S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         5062
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   February 11, 2015
                                      ___________
       Introduced by M. of A. GOTTFRIED, ABINANTI, BARRON, BENEDETTO, BICHOTTE,
         BLAKE, BRONSON, BROOK-KRASNY, CLARK, COLTON, COOK, CRESPO, CYMBROWITZ,
         DINOWITZ,  ENGLEBRIGHT,  GANTT,  HIKIND,  JAFFEE, JEAN-PIERRE, JOYNER,
         KAVANAGH,   KIM,   LAVINE,   LIFTON,   LINARES,    LUPARDO,    MOSLEY,
         PEOPLES-STOKES, PERRY, PICHARDO, RAMOS, ROBERTS, RODRIGUEZ, ROSENTHAL,
         RUSSELL,  SCHIMEL, SEAWRIGHT, SEPULVEDA, STECK, STIRPE, TITONE, TITUS,
         WALKER, WEINSTEIN, WEPRIN -- Multi-Sponsored by -- M. of A.    ABBATE,
         ARROYO,  AUBRY, BRENNAN, CAHILL, CAMARA, DAVILA, FAHY, FARRELL, GLICK,
         GUNTHER, HOOPER, LENTOL, MAGEE, MAGNARELLI, MARKEY,  MAYER,  McDONALD,
         O'DONNELL,  ORTIZ,  PAULIN, PERSAUD, PRETLOW, QUART, RIVERA, ROBINSON,
         ROZIC, SCARBOROUGH, SIMON, SKARTADOS, SOLAGES, THIELE, WRIGHT --  read
         once and referred to the Committee on Health
       AN  ACT  to  amend  the  public health law and the state finance law, in
         relation to enacting the "New York health act" and 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
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD07764-02-5
       A. 5062                             2
    1  co-pays, restricted provider networks and high  out-of-network  charges.
    2  Businesses  have  also experienced increases in the costs of health care
    3  benefits for their employees, and many employers are shifting  a  larger
    4  share  of  the  cost of coverage to their employees or dropping coverage
    5  entirely.  Health care providers are also affected by inadequate  health
    6  coverage  in  New  York  state.  A large portion of voluntary and public
    7  hospitals, health centers and other providers now experience substantial
    8  losses due to the provision of care that is  uncompensated.  Individuals
    9  often  find that they are deprived of affordable care and choice because
   10  of decisions by health plans guided by the plan's economic needs  rather
   11  than  their  health  care needs. To address the fiscal crisis facing the
   12  health care system and the state and to assure New Yorkers can  exercise
   13  their right to health care, affordable and comprehensive health coverage
   14  must  be  provided.  Pursuant  to the state constitution's charge to the
   15  legislature to provide for the health of New Yorkers,  this  legislation
   16  is  an  enactment  of  state  concern  for the purpose of establishing a
   17  comprehensive universal single-payer health care coverage program and  a
   18  health  care cost control system for the benefit of all residents of the
   19  state of New York.
   20    2. It is the intent of the Legislature to create the New  York  Health
   21  program  to provide a universal health plan for every New Yorker, funded
   22  by broad-based revenue based on ability to pay.  The state shall work to
   23  obtain waivers relating to Medicaid, Child Health  Plus,  Medicare,  the
   24  Affordable  Care  Act, and any other appropriate federal programs, under
   25  which federal funds and other subsidies that would otherwise be paid  to
   26  New  York State and New Yorkers for health coverage that will be equaled
   27  or exceeded by New York Health will be paid by the federal government to
   28  New York State and deposited in the New York Health  trust  fund.  Under
   29  such a waiver, health coverage under those programs will be replaced and
   30  merged  into  New York Health, which will operate as a true single-payer
   31  program.
   32    If such a waiver is not obtained,  the  state  shall  use  state  plan
   33  amendments  and seek waivers to maximize, and make as seamless as possi-
   34  ble, the use of federally-matched health  programs  and  federal  health
   35  programs  in  New York Health.   Thus, even where other programs such as
   36  Medicaid or Medicare may contribute to paying for care, it is  the  goal
   37  of  this  legislation  that  the  coverage will be delivered by New York
   38  Health and, as much as possible, the multiple sources of funding will be
   39  pooled with other New York Health funds and not be apparent to New  York
   40  Health  members  or participating providers.   This program will promote
   41  movement away from fee-for-service payment, which tends to reward  quan-
   42  tity  and  requires excessive administrative expense, and towards alter-
   43  nate payment methodologies, such as  global  or  capitated  payments  to
   44  providers  or health care organizations, that promote quality, efficien-
   45  cy, investment in primary and preventive care, and innovation and  inte-
   46  gration in the organizing of health care.
   47    3.  This  act  does  not  create  any  employment benefit, nor does it
   48  require, prohibit, or limit the providing of any employment benefit.
   49    4. In order to promote improved quality of, and access to, health care
   50  services and promote improved clinical outcomes, it is the policy of the
   51  state to encourage cooperative, collaborative and  integrative  arrange-
   52  ments  among  health  care providers who might otherwise be competitors,
   53  under the active supervision of the commissioner of health.  It  is  the
   54  intent  of  the state to supplant competition with such arrangements and
   55  regulation only to the extent necessary to accomplish  the  purposes  of
   56  this  act,  and  to  provide  state  action immunity under the state and
       A. 5062                             3
    1  federal antitrust laws  to  health  care  providers,  particularly  with
    2  respect  to  their  relations with the single-payer New York Health plan
    3  created by this act.
    4    S  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
    5  health law are renumbered article 80 and sections 8000, 8001,  8002  and
    6  8003, respectively, and a new article 51 is added to read as follows:
    7                                  ARTICLE 51
    8                               NEW YORK HEALTH
    9  SECTION 5100. DEFINITIONS.
   10          5101. PROGRAM CREATED.
   11          5102. BOARD OF TRUSTEES.
   12          5103. ELIGIBILITY AND ENROLLMENT.
   13          5104. BENEFITS.
   14          5105. HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHOD-
   15                  OLOGIES.
   16          5106. HEALTH CARE ORGANIZATIONS.
   17          5107. PROGRAM STANDARDS.
   18          5108. REGULATIONS.
   19          5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS.
   20          5110. ADDITIONAL PROVISIONS.
   21    S 5100. DEFINITIONS. AS USED IN  THIS  ARTICLE,  THE  FOLLOWING  TERMS
   22  SHALL  HAVE  THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
   23  OTHERWISE:
   24    1. "BOARD" MEANS THE BOARD OF TRUSTEES OF THE NEW YORK HEALTH  PROGRAM
   25  CREATED  BY SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE, AND "TRUSTEE"
   26  MEANS A TRUSTEE OF THE BOARD.
   27    2. "CARE COORDINATION" MEANS SERVICES PROVIDED BY A  CARE  COORDINATOR
   28  UNDER SUBDIVISION TWO OF SECTION FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE.
   29    3.  "CARE  COORDINATOR"  MEANS  AN  INDIVIDUAL  OR  ENTITY APPROVED TO
   30  PROVIDE CARE COORDINATION UNDER SUBDIVISION  TWO  OF  SECTION  FIFTY-ONE
   31  HUNDRED FIVE OF THIS ARTICLE.
   32    4. "FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM" MEANS THE MEDICAL ASSIST-
   33  ANCE  PROGRAM  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
   34  LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-NINE-GG
   35  OF  THE  SOCIAL  SERVICES  LAW,  AND THE CHILD HEALTH PLUS PROGRAM UNDER
   36  TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
   37    5. "HEALTH CARE ORGANIZATION" MEANS AN ENTITY THAT IS APPROVED BY  THE
   38  COMMISSIONER  UNDER  SECTION  FIFTY-ONE  HUNDRED  SIX OF THIS ARTICLE TO
   39  PROVIDE HEALTH CARE SERVICES TO MEMBERS UNDER THE PROGRAM.
   40    6. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
   41  COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
   42    7. "IMPLEMENTATION PERIOD" MEANS THE PERIOD UNDER SUBDIVISION THREE OF
   43  SECTION FIFTY-ONE HUNDRED ONE OF THIS ARTICLE DURING WHICH  THE  PROGRAM
   44  WILL BE SUBJECT TO SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT
   45  IS FULLY IMPLEMENTED UNDER THAT SECTION.
   46    8.  "LONG  TERM CARE" MEANS LONG TERM CARE, TREATMENT, MAINTENANCE, OR
   47  SERVICES NOT COVERED UNDER CHILD HEALTH PLUS, AS APPROPRIATE,  WITH  THE
   48  EXCEPTION OF SHORT TERM REHABILITATION, AS DEFINED BY THE COMMISSIONER.
   49    9.  "MEDICAID"  OR  "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
   50  FIVE OF THE SOCIAL SERVICES LAW AND  THE  PROGRAM  THEREUNDER.    "CHILD
   51  HEALTH  PLUS"  MEANS  TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER
   52  AND THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF THE  FEDERAL
   53  SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.  "BASIC HEALTH PROGRAM"
   54  MEANS SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW AND
   55  THE PROGRAM THEREUNDER.
   56    10. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.
       A. 5062                             4
    1    11.  "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST FUND
    2  ESTABLISHED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE LAW.
    3    12.  "OUT-OF-STATE  HEALTH  CARE  SERVICE" MEANS A HEALTH CARE SERVICE
    4  PROVIDED TO A MEMBER WHILE THE MEMBER IS OUT OF THE STATE AND (A) IT  IS
    5  MEDICALLY  NECESSARY  THAT THE HEALTH CARE SERVICE BE PROVIDED WHILE THE
    6  MEMBER IS OUT OF THE STATE, OR (B) IT IS CLINICALLY APPROPRIATE THAT THE
    7  HEALTH CARE SERVICE BE PROVIDED BY A  PARTICULAR  HEALTH  CARE  PROVIDER
    8  LOCATED OUT OF THE STATE RATHER THAN IN THE STATE.
    9    13.  "PARTICIPATING PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS A
   10  HEALTH CARE  PROVIDER  QUALIFIED  UNDER  SUBDIVISION  THREE  OF  SECTION
   11  FIFTY-ONE  HUNDRED  FIVE  OF  THIS  ARTICLE  THAT  PROVIDES  HEALTH CARE
   12  SERVICES TO MEMBERS UNDER THE PROGRAM, OR A HEALTH CARE ORGANIZATION.
   13    14. "AFFORDABLE CARE ACT" MEANS THE  FEDERAL  PATIENT  PROTECTION  AND
   14  AFFORDABLE  CARE  ACT, PUBLIC LAW 111-148, AS AMENDED BY THE HEALTH CARE
   15  AND EDUCATION RECONCILIATION ACT OF 2010, PUBLIC  LAW  111-152,  AND  AS
   16  OTHERWISE AMENDED AND ANY REGULATIONS OR GUIDANCE ISSUED THEREUNDER.
   17    15.  "PERSON"  MEANS ANY INDIVIDUAL OR NATURAL PERSON, TRUST, PARTNER-
   18  SHIP, ASSOCIATION,  UNINCORPORATED  ASSOCIATION,  CORPORATION,  COMPANY,
   19  LIMITED  LIABILITY  COMPANY,  PROPRIETORSHIP, JOINT VENTURE, FIRM, JOINT
   20  STOCK ASSOCIATION, DEPARTMENT, AGENCY, AUTHORITY, OR OTHER LEGAL ENTITY,
   21  WHETHER FOR-PROFIT, NOT-FOR-PROFIT OR GOVERNMENTAL.
   22    16. "PROGRAM" MEANS THE NEW YORK HEALTH  PROGRAM  CREATED  BY  SECTION
   23  FIFTY-ONE HUNDRED ONE OF THIS ARTICLE.
   24    17. "PRESCRIPTION AND NON-PRESCRIPTION DRUGS" MEANS PRESCRIPTION DRUGS
   25  AS DEFINED IN SECTION TWO HUNDRED SEVENTY OF THIS CHAPTER, AND NON-PRES-
   26  CRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
   27    18.  "RESIDENT" MEANS AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE IS IN
   28  THE STATE, AS DETERMINED ACCORDING TO REGULATIONS OF THE COMMISSIONER.
   29    S 5101. PROGRAM CREATED. 1. THE NEW  YORK  HEALTH  PROGRAM  IS  HEREBY
   30  CREATED  IN  THE DEPARTMENT. THE COMMISSIONER SHALL ESTABLISH AND IMPLE-
   31  MENT THE PROGRAM UNDER THIS ARTICLE. THE PROGRAM SHALL  PROVIDE  COMPRE-
   32  HENSIVE HEALTH COVERAGE TO EVERY RESIDENT WHO ENROLLS IN THE PROGRAM.
   33    2.  THE  COMMISSIONER SHALL, TO THE MAXIMUM EXTENT POSSIBLE, ORGANIZE,
   34  ADMINISTER AND MARKET THE PROGRAM AND SERVICES AS A SINGLE PROGRAM UNDER
   35  THE NAME "NEW YORK HEALTH" OR SUCH OTHER NAME AS THE COMMISSIONER  SHALL
   36  DETERMINE,  REGARDLESS  OF UNDER WHICH LAW OR SOURCE THE DEFINITION OF A
   37  BENEFIT IS FOUND INCLUDING (ON A VOLUNTARY BASIS) RETIREE  HEALTH  BENE-
   38  FITS.    IN  IMPLEMENTING THIS SUBDIVISION, THE COMMISSIONER SHALL AVOID
   39  JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN THESE PROGRAMS AND SHALL
   40  TAKE CARE TO PROMOTE PUBLIC UNDERSTANDING  AND  AWARENESS  OF  AVAILABLE
   41  BENEFITS AND PROGRAMS.
   42    3. THE COMMISSIONER SHALL DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLL-
   43  ING IN THE PROGRAM. THERE SHALL BE AN IMPLEMENTATION PERIOD, WHICH SHALL
   44  BEGIN  ON  THE  DATE THAT INDIVIDUALS MAY BEGIN ENROLLING IN THE PROGRAM
   45  AND SHALL END AS DETERMINED BY THE COMMISSIONER.
   46    4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE PURSUANT TO THE INSURANCE
   47  LAW OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED  UNDER  THIS  CHAPTER
   48  MAY,  IF  OTHERWISE  AUTHORIZED,  OFFER  BENEFITS  THAT DO NOT COVER ANY
   49  SERVICE FOR WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER THE  PROGRAM,
   50  BUT  MAY NOT OFFER BENEFITS THAT COVER ANY SERVICE FOR WHICH COVERAGE IS
   51  OFFERED TO INDIVIDUALS UNDER THE PROGRAM. PROVIDED, HOWEVER,  THAT  THIS
   52  SUBDIVISION  SHALL  NOT  PROHIBIT (A) THE OFFERING OF ANY BENEFITS TO OR
   53  FOR INDIVIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR  SELF-EM-
   54  PLOYED  IN  THE STATE BUT WHO ARE NOT RESIDENTS OF THE STATE, OR (B) THE
   55  OFFERING OF BENEFITS DURING THE IMPLEMENTATION PERIOD TO INDIVIDUALS WHO
       A. 5062                             5
    1  ENROLLED OR MAY ENROLL AS MEMBERS OF THE PROGRAM, OR (C) THE OFFERING OF
    2  RETIREE HEALTH BENEFITS.
    3    5.  A  COLLEGE, UNIVERSITY OR OTHER INSTITUTION OF HIGHER EDUCATION IN
    4  THE STATE MAY PURCHASE COVERAGE UNDER THE PROGRAM FOR  ANY  STUDENT,  OR
    5  STUDENT'S DEPENDENT, WHO IS NOT A RESIDENT OF THE STATE.
    6    6.  TO  THE  EXTENT ANY PROVISION OF THIS CHAPTER, THE SOCIAL SERVICES
    7  LAW OR THE INSURANCE LAW:
    8    (A) IS INCONSISTENT WITH ANY PROVISION OF THIS ARTICLE OR THE LEGISLA-
    9  TIVE INTENT OF THE NEW YORK HEALTH ACT, THIS  ARTICLE  SHALL  APPLY  AND
   10  PREVAIL, EXCEPT WHERE EXPLICITLY PROVIDED OTHERWISE BY THIS ARTICLE; AND
   11    (B) IS CONSISTENT WITH THE PROVISIONS OF THIS ARTICLE AND THE LEGISLA-
   12  TIVE  INTENT OF THE NEW YORK HEALTH ACT, THE PROVISION OF THAT LAW SHALL
   13  APPLY.
   14    S 5102. BOARD OF TRUSTEES. 1. THE NEW YORK HEALTH BOARD OF TRUSTEES IS
   15  HEREBY CREATED IN THE DEPARTMENT. THE BOARD OF TRUSTEES  SHALL,  AT  THE
   16  REQUEST  OF  THE  COMMISSIONER,  CONSIDER  ANY  MATTER TO EFFECTUATE THE
   17  PROVISIONS AND PURPOSES OF THIS ARTICLE, AND MAY ADVISE THE COMMISSIONER
   18  THEREON; AND IT MAY, FROM TIME TO TIME, SUBMIT TO THE  COMMISSIONER  ANY
   19  RECOMMENDATIONS  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTI-
   20  CLE. THE COMMISSIONER MAY PROPOSE REGULATIONS  UNDER  THIS  ARTICLE  AND
   21  AMENDMENTS THERETO FOR CONSIDERATION BY THE BOARD. THE BOARD OF TRUSTEES
   22  SHALL  HAVE  NO EXECUTIVE, ADMINISTRATIVE OR APPOINTIVE DUTIES EXCEPT AS
   23  OTHERWISE PROVIDED BY LAW. THE BOARD OF TRUSTEES  SHALL  HAVE  POWER  TO
   24  ESTABLISH,  AND  FROM  TIME TO TIME, AMEND REGULATIONS TO EFFECTUATE THE
   25  PROVISIONS AND PURPOSES OF THIS ARTICLE,  SUBJECT  TO  APPROVAL  BY  THE
   26  COMMISSIONER.
   27    2. THE BOARD SHALL BE COMPOSED OF:
   28    (A)  THE  COMMISSIONER,  THE SUPERINTENDENT OF FINANCIAL SERVICES, AND
   29  THE DIRECTOR OF THE BUDGET, OR THEIR DESIGNEES, AS EX OFFICIO MEMBERS;
   30    (B) SEVENTEEN TRUSTEES APPOINTED BY THE GOVERNOR;
   31    (I) FIVE OF WHOM SHALL BE  REPRESENTATIVES  OF  HEALTH  CARE  CONSUMER
   32  ADVOCACY  ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY,
   33  WHO HAVE BEEN INVOLVED IN ACTIVITIES RELATED  TO  HEALTH  CARE  CONSUMER
   34  ADVOCACY, INCLUDING ISSUES OF INTEREST TO LOW- AND MODERATE-INCOME INDI-
   35  VIDUALS;
   36    (II)  TWO  OF  WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL ORGANIZA-
   37  TIONS REPRESENTING PHYSICIANS;
   38    (III) TWO OF WHOM SHALL BE REPRESENTATIVES OF  PROFESSIONAL  ORGANIZA-
   39  TIONS  REPRESENTING  LICENSED  OR  REGISTERED  HEALTH CARE PROFESSIONALS
   40  OTHER THAN PHYSICIANS;
   41    (IV) THREE OF WHOM SHALL BE REPRESENTATIVES OF HOSPITALS, ONE OF  WHOM
   42  SHALL BE A REPRESENTATIVE OF PUBLIC HOSPITALS;
   43    (V) ONE OF WHOM SHALL BE REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
   44    (VI)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
   45  TIONS; AND
   46    (VII) TWO OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
   47    (C) EIGHT TRUSTEES APPOINTED BY THE GOVERNOR; THREE TO BE APPOINTED ON
   48  THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; THREE TO BE APPOINTED
   49  ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE;  ONE  TO
   50  BE  APPOINTED ON THE RECOMMENDATION OF THE MINORITY LEADER OF THE ASSEM-
   51  BLY; AND ONE TO BE APPOINTED ON THE RECOMMENDATION OF THE MINORITY LEAD-
   52  ER OF THE SENATE.
   53    3. AFTER THE END OF THE IMPLEMENTATION PERIOD, NO PERSON  SHALL  BE  A
   54  TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM, EXCEPT THE EX OFFI-
   55  CIO TRUSTEES. EACH TRUSTEE SHALL SERVE AT THE PLEASURE OF THE APPOINTING
   56  OFFICER, EXCEPT THE EX OFFICIO TRUSTEES.
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    1    4.  THE  CHAIR  OF THE BOARD SHALL BE APPOINTED, AND MAY BE REMOVED AS
    2  CHAIR, BY THE GOVERNOR FROM AMONG THE TRUSTEES. THE BOARD SHALL MEET  AT
    3  LEAST  FOUR  TIMES  EACH  CALENDAR YEAR. MEETINGS SHALL BE HELD UPON THE
    4  CALL OF THE CHAIR AND AS PROVIDED  BY  THE  BOARD.  A  MAJORITY  OF  THE
    5  APPOINTED  TRUSTEES  SHALL BE A QUORUM OF THE BOARD, AND THE AFFIRMATIVE
    6  VOTE OF A MAJORITY OF THE TRUSTEES VOTING, BUT NOT LESS THAN TEN,  SHALL
    7  BE  NECESSARY  FOR  ANY  ACTION  TO BE TAKEN BY THE BOARD. THE BOARD MAY
    8  ESTABLISH AN EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR DUTIES OF THE
    9  BOARD AS IT MAY PROVIDE, AND OTHER COMMITTEES TO ASSIST THE BOARD OR THE
   10  EXECUTIVE COMMITTEE. THE CHAIR OF THE BOARD SHALL  CHAIR  THE  EXECUTIVE
   11  COMMITTEE  AND  SHALL APPOINT THE CHAIR AND MEMBERS OF ALL OTHER COMMIT-
   12  TEES. THE BOARD OF TRUSTEES MAY APPOINT ONE OR MORE ADVISORY COMMITTEES.
   13  MEMBERS OF ADVISORY COMMITTEES NEED NOT BE MEMBERS OF THE BOARD OF TRUS-
   14  TEES.
   15    5. TRUSTEES SHALL SERVE WITHOUT COMPENSATION BUT SHALL  BE  REIMBURSED
   16  FOR  THEIR  NECESSARY  AND ACTUAL EXPENSES INCURRED WHILE ENGAGED IN THE
   17  BUSINESS OF THE BOARD.
   18    6. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, NO OFFICER OR
   19  EMPLOYEE OF THE STATE OR ANY LOCAL GOVERNMENT SHALL FORFEIT OR BE DEEMED
   20  TO HAVE FORFEITED HIS OR HER OFFICE OR EMPLOYMENT BY REASON OF  BEING  A
   21  TRUSTEE.
   22    7.  THE  BOARD  AND ITS COMMITTEES AND ADVISORY COMMITTEES MAY REQUEST
   23  AND RECEIVE THE ASSISTANCE OF THE DEPARTMENT  AND  ANY  OTHER  STATE  OR
   24  LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
   25    8. NO LATER THAN TWO YEARS AFTER THE EFFECTIVE DATE OF THIS ARTICLE:
   26    (A) THE BOARD SHALL DEVELOP A PROPOSAL, CONSISTENT WITH THE PRINCIPLES
   27  OF  THIS  ARTICLE, FOR PROVISION BY THE PROGRAM OF LONG-TERM CARE COVER-
   28  AGE, INCLUDING THE DEVELOPMENT OF A PROPOSAL, CONSISTENT WITH THE  PRIN-
   29  CIPLES  OF  THIS  ARTICLE, FOR ITS FUNDING.  IN DEVELOPING THE PROPOSAL,
   30  THE BOARD SHALL CONSULT WITH AN ADVISORY  COMMITTEE,  APPOINTED  BY  THE
   31  CHAIR OF THE BOARD, INCLUDING REPRESENTATIVES OF CONSUMERS AND POTENTIAL
   32  CONSUMERS  OF  LONG-TERM  CARE,  PROVIDERS OF LONG-TERM CARE, LABOR, AND
   33  OTHER INTERESTED PARTIES. THE BOARD SHALL PRESENT ITS  PROPOSAL  TO  THE
   34  GOVERNOR AND THE LEGISLATURE.
   35    (B)  THE  BOARD SHALL DEVELOP PROPOSALS FOR: (I) INCORPORATING RETIREE
   36  HEALTH BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER  RETI-
   37  REE  HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK HEALTH
   38  BUT LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING  EMPLOYER
   39  RETIREE  HEALTH  BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED SUCH BENEFITS
   40  WHILE RESIDING IN THE STATE PRIOR TO  THE  IMPLEMENTATION  OF  NEW  YORK
   41  HEALTH AND LIVE AS RETIREES OUT OF THE STATE.
   42    (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK HEALTH COVERAGE OF
   43  HEALTH  CARE  SERVICES  COVERED  UNDER  THE  WORKERS'  COMPENSATION LAW,
   44  INCLUDING WHETHER AND HOW TO CONTINUE FUNDING FOR THOSE  SERVICES  UNDER
   45  THAT  LAW  AND  WHETHER  AND HOW TO INCORPORATE AN ELEMENT OF EXPERIENCE
   46  RATING.
   47    S 5103. ELIGIBILITY AND ENROLLMENT. 1. EVERY  RESIDENT  OF  THE  STATE
   48  SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
   49    2.  NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM OR OTHER CHARGE FOR
   50  ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.
   51    S 5104. BENEFITS. 1. THE PROGRAM SHALL  PROVIDE  COMPREHENSIVE  HEALTH
   52  COVERAGE  TO  EVERY MEMBER, WHICH SHALL INCLUDE ALL HEALTH CARE SERVICES
   53  REQUIRED TO BE COVERED UNDER ANY OF THE  FOLLOWING,  WITHOUT  REGARD  TO
   54  WHETHER  THE  MEMBER  WOULD  OTHERWISE BE ELIGIBLE FOR OR COVERED BY THE
   55  PROGRAM OR SOURCE REFERRED TO:
   56    (A) FOR EVERY MEMBER UNDER THE AGE OF TWENTY-ONE, CHILD HEALTH PLUS;
       A. 5062                             7
    1    (B) MEDICAID;
    2    (C) MEDICARE;
    3    (D)  ARTICLE  FORTY-FOUR  OF  THIS  CHAPTER  OR  ARTICLE THIRTY-TWO OR
    4  FORTY-THREE OF THE INSURANCE LAW;
    5    (E) ARTICLE ELEVEN OF THE CIVIL SERVICE LAW, AS OF THE DATE  ONE  YEAR
    6  BEFORE THE BEGINNING OF THE IMPLEMENTATION PERIOD;
    7    (F)  ANY  COST  INCURRED DEFINED IN PARAGRAPH ONE OF SUBSECTION (A) OF
    8  SECTION FIFTY-ONE HUNDRED TWO OF THE INSURANCE LAW, PROVIDED  THAT  THIS
    9  COVERAGE  SHALL  NOT  REPLACE  COVERAGE  UNDER  ARTICLE FIFTY-ONE OF THE
   10  INSURANCE LAW;
   11    (G) ANY ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED  TO  THE
   12  PROGRAM'S BENEFITS BY THE PROGRAM; AND
   13    (H)  PROVIDED  THAT  NONE  OF  THE ABOVE SHALL INCLUDE LONG TERM CARE,
   14  UNTIL A PROPOSAL UNDER PARAGRAPH (A) OF  SUBDIVISION  EIGHT  OF  SECTION
   15  FIFTY-ONE HUNDRED TWO OF THIS ARTICLE IS ENACTED INTO LAW.
   16    2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM, DEDUCTIBLE, CO-PAY-
   17  MENT OR CO-INSURANCE UNDER THE PROGRAM.
   18    3.  THE  PROGRAM SHALL PROVIDE FOR PAYMENT UNDER THE PROGRAM FOR EMER-
   19  GENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO MEMBERS OR INDIVID-
   20  UALS ENTITLED TO BECOME MEMBERS WHO HAVE NOT HAD A  REASONABLE  OPPORTU-
   21  NITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR.
   22    S  5105.  HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHODOL-
   23  OGIES.  1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE  PROVIDER
   24  QUALIFIED  TO  PARTICIPATE  UNDER  THIS  SECTION MAY PROVIDE HEALTH CARE
   25  SERVICES UNDER THE PROGRAM, PROVIDED THAT THE HEALTH  CARE  PROVIDER  IS
   26  OTHERWISE  LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR THE
   27  INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.
   28    (B) A MEMBER MAY CHOOSE TO RECEIVE  HEALTH  CARE  SERVICES  UNDER  THE
   29  PROGRAM  FROM  ANY PARTICIPATING PROVIDER, CONSISTENT WITH PROVISIONS OF
   30  THIS ARTICLE RELATING TO CARE COORDINATION  AND  HEALTH  CARE  ORGANIZA-
   31  TIONS,  THE  WILLINGNESS  OR  AVAILABILITY  OF  THE PROVIDER (SUBJECT TO
   32  PROVISIONS OF THIS ARTICLE RELATING TO DISCRIMINATION), AND  THE  APPRO-
   33  PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
   34    2. CARE COORDINATION.
   35    (A)  CARE COORDINATION SHALL INCLUDE, BUT NOT BE LIMITED TO, MANAGING,
   36  REFERRING  TO,  LOCATING,  COORDINATING,  AND  MONITORING  HEALTH   CARE
   37  SERVICES  FOR  THE  MEMBER TO ASSURE THAT ALL MEDICALLY NECESSARY HEALTH
   38  CARE SERVICES ARE MADE AVAILABLE TO AND  ARE  EFFECTIVELY  USED  BY  THE
   39  MEMBER  IN A TIMELY MANNER, CONSISTENT WITH PATIENT AUTONOMY. CARE COOR-
   40  DINATION IS NOT A REQUIREMENT FOR PRIOR AUTHORIZATION  FOR  HEALTH  CARE
   41  SERVICES  AND  REFERRAL  SHALL NOT BE REQUIRED FOR A MEMBER TO RECEIVE A
   42  HEALTH CARE SERVICE.
   43    (B) A CARE COORDINATOR MAY BE AN INDIVIDUAL OR ENTITY THAT IS APPROVED
   44  BY THE PROGRAM THAT IS:
   45    (I) A HEALTH CARE PRACTITIONER WHO IS: (A) THE MEMBER'S  PRIMARY  CARE
   46  PRACTITIONER; (B) AT THE OPTION OF A FEMALE MEMBER, THE MEMBER'S PROVID-
   47  ER  OF  PRIMARY GYNECOLOGICAL CARE; OR (C) AT THE OPTION OF A MEMBER WHO
   48  HAS A CHRONIC CONDITION  THAT  REQUIRES  SPECIALTY  CARE,  A  SPECIALIST
   49  HEALTH  CARE  PRACTITIONER WHO REGULARLY AND CONTINUALLY PROVIDES TREAT-
   50  MENT FOR THAT CONDITION TO THE MEMBER;
   51    (II) AN ENTITY LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER  OR
   52  CERTIFIED  UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER, A MANAGED LONG TERM
   53  CARE PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF  THIS  CHAPTER  OR
   54  OTHER  PROGRAM  MODEL  UNDER  PARAGRAPH (B) OF SUBDIVISION SEVEN OF SUCH
   55  SECTION, OR, WITH RESPECT TO A MEMBER WHO RECEIVES CHRONIC MENTAL HEALTH
   56  CARE SERVICES, AN ENTITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL
       A. 5062                             8
    1  HYGIENE LAW OR OTHER ENTITY APPROVED BY THE COMMISSIONER IN CONSULTATION
    2  WITH THE COMMISSIONER OF MENTAL HEALTH;
    3    (III) A HEALTH CARE ORGANIZATION;
    4    (IV) A TAFT-HARTLEY FUND, WITH RESPECT TO ITS MEMBERS AND THEIR FAMILY
    5  MEMBERS;  PROVIDED THAT THIS PROVISION SHALL NOT PRECLUDE A TAFT-HARTLEY
    6  FUND FROM BECOMING A CARE COORDINATOR UNDER  SUBPARAGRAPH  (V)  OF  THIS
    7  PARAGRAPH  OR A HEALTH CARE ORGANIZATION UNDER SECTION FIFTY-ONE HUNDRED
    8  SIX OF THIS ARTICLE; OR
    9    (V) ANY NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY APPROVED BY THE PROGRAM.
   10    (C) HEALTH CARE SERVICES PROVIDED TO A MEMBER SHALL NOT BE SUBJECT  TO
   11  PAYMENT  UNDER  THE  PROGRAM  UNLESS  THE MEMBER IS ENROLLED WITH A CARE
   12  COORDINATOR AT THE TIME THE HEALTH  CARE  SERVICE  IS  PROVIDED,  EXCEPT
   13  WHERE PROVIDED UNDER SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR
   14  OF  THIS ARTICLE. EVERY MEMBER SHALL ENROLL WITH A CARE COORDINATOR THAT
   15  AGREES TO PROVIDE CARE COORDINATION TO THE  MEMBER  PRIOR  TO  RECEIVING
   16  HEALTH  CARE SERVICES TO BE PAID FOR UNDER THE PROGRAM. THE MEMBER SHALL
   17  REMAIN ENROLLED WITH THAT CARE  COORDINATOR  UNTIL  THE  MEMBER  BECOMES
   18  ENROLLED  WITH  A  DIFFERENT  CARE COORDINATOR OR CEASES TO BE A MEMBER.
   19  MEMBERS HAVE THE RIGHT TO CHANGE THEIR  CARE  COORDINATOR  ON  TERMS  AT
   20  LEAST   AS  PERMISSIVE  AS  THE  PROVISIONS  OF  SECTION  THREE  HUNDRED
   21  SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW RELATING TO AN INDIVIDUAL CHANG-
   22  ING HIS OR HER PRIMARY CARE PROVIDER OR MANAGED CARE PROVIDER.
   23    (D) CARE COORDINATION SHALL BE PROVIDED TO THE MEMBER BY THE  MEMBER'S
   24  CARE COORDINATOR.  A CARE COORDINATOR MAY EMPLOY OR UTILIZE THE SERVICES
   25  OF  OTHER  INDIVIDUALS  OR  ENTITIES TO ASSIST IN PROVIDING CARE COORDI-
   26  NATION FOR THE MEMBER, CONSISTENT WITH REGULATIONS OF THE COMMISSIONER.
   27    (E) A HEALTH CARE ORGANIZATION MAY ESTABLISH RULES  RELATING  TO  CARE
   28  COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
   29  THIS  SUBDIVISION  BUT  OTHERWISE CONSISTENT WITH THIS ARTICLE AND OTHER
   30  APPLICABLE LAWS. NOTHING IN THIS SUBDIVISION SHALL AUTHORIZE  ANY  INDI-
   31  VIDUAL TO ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION
   32  LAW.
   33    (F) THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT PROCEDURES AND STAND-
   34  ARDS FOR AN INDIVIDUAL OR ENTITY TO BE APPROVED TO BE A CARE COORDINATOR
   35  IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS
   36  RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
   37  APPROVAL ON A DETERMINATION THAT THE INDIVIDUAL OR ENTITY IS INCOMPETENT
   38  TO  BE  A CARE COORDINATOR OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
   39  EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
   40  EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
   41  A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
   42  STANDARDS  SHALL  NOT  LIMIT  APPROVAL  TO  BE A CARE COORDINATOR IN THE
   43  PROGRAM FOR ECONOMIC PURPOSES AND SHALL BE CONSISTENT WITH GOOD  PROFES-
   44  SIONAL PRACTICE. IN DEVELOPING THE PROCEDURES AND STANDARDS, THE COMMIS-
   45  SIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS DEVELOPED BY NATIONAL
   46  ACCREDITING  AND  PROFESSIONAL  ORGANIZATIONS;  AND  (II)  CONSULT  WITH
   47  NATIONAL AND LOCAL ORGANIZATIONS WORKING ON CARE COORDINATION OR SIMILAR
   48  MODELS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS, CLINICS, AND
   49  CONSUMERS AND THEIR REPRESENTATIVES. WHEN  DEVELOPING  AND  IMPLEMENTING
   50  STANDARDS  OF  APPROVAL  OF  CARE COORDINATORS FOR INDIVIDUALS RECEIVING
   51  CHRONIC MENTAL HEALTH CARE SERVICES, THE COMMISSIONER SHALL CONSULT WITH
   52  THE COMMISSIONER OF MENTAL HEALTH. AN INDIVIDUAL OR ENTITY MAY NOT BE  A
   53  CARE  COORDINATOR  UNLESS THE SERVICES INCLUDED IN CARE COORDINATION ARE
   54  WITHIN THE INDIVIDUAL'S PROFESSIONAL SCOPE OF PRACTICE OR  THE  ENTITY'S
   55  LEGAL AUTHORITY.
       A. 5062                             9
    1    (G)  TO  MAINTAIN APPROVAL UNDER THE PROGRAM, A CARE COORDINATOR MUST:
    2  (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSIONER;  AND
    3  (II)  PROVIDE  DATA TO THE DEPARTMENT AS REQUIRED BY THE COMMISSIONER TO
    4  ENABLE THE COMMISSIONER TO EVALUATE THE IMPACT OF CARE  COORDINATORS  ON
    5  QUALITY, OUTCOMES AND COST.
    6    3.  HEALTH  CARE  PROVIDERS.  (A) THE COMMISSIONER SHALL ESTABLISH AND
    7  MAINTAIN PROCEDURES AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE QUALI-
    8  FIED TO PARTICIPATE IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO  PROCE-
    9  DURES  AND STANDARDS RELATING TO THE REVOCATION, SUSPENSION, LIMITATION,
   10  OR ANNULMENT OF QUALIFICATION TO PARTICIPATE ON A DETERMINATION THAT THE
   11  HEALTH CARE PROVIDER IS AN INCOMPETENT PROVIDER OF SPECIFIC HEALTH  CARE
   12  SERVICES OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS EITHER INCONSIST-
   13  ENT  WITH PROGRAM STANDARDS AND REGULATIONS OR WHICH EXHIBITS AN UNWILL-
   14  INGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS A POTENTIAL THREAT
   15  TO THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND STANDARDS SHALL  NOT
   16  LIMIT  HEALTH  CARE  PROVIDER  PARTICIPATION IN THE PROGRAM FOR ECONOMIC
   17  PURPOSES AND SHALL BE CONSISTENT WITH GOOD  PROFESSIONAL  PRACTICE.  ANY
   18  HEALTH  CARE  PROVIDER  WHO  IS QUALIFIED TO PARTICIPATE UNDER MEDICAID,
   19  CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE QUALIFIED TO PARTIC-
   20  IPATE IN THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION, SUSPEN-
   21  SION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE IN ANY OF
   22  THOSE PROGRAMS SHALL APPLY TO THE HEALTH CARE  PROVIDER'S  QUALIFICATION
   23  TO  PARTICIPATE  IN  THE  PROGRAM;  PROVIDED THAT A HEALTH CARE PROVIDER
   24  QUALIFIED UNDER THIS SENTENCE SHALL  FOLLOW  THE  PROCEDURES  TO  BECOME
   25  QUALIFIED UNDER THE PROGRAM BY THE END OF THE IMPLEMENTATION PERIOD.
   26    (B) THE COMMISSIONER SHALL ESTABLISH AND MAINTAIN PROCEDURES AND STAN-
   27  DARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR
   28  PURPOSES OF PROVIDING COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH
   29  CARE SERVICES.
   30    4.  PAYMENT  FOR HEALTH CARE SERVICES. (A) THE COMMISSIONER MAY ESTAB-
   31  LISH BY REGULATION PAYMENT METHODOLOGIES FOR HEALTH  CARE  SERVICES  AND
   32  CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM BY PARTICIPATING
   33  PROVIDERS,  CARE COORDINATORS, AND HEALTH CARE ORGANIZATIONS.  THERE MAY
   34  BE A VARIETY OF DIFFERENT PAYMENT METHODOLOGIES, INCLUDING THOSE  ESTAB-
   35  LISHED  ON  A  DEMONSTRATION  BASIS. ALL PAYMENT RATES UNDER THE PROGRAM
   36  SHALL BE REASONABLE AND REASONABLY RELATED TO THE  COST  OF  EFFICIENTLY
   37  PROVIDING  THE HEALTH CARE SERVICE AND ASSURING AN ADEQUATE AND ACCESSI-
   38  BLE SUPPLY OF HEALTH CARE SERVICE.   UNTIL AND  UNLESS  ANOTHER  PAYMENT
   39  METHODOLOGY  IS  ESTABLISHED,  HEALTH  CARE SERVICES PROVIDED TO MEMBERS
   40  UNDER THE PROGRAM SHALL BE PAID FOR ON A FEE-FOR-SERVICE  BASIS,  EXCEPT
   41  FOR CARE COORDINATION.
   42    (B)  THE  PROGRAM  SHALL ENGAGE IN GOOD FAITH NEGOTIATIONS WITH HEALTH
   43  CARE PROVIDERS' REPRESENTATIVES UNDER TITLE III OF ARTICLE FORTY-NINE OF
   44  THIS CHAPTER, INCLUDING, BUT NOT LIMITED TO, IN  RELATION  TO  RATES  OF
   45  PAYMENT AND PAYMENT METHODOLOGIES.
   46    (C)  NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, PAYMENT FOR
   47  DRUGS PROVIDED BY PHARMACIES UNDER THE PROGRAM SHALL BE MADE PURSUANT TO
   48  ARTICLE TWO-A OF THIS CHAPTER. HOWEVER, THE PROGRAM  SHALL  PROVIDE  FOR
   49  PAYMENT  FOR PRESCRIPTION DRUGS UNDER SECTION 340B OF THE FEDERAL PUBLIC
   50  SERVICE ACT WHERE APPLICABLE. PAYMENT FOR PRESCRIPTION DRUGS PROVIDED BY
   51  HEALTH CARE PROVIDERS OTHER THAN PHARMACIES SHALL BE PURSUANT  TO  OTHER
   52  PROVISIONS OF THIS ARTICLE.
   53    (D)  PAYMENT  FOR  HEALTH CARE SERVICES ESTABLISHED UNDER THIS ARTICLE
   54  SHALL BE CONSIDERED PAYMENT IN FULL. A PARTICIPATING PROVIDER SHALL  NOT
   55  CHARGE  ANY RATE IN EXCESS OF THE PAYMENT ESTABLISHED UNDER THIS ARTICLE
   56  FOR ANY HEALTH CARE SERVICE UNDER THE PROGRAM PROVIDED TO A  MEMBER  AND
       A. 5062                            10
    1  SHALL  NOT  SOLICIT OR ACCEPT PAYMENT FROM ANY MEMBER OR THIRD PARTY FOR
    2  ANY SUCH SERVICE EXCEPT AS PROVIDED UNDER SECTION FIFTY-ONE HUNDRED NINE
    3  OF THIS ARTICLE.  HOWEVER, THIS PARAGRAPH SHALL NOT PRECLUDE THE PROGRAM
    4  FROM  ACTING AS A PRIMARY OR SECONDARY PAYER IN CONJUNCTION WITH ANOTHER
    5  THIRD-PARTY PAYER WHERE PERMITTED UNDER SECTION FIFTY-ONE  HUNDRED  NINE
    6  OF THIS ARTICLE.
    7    (E)  THE  PROGRAM MAY PROVIDE IN PAYMENT METHODOLOGIES FOR PAYMENT FOR
    8  CAPITAL RELATED EXPENSES FOR SPECIFICALLY  IDENTIFIED  CAPITAL  EXPENDI-
    9  TURES  INCURRED  BY  NOT-FOR-PROFIT  OR  GOVERNMENTAL ENTITIES CERTIFIED
   10  UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER. ANY CAPITAL RELATED  EXPENSE
   11  GENERATED  BY  A  CAPITAL EXPENDITURE THAT REQUIRES OR REQUIRED APPROVAL
   12  UNDER ARTICLE TWENTY-EIGHT OF  THIS  CHAPTER  MUST  HAVE  RECEIVED  THAT
   13  APPROVAL  FOR  THE  CAPITAL  RELATED  EXPENSE  TO  BE PAID FOR UNDER THE
   14  PROGRAM.
   15    (F) THE COMMISSIONER SHALL PROVIDE BY  REGULATION FOR PAYMENT  METHOD-
   16  OLOGIES AND PROCEDURES FOR PAYING FOR OUT-OF-STATE HEALTH CARE SERVICES.
   17    5.  (A)  FOR  PURPOSES  OF  THIS SUBDIVISION, "INCOME-ELIGIBLE MEMBER"
   18  MEANS A MEMBER WHO IS ENROLLED  IN  A  FEDERALLY-MATCHED  PUBLIC  HEALTH
   19  PROGRAM AND (I) THERE IS FEDERAL FINANCIAL PARTICIPATION IN THE INDIVID-
   20  UAL'S  HEALTH  COVERAGE, OR (II) THE MEMBER IS ELIGIBLE TO ENROLL IN THE
   21  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM BY REASON OF  INCOME,  AGE,  AND
   22  RESOURCES  (WHERE APPLICABLE) UNDER STATE LAW IN EFFECT ON THE EFFECTIVE
   23  DATE OF THIS SECTION, BUT THERE IS NO FEDERAL FINANCIAL PARTICIPATION IN
   24  THE INDIVIDUAL'S HEALTH COVERAGE.
   25    (B) THE PROGRAM, WITH RESPECT TO  INCOME-ELIGIBLE  MEMBERS,  SHALL  BE
   26  CONSIDERED A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR GOVERNMENT PAYOR
   27  UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER WITH RESPECT TO THE FOLLOWING
   28  PROVISIONS,  AND WITH RESPECT TO THOSE MEMBERS WHO ARE NOT INCOME-ELIGI-
   29  BLE MEMBERS, SHALL NOT BE CONSIDERED A FEDERALLY-MATCHED  PUBLIC  HEALTH
   30  PROGRAM  OR  GOVERNMENTAL  AGENCY  BUT SHALL BE DEEMED TO BE A SPECIFIED
   31  THIRD-PARTY PAYOR UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER.
   32    S 5106. HEALTH CARE ORGANIZATIONS. 1. A MEMBER MAY  CHOOSE  TO  ENROLL
   33  WITH  AND  RECEIVE  HEALTH CARE SERVICES UNDER THE PROGRAM FROM A HEALTH
   34  CARE ORGANIZATION.
   35    2. A HEALTH CARE ORGANIZATION SHALL BE  A  NOT-FOR-PROFIT  OR  GOVERN-
   36  MENTAL ENTITY THAT IS APPROVED BY THE COMMISSIONER THAT IS:
   37    (A)  AN  ACCOUNTABLE  CARE ORGANIZATION UNDER ARTICLE TWENTY-NINE-E OF
   38  THIS CHAPTER; OR
   39    (B) A TAFT-HARTLEY FUND (I) WITH RESPECT  TO  ITS  MEMBERS  AND  THEIR
   40  FAMILY  MEMBERS,  AND  (II) IF ALLOWED BY APPLICABLE LAW AND APPROVED BY
   41  THE COMMISSIONER, FOR OTHER MEMBERS OF THE PROGRAM;  PROVIDED  THAT  THE
   42  COMMISSIONER  SHALL PROVIDE BY REGULATION THAT WHERE A TAFT-HARTLEY FUND
   43  IS ACTING UNDER THIS SUBPARAGRAPH THERE ARE PROTECTIONS FOR HEALTH  CARE
   44  PROVIDERS  AND  PATIENTS  COMPARABLE  TO THOSE APPLICABLE TO ACCOUNTABLE
   45  CARE ORGANIZATIONS.
   46    3. A HEALTH CARE ORGANIZATION MAY BE RESPONSIBLE FOR ALL  OR  PART  OF
   47  THE  HEALTH  CARE  SERVICES  TO WHICH ITS MEMBERS ARE ENTITLED UNDER THE
   48  PROGRAM, CONSISTENT WITH THE TERMS OF ITS APPROVAL BY THE COMMISSIONER.
   49    4. (A) THE COMMISSIONER SHALL DEVELOP  AND  IMPLEMENT  PROCEDURES  AND
   50  STANDARDS  FOR AN ENTITY TO BE APPROVED TO BE A HEALTH CARE ORGANIZATION
   51  IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO  PROCEDURES  AND  STANDARDS
   52  RELATING  TO  THE  REVOCATION,  SUSPENSION,  LIMITATION, OR ANNULMENT OF
   53  APPROVAL ON A DETERMINATION THAT THE  ENTITY  IS  INCOMPETENT  TO  BE  A
   54  HEALTH  CARE  ORGANIZATION OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
   55  EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
   56  EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
       A. 5062                            11
    1  A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
    2  STANDARDS  SHALL  NOT LIMIT APPROVAL TO BE A HEALTH CARE ORGANIZATION IN
    3  THE PROGRAM FOR ECONOMIC PURPOSES AND  SHALL  BE  CONSISTENT  WITH  GOOD
    4  PROFESSIONAL  PRACTICE.  IN DEVELOPING THE PROCEDURES AND STANDARDS, THE
    5  COMMISSIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS  DEVELOPED   BY
    6  NATIONAL  ACCREDITING  AND  PROFESSIONAL ORGANIZATIONS; AND (II) CONSULT
    7  WITH NATIONAL AND LOCAL ORGANIZATIONS WORKING IN  THE  FIELD  OF  HEALTH
    8  CARE  ORGANIZATIONS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS,
    9  CLINICS, AND CONSUMERS AND THEIR REPRESENTATIVES.  WHEN  DEVELOPING  AND
   10  IMPLEMENTING  STANDARDS  OF  APPROVAL  OF HEALTH CARE ORGANIZATIONS, THE
   11  COMMISSIONER SHALL CONSULT WITH THE COMMISSIONER OF  MENTAL  HEALTH  AND
   12  THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES.
   13    (B) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A HEALTH CARE ORGANIZATION
   14  MUST:  (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSION-
   15  ER; AND (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY  THE  COMMIS-
   16  SIONER  TO ENABLE THE COMMISSIONER TO EVALUATE THE HEALTH CARE ORGANIZA-
   17  TION IN RELATION  TO  QUALITY  OF  HEALTH  CARE  SERVICES,  HEALTH  CARE
   18  OUTCOMES, AND COST.
   19    5.  THE  COMMISSIONER  SHALL  MAKE REGULATIONS RELATING TO HEALTH CARE
   20  ORGANIZATIONS CONSISTENT WITH AND TO ENSURE COMPLIANCE WITH  THIS  ARTI-
   21  CLE.
   22    6.  THE  PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY A
   23  HEALTH CARE ORGANIZATION THROUGH HEALTH  CARE  PROVIDERS  SHALL  NOT  BE
   24  CONSIDERED  THE PRACTICE OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCA-
   25  TION LAW BY THE HEALTH CARE ORGANIZATION.
   26    S  5107.  PROGRAM  STANDARDS.  1.  THE  COMMISSIONER  SHALL  ESTABLISH
   27  REQUIREMENTS AND STANDARDS FOR THE PROGRAM AND FOR HEALTH CARE ORGANIZA-
   28  TIONS,  CARE  COORDINATORS,  AND  HEALTH CARE PROVIDERS, CONSISTENT WITH
   29  THIS ARTICLE, INCLUDING REQUIREMENTS AND STANDARDS FOR, AS APPLICABLE:
   30    (A) THE SCOPE, QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES;
   31    (B) RELATIONS BETWEEN HEALTH CARE ORGANIZATIONS OR HEALTH CARE PROVID-
   32  ERS AND MEMBERS; AND
   33    (C) RELATIONS  BETWEEN  HEALTH  CARE  ORGANIZATIONS  AND  HEALTH  CARE
   34  PROVIDERS,  INCLUDING  (I) CREDENTIALING AND PARTICIPATION IN THE HEALTH
   35  CARE ORGANIZATION; AND (II) TERMS, METHODS AND RATES OF PAYMENT.
   36    2. REQUIREMENTS AND STANDARDS UNDER THE PROGRAM SHALL INCLUDE, BUT NOT
   37  BE LIMITED TO, PROVISIONS TO PROMOTE THE FOLLOWING:
   38    (A) SIMPLIFICATION, TRANSPARENCY, UNIFORMITY, AND FAIRNESS  IN  HEALTH
   39  CARE  PROVIDER  CREDENTIALING AND PARTICIPATION IN HEALTH CARE ORGANIZA-
   40  TION NETWORKS, REFERRALS, PAYMENT PROCEDURES AND RATES, CLAIMS  PROCESS-
   41  ING, AND APPROVAL OF HEALTH CARE SERVICES, AS APPLICABLE;
   42    (B)  PRIMARY  AND  PREVENTIVE  CARE,  CARE COORDINATION, EFFICIENT AND
   43  EFFECTIVE HEALTH CARE  SERVICES,  QUALITY  ASSURANCE,  COORDINATION  AND
   44  INTEGRATION  OF HEALTH CARE SERVICES, INCLUDING USE OF APPROPRIATE TECH-
   45  NOLOGY, AND PROMOTION OF PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL HEALTH;
   46    (C) ELIMINATION OF HEALTH CARE DISPARITIES;
   47    (D) NON-DISCRIMINATION WITH RESPECT TO MEMBERS AND HEALTH CARE PROVID-
   48  ERS ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, DISABIL-
   49  ITY, AGE, SEX, SEXUAL ORIENTATION, GENDER  IDENTITY  OR  EXPRESSION,  OR
   50  ECONOMIC  CIRCUMSTANCES;  PROVIDED  THAT  HEALTH  CARE SERVICES PROVIDED
   51  UNDER THE PROGRAM SHALL BE APPROPRIATE TO THE PATIENT'S CLINICALLY-RELE-
   52  VANT CIRCUMSTANCES; AND
   53    (E) ACCESSIBILITY  OF  CARE  COORDINATION,  HEALTH  CARE  ORGANIZATION
   54  SERVICES  AND  HEALTH  CARE SERVICES, INCLUDING ACCESSIBILITY FOR PEOPLE
   55  WITH DISABILITIES AND PEOPLE WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND
       A. 5062                            12
    1  ENGLISH, AND THE PROVIDING OF CARE COORDINATION, HEALTH  CARE  ORGANIZA-
    2  TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER.
    3    3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
    4  A  FOR-PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS AND
    5  STANDARDS AS ENTITIES ORGANIZED AS NOT-FOR-PROFIT ENTITIES, AND PAYMENTS
    6  UNDER THE PROGRAM PAID TO SUCH  ENTITIES  SHALL  NOT  BE  CALCULATED  TO
    7  ACCOMMODATE  THE  GENERATION OF PROFIT OR REVENUE FOR DIVIDENDS OR OTHER
    8  RETURN ON INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A
    9  NOT-FOR-PROFIT ENTITY.
   10    4. EVERY PARTICIPATING PROVIDER SHALL  FURNISH  TO  THE  PROGRAM  SUCH
   11  INFORMATION  TO,  AND PERMIT EXAMINATION OF ITS RECORDS BY, THE PROGRAM,
   12  AS MAY BE REASONABLY REQUIRED FOR PURPOSES  OF  REVIEWING  ACCESSIBILITY
   13  AND  UTILIZATION  OF  HEALTH  CARE SERVICES, QUALITY ASSURANCE, AND COST
   14  CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR OTHER STUDIES OF
   15  THE OPERATION OF THE PROGRAM OR FOR PROTECTION AND PROMOTION OF  PUBLIC,
   16  ENVIRONMENTAL AND OCCUPATIONAL HEALTH.
   17    5.  IN  DEVELOPING  REQUIREMENTS AND STANDARDS AND MAKING OTHER POLICY
   18  DETERMINATIONS UNDER THIS ARTICLE, THE COMMISSIONER SHALL  CONSULT  WITH
   19  REPRESENTATIVES  OF  MEMBERS,  HEALTH CARE PROVIDERS, CARE COORDINATORS,
   20  HEALTH CARE ORGANIZATIONS AND OTHER INTERESTED PARTIES.
   21    6.  THE PROGRAM SHALL MAINTAIN THE CONFIDENTIALITY  OF  ALL  DATA  AND
   22  OTHER  INFORMATION  COLLECTED  UNDER THE PROGRAM WHEN SUCH DATA WOULD BE
   23  NORMALLY CONSIDERED CONFIDENTIAL DATA BETWEEN A PATIENT AND HEALTH  CARE
   24  PROVIDER.  AGGREGATE DATA OF THE PROGRAM WHICH IS DERIVED FROM CONFIDEN-
   25  TIAL  DATA  BUT DOES NOT VIOLATE PATIENT CONFIDENTIALITY SHALL BE PUBLIC
   26  INFORMATION.
   27    S 5108. REGULATIONS. THE  COMMISSIONER  MAY  APPROVE  REGULATIONS  AND
   28  AMENDMENTS  THERETO,  UNDER SUBDIVISION ONE OF SECTION FIFTY-ONE HUNDRED
   29  TWO OF THIS ARTICLE. THE COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS
   30  THERETO TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTICLE ON  AN
   31  EMERGENCY  BASIS  UNDER SECTION TWO HUNDRED TWO OF THE STATE ADMINISTRA-
   32  TIVE PROCEDURE ACT, PROVIDED THAT SUCH REGULATIONS OR  AMENDMENTS  SHALL
   33  NOT  BECOME  PERMANENT  UNLESS  ADOPTED UNDER SUBDIVISION ONE OF SECTION
   34  FIFTY-ONE HUNDRED TWO OF THIS ARTICLE.
   35    S 5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS. 1. THE COMMIS-
   36  SIONER SHALL SEEK ALL FEDERAL WAIVERS AND OTHER  FEDERAL  APPROVALS  AND
   37  ARRANGEMENTS  AND  SUBMIT STATE PLAN AMENDMENTS NECESSARY TO OPERATE THE
   38  PROGRAM CONSISTENT WITH THIS ARTICLE.
   39    2. (A) THE COMMISSIONER SHALL APPLY TO THE  SECRETARY  OF  HEALTH  AND
   40  HUMAN  SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS OF
   41  REQUIREMENTS, AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY  FEDERAL-
   42  LY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER
   43  FEDERAL  PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH CARE
   44  SERVICES, THAT ARE NECESSARY TO ENABLE ALL NEW YORK  HEALTH  MEMBERS  TO
   45  RECEIVE ALL BENEFITS UNDER THE PROGRAM THROUGH THE PROGRAM TO ENABLE THE
   46  STATE  TO  IMPLEMENT THIS ARTICLE AND TO RECEIVE AND DEPOSIT ALL FEDERAL
   47  PAYMENTS UNDER THOSE PROGRAMS (INCLUDING FUNDS THAT MAY BE  PROVIDED  IN
   48  LIEU  OF PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES, AND SMALL BUSINESS
   49  TAX CREDITS) IN THE STATE TREASURY TO THE CREDIT OF THE NEW YORK  HEALTH
   50  TRUST  FUND CREATED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE LAW
   51  AND TO USE THOSE FUNDS  FOR  THE  NEW  YORK  HEALTH  PROGRAM  AND  OTHER
   52  PROVISIONS  UNDER THIS ARTICLE. TO THE EXTENT POSSIBLE, THE COMMISSIONER
   53  SHALL NEGOTIATE ARRANGEMENTS WITH THE FEDERAL GOVERNMENT IN  WHICH  BULK
   54  OR  LUMP-SUM  FEDERAL  PAYMENTS  ARE PAID TO NEW YORK HEALTH IN PLACE OF
   55  FEDERAL SPENDING OR TAX BENEFITS FOR FEDERALLY-MATCHED  HEALTH  PROGRAMS
   56  OR FEDERAL HEALTH PROGRAMS.
       A. 5062                            13
    1    (B)  THE  COMMISSIONER MAY REQUIRE MEMBERS OR APPLICANTS TO BE MEMBERS
    2  TO PROVIDE INFORMATION NECESSARY FOR THE  PROGRAM  TO  COMPLY  WITH  ANY
    3  WAIVER OR ARRANGEMENT UNDER THIS SUBDIVISION.
    4    3.  (A)  IF ACTIONS TAKEN UNDER SUBDIVISION TWO OF THIS SECTION DO NOT
    5  ACCOMPLISH ALL RESULTS INTENDED UNDER THAT SUBDIVISION, THEN THIS SUBDI-
    6  VISION SHALL APPLY AND SHALL AUTHORIZE ADDITIONAL ACTIONS TO EFFECTIVELY
    7  IMPLEMENT  NEW  YORK  HEALTH  TO  THE  MAXIMUM  EXTENT  POSSIBLE  AS   A
    8  SINGLE-PAYER PROGRAM CONSISTENT WITH THIS ARTICLE.
    9    (B)  THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS ARTICLE TO
   10  ENABLE NEW YORK HEALTH TO ADMINISTER MEDICARE IN NEW YORK STATE  AND  TO
   11  BE  A  PROVIDER  OF  DRUG  COVERAGE  UNDER  MEDICARE PART D FOR ELIGIBLE
   12  MEMBERS OF NEW YORK HEALTH.
   13    (C)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
   14  PROVISIONS  OF  THIS  SECTION  RELATING  TO ANY FEDERALLY-MATCHED PUBLIC
   15  HEALTH PROGRAM OR MEDICARE AS  NECESSARY  TO  IMPLEMENT  ANY  WAIVER  OR
   16  ARRANGEMENT  UNDER  THIS  SECTION  OR TO MAXIMIZE THE BENEFIT TO THE NEW
   17  YORK HEALTH PROGRAM UNDER THIS SECTION, PROVIDED THAT THE  COMMISSIONER,
   18  IN  CONSULTATION  WITH  THE DIRECTOR OF THE BUDGET, SHALL DETERMINE THAT
   19  SUCH WAIVER OR MODIFICATION IS IN THE  BEST  INTERESTS  OF  THE  MEMBERS
   20  AFFECTED BY THE ACTION AND THE STATE.
   21    (D)    THE   COMMISSIONER   MAY   APPLY   FOR   COVERAGE   UNDER   ANY
   22  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM ON  BEHALF  OF  ANY  MEMBER  AND
   23  ENROLL  THE  MEMBER  IN  THE  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
   24  MEDICARE  IF  THE  MEMBER  IS  ELIGIBLE  FOR  IT.     ENROLLMENT  IN   A
   25  FEDERALLY-MATCHED  PUBLIC HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE ANY
   26  MEMBER TO LOSE ANY HEALTH CARE SERVICE PROVIDED BY THE PROGRAM OR DIMIN-
   27  ISH ANY RIGHT THE MEMBER WOULD OTHERWISE HAVE.
   28    (E) THE COMMISSIONER SHALL BY REGULATION INCREASE THE INCOME ELIGIBIL-
   29  ITY LEVEL, INCREASE OR ELIMINATE  THE  RESOURCE  TEST  FOR  ELIGIBILITY,
   30  SIMPLIFY ANY PROCEDURAL OR DOCUMENTATION REQUIREMENT FOR ENROLLMENT, AND
   31  INCREASE  THE  BENEFITS FOR ANY FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM,
   32  NOTWITHSTANDING ANY LAW OR REGULATION TO THE CONTRARY. THE  COMMISSIONER
   33  MAY ACT UNDER THIS PARAGRAPH UPON A FINDING, APPROVED BY THE DIRECTOR OF
   34  THE  BUDGET,  THAT  THE  ACTION  (I) WILL HELP TO INCREASE THE NUMBER OF
   35  MEMBERS WHO ARE ELIGIBLE FOR AND ENROLLED  IN  FEDERALLY-MATCHED  PUBLIC
   36  HEALTH  PROGRAMS;  (II) WILL NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY
   37  HEALTH CARE SERVICE OR RIGHT THE INDIVIDUAL WOULD OTHERWISE HAVE;  (III)
   38  IS  IN  THE  INTEREST  OF  THE PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS
   39  RECEIVED ANY NECESSARY FEDERAL WAIVERS OR APPROVALS  TO  ENSURE  FEDERAL
   40  FINANCIAL PARTICIPATION. ACTIONS UNDER THIS PARAGRAPH SHALL NOT APPLY TO
   41  ELIGIBILITY FOR PAYMENT FOR LONG TERM CARE.
   42    (F)  TO ENABLE THE COMMISSIONER TO APPLY FOR COVERAGE UNDER ANY FEDER-
   43  ALLY-MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE ON BEHALF OF  ANY  MEMBER
   44  AND  ENROLL THE MEMBER IN THE FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
   45  MEDICARE IF THE MEMBER IS ELIGIBLE FOR IT, THE COMMISSIONER MAY  REQUIRE
   46  THAT  EVERY MEMBER OR APPLICANT TO BE A MEMBER SHALL PROVIDE INFORMATION
   47  TO ENABLE THE COMMISSIONER TO DETERMINE WHETHER THE APPLICANT IS  ELIGI-
   48  BLE  FOR A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM AND FOR MEDICARE (AND
   49  ANY PROGRAM OR BENEFIT UNDER MEDICARE). THE PROGRAM SHALL MAKE A REASON-
   50  ABLE EFFORT TO NOTIFY MEMBERS OF THEIR OBLIGATIONS UNDER THIS PARAGRAPH.
   51  AFTER A REASONABLE EFFORT HAS BEEN  MADE  TO  CONTACT  THE  MEMBER,  THE
   52  MEMBER  SHALL  BE  NOTIFIED  IN WRITING THAT HE OR SHE HAS SIXTY DAYS TO
   53  PROVIDE SUCH REQUIRED INFORMATION. IF SUCH INFORMATION IS  NOT  PROVIDED
   54  WITHIN THE SIXTY DAY PERIOD, THE MEMBER'S COVERAGE UNDER THE PROGRAM MAY
   55  BE TERMINATED.
       A. 5062                            14
    1    (G)  AS  A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE SERVICES
    2  UNDER THE PROGRAM, A MEMBER WHO IS ELIGIBLE FOR BENEFITS UNDER  MEDICARE
    3  SHALL ENROLL IN MEDICARE, INCLUDING PARTS A, B AND D.
    4    (H)  THE  PROGRAM  SHALL  PROVIDE  PREMIUM  ASSISTANCE FOR ALL MEMBERS
    5  ENROLLING IN A MEDICARE PART D DRUG  COVERAGE  UNDER  SECTION  1860D  OF
    6  TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT LIMITED TO THE LOW-INCOME
    7  BENCHMARK PREMIUM AMOUNT ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE
    8  AND MEDICAID SERVICES AND ANY OTHER AMOUNT WHICH SUCH AGENCY ESTABLISHES
    9  UNDER  ITS  DE MINIMIS PREMIUM POLICY, EXCEPT THAT SUCH PAYMENTS MADE ON
   10  BEHALF OF MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY  EXCEED  THE
   11  LOW-INCOME  BENCHMARK  PREMIUM AMOUNT IF DETERMINED TO BE COST EFFECTIVE
   12  TO THE PROGRAM.
   13    (I) IF THE COMMISSIONER HAS  REASONABLE  GROUNDS  TO  BELIEVE  THAT  A
   14  MEMBER  COULD  BE  ELIGIBLE  FOR AN INCOME-RELATED SUBSIDY UNDER SECTION
   15  1860D-14 OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT,  THE  MEMBER
   16  SHALL  PROVIDE,  AND AUTHORIZE THE PROGRAM TO OBTAIN, ANY INFORMATION OR
   17  DOCUMENTATION REQUIRED TO ESTABLISH THE MEMBER'S  ELIGIBILITY  FOR  SUCH
   18  SUBSIDY,  PROVIDED THAT THE COMMISSIONER SHALL ATTEMPT TO OBTAIN AS MUCH
   19  OF THE INFORMATION AND DOCUMENTATION AS POSSIBLE FROM RECORDS  THAT  ARE
   20  AVAILABLE TO HIM OR HER.
   21    (J)  THE  PROGRAM  SHALL MAKE A REASONABLE EFFORT TO NOTIFY MEMBERS OF
   22  THEIR OBLIGATIONS UNDER THIS SUBDIVISION. AFTER A REASONABLE EFFORT  HAS
   23  BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
   24  THAT  HE  OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED INFORMATION. IF
   25  SUCH INFORMATION IS NOT  PROVIDED  WITHIN  THE  SIXTY  DAY  PERIOD,  THE
   26  MEMBER'S COVERAGE UNDER THE PROGRAM MAY BE TERMINATED.
   27    S  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
   28  WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
   29    (A) CONSUMER ASSISTANCE TO INDIVIDUALS WITH RESPECT TO SELECTION OF  A
   30  CARE  COORDINATOR  OR  HEALTH  CARE  ORGANIZATION,  ENROLLING, OBTAINING
   31  HEALTH CARE SERVICES, DISENROLLING, AND OTHER MATTERS  RELATING  TO  THE
   32  PROGRAM;
   33    (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
   34  AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, HEALTH CARE SERVICES
   35  UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
   36  IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
   37    (C) CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES  PROVIDING
   38  AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, CARE COORDINATION TO
   39  MEMBERS.
   40    2. THE COMMISSIONER SHALL PROVIDE GRANTS FROM FUNDS IN  THE  NEW  YORK
   41  HEALTH  TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO HEALTH
   42  SYSTEMS AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS  CHAP-
   43  TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
   44    3. THE COMMISSIONER SHALL PROVIDE FUNDS FROM THE NEW YORK HEALTH TRUST
   45  FUND  OR  OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSIONER OF
   46  LABOR FOR A PROGRAM FOR RETRAINING  AND  ASSISTING  JOB  TRANSITION  FOR
   47  INDIVIDUALS  EMPLOYED  OR  PREVIOUSLY  EMPLOYED  IN  THE FIELD OF HEALTH
   48  INSURANCE AND OTHER THIRD-PARTY PAYMENT FOR  HEALTH  CARE  OR  PROVIDING
   49  SERVICES  TO  HEALTH  CARE PROVIDERS TO DEAL WITH THIRD-PARTY PAYERS FOR
   50  HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN ENDED AS  A  RESULT  OF  THE
   51  IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM, CONSISTENT WITH OTHERWISE
   52  APPLICABLE LAW.
   53    4. THE COMMISSIONER SHALL, DIRECTLY AND THROUGH GRANTS TO NOT-FOR-PRO-
   54  FIT ENTITIES, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH THE NEW YORK
   55  HEALTH PROGRAM, TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL AND OCCUPA-
   56  TIONAL  HEALTH,  INCLUDING  COOPERATION  WITH  OTHER DATA COLLECTION AND
       A. 5062                            15
    1  RESEARCH PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH  THIS  ARTICLE  AND
    2  OTHERWISE APPLICABLE LAW.
    3    S 4. Financing of New York Health. 1. The governor shall submit to the
    4  legislature  a  revenue plan and legislative bills to implement the plan
    5  (referred to collectively in this section as the "revenue proposal")  to
    6  provide the revenue necessary to finance the New York Health program, as
    7  created  by  article  51  of  the public health law (referred to in this
    8  section as the "program"), taking into consideration anticipated federal
    9  revenue available for the program. The revenue proposal shall be submit-
   10  ted to the legislature as part of the executive budget under article VII
   11  of the state constitution, for the fiscal year commencing on  the  first
   12  day  of April in the calendar year after this act shall become a law. In
   13  developing the revenue proposal, the governor shall consult with  appro-
   14  priate officials of the executive branch; the temporary president of the
   15  senate; the speaker of the assembly; the chairs of the fiscal and health
   16  committees  of the senate and assembly; and representatives of business,
   17  labor, consumers and local government.
   18    2. (a) Basic structure. The basic structure of  the  revenue  proposal
   19  shall be as follows: Revenue for the program shall come from two assess-
   20  ments  (referred  to collectively in this section as the "assessments").
   21  First, there shall  be  a  progressively  graduated  assessment  on  all
   22  payroll  and  self-employed  income  (referred to in this section as the
   23  "payroll assessment"), paid by employers, employees  and  self-employed,
   24  similar  to  the Medicare tax. Higher brackets of income subject to this
   25  assessment shall be assessed at a higher marginal rate than lower brack-
   26  ets.  Second, there shall be a  progressively  graduated  assessment  on
   27  taxable  income  (such  as  interest,  dividends, and capital gains) not
   28  subject to the payroll assessment (referred to in this  section  as  the
   29  "non-payroll  assessment"). The assessments will be set at levels antic-
   30  ipated to produce sufficient revenue to finance the  program  and  other
   31  provisions  of  article  51 of the public health law, to be scaled up as
   32  enrollment grows, taking into consideration anticipated federal  revenue
   33  available  for  the program. Provision shall be made for state residents
   34  (who are eligible for the program) who are  employed  out-of-state,  and
   35  non-residents (who are not eligible for the program) who are employed in
   36  the state.
   37    (b)  Payroll  assessment.  The  income  to  be  subject to the payroll
   38  assessment shall be all income subject to the Medicare tax. The  assess-
   39  ment shall be set at a particular percentage of that income, which shall
   40  be progressively graduated, so the percentage is higher on higher brack-
   41  ets  of  income. For employed individuals, the employer shall pay eighty
   42  percent of the assessment and the employee shall pay twenty  percent  of
   43  the  assessment, except that an employer may agree to pay all or part of
   44  the employee's share.   A self-employed individual shall  pay  the  full
   45  assessment.
   46    (c)  Non-payroll  income  assessment.  There shall be an assessment on
   47  upper-bracket taxable personal income that is not subject to the payroll
   48  assessment. It shall be progressively  graduated  and  structured  as  a
   49  percentage of the personal income tax on that income.
   50    (d) Phased-in rates. Early in the program, when enrollment is growing,
   51  the  amount  of  the  assessments  shall be at an appropriate level, and
   52  shall be raised as anticipated enrollment grows,  to  cover  the  actual
   53  cost  of  the  program  and other provisions of article 51 of the public
   54  health law. The revenue proposal shall include a mechanism for determin-
   55  ing the rates of the assessments.
       A. 5062                            16
    1    (e) Cross-border employees. (i) State residents employed out-of-state.
    2  If an individual is employed out-of-state by an employer that is subject
    3  to New York state law, the employer and employee shall  be  required  to
    4  pay the payroll assessment as to that employee as if the employment were
    5  in  the  state. If an individual is employed out-of-state by an employer
    6  that is not subject to New York state law, either (A) the  employer  and
    7  employee shall voluntarily comply with the assessment or (B) the employ-
    8  ee shall pay the assessment as if he or she were self-employed.
    9    (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
   10  assessment shall apply to any out-of-state resident who is  employed  or
   11  self-employed in the state.  (B) In the case of an out-of-state resident
   12  who is employed or self-employed in the state, such individual and indi-
   13  vidual's  employer  shall  be  able to take a credit against the payroll
   14  assessments they would otherwise pay, as to the individual  for  amounts
   15  they spend on health benefits for the individual that would otherwise be
   16  covered  by  the program if the individual were a member of the program.
   17  For employers, the credit shall be available regardless of the  form  of
   18  the  health benefit (e.g., health insurance, a self-insured plan, direct
   19  services, or reimbursement for services), to make sure that the  revenue
   20  proposal  does  not  relate  to  employment benefits in violation of the
   21  federal ERISA.  For non-employment-based spending  by  individuals,  the
   22  credit  shall be available for and limited to spending for health cover-
   23  age (not out-of-pocket health spending). The credit shall  be  available
   24  without  regard  to  how  little is spent or how sparse the benefit. The
   25  credit may only be taken against the  payroll  assessments.  Any  excess
   26  amount  may  not be applied to other tax liability. For employment-based
   27  health benefits, the credit shall be distributed  between  the  employer
   28  and  employee  in  the  same  proportion as the spending by each for the
   29  benefit. The employer and  employee  may  each  apply  their  respective
   30  portion  of the credit to their respective portion of the assessment. If
   31  any provision of this clause or any application of it shall be ruled  to
   32  violate  federal  ERISA, the provision or the application of it shall be
   33  null and void and the ruling shall not affect  any  other  provision  or
   34  application of this section or the act that enacted it.
   35    3.   The  revenue  proposal  shall  include  a  plan  and  legislative
   36  provisions  for  ending  the  requirement  for  local  social   services
   37  districts  to  pay  part  of  the  cost  of Medicaid and replacing those
   38  payments with revenue from the assessments under the revenue proposal.
   39    4. To the extent that the revenue proposal differs from the  terms  of
   40  subdivision two of this section, the revenue proposal shall state how it
   41  differs  from those terms and reasons for and the effects of the differ-
   42  ences.
   43    5. All revenue from the assessments shall be deposited in the New York
   44  Health trust fund account under section 89-i of the state finance law.
   45    S 5.  Article 49 of the public health law is amended by adding  a  new
   46  title 3 to read as follows:
   47                                  TITLE III
   48            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
   49                               NEW YORK HEALTH
   50  SECTION 4920. DEFINITIONS.
   51          4921. COLLECTIVE NEGOTIATION AUTHORIZED.
   52          4922. COLLECTIVE NEGOTIATION REQUIREMENTS.
   53          4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
   54          4924. CERTAIN COLLECTIVE ACTION PROHIBITED.
   55          4925. FEES.
   56          4926. CONFIDENTIALITY.
       A. 5062                            17
    1          4927. SEVERABILITY AND CONSTRUCTION.
    2    S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
    3    1. "NEW YORK HEALTH" MEANS THE PROGRAM UNDER ARTICLE FIFTY-ONE OF THIS
    4  CHAPTER.
    5    2.  "PERSON"  MEANS  AN  INDIVIDUAL,  ASSOCIATION, CORPORATION, OR ANY
    6  OTHER LEGAL ENTITY.
    7    3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY THAT IS
    8  AUTHORIZED BY HEALTH CARE PROVIDERS TO NEGOTIATE ON  THEIR  BEHALF  WITH
    9  NEW  YORK  HEALTH  OVER TERMS AND CONDITIONS AFFECTING THOSE HEALTH CARE
   10  PROVIDERS.
   11    4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
   12  RECT, BY A BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS  MADE  ON  AN
   13  EMPLOYER.
   14    5.  "HEALTH  CARE PROVIDER" MEANS A PERSON WHO IS LICENSED, CERTIFIED,
   15  REGISTERED OR AUTHORIZED TO PRACTICE A HEALTH CARE  PROFESSION  PURSUANT
   16  TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRACTICES THAT PROFESSION AS
   17  A  HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR OR WHO IS AN OWNER,
   18  OFFICER, SHAREHOLDER, OR PROPRIETOR OF A HEALTH  CARE  PROVIDER;  OR  AN
   19  ENTITY  THAT EMPLOYS OR UTILIZES HEALTH CARE PROVIDERS TO PROVIDE HEALTH
   20  CARE SERVICES, INCLUDING BUT NOT LIMITED TO A  HOSPITAL  LICENSED  UNDER
   21  ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR AN ACCOUNTABLE CARE ORGANIZATION
   22  UNDER  ARTICLE  TWENTY-NINE-E  OF  THIS  CHAPTER. A HEALTH CARE PROVIDER
   23  UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
   24  HEALTH CARE PROVIDER SHALL NOT BE DEEMED  A  HEALTH  CARE  PROVIDER  FOR
   25  PURPOSES OF THIS TITLE.
   26    S  4921.  COLLECTIVE  NEGOTIATION AUTHORIZED. 1. HEALTH CARE PROVIDERS
   27  MAY MEET AND COMMUNICATE FOR THE  PURPOSE  OF  COLLECTIVELY  NEGOTIATING
   28  WITH  NEW YORK HEALTH ON ANY MATTER RELATING TO NEW YORK HEALTH, INCLUD-
   29  ING BUT NOT LIMITED TO RATES OF PAYMENT AND PAYMENT METHODOLOGIES.
   30    2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
   31  ALTERATION OF THE TERMS OF THE INTERNAL AND EXTERNAL  REVIEW  PROCEDURES
   32  SET FORTH IN LAW.
   33    3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF NEW
   34  YORK HEALTH BY HEALTH CARE PROVIDERS.
   35    4.  NOTHING  IN  THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE
   36  TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF NEW YORK HEALTH TO
   37  OBTAIN OR RETAIN ACCREDITATION BY THE  NATIONAL  COMMITTEE  FOR  QUALITY
   38  ASSURANCE OR A SIMILAR BODY OR TO COMPLY WITH APPLICABLE STATE OR FEDER-
   39  AL LAW.
   40    S 4922. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
   41  RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
   42    (A)  HEALTH  CARE  PROVIDERS  MAY  COMMUNICATE  WITH OTHER HEALTH CARE
   43  PROVIDERS REGARDING THE TERMS AND CONDITIONS TO BE NEGOTIATED  WITH  NEW
   44  YORK HEALTH;
   45    (B)  HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE PROVIDERS'
   46  REPRESENTATIVES;
   47    (C) A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY  AUTHOR-
   48  IZED  TO  NEGOTIATE  WITH  NEW  YORK HEALTH ON BEHALF OF THE HEALTH CARE
   49  PROVIDERS AS A GROUP;
   50    (D) A HEALTH CARE PROVIDER CAN BE BOUND BY THE  TERMS  AND  CONDITIONS
   51  NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
   52    (E)  IN  COMMUNICATING  OR NEGOTIATING WITH THE HEALTH CARE PROVIDERS'
   53  REPRESENTATIVE, NEW YORK HEALTH IS ENTITLED TO OFFER AND PROVIDE DIFFER-
   54  ENT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
       A. 5062                            18
    1    2. NOTHING IN THIS TITLE SHALL AFFECT OR LIMIT THE RIGHT OF  A  HEALTH
    2  CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY PETITION
    3  A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
    4    3.  NOTHING  IN  THIS TITLE SHALL AFFECT OR LIMIT COLLECTIVE ACTION OR
    5  COLLECTIVE BARGAINING ON THE PART OF ANY HEALTH CARE PROVIDER  WITH  HIS
    6  OR  HER  EMPLOYER  OR  ANY  OTHER LAWFUL COLLECTIVE ACTION OR COLLECTIVE
    7  BARGAINING.
    8    S 4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. BEFORE
    9  ENGAGING IN COLLECTIVE NEGOTIATIONS WITH NEW YORK HEALTH  ON  BEHALF  OF
   10  HEALTH  CARE  PROVIDERS,  A  HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL
   11  FILE WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE  COMMISSION-
   12  ER,  INFORMATION  IDENTIFYING  THE  REPRESENTATIVE, THE REPRESENTATIVE'S
   13  PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO ENSURE COMPLI-
   14  ANCE WITH THIS TITLE.
   15    S 4924. CERTAIN COLLECTIVE ACTION PROHIBITED. 1.  THIS  TITLE  IS  NOT
   16  INTENDED  TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN CONCERT
   17  IN RESPONSE TO A HEALTH CARE PROVIDERS' REPRESENTATIVE'S DISCUSSIONS  OR
   18  NEGOTIATIONS WITH NEW YORK HEALTH EXCEPT AS AUTHORIZED BY OTHER LAW.
   19    2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
   20  MENT  THAT  EXCLUDES,  LIMITS  THE PARTICIPATION OR REIMBURSEMENT OF, OR
   21  OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
   22  PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE  PERFORM-
   23  ANCE  OF  SERVICES  THAT  ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
   24  PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   25    S 4925. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OF  NEGOTIAT-
   26  ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
   27  A  REPRESENTATIVE.  THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
   28  DEEMED REASONABLE AND NECESSARY TO  COVER  THE  COSTS  INCURRED  BY  THE
   29  DEPARTMENT IN ADMINISTERING THIS TITLE.
   30    S 4926. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
   31  BE  REPORTED  TO THE DEPARTMENT UNDER THIS TITLE SHALL NOT BE SUBJECT TO
   32  DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
   33  TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
   34    S 4927. SEVERABILITY AND CONSTRUCTION. IF ANY PROVISION OR APPLICATION
   35  OF THIS TITLE SHALL BE HELD TO BE INVALID, OR TO VIOLATE  OR  BE  INCON-
   36  SISTENT  WITH  ANY  APPLICABLE FEDERAL LAW OR REGULATION, THAT SHALL NOT
   37  AFFECT OTHER PROVISIONS OR APPLICATIONS OF THIS TITLE WHICH CAN BE GIVEN
   38  EFFECT WITHOUT THAT PROVISION OR  APPLICATION;  AND  TO  THAT  END,  THE
   39  PROVISIONS  AND APPLICATIONS OF THIS TITLE ARE SEVERABLE. THE PROVISIONS
   40  OF THIS TITLE SHALL  BE  LIBERALLY  CONSTRUED  TO  GIVE  EFFECT  TO  THE
   41  PURPOSES THEREOF.
   42    S  6.  Subdivision  11  of  section  270  of the public health law, as
   43  amended by section 2-a of part C of chapter 58 of the laws of  2008,  is
   44  amended to read as follows:
   45    11.  "State  public  health plan" means the medical assistance program
   46  established by title eleven of article five of the social  services  law
   47  (referred  to in this article as "Medicaid"), the elderly pharmaceutical
   48  insurance coverage program established by title three of article two  of
   49  the  elder  law (referred to in this article as "EPIC"), and the [family
   50  health plus program established by section three  hundred  sixty-nine-ee
   51  of  the social services law to the extent that section provides that the
   52  program shall be subject to this article] NEW YORK HEALTH PROGRAM ESTAB-
   53  LISHED BY ARTICLE FIFTY-ONE OF THIS CHAPTER.
   54    S 7. The state finance law is amended by adding a new section 89-i  to
   55  read as follows:
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    1    S  89-I. NEW YORK HEALTH TRUST FUND. 1. THERE IS HEREBY ESTABLISHED IN
    2  THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSIONER OF TAXA-
    3  TION AND FINANCE A SPECIAL REVENUE FUND TO BE KNOWN  AS  THE  "NEW  YORK
    4  HEALTH  TRUST FUND", HEREINAFTER KNOWN AS "THE FUND". THE DEFINITIONS IN
    5  SECTION  FIFTY-ONE  HUNDRED OF THE PUBLIC HEALTH LAW SHALL APPLY TO THIS
    6  SECTION.
    7    2. THE FUND SHALL CONSIST OF:
    8    (A) ALL MONIES  OBTAINED  FROM  ASSESSMENTS  PURSUANT  TO  LEGISLATION
    9  ENACTED AS PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
   10    (B)  FEDERAL  PAYMENTS  RECEIVED AS A RESULT OF ANY WAIVER OF REQUIRE-
   11  MENTS GRANTED OR OTHER ARRANGEMENTS  AGREED  TO  BY  THE  UNITED  STATES
   12  SECRETARY  OF  HEALTH  AND  HUMAN  SERVICES OR OTHER APPROPRIATE FEDERAL
   13  OFFICIALS FOR HEALTH  CARE  PROGRAMS  ESTABLISHED  UNDER  MEDICARE,  ANY
   14  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM, OR THE AFFORDABLE CARE ACT;
   15    (C)  THE  AMOUNTS PAID BY THE DEPARTMENT OF HEALTH THAT ARE EQUIVALENT
   16  TO THOSE AMOUNTS THAT ARE PAID ON BEHALF  OF  RESIDENTS  OF  THIS  STATE
   17  UNDER  MEDICARE,  ANY  FEDERALLY-MATCHED  PUBLIC  HEALTH PROGRAM, OR THE
   18  AFFORDABLE CARE ACT FOR HEALTH BENEFITS WHICH ARE EQUIVALENT  TO  HEALTH
   19  BENEFITS COVERED UNDER NEW YORK HEALTH;
   20    (D)  FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION OF SERVICES
   21  AUTHORIZED UNDER TITLE XX OF THE FEDERAL SOCIAL SECURITY ACT THAT  WOULD
   22  OTHERWISE  BE  COVERED UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW;
   23  AND
   24    (E) STATE MONIES THAT WOULD OTHERWISE BE APPROPRIATED TO  ANY  GOVERN-
   25  MENTAL  AGENCY,  OFFICE,  PROGRAM,  INSTRUMENTALITY OR INSTITUTION WHICH
   26  PROVIDES HEALTH SERVICES, FOR SERVICES AND BENEFITS  COVERED  UNDER  NEW
   27  YORK HEALTH. PAYMENTS TO THE FUND PURSUANT TO THIS PARAGRAPH SHALL BE IN
   28  AN  AMOUNT  EQUAL  TO  THE  MONEY  APPROPRIATED FOR SUCH PURPOSES IN THE
   29  FISCAL YEAR BEGINNING IMMEDIATELY PRECEDING THE EFFECTIVE  DATE  OF  THE
   30  NEW YORK HEALTH ACT.
   31    3.  MONIES  IN  THE  FUND  SHALL ONLY BE USED FOR PURPOSES ESTABLISHED
   32  UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW.
   33    S 8. Temporary commission on implementation. 1. There is hereby estab-
   34  lished a temporary commission on implementation of the New  York  Health
   35  program,  hereinafter  to  be  known  as  the  commission, consisting of
   36  fifteen members: five members, including the chair, shall  be  appointed
   37  by the governor; four members shall be appointed by the temporary presi-
   38  dent of the senate, one member shall be appointed by the senate minority
   39  leader;  four members shall be appointed by the speaker of the assembly,
   40  and one member shall be appointed by the assembly minority  leader.  The
   41  commissioner  of  health,  the superintendent of financial services, and
   42  the commissioner of taxation and finance, or their designees shall serve
   43  as non-voting ex-officio members of the commission.
   44    2. Members of the commission shall receive such assistance as  may  be
   45  necessary  from  other  state  agencies  and entities, and shall receive
   46  necessary expenses incurred in the  performance  of  their  duties.  The
   47  commission  may  employ staff as needed, prescribe their duties, and fix
   48  their compensation within amounts appropriated for the commission.
   49    3. The commission shall examine the laws and regulations of the  state
   50  and  make  such recommendations as are necessary to conform the laws and
   51  regulations of the state and article 51 of the public health law  estab-
   52  lishing the New York Health program and other provisions of law relating
   53  to  the  New  York  Health  program,  and  to  improve and implement the
   54  program. The commission shall report its recommendations to the governor
   55  and the legislature.
       A. 5062                            20
    1    S 9.  Severability. If any provision or application of this act  shall
    2  be  held to be invalid, or to violate or be inconsistent with any appli-
    3  cable federal law or regulation, that shall not affect other  provisions
    4  or  applications  of  this  act  which  can be given effect without that
    5  provision  or  application; and to that end, the provisions and applica-
    6  tions of this act are severable.
    7    S 10. This act shall take effect immediately.