Bill Text: NY A06058 | 2021-2022 | General Assembly | Introduced
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 84-0)
Status: (Introduced) 2022-05-10 - reported referred to ways and means [A06058 Detail]
Download: New_York-2021-A06058-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 6058 2021-2022 Regular Sessions IN ASSEMBLY March 8, 2021 ___________ Introduced by M. of A. GOTTFRIED, ABINANTI, ANDERSON, BARRETT, BARRON, BENEDETTO, BICHOTTE HERMELYN, BRONSON, BURDICK, CAHILL, CARROLL, CLARK, COLTON, COOK, CRUZ, CYMBROWITZ, DE LA ROSA, DICKENS, DILAN, DINOWITZ, ENGLEBRIGHT, EPSTEIN, FALL, FERNANDEZ, FRONTUS, GALLAGHER, GONZALEZ-ROJAS, HUNTER, HYNDMAN, JACKSON, JEAN-PIERRE, JOYNER, KELLES, KIM, LAVINE, LUNSFORD, LUPARDO, MAMDANI, MEEKS, MITAYNES, NIOU, PAULIN, PEOPLES-STOKES, PERRY, PHEFFER AMATO, PICHARDO, RAJKUMAR, RAMOS, REYES, RICHARDSON, J. RIVERA, RODRIGUEZ, L. ROSENTHAL, SAYEGH, SEAWRIGHT, SILLITTI, SIMON, SOLAGES, FORREST, STECK, STIRPE, TAYLOR, THIELE, VANEL, WALKER, WALLACE, WEPRIN, WILLIAMS -- Multi-Sponsored by -- M. of A. AUBRY, DAVILA, FAHY, GALEF, GLICK, GUNTHER, MAGNARELLI, O'DONNELL, PRETLOW, QUART, D. ROSENTHAL, 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 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 EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD00273-03-1A. 6058 2 1 not acceptable. There is no plan other than the New York health act 2 that will enable New York state to meet that need. New Yorkers - as 3 individuals, employers, and taxpayers - have experienced a rise in the 4 cost of health care and coverage in recent years, including rising 5 premiums, deductibles and co-pays, restricted provider networks and high 6 out-of-network charges. Many New Yorkers go without health care because 7 they cannot afford it or suffer financial hardship to get it. Busi- 8 nesses have also experienced increases in the costs of health care bene- 9 fits for their employees, and many employers are shifting a larger share 10 of the cost of coverage to their employees or dropping coverage entire- 11 ly. Including long-term services and supports (LTSS) in New York Health 12 is a major step forward for older adults, people with disabilities, and 13 their families. Older adults and people with disabilities often cannot 14 receive the services necessary to stay in the community or other LTSS. 15 Even when older adults and people with disabilities receive LTSS, espe- 16 cially services in the community, it is often at the cost of unreason- 17 able demands on unpaid family caregivers, depleting their own or family 18 resources, or impoverishing themselves to qualify for public coverage. 19 Health care providers are also affected by inadequate health coverage in 20 New York state. A large portion of hospitals, health centers and other 21 providers now experience substantial losses due to the provision of care 22 that is uncompensated. Medicaid and Medicare often do not pay rates 23 that are reasonably related to the cost of efficiently providing health 24 care services and sufficient to assure an adequate and accessible supply 25 of health care services, as guaranteed under the New York Health Act. 26 Individuals often find that they are deprived of affordable care and 27 choice because of decisions by health plans guided by the plan's econom- 28 ic interests rather than the individual's health care needs. To address 29 the fiscal crisis facing the health care system and the state and to 30 assure New Yorkers can exercise their right to health care, affordable 31 and comprehensive health coverage must be provided. Pursuant to the 32 state constitution's charge to the legislature to provide for the health 33 of New Yorkers, this legislation is an enactment of state concern for 34 the purpose of establishing a comprehensive universal guaranteed health 35 care coverage program and a health care cost control system for the 36 benefit of all residents of the state of New York. 37 2. (a) It is the intent of the Legislature to create the New York 38 Health program to provide a universal single payer health plan for every 39 New Yorker, funded by broad-based revenue based on ability to pay. The 40 legislature intends that federal waivers and approvals be sought where 41 they will improve the administration of the New York Health program, but 42 the legislature intends that the program be implemented even in the 43 absence of such waivers or approvals. The state shall work to obtain 44 waivers and other approvals relating to Medicaid, Child Health Plus, 45 Medicare, the Affordable Care Act, and any other appropriate federal 46 programs, under which federal funds and other subsidies that would 47 otherwise be paid to New York State, New Yorkers, and health care 48 providers for health coverage that will be equaled or exceeded by New 49 York Health will be paid by the federal government to New York State and 50 deposited in the New York Health trust fund, or paid to health care 51 providers and individuals in combination with New York Health trust fund 52 payments, and for other program modifications (including elimination of 53 cost sharing and insurance premiums). Under such waivers and approvals, 54 health coverage under those programs will, to the maximum extent possi- 55 ble, be replaced and merged into New York Health, which will operate as 56 a true single-payer program.A. 6058 3 1 (b) If any necessary waiver or approval is not obtained, the state 2 shall use state plan amendments and seek waivers and approvals to maxi- 3 mize, and make as seamless as possible, the use of federally-matched 4 health programs and federal health programs in New York Health. Thus, 5 even where other programs such as Medicaid or Medicare may contribute to 6 paying for care, it is the goal of this legislation that the coverage 7 will be delivered by New York Health and, as much as possible, the 8 multiple sources of funding will be pooled with other New York Health 9 funds and not be apparent to New York Health members or participating 10 providers. 11 (c) This program will promote movement away from fee-for-service 12 payment, which tends to reward quantity and requires excessive adminis- 13 trative expense, and towards alternate payment methodologies, such as 14 global or capitated payments to providers or health care organizations, 15 that promote quality, efficiency, investment in primary and preventive 16 care, and innovation and integration in the organizing of health care. 17 (d) The program shall promote the use of clinical data to improve the 18 quality of health care and public health, consistent with protection of 19 patient confidentiality. The program shall maximize patient autonomy in 20 choice of health care providers and health care decision making. Care 21 coordination within the program shall ensure management and coordination 22 among a patient's health care services, consistent with patient autonomy 23 and person-centered service planning, rather than acting as a gatekeeper 24 to needed services. 25 (e) The program shall operate with care, skill, prudence, diligence, 26 and professionalism, and for the best interests primarily of the members 27 and health care providers. 28 3. This act does not create or relate to any employment benefit or 29 employment benefit plan, nor does it require, prohibit, or limit the 30 providing of any employment benefit or employment benefit plan. 31 4. In order to promote improved quality of, and access to, health care 32 services and promote improved clinical outcomes, it is the policy of the 33 state to encourage cooperative, collaborative and integrative arrange- 34 ments among health care providers who might otherwise be competitors, 35 under the active supervision of the commissioner of health. It is the 36 intent of the state to supplant competition with such arrangements and 37 regulation only to the extent necessary to accomplish the purposes of 38 this act, and to provide state action immunity under the state and 39 federal antitrust laws to health care providers, particularly with 40 respect to their relations with the single-payer New York Health plan 41 created by this act. 42 5. There have been numerous professional economic analyses of state 43 and national single-payer health proposals, including the New York 44 Health Act, by noted consulting firms and academic economists. They have 45 almost all come to similar conclusions of net savings in the cost of 46 health coverage and health care. These savings are driven by (a) elimi- 47 nating the administrative bureaucracy costs, marketing, and profit of 48 multiple health plans and replacing that with the dramatically lower 49 costs of running a single-payer system; (b) substantially reducing the 50 administrative costs borne by health care providers dealing with those 51 health plans; and (c) using the negotiating power of 20 million consum- 52 ers to achieve lower drug prices. These savings will more than offset 53 costs primarily from (a) relieving patients of deductibles, co-pays, and 54 out-of-network charges; (b) covering the uninsured; (c) increasing 55 provider payment rates above Medicare and Medicaid rates; and (d) 56 replacing uncompensated home health care with paid care. Unlike premiumsA. 6058 4 1 and out-of-pocket spending, the New York Health Act tax will be progres- 2 sively graduated based on ability to pay. The vast majority of New 3 Yorkers today spend dramatically more in premiums, deductibles and other 4 out-of-pocket costs than they will in New York Health Act taxes. They 5 will have broader coverage (including long-term care), no restricted 6 provider networks or out-of-network charges, and no deductibles or 7 co-pays. 8 § 3. Article 50 and sections 5000, 5001, 5002 and 5003 of the public 9 health law are renumbered article 80 and sections 8000, 8001, 8002 and 10 8003, respectively, and a new article 51 is added to read as follows: 11 ARTICLE 51 12 NEW YORK HEALTH 13 Section 5100. Definitions. 14 5101. Program created. 15 5102. Board of trustees. 16 5103. Eligibility and enrollment. 17 5104. Benefits. 18 5105. Health care providers; care coordination; payment method- 19 ologies. 20 5106. Health care organizations. 21 5107. Program standards. 22 5108. Regulations. 23 5109. Provisions relating to federal health programs. 24 5110. Additional provisions. 25 5111. Regional advisory councils. 26 § 5100. Definitions. As used in this article, the following terms 27 shall have the following meanings, unless the context clearly requires 28 otherwise: 29 1. "Board" means the board of trustees of the New York Health program 30 created by section fifty-one hundred two of this article, and "trustee" 31 means a trustee of the board. 32 2. "Care coordination" means, but is not limited to, managing, refer- 33 ring to, locating, coordinating, and monitoring health care services for 34 the member to assure that all medically necessary health care services 35 are made available to and are effectively used by the member in a timely 36 manner, consistent with patient autonomy. Care coordination does not 37 include a requirement for prior authorization for health care services 38 or for referral for a member to receive a health care service. 39 3. "Care coordinator" means an individual or entity approved to 40 provide care coordination under subdivision two of section fifty-one 41 hundred five of this article. 42 4. "Federally-matched public health program" means the medical assist- 43 ance program under title eleven of article five of the social services 44 law, the basic health program under section three hundred sixty-nine-gg 45 of the social services law, and the child health plus program under 46 title one-A of article twenty-five of this chapter. 47 5. "Health care organization" means an entity that is approved by the 48 commissioner under section fifty-one hundred six of this article to 49 provide health care services to members under the program. 50 6. "Health care provider" means any individual or entity legally 51 authorized to provide a health care service under Medicaid or Medicare 52 or this article. "Health care professional" means a health care provider 53 that is an individual licensed, certified, registered or otherwise 54 authorized to practice under title eight of the education law to provide 55 such health care service, acting within his or her lawful scope of prac- 56 tice.A. 6058 5 1 7. "Health care service" means any health care service, including care 2 coordination, included as a benefit under the program. 3 8. "Implementation period" means the period under subdivision three of 4 section fifty-one hundred one of this article during which the program 5 will be subject to special eligibility and financing provisions until it 6 is fully implemented under that section. 7 9. "Medicaid" or "medical assistance" means title eleven of article 8 five of the social services law and the program thereunder. "Child 9 health plus" means title one-A of article twenty-five of this chapter 10 and the program thereunder. "Medicare" means title XVIII of the federal 11 social security act and the programs thereunder. "Affordable care act" 12 means the federal patient protection and affordable care act, public law 13 111-148, as amended by the health care and education reconciliation act 14 of 2010, public law 111-152, and as otherwise amended and any regu- 15 lations or guidance issued thereunder. "Basic health program" means 16 section three hundred sixty-nine-gg of the social services law and the 17 program thereunder. 18 10. "Member" means an individual who is enrolled in the program. 19 11. "New York Health", "New York Health program", and "program" mean 20 the New York Health program created by section fifty-one hundred one of 21 this article. 22 12. "New York Health trust fund" means the New York Health trust fund 23 established under section eighty-nine-j of the state finance law. 24 13. "Out-of-state health care service" means a health care service 25 provided to a member while the member is temporarily out of the state 26 and (a) it is medically necessary that the health care service be 27 provided while the member is out of the state, or (b) it is clinically 28 appropriate that the health care service be provided by a particular 29 health care provider located out of the state rather than in the state. 30 However, any health care service provided to a New York Health enrollee 31 by a health care provider qualified under paragraph (a) of subdivision 32 three of section fifty-one hundred five of this article that is located 33 outside the state shall not be considered an out-of-state service and 34 shall be covered as otherwise provided in this article. 35 14. "Participating provider" means any individual or entity that is a 36 health care provider qualified under subdivision three of section 37 fifty-one hundred five of this article that provides health care 38 services to members under the program, or a health care organization. 39 15. "Person" means any individual or natural person, trust, partner- 40 ship, association, unincorporated association, corporation, company, 41 limited liability company, proprietorship, joint venture, firm, joint 42 stock association, department, agency, authority, or other legal entity, 43 whether for-profit, not-for-profit or governmental. 44 16. "Prescription and non-prescription drugs" means prescription drugs 45 as defined in section two hundred seventy of this chapter, and non-pres- 46 cription smoking cessation products or devices. 47 17. "Resident" means an individual whose primary place of abode is in 48 the state or, in the case of an individual whose primary place of abode 49 is not in the state, who is employed or self-employed full-time in the 50 state, without regard to the individual's immigration status, as deter- 51 mined according to regulations of the commissioner. Such regulations 52 shall include a process for appealing denials of residency. 53 § 5101. Program created. 1. The New York Health program is hereby 54 created in the department. The commissioner shall establish and imple- 55 ment the program under this article. The program shall provide compre- 56 hensive health coverage to every resident who enrolls in the program.A. 6058 6 1 2. The commissioner shall, to the maximum extent possible, organize, 2 administer and market the program and services as a single program under 3 the name "New York Health" or such other name as the commissioner shall 4 determine, regardless of under which law or source the definition of a 5 benefit is found including (on a voluntary basis) retiree health bene- 6 fits. In implementing this article, the commissioner shall avoid jeop- 7 ardizing federal financial participation in these programs and shall 8 take care to promote public understanding and awareness of available 9 benefits and programs. 10 3. The commissioner shall determine when individuals may begin enroll- 11 ing in the program. There shall be an implementation period, which shall 12 begin on the date that individuals may begin enrolling in the program 13 and shall end as determined by the commissioner. Individuals may not 14 enroll in the New York Health program until the legislature has enacted 15 the revenue proposal, as amended, and as the legislature shall further 16 provide. 17 4. An insurer authorized to provide coverage pursuant to the insurance 18 law or a health maintenance organization certified under this chapter 19 may, if otherwise authorized, offer benefits that do not cover any 20 service for which coverage is offered to individuals under the program, 21 but may not offer benefits that cover any service for which coverage is 22 offered to individuals under the program. Provided, however, that this 23 subdivision shall not prohibit (a) the offering of any benefits to or 24 for individuals, including their families, who are employed or self-em- 25 ployed in the state but who are not residents of the state, or (b) the 26 offering of benefits during the implementation period to individuals who 27 enrolled or may enroll as members of the program, or (c) the offering of 28 retiree health benefits. 29 5. A college, university or other institution of higher education in 30 the state may purchase coverage under the program for any student, or 31 student's dependent, who is not a resident of the state. 32 6. To the extent any provision of this chapter, the social services 33 law, the insurance law or the elder law: 34 (a) is inconsistent with any provision of this article or the legisla- 35 tive intent of the New York Health Act, this article shall apply and 36 prevail, except where explicitly provided otherwise by this article; or 37 explicitly required by applicable federal law or regulations and 38 (b) is consistent with the provisions of this article and the legisla- 39 tive intent of the New York Health Act, the provision of that law shall 40 apply. 41 7. (a) (i) The program shall be deemed to be a health care plan for 42 purposes of external appeal under article forty-nine of this chapter 43 (referred to in this subdivision as "article forty-nine"), subject to 44 this subdivision and any other applicable provision of this article. 45 (ii) An external appeal shall not require utilization review or an 46 adverse determination under title one of article forty-nine of this 47 chapter. Any reference in article forty-nine to utilization review or a 48 universal review agent shall mean the program. Where the program makes 49 an adverse determination, an external appeal shall be automatic unless 50 specifically waived or withdrawn by the member or the member's designee. 51 Services, including services provided for a chronic condition, will 52 continue unchanged until the outcome of the external appeal decision is 53 issued. Where an external appeal is initiated or pursued by the 54 patient's health care provider, the provider shall notify the member or 55 the member's designee, and it shall be subject to the member's or 56 member's designee's right to waive or withdraw the external appeal. NoA. 6058 7 1 fee shall be required to be paid by any party to an external appeal, 2 including the member's health care provider. 3 (iii) Where an external appeal is denied, the external appeal agent 4 shall notify the member or the member's designee and, where appropriate, 5 the member's health care provider, within two business days of the 6 determination. The notice shall include a statement that the member, 7 member's designee or health care provider has the right to appeal the 8 determination to a fair hearing under this subdivision and seek judicial 9 review. 10 (iv) An enrollee may designate a person or entity, including, but not 11 limited to, the enrollee's family member, care coordinator, a health 12 care organization providing the service under review or appeal, or a 13 labor union or an entity affiliated with and designated by a labor union 14 of which the enrollee or enrollee's family member is a member, to serve 15 as the enrollee's designee for purposes of that article, if the person 16 or entity agrees to be the designee. 17 (b) (i) This paragraph applies where an external appeal is denied in 18 whole or in part; or the program denies coverage for a health care 19 service on any grounds other than under article forty-nine; or the 20 program makes any other determination as to a member or individual seek- 21 ing to become a member, contrary to the interest of the member or indi- 22 vidual (including but not limited to a denial of eligibility for lack of 23 residence). 24 (ii) The program shall notify the member or individual, member's 25 designee or health care provider, as appropriate, that the person has 26 the right to appeal the determination to a fair hearing under this 27 subdivision or seek judicial review. 28 (iii) The commissioner shall establish by regulation a process for 29 fair hearings under this subdivision. The process shall at a minimum 30 conform to the standards for fair hearings under section twenty-two of 31 the social services law. 32 (c) Article seventy-eight of the civil practice law and rules shall 33 apply to any matter under this article. 34 8. (a) No member shall be required to receive any health care service 35 through any entity organized, certified or operating under guidelines 36 under article forty-four of this chapter, or specified under section 37 three hundred sixty-four-j of the social services law, the insurance law 38 or the elder law. No such entity shall receive payment for health care 39 services (other than care coordination) from the program. 40 (b) However, this subdivision shall not preclude the use of a Medicare 41 managed care ("Medicare advantage") entity or other entity created by or 42 under the direction of the program where reasonably necessary to maxi- 43 mize federal financial participation or other federal financial support 44 under any federally-matched public health program, Medicare or the 45 Affordable Care Act. Any entity under this paragraph shall, to the maxi- 46 mum extent feasible, operate in the background, without burden on or 47 interference with the member and health care provider, without depriving 48 the member or health care provider of any right or benefit under the 49 program and otherwise consistent with this article. 50 9. The program shall include provisions for an appropriate reserve 51 fund. 52 10. (a) This subdivision applies to every person who is a retiree of a 53 public employer, as defined in section two hundred one of the civil 54 service law, and any person who is a beneficiary of the retiree's public 55 employee retiree health benefit. Any reference to the retiree shall mean 56 and include any beneficiary of the retiree. This subdivision does notA. 6058 8 1 create or increase any eligibility for any public employee retiree 2 health benefit that would not otherwise exist and does not diminish any 3 public employee retiree health benefit. 4 (b) This paragraph applies to the retiree while he or she is a resi- 5 dent of New York state. The retiree shall enroll in the program. If, by 6 the implementation date, the retiree has not enrolled in the program, 7 the appropriate public employee retiree health benefit program and the 8 commissioner shall enroll the retiree in the New York Health program. If 9 the retiree's public employee retiree health benefit includes any 10 service for which coverage is not offered under the New York Health 11 program, the retiree shall continue to receive that benefit from the 12 appropriate public employee retiree health benefit program. 13 (c) For every retiree, while he or she is not a resident of New York 14 state, the appropriate public employee retiree health benefit program 15 shall maintain the retiree's public employee retiree health benefit as 16 if this article had not been enacted. 17 § 5102. Board of trustees. 1. The New York Health board of trustees is 18 hereby created in the department. The board of trustees shall, at the 19 request of the commissioner, consider any matter to effectuate the 20 provisions and purposes of this article, and may advise the commissioner 21 thereon; and it may, from time to time, submit to the commissioner any 22 recommendations to effectuate the provisions and purposes of this arti- 23 cle. The commissioner may propose regulations under this article and 24 amendments thereto for consideration by the board. The board of trustees 25 shall have no executive, administrative or appointive duties except as 26 otherwise provided by law. The board of trustees shall have power to 27 establish, and from time to time, amend regulations to effectuate the 28 provisions and purposes of this article, subject to approval by the 29 commissioner. 30 2. The board shall be composed of: 31 (a) the commissioner, the superintendent of financial services, and 32 the director of the budget, or their designees, as ex officio members: 33 (b) thirty-one trustees appointed by the governor; 34 (i) six of whom shall be representatives of health care consumer advo- 35 cacy organizations which have a statewide or regional constituency, who 36 have been involved in issues of interest to low- and moderate-income 37 individuals, older adults, and people with disabilities; at least three 38 of whom shall represent organizations led by consumers in those groups; 39 (ii) three of whom shall be representatives of professional organiza- 40 tions representing physicians; 41 (iii) five of whom shall be representatives of professional organiza- 42 tions representing licensed or registered health care professionals 43 other than physicians; 44 (iv) three of whom shall be representatives of general hospitals, one 45 of whom shall be a representative of public general hospitals; 46 (v) one of whom shall be a representative of community health centers; 47 (vi) two of whom shall be representatives of rehabilitation or home 48 care providers; 49 (vii) two of whom shall be representatives of behavioral or mental 50 health or disability service providers; 51 (viii) two of whom shall be representatives of health care organiza- 52 tions; 53 (ix) three of whom shall be representatives of organized labor; 54 (x) two of whom shall have demonstrated expertise in health care 55 finance; andA. 6058 9 1 (xi) two of whom shall be employers or representatives of employers 2 who pay the payroll tax under this article, or, prior to the tax becom- 3 ing effective, will pay the tax; and 4 (c) fourteen trustees appointed by the governor; five of whom to be 5 appointed on the recommendation of the speaker of the assembly; five of 6 whom to be appointed on the recommendation of the temporary president of 7 the senate; two of whom to be appointed on the recommendation of the 8 minority leader of the assembly; and two of whom to be appointed on the 9 recommendation of the minority leader of the senate. 10 3. (a) After the end of the implementation period, no person shall be 11 a trustee unless he or she is a member of the program. 12 (b) Each trustee shall serve at the pleasure of the appointing offi- 13 cer, except the ex officio trustees. 14 4. The chair of the board shall be appointed, and may be removed as 15 chair, by the governor from among the trustees. The board shall meet at 16 least four times each calendar year. Meetings shall be held upon the 17 call of the chair and as provided by the board. A majority of the 18 appointed trustees shall be a quorum of the board, and the affirmative 19 vote of a majority of the trustees voting, but not less than twelve, 20 shall be necessary for any action to be taken by the board. The board 21 may establish an executive committee to exercise any powers or duties of 22 the board as it may provide, and other committees to assist the board or 23 the executive committee. The chair of the board shall chair the execu- 24 tive committee and shall appoint the chair and members of all other 25 committees. The board of trustees may appoint one or more advisory 26 committees. Members of advisory committees need not be members of the 27 board of trustees. 28 5. Trustees shall serve without compensation but shall be reimbursed 29 for their necessary and actual expenses incurred while engaged in the 30 business of the board. However, the board may provide for compensation 31 in cases where a lack of compensation would limit the ability of a trus- 32 tee or represented organization to participate in board business. 33 6. Notwithstanding any provision of law to the contrary, no officer or 34 employee of the state or any local government shall forfeit or be deemed 35 to have forfeited his or her office or employment by reason of being a 36 trustee. 37 7. The board and its committees and advisory committees may request 38 and receive the assistance of the department and any other state or 39 local governmental entity in exercising its powers and duties. 40 8. No later than two years after the effective date of this article: 41 (a) The board shall develop proposals for: (i) incorporating retiree 42 health benefits into New York Health; (ii) accommodating employer reti- 43 ree health benefits for people who have been members of New York Health 44 but live as retirees out of the state; and (iii) accommodating employer 45 retiree health benefits for people who earned or accrued such benefits 46 while residing in the state prior to the implementation of New York 47 Health and live as retirees out of the state. The board shall present 48 its proposals to the governor and the legislature. 49 (b) The board shall develop a proposal for New York Health coverage of 50 health care services covered under the workers' compensation law, 51 including whether and how to continue funding for those services under 52 that law and whether and how to incorporate an element of experience 53 rating. 54 (c) The board shall develop a proposal for New York Health coverage, 55 for members, of health care services covered under paragraph one of 56 subsection (a) of section fifty-one hundred two of the insurance lawA. 6058 10 1 relating to motor vehicle insurance reparations, including whether and 2 how to continue funding for those services. 3 (d) The board shall develop a proposal for integration of federal 4 veterans health administration programs with New York Health coverage of 5 health care services; provided however that enrollment in or eligibility 6 for federal veterans health administration programs shall not affect a 7 resident's eligibility for New York Health coverage. 8 § 5103. Eligibility and enrollment. 1. Every resident of the state 9 shall be eligible and entitled to enroll as a member under the program. 10 2. No individual shall be required to pay any premium or other charge 11 for enrolling in or being a member under the program. 12 3. A newborn child shall be enrolled as of the date of the child's 13 birth if enrollment is done prior to the child's birth or within sixty 14 days after the child's birth. 15 § 5104. Benefits. 1. The program shall provide comprehensive health 16 coverage to every member, which shall include all health care services 17 required to be covered under any of the following, without regard to 18 whether the member would otherwise be eligible for or covered by the 19 program or source referred to: 20 (a) child health plus; 21 (b) Medicaid, including but not limited to services provided under 22 Medicaid waiver programs, including but not limited to those granted 23 under section 1915 of the federal social security act to persons with 24 traumatic brain injuries or qualifying for nursing home diversion and 25 transition services; 26 (c) Medicare; 27 (d) article forty-four of this chapter or article thirty-two or 28 forty-three of the insurance law; 29 (e) article eleven of the civil service law, as of the date one year 30 before the beginning of the implementation period; 31 (f) any cost incurred defined in paragraph one of subsection (a) of 32 section fifty-one hundred two of the insurance law, provided that this 33 coverage shall not replace coverage under article fifty-one of the 34 insurance law; 35 (g) any additional health care service authorized to be added to the 36 program's benefits by the program; and 37 (h) provided that where any state law or regulation related to any 38 federally-matched public health program states that a benefit is contin- 39 gent on federal financial participation, or words to that effect, the 40 benefit shall be included under the New York Health program without 41 regard to federal financial participation. 42 2. No member shall be required to pay any premium, deductible, co-pay- 43 ment or co-insurance under the program. 44 3. The program shall provide for payment under the program for: 45 (a) emergency and temporary health care services provided to a member 46 or individual entitled to become a member who has not had a reasonable 47 opportunity to become a member or to enroll with a care coordinator; and 48 (b) health care services provided in an emergency to an individual who 49 is entitled to become a member or enrolled with a care coordinator, 50 regardless of having had an opportunity to do so. 51 § 5105. Health care providers; care coordination; payment methodol- 52 ogies. 1. Choice of health care provider. (a) Any health care provider 53 qualified to participate under this section may provide health care 54 services under the program, provided that the health care provider is 55 otherwise legally authorized to perform the health care service for the 56 individual and under the circumstances involved.A. 6058 11 1 (b) A member may choose to receive health care services under the 2 program from any participating provider, consistent with provisions of 3 this article relating to care coordination and health care organiza- 4 tions, the willingness or availability of the provider (subject to 5 provisions of this article relating to discrimination), and the appro- 6 priate clinically-relevant circumstances. 7 2. Care coordination. (a) A care coordinator may be an individual or 8 entity that is approved by the program that is: 9 (i) a health care practitioner who is: (A) the member's primary care 10 practitioner; (B) at the option of a female member, the member's provid- 11 er of primary gynecological care; or (C) at the option of a member who 12 has a chronic condition that requires specialty care, a specialist 13 health care practitioner who regularly and continually provides treat- 14 ment for that condition to the member; 15 (ii) an entity licensed under article twenty-eight of this chapter or 16 certified under article thirty-six of this chapter, or, with respect to 17 a member who receives chronic mental health care services, an entity 18 licensed under article thirty-one of the mental hygiene law or other 19 entity approved by the commissioner in consultation with the commission- 20 er of mental health; 21 (iii) a health care organization; 22 (iv) a labor union or an entity affiliated with and designated by a 23 labor union of which the enrollee or enrollee's family member is a 24 member, with respect to its members and their family members; provided 25 that this provision shall not preclude such an entity from becoming a 26 care coordinator under subparagraph (v) of this paragraph or a health 27 care organization under section fifty-one hundred six of this article; 28 or 29 (v) any not-for-profit or governmental entity approved by the program. 30 (b)(i) Every member shall enroll with a care coordinator that agrees 31 to provide care coordination to the member prior to receiving health 32 care services to be paid for under the program. Health care services 33 provided to a member shall not be subject to payment under the program 34 unless the member is enrolled with a care coordinator at the time the 35 health care service is provided. 36 (ii) This paragraph shall not apply to health care services provided 37 under subdivision three of section fifty-one hundred four of this arti- 38 cle (certain emergency or temporary services). 39 (iii) The member shall remain enrolled with that care coordinator 40 until the member becomes enrolled with a different care coordinator or 41 ceases to be a member. Members have the right to change their care coor- 42 dinator on terms at least as permissive as the provisions of section 43 three hundred sixty-four-j of the social services law relating to an 44 individual changing his or her primary care provider or managed care 45 provider. 46 (c) Care coordination shall be provided to the member by the member's 47 care coordinator. A care coordinator may employ or utilize the services 48 of other individuals or entities to assist in providing care coordi- 49 nation for the member, consistent with regulations of the commissioner. 50 (d) A health care organization may establish rules relating to care 51 coordination for members in the health care organization, different from 52 this subdivision but otherwise consistent with this article and other 53 applicable laws. 54 (e) The commissioner shall develop and implement procedures and stand- 55 ards for an individual or entity to be approved to be a care coordinator 56 in the program, including but not limited to procedures and standardsA. 6058 12 1 relating to the revocation, suspension, limitation, or annulment of 2 approval on a determination that the individual or entity is not quali- 3 fied or competent to be a care coordinator or has exhibited a course of 4 conduct which is either inconsistent with program standards and regu- 5 lations or which exhibits an unwillingness to meet such standards and 6 regulations, or is a potential threat to the public health or safety. 7 Such procedures and standards shall not limit approval to be a care 8 coordinator in the program for criteria other than those under this 9 section and shall be consistent with good professional practice. In 10 developing the procedures and standards, the commissioner shall: (i) 11 consider existing standards developed by national accrediting and 12 professional organizations; and (ii) consult with national and local 13 organizations working on care coordination or similar models, including 14 health care practitioners, hospitals, clinics, birth centers, long-term 15 supports and service providers, consumers and their representatives, and 16 labor organizations representing health care workers. When developing 17 and implementing standards of approval of care coordinators for individ- 18 uals receiving chronic mental health care services, the commissioner 19 shall consult with the commissioner of mental health. An individual or 20 entity may not be a care coordinator unless the services included in 21 care coordination are within the individual's professional scope of 22 practice or the entity's legal authority. 23 (f) To maintain approval under the program, a care coordinator must: 24 (i) renew its status at a frequency determined by the commissioner; and 25 (ii) provide data to the department as required by the commissioner to 26 enable the commissioner to evaluate the impact of care coordinators on 27 quality, outcomes, cost, and patient and provider satisfaction. 28 (g) Nothing in this subdivision shall authorize any individual to 29 engage in any act in violation of title eight of the education law. 30 3. Health care providers. (a) The commissioner shall establish and 31 maintain procedures and standards for health care providers to be quali- 32 fied to participate in the program, including but not limited to proce- 33 dures and standards relating to the revocation, suspension, limitation, 34 or annulment of qualification to participate on a determination that the 35 health care provider is not qualified or competent to be a provider of 36 specific health care services or has exhibited a course of conduct which 37 is either inconsistent with program standards and regulations or which 38 exhibits an unwillingness to meet such standards and regulations, or is 39 a potential threat to the public health or safety. Such procedures and 40 standards shall not limit health care provider participation in the 41 program for criteria other than those under this section and shall be 42 consistent with good professional practice. Such procedures and stand- 43 ards may be different for different types of health care providers and 44 health care professionals. The commissioner may require that health 45 care providers and health care professionals participate in Medicaid, 46 child health plus, or Medicare to qualify to participate in the program. 47 Any health care provider that is qualified to participate under Medi- 48 caid, child health plus or Medicare shall be deemed to be qualified to 49 participate in the program, and any health care provider's revocation, 50 suspension, limitation, or annulment of qualification to participate in 51 any of those programs shall apply to the health care provider's quali- 52 fication to participate in the program; provided that a health care 53 provider qualified under this sentence shall follow the procedures to 54 become qualified under the program by the end of the implementation 55 period.A. 6058 13 1 (b) The commissioner shall establish and maintain procedures and stan- 2 dards for recognizing health care providers located out of the state for 3 purposes of providing coverage under the program for out-of-state health 4 care services. 5 (c) Procedures and standards under this subdivision shall include 6 provisions for expedited temporary qualification to participate in the 7 program for health care professionals who are (i) temporarily authorized 8 to practice in the state or (ii) are recently arrived in the state or 9 recently authorized to practice in the state. 10 4. Payment for health care services. (a) (i) The commissioner may 11 establish by regulation payment methodologies for health care services 12 and care coordination provided to members under the program by partic- 13 ipating providers, care coordinators, and health care organizations. 14 There may be a variety of different payment methodologies, including 15 those established on a demonstration basis. 16 (ii) All payment methodologies and rates under the program shall be 17 reasonable and reasonably related to the cost of efficiently providing 18 the health care service and assuring an adequate and accessible supply 19 of the health care service. 20 (iii) In determining such payment methodologies and rates, the commis- 21 sioner shall consider factors including usual and customary rates imme- 22 diately prior to the implementation of the program, reported in a bench- 23 marking database maintained by a nonprofit organization specified by the 24 superintendent of financial services, under section six hundred three of 25 the financial services law; the level of training, education, and expe- 26 rience of the health care provider or providers involved; and the scope 27 of services, complexity, and circumstances of care including geographic 28 factors. Until and unless other applicable payment methodologies are 29 established, health care services provided to members under the program 30 shall be paid for on a fee-for-service basis, except for care coordi- 31 nation. 32 (b) The program shall engage in good faith negotiations with health 33 care providers' representatives under title III of article forty-nine of 34 this chapter, including, but not limited to, in relation to rates of 35 payment and payment methodologies. 36 (c) (i) Prescription drugs eligible for reimbursement under this arti- 37 cle and dispensed by a pharmacy shall be provided and paid for under the 38 preferred drug program and the clinical drug review program under title 39 one of article two-A of this chapter, except as otherwise provided in 40 this paragraph. As used in this paragraph, "managed care provider" 41 means an entity under paragraph (b) of subdivision eight of section 42 fifty-one hundred one of this article that qualifies under the federal 43 Public Health Services Act (the "340B program"). 44 (ii) Where the member is enrolled in a managed care provider and a 45 prescription for the member is made under section 340B of the federal 46 Public Health Service Act (the "340B program") and under a memorandum of 47 understanding relating to the 340B program between the New York Health 48 program and the relevant 340B program covered entity, the managed care 49 provider shall purchase, pay for and provide for the drugs under the 50 340B program. However, the prescription shall be subject to section two 51 hundred seventy-three (preferred drug program prior authorization) and 52 section two hundred seventy-four (clinical drug review program) of this 53 chapter. 54 (iii) The New York Health program shall enter into and maintain a 55 memorandum of understanding relating to the 340B program with each 340B 56 covered entity in the state that agrees to do so.A. 6058 14 1 (iv) Where prescription drugs are not dispensed through a pharmacy, 2 payment shall be made as otherwise provided in this article, including 3 use of the 340B program as appropriate. 4 (d) Payment for health care services established under this article 5 shall be considered payment in full. A participating provider shall not 6 charge any rate in excess of the payment established under this article 7 for any health care service provided under the program and shall not 8 solicit or accept payment from any member or third party for any such 9 service except as provided under section fifty-one hundred nine of this 10 article. However, this paragraph shall not preclude the program from 11 acting as a primary or secondary payer in conjunction with another 12 third-party payer where permitted under section fifty-one hundred nine 13 of this article. 14 (e) The program may provide in payment methodologies for payment for 15 capital related expenses for specifically identified capital expendi- 16 tures incurred by not-for-profit or governmental entities certified 17 under article twenty-eight of this chapter. Any capital related expense 18 generated by a capital expenditure that requires or required approval 19 under article twenty-eight of this chapter must have received that 20 approval for the capital related expense to be paid for under the 21 program. 22 (f) Payment methodologies and rates shall include a distinct component 23 of reimbursement for direct and indirect graduate medical education as 24 defined, calculated and implemented pursuant to section twenty-eight 25 hundred seven-c of this chapter. 26 (g) The commissioner shall provide by regulation for payment method- 27 ologies and procedures for paying for out-of-state health care services. 28 5. Prior authorization. The program shall not require prior authori- 29 zation for any health care service in any manner more restrictive of 30 access to or payment for the service than would be required for the 31 service under Medicare Part A or Part B. Prior authorization for 32 prescription drugs provided by pharmacies under the program shall be 33 under title one of article two-A of this chapter. 34 § 5106. Health care organizations. 1. A member may choose to enroll 35 with and receive health care services under the program from a health 36 care organization. 37 2. A health care organization shall be a not-for-profit or govern- 38 mental entity that is approved by the commissioner that is: 39 (a) an accountable care organization under article twenty-nine-E of 40 this chapter; or 41 (b) a labor union or an entity affiliated with and designated by a 42 labor union of which the enrollee or enrollee's family member is a 43 member (i) with respect to its members and their family members, and 44 (ii) if allowed by applicable law and approved by the commissioner, for 45 other members of the program. 46 3. A health care organization may be responsible for providing all or 47 part of the health care services to which its members are entitled under 48 the program, consistent with the terms of its approval by the commis- 49 sioner. 50 4. (a) The commissioner shall develop and implement procedures and 51 standards for an entity to be approved to be a health care organization 52 in the program, including but not limited to procedures and standards 53 relating to the revocation, suspension, limitation, or annulment of 54 approval on a determination that the entity is not competent to be a 55 health care organization or has exhibited a course of conduct which is 56 either inconsistent with program standards and regulations or whichA. 6058 15 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 approval to be a health care organization in 4 the program for criteria other than those under this section and shall 5 be consistent with good professional practice. In developing the proce- 6 dures and standards, the commissioner shall: (i) consider existing stan- 7 dards developed by national accrediting and professional organizations; 8 and (ii) consult with national and local organizations working in the 9 field of health care organizations, including health care practitioners, 10 hospitals, clinics, birth centers, long-term supports and service 11 providers, consumers and their representatives and labor organizations 12 representing health care workers. When developing and implementing stan- 13 dards of approval of health care organizations, the commissioner shall 14 consult with the commissioner of mental health, the commissioner of 15 developmental disabilities, the director of the state office for the 16 aging, the commissioner of the office of addiction services and 17 supports, and the commissioner of the division of human rights. 18 (b) To maintain approval under the program, a health care organization 19 must: (i) renew its status at a frequency determined by the commission- 20 er; and (ii) provide data to the department as required by the commis- 21 sioner to enable the commissioner to evaluate the health care organiza- 22 tion in relation to quality of health care services, health care 23 outcomes, cost, and patient and provider satisfaction. 24 5. The commissioner shall make regulations relating to health care 25 organizations consistent with and to ensure compliance with this arti- 26 cle. 27 6. The provision of health care services directly or indirectly by a 28 health care organization through health care providers shall not be 29 considered the practice of a profession under title eight of the educa- 30 tion law by the health care organization. 31 § 5107. Program standards. 1. The commissioner shall establish 32 requirements and standards for the program and for health care organiza- 33 tions, care coordinators, and health care providers, consistent with 34 this article, including requirements and standards for, as applicable: 35 (a) the scope, quality and accessibility of health care services; 36 (b) relations between health care organizations or health care provid- 37 ers and members; and 38 (c) relations between health care organizations and health care 39 providers, including (i) credentialing and participation in the health 40 care organization; and (ii) terms, methods and rates of payment. 41 2. Requirements and standards under the program shall include, but not 42 be limited to, provisions to promote the following: 43 (a) simplification, transparency, uniformity, and fairness in health 44 care provider credentialing and participation in health care organiza- 45 tion networks, referrals, payment procedures and rates, claims process- 46 ing, and approval of health care services, as applicable; 47 (b) primary and preventive care, care coordination, efficient and 48 effective health care services, quality assurance, coordination and 49 integration of health care services, including use of appropriate tech- 50 nology, and promotion of public, environmental and occupational health; 51 (c) elimination of health care disparities; 52 (d) non-discrimination with respect to members and health care provid- 53 ers on the basis of race, ethnicity, national origin, religion, disabil- 54 ity, age, sex, sexual orientation, gender identity or expression, or 55 economic circumstances; provided that health care services providedA. 6058 16 1 under the program shall be appropriate to the patient's clinically-rele- 2 vant circumstances; 3 (e) accessibility of care coordination, health care organization 4 services and health care services, including accessibility for people 5 with disabilities and people with limited ability to speak or understand 6 English, and the providing of care coordination, health care organiza- 7 tion services and health care services in a culturally competent manner; 8 and 9 (f) especially in relation to long-term supports and services, the 10 maximization and prioritization of the most integrated community-based 11 supports and services. 12 3. Any participating provider or care coordinator that is organized as 13 a for-profit entity (other than a professional practice of one or more 14 health care professionals) shall be required to meet the same require- 15 ments and standards as entities organized as not-for-profit entities, 16 and payments under the program paid to such entities shall not be calcu- 17 lated to accommodate the generation of profit or revenue for dividends 18 or other return on investment or the payment of taxes that would not be 19 paid by a not-for-profit entity. 20 4. Every participating provider shall furnish to the program such 21 information to, and permit examination of its records by, the program, 22 as may be reasonably required for purposes of reviewing accessibility 23 and utilization of health care services, quality assurance, promoting 24 improved patient outcomes and cost containment, the making of payments, 25 and statistical or other studies of the operation of the program or for 26 protection and promotion of public, environmental and occupational 27 health. 28 5. In developing requirements and standards and making other policy 29 determinations under this article, the commissioner shall consult with 30 the commissioner of mental health, the commissioner of developmental 31 disabilities, the director of the state office for the aging, the 32 commissioner of the office of addiction services and supports, the 33 commissioner of the division of human rights, representatives of 34 members, health care providers, care coordinators, health care organiza- 35 tions employers, organized labor including representatives of health 36 care workers, and other interested parties. 37 6. The program shall maintain the security and confidentiality of all 38 data and other information collected under the program when such data 39 would be normally considered confidential patient data. Aggregate data 40 of the program which is derived from confidential data but does not 41 violate patient confidentiality shall be public information including 42 for purposes of article six of the public officers law. 43 § 5108. Regulations. The commissioner shall make regulations under 44 this article by approving regulations and amendments thereto, under 45 subdivision one of section fifty-one hundred two of this article. The 46 commissioner may make regulations or amendments thereto under this arti- 47 cle on an emergency basis under section two hundred two of the state 48 administrative procedure act, provided that such regulations or amend- 49 ments shall not become permanent unless adopted under subdivision one of 50 section fifty-one hundred two of this article. 51 § 5109. Provisions relating to federal health programs. 1. The commis- 52 sioner shall seek all federal waivers and other federal approvals and 53 arrangements and submit state plan amendments necessary to operate the 54 program consistent with this article to the maximum extent possible. No 55 provision of this article and no action under the program shall diminishA. 6058 17 1 any right or benefit the member would otherwise have under any federal- 2 ly-matched program or Medicare. 3 2. (a) The commissioner shall apply to the secretary of health and 4 human services or other appropriate federal official for all waivers of 5 requirements, and make other arrangements, under Medicare, any federal- 6 ly-matched public health program, the affordable care act, and any other 7 federal programs that provide federal funds for payment for health care 8 services, that are necessary to enable all New York Health members to 9 receive all benefits under the program through the program to enable the 10 state to implement this article and to receive and deposit all federal 11 payments under those programs (including funds that may be provided in 12 lieu of premium tax credits, cost-sharing subsidies, and small business 13 tax credits) in the state treasury to the credit of the New York Health 14 trust fund and to use those funds for the New York Health program and 15 other provisions under this article. To the extent possible, the commis- 16 sioner shall negotiate arrangements with the federal government in which 17 bulk or lump-sum federal payments are paid to New York Health in place 18 of federal spending or tax benefits for federally-matched health 19 programs or federal health programs. The commissioner shall take 20 actions under paragraph (b) of subdivision eight of section fifty-one 21 hundred one of this article as reasonably necessary. 22 (b) The commissioner may require members or applicants to be members 23 to provide information necessary for the program to comply with any 24 waiver or arrangement under this subdivision. 25 3. (a) The commissioner may take actions consistent with this article 26 to enable New York Health to administer Medicare in New York state, to 27 create a Medicare managed care plan ("Medicare Advantage") that would 28 operate consistent with this article, and to be a provider of drug 29 coverage under Medicare part D for eligible members of New York Health. 30 (b) The commissioner may waive or modify the applicability of 31 provisions of this section relating to any federally-matched public 32 health program or Medicare as necessary to implement any waiver or 33 arrangement under this section or to maximize the benefit to the New 34 York Health program under this section, provided that the commissioner, 35 in consultation with the director of the budget, shall determine that 36 such waiver or modification is in the best interests of the members 37 affected by the action and the state, and provided further that no 38 action under this paragraph shall diminish any right or benefit the 39 member would otherwise have under the program or any federally-matched 40 public health program or Medicare. 41 (c) The commissioner may apply for coverage under any federally- 42 matched public health program on behalf of any member and enroll the 43 member in the federally-matched public health program or Medicare if the 44 member is eligible for it. Enrollment in a federally-matched public 45 health program or Medicare shall not cause any member to lose any health 46 care service provided by the program or diminish any right or benefit 47 the member would otherwise have. 48 (d) The commissioner shall by regulation increase the income eligibil- 49 ity level, increase or eliminate the resource test for eligibility, 50 simplify any procedural or documentation requirement for enrollment, and 51 increase the benefits for any federally-matched public health program, 52 and for any program to reduce or eliminate an individual's coinsurance, 53 cost-sharing or premium obligations or increase an individual's eligi- 54 bility for any federal financial support related to Medicare or the 55 affordable care act notwithstanding any law or regulation to the contra- 56 ry. The commissioner may act under this paragraph upon a finding,A. 6058 18 1 approved by the director of the budget, that the action (i) will help to 2 increase the number of members who are eligible for and enrolled in 3 federally-matched public health programs, or for any program to reduce 4 or eliminate an individual's coinsurance, cost-sharing or premium obli- 5 gations or increase an individual's eligibility for any federal finan- 6 cial support related to Medicare or the affordable care act; (ii) will 7 not diminish any individual's access to any health care service, benefit 8 or right the individual would otherwise have; (iii) is in the interest 9 of the program; and (iv) does not require or has received any necessary 10 federal waivers or approvals to ensure federal financial participation. 11 (e) To enable the commissioner to apply for coverage or financial 12 support under any federally-matched public health program, the Afforda- 13 ble Care Act, or Medicare on behalf of any member and enroll the member 14 in any such program, including an entity under paragraph (b) of subdivi- 15 sion eight of section fifty-one hundred one of this article if the 16 member is eligible for it, the commissioner may require that every 17 member or applicant to be a member shall provide information to enable 18 the commissioner to determine whether the applicant is eligible for such 19 program. The program shall make a reasonable effort to notify members 20 of their obligations under this paragraph. After a reasonable effort has 21 been made to contact the member, the member shall be notified in writing 22 that he or she has sixty days to provide such required information. If 23 such information is not provided within the sixty day period, the 24 member's coverage under the program may be terminated. Upon the member's 25 satisfactory provision of the information, the member's coverage under 26 the program shall be reinstated retroactive to the date upon which the 27 coverage was terminated. 28 (f) To the extent necessary for purposes of this section, as a condi- 29 tion of continued eligibility for health care services under the 30 program, a member who is eligible for benefits under Medicare shall 31 enroll in Medicare, including parts A, B and D. 32 (g) The program shall provide premium assistance for all members 33 enrolling in a Medicare part D drug coverage under section 1860D of 34 Title XVIII of the federal social security act limited to the low-income 35 benchmark premium amount established by the federal centers for Medicare 36 and Medicaid services and any other amount which such agency establishes 37 under its de minimis premium policy, except that such payments made on 38 behalf of members enrolled in a Medicare advantage plan may exceed the 39 low-income benchmark premium amount if determined to be cost effective 40 to the program. 41 (h) If the commissioner has reasonable grounds to believe that a 42 member could be eligible for an income-related subsidy under section 43 1860D-14 of Title XVIII of the federal social security act, the member 44 shall provide, and authorize the program to obtain, any information or 45 documentation required to establish the member's eligibility for such 46 subsidy, provided that the commissioner shall attempt to obtain as much 47 of the information and documentation as possible from records that are 48 available to him or her. 49 (i) The program shall make a reasonable effort to notify members of 50 their obligations under this subdivision. After a reasonable effort has 51 been made to contact the member, the member shall be notified in writing 52 that he or she has sixty days to provide such required information. If 53 such information is not provided within the sixty day period, the 54 member's coverage under the program may be terminated. Upon the 55 member's satisfactory provision of the information, the member's cover-A. 6058 19 1 age under the program shall be reinstated retroactive to the date upon 2 which the coverage was terminated. 3 § 5110. Additional provisions. 1. The commissioner shall contract 4 with not-for-profit organizations to provide: 5 (a) consumer assistance to individuals with respect to selection and 6 changing selection of a care coordinator or health care organization, 7 enrolling, obtaining health care services, and other matters relating to 8 the program; 9 (b) health care provider assistance to health care providers providing 10 and seeking or considering whether to provide, health care services 11 under the program, with respect to participating in a health care organ- 12 ization and dealing with a health care organization; and 13 (c) care coordinator assistance to individuals and entities providing 14 and seeking or considering whether to provide, care coordination to 15 members. 16 2. The commissioner shall provide grants from funds in the New York 17 Health trust fund or otherwise appropriated for this purpose, to health 18 systems agencies under section twenty-nine hundred four-b of this chap- 19 ter to support the operation of such health systems agencies. 20 3. Retraining and re-employment of impacted employees. (a) As used in 21 this subdivision: 22 (i) "Third party payer" has its ordinary meaning and includes any 23 entity that provides or arranges reimbursement in whole or in part for 24 the purchase of health care services. 25 (ii) "Health care provider administrative employee" means an employee 26 of a health care provider primarily engaged in relations or dealings 27 with third party payers or seeking payment or reimbursement for health 28 care services from third party payers. 29 (iii) "Impacted employee" means an individual who, at any time from 30 the date this section becomes a law until two years after the end of the 31 implementation period, is employed by a third party payer or is a health 32 care provider administrative employee, and whose employment ends or is 33 reasonably anticipated to end as a result of the implementation of the 34 New York Health program. 35 (b) Within ninety days after this section shall become a law, the 36 commissioner of labor shall convene a retraining and re-employment task 37 force including but not limited to: representatives of potential 38 impacted employees, human resource departments of third party payers and 39 health care providers, individuals with experience and expertise in 40 retraining and re-employment programs relevant to the circumstances of 41 impacted employees, and representatives of the commissioner of labor. 42 The commissioner of labor and the task force shall review and provide: 43 (i) analysis of potential impacted employees by job title and 44 geography; 45 (ii) competency mapping and labor market analysis of impacted employee 46 occupations with job openings; and 47 (iii) establishment of regional retraining and re-employment systems, 48 including but not limited to job boards, outplacement services, job 49 search services, career advisement services, and retraining advisement, 50 to be coordinated with the regional advisory councils established under 51 section fifty-one hundred eleven of this article. 52 (c) (i) Three or more impacted employees, a recognized union of work- 53 ers including impacted employees, or an employer of impacted employees 54 may file a petition with the commissioner of labor to certify such 55 employees as being impacted employees. 56 (ii) Impacted employees shall be eligible for:A. 6058 20 1 (A) up to two years of retraining at any training provider approved by 2 the commissioner of labor; and 3 (B) up to two years of unemployment benefits, provided that the 4 impacted employee is enrolled in a department of labor approved training 5 program, is actively seeking employment, and is not currently employed 6 full time; provided, however, that such impacted employee may maintain 7 unemployment benefits for up to two years even if he or she does not 8 meet the criteria set forth in this clause but is sixty-three years of 9 age or older at the time of loss of employment as an impacted employee. 10 (d) The commissioner shall provide funds from the New York Health 11 trust fund or otherwise appropriated for this purpose to the commission- 12 er of labor for retraining and re-employment programs for impacted 13 employees under this subdivision. 14 (e) The commissioner of labor shall make regulations and take other 15 actions reasonably necessary to implement this subdivision. This subdi- 16 vision shall be implemented consistent with applicable law and regu- 17 lations. 18 4. The commissioner shall, directly and through grants to not-for-pro- 19 fit entities, conduct programs using data collected through the New York 20 Health program, to promote and protect the quality of health care 21 services, patient outcomes, and public, environmental and occupational 22 health, including cooperation with other data collection and research 23 programs of the department, consistent with this article, the protection 24 of the security and confidentiality of individually identifiable patient 25 information, and otherwise applicable law. 26 5. Settlements and judgments. This subdivision applies where any 27 settlement, judgment or order in the course of litigation, or any 28 contract or agreement made as an alternative to litigation, provides 29 that one party shall pay for health care coverage for another party who 30 is entitled to enroll in the program. Any party to the settlement, judg- 31 ment, order, contract or agreement may apply to an appropriate court for 32 modification of the judgment, order, contract or agreement. The modifi- 33 cation may provide that the paying party, instead of paying for health 34 care coverage, shall pay all or part of the New York Health tax that is 35 owed by the other party, and may include other or further provisions. 36 The modifications shall be appropriate, consistent with the program, and 37 in the interest of justice. As used in this subdivision, "New York 38 Health tax" means the tax or taxes enacted by the legislature as part of 39 the revenue proposal, as amended, to fund the program. 40 § 5111. Regional advisory councils. 1. The New York Health regional 41 advisory councils (each referred to in this article as a "regional advi- 42 sory council") are hereby created in the department. 43 2. There shall be a regional advisory council established in each of 44 the following regions: 45 (a) Long Island, consisting of Nassau and Suffolk counties; 46 (b) New York City; 47 (c) Hudson Valley, consisting of Delaware, Dutchess, Orange, Putnam, 48 Rockland, Sullivan, Ulster, Westchester counties; 49 (d) Northern, consisting of Albany, Clinton, Columbia, Essex, Frank- 50 lin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Lewis, Montgomery, 51 Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, St. Lawrence, 52 Warren, Washington counties; 53 (e) Central, consisting of Broome, Cayuga, Chemung, Chenango, Cort- 54 land, Livingston, Madison, Monroe, Oneida, Onondaga, Ontario, Oswego, 55 Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates counties; andA. 6058 21 1 (f) Western, consisting of Allegany, Cattaraugus, Chautauqua, Erie, 2 Genesee, Niagara, Orleans, Wyoming counties. 3 3. Each regional advisory council shall be composed of not fewer than 4 twenty-seven members, as determined by the commissioner and the board, 5 as necessary to appropriately represent the diverse needs and concerns 6 of the region. Members of a regional advisory council shall be residents 7 of or have their principal place of business in the region served by the 8 regional advisory council. 9 4. Appointment of members of the regional advisory councils. 10 (a) The twenty-seven members shall be appointed as follows: 11 (i) nine members shall be appointed by the governor; 12 (ii) six members shall be appointed by the governor on the recommenda- 13 tion of the speaker of the assembly; 14 (iii) six members shall be appointed by the governor on the recommen- 15 dation of the temporary president of the senate; 16 (iv) three members shall be appointed by the governor on the recommen- 17 dation of the minority leader of the assembly; and 18 (v) three members shall be appointed by the governor on the recommen- 19 dation of the minority leader of the senate. 20 Where a regional advisory council has more than twenty-seven members, 21 additional members shall be appointed and recommended by these officials 22 in the same proportion as the twenty-seven members. 23 (b) Regional advisory council membership shall include but not be 24 limited to: 25 (i) representatives of organizations with a regional constituency that 26 advocate for health care consumers, older adults, and people with disa- 27 bilities including organizations led by members of those groups, who 28 shall constitute at least one third of the membership of each regional 29 council; 30 (ii) representatives of professional organizations representing physi- 31 cians; 32 (iii) representatives of professional organizations representing 33 health care professionals other than physicians; 34 (iv) representatives of general hospitals, including public hospitals; 35 (v) representatives of community health centers; 36 (vi) representatives of mental health, behavioral health (including 37 substance use), physical disability, developmental disability, rehabili- 38 tation, home care and other service providers; 39 (vii) representatives of women's health service providers; 40 (viii) representatives of health service providers serving lesbian, 41 gay, bisexual, transgender, gender non-conforming, and nonbinary 42 patients; 43 (ix) representatives of health care organizations; 44 (x) representatives of organized labor including representatives of 45 health care workers; 46 (xi) representatives of employers; and 47 (xii) representatives of municipal and county government. 48 5. Members of a regional advisory council shall be appointed for terms 49 of three years provided, however, that of the members first appointed, 50 one-third shall be appointed for one year terms and one-third shall be 51 appointed for two year terms. Vacancies shall be filled in the same 52 manner as original appointments for the remainder of any unexpired term. 53 No person shall be a member of a regional advisory council for more than 54 six years in any period of twelve consecutive years. 55 6. Members of the regional advisory councils shall serve without 56 compensation but shall be reimbursed for their necessary and actualA. 6058 22 1 expenses incurred while engaged in the business of the advisory coun- 2 cils. The program shall provide financial support for such expenses and 3 other expenses of the regional advisory councils. However, the board may 4 provide for compensation in cases where a lack of compensation would 5 limit the ability of a trustee or represented organization to partic- 6 ipate in council business. 7 7. Each regional advisory council shall meet at least quarterly. Each 8 regional advisory council may form committees to assist it in its work. 9 Members of a committee need not be members of the regional advisory 10 council. The New York City regional advisory council shall form a 11 committee for each borough of New York City, to assist the regional 12 advisory council in its work as it relates particularly to that borough. 13 8. Each regional advisory council shall advise the commissioner, the 14 board, the governor and the legislature on all matters relating to the 15 development and implementation of the New York Health program. 16 9. Each regional advisory council shall adopt, and from time to time 17 revise, a community health improvement plan for its region for the 18 purpose of: 19 (a) promoting the delivery of health care services in the region, 20 improving the quality and accessibility of care, including cultural 21 competency, clinical integration of care between service providers 22 including but not limited to physical, mental, and behavioral health, 23 physical and developmental disability services, and long-term supports 24 and services; 25 (b) facility and health services planning in the region; 26 (c) identifying gaps in regional health care services; 27 (d) promoting increased public knowledge and responsibility regarding 28 the availability and appropriate utilization of health care services. 29 Each community health improvement plan shall be submitted to the commis- 30 sioner and the board and shall be posted on the department's website; 31 (e) identifying needs in professional and service personnel required 32 to deliver health care services; and 33 (f) coordinating regional implementation of retraining and re-employ- 34 ment programs for impacted employees under subdivision three of section 35 fifty-one hundred ten of this article. 36 10. Each regional advisory council shall hold at least four public 37 hearings annually on matters relating to the New York Health program and 38 the development and implementation of the community health improvement 39 plan. 40 11. Each regional advisory council shall publish an annual report to 41 the commissioner and the board on the progress of the community health 42 improvement plan. These reports shall be posted on the department's 43 website. 44 12. All meetings of the regional advisory councils and committees 45 shall be subject to article six of the public officers law. 46 § 4. Financing of New York Health. 1. (a) As used in this section, 47 unless the context clearly requires otherwise: 48 (i) "New York Health program" and the "program" mean the New York 49 Health program, as created by article 51 of the public health law and 50 all provisions of that article. 51 (ii) "Revenue proposal" means the revenue plan and legislative bills, 52 as proposed and enacted under this section, to provide the revenue 53 necessary to finance the New York Health program. 54 (iii) "Tax" means the payroll tax or non-payroll tax to be enacted 55 under the revenue proposal. "Payroll tax" means the tax on payroll 56 income and self-employed income subject to the Medicare Part A tax,A. 6058 23 1 provided for in subdivision two of this section. "Non-payroll tax" means 2 the tax on taxable income (such as interest, dividends, and capital 3 gains) not subject to the payroll tax, provided for in subdivision two 4 of this section. 5 (b) The governor shall submit to the legislature a revenue proposal. 6 The revenue proposal shall be submitted to the legislature as part of 7 the executive budget under article VII of the state constitution, for 8 the fiscal year commencing on the first day of April in the calendar 9 year after this act shall become a law. In developing the revenue 10 proposal, the governor shall consult with appropriate officials of the 11 executive branch; the temporary president of the senate; the speaker of 12 the assembly; the chairs of the fiscal and health committees of the 13 senate and assembly; and representatives of business, labor, consumers 14 and local government. 15 2. (a) Basic structure. The basic structure of the revenue proposal 16 shall be as follows: Revenue for the program shall come from two taxes. 17 First, there shall be a progressively graduated tax on all payroll and 18 self-employed income, paid by employers, employees and self-employed 19 individuals. Second, there shall be a progressively graduated tax on 20 taxable income (such as interest, dividends, and capital gains) not 21 subject to the payroll tax. Income in the bracket below twenty-five 22 thousand dollars per year shall be exempt from the taxes; provided that 23 for individuals enrolled in Medicare as defined in the program, income 24 in the bracket below fifty thousand dollars per year shall be exempt 25 from the taxes. Higher brackets of income subject to the taxes shall be 26 assessed at a higher marginal rate than lower brackets. The taxes shall 27 be set at levels anticipated to produce sufficient revenue to finance 28 the program, to be scaled up as enrollment grows, taking into consider- 29 ation anticipated federal revenue available for the program. Provision 30 shall be made for state residents who are employed out-of-state, and 31 non-residents who are employed in the state (including those employed 32 less than full-time). 33 (b) Payroll tax. The income to be subject to the payroll tax shall be 34 all income subject to the Medicare Part A tax. The payroll tax shall be 35 set at a percentage of that income, which shall be progressively gradu- 36 ated, so the percentage is higher on higher brackets of income. For 37 employed individuals, the employer shall pay eighty percent of the 38 payroll tax and the employee shall pay twenty percent of the tax, except 39 that an employer may agree to pay all or part of the employee's share. 40 A self-employed individual shall pay the full tax. 41 (c) Non-payroll income tax. There shall be a tax on income that is 42 subject to the personal income tax under article 22 of the tax law and 43 is not subject to the payroll tax. It shall be set at a percentage of 44 that income, which shall be progressively graduated, so the percentage 45 is higher on higher brackets of income. 46 (d) Phased-in rates. Early in the program, when enrollment is growing, 47 the amount of the taxes shall be at an appropriate level, and shall be 48 changed as anticipated enrollment grows, to cover the actual cost of the 49 program. The revenue proposal shall include a mechanism for determining 50 the rates of the taxes. 51 (e) Cross-border employees. (i) State residents employed out-of-state. 52 If an individual is employed out-of-state by an employer that is subject 53 to New York state law, the employer and employee shall be required to 54 pay the payroll tax as to that employee as if the employment were in the 55 state. If an individual is employed out-of-state by an employer that is 56 not subject to New York state law, either (A) the employer and employeeA. 6058 24 1 shall voluntarily comply with the tax or (B) the employee shall pay the 2 tax as if he or she were self-employed. 3 (ii) Out-of-state residents employed in the state. The payroll tax 4 shall apply to any out-of-state resident who is employed or self-em- 5 ployed in the state. Such individual and individual's employer shall be 6 able to take a credit against the payroll taxes each would otherwise pay 7 as to that individual for amounts they spend respectively on health 8 benefits (A) for the individual, if the individual is not eligible to be 9 a member of the program, and (B) for any member of the individual's 10 immediate family. For the employer, the credit shall be available 11 regardless of the form of the health benefit (e.g., health insurance, a 12 self-insured plan, direct services, or reimbursement for services), to 13 make sure that the revenue proposal does not relate to employment bene- 14 fits in violation of any federal law. For non-employment-based spending 15 by the individual, the credit shall be available for and limited to 16 spending for health coverage (not out-of-pocket health spending). The 17 credit shall be available without regard to how little is spent or how 18 sparse the benefit. The credit may only be taken against the payroll 19 tax. Any excess amount may not be applied to other tax liability. The 20 credit shall be distributed between the employer and employee in the 21 same proportion as the spending by each for the benefit and may be 22 applied to their respective portion of the tax. If any provision of this 23 subparagraph or any application of it shall be ruled to violate federal 24 law, the provision or the application of it shall be null and void and 25 the ruling shall not affect any other provision or application of this 26 section or the act that enacted it. 27 3. (a) The revenue proposal shall include a plan and legislative 28 provisions for ending the requirement for local social services 29 districts to pay part of the cost of Medicaid and replacing those 30 payments with revenue from the taxes under the revenue proposal. 31 (b) The taxes under this section shall not supplant the spending of 32 other state revenue to pay for the Medicaid program as it exists as of 33 the enactment of the revenue proposal as amended, unless the revenue 34 proposal as amended provides otherwise. 35 4. To the extent that the revenue proposal differs from the terms of 36 subdivision two or paragraph (b) of subdivision three of this section, 37 the revenue proposal shall state how it differs from those terms and 38 reasons for and the effects of the differences. 39 5. All revenue from the taxes shall be deposited in the New York 40 Health trust fund account under section 89-j of the state finance law. 41 § 5. Article 49 of the public health law is amended by adding a new 42 title 3 to read as follows: 43 TITLE III 44 COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH 45 NEW YORK HEALTH 46 Section 4920. Definitions. 47 4921. Collective negotiation authorized. 48 4922. Collective negotiation requirements. 49 4923. Requirements for health care providers' representative. 50 4924. Mediation. 51 4925. Certain collective action prohibited. 52 4926. Fees. 53 4927. Confidentiality. 54 4928. Severability and construction. 55 § 4920. Definitions. For purposes of this title:A. 6058 25 1 1. "New York Health" means the program under article fifty-one of this 2 chapter. 3 2. "Person" means an individual, association, corporation, or any 4 other legal entity. 5 3. "Health care providers' representative" means a third party that is 6 authorized by health care providers to negotiate on their behalf with 7 New York Health over terms and conditions affecting those health care 8 providers. 9 4. "Strike" means a work stoppage in part or in whole, direct or indi- 10 rect, by a body of workers to gain compliance with demands made on an 11 employer. 12 5. "Health care provider" means a health care provider under article 13 fifty-one of this chapter. A health care professional as defined in 14 article fifty-one of this chapter who practices as an employee or inde- 15 pendent contractor of another health care provider shall not be deemed a 16 health care provider for purposes of this title. 17 § 4921. Collective negotiation authorized. 1. Health care providers 18 may meet and communicate for the purpose of collectively negotiating 19 with New York Health on any matter relating to New York Health, includ- 20 ing but not limited to rates of payment and payment methodologies. 21 2. Nothing in this section shall be construed to allow or authorize an 22 alteration of the terms of the internal and external review procedures 23 set forth in law. 24 3. Nothing in this section shall be construed to allow a strike of New 25 York Health by health care providers. 26 4. Nothing in this section shall be construed to allow or authorize 27 terms or conditions which would impede the ability of New York Health to 28 obtain or retain accreditation by the national committee for quality 29 assurance or a similar body or to comply with applicable state or feder- 30 al law. 31 § 4922. Collective negotiation requirements. 1. Collective negotiation 32 rights granted by this title must conform to the following requirements: 33 (a) health care providers may communicate with other health care 34 providers regarding the terms and conditions to be negotiated with New 35 York Health; 36 (b) health care providers may communicate with health care providers' 37 representatives; 38 (c) a health care providers' representative is the only party author- 39 ized to negotiate with New York Health on behalf of the health care 40 providers as a group; 41 (d) a health care provider can be bound by the terms and conditions 42 negotiated by the health care providers' representatives; and 43 (e) in communicating or negotiating with the health care providers' 44 representative, New York Health is entitled to offer and provide differ- 45 ent terms and conditions to individual competing health care providers. 46 2. Nothing in this title shall affect or limit the right of a health 47 care provider or group of health care providers to collectively petition 48 a government entity for a change in a law, rule, or regulation. 49 3. Nothing in this title shall affect or limit collective action or 50 collective bargaining on the part of any health care provider with his 51 or her employer or any other lawful collective action or collective 52 bargaining. 53 § 4923. Requirements for health care providers' representative. Before 54 engaging in collective negotiations with New York Health on behalf of 55 health care providers, a health care providers' representative shall 56 file with the commissioner, in the manner prescribed by the commission-A. 6058 26 1 er, information identifying the representative, the representative's 2 plan of operation, and the representative's procedures to ensure compli- 3 ance with this title. 4 § 4924. Mediation. 1. In the event the commissioner determines that an 5 impasse exists in the negotiations, the commissioner shall render 6 assistance as follows: 7 (a) to assist the parties to effect a voluntary resolution of the 8 negotiations, the commissioner shall appoint a mediator who is mutually 9 acceptable to both the health care providers' representative and the 10 representative of New York Health. If the mediator is successful in 11 resolving the impasse, then the health care providers' representative 12 shall proceed as set forth in this article; 13 (b) if an impasse continues, the commissioner shall appoint a fact- 14 finding board of not more than three members, who are mutually accepta- 15 ble to both the health care providers' representative and the represen- 16 tative of New York Health. The fact-finding board shall have, in 17 addition to the powers delegated to it by the board, the power to make 18 recommendations for the resolution of the dispute; 19 (c) the fact-finding board, acting by a majority of its members, shall 20 transmit its findings of fact and recommendations for resolution of the 21 dispute to the commissioner, and may thereafter assist the parties to 22 effect a voluntary resolution of the dispute. The fact-finding board 23 shall also share its findings of fact and recommendations with the 24 health care providers' representative and the representative of New York 25 Health. If within twenty days after the submission of the findings of 26 fact and recommendations, the impasse continues, the commissioner shall 27 order a resolution to the negotiations based upon the findings of fact 28 and recommendations submitted by the fact-finding board. 29 § 4925. Certain collective action prohibited. 1. This title is not 30 intended to authorize competing health care providers to act in concert 31 in response to a health care providers' representative's discussions or 32 negotiations with New York Health except as authorized by other law. 33 2. No health care providers' representative shall negotiate any agree- 34 ment that excludes, limits the participation or reimbursement of, or 35 otherwise limits the scope of services to be provided by any health care 36 provider or group of health care providers with respect to the perform- 37 ance of services that are within the health care provider's lawful scope 38 or terms of practice, license, registration, or certificate. 39 § 4926. Fees. Each person who acts as the representative of negotiat- 40 ing parties under this title shall pay to the department a fee to act as 41 a representative. The commissioner, by regulation, shall set fees in 42 amounts deemed reasonable and necessary to cover the costs incurred by 43 the department in administering this title. 44 § 4927. Confidentiality. All reports and other information required to 45 be reported to the department under this title shall not be subject to 46 disclosure under article six of the public officers law. 47 § 4928. Severability and construction. If any provision or application 48 of this title shall be held to be invalid, or to violate or be incon- 49 sistent with any applicable federal law or regulation, that shall not 50 affect other provisions or applications of this title which can be given 51 effect without that provision or application; and to that end, the 52 provisions and applications of this title are severable. The provisions 53 of this title shall be liberally construed to give effect to the 54 purposes thereof.A. 6058 27 1 § 6. Subdivision 11 of section 270 of the public health law, as 2 amended by section 2-a of part C of chapter 58 of the laws of 2008, is 3 amended to read as follows: 4 11. "State public health plan" means the medical assistance program 5 established by title eleven of article five of the social services law 6 (referred to in this article as "Medicaid"), the elderly pharmaceutical 7 insurance coverage program established by title three of article two of 8 the elder law (referred to in this article as "EPIC"), and the [family9health plus program established by section three hundred sixty-nine-ee10of the social services law to the extent that section provides that the11program shall be subject to this article] New York Health program estab- 12 lished by article fifty-one of this chapter. 13 § 7. The state finance law is amended by adding a new section 89-j to 14 read as follows: 15 § 89-j. New York Health trust fund. 1. There is hereby established in 16 the joint custody of the state comptroller and the commissioner of taxa- 17 tion and finance a special revenue fund to be known as the "New York 18 Health trust fund", referred to in this section as "the fund". The defi- 19 nitions in section fifty-one hundred of the public health law shall 20 apply to this section. 21 2. The fund shall consist of: 22 (a) all monies obtained from taxes pursuant to legislation enacted as 23 proposed under section three of the New York Health act; 24 (b) federal payments received as a result of any waiver or other 25 arrangements agreed to by the United States secretary of health and 26 human services or other appropriate federal officials for health care 27 programs established under Medicare, any federally-matched public health 28 program, or the affordable care act; 29 (c) the amounts paid by the department of health that are equivalent 30 to those amounts that are paid on behalf of residents of this state 31 under Medicare, any federally-matched public health program, or the 32 affordable care act for health benefits which are equivalent to health 33 benefits covered under New York Health; 34 (d) federal and state funds for purposes of the provision of services 35 authorized under title XX of the federal social security act that would 36 otherwise be covered under article fifty-one of the public health law; 37 and 38 (e) state monies that would otherwise be appropriated to any govern- 39 mental agency, office, program, instrumentality or institution which 40 provides health services, for services and benefits covered under New 41 York Health. Payments to the fund pursuant to this paragraph shall be in 42 an amount equal to the money appropriated for such purposes in the 43 fiscal year beginning immediately preceding the effective date of the 44 New York Health act. 45 3. Monies in the fund shall only be used for purposes established 46 under article fifty-one of the public health law. 47 § 8. Temporary commission on implementation. 1. There is hereby estab- 48 lished a temporary commission on implementation of the New York Health 49 program, referred to in this section as the commission, consisting of 50 fifteen members: five members, including the chair, shall be appointed 51 by the governor; four members shall be appointed by the temporary presi- 52 dent of the senate, one member shall be appointed by the senate minority 53 leader; four members shall be appointed by the speaker of the assembly, 54 and one member shall be appointed by the assembly minority leader. The 55 commissioner of health, the superintendent of financial services, andA. 6058 28 1 the commissioner of taxation and finance, or their designees shall serve 2 as non-voting ex-officio members of the commission. 3 2. Members of the commission shall receive such assistance as may be 4 necessary from other state agencies and entities, and shall receive 5 reasonable and necessary expenses incurred in the performance of their 6 duties. The commission may employ staff as needed, prescribe their 7 duties, and fix their compensation within amounts appropriated for the 8 commission. 9 3. The commission shall examine the laws and regulations of the state 10 and consult with health care providers, consumers, and other stakehold- 11 ers and make such recommendations as are necessary to conform the laws 12 and regulations of the state and article 51 of the public health law 13 establishing the New York Health program and other provisions of law 14 relating to the New York Health program, and to improve and implement 15 the program. The commission shall report its recommendations to the 16 governor and the legislature. The commission shall immediately begin 17 development of proposals consistent with the principles of article 51 of 18 the public health law for provision of health care services covered 19 under the workers' compensation law; and incorporation of retiree health 20 benefits, as described in paragraphs (a), (b) and (c) of subdivision 8 21 of section 5102 of the public health law. The commission shall provide 22 its work product and assistance to the board established pursuant to 23 section 5102 of the public health law upon completion of the appointment 24 of the board. 25 § 9. Severability. If any provision or application of this act shall 26 be held to be invalid, or to violate or be inconsistent with any appli- 27 cable federal law or regulation, that shall not affect other provisions 28 or applications of this act which can be given effect without that 29 provision or application; and to that end, the provisions and applica- 30 tions of this act are severable. 31 § 10. This act shall take effect immediately.
