S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  3555--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 28, 2025
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be  committed  to  the  Committee  on  Aging  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN  ACT  to  amend the elder law, in relation to improving and expanding
   the pharmaceutical insurance coverage  program  for  certain  medicare
   enrollees
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 240 of the elder law is amended to read as follows:
   § 240. Short title. This title shall be known and may be cited as  the
 "program for [elderly] EXPANDED pharmaceutical insurance coverage".
   § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
 8  as added by section 2 of part A of chapter 59 of the laws of 2011 and
 as renumbered by section 3 of part T of chapter 56 of the laws of  2012,
 are amended to read as follows:
   3. "Income" shall mean "household gross income" as defined in the real
 property  tax  circuit  breaker credit program, pursuant to subparagraph
 (C) of paragraph one of subsection (e) of section six hundred six of the
 tax law, but only shall include the income  of  program  applicants  and
 spouses  and shall exclude the income of other members of the household,
 BUT SHALL NOT INCLUDE ANY INCREASE IN INCOME DERIVED FROM SOCIAL SECURI-
 TY INCOME OR PENSION BENEFITS THAT INCREASE OVER THE PREVIOUS  YEAR  DUE
 SOLELY  TO  A COST-OF-LIVING ADJUSTMENT PROVIDED BY THE PROGRAM ADMINIS-
 TRATORS.
   8. "Medicare part D excluded drug classes" shall  mean  any  drugs  or
 classes  of drugs, or their medical uses, which are described in section
 1927(d)(2) or 1927(d)(3) of the federal social security  act,  with  the
 exception of smoking cessation agents AND MEDICAL MARIJUANA DISPENSED IN
 THE STATE OF NEW YORK.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00974-02-5
 S. 3555--A                          2
              

 
   § 3. The elder law is amended by adding a new section 242-a to read as
 follows:
   §  242-A.  EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL.  1. THERE
 IS HEREBY ESTABLISHED WITHIN THE EXECUTIVE DEPARTMENT,  A  PANEL  TO  BE
 KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
 PURPOSES  OF  THIS SECTION, THE TERM "THE PANEL" SHALL MEAN THE EXPANDED
 PHARMACEUTICAL INSURANCE COVERAGE PANEL.
   2. THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS  OF
 EDUCATION  AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF FINANCIAL
 SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
 OF THE BUDGET. EACH PANEL MEMBER  MAY  DESIGNATE  AN  OFFICER  OF  THEIR
 RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
 THE  POWERS  OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL FROM WHICH
 SUCH PANEL MEMBER MAY BE ABSENT.
   3. THE DIRECTOR OF THE OFFICE FOR THE AGING AND  THE  COMMISSIONER  OF
 HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
   4.  THE  PANEL  SHALL  MEET  AT  SUCH TIMES AS MAY BE REQUESTED BY THE
 CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
   5. THE PANEL SHALL:
   (A) SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET,  PROMULGATE
 PROGRAM  REGULATIONS  PURSUANT  TO SECTION TWO HUNDRED FORTY-SIX OF THIS
 TITLE;
   (B) DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES  OF
 ELIGIBLE  PROGRAM  PARTICIPANTS  PURSUANT TO SECTIONS TWO HUNDRED FORTY-
 SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
   (C) ENTER INTO CONTRACTS PURSUANT TO SECTION TWO  HUNDRED  FORTY-THREE
 OF THIS TITLE;
   (D)  RECOMMEND  AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS FOR THE
 EFFICIENT AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH  THE
 PROVISIONS  OF  THIS  TITLE WITH THE ADVICE OF THE ADVISORY COMMITTEE AS
 DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
   (E) DEVELOP AND IMPLEMENT, IN COOPERATION WITH AREA  OFFICES  FOR  THE
 AGING,  AN  OUTREACH  PROGRAM  TO INFORM ELIGIBLE APPLICANTS OF BENEFITS
 THEY MAY BE ENTITLED TO PURSUANT TO THIS TITLE, AND  TO  MAKE  AVAILABLE
 INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
 COVERAGE   AND  BENEFITS  TO  WHICH  THEY  MAY  BE  ENTITLED  THROUGH  A
 PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
   (F) PREPARE AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO  THE  GOVERNOR,
 THE  TEMPORARY  PRESIDENT OF THE SENATE, AND THE SPEAKER OF THE ASSEMBLY
 NO LATER THAN THE FIRST DAY OF JANUARY OF EACH  YEAR.  THE  PANEL  SHALL
 INCLUDE  IN  SUCH  REPORT,  AT A MINIMUM, ANNUAL STATISTICAL INFORMATION
 REGARDING THE NUMBER OF PERSONS  ENROLLED  IN  THE  PROGRAM  BY  MARITAL
 STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
 NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
 RECEIVE  AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE FEDERAL
 SOCIAL SECURITY ACT, AND  THE  NUMBER  THAT  SO  QUALIFY  THROUGH  THEIR
 ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
 PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
 ADMINISTRATIVE  COST  CONTAINMENT INITIATIVES COMPLETED DURING THE YEAR,
 PROJECTIONS OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN  EVALU-
 ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
 THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
   6.  THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES
 AS PANEL MEMBERS.
   7. THERE SHALL BE AN ADVISORY COMMITTEE  TO  THE  PANEL  COMPRISED  OF
 TWELVE  PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR, THREE
 S. 3555--A                          3
 
 MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
 MEMBER SHALL BE APPOINTED BY THE MINORITY LEADER OF  THE  SENATE,  THREE
 MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
 SHALL  BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.  THE COMMIT-
 TEE MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS,  PHARMA-
 CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
 SIXTY  PERCENT  OF  THE  COMMITTEE MEMBERSHIP SHALL REPRESENT CONSUMERS.
 COMMITTEE MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES  BUT
 SHALL  BE  ALLOWED  THEIR  ACTUAL AND NECESSARY EXPENSES INCURRED IN THE
 PERFORMANCE OF THEIR DUTIES.
   § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
 1 as amended by section 4 of part T of chapter 56 of the laws  of  2012,
 and  subdivision  2  as amended by section 12 of part A of chapter 60 of
 the laws of 2014, are amended to read as follows:
   1. Persons eligible  for  comprehensive  coverage  under  section  two
 hundred forty-seven of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-FOUR, DURING THE
 YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST SIXTY YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-SEVEN IS  AT  LEAST  FIFTY  YEARS  OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST FORTY-FIVE YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST FORTY YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND  THIRTY  IS  AT  LEAST  THIRTY-FIVE
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST THIRTY
 YEARS  OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-TWO IS AT LEAST TWEN-
 TY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-THREE IS AT
 LEAST EIGHTEEN YEARS OF AGE; and whose  income  for  the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 beginning on or after January first, two thousand five, is less than  or
 equal  to  twenty thousand dollars.   After the initial determination of
 eligibility, each eligible individual must be redetermined  eligible  at
 least every twenty-four months; and
   (b)  any  married resident who IS ENROLLED IN MEDICARE AND is at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-FOUR, DURING THE
 YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST SIXTY YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-SEVEN IS  AT  LEAST  FIFTY  YEARS  OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST FORTY-FIVE YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST FORTY YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND  THIRTY  IS  AT  LEAST  THIRTY-FIVE
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST THIRTY
 YEARS  OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-TWO IS AT LEAST TWEN-
 TY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-THREE IS AT
 LEAST EIGHTEEN YEARS OF AGE; and whose  income  for  the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 when combined with the income in the same calendar year of such  married
 person's  spouse  beginning on or after January first, two thousand one,
 is less than or equal to twenty-six thousand dollars. After the  initial
 determination  of eligibility, each eligible individual must be redeter-
 mined eligible at least every twenty-four months.
   2. Persons  eligible  for  catastrophic  coverage  under  section  two
 hundred forty-eight of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-FOUR, DURING THE
 YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST SIXTY YEARS OF AGE, DURING THE
 S. 3555--A                          4
 
 YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-SEVEN IS  AT  LEAST  FIFTY  YEARS  OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST FORTY-FIVE YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST FORTY YEARS
 OF  AGE,  DURING  THE  YEAR  TWO THOUSAND THIRTY IS AT LEAST THIRTY-FIVE
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST THIRTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-TWO IS AT LEAST  TWEN-
 TY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-THREE IS AT
 LEAST  EIGHTEEN  YEARS  OF  AGE;  and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 beginning  on  or  after  January  first, two thousand one, is more than
 twenty thousand and less than or equal to seventy-five thousand dollars.
 After the initial determination of eligibility, each eligible individual
 must be redetermined eligible at least every twenty-four months; and
   (b) any married resident who is ENROLLED  IN  MEDICARE  AND  at  least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-FOUR, DURING THE
 YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST SIXTY YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING
 THE  YEAR  TWO  THOUSAND  TWENTY-SEVEN  IS  AT LEAST FIFTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST  FORTY-FIVE  YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST FORTY YEARS
 OF  AGE,  DURING  THE  YEAR  TWO THOUSAND THIRTY IS AT LEAST THIRTY-FIVE
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST THIRTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-TWO IS AT LEAST  TWEN-
 TY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-THREE IS AT
 LEAST  EIGHTEEN  YEARS  OF  AGE;  and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 when  combined with the income in the same calendar year of such married
 person's spouse beginning on or after January first, two  thousand  one,
 is  more  than twenty-six thousand dollars and less than or equal to one
 hundred thousand dollars. After the initial determination  of  eligibil-
 ity,  each  eligible  individual  must be redetermined eligible at least
 every twenty-four months.
   § 5. Paragraphs (e) and (f) of subdivision 3 of  section  242  of  the
 elder  law, paragraph (e) as amended by section 3-d of part A of chapter
 59 of the laws of 2011, and paragraph (f) as amended  by  section  1  of
 part  T  of  chapter  56  of  the  laws  of 2012, are amended to read as
 follows:
   (e) As a condition of eligibility for benefits under this title, if  a
 program  participant's  income  indicates  that the participant could be
 eligible for an income-related subsidy under  section  1860D-14  of  the
 federal  social  security  act by either applying for such subsidy or by
 enrolling in a medicare savings program as a qualified medicare  benefi-
 ciary  (QMB),  a  specified low-income medicare beneficiary (SLMB), or a
 qualifying  individual  (QI),  a  program  participant  is  required  to
 provide,  and  to authorize the [elderly] EXPANDED pharmaceutical insur-
 ance coverage  program  to  obtain,  any  information  or  documentation
 required  to  establish  the participant's eligibility for such subsidy,
 and to authorize the [elderly] EXPANDED pharmaceutical insurance  cover-
 age program to apply on behalf of the participant for the subsidy or the
 medicare  savings  program.  [The elderly] UPON RECEIPT OF AN ENROLLMENT
 APPLICATION, OR AT ANY TIME AFTER ENROLLMENT WHEN THE PROGRAM HAS INFOR-
 MATION THAT INDICATES AN  ENROLLEE  IS  ELIGIBLE  FOR  A  SUBSIDY  UNDER
 SECTION  1860D-14  OF  THE  FEDERAL SOCIAL SECURITY ACT OR IN A MEDICARE
 SAVINGS PROGRAM, THE EXPANDED pharmaceutical insurance coverage  program
 shall make a reasonable effort to notify the program participant of [his
 S. 3555--A                          5

 or  her]  SUCH  PARTICIPANT'S  need to provide any of the above required
 information. After a reasonable effort has  been  made  to  contact  the
 participant, a participant shall be notified in writing that [he or she]
 SUCH PARTICIPANT has sixty days to provide such required information. If
 such  information  is  not  provided  within  the  sixty day period, the
 participant's coverage may be terminated.  A PROGRAM PARTICIPANT WHO  IS
 ELIGIBLE  TO ENROLL IN THE MEDICARE SAVINGS PROGRAM SHALL BE ASSISTED TO
 DO SO, AND THEIR  EXPANDED  PHARMACEUTICAL  INSURANCE  COVERAGE  PROGRAM
 ENROLLMENT  SHALL  BE  IN  PLACE THROUGHOUT THE MEDICARE SAVINGS PROGRAM
 APPLICATION PROCESS.
   (f) As a condition of eligibility for benefits  under  this  title,  a
 program participant is required to be enrolled in Medicare part D and to
 maintain  such  enrollment.  For  unmarried participants with individual
 annual income less than or equal to twenty-three  thousand  dollars  and
 married  participants  with  joint  annual  income less than or equal to
 twenty-nine thousand  dollars,  the  [elderly]  EXPANDED  pharmaceutical
 insurance  coverage  program  shall  pay  for  the portion of the part D
 monthly premium, AND ANY LATE ENROLLMENT  PENALTY  THAT  MAY  HAVE  BEEN
 ASSESSED,  that  is  the  responsibility  of the participant. Such TOTAL
 payment shall be limited to  the  low-income  benchmark  premium  amount
 established  by  the  federal centers for medicare and medicaid services
 and any other amount which such agency establishes under its de  minimus
 premium policy.
   §  6.  Subdivision  3  of  section  250 of the elder law is amended by
 adding a new paragraph (f) to read as follows:
   (F) THE EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PROGRAM SHALL  POST
 TO ITS WEBSITE THE NAMES OF MANUFACTURERS THAT HAVE A REBATE PROGRAM AND
 LIST  THE DRUGS THAT ARE COVERED BY SUCH REBATE PROGRAM IN A MANNER THAT
 PROVIDES ENROLLEES WITH ACCESS TO SUCH INFORMATION PRIOR TO  THE  ANNUAL
 MEDICARE OPEN ENROLLMENT PERIOD.
   § 7. This act shall take effect immediately.