5.  "HEALTH  CARE PROVIDER" MEANS A HEALTH CARE PROVIDER UNDER ARTICLE
 FIFTY-ONE OF THIS CHAPTER. A HEALTH  CARE  PROFESSIONAL  AS  DEFINED  IN
 ARTICLE  FIFTY-ONE OF THIS CHAPTER WHO PRACTICES AS AN EMPLOYEE OR INDE-
 PENDENT CONTRACTOR OF ANOTHER HEALTH CARE PROVIDER SHALL NOT BE DEEMED A
 HEALTH CARE PROVIDER FOR PURPOSES OF THIS TITLE.
   § 4921. COLLECTIVE NEGOTIATION AUTHORIZED. 1.  HEALTH  CARE  PROVIDERS
 MAY  MEET  AND  COMMUNICATE  FOR THE PURPOSE OF COLLECTIVELY NEGOTIATING
 WITH NEW YORK HEALTH ON ANY MATTER RELATING TO NEW YORK HEALTH,  INCLUD-
 ING BUT NOT LIMITED TO RATES OF PAYMENT AND PAYMENT METHODOLOGIES.
   2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
 ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
 SET FORTH IN LAW.
   3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF NEW
 YORK HEALTH BY HEALTH CARE PROVIDERS.
   4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
 TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF NEW YORK HEALTH TO
 OBTAIN  OR  RETAIN  ACCREDITATION  BY THE NATIONAL COMMITTEE FOR QUALITY
 ASSURANCE OR A SIMILAR BODY OR TO COMPLY WITH APPLICABLE STATE OR FEDER-
 AL LAW.
   § 4922. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
 RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   (A) HEALTH CARE PROVIDERS  MAY  COMMUNICATE  WITH  OTHER  HEALTH  CARE
 PROVIDERS  REGARDING  THE TERMS AND CONDITIONS TO BE NEGOTIATED WITH NEW
 YORK HEALTH;
   (B) HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE  PROVIDERS'
 REPRESENTATIVES;
   (C)  A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY AUTHOR-
 IZED TO NEGOTIATE WITH NEW YORK HEALTH ON  BEHALF  OF  THE  HEALTH  CARE
 PROVIDERS AS A GROUP;
   (D)  A  HEALTH  CARE PROVIDER CAN BE BOUND BY THE TERMS AND CONDITIONS
 NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   (E) IN COMMUNICATING OR NEGOTIATING WITH THE  HEALTH  CARE  PROVIDERS'
 REPRESENTATIVE, NEW YORK HEALTH IS ENTITLED TO OFFER AND PROVIDE DIFFER-
 ENT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
   2.  NOTHING  IN THIS TITLE SHALL AFFECT OR LIMIT THE RIGHT OF A HEALTH
 CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY PETITION
 A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
   3. NOTHING IN THIS TITLE SHALL AFFECT OR LIMIT  COLLECTIVE  ACTION  OR
 COLLECTIVE  BARGAINING  ON THE PART OF ANY HEALTH CARE PROVIDER WITH HIS
 OR HER EMPLOYER OR ANY OTHER  LAWFUL  COLLECTIVE  ACTION  OR  COLLECTIVE
 BARGAINING.
   § 4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. BEFORE
 ENGAGING  IN  COLLECTIVE  NEGOTIATIONS WITH NEW YORK HEALTH ON BEHALF OF
 HEALTH CARE PROVIDERS, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  SHALL
 FILE  WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE COMMISSION-

 A. 6058                            26
 
 ER, INFORMATION IDENTIFYING  THE  REPRESENTATIVE,  THE  REPRESENTATIVE'S
 PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO ENSURE COMPLI-
 ANCE WITH THIS TITLE.
   § 4924. MEDIATION. 1. IN THE EVENT THE COMMISSIONER DETERMINES THAT AN
 IMPASSE  EXISTS  IN  THE  NEGOTIATIONS,  THE  COMMISSIONER  SHALL RENDER
 ASSISTANCE AS FOLLOWS:
   (A) TO ASSIST THE PARTIES TO EFFECT  A  VOLUNTARY  RESOLUTION  OF  THE
 NEGOTIATIONS,  THE COMMISSIONER SHALL APPOINT A MEDIATOR WHO IS MUTUALLY
 ACCEPTABLE TO BOTH THE HEALTH CARE  PROVIDERS'  REPRESENTATIVE  AND  THE
 REPRESENTATIVE  OF  NEW  YORK  HEALTH.  IF THE MEDIATOR IS SUCCESSFUL IN
 RESOLVING THE IMPASSE, THEN THE HEALTH  CARE  PROVIDERS'  REPRESENTATIVE
 SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
   (B)  IF  AN  IMPASSE CONTINUES, THE COMMISSIONER SHALL APPOINT A FACT-
 FINDING BOARD OF NOT MORE THAN THREE MEMBERS, WHO ARE MUTUALLY  ACCEPTA-
 BLE  TO BOTH THE HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE REPRESEN-
 TATIVE OF NEW  YORK  HEALTH.  THE  FACT-FINDING  BOARD  SHALL  HAVE,  IN
 ADDITION  TO  THE POWERS DELEGATED TO IT BY THE BOARD, THE POWER TO MAKE
 RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
   (C) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
 TRANSMIT ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF  THE
 DISPUTE  TO  THE  COMMISSIONER, AND MAY THEREAFTER ASSIST THE PARTIES TO
 EFFECT A VOLUNTARY RESOLUTION OF THE  DISPUTE.  THE  FACT-FINDING  BOARD
 SHALL  ALSO  SHARE  ITS  FINDINGS  OF  FACT AND RECOMMENDATIONS WITH THE
 HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE REPRESENTATIVE OF NEW YORK
 HEALTH. IF WITHIN TWENTY DAYS AFTER THE SUBMISSION OF  THE  FINDINGS  OF
 FACT  AND RECOMMENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL
 ORDER A RESOLUTION TO THE NEGOTIATIONS BASED UPON THE FINDINGS  OF  FACT
 AND RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
   §  4925.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
 INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
 IN  RESPONSE TO A HEALTH CARE PROVIDERS' REPRESENTATIVE'S DISCUSSIONS OR
 NEGOTIATIONS WITH NEW YORK HEALTH EXCEPT AS AUTHORIZED BY OTHER LAW.
   2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
 MENT THAT EXCLUDES, LIMITS THE PARTICIPATION  OR  REIMBURSEMENT  OF,  OR
 OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
 PROVIDER  OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE PERFORM-
 ANCE OF SERVICES THAT ARE WITHIN THE HEALTH CARE PROVIDER'S LAWFUL SCOPE
 OR TERMS OF PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   § 4926. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OF  NEGOTIAT-
 ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
 A  REPRESENTATIVE.  THE  COMMISSIONER,  BY REGULATION, SHALL SET FEES IN
 AMOUNTS DEEMED REASONABLE AND NECESSARY TO COVER THE COSTS  INCURRED  BY
 THE DEPARTMENT IN ADMINISTERING THIS TITLE.
   § 4927. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
 BE  REPORTED  TO THE DEPARTMENT UNDER THIS TITLE SHALL NOT BE SUBJECT TO
 DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
   § 4928. SEVERABILITY AND CONSTRUCTION. IF ANY PROVISION OR APPLICATION
 OF THIS TITLE SHALL BE HELD TO BE INVALID, OR TO VIOLATE  OR  BE  INCON-
 SISTENT  WITH  ANY  APPLICABLE FEDERAL LAW OR REGULATION, THAT SHALL NOT
 AFFECT OTHER PROVISIONS OR APPLICATIONS OF THIS TITLE WHICH CAN BE GIVEN
 EFFECT WITHOUT THAT PROVISION OR  APPLICATION;  AND  TO  THAT  END,  THE
 PROVISIONS  AND APPLICATIONS OF THIS TITLE ARE SEVERABLE. THE PROVISIONS
 OF THIS TITLE SHALL  BE  LIBERALLY  CONSTRUED  TO  GIVE  EFFECT  TO  THE
 PURPOSES THEREOF.

 A. 6058                            27
 
   §  6.  Subdivision  11  of  section  270  of the public health law, as
 amended by section 2-a of part C of chapter 58 of the laws of  2008,  is
 amended to read as follows:
   11.  "State  public  health plan" means the medical assistance program
 established by title eleven of article five of the social  services  law
 (referred  to in this article as "Medicaid"), the elderly pharmaceutical
 insurance coverage program established by title three of article two  of
 the  elder  law (referred to in this article as "EPIC"), and the [family
 health plus program established by section three  hundred  sixty-nine-ee
 of  the social services law to the extent that section provides that the
 program shall be subject to this article] NEW YORK HEALTH PROGRAM ESTAB-
 LISHED BY ARTICLE FIFTY-ONE OF THIS CHAPTER.
   § 7. The state finance law is amended by adding a new section 89-j  to
 read as follows:
   §  89-J. NEW YORK HEALTH TRUST FUND. 1. THERE IS HEREBY ESTABLISHED IN
 THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSIONER OF TAXA-
 TION AND FINANCE A SPECIAL REVENUE FUND TO BE KNOWN  AS  THE  "NEW  YORK
 HEALTH TRUST FUND", REFERRED TO IN THIS SECTION AS "THE FUND". THE DEFI-
 NITIONS  IN  SECTION  FIFTY-ONE  HUNDRED  OF THE PUBLIC HEALTH LAW SHALL
 APPLY TO THIS SECTION.
   2. THE FUND SHALL CONSIST OF:
   (A) ALL MONIES OBTAINED FROM TAXES PURSUANT TO LEGISLATION ENACTED  AS
 PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
   (B)  FEDERAL  PAYMENTS  RECEIVED  AS  A  RESULT OF ANY WAIVER OR OTHER
 ARRANGEMENTS AGREED TO BY THE UNITED  STATES  SECRETARY  OF  HEALTH  AND
 HUMAN  SERVICES  OR  OTHER APPROPRIATE FEDERAL OFFICIALS FOR HEALTH CARE
 PROGRAMS ESTABLISHED UNDER MEDICARE, ANY FEDERALLY-MATCHED PUBLIC HEALTH
 PROGRAM, OR THE AFFORDABLE CARE ACT;
   (C) THE AMOUNTS PAID BY THE DEPARTMENT OF HEALTH THAT  ARE  EQUIVALENT
 TO  THOSE  AMOUNTS  THAT  ARE  PAID ON BEHALF OF RESIDENTS OF THIS STATE
 UNDER MEDICARE, ANY FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM,  OR  THE
 AFFORDABLE  CARE  ACT FOR HEALTH BENEFITS WHICH ARE EQUIVALENT TO HEALTH
 BENEFITS COVERED UNDER NEW YORK HEALTH;
   (D) FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION OF  SERVICES
 AUTHORIZED  UNDER TITLE XX OF THE FEDERAL SOCIAL SECURITY ACT THAT WOULD
 OTHERWISE BE COVERED UNDER ARTICLE FIFTY-ONE OF THE PUBLIC  HEALTH  LAW;
 AND
   (E)  STATE  MONIES THAT WOULD OTHERWISE BE APPROPRIATED TO ANY GOVERN-
 MENTAL AGENCY, OFFICE, PROGRAM,  INSTRUMENTALITY  OR  INSTITUTION  WHICH
 PROVIDES  HEALTH  SERVICES,  FOR SERVICES AND BENEFITS COVERED UNDER NEW
 YORK HEALTH. PAYMENTS TO THE FUND PURSUANT TO THIS PARAGRAPH SHALL BE IN
 AN AMOUNT EQUAL TO THE MONEY  APPROPRIATED  FOR  SUCH  PURPOSES  IN  THE
 FISCAL  YEAR  BEGINNING  IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF THE
 NEW YORK HEALTH ACT.
   3. MONIES IN THE FUND SHALL ONLY  BE  USED  FOR  PURPOSES  ESTABLISHED
 UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW.
   § 8. Temporary commission on implementation. 1. There is hereby estab-
 lished  a  temporary commission on implementation of the New York Health
 program, referred to in this section as the  commission,  consisting  of
 fifteen  members:  five members, including the chair, shall be appointed
 by the governor; four members shall be appointed by the temporary presi-
 dent of the senate, one member shall be appointed by the senate minority
 leader; four members shall be appointed by the speaker of the  assembly,
 and  one  member shall be appointed by the assembly minority leader. The
 commissioner of health, the superintendent of  financial  services,  and

 A. 6058                            28
 
 the commissioner of taxation and finance, or their designees shall serve
 as non-voting ex-officio members of the commission.
   2.  Members  of the commission shall receive such assistance as may be
 necessary from other state agencies  and  entities,  and  shall  receive
 reasonable  and  necessary expenses incurred in the performance of their
 duties. The commission may  employ  staff  as  needed,  prescribe  their
 duties,  and  fix their compensation within amounts appropriated for the
 commission.
   3. The commission shall examine the laws and regulations of the  state
 and  consult with health care providers, consumers, and other stakehold-
 ers and make such recommendations as are necessary to conform  the  laws
 and  regulations  of  the  state and article 51 of the public health law
 establishing the New York Health program and  other  provisions  of  law
 relating  to  the  New York Health program, and to improve and implement
 the program. The commission shall  report  its  recommendations  to  the
 governor  and  the legislature.   The commission shall immediately begin
 development of proposals consistent with the principles of article 51 of
 the public health law for provision  of  health  care  services  covered
 under the workers' compensation law; and incorporation of retiree health
 benefits,  as  described in paragraphs (a), (b) and (c) of subdivision 8
 of section 5102 of the public health law.  The commission shall  provide
 its  work  product  and  assistance to the board established pursuant to
 section 5102 of the public health law upon completion of the appointment
 of the board.
   § 9.  Severability. If any provision or application of this act  shall
 be  held to be invalid, or to violate or be inconsistent with any appli-
 cable federal law or regulation, that shall not affect other  provisions
 or  applications  of  this  act  which  can be given effect without that
 provision or application; and to that end, the provisions  and  applica-
 tions of this act are severable.
   § 10. This act shall take effect immediately.