S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3525
                              2015-2016 Regular Sessions
                                   I N  S E N A T E
                                   February 11, 2015
                                      ___________
       Introduced by Sens. PERKINS, ADDABBO, AVELLA, BRESLIN, DILAN, ESPAILLAT,
         HASSELL-THOMPSON,   HOYLMAN,  KRUEGER,  LATIMER,  MONTGOMERY,  PARKER,
         PERALTA, RIVERA, SAMPSON, SANDERS, SERRANO, SQUADRON, STAVISKY -- read
         twice and ordered printed, and when printed to  be  committed  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 to establishing New
         York Health
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Short  title. This act shall be known and may be cited as
    2  the "New York health act".
    3    S 2. Legislative  findings  and  intent.  1.  The  state  constitution
    4  states:  "The  protection and promotion of the health of the inhabitants
    5  of the state are matters of public concern and provision therefor  shall
    6  be made by the state and by such of its subdivisions and in such manner,
    7  and by such means as the legislature shall from time to time determine."
    8  (Article  XVII,  S3.)  The legislature finds and declares that all resi-
    9  dents of the state have the right to health care.    While  the  federal
   10  Affordable  Care Act brought many improvements in health care and health
   11  coverage, it still leaves many New  Yorkers  without  coverage  or  with
   12  inadequate  coverage.  New  Yorkers  -  as  individuals,  employers, and
   13  taxpayers - have experienced a rise in  the  cost  of  health  care  and
   14  coverage  in  recent  years,  including rising premiums, deductibles and
   15  co-pays, restricted provider networks and high  out-of-network  charges.
   16  Businesses  have  also experienced increases in the costs of health care
   17  benefits for their employees, and many employers are shifting  a  larger
   18  share  of  the  cost of coverage to their employees or dropping coverage
   19  entirely.  Health care providers are also affected by inadequate  health
   20  coverage  in  New  York  state.  A large portion of voluntary and public
   21  hospitals, health centers and other providers now experience substantial
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD07764-02-5
       S. 3525                             2
    1  losses due to the provision of care that is  uncompensated.  Individuals
    2  often  find that they are deprived of affordable care and choice because
    3  of decisions by health plans guided by the plan's economic needs  rather
    4  than  their  health  care needs. To address the fiscal crisis facing the
    5  health care system and the state and to assure New Yorkers can  exercise
    6  their right to health care, affordable and comprehensive health coverage
    7  must  be  provided.  Pursuant  to the state constitution's charge to the
    8  legislature to provide for the health of New Yorkers,  this  legislation
    9  is  an  enactment  of  state  concern  for the purpose of establishing a
   10  comprehensive universal single-payer health care coverage program and  a
   11  health  care cost control system for the benefit of all residents of the
   12  state of New York.
   13    2. It is the intent of the Legislature to create the New  York  Health
   14  program  to provide a universal health plan for every New Yorker, funded
   15  by broad-based revenue based on ability to pay.  The state shall work to
   16  obtain waivers relating to Medicaid, Child Health  Plus,  Medicare,  the
   17  Affordable  Care  Act, and any other appropriate federal programs, under
   18  which federal funds and other subsidies that would otherwise be paid  to
   19  New  York State and New Yorkers for health coverage that will be equaled
   20  or exceeded by New York Health will be paid by the federal government to
   21  New York State and deposited in the New York Health  trust  fund.  Under
   22  such a waiver, health coverage under those programs will be replaced and
   23  merged  into  New York Health, which will operate as a true single-payer
   24  program.
   25    If such a waiver is not obtained,  the  state  shall  use  state  plan
   26  amendments  and seek waivers to maximize, and make as seamless as possi-
   27  ble, the use of federally-matched health  programs  and  federal  health
   28  programs  in  New York Health.   Thus, even where other programs such as
   29  Medicaid or Medicare may contribute to paying for care, it is  the  goal
   30  of  this  legislation  that  the  coverage will be delivered by New York
   31  Health and, as much as possible, the multiple sources of funding will be
   32  pooled with other New York Health funds and not be apparent to New  York
   33  Health  members  or participating providers.   This program will promote
   34  movement away from fee-for-service payment, which tends to reward  quan-
   35  tity  and  requires excessive administrative expense, and towards alter-
   36  nate payment methodologies, such as  global  or  capitated  payments  to
   37  providers  or health care organizations, that promote quality, efficien-
   38  cy, investment in primary and preventive care, and innovation and  inte-
   39  gration in the organizing of health care.
   40    3.  This  act  does  not  create  any  employment benefit, nor does it
   41  require, prohibit, or limit the providing of any employment benefit.
   42    4. In order to promote improved quality of, and access to, health care
   43  services and promote improved clinical outcomes, it is the policy of the
   44  state to encourage cooperative, collaborative and  integrative  arrange-
   45  ments  among  health  care providers who might otherwise be competitors,
   46  under the active supervision of the commissioner of health.  It  is  the
   47  intent  of  the state to supplant competition with such arrangements and
   48  regulation only to the extent necessary to accomplish  the  purposes  of
   49  this  act,  and  to  provide  state  action immunity under the state and
   50  federal antitrust laws  to  health  care  providers,  particularly  with
   51  respect  to  their  relations with the single-payer New York Health plan
   52  created by this act.
   53    S 3. Article 50 and sections 5000, 5001, 5002 and 5003 of  the  public
   54  health  law  are renumbered article 80 and sections 8000, 8001, 8002 and
   55  8003, respectively, and a new article 51 is added to read as follows:
       S. 3525                             3
    1                                  ARTICLE 51
    2                               NEW YORK HEALTH
    3  SECTION 5100. DEFINITIONS.
    4          5101. PROGRAM CREATED.
    5          5102. BOARD OF TRUSTEES.
    6          5103. ELIGIBILITY AND ENROLLMENT.
    7          5104. BENEFITS.
    8          5105. HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHOD-
    9                  OLOGIES.
   10          5106. HEALTH CARE ORGANIZATIONS.
   11          5107. PROGRAM STANDARDS.
   12          5108. REGULATIONS.
   13          5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS.
   14          5110. ADDITIONAL PROVISIONS.
   15    S 5100. DEFINITIONS. AS USED IN  THIS  ARTICLE,  THE  FOLLOWING  TERMS
   16  SHALL  HAVE  THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
   17  OTHERWISE:
   18    1. "BOARD" MEANS THE BOARD OF TRUSTEES OF THE NEW YORK HEALTH  PROGRAM
   19  CREATED  BY SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE, AND "TRUSTEE"
   20  MEANS A TRUSTEE OF THE BOARD.
   21    2. "CARE COORDINATION" MEANS SERVICES PROVIDED BY A  CARE  COORDINATOR
   22  UNDER SUBDIVISION TWO OF SECTION FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE.
   23    3.  "CARE  COORDINATOR"  MEANS  AN  INDIVIDUAL  OR  ENTITY APPROVED TO
   24  PROVIDE CARE COORDINATION UNDER SUBDIVISION  TWO  OF  SECTION  FIFTY-ONE
   25  HUNDRED FIVE OF THIS ARTICLE.
   26    4. "FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM" MEANS THE MEDICAL ASSIST-
   27  ANCE  PROGRAM  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
   28  LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-NINE-GG
   29  OF  THE  SOCIAL  SERVICES  LAW,  AND THE CHILD HEALTH PLUS PROGRAM UNDER
   30  TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
   31    5. "HEALTH CARE ORGANIZATION" MEANS AN ENTITY THAT IS APPROVED BY  THE
   32  COMMISSIONER  UNDER  SECTION  FIFTY-ONE  HUNDRED  SIX OF THIS ARTICLE TO
   33  PROVIDE HEALTH CARE SERVICES TO MEMBERS UNDER THE PROGRAM.
   34    6. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
   35  COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
   36    7. "IMPLEMENTATION PERIOD" MEANS THE PERIOD UNDER SUBDIVISION THREE OF
   37  SECTION FIFTY-ONE HUNDRED ONE OF THIS ARTICLE DURING WHICH  THE  PROGRAM
   38  WILL BE SUBJECT TO SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT
   39  IS FULLY IMPLEMENTED UNDER THAT SECTION.
   40    8.  "LONG  TERM CARE" MEANS LONG TERM CARE, TREATMENT, MAINTENANCE, OR
   41  SERVICES NOT COVERED UNDER CHILD HEALTH PLUS, AS APPROPRIATE,  WITH  THE
   42  EXCEPTION OF SHORT TERM REHABILITATION, AS DEFINED BY THE COMMISSIONER.
   43    9.  "MEDICAID"  OR  "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
   44  FIVE OF THE SOCIAL SERVICES LAW AND  THE  PROGRAM  THEREUNDER.    "CHILD
   45  HEALTH  PLUS"  MEANS  TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER
   46  AND THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF THE  FEDERAL
   47  SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.  "BASIC HEALTH PROGRAM"
   48  MEANS SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW AND
   49  THE PROGRAM THEREUNDER.
   50    10. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.
   51    11.  "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST FUND
   52  ESTABLISHED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE LAW.
   53    12. "OUT-OF-STATE HEALTH CARE SERVICE" MEANS  A  HEALTH  CARE  SERVICE
   54  PROVIDED  TO A MEMBER WHILE THE MEMBER IS OUT OF THE STATE AND (A) IT IS
   55  MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE BE PROVIDED  WHILE  THE
   56  MEMBER IS OUT OF THE STATE, OR (B) IT IS CLINICALLY APPROPRIATE THAT THE
       S. 3525                             4
    1  HEALTH  CARE  SERVICE  BE  PROVIDED BY A PARTICULAR HEALTH CARE PROVIDER
    2  LOCATED OUT OF THE STATE RATHER THAN IN THE STATE.
    3    13.  "PARTICIPATING PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS A
    4  HEALTH CARE  PROVIDER  QUALIFIED  UNDER  SUBDIVISION  THREE  OF  SECTION
    5  FIFTY-ONE  HUNDRED  FIVE  OF  THIS  ARTICLE  THAT  PROVIDES  HEALTH CARE
    6  SERVICES TO MEMBERS UNDER THE PROGRAM, OR A HEALTH CARE ORGANIZATION.
    7    14. "AFFORDABLE CARE ACT" MEANS THE  FEDERAL  PATIENT  PROTECTION  AND
    8  AFFORDABLE  CARE  ACT, PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE
    9  AND EDUCATION RECONCILIATION ACT OF 2010, PUBLIC  LAW  111-152,  AND  AS
   10  OTHERWISE AMENDED AND ANY REGULATIONS OR GUIDANCE ISSUED THEREUNDER.
   11    15.  "PERSON"  MEANS ANY INDIVIDUAL OR NATURAL PERSON, TRUST, PARTNER-
   12  SHIP, ASSOCIATION,  UNINCORPORATED  ASSOCIATION,  CORPORATION,  COMPANY,
   13  LIMITED  LIABILITY  COMPANY,  PROPRIETORSHIP, JOINT VENTURE, FIRM, JOINT
   14  STOCK ASSOCIATION, DEPARTMENT, AGENCY, AUTHORITY, OR OTHER LEGAL ENTITY,
   15  WHETHER FOR-PROFIT, NOT-FOR-PROFIT OR GOVERNMENTAL.
   16    16. "PROGRAM" MEANS THE NEW YORK HEALTH  PROGRAM  CREATED  BY  SECTION
   17  FIFTY-ONE HUNDRED ONE OF THIS ARTICLE.
   18    17. "PRESCRIPTION AND NON-PRESCRIPTION DRUGS" MEANS PRESCRIPTION DRUGS
   19  AS DEFINED IN SECTION TWO HUNDRED SEVENTY OF THIS CHAPTER, AND NON-PRES-
   20  CRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
   21    18.  "RESIDENT" MEANS AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE IS IN
   22  THE STATE, AS DETERMINED ACCORDING TO REGULATIONS OF THE COMMISSIONER.
   23    S 5101. PROGRAM CREATED. 1. THE NEW  YORK  HEALTH  PROGRAM  IS  HEREBY
   24  CREATED  IN  THE DEPARTMENT. THE COMMISSIONER SHALL ESTABLISH AND IMPLE-
   25  MENT THE PROGRAM UNDER THIS ARTICLE. THE PROGRAM SHALL  PROVIDE  COMPRE-
   26  HENSIVE HEALTH COVERAGE TO EVERY RESIDENT WHO ENROLLS IN THE PROGRAM.
   27    2.  THE  COMMISSIONER SHALL, TO THE MAXIMUM EXTENT POSSIBLE, ORGANIZE,
   28  ADMINISTER AND MARKET THE PROGRAM AND SERVICES AS A SINGLE PROGRAM UNDER
   29  THE NAME "NEW YORK HEALTH" OR SUCH OTHER NAME AS THE COMMISSIONER  SHALL
   30  DETERMINE,  REGARDLESS  OF UNDER WHICH LAW OR SOURCE THE DEFINITION OF A
   31  BENEFIT IS FOUND INCLUDING (ON A VOLUNTARY BASIS) RETIREE  HEALTH  BENE-
   32  FITS.    IN  IMPLEMENTING THIS SUBDIVISION, THE COMMISSIONER SHALL AVOID
   33  JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN THESE PROGRAMS AND SHALL
   34  TAKE CARE TO PROMOTE PUBLIC UNDERSTANDING  AND  AWARENESS  OF  AVAILABLE
   35  BENEFITS AND PROGRAMS.
   36    3. THE COMMISSIONER SHALL DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLL-
   37  ING IN THE PROGRAM. THERE SHALL BE AN IMPLEMENTATION PERIOD, WHICH SHALL
   38  BEGIN  ON  THE  DATE THAT INDIVIDUALS MAY BEGIN ENROLLING IN THE PROGRAM
   39  AND SHALL END AS DETERMINED BY THE COMMISSIONER.
   40    4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE PURSUANT TO THE INSURANCE
   41  LAW OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED  UNDER  THIS  CHAPTER
   42  MAY,  IF  OTHERWISE  AUTHORIZED,  OFFER  BENEFITS  THAT DO NOT COVER ANY
   43  SERVICE FOR WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER THE  PROGRAM,
   44  BUT  MAY NOT OFFER BENEFITS THAT COVER ANY SERVICE FOR WHICH COVERAGE IS
   45  OFFERED TO INDIVIDUALS UNDER THE PROGRAM. PROVIDED, HOWEVER,  THAT  THIS
   46  SUBDIVISION  SHALL  NOT  PROHIBIT (A) THE OFFERING OF ANY BENEFITS TO OR
   47  FOR INDIVIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR  SELF-EM-
   48  PLOYED  IN  THE STATE BUT WHO ARE NOT RESIDENTS OF THE STATE, OR (B) THE
   49  OFFERING OF BENEFITS DURING THE IMPLEMENTATION PERIOD TO INDIVIDUALS WHO
   50  ENROLLED OR MAY ENROLL AS MEMBERS OF THE PROGRAM, OR (C) THE OFFERING OF
   51  RETIREE HEALTH BENEFITS.
   52    5. A COLLEGE, UNIVERSITY OR OTHER INSTITUTION OF HIGHER  EDUCATION  IN
   53  THE  STATE  MAY  PURCHASE COVERAGE UNDER THE PROGRAM FOR ANY STUDENT, OR
   54  STUDENT'S DEPENDENT, WHO IS NOT A RESIDENT OF THE STATE.
   55    6. TO THE EXTENT ANY PROVISION OF THIS CHAPTER,  THE  SOCIAL  SERVICES
   56  LAW OR THE INSURANCE LAW:
       S. 3525                             5
    1    (A) IS INCONSISTENT WITH ANY PROVISION OF THIS ARTICLE OR THE LEGISLA-
    2  TIVE  INTENT  OF  THE  NEW YORK HEALTH ACT, THIS ARTICLE SHALL APPLY AND
    3  PREVAIL, EXCEPT WHERE EXPLICITLY PROVIDED OTHERWISE BY THIS ARTICLE; AND
    4    (B) IS CONSISTENT WITH THE PROVISIONS OF THIS ARTICLE AND THE LEGISLA-
    5  TIVE  INTENT OF THE NEW YORK HEALTH ACT, THE PROVISION OF THAT LAW SHALL
    6  APPLY.
    7    S 5102. BOARD OF TRUSTEES. 1. THE NEW YORK HEALTH BOARD OF TRUSTEES IS
    8  HEREBY CREATED IN THE DEPARTMENT. THE BOARD OF TRUSTEES  SHALL,  AT  THE
    9  REQUEST  OF  THE  COMMISSIONER,  CONSIDER  ANY  MATTER TO EFFECTUATE THE
   10  PROVISIONS AND PURPOSES OF THIS ARTICLE, AND MAY ADVISE THE COMMISSIONER
   11  THEREON; AND IT MAY, FROM TIME TO TIME, SUBMIT TO THE  COMMISSIONER  ANY
   12  RECOMMENDATIONS  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTI-
   13  CLE. THE COMMISSIONER MAY PROPOSE REGULATIONS  UNDER  THIS  ARTICLE  AND
   14  AMENDMENTS THERETO FOR CONSIDERATION BY THE BOARD. THE BOARD OF TRUSTEES
   15  SHALL  HAVE  NO EXECUTIVE, ADMINISTRATIVE OR APPOINTIVE DUTIES EXCEPT AS
   16  OTHERWISE PROVIDED BY LAW. THE BOARD OF TRUSTEES  SHALL  HAVE  POWER  TO
   17  ESTABLISH,  AND  FROM  TIME TO TIME, AMEND REGULATIONS TO EFFECTUATE THE
   18  PROVISIONS AND PURPOSES OF THIS ARTICLE,  SUBJECT  TO  APPROVAL  BY  THE
   19  COMMISSIONER.
   20    2. THE BOARD SHALL BE COMPOSED OF:
   21    (A)  THE  COMMISSIONER,  THE SUPERINTENDENT OF FINANCIAL SERVICES, AND
   22  THE DIRECTOR OF THE BUDGET, OR THEIR DESIGNEES, AS EX OFFICIO MEMBERS;
   23    (B) SEVENTEEN TRUSTEES APPOINTED BY THE GOVERNOR;
   24    (I) FIVE OF WHOM SHALL BE  REPRESENTATIVES  OF  HEALTH  CARE  CONSUMER
   25  ADVOCACY  ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY,
   26  WHO HAVE BEEN INVOLVED IN ACTIVITIES RELATED  TO  HEALTH  CARE  CONSUMER
   27  ADVOCACY, INCLUDING ISSUES OF INTEREST TO LOW- AND MODERATE-INCOME INDI-
   28  VIDUALS;
   29    (II)  TWO  OF  WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL ORGANIZA-
   30  TIONS REPRESENTING PHYSICIANS;
   31    (III) TWO OF WHOM SHALL BE REPRESENTATIVES OF  PROFESSIONAL  ORGANIZA-
   32  TIONS  REPRESENTING  LICENSED  OR  REGISTERED  HEALTH CARE PROFESSIONALS
   33  OTHER THAN PHYSICIANS;
   34    (IV) THREE OF WHOM SHALL BE REPRESENTATIVES OF HOSPITALS, ONE OF  WHOM
   35  SHALL BE A REPRESENTATIVE OF PUBLIC HOSPITALS;
   36    (V) ONE OF WHOM SHALL BE REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
   37    (VI)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
   38  TIONS; AND
   39    (VII) TWO OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
   40    (C) EIGHT TRUSTEES APPOINTED BY THE GOVERNOR; THREE TO BE APPOINTED ON
   41  THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; THREE TO BE APPOINTED
   42  ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE;  ONE  TO
   43  BE  APPOINTED ON THE RECOMMENDATION OF THE MINORITY LEADER OF THE ASSEM-
   44  BLY; AND ONE TO BE APPOINTED ON THE RECOMMENDATION OF THE MINORITY LEAD-
   45  ER OF THE SENATE.
   46    3. AFTER THE END OF THE IMPLEMENTATION PERIOD, NO PERSON  SHALL  BE  A
   47  TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM, EXCEPT THE EX OFFI-
   48  CIO TRUSTEES. EACH TRUSTEE SHALL SERVE AT THE PLEASURE OF THE APPOINTING
   49  OFFICER, EXCEPT THE EX OFFICIO TRUSTEES.
   50    4.  THE  CHAIR  OF THE BOARD SHALL BE APPOINTED, AND MAY BE REMOVED AS
   51  CHAIR, BY THE GOVERNOR FROM AMONG THE TRUSTEES. THE BOARD SHALL MEET  AT
   52  LEAST  FOUR  TIMES  EACH  CALENDAR YEAR. MEETINGS SHALL BE HELD UPON THE
   53  CALL OF THE CHAIR AND AS PROVIDED  BY  THE  BOARD.  A  MAJORITY  OF  THE
   54  APPOINTED  TRUSTEES  SHALL BE A QUORUM OF THE BOARD, AND THE AFFIRMATIVE
   55  VOTE OF A MAJORITY OF THE TRUSTEES VOTING, BUT NOT LESS THAN TEN,  SHALL
   56  BE  NECESSARY  FOR  ANY  ACTION  TO BE TAKEN BY THE BOARD. THE BOARD MAY
       S. 3525                             6
    1  ESTABLISH AN EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR DUTIES OF THE
    2  BOARD AS IT MAY PROVIDE, AND OTHER COMMITTEES TO ASSIST THE BOARD OR THE
    3  EXECUTIVE COMMITTEE. THE CHAIR OF THE BOARD SHALL  CHAIR  THE  EXECUTIVE
    4  COMMITTEE  AND  SHALL APPOINT THE CHAIR AND MEMBERS OF ALL OTHER COMMIT-
    5  TEES. THE BOARD OF TRUSTEES MAY APPOINT ONE OR MORE ADVISORY COMMITTEES.
    6  MEMBERS OF ADVISORY COMMITTEES NEED NOT BE MEMBERS OF THE BOARD OF TRUS-
    7  TEES.
    8    5. TRUSTEES SHALL SERVE WITHOUT COMPENSATION BUT SHALL  BE  REIMBURSED
    9  FOR  THEIR  NECESSARY  AND ACTUAL EXPENSES INCURRED WHILE ENGAGED IN THE
   10  BUSINESS OF THE BOARD.
   11    6. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, NO OFFICER OR
   12  EMPLOYEE OF THE STATE OR ANY LOCAL GOVERNMENT SHALL FORFEIT OR BE DEEMED
   13  TO HAVE FORFEITED HIS OR HER OFFICE OR EMPLOYMENT BY REASON OF  BEING  A
   14  TRUSTEE.
   15    7.  THE  BOARD  AND ITS COMMITTEES AND ADVISORY COMMITTEES MAY REQUEST
   16  AND RECEIVE THE ASSISTANCE OF THE DEPARTMENT  AND  ANY  OTHER  STATE  OR
   17  LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
   18    8. NO LATER THAN TWO YEARS AFTER THE EFFECTIVE DATE OF THIS ARTICLE:
   19    (A) THE BOARD SHALL DEVELOP A PROPOSAL, CONSISTENT WITH THE PRINCIPLES
   20  OF  THIS  ARTICLE, FOR PROVISION BY THE PROGRAM OF LONG-TERM CARE COVER-
   21  AGE, INCLUDING THE DEVELOPMENT OF A PROPOSAL, CONSISTENT WITH THE  PRIN-
   22  CIPLES  OF  THIS  ARTICLE, FOR ITS FUNDING.  IN DEVELOPING THE PROPOSAL,
   23  THE BOARD SHALL CONSULT WITH AN ADVISORY  COMMITTEE,  APPOINTED  BY  THE
   24  CHAIR OF THE BOARD, INCLUDING REPRESENTATIVES OF CONSUMERS AND POTENTIAL
   25  CONSUMERS  OF  LONG-TERM  CARE,  PROVIDERS OF LONG-TERM CARE, LABOR, AND
   26  OTHER INTERESTED PARTIES. THE BOARD SHALL PRESENT ITS  PROPOSAL  TO  THE
   27  GOVERNOR AND THE LEGISLATURE.
   28    (B)  THE  BOARD SHALL DEVELOP PROPOSALS FOR: (I) INCORPORATING RETIREE
   29  HEALTH BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER  RETI-
   30  REE  HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK HEALTH
   31  BUT LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING  EMPLOYER
   32  RETIREE  HEALTH  BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED SUCH BENEFITS
   33  WHILE RESIDING IN THE STATE PRIOR TO  THE  IMPLEMENTATION  OF  NEW  YORK
   34  HEALTH AND LIVE AS RETIREES OUT OF THE STATE.
   35    (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK HEALTH COVERAGE OF
   36  HEALTH  CARE  SERVICES  COVERED  UNDER  THE  WORKERS'  COMPENSATION LAW,
   37  INCLUDING WHETHER AND HOW TO CONTINUE FUNDING FOR THOSE  SERVICES  UNDER
   38  THAT  LAW  AND  WHETHER  AND HOW TO INCORPORATE AN ELEMENT OF EXPERIENCE
   39  RATING.
   40    S 5103. ELIGIBILITY AND ENROLLMENT. 1. EVERY  RESIDENT  OF  THE  STATE
   41  SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
   42    2.  NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM OR OTHER CHARGE FOR
   43  ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.
   44    S 5104. BENEFITS. 1. THE PROGRAM SHALL  PROVIDE  COMPREHENSIVE  HEALTH
   45  COVERAGE  TO  EVERY MEMBER, WHICH SHALL INCLUDE ALL HEALTH CARE SERVICES
   46  REQUIRED TO BE COVERED UNDER ANY OF THE  FOLLOWING,  WITHOUT  REGARD  TO
   47  WHETHER  THE  MEMBER  WOULD  OTHERWISE BE ELIGIBLE FOR OR COVERED BY THE
   48  PROGRAM OR SOURCE REFERRED TO:
   49    (A) FOR EVERY MEMBER UNDER THE AGE OF TWENTY-ONE, CHILD HEALTH PLUS;
   50    (B) MEDICAID;
   51    (C) MEDICARE;
   52    (D) ARTICLE FORTY-FOUR  OF  THIS  CHAPTER  OR  ARTICLE  THIRTY-TWO  OR
   53  FORTY-THREE OF THE INSURANCE LAW;
   54    (E)  ARTICLE  ELEVEN OF THE CIVIL SERVICE LAW, AS OF THE DATE ONE YEAR
   55  BEFORE THE BEGINNING OF THE IMPLEMENTATION PERIOD;
       S. 3525                             7
    1    (F) ANY COST INCURRED DEFINED IN PARAGRAPH ONE OF  SUBSECTION  (A)  OF
    2  SECTION  FIFTY-ONE  HUNDRED TWO OF THE INSURANCE LAW, PROVIDED THAT THIS
    3  COVERAGE SHALL NOT REPLACE  COVERAGE  UNDER  ARTICLE  FIFTY-ONE  OF  THE
    4  INSURANCE LAW;
    5    (G)  ANY  ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED TO THE
    6  PROGRAM'S BENEFITS BY THE PROGRAM; AND
    7    (H) PROVIDED THAT NONE OF THE ABOVE  SHALL  INCLUDE  LONG  TERM  CARE,
    8  UNTIL  A  PROPOSAL  UNDER  PARAGRAPH (A) OF SUBDIVISION EIGHT OF SECTION
    9  FIFTY-ONE HUNDRED TWO OF THIS ARTICLE IS ENACTED INTO LAW.
   10    2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM, DEDUCTIBLE, CO-PAY-
   11  MENT OR CO-INSURANCE UNDER THE PROGRAM.
   12    3. THE PROGRAM SHALL PROVIDE FOR PAYMENT UNDER THE PROGRAM  FOR  EMER-
   13  GENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO MEMBERS OR INDIVID-
   14  UALS  ENTITLED  TO BECOME MEMBERS WHO HAVE NOT HAD A REASONABLE OPPORTU-
   15  NITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR.
   16    S 5105. HEALTH CARE PROVIDERS; CARE  COORDINATION;  PAYMENT  METHODOL-
   17  OGIES.   1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE PROVIDER
   18  QUALIFIED TO PARTICIPATE UNDER THIS  SECTION  MAY  PROVIDE  HEALTH  CARE
   19  SERVICES  UNDER  THE  PROGRAM, PROVIDED THAT THE HEALTH CARE PROVIDER IS
   20  OTHERWISE LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR  THE
   21  INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.
   22    (B)  A  MEMBER  MAY  CHOOSE  TO RECEIVE HEALTH CARE SERVICES UNDER THE
   23  PROGRAM FROM ANY PARTICIPATING PROVIDER, CONSISTENT WITH  PROVISIONS  OF
   24  THIS  ARTICLE  RELATING  TO  CARE COORDINATION AND HEALTH CARE ORGANIZA-
   25  TIONS, THE WILLINGNESS OR  AVAILABILITY  OF  THE  PROVIDER  (SUBJECT  TO
   26  PROVISIONS  OF  THIS ARTICLE RELATING TO DISCRIMINATION), AND THE APPRO-
   27  PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
   28    2. CARE COORDINATION.
   29    (A) CARE COORDINATION SHALL INCLUDE, BUT NOT BE LIMITED TO,  MANAGING,
   30  REFERRING   TO,  LOCATING,  COORDINATING,  AND  MONITORING  HEALTH  CARE
   31  SERVICES FOR THE MEMBER TO ASSURE THAT ALL  MEDICALLY  NECESSARY  HEALTH
   32  CARE  SERVICES  ARE  MADE  AVAILABLE  TO AND ARE EFFECTIVELY USED BY THE
   33  MEMBER IN A TIMELY MANNER, CONSISTENT WITH PATIENT AUTONOMY. CARE  COOR-
   34  DINATION  IS  NOT  A REQUIREMENT FOR PRIOR AUTHORIZATION FOR HEALTH CARE
   35  SERVICES AND REFERRAL SHALL NOT BE REQUIRED FOR A MEMBER  TO  RECEIVE  A
   36  HEALTH CARE SERVICE.
   37    (B) A CARE COORDINATOR MAY BE AN INDIVIDUAL OR ENTITY THAT IS APPROVED
   38  BY THE PROGRAM THAT IS:
   39    (I)  A  HEALTH CARE PRACTITIONER WHO IS: (A) THE MEMBER'S PRIMARY CARE
   40  PRACTITIONER; (B) AT THE OPTION OF A FEMALE MEMBER, THE MEMBER'S PROVID-
   41  ER OF PRIMARY GYNECOLOGICAL CARE; OR (C) AT THE OPTION OF A  MEMBER  WHO
   42  HAS  A  CHRONIC  CONDITION  THAT  REQUIRES  SPECIALTY CARE, A SPECIALIST
   43  HEALTH CARE PRACTITIONER WHO REGULARLY AND CONTINUALLY  PROVIDES  TREAT-
   44  MENT FOR THAT CONDITION TO THE MEMBER;
   45    (II)  AN ENTITY LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR
   46  CERTIFIED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER, A MANAGED LONG  TERM
   47  CARE  PLAN  UNDER  SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER OR
   48  OTHER PROGRAM MODEL UNDER PARAGRAPH (B) OF  SUBDIVISION  SEVEN  OF  SUCH
   49  SECTION, OR, WITH RESPECT TO A MEMBER WHO RECEIVES CHRONIC MENTAL HEALTH
   50  CARE SERVICES, AN ENTITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL
   51  HYGIENE LAW OR OTHER ENTITY APPROVED BY THE COMMISSIONER IN CONSULTATION
   52  WITH THE COMMISSIONER OF MENTAL HEALTH;
   53    (III) A HEALTH CARE ORGANIZATION;
   54    (IV) A TAFT-HARTLEY FUND, WITH RESPECT TO ITS MEMBERS AND THEIR FAMILY
   55  MEMBERS;  PROVIDED THAT THIS PROVISION SHALL NOT PRECLUDE A TAFT-HARTLEY
   56  FUND FROM BECOMING A CARE COORDINATOR UNDER  SUBPARAGRAPH  (V)  OF  THIS
       S. 3525                             8
    1  PARAGRAPH  OR A HEALTH CARE ORGANIZATION UNDER SECTION FIFTY-ONE HUNDRED
    2  SIX OF THIS ARTICLE; OR
    3    (V) ANY NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY APPROVED BY THE PROGRAM.
    4    (C)  HEALTH CARE SERVICES PROVIDED TO A MEMBER SHALL NOT BE SUBJECT TO
    5  PAYMENT UNDER THE PROGRAM UNLESS THE MEMBER  IS  ENROLLED  WITH  A  CARE
    6  COORDINATOR  AT  THE  TIME  THE  HEALTH CARE SERVICE IS PROVIDED, EXCEPT
    7  WHERE PROVIDED UNDER SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR
    8  OF THIS ARTICLE. EVERY MEMBER SHALL ENROLL WITH A CARE COORDINATOR  THAT
    9  AGREES  TO  PROVIDE  CARE  COORDINATION TO THE MEMBER PRIOR TO RECEIVING
   10  HEALTH CARE SERVICES TO BE PAID FOR UNDER THE PROGRAM. THE MEMBER  SHALL
   11  REMAIN  ENROLLED  WITH  THAT  CARE  COORDINATOR UNTIL THE MEMBER BECOMES
   12  ENROLLED WITH A DIFFERENT CARE COORDINATOR OR CEASES  TO  BE  A  MEMBER.
   13  MEMBERS  HAVE  THE  RIGHT  TO  CHANGE THEIR CARE COORDINATOR ON TERMS AT
   14  LEAST  AS  PERMISSIVE  AS  THE  PROVISIONS  OF  SECTION  THREE   HUNDRED
   15  SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW RELATING TO AN INDIVIDUAL CHANG-
   16  ING HIS OR HER PRIMARY CARE PROVIDER OR MANAGED CARE PROVIDER.
   17    (D)  CARE COORDINATION SHALL BE PROVIDED TO THE MEMBER BY THE MEMBER'S
   18  CARE COORDINATOR.  A CARE COORDINATOR MAY EMPLOY OR UTILIZE THE SERVICES
   19  OF OTHER INDIVIDUALS OR ENTITIES TO ASSIST  IN  PROVIDING  CARE  COORDI-
   20  NATION FOR THE MEMBER, CONSISTENT WITH REGULATIONS OF THE COMMISSIONER.
   21    (E)  A  HEALTH  CARE ORGANIZATION MAY ESTABLISH RULES RELATING TO CARE
   22  COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
   23  THIS SUBDIVISION BUT OTHERWISE CONSISTENT WITH THIS  ARTICLE  AND  OTHER
   24  APPLICABLE  LAWS.  NOTHING IN THIS SUBDIVISION SHALL AUTHORIZE ANY INDI-
   25  VIDUAL TO ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION
   26  LAW.
   27    (F) THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT PROCEDURES AND STAND-
   28  ARDS FOR AN INDIVIDUAL OR ENTITY TO BE APPROVED TO BE A CARE COORDINATOR
   29  IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO  PROCEDURES  AND  STANDARDS
   30  RELATING  TO  THE  REVOCATION,  SUSPENSION,  LIMITATION, OR ANNULMENT OF
   31  APPROVAL ON A DETERMINATION THAT THE INDIVIDUAL OR ENTITY IS INCOMPETENT
   32  TO BE A CARE COORDINATOR OR HAS EXHIBITED A COURSE OF CONDUCT  WHICH  IS
   33  EITHER  INCONSISTENT  WITH  PROGRAM  STANDARDS  AND REGULATIONS OR WHICH
   34  EXHIBITS AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR  IS
   35  A  POTENTIAL  THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND
   36  STANDARDS SHALL NOT LIMIT APPROVAL TO  BE  A  CARE  COORDINATOR  IN  THE
   37  PROGRAM  FOR ECONOMIC PURPOSES AND SHALL BE CONSISTENT WITH GOOD PROFES-
   38  SIONAL PRACTICE. IN DEVELOPING THE PROCEDURES AND STANDARDS, THE COMMIS-
   39  SIONER SHALL: (I) CONSIDER  EXISTING  STANDARDS  DEVELOPED  BY  NATIONAL
   40  ACCREDITING  AND  PROFESSIONAL  ORGANIZATIONS;  AND  (II)  CONSULT  WITH
   41  NATIONAL AND LOCAL ORGANIZATIONS WORKING ON CARE COORDINATION OR SIMILAR
   42  MODELS, INCLUDING HEALTH CARE  PRACTITIONERS,  HOSPITALS,  CLINICS,  AND
   43  CONSUMERS  AND  THEIR  REPRESENTATIVES. WHEN DEVELOPING AND IMPLEMENTING
   44  STANDARDS OF APPROVAL OF CARE  COORDINATORS  FOR  INDIVIDUALS  RECEIVING
   45  CHRONIC MENTAL HEALTH CARE SERVICES, THE COMMISSIONER SHALL CONSULT WITH
   46  THE  COMMISSIONER OF MENTAL HEALTH. AN INDIVIDUAL OR ENTITY MAY NOT BE A
   47  CARE COORDINATOR UNLESS THE SERVICES INCLUDED IN CARE  COORDINATION  ARE
   48  WITHIN  THE  INDIVIDUAL'S PROFESSIONAL SCOPE OF PRACTICE OR THE ENTITY'S
   49  LEGAL AUTHORITY.
   50    (G) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A CARE  COORDINATOR  MUST:
   51  (I)  RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSIONER; AND
   52  (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY THE  COMMISSIONER  TO
   53  ENABLE  THE  COMMISSIONER TO EVALUATE THE IMPACT OF CARE COORDINATORS ON
   54  QUALITY, OUTCOMES AND COST.
   55    3. HEALTH CARE PROVIDERS. (A) THE  COMMISSIONER  SHALL  ESTABLISH  AND
   56  MAINTAIN PROCEDURES AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE QUALI-
       S. 3525                             9
    1  FIED  TO PARTICIPATE IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO PROCE-
    2  DURES AND STANDARDS RELATING TO THE REVOCATION, SUSPENSION,  LIMITATION,
    3  OR ANNULMENT OF QUALIFICATION TO PARTICIPATE ON A DETERMINATION THAT THE
    4  HEALTH  CARE PROVIDER IS AN INCOMPETENT PROVIDER OF SPECIFIC HEALTH CARE
    5  SERVICES OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS EITHER INCONSIST-
    6  ENT WITH PROGRAM STANDARDS AND REGULATIONS OR WHICH EXHIBITS AN  UNWILL-
    7  INGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS A POTENTIAL THREAT
    8  TO  THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND STANDARDS SHALL NOT
    9  LIMIT HEALTH CARE PROVIDER PARTICIPATION IN  THE  PROGRAM  FOR  ECONOMIC
   10  PURPOSES  AND  SHALL  BE CONSISTENT WITH GOOD PROFESSIONAL PRACTICE. ANY
   11  HEALTH CARE PROVIDER WHO IS QUALIFIED  TO  PARTICIPATE  UNDER  MEDICAID,
   12  CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE QUALIFIED TO PARTIC-
   13  IPATE IN THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION, SUSPEN-
   14  SION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE IN ANY OF
   15  THOSE  PROGRAMS  SHALL APPLY TO THE HEALTH CARE PROVIDER'S QUALIFICATION
   16  TO PARTICIPATE IN THE PROGRAM; PROVIDED  THAT  A  HEALTH  CARE  PROVIDER
   17  QUALIFIED  UNDER  THIS  SENTENCE  SHALL  FOLLOW THE PROCEDURES TO BECOME
   18  QUALIFIED UNDER THE PROGRAM BY THE END OF THE IMPLEMENTATION PERIOD.
   19    (B) THE COMMISSIONER SHALL ESTABLISH AND MAINTAIN PROCEDURES AND STAN-
   20  DARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR
   21  PURPOSES OF PROVIDING COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH
   22  CARE SERVICES.
   23    4. PAYMENT FOR HEALTH CARE SERVICES. (A) THE COMMISSIONER  MAY  ESTAB-
   24  LISH  BY  REGULATION  PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES AND
   25  CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM BY PARTICIPATING
   26  PROVIDERS, CARE COORDINATORS, AND HEALTH CARE ORGANIZATIONS.  THERE  MAY
   27  BE  A VARIETY OF DIFFERENT PAYMENT METHODOLOGIES, INCLUDING THOSE ESTAB-
   28  LISHED ON A DEMONSTRATION BASIS. ALL PAYMENT  RATES  UNDER  THE  PROGRAM
   29  SHALL  BE  REASONABLE  AND REASONABLY RELATED TO THE COST OF EFFICIENTLY
   30  PROVIDING THE HEALTH CARE SERVICE AND ASSURING AN ADEQUATE AND  ACCESSI-
   31  BLE  SUPPLY  OF  HEALTH CARE SERVICE.   UNTIL AND UNLESS ANOTHER PAYMENT
   32  METHODOLOGY IS ESTABLISHED, HEALTH CARE  SERVICES  PROVIDED  TO  MEMBERS
   33  UNDER  THE  PROGRAM SHALL BE PAID FOR ON A FEE-FOR-SERVICE BASIS, EXCEPT
   34  FOR CARE COORDINATION.
   35    (B) THE PROGRAM SHALL ENGAGE IN GOOD FAITH  NEGOTIATIONS  WITH  HEALTH
   36  CARE PROVIDERS' REPRESENTATIVES UNDER TITLE III OF ARTICLE FORTY-NINE OF
   37  THIS  CHAPTER,  INCLUDING,  BUT  NOT LIMITED TO, IN RELATION TO RATES OF
   38  PAYMENT AND PAYMENT METHODOLOGIES.
   39    (C) NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, PAYMENT  FOR
   40  DRUGS PROVIDED BY PHARMACIES UNDER THE PROGRAM SHALL BE MADE PURSUANT TO
   41  ARTICLE  TWO-A  OF  THIS CHAPTER. HOWEVER, THE PROGRAM SHALL PROVIDE FOR
   42  PAYMENT FOR PRESCRIPTION DRUGS UNDER SECTION 340B OF THE FEDERAL  PUBLIC
   43  SERVICE ACT WHERE APPLICABLE. PAYMENT FOR PRESCRIPTION DRUGS PROVIDED BY
   44  HEALTH  CARE  PROVIDERS OTHER THAN PHARMACIES SHALL BE PURSUANT TO OTHER
   45  PROVISIONS OF THIS ARTICLE.
   46    (D) PAYMENT FOR HEALTH CARE SERVICES ESTABLISHED  UNDER  THIS  ARTICLE
   47  SHALL  BE CONSIDERED PAYMENT IN FULL. A PARTICIPATING PROVIDER SHALL NOT
   48  CHARGE ANY RATE IN EXCESS OF THE PAYMENT ESTABLISHED UNDER THIS  ARTICLE
   49  FOR  ANY  HEALTH CARE SERVICE UNDER THE PROGRAM PROVIDED TO A MEMBER AND
   50  SHALL NOT SOLICIT OR ACCEPT PAYMENT FROM ANY MEMBER OR THIRD  PARTY  FOR
   51  ANY SUCH SERVICE EXCEPT AS PROVIDED UNDER SECTION FIFTY-ONE HUNDRED NINE
   52  OF THIS ARTICLE.  HOWEVER, THIS PARAGRAPH SHALL NOT PRECLUDE THE PROGRAM
   53  FROM  ACTING AS A PRIMARY OR SECONDARY PAYER IN CONJUNCTION WITH ANOTHER
   54  THIRD-PARTY PAYER WHERE PERMITTED UNDER SECTION FIFTY-ONE  HUNDRED  NINE
   55  OF THIS ARTICLE.
       S. 3525                            10
    1    (E)  THE  PROGRAM MAY PROVIDE IN PAYMENT METHODOLOGIES FOR PAYMENT FOR
    2  CAPITAL RELATED EXPENSES FOR SPECIFICALLY  IDENTIFIED  CAPITAL  EXPENDI-
    3  TURES  INCURRED  BY  NOT-FOR-PROFIT  OR  GOVERNMENTAL ENTITIES CERTIFIED
    4  UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER. ANY CAPITAL RELATED  EXPENSE
    5  GENERATED  BY  A  CAPITAL EXPENDITURE THAT REQUIRES OR REQUIRED APPROVAL
    6  UNDER ARTICLE TWENTY-EIGHT OF  THIS  CHAPTER  MUST  HAVE  RECEIVED  THAT
    7  APPROVAL  FOR  THE  CAPITAL  RELATED  EXPENSE  TO  BE PAID FOR UNDER THE
    8  PROGRAM.
    9    (F) THE COMMISSIONER SHALL PROVIDE BY  REGULATION FOR PAYMENT  METHOD-
   10  OLOGIES AND PROCEDURES FOR PAYING FOR OUT-OF-STATE HEALTH CARE SERVICES.
   11    5.  (A)  FOR  PURPOSES  OF  THIS SUBDIVISION, "INCOME-ELIGIBLE MEMBER"
   12  MEANS A MEMBER WHO IS ENROLLED  IN  A  FEDERALLY-MATCHED  PUBLIC  HEALTH
   13  PROGRAM AND (I) THERE IS FEDERAL FINANCIAL PARTICIPATION IN THE INDIVID-
   14  UAL'S  HEALTH  COVERAGE, OR (II) THE MEMBER IS ELIGIBLE TO ENROLL IN THE
   15  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM BY REASON OF  INCOME,  AGE,  AND
   16  RESOURCES  (WHERE APPLICABLE) UNDER STATE LAW IN EFFECT ON THE EFFECTIVE
   17  DATE OF THIS SECTION, BUT THERE IS NO FEDERAL FINANCIAL PARTICIPATION IN
   18  THE INDIVIDUAL'S HEALTH COVERAGE.
   19    (B) THE PROGRAM, WITH RESPECT TO  INCOME-ELIGIBLE  MEMBERS,  SHALL  BE
   20  CONSIDERED A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR GOVERNMENT PAYOR
   21  UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER WITH RESPECT TO THE FOLLOWING
   22  PROVISIONS,  AND WITH RESPECT TO THOSE MEMBERS WHO ARE NOT INCOME-ELIGI-
   23  BLE MEMBERS, SHALL NOT BE CONSIDERED A FEDERALLY-MATCHED  PUBLIC  HEALTH
   24  PROGRAM  OR  GOVERNMENTAL  AGENCY  BUT SHALL BE DEEMED TO BE A SPECIFIED
   25  THIRD-PARTY PAYOR UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER.
   26    S 5106. HEALTH CARE ORGANIZATIONS. 1. A MEMBER MAY  CHOOSE  TO  ENROLL
   27  WITH  AND  RECEIVE  HEALTH CARE SERVICES UNDER THE PROGRAM FROM A HEALTH
   28  CARE ORGANIZATION.
   29    2. A HEALTH CARE ORGANIZATION SHALL BE  A  NOT-FOR-PROFIT  OR  GOVERN-
   30  MENTAL ENTITY THAT IS APPROVED BY THE COMMISSIONER THAT IS:
   31    (A)  AN  ACCOUNTABLE  CARE ORGANIZATION UNDER ARTICLE TWENTY-NINE-E OF
   32  THIS CHAPTER; OR
   33    (B) A TAFT-HARTLEY FUND (I) WITH RESPECT  TO  ITS  MEMBERS  AND  THEIR
   34  FAMILY  MEMBERS,  AND  (II) IF ALLOWED BY APPLICABLE LAW AND APPROVED BY
   35  THE COMMISSIONER, FOR OTHER MEMBERS OF THE PROGRAM;  PROVIDED  THAT  THE
   36  COMMISSIONER  SHALL PROVIDE BY REGULATION THAT WHERE A TAFT-HARTLEY FUND
   37  IS ACTING UNDER THIS SUBPARAGRAPH THERE ARE PROTECTIONS FOR HEALTH  CARE
   38  PROVIDERS  AND  PATIENTS  COMPARABLE  TO THOSE APPLICABLE TO ACCOUNTABLE
   39  CARE ORGANIZATIONS.
   40    3. A HEALTH CARE ORGANIZATION MAY BE RESPONSIBLE FOR ALL  OR  PART  OF
   41  THE  HEALTH  CARE  SERVICES  TO WHICH ITS MEMBERS ARE ENTITLED UNDER THE
   42  PROGRAM, CONSISTENT WITH THE TERMS OF ITS APPROVAL BY THE COMMISSIONER.
   43    4. (A) THE COMMISSIONER SHALL DEVELOP  AND  IMPLEMENT  PROCEDURES  AND
   44  STANDARDS  FOR AN ENTITY TO BE APPROVED TO BE A HEALTH CARE ORGANIZATION
   45  IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO  PROCEDURES  AND  STANDARDS
   46  RELATING  TO  THE  REVOCATION,  SUSPENSION,  LIMITATION, OR ANNULMENT OF
   47  APPROVAL ON A DETERMINATION THAT THE  ENTITY  IS  INCOMPETENT  TO  BE  A
   48  HEALTH  CARE  ORGANIZATION OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
   49  EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
   50  EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
   51  A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
   52  STANDARDS  SHALL  NOT LIMIT APPROVAL TO BE A HEALTH CARE ORGANIZATION IN
   53  THE PROGRAM FOR ECONOMIC PURPOSES AND  SHALL  BE  CONSISTENT  WITH  GOOD
   54  PROFESSIONAL  PRACTICE.  IN DEVELOPING THE PROCEDURES AND STANDARDS, THE
   55  COMMISSIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS  DEVELOPED   BY
   56  NATIONAL  ACCREDITING  AND  PROFESSIONAL ORGANIZATIONS; AND (II) CONSULT
       S. 3525                            11
    1  WITH NATIONAL AND LOCAL ORGANIZATIONS WORKING IN  THE  FIELD  OF  HEALTH
    2  CARE  ORGANIZATIONS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS,
    3  CLINICS, AND CONSUMERS AND THEIR REPRESENTATIVES.  WHEN  DEVELOPING  AND
    4  IMPLEMENTING  STANDARDS  OF  APPROVAL  OF HEALTH CARE ORGANIZATIONS, THE
    5  COMMISSIONER SHALL CONSULT WITH THE COMMISSIONER OF  MENTAL  HEALTH  AND
    6  THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES.
    7    (B) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A HEALTH CARE ORGANIZATION
    8  MUST:  (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSION-
    9  ER; AND (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY  THE  COMMIS-
   10  SIONER  TO ENABLE THE COMMISSIONER TO EVALUATE THE HEALTH CARE ORGANIZA-
   11  TION IN RELATION  TO  QUALITY  OF  HEALTH  CARE  SERVICES,  HEALTH  CARE
   12  OUTCOMES, AND COST.
   13    5.  THE  COMMISSIONER  SHALL  MAKE REGULATIONS RELATING TO HEALTH CARE
   14  ORGANIZATIONS CONSISTENT WITH AND TO ENSURE COMPLIANCE WITH  THIS  ARTI-
   15  CLE.
   16    6.  THE  PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY A
   17  HEALTH CARE ORGANIZATION THROUGH HEALTH  CARE  PROVIDERS  SHALL  NOT  BE
   18  CONSIDERED  THE PRACTICE OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCA-
   19  TION LAW BY THE HEALTH CARE ORGANIZATION.
   20    S  5107.  PROGRAM  STANDARDS.  1.  THE  COMMISSIONER  SHALL  ESTABLISH
   21  REQUIREMENTS AND STANDARDS FOR THE PROGRAM AND FOR HEALTH CARE ORGANIZA-
   22  TIONS,  CARE  COORDINATORS,  AND  HEALTH CARE PROVIDERS, CONSISTENT WITH
   23  THIS ARTICLE, INCLUDING REQUIREMENTS AND STANDARDS FOR, AS APPLICABLE:
   24    (A) THE SCOPE, QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES;
   25    (B) RELATIONS BETWEEN HEALTH CARE ORGANIZATIONS OR HEALTH CARE PROVID-
   26  ERS AND MEMBERS; AND
   27    (C) RELATIONS  BETWEEN  HEALTH  CARE  ORGANIZATIONS  AND  HEALTH  CARE
   28  PROVIDERS,  INCLUDING  (I) CREDENTIALING AND PARTICIPATION IN THE HEALTH
   29  CARE ORGANIZATION; AND (II) TERMS, METHODS AND RATES OF PAYMENT.
   30    2. REQUIREMENTS AND STANDARDS UNDER THE PROGRAM SHALL INCLUDE, BUT NOT
   31  BE LIMITED TO, PROVISIONS TO PROMOTE THE FOLLOWING:
   32    (A) SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS  IN  HEALTH
   33  CARE  PROVIDER  CREDENTIALING AND PARTICIPATION IN HEALTH CARE ORGANIZA-
   34  TION NETWORKS, REFERRALS, PAYMENT PROCEDURES AND RATES, CLAIMS  PROCESS-
   35  ING, AND APPROVAL OF HEALTH CARE SERVICES, AS APPLICABLE;
   36    (B)  PRIMARY  AND  PREVENTIVE  CARE,  CARE COORDINATION, EFFICIENT AND
   37  EFFECTIVE HEALTH CARE  SERVICES,  QUALITY  ASSURANCE,  COORDINATION  AND
   38  INTEGRATION  OF HEALTH CARE SERVICES, INCLUDING USE OF APPROPRIATE TECH-
   39  NOLOGY, AND PROMOTION OF PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL HEALTH;
   40    (C) ELIMINATION OF HEALTH CARE DISPARITIES;
   41    (D) NON-DISCRIMINATION WITH RESPECT TO MEMBERS AND HEALTH CARE PROVID-
   42  ERS ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, DISABIL-
   43  ITY, AGE, SEX, SEXUAL ORIENTATION, GENDER  IDENTITY  OR  EXPRESSION,  OR
   44  ECONOMIC  CIRCUMSTANCES;  PROVIDED  THAT  HEALTH  CARE SERVICES PROVIDED
   45  UNDER THE PROGRAM SHALL BE APPROPRIATE TO THE PATIENT'S CLINICALLY-RELE-
   46  VANT CIRCUMSTANCES; AND
   47    (E) ACCESSIBILITY  OF  CARE  COORDINATION,  HEALTH  CARE  ORGANIZATION
   48  SERVICES  AND  HEALTH  CARE SERVICES, INCLUDING ACCESSIBILITY FOR PEOPLE
   49  WITH DISABILITIES AND PEOPLE WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND
   50  ENGLISH, AND THE PROVIDING OF CARE COORDINATION, HEALTH  CARE  ORGANIZA-
   51  TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER.
   52    3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
   53  A  FOR-PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS AND
   54  STANDARDS AS ENTITIES ORGANIZED AS NOT-FOR-PROFIT ENTITIES, AND PAYMENTS
   55  UNDER THE PROGRAM PAID TO SUCH  ENTITIES  SHALL  NOT  BE  CALCULATED  TO
   56  ACCOMMODATE  THE  GENERATION OF PROFIT OR REVENUE FOR DIVIDENDS OR OTHER
       S. 3525                            12
    1  RETURN ON INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A
    2  NOT-FOR-PROFIT ENTITY.
    3    4.  EVERY  PARTICIPATING  PROVIDER  SHALL  FURNISH TO THE PROGRAM SUCH
    4  INFORMATION TO, AND PERMIT EXAMINATION OF ITS RECORDS BY,  THE  PROGRAM,
    5  AS  MAY  BE  REASONABLY REQUIRED FOR PURPOSES OF REVIEWING ACCESSIBILITY
    6  AND UTILIZATION OF HEALTH CARE SERVICES,  QUALITY  ASSURANCE,  AND  COST
    7  CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR OTHER STUDIES OF
    8  THE  OPERATION OF THE PROGRAM OR FOR PROTECTION AND PROMOTION OF PUBLIC,
    9  ENVIRONMENTAL AND OCCUPATIONAL HEALTH.
   10    5. IN DEVELOPING REQUIREMENTS AND STANDARDS AND  MAKING  OTHER  POLICY
   11  DETERMINATIONS  UNDER  THIS ARTICLE, THE COMMISSIONER SHALL CONSULT WITH
   12  REPRESENTATIVES OF MEMBERS, HEALTH CARE  PROVIDERS,  CARE  COORDINATORS,
   13  HEALTH CARE ORGANIZATIONS AND OTHER INTERESTED PARTIES.
   14    6.    THE  PROGRAM  SHALL MAINTAIN THE CONFIDENTIALITY OF ALL DATA AND
   15  OTHER INFORMATION COLLECTED UNDER THE PROGRAM WHEN SUCH  DATA  WOULD  BE
   16  NORMALLY  CONSIDERED CONFIDENTIAL DATA BETWEEN A PATIENT AND HEALTH CARE
   17  PROVIDER.  AGGREGATE DATA OF THE PROGRAM WHICH IS DERIVED FROM CONFIDEN-
   18  TIAL DATA BUT DOES NOT VIOLATE PATIENT CONFIDENTIALITY SHALL  BE  PUBLIC
   19  INFORMATION.
   20    S  5108.  REGULATIONS.  THE  COMMISSIONER  MAY APPROVE REGULATIONS AND
   21  AMENDMENTS THERETO, UNDER SUBDIVISION ONE OF SECTION  FIFTY-ONE  HUNDRED
   22  TWO OF THIS ARTICLE. THE COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS
   23  THERETO  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTICLE ON AN
   24  EMERGENCY BASIS UNDER SECTION TWO HUNDRED TWO OF THE  STATE  ADMINISTRA-
   25  TIVE  PROCEDURE  ACT, PROVIDED THAT SUCH REGULATIONS OR AMENDMENTS SHALL
   26  NOT BECOME PERMANENT UNLESS ADOPTED UNDER  SUBDIVISION  ONE  OF  SECTION
   27  FIFTY-ONE HUNDRED TWO OF THIS ARTICLE.
   28    S 5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS. 1. THE COMMIS-
   29  SIONER  SHALL  SEEK  ALL FEDERAL WAIVERS AND OTHER FEDERAL APPROVALS AND
   30  ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS NECESSARY TO  OPERATE  THE
   31  PROGRAM CONSISTENT WITH THIS ARTICLE.
   32    2.  (A)  THE  COMMISSIONER  SHALL APPLY TO THE SECRETARY OF HEALTH AND
   33  HUMAN SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS  OF
   34  REQUIREMENTS,  AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERAL-
   35  LY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER
   36  FEDERAL PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH  CARE
   37  SERVICES,  THAT  ARE  NECESSARY TO ENABLE ALL NEW YORK HEALTH MEMBERS TO
   38  RECEIVE ALL BENEFITS UNDER THE PROGRAM THROUGH THE PROGRAM TO ENABLE THE
   39  STATE TO IMPLEMENT THIS ARTICLE AND TO RECEIVE AND DEPOSIT  ALL  FEDERAL
   40  PAYMENTS  UNDER  THOSE PROGRAMS (INCLUDING FUNDS THAT MAY BE PROVIDED IN
   41  LIEU OF PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES, AND SMALL  BUSINESS
   42  TAX  CREDITS) IN THE STATE TREASURY TO THE CREDIT OF THE NEW YORK HEALTH
   43  TRUST FUND CREATED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE  LAW
   44  AND  TO  USE  THOSE  FUNDS  FOR  THE  NEW  YORK HEALTH PROGRAM AND OTHER
   45  PROVISIONS UNDER THIS ARTICLE. TO THE EXTENT POSSIBLE, THE  COMMISSIONER
   46  SHALL  NEGOTIATE  ARRANGEMENTS WITH THE FEDERAL GOVERNMENT IN WHICH BULK
   47  OR LUMP-SUM FEDERAL PAYMENTS ARE PAID TO NEW YORK  HEALTH  IN  PLACE  OF
   48  FEDERAL  SPENDING  OR TAX BENEFITS FOR FEDERALLY-MATCHED HEALTH PROGRAMS
   49  OR FEDERAL HEALTH PROGRAMS.
   50    (B) THE COMMISSIONER MAY REQUIRE MEMBERS OR APPLICANTS TO  BE  MEMBERS
   51  TO  PROVIDE  INFORMATION  NECESSARY  FOR  THE PROGRAM TO COMPLY WITH ANY
   52  WAIVER OR ARRANGEMENT UNDER THIS SUBDIVISION.
   53    3. (A) IF ACTIONS TAKEN UNDER SUBDIVISION TWO OF THIS SECTION  DO  NOT
   54  ACCOMPLISH ALL RESULTS INTENDED UNDER THAT SUBDIVISION, THEN THIS SUBDI-
   55  VISION SHALL APPLY AND SHALL AUTHORIZE ADDITIONAL ACTIONS TO EFFECTIVELY
       S. 3525                            13
    1  IMPLEMENT   NEW  YORK  HEALTH  TO  THE  MAXIMUM  EXTENT  POSSIBLE  AS  A
    2  SINGLE-PAYER PROGRAM CONSISTENT WITH THIS ARTICLE.
    3    (B)  THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS ARTICLE TO
    4  ENABLE NEW YORK HEALTH TO ADMINISTER MEDICARE IN NEW YORK STATE  AND  TO
    5  BE  A  PROVIDER  OF  DRUG  COVERAGE  UNDER  MEDICARE PART D FOR ELIGIBLE
    6  MEMBERS OF NEW YORK HEALTH.
    7    (C)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
    8  PROVISIONS  OF  THIS  SECTION  RELATING  TO ANY FEDERALLY-MATCHED PUBLIC
    9  HEALTH PROGRAM OR MEDICARE AS  NECESSARY  TO  IMPLEMENT  ANY  WAIVER  OR
   10  ARRANGEMENT  UNDER  THIS  SECTION  OR TO MAXIMIZE THE BENEFIT TO THE NEW
   11  YORK HEALTH PROGRAM UNDER THIS SECTION, PROVIDED THAT THE  COMMISSIONER,
   12  IN  CONSULTATION  WITH  THE DIRECTOR OF THE BUDGET, SHALL DETERMINE THAT
   13  SUCH WAIVER OR MODIFICATION IS IN THE  BEST  INTERESTS  OF  THE  MEMBERS
   14  AFFECTED BY THE ACTION AND THE STATE.
   15    (D)    THE   COMMISSIONER   MAY   APPLY   FOR   COVERAGE   UNDER   ANY
   16  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM ON  BEHALF  OF  ANY  MEMBER  AND
   17  ENROLL  THE  MEMBER  IN  THE  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
   18  MEDICARE  IF  THE  MEMBER  IS  ELIGIBLE  FOR  IT.     ENROLLMENT  IN   A
   19  FEDERALLY-MATCHED  PUBLIC HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE ANY
   20  MEMBER TO LOSE ANY HEALTH CARE SERVICE PROVIDED BY THE PROGRAM OR DIMIN-
   21  ISH ANY RIGHT THE MEMBER WOULD OTHERWISE HAVE.
   22    (E) THE COMMISSIONER SHALL BY REGULATION INCREASE THE INCOME ELIGIBIL-
   23  ITY LEVEL, INCREASE OR ELIMINATE  THE  RESOURCE  TEST  FOR  ELIGIBILITY,
   24  SIMPLIFY ANY PROCEDURAL OR DOCUMENTATION REQUIREMENT FOR ENROLLMENT, AND
   25  INCREASE  THE  BENEFITS FOR ANY FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM,
   26  NOTWITHSTANDING ANY LAW OR REGULATION TO THE CONTRARY. THE  COMMISSIONER
   27  MAY ACT UNDER THIS PARAGRAPH UPON A FINDING, APPROVED BY THE DIRECTOR OF
   28  THE  BUDGET,  THAT  THE  ACTION  (I) WILL HELP TO INCREASE THE NUMBER OF
   29  MEMBERS WHO ARE ELIGIBLE FOR AND ENROLLED  IN  FEDERALLY-MATCHED  PUBLIC
   30  HEALTH  PROGRAMS;  (II) WILL NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY
   31  HEALTH CARE SERVICE OR RIGHT THE INDIVIDUAL WOULD OTHERWISE HAVE;  (III)
   32  IS  IN  THE  INTEREST  OF  THE PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS
   33  RECEIVED ANY NECESSARY FEDERAL WAIVERS OR APPROVALS  TO  ENSURE  FEDERAL
   34  FINANCIAL PARTICIPATION. ACTIONS UNDER THIS PARAGRAPH SHALL NOT APPLY TO
   35  ELIGIBILITY FOR PAYMENT FOR LONG TERM CARE.
   36    (F)  TO ENABLE THE COMMISSIONER TO APPLY FOR COVERAGE UNDER ANY FEDER-
   37  ALLY-MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE ON BEHALF OF  ANY  MEMBER
   38  AND  ENROLL THE MEMBER IN THE FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
   39  MEDICARE IF THE MEMBER IS ELIGIBLE FOR IT, THE COMMISSIONER MAY  REQUIRE
   40  THAT  EVERY MEMBER OR APPLICANT TO BE A MEMBER SHALL PROVIDE INFORMATION
   41  TO ENABLE THE COMMISSIONER TO DETERMINE WHETHER THE APPLICANT IS  ELIGI-
   42  BLE  FOR A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM AND FOR MEDICARE (AND
   43  ANY PROGRAM OR BENEFIT UNDER MEDICARE). THE PROGRAM SHALL MAKE A REASON-
   44  ABLE EFFORT TO NOTIFY MEMBERS OF THEIR OBLIGATIONS UNDER THIS PARAGRAPH.
   45  AFTER A REASONABLE EFFORT HAS BEEN  MADE  TO  CONTACT  THE  MEMBER,  THE
   46  MEMBER  SHALL  BE  NOTIFIED  IN WRITING THAT HE OR SHE HAS SIXTY DAYS TO
   47  PROVIDE SUCH REQUIRED INFORMATION. IF SUCH INFORMATION IS  NOT  PROVIDED
   48  WITHIN THE SIXTY DAY PERIOD, THE MEMBER'S COVERAGE UNDER THE PROGRAM MAY
   49  BE TERMINATED.
   50    (G)  AS  A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE SERVICES
   51  UNDER THE PROGRAM, A MEMBER WHO IS ELIGIBLE FOR BENEFITS UNDER  MEDICARE
   52  SHALL ENROLL IN MEDICARE, INCLUDING PARTS A, B AND D.
   53    (H)  THE  PROGRAM  SHALL  PROVIDE  PREMIUM  ASSISTANCE FOR ALL MEMBERS
   54  ENROLLING IN A MEDICARE PART D DRUG  COVERAGE  UNDER  SECTION  1860D  OF
   55  TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT LIMITED TO THE LOW-INCOME
   56  BENCHMARK PREMIUM AMOUNT ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE
       S. 3525                            14
    1  AND MEDICAID SERVICES AND ANY OTHER AMOUNT WHICH SUCH AGENCY ESTABLISHES
    2  UNDER  ITS  DE MINIMIS PREMIUM POLICY, EXCEPT THAT SUCH PAYMENTS MADE ON
    3  BEHALF OF MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY  EXCEED  THE
    4  LOW-INCOME  BENCHMARK  PREMIUM AMOUNT IF DETERMINED TO BE COST EFFECTIVE
    5  TO THE PROGRAM.
    6    (I) IF THE COMMISSIONER HAS  REASONABLE  GROUNDS  TO  BELIEVE  THAT  A
    7  MEMBER  COULD  BE  ELIGIBLE  FOR AN INCOME-RELATED SUBSIDY UNDER SECTION
    8  1860D-14 OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT,  THE  MEMBER
    9  SHALL  PROVIDE,  AND AUTHORIZE THE PROGRAM TO OBTAIN, ANY INFORMATION OR
   10  DOCUMENTATION REQUIRED TO ESTABLISH THE MEMBER'S  ELIGIBILITY  FOR  SUCH
   11  SUBSIDY,  PROVIDED THAT THE COMMISSIONER SHALL ATTEMPT TO OBTAIN AS MUCH
   12  OF THE INFORMATION AND DOCUMENTATION AS POSSIBLE FROM RECORDS  THAT  ARE
   13  AVAILABLE TO HIM OR HER.
   14    (J)  THE  PROGRAM  SHALL MAKE A REASONABLE EFFORT TO NOTIFY MEMBERS OF
   15  THEIR OBLIGATIONS UNDER THIS SUBDIVISION. AFTER A REASONABLE EFFORT  HAS
   16  BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
   17  THAT  HE  OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED INFORMATION. IF
   18  SUCH INFORMATION IS NOT  PROVIDED  WITHIN  THE  SIXTY  DAY  PERIOD,  THE
   19  MEMBER'S COVERAGE UNDER THE PROGRAM MAY BE TERMINATED.
   20    S  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
   21  WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
   22    (A) CONSUMER ASSISTANCE TO INDIVIDUALS WITH RESPECT TO SELECTION OF  A
   23  CARE  COORDINATOR  OR  HEALTH  CARE  ORGANIZATION,  ENROLLING, OBTAINING
   24  HEALTH CARE SERVICES, DISENROLLING, AND OTHER MATTERS  RELATING  TO  THE
   25  PROGRAM;
   26    (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
   27  AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, HEALTH CARE SERVICES
   28  UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
   29  IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
   30    (C) CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES  PROVIDING
   31  AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, CARE COORDINATION TO
   32  MEMBERS.
   33    2. THE COMMISSIONER SHALL PROVIDE GRANTS FROM FUNDS IN  THE  NEW  YORK
   34  HEALTH  TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO HEALTH
   35  SYSTEMS AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS  CHAP-
   36  TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
   37    3. THE COMMISSIONER SHALL PROVIDE FUNDS FROM THE NEW YORK HEALTH TRUST
   38  FUND  OR  OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSIONER OF
   39  LABOR FOR A PROGRAM FOR RETRAINING  AND  ASSISTING  JOB  TRANSITION  FOR
   40  INDIVIDUALS  EMPLOYED  OR  PREVIOUSLY  EMPLOYED  IN  THE FIELD OF HEALTH
   41  INSURANCE AND OTHER THIRD-PARTY PAYMENT FOR  HEALTH  CARE  OR  PROVIDING
   42  SERVICES  TO  HEALTH  CARE PROVIDERS TO DEAL WITH THIRD-PARTY PAYERS FOR
   43  HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN ENDED AS  A  RESULT  OF  THE
   44  IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM, CONSISTENT WITH OTHERWISE
   45  APPLICABLE LAW.
   46    4. THE COMMISSIONER SHALL, DIRECTLY AND THROUGH GRANTS TO NOT-FOR-PRO-
   47  FIT ENTITIES, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH THE NEW YORK
   48  HEALTH PROGRAM, TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL AND OCCUPA-
   49  TIONAL  HEALTH,  INCLUDING  COOPERATION  WITH  OTHER DATA COLLECTION AND
   50  RESEARCH PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH  THIS  ARTICLE  AND
   51  OTHERWISE APPLICABLE LAW.
   52    S 4. Financing of New York Health. 1. The governor shall submit to the
   53  legislature  a  revenue plan and legislative bills to implement the plan
   54  (referred to collectively in this section as the "revenue proposal")  to
   55  provide the revenue necessary to finance the New York Health program, as
   56  created  by  article  51  of  the public health law (referred to in this
       S. 3525                            15
    1  section as the "program"), taking into consideration anticipated federal
    2  revenue available for the program. The revenue proposal shall be submit-
    3  ted to the legislature as part of the executive budget under article VII
    4  of  the  state constitution, for the fiscal year commencing on the first
    5  day of April in the calendar year after this act shall become a law.  In
    6  developing  the revenue proposal, the governor shall consult with appro-
    7  priate officials of the executive branch; the temporary president of the
    8  senate; the speaker of the assembly; the chairs of the fiscal and health
    9  committees of the senate and assembly; and representatives of  business,
   10  labor, consumers and local government.
   11    2.  (a)  Basic  structure. The basic structure of the revenue proposal
   12  shall be as follows: Revenue for the program shall come from two assess-
   13  ments (referred to collectively in this section as  the  "assessments").
   14  First,  there  shall  be  a  progressively  graduated  assessment on all
   15  payroll and self-employed income (referred to in  this  section  as  the
   16  "payroll  assessment"),  paid by employers, employees and self-employed,
   17  similar to the Medicare tax. Higher brackets of income subject  to  this
   18  assessment shall be assessed at a higher marginal rate than lower brack-
   19  ets.    Second,  there  shall be a progressively graduated assessment on
   20  taxable income (such as interest,  dividends,  and  capital  gains)  not
   21  subject  to  the  payroll assessment (referred to in this section as the
   22  "non-payroll assessment"). The assessments will be set at levels  antic-
   23  ipated  to  produce  sufficient revenue to finance the program and other
   24  provisions of article 51 of the public health law, to be  scaled  up  as
   25  enrollment  grows, taking into consideration anticipated federal revenue
   26  available for the program. Provision shall be made for  state  residents
   27  (who  are  eligible  for the program) who are employed out-of-state, and
   28  non-residents (who are not eligible for the program) who are employed in
   29  the state.
   30    (b) Payroll assessment. The  income  to  be  subject  to  the  payroll
   31  assessment  shall be all income subject to the Medicare tax. The assess-
   32  ment shall be set at a particular percentage of that income, which shall
   33  be progressively graduated, so the percentage is higher on higher brack-
   34  ets of income. For employed individuals, the employer shall  pay  eighty
   35  percent  of  the assessment and the employee shall pay twenty percent of
   36  the assessment, except that an employer may agree to pay all or part  of
   37  the  employee's  share.    A self-employed individual shall pay the full
   38  assessment.
   39    (c) Non-payroll income assessment. There shall  be  an  assessment  on
   40  upper-bracket taxable personal income that is not subject to the payroll
   41  assessment.  It  shall  be  progressively  graduated and structured as a
   42  percentage of the personal income tax on that income.
   43    (d) Phased-in rates. Early in the program, when enrollment is growing,
   44  the amount of the assessments shall be  at  an  appropriate  level,  and
   45  shall  be  raised  as  anticipated enrollment grows, to cover the actual
   46  cost of the program and other provisions of article  51  of  the  public
   47  health law. The revenue proposal shall include a mechanism for determin-
   48  ing the rates of the assessments.
   49    (e) Cross-border employees. (i) State residents employed out-of-state.
   50  If an individual is employed out-of-state by an employer that is subject
   51  to  New  York  state law, the employer and employee shall be required to
   52  pay the payroll assessment as to that employee as if the employment were
   53  in the state. If an individual is employed out-of-state by  an  employer
   54  that  is  not subject to New York state law, either (A) the employer and
   55  employee shall voluntarily comply with the assessment or (B) the employ-
   56  ee shall pay the assessment as if he or she were self-employed.
       S. 3525                            16
    1    (ii) Out-of-state residents employed in the state.   (A)  The  payroll
    2  assessment  shall  apply to any out-of-state resident who is employed or
    3  self-employed in the state.  (B) In the case of an out-of-state resident
    4  who is employed or self-employed in the state, such individual and indi-
    5  vidual's  employer  shall  be  able to take a credit against the payroll
    6  assessments they would otherwise pay, as to the individual  for  amounts
    7  they spend on health benefits for the individual that would otherwise be
    8  covered  by  the program if the individual were a member of the program.
    9  For employers, the credit shall be available regardless of the  form  of
   10  the  health benefit (e.g., health insurance, a self-insured plan, direct
   11  services, or reimbursement for services), to make sure that the  revenue
   12  proposal  does  not  relate  to  employment benefits in violation of the
   13  federal ERISA.  For non-employment-based spending  by  individuals,  the
   14  credit  shall be available for and limited to spending for health cover-
   15  age (not out-of-pocket health spending). The credit shall  be  available
   16  without  regard  to  how  little is spent or how sparse the benefit. The
   17  credit may only be taken against the  payroll  assessments.  Any  excess
   18  amount  may  not be applied to other tax liability. For employment-based
   19  health benefits, the credit shall be distributed  between  the  employer
   20  and  employee  in  the  same  proportion as the spending by each for the
   21  benefit. The employer and  employee  may  each  apply  their  respective
   22  portion  of the credit to their respective portion of the assessment. If
   23  any provision of this clause or any application of it shall be ruled  to
   24  violate  federal  ERISA, the provision or the application of it shall be
   25  null and void and the ruling shall not affect  any  other  provision  or
   26  application of this section or the act that enacted it.
   27    3.   The  revenue  proposal  shall  include  a  plan  and  legislative
   28  provisions  for  ending  the  requirement  for  local  social   services
   29  districts  to  pay  part  of  the  cost  of Medicaid and replacing those
   30  payments with revenue from the assessments under the revenue proposal.
   31    4. To the extent that the revenue proposal differs from the  terms  of
   32  subdivision two of this section, the revenue proposal shall state how it
   33  differs  from those terms and reasons for and the effects of the differ-
   34  ences.
   35    5. All revenue from the assessments shall be deposited in the New York
   36  Health trust fund account under section 89-i of the state finance law.
   37    S 5.  Article 49 of the public health law is amended by adding  a  new
   38  title 3 to read as follows:
   39                                  TITLE III
   40            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
   41                               NEW YORK HEALTH
   42  SECTION 4920. DEFINITIONS.
   43          4921. COLLECTIVE NEGOTIATION AUTHORIZED.
   44          4922. COLLECTIVE NEGOTIATION REQUIREMENTS.
   45          4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
   46          4924. CERTAIN COLLECTIVE ACTION PROHIBITED.
   47          4925. FEES.
   48          4926. CONFIDENTIALITY.
   49          4927. SEVERABILITY AND CONSTRUCTION.
   50    S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
   51    1. "NEW YORK HEALTH" MEANS THE PROGRAM UNDER ARTICLE FIFTY-ONE OF THIS
   52  CHAPTER.
   53    2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
   54  OTHER LEGAL ENTITY.
   55    3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY THAT IS
   56  AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON  THEIR  BEHALF  WITH
       S. 3525                            17
    1  NEW  YORK  HEALTH  OVER TERMS AND CONDITIONS AFFECTING THOSE HEALTH CARE
    2  PROVIDERS.
    3    4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
    4  RECT,  BY  A  BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
    5  EMPLOYER.
    6    5. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
    7  REGISTERED  OR  AUTHORIZED TO PRACTICE A HEALTH CARE PROFESSION PURSUANT
    8  TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRACTICES THAT PROFESSION AS
    9  A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR OR WHO IS AN  OWNER,
   10  OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF A HEALTH CARE PROVIDER; OR AN
   11  ENTITY THAT EMPLOYS OR UTILIZES HEALTH CARE PROVIDERS TO PROVIDE  HEALTH
   12  CARE  SERVICES,  INCLUDING  BUT NOT LIMITED TO A HOSPITAL LICENSED UNDER
   13  ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR AN ACCOUNTABLE CARE ORGANIZATION
   14  UNDER ARTICLE TWENTY-NINE-E OF THIS  CHAPTER.  A  HEALTH  CARE  PROVIDER
   15  UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
   16  HEALTH  CARE  PROVIDER  SHALL  NOT  BE DEEMED A HEALTH CARE PROVIDER FOR
   17  PURPOSES OF THIS TITLE.
   18    S 4921. COLLECTIVE NEGOTIATION AUTHORIZED. 1.  HEALTH  CARE  PROVIDERS
   19  MAY  MEET  AND  COMMUNICATE  FOR THE PURPOSE OF COLLECTIVELY NEGOTIATING
   20  WITH NEW YORK HEALTH ON ANY MATTER RELATING TO NEW YORK HEALTH,  INCLUD-
   21  ING BUT NOT LIMITED TO RATES OF PAYMENT AND PAYMENT METHODOLOGIES.
   22    2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
   23  ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
   24  SET FORTH IN LAW.
   25    3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF NEW
   26  YORK HEALTH BY HEALTH CARE PROVIDERS.
   27    4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
   28  TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF NEW YORK HEALTH TO
   29  OBTAIN  OR  RETAIN  ACCREDITATION  BY THE NATIONAL COMMITTEE FOR QUALITY
   30  ASSURANCE OR A SIMILAR BODY OR TO COMPLY WITH APPLICABLE STATE OR FEDER-
   31  AL LAW.
   32    S 4922. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
   33  RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   34    (A) HEALTH CARE PROVIDERS  MAY  COMMUNICATE  WITH  OTHER  HEALTH  CARE
   35  PROVIDERS  REGARDING  THE TERMS AND CONDITIONS TO BE NEGOTIATED WITH NEW
   36  YORK HEALTH;
   37    (B) HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE  PROVIDERS'
   38  REPRESENTATIVES;
   39    (C)  A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY AUTHOR-
   40  IZED TO NEGOTIATE WITH NEW YORK HEALTH ON  BEHALF  OF  THE  HEALTH  CARE
   41  PROVIDERS AS A GROUP;
   42    (D)  A  HEALTH  CARE PROVIDER CAN BE BOUND BY THE TERMS AND CONDITIONS
   43  NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   44    (E) IN COMMUNICATING OR NEGOTIATING WITH THE  HEALTH  CARE  PROVIDERS'
   45  REPRESENTATIVE, NEW YORK HEALTH IS ENTITLED TO OFFER AND PROVIDE DIFFER-
   46  ENT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
   47    2.  NOTHING  IN THIS TITLE SHALL AFFECT OR LIMIT THE RIGHT OF A HEALTH
   48  CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY PETITION
   49  A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
   50    3. NOTHING IN THIS TITLE SHALL AFFECT OR LIMIT  COLLECTIVE  ACTION  OR
   51  COLLECTIVE  BARGAINING  ON THE PART OF ANY HEALTH CARE PROVIDER WITH HIS
   52  OR HER EMPLOYER OR ANY OTHER  LAWFUL  COLLECTIVE  ACTION  OR  COLLECTIVE
   53  BARGAINING.
   54    S 4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. BEFORE
   55  ENGAGING  IN  COLLECTIVE  NEGOTIATIONS WITH NEW YORK HEALTH ON BEHALF OF
   56  HEALTH CARE PROVIDERS, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  SHALL
       S. 3525                            18
    1  FILE  WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE COMMISSION-
    2  ER, INFORMATION IDENTIFYING  THE  REPRESENTATIVE,  THE  REPRESENTATIVE'S
    3  PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO ENSURE COMPLI-
    4  ANCE WITH THIS TITLE.
    5    S  4924.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
    6  INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
    7  IN  RESPONSE TO A HEALTH CARE PROVIDERS' REPRESENTATIVE'S DISCUSSIONS OR
    8  NEGOTIATIONS WITH NEW YORK HEALTH EXCEPT AS AUTHORIZED BY OTHER LAW.
    9    2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
   10  MENT THAT EXCLUDES, LIMITS THE PARTICIPATION  OR  REIMBURSEMENT  OF,  OR
   11  OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
   12  PROVIDER  OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE PERFORM-
   13  ANCE OF SERVICES THAT ARE WITHIN THE HEALTH  CARE  PROVIDER'S  SCOPE  OF
   14  PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   15    S  4925. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OF NEGOTIAT-
   16  ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
   17  A REPRESENTATIVE. THE COMMISSIONER, BY RULE, SHALL SET FEES  IN  AMOUNTS
   18  DEEMED  REASONABLE  AND  NECESSARY  TO  COVER  THE COSTS INCURRED BY THE
   19  DEPARTMENT IN ADMINISTERING THIS TITLE.
   20    S 4926. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
   21  BE REPORTED TO THE DEPARTMENT UNDER THIS TITLE SHALL NOT BE  SUBJECT  TO
   22  DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
   23  TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   24    S 4927. SEVERABILITY AND CONSTRUCTION. IF ANY PROVISION OR APPLICATION
   25  OF  THIS  TITLE  SHALL BE HELD TO BE INVALID, OR TO VIOLATE OR BE INCON-
   26  SISTENT WITH ANY APPLICABLE FEDERAL LAW OR REGULATION,  THAT  SHALL  NOT
   27  AFFECT OTHER PROVISIONS OR APPLICATIONS OF THIS TITLE WHICH CAN BE GIVEN
   28  EFFECT  WITHOUT  THAT  PROVISION  OR  APPLICATION;  AND TO THAT END, THE
   29  PROVISIONS AND APPLICATIONS OF THIS TITLE ARE SEVERABLE. THE  PROVISIONS
   30  OF  THIS  TITLE  SHALL  BE  LIBERALLY  CONSTRUED  TO  GIVE EFFECT TO THE
   31  PURPOSES THEREOF.
   32    S 6. Subdivision 11 of section  270  of  the  public  health  law,  as
   33  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
   34  amended to read as follows:
   35    11. "State public health plan" means the  medical  assistance  program
   36  established  by  title eleven of article five of the social services law
   37  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
   38  insurance  coverage program established by title three of article two of
   39  the elder law (referred to in this article as "EPIC"), and  the  [family
   40  health  plus  program established by section three hundred sixty-nine-ee
   41  of the social services law to the extent that section provides that  the
   42  program shall be subject to this article] NEW YORK HEALTH PROGRAM ESTAB-
   43  LISHED BY ARTICLE FIFTY-ONE OF THIS CHAPTER.
   44    S  7. The state finance law is amended by adding a new section 89-i to
   45  read as follows:
   46    S 89-I. NEW YORK HEALTH TRUST FUND. 1. THERE IS HEREBY ESTABLISHED  IN
   47  THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSIONER OF TAXA-
   48  TION  AND  FINANCE  A  SPECIAL REVENUE FUND TO BE KNOWN AS THE "NEW YORK
   49  HEALTH TRUST FUND", HEREINAFTER KNOWN AS "THE FUND". THE DEFINITIONS  IN
   50  SECTION  FIFTY-ONE  HUNDRED OF THE PUBLIC HEALTH LAW SHALL APPLY TO THIS
   51  SECTION.
   52    2. THE FUND SHALL CONSIST OF:
   53    (A) ALL MONIES  OBTAINED  FROM  ASSESSMENTS  PURSUANT  TO  LEGISLATION
   54  ENACTED AS PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
   55    (B)  FEDERAL  PAYMENTS  RECEIVED AS A RESULT OF ANY WAIVER OF REQUIRE-
   56  MENTS GRANTED OR OTHER ARRANGEMENTS  AGREED  TO  BY  THE  UNITED  STATES
       S. 3525                            19
    1  SECRETARY  OF  HEALTH  AND  HUMAN  SERVICES OR OTHER APPROPRIATE FEDERAL
    2  OFFICIALS FOR HEALTH  CARE  PROGRAMS  ESTABLISHED  UNDER  MEDICARE,  ANY
    3  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM, OR THE AFFORDABLE CARE ACT;
    4    (C)  THE  AMOUNTS PAID BY THE DEPARTMENT OF HEALTH THAT ARE EQUIVALENT
    5  TO THOSE AMOUNTS THAT ARE PAID ON BEHALF  OF  RESIDENTS  OF  THIS  STATE
    6  UNDER  MEDICARE,  ANY  FEDERALLY-MATCHED  PUBLIC  HEALTH PROGRAM, OR THE
    7  AFFORDABLE CARE ACT FOR HEALTH BENEFITS WHICH ARE EQUIVALENT  TO  HEALTH
    8  BENEFITS COVERED UNDER NEW YORK HEALTH;
    9    (D)  FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION OF SERVICES
   10  AUTHORIZED UNDER TITLE XX OF THE FEDERAL SOCIAL SECURITY ACT THAT  WOULD
   11  OTHERWISE  BE  COVERED UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW;
   12  AND
   13    (E) STATE MONIES THAT WOULD OTHERWISE BE APPROPRIATED TO  ANY  GOVERN-
   14  MENTAL  AGENCY,  OFFICE,  PROGRAM,  INSTRUMENTALITY OR INSTITUTION WHICH
   15  PROVIDES HEALTH SERVICES, FOR SERVICES AND BENEFITS  COVERED  UNDER  NEW
   16  YORK HEALTH. PAYMENTS TO THE FUND PURSUANT TO THIS PARAGRAPH SHALL BE IN
   17  AN  AMOUNT  EQUAL  TO  THE  MONEY  APPROPRIATED FOR SUCH PURPOSES IN THE
   18  FISCAL YEAR BEGINNING IMMEDIATELY PRECEDING THE EFFECTIVE  DATE  OF  THE
   19  NEW YORK HEALTH ACT.
   20    3.  MONIES  IN  THE  FUND  SHALL ONLY BE USED FOR PURPOSES ESTABLISHED
   21  UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW.
   22    S 8. Temporary commission on implementation. 1. There is hereby estab-
   23  lished a temporary commission on implementation of the New  York  Health
   24  program,  hereinafter  to  be  known  as  the  commission, consisting of
   25  fifteen members: five members, including the chair, shall  be  appointed
   26  by the governor; four members shall be appointed by the temporary presi-
   27  dent of the senate, one member shall be appointed by the senate minority
   28  leader;  four members shall be appointed by the speaker of the assembly,
   29  and one member shall be appointed by the assembly minority  leader.  The
   30  commissioner  of  health,  the superintendent of financial services, and
   31  the commissioner of taxation and finance, or their designees shall serve
   32  as non-voting ex-officio members of the commission.
   33    2. Members of the commission shall receive such assistance as  may  be
   34  necessary  from  other  state  agencies  and entities, and shall receive
   35  necessary expenses incurred in the  performance  of  their  duties.  The
   36  commission  may  employ staff as needed, prescribe their duties, and fix
   37  their compensation within amounts appropriated for the commission.
   38    3. The commission shall examine the laws and regulations of the  state
   39  and  make  such recommendations as are necessary to conform the laws and
   40  regulations of the state and article 51 of the public health law  estab-
   41  lishing the New York Health program and other provisions of law relating
   42  to  the  New  York  Health  program,  and  to  improve and implement the
   43  program. The commission shall report its recommendations to the governor
   44  and the legislature.
   45    S 9.  Severability. If any provision or application of this act  shall
   46  be  held to be invalid, or to violate or be inconsistent with any appli-
   47  cable federal law or regulation, that shall not affect other  provisions
   48  or  applications  of  this  act  which  can be given effect without that
   49  provision or application; and to that end, the provisions  and  applica-
   50  tions of this act are severable.
   51    S 10. This act shall take effect immediately.