Bill Text: NY A05248 | 2019-2020 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
Spectrum: Partisan Bill (Democrat 83-0)
Status: (Introduced - Dead) 2020-05-22 - print number 5248a [A05248 Detail]
Download: New_York-2019-A05248-Introduced.html
Bill Title: Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
Spectrum: Partisan Bill (Democrat 83-0)
Status: (Introduced - Dead) 2020-05-22 - print number 5248a [A05248 Detail]
Download: New_York-2019-A05248-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 5248 2019-2020 Regular Sessions IN ASSEMBLY February 8, 2019 ___________ Introduced by M. of A. GOTTFRIED, ABINANTI, BARRETT, BARRON, BENEDETTO, BICHOTTE, BLAKE, BRONSON, BURKE, CAHILL, CARROLL, COLTON, COOK, CRES- PO, CRUZ, CYMBROWITZ, DE LA ROSA, DICKENS, DILAN, DINOWITZ, D'URSO, ENGLEBRIGHT, EPSTEIN, FERNANDEZ, FRONTUS, GANTT, HUNTER, HYNDMAN, JAFFEE, JEAN-PIERRE, JOYNER, KIM, LAVINE, LIFTON, LUPARDO, M. G. MILL- ER, MOSLEY, NIOU, ORTIZ, PAULIN, PEOPLES-STOKES, PERRY, PHEFFER AMATO, PICHARDO, RAMOS, REYES, RICHARDSON, RIVERA, RODRIGUEZ, L. ROSENTHAL, SEAWRIGHT, SIMON, SIMOTAS, SOLAGES, STECK, STIRPE, TAYLOR, THIELE, TITUS, VANEL, WALKER, WALLACE, WEINSTEIN, WEPRIN, WILLIAMS, WRIGHT -- Multi-Sponsored by -- M. of A. ABBATE, ARROYO, AUBRY, DAVILA, DenDEKK- ER, FAHY, GALEF, GLICK, GUNTHER, LENTOL, MAGNARELLI, O'DONNELL, PRET- LOW, QUART, ROZIC -- read once and referred to the Committee on Health AN ACT to amend the public health law and the state finance law, in relation to enacting the "New York health act" and to establishing New York Health The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "New York health act". 3 § 2. Legislative findings and intent. 1. The state constitution 4 states: "The protection and promotion of the health of the inhabitants 5 of the state are matters of public concern and provision therefor shall 6 be made by the state and by such of its subdivisions and in such manner, 7 and by such means as the legislature shall from time to time determine." 8 (Article XVII, §3.) The legislature finds and declares that all resi- 9 dents of the state have the right to health care. While the federal 10 Affordable Care Act brought many improvements in health care and health 11 coverage, it still leaves many New Yorkers without coverage or with 12 inadequate coverage. Millions of New Yorkers do not get the health care 13 they need or face financial obstacles and hardships to get it. That is 14 not acceptable. There is no plan other than the New York health act EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09777-01-9A. 5248 2 1 that will enable New York state to meet that need. New Yorkers - as 2 individuals, employers, and taxpayers - have experienced a rise in the 3 cost of health care and coverage in recent years, including rising 4 premiums, deductibles and co-pays, restricted provider networks and high 5 out-of-network charges. Many New Yorkers go without health care because 6 they cannot afford it or suffer financial hardship to get it. Busi- 7 nesses have also experienced increases in the costs of health care bene- 8 fits for their employees, and many employers are shifting a larger share 9 of the cost of coverage to their employees or dropping coverage entire- 10 ly. Including long-term services and supports (LTSS) in New York Health 11 is a major step forward for older adults, people with disabilities, and 12 their families. Older adults and people with disabilities often cannot 13 receive the services necessary to stay in the community or other LTSS. 14 Even when older adults and people with disabilities receive LTSS, espe- 15 cially services in the community, it is often at the cost of unreason- 16 able demands on unpaid family caregivers, depleting their own or family 17 resources, or impoverishing themselves to qualify for public coverage. 18 Health care providers are also affected by inadequate health coverage in 19 New York state. A large portion of hospitals, health centers and other 20 providers now experience substantial losses due to the provision of care 21 that is uncompensated. Individuals often find that they are deprived of 22 affordable care and choice because of decisions by health plans guided 23 by the plan's economic interests rather than the individual's health 24 care needs. To address the fiscal crisis facing the health care system 25 and the state and to assure New Yorkers can exercise their right to 26 health care, affordable and comprehensive health coverage must be 27 provided. Pursuant to the state constitution's charge to the legislature 28 to provide for the health of New Yorkers, this legislation is an enact- 29 ment of state concern for the purpose of establishing a comprehensive 30 universal guaranteed health care coverage program and a health care cost 31 control system for the benefit of all residents of the state of New 32 York. 33 2. (a) It is the intent of the Legislature to create the New York 34 Health program to provide a universal single payer health plan for every 35 New Yorker, funded by broad-based revenue based on ability to pay. The 36 legislature intends that federal waivers and approvals be sought where 37 they will improve the administration of the New York Health program, but 38 the legislature intends that the program be implemented even in the 39 absence of such waivers or approvals. The state shall work to obtain 40 waivers and other approvals relating to Medicaid, Child Health Plus, 41 Medicare, the Affordable Care Act, and any other appropriate federal 42 programs, under which federal funds and other subsidies that would 43 otherwise be paid to New York State, New Yorkers, and health care 44 providers for health coverage that will be equaled or exceeded by New 45 York Health will be paid by the federal government to New York State and 46 deposited in the New York Health trust fund, or paid to health care 47 providers and individuals in combination with New York Health trust fund 48 payments, and for other program modifications (including elimination of 49 cost sharing and insurance premiums). Under such waivers and approvals, 50 health coverage under those programs will, to the maximum extent possi- 51 ble, be replaced and merged into New York Health, which will operate as 52 a true single-payer program. 53 (b) If any necessary waiver or approval is not obtained, the state 54 shall use state plan amendments and seek waivers and approvals to maxi- 55 mize, and make as seamless as possible, the use of federally-matched 56 health programs and federal health programs in New York Health. Thus,A. 5248 3 1 even where other programs such as Medicaid or Medicare may contribute to 2 paying for care, it is the goal of this legislation that the coverage 3 will be delivered by New York Health and, as much as possible, the 4 multiple sources of funding will be pooled with other New York Health 5 funds and not be apparent to New York Health members or participating 6 providers. 7 (c) This program will promote movement away from fee-for-service 8 payment, which tends to reward quantity and requires excessive adminis- 9 trative expense, and towards alternate payment methodologies, such as 10 global or capitated payments to providers or health care organizations, 11 that promote quality, efficiency, investment in primary and preventive 12 care, and innovation and integration in the organizing of health care. 13 (d) The program shall promote the use of clinical data to improve the 14 quality of health care and public health, consistent with protection of 15 patient confidentiality. The program shall maximize patient autonomy in 16 choice of health care providers and health care decision making. Care 17 coordination within the program shall ensure management and coordination 18 among a patient's health care services, consistent with patient autonomy 19 and person-centered service planning, rather than acting as a gatekeeper 20 to needed services. 21 3. This act does not create any employment benefit, nor does it 22 require, prohibit, or limit the providing of any employment benefit. 23 4. In order to promote improved quality of, and access to, health care 24 services and promote improved clinical outcomes, it is the policy of the 25 state to encourage cooperative, collaborative and integrative arrange- 26 ments among health care providers who might otherwise be competitors, 27 under the active supervision of the commissioner of health. It is the 28 intent of the state to supplant competition with such arrangements and 29 regulation only to the extent necessary to accomplish the purposes of 30 this act, and to provide state action immunity under the state and 31 federal antitrust laws to health care providers, particularly with 32 respect to their relations with the single-payer New York Health plan 33 created by this act. 34 § 3. Article 50 and sections 5000, 5001, 5002 and 5003 of the public 35 health law are renumbered article 80 and sections 8000, 8001, 8002 and 36 8003, respectively, and a new article 51 is added to read as follows: 37 ARTICLE 51 38 NEW YORK HEALTH 39 Section 5100. Definitions. 40 5101. Program created. 41 5102. Board of trustees. 42 5103. Eligibility and enrollment. 43 5104. Benefits. 44 5105. Health care providers; care coordination; payment method- 45 ologies. 46 5106. Health care organizations. 47 5107. Program standards. 48 5108. Regulations. 49 5109. Provisions relating to federal health programs. 50 5110. Additional provisions. 51 5111. Regional advisory councils. 52 § 5100. Definitions. As used in this article, the following terms 53 shall have the following meanings, unless the context clearly requires 54 otherwise:A. 5248 4 1 1. "Board" means the board of trustees of the New York Health program 2 created by section fifty-one hundred two of this article, and "trustee" 3 means a trustee of the board. 4 2. "Care coordination" means, but is not limited to, managing, refer- 5 ring to, locating, coordinating, and monitoring health care services for 6 the member to assure that all medically necessary health care services 7 are made available to and are effectively used by the member in a timely 8 manner, consistent with patient autonomy. Care coordination does not 9 include a requirement for prior authorization for health care services 10 or for referral for a member to receive a health care service. 11 3. "Care coordinator" means an individual or entity approved to 12 provide care coordination under subdivision two of section fifty-one 13 hundred five of this article. 14 4. "Federally-matched public health program" means the medical assist- 15 ance program under title eleven of article five of the social services 16 law, the basic health program under section three hundred sixty-nine-gg 17 of the social services law, and the child health plus program under 18 title one-A of article twenty-five of this chapter. 19 5. "Health care organization" means an entity that is approved by the 20 commissioner under section fifty-one hundred six of this article to 21 provide health care services to members under the program. 22 6. "Health care provider" means any individual or entity legally 23 authorized to provide a health care service under Medicaid or Medicare 24 or this article. "Health care professional" means a health care provider 25 that is an individual licensed, certified, registered or otherwise 26 authorized to practice under title eight of the education law to provide 27 such health care service, acting within his or her lawful scope of prac- 28 tice. 29 7. "Health care service" means any health care service, including care 30 coordination, included as a benefit under the program. 31 8. "Implementation period" means the period under subdivision three of 32 section fifty-one hundred one of this article during which the program 33 will be subject to special eligibility and financing provisions until it 34 is fully implemented under that section. 35 10. "Medicaid" or "medical assistance" means title eleven of article 36 five of the social services law and the program thereunder. "Child 37 health plus" means title one-A of article twenty-five of this chapter 38 and the program thereunder. "Medicare" means title XVIII of the federal 39 social security act and the programs thereunder. "Affordable care act" 40 means the federal patient protection and affordable care act, public law 41 111-148, as amended by the health care and education reconciliation act 42 of 2010, public law 111-152, and as otherwise amended and any regu- 43 lations or guidance issued thereunder. "Basic health program" means 44 section three hundred sixty-nine-gg of the social services law and the 45 program thereunder. 46 11. "Member" means an individual who is enrolled in the program. 47 12. "New York Health", "New York Health program", and "program" mean 48 the New York Health program created by section fifty-one hundred one of 49 this article. 50 13. "New York Health trust fund" means the New York Health trust fund 51 established under section eighty-nine-j of the state finance law. 52 14. "Out-of-state health care service" means a health care service 53 provided to a member while the member is temporarily out of the state 54 and (a) it is medically necessary that the health care service be 55 provided while the member is out of the state, or (b) it is clinically 56 appropriate that the health care service be provided by a particularA. 5248 5 1 health care provider located out of the state rather than in the state. 2 However, any health care service provided to a New York Health enrollee 3 by a health care provider qualified under paragraph (a) of subdivision 4 three of section fifty-one hundred five of this article that is located 5 outside the state shall not be considered an out-of-state service and 6 shall be covered as otherwise provided in this article. 7 15. "Participating provider" means any individual or entity that is a 8 health care provider qualified under subdivision three of section 9 fifty-one hundred five of this article that provides health care 10 services to members under the program, or a health care organization. 11 16. "Person" means any individual or natural person, trust, partner- 12 ship, association, unincorporated association, corporation, company, 13 limited liability company, proprietorship, joint venture, firm, joint 14 stock association, department, agency, authority, or other legal entity, 15 whether for-profit, not-for-profit or governmental. 16 17. "Prescription and non-prescription drugs" means prescription drugs 17 as defined in section two hundred seventy of this chapter, and non-pres- 18 cription smoking cessation products or devices. 19 18. "Resident" means an individual whose primary place of abode is in 20 the state, without regard to the individual's immigration status, as 21 determined according to regulations of the commissioner. 22 § 5101. Program created. 1. The New York Health program is hereby 23 created in the department. The commissioner shall establish and imple- 24 ment the program under this article. The program shall provide compre- 25 hensive health coverage to every resident who enrolls in the program. 26 2. The commissioner shall, to the maximum extent possible, organize, 27 administer and market the program and services as a single program under 28 the name "New York Health" or such other name as the commissioner shall 29 determine, regardless of under which law or source the definition of a 30 benefit is found including (on a voluntary basis) retiree health bene- 31 fits. In implementing this article, the commissioner shall avoid jeop- 32 ardizing federal financial participation in these programs and shall 33 take care to promote public understanding and awareness of available 34 benefits and programs. 35 3. The commissioner shall determine when individuals may begin enroll- 36 ing in the program. There shall be an implementation period, which shall 37 begin on the date that individuals may begin enrolling in the program 38 and shall end as determined by the commissioner. 39 4. An insurer authorized to provide coverage pursuant to the insurance 40 law or a health maintenance organization certified under this chapter 41 may, if otherwise authorized, offer benefits that do not cover any 42 service for which coverage is offered to individuals under the program, 43 but may not offer benefits that cover any service for which coverage is 44 offered to individuals under the program. Provided, however, that this 45 subdivision shall not prohibit (a) the offering of any benefits to or 46 for individuals, including their families, who are employed or self-em- 47 ployed in the state but who are not residents of the state, or (b) the 48 offering of benefits during the implementation period to individuals who 49 enrolled or may enroll as members of the program, or (c) the offering of 50 retiree health benefits. 51 5. A college, university or other institution of higher education in 52 the state may purchase coverage under the program for any student, or 53 student's dependent, who is not a resident of the state. 54 6. To the extent any provision of this chapter, the social services 55 law, the insurance law or the elder law:A. 5248 6 1 (a) is inconsistent with any provision of this article or the legisla- 2 tive intent of the New York Health Act, this article shall apply and 3 prevail, except where explicitly provided otherwise by this article; and 4 (b) is consistent with the provisions of this article and the legisla- 5 tive intent of the New York Health Act, the provision of that law shall 6 apply. 7 7. The program shall be deemed to be a health care plan for purposes 8 of utilization review and external appeal under article forty-nine of 9 this chapter. An enrollee may designate a person or entity, including, 10 but not limited to, a representative of the enrollee's care coordinator, 11 a health care organization providing the service under review or appeal, 12 or a labor union or Taft-Hartley fund of which such enrollee or 13 enrollee's family member is a member to serve as the enrollee's designee 14 for purposes of that article, if the person or entity agrees to be the 15 designee. 16 8. (a) No member shall be required to receive any health care service 17 through any entity organized, certified or operating under guidelines 18 under article forty-four of this chapter, or specified under section 19 three hundred sixty-four-j of the social services law, the insurance law 20 or the elder law. No such entity shall receive payment for health care 21 services (other than care coordination) from the program. 22 (b) However, this subdivision shall not preclude the use of a Medicare 23 managed care ("Medicare advantage") entity or other entity created by or 24 under the direction of the program where reasonably necessary to maxi- 25 mize federal financial participation or other federal financial support 26 under any federally-matched public health program, Medicare or the 27 Affordable Care Act. Any entity under this paragraph shall, to the maxi- 28 mum extent feasible, operate in the background, without burden on or 29 interference with the member and health care provider, without depriving 30 the member or health care provider of any right or benefit under the 31 program and otherwise consistent with this article. 32 9. The program shall include provisions for an appropriate reserve 33 fund. 34 10. (a) This subdivision applies to every person who is a retiree of a 35 public employer, as defined in section two hundred one of the civil 36 service law, and any person who is a beneficiary of the retiree's public 37 employee retiree health benefit. Any reference to the retiree shall mean 38 and include any beneficiary of the retiree. This subdivision does not 39 create or increase any eligibility for any public employee retiree 40 health benefit that would not otherwise exist and does not diminish any 41 public employee retiree health benefit. 42 (b) This paragraph applies to the retiree while he or she is a resi- 43 dent of New York state. The retiree shall enroll in the program. If, by 44 the implementation date, the retiree has not enrolled in the program, 45 the appropriate public employee retirement system and the commissioner 46 shall enroll the retiree in the New York Health program. If the 47 retiree's public employee retiree health benefit includes any service 48 for which coverage is not offered under the New York Health program, the 49 retiree shall continue to receive that benefit from the public employee 50 retirement program. 51 (c) For every retiree, while he or she is not a resident of New York 52 state, the appropriate public employee retirement system shall maintain 53 the retiree's public employee retiree health benefit as if this article 54 had not been enacted. 55 § 5102. Board of trustees. 1. The New York Health board of trustees is 56 hereby created in the department. The board of trustees shall, at theA. 5248 7 1 request of the commissioner, consider any matter to effectuate the 2 provisions and purposes of this article, and may advise the commissioner 3 thereon; and it may, from time to time, submit to the commissioner any 4 recommendations to effectuate the provisions and purposes of this arti- 5 cle. The commissioner may propose regulations under this article and 6 amendments thereto for consideration by the board. The board of trustees 7 shall have no executive, administrative or appointive duties except as 8 otherwise provided by law. The board of trustees shall have power to 9 establish, and from time to time, amend regulations to effectuate the 10 provisions and purposes of this article, subject to approval by the 11 commissioner. 12 2. The board shall be composed of: 13 (a) the commissioner, the superintendent of financial services, and 14 the director of the budget, or their designees, as ex officio members; 15 (b) twenty-six trustees appointed by the governor; 16 (i) six of whom shall be representatives of health care consumer advo- 17 cacy organizations which have a statewide or regional constituency, who 18 have been involved in issues of interest to low- and moderate-income 19 individuals, older adults, and people with disabilities; at least three 20 of whom shall represent organizations led by consumers in those groups; 21 (ii) two of whom shall be representatives of professional organiza- 22 tions representing physicians; 23 (iii) two of whom shall be representatives of professional organiza- 24 tions representing licensed or registered health care professionals 25 other than physicians; 26 (iv) three of whom shall be representatives of general hospitals, one 27 of whom shall be a representative of public general hospitals; 28 (v) one of whom shall be a representative of community health centers; 29 (vi) two of whom shall be representatives of rehabilitation or home 30 care providers; 31 (vii) two of whom shall be representatives of behavioral or mental 32 health or disability service providers; 33 (viii) two of whom shall be representatives of health care organiza- 34 tions; 35 (ix) two of whom shall be representatives of organized labor; 36 (x) two of whom shall have demonstrated expertise in health care 37 finance; and 38 (xi) two of whom shall be employers or representatives of employers 39 who pay the payroll tax under this article, or, prior to the tax becom- 40 ing effective, will pay the tax; 41 (c) fourteen trustees appointed by the governor; five of whom to be 42 appointed on the recommendation of the speaker of the assembly; five of 43 whom to be appointed on the recommendation of the temporary president of 44 the senate; two of whom to be appointed on the recommendation of the 45 minority leader of the assembly; and two of whom to be appointed on the 46 recommendation of the minority leader of the senate. 47 3. After the end of the implementation period, no person shall be a 48 trustee unless he or she is a member of the program, except the ex offi- 49 cio trustees. Each trustee shall serve at the pleasure of the appointing 50 officer, except the ex officio trustees. 51 4. The chair of the board shall be appointed, and may be removed as 52 chair, by the governor from among the trustees. The board shall meet at 53 least four times each calendar year. Meetings shall be held upon the 54 call of the chair and as provided by the board. A majority of the 55 appointed trustees shall be a quorum of the board, and the affirmative 56 vote of a majority of the trustees voting, but not less than ten, shallA. 5248 8 1 be necessary for any action to be taken by the board. The board may 2 establish an executive committee to exercise any powers or duties of the 3 board as it may provide, and other committees to assist the board or the 4 executive committee. The chair of the board shall chair the executive 5 committee and shall appoint the chair and members of all other commit- 6 tees. The board of trustees may appoint one or more advisory committees. 7 Members of advisory committees need not be members of the board of trus- 8 tees. 9 5. Trustees shall serve without compensation but shall be reimbursed 10 for their necessary and actual expenses incurred while engaged in the 11 business of the board. 12 6. Notwithstanding any provision of law to the contrary, no officer or 13 employee of the state or any local government shall forfeit or be deemed 14 to have forfeited his or her office or employment by reason of being a 15 trustee. 16 7. The board and its committees and advisory committees may request 17 and receive the assistance of the department and any other state or 18 local governmental entity in exercising its powers and duties. 19 8. No later than two years after the effective date of this article: 20 (a) The board shall develop proposals for: (i) incorporating retiree 21 health benefits into New York Health; (ii) accommodating employer reti- 22 ree health benefits for people who have been members of New York Health 23 but live as retirees out of the state; and (iii) accommodating employer 24 retiree health benefits for people who earned or accrued such benefits 25 while residing in the state prior to the implementation of New York 26 Health and live as retirees out of the state. The board shall present 27 its proposals to the governor and the legislature. 28 (b) The board shall develop a proposal for New York Health coverage of 29 health care services covered under the workers' compensation law, 30 including whether and how to continue funding for those services under 31 that law and whether and how to incorporate an element of experience 32 rating. 33 § 5103. Eligibility and enrollment. 1. Every resident of the state 34 shall be eligible and entitled to enroll as a member under the program. 35 2. No individual shall be required to pay any premium or other charge 36 for enrolling in or being a member under the program. 37 3. A newborn child shall be enrolled as of the date of the child's 38 birth if enrollment is done prior to the child's birth or within sixty 39 days after the child's birth. 40 § 5104. Benefits. 1. The program shall provide comprehensive health 41 coverage to every member, which shall include all health care services 42 required to be covered under any of the following, without regard to 43 whether the member would otherwise be eligible for or covered by the 44 program or source referred to: 45 (a) child health plus; 46 (b) Medicaid; 47 (c) Medicare; 48 (d) article forty-four of this chapter or article thirty-two or 49 forty-three of the insurance law; 50 (e) article eleven of the civil service law, as of the date one year 51 before the beginning of the implementation period; 52 (f) any cost incurred defined in paragraph one of subsection (a) of 53 section fifty-one hundred two of the insurance law, provided that this 54 coverage shall not replace coverage under article fifty-one of the 55 insurance law;A. 5248 9 1 (g) any additional health care service authorized to be added to the 2 program's benefits by the program; and 3 (h) provided that where any state law or regulation related to any 4 federally-matched public health program states that a benefit is contin- 5 gent on federal financial participation, or words to that effect, the 6 benefit shall be included under the New York Health program without 7 regard to federal financial participation. 8 2. No member shall be required to pay any premium, deductible, co-pay- 9 ment or co-insurance under the program. 10 3. The program shall provide for payment under the program for: 11 (a) emergency and temporary health care services provided to a member 12 or individual entitled to become a member who has not had a reasonable 13 opportunity to become a member or to enroll with a care coordinator; and 14 (b) health care services provided in an emergency to an individual who 15 is entitled to become a member or enrolled with a care coordinator, 16 regardless of having had an opportunity to do so. 17 § 5105. Health care providers; care coordination; payment methodol- 18 ogies. 1. Choice of health care provider. (a) Any health care provider 19 qualified to participate under this section may provide health care 20 services under the program, provided that the health care provider is 21 otherwise legally authorized to perform the health care service for the 22 individual and under the circumstances involved. 23 (b) A member may choose to receive health care services under the 24 program from any participating provider, consistent with provisions of 25 this article relating to care coordination and health care organiza- 26 tions, the willingness or availability of the provider (subject to 27 provisions of this article relating to discrimination), and the appro- 28 priate clinically-relevant circumstances. 29 2. Care coordination. (a) A care coordinator may be an individual or 30 entity that is approved by the program that is: 31 (i) a health care practitioner who is: (A) the member's primary care 32 practitioner; (B) at the option of a female member, the member's provid- 33 er of primary gynecological care; or (C) at the option of a member who 34 has a chronic condition that requires specialty care, a specialist 35 health care practitioner who regularly and continually provides treat- 36 ment for that condition to the member; 37 (ii) an entity licensed under article twenty-eight of this chapter or 38 certified under article thirty-six of this chapter, or, with respect to 39 a member who receives chronic mental health care services, an entity 40 licensed under article thirty-one of the mental hygiene law or other 41 entity approved by the commissioner in consultation with the commission- 42 er of mental health; 43 (iii) a health care organization; 44 (iv) a Taft-Hartley fund or labor union, with respect to its members 45 and their family members; provided that this provision shall not 46 preclude a Taft-Hartley fund or labor union from becoming a care coordi- 47 nator under subparagraph (v) of this paragraph or a health care organ- 48 ization under section fifty-one hundred six of this article; or 49 (v) any not-for-profit or governmental entity approved by the program. 50 (b)(i) Every member shall enroll with a care coordinator that agrees 51 to provide care coordination to the member prior to receiving health 52 care services to be paid for under the program. Health care services 53 provided to a member shall not be subject to payment under the program 54 unless the member is enrolled with a care coordinator at the time the 55 health care service is provided.A. 5248 10 1 (ii) This paragraph shall not apply to health care services provided 2 under subdivision three of section fifty-one hundred four of this arti- 3 cle. 4 (iii) The member shall remain enrolled with that care coordinator 5 until the member becomes enrolled with a different care coordinator or 6 ceases to be a member. Members have the right to change their care coor- 7 dinator on terms at least as permissive as the provisions of section 8 three hundred sixty-four-j of the social services law relating to an 9 individual changing his or her primary care provider or managed care 10 provider. 11 (c) Care coordination shall be provided to the member by the member's 12 care coordinator. A care coordinator may employ or utilize the services 13 of other individuals or entities to assist in providing care coordi- 14 nation for the member, consistent with regulations of the commissioner. 15 (d) A health care organization may establish rules relating to care 16 coordination for members in the health care organization, different from 17 this subdivision but otherwise consistent with this article and other 18 applicable laws. 19 (e) The commissioner shall develop and implement procedures and stand- 20 ards for an individual or entity to be approved to be a care coordinator 21 in the program, including but not limited to procedures and standards 22 relating to the revocation, suspension, limitation, or annulment of 23 approval on a determination that the individual or entity is not compe- 24 tent to be a care coordinator or has exhibited a course of conduct which 25 is either inconsistent with program standards and regulations or which 26 exhibits an unwillingness to meet such standards and regulations, or is 27 a potential threat to the public health or safety. Such procedures and 28 standards shall not limit approval to be a care coordinator in the 29 program for economic purposes and shall be consistent with good profes- 30 sional practice. In developing the procedures and standards, the commis- 31 sioner shall: (i) consider existing standards developed by national 32 accrediting and professional organizations; and (ii) consult with 33 national and local organizations working on care coordination or similar 34 models, including health care practitioners, hospitals, clinics, and 35 consumers and their representatives. When developing and implementing 36 standards of approval of care coordinators for individuals receiving 37 chronic mental health care services, the commissioner shall consult with 38 the commissioner of mental health. An individual or entity may not be a 39 care coordinator unless the services included in care coordination are 40 within the individual's professional scope of practice or the entity's 41 legal authority. 42 (f) To maintain approval under the program, a care coordinator must: 43 (i) renew its status at a frequency determined by the commissioner; and 44 (ii) provide data to the department as required by the commissioner to 45 enable the commissioner to evaluate the impact of care coordinators on 46 quality, outcomes and cost. 47 (g) Nothing in this subdivision shall authorize any individual to 48 engage in any act in violation of title eight of the education law. 49 3. Health care providers. (a) The commissioner shall establish and 50 maintain procedures and standards for health care providers to be quali- 51 fied to participate in the program, including but not limited to proce- 52 dures and standards relating to the revocation, suspension, limitation, 53 or annulment of qualification to participate on a determination that the 54 health care provider is not competent to be a provider of specific 55 health care services or has exhibited a course of conduct which is 56 either inconsistent with program standards and regulations or whichA. 5248 11 1 exhibits an unwillingness to meet such standards and regulations, or is 2 a potential threat to the public health or safety. Such procedures and 3 standards shall not limit health care provider participation in the 4 program for economic purposes and shall be consistent with good profes- 5 sional practice. Such procedures and standards may be different for 6 different types of health care providers and health care professionals. 7 Any health care provider who is qualified to participate under Medicaid, 8 child health plus or Medicare shall be deemed to be qualified to partic- 9 ipate in the program, and any health care provider's revocation, suspen- 10 sion, limitation, or annulment of qualification to participate in any of 11 those programs shall apply to the health care provider's qualification 12 to participate in the program; provided that a health care provider 13 qualified under this sentence shall follow the procedures to become 14 qualified under the program by the end of the implementation period. 15 (b) The commissioner shall establish and maintain procedures and stan- 16 dards for recognizing health care providers located out of the state for 17 purposes of providing coverage under the program for out-of-state health 18 care services. 19 (c) Procedures and standards under this subdivision shall include 20 provisions for expedited temporary qualification to participate in the 21 program for health care professionals who are (i) temporarily authorized 22 to practice in the state or (ii) are recently arrived in the state or 23 recently authorized to practice in the state. 24 4. Payment for health care services. (a) The commissioner may estab- 25 lish by regulation payment methodologies for health care services and 26 care coordination provided to members under the program by participating 27 providers, care coordinators, and health care organizations. There may 28 be a variety of different payment methodologies, including those estab- 29 lished on a demonstration basis. All payment rates under the program 30 shall be reasonable and reasonably related to the cost of efficiently 31 providing the health care service and assuring an adequate and accessi- 32 ble supply of the health care service. Until and unless another payment 33 methodology is established, health care services provided to members 34 under the program shall be paid for on a fee-for-service basis, except 35 for care coordination. 36 (b) The program shall engage in good faith negotiations with health 37 care providers' representatives under title III of article forty-nine of 38 this chapter, including, but not limited to, in relation to rates of 39 payment and payment methodologies. 40 (c) Notwithstanding any provision of law to the contrary, payment for 41 drugs provided by pharmacies under the program shall be made pursuant to 42 title one of article two-A of this chapter. However, the program shall 43 provide for payment for prescription drugs under section 340B of the 44 federal public service act where applicable. Payment for prescription 45 drugs provided by health care providers other than pharmacies shall be 46 pursuant to other provisions of this article. 47 (d) Payment for health care services established under this article 48 shall be considered payment in full. A participating provider shall not 49 charge any rate in excess of the payment established under this article 50 for any health care service provided under the program and shall not 51 solicit or accept payment from any member or third party for any such 52 service except as provided under section fifty-one hundred nine of this 53 article. However, this paragraph shall not preclude the program from 54 acting as a primary or secondary payer in conjunction with another 55 third-party payer where permitted under section fifty-one hundred nine 56 of this article.A. 5248 12 1 (e) The program may provide in payment methodologies for payment for 2 capital related expenses for specifically identified capital expendi- 3 tures incurred by not-for-profit or governmental entities certified 4 under article twenty-eight of this chapter. Any capital related expense 5 generated by a capital expenditure that requires or required approval 6 under article twenty-eight of this chapter must have received that 7 approval for the capital related expense to be paid for under the 8 program. 9 (f) Payment methodologies and rates shall include a distinct component 10 of reimbursement for direct and indirect graduate medical education as 11 defined, calculated and implemented pursuant to section twenty-eight 12 hundred seven-c of this chapter. 13 (g) The commissioner shall provide by regulation for payment method- 14 ologies and procedures for paying for out-of-state health care services. 15 5. Prior authorization. The program shall not require prior authori- 16 zation for any health care service in any manner more restrictive of 17 access to or payment for the service than would be required for the 18 service under Medicare Part A or Part B. Prior authorization for 19 prescription drugs provided by pharmacies under the program shall be 20 under title one of article two-A of this chapter. 21 § 5106. Health care organizations. 1. A member may choose to enroll 22 with and receive health care services under the program from a health 23 care organization. 24 2. A health care organization shall be a not-for-profit or govern- 25 mental entity that is approved by the commissioner that is: 26 (a) an accountable care organization under article twenty-nine-E of 27 this chapter; or 28 (b) a Taft-Hartley fund (i) with respect to its members and their 29 family members, and (ii) if allowed by applicable law and approved by 30 the commissioner, for other members of the program. 31 3. A health care organization may be responsible for providing all or 32 part of the health care services to which its members are entitled under 33 the program, consistent with the terms of its approval by the commis- 34 sioner. 35 4. (a) The commissioner shall develop and implement procedures and 36 standards for an entity to be approved to be a health care organization 37 in the program, including but not limited to procedures and standards 38 relating to the revocation, suspension, limitation, or annulment of 39 approval on a determination that the entity is not competent to be a 40 health care organization or has exhibited a course of conduct which is 41 either inconsistent with program standards and regulations or which 42 exhibits an unwillingness to meet such standards and regulations, or is 43 a potential threat to the public health or safety. Such procedures and 44 standards shall not limit approval to be a health care organization in 45 the program for economic purposes and shall be consistent with good 46 professional practice. In developing the procedures and standards, the 47 commissioner shall: (i) consider existing standards developed by 48 national accrediting and professional organizations; and (ii) consult 49 with national and local organizations working in the field of health 50 care organizations, including health care practitioners, hospitals, 51 clinics, long-term supports and service providers, consumers and their 52 representatives and labor organizations representing health care work- 53 ers. When developing and implementing standards of approval of health 54 care organizations, the commissioner shall consult with the commissioner 55 of mental health, the commissioner of developmental disabilities, theA. 5248 13 1 director of the state office for the aging and the commissioner of the 2 office of alcoholism and substance abuse services. 3 (b) To maintain approval under the program, a health care organization 4 must: (i) renew its status at a frequency determined by the commission- 5 er; and (ii) provide data to the department as required by the commis- 6 sioner to enable the commissioner to evaluate the health care organiza- 7 tion in relation to quality of health care services, health care 8 outcomes, and cost. 9 5. The commissioner shall make regulations relating to health care 10 organizations consistent with and to ensure compliance with this arti- 11 cle. 12 6. The provision of health care services directly or indirectly by a 13 health care organization through health care providers shall not be 14 considered the practice of a profession under title eight of the educa- 15 tion law by the health care organization. 16 § 5107. Program standards. 1. The commissioner shall establish 17 requirements and standards for the program and for health care organiza- 18 tions, care coordinators, and health care providers, consistent with 19 this article, including requirements and standards for, as applicable: 20 (a) the scope, quality and accessibility of health care services; 21 (b) relations between health care organizations or health care provid- 22 ers and members; and 23 (c) relations between health care organizations and health care 24 providers, including (i) credentialing and participation in the health 25 care organization; and (ii) terms, methods and rates of payment. 26 2. Requirements and standards under the program shall include, but not 27 be limited to, provisions to promote the following: 28 (a) simplification, transparency, uniformity, and fairness in health 29 care provider credentialing and participation in health care organiza- 30 tion networks, referrals, payment procedures and rates, claims process- 31 ing, and approval of health care services, as applicable; 32 (b) primary and preventive care, care coordination, efficient and 33 effective health care services, quality assurance, coordination and 34 integration of health care services, including use of appropriate tech- 35 nology, and promotion of public, environmental and occupational health; 36 (c) elimination of health care disparities; 37 (d) non-discrimination with respect to members and health care provid- 38 ers on the basis of race, ethnicity, national origin, religion, disabil- 39 ity, age, sex, sexual orientation, gender identity or expression, or 40 economic circumstances; provided that health care services provided 41 under the program shall be appropriate to the patient's clinically-rele- 42 vant circumstances; 43 (e) accessibility of care coordination, health care organization 44 services and health care services, including accessibility for people 45 with disabilities and people with limited ability to speak or understand 46 English, and the providing of care coordination, health care organiza- 47 tion services and health care services in a culturally competent manner; 48 and 49 (f) especially in relation to long-term supports and services, the 50 maximization and prioritization of the most integrated community-based 51 supports and services. 52 3. Any participating provider or care coordinator that is organized as 53 a for-profit entity (other than a professional practice of one or more 54 health care professionals) shall be required to meet the same require- 55 ments and standards as entities organized as not-for-profit entities, 56 and payments under the program paid to such entities shall not be calcu-A. 5248 14 1 lated to accommodate the generation of profit or revenue for dividends 2 or other return on investment or the payment of taxes that would not be 3 paid by a not-for-profit entity. 4 4. Every participating provider shall furnish to the program such 5 information to, and permit examination of its records by, the program, 6 as may be reasonably required for purposes of reviewing accessibility 7 and utilization of health care services, quality assurance, promoting 8 improved patient outcomes and cost containment, the making of payments, 9 and statistical or other studies of the operation of the program or for 10 protection and promotion of public, environmental and occupational 11 health. 12 5. In developing requirements and standards and making other policy 13 determinations under this article, the commissioner shall consult with 14 representatives of members, health care providers, care coordinators, 15 health care organizations employers, organized labor including repre- 16 sentatives of health care workers, and other interested parties. 17 6. The program shall maintain the security and confidentiality of all 18 data and other information collected under the program when such data 19 would be normally considered confidential patient data. Aggregate data 20 of the program which is derived from confidential data but does not 21 violate patient confidentiality shall be public information including 22 for purposes of article six of the public officers law. 23 § 5108. Regulations. The commissioner may make regulations under this 24 article by approving regulations and amendments thereto, under subdivi- 25 sion one of section fifty-one hundred two of this article. The commis- 26 sioner may make regulations or amendments thereto under this article on 27 an emergency basis under section two hundred two of the state adminis- 28 trative procedure act, provided that such regulations or amendments 29 shall not become permanent unless adopted under subdivision one of 30 section fifty-one hundred two of this article. 31 § 5109. Provisions relating to federal health programs. 1. The commis- 32 sioner shall seek all federal waivers and other federal approvals and 33 arrangements and submit state plan amendments necessary to operate the 34 program consistent with this article to the maximum extent possible. 35 2. (a) The commissioner shall apply to the secretary of health and 36 human services or other appropriate federal official for all waivers of 37 requirements, and make other arrangements, under Medicare, any federal- 38 ly-matched public health program, the affordable care act, and any other 39 federal programs that provide federal funds for payment for health care 40 services, that are necessary to enable all New York Health members to 41 receive all benefits under the program through the program to enable the 42 state to implement this article and to receive and deposit all federal 43 payments under those programs (including funds that may be provided in 44 lieu of premium tax credits, cost-sharing subsidies, and small business 45 tax credits) in the state treasury to the credit of the New York Health 46 trust fund and to use those funds for the New York Health program and 47 other provisions under this article. To the extent possible, the commis- 48 sioner shall negotiate arrangements with the federal government in which 49 bulk or lump-sum federal payments are paid to New York Health in place 50 of federal spending or tax benefits for federally-matched health 51 programs or federal health programs. The commissioner shall take 52 actions under paragraph (b) of subdivision eight of section fifty-one 53 hundred one of this article as reasonably necessary. 54 (b) The commissioner may require members or applicants to be members 55 to provide information necessary for the program to comply with any 56 waiver or arrangement under this subdivision.A. 5248 15 1 3. (a) The commissioner may take actions consistent with this article 2 to enable New York Health to administer Medicare in New York state, to 3 create a Medicare managed care plan ("Medicare Advantage") that would 4 operate consistent with this article, and to be a provider of drug 5 coverage under Medicare part D for eligible members of New York Health. 6 (b) The commissioner may waive or modify the applicability of 7 provisions of this section relating to any federally-matched public 8 health program or Medicare as necessary to implement any waiver or 9 arrangement under this section or to maximize the benefit to the New 10 York Health program under this section, provided that the commissioner, 11 in consultation with the director of the budget, shall determine that 12 such waiver or modification is in the best interests of the members 13 affected by the action and the state. 14 (c) The commissioner may apply for coverage under any federally- 15 matched public health program on behalf of any member and enroll the 16 member in the federally-matched public health program or Medicare if the 17 member is eligible for it. Enrollment in a federally-matched public 18 health program or Medicare shall not cause any member to lose any health 19 care service provided by the program or diminish any right the member 20 would otherwise have. 21 (d) The commissioner shall by regulation increase the income eligibil- 22 ity level, increase or eliminate the resource test for eligibility, 23 simplify any procedural or documentation requirement for enrollment, and 24 increase the benefits for any federally-matched public health program, 25 and for any program to reduce or eliminate an individual's coinsurance, 26 cost-sharing or premium obligations or increase an individual's eligi- 27 bility for any federal financial support related to Medicare or the 28 affordable care act notwithstanding any law or regulation to the contra- 29 ry. The commissioner may act under this paragraph upon a finding, 30 approved by the director of the budget, that the action (i) will help to 31 increase the number of members who are eligible for and enrolled in 32 federally-matched public health programs, or for any program to reduce 33 or eliminate an individual's coinsurance, cost-sharing or premium obli- 34 gations or increase an individual's eligibility for any federal finan- 35 cial support related to Medicare or the affordable care act; (ii) will 36 not diminish any individual's access to any health care service, benefit 37 or right the individual would otherwise have; (iii) is in the interest 38 of the program; and (iv) does not require or has received any necessary 39 federal waivers or approvals to ensure federal financial participation. 40 (e) To enable the commissioner to apply for coverage or financial 41 support under any federally-matched public health program, the Afforda- 42 ble Care Act, or Medicare on behalf of any member and enroll the member 43 in any such program, including an entity under paragraph (b) of subdivi- 44 sion eight of section fifty-one hundred one of this article if the 45 member is eligible for it, the commissioner may require that every 46 member or applicant to be a member shall provide information to enable 47 the commissioner to determine whether the applicant is eligible for such 48 program. The program shall make a reasonable effort to notify members 49 of their obligations under this paragraph. After a reasonable effort has 50 been made to contact the member, the member shall be notified in writing 51 that he or she has sixty days to provide such required information. If 52 such information is not provided within the sixty day period, the 53 member's coverage under the program may be terminated. 54 (f) To the extent necessary for purposes of this section, as a condi- 55 tion of continued eligibility for health care services under theA. 5248 16 1 program, a member who is eligible for benefits under Medicare shall 2 enroll in Medicare, including parts A, B and D. 3 (g) The program shall provide premium assistance for all members 4 enrolling in a Medicare part D drug coverage under section 1860D of 5 Title XVIII of the federal social security act limited to the low-income 6 benchmark premium amount established by the federal centers for Medicare 7 and Medicaid services and any other amount which such agency establishes 8 under its de minimis premium policy, except that such payments made on 9 behalf of members enrolled in a Medicare advantage plan may exceed the 10 low-income benchmark premium amount if determined to be cost effective 11 to the program. 12 (h) If the commissioner has reasonable grounds to believe that a 13 member could be eligible for an income-related subsidy under section 14 1860D-14 of Title XVIII of the federal social security act, the member 15 shall provide, and authorize the program to obtain, any information or 16 documentation required to establish the member's eligibility for such 17 subsidy, provided that the commissioner shall attempt to obtain as much 18 of the information and documentation as possible from records that are 19 available to him or her. 20 (i) The program shall make a reasonable effort to notify members of 21 their obligations under this subdivision. After a reasonable effort has 22 been made to contact the member, the member shall be notified in writing 23 that he or she has sixty days to provide such required information. If 24 such information is not provided within the sixty day period, the 25 member's coverage under the program may be terminated. 26 § 5110. Additional provisions. 1. The commissioner shall contract 27 with not-for-profit organizations to provide: 28 (a) consumer assistance to individuals with respect to selection and 29 changing selection of a care coordinator or health care organization, 30 enrolling, obtaining health care services, and other matters relating to 31 the program; 32 (b) health care provider assistance to health care providers providing 33 and seeking or considering whether to provide, health care services 34 under the program, with respect to participating in a health care organ- 35 ization and dealing with a health care organization; and 36 (c) care coordinator assistance to individuals and entities providing 37 and seeking or considering whether to provide, care coordination to 38 members. 39 2. The commissioner shall provide grants from funds in the New York 40 Health trust fund or otherwise appropriated for this purpose, to health 41 systems agencies under section twenty-nine hundred four-b of this chap- 42 ter to support the operation of such health systems agencies. 43 3. Retraining and re-employment of impacted employees. (a) As used in 44 this subdivision: 45 (i) "Third party payer" means an insurer authorized to provide health 46 coverage under the insurance law, a health maintenance organization 47 under article forty-four of this chapter, a self-insured plan providing 48 health coverage, or any other third party payer for health care 49 services. 50 (ii) "Health care provider administrative employee" means an employee 51 of a health care provider primarily engaged in relations or dealings 52 with third party payers or seeking payment or reimbursement for health 53 care services from third party payers. 54 (iii) "Impacted employee" means an individual who, at any time from 55 the date this section becomes a law until two years after the end of the 56 implementation period, is employed by a third party payer or is a healthA. 5248 17 1 care provider administrative employee, and whose employment ends as a 2 result of the implementation of the New York Health program. 3 (b) Within ninety days after this section shall become a law, the 4 commissioner of labor shall convene a retraining and re-employment task 5 force including but not limited to: representatives of potential 6 impacted employees, human resource departments of third party payers and 7 health care providers, individuals with experience and expertise in 8 retraining and re-employment programs relevant to the circumstances of 9 impacted employees, and representatives of the commissioner of labor. 10 The commissioner of labor and the task force shall review and provide: 11 (i) analysis of potential impacted employees by job title and 12 geography; 13 (ii) competency mapping and labor market analysis of impacted employee 14 occupations with job openings; and 15 (iii) establishment of regional retraining and re-employment systems, 16 including but not limited to job boards, outplacement services, job 17 search services, career advisement services, and retraining advisement, 18 to be coordinated with the regional advisory councils established under 19 section fifty-one hundred eleven of this article. 20 (c) (i) Three or more impacted employees, a recognized union of work- 21 ers including impacted employees, or an employer of impacted employees 22 may file a petition with the commissioner of labor to certify such 23 employees as being impacted employees. 24 (ii) Impacted employees shall be eligible for: 25 (A) up to two years of retraining at any training provider approved by 26 the commissioner of labor; and 27 (B) up to two years of unemployment benefits, provided that the 28 impacted employee is enrolled in a department of labor approved training 29 program, is actively seeking employment, and is not currently employed 30 full time; provided, however, that such impacted employee may maintain 31 unemployment benefits for up to two years even if he or she does not 32 meet the criteria set forth in this clause but is sixty-three years of 33 age or older at the time of loss of employment as an impacted employee. 34 (d) The commissioner shall provide funds from the New York Health 35 trust fund or otherwise appropriated for this purpose to the commission- 36 er of labor for retraining and re-employment programs for impacted 37 employees under this subdivision. 38 (e) The commissioner of labor shall make regulations and take other 39 actions reasonably necessary to implement this subdivision. This subdi- 40 vision shall be implemented consistent with applicable law and regu- 41 lations. 42 4. The commissioner shall, directly and through grants to not-for-pro- 43 fit entities, conduct programs using data collected through the New York 44 Health program, to promote and protect the quality of health care 45 services, patient outcomes, and public, environmental and occupational 46 health, including cooperation with other data collection and research 47 programs of the department, consistent with this article, the protection 48 of the security and confidentiality of individually identifiable patient 49 information, and otherwise applicable law. 50 § 5111. Regional advisory councils. 1. The New York Health regional 51 advisory councils (each referred to in this article as a "regional advi- 52 sory council") are hereby created in the department. 53 2. There shall be a regional advisory council established in each of 54 the following regions: 55 (a) Long Island, consisting of Nassau and Suffolk counties; 56 (b) New York City;A. 5248 18 1 (c) Hudson Valley, consisting of Delaware, Dutchess, Orange, Putnam, 2 Rockland, Sullivan, Ulster, Westchester counties; 3 (d) Northern, consisting of Albany, Clinton, Columbia, Essex, Frank- 4 lin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Lewis, Montgomery, 5 Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, St. Lawrence, 6 Warren, Washington counties; 7 (e) Central, consisting of Broome, Cayuga, Chemung, Chenango, Cort- 8 land, Livingston, Madison, Monroe, Oneida, Onondaga, Ontario, Oswego, 9 Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates counties; and 10 (f) Western, consisting of Allegany, Cattaraugus, Chautauqua, Erie, 11 Genesee, Niagara, Orleans, Wyoming counties. 12 3. Each regional advisory council shall be composed of not fewer than 13 twenty-seven members, as determined by the commissioner and the board, 14 as necessary to appropriately represent the diverse needs and concerns 15 of the region. Members of a regional advisory council shall be residents 16 of or have their principal place of business in the region served by the 17 regional advisory council. 18 4. Appointment of members of the regional advisory councils. 19 (a) The twenty-seven members shall be appointed as follows: 20 (i) nine members shall be appointed by the governor; 21 (ii) six members shall be appointed by the governor on the recommenda- 22 tion of the speaker of the assembly; 23 (iii) six members shall be appointed by the governor on the recommen- 24 dation of the temporary president of the senate; 25 (iv) three members shall be appointed by the governor on the recommen- 26 dation of the minority leader of the assembly; and 27 (v) three members shall be appointed by the governor on the recommen- 28 dation of the minority leader of the senate. 29 Where a regional advisory council has more than twenty-seven members, 30 additional members shall be appointed and recommended by these officials 31 in the same proportion as the twenty-seven members. 32 (b) Regional advisory council membership shall include but not be 33 limited to: 34 (i) representatives of organizations with a regional constituency that 35 advocate for health care consumers, older adults, and people with disa- 36 bilities including organizations led by members of those groups, who 37 shall constitute at least one third of the membership of each regional 38 council; 39 (ii) representatives of professional organizations representing physi- 40 cians; 41 (iii) representatives of professional organizations representing 42 health care professionals other than physicians; 43 (iv) representatives of general hospitals, including public hospitals; 44 (v) representatives of community health centers; 45 (vi) representatives of mental health, behavioral health (including 46 substance use), physical disability, developmental disability, rehabili- 47 tation, home care and other service providers; 48 (vii) representatives of women's health service providers; 49 (viii) representatives of health care organizations; 50 (ix) representatives of organized labor including representatives of 51 health care workers; 52 (x) representatives of employers; and 53 (xi) representatives of municipal and county government. 54 5. Members of a regional advisory council shall be appointed for terms 55 of three years provided, however, that of the members first appointed, 56 one-third shall be appointed for one year terms and one-third shall beA. 5248 19 1 appointed for two year terms. Vacancies shall be filled in the same 2 manner as original appointments for the remainder of any unexpired term. 3 No person shall be a member of a regional advisory council for more than 4 six years in any period of twelve consecutive years. 5 6. Members of the regional advisory councils shall serve without 6 compensation but shall be reimbursed for their necessary and actual 7 expenses incurred while engaged in the business of the advisory coun- 8 cils. The program shall provide financial support for such expenses and 9 other expenses of the regional advisory councils. 10 7. Each regional advisory council shall meet at least quarterly. Each 11 regional advisory council may form committees to assist it in its work. 12 Members of a committee need not be members of the regional advisory 13 council. The New York City regional advisory council shall form a 14 committee for each borough of New York City, to assist the regional 15 advisory council in its work as it relates particularly to that borough. 16 8. Each regional advisory council shall advise the commissioner, the 17 board, the governor and the legislature on all matters relating to the 18 development and implementation of the New York Health program. 19 9. Each regional advisory council shall adopt, and from time to time 20 revise, a community health improvement plan for its region for the 21 purpose of: 22 (a) promoting the delivery of health care services in the region, 23 improving the quality and accessibility of care, including cultural 24 competency, clinical integration of care between service providers 25 including but not limited to physical, mental, and behavioral health, 26 physical and developmental disability services, and long-term supports 27 and services; 28 (b) facility and health services planning in the region; 29 (c) identifying gaps in regional health care services; 30 (d) promoting increased public knowledge and responsibility regarding 31 the availability and appropriate utilization of health care services. 32 Each community health improvement plan shall be submitted to the commis- 33 sioner and the board and shall be posted on the department's website; 34 (e) identifying needs in professional and service personnel required 35 to deliver health care services; and 36 (f) coordinating regional implementation of retraining and re-employ- 37 ment programs for impacted employees under subdivision three of section 38 fifty-one hundred ten of this article. 39 10. Each regional advisory council shall hold at least four public 40 hearings annually on matters relating to the New York Health program and 41 the development and implementation of the community health improvement 42 plan. 43 11. Each regional advisory council shall publish an annual report to 44 the commissioner and the board on the progress of the community health 45 improvement plan. These reports shall be posted on the department's 46 website. 47 12. All meetings of the regional advisory councils and committees 48 shall be subject to article six of the public officers law. 49 § 4. Financing of New York Health. 1. The governor shall submit to the 50 legislature a revenue plan and legislative bills to implement the plan 51 (referred to collectively in this section as the "revenue proposal") to 52 provide the revenue necessary to finance the New York Health program, as 53 created by article 51 of the public health law and all provisions of 54 that article (referred to in this section as the "program"), taking into 55 consideration anticipated federal revenue available for the program. The 56 revenue proposal shall be submitted to the legislature as part of theA. 5248 20 1 executive budget under article VII of the state constitution, for the 2 fiscal year commencing on the first day of April in the calendar year 3 after this act shall become a law. In developing the revenue proposal, 4 the governor shall consult with appropriate officials of the executive 5 branch; the temporary president of the senate; the speaker of the assem- 6 bly; the chairs of the fiscal and health committees of the senate and 7 assembly; and representatives of business, labor, consumers and local 8 government. 9 2. (a) Basic structure. The basic structure of the revenue proposal 10 shall be as follows: Revenue for the program shall come from two taxes 11 (referred to collectively in this section as the "taxes"). First, there 12 shall be a progressively graduated tax on all payroll and self-employed 13 income (referred to in this section as the "payroll tax"), paid by 14 employers, employees and self-employed individuals. Second, there shall 15 be a progressively graduated tax on taxable income (such as interest, 16 dividends, and capital gains) not subject to the payroll tax (referred 17 to in this section as the "non-payroll tax"). Income in the bracket 18 below twenty-five thousand dollars per year shall be exempt from the 19 taxes. Higher brackets of income subject to the taxes shall be assessed 20 at a higher marginal rate than lower brackets. The taxes shall be set 21 at levels anticipated to produce sufficient revenue to finance the 22 program, to be scaled up as enrollment grows, taking into consideration 23 anticipated federal revenue available for the program. Provision shall 24 be made for state residents (who are eligible for the program) who are 25 employed out-of-state, and non-residents (who are not eligible for the 26 program) who are employed in the state. 27 (b) Payroll tax. The income to be subject to the payroll tax shall be 28 all income subject to the Medicare Part A tax. The tax shall be set at a 29 percentage of that income, which shall be progressively graduated, so 30 the percentage is higher on higher brackets of income. For employed 31 individuals, the employer shall pay eighty percent of the tax and the 32 employee shall pay twenty percent of the tax, except that an employer 33 may agree to pay all or part of the employee's share. A self-employed 34 individual shall pay the full tax. 35 (c) Non-payroll income tax. There shall be a tax on income that is 36 subject to the personal income tax under article 22 of the tax law and 37 is not subject to the payroll tax. It shall be set at a percentage of 38 that income, which shall be progressively graduated, so the percentage 39 is higher on higher brackets of income. 40 (d) Phased-in rates. Early in the program, when enrollment is growing, 41 the amount of the taxes shall be at an appropriate level, and shall be 42 changed as anticipated enrollment grows, to cover the actual cost of the 43 program. The revenue proposal shall include a mechanism for determining 44 the rates of the taxes. 45 (e) Cross-border employees. (i) State residents employed out-of-state. 46 If an individual is employed out-of-state by an employer that is subject 47 to New York state law, the employer and employee shall be required to 48 pay the payroll tax as to that employee as if the employment were in the 49 state. If an individual is employed out-of-state by an employer that is 50 not subject to New York state law, either (A) the employer and employee 51 shall voluntarily comply with the tax or (B) the employee shall pay the 52 tax as if he or she were self-employed. 53 (ii) Out-of-state residents employed in the state. (A) The payroll 54 tax shall apply to any out-of-state resident who is employed or self-em- 55 ployed in the state. (B) In the case of an out-of-state resident who is 56 employed or self-employed in the state, such individual and individual'sA. 5248 21 1 employer shall be able to take a credit against the payroll taxes each 2 would otherwise pay as to that individual for amounts they spend respec- 3 tively on health benefits for the individual that would otherwise be 4 covered by the program if the individual were a member of the program. 5 For the employer, the credit shall be available regardless of the form 6 of the health benefit (e.g., health insurance, a self-insured plan, 7 direct services, or reimbursement for services), to make sure that the 8 revenue proposal does not relate to employment benefits in violation of 9 the federal ERISA. For non-employment-based spending by the individual, 10 the credit shall be available for and limited to spending for health 11 coverage (not out-of-pocket health spending). The credit shall be avail- 12 able without regard to how little is spent or how sparse the benefit. 13 The credit may only be taken against the payroll tax. Any excess amount 14 may not be applied to other tax liability. The credit shall be distrib- 15 uted between the employer and employee in the same proportion as the 16 spending by each for the benefit and may be applied to their respective 17 portion of the tax. (C) If any provision of this subparagraph or any 18 application of it shall be ruled to violate federal ERISA, the provision 19 or the application of it shall be null and void and the ruling shall not 20 affect any other provision or application of this section or the act 21 that enacted it. 22 3. (a) The revenue proposal shall include a plan and legislative 23 provisions for ending the requirement for local social services 24 districts to pay part of the cost of Medicaid and replacing those 25 payments with revenue from the taxes under the revenue proposal. 26 (b) The taxes under this section shall not supplant the spending of 27 other state revenue to pay for the Medicaid program as it exists as of 28 the enactment of the revenue proposal as amended, unless the revenue 29 proposal as amended provides otherwise. 30 4. To the extent that the revenue proposal differs from the terms of 31 subdivision two or paragraph (b) of subdivision three of this section, 32 the revenue proposal shall state how it differs from those terms and 33 reasons for and the effects of the differences. 34 5. All revenue from the taxes shall be deposited in the New York 35 Health trust fund account under section 89-j of the state finance law. 36 § 5. Article 49 of the public health law is amended by adding a new 37 title 3 to read as follows: 38 TITLE III 39 COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH 40 NEW YORK HEALTH 41 Section 4920. Definitions. 42 4921. Collective negotiation authorized. 43 4922. Collective negotiation requirements. 44 4923. Requirements for health care providers' representative. 45 4924. Mediation. 46 4925. Certain collective action prohibited. 47 4926. Fees. 48 4927. Confidentiality. 49 4928. Severability and construction. 50 § 4920. Definitions. For purposes of this title: 51 1. "New York Health" means the program under article fifty-one of this 52 chapter. 53 2. "Person" means an individual, association, corporation, or any 54 other legal entity. 55 3. "Health care providers' representative" means a third party that is 56 authorized by health care providers to negotiate on their behalf withA. 5248 22 1 New York Health over terms and conditions affecting those health care 2 providers. 3 4. "Strike" means a work stoppage in part or in whole, direct or indi- 4 rect, by a body of workers to gain compliance with demands made on an 5 employer. 6 5. "Health care provider" means a health care provider under article 7 fifty-one of this chapter. A health care professional as defined in 8 article fifty-one of this chapter who practices as an employee or inde- 9 pendent contractor of another health care provider shall not be deemed a 10 health care provider for purposes of this title. 11 § 4921. Collective negotiation authorized. 1. Health care providers 12 may meet and communicate for the purpose of collectively negotiating 13 with New York Health on any matter relating to New York Health, includ- 14 ing but not limited to rates of payment and payment methodologies. 15 2. Nothing in this section shall be construed to allow or authorize an 16 alteration of the terms of the internal and external review procedures 17 set forth in law. 18 3. Nothing in this section shall be construed to allow a strike of New 19 York Health by health care providers. 20 4. Nothing in this section shall be construed to allow or authorize 21 terms or conditions which would impede the ability of New York Health to 22 obtain or retain accreditation by the national committee for quality 23 assurance or a similar body or to comply with applicable state or feder- 24 al law. 25 § 4922. Collective negotiation requirements. 1. Collective negotiation 26 rights granted by this title must conform to the following requirements: 27 (a) health care providers may communicate with other health care 28 providers regarding the terms and conditions to be negotiated with New 29 York Health; 30 (b) health care providers may communicate with health care providers' 31 representatives; 32 (c) a health care providers' representative is the only party author- 33 ized to negotiate with New York Health on behalf of the health care 34 providers as a group; 35 (d) a health care provider can be bound by the terms and conditions 36 negotiated by the health care providers' representatives; and 37 (e) in communicating or negotiating with the health care providers' 38 representative, New York Health is entitled to offer and provide differ- 39 ent terms and conditions to individual competing health care providers. 40 2. Nothing in this title shall affect or limit the right of a health 41 care provider or group of health care providers to collectively petition 42 a government entity for a change in a law, rule, or regulation. 43 3. Nothing in this title shall affect or limit collective action or 44 collective bargaining on the part of any health care provider with his 45 or her employer or any other lawful collective action or collective 46 bargaining. 47 § 4923. Requirements for health care providers' representative. Before 48 engaging in collective negotiations with New York Health on behalf of 49 health care providers, a health care providers' representative shall 50 file with the commissioner, in the manner prescribed by the commission- 51 er, information identifying the representative, the representative's 52 plan of operation, and the representative's procedures to ensure compli- 53 ance with this title. 54 § 4924. Mediation. 1. In the event the commissioner determines that an 55 impasse exists in the negotiations, the commissioner shall render 56 assistance as follows:A. 5248 23 1 (a) to assist the parties to effect a voluntary resolution of the 2 negotiations, the commissioner shall appoint a mediator who is mutually 3 acceptable to both the health care providers' representative and the 4 representative of New York Health. If the mediator is successful in 5 resolving the impasse, then the health care providers' representative 6 shall proceed as set forth in this article; 7 (b) if an impasse continues, the commissioner shall appoint a fact- 8 finding board of not more than three members, who are mutually accepta- 9 ble to both the health care providers' representative and the represen- 10 tative of New York Health. The fact-finding board shall have, in 11 addition to the powers delegated to it by the board, the power to make 12 recommendations for the resolution of the dispute; 13 (c) the fact-finding board, acting by a majority of its members, shall 14 transmit its findings of fact and recommendations for resolution of the 15 dispute to the commissioner, and may thereafter assist the parties to 16 effect a voluntary resolution of the dispute. The fact-finding board 17 shall also share its findings of fact and recommendations with the 18 health care providers' representative and the representative of New York 19 Health. If within twenty days after the submission of the findings of 20 fact and recommendations, the impasse continues, the commissioner shall 21 order a resolution to the negotiations based upon the findings of fact 22 and recommendations submitted by the fact-finding board. 23 § 4925. Certain collective action prohibited. 1. This title is not 24 intended to authorize competing health care providers to act in concert 25 in response to a health care providers' representative's discussions or 26 negotiations with New York Health except as authorized by other law. 27 2. No health care providers' representative shall negotiate any agree- 28 ment that excludes, limits the participation or reimbursement of, or 29 otherwise limits the scope of services to be provided by any health care 30 provider or group of health care providers with respect to the perform- 31 ance of services that are within the health care provider's lawful scope 32 or terms of practice, license, registration, or certificate. 33 § 4926. Fees. Each person who acts as the representative of negotiat- 34 ing parties under this title shall pay to the department a fee to act as 35 a representative. The commissioner, by regulation, shall set fees in 36 amounts deemed reasonable and necessary to cover the costs incurred by 37 the department in administering this title. 38 § 4927. Confidentiality. All reports and other information required to 39 be reported to the department under this title shall not be subject to 40 disclosure under article six of the public officers law. 41 § 4928. Severability and construction. If any provision or application 42 of this title shall be held to be invalid, or to violate or be incon- 43 sistent with any applicable federal law or regulation, that shall not 44 affect other provisions or applications of this title which can be given 45 effect without that provision or application; and to that end, the 46 provisions and applications of this title are severable. The provisions 47 of this title shall be liberally construed to give effect to the 48 purposes thereof. 49 § 6. Subdivision 11 of section 270 of the public health law, as 50 amended by section 2-a of part C of chapter 58 of the laws of 2008, is 51 amended to read as follows: 52 11. "State public health plan" means the medical assistance program 53 established by title eleven of article five of the social services law 54 (referred to in this article as "Medicaid"), the elderly pharmaceutical 55 insurance coverage program established by title three of article two of 56 the elder law (referred to in this article as "EPIC"), and the [familyA. 5248 24 1health plus program established by section three hundred sixty-nine-ee2of the social services law to the extent that section provides that the3program shall be subject to this article] New York Health program estab- 4 lished by article fifty-one of this chapter. 5 § 7. The state finance law is amended by adding a new section 89-j to 6 read as follows: 7 § 89-j. New York Health trust fund. 1. There is hereby established in 8 the joint custody of the state comptroller and the commissioner of taxa- 9 tion and finance a special revenue fund to be known as the "New York 10 Health trust fund", referred to in this section as "the fund". The defi- 11 nitions in section fifty-one hundred of the public health law shall 12 apply to this section. 13 2. The fund shall consist of: 14 (a) all monies obtained from taxes pursuant to legislation enacted as 15 proposed under section three of the New York Health act; 16 (b) federal payments received as a result of any waiver or other 17 arrangements agreed to by the United States secretary of health and 18 human services or other appropriate federal officials for health care 19 programs established under Medicare, any federally-matched public health 20 program, or the affordable care act; 21 (c) the amounts paid by the department of health that are equivalent 22 to those amounts that are paid on behalf of residents of this state 23 under Medicare, any federally-matched public health program, or the 24 affordable care act for health benefits which are equivalent to health 25 benefits covered under New York Health; 26 (d) federal and state funds for purposes of the provision of services 27 authorized under title XX of the federal social security act that would 28 otherwise be covered under article fifty-one of the public health law; 29 and 30 (e) state monies that would otherwise be appropriated to any govern- 31 mental agency, office, program, instrumentality or institution which 32 provides health services, for services and benefits covered under New 33 York Health. Payments to the fund pursuant to this paragraph shall be in 34 an amount equal to the money appropriated for such purposes in the 35 fiscal year beginning immediately preceding the effective date of the 36 New York Health act. 37 3. Monies in the fund shall only be used for purposes established 38 under article fifty-one of the public health law. 39 § 8. Temporary commission on implementation. 1. There is hereby estab- 40 lished a temporary commission on implementation of the New York Health 41 program, referred to in this section as the commission, consisting of 42 fifteen members: five members, including the chair, shall be appointed 43 by the governor; four members shall be appointed by the temporary presi- 44 dent of the senate, one member shall be appointed by the senate minority 45 leader; four members shall be appointed by the speaker of the assembly, 46 and one member shall be appointed by the assembly minority leader. The 47 commissioner of health, the superintendent of financial services, and 48 the commissioner of taxation and finance, or their designees shall serve 49 as non-voting ex-officio members of the commission. 50 2. Members of the commission shall receive such assistance as may be 51 necessary from other state agencies and entities, and shall receive 52 reasonable and necessary expenses incurred in the performance of their 53 duties. The commission may employ staff as needed, prescribe their 54 duties, and fix their compensation within amounts appropriated for the 55 commission.A. 5248 25 1 3. The commission shall examine the laws and regulations of the state 2 and make such recommendations as are necessary to conform the laws and 3 regulations of the state and article 51 of the public health law estab- 4 lishing the New York Health program and other provisions of law relating 5 to the New York Health program, and to improve and implement the 6 program. The commission shall report its recommendations to the governor 7 and the legislature. The commission shall immediately begin development 8 of proposals consistent with the principles of article 51 of the public 9 health law for provision of health care services covered under the work- 10 ers' compensation law; and incorporation of retiree health benefits, as 11 described in paragraphs (a), (b) and (c) of subdivision 8 of section 12 5102 of the public health law. The commission shall provide its work 13 product and assistance to the board established pursuant to section 5102 14 of the public health law upon completion of the appointment of the 15 board. 16 § 9. Severability. If any provision or application of this act shall 17 be held to be invalid, or to violate or be inconsistent with any appli- 18 cable federal law or regulation, that shall not affect other provisions 19 or applications of this act which can be given effect without that 20 provision or application; and to that end, the provisions and applica- 21 tions of this act are severable. 22 § 10. This act shall take effect immediately.
