Bill Text: NY A04009 | 2011-2012 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relates to Medicare part D; relates to early intervention services; relates to tobacco control and insurance initiatives pool distributions; relates to clinical laboratories; relates to the distribution of HEAL NY capital grants; extends numerous provisions of law; repeals provisions of law relating to elderly pharmaceutical insurance; relates to rates of payment and medical assistance; relates to the distribution of pool allocations and graduate medical education; relates to health care initiative pool distributions; extends payment provisions for general hospitals; extends access to community health care services in rural areas; continues the priority restoration adjustment; relates to medical and professional malpractice insurance; relates to the liquidation of domestic insurers; relates to rates of payment for personal care service providers, residential health care facilities and diagnostic and treatment centers; relates to payments to residential health care facilities and other reimbursements; authorizes bad debt and charity care allowances for certified home health agencies; relates to capital related inpatient expenses; relates to rates of payment for long term home health care programs; relates to the effectiveness of the child health insurance plan; relates to the suspension of eligibility for medical assistance; foregoes certain adjustments during the 2011-2012 state fiscal year; relates to the closure and the reduction in size of certain facilities serving persons with mental illness; relates to general hospital inpatient reimbursement for annual rates; establishes ceiling limitations for certain rates of payment; repeals certain provisions of the social services law relating to prescription drug payments; initiates a study to determine costs incurred by public school districts for certain medical care, services and supplies; relates to the calculation of capital costs; relates to the HIV special needs plan; relates to the pharmacy and therapeutics committee and the preferred drug program; relates to covered part D drugs, limited coverage for formula therapy, prescription footwear, speech therapy, physical therapy and occupational therapy, payment for home health care nursing services, and coverage for smoking cessation counseling services, the furnishing of medical assistance to applicants with responsible relatives, and mail order prescriptions; relates to the commissioner of health's authority to negotiate agreements resolving multiple pending rate appeals; relates to diagnostic care centers; relates to temporary operator certificates for general hospitals or diagnostic and treatment centers; relates to health home services; relates to managed long term care plans and residential health care facilities; relates to insurance co-payments; provides palliative care support for patients with advanced life limiting conditions and illnesses; relates to the provision of home health care services; establishes a workgroup to develop a plan and draft legislation for the purpose of operating and managing public nursing homes; encourages cooperative, collaborative and integrative arrangements between health care providers, payers, and others; relates to the definition of estate; relates to the New York state medical indemnity fund and the New York state hospital quality initiative; requires compliance with operational standards by hospitals and providers of services in hospitals; creates an accountable care organization demonstration program; limits the reporting of death by the operator of an adult home or residence; requires preclaim review for participating providers of medical assistance program items and services; relates to seeking federal approvals to establish payment methodologies with accountable care organizations; relates to medical assistance for needy persons; relates to the character and adequacy of assistance; relates to residential health care facility supplemental payments, non-capital components of rates, and temporary nursing home stability contributions; authorizes the commissioner of health to enter into contracts for purposes of the Early Innovator federal grant award; and relates to applications for orders of rehabilitation or liquidation.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2011-03-30 - substituted by s2809d [A04009 Detail]
Download: New_York-2011-A04009-Amended.html
Bill Title: Relates to Medicare part D; relates to early intervention services; relates to tobacco control and insurance initiatives pool distributions; relates to clinical laboratories; relates to the distribution of HEAL NY capital grants; extends numerous provisions of law; repeals provisions of law relating to elderly pharmaceutical insurance; relates to rates of payment and medical assistance; relates to the distribution of pool allocations and graduate medical education; relates to health care initiative pool distributions; extends payment provisions for general hospitals; extends access to community health care services in rural areas; continues the priority restoration adjustment; relates to medical and professional malpractice insurance; relates to the liquidation of domestic insurers; relates to rates of payment for personal care service providers, residential health care facilities and diagnostic and treatment centers; relates to payments to residential health care facilities and other reimbursements; authorizes bad debt and charity care allowances for certified home health agencies; relates to capital related inpatient expenses; relates to rates of payment for long term home health care programs; relates to the effectiveness of the child health insurance plan; relates to the suspension of eligibility for medical assistance; foregoes certain adjustments during the 2011-2012 state fiscal year; relates to the closure and the reduction in size of certain facilities serving persons with mental illness; relates to general hospital inpatient reimbursement for annual rates; establishes ceiling limitations for certain rates of payment; repeals certain provisions of the social services law relating to prescription drug payments; initiates a study to determine costs incurred by public school districts for certain medical care, services and supplies; relates to the calculation of capital costs; relates to the HIV special needs plan; relates to the pharmacy and therapeutics committee and the preferred drug program; relates to covered part D drugs, limited coverage for formula therapy, prescription footwear, speech therapy, physical therapy and occupational therapy, payment for home health care nursing services, and coverage for smoking cessation counseling services, the furnishing of medical assistance to applicants with responsible relatives, and mail order prescriptions; relates to the commissioner of health's authority to negotiate agreements resolving multiple pending rate appeals; relates to diagnostic care centers; relates to temporary operator certificates for general hospitals or diagnostic and treatment centers; relates to health home services; relates to managed long term care plans and residential health care facilities; relates to insurance co-payments; provides palliative care support for patients with advanced life limiting conditions and illnesses; relates to the provision of home health care services; establishes a workgroup to develop a plan and draft legislation for the purpose of operating and managing public nursing homes; encourages cooperative, collaborative and integrative arrangements between health care providers, payers, and others; relates to the definition of estate; relates to the New York state medical indemnity fund and the New York state hospital quality initiative; requires compliance with operational standards by hospitals and providers of services in hospitals; creates an accountable care organization demonstration program; limits the reporting of death by the operator of an adult home or residence; requires preclaim review for participating providers of medical assistance program items and services; relates to seeking federal approvals to establish payment methodologies with accountable care organizations; relates to medical assistance for needy persons; relates to the character and adequacy of assistance; relates to residential health care facility supplemental payments, non-capital components of rates, and temporary nursing home stability contributions; authorizes the commissioner of health to enter into contracts for purposes of the Early Innovator federal grant award; and relates to applications for orders of rehabilitation or liquidation.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2011-03-30 - substituted by s2809d [A04009 Detail]
Download: New_York-2011-A04009-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
4009--C
I N A S S E M B L Y
February 1, 2011
___________
A BUDGET BILL, submitted by the Governor pursuant to article seven of
the Constitution -- read once and referred to the Committee on Ways
and Means -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee -- again reported from said
committee with amendments, ordered reprinted as amended and recommit-
ted to said committee -- again reported from said committee with
amendments, ordered reprinted as amended and recommitted to said
committee
AN ACT to amend the public health law, in relation to individualized
family service plans; to amend the public health law, in relation to
tobacco control and insurance initiatives pool distributions; to amend
the public health law, in relation to clinical laboratories; to amend
the public health law, in relation to distribution of HEAL NY capital
grants; to amend section 32 of part A of chapter 58 of the laws of
2008, amending the elder law and other laws relating to reimbursement
to particular provider pharmacies and prescription drug coverage, in
relation to the effectiveness thereof; to amend section 4 of part X2
of chapter 62 of the laws of 2003, amending the public health law
relating to allowing for the use of funds of the office of profes-
sional medical conduct for activities of the patient health informa-
tion and quality improvement act of 2000, in relation to the effec-
tiveness thereof; to amend paragraph b of subdivision 1 of section 76
of chapter 731 of the laws of 1993, amending the public health law and
other laws relating to reimbursement, delivery and capital costs of
ambulatory health care services and inpatient hospital services, in
relation to the effectiveness thereof; to amend section 4 of chapter
505 of the laws of 1995, amending the public health law relating to
the operation of department of health facilities, in relation to the
effectiveness thereof; and to amend section 3 of chapter 303 of the
laws of 1999, amending the New York state medical care facilities
finance agency act relating to financing health facilities, in
relation to the effectiveness thereof (Part A); to amend the public
health law, in relation to rates of payment and medical assistance;
and to amend chapter 58 of the laws of 2009, amending the public
health law and other laws relating to Medicaid reimbursements to resi-
dential health care facilities, in relation to adjustments to Medicaid
ratio of payment for inpatient services (Part B); to amend the New
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12571-04-1
A. 4009--C 2
York Health Care Reform Act of 1996, in relation to extending certain
provisions relating thereto; to amend the New York Health Care Reform
Act of 2000, in relation to extending the effectiveness of provisions
thereof; to amend the public health law, in relation to the distrib-
ution of pool allocations and graduate medical education; to amend
chapter 62 of the laws of 2003 amending the general business law and
other laws relating to enacting major components necessary to imple-
ment the state fiscal plan for the 2003-04 state fiscal year, in
relation to the deposit of certain funds; to amend the public health
law, in relation to health care initiative pool distributions; to
amend the public authorities law, in relation to the transfer of
certain funds; to amend the social services law, in relation to
extending payment provisions for general hospitals; to amend chapter
600 of the laws of 1986 amending the public health law relating to the
development of pilot reimbursement programs for ambulatory care
services, in relation to the effectiveness of such chapter; to amend
chapter 520 of the laws of 1978 relating to providing for a comprehen-
sive survey of health care financing, education and illness prevention
and creating councils for the conduct thereof, in relation to extend-
ing the effectiveness of portions thereof; to amend the public health
law, in relation to extending access to community health care services
in rural areas; to amend the public health law, in relation to contin-
uing the priority restoration adjustment; to amend chapter 266 of the
laws of 1986 amending the civil practice law and rules and other laws
relating to malpractice and professional medical conduct, in relation
to extending the applicability of certain provisions thereof; to amend
the insurance law, in relation to liquidation of domestic insurers; to
amend chapter 63 of the laws of 2001 amending chapter 20 of the laws
of 2001 amending the military law and other laws relating to making
appropriations for the support of government, in relation to extending
the applicability of certain provisions thereof; to amend chapter 904
of the laws of 1984, amending the public health law and the social
services law relating to encouraging comprehensive health services, in
relation to the effectiveness thereof; to amend the social services
law and the public health law, in relation to rates of payment for
personal care service providers, residential health care facilities
and diagnostic and treatment centers; and to amend chapter 495 of the
laws of 2004 amending the insurance law and the public health law
relating to the New York state health insurance continuation assist-
ance demonstration project, in relation to the effectiveness of such
provisions (Part C); to amend the public health law, in relation to
payments to residential health care facilities; to amend chapter 474
of the laws of 1996, amending the education law and other laws relat-
ing to rates for residential healthcare facilities, in relation to
reimbursements; to amend chapter 884 of the laws of 1990, amending the
public health law relating to authorizing bad debt and charity care
allowances for certified home health agencies, in relation to the
effectiveness thereof; to amend the public health law, in relation to
capital related inpatient expenses; to amend part C of chapter 58 of
the laws of 2007, amending the social services law and other laws
relating to enacting the major components of legislation necessary to
implement the health and mental hygiene budget for the 2007-2008 state
fiscal year, in relation to rates of payment by state governmental
agencies; to amend chapter 81 of the laws of 1995, amending the public
health law and other laws relating to medical reimbursement and
welfare reform, in relation to reimbursements and the effectiveness
A. 4009--C 3
thereof; to amend chapter 451 of the laws of 2007, amending the public
health law, the social services law and the insurance law relating to
providing enhanced consumer and provider protections, in relation to
extending the effectiveness of certain provisions thereof; to amend
the public health law, in relation to rates of payment for long term
home health care programs; to amend chapter 2 of the laws of 1998,
amending the public health law and other laws relating to expanding
the child health insurance plan, in relation to the effectiveness of
certain provisions thereof; to amend chapter 649 of the laws of 1996,
amending the public health law, the mental hygiene law and the social
services law relating to authorizing the establishment of special
needs plans, in relation to the effectiveness thereof; to amend chap-
ter 58 of the laws of 2008, amending the social services law and the
public health law relating to adjustments of rates, in relation to the
effectiveness of certain provisions thereof; to amend chapter 535 of
the laws of 1983, amending the social services law relating to eligi-
bility of certain enrollees for medical assistance, in relation to the
effectiveness thereof; to amend chapter 710 of the laws of 1988,
amending the social services law and the education law relating to
medical assistance eligibility of certain persons and providing for
managed medical care demonstration programs, in relation to the effec-
tiveness thereof; to amend chapter 165 of the laws of 1991, amending
the public health law and other laws relating to establishing payments
for medical assistance, in relation to the effectiveness thereof; to
amend chapter 41 of the laws of 1992 amending the public health law
and other laws relating to health care providers, in relation to the
effectiveness thereof; and to repeal certain provisions of the public
health law relating to capital related inpatient expenses (Part D); to
amend the social services law, in relation to suspension of eligibil-
ity for medical assistance (Part E); to amend chapter 57 of the laws
of 2006, relating to establishing a cost of living adjustment for
designated human services programs, in relation to foregoing such
adjustment during the 2011-2012 state fiscal year (Part F); to amend
the mental hygiene law, in relation to the closure and the reduction
in size of certain facilities serving persons with mental illness; and
to repeal certain provisions of such law relating thereto (Part G) to
amend the public health law, in relation to general hospital inpatient
reimbursement for annual rates; to amend chapter 1 of the laws of 1999
amending the public health law and other laws relating to enacting the
New York Health Care Reform Act of 2000, in relation to rates of
payment for residential health care facilities; to amend the public
health law, in relation to establishing ceiling limitations for
certain rates of payment; to amend the public health law, in relation
to a preferred drug program and clinical drug review program in medi-
caid managed care; to repeal certain provisions of the social services
law relating to prescription drug payments; to amend the social
services law, in relation to a study to determine costs incurred by
public school districts for certain medical care, services and
supplies; to amend the public health law, in relation to calculation
of capital costs and to repeal certain provisions of such law relating
thereto; to amend the public health law, in relation to the pharmacy
and therapeutics committee and the preferred drug program; and to
repeal certain provisions of such law relating thereto; to amend the
public health law, in relation to pharmacy benefit managers; to amend
the social services law, in relation to spousal refusal; to amend the
social services law and the public health law, in relation to covered
A. 4009--C 4
part D drugs, limited coverage for formula therapy, prescription foot-
wear, speech therapy, physical therapy and occupational therapy,
payment for home health care nursing services, and coverage for smok-
ing cessation counseling services, the furnishing of medical assist-
ance to applicants with responsible relatives, and the commissioner of
health's authority to negotiate agreements resolving multiple pending
rate appeals; to repeal subdivision 12 of section 272 of the public
health law relating to authorization under the preferred drug program
for anti-psychotics, anti-depressants, anti-rejection drugs for trans-
plants and anti-retrovirals used in the treatment of HIV and AIDS; to
amend the public health law, in relation to temporary operator certif-
icates for general hospitals or diagnostic and treatment centers; to
amend the social services law, in relation to health home services; to
amend the public health law, in relation to managed long term care
plans; to amend the public health law, in relation to providing palli-
ative care support for patients with advanced life limiting conditions
and illnesses; to amend the social services law, in relation to
provisions of home health care services; to amend the public health
law, in relation to establishing the New York state neurological
impairment fund and the New York state neurological impairment board;
to amend the public health law, in relation to adverse event reporting
and the scope of the statewide planning and research cooperative
system; to amend the social services law, in relation to requiring the
Medicaid plan to be posted on the department of health website; to
amend the social services law, in relation to defining certain terms
as used in the social services law, and to require preclaim review for
participating providers of medical assistance program items and
services; to amend the public health law and the social services law,
in relation to accountable care organizations and medical home multi-
payor programs; to amend the public health law, and part B of chapter
58 of the laws of 2010, amending chapter 474 of the laws of 1996
amending the education law and other laws relating to rates for resi-
dential healthcare facilities and other laws relating to Medicaid
payments, in relation to seeking federal approvals to establish
payment methodologies with accountable care organizations; to amend
the social services law, in relation to medical assistance for needy
persons and to repeal certain provisions of such law relating thereto;
to amend the tax law, in relation to increasing credits for long-term
care insurance; to amend the social services law, in relation to the
character and adequacy of assistance; in relation to authorizing the
development and implementation of a two percent reduction plan for all
Medicaid payments provided during the 2011-2012 and 2012-2013 fiscal
years and of a Medicaid savings allocation plan to limit projected
department of health Medicaid state funds disbursements to levels
assumed in the enacted budget financial plan; to amend section 3-d of
part B of chapter 58 of the laws of 2010, amending the public health
law relating to duties of the department and cardiac service informa-
tion, in relation to payment related to the HIV special needs plan;
and providing for the repeal of certain provisions upon expiration
thereof (Part H); and in relation to authorize and direct the comp-
troller to deposit funds to the credit of the capital projects fund;
and to amend chapter 174 of the laws of 1968 constituting the New York
state urban development corporation act, in relation to financing
economic development and regional initiatives and in relation to the
issuance of bonds or notes for the purpose of funding project costs
for regional economic development council initiatives, communities
A. 4009--C 5
impacted by the closure of New York state prison and correctional
facilities and other states' costs associated with such projects (Part
I)
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2011-2012
3 state fiscal year. Each component is wholly contained within a Part
4 identified as Parts A through I. The effective date for each particular
5 provision contained within such Part is set forth in the last section of
6 such Part. Any provision in any section contained within a Part, includ-
7 ing the effective date of the Part, which makes a reference to a section
8 "of this act", when used in connection with that particular component,
9 shall be deemed to mean and refer to the corresponding section of the
10 Part in which it is found. Section three of this act sets forth the
11 general effective date of this act.
12 PART A
13 Section 1. Subdivisions 4 and 5 of section 2545 of the public health
14 law, as added by section 2 of chapter 428 of the laws of 1992, are
15 amended to read as follows:
16 4. If the IFSP TEAM MEMBERS, INCLUDING THE early intervention official
17 and the parent agree on the IFSP, the IFSP shall be deemed final and the
18 service coordinator shall be authorized to implement the plan.
19 5. If the IFSP TEAM MEMBERS, INCLUDING THE early intervention official
20 and the parent do not agree on an IFSP, the service coordinator shall
21 implement the sections of the proposed IFSP that are not in dispute, and
22 the parent shall have the due process rights set forth in section twen-
23 ty-five hundred forty-nine of this title.
24 S 2. Subdivision 2 of section 605 of the public health law, as amended
25 by section 7 of part B of chapter 57 of the laws of 2006, is amended to
26 read as follows:
27 2. State aid reimbursement for public health services provided by a
28 municipality under this title, shall be made [as follows:
29 (a)] if the municipality is providing some or all of the basic public
30 health services identified in paragraph (b) of subdivision three of
31 section six hundred two of this title, pursuant to an approved plan, at
32 a rate of no less than thirty-six per centum of the difference between
33 the amount of moneys expended by the municipality for public health
34 services required by paragraph (b) of subdivision three of section six
35 hundred two of this title during the fiscal year and the base grant
36 provided pursuant to subdivision one of this section. No such reimburse-
37 ment shall be provided for services if they are not approved in a plan
38 or if no plan is submitted for such services.
39 [(b) if the municipality is providing other public health services
40 within limits to be prescribed by regulation by the commissioner in
41 addition to some or all of the public health services required in para-
42 graph (b) of subdivision three of section six hundred two of this title,
43 pursuant to an approved plan, at a rate of not less than thirty-six per
44 centum of the moneys expended by the municipality for such other
45 services. No such reimbursement shall be provided for services if they
A. 4009--C 6
1 are not approved in a plan or if no plan is submitted for such
2 services.]
3 S 3. Paragraph (fff) of subdivision 1 of section 2807-v of the public
4 health law, as amended by section 5 of part B of chapter 58 of the laws
5 of 2008, is amended to read as follows:
6 (fff) Funds shall be made available to the empire state stem cell fund
7 established by section ninety-nine-p of the state finance law [from the
8 public asset as defined in section four thousand three hundred one of
9 the insurance law and accumulated from the conversion of one or more
10 article forty-three corporations and its or their not-for-profit subsid-
11 iaries occurring on or after January first, two thousand seven. Such
12 funds shall be made available] within amounts appropriated up to fifty
13 million dollars annually and shall not exceed five hundred million
14 dollars in total.
15 S 4. Intentionally Omitted.
16 S 5. Subdivision 3 of section 571 of the public health law, as amended
17 by chapter 436 of the laws of 1993, is amended to read as follows:
18 3. "Reference system" means a system of [periodic testing] ASSESSMENT
19 of methods, procedures and materials of clinical laboratories and blood
20 banks, including, but not limited to, ONGOING VALIDATION WHICH MAY
21 INCLUDE DIRECT TESTING AND EXPERIMENTATION BY THE DEPARTMENT OF SUCH
22 METHODS, PROCEDURES AND MATERIALS, the distribution of [manuals of
23 approved methods] STANDARDS AND GUIDELINES, inspection of facilities,
24 [cooperative research, and] periodic submission of test specimens for
25 examination, AND RESEARCH CONDUCTED BY THE DEPARTMENT THAT INVOLVES THE
26 STUDY OF NEW OR EXISTING METHODS, PROCEDURES AND MATERIALS IN THE FIELD
27 OF CLINICAL LABORATORY MEDICINE, AND SUCH OTHER ACTIVITIES AS MAY BE SET
28 FORTH IN REGULATION.
29 S 6. Subdivisions 1, 2 and 6 of section 575 of the public health law,
30 as amended by chapter 436 of the laws of 1993, are amended to read as
31 follows:
32 1. Application for a permit shall be made by the owner and the direc-
33 tor of the clinical laboratory or blood bank [upon forms provided by the
34 department] IN A MANNER AND FORMAT PRESCRIBED BY THE DEPARTMENT. The
35 application shall contain the name of the owner, the name of the direc-
36 tor, the procedures or categories of procedures or services for which
37 the permit is sought, the location or locations and physical description
38 of the facility or location or locations at which tests are to be
39 performed or at which a blood bank is to be operated, and such other
40 information as the department may require.
41 2. A permit OR PERMIT CATEGORY shall not be issued unless a valid
42 certificate of qualification in the category of procedures for which the
43 permit is sought has been issued to the director pursuant to the
44 provisions of section five hundred seventy-three of this title, [and]
45 unless ALL FEES AND OUTSTANDING PENALTIES, IF ANY, HAVE BEEN PAID, AND
46 the department finds that the clinical laboratory or blood bank is
47 competently staffed and properly equipped, and will be operated in the
48 manner required by this title.
49 6. A permit shall become void by a change in the director, owner, or
50 location. A CATEGORY ON A PERMIT SHALL BECOME VOID BY A CHANGE IN THE
51 DIRECTOR FOR THAT CATEGORY. The department may, pursuant to regulations
52 adopted under this title, extend the date on which a permit OR CATEGORY
53 ON A PERMIT shall become void for a period not to exceed sixty days from
54 the date of a change of the director, owner or location. An application
55 for a NEW permit [may] MUST be made [at any time,] in the manner
56 provided by this section.
A. 4009--C 7
1 S 7. Subdivision 3 and paragraphs (a), (b), (c) and (e) of subdivision
2 4 of section 576 of the public health law, as amended by chapter 436 of
3 the laws of 1993, are amended to read as follows:
4 3. The department shall operate a reference system and shall prescribe
5 standards for the PROPER OPERATION OF CLINICAL LABORATORIES AND BLOOD
6 BANKS AND FOR THE examination of specimens. As part of such reference
7 system, the department may REVIEW AND APPROVE TESTING METHODS DEVELOPED
8 OR MODIFIED BY CLINICAL LABORATORIES AND BLOOD BANKS PRIOR TO THE TEST-
9 ING METHODS BEING OFFERED IN THIS STATE, AND MAY require clinical labo-
10 ratories and blood banks to analyze test samples submitted by the
11 department and to report on the results of such analyses. The rules and
12 regulations of the department shall prescribe the REQUIREMENTS FOR THE
13 PROPER OPERATION OF A CLINICAL LABORATORY OR BLOOD BANK, FOR THE
14 APPROVAL OF METHODS AND THE manner in which proficiency testing or
15 analyses of samples shall be performed and reports submitted. Failure to
16 meet department standards FOR THE PROPER OPERATION OF A CLINICAL LABORA-
17 TORY OR BLOOD BANK, INCLUDING THE CRITERIA FOR APPROVAL OF METHODS, OR
18 FAILURE TO MAINTAIN SATISFACTORY PERFORMANCE in proficiency testing
19 shall result in termination of the permit in the category or categories
20 of testing established by the department in regulation until remediation
21 is achieved. Such standards shall be at least as stringent as federal
22 standards promulgated under the federal clinical laboratory improvement
23 [act] AMENDMENTS of nineteen hundred eighty-eight. Such failure and
24 termination shall be subject to review in accordance with regulations
25 adopted by the department.
26 (a) The department may adopt and amend rules and regulations to effec-
27 tuate the provisions and purposes of this title. Such rules and regu-
28 lations shall establish [inspection and reference] fees for clinical
29 laboratories and blood banks in amounts not exceeding the cost of the
30 [inspection and] reference [program] SYSTEM for clinical laboratories
31 and blood banks and shall be subject to the approval of the director of
32 the budget. THE COMMISSIONER SHALL DETERMINE THE PROPER COST ALLOCATION
33 METHOD TO UTILIZE TO DETERMINE THE COST OF THE REFERENCE SYSTEM. THE FEE
34 PAID BY THE DEPARTMENT TO MAINTAIN AN EXEMPTION FOR CLINICAL LABORATO-
35 RIES AND BLOOD BANKS FROM THE REQUIREMENTS OF THE FEDERAL CLINICAL LABO-
36 RATORY IMPROVEMENT AMENDMENTS OF NINETEEN HUNDRED EIGHTY-EIGHT SHALL BE
37 DEEMED A COST OF THE REFERENCE SYSTEM.
38 (b) In determining the fee charges to be assessed, the department
39 shall, on or before May first of each year, compute the [total actual]
40 costs for the preceding state fiscal year which were expended to operate
41 and administer the duties of the department pursuant to this title. The
42 department shall, at such time or times and pursuant to such procedure
43 as it shall determine by regulation, bill and collect from each clinical
44 laboratory and blood bank an amount computed by multiplying such total
45 computed operating expenses of the department by a fraction the numera-
46 tor of which is the gross annual receipts of such clinical laboratory or
47 blood bank during such twelve month period preceding the date of compu-
48 tation as the department shall designate by regulation, and the denomi-
49 nator of which is the total gross annual receipts of all clinical labo-
50 ratories or blood banks operating in the state during such period.
51 (c) Each such clinical laboratory and blood bank shall submit to the
52 department, in such form and at such times as the department may
53 require, a report containing information regarding its gross annual
54 receipts [from the performance of tests or examination of specimens] FOR
55 ALL ACTIVITIES PERFORMED pursuant to a permit issued by the department
56 in accordance with the provisions of section five hundred seventy-five
A. 4009--C 8
1 of this title. The department may require additional information and
2 audit and review such information to verify its accuracy.
3 (e) On or before September fifteenth of each year, the department
4 shall [recompute the actual] RECONCILE ITS costs and expenses [of the
5 department] FOR THE REFERENCE SYSTEM for the preceding state fiscal year
6 and shall, on or before October fifteenth send to each clinical labora-
7 tory and blood bank, a statement setting forth the amount due and paya-
8 ble by, or the amount computed to the credit of, such clinical laborato-
9 ry or blood bank, computed on the basis of the above stated formula,
10 except that for the purposes of such computation the fraction shall be
11 multiplied against the total recomputed [actual] expenses of the depart-
12 ment for such fiscal year. Any amount due shall be payable not later
13 than thirty days following the date of such statement. Any credit shall
14 be applied against any succeeding payment due.
15 S 8. Subdivision 1 of section 577 of the public health law is amended
16 by adding a new paragraph (i) to read as follows:
17 (I) HAS BEEN FOUND UPON INSPECTION BY THE DEPARTMENT TO BE IN NONCOM-
18 PLIANCE WITH A PROVISION OR PROVISIONS OF THIS TITLE OR THE RULES AND
19 REGULATIONS PROMULGATED HEREUNDER, AND HAS FAILED TO ADDRESS SUCH FIND-
20 INGS AS REQUIRED BY THE DEPARTMENT.
21 S 9. Intentionally Omitted.
22 S 10. Intentionally Omitted.
23 S 11. Intentionally Omitted.
24 S 12. Intentionally Omitted.
25 S 13. Section 32 of part A of chapter 58 of the laws of 2008, amending
26 the elder law and other laws relating to reimbursement to particular
27 provider pharmacies and prescription drug coverage, as amended by
28 section 20 of part OO of chapter 57 of the laws of 2008, is amended to
29 read as follows:
30 S 32. This act shall take effect immediately and shall be deemed to
31 have been in full force and effect on and after April 1, 2008; provided
32 however, that sections one, six-a, nineteen, twenty, twenty-four, and
33 twenty-five of this act shall take effect July 1, 2008; [provided howev-
34 er that sections sixteen, seventeen and eighteen of this act shall
35 expire April 1, 2011;] provided, however, that the amendments made by
36 section twenty-eight of this act shall take effect on the same date as
37 section 1 of chapter 281 of the laws of 2007 takes effect; provided
38 further, that sections twenty-nine, thirty, and thirty-one of this act
39 shall take effect October 1, 2008; provided further, that section twen-
40 ty-seven of this act shall take effect January 1, 2009; and provided
41 further, that section twenty-seven of this act shall expire and be
42 deemed repealed March 31, [2011] 2014; and provided, further, however,
43 that the amendments to subdivision 1 of section 241 of the education law
44 made by section twenty-nine of this act shall not affect the expiration
45 of such subdivision and shall be deemed to expire therewith and provided
46 that the amendments to section 272 of the public health law made by
47 section thirty of this act shall not affect the repeal of such section
48 and shall be deemed repealed therewith.
49 S 14. Section 4 of part X2 of chapter 62 of the laws of 2003, amending
50 the public health law relating to allowing for the use of funds of the
51 office of professional medical conduct for activities of the patient
52 health information and quality improvement act of 2000, as amended by
53 chapter 21 of the laws of 2010, is amended to read as follows:
54 S 4. This act shall take effect immediately; provided that the
55 provisions of section one of this act shall be deemed to have been in
56 full force and effect on and after April 1, 2003, and shall expire March
A. 4009--C 9
1 31, [2011] 2013 when upon such date the provisions of such section shall
2 be deemed repealed.
3 S 15. Paragraph (b) of subdivision 1 of section 76 of chapter 731 of
4 the laws of 1993, amending the public health law and other laws relating
5 to reimbursement, delivery and capital cost of ambulatory health care
6 services and inpatient hospital services, as amended by section 14 of
7 part A of chapter 58 of the laws of 2007, is amended to read as follows:
8 (b) sections fifteen through nineteen and subdivision 3 of section
9 2807-e of the public health law as added by section twenty of this act
10 shall expire on [July 1, 2011] JULY 1, 2014, and section seventy-four of
11 this act shall expire on July 1, 2007;
12 S 16. Section 4 of chapter 505 of the laws of 1995, amending the
13 public health law relating to the operation of department of health
14 facilities, as amended by chapter 609 of the laws of 2007, is amended to
15 read as follows:
16 S 4. This act shall take effect immediately[; provided, however, that
17 the provisions of paragraph (b) of subdivision 4 of section 409-c of the
18 public health law, as added by section three of this act, shall take
19 effect January 1, 1996 and shall expire and be deemed repealed sixteen
20 years from the effective date thereof].
21 S 17. Section 3 of chapter 303 of the laws of 1999, amending the New
22 York state medical care facilities finance agency act relating to
23 financing health facilities, as amended by chapter 607 of the laws of
24 2007, is amended to read as follows:
25 S 3. This act shall take effect immediately[, provided, however, that
26 subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of
27 1973, as added by section one of this act, shall expire and be deemed
28 repealed June 30, 2011; and provided further, however, that the expira-
29 tion and repeal of such subdivision 15-a shall not affect or impair in
30 any manner any health facilities bonds issued, or any lease or purchase
31 of a health facility executed, pursuant to such subdivision 15-a prior
32 to its expiration and repeal and that, with respect to any such bonds
33 issued and outstanding as of June 30, 2011, the provisions of such
34 subdivision 15-a as they existed immediately prior to such expiration
35 and repeal shall continue to apply through the latest maturity date of
36 any such bonds, or their earlier retirement or redemption, for the sole
37 purpose of authorizing the issuance of refunding bonds to refund bonds
38 previously issued pursuant thereto].
39 S 18. This act shall take effect April 1, 2011, provided, however
40 that:
41 (a) section two of this act shall take effect July 1, 2011; and
42 (b) related to sections five, six, seven and eight of this act, the
43 commissioner of health is authorized to promulgate, on an emergency
44 basis, any regulations necessary to implement any provision of such
45 sections upon their effective date.
46 PART B
47 Section 1. (a) Notwithstanding any inconsistent provision of law,
48 rule or regulation to the contrary, and subject to the availability of
49 federal financial participation, effective for the period April 1, 2011
50 through March 31, 2012, and each state fiscal year thereafter, the
51 department of health is authorized to make supplemental Medicaid
52 payments for professional services provided by physicians, nurse practi-
53 tioners and physician assistants who are participating in a plan for the
54 management of clinical practice at the State University of New York, in
A. 4009--C 10
1 accordance with title 11 of article 5 of the social services law for
2 patients eligible for federal financial participation under title XIX of
3 the federal social security act, in amounts that will increase fees for
4 such professional services to an amount equal to the average commercial
5 rate that would otherwise be received for such services rendered by such
6 physicians, nurse practitioners and physician assistants. The calcu-
7 lation of such supplemental fee payments shall be made in accordance
8 with applicable federal law and regulation and subject to the approval
9 of the division of the budget. Such supplemental Medicaid fee payments
10 may be added to the professional fees paid under the fee schedule or
11 made as aggregate lump sum payments to eligible clinical practice plans
12 authorized to receive professional fees.
13 (b) The affiliated State University of New York health science centers
14 shall be responsible for payment of one hundred percent of the non-fed-
15 eral share of such supplemental Medicaid payments for all services
16 provided by physicians, nurse practitioners and physician assistants who
17 are participating in a plan for the management of clinical practice, in
18 accordance with section 365-a of the social services law, regardless of
19 whether another social services district or the department of health may
20 otherwise be responsible for furnishing medical assistance to the eligi-
21 ble persons receiving such services.
22 S 2. Subdivision 21 of section 2807-c of the public health law is
23 amended by adding a new paragraph (e-1) to read as follows:
24 (E-1) FOR PERIODS ON AND AFTER JANUARY FIRST, TWO THOUSAND ELEVEN, FOR
25 PURPOSES OF CALCULATIONS PURSUANT TO PARAGRAPHS (B) AND (C) OF THIS
26 SUBDIVISION OF MAXIMUM DISPROPORTIONATE SHARE PAYMENT DISTRIBUTIONS FOR
27 A RATE YEAR OR PART THEREOF, COSTS INCURRED OF FURNISHING HOSPITAL
28 SERVICES NET OF MEDICAL ASSISTANCE PAYMENTS, OTHER THAN DISPROPORTIONATE
29 SHARE PAYMENTS, AND PAYMENTS BY UNINSURED PATIENTS SHALL FOR THE TWO
30 THOUSAND ELEVEN CALENDAR YEAR, SHALL BE DETERMINED INITIALLY BASED ON
31 EACH HOSPITAL'S SUBMISSION OF A FULLY COMPLETED TWO THOUSAND EIGHT
32 DISPROPORTIONATE SHARE HOSPITAL DATA COLLECTION TOOL, WHICH IS REQUIRED
33 TO BE SUBMITTED TO THE DEPARTMENT BY MARCH THIRTY-FIRST, TWO THOUSAND
34 ELEVEN, AND SHALL BE SUBSEQUENTLY REVISED TO REFLECT EACH HOSPITAL'S
35 SUBMISSION OF A FULLY COMPLETED TWO THOUSAND NINE DISPROPORTIONATE SHARE
36 HOSPITAL DATA COLLECTION TOOL, WHICH IS REQUIRED TO BE SUBMITTED TO THE
37 DEPARTMENT BY OCTOBER FIRST, TWO THOUSAND ELEVEN.
38 FOR CALENDAR YEARS ON AND AFTER TWO THOUSAND TWELVE, SUCH INITIAL
39 DETERMINATIONS SHALL REFLECT SUBMISSION OF DATA AS REQUIRED BY THE
40 COMMISSIONER ON A SPECIFIED DATE. ALL SUCH INITIAL DETERMINATIONS SHALL
41 SUBSEQUENTLY BE REVISED TO REFLECT ANNUAL RATE PERIOD DATA AND STATIS-
42 TICS. INDIGENT CARE PAYMENTS WILL BE WITHHELD IN INSTANCES WHEN A HOSPI-
43 TAL HAS NOT SUBMITTED REQUIRED INFORMATION BY THE DUE DATES PRESCRIBED
44 IN THIS PARAGRAPH, PROVIDED, HOWEVER, THAT SUCH PAYMENTS SHALL BE MADE
45 UPON SUBMISSION OF SUCH REQUIRED DATA. FOR PURPOSES OF CALCULATIONS
46 PURSUANT TO PARAGRAPH (D) OF THIS SUBDIVISION OF ELIGIBILITY TO RECEIVE
47 DISPROPORTIONATE SHARE PAYMENTS FOR A RATE YEAR OR PART THEREOF, THE
48 HOSPITAL INPATIENT UTILIZATION RATE SHALL BE DETERMINED BASED ON THE
49 BASE YEAR STATISTICS IN ACCORDANCE WITH THE METHODOLOGY ESTABLISHED BY
50 THE COMMISSIONER, AND COSTS INCURRED OF FURNISHING HOSPITAL SERVICES
51 SHALL BE DETERMINED IN ACCORDANCE WITH A METHODOLOGY ESTABLISHED BY THE
52 COMMISSIONER CONSISTENT WITH REQUIREMENTS OF THE SECRETARY OF THE
53 DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR PURPOSES OF FEDERAL FINAN-
54 CIAL PARTICIPATION PURSUANT TO THE TITLE XIX OF THE FEDERAL SOCIAL SECU-
55 RITY ACT IN DISPROPORTIONATE SHARE PAYMENTS.
A. 4009--C 11
1 S 3. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
2 2808 of the public health law, as amended by section 1 of part D of
3 chapter 58 of the laws of 2010, is amended to read as follows:
4 (i) Subject to the provisions of subparagraphs (ii) through (xiv) of
5 this paragraph, for periods on and after April first, two thousand nine
6 through June thirtieth, two thousand eleven the operating cost component
7 of rates of payment shall reflect allowable operating costs as reported
8 in each facility's cost report for the two thousand two calendar year,
9 as adjusted for inflation on an annual basis in accordance with the
10 methodology set forth in paragraph (c) of subdivision ten of section
11 twenty-eight hundred seven-c of this article, provided, however, that
12 for those facilities which do not receive a per diem add-on adjustment
13 pursuant to subparagraph (ii) of paragraph (a) of this subdivision,
14 rates shall be further adjusted to include the proportionate benefit, as
15 determined by the commissioner, of the expiration of the opening para-
16 graph and paragraph (a) of subdivision sixteen of this section and of
17 paragraph (a) of subdivision fourteen of this section, and provided
18 further that the operating cost component of rates of payment for those
19 facilities which did not receive a per diem adjustment in accordance
20 with subparagraph (ii) of paragraph (a) of this subdivision shall not be
21 less than the operating component such facilities received in the two
22 thousand eight rate period, as adjusted for inflation on an annual basis
23 in accordance with the methodology set forth in paragraph (c) of subdi-
24 vision ten of section twenty-eight hundred seven-c of this article and
25 further provided, however, that rates for facilities whose operating
26 cost component reflects base year costs subsequent to January first, two
27 thousand two shall have rates computed in accordance with this para-
28 graph, utilizing allowable operating costs as reported in such subse-
29 quent base year period, and trended forward to the rate year in accord-
30 ance with applicable inflation factors, AND PROVIDED FURTHER, HOWEVER,
31 THAT NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION,
32 RATE ADJUSTMENTS AS DESCRIBED IN THIS SUBPARAGRAPH AND AS EFFECTIVE FOR
33 RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND NINE THROUGH JUNE
34 THIRTIETH, TWO THOUSAND ELEVEN, SHALL NOT BE IMPLEMENTED AND PAID PRIOR
35 TO JULY FIRST, TWO THOUSAND ELEVEN.
36 S 4. Section 2 of part D of chapter 58 of the laws of 2009, amending
37 the public health law and other laws relating to Medicaid reimbursements
38 to residential health care facilities, as amended by section 3 of Part D
39 of chapter 58 of the laws of 2010, is amended to read as follows:
40 S 2. Notwithstanding paragraph (b) of subdivision 2-b of section 2808
41 of the public health law or any other contrary provision of law, with
42 regard to adjustments to medicaid rates of payment for inpatient
43 services provided by residential health care facilities for the period
44 April 1, 2009 through March 31, 2010, made pursuant to paragraph (b) of
45 subdivision 2-b of section 2808 of the public health law, the commis-
46 sioner of health and the director of the budget shall, upon a determi-
47 nation that such adjustments, including the application of adjustments
48 authorized by the provisions of paragraph (g) of subdivision 2-b of
49 section 2808 of the public health law, shall result in an aggregate
50 increase in total Medicaid rates of payment for such services for such
51 period that is less than or more than two hundred ten million dollars
52 ($210,000,000), make such proportional adjustments to such rates as are
53 necessary to result in an increase of such aggregate expenditures of two
54 hundred ten million dollars ($210,000,000), and provided further, howev-
55 er, that notwithstanding section 2808 of the public health law or any
56 other contrary provision of law, with regard to adjustments to inpatient
A. 4009--C 12
1 rates of payment made pursuant to section 2808 of the public health law
2 for inpatient services provided by residential health care facilities
3 for the period April 1, 2010 through [June 30, 2011] MARCH 31, 2012, the
4 commissioner of health and the director of the budget shall, upon a
5 determination by such commissioner and such director that such rate
6 adjustments shall, prior to the application of any applicable adjustment
7 for inflation, result in an aggregate increase in total Medicaid rates
8 of payment for such services, including payments made pursuant to
9 subparagraph (i) of paragraph (d) of subdivision 2-c of section 2808 of
10 the public health law, make such proportional adjustments to such rates
11 as are necessary to reduce such total aggregate rate adjustments such
12 that the aggregate total reflects no such increase or decrease, and
13 provided further, however, the case mix adjustments as otherwise author-
14 ized by subparagraph (ii) of paragraph (b) of subdivision 2-b of section
15 2808 of the public health law and as scheduled for January of 2011 shall
16 not be made. Adjustments made pursuant to this section shall not be
17 subject to subsequent correction or reconciliation.
18 S4-a. Subdivision 2-c of section 2808 of the public health law is
19 REPEALED and a new subdivision 2-c is added to read as follows:
20 2-C. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SECTION OR
21 ANY OTHER CONTRARY PROVISION OF LAW AND SUBJECT TO THE AVAILABILITY OF
22 FEDERAL FINANCIAL PARTICIPATION, THE NON-CAPITAL COMPONENT OF RATES OF
23 PAYMENT BY GOVERNMENTAL AGENCIES FOR INPATIENT SERVICES PROVIDED BY
24 RESIDENTIAL HEALTH CARE FACILITIES ON AND AFTER JULY FIRST, TWO THOUSAND
25 ELEVEN SHALL REFLECT A DIRECT STATEWIDE PRICE COMPONENT, AND INDIRECT
26 STATEWIDE PRICE COMPONENT, AND A FACILITY SPECIFIC NON-COMPARABLE COMPO-
27 NENT, UTILIZING ALLOWABLE OPERATING COSTS FOR A BASE YEAR AS DETERMINED
28 BY THE COMMISSIONER BY REGULATION.
29 (B) THE DIRECT AND INDIRECT STATEWIDE PRICE COMPONENTS SHALL BE
30 ADJUSTED BY A WAGE EQUALIZATION FACTOR AND THE DIRECT STATEWIDE PRICE
31 COMPONENT SHALL BE SUBJECT TO A CASE MIX ADJUSTMENT UTILIZING THE
32 PATIENTS THAT ARE ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO TILE ELEV-
33 EN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW.
34 (C) THE NON-CAPITAL COMPONENT OF THE RATES FOR (I) AIDS FACILITIES OR
35 DISCRETE AIDS UNITS WITHIN FACILITIES, (II) DISCRETE UNITS FOR RESIDENTS
36 RECEIVING CARE IN A LONG-TERM INPATIENT REHABILITATION PROGRAM FOR TRAU-
37 MATIC BRAIN INJURED PERSONS, (III) DISCRETE UNITS PROVIDING SPECIALIZED
38 PROGRAMS FOR RESIDENTS REQUIRING BEHAVIORAL INTERVENTIONS, (IV) DISCRETE
39 UNITS FOR LONG-TERM VENTILATOR DEPENDENT RESIDENTS, AND (V) FACILITIES
40 OR DISCRETE UNITS WITHIN FACILITIES THAT PROVIDE EXTENSIVE NURSING,
41 MEDICAL, PSYCHOLOGICAL AND COUNSELING SUPPORT SERVICES SOLELY TO CHIL-
42 DREN SHALL BE ESTABLISHED PURSUANT TO REGULATIONS PROMULGATED PURSUANT
43 TO THIS SUBDIVISION.
44 (D) THE COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE
45 EMERGENCY REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION
46 AND SUCH REGULATIONS MAY ALSO INCLUDE, BUT NOT BE LIMITED TO, PROVISIONS
47 FOR RATE ADJUSTMENTS OR PAYMENT ENHANCEMENTS TO FACILITATE THE TRANSI-
48 TION OF FACILITIES TO THE RATE-SETTING METHODOLOGY ESTABLISHED BY THIS
49 SUBDIVISION AND FOR FACILITATING QUALITY IMPROVEMENTS IN RESIDENTIAL
50 HEALTH CARE FACILITIES.
51 (E) SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTICIPATION,
52 THE COMMISSIONER IS AUTHORIZED TO ESTABLISH A QUALITY OF CARE INCENTIVE
53 POOL OR POOLS FOR ELIGIBLE RESIDENTIAL HEALTH CARE FACILITIES AND
54 INCREASE THE MEDICAID RATES OF PAYMENT FOR SUCH ELIGIBLE FACILITIES FROM
55 THIS POOL OR POOLS. WITHIN AMOUNTS AVAILABLE, PAYMENTS WILL BE DETER-
56 MINED BY THE COMMISSIONER BY APPLYING CRITERIA, INCLUDING, BUT NOT
A. 4009--C 13
1 LIMITED TO, THE QUALITY COMPONENTS OF THE MINIMUM DATA SET REQUIRED
2 UNDER FEDERAL LAW, SURVEY INFORMATION, DIRECT CARE STAFFING, INCLUDING
3 LABOR COSTS, AND OTHER FACILITY DATA.
4 S 5. Notwithstanding any contrary provision of law and subject to the
5 availability of federal financial participation, for periods on and
6 after July 1, 2011, Medicaid rates of payments for inpatient services
7 provided by residential health care facilities which, as of the effec-
8 tive date of this section, operate discrete units for treatment of resi-
9 dents with huntington's disease, shall be increased by a rate add-on
10 amount. The aggregate amount of such rate add-ons for the period July 1,
11 2011 through December 31, 2011 shall be eight hundred fifty thousand
12 dollars ($850,000), and shall be one million seven hundred thousand
13 dollars ($1,700,000) for the 2012 calendar year and each year thereafter
14 and such amounts shall be allocated to each eligible residential health
15 care facility proportionally, based on the number of beds in each facil-
16 ity's discrete unit for treatment of huntington's disease relative to
17 the total number of such beds in all such units. Such rate add-ons shall
18 be computed utilizing reported Medicaid days from certified cost reports
19 as submitted to the department of health for the calendar year period
20 two years prior to the applicable rate year and, further, such rate
21 add-ons shall not be subject to subsequent adjustment or reconciliation.
22 S 6. Notwithstanding section 448 of chapter 170 of the laws of 1994
23 and section 4 of chapter 81 of the laws of 1995, as amended, and any
24 other inconsistent provision of law or regulation and subject to the
25 availability of federal financial participation, for the period April 1,
26 2011 through June 30, 2011, medical assistance rates of payment to resi-
27 dential health care facilities and diagnostic treatment centers licensed
28 under article 28 of the public health law for adult day health care
29 services provided to registrants with acquired immunodeficiency syndrome
30 (AIDS) or other human immunodeficiency virus (HIV) related illnesses,
31 shall be increased by an aggregate amount of one million eight hundred
32 sixty-seven thousand dollars ($1,867,000). Such amount shall be allo-
33 cated proportionally among such providers based on the medical assist-
34 ance visits reported by each provider in the most recently available
35 cost report, as submitted to the department of health by January 1,
36 2011, and shall be included as adjustments to each provider's daily rate
37 of payment for such services. Such adjustments shall not be subject to
38 subsequent adjustment or reconciliation.
39 S 7. Notwithstanding any contrary provision of law or regulation and
40 subject to availability of federal financial participation, for the
41 period April 1, 2011 through June 30, 2011, rates of payment by govern-
42 mental agencies to residential health care facilities and diagnostic and
43 treatment centers licensed under article 28 of the public health law for
44 adult day health care services provided to registrants with acquired
45 immunodeficiency syndrome (AIDS) or other human immunodeficiency virus
46 (HIV) related illnesses, shall reflect an adjustment to such rates of
47 payments in an aggregate amount of two hundred thirty-six thousand
48 dollars ($236,000) and distributed proportionally as rate add-ons, based
49 on each eligible providers' Medicaid visits as reported in such provid-
50 er's most recently available cost report as submitted to the department
51 of health prior to January 1, 2011, and provided further, however, that
52 such adjustments shall not be subject to subsequent adjustment or recon-
53 ciliation.
54 S 8. Subparagraph (vi) of paragraph (b) of subdivision 2 of section
55 2807-d of the public health law, as amended by section 37 of part C of
56 chapter 58 of the laws of 2007, is amended to read as follows:
A. 4009--C 14
1 (vi) Notwithstanding any contrary provision of this paragraph or any
2 other provision of law or regulation to the contrary, for residential
3 health care facilities the assessment shall be six percent of each resi-
4 dential health care facility's gross receipts received from all patient
5 care services and other operating income on a cash basis for the period
6 April first, two thousand two through March thirty-first, two thousand
7 three for hospital or health-related services, including adult day
8 services; provided, however, that residential health care facilities'
9 gross receipts attributable to payments received pursuant to title XVIII
10 of the federal social security act (medicare) shall be excluded from the
11 assessment; provided, however, that for all such gross receipts received
12 on or after April first, two thousand three through March thirty-first,
13 two thousand five, such assessment shall be five percent, and further
14 provided that for all such gross receipts received on or after April
15 first, two thousand five through March thirty-first, two thousand nine,
16 and on or after April first, two thousand nine through March thirty-
17 first, two thousand eleven such assessment shall be six percent, AND
18 FURTHER PROVIDED THAT FOR ALL SUCH GROSS RECEIPTS RECEIVED ON OR AFTER
19 APRIL FIRST, TWO THOUSAND ELEVEN SUCH ASSESSMENT SHALL BE SIX PERCENT.
20 S 9. Intentionally omitted.
21 S 10. Notwithstanding any inconsistent provision of law, rule or regu-
22 lation, for purposes of implementing the provisions of the public health
23 law and the social services law, references to titles XIX and XXI of the
24 federal social security act in the public health law and the social
25 services law shall be deemed to include and also to mean any successor
26 titles thereto under the federal social security act.
27 S 11. Notwithstanding any inconsistent provision of law, rule or regu-
28 lation, the effectiveness of the provisions of sections 2807 and 3614 of
29 the public health law, section 18 of chapter 2 of the laws of 1988, and
30 18 NYCRR 505.14(h), as they relate to time frames for notice, approval
31 or certification of rates of payment, are hereby suspended and without
32 force or effect for purposes of implementing the provisions of this act.
33 S 12. Severability clause. If any clause, sentence, paragraph, subdi-
34 vision, section or part of this act shall be adjudged by any court of
35 competent jurisdiction to be invalid, such judgment shall not affect,
36 impair or invalidate the remainder thereof, but shall be confined in its
37 operation to the clause, sentence, paragraph, subdivision, section or
38 part thereof directly involved in the controversy in which such judg-
39 ment shall have been rendered. It is hereby declared to be the intent of
40 the legislature that this act would have been enacted even if such
41 invalid provisions had not been included herein.
42 S 13. This act shall take effect immediately and shall be deemed to
43 have been in full force and effect on and after April 1, 2011; provided,
44 however, that:
45 (a) any rules or regulations necessary to implement the provisions of
46 this act may be promulgated and any procedures, forms, or instructions
47 necessary for such implementation may be adopted and issued on or after
48 the date this act shall have become a law;
49 (b) this act shall not be construed to alter, change, affect, impair
50 or defeat any rights, obligations, duties or interests accrued, incurred
51 or conferred prior to the effective date of this act;
52 (c) the commissioner of health and the superintendent of insurance and
53 any appropriate council may take any steps necessary to implement this
54 act prior to its effective date;
55 (d) notwithstanding any inconsistent provision of the state adminis-
56 trative procedure act or any other provision of law, rule or regulation,
A. 4009--C 15
1 the commissioner of health and the superintendent of insurance and any
2 appropriate council is authorized to adopt or amend or promulgate on an
3 emergency basis any regulation he or she or such council determines
4 necessary to implement any provision of this act on its effective date;
5 and
6 (e) the provisions of this act shall become effective notwithstanding
7 the failure of the commissioner of health or the superintendent of
8 insurance or any council to adopt or amend or promulgate regulations
9 implementing this act.
10 PART C
11 Section 1. Subdivision 5 of section 168 of chapter 639 of the laws of
12 1996, constituting the New York Health Care Reform Act of 1996, as
13 amended by section 1 of part B of chapter 58 of the laws of 2008, is
14 amended to read as follows:
15 5. sections 2807-c, 2807-j, 2807-s and 2807-t of the public health
16 law, as amended or as added by this act, shall expire on December 31,
17 [2011] 2014, and shall be thereafter effective only in respect to any
18 act done on or before such date or action or proceeding arising out of
19 such act including continued collections of funds from assessments and
20 allowances and surcharges established pursuant to sections 2807-c,
21 2807-j, 2807-s and 2807-t of the public health law, and administration
22 and distributions of funds from pools established pursuant to sections
23 2807-c, 2807-j, 2807-k, 2807-l, 2807-m, 2807-s and 2807-t of the public
24 health law related to patient services provided before December 31,
25 [2011] 2014, and continued expenditure of funds authorized for programs
26 and grants until the exhaustion of funds therefor;
27 S 2. Subdivision 1 of section 138 of chapter 1 of the laws of 1999,
28 constituting the New York Health Care Reform Act of 2000, as amended by
29 section 1-a of part B of chapter 58 of the laws of 2008, is amended to
30 read as follows:
31 1. sections 2807-c, 2807-j, 2807-s, and 2807-t of the public health
32 law, as amended by this act, shall expire on December 31, [2011] 2014,
33 and shall be thereafter effective only in respect to any act done before
34 such date or action or proceeding arising out of such act including
35 continued collections of funds from assessments and allowances and
36 surcharges established pursuant to sections 2807-c, 2807-j, 2807-s and
37 2807-t of the public health law, and administration and distributions of
38 funds from pools established pursuant to sections 2807-c, 2807-j,
39 2807-k, 2807-l, 2807-m, 2807-s, 2807-t, 2807-v and 2807-w of the public
40 health law, as amended or added by this act, related to patient services
41 provided before December 31, [2011] 2014, and continued expenditure of
42 funds authorized for programs and grants until the exhaustion of funds
43 therefor;
44 S 3. Paragraph (a) of subdivision 9 of section 2807-j of the public
45 health law, as amended by section 2 of part B of chapter 58 of the laws
46 of 2008, is amended to read as follows:
47 (a) funds shall be deposited and credited to a special revenue-other
48 fund to be established by the comptroller or to the health care reform
49 act (HCRA) resources fund established pursuant to section ninety-two-dd
50 of the state finance law, whichever is applicable. To the extent of
51 funds appropriated therefore, the commissioner shall make payments to
52 general hospitals related to bad debt and charity care pursuant to
53 section twenty-eight hundred seven-k of this article. Funds shall be
54 deposited in the following amounts:
A. 4009--C 16
1 (i) fifty-seven and thirty-three-hundredths percent of the funds accu-
2 mulated for the period January first, nineteen hundred ninety-seven
3 through December thirty-first, nineteen hundred ninety-seven,
4 (ii) fifty-seven and one-hundredths percent of the funds accumulated
5 for the period January first, nineteen hundred ninety-eight through
6 December thirty-first, nineteen hundred ninety-eight,
7 (iii) fifty-five and thirty-two-hundredths percent of the funds accu-
8 mulated for the period January first, nineteen hundred ninety-nine
9 through December thirty-first, nineteen hundred ninety-nine, and
10 (iv) seven hundred sixty-five million dollars annually of the funds
11 accumulated for the periods January first, two thousand through December
12 thirty-first, two thousand [ten] THIRTEEN, and
13 (v) one hundred ninety-one million two hundred fifty thousand dollars
14 of the funds accumulated for the period January first, two thousand
15 [eleven] FOURTEEN through March thirty-first, two thousand [eleven]
16 FOURTEEN.
17 S 4. Section 34 of part A3 of chapter 62 of the laws of 2003, amending
18 the general business law and other laws relating to enacting major
19 components necessary to implement the state fiscal plan for the 2003-04
20 state fiscal year, as amended by section 3 of part B of chapter 58 of
21 the laws of 2008, is amended to read as follows:
22 S 34. (1) Notwithstanding any inconsistent provision of law, rule or
23 regulation and effective April 1, 2008 through March 31, [2011] 2014,
24 the commissioner of health is authorized to transfer and the state comp-
25 troller is authorized and directed to receive for deposit to the credit
26 of the department of health's special revenue fund - other, health care
27 reform act (HCRA) resources fund - 061, provider collection monitoring
28 account, within amounts appropriated each year, those funds collected
29 and accumulated pursuant to section 2807-v of the public health law,
30 including income from invested funds, for the purpose of payment for
31 administrative costs of the department of health related to adminis-
32 tration of statutory duties for the collections and distributions
33 authorized by section 2807-v of the public health law.
34 (2) Notwithstanding any inconsistent provision of law, rule or regu-
35 lation and effective April 1, 2008 through March 31, [2011] 2014, the
36 commissioner of health is authorized to transfer and the state comp-
37 troller is authorized and directed to receive for deposit to the credit
38 of the department of health's special revenue fund - other, health care
39 reform act (HCRA) resources fund - 061, provider collection monitoring
40 account, within amounts appropriated each year, those funds collected
41 and accumulated and interest earned through surcharges on payments for
42 health care services pursuant to section 2807-s of the public health law
43 and from assessments pursuant to section 2807-t of the public health law
44 for the purpose of payment for administrative costs of the department of
45 health related to administration of statutory duties for the collections
46 and distributions authorized by sections 2807-s, 2807-t, and 2807-m of
47 the public health law.
48 (3) Notwithstanding any inconsistent provision of law, rule or regu-
49 lation and effective April 1, 2008 through March 31, [2011] 2014, the
50 commissioner of health is authorized to transfer and the comptroller is
51 authorized to deposit, within amounts appropriated each year, those
52 funds authorized for distribution in accordance with the provisions of
53 paragraph (a) of subdivision 1 of section 2807-l of the public health
54 law for the purposes of payment for administrative costs of the depart-
55 ment of health related to the child health insurance plan program
56 authorized pursuant to title 1-A of article 25 of the public health law
A. 4009--C 17
1 into the special revenue funds - other, health care reform act (HCRA)
2 resources fund - 061, child health insurance account, established within
3 the department of health.
4 (4) Notwithstanding any inconsistent provision of law, rule or regu-
5 lation and effective April 1, 2008 through March 31, [2011] 2014, the
6 commissioner of health is authorized to transfer and the comptroller is
7 authorized to deposit, within amounts appropriated each year, those
8 funds authorized for distribution in accordance with the provisions of
9 paragraph (e) of subdivision 1 of section 2807-l of the public health
10 law for the purpose of payment for administrative costs of the depart-
11 ment of health related to the health occupation development and work-
12 place demonstration program established pursuant to section 2807-h and
13 the health workforce retraining program established pursuant to section
14 2807-g of the public health law into the special revenue funds - other,
15 health care reform act (HCRA) resources fund - 061, health occupation
16 development and workplace demonstration program account, established
17 within the department of health.
18 (5) Notwithstanding any inconsistent provision of law, rule or regu-
19 lation and effective April 1, 2008 through March 31, [2011] 2014, the
20 commissioner of health is authorized to transfer and the comptroller is
21 authorized to deposit, within amounts appropriated each year, those
22 funds allocated pursuant to paragraph (j) of subdivision 1 of section
23 2807-v of the public health law for the purpose of payment for adminis-
24 trative costs of the department of health related to administration of
25 the state's tobacco control programs and cancer services provided pursu-
26 ant to sections 2807-r and 1399-ii of the public health law into such
27 accounts established within the department of health for such purposes.
28 (6) Notwithstanding any inconsistent provision of law, rule or regu-
29 lation and effective April 1, 2008 through March 31, [2011] 2014, the
30 commissioner of health is authorized to transfer and the comptroller is
31 authorized to deposit, within amounts appropriated each year, the funds
32 authorized for distribution in accordance with the provisions of section
33 2807-l of the public health law for the purposes of payment for adminis-
34 trative costs of the department of health related to the programs funded
35 pursuant to section 2807-l of the public health law into the special
36 revenue funds - other, health care reform act (HCRA) resources fund -
37 061, pilot health insurance account, established within the department
38 of health.
39 (7) Notwithstanding any inconsistent provision of law, rule or regu-
40 lation and effective April 1, 2008 through March 31, [2011] 2014, the
41 commissioner of health is authorized to transfer and the comptroller is
42 authorized to deposit, within amounts appropriated each year, those
43 funds authorized for distribution in accordance with the provisions of
44 subparagraph (ii) of paragraph (f) of subdivision 19 of section 2807-c
45 of the public health law from monies accumulated and interest earned in
46 the bad debt and charity care and capital statewide pools through an
47 assessment charged to general hospitals pursuant to the provisions of
48 subdivision 18 of section 2807-c of the public health law and those
49 funds authorized for distribution in accordance with the provisions of
50 section 2807-l of the public health law for the purposes of payment for
51 administrative costs of the department of health related to programs
52 funded under section 2807-l of the public health law into the special
53 revenue funds - other, health care reform act (HCRA) resources fund -
54 061, primary care initiatives account, established within the department
55 of health.
A. 4009--C 18
1 (8) Notwithstanding any inconsistent provision of law, rule or regu-
2 lation and effective April 1, 2008 through March 31, [2011] 2014, the
3 commissioner of health is authorized to transfer and the comptroller is
4 authorized to deposit, within amounts appropriated each year, those
5 funds authorized for distribution in accordance with section 2807-l of
6 the public health law for the purposes of payment for administrative
7 costs of the department of health related to programs funded under
8 section 2807-l of the public health law into the special revenue funds -
9 other, health care reform act (HCRA) resources fund - 061, health care
10 delivery administration account, established within the department of
11 health.
12 (9) Notwithstanding any inconsistent provision of law, rule or regu-
13 lation and effective April 1, 2008 through March 31, [2011] 2014, the
14 commissioner of health is authorized to transfer and the comptroller is
15 authorized to deposit, within amounts appropriated each year, those
16 funds authorized pursuant to sections 2807-d, 3614-a and 3614-b of the
17 public health law and section 367-i of the social services law and for
18 distribution in accordance with the provisions of subdivision 9 of
19 section 2807-j of the public health law for the purpose of payment for
20 administration of statutory duties for the collections and distributions
21 authorized by sections 2807-c, 2807-d, 2807-j, 2807-k, 2807-l, 3614-a
22 and 3614-b of the public health law and section 367-i of the social
23 services law into the special revenue funds - other, health care reform
24 act (HCRA) resources fund - 061, provider collection monitoring account,
25 established within the department of health.
26 S 5. Subparagraphs (xiv) and (xv) of paragraph (a) of subdivision 6 of
27 section 2807-s of the public health law, as amended by section 4 of part
28 I of chapter 2 of the laws of 2009, are amended to read as follows:
29 (xiv) A gross annual statewide amount for the period January first,
30 two thousand nine through December thirty-first, two thousand [ten]
31 THIRTEEN, shall be nine hundred [thirty-nine] FORTY-FOUR million
32 dollars.
33 (xv) A gross statewide amount for the period January first, two thou-
34 sand [eleven] FOURTEEN through March thirty-first, two thousand [eleven]
35 FOURTEEN, shall be two hundred [thirty-four] THIRTY-SIX million [seven
36 hundred fifty thousand] dollars.
37 S 5-a. Subparagraphs (iv) and (v) of paragraph (c) of subdivision 6 of
38 section 2807-s of the public health law, as amended by section 12 of
39 part B of chapter 58 of the laws of 2008, are amended to read as
40 follows:
41 (iv) A further gross annual statewide amount for two thousand, two
42 thousand one, two thousand two, two thousand three, two thousand four,
43 two thousand five, two thousand six, two thousand seven, two thousand
44 eight, two thousand nine [and], two thousand ten, TWO THOUSAND ELEVEN,
45 TWO THOUSAND TWELVE AND TWO THOUSAND THIRTEEN shall be eighty-nine
46 million dollars.
47 (v) A further gross statewide amount for the period January first, two
48 thousand [eleven] FOURTEEN through March thirty-first, two thousand
49 [eleven] FOURTEEN, shall be twenty-two million two hundred fifty thou-
50 sand dollars.
51 S 5-b. Subparagraphs (i) and (ii) of paragraph (e) of subdivision 6 of
52 section 2807-s of the public health law, as amended by section 13 of
53 part B of chapter 58 of the laws of 2008, are amended to read as
54 follows:
A. 4009--C 19
1 (i) A further gross annual statewide amount shall be twelve million
2 dollars for each period prior to January first, two thousand [eleven]
3 FOURTEEN.
4 (ii) A further gross statewide amount for the period January first,
5 two thousand [eleven] FOURTEEN through March thirty-first, two thousand
6 [eleven] FOURTEEN shall be three million dollars.
7 S 6. Intentionally omitted.
8 S 7. Section 2807-l of the public health law, as amended by section 4
9 of part B of chapter 58 of the laws of 2008, clause (A) of subparagraph
10 (i) of paragraph (b) of subdivision 1 as amended by section 51 of part B
11 and paragraph (n) of subdivision 1 as amended by section 9 of part C of
12 chapter 58 of the laws of 2009, subparagraph (iv) of paragraph (c) of
13 subdivision 1 as amended by section 13 of part B of chapter 109 of the
14 laws of 2010, is amended to read as follows:
15 S 2807-l. Health care initiatives pool distributions. 1. Funds accumu-
16 lated in the health care initiatives pools pursuant to paragraph (b) of
17 subdivision nine of section twenty-eight hundred seven-j of this arti-
18 cle, or the health care reform act (HCRA) resources fund established
19 pursuant to section ninety-two-dd of the state finance law, whichever is
20 applicable, including income from invested funds, shall be distributed
21 or retained by the commissioner or by the state comptroller, as applica-
22 ble, in accordance with the following.
23 (a) Funds shall be reserved and accumulated from year to year and
24 shall be available, including income from invested funds, for purposes
25 of distributions to programs to provide health care coverage for unin-
26 sured or underinsured children pursuant to sections twenty-five hundred
27 ten and twenty-five hundred eleven of this chapter from the respective
28 health care initiatives pools established for the following periods in
29 the following amounts:
30 (i) from the pool for the period January first, nineteen hundred nine-
31 ty-seven through December thirty-first, nineteen hundred ninety-seven,
32 up to one hundred twenty million six hundred thousand dollars;
33 (ii) from the pool for the period January first, nineteen hundred
34 ninety-eight through December thirty-first, nineteen hundred ninety-
35 eight, up to one hundred sixty-four million five hundred thousand
36 dollars;
37 (iii) from the pool for the period January first, nineteen hundred
38 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
39 up to one hundred eighty-one million dollars;
40 (iv) from the pool for the period January first, two thousand through
41 December thirty-first, two thousand, two hundred seven million dollars;
42 (v) from the pool for the period January first, two thousand one
43 through December thirty-first, two thousand one, two hundred thirty-five
44 million dollars;
45 (vi) from the pool for the period January first, two thousand two
46 through December thirty-first, two thousand two, three hundred twenty-
47 four million dollars;
48 (vii) from the pool for the period January first, two thousand three
49 through December thirty-first, two thousand three, up to four hundred
50 fifty million three hundred thousand dollars;
51 (viii) from the pool for the period January first, two thousand four
52 through December thirty-first, two thousand four, up to four hundred
53 sixty million nine hundred thousand dollars;
54 (ix) from the pool or the health care reform act (HCRA) resources
55 fund, whichever is applicable, for the period January first, two thou-
A. 4009--C 20
1 sand five through December thirty-first, two thousand five, up to one
2 hundred fifty-three million eight hundred thousand dollars;
3 (x) from the health care reform act (HCRA) resources fund for the
4 period January first, two thousand six through December thirty-first,
5 two thousand six, up to three hundred twenty-five million four hundred
6 thousand dollars;
7 (xi) from the health care reform act (HCRA) resources fund for the
8 period January first, two thousand seven through December thirty-first,
9 two thousand seven, up to four hundred twenty-eight million fifty-nine
10 thousand dollars;
11 (xii) from the health care reform act (HCRA) resources fund for the
12 period January first, two thousand eight through December thirty-first,
13 two thousand ten, up to four hundred fifty-three million six hundred
14 seventy-four thousand dollars annually; [and]
15 (xiii) from the health care reform act (HCRA) resources fund for the
16 period January first, two thousand eleven, through March thirty-first,
17 two thousand eleven, up to one hundred thirteen million four hundred
18 eighteen thousand dollars[.];
19 (XIV) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
20 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN, THROUGH MARCH THIRTY-FIRST, TWO
21 THOUSAND TWELVE, UP TO THREE HUNDRED TWENTY-FOUR MILLION SEVEN HUNDRED
22 FORTY-FOUR THOUSAND DOLLARS;
23 (XV) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
24 PERIOD APRIL FIRST, TWO THOUSAND TWELVE, THROUGH MARCH THIRTY-FIRST, TWO
25 THOUSAND THIRTEEN, UP TO THREE HUNDRED FORTY-SIX MILLION FOUR HUNDRED
26 FORTY-FOUR THOUSAND DOLLARS; AND
27 (XVI) FROM THE HEALTH CARE REFORM ACT (HCRA) RESOURCES FUND FOR THE
28 PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN, THROUGH MARCH THIRTY-FIRST,
29 TWO THOUSAND FOURTEEN, UP TO THREE HUNDRED SEVENTY MILLION SIX HUNDRED
30 NINETY-FIVE THOUSAND DOLLARS.
31 (b) Funds shall be reserved and accumulated from year to year and
32 shall be available, including income from invested funds, for purposes
33 of distributions for health insurance programs under the individual
34 subsidy programs established pursuant to the expanded health care cover-
35 age act of nineteen hundred eighty-eight as amended, and for evaluation
36 of such programs from the respective health care initiatives pools or
37 the health care reform act (HCRA) resources fund, whichever is applica-
38 ble, established for the following periods in the following amounts:
39 (i) (A) an amount not to exceed six million dollars on an annualized
40 basis for the periods January first, nineteen hundred ninety-seven
41 through December thirty-first, nineteen hundred ninety-nine; up to six
42 million dollars for the period January first, two thousand through
43 December thirty-first, two thousand; up to five million dollars for the
44 period January first, two thousand one through December thirty-first,
45 two thousand one; up to four million dollars for the period January
46 first, two thousand two through December thirty-first, two thousand two;
47 up to two million six hundred thousand dollars for the period January
48 first, two thousand three through December thirty-first, two thousand
49 three; up to one million three hundred thousand dollars for the period
50 January first, two thousand four through December thirty-first, two
51 thousand four; up to six hundred seventy thousand dollars for the period
52 January first, two thousand five through June thirtieth, two thousand
53 five; up to one million three hundred thousand dollars for the period
54 April first, two thousand six through March thirty-first, two thousand
55 seven; and up to one million three hundred thousand dollars annually for
56 the period April first, two thousand seven through March thirty-first,
A. 4009--C 21
1 two thousand nine, shall be allocated to individual subsidy programs;
2 and
3 (B) an amount not to exceed seven million dollars on an annualized
4 basis for the periods during the period January first, nineteen hundred
5 ninety-seven through December thirty-first, nineteen hundred ninety-nine
6 and four million dollars annually for the periods January first, two
7 thousand through December thirty-first, two thousand two, and three
8 million dollars for the period January first, two thousand three through
9 December thirty-first, two thousand three, and two million dollars for
10 the period January first, two thousand four through December thirty-
11 first, two thousand four, and two million dollars for the period January
12 first, two thousand five through June thirtieth, two thousand five shall
13 be allocated to the catastrophic health care expense program.
14 (ii) Notwithstanding any law to the contrary, the characterizations of
15 the New York state small business health insurance partnership program
16 as in effect prior to June thirtieth, two thousand three, voucher
17 program as in effect prior to December thirty-first, two thousand one,
18 individual subsidy program as in effect prior to June thirtieth, two
19 thousand five, and catastrophic health care expense program, as in
20 effect prior to June thirtieth, two thousand five, may, for the purposes
21 of identifying matching funds for the community health care conversion
22 demonstration project described in a waiver of the provisions of title
23 XIX of the federal social security act granted to the state of New York
24 and dated July fifteenth, nineteen hundred ninety-seven, may continue to
25 be used to characterize the insurance programs in sections four thousand
26 three hundred twenty-one-a, four thousand three hundred twenty-two-a,
27 four thousand three hundred twenty-six and four thousand three hundred
28 twenty-seven of the insurance law, which are successor programs to these
29 programs.
30 (c) Up to seventy-eight million dollars shall be reserved and accumu-
31 lated from year to year from the pool for the period January first,
32 nineteen hundred ninety-seven through December thirty-first, nineteen
33 hundred ninety-seven, for purposes of public health programs, up to
34 seventy-six million dollars shall be reserved and accumulated from year
35 to year from the pools for the periods January first, nineteen hundred
36 ninety-eight through December thirty-first, nineteen hundred ninety-
37 eight and January first, nineteen hundred ninety-nine through December
38 thirty-first, nineteen hundred ninety-nine, up to eighty-four million
39 dollars shall be reserved and accumulated from year to year from the
40 pools for the period January first, two thousand through December thir-
41 ty-first, two thousand, up to eighty-five million dollars shall be
42 reserved and accumulated from year to year from the pools for the period
43 January first, two thousand one through December thirty-first, two thou-
44 sand one, up to eighty-six million dollars shall be reserved and accumu-
45 lated from year to year from the pools for the period January first, two
46 thousand two through December thirty-first, two thousand two, up to
47 eighty-six million one hundred fifty thousand dollars shall be reserved
48 and accumulated from year to year from the pools for the period January
49 first, two thousand three through December thirty-first, two thousand
50 three, up to fifty-eight million seven hundred eighty thousand dollars
51 shall be reserved and accumulated from year to year from the pools for
52 the period January first, two thousand four through December thirty-
53 first, two thousand four, up to sixty-eight million seven hundred thirty
54 thousand dollars shall be reserved and accumulated from year to year
55 from the pools or the health care reform act (HCRA) resources fund,
56 whichever is applicable, for the period January first, two thousand five
A. 4009--C 22
1 through December thirty-first, two thousand five, up to ninety-four
2 million three hundred fifty thousand dollars shall be reserved and accu-
3 mulated from year to year from the health care reform act (HCRA)
4 resources fund for the period January first, two thousand six through
5 December thirty-first, two thousand six, up to seventy million nine
6 hundred thirty-nine thousand dollars shall be reserved and accumulated
7 from year to year from the health care reform act (HCRA) resources fund
8 for the period January first, two thousand seven through December thir-
9 ty-first, two thousand seven, up to fifty-five million six hundred
10 eighty-nine thousand dollars annually shall be reserved and accumulated
11 from year to year from the health care reform act (HCRA) resources fund
12 for the period January first, two thousand eight through December thir-
13 ty-first, two thousand ten, [and] up to thirteen million nine hundred
14 twenty-two thousand dollars shall be reserved and accumulated from year
15 to year from the health care reform act (HCRA) resources fund for the
16 period January first, two thousand eleven through March thirty-first,
17 two thousand eleven, AND FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOU-
18 SAND ELEVEN, UP TO FUNDING AMOUNTS SPECIFIED BELOW and shall be avail-
19 able, including income from invested funds, for:
20 (i) deposit by the commissioner, within amounts appropriated, and the
21 state comptroller is hereby authorized and directed to receive for
22 deposit to, to the credit of the department of health's special revenue
23 fund - other, hospital based grants program account or the health care
24 reform act (HCRA) resources fund, whichever is applicable, for purposes
25 of services and expenses related to general hospital based grant
26 programs, up to twenty-two million dollars annually from the nineteen
27 hundred ninety-seven pool, nineteen hundred ninety-eight pool, nineteen
28 hundred ninety-nine pool, two thousand pool, two thousand one pool and
29 two thousand two pool, respectively, up to twenty-two million dollars
30 from the two thousand three pool, up to ten million dollars for the
31 period January first, two thousand four through December thirty-first,
32 two thousand four, up to eleven million dollars for the period January
33 first, two thousand five through December thirty-first, two thousand
34 five, up to twenty-two million dollars for the period January first, two
35 thousand six through December thirty-first, two thousand six, up to
36 twenty-two million ninety-seven thousand dollars annually for the period
37 January first, two thousand seven through December thirty-first, two
38 thousand ten, [and] up to five million five hundred twenty-four thousand
39 dollars for the period January first, two thousand eleven through March
40 thirty-first, two thousand eleven, UP TO THIRTEEN MILLION FOUR HUNDRED
41 FORTY-FIVE THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND
42 ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, AND UP TO THIR-
43 TEEN MILLION THREE HUNDRED SEVENTY-FIVE THOUSAND DOLLARS EACH STATE
44 FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH
45 MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
46 (ii) deposit by the commissioner, within amounts appropriated, and the
47 state comptroller is hereby authorized and directed to receive for
48 deposit to, to the credit of the emergency medical services training
49 account established in section ninety-seven-q of the state finance law
50 or the health care reform act (HCRA) resources fund, whichever is appli-
51 cable, up to sixteen million dollars on an annualized basis for the
52 periods January first, nineteen hundred ninety-seven through December
53 thirty-first, nineteen hundred ninety-nine, up to twenty million dollars
54 for the period January first, two thousand through December thirty-
55 first, two thousand, up to twenty-one million dollars for the period
56 January first, two thousand one through December thirty-first, two thou-
A. 4009--C 23
1 sand one, up to twenty-two million dollars for the period January first,
2 two thousand two through December thirty-first, two thousand two, up to
3 twenty-two million five hundred fifty thousand dollars for the period
4 January first, two thousand three through December thirty-first, two
5 thousand three, up to nine million six hundred eighty thousand dollars
6 for the period January first, two thousand four through December thir-
7 ty-first, two thousand four, up to twelve million one hundred thirty
8 thousand dollars for the period January first, two thousand five through
9 December thirty-first, two thousand five, up to twenty-four million two
10 hundred fifty thousand dollars for the period January first, two thou-
11 sand six through December thirty-first, two thousand six, up to twenty
12 million four hundred ninety-two thousand dollars annually for the period
13 January first, two thousand seven through December thirty-first, two
14 thousand ten, [and] up to five million one hundred twenty-three thousand
15 dollars for the period January first, two thousand eleven through March
16 thirty-first, two thousand eleven, UP TO EIGHTEEN MILLION THREE HUNDRED
17 FIFTY THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
18 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO EIGHTEEN MILLION
19 NINE HUNDRED FIFTY THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO
20 THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND
21 UP TO NINETEEN MILLION FOUR HUNDRED NINETEEN THOUSAND DOLLARS FOR THE
22 PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST,
23 TWO THOUSAND FOURTEEN;
24 (iii) priority distributions by the commissioner up to thirty-two
25 million dollars on an annualized basis for the period January first, two
26 thousand through December thirty-first, two thousand four, up to thir-
27 ty-eight million dollars on an annualized basis for the period January
28 first, two thousand five through December thirty-first, two thousand
29 six, up to eighteen million two hundred fifty thousand dollars for the
30 period January first, two thousand seven through December thirty-first,
31 two thousand seven, up to three million dollars annually for the period
32 January first, two thousand eight through December thirty-first, two
33 thousand ten, [and] up to seven hundred fifty thousand dollars for the
34 period January first, two thousand eleven through March thirty-first,
35 two thousand eleven, AND UP TO TWO MILLION NINE HUNDRED THOUSAND DOLLARS
36 EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
37 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN to be allocated (A)
38 for the purposes established pursuant to subparagraph (ii) of paragraph
39 (f) of subdivision nineteen of section twenty-eight hundred seven-c of
40 this article as in effect on December thirty-first, nineteen hundred
41 ninety-six and as may thereafter be amended, up to fifteen million
42 dollars annually for the periods January first, two thousand through
43 December thirty-first, two thousand four, up to twenty-one million
44 dollars annually for the period January first, two thousand five through
45 December thirty-first, two thousand six, and up to seven million five
46 hundred thousand dollars for the period January first, two thousand
47 seven through March thirty-first, two thousand seven;
48 (B) pursuant to a memorandum of understanding entered into by the
49 commissioner, the majority leader of the senate and the speaker of the
50 assembly, for the purposes outlined in such memorandum upon the recom-
51 mendation of the majority leader of the senate, up to eight million
52 five hundred thousand dollars annually for the period January first, two
53 thousand through December thirty-first, two thousand six, and up to four
54 million two hundred fifty thousand dollars for the period January first,
55 two thousand seven through June thirtieth, two thousand seven, and for
56 the purposes outlined in such memorandum upon the recommendation of the
A. 4009--C 24
1 speaker of the assembly, up to eight million five hundred thousand
2 dollars annually for the periods January first, two thousand through
3 December thirty-first, two thousand six, and up to four million two
4 hundred fifty thousand dollars for the period January first, two thou-
5 sand seven through June thirtieth, two thousand seven; and
6 (C) for services and expenses, including grants, related to emergency
7 assistance distributions as designated by the commissioner. Notwith-
8 standing section one hundred twelve or one hundred sixty-three of the
9 state finance law or any other contrary provision of law, such distrib-
10 utions shall be limited to providers or programs where, as determined by
11 the commissioner, emergency assistance is vital to protect the life or
12 safety of patients, to ensure the retention of facility caregivers or
13 other staff, or in instances where health facility operations are jeop-
14 ardized, or where the public health is jeopardized or other emergency
15 situations exist, up to three million dollars annually for the period
16 April first, two thousand seven through March thirty-first, two thousand
17 eleven, AND UP TO TWO MILLION NINE HUNDRED THOUSAND DOLLARS EACH STATE
18 FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
19 MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN. Upon any distribution of
20 such funds, the commissioner shall immediately notify the chair and
21 ranking minority member of the senate finance committee, the assembly
22 ways and means committee, the senate committee on health, and the assem-
23 bly committee on health;
24 (iv) distributions by the commissioner related to poison control
25 centers pursuant to subdivision seven of section twenty-five hundred-d
26 of this chapter, up to five million dollars for the period January
27 first, nineteen hundred ninety-seven through December thirty-first,
28 nineteen hundred ninety-seven, up to three million dollars on an annual-
29 ized basis for the periods during the period January first, nineteen
30 hundred ninety-eight through December thirty-first, nineteen hundred
31 ninety-nine, up to five million dollars annually for the periods January
32 first, two thousand through December thirty-first, two thousand two, up
33 to four million six hundred thousand dollars annually for the periods
34 January first, two thousand three through December thirty-first, two
35 thousand four, up to five million one hundred thousand dollars for the
36 period January first, two thousand five through December thirty-first,
37 two thousand six annually, up to five million one hundred thousand
38 dollars annually for the period January first, two thousand seven
39 through December thirty-first, two thousand nine, up to three million
40 six hundred thousand dollars for the period January first, two thousand
41 ten through December thirty-first, two thousand ten, [and] up to seven
42 hundred seventy-five thousand dollars for the period January first, two
43 thousand eleven through March thirty-first, two thousand eleven, AND UP
44 TO TWO MILLION FIVE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR
45 THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
46 TWO THOUSAND FOURTEEN; and
47 (v) deposit by the commissioner, within amounts appropriated, and the
48 state comptroller is hereby authorized and directed to receive for
49 deposit to, to the credit of the department of health's special revenue
50 fund - other, miscellaneous special revenue fund - 339 maternal and
51 child HIV services account or the health care reform act (HCRA)
52 resources fund, whichever is applicable, for purposes of a special
53 program for HIV services for [infants and pregnant] women AND CHILDREN,
54 INCLUDING ADOLESCENTS pursuant to section [seventy-one of chapter seven
55 hundred thirty-one of the laws of nineteen hundred ninety-three, amend-
56 ing] TWENTY-FIVE HUNDRED-F-ONE OF the public health law [and other laws
A. 4009--C 25
1 relating to reimbursement, delivery and capital costs of ambulatory
2 health care services and inpatient hospital services], up to five
3 million dollars annually for the periods January first, two thousand
4 through December thirty-first, two thousand two, up to five million
5 dollars for the period January first, two thousand three through Decem-
6 ber thirty-first, two thousand three, up to two million five hundred
7 thousand dollars for the period January first, two thousand four through
8 December thirty-first, two thousand four, up to two million five hundred
9 thousand dollars for the period January first, two thousand five through
10 December thirty-first, two thousand five, up to five million dollars for
11 the period January first, two thousand six through December thirty-
12 first, two thousand six, up to five million dollars annually for the
13 period January first, two thousand seven through December thirty-first,
14 two thousand ten, [and] up to one million two hundred fifty thousand
15 dollars for the period January first, two thousand eleven through March
16 thirty-first, two thousand eleven, AND UP TO FIVE MILLION DOLLARS EACH
17 STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
18 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
19 (d) (i) An amount of up to twenty million dollars annually for the
20 period January first, two thousand through December thirty-first, two
21 thousand six, up to ten million dollars for the period January first,
22 two thousand seven through June thirtieth, two thousand seven, up to
23 twenty million dollars annually for the period January first, two thou-
24 sand eight through December thirty-first, two thousand ten, [and] up to
25 five million dollars for the period January first, two thousand eleven
26 through March thirty-first, two thousand eleven, AND UP TO NINETEEN
27 MILLION SIX HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
28 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
29 THOUSAND FOURTEEN, shall be transferred to the health facility restruc-
30 turing pool established pursuant to section twenty-eight hundred fifteen
31 of this article;
32 (ii) provided, however, amounts transferred pursuant to subparagraph
33 (i) of this paragraph may be reduced in an amount to be approved by the
34 director of the budget to reflect the amount received from the federal
35 government under the state's 1115 waiver which is directed under its
36 terms and conditions to the health facility restructuring program.
37 (e) Funds shall be reserved and accumulated from year to year and
38 shall be available, including income from invested funds, for purposes
39 of distributions to organizations to support the health workforce
40 retraining program established pursuant to section twenty-eight hundred
41 seven-g of this article from the respective health care initiatives
42 pools established for the following periods in the following amounts
43 from the pools or the health care reform act (HCRA) resources fund,
44 whichever is applicable, during the period January first, nineteen
45 hundred ninety-seven through December thirty-first, nineteen hundred
46 ninety-nine, up to fifty million dollars on an annualized basis, up to
47 thirty million dollars for the period January first, two thousand
48 through December thirty-first, two thousand, up to forty million dollars
49 for the period January first, two thousand one through December thirty-
50 first, two thousand one, up to fifty million dollars for the period
51 January first, two thousand two through December thirty-first, two thou-
52 sand two, up to forty-one million one hundred fifty thousand dollars for
53 the period January first, two thousand three through December thirty-
54 first, two thousand three, up to forty-one million one hundred fifty
55 thousand dollars for the period January first, two thousand four through
56 December thirty-first, two thousand four, up to fifty-eight million
A. 4009--C 26
1 three hundred sixty thousand dollars for the period January first, two
2 thousand five through December thirty-first, two thousand five, up to
3 fifty-two million three hundred sixty thousand dollars for the period
4 January first, two thousand six through December thirty-first, two thou-
5 sand six, up to thirty-five million four hundred thousand dollars annu-
6 ally for the period January first, two thousand seven through December
7 thirty-first, two thousand ten [and], up to eight million eight hundred
8 fifty thousand dollars for the period January first, two thousand eleven
9 through March thirty-first, two thousand eleven, AND UP TO TWENTY-EIGHT
10 MILLION FOUR HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
11 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
12 THOUSAND FOURTEEN, less the amount of funds available for allocations
13 for rate adjustments for workforce training programs for payments by
14 state governmental agencies for inpatient hospital services.
15 (f) Funds shall be accumulated and transferred from as follows:
16 (i) from the pool for the period January first, nineteen hundred nine-
17 ty-seven through December thirty-first, nineteen hundred ninety-seven,
18 (A) thirty-four million six hundred thousand dollars shall be trans-
19 ferred to funds reserved and accumulated pursuant to paragraph (b) of
20 subdivision nineteen of section twenty-eight hundred seven-c of this
21 article, and (B) eighty-two million dollars shall be transferred and
22 deposited and credited to the credit of the state general fund medical
23 assistance local assistance account;
24 (ii) from the pool for the period January first, nineteen hundred
25 ninety-eight through December thirty-first, nineteen hundred ninety-
26 eight, eighty-two million dollars shall be transferred and deposited and
27 credited to the credit of the state general fund medical assistance
28 local assistance account;
29 (iii) from the pool for the period January first, nineteen hundred
30 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
31 eighty-two million dollars shall be transferred and deposited and cred-
32 ited to the credit of the state general fund medical assistance local
33 assistance account;
34 (iv) from the pool or the health care reform act (HCRA) resources
35 fund, whichever is applicable, for the period January first, two thou-
36 sand through December thirty-first, two thousand four, eighty-two
37 million dollars annually, and for the period January first, two thousand
38 five through December thirty-first, two thousand five, eighty-two
39 million dollars, and for the period January first, two thousand six
40 through December thirty-first, two thousand six, eighty-two million
41 dollars, and for the period January first, two thousand seven through
42 December thirty-first, two thousand seven, eighty-two million dollars,
43 and for the period January first, two thousand eight through December
44 thirty-first, two thousand eight, ninety million seven hundred thousand
45 dollars shall be deposited by the commissioner, and the state comp-
46 troller is hereby authorized and directed to receive for deposit to the
47 credit of the state special revenue fund - other, HCRA transfer fund,
48 medical assistance account;
49 (v) from the health care reform act (HCRA) resources fund for the
50 period January first, two thousand nine through December thirty-first,
51 two thousand nine, one hundred eight million nine hundred seventy-five
52 thousand dollars, and for the period January first, two thousand ten
53 through December thirty-first, two thousand ten, one hundred twenty-six
54 million one hundred thousand dollars, [and] for the period January
55 first, two thousand eleven through March thirty-first, two thousand
56 eleven, twenty million five hundred thousand dollars, AND FOR EACH STATE
A. 4009--C 27
1 FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
2 MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, ONE HUNDRED FORTY-SIX MILLION
3 FOUR HUNDRED THOUSAND DOLLARS, shall be deposited by the commissioner,
4 and the state comptroller is hereby authorized and directed to receive
5 for deposit, to the credit of the state special revenue fund - other,
6 HCRA transfer fund, medical assistance account.
7 (g) Funds shall be transferred to primary health care services pools
8 created by the commissioner, and shall be available, including income
9 from invested funds, for distributions in accordance with former section
10 twenty-eight hundred seven-bb of this article from the respective health
11 care initiatives pools for the following periods in the following
12 percentage amounts of funds remaining after allocations in accordance
13 with paragraphs (a) through (f) of this subdivision:
14 (i) from the pool for the period January first, nineteen hundred nine-
15 ty-seven through December thirty-first, nineteen hundred ninety-seven,
16 fifteen and eighty-seven-hundredths percent;
17 (ii) from the pool for the period January first, nineteen hundred
18 ninety-eight through December thirty-first, nineteen hundred ninety-
19 eight, fifteen and eighty-seven-hundredths percent; and
20 (iii) from the pool for the period January first, nineteen hundred
21 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
22 sixteen and thirteen-hundredths percent.
23 (h) Funds shall be reserved and accumulated from year to year by the
24 commissioner and shall be available, including income from invested
25 funds, for purposes of primary care education and training pursuant to
26 article nine of this chapter from the respective health care initiatives
27 pools established for the following periods in the following percentage
28 amounts of funds remaining after allocations in accordance with para-
29 graphs (a) through (f) of this subdivision and shall be available for
30 distributions as follows:
31 (i) funds shall be reserved and accumulated:
32 (A) from the pool for the period January first, nineteen hundred nine-
33 ty-seven through December thirty-first, nineteen hundred ninety-seven,
34 six and thirty-five-hundredths percent;
35 (B) from the pool for the period January first, nineteen hundred nine-
36 ty-eight through December thirty-first, nineteen hundred ninety-eight,
37 six and thirty-five-hundredths percent; and
38 (C) from the pool for the period January first, nineteen hundred nine-
39 ty-nine through December thirty-first, nineteen hundred ninety-nine, six
40 and forty-five-hundredths percent;
41 (ii) funds shall be available for distributions including income from
42 invested funds as follows:
43 (A) for purposes of the primary care physician loan repayment program
44 in accordance with section nine hundred three of this chapter, up to
45 five million dollars on an annualized basis;
46 (B) for purposes of the primary care practitioner scholarship program
47 in accordance with section nine hundred four of this chapter, up to two
48 million dollars on an annualized basis;
49 (C) for purposes of minority participation in medical education grants
50 in accordance with section nine hundred six of this chapter, up to one
51 million dollars on an annualized basis; and
52 (D) provided, however, that the commissioner may reallocate any funds
53 remaining or unallocated for distributions for the primary care practi-
54 tioner scholarship program in accordance with section nine hundred four
55 of this chapter.
A. 4009--C 28
1 (i) Funds shall be reserved and accumulated from year to year and
2 shall be available, including income from invested funds, for distrib-
3 utions in accordance with section twenty-nine hundred fifty-two and
4 section twenty-nine hundred fifty-eight of this chapter for rural health
5 care delivery development and rural health care access development,
6 respectively, from the respective health care initiatives pools or the
7 health care reform act (HCRA) resources fund, whichever is applicable,
8 for the following periods in the following percentage amounts of funds
9 remaining after allocations in accordance with paragraphs (a) through
10 (f) of this subdivision, and for periods on and after January first, two
11 thousand, in the following amounts:
12 (i) from the pool for the period January first, nineteen hundred nine-
13 ty-seven through December thirty-first, nineteen hundred ninety-seven,
14 thirteen and forty-nine-hundredths percent;
15 (ii) from the pool for the period January first, nineteen hundred
16 ninety-eight through December thirty-first, nineteen hundred ninety-
17 eight, thirteen and forty-nine-hundredths percent;
18 (iii) from the pool for the period January first, nineteen hundred
19 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
20 thirteen and seventy-one-hundredths percent;
21 (iv) from the pool for the periods January first, two thousand through
22 December thirty-first, two thousand two, seventeen million dollars annu-
23 ally, and for the period January first, two thousand three through
24 December thirty-first, two thousand three, up to fifteen million eight
25 hundred fifty thousand dollars;
26 (v) from the pool or the health care reform act (HCRA) resources fund,
27 whichever is applicable, for the period January first, two thousand four
28 through December thirty-first, two thousand four, up to fifteen million
29 eight hundred fifty thousand dollars, and for the period January first,
30 two thousand five through December thirty-first, two thousand five, up
31 to nineteen million two hundred thousand dollars, and for the period
32 January first, two thousand six through December thirty-first, two thou-
33 sand six, up to nineteen million two hundred thousand dollars, for the
34 period January first, two thousand seven through December thirty-first,
35 two thousand ten, up to eighteen million one hundred fifty thousand
36 dollars annually, [and] for the period January first, two thousand elev-
37 en through March thirty-first, two thousand eleven, up to four million
38 five hundred thirty-eight thousand dollars, AND FOR EACH STATE FISCAL
39 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
40 TY-FIRST, TWO THOUSAND FOURTEEN, UP TO SIXTEEN MILLION TWO HUNDRED THOU-
41 SAND DOLLARS.
42 (j) Funds shall be reserved and accumulated from year to year and
43 shall be available, including income from invested funds, for purposes
44 of distributions related to health information and health care quality
45 improvement pursuant to former section twenty-eight hundred seven-n of
46 this article from the respective health care initiatives pools estab-
47 lished for the following periods in the following percentage amounts of
48 funds remaining after allocations in accordance with paragraphs (a)
49 through (f) of this subdivision:
50 (i) from the pool for the period January first, nineteen hundred nine-
51 ty-seven through December thirty-first, nineteen hundred ninety-seven,
52 six and thirty-five-hundredths percent;
53 (ii) from the pool for the period January first, nineteen hundred
54 ninety-eight through December thirty-first, nineteen hundred ninety-
55 eight, six and thirty-five-hundredths percent; and
A. 4009--C 29
1 (iii) from the pool for the period January first, nineteen hundred
2 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
3 six and forty-five-hundredths percent.
4 (k) Funds shall be reserved and accumulated from year to year and
5 shall be available, including income from invested funds, for allo-
6 cations and distributions in accordance with section twenty-eight
7 hundred seven-p of this article for diagnostic and treatment center
8 uncompensated care from the respective health care initiatives pools or
9 the health care reform act (HCRA) resources fund, whichever is applica-
10 ble, for the following periods in the following percentage amounts of
11 funds remaining after allocations in accordance with paragraphs (a)
12 through (f) of this subdivision, and for periods on and after January
13 first, two thousand, in the following amounts:
14 (i) from the pool for the period January first, nineteen hundred nine-
15 ty-seven through December thirty-first, nineteen hundred ninety-seven,
16 thirty-eight and one-tenth percent;
17 (ii) from the pool for the period January first, nineteen hundred
18 ninety-eight through December thirty-first, nineteen hundred ninety-
19 eight, thirty-eight and one-tenth percent;
20 (iii) from the pool for the period January first, nineteen hundred
21 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
22 thirty-eight and seventy-one-hundredths percent;
23 (iv) from the pool for the periods January first, two thousand through
24 December thirty-first, two thousand two, forty-eight million dollars
25 annually, and for the period January first, two thousand three through
26 June thirtieth, two thousand three, twenty-four million dollars;
27 (v) (A) from the pool or the health care reform act (HCRA) resources
28 fund, whichever is applicable, for the period July first, two thousand
29 three through December thirty-first, two thousand three, up to six
30 million dollars, for the period January first, two thousand four through
31 December thirty-first, two thousand six, up to twelve million dollars
32 annually, for the period January first, two thousand seven through
33 December thirty-first, two thousand [ten] THIRTEEN, up to forty-eight
34 million dollars annually, and for the period January first, two thousand
35 [eleven] FOURTEEN through March thirty-first, two thousand [eleven]
36 FOURTEEN, up to twelve million dollars;
37 (B) from the health care reform act (HCRA) resources fund for the
38 period January first, two thousand six through December thirty-first,
39 two thousand six, an additional seven million five hundred thousand
40 dollars, for the period January first, two thousand seven through Decem-
41 ber thirty-first, two thousand [ten] THIRTEEN, an additional seven
42 million five hundred thousand dollars annually, and for the period Janu-
43 ary first, two thousand [eleven] FOURTEEN through March thirty-first,
44 two thousand [eleven] FOURTEEN, an additional one million eight hundred
45 seventy-five thousand dollars, for voluntary non-profit diagnostic and
46 treatment center uncompensated care in accordance with subdivision
47 four-c of section twenty-eight hundred seven-p of this article; and
48 (vi) funds reserved and accumulated pursuant to this paragraph for
49 periods on and after July first, two thousand three, shall be deposited
50 by the commissioner, within amounts appropriated, and the state comp-
51 troller is hereby authorized and directed to receive for deposit to the
52 credit of the state special revenue funds - other, HCRA transfer fund,
53 medical assistance account, for purposes of funding the state share of
54 rate adjustments made pursuant to section twenty-eight hundred seven-p
55 of this article, provided, however, that in the event federal financial
56 participation is not available for rate adjustments made pursuant to
A. 4009--C 30
1 paragraph (b) of subdivision one of section twenty-eight hundred seven-p
2 of this article, funds shall be distributed pursuant to paragraph (a) of
3 subdivision one of section twenty-eight hundred seven-p of this article
4 from the respective health care initiatives pools or the health care
5 reform act (HCRA) resources fund, whichever is applicable.
6 (l) Funds shall be reserved and accumulated from year to year by the
7 commissioner and shall be available, including income from invested
8 funds, for transfer to and allocation for services and expenses for the
9 payment of benefits to recipients of drugs under the AIDS drug assist-
10 ance program (ADAP) - HIV uninsured care program as administered by
11 Health Research Incorporated from the respective health care initi-
12 atives pools or the health care reform act (HCRA) resources fund, which-
13 ever is applicable, established for the following periods in the follow-
14 ing percentage amounts of funds remaining after allocations in
15 accordance with paragraphs (a) through (f) of this subdivision, and for
16 periods on and after January first, two thousand, in the following
17 amounts:
18 (i) from the pool for the period January first, nineteen hundred nine-
19 ty-seven through December thirty-first, nineteen hundred ninety-seven,
20 nine and fifty-two-hundredths percent;
21 (ii) from the pool for the period January first, nineteen hundred
22 ninety-eight through December thirty-first, nineteen hundred ninety-
23 eight, nine and fifty-two-hundredths percent;
24 (iii) from the pool for the period January first, nineteen hundred
25 ninety-nine and December thirty-first, nineteen hundred ninety-nine,
26 nine and sixty-eight-hundredths percent;
27 (iv) from the pool for the periods January first, two thousand through
28 December thirty-first, two thousand two, up to twelve million dollars
29 annually, and for the period January first, two thousand three through
30 December thirty-first, two thousand three, up to forty million dollars;
31 and
32 (v) from the pool or the health care reform act (HCRA) resources fund,
33 whichever is applicable, for the periods January first, two thousand
34 four through December thirty-first, two thousand four, up to fifty-six
35 million dollars, for the period January first, two thousand five through
36 December thirty-first, two thousand six, up to sixty million dollars
37 annually, for the period January first, two thousand seven through
38 December thirty-first, two thousand ten, up to sixty million dollars
39 annually, [and] for the period January first, two thousand eleven
40 through March thirty-first, two thousand eleven, up to fifteen million
41 dollars, AND EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO
42 THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, UP TO
43 FORTY-TWO MILLION THREE HUNDRED THOUSAND DOLLARS.
44 (m) Funds shall be reserved and accumulated from year to year and
45 shall be available, including income from invested funds, for purposes
46 of distributions pursuant to section twenty-eight hundred seven-r of
47 this article for cancer related services from the respective health care
48 initiatives pools or the health care reform act (HCRA) resources fund,
49 whichever is applicable, established for the following periods in the
50 following percentage amounts of funds remaining after allocations in
51 accordance with paragraphs (a) through (f) of this subdivision, and for
52 periods on and after January first, two thousand, in the following
53 amounts:
54 (i) from the pool for the period January first, nineteen hundred nine-
55 ty-seven through December thirty-first, nineteen hundred ninety-seven,
56 seven and ninety-four-hundredths percent;
A. 4009--C 31
1 (ii) from the pool for the period January first, nineteen hundred
2 ninety-eight through December thirty-first, nineteen hundred ninety-
3 eight, seven and ninety-four-hundredths percent;
4 (iii) from the pool for the period January first, nineteen hundred
5 ninety-nine and December thirty-first, nineteen hundred ninety-nine, six
6 and forty-five-hundredths percent;
7 (iv) from the pool for the period January first, two thousand through
8 December thirty-first, two thousand two, up to ten million dollars on an
9 annual basis;
10 (v) from the pool for the period January first, two thousand three
11 through December thirty-first, two thousand four, up to eight million
12 nine hundred fifty thousand dollars on an annual basis;
13 (vi) from the pool or the health care reform act (HCRA) resources
14 fund, whichever is applicable, for the period January first, two thou-
15 sand five through December thirty-first, two thousand six, up to ten
16 million fifty thousand dollars on an annual basis, for the period Janu-
17 ary first, two thousand seven through December thirty-first, two thou-
18 sand ten, up to nineteen million dollars annually, and for the period
19 January first, two thousand eleven through March thirty-first, two thou-
20 sand eleven, up to four million seven hundred fifty thousand dollars.
21 (n) Funds shall be accumulated and transferred from the health care
22 reform act (HCRA) resources fund as follows: for the period April first,
23 two thousand seven through March thirty-first, two thousand eight, and
24 on an annual basis for the periods April first, two thousand eight
25 through November thirtieth, two thousand nine, funds within amounts
26 appropriated shall be transferred and deposited and credited to the
27 credit of the state special revenue funds - other, HCRA transfer fund,
28 medical assistance account, for purposes of funding the state share of
29 rate adjustments made to public and voluntary hospitals in accordance
30 with paragraphs (i) and (j) of subdivision one of section twenty-eight
31 hundred seven-c of this article.
32 2. Notwithstanding any inconsistent provision of law, rule or regu-
33 lation, any funds accumulated in the health care initiatives pools
34 pursuant to paragraph (b) of subdivision nine of section twenty-eight
35 hundred seven-j of this article, as a result of surcharges, assessments
36 or other obligations during the periods January first, nineteen hundred
37 ninety-seven through December thirty-first, nineteen hundred ninety-
38 nine, which are unused or uncommitted for distributions pursuant to this
39 section shall be reserved and accumulated from year to year by the
40 commissioner and, within amounts appropriated, transferred and deposited
41 into the special revenue funds - other, miscellaneous special revenue
42 fund - 339, child health insurance account or any successor fund or
43 account, for purposes of distributions to implement the child health
44 insurance program established pursuant to sections twenty-five hundred
45 ten and twenty-five hundred eleven of this chapter for periods on and
46 after January first, two thousand one; provided, however, funds reserved
47 and accumulated for priority distributions pursuant to subparagraph
48 (iii) of paragraph (c) of subdivision one of this section shall not be
49 transferred and deposited into such account pursuant to this subdivi-
50 sion; and provided further, however, that any unused or uncommitted pool
51 funds accumulated and allocated pursuant to paragraph (j) of subdivision
52 one of this section shall be distributed for purposes of the health
53 information and quality improvement act of 2000.
54 3. Revenue from distributions pursuant to this section shall not be
55 included in gross revenue received for purposes of the assessments
56 pursuant to subdivision eighteen of section twenty-eight hundred seven-c
A. 4009--C 32
1 of this article, subject to the provisions of paragraph (e) of subdivi-
2 sion eighteen of section twenty-eight hundred seven-c of this article,
3 and shall not be included in gross revenue received for purposes of the
4 assessments pursuant to section twenty-eight hundred seven-d of this
5 article, subject to the provisions of subdivision twelve of section
6 twenty-eight hundred seven-d of this article.
7 S 8. Subdivision 1 of section 2807-v of the public health law, as
8 amended by section 5 of part B of chapter 58 of the laws of 2008, para-
9 graphs (g), (h), (i) and (i-1) as amended by section 5 of part I of
10 chapter 2 of the laws of 2009, subparagraphs (xi) and (xii) of paragraph
11 (j) as amended by section 12, paragraph (jj) as amended by section 10,
12 subparagraph (vii) of paragraph (qq) as amended by section 11 and
13 subparagraph (vii) of paragraph (uu) as amended by section 9 of part B
14 of chapter 109 of the laws of 2010, paragraph (s) as amended by section
15 8, paragraphs (x) and (y) as amended by section 6, paragraph (kk) as
16 amended by section 124, subparagraph (vi) of paragraph (uu) as amended
17 by section 120, paragraph (xx) as amended by section 10 and paragraphs
18 (ggg) and (hhh) as amended by section 7 of part C of chapter 58 of the
19 laws of 2009, is amended to read as follows:
20 1. Funds accumulated in the tobacco control and insurance initiatives
21 pool or in the health care reform act (HCRA) resources fund established
22 pursuant to section ninety-two-dd of the state finance law, whichever is
23 applicable, including income from invested funds, shall be distributed
24 or retained by the commissioner or by the state comptroller, as applica-
25 ble, in accordance with the following:
26 (a) Funds shall be deposited by the commissioner, within amounts
27 appropriated, and the state comptroller is hereby authorized and
28 directed to receive for deposit to the credit of the state special
29 revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
30 medicaid administration account, or any successor fund or account, for
31 purposes of services and expenses related to the toll-free medicaid
32 fraud hotline established pursuant to section one hundred eight of chap-
33 ter one of the laws of nineteen hundred ninety-nine from the tobacco
34 control and insurance initiatives pool established for the following
35 periods in the following amounts: four hundred thousand dollars annually
36 for the periods January first, two thousand through December thirty-
37 first, two thousand two, up to four hundred thousand dollars for the
38 period January first, two thousand three through December thirty-first,
39 two thousand three, up to four hundred thousand dollars for the period
40 January first, two thousand four through December thirty-first, two
41 thousand four, up to four hundred thousand dollars for the period Janu-
42 ary first, two thousand five through December thirty-first, two thousand
43 five, up to four hundred thousand dollars for the period January first,
44 two thousand six through December thirty-first, two thousand six, up to
45 four hundred thousand dollars for the period January first, two thousand
46 seven through December thirty-first, two thousand seven, up to four
47 hundred thousand dollars for the period January first, two thousand
48 eight through December thirty-first, two thousand eight, up to four
49 hundred thousand dollars for the period January first, two thousand nine
50 through December thirty-first, two thousand nine, up to four hundred
51 thousand dollars for the period January first, two thousand ten through
52 December thirty-first, two thousand ten, [and] up to one hundred thou-
53 sand dollars for the period January first, two thousand eleven through
54 March thirty-first, two thousand eleven AND WITHIN AMOUNTS APPROPRIATED
55 ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN.
A. 4009--C 33
1 (b) Funds shall be reserved and accumulated from year to year and
2 shall be available, including income from invested funds, for purposes
3 of payment of audits or audit contracts necessary to determine payor and
4 provider compliance with requirements set forth in sections twenty-eight
5 hundred seven-j, twenty-eight hundred seven-s and twenty-eight hundred
6 seven-t of this article [and hospital compliance with paragraph six of
7 subdivision (a) of section 405.4 of title 10 of the official compilation
8 of codes, rules and regulations of the state of New York in accordance
9 with subdivision nine of section twenty-eight hundred three of this
10 article] from the tobacco control and insurance initiatives pool estab-
11 lished for the following periods in the following amounts: five million
12 six hundred thousand dollars annually for the periods January first, two
13 thousand through December thirty-first, two thousand two, up to five
14 million dollars for the period January first, two thousand three through
15 December thirty-first, two thousand three, up to five million dollars
16 for the period January first, two thousand four through December thir-
17 ty-first, two thousand four, up to five million dollars for the period
18 January first, two thousand five through December thirty first, two
19 thousand five, up to five million dollars for the period January first,
20 two thousand six through December thirty-first, two thousand six, up to
21 seven million eight hundred thousand dollars for the period January
22 first, two thousand seven through December thirty-first, two thousand
23 seven, and up to eight million three hundred twenty-five thousand
24 dollars for the period January first, two thousand eight through Decem-
25 ber thirty-first, two thousand eight, up to eight million five hundred
26 thousand dollars for the period January first, two thousand nine through
27 December thirty-first, two thousand nine, up to eight million five
28 hundred thousand dollars for the period January first, two thousand ten
29 through December thirty-first, two thousand ten, [and] up to two million
30 one hundred twenty-five thousand dollars for the period January first,
31 two thousand eleven through March thirty-first, two thousand eleven, AND
32 UP TO FOURTEEN MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
33 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
34 TY-FIRST, TWO THOUSAND FOURTEEN.
35 (c) Funds shall be deposited by the commissioner, within amounts
36 appropriated, and the state comptroller is hereby authorized and
37 directed to receive for deposit to the credit of the state special
38 revenue funds - other, HCRA transfer fund, enhanced community services
39 account, or any successor fund or account, for mental health services
40 programs for case management services for adults and children; supported
41 housing; home and community based waiver services; family based treat-
42 ment; family support services; mobile mental health teams; transitional
43 housing; and community oversight, established pursuant to articles seven
44 and forty-one of the mental hygiene law and subdivision nine of section
45 three hundred sixty-six of the social services law; and for comprehen-
46 sive care centers for eating disorders pursuant to THE FORMER section
47 twenty-seven hundred ninety-nine-l of this chapter, provided however
48 that, for such centers, funds in the amount of five hundred thousand
49 dollars on an annualized basis shall be transferred from the enhanced
50 community services account, or any successor fund or account, and depos-
51 ited into the fund established by section ninety-five-e of the state
52 finance law; from the tobacco control and insurance initiatives pool
53 established for the following periods in the following amounts:
54 (i) forty-eight million dollars to be reserved, to be retained or for
55 distribution pursuant to a chapter of the laws of two thousand, for the
A. 4009--C 34
1 period January first, two thousand through December thirty-first, two
2 thousand;
3 (ii) eighty-seven million dollars to be reserved, to be retained or
4 for distribution pursuant to a chapter of the laws of two thousand one,
5 for the period January first, two thousand one through December thirty-
6 first, two thousand one;
7 (iii) eighty-seven million dollars to be reserved, to be retained or
8 for distribution pursuant to a chapter of the laws of two thousand two,
9 for the period January first, two thousand two through December thirty-
10 first, two thousand two;
11 (iv) eighty-eight million dollars to be reserved, to be retained or
12 for distribution pursuant to a chapter of the laws of two thousand
13 three, for the period January first, two thousand three through December
14 thirty-first, two thousand three;
15 (v) eighty-eight million dollars, plus five hundred thousand dollars,
16 to be reserved, to be retained or for distribution pursuant to a chapter
17 of the laws of two thousand four, and pursuant to THE FORMER section
18 twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
19 ary first, two thousand four through December thirty-first, two thousand
20 four;
21 (vi) eighty-eight million dollars, plus five hundred thousand dollars,
22 to be reserved, to be retained or for distribution pursuant to a chapter
23 of the laws of two thousand five, and pursuant to THE FORMER section
24 twenty-seven hundred ninety-nine-l of this chapter, for the period Janu-
25 ary first, two thousand five through December thirty-first, two thousand
26 five;
27 (vii) eighty-eight million dollars, plus five hundred thousand
28 dollars, to be reserved, to be retained or for distribution pursuant to
29 a chapter of the laws of two thousand six, and pursuant to section twen-
30 ty-seven hundred ninety-nine-l of this chapter, for the period January
31 first, two thousand six through December thirty-first, two thousand six;
32 (viii) eighty-six million four hundred thousand dollars, plus five
33 hundred thousand dollars, to be reserved, to be retained or for distrib-
34 ution pursuant to a chapter of the laws of two thousand seven and pursu-
35 ant to THE FORMER section twenty-seven hundred ninety-nine-l of this
36 chapter, for the period January first, two thousand seven through Decem-
37 ber thirty-first, two thousand seven; and
38 (ix) twenty-two million nine hundred thirteen thousand dollars, plus
39 one hundred twenty-five thousand dollars, to be reserved, to be retained
40 or for distribution pursuant to a chapter of the laws of two thousand
41 eight and pursuant to THE FORMER section twenty-seven hundred ninety-
42 nine-l of this chapter, for the period January first, two thousand eight
43 through March thirty-first, two thousand eight.
44 (d) Funds shall be deposited by the commissioner, within amounts
45 appropriated, and the state comptroller is hereby authorized and
46 directed to receive for deposit to the credit of the state special
47 revenue funds - other, HCRA transfer fund, medical assistance account,
48 or any successor fund or account, for purposes of funding the state
49 share of services and expenses related to the family health plus program
50 including up to two and one-half million dollars annually for the period
51 January first, two thousand through December thirty-first, two thousand
52 two, for administration and marketing costs associated with such program
53 established pursuant to clause (A) of subparagraph (v) of paragraph (a)
54 of subdivision two of section three hundred sixty-nine-ee of the social
55 services law from the tobacco control and insurance initiatives pool
56 established for the following periods in the following amounts:
A. 4009--C 35
1 (i) three million five hundred thousand dollars for the period January
2 first, two thousand through December thirty-first, two thousand;
3 (ii) twenty-seven million dollars for the period January first, two
4 thousand one through December thirty-first, two thousand one; and
5 (iii) fifty-seven million dollars for the period January first, two
6 thousand two through December thirty-first, two thousand two.
7 (e) Funds shall be deposited by the commissioner, within amounts
8 appropriated, and the state comptroller is hereby authorized and
9 directed to receive for deposit to the credit of the state special
10 revenue funds - other, HCRA transfer fund, medical assistance account,
11 or any successor fund or account, for purposes of funding the state
12 share of services and expenses related to the family health plus program
13 including up to two and one-half million dollars annually for the period
14 January first, two thousand through December thirty-first, two thousand
15 two for administration and marketing costs associated with such program
16 established pursuant to clause (B) of subparagraph (v) of paragraph (a)
17 of subdivision two of section three hundred sixty-nine-ee of the social
18 services law from the tobacco control and insurance initiatives pool
19 established for the following periods in the following amounts:
20 (i) two million five hundred thousand dollars for the period January
21 first, two thousand through December thirty-first, two thousand;
22 (ii) thirty million five hundred thousand dollars for the period Janu-
23 ary first, two thousand one through December thirty-first, two thousand
24 one; and
25 (iii) sixty-six million dollars for the period January first, two
26 thousand two through December thirty-first, two thousand two.
27 (f) Funds shall be deposited by the commissioner, within amounts
28 appropriated, and the state comptroller is hereby authorized and
29 directed to receive for deposit to the credit of the state special
30 revenue funds - other, HCRA transfer fund, medicaid fraud hotline and
31 medicaid administration account, or any successor fund or account, for
32 purposes of payment of administrative expenses of the department related
33 to the family health plus program established pursuant to section three
34 hundred sixty-nine-ee of the social services law from the tobacco
35 control and insurance initiatives pool established for the following
36 periods in the following amounts: five hundred thousand dollars on an
37 annual basis for the periods January first, two thousand through Decem-
38 ber thirty-first, two thousand six, five hundred thousand dollars for
39 the period January first, two thousand seven through December thirty-
40 first, two thousand seven, and five hundred thousand dollars for the
41 period January first, two thousand eight through December thirty-first,
42 two thousand eight, five hundred thousand dollars for the period January
43 first, two thousand nine through December thirty-first, two thousand
44 nine, five hundred thousand dollars for the period January first, two
45 thousand ten through December thirty-first, two thousand ten, [and] one
46 hundred twenty-five thousand dollars for the period January first, two
47 thousand eleven through March thirty-first, two thousand eleven AND
48 WITHIN AMOUNTS APPROPRIATED ON AND AFTER APRIL FIRST, TWO THOUSAND ELEV-
49 EN.
50 (g) Funds shall be reserved and accumulated from year to year and
51 shall be available, including income from invested funds, for purposes
52 of services and expenses related to the health maintenance organization
53 direct pay market program established pursuant to sections forty-three
54 hundred twenty-one-a and forty-three hundred twenty-two-a of the insur-
55 ance law from the tobacco control and insurance initiatives pool estab-
56 lished for the following periods in the following amounts:
A. 4009--C 36
1 (i) up to thirty-five million dollars for the period January first,
2 two thousand through December thirty-first, two thousand of which fifty
3 percentum shall be allocated to the program pursuant to section four
4 thousand three hundred twenty-one-a of the insurance law and fifty
5 percentum to the program pursuant to section four thousand three hundred
6 twenty-two-a of the insurance law;
7 (ii) up to thirty-six million dollars for the period January first,
8 two thousand one through December thirty-first, two thousand one of
9 which fifty percentum shall be allocated to the program pursuant to
10 section four thousand three hundred twenty-one-a of the insurance law
11 and fifty percentum to the program pursuant to section four thousand
12 three hundred twenty-two-a of the insurance law;
13 (iii) up to thirty-nine million dollars for the period January first,
14 two thousand two through December thirty-first, two thousand two of
15 which fifty percentum shall be allocated to the program pursuant to
16 section four thousand three hundred twenty-one-a of the insurance law
17 and fifty percentum to the program pursuant to section four thousand
18 three hundred twenty-two-a of the insurance law;
19 (iv) up to forty million dollars for the period January first, two
20 thousand three through December thirty-first, two thousand three of
21 which fifty percentum shall be allocated to the program pursuant to
22 section four thousand three hundred twenty-one-a of the insurance law
23 and fifty percentum to the program pursuant to section four thousand
24 three hundred twenty-two-a of the insurance law;
25 (v) up to forty million dollars for the period January first, two
26 thousand four through December thirty-first, two thousand four of which
27 fifty percentum shall be allocated to the program pursuant to section
28 four thousand three hundred twenty-one-a of the insurance law and fifty
29 percentum to the program pursuant to section four thousand three hundred
30 twenty-two-a of the insurance law;
31 (vi) up to forty million dollars for the period January first, two
32 thousand five through December thirty-first, two thousand five of which
33 fifty percentum shall be allocated to the program pursuant to section
34 four thousand three hundred twenty-one-a of the insurance law and fifty
35 percentum to the program pursuant to section four thousand three hundred
36 twenty-two-a of the insurance law;
37 (vii) up to forty million dollars for the period January first, two
38 thousand six through December thirty-first, two thousand six of which
39 fifty percentum shall be allocated to the program pursuant to section
40 four thousand three hundred twenty-one-a of the insurance law and fifty
41 percentum shall be allocated to the program pursuant to section four
42 thousand three hundred twenty-two-a of the insurance law;
43 (viii) up to forty million dollars for the period January first, two
44 thousand seven through December thirty-first, two thousand seven of
45 which fifty percentum shall be allocated to the program pursuant to
46 section four thousand three hundred twenty-one-a of the insurance law
47 and fifty percentum shall be allocated to the program pursuant to
48 section four thousand three hundred twenty-two-a of the insurance law;
49 and
50 (ix) up to forty million dollars for the period January first, two
51 thousand eight through December thirty-first, two thousand eight of
52 which fifty per centum shall be allocated to the program pursuant to
53 section four thousand three hundred twenty-one-a of the insurance law
54 and fifty per centum shall be allocated to the program pursuant to
55 section four thousand three hundred twenty-two-a of the insurance law.
A. 4009--C 37
1 (h) Funds shall be reserved and accumulated from year to year and
2 shall be available, including income from invested funds, for purposes
3 of services and expenses related to the healthy New York individual
4 program established pursuant to sections four thousand three hundred
5 twenty-six and four thousand three hundred twenty-seven of the insurance
6 law from the tobacco control and insurance initiatives pool established
7 for the following periods in the following amounts:
8 (i) up to six million dollars for the period January first, two thou-
9 sand one through December thirty-first, two thousand one;
10 (ii) up to twenty-nine million dollars for the period January first,
11 two thousand two through December thirty-first, two thousand two;
12 (iii) up to five million one hundred thousand dollars for the period
13 January first, two thousand three through December thirty-first, two
14 thousand three;
15 (iv) up to twenty-four million six hundred thousand dollars for the
16 period January first, two thousand four through December thirty-first,
17 two thousand four;
18 (v) up to thirty-four million six hundred thousand dollars for the
19 period January first, two thousand five through December thirty-first,
20 two thousand five;
21 (vi) up to fifty-four million eight hundred thousand dollars for the
22 period January first, two thousand six through December thirty-first,
23 two thousand six;
24 (vii) up to sixty-one million seven hundred thousand dollars for the
25 period January first, two thousand seven through December thirty-first,
26 two thousand seven; and
27 (viii) up to one hundred three million seven hundred fifty thousand
28 dollars for the period January first, two thousand eight through Decem-
29 ber thirty-first, two thousand eight.
30 (i) Funds shall be reserved and accumulated from year to year and
31 shall be available, including income from invested funds, for purposes
32 of services and expenses related to the healthy New York group program
33 established pursuant to sections four thousand three hundred twenty-six
34 and four thousand three hundred twenty-seven of the insurance law from
35 the tobacco control and insurance initiatives pool established for the
36 following periods in the following amounts:
37 (i) up to thirty-four million dollars for the period January first,
38 two thousand one through December thirty-first, two thousand one;
39 (ii) up to seventy-seven million dollars for the period January first,
40 two thousand two through December thirty-first, two thousand two;
41 (iii) up to ten million five hundred thousand dollars for the period
42 January first, two thousand three through December thirty-first, two
43 thousand three;
44 (iv) up to twenty-four million six hundred thousand dollars for the
45 period January first, two thousand four through December thirty-first,
46 two thousand four;
47 (v) up to thirty-four million six hundred thousand dollars for the
48 period January first, two thousand five through December thirty-first,
49 two thousand five;
50 (vi) up to fifty-four million eight hundred thousand dollars for the
51 period January first, two thousand six through December thirty-first,
52 two thousand six;
53 (vii) up to sixty-one million seven hundred thousand dollars for the
54 period January first, two thousand seven through December thirty-first,
55 two thousand seven; and
A. 4009--C 38
1 (viii) up to one hundred three million seven hundred fifty thousand
2 dollars for the period January first, two thousand eight through Decem-
3 ber thirty-first, two thousand eight.
4 (i-1) Notwithstanding the provisions of paragraphs (h) and (i) of this
5 subdivision, the commissioner shall reserve and accumulate up to two
6 million five hundred thousand dollars annually for the periods January
7 first, two thousand four through December thirty-first, two thousand
8 six, one million four hundred thousand dollars for the period January
9 first, two thousand seven through December thirty-first, two thousand
10 seven, two million dollars for the period January first, two thousand
11 eight through December thirty-first, two thousand eight, from funds
12 otherwise available for distribution under such paragraphs for the
13 services and expenses related to the pilot program for entertainment
14 industry employees included in subsection (b) of section one thousand
15 one hundred twenty-two of the insurance law, and an additional seven
16 hundred thousand dollars annually for the periods January first, two
17 thousand four through December thirty-first, two thousand six, an addi-
18 tional three hundred thousand dollars for the period January first, two
19 thousand seven through June thirtieth, two thousand seven for services
20 and expenses related to the pilot program for displaced workers included
21 in subsection (c) of section one thousand one hundred twenty-two of the
22 insurance law.
23 (j) Funds shall be reserved and accumulated from year to year and
24 shall be available, including income from invested funds, for purposes
25 of services and expenses related to the tobacco use prevention and
26 control program established pursuant to sections thirteen hundred nine-
27 ty-nine-ii and thirteen hundred ninety-nine-jj of this chapter, from the
28 tobacco control and insurance initiatives pool established for the
29 following periods in the following amounts:
30 (i) up to thirty million dollars for the period January first, two
31 thousand through December thirty-first, two thousand;
32 (ii) up to forty million dollars for the period January first, two
33 thousand one through December thirty-first, two thousand one;
34 (iii) up to forty million dollars for the period January first, two
35 thousand two through December thirty-first, two thousand two;
36 (iv) up to thirty-six million nine hundred fifty thousand dollars for
37 the period January first, two thousand three through December thirty-
38 first, two thousand three;
39 (v) up to thirty-six million nine hundred fifty thousand dollars for
40 the period January first, two thousand four through December thirty-
41 first, two thousand four;
42 (vi) up to forty million six hundred thousand dollars for the period
43 January first, two thousand five through December thirty-first, two
44 thousand five;
45 (vii) up to eighty-one million nine hundred thousand dollars for the
46 period January first, two thousand six through December thirty-first,
47 two thousand six, provided, however, that within amounts appropriated, a
48 portion of such funds may be transferred to the Roswell Park Cancer
49 Institute Corporation to support costs associated with cancer research;
50 (viii) up to ninety-four million one hundred fifty thousand dollars
51 for the period January first, two thousand seven through December thir-
52 ty-first, two thousand seven, provided, however, that within amounts
53 appropriated, a portion of such funds may be transferred to the Roswell
54 Park Cancer Institute Corporation to support costs associated with
55 cancer research;
A. 4009--C 39
1 (ix) up to ninety-four million one hundred fifty thousand dollars for
2 the period January first, two thousand eight through December thirty-
3 first, two thousand eight;
4 (x) up to ninety-four million one hundred fifty thousand dollars for
5 the period January first, two thousand nine through December thirty-
6 first, two thousand nine;
7 (xi) up to eighty-seven million seven hundred seventy-five thousand
8 dollars for the period January first, two thousand ten through December
9 thirty-first, two thousand ten; [and]
10 (xii) up to twenty-one million four hundred twelve thousand dollars
11 for the period January first, two thousand eleven through March thirty-
12 first, two thousand eleven[.]; AND
13 (XIII) UP TO FIFTY-TWO MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE
14 FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
15 MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
16 (k) Funds shall be deposited by the commissioner, within amounts
17 appropriated, and the state comptroller is hereby authorized and
18 directed to receive for deposit to the credit of the state special
19 revenue fund - other, HCRA transfer fund, health care services account,
20 or any successor fund or account, for purposes of services and expenses
21 related to public health programs, including comprehensive care centers
22 for eating disorders pursuant to THE FORMER section twenty-seven hundred
23 ninety-nine-l of this chapter, provided however that, for such centers,
24 funds in the amount of five hundred thousand dollars on an annualized
25 basis shall be transferred from the health care services account, or any
26 successor fund or account, and deposited into the fund established by
27 section ninety-five-e of the state finance law FOR PERIODS PRIOR TO
28 MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, from the tobacco control and
29 insurance initiatives pool established for the following periods in the
30 following amounts:
31 (i) up to thirty-one million dollars for the period January first, two
32 thousand through December thirty-first, two thousand;
33 (ii) up to forty-one million dollars for the period January first, two
34 thousand one through December thirty-first, two thousand one;
35 (iii) up to eighty-one million dollars for the period January first,
36 two thousand two through December thirty-first, two thousand two;
37 (iv) one hundred twenty-two million five hundred thousand dollars for
38 the period January first, two thousand three through December thirty-
39 first, two thousand three;
40 (v) one hundred eight million five hundred seventy-five thousand
41 dollars, plus an additional five hundred thousand dollars, for the peri-
42 od January first, two thousand four through December thirty-first, two
43 thousand four;
44 (vi) ninety-one million eight hundred thousand dollars, plus an addi-
45 tional five hundred thousand dollars, for the period January first, two
46 thousand five through December thirty-first, two thousand five;
47 (vii) one hundred fifty-six million six hundred thousand dollars, plus
48 an additional five hundred thousand dollars, for the period January
49 first, two thousand six through December thirty-first, two thousand six;
50 (viii) one hundred fifty-one million four hundred thousand dollars,
51 plus an additional five hundred thousand dollars, for the period January
52 first, two thousand seven through December thirty-first, two thousand
53 seven;
54 (ix) one hundred sixteen million nine hundred forty-nine thousand
55 dollars, plus an additional five hundred thousand dollars, for the peri-
A. 4009--C 40
1 od January first, two thousand eight through December thirty-first, two
2 thousand eight;
3 (x) one hundred sixteen million nine hundred forty-nine thousand
4 dollars, plus an additional five hundred thousand dollars, for the peri-
5 od January first, two thousand nine through December thirty-first, two
6 thousand nine;
7 (xi) one hundred sixteen million nine hundred forty-nine thousand
8 dollars, plus an additional five hundred thousand dollars, for the peri-
9 od January first, two thousand ten through December thirty-first, two
10 thousand ten; [and]
11 (xii) twenty-nine million two hundred thirty-seven thousand two
12 hundred fifty dollars, plus an additional one hundred twenty-five thou-
13 sand dollars, for the period January first, two thousand eleven through
14 March thirty-first, two thousand eleven[.];
15 (XIII) ONE HUNDRED TWENTY MILLION THIRTY-EIGHT THOUSAND DOLLARS FOR
16 THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
17 TWO THOUSAND TWELVE; AND
18 (XIV) ONE HUNDRED NINETEEN MILLION FOUR HUNDRED SEVEN THOUSAND DOLLARS
19 EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE
20 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
21 (l) Funds shall be deposited by the commissioner, within amounts
22 appropriated, and the state comptroller is hereby authorized and
23 directed to receive for deposit to the credit of the state special
24 revenue funds - other, HCRA transfer fund, medical assistance account,
25 or any successor fund or account, for purposes of funding the state
26 share of the personal care and certified home health agency rate or fee
27 increases established pursuant to subdivision three of section three
28 hundred sixty-seven-o of the social services law from the tobacco
29 control and insurance initiatives pool established for the following
30 periods in the following amounts:
31 (i) twenty-three million two hundred thousand dollars for the period
32 January first, two thousand through December thirty-first, two thousand;
33 (ii) twenty-three million two hundred thousand dollars for the period
34 January first, two thousand one through December thirty-first, two thou-
35 sand one;
36 (iii) twenty-three million two hundred thousand dollars for the period
37 January first, two thousand two through December thirty-first, two thou-
38 sand two;
39 (iv) up to sixty-five million two hundred thousand dollars for the
40 period January first, two thousand three through December thirty-first,
41 two thousand three;
42 (v) up to sixty-five million two hundred thousand dollars for the
43 period January first, two thousand four through December thirty-first,
44 two thousand four;
45 (vi) up to sixty-five million two hundred thousand dollars for the
46 period January first, two thousand five through December thirty-first,
47 two thousand five;
48 (vii) up to sixty-five million two hundred thousand dollars for the
49 period January first, two thousand six through December thirty-first,
50 two thousand six;
51 (viii) up to sixty-five million two hundred thousand dollars for the
52 period January first, two thousand seven through December thirty-first,
53 two thousand seven; and
54 (ix) up to sixteen million three hundred thousand dollars for the
55 period January first, two thousand eight through March thirty-first, two
56 thousand eight.
A. 4009--C 41
1 (m) Funds shall be deposited by the commissioner, within amounts
2 appropriated, and the state comptroller is hereby authorized and
3 directed to receive for deposit to the credit of the state special
4 revenue funds - other, HCRA transfer fund, medical assistance account,
5 or any successor fund or account, for purposes of funding the state
6 share of services and expenses related to home care workers insurance
7 pilot demonstration programs established pursuant to subdivision two of
8 section three hundred sixty-seven-o of the social services law from the
9 tobacco control and insurance initiatives pool established for the
10 following periods in the following amounts:
11 (i) three million eight hundred thousand dollars for the period Janu-
12 ary first, two thousand through December thirty-first, two thousand;
13 (ii) three million eight hundred thousand dollars for the period Janu-
14 ary first, two thousand one through December thirty-first, two thousand
15 one;
16 (iii) three million eight hundred thousand dollars for the period
17 January first, two thousand two through December thirty-first, two thou-
18 sand two;
19 (iv) up to three million eight hundred thousand dollars for the period
20 January first, two thousand three through December thirty-first, two
21 thousand three;
22 (v) up to three million eight hundred thousand dollars for the period
23 January first, two thousand four through December thirty-first, two
24 thousand four;
25 (vi) up to three million eight hundred thousand dollars for the period
26 January first, two thousand five through December thirty-first, two
27 thousand five;
28 (vii) up to three million eight hundred thousand dollars for the peri-
29 od January first, two thousand six through December thirty-first, two
30 thousand six;
31 (viii) up to three million eight hundred thousand dollars for the
32 period January first, two thousand seven through December thirty-first,
33 two thousand seven; and
34 (ix) up to nine hundred fifty thousand dollars for the period January
35 first, two thousand eight through March thirty-first, two thousand
36 eight.
37 (n) Funds shall be transferred by the commissioner and shall be depos-
38 ited to the credit of the special revenue funds - other, miscellaneous
39 special revenue fund - 339, elderly pharmaceutical insurance coverage
40 program premium account authorized pursuant to the provisions of title
41 three of article two of the elder law, or any successor fund or account,
42 for funding state expenses relating to the program from the tobacco
43 control and insurance initiatives pool established for the following
44 periods in the following amounts:
45 (i) one hundred seven million dollars for the period January first,
46 two thousand through December thirty-first, two thousand;
47 (ii) one hundred sixty-four million dollars for the period January
48 first, two thousand one through December thirty-first, two thousand one;
49 (iii) three hundred twenty-two million seven hundred thousand dollars
50 for the period January first, two thousand two through December thirty-
51 first, two thousand two;
52 (iv) four hundred thirty-three million three hundred thousand dollars
53 for the period January first, two thousand three through December thir-
54 ty-first, two thousand three;
A. 4009--C 42
1 (v) five hundred four million one hundred fifty thousand dollars for
2 the period January first, two thousand four through December thirty-
3 first, two thousand four;
4 (vi) five hundred sixty-six million eight hundred thousand dollars for
5 the period January first, two thousand five through December thirty-
6 first, two thousand five;
7 (vii) six hundred three million one hundred fifty thousand dollars for
8 the period January first, two thousand six through December thirty-
9 first, two thousand six;
10 (viii) six hundred sixty million eight hundred thousand dollars for
11 the period January first, two thousand seven through December thirty-
12 first, two thousand seven;
13 (ix) three hundred sixty-seven million four hundred sixty-three thou-
14 sand dollars for the period January first, two thousand eight through
15 December thirty-first, two thousand eight;
16 (x) three hundred thirty-four million eight hundred twenty-five thou-
17 sand dollars for the period January first, two thousand nine through
18 December thirty-first, two thousand nine;
19 (xi) three hundred forty-four million nine hundred thousand dollars
20 for the period January first, two thousand ten through December thirty-
21 first, two thousand ten; [and]
22 (xii) eighty-seven million seven hundred eighty-eight thousand dollars
23 for the period January first, two thousand eleven through March thirty-
24 first, two thousand eleven[.];
25 (XIII) ONE HUNDRED FORTY-THREE MILLION ONE HUNDRED FIFTY THOUSAND
26 DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
27 THIRTY-FIRST, TWO THOUSAND TWELVE;
28 (XIV) ONE HUNDRED TWENTY MILLION NINE HUNDRED FIFTY THOUSAND DOLLARS
29 FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
30 THIRTY-FIRST, TWO THOUSAND THIRTEEN; AND
31 (XV) ONE HUNDRED TWENTY-EIGHT MILLION EIGHT HUNDRED FIFTY THOUSAND
32 DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
33 THIRTY-FIRST, TWO THOUSAND FOURTEEN.
34 (o) Funds shall be reserved and accumulated and shall be transferred
35 to the Roswell Park Cancer Institute Corporation, from the tobacco
36 control and insurance initiatives pool established for the following
37 periods in the following amounts:
38 (i) up to ninety million dollars for the period January first, two
39 thousand through December thirty-first, two thousand;
40 (ii) up to sixty million dollars for the period January first, two
41 thousand one through December thirty-first, two thousand one;
42 (iii) up to eighty-five million dollars for the period January first,
43 two thousand two through December thirty-first, two thousand two;
44 (iv) eighty-five million two hundred fifty thousand dollars for the
45 period January first, two thousand three through December thirty-first,
46 two thousand three;
47 (v) seventy-eight million dollars for the period January first, two
48 thousand four through December thirty-first, two thousand four;
49 (vi) seventy-eight million dollars for the period January first, two
50 thousand five through December thirty-first, two thousand five;
51 (vii) ninety-one million dollars for the period January first, two
52 thousand six through December thirty-first, two thousand six;
53 (viii) seventy-eight million dollars for the period January first, two
54 thousand seven through December thirty-first, two thousand seven;
55 (ix) seventy-eight million dollars for the period January first, two
56 thousand eight through December thirty-first, two thousand eight;
A. 4009--C 43
1 (x) seventy-eight million dollars for the period January first, two
2 thousand nine through December thirty-first, two thousand nine;
3 (xi) seventy-eight million dollars for the period January first, two
4 thousand ten through December thirty-first, two thousand ten; [and]
5 (xii) nineteen million five hundred thousand dollars for the period
6 January first, two thousand eleven through March thirty-first, two thou-
7 sand eleven[.]; AND
8 (XIII) SIXTY-NINE MILLION EIGHT HUNDRED FORTY THOUSAND DOLLARS EACH
9 STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
10 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
11 (p) Funds shall be deposited by the commissioner, within amounts
12 appropriated, and the state comptroller is hereby authorized and
13 directed to receive for deposit to the credit of the state special
14 revenue funds - other, indigent care fund - 068, indigent care account,
15 or any successor fund or account, for purposes of providing a medicaid
16 disproportionate share payment from the high need indigent care adjust-
17 ment pool established pursuant to section twenty-eight hundred seven-w
18 of this article, from the tobacco control and insurance initiatives pool
19 established for the following periods in the following amounts:
20 (i) eighty-two million dollars annually for the periods January first,
21 two thousand through December thirty-first, two thousand two;
22 (ii) up to eighty-two million dollars for the period January first,
23 two thousand three through December thirty-first, two thousand three;
24 (iii) up to eighty-two million dollars for the period January first,
25 two thousand four through December thirty-first, two thousand four;
26 (iv) up to eighty-two million dollars for the period January first,
27 two thousand five through December thirty-first, two thousand five;
28 (v) up to eighty-two million dollars for the period January first, two
29 thousand six through December thirty-first, two thousand six;
30 (vi) up to eighty-two million dollars for the period January first,
31 two thousand seven through December thirty-first, two thousand seven;
32 (vii) up to eighty-two million dollars for the period January first,
33 two thousand eight through December thirty-first, two thousand eight;
34 (viii) up to eighty-two million dollars for the period January first,
35 two thousand nine through December thirty-first, two thousand nine;
36 (ix) up to eighty-two million dollars for the period January first,
37 two thousand ten through December thirty-first, two thousand ten; [and]
38 (x) up to twenty million five hundred thousand dollars for the period
39 January first, two thousand eleven through March thirty-first, two thou-
40 sand eleven; AND
41 (XI) UP TO EIGHTY-TWO MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
42 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
43 THOUSAND FOURTEEN.
44 (q) Funds shall be reserved and accumulated from year to year and
45 shall be available, including income from invested funds, for purposes
46 of providing distributions to eligible school based health centers
47 established pursuant to section eighty-eight of chapter one of the laws
48 of nineteen hundred ninety-nine, from the tobacco control and insurance
49 initiatives pool established for the following periods in the following
50 amounts:
51 (i) seven million dollars annually for the period January first, two
52 thousand through December thirty-first, two thousand two;
53 (ii) up to seven million dollars for the period January first, two
54 thousand three through December thirty-first, two thousand three;
55 (iii) up to seven million dollars for the period January first, two
56 thousand four through December thirty-first, two thousand four;
A. 4009--C 44
1 (iv) up to seven million dollars for the period January first, two
2 thousand five through December thirty-first, two thousand five;
3 (v) up to seven million dollars for the period January first, two
4 thousand six through December thirty-first, two thousand six;
5 (vi) up to seven million dollars for the period January first, two
6 thousand seven through December thirty-first, two thousand seven;
7 (vii) up to seven million dollars for the period January first, two
8 thousand eight through December thirty-first, two thousand eight;
9 (viii) up to seven million dollars for the period January first, two
10 thousand nine through December thirty-first, two thousand nine;
11 (ix) up to seven million dollars for the period January first, two
12 thousand ten through December thirty-first, two thousand ten; [and]
13 (x) up to one million seven hundred fifty thousand dollars for the
14 period January first, two thousand eleven through March thirty-first,
15 two thousand eleven; AND
16 (XI) UP TO FIVE MILLION SIX HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
17 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
18 TY-FIRST, TWO THOUSAND FOURTEEN.
19 (r) Funds shall be deposited by the commissioner within amounts appro-
20 priated, and the state comptroller is hereby authorized and directed to
21 receive for deposit to the credit of the state special revenue funds -
22 other, HCRA transfer fund, medical assistance account, or any successor
23 fund or account, for purposes of providing distributions for supplemen-
24 tary medical insurance for Medicare part B premiums, physicians
25 services, outpatient services, medical equipment, supplies and other
26 health services, from the tobacco control and insurance initiatives pool
27 established for the following periods in the following amounts:
28 (i) forty-three million dollars for the period January first, two
29 thousand through December thirty-first, two thousand;
30 (ii) sixty-one million dollars for the period January first, two thou-
31 sand one through December thirty-first, two thousand one;
32 (iii) sixty-five million dollars for the period January first, two
33 thousand two through December thirty-first, two thousand two;
34 (iv) sixty-seven million five hundred thousand dollars for the period
35 January first, two thousand three through December thirty-first, two
36 thousand three;
37 (v) sixty-eight million dollars for the period January first, two
38 thousand four through December thirty-first, two thousand four;
39 (vi) sixty-eight million dollars for the period January first, two
40 thousand five through December thirty-first, two thousand five;
41 (vii) sixty-eight million dollars for the period January first, two
42 thousand six through December thirty-first, two thousand six;
43 (viii) seventeen million five hundred thousand dollars for the period
44 January first, two thousand seven through December thirty-first, two
45 thousand seven;
46 (ix) sixty-eight million dollars for the period January first, two
47 thousand eight through December thirty-first, two thousand eight;
48 (x) sixty-eight million dollars for the period January first, two
49 thousand nine through December thirty-first, two thousand nine;
50 (xi) sixty-eight million dollars for the period January first, two
51 thousand ten through December thirty-first, two thousand ten; [and]
52 (xii) seventeen million dollars for the period January first, two
53 thousand eleven through March thirty-first, two thousand eleven[.]; AND
54 (XIII) SIXTY-EIGHT MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
55 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
56 THOUSAND FOURTEEN.
A. 4009--C 45
1 (s) Funds shall be deposited by the commissioner within amounts appro-
2 priated, and the state comptroller is hereby authorized and directed to
3 receive for deposit to the credit of the state special revenue funds -
4 other, HCRA transfer fund, medical assistance account, or any successor
5 fund or account, for purposes of providing distributions pursuant to
6 paragraphs (s-5), (s-6), (s-7) and (s-8) of subdivision eleven of
7 section twenty-eight hundred seven-c of this article from the tobacco
8 control and insurance initiatives pool established for the following
9 periods in the following amounts:
10 (i) eighteen million dollars for the period January first, two thou-
11 sand through December thirty-first, two thousand;
12 (ii) twenty-four million dollars annually for the periods January
13 first, two thousand one through December thirty-first, two thousand two;
14 (iii) up to twenty-four million dollars for the period January first,
15 two thousand three through December thirty-first, two thousand three;
16 (iv) up to twenty-four million dollars for the period January first,
17 two thousand four through December thirty-first, two thousand four;
18 (v) up to twenty-four million dollars for the period January first,
19 two thousand five through December thirty-first, two thousand five;
20 (vi) up to twenty-four million dollars for the period January first,
21 two thousand six through December thirty-first, two thousand six;
22 (vii) up to twenty-four million dollars for the period January first,
23 two thousand seven through December thirty-first, two thousand seven;
24 (viii) up to twenty-four million dollars for the period January first,
25 two thousand eight through December thirty-first, two thousand eight;
26 and
27 (ix) up to twenty-two million dollars for the period January first,
28 two thousand nine through November thirtieth, two thousand nine.
29 (t) Funds shall be reserved and accumulated from year to year by the
30 commissioner and shall be made available, including income from invested
31 funds:
32 (i) For the purpose of making grants to a state owned and operated
33 medical school which does not have a state owned and operated hospital
34 on site and available for teaching purposes. Notwithstanding sections
35 one hundred twelve and one hundred sixty-three of the state finance law,
36 such grants shall be made in the amount of up to five hundred thousand
37 dollars for the period January first, two thousand through December
38 thirty-first, two thousand;
39 (ii) For the purpose of making grants to medical schools pursuant to
40 section eighty-six-a of chapter one of the laws of nineteen hundred
41 ninety-nine in the sum of up to four million dollars for the period
42 January first, two thousand through December thirty-first, two thousand;
43 and
44 (iii) The funds disbursed pursuant to subparagraphs (i) and (ii) of
45 this paragraph from the tobacco control and insurance initiatives pool
46 are contingent upon meeting all funding amounts established pursuant to
47 paragraphs (a), (b), (c), (d), (e), (f), (l), (m), (n), (p), (q), (r)
48 and (s) of this subdivision, paragraph (a) of subdivision nine of
49 section twenty-eight hundred seven-j of this article, and paragraphs
50 (a), (i) and (k) of subdivision one of section twenty-eight hundred
51 seven-l of this article.
52 (u) Funds shall be deposited by the commissioner, within amounts
53 appropriated, and the state comptroller is hereby authorized and
54 directed to receive for deposit to the credit of the state special
55 revenue funds - other, HCRA transfer fund, medical assistance account,
56 or any successor fund or account, for purposes of funding the state
A. 4009--C 46
1 share of services and expenses related to the nursing home quality
2 improvement demonstration program established pursuant to section twen-
3 ty-eight hundred eight-d of this article from the tobacco control and
4 insurance initiatives pool established for the following periods in the
5 following amounts:
6 (i) up to twenty-five million dollars for the period beginning April
7 first, two thousand two and ending December thirty-first, two thousand
8 two, and on an annualized basis, for each annual period thereafter
9 beginning January first, two thousand three and ending December thirty-
10 first, two thousand four;
11 (ii) up to eighteen million seven hundred fifty thousand dollars for
12 the period January first, two thousand five through December thirty-
13 first, two thousand five; and
14 (iii) up to fifty-six million five hundred thousand dollars for the
15 period January first, two thousand six through December thirty-first,
16 two thousand six.
17 (v) Funds shall be transferred by the commissioner and shall be depos-
18 ited to the credit of the hospital excess liability pool created pursu-
19 ant to section eighteen of chapter two hundred sixty-six of the laws of
20 nineteen hundred eighty-six, or any successor fund or account, for
21 purposes of expenses related to the purchase of excess medical malprac-
22 tice insurance and the cost of administrating the pool, including costs
23 associated with the risk management program established pursuant to
24 section forty-two of part A of chapter one of the laws of two thousand
25 two required by paragraph (a) of subdivision one of section eighteen of
26 chapter two hundred sixty-six of the laws of nineteen hundred eighty-six
27 as may be amended from time to time, from the tobacco control and insur-
28 ance initiatives pool established for the following periods in the
29 following amounts:
30 (i) up to fifty million dollars or so much as is needed for the period
31 January first, two thousand two through December thirty-first, two thou-
32 sand two;
33 (ii) up to seventy-six million seven hundred thousand dollars for the
34 period January first, two thousand three through December thirty-first,
35 two thousand three;
36 (iii) up to sixty-five million dollars for the period January first,
37 two thousand four through December thirty-first, two thousand four;
38 (iv) up to sixty-five million dollars for the period January first,
39 two thousand five through December thirty-first, two thousand five;
40 (v) up to one hundred thirteen million eight hundred thousand dollars
41 for the period January first, two thousand six through December thirty-
42 first, two thousand six;
43 (vi) up to one hundred thirty million dollars for the period January
44 first, two thousand seven through December thirty-first, two thousand
45 seven;
46 (vii) up to one hundred thirty million dollars for the period January
47 first, two thousand eight through December thirty-first, two thousand
48 eight;
49 (viii) up to one hundred thirty million dollars for the period January
50 first, two thousand nine through December thirty-first, two thousand
51 nine;
52 (ix) up to one hundred thirty million dollars for the period January
53 first, two thousand ten through December thirty-first, two thousand ten;
54 [and]
A. 4009--C 47
1 (x) up to thirty-two million five hundred thousand dollars for the
2 period January first, two thousand eleven through March thirty-first,
3 two thousand eleven[.]; AND
4 (XI) UP TO ONE HUNDRED TWENTY-SEVEN MILLION FOUR HUNDRED THOUSAND
5 DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND
6 ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
7 (w) Funds shall be deposited by the commissioner, within amounts
8 appropriated, and the state comptroller is hereby authorized and
9 directed to receive for deposit to the credit of the state special
10 revenue funds - other, HCRA transfer fund, medical assistance account,
11 or any successor fund or account, for purposes of funding the state
12 share of the treatment of breast and cervical cancer pursuant to para-
13 graph (v) of subdivision four of section three hundred sixty-six of the
14 social services law, from the tobacco control and insurance initiatives
15 pool established for the following periods in the following amounts:
16 (i) up to four hundred fifty thousand dollars for the period January
17 first, two thousand two through December thirty-first, two thousand two;
18 (ii) up to two million one hundred thousand dollars for the period
19 January first, two thousand three through December thirty-first, two
20 thousand three;
21 (iii) up to two million one hundred thousand dollars for the period
22 January first, two thousand four through December thirty-first, two
23 thousand four;
24 (iv) up to two million one hundred thousand dollars for the period
25 January first, two thousand five through December thirty-first, two
26 thousand five;
27 (v) up to two million one hundred thousand dollars for the period
28 January first, two thousand six through December thirty-first, two thou-
29 sand six;
30 (vi) up to two million one hundred thousand dollars for the period
31 January first, two thousand seven through December thirty-first, two
32 thousand seven;
33 (vii) up to two million one hundred thousand dollars for the period
34 January first, two thousand eight through December thirty-first, two
35 thousand eight;
36 (viii) up to two million one hundred thousand dollars for the period
37 January first, two thousand nine through December thirty-first, two
38 thousand nine;
39 (ix) up to two million one hundred thousand dollars for the period
40 January first, two thousand ten through December thirty-first, two thou-
41 sand ten; [and]
42 (x) up to five hundred twenty-five thousand dollars for the period
43 January first, two thousand eleven through March thirty-first, two thou-
44 sand eleven[.]; AND
45 (XI) UP TO TWO MILLION ONE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
46 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
47 TY-FIRST, TWO THOUSAND FOURTEEN.
48 (x) Funds shall be deposited by the commissioner, within amounts
49 appropriated, and the state comptroller is hereby authorized and
50 directed to receive for deposit to the credit of the state special
51 revenue funds - other, HCRA transfer fund, medical assistance account,
52 or any successor fund or account, for purposes of funding the state
53 share of the non-public general hospital rates increases for recruitment
54 and retention of health care workers from the tobacco control and insur-
55 ance initiatives pool established for the following periods in the
56 following amounts:
A. 4009--C 48
1 (i) twenty-seven million one hundred thousand dollars on an annualized
2 basis for the period January first, two thousand two through December
3 thirty-first, two thousand two;
4 (ii) fifty million eight hundred thousand dollars on an annualized
5 basis for the period January first, two thousand three through December
6 thirty-first, two thousand three;
7 (iii) sixty-nine million three hundred thousand dollars on an annual-
8 ized basis for the period January first, two thousand four through
9 December thirty-first, two thousand four;
10 (iv) sixty-nine million three hundred thousand dollars for the period
11 January first, two thousand five through December thirty-first, two
12 thousand five;
13 (v) sixty-nine million three hundred thousand dollars for the period
14 January first, two thousand six through December thirty-first, two thou-
15 sand six;
16 (vi) sixty-five million three hundred thousand dollars for the period
17 January first, two thousand seven through December thirty-first, two
18 thousand seven;
19 (vii) sixty-one million one hundred fifty thousand dollars for the
20 period January first, two thousand eight through December thirty-first,
21 two thousand eight; and
22 (viii) forty-eight million seven hundred twenty-one thousand dollars
23 for the period January first, two thousand nine through November thirti-
24 eth, two thousand nine.
25 (y) Funds shall be reserved and accumulated from year to year and
26 shall be available, including income from invested funds, for purposes
27 of grants to public general hospitals for recruitment and retention of
28 health care workers pursuant to paragraph (b) of subdivision thirty of
29 section twenty-eight hundred seven-c of this article from the tobacco
30 control and insurance initiatives pool established for the following
31 periods in the following amounts:
32 (i) eighteen million five hundred thousand dollars on an annualized
33 basis for the period January first, two thousand two through December
34 thirty-first, two thousand two;
35 (ii) thirty-seven million four hundred thousand dollars on an annual-
36 ized basis for the period January first, two thousand three through
37 December thirty-first, two thousand three;
38 (iii) fifty-two million two hundred thousand dollars on an annualized
39 basis for the period January first, two thousand four through December
40 thirty-first, two thousand four;
41 (iv) fifty-two million two hundred thousand dollars for the period
42 January first, two thousand five through December thirty-first, two
43 thousand five;
44 (v) fifty-two million two hundred thousand dollars for the period
45 January first, two thousand six through December thirty-first, two thou-
46 sand six;
47 (vi) forty-nine million dollars for the period January first, two
48 thousand seven through December thirty-first, two thousand seven;
49 (vii) forty-nine million dollars for the period January first, two
50 thousand eight through December thirty-first, two thousand eight; and
51 (viii) twelve million two hundred fifty thousand dollars for the peri-
52 od January first, two thousand nine through March thirty-first, two
53 thousand nine.
54 Provided, however, amounts pursuant to this paragraph may be reduced
55 in an amount to be approved by the director of the budget to reflect
56 amounts received from the federal government under the state's 1115
A. 4009--C 49
1 waiver which are directed under its terms and conditions to the health
2 workforce recruitment and retention program.
3 (z) Funds shall be deposited by the commissioner, within amounts
4 appropriated, and the state comptroller is hereby authorized and
5 directed to receive for deposit to the credit of the state special
6 revenue funds - other, HCRA transfer fund, medical assistance account,
7 or any successor fund or account, for purposes of funding the state
8 share of the non-public residential health care facility rate increases
9 for recruitment and retention of health care workers pursuant to para-
10 graph (a) of subdivision eighteen of section twenty-eight hundred eight
11 of this article from the tobacco control and insurance initiatives pool
12 established for the following periods in the following amounts:
13 (i) twenty-one million five hundred thousand dollars on an annualized
14 basis for the period January first, two thousand two through December
15 thirty-first, two thousand two;
16 (ii) thirty-three million three hundred thousand dollars on an annual-
17 ized basis for the period January first, two thousand three through
18 December thirty-first, two thousand three;
19 (iii) forty-six million three hundred thousand dollars on an annual-
20 ized basis for the period January first, two thousand four through
21 December thirty-first, two thousand four;
22 (iv) forty-six million three hundred thousand dollars for the period
23 January first, two thousand five through December thirty-first, two
24 thousand five;
25 (v) forty-six million three hundred thousand dollars for the period
26 January first, two thousand six through December thirty-first, two thou-
27 sand six;
28 (vi) thirty million nine hundred thousand dollars for the period Janu-
29 ary first, two thousand seven through December thirty-first, two thou-
30 sand seven;
31 (vii) twenty-four million seven hundred thousand dollars for the peri-
32 od January first, two thousand eight through December thirty-first, two
33 thousand eight;
34 (viii) twelve million three hundred seventy-five thousand dollars for
35 the period January first, two thousand nine through December thirty-
36 first, two thousand nine;
37 (ix) nine million three hundred thousand dollars for the period Janu-
38 ary first, two thousand ten through December thirty-first, two thousand
39 ten; and
40 (x) two million three hundred twenty-five thousand dollars for the
41 period January first, two thousand eleven through March thirty-first,
42 two thousand eleven.
43 (aa) Funds shall be reserved and accumulated from year to year and
44 shall be available, including income from invested funds, for purposes
45 of grants to public residential health care facilities for recruitment
46 and retention of health care workers pursuant to paragraph (b) of subdi-
47 vision eighteen of section twenty-eight hundred eight of this article
48 from the tobacco control and insurance initiatives pool established for
49 the following periods in the following amounts:
50 (i) seven million five hundred thousand dollars on an annualized basis
51 for the period January first, two thousand two through December thirty-
52 first, two thousand two;
53 (ii) eleven million seven hundred thousand dollars on an annualized
54 basis for the period January first, two thousand three through December
55 thirty-first, two thousand three;
A. 4009--C 50
1 (iii) sixteen million two hundred thousand dollars on an annualized
2 basis for the period January first, two thousand four through December
3 thirty-first, two thousand four;
4 (iv) sixteen million two hundred thousand dollars for the period Janu-
5 ary first, two thousand five through December thirty-first, two thousand
6 five;
7 (v) sixteen million two hundred thousand dollars for the period Janu-
8 ary first, two thousand six through December thirty-first, two thousand
9 six;
10 (vi) ten million eight hundred thousand dollars for the period January
11 first, two thousand seven through December thirty-first, two thousand
12 seven;
13 (vii) six million seven hundred fifty thousand dollars for the period
14 January first, two thousand eight through December thirty-first, two
15 thousand eight; and
16 (viii) one million three hundred fifty thousand dollars for the period
17 January first, two thousand nine through December thirty-first, two
18 thousand nine.
19 (bb)(i) Funds shall be deposited by the commissioner, within amounts
20 appropriated, and subject to the availability of federal financial
21 participation, and the state comptroller is hereby authorized and
22 directed to receive for deposit to the credit of the state special
23 revenue funds - other, HCRA transfer fund, medical assistance account,
24 or any successor fund or account, for the purpose of supporting the
25 state share of adjustments to Medicaid rates of payment for personal
26 care services provided pursuant to paragraph (e) of subdivision two of
27 section three hundred sixty-five-a of the social services law, for local
28 social service districts which include a city with a population of over
29 one million persons and computed and distributed in accordance with
30 memorandums of understanding to be entered into between the state of New
31 York and such local social service districts for the purpose of support-
32 ing the recruitment and retention of personal care service workers or
33 any worker with direct patient care responsibility, from the tobacco
34 control and insurance initiatives pool established for the following
35 periods and the following amounts:
36 (A) forty-four million dollars, on an annualized basis, for the period
37 April first, two thousand two through December thirty-first, two thou-
38 sand two;
39 (B) seventy-four million dollars, on an annualized basis, for the
40 period January first, two thousand three through December thirty-first,
41 two thousand three;
42 (C) one hundred four million dollars, on an annualized basis, for the
43 period January first, two thousand four through December thirty-first,
44 two thousand four;
45 (D) one hundred thirty-six million dollars, on an annualized basis,
46 for the period January first, two thousand five through December thir-
47 ty-first, two thousand five;
48 (E) one hundred thirty-six million dollars, on an annualized basis,
49 for the period January first, two thousand six through December thirty-
50 first, two thousand six;
51 (F) one hundred thirty-six million dollars for the period January
52 first, two thousand seven through December thirty-first, two thousand
53 seven;
54 (G) one hundred thirty-six million dollars for the period January
55 first, two thousand eight through December thirty-first, two thousand
56 eight;
A. 4009--C 51
1 (H) one hundred thirty-six million dollars for the period January
2 first, two thousand nine through December thirty-first, two thousand
3 nine;
4 (I) one hundred thirty-six million dollars for the period January
5 first, two thousand ten through December thirty-first, two thousand ten;
6 [and]
7 (J) thirty-four million dollars for the period January first, two
8 thousand eleven through March thirty-first, two thousand eleven[.]; AND
9 (K) ONE HUNDRED THIRTY-SIX MILLION DOLLARS EACH STATE FISCAL YEAR FOR
10 THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
11 TWO THOUSAND FOURTEEN.
12 (ii) Adjustments to Medicaid rates made pursuant to this paragraph
13 shall not, in aggregate, exceed the following amounts for the following
14 periods:
15 (A) for the period April first, two thousand two through December
16 thirty-first, two thousand two, one hundred ten million dollars;
17 (B) for the period January first, two thousand three through December
18 thirty-first, two thousand three, one hundred eighty-five million
19 dollars;
20 (C) for the period January first, two thousand four through December
21 thirty-first, two thousand four, two hundred sixty million dollars;
22 (D) for the period January first, two thousand five through December
23 thirty-first, two thousand five, three hundred forty million dollars;
24 (E) for the period January first, two thousand six through December
25 thirty-first, two thousand six, three hundred forty million dollars;
26 (F) for the period January first, two thousand seven through December
27 thirty-first, two thousand seven, three hundred forty million dollars;
28 (G) for the period January first, two thousand eight through December
29 thirty-first, two thousand eight, three hundred forty million dollars;
30 (H) for the period January first, two thousand nine through December
31 thirty-first, two thousand nine, three hundred forty million dollars;
32 (I) for the period January first, two thousand ten through December
33 thirty-first, two thousand ten, three hundred forty million dollars;
34 [and]
35 (J) for the period January first, two thousand eleven through March
36 thirty-first, two thousand eleven, eighty-five million dollars[.]; AND
37 (K) FOR EACH STATE FISCAL YEAR WITHIN THE PERIOD APRIL FIRST, TWO
38 THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, THREE
39 HUNDRED FORTY MILLION DOLLARS.
40 (iii) Personal care service providers which have their rates adjusted
41 pursuant to this paragraph shall use such funds for the purpose of
42 recruitment and retention of non-supervisory personal care services
43 workers or any worker with direct patient care responsibility only and
44 are prohibited from using such funds for any other purpose. Each such
45 personal care services provider shall submit, at a time and in a manner
46 to be determined by the commissioner, a written certification attesting
47 that such funds will be used solely for the purpose of recruitment and
48 retention of non-supervisory personal care services workers or any work-
49 er with direct patient care responsibility. The commissioner is author-
50 ized to audit each such provider to ensure compliance with the written
51 certification required by this subdivision and shall recoup any funds
52 determined to have been used for purposes other than recruitment and
53 retention of non-supervisory personal care services workers or any work-
54 er with direct patient care responsibility. Such recoupment shall be in
55 addition to any other penalties provided by law.
A. 4009--C 52
1 (cc) Funds shall be deposited by the commissioner, within amounts
2 appropriated, and the state comptroller is hereby authorized and
3 directed to receive for deposit to the credit of the state special
4 revenue funds - other, HCRA transfer fund, medical assistance account,
5 or any successor fund or account, for the purpose of supporting the
6 state share of adjustments to Medicaid rates of payment for personal
7 care services provided pursuant to paragraph (e) of subdivision two of
8 section three hundred sixty-five-a of the social services law, for local
9 social service districts which shall not include a city with a popu-
10 lation of over one million persons for the purpose of supporting the
11 personal care services worker recruitment and retention program as
12 established pursuant to section three hundred sixty-seven-q of the
13 social services law, from the tobacco control and insurance initiatives
14 pool established for the following periods and the following amounts:
15 (i) two million eight hundred thousand dollars for the period April
16 first, two thousand two through December thirty-first, two thousand two;
17 (ii) five million six hundred thousand dollars, on an annualized
18 basis, for the period January first, two thousand three through December
19 thirty-first, two thousand three;
20 (iii) eight million four hundred thousand dollars, on an annualized
21 basis, for the period January first, two thousand four through December
22 thirty-first, two thousand four;
23 (iv) ten million eight hundred thousand dollars, on an annualized
24 basis, for the period January first, two thousand five through December
25 thirty-first, two thousand five;
26 (v) ten million eight hundred thousand dollars, on an annualized
27 basis, for the period January first, two thousand six through December
28 thirty-first, two thousand six;
29 (vi) eleven million two hundred thousand dollars for the period Janu-
30 ary first, two thousand seven through December thirty-first, two thou-
31 sand seven;
32 (vii) eleven million two hundred thousand dollars for the period Janu-
33 ary first, two thousand eight through December thirty-first, two thou-
34 sand eight;
35 (viii) eleven million two hundred thousand dollars for the period
36 January first, two thousand nine through December thirty-first, two
37 thousand nine;
38 (ix) eleven million two hundred thousand dollars for the period Janu-
39 ary first, two thousand ten through December thirty-first, two thousand
40 ten; [and]
41 (x) two million eight hundred thousand dollars for the period January
42 first, two thousand eleven through March thirty-first, two thousand
43 eleven[.]; AND
44 (XI) ELEVEN MILLION TWO HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
45 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
46 TY-FIRST, TWO THOUSAND FOURTEEN.
47 (dd) Funds shall be deposited by the commissioner, within amounts
48 appropriated, and the state comptroller is hereby authorized and
49 directed to receive for deposit to the credit of the state special
50 revenue fund - other, HCRA transfer fund, medical assistance account, or
51 any successor fund or account, for purposes of funding the state share
52 of Medicaid expenditures for physician services from the tobacco control
53 and insurance initiatives pool established for the following periods in
54 the following amounts:
55 (i) up to fifty-two million dollars for the period January first, two
56 thousand two through December thirty-first, two thousand two;
A. 4009--C 53
1 (ii) eighty-one million two hundred thousand dollars for the period
2 January first, two thousand three through December thirty-first, two
3 thousand three;
4 (iii) eighty-five million two hundred thousand dollars for the period
5 January first, two thousand four through December thirty-first, two
6 thousand four;
7 (iv) eighty-five million two hundred thousand dollars for the period
8 January first, two thousand five through December thirty-first, two
9 thousand five;
10 (v) eighty-five million two hundred thousand dollars for the period
11 January first, two thousand six through December thirty-first, two thou-
12 sand six;
13 (vi) [eight-five] EIGHTY-FIVE million two hundred thousand dollars for
14 the period January first, two thousand seven through December thirty-
15 first, two thousand seven;
16 (vii) eighty-five million two hundred thousand dollars for the period
17 January first, two thousand eight through December thirty-first, two
18 thousand eight;
19 (viii) eighty-five million two hundred thousand dollars for the period
20 January first, two thousand nine through December thirty-first, two
21 thousand nine;
22 (ix) eighty-five million two hundred thousand dollars for the period
23 January first, two thousand ten through December thirty-first, two thou-
24 sand ten; [and]
25 (x) twenty-one million three hundred thousand dollars for the period
26 January first, two thousand eleven through March thirty-first, two thou-
27 sand eleven[.]; AND
28 (XI) EIGHTY-FIVE MILLION TWO HUNDRED THOUSAND DOLLARS EACH STATE
29 FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
30 MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
31 (ee) Funds shall be deposited by the commissioner, within amounts
32 appropriated, and the state comptroller is hereby authorized and
33 directed to receive for deposit to the credit of the state special
34 revenue fund - other, HCRA transfer fund, medical assistance account, or
35 any successor fund or account, for purposes of funding the state share
36 of the free-standing diagnostic and treatment center rate increases for
37 recruitment and retention of health care workers pursuant to subdivision
38 seventeen of section twenty-eight hundred seven of this article from the
39 tobacco control and insurance initiatives pool established for the
40 following periods in the following amounts:
41 (i) three million two hundred fifty thousand dollars for the period
42 April first, two thousand two through December thirty-first, two thou-
43 sand two;
44 (ii) three million two hundred fifty thousand dollars on an annualized
45 basis for the period January first, two thousand three through December
46 thirty-first, two thousand three;
47 (iii) three million two hundred fifty thousand dollars on an annual-
48 ized basis for the period January first, two thousand four through
49 December thirty-first, two thousand four;
50 (iv) three million two hundred fifty thousand dollars for the period
51 January first, two thousand five through December thirty-first, two
52 thousand five;
53 (v) three million two hundred fifty thousand dollars for the period
54 January first, two thousand six through December thirty-first, two thou-
55 sand six;
A. 4009--C 54
1 (vi) three million two hundred fifty thousand dollars for the period
2 January first, two thousand seven through December thirty-first, two
3 thousand seven;
4 (vii) three million four hundred thirty-eight thousand dollars for the
5 period January first, two thousand eight through December thirty-first,
6 two thousand eight;
7 (viii) two million four hundred fifty thousand dollars for the period
8 January first, two thousand nine through December thirty-first, two
9 thousand nine;
10 (ix) one million five hundred thousand dollars for the period January
11 first, two thousand ten through December thirty-first, two thousand ten;
12 and
13 (x) three hundred twenty-five thousand dollars for the period January
14 first, two thousand eleven through March thirty-first, two thousand
15 eleven.
16 (ff) Funds shall be deposited by the commissioner, within amounts
17 appropriated, and the state comptroller is hereby authorized and
18 directed to receive for deposit to the credit of the state special
19 revenue fund - other, HCRA transfer fund, medical assistance account, or
20 any successor fund or account, for purposes of funding the state share
21 of Medicaid expenditures for disabled persons as authorized pursuant to
22 subparagraphs twelve and thirteen of paragraph (a) of subdivision one of
23 section three hundred sixty-six of the social services law from the
24 tobacco control and insurance initiatives pool established for the
25 following periods in the following amounts:
26 (i) one million eight hundred thousand dollars for the period April
27 first, two thousand two through December thirty-first, two thousand two;
28 (ii) sixteen million four hundred thousand dollars on an annualized
29 basis for the period January first, two thousand three through December
30 thirty-first, two thousand three;
31 (iii) eighteen million seven hundred thousand dollars on an annualized
32 basis for the period January first, two thousand four through December
33 thirty-first, two thousand four;
34 (iv) thirty million six hundred thousand dollars for the period Janu-
35 ary first, two thousand five through December thirty-first, two thousand
36 five;
37 (v) thirty million six hundred thousand dollars for the period January
38 first, two thousand six through December thirty-first, two thousand six;
39 (vi) thirty million six hundred thousand dollars for the period Janu-
40 ary first, two thousand seven through December thirty-first, two thou-
41 sand seven;
42 (vii) fifteen million dollars for the period January first, two thou-
43 sand eight through December thirty-first, two thousand eight;
44 (viii) fifteen million dollars for the period January first, two thou-
45 sand nine through December thirty-first, two thousand nine;
46 (ix) fifteen million dollars for the period January first, two thou-
47 sand ten through December thirty-first, two thousand ten; [and]
48 (x) three million seven hundred fifty thousand dollars for the period
49 January first, two thousand eleven through March thirty-first, two thou-
50 sand eleven[.]; AND
51 (XI) FIFTEEN MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
52 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
53 SAND FOURTEEN.
54 (gg) Funds shall be reserved and accumulated from year to year and
55 shall be available, including income from invested funds, for purposes
56 of grants to non-public general hospitals pursuant to paragraph (c) of
A. 4009--C 55
1 subdivision thirty of section twenty-eight hundred seven-c of this arti-
2 cle from the tobacco control and insurance initiatives pool established
3 for the following periods in the following amounts:
4 (i) up to one million three hundred thousand dollars on an annualized
5 basis for the period January first, two thousand two through December
6 thirty-first, two thousand two;
7 (ii) up to three million two hundred thousand dollars on an annualized
8 basis for the period January first, two thousand three through December
9 thirty-first, two thousand three;
10 (iii) up to five million six hundred thousand dollars on an annualized
11 basis for the period January first, two thousand four through December
12 thirty-first, two thousand four;
13 (iv) up to eight million six hundred thousand dollars for the period
14 January first, two thousand five through December thirty-first, two
15 thousand five;
16 (v) up to eight million six hundred thousand dollars on an annualized
17 basis for the period January first, two thousand six through December
18 thirty-first, two thousand six;
19 (vi) up to two million six hundred thousand dollars for the period
20 January first, two thousand seven through December thirty-first, two
21 thousand seven;
22 (vii) up to two million six hundred thousand dollars for the period
23 January first, two thousand eight through December thirty-first, two
24 thousand eight;
25 (viii) up to two million six hundred thousand dollars for the period
26 January first, two thousand nine through December thirty-first, two
27 thousand nine;
28 (ix) up to two million six hundred thousand dollars for the period
29 January first, two thousand ten through December thirty-first, two thou-
30 sand ten; and
31 (x) up to six hundred fifty thousand dollars for the period January
32 first, two thousand eleven through March thirty-first, two thousand
33 eleven.
34 (hh) Funds shall be deposited by the commissioner, within amounts
35 appropriated, and the state comptroller is hereby authorized and
36 directed to receive for deposit to the credit of the special revenue
37 fund - other, HCRA transfer fund, medical assistance account for
38 purposes of providing financial assistance to residential health care
39 facilities pursuant to subdivisions nineteen and twenty-one of section
40 twenty-eight hundred eight of this article, from the tobacco control and
41 insurance initiatives pool established for the following periods in the
42 following amounts:
43 (i) for the period April first, two thousand two through December
44 thirty-first, two thousand two, ten million dollars;
45 (ii) for the period January first, two thousand three through December
46 thirty-first, two thousand three, nine million four hundred fifty thou-
47 sand dollars;
48 (iii) for the period January first, two thousand four through December
49 thirty-first, two thousand four, nine million three hundred fifty thou-
50 sand dollars;
51 (iv) up to fifteen million dollars for the period January first, two
52 thousand five through December thirty-first, two thousand five;
53 (v) up to fifteen million dollars for the period January first, two
54 thousand six through December thirty-first, two thousand six;
55 (vi) up to fifteen million dollars for the period January first, two
56 thousand seven through December thirty-first, two thousand seven;
A. 4009--C 56
1 (vii) up to fifteen million dollars for the period January first, two
2 thousand eight through December thirty-first, two thousand eight;
3 (viii) up to fifteen million dollars for the period January first, two
4 thousand nine through December thirty-first, two thousand nine;
5 (ix) up to fifteen million dollars for the period January first, two
6 thousand ten through December thirty-first, two thousand ten; [and]
7 (x) up to three million seven hundred fifty thousand dollars for the
8 period January first, two thousand eleven through March thirty-first,
9 two thousand eleven[.]; AND
10 (XI) FIFTEEN MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
11 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
12 SAND FOURTEEN.
13 (ii) Funds shall be deposited by the commissioner, within amounts
14 appropriated, and the state comptroller is hereby authorized and
15 directed to receive for deposit to the credit of the state special
16 revenue funds - other, HCRA transfer fund, medical assistance account,
17 or any successor fund or account, for the purpose of supporting the
18 state share of Medicaid expenditures for disabled persons as authorized
19 by sections 1619 (a) and (b) of the federal social security act pursuant
20 to the tobacco control and insurance initiatives pool established for
21 the following periods in the following amounts:
22 (i) six million four hundred thousand dollars for the period April
23 first, two thousand two through December thirty-first, two thousand two;
24 (ii) eight million five hundred thousand dollars, for the period Janu-
25 ary first, two thousand three through December thirty-first, two thou-
26 sand three;
27 (iii) eight million five hundred thousand dollars for the period Janu-
28 ary first, two thousand four through December thirty-first, two thousand
29 four;
30 (iv) eight million five hundred thousand dollars for the period Janu-
31 ary first, two thousand five through December thirty-first, two thousand
32 five;
33 (v) eight million five hundred thousand dollars for the period January
34 first, two thousand six through December thirty-first, two thousand six;
35 (vi) eight million six hundred thousand dollars for the period January
36 first, two thousand seven through December thirty-first, two thousand
37 seven;
38 (vii) eight million five hundred thousand dollars for the period Janu-
39 ary first, two thousand eight through December thirty-first, two thou-
40 sand eight;
41 (viii) eight million five hundred thousand dollars for the period
42 January first, two thousand nine through December thirty-first, two
43 thousand nine;
44 (ix) eight million five hundred thousand dollars for the period Janu-
45 ary first, two thousand ten through December thirty-first, two thousand
46 ten; [and]
47 (x) two million one hundred twenty-five thousand dollars for the peri-
48 od January first, two thousand eleven through March thirty-first, two
49 thousand eleven; AND
50 (XI) EIGHT MILLION FIVE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
51 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
52 TY-FIRST, TWO THOUSAND FOURTEEN.
53 (jj) Funds shall be reserved and accumulated from year to year and
54 shall be available, including income from invested funds, for the
55 purposes of a grant program to improve access to infertility services,
56 treatments and procedures, from the tobacco control and insurance initi-
A. 4009--C 57
1 atives pool established for the period January first, two thousand two
2 through December thirty-first, two thousand two in the amount of nine
3 million one hundred seventy-five thousand dollars, for the period April
4 first, two thousand six through March thirty-first, two thousand seven
5 in the amount of five million dollars, for the period April first, two
6 thousand seven through March thirty-first, two thousand eight in the
7 amount of five million dollars, for the period April first, two thousand
8 eight through March thirty-first, two thousand nine in the amount of
9 five million dollars, and for the period April first, two thousand nine
10 through March thirty-first, two thousand ten in the amount of five
11 million dollars, [and] for the period April first, two thousand ten
12 through March thirty-first, two thousand eleven in the amount of two
13 million two hundred thousand dollars, AND FOR THE PERIOD APRIL FIRST,
14 TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE UP
15 TO ONE MILLION ONE HUNDRED THOUSAND DOLLARS.
16 (kk) Funds shall be deposited by the commissioner, within amounts
17 appropriated, and the state comptroller is hereby authorized and
18 directed to receive for deposit to the credit of the state special
19 revenue funds -- other, HCRA transfer fund, medical assistance account,
20 or any successor fund or account, for purposes of funding the state
21 share of Medical Assistance Program expenditures from the tobacco
22 control and insurance initiatives pool established for the following
23 periods in the following amounts:
24 (i) thirty-eight million eight hundred thousand dollars for the period
25 January first, two thousand two through December thirty-first, two thou-
26 sand two;
27 (ii) up to two hundred ninety-five million dollars for the period
28 January first, two thousand three through December thirty-first, two
29 thousand three;
30 (iii) up to four hundred seventy-two million dollars for the period
31 January first, two thousand four through December thirty-first, two
32 thousand four;
33 (iv) up to nine hundred million dollars for the period January first,
34 two thousand five through December thirty-first, two thousand five;
35 (v) up to eight hundred sixty-six million three hundred thousand
36 dollars for the period January first, two thousand six through December
37 thirty-first, two thousand six;
38 (vi) up to six hundred sixteen million seven hundred thousand dollars
39 for the period January first, two thousand seven through December thir-
40 ty-first, two thousand seven;
41 (vii) up to five hundred seventy-eight million nine hundred twenty-
42 five thousand dollars for the period January first, two thousand eight
43 through December thirty-first, two thousand eight; and
44 (viii) within amounts appropriated on and after January first, two
45 thousand nine.
46 (ll) Funds shall be deposited by the commissioner, within amounts
47 appropriated, and the state comptroller is hereby authorized and
48 directed to receive for deposit to the credit of the state special
49 revenue funds -- other, HCRA transfer fund, medical assistance account,
50 or any successor fund or account, for purposes of funding the state
51 share of Medicaid expenditures related to the city of New York from the
52 tobacco control and insurance initiatives pool established for the
53 following periods in the following amounts:
54 (i) eighty-two million seven hundred thousand dollars for the period
55 January first, two thousand two through December thirty-first, two thou-
56 sand two;
A. 4009--C 58
1 (ii) one hundred twenty-four million six hundred thousand dollars for
2 the period January first, two thousand three through December thirty-
3 first, two thousand three;
4 (iii) one hundred twenty-four million seven hundred thousand dollars
5 for the period January first, two thousand four through December thir-
6 ty-first, two thousand four;
7 (iv) one hundred twenty-four million seven hundred thousand dollars
8 for the period January first, two thousand five through December thir-
9 ty-first, two thousand five;
10 (v) one hundred twenty-four million seven hundred thousand dollars for
11 the period January first, two thousand six through December thirty-
12 first, two thousand six;
13 (vi) one hundred twenty-four million seven hundred thousand dollars
14 for the period January first, two thousand seven through December thir-
15 ty-first, two thousand seven;
16 (vii) one hundred twenty-four million seven hundred thousand dollars
17 for the period January first, two thousand eight through December thir-
18 ty-first, two thousand eight;
19 (viii) one hundred twenty-four million seven hundred thousand dollars
20 for the period January first, two thousand nine through December thir-
21 ty-first, two thousand nine;
22 (ix) one hundred twenty-four million seven hundred thousand dollars
23 for the period January first, two thousand ten through December thirty-
24 first, two thousand ten; [and]
25 (x) thirty-one million one hundred seventy-five thousand dollars for
26 the period January first, two thousand eleven through March thirty-
27 first, two thousand eleven[.]; AND
28 (XI) ONE HUNDRED TWENTY-FOUR MILLION SEVEN HUNDRED THOUSAND DOLLARS
29 EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
30 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN.
31 (mm) Funds shall be deposited by the commissioner, within amounts
32 appropriated, and the state comptroller is hereby authorized and
33 directed to receive for deposit to the credit of the state special
34 revenue funds - other, HCRA transfer fund, medical assistance account,
35 or any successor fund or account, for purposes of funding specified
36 percentages of the state share of services and expenses related to the
37 family health plus program in accordance with the following schedule:
38 (i) (A) for the period January first, two thousand three through
39 December thirty-first, two thousand four, one hundred percent of the
40 state share;
41 (B) for the period January first, two thousand five through December
42 thirty-first, two thousand five, seventy-five percent of the state
43 share; and,
44 (C) for periods beginning on and after January first, two thousand
45 six, fifty percent of the state share.
46 (ii) Funding for the family health plus program will include up to
47 five million dollars annually for the period January first, two thousand
48 three through December thirty-first, two thousand six, up to five
49 million dollars for the period January first, two thousand seven through
50 December thirty-first, two thousand seven, up to seven million two
51 hundred thousand dollars for the period January first, two thousand
52 eight through December thirty-first, two thousand eight, up to seven
53 million two hundred thousand dollars for the period January first, two
54 thousand nine through December thirty-first, two thousand nine, up to
55 seven million two hundred thousand dollars for the period January first,
56 two thousand ten through December thirty-first, two thousand ten, [and]
A. 4009--C 59
1 up to one million eight hundred thousand dollars for the period January
2 first, two thousand eleven through March thirty-first, two thousand
3 eleven, UP TO SIX MILLION FORTY-NINE THOUSAND DOLLARS FOR THE PERIOD
4 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
5 SAND TWELVE, UP TO SIX MILLION TWO HUNDRED EIGHTY-NINE THOUSAND DOLLARS
6 FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
7 THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND UP TO SIX MILLION FOUR HUNDRED
8 SIXTY-ONE THOUSAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND
9 THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, for adminis-
10 tration and marketing costs associated with such program established
11 pursuant to clauses (A) and (B) of subparagraph (v) of paragraph (a) of
12 subdivision two of section three hundred sixty-nine-ee of the social
13 services law from the tobacco control and insurance initiatives pool
14 established for the following periods in the following amounts:
15 (A) one hundred ninety million six hundred thousand dollars for the
16 period January first, two thousand three through December thirty-first,
17 two thousand three;
18 (B) three hundred seventy-four million dollars for the period January
19 first, two thousand four through December thirty-first, two thousand
20 four;
21 (C) five hundred thirty-eight million four hundred thousand dollars
22 for the period January first, two thousand five through December thir-
23 ty-first, two thousand five;
24 (D) three hundred eighteen million seven hundred seventy-five thousand
25 dollars for the period January first, two thousand six through December
26 thirty-first, two thousand six;
27 (E) four hundred eighty-two million eight hundred thousand dollars for
28 the period January first, two thousand seven through December thirty-
29 first, two thousand seven;
30 (F) five hundred seventy million twenty-five thousand dollars for the
31 period January first, two thousand eight through December thirty-first,
32 two thousand eight;
33 (G) six hundred ten million seven hundred twenty-five thousand dollars
34 for the period January first, two thousand nine through December thir-
35 ty-first, two thousand nine;
36 (H) six hundred twenty-seven million two hundred seventy-five thousand
37 dollars for the period January first, two thousand ten through December
38 thirty-first, two thousand ten; [and]
39 (I) one hundred fifty-seven million eight hundred seventy-five thou-
40 sand dollars for the period January first, two thousand eleven through
41 March thirty-first, two thousand eleven[.];
42 (J) SIX HUNDRED TWENTY-EIGHT MILLION FOUR HUNDRED THOUSAND DOLLARS FOR
43 THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
44 TWO THOUSAND TWELVE;
45 (K) SIX HUNDRED FIFTY MILLION FOUR HUNDRED THOUSAND DOLLARS FOR THE
46 PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST, TWO
47 THOUSAND THIRTEEN; AND
48 (L) SIX HUNDRED FIFTY MILLION FOUR HUNDRED THOUSAND DOLLARS FOR THE
49 PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST,
50 TWO THOUSAND FOURTEEN.
51 (nn) Funds shall be deposited by the commissioner, within amounts
52 appropriated, and the state comptroller is hereby authorized and
53 directed to receive for deposit to the credit of the state special
54 revenue fund - other, HCRA transfer fund, health care services account,
55 or any successor fund or account, for purposes related to adult home
56 initiatives for medicaid eligible residents of residential facilities
A. 4009--C 60
1 licensed pursuant to section four hundred sixty-b of the social services
2 law from the tobacco control and insurance initiatives pool established
3 for the following periods in the following amounts:
4 (i) up to four million dollars for the period January first, two thou-
5 sand three through December thirty-first, two thousand three;
6 (ii) up to six million dollars for the period January first, two thou-
7 sand four through December thirty-first, two thousand four;
8 (iii) up to eight million dollars for the period January first, two
9 thousand five through December thirty-first, two thousand five,
10 provided, however, that up to five million two hundred fifty thousand
11 dollars of such funds shall be received by the comptroller and deposited
12 to the credit of the special revenue fund - other / aid to localities,
13 HCRA transfer fund - 061, enhanced community services account - 05, or
14 any successor fund or account, for the purposes set forth in this para-
15 graph;
16 (iv) up to eight million dollars for the period January first, two
17 thousand six through December thirty-first, two thousand six, provided,
18 however, that up to five million two hundred fifty thousand dollars of
19 such funds shall be received by the comptroller and deposited to the
20 credit of the special revenue fund - other / aid to localities, HCRA
21 transfer fund - 061, enhanced community services account - 05, or any
22 successor fund or account, for the purposes set forth in this paragraph;
23 (v) up to eight million dollars for the period January first, two
24 thousand seven through December thirty-first, two thousand seven,
25 provided, however, that up to five million two hundred fifty thousand
26 dollars of such funds shall be received by the comptroller and deposited
27 to the credit of the special revenue fund - other / aid to localities,
28 HCRA transfer fund - 061, enhanced community services account - 05, or
29 any successor fund or account, for the purposes set forth in this para-
30 graph;
31 (vi) up to two million seven hundred fifty thousand dollars for the
32 period January first, two thousand eight through December thirty-first,
33 two thousand eight;
34 (vii) up to two million seven hundred fifty thousand dollars for the
35 period January first, two thousand nine through December thirty-first,
36 two thousand nine;
37 (viii) up to two million seven hundred fifty thousand dollars for the
38 period January first, two thousand ten through December thirty-first,
39 two thousand ten; and
40 (ix) up to six hundred eighty-eight thousand dollars for the period
41 January first, two thousand eleven through March thirty-first, two thou-
42 sand eleven.
43 (oo) Funds shall be reserved and accumulated from year to year and
44 shall be available, including income from invested funds, for purposes
45 of grants to non-public general hospitals pursuant to paragraph (e) of
46 subdivision twenty-five of section twenty-eight hundred seven-c of this
47 article from the tobacco control and insurance initiatives pool estab-
48 lished for the following periods in the following amounts:
49 (i) up to five million dollars on an annualized basis for the period
50 January first, two thousand four through December thirty-first, two
51 thousand four;
52 (ii) up to five million dollars for the period January first, two
53 thousand five through December thirty-first, two thousand five;
54 (iii) up to five million dollars for the period January first, two
55 thousand six through December thirty-first, two thousand six;
A. 4009--C 61
1 (iv) up to five million dollars for the period January first, two
2 thousand seven through December thirty-first, two thousand seven; and
3 (v) up to five million dollars for the period January first, two thou-
4 sand eight through December thirty-first, two thousand eight;
5 (vi) up to five million dollars for the period January first, two
6 thousand nine through December thirty-first, two thousand nine;
7 (vii) up to five million dollars for the period January first, two
8 thousand ten through December thirty-first, two thousand ten; and
9 (viii) up to one million two hundred fifty thousand dollars for the
10 period January first, two thousand eleven through March thirty-first,
11 two thousand eleven.
12 (pp) Funds shall be reserved and accumulated from year to year and
13 shall be available, including income from invested funds, for the
14 purpose of supporting the provision of tax credits for long term care
15 insurance pursuant to subdivision one of section one hundred ninety of
16 the tax law, paragraph (a) of subdivision twenty-five-a of section two
17 hundred ten of such law, subsection (aa) of section six hundred six of
18 such law, paragraph one of subsection (k) of section fourteen hundred
19 fifty-six of such law and paragraph one of subdivision (m) of section
20 fifteen hundred eleven of such law, in the following amounts:
21 (i) ten million dollars for the period January first, two thousand
22 four through December thirty-first, two thousand four;
23 (ii) ten million dollars for the period January first, two thousand
24 five through December thirty-first, two thousand five;
25 (iii) ten million dollars for the period January first, two thousand
26 six through December thirty-first, two thousand six; and
27 (iv) five million dollars for the period January first, two thousand
28 seven through June thirtieth, two thousand seven.
29 (qq) Funds shall be reserved and accumulated from year to year and
30 shall be available, including income from invested funds, for the
31 purpose of supporting the long-term care insurance education and
32 outreach program established pursuant to section two hundred seventeen-a
33 of the elder law for the following periods in the following amounts:
34 (i) up to five million dollars for the period January first, two thou-
35 sand four through December thirty-first, two thousand four; of such
36 funds one million nine hundred fifty thousand dollars shall be made
37 available to the department for the purpose of developing, implementing
38 and administering the long-term care insurance education and outreach
39 program and three million fifty thousand dollars shall be deposited by
40 the commissioner, within amounts appropriated, and the comptroller is
41 hereby authorized and directed to receive for deposit to the credit of
42 the special revenue funds - other, HCRA transfer fund, long term care
43 insurance resource center account of the state office for the aging or
44 any future account designated for the purpose of implementing the long
45 term care insurance education and outreach program and providing the
46 long term care insurance resource centers with the necessary resources
47 to carry out their operations;
48 (ii) up to five million dollars for the period January first, two
49 thousand five through December thirty-first, two thousand five; of such
50 funds one million nine hundred fifty thousand dollars shall be made
51 available to the department for the purpose of developing, implementing
52 and administering the long-term care insurance education and outreach
53 program and three million fifty thousand dollars shall be deposited by
54 the commissioner, within amounts appropriated, and the comptroller is
55 hereby authorized and directed to receive for deposit to the credit of
56 the special revenue funds - other, HCRA transfer fund, long term care
A. 4009--C 62
1 insurance resource center account of the state office for the aging or
2 any future account designated for the purpose of implementing the long
3 term care insurance education and outreach program and providing the
4 long term care insurance resource centers with the necessary resources
5 to carry out their operations;
6 (iii) up to five million dollars for the period January first, two
7 thousand six through December thirty-first, two thousand six; of such
8 funds one million nine hundred fifty thousand dollars shall be made
9 available to the department for the purpose of developing, implementing
10 and administering the long-term care insurance education and outreach
11 program and three million fifty thousand dollars shall be made available
12 to the office for the aging for the purpose of providing the long term
13 care insurance resource centers with the necessary resources to carry
14 out their operations;
15 (iv) up to five million dollars for the period January first, two
16 thousand seven through December thirty-first, two thousand seven; of
17 such funds one million nine hundred fifty thousand dollars shall be made
18 available to the department for the purpose of developing, implementing
19 and administering the long-term care insurance education and outreach
20 program and three million fifty thousand dollars shall be made available
21 to the office for the aging for the purpose of providing the long term
22 care insurance resource centers with the necessary resources to carry
23 out their operations;
24 (v) up to five million dollars for the period January first, two thou-
25 sand eight through December thirty-first, two thousand eight; of such
26 funds one million nine hundred fifty thousand dollars shall be made
27 available to the department for the purpose of developing, implementing
28 and administering the long term care insurance education and outreach
29 program and three million fifty thousand dollars shall be made available
30 to the office for the aging for the purpose of providing the long term
31 care insurance resource centers with the necessary resources to carry
32 out their operations;
33 (vi) up to five million dollars for the period January first, two
34 thousand nine through December thirty-first, two thousand nine; of such
35 funds one million nine hundred fifty thousand dollars shall be made
36 available to the department for the purpose of developing, implementing
37 and administering the long-term care insurance education and outreach
38 program and three million fifty thousand dollars shall be made available
39 to the office for the aging for the purpose of providing the long-term
40 care insurance resource centers with the necessary resources to carry
41 out their operations;
42 (vii) up to four hundred eighty-eight thousand dollars for the period
43 January first, two thousand ten through March thirty-first, two thousand
44 ten; of such funds four hundred eighty-eight thousand dollars shall be
45 made available to the department for the purpose of developing, imple-
46 menting and administering the long-term care insurance education and
47 outreach program.
48 (rr) Funds shall be reserved and accumulated from the tobacco control
49 and insurance initiatives pool and shall be available, including income
50 from invested funds, for the purpose of supporting expenses related to
51 implementation of the provisions of title III of article twenty-nine-D
52 of this chapter, for the following periods and in the following amounts:
53 (i) up to ten million dollars for the period January first, two thou-
54 sand six through December thirty-first, two thousand six;
55 (ii) up to ten million dollars for the period January first, two thou-
56 sand seven through December thirty-first, two thousand seven;
A. 4009--C 63
1 (iii) up to ten million dollars for the period January first, two
2 thousand eight through December thirty-first, two thousand eight;
3 (iv) up to ten million dollars for the period January first, two thou-
4 sand nine through December thirty-first, two thousand nine;
5 (v) up to ten million dollars for the period January first, two thou-
6 sand ten through December thirty-first, two thousand ten; and
7 (vi) up to two million five hundred thousand dollars for the period
8 January first, two thousand eleven through March thirty-first, two thou-
9 sand eleven.
10 (ss) Funds shall be reserved and accumulated from the tobacco control
11 and insurance initiatives pool and used for a health care stabilization
12 program established by the commissioner for the purposes of stabilizing
13 critical health care providers and health care programs whose ability to
14 continue to provide appropriate services are threatened by financial or
15 other challenges, in the amount of up to twenty-eight million dollars
16 for the period July first, two thousand four through June thirtieth, two
17 thousand five. Notwithstanding the provisions of section one hundred
18 twelve of the state finance law or any other inconsistent provision of
19 the state finance law or any other law, funds available for distribution
20 pursuant to this paragraph may be allocated and distributed by the
21 commissioner, or the state comptroller as applicable without a compet-
22 itive bid or request for proposal process. Considerations relied upon by
23 the commissioner in determining the allocation and distribution of these
24 funds shall include, but not be limited to, the following: (i) the
25 importance of the provider or program in meeting critical health care
26 needs in the community in which it operates; (ii) the provider or
27 program provision of care to under-served populations; (iii) the quality
28 of the care or services the provider or program delivers; (iv) the abil-
29 ity of the provider or program to continue to deliver an appropriate
30 level of care or services if additional funding is made available; (v)
31 the ability of the provider or program to access, in a timely manner,
32 alternative sources of funding, including other sources of government
33 funding; (vi) the ability of other providers or programs in the communi-
34 ty to meet the community health care needs; (vii) whether the provider
35 or program has an appropriate plan to improve its financial condition;
36 and (viii) whether additional funding would permit the provider or
37 program to consolidate, relocate, or close programs or services where
38 such actions would result in greater stability and efficiency in the
39 delivery of needed health care services or programs.
40 (tt) Funds shall be reserved and accumulated from year to year and
41 shall be available, including income from invested funds, for purposes
42 of providing grants for two long term care demonstration projects
43 designed to test new models for the delivery of long term care services
44 established pursuant to section twenty-eight hundred seven-x of this
45 chapter, for the following periods and in the following amounts:
46 (i) up to five hundred thousand dollars for the period January first,
47 two thousand four through December thirty-first, two thousand four;
48 (ii) up to five hundred thousand dollars for the period January first,
49 two thousand five through December thirty-first, two thousand five;
50 (iii) up to five hundred thousand dollars for the period January
51 first, two thousand six through December thirty-first, two thousand six;
52 (iv) up to one million dollars for the period January first, two thou-
53 sand seven through December thirty-first, two thousand seven; and
54 (v) up to two hundred fifty thousand dollars for the period January
55 first, two thousand eight through March thirty-first, two thousand
56 eight.
A. 4009--C 64
1 (uu) Funds shall be reserved and accumulated from year to year and
2 shall be available, including income from invested funds, for the
3 purpose of supporting disease management and telemedicine demonstration
4 programs authorized pursuant to [sections] SECTION twenty-one hundred
5 eleven [and thirty-six hundred twenty-one] of this chapter[, respective-
6 ly,] for the following periods in the following amounts:
7 (i) five million dollars for the period January first, two thousand
8 four through December thirty-first, two thousand four, of which three
9 million dollars shall be available for disease management demonstration
10 programs and two million dollars shall be available for telemedicine
11 demonstration programs;
12 (ii) five million dollars for the period January first, two thousand
13 five through December thirty-first, two thousand five, of which three
14 million dollars shall be available for disease management demonstration
15 programs and two million dollars shall be available for telemedicine
16 demonstration programs;
17 (iii) nine million five hundred thousand dollars for the period Janu-
18 ary first, two thousand six through December thirty-first, two thousand
19 six, of which seven million five hundred thousand dollars shall be
20 available for disease management demonstration programs and two million
21 dollars shall be available for telemedicine demonstration programs;
22 (iv) nine million five hundred thousand dollars for the period January
23 first, two thousand seven through December thirty-first, two thousand
24 seven, of which seven million five hundred thousand dollars shall be
25 available for disease management demonstration programs and one million
26 dollars shall be available for telemedicine demonstration programs;
27 (v) nine million five hundred thousand dollars for the period January
28 first, two thousand eight through December thirty-first, two thousand
29 eight, of which seven million five hundred thousand dollars shall be
30 available for disease management demonstration programs and two million
31 dollars shall be available for telemedicine demonstration programs;
32 (vi) seven million eight hundred thirty-three thousand three hundred
33 thirty-three dollars for the period January first, two thousand nine
34 through December thirty-first, two thousand nine, of which seven million
35 five hundred thousand dollars shall be available for disease management
36 demonstration programs and three hundred thirty-three thousand three
37 hundred thirty-three dollars shall be available for telemedicine demon-
38 stration programs for the period January first, two thousand nine
39 through March first, two thousand nine;
40 (vii) one million eight hundred seventy-five thousand dollars for the
41 period January first, two thousand ten through March thirty-first, two
42 thousand ten shall be available for disease management demonstration
43 programs.
44 (ww) Funds shall be deposited by the commissioner, within amounts
45 appropriated, and the state comptroller is hereby authorized and
46 directed to receive for the deposit to the credit of the state special
47 revenue funds - other, HCRA transfer fund, medical assistance account,
48 or any successor fund or account, for purposes of funding the state
49 share of the general hospital rates increases for recruitment and
50 retention of health care workers pursuant to paragraph (e) of subdivi-
51 sion thirty of section twenty-eight hundred seven-c of this article from
52 the tobacco control and insurance initiatives pool established for the
53 following periods in the following amounts:
54 (i) sixty million five hundred thousand dollars for the period January
55 first, two thousand five through December thirty-first, two thousand
56 five; and
A. 4009--C 65
1 (ii) sixty million five hundred thousand dollars for the period Janu-
2 ary first, two thousand six through December thirty-first, two thousand
3 six.
4 (xx) Funds shall be deposited by the commissioner, within amounts
5 appropriated, and the state comptroller is hereby authorized and
6 directed to receive for the deposit to the credit of the state special
7 revenue funds - other, HCRA transfer fund, medical assistance account,
8 or any successor fund or account, for purposes of funding the state
9 share of the general hospital rates increases for rural hospitals pursu-
10 ant to subdivision thirty-two of section twenty-eight hundred seven-c of
11 this article from the tobacco control and insurance initiatives pool
12 established for the following periods in the following amounts:
13 (i) three million five hundred thousand dollars for the period January
14 first, two thousand five through December thirty-first, two thousand
15 five;
16 (ii) three million five hundred thousand dollars for the period Janu-
17 ary first, two thousand six through December thirty-first, two thousand
18 six;
19 (iii) three million five hundred thousand dollars for the period Janu-
20 ary first, two thousand seven through December thirty-first, two thou-
21 sand seven;
22 (iv) three million five hundred thousand dollars for the period Janu-
23 ary first, two thousand eight through December thirty-first, two thou-
24 sand eight; and
25 (v) three million two hundred eight thousand dollars for the period
26 January first, two thousand nine through November thirtieth, two thou-
27 sand nine.
28 (yy) Funds shall be reserved and accumulated from year to year and
29 shall be available, within amounts appropriated and notwithstanding
30 section one hundred twelve of the state finance law and any other
31 contrary provision of law, for the purpose of supporting grants not to
32 exceed five million dollars to be made by the commissioner without a
33 competitive bid or request for proposal process, in support of the
34 delivery of critically needed health care services, to health care
35 providers located in the counties of Erie and Niagara which executed a
36 memorandum of closing and conducted a merger closing in escrow on Novem-
37 ber twenty-fourth, nineteen hundred ninety-seven and which entered into
38 a settlement dated December thirtieth, two thousand four for a loss on
39 disposal of assets under the provisions of title XVIII of the federal
40 social security act applicable to mergers occurring prior to December
41 first, nineteen hundred ninety-seven.
42 (zz) Funds shall be reserved and accumulated from year to year and
43 shall be available, within amounts appropriated, for the purpose of
44 supporting expenditures authorized pursuant to section twenty-eight
45 hundred eighteen of this article from the tobacco control and insurance
46 initiatives pool established for the following periods in the following
47 amounts:
48 (i) six million five hundred thousand dollars for the period January
49 first, two thousand five through December thirty-first, two thousand
50 five;
51 (ii) one hundred eight million three hundred thousand dollars for the
52 period January first, two thousand six through December thirty-first,
53 two thousand six, provided, however, that within amounts appropriated in
54 the two thousand six through two thousand seven state fiscal year, a
55 portion of such funds may be transferred to the Roswell Park Cancer
56 Institute Corporation to fund capital costs;
A. 4009--C 66
1 (iii) one hundred seventy-one million dollars for the period January
2 first, two thousand seven through December thirty-first, two thousand
3 seven, provided, however, that within amounts appropriated in the two
4 thousand six through two thousand seven state fiscal year, a portion of
5 such funds may be transferred to the Roswell Park Cancer Institute
6 Corporation to fund capital costs;
7 (iv) one hundred seventy-one million five hundred thousand dollars for
8 the period January first, two thousand eight through December thirty-
9 first, two thousand eight;
10 (v) one hundred twenty-eight million seven hundred fifty thousand
11 dollars for the period January first, two thousand nine through December
12 thirty-first, two thousand nine;
13 (vi) one hundred thirty-one million three hundred seventy-five thou-
14 sand dollars for the period January first, two thousand ten through
15 December thirty-first, two thousand ten; [and]
16 (vii) thirty-four million two hundred fifty thousand dollars for the
17 period January first, two thousand eleven through March thirty-first,
18 two thousand eleven[.];
19 (VIII) FOUR HUNDRED THIRTY-THREE MILLION THREE HUNDRED SIXTY-SIX THOU-
20 SAND DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
21 MARCH THIRTY-FIRST, TWO THOUSAND TWELVE;
22 (IX) ONE HUNDRED FIFTY MILLION EIGHT HUNDRED SIX THOUSAND DOLLARS FOR
23 THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST,
24 TWO THOUSAND THIRTEEN; AND
25 (X) SEVENTY-EIGHT MILLION SEVENTY-ONE THOUSAND DOLLARS FOR THE PERIOD
26 APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
27 SAND FOURTEEN.
28 (aaa) Funds shall be reserved and accumulated from year to year and
29 shall be available, including income from invested funds, for services
30 and expenses related to school based health centers, in an amount up to
31 three million five hundred thousand dollars for the period April first,
32 two thousand six through March thirty-first, two thousand seven, up to
33 three million five hundred thousand dollars for the period April first,
34 two thousand seven through March thirty-first, two thousand eight, up to
35 three million five hundred thousand dollars for the period April first,
36 two thousand eight through March thirty-first, two thousand nine, up to
37 three million five hundred thousand dollars for the period April first,
38 two thousand nine through March thirty-first, two thousand ten, [and] up
39 to three million five hundred thousand dollars for the period April
40 first, two thousand ten through March thirty-first, two thousand eleven,
41 AND UP TO TWO MILLION EIGHT HUNDRED THOUSAND DOLLARS EACH STATE FISCAL
42 YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIR-
43 TY-FIRST, TWO THOUSAND FOURTEEN. The total amount of funds provided
44 herein shall be distributed as grants based on the ratio of each provid-
45 er's total enrollment for all sites to the total enrollment of all
46 providers. This formula shall be applied to the total amount provided
47 herein.
48 (bbb) Funds shall be reserved and accumulated from year to year and
49 shall be available, including income from invested funds, for purposes
50 of awarding grants to operators of adult homes, enriched housing
51 programs and residences through the enhancing abilities and life experi-
52 ence (EnAbLe) program to provide for the installation, operation and
53 maintenance of air conditioning in resident rooms, consistent with this
54 paragraph, in an amount up to two million dollars for the period April
55 first, two thousand six through March thirty-first, two thousand seven,
56 up to three million eight hundred thousand dollars for the period April
A. 4009--C 67
1 first, two thousand seven through March thirty-first, two thousand
2 eight, up to three million eight hundred thousand dollars for the period
3 April first, two thousand eight through March thirty-first, two thousand
4 nine, up to three million eight hundred thousand dollars for the period
5 April first, two thousand nine through March thirty-first, two thousand
6 ten, and up to three million eight hundred thousand dollars for the
7 period April first, two thousand ten through March thirty-first, two
8 thousand eleven. Residents shall not be charged utility cost for the use
9 of air conditioners supplied under the EnAbLe program. All such air
10 conditioners must be operated in occupied resident rooms consistent with
11 requirements applicable to common areas.
12 (ccc) Funds shall be deposited by the commissioner, within amounts
13 appropriated, and the state comptroller is hereby authorized and
14 directed to receive for the deposit to the credit of the state special
15 revenue funds - other, HCRA transfer fund, medical assistance account,
16 or any successor fund or account, for purposes of funding the state
17 share of increases in the rates for certified home health agencies, long
18 term home health care programs, AIDS home care programs, hospice
19 programs and managed long term care plans and approved managed long term
20 care operating demonstrations as defined in section forty-four hundred
21 three-f of this chapter for recruitment and retention of health care
22 workers pursuant to subdivisions nine and ten of section thirty-six
23 hundred fourteen of this chapter from the tobacco control and insurance
24 initiatives pool established for the following periods in the following
25 amounts:
26 (i) twenty-five million dollars for the period June first, two thou-
27 sand six through December thirty-first, two thousand six;
28 (ii) fifty million dollars for the period January first, two thousand
29 seven through December thirty-first, two thousand seven;
30 (iii) fifty million dollars for the period January first, two thousand
31 eight through December thirty-first, two thousand eight;
32 (iv) fifty million dollars for the period January first, two thousand
33 nine through December thirty-first, two thousand nine;
34 (v) fifty million dollars for the period January first, two thousand
35 ten through December thirty-first, two thousand ten; [and]
36 (vi) twelve million five hundred thousand dollars for the period Janu-
37 ary first, two thousand eleven through March thirty-first, two thousand
38 eleven[.]; AND
39 (VII) FIFTY MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
40 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
41 SAND FOURTEEN.
42 (ddd) Funds shall be deposited by the commissioner, within amounts
43 appropriated, and the state comptroller is hereby authorized and
44 directed to receive for the deposit to the credit of the state special
45 revenue funds - other, HCRA transfer fund, medical assistance account,
46 or any successor fund or account, for purposes of funding the state
47 share of increases in the medical assistance rates for providers for
48 purposes of enhancing the provision, quality and/or efficiency of home
49 care services pursuant to subdivision eleven of section thirty-six
50 hundred fourteen of this chapter from the tobacco control and insurance
51 initiatives pool established for the following period in the amount of
52 eight million dollars for the period April first, two thousand six
53 through December thirty-first, two thousand six.
54 (eee) Funds shall be reserved and accumulated from year to year and
55 shall be available, including income from invested funds, to the Center
56 for Functional Genomics at the State University of New York at Albany,
A. 4009--C 68
1 for the purposes of the Adirondack network for cancer education and
2 research in rural communities grant program to improve access to health
3 care and shall be made available from the tobacco control and insurance
4 initiatives pool established for the following period in the amount of
5 up to five million dollars for the period January first, two thousand
6 six through December thirty-first, two thousand six.
7 (fff) Funds shall be made available to the empire state stem cell fund
8 established by section ninety-nine-p of the state finance law from the
9 public asset as defined in section four thousand three hundred one of
10 the insurance law and accumulated from the conversion of one or more
11 article forty-three corporations and its or their not-for-profit subsid-
12 iaries occurring on or after January first, two thousand seven. Such
13 funds shall be made available within amounts appropriated up to fifty
14 million dollars annually and shall not exceed five hundred million
15 dollars in total.
16 (ggg) Funds shall be deposited by the commissioner, within amounts
17 appropriated, and the state comptroller is hereby authorized and
18 directed to receive for deposit to the credit of the state special
19 revenue fund - other, HCRA transfer fund, medical assistance account, or
20 any successor fund or account, for the purpose of supporting the state
21 share of Medicaid expenditures for hospital translation services as
22 authorized pursuant to paragraph (k) of subdivision one of section twen-
23 ty-eight hundred seven-c of this article from the tobacco control and
24 initiatives pool established for the following periods in the following
25 amounts:
26 (i) sixteen million dollars for the period July first, two thousand
27 eight through December thirty-first, two thousand eight; and
28 (ii) fourteen million seven hundred thousand dollars for the period
29 January first, two thousand nine through November thirtieth, two thou-
30 sand nine.
31 (hhh) Funds shall be deposited by the commissioner, within amounts
32 appropriated, and the state comptroller is hereby authorized and
33 directed to receive for deposit to the credit of the state special
34 revenue fund - other, HCRA transfer fund, medical assistance account, or
35 any successor fund or account, for the purpose of supporting the state
36 share of Medicaid expenditures for adjustments to inpatient rates of
37 payment for general hospitals located in the counties of Nassau and
38 Suffolk as authorized pursuant to paragraph (l) of subdivision one of
39 section twenty-eight hundred seven-c of this article from the tobacco
40 control and initiatives pool established for the following periods in
41 the following amounts:
42 (i) two million five hundred thousand dollars for the period April
43 first, two thousand eight through December thirty-first, two thousand
44 eight; and
45 (ii) two million two hundred ninety-two thousand dollars for the peri-
46 od January first, two thousand nine through November thirtieth, two
47 thousand nine.
48 S 9. Subdivision 3 of section 1680-j of the public authorities law, as
49 amended by section 34 of part C of chapter 58 of the laws of 2009, is
50 amended to read as follows:
51 3. Notwithstanding any law to the contrary, and in accordance with
52 section four of the state finance law, the comptroller is hereby author-
53 ized and directed to transfer from the health care reform act (HCRA)
54 resources fund (061) to the general fund, upon the request of the direc-
55 tor of the budget, up to $6,500,000 on or before March 31, 2006, and the
56 comptroller is further hereby authorized and directed to transfer from
A. 4009--C 69
1 the healthcare reform act (HCRA); Resources fund (061) to the Capital
2 Projects Fund, upon the request of the director of budget, up to
3 $139,000,000 for the period April 1, 2006 through March 31, 2007, up to
4 $171,100,000 for the period April 1, 2007 through March 31, 2008, up to
5 $208,100,000 for the period April 1, 2008 through March 31, 2009, up to
6 $151,600,000 for the period April 1, 2009 through March 31, 2010, [and]
7 up to [$238,000,000] $215,743,000 for the period April 1, 2010 through
8 March 31, 2011, UP TO $433,366,000 FOR THE PERIOD APRIL 1, 2011 THROUGH
9 MARCH 31, 2012, UP TO $150,806,000 FOR THE PERIOD APRIL 1, 2012 THROUGH
10 MARCH 31, 2013, UP TO $78,071,000 FOR THE PERIOD APRIL 1, 2013 THROUGH
11 MARCH 31, 2014, AND UP TO $86,005,000 FOR THE PERIOD APRIL 1, 2014
12 THROUGH MARCH 31, 2015.
13 S 10. Paragraph (a) of subdivision 12 of section 367-b of the social
14 services law, as amended by section 8 of part B of chapter 58 of the
15 laws of 2008, is amended to read as follows:
16 (a) For the purpose of regulating cash flow for general hospitals, the
17 department shall develop and implement a payment methodology to provide
18 for timely payments for inpatient hospital services eligible for case
19 based payments per discharge based on diagnosis-related groups provided
20 during the period January first, nineteen hundred eighty-eight through
21 March thirty-first two thousand [eleven] FOURTEEN, by such hospitals
22 which elect to participate in the system.
23 S 11. Section 2 of chapter 600 of the laws of 1986, amending the
24 public health law relating to the development of pilot reimbursement
25 programs for ambulatory care services, as amended by section 9 of part B
26 of chapter 58 of the laws of 2008, is amended to read as follows:
27 S 2. This act shall take effect immediately, except that this act
28 shall expire and be of no further force and effect on and after April 1,
29 [2011] 2014; provided, however, that the commissioner of health shall
30 submit a report to the governor and the legislature detailing the objec-
31 tive, impact, design and computation of any pilot reimbursement program
32 established pursuant to this act, on or before March 31, 1994 and annu-
33 ally thereafter. Such report shall include an assessment of the finan-
34 cial impact of such payment system on providers, as well as the impact
35 of such system on access to care.
36 S 12. Paragraph (i) of subdivision (b) of section 1 of chapter 520 of
37 the laws of 1978, relating to providing for a comprehensive survey of
38 health care financing, education and illness prevention and creating
39 councils for the conduct thereof, as amended by section 11 of part B of
40 chapter 58 of the laws of 2008, is amended to read as follows:
41 (i) oversight and evaluation of the inpatient financing system in
42 place for 1988 through March 31, [2011] 2014, and the appropriateness
43 and effectiveness of the bad debt and charity care financing provisions;
44 S 13. The opening paragraph of section 2952 of the public health law,
45 as amended by section 21 of part B of chapter 58 of the laws of 2008, is
46 amended to read as follows:
47 To the extent of funds available therefor, the sum of seven million
48 dollars shall annually be available for periods prior to January first,
49 two thousand three, and up to six million five hundred thirty thousand
50 dollars annually for the period January first, two thousand three
51 through December thirty-first, two thousand four, up to seven million
52 sixty-two thousand dollars for the period January first, two thousand
53 five through December thirty-first, two thousand six annually, up to
54 seven million sixty-two thousand dollars annually for the period January
55 first, two thousand seven through December thirty-first, two thousand
56 ten, [and] up to one million seven hundred sixty-six thousand dollars
A. 4009--C 70
1 for the period January first, two thousand eleven through March thirty-
2 first, two thousand eleven, AND WITHIN AMOUNTS APPROPRIATED FOR EACH
3 STATE FISCAL YEAR ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, shall
4 be available to the commissioner from funds made available pursuant to
5 section twenty-eight hundred seven-l of this chapter for grants pursuant
6 to this section.
7 S 14. Subdivision 1 of section 2958 of the public health law, as
8 amended by section 22 of part B of chapter 58 of the laws of 2008, is
9 amended to read as follows:
10 1. To the extent of funds available therefor, the sum of ten million
11 dollars shall annually be made available for periods prior to January
12 first, two thousand three, and up to nine million three hundred twenty
13 thousand dollars for the period January first, two thousand three
14 through December thirty-first, two thousand three, up to nine million
15 three hundred twenty thousand dollars for the period January first, two
16 thousand four through December thirty-first, two thousand four, up to
17 twelve million eighty-eight thousand dollars for the period January
18 first, two thousand five through December thirty-first, two thousand
19 five, up to twelve million eighty-eight thousand dollars for the period
20 January first, two thousand six through December thirty-first, two thou-
21 sand six, up to eleven million eighty-eight thousand dollars annually
22 for the period January first, two thousand seven through December thir-
23 ty-first, two thousand ten, [and] up to two million seven hundred seven-
24 ty-two thousand dollars for the period January first, two thousand elev-
25 en through March thirty-first, two thousand eleven, AND WITHIN AMOUNTS
26 APPROPRIATED FOR EACH STATE FISCAL YEAR ON AND AFTER APRIL FIRST, TWO
27 THOUSAND ELEVEN, shall be available to the commissioner from funds
28 pursuant to section twenty-eight hundred seven-l of this chapter to
29 provide assistance to general hospitals classified as a rural hospital
30 for purposes of determining payment for inpatient services provided to
31 beneficiaries of title XVIII of the federal social security act (Medi-
32 care) or under state regulations, in recognition of the unique costs
33 incurred by these facilities to provide hospital services in remote or
34 sparsely populated areas pursuant to subdivision two of this section.
35 S 15. Paragraph (a) of subdivision 1 of section 18 of chapter 266 of
36 the laws of 1986, amending the civil practice law and rules and other
37 laws relating to malpractice and professional medical conduct, as
38 amended by section 23 of part B of chapter 58 of the laws of 2008, is
39 amended to read as follows:
40 (a) The superintendent of insurance and the commissioner of health or
41 their designee shall, from funds available in the hospital excess
42 liability pool created pursuant to subdivision [(5)] 5 of this section,
43 purchase a policy or policies for excess insurance coverage, as author-
44 ized by paragraph [(1)] 1 of subsection (e) of section 5502 of the
45 insurance law; or from an insurer, other than an insurer described in
46 section 5502 of the insurance law, duly authorized to write such cover-
47 age and actually writing medical malpractice insurance in this state; or
48 shall purchase equivalent excess coverage in a form previously approved
49 by the superintendent of insurance for purposes of providing equivalent
50 excess coverage in accordance with section 19 of chapter 294 of the laws
51 of 1985, for medical or dental malpractice occurrences between July 1,
52 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988, between
53 July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990,
54 between July 1, 1990 and June 30, 1991, between July 1, 1991 and June
55 30, 1992, between July 1, 1992 and June 30, 1993, between July 1, 1993
56 and June 30, 1994, between July 1, 1994 and June 30, 1995, between July
A. 4009--C 71
1 1, 1995 and June 30, 1996, between July 1, 1996 and June 30, 1997,
2 between July 1, 1997 and June 30, 1998, between July 1, 1998 and June
3 30, 1999, between July 1, 1999 and June 30, 2000, between July 1, 2000
4 and June 30, 2001, between July 1, 2001 and June 30, 2002, between July
5 1, 2002 and June 30, 2003, between July 1, 2003 and June 30, 2004,
6 between July 1, 2004 and June 30, 2005, between July 1, 2005 and June
7 30, 2006, between July 1, 2006 and June 30, 2007, between July 1, 2007
8 and June 30, 2008, between July 1, 2008 and June 30, 2009, between July
9 1, 2009 and June 30, 2010, [and] between July 1, 2010 and June 30, 2011,
10 BETWEEN JULY 1, 2011 AND JUNE 30, 2012, BETWEEN JULY 1, 2012 AND JUNE
11 30, 2013 AND BETWEEN JULY 1, 2013 AND JUNE 30, 2014 or reimburse the
12 hospital where the hospital purchases equivalent excess coverage as
13 defined in subparagraph (i) of paragraph (a) of subdivision [(1-a)] 1-A
14 of this section for medical or dental malpractice occurrences between
15 July 1, 1987 and June 30, 1988, between July 1, 1988 and June 30, 1989,
16 between July 1, 1989 and June 30, 1990, between July 1, 1990 and June
17 30, 1991, between July 1, 1991 and June 30, 1992, between July 1, 1992
18 and June 30, 1993, between July 1, 1993 and June 30, 1994, between July
19 1, 1994 and June 30, 1995, between July 1, 1995 and June 30, 1996,
20 between July 1, 1996 and June 30, 1997, between July 1, 1997 and June
21 30, 1998, between July 1, 1998 and June 30, 1999, between July 1, 1999
22 and June 30, 2000, between July 1, 2000 and June 30, 2001, between July
23 1, 2001 and June 30, 2002, between July 1, 2002 and June 30, 2003,
24 between July 1, 2003 and June 30, 2004, between July 1, 2004 and June
25 30, 2005, between July 1, 2005 and June 30, 2006, between July 1, 2006
26 and June 30, 2007, between July 1, 2007 and June 30, 2008, between July
27 1, 2008 and June 30, 2009, between July 1, 2009 and June 30, 2010, [and]
28 between July 1, 2010 and June 30, 2011, BETWEEN JULY 1, 2011 AND JUNE
29 30, 2012, BETWEEN JULY 1, 2012 AND JUNE 30, 2013 AND BETWEEN JULY 1,
30 2013 AND JUNE 30, 2014 for physicians or dentists certified as eligible
31 for each such period or periods pursuant to subdivision [(2)] 2 of this
32 section by a general hospital licensed pursuant to article 28 of the
33 public health law; provided that no single insurer shall write more than
34 fifty percent of the total excess premium for a given policy year; and
35 provided, however, that such eligible physicians or dentists must have
36 in force an individual policy, from an insurer licensed in this state of
37 primary malpractice insurance coverage in amounts of no less than one
38 million three hundred thousand dollars for each claimant and three
39 million nine hundred thousand dollars for all claimants under that poli-
40 cy during the period of such excess coverage for such occurrences or be
41 endorsed as additional insureds under a hospital professional liability
42 policy which is offered through a voluntary attending physician ("chan-
43 neling") program previously permitted by the superintendent of insurance
44 during the period of such excess coverage for such occurrences. During
45 such period, such policy for excess coverage or such equivalent excess
46 coverage shall, when combined with the physician's or dentist's primary
47 malpractice insurance coverage or coverage provided through a voluntary
48 attending physician ("channeling") program, total an aggregate level of
49 two million three hundred thousand dollars for each claimant and six
50 million nine hundred thousand dollars for all claimants from all such
51 policies with respect to occurrences in each of such years provided,
52 however, if the cost of primary malpractice insurance coverage in excess
53 of one million dollars, but below the excess medical malpractice insur-
54 ance coverage provided pursuant to this act, exceeds the rate of nine
55 percent per annum, then the required level of primary malpractice insur-
56 ance coverage in excess of one million dollars for each claimant shall
A. 4009--C 72
1 be in an amount of not less than the dollar amount of such coverage
2 available at nine percent per annum; the required level of such coverage
3 for all claimants under that policy shall be in an amount not less than
4 three times the dollar amount of coverage for each claimant; and excess
5 coverage, when combined with such primary malpractice insurance cover-
6 age, shall increase the aggregate level for each claimant by one million
7 dollars and three million dollars for all claimants; and provided
8 further, that, with respect to policies of primary medical malpractice
9 coverage that include occurrences between April 1, 2002 and June 30,
10 2002, such requirement that coverage be in amounts no less than one
11 million three hundred thousand dollars for each claimant and three
12 million nine hundred thousand dollars for all claimants for such occur-
13 rences shall be effective April 1, 2002.
14 S 16. Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
15 amending the civil practice law and rules and other laws relating to
16 malpractice and professional medical conduct, as amended by section 24
17 of part B of chapter 58 of the laws of 2008, is amended to read as
18 follows:
19 (3)(a) The superintendent of insurance shall determine and certify to
20 each general hospital and to the commissioner of health the cost of
21 excess malpractice insurance for medical or dental malpractice occur-
22 rences between July 1, 1986 and June 30, 1987, between July 1, 1988 and
23 June 30, 1989, between July 1, 1989 and June 30, 1990, between July 1,
24 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, between
25 July 1, 1992 and June 30, 1993, between July 1, 1993 and June 30, 1994,
26 between July 1, 1994 and June 30, 1995, between July 1, 1995 and June
27 30, 1996, between July 1, 1996 and June 30, 1997, between July 1, 1997
28 and June 30, 1998, between July 1, 1998 and June 30, 1999, between July
29 1, 1999 and June 30, 2000, between July 1, 2000 and June 30, 2001,
30 between July 1, 2001 and June 30, 2002, between July 1, 2002 and June
31 30, 2003, between July 1, 2003 and June 30, 2004, between July 1, 2004
32 and June 30, 2005, between July 1, 2005 and June 30, 2006, between July
33 1, 2006 and June 30, 2007, between July 1, 2007 and June 30, 2008,
34 between July 1, 2008 and June 30, 2009, between July 1, 2009 and June
35 30, 2010, [and] between July 1, 2010 and June 30, 2011, BETWEEN JULY 1,
36 2011 AND JUNE 30, 2012, BETWEEN JULY 1, 2012 AND JUNE 30, 2013, AND
37 BETWEEN JULY 1, 2013 AND JUNE 30, 2014 allocable to each general hospi-
38 tal for physicians or dentists certified as eligible for purchase of a
39 policy for excess insurance coverage by such general hospital in accord-
40 ance with subdivision [(2)] 2 of this section, and may amend such deter-
41 mination and certification as necessary.
42 (b) The superintendent of insurance shall determine and certify to
43 each general hospital and to the commissioner of health the cost of
44 excess malpractice insurance or equivalent excess coverage for medical
45 or dental malpractice occurrences between July 1, 1987 and June 30,
46 1988, between July 1, 1988 and June 30, 1989, between July 1, 1989 and
47 June 30, 1990, between July 1, 1990 and June 30, 1991, between July 1,
48 1991 and June 30, 1992, between July 1, 1992 and June 30, 1993, between
49 July 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995,
50 between July 1, 1995 and June 30, 1996, between July 1, 1996 and June
51 30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998
52 and June 30, 1999, between July 1, 1999 and June 30, 2000, between July
53 1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002,
54 between July 1, 2002 and June 30, 2003, between July 1, 2003 and June
55 30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005
56 and June 30, 2006, between July 1, 2006 and June 30, 2007, between July
A. 4009--C 73
1 1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009,
2 between July 1, 2009 and June 30, 2010, [and] between July 1, 2010 and
3 June 30, 2011, BETWEEN JULY 1, 2011 AND JUNE 30, 2012, BETWEEN JULY 1,
4 2012 AND JUNE 30, 2013, AND BETWEEN JULY 1, 2013 AND JUNE 30, 2014 allo-
5 cable to each general hospital for physicians or dentists certified as
6 eligible for purchase of a policy for excess insurance coverage or
7 equivalent excess coverage by such general hospital in accordance with
8 subdivision [(2)] 2 of this section, and may amend such determination
9 and certification as necessary. The superintendent of insurance shall
10 determine and certify to each general hospital and to the commissioner
11 of health the ratable share of such cost allocable to the period July 1,
12 1987 to December 31, 1987, to the period January 1, 1988 to June 30,
13 1988, to the period July 1, 1988 to December 31, 1988, to the period
14 January 1, 1989 to June 30, 1989, to the period July 1, 1989 to December
15 31, 1989, to the period January 1, 1990 to June 30, 1990, to the period
16 July 1, 1990 to December 31, 1990, to the period January 1, 1991 to June
17 30, 1991, to the period July 1, 1991 to December 31, 1991, to the period
18 January 1, 1992 to June 30, 1992, to the period July 1, 1992 to December
19 31, 1992, to the period January 1, 1993 to June 30, 1993, to the period
20 July 1, 1993 to December 31, 1993, to the period January 1, 1994 to June
21 30, 1994, to the period July 1, 1994 to December 31, 1994, to the period
22 January 1, 1995 to June 30, 1995, to the period July 1, 1995 to December
23 31, 1995, to the period January 1, 1996 to June 30, 1996, to the period
24 July 1, 1996 to December 31, 1996, to the period January 1, 1997 to June
25 30, 1997, to the period July 1, 1997 to December 31, 1997, to the period
26 January 1, 1998 to June 30, 1998, to the period July 1, 1998 to December
27 31, 1998, to the period January 1, 1999 to June 30, 1999, to the period
28 July 1, 1999 to December 31, 1999, to the period January 1, 2000 to June
29 30, 2000, to the period July 1, 2000 to December 31, 2000, to the period
30 January 1, 2001 to June 30, 2001, to the period July 1, 2001 to June 30,
31 2002, to the period July 1, 2002 to June 30, 2003, to the period July 1,
32 2003 to June 30, 2004, to the period July 1, 2004 to June 30, 2005, to
33 the period July 1, 2005 and June 30, 2006, to the period July 1, 2006
34 and June 30, 2007, to the period July 1, 2007 and June 30, 2008, to the
35 period July 1, 2008 and June 30, 2009, to the period July 1, 2009 and
36 June 30, 2010, [and] to the period July 1, 2010 and June 30, 2011, TO
37 THE PERIOD JULY 1, 2011 AND JUNE 30, 2012, TO THE PERIOD JULY 1, 2012
38 AND JUNE 30, 2013, AND TO THE PERIOD JULY 1, 2013 AND JUNE 30, 2014.
39 S 17. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of
40 section 18 of chapter 266 of the laws of 1986, amending the civil prac-
41 tice law and rules and other laws relating to malpractice and profes-
42 sional medical conduct, as amended by section 25 of part B of chapter 58
43 of the laws of 2008, are amended to read as follows:
44 (a) To the extent funds available to the hospital excess liability
45 pool pursuant to subdivision [(5)] 5 of this section as amended, and
46 pursuant to section 6 of part J of chapter 63 of the laws of 2001, as
47 may from time to time be amended, which amended this subdivision, are
48 insufficient to meet the costs of excess insurance coverage or equiv-
49 alent excess coverage for coverage periods during the period July 1,
50 1992 to June 30, 1993, during the period July 1, 1993 to June 30, 1994,
51 during the period July 1, 1994 to June 30, 1995, during the period July
52 1, 1995 to June 30, 1996, during the period July 1, 1996 to June 30,
53 1997, during the period July 1, 1997 to June 30, 1998, during the period
54 July 1, 1998 to June 30, 1999, during the period July 1, 1999 to June
55 30, 2000, during the period July 1, 2000 to June 30, 2001, during the
56 period July 1, 2001 to October 29, 2001, during the period April 1, 2002
A. 4009--C 74
1 to June 30, 2002, during the period July 1, 2002 to June 30, 2003,
2 during the period July 1, 2003 to June 30, 2004, during the period July
3 1, 2004 to June 30, 2005, during the period July 1, 2005 to June 30,
4 2006, during the period July 1, 2006 to June 30, 2007, during the period
5 July 1, 2007 to June 30, 2008, during the period July 1, 2008 to June
6 30, 2009, during the period July 1, 2009 to June 30, 2010 [and], during
7 the period July 1, 2010 to June 30, 2011, DURING THE PERIOD JULY 1, 2011
8 TO JUNE 30, 2012, DURING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, AND
9 DURING THE PERIOD JULY 1, 2013 TO JUNE 30, 2014 allocated or reallocated
10 in accordance with paragraph (a) of subdivision [(4-a)] 4-A of this
11 section to rates of payment applicable to state governmental agencies,
12 each physician or dentist for whom a policy for excess insurance cover-
13 age or equivalent excess coverage is purchased for such period shall be
14 responsible for payment to the provider of excess insurance coverage or
15 equivalent excess coverage of an allocable share of such insufficiency,
16 based on the ratio of the total cost of such coverage for such physician
17 to the sum of the total cost of such coverage for all physicians applied
18 to such insufficiency.
19 (b) Each provider of excess insurance coverage or equivalent excess
20 coverage covering the period July 1, 1992 to June 30, 1993, or covering
21 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
22 1994 to June 30, 1995, or covering the period July 1, 1995 to June 30,
23 1996, or covering the period July 1, 1996 to June 30, 1997, or covering
24 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
25 1998 to June 30, 1999, or covering the period July 1, 1999 to June 30,
26 2000, or covering the period July 1, 2000 to June 30, 2001, or covering
27 the period July 1, 2001 to October 29, 2001, or covering the period
28 April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to
29 June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
30 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
31 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
32 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
33 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
34 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
35 June 30, 2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, OR
36 COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING THE PERI-
37 OD JULY 1, 2013 TO JUNE 30, 2014 shall notify a covered physician or
38 dentist by mail, mailed to the address shown on the last application for
39 excess insurance coverage or equivalent excess coverage, of the amount
40 due to such provider from such physician or dentist for such coverage
41 period determined in accordance with paragraph (a) of this subdivision.
42 Such amount shall be due from such physician or dentist to such provider
43 of excess insurance coverage or equivalent excess coverage in a time and
44 manner determined by the superintendent of insurance.
45 (c) If a physician or dentist liable for payment of a portion of the
46 costs of excess insurance coverage or equivalent excess coverage cover-
47 ing the period July 1, 1992 to June 30, 1993, or covering the period
48 July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to
49 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
50 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
51 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
52 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
53 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
54 od July 1, 2001 to October 29, 2001, or covering the period April 1,
55 2002 to June 30, 2002, or covering the period July 1, 2002 to June 30,
56 2003, or covering the period July 1, 2003 to June 30, 2004, or covering
A. 4009--C 75
1 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
2 2005 to June 30, 2006, or covering the period July 1, 2006 to June 30,
3 2007, or covering the period July 1, 2007 to June 30, 2008, or covering
4 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
5 2009 to June 30, 2010, or covering the period July 1, 2010 to June 30,
6 2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, OR COVERING
7 THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING THE PERIOD JULY 1,
8 2013 TO JUNE 30, 2014 determined in accordance with paragraph (a) of
9 this subdivision fails, refuses or neglects to make payment to the
10 provider of excess insurance coverage or equivalent excess coverage in
11 such time and manner as determined by the superintendent of insurance
12 pursuant to paragraph (b) of this subdivision, excess insurance coverage
13 or equivalent excess coverage purchased for such physician or dentist in
14 accordance with this section for such coverage period shall be cancelled
15 and shall be null and void as of the first day on or after the commence-
16 ment of a policy period where the liability for payment pursuant to this
17 subdivision has not been met.
18 (d) Each provider of excess insurance coverage or equivalent excess
19 coverage shall notify the superintendent of insurance and the commis-
20 sioner of health or their designee of each physician and dentist eligi-
21 ble for purchase of a policy for excess insurance coverage or equivalent
22 excess coverage covering the period July 1, 1992 to June 30, 1993, or
23 covering the period July 1, 1993 to June 30, 1994, or covering the peri-
24 od July 1, 1994 to June 30, 1995, or covering the period July 1, 1995 to
25 June 30, 1996, or covering the period July 1, 1996 to June 30, 1997, or
26 covering the period July 1, 1997 to June 30, 1998, or covering the peri-
27 od July 1, 1998 to June 30, 1999, or covering the period July 1, 1999 to
28 June 30, 2000, or covering the period July 1, 2000 to June 30, 2001, or
29 covering the period July 1, 2001 to October 29, 2001, or covering the
30 period April 1, 2002 to June 30, 2002, or covering the period July 1,
31 2002 to June 30, 2003, or covering the period July 1, 2003 to June 30,
32 2004, or covering the period July 1, 2004 to June 30, 2005, or covering
33 the period July 1, 2005 to June 30, 2006, or covering the period July 1,
34 2006 to June 30, 2007, or covering the period July 1, 2007 to June 30,
35 2008, or covering the period July 1, 2008 to June 30, 2009, or covering
36 the period July 1, 2009 to June 30, 2010, or covering the period July 1,
37 2010 to June 30, 2011, OR COVERING THE PERIOD JULY 1, 2011 TO JUNE 30,
38 2012, OR COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, OR COVERING
39 THE PERIOD JULY 1, 2013 TO JUNE 30, 2014 that has made payment to such
40 provider of excess insurance coverage or equivalent excess coverage in
41 accordance with paragraph (b) of this subdivision and of each physician
42 and dentist who has failed, refused or neglected to make such payment.
43 (e) A provider of excess insurance coverage or equivalent excess
44 coverage shall refund to the hospital excess liability pool any amount
45 allocable to the period July 1, 1992 to June 30, 1993, and to the period
46 July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June
47 30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the
48 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
49 June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to
50 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
51 to June 30, 2001, and to the period July 1, 2001 to October 29, 2001,
52 and to the period April 1, 2002 to June 30, 2002, and to the period July
53 1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30,
54 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
55 July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June
56 30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the
A. 4009--C 76
1 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
2 June 30, 2010, and to the period July 1, 2010 to June 30, 2011, AND TO
3 THE PERIOD JULY 1, 2011 TO JUNE 30, 2012, AND TO THE PERIOD JULY 1, 2012
4 TO JUNE 30, 2013, AND TO THE PERIOD JULY 1, 2013 TO JUNE 30, 2014
5 received from the hospital excess liability pool for purchase of excess
6 insurance coverage or equivalent excess coverage covering the period
7 July 1, 1992 to June 30, 1993, and covering the period July 1, 1993 to
8 June 30, 1994, and covering the period July 1, 1994 to June 30, 1995,
9 and covering the period July 1, 1995 to June 30, 1996, and covering the
10 period July 1, 1996 to June 30, 1997, and covering the period July 1,
11 1997 to June 30, 1998, and covering the period July 1, 1998 to June 30,
12 1999, and covering the period July 1, 1999 to June 30, 2000, and cover-
13 ing the period July 1, 2000 to June 30, 2001, and covering the period
14 July 1, 2001 to October 29, 2001, and covering the period April 1, 2002
15 to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003,
16 and covering the period July 1, 2003 to June 30, 2004, and covering the
17 period July 1, 2004 to June 30, 2005, and covering the period July 1,
18 2005 to June 30, 2006, and covering the period July 1, 2006 to June 30,
19 2007, and covering the period July 1, 2007 to June 30, 2008, and cover-
20 ing the period July 1, 2008 to June 30, 2009, and covering the period
21 July 1, 2009 to June 30, 2010, and covering the period July 1, 2010 to
22 June 30, 2011, AND COVERING THE PERIOD JULY 1, 2011 TO JUNE 30, 2012,
23 AND COVERING THE PERIOD JULY 1, 2012 TO JUNE 30, 2013, AND COVERING THE
24 PERIOD JULY 1, 2013 TO JUNE 30, 2014 for a physician or dentist where
25 such excess insurance coverage or equivalent excess coverage is
26 cancelled in accordance with paragraph (c) of this subdivision.
27 S 18. Section 40 of chapter 266 of the laws of 1986, amending the
28 civil practice law and rules and other laws relating to malpractice and
29 professional medical conduct, as amended by chapter 216 of the laws of
30 2009, is amended to read as follows:
31 S 40. The superintendent of insurance shall establish rates for poli-
32 cies providing coverage for physicians and surgeons medical malpractice
33 for the periods commencing July 1, 1985 and ending June 30, [2011] 2014;
34 provided, however, that notwithstanding any other provision of law, the
35 superintendent shall not establish or approve any increase in rates for
36 the period commencing July 1, 2009 and ending June 30, 2010. The super-
37 intendent shall direct insurers to establish segregated accounts for
38 premiums, payments, reserves and investment income attributable to such
39 premium periods and shall require periodic reports by the insurers
40 regarding claims and expenses attributable to such periods to monitor
41 whether such accounts will be sufficient to meet incurred claims and
42 expenses. On or after July 1, 1989, the superintendent shall impose a
43 surcharge on premiums to satisfy a projected deficiency that is attrib-
44 utable to the premium levels established pursuant to this section for
45 such periods; provided, however, that such annual surcharge shall not
46 exceed eight percent of the established rate until July 1, [2011] 2014,
47 at which time and thereafter such surcharge shall not exceed twenty-five
48 percent of the approved adequate rate, and that such annual surcharges
49 shall continue for such period of time as shall be sufficient to satisfy
50 such deficiency. The superintendent shall not impose such surcharge
51 during the period commencing July 1, 2009 and ending June 30, 2010. On
52 and after July 1, 1989, the surcharge prescribed by this section shall
53 be retained by insurers to the extent that they insured physicians and
54 surgeons during the July 1, 1985 through June 30, [2011] 2014 policy
55 periods; in the event and to the extent physicians and surgeons were
56 insured by another insurer during such periods, all or a pro rata share
A. 4009--C 77
1 of the surcharge, as the case may be, shall be remitted to such other
2 insurer in accordance with rules and regulations to be promulgated by
3 the superintendent. Surcharges collected from physicians and surgeons
4 who were not insured during such policy periods shall be apportioned
5 among all insurers in proportion to the premium written by each insurer
6 during such policy periods; if a physician or surgeon was insured by an
7 insurer subject to rates established by the superintendent during such
8 policy periods, and at any time thereafter a hospital, health mainte-
9 nance organization, employer or institution is responsible for respond-
10 ing in damages for liability arising out of such physician's or
11 surgeon's practice of medicine, such responsible entity shall also remit
12 to such prior insurer the equivalent amount that would then be collected
13 as a surcharge if the physician or surgeon had continued to remain
14 insured by such prior insurer. In the event any insurer that provided
15 coverage during such policy periods is in liquidation, the
16 property/casualty insurance security fund shall receive the portion of
17 surcharges to which the insurer in liquidation would have been entitled.
18 The surcharges authorized herein shall be deemed to be income earned for
19 the purposes of section 2303 of the insurance law. The superintendent,
20 in establishing adequate rates and in determining any projected defi-
21 ciency pursuant to the requirements of this section and the insurance
22 law, shall give substantial weight, determined in his discretion and
23 judgment, to the prospective anticipated effect of any regulations
24 promulgated and laws enacted and the public benefit of stabilizing
25 malpractice rates and minimizing rate level fluctuation during the peri-
26 od of time necessary for the development of more reliable statistical
27 experience as to the efficacy of such laws and regulations affecting
28 medical, dental or podiatric malpractice enacted or promulgated in 1985,
29 1986, by this act and at any other time. Notwithstanding any provision
30 of the insurance law, rates already established and to be established by
31 the superintendent pursuant to this section are deemed adequate if such
32 rates would be adequate when taken together with the maximum authorized
33 annual surcharges to be imposed for a reasonable period of time whether
34 or not any such annual surcharge has been actually imposed as of the
35 establishment of such rates.
36 S 19. Subsection (c) of section 2343 of the insurance law, as amended
37 by section 27 of part B of chapter 58 of the laws of 2008, is amended to
38 read as follows:
39 (c) Notwithstanding any other provision of this chapter, no applica-
40 tion for an order of rehabilitation or liquidation of a domestic insurer
41 whose primary liability arises from the business of medical malpractice
42 insurance, as that term is defined in subsection (b) of section five
43 thousand five hundred one of this chapter, shall be made on the grounds
44 specified in subsection (a) or (c) of section seven thousand four
45 hundred two of this chapter at any time prior to June thirtieth, two
46 thousand [eleven] FOURTEEN.
47 S 20. Section 5 and subdivisions (a) and (e) of section 6 of part J of
48 chapter 63 of the laws of 2001, amending chapter 20 of the laws of 2001
49 amending the military law and other laws relating to making appropri-
50 ations for the support of government, as amended by section 28 of part B
51 of chapter 58 of the laws of 2008, are amended to read as follows:
52 S 5. The superintendent of insurance and the commissioner of health
53 shall determine, no later than June 15, 2002, June 15, 2003, June 15,
54 2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008, June
55 15, 2009, June 15, 2010, [and] June 15, 2011, JUNE 15, 2012, JUNE 15,
56 2013, AND JUNE 15, 2014, the amount of funds available in the hospital
A. 4009--C 78
1 excess liability pool, created pursuant to section 18 of chapter 266 of
2 the laws of 1986, and whether such funds are sufficient for purposes of
3 purchasing excess insurance coverage for eligible participating physi-
4 cians and dentists during the period July 1, 2001 to June 30, 2002, or
5 July 1, 2002 to June 30, 2003, or July 1, 2003 to June 30, 2004, or July
6 1, 2004 to June 30, 2005, or July 1, 2005 to June 30, 2006, or July 1,
7 2006 to June 30, 2007, or July 1, 2007 to June 30, 2008, or July 1, 2008
8 to June 30, 2009, or July 1, 2009 to June 30, 2010, or July 1, 2010 to
9 June 30, 2011, OR JULY 1, 2011 TO JUNE 30, 2012, OR JULY 1, 2012 TO JUNE
10 30, 2013, OR JULY 1, 2013 TO JUNE 30, 2014, as applicable.
11 (a) This section shall be effective only upon a determination, pursu-
12 ant to section five of this act, by the superintendent of insurance and
13 the commissioner of health, and a certification of such determination to
14 the state director of the budget, the chair of the senate committee on
15 finance and the chair of the assembly committee on ways and means, that
16 the amount of funds in the hospital excess liability pool, created
17 pursuant to section 18 of chapter 266 of the laws of 1986, is insuffi-
18 cient for purposes of purchasing excess insurance coverage for eligible
19 participating physicians and dentists during the period July 1, 2001 to
20 June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 to June
21 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to June 30,
22 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 30,
23 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
24 2010, or July 1, 2010 to June 30, 2011, OR JULY 1, 2011 TO JUNE 30,
25 2012, OR JULY 1, 2012 TO JUNE 30, 2013, OR JULY 1, 2013 TO JUNE 30,
26 2014, as applicable.
27 (e) The commissioner of health shall transfer for deposit to the
28 hospital excess liability pool created pursuant to section 18 of chapter
29 266 of the laws of 1986 such amounts as directed by the superintendent
30 of insurance for the purchase of excess liability insurance coverage for
31 eligible participating physicians and dentists for the policy year July
32 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1,
33 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005
34 to June 30, 2006, or July 1, 2006 to June 30, 2007, as applicable, and
35 the cost of administering the hospital excess liability pool for such
36 applicable policy year, pursuant to the program established in chapter
37 266 of the laws of 1986, as amended, no later than June 15, 2002, June
38 15, 2003, June 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007,
39 June 15, 2008, June 15, 2009, June 15, 2010, [and] June 15, 2011, JUNE
40 15, 2012, JUNE 15, 2013, AND JUNE 15, 2014, as applicable.
41 S 21. Section 18 of chapter 904 of the laws of 1984, amending the
42 public health law and the social services law relating to encouraging
43 comprehensive health services, as amended by section 64 of part C of
44 chapter 58 of the laws of 2008, is amended to read as follows:
45 S 18. This act shall take effect immediately, except that sections
46 six, nine, ten and eleven of this act shall take effect on the sixtieth
47 day after it shall have become a law, sections two, three, four and nine
48 of this act shall expire and be of no further force or effect on or
49 after March 31, [2012] 2014, section two of this act shall take effect
50 on April 1, 1985 or seventy-five days following the submission of the
51 report required by section one of this act, whichever is later, and
52 sections eleven and thirteen of this act shall expire and be of no
53 further force or effect on or after March 31, 1988.
54 S 22. Paragraphs (i) and (j) of subdivision 1 of section 367-q of the
55 social services law, as added by section 22-d of part B of chapter 58 of
A. 4009--C 79
1 the laws of 2008, are amended and three new paragraphs (k), (l) and (m)
2 are added to read as follows:
3 (i) for the period April first, two thousand nine through March thir-
4 ty-first, two thousand ten, twenty-eight million five hundred thousand
5 dollars; [and]
6 (j) for the period April first, two thousand ten through March thir-
7 ty-first, two thousand eleven, twenty-eight million five hundred thou-
8 sand dollars[.];
9 (K) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
10 THIRTY-FIRST, TWO THOUSAND TWELVE, TWENTY-EIGHT MILLION FIVE HUNDRED
11 THOUSAND DOLLARS;
12 (L) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
13 THIRTY-FIRST, TWO THOUSAND THIRTEEN, TWENTY-EIGHT MILLION FIVE HUNDRED
14 THOUSAND DOLLARS; AND
15 (M) FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
16 THIRTY-FIRST, TWO THOUSAND FOURTEEN, TWENTY-EIGHT MILLION FIVE HUNDRED
17 THOUSAND DOLLARS.
18 S 23. Paragraph (f) of subdivision 9 of section 3614 of the public
19 health law, as added by section 22-e of part B of chapter 58 of the laws
20 of 2008, is amended and three new paragraphs (g), (h) and (i) are added
21 to read as follows:
22 (f) for the period April first, two thousand ten through March thir-
23 ty-first, two thousand eleven, up to one hundred million dollars[.];
24 (G) FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
25 THIRTY-FIRST, TWO THOUSAND TWELVE, UP TO ONE HUNDRED MILLION DOLLARS;
26 (H) FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH
27 THIRTY-FIRST, TWO THOUSAND THIRTEEN, UP TO ONE HUNDRED MILLION DOLLARS;
28 (I) FOR THE PERIOD APRIL FIRST, TWO THOUSAND THIRTEEN THROUGH MARCH
29 THIRTY-FIRST, TWO THOUSAND FOURTEEN, UP TO ONE HUNDRED MILLION DOLLARS.
30 S 24. Paragraph (a) of subdivision 10 of section 3614 of the public
31 health law, as amended by section 5 of part C of chapter 109 of the laws
32 of 2006, is amended to read as follows:
33 (a) Such adjustments to rates of payments shall be allocated propor-
34 tionally based on each certified home health agency's, long term home
35 health care program, AIDS home care and hospice program's home health
36 aide or other direct care services total annual hours of service
37 provided to medicaid patients, as reported in each such agency's most
38 [recent] RECENTLY AVAILABLE cost report as submitted to the department
39 [prior to November first, two thousand five] or for the purpose of the
40 managed long term care program a suitable proxy developed by the depart-
41 ment in consultation with the interested parties. Payments made pursuant
42 to this section shall not be subject to subsequent adjustment or recon-
43 ciliation.
44 S 25. Section 4 of chapter 495 of the laws of 2004, amending the
45 insurance law and the public health law relating to the New York state
46 health insurance continuation assistance demonstration project, as
47 amended by section 29 of part B of chapter 58 of the laws of 2008, is
48 amended to read as follows:
49 S 4. This act shall take effect on the sixtieth day after it shall
50 have become a law; provided, however, that this act shall remain in
51 effect until July 1, [2011] 2014 when upon such date the provisions of
52 this act shall expire and be deemed repealed; provided, further, that a
53 displaced worker shall be eligible for continuation assistance retroac-
54 tive to July 1, 2004.
55 S 26. The opening paragraph of paragraph (b) and paragraphs (c), (d),
56 (e), (f) and (g) of subdivision 5-a of section 2807-m of the public
A. 4009--C 80
1 health law, the opening paragraph of paragraph (b) as amended by section
2 4 of part B of chapter 109 of the laws of 2010, paragraphs (c), (f) and
3 (g) and the opening paragraphs of paragraphs (d) and (e) as amended by
4 section 98 of part C of chapter 58 of the laws of 2009 and paragraphs
5 (d) and (e) as added by section 75-c of part C of chapter 58 of the laws
6 of 2008, are amended to read as follows:
7 Nine million one hundred twenty thousand dollars annually for the
8 period January first, two thousand nine through December thirty-first,
9 two thousand ten, and two million two hundred eighty thousand dollars
10 for the period January first, two thousand eleven, AND NINE MILLION ONE
11 HUNDRED TWENTY THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
12 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
13 SAND FOURTEEN, through March thirty-first, two thousand eleven, shall be
14 set aside and reserved by the commissioner from the regional pools
15 established pursuant to subdivision two of this section to be allocated
16 regionally with two-thirds of the available funding going to New York
17 city and one-third of the available funding going to the rest of the
18 state and shall be available for distribution as follows:
19 (c) Ambulatory care training. Four million nine hundred thousand
20 dollars for the period January first, two thousand eight through Decem-
21 ber thirty-first, two thousand eight, four million nine hundred thousand
22 dollars for the period January first, two thousand nine through December
23 thirty-first, two thousand nine, four million nine hundred thousand
24 dollars for the period January first, two thousand ten through December
25 thirty-first, two thousand ten, [and] one million two hundred twenty-
26 five thousand dollars for the period January first, two thousand eleven
27 through March thirty-first, two thousand eleven, AND FOUR MILLION THREE
28 HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL
29 FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND
30 FOURTEEN, shall be set aside and reserved by the commissioner from the
31 regional pools established pursuant to subdivision two of this section
32 and shall be available for distributions to sponsoring institutions to
33 be directed to support clinical training of medical students and resi-
34 dents in free-standing ambulatory care settings, including community
35 health centers and private practices. Such funding shall be allocated
36 regionally with two-thirds of the available funding going to New York
37 city and one-third of the available funding going to the rest of the
38 state and shall be distributed to sponsoring institutions in each region
39 pursuant to a request for application or request for proposal process
40 with preference being given to sponsoring institutions which provide
41 training in sites located in underserved rural or inner-city areas and
42 those that include medical students in such training.
43 (d) Physician loan repayment program. One million nine hundred sixty
44 thousand dollars for the period January first, two thousand eight
45 through December thirty-first, two thousand eight, one million nine
46 hundred sixty thousand dollars for the period January first, two thou-
47 sand nine through December thirty-first, two thousand nine, one million
48 nine hundred sixty thousand dollars for the period January first, two
49 thousand ten through December thirty-first, two thousand ten, [and] four
50 hundred ninety thousand dollars for the period January first, two thou-
51 sand eleven through March thirty-first, two thousand eleven, AND ONE
52 MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE
53 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
54 THOUSAND FOURTEEN, shall be set aside and reserved by the commissioner
55 from the regional pools established pursuant to subdivision two of this
56 section and shall be available for purposes of physician loan repayment
A. 4009--C 81
1 in accordance with subdivision ten of this section. Such funding shall
2 be allocated regionally with one-third of available funds going to New
3 York city and two-thirds of available funds going to the rest of the
4 state and shall be distributed in a manner to be determined by the
5 commissioner as follows:
6 (i) Funding shall first be awarded to repay loans of up to twenty-five
7 physicians who train in primary care or specialty tracks in teaching
8 general hospitals, and who enter and remain in primary care or specialty
9 practices in underserved communities, as determined by the commissioner.
10 (ii) After distributions in accordance with subparagraph (i) of this
11 paragraph, all remaining funds shall be awarded to repay loans of physi-
12 cians who enter and remain in primary care or specialty practices in
13 underserved communities, as determined by the commissioner, including
14 but not limited to physicians working in general hospitals, or other
15 health care facilities.
16 (iii) In no case shall less than fifty percent of the funds available
17 pursuant to this paragraph be distributed in accordance with subpara-
18 graphs (i) and (ii) of this paragraph to physicians identified by gener-
19 al hospitals.
20 (e) Physician practice support. Four million nine hundred thousand
21 dollars for the period January first, two thousand eight through Decem-
22 ber thirty-first, two thousand eight, four million nine hundred thousand
23 dollars annually for the period January first, two thousand nine through
24 December thirty-first, two thousand ten, [and] one million two hundred
25 twenty-five thousand dollars for the period January first, two thousand
26 eleven through March thirty-first, two thousand eleven, AND FOUR MILLION
27 THREE HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD
28 APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOU-
29 SAND FOURTEEN, shall be set aside and reserved by the commissioner from
30 the regional pools established pursuant to subdivision two of this
31 section and shall be available for purposes of physician practice
32 support. Such funding shall be allocated regionally with one-third of
33 available funds going to New York city and two-thirds of available funds
34 going to the rest of the state and shall be distributed in a manner to
35 be determined by the commissioner as follows:
36 (i) Preference in funding shall first be accorded to teaching general
37 hospitals for up to twenty-five awards, to support costs incurred by
38 physicians trained in primary or specialty tracks who thereafter estab-
39 lish or join practices in underserved communities, as determined by the
40 commissioner.
41 (ii) After distributions in accordance with subparagraph (i) of this
42 paragraph, all remaining funds shall be awarded to physicians to support
43 the cost of establishing or joining practices in underserved communi-
44 ties, as determined by the commissioner, and to hospitals and other
45 health care providers to recruit new physicians to provide services in
46 underserved communities, as determined by the commissioner.
47 (iii) In no case shall less than fifty percent of the funds available
48 pursuant to this paragraph be distributed to general hospitals in
49 accordance with subparagraphs (i) and (ii) of this paragraph.
50 (f) Study on physician workforce. Five hundred ninety thousand dollars
51 annually for the period January first, two thousand eight through Decem-
52 ber thirty-first, two thousand ten, [and] one hundred forty-eight thou-
53 sand dollars for the period January first, two thousand eleven through
54 March thirty-first, two thousand eleven, AND FIVE HUNDRED SIXTEEN THOU-
55 SAND DOLLARS EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO
56 THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, shall
A. 4009--C 82
1 be set aside and reserved by the commissioner from the regional pools
2 established pursuant to subdivision two of this section and shall be
3 available to fund a study of physician workforce needs and solutions
4 including, but not limited to, an analysis of residency programs and
5 projected physician workforce and community needs. The commissioner
6 shall enter into agreements with one or more organizations to conduct
7 such study based on a request for proposal process.
8 (g) Diversity in medicine/post-baccalaureate program. Notwithstanding
9 any inconsistent provision of section one hundred twelve or one hundred
10 sixty-three of the state finance law or any other law, one million nine
11 hundred sixty thousand dollars annually for the period January first,
12 two thousand eight through December thirty-first, two thousand ten,
13 [and] four hundred ninety thousand dollars for the period January first,
14 two thousand eleven through March thirty-first, two thousand eleven, AND
15 ONE MILLION SEVEN HUNDRED THOUSAND DOLLARS EACH STATE FISCAL YEAR FOR
16 THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST,
17 TWO THOUSAND FOURTEEN, shall be set aside and reserved by the commis-
18 sioner from the regional pools established pursuant to subdivision two
19 of this section and shall be available for distributions to the Associ-
20 ated Medical Schools of New York to fund its diversity program including
21 existing and new post-baccalaureate programs for minority and econom-
22 ically disadvantaged students and encourage participation from all
23 medical schools in New York. The associated medical schools of New York
24 shall report to the commissioner on an annual basis regarding the use of
25 funds for such purpose in such form and manner as specified by the
26 commissioner.
27 S 26-a. Subdivision 7 of section 2807-m of the public health law, as
28 amended by section 99 of part C of chapter 58 of the laws of 2009, is
29 amended to read as follows:
30 7. Notwithstanding any inconsistent provision of section one hundred
31 twelve or one hundred sixty-three of the state finance law or any other
32 law, up to one million dollars for the period January first, two thou-
33 sand through December thirty-first, two thousand, one million six
34 hundred thousand dollars annually for the periods January first, two
35 thousand one through December thirty-first, two thousand eight, one
36 million five hundred thousand dollars annually for the periods January
37 first, two thousand nine through December thirty-first, two thousand
38 ten, [and] three hundred seventy-five thousand dollars for the period
39 January first, two thousand eleven through March thirty-first, two thou-
40 sand eleven, AND ONE MILLION THREE HUNDRED TWENTY THOUSAND DOLLARS EACH
41 STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
42 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN, shall be set aside
43 and reserved by the commissioner from the regional pools established
44 pursuant to subdivision two of this section and shall be available for
45 distributions to the New York state area health education center program
46 for the purpose of expanding community-based training of medical
47 students. In addition, one million dollars annually for the period Janu-
48 ary first, two thousand eight through December thirty-first, two thou-
49 sand ten, [and] two hundred fifty thousand dollars for the period Janu-
50 ary first, two thousand eleven through March thirty-first, two thousand
51 eleven, AND EIGHT HUNDRED EIGHTY THOUSAND DOLLARS EACH STATE FISCAL YEAR
52 FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
53 THIRTY-FIRST, TWO THOUSAND FOURTEEN, shall be set aside and reserved by
54 the commissioner from the regional pools established pursuant to subdi-
55 vision two of this section and shall be available for distributions to
56 the New York state area health education center program for the purpose
A. 4009--C 83
1 of post-secondary training of health care professionals who will achieve
2 specific program outcomes within the New York state area health educa-
3 tion center program. The New York state area health education center
4 program shall report to the commissioner on an annual basis regarding
5 the use of funds for each purpose in such form and manner as specified
6 by the commissioner.
7 S 27. Subdivision 4-c of section 2807-p of the public health law, as
8 amended by section 13-c of Part C of chapter 58 of the laws of 2009, is
9 amended to read as follows:
10 4-c. Notwithstanding any provision of law to the contrary, the commis-
11 sioner shall make additional payments for uncompensated care to volun-
12 tary non-profit diagnostic and treatment centers that are eligible for
13 distributions under subdivision four of this section in the following
14 amounts: for the period June first, two thousand six through December
15 thirty-first, two thousand six, in the amount of seven million five
16 hundred thousand dollars, for the period January first, two thousand
17 seven through December thirty-first, two thousand seven, seven million
18 five hundred thousand dollars, for the period January first, two thou-
19 sand eight through December thirty-first, two thousand eight, seven
20 million five hundred thousand dollars, for the period January first, two
21 thousand nine through December thirty-first, two thousand nine, fifteen
22 million five hundred thousand dollars, for the period January first, two
23 thousand ten through December thirty-first, two thousand ten, seven
24 million five hundred thousand dollars, FOR THE PERIOD JANUARY FIRST, TWO
25 THOUSAND ELEVEN THOUGH DECEMBER THIRTY-FIRST, TWO THOUSAND ELEVEN, SEVEN
26 MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR THE PERIOD JANUARY FIRST, TWO
27 THOUSAND TWELVE THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND TWELVE,
28 SEVEN MILLION FIVE HUNDRED THOUSAND DOLLARS, FOR THE PERIOD JANUARY
29 FIRST, TWO THOUSAND THIRTEEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND
30 THIRTEEN, SEVEN MILLION FIVE HUNDRED THOUSAND DOLLARS, and for the peri-
31 od January first, two thousand [eleven] FOURTEEN through March thirty-
32 first, two thousand [eleven] FOURTEEN, in the amount of one million
33 eight hundred seventy-five thousand dollars, provided, however, that for
34 periods on and after January first, two thousand eight, such additional
35 payments shall be distributed to voluntary, non-profit diagnostic and
36 treatment centers and to public diagnostic and treatment centers in
37 accordance with paragraph (g) of subdivision four of this section. In
38 the event that federal financial participation is available for rate
39 adjustments pursuant to this section, the commissioner shall make such
40 payments as additional adjustments to rates of payment for voluntary
41 non-profit diagnostic and treatment centers that are eligible for
42 distributions under subdivision four-a of this section in the following
43 amounts: for the period June first, two thousand six through December
44 thirty-first, two thousand six, fifteen million dollars in the aggre-
45 gate, and for the period January first, two thousand seven through June
46 thirtieth, two thousand seven, seven million five hundred thousand
47 dollars in the aggregate. The amounts allocated pursuant to this para-
48 graph shall be aggregated with and distributed pursuant to the same
49 methodology applicable to the amounts allocated to such diagnostic and
50 treatment centers for such periods pursuant to subdivision four of this
51 section if federal financial participation is not available, or pursuant
52 to subdivision four-a of this section if federal financial participation
53 is available. Notwithstanding section three hundred sixty-eight-a of
54 the social services law, there shall be no local share in a medical
55 assistance payment adjustment under this subdivision.
A. 4009--C 84
1 S 28. Subdivision 3 and paragraph (a) of subdivision 4 of section
2 2807-k of the public health law, as amended by section 15 of part C of
3 chapter 58 of the laws of 2010, are amended to read as follows:
4 3. Each major public general hospital shall be allocated for distrib-
5 ution from the pools established pursuant to this section for each year
6 through December thirty-first, two thousand [eleven] FOURTEEN, an amount
7 equal to the amount allocated to such major public general hospital from
8 the regional pool established pursuant to subdivision seventeen of
9 section twenty-eight hundred seven-c of this article for the period
10 January first, nineteen hundred ninety-six through December thirty-
11 first, nineteen hundred ninety-six, provided, however, that payments on
12 and after January first, two thousand nine shall be subject to the
13 provisions of subdivision five-a of this section.
14 (a) From funds in the pool for each year, thirty-six million dollars
15 shall be reserved on an annual basis through December thirty-first, two
16 thousand [eleven] FOURTEEN, for distribution as high need adjustments in
17 accordance with subdivision six of this section, provided, however, that
18 payments on and after January first, two thousand nine shall be subject
19 to the provisions of subdivision five-a of this section.
20 S 29. The opening paragraph, paragraph (a) of subdivision 1 and subdi-
21 vision 2 of section 2807-w of the public health law, as amended by
22 section 14 of part C of chapter 58 of the laws of 2010, are amended to
23 read as follows:
24 Funds allocated pursuant to paragraph (p) of subdivision one of
25 section twenty-eight hundred seven-v of this article, shall be deposited
26 as authorized and used for the purpose of making medicaid dispropor-
27 tionate share payments of up to eighty-two million dollars on an annual-
28 ized basis pursuant to subdivision twenty-one of section twenty-eight
29 hundred seven-c of this article, for the period January first, two thou-
30 sand through March thirty-first, two thousand [eleven] FOURTEEN, in
31 accordance with the following:
32 (a) Each eligible rural hospital shall receive one hundred forty thou-
33 sand dollars on an annualized basis for the periods January first, two
34 thousand through December thirty-first, two thousand [eleven] FOURTEEN,
35 provided as a disproportionate share payment; provided, however, that if
36 such payment pursuant to this paragraph exceeds a hospital's applicable
37 disproportionate share limit, then the total amount in excess of such
38 limit shall be provided as a nondisproportionate share payment in the
39 form of a grant directly from this pool without allocation to the
40 special revenue funds - other, indigent care fund - 068, or any succes-
41 sor fund or account, and provided further that payments for periods on
42 and after January first, two thousand nine shall be subject to the
43 provisions of subdivision five-a of section twenty-eight hundred seven-k
44 of this article;
45 2. From the funds in the pool each year, thirty-six million dollars on
46 an annualized basis for the periods January first, two thousand through
47 December thirty-first, two thousand [eleven] FOURTEEN, of the funds not
48 distributed in accordance with subdivision one of this section, shall be
49 distributed in accordance with the formula set forth in subdivision six
50 of section twenty-eight hundred seven-k of this article, provided,
51 however, that payments for periods on and after January first, two thou-
52 sand nine shall be subject to the provisions of subdivision five-a of
53 section twenty-eight hundred seven-k of this article.
54 S 30. Subparagraph (v) of paragraph (a) of subdivision 3 of section
55 2807-j of the public health law, as added by chapter 639 of the laws of
56 1996, is amended to read as follows:
A. 4009--C 85
1 (v) revenue received from physician practice or faculty practice plan
2 discrete billings for [private practicing] physician services;
3 S 31. Clause (D) of subparagraph (ii) of paragraph (b) of subdivision
4 3 of section 2807-j of the public health law, as added by chapter 639 of
5 the laws of 1996, is amended to read as follows:
6 (D) revenue received from physician practice or faculty practice plan
7 discrete billings for [private practicing] physician services;
8 S 32. Notwithstanding any inconsistent provision of law, rule or regu-
9 lation, for purposes of implementing the provisions of the public health
10 law and the social services law, references to titles XIX and XXI of the
11 federal social security act in the public health law and the social
12 services law shall be deemed to include and also to mean any successor
13 titles thereto under the federal social security act.
14 S 33. Notwithstanding any inconsistent provision of law, rule or regu-
15 lation, the effectiveness of the provisions of sections 2807 and 3614 of
16 the public health law, section 18 of chapter 2 of the laws of 1988, and
17 18 NYCRR 505.14(h), as they relate to time frames for notice, approval
18 or certification of rates of payment, are hereby suspended and without
19 force or effect for purposes of implementing the provisions of this act.
20 S 34. Severability clause. If any clause, sentence, paragraph, subdi-
21 vision, section or part of this act shall be adjudged by any court of
22 competent jurisdiction to be invalid, such judgement shall not affect,
23 impair or invalidate the remainder thereof, but shall be confined in its
24 operation to the clause, sentence, paragraph, subdivision, section or
25 part thereof directly involved in the controversy in which such judge-
26 ment shall have been rendered. It is hereby declared to be the intent of
27 the legislature that this act would have been enacted even if such
28 invalid provisions had not been included herein.
29 S 35. This act shall take effect immediately and shall be deemed to
30 have been in full force and effect on and after April 1, 2011, provided
31 that:
32 (a) any rules or regulations necessary to implement the provisions of
33 this act may be promulgated and any procedures, forms, or instructions
34 necessary for such implementation may be adopted and issued on or after
35 the date this act shall have become a law;
36 (b) this act shall not be construed to alter, change, affect, impair
37 or defeat any rights, obligations, duties or interests accrued, incurred
38 or conferred prior to the effective date of this act;
39 (c) the commissioner of health and the superintendent of insurance and
40 any appropriate council may take any steps necessary to implement this
41 act prior to its effective date;
42 (d) notwithstanding any inconsistent provision of the state adminis-
43 trative procedure act or any other provision of law, rule or regulation,
44 the commissioner of health and the superintendent of insurance and any
45 appropriate council is authorized to adopt or amend or promulgate on an
46 emergency basis any regulation he or she or such council determines
47 necessary to implement any provision of this act on its effective date;
48 (e) the provisions of this act shall become effective notwithstanding
49 the failure of the commissioner of health or the superintendent of
50 insurance or any council to adopt or amend or promulgate regulations
51 implementing this act;
52 (f) the amendments to sections 2807-j and 2807-s of the public health
53 law made by sections three, five, five-a, five-b, six, thirty and thir-
54 ty-one, respectively, of this act shall not affect the expiration of
55 such sections and shall expire therewith; and
A. 4009--C 86
1 (g) the amendments to paragraph (i-l) of subdivision 1 of section
2 2807-v of the public health law made by section eight of this act shall
3 not affect the repeal of such paragraph and shall be deemed repealed
4 therewith.
5 PART D
6 Section 1. Paragraph (e-1) of subdivision 12 of section 2808 of the
7 public health law, as separately amended by section 11 of part B and
8 section 21 of part D of chapter 58 of the laws of 2009, is amended to
9 read as follows:
10 (e-1) Notwithstanding any inconsistent provision of law or regulation,
11 the commissioner shall provide, in addition to payments established
12 pursuant to this article prior to application of this section, addi-
13 tional payments under the medical assistance program pursuant to title
14 eleven of article five of the social services law for non-state operated
15 public residential health care facilities, including public residential
16 health care facilities located in the county of Nassau, the county of
17 Westchester and the county of Erie, but excluding public residential
18 health care facilities operated by a town or city within a county, in
19 aggregate annual amounts of up to one hundred fifty million dollars in
20 additional payments for the state fiscal year beginning April first, two
21 thousand six and for the state fiscal year beginning April first, two
22 thousand seven and for the state fiscal year beginning April first, two
23 thousand eight and of up to three hundred million dollars in such aggre-
24 gate annual additional payments for the state fiscal year beginning
25 April first, two thousand nine, and for the state fiscal year beginning
26 April first, two thousand ten and for the state fiscal year beginning
27 April first, two thousand eleven, AND EACH STATE FISCAL YEAR THEREAFTER.
28 The amount allocated to each eligible public residential health care
29 facility for this period shall be computed in accordance with the
30 provisions of paragraph (f) of this subdivision, provided, however, that
31 patient days shall be utilized for such computation reflecting actual
32 reported data for two thousand three and each representative succeeding
33 year as applicable.
34 S 2. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
35 the laws of 1996, amending the education law and other laws relating to
36 rates for residential healthcare facilities, as amended by section 2 of
37 part B of chapter 58 of the laws of 2010, is amended to read as follows:
38 (a) Notwithstanding any inconsistent provision of law or regulation to
39 the contrary, effective beginning August 1, 1996, for the period April
40 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
41 1998 through March 31, 1999, August 1, 1999, for the period April 1,
42 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
43 through March 31, 2001, April 1, 2001, for the period April 1, 2001
44 through March 31, 2002, April 1, 2002, for the period April 1, 2002
45 through March 31, 2003, and for the state fiscal year beginning April 1,
46 2005 through March 31, 2006, and for the state fiscal year beginning
47 April 1, 2006 through March 31, 2007, and for the state fiscal year
48 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
49 year beginning April 1, 2008 through March 31, 2009, and for the state
50 fiscal year beginning April 1, 2009 through March 31, 2010, and for the
51 state fiscal year beginning April 1, 2010 through March 31, 2011, AND
52 FOR EACH STATE FISCAL YEAR THEREAFTER, the department of health is
53 authorized to pay public general hospitals, as defined in subdivision 10
54 of section 2801 of the public health law, operated by the state of New
A. 4009--C 87
1 York or by the state university of New York or by a county, which shall
2 not include a city with a population of over one million, of the state
3 of New York, and those public general hospitals located in the county of
4 Westchester, the county of Erie or the county of Nassau, additional
5 payments for inpatient hospital services as medical assistance payments
6 pursuant to title 11 of article 5 of the social services law for
7 patients eligible for federal financial participation under title XIX of
8 the federal social security act in medical assistance pursuant to the
9 federal laws and regulations governing disproportionate share payments
10 to hospitals up to one hundred percent of each such public general
11 hospital's medical assistance and uninsured patient losses after all
12 other medical assistance, including disproportionate share payments to
13 such public general hospital for 1996, 1997, 1998, and 1999, based
14 initially for 1996 on reported 1994 reconciled data as further recon-
15 ciled to actual reported 1996 reconciled data, and for 1997 based
16 initially on reported 1995 reconciled data as further reconciled to
17 actual reported 1997 reconciled data, for 1998 based initially on
18 reported 1995 reconciled data as further reconciled to actual reported
19 1998 reconciled data, for 1999 based initially on reported 1995 recon-
20 ciled data as further reconciled to actual reported 1999 reconciled
21 data, for 2000 based initially on reported 1995 reconciled data as
22 further reconciled to actual reported 2000 data, for 2001 based initial-
23 ly on reported 1995 reconciled data as further reconciled to actual
24 reported 2001 data, for 2002 based initially on reported 2000 reconciled
25 data as further reconciled to actual reported 2002 data, and for state
26 fiscal years beginning on April 1, 2005, based initially on reported
27 2000 reconciled data as further reconciled to actual reported data for
28 2005, and for state fiscal years beginning on April 1, 2006, based
29 initially on reported 2000 reconciled data as further reconciled to
30 actual reported data for 2006, for state fiscal years beginning on and
31 after April 1, 2007 through March 31, 2009, based initially on reported
32 2000 reconciled data as further reconciled to actual reported data for
33 2007 and 2008, respectively, for state fiscal years beginning on and
34 after April 1, 2009, based initially on reported 2007 reconciled data,
35 adjusted for authorized Medicaid rate changes applicable to the state
36 fiscal year, and as further reconciled to actual reported data for 2009,
37 for state fiscal years beginning on and after April 1, 2010, based
38 initially on reported reconciled data from the base year two years prior
39 to the payment year, adjusted for authorized Medicaid rate changes
40 applicable to the state fiscal year, and further reconciled to actual
41 reported data from such payment year, and to actual reported data for
42 each respective succeeding year. The payments may be added to rates of
43 payment or made as aggregate payments to an eligible public general
44 hospital.
45 S 3. Section 11 of chapter 884 of the laws of 1990, amending the
46 public health law relating to authorizing bad debt and charity care
47 allowances for certified home health agencies, as amended by section 14
48 of part B of chapter 58 of the laws of 2009, is amended to read as
49 follows:
50 S 11. This act shall take effect immediately and:
51 (a) sections one and three shall expire on December 31, 1996,
52 (b) sections four through ten shall expire on June 30, [2011] 2013,
53 and
54 (c) provided that the amendment to section 2807-b of the public health
55 law by section two of this act shall not affect the expiration of such
A. 4009--C 88
1 section 2807-b as otherwise provided by law and shall be deemed to
2 expire therewith.
3 S 4. Subdivision 2 of section 246 of chapter 81 of the laws of 1995,
4 amending the public health law and other laws relating to medical
5 reimbursement and welfare reform, as amended by section 15 of part B of
6 chapter 58 of the laws of 2009, is amended to read as follows:
7 2. Sections five, seven through nine, twelve through fourteen, and
8 eighteen of this act shall be deemed to have been in full force and
9 effect on and after April 1, 1995 through March 31, 1999 and on and
10 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
11 through March 31, 2003 and on and after April 1, 2003 through March 31,
12 2006 and on and after April 1, 2006 through March 31, 2007 and on and
13 after April 1, 2007 through March 31, 2009 and on and after April 1,
14 2009 through March 31, 2011 AND SECTIONS TWELVE, THIRTEEN AND FOURTEEN
15 OF THIS ACT SHALL BE DEEMED TO BE IN FULL FORCE AND EFFECT ON AND AFTER
16 APRIL 1, 2011;
17 S 5. Intentionally omitted.
18 S 6. Intentionally omitted.
19 S 7. Paragraphs (a) and (e) of subdivision 8 of section 2807-c of the
20 public health law, paragraph (a) as amended by chapter 731 of the laws
21 of 1993 and paragraph (e) as added by chapter 81 of the laws of 1995,
22 are amended to read as follows:
23 (a) Capital related inpatient expenses including but not limited to
24 straight line depreciation on buildings and non-movable equipment,
25 accelerated depreciation on major movable equipment if requested by the
26 hospital, rentals and interest on capital debt (or for hospitals
27 financed pursuant to article twenty-eight-B of this chapter, such
28 expenses, including amortization in lieu of depreciation, as determined
29 pursuant to the reimbursement regulations promulgated pursuant to such
30 article and article twenty-eight of this chapter), [and excluding costs
31 related to services provided to beneficiaries of title XVIII of the
32 federal social security act (medicare),] shall be included in rates of
33 payment determined pursuant to this section based on a budget for capi-
34 tal related inpatient expenses and subsequently reconciled to actual
35 expenses and statistics through appropriate audit procedures. General
36 hospitals shall submit to the commissioner, at least one hundred twenty
37 days prior to the commencement of each year, a schedule of capital
38 related inpatient expenses for the forthcoming year. Any capital expend-
39 iture which requires or required approval pursuant to this article must
40 have received such approval for any capital related expense generated by
41 such capital expenditure to be included in rates of payment. The basis
42 for determining capital related inpatient expenses shall be the lesser
43 of actual cost or the final amount specifically approved for the
44 construction of the capital asset. The submitted budget may include the
45 capital related inpatient expenses for all existing capital assets as
46 well as estimates of capital related inpatient expenses for capital
47 assets to be acquired or placed in use prior to the commencement of the
48 rate year or during the rate year provided all required approvals have
49 been obtained.
50 The council shall adopt, with the approval of the commissioner, regu-
51 lations to:
52 (i) identify by type the eligible capital related inpatient expenses;
53 (ii) safeguard the future financial viability of voluntary, non-profit
54 general hospitals by requiring funding of inpatient depreciation on
55 building and fixed and movable equipment;
A. 4009--C 89
1 (iii) provide authorization to adjust inpatient rates by advancing
2 payment of depreciation as needed, in instances of capital debt related
3 financial distress of voluntary, non-profit general hospitals; and
4 (iv) provide a methodology for the reimbursement treatment of sales.
5 (e) Notwithstanding any inconsistent provision of this subdivision,
6 commencing April first, nineteen hundred ninety-five, when a factor for
7 reconciliation of budgeted capital related inpatient expenses to actual
8 capital related inpatient expenses [excluding costs related to services
9 provided to beneficiaries of title XVIII of the federal social security
10 act (medicare)] for a prior year is included in the capital related
11 inpatient expenses component of rates of payment, such capital related
12 inpatient expenses component of rates of payment shall be reduced by the
13 commissioner by the difference between the reconciled capital related
14 inpatient expenses included in rates of payment determined in accordance
15 with paragraphs (a), (b) and (c) of this subdivision for such prior year
16 and capital related inpatient expenses for such prior year calculated
17 [based on a determination of costs related to services provided to bene-
18 ficiaries of title XVIII of the federal social security act (medicare)]
19 based on the hospital's average capital related inpatient expenses
20 computed on a per diem basis.
21 S 8. Paragraph (d) of subdivision 8 of section 2807-c of the public
22 health law is REPEALED.
23 S 9. Section 194 of chapter 474 of the laws of 1996, amending the
24 education law and other laws relating to rates for residential health
25 care facilities, as amended by section 24 of part B of chapter 58 of the
26 laws of 2009, is amended to read as follows:
27 S 194. 1. Notwithstanding any inconsistent provision of law or regu-
28 lation, the trend factors used to project reimbursable operating costs
29 to the rate period for purposes of determining rates of payment pursuant
30 to article 28 of the public health law for residential health care
31 facilities for reimbursement of inpatient services provided to patients
32 eligible for payments made by state governmental agencies on and after
33 April 1, 1996 through March 31, 1999 and for payments made on and after
34 July 1, 1999 through March 31, 2000 and on and after April 1, 2000
35 through March 31, 2003 and on and after April 1, 2003 through March 31,
36 2007 and on and after April 1, 2007 through March 31, 2009 and on and
37 after April 1, 2009 through March 31, 2011 AND ON AND AFTER APRIL 1,
38 2011 shall reflect no trend factor projections or adjustments for the
39 period April 1, 1996, through March 31, 1997.
40 2. The commissioner of health shall adjust such rates of payment to
41 reflect the exclusion pursuant to this section of such specified trend
42 factor projections or adjustments.
43 S 10. Subdivision 1 of section 89-a of part C of chapter 58 of the
44 laws of 2007, amending the social services law and other laws relating
45 to enacting the major components of legislation necessary to implement
46 the health and mental hygiene budget for the 2007-2008 state fiscal
47 year, as amended by section 25 of part B of chapter 58 of the laws of
48 2009, is amended to read as follows:
49 1. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c
50 of the public health law and section 21 of chapter 1 of the laws of
51 1999, as amended, and any other inconsistent provision of law or regu-
52 lation to the contrary, in determining rates of payments by state
53 governmental agencies effective for services provided beginning April 1,
54 2006, through March 31, 2009, and on and after April 1, 2009 through
55 March 31, 2011, AND ON AND AFTER APRIL 1, 2011 for inpatient and outpa-
56 tient services provided by general hospitals and for inpatient services
A. 4009--C 90
1 and outpatient adult day health care services provided by residential
2 health care facilities pursuant to article 28 of the public health law,
3 the commissioner of health shall apply a trend factor projection of two
4 and twenty-five hundredths percent attributable to the period January 1,
5 2006 through December 31, 2006, and on and after January 1, 2007,
6 provided, however, that on reconciliation of such trend factor for the
7 period January 1, 2006 through December 31, 2006 pursuant to paragraph
8 (c) of subdivision 10 of section 2807-c of the public health law, such
9 trend factor shall be the final US Consumer Price Index (CPI) for all
10 urban consumers, as published by the US Department of Labor, Bureau of
11 Labor Statistics less twenty-five hundredths of a percentage point.
12 S 11. Paragraph (f) of subdivision 1 of section 64 of chapter 81 of
13 the laws of 1995, amending the public health law and other laws relating
14 to medical reimbursement and welfare reform, as amended by section 26 of
15 part B of chapter 58 of the laws of 2009, is amended to read as follows:
16 (f) Prior to February 1, 2001, February 1, 2002, February 1, 2003,
17 February 1, 2004, February 1, 2005, February 1, 2006, February 1, 2007,
18 February 1, 2008, February 1, 2009, February 1, 2010, [and] February 1,
19 2011, FEBRUARY 1, 2012, AND FEBRUARY 1, 2013 the commissioner of health
20 shall calculate the result of the statewide total of residential health
21 care facility days of care provided to beneficiaries of title XVIII of
22 the federal social security act (medicare), divided by the sum of such
23 days of care plus days of care provided to residents eligible for
24 payments pursuant to title 11 of article 5 of the social services law
25 minus the number of days provided to residents receiving hospice care,
26 expressed as a percentage, for the period commencing January 1, through
27 November 30, of the prior year respectively, based on such data for such
28 period. This value shall be called the 2000, 2001, 2002, 2003, 2004,
29 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
30 target percentage respectively.
31 S 12. Subparagraph (ii) of paragraph (b) of subdivision 3 of section
32 64 of chapter 81 of the laws of 1995, amending the public health law and
33 other laws relating to medical reimbursement and welfare reform, as
34 amended by section 27 of part B of chapter 58 of the laws of 2009, is
35 amended to read as follows:
36 (ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
37 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide target
38 percentages are not for each year at least three percentage points high-
39 er than the statewide base percentage, the commissioner of health shall
40 determine the percentage by which the statewide target percentage for
41 each year is not at least three percentage points higher than the state-
42 wide base percentage. The percentage calculated pursuant to this para-
43 graph shall be called the 1997, 1998, 2000, 2001, 2002, 2003, 2004,
44 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
45 reduction percentage respectively. If the 1997, 1998, 2000, 2001, 2002,
46 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND
47 2013 statewide target percentage for the respective year is at least
48 three percentage points higher than the statewide base percentage, the
49 statewide reduction percentage for the respective year shall be zero.
50 S 13. Subparagraph (iii) of paragraph (b) of subdivision 4 of section
51 64 of chapter 81 of the laws of 1995, amending the public health law and
52 other laws relating to medical reimbursement and welfare reform, as
53 amended by section 28 of part B of chapter 58 of the laws of 2009, is
54 amended to read as follows:
55 (iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008,
56 2009, 2010 [and], 2011, 2012, AND 2013 statewide reduction percentage
A. 4009--C 91
1 shall be multiplied by one hundred two million dollars respectively to
2 determine the 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
3 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide aggregate
4 reduction amount. If the 1998 and the 2000, 2001, 2002, 2003, 2004,
5 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
6 reduction percentage shall be zero respectively, there shall be no 1998,
7 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and],
8 2011, 2012, AND 2013 reduction amount.
9 S 14. Paragraph (b) of subdivision 5 of section 64 of chapter 81 of
10 the laws of 1995, amending the public health law and other laws relating
11 to medical reimbursement and welfare reform, as amended by section 29 of
12 part B of chapter 58 of the laws of 2009, is amended to read as follows:
13 (b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
14 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 statewide
15 aggregate reduction amounts shall for each year be allocated by the
16 commissioner of health among residential health care facilities that are
17 eligible to provide services to beneficiaries of title XVIII of the
18 federal social security act (medicare) and residents eligible for
19 payments pursuant to title 11 of article 5 of the social services law on
20 the basis of the extent of each facility's failure to achieve a two
21 percentage points increase in the 1996 target percentage, a three
22 percentage point increase in the 1997, 1998, 2000, 2001, 2002, 2003,
23 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013
24 target percentage and a two and one-quarter percentage point increase in
25 the 1999 target percentage for each year, compared to the base percent-
26 age, calculated on a facility specific basis for this purpose, compared
27 to the statewide total of the extent of each facility's failure to
28 achieve a two percentage points increase in the 1996 and a three
29 percentage point increase in the 1997 and a three percentage point
30 increase in the 1998 and a two and one-quarter percentage point increase
31 in the 1999 target percentage and a three percentage point increase in
32 the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010
33 [and], 2011, 2012, AND 2013 target percentage compared to the base
34 percentage. These amounts shall be called the 1996, 1997, 1998, 1999,
35 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and],
36 2011, 2012, AND 2013 facility specific reduction amounts respectively.
37 S 14-a. Section 228 of chapter 474 of the laws of 1996, amending the
38 education law and other laws relating to rates for residential health
39 care facilities, as amended by section 30 of part B of chapter 58 of the
40 laws of 2009, is amended to read as follows:
41 S 228. 1. Definitions. (a) Regions, for purposes of this section,
42 shall mean a downstate region to consist of Kings, New York, Richmond,
43 Queens, Bronx, Nassau and Suffolk counties and an upstate region to
44 consist of all other New York state counties. A certified home health
45 agency or long term home health care program shall be located in the
46 same county utilized by the commissioner of health for the establishment
47 of rates pursuant to article 36 of the public health law.
48 (b) Certified home health agency (CHHA) shall mean such term as
49 defined in section 3602 of the public health law.
50 (c) Long term home health care program (LTHHCP) shall mean such term
51 as defined in subdivision 8 of section 3602 of the public health law.
52 (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
53 ly, located within a region.
54 (e) Medicaid revenue percentage, for purposes of this section, shall
55 mean CHHA and LTHHCP revenues attributable to services provided to
56 persons eligible for payments pursuant to title 11 of article 5 of the
A. 4009--C 92
1 social services law divided by such revenues plus CHHA and LTHHCP reven-
2 ues attributable to services provided to beneficiaries of Title XVIII of
3 the federal social security act (medicare).
4 (f) Base period, for purposes of this section, shall mean calendar
5 year 1995.
6 (g) Target period. For purposes of this section, the 1996 target peri-
7 od shall mean August 1, 1996 through March 31, 1997, the 1997 target
8 period shall mean January 1, 1997 through November 30, 1997, the 1998
9 target period shall mean January 1, 1998 through November 30, 1998, the
10 1999 target period shall mean January 1, 1999 through November 30, 1999,
11 the 2000 target period shall mean January 1, 2000 through November 30,
12 2000, the 2001 target period shall mean January 1, 2001 through November
13 30, 2001, the 2002 target period shall mean January 1, 2002 through
14 November 30, 2002, the 2003 target period shall mean January 1, 2003
15 through November 30, 2003, the 2004 target period shall mean January 1,
16 2004 through November 30, 2004, and the 2005 target period shall mean
17 January 1, 2005 through November 30, 2005, the 2006 target period shall
18 mean January 1, 2006 through November 30, 2006, and the 2007 target
19 period shall mean January 1, 2007 through November 30, 2007 and the 2008
20 target period shall mean January 1, 2008 through November 30, 2008, and
21 the 2009 target period shall mean January 1, 2009 through November 30,
22 2009 and the 2010 target period shall mean January 1, 2010 through
23 November 30, 2010 and the 2011 target period shall mean January 1, 2011
24 through November 30, 2011 AND THE 2012 TARGET PERIOD SHALL MEAN JANUARY
25 1, 2012 THROUGH NOVEMBER 30, 2012 AND THE 2013 TARGET PERIOD SHALL MEAN
26 JANUARY 1, 2013 THROUGH NOVEMBER 30, 2013.
27 2. (a) Prior to February 1, 1997, for each regional group the commis-
28 sioner of health shall calculate the 1996 medicaid revenue percentages
29 for the period commencing August 1, 1996 to the last date for which such
30 data is available and reasonably accurate.
31 (b) Prior to February 1, 1998, prior to February 1, 1999, prior to
32 February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
33 prior to February 1, 2003, prior to February 1, 2004, prior to February
34 1, 2005, prior to February 1, 2006, prior to February 1, 2007, prior to
35 February 1, 2008, prior to February 1, 2009, prior to February 1, 2010
36 [and], prior to February 1, 2011, PRIOR TO FEBRUARY 1, 2012 AND PRIOR TO
37 FEBRUARY 1, 2013 for each regional group the commissioner of health
38 shall calculate the prior year's medicaid revenue percentages for the
39 period commencing January 1 through November 30 of such prior year.
40 3. By September 15, 1996, for each regional group the commissioner of
41 health shall calculate the base period medicaid revenue percentage.
42 4. (a) For each regional group, the 1996 target medicaid revenue
43 percentage shall be calculated by subtracting the 1996 medicaid revenue
44 reduction percentages from the base period medicaid revenue percentages.
45 The 1996 medicaid revenue reduction percentage, taking into account
46 regional and program differences in utilization of medicaid and medicare
47 services, for the following regional groups shall be equal to:
48 (i) one and one-tenth percentage points for CHHAs located within the
49 downstate region;
50 (ii) six-tenths of one percentage point for CHHAs located within the
51 upstate region;
52 (iii) one and eight-tenths percentage points for LTHHCPs located with-
53 in the downstate region; and
54 (iv) one and seven-tenths percentage points for LTHHCPs located within
55 the upstate region.
A. 4009--C 93
1 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
2 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional group,
3 the target medicaid revenue percentage for the respective year shall be
4 calculated by subtracting the respective year's medicaid revenue
5 reduction percentage from the base period medicaid revenue percentage.
6 The medicaid revenue reduction percentages for 1997, 1998, 2000, 2001,
7 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 [and], 2011, 2012,
8 AND 2013 taking into account regional and program differences in utili-
9 zation of medicaid and medicare services, for the following regional
10 groups shall be equal to for each such year:
11 (i) one and one-tenth percentage points for CHHAs located within the
12 downstate region;
13 (ii) six-tenths of one percentage point for CHHAs located within the
14 upstate region;
15 (iii) one and eight-tenths percentage points for LTHHCPs located with-
16 in the downstate region; and
17 (iv) one and seven-tenths percentage points for LTHHCPs located within
18 the upstate region.
19 (c) For each regional group, the 1999 target medicaid revenue percent-
20 age shall be calculated by subtracting the 1999 medicaid revenue
21 reduction percentage from the base period medicaid revenue percentage.
22 The 1999 medicaid revenue reduction percentages, taking into account
23 regional and program differences in utilization of medicaid and medicare
24 services, for the following regional groups shall be equal to:
25 (i) eight hundred twenty-five thousandths (.825) of one percentage
26 point for CHHAs located within the downstate region;
27 (ii) forty-five hundredths (.45) of one percentage point for CHHAs
28 located within the upstate region;
29 (iii) one and thirty-five hundredths percentage points (1.35) for
30 LTHHCPs located within the downstate region; and
31 (iv) one and two hundred seventy-five thousandths percentage points
32 (1.275) for LTHHCPs located within the upstate region.
33 5. (a) For each regional group, if the 1996 medicaid revenue percent-
34 age is not equal to or less than the 1996 target medicaid revenue
35 percentage, the commissioner of health shall compare the 1996 medicaid
36 revenue percentage to the 1996 target medicaid revenue percentage to
37 determine the amount of the shortfall which, when divided by the 1996
38 medicaid revenue reduction percentage, shall be called the 1996
39 reduction factor. These amounts, expressed as a percentage, shall not
40 exceed one hundred percent. If the 1996 medicaid revenue percentage is
41 equal to or less than the 1996 target medicaid revenue percentage, the
42 1996 reduction factor shall be zero.
43 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
44 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional
45 group, if the medicaid revenue percentage for the respective year is not
46 equal to or less than the target medicaid revenue percentage for such
47 respective year, the commissioner of health shall compare such respec-
48 tive year's medicaid revenue percentage to such respective year's target
49 medicaid revenue percentage to determine the amount of the shortfall
50 which, when divided by the respective year's medicaid revenue reduction
51 percentage, shall be called the reduction factor for such respective
52 year. These amounts, expressed as a percentage, shall not exceed one
53 hundred percent. If the medicaid revenue percentage for a particular
54 year is equal to or less than the target medicaid revenue percentage for
55 that year, the reduction factor for that year shall be zero.
A. 4009--C 94
1 6. (a) For each regional group, the 1996 reduction factor shall be
2 multiplied by the following amounts to determine each regional group's
3 applicable 1996 state share reduction amount:
4 (i) two million three hundred ninety thousand dollars ($2,390,000) for
5 CHHAs located within the downstate region;
6 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
7 within the upstate region;
8 (iii) one million two hundred seventy thousand dollars ($1,270,000)
9 for LTHHCPs located within the downstate region; and
10 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
11 located within the upstate region.
12 For each regional group reduction, if the 1996 reduction factor shall
13 be zero, there shall be no 1996 state share reduction amount.
14 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
15 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional group,
16 the reduction factor for the respective year shall be multiplied by the
17 following amounts to determine each regional group's applicable state
18 share reduction amount for such respective year:
19 (i) two million three hundred ninety thousand dollars ($2,390,000) for
20 CHHAs located within the downstate region;
21 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
22 within the upstate region;
23 (iii) one million two hundred seventy thousand dollars ($1,270,000)
24 for LTHHCPs located within the downstate region; and
25 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
26 located within the upstate region.
27 For each regional group reduction, if the reduction factor for a
28 particular year shall be zero, there shall be no state share reduction
29 amount for such year.
30 (c) For each regional group, the 1999 reduction factor shall be multi-
31 plied by the following amounts to determine each regional group's appli-
32 cable 1999 state share reduction amount:
33 (i) one million seven hundred ninety-two thousand five hundred dollars
34 ($1,792,500) for CHHAs located within the downstate region;
35 (ii) five hundred sixty-two thousand five hundred dollars ($562,500)
36 for CHHAs located within the upstate region;
37 (iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
38 for LTHHCPs located within the downstate region; and
39 (iv) four hundred forty-two thousand five hundred dollars ($442,500)
40 for LTHHCPs located within the upstate region.
41 For each regional group reduction, if the 1999 reduction factor shall
42 be zero, there shall be no 1999 state share reduction amount.
43 7. (a) For each regional group, the 1996 state share reduction amount
44 shall be allocated by the commissioner of health among CHHAs and LTHHCPs
45 on the basis of the extent of each CHHA's and LTHHCP's failure to
46 achieve the 1996 target medicaid revenue percentage, calculated on a
47 provider specific basis utilizing revenues for this purpose, expressed
48 as a proportion of the total of each CHHA's and LTHHCP's failure to
49 achieve the 1996 target medicaid revenue percentage within the applica-
50 ble regional group. This proportion shall be multiplied by the applica-
51 ble 1996 state share reduction amount calculation pursuant to paragraph
52 (a) of subdivision 6 of this section. This amount shall be called the
53 1996 provider specific state share reduction amount.
54 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
55 2007, 2008, 2009, 2010 [and], 2011, 2012, AND 2013 for each regional
56 group, the state share reduction amount for the respective year shall be
A. 4009--C 95
1 allocated by the commissioner of health among CHHAs and LTHHCPs on the
2 basis of the extent of each CHHA's and LTHHCP's failure to achieve the
3 target medicaid revenue percentage for the applicable year, calculated
4 on a provider specific basis utilizing revenues for this purpose,
5 expressed as a proportion of the total of each CHHA's and LTHHCP's fail-
6 ure to achieve the target medicaid revenue percentage for the applicable
7 year within the applicable regional group. This proportion shall be
8 multiplied by the applicable year's state share reduction amount calcu-
9 lation pursuant to paragraph (b) or (c) of subdivision 6 of this
10 section. This amount shall be called the provider specific state share
11 reduction amount for the applicable year.
12 8. (a) The 1996 provider specific state share reduction amount shall
13 be due to the state from each CHHA and LTHHCP and may be recouped by the
14 state by March 31, 1997 in a lump sum amount or amounts from payments
15 due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
16 social services law.
17 (b) The provider specific state share reduction amount for 1997, 1998,
18 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010
19 [and], 2011, 2012, AND 2013 respectively, shall be due to the state from
20 each CHHA and LTHHCP and each year the amount due for such year may be
21 recouped by the state by March 31 of the following year in a lump sum
22 amount or amounts from payments due to the CHHA and LTHHCP pursuant to
23 title 11 of article 5 of the social services law.
24 9. CHHAs and LTHHCPs shall submit such data and information at such
25 times as the commissioner of health may require for purposes of this
26 section. The commissioner of health may use data available from third-
27 party payors.
28 10. On or about June 1, 1997, for each regional group the commissioner
29 of health shall calculate for the period August 1, 1996 through March
30 31, 1997 a medicaid revenue percentage, a reduction factor, a state
31 share reduction amount, and a provider specific state share reduction
32 amount in accordance with the methodology provided in paragraph (a) of
33 subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
34 sion 6 and paragraph (a) of subdivision 7 of this section. The provider
35 specific state share reduction amount calculated in accordance with this
36 subdivision shall be compared to the 1996 provider specific state share
37 reduction amount calculated in accordance with paragraph (a) of subdivi-
38 sion 7 of this section. Any amount in excess of the amount determined in
39 accordance with paragraph (a) of subdivision 7 of this section shall be
40 due to the state from each CHHA and LTHHCP and may be recouped in
41 accordance with paragraph (a) of subdivision 8 of this section. If the
42 amount is less than the amount determined in accordance with paragraph
43 (a) of subdivision 7 of this section, the difference shall be refunded
44 to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
45 and LTHHCPs shall submit data for the period August 1, 1996 through
46 March 31, 1997 to the commissioner of health by April 15, 1997.
47 11. If a CHHA or LTHHCP fails to submit data and information as
48 required for purposes of this section:
49 (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
50 caid revenue percentage between the applicable base period and the
51 applicable target period for purposes of the calculations pursuant to
52 this section; and
53 (b) the commissioner of health shall reduce the current rate paid to
54 such CHHA and such LTHHCP by state governmental agencies pursuant to
55 article 36 of the public health law by one percent for a period begin-
56 ning on the first day of the calendar month following the applicable due
A. 4009--C 96
1 date as established by the commissioner of health and continuing until
2 the last day of the calendar month in which the required data and infor-
3 mation are submitted.
4 12. The commissioner of health shall inform in writing the director of
5 the budget and the chair of the senate finance committee and the chair
6 of the assembly ways and means committee of the results of the calcu-
7 lations pursuant to this section.
8 S 15. Subdivision 5-a of section 246 of chapter 81 of the laws of
9 1995, amending the public health law and other laws relating to medical
10 reimbursement and welfare reform, as amended by section 32 of part B of
11 chapter 58 of the laws of 2009, is amended to read as follows:
12 5-a. Section sixty-four-a of this act shall be deemed to have been in
13 full force and effect on and after April 1, 1995 through March 31, 1999
14 and on and after July 1, 1999 through March 31, 2000 and on and after
15 April 1, 2000 through March 31, 2003 and on and after April 1, 2003
16 through March 31, 2007, and on and after April 1, 2007 through March 31,
17 2009, and on and after April 1, 2009 through March 31, 2011, AND ON AND
18 AFTER APRIL 1, 2011 THROUGH MARCH 31, 2013;
19 S 16. Section 64-b of chapter 81 of the laws of 1995, amending the
20 public health law and other laws relating to medical reimbursement and
21 welfare reform, as amended by section 33 of part B of chapter 58 of the
22 laws of 2009, is amended to read as follows:
23 S 64-b. Notwithstanding any inconsistent provision of law, the
24 provisions of subdivision 7 of section 3614 of the public health law, as
25 amended, shall remain and be in full force and effect on April 1, 1995
26 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
27 and after April 1, 2000 through March 31, 2003 and on and after April 1,
28 2003 through March 31, 2007, and on and after April 1, 2007 through
29 March 31, 2009, and on and after April 1, 2009 through March 31, 2011,
30 AND ON AND AFTER APRIL 1, 2011 THROUGH MARCH 31, 2013.
31 S 17. Subdivision 1 of section 20 of chapter 451 of the laws of 2007,
32 amending the public health law, the social services law and the insur-
33 ance law, relating to providing enhanced consumer and provider
34 protections, as amended by section 38 of part B of chapter 58 of the
35 laws of 2009, is amended to read as follows:
36 1. sections four, eleven and thirteen of this act shall take effect
37 immediately and shall expire and be deemed repealed June 30, [2011]
38 2013;
39 S 18. The opening paragraph of subdivision 7-a of section 3614 of the
40 public health law, as amended by section 46 of part B of chapter 58 of
41 the laws of 2009, is amended to read as follows:
42 Notwithstanding any inconsistent provision of law or regulation, for
43 the purposes of establishing rates of payment by governmental agencies
44 for long term home health care programs for the period April first, two
45 thousand five, through December thirty-first, two thousand five, and for
46 the period January first, two thousand six through March thirty-first,
47 two thousand seven, and on and after April first, two thousand seven
48 through March thirty-first, two thousand nine, and on and after April
49 first, two thousand nine through March thirty-first, two thousand elev-
50 en, AND ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
51 THIRTY-FIRST, TWO THOUSAND THIRTEEN, the reimbursable base year adminis-
52 trative and general costs of a provider of services shall not exceed the
53 statewide average of total reimbursable base year administrative and
54 general costs of such providers of services.
55 S 19. Subdivisions 3, 4 and 5 of section 47 of chapter 2 of the laws
56 of 1998, amending the public health law and other laws relating to
A. 4009--C 97
1 expanding the child health insurance plan, as amended by section 24 of
2 part A of chapter 58 of the laws of 2007, are amended to read as
3 follows:
4 3. section six of this act shall take effect January 1, 1999;
5 [provided, however, that subparagraph (iii) of paragraph (c) of subdivi-
6 sion 9 of section 2510 of the public health law, as added by this act,
7 shall expire on July 1, 2011;]
8 4. sections two, three, four, seven, eight, nine, fourteen, fifteen,
9 sixteen, eighteen, eighteen-a, twenty-three, twenty-four, and twenty-
10 nine of this act shall take effect January 1, 1999 [and shall expire on
11 July 1, 2011]; section twenty-five of this act shall take effect on
12 January 1, 1999 and shall expire on April 1, 2005;
13 5. section twelve of this act shall take effect January 1, 1999;
14 [provided, however, paragraphs (g) and (h) of subdivision 2 of section
15 2511 of the public health law, as added by such section, shall expire on
16 July 1, 2011;]
17 S 20. Section 10 of chapter 649 of the laws of 1996, amending the
18 public health law, the mental hygiene law and the social services law
19 relating to authorizing the establishment of special needs plans, as
20 amended by section 63 of part C of chapter 58 of the laws of 2008, is
21 amended to read as follows:
22 S 10. This act shall take effect immediately and shall be deemed to
23 have been in full force and effect on and after July 1, 1996; [provided,
24 however, that sections one, two and three of this act shall expire and
25 be deemed repealed on March 31, 2012] provided, however that the amend-
26 ments to section 364-j of the social services law made by section four
27 of this act shall not affect the expiration of such section and shall be
28 deemed to expire therewith and provided, further, that the provisions of
29 subdivisions 8, 9 and 10 of section 4401 of the public health law, as
30 added by section one of this act; section 4403-d of the public health
31 law as added by section two of this act and the provisions of section
32 seven of this act, except for the provisions relating to the establish-
33 ment of no more than twelve comprehensive HIV special needs plans, shall
34 expire and be deemed repealed on July 1, 2000.
35 S 21. Subdivision (i-1) of section 79 of part C of chapter 58 of the
36 laws of 2008, amending the social services law and the public health law
37 relating to adjustments of rates, is amended to read as follows:
38 (i-1) section thirty-one-a of this act shall be deemed repealed July
39 1, [2011] 2014;
40 S 22. Section 2 of chapter 535 of the laws of 1983, amending the
41 social services law relating to eligibility of certain enrollees for
42 medical assistance, as amended by section 69 of part C of chapter 58 of
43 the laws of 2008, is amended to read as follows:
44 S 2. This act shall take effect immediately [and shall remain in full
45 force and effect through March 31, 2012].
46 S 23. Subdivision 12 of section 246 of chapter 81 of the laws of 1995,
47 amending the public health law and other laws relating to medical
48 reimbursement and welfare reform, as amended by section 56 of part C of
49 chapter 58 of the laws of 2008, is amended to read as follows:
50 12. Sections one hundred five-b through one hundred five-f of this act
51 shall expire March 31, [2011] 2013.
52 S 24. Intentionally omitted.
53 S 25. Section 11 of chapter 710 of the laws of 1988, amending the
54 social services law and the education law relating to medical assistance
55 eligibility of certain persons and providing for managed medical care
A. 4009--C 98
1 demonstration programs, as amended by section 66 of part C of chapter 58
2 of the laws of 2008, is amended to read as follows:
3 S 11. This act shall take effect immediately; except that the
4 provisions of sections one, two, three, four, eight and ten of this act
5 shall take effect on the ninetieth day after it shall have become a law;
6 and except that the provisions of sections five, six and seven of this
7 act shall take effect January 1, 1989; and except that effective imme-
8 diately, the addition, amendment and/or repeal of any rule or regulation
9 necessary for the implementation of this act on its effective date are
10 authorized and directed to be made and completed on or before such
11 effective date; provided, however, that [the provisions of section 364-j
12 of the social services law, as added by section one of this act shall
13 expire and be deemed repealed on and after March 31, 2012,] the
14 provisions of section 364-k of the social services law, as added by
15 section two of this act, except subdivision 10 of such section, shall
16 expire and be deemed repealed on and after January 1, 1994, and the
17 provisions of subdivision 10 of section 364-k of the social services
18 law, as added by section two of this act, shall expire and be deemed
19 repealed on January 1, 1995.
20 S 26. Subdivision (c) of section 62 of chapter 165 of the laws of
21 1991, amending the public health law and other laws relating to estab-
22 lishing payments for medical assistance, as amended by section 67 of
23 part C of chapter 58 of the laws of 2008, is amended to read as follows:
24 (c) section 364-j of the social services law, as amended by section
25 eight of this act and subdivision 6 of section 367-a of the social
26 services law as added by section twelve of this act shall expire and be
27 deemed repealed on March 31, [2012] 2015 and provided further, that the
28 amendments to the provisions of section 364-j of the social services law
29 MADE BY SECTION EIGHT OF THIS ACT shall only apply to managed care
30 programs approved on or after the effective date of this act;
31 S 26-a. Subdivision (x) of section 165 of chapter 41 of the laws of
32 1992, amending the public health law and other laws relating to health
33 care providers, as amended by section 70 of part C of chapter 58 of the
34 laws of 2008, is amended to read as follows:
35 (x) provided further that the provisions of paragraphs (a), (b), (d),
36 (e), (f) and (g) of subdivision 6 of section 367-a of the social
37 services law, as added by, and the amendatory language of paragraph (c)
38 of such subdivision as added by section ninety-one of this act, shall
39 expire and be deemed repealed on and after March 31, [2012] 2015 and on
40 such date the provisions of paragraph (c) shall be read as set out imme-
41 diately preceding the effective date of this act;
42 S 27. Notwithstanding any inconsistent provision of law, rule or regu-
43 lation, for purposes of implementing the provisions of the public health
44 law and the social services law, references to titles XIX and XXI of the
45 federal social security act in the public health law and the social
46 services law shall be deemed to include and also to mean any successor
47 titles thereto under the federal social security act.
48 S 28. Notwithstanding any inconsistent provision of law, rule or regu-
49 lation, the effectiveness of the provisions of sections 2807 and 3614 of
50 the public health law, section 18 of chapter 2 of the laws of 1988, and
51 18 NYCRR 505.14(h), as they relate to time frames for notice, approval
52 or certification of rates of payment, are hereby suspended and without
53 force or effect for purposes of implementing the provisions of this act.
54 S 29. Severability clause. If any clause, sentence, paragraph, subdi-
55 vision, section or part of this act shall be adjudged by any court of
56 competent jurisdiction to be invalid, such judgment shall not affect,
A. 4009--C 99
1 impair or invalidate the remainder thereof, but shall be confined in its
2 operation to the clause, sentence, paragraph, subdivision, section or
3 part thereof directly involved in the controversy in which such judge-
4 ment shall have been rendered. It is hereby declared to be the intent of
5 the legislature that this act would have been enacted even if such
6 invalid provisions had not been included herein.
7 S 30. This act shall take effect immediately and shall be deemed to
8 have been in full force and effect on and after April 1, 2011.
9 PART E
10 Section 1. Section 366 of the social services law is amended by adding
11 a new subdivision 1-b to read as follows:
12 1-B. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, IN THE EVENT THAT A
13 PERSON WHO IS AN INPATIENT IN AN INSTITUTION FOR MENTAL DISEASES, AS
14 DEFINED BY FEDERAL LAW AND REGULATIONS, AND WHO WAS IN RECEIPT OF
15 MEDICAL ASSISTANCE PURSUANT TO THIS TITLE IMMEDIATELY PRIOR TO BEING
16 ADMITTED TO SUCH FACILITY, OR WHO WAS DIRECTLY ADMITTED TO SUCH FACILITY
17 AFTER BEING AN INPATIENT IN ANOTHER INSTITUTION FOR MENTAL DISEASES AND
18 WHO WAS IN RECEIPT OF MEDICAL ASSISTANCE PRIOR TO ADMISSION TO SUCH
19 TRANSFERRING INSTITUTION, SUCH PERSON SHALL REMAIN ELIGIBLE FOR MEDICAL
20 ASSISTANCE WHILE AN INPATIENT IN SUCH FACILITY; PROVIDED, HOWEVER, THAT
21 NO MEDICAL ASSISTANCE SHALL BE FURNISHED PURSUANT TO THIS TITLE FOR ANY
22 CARE, SERVICES, OR SUPPLIES PROVIDED DURING THE TIME THAT SUCH PERSON IS
23 AN INPATIENT, EXCEPT TO THE EXTENT THAT FEDERAL FINANCIAL PARTICIPATION
24 IS AVAILABLE FOR THE COSTS OF SUCH CARE, SERVICES, OR SUPPLIES. UPON
25 RELEASE FROM SUCH FACILITY, SUCH PERSON SHALL CONTINUE TO BE ELIGIBLE
26 FOR RECEIPT OF MEDICAL ASSISTANCE FURNISHED PURSUANT TO THIS TITLE UNTIL
27 SUCH TIME AS THE PERSON IS DETERMINED TO NO LONGER BE ELIGIBLE FOR
28 RECEIPT OF SUCH ASSISTANCE. TO THE EXTENT PERMITTED BY FEDERAL LAW, THE
29 TIME DURING WHICH SUCH PERSON IS AN INPATIENT IN AN INSTITUTION FOR
30 MENTAL DISEASES SHALL NOT BE INCLUDED IN ANY CALCULATION OF WHEN THE
31 PERSON MUST RECERTIFY HIS OR HER ELIGIBILITY FOR MEDICAL ASSISTANCE IN
32 ACCORDANCE WITH THIS ARTICLE.
33 S 2. Paragraph (c) of subdivision 1 of section 366 of the social
34 services law, as amended by chapter 355 of the laws of 2007, is amended
35 to read as follows:
36 (c) except as provided in subparagraph six of paragraph (a) of this
37 subdivision or subdivision one-a OR SUBDIVISION ONE-B of this section,
38 is not an inmate or patient in an institution or facility wherein
39 medical assistance for needy persons may not be provided in accordance
40 with applicable federal or state requirements; and
41 S 3. This act shall take effect April 1, 2011; provided that all
42 actions necessary for the timely implementation of this act, including
43 revisions to information, eligibility and benefit computer systems
44 utilized by social services districts and administered by the department
45 of health of the state of New York, shall be taken prior to such effec-
46 tive date so that the provisions of this act may be implemented on such
47 date.
48 PART F
49 Section 1. Subdivisions 3-b and 3-c of section 1 of part C of chapter
50 57 of the laws of 2006, relating to establishing a cost of living
51 adjustment for designated human services programs, as amended by section
A. 4009--C 100
1 1 of part F of chapter 111 of the laws of 2010, are amended to read as
2 follows:
3 3-b. Notwithstanding any inconsistent provision of law, beginning
4 April 1, 2009 and ending March 31, [2011] 2012, the commissioners shall
5 not include a COLA for the purpose of establishing rates of payments,
6 contracts or any other form of reimbursement.
7 3-c. Notwithstanding any inconsistent provision of law, beginning
8 April 1, [2011] 2012 and ending March 31, [2014] 2015, the commissioners
9 shall develop the COLA under this section using the actual U.S. consumer
10 price index for all urban consumers (CPI-U) published by the United
11 States department of labor, bureau of labor statistics for the twelve
12 month period ending in July of the budget year prior to such state
13 fiscal year, for the purpose of establishing rates of payments,
14 contracts or any other form of reimbursement.
15 S 2. Section 4 of part C of chapter 57 of the laws of 2006, relating
16 to establishing a cost of living adjustment for designated human
17 services programs, as amended by section 2 of part F of chapter 111 of
18 the laws of 2010, is amended to read as follows:
19 S 4. This act shall take effect immediately and shall be deemed to
20 have been in full force and effect on and after April 1, 2006; provided
21 section one of this act shall expire and be deemed repealed April 1,
22 [2014] 2015; provided, further, that sections two and three of this act
23 shall expire and be deemed repealed December 31, 2009.
24 S 3. This act shall take effect immediately and shall be deemed to
25 have been in full force and effect on and after April 1, 2011; provided,
26 however, that the amendments to section 1 of part C of chapter 57 of the
27 laws of 2006 made by section one of this act shall not affect the repeal
28 of such section and shall be deemed repealed therewith.
29 PART G
30 Section 1. Subdivision (b) of section 7.17 of the mental hygiene law,
31 as amended by section 1 of part J of chapter 58 of the laws of 2005, is
32 amended to read as follows:
33 (b) There shall be in the office the hospitals named below for the
34 care, treatment and rehabilitation of [the mentally disabled] PERSONS
35 WITH MENTAL ILLNESS and for research and teaching in the science and
36 skills required for the care, treatment and rehabilitation of such
37 [mentally disabled] PERSONS WITH MENTAL ILLNESS.
38 Greater Binghamton Health Center
39 Bronx Psychiatric Center
40 Buffalo Psychiatric Center
41 Capital District Psychiatric Center
42 Central New York Psychiatric Center
43 Creedmoor Psychiatric Center
44 Elmira Psychiatric Center
45 Hudson River Psychiatric Center
46 Kingsboro Psychiatric Center
47 Kirby Forensic Psychiatric Center
48 Manhattan Psychiatric Center
49 Mid-Hudson Forensic Psychiatric Center
50 Mohawk Valley Psychiatric Center
51 Nathan S. Kline Institute for Psychiatric Research
52 New York State Psychiatric Institute
53 Pilgrim Psychiatric Center
54 Richard H. Hutchings Psychiatric Center
A. 4009--C 101
1 Rochester Psychiatric Center
2 Rockland Psychiatric Center
3 St. Lawrence Psychiatric Center
4 South Beach Psychiatric Center
5 Bronx Children's Psychiatric Center
6 Brooklyn Children's [Psychiatric] Center
7 Queens Children's Psychiatric Center
8 Rockland Children's Psychiatric Center
9 Sagamore Children's Psychiatric Center
10 Western New York Children's Psychiatric Center
11 The New York State Psychiatric Institute and The Nathan S. Kline
12 Institute for Psychiatric Research are designated as institutes for the
13 conduct of medical research and other scientific investigation directed
14 towards furthering knowledge of the etiology, diagnosis, treatment and
15 prevention of mental illness. THE BROOKLYN CHILDREN'S CENTER IS A
16 FACILITY OPERATED BY THE OFFICE TO PROVIDE COMMUNITY-BASED MENTAL HEALTH
17 SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES.
18 S 2. Notwithstanding the provisions of subdivisions (b) and (e) of
19 section 7.17 of the mental hygiene law, section 41.55 of the mental
20 hygiene law, the office of mental health is authorized in state fiscal
21 year 2011-12 to close, consolidate, reduce, transfer or otherwise rede-
22 sign services of hospitals, other facilities and programs operated by
23 the office of mental health, and to implement significant service
24 reductions and reconfigurations provided that the commissioner of mental
25 health comply with subdivision (g) of section 7.17 of the mental hygiene
26 law for any closure, consolidation or merger. Notwithstanding subdivi-
27 sion (g) of section 7.17 of the mental hygiene law, the commissioner of
28 mental health is authorized to perform any significant service
29 reductions that would not otherwise result in the closure, consolidation
30 or merger of a facility which shall include, but not be limited to,
31 closures of wards at a state-operated psychiatric center, or the trans-
32 fer of beds to transitional placement programs provided that the commis-
33 sioner of mental health provide at least 30 days notice of such
34 reductions to the speaker of the assembly and temporary president of the
35 senate.
36 Prior to making any significant service reduction that will result in
37 a workforce reduction at department of mental health facilities or
38 programs operated by the office of mental health in state fiscal year
39 2011-12, the commissioner of mental health shall take the following
40 actions:
41 (a) confer with the department of civil service, the governor's office
42 of employee relations and any other state agency to develop strategies
43 which attempt to minimize the impact on the state workforce by providing
44 assistance in obtaining state employment in state-operated community-
45 based services or other employment opportunities, and to develop strate-
46 gies for the development of necessary retraining and redeployment
47 programs. In planning such strategies, the commissioner of mental health
48 shall provide for the participation of the representatives of the
49 employee labor organizations and for the participation of managerial and
50 confidential employees to ensure continuity of employment;
51 (b) consult with the department of economic development and any other
52 appropriate state agencies to develop strategies which attempt to mini-
53 mize the impact of such significant service reductions on the local and
54 regional economies; and
55 (c) consult with the office of general services and any other appro-
56 priate state agency in developing a mechanism for determining alterna-
A. 4009--C 102
1 tive uses for land and buildings to be vacated by the office of mental
2 health. Such a mechanism should include a review of other programs or
3 state agencies that could feasibly expand their operations onto a state-
4 operated hospital campus and are compatible with health, safety and
5 programmatic needs of patients served in such facilities.
6 S 3. Section 7.17 of the mental hygiene law is amended by adding a new
7 subdivision (g) to read as follows:
8 (G) THE COMMISSIONER SHALL SUBMIT A REPORT TO THE GOVERNOR, TEMPORARY
9 PRESIDENT OF THE SENATE, AND SPEAKER OF THE ASSEMBLY AT LEAST NINETY
10 DAYS PRIOR TO ANY SIGNIFICANT SERVICE REDUCTION THAT WOULD RESULT IN THE
11 CLOSURE, CONSOLIDATION, OR MERGER OF A FACILITY LICENSED BY THE OFFICE
12 LISTING THE SPECIFIC HOSPITALS TO BE IMPACTED AND DESCRIBING THE PROCESS
13 FOR SELECTING SUCH FACILITIES, WHICH SHALL BE BASED ON THE FOLLOWING
14 CRITERIA:
15 (1) COMMUNITY MENTAL HEALTH SERVICES CURRENTLY AVAILABLE IN THE FACIL-
16 ITY CATCHMENT AREA;
17 (2) ABILITY OF COMMUNITY MENTAL HEALTH SERVICES TO MEET THE BEHAVIORAL
18 HEALTH NEEDS OF THE IMPACTED CONSUMERS;
19 (3) THE FEASIBILITY OF COST EFFECTIVELY RETROFITTING THE TECHNOLOGY
20 AND COMMUNICATION SYSTEMS OF THE FACILITY;
21 (4) THE ANTICIPATED IMPACT OF THE SIGNIFICANT SERVICE REDUCTION ON
22 ACCESS TO MENTAL HEALTH SERVICES;
23 (5) A PLAN FOR PATIENT PLACEMENT OF PERSONS CURRENTLY BEING SERVED AT
24 THE IMPACTED FACILITY;
25 (6) THE LONG-TERM NEED FOR MENTAL HEALTH SERVICES IN THE CATCHMENT
26 AREA CURRENTLY SERVED BY THE IMPACTED FACILITY;
27 (7) THE COMMUNITY HOSPITALS IN THE CATCHMENT AREA OF THE IMPACTED
28 FACILITY AND THEIR CAPACITY TO PROVIDE BOTH EMERGENCY AND SHORT-TERM
29 ACUTE INPATIENT CARE, A MEASURE OF ANTICIPATED UNMET NEED, AND AN
30 ASSESSMENT OF THE FISCAL IMPACT ON THESE HOSPITALS PROVIDING SUCH
31 SERVICES; AND
32 (8) IMPACT ON THE WORKFORCE.
33 FINDINGS ASSOCIATED WITH EACH OF THE CRITERIA REQUIRED BY THIS SUBDI-
34 VISION SHALL BE INCLUDED IN THE REPORT.
35 S 4. Severability clause. If any clause, sentence, paragraph, subdivi-
36 sion, section or part of this act shall be adjudged by any court of
37 competent jurisdiction to be invalid, such judgment shall not affect,
38 impair, or invalidate the remainder thereof, but shall be confined in
39 its operation to the clause, sentence, paragraph, subdivision, section
40 or part thereof directly involved in the controversy in which such judg-
41 ment shall have been rendered. It is hereby declared to be the intent
42 of the legislature that this act would have been enacted even if such
43 invalid provisions had not been included herein.
44 S 5. This act shall take effect April 1, 2011; provided that section
45 two of this act shall expire and be deemed repealed March 31, 2012.
46 PART H
47 Section 1. Subparagraph 1 of paragraph (c) of subdivision 10 of
48 section 2807-c of the public health law, as amended by chapter 419 of
49 the laws of 2000, is amended to read as follows:
50 (1) For rate periods on and after April first, two thousand THROUGH
51 MARCH THIRTY-FIRST, TWO THOUSAND ELEVEN, the commissioner shall estab-
52 lish trend factors for rates of payment for state governmental agencies
53 to project for the effects of inflation except that such trend factors
54 shall not be applied to services for which rates of payment are estab-
A. 4009--C 103
1 lished by the commissioners of the department of mental hygiene. The
2 factors shall be applied to the appropriate portion of reimbursable
3 costs.
4 S 2. Section 21 of chapter 1 of the laws of 1999 amending the public
5 health law and other laws relating to enacting the New York Health Care
6 Reform Act of 2000, as amended by section 18 of part D of chapter 58 of
7 the laws of 2009, is amended to read as follows:
8 S 21. Notwithstanding any inconsistent provision of law, effective FOR
9 RATE PERIODS April 1, 2000 THROUGH MARCH 31, 2011, in determining rates
10 of payment for residential health care facilities pursuant to section
11 2808 of the public health law, hospital outpatient services and diagnos-
12 tic and treatment centers pursuant to section 2807 of the public health
13 law, unless otherwise subject to the limits set forth in section 4 of
14 chapter 81 of the laws of 1995, as amended by this act, certified home
15 health agencies and long term home health care programs pursuant to
16 section 3614-a of the public health law and personal care services
17 pursuant to section 367-i of the social services law, and for periods on
18 and after April 1, 2009, adult day health care services provided to
19 patients diagnosed with AIDS as defined by applicable regulations, the
20 commissioner of health shall apply trend factors using the methodology
21 described in paragraph (c) of subdivision 10 of section 2807-c of the
22 public health law, except that such trend factors shall not be applied
23 to services for which rates of payment are established by the commis-
24 sioners of the department of mental hygiene. Nothing in this section is
25 intended to reduce a change in any existing provision of law establish-
26 ing maximum reimbursement rates.
27 S 2-a. Notwithstanding any contrary provision of law, rule or regu-
28 lation, for Medicaid rates of payment for services provided on and after
29 April 1, 2011 the commissioner of health is authorized to promulgate
30 regulations, including emergency regulations, with regard to trend
31 factor adjustments for inflation which may be applied to such rates of
32 payment with regard to hospice services provided pursuant to article 40
33 of the public health law, assisted living program services provided
34 pursuant to section 461-1 of the social services law, foster care
35 services provided pursuant to article 6 of the social services law,
36 adult day health care services provided pursuant to article 28 of the
37 public health law or personal care services provided in those local
38 social services districts, including New York city, whose rates of
39 payment for such services is established by such social services
40 districts pursuant to a rate-setting exemption issued by the commission-
41 er of health to such local social services districts in accordance with
42 applicable regulations.
43 S 3. Section 3614 of the public health law is amended by adding a new
44 subdivision 12 to read as follows:
45 12. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
46 LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
47 IPATION, EFFECTIVE ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
48 MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, RATES OF PAYMENT BY GOVERNMENT
49 AGENCIES FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, EXCEPT
50 FOR SUCH SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF AGE AND
51 OTHER DISCRETE GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER PURSUANT
52 TO REGULATIONS, SHALL REFLECT CEILING LIMITATIONS DETERMINED IN ACCORD-
53 ANCE WITH THIS SUBDIVISION, PROVIDED, HOWEVER, THAT AT THE DISCRETION OF
54 THE COMMISSIONER SUCH CEILINGS MAY, AS AN ALTERNATIVE, BE APPLIED TO
55 PAYMENTS FOR SERVICES PROVIDED ON AND AFTER APRIL FIRST, TWO THOUSAND
56 ELEVEN, EXCEPT FOR SUCH SERVICES PROVIDED TO CHILDREN AND OTHER DISCRETE
A. 4009--C 104
1 GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER PURSUANT TO REGULATIONS.
2 IN DETERMINING SUCH PAYMENTS OR RATES OF PAYMENT, AGENCY CEILINGS SHALL
3 BE ESTABLISHED. SUCH CEILINGS SHALL BE APPLIED TO PAYMENTS OR RATES OF
4 PAYMENT FOR CERTIFIED HOME HEALTH AGENCY SERVICES AS ESTABLISHED PURSU-
5 ANT TO THIS SECTION AND APPLICABLE REGULATIONS. CEILINGS SHALL BE BASED
6 ON A BLEND OF: (I) AN AGENCY'S TWO THOUSAND NINE AVERAGE PER PATIENT
7 MEDICAID CLAIMS, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE COMMIS-
8 SIONER; AND (II) THE TWO THOUSAND NINE STATEWIDE AVERAGE PER PATIENT
9 MEDICAID CLAIMS ADJUSTED BY A REGIONAL WAGE INDEX FACTOR AND AN AGENCY
10 PATIENT CASE MIX INDEX, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE
11 COMMISSIONER. SUCH CEILINGS WILL BE EFFECTIVE APRIL FIRST, TWO THOUSAND
12 ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. AN INTERIM
13 PAYMENT OR RATE OF PAYMENT ADJUSTMENT EFFECTIVE APRIL FIRST, TWO THOU-
14 SAND ELEVEN, SHALL BE APPLIED TO AGENCIES WITH PROJECTED AVERAGE PER
15 PATIENT MEDICAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, TO BE OVER
16 THEIR CEILINGS. SUCH AGENCIES SHALL HAVE THEIR PAYMENTS OR RATES OF
17 PAYMENT REDUCED TO REFLECT THE AMOUNT BY WHICH SUCH CLAIMS EXCEED THEIR
18 CEILINGS.
19 (B) CEILING LIMITATIONS DETERMINED PURSUANT TO PARAGRAPH (A) OF THIS
20 SUBDIVISION SHALL BE SUBJECT TO RECONCILIATION. IN DETERMINING PAYMENT
21 OR RATE OF PAYMENT ADJUSTMENTS BASED ON SUCH RECONCILIATION, ADJUSTED
22 AGENCY CEILINGS SHALL BE ESTABLISHED. SUCH ADJUSTED CEILINGS SHALL BE
23 BASED ON A BLEND OF: (I) AN AGENCY'S TWO THOUSAND NINE AVERAGE PER
24 PATIENT MEDICAID CLAIMS ADJUSTED BY THE PERCENTAGE OF INCREASE OR
25 DECREASE IN SUCH AGENCY'S PATIENT CASE MIX FROM THE TWO THOUSAND NINE
26 CALENDAR YEAR TO THE ANNUAL PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
27 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, WEIGHTED AT A PERCENT-
28 AGE AS DETERMINED BY THE COMMISSIONER; AND (II) THE TWO THOUSAND NINE
29 STATEWIDE AVERAGE PER PATIENT MEDICAID CLAIMS ADJUSTED BY A REGIONAL
30 WAGE INDEX FACTOR AND THE AGENCY'S PATIENT CASE MIX INDEX FOR THE ANNUAL
31 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
32 THOUSAND TWELVE, WEIGHTED AT A PERCENTAGE AS DETERMINED BY THE COMMIS-
33 SIONER. SUCH ADJUSTED AGENCY CEILING SHALL BE COMPARED TO ACTUAL MEDI-
34 CAID PAID CLAIMS FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH
35 MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. IN THOSE INSTANCES WHEN AN
36 AGENCY'S ACTUAL PER PATIENT MEDICAID CLAIMS ARE DETERMINED TO EXCEED THE
37 AGENCY'S ADJUSTED CEILING, THE AMOUNT OF SUCH EXCESS SHALL BE DUE FROM
38 EACH SUCH AGENCY TO THE STATE AND MAY BE RECOUPED BY THE DEPARTMENT IN A
39 LUMP SUM AMOUNT OR THROUGH REDUCTIONS IN THE MEDICAID PAYMENTS DUE TO
40 THE AGENCY. IN THOSE INSTANCES WHERE AN INTERIM PAYMENT OR RATE OF
41 PAYMENT ADJUSTMENT WAS APPLIED TO AN AGENCY IN ACCORDANCE WITH PARAGRAPH
42 (A) OF THIS SUBDIVISION, AND SUCH AGENCY'S ACTUAL PER PATIENT MEDICAID
43 CLAIMS ARE DETERMINED TO BE LESS THAN THE AGENCY'S ADJUSTED CEILING, THE
44 AMOUNT BY WHICH SUCH MEDICAID CLAIMS ARE LESS THAN THE AGENCY'S ADJUSTED
45 CEILING SHALL BE REMITTED TO EACH SUCH AGENCY BY THE DEPARTMENT IN A
46 LUMP SUM AMOUNT OR THROUGH AN INCREASE IN THE MEDICAID PAYMENTS DUE TO
47 THE AGENCY.
48 (C) INTERIM PAYMENT OR RATE OF PAYMENT ADJUSTMENTS PURSUANT TO THIS
49 SUBDIVISION SHALL BE BASED ON MEDICAID PAID CLAIMS, AS DETERMINED BY THE
50 COMMISSIONER, FOR SERVICES PROVIDED BY AGENCIES IN THE BASE YEAR TWO
51 THOUSAND NINE. AMOUNTS DUE FROM RECONCILING RATE ADJUSTMENTS SHALL BE
52 BASED ON MEDICAID PAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, FOR
53 SERVICES PROVIDED BY AGENCIES IN THE BASE YEAR TWO THOUSAND NINE AND
54 MEDICAID PAID CLAIMS, AS DETERMINED BY THE COMMISSIONER, FOR SERVICES
55 PROVIDED BY AGENCIES IN THE RECONCILIATION PERIOD APRIL FIRST, TWO THOU-
56 SAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE. IN DETER-
A. 4009--C 105
1 MINING CASE MIX, EACH PATIENT SHALL BE CLASSIFIED USING A SYSTEM BASED
2 ON MEASURES WHICH MAY INCLUDE, BUT NOT BE LIMITED TO, CLINICAL AND FUNC-
3 TIONAL MEASURES, AS REPORTED ON THE FEDERAL OUTCOME AND ASSESSMENT
4 INFORMATION SET (OASIS), AS MAY BE AMENDED.
5 (D) THE COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND SUBMIT ANY
6 DATA REQUIRED TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION. THE
7 COMMISSIONER MAY PROMULGATE REGULATIONS, INCLUDING EMERGENCY REGU-
8 LATIONS, TO IMPLEMENT THE PROVISIONS OF THIS SUBDIVISION.
9 (E) PAYMENTS OR RATE OF PAYMENT ADJUSTMENTS DETERMINED PURSUANT TO
10 THIS SUBDIVISION SHALL, FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN
11 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE, BE RETROACTIVELY RECON-
12 CILED UTILIZING THE METHODOLOGY IN PARAGRAPH (B) OF THIS SUBDIVISION AND
13 UTILIZING ACTUAL PAID CLAIMS FROM SUCH PERIOD.
14 (F) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF THIS SUBDIVISION,
15 PAYMENTS OR RATE OF PAYMENT ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVI-
16 SION SHALL NOT RESULT IN AN AGGREGATE ANNUAL DECREASE IN MEDICAID
17 PAYMENTS TO PROVIDERS SUBJECT TO THIS SUBDIVISION THAT IS IN EXCESS OF
18 TWO HUNDRED MILLION DOLLARS, AS DETERMINED BY THE COMMISSIONER AND NOT
19 SUBJECT TO SUBSEQUENT ADJUSTMENT, AND THE COMMISSIONER SHALL MAKE SUCH
20 ADJUSTMENTS TO SUCH PAYMENTS OR RATES OF PAYMENT AS ARE NECESSARY TO
21 ENSURE THAT SUCH AGGREGATE LIMITS ON PAYMENT DECREASES ARE NOT EXCEEDED.
22 S 4. Section 3614 of the public health law is amended by adding a new
23 subdivision 13 to read as follows:
24 13. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGU-
25 LATION AND SUBJECT TO THE AVAILABILITY OF FEDERAL FINANCIAL PARTIC-
26 IPATION, EFFECTIVE APRIL FIRST, TWO THOUSAND TWELVE, PAYMENTS BY GOVERN-
27 MENT AGENCIES FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES,
28 EXCEPT FOR SUCH SERVICES PROVIDED TO CHILDREN UNDER EIGHTEEN YEARS OF
29 AGE AND OTHER DISCREET GROUPS AS MAY BE DETERMINED BY THE COMMISSIONER
30 PURSUANT TO REGULATIONS, SHALL BE BASED ON EPISODIC PAYMENTS. IN ESTAB-
31 LISHING SUCH PAYMENTS, A STATEWIDE BASE PRICE SHALL BE ESTABLISHED FOR
32 EACH SIXTY DAY EPISODE OF CARE AND ADJUSTED BY A REGIONAL WAGE INDEX
33 FACTOR AND AN INDIVIDUAL PATIENT CASE MIX INDEX. SUCH EPISODIC PAYMENTS
34 MAY BE FURTHER ADJUSTED FOR LOW UTILIZATION CASES AND TO REFLECT A
35 PERCENTAGE LIMITATION OF THE COST FOR HIGH-UTILIZATION CASES THAT EXCEED
36 OUTLIER THRESHOLDS OF SUCH PAYMENTS.
37 (B) INITIAL BASE YEAR EPISODIC PAYMENTS SHALL BE BASED ON MEDICAID
38 PAID CLAIMS, AS DETERMINED AND ADJUSTED BY THE COMMISSIONER TO ACHIEVE
39 SAVINGS COMPARABLE TO THE PRIOR STATE FISCAL YEAR, FOR SERVICES PROVIDED
40 BY ALL CERTIFIED HOME HEALTH AGENCIES IN THE BASE YEAR TWO THOUSAND
41 NINE. SUBSEQUENT BASE YEAR EPISODIC PAYMENTS MAY BE BASED ON MEDICAID
42 PAID CLAIMS FOR SERVICES PROVIDED BY ALL CERTIFIED HOME HEALTH AGENCIES
43 IN A BASE YEAR SUBSEQUENT TO TWO THOUSAND NINE, AS DETERMINED BY THE
44 COMMISSIONER, PROVIDED, HOWEVER, THAT SUCH BASE YEAR ADJUSTMENT SHALL BE
45 MADE NOT LESS FREQUENTLY THAN EVERY THREE YEARS. IN DETERMINING CASE
46 MIX, EACH PATIENT SHALL BE CLASSIFIED USING A SYSTEM BASED ON MEASURES
47 WHICH MAY INCLUDE, BUT NOT LIMITED TO, CLINICAL AND FUNCTIONAL MEASURES,
48 AS REPORTED ON THE FEDERAL OUTCOME AND ASSESSMENT INFORMATION SET
49 (OASIS), AS MAY BE AMENDED.
50 (C) THE COMMISSIONER MAY REQUIRE AGENCIES TO COLLECT AND SUBMIT ANY
51 DATA REQUIRED TO IMPLEMENT THIS SUBDIVISION. THE COMMISSIONER MAY
52 PROMULGATE REGULATIONS, INCLUDING EMERGENCY REGULATIONS, TO IMPLEMENT
53 THE PROVISIONS OF THIS SUBDIVISION.
54 S 5. Sections 365-i and 369-dd of the social services law are
55 REPEALED.
A. 4009--C 106
1 S 5-a. Subparagraph (v) of paragraph (e) of subdivision 1 and subdivi-
2 sion 2-b of section 369-ee of the social services law, subparagraph (v)
3 of paragraph (e) of subdivision 1 as amended by section 1 of part C and
4 subdivision 2-b as added by section 2 of part C of chapter 58 of the
5 laws of 2008, are amended to read as follows:
6 (v) prescription drugs [as defined in section two hundred seventy of
7 the public health law, which shall be provided pursuant to subdivision
8 two-b of this section,] and non-prescription smoking cessation products
9 or devices;
10 2-b. Prescription drug payments. [(a) Subject to paragraph (b) of this
11 subdivision, payment for drugs, except for such drugs provided by
12 medical practitioners, and for which payment is authorized pursuant to
13 paragraph (e) of subdivision one of this section, shall be made pursuant
14 to subdivision nine of section three hundred sixty-seven-a of this arti-
15 cle and article two-A of the public health law and subdivision four of
16 section three hundred sixty-five-a of this article. Payment for such
17 drugs provided by medical practitioners shall be included in the capita-
18 tion payment for services or supplies provided to persons eligible for
19 health care services under this title.
20 (b)] Payment for drugs for which payment is authorized pursuant to
21 paragraph (e) of subdivision one of this section[, and that are provided
22 by an employer partnership for family health plus plan authorized by
23 section three hundred sixty-nine-ff of this title,] shall be included in
24 the capitation payment for services or supplies provided to persons
25 eligible for health care services under [such] A FAMILY HEALTH INSURANCE
26 plan.
27 S 5-b. The public health law is amended by adding a new section 275-a
28 to read as follows:
29 S 275-A. PREFERRED DRUG PROGRAM AND CLINICAL DRUG REVIEW PROGRAM IN
30 MEDICAID MANAGED CARE. PAYMENT FOR PRESCRIPTION DRUGS SHALL BE INCLUDED
31 IN THEY CAPITATION PAYMENT OF A MANAGED CARE ORGANIZATION UNDER SECTION
32 THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW ONLY PURSUANT TO A
33 CONTRACT UNDER THIS SECTION, EXCEPT THAT SUCH PAYMENTS MAY BE INCLUDED
34 IN THE CAPITATION PAYMENT WITHOUT SUCH A CONTRACT IF THE COMMISSIONER
35 DETERMINES THAT SUCH A CONTRACT WOULD NOT BE IN THE FINANCIAL INTERESTS
36 OF THE STATE. THE COMMISSIONER MAY CONTRACT WITH A MANAGED CARE ORGAN-
37 IZATION UNDER SEDITION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES
38 LAW TO INCLUDE PAYMENTS FOR PRESCRIPTION DRUGS IN THE CAPITATION PAYMENT
39 OF THE MANAGED CARE ORGANIZATION. THE CONTRACT SHALL INCLUDE TERMS
40 REQUIRED BY THE COMMISSIONING TO MAXIMIZE SAVINGS TO THE MEDICAID
41 PROGRAMS AND PROTECT THE HEALTH AND INTERESTS OF THE MANAGED CARE ORGAN-
42 IZATION'S ENROLLEES, AND SHALL PROVIDE:
43 1. THE MANAGED CARE ORGANIZATION SHALL USE THE PREFERRED DRUG LIST
44 UNDER THIS ARTICLE AND SHALL REQUIRE PRIOR AUTHORIZATION AS REQUIRED BY
45 THE CLINICAL DRUG REVIEW PROGRAM UNDER THIS ARTICLE.
46 2. WHERE PRIOR AUTHORIZATION IS REQUIRED BY THE PREFERRED DRUG PROGRAM
47 OR THE CLINICAL DRUG REVIEW PROGRAM UNDER THIS ARTICLE, THE MANAGED CARE
48 ORGANIZATION SHALL USE A PRIOR AUTHORIZATION SYSTEM THAT IS CONSISTENT
49 WITH THIS ARTICLE OR THE CONTRACT MAY PROVIDE FOR THE MANAGED CARE
50 ORGANIZATION TO USE THE PRIOR AUTHORIZATION SYSTEM OPERATED BY THE
51 DEPARTMENT UNDER THIS ARTICLE AND MAY PROVIDE FOR APPROPRIATE PAYMENT
52 FOR THAT USE.
53 3. THE MANAGED CARE ORGANIZATION SHALL COMPLY WITH OTHER PROVISIONS OF
54 TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW APPLICABLE TO
55 PRESCRIPTION DRUGS, INCLUDING THE STEP THERAPY PROGRAM.
A. 4009--C 107
1 S 6. Section 368-d of the social services law is amended by adding
2 three new subdivisions 4, 5 and 6 to read as follows:
3 4. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE OR
4 MORE ENTITIES TO CONDUCT A STUDY TO DETERMINE ACTUAL DIRECT AND INDIRECT
5 COSTS INCURRED BY PUBLIC SCHOOL DISTRICTS AND STATE OPERATED/STATE
6 SUPPORTED SCHOOLS WHICH OPERATE PURSUANT TO ARTICLE EIGHTY-FIVE, EIGHT-
7 Y-SEVEN OR EIGHTY-EIGHT OF THE EDUCATION LAW FOR MEDICAL CARE, SERVICES
8 AND SUPPLIES, INCLUDING RELATED SPECIAL EDUCATION SERVICES AND SPECIAL
9 TRANSPORTATION, FURNISHED TO CHILDREN WITH HANDICAPPING CONDITIONS.
10 5. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
11 TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
12 ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW,
13 THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
14 CONTRACTS UNDER SUBDIVISION FOUR OF THIS SECTION WITHOUT A COMPETITIVE
15 BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
16 (A) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
17 OF NO LESS THAN THIRTY DAYS:
18 (I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
19 THE CONTRACT OR CONTRACTS;
20 (II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
21 (III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
22 SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
23 INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
24 (IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
25 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
26 (B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
27 PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
28 COMMISSIONER OF HEALTH; AND
29 (C) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
30 CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
31 PURPOSES OF THIS SECTION.
32 6. THE COMMISSIONER SHALL EVALUATE THE RESULTS OF THE STUDY CONDUCTED
33 PURSUANT TO SUBDIVISION FOUR OF THIS SECTION TO DETERMINE, AFTER IDEN-
34 TIFICATION OF ACTUAL DIRECT AND INDIRECT COSTS INCURRED BY PUBLIC SCHOOL
35 DISTRICTS AND STATE OPERATED/STATE SUPPORTED SCHOOLS, WHETHER IT IS
36 ADVISABLE TO CLAIM FEDERAL REIMBURSEMENT FOR EXPENDITURES UNDER THIS
37 SECTION AS CERTIFIED PUBLIC EXPENDITURES. IN THE EVENT SUCH CLAIMS ARE
38 SUBMITTED, IF FEDERAL REIMBURSEMENT RECEIVED FOR CERTIFIED PUBLIC
39 EXPENDITURES ON BEHALF OF MEDICAL ASSISTANCE RECIPIENTS WHOSE ASSISTANCE
40 AND CARE ARE THE RESPONSIBILITY OF A SOCIAL SERVICES DISTRICT IN A CITY
41 WITH A POPULATION OF OVER TWO MILLION, RESULTS IN A DECREASE IN THE
42 STATE SHARE OF ANNUAL EXPENDITURES PURSUANT TO THIS SECTION FOR SUCH
43 RECIPIENTS, THEN TO THE EXTENT THAT THE AMOUNT OF ANY SUCH DECREASE WHEN
44 COMBINED WITH ANY DECREASE IN THE STATE SHARE OF ANNUAL EXPENDITURES
45 DESCRIBED IN SUBDIVISION FIVE OF SECTION THREE HUNDRED SIXTY-EIGHT-E OF
46 THIS TITLE EXCEEDS FIFTY MILLION DOLLARS, THE EXCESS AMOUNT SHALL BE
47 TRANSFERRED TO SUCH CITY. ANY SUCH EXCESS AMOUNT TRANSFERRED SHALL NOT
48 BE CONSIDERED A REVENUE RECEIVED BY SUCH SOCIAL SERVICES DISTRICT IN
49 DETERMINING THE DISTRICT'S ACTUAL MEDICAL ASSISTANCE EXPENDITURES FOR
50 PURPOSES OF PARAGRAPH (B) OF SECTION ONE OF PART C OF CHAPTER
51 FIFTY-EIGHT OF THE LAWS OF TWO THOUSAND FIVE.
52 S 7. Section 368-e of the social services law is amended by adding
53 three new subdivisions 3, 4 and 5 to read as follows:
54 3. THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE OR
55 MORE ENTITIES TO CONDUCT A STUDY TO DETERMINE ACTUAL DIRECT AND INDIRECT
56 COSTS INCURRED BY COUNTIES FOR MEDICAL CARE, SERVICES AND SUPPLIES,
A. 4009--C 108
1 INCLUDING RELATED SPECIAL EDUCATION SERVICES AND SPECIAL TRANSPORTATION,
2 FURNISHED TO PRE-SCHOOL CHILDREN WITH HANDICAPPING CONDITIONS.
3 4. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
4 TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
5 ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW,
6 THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
7 CONTRACTS UNDER SUBDIVISION THREE OF THIS SECTION WITHOUT A COMPETITIVE
8 BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
9 (A) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
10 OF NO LESS THAN THIRTY DAYS:
11 (I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
12 THE CONTRACT OR CONTRACTS;
13 (II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
14 (III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
15 SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
16 INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
17 (IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
18 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
19 (B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
20 PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
21 COMMISSIONER OF HEALTH; AND
22 (C) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
23 CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
24 PURPOSES OF THIS SECTION.
25 5. THE COMMISSIONER SHALL EVALUATE THE RESULTS OF THE STUDY CONDUCTED
26 PURSUANT TO SUBDIVISION THREE OF THIS SECTION TO DETERMINE, AFTER IDEN-
27 TIFICATION OF ACTUAL DIRECT AND INDIRECT COSTS INCURRED BY COUNTIES FOR
28 MEDICAL CARE, SERVICES, AND SUPPLIES FURNISHED TO PRE-SCHOOL CHILDREN
29 WITH HANDICAPPING CONDITIONS, WHETHER IT IS ADVISABLE TO CLAIM FEDERAL
30 REIMBURSEMENT FOR EXPENDITURES UNDER THIS SECTION AS CERTIFIED PUBLIC
31 EXPENDITURES. IN THE EVENT SUCH CLAIMS ARE SUBMITTED, IF FEDERAL
32 REIMBURSEMENT RECEIVED FOR CERTIFIED PUBLIC EXPENDITURES ON BEHALF OF
33 MEDICAL ASSISTANCE RECIPIENTS WHOSE ASSISTANCE AND CARE ARE THE RESPON-
34 SIBILITY OF A SOCIAL SERVICES DISTRICT IN A CITY WITH A POPULATION OF
35 OVER TWO MILLION, RESULTS IN A DECREASE IN THE STATE SHARE OF ANNUAL
36 EXPENDITURES PURSUANT TO THIS SECTION FOR SUCH RECIPIENTS, THEN TO THE
37 EXTENT THAT THE AMOUNT OF ANY SUCH DECREASE WHEN COMBINED WITH ANY
38 DECREASE IN THE STATE SHARE OF ANNUAL EXPENDITURES DESCRIBED IN SUBDIVI-
39 SION SIX OF SECTION THREE HUNDRED SIXTY-EIGHT-D OF THIS TITLE EXCEEDS
40 FIFTY MILLION DOLLARS, THE EXCESS AMOUNT SHALL BE TRANSFERRED TO SUCH
41 CITY. ANY SUCH EXCESS AMOUNT TRANSFERRED SHALL NOT BE CONSIDERED A
42 REVENUE RECEIVED BY SUCH SOCIAL SERVICES DISTRICT IN DETERMINING THE
43 DISTRICT'S ACTUAL MEDICAL ASSISTANCE EXPENDITURES FOR PURPOSES OF PARA-
44 GRAPH (B) OF SECTION ONE OF PART C OF CHAPTER FIFTY-EIGHT OF THE LAWS OF
45 TWO THOUSAND FIVE.
46 S 8. Paragraph d of subdivision 20 of section 2808 of the public
47 health law is REPEALED and a new paragraph d is added to read as
48 follows:
49 D. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, RULE OR REGULATION,
50 FOR RATE PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, THE
51 CAPITAL COST COMPONENT OF MEDICAID RATES OF PAYMENT FOR SERVICES
52 PROVIDED BY RESIDENTIAL HEALTH CARE FACILITIES SHALL NOT INCLUDE ANY
53 PAYMENT FACTOR FOR RETURN ON OR RETURN OF EQUITY.
54 S 9. Paragraph (b) of subdivision 11 of section 272 of the public
55 health law, as added by section 36 of part C of chapter 58 of the laws
56 of 2009, is amended to read as follows:
A. 4009--C 109
1 (b) The commissioner may designate a pharmaceutical manufacturer as
2 one with whom the commissioner is negotiating or has negotiated a
3 manufacturer agreement, and all of the drugs it manufactures or markets
4 shall be included in the preferred drug program. The commissioner may
5 negotiate directly with a pharmaceutical manufacturer for rebates relat-
6 ing to any or all of the drugs it manufactures or markets. A manufactur-
7 er agreement shall designate any or all of the drugs manufactured or
8 marketed by the pharmaceutical manufacturer as being preferred or non
9 preferred drugs. When a pharmaceutical manufacturer has been designated
10 by the commissioner under this paragraph but THE COMMISSIONER has not
11 reached a manufacturer agreement with the pharmaceutical manufacturer,
12 then THE COMMISSIONER MAY DESIGNATE SOME OR all of the drugs manufac-
13 tured or marketed by the pharmaceutical manufacturer [shall be] AS non
14 preferred drugs. However, notwithstanding this paragraph, any drug that
15 is selected to be on the preferred drug list under paragraph (b) of
16 subdivision ten of this section on grounds that it is significantly more
17 clinically effective and safer than other drugs in its therapeutic class
18 shall be a preferred drug.
19 S 10. Paragraphs (a), (b), (c), (d) and (e) of subdivision 9 of
20 section 367-a of the social services law are REPEALED, paragraphs (f),
21 (g), (h) and (i) are relettered paragraphs (b), (c), (d) and (e) and the
22 opening paragraph of subdivision 9, as amended by chapter 19 of the laws
23 of 1998, is amended to read as follows:
24 (A) Notwithstanding any inconsistent provision of law or regulation to
25 the contrary, for those drugs which may not be dispensed without a
26 prescription as required by section sixty-eight hundred ten of the
27 education law and for which payment is authorized pursuant to paragraph
28 (g) of subdivision two of section three hundred sixty-five-a of this
29 title, payments FOR SUCH DRUGS AND DISPENSING FEES under this title
30 shall be made at [the following] amounts[:] ESTABLISHED BY THE COMMIS-
31 SIONER PROVIDED, HOWEVER, THAT THE SOLE AND MULTIPLE SOURCE BRAND NAME
32 DRUGS DISPENSED BY A SPECIALIZED HIV PHARMACY, AS DEFINED IN PARAGRAPH
33 (B) OF THIS SUBDIVISION, ACQUISITION COST MEANS THE AVERAGE WHOLESALE
34 PRICE OF A PRESCRIPTION DRUG BASED UPON THE PACKAGE SIZE DISPENSED FROM,
35 AS REPORTED BY THE PRESCRIPTION DRUG PRICING SERVICE USED BY THE DEPART-
36 MENT, LESS TWELVE PERCENT THEREOF, AND UPDATED MONTHLY BY THE DEPART-
37 MENT; AND FOR MULTIPLE SOURCE GENERIC DRUGS DISPENSED BY A SPECIALIZED
38 HIV PHARMACY, AS DEFINED IN PARAGRAPH (B) OF THIS SUBDIVISION, ACQUISI-
39 TION COST MEANS THE LOWER OF THE AVERAGE WHOLESALE PRICE OF A
40 PRESCRIPTION DRUG BASED ON THE PACKAGE SIZE DISPENSED FROM, AS REPORTED
41 BY THE PRESCRIPTION DRUG BASED ON THE PACKAGE SIZE DISPENSED FORM, AS
42 REPORTED BY THE PRESCRIPTION DRUG PRICING SERVICES USED BY THE DEPART-
43 MENT, LESS TWELVE PERCENT THEREOF, OR THE MAXIMUM ACQUISITION COST, AS
44 PRESCRIBED BY REGULATIONS.
45 S 11. Intentionally Omitted.
46 S 12. Intentionally omitted.
47 S 13. Subdivision 1 of section 271 of the public health law, as added
48 by section 10 of part C of chapter 58 of the laws of 2005, is amended to
49 read as follows:
50 1. There is hereby established in the department a pharmacy and thera-
51 peutics committee. The committee shall consist of [seventeen] EIGHTEEN
52 members, who shall be appointed by the commissioner and who shall serve
53 three year terms; except that for the initial appointments to the
54 committee, five members shall serve one year terms, seven shall serve
55 two year terms, and five shall serve three year terms. Committee members
56 may be reappointed upon the completion of their terms. [No] WITH THE
A. 4009--C 110
1 EXCEPTION OF THE CHAIRPERSON, NO member of the committee shall be an
2 employee of the state or any subdivision of the state, other than for
3 his or her membership on the committee, except for employees of health
4 care facilities or universities operated by the state, a public benefit
5 corporation, the State University of New York or municipalities.
6 S 14. Paragraphs (d) and (e) of subdivision 2 of section 271 of the
7 public health law, as added by section 10 of part C of chapter 58 of the
8 laws of 2005, are amended, and a new paragraph (f) is added to read as
9 follows:
10 (d) one person with expertise in drug utilization review who is either
11 a health care professional licensed under title eight of the education
12 law, is a pharmacologist or has a doctorate in pharmacology; [and]
13 (e) three persons who shall be consumers or representatives of organ-
14 izations with a regional or statewide constituency and who have been
15 involved in activities related to health care consumer advocacy, includ-
16 ing issues affecting Medicaid or EPIC recipients[.]; AND
17 (F) A CHAIRPERSON DESIGNATED PURSUANT TO SUBDIVISION FOUR OF THIS
18 SECTION.
19 S 15. Subdivision 4 of section 271 of the public health law is
20 REPEALED and a new subdivision 4 is added to read as follows:
21 4. THE COMMISSIONER SHALL DESIGNATE A MEMBER OF THE DEPARTMENT TO
22 SERVE AS CHAIRPERSON OF THE COMMITTEE.
23 S 16. Intentionally omitted.
24 S 17. Subdivision 10 of section 272 of the public health law is
25 amended by adding a new paragraph (d) to read as follows:
26 (D) NOTWITHSTANDING ANY PROVISION OF THIS SECTION TO THE CONTRARY, THE
27 COMMISSIONER MAY DESIGNATE THERAPEUTIC CLASSES OF DRUGS OR INDIVIDUAL
28 DRUGS IN A THERAPEUTIC CLASS AS PREFERRED PRIOR TO ANY REVIEW THAT MAY
29 BE CONDUCTED BY THE COMMITTEE PURSUANT TO THIS SECTION; PROVIDED THAT
30 THIS PARAGRAPH SHALL ONLY APPLY TO A THERAPEUTIC CLASS AS TO WHICH THE
31 COMMIT5TEE HAS MADE A DETERMINATION AND TAKEN APPROPRIATE ACTION UNDER
32 PARAGRAPH (B) OF THIS SUBDIVISION, RELATING TO DRUGS THAT MAY BE SIGNIF-
33 ICANTLY CLINICALLY MORE SAFE AND EFFECTIVE.
34 S 18. Paragraphs (b) and (c) of subdivision 3 of section 273 of the
35 public health law, as added by section 10 of part C of chapter 58 of the
36 laws of 2005, are amended to read as follows:
37 (b) In the event that the patient does not meet the criteria in para-
38 graph (a) of this subdivision, the prescriber may provide additional
39 information to the program to justify the use of a prescription drug
40 that is not on the preferred drug list. The program shall provide a
41 reasonable opportunity for a prescriber to reasonably present his or her
42 justification of prior authorization. [If, after consultation with the
43 program, the prescriber, in his or her reasonable professional judgment,
44 determines that the use of a prescription drug that is not on the
45 preferred drug list is warranted, the prescriber's determination shall
46 be final.]
47 (c) [If a prescriber meets the requirements of paragraph (a) or (b) of
48 this subdivision, the prescriber shall be granted prior authorization
49 under this section] PRIOR AUTHORIZATION FOR THE NON-PREFERRED DRUG SHALL
50 BE DENIED IF THE PRESCRIBER FAILS TO MEET THE REQUIREMENTS OF PARAGRAPH
51 (A) OF THIS SUBDIVISION OR, IF AFTER CONSULTATION WITH THE PROGRAM AS
52 DESCRIBED IN PARAGRAPH (B) OF THIS SUBDIVISION, THE PROGRAM DETERMINES
53 THAT THE USE OF THE PRESCRIBED DRUG THAT IS NOT ON THE PREFERRED DRUG
54 LIST IS NOT WARRANTED.
55 S 19. The public health law is amended by adding a new section 279 to
56 read as follows:
A. 4009--C 111
1 S 279. PHARMACY BENEFIT MANAGERS. 1. DEFINITIONS. AS USED IN THIS
2 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
3 (A) "HEALTH PLAN OR PROVIDER" MEANS AN ENTITY FOR WHICH A PHARMACY
4 BENEFIT MANAGER PROVIDES PHARMACY BENEFIT MANAGEMENT INCLUDING, BUT NOT
5 LIMITED TO: (I) A HEALTH BENEFIT PLAN OR OTHER ENTITY THAT APPROVES,
6 PROVIDES, ARRANGES FOR, OR PAYS FOR HEALTH CARE ITEMS OR SERVICES, UNDER
7 WHICH PRESCRIPTION DRUGS FOR BENEFICIARIES OF THE ENTITY ARE PURCHASED
8 OR WHICH PROVIDES OR ARRANGES REIMBURSEMENT IN WHOLE OR IN PART FOR THE
9 PURCHASE OF PRESCRIPTION DRUGS; OR (II) A HEALTH CARE PROVIDER OR
10 PROFESSIONAL, INCLUDING A STATE OR LOCAL GOVERNMENT ENTITY, THAT
11 ACQUIRES PRESCRIPTION DRUGS TO USE OR DISPENSE IN PROVIDING HEALTH CARE
12 TO PATIENTS.
13 (B) "PHARMACY BENEFIT MANAGEMENT" MEANS THE SERVICE PROVIDED TO A
14 HEALTH PLAN OR PROVIDER, DIRECTLY OR THROUGH ANOTHER ENTITY, INCLUDING
15 THE PROCUREMENT OF PRESCRIPTION DRUGS TO BE DISPENSED TO PATIENTS, OR
16 THE ADMINISTRATION OR MANAGEMENT OF PRESCRIPTION DRUG BENEFITS, INCLUD-
17 ING BUT NOT LIMITED TO, ANY OF THE FOLLOWING:
18 (I) MAIL SERVICE PHARMACY;
19 (II) CLAIMS PROCESSING, RETAIL NETWORK MANAGEMENT, OR PAYMENT OF
20 CLAIMS TO PHARMACIES FOR DISPENSING PRESCRIPTION DRUGS;
21 (III) CLINICAL OR OTHER FORMULARY OR PREFERRED DRUG LIST DEVELOPMENT
22 OR MANAGEMENT;
23 (IV) NEGOTIATION OR ADMINISTRATION OF REBATES, DISCOUNTS, PAYMENT
24 DIFFERENTIALS, OR OTHER INCENTIVES, FOR THE INCLUSION OF PARTICULAR
25 PRESCRIPTION DRUGS IN A PARTICULAR CATEGORY OR TO PROMOTE THE PURCHASE
26 OF PARTICULAR PRESCRIPTION DRUGS;
27 (V) PATIENT COMPLIANCE, THERAPEUTIC INTERVENTION, OR GENERIC SUBSTI-
28 TUTION PROGRAMS; AND
29 (VI) DISEASE MANAGEMENT.
30 (C) "PHARMACY BENEFIT MANAGER" MEANS ANY ENTITY THAT PERFORMS PHARMACY
31 BENEFIT MANAGEMENT FOR A HEALTH PLAN OR PROVIDER.
32 2. APPLICATION OF SECTION. THIS SECTION APPLIES TO THE PROVIDING OF
33 PHARMACY BENEFIT MANAGEMENT BY A PHARMACY BENEFIT MANAGER TO A PARTIC-
34 ULAR HEALTH PLAN OR PROVIDER.
35 3. DUTY, ACCOUNTABILITY AND TRANSPARENCY. (A) THE PHARMACY BENEFIT
36 MANAGER SHALL HAVE A FIDUCIARY RELATIONSHIP WITH AND OBLIGATION TO THE
37 HEALTH PLAN OR PROVIDER, AND SHALL PERFORM PHARMACY BENEFIT MANAGEMENT
38 WITH CARE, SKILL, PRUDENCE, DILIGENCE, AND PROFESSIONALISM.
39 (B) ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT MANAGER IN RELATION TO
40 PROVIDING PHARMACY BENEFIT MANAGEMENT SHALL BE RECEIVED BY THE PHARMACY
41 BENEFIT MANAGER IN TRUST FOR THE HEALTH PLAN OR PROVIDER AND SHALL BE
42 USED OR DISTRIBUTED ONLY PURSUANT TO THE PHARMACY BENEFIT MANAGER'S
43 CONTRACT WITH THE HEALTH PLAN OR PROVIDER OR APPLICABLE LAW; EXCEPT FOR
44 ANY FEE OR PAYMENT EXPRESSLY PROVIDED FOR IN THE CONTRACT BETWEEN THE
45 PHARMACY BENEFIT MANAGER AND THE HEALTH PLAN OR PROVIDER TO COMPENSATE
46 THE PHARMACY BENEFIT MANAGER FOR ITS SERVICES.
47 (C) THE PHARMACY BENEFIT MANAGER SHALL PERIODICALLY ACCOUNT TO THE
48 HEALTH PLAN OR PROVIDER FOR ALL FUNDS RECEIVED BY THE PHARMACY BENEFIT
49 MANAGER. THE HEALTH PLAN OR PROVIDER SHALL HAVE ACCESS TO ALL FINANCIAL
50 AND UTILIZATION INFORMATION OF THE PHARMACY BENEFIT MANAGER IN RELATION
51 TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
52 (D) THE PHARMACY BENEFIT MANAGER SHALL DISCLOSE IN WRITING TO THE
53 HEALTH PLAN OR PROVIDER THE TERMS AND CONDITIONS OF ANY CONTRACT OR
54 ARRANGEMENT BETWEEN THE PHARMACY BENEFIT MANAGER AND ANY PARTY RELATING
55 TO PHARMACY BENEFIT MANAGEMENT PROVIDED TO THE HEALTH PLAN OR PROVIDER.
A. 4009--C 112
1 (E) THE PHARMACY BENEFIT MANAGER SHALL DISCLOSE IN WRITING TO THE
2 HEALTH PLAN OR PROVIDER ANY ACTIVITY, POLICY, PRACTICE, CONTRACT OR
3 ARRANGEMENT OF THE PHARMACY BENEFIT MANAGER THAT DIRECTLY OR INDIRECTLY
4 PRESENTS ANY CONFLICT OF INTEREST WITH THE PHARMACY BENEFIT MANAGER'S
5 RELATIONSHIP WITH OR OBLIGATION TO THE HEALTH PLAN OR PROVIDER.
6 (F) ANY INFORMATION REQUIRED TO BE DISCLOSED BY A PHARMACY BENEFIT
7 MANAGER TO A HEALTH PLAN OR PROVIDER UNDER THIS SECTION THAT IS REASON-
8 ABLY DESIGNATED BY THE PHARMACY BENEFIT MANAGER AS PROPRIETARY OR TRADE
9 SECRET INFORMATION SHALL BE KEPT CONFIDENTIAL BY THE HEALTH PLAN OR
10 PROVIDER, EXCEPT AS REQUIRED OR PERMITTED BY LAW, INCLUDING DISCLOSURE
11 NECESSARY TO PROSECUTE OR DEFEND ANY LEGITIMATE LEGAL CLAIM OR CAUSE OF
12 ACTION.
13 4. PRESCRIPTIONS. A PHARMACY BENEFIT MANAGER MAY NOT SUBSTITUTE OR
14 CAUSE THE SUBSTITUTING OF ONE PRESCRIPTION DRUG FOR ANOTHER IN DISPENS-
15 ING A PRESCRIPTION, OR ALTER OR CAUSE THE ALTERING OF THE TERMS OF A
16 PRESCRIPTION, EXCEPT WITH THE APPROVAL OF THE PRESCRIBER OR AS EXPLICIT-
17 LY REQUIRED OR PERMITTED BY LAW.
18 S 20. Paragraph (g) of subdivision 4 of section 365-a of the social
19 services law, as amended by section 61 of part C of chapter 58 of the
20 laws of 2007, is amended to read as follows:
21 (g) for eligible persons who are also beneficiaries under part D of
22 title XVIII of the federal social security act, drugs which are denomi-
23 nated as "covered part D drugs" under section 1860D-2(e) of such act[;
24 provided however that, for purposes of this paragraph, "covered part D
25 drugs" shall not mean atypical anti-psychotics, anti-depressants, anti-
26 retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
27 used for the treatment of organ and tissue transplants].
28 S 21. Subdivision 12 of section 272 of the public health law is
29 REPEALED.
30 S 22. Intentionally omitted.
31 S 23. Paragraph (g) of subdivision 2 of section 365-a of the social
32 services law, as amended by section 1 of part F of chapter 497 of the
33 laws of 2008, is amended to read as follows:
34 (g) sickroom supplies, eyeglasses, prosthetic appliances and dental
35 prosthetic appliances furnished in accordance with the regulations of
36 the department[,]; provided FURTHER that: (I) the commissioner of health
37 is authorized to implement a preferred diabetic supply program wherein
38 the department of health will receive enhanced rebates from preferred
39 manufacturers of glucometers and test strips, and may subject non-pre-
40 ferred manufacturers' glucometers and test strips to prior authorization
41 under section two hundred seventy-three of the public health law; (II)
42 ENTERAL FORMULA THERAPY IS LIMITED TO COVERAGE ONLY FOR NASOGASTRIC,
43 JEJUNOSTOMY, OR GASTROSTOMY TUBE FEEDING OR FOR TREATMENT OF AN INBORN
44 ERROR OF METABOLISM; OTHER NUTRITIONAL OR DIETARY SUPPLEMENTS ARE NOT
45 COVERED; (III) PRESCRIPTION FOOTWEAR AND INSERTS ARE LIMITED TO COVERAGE
46 ONLY WHEN USED AS AN INTEGRAL PART OF A LOWER LIMB ORTHOTIC APPLIANCE,
47 AS PART OF A DIABETIC TREATMENT PLAN, OR TO ADDRESS GROWTH AND DEVELOP-
48 MENT PROBLEMS IN CHILDREN; AND (IV) COMPRESSION AND SUPPORT STOCKINGS
49 ARE LIMITED TO COVERAGE ONLY FOR PREGNANCY OR TREATMENT OF VENOUS STASIS
50 ULCERS;
51 (G-1) drugs provided on an in-patient basis, those drugs contained on
52 the list established by regulation of the commissioner of health pursu-
53 ant to subdivision four of this section, and those drugs which may not
54 be dispensed without a prescription as required by section sixty-eight
55 hundred ten of the education law and which the commissioner of health
56 shall determine to be reimbursable based upon such factors as the avail-
A. 4009--C 113
1 ability of such drugs or alternatives at low cost if purchased by a
2 medicaid recipient, or the essential nature of such drugs as described
3 by such commissioner in regulations, provided, however, that such drugs,
4 exclusive of long-term maintenance drugs, shall be dispensed in quanti-
5 ties no greater than a thirty day supply or one hundred doses, whichever
6 is greater; provided further that the commissioner of health is author-
7 ized to require prior authorization for any refill of a prescription
8 when less than seventy-five percent of the previously dispensed amount
9 per fill should have been used were the product used as normally indi-
10 cated; PROVIDED FURTHER THAT THE COMMISSIONER OF HEALTH IS AUTHORIZED TO
11 REQUIRE PRIOR AUTHORIZATION OF PRESCRIPTIONS OF OPIOID ANALGESICS IN
12 EXCESS OF FOUR PRESCRIPTIONS IN A THIRTY-DAY PERIOD IN ACCORDANCE WITH
13 SECTION TWO HUNDRED SEVENTY-THREE OF THE PUBLIC HEALTH LAW; medical
14 assistance shall not include any drug provided on other than an in-pa-
15 tient basis for which a recipient is charged or a claim is made in the
16 case of a prescription drug, in excess of the maximum reimbursable
17 amounts to be established by department regulations in accordance with
18 standards established by the secretary of the United States department
19 of health and human services, or, in the case of a drug not requiring a
20 prescription, in excess of the maximum reimbursable amount established
21 by the commissioner of health pursuant to paragraph (a) of subdivision
22 four of this section;
23 S 24. Paragraph (a) of subdivision 3 of section 366 of the social
24 services law, as amended by chapter 110 of the laws of 1971, is amended
25 to read as follows:
26 (a) Medical assistance shall be furnished to applicants in cases
27 where, although such applicant has a responsible relative with suffi-
28 cient income and resources to provide medical assistance as determined
29 by the regulations of the department, the income and resources of the
30 responsible relative are not available to such applicant because of the
31 absence of such relative [or] AND the refusal or failure of such rela-
32 tive to provide the necessary care and assistance, OR BECAUSE OF ABUSE
33 OR NEGLECT, OR BECAUSE OF THE REFUSAL OR FAILURE OF THE RESPONSIBLE
34 RELATIVE WHO IS NOT ABSENT, WHERE THE INCOME AND RESOURCES OF SUCH RELA-
35 TIVE DO NOT EXCEED TWO HUNDRED PERCENT OF THE AMOUNTS OF THE "COMMUNITY
36 SPOUSE MONTHLY INCOME ALLOWANCE" AND THE "COMMUNITY SPOUSE RESOURCE
37 ALLOWANCE" DETERMINED PURSUANT TO SUBDIVISION TWO OF SECTION THREE
38 HUNDRED SIXTY-SIX-C OF THIS TITLE AND REGULATIONS UNDER THAT SUBDIVI-
39 SION, OR AS OTHERWISE DETERMINED UNDER SUCH SECTION, INCLUDING PURSUANT
40 TO FAIR HEARING OR FAMILY COURT DETERMINATION. In such cases, however,
41 the furnishing of such assistance shall create an implied contract with
42 such relative, and the cost thereof may be recovered from such relative
43 in accordance with title six of article three OF THIS CHAPTER and other
44 applicable provisions of law.
45 S 25. Paragraph (b) of subdivision 17 of section 2808 of the public
46 health law, as added by section 30 of part B of chapter 109 of the laws
47 of 2010, is amended and a new paragraph (c) is added to read as follows:
48 (b) Notwithstanding any inconsistent provision of law or regulation to
49 the contrary, for the state fiscal year beginning April first, two thou-
50 sand ten and ending March thirty-first, two thousand [eleven] FIFTEEN,
51 the commissioner shall not be required to revise certified rates of
52 payment established pursuant to this article for rate periods prior to
53 April first, two thousand [eleven] FIFTEEN, based on consideration of
54 rate appeals filed by residential health care facilities or based upon
55 adjustments to capital cost reimbursement as a result of approval by the
56 commissioner of an application for construction under section twenty-
A. 4009--C 114
1 eight hundred two of this article, in excess of an aggregate annual
2 amount of eighty million dollars for EACH such state fiscal year. In
3 revising such rates within such fiscal limit, the commissioner shall, in
4 prioritizing such rate appeals, include consideration of which facili-
5 ties the commissioner determines are facing significant financial hard-
6 ship as well as such other considerations as the commissioner deems
7 appropriate and, further, the commissioner is authorized to enter into
8 agreements with such facilities or any other facility to resolve multi-
9 ple pending rate appeals based upon a negotiated aggregate amount and
10 may offset such negotiated aggregate amounts against any amounts owed by
11 the facility to the department, including, but not limited to, amounts
12 owed pursuant to section twenty-eight hundred seven-d of this article;
13 PROVIDED, HOWEVER, THAT THE COMMISSIONER'S AUTHORITY TO NEGOTIATE SUCH
14 AGREEMENTS RESOLVING MULTIPLE PENDING RATE APPEALS AS HEREINBEFORE
15 DESCRIBED SHALL CONTINUE ON AND AFTER APRIL FIRST, TWO THOUSAND FIFTEEN.
16 Rate adjustments made pursuant to this paragraph remain fully subject to
17 approval by the director of the budget in accordance with the provisions
18 of subdivision two of section twenty-eight hundred seven of this arti-
19 cle.
20 (C) NOTWITHSTANDING ANY OTHER CONTRARY PROVISION OF LAW, RULE OR REGU-
21 LATION, FOR PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN THE
22 COMMISSIONER SHALL PROMULGATE REGULATIONS, AND MAY PROMULGATE EMERGENCY
23 REGULATIONS, ESTABLISHING PRIORITIES AND TIME FRAMES FOR PROCESSING RATE
24 APPEALS, INCLUDING RATE APPEALS FILED PRIOR TO APRIL FIRST, TWO THOUSAND
25 ELEVEN, WITHIN AVAILABLE ADMINISTRATIVE RESOURCES; PROVIDED, HOWEVER,
26 THAT SUCH REGULATIONS SHALL NOT BE INCONSISTENT WITH THE PROVISIONS OF
27 PARAGRAPH (B) OF THIS SUBDIVISION.
28 S 26. Notwithstanding any provision of law to the contrary and subject
29 to the availability of federal financial participation, for periods on
30 and after April 1, 2011, clinics certified pursuant to articles 16, 31
31 or 32 of the mental hygiene law shall be subject to targeted Medicaid
32 reimbursement rate reductions in accordance with the provisions of this
33 section. Such reductions shall be based on utilization thresholds which
34 may be established either as provider-specific or patient-specific
35 thresholds. Provider-specific thresholds shall be based on average
36 patient utilization for a given provider in comparison to a peer based
37 standard to be determined for each service. When applying a provider-
38 specific threshold, rates will be reduced on a prospective basis based
39 on the amount any provider is over the determined threshold level.
40 Patient-specific thresholds will be based on annual thresholds deter-
41 mined for each service over which the per visit payment for each visit
42 in excess of the standard during a twelve month period shall be reduced
43 by a pre-determined amount. The thresholds, peer based standards and the
44 payment reductions shall be determined by the department of health, with
45 the approval of the division of the budget, and in consultation with the
46 office of mental health, the office for people with developmental disa-
47 bilities and the office of alcoholism and substance abuse services, and
48 any such resulting rates shall be subject to certification by the appro-
49 priate commissioners pursuant to subdivision (a) of section 43.02 of the
50 mental hygiene law. The base period used to establish the thresholds
51 shall be the 2009 calendar year. The total annualized reduction in
52 payments shall be no less than $10,900,000 for Article 31 clinics, no
53 less than $2,400,000 for Article 16 clinics, and no less than
54 $13,250,000 for Article 32 clinics. The commissioner of health may
55 promulgate regulations, including emergency regulations, to implement
56 the provisions of this section.
A. 4009--C 115
1 S 27. Paragraph (h) of subdivision 2 of section 365-a of the social
2 services law, as amended by chapter 444 of the laws of 1979 and as
3 relettered by chapter 478 of the laws of 1980, is amended to read as
4 follows:
5 (h) SPEECH THERAPY, AND WHEN PROVIDED AT THE DIRECTION OF A PHYSICIAN
6 OR NURSE PRACTITIONER, physical therapy [and relative] INCLUDING RELATED
7 rehabilitative services [when provided at the direction of a physician]
8 AND OCCUPATIONAL THERAPY; PROVIDED, HOWEVER, THAT SPEECH THERAPY, PHYS-
9 ICAL THERAPY AND OCCUPATIONAL THERAPY EACH SHALL BE LIMITED TO COVERAGE
10 OF TWENTY VISITS PER YEAR; SUCH LIMITATION SHALL NOT APPLY TO PERSONS
11 WITH DEVELOPMENTAL DISABILITIES AND FOR PERSONS WITH A PHYSICAL DISABIL-
12 ITY, ANY ADDITIONAL VISITS SHALL BE SUBJECT TO PRIOR AUTHORIZATION
13 PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-G OF THIS ARTICLE;
14 S 28. Section 3614 of the public health law is amended by adding a new
15 subdivision 2-a to read as follows:
16 2-A. NOTWITHSTANDING ANY CONTRARY LAW, RULE OR REGULATION, FOR RATE
17 PERIODS ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN, MEDICAID RATES OF
18 PAYMENTS FOR SERVICES PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, BY
19 LONG TERM HOME HEALTH CARE PROGRAMS OR BY AN AIDS HOME CARE PROGRAM
20 SHALL NOT REFLECT A SEPARATE PAYMENT FOR HOME CARE NURSING SERVICES
21 PROVIDED TO PATIENTS DIAGNOSED WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME
22 (AIDS).
23 S 29. Paragraph (h) of subdivision 5-a of section 2807-m of the public
24 health law is relettered paragraph (i) and a new paragraph (h) is added
25 to read as follows:
26 (H) PUBLIC HEALTH SERVICES CORPS (PHSC). ONE MILLION DOLLARS FOR THE
27 PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH THIRTY-FIRST, TWO
28 THOUSAND TWELVE, AND TWO MILLION DOLLARS EACH STATE FISCAL YEAR FOR THE
29 PERIOD APRIL FIRST, TWO THOUSAND TWELVE THROUGH MARCH THIRTY-FIRST, TWO
30 THOUSAND FOURTEEN SHALL BE SET ASIDE AND RESERVED BY THE COMMISSIONER
31 FROM THE REGIONAL POOLS ESTABLISHED PURSUANT TO SUBDIVISION TWO OF THIS
32 SECTION AND SHALL BE AVAILABLE TO FUND AWARDS MADE PURSUANT TO A COMPET-
33 ITIVE REQUEST FOR PROPOSAL OR REQUEST FOR APPLICATION PROCESS TO SUPPORT
34 WELL-TRAINED, HIGHLY QUALIFIED NON-PHYSICIAN HEALTH PROFESSIONALS DEDI-
35 CATED TO DELIVERING PUBLIC HEALTH AND HEALTH CARE SERVICES TO UNDER-
36 SERVED COMMUNITIES OUTSIDE THEIR REGULARLY SCHEDULED EMPLOYMENT IN
37 ACCORDANCE WITH THE FOLLOWING:
38 (I) PHSC MEMBERS SHALL BE NON-PHYSICIAN CLINICAL SERVICE PROVIDERS WHO
39 MAY INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING HEALTH CARE PROFES-
40 SIONALS: MENTAL HEALTH SPECIALISTS, INCLUDING CLINICAL PSYCHOLOGISTS AND
41 CLINICAL SOCIAL WORKERS, DENTISTS AND DENTAL HYGIENISTS, NURSE PRACTI-
42 TIONERS AND PHYSICIAN ASSISTANTS, DIETICIANS, PUBLIC HEALTH NURSES AND
43 OTHER REGISTERED NURSES, BACHELOR OF SCIENCE NURSES, LICENSED PRACTICAL
44 NURSES, EPIDEMIOLOGISTS, PUBLIC HEALTH EDUCATORS AND GRADUATE STUDENTS
45 IN PUBLIC HEALTH WHO WANT TO PROVIDE SERVICE TO STATE AND LOCAL HEALTH
46 DEPARTMENTS VIA AN INTERNSHIP. THIS PARAGRAPH SHALL NOT BE CONSTRUED TO
47 ALTER THE LAWFUL SCOPE OF PRACTICE OF ANY SUCH HEALTH CARE PROFESSIONAL
48 UNDER TITLE EIGHT OF THE EDUCATION LAW.
49 (II) PHSC MEMBERS GRANTED AWARDS PURSUANT TO THIS PARAGRAPH SHALL
50 RECEIVE UP TO FIFTEEN THOUSAND DOLLARS ANNUALLY ON AN INDIVIDUAL BASIS
51 TO PROVIDE CLINICAL, HEALTH PROMOTION AND DISEASE PREVENTION INVESTI-
52 GATION, ANALYSIS AND SERVICES TO MEDICALLY INDIGENT POPULATIONS AND
53 COMMUNITIES IN NEW YORK STATE AS DETERMINED BY THE COMMISSIONER AND MAY
54 INCLUDE, BUT NOT BE LIMITED TO, ANY NUMBER OF THE FOLLOWING ACTIVITIES:
55 (A) CLINICAL TREATMENT IN UNDERSERVED AREAS INCLUDING VACCINATIONS,
56 PHYSICALS AND DENTAL CHECKUPS;
A. 4009--C 116
1 (B) PUBLIC HEALTH EMERGENCY RESPONSE AS DIRECTED BY THE GOVERNOR;
2 (C) PUBLIC HEALTH EDUCATION WORKSHOPS INCLUDING CLASSES ON NUTRITION,
3 FAMILY PLANNING, ALCOHOL AND DRUG ABUSE AND ELDER CARE;
4 (D) COMMUNITY HEALTH EVALUATION STUDIES INCLUDING ASSISTANCE WITH
5 EPIDEMIOLOGIC STUDIES IN A PARTICULAR COMMUNITY;
6 (E) DISEASE OUTBREAK INVESTIGATIONS; AND
7 (F) CAREER DEVELOPMENT INSTRUCTION IN DESIGNATED SCHOOLS.
8 (III) PHSC MEMBERS SHALL: PROVIDE UP TO THREE HUNDRED HOURS OF
9 SERVICES; DELIVER SERVICES IN EXISTING VENUES SUCH AS HOSPITALS,
10 FREE-STANDING CLINICS, COUNTY HEALTH DEPARTMENTS, SCHOOLS, NURSING
11 HOMES, TOWN HALLS AND ANY OTHER VENUE IN A RURAL OR INNER-CITY AREA; AND
12 ATTEND ANNUAL TRAINING PROVIDED IN DESIGNATED LOCATIONS IN NEW YORK
13 STATE WHICH SHALL ADDRESS HEALTH SYSTEM CONCERNS SUCH AS PREVENTABLE
14 EVENTS, PATIENT WITH MULTIPLE DIAGNOSES AND MEDICAL HOME MODELS.
15 (IV) UP TO FIFTEEN PERCENT OF FUNDING AVAILABLE PURSUANT TO THIS PARA-
16 GRAPH SHALL BE USED FOR ADMINISTRATION OF THE PHSC PROGRAM, INCLUDING
17 PHSC MEMBER TRAINING, TRAVEL AND PLACEMENT.
18 S 30. Subparagraphs (x), (xi), (xii), (xiii) and (xiv) of paragraph
19 (a) of subdivision 7 of section 2807-s of the public health law, as
20 amended by section 100 of part C of chapter 58 of the laws of 2009, are
21 amended to read as follows:
22 (x) forty-seven million two hundred ten thousand dollars on an annual
23 basis for the periods January first, two thousand nine through December
24 thirty-first, two thousand ten; [and]
25 (xi) eleven million eight hundred thousand dollars for the period
26 January first, two thousand eleven through March thirty-first, two thou-
27 sand eleven;
28 (xii) TWENTY-FOUR MILLION EIGHT HUNDRED THIRTY-SIX THOUSAND DOLLARS
29 FOR THE PERIOD APRIL FIRST, TWO THOUSAND ELEVEN THROUGH MARCH
30 THIRTY-FIRST, TWO THOUSAND TWELVE;
31 (XIII) TWENTY-FIVE MILLION EIGHT HUNDRED THIRTY-SIX THOUSAND DOLLARS
32 EACH STATE FISCAL YEAR FOR THE PERIOD APRIL FIRST, TWO THOUSAND TWELVE
33 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FOURTEEN;
34 (XIV) provided, however, for periods prior to January first, two thou-
35 sand nine, amounts set forth in this paragraph may be reduced by the
36 commissioner in an amount to be approved by the director of the budget
37 to reflect the amount received from the federal government under the
38 state's 1115 waiver which is directed under its terms and conditions to
39 the graduate medical education program established pursuant to section
40 twenty-eight hundred seven-m of this article;
41 [(xiii)] (XV) provided further, however, for periods prior to July
42 first, two thousand nine, amounts set forth in this paragraph shall be
43 reduced by an amount equal to the total actual distribution reductions
44 for all facilities pursuant to paragraph (e) of subdivision three of
45 section twenty-eight hundred seven-m of this article; and
46 [(xiv)] (XVI) provided further, however, for periods prior to July
47 first, two thousand nine, amounts set forth in this paragraph shall be
48 reduced by an amount equal to the actual distribution reductions for all
49 facilities pursuant to paragraph (s) of subdivision one of section twen-
50 ty-eight hundred seven-m of this article.
51 S 31. Paragraph (s) of subdivision 2 of section 365-a of the social
52 services law, as amended by section 46 of part B of chapter 58 of the
53 laws of 2010, is amended to read as follows:
54 (s) smoking cessation counseling services [for pregnant women on any
55 day of pregnancy through the end of the month in which the one hundred
56 eightieth day following the end of the pregnancy occurs, and children
A. 4009--C 117
1 and adolescents ten to twenty years of age, during a medical visit when
2 provided by a general hospital outpatient department or a free-standing
3 clinic, or by a physician, registered physician's assistant, registered
4 nurse practitioner or licensed midwife in office-based settings];
5 provided, however, that the provisions of this paragraph [relating to
6 smoking cessation counseling services] shall not take effect unless all
7 necessary approvals under federal law and regulation have been obtained
8 to receive federal financial participation in the costs of such
9 services.
10 S 32. Subparagraph (i) of paragraph (b-1) of subdivision 1 of section
11 2807-c of the public health law, as amended by section 10 of part C of
12 chapter 58 of the laws of 2010, is amended to read as follows:
13 (i) For patients discharged on and after January first, nineteen
14 hundred ninety-seven and prior to January first, two thousand and on and
15 after January first, two thousand, payments to general hospitals for
16 reimbursement of inpatient hospital services provided to patients eligi-
17 ble for payments pursuant to the workers' compensation law, the volun-
18 teer firefighters' benefit law, the volunteer ambulance workers' benefit
19 law, and the comprehensive motor vehicle insurance reparations act shall
20 be at the rates of payment determined pursuant to this section for state
21 governmental agencies, excluding adjustments pursuant to subdivision
22 fourteen-f of this section and subdivision thirty-three of this section
23 [and], excluding such further reductions to such payments as are enacted
24 as part of the state budget for the state fiscal year commencing April
25 first, two thousand ten AND EXCLUDING SUCH FURTHER REDUCTIONS TO SUCH
26 PAYMENTS AS ARE ENACTED AS PART OF THE STATE BUDGET FOR STATE FISCAL
27 YEARS COMMENCING ON AND AFTER APRIL FIRST, TWO THOUSAND ELEVEN.
28 S 33. The public health law is amended by adding a new section 3614-c
29 to read as follows:
30 S 3614-C. HOME CARE WORKER WAGE PARITY. 1. AS USED IN THIS SECTION,
31 THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANING:
32 (A) "LIVING WAGE LAW" MEANS ANY LAW ENACTED BY A MUNICIPAL GOVERNMENT
33 IN THE STATE OF NEW YORK WHICH ESTABLISHES A MINIMUM WAGE FOR SOME OR
34 ALL EMPLOYEES WHO PERFORM WORK ON MUNICIPAL GOVERNMENT CONTRACTS.
35 (B) "SOCIAL SERVICES DISTRICT" MEANS ANY SOCIAL SERVICES DISTRICT
36 RECOGNIZED BY THE DEPARTMENT ON JANUARY FIRST, TWO THOUSAND ELEVEN.
37 (C) "MUNICIPAL GOVERNMENT" MEANS ANY CITY OR COUNTY GOVERNMENT.
38 (D) "TOTAL COMPENSATION" MEANS ALL WAGES AND OTHER DIRECT COMPENSATION
39 PAID TO OR PROVIDED ON BEHALF OF THE EMPLOYEE INCLUDING, BUT NOT LIMITED
40 TO, WAGES, HEALTH, EDUCATION OR PENSION BENEFITS, SUPPLEMENTS IN LIEU OF
41 BENEFITS AND COMPENSATED TIME OFF, EXCEPT THAT IT DOES NOT INCLUDE
42 EMPLOYER TAXES OR EMPLOYER PORTION OF PAYMENTS FOR STATUTORY BENEFITS,
43 INCLUDING BUT NOT LIMITED TO FICA, DISABILITY INSURANCE, UNEMPLOYMENT
44 INSURANCE AND WORKERS' COMPENSATION.
45 (E) "PREVAILING RATE OF TOTAL COMPENSATION" MEANS THE AVERAGE HOURLY
46 AMOUNT OF TOTAL COMPENSATION PAID TO ALL HOME CARE AIDES COVERED BY
47 WHATEVER COLLECTIVELY BARGAINED AGREEMENT COVERS THE GREATEST NUMBER OF
48 HOME CARE AIDES IN A SOCIAL SERVICES DISTRICT. THE PREVAILING RATE SHALL
49 BE CALCULATED SEPARATELY FOR EACH SOCIAL SERVICES DISTRICT, PROVIDED
50 THAT THE SOCIAL SERVICES DISTRICT IS COTERMINOUS WITH THE GEOGRAPHIC
51 BOUNDARIES OF A MUNICIPAL GOVERNMENT WHICH HAS ENACTED A LIVING WAGE
52 LAW. FOR PURPOSES OF THIS DEFINITION, ANY SET OF COLLECTIVELY BARGAINED
53 AGREEMENTS IN A SOCIAL SERVICES DISTRICT WITH SUBSTANTIALLY THE SAME
54 TERMS AND CONDITIONS RELATING TO TOTAL COMPENSATION SHALL BE CONSIDERED
55 AS A SINGLE COLLECTIVELY BARGAINED AGREEMENT.
A. 4009--C 118
1 (F) "HOME CARE AIDE" MEANS A HOME HEALTH AIDE, PERSONAL CARE AIDE,
2 HOME ATTENDANT OR OTHER LICENSED OR UNLICENSED PERSON WHOSE PRIMARY
3 RESPONSIBILITY INCLUDES THE PROVISION OF IN-HOME ASSISTANCE WITH ACTIV-
4 ITIES OF DAILY LIVING INSTRUMENTAL ACTIVITIES OF DAILY LIVING OR
5 HEALTH-RELATED TASKS.
6 (G) "MANAGED CARE PLAN" MEANS ANY MANAGED CARE PROGRAM, ORGANIZATION
7 OR DEMONSTRATION COVERING PERSONAL CARE OR HOME HEALTH AIDE SERVICES,
8 AND WHICH RECEIVES PREMIUMS FUNDED, IN WHOLE OR IN PART, BY THE NEW YORK
9 STATE MEDICAL ASSISTANCE PROGRAM, INCLUDING BUT NOT LIMITED TO ALL MEDI-
10 CAID MANAGED CARE, MEDICAID MANAGED LONG TERM CARE, MEDICAID ADVANTAGE,
11 AND MEDICAID ADVANTAGE PLUS PLANS AND ALL PROGRAMS OF ALL-INCLUSIVE CARE
12 FOR THE ELDERLY.
13 (H) "EPISODE OF CARE" MEANS ANY SERVICE UNIT REIMBURSED, IN WHOLE OR
14 IN PART, BY THE NEW YORK STATE MEDICAL ASSISTANCE PROGRAM, WHETHER
15 THROUGH DIRECT REIMBURSEMENT OR COVERED BY A PREMIUM PAYMENT, AND WHICH
16 COVERS, IN WHOLE OR IN PART, ANY SERVICE PROVIDED BY A HOME CARE AIDE,
17 INCLUDING BUT NOT LIMITED TO ALL SERVICE UNITS DEFINED AS VISITS, HOURS,
18 DAYS, MONTHS OR EPISODES.
19 2. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW, RULE OR REGU-
20 LATION, EFFECTIVE JANUARY FIRST, TWO THOUSAND TWELVE, NO PAYMENTS BY
21 GOVERNMENT AGENCIES SHALL BE MADE TO CERTIFIED HOME HEALTH AGENCIES,
22 LONG TERM HOME HEALTH CARE PROGRAMS OR MANAGED CARE PLANS FOR ANY
23 EPISODE OF CARE FURNISHED, IN WHOLE OR IN PART, BY ANY HOME CARE AIDE
24 WHO IS COMPENSATED AT AMOUNTS LESS THAN THE APPLICABLE MINIMUM RATE OF
25 HOME CARE AIDE TOTAL COMPENSATION ESTABLISHED PURSUANT TO THIS SECTION,
26 PROVIDED THAT THE EPISODE OF CARE IS PROVIDED IN A SOCIAL SERVICES
27 DISTRICT COTERMINOUS WITH THE GEOGRAPHIC BOUNDARIES OF ANY MUNICIPAL
28 GOVERNMENT WHICH HAS ENACTED A LIVING WAGE LAW.
29 3. THE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPENSATION SHALL BE:
30 (A) FOR THE PERIOD MARCH FIRST, TWO THOUSAND TWELVE THROUGH FEBRUARY
31 TWENTY-EIGHTH, TWO THOUSAND THIRTEEN, NINETY PERCENT OF THE TOTAL
32 COMPENSATION MANDATED BY THE LIVING WAGE LAW OF THE MUNICIPAL GOVERNMENT
33 WHOSE GEOGRAPHIC BOUNDARIES ARE COTERMINOUS WITH THE SOCIAL SERVICES
34 DISTRICT IN WHICH THE EPISODE OF CARE IS PROVIDED;
35 (B) FOR THE PERIOD MARCH FIRST, TWO THOUSAND THIRTEEN THROUGH FEBRUARY
36 TWENTY-EIGHTH, TWO THOUSAND FOURTEEN, NINETY-FIVE PERCENT OF THE TOTAL
37 COMPENSATION MANDATED BY THE LIVING WAGE LAW OF THE MUNICIPAL GOVERNMENT
38 WHOSE GEOGRAPHIC BOUNDARIES ARE COTERMINOUS WITH THE SOCIAL SERVICES
39 DISTRICT IN WHICH THE EPISODE OF CARE IS PROVIDED;
40 (C) FOR ALL PERIODS ON AND AFTER MARCH FIRST, TWO THOUSAND FOURTEEN,
41 NO LESS THAN THE PREVAILING RATE OF TOTAL COMPENSATION AS OF JANUARY
42 FIRST, TWO THOUSAND ELEVEN, OR THE TOTAL COMPENSATION MANDATED BY THE
43 LIVING WAGE LAW OF THE MUNICIPAL GOVERNMENT WHOSE GEOGRAPHIC BOUNDARIES
44 ARE COTERMINOUS WITH THE SOCIAL SERVICES DISTRICT IN WHICH THE EPISODE
45 OF CARE IS PROVIDED, WHICHEVER IS GREATER.
46 4. ANY PORTION OF THE MINIMUM RATE OF HOME CARE AIDE TOTAL COMPEN-
47 SATION ATTRIBUTABLE TO HEALTH BENEFIT COSTS OR PAYMENTS IN LIEU OF
48 HEALTH BENEFITS, AND PAID TIME OFF, AS ESTABLISHED PURSUANT TO SUBDIVI-
49 SION THREE OF THIS SECTION SHALL BE SUPERSEDED BY THE TERMS OF ANY
50 EMPLOYER BONA FIDE COLLECTIVE BARGAINING AGREEMENT IN EFFECT AS OF JANU-
51 ARY FIRST, TWO THOUSAND ELEVEN, OR A SUCCESSOR TO SUCH AGREEMENT, WHICH
52 PROVIDES FOR HOME CARE AIDES' HEALTH BENEFITS THROUGH PAYMENTS TO JOINT-
53 LY ADMINISTERED LABOR-MANAGEMENT FUNDS.
54 5. THE TERMS OF THIS SECTION SHALL APPLY EQUALLY TO SERVICES PROVIDED
55 BY HOME CARE AIDES WHO WORK ON EPISODES OF CARE AS DIRECT EMPLOYEES OF
56 CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR
A. 4009--C 119
1 MANAGED CARE PLANS, OR AS EMPLOYEES OF LICENSED HOME CARE SERVICES AGEN-
2 CIES, LIMITED LICENSED HOME CARE SERVICES AGENCIES, OR UNDER ANY OTHER
3 ARRANGEMENT.
4 6. NO PAYMENTS BY GOVERNMENT AGENCIES SHALL BE MADE TO CERTIFIED HOME
5 HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR MANAGED CARE
6 PLANS FOR ANY EPISODE OF CARE WITHOUT THE CERTIFIED HOME HEALTH AGENCY,
7 LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAVING DELIV-
8 ERED PRIOR WRITTEN CERTIFICATION TO THE COMMISSIONER, ON FORMS PREPARED
9 BY THE DEPARTMENT IN CONSULTATION WITH THE DEPARTMENT OF LABOR, THAT ALL
10 SERVICES PROVIDED UNDER EACH EPISODE OF CARE ARE IN FULL COMPLIANCE WITH
11 THE TERMS OF THIS SECTION AND ANY REGULATIONS PROMULGATED PURSUANT TO
12 THIS SECTION.
13 7. IF A CERTIFIED HOME HEALTH AGENCY OR LONG TERM HOME HEALTH CARE
14 PROGRAM ELECTS TO PROVIDE HOME CARE AIDE SERVICES THROUGH CONTRACTS WITH
15 LICENSED HOME CARE SERVICES AGENCIES OR THROUGH OTHER THIRD PARTIES,
16 PROVIDED THAT THE EPISODE OF CARE ON WHICH THE HOME CARE AIDE WORKS IS
17 COVERED UNDER THE TERMS OF THIS SECTION, THE CERTIFIED HOME HEALTH AGEN-
18 CY, LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN MUST OBTAIN
19 A WRITTEN CERTIFICATION FROM THE LICENSED HOME CARE SERVICES AGENCY OR
20 OTHER THIRD PARTY, ON FORMS PREPARED BY THE DEPARTMENT IN CONSULTATION
21 WITH THE DEPARTMENT OF LABOR, WHICH ATTESTS TO THE LICENSED HOME CARE
22 SERVICES AGENCY'S OR OTHER THIRD PARTY'S COMPLIANCE WITH THE TERMS OF
23 THIS SECTION. SUCH CERTIFICATIONS SHALL ALSO OBLIGATE THE CERTIFIED HOME
24 HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN
25 TO OBTAIN, ON NO LESS THAN A QUARTERLY BASIS, ALL INFORMATION FROM THE
26 LICENSED HOME CARE SERVICES AGENCY OR OTHER THIRD PARTIES NECESSARY TO
27 VERIFY COMPLIANCE WITH THE TERMS OF THIS SECTION. SUCH CERTIFICATIONS
28 AND THE INFORMATION EXCHANGED PURSUANT TO THEM SHALL BE RETAINED BY ALL
29 CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, OR
30 MANAGED CARE PLANS, AND ALL LICENSED HOME CARE SERVICES AGENCIES, OR
31 OTHER THIRD PARTIES FOR A PERIOD OF NO LESS THAN TEN YEARS, AND MADE
32 AVAILABLE TO THE DEPARTMENT UPON REQUEST.
33 8. THE COMMISSIONER SHALL DISTRIBUTE TO ALL CERTIFIED HOME HEALTH
34 AGENCIES, LONG TERM HOME HEALTH CARE PROGRAMS, AND MANAGED CARE PLANS
35 OFFICIAL NOTICE OF THE MINIMUM RATES OF HOME CARE AIDE COMPENSATION AT
36 LEAST ONE HUNDRED TWENTY DAYS PRIOR TO THE EFFECTIVE DATE OF EACH MINI-
37 MUM RATE FOR EACH SOCIAL SERVICES DISTRICT COVERED BY THE TERMS OF THIS
38 SECTION.
39 9. THE COMMISSIONER IS AUTHORIZED TO PROMULGATE REGULATIONS, AND MAY
40 PROMULGATE EMERGENCY REGULATIONS, TO IMPLEMENT THE PROVISIONS OF THIS
41 SECTION.
42 10. NOTHING IN THIS SECTION SHOULD BE CONSTRUED AS APPLICABLE TO ANY
43 SERVICE PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, LONG TERM HOME
44 HEALTH CARE PROGRAMS, OR MANAGED CARE PLANS EXCEPT FOR ALL EPISODES OF
45 CARE REIMBURSED IN WHOLE OR IN PART BY THE NEW YORK MEDICAID PROGRAM.
46 11. NO CERTIFIED HOME HEALTH AGENCY, MANAGED CARE PLAN OR LONG TERM
47 HOME HEALTH CARE PROGRAM SHALL BE LIABLE FOR RECOUPMENT OF PAYMENTS FOR
48 SERVICES PROVIDED THROUGH A LICENSED HOME CARE SERVICES AGENCY OR OTHER
49 THIRD PARTY WITH WHICH THE CERTIFIED HOME HEALTH AGENCY, LONG TERM HOME
50 HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAS A CONTRACT BECAUSE THE
51 LICENSED AGENCY OR OTHER THIRD PARTY FAILED TO COMPLY WITH THE
52 PROVISIONS OF THIS SECTION IF THE CERTIFIED HOME HEALTH AGENCY, LONG
53 TERM HOME HEALTH CARE PROGRAM, OR MANAGED CARE PLAN HAS REASONABLY AND
54 IN GOOD FAITH COLLECTED CERTIFICATIONS AND ALL INFORMATION REQUIRED
55 PURSUANT TO SUBDIVISIONS SIX AND SEVEN OF THIS SECTION.
A. 4009--C 120
1 S 33-a. The social services law is amended by adding a new section
2 364-J-3 to read as follows:
3 S 364-J-3. PROVISION OF HOME CARE SERVICES TO MANAGED CARE ENROLLEES.
4 1. FOR ALL BENEFICIARIES NEWLY ENROLLING IN MANAGED CARE PLANS IN NEW
5 YORK CITY ON OR AFTER APRIL FIRST, TWO THOUSAND TWELVE, AND FOR ALL
6 BENEFICIARIES ENROLLED IN MANAGED CARE PLANS IN NEW YORK CITY ON OR
7 AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, AND FOR ALL BENEFICIARIES
8 MANDATED TO ENROLL IN MANAGED CARE PLANS, MANAGED CARE PLANS SHALL ONLY
9 COVER HOME CARE SERVICES IF DELIVERED UNDER CONTRACT TO PROVIDERS THAT
10 HAVE BEEN EXPRESSLY APPROVED BY THE DEPARTMENT OF HEALTH OR ITS DESIGNEE
11 TO PROVIDE HOME CARE SERVICES TO MANAGED CARE BENEFICIARIES IN THE
12 SOCIAL SERVICES DISTRICT WHERE THE BENEFICIARY RESIDES. THIS REQUIREMENT
13 SHALL APPLY TO ALL BENEFICIARIES WHOSE MANAGED CARE IS FINANCED, IN
14 WHOLE OR IN PART, BY THE MEDICAL ASSISTANCE PROGRAM OF NEW YORK STATE.
15 2. APPROVAL FOR ELIGIBILITY TO PROVIDE HOME CARE SERVICES TO MANAGED
16 CARE BENEFICIARIES SHALL TAKE THE FORM OF A CERTIFIED PROVIDER AGREEMENT
17 ENTERED INTO BETWEEN THE PROVIDER OF HOME CARE SERVICES AND THE DEPART-
18 MENT OF HEALTH OR ITS DESIGNEE, SPECIFYING THE TERMS OF THE PROVIDER'S
19 ELIGIBILITY TO PROVIDE HOME CARE SERVICES TO MANAGED CARE BENEFICIARIES,
20 ITS RIGHTS AND OBLIGATIONS IN RELATION TO THE MANAGED CARE PLAN AUTHOR-
21 IZING SUCH SERVICES, AND ANY CONTINGENCIES NECESSARY TO ENSURE THAT THE
22 PROVIDER OF HOME CARE SERVICES DELIVERS SATISFACTORY PERFORMANCE
23 THROUGHOUT THE DURATION OF THE AGREEMENT. THE DEPARTMENT OF HEALTH OR
24 ITS DESIGNEE SHALL HAVE RESPONSIBILITY FOR OVERSEEING ALL APPROVED AGEN-
25 CIES' COMPLIANCE WITH THE TERMS AND CONDITIONS OF THEIR PROVIDER AGREE-
26 MENTS ON AN ONGOING BASIS.
27 3. NO PROVIDER AGREEMENT SHALL BE VALID FOR PERIODS GREATER THAN THREE
28 YEARS. NO LIMIT SHALL BE PLACED ON THE NUMBER OF TIMES A PROVIDER MAY BE
29 REAPPROVED FOR ELIGIBILITY TO SERVE MANAGED CARE BENEFICIARIES. THE
30 DEPARTMENT OF HEALTH OR ITS DESIGNEE SHALL RESERVE THE RIGHT TO REVOKE
31 ANY APPROVAL TO PROVIDE HOME CARE SERVICES TO MANAGED CARE BENEFICIARIES
32 AT ANY TIME IN INSTANCES WHERE THE APPROVED AGENCY HAS BEEN IN MATERIAL
33 NON-COMPLIANCE WITH THE TERMS OF THE CERTIFIED PROVIDER AGREEMENT.
34 4. NO PROVIDER OF HOME CARE SERVICES SHALL BE APPROVED FOR ELIGIBILITY
35 TO SERVE MANAGED CARE BENEFICIARIES UNLESS THE PROVIDER OF HOME CARE
36 SERVICES MEETS AT LEAST ONE OF THE FOLLOWING MINIMUM CRITERIA:
37 (A) THE PROVIDER, OR AN AFFILIATE OF THE PROVIDER, HAS AN ESTABLISHED
38 RECORD OF PROVIDING HOME CARE SERVICES TO THE MEDICAID PERSONAL CARE
39 PROGRAM AND UNDER CONTRACT WITH THE HUMAN RESOURCES ADMINISTRATION IN
40 NEW YORK CITY;
41 (B) THE PROVIDER IS AFFILIATED WITH A LONG TERM HOME HEALTH CARE
42 PROGRAM OR MANAGED LONG TERM CARE PLAN; OR
43 (C) THE PROVIDER OR ITS AFFILIATE HAS AN EXCEPTIONAL PRIOR RECORD OF
44 INVESTING IN THE QUALITY AND SUSTAINABILITY OF THE LONG TERM CARE WORK-
45 FORCE, INCLUDING, BUT NOT LIMITED TO, THE PROVISION OF TRAINING THROUGH
46 A DEPARTMENT OF HEALTH APPROVED TRAINING PROGRAM AND THE PROVISION OF
47 HEALTH AND EDUCATION BENEFITS TO EMPLOYEES.
48 5. EXCEPT FOR MATERIAL INSTANCES OF NON-COMPLIANCE WITH PROGRAM
49 REQUIREMENTS, ALL PROVIDERS OF HOME CARE SERVICES TO THE MEDICAID
50 PERSONAL CARE PROGRAM UNDER CONTRACT WITH THE HUMAN RESOURCES ADMINIS-
51 TRATION AS OF JANUARY FIRST, TWO THOUSAND ELEVEN, SHALL BE APPROVED FOR
52 ELIGIBILITY TO SUBCONTRACT WITH MANAGED CARE PLANS IN NEW YORK CITY
53 THROUGH MARCH THIRTY-FIRST, TWO THOUSAND FIFTEEN.
54 6. NO PROVIDER SHALL BE APPROVED AS ELIGIBLE TO PROVIDE HOME CARE
55 SERVICES TO MANAGED CARE BENEFICIARIES UNLESS IT COMPENSATES ALL ITS
A. 4009--C 121
1 HOME CARE EMPLOYEES IN COMPLIANCE WITH THE PROVISIONS OF SECTION THIR-
2 TY-SIX HUNDRED FOURTEEN-C OF THE PUBLIC HEALTH LAW.
3 7. FOR THE NEW YORK CITY SOCIAL SERVICES DISTRICT, NO PROVIDER SHALL
4 BE APPROVED UNLESS THE TOTAL DOLLAR VALUE OF ALL EMPLOYEE COMPENSATION
5 PAID BY THE PROVIDER TO ITS HOME CARE EMPLOYEES WHO WERE EMPLOYEES IN
6 THE MEDICAID PERSONAL CARE PROGRAM AS OF JANUARY FIRST, TWO THOUSAND
7 ELEVEN, INCLUSIVE OF WAGES, BENEFITS, PAYMENTS IN LIEU OF BENEFITS, AND
8 PAID TIME OFF, CALCULATED ON AN AVERAGE HOURLY BASIS, IS NO LESS THAN
9 THE MOST COMMON PREVAILING LEVEL OF TOTAL COMPENSATION PAID TO EMPLOYEES
10 BY AGENCIES PROVIDING MEDICAID PERSONAL CARE PROGRAM SERVICES UNDER
11 CONTRACT WITH THE HUMAN RESOURCES ADMINISTRATION AS OF JANUARY FIRST,
12 TWO THOUSAND ELEVEN, AS DETERMINED BY THE HUMAN RESOURCES ADMINIS-
13 TRATION.
14 8. PROVIDERS OF HOME CARE SERVICES TO MORE THAN THREE HUNDRED FIFTY
15 MANAGED LONG TERM CARE OR LONG TERM HOME HEALTH CARE BENEFICIARIES AS OF
16 JANUARY FIRST, TWO THOUSAND ELEVEN, MUST BE AFFORDED AN OPPORTUNITY TO
17 APPLY FOR APPROVAL TO PROVIDE HOME CARE SERVICES TO MANAGED LONG TERM
18 CARE BENEFICIARIES FOR PERIODS BEGINNING NO LATER THAN APRIL FIRST, TWO
19 THOUSAND TWELVE, PROVIDED THAT ALL SUCH APPLICANTS SHALL STILL BE
20 CONSIDERED FOR APPROVAL IN ACCORDANCE WITH ALL OTHERWISE APPLICABLE
21 PROVISIONS OF THIS SECTION.
22 9. ALL APPROVED PROVIDERS, AS WELL AS ALL PROVIDERS SEEKING APPROVAL
23 TO PROVIDE HOME CARE SERVICES TO MANAGED CARE BENEFICIARIES SHALL
24 FURNISH TO THE DEPARTMENT OF HEALTH OR ITS DESIGNEE, UPON THEIR REQUEST,
25 ALL INFORMATION NECESSARY TO IMPLEMENT ANY PROVISION OF THIS SECTION.
26 10. FOR PURPOSES OF THIS SECTION:
27 (A) HOME CARE SERVICES SHALL MEAN ALL SERVICES PROVIDED BY HOME HEALTH
28 AIDES, PERSONAL CARE AIDES, HOME ATTENDANTS OR OTHER LICENSED OR UNLI-
29 CENSED PERSONNEL WHOSE PRIMARY RESPONSIBILITIES INCLUDE THE PROVISION OF
30 IN HOME ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, INSTRUMENTAL ACTIV-
31 ITIES OF DAILY LIVING, OR HEALTH RELATED TASKS.
32 (B) PROVIDERS OF HOME CARE SERVICES SHALL MEAN CERTIFIED HOME HEALTH
33 AGENCIES, LONG TERM HOME HEALTH PROGRAMS, LICENSED HOME CARE SERVICES
34 AGENCIES, CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAMS OR ENTITIES
35 PROVIDING HOME CARE SERVICES TO THE MEDICAID PERSONAL CARE PROGRAM UNDER
36 CONTRACT WITH THE HUMAN RESOURCES ADMINISTRATION IN NEW YORK CITY AS OF
37 JANUARY FIRST, TWO THOUSAND ELEVEN.
38 (C) THE MEDICAID PERSONAL CARE PROGRAM SHALL INCLUDE ALL SERVICES
39 PROVIDED UNDER NEW YORK STATE'S MEDICAL ASSISTANCE PROGRAM IN NEW YORK
40 CITY, INCLUDING BOTH THE HOME ATTENDANT PROGRAM AND THE CONSUMER
41 DIRECTED PERSONAL ASSISTANCE PROGRAM.
42 (D) "MANAGED CARE PLAN" MEANS ANY MANAGED CARE PROGRAM OR DEMON-
43 STRATION COVERING PERSONAL CARE OR HOME HEALTH AIDE SERVICES, AND WHICH
44 RECEIVES PREMIUMS FUNDED, IN WHOLE OR IN PART, BY THE NEW YORK STATE
45 MEDICAL ASSISTANCE PROGRAM, INCLUDING BUT NOT LIMITED TO ALL MEDICAID
46 MANAGED CARE, MEDICAID MANAGED LONG TERM CARE, MEDICAID ADVANTAGE, AND
47 MEDICAID ADVANTAGE PLUS PLANS, AND ALL PROGRAMS OF ALL INCLUSIVE CARE
48 FOR THE ELDERLY.
49 S 34. The public health law is amended by adding a new section 2806-a
50 to read as follows:
51 S 2806-A. TEMPORARY OPERATOR. 1. FOR THE PURPOSES OF THIS SECTION:
52 (A) THE TERM "ESTABLISHED OPERATOR" SHALL MEAN THE OPERATOR OF A GENERAL
53 HOSPITAL OR A DIAGNOSTIC AND TREATMENT CENTER THAT HAS BEEN ESTABLISHED
54 AND ISSUED AN OPERATING CERTIFICATE AS SUCH PURSUANT TO THIS ARTICLE;
55 AND (B) THE TERM "TEMPORARY OPERATOR" SHALL MEAN ANY PERSON OR ENTITY
56 THAT:
A. 4009--C 122
1 (I) AGREES TO OPERATE THE GENERAL HOSPITAL OR A DIAGNOSTIC AND TREAT-
2 MENT CENTER ON A TEMPORARY BASIS IN THE BEST INTERESTS OF THE PATIENTS
3 AND THE COMMUNITY SERVED BY THE GENERAL HOSPITAL OR BY THE DIAGNOSTIC
4 AND TREATMENT CENTER; AND
5 (II) HAS DEMONSTRATED THAT HE OR SHE HAS THE CHARACTER, COMPETENCE AND
6 FINANCIAL ABILITY TO OPERATE THE GENERAL HOSPITAL OR THE DIAGNOSTIC AND
7 TREATMENT CENTER IN COMPLIANCE WITH APPLICABLE STANDARDS.
8 2. (A) WHEN A STATEMENT OF DEFICIENCIES HAS BEEN ISSUED BY THE DEPART-
9 MENT AND UPON A DETERMINATION BY THE COMMISSIONER THAT THERE EXIST
10 SIGNIFICANT MANAGEMENT FAILURES, INCLUDING BUT NOT LIMITED TO ADMINIS-
11 TRATIVE, OPERATIONAL OR CLINICAL DEFICIENCIES OR FINANCIAL INSTABILITY,
12 IN A GENERAL HOSPITAL OR IN A DIAGNOSTIC AND TREATMENT CENTER THAT (I)
13 SERIOUSLY ENDANGER THE LIFE, HEALTH OR SAFETY OF PATIENTS OR (II) JEOP-
14 ARDIZE EXISTING OR CONTINUED ACCESS TO NECESSARY SERVICES WITHIN THE
15 COMMUNITY, HE OR SHE SHALL APPOINT A TEMPORARY OPERATOR TO ASSUME SOLE
16 CONTROL OVER AND SOLE RESPONSIBILITY FOR THE OPERATIONS OF THAT GENERAL
17 HOSPITAL OR DIAGNOSTIC AND TREATMENT CENTER. THE APPOINTMENT OF A TEMPO-
18 RARY OPERATOR SHALL BE IN ADDITION TO ANY OTHER REMEDIES PROVIDED BY
19 LAW.
20 (B) THE ESTABLISHED OPERATOR OF A GENERAL HOSPITAL OR A DIAGNOSTIC AND
21 TREATMENT CENTER MAY AT ANY TIME REQUEST THE COMMISSIONER TO APPOINT A
22 TEMPORARY OPERATOR. UPON RECEIVING SUCH A REQUEST, THE COMMISSIONER MAY,
23 IF HE OR SHE DETERMINES THAT SUCH AN ACTION IS NECESSARY TO RESTORE OR
24 ENSURE THE PROVISION OF QUALITY CARE TO THE PATIENTS, ENTER INTO AN
25 AGREEMENT WITH THE ESTABLISHED OPERATOR FOR THE APPOINTMENT OF A TEMPO-
26 RARY OPERATOR TO ASSUME SOLE CONTROL OVER AND SOLE RESPONSIBILITY FOR
27 THE OPERATIONS OF THAT GENERAL HOSPITAL OR DIAGNOSTIC AND TREATMENT
28 CENTER.
29 3. A TEMPORARY OPERATOR APPOINTED PURSUANT TO THIS SECTION SHALL USE
30 HIS OR HER BEST EFFORTS TO CORRECT OR ELIMINATE ANY DEFICIENCIES,
31 MANAGEMENT FAILURES OR FINANCIAL INSTABILITY IN THE GENERAL HOSPITAL OR
32 DIAGNOSTIC AND TREATMENT CENTER AND TO MAINTAIN AND STRENGTHEN THE QUAL-
33 ITY AND ACCESSIBILITY OF HEALTH CARE SERVICES IN THE COMMUNITY SERVED BY
34 THE FACILITY. SUCH CORRECTION OR ELIMINATION OF DEFICIENCIES, MANAGEMENT
35 FAILURES OR FINANCIAL INSTABILITY SHALL NOT INCLUDE MAJOR ALTERATIONS OF
36 THE PHYSICAL STRUCTURE OF THE FACILITY. DURING THE TERM OF HIS OR HER
37 APPOINTMENT, THE TEMPORARY OPERATOR SHALL HAVE THE AUTHORITY TO DIRECT
38 THE MANAGEMENT OF THE GENERAL HOSPITAL OR DIAGNOSTIC AND TREATMENT
39 CENTER IN ALL ASPECTS OF OPERATION AND SHALL BE AFFORDED FULL ACCESS TO
40 THE ACCOUNTS AND RECORDS OF THE FACILITY. THE TEMPORARY OPERATOR SHALL,
41 DURING THIS PERIOD, OPERATE THE GENERAL HOSPITAL OR DIAGNOSTIC AND
42 TREATMENT CENTER IN SUCH A MANNER AS TO ENSURE SAFETY AND THE QUALITY
43 AND ACCESSIBILITY OF HEALTH CARE FOR THE PATIENTS. THE TEMPORARY OPERA-
44 TOR SHALL HAVE THE POWER TO LET CONTRACTS THEREFOR OR INCUR EXPENSES ON
45 BEHALF OF THE GENERAL HOSPITAL OR DIAGNOSTIC AND TREATMENT CENTER,
46 PROVIDED THAT WHERE INDIVIDUAL ITEMS OF REPAIRS, IMPROVEMENTS OR
47 SUPPLIES EXCEED TEN THOUSAND DOLLARS, THE TEMPORARY OPERATOR SHALL
48 OBTAIN PRICE QUOTATIONS FROM AT LEAST THREE REPUTABLE SOURCES. THE
49 TEMPORARY OPERATOR SHALL NOT BE REQUIRED TO FILE ANY BOND. NO SECURITY
50 INTEREST IN ANY REAL OR PERSONAL PROPERTY COMPRISING THE FACILITY OR
51 CONTAINED WITHIN THE FACILITY, OR IN ANY FIXTURE OF THE FACILITY, SHALL
52 BE IMPAIRED OR DIMINISHED IN PRIORITY BY THE TEMPORARY OPERATOR. NEITHER
53 THE TEMPORARY OPERATOR NOR THE DEPARTMENT SHALL ENGAGE IN ANY ACTIVITY
54 THAT CONSTITUTES A CONFISCATION OF PROPERTY WITHOUT THE PAYMENT OF FAIR
55 COMPENSATION.
A. 4009--C 123
1 4. THE TEMPORARY OPERATOR SHALL BE ENTITLED TO A REASONABLE FEE, AS
2 DETERMINED BY THE COMMISSIONER, AND NECESSARY EXPENSES INCURRED DURING
3 HIS OR HER PERFORMANCE AS TEMPORARY OPERATOR, TO BE PAID FROM THE REVEN-
4 UE OF THE GENERAL HOSPITAL OR DIAGNOSTIC AND TREATMENT CENTER. THE
5 TEMPORARY OPERATOR SHALL COLLECT INCOMING PAYMENTS FROM ALL SOURCES AND
6 APPLY THEM FIRST TO THE REASONABLE FEE AND TO COSTS INCURRED IN THE
7 PERFORMANCE OF HIS OR HER FUNCTIONS AS TEMPORARY OPERATOR. THE TEMPORARY
8 OPERATOR SHALL BE LIABLE ONLY IN HIS OR HER CAPACITY AS TEMPORARY OPERA-
9 TOR FOR INJURY TO PERSON AND PROPERTY BY REASON OF CONDITIONS OF THE
10 GENERAL HOSPITAL OR DIAGNOSTIC AND TREATMENT CENTER IN A CASE WHERE AN
11 ESTABLISHED OPERATOR WOULD HAVE BEEN LIABLE; HE OR SHE SHALL NOT HAVE
12 ANY LIABILITY IN HIS OR HER PERSONAL CAPACITY, EXCEPT FOR GROSS NEGLI-
13 GENCE AND INTENTIONAL ACTS.
14 5. THE INITIAL TERM OF THE APPOINTMENT OF THE TEMPORARY OPERATOR SHALL
15 NOT EXCEED ONE HUNDRED TWENTY DAYS. ADDITIONAL APPOINTMENTS OF UP TO
16 NINETY DAYS MAY BE MADE WHEN THE COMMISSIONER DETERMINES THAT ADDITIONAL
17 TERMS ARE NECESSARY TO CORRECT THE DEFICIENCIES, MANAGEMENT FAILURES OR
18 FINANCIAL INSTABILITY THAT REQUIRED THE APPOINTMENT OF THE TEMPORARY
19 OPERATOR. WITHIN FOURTEEN DAYS PRIOR TO THE TERMINATION OF EACH TERM OF
20 THE APPOINTMENT OF THE TEMPORARY OPERATOR, THE TEMPORARY OPERATOR SHALL
21 SUBMIT TO THE COMMISSIONER A REPORT DESCRIBING THE ACTIONS TAKEN DURING
22 THE APPOINTMENT TO ADDRESS SUCH DEFICIENCIES, MANAGEMENT FAILURES AND/OR
23 FINANCIAL INSTABILITY. THE REPORT SHALL REFLECT BEST EFFORTS TO PRODUCE
24 A FULL AND COMPLETE ACCOUNTING.
25 6. THE COMMISSIONER SHALL, UPON MAKING A DETERMINATION TO APPOINT A
26 TEMPORARY OPERATOR PURSUANT TO PARAGRAPH (A) OF SUBDIVISION TWO OF THIS
27 SECTION, CAUSE THE ESTABLISHED OPERATOR OF THE GENERAL HOSPITAL OR DIAG-
28 NOSTIC AND TREATMENT CENTER TO BE NOTIFIED OF THE DETERMINATION BY
29 REGISTERED OR CERTIFIED MAIL ADDRESSED TO THE PRINCIPAL OFFICE OF THE
30 ESTABLISHED OPERATOR. UPON RECEIPT OF SUCH NOTIFICATION AT THE PRINCIPAL
31 OFFICE OF THE ESTABLISHED OPERATOR AND BEFORE THE EXPIRATION OF TEN DAYS
32 THEREAFTER, THE ESTABLISHED OPERATOR MAY REQUEST AN ADMINISTRATIVE HEAR-
33 ING ON THE DETERMINATION TO BE HELD NO LATER THAN SIXTY DAYS FROM THE
34 DATE OF THE APPOINTMENT OF THE TEMPORARY OPERATOR. ANY SUCH HEARING
35 SHALL BE STRICTLY LIMITED TO THE ISSUE OF WHETHER THE DETERMINATION OF
36 THE COMMISSIONER IS SUPPORTED BY SUBSTANTIAL EVIDENCE.
37 7. NO PROVISION CONTAINED IN THIS SECTION SHALL BE DEEMED TO RELIEVE
38 THE ESTABLISHED OPERATOR OR ANY OTHER PERSON OF ANY CIVIL OR CRIMINAL
39 LIABILITY INCURRED, OR ANY DUTY IMPOSED BY LAW, BY REASON OF ACTS OR
40 OMISSIONS OF THE ESTABLISHED OPERATOR OR ANY OTHER PERSON PRIOR TO THE
41 APPOINTMENT OF ANY TEMPORARY OPERATOR HEREUNDER; NOR SHALL ANYTHING
42 CONTAINED IN THIS SECTION BE CONSTRUED TO SUSPEND DURING THE TERM OF THE
43 APPOINTMENT OF THE TEMPORARY OPERATOR ANY OBLIGATION OF THE ESTABLISHED
44 OPERATOR OR ANY OTHER PERSON FOR THE PAYMENT OF TAXES OR OTHER OPERATING
45 AND MAINTENANCE EXPENSES OF THE FACILITY NOR OF THE ESTABLISHED OPERATOR
46 OR ANY OTHER PERSON FOR THE PAYMENT OF MORTGAGES OR LIENS.
47 S 35. The public health law is amended by adding a new article 29-AA
48 to read as follows:
49 ARTICLE 29-AA
50 PATIENT CENTERED MEDICAL HOMES
51 SECTION 2959-A. MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM.
52 S 2959-A. MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM. 1. (A)
53 THE COMMISSIONER IS AUTHORIZED TO ESTABLISH MEDICAL HOME MULTIPAYOR
54 PROGRAMS (REFERRED TO IN THIS SECTION AS A "PROGRAM") WHEREBY ENHANCED
55 PAYMENTS ARE MADE TO PRIMARY CARE CLINICIANS AND CLINICS STATEWIDE THAT
56 ARE CERTIFIED AS MEDICAL HOMES FOR THE PURPOSE OF IMPROVING HEALTH CARE
A. 4009--C 124
1 OUTCOMES AND EFFICIENCY THROUGH IMPROVED ACCESS, PATIENT CARE CONTINUITY
2 AND COORDINATION OF HEALTH SERVICES.
3 (B) AS USED IN THIS SECTION:
4 (I) "CLINIC" MEANS A GENERAL HOSPITAL PROVIDING OUTPATIENT CARE OR
5 DIAGNOSTIC AND TREATMENT CENTER, LICENSED UNDER ARTICLE TWENTY-EIGHT OF
6 THIS CHAPTER; AND
7 (II) "PRIMARY CARE CLINICIAN" MEANS A HEALTH CARE PRACTITIONER ACTING
8 WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE
9 EDUCATION LAW WHO IS: (A) A PHYSICIAN OR NURSE PRACTITIONER PRACTICING
10 IN A PRIMARY CARE SPECIALTY; (B) A PHYSICIAN, NURSE PRACTITIONER, OR
11 MIDWIFE PRACTICING PRIMARY GYNECOLOGICAL CARE FOR FEMALE PATIENTS; OR
12 (C) A PHYSICIAN OR NURSE PRACTITIONER PRACTICING IN A NON-PRIMARY CARE
13 SPECIALTY, FOR A PATIENT WHO HAS A CHRONIC CONDITION THAT REQUIRES
14 SPECIALTY CARE, WHERE THE SPECIALIST HEALTH CARE PRACTITIONER REGULARLY
15 AND CONTINUALLY PROVIDES TREATMENT FOR THAT CONDITION TO THE PATIENT.
16 (III) "PRIMARY CARE MEDICAL HOME COLLABORATIVE" MEANS AN ENTITY
17 APPROVED BY THE COMMISSIONER WHICH SHALL INCLUDE BUT NOT BE LIMITED TO
18 HEALTH CARE PROVIDERS, WHICH MAY INCLUDE BUT NOT BE LIMITED TO HOSPI-
19 TALS, DIAGNOSTIC AND TREATMENT CENTERS, PRIVATE PRACTICES AND INDEPEND-
20 ENT PRACTICE ASSOCIATIONS, AND PAYORS OF HEALTH CARE SERVICES, WHICH MAY
21 INCLUDE BUT NOT BE LIMITED TO EMPLOYERS, HEALTH PLANS AND INSURERS.
22 2. (A) IN ORDER TO PROMOTE IMPROVED QUALITY OF, AND ACCESS TO, HEALTH
23 CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES, IT IS THE POLICY
24 OF THE STATE TO ENCOURAGE COOPERATIVE, COLLABORATIVE AND INTEGRATIVE
25 ARRANGEMENTS AMONG PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE
26 SERVICES PROVIDERS WHO MIGHT OTHERWISE BE COMPETITORS, UNDER THE ACTIVE
27 SUPERVISION OF THE COMMISSIONER. IT IS THE INTENT OF THE STATE TO
28 SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS AND REGULATION ONLY TO THE
29 EXTENT NECESSARY TO ACCOMPLISH THE PURPOSES OF THIS ARTICLE, AND TO
30 PROVIDE STATE ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS
31 TO PAYORS OF HEALTH CARE SERVICES AND HEALTH CARE SERVICES PROVIDERS
32 WITH RESPECT TO THE PLANNING, IMPLEMENTATION AND OPERATION OF THE MULTI-
33 PAYOR PATIENT CENTERED MEDICAL HOME PROGRAM.
34 (B) THE COMMISSIONER OR HIS OR HER DULY AUTHORIZED REPRESENTATIVE MAY
35 ENGAGE IN APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
36 ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
37 INSPECT OR REQUEST ADDITIONAL DOCUMENTATION FROM PAYORS OF HEALTH CARE
38 SERVICES AND HEALTH CARE SERVICES PROVIDERS TO VERIFY THAT MEDICAL HOMES
39 CERTIFIED PURSUANT TO THIS SECTION OPERATE IN ACCORDANCE WITH ITS INTENT
40 AND PURPOSE.
41 3. THE COMMISSIONER IS AUTHORIZED TO PARTICIPATE IN, ACTIVELY SUPER-
42 VISE, FACILITATE AND APPROVE A PRIMARY CARE MEDICAL HOME COLLABORATIVE
43 FOR EACH PROGRAM AROUND THE STATE TO ESTABLISH: (A) THE BOUNDARIES OF
44 EACH PROGRAM AND THE PROVIDERS ELIGIBLE TO PARTICIPATE, PROVIDED THAT
45 THE BOUNDARIES OF PROGRAMS MAY OVERLAP; (B) PRACTICE STANDARDS FOR EACH
46 MEDICAL HOME PROGRAM ADOPTED WITH CONSIDERATION OF EXISTING STANDARDS
47 DEVELOPED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE ("NCQA"), THE
48 JOINT COMMISSION OF ACCREDITATION OF HEALTHCARE ORGANIZATIONS ("JCAHCO"
49 OR THE "JOINT COMMISSION"), AMERICAN ACCREDITATION HEALTHCARE COMMISSION
50 ("URAC"), AMERICAN COLLEGE OF PHYSICIANS, THE AMERICAN ACADEMY OF FAMILY
51 PHYSICIANS, THE AMERICAN ACADEMY OF PEDIATRICS, AND THE AMERICAN OSTEO-
52 PATHIC ASSOCIATION; THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, AND THE
53 AMERICAN COLLEGE OF NURSE PRACTITIONERS; (C) METHODOLOGIES BY WHICH
54 PAYORS WILL PROVIDE ENHANCED RATES OF PAYMENT TO CERTIFIED MEDICAL
55 HOMES; (D) METHODOLOGIES TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES
56 THAT MEET SPECIFIC PROCESS OR OUTCOME STANDARDS ESTABLISHED BY EACH
A. 4009--C 125
1 MULTIPAYOR PATIENT CENTERED MEDICAL HOME COLLABORATIVE. (E) ALTERNATIVE
2 METHODOLOGIES FOR PAYORS OF HEALTH CARE SERVICES TO HEALTH CARE PROVID-
3 ERS UNDER THE PROGRAM; (F) PROVISIONS FOR PAYMENTS TO PROVIDERS THAT MAY
4 VARY BY SIZE OR FORM OF ORGANIZATION OF THE PROVIDER, OR PATIENT CASE
5 MIX, TO ACCOMMODATE DIFFERENT LEVELS OF RESOURCES AND DIFFICULTY TO MEET
6 THE STANDARDS OF THE PROGRAM; (G) PROVISIONS FOR PAYMENTS TO ENTITIES
7 THAT PROVIDE SERVICES TO HEALTH CARE PROVIDERS TO ASSIST THEM IN MEETING
8 MEDICAL HOME STANDARDS UNDER THE PROGRAM SUCH AS THE SERVICES OF COMMU-
9 NITY HEALTH WORKERS; (H) REQUIREMENTS FOR COLLECTING DATA RELATING TO
10 THE PROVIDING AND PAYING FOR HEALTH CARE SERVICES UNDER THE PROGRAM AND
11 PROVIDING OF DATA TO THE COMMISSIONER, PAYORS AND HEALTH CARE PROVIDERS
12 UNDER THE PROGRAM, TO PROMOTE THE EFFECTIVE OPERATION AND EVALUATION OF
13 THE PROGRAM, CONSISTENT WITH PROTECTION OF THE CONFIDENTIALITY OF INDI-
14 VIDUAL PATIENT INFORMATION; AND (I) PROVISIONS UNDER WHICH THE COMMIS-
15 SIONER MAY TERMINATE THE PROGRAM.
16 4. THE COMMISSIONER IS AUTHORIZED TO ESTABLISH AN ADVISORY GROUP OF
17 STATE AGENCIES AND STAKEHOLDERS, SUCH AS PROFESSIONAL ORGANIZATIONS AND
18 ASSOCIATIONS, AND CONSUMERS, TO IDENTIFY LEGAL AND/OR ADMINISTRATIVE
19 BARRIERS TO THE SHARING OF CARE MANAGEMENT AND CARE COORDINATION
20 SERVICES AMONG PARTICIPATING HEALTH CARE SERVICES PROVIDERS AND TO MAKE
21 RECOMMENDATIONS FOR STATUTORY AND/OR REGULATORY CHANGES TO ADDRESS SUCH
22 BARRIERS.
23 5. PATIENT, PAYOR AND HEALTH CARE SERVICES PROVIDER PARTICIPATION IN
24 THE MULTIPAYOR PATIENT CENTERED MEDICAL HOME PROGRAM SHALL BE ON A
25 VOLUNTARY BASIS.
26 6. CLINICS AND PRIMARY CARE CLINICIANS PARTICIPATING IN A PROGRAM ARE
27 NOT ELIGIBLE FOR ADDITIONAL ENHANCEMENTS OR BONUSES UNDER THE STATEWIDE
28 PATIENT CENTERED MEDICAL HOME PROGRAM ESTABLISHED PURSUANT TO SECTION
29 THREE HUNDRED SIXTY-FOUR-M OF THE SOCIAL SERVICES LAW.
30 7. SUBJECT TO THE AVAILABILITY OF FUNDING AND FEDERAL FINANCIAL
31 PARTICIPATION, THE COMMISSIONER IS AUTHORIZED:
32 (A) TO PAY ENHANCED RATES OF PAYMENT UNDER MEDICAID FEE-FOR-SERVICE,
33 MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS TO CLIN-
34 ICS AND CLINICIANS THAT ARE CERTIFIED AS PATIENT CENTERED MEDICAL HOMES
35 UNDER THIS TITLE;
36 (B) TO PAY ADDITIONAL AMOUNTS FOR MEDICAL HOMES THAT MEET SPECIFIC
37 PROCESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER IN CONSULTA-
38 TION WITH EACH MULTIPAYOR PATIENT CENTERED MEDICAL HOME COLLABORATIVE;
39 (C) TO AUTHORIZE ALTERNATIVE PAYMENT METHODOLOGIES UNDER MEDICAID
40 FEE-FOR-SERVICE, MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD
41 HEALTH PLUS FOR HEALTH CARE PROVIDERS AND TO SERVE THE PURPOSES OF THE
42 PROGRAM, INCLUDING PAYMENTS TO ENTITIES UNDER PARAGRAPH (G) OF SUBDIVI-
43 SION THREE OF THIS SECTION; AND
44 (D) TO TEST NEW MODELS OF PAYMENT TO HIGH VOLUME MEDICAID PRIMARY CARE
45 MEDICAL HOME PRACTICES THAT INCORPORATE RISK ADJUSTED GLOBAL PAYMENTS
46 COMBINED WITH CARE MANAGEMENT AND PAY FOR PERFORMANCE ADJUSTMENTS.
47 8. (A) THE COMMISSIONER IS AUTHORIZED TO CONTRACT WITH ONE OR MORE
48 ENTITIES TO ASSIST THE STATE IN IMPLEMENTING THE PROVISIONS OF THIS
49 SECTION. SUCH ENTITY OR ENTITIES SHALL BE THE SAME ENTITY OR ENTITIES
50 CHOSEN TO ASSIST IN THE IMPLEMENTATION OF THE HEALTH HOME PROVISIONS OF
51 SECTION THREE HUNDRED SIXTY-FIVE-L OF THE SOCIAL SERVICES LAW. RESPON-
52 SIBILITIES OF THE CONTRACTOR SHALL INCLUDE BUT NOT BE LIMITED TO: DEVEL-
53 OPING RECOMMENDATIONS WITH RESPECT TO PROGRAM POLICY, REIMBURSEMENT,
54 SYSTEM REQUIREMENTS, REPORTING REQUIREMENTS, EVALUATION PROTOCOLS, AND
55 PROVIDER AND PATIENT ENROLLMENT; PROVIDING TECHNICAL ASSISTANCE TO
A. 4009--C 126
1 POTENTIAL MEDICAL HOME AND HEALTH HOME PROVIDERS; DATA COLLECTION; DATA
2 SHARING; PROGRAM EVALUATION, AND PREPARATION OF REPORTS.
3 (B) THE COMMISSIONER IS AUTHORIZED TO ENTER INTO A CONTRACT OR
4 CONTRACTS UNDER PARAGRAPH (A) OF THIS SUBDIVISION THROUGH A REQUEST FOR
5 PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
6 (I) THE DEPARTMENT SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS
7 THAN THIRTY DAYS:
8 (1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
9 THE CONTRACT OR CONTRACTS;
10 (2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
11 (3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
12 SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
13 TION IS FIRST POSTED ON THE WEBSITE; AND
14 (4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
15 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
16 (II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
17 PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
18 COMMISSIONER; AND
19 (III) THE COMMISSIONER SHALL SELECT SUCH CONTRACTOR OR CONTRACTORS
20 THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE PURPOSES OF
21 THIS SECTION.
22 9. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT, PROVIDE:
23 (A) TECHNICAL ASSISTANCE TO A PRIMARY CARE MEDICAL HOME COLLABORATIVE
24 IN RELATION TO ESTABLISHING AND OPERATING A PROGRAM;
25 (B) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING IN A PROGRAM AS TO
26 MATTERS RELATING TO THE PROGRAM;
27 (C) TECHNICAL AND OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
28 IPATING IN A PROGRAM AS TO MATTERS RELATING TO THE PROGRAM, INCLUDING
29 ACHIEVING MEDICAL HOME STANDARDS;
30 (D) CARE COORDINATION PROVIDER TECHNICAL AND OTHER ASSISTANCE TO INDI-
31 VIDUALS AND ENTITIES PROVIDING CARE COORDINATION SERVICES TO HEALTH CARE
32 PROVIDERS UNDER A PROGRAM; AND
33 (E) INFORMATION SHARING AND OTHER ASSISTANCE AMONG PROGRAMS TO IMPROVE
34 THE OPERATION OF PROGRAMS, CONSISTENT WITH APPLICABLE LAWS RELATING TO
35 PATIENT CONFIDENTIALITY.
36 10. THE COMMISSIONER SHALL, TO THE EXTENT NECESSARY FOR THE PURPOSE OF
37 THIS SECTION, SUBMIT THE APPROPRIATE WAIVERS AND OTHER APPLICATIONS,
38 INCLUDING, BUT NOT LIMITED TO, THOSE AUTHORIZED PURSUANT TO SECTIONS
39 ELEVEN HUNDRED FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL
40 SOCIAL SECURITY ACT, OR SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS OR
41 APPLICATIONS NECESSARY TO ACHIEVE THE PURPOSES OF HIGH QUALITY, INTE-
42 GRATED, AND COST EFFECTIVE CARE AND INTEGRATED FINANCIAL ELIGIBILITY
43 POLICIES UNDER MEDICAID, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS OR
44 MEDICARE. COPIES OF SUCH ORIGINAL WAIVER AND OTHER APPLICATIONS SHALL BE
45 PROVIDED TO THE CHAIRMAN OF THE SENATE FINANCE COMMITTEE AND THE CHAIR-
46 MAN OF THE ASSEMBLY WAYS AND MEANS COMMITTEE SIMULTANEOUSLY WITH THEIR
47 SUBMISSION TO THE FEDERAL GOVERNMENT.
48 11. THE ADIRONDACK MEDICAL HOME MULTIPAYOR DEMONSTRATION PROGRAM
49 (INCLUDING THE ADIRONDACK MEDICAL HOME COLLABORATIVE) PREVIOUSLY ESTAB-
50 LISHED UNDER SECTION TWENTY-NINE HUNDRED FIFTY-NINE OF THIS CHAPTER IS
51 CONTINUED AND SHALL BE DEEMED TO BE A PROGRAM UNDER THIS SECTION.
52 12. THE COMMISSIONER SHALL ANNUALLY REPORT TO THE GOVERNOR AND THE
53 LEGISLATURE ON THE OPERATION OF THE PROGRAMS AND THEIR EFFECTIVENESS IN
54 ACHIEVING THE PURPOSES OF THIS SECTION, WITH PARTICULAR REFERENCE TO THE
55 QUALITY, COST, AND OUTCOMES FOR ENROLLEES IN MEDICAID FEE-FOR-SERVICE,
56 MEDICAID MANAGED CARE, FAMILY HEALTH PLUS AND CHILD HEALTH PLUS.
A. 4009--C 127
1 S 36. Subparagraph (xi) of paragraph (b) of subdivision 35 of section
2 2807-c of the public health law, as added by section 2 of part C of
3 chapter 58 of the laws of 2009, is amended and three new subparagraphs
4 (xii), (xiii) and (xiv) are added to read as follows:
5 (xi) Rates for teaching general hospitals shall include reimbursement
6 for direct and indirect graduate medical education as defined and calcu-
7 lated pursuant to such regulations. In addition, such regulations shall
8 specify the reports and information required by the commissioner to
9 assess the cost, quality and health system needs for medical education
10 provided[.];
11 (XII) SUCH REGULATIONS MAY INCORPORATE QUALITY RELATED MEASURES
12 PERTAINING TO POTENTIALLY PREVENTABLE CONDITIONS AND COMPLICATIONS,
13 INCLUDING, BUT NOT LIMITED TO, DISEASES OR COMPLICATIONS OF CARE
14 ACQUIRED IN THE HOSPITAL AND INJURIES SUSTAINED IN THE HOSPITAL;
15 (XIII) SUCH REGULATIONS MAY INCORPORATE QUALITY RELATED MEASURES
16 PERTAINING TO THE INAPPROPRIATE USE OF CERTAIN MEDICAL PROCEDURES,
17 INCLUDING, BUT NOT LIMITED TO, CESAREAN DELIVERIES, CORONARY ARTERY
18 BYPASS GRAFTS AND PERCUTANEOUS CORONARY INTERVENTIONS;
19 (XIV) SUCH REGULATIONS MAY IMPOSE A FEE ON GENERAL HOSPITAL SUFFICIENT
20 TO COVER THE COSTS OF AUDITING THE INSTITUTIONAL COST REPORTS SUBMITTED
21 BY GENERAL HOSPITALS.
22 S 37. The social services law is amended by adding a new section 365-l
23 to read as follows:
24 S 365-L. HEALTH HOMES. 1. NOTWITHSTANDING ANY LAW, RULE OR REGULATION
25 TO THE CONTRARY, THE COMMISSIONER OF HEALTH IS AUTHORIZED, IN CONSULTA-
26 TION WITH THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, OFFICE OF
27 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, AND OFFICE FOR PEOPLE WITH
28 DEVELOPMENTAL DISABILITIES, TO (A) ESTABLISH, IN ACCORDANCE WITH APPLI-
29 CABLE FEDERAL LAW AND REGULATIONS, STANDARDS FOR THE PROVISION OF HEALTH
30 HOME SERVICES TO MEDICAID ENROLLEES WITH CHRONIC CONDITIONS, (B) ESTAB-
31 LISH PAYMENT METHODOLOGIES FOR HEALTH HOME SERVICES BASED ON FACTORS
32 INCLUDING BUT NOT LIMITED TO THE COMPLEXITY OF THE CONDITIONS PROVIDERS
33 WILL BE MANAGING, THE ANTICIPATED AMOUNT OF PATIENT CONTACT NEEDED TO
34 MANAGE SUCH CONDITIONS, AND THE HEALTH CARE COST SAVINGS REALIZED BY
35 PROVISION OF HEALTH HOME SERVICES, (C) ESTABLISH THE CRITERIA UNDER
36 WHICH A MEDICAID ENROLLEE WILL BE DESIGNATED AS BEING AN ELIGIBLE INDI-
37 VIDUAL WITH CHRONIC CONDITIONS FOR PURPOSES OF THIS PROGRAM, (D) ASSIGN
38 ANY MEDICAID ENROLLEE DESIGNATED AS AN ELIGIBLE INDIVIDUAL WITH CHRONIC
39 CONDITIONS TO A PROVIDER OF HEALTH HOME SERVICES. FOR THE PURPOSES OF
40 THIS SECTION, HEALTH HOME SERVICES SHALL HAVE THE SAME MEANING AS
41 DEFINED IN PARAGRAPH (4) OF SUBDIVISION (A) IN SECTION 1945 OF TITLE XIX
42 OF THE FEDERAL SOCIAL SECURITY ACT.
43 2. IN ADDITION TO PAYMENTS MADE FOR HEALTH HOME SERVICES PURSUANT TO
44 SUBDIVISION ONE OF THIS SECTION, THE COMMISSIONER IS AUTHORIZED TO PAY
45 ADDITIONAL AMOUNTS TO PROVIDERS OF HEALTH HOME SERVICES THAT MEET PROC-
46 ESS OR OUTCOME STANDARDS SPECIFIED BY THE COMMISSIONER.
47 3. A MEDICAID ENROLLEE SHALL BE ASSIGNED TO A PROVIDER OR PROVIDERS OF
48 HEALTH HOME SERVICES, ONLY UPON ACCEPTANCE OF AN OFFER BY THE COMMIS-
49 SIONER TO ASSIGN SUCH ENROLLEE.
50 4. PAYMENTS AUTHORIZED PURSUANT TO THIS SECTION WILL BE MADE WITH
51 STATE FUNDS ONLY, TO THE EXTENT THAT SUCH FUNDS ARE APPROPRIATED THERE-
52 FORE, UNTIL SUCH TIME AS FEDERAL FINANCIAL PARTICIPATION IN THE COSTS OF
53 SUCH SERVICES IS AVAILABLE.
54 5. THE COMMISSIONER IS AUTHORIZED TO SUBMIT AMENDMENTS TO THE STATE
55 PLAN FOR MEDICAL ASSISTANCE AND/OR SUBMIT ONE OR MORE APPLICATIONS FOR
56 WAIVERS OF THE FEDERAL SOCIAL SECURITY ACT, TO OBTAIN FEDERAL FINANCIAL
A. 4009--C 128
1 PARTICIPATION IN THE COSTS OF HEALTH HOME SERVICES PROVIDED PURSUANT TO
2 THIS SECTION, AND AS PROVIDED IN SUBDIVISION THREE OF THIS SECTION.
3 6. NOTWITHSTANDING ANY LIMITATIONS IMPOSED BY SECTION THREE HUNDRED
4 SIXTY-FOUR-L OF THIS TITLE ON ENTITIES PARTICIPATING IN DEMONSTRATION
5 PROJECTS ESTABLISHED PURSUANT TO SUCH SECTION, THE COMMISSIONER IS
6 AUTHORIZED TO ALLOW SUCH ENTITIES WHICH MEET THE REQUIREMENTS OF THIS
7 SECTION TO PROVIDE HEALTH HOME SERVICES.
8 7. NOTWITHSTANDING ANY LAW, RULE, OR REGULATION TO THE CONTRARY, THE
9 COMMISSIONERS OF THE DEPARTMENT OF HEALTH, THE OFFICE OF MENTAL HEALTH,
10 THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, AND THE OFFICE OF
11 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO JOINTLY ESTAB-
12 LISH A SINGLE SET OF OPERATING AND REPORTING REQUIREMENTS AND A SINGLE
13 SET OF CONSTRUCTION AND SURVEY REQUIREMENTS FOR ENTITIES THAT:
14 (A) CAN DEMONSTRATE EXPERIENCE IN THE DELIVERY OF HEALTH, AND MENTAL
15 HEALTH AND/OR ALCOHOL AND SUBSTANCE ABUSE SERVICES AND/OR SERVICES TO
16 PERSONS WITH DEVELOPMENTAL DISABILITIES, AND THE CAPACITY TO OFFER INTE-
17 GRATED DELIVERY OF SUCH SERVICES IN EACH LOCATION APPROVED BY THE
18 COMMISSIONER; AND
19 (B) MEET THE STANDARDS ESTABLISHED PURSUANT TO SUBDIVISION ONE OF THIS
20 SECTION FOR PROVIDING AND RECEIVING PAYMENT FOR HEALTH HOME SERVICES;
21 PROVIDED, HOWEVER, THAT AN ENTITY MEETING THE STANDARDS ESTABLISHED
22 PURSUANT TO SUBDIVISION ONE OF THIS SECTION SHALL NOT BE REQUIRED TO BE
23 AN INTEGRATED SERVICE PROVIDER PURSUANT TO THIS SUBDIVISION.
24 IN ESTABLISHING A SINGLE SET OF OPERATING AND REPORTING REQUIREMENTS
25 AND A SINGLE SET OF CONSTRUCTION AND SURVEY REQUIREMENTS FOR ENTITIES
26 DESCRIBED IN THIS SUBDIVISION, THE COMMISSIONERS OF THE DEPARTMENT OF
27 HEALTH, THE OFFICE OF MENTAL HEALTH, THE OFFICE FOR PEOPLE WITH DEVELOP-
28 MENTAL DISABILITIES, AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE
29 SERVICES ARE AUTHORIZED TO WAIVE ANY REGULATORY REQUIREMENTS AS ARE
30 NECESSARY TO AVOID DUPLICATION OF REQUIREMENTS AND TO ALLOW THE INTE-
31 GRATED DELIVERY OF SERVICES IN A RATIONAL AND EFFICIENT MANNER.
32 8. (A) THE COMMISSIONER OF HEALTH IS AUTHORIZED TO CONTRACT WITH ONE
33 OR MORE ENTITIES TO ASSIST THE STATE IN IMPLEMENTING THE PROVISIONS OF
34 THIS SECTION. SUCH ENTITY OR ENTITIES SHALL BE THE SAME ENTITY OR ENTI-
35 TIES CHOSEN TO ASSIST IN THE IMPLEMENTATION OF THE MULTIPAYOR PATIENT
36 CENTERED MEDICAL HOME PROGRAM PURSUANT TO SECTION TWENTY-NINE HUNDRED
37 FIFTY-NINE-A OF THE PUBLIC HEALTH LAW. RESPONSIBILITIES OF THE CONTRAC-
38 TOR SHALL INCLUDE BUT NOT BE LIMITED TO: DEVELOPING RECOMMENDATIONS WITH
39 RESPECT TO PROGRAM POLICY, REIMBURSEMENT, SYSTEM REQUIREMENTS, REPORTING
40 REQUIREMENTS, EVALUATION PROTOCOLS, AND PROVIDER AND PATIENT ENROLLMENT;
41 PROVIDING TECHNICAL ASSISTANCE TO POTENTIAL MEDICAL HOME AND HEALTH HOME
42 PROVIDERS; DATA COLLECTION; DATA SHARING; PROGRAM EVALUATION, AND PREPA-
43 RATION OF REPORTS.
44 (B) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
45 TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
46 ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW,
47 THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ENTER INTO A CONTRACT OR
48 CONTRACTS UNDER PARAGRAPH (A) OF THIS SUBDIVISION WITHOUT A COMPETITIVE
49 BID OR REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
50 (I) THE DEPARTMENT OF HEALTH SHALL POST ON ITS WEBSITE, FOR A PERIOD
51 OF NO LESS THAN THIRTY DAYS:
52 (1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
53 THE CONTRACT OR CONTRACTS;
54 (2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
A. 4009--C 129
1 (3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
2 SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
3 TION IS FIRST POSTED ON THE WEBSITE; AND
4 (4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
5 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
6 (II) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
7 PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
8 COMMISSIONER OF HEALTH; AND
9 (III) THE COMMISSIONER OF HEALTH SHALL SELECT SUCH CONTRACTOR OR
10 CONTRACTORS THAT, IN HIS OR HER DISCRETION, ARE BEST SUITED TO SERVE THE
11 PURPOSES OF THIS SECTION.
12 S 38. Section 2816 of the public health law, as added by chapter 225
13 of the laws of 2001 and paragraph (a) of subdivision 2 as amended by
14 section 19 of part D of chapter 57 of the laws of 2006, is amended to
15 read as follows:
16 S 2816. Statewide planning and research cooperative system. 1. (A)
17 The statewide planning and research cooperative system in the department
18 is continued, as provided in AND SUBJECT TO this section. The [statewide
19 planning and research cooperative] system shall be developed and oper-
20 ated by the commissioner in consultation with the council, [and shall be
21 comprised of such data elements] as may be specified by regulation OF
22 THE COMMISSIONER. IN MAKING REGULATIONS UNDER THIS SECTION, THE COMMIS-
23 SIONER SHALL CONSULT WITH THE SUPERINTENDENT OF INSURANCE, HEALTH CARE
24 PROVIDERS, THIRD-PARTY HEALTH CARE PAYERS, AND ADVOCATES REPRESENTING
25 PATIENTS; PROTECT THE CONFIDENTIALITY OF PATIENT-IDENTIFIABLE INFORMA-
26 TION; PROMOTE THE ACCURACY AND COMPLETENESS OF REPORTING; AND MINIMIZE
27 THE BURDEN ON INSTITUTIONAL AND NON-INSTITUTIONAL HEALTH CARE PROVIDERS
28 AND THIRD-PARTY HEALTH CARE PAYERS.
29 (B) AS USED IN THIS SECTION, UNLESS THE CONTEXT CLEARLY REQUIRES
30 OTHERWISE:
31 (I) "HEALTH CARE" MEANS ANY SERVICES, SUPPLIES, EQUIPMENT, OR
32 PRESCRIPTION DRUGS REFERRED TO IN SUBDIVISION TWO OF THIS SECTION.
33 (II) "HEALTH CARE PROVIDER" INCLUDES, IN ADDITION TO ITS ORDINARY
34 MEANINGS, AN ENTITY THAT IS AN INTEGRATED ORGANIZATION OF HEALTH CARE
35 PROVIDERS OR AN ACCOUNTABLE CARE ORGANIZATION OF HEALTH CARE PROVIDERS.
36 (III) "SYSTEM" MEANS THE STATEWIDE PLANNING AND RESEARCH COOPERATIVE
37 SYSTEM UNDER THIS SECTION.
38 (IV) "THIRD-PARTY HEALTH CARE PAYER" INCLUDES, IN ADDITION TO ITS
39 ORDINARY MEANINGS, AN ENTITY SUCH AS A PHARMACY BENEFITS MANAGER, FISCAL
40 ADMINISTRATOR, OR ADMINISTRATIVE SERVICES PROVIDER THAT PARTICIPATES IN
41 THE ADMINISTRATION OF A THIRD-PARTY HEALTH CARE PAYER SYSTEM.
42 2. Regulations governing the [statewide planning and research cooper-
43 ative] system shall include, but not be limited to, the following:
44 (a) Specification of patient, ENROLLEE, and other data elements and
45 format [to] WHICH SHALL be reported including data related to:
46 (i) inpatient hospitalization data from general hospitals;
47 (ii) ambulatory surgery data from hospital-based ambulatory surgery
48 services and all other ambulatory surgery facilities licensed under this
49 article;
50 (iii) emergency department data from general hospitals;
51 (iv) outpatient [clinic] AND PRESCRIPTION DATA, INCLUDING BUT NOT
52 LIMITED TO data from OR RELATING TO SERVICES, SUPPLIES, EQUIPMENT, AND
53 PRESCRIPTION DRUGS PROVIDED OR ORDERED BY general hospitals and diagnos-
54 tic and treatment centers licensed under this article, [provided, howev-
55 er, that notwithstanding subdivision one of this section the commission-
56 er, in consultation with the health care industry, is authorized to
A. 4009--C 130
1 promulgate or adopt any rules or regulations necessary to implement the
2 collection of data pursuant to this subparagraph] PHARMACIES, CLINICAL
3 LABORATORIES, AND OTHER HEALTH CARE PROVIDERS;
4 (V) ENROLLEE DATA; and
5 [(v)] (VI) the data specified in this paragraph shall include the
6 identification of patients transferred, admitted or treated subsequent
7 to a medical, surgical or diagnostic procedure by a licensed health care
8 professional OR at a HEALTH CARE site or facility [other than those
9 specified in subparagraph (i), (ii), (iii) or (iv) of this paragraph].
10 (b) Standards to assure the protection of patient privacy in data
11 collected and released under this section.
12 (c) Standards for the publication and release of data reported in
13 accordance with this section.
14 (D) PROVISIONS DETERMINING THE CIRCUMSTANCES UNDER WHICH DATA SHALL BE
15 REPORTED BY AN APPROPRIATE HEALTH CARE PROVIDER OR THIRD-PARTY HEALTH
16 CARE PAYER.
17 (E) PROVISIONS TO ACQUIRE DATA RELATING TO HEALTH CARE PROVIDED (I) TO
18 PATENTS FOR WHOM THERE IS NO THIRD-PARTY HEALTH CARE PAYER, AND (II)
19 UNDER ARRANGEMENTS THAT DO NOT INVOLVE FEE-FOR-SERVICE PAYMENT.
20 (F) PHASED-IN IMPLEMENTATION OF THE SYSTEM.
21 3. THE COMMISSIONER MAY PROVIDE THAT THE SYSTEM MAY PARTICIPATE IN OR
22 COOPERATE WITH A SIMILAR SYSTEM OPERATED BY, OR RECEIVE INFORMATION FROM
23 OR PROVIDE INFORMATION TO, A REGIONAL OR NATIONAL ENTITY OR ANOTHER
24 JURISDICTION, INCLUDING MAKING APPROPRIATE AGREEMENTS AND APPLYING FOR
25 APPROVALS, PROVIDED THAT THE PROTECTIONS FOR HEALTH CARE PROVIDERS,
26 PATIENTS, AND THIRD-PARTY HEALTH CARE PAYERS IN THIS SECTION ARE
27 PRESERVED AND COMPARABLE PROVISIONS ARE INCLUDED IN THE OTHER SYSTEM.
28 S 39. The social services law is amended by adding a new section 363-e
29 to read as follows:
30 S 363-E. MEDICAID PLAN, APPLICATIONS FOR WAIVERS AND PLAN AMENDMENTS;
31 PUBLIC DISCLOSURE. 1. THE COMMISSIONER OF HEALTH SHALL POST ON THE
32 DEPARTMENT OF HEALTH INTERNET WEBSITE THE ENTIRETY OF THE STATE'S PLAN
33 FOR MEDICAL ASSISTANCE AS REQUIRED BY TITLE XIX OF THE FEDERAL SOCIAL
34 SECURITY ACT, OR ITS SUCCESSOR, AND EVERY AMENDMENT AND CHANGE TO THE
35 PLAN. NO AMENDMENT OR CHANGE TO THE PLAN SHALL TAKE EFFECT UNTIL THE
36 AMENDMENT OR CHANGE SHALL BE SO POSTED.
37 2. THE COMMISSIONER OF HEALTH SHALL POST ON THE DEPARTMENT OF HEALTH
38 INTERNET WEBSITE: (A) EVERY APPLICATION OR DRAFT APPLICATION FOR A
39 FEDERAL WAIVER AND EVERY PROPOSED OR DRAFT PROPOSED STATE PLAN AMEND-
40 MENT, RELATING TO THE STATE'S PLAN FOR MEDICAL ASSISTANCE, TOGETHER WITH
41 ANY MATERIAL RELATED THERETO, SUBMITTED TO THE FEDERAL DEPARTMENT OF
42 HEALTH AND HUMAN SERVICES, OR ANY SUCCESSOR AGENCY OR PART THEREOF,
43 IMMEDIATELY UPON SUCH SUBMISSION, AND (B) CURRENT INFORMATION ON THE
44 STATUS OF SUCH WAIVER APPLICATION OR PLAN AMENDMENT.
45 S 40. Paragraph (u) of subdivision 2 of section 365-a of the social
46 services law, as amended by section 42 of part B of chapter 58 of the
47 laws of 2010, is amended to read as follows:
48 (u) screening, brief intervention, and referral to treatment [in
49 hospital outpatient and emergency departments and free-standing diagnos-
50 tic and treatment centers] of individuals at risk for substance abuse
51 including referral to the appropriate level of intervention and treat-
52 ment in a community setting; provided, however, that the provisions of
53 this paragraph relating to screening, brief intervention, and referral
54 to treatment services shall not take effect unless all necessary
55 approvals under federal law and regulation have been obtained to receive
56 federal financial participation in such costs.
A. 4009--C 131
1 S 41. Paragraphs (d) and (e) of subdivision 1 and paragraphs (c) and
2 (d) of subdivision 2 of section 4403-f of the public health law, para-
3 graph (d) of subdivision 1 as amended by section 6 of part C of chapter
4 58 of the laws of 2007, paragraph (e) of subdivision 1 as amended by
5 section 65-d of part A of chapter 57 of the laws of 2006, paragraph (c)
6 of subdivision 2 as added by chapter 659 of the laws of 1997 and para-
7 graph (d) of subdivision 2 as amended by section 9 of part C of chapter
8 58 of the laws of 2007, and paragraphs (d) and (e) of subdivision 1 as
9 relettered by section 7 of part C of chapter 58 of the laws of 2007, are
10 amended to read as follows:
11 (d) ["Approved managed long term care demonstration" means the sites
12 approved by the commissioner to participate in the "Evaluated Medicaid
13 Long Term Care Capitation Program".
14 (e)] "Health and long term care services" means services including,
15 but not limited to primary care, acute care, home and community-based
16 and institution-based long term care and ancillary services (that shall
17 include medical supplies and nutritional supplements) that are necessary
18 to meet the needs of persons whom the plan is authorized to enroll.
19 (c) [a description that demonstrates the cost-effectiveness of the
20 program as compared to the cost of services clients would otherwise have
21 received;
22 (d)] adequate documentation of the appropriate licenses, certif-
23 ications or approvals to provide care as planned, including contracts
24 with such providers as may be necessary to provide the full complement
25 of services required to be provided under this section.
26 S 41-a. Subdivision 3 of section 4403-f of the public health law, as
27 amended by chapter 627 of the laws of 2008, is amended to read as
28 follows:
29 3. Certificate of authority; approval. The commissioner shall not
30 approve an application for a certificate of authority unless the appli-
31 cant demonstrates to the commissioner's satisfaction:
32 (a) [the relative cost effectiveness to the medical assistance program
33 when compared to other managed long term care plans proposing to serve,
34 or serving, comparable populations;
35 (b)] that it will have in place acceptable quality-assurance mech-
36 anisms, grievance procedures, mechanisms to protect the rights of enrol-
37 lees and case management services to ensure continuity, quality, appro-
38 priateness and coordination of care;
39 [(c)] (B) that it will include [an] enrollment [process] AND DISEN-
40 ROLLMENT PROCESSES CONSISTENT WITH SECTION THREE HUNDRED SIXTY-FOUR-J OF
41 THE SOCIAL SERVICES LAW AND which shall ensure that enrollment in the
42 plan is informed [and voluntary by enrollees or their representatives
43 and a voluntary disenrollment process]. The application shall [include
44 the specific grounds that would warrant involuntary disenrollment
45 provided, however,] DESCRIBE THE DISENROLLMENT PROCESS, WHICH SHALL
46 PROVIDE THAT an otherwise eligible enrollee shall not be involuntarily
47 disenrolled on the basis of health status;
48 [(d)] (C) satisfactory evidence of the character and competence of the
49 proposed operators and reasonable assurance that the applicant will
50 provide high quality services to an enrolled population;
51 [(e)] (D) sufficient management systems capacity to meet the require-
52 ments of this section and the ability to efficiently process payment for
53 covered services;
54 [(f)] (E) readiness and capability to [achieve full capitation for
55 services reimbursed pursuant to title XVIII of the federal social secu-
56 rity act or, for an applicant designated as an eligible applicant prior
A. 4009--C 132
1 to April first, two thousand seven pursuant to paragraph (d) of subdivi-
2 sion six of this section that has its principal place of business in
3 Bronx county and is unable to achieve such full capitation, readiness
4 and capability to achieve full capitation on a scheduled basis for]
5 MAXIMIZE REIMBURSEMENT OF AND COORDINATE services reimbursed pursuant to
6 title XVIII of the federal social security act [or capability and proto-
7 cols for benefit coordination for services reimbursed pursuant to such
8 title] and all other applicable benefits, with such benefit coordination
9 including, but not limited to, measures to support sound clinical deci-
10 sions, reduce administrative complexity, coordinate access to services,
11 maximize benefits available pursuant to such title and ensure that
12 necessary care is provided;
13 [(g)] (F) readiness and capability to [achieve full capitation for]
14 ARRANGE AND MANAGE COVERED SERVICES AND COORDINATE OTHER services reim-
15 bursed pursuant to title XIX of the federal social security act;
16 [(h)] (G) willingness and capability of taking, or cooperating in, all
17 steps necessary to secure and integrate any potential sources of funding
18 for services provided by the managed long term care plan, including, but
19 not limited to, funding available under titles XVI, XVIII, XIX and XX of
20 the federal social security act, the federal older Americans act of
21 nineteen hundred sixty-five, as amended, or any successor provisions
22 subject to approval of the director of the state office for aging, and
23 through financing options such as those authorized pursuant to section
24 three hundred sixty-seven-f of the social services law;
25 [(i)] (H) that the CONTRACTUAL arrangements for PROVIDERS OF health
26 and long term care services IN THE BENEFIT PACKAGE ARE SUFFICIENT TO
27 ensure the availability and accessibility of such services to the
28 proposed enrolled population CONSISTENT WITH GUIDELINES ESTABLISHED BY
29 THE COMMISSIONER; WITH RESPECT TO INDIVIDUALS IN RECEIPT OF SUCH
30 SERVICES PRIOR TO ENROLLMENT, SUCH GUIDELINES SHALL REQUIRE THE MANAGED
31 LONG TERM CARE PLAN TO CONTRACT WITH AGENCIES CURRENTLY PROVIDING SUCH
32 SERVICES, IN ORDER TO PROMOTE CONTINUITY OF CARE; and
33 [(j)] (I) that the applicant is financially responsible and may be
34 expected to meet its obligations to its enrolled members.
35 S 41-b. Subdivisions 5, 6, 7 and 10 of section 4403-f of the public
36 health law, subdivision 5 as amended by section 15 of part C of chapter
37 58 of the laws of 2007, subdivisions 6 and 7 as added by chapter 659 of
38 the laws of 1997, paragraphs (a), (b) and (c) of subdivision 6 as
39 amended by section 6 of part C of chapter 58 of the laws of 2010, para-
40 graph (d) of subdivision 6 as amended by section 17 of part C of chapter
41 58 of the laws of 2007, paragraphs (c) and (d) of subdivision 7 as
42 amended by section 18 of part C of chapter 58 of the laws of 2007, para-
43 graphs (e) and (g) of subdivision 7 as relettered by section 20 of part
44 C of chapter 58 of the laws of 2007, paragraph (h) of subdivision 7 as
45 added by section 65-c of part A of chapter 57 of the laws of 2006, para-
46 graph (i) as added by section 65-f of part A of chapter 57 of the laws
47 of 2006, and such paragraphs (h) and (i) as relettered by section 20 of
48 part C of chapter 58 of the laws of 2007, paragraph (f) of subdivision 7
49 as amended by section 7 of part C of chapter 58 of the laws of 2010,
50 subparagraph (iii) of paragraph (h) of subdivision 7 as amended by
51 section 19 of part C of chapter 58 of the laws of 2007, subdivision 10
52 as amended by chapter 192 of the laws of 2006 and renumbered by section
53 22 of part C of chapter 58 of the laws of 2007, are amended to read as
54 follows:
55 5. Applicability of other laws. A managed long term care plan [or
56 approved managed long term care demonstration] shall be subject to the
A. 4009--C 133
1 provisions of the insurance law and regulations applicable to health
2 maintenance organizations, this article and regulations promulgated
3 pursuant thereto. To the extent that the provisions of this section are
4 inconsistent with the provisions of this chapter or the provisions of
5 the insurance law, the provisions of this section shall prevail.
6 6. Approval authority. (a) An applicant shall be issued a certificate
7 of authority as a managed long term care plan upon a determination by
8 the commissioner that the applicant complies with the operating require-
9 ments for a managed long term care plan under this section. [The commis-
10 sioner shall issue no more than fifty certificates of authority to
11 managed long term care plans pursuant to this section. For purposes of
12 issuance of no more than fifty certificates of authority, such certif-
13 icates shall include those certificates issued pursuant to paragraphs
14 (b) and (c) of this subdivision.]
15 (b) An operating demonstration shall be issued a certificate of
16 authority as a managed long term care plan upon a determination by the
17 commissioner that such demonstration complies with the operating
18 requirements for a managed long term care plan under this section.
19 [Except as otherwise expressly provided in paragraphs (d) and (e) of
20 subdivision seven of this section, nothing] NOTHING in this section
21 shall be construed to affect the continued legal authority of an operat-
22 ing demonstration to operate its previously approved program.
23 [(c) An approved managed long term care demonstration shall be issued
24 a certificate of authority as a managed long term care plan upon a
25 determination by the commissioner that such demonstration complies with
26 the operating requirements for a managed long term care plan under this
27 section. Notwithstanding any inconsistent provision of law to the
28 contrary, all authority for the operation of approved managed long term
29 care demonstrations which have not been issued a certificate of authori-
30 ty as a managed long term care plan, shall expire one year after the
31 adoption of regulations implementing managed long term care plans.
32 (d) The majority leader of the senate and the speaker of the assembly
33 may each designate in writing up to fifteen eligible applicants to apply
34 to be approved managed long term care demonstrations or plans. The
35 commissioner may designate in writing up to eleven eligible applicants
36 to apply to be approved managed long term care demonstrations or plans.]
37 7. Program oversight and administration. (a)(i) The commissioner shall
38 promulgate regulations to implement this section and to ensure the qual-
39 ity, appropriateness and cost-effectiveness of the services provided by
40 managed long term care plans. The commissioner may waive rules and regu-
41 lations of the department, including but not limited to, those pertain-
42 ing to duplicative requirements concerning record keeping, boards of
43 directors, staffing and reporting, when such waiver will promote the
44 efficient delivery of appropriate, quality, cost-effective services and
45 when the health, safety and general welfare of enrollees will not be
46 impaired as a result of such waiver. In order to achieve managed long
47 term care plan system efficiencies and coordination and to promote the
48 objectives of high quality, integrated and cost effective care, the
49 commissioner may establish a single coordinated surveillance process,
50 allow for a comprehensive quality improvement and review process to meet
51 component quality requirements, and require a uniform cost report. The
52 commissioner shall require managed long term care plans to utilize qual-
53 ity improvement measures, based on health outcomes data, for internal
54 quality assessment processes and may utilize such measures as part of
55 the single coordinated surveillance process.
A. 4009--C 134
1 (ii) Notwithstanding any inconsistent provision of the social services
2 law to the contrary, the commissioner shall, pursuant to regulation,
3 determine whether and the extent to which the applicable provisions of
4 the social services law or regulations relating to approvals and author-
5 izations of, and utilization limitations on, health and long term care
6 services reimbursed pursuant to title XIX of the federal social security
7 act, including, but not limited to, fiscal assessment requirements, are
8 inconsistent with the flexibility necessary for the efficient adminis-
9 tration of managed long term care plans and such regulations shall
10 provide that such provisions shall not be applicable to enrollees or
11 managed long term care plans, provided that such determinations are
12 consistent with applicable federal law and regulation.
13 (b) (I) The commissioner shall, to the extent necessary, submit the
14 appropriate waivers, including, but not limited to, those authorized
15 pursuant to sections eleven hundred fifteen and nineteen hundred fifteen
16 of the federal social security act, or successor provisions, and any
17 other waivers necessary to achieve the purposes of high quality, inte-
18 grated, and cost effective care and integrated financial eligibility
19 policies under the medical assistance program or pursuant to title XVIII
20 of the federal social security act. (II) IN ADDITION, THE COMMISSIONER
21 IS AUTHORIZED TO SUBMIT THE APPROPRIATE WAIVERS, INCLUDING BUT NOT
22 LIMITED TO THOSE AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED FIFTEEN
23 AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT OR
24 SUCCESSOR PROVISIONS, AND ANY OTHER WAIVERS NECESSARY TO REQUIRE MEDICAL
25 ASSISTANCE RECIPIENTS WHO ARE TWENTY-ONE YEARS OF AGE OR OLDER AND WHO
26 REQUIRE COMMUNITY-BASED LONG TERM CARE SERVICES, AS SPECIFIED BY THE
27 COMMISSIONER, FOR MORE THAN ONE HUNDRED AND TWENTY DAYS, TO RECEIVE SUCH
28 SERVICES THROUGH AN AVAILABLE PLAN CERTIFIED PURSUANT TO THIS SECTION OR
29 A CERTIFIED HOME HEALTH AGENCY OR A LONG TERM HOME HEALTH PROGRAM, SPEC-
30 IFIED BY THE COMMISSIONER, OR OTHER CARE COORDINATION PROGRAM THAT IS A
31 MANAGED CARE PROGRAM OR AN ACCOUNTABLE CARE ORGANIZATION UNDER ARTICLE
32 FORTY-FOUR-A OF THIS CHAPTER, SPECIFIED BY THE COMMISSIONER. THIS
33 SUBPARAGRAPH AND ANY PLAN CERTIFIED PURSUANT TO THIS SUBPARAGRAPH SHALL
34 BE SUBJECT TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES
35 LAW. Copies of such original waiver applications shall be provided to
36 the chairman of the senate finance committee and the chairman of the
37 assembly ways and means committee simultaneously with their submission
38 to the federal government. THE COMMISSIONER SHALL DEVELOP A WORKGROUP,
39 COMPRISED OF STAKEHOLDERS REPRESENTING PROVIDERS, LABOR, CONSUMERS, THE
40 MEDICAID MANAGED CARE ADVISORY REVIEW PANEL, AND THE LEGISLATURE TO
41 FURTHER EVALUATE AND PROMOTE THE TRANSITION OF PERSONS IN RECEIPT OF
42 HOME AND COMMUNITY-BASED LONG TERM CARE SERVICES INTO MANAGED LONG TERM
43 CARE PLANS AND OTHER CARE COORDINATION MODELS.
44 (c)(i) A managed long term care plan shall not use deceptive or coer-
45 cive marketing methods to encourage participants to enroll. A managed
46 long term care plan shall not distribute marketing materials to poten-
47 tial enrollees before such materials have been approved by the commis-
48 sioner.
49 (ii) The commissioner shall ensure, through periodic reviews of
50 managed long term care plans, that enrollment [was a voluntary and] AND
51 DISENROLLMENT WAS CONSISTENT WITH SECTION THREE HUNDRED SIXTY-FOUR-J OF
52 THE SOCIAL SERVICES LAW AND WAS AN informed choice; such plan has only
53 enrolled persons whom it is authorized to enroll, and plan services are
54 promptly available to enrollees when appropriate. Such periodic reviews
55 shall be made according to standards as determined by the commissioner
56 in regulations.
A. 4009--C 135
1 (d) Notwithstanding any provision of law, rule or regulation to the
2 contrary, the commissioner may issue a request for proposals to carry
3 out reviews of enrollment and assessment activities in managed long term
4 care plans and operating demonstrations with respect to enrollees eligi-
5 ble to receive services under title XIX of the federal social security
6 act to determine if enrollment meets the requirements of subparagraph
7 (ii) of paragraph (c) of this subdivision; and that assessments of such
8 enrollees' health, functional and other status, for the purpose of
9 adjusting premiums, were accurate. [Evaluations shall address each
10 bidder's ability to ensure that enrollments in such plans are promptly
11 reviewed and that medical assistance required to be furnished pursuant
12 to title eleven of article five of the social services law will be
13 appropriately furnished to the recipients for whom the local commission-
14 ers are responsible pursuant to section three hundred sixty-five of such
15 title and that plan implementation will be consistent with the proper
16 and efficient administration of the medical assistance program and
17 managed long term care plans.]
18 (e) The commissioner may, in his or her discretion for the purpose of
19 protection of enrollees, impose measures including, but not limited to,
20 bans on further enrollments and requirements for use of enrollment
21 brokers until any identified problems are resolved to the satisfaction
22 of the commissioner.
23 (f) Continuation of a certificate of authority issued under this
24 section shall be contingent upon satisfactory performance by the managed
25 long term care plan in the delivery, continuity, accessibility, cost
26 effectiveness and quality of the services to enrolled members; compli-
27 ance with applicable provisions of this section and rules and regu-
28 lations promulgated thereunder; the continuing fiscal solvency of the
29 organization; and, federal financial participation in payments on behalf
30 of enrollees who are eligible to receive services under title XIX of the
31 federal social security act.
32 (g) [The commissioner shall ensure that (i) a process exists for the
33 resolution of disputes concerning the accuracy of assessments performed
34 pursuant to paragraphs (d) and (e) of this subdivision; and (ii) the
35 tasks described in paragraphs (d) and (e) of this subdivision are
36 consistently administered.
37 (h)] (i) Managed long term care plans and demonstrations may enroll
38 eligible persons in the plan or demonstration upon the completion of a
39 comprehensive assessment that shall include, but not be limited to, an
40 evaluation of the medical, social and environmental needs of each
41 prospective enrollee in such program. This assessment shall also serve
42 as the basis for the development and provision of an appropriate plan of
43 care for the [prospective] enrollee. UPON APPROVAL OF FEDERAL WAIVERS
44 PURSUANT TO PARAGRAPH (B) OF THIS SUBDIVISION WHICH REQUIRE MEDICAL
45 ASSISTANCE RECIPIENTS WHO REQUIRE COMMUNITY-BASED LONG TERM CARE
46 SERVICES TO ENROLL IN A PLAN, AND UPON APPROVAL OF THE COMMISSIONER, A
47 PLAN MAY ENROLL AN APPLICANT WHO IS CURRENTLY RECEIVING HOME AND COMMU-
48 NITY-BASED SERVICES AND COMPLETE THE COMPREHENSIVE ASSESSMENT WITHIN
49 THIRTY DAYS OF ENROLLMENT PROVIDED THAT THE PLAN CONTINUES TO COVER
50 TRANSITIONAL CARE UNTIL SUCH TIME AS THE ASSESSMENT IS COMPLETED.
51 (ii) The assessment shall be completed by a representative of the
52 managed long term care plan or demonstration, in consultation with the
53 prospective enrollee's health care practitioner AS NECESSARY. The
54 commissioner shall prescribe the forms on which the assessment shall be
55 made.
A. 4009--C 136
1 (iii) The [completed assessment and documentation of the] enrollment
2 APPLICATION shall be submitted by the managed long term care plan or
3 demonstration to the [local department of social services, or to a
4 contractor selected pursuant to paragraph (d) of this subdivision,]
5 DEPARTMENT prior to the commencement of services under the managed long
6 term care plan or demonstration. For purposes of reimbursement of the
7 managed long term care plan or demonstration, if the [completed assess-
8 ment and documentation are] ENROLLMENT APPLICATION IS submitted on or
9 before the twentieth day of the month, the enrollment shall commence on
10 the first day of the month following the completion and submission and
11 if the [completed assessment and documentation are] ENROLLMENT APPLICA-
12 TION IS submitted after the twentieth day of the month, the enrollment
13 shall commence on the first day of the second month following
14 submission. Enrollments conducted by a plan or demonstration shall be
15 subject to review and audit by the department [and by the local social
16 services district] or a contractor selected pursuant to paragraph (d) of
17 this subdivision.
18 (iv) Continued enrollment in a managed long term care plan or demon-
19 stration paid for by government funds shall be based upon a comprehen-
20 sive assessment of the medical, social and environmental needs of the
21 recipient of the services. Such assessment shall be performed at least
22 [annually] EVERY SIX MONTHS by the managed long term care plan serving
23 the enrollee. The commissioner shall prescribe the forms on which the
24 assessment will be made.
25 [(i)] (H) The commissioner shall, upon request by a managed long term
26 care plan[, approved managed long term care demonstration,] or operating
27 demonstration, and consistent with federal regulations promulgated
28 pursuant to the Health Insurance Portability and Accountability Act,
29 share with such plan or demonstration the following data if it is avail-
30 able:
31 (i) information concerning utilization of services and providers by
32 each of its enrollees prior to and during enrollment, including but not
33 limited to utilization of emergency department services, prescription
34 drugs, and hospital and nursing facility admissions.
35 (ii) aggregate data concerning utilization and costs for enrollees and
36 for comparable cohorts served through the Medicaid fee-for-service
37 program.
38 10. [The] NOTWITHSTANDING ANY INCONSISTENT PROVISION TO THE CONTRARY,
39 THE ENROLLMENT AND DISENROLLMENT PROCESS AND services provided or
40 arranged by all operating demonstrations or any program that receives
41 designation as a Program of All-Inclusive Care for the Elderly (PACE) as
42 authorized by federal public law 105-33, subtitle I of title IV of the
43 Balanced Budget Act of 1997, MUST MEET ALL APPLICABLE FEDERAL REQUIRE-
44 MENTS. SERVICES may include, but need not be limited to, housing, inpa-
45 tient and outpatient hospital services, nursing home care, home health
46 care, adult day care, assisted living services provided in accordance
47 with article forty-six-B of this chapter, adult care facility services,
48 enriched housing program services, hospice care, respite care, personal
49 care, homemaker services, diagnostic laboratory services, therapeutic
50 and diagnostic radiologic services, emergency services, emergency alarm
51 systems, home delivered meals, physical adaptations to the client's
52 home, physician care (including consultant and referral services),
53 ancillary services, case management services, transportation, and
54 related medical services.
55 S 42. The social services law is amended by adding a new section 365-m
56 to read as follows:
A. 4009--C 137
1 S 365-M. ADMINISTRATION AND MANAGEMENT OF BEHAVIORAL HEALTH SERVICES.
2 DEFINITIONS. NOTWITHSTANDING ANY INCONSISTENT SECTION OF LAW, FOR THE
3 PURPOSES OF THIS SECTION:
4 (A) "BEHAVIORAL HEALTH ORGANIZATION" SHALL MEAN A REGIONAL ENTITY THAT
5 ARRANGES FOR THE PROVISION OF BEHAVIORAL HEALTH SERVICES, WHICH SHALL
6 INCLUDE, BUT NOT BE LIMITED TO, INPATIENT, OUTPATIENT, RESIDENTIAL, PEER
7 TO PEER, AND ALL OTHER RELATED SERVICES FOR THE TREATMENT AND RECOVERY
8 OF PERSON WITH A MENTAL ILLNESS OR ADDITION; PROVIDERS CARE MANAGEMENT,
9 APPROVES, COORDINATES, AND OVERSEES SUCH SERVICES; CERTIFIES OR RECERTI-
10 FIES BEHAVIORAL HEALTH SERVICE PROVIDERS; AND INTEGRATES SUCH SERVICES
11 WITH OTHER SERVICES AVAILABLE UNDER THIS TITLE.
12 (B) "BEHAVIORAL HEALTH PROVIDER" SHALL MEAN AN INDIVIDUAL, ASSOCI-
13 ATION, CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY, OR PUBLIC OR
14 PRIVATE AGENCY, OTHER THAN AN AGENCY OR DEPARTMENT OF THE STATE, WHICH
15 PROVIDES SERVICE FOR PERSONS WITH A MENTAL ILLNESS OR ADDICTION.
16 2. (A) THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE
17 OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE
18 COMMISSIONER OF HEALTH AND WITH THE APPROVAL OF THE DIVISION OF THE
19 BUDGET, SHALL HAVE RESPONSIBILITY FOR JOINTLY DESIGNATING REGIONAL
20 BEHAVIORAL HEALTH ORGANIZATIONS TO PROVIDE ADMINISTRATIVE AND MANAGEMENT
21 SERVICES FOR THE PURPOSES OF PRIOR APPROVING AND COORDINATING THE
22 PROVISION OF BEHAVIORAL HEALTH SERVICES, AND INTEGRATING SUCH BEHAVIORAL
23 HEALTH SERVICES WITH OTHER SERVICES AVAILABLE UNDER THIS TITLE, FOR
24 RECIPIENTS OF MEDICAL ASSISTANCE WHO ARE NOT ENROLLED IN MANAGED CARE,
25 AND FOR SUCH APPROVAL, COORDINATION, AND INTEGRATION OF BEHAVIORAL
26 HEALTH SERVICES THAT ARE NOT PROVIDED THROUGH MANAGED CARE PROGRAMS
27 UNDER THIS TITLE FOR INDIVIDUALS REGARDLESS OF WHETHER OR NOT SUCH INDI-
28 VIDUALS ARE ENROLLED IN MANAGED CARE PROGRAMS.
29 (B) BEHAVIORAL HEALTH ORGANIZATIONS SHALL ARRANGE FOR ACCESS TO BEHAV-
30 IORAL HEALTH PROVIDERS. EACH BEHAVIORAL HEALTH PROVIDER SHALL POSSESS
31 THE EXPERTISE AND SUFFICIENT RESOURCES TO ASSURE THE DELIVERY OF QUALITY
32 BEHAVIORAL HEALTH CARE TO PARTICIPANTS IN AN APPROPRIATE AND TIMELY
33 MANNER. WHEN ONLY ONE BEHAVIORAL HEALTH ORGANIZATIONS IS AVAILABLE IN A
34 REGION, SUCH ORGANIZATION SHALL OFFER A CHOICE OF AT LEAST THREE BEHAV-
35 IORAL HEALTH PROVIDERS FOR EACH SERVICE OFFERED UNDER THE PLAN, TO THE
36 EXTENT PRACTICABLE.
37 (C) BEHAVIORAL HEALTH ORGANIZATIONS SHALL PROVIDE PARTICIPANTS WITH
38 THE OPPORTUNITY FOR FACE TO FACE COUNSELING, INCLUDING INDIVIDUAL COUN-
39 SELING UPON REQUEST, OF THE PARTICIPANT. THE BEHAVIORAL HEALTH ORGANIZA-
40 TION SHALL ALSO PROVIDE PARTICIPANTS WITH INFORMATION IN A CULTURALLY
41 AND LINGUISTICALLY APPROPRIATE AND UNDERSTANDABLE MANNER, IN LIGHT OF
42 THE PARTICIPANT'S NEEDS, CIRCUMSTANCES AND LANGUAGE PROFICIENCY, SUFFI-
43 CIENT TO ENABLE THE PARTICIPANTS TO MAKE AN INFORMED SELECTION OF APPRO-
44 PRIATE CARE. BEHAVIORAL HEALTH ORGANIZATIONS SHALL INQUIRE INTO EACH
45 PARTICIPANT'S EXISTING RELATIONSHIPS WITH THE BEHAVIORAL HEALTH SYSTEM
46 AND EXPLAIN WHETHER AND HOW SUCH RELATIONSHIPS MAY BE MAINTAINED.
47 (D) BEHAVIORAL HEALTH ORGANIZATIONS SHALL FURTHER INQUIRE INTO EACH
48 PARTICIPANT'S BEHAVIORAL HEALTH STATUS IN ORDER TO IDENTIFY BEHAVIORAL
49 CONDITIONS THAT REQUIRE IMMEDIATE ATTENTION OR CONTINUITY OF CARE, AND
50 PROVIDE TO PARTICIPANTS INFORMATION REGARDING BEHAVIORAL HEALTH CARE
51 OPTIONS AVAILABLE. ANY INFORMATION DISCLOSED TO COUNSELORS SHALL BE KEPT
52 CONFIDENTIAL IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE MENTAL
53 HYGIENE LAW, AND AS APPROPRIATE, THE PUBLIC HEALTH LAW.
54 (E) BEHAVIORAL HEALTH ORGANIZATIONS SHALL ALSO BE RESPONSIBLE FOR
55 SAFEGUARDING AGAINST UNNECESSARY UTILIZATION OF SUCH CARE AND SERVICES
A. 4009--C 138
1 AND ASSURING THAT PAYMENTS ARE CONSISTENT WITH THE EFFICIENT AND ECONOM-
2 ICAL DELIVERY OF QUALITY CARE.
3 3. BEHAVIORAL HEALTH ORGANIZATIONS UNDER THIS SECTION SHALL OPERATE
4 UNDER REGULATIONS OF THE DEPARTMENT THAT PROVIDE:
5 (A) PRIOR APPROVAL OR PRIOR AUTHORIZATION SHALL BE DONE CONSISTENT
6 WITH SECTIONS THREE HUNDRED SIXTY-FIVE-G OF THIS ARTICLE OR, IN THE CASE
7 OF PRESCRIPTION DRUGS, ARTICLE TWO-A OF THE PUBLIC HEALTH LAW;
8 (B) FOR RECIPIENTS WHO ARE NOT ENROLLED IN MEDICAID MANAGED CARE, ALL
9 SERVICES OTHER THAN BEHAVIORAL HEALTH THAT ARE AVAILABLE UNDER THIS
10 TITLE SHALL BE SUBJECT TO OTHERWISE-APPLICABLE PROVISIONS OF THIS TITLE;
11 AND
12 (C) AN APPEALS PROCESS FOR ANY DENIAL OF CARE OR CLAIMS.
13 4. IN DESIGNATING BEHAVIORAL HEALTH ORGANIZATIONS THE COMMISSIONERS OF
14 THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND SUBSTANCE
15 ABUSE SERVICES ARE AUTHORIZED TO CONTRACT, AFTER CONSULTATION WITH THE
16 COMMISSIONER OF HEALTH, WITH REGIONAL BEHAVIORAL HEALTH ORGANIZATIONS OR
17 OTHER ENTITIES. SUCH CONTRACTS MAY INCLUDE RESPONSIBILITY FOR RECEIPT,
18 REVIEW, AND DETERMINATION OF PRIOR AUTHORIZATION REQUESTS FOR BEHAVIORAL
19 HEALTH CARE AND SERVICES, CONSISTENT WITH CRITERIA ESTABLISHED OR
20 APPROVED BY THE COMMISSIONERS OF MENTAL HEALTH AND ALCOHOLISM AND
21 SUBSTANCE ABUSE SERVICES, AND AUTHORIZATION OF APPROPRIATE CARE AND
22 SERVICES BASED ON DOCUMENTED PATIENT MEDICAL NEED.
23 3. THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF
24 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES ARE AUTHORIZED TO ENTER INTO A
25 CONTRACT OR CONTRACTS UNDER SUBDIVISIONS ONE AND TWO OF THIS SECTION
26 THROUGH A REQUEST FOR PROPOSAL PROCESS, PROVIDED, HOWEVER, THAT:
27 (A) THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF ALCOHOLISM AND
28 SUBSTANCE ABUSE SERVICES SHALL POST ON THEIR WEBSITES, FOR A PERIOD OF
29 NO LESS THAN THIRTY DAYS:
30 (I) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
31 THE CONTRACTOR CONTRACTS;
32 (II) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
33 (III) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY
34 SEEK SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH
35 INFORMATION IS FIRST POSTED ON THE WEBSITE; AND
36 (IV) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
37 SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
38 (B) ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
39 PROSPECTIVE CONTRACTORS IN TIMELY FASHION SHALL BE REVIEWED BY THE
40 COMMISSIONERS; AND
41 (C) THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH AND THE OFFICE OF
42 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, IN CONSULTATION WITH THE
43 COMMISSIONER OF HEALTH, SHALL SELECT SUCH CONTRACTOR OR CONTRACTORS
44 THAT, IN THEIR DISCRETION, HAVE DEMONSTRATED THE ABILITY TO EFFECTIVELY,
45 EFFICIENTLY, AND ECONOMICALLY INTEGRATE BEHAVIORAL HEALTH AND HEALTH
46 SERVICES; HAVE THE REQUISITE EXPERTISE AND FINANCIAL RESOURCES; HAVE
47 DEMONSTRATED THAT THEIR DIRECTORS, SPONSORS, MEMBERS, MANAGERS, PARTNERS
48 OR OPERATORS HAVE THE REQUISITE CHARACTER, COMPETENCE AND STANDING IN
49 THE COMMUNITY, AND ARE BEST SUITED TO SERVE THE PURPOSES OF THIS
50 SECTION.
51 4. THE COMMISSIONERS OF THE OFFICE OF MENTAL HEALTH, THE OFFICE OF
52 ALCOHOLISM AND SUBSTANCE ABUSE SERVICES AND THE DEPARTMENT OF HEALTH,
53 SHALL HAVE THE RESPONSIBILITY FOR JOINTLY DESIGNATING ON A REGIONAL
54 BASIS, AFTER CONSULTATION WITH THE CITY OF NEW YORK'S LOCAL SOCIAL
55 SERVICES DISTRICT AND LOCAL GOVERNMENTAL UNIT, AS SUCH TERM IS DEFINED
56 IN THE MENTAL HYGIENE LAW, AND AFTER CONSULTATION OF OTHER AFFECTED
A. 4009--C 139
1 COUNTIES, A LIMITED NUMBER OF SPECIALIZED MANAGED CARE PLANS, SPECIAL
2 NEED MANAGED CARE PLANS, AND/OR INTEGRATED PHYSICAL AND BEHAVIORAL
3 HEALTH PROVIDER SYSTEMS CERTIFIED UNDER ARTICLE FORTY-FOUR-A OF THE
4 PUBLIC HEALTH LAW (ACCOUNTABLE CARE ORGANIZATIONS) CAPABLE OF MANAGING
5 THE BEHAVIORAL AND PHYSICAL HEALTH NEEDS OF MEDICAL ASSISTANCE ENROLLEES
6 WITH SIGNIFICANT BEHAVIORAL HEALTH NEEDS UNDER SECTION THREE HUNDRED
7 SIXTY-FOUR-J OF THIS TITLE. INITIAL DESIGNATIONS OF SUCH PLANS OR
8 PROVIDER SYSTEMS SHOULD BE MADE NO LATER THAN APRIL FIRST, TWO THOUSAND
9 THIRTEEN, PROVIDED, HOWEVER, SUCH DESIGNATIONS SHALL BE CONTINGENT UPON
10 A DETERMINATION BY SUCH STATE COMMISSIONERS THAT THE ENTITIES TO BE
11 DESIGNATED HAVE THE CAPACITY AND FINANCIAL ABILITY TO PROVIDE SERVICES
12 IN SUCH PLANS OR PROVIDER SYSTEMS, AND THAT THE REGION HAS A SUFFICIENT
13 POPULATION AND SERVICE BASE TO SUPPORT SUCH PLANS AND SYSTEMS. ONCE
14 DESIGNATED, THE COMMISSIONER OF HEALTH SHALL MAKE ARRANGEMENTS TO ENROLL
15 SUCH ENROLLEES, CONSISTENT WITH SECTION THREE HUNDRED SIXTY-FOUR-J OF
16 THIS TITLE, IN SUCH PLANS OR INTEGRATED PROVIDER SYSTEMS AND TO PAY SUCH
17 PLANS OR PROVIDER SYSTEMS ON A CAPITATED OR OTHER BASIS TO MANAGE, COOR-
18 DINATE, AND PAY FOR BEHAVIORAL AND PHYSICAL HEALTH MEDICAL ASSISTANCE
19 SERVICES FOR SUCH ENROLLEES. THE DESIGNATIONS OF SUCH PLANS AND PROVID-
20 ER SYSTEMS, AND ANY RESULTING CONTRACTS WITH SUCH PLANS, PROVIDERS OR
21 PROVIDER SYSTEMS ARE AUTHORIZED TO BE ENTERED INTO BY SUCH STATE COMMIS-
22 SIONERS THROUGH A REQUEST FOR PROPOSAL PROCESS. OVERSIGHT OF SUCH
23 CONTRACTS WITH SUCH PLANS, PROVIDERS OR PROVIDER SYSTEMS SHALL BE THE
24 JOINT RESPONSIBILITY OF SUCH STATE COMMISSIONERS, AND FOR CONTRACTS
25 AFFECTING THE CITY OF NEW YORK, ALSO WITH THE CITY'S LOCAL SOCIAL
26 SERVICES DISTRICT AND LOCAL GOVERNMENTAL UNIT, AS SUCH TERM IS DEFINED
27 IN THE MENTAL HYGIENE LAW.
28 S 48. The public health law is amended by adding a new section 2997-d
29 to read as follows:
30 S 2997-D. HOSPITAL, NURSING HOME, HOME CARE, SPECIAL NEEDS ASSISTED
31 LIVING RESIDENCES AND ENHANCED ASSISTED LIVING RESIDENCES PALLIATIVE
32 CARE SUPPORT. 1. (A) "PALLIATIVE CARE" MEANS THE ACTIVE, INTERDISCIPLI-
33 NARY CARE OF PATIENTS WITH ADVANCED, LIFE-LIMITING ILLNESS, FOCUSING ON
34 RELIEF OF DISTRESSING PHYSICAL AND PSYCHOSOCIAL SYMPTOMS AND MEETING
35 SPIRITUAL NEEDS. ITS GOAL IS ACHIEVEMENT OF THE BEST QUALITY OF LIFE FOR
36 PATIENTS AND FAMILIES.
37 (B) "APPROPRIATE" HAS THE SAME MEANING AS PARAGRAPH (A) OF SUBDIVISION
38 ONE OF SECTION TWENTY-NINE HUNDRED NINETY-SEVEN-C OF THIS TITLE.
39 2. GENERAL HOSPITALS, NURSING HOMES, ORGANIZATIONS LICENSED OR CERTI-
40 FIED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER, AND ORGANIZATIONS
41 LICENSED AS SPECIAL NEEDS ASSISTED LIVING RESIDENCES OR ENHANCED
42 ASSISTED LIVING RESIDENCES PURSUANT TO ARTICLE FORTY-SIX-B OF THIS CHAP-
43 TER SHALL ESTABLISH POLICIES AND PROCEDURES TO PROVIDE PATIENTS WITH
44 ADVANCED LIFE LIMITING CONDITIONS AND ILLNESSES WHO MIGHT BENEFIT FROM
45 PALLIATIVE CARE AND PAIN MANAGEMENT SERVICES WITH ACCESS TO INFORMATION
46 AND COUNSELING REGARDING PALLIATIVE CARE AND PAIN MANAGEMENT OPTIONS
47 APPROPRIATE TO THE PATIENT. POLICIES MUST INCLUDE PROVISION FOR
48 PATIENTS WHO LACK CAPACITY TO MAKE MEDICAL DECISIONS, SO THAT ACCESS TO
49 SUCH INFORMATION AND COUNSELING SHALL BE PROVIDED TO THE PERSONS WHO ARE
50 LEGALLY AUTHORIZED TO MAKE MEDICAL DECISIONS ON BEHALF OF SUCH PATIENTS.
51 3. GENERAL HOSPITALS, NURSING HOMES, ORGANIZATIONS LICENSED OR CERTI-
52 FIED PURSUANT TO ARTICLE THIRTY-SIX OF THIS CHAPTER, AND ORGANIZATIONS
53 LICENSED AS SPECIAL NEEDS ASSISTED LIVING RESIDENCES OR ENHANCED
54 ASSISTED LIVING RESIDENCES PURSUANT TO ARTICLE FORTY-SIX-B OF THIS CHAP-
55 TER SHALL FACILITATE ACCESS TO APPROPRIATE PALLIATIVE CARE AND PAIN
A. 4009--C 140
1 MANAGEMENT CONSULTATIONS AND SERVICES INCLUDING BUT NOT LIMITED TO
2 REFERRALS CONSISTENT WITH PATIENT NEEDS AND PREFERENCES.
3 S 49. Intentionally omitted.
4 S 50. Intentionally omitted.
5 S 51. Intentionally omitted.
6 S 52. Article 29-D of the public health law is amended by adding a new
7 title 4 to read as follows:
8 TITLE 4
9 NEUROLOGICAL IMPAIRMENT FUND
10 SECTION 2999-G. NEW YORK STATE NEUROLOGICAL IMPAIRMENT FUND.
11 2999-H. DEFINITIONS.
12 2999-I. NEW YORK STATE NEUROLOGICAL IMPAIRMENT BOARD.
13 2999-J. CUSTODY AND ADMINISTRATION OF THE FUND.
14 S 2999-G. NEW YORK STATE NEUROLOGICAL IMPAIRMENT FUND. THERE IS HEREBY
15 CREATED THE NEW YORK STATE NEUROLOGICAL IMPAIRMENT FUND (THE "FUND")
16 WITHIN THE DEPARTMENT OF FINANCIAL SERVICES TO BE ADMINISTERED BY THE
17 NEW YORK STATE NEUROLOGICAL IMPAIRMENT BOARD. THE FUND SHALL BE USED TO
18 MITIGATE OR SUBSIDIZE COSTS RELATED TO MEDICAL MALPRACTICE OR PREMIUMS
19 OF MEDICAL MALPRACTICE INSURANCE, AS DEFINED IN SUBSECTION (B) OF
20 SECTION FIFTY-FIVE HUNDRED ONE OF THE INSURANCE LAW, RELATED TO OBSTET-
21 RIC SERVICES OF QUALIFIED HOSPITALS.
22 S 2999-H. DEFINITIONS. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF
23 LAW, FOR THE PURPOSES OF THIS ARTICLE "QUALIFIED HOSPITAL" SHALL MEAN A
24 GENERAL HOSPITAL, AS DEFINED IN ARTICLE TWENTY-EIGHT OF THIS CHAPTER,
25 THAT IS CERTIFIED BY THE NEW YORK STATE NEUROLOGICAL IMPAIRMENT BOARD TO
26 HAVE IMPLEMENTED AN OBSTETRICAL PATIENT SAFETY ASSESSMENT PROGRAM
27 APPROVED BY THE NEW YORK STATE OBSTETRICAL PATIENT SAFETY ASSESSMENT
28 WORKGROUP.
29 S 2999-I. NEW YORK STATE NEUROLOGICAL IMPAIRMENT BOARD. 1. THE NEW
30 YORK STATE NEUROLOGICAL IMPAIRMENT BOARD ("THE BOARD") IS HEREBY CREATED
31 FOR PURPOSES OF CERTIFYING QUALIFIED HOSPITALS AND MANAGING THE NEURO-
32 LOGICAL IMPAIRMENT FUND PURSUANT TO SECTION TWENTY-NINE HUNDRED NINETY-
33 NINE-G OF THIS TITLE.
34 2. THE BOARD SHALL BE GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF
35 NINE MEMBERS; THREE APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE THE
36 SUPERINTENDENT OF FINANCIAL SERVICES, THREE APPOINTED BY THE TEMPORARY
37 PRESIDENT OF THE SENATE, AND THREE APPOINTED BY THE SPEAKER OF THE
38 ASSEMBLY. ALL OF THE DIRECTORS SHALL HAVE EQUAL VOTING RIGHTS AND SIX OR
39 MORE DIRECTORS SHALL CONSTITUTE A QUORUM. THE AFFIRMATIVE VOTE OF SIX
40 DIRECTORS SHALL BE NECESSARY FOR THE TRANSACTION OF ANY BUSINESS OR THE
41 EXERCISE OF ANY POWER OF THE BOARD. THE SUPERINTENDENT OF FINANCIAL
42 SERVICES SHALL BE THE CHAIR OF THE BOARD.
43 3. A VACANCY OCCURRING IN A BOARD MEMBER POSITION SHALL BE FILLED IN
44 THE SAME MANNER AS THE INITIAL APPOINTMENT TO THAT POSITION.
45 4. THE BOARD IS CHARGED WITH THE FOLLOWING POWERS AND DUTIES:
46 (A) CERTIFY, OR CAUSE TO BE CERTIFIED, GENERAL HOSPITALS THAT HAVE
47 IMPLEMENTED AN OBSTETRICAL PATIENT SAFETY ASSESSMENT PROGRAM APPROVED BY
48 THE NEW YORK STATE OBSTETRICAL PATIENT SAFETY ASSESSMENT WORKGROUP
49 PURSUANT TO SECTION TWENTY-NINE HUNDRED NINETY-NINE-L OF THIS ARTICLE;
50 (B) ESTABLISH A MECHANISM TO MITIGATE OR SUBSIDIZE COSTS RELATED TO
51 MEDICAL MALPRACTICE OR MEDICAL MALPRACTICE INSURANCE PREMIUMS RELATED TO
52 OBSTETRIC SERVICES OF QUALIFIED HOSPITALS AND TAKE NECESSARY ACTIONS TO
53 IMPLEMENT SUCH PLAN;
54 (C) ESTABLISH RULES AND PROCEDURES FOR DISBURSEMENT OF FUNDS;
55 (D) ESTABLISH RULES FOR ELIGIBILITY AND CONTINUED ELIGIBILITY FOR
56 OBTAINING BENEFITS THROUGH THE FUND BY QUALIFIED HOSPITALS; AND
A. 4009--C 141
1 (E) ENGAGE IN SUCH ADDITIONAL ACTIONS AS THE BOARD OF DIRECTORS MAY
2 DEEM NECESSARY OR PROPER FOR THE EXECUTION OF THE POWERS AND DUTIES OF
3 THE BOARD.
4 5. NO LIABILITY OR CAUSE OF ACTION SHALL EXIST AGAINST THE BOARD, ITS
5 MEMBERS OR EMPLOYEES, AND THE SUPERINTENDENT OF FINANCIAL SERVICES OR
6 HIS OR HER AUTHORIZED REPRESENTATIVES FOR ALL REASONABLE AND GOOD FAITH
7 ACTIONS TAKEN PURSUANT TO THIS ARTICLE.
8 S 2999-J. CUSTODY AND ADMINISTRATION OF THE FUND. 1. THE COMPTROLLER
9 SHALL BE THE CUSTODIAN OF THE FUND. ALL PAYMENTS FROM THE FUND SHALL BE
10 MADE BY THE COMPTROLLER UPON CERTIFICATES SIGNED BY THE CHAIR OF THE NEW
11 YORK STATE NEUROLOGICAL IMPAIRMENT BOARD, OR HIS OR HER DESIGNEE, AS
12 HEREINAFTER PROVIDED. THE FUND SHALL BE SEPARATE AND APART FROM ANY
13 OTHER FUND AND FROM ALL OTHER STATE MONIES. NO MONIES FROM THE FUND
14 SHALL BE TRANSFERRED TO ANY OTHER FUND, NOR SHALL ANY SUCH MONIES BE
15 APPLIED TO THE MAKING OF ANY PAYMENT FOR ANY PURPOSE OTHER THAN THE
16 PURPOSE SET FORTH IN THIS TITLE.
17 2. THE FUND SHALL BE ADMINISTERED BY THE NEW YORK STATE NEUROLOGICAL
18 IMPAIRMENT BOARD IN ACCORDANCE WITH THE PROVISIONS OF THIS ARTICLE.
19 3. THE EXPENSE OF ADMINISTERING THE FUND, INCLUDING THE EXPENSES
20 INCURRED BY THE DEPARTMENT, SHALL BE PAID FROM THE FUND.
21 4. MONIES FOR THE FUND WILL BE PROVIDED PURSUANT TO THIS CHAPTER.
22 5. BEGINNING APRIL FIRST, TWO THOUSAND TWELVE AND ANNUALLY THEREAFT-
23 ER, THE SUPERINTENDENT OF FINANCIAL SERVICES SHALL CAUSE TO BE DEPOSITED
24 INTO THE FUND, SUBJECT TO AVAILABLE APPROPRIATIONS, AN AMOUNT EQUAL TO
25 THE DIFFERENCE BETWEEN THE AMOUNT APPROPRIATED TO THE FUND IN THE
26 PRECEDING YEAR, AS INCREASED BY THE ADJUSTMENT FACTOR DEFINED IN SUBDI-
27 VISION SIX OF THIS SECTION, AND THE ASSETS OF THE FUND AT THE CONCLUSION
28 OF THAT FISCAL YEAR.
29 6. FOR PURPOSES OF THIS SECTION, THE ADJUSTMENT FACTOR REFERENCED IN
30 THIS SECTION SHALL BE THE TEN YEAR ROLLING AVERAGE MEDICAL COMPONENT OF
31 THE CONSUMER PRICE INDEX AS PUBLISHED BY THE UNITED STATES DEPARTMENT OF
32 LABOR, BUREAU OF LABOR STATISTICS, FOR THE PRECEDING TEN YEARS.
33 S 52-a. Article 29-D of the public health law is amended by adding a
34 new title 5 to read as follows:
35 TITLE 5
36 SECTION 2999-L. NEW YORK STATE OBSTETRICAL PATIENT SAFETY ASSESSMENT
37 WORKGROUP.
38 S 2999-L. NEW YORK STATE OBSTETRICAL PATIENT SAFETY ASSESSMENT WORK-
39 GROUP. 1. THE COMMISSIONER SHALL, WITHIN THIRTY DAYS OF THE EFFECTIVE
40 DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND ELEVEN WHICH ADDED THIS
41 TITLE, CREATE AND CONVENE THE NEW YORK STATE OBSTETRICAL PATIENT SAFETY
42 ASSESSMENT WORKGROUP. THE WORKGROUP SHALL BE COMPRISED OF MEDICAL,
43 HOSPITAL AND ACADEMIC EXPERTS, PATIENT REPRESENTATIVES, AND OTHER STAKE-
44 HOLDERS AS THE COMMISSIONER DEEMS APPROPRIATE.
45 2. THE WORKGROUP IS CHARGED WITH ESTABLISHING INITIATIVES AND GUIDANCE
46 TO GENERAL HOSPITALS TO ENCOURAGE THE REDUCTION OF BIRTH-RELATED NEURO-
47 LOGICAL IMPAIRED INJURIES AND APPROVING OBSTETRICAL PATIENT SAFETY
48 PROGRAMS OF SUCH GENERAL HOSPITALS.
49 3. NO LATER THAN JULY FIRST, TWO THOUSAND ELEVEN, THE WORKGROUP SHALL
50 CREATE A MECHANISM OF APPROVING OBSTETRICAL PATIENT SAFETY ASSESSMENT
51 PROGRAMS.
52 S 52-b. Subdivision 1 of section 2807-v of the public health law is
53 amended by adding a new paragraph (iii) to read as follows:
54 (III) FUNDS SHALL BE RESERVED AND SET ASIDE AND ACCUMULATED FROM YEAR
55 TO YEAR AND SHALL BE MADE AVAILABLE, INCLUDING INCOME FROM INVESTMENT
56 FUNDS, FOR THE PURPOSE OF SUPPORTING THE NEW YORK STATE NEUROLOGICAL
A. 4009--C 142
1 IMPAIRMENT FUND AS AUTHORIZED PURSUANT TO TITLE FOUR OF ARTICLE TWENTY-
2 NINE-D OF THIS CHAPTER, FOR THE FOLLOWING PERIODS AND IN THE FOLLOWING
3 AMOUNTS, PROVIDED, HOWEVER, THAT THE COMMISSIONER IS AUTHORIZED TO SEEK
4 WAVIER AUTHORITY FROM THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID FOR
5 THE PURPOSE OF SECURING MEDICAID FEDERAL FINANCIAL PARTICIPATION FOR
6 SUCH PROGRAM, IN WHICH CASE THE FUNDING AUTHORIZED PURSUANT TO THIS
7 PARAGRAPH SHALL BE UTILIZED AS THE NON-FEDERAL SHARE FOR SUCH PAYMENTS:
8 ONE HUNDRED MILLION DOLLARS FOR THE PERIOD APRIL FIRST, TWO THOUSAND
9 ELEVEN THROUGH MARCH THIRTY-FIRST, TWO THOUSAND TWELVE.
10 S 52-c. The public health law is amended by adding a new section
11 2807-d-1 to read as follows:
12 S 2807-D-1. HOSPITAL QUALITY CONTRIBUTIONS. 1. NOTWITHSTANDING ANY
13 CONTRARY PROVISION OF LAW AND SUBJECT TO THE RECEIPT OF ALL NECESSARY
14 FEDERAL APPROVALS OR WAIVERS, FOR PERIODS ON AND AFTER JULY FIRST, TWO
15 THOUSAND ELEVEN, A QUALITY CONTRIBUTION SHALL BE IMPOSED ON THE INPA-
16 TIENT REVENUE OF EACH GENERAL HOSPITAL EQUAL TO THREE TENTHS OF ONE
17 PERCENT OF SUCH REVENUE, AS DEFINED IN ACCORDANCE WITH PARAGRAPH (A) OF
18 SUBDIVISION THREE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-D OF THIS ARTI-
19 CLE, AND PROVIDED FURTHER, HOWEVER, THAT ON AND AFTER JULY FIRST, TWO
20 THOUSAND ELEVEN, AN ADDITIONAL QUALITY CONTRIBUTION EQUAL TO FOUR
21 PERCENT OF SUCH INPATIENT REVENUE SHALL BE IMPOSED WITH REGARD TO ALL
22 SUCH INPATIENT REVENUE THAT IS RECEIVED FOR THE PROVISION OF INPATIENT
23 OBSTETRICAL PATIENT CARE SERVICES, PROVIDED, HOWEVER, THAT SUCH ADDI-
24 TIONAL QUALITY CONTRIBUTION IS SUBJECT TO RECEIPT OF ALL NECESSARY
25 FEDERAL APPROVALS OR WAIVERS, AS DETERMINED AS NECESSARY BY THE COMMIS-
26 SIONER, AND PROVIDED FURTHER, HOWEVER, THAT IN THE EVENT THE COMMISSION-
27 ER, IN CONSULTATION WITH THE DIRECTOR OF THE BUDGET, DETERMINES THAT
28 SUCH QUALITY CONTRIBUTION AND SUCH ADDITIONAL QUALITY CONTRIBUTION SHALL
29 RAISE LESS THAN OR MORE THAN TOTAL QUALITY COLLECTION AMOUNT SET FORTH
30 IN SUBDIVISION TWO OF THIS SECTION, THEN IN THAT EVENT THE COMMISSIONER,
31 IN CONSULTATION WITH THE DIRECTOR OF THE BUDGET, MAY PROMULGATE REGU-
32 LATIONS, AND MAY PROMULGATE EMERGENCY REGULATIONS, INCREASING OR
33 DECREASING SUCH QUALITY CONTRIBUTIONS BY AMOUNTS SUFFICIENT TO ENSURE
34 THE COLLECTION OF SUCH ANNUAL QUALITY CONTRIBUTION AMOUNT AND TO ENSURE
35 THAT FIFTY-FIVE PERCENT OF SUCH AGGREGATE AMOUNT IS RAISED BY SUCH QUAL-
36 ITY CONTRIBUTION AND FORTY-FIVE PERCENT IS RAISED BY SUCH ADDITIONAL
37 QUALITY CONTRIBUTION.
38 2. THE ANNUAL QUALITY CONTRIBUTION AMOUNT REFERENCED IN SUBDIVISION
39 ONE OF THIS SECTION SHALL BE ONE HUNDRED SEVENTY MILLION DOLLARS FOR THE
40 STATE FISCAL YEAR BEGINNING APRIL FIRST, TWO THOUSAND ELEVEN, AND FOR
41 EACH SUBSEQUENT STATE FISCAL YEAR THEREAFTER IT SHALL BE THE AMOUNT OF
42 THE PRECEDING YEAR AS INCREASED BY THE TEN YEAR ROLLING AVERAGE OF THE
43 MEDICAL COMPONENT OF THE CONSUMER PRICE INDEX AS PUBLISHED BY THE UNITED
44 STATES DEPARTMENT OF LABOR, BUREAU OF LABOR STATISTICS, FOR THE PRECED-
45 ING TEN YEARS.
46 3. THE QUALITY CONTRIBUTIONS DESCRIBED IN THIS SECTION SHALL BE ADMIN-
47 ISTERED IN ACCORDANCE WITH AND SUBJECT TO THE PROVISIONS OF SUBDIVISIONS
48 FOUR, FIVE, SIX, SEVEN, EIGHT AND TWELVE OF SECTION TWENTY-EIGHT HUNDRED
49 SEVEN-D OF THIS ARTICLE, PROVIDED, HOWEVER, THAT SUCH QUALITY CONTRIB-
50 UTIONS SHALL BE DEPOSITED IN THE HCRA RESOURCES FUND AS ESTABLISHED
51 PURSUANT TO SECTION NINETY-TWO-DD OF THE STATE FINANCE LAW; AND PROVIDED
52 FURTHER, HOWEVER, THAT SUCH CONTRIBUTION SHALL NOT BE AN ALLOWABLE COST
53 IN THE DETERMINATION OF REIMBURSEMENT RATES OF PAYMENT COMPUTED PURSUANT
54 TO THIS ARTICLE.
55 S 53. Intentionally omitted.
A. 4009--C 143
1 S 54. Subparagraph 12 of paragraph (a) of subdivision 1 of section
2 366 of the social services law, as amended by section 42-a of part C of
3 chapter 58 of the laws of 2008, is amended to read as follows:
4 (12) is a disabled person at least sixteen years of age, but under the
5 age of sixty-five, who: would be eligible for benefits under the supple-
6 mental security income program but for earnings in excess of the allow-
7 able limit; has net available income that does not exceed two hundred
8 fifty percent of the applicable federal income official poverty line, as
9 defined and updated by the United States department of health and human
10 services, for a one-person or two-person household, as defined by the
11 commissioner in regulation; has household resources, as defined in para-
12 graph (e) of subdivision two of section three hundred sixty-six-c of
13 this title, OTHER THAN RETIREMENT ACCOUNTS, that do not exceed [the
14 amount described in subparagraph four of paragraph (a) of subdivision
15 two of this section] TWENTY THOUSAND DOLLARS for a one-person HOUSEHOLD
16 or THIRTY THOUSAND DOLLARS FOR A two-person household, as defined by the
17 commissioner in regulation; and contributes to the cost of medical
18 assistance provided pursuant to this subparagraph in accordance with
19 subdivision twelve of section three hundred sixty-seven-a of this title;
20 for purposes of this subparagraph, disabled means having a medically
21 determinable impairment of sufficient severity and duration to qualify
22 for benefits under section 1902(a)(10)(A)(ii)(xv) of the social security
23 act; or
24 S 55. Intentionally omitted.
25 S 56. Intentionally omitted.
26 S 57. Intentionally omitted.
27 S 58. Section 2805-l of the public health law, as added by chapter 266
28 of the laws of 1986, subdivision 3 as amended by chapter 542 of the laws
29 of 2000, subdivision 4 as added and subdivision 5 as renumbered by chap-
30 ter 632 of the laws of 2006, is amended to read as follows:
31 S 2805-l. [Incident] ADVERSE EVENT reporting. 1. (A) All hospitals[,
32 as defined in subdivision ten of section twenty-eight hundred one of
33 this article,] shall be required to report [incidents] EVENTS described
34 by subdivision two of this section to the department in a manner and
35 within time periods as may be specified by regulation of the department.
36 (B) FOR PURPOSES OF THIS SECTION, "HOSPITAL" MEANS ANY GENERAL HOSPI-
37 TAL OR DIAGNOSTIC AND TREATMENT CENTER.
38 2. The following [incidents] ADVERSE EVENTS shall be reported to the
39 department:
40 (a) patients' deaths or impairments of bodily functions in circum-
41 stances other than those related to the natural course of illness,
42 disease or proper treatment in accordance with generally accepted
43 medical standards;
44 (b) fires in the hospital which disrupt the provision of patient care
45 services or cause harm to patients or staff;
46 (c) equipment malfunction during treatment or diagnosis of a patient
47 which did or could have adversely affected a patient or hospital person-
48 nel;
49 (d) poisoning occurring within the hospital;
50 (e) strikes by hospital staff;
51 (f) disasters or other emergency situations external to the hospital
52 environment which affect hospital operations; and
53 (g) termination of any services vital to the continued safe operation
54 of the hospital or to the health and safety of its patients and person-
55 nel, including but not limited to the anticipated or actual termination
A. 4009--C 144
1 of telephone, electric, gas, fuel, water, heat, air conditioning, rodent
2 or pest control, laundry services, food or contract services.
3 (H) OTHER SERIOUS ADVERSE EVENTS AS DETERMINED BY THE COMMISSIONER, BY
4 REGULATION, AFTER CONSIDERATION OF NATIONAL STANDARDS AND EXPERT ADVICE
5 IN CONSULTATION AS APPROPRIATE WITH CLINICIANS, HOSPITAL ADMINISTRATORS,
6 RESEARCHERS AND CONSUMERS WITH EXPERTISE IN THE AREA OF PATIENT SAFETY
7 AND QUALITY IMPROVEMENT.
8 3. The hospital shall conduct an investigation of [incidents] EVENTS
9 described in paragraphs (a) through (d) of subdivision two of this
10 section within thirty days of obtaining knowledge of any information
11 which reasonably appears to show that such an [incident] EVENT has
12 occurred, provided that, if the hospital reasonably expects such inves-
13 tigation to extend beyond such thirty day period, the hospital shall
14 notify the department of such expectation and the reason therefor, and
15 shall inform the department of the expected completion date of the
16 investigation. The hospital shall provide to the department a copy of
17 the investigation report within twenty-four hours of completion. Nothing
18 herein shall limit the authority of the department to conduct an inves-
19 tigation of [incidents] ADVERSE EVENTS occurring in [general] hospitals.
20 4. THE DEPARTMENT SHALL:
21 (A) ANALYZE EVENT REPORTS, FINDINGS OF THE INVESTIGATIONS, THEIR ROOT
22 CAUSE ANALYSES, AND CORRECTIVE ACTION PLANS TO DETERMINE PATTERNS OF
23 SYSTEMIC FAILURE IN THE HEALTH CARE SYSTEM AND IDENTIFY SUCCESSFUL METH-
24 ODS TO CORRECT THESE FAILURES AND USE SUCH ANALYSES IN THE DEVELOPMENT,
25 DISSEMINATING AND TRACKING OF PATIENT SAFETY GOALS AND BEST PRACTICES IN
26 PATIENT SAFETY; AND
27 (B) COMMUNICATE TO FACILITIES THE DEPARTMENT'S CONCLUSIONS, IF ANY,
28 REGARDING EVENT REPORTS, PATTERNS OF SYSTEMIC FAILURE, AND RECOMMENDA-
29 TIONS FOR CORRECTIVE ACTION RESULTING FROM THE ANALYSIS OF SUBMISSIONS
30 FROM FACILITIES AND MAY RELEASE TO HOSPITALS OR THE PUBLIC OR BOTH
31 ANALYSES AND FINDINGS DERIVED FROM THE ADVERSE EVENT DATA IN A FORMAT
32 THAT DOES NOT IDENTIFY SPECIFIC PATIENTS.
33 [4] 6. The commissioner shall establish protocols for hospital
34 personnel where a patient under the age of eighteen years dies during
35 transportation to the hospital or while at the hospital, under circum-
36 stances other than those related to the natural course of illness,
37 disease or proper treatment in accordance with generally accepted
38 medical standards. Such protocols shall address matters including, but
39 not limited to, the following:
40 (a) medical and social history, and examination of the patient;
41 (b) preservation of evidence and chain of custody;
42 (c) questioning of the patient's family, guardian or person in
43 parental authority;
44 (d) circumstances surrounding the injury resulting in death;
45 (e) determination of the cause of death;
46 (f) notification of law enforcement personnel; and
47 (g) reporting requirements under title six of article six of the
48 social services law.
49 In developing such protocols, the commissioner shall consult with the
50 office of children and family services, local departments of social
51 services, coordinators of child fatality review teams established pursu-
52 ant to section four hundred twenty-two-b of the social services law, law
53 enforcement agencies, pediatricians preferably with expertise in the
54 area of child abuse and maltreatment or forensic pediatrics, and such
55 other persons as the commissioner deems necessary.
A. 4009--C 145
1 [5] 7. The commissioner shall make, adopt, promulgate and enforce
2 such rules and regulations as he may deem appropriate to effectuate the
3 purposes of this section.
4 S 59. Intentionally omitted.
5 S 60. Intentionally omitted.
6 S 61. Intentionally omitted.
7 S 62. Intentionally omitted.
8 S 63. The social servicers law is amended by adding a new section
9 363-e to read as follows:
10 S 363-E. 1. DEFINITIONS: NOTWITHSTANDING ANY INCONSISTENT SECTION OF
11 LAW, FOR THE PURPOSES OF THIS SECTION:
12 (A) "VERIFICATION ORGANIZATION" MEANS AN ENTITY, OPERATING IN A MANNER
13 CONSISTENT WITH SECTION ELEVEN HUNDRED EIGHTY ONE OF TITLE TWENTY NINE
14 OF THE UNITED STATES CODE AND SECTIONS THIRTEEN HUNDRED TWENTY-A AND
15 THIRTEEN HUNDRED NINETY FIVE OF TITLE FORTY-TWO OF THE UNITED STATES
16 CODE AND REGULATIONS ESTABLISHED THEREUNDER, WHICH USES ELECTRONIC MEANS
17 INCLUDING BUT NOT LIMITED TO CONTEMPORANEOUS TELEPHONE VERIFICATION OR
18 CONTEMPORANEOUS VERIFIED ELECTRONIC DATA TO VERIFY WHETHER A SERVICE OR
19 ITEM WAS PROVIDED TO AN ELIGIBLE MEDICAID RECIPIENT. FOR EACH SERVICE OR
20 ITEM THE VERIFICATION ORGANIZATION SHALL CAPTURE:
21 (I) THE IDENTITY OF THE INDIVIDUAL PROVIDING SERVICES OR ITEMS TO THE
22 MEDICAID RECIPIENT;
23 (II) THE IDENTITY OF THE MEDICAID RECIPIENT; AND
24 (III) THE DATE, TIME, DURATION, LOCATION AND TYPE OF SERVICE OR ITEM.
25 A LIST OF VERIFICATION ORGANIZATIONS SHALL BE JOINTLY DEVELOPED BY THE
26 DEPARTMENT OF HEALTH AND THE OFFICE OF THE MEDICAID INSPECTOR GENERAL.
27 (B) "EXCEPTION REPORT" MEANS AN ELECTRONIC REPORT CONTAINING ALL THE
28 DATA FIELDS IN PARAGRAPH (F) OF THIS SUBDIVISION FOR CONFLICTS BETWEEN
29 SERVICES OR ITEMS ON THE BASIS OF THE IDENTITY OF THE PERSON PROVIDING
30 THE SERVICE OR ITEM TO THE MEDICAID RECIPIENT, THE IDENTITY OF THE MEDI-
31 CAID RECIPIENT, AND/OR TIME, DATE, DURATION OR LOCATION OF SERVICE;
32 (C) "CONFLICT REPORT" MEANS AN ELECTRONIC REPORT CONTAINING ALL OF THE
33 DATA FIELDS IN PARAGRAPH (F) OF THIS SUBDIVISION DETAILING INCONGRUITIES
34 IN SERVICES OR ITEMS BETWEEN SCHEDULING AND/OR LOCATION OF SERVICE WHEN
35 COMPARED TO A DUTY ROSTER.
36 (D) "HOME CARE PROVIDER" MEANS A CERTIFIED HOME HEALTH AGENCY, LONG
37 TERM HOME HEALTH AGENCY OR PERSONAL CARE PROVIDER WITH TOTAL MEDICAID
38 REIMBURSEMENTS EXCEEDING FIFTEEN MILLION DOLLARS PER CALENDAR YEAR.
39 2. PRECLAIM REVIEW FOR PARTICIPATING PROVIDERS OF MEDICAL ASSISTANCE
40 PROGRAM SERVICES AND ITEMS. EVERY SERVICE OR ITEM WITHIN A CLAIM SUBMIT-
41 TED BY A HOME CARE PROVIDER SHALL BE REVIEWED AND VERIFIED BY A VERIFI-
42 CATION ORGANIZATION PRIOR TO SUBMISSION OF A CLAIM TO THE DEPARTMENT OF
43 HEALTH. THE VERIFICATION ORGANIZATION SHALL DECLARE EACH SERVICE OR ITEM
44 TO BE VERIFIED OR UNVERIFIED. EACH HOME CARE PROVIDER SHALL RECEIVE AND
45 MAINTAIN REPORTS FROM THE VERIFICATION ORGANIZATION WHICH SHALL CONTAIN
46 DATA ON:
47 A. VERIFIED SERVICES OR ITEMS, INCLUDING WHETHER A SERVICE APPEARED ON
48 A CONFLICT OR EXCEPTION REPORT BEFORE VERIFICATION AND HOW THAT CONFLICT
49 OR EXCEPTION WAS RESOLVED; AND
50 B. SERVICES OR ITEMS THAT WERE NOT VERIFIED, INCLUDING CONFLICT AND
51 EXCEPTION REPORT DATA FOR THESE SERVICES.
52 S 64. Intentionally omitted.
53 S 65. Subparagraph (iii) of paragraph (d) of subdivision 1 of section
54 367-a of the social services law, as amended by section 53 of part C of
55 chapter 58 of the laws of 2008, is amended to read as follows:
A. 4009--C 146
1 (iii) When payment under part B of title XVIII of the federal social
2 security act for items and services provided to eligible persons who are
3 also beneficiaries under part B of title XVIII of the federal social
4 security act and for items and services provided to qualified medicare
5 beneficiaries under part B of title XVIII of the federal social security
6 act would exceed the amount that otherwise would be made under this
7 title if provided to an eligible person other than a person who is also
8 a beneficiary under part B or is a qualified medicare beneficiary, the
9 amount payable FOR SERVICES COVERED under this title shall be twenty
10 percent of the amount of any co-insurance liability of such eligible
11 persons pursuant to federal law were they not eligible for medical
12 assistance or were they not qualified medicare beneficiaries with
13 respect to such benefits under such part B; provided, however, amounts
14 payable under this title for items and services provided to eligible
15 persons who are also beneficiaries under part B or to qualified medicare
16 beneficiaries by an ambulance service under the authority of an operat-
17 ing certificate issued pursuant to article thirty of the public health
18 law, a psychologist licensed under article one hundred fifty-three of
19 the education law, or a facility under the authority of an operating
20 certificate issued pursuant to article sixteen, thirty-one or thirty-two
21 of the mental hygiene law [and with respect to outpatient hospital and
22 clinic items and services provided by a facility under the authority of
23 an operating certificate issued pursuant to article twenty-eight of the
24 public health law], shall not be less than the amount of any co-insu-
25 rance liability of such eligible persons or such qualified medicare
26 beneficiaries, or for which such eligible persons or such qualified
27 medicare beneficiaries would be liable under federal law were they not
28 eligible for medical assistance or were they not qualified medicare
29 beneficiaries with respect to such benefits under part B.
30 S 65-a. Subdivision 1 of section 367-a of the social services law is
31 amended by adding a new paragraph (g) to read as follows:
32 (G) NOTWITHSTANDING ANY PROVISION OF THIS SECTION TO THE CONTRARY,
33 AMOUNTS PAYABLE UNDER THIS TITLE FOR MEDICAL ASSISTANCE IN THE FORM OF
34 HOSPITAL OUTPATIENT SERVICES OR DIAGNOSTIC AND TREATMENT CENTER SERVICES
35 PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW PROVIDED TO
36 ELIGIBLE PERSONS WHO ARE ALSO BENEFICIARIES UNDER PART B OF TITLE XVIII
37 OF THE FEDERAL SOCIAL SECURITY ACT SHALL NOT EXCEED THE APPROVED MEDICAL
38 ASSISTANCE PAYMENT LEVEL LESS THE AMOUNT PAYABLE UNDER PART B.
39 S 66. The public health law is amended by adding a new article 44-A
40 to read as follows:
41 ARTICLE 44-A
42 ACCOUNTABLE CARE ORGANIZATIONS
43 SECTION 4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE.
44 4421. DEFINITIONS.
45 4422. ESTABLISHMENT OF ACCOUNTABLE CARE ORGANIZATIONS.
46 4423. CERTIFICATE OF AUTHORITY.
47 S 4420. ACCOUNTABLE CARE ORGANIZATIONS; FINDINGS; PURPOSE. THE LEGIS-
48 LATURE INTENDS TO FACILITATE THE ABILITY OF ACCOUNTABLE CARE ORGANIZA-
49 TIONS TO ASSUME A LARGER ROLE IN DELIVERING A FULL ARRAY OF HEALTH CARE
50 SERVICES, FROM PRIMARY AND PREVENTIVE CARE THROUGH ACUTE INPATIENT
51 HOSPITAL AND POST-HOSPITAL CARE. THE LEGISLATURE FINDS THAT THE FORMA-
52 TION AND OPERATION OF ACCOUNTABLE CARE ORGANIZATIONS UNDER THIS ARTICLE
53 CAN BE CONSISTENT WITH THE PURPOSES OF FEDERAL AND STATE ANTI-TRUST,
54 ANTI-REFERRAL, AND OTHER STATUTES, INCLUDING REDUCING OVER-UTILIZATION
55 AND EXPENDITURES. THE LEGISLATURE FINDS THAT THE DEVELOPMENT OF ACCOUNT-
56 ABLE CARE ORGANIZATIONS UNDER THIS ARTICLE WILL REDUCE HEALTH CARE
A. 4009--C 147
1 COSTS, PROMOTE EFFECTIVE ALLOCATION OF HEALTH CARE RESOURCES, AND
2 ENHANCE THE QUALITY AND ACCESSIBILITY OF HEALTH CARE. THE LEGISLATURE
3 FINDS THAT THIS ARTICLE IS NECESSARY TO PROMOTE THE FORMATION OF
4 ACCOUNTABLE CARE ORGANIZATIONS AND PROTECT THE PUBLIC INTEREST AND THE
5 INTERESTS OF PATIENTS AND HEALTH CARE PROVIDERS.
6 S 4421. DEFINITIONS. AS USED IN THIS ARTICLE, THE FOLLOWING TERMS
7 SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
8 OTHERWISE:
9 1. "ACCOUNTABLE CARE ORGANIZATION" AND "ACO" MEAN AN ACCOUNTABLE CARE
10 ORGANIZATION CERTIFIED BY THE COMMISSIONER UNDER THIS ARTICLE.
11 2. "CERTIFICATE OF AUTHORITY" OR "CERTIFICATE" MEANS A CERTIFICATE OF
12 AUTHORITY ISSUED BY THE COMMISSIONER UNDER THIS ARTICLE.
13 3. "HEALTH CARE PROVIDER" MEANS AN ENTITY LICENSED OR CERTIFIED UNDER
14 ARTICLE TWENTY-EIGHT OR THIRTY-SIX OF THIS CHAPTER; AN ENTITY LICENSED
15 OR CERTIFIED UNDER ARTICLE SIXTEEN, THIRTY-ONE OR THIRTY-TWO OF THE
16 MENTAL HYGIENE LAW; OR A HEALTH CARE PRACTITIONER LICENSED OR CERTIFIED
17 UNDER TITLE EIGHT OF THE EDUCATION LAW OR A LAWFUL COMBINATION OF SUCH
18 HEALTH CARE PRACTITIONERS; IT MAY ALSO INCLUDE OTHER ENTITIES THAT
19 PROVIDE TECHNICAL ASSISTANCE, INFORMATION SYSTEMS AND SERVICES, CARE
20 COORDINATION AND OTHER SERVICES TO HEALTH CARE PROVIDERS AND PATIENTS
21 PARTICIPATING IN AN ACO.
22 4. "PRIMARY CARE" MEANS THE HEALTH CARE FIELDS OF FAMILY PRACTICE,
23 GENERAL PEDIATRICS, PRIMARY CARE INTERNAL MEDICINE, PRIMARY CARE OBSTET-
24 RICS, OR PRIMARY CARE GYNECOLOGY, WITHOUT REGARD TO BOARD CERTIFICATION,
25 AND SHALL APPLY TO ANY HEALTH CARE PROVIDER ACTING WITHIN HIS, HER, OR
26 ITS LAWFUL SCOPE OF PRACTICE.
27 5. "THIRD-PARTY HEALTH CARE PAYER" INCLUDES, IN ADDITION TO ITS ORDI-
28 NARY MEANINGS, AN ENTITY SUCH AS A PHARMACY BENEFITS MANAGER, FISCAL
29 ADMINISTRATOR, OR ADMINISTRATIVE SERVICES PROVIDER THAT PARTICIPATES IN
30 THE ADMINISTRATION OF A THIRD-PARTY HEALTH CARE PAYER SYSTEM.
31 S 4422. ESTABLISHMENT OF ACCOUNTABLE CARE ORGANIZATIONS. 1. AN
32 ACCOUNTABLE CARE ORGANIZATION IS A NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY
33 WHICH (A) IS AN ORGANIZATION OF HEALTH CARE PROVIDERS THAT WORK TOGETHER
34 TO PROVIDE, MANAGE, AND COORDINATE HEALTH CARE (INCLUDING PRIMARY CARE)
35 FOR A DEFINED POPULATION; WITH A MECHANISM FOR SHARED GOVERNANCE; THE
36 ABILITY TO NEGOTIATE, RECEIVE, AND DISTRIBUTE PAYMENTS; AND ACCOUNTABIL-
37 ITY FOR THE QUALITY, COST, AND DELIVERY OF HEALTH CARE TO THE ACO'S
38 PATIENTS; IN ACCORDANCE WITH THIS ARTICLE; AND (B) HAS BEEN ISSUED A
39 CERTIFICATE OF AUTHORITY BY THE COMMISSIONER UNDER THIS ARTICLE.
40 2. AN ACO SHALL:
41 (A) HAVE A GOVERNANCE SYSTEM THAT REASONABLY, EQUITABLY AND DEMOCRAT-
42 ICALLY REPRESENTS THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, EMPLOY-
43 EES OF PARTICIPATING HEALTH CARE PROVIDERS, THE ACO'S ENROLLEES AND
44 PATIENTS, AND THE GENERAL PUBLIC.
45 (B) DEFINE THE POPULATION PROPOSED TO BE SERVED BY THE ACO, WHICH MAY
46 INCLUDE REFERENCE TO A GEOGRAPHICAL AREA AND PATIENT CHARACTERISTICS.
47 (C) INCLUDE AN ADEQUATE NETWORK OF PARTICIPATING HEALTH CARE PROVIDERS
48 TO PROVIDE THE HEALTH CARE FOR WHICH THE ACO IS ACCOUNTABLE, INCLUDING
49 PRIMARY CARE HEALTH CARE PROVIDERS, AND AT LEAST ONE FEDERALLY-QUALIFIED
50 HEALTH CENTER (PROVIDED THAT THE COMMISSIONER MAY WAIVE THIS REQUIREMENT
51 IF THERE IS NO FEDERALLY-QUALIFIED HEALTH CENTER SERVING THE AREA SERVED
52 BY THE ACO).
53 (D) HAVE DEFINED MECHANISMS FOR PROVIDING, MANAGING, AND COORDINATING
54 HIGH QUALITY HEALTH CARE FOR THE ACO'S PATIENTS, INCLUDING: ELEVATING
55 THE SERVICES OF PRIMARY CARE HEALTH CARE PROVIDERS TO MEET PATIENT-CEN-
56 TERED MEDICAL HOME STANDARDS; COORDINATING INTENSIVE SERVICES FOR
A. 4009--C 148
1 COMPLEX HIGH-NEED PATIENTS; PROVIDING ACCESS TO HEALTH CARE PROVIDERS
2 THAT ARE NOT PARTICIPANTS IN THE ACO; AND PROVIDING ACCESS TO THE FULL
3 RANGE OF REPRODUCTIVE HEALTH CARE FOR THE POPULATION SERVED.
4 (E) HAVE DEFINED MECHANISMS FOR RECEIVING AND DISTRIBUTING PAYMENTS TO
5 THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INCENTIVE
6 PAYMENTS (WHICH MAY INCLUDE MEDICAL HOME PAYMENTS) AND PAYMENTS FOR
7 HEALTH CARE SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS AND PATIENTS.
8 AN ACO MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS RECEIVED BY PARTIC-
9 IPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS AND PATIENTS.
10 (F) HAVE REASONABLE MECHANISMS AND CRITERIA FOR ACCEPTING HEALTH CARE
11 PROVIDERS TO PARTICIPATE IN THE ACO THAT ARE RELATED TO THE NEEDS OF THE
12 PATIENT POPULATION TO BE SERVED AND NEEDS AND PURPOSES OF THE ACO AND DO
13 NOT DISCRIMINATE ON OTHER GROUNDS.
14 (G) HAVE A LEADERSHIP AND MANAGEMENT STRUCTURE THAT INCLUDES CLINICAL
15 AND ADMINISTRATIVE SYSTEMS AND CLINICAL PARTICIPATION.
16 (H) HAVE APPROPRIATE QUALITY ASSURANCE MECHANISMS, GRIEVANCE PROCE-
17 DURES FOR HEALTH CARE PROVIDERS AND PATIENTS, AND PROCEDURES FOR REVIEW-
18 ING AND APPEALING PATIENT CARE DECISIONS.
19 (I) PROVIDE SATISFACTORY EVIDENCE OF THE CHARACTER AND COMPETENCE OF
20 THE ACO.
21 (J) HAVE THE ABILITY TO OPERATE ON A FISCALLY SOUND AND FINANCIALLY
22 RESPONSIBLE BASIS, INCLUDING REASONABLE CAPITALIZATION AND RESERVES, AND
23 CONSIDERING THE PAYMENT ARRANGEMENTS ENTERED INTO BY THE ACO.
24 (K) IN ITS APPLICATION AND FROM TIME TO TIME, AS REQUIRED BY THE
25 COMMISSIONER, PROVIDE THE COMMISSIONER WITH INFORMATION AND DATA RELAT-
26 ING TO:
27 (I) THE ACO'S PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INDIVID-
28 UAL HEALTH CARE PRACTITIONERS AFFILIATED WITH SUCH HEALTH CARE PROVIDER
29 WHO PROVIDE HEALTH CARE TO THE HEALTH CARE PROVIDER'S PATIENTS.
30 (II) DATA, INCLUDING ENCOUNTER DATA, RELATING TO THE NATURE, OUTCOME,
31 AND QUALITY OF, AND PAYMENT FOR, HEALTH CARE PROVIDED BY THE PARTICIPAT-
32 ING HEALTH CARE PROVIDER TO THE PARTICIPATING PATIENT.
33 (L) HAVE MECHANISMS TO PROMOTE EVIDENCE-BASED HEALTH CARE, PATIENT
34 ENGAGEMENT, COORDINATION OF CARE, ELECTRONIC HEALTH RECORDS, AND OTHER
35 ENABLING TECHNOLOGIES.
36 3. THE COMMISSIONER, IN CONSULTATION WITH HEALTH CARE PROVIDERS,
37 THIRD-PARTY HEALTH CARE PAYERS, ADVOCATES REPRESENTING PATIENTS, THE
38 SUPERINTENDENT OF INSURANCE, AND OTHER APPROPRIATE PARTIES, SHALL:
39 (A) ESTABLISH APPROPRIATE REQUIREMENTS FOR ACOS TO PROMOTE COMPLIANCE
40 WITH THE PURPOSES OF THIS ARTICLE.
41 (B) ESTABLISH APPROPRIATE PERFORMANCE STANDARDS FOR, AND MEASURES TO
42 ASSESS, THE QUALITY OF CARE PROVIDED BY AN ACO, SUCH AS MEASURES OF:
43 (I) CLINICAL PROCESSES AND OUTCOMES;
44 (II) PATIENT AND, WHERE PRACTICABLE, CAREGIVER EXPERIENCE OF CARE;
45 (III) UTILIZATION, SUCH AS RATES OF HOSPITAL ADMISSION FOR AMBULATORY
46 CARE SENSITIVE CONDITIONS, EMERGENCY ROOM USE, AND HOSPITAL RE-ADMIS-
47 SIONS.
48 (C) PROVIDE FOR PUBLIC DISCLOSURE, ON THE DEPARTMENT'S WEBSITE, OF
49 STATISTICAL DATA RELATING TO THE QUALITY OF SERVICES, PERFORMANCE, AND
50 OTHER CHARACTERISTICS OF ACOS, WHICH IS APPROPRIATELY ADJUSTED FOR CASE
51 MIX AND EXCLUDES ANY INDIVIDUAL PATIENT IDENTIFYING INFORMATION.
52 (D) MAKE REGULATIONS, SET STANDARDS, AND TAKE OTHER ACTIONS TO PROMOTE
53 THE ABILITY OF AN ACO TO PARTICIPATE IN APPLICABLE FEDERAL PROGRAMS FOR
54 ACCOUNTABLE CARE ORGANIZATIONS.
55 4. (A) IN ORDER TO PROMOTE IMPROVED QUALITY AND EFFICIENCY OF, AND
56 ACCESS TO, HEALTH CARE SERVICES AND PROMOTE IMPROVED CLINICAL OUTCOMES,
A. 4009--C 149
1 IT SHALL BE THE POLICY OF THE STATE RELATING TO ACOS TO ENCOURAGE COOP-
2 ERATIVE, COLLABORATIVE AND INTEGRATIVE ARRANGEMENTS AMONG THIRD-PARTY
3 HEALTH CARE PAYERS AND HEALTH CARE PROVIDERS WHO MIGHT OTHERWISE BE
4 COMPETITORS, UNDER THE ACTIVE SUPERVISION OF THE COMMISSIONER. TO THE
5 EXTENT SUCH ARRANGEMENTS MIGHT BE ANTI-COMPETITIVE WITHIN THE MEANING
6 AND INTENT OF THE FEDERAL OR STATE ANTITRUST LAWS, THE INTENT OF THE
7 STATE IS TO SUPPLANT COMPETITION WITH SUCH ARRANGEMENTS AND WITH REGU-
8 LATION UNDER THIS ARTICLE, TO THE EXTENT NECESSARY TO ACCOMPLISH THE
9 PURPOSES OF THIS ARTICLE RELATING TO ACOS, AND PROVIDE STATE ACTION
10 IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS WITH RESPECT TO THE
11 PLANNING, IMPLEMENTATION AND OPERATION OF ACOS AND THIRD-PARTY HEALTH
12 CARE PAYERS AND HEALTH CARE PROVIDERS. THE COMMISSIONER SHALL PROVIDE
13 REASONABLE AND APPROPRIATE STATE SUPERVISION NECESSARY TO PROMOTE STATE
14 ACTION IMMUNITY UNDER THE STATE AND FEDERAL ANTITRUST LAWS, AND MAY
15 INSPECT, REQUIRE, OR REQUEST ADDITIONAL DOCUMENTATION AND TAKE OTHER
16 ACTIONS UNDER THIS ARTICLE TO VERIFY AND MAKE SURE THAT THIS ARTICLE IS
17 IMPLEMENTED IN ACCORDANCE WITH ITS INTENT AND PURPOSE.
18 (B) TO THE EXTENT THE FORMATION OR OPERATION OF AN ACO OR ITS ARRANGE-
19 MENTS WITH THIRD-PARTY HEALTH CARE PAYERS OR HEALTH CARE PROVIDERS MAY
20 VIOLATE THE FEDERAL CIVIL MONETARY PAYMENT LAWS, OR FEDERAL OR STATE
21 ANTI-KICKBACK, PATIENT REFERRAL, OR FEE-SPLITTING LAWS, THE COMMISSIONER
22 SHALL PROVIDE REASONABLE AND APPROPRIATE REGULATION, SUPERVISION, AND
23 WAIVERS UNDER THOSE STATUTES AND THEIR REGULATIONS TO ENABLE SUCH FORMA-
24 TION, OPERATION OR ARRANGEMENTS TO PROCEED AND TO MAKE SURE THAT THEY DO
25 SO CONSISTENTLY WITH THE PURPOSES OF THIS ARTICLE.
26 (C) THE PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY BY AN
27 ACO THROUGH HEALTH CARE PROVIDERS SHALL NOT BE CONSIDERED THE PRACTICE
28 OF A PROFESSION UNDER TITLE EIGHT OF THE EDUCATION LAW BY THE ACO.
29 5. (A) AN ACO (I) SHALL BE DEEMED TO BE A HEALTH PLAN, SOLELY FOR
30 PURPOSES OF ARTICLE FORTY-NINE OF THIS CHAPTER, EXCEPT WHERE THE FUNC-
31 TIONS OF A HEALTH PLAN UNDER THAT ARTICLE ARE THE RESPONSIBILITY OF A
32 THIRD-PARTY HEALTH CARE PAYER, AND (II) SHALL BE DEEMED TO BE A MANAGED
33 CARE PRODUCT, SOLELY FOR PURPOSES OF ARTICLE FORTY-EIGHT OF THE INSUR-
34 ANCE LAW, EXCEPT WHERE THE FUNCTIONS OF A MANAGED CARE PRODUCT UNDER
35 THAT ARTICLE ARE THE RESPONSIBILITY OF A THIRD-PARTY HEALTH CARE PAYER.
36 (B) WHERE AN ACO CONTRACTS WITH AN ENROLLEE OR PATIENT TO PROVIDE
37 HEALTH CARE SERVICES TO THAT PERSON, WHERE PAYMENT FOR THOSE SERVICES IS
38 NOT PRIMARILY THE RESPONSIBILITY OF A THIRD-PARTY HEALTH CARE PAYER,
39 NOTHING IN THIS ARTICLE SHALL PRECLUDE THE ACO FROM BEING DEEMED TO BE A
40 HEALTH MAINTENANCE ORGANIZATION SUBJECT TO ARTICLE FORTY-FOUR OF THIS
41 CHAPTER OR ENGAGED IN THE BUSINESS OF INSURANCE AND SUBJECT TO APPLICA-
42 BLE PROVISIONS OF THE INSURANCE LAW, INCLUDING ARTICLE FORTY-EIGHT OF
43 THE INSURANCE LAW.
44 6. (A) (I) AN ACO MAY ENTER INTO ARRANGEMENTS WITH ONE OR MORE THIRD-
45 PARTY HEALTH CARE PAYERS TO ESTABLISH PAYMENT METHODOLOGIES FOR HEALTH
46 CARE SERVICES FOR THE THIRD-PARTY HEALTH CARE PAYER'S ENROLLEES PROVIDED
47 BY THE ACO OR FOR WHICH THE ACO IS RESPONSIBLE, SUCH AS FULL OR PARTIAL
48 CAPITATION OR OTHER ARRANGEMENTS. SUCH ARRANGEMENTS MAY INCLUDE
49 PROVISION FOR THE ACO TO RECEIVE AND DISTRIBUTE PAYMENTS TO THE ACO'S
50 PARTICIPATING HEALTH CARE PROVIDERS, INCLUDING INCENTIVE PAYMENTS AND
51 PAYMENTS FOR HEALTH CARE SERVICES FROM THIRD-PARTY HEALTH CARE PAYERS
52 AND PATIENTS. AN ACO MAY INCLUDE MECHANISMS FOR POOLING PAYMENTS
53 RECEIVED BY PARTICIPATING HEALTH CARE PROVIDERS FROM THIRD-PARTY PAYERS
54 AND PATIENTS.
55 (II) THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF
56 INSURANCE, MAY AUTHORIZE A THIRD-PARTY HEALTH CARE PAYER TO PARTICIPATE
A. 4009--C 150
1 IN PAYMENT METHODOLOGIES WITH AN ACO UNDER THIS PARAGRAPH, NOTWITHSTAND-
2 ING ANY CONTRARY PROVISION OF THIS CHAPTER, THE INSURANCE LAW, THE
3 SOCIAL SERVICES LAW, OR THE ELDER LAW, ON FINDING THAT THE PAYMENT METH-
4 ODOLOGY IS CONSISTENT WITH THE PURPOSES OF THIS ARTICLE.
5 (III) NO THIRD-PARTY HEALTH CARE PAYER SHALL:
6 (A) IMPOSE ANY DEDUCTIBLE, CO-PAYMENT OR OTHER FORM OF CO-INSURANCE ON
7 ANY ENROLLEE OR PATIENT IN CONNECTION WITH THE ENROLLEE OR PATIENT
8 PARTICIPATING IN AN ACO THAT IS HIGHER THAN IT WOULD OTHERWISE IMPOSE;
9 OR
10 (B) MAKE ANY DISTINCTION OR DISCRIMINATION AGAINST ANY ENROLLEE OR
11 PATIENT IN CONNECTION WITH THE ENROLLEE OR PATIENT PARTICIPATING IN AN
12 ACO, OR IMPOSE ANY RESTRICTION ON WHICH OF ITS ENROLLEES OR PATIENTS MAY
13 PARTICIPATE IN AN ACO; PROVIDED THAT
14 (C) THIS SUBDIVISION SHALL NOT BE CONSTRUED TO BAR A THIRD-PARTY
15 HEALTH CARE PAYER FROM PROVIDING INCENTIVES FOR ENROLLEES OR PATIENTS TO
16 PARTICIPATE IN AN ACO; AND
17 (D) ENROLLEE, PATIENT, AND HEALTH CARE PROVIDER PARTICIPATION IN AN
18 ACO SHALL BE ON A VOLUNTARY BASIS.
19 (B) WITH RESPECT TO ARRANGEMENTS INVOLVING PUBLIC HEALTH COVERAGE AND
20 AN ACO, THE COMMISSIONER:
21 (I) SHALL SEEK TO PROMOTE THE ESTABLISHMENT OF ACOS;
22 (II) MAY PROMOTE USE OF RISK-ADJUSTMENT AND STOP-LOSS METHODOLOGIES;
23 AND
24 (III) MAY ESTABLISH PAYMENT METHODOLOGIES, INCLUDING FOR MEDICAID
25 FEE-FOR-SERVICE AND MEDICAID MANAGED CARE.
26 (C) AN ACO MAY SEEK TO FOCUS ON PROVIDING HEALTH CARE SERVICES TO
27 PATIENTS WITH ONE OR MORE CHRONIC CONDITIONS OR SPECIAL NEEDS. HOWEVER,
28 AN ACO MAY NOT OTHERWISE, ON THE BASIS OF A PERSON'S MEDICAL OR DEMO-
29 GRAPHIC CHARACTERISTICS, DISCRIMINATE FOR OR AGAINST OR DISCOURAGE OR
30 ENCOURAGE ANY PERSON OR PERSONS WITH RESPECT TO ENROLLING OR PARTICIPAT-
31 ING IN THE ACO.
32 (D) AN ACO SHALL NOT, BY INCENTIVES OR OTHERWISE, DISCOURAGE A HEALTH
33 CARE PROVIDER FROM PROVIDING OR AN ENROLLEE OR PATIENT FROM SEEKING
34 APPROPRIATE HEALTH CARE SERVICES.
35 (E) AN ACO SHALL NOT DISCRIMINATE AGAINST OR DISADVANTAGE A PATIENT OR
36 PATIENT'S REPRESENTATIVE FOR THE EXERCISE OF PATIENT AUTONOMY.
37 7. THE COMMISSIONER IS AUTHORIZED TO SEEK FEDERAL GRANTS, APPROVALS,
38 AND WAIVERS TO IMPLEMENT THIS ARTICLE, INCLUDING FEDERAL FINANCIAL
39 PARTICIPATION UNDER PUBLIC HEALTH COVERAGE. THE COMMISSIONER SHALL
40 PROVIDE COPIES OF APPLICATIONS AND OTHER DOCUMENTS SEEKING SUCH FEDERAL
41 GRANTS, APPROVALS, AND WAIVERS TO THE CHAIRS OF THE SENATE FINANCE
42 COMMITTEE, THE ASSEMBLY WAYS AND MEANS COMMITTEE, AND THE SENATE AND
43 ASSEMBLY HEALTH COMMITTEES SIMULTANEOUSLY WITH THEIR SUBMISSION TO THE
44 FEDERAL GOVERNMENT.
45 8. THE COMMISSIONER MAY DIRECTLY, OR BY CONTRACT WITH NOT-FOR-PROFIT
46 ORGANIZATIONS, PROVIDE:
47 (A) CONSUMER ASSISTANCE TO PATIENTS PARTICIPATING IN OR CONSIDERING
48 PARTICIPATING IN AN ACO AS TO MATTERS RELATING TO ACOS;
49 (B) TECHNICAL AND OTHER ASSISTANCE TO HEALTH CARE PROVIDERS PARTIC-
50 IPATING IN AN ACO AS TO MATTERS RELATING TO THE ACO;
51 (C) ASSISTANCE TO ACOS TO PROMOTE THEIR FORMATION AND IMPROVE THEIR
52 OPERATION, INCLUDING ASSISTANCE UNDER SECTION TWENTY-EIGHT HUNDRED EIGH-
53 TEEN OF THIS CHAPTER;
54 (D) INFORMATION SHARING AND OTHER ASSISTANCE AMONG ACOS TO IMPROVE THE
55 OPERATION OF ACOS.
A. 4009--C 151
1 S 4423. CERTIFICATE OF AUTHORITY. 1. THE COMMISSIONER SHALL ISSUE A
2 CERTIFICATE OF AUTHORITY TO AN APPLICANT THAT SATISFIES THE REQUIREMENTS
3 UNDER THIS ARTICLE FOR ESTABLISHMENT OF AN ACO.
4 2. THE COMMISSIONER MAY LIMIT, SUSPEND, OR TERMINATE A CERTIFICATE OF
5 AUTHORITY IF THE ACO IS NOT OPERATING IN ACCORDANCE WITH THIS ARTICLE.
6 3. THE COMMISSIONER SHALL ESTABLISH, BY REGULATION, REASONABLE AND
7 APPROPRIATE PROCEDURES UNDER THIS SECTION, CONSISTENT WITH THE STATE
8 ADMINISTRATIVE PROCEDURE ACT.
9 4. THE COMMISSIONER SHALL NOT APPROVE ANY CERTIFICATE OF AUTHORITY
10 UNDER THIS ARTICLE AFTER DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
11 S 66-a. Subdivision 1 of section 2 of the public health law is amended
12 by adding eight new paragraphs (o), (p), (q), (r), (s), (t), (u), and
13 (v) to read as follows:
14 (O) "MEDICAID" OR "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
15 FIVE OF THE SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
16 (P) "FAMILY HEALTH PLUS" MEANS TITLE ELEVEN-D OF ARTICLE FIVE OF THE
17 SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
18 (Q) "CHILD HEALTH PLUS" MEANS TITLE ONE-A OF ARTICLE TWENTY-FIVE OF
19 THIS CHAPTER AND THE PROGRAM THEREUNDER.
20 (R) "MEDICAID MANAGED CARE" MEANS MEDICAID PROVIDED UNDER SECTION
21 THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW.
22 (S) "MEDICAID FEE-FOR-SERVICE" MEANS MEDICAID PROVIDED OTHER THAN
23 UNDER MEDICAID MANAGED CARE.
24 (T) "MEDICARE" MEANS TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT
25 AND THE PROGRAMS THEREUNDER.
26 (U) "EPIC" MEANS TITLE THREE OF ARTICLE TWO OF THE ELDER LAW AND THE
27 PROGRAM THEREUNDER.
28 (V) "PUBLIC HEALTH COVERAGE" MEANS MEDICAID, CHILD HEALTH PLUS, FAMILY
29 HEALTH PLUS, MEDICARE (TO THE EXTENT IT IS SUBJECT TO STATE LAW IN THE
30 CONTEXT IN WHICH THE TERM IS USED), AND EPIC.
31 S 66-b. Paragraph (b) of subdivision 1 of section 364-j of the social
32 services law, as amended by chapter 649 of the laws of 1996, subpara-
33 graphs (i) and (ii) as amended by chapter 433 of the laws of 1997, is
34 amended to read as follows:
35 (b) "Managed care provider". An entity that provides or arranges for
36 the provision of medical assistance services and supplies to partic-
37 ipants directly or indirectly (including by referral), including case
38 management; and:
39 (i) is authorized to operate under article forty-four of the public
40 health law or article forty-three of the insurance law and provides or
41 arranges, directly or indirectly (including by referral) for covered
42 comprehensive health services on a full capitation basis; [or]
43 (ii) is authorized as a partially capitated program pursuant to
44 section three hundred sixty-four-f of this title or section forty-four
45 hundred three-e of the public health law or section 1915b of the social
46 security act; OR
47 (III) IS AN ACCOUNTABLE CARE ORGANIZATION UNDER ARTICLE FORTY-FOUR-A
48 OF THE PUBLIC HEALTH LAW.
49 S 67. Section 18 of part B of chapter 58 of the laws of 2010, amending
50 chapter 474 of the laws of 1996, amending the education law and other
51 laws relating to rates for residential healthcare facilities and other
52 laws relating to Medicaid payments, is amended to read as follows:
53 S 18. Notwithstanding any contrary provision of law, surcharges and
54 assessments due and owing pursuant to sections 2807-j, 2807-s and 2807-t
55 of the public health law for any period prior to January 1, [2010] 2011,
56 which are paid and accompanied by all required reports and which are
A. 4009--C 152
1 received on or before December 31, [2010] 2011 shall not be subject to
2 interest or penalties as otherwise provided in such sections, provided,
3 however, that such reports may be based on estimates by payors and
4 designated providers of services of the amounts owed, subject to subse-
5 quent audit by the commissioner of health or the commissioner's desig-
6 nee, and provided further, however, with regard to all principal, inter-
7 est and penalty amounts collected by the commissioner of health prior to
8 the effective date of this act, the penalty provisions of sections
9 2807-j, 2807-s and 2807-t of the public health law shall remain in full
10 force and effect and such amounts collected shall not be subject to
11 further adjustment pursuant to this section, and provided further,
12 however, that payments of principal amounts of surcharges and assess-
13 ments which were paid late and received prior to the effective date of
14 this provision, and in regard to which interest and penalty amounts have
15 not been collected, shall not be subject to such interest and penalties,
16 and provided, further, however, that the provisions of this section
17 shall not apply to delinquent amounts which have been referred by the
18 commissioner of health for recoupment or collection proceeding.
19 Furthermore, the provisions of this section shall not apply to any
20 surcharge or assessment payments made in response to a final audit find-
21 ing issued by the commissioner of health or the commissioner's designee.
22 S 68. Section 2807-j of the public health law is amended by adding a
23 new subdivision 13 to read as follows:
24 13. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISIONS OF THIS SECTION OR
25 ANY OTHER CONTRARY PROVISION OF LAW, FOR PERIODS ON OR AFTER JULY FIRST,
26 TWO THOUSAND ELEVEN, EACH THIRD PARTY PAYOR WHICH HAS ENTERED INTO AN
27 ELECTION AGREEMENT WITH THE COMMISSIONER PURSUANT TO SUBDIVISION FIVE OF
28 THIS SECTION MAY, AS A CONDITION OF SUCH ELECTION, BE REQUIRED BY THE
29 COMMISSIONER TO PAY TO THE COMMISSIONER OR THE COMMISSIONER'S DESIGNEE,
30 A PERCENTAGE SURCHARGE EQUAL TO THE SURCHARGE PERCENT SET FORTH IN PARA-
31 GRAPH (C) OF SUBDIVISION TWO OF THIS SECTION FOR THE SAME PERIOD AND
32 APPLIED TO ALL PAYMENTS MADE BY SUCH THIRD PARTY PAYORS FOR PATIENT CARE
33 SERVICES PROVIDED WITHIN THE STATE OF NEW YORK BY PHYSICIANS IN PHYSI-
34 CIAN OFFICES OR IN URGENT CARE FACILITIES THAT ARE NOT OTHERWISE
35 LICENSED PURSUANT TO THIS ARTICLE AND WHICH ARE BILLED AS SURGERY OR
36 RADIOLOGY SERVICES IN ACCORDANCE WITH THE CURRENT PROCEDURE TERMINOLOGY,
37 FOURTH EDITION, AS PUBLISHED BY THE AMERICAN MEDICAL ASSOCIATION.
38 (B) SUCH PAYMENTS SHALL BE MADE AND REPORTED AT THE SAME TIME AND IN
39 THE SAME MANNER AS THE PAYMENTS AND REPORTS WHICH ARE OTHERWISE SUBMIT-
40 TED BY EACH THIRD PARTY PAYOR TO THE COMMISSIONER OR THE COMMISSIONER'S
41 DESIGNEE IN ACCORDANCE WITH THIS SECTION. SUCH PAYMENTS SHALL BE SUBJECT
42 TO AUDIT BY THE COMMISSIONER IN THE SAME MANNER AS THE OTHER PAYMENTS
43 OTHERWISE SUBMITTED AND REPORTED PURSUANT TO THIS SECTION. THE COMMIS-
44 SIONER MAY TAKE ALL MEASURES TO COLLECT DELINQUENT PAYMENTS DUE PURSUANT
45 TO THIS SUBDIVISION AS ARE OTHERWISE PERMITTED WITH REGARD TO DELINQUENT
46 PAYMENTS DUE PURSUANT TO OTHER SUBDIVISIONS OF THIS SECTION.
47 (C) SURCHARGES PURSUANT TO THIS SUBDIVISION SHALL NOT APPLY TO
48 PAYMENTS MADE BY THIRD PARTY PAYORS FOR SERVICES PROVIDED TO PATIENTS
49 INSURED BY MEDICAID OR BY THE CHILD HEALTH PLUS PROGRAM OR TO ANY
50 PATIENT IN A CATEGORY THAT IS EXEMPT FROM SURCHARGE OBLIGATIONS ASSESSED
51 PURSUANT TO SUBDIVISIONS ONE THROUGH TWELVE OF THIS SECTION.
52 S 69. Subparagraph (iii) of paragraph (b) of subdivision 25 of section
53 2808 of the public health law, as added by section 31 of part B of chap-
54 ter 109 of the laws of 2010, is amended and a new subparagraph (iv) is
55 added to read as follows:
A. 4009--C 153
1 (iii) payment to a facility for reserved bed days provided on behalf
2 of such person for non-hospitalization leaves of absence may not exceed
3 ten days in any twelve month period[.]; AND
4 (IV) PAYMENTS FOR RESERVED BED DAYS FOR TEMPORARY HOSPITALIZATIONS
5 SHALL ONLY BE MADE TO A RESIDENTIAL HEALTH CARE FACILITY IF AT LEAST
6 FIFTY PERCENT OF THE FACILITY'S RESIDENTS ELIGIBLE TO PARTICIPATE IN A
7 MEDICARE MANAGED CARE PLAN, A MANAGED LONG TERM CARE PLAN, A PROGRAM OF
8 ALL INCLUSIVE CARE FOR THE ELDERLY, OR OTHER MANAGED CARE PLAN THAT
9 INCLUDES MEDICARE, ARE ENROLLED IN SUCH A PLAN.
10 S 70. Intentionally omitted.
11 S 71. Intentionally omitted.
12 S 72. Intentionally omitted.
13 S 73. Intentionally omitted.
14 S 74. Section 366 of the social services law is amended by adding a
15 new subdivision 14 to read as follows:
16 14. THE COMMISSIONER OF HEALTH MAY MAKE ANY AVAILABLE AMENDMENTS TO
17 THE STATE PLAN FOR MEDICAL ASSISTANCE SUBMITTED PURSUANT TO SECTION
18 THREE HUNDRED SIXTY-THREE-A OF THIS TITLE, OR, IF AN AMENDMENT IS NOT
19 POSSIBLE, DEVELOP AND SUBMIT AN APPLICATION FOR ANY WAIVER OR APPROVAL
20 UNDER THE FEDERAL SOCIAL SECURITY ACT THAT MAY BE NECESSARY TO DISREGARD
21 OR EXEMPT AN AMOUNT OF INCOME, FOR THE PURPOSE OF ASSISTING WITH HOUSING
22 COSTS, FOR INDIVIDUALS RECEIVING COVERAGE OF NURSING FACILITY SERVICES
23 UNDER THIS TITLE WHO ARE: (I) DISCHARGED FROM THE NURSING FACILITY TO
24 THE COMMUNITY; (II) ENROLLED IN A PLAN CERTIFIED PURSUANT TO SECTION
25 FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW; AND (III) WHILE SO
26 ENROLLED, NOT CONSIDERED AN "INSTITUTIONALIZED SPOUSE" FOR PURPOSES OF
27 SECTION THREE HUNDRED SIXTY-SIX-C OF THIS TITLE.
28 S 75. Intentionally Omitted.
29 S 76. Subdivision 6 of section 364-i of the social services law is
30 amended by adding a new paragraph (a-2) to read as follows:
31 (A-2) AT THE TIME OF APPLICATION FOR PRESUMPTIVE ELIGIBILITY PURSUANT
32 TO THIS SUBDIVISION, A PREGNANT WOMAN WHO RESIDES IN A SOCIAL SERVICES
33 DISTRICT THAT HAS IMPLEMENTED THE STATE'S MANAGED CARE PROGRAM PURSUANT
34 TO SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE MUST CHOOSE A
35 MANAGED CARE PROVIDER. IF A MANAGED CARE PROVIDER IS NOT CHOSEN AT THE
36 TIME OF APPLICATION, THE PREGNANT WOMAN WILL BE ASSIGNED TO A MANAGED
37 CARE PROVIDER IN ACCORDANCE WITH SUBPARAGRAPHS (II), (III), (IV) AND (V)
38 OF PARAGRAPH (F) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED
39 SIXTY-FOUR-J OF THIS TITLE.
40 S 77. Paragraphs (b), (c), (d) and (f) of subdivision 3 of section
41 364-j of the social services law are REPEALED, paragraph (e) is relet-
42 tered paragraph (d), and two new paragraphs (b) and (c) are added to
43 read as follows:
44 (B) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE REQUIRED
45 TO PARTICIPATE IN A MANAGED CARE PROGRAM ESTABLISHED PURSUANT TO THIS
46 SECTION:
47 (I) INDIVIDUALS WITH A CHRONIC MEDICAL CONDITION WHO ARE BEING TREATED
48 BY A SPECIALIST PHYSICIAN THAT IS NOT ASSOCIATED WITH A MANAGED CARE
49 PROVIDER IN THE INDIVIDUAL'S SOCIAL SERVICES DISTRICT MAY DEFER PARTIC-
50 IPATION IN THE MANAGED CARE PROGRAM FOR SIX MONTHS OR UNTIL THE COURSE
51 OF TREATMENT IS COMPLETE, WHICHEVER OCCURS FIRST; AND
52 (II) NATIVE AMERICANS.
53 (C) THE FOLLOWING MEDICAL ASSISTANCE RECIPIENTS SHALL NOT BE ELIGIBLE
54 TO PARTICIPATE IN A MANAGED CARE PROGRAM ESTABLISHED PURSUANT TO THIS
55 SECTION:
A. 4009--C 154
1 (I) A PERSON ELIGIBLE FOR MEDICARE PARTICIPATING IN A CAPITATED DEMON-
2 STRATION PROGRAM FOR LONG TERM CARE;
3 (II) AN INFANT LIVING WITH AN INCARCERATED MOTHER IN A STATE OR LOCAL
4 CORRECTIONAL FACILITY AS DEFINED IN SECTION TWO OF THE CORRECTION LAW;
5 (III) A PERSON WHO IS EXPECTED TO BE ELIGIBLE FOR MEDICAL ASSISTANCE
6 FOR LESS THAN SIX MONTHS;
7 (IV) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE BENEFITS ONLY
8 WITH RESPECT TO TUBERCULOSIS-RELATED SERVICES;
9 (V) INDIVIDUALS RECEIVING HOSPICE SERVICES AT TIME OF ENROLLMENT;
10 (VI) A PERSON WHO HAS PRIMARY MEDICAL OR HEALTH CARE COVERAGE AVAIL-
11 ABLE FROM OR UNDER A THIRD-PARTY PAYOR WHICH MAY BE MAINTAINED BY
12 PAYMENT, OR PART PAYMENT, OF THE PREMIUM OR COST SHARING AMOUNTS, WHEN
13 PAYMENT OF SUCH PREMIUM OR COST SHARING AMOUNTS WOULD BE COST-EFFECTIVE,
14 AS DETERMINED BY THE LOCAL SOCIAL SERVICES DISTRICT;
15 (VII) A PERSON RECEIVING FAMILY PLANNING SERVICES PURSUANT TO SUBPARA-
16 GRAPH ELEVEN OF PARAGRAPH (A) OF SUBDIVISION ONE OF SECTION THREE
17 HUNDRED SIXTY-SIX OF THIS TITLE;
18 (VIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
19 PARAGRAPH (V) OF SUBDIVISION FOUR OF SECTION THREE HUNDRED SIXTY-SIX OF
20 THIS TITLE; AND
21 (IX) A PERSON WHO IS MEDICARE/MEDICAID DUALLY ELIGIBLE AND WHO IS NOT
22 ENROLLED IN A MEDICARE MANAGED CARE PLAN.
23 S 77-a. Paragraph (g) of subdivision 3 of section 364-j of the social
24 services law, as amended by chapter 649 of the laws of 1996, and subpar-
25 agraph (i) as amended by section 30 of part C of chapter 58 of the laws
26 of 2008, is amended to read as follows:
27 [(g)] (E) The following categories of individuals [will not] MAY be
28 required to enroll with a managed care program [until] WHEN program
29 features and reimbursement rates are approved by the commissioner of
30 health and, as appropriate, the [commissioner] COMMISSIONERS of THE
31 DEPARTMENT OF mental health, THE OFFICE FOR PERSONS WITH DEVELOPMENTAL
32 DISABILITIES, AND THE OFFICE OF ALCOHOL AND SUBSTANCE ABUSE SERVICES:
33 (i) an individual dually eligible for medical assistance and benefits
34 under the federal Medicare program and enrolled in a Medicare managed
35 care plan offered by an entity that is also a managed care provider;
36 provided that (notwithstanding paragraph (g) of subdivision four of this
37 section):
38 (a) if the individual changes his or her Medicare managed care plan as
39 authorized by title XVIII of the federal social security act, and
40 enrolls in another Medicare managed care plan that is also a managed
41 care provider, the individual shall be (if required by the commissioner
42 under this paragraph) enrolled in that managed care provider;
43 (b) if the individual changes his or her Medicare managed care plan as
44 authorized by title XVIII of the federal social security act, but
45 enrolls in another Medicare managed care plan that is not also a managed
46 care provider, the individual shall be disenrolled from the managed care
47 provider in which he or she was enrolled and withdraw from the managed
48 care program;
49 (c) if the individual disenrolls from his or her Medicare managed care
50 plan as authorized by title XVIII of the federal social security act,
51 and does not enroll in another Medicare managed care plan, the individ-
52 ual shall be disenrolled from the managed care provider in which he or
53 she was enrolled and withdraw from the managed care program;
54 (d) nothing herein shall require an individual enrolled in a managed
55 long term care plan, pursuant to section forty-four hundred three-f of
56 the public health law, to disenroll from such program.
A. 4009--C 155
1 (ii) an individual eligible for supplemental security income;
2 (iii) HIV positive individuals; [and]
3 (iv) persons with serious mental illness and children and adolescents
4 with serious emotional disturbances, as defined in section forty-four
5 hundred one of the public health law[.];
6 (V) A PERSON RECEIVING SERVICES PROVIDED BY A RESIDENTIAL ALCOHOL OR
7 SUBSTANCE ABUSE PROGRAM OR FACILITY FOR THE MENTALLY RETARDED;
8 (VI) A PERSON RECEIVING SERVICES PROVIDED BY AN INTERMEDIATE CARE
9 FACILITY FOR THE MENTALLY RETARDED OR WHO HAS CHARACTERISTICS AND NEEDS
10 SIMILAR TO SUCH PERSONS;
11 (VII) A PERSON WITH A DEVELOPMENTAL OR PHYSICAL DISABILITY WHO
12 RECEIVES HOME AND COMMUNITY-BASED SERVICES OR CARE-AT-HOME SERVICES
13 THROUGH EXISTING WAIVERS UNDER SECTION NINETEEN HUNDRED FIFTEEN (C) OF
14 THE FEDERAL SOCIAL SECURITY ACT OR WHO HAS CHARACTERISTICS AND NEEDS
15 SIMILAR TO SUCH PERSONS;
16 (VIII) A PERSON WHO IS ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
17 SUBPARAGRAPH TWELVE OR SUBPARAGRAPH THIRTEEN OF PARAGRAPH (A) OF SUBDI-
18 VISION ONE OF SECTION THREE HUNDRED SIXTY-SIX OF THIS TITLE;
19 (IX) A PERSON RECEIVING SERVICES PROVIDED BY A LONG TERM HOME HEALTH
20 CARE PROGRAM, OR A PERSON RECEIVING INPATIENT SERVICES IN A STATE-OPER-
21 ATED PSYCHIATRIC FACILITY OR A RESIDENTIAL TREATMENT FACILITY FOR CHIL-
22 DREN AND YOUTH;
23 (X) CERTIFIED BLIND OR DISABLED CHILDREN LIVING OR EXPECTED TO BE
24 LIVING SEPARATE AND APART FROM THE PARENT FOR THIRTY DAYS OR MORE;
25 (XI) RESIDENTS OF NURSING FACILITIES;
26 (XII) A FOSTER CHILD IN THE PLACEMENT OF A VOLUNTARY AGENCY OR IN THE
27 DIRECT CARE OF THE LOCAL SOCIAL SERVICES DISTRICT;
28 (XIII) A PERSON OR FAMILY THAT IS HOMELESS; AND
29 (XIV) INDIVIDUALS FOR WHOM A MANAGED CARE PROVIDER IS NOT GEOGRAPH-
30 ICALLY ACCESSIBLE SO AS TO REASONABLY PROVIDE SERVICES TO THE PERSON. A
31 MANAGED CARE PROVIDER IS NOT GEOGRAPHICALLY ACCESSIBLE IF THE PERSON
32 CANNOT ACCESS THE PROVIDER'S SERVICES IN A TIMELY FASHION DUE TO
33 DISTANCE OR TRAVEL TIME.
34 S 78. Subparagraph (v) of paragraph (e) of subdivision 4 of section
35 364-j of the social services law, as amended by section 14 of part C of
36 chapter 58 of the laws of 2004, is amended to read as follows:
37 (v) Upon delivery of the pre-enrollment information, the local
38 district or the enrollment organization shall certify the participant's
39 receipt of such information. Upon verification that the participant has
40 received the pre-enrollment education information, a managed care
41 provider, a local district or the enrollment organization may enroll a
42 participant into a managed care provider. Managed care providers must
43 submit enrollment forms to the local department of social services. Upon
44 enrollment, participants will sign an attestation that they have been
45 informed that: participants have a choice of managed care providers;
46 participants have a choice of primary care practitioners; and, except as
47 otherwise provided in this section, including but not limited to the
48 exceptions listed in subparagraph (iii) of paragraph (a) of this subdi-
49 vision, participants must exclusively use their primary care practition-
50 ers and plan providers. The commissioner of health [or with respect to a
51 managed care plan serving participants in a city with a population of
52 over two million, the local department of social services in such city,]
53 may suspend or curtail enrollment or impose sanctions for failure to
54 appropriately notify clients as required in this subparagraph.
A. 4009--C 156
1 S 79. Subparagraph (i) of paragraph (f) of subdivision 4 of section
2 364-j of the social services law, as amended by section 14 of part C of
3 chapter 58 of the laws of 2004, is amended to read as follows:
4 (i) Participants SHALL CHOOSE A MANAGED CARE PROVIDER AT THE TIME OF
5 APPLICATION FOR MEDICAL ASSISTANCE; IF THE PARTICIPANT DOES NOT CHOOSE
6 SUCH A PROVIDER THE COMMISSIONER SHALL ASSIGN SUCH PARTICIPANT TO A
7 MANAGED CARE PROVIDER IN ACCORDANCE WITH SUBPARAGRAPHS (II), (III), (IV)
8 AND (V) OF THIS PARAGRAPH. PARTICIPANTS ALREADY IN RECEIPT OF MEDICAL
9 ASSISTANCE shall have no less than [sixty] THIRTY days from the date
10 selected by the district to enroll in the managed care program to select
11 a managed care provider, and as appropriate, a mental health special
12 needs plan, and shall be provided with information to make an informed
13 choice. Where a participant has not selected such a provider or mental
14 health special needs plan, the commissioner of health shall assign such
15 participant to a managed care provider, and as appropriate, to a mental
16 health special needs plan, taking into account capacity and geographic
17 accessibility. The commissioner may after the period of time established
18 in subparagraph (ii) of this paragraph assign participants to a managed
19 care provider taking into account quality performance criteria and cost.
20 Provided however, cost criteria shall not be of greater value than qual-
21 ity criteria in assigning participants.
22 S 80. Paragraphs (d), (e), and (f) of subdivision 5 of section 364-j
23 of the social services law, as added by section 15 of part C of chapter
24 58 of the laws of 2004, are amended to read as follows:
25 (d) Notwithstanding any inconsistent provision of this title and
26 section one hundred sixty-three of the state finance law, the commis-
27 sioner of health [or the local department of social services in a city
28 with a population of over two million] may contract with managed care
29 providers approved under paragraph (b) of this subdivision, without a
30 competitive bid or request for proposal process, to provide coverage for
31 participants pursuant to this title.
32 (e) Notwithstanding any inconsistent provision of this title and
33 section one hundred forty-three of the economic development law, no
34 notice in the procurement opportunities newsletter shall be required for
35 contracts awarded by the commissioner of health [or the local department
36 of social services in a city with a population of over two million], to
37 qualified managed care providers pursuant to this section.
38 (f) The care and services described in subdivision four of this
39 section will be furnished by a managed care provider pursuant to the
40 provisions of this section when such services are furnished in accord-
41 ance with an agreement with the department of health [or the local
42 department of social services in a city with a population of over two
43 million], and meet applicable federal law and regulations.
44 S 81. Paragraph (k) of subdivision 2 of section 365-a of the social
45 services law, as amended by chapter 659 of the laws of 1997, is amended
46 to read as follows:
47 (k) care and services furnished by an entity offering a comprehensive
48 health services plan, including an entity that has received a certif-
49 icate of authority pursuant to sections forty-four hundred three,
50 forty-four hundred three-a or forty-four hundred eight-a of the public
51 health law (as added by chapter six hundred thirty-nine of the laws of
52 nineteen hundred ninety-six) or a health maintenance organization
53 authorized under article forty-three of the insurance law, to eligible
54 individuals residing in the geographic area served by such entity, when
55 such services are furnished in accordance with an agreement approved by
56 the department which meets the requirements of federal law and regu-
A. 4009--C 157
1 lations [provided, that no such agreement shall allow for medical
2 assistance payments on a capitated basis for nursing facility, home care
3 or other long term care services of a duration and scope defined in
4 regulations of the department of health promulgated pursuant to section
5 forty-four hundred three-f of the public health law, unless such entity
6 has received a certificate of authority as a managed long term care plan
7 or is an operating demonstration or is an approved managed long term
8 care demonstration, pursuant to such section].
9 S 82. Paragraph (a) of subdivision 1 of section 367-f of the social
10 services law, as amended by section 37 of part D of chapter 58 of the
11 laws of 2009, is amended to read as follows:
12 (a) "Medicaid extended coverage" shall mean eligibility for medical
13 assistance (i) without regard to the resource requirements of section
14 three hundred sixty-six of this title, or in the case of an individual
15 covered under an insurance policy or certificate described in subdivi-
16 sion two of this section that provided a residential health care facili-
17 ty benefit less than [three] TWO years in duration, without consider-
18 ation of an amount of resources equivalent to the value of benefits
19 received by the individual under such policy or certificate, as deter-
20 mined under the rules of the partnership for long-term care program;
21 (ii) without regard to the recovery of medical assistance from the
22 estates of individuals and the imposition of liens on the homes of
23 persons pursuant to section three hundred sixty-nine of this title, with
24 respect to resources exempt from consideration pursuant to subparagraph
25 (i) of this paragraph; provided, however, that nothing in this section
26 shall prevent the imposition of a lien or recovery against property of
27 an individual on account of medical assistance incorrectly paid; and
28 (iii) based on an income eligibility standard for married couples equal
29 to the amount of the minimum monthly maintenance needs allowance defined
30 in paragraph (h) of subdivision two of section three hundred sixty-six-c
31 of this title, and for single individuals equal to one-half of such
32 amount; provided, however, that the commissioner of health shall not be
33 required to implement the provisions of this subparagraph if the use of
34 such income eligibility standards will result in a loss of federal
35 financial participation in the costs of Medicaid extended coverage
36 furnished in accordance with subparagraphs (i) and (ii) of this para-
37 graph.
38 S 83. Subdivision 1 of section 190 of the tax law, as amended by
39 section 17 of part B of chapter 58 of the laws of 2004, is amended to
40 read as follows:
41 1. General. A taxpayer shall be allowed a credit against the tax
42 imposed by this article, other than the taxes and fees imposed by
43 sections one hundred eighty and one hundred eighty-one of this article,
44 equal to [twenty] FORTY percent of the premium paid during the taxable
45 year for long-term care insurance. In order to qualify for such credit,
46 the taxpayer's premium payment must be for the purchase of or for
47 continuing coverage under a long-term care insurance policy that quali-
48 fies for such credit pursuant to section one thousand one hundred seven-
49 teen of the insurance law.
50 S 84. Paragraph (a) of subdivision 25-a of section 210 of the tax law,
51 as amended by section 18 of part B of chapter 58 of the laws of 2004, is
52 amended to read as follows:
53 (a) A taxpayer shall be allowed a credit against the tax imposed by
54 this article equal to [twenty] FORTY percent of the premium paid during
55 the taxable year for long-term care insurance. In order to qualify for
56 such credit, the taxpayer's premium payment must be for the purchase of
A. 4009--C 158
1 or for continuing coverage under a long-term care insurance policy that
2 qualifies for such credit pursuant to section one thousand one hundred
3 seventeen of the insurance law.
4 S 85. Paragraph 1 of subsection (aa) of section 606 of the tax law, as
5 amended by section 1 of part P of chapter 61 of the laws of 2005, is
6 amended to read as follows:
7 (1) Residents. A taxpayer shall be allowed a credit against the tax
8 imposed by this article equal to [twenty] FORTY percent of the premium
9 paid during the taxable year for long-term care insurance. In order to
10 qualify for such credit, the taxpayer's premium payment must be for the
11 purchase of or for continuing coverage under a long-term care insurance
12 policy that qualifies for such credit pursuant to section one thousand
13 one hundred seventeen of the insurance law. If the amount of the credit
14 allowable under this subsection for any taxable year shall exceed the
15 taxpayer's tax for such year, the excess may be carried over to the
16 following year or years and may be deducted from the taxpayer's tax for
17 such year or years.
18 S 86. Paragraph 1 of subsection (k) of section 1456 of the tax law, as
19 amended by section 20 of part B of chapter 58 of the laws of 2004, is
20 amended to read as follows:
21 (1) A taxpayer shall be allowed a credit against the tax imposed by
22 this article equal to [twenty] FORTY percent of the premium paid during
23 the taxable year for long-term care insurance. In order to qualify for
24 such credit, the taxpayer's premium payment must be for the purchase of
25 or for continuing coverage under a long-term care insurance policy that
26 qualifies for such credit pursuant to section one thousand one hundred
27 seventeen of the insurance law.
28 S 87. Paragraph 1 of subdivision (m) of section 1511 of the tax law,
29 as amended by section 21 of part B of chapter 58 of the laws of 2004, is
30 amended to read as follows:
31 (1) A taxpayer shall be allowed a credit against the tax imposed by
32 this article equal to [twenty] FORTY percent of the premium paid during
33 the taxable year for long-term care insurance. In order to qualify for
34 such credit, the taxpayer's premium payment must be for the purchase of
35 or for continuing coverage under a long-term care insurance policy that
36 qualifies for such credit pursuant to section one thousand one hundred
37 seventeen of the insurance law.
38 S 88. Subparagraph 11 of paragraph (a) of subdivision 1 of section 366
39 of the social services law, as amended by section 1-h of part C of chap-
40 ter 58 of the laws of 2007, is amended to read as follows:
41 (11) for purposes of receiving family planning services eligible for
42 reimbursement by the federal government at a rate of ninety percent, is
43 not otherwise eligible for medical assistance and whose income is two
44 hundred percent or less of the comparable federal income official pover-
45 ty line (as defined and annually revised by the United States department
46 of health and human services); provided, however, that such ninety
47 percent limitation shall not apply to those services identified by the
48 commissioner of health as services, including treatment for sexually
49 transmitted diseases, generally performed as part of or as a follow-up
50 to a service eligible for such ninety percent reimbursement; PROVIDED
51 FURTHER THAT THE COMMISSIONER OF HEALTH IS AUTHORIZED TO ESTABLISH
52 CRITERIA FOR PRESUMPTIVE ELIGIBILITY FOR SERVICES PROVIDED PURSUANT TO
53 THIS SUBPARAGRAPH IN ACCORDANCE WITH ALL APPLICABLE REQUIREMENTS OF
54 FEDERAL LAW OR REGULATION PERTAINING TO SUCH ELIGIBILITY. The commis-
55 sioner of health shall submit whatever waiver applications as may be
56 necessary to receive federal financial participation for services
A. 4009--C 159
1 provided under this subparagraph and the provisions of this subparagraph
2 shall be effective if and so long as such federal financial partic-
3 ipation shall be available; or
4 S 89. Paragraph (e) of subdivision 2 of section 365-a of the social
5 services law, as amended by chapter 170 of the laws of 1994, is amended
6 to read as follows:
7 (e) (I) personal care services, including personal emergency response
8 services, shared aide and an individual aide, SUBJECT TO THE PROVISIONS
9 OF SUBPARAGRAPHS (II), (III), AND (IV) OF THIS PARAGRAPH, furnished to
10 an individual who is not an inpatient or resident of a hospital, nursing
11 facility, intermediate care facility for the mentally retarded, or
12 institution for mental disease, as determined to meet the recipient's
13 needs for assistance when cost effective and appropriate [in accordance
14 with section three hundred sixty-seven-k and section three hundred
15 sixty-seven-o of this title], and when prescribed by a physician, in
16 accordance with the recipient's plan of treatment and provided by indi-
17 viduals who are qualified to provide such services, who are supervised
18 by a registered nurse and who are not members of the recipient's family,
19 and furnished in the recipient's home or other location;
20 (II) PURSUANT TO REGULATION, WHICH SHALL NOT BE EMERGENCY REGULATION,
21 THE COMMISSIONER IS AUTHORIZED TO ADOPT STANDARDS FOR THE PROVISION AND
22 MANAGEMENT OF SERVICES AVAILABLE UNDER THIS PARAGRAPH FOR INDIVIDUALS
23 WHOSE NEED FOR SUCH SERVICES EXCEEDS A SPECIFIED LEVEL TO BE DETERMINED
24 BY THE COMMISSIONER;
25 PROVIDE ASSISTANCE TO PERSONS RECEIVING SERVICES UNDER THIS PARAGRAPH
26 WHO ARE TRANSITIONING TO RECEIVING CARE FROM A MANAGED LONG TERM CARE
27 PLAN CERTIFIED PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THE
28 PUBLIC HEALTH LAW;
29 PERSONAL CARE SERVICES AVAILABLE PURSUANT TO THIS PARAGRAPH SHALL NOT
30 EXCEED EIGHT HOURS PER WEEK FOR INDIVIDUALS WHOSE NEEDS ARE LIMITED TO
31 NUTRITIONAL AND ENVIRONMENTAL SUPPORT FUNCTIONS;
32 S 90. Two percent reduction plan. (a) Notwithstanding any other
33 provision of law to the contrary, for the state fiscal years beginning
34 April 1, 2011 and ending on March 31, 2013, all Medicaid payments made
35 for services provided on and after April 1, 2011, shall, except as here-
36 inafter provided, be subject to a uniform two percent reduction, which
37 shall be applied, to the extent practicable, in equal amounts for all
38 Medicaid payments made during each state fiscal year described herein,
39 provided, however, the commissioner of health, in consultation with the
40 director of the budget shall be authorized to develop and implement an
41 alternative reduction plan to achieve an equivalent amount of savings
42 provided in this section. The alternative reduction plan must be
43 provided in writing and shall be filed with the chairman of the senate
44 finance committee and the chairman of the assembly ways and means
45 committee not less than sixty days prior to the application of such
46 reduction. The alternative reduction plan must also be posted on the
47 website of the department of health for a period of not less than sixty
48 days prior to the application of such reduction. Any reductions made
49 pursuant to this section shall achieve up to three hundred forty-five
50 million dollars in Medicaid state share savings annually, except as
51 herein after provided, for services provided on and after April 1, 2011
52 through March 31, 2013.
53 (b) The following types of appropriations shall be exempt from
54 reductions pursuant to this section:
55 (i) any reductions that would violate federal law including, but not
56 limited to, payments required pursuant to the federal Medicare program;
A. 4009--C 160
1 (ii) any reductions related to payments pursuant to article 32, arti-
2 cle 31 and article 16 of the mental hygiene law;
3 (iii) payments the state is obligated to make pursuant to court orders
4 or judgments;
5 (iv) payments for which the non-federal share does not reflect any
6 state funding; and
7 (v) payments with regard to which it is determined by the commissioner
8 of health and the director of the budget that application of reductions
9 pursuant to this section would result, by operation of federal law, in a
10 lower federal medical assistance percentage applicable to such payments.
11 (c) Reductions to Medicaid payments or Medicaid rates of payment made
12 pursuant to this section shall be subject to the receipt of all neces-
13 sary federal approvals.
14 (d) Not less than thirty days prior to the conclusion of each state
15 fiscal year in which the provisions of this section apply, the depart-
16 ment of health shall prepare and transmit a report to the legislature
17 that details the actions taken to implement the Medicaid state share
18 reductions established pursuant to this section. Such report shall be
19 provided to the chairman of the senate finance committee and the chair-
20 man of the assembly ways and means committee.
21 S 2. Notwithstanding any inconsistent provision of state law, rule or
22 regulation to the contrary, subject to federal approval, the year to
23 year rate of growth of department of health Medicaid state funds spend-
24 ing shall not exceed the ten year rolling average of the medical compo-
25 nent of the consumer price index as published by the United States
26 department of labor, bureau of labor statistics, for the preceding ten
27 years.
28 S 3. Medicaid savings allocation plan. (a) Notwithstanding any other
29 provision of law to the contrary, for the state fiscal years beginning
30 April 1, 2011 and ending on March 31, 2013, the director of the budget,
31 in consultation with the commissioner of health, shall develop and
32 implement a Medicaid savings allocation plan to limit projected depart-
33 ment of health Medicaid state funds disbursements to levels assumed in
34 the enacted budget financial plan, provided however, in state fiscal
35 year 2011-12, such Medicaid savings allocation plan shall include a
36 state funds reduction to meet the criteria established in section two of
37 this act. The Medicaid savings allocation plan shall be comprised of the
38 following: (i) a uniform percentage reduction which shall be applied, to
39 the extent practicable, in equal amounts for all Medicaid payments made
40 during each state fiscal year described herein; or (ii) an alternative
41 Medicaid savings allocation plan that will achieve an amount of savings
42 to conform with section two of this act. Any savings resulting from this
43 section of law shall be in addition to any actions pursuant to section
44 one of this act. The Medicaid savings allocation plan shall be provided
45 in writing and shall be filed with the chairman of the senate finance
46 committee and the chairman of the assembly ways and means committee not
47 less than sixty days prior to the application of such reduction. The
48 Medicaid savings allocation plan must also be posted on the website of
49 the department of health for a period of not less than sixty days prior
50 to the application of such reduction. The Medicaid savings plan author-
51 ized by this section may be adjusted by the director of the budget to
52 account for any changes in the New York state federal medical assistance
53 percentage amount established pursuant to the federal social security
54 act.
55 (b) Such Medicaid savings allocation plan shall be designed in compli-
56 ance with the following requirements:
A. 4009--C 161
1 (1) reductions shall be made in compliance with applicable federal
2 law, including the provisions of the Patient Protection and Affordable
3 Care Act, Public Law No. 111-148, and the Health Care and Education
4 Reconciliation Act of 2010, Public Law No. 111-152 (collectively
5 "Affordable Care Act") and any subsequent amendments thereto or regu-
6 lations promulgated thereunder;
7 (2) reductions shall be made in a manner that complies with the state
8 Medicaid plan approved by the federal centers for Medicare and Medicaid
9 services, provided, however, that the commissioner of health is author-
10 ized to submit any state plan amendment or seek other federal approval,
11 including waiver authority, to implement the provisions of the Medicaid
12 savings allocation plan that meets the criteria set forth herein;
13 (3) reductions shall be made in a manner that maximizes federal finan-
14 cial participation, to the extent practicable, including any federal
15 financial participation that is available or is reasonably expected to
16 become available under the Affordable Care Act;
17 (4) reductions shall be made uniformly among categories of service, to
18 the extent practicable, and shall be made uniformly within a category of
19 service, to the extent practicable, except where the commissioner of
20 health determines that there are sufficient grounds for non-uniformity,
21 including but not limited to: the extent to which specific categories of
22 service, or providers within each category of service contributed to
23 department of health Medicaid state funds spending in excess of the
24 limits specified in section ninety of this act; consistency with para-
25 graph six of this subdivision, or the potential benefits of pursuing
26 innovative payment models contemplated by the Affordable Care Act, in
27 which case such grounds shall be set forth in the Medicaid savings allo-
28 cation plan;
29 (5) reductions shall be made in a manner that does not unnecessarily
30 create administrative burdens to Medicaid applicants and recipients or
31 providers; and
32 (6) reductions shall be made to protect, as much as practicable, safe-
33 ty net services in underserved communities and to underserved popu-
34 lations and to encourage and discourage certain activities of providers
35 of particular health care services in order to improve quality of and
36 access to care.
37 (c) In accordance with the Medicaid savings allocation plan, the
38 commissioner of the department of health shall reduce department of
39 health state funds Medicaid disbursements for services and expenses in
40 regular intervals, and in accordance with the Medicaid savings allo-
41 cation plan. The following types of appropriations shall be exempt from
42 reductions pursuant to this section:
43 (i) any reductions that would violate federal law including, but not
44 limited to, payments required pursuant to the federal Medicare program;
45 (ii) any reductions related to payments pursuant to article 32, arti-
46 cle 31 and article 16 of the mental hygiene law;
47 (iii) payments the state is obligated to make pursuant to court orders
48 or judgments;
49 (iv) payments for which the non-federal share does not reflect any
50 state funding; and
51 (v) payments with regard to which it is determined by the commissioner
52 of health and the director of the budget that application of reductions
53 pursuant to this section would result, by operation of federal law, in a
54 lower federal medical assistance percentage applicable to such payments.
A. 4009--C 162
1 (d) Reductions to Medicaid payments or Medicaid rates of payment made
2 pursuant to this section shall be subject to the receipt of all neces-
3 sary federal approvals.
4 S 91. Intentionally omitted.
5 S 92. Intentionally omitted.
6 S 92-a. 1. Notwithstanding any inconsistent provision of law, rule or
7 regulation to the contrary, and subject to the availability of federal
8 financial participation, effective for the period April 1, 2011 through
9 March 31, 2012, and each state fiscal year thereafter, the department of
10 health is authorized to make supplemental Medicaid payments for profes-
11 sional services provided by physicians, nurse practitioners and physi-
12 cian assistants who are employed by non-state operated public general
13 hospitals operated by a public benefit corporation located in a city of
14 more than one million persons or who are providing professional services
15 at a facility of such public benefit corporation as a member of a prac-
16 tice plan under contract to provide services to patients of such a
17 public benefit corporation, in accordance with title 11 of article 5 of
18 the social services law for patients eligible for federal financial
19 participation under title XIX of the federal social security act, in
20 amounts that will increase fees for such professional services to an
21 amount equal to either the Medicare rate or the average commercial rate
22 that would otherwise be received for such services rendered by such
23 physicians, nurse practitioners and physician assistants, provided,
24 however, that such supplemental fee payments shall not be available with
25 regard to services provided at facilities participating in the Medicare
26 Teaching Election Amendment. The calculation of such supplemental fee
27 payments shall be made in accordance with applicable federal law and
28 regulation and subject to the approval of the division of the budget.
29 Such supplemental Medicaid fee payments may be added to the professional
30 fees paid under the fee schedule or made as aggregate lump sum payments
31 to entities authorized to receive professional fees.
32 2. Public general hospitals as described in subdivision one of this
33 section shall, notwithstanding the social services district Medicaid cap
34 provisions of Part C of Chapter 58 of the laws of 2005, be responsible
35 for payment of one hundred percent of the non-federal share of such
36 supplemental Medicaid payments for all services provided by physicians,
37 nurse practitioners and physician assistants who are employed by such
38 public general hospitals, in accordance with section 365-a of the social
39 services law, regardless of whether another social services district of
40 the department of health may otherwise be responsible for furnishing
41 medical assistance to the eligible persons receiving such services.
42 Social services district funding of the non-federal share of any such
43 payments shall be deemed to be voluntary for purposes of the increased
44 federal medical assistance percentage provisions of the American Recov-
45 ery and Reinvestment Act of 2009, provided, however, that in the event
46 the federal Centers for Medicare and Medicaid Services determines that
47 such non-federal share payments are not voluntary payments for purposes
48 of such Act, the provisions of this section shall be null and void.
49 S 92-b. Section 3-d of part B of chapter 58 of the laws of 2010 amend-
50 ing the public health law relating to duties of the department and
51 cardiac service information is amended to read as follows:
52 S 3-d. 1. Notwithstanding any provision of law, rule or regulation to
53 the contrary, and subject to the availability of federal financial
54 participation, for periods on and after April 1, 2010, payments made to
55 managed care providers sponsored by a public benefit corporation located
56 in a city of more than one million persons which provide coverage prima-
A. 4009--C 163
1 rily to Medicaid patients in accordance with sections 364-j and 369-ee
2 of the social services law may, at the election of the social services
3 district, be increased up to an annual aggregate amount of two hundred
4 million dollars; provided, however that, notwithstanding the social
5 services district Medicaid cap provisions of part C of chapter 58 of the
6 laws of 2005, such social services district shall be responsible for
7 payment of one hundred percent of the non-federal share of such
8 increase, and provided further, however, that such payment increases
9 shall not be applied to payments related to the Medicaid advantage
10 program [or the HIV special needs plan]. Social services district fund-
11 ing of the non-federal share of any such payments shall be deemed to be
12 voluntary for purposes of the increased federal medical assistance
13 percentage provisions of the American Recovery and Reinvestment Act of
14 2009; provided however that, in the event the federal Centers for Medi-
15 care and Medicaid Services determines that such non-federal share
16 payments are not voluntary payments for purposes of such Act, the
17 provisions of this section shall be null and void.
18 INSERT 4
19 S 93. Notwithstanding any inconsistent provision of law, rule or regu-
20 lation, for purposes of implementing the provisions of the public health
21 law and the social services law, references to titles XIX and XXI of the
22 federal social security act in the public health law and the social
23 services law shall be deemed to include and also to mean any successor
24 titles thereto under the federal social security act.
25 S 94. Notwithstanding any inconsistent provision of law, rule or regu-
26 lation, the effectiveness of the provisions of sections 2807 and 3614 of
27 the public health law, section 18 of chapter 2 of the laws of 1988, and
28 18 NYCRR 505.14(h), as they relate to time frames for notice, approval
29 or certification of rates of payment, are hereby suspended and without
30 force or effect for purposes of implementing the provisions of this act.
31 S 95. Severability clause. If any clause, sentence, paragraph, subdi-
32 vision, section or part of this act shall be adjudged by any court of
33 competent jurisdiction to be invalid, such judgment shall not affect,
34 impair or invalidate the remainder thereof, but shall be confined in its
35 operation to the clause, sentence, paragraph, subdivision, section or
36 part thereof directly involved in the controversy in which such judgment
37 shall have been rendered. It is hereby declared to be the intent of the
38 legislature that this act would have been enacted even if such invalid
39 provisions had not been included herein.
40 S 96. This act shall take effect immediately and shall be deemed to
41 have been in full force and effect on and after April 1, 2011; provided
42 however, that:
43 (a) the amendment to subparagraph 1 of paragraph (c) of subdivision 10
44 of section 2807-c of the public health law made by section one of this
45 act shall not affect the expiration of such subparagraph and shall
46 expire and be deemed repealed therewith;
47 (b) the amendments to section 272 of the public health law, made by
48 sections nine, sixteen and seventeen of this act shall not affect the
49 repeal of such section and shall expire and be deemed repealed there-
50 with;
51 (b-1) the amendments to subdivision 9 of section 367-a of the social
52 services law made by section ten of this act shall not affect the expi-
53 ration of such subdivision and shall be deemed to expire therewith;
54 (c) the amendments to subdivision 22 of section 6802 of the education
55 law, made by section twelve of this act shall not affect the repeal of
56 such subdivision and shall expire and be deemed repealed therewith;
A. 4009--C 164
1 (d) the amendments to section 271 of the public health law, made by
2 sections thirteen, fourteen and fifteen of this act shall not affect the
3 repeal of such section and shall expire and be deemed repealed there-
4 with;
5 (e) the amendments to subparagraph (i) of paragraph (b-1) of subdivi-
6 sion 1 of section 2807-c of the public health law made by section thir-
7 ty-two of this act shall not affect the expiration of such paragraph and
8 shall be deemed to expire therewith;
9 (f) the amendments to section 4403-f of the public health law made by
10 sections forty-one, forty-one-a and forty-one-b of this act shall not
11 affect the repeal of such section and shall be deemed repealed there-
12 with;
13 (g) the amendments to subdivision 6 of section 367-a of the social
14 services law, made by sections forty-three, forty-four and forty-five of
15 this act shall not affect the repeal of such subdivision and shall
16 expire and be deemed repealed therewith;
17 (h) sections thirty-six, fifty, fifty-one and sixty-eight of this act
18 shall take effect on the ninetieth day after it shall have become a law;
19 (i) the amendments to section 2807-j of the public health law made by
20 section sixty-eight of this act shall not affect the expiration of such
21 section and shall be deemed to expire therewith;
22 (j) sections five, twenty, twenty-one, twenty-four twenty-seven,
23 forty-one, forty-one-a, forty-one-b, forty-three, forty-four, forty-
24 five, forty-six, forty-eight, fifty-four, fifty-eight, seventy, seven-
25 ty-one, seventy-two and seventy-three of this act shall take effect on
26 the one hundred eightieth day after it shall have become a law;
27 (k) section forty-seven of this act shall take effect on October 1,
28 2011;
29 (l) the amendments to paragraph 6 of subdivision (a) of section 31.02
30 of the mental hygiene law made by section seventy-two of this act shall
31 not affect the repeal of such paragraph and shall be deemed to be
32 repealed therewith;
33 (m) the amendments to section 364-j of the social services law made by
34 sections sixty-six-b, seventy-seven, seventy-seven-a, seventy-eight,
35 seventy-nine and eighty of this act shall not affect the repeal of such
36 section and shall be deemed repealed therewith;
37 (n) the amendments to paragraph (k) of subdivision 2 of section 365-a
38 of the social services law made by section eighty-one of this act shall
39 not affect the expiration of such subdivision and shall be deemed to
40 expire therewith;
41 (o) section twelve of this act shall take effect August 1, 2011;
42 (p) sections thirteen, fourteen, fifteen, sixteen, and seventeen and
43 of this act shall take effect May 1, 2011;
44 (p-1) section eighteen shall take effect May 1, 2011 and be deemed
45 repealed on March 31, 2012;
46 (q) section twenty-three of this act shall take effect December 1,
47 2011;
48 (r) section forty of this act shall take effect September 1, 2011;
49 (s) sections sixty-nine, eighty-two, eighty-three, eighty-four, eight-
50 y-five, eighty-six, and eighty-seven of this act shall take effect on
51 January 1, 2012 and shall apply to taxable years beginning on or after
52 January 1, 2012;
53 (t) section nineteen of this act shall take effect on the ninetieth
54 day after it shall become a law and shall apply to any contract for
55 providing pharmacy benefit management made or renewed on or after that
56 date; and, provided, that the amendment to article 2-A of the public
A. 4009--C 165
1 health law made by section nineteen of this act shall survive the repeal
2 of such article as provided in section 79 of part C of chapter 58 of the
3 laws of 2005, as amended;
4 (u) section ninety-one of this act shall take effect April 1, 2012;
5 (v) any rules or regulations necessary to implement the provisions of
6 this act may be promulgated and any procedures, forms, or instructions
7 necessary for such implementation may be adopted and issued on or after
8 the date this act shall have become a law, provided that the department
9 of health may promulgate regulations including on an emergency basis,
10 necessary to implement this act, prior to its effective date;
11 (w) this act shall not be construed to alter, change, affect, impair
12 or defeat any rights, obligations, duties or interests accrued, incurred
13 or conferred prior to the effective date of this act;
14 (x) the commissioner of health and the superintendent of insurance and
15 any appropriate council may take any steps necessary to implement this
16 act prior to its effective date;
17 (y) notwithstanding any inconsistent provision of the state adminis-
18 trative procedure act or any other provision of law, rule or regulation,
19 the commissioner of health and the superintendent of insurance and any
20 appropriate council is authorized to adopt or amend or promulgate on an
21 emergency basis any regulation he or she or such council determines
22 necessary to implement any provision of this act on its effective date;
23 (z) sections fifty-two through fifty-two-m of this act shall take
24 effect on the ninetieth day after it shall have become law, provided
25 that it shall apply to birth-related neurological injury lawsuits in
26 existence as of the date of enactment and to all birth-related neurolog-
27 ical injury lawsuits commenced subsequently to the date of enactment,
28 and provided further that the commissioner of health and the superinten-
29 dent of financial regulations shall be authorized to promulgate any
30 regulations as necessary to implement such sections prior to such effec-
31 tive date, including on an emergency basis; and
32 (aa) the provisions of this act shall become effective notwithstanding
33 the failure of the commissioner of health or the superintendent of
34 insurance or any council to adopt or amend or promulgate regulations
35 implementing this act.
36 PART I
37 Section 1. Notwithstanding any other law, rule, or regulation to the
38 contrary, the comptroller is hereby authorized and directed to deposit
39 to the credit of the capital projects fund, reimbursement from the
40 proceeds of notes or bonds issued by the urban development corporation
41 for capital appropriation of $130,550,000 authorized by a chapter of the
42 laws of 2011 to the urban development corporation for services and
43 expenses related to the regional economic development council initi-
44 ative, reimbursement from the proceeds of notes or bonds issued by the
45 urban development corporation for capital appropriation of $100,000,000
46 authorized by a chapter of the laws of 2011 to the urban development
47 corporation for services and expenses related to the economic transfor-
48 mation program.
49 S 2. Section 1 of chapter 174 of the laws of 1968, constituting the
50 New York state urban development corporation act, is amended by adding a
51 new section 44 to read as follows:
52 S 44. 1. NOTWITHSTANDING THE PROVISIONS OF ANY OTHER LAW TO THE
53 CONTRARY, THE DORMITORY AUTHORITY AND THE CORPORATION ARE HEREBY AUTHOR-
54 IZED TO ISSUE BONDS OR NOTES IN ONE OR MORE SERIES FOR THE PURPOSE OF
A. 4009--C 166
1 FUNDING PROJECT COSTS FOR THE REGIONAL ECONOMIC DEVELOPMENT COUNCIL
2 INITIATIVE, THE ECONOMIC TRANSFORMATION PROGRAM AND OTHER STATE COSTS
3 ASSOCIATED WITH SUCH PROJECTS. THE AGGREGATE PRINCIPAL AMOUNT OF BONDS
4 AUTHORIZED TO BE ISSUED PURSUANT TO THIS SECTION SHALL NOT EXCEED TWO
5 HUNDRED THIRTY MILLION FIVE HUNDRED FIFTY THOUSAND DOLLARS, EXCLUDING
6 BONDS ISSUED TO FUND ONE OR MORE DEBT SERVICE RESERVE FUNDS, TO PAY
7 COSTS OF ISSUANCE OF SUCH BONDS, AND BONDS OR NOTES ISSUED TO REFUND OR
8 OTHERWISE REPAY SUCH BONDS OR NOTES PREVIOUSLY ISSUED. SUCH BONDS AND
9 NOTES OF THE DORMITORY AUTHORITY AND THE CORPORATION SHALL NOT BE A DEBT
10 OF THE STATE, AND THE STATE SHALL NOT BE LIABLE THEREON, NOR SHALL THEY
11 BE PAYABLE OUT OF ANY FUNDS OTHER THAN THOSE APPROPRIATED BY THE STATE
12 TO THE DORMITORY AUTHORITY AND THE CORPORATION FOR PRINCIPAL, INTEREST,
13 AND RELATED EXPENSES PURSUANT TO A SERVICE CONTRACT AND SUCH BONDS AND
14 NOTES SHALL CONTAIN ON THE FACE THEREOF A STATEMENT TO SUCH EFFECT.
15 EXCEPT FOR PURPOSES OF COMPLYING WITH THE INTERNAL REVENUE CODE, ANY
16 INTEREST INCOME EARNED ON BOND PROCEEDS SHALL ONLY BE USED TO PAY DEBT
17 SERVICE ON SUCH BONDS.
18 2. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, IN
19 ORDER TO ASSIST THE DORMITORY AUTHORITY AND THE CORPORATION IN UNDERTAK-
20 ING THE FINANCING FOR PROJECT COSTS FOR THE REGIONAL ECONOMIC DEVELOP-
21 MENT COUNCIL INITIATIVE, THE ECONOMIC TRANSFORMATION PROGRAM AND OTHER
22 STATE COSTS ASSOCIATED WITH SUCH PROJECTS, THE DIRECTOR OF THE BUDGET IS
23 HEREBY AUTHORIZED TO ENTER INTO ONE OR MORE SERVICE CONTRACTS WITH THE
24 DORMITORY AUTHORITY AND THE CORPORATION, NONE OF WHICH SHALL EXCEED
25 THIRTY YEARS IN DURATION, UPON SUCH TERMS AND CONDITIONS AS THE DIRECTOR
26 OF THE BUDGET AND THE DORMITORY AUTHORITY AND THE CORPORATION AGREE, SO
27 AS TO ANNUALLY PROVIDE TO THE DORMITORY AUTHORITY AND THE CORPORATION,
28 IN THE AGGREGATE, A SUM NOT TO EXCEED THE PRINCIPAL, INTEREST, AND
29 RELATED EXPENSES REQUIRED FOR SUCH BONDS AND NOTES. ANY SERVICE CONTRACT
30 ENTERED INTO PURSUANT TO THIS SECTION SHALL PROVIDE THAT THE OBLIGATION
31 OF THE STATE TO PAY THE AMOUNT THEREIN PROVIDED SHALL NOT CONSTITUTE A
32 DEBT OF THE STATE WITHIN THE MEANING OF ANY CONSTITUTIONAL OR STATUTORY
33 PROVISION AND SHALL BE DEEMED EXECUTORY ONLY TO THE EXTENT OF MONIES
34 AVAILABLE AND THAT NO LIABILITY SHALL BE INCURRED BY THE STATE BEYOND
35 THE MONIES AVAILABLE FOR SUCH PURPOSE, SUBJECT TO ANNUAL APPROPRIATION
36 BY THE LEGISLATURE. ANY SUCH CONTRACT OR ANY PAYMENTS MADE OR TO BE
37 MADE THEREUNDER MAY BE ASSIGNED AND PLEDGED BY THE DORMITORY AUTHORITY
38 AND THE CORPORATION AS SECURITY FOR ITS BONDS AND NOTES, AS AUTHORIZED
39 BY THIS SECTION.
40 S 3. This act shall take effect immediately.
41 S 2. Severability clause. If any clause, sentence, paragraph, subdivi-
42 sion, section or part of this act shall be adjudged by any court of
43 competent jurisdiction to be invalid, such judgment shall not affect,
44 impair, or invalidate the remainder thereof, but shall be confined in
45 its operation to the clause, sentence, paragraph, subdivision, section
46 or part thereof directly involved in the controversy in which such judg-
47 ment shall have been rendered. It is hereby declared to be the intent of
48 the legislature that this act would have been enacted even if such
49 invalid provisions had not been included herein.
50 S 3. This act shall take effect immediately provided, however, that
51 the applicable effective date of Parts A through I of this act shall be
52 as specifically set forth in the last section of such Parts.
