S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8515
 
                           I N  A S S E M B L Y
 
                              January 4, 2024
                                ___________
 
 Introduced  by  M.  of A. PHEFFER AMATO -- read once and referred to the
   Committee on Health
 
 AN ACT to amend the public health law, in relation to the New York state
   adult cystic fibrosis program; and to amend a chapter of the  laws  of
   2023,  amending  the  public  health  law relating to the adult cystic
   fibrosis assistance program, as proposed in legislative bills  numbers
   S. 6521 and A. 3089, in relation to the effectiveness thereof
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 2795 of the public health law, as added by a  chap-
 ter  of the laws of 2023, amending the public health law relating to the
 adult cystic fibrosis assistance program,  as  proposed  in  legislative
 bills numbers S. 6521 and A. 3089, is amended to read as follows:
   §  2795.  [Adult]  NEW  YORK  STATE  ADULT  cystic fibrosis assistance
 program. 1. [The commissioner] SUBJECT TO  AVAILABLE  APPROPRIATION  FOR
 THE PURPOSE OUTLINED IN THIS ARTICLE, THE DEPARTMENT shall establish [a]
 AN  ADULT  CYSTIC  FIBROSIS ASSISTANCE program [to reimburse the cost of
 providing health care or health insurance to  eligible  individuals  who
 have], WHICH SHALL BE KNOWN AS THE "NEW YORK STATE ADULT CYSTIC FIBROSIS
 ASSISTANCE  PROGRAM",  AND WHICH SHALL CONSIST OF ADMINISTRATIVE SUPPORT
 SERVICES FOR THE PROVISION OF FINANCIAL ASSISTANCE FOR SERVICES SUCH  AS
 PRESCRIPTION DRUG COSTS, DEVICE COSTS, MEDICAL CARE SERVICES, BEHAVIORAL
 HEALTH  SERVICES,  AND  INSURANCE  PREMIUMS  FOR THE TREATMENT OF cystic
 fibrosis DISEASE AND ITS CONDITIONS.
   2. [To be a fully eligible individual for whom  health  care  will  be
 provided under this section, such individual:
   (a) shall be at least twenty-one years old;
   (b) shall have been diagnosed as having cystic fibrosis;
   (c) shall have resided in the state for a minimum of twelve continuous
 months immediately prior to application for services under this section;
   (d)  shall  not  be  eligible  for medical benefits under any group or
 individual health insurance policy; and
   (e) shall not be eligible for medical  assistance  pursuant  to  title
 eleven  of  article five of the social services law solely due to earned

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

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 income] THE COMMISSIONER SHALL ENTER INTO A CONTRACT FOR  THE  OPERATION
 AND PROMOTION OF THE ADULT CYSTIC FIBROSIS ASSISTANCE PROGRAM SUBJECT TO
 SUCH  TERMS AND CONDITIONS AS MAY BE CONTAINED WITHIN SUCH CONTRACT WITH
 AN  ORGANIZATION  THAT  HAS EXPERIENCE AND EXPERTISE IMPROVING ACCESS TO
 HEALTHCARE FOR PATIENTS WHO ARE  UNDERINSURED  BY  DISPERSING  FINANCIAL
 ASSISTANCE  GRANTS  TO  COVER  COSTS OF ESSENTIAL TREATMENTS AND MEDICA-
 TIONS.   THE CONTRACTOR MAY SUBCONTRACT  AS  NEEDED  FOR  THE  EFFECTIVE
 PERFORMANCE  OF  THE  CONTRACT. ALL SUCH SUBCONTRACTORS AND THE TERMS OF
 SUCH SUBCONTRACTS SHALL BE SUBJECT TO APPROVAL BY THE COMMISSIONER.
   3. [To be a partially eligible individual for whom health care will be
 provided under this section, such individual shall meet all the criteria
 of a fully eligible individual except that a partially eligible individ-
 ual shall be an individual who is eligible for  medical  benefits  under
 any group or individual health insurance policy but which does not cover
 all services necessary for the care and treatment of cystic fibrosis.
   4. The commissioner shall require each fully eligible individual, upon
 determination  of  eligibility,  to make application to a private health
 insurance provider as prescribed by the commissioner for  an  individual
 health insurance policy. If and when such policy is granted, the commis-
 sioner shall approve payment for the associated premium.
   5.  The  commissioner  shall authorize payment for services related to
 the care and treatment of cystic fibrosis not  otherwise  covered  by  a
 health insurance policy.  Providers of such services shall be reimbursed
 at  the  same rate and claims for payment shall be made as if such indi-
 vidual was eligible for benefits pursuant to  title  eleven  of  article
 five of the social services law.
   6.  All  eligible  individuals  shall  be required to contribute seven
 percent of their net annual income toward the cost of  care  and/or  the
 cost of the annual health insurance premium.
   7.  The  commissioner  shall, in consultation with the commissioner of
 social services, promulgate rules and regulations necessary to implement
 the provisions of this article]  THE  DUTIES  OF  THE  CONTRACTOR  SHALL
 INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING:
   (A)  VERIFICATION  OF  PATIENT  ELIGIBILITY  FOR  FINANCIAL ASSISTANCE
 GRANTS ALLOWABLE PURSUANT TO PARAGRAPH (B) OF THIS  SUBDIVISION.  TO  BE
 ELIGIBLE FOR A FINANCIAL ASSISTANCE GRANT, A PATIENT SHALL MEET CRITERIA
 DETERMINED BY THE DEPARTMENT, WHICH SHALL INCLUDE BUT NOT BE LIMITED TO,
 REQUIRING THE PATIENT:
   (I) BE A NEW YORK STATE RESIDENT;
   (II) BE AT LEAST TWENTY-ONE YEARS OF AGE OR OLDER;
   (III) HAVE A DIAGNOSIS OF CYSTIC FIBROSIS; AND
   (IV)  HAVE  SOME  FORM OF PRIMARY PRIVATE HEALTH INSURANCE OR MEDICARE
 AND IS NOT ELIGIBLE FOR STATE MEDICAID, AND SHALL MAINTAIN HEALTH INSUR-
 ANCE DURING THE FINANCIAL ASSISTANCE AWARD PERIOD;
   (B) REVIEW OF FINANCIAL ASSISTANCE  GRANT  APPLICATIONS  SUBMITTED  BY
 ELIGIBLE  PATIENTS  FOR APPROVAL, FOR SERVICES INCLUDING BUT NOT LIMITED
 TO PRESCRIPTION DRUG COSTS, DEVICE COSTS, MEDICAL CARE SERVICES,  BEHAV-
 IORAL  HEALTH  SERVICES, AND MEDICAL, VISION AND DENTAL INSURANCE PREMI-
 UMS, FOR PATIENT TREATMENT OF CYSTIC FIBROSIS;
   (C) DISBURSEMENT OF GRANT FUNDING FOR APPLICATIONS  APPROVED  PURSUANT
 TO  PARAGRAPH  (B) OF THIS SUBDIVISION RELATED TO THE CARE AND TREATMENT
 OF CYSTIC FIBROSIS NOT OTHERWISE COVERED BY A HEALTH INSURANCE POLICY;
   (D) PREPARATION AND SUBMISSION OF A MONTHLY REPORT TO THE  DEPARTMENT.
 SUCH REPORT SHALL INCLUDE BUT NOT BE LIMITED TO:
   (I)  NEW  GRANTS,  WHICH  IS  THE  NUMBER  OF NEW GRANT RECIPIENTS FOR
 INITIAL GRANT PERIODS;
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   (II) RENEWAL GRANTS, WHICH IS THE NUMBER OF RENEWAL  GRANT  RECIPIENTS
 FOR RENEWAL GRANT PERIODS;
   (III) TOTAL ACTIVE GRANT RECIPIENT COUNT, WHICH IS THE TOTAL NUMBER OF
 ACTIVE GRANT RECIPIENTS;
   (IV) GRANT RECIPIENTS BY INSURANCE TYPE, WHICH IS THE NUMBER OF ACTIVE
 GRANT RECIPIENTS SORTED BY INSURANCE TYPE;
   (V)  PROGRAM  EXPENSES,  WHICH  IS  THE  TOTAL  AMOUNT SPENT SORTED BY
 ASSISTANCE TYPE BUT DOES NOT INCLUDE ADMINISTRATION FEES;
   (VI) APPLICATION OUTCOMES REPORT, WHICH IS THE NUMBER OF GRANT RECIPI-
 ENTS WHO HAVE BECOME INACTIVE, SORTED BY REASON; AND
   (VII) ALLOTMENT USED, WHICH IS THE TOTAL AMOUNT OF  COPAYMENT  ASSIST-
 ANCE PROVIDED TO EACH GRANT RECIPIENT COMPARED TO WHAT IS CURRENTLY USED
 BY THE GRANT RECIPIENT.
   §  2.  Section 2 of a chapter of the laws of 2023, amending the public
 health law relating to the adult cystic fibrosis assistance program,  as
 proposed in legislative bills numbers S. 6521 and A. 3089, is amended to
 read as follows:
   § 2. This act shall take effect immediately AND SHALL EXPIRE MARCH 31,
 2024  WHEN  UPON  SUCH  DATE  THE PROVISIONS OF THIS ACT SHALL BE DEEMED
 REPEALED.
   § 3. This act shall take effect immediately; provided,  however,  that
 section  one  of  this act shall take effect on the same date and in the
 same manner as a chapter of the laws of 2023 amending the public  health
 law  relating  to  the  adult  cystic  fibrosis  assistance  program, as
 proposed in legislative bills numbers S. 6521 and A. 3089, takes effect;
 provided, further, that the amendments to section  2795  of  the  public
 health  law  made by section one of this act shall not affect the repeal
 of such section and shall be deemed repealed therewith.