STATE OF NEW YORK
________________________________________________________________________
S. 8307--A A. 8807--A
SENATE - ASSEMBLY
January 17, 2024
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee
AN ACT to amend part H of chapter 59 of the laws of 2011, amending the
public health law and other laws relating to general hospital
reimbursement for annual rates, in relation to known and projected
department of health state fund medicaid expenditures (Part A); to
amend the public health law, in relation to extending certain
provisions related to the issuance of accountable care organization
certifications and state oversight of antitrust provisions; and to
amend part D of chapter 56 of the laws of 2013 amending the social
services law relating to eligibility conditions, chapter 649 of the
laws of 1996 amending the public health law, the mental hygiene law
and the social services law relating to authorizing the establishment
of special needs plans, part V of chapter 57 of the laws of 2022
amending the public health law and the insurance law relating to
reimbursement for commercial and Medicaid services provided via tele-
health, chapter 659 of the laws of 1997 amending the public health law
and other laws relating to creation of continuing care retirement
communities, part NN of chapter 57 of the laws of 2018 amending the
public health law and the state finance law relating to enacting the
opioid stewardship act, part II of chapter 54 of the laws of 2016
amending part C of chapter 58 of the laws of 2005 relating to author-
izing reimbursements for expenditures made by or on behalf of social
services districts for medical assistance for needy persons and admin-
istration thereof, part B of chapter 57 of the laws of 2015 amending
the social services law and other laws relating to energy audits
and/or disaster preparedness reviews of residential healthcare facili-
ties by the commissioner, and part H of chapter 57 of the laws of 2019
amending the public health law relating to waiver of certain regu-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12671-02-4
S. 8307--A 2 A. 8807--A
lations, in relation to the effectiveness thereof (Part B); to amend
the education law, in relation to removing the exemption for school
psychologists to render early intervention services; and to amend
chapter 217 of the laws of 2015, amending the education law relating
to certified school psychologists and special education services and
programs for preschool children with handicapping conditions, in
relation to the effectiveness thereof (Part C); to amend the public
health law, in relation to reducing the hospital capital rate add-on;
to amend part ZZ of chapter 56 of the laws of 2020 amending the tax
law and the social services law relating to certain Medicaid manage-
ment, in relation to the effectiveness thereof; to amend part E of
chapter 57 of the laws of 2015, amending the public health law relat-
ing to the payment of certain funds for uncompensated care, in
relation to certain payments being made as outpatient upper payment
limit payments for outpatient hospital services during certain state
fiscal years and calendar years; to amend part B of chapter 57 of the
laws of 2015, amending the social services law relating to supple-
mental rebates, in relation to authorizing the department of health to
increase operating cost component of rates of payment for general
hospital outpatient services and authorizing the department of health
to pay a public hospital adjustment to public general hospitals during
certain state fiscal years and calendar years; to amend the public
health law, in relation to authorizing the commissioner to make addi-
tional inpatient hospital payments during certain state fiscal years
and calendar years; and to amend part B of chapter 58 of the laws of
2010, amending the social services law and the public health law
relating to prescription drug coverage for needy persons and health
care initiatives pools, in relation to authorizing the department of
health to make Medicaid payment increases for county operated free-
standing clinics during certain state fiscal years and calendar years
(Part D); to amend the public health law, in relation to freezing the
operating component of the rates for skilled nursing facilities,
reducing the capital component of the rates for skilled nursing facil-
ities by an additional ten percent, and eligibility for admission to
the New York state veterans' home (Part E); to amend the social
services law, in relation to making the special needs assisted living
residence voucher program permanent; and to amend the public health
law, in relation to assisted living quality improvement standards
(Part F); to amend the public health law, in relation to home care
worker wage parity; and to repeal certain provisions of the public
health law relating thereto (Part G); to amend the financial services
law, in relation to excluding managed care plans from the independent
resolution process; to amend the social services law and the public
health law, in relation to providing authority for the department of
health to competitively procure managed care organizations participat-
ing in medicaid managed care programs; to amend part I of chapter 57
of the laws of 2022, providing a one percent across the board payment
increase to all qualifying fee-for-service Medicaid rates, in relation
to eliminating the one percent rate increase to managed care organiza-
tions; and to repeal certain provisions of the social services law
relating thereto (Part H); to amend the social services law, in
relation to copayments for drugs; to amend the public health law, in
relation to prescriber prevails; to amend the public health law, in
relation to the Medicaid drug cap and pharmacy cost reporting; and to
repeal certain provisions of the social services law relating to
coverage for certain prescription drugs (Part I); to amend the social
S. 8307--A 3 A. 8807--A
services law, in relation to renaming the basic health program to the
essential plan; to amend part H of chapter 57 of the laws of 2021,
amending the social services law relating to eliminating consumer-paid
premium payments in the basic health program, in relation to the
effectiveness thereof; and to amend part BBB of chapter 56 of the laws
of 2022, amending the public health law and other laws relating to
permitting the commissioner of health to submit a waiver that expands
eligibility for New York's basic health program and increases the
federal poverty limit cap for basic health program eligibility from
two hundred to two hundred fifty percent, in relation to extending
certain provisions related to providing long-term services and
supports under the essential plan; and to amend the public health law,
in relation to adding references to the 1332 state innovation waiver,
providing a new subsidy to assist low-income New Yorkers with the
payment of premiums, cost sharing or both through the marketplace, and
adding the 1332 state innovation program to the functions of the
marketplace (Part J); to amend chapter 266 of the laws of 1986 amend-
ing the civil practice law and rules and other laws relating to malp-
ractice and professional medical conduct, in relation to insurance
coverage paid for by funds from the hospital excess liability pool and
extending the effectiveness of certain provisions thereof; to amend
part J of chapter 63 of the laws of 2001 amending chapter 266 of the
laws of 1986 amending the civil practice law and rules and other laws
relating to malpractice and professional medical conduct, in relation
to extending certain provisions concerning the hospital excess liabil-
ity pool; and to amend part H of chapter 57 of the laws of 2017 amend-
ing the New York Health Care Reform Act of 1996 and other laws relat-
ing to extending certain provisions relating thereto, in relation to
extending provisions relating to excess coverage (Part K); to amend
the public health law and the state finance law, in relation to the
discontinuation of the empire clinical research investigator program;
to amend the public health law, in relation to the discontinuance of
participation and membership during a three year demonstration period
in a physician committee of the Medical Society of the State of New
York or the New York State Osteopathic Society; to repeal subdivision
9 of section 2803 of the public health law, relating to the hospital
audit program; to repeal section 461-s of the social services law,
relating to enhancing the quality of adult living program for adult
care facilities; to repeal paragraph (c) of subdivision 1 of section
461-b of the social services law, relating to an appropriation made
available for the purposes of funding the operating assistance sub-
program for enriched housing; to repeal article 27-H of the public
health law, relating to the tick-borne disease institute; and to
repeal paragraph (g) of subdivision 11 of section 230 of the public
health law, relating to reporting of professional misconduct (Part L);
to amend the social services law and the public health law, in
relation to authorizing continuous coverage in Medicaid and child
health plus, for eligible children ages zero to six (Part M); to amend
the public health law, in relation to authorizing the commissioner of
health to issue a statewide standing order for the provision of doula
services, providing medical services to pregnant minors, and to the
provision of contraception (Part N); to amend the public health law,
in relation to expanding financial assistance; and to amend the gener-
al business law, in relation to additional consumer protection for
medical debt and restricting the applications for and use of credit
cards and medical financial products (Part O); to amend part C of
S. 8307--A 4 A. 8807--A
chapter 57 of the laws of 2022 amending the public health law and the
education law relating to allowing pharmacists to direct limited
service laboratories and order and administer COVID-19 and influenza
tests and modernizing nurse practitioners, and chapter 21 of the laws
of 2011 amending the education law relating to authorizing pharmacists
to perform collaborative drug therapy management with physicians in
certain settings, in relation to the effectiveness thereof (Part P);
to amend the education law and the public health law, in relation to
the scope of practice of physician assistants, certified nurse aides,
medical assistants, dentists and dental hygienists (Part Q); to amend
the education law, in relation to enacting the interstate medical
licensure compact; and to amend the education law, in relation to
enacting the nurse licensure compact (Part R); to amend the public
health law, in relation to establishing the healthcare safety net
transformation program (Part S); to amend the public health law and
the education law, in relation to making necessary changes to end the
HIV, HCV, HBV, syphilis and mpox epidemics; and to repeal certain
provisions the public health law relating thereto (Part T); to amend
the public health law, in relation to increasing prescription monitor-
ing program data retention periods and allowing enhanced data sharing
to combat the opioid crisis, updating controlled substance schedules
to conform with those of the federal drug enforcement administration,
permitting providers to distribute three-day supplies of buprenor-
phine, and updating the term "addict" to "person with a substance use
disorder" in certain provisions of such law; and to repeal section
3372 of such law relating to practitioner patient reporting (Part U);
to amend the public health law, in relation to expanding hospital
services and home care collaboration into the home and community; to
amend the public health law and the education law, in relation to
modernizing the state of New York's emergency medical system and work-
force; to amend the public health law, in relation to establishing the
paramedic urgent care program; and to amend chapter 137 of the laws of
2023 amending the public health law relating to establishing a commu-
nity-based paramedicine demonstration program, in relation to extend-
ing the effectiveness thereof (Part V); to amend the elder law, in
relation to establishing the interagency elder justice coordinating
council (Part W); intentionally omitted (Part X); to amend chapter 62
of the laws of 2003, amending the mental hygiene law and the state
finance law relating to the community mental health support and work-
force reinvestment program, the membership of subcommittees for mental
health of community services boards and the duties of such subcommit-
tees and creating the community mental health and workforce reinvest-
ment account, in relation to the effectiveness thereof (Part Y); to
amend part NN of chapter 58 of the laws of 2015, amending the mental
hygiene law relating to clarifying the authority of the commissioners
in the department of mental hygiene to design and implement time-lim-
ited demonstration programs, in relation to making such provisions
permanent (Part Z); to amend the insurance law, in relation to setting
minimal reimbursement for behavioral health treatment (Part AA); to
amend chapter 723 of the laws of 1989 amending the mental hygiene law
and other laws relating to comprehensive psychiatric emergency
programs, in relation to the effectiveness of certain provisions
thereof (Part BB); to amend the social services law, in relation to
clarifying the requirements related to referrals of substantiated
reports of abuse or neglect from the justice center to the office of
the Medicaid inspector general (Part CC); to amend part A of chapter
S. 8307--A 5 A. 8807--A
111 of the laws of 2010 amending the mental hygiene law relating to
the receipt of federal and state benefits received by individuals
receiving care in facilities operated by an office of the department
of mental hygiene, in relation to the effectiveness thereof (Part DD);
to amend the education law, in relation to expanding the description
of certain services which are not prohibited by statutes governing the
practice of nursing (Part EE); to establish a cost of living adjust-
ment for designated human services programs (Part FF); to amend the
social services law, in relation to providing contracting flexibility
in relation to 1115 medicaid waivers (Part GG); and to amend the
social services law, in relation to the removal of the fiscal interme-
diary procurement and replacing it with an authorization process; to
amend the public health law, in relation to eliminating conflicts of
interest between consumer directed personal assistance program fiscal
intermediaries and licensed home care services agencies; to amend the
social services law, in relation to the consumer directed personal
assistance program; and to repeal certain provisions of the social
services law relating thereto (Part HH)
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. This act enacts into law major components of legislation
2 necessary to implement the state health and mental hygiene budget for
3 the 2024-2025 state fiscal year. Each component is wholly contained
4 within a Part identified as Parts A through HH. The effective date for
5 each particular provision contained within such Part is set forth in the
6 last section of such Part. Any provision in any section contained within
7 a Part, including the effective date of the Part, which makes a refer-
8 ence to a section "of this act", when used in connection with that
9 particular component, shall be deemed to mean and refer to the corre-
10 sponding section of the Part in which it is found. Section three of this
11 act sets forth the general effective date of this act.
12 PART A
13 Section 1. Paragraph (a) of subdivision 1 of section 92 of part H of
14 chapter 59 of the laws of 2011, amending the public health law and other
15 laws relating to general hospital reimbursement for annual rates, as
16 amended by section 1 of part A of chapter 57 of the laws of 2023, is
17 amended to read as follows:
18 (a) For state fiscal years 2011-12 through [2024-25] 2025-26, the
19 director of the budget, in consultation with the commissioner of health
20 referenced as "commissioner" for purposes of this section, shall assess
21 on a quarterly basis, as reflected in quarterly reports pursuant to
22 subdivision five of this section known and projected department of
23 health state funds medicaid expenditures by category of service and by
24 geographic regions, as defined by the commissioner.
25 § 2. This act shall take effect immediately and shall be deemed to
26 have been in full force and effect on and after April 1, 2024.
27 PART B
28 Section 1. Subdivision p of section 76 of part D of chapter 56 of the
29 laws of 2013 amending the social services law relating to eligibility
S. 8307--A 6 A. 8807--A
1 conditions, as amended by section 2 of part E of chapter 57 of the laws
2 of 2019, is amended to read as follows:
3 p. the amendments to subparagraph 7 of paragraph (b) of subdivision 1
4 of section 366 of the social services law made by section one of this
5 act shall expire and be deemed repealed October 1, [2024] 2029.
6 § 2. Section 10 of chapter 649 of the laws of 1996 amending the public
7 health law, the mental hygiene law and the social services law relating
8 to authorizing the establishment of special needs plans, as amended by
9 section 21 of part E of chapter 57 of the laws of 2019, is amended to
10 read as follows:
11 § 10. This act shall take effect immediately and shall be deemed to
12 have been in full force and effect on and after July 1, 1996; provided,
13 however, that sections one, two and three of this act shall expire and
14 be deemed repealed [on] March 31, [2025] 2030 provided, however that the
15 amendments to section 364-j of the social services law made by section
16 four of this act shall not affect the expiration of such section and
17 shall be deemed to expire therewith and provided, further, that the
18 provisions of subdivisions 8, 9 and 10 of section 4401 of the public
19 health law, as added by section one of this act; section 4403-d of the
20 public health law as added by section two of this act and the provisions
21 of section seven of this act, except for the provisions relating to the
22 establishment of no more than twelve comprehensive HIV special needs
23 plans, shall expire and be deemed repealed on July 1, 2000.
24 § 3. Subdivision 3 of section 2999-p of the public health law, as
25 amended by section 8 of part BB of chapter 56 of the laws of 2020, is
26 amended to read as follows:
27 3. The commissioner may issue a certificate of authority to an entity
28 that meets conditions for ACO certification as set forth in regulations
29 made by the commissioner pursuant to section twenty-nine hundred nine-
30 ty-nine-q of this article. The commissioner shall not issue any new
31 certificate under this article after December thirty-first, two thousand
32 [twenty-four] twenty-eight.
33 § 4. Subdivision 1 of section 2999-aa of the public health law, as
34 amended by section 9 of part S of chapter 57 of the laws of 2021, is
35 amended to read as follows:
36 1. In order to promote improved quality and efficiency of, and access
37 to, health care services and to promote improved clinical outcomes to
38 the residents of New York, it shall be the policy of the state to
39 encourage, where appropriate, cooperative, collaborative and integrative
40 arrangements including but not limited to, mergers and acquisitions
41 among health care providers or among others who might otherwise be
42 competitors, under the active supervision of the commissioner. To the
43 extent such arrangements, or the planning and negotiations that precede
44 them, might be anti-competitive within the meaning and intent of the
45 state and federal antitrust laws, the intent of the state is to supplant
46 competition with such arrangements under the active supervision and
47 related administrative actions of the commissioner as necessary to
48 accomplish the purposes of this article, and to provide state action
49 immunity under the state and federal antitrust laws with respect to
50 activities undertaken by health care providers and others pursuant to
51 this article, where the benefits of such active supervision, arrange-
52 ments and actions of the commissioner outweigh any disadvantages likely
53 to result from a reduction of competition. The commissioner shall not
54 approve an arrangement for which state action immunity is sought under
55 this article without first consulting with, and receiving a recommenda-
56 tion from, the public health and health planning council. No arrangement
S. 8307--A 7 A. 8807--A
1 under this article shall be approved after December thirty-first, two
2 thousand [twenty-four] twenty-eight.
3 § 5. Section 7 of part V of chapter 57 of the laws of 2022 amending
4 the public health law and the insurance law relating to reimbursement
5 for commercial and Medicaid services provided via telehealth, is amended
6 to read as follows:
7 § 7. This act shall take effect immediately and shall be deemed to
8 have been in full force and effect on and after April 1, 2022; provided,
9 however, this act shall expire and be deemed repealed on and after April
10 1, [2024] 2025.
11 § 6. Section 97 of chapter 659 of the laws of 1997 amending the public
12 health law and other laws relating to creation of continuing care
13 retirement communities, as amended by section 11 of part Z of chapter 57
14 of the laws of 2018, is amended to read as follows:
15 § 97. This act shall take effect immediately, provided, however, that
16 the amendments to subdivision 4 of section 854 of the general municipal
17 law made by section seventy of this act shall not affect the expiration
18 of such subdivision and shall be deemed to expire therewith and provided
19 further that sections sixty-seven and sixty-eight of this act shall
20 apply to taxable years beginning on or after January 1, 1998 and
21 provided further that sections eighty-one through eighty-seven of this
22 act shall expire and be deemed repealed on December 31, [2024] 2029 and
23 provided further, however, that the amendments to section ninety of this
24 act shall take effect January 1, 1998 and shall apply to all policies,
25 contracts, certificates, riders or other evidences of coverage of long
26 term care insurance issued, renewed, altered or modified pursuant to
27 section 3229 of the insurance law on or after such date.
28 § 7. Section 5 of part NN of chapter 57 of the laws of 2018 amending
29 the public health law and the state finance law relating to enacting the
30 opioid stewardship act, as amended by section 5 of part XX of chapter 59
31 of the laws of 2019, is amended to read as follows:
32 § 5. This act shall take effect July 1, 2018 and shall expire and be
33 deemed to be repealed on June 30, [2024] 2027, provided that, effective
34 immediately, the addition, amendment and/or repeal of any rule or regu-
35 lation necessary for the implementation of this act on its effective
36 date are authorized to be made and completed on or before such effective
37 date, and, provided that this act shall only apply to the sale or
38 distribution of opioids in the state of New York on or before December
39 31, 2018.
40 § 8. Section 2 of part II of chapter 54 of the laws of 2016 amending
41 part C of chapter 58 of the laws of 2005 relating to authorizing
42 reimbursements for expenditures made by or on behalf of social services
43 districts for medical assistance for needy persons and administration
44 thereof, as amended by section 6 of part CC of chapter 57 of the laws of
45 2022, is amended to read as follows:
46 § 2. This act shall take effect immediately and shall expire and be
47 deemed repealed March 31, [2024] 2026.
48 § 9. Subdivision 5 of section 60 of part B of chapter 57 of the laws
49 of 2015 amending the social services law and other laws relating to
50 energy audits and/or disaster preparedness reviews of residential
51 healthcare facilities by the commissioner, as amended by chapter 125 of
52 the laws of 2021, is amended to read as follows:
53 5. section thirty-eight of this act shall expire and be deemed
54 repealed July 1, [2024] 2027;
55 § 10. Section 7 of part H of chapter 57 of the laws of 2019, amending
56 the public health law relating to waiver of certain regulations, as
S. 8307--A 8 A. 8807--A
1 amended by section 1 of part GG of chapter 57 of the laws of 2022, is
2 amended to read as follows:
3 § 7. This act shall take effect immediately and shall be deemed to
4 have been in full force and effect on and after April 1, 2019, provided,
5 however, that section two of this act shall expire on April 1, [2024]
6 2026.
7 § 11. This act shall take effect immediately.
8 PART C
9 Section 1. Paragraph d of subdivision 6 of section 4410 of the educa-
10 tion law, as amended by chapter 217 of the laws of 2015, is amended to
11 read as follows:
12 d. Notwithstanding any other provision of law to the contrary, the
13 exemption in subdivision one of section seventy-six hundred five of this
14 chapter shall apply to persons employed on a full-time or part-time
15 salary basis, which may include on an hourly, weekly, or monthly basis,
16 or on a fee for evaluation services basis provided that such person is
17 employed by and under the dominion and control of a center-based program
18 approved pursuant to subdivision nine of this section as a certified
19 school psychologist to provide activities, services and use of the title
20 psychologist to students enrolled in such approved center-based program;
21 and to certified school psychologists employed on a full-time or part-
22 time salary basis, which may include on an hourly, weekly, or monthly
23 basis, or on a fee for evaluation services basis provided that the
24 school psychologist is employed by and under the dominion and control of
25 a program that has been approved pursuant to paragraph b of subdivision
26 nine of this section, or subdivision nine-a of this section, to conduct
27 a multi-disciplinary evaluation of a preschool child having or suspected
28 of having a disability where authorized by paragraph a [or b] of subdi-
29 vision six of section sixty-five hundred three-b of this chapter[; and
30 to certified school psychologists employed on a full-time or part-time
31 salary basis, which may include on an hourly, weekly, or monthly basis,
32 or on a fee for evaluation services basis provided that such psychol-
33 ogist is employed by and under the dominion and control of an agency
34 approved in accordance with title two-A of article twenty-five of the
35 public health law to deliver early intervention program multidiscipli-
36 nary evaluations, service coordination services and early intervention
37 program services, where authorized by paragraph a or b of subdivision
38 six of section sixty-five hundred three-b of this chapter, each], in the
39 course of their employment. Nothing in this section shall be construed
40 to authorize a certified school psychologist or group of such school
41 psychologists to engage in independent practice or practice outside of
42 an employment relationship.
43 § 2. Subdivision 1 of section 7605 of the education law, as amended by
44 chapter 217 of the laws of 2015, is amended to read as follows:
45 1. The activities, services, and use of the title of psychologist, or
46 any derivation thereof, on the part of a person in the employ of a
47 federal, state, county or municipal agency, or other political subdivi-
48 sion, or a chartered elementary or secondary school or degree-granting
49 educational institution insofar as such activities and services are a
50 part of the duties of his salaried position; or on the part of a person
51 in the employ as a certified school psychologist on a full-time or part-
52 time salary basis, which may include on an hourly, weekly, or monthly
53 basis, or on a fee for evaluation services basis provided that such
54 person employed as a certified school psychologist is employed by and
S. 8307--A 9 A. 8807--A
1 under the dominion and control of a preschool special education program
2 approved pursuant to paragraph b of subdivision nine or subdivision
3 nine-a of section forty-four hundred ten of this chapter to provide
4 activities, services and to use the title "certified school psychol-
5 ogist", so long as this shall not be construed to permit the use of the
6 title "licensed psychologist", to students enrolled in such approved
7 program or to conduct a multidisciplinary evaluation of a preschool
8 child having or suspected of having a disability[; or on the part of a
9 person in the employ as a certified school psychologist on a full-time
10 or part-time salary basis, which may include on an hourly, weekly or
11 monthly basis, or on a fee for evaluation services basis provided that
12 such person employed as a certified school psychologist is employed by
13 and under the dominion and control of an agency approved in accordance
14 with title two-A of article twenty-five of the public health law to
15 deliver early intervention program multidisciplinary evaluations,
16 service coordination services and early intervention program services],
17 where each such preschool special education program [or early inter-
18 vention provider] is authorized by paragraph a [or b] of subdivision six
19 of section sixty-five hundred [three] three-b of this title[, each] in
20 the course of their employment. Nothing in this subdivision shall be
21 construed to authorize a certified school psychologist or group of such
22 school psychologists to engage in independent practice or practice
23 outside of an employment relationship.
24 § 3. Section 3 of chapter 217 of the laws of 2015, amending the educa-
25 tion law relating to certified school psychologists and special educa-
26 tion services and programs for preschool children with handicapping
27 conditions, as amended by chapter 339 of the laws of 2022, is amended to
28 read as follows:
29 § 3. This act shall take effect immediately and shall be deemed to
30 have been in full force and effect on and after July 1, 2014, provided,
31 however that the provisions of this act shall expire and be deemed
32 repealed June 30, [2024] 2026.
33 § 4. This act shall take effect immediately and shall be deemed to
34 have been in full force and effect on and after April 1, 2024; provided,
35 however, that the amendments to paragraph d of subdivision 6 of section
36 4410 of the education law made by section one of this act shall not
37 affect the expiration of such paragraph and shall be deemed to expire
38 therewith; provided further, however, that the amendments to subdivision
39 1 of section 7605 of the education law made by section two of this act
40 shall not affect the expiration of such subdivision and shall be deemed
41 to expire therewith.
42 PART D
43 Section 1. Paragraph (c) of subdivision 8 of section 2807-c of the
44 public health law, as amended by section 1 of part D of chapter 57 of
45 the laws of 2021, is amended to read as follows:
46 (c) In order to reconcile capital related inpatient expenses included
47 in rates of payment based on a budget to actual expenses and statistics
48 for the rate period for a general hospital, rates of payment for a
49 general hospital shall be adjusted to reflect the dollar value of the
50 difference between capital related inpatient expenses included in the
51 computation of rates of payment for a prior rate period based on a budg-
52 et and actual capital related inpatient expenses for such prior rate
53 period, each as determined in accordance with paragraph (a) of this
54 subdivision, adjusted to reflect increases or decreases in volume of
S. 8307--A 10 A. 8807--A
1 service in such prior rate period compared to statistics applied in
2 determining the capital related inpatient expenses component of rates of
3 payment based on a budget for such prior rate period.
4 For rates effective April first, two thousand twenty through March
5 thirty-first, two thousand twenty-one, the budgeted capital-related
6 expenses add-on as described in paragraph (a) of this subdivision, based
7 on a budget submitted in accordance to paragraph (a) of this subdivi-
8 sion, shall be reduced by five percent relative to the rate in effect on
9 such date; and the actual capital expenses add-on as described in para-
10 graph (a) of this subdivision, based on actual expenses and statistics
11 through appropriate audit procedures in accordance with paragraph (a) of
12 this subdivision shall be reduced by five percent relative to the rate
13 in effect on such date.
14 For rates effective [on and after] April first, two thousand twenty-
15 one through September thirtieth, two thousand twenty-four, the budgeted
16 capital-related expenses add-on as described in paragraph (a) of this
17 subdivision, based on a budget submitted in accordance to paragraph (a)
18 of this subdivision, shall be reduced by ten percent relative to the
19 rate in effect on such date; and the actual capital expenses add-on as
20 described in paragraph (a) of this subdivision, based on actual expenses
21 and statistics through appropriate audit procedures in accordance with
22 paragraph (a) of this subdivision shall be reduced by ten percent rela-
23 tive to the rate in effect on such date.
24 For rates effective on and after October first, two thousand twenty-
25 four, the budgeted capital-related expenses add-on as described in para-
26 graph (a) of this subdivision, based on a budget submitted in accordance
27 with paragraph (a) of this subdivision, shall be reduced by twenty
28 percent relative to the rate in effect on such date; and the actual
29 capital expenses add-on as described in paragraph (a) of this subdivi-
30 sion shall be reduced by twenty percent relative to the rate in effect
31 on such date.
32 For any rate year, all reconciliation add-on amounts calculated [on
33 and after] for the period of April first, two thousand twenty through
34 September thirtieth, two thousand twenty-four shall be reduced by ten
35 percent, and all reconciliation recoupment amounts calculated [on or
36 after] for the period of April first, two thousand twenty through
37 September thirtieth, two thousand twenty-four shall increase by ten
38 percent.
39 For any rate year, all reconciliation add-on amounts calculated on and
40 after October first, two thousand twenty-four shall be reduced by twenty
41 percent, and all reconciliation recoupment amounts calculated on or
42 after October first, two thousand twenty-four shall increase by twenty
43 percent.
44 Notwithstanding any inconsistent provision of subparagraph (i) of
45 paragraph (e) of subdivision nine of this section, capital related inpa-
46 tient expenses of a general hospital included in the computation of
47 rates of payment based on a budget shall not be included in the computa-
48 tion of a volume adjustment made in accordance with such subparagraph.
49 Adjustments to rates of payment for a general hospital made pursuant to
50 this paragraph shall be made in accordance with paragraph (c) of subdi-
51 vision eleven of this section. Such adjustments shall not be carried
52 forward except for such volume adjustment as may be authorized in
53 accordance with subparagraph (i) of paragraph (e) of subdivision nine of
54 this section for such general hospital.
55 § 2. Section 5 of part ZZ of chapter 56 of the laws of 2020 amending
56 the tax law and the social services law relating to certain Medicaid
S. 8307--A 11 A. 8807--A
1 management, as amended by section 3 of part RR of chapter 57 of the laws
2 of 2022, is amended to read as follows:
3 § 5. This act shall take effect immediately and shall be deemed
4 repealed [five] eight years after such effective date.
5 § 3. Section 2 of part E of chapter 57 of the laws of 2015, amending
6 the public health law relating to the payment of certain funds for
7 uncompensated care, is amended to read as follows:
8 § 2. Notwithstanding any inconsistent provision of law, rule or regu-
9 lation to the contrary, and subject to the availability of federal
10 financial participation pursuant to title XIX of the federal social
11 security act, effective for [periods on and after] each state fiscal
12 year from April 1, 2015, through December 31, 2024; and for the calendar
13 year January 1, 2025 through December 31, 2025; and for each calendar
14 year thereafter, payments pursuant to paragraph (i) of subdivision 35 of
15 section 2807-c of the public health law may be made as outpatient upper
16 payment limit payments for outpatient hospital services, not to exceed
17 an amount of three hundred thirty-nine million dollars annually between
18 payments authorized under this section and such section of the public
19 health law. Such payments shall be made as medical assistance payments
20 for outpatient services pursuant to title 11 of article 5 of the social
21 services law for patients eligible for federal financial participation
22 under title XIX of the federal social security act for general hospital
23 outpatient services and general hospital emergency room services issued
24 pursuant to paragraph (g) of subdivision 2 of section 2807 of the public
25 health law to general hospitals, other than major public general hospi-
26 tals, providing emergency room services and including safety net hospi-
27 tals, which shall, for the purpose of this paragraph, be defined as
28 having either: a Medicaid share of total inpatient hospital discharges
29 of at least thirty-five percent, including both fee-for-service and
30 managed care discharges for acute and exempt services; or a Medicaid
31 share of total discharges of at least thirty percent, including both
32 fee-for-service and managed care discharges for acute and exempt
33 services, and also providing obstetrical services. Eligibility to
34 receive such additional payments shall be based on data from the period
35 two years prior to the rate year, as reported on the institutional cost
36 report submitted to the department as of October first of the prior rate
37 year. No eligible general hospital's annual payment amount pursuant to
38 this section shall exceed the lower of the sum of the annual amounts due
39 that hospital pursuant to section twenty-eight hundred seven-k and
40 section twenty-eight hundred seven-w of the public health law; or the
41 hospital's facility specific projected disproportionate share hospital
42 payment ceiling established pursuant to federal law, provided, however,
43 that payment amounts to eligible hospitals in excess of the lower of
44 such sum or payment ceiling shall be reallocated to eligible hospitals
45 that do not have excess payment amounts. Such reallocations shall be
46 proportional to each such hospital's aggregate payment amount pursuant
47 to paragraph (i) of subdivision 35 of section 2807-c of the public
48 health law and this section to the total of all payment amounts for such
49 eligible hospitals. Such adjustment payment may be added to rates of
50 payment or made as aggregate payments to eligible general hospitals
51 other than major public general hospitals. The distribution of such
52 payments shall be pursuant to a methodology approved by the commissioner
53 of health in regulation.
54 § 4. Section 21 of part B of chapter 57 of the laws of 2015, amending
55 the social services law relating to supplemental rebates, is amended to
56 read as follows:
S. 8307--A 12 A. 8807--A
1 § 21. Notwithstanding any inconsistent provision of law, rule or regu-
2 lation to the contrary, and subject to the availability of federal
3 financial participation pursuant to title XIX of the federal social
4 security act, effective for [the period] each state fiscal year from
5 April 1, 2011 through [March 31, 2012, and state fiscal years] December
6 31, 2024; and for the calendar year January 1, 2025 through December 31,
7 2025; and for each calendar year thereafter, the department of health is
8 authorized to increase the operating cost component of rates of payment
9 for general hospital outpatient services and general hospital emergency
10 room services issued pursuant to paragraph (g) of subdivision 2 of
11 section 2807 of the public health law for public general hospitals, as
12 defined in subdivision 10 of section 2801 of the public health law,
13 other than those operated by the state of New York or the state univer-
14 sity of New York, and located in a city with a population over one
15 million, up to two hundred eighty-seven million dollars annually as
16 medical assistance payments for outpatient services pursuant to title 11
17 of article 5 of the social services law for patients eligible for feder-
18 al financial participation under title XIX of the federal social securi-
19 ty act based on such criteria and methodologies as the commissioner may
20 from time to time set through a memorandum of understanding with the New
21 York city health and hospitals corporation, and such adjustments shall
22 be paid by means of one or more estimated payments, with such estimated
23 payments to be reconciled to the commissioner of health's final adjust-
24 ment determinations after the disproportionate share hospital payment
25 adjustment caps have been calculated for such period under sections
26 1923(f) and (g) of the federal social security act. Such adjustment
27 payment may be added to rates of payment or made as aggregate payments
28 to eligible public general hospitals.
29 § 5. The opening paragraph of subparagraph (i) of paragraph (i) of
30 subdivision 35 of section 2807-c of the public health law, as amended by
31 section 4 of part C of chapter 56 of the laws of 2013, is amended to
32 read as follows:
33 Notwithstanding any inconsistent provision of this subdivision or any
34 other contrary provision of law and subject to the availability of
35 federal financial participation, for [the period] each state fiscal year
36 from July first, two thousand ten through [March thirty-first, two thou-
37 sand eleven,] December thirty-first, two thousand twenty-four; and [each
38 state fiscal year period] for the calendar year January first, two thou-
39 sand twenty-five through December thirty-first, two thousand twenty-
40 five; and for each calendar year thereafter, the commissioner shall make
41 additional inpatient hospital payments up to the aggregate upper payment
42 limit for inpatient hospital services after all other medical assistance
43 payments, but not to exceed two hundred thirty-five million five hundred
44 thousand dollars for the period July first, two thousand ten through
45 March thirty-first, two thousand eleven, three hundred fourteen million
46 dollars for each state fiscal year beginning April first, two thousand
47 eleven, through March thirty-first, two thousand thirteen, and no less
48 than three hundred thirty-nine million dollars for each state fiscal
49 year [thereafter] until December thirty-first, two thousand twenty-four;
50 and then from calendar year January first, two thousand twenty-five
51 through December thirty-first, two thousand twenty-five; and for each
52 calendar year thereafter, to general hospitals, other than major public
53 general hospitals, providing emergency room services and including safe-
54 ty net hospitals, which shall, for the purpose of this paragraph, be
55 defined as having either: a Medicaid share of total inpatient hospital
56 discharges of at least thirty-five percent, including both fee-for-ser-
S. 8307--A 13 A. 8807--A
1 vice and managed care discharges for acute and exempt services; or a
2 Medicaid share of total discharges of at least thirty percent, including
3 both fee-for-service and managed care discharges for acute and exempt
4 services, and also providing obstetrical services. Eligibility to
5 receive such additional payments shall be based on data from the period
6 two years prior to the rate year, as reported on the institutional cost
7 report submitted to the department as of October first of the prior rate
8 year. Such payments shall be made as medical assistance payments for
9 fee-for-service inpatient hospital services pursuant to title eleven of
10 article five of the social services law for patients eligible for feder-
11 al financial participation under title XIX of the federal social securi-
12 ty act and in accordance with the following:
13 § 6. Section 18 of part B of chapter 57 of the laws of 2015, amending
14 the social services law relating to supplemental rebates, is amended to
15 read as follows:
16 § 18. Notwithstanding any inconsistent provision of law or regulation
17 to the contrary, and subject to the availability of federal financial
18 participation pursuant to title XIX of the federal social security act,
19 effective for [the period] each state fiscal year from April 1, 2012,
20 through [March 31, 2013, and state fiscal years] December 31, 2024; and
21 for the calendar year from January 1, 2025 through December 31, 2025;
22 and for each calendar year thereafter, the department of health is
23 authorized to pay a public hospital adjustment to public general hospi-
24 tals, as defined in subdivision 10 of section 2801 of the public health
25 law, other than those operated by the state of New York or the state
26 university of New York, and located in a city with a population of over
27 1 million, of up to one billion eighty million dollars annually as
28 medical assistance payments for inpatient services pursuant to title 11
29 of article 5 of the social services law for patients eligible for feder-
30 al financial participation under title XIX of the federal social securi-
31 ty act based on such criteria and methodologies as the commissioner may
32 from time to time set through a memorandum of understanding with the New
33 York city health and hospitals corporation, and such adjustments shall
34 be paid by means of one or more estimated payments, with such estimated
35 payments to be reconciled to the commissioner of health's final adjust-
36 ment determinations after the disproportionate share hospital payment
37 adjustment caps have been calculated for such period under sections
38 1923(f) and (g) of the federal social security act. Such adjustment
39 payment may be added to rates of payment or made as aggregate payments
40 to eligible public general hospitals.
41 § 7. Subdivision 1 of section 3-a of part B of chapter 58 of the laws
42 of 2010, amending the social services law and the public health law
43 relating to prescription drug coverage for needy persons and health care
44 initiatives pools, is amended to read as follows:
45 1. Notwithstanding any inconsistent provision of law, rule or regu-
46 lation to the contrary, and subject to the availability of federal
47 financial participation, effective for [the period] each state fiscal
48 year from August 1, 2010 through [March 31, 2011, and each state fiscal
49 year] December 31, 2024; and for the calendar year from January 1, 2025
50 through December 31, 2025; and for each calendar year thereafter, the
51 department of health is authorized to make Medicaid payment increases
52 for diagnostic and treatment centers (DTC) services issued pursuant to
53 section 2807 of the public health law for public DTCs operated by the
54 New York City Health and Hospitals Corporation, at the election of the
55 social services district in which an eligible DTC is physically located,
56 of up to twelve million six hundred thousand dollars on an annualized
S. 8307--A 14 A. 8807--A
1 basis for DTC services pursuant to title 11 of article 5 of the social
2 services law for patients eligible for federal financial participation
3 under title XIX of the federal social security act based on each such
4 DTC's proportionate share of the sum of all clinic visits for all facil-
5 ities eligible for an adjustment pursuant to this section for the base
6 year two years prior to the rate year. Such proportionate share payments
7 may be added to rates of payment or made as aggregate payments to eligi-
8 ble DTCs.
9 § 8. Subdivision 1 of section 3-b of part B of chapter 58 of the laws
10 of 2010, amending the social services law and the public health law
11 relating to prescription drug coverage for needy persons and health care
12 initiatives pools, is amended to read as follows:
13 1. Notwithstanding any inconsistent provision of law, rule or regu-
14 lation to the contrary, and subject to the availability of federal
15 financial participation, effective for [the period] each state fiscal
16 year from August 1, 2010 through [March 31, 2011, and each state fiscal
17 year] December 31, 2024; and for the calendar year from January 1, 2025
18 through December 31, 2025; and for each calendar year thereafter, the
19 department of health, is authorized to make Medicaid payment increases
20 for county operated diagnostic and treatment centers (DTC) services
21 issued pursuant to section 2807 of the public health law and for
22 services provided by county operated free-standing clinics licensed
23 pursuant to articles 31 and 32 of the mental hygiene law, but not
24 including facilities operated by the New York City Health and Hospitals
25 Corporation, of up to five million four hundred thousand dollars on an
26 annualized basis for such services pursuant to title 11 of article 5 of
27 the social services law for patients eligible for federal financial
28 participation under title XIX of the federal social security act. Local
29 social services districts may decline such increased payments to their
30 sponsored DTCs and free-standing clinics, provided they provide written
31 notification to the commissioner of health, within thirty days following
32 receipt of notification of a payment pursuant to this section. Distrib-
33 utions pursuant to this section shall be based on each facility's
34 proportionate share of the sum of all DTC and clinic visits for all
35 facilities receiving payments pursuant to this section for the base year
36 two years prior to the rate year. Such proportionate share payments may
37 be added to rates or payment or made as aggregate payments to eligible
38 facilities.
39 § 9. Paragraph (e-1) of subdivision 12 of section 2808 of the public
40 health law, as amended by section 15 of part B of chapter 57 of the laws
41 of 2023, is amended to read as follows:
42 (e-1) Notwithstanding any inconsistent provision of law or regulation,
43 the commissioner shall provide, in addition to payments established
44 pursuant to this article prior to application of this section, addi-
45 tional payments under the medical assistance program pursuant to title
46 eleven of article five of the social services law for non-state operated
47 public residential health care facilities, including public residential
48 health care facilities located in the county of Nassau, the county of
49 Westchester and the county of Erie, but excluding public residential
50 health care facilities operated by a town or city within a county, in
51 aggregate annual amounts of up to one hundred fifty million dollars in
52 additional payments for the state fiscal year beginning April first, two
53 thousand six and for the state fiscal year beginning April first, two
54 thousand seven and for the state fiscal year beginning April first, two
55 thousand eight and of up to three hundred million dollars in such aggre-
56 gate annual additional payments for the state fiscal year beginning
S. 8307--A 15 A. 8807--A
1 April first, two thousand nine, and for the state fiscal year beginning
2 April first, two thousand ten and for the state fiscal year beginning
3 April first, two thousand eleven, and for the state fiscal years begin-
4 ning April first, two thousand twelve and April first, two thousand
5 thirteen, and of up to five hundred million dollars in such aggregate
6 annual additional payments for the state fiscal years beginning April
7 first, two thousand fourteen, April first, two thousand fifteen and
8 April first, two thousand sixteen and of up to five hundred million
9 dollars in such aggregate annual additional payments for the state
10 fiscal years beginning April first, two thousand seventeen, April first,
11 two thousand eighteen, and April first, two thousand nineteen, and of up
12 to five hundred million dollars in such aggregate annual additional
13 payments for the state fiscal years beginning April first, two thousand
14 twenty, April first, two thousand twenty-one, and April first, two thou-
15 sand twenty-two, and of up to five hundred million dollars in such
16 aggregate annual additional payments for the state fiscal years begin-
17 ning April first, two thousand twenty-three, and from April first, two
18 thousand twenty-four until December thirty-first, two thousand twenty-
19 four, and [April first, two thousand twenty-five] for the calendar year
20 January first, two thousand twenty-five through December thirty-first,
21 two thousand twenty-five, and for each calendar year thereafter. The
22 amount allocated to each eligible public residential health care facili-
23 ty for this period shall be computed in accordance with the provisions
24 of paragraph (f) of this subdivision, provided, however, that patient
25 days shall be utilized for such computation reflecting actual reported
26 data for two thousand three and each representative succeeding year as
27 applicable, and provided further, however, that, in consultation with
28 impacted providers, of the funds allocated for distribution in the state
29 fiscal year beginning April first, two thousand thirteen, up to thirty-
30 two million dollars may be allocated in accordance with paragraph (f-1)
31 of this subdivision.
32 § 10. This act shall take effect immediately; provided, however,
33 section one of this act shall take effect October 1, 2024; and provided,
34 further, that sections three, four, five, six, seven, eight and nine of
35 this act shall take effect January 1, 2025.
36 PART E
37 Section 1. Subparagraph (ii) of paragraph (b) of subdivision 2-b of
38 section 2808 of the public health law, as added by section 47 of part C
39 of chapter 109 of the laws of 2006, is amended to read as follows:
40 (ii) (A) The operating component of rates shall be subject to case mix
41 adjustment through application of the relative resource utilization
42 groups system of patient classification (RUG-III) employed by the feder-
43 al government with regard to payments to skilled nursing facilities
44 pursuant to title XVIII of the federal social security act (Medicare),
45 as revised by regulation to reflect New York state wages and fringe
46 benefits, provided, however, that such RUG-III classification system
47 weights shall be increased in the following amounts for the following
48 categories of residents: [(A)] (1) thirty minutes for the impaired
49 cognition A category, [(B)] (2) forty minutes for the impaired cognition
50 B category, and [(C)] (3) twenty-five minutes for the reduced physical
51 functions B category. Such adjustments shall be made in January and
52 July of each calendar year. Such adjustments and related patient classi-
53 fications in each facility shall be subject to audit review in accord-
54 ance with regulations promulgated by the commissioner.
S. 8307--A 16 A. 8807--A
1 (B) Effective April first, two thousand twenty-four, the case mix
2 adjustment from the operating component of the rates for skilled nursing
3 facilities shall remain unchanged from the July two thousand twenty-
4 three rates during the development and until full implementation of a
5 case mix methodology using the Patient Driven Payment Model.
6 § 2. Subparagraph (iv) of paragraph (b) of subdivision 2-b of section
7 2808 of the public health law, as amended by section 1 of part NN of
8 chapter 56 of the laws of 2020, is amended to read as follows:
9 (iv) The capital cost component of rates on and after January first,
10 two thousand nine shall: (A) fully reflect the cost of local property
11 taxes and payments made in lieu of local property taxes, as reported in
12 each facility's cost report submitted for the year two years prior to
13 the rate year; (B) provided, however, notwithstanding any inconsistent
14 provision of this article, commencing April first, two thousand twenty
15 for rates of payment for patients eligible for payments made by state
16 governmental agencies, the capital cost component determined in accord-
17 ance with this subparagraph and inclusive of any shared savings for
18 eligible facilities that elect to refinance their mortgage loans pursu-
19 ant to paragraph (d) of subdivision two-a of this section, shall be
20 reduced by the commissioner by five percent; and (C) provided, however,
21 notwithstanding any inconsistent provision of this article, commencing
22 April first, two thousand twenty-four for rates of payment for patients
23 eligible for payments made by state governmental agencies, the capital
24 cost component determined in accordance with this subparagraph and
25 inclusive of any shared savings for eligible facilities that elect to
26 refinance their mortgage loans pursuant to paragraph (d) of subdivision
27 two-a of this section, shall be reduced by the commissioner by an addi-
28 tional ten percent.
29 § 3. Paragraph (h) of subdivision 1 of section 2632 of the public
30 health law, as amended by chapter 414 of the laws of 2015, is amended to
31 read as follows:
32 (h) in the Persian Gulf conflict from the second day of August, nine-
33 teen hundred ninety to the end of such conflict including military
34 service in Operation Enduring Freedom, Operation Iraqi Freedom, Opera-
35 tion New Dawn or Operation Inherent Resolve and was the recipient of the
36 global war on terrorism expeditionary medal or the Iraq campaign medal
37 or the Afghanistan campaign medal; and who was a resident of the state
38 of New York at the time of entry upon such active duty or who shall have
39 been a resident of this state for [one year] six months next preceding
40 the application for admission shall be entitled to admission to said
41 home after the approval of the application by the board of visitors,
42 subject to the provisions of this article and to the conditions, limita-
43 tions and penalties prescribed by the regulations of the department. Any
44 such veteran or dependent, who otherwise fulfills the requirements set
45 forth in this section, may be admitted directly to the skilled nursing
46 facility or the health related facility provided such veteran or depend-
47 ent is certified by a physician designated or approved by the department
48 to require the type of care provided by such facilities.
49 § 4. This act shall take effect immediately and shall be deemed to
50 have been in full force and effect on and after April 1, 2024.
51 PART F
52 Section 1. Paragraph (n) of subdivision 3 of section 461-l of the
53 social services law, as amended by section 2 of part B of chapter 57 of
54 the laws of 2018, is amended to read as follows:
S. 8307--A 17 A. 8807--A
1 (n) The commissioner of health is authorized to create a program to
2 subsidize the cost of assisted living for those individuals living with
3 Alzheimer's disease and dementia who are not eligible for medical
4 assistance pursuant to title eleven of article five of this chapter and
5 reside in a special needs assisted living residence certified under
6 section forty-six hundred fifty-five of the public health law. The
7 program shall authorize up to two hundred vouchers to individuals
8 through an application process and pay for up to seventy-five percent of
9 the average private pay rate in the respective region. The commissioner
10 of health may propose rules and regulations to effectuate this
11 provision.
12 § 2. Subdivisions 7 and 8 of section 4656 of the public health law, as
13 added by chapter 2 of the laws of 2004, are renumbered subdivisions 8
14 and 9 and a new subdivision 7 is added to read as follows:
15 7. (a) All assisted living residences, as defined in subdivision one
16 of section forty-six hundred fifty-one of this article, including those
17 licensed and certified as an assisted living residence, special needs
18 assisted living residence, or enhanced assisted living residence, shall:
19 (i) report annually on quality measures to be established by the
20 department, in the form and format prescribed by the department, with
21 the first report due no later than January thirty-first, two thousand
22 twenty-five; and
23 (ii) post the monthly service rate, staffing complement, approved
24 admission or residency agreement, and a consumer-friendly summary of all
25 service fees in a conspicuous place on the facility's website and in a
26 public space within the facility. Such information shall be made avail-
27 able to the public on forms developed by the department. Beginning on
28 January first, two thousand twenty-five, this information shall also be
29 reported to the department.
30 (b) The department shall score the results of the assisted living
31 quality reporting obtained pursuant to paragraph (a) of this subdivi-
32 sion. Top scoring facilities shall be granted the classification of
33 advanced standing on their annual surveillance schedules.
34 (i) Notwithstanding subparagraph one of paragraph (a) of subdivision
35 two of section four hundred sixty-one-a of the social services law,
36 facilities achieving an advanced standing classification shall be
37 surveyed every twelve to eighteen months. All other facilities shall be
38 surveyed on an unannounced basis no less than annually; provided, howev-
39 er, that this shall not apply to surveys, inspections or investigations
40 based on complaints received by the department under any other provision
41 of law.
42 (ii) Facilities may remain on advanced standing classification
43 provided they meet the scoring requirements in the assisted living qual-
44 ity reporting.
45 (c) Effective January thirty-first, two thousand twenty-five, the
46 department may post on its website the results of the assisted living
47 quality reporting collected pursuant to subparagraph (i) of paragraph
48 (a) of this subdivision.
49 § 3. Subparagraph 1 of paragraph (a) of subdivision 2 of section 461-a
50 of the social services law, as amended by chapter 735 of the laws of
51 1994, is amended and a new subparagraph 1-a is added to read as follows:
52 (1) Such facilities receiving the department's highest rating shall be
53 inspected at least once every eighteen months on an unannounced basis.
54 Such rating determination shall be made pursuant to an evaluation of
55 quality indicators as developed by the department and published on the
56 department's website.
S. 8307--A 18 A. 8807--A
1 (1-a) (i) Adult care facilities dually licensed to provide assisted
2 living pursuant to the requirements specified in section forty-six
3 hundred fifty-three of the public health law may seek accreditation by
4 one or more nationally recognized accrediting agencies determined by the
5 commissioner.
6 (ii) Such accreditation agencies shall report data and information, in
7 a manner and form as determined by the department, pertaining to those
8 assisted living residences accredited by such agencies, those assisted
9 living residences that seek but do not receive such accreditation, and
10 those assisted living residences which obtain but lose such accredi-
11 tation.
12 (iii) Notwithstanding the provisions of subparagraph one of this para-
13 graph, or any other provision of law, assisted living residences which
14 have obtained accreditation from a nationally recognized accreditation
15 organization approved by the department and which meet eligibility
16 criteria, as determined by the department, may, at the discretion of the
17 commissioner, be exempt from the department inspection required in this
18 subdivision for the duration they maintain their accreditation in good
19 standing. The operator of an adult care facility that obtains but subse-
20 quently loses accreditation shall report such loss to the department
21 within ten business days in a manner and form determined by the depart-
22 ment and will no longer be exempt from the department inspection
23 required in this subdivision. The department shall post on its website a
24 list of all accredited assisted living residences.
25 § 4. This act shall take effect immediately and shall be deemed to
26 have been in full force and effect on and after April 1, 2024; provided,
27 however, the provisions of sections two and three of this act shall take
28 effect on the one hundred twentieth day after it shall have become a
29 law.
30 PART G
31 Section 1. Paragraph (i) of subdivision 1 of section 3614-c of the
32 public health law is REPEALED.
33 § 2. Paragraph (d) of subdivision 1, and subdivisions 2, 4, 5, 5-a, 6,
34 6-a, 7, 7-a, 9 and 10 of section 3614-c of the public health law, subdi-
35 visions 2, 4, 5, 6, 7, 9 and 10 as amended and subdivisions 6-a and 7-a
36 as added by section 1 and subdivision 5-a as added by section 1-a of
37 part OO of chapter 56 of the laws of 2020, are amended to read as
38 follows:
39 (d) "Home care aide" means a home health aide, personal care aide,
40 home attendant, [personal assistant performing consumer directed
41 personal assistance services pursuant to section three hundred sixty-
42 five-f of the social services law,] or other licensed or unlicensed
43 person whose primary responsibility includes the provision of in-home
44 assistance with activities of daily living, instrumental activities of
45 daily living or health-related tasks; provided, however, that home care
46 aide does not include any individual (i) working on a casual basis, or
47 (ii) [(except for a person employed under the consumer directed personal
48 assistance program under section three hundred sixty-five-f of the
49 social services law)] who is a relative through blood, marriage or
50 adoption of: (1) the employer; or (2) the person for whom the worker is
51 delivering services, under a program funded or administered by federal,
52 state or local government.
53 2. Notwithstanding any inconsistent provision of law, rule or regu-
54 lation, no payments by government agencies shall be made to certified
S. 8307--A 19 A. 8807--A
1 home health agencies, long term home health care programs, managed care
2 plans, [fiscal intermediaries,] the nursing home transition and diver-
3 sion waiver program under section three hundred sixty-six of the social
4 services law, or the traumatic brain injury waiver program under section
5 twenty-seven hundred forty of this chapter for any episode of care
6 furnished, in whole or in part, by any home care aide who is compensated
7 at amounts less than the applicable minimum rate of home care aide total
8 compensation established pursuant to this section.
9 4. The terms of this section shall apply equally to services provided
10 by home care aides who work on episodes of care as direct employees of
11 certified home health agencies, long term home health care programs, or
12 managed care plans, or as employees of licensed home care services agen-
13 cies, limited licensed home care services agencies, [or fiscal interme-
14 diaries,] or under any other arrangement.
15 5. No payments by government agencies shall be made to certified home
16 health agencies, licensed home care services agencies, long term home
17 health care programs, managed care plans[, fiscal intermediaries] for
18 any episode of care without the certified home health agency, licensed
19 home care services agency, long term home health care program, or
20 managed care plan [or the fiscal intermediary], having delivered prior
21 written certification to the commissioner annually, at a time prescribed
22 by the commissioner, on forms prepared by the department in consultation
23 with the department of labor, that all services provided under each
24 episode of care during the period covered by the certification are in
25 full compliance with the terms of this section and any regulations
26 promulgated pursuant to this section and that no portion of the dollars
27 spent or to be spent to satisfy the wage or benefit portion under this
28 section shall be returned to the certified home health agency, licensed
29 home care services agency, long term home health care program, or
30 managed care plan, [or fiscal intermediary,] related persons or enti-
31 ties, other than to a home care aide as defined in this section to whom
32 the wage or benefits are due, as a refund, dividend, profit, or in any
33 other manner. Such written certification shall also verify that the
34 certified home health agency, long term home health care program, or
35 managed care plan has received from the licensed home care services
36 agency, [fiscal intermediary,] or other third party an annual statement
37 of wage parity hours and expenses on a form provided by the department
38 of labor accompanied by an independently-audited financial statement
39 verifying such expenses.
40 5-a. No portion of the dollars spent or to be spent to satisfy the
41 wage or benefit portion under this section shall be returned to the
42 certified home health agency, licensed home care services agency, long
43 term home health care program, or managed care plan, [or fiscal interme-
44 diary,] related persons or entities, other than to a home care aide as
45 defined in this section to whom the wage or benefits are due, as a
46 refund, dividend, profit, or in any other manner.
47 6. If a certified home health agency, long term home health care
48 program or managed care plan elects to provide home care aide services
49 through contracts with licensed home care services agencies, [fiscal
50 intermediaries,] or through other third parties, provided that the
51 episode of care on which the home care aide works is covered under the
52 terms of this section, the certified home health agency, long term home
53 health care program, or managed care plan shall include in its
54 contracts, a requirement that it be provided with a written certif-
55 ication, verified by oath, from the licensed home care services agency,
56 [fiscal intermediary,] or other third party, on forms prepared by the
S. 8307--A 20 A. 8807--A
1 department in consultation with the department of labor, which attests
2 to the licensed home care services agency's, [fiscal intermediary's,] or
3 other third party's compliance with the terms of this section. Such
4 contracts shall also obligate the licensed home care services agency,
5 [fiscal intermediary,] or other third party to provide the certified
6 home health agency, long term home health care program, or managed care
7 plan all information from the licensed home care services agency,
8 [fiscal intermediary] or other third party necessary to verify compli-
9 ance with the terms of this section, which shall include an annual
10 compliance statement of wage parity hours and expenses on a form
11 provided by the department of labor accompanied by an independently-au-
12 dited financial statement verifying such expenses. Such annual state-
13 ments shall be available no less than annually for the previous calendar
14 year, at a time as prescribed by the commissioner. Such certifications,
15 the information necessary to verify compliance, and the annual compli-
16 ance statement and financial statements shall be retained by all certi-
17 fied home health agencies, long term home health care programs, or
18 managed care plans, and all licensed home care services agencies,
19 [fiscal intermediaries,] or other third parties for a period of no less
20 than ten years, and made available to the department upon request. Any
21 licensed home care services agency, [fiscal intermediary,] or other
22 third party who shall upon oath verify any statement required to be
23 transmitted under this section and any regulations promulgated pursuant
24 to this section which is known by such party to be false shall be guilty
25 of perjury and punishable as provided by the penal law.
26 6-a. The certified home health agency, long term home health care
27 program, or managed care plan shall review and assess the annual compli-
28 ance statement of wage parity hours and expenses and make a written
29 referral to the department of labor for any reasonably suspected fail-
30 ures of licensed home care services agencies, [fiscal intermediaries,]
31 or third parties to conform to the wage parity requirements of this
32 section.
33 7. The commissioner shall distribute to all certified home health
34 agencies, long term home health care programs, managed care plans, and
35 licensed home care services agencies[, and fiscal intermediaries] offi-
36 cial notice of the minimum rates of home care aide compensation at least
37 one hundred twenty days prior to the effective date of each minimum rate
38 for each social services district covered by the terms of this section.
39 7-a. Any certified home health agency, licensed home care services
40 agency, long term home health care program, managed care plan, [or
41 fiscal intermediary,] or other third party that willfully pays less than
42 such stipulated minimums regarding wages and supplements, as established
43 in this section, shall be guilty of a misdemeanor and upon conviction
44 shall be punished, for a first offense by a fine of five hundred dollars
45 or by imprisonment for not more than thirty days, or by both fine and
46 imprisonment; for a second offense by a fine of one thousand dollars,
47 and in addition thereto the contract on which the violation has occurred
48 shall be forfeited; and no such person or corporation shall be entitled
49 to receive any sum nor shall any officer, agent or employee of the state
50 pay the same or authorize its payment from the funds under his or her
51 charge or control to any person or corporation for work done upon any
52 contract, on which the certified home health agency, licensed home care
53 services agency, long term home health care program, managed care plan,
54 [or fiscal intermediary,] or other third party has been convicted of a
55 second offense in violation of the provisions of this section.
S. 8307--A 21 A. 8807--A
1 9. Nothing in this section should be construed as applicable to any
2 service provided by certified home health agencies, licensed home care
3 services agencies, long term home health care programs[,] or managed
4 care plans[, or fiscal intermediaries] except for all episodes of care
5 reimbursed in whole or in part by the New York Medicaid program.
6 10. No certified home health agency, managed care plan, or long term
7 home health care program shall be liable for recoupment of payments or
8 any other penalty under this section for services provided through a
9 licensed home care services agency, [fiscal intermediary,] or other
10 third party with which the certified home health agency, long term home
11 health care program, or managed care plan has a contract because the
12 licensed agency, [fiscal intermediary,] or other third party failed to
13 comply with the provisions of this section if the certified home health
14 agency, long term home health care program, or managed care plan has
15 reasonably and in good faith collected certifications and all informa-
16 tion required pursuant to this section and conducts the monitoring and
17 reporting required by this section.
18 § 3. Paragraph (a) of subdivision 1 of section 3614-f of the public
19 health law, as added by section 3 of part NN of chapter 57 of the laws
20 of 2023, is amended to read as follows:
21 (a) "Home care aide" [shall have the same meaning as defined in
22 section thirty-six hundred fourteen-c of this article] means, for the
23 purpose of this section, a home health aide, personal care aide, home
24 attendant, personal assistant performing consumer directed personal
25 assistance services pursuant to section three hundred sixty-five-f of
26 the social services law, or other licensed or unlicensed person whose
27 primary responsibility includes the provision of in-home assistance with
28 activities of daily living, instrumental activities of daily living or
29 health-related tasks; provided, however, that home care aide does not
30 include any individual (i)working on a casual basis, or (ii) (except for
31 a person employed under the consumer directed personal assistance
32 program under section three hundred sixty-five-f of the social services
33 law) who is a relative through blood, marriage or adoption of: (1) the
34 employer; or (2) the person for whom the worker is delivering services,
35 under a program funded or administered by federal, state or local
36 government.
37 § 4. This act shall take effect October 1, 2024.
38 PART H
39 Section 1. Section 602 of the financial services law, as added by
40 section 26 of part H of chapter 60 of the laws of 2014, is amended to
41 read as follows:
42 § 602. Applicability. [(a)] This article shall not apply to health
43 care services, including emergency services, where physician fees are
44 subject to schedules or other monetary limitations under any other law,
45 including the workers' compensation law and article fifty-one of the
46 insurance law, and shall not preempt any such law. This article also
47 shall not apply to health care services, including emergency services,
48 subject to medical assistance program coverage provided pursuant to
49 section three hundred sixty-four-j of the social services law.
50 § 2. Subdivision 2 of section 364-j of the social services law is
51 amended by adding a new paragraph (e) to read as follows:
52 (e) Effective April first, two thousand twenty-four and expiring on
53 the date the commissioner publishes on the department's website a
54 request for proposals in accordance with paragraph (a) of subdivision
S. 8307--A 22 A. 8807--A
1 five of this section, the commissioner shall place a moratorium on the
2 processing and approval of applications seeking authority to establish a
3 managed care provider, including applications seeking authorization to
4 expand the scope of eligible enrollee populations. Such moratorium shall
5 not apply to:
6 (i) applications submitted to the department prior to January first,
7 two thousand twenty-four;
8 (ii) applications seeking approval to transfer ownership or control of
9 an existing managed care provider;
10 (iii) applications seeking authorization to expand an existing managed
11 care provider's approved service area;
12 (iv) applications seeking authorization to form or operate a managed
13 care provider through an entity certified under section forty-four
14 hundred three-c or forty-four hundred three-g of the public health law;
15 (v) applications demonstrating to the commissioner's satisfaction that
16 submission of the application for consideration would be appropriate to
17 address a serious concern with care delivery, such as a lack of adequate
18 access to managed care providers in a geographic area or a lack of
19 adequate and appropriate care, language and cultural competence, or
20 special needs services.
21 § 3. Subdivision 5 of section 364-j of the social services law, as
22 amended by section 15 of part C of chapter 58 of the laws of 2004, para-
23 graph (a) as amended by section 40 of part A of chapter 56 of the laws
24 of 2013, and paragraphs (d), (e) and (f) as amended by section 80 of
25 part H of chapter 59 of the laws of 2011, is amended to read as follows:
26 5. Managed care programs shall be conducted in accordance with the
27 requirements of this section and, to the extent practicable, encourage
28 the provision of comprehensive medical services, pursuant to this arti-
29 cle.
30 (a) Notwithstanding sections one hundred twelve and one hundred
31 sixty-three of the state finance law, sections one hundred forty-two and
32 one hundred forty-three of the economic development law, and any other
33 inconsistent provision of law, [The] the [managed care program] commis-
34 sioner of health shall, through a competitive bid process based on
35 proposals submitted to the department, provide for the selection of
36 qualified managed care providers [by the commissioner of health] to
37 participate in the managed care program pursuant to a contract with the
38 department, including [comprehensive HIV special needs plans and]
39 special needs managed care plans in accordance with the provisions of
40 section three hundred sixty-five-m of this title; provided, however,
41 [that] notwithstanding sections one hundred twelve and one hundred
42 sixty-three of the state finance law, sections one hundred forty-two and
43 one hundred forty-three of the economic development law, and any other
44 inconsistent provision of law, the commissioner of health may contract
45 directly with comprehensive HIV special needs plans [consistent with
46 standards set forth in this section] without a competitive bid process,
47 and assure that such providers are accessible taking into account the
48 needs of persons with disabilities and the differences between rural,
49 suburban, and urban settings, and in sufficient numbers to meet the
50 health care needs of participants, and shall consider the extent to
51 which major public hospitals are included within such providers'
52 networks[.]; and provided further that:
53 [(b) A proposal] (i) Proposals submitted by a managed care provider to
54 participate in the managed care program shall:
55 [(i)] (A) designate the geographic [area] areas, as defined by the
56 commissioner in the request for proposals, to be served [by the provid-
S. 8307--A 23 A. 8807--A
1 er], and estimate the number of eligible participants and actual partic-
2 ipants in such designated area;
3 [(ii)] (B) include a network of health care providers in sufficient
4 numbers and geographically accessible to service program participants;
5 [(iii)] (C) describe the procedures for marketing in the program
6 location, including the designation of other entities which may perform
7 such functions under contract with the organization;
8 [(iv)] (D) describe the quality assurance, utilization review and case
9 management mechanisms to be implemented;
10 [(v)] (E) demonstrate the applicant's ability to meet the data analy-
11 sis and reporting requirements of the program;
12 [(vi)] (F) demonstrate financial feasibility of the program; and
13 [(vii)] (G) include such other information as the commissioner of
14 health may deem appropriate.
15 [(c) The commissioner of health shall make a determination whether to
16 approve, disapprove or recommend modification of the proposal.
17 (d) Notwithstanding any inconsistent provision of this title and
18 section one hundred sixty-three of the state finance law, the commis-
19 sioner of health may contract with managed care providers approved under
20 paragraph (b) of this subdivision, without a competitive bid or request
21 for proposal process, to provide coverage for participants pursuant to
22 this title.
23 (e) Notwithstanding any inconsistent provision of this title and
24 section one hundred forty-three of the economic development law, no
25 notice in the procurement opportunities newsletter shall be required for
26 contracts awarded by the commissioner of health, to qualified managed
27 care providers pursuant to this section.
28 (f)] (ii) In addition to the criteria described in subparagraph (i) of
29 this paragraph, the commissioner shall also consider:
30 (A) accessibility and geographic distribution of network providers,
31 taking into account the needs of persons with disabilities and the
32 differences between rural, suburban, and urban settings;
33 (B) the extent to which major public hospitals are included in the
34 submitted provider network;
35 (C) demonstrated cultural and language competencies specific to the
36 population of participants;
37 (D) the corporate organization and status of the bidder as a charita-
38 ble corporation under the not-for-profit corporation law;
39 (E) the ability of a bidder to offer plans in multiple regions;
40 (F) the type and number of products the bidder proposes to operate,
41 including products bid for in accordance with the provisions of subdivi-
42 sion six of section forty-four hundred three-f of the public health law,
43 and other products determined by the commissioner, including but not
44 necessarily limited to those operated under title one-A of article twen-
45 ty-five of the public health law and section three hundred sixty-nine-gg
46 of this article;
47 (G) whether the bidder participates in products for integrated care
48 for participants who are dually eligible for Medicaid and medicare;
49 (H) whether the bidder participates in value based payment arrange-
50 ments as defined by the department, including the delegation of signif-
51 icant financial risk to clinically integrated provider networks;
52 (I) the bidder's commitment to participation in managed care in the
53 state;
54 (J) the bidder's commitment to quality improvement;
55 (K) the bidder's commitment to community reinvestment spending, as
56 shall be defined in the procurement;
S. 8307--A 24 A. 8807--A
1 (L) for current or previously authorized managed care providers, past
2 performance in meeting managed care contract or federal or state
3 requirements, and if the commissioner issued any statements of findings,
4 statements of deficiency, intermediate sanctions or enforcement actions
5 to a bidder for non-compliance with such requirements, whether the
6 bidder addressed such issues in a timely manner; and
7 (M) any other criteria deemed appropriate by the commissioner.
8 (iii) Subparagraphs (i) and (ii) of this paragraph describing proposal
9 content and selection criteria requirements shall not be construed as
10 limiting or requiring the commissioner to evaluate such content or
11 criteria on a pass/fail scale, or other methodological basis; provided
12 however, that the commissioner must consider all such content and crite-
13 ria using methods determined by the commissioner in their discretion
14 and, as applicable, in consultation with the commissioners of the office
15 of mental health, the office for people with developmental disabilities,
16 the office of addiction services and supports, and the office of chil-
17 dren and family services.
18 (iv) The department shall post on its website:
19 (A) The request for proposals and a description of the proposed
20 services to be provided pursuant to contracts in accordance with this
21 subdivision;
22 (B) The criteria on which the department shall determine qualified
23 bidders and evaluate their proposals, including all criteria identified
24 in this subdivision;
25 (C) The manner by which a proposal may be submitted, which may include
26 submission by electronic means;
27 (D) The manner by which a managed care provider may continue to
28 participate in the managed care program pending award of managed care
29 providers through a competitive bid process pursuant to this subdivi-
30 sion; and
31 (E) Upon award, the managed care providers that the commissioner
32 intends to contract with pursuant to this subdivision, provided that the
33 commissioner shall update such list to indicate the final slate of
34 contracted managed care providers.
35 (v) Awards and contracting. (A) All responsible and responsive
36 submissions that are received from bidders in a timely fashion shall be
37 reviewed by the commissioner of health in consultation with the commis-
38 sioners of the office of mental health, the office for people with
39 developmental disabilities, the office of addiction services and
40 supports, and the office of children and family services, as applicable.
41 The commissioner shall consider comments resulting from the review of
42 proposals and make awards in consultation with such agencies.
43 (B) The commissioner may make awards under this subdivision for each
44 product, for which proposals were requested, to two or more managed care
45 providers in each geographic region defined by the commissioner in the
46 request for proposals for which at least two managed care providers have
47 submitted a proposal, and shall have discretion to offer more contracts
48 based on need for access.
49 (C) Managed care providers awarded under this subdivision shall be
50 entitled to enter into a contract with the department for the purpose of
51 participating in the managed care program. Such contracts shall run for
52 a term to be determined by the commissioner, which may be renewed or
53 modified from time to time without a new request for proposals, to
54 ensure consistency with changes in federal and state laws, regulations
55 and policies, including but not limited to the expansion or reduction of
S. 8307--A 25 A. 8807--A
1 medical assistance services available to the participants through a
2 managed care provider.
3 (D) Nothing in this paragraph or other provision of this section shall
4 be construed to limit in any way the ability of the department to termi-
5 nate awarded contracts for cause, which shall include but not be limited
6 to any violation of the terms of such contracts or violations of state
7 or federal laws and regulations and any loss of necessary state or
8 federal funding.
9 (E) Nothing in this paragraph or other provision of this section shall
10 be construed to limit in any way the ability of the department to issue
11 a new request for proposals for a term following an existing term of an
12 award.
13 (b) Transitioning the managed care program. (i) Within sixty-days of
14 the department issuing the request for proposals under paragraph (a) of
15 this subdivision, a managed care provider that was approved to partic-
16 ipate in the managed care program prior to the issuance of the request
17 for proposals, shall submit its intention to complete such proposal to
18 the department. (ii) A managed care provider that: (A) fails to submit
19 its intent timely, (B) indicates within the sixty-days its intent not to
20 complete such a proposal, (C) fails to submit a proposal within the
21 further timeframe specified by the commissioner in the request for
22 proposals, or (D) is not awarded the ability to participate in the
23 managed care program under paragraph (a) of this subdivision, shall,
24 upon direction from the commissioner, terminate its services and oper-
25 ations in accordance with the contract between the managed care provider
26 and the department and shall be additionally required to maintain cover-
27 age of participants for such period of time as determined necessary by
28 the commissioner to achieve the safe and orderly transfer of partic-
29 ipants.
30 (c) Addressing needs for additional managed care providers to ensure
31 participant access and choice. If necessary to ensure access to a suffi-
32 cient number of managed care providers on a geographic or other basis,
33 including a lack of adequate and appropriate care, language and cultural
34 competence, or special needs services, the commissioner may reissue a
35 request for proposals as provided for under paragraph (a) of this subdi-
36 vision, provided however that such request may be limited to the
37 geographic or other basis of need that the request for proposals is
38 seeking to address. Any awards made shall be subject to the requirements
39 of this section, including but not limited to the minimum and maximum
40 number of awards in a region.
41 (d) The care and services described in subdivision four of this
42 section will be furnished by a managed care provider pursuant to the
43 provisions of this section when such services are furnished in accord-
44 ance with an agreement with the department of health, and meet applica-
45 ble federal law and regulations.
46 [(g)] (e) The commissioner of health may delegate some or all of the
47 tasks identified in this section to the local districts.
48 [(h)] (f) Any delegation pursuant to paragraph [(g)] (e) of this
49 subdivision shall be reflected in the contract between a managed care
50 provider and the commissioner of health.
51 § 4. Subdivision 4 of section 365-m of the social services law is
52 REPEALED and a new subdivision 4 is added to read as follows:
53 4. The commissioner of health, jointly with the commissioners of the
54 office of mental health and the office of addiction services and
55 supports, shall select a limited number of special needs managed care
56 plans under section three hundred sixty-four-j of this title, in accord-
S. 8307--A 26 A. 8807--A
1 ance with subdivision five of such section, capable of managing the
2 behavioral and physical health needs of medical assistance enrollees
3 with significant behavioral health needs.
4 § 5. The opening paragraph of subdivision 2 of section 4403-f of the
5 public health law, as amended by section 8 of part C of chapter 58 of
6 the laws of 2007, is amended to read as follows:
7 Certificate of Authority; form. An eligible applicant shall submit an
8 application for a certificate of authority to operate a managed long
9 term care plan upon forms prescribed by the commissioner, including any
10 such forms or processes as may be required or prescribed by the commis-
11 sioner in accordance with the competitive bid process under subdivision
12 six of this section. Such eligible applicant shall submit information
13 and documentation to the commissioner which shall include, but not be
14 limited to:
15 § 6. Subdivision 3 of section 4403-f of the public health law, as
16 amended by section 41-a of part H of chapter 59 of the laws of 2011, is
17 amended to read as follows:
18 3. Certificate of authority; approval. (a) The commissioner shall not
19 approve an application for a certificate of authority unless the appli-
20 cant demonstrates to the commissioner's satisfaction:
21 [(a)] (i) that it will have in place acceptable quality-assurance
22 mechanisms, grievance procedures, mechanisms to protect the rights of
23 enrollees and case management services to ensure continuity, quality,
24 appropriateness and coordination of care;
25 [(b)] (ii) that it will include an enrollment process which shall
26 ensure that enrollment in the plan is informed. The application shall
27 describe the disenrollment process, which shall provide that an other-
28 wise eligible enrollee shall not be involuntarily disenrolled on the
29 basis of health status;
30 [(c)] (iii) satisfactory evidence of the character and competence of
31 the proposed operators and reasonable assurance that the applicant will
32 provide high quality services to an enrolled population;
33 [(d)] (iv) sufficient management systems capacity to meet the require-
34 ments of this section and the ability to efficiently process payment for
35 covered services;
36 [(e)] (v) readiness and capability to maximize reimbursement of and
37 coordinate services reimbursed pursuant to title XVIII of the federal
38 social security act and all other applicable benefits, with such benefit
39 coordination including, but not limited to, measures to support sound
40 clinical decisions, reduce administrative complexity, coordinate access
41 to services, maximize benefits available pursuant to such title and
42 ensure that necessary care is provided;
43 [(f)] (vi) readiness and capability to arrange and manage covered
44 services and coordinate non-covered services which could include prima-
45 ry, specialty, and acute care services reimbursed pursuant to title XIX
46 of the federal social security act;
47 [(g)] (vii) willingness and capability of taking, or cooperating in,
48 all steps necessary to secure and integrate any potential sources of
49 funding for services provided by the managed long term care plan,
50 including, but not limited to, funding available under titles XVI,
51 XVIII, XIX and XX of the federal social security act, the federal older
52 Americans act of nineteen hundred sixty-five, as amended, or any succes-
53 sor provisions subject to approval of the director of the state office
54 for aging, and through financing options such as those authorized pursu-
55 ant to section three hundred sixty-seven-f of the social services law;
S. 8307--A 27 A. 8807--A
1 [(h)] (viii) that the contractual arrangements for providers of health
2 and long term care services in the benefit package are sufficient to
3 ensure the availability and accessibility of such services to the
4 proposed enrolled population consistent with guidelines established by
5 the commissioner; with respect to individuals in receipt of such
6 services prior to enrollment, such guidelines shall require the managed
7 long term care plan to contract with agencies currently providing such
8 services, in order to promote continuity of care. In addition, such
9 guidelines shall require managed long term care plans to offer and cover
10 consumer directed personal assistance services for eligible individuals
11 who elect such services pursuant to section three hundred sixty-five-f
12 of the social services law; and
13 [(i)] (ix) that the applicant is financially responsible and may be
14 expected to meet its obligations to its enrolled members.
15 (b) Notwithstanding paragraph (a) of this subdivision, the approval of
16 any application for certification as a managed long term care plan under
17 this section for a plan that seeks to cover a population of enrollees
18 eligible for services under title XIX of the federal social security
19 act, shall be subject to and conditioned on selection through the
20 competitive bid process provided under subdivision six of this section.
21 § 7. Subdivision 6 of section 4403-f of the public health law, as
22 amended by section 41-b of part H of chapter 59 of the laws of 2011,
23 paragraph (a) as amended by section 2 of part I of chapter 57 of the
24 laws of 2023, paragraphs (d), (e), and (f) as added by section 5 of part
25 MM of chapter 56 of the laws of 2020, and the opening paragraph of
26 subparagraph (i) of paragraph (d) as amended by section 3 of part I of
27 chapter 57 of the laws of 2023, is amended to read as follows:
28 6. Approval authority. [(a)] An applicant shall be issued a certif-
29 icate of authority as a managed long term care plan upon a determination
30 by the commissioner that the applicant complies with the operating
31 requirements for a managed long term care plan under this section;
32 provided, however, that any managed long term care plan seeking to
33 provide health and long term care services to a population of enrollees
34 that are eligible under title XIX of the federal social security act
35 shall not receive a certificate of authority, nor be eligible for a
36 contract to provide such services with the department, unless selected
37 through the competitive bid process described in this subdivision. [The
38 commissioner shall issue no more than seventy-five certificates of
39 authority to managed long term care plans pursuant to this section.
40 (a-1) Nothing in this section shall be construed as requiring the
41 department to contract with or to contract for a particular line of
42 business with an entity certified under this section for the provision
43 of services available under title eleven of article five of the social
44 services law. A managed long term care plan that has been issued a
45 certificate of authority, or an applicant for a certificate of authority
46 as a managed long term care plan that has in any of the three calendar
47 years immediately preceding the application, met any of the following
48 criteria shall not be eligible for a contract for the provision of
49 services available under title eleven of article five of the social
50 services law: (i) classified as a poor performer, or substantially simi-
51 lar terminology, by the centers for medicare and medicaid services; or
52 (ii) an excessive volume of penalties, statements of findings, state-
53 ments of deficiency, intermediate sanctions or enforcement actions,
54 regardless of whether the applicant has addressed such issues in a time-
55 ly manner.
S. 8307--A 28 A. 8807--A
1 (b) An operating demonstration shall be issued a certificate of
2 authority as a managed long term care plan upon a determination by the
3 commissioner that such demonstration complies with the operating
4 requirements for a managed long term care plan under this section.
5 Nothing in this section shall be construed to affect the continued legal
6 authority of an operating demonstration to operate its previously
7 approved program.
8 (c) For the period beginning April first, two thousand twelve and
9 ending March thirty-first, two thousand fifteen, the majority leader of
10 the senate and the speaker of the assembly may each recommend to the
11 commissioner, in writing, up to four eligible applicants to convert to
12 be approved managed long term care plans. An applicant shall only be
13 approved and issued a certificate of authority if the commissioner
14 determines that the applicant meets the requirements of subdivision
15 three of this section. The majority leader of the senate or the speaker
16 of the assembly may assign their authority to recommend one or more
17 applicants under this section to the commissioner]
18 (a) Notwithstanding sections one hundred twelve and one hundred
19 sixty-three of the state finance law, sections one hundred forty-two and
20 one hundred forty-three of the economic development law, and any other
21 inconsistent provision of law, the commissioner shall, through a compet-
22 itive bid process based on proposals submitted to the department,
23 provide for the selection of qualified managed long term care plans to
24 provide health and long term care services to enrollees who are eligible
25 under title XIX of the federal social security act pursuant to a
26 contract with the department; provided, however, that:
27 (i) A proposal submitted by a managed long term care plan shall
28 include information sufficient to allow the commissioner to evaluate the
29 bidder in accordance with the requirements identified in subdivisions
30 two, three and four of this section.
31 (ii) In addition to the criteria described in subparagraph (i) of this
32 paragraph, the commissioner shall also consider:
33 (A) accessibility and geographic distribution of network providers,
34 taking into account the needs of persons with disabilities and the
35 differences between rural, suburban, and urban settings;
36 (B) the extent to which major public hospitals are included in the
37 submitted provider network;
38 (C) demonstrated cultural and language competencies specific to the
39 population of participants;
40 (D) the corporate organization and status of the bidder as a charita-
41 ble corporation under the not-for-profit corporation law;
42 (E) the ability of a bidder to offer plans in multiple regions;
43 (F) the type and number of products the bidder proposes to operate,
44 including products applied for in accordance with the provisions of
45 subdivision five of section three hundred sixty-four-j of the social
46 services law, and other products determined by the commissioner, includ-
47 ing but not necessarily limited to those operated under title one-A of
48 article twenty-five of this chapter and section three hundred sixty-
49 nine-gg of the social services law;
50 (G) whether the bidder participates in products for integrated care
51 for participants who are dually eligible for Medicaid and medicare;
52 (H) whether the bidder participates in value based payment arrange-
53 ments as defined by the department, including the delegation of signif-
54 icant financial risk to clinically integrated provider networks;
55 (I) the bidder's commitment to participation in managed care in the
56 state;
S. 8307--A 29 A. 8807--A
1 (J) the bidder's commitment to quality improvement;
2 (K) the bidder's commitment to community reinvestment spending, as
3 shall be defined in the procurement;
4 (L) for current or previously authorized managed care providers, past
5 performance in meeting managed care contract or federal or state
6 requirements, and if the commissioner issued any statements of findings,
7 statements of deficiency, intermediate sanctions or enforcement actions
8 to a bidder for non-compliance with such requirements, whether the
9 bidder addressed such issues in a timely manner; and
10 (M) any other criteria deemed appropriate by the commissioner.
11 (iii) Subparagraphs (i) and (ii) of this paragraph describing proposal
12 content and selection criteria requirements shall not be construed as
13 limiting or requiring the commissioner to evaluate such content or
14 criteria on a pass/fail scale, or other particular methodological basis;
15 provided however, that the commissioner must consider all such content
16 and criteria using methods determined by the commissioner in their
17 discretion and, as applicable, in consultation with the commissioners of
18 the office of mental health, the office for people with developmental
19 disabilities, the office of addiction services and supports, and the
20 office of children and family services.
21 (iv) The department shall post on its website:
22 (A) The request for proposals and a description of the proposed
23 services to be provided pursuant to contracts in accordance with this
24 subdivision;
25 (B) The criteria on which the department shall determine qualified
26 bidders and evaluate their applications, including all criteria identi-
27 fied in this subdivision;
28 (C) The manner by which a proposal may be submitted, which may include
29 submission by electronic means;
30 (D) The manner by which a managed long term care plan may continue to
31 provide health and long term care services to enrollees who are eligible
32 under title XIX of the federal social security act pending awards to
33 managed long term care plans through a competitive bid process pursuant
34 to this subdivision; and
35 (E) Upon award, the managed long term care plans that the commissioner
36 intends to contract with pursuant to this subdivision, provided that the
37 commissioner shall update such list to indicate the final slate of
38 contracted managed long term care plans.
39 (v) Award and contracting. (A) All responsible and responsive
40 submissions that are received from bidders in a timely fashion shall be
41 reviewed by the commissioner in consultation with the commissioners of
42 the office of mental health, the office for people with developmental
43 disabilities, the office of addiction services and supports, and the
44 office of children and family services, as applicable. The commissioner
45 shall consider comments resulting from the review of proposals and make
46 awards in consultation with such agencies.
47 (B) The commissioner may make awards under this subdivision, for each
48 product for which proposals were requested, to two or more managed long
49 term care plans in each geographic region defined by the commissioner in
50 the request for proposals for which at least two managed long term care
51 plans have submitted a proposal, and shall have discretion to offer more
52 contracts based on need for access.
53 (C) Managed long term care plans awarded under this subdivision shall
54 be entitled to enter into a contract with the department for the purpose
55 of providing health and long term care services to enrollees who are
56 eligible under title XIX of the federal social security act. Such
S. 8307--A 30 A. 8807--A
1 contracts shall run for a term to be determined by the commissioner,
2 which may be renewed or modified from time to time without a new request
3 for proposals, to ensure consistency with changes in federal and state
4 laws, regulations and policies, including but not limited to the expan-
5 sion or reduction of medical assistance services available to the
6 participants through a managed long term care plan.
7 (D) Nothing in this paragraph or other provision of this section shall
8 be construed to limit in any way the ability of the department to termi-
9 nate awarded contracts for cause, which shall include but not be limited
10 to any violation of the terms of such contracts or violations of state
11 or federal laws and regulations and any loss of necessary state or
12 federal funding.
13 (E) Nothing in this paragraph or other provision of this section shall
14 be construed to limit in any way the ability of the department to issue
15 a new request for proposals for a term following an existing term of an
16 award.
17 (b) Transitioning enrollees who are eligible under title XIX of the
18 federal social security act (i) Within sixty-days of the department
19 issuing the request for proposals under paragraph (a) of this subdivi-
20 sion, a managed long term care plan that was approved to provide health
21 and long term care services to enrollees who are eligible under title
22 XIX of the federal social security act prior to the issuance of the
23 request for proposals, shall submit its intention to complete such
24 proposal to the department.
25 (ii) A managed long term care plan that: (A) fails to submit its
26 intent timely; (B) indicates within the sixty-days its intent not to
27 complete such a proposal, (C) fails to submit a proposal within the
28 further timeframe specified by the commissioner in the request for
29 proposals, or (D) is not awarded the ability to provide health and long
30 term care services to enrollees who are eligible under title XIX of the
31 federal social security act under paragraph (a) of this subdivision,
32 shall, upon direction from the commissioner, terminate its services and
33 operations in accordance with the contract between the managed long term
34 care plan and the department and shall be additionally required to main-
35 tain coverage of enrollees for such period of time as determined neces-
36 sary by the commissioner to achieve the safe and orderly transfer of
37 enrollees.
38 (c) Addressing needs for additional managed long term care plans to
39 ensure access and choice for enrollees eligible under title XIX of the
40 federal social security act. If necessary to ensure access to a suffi-
41 cient number of managed long term care plans on a geographic or other
42 basis, including a lack of adequate and appropriate care, language and
43 cultural competence, or special needs services, the commissioner may
44 reissue a request for proposals as provided for under paragraph (a) of
45 this subdivision, provided however that such request may be limited to
46 the geographic or other basis of need that the request for proposals
47 seeks to address. Any awards made shall be subject to the requirements
48 of this section, including but not limited to the minimum and maximum
49 number of awards in a region.
50 (d) (i) Effective April first, two thousand twenty, and expiring
51 [March thirty-first, two thousand twenty-seven] on the date the commis-
52 sioner publishes on the department's website a request for proposals in
53 accordance with subparagraph (iv) of paragraph (a) of this subdivision,
54 the commissioner shall place a moratorium on the processing and approval
55 of applications seeking a certificate of authority as a managed long
56 term care plan pursuant to this section, including applications seeking
S. 8307--A 31 A. 8807--A
1 authorization to expand an existing managed long term care plan's
2 approved service area or scope of eligible enrollee populations. Such
3 moratorium shall not apply to:
4 (A) applications submitted to the department prior to January first,
5 two thousand twenty;
6 (B) applications seeking approval to transfer ownership or control of
7 an existing managed long term care plan;
8 (C) applications demonstrating to the commissioner's satisfaction that
9 submission of the application for consideration would be appropriate to
10 address a serious concern with care delivery, such as a lack of adequate
11 access to managed long term care plans in a geographic area or a lack of
12 adequate and appropriate care, language and cultural competence, or
13 special needs services; and
14 (D) applications seeking to operate under the PACE (Program of All-In-
15 clusive Care for the Elderly) model as authorized by federal public law
16 105-33, subtitle I of title IV of the Balanced Budget Act of 1997, or to
17 serve individuals dually eligible for services and benefits under titles
18 XVIII and XIX of the federal social security act in conjunction with an
19 affiliated Medicare Dual Eligible Special Needs Plan, based on the need
20 for such plans and the experience of applicants in serving dually eligi-
21 ble individuals as determined by the commissioner in their discretion.
22 (ii) For the duration of the moratorium, the commissioner shall assess
23 the public need for managed long term care plans that are not integrated
24 with an affiliated Medicare plan, the ability of such plans to provide
25 high quality and cost effective care for their membership, and based on
26 such assessment develop a process and conduct an orderly wind-down and
27 elimination of such plans, which shall coincide with the expiration of
28 the moratorium unless the commissioner determines that a longer wind-
29 down period is needed.
30 (e) [For the duration of the moratorium under paragraph (d) of this
31 subdivision] From April first, two thousand twenty, until March thirty-
32 first, two thousand twenty-four, the commissioner shall establish, and
33 enforce by means of a premium withholding equal to three percent of the
34 base rate, an annual cap on total enrollment (enrollment cap) for each
35 managed long term care plan, subject to subparagraphs (ii) and (iii) of
36 this paragraph, based on a percentage of each plan's reported enrollment
37 as of October first, two thousand twenty.
38 (i) The specific percentage of each plan's enrollment cap shall be
39 established by the commissioner based on: (A) the ability of individuals
40 eligible for such plans to access health and long term care services,
41 (B) plan quality of care scores, (C) historical plan disenrollment, (D)
42 the projected growth of individuals eligible for such plans in different
43 regions of the state, (E) historical plan enrollment of patients with
44 varying levels of need and acuity, and (F) other factors in the commis-
45 sioner's discretion to ensure compliance with federal requirements,
46 appropriate access to plan services, and choice by eligible individuals.
47 (ii) In the event that a plan exceeds its annual enrollment cap, the
48 commissioner is authorized under this paragraph to retain all or a
49 portion of the premium withheld based on the amount over which a plan
50 exceeds its enrollment cap. Penalties assessed pursuant to this subdivi-
51 sion shall be determined by regulation.
52 (iii) The commissioner may not establish an annual cap on total
53 enrollment under this paragraph for plans' lines of business operating
54 under the PACE (Program of All-Inclusive Care for the Elderly) model as
55 authorized by federal public law 105-33, subtitle I of title IV of the
56 Balanced Budget Act of 1997, or that serve individuals dually eligible
S. 8307--A 32 A. 8807--A
1 for services and benefits under titles XVIII and XIX of the federal
2 social security act in conjunction with an affiliated Medicare Dual
3 Eligible Special Needs Plan.
4 [(f) In implementing the provisions of paragraphs (d) and (e) of this
5 subdivision, the commissioner shall, to the extent practicable, consider
6 and select methodologies that seek to maximize continuity of care and
7 minimize disruption to the provider labor workforce, and shall, to the
8 extent practicable and consistent with the ratios set forth herein,
9 continue to support contracts between managed long term care plans and
10 licensed home care services agencies that are based on a commitment to
11 quality and value.]
12 § 8. Section 1 of part I of chapter 57 of the laws of 2022, providing
13 a one percent across the board payment increase to all qualifying fee-
14 for-service Medicaid rates, is amended by adding two new subdivisions 3
15 and 4 to read as follows:
16 3. For the state fiscal years beginning April 1, 2024, and thereafter,
17 all department of health Medicaid payments made to Medicaid managed care
18 organizations will no longer be subject to the uniform rate increase in
19 subdivision one of this section.
20 4. Rate adjustments made pursuant to subdivisions one through three of
21 this section shall not be subject to the notification requirements set
22 forth in subdivision 7 of section 2807 of the public health law.
23 § 9. Section 364-j of the social services law is amended by adding a
24 new subdivision 40 to read as follows:
25 40. (a) The commissioner shall be entitled to recover liquidated
26 damages from managed care organizations for failure to meet the contrac-
27 tual obligations and performance standards of their contract.
28 (b) The commissioner shall have sole discretion in determining whether
29 to impose a recovery of the financial loss and damages for noncompliance
30 with any provision of the contract.
31 (c) (i) Liquidated damages imposed by this subdivision against a
32 managed care organization shall be from two hundred fifty dollars up to
33 twenty-five thousand dollars per violation depending on the severity of
34 the noncompliance determined by the commissioner.
35 (ii) Any liquidated damages findings as a result of the review
36 required by this subdivision shall be due and payable sixty calendar
37 days from the issuance of a statement of damages regardless of any
38 dispute in the amount or interpretation of the amount due contained in
39 the statement of damages.
40 (iii) The commissioner may elect, in their sole discretion, to collect
41 damages imposed by this section from, and as a set off against, payments
42 due to the managed care organization, or payments that becomes due any
43 time after the calculation of liquidated damages. Deductions shall
44 continue until the full amount of the noticed damages are paid in full.
45 (iv) All liquidated damages imposed by this subdivision shall be paid
46 out of the administrative costs and profits of the managed care organ-
47 ization.
48 (v) The managed care organization shall not pass the liquidated
49 damages imposed under this subdivision through to any provider and/or
50 subcontractor.
51 (d)(i) managed care organization must submit a written request of its
52 dispute A managed care organization may dispute the imposition of liqui-
53 dated damages in writing, and in the form and manner prescribed by the
54 commissioner, within thirty calendar days from the date of the state-
55 ment of damages.
S. 8307--A 33 A. 8807--A
1 (ii) Disputes that are not delivered in the format and timeframe spec-
2 ified by the department shall be denied by the department and deemed
3 waived by the managed care organization.
4 (iii) A managed care organization shall waive any arguments, materi-
5 als, data, and information not contained in or accompanying a timely
6 submitted written dispute, including for use in any subsequent legal or
7 administrative proceeding.
8 (iv) The commissioner or their designee shall decide the dispute,
9 reduce the decision to writing and issue their decision to the managed
10 care organization within ninety calendar days of receipt of the dispute.
11 This written decision shall be final.
12 (e) For the purposes of this subdivision a violation shall mean: (i) a
13 determination by the commissioner that the managed care organization
14 failed to act as required under the model contract or applicable federal
15 and state statutes, rules or regulations governing managed care organ-
16 ization; (ii) each instance of a managed care organization failing to
17 furnish necessary and/or required medical services or items to each
18 enrollee shall be a separate violation. For the purposes of this subdi-
19 vision, each day that an ongoing violation continues shall be a separate
20 violation.
21 (f) For purposes of this subdivision managed care organization shall
22 mean any managed care organizations subject to this section and article
23 forty-four of the public health law, including managed long term care
24 plans.
25 (g) Nothing in this subdivision shall prohibit the imposition of
26 damages, penalties or other relief, otherwise authorized by law, includ-
27 ing but not limited to cases of fraud, waste or abuse.
28 § 10. This act shall not be construed to prohibit managed care provid-
29 ers participating in the managed care program and managed long term care
30 plans approved to provide health and long term care services to enrol-
31 lees who are eligible under title XIX of the federal social security
32 act, that were so authorized as of the effective date of this act from
33 continuing operations as authorized until such time as awards are made
34 in accordance with this act and such additional time subject to direc-
35 tion from the commissioner of health to ensure the safe and orderly
36 transfer of participants.
37 § 11. This act shall take effect immediately and shall apply to
38 disputes filed with the superintendent of financial services pursuant to
39 article six of the financial services law on or after such effective
40 date; provided that:
41 (a) the amendments to section 364-j of the social services law made by
42 sections two, three and nine of this act shall not affect the repeal of
43 such section and shall be deemed repealed therewith; and
44 (b) the amendments to section 4403-f of the public health law made by
45 sections five, six and seven of this act shall not affect the repeal of
46 such section and shall be deemed repealed therewith.
47 PART I
48 Section 1. Paragraph (a) of subdivision 4 of section 365-a of the
49 social services law, as amended by chapter 493 of the laws of 2010, is
50 amended to read as follows:
51 (a) drugs which may be dispensed without a prescription as required by
52 section sixty-eight hundred ten of the education law; provided, however,
53 that the state commissioner of health may by regulation specify certain
54 of such drugs which may be reimbursed as an item of medical assistance
S. 8307--A 34 A. 8807--A
1 in accordance with the price schedule established by such commissioner.
2 Notwithstanding any other provision of law, [additions] modifications to
3 the list of drugs reimbursable under this paragraph may be filed as
4 regulations by the commissioner of health without prior notice and
5 comment;
6 § 2. Paragraph (b) of subdivision 3 of section 273 of the public
7 health law, as added by section 10 of part C of chapter 58 of the laws
8 of 2005, is amended to read as follows:
9 (b) In the event that the patient does not meet the criteria in para-
10 graph (a) of this subdivision, the prescriber may provide additional
11 information to the program to justify the use of a prescription drug
12 that is not on the preferred drug list. The program shall provide a
13 reasonable opportunity for a prescriber to reasonably present his or her
14 justification of prior authorization. [If, after consultation with the
15 program, the prescriber, in his or her reasonable professional judgment,
16 determines that] The program will consider the additional information
17 and the justification presented to determine whether the use of a
18 prescription drug that is not on the preferred drug list is warranted,
19 and the [prescriber's] program's determination shall be final.
20 § 3. Subdivisions 25 and 25-a of section 364-j of the social services
21 law are REPEALED.
22 § 4. Section 280 of the public health law, as amended by section 8 of
23 part D of chapter 57 of the laws of 2018, paragraph (b) of subdivision 2
24 as amended by section 5, subdivision 3 as amended by section 6, para-
25 graph (a) of subdivision 5 as amended by section 7, subparagraph (iii)
26 of paragraph (e) as amended by section 6-a and subdivision 8 as amended
27 by section 9 of part B of chapter 57 of the laws of 2019, paragraphs
28 (c) and (d) of subdivision 2 as amended and paragraph (e) of subdivision
29 2 as added by section 2 of part FFF of chapter 56 of the laws of 2020,
30 the opening paragraph of paragraph (a) of subdivision 6 and paragraph
31 (a) of subdivision 7 as amended by sections 3 and 4, respectively, of
32 part GG of chapter 56 of the laws of 2020, is amended to read as
33 follows:
34 § 280. Medicaid drug cap. 1. The legislature hereby finds and declares
35 that there is a significant public interest for the Medicaid program to
36 manage drug costs in a manner that ensures patient access while provid-
37 ing financial stability for the state and participating providers.
38 Since two thousand eleven, the state has taken significant steps to
39 contain costs in the Medicaid program by imposing a statutory limit on
40 annual growth. Drug expenditures, however, continually outpace other
41 cost components causing significant pressure on the state, providers,
42 and patient access operating under the Medicaid global cap. It is there-
43 fore intended that the department establish a [Medicaid drug cap as a
44 separate component within the Medicaid global cap] supplemental rebate
45 program as part of a focused and sustained effort to balance the growth
46 of drug expenditures with the growth of total Medicaid expenditures.
47 2. The commissioner shall [establish a year to year] review at least
48 annually the department of health state funds Medicaid drug [expenditure
49 growth target as follows:
50 (a) for state fiscal year two thousand seventeen--two thousand eigh-
51 teen, be limited to the ten-year rolling average of the medical compo-
52 nent of the consumer price index plus five percent and minus a pharmacy
53 savings target of fifty-five million dollars; and
54 (b) for state fiscal year two thousand eighteen--two thousand nine-
55 teen, be limited to the ten-year rolling average of the medical compo-
S. 8307--A 35 A. 8807--A
1 nent of the consumer price index plus four percent and minus a pharmacy
2 savings target of eighty-five million dollars;
3 (c) for state fiscal year two thousand nineteen--two thousand twenty,
4 be limited to the ten-year rolling average of the medical component of
5 the consumer price index plus four percent and minus a pharmacy savings
6 target of eighty-five million dollars;
7 (d) for state fiscal year two thousand twenty--two thousand twenty-
8 one, be limited to the ten-year rolling average of the medical component
9 of the consumer price index plus two percent; and
10 (e) for state fiscal year two thousand twenty-one--two thousand twen-
11 ty-two and fiscal years thereafter, be limited in accordance with subdi-
12 vision one of section ninety-one of part H of chapter fifty-nine of the
13 laws of two thousand eleven, as amended] expenditures to identify drugs,
14 including but not limited to, drugs in the eightieth percentile or high-
15 er of total spend, net of rebate or in the eightieth percentile or high-
16 er based on cost per claim, net of rebate.
17 3. (a) The [department and the division of the budget shall assess on
18 a quarterly basis the projected total amount to be expended in the year
19 on a cash basis by the Medicaid program for each drug, and the projected
20 annual amount of state funds Medicaid drug expenditures on a cash basis
21 for all drugs, which shall be a component of the projected department of
22 health state funds Medicaid expenditures calculated for purposes of
23 sections ninety-one and ninety-two of part H of chapter fifty-nine of
24 the laws of two thousand eleven. For purposes of this section, state
25 funds Medicaid drug expenditures include amounts expended for drugs in
26 both the Medicaid fee-for-service program and Medicaid managed care
27 programs, minus the amount of any drug rebates or supplemental drug
28 rebates received by the department, including rebates pursuant to subdi-
29 vision five of this section with respect to rebate targets. The depart-
30 ment and the division of the budget shall report in December of each
31 year, for the prior April through October, to the drug utilization
32 review board the projected state funds Medicaid drug expenditures
33 including the amounts, in aggregate thereof, attributable to the net
34 cost of: changes in the utilization of drugs by Medicaid recipients;
35 changes in the number of Medicaid recipients; changes to the cost of
36 brand name drugs and changes to the cost of generic drugs. The informa-
37 tion contained in the report shall not be publicly released in a manner
38 that allows for the identification of an individual drug or manufacturer
39 or that is likely to compromise the financial competitive, or proprie-
40 tary nature of the information.
41 (a) In the event the director of the budget determines, based on Medi-
42 caid drug expenditures for the previous quarter or other relevant infor-
43 mation, that the total department of health state funds Medicaid drug
44 expenditure is projected to exceed the annual growth limitation imposed
45 by subdivision two of this section, the] commissioner may identify and
46 refer drugs, including but not limited to, drugs in the eightieth
47 percentile or higher of total spend, net of rebate or in the eightieth
48 percentile or higher based on cost per claim, net of rebate, to the drug
49 utilization review board established by section three hundred sixty-
50 nine-bb of the social services law for a recommendation as to whether a
51 target supplemental Medicaid rebate should be paid by the manufacturer
52 of the drug to the department and the target amount of the rebate.
53 (b) If the department intends to refer a drug to the drug utilization
54 review board pursuant to paragraph (a) of this subdivision, the depart-
55 ment shall notify the manufacturer of such drug and shall attempt to
56 reach agreement with the manufacturer on a rebate for the drug prior to
S. 8307--A 36 A. 8807--A
1 referring the drug to the drug utilization review board for review.
2 Such rebate may be based on evidence-based research, including, but not
3 limited to, such research operated or conducted by or for other state
4 governments, the federal government, the governments of other nations,
5 and third party payers or multi-state coalitions, provided however that
6 the department shall account for the effectiveness of the drug in treat-
7 ing the conditions for which it is prescribed or in improving a
8 patient's health, quality of life, or overall health outcomes, and the
9 likelihood that use of the drug will reduce the need for other medical
10 care, including hospitalization.
11 (c) In the event that the commissioner and the manufacturer have
12 previously agreed to a supplemental rebate for a drug pursuant to para-
13 graph (b) of this subdivision or paragraph (e) of subdivision seven of
14 section three hundred sixty-seven-a of the social services law, the drug
15 shall not be referred to the drug utilization review board for any
16 further supplemental rebate for the duration of the previous rebate
17 agreement, provided however, the commissioner may refer a drug to the
18 drug utilization review board if the commissioner determines there are
19 significant and substantiated utilization or market changes, new
20 evidence-based research, or statutory or federal regulatory changes that
21 warrant additional rebates. In such cases, the department shall notify
22 the manufacturer and provide evidence of the changes or research that
23 would warrant additional rebates, and shall attempt to reach agreement
24 with the manufacturer on a rebate for the drug prior to referring the
25 drug to the drug utilization review board for review.
26 (d) The department shall consider a drug's actual cost to the state,
27 including current rebate amounts, prior to seeking an additional rebate
28 pursuant to paragraph (b) or (c) of this subdivision.
29 (e) [The commissioner shall be authorized to take the actions
30 described in this section only so long as total Medicaid drug expendi-
31 tures are projected to exceed the annual growth limitation imposed by
32 subdivision two of this section.] If the commissioner is unsuccessful in
33 entering into a rebate arrangement with the manufacturer of the drug
34 satisfactory to the department, the drug manufacturer shall, in that
35 event be required to provide to the department, on a standard reporting
36 form developed by the department, the following information:
37 (i) the actual cost of developing, manufacturing, producing (including
38 the cost per dose of production), and distributing the drug;
39 (ii) research and development costs of the drug, including payments to
40 predecessor entities conducting research and development, such as
41 biotechnology companies, universities and medical schools, and private
42 research institutions;
43 (iii) administrative, marketing, and advertising costs for the drug,
44 apportioned by marketing activities that are directed to consumers,
45 marketing activities that are directed to prescribers, and the total
46 cost of all marketing and advertising that is directed primarily to
47 consumers and prescribers in New York, including but not limited to
48 prescriber detailing, copayment discount programs, and direct-to-consum-
49 er marketing;
50 (iv) the extent of utilization of the drug;
51 (v) prices for the drug that are charged to purchasers outside the
52 United States;
53 (vi) prices charged to typical purchasers in the state, including but
54 not limited to pharmacies, pharmacy chains, pharmacy wholesalers, or
55 other direct purchasers;
S. 8307--A 37 A. 8807--A
1 (vii) the average rebates and discounts provided per payer type in the
2 state; and
3 (viii) the average profit margin of each drug over the prior five-year
4 period and the projected profit margin anticipated for such drug.
5 (f) All information disclosed pursuant to paragraph (e) of this subdi-
6 vision shall be considered confidential and shall not be disclosed by
7 the department in a form that identifies a specific manufacturer or
8 prices charged for drugs by such manufacturer.
9 4. In determining whether to recommend a target supplemental rebate
10 for a drug, the drug utilization review board shall consider the actual
11 cost of the drug to the Medicaid program, including federal and state
12 rebates, and may consider, among other things:
13 (a) the drug's impact on the Medicaid drug spending growth target and
14 the adequacy of capitation rates of participating Medicaid managed care
15 plans, and the drug's affordability and value to the Medicaid program;
16 or
17 (b) significant and unjustified increases in the price of the drug; or
18 (c) whether the drug may be priced disproportionately to its therapeu-
19 tic benefits.
20 5. (a) If the drug utilization review board recommends a target rebate
21 amount on a drug referred by the commissioner, the department shall
22 negotiate with the drug's manufacturer for a supplemental rebate to be
23 paid by the manufacturer in an amount not to exceed such target rebate
24 amount. [A rebate requirement shall apply beginning with the first day
25 of the state fiscal year during which the rebate was required without
26 regard to the date the department enters into the rebate agreement with
27 the manufacturer.]
28 (b) The supplemental rebate required by paragraph (a) of this subdivi-
29 sion shall apply to drugs dispensed to enrollees of managed care provid-
30 ers pursuant to section three hundred sixty-four-j of the social
31 services law and to drugs dispensed to Medicaid recipients who are not
32 enrollees of such providers.
33 (c) [If the drug utilization review board recommends a target rebate
34 amount for a drug and the department is unable to negotiate a rebate
35 from the manufacturer in an amount that is at least seventy-five percent
36 of the target rebate amount, the commissioner is authorized to waive the
37 provisions of paragraph (b) of subdivision three of section two hundred
38 seventy-three of this article and the provisions of subdivisions twen-
39 ty-five and twenty-five-a of section three hundred sixty-four-j of the
40 social services law with respect to such drug; however, this waiver
41 shall not be implemented in situations where it would prevent access by
42 a Medicaid recipient to a drug which is the only treatment for a partic-
43 ular disease or condition. Under no circumstances shall the commissioner
44 be authorized to waive such provisions with respect to more than two
45 drugs in a given time.
46 (d)] Where the department and a manufacturer enter into a rebate
47 agreement pursuant to this section, which may be in addition to existing
48 rebate agreements entered into by the manufacturer with respect to the
49 same drug, no additional rebates shall be required to be paid by the
50 manufacturer to a managed care provider or any of a managed care provid-
51 er's agents, including but not limited to any pharmacy benefit manager,
52 while the department is collecting the rebate pursuant to this section.
53 [(e)] (d) In formulating a recommendation concerning a target rebate
54 amount for a drug, the drug utilization review board may consider:
55 (i) publicly available information relevant to the pricing of the
56 drug;
S. 8307--A 38 A. 8807--A
1 (ii) information supplied by the department relevant to the pricing of
2 the drug;
3 (iii) information relating to value-based pricing provided, however,
4 if the department directly invites any third party to provide cost-ef-
5 fectiveness analysis or research related to value-based pricing, and the
6 department receives and considers such analysis or research for use by
7 the board, such third party shall disclose any funding sources. The
8 department shall, if reasonably possible, make publicly available the
9 following documents in its possession that it relies upon to provide
10 cost effectiveness analyses or research related to value-based pricing:
11 (A) descriptions of underlying methodologies; (B) assumptions and limi-
12 tations of research findings; and (C) if available, data that presents
13 results in a way that reflects different outcomes for affected subpopu-
14 lations;
15 (iv) the seriousness and prevalence of the disease or condition that
16 is treated by the drug;
17 (v) the extent of utilization of the drug;
18 (vi) the effectiveness of the drug in treating the conditions for
19 which it is prescribed, or in improving a patient's health, quality of
20 life, or overall health outcomes;
21 (vii) the likelihood that use of the drug will reduce the need for
22 other medical care, including hospitalization;
23 (viii) the average wholesale price, wholesale acquisition cost, retail
24 price of the drug, and the cost of the drug to the Medicaid program
25 minus rebates received by the state;
26 (ix) in the case of generic drugs, the number of pharmaceutical
27 manufacturers that produce the drug;
28 (x) whether there are pharmaceutical equivalents to the drug; and
29 (xi) information supplied by the manufacturer, if any, explaining the
30 relationship between the pricing of the drug and the cost of development
31 of the drug and/or the therapeutic benefit of the drug, or that is
32 otherwise pertinent to the manufacturer's pricing decision; any such
33 information, including the information on the standard reporting form
34 requirement in paragraph (e) of subdivision three of this section,
35 provided shall be considered confidential and shall not be disclosed by
36 the drug utilization review board in a form that identifies a specific
37 manufacturer or prices charged for drugs by such manufacturer.
38 6. [(a) If the drug utilization review board recommends a target
39 rebate amount or if the commissioner identifies a drug as a high cost
40 drug pursuant to subparagraph (vii) of paragraph (e) of subdivision 7 of
41 section three hundred sixty-seven-a of the social services law and the
42 department is unsuccessful in entering into a rebate arrangement with
43 the manufacturer of the drug satisfactory to the department, the drug
44 manufacturer shall in that event be required to provide to the depart-
45 ment, on a standard reporting form developed by the department, the
46 following information:
47 (i) the actual cost of developing, manufacturing, producing (including
48 the cost per dose of production), and distributing the drug;
49 (ii) research and development costs of the drug, including payments to
50 predecessor entities conducting research and development, such as
51 biotechnology companies, universities and medical schools, and private
52 research institutions;
53 (iii) administrative, marketing, and advertising costs for the drug,
54 apportioned by marketing activities that are directed to consumers,
55 marketing activities that are directed to prescribers, and the total
56 cost of all marketing and advertising that is directed primarily to
S. 8307--A 39 A. 8807--A
1 consumers and prescribers in New York, including but not limited to
2 prescriber detailing, copayment discount programs, and direct-to-consum-
3 er marketing;
4 (iv) the extent of utilization of the drug;
5 (v) prices for the drug that are charged to purchasers outside the
6 United States;
7 (vi) prices charged to typical purchasers in the state, including but
8 not limited to pharmacies, pharmacy chains, pharmacy wholesalers, or
9 other direct purchasers;
10 (vii) the average rebates and discounts provided per payer type in the
11 State; and
12 (viii) the average profit margin of each drug over the prior five-year
13 period and the projected profit margin anticipated for such drug.
14 (b) All information disclosed pursuant to paragraph (a) of this subdi-
15 vision shall be considered confidential and shall not be disclosed by
16 the department in a form that identifies a specific manufacturer or
17 prices charged for drugs by such manufacturer.
18 7.] (a) [If, after] After taking into account all rebates and supple-
19 mental rebates received by the department, including rebates received to
20 date pursuant to this section[, total Medicaid drug expenditures are
21 still projected to exceed the annual growth limitation imposed by subdi-
22 vision two of this section], the commissioner may: subject any drug of a
23 manufacturer referred to the drug utilization review board under this
24 section to prior approval in accordance with existing processes and
25 procedures when such manufacturer has not entered into a supplemental
26 rebate arrangement as required by this section; direct a managed care
27 plan to limit or reduce reimbursement for a drug provided by a medical
28 practitioner if the drug utilization review board recommends a target
29 rebate amount for such drug and the manufacturer has failed to enter
30 into a rebate arrangement required by this section; direct managed care
31 plans to remove from their Medicaid formularies any drugs of a manufac-
32 turer who has a drug that the drug utilization review board recommends a
33 target rebate amount for and the manufacturer has failed to enter into a
34 rebate arrangement required by this section; promote the use of cost
35 effective and clinically appropriate drugs other than those of a
36 manufacturer who has a drug that the drug utilization review board
37 recommends a target rebate amount and the manufacturer has failed to
38 enter into a rebate arrangement required by this section; allow manufac-
39 turers to accelerate rebate payments under existing rebate contracts;
40 and such other actions as authorized by law. [The commissioner shall
41 provide written notice to the legislature thirty days prior to taking
42 action pursuant to this paragraph, unless action is necessary in the
43 fourth quarter of a fiscal year to prevent total Medicaid drug expendi-
44 tures from exceeding the limitation imposed by subdivision two of this
45 section, in which case such notice to the legislature may be less than
46 thirty days.]
47 (b) The commissioner shall be authorized to take the actions described
48 in paragraph (a) of this subdivision [only so long as total Medicaid
49 drug expenditures are projected to exceed the annual growth limitation
50 imposed by subdivision two of this section]. In addition, no such
51 actions shall be deemed to supersede the provisions of paragraph (b) of
52 subdivision three of section two hundred seventy-three of this article
53 or the provisions of subdivisions twenty-five and twenty-five-a of
54 section three hundred sixty-four-j of the social services law[, except
55 as allowed by paragraph (c) of subdivision five of this section];
56 provided further that nothing in this section shall prevent access by a
S. 8307--A 40 A. 8807--A
1 Medicaid recipient to a drug which is the only treatment for a partic-
2 ular disease or condition.
3 [8.] 7. The commissioner, upon request of the chair of the drug utili-
4 zation review board, shall provide a report [by July first annually to
5 the drug utilization review board] on savings achieved through the drug
6 cap in the last fiscal year. Such report shall provide data on what
7 savings were achieved [through actions pursuant to subdivisions three,
8 five and seven of this section, respectively, and what savings were
9 achieved through other means] and how such savings were calculated and
10 implemented.
11 § 5. Paragraph (e) of subdivision 7 of section 367-a of the social
12 services law, as amended by section 1 of part GG of chapter 56 of the
13 laws of 2020, the opening paragraph as amended by section 24 of part B
14 of chapter 57 of the laws of 2023, is amended to read as follows:
15 (e) During the period from April first, two thousand fifteen through
16 March thirty-first, two thousand twenty-six, the commissioner may, in
17 lieu of a managed care provider or pharmacy benefit manager, negotiate
18 directly and enter into an arrangement with a pharmaceutical manufactur-
19 er for the provision of supplemental rebates relating to pharmaceutical
20 utilization by enrollees of managed care providers pursuant to section
21 three hundred sixty-four-j of this title and may also negotiate directly
22 and enter into such an agreement relating to pharmaceutical utilization
23 by medical assistance recipients not so enrolled. Such rebate arrange-
24 ments shall be limited to the following: antiretrovirals approved by the
25 FDA for the treatment of HIV/AIDS, accelerated approval drugs estab-
26 lished pursuant to subparagraph (ix) of this paragraph, opioid depend-
27 ence agents and opioid antagonists listed in a statewide formulary
28 established pursuant to subparagraph (vii) of this paragraph, hepatitis
29 C agents, high cost drugs as provided for in subparagraph (viii) of this
30 paragraph, gene therapies as provided for in subparagraph (ix) of this
31 paragraph, and any other class or drug designated by the commissioner
32 for which the pharmaceutical manufacturer has in effect a rebate
33 arrangement with the federal secretary of health and human services
34 pursuant to 42 U.S.C. § 1396r-8, and for which the state has established
35 standard clinical criteria. No agreement entered into pursuant to this
36 paragraph shall have an initial term or be extended beyond the expira-
37 tion or repeal of this paragraph.
38 (i) The manufacturer shall not enter into any rebate arrangements with
39 a managed care provider, or any of a managed care provider's agents,
40 including but not limited to any pharmacy benefit manager on the gene
41 therapy, drug, or drug classes subject to this paragraph when the state
42 has a rebate arrangement in place and standard clinical criteria are
43 imposed on the managed care provider.
44 (ii) The commissioner shall establish adequate rates of reimbursement
45 which shall take into account both the impact of the commissioner nego-
46 tiating such arrangements and any limitations imposed on the managed
47 care provider's ability to establish clinical criteria relating to the
48 utilization of such drugs. In developing the managed care provider's
49 reimbursement rate, the commissioner shall identify the amount of
50 reimbursement for such drugs as a separate and distinct component from
51 the reimbursement otherwise made for prescription drugs as prescribed by
52 this section.
53 (iii) [The commissioner shall submit a report to the temporary presi-
54 dent of the senate and the speaker of the assembly annually by December
55 thirty-first. The report shall analyze the adequacy of rates to managed
S. 8307--A 41 A. 8807--A
1 care providers for drug expenditures related to the classes under this
2 paragraph.
3 (iv)] Nothing in this paragraph shall be construed to require a phar-
4 maceutical manufacturer to enter into a rebate arrangement satisfactory
5 to the commissioner relating to pharmaceutical utilization by enrollees
6 of managed care providers pursuant to section three hundred sixty-four-j
7 of this title or relating to pharmaceutical utilization by medical
8 assistance recipients not so enrolled.
9 [(v)] (iv) All clinical criteria, including requirements for prior
10 approval, and all utilization review determinations established by the
11 state as described in this paragraph for the gene therapies, drugs, or
12 drug classes subject to this paragraph shall be developed using
13 evidence-based and peer-reviewed clinical review criteria in accordance
14 with article two-A of the public health law, as applicable.
15 [(vi)] (v) All prior authorization and utilization review determi-
16 nations related to the coverage of any drug subject to this paragraph
17 shall be subject to article forty-nine of the public health law, section
18 three hundred sixty-four-j of this title, and article forty-nine of the
19 insurance law, as applicable. Nothing in this paragraph shall diminish
20 any rights relating to access, prior authorization, or appeal relating
21 to any drug class or drug afforded to a recipient under any other
22 provision of law.
23 [(vii)] (vi) The department shall publish a statewide formulary of
24 opioid dependence agents and opioid antagonists, which shall include as
25 "preferred drugs" all drugs in such classes, which shall include all
26 subclasses of a given drug that have a different pharmacological route
27 of administration, provided that:
28 (A) for all drugs that are included as of the date of the enactment of
29 this subparagraph on a formulary of a managed care provider, as defined
30 in section three hundred sixty-four-j of this title, or in the Medicaid
31 fee-for-service preferred drug program pursuant to section two hundred
32 seventy-two of the public health law, the cost to the department for
33 such drug is equal to or less than the lowest cost paid for the drug by
34 any managed care provider or by the Medicaid fee-for-service program
35 after the application of any rebates, as of the date that the department
36 implements the statewide formulary established by this subparagraph.
37 Where there is a generic version of the drug approved by the Food and
38 Drug Administration as bioequivalent to a brand name drug pursuant to 21
39 U.S.C. § 355(j)(8)(B), the cost to the department for the brand and
40 generic versions shall be equal to or less than the lower of the two
41 maximum costs determined pursuant to the previous sentence; and
42 (B) for all drugs that are not included as of the date of the enact-
43 ment of this subparagraph on a formulary of a managed care provider, as
44 defined in section three hundred sixty-four-j of this title, or in the
45 Medicaid fee-for-service preferred drug program pursuant to section two
46 hundred seventy-two of the public health law, the department is able to
47 obtain the drug at a cost that is equal to or less than the lowest cost
48 to the department of other comparable drugs in the class, after the
49 application of any rebates. Where there is a generic version of the drug
50 approved by the Food and Drug Administration as bioequivalent to a brand
51 name drug pursuant to 21 U.S.C. § 355(j)(8)(B), the cost to the depart-
52 ment for the brand and generic versions shall be equal to or less than
53 the lower of the two maximum costs determined pursuant to the previous
54 sentence.
55 [(viii)] (vii) The commissioner may identify and refer high cost
56 drugs, as defined in clause (D) of this subparagraph, that are not
S. 8307--A 42 A. 8807--A
1 included as of the date of the enactment of this subparagraph on a
2 formulary of a managed care provider or covered by the Medicaid fee for
3 service of program to the drug utilization review board established by
4 section three hundred sixty-nine-bb of this article for a recommendation
5 as to whether a target supplemental Medicaid rebate should be paid by
6 the manufacturer of the drug to the department and the target amount of
7 the rebate.
8 (A) If the commissioner intends to refer a high cost drug to the drug
9 utilization review board pursuant to this subparagraph, the commissioner
10 shall notify the manufacturer of such drug and shall attempt to reach
11 agreement with the manufacturer on a rebate arrangement satisfactory to
12 the commissioner for the drug prior to referring the drug to the drug
13 utilization review board for review. Such arrangement may be based on
14 evidence based research, including, but not limited to, such research
15 operated or conducted by or for other state governments, the federal
16 government, the governments of other nations, and third party payers or
17 multi-state coalitions, provided however that the department shall
18 account for the effectiveness of the drug in treating the conditions for
19 which it is prescribed or in improving a patient's health, quality of
20 life, or overall health outcomes, and the likelihood that use of the
21 drug will reduce the need for other medical care, including hospitaliza-
22 tion.
23 (B) In the event that the commissioner and the manufacturer have
24 previously agreed to a rebate arrangement for a drug pursuant to this
25 paragraph, the drug shall not be referred to the drug utilization review
26 board for any further rebate agreement for the duration of the previous
27 rebate agreement, provided however, the commissioner may refer a drug to
28 the drug utilization review board if the commissioner determines there
29 are significant and substantiated utilization or market changes, new
30 evidence-based research, or statutory or federal regulatory changes that
31 warrant additional rebates. In such cases, the department shall notify
32 the manufacturer and provide evidence of the changes or research that
33 would warrant additional rebates, and shall attempt to reach agreement
34 with the manufacturer on a rebate for the drug prior to referring the
35 drug to the drug utilization review board for review.
36 (C) If the commissioner is unsuccessful in entering into a rebate
37 arrangement with the manufacturer of the drug satisfactory to the
38 department, the drug manufacturer shall in that event be required to
39 provide to the department, on a standard reporting form developed by the
40 department, the information as described in paragraph (e) of subdivision
41 [six] three of section two hundred eighty of the public health law. All
42 information disclosed pursuant to this clause shall be considered confi-
43 dential and shall not be disclosed by the department in a form that
44 identifies a specific manufacturer or prices charged for drugs by such
45 manufacturer.
46 (D) For the purposes of this subparagraph, the term "high cost drug"
47 shall mean a brand name drug or biologic that has a launch wholesale
48 acquisition cost of thirty thousand dollars or more per year or course
49 of treatment, or a biosimilar drug that has a launch wholesale acquisi-
50 tion cost that is not at least fifteen percent lower than the referenced
51 brand biologic at the time the biosimilar is launched, or a generic drug
52 that has a wholesale acquisition cost of one hundred dollars or more for
53 a thirty day supply or recommended dosage approved for labeling by the
54 federal Food and Drug Administration, or a brand name drug or biologic
55 that has a wholesale acquisition cost increase of three thousand dollars
S. 8307--A 43 A. 8807--A
1 or more in any twelve-month period, or course of treatment if less than
2 twelve months.
3 [(ix)] (viii) For purposes of this paragraph, a "gene therapy" is a
4 drug (A) approved under section 505 of the Federal Food, Drug and
5 Cosmetics Act or licensed under subsection (a) or (k) of section 351 of
6 the Public Health Services Act; (B) that treats a rare disease or condi-
7 tion, as defined in 21 USC § 360bb(a)(2), that is life-threatening, as
8 defined in 42 CFR 321.18; (C) is considered a gene therapy by the feder-
9 al Food and Drug Administration for which a biologics license pursuant
10 to 21 CFR 600-680 is held; (D) if administered in accordance with the
11 labeling of such drug, is expected to result in either the cure of such
12 disease or condition or a reduction in the symptoms of such disease or
13 condition that materially improves the patient's length or quality of
14 life; and (E) is expected to achieve the result described in clause (D)
15 of this subparagraph after not more than three administrations.
16 (ix) For purposes of this paragraph, an "accelerated approval" is a
17 drug or labeled indication of a drug authorized by the Federal Food,
18 Drug and Cosmetic Act for drugs for serious conditions that fill an
19 unmet medical need based on whether the drug has an effect on a surro-
20 gate clinical endpoint, and contingent upon verification of clinical
21 benefit in confirmatory trials.
22 § 6. Paragraph (g) of subdivision 2 of section 365-a of the social
23 services law, as amended by section 21 of part A of chapter 56 of the
24 laws of 2013, is amended to read as follows:
25 (g) sickroom supplies, eyeglasses, prosthetic appliances and dental
26 prosthetic appliances furnished in accordance with the regulations of
27 the department; provided further that: (i) the commissioner of health is
28 authorized to implement a preferred diabetic supply program wherein the
29 department of health will receive enhanced rebates from preferred
30 manufacturers [of] for products and supplies, including but not limited
31 to, glucometers and test strips, and may subject non-preferred manufac-
32 turers' products and supplies, including but not limited to, glucometers
33 and test strips to prior authorization under section two hundred seven-
34 ty-three of the public health law; (ii) enteral formula therapy and
35 nutritional supplements are limited to coverage only for nasogastric,
36 jejunostomy, or gastrostomy tube feeding, for treatment of an inborn
37 metabolic disorder, or to address growth and development problems in
38 children, or, subject to standards established by the commissioner, for
39 persons with a diagnosis of HIV infection, AIDS or HIV-related illness
40 or other diseases and conditions; (iii) prescription footwear and
41 inserts are limited to coverage only when used as an integral part of a
42 lower limb orthotic appliance, as part of a diabetic treatment plan, or
43 to address growth and development problems in children; (iv) compression
44 and support stockings are limited to coverage only for pregnancy or
45 treatment of venous stasis ulcers; and (v) the commissioner of health is
46 authorized to implement an incontinence supply utilization management
47 program to reduce costs without limiting access through the existing
48 provider network, including but not limited to single or multiple source
49 contracts or, a preferred incontinence supply program wherein the
50 department of health will receive enhanced rebates from preferred
51 manufacturers of incontinence supplies, and may subject non-preferred
52 manufacturers' incontinence supplies to prior approval pursuant to regu-
53 lations of the department, provided any necessary approvals under feder-
54 al law have been obtained to receive federal financial participation in
55 the costs of incontinence supplies provided pursuant to this subpara-
56 graph;
S. 8307--A 44 A. 8807--A
1 § 7. The public health law is amended by adding a new section 280-d to
2 read as follows:
3 § 280-d. Pharmacy cost reporting. 1. The department shall develop and
4 implement a cost reporting program for licensed pharmacies that partic-
5 ipate in the Medicaid program. Such program shall include a requirement
6 to submit an annual cost report on a form designated by the department.
7 Information shall include, but not be limited to, costs incurred during
8 procurement and dispensing of prescription drugs.
9 2. Such cost reports are subject to audit. In the event that any
10 information or data which a pharmacy has submitted to the department, on
11 the required reporting forms is inaccurate or incorrect, such pharmacy
12 shall within fifteen business days, submit to the department a
13 correction of such information or data.
14 3. Timely filing of such report is a requirement of participation in
15 the Medicaid pharmacy program. In the event that a pharmacy fails to
16 file the required reports on or before the required due date, such phar-
17 macy may be subject to removal as a provider from the fee-for-service
18 pharmacy program.
19 § 8. Paragraphs (a), (b) and (c) of subdivision 9 of section 367-a of
20 the social services law, paragraphs (a) and (c) as amended by chapter 19
21 of the laws of 1998, paragraph (b) as amended by section 3 of part C of
22 chapter 58 of the laws of 2004, subparagraphs (i) and (ii) of paragraph
23 (b) as amended by section 7 of part D of chapter 57 of the laws of 2017,
24 and subparagraph (iii) of paragraph (b) as added by section 29 of part E
25 of chapter 63 of the laws of 2005, are amended to read as follows:
26 (a) for drugs provided by medical practitioners and claimed separately
27 by the practitioners[, the actual cost of the drugs to the practition-
28 ers; and] the lower of:
29 (i) (1) an amount equal to the national average drug acquisition cost
30 set by the federal centers for medicare and medicaid services for the
31 drug, if any, or if such amount is not available, the wholesale acquisi-
32 tion cost of the drug based on the package size dispensed from, as
33 reported by the prescription drug pricing service used by the depart-
34 ment, (2) the federal upper limit, if any, established by the federal
35 centers for medicare and medicaid services; (3) the state maximum acqui-
36 sition cost, if any, established pursuant to paragraph (e) of this
37 subdivision; or (4) the actual cost of the drug to the practitioner.
38 (ii) Notwithstanding subparagraph (i) and paragraph (e) of this subdi-
39 vision, if a drug has been purchased from a manufacturer by a covered
40 entity pursuant to section 340B of the federal public health service act
41 (42 USCA § 256b), the actual amount paid by such covered entity. For
42 purposes of this subparagraph, a "covered entity" is an entity that
43 meets the requirements of paragraph four of subsection (a) of such
44 section, that elects to participate in the program established by such
45 section, and that causes claims for payment for drugs covered by this
46 subparagraph to be submitted to the medical assistance program, either
47 directly or through an authorized contract pharmacy. No medical assist-
48 ance payments may be made to a covered entity or to an authorized
49 contract pharmacy of a covered entity for drugs that are eligible for
50 purchase under the section 340B program and are dispensed on an outpa-
51 tient basis to patients of the covered entity, other than under the
52 provisions of this subparagraph.
53 (b) for drugs dispensed by pharmacies:
54 (i) (A) if the drug dispensed is a generic prescription drug, the
55 lower of: (1) an amount equal to the national average drug acquisition
56 cost set by the federal centers for medicare and medicaid services for
S. 8307--A 45 A. 8807--A
1 the drug, if any, or if such amount if not available, the wholesale
2 acquisition cost of the drug based on the package size dispensed from,
3 as reported by the prescription drug pricing service used by the depart-
4 ment, less seventeen and one-half percent thereof; (2) the federal upper
5 limit, if any, established by the federal centers for medicare and medi-
6 caid services; (3) the state maximum acquisition cost, if any, estab-
7 lished pursuant to paragraph (e) of this subdivision; or (4) the
8 dispensing pharmacy's usual and customary price charged to the general
9 public; (B) if the drug dispensed is available without a prescription as
10 required by section sixty-eight hundred ten of the education law but is
11 reimbursed as an item of medical assistance pursuant to paragraph (a) of
12 subdivision four of section three hundred sixty-five-a of this title,
13 the lower of (1) an amount equal to the national average drug acquisi-
14 tion cost set by the federal centers for medicare and medicaid services
15 for the drug, if any, or if such amount is not available, the wholesale
16 acquisition cost of the drug based on the package size dispensed from,
17 as reported by the prescription drug pricing service used by the depart-
18 ment, (2) the federal upper limit, if any, established by the federal
19 centers for medicare and medicaid services; (3) the state maximum acqui-
20 sition cost if any, established pursuant to paragraph (e) of this subdi-
21 vision; or (4) the dispensing pharmacy's usual and customary price
22 charged to the general public;
23 (ii) if the drug dispensed is a brand-name prescription drug, the
24 lower of:
25 (A) an amount equal to the national average drug acquisition cost set
26 by the federal centers for medicare and medicaid services for the drug,
27 if any, or if such amount is not available, the wholesale acquisition
28 cost of the drug based on the package size dispensed from, as reported
29 by the prescription drug pricing service used by the department[, less
30 three and three-tenths percent thereof]; or (B) the dispensing pharma-
31 cy's usual and customary price charged to the general public; and
32 (iii) notwithstanding subparagraphs (i) and (ii) of this paragraph and
33 paragraphs (d) and (e) of this subdivision, if the drug dispensed is a
34 drug that has been purchased from a manufacturer by a covered entity
35 pursuant to section 340B of the federal public health service act (42
36 USCA § 256b), the actual amount paid by such covered entity pursuant to
37 such section, plus the reasonable administrative costs, as determined by
38 the commissioner, incurred by the covered entity or by an authorized
39 contract pharmacy in connection with the purchase and dispensing of such
40 drug and the tracking of such transactions. For purposes of this subpar-
41 agraph, a "covered entity" is an entity that meets the requirements of
42 paragraph four of subsection (a) of such section, that elects to partic-
43 ipate in the program established by such section, and that causes claims
44 for payment for drugs covered by this subparagraph to be submitted to
45 the medical assistance program, either directly or through an authorized
46 contract pharmacy. No medical assistance payments may be made to a
47 covered entity or to an authorized contract pharmacy of a covered entity
48 for drugs that are eligible for purchase under the section 340B program
49 and are dispensed on an outpatient basis to patients of the covered
50 entity, other than under the provisions of this subparagraph. Pharmacies
51 submitting claims for reimbursement of drugs purchased pursuant to
52 section 340B of the public health service act shall notify the depart-
53 ment that the claim is eligible for purchase under the 340B program,
54 consistent with claiming instructions issued by the department to iden-
55 tify such claims.
S. 8307--A 46 A. 8807--A
1 (c) Notwithstanding subparagraph (i) of paragraph (b) of this subdivi-
2 sion, if a qualified prescriber certifies "brand medically necessary" or
3 "brand necessary" in his or her own handwriting directly on the face of
4 a prescription, or in the case of electronic prescriptions, inserts an
5 electronic direction to clarify "brand medically necessary" or "brand
6 necessary", for a multiple source drug for which a specific upper limit
7 of reimbursement has been established by the federal agency, in addition
8 to writing "d a w" in the box provided for such purpose on the
9 prescription form, payment under this title for such drug must be made
10 under the provisions of subparagraph (ii) of such paragraph.
11 § 9. This act shall take effect October 1, 2024; provided that
12 sections two and three of this act shall take effect January 1, 2025;
13 and provided however, that the amendments to paragraph (e) of subdivi-
14 sion 7 of section 367-a of the social services law made by section five
15 of this act shall not affect the repeal of such paragraph and shall be
16 deemed repealed therewith provided, further, that the amendments to
17 subdivision 9 of section 367-a of the social services law made by
18 section eight of this act shall not affect the expiration of such subdi-
19 vision pursuant to section 4 of chapter 19 of the laws of 1998, as
20 amended, and shall expire therewith.
21 PART J
22 Section 1. The title heading of title 11-D of article 5 of the social
23 services law, as amended by section 1 of part H of chapter 57 of the
24 laws of 2021, is amended to read as follows:
25 [BASIC HEALTH PROGRAM] ESSENTIAL PLAN
26 § 2. Section 3 of part H of chapter 57 of the laws of 2021, amending
27 the social services law relating to eliminating consumer-paid premium
28 payments in the basic health program, is amended to read as follows:
29 § 3. This act shall take effect June 1, 2021 [and]; provided, however,
30 section two of this act shall expire and be deemed repealed should
31 federal approval be withdrawn or 42 U.S.C. 18051 be repealed; provided
32 that the commissioner of health shall notify the legislative bill draft-
33 ing commission upon the withdrawal of federal approval or the repeal of
34 42 U.S.C. 18051 in order that the commission may maintain an accurate
35 and timely effective data base of the official text of the laws of the
36 state of New York in furtherance of effectuating the provisions of
37 section 44 of the legislative law and section 70-b of the public offi-
38 cers law.
39 § 3. Subdivisions (b) and (c) of section 8 of part BBB of chapter 56
40 of the laws of 2022, amending the public health law and other laws
41 relating to permitting the commissioner of health to submit a waiver
42 that expands eligibility for New York's basic health program and
43 increases the federal poverty limit cap for basic health program eligi-
44 bility from two hundred to two hundred fifty percent, are amended to
45 read as follows:
46 (b) section four of this act shall expire and be deemed repealed
47 December 31, [2024] 2025; provided, however, the amendments to paragraph
48 (c) of subdivision 1 of section 369-gg of the social services law made
49 by such section of this act shall be subject to the expiration and
50 reversion of such paragraph pursuant to section 2 of part H of chapter
51 57 of the laws of 2021 when upon such date, the provisions of section
52 five of this act shall take effect; provided, however, the amendments to
53 such paragraph made by section five of this act shall expire and be
54 deemed repealed December 31, [2024] 2025;
S. 8307--A 47 A. 8807--A
1 (c) section six of this act shall take effect January 1, [2025] 2026;
2 provided, however, the amendments to paragraph (c) of subdivision 1 of
3 section 369-gg of the social services law made by such section of this
4 act shall be subject to the expiration and reversion of such paragraph
5 pursuant to section 2 of part H of chapter 57 of the laws of 2021 when
6 upon such date, the provisions of section seven of this act shall take
7 effect; and
8 § 4. Paragraph (a) of subdivision 1 of section 268-c of the public
9 health law, as added by section 2 of part T of chapter 57 of the laws of
10 2019, is amended to read as follows:
11 (a) Perform eligibility determinations for federal and state insurance
12 affordability programs including medical assistance in accordance with
13 section three hundred sixty-six of the social services law, child health
14 plus in accordance with section twenty-five hundred eleven of this chap-
15 ter, the basic health program in accordance with section three hundred
16 sixty-nine-gg of the social services law, the 1332 state innovation
17 program in accordance with section three hundred sixty-nine-ii of the
18 social services law, premium tax credits and cost-sharing reductions and
19 qualified health plans in accordance with applicable law and other
20 health insurance programs as determined by the commissioner;
21 § 5. Subdivision 16 of section 268-c of the public health law, as
22 added by section 2 of part T of chapter 57 of the laws of 2019, is
23 amended to read as follows:
24 16. In accordance with applicable federal and state law, inform indi-
25 viduals of eligibility requirements for the Medicaid program under title
26 XIX of the social security act and the social services law, the chil-
27 dren's health insurance program (CHIP) under title XXI of the social
28 security act and this chapter, the basic health program under section
29 three hundred sixty-nine-gg of the social services law, the 1332 state
30 innovation program in accordance with section three hundred sixty-nine-
31 ii of the social services law, or any applicable state or local public
32 health insurance program and if, through screening of the application by
33 the Marketplace, the Marketplace determines that such individuals are
34 eligible for any such program, enroll such individuals in such program.
35 § 6. Section 268-c of the public health law is amended by adding a new
36 subdivision 26 to read as follows:
37 26. Subject to federal approval if required, the use of state funds
38 and the availability of funds in the 1332 state innovation program fund
39 established pursuant to section ninety-eight-d of the state finance law,
40 the commissioner shall have the authority to establish a program to
41 provide subsidies for the payment of premium or cost sharing or both to
42 assist individuals who are eligible to purchase qualified health plans
43 through the marketplace, or take such other action as appropriate to
44 reduce or eliminate qualified health plan premiums or cost-sharing or
45 both.
46 § 7. Subparagraph (i) of paragraph (a) of subdivision 4 of section
47 268-e of the public health law, as added by section 2 of part T of chap-
48 ter 57 of the laws of 2019, is amended to read as follows:
49 (i) An initial determination of eligibility, including:
50 (A) eligibility to enroll in a qualified health plan;
51 (B) eligibility for Medicaid;
52 (C) eligibility for Child Health Plus;
53 (D) eligibility for the Basic Health Program;
54 (E) eligibility for the 1332 state innovation program;
55 (F) the amount of advance payments of the premium tax credit and level
56 of cost-sharing reductions;
S. 8307--A 48 A. 8807--A
1 [(F)] (G) the amount of any other subsidy that may be available under
2 law; and
3 [(G)] (H) eligibility for such other health insurance programs as
4 determined by the commissioner; and
5 § 8. Section 268 of the public health law, as added by section 2 of
6 part T of chapter 57 of the laws of 2019, is amended to read as follows:
7 The purpose of this title is to codify the establishment of the health
8 benefit exchange in New York, known as NY State of Health, The Official
9 Health Plan Marketplace (Marketplace), in conformance with Executive
10 Order 42 (Cuomo) issued April 12, 2012. The Marketplace shall continue
11 to perform eligibility determinations for federal and state insurance
12 affordability programs including medical assistance in accordance with
13 section three hundred sixty-six of the social services law, child health
14 plus in accordance with section twenty-five hundred eleven of this chap-
15 ter, the basic health program in accordance with section three hundred
16 sixty-nine-gg of the social services law, the 1332 state innovation
17 program in accordance with section three hundred sixty-nine-ii of the
18 social service law, and premium tax credits and cost-sharing reductions,
19 together with performing eligibility determinations for qualified health
20 plans and such other health insurance programs as determined by the
21 commissioner. The Marketplace shall also facilitate enrollment in insur-
22 ance affordability programs, qualified health plans and other health
23 insurance programs as determined by the commissioner, the purchase and
24 sale of qualified health plans and/or other or additional health plans
25 certified by the Marketplace pursuant to this title, and shall continue
26 to have the authority to operate a small business health options program
27 ("SHOP") to assist eligible small employers in selecting qualified
28 health plans and/or other or additional health plans certified by the
29 Marketplace and to determine small employer eligibility for purposes of
30 small employer tax credits. It is the intent of the legislature, by
31 codifying the Marketplace in state statute, to continue to promote qual-
32 ity and affordable health coverage and care, reduce the number of unin-
33 sured persons, provide a transparent marketplace, educate consumers and
34 assist individuals with access to coverage, premium assistance tax cred-
35 its and cost-sharing reductions. In addition, the legislature declares
36 the intent that the Marketplace continue to be properly integrated with
37 insurance affordability programs, including Medicaid, child health plus
38 and the basic health program, the 1332 state innovation program, and
39 such other health insurance programs as determined by the commissioner.
40 § 9. Subdivision 8 of section 268-a of the public health law, as added
41 by section 2 of part T of chapter 57 of the laws of 2019, is amened to
42 read as follows:
43 8. "Insurance affordability program" means Medicaid, child health
44 plus, the basic health program, the 1332 state innovation program, post-
45 partum extended coverage and any other health insurance subsidy program
46 designated as such by the commissioner.
47 § 10. This act shall take effect immediately and shall be deemed to
48 have been in full force and effect on and after April 1, 2024; provided,
49 however, that section six of this act shall only take effect upon the
50 commissioner of health obtaining and maintaining all necessary approvals
51 from the secretary of health and human services and the secretary of the
52 treasury based on an amended application for a waiver for state inno-
53 vation pursuant to section 1332 of the patient protection and affordable
54 care act (P.L. 111-148) and subdivision 25 of section 268-c of the
55 public health law; and provided, further, that the commissioner of
56 health shall notify the legislative bill drafting commission upon the
S. 8307--A 49 A. 8807--A
1 occurrence of the enactment of the legislation provided for in section
2 six of this act in order that the commission may maintain an accurate
3 and timely effective data base of the official text of the laws of the
4 state of New York in furtherance of effectuating the provisions of
5 section 44 of the legislative law and section 70-b of the public offi-
6 cers law.
7 PART K
8 Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266
9 of the laws of 1986, amending the civil practice law and rules and other
10 laws relating to malpractice and professional medical conduct, as
11 amended by section 1 of part F of chapter 57 of the laws of 2023, is
12 amended and a new subdivision 9 is added to read as follows:
13 (a) The superintendent of financial services and the commissioner of
14 health or their designee shall, from funds available in the hospital
15 excess liability pool created pursuant to subdivision 5 of this section,
16 purchase a policy or policies for excess insurance coverage, as author-
17 ized by paragraph 1 of subsection (e) of section 5502 of the insurance
18 law; or from an insurer, other than an insurer described in section 5502
19 of the insurance law, duly authorized to write such coverage and actual-
20 ly writing medical malpractice insurance in this state; or shall
21 purchase equivalent excess coverage in a form previously approved by the
22 superintendent of financial services for purposes of providing equiv-
23 alent excess coverage in accordance with section 19 of chapter 294 of
24 the laws of 1985, for medical or dental malpractice occurrences between
25 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988,
26 between July 1, 1988 and June 30, 1989, between July 1, 1989 and June
27 30, 1990, between July 1, 1990 and June 30, 1991, between July 1, 1991
28 and June 30, 1992, between July 1, 1992 and June 30, 1993, between July
29 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995,
30 between July 1, 1995 and June 30, 1996, between July 1, 1996 and June
31 30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998
32 and June 30, 1999, between July 1, 1999 and June 30, 2000, between July
33 1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002,
34 between July 1, 2002 and June 30, 2003, between July 1, 2003 and June
35 30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005
36 and June 30, 2006, between July 1, 2006 and June 30, 2007, between July
37 1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009,
38 between July 1, 2009 and June 30, 2010, between July 1, 2010 and June
39 30, 2011, between July 1, 2011 and June 30, 2012, between July 1, 2012
40 and June 30, 2013, between July 1, 2013 and June 30, 2014, between July
41 1, 2014 and June 30, 2015, between July 1, 2015 and June 30, 2016,
42 between July 1, 2016 and June 30, 2017, between July 1, 2017 and June
43 30, 2018, between July 1, 2018 and June 30, 2019, between July 1, 2019
44 and June 30, 2020, between July 1, 2020 and June 30, 2021, between July
45 1, 2021 and June 30, 2022, between July 1, 2022 and June 30, 2023, [and]
46 between July 1, 2023 and June 30, 2024, and between July 1, 2024 and
47 June 30, 2025 or reimburse the hospital where the hospital purchases
48 equivalent excess coverage as defined in subparagraph (i) of paragraph
49 (a) of subdivision 1-a of this section for medical or dental malpractice
50 occurrences between July 1, 1987 and June 30, 1988, between July 1, 1988
51 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July
52 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992,
53 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June
54 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995
S. 8307--A 50 A. 8807--A
1 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July
2 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999,
3 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June
4 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002
5 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July
6 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006,
7 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June
8 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009
9 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July
10 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013,
11 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June
12 30, 2015, between July 1, 2015 and June 30, 2016, between July 1, 2016
13 and June 30, 2017, between July 1, 2017 and June 30, 2018, between July
14 1, 2018 and June 30, 2019, between July 1, 2019 and June 30, 2020,
15 between July 1, 2020 and June 30, 2021, between July 1, 2021 and June
16 30, 2022, between July 1, 2022 and June 30, 2023, [and] between July 1,
17 2023 and June 30, 2024, and between July 1, 2024 and June 30, 2025 for
18 physicians or dentists certified as eligible for each such period or
19 periods pursuant to subdivision 2 of this section by a general hospital
20 licensed pursuant to article 28 of the public health law; provided that
21 no single insurer shall write more than fifty percent of the total
22 excess premium for a given policy year; and provided, however, that such
23 eligible physicians or dentists must have in force an individual policy,
24 from an insurer licensed in this state of primary malpractice insurance
25 coverage in amounts of no less than one million three hundred thousand
26 dollars for each claimant and three million nine hundred thousand
27 dollars for all claimants under that policy during the period of such
28 excess coverage for such occurrences or be endorsed as additional
29 insureds under a hospital professional liability policy which is offered
30 through a voluntary attending physician ("channeling") program previous-
31 ly permitted by the superintendent of financial services during the
32 period of such excess coverage for such occurrences. During such period,
33 such policy for excess coverage or such equivalent excess coverage
34 shall, when combined with the physician's or dentist's primary malprac-
35 tice insurance coverage or coverage provided through a voluntary attend-
36 ing physician ("channeling") program, total an aggregate level of two
37 million three hundred thousand dollars for each claimant and six million
38 nine hundred thousand dollars for all claimants from all such policies
39 with respect to occurrences in each of such years provided, however, if
40 the cost of primary malpractice insurance coverage in excess of one
41 million dollars, but below the excess medical malpractice insurance
42 coverage provided pursuant to this act, exceeds the rate of nine percent
43 per annum, then the required level of primary malpractice insurance
44 coverage in excess of one million dollars for each claimant shall be in
45 an amount of not less than the dollar amount of such coverage available
46 at nine percent per annum; the required level of such coverage for all
47 claimants under that policy shall be in an amount not less than three
48 times the dollar amount of coverage for each claimant; and excess cover-
49 age, when combined with such primary malpractice insurance coverage,
50 shall increase the aggregate level for each claimant by one million
51 dollars and three million dollars for all claimants; and provided
52 further, that, with respect to policies of primary medical malpractice
53 coverage that include occurrences between April 1, 2002 and June 30,
54 2002, such requirement that coverage be in amounts no less than one
55 million three hundred thousand dollars for each claimant and three
S. 8307--A 51 A. 8807--A
1 million nine hundred thousand dollars for all claimants for such occur-
2 rences shall be effective April 1, 2002.
3 (9) This subdivision shall apply only to excess insurance coverage or
4 equivalent excess coverage for physicians or dentists that is eligible
5 to be paid for from funds available in the hospital excess liability
6 pool.
7 (a) Notwithstanding any law to the contrary, for any policy period
8 beginning on or after July 1, 2023, excess coverage shall be purchased
9 by a physician or dentist directly from a provider of excess insurance
10 coverage or equivalent excess coverage. At the conclusion of the policy
11 period the superintendent of financial services and the commissioner of
12 health or their designee shall, from funds available in the hospital
13 excess liability pool created pursuant to subdivision 5 of this section,
14 pay fifty percent of the premium to the provider of excess insurance
15 coverage or equivalent excess coverage, and the remaining fifty percent
16 shall be paid one year thereafter.
17 (b) Notwithstanding any law to the contrary, for any policy period
18 beginning on or after July 1, 2024, excess coverage shall be purchased
19 by a physician or dentist directly from a provider of excess insurance
20 coverage or equivalent excess coverage. Such provider of excess insur-
21 ance coverage or equivalent excess coverage shall bill, in a manner
22 consistent with paragraph (f) of this subdivision, the physician or
23 dentist for an amount equal to fifty percent of the premium for such
24 coverage, as established pursuant to paragraph (d) of this subdivision,
25 during the policy period. At the conclusion of the policy period the
26 superintendent of financial services and the commissioner of health or
27 their designee shall, from funds available in the hospital excess
28 liability pool created pursuant to subdivision 5 of this section, pay
29 half of the remaining fifty percent of the premium to the provider of
30 excess insurance coverage or equivalent excess coverage, and the remain-
31 ing twenty-five percent shall be paid one year thereafter. If the funds
32 available in the hospital excess liability pool are insufficient to meet
33 the percent of the costs of the excess coverage, the provisions of
34 subdivision 8 of this section shall apply.
35 (c) If at the conclusion of the policy period, a physician or dentist,
36 eligible for excess coverage paid for from funds available in the hospi-
37 tal excess liability pool, has failed to pay an amount equal to fifty
38 percent of the premium as established pursuant to paragraph (d) of this
39 subdivision, such excess coverage shall be cancelled and shall be null
40 and void as of the first day on or after the commencement of a policy
41 period where the liability for payment pursuant to this subdivision has
42 not been met. The provider of excess coverage shall remit any portion of
43 premium paid by the eligible physician or dentist for such a policy
44 period.
45 (d) The superintendent of financial services shall establish a rate
46 consistent with subdivision 3 of this section that providers of excess
47 insurance coverage or equivalent excess coverage will charge for such
48 coverage for each policy period. For the policy period beginning July 1,
49 2024, the superintendent of financial services may direct that the
50 premium for that policy period be the same as it was for the policy
51 period that concluded June 30, 2023.
52 (e) No provider of excess insurance coverage or equivalent excess
53 coverage shall issue excess coverage to which this subdivision applies
54 to any physician or dentist unless that physician or dentist meets the
55 eligibility requirements for such coverage set forth in this section.
56 The superintendent of financial services and the commissioner of health
S. 8307--A 52 A. 8807--A
1 or their designee shall not make any payment under this subdivision to a
2 provider of excess insurance coverage or equivalent excess coverage for
3 excess coverage issued to a physician or dentist who does not meet the
4 eligibility requirements for participation in the hospital excess
5 liability pool program set forth in this section.
6 (f) A provider of excess insurance coverage or equivalent coverage
7 that issues excess coverage under this subdivision shall bill the physi-
8 cian or dentist for the portion of the premium required under paragraph
9 (a) of this subdivision in twelve equal monthly installments or in such
10 other manner as the physician or dentist may agree.
11 (g) The superintendent of financial services in consultation with the
12 commissioner of health may promulgate regulations giving effect to the
13 provisions of this subdivision.
14 § 2. Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
15 amending the civil practice law and rules and other laws relating to
16 malpractice and professional medical conduct, as amended by section 2 of
17 part F of chapter 57 of the laws of 2023, is amended to read as follows:
18 (3)(a) The superintendent of financial services shall determine and
19 certify to each general hospital and to the commissioner of health the
20 cost of excess malpractice insurance for medical or dental malpractice
21 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988
22 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July
23 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992,
24 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June
25 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995
26 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July
27 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999,
28 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June
29 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002
30 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July
31 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006,
32 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June
33 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009
34 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July
35 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013,
36 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June
37 30, 2015, between July 1, 2015 and June 30, 2016, between July 1, 2016
38 and June 30, 2017, between July 1, 2017 and June 30, 2018, between July
39 1, 2018 and June 30, 2019, between July 1, 2019 and June 30, 2020,
40 between July 1, 2020 and June 30, 2021, between July 1, 2021 and June
41 30, 2022, between July 1, 2022 and June 30, 2023, [and] between July 1,
42 2023 and June 30, 2024, and between July 1, 2024 and June 30, 2025 allo-
43 cable to each general hospital for physicians or dentists certified as
44 eligible for purchase of a policy for excess insurance coverage by such
45 general hospital in accordance with subdivision 2 of this section, and
46 may amend such determination and certification as necessary.
47 (b) The superintendent of financial services shall determine and
48 certify to each general hospital and to the commissioner of health the
49 cost of excess malpractice insurance or equivalent excess coverage for
50 medical or dental malpractice occurrences between July 1, 1987 and June
51 30, 1988, between July 1, 1988 and June 30, 1989, between July 1, 1989
52 and June 30, 1990, between July 1, 1990 and June 30, 1991, between July
53 1, 1991 and June 30, 1992, between July 1, 1992 and June 30, 1993,
54 between July 1, 1993 and June 30, 1994, between July 1, 1994 and June
55 30, 1995, between July 1, 1995 and June 30, 1996, between July 1, 1996
56 and June 30, 1997, between July 1, 1997 and June 30, 1998, between July
S. 8307--A 53 A. 8807--A
1 1, 1998 and June 30, 1999, between July 1, 1999 and June 30, 2000,
2 between July 1, 2000 and June 30, 2001, between July 1, 2001 and June
3 30, 2002, between July 1, 2002 and June 30, 2003, between July 1, 2003
4 and June 30, 2004, between July 1, 2004 and June 30, 2005, between July
5 1, 2005 and June 30, 2006, between July 1, 2006 and June 30, 2007,
6 between July 1, 2007 and June 30, 2008, between July 1, 2008 and June
7 30, 2009, between July 1, 2009 and June 30, 2010, between July 1, 2010
8 and June 30, 2011, between July 1, 2011 and June 30, 2012, between July
9 1, 2012 and June 30, 2013, between July 1, 2013 and June 30, 2014,
10 between July 1, 2014 and June 30, 2015, between July 1, 2015 and June
11 30, 2016, between July 1, 2016 and June 30, 2017, between July 1, 2017
12 and June 30, 2018, between July 1, 2018 and June 30, 2019, between July
13 1, 2019 and June 30, 2020, between July 1, 2020 and June 30, 2021,
14 between July 1, 2021 and June 30, 2022, between July 1, 2022 and June
15 30, 2023, [and] between July 1, 2023 and June 30, 2024, and between July
16 1, 2024 and June 30, 2025 allocable to each general hospital for physi-
17 cians or dentists certified as eligible for purchase of a policy for
18 excess insurance coverage or equivalent excess coverage by such general
19 hospital in accordance with subdivision 2 of this section, and may amend
20 such determination and certification as necessary. The superintendent of
21 financial services shall determine and certify to each general hospital
22 and to the commissioner of health the ratable share of such cost alloca-
23 ble to the period July 1, 1987 to December 31, 1987, to the period Janu-
24 ary 1, 1988 to June 30, 1988, to the period July 1, 1988 to December 31,
25 1988, to the period January 1, 1989 to June 30, 1989, to the period July
26 1, 1989 to December 31, 1989, to the period January 1, 1990 to June 30,
27 1990, to the period July 1, 1990 to December 31, 1990, to the period
28 January 1, 1991 to June 30, 1991, to the period July 1, 1991 to December
29 31, 1991, to the period January 1, 1992 to June 30, 1992, to the period
30 July 1, 1992 to December 31, 1992, to the period January 1, 1993 to June
31 30, 1993, to the period July 1, 1993 to December 31, 1993, to the period
32 January 1, 1994 to June 30, 1994, to the period July 1, 1994 to December
33 31, 1994, to the period January 1, 1995 to June 30, 1995, to the period
34 July 1, 1995 to December 31, 1995, to the period January 1, 1996 to June
35 30, 1996, to the period July 1, 1996 to December 31, 1996, to the period
36 January 1, 1997 to June 30, 1997, to the period July 1, 1997 to December
37 31, 1997, to the period January 1, 1998 to June 30, 1998, to the period
38 July 1, 1998 to December 31, 1998, to the period January 1, 1999 to June
39 30, 1999, to the period July 1, 1999 to December 31, 1999, to the period
40 January 1, 2000 to June 30, 2000, to the period July 1, 2000 to December
41 31, 2000, to the period January 1, 2001 to June 30, 2001, to the period
42 July 1, 2001 to June 30, 2002, to the period July 1, 2002 to June 30,
43 2003, to the period July 1, 2003 to June 30, 2004, to the period July 1,
44 2004 to June 30, 2005, to the period July 1, 2005 and June 30, 2006, to
45 the period July 1, 2006 and June 30, 2007, to the period July 1, 2007
46 and June 30, 2008, to the period July 1, 2008 and June 30, 2009, to the
47 period July 1, 2009 and June 30, 2010, to the period July 1, 2010 and
48 June 30, 2011, to the period July 1, 2011 and June 30, 2012, to the
49 period July 1, 2012 and June 30, 2013, to the period July 1, 2013 and
50 June 30, 2014, to the period July 1, 2014 and June 30, 2015, to the
51 period July 1, 2015 and June 30, 2016, to the period July 1, 2016 and
52 June 30, 2017, to the period July 1, 2017 to June 30, 2018, to the peri-
53 od July 1, 2018 to June 30, 2019, to the period July 1, 2019 to June 30,
54 2020, to the period July 1, 2020 to June 30, 2021, to the period July 1,
55 2021 to June 30, 2022, to the period July 1, 2022 to June 30, 2023,
S. 8307--A 54 A. 8807--A
1 [and] to the period July 1, 2023 to June 30, 2024, and to the period
2 July 1, 2024 to June 30, 2025.
3 § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section
4 18 of chapter 266 of the laws of 1986, amending the civil practice law
5 and rules and other laws relating to malpractice and professional
6 medical conduct, as amended by section 3 of part F of chapter 57 of the
7 laws of 2023, are amended to read as follows:
8 (a) To the extent funds available to the hospital excess liability
9 pool pursuant to subdivision 5 of this section as amended, and pursuant
10 to section 6 of part J of chapter 63 of the laws of 2001, as may from
11 time to time be amended, which amended this subdivision, are insuffi-
12 cient to meet the costs of excess insurance coverage or equivalent
13 excess coverage for coverage periods during the period July 1, 1992 to
14 June 30, 1993, during the period July 1, 1993 to June 30, 1994, during
15 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
16 to June 30, 1996, during the period July 1, 1996 to June 30, 1997,
17 during the period July 1, 1997 to June 30, 1998, during the period July
18 1, 1998 to June 30, 1999, during the period July 1, 1999 to June 30,
19 2000, during the period July 1, 2000 to June 30, 2001, during the period
20 July 1, 2001 to October 29, 2001, during the period April 1, 2002 to
21 June 30, 2002, during the period July 1, 2002 to June 30, 2003, during
22 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
23 to June 30, 2005, during the period July 1, 2005 to June 30, 2006,
24 during the period July 1, 2006 to June 30, 2007, during the period July
25 1, 2007 to June 30, 2008, during the period July 1, 2008 to June 30,
26 2009, during the period July 1, 2009 to June 30, 2010, during the period
27 July 1, 2010 to June 30, 2011, during the period July 1, 2011 to June
28 30, 2012, during the period July 1, 2012 to June 30, 2013, during the
29 period July 1, 2013 to June 30, 2014, during the period July 1, 2014 to
30 June 30, 2015, during the period July 1, 2015 to June 30, 2016, during
31 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017
32 to June 30, 2018, during the period July 1, 2018 to June 30, 2019,
33 during the period July 1, 2019 to June 30, 2020, during the period July
34 1, 2020 to June 30, 2021, during the period July 1, 2021 to June 30,
35 2022, during the period July 1, 2022 to June 30, 2023, [and] during the
36 period July 1, 2023 to June 30, 2024, and during the period July 1, 2024
37 to June 30, 2025 allocated or reallocated in accordance with paragraph
38 (a) of subdivision 4-a of this section to rates of payment applicable to
39 state governmental agencies, each physician or dentist for whom a policy
40 for excess insurance coverage or equivalent excess coverage is purchased
41 for such period shall be responsible for payment to the provider of
42 excess insurance coverage or equivalent excess coverage of an allocable
43 share of such insufficiency, based on the ratio of the total cost of
44 such coverage for such physician to the sum of the total cost of such
45 coverage for all physicians applied to such insufficiency.
46 (b) Each provider of excess insurance coverage or equivalent excess
47 coverage covering the period July 1, 1992 to June 30, 1993, or covering
48 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
49 1994 to June 30, 1995, or covering the period July 1, 1995 to June 30,
50 1996, or covering the period July 1, 1996 to June 30, 1997, or covering
51 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
52 1998 to June 30, 1999, or covering the period July 1, 1999 to June 30,
53 2000, or covering the period July 1, 2000 to June 30, 2001, or covering
54 the period July 1, 2001 to October 29, 2001, or covering the period
55 April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to
56 June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
S. 8307--A 55 A. 8807--A
1 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
2 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
3 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
4 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
5 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
6 June 30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
7 covering the period July 1, 2012 to June 30, 2013, or covering the peri-
8 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to
9 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016, or
10 covering the period July 1, 2016 to June 30, 2017, or covering the peri-
11 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to
12 June 30, 2019, or covering the period July 1, 2019 to June 30, 2020, or
13 covering the period July 1, 2020 to June 30, 2021, or covering the peri-
14 od July 1, 2021 to June 30, 2022, or covering the period July 1, 2022 to
15 June 30, 2023, or covering the period July 1, 2023 to June 30, 2024, or
16 covering the period July 1, 2024 to June 30, 2025 shall notify a covered
17 physician or dentist by mail, mailed to the address shown on the last
18 application for excess insurance coverage or equivalent excess coverage,
19 of the amount due to such provider from such physician or dentist for
20 such coverage period determined in accordance with paragraph (a) of this
21 subdivision. Such amount shall be due from such physician or dentist to
22 such provider of excess insurance coverage or equivalent excess coverage
23 in a time and manner determined by the superintendent of financial
24 services.
25 (c) If a physician or dentist liable for payment of a portion of the
26 costs of excess insurance coverage or equivalent excess coverage cover-
27 ing the period July 1, 1992 to June 30, 1993, or covering the period
28 July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to
29 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
30 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
31 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
32 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
33 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
34 od July 1, 2001 to October 29, 2001, or covering the period April 1,
35 2002 to June 30, 2002, or covering the period July 1, 2002 to June 30,
36 2003, or covering the period July 1, 2003 to June 30, 2004, or covering
37 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
38 2005 to June 30, 2006, or covering the period July 1, 2006 to June 30,
39 2007, or covering the period July 1, 2007 to June 30, 2008, or covering
40 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
41 2009 to June 30, 2010, or covering the period July 1, 2010 to June 30,
42 2011, or covering the period July 1, 2011 to June 30, 2012, or covering
43 the period July 1, 2012 to June 30, 2013, or covering the period July 1,
44 2013 to June 30, 2014, or covering the period July 1, 2014 to June 30,
45 2015, or covering the period July 1, 2015 to June 30, 2016, or covering
46 the period July 1, 2016 to June 30, 2017, or covering the period July 1,
47 2017 to June 30, 2018, or covering the period July 1, 2018 to June 30,
48 2019, or covering the period July 1, 2019 to June 30, 2020, or covering
49 the period July 1, 2020 to June 30, 2021, or covering the period July 1,
50 2021 to June 30, 2022, or covering the period July 1, 2022 to June 30,
51 2023, or covering the period July 1, 2023 to June 30, 2024, or covering
52 the period July 1, 2024 to June 30, 2025 determined in accordance with
53 paragraph (a) of this subdivision fails, refuses or neglects to make
54 payment to the provider of excess insurance coverage or equivalent
55 excess coverage in such time and manner as determined by the superinten-
56 dent of financial services pursuant to paragraph (b) of this subdivi-
S. 8307--A 56 A. 8807--A
1 sion, excess insurance coverage or equivalent excess coverage purchased
2 for such physician or dentist in accordance with this section for such
3 coverage period shall be cancelled and shall be null and void as of the
4 first day on or after the commencement of a policy period where the
5 liability for payment pursuant to this subdivision has not been met.
6 (d) Each provider of excess insurance coverage or equivalent excess
7 coverage shall notify the superintendent of financial services and the
8 commissioner of health or their designee of each physician and dentist
9 eligible for purchase of a policy for excess insurance coverage or
10 equivalent excess coverage covering the period July 1, 1992 to June 30,
11 1993, or covering the period July 1, 1993 to June 30, 1994, or covering
12 the period July 1, 1994 to June 30, 1995, or covering the period July 1,
13 1995 to June 30, 1996, or covering the period July 1, 1996 to June 30,
14 1997, or covering the period July 1, 1997 to June 30, 1998, or covering
15 the period July 1, 1998 to June 30, 1999, or covering the period July 1,
16 1999 to June 30, 2000, or covering the period July 1, 2000 to June 30,
17 2001, or covering the period July 1, 2001 to October 29, 2001, or cover-
18 ing the period April 1, 2002 to June 30, 2002, or covering the period
19 July 1, 2002 to June 30, 2003, or covering the period July 1, 2003 to
20 June 30, 2004, or covering the period July 1, 2004 to June 30, 2005, or
21 covering the period July 1, 2005 to June 30, 2006, or covering the peri-
22 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to
23 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009, or
24 covering the period July 1, 2009 to June 30, 2010, or covering the peri-
25 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to
26 June 30, 2012, or covering the period July 1, 2012 to June 30, 2013, or
27 covering the period July 1, 2013 to June 30, 2014, or covering the peri-
28 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to
29 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017, or
30 covering the period July 1, 2017 to June 30, 2018, or covering the peri-
31 od July 1, 2018 to June 30, 2019, or covering the period July 1, 2019 to
32 June 30, 2020, or covering the period July 1, 2020 to June 30, 2021, or
33 covering the period July 1, 2021 to June 30, 2022, or covering the peri-
34 od July 1, 2022 to June 30, 2023, or covering the period July 1, 2023 to
35 June 30, 2024, or covering the period July 1, 2024 to June 30, 2025 that
36 has made payment to such provider of excess insurance coverage or equiv-
37 alent excess coverage in accordance with paragraph (b) of this subdivi-
38 sion and of each physician and dentist who has failed, refused or
39 neglected to make such payment.
40 (e) A provider of excess insurance coverage or equivalent excess
41 coverage shall refund to the hospital excess liability pool any amount
42 allocable to the period July 1, 1992 to June 30, 1993, and to the period
43 July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June
44 30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the
45 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
46 June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to
47 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
48 to June 30, 2001, and to the period July 1, 2001 to October 29, 2001,
49 and to the period April 1, 2002 to June 30, 2002, and to the period July
50 1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30,
51 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
52 July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June
53 30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the
54 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
55 June 30, 2010, and to the period July 1, 2010 to June 30, 2011, and to
56 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
S. 8307--A 57 A. 8807--A
1 to June 30, 2013, and to the period July 1, 2013 to June 30, 2014, and
2 to the period July 1, 2014 to June 30, 2015, and to the period July 1,
3 2015 to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and
4 to the period July 1, 2017 to June 30, 2018, and to the period July 1,
5 2018 to June 30, 2019, and to the period July 1, 2019 to June 30, 2020,
6 and to the period July 1, 2020 to June 30, 2021, and to the period July
7 1, 2021 to June 30, 2022, and to the period July 1, 2022 to June 30,
8 2023, and to the period July 1, 2023 to June 30, 2024, and to the period
9 July 1, 2024 to June 30, 2025 received from the hospital excess liabil-
10 ity pool for purchase of excess insurance coverage or equivalent excess
11 coverage covering the period July 1, 1992 to June 30, 1993, and covering
12 the period July 1, 1993 to June 30, 1994, and covering the period July
13 1, 1994 to June 30, 1995, and covering the period July 1, 1995 to June
14 30, 1996, and covering the period July 1, 1996 to June 30, 1997, and
15 covering the period July 1, 1997 to June 30, 1998, and covering the
16 period July 1, 1998 to June 30, 1999, and covering the period July 1,
17 1999 to June 30, 2000, and covering the period July 1, 2000 to June 30,
18 2001, and covering the period July 1, 2001 to October 29, 2001, and
19 covering the period April 1, 2002 to June 30, 2002, and covering the
20 period July 1, 2002 to June 30, 2003, and covering the period July 1,
21 2003 to June 30, 2004, and covering the period July 1, 2004 to June 30,
22 2005, and covering the period July 1, 2005 to June 30, 2006, and cover-
23 ing the period July 1, 2006 to June 30, 2007, and covering the period
24 July 1, 2007 to June 30, 2008, and covering the period July 1, 2008 to
25 June 30, 2009, and covering the period July 1, 2009 to June 30, 2010,
26 and covering the period July 1, 2010 to June 30, 2011, and covering the
27 period July 1, 2011 to June 30, 2012, and covering the period July 1,
28 2012 to June 30, 2013, and covering the period July 1, 2013 to June 30,
29 2014, and covering the period July 1, 2014 to June 30, 2015, and cover-
30 ing the period July 1, 2015 to June 30, 2016, and covering the period
31 July 1, 2016 to June 30, 2017, and covering the period July 1, 2017 to
32 June 30, 2018, and covering the period July 1, 2018 to June 30, 2019,
33 and covering the period July 1, 2019 to June 30, 2020, and covering the
34 period July 1, 2020 to June 30, 2021, and covering the period July 1,
35 2021 to June 30, 2022, and covering the period July 1, 2022 to June 30,
36 2023 for, and covering the period July 1, 2023 to June 30, 2024, and
37 covering the period July 1, 2024 to June 30, 2025 a physician or dentist
38 where such excess insurance coverage or equivalent excess coverage is
39 cancelled in accordance with paragraph (c) of this subdivision.
40 § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil
41 practice law and rules and other laws relating to malpractice and
42 professional medical conduct, as amended by section 4 of part F of chap-
43 ter 57 of the laws of 2023, is amended to read as follows:
44 § 40. The superintendent of financial services shall establish rates
45 for policies providing coverage for physicians and surgeons medical
46 malpractice for the periods commencing July 1, 1985 and ending June 30,
47 [2024] 2025; provided, however, that notwithstanding any other provision
48 of law, the superintendent shall not establish or approve any increase
49 in rates for the period commencing July 1, 2009 and ending June 30,
50 2010. The superintendent shall direct insurers to establish segregated
51 accounts for premiums, payments, reserves and investment income attrib-
52 utable to such premium periods and shall require periodic reports by the
53 insurers regarding claims and expenses attributable to such periods to
54 monitor whether such accounts will be sufficient to meet incurred claims
55 and expenses. On or after July 1, 1989, the superintendent shall impose
56 a surcharge on premiums to satisfy a projected deficiency that is
S. 8307--A 58 A. 8807--A
1 attributable to the premium levels established pursuant to this section
2 for such periods; provided, however, that such annual surcharge shall
3 not exceed eight percent of the established rate until July 1, [2024]
4 2025, at which time and thereafter such surcharge shall not exceed twen-
5 ty-five percent of the approved adequate rate, and that such annual
6 surcharges shall continue for such period of time as shall be sufficient
7 to satisfy such deficiency. The superintendent shall not impose such
8 surcharge during the period commencing July 1, 2009 and ending June 30,
9 2010. On and after July 1, 1989, the surcharge prescribed by this
10 section shall be retained by insurers to the extent that they insured
11 physicians and surgeons during the July 1, 1985 through June 30, [2024]
12 2025 policy periods; in the event and to the extent physicians and
13 surgeons were insured by another insurer during such periods, all or a
14 pro rata share of the surcharge, as the case may be, shall be remitted
15 to such other insurer in accordance with rules and regulations to be
16 promulgated by the superintendent. Surcharges collected from physicians
17 and surgeons who were not insured during such policy periods shall be
18 apportioned among all insurers in proportion to the premium written by
19 each insurer during such policy periods; if a physician or surgeon was
20 insured by an insurer subject to rates established by the superintendent
21 during such policy periods, and at any time thereafter a hospital,
22 health maintenance organization, employer or institution is responsible
23 for responding in damages for liability arising out of such physician's
24 or surgeon's practice of medicine, such responsible entity shall also
25 remit to such prior insurer the equivalent amount that would then be
26 collected as a surcharge if the physician or surgeon had continued to
27 remain insured by such prior insurer. In the event any insurer that
28 provided coverage during such policy periods is in liquidation, the
29 property/casualty insurance security fund shall receive the portion of
30 surcharges to which the insurer in liquidation would have been entitled.
31 The surcharges authorized herein shall be deemed to be income earned for
32 the purposes of section 2303 of the insurance law. The superintendent,
33 in establishing adequate rates and in determining any projected defi-
34 ciency pursuant to the requirements of this section and the insurance
35 law, shall give substantial weight, determined in his discretion and
36 judgment, to the prospective anticipated effect of any regulations
37 promulgated and laws enacted and the public benefit of stabilizing
38 malpractice rates and minimizing rate level fluctuation during the peri-
39 od of time necessary for the development of more reliable statistical
40 experience as to the efficacy of such laws and regulations affecting
41 medical, dental or podiatric malpractice enacted or promulgated in 1985,
42 1986, by this act and at any other time. Notwithstanding any provision
43 of the insurance law, rates already established and to be established by
44 the superintendent pursuant to this section are deemed adequate if such
45 rates would be adequate when taken together with the maximum authorized
46 annual surcharges to be imposed for a reasonable period of time whether
47 or not any such annual surcharge has been actually imposed as of the
48 establishment of such rates.
49 § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J of
50 chapter 63 of the laws of 2001, amending chapter 266 of the laws of
51 1986, amending the civil practice law and rules and other laws relating
52 to malpractice and professional medical conduct, as amended by section 5
53 of part F of chapter 57 of the laws of 2023, are amended to read as
54 follows:
55 § 5. The superintendent of financial services and the commissioner of
56 health shall determine, no later than June 15, 2002, June 15, 2003, June
S. 8307--A 59 A. 8807--A
1 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008,
2 June 15, 2009, June 15, 2010, June 15, 2011, June 15, 2012, June 15,
3 2013, June 15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June
4 15, 2018, June 15, 2019, June 15, 2020, June 15, 2021, June 15, 2022,
5 June 15, 2023, [and] June 15, 2024, and June 15, 2025 the amount of
6 funds available in the hospital excess liability pool, created pursuant
7 to section 18 of chapter 266 of the laws of 1986, and whether such funds
8 are sufficient for purposes of purchasing excess insurance coverage for
9 eligible participating physicians and dentists during the period July 1,
10 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003
11 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to
12 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June
13 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30,
14 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 30,
15 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
16 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30,
17 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30,
18 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30,
19 2020, or July 1, 2020 to June 30, 2021, or July 1, 2021 to June 30,
20 2022, or July 1, 2022 to June 30, 2023, or July 1, 2023 to June 30,
21 2024, or July 1, 2024 to June 30, 2025 as applicable.
22 (a) This section shall be effective only upon a determination, pursu-
23 ant to section five of this act, by the superintendent of financial
24 services and the commissioner of health, and a certification of such
25 determination to the state director of the budget, the chair of the
26 senate committee on finance and the chair of the assembly committee on
27 ways and means, that the amount of funds in the hospital excess liabil-
28 ity pool, created pursuant to section 18 of chapter 266 of the laws of
29 1986, is insufficient for purposes of purchasing excess insurance cover-
30 age for eligible participating physicians and dentists during the period
31 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July
32 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,
33 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007
34 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to
35 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June
36 30, 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
37 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30,
38 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30,
39 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30,
40 2020, or July 1, 2020 to June 30, 2021, or July 1, 2021 to June 30,
41 2022, or July 1, 2022 to June 30, 2023, or July 1, 2023 to June 30, 2024
42 , or July 1, 2024 to June 30, 2025 as applicable.
43 (e) The commissioner of health shall transfer for deposit to the
44 hospital excess liability pool created pursuant to section 18 of chapter
45 266 of the laws of 1986 such amounts as directed by the superintendent
46 of financial services for the purchase of excess liability insurance
47 coverage for eligible participating physicians and dentists for the
48 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30,
49 2003, or July 1, 2003 to June 30, 2004, or July 1, 2004 to June 30,
50 2005, or July 1, 2005 to June 30, 2006, or July 1, 2006 to June 30,
51 2007, as applicable, and the cost of administering the hospital excess
52 liability pool for such applicable policy year, pursuant to the program
53 established in chapter 266 of the laws of 1986, as amended, no later
54 than June 15, 2002, June 15, 2003, June 15, 2004, June 15, 2005, June
55 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009, June 15, 2010,
56 June 15, 2011, June 15, 2012, June 15, 2013, June 15, 2014, June 15,
S. 8307--A 60 A. 8807--A
1 2015, June 15, 2016, June 15, 2017, June 15, 2018, June 15, 2019, June
2 15, 2020, June 15, 2021, June 15, 2022, June 15, 2023, [and] June 15,
3 2024, and June 15, 2025 as applicable.
4 § 6. Section 20 of part H of chapter 57 of the laws of 2017, amending
5 the New York Health Care Reform Act of 1996 and other laws relating to
6 extending certain provisions thereto, as amended by section 6 of part F
7 of chapter 57 of the laws of 2023, is amended to read as follows:
8 § 20. Notwithstanding any law, rule or regulation to the contrary,
9 only physicians or dentists who were eligible, and for whom the super-
10 intendent of financial services and the commissioner of health, or their
11 designee, purchased, with funds available in the hospital excess liabil-
12 ity pool, a full or partial policy for excess coverage or equivalent
13 excess coverage for the coverage period ending the thirtieth of June,
14 two thousand [twenty-three] twenty-four, shall be eligible to apply for
15 such coverage for the coverage period beginning the first of July, two
16 thousand [twenty-three] twenty-four; provided, however, if the total
17 number of physicians or dentists for whom such excess coverage or equiv-
18 alent excess coverage was purchased for the policy year ending the thir-
19 tieth of June, two thousand [twenty-three] twenty-four exceeds the total
20 number of physicians or dentists certified as eligible for the coverage
21 period beginning the first of July, two thousand [twenty-three] twenty-
22 four, then the general hospitals may certify additional eligible physi-
23 cians or dentists in a number equal to such general hospital's propor-
24 tional share of the total number of physicians or dentists for whom
25 excess coverage or equivalent excess coverage was purchased with funds
26 available in the hospital excess liability pool as of the thirtieth of
27 June, two thousand [twenty-three] twenty-four, as applied to the differ-
28 ence between the number of eligible physicians or dentists for whom a
29 policy for excess coverage or equivalent excess coverage was purchased
30 for the coverage period ending the thirtieth of June, two thousand
31 [twenty-three] twenty-four and the number of such eligible physicians or
32 dentists who have applied for excess coverage or equivalent excess
33 coverage for the coverage period beginning the first of July, two thou-
34 sand [twenty-three] twenty-four.
35 § 7. This act shall take effect immediately and shall be deemed to
36 have been in full force and effect on and after April 1, 2024.
37 PART L
38 Section 1. Subdivision 9 of section 2803 of the public health law is
39 REPEALED.
40 § 2. Section 461-s of the social services law is REPEALED.
41 § 3. Subdivision 1, paragraph (f) of subdivision 3, paragraphs (a) and
42 (d) of subdivision 5 and subdivisions 5-a and 12 of section 2807-m of
43 the public health law, subdivision 1, paragraph (f) of subdivision 3,
44 paragraph (a) of subdivision 5 and subdivision 12 as amended and para-
45 graph (d) of subdivision 5 as added by section 6 of part Y of chapter 56
46 of the laws of 2020 and subdivision 5-a as amended by section 6 of part
47 C of chapter 57 of the laws of 2023, are amended to read as follows:
48 1. Definitions. For purposes of this section, the following defi-
49 nitions shall apply, unless the context clearly requires otherwise:
50 (a) ["Clinical research" means patient-oriented research, epidemiolog-
51 ic and behavioral studies, or outcomes research and health services
52 research that is approved by an institutional review board by the time
53 the clinical research position is filled.
S. 8307--A 61 A. 8807--A
1 (b) "Clinical research plan" means a plan submitted by a consortium or
2 teaching general hospital for a clinical research position which demon-
3 strates, in a form to be provided by the commissioner, the following:
4 (i) financial support for overhead, supervision, equipment and other
5 resources equal to the amount of funding provided pursuant to subpara-
6 graph (i) of paragraph (b) of subdivision five-a of this section by the
7 teaching general hospital or consortium for the clinical research posi-
8 tion;
9 (ii) experience the sponsor-mentor and teaching general hospital has
10 in clinical research and the medical field of the study;
11 (iii) methods, data collection and anticipated measurable outcomes of
12 the clinical research to be performed;
13 (iv) training goals, objectives and experience the researcher will be
14 provided to assess a future career in clinical research;
15 (v) scientific relevance, merit and health implications of the
16 research to be performed;
17 (vi) information on potential scientific meetings and peer review
18 journals where research results can be disseminated;
19 (vii) clear and comprehensive details on the clinical research posi-
20 tion;
21 (viii) qualifications necessary for the clinical research position and
22 strategy for recruitment;
23 (ix) non-duplication with other clinical research positions from the
24 same teaching general hospital or consortium;
25 (x) methods to track the career of the clinical researcher once the
26 term of the position is complete; and
27 (xi) any other information required by the commissioner to implement
28 subparagraph (i) of paragraph (b) of subdivision five-a of this section.
29 (xii) The clinical review plan submitted in accordance with this para-
30 graph may be reviewed by the commissioner in consultation with experts
31 outside the department of health.
32 (c) "Clinical research position" means a post-graduate residency posi-
33 tion which:
34 (i) shall not be required in order for the researcher to complete a
35 graduate medical education program;
36 (ii) may be reimbursed by other sources but only for costs in excess
37 of the funding distributed in accordance with subparagraph (i) of para-
38 graph (b) of subdivision five-a of this section;
39 (iii) shall exceed the minimum standards that are required by the
40 residency review committee in the specialty the researcher has trained
41 or is currently training;
42 (iv) shall not be previously funded by the teaching general hospital
43 or supported by another funding source at the teaching general hospital
44 in the past three years from the date the clinical research plan is
45 submitted to the commissioner;
46 (v) may supplement an existing research project;
47 (vi) shall be equivalent to a full-time position comprising of no less
48 than thirty-five hours per week for one or two years;
49 (vii) shall provide, or be filled by a researcher who has formalized
50 instruction in clinical research, including biostatistics, clinical
51 trial design, grant writing and research ethics;
52 (viii) shall be supervised by a sponsor-mentor who shall either (A) be
53 employed, contracted for employment or paid through an affiliated facul-
54 ty practice plan by a teaching general hospital which has received at
55 least one research grant from the National Institutes of Health in the
56 past five years from the date the clinical research plan is submitted to
S. 8307--A 62 A. 8807--A
1 the commissioner; (B) maintain a faculty appointment at a medical,
2 dental or podiatric school located in New York state that has received
3 at least one research grant from the National Institutes of Health in
4 the past five years from the date the clinical research plan is submit-
5 ted to the commissioner; or (C) be collaborating in the clinical
6 research plan with a researcher from another institution that has
7 received at least one research grant from the National Institutes of
8 Health in the past five years from the date the clinical research plan
9 is submitted to the commissioner; and
10 (ix) shall be filled by a researcher who is (A) enrolled or has
11 completed a graduate medical education program, as defined in paragraph
12 (i) of this subdivision; (B) a United States citizen, national, or
13 permanent resident of the United States; and (C) a graduate of a
14 medical, dental or podiatric school located in New York state, a gradu-
15 ate or resident in a graduate medical education program, as defined in
16 paragraph (i) of this subdivision, where the sponsoring institution, as
17 defined in paragraph (q) of this subdivision, is located in New York
18 state, or resides in New York state at the time the clinical research
19 plan is submitted to the commissioner.
20 (d)] "Consortium" means an organization or association, approved by
21 the commissioner in consultation with the council, of general hospitals
22 which provide graduate medical education, together with any affiliated
23 site; provided that such organization or association may also include
24 other providers of health care services, medical schools, payors or
25 consumers, and which meet other criteria pursuant to subdivision six of
26 this section.
27 [(e)] (b) "Council" means the New York state council on graduate
28 medical education.
29 [(f)] (c) "Direct medical education" means the direct costs of resi-
30 dents, interns and supervising physicians.
31 [(g)] (d) "Distribution period" means each calendar year set forth in
32 subdivision two of this section.
33 [(h)] (e) "Faculty" means persons who are employed by or under
34 contract for employment with a teaching general hospital or are paid
35 through a teaching general hospital's affiliated faculty practice plan
36 and maintain a faculty appointment at a medical school. Such persons
37 shall not be limited to persons with a degree in medicine.
38 [(i)] (f) "Graduate medical education program" means a post-graduate
39 medical education residency in the United States which has received
40 accreditation from a nationally recognized accreditation body or has
41 been approved by a nationally recognized organization for medical,
42 osteopathic, podiatric or dental residency programs including, but not
43 limited to, specialty boards.
44 [(j)] (g) "Indirect medical education" means the estimate of costs,
45 other than direct costs, of educational activities in teaching hospitals
46 as determined in accordance with the methodology applicable for purposes
47 of determining an estimate of indirect medical education costs for
48 reimbursement for inpatient hospital service pursuant to title XVIII of
49 the federal social security act (medicare).
50 [(k)] (h) "Medicare" means the methodology used for purposes of reim-
51 bursing inpatient hospital services provided to beneficiaries of title
52 XVIII of the federal social security act.
53 [(l)] (i) "Primary care" residents specialties shall include family
54 medicine, general pediatrics, primary care internal medicine, and prima-
55 ry care obstetrics and gynecology. In determining whether a residency is
56 in primary care, the commissioner shall consult with the council.
S. 8307--A 63 A. 8807--A
1 [(m)] (j) "Regions", for purposes of this section, shall mean the
2 regions as defined in paragraph (b) of subdivision sixteen of section
3 twenty-eight hundred seven-c of this article as in effect on June thir-
4 tieth, nineteen hundred ninety-six. For purposes of distributions pursu-
5 ant to subdivision five-a of this section, except distributions made in
6 accordance with paragraph (a) of subdivision five-a of this section,
7 "regions" shall be defined as New York city and the rest of the state.
8 [(n)] (k) "Regional pool" means a professional education pool estab-
9 lished on a regional basis by the commissioner from funds available
10 pursuant to sections twenty-eight hundred seven-s and twenty-eight
11 hundred seven-t of this article.
12 [(o)] (l) "Resident" means a person in a graduate medical education
13 program which has received accreditation from a nationally recognized
14 accreditation body or in a program approved by any other nationally
15 recognized organization for medical, osteopathic or dental residency
16 programs including, but not limited to, specialty boards.
17 [(p) "Shortage specialty" means a specialty determined by the commis-
18 sioner, in consultation with the council, to be in short supply in the
19 state of New York.
20 (q)] (m) "Sponsoring institution" means the entity that has the over-
21 all responsibility for a program of graduate medical education. Such
22 institutions shall include teaching general hospitals, medical schools,
23 consortia and diagnostic and treatment centers.
24 [(r)] (n) "Weighted resident count" means a teaching general hospi-
25 tal's total number of residents as of July first, nineteen hundred nine-
26 ty-five, including residents in affiliated non-hospital ambulatory
27 settings, reported to the commissioner. Such resident counts shall
28 reflect the weights established in accordance with rules and regulations
29 adopted by the state hospital review and planning council and approved
30 by the commissioner for purposes of implementing subdivision twenty-five
31 of section twenty-eight hundred seven-c of this article and in effect on
32 July first, nineteen hundred ninety-five. Such weights shall not be
33 applied to specialty hospitals, specified by the commissioner, whose
34 primary care mission is to engage in research, training and clinical
35 care in specialty eye and ear, special surgery, orthopedic, joint
36 disease, cancer, chronic care or rehabilitative services.
37 [(s)] (o) "Adjustment amount" means an amount determined for each
38 teaching hospital for periods prior to January first, two thousand nine
39 by:
40 (i) determining the difference between (A) a calculation of what each
41 teaching general hospital would have been paid if payments made pursuant
42 to paragraph (a-3) of subdivision one of section twenty-eight hundred
43 seven-c of this article between January first, nineteen hundred ninety-
44 six and December thirty-first, two thousand three were based solely on
45 the case mix of persons eligible for medical assistance under the
46 medical assistance program pursuant to title eleven of article five of
47 the social services law who are enrolled in health maintenance organiza-
48 tions and persons paid for under the family health plus program enrolled
49 in approved organizations pursuant to title eleven-D of article five of
50 the social services law during those years, and (B) the actual payments
51 to each such hospital pursuant to paragraph (a-3) of subdivision one of
52 section twenty-eight hundred seven-c of this article between January
53 first, nineteen hundred ninety-six and December thirty-first, two thou-
54 sand three.
S. 8307--A 64 A. 8807--A
1 (ii) reducing proportionally each of the amounts determined in subpar-
2 agraph (i) of this paragraph so that the sum of all such amounts totals
3 no more than one hundred million dollars;
4 (iii) further reducing each of the amounts determined in subparagraph
5 (ii) of this paragraph by the amount received by each hospital as a
6 distribution from funds designated in paragraph (a) of subdivision five
7 of this section attributable to the period January first, two thousand
8 three through December thirty-first, two thousand three, except that if
9 such amount was provided to a consortium then the amount of the
10 reduction for each hospital in the consortium shall be determined by
11 applying the proportion of each hospital's amount determined under
12 subparagraph (i) of this paragraph to the total of such amounts of all
13 hospitals in such consortium to the consortium award;
14 (iv) further reducing each of the amounts determined in subparagraph
15 (iii) of this paragraph by the amounts specified in paragraph [(t)] (p)
16 of this subdivision; and
17 (v) dividing each of the amounts determined in subparagraph (iii) of
18 this paragraph by seven.
19 [(t)] (p) "Extra reduction amount" shall mean an amount determined for
20 a teaching hospital for which an adjustment amount is calculated pursu-
21 ant to paragraph [(s)] (o) of this subdivision that is the hospital's
22 proportionate share of the sum of the amounts specified in paragraph
23 [(u)] (q) of this subdivision determined based upon a comparison of the
24 hospital's remaining liability calculated pursuant to paragraph [(s)]
25 (o) of this subdivision to the sum of all such hospital's remaining
26 liabilities.
27 [(u)] (q) "Allotment amount" shall mean an amount determined for
28 teaching hospitals as follows:
29 (i) for a hospital for which an adjustment amount pursuant to para-
30 graph [(s)] (o) of this subdivision does not apply, the amount received
31 by the hospital pursuant to paragraph (a) of subdivision five of this
32 section attributable to the period January first, two thousand three
33 through December thirty-first, two thousand three, or
34 (ii) for a hospital for which an adjustment amount pursuant to para-
35 graph [(s)] (o) of this subdivision applies and which received a
36 distribution pursuant to paragraph (a) of subdivision five of this
37 section attributable to the period January first, two thousand three
38 through December thirty-first, two thousand three that is greater than
39 the hospital's adjustment amount, the difference between the distrib-
40 ution amount and the adjustment amount.
41 (f) Effective January first, two thousand five through December thir-
42 ty-first, two thousand eight, each teaching general hospital shall
43 receive a distribution from the applicable regional pool based on its
44 distribution amount determined under paragraphs (c), (d) and (e) of this
45 subdivision and reduced by its adjustment amount calculated pursuant to
46 paragraph [(s)] (o) of subdivision one of this section and, for distrib-
47 utions for the period January first, two thousand five through December
48 thirty-first, two thousand five, further reduced by its extra reduction
49 amount calculated pursuant to paragraph [(t)] (p) of subdivision one of
50 this section.
51 (a) Up to thirty-one million dollars annually for the periods January
52 first, two thousand through December thirty-first, two thousand three,
53 and up to twenty-five million dollars plus the sum of the amounts speci-
54 fied in paragraph [(n)] (k) of subdivision one of this section for the
55 period January first, two thousand five through December thirty-first,
56 two thousand five, and up to thirty-one million dollars annually for the
S. 8307--A 65 A. 8807--A
1 period January first, two thousand six through December thirty-first,
2 two thousand seven, shall be set aside and reserved by the commissioner
3 from the regional pools established pursuant to subdivision two of this
4 section for supplemental distributions in each such region to be made by
5 the commissioner to consortia and teaching general hospitals in accord-
6 ance with a distribution methodology developed in consultation with the
7 council and specified in rules and regulations adopted by the commis-
8 sioner.
9 (d) Notwithstanding any other provision of law or regulation, for the
10 period January first, two thousand five through December thirty-first,
11 two thousand five, the commissioner shall distribute as supplemental
12 payments the allotment specified in paragraph [(n)] (k) of subdivision
13 one of this section.
14 5-a. Graduate medical education innovations pool. (a) Supplemental
15 distributions. (i) Thirty-one million dollars for the period January
16 first, two thousand eight through December thirty-first, two thousand
17 eight, shall be set aside and reserved by the commissioner from the
18 regional pools established pursuant to subdivision two of this section
19 and shall be available for distributions pursuant to subdivision five of
20 this section and in accordance with section 86-1.89 of title 10 of the
21 codes, rules and regulations of the state of New York as in effect on
22 January first, two thousand eight[; provided, however, for purposes of
23 funding the empire clinical research investigation program (ECRIP) in
24 accordance with paragraph eight of subdivision (e) and paragraph two of
25 subdivision (f) of section 86-1.89 of title 10 of the codes, rules and
26 regulations of the state of New York, distributions shall be made using
27 two regions defined as New York city and the rest of the state and the
28 dollar amount set forth in subparagraph (i) of paragraph two of subdivi-
29 sion (f) of section 86-1.89 of title 10 of the codes, rules and regu-
30 lations of the state of New York shall be increased from sixty thousand
31 dollars to seventy-five thousand dollars].
32 (ii) For periods on and after January first, two thousand nine,
33 supplemental distributions pursuant to subdivision five of this section
34 and in accordance with section 86-1.89 of title 10 of the codes, rules
35 and regulations of the state of New York shall no longer be made and the
36 provisions of section 86-1.89 of title 10 of the codes, rules and regu-
37 lations of the state of New York shall be null and void.
38 (b) [Empire clinical research investigator program (ECRIP). Nine
39 million one hundred twenty thousand dollars annually for the period
40 January first, two thousand nine through December thirty-first, two
41 thousand ten, and two million two hundred eighty thousand dollars for
42 the period January first, two thousand eleven, through March thirty-
43 first, two thousand eleven, nine million one hundred twenty thousand
44 dollars each state fiscal year for the period April first, two thousand
45 eleven through March thirty-first, two thousand fourteen, up to eight
46 million six hundred twelve thousand dollars each state fiscal year for
47 the period April first, two thousand fourteen through March thirty-
48 first, two thousand seventeen, up to eight million six hundred twelve
49 thousand dollars each state fiscal year for the period April first, two
50 thousand seventeen through March thirty-first, two thousand twenty, up
51 to eight million six hundred twelve thousand dollars each state fiscal
52 year for the period April first, two thousand twenty through March thir-
53 ty-first, two thousand twenty-three, and up to eight million six hundred
54 twelve thousand dollars each state fiscal year for the period April
55 first, two thousand twenty-three through March thirty-first, two thou-
56 sand twenty-six, shall be set aside and reserved by the commissioner
S. 8307--A 66 A. 8807--A
1 from the regional pools established pursuant to subdivision two of this
2 section to be allocated regionally with two-thirds of the available
3 funding going to New York city and one-third of the available funding
4 going to the rest of the state and shall be available for distribution
5 as follows:
6 Distributions shall first be made to consortia and teaching general
7 hospitals for the empire clinical research investigator program (ECRIP)
8 to help secure federal funding for biomedical research, train clinical
9 researchers, recruit national leaders as faculty to act as mentors, and
10 train residents and fellows in biomedical research skills based on
11 hospital-specific data submitted to the commissioner by consortia and
12 teaching general hospitals in accordance with clause (G) of this subpar-
13 agraph. Such distributions shall be made in accordance with the follow-
14 ing methodology:
15 (A) The greatest number of clinical research positions for which a
16 consortium or teaching general hospital may be funded pursuant to this
17 subparagraph shall be one percent of the total number of residents
18 training at the consortium or teaching general hospital on July first,
19 two thousand eight for the period January first, two thousand nine
20 through December thirty-first, two thousand nine rounded up to the near-
21 est one position.
22 (B) Distributions made to a consortium or teaching general hospital
23 shall equal the product of the total number of clinical research posi-
24 tions submitted by a consortium or teaching general hospital and
25 accepted by the commissioner as meeting the criteria set forth in para-
26 graph (b) of subdivision one of this section, subject to the reduction
27 calculation set forth in clause (C) of this subparagraph, times one
28 hundred ten thousand dollars.
29 (C) If the dollar amount for the total number of clinical research
30 positions in the region calculated pursuant to clause (B) of this
31 subparagraph exceeds the total amount appropriated for purposes of this
32 paragraph, including clinical research positions that continue from and
33 were funded in prior distribution periods, the commissioner shall elimi-
34 nate one-half of the clinical research positions submitted by each
35 consortium or teaching general hospital rounded down to the nearest one
36 position. Such reduction shall be repeated until the dollar amount for
37 the total number of clinical research positions in the region does not
38 exceed the total amount appropriated for purposes of this paragraph. If
39 the repeated reduction of the total number of clinical research posi-
40 tions in the region by one-half does not render a total funding amount
41 that is equal to or less than the total amount reserved for that region
42 within the appropriation, the funding for each clinical research posi-
43 tion in that region shall be reduced proportionally in one thousand
44 dollar increments until the total dollar amount for the total number of
45 clinical research positions in that region does not exceed the total
46 amount reserved for that region within the appropriation. Any reduction
47 in funding will be effective for the duration of the award. No clinical
48 research positions that continue from and were funded in prior distrib-
49 ution periods shall be eliminated or reduced by such methodology.
50 (D) Each consortium or teaching general hospital shall receive its
51 annual distribution amount in accordance with the following:
52 (I) Each consortium or teaching general hospital with a one-year ECRIP
53 award shall receive its annual distribution amount in full upon
54 completion of the requirements set forth in items (I) and (II) of clause
55 (G) of this subparagraph. The requirements set forth in items (IV) and
56 (V) of clause (G) of this subparagraph must be completed by the consor-
S. 8307--A 67 A. 8807--A
1 tium or teaching general hospital in order for the consortium or teach-
2 ing general hospital to be eligible to apply for ECRIP funding in any
3 subsequent funding cycle.
4 (II) Each consortium or teaching general hospital with a two-year
5 ECRIP award shall receive its first annual distribution amount in full
6 upon completion of the requirements set forth in items (I) and (II) of
7 clause (G) of this subparagraph. Each consortium or teaching general
8 hospital will receive its second annual distribution amount in full upon
9 completion of the requirements set forth in item (III) of clause (G) of
10 this subparagraph. The requirements set forth in items (IV) and (V) of
11 clause (G) of this subparagraph must be completed by the consortium or
12 teaching general hospital in order for the consortium or teaching gener-
13 al hospital to be eligible to apply for ECRIP funding in any subsequent
14 funding cycle.
15 (E) Each consortium or teaching general hospital receiving distrib-
16 utions pursuant to this subparagraph shall reserve seventy-five thousand
17 dollars to primarily fund salary and fringe benefits of the clinical
18 research position with the remainder going to fund the development of
19 faculty who are involved in biomedical research, training and clinical
20 care.
21 (F) Undistributed or returned funds available to fund clinical
22 research positions pursuant to this paragraph for a distribution period
23 shall be available to fund clinical research positions in a subsequent
24 distribution period.
25 (G) In order to be eligible for distributions pursuant to this subpar-
26 agraph, each consortium and teaching general hospital shall provide to
27 the commissioner by July first of each distribution period, the follow-
28 ing data and information on a hospital-specific basis. Such data and
29 information shall be certified as to accuracy and completeness by the
30 chief executive officer, chief financial officer or chair of the consor-
31 tium governing body of each consortium or teaching general hospital and
32 shall be maintained by each consortium and teaching general hospital for
33 five years from the date of submission:
34 (I) For each clinical research position, information on the type,
35 scope, training objectives, institutional support, clinical research
36 experience of the sponsor-mentor, plans for submitting research outcomes
37 to peer reviewed journals and at scientific meetings, including a meet-
38 ing sponsored by the department, the name of a principal contact person
39 responsible for tracking the career development of researchers placed in
40 clinical research positions, as defined in paragraph (c) of subdivision
41 one of this section, and who is authorized to certify to the commission-
42 er that all the requirements of the clinical research training objec-
43 tives set forth in this subparagraph shall be met. Such certification
44 shall be provided by July first of each distribution period;
45 (II) For each clinical research position, information on the name,
46 citizenship status, medical education and training, and medical license
47 number of the researcher, if applicable, shall be provided by December
48 thirty-first of the calendar year following the distribution period;
49 (III) Information on the status of the clinical research plan, accom-
50 plishments, changes in research activities, progress, and performance of
51 the researcher shall be provided upon completion of one-half of the
52 award term;
53 (IV) A final report detailing training experiences, accomplishments,
54 activities and performance of the clinical researcher, and data, meth-
55 ods, results and analyses of the clinical research plan shall be
56 provided three months after the clinical research position ends; and
S. 8307--A 68 A. 8807--A
1 (V) Tracking information concerning past researchers, including but
2 not limited to (A) background information, (B) employment history, (C)
3 research status, (D) current research activities, (E) publications and
4 presentations, (F) research support, and (G) any other information
5 necessary to track the researcher; and
6 (VI) Any other data or information required by the commissioner to
7 implement this subparagraph.
8 (H) Notwithstanding any inconsistent provision of this subdivision,
9 for periods on and after April first, two thousand thirteen, ECRIP grant
10 awards shall be made in accordance with rules and regulations promulgat-
11 ed by the commissioner. Such regulations shall, at a minimum:
12 (1) provide that ECRIP grant awards shall be made with the objective
13 of securing federal funding for biomedical research, training clinical
14 researchers, recruiting national leaders as faculty to act as mentors,
15 and training residents and fellows in biomedical research skills;
16 (2) provide that ECRIP grant applicants may include interdisciplinary
17 research teams comprised of teaching general hospitals acting in collab-
18 oration with entities including but not limited to medical centers,
19 hospitals, universities and local health departments;
20 (3) provide that applications for ECRIP grant awards shall be based on
21 such information requested by the commissioner, which shall include but
22 not be limited to hospital-specific data;
23 (4) establish the qualifications for investigators and other staff
24 required for grant projects eligible for ECRIP grant awards; and
25 (5) establish a methodology for the distribution of funds under ECRIP
26 grant awards.
27 (c)] Physician loan repayment program. One million nine hundred sixty
28 thousand dollars for the period January first, two thousand eight
29 through December thirty-first, two thousand eight, one million nine
30 hundred sixty thousand dollars for the period January first, two thou-
31 sand nine through December thirty-first, two thousand nine, one million
32 nine hundred sixty thousand dollars for the period January first, two
33 thousand ten through December thirty-first, two thousand ten, four
34 hundred ninety thousand dollars for the period January first, two thou-
35 sand eleven through March thirty-first, two thousand eleven, one million
36 seven hundred thousand dollars each state fiscal year for the period
37 April first, two thousand eleven through March thirty-first, two thou-
38 sand fourteen, up to one million seven hundred five thousand dollars
39 each state fiscal year for the period April first, two thousand fourteen
40 through March thirty-first, two thousand seventeen, up to one million
41 seven hundred five thousand dollars each state fiscal year for the peri-
42 od April first, two thousand seventeen through March thirty-first, two
43 thousand twenty, up to one million seven hundred five thousand dollars
44 each state fiscal year for the period April first, two thousand twenty
45 through March thirty-first, two thousand twenty-three, and up to one
46 million seven hundred five thousand dollars each state fiscal year for
47 the period April first, two thousand twenty-three through March thirty-
48 first, two thousand twenty-six, shall be set aside and reserved by the
49 commissioner from the regional pools established pursuant to subdivision
50 two of this section and shall be available for purposes of physician
51 loan repayment in accordance with subdivision ten of this section.
52 Notwithstanding any contrary provision of this section, sections one
53 hundred twelve and one hundred sixty-three of the state finance law, or
54 any other contrary provision of law, such funding shall be allocated
55 regionally with one-third of available funds going to New York city and
56 two-thirds of available funds going to the rest of the state and shall
S. 8307--A 69 A. 8807--A
1 be distributed in a manner to be determined by the commissioner without
2 a competitive bid or request for proposal process as follows:
3 (i) Funding shall first be awarded to repay loans of up to twenty-five
4 physicians who train in primary care or specialty tracks in teaching
5 general hospitals, and who enter and remain in primary care or specialty
6 practices in underserved communities, as determined by the commissioner.
7 (ii) After distributions in accordance with subparagraph (i) of this
8 paragraph, all remaining funds shall be awarded to repay loans of physi-
9 cians who enter and remain in primary care or specialty practices in
10 underserved communities, as determined by the commissioner, including
11 but not limited to physicians working in general hospitals, or other
12 health care facilities.
13 (iii) In no case shall less than fifty percent of the funds available
14 pursuant to this paragraph be distributed in accordance with subpara-
15 graphs (i) and (ii) of this paragraph to physicians identified by gener-
16 al hospitals.
17 (iv) In addition to the funds allocated under this paragraph, for the
18 period April first, two thousand fifteen through March thirty-first, two
19 thousand sixteen, two million dollars shall be available for the
20 purposes described in subdivision ten of this section;
21 (v) In addition to the funds allocated under this paragraph, for the
22 period April first, two thousand sixteen through March thirty-first, two
23 thousand seventeen, two million dollars shall be available for the
24 purposes described in subdivision ten of this section;
25 (vi) Notwithstanding any provision of law to the contrary, and subject
26 to the extension of the Health Care Reform Act of 1996, sufficient funds
27 shall be available for the purposes described in subdivision ten of this
28 section in amounts necessary to fund the remaining year commitments for
29 awards made pursuant to subparagraphs (iv) and (v) of this paragraph.
30 [(d)] (c) Physician practice support. Four million nine hundred thou-
31 sand dollars for the period January first, two thousand eight through
32 December thirty-first, two thousand eight, four million nine hundred
33 thousand dollars annually for the period January first, two thousand
34 nine through December thirty-first, two thousand ten, one million two
35 hundred twenty-five thousand dollars for the period January first, two
36 thousand eleven through March thirty-first, two thousand eleven, four
37 million three hundred thousand dollars each state fiscal year for the
38 period April first, two thousand eleven through March thirty-first, two
39 thousand fourteen, up to four million three hundred sixty thousand
40 dollars each state fiscal year for the period April first, two thousand
41 fourteen through March thirty-first, two thousand seventeen, up to four
42 million three hundred sixty thousand dollars for each state fiscal year
43 for the period April first, two thousand seventeen through March thir-
44 ty-first, two thousand twenty, up to four million three hundred sixty
45 thousand dollars for each fiscal year for the period April first, two
46 thousand twenty through March thirty-first, two thousand twenty-three,
47 and up to four million three hundred sixty thousand dollars for each
48 fiscal year for the period April first, two thousand twenty-three
49 through March thirty-first, two thousand twenty-six, shall be set aside
50 and reserved by the commissioner from the regional pools established
51 pursuant to subdivision two of this section and shall be available for
52 purposes of physician practice support. Notwithstanding any contrary
53 provision of this section, sections one hundred twelve and one hundred
54 sixty-three of the state finance law, or any other contrary provision of
55 law, such funding shall be allocated regionally with one-third of avail-
56 able funds going to New York city and two-thirds of available funds
S. 8307--A 70 A. 8807--A
1 going to the rest of the state and shall be distributed in a manner to
2 be determined by the commissioner without a competitive bid or request
3 for proposal process as follows:
4 (i) Preference in funding shall first be accorded to teaching general
5 hospitals for up to twenty-five awards, to support costs incurred by
6 physicians trained in primary or specialty tracks who thereafter estab-
7 lish or join practices in underserved communities, as determined by the
8 commissioner.
9 (ii) After distributions in accordance with subparagraph (i) of this
10 paragraph, all remaining funds shall be awarded to physicians to support
11 the cost of establishing or joining practices in underserved communi-
12 ties, as determined by the commissioner, and to hospitals and other
13 health care providers to recruit new physicians to provide services in
14 underserved communities, as determined by the commissioner.
15 (iii) In no case shall less than fifty percent of the funds available
16 pursuant to this paragraph be distributed to general hospitals in
17 accordance with subparagraphs (i) and (ii) of this paragraph.
18 [(e)] (d) Work group. For funding available pursuant to paragraphs (b)
19 and (c)[, (d) and (e)] of this subdivision:
20 (i) The department shall appoint a work group from recommendations
21 made by associations representing physicians, general hospitals and
22 other health care facilities to develop a streamlined application proc-
23 ess by June first, two thousand twelve.
24 (ii) Subject to available funding, applications shall be accepted on a
25 continuous basis. The department shall provide technical assistance to
26 applicants to facilitate their completion of applications. An applicant
27 shall be notified in writing by the department within ten days of
28 receipt of an application as to whether the application is complete and
29 if the application is incomplete, what information is outstanding. The
30 department shall act on an application within thirty days of receipt of
31 a complete application.
32 [(f)] (e) Study on physician workforce. Five hundred ninety thousand
33 dollars annually for the period January first, two thousand eight
34 through December thirty-first, two thousand ten, one hundred forty-eight
35 thousand dollars for the period January first, two thousand eleven
36 through March thirty-first, two thousand eleven, five hundred sixteen
37 thousand dollars each state fiscal year for the period April first, two
38 thousand eleven through March thirty-first, two thousand fourteen, up to
39 four hundred eighty-seven thousand dollars each state fiscal year for
40 the period April first, two thousand fourteen through March thirty-
41 first, two thousand seventeen, up to four hundred eighty-seven thousand
42 dollars for each state fiscal year for the period April first, two thou-
43 sand seventeen through March thirty-first, two thousand twenty, up to
44 four hundred eighty-seven thousand dollars each state fiscal year for
45 the period April first, two thousand twenty through March thirty-first,
46 two thousand twenty-three, and up to four hundred eighty-seven thousand
47 dollars each state fiscal year for the period April first, two thousand
48 twenty-three through March thirty-first, two thousand twenty-six, shall
49 be set aside and reserved by the commissioner from the regional pools
50 established pursuant to subdivision two of this section and shall be
51 available to fund a study of physician workforce needs and solutions
52 including, but not limited to, an analysis of residency programs and
53 projected physician workforce and community needs. The commissioner
54 shall enter into agreements with one or more organizations to conduct
55 such study based on a request for proposal process.
S. 8307--A 71 A. 8807--A
1 [(g)] (f) Diversity in medicine/post-baccalaureate program. Notwith-
2 standing any inconsistent provision of section one hundred twelve or one
3 hundred sixty-three of the state finance law or any other law, one
4 million nine hundred sixty thousand dollars annually for the period
5 January first, two thousand eight through December thirty-first, two
6 thousand ten, four hundred ninety thousand dollars for the period Janu-
7 ary first, two thousand eleven through March thirty-first, two thousand
8 eleven, one million seven hundred thousand dollars each state fiscal
9 year for the period April first, two thousand eleven through March thir-
10 ty-first, two thousand fourteen, up to one million six hundred five
11 thousand dollars each state fiscal year for the period April first, two
12 thousand fourteen through March thirty-first, two thousand seventeen, up
13 to one million six hundred five thousand dollars each state fiscal year
14 for the period April first, two thousand seventeen through March thir-
15 ty-first, two thousand twenty, up to one million six hundred five thou-
16 sand dollars each state fiscal year for the period April first, two
17 thousand twenty through March thirty-first, two thousand twenty-three,
18 and up to one million six hundred five thousand dollars each state
19 fiscal year for the period April first, two thousand twenty-three
20 through March thirty-first, two thousand twenty-six, shall be set aside
21 and reserved by the commissioner from the regional pools established
22 pursuant to subdivision two of this section and shall be available for
23 distributions to the Associated Medical Schools of New York to fund its
24 diversity program including existing and new post-baccalaureate programs
25 for minority and economically disadvantaged students and encourage
26 participation from all medical schools in New York. The associated
27 medical schools of New York shall report to the commissioner on an annu-
28 al basis regarding the use of funds for such purpose in such form and
29 manner as specified by the commissioner.
30 [(h)] (g) In the event there are undistributed funds within amounts
31 made available for distributions pursuant to this subdivision, such
32 funds may be reallocated and distributed in current or subsequent
33 distribution periods in a manner determined by the commissioner for any
34 purpose set forth in this subdivision.
35 12. Notwithstanding any provision of law to the contrary, applications
36 submitted on or after April first, two thousand sixteen, for the physi-
37 cian loan repayment program pursuant to paragraph [(c)] (b) of subdivi-
38 sion five-a of this section and subdivision ten of this section or the
39 physician practice support program pursuant to paragraph [(d)] (c) of
40 subdivision five-a of this section, shall be subject to the following
41 changes:
42 (a) Awards shall be made from the total funding available for new
43 awards under the physician loan repayment program and the physician
44 practice support program, with neither program limited to a specific
45 funding amount within such total funding available;
46 (b) An applicant may apply for an award for either physician loan
47 repayment or physician practice support, but not both;
48 (c) An applicant shall agree to practice for three years in an under-
49 served area and each award shall provide up to forty thousand dollars
50 for each of the three years; and
51 (d) To the extent practicable, awards shall be timed to be of use for
52 job offers made to applicants.
53 § 4. Subparagraph (xvi) of paragraph (a) of subdivision 7 of section
54 2807-s of the public health law, as amended by section 8 of part Y of
55 chapter 56 of the laws of 2020, is amended to read as follows:
S. 8307--A 72 A. 8807--A
1 (xvi) provided further, however, for periods prior to July first, two
2 thousand nine, amounts set forth in this paragraph shall be reduced by
3 an amount equal to the actual distribution reductions for all facilities
4 pursuant to paragraph [(s)] (o) of subdivision one of section twenty-
5 eight hundred seven-m of this article.
6 § 5. Subdivision (c) of section 92-dd of the state finance law, as
7 amended by section 9 of part Y of chapter 56 of the laws of 2020, is
8 amended to read as follows:
9 (c) The pool administrator shall, from appropriated funds transferred
10 to the pool administrator from the comptroller, continue to make
11 payments as required pursuant to sections twenty-eight hundred seven-k,
12 twenty-eight hundred seven-m (not including payments made pursuant to
13 subdivision five-b and paragraphs (b), (c)[, (d),, (f)] and [(g)] (f) of
14 subdivision five-a of section twenty-eight hundred seven-m), and twen-
15 ty-eight hundred seven-w of the public health law, paragraph (e) of
16 subdivision twenty-five of section twenty-eight hundred seven-c of the
17 public health law, paragraphs (b) and (c) of subdivision thirty of
18 section twenty-eight hundred seven-c of the public health law, paragraph
19 (b) of subdivision eighteen of section twenty-eight hundred eight of the
20 public health law, subdivision seven of section twenty-five hundred-d of
21 the public health law and section eighty-eight of chapter one of the
22 laws of nineteen hundred ninety-nine.
23 § 6. Paragraph (c) of subdivision 1 of section 461-b of the social
24 services law is REPEALED.
25 § 7. Article 27-H of the public health law is REPEALED.
26 § 8. Paragraph (c) of subdivision 11 of section 230 of the public
27 health law, as amended by chapter 343 of the laws of 1980, subparagraph
28 (ii) as amended by section 10 of part B of chapter 57 of the laws of
29 2023, is amended to read as follows:
30 (c) Notwithstanding the foregoing, no physician shall be responsible
31 for reporting pursuant to paragraph (a) of this subdivision with respect
32 to any information discovered by such physician solely as a result of:
33 [(i)] Participation in a properly conducted mortality and/or morbidity
34 conference, departmental meeting or a medical or tissue committee
35 constituted pursuant to the by-laws of a hospital which is duly estab-
36 lished pursuant to article twenty-eight of the public health law, unless
37 the procedures of such conference, department or committee of such
38 hospital shall have been declared to be unacceptable for the purpose
39 hereof by the commissioner, and provided that the obligations of report-
40 ing such information when appropriate to do so shall be the responsibil-
41 ity of the chairperson of such conference, department or committee[,
42 or].
43 [(ii) Participation and membership during a three year demonstration
44 period in a physician committee of the Medical Society of the State of
45 New York or the New York State Osteopathic Society whose purpose is to
46 confront and refer to treatment physicians who are thought to be suffer-
47 ing from alcoholism, drug abuse, or mental illness. Such demonstration
48 period shall commence on April first, nineteen hundred eighty and termi-
49 nate on May thirty-first, nineteen hundred eighty-three. An additional
50 demonstration period shall commence on June first, nineteen hundred
51 eighty-three and terminate on March thirty-first, nineteen hundred
52 eighty-six. An additional demonstration period shall commence on April
53 first, nineteen hundred eighty-six and terminate on March thirty-first,
54 nineteen hundred eighty-nine. An additional demonstration period shall
55 commence April first, nineteen hundred eighty-nine and terminate March
56 thirty-first, nineteen hundred ninety-two. An additional demonstration
S. 8307--A 73 A. 8807--A
1 period shall commence April first, nineteen hundred ninety-two and
2 terminate March thirty-first, nineteen hundred ninety-five. An addi-
3 tional demonstration period shall commence on April first, nineteen
4 hundred ninety-five and terminate on March thirty-first, nineteen
5 hundred ninety-eight. An additional demonstration period shall commence
6 on April first, nineteen hundred ninety-eight and terminate on March
7 thirty-first, two thousand three. An additional demonstration period
8 shall commence on April first, two thousand three and terminate on March
9 thirty-first, two thousand thirteen. An additional demonstration period
10 shall commence April first, two thousand thirteen and terminate on March
11 thirty-first, two thousand eighteen. An additional demonstration period
12 shall commence April first, two thousand eighteen and terminate on July
13 first, two thousand twenty-eight provided, however, that the commission-
14 er may prescribe requirements for the continuation of such demonstration
15 program, including periodic reviews of such programs and submission of
16 any reports and data necessary to permit such reviews. During these
17 additional periods, the provisions of this subparagraph shall also apply
18 to a physician committee of a county medical society.]
19 § 9. Paragraph (g) of subdivision 11 of section 230 of the public
20 health law is REPEALED and paragraph (h) is relettered paragraph (g).
21 § 10. This act shall take effect immediately and shall be deemed to
22 have been in full force and effect on and after April 1, 2024; provided,
23 however, the amendments to subparagraph (xvi) of paragraph (a) of subdi-
24 vision 7 of section 2807-s of the public health law made by section four
25 of this act shall not affect the expiration of such section and shall be
26 deemed to expire therewith.
27 PART M
28 Section 1. Subparagraph 3 of paragraph (b) of subdivision 4 of section
29 366 of the social services law, as added by section 2 of part D of chap-
30 ter 56 of the laws of 2013, is amended to read as follows:
31 (3) (A) A child [under] between the [age] ages of six and nineteen who
32 is determined eligible for medical assistance under the provisions of
33 this section, shall, consistent with applicable federal requirements,
34 remain eligible for such assistance until [the earlier of:
35 (i)] the last day of the month which is twelve months following the
36 determination [or redetermination] or renewal of eligibility for such
37 assistance[; or
38 (ii) the last day of the month in which the child reaches the age of
39 nineteen].
40 (B) A child under the age of six who is determined eligible for
41 medical assistance under the provisions of this section, shall, consist-
42 ent with applicable federal requirements, remain continuously eligible
43 for medical assistance coverage until the later of:
44 (i) the last day of the twelfth month following the determination or
45 renewal of eligibility for such assistance; or
46 (ii) the last day of the month in which the child reaches the age of
47 six.
48 § 2. Subdivision 6 of section 2510 of the public health law is amended
49 by adding a new paragraph (e) to read as follows:
50 (e) an eligible child under six years of age shall, consistent with
51 applicable federal requirements, remain continuously enrolled until the
52 later of:
53 (i) the last day of the twelfth month following the date of enrollment
54 or recertification in the child health insurance plan; or
S. 8307--A 74 A. 8807--A
1 (ii) the last day of the month in which the child reaches the age of
2 six.
3 § 3. This act shall take effect January 1, 2025.
4 PART N
5 Section 1. Paragraph (d) of subdivision 4 of section 206 of the public
6 health law, as added by chapter 602 of the laws of 2007, is amended and
7 a new paragraph (e) is added to read as follows:
8 (d) assess civil penalties against a public water system which
9 provides water to the public for human consumption through pipes or
10 other constructed conveyances, as further defined in the state sanitary
11 code or, in the case of mass gatherings, the person who holds or
12 promotes the mass gathering as defined in subdivision five of section
13 two hundred twenty-five of this article not to exceed twenty-five thou-
14 sand dollars per day, for each violation of or failure to comply with
15 any term or provision of the state sanitary code as it relates to public
16 water systems that serve a population of five thousand or more persons
17 or any mass gatherings, which penalty may be assessed after a hearing or
18 an opportunity to be heard[.];
19 (e) notwithstanding section sixty-five hundred thirty of the education
20 law, issue a non-patient specific statewide standing order for the
21 provision of doula services for pregnant, birthing, and postpartum indi-
22 viduals through twelve months postpartum.
23 § 2. Subdivision 3 of section 2504 of the public health law, as added
24 by chapter 976 of the laws of 1984, is amended to read as follows:
25 3. Any person, including a minor, who is pregnant may give effective
26 consent for any and all medical, dental, health and hospital services
27 relating to [prenatal] reproductive health care, including consent to
28 terminate a pregnancy for any reason.
29 § 3. The opening paragraph of section 2599-aa of the public health
30 law, as added by chapter 1 of the laws of 2019, is amended to read as
31 follows:
32 The legislature finds that comprehensive reproductive health care is a
33 fundamental component of every individual's health, privacy and
34 equality, including minors. Therefore, it is the policy of the state
35 that:
36 § 4. The public health law is amended by adding a new section
37 2599-bb-1 to read as follows:
38 § 2599-bb-1. Contraception. 1. A health care practitioner licensed,
39 certified, or authorized under title eight of the education law, acting
40 within their lawful scope of practice, may prescribe or distribute a
41 contraceptive device or medication when, according to the practitioner's
42 reasonable and good faith professional judgment based on the facts of
43 the patient's case, they determine the patient is able to medically
44 tolerate such treatment.
45 2. This article shall be construed and applied consistent with and
46 subject to applicable laws and applicable and authorized regulations
47 governing health care procedures.
48 § 5. Section 2504 of the public health law is amended by adding a new
49 subdivision 8 to read as follows:
50 8. Drug, cannabis, or alcohol testing for pregnant or postpartum indi-
51 viduals.
52 (a) Definition. As used in this subdivision, "test" shall mean a test
53 using a biological sample, including, but not limited to, urine, blood,
54 or hair, for the presence of drugs, cannabis, or alcohol.
S. 8307--A 75 A. 8807--A
1 (b) Unless legally authorized to do so, no health care professional
2 licensed, certified, or authorized under title eight of the education
3 law shall:
4 (i) perform a drug, cannabis, or alcohol test on a person who is preg-
5 nant or up to one year postpartum unless:
6 (A) the pregnant or postpartum patient gives prior verbal or written
7 informed consent specific to the drug, cannabis, or alcohol test; and
8 (B) the performance of the drug, cannabis, or alcohol test is within
9 the scope of medical care being provided to the patient.
10 (c) Verbal or written informed consent to a drug, cannabis, or alcohol
11 test pursuant to this subdivision shall occur prior to administration,
12 in language understandable to the pregnant or postpartum patient, under
13 circumstances that provide such person sufficient opportunity to consid-
14 er whether or not to authorize the drug, cannabis, or alcohol test and
15 minimize the possibility of coercion or undue influence, and shall
16 consist of verbal authorization memorialized in the medical record or
17 written authorization that is dated and signed. Such authorization shall
18 include the following:
19 (i) a statement explaining that consenting to a drug, cannabis, or
20 alcohol test is voluntary and requires written or verbal informed
21 consent, except when conditions under subdivision four of this section
22 or paragraph (d) of this subdivision are met;
23 (ii) a statement that testing positive for drugs, cannabis, or alcohol
24 could have legal consequences;
25 (iii) a statement explaining the extent of confidentiality of the test
26 results;
27 (iv) a statement of the medical purpose of the test; and
28 (v) a general description of the test.
29 (d) Drug, cannabis, or alcohol testing pursuant to this subdivision
30 may be performed without consent of the patient when, in the health care
31 professional's judgment, an emergency exists and the patient is in imme-
32 diate need of medical attention, and an attempt to secure consent would
33 result in delay of treatment that could increase the risk to the
34 patient's life or health. In the case that drug, cannabis, or alcohol
35 testing is performed under these circumstances, the results shall be
36 discussed with the patient, in language understandable to the patient
37 and shall consist of verbal notification or written notification that is
38 dated, signed, and includes the following:
39 (i) a statement that testing positive for drugs, cannabis, or alcohol
40 could have legal consequences;
41 (ii) a statement in the medical record with a description of the emer-
42 gency that necessitated unconsented drug, cannabis, or alcohol testing;
43 and
44 (iii) a statement explaining the extent of confidentiality of the
45 results.
46 (e) Nothing in this section shall diminish any other requirement to
47 obtain informed consent for a drug, cannabis, or alcohol test or any
48 other procedure.
49 § 6. This act shall take effect immediately and shall be deemed to
50 have been in full force and effect on and after April 1, 2024.
51 PART O
52 Section 1. Subdivision 1 of section 2807-k of the public health law is
53 amended by adding a new paragraph (h) to read as follows:
S. 8307--A 76 A. 8807--A
1 (h) "Underinsured" shall mean an individual with out of pocket medical
2 costs that amount to more than ten percent of such individual's gross
3 annual income for the past twelve months.
4 § 2. Subdivision 9-a of section 2807-k of the public health law, as
5 added by section 39-a of part A of chapter 57 of the laws of 2006 and
6 paragraph (k) as added by section 43 of part B of chapter 58 of the laws
7 of 2008, is amended to read as follows:
8 9-a. (a) As a condition for participation in pool distributions
9 authorized pursuant to this section and section twenty-eight hundred
10 seven-w of this article for periods on and after January first, two
11 thousand nine, general hospitals shall, effective for periods on and
12 after January first, two thousand seven, establish financial aid poli-
13 cies and procedures, in accordance with the provisions of this subdivi-
14 sion, for reducing charges otherwise applicable to low-income individ-
15 uals without health insurance or underinsured individuals, or who have
16 exhausted their health insurance benefits, and who can demonstrate an
17 inability to pay full charges, and also, at the hospital's discretion,
18 for reducing or discounting the collection of co-pays and deductible
19 payments from those individuals who can demonstrate an inability to pay
20 such amounts.
21 (b) Such reductions from charges for [uninsured] patients with incomes
22 below at least [three] four hundred percent of the federal poverty level
23 shall result in a charge to such individuals that does not exceed [the
24 greater of] the amount that would have been paid for the same services
25 [by the "highest volume payor" for such general hospital as defined in
26 subparagraph (v) of this paragraph, or for services provided pursuant to
27 title XVIII of the federal social security act (medicare), or for
28 services] provided pursuant to title XIX of the federal social security
29 act (medicaid), and provided further that such amounts shall be adjusted
30 according to income level as follows:
31 (i) For patients with incomes [at or] below at least [one] two hundred
32 percent of the federal poverty level, the hospital shall [collect no
33 more than a nominal payment amount, consistent with guidelines estab-
34 lished by the commissioner] waive all charges. No nominal payment shall
35 be collected;
36 (ii) For patients with incomes between at least [one] two hundred
37 [one] percent and [one] up to three hundred [fifty] percent of the
38 federal poverty level, the hospital shall collect no more than the
39 amount identified after application of a proportional sliding fee sched-
40 ule under which patients with lower incomes shall pay the lowest amount.
41 Such schedule shall provide that the amount the hospital may collect for
42 such patients increases [from the nominal amount described in subpara-
43 graph (i) of this paragraph] in equal increments as the income of the
44 patient increases, up to a maximum of [twenty] ten percent of the
45 [greater of the] amount that would have been paid for the same services
46 [by the "highest volume payor" for such general hospital, as defined in
47 subparagraph (v) of this paragraph, or for services provided pursuant to
48 title XVIII of the federal social security act (medicare) or for
49 services] provided pursuant to title XIX of the federal social security
50 act (medicaid), or for underinsured patients, up to a maximum of ten
51 percent of the amount that would have been paid pursuant to such
52 patient's insurance cost sharing;
53 (iii) For patients with incomes between at least [one] three hundred
54 [fifty-one] one percent and [two] four hundred [fifty] percent of the
55 federal poverty level, the hospital shall collect no more than the
56 amount identified after application of a proportional sliding fee sched-
S. 8307--A 77 A. 8807--A
1 ule under which patients with lower income shall pay the lowest amounts.
2 Such schedule shall provide that the amount the hospital may collect for
3 such patients increases from the [twenty] ten percent figure described
4 in subparagraph (ii) of this paragraph in equal increments as the income
5 of the patient increases, up to a maximum of [the greater] twenty
6 percent of the amount that would have been paid for the same services
7 [by the "highest volume payor" for such general hospital, as defined in
8 subparagraph (v) of this paragraph, or for services provided pursuant to
9 title XVIII of the federal social security act (medicare) or for
10 services] provided pursuant to title XIX of the federal social security
11 act (medicaid), or for underinsured patients, up to a maximum of twenty
12 percent of the amount that would have been paid pursuant to such
13 patient's insurance cost sharing; [and
14 (iv) For patients with incomes between at least two hundred fifty-one
15 percent and three hundred percent of the federal poverty level, the
16 hospital shall collect no more than the greater of the amount that would
17 have been paid for the same services by the "highest volume payor" for
18 such general hospital as defined in subparagraph (v) of this paragraph,
19 or for services provided pursuant to title XVIII of the federal social
20 security act (medicare), or for services provided pursuant to title XIX
21 of the federal social security act (medicaid).
22 (v) For the purposes of this paragraph, "highest volume payor" shall
23 mean the insurer, corporation or organization licensed, organized or
24 certified pursuant to article thirty-two, forty-two or forty-three of
25 the insurance law or article forty-four of this chapter, or other third-
26 party payor, which has a contract or agreement to pay claims for
27 services provided by the general hospital and incurred the highest
28 volume of claims in the previous calendar year.
29 (vi) A hospital may implement policies and procedures to permit, but
30 not require, consideration on a case-by-case basis of exceptions to the
31 requirements described in subparagraphs (i) and (ii) of this paragraph
32 based upon the existence of significant assets owned by the patient that
33 should be taken into account in determining the appropriate payment
34 amount for that patient's care, provided, however, that such proposed
35 policies and procedures shall be subject to the prior review and
36 approval of the commissioner and, if approved, shall be included in the
37 hospital's financial assistance policy established pursuant to this
38 section, and provided further that, if such approval is granted, the
39 maximum amount that may be collected shall not exceed the greater of the
40 amount that would have been paid for the same services by the "highest
41 volume payor" for such general hospital as defined in subparagraph (v)
42 of this paragraph, or for services provided pursuant to title XVIII of
43 the federal social security act (medicare), or for services provided
44 pursuant to title XIX of the federal social security act (medicaid). In
45 the event that a general hospital reviews a patient's assets in deter-
46 mining payment adjustments such policies and procedures shall not
47 consider as assets a patient's primary residence, assets held in a tax-
48 deferred or comparable retirement savings account, college savings
49 accounts, or cars used regularly by a patient or immediate family
50 members.
51 (vii)] (iv) Nothing in this paragraph shall be construed to limit a
52 hospital's ability to establish patient eligibility for payment
53 discounts at income levels higher than those specified herein and/or to
54 provide greater payment discounts for eligible patients than those
55 required by this paragraph.
S. 8307--A 78 A. 8807--A
1 (c) Such policies and procedures shall be clear, understandable, in
2 writing and publicly available in summary form and each general hospital
3 participating in the pool shall ensure that every patient is made aware
4 of the existence of such policies and procedures and is provided, in a
5 timely manner, with a summary of such policies and procedures [upon
6 request]. Any summary provided to patients shall, at a minimum, include
7 specific information as to income levels used to determine eligibility
8 for assistance, a description of the primary service area of the hospi-
9 tal and the means of applying for assistance. For general hospitals with
10 twenty-four hour emergency departments, such policies and procedures
11 shall require the written notification of patients during the intake and
12 registration process, and during discharge of the patient, and through
13 the conspicuous posting of language-appropriate information in the
14 general hospital, and information on bills and statements sent to
15 patients, that financial aid may be available to qualified patients and
16 how to obtain further information. For specialty hospitals without twen-
17 ty-four hour emergency departments, such notification shall take place
18 through written materials provided to patients during the intake and
19 registration process prior to the provision of any health care services
20 or procedures, and during discharge of the patient, and through informa-
21 tion on bills and statements sent to patients, that financial aid may be
22 available to qualified patients and how to obtain further information.
23 Application materials shall include a notice to patients that upon
24 submission of a completed application, including any information or
25 documentation needed to determine the patient's eligibility pursuant to
26 the hospital's financial assistance policy, the patient may disregard
27 any bills until the hospital has rendered a decision on the application
28 in accordance with this paragraph.
29 (d) Such policies and procedures shall include clear, objective crite-
30 ria for determining a patient's ability to pay and for providing such
31 adjustments to payment requirements as are necessary. In addition to
32 adjustment mechanisms such as sliding fee schedules and discounts to
33 fixed standards, such policies and procedures shall also provide for the
34 use of installment plans for the payment of outstanding balances by
35 patients pursuant to the provisions of the hospital's financial assist-
36 ance policy. The monthly payment under such a plan shall not exceed
37 [ten] five percent of the gross monthly income of the patient[,
38 provided, however, that if patient assets are considered under such a
39 policy, then patient assets which are not excluded assets pursuant to
40 subparagraph (vi) of paragraph (b) of this subdivision may be considered
41 in addition to the limit on monthly payments]. The rate of interest
42 charged to the patient on the unpaid balance, if any, shall not exceed
43 [the rate for a ninety-day security issued by the United States Depart-
44 ment of Treasury, plus .5] two percent and no plan shall include an
45 accelerator or similar clause under which a higher rate of interest is
46 triggered upon a missed payment. If such policies and procedures include
47 a requirement of a deposit prior to non-emergent, medically-necessary
48 care, such deposit must be included as part of any financial aid consid-
49 eration. Such policies and procedures shall be applied consistently to
50 all eligible patients.
51 (e) Such policies and procedures shall permit patients to apply for
52 assistance [within at least ninety days of the date of discharge or date
53 of service and provide at least twenty days for patients to submit a
54 completed application] at any time during the collection process. Such
55 policies and procedures may require that patients seeking payment
56 adjustments provide appropriate financial information and documentation
S. 8307--A 79 A. 8807--A
1 in support of their application, provided, however, that such applica-
2 tion process shall not be unduly burdensome or complex. General hospi-
3 tals shall, upon request, assist patients in understanding the hospi-
4 tal's policies and procedures and in applying for payment adjustments.
5 Application forms shall be printed in the "primary languages" of
6 patients served by the general hospital. For the purposes of this para-
7 graph, "primary languages" shall include any language that is either (i)
8 used to communicate, during at least five percent of patient visits in a
9 year, by patients who cannot speak, read, write or understand the
10 English language at the level of proficiency necessary for effective
11 communication with health care providers, or (ii) spoken by non-English
12 speaking individuals comprising more than one percent of the primary
13 hospital service area population, as calculated using demographic infor-
14 mation available from the United States Bureau of the Census, supple-
15 mented by data from school systems. Decisions regarding such applica-
16 tions shall be made within thirty days of receipt of a completed
17 application. Such policies and procedures shall require that the hospi-
18 tal issue any denial/approval of such application in writing with infor-
19 mation on how to appeal the denial and shall require the hospital to
20 establish an appeals process under which it will evaluate the denial of
21 an application. Nothing in this subdivision shall be interpreted as
22 prohibiting a hospital from making the availability of financial assist-
23 ance contingent upon the patient first applying for coverage under title
24 XIX of the social security act (medicaid) or another insurance program
25 if, in the judgment of the hospital, the patient may be eligible for
26 medicaid or another insurance program, and upon the patient's cooper-
27 ation in following the hospital's financial assistance application
28 requirements, including the provision of information needed to make a
29 determination on the patient's application in accordance with the hospi-
30 tal's financial assistance policy.
31 (f) Such policies and procedures shall provide that patients with
32 incomes below [three] four hundred percent of the federal poverty level
33 are deemed presumptively eligible for payment adjustments and shall
34 conform to the requirements set forth in paragraph (b) of this subdivi-
35 sion, provided, however, that nothing in this subdivision shall be
36 interpreted as precluding hospitals from extending such payment adjust-
37 ments to other patients, either generally or on a case-by-case basis.
38 Such policies and procedures shall provide financial aid for emergency
39 hospital services, including emergency transfers pursuant to the federal
40 emergency medical treatment and active labor act (42 USC 1395dd), to
41 patients who reside in New York state and for medically necessary hospi-
42 tal services for patients who reside in the hospital's primary service
43 area as determined according to criteria established by the commission-
44 er. In developing such criteria, the commissioner shall consult with
45 representatives of the hospital industry, health care consumer advocates
46 and local public health officials. Such criteria shall be made available
47 to the public no less than thirty days prior to the date of implementa-
48 tion and shall, at a minimum:
49 (i) prohibit a hospital from developing or altering its primary
50 service area in a manner designed to avoid medically underserved commu-
51 nities or communities with high percentages of uninsured residents;
52 (ii) ensure that every geographic area of the state is included in at
53 least one general hospital's primary service area so that eligible
54 patients may access care and financial assistance; and
55 (iii) require the hospital to notify the commissioner upon making any
56 change to its primary service area, and to include a description of its
S. 8307--A 80 A. 8807--A
1 primary service area in the hospital's annual implementation report
2 filed pursuant to subdivision three of section twenty-eight hundred
3 three-l of this article.
4 (g) Nothing in this subdivision shall be interpreted as precluding
5 hospitals from extending payment adjustments for medically necessary
6 non-emergency hospital services to patients outside of the hospital's
7 primary service area. For patients determined to be eligible for finan-
8 cial aid under the terms of a hospital's financial aid policy, such
9 policies and procedures shall prohibit any limitations on financial aid
10 for services based on the medical condition of the applicant, other than
11 typical limitations or exclusions based on medical necessity or the
12 clinical or therapeutic benefit of a procedure or treatment.
13 (h) Such policies and procedures shall prohibit the denial of admis-
14 sion or denial of treatment for services that are reasonably anticipated
15 to be medically necessary because the patient has an unpaid medical
16 bill. Such policies and procedures shall [not permit] prohibit the
17 forced sale or foreclosure of a patient's primary residence in order to
18 collect an outstanding medical bill and shall require the hospital to
19 refrain from sending an account to collection if the patient has submit-
20 ted a completed application for financial aid, including any required
21 supporting documentation, while the hospital determines the patient's
22 eligibility for such aid. Such policies and procedures shall prohibit
23 the sale of medical debt accumulated pursuant to this section to a third
24 party, unless the third party explicitly purchases such medical debt in
25 order to relieve the debt of the patient. Such policies and procedures
26 shall provide for written notification, which shall include notification
27 on a patient bill, to a patient not less than thirty days prior to the
28 referral of debts for collection and shall require that the collection
29 agency obtain the hospital's written consent prior to commencing a legal
30 action. Such policies and procedures shall prohibit a hospital from
31 commencing a legal action related to the recovery of medical debt or
32 unpaid bills against patients with incomes below four hundred percent of
33 the federal poverty level. In any legal action related to the recovery
34 of medical debt or unpaid bills by or on behalf of a hospital, the
35 complaint shall be accompanied by an affidavit by the hospital's chief
36 financial officer stating that based upon the hospital's reasonable
37 effort to determine the patient's income, the patient whom they are
38 taking legal action against does not have an income below four hundred
39 percent of the federal poverty level. Such policies and procedures shall
40 require all general hospital staff who interact with patients or have
41 responsibility for billing and collections to be trained in such poli-
42 cies and procedures, and require the implementation of a mechanism for
43 the general hospital to measure its compliance with such policies and
44 procedures. Such policies and procedures shall require that any
45 collection agency under contract with a general hospital for the
46 collection of debts follow the hospital's financial assistance policy,
47 including providing information to patients on how to apply for finan-
48 cial assistance where appropriate. Such policies and procedures shall
49 prohibit collections from a patient who is determined to be eligible for
50 medical assistance pursuant to title XIX of the federal social security
51 act at the time services were rendered and for which services medicaid
52 payment is available.
53 (i) Reports required to be submitted to the department by each general
54 hospital as a condition for participation in the pools, and which
55 contain, in accordance with applicable regulations, a certification from
56 an independent certified public accountant or independent licensed
S. 8307--A 81 A. 8807--A
1 public accountant or an attestation from a senior official of the hospi-
2 tal that the hospital is in compliance with conditions of participation
3 in the pools, shall also contain, for reporting periods on and after
4 January first, two thousand seven:
5 (i) a report on hospital costs incurred and uncollected amounts in
6 providing services to eligible patients without insurance[, including
7 the amount of care provided for a nominal payment amount,] during the
8 period covered by the report;
9 (ii) hospital costs incurred and uncollected amounts for deductibles
10 and coinsurance for eligible patients with insurance or other third-par-
11 ty payor coverage;
12 (iii) the number of patients, including their age, race, ethnicity,
13 gender and insurance status, organized according to United States postal
14 service zip code, who applied for financial assistance pursuant to the
15 hospital's financial assistance policy, and the number, organized
16 according to United States postal service zip code, whose applications
17 were approved and whose applications were denied;
18 (iv) the reimbursement received for indigent care from the pool estab-
19 lished pursuant to this section;
20 (v) the amount of funds that have been expended on charity care from
21 charitable bequests made or trusts established for the purpose of
22 providing financial assistance to patients who are eligible in accord-
23 ance with the terms of such bequests or trusts;
24 (vi) for hospitals located in social services districts in which the
25 district allows hospitals to assist patients with such applications, the
26 number of applications for eligibility under title XIX of the social
27 security act (medicaid) that the hospital assisted patients in complet-
28 ing and the number denied and approved; and
29 (vii) the hospital's financial losses resulting from services provided
30 under medicaid[; and
31 (viii) the number of liens placed on the primary residences of
32 patients through the collection process used by a hospital].
33 (j) Within ninety days of the effective date of this subdivision each
34 hospital shall submit to the commissioner a written report on its poli-
35 cies and procedures for financial assistance to patients which are used
36 by the hospital on the effective date of this subdivision. Such report
37 shall include copies of its policies and procedures, including material
38 which is distributed to patients, and a description of the hospital's
39 financial aid policies and procedures. Such description shall include
40 the income levels of patients on which eligibility is based, the finan-
41 cial aid eligible patients receive and the means of calculating such
42 aid, and the service area, if any, used by the hospital to determine
43 eligibility.
44 (k) In the event it is determined by the commissioner that the state
45 will be unable to secure all necessary federal approvals to include, as
46 part of the state's approved state plan under title nineteen of the
47 federal social security act, a requirement, as set forth in paragraph
48 [one] (a) of this subdivision, that compliance with this subdivision is
49 a condition of participation in pool distributions authorized pursuant
50 to this section and section twenty-eight hundred seven-w of this arti-
51 cle, then such condition of participation shall be deemed null and void
52 and, notwithstanding section twelve of this chapter, failure to comply
53 with the provisions of this subdivision by a hospital on and after the
54 date of such determination shall make such hospital liable for a civil
55 penalty not to exceed ten thousand dollars for each such violation. The
S. 8307--A 82 A. 8807--A
1 imposition of such civil penalties shall be subject to the provisions of
2 section twelve-a of this chapter.
3 (l) A hospital or its collection agent shall not commence a civil
4 action against a patient or delegate a collection activity to a debt
5 collector for nonpayment for at least one hundred eighty days after the
6 first post-service bill is issued and until a hospital has made reason-
7 able efforts to determine whether a patient qualifies for financial
8 assistance.
9 § 3. The public health law is amended by adding a new section 18-c to
10 read as follows:
11 § 18-c. Separate patient consent for treatment and payment for health
12 care services. Informed consent from a patient to provide any treatment,
13 procedure, examination or other direct health care services shall be
14 obtained separately from such patient's consent to pay for the services.
15 Consent to pay for any health care services by a patient shall not be
16 given prior to the patient receiving such services and discussing treat-
17 ment costs. For purposes of this section, "consent" means an action
18 which: (a) clearly and conspicuously communicates the individual's
19 authorization of an act or practice; (b) is made in the absence of any
20 mechanism in the user interface that has the purpose or substantial
21 effect of obscuring, subverting, or impairing decision-making or choice
22 to obtain consent; and (c) cannot be inferred from inaction.
23 § 4. The general business law is amended by adding two new sections
24 349-g and 519-a to read as follows:
25 § 349-g. Restrictions on applications for and use of credit cards and
26 medical financial products. 1. For purposes of this section, the follow-
27 ing terms shall have the following meanings:
28 (a) "Medical financial products" shall mean medical credit cards and
29 third-party medical installment loans.
30 (b) "Health care provider" shall mean a health care professional
31 licensed, registered or certified pursuant to title eight of the educa-
32 tion law.
33 (c) "Provider offices" shall mean either of the following:
34 (i) An office of a health care provider in solo practice; or
35 (ii) An office in which services or goods are personally provided by
36 the health care provider or by employees in that office, or personally
37 by independent contractors in that office, in accordance with law.
38 Employees and independent contractors shall be licensed or certified
39 when licensure or certification is required by law.
40 2. It shall be prohibited for any individual to complete any portion
41 of an application for medical financial products for the patient or
42 otherwise arrange for or establish an application that is not completely
43 filled out by the patient.
44 § 519-a. Medical financial products; payment for health care services.
45 1. For purposes of this section, the following terms shall have the
46 following meanings:
47 (a) "Credit card" shall have the same meaning as in section five
48 hundred eleven of this article.
49 (b) "Medical credit card" means a credit card issued under an open-end
50 or closed-end plan offered specifically for the payment of health care
51 services, products, or devices provided to a person.
52 2. No health care provider shall require credit card pre-authorization
53 nor require the patient to have a credit card on file prior to providing
54 emergency or medically necessary medical services to such patient.
55 3. Health care providers shall notify all patients about the risks of
56 paying for medical services with a credit card. Such notification shall
S. 8307--A 83 A. 8807--A
1 highlight the fact that by using a credit card to pay for medical
2 services, the patient is forgoing state and federal protections that
3 regard medical debt. The commissioner of health shall have the authori-
4 ty and sole discretion to set requirements for the contents of such
5 notices.
6 § 5. This act shall take effect six months after it shall have become
7 a law.
8 PART P
9 Section 1. Section 8 of part C of chapter 57 of the laws of 2022
10 amending the public health law and the education law relating to allow-
11 ing pharmacists to direct limited service laboratories and order and
12 administer COVID-19 and influenza tests and modernizing nurse practi-
13 tioners, is amended to read as follows:
14 § 8. This act shall take effect immediately and shall be deemed to
15 have been in full force and effect on and after April 1, 2022; provided,
16 however, that sections [one, two,] three[,] and four[, six and seven] of
17 this act shall expire and be deemed repealed [two years after it shall
18 have become a law] April 1, 2026.
19 § 2. Section 5 of chapter 21 of the laws of 2011 amending the educa-
20 tion law relating to authorizing pharmacists to perform collaborative
21 drug therapy management with physicians in certain settings, as amended
22 by section 5 of part CC of chapter 57 of the laws of 2022, is amended to
23 read as follows:
24 § 5. This act shall take effect on the one hundred twentieth day after
25 it shall have become a law[, provided, however, that the provisions of
26 sections two, three, and four of this act shall expire and be deemed
27 repealed July 1, 2024]; provided, however, that the amendments to subdi-
28 vision 1 of section 6801 of the education law made by section one of
29 this act shall be subject to the expiration and reversion of such subdi-
30 vision pursuant to section 8 of chapter 563 of the laws of 2008, when
31 upon such date the provisions of section one-a of this act shall take
32 effect; provided, further, that effective immediately, the addition,
33 amendment and/or repeal of any rule or regulation necessary for the
34 implementation of this act on its effective date are authorized and
35 directed to be made and completed on or before such effective date.
36 § 3. This act shall take effect immediately and shall be deemed to
37 have been in full force and effect on and after April 1, 2024.
38 PART Q
39 Section 1. Section 6542 of the education law, as amended by chapter 48
40 of the laws of 2012, subdivisions 3 and 5 as amended by section 1 of
41 part T of chapter 57 of the laws of 2013, is amended to read as follows:
42 § 6542. Performance of medical services. 1. Notwithstanding any other
43 provision of law, a physician assistant may perform medical services,
44 but only when under the supervision of a physician and only when such
45 acts and duties as are assigned to him or her are within the scope of
46 practice of such supervising physician unless otherwise permitted by
47 this section.
48 1-a. (a) A physician assistant may practice without the supervision of
49 a physician under the following circumstances:
50 (i) Where the physician assistant, licensed under section sixty-five
51 hundred forty-one of this article has practiced for more than eight
52 thousand hours; and
S. 8307--A 84 A. 8807--A
1 (A) is practicing in primary care. For purposes of this clause,
2 "primary care" shall mean non-surgical care in the fields of general
3 pediatrics, general adult medicine, general geriatric medicine, general
4 internal medicine, obstetrics and gynecology, family medicine, or such
5 other related areas as determined by the commissioner of health; or
6 (B) is employed by a health system or hospital established under arti-
7 cle twenty-eight of the public health law, and the health system or
8 hospital determines the physician assistant meets the qualifications of
9 the medical staff bylaws and the health system or hospital gives the
10 physician assistant privileges; and
11 (ii) Where a physician assistant licensed under section sixty-five
12 hundred forty-one of this article has completed a program approved by
13 the department of health, in consultation with the department, when such
14 services are performed within the scope of such program.
15 (b) The department and the department of health are authorized to
16 promulgate and update regulations pursuant to this section.
17 2. [Supervision] Where supervision is required by this section, it
18 shall be continuous but shall not be construed as necessarily requiring
19 the physical presence of the supervising physician at the time and place
20 where such services are performed.
21 3. [No physician shall employ or supervise more than four physician
22 assistants in his or her private practice.
23 4.] Nothing in this article shall prohibit a hospital from employing
24 physician assistants provided they [work under the supervision of a
25 physician designated by the hospital and not beyond the scope of prac-
26 tice of such physician. The numerical limitation of subdivision three of
27 this section shall not apply to services performed in a hospital.
28 5. Notwithstanding any other provision of this article, nothing shall
29 prohibit a physician employed by or rendering services to the department
30 of corrections and community supervision under contract from supervising
31 no more than six physician assistants in his or her practice for the
32 department of corrections and community supervision.
33 6. Notwithstanding any other provision of law, a trainee in an
34 approved program may perform medical services when such services are
35 performed within the scope of such program.] meet the qualifications of
36 the medical staff bylaws and are given privileges and otherwise meet the
37 requirements of this section.
38 4. A physician assistant shall be authorized to prescribe, dispense,
39 order, administer, or procure items necessary to commence or complete a
40 course of therapy.
41 5. A physician assistant may prescribe and order a patient specific
42 order or non-patient specific regimen to a licensed pharmacist or regis-
43 tered professional nurse, pursuant to regulations promulgated by the
44 commissioner of health, and consistent with the public health law, for
45 administering immunizations. Nothing in this subdivision shall authorize
46 unlicensed persons to administer immunizations, vaccines or other drugs.
47 [7] 6. Nothing in this article, or in article thirty-seven of the
48 public health law, shall be construed to authorize physician assistants
49 to perform those specific functions and duties specifically delegated by
50 law to those persons licensed as allied health professionals under the
51 public health law or this chapter.
52 § 2. Subdivision 1 of section 3701 of the public health law, as
53 amended by chapter 48 of the laws of 2012, is amended to read as
54 follows:
55 1. to promulgate regulations defining and restricting the duties
56 [which may be assigned to] of physician assistants [by their supervising
S. 8307--A 85 A. 8807--A
1 physician, the degree of supervision required and the manner in which
2 such duties may be performed] consistent with section sixty-five hundred
3 forty-two of the education law.;
4 § 3. Section 3702 of the public health law, as amended by chapter 48
5 of the laws of 2012, is amended to read as follows:
6 § 3702. Special provisions. 1. Inpatient medical orders. A licensed
7 physician assistant employed or extended privileges by a hospital may,
8 if permissible under the bylaws, rules and regulations of the hospital,
9 write medical orders, including those for controlled substances and
10 durable medical equipment, for inpatients [under the care of the physi-
11 cian responsible for his or her supervision. Countersignature of such
12 orders may be required if deemed necessary and appropriate by the super-
13 vising physician or the hospital, but in no event shall countersignature
14 be required prior to execution].
15 2. Withdrawing blood. A licensed physician assistant or certified
16 nurse practitioner acting within his or her lawful scope of practice may
17 supervise and direct the withdrawal of blood for the purpose of deter-
18 mining the alcoholic or drug content therein under subparagraph one of
19 paragraph (a) of subdivision four of section eleven hundred ninety-four
20 of the vehicle and traffic law, notwithstanding any provision to the
21 contrary in clause (ii) of such subparagraph.
22 3. Prescriptions for controlled substances. A licensed physician
23 assistant, in good faith and acting within his or her lawful scope of
24 practice, and to the extent assigned by his or her supervising physician
25 as applicable by section sixty-five hundred forty-two of the education
26 law, may prescribe controlled substances as a practitioner under article
27 thirty-three of this chapter, to patients under the care of such physi-
28 cian responsible for his or her supervision. The commissioner, in
29 consultation with the commissioner of education, may promulgate such
30 regulations as are necessary to carry out the purposes of this section.
31 § 4. Section 3703 of the public health law, as amended by chapter 48
32 of the laws of 2012, is amended to read as follows:
33 § 3703. Statutory construction. A physician assistant may perform any
34 function in conjunction with a medical service lawfully performed by the
35 physician assistant, in any health care setting, that a statute author-
36 izes or directs a physician to perform and that is appropriate to the
37 education, training and experience of the licensed physician assistant
38 and within the ordinary practice of the supervising physician, as appli-
39 cable pursuant to section sixty-five hundred forty-two of the education
40 law. This section shall not be construed to increase or decrease the
41 lawful scope of practice of a physician assistant under the education
42 law.
43 § 5. Paragraph a of subdivision 2 of section 902 of the education law,
44 as amended by chapter 376 of the laws of 2015, is amended to read as
45 follows:
46 a. The board of education, and the trustee or board of trustees of
47 each school district, shall employ, at a compensation to be agreed upon
48 by the parties, a qualified physician, a physician assistant, or a nurse
49 practitioner to the extent authorized by the nurse practice act and
50 consistent with subdivision three of section six thousand nine hundred
51 two of this chapter, to perform the duties of the director of school
52 health services, including any duties conferred on the school physician
53 or school medical inspector under any provision of law, to perform and
54 coordinate the provision of health services in the public schools and to
55 provide health appraisals of students attending the public schools in
56 the city or district. The physicians, physicians assistants or nurse
S. 8307--A 86 A. 8807--A
1 practitioners so employed shall be duly licensed pursuant to applicable
2 law.
3 § 6. Subdivision 5 of section 6810 of the education law, as added by
4 chapter 881 of the laws of 1972, is amended to read as follows:
5 5. Records of all prescriptions filled or refilled shall be maintained
6 for a period of at least five years and upon request made available for
7 inspection and copying by a representative of the department. Such
8 records shall indicate date of filling or refilling, [doctor's]
9 prescriber's name, patient's name and address and the name or initials
10 of the pharmacist who prepared, compounded, or dispensed the
11 prescription. Records of prescriptions for controlled substances shall
12 be maintained pursuant to requirements of article thirty-three of the
13 public health law.
14 § 7. Subdivision 27 of section 3302 of the public health law, as
15 amended by chapter 92 of the laws of 2021, is amended to read as
16 follows:
17 27. "Practitioner" means:
18 A physician, physician assistant, dentist, podiatrist, veterinarian,
19 scientific investigator, or other person licensed, or otherwise permit-
20 ted to dispense, administer or conduct research with respect to a
21 controlled substance in the course of a licensed professional practice
22 or research licensed pursuant to this article. Such person shall be
23 deemed a "practitioner" only as to such substances, or conduct relating
24 to such substances, as is permitted by [his] their license, permit or
25 otherwise permitted by law.
26 § 8. Section 6908 of the education law is amended by adding a new
27 subdivision 3 to read as follows:
28 3. This article shall not be construed as prohibiting medication
29 related tasks provided by a certified medication aide working in a resi-
30 dential health care facility, as defined in section twenty-eight hundred
31 one of the public health law, in accordance with regulations developed
32 by the commissioner, in consultation with the commissioner of health.
33 The commissioner, in consultation with the commissioner of health, shall
34 adopt regulations governing certified medication aides that, at a mini-
35 mum, shall:
36 a. specify the medication-related tasks that may be performed by
37 certified medication aides pursuant to this subdivision. Such tasks
38 shall include the administration of medications which are routine and
39 pre-filled or otherwise packaged in a manner that promotes relative ease
40 of administration, provided that administration of medications by
41 injection, sterile procedures, and central line maintenance shall be
42 prohibited. Provided, however, such prohibition shall not apply to
43 injections of insulin or other injections for diabetes care, to
44 injections of low molecular weight heparin, and to pre-filled auto-in-
45 jections of naloxone and epinephrine for emergency purposes, and
46 provided, further, that entities employing certified medication aides
47 pursuant to this subdivision shall establish a systematic approach to
48 address drug diversion;
49 b. provide that medication-related tasks performed by certified medi-
50 cation aides may be performed only under the supervision of a registered
51 professional nurse licensed in New York state, as set forth in this
52 subdivision and subdivision twelve of section sixty-nine hundred nine of
53 this article;
54 c. establish a process by which a registered professional nurse may
55 assign medication-related tasks to a certified medication aide. Such
56 process shall include, but not be limited to:
S. 8307--A 87 A. 8807--A
1 (i) allowing assignment of medication-related tasks to a certified
2 medication aide only where such certified medication aide has demon-
3 strated to the satisfaction of the supervising registered professional
4 nurse competency in every medication-related task that such certified
5 medication aide is authorized to perform, a willingness to perform such
6 medication-related tasks, and the ability to effectively and efficiently
7 communicate with the individual receiving services and understand such
8 individual's needs;
9 (ii) authorizing the supervising registered professional nurse to
10 revoke any assigned medication-related task from a certified medication
11 aide for any reason; and
12 (iii) authorizing multiple registered professional nurses to jointly
13 agree to assign medication-related tasks to a certified medication aide,
14 provided further that only one registered professional nurse shall be
15 required to determine if the certified medication aide has demonstrated
16 competency in the medication-related task to be performed;
17 d. provide that medication-related tasks may be performed only in
18 accordance with and pursuant to an authorized health practitioner's
19 ordered care;
20 e. provide that only a certified nurse aide may perform medication-re-
21 lated tasks as a certified medication aide when such aide has:
22 (i) a valid New York state nurse aide certificate;
23 (ii) a high school diploma, or its equivalent;
24 (iii) evidence of being at least eighteen years old;
25 (iv) at least one year of experience providing nurse aide services in
26 a residential health care facility licensed pursuant to article twenty-
27 eight of the public health law or a similarly licensed facility in
28 another state or United States territory;
29 (v) the ability to read, write, and speak English and to perform basic
30 math skills;
31 (vi) completed the requisite training and demonstrated competencies of
32 a certified medication aide as determined by the commissioner of health
33 in consultation with the commissioner;
34 (vii) successfully completed competency examinations satisfactory to
35 the commissioner of health in consultation with the commissioner; and
36 (viii) meets other appropriate qualifications as determined by the
37 commissioner of health in consultation with the commissioner;
38 f. prohibit a certified medication aide from holding themselves out,
39 or accepting employment as, a person licensed to practice nursing under
40 the provisions of this article;
41 g. provide that a certified medication aide is not required nor
42 permitted to assess the medication or medical needs of an individual;
43 h. provide that a certified medication aide shall not be authorized to
44 perform any medication-related tasks or activities pursuant to this
45 subdivision that are outside the scope of practice of a licensed practi-
46 cal nurse or any medication-related tasks that have not been appropri-
47 ately assigned by the supervising registered professional nurse;
48 i. provide that a certified medication aide shall document all medica-
49 tion-related tasks provided to an individual, including medication
50 administration to each individual through the use of a medication admin-
51 istration record; and
52 j. provide that the supervising registered professional nurse shall
53 retain the discretion to decide whether to assign medication-related
54 tasks to certified medication aides under this program and shall not be
55 subject to coercion, retaliation, or the threat of retaliation.
S. 8307--A 88 A. 8807--A
1 § 9. Section 6909 of the education law is amended by adding two new
2 subdivisions 12 and 13 to read as follows:
3 12. A registered professional nurse, while working for a residential
4 health care facility licensed pursuant to article twenty-eight of the
5 public health law, may, in accordance with this subdivision, assign
6 certified medication aides to perform medication-related tasks for indi-
7 viduals pursuant to the provisions of subdivision three of section
8 sixty-nine hundred eight of this article and supervise certified medica-
9 tion aides who perform assigned medication-related tasks.
10 13. Notwithstanding subdivision seven of section sixty-five hundred
11 nine of this title, a certified nurse practitioner may directly assign
12 and supervise a medical assistant in an outpatient setting the task of
13 drawing and administering immunizations to patients, provided such
14 medical assistant receives appropriate training from the certified nurse
15 practitioner and the certified nurse practitioner remains responsible
16 for the actions of the medical assistant.
17 § 10. Paragraph (a) of subdivision 3 of section 2803-j of the public
18 health law, as added by chapter 717 of the laws of 1989, is amended to
19 read as follows:
20 (a) Identification of individuals who have successfully completed a
21 nurse aide training and competency evaluation program, [or] a nurse aide
22 competency evaluation program, or a medication aide program;
23 § 11. Section 6527 of the education law is amended by adding a new
24 subdivision 12 to read as follows:
25 12. Notwithstanding subdivision eleven of section sixty-five hundred
26 thirty of this title, a licensed physician may directly assign and
27 supervise a medical assistant in an outpatient setting the task of draw-
28 ing and administering immunizations to patients, provided such medical
29 assistant receives appropriate training from the licensed physician and
30 the licensed physician remains responsible for the actions of the
31 medical assistant.
32 § 12. Section 6545 of the education law, as amended by chapter 48 of
33 the laws of 2012, is amended to read as follows:
34 § 6545. [Emergency services rendered by physician assistant] Special
35 provisions. 1. Notwithstanding any inconsistent provision of any gener-
36 al, special or local law, any physician assistant properly licensed in
37 this state who voluntarily and without the expectation of monetary
38 compensation renders first aid or emergency treatment at the scene of an
39 accident or other emergency, outside a hospital, doctor's office or any
40 other place having proper and necessary medical equipment, to a person
41 who is unconscious, ill or injured, shall not be liable for damages for
42 injuries alleged to have been sustained by such person or for damages
43 for the death of such person alleged to have occurred by reason of an
44 act or omission in the rendering of such first aid or emergency treat-
45 ment unless it is established that such injuries were or such death was
46 caused by gross negligence on the part of such physician assistant.
47 Nothing in this section shall be deemed or construed to relieve a
48 licensed physician assistant from liability for damages for injuries or
49 death caused by an act or omission on the part of a physician assistant
50 while rendering professional services in the normal and ordinary course
51 of his or her practice.
52 2. Notwithstanding subdivision eleven of section sixty-five hundred
53 thirty of this title, a licensed physician assistant authorized pursuant
54 to section sixty-five hundred forty-two of this article to practice
55 without supervision of a physician, may directly assign and supervise a
56 medical assistant in an outpatient setting the task of drawing and
S. 8307--A 89 A. 8807--A
1 administering immunizations to patients, provided such medical assistant
2 receives appropriate training from the licensed physician assistant and
3 the licensed physician assistant remains responsible for the actions of
4 the medical assistant.
5 § 13. Section 6601 of the education law, as amended by chapter 576 of
6 the laws of 2001, is amended to read as follows:
7 § 6601. Definition of practice of dentistry. The practice of the
8 profession of dentistry is defined as diagnosing, treating, operating,
9 or prescribing for any disease, pain, injury, deformity, or physical
10 condition of the oral and maxillofacial area related to restoring and
11 maintaining dental health. The practice of dentistry includes the
12 prescribing and fabrication of dental prostheses and appliances. The
13 practice of dentistry may include performing physical evaluations in
14 conjunction with the provision of dental treatment, including the admin-
15 istration of vaccinations against influenza, SARS-CoV-2, Human papillo-
16 mavirus (HPV), and vaccinations related to a declared public health
17 emergency. The practice of dentistry may also include offering of HIV,
18 hepatitis C, and hemoglobin A1C screening or diagnostic tests.
19 § 14. Section 6605-b of the education law, as added by chapter 437 of
20 the laws of 2001 and subdivision 1 as amended by chapter 198 of the laws
21 of 2022, is amended to read as follows:
22 § 6605-b. Dental hygiene restricted local infiltration and block
23 anesthesia/nitrous oxide analgesia certificate. 1. A dental hygienist
24 shall not administer or monitor nitrous oxide analgesia or local infil-
25 tration or block anesthesia in the practice of dental hygiene without a
26 dental hygiene restricted local infiltration and block
27 anesthesia/nitrous oxide analgesia certificate and except under the
28 personal supervision of a dentist and in accordance with regulations
29 promulgated by the commissioner. Personal supervision, for purposes of
30 this section, means that the supervising dentist remains in the dental
31 office where the local infiltration or block anesthesia or nitrous oxide
32 analgesia services are being performed, personally authorizes and
33 prescribes the use of local infiltration or block anesthesia or nitrous
34 oxide analgesia for the patient and, before dismissal of the patient,
35 personally examines the condition of the patient after the use of local
36 infiltration or block anesthesia or nitrous oxide analgesia is
37 completed. It is professional misconduct for a dentist to fail to
38 provide the supervision required by this section, and any dentist found
39 guilty of such misconduct under the procedures prescribed in section
40 sixty-five hundred ten of this title shall be subject to the penalties
41 prescribed in section sixty-five hundred eleven of this title.
42 2. The commissioner shall promulgate regulations establishing stand-
43 ards and procedures for the issuance of such certificate. Such standards
44 shall require completion of an educational program and/or course of
45 training or experience sufficient to ensure that a dental hygienist is
46 specifically trained in the administration and monitoring of nitrous
47 oxide analgesia and local infiltration or block anesthesia, the possible
48 effects of such use, and in the recognition of and response to possible
49 emergency situations.
50 3. The fee for a dental hygiene restricted local infiltration and
51 block anesthesia/nitrous oxide analgesia certificate shall be twenty-
52 five dollars and shall be paid on a triennial basis upon renewal of such
53 certificate. A certificate may be suspended or revoked in the same
54 manner as a license to practice dental hygiene.
55 § 15. Subdivision 1 of section 6606 of the education law, as amended
56 by chapter 239 of the laws of 2013, is amended to read as follows:
S. 8307--A 90 A. 8807--A
1 1. The practice of the profession of dental hygiene is defined as the
2 performance of dental services which shall include removing calcareous
3 deposits, accretions and stains from the exposed surfaces of the teeth
4 which begin at the epithelial attachment and applying topical agents
5 indicated for a complete dental prophylaxis, removing cement, placing or
6 removing rubber dam, removing sutures, placing matrix band, providing
7 patient education, applying topical medication, placing pre-fit ortho-
8 dontic bands, using light-cure composite material, taking cephalometric
9 radiographs, taking two-dimensional and three-dimensional photography of
10 dentition, adjusting removable appliances including nightguards, bleach-
11 ing trays, retainers and dentures, placing and exposing diagnostic
12 dental X-ray films, performing topical fluoride applications and topical
13 anesthetic applications, polishing teeth, taking medical history, chart-
14 ing caries, taking impressions for study casts, placing and removing
15 temporary restorations, administering and monitoring nitrous oxide
16 analgesia and administering and monitoring local infiltration and block
17 anesthesia, subject to certification in accordance with section sixty-
18 six hundred five-b of this article, and any other function in the defi-
19 nition of the practice of dentistry as may be delegated by a licensed
20 dentist in accordance with regulations promulgated by the commissioner.
21 The practice of dental hygiene may be conducted in the office of any
22 licensed dentist or in any appropriately equipped school or public
23 institution but must be done either under the supervision of a licensed
24 dentist or, in the case of a registered dental hygienist working for a
25 hospital as defined in article twenty-eight of the public health law[,]
26 or pursuant to a collaborative arrangement with a licensed and regis-
27 tered dentist [who has a formal relationship with the same hospital]
28 pursuant to section sixty-six hundred seven-a of this article and in
29 accordance with regulations promulgated by the department in consulta-
30 tion with the department of health. [Such collaborative arrangement
31 shall not obviate or supersede any law or regulation which requires
32 identified services to be performed under the personal supervision of a
33 dentist. When dental hygiene services are provided pursuant to a colla-
34 borative agreement, such dental hygienist shall instruct individuals to
35 visit a licensed dentist for comprehensive examination or treatment.]
36 § 16. The education law is amended by adding a new section 6607-a to
37 read as follows:
38 § 6607-a. Practice of collaborative practice dental hygiene and use of
39 title "registered dental hygienist, collaborative practice" (RDH-CP). 1.
40 The practice of the profession of dental hygiene, as defined under this
41 article, may be performed in collaboration with a licensed dentist
42 provided such services are performed in accordance with a written prac-
43 tice agreement and written practice protocols to be known as a collabo-
44 rative practice agreement. Under a collaborative practice agreement,
45 dental hygienists may perform all services which are designated in regu-
46 lation without prior evaluation of a dentist or medical professional and
47 may be performed without supervision in a collaborative practice
48 setting.
49 2. (a) The collaborative practice agreement shall include consider-
50 ation for medically compromised patients, specific medical conditions,
51 and age-and procedure-specific practice protocols, including, but not
52 limited to recommended intervals for the performance of dental hygiene
53 services and a periodicity in which an examination by a dentist should
54 occur.
55 (b) The collaborative agreement shall be:
S. 8307--A 91 A. 8807--A
1 (i) signed and maintained by the dentist, the dental hygienist, and
2 the facility, program, or organization;
3 (ii) reviewed annually by the collaborating dentist and dental hygien-
4 ist; and
5 (iii) made available to the department and other interested parties
6 upon request.
7 (c) Only one agreement between a collaborating dentist and registered
8 dental hygienist, collaborative practice (RDH-CP) may be in force at a
9 time.
10 3. Before performing any services authorized under this section, a
11 dental hygienist shall provide the patient with a written statement
12 advising the patient that the dental hygiene services provided are not a
13 substitute for a dental examination by a licensed dentist and instruct-
14 ing individuals to visit a licensed dentist for comprehensive examina-
15 tion or treatment. If the dental hygienist makes any referrals to the
16 patient for further dental procedures, the dental hygienist must fill
17 out a referral form and provide a copy of the form to the collaborating
18 dentist.
19 4. The collaborative practice dental hygienist may enter into a
20 contractual arrangement with any New York state licensed and registered
21 dentist, health care facility, program, and/or non-profit organization
22 to perform dental hygiene services in the following settings: dental
23 offices; long-term care facilities/skilled nursing facilities; public or
24 private schools; public health agencies/federally qualified health
25 centers; correctional facilities; public institutions/mental health
26 facilities; drug treatment facilities; and domestic violence shelters.
27 5. A collaborating dentist shall have collaborative agreements with no
28 more than six collaborative practice dental hygienists. The department
29 may grant exceptions to these limitations for public health settings on
30 a case-by-case basis.
31 6. A dental hygienist must make application to the department to prac-
32 tice as a registered dental hygienist, collaborative practice (RDH-CP)
33 and pay a fee set by the department. As a condition of collaborative
34 practice, the dental hygienist shall have been engaged in practice for
35 at least three years with a minimum of four thousand five hundred prac-
36 tice hours and shall complete an eight hour continuing education program
37 that includes instruction in medical emergency procedures, risk manage-
38 ment, dental hygiene jurisprudence and professional ethics.
39 § 17. This act shall take effect immediately and shall be deemed to
40 have been in full force and effect on and after April 1, 2024; provided,
41 however, that sections one through seven of this act shall take effect
42 one year after this act shall have become a law.
43 PART R
44 Section 1. The education law is amended by adding a new article 169 to
45 read as follows:
46 ARTICLE 169
47 INTERSTATE MEDICAL LICENSURE COMPACT
48 Section 8860. Short title.
49 8861. Purpose.
50 8862. Definitions.
51 8863. Eligibility.
52 8864. Designation of state of principal license.
53 8865. Application and issuance of expedited licensure.
54 8866. Fees for expedited licensure.
S. 8307--A 92 A. 8807--A
1 8867. Renewal and continued participation.
2 8868. Coordinated information system.
3 8869. Joint investigations.
4 8870. Disciplinary actions.
5 8871. Interstate medical licensure compact commission.
6 8872. Powers and duties of the interstate commission.
7 8873. Finance powers.
8 8874. Organization and operation of the interstate commission.
9 8875. Rulemaking functions of the interstate commission.
10 8876. Oversight of interstate compact.
11 8877. Enforcement of interstate compact.
12 8878. Default procedures.
13 8879. Dispute resolution.
14 8880. Member states, effective date and amendment.
15 8881. Withdrawal.
16 8882. Dissolution.
17 8883. Severability and construction.
18 8884. Binding effect of compact and other laws.
19 § 8860. Short title. This article shall be known and may be cited as
20 the "interstate medical licensure compact".
21 § 8861. Purpose. In order to strengthen access to health care, and in
22 recognition of the advances in the delivery of health care, the member
23 states of the interstate medical licensure compact have allied in common
24 purpose to develop a comprehensive process that complements the existing
25 licensing and regulatory authority of state medical boards, provides a
26 streamlined process that allows physicians to become licensed in multi-
27 ple states, thereby enhancing the portability of a medical license and
28 ensuring the safety of patients. The compact creates another pathway
29 for licensure and does not otherwise change a state's existing medical
30 practice act. The compact also adopts the prevailing standard for licen-
31 sure and affirms that the practice of medicine occurs where the patient
32 is located at the time of the physician-patient encounter, and there-
33 fore, requires the physician to be under the jurisdiction of the state
34 medical board where the patient is located. State medical boards that
35 participate in the compact retain the jurisdiction to impose an adverse
36 action against a license to practice medicine in that state issued to a
37 physician through the procedures in the compact.
38 § 8862. Definitions. In this compact:
39 1. "Bylaws" means those bylaws established by the interstate commis-
40 sion pursuant to section eighty-eight hundred seventy-one of this arti-
41 cle for its governance, or for directing and controlling its actions and
42 conduct.
43 2. "Commissioner" means the voting representative appointed by each
44 member board pursuant to section eighty-eight hundred seventy-one of
45 this article.
46 3. "Conviction" means a finding by a court that an individual is guil-
47 ty of a criminal offense through adjudication, or entry of a plea of
48 guilt or no contest to the charge by the offender. Evidence of an entry
49 of a conviction of a criminal offense by the court shall be considered
50 final for purposes of disciplinary action by a member board.
51 4. "Expedited license" means a full and unrestricted medical license
52 granted by a member state to an eligible physician through the process
53 set forth in the compact.
54 5. "Interstate commission" means the interstate commission created
55 pursuant to section eighty-eight hundred seventy-one of this article.
S. 8307--A 93 A. 8807--A
1 6. "License" means authorization by a member state for a physician to
2 engage in the practice of medicine, which would be unlawful without
3 authorization.
4 7. "Medical practice act" means laws and regulations governing the
5 practice of allopathic and osteopathic medicine within a member state.
6 8. "Member board" means a state agency in a member state that acts in
7 the sovereign interests of the state by protecting the public through
8 licensure, regulation, and education of physicians as directed by the
9 state government.
10 9. "Member state" means a state that has enacted the compact.
11 10. "Practice of medicine" means the clinical prevention, diagnosis,
12 or treatment of human disease, injury, or condition requiring a physi-
13 cian to obtain and maintain a license in compliance with the medical
14 practice act of a member state.
15 11. "Physician" means any person who:
16 (a) Is a graduate of a medical school accredited by the Liaison
17 Committee on Medical Education, the Commission on Osteopathic College
18 Accreditation, or a medical school listed in the International Medical
19 Education Directory or its equivalent;
20 (b) Passed each component of the United States Medical Licensing Exam-
21 ination (USMLE) or the Comprehensive Osteopathic Medical Licensing Exam-
22 ination (COMLEX-USA) within three attempts, or any of its predecessor
23 examinations accepted by a state medical board as an equivalent examina-
24 tion for licensure purposes;
25 (c) Successfully completed graduate medical education approved by the
26 Accreditation Council for Graduate Medical Education or the American
27 Osteopathic Association;
28 (d) Holds specialty certification or a time-unlimited specialty
29 certificate recognized by the American Board of Medical Specialties or
30 the American Osteopathic Association's Bureau of Osteopathic Special-
31 ists;
32 (e) Possesses a full and unrestricted license to engage in the prac-
33 tice of medicine issued by a member board;
34 (f) Has never been convicted, received adjudication, deferred adjudi-
35 cation, community supervision, or deferred disposition for any offense
36 by a court of appropriate jurisdiction;
37 (g) Has never held a license authorizing the practice of medicine
38 subjected to discipline by a licensing agency in any state, federal, or
39 foreign jurisdiction, excluding any action related to non-payment of
40 fees related to a license;
41 (h) Has never had a controlled substance license or permit suspended
42 or revoked by a state or the United States drug enforcement adminis-
43 tration; and
44 (i) Is not under active investigation by a licensing agency or law
45 enforcement authority in any state, federal, or foreign jurisdiction.
46 12. "Offense" means a felony, gross misdemeanor, or crime of moral
47 turpitude.
48 13. "Rule" means a written statement by the interstate commission
49 promulgated pursuant to section eighty-eight hundred seventy-two of this
50 article that is of general applicability, implements, interprets, or
51 prescribes a policy or provision of the compact, or an organizational,
52 procedural, or practice requirement of the interstate commission, and
53 has the force and effect of statutory law in a member state, and
54 includes the amendment, repeal, or suspension of an existing rule.
55 14. "State" means any state, commonwealth, district, or territory of
56 the United States.
S. 8307--A 94 A. 8807--A
1 15. "State of principal license" means a member state where a physi-
2 cian holds a license to practice medicine and which has been designated
3 as such by the physician for purposes of registration and participation
4 in the compact.
5 § 8863. Eligibility. 1. A physician must meet the eligibility require-
6 ments as defined in subdivision eleven of section eighty-eight hundred
7 sixty-two of this article to receive an expedited license under the
8 terms and provisions of the compact.
9 2. A physician who does not meet the requirements of subdivision elev-
10 en of section eighty-eight hundred sixty-two of this article may obtain
11 a license to practice medicine in a member state if the individual
12 complies with all laws and requirements, other than the compact, relat-
13 ing to the issuance of a license to practice medicine in that state.
14 § 8864. Designation of state of principal license. 1. A physician
15 shall designate a member state as the state of principal license for
16 purposes of registration for expedited licensure through the compact if
17 the physician possesses a full and unrestricted license to practice
18 medicine in that state, and the state is:
19 (a) the state of principal residence for the physician, or
20 (b) the state where at least twenty-five percent of the practice of
21 medicine occurs, or
22 (c) the location of the physician's employer, or
23 (d) if no state qualifies under paragraph (a), (b), or (c) of this
24 subdivision, the state designated as state of residence for purpose of
25 federal income tax.
26 2. A physician may redesignate a member state as state of principal
27 license at any time, as long as the state meets the requirements of
28 subdivision one of this section.
29 3. The interstate commission is authorized to develop rules to facili-
30 tate redesignation of another member state as the state of principal
31 license.
32 § 8865. Application and issuance of expedited licensure. 1. A physi-
33 cian seeking licensure through the compact shall file an application for
34 an expedited license with the member board of the state selected by the
35 physician as the state of principal license.
36 2. Upon receipt of an application for an expedited license, the member
37 board within the state selected as the state of principal license shall
38 evaluate whether the physician is eligible for expedited licensure and
39 issue a letter of qualification, verifying or denying the physician's
40 eligibility, to the interstate commission.
41 (a) Static qualifications, which include verification of medical
42 education, graduate medical education, results of any medical or licens-
43 ing examination, and other qualifications as determined by the inter-
44 state commission through rule, shall not be subject to additional prima-
45 ry source verification where already primary source verified by the
46 state of principal license.
47 (b) The member board within the state selected as the state of princi-
48 pal license shall, in the course of verifying eligibility, perform a
49 criminal background check of an applicant, including the use of the
50 results of fingerprint or other biometric data checks compliant with the
51 requirements of the Federal Bureau of Investigation, with the exception
52 of federal employees who have suitability determination in accordance
53 with U.S. C.F.R. § 731.202.
54 (c) Appeal on the determination of eligibility shall be made to the
55 member state where the application was filed and shall be subject to the
56 law of that state.
S. 8307--A 95 A. 8807--A
1 3. Upon verification under subdivision two of this section, physicians
2 eligible for an expedited license shall complete the registration proc-
3 ess established by the interstate commission to receive a license in a
4 member state selected pursuant to subdivision one of this section,
5 including the payment of any applicable fees.
6 4. After receiving verification of eligibility under subdivision two
7 of this section and any fees under subdivision three of this section, a
8 member board shall issue an expedited license to the physician. This
9 license shall authorize the physician to practice medicine in the issu-
10 ing state consistent with the medical practice act and all applicable
11 laws and regulations of the issuing member board and member state.
12 5. An expedited license shall be valid for a period consistent with
13 the licensure period in the member state and in the same manner as
14 required for other physicians holding a full and unrestricted license
15 within the member state.
16 6. An expedited license obtained though the compact shall be termi-
17 nated if a physician fails to maintain a license in the state of princi-
18 pal licensure for a non-disciplinary reason, without redesignation of a
19 new state of principal licensure.
20 7. The interstate commission is authorized to develop rules regarding
21 the application process, including payment of any applicable fees, and
22 the issuance of an expedited license.
23 § 8866. Fees for expedited licensure. 1. A member state issuing an
24 expedited license authorizing the practice of medicine in that state may
25 impose a fee for a license issued or renewed through the compact.
26 2. The interstate commission is authorized to develop rules regarding
27 fees for expedited licenses.
28 § 8867. Renewal and continued participation. 1. A physician seeking to
29 renew an expedited license granted in a member state shall complete a
30 renewal process with the interstate commission if the physician:
31 (a) Maintains a full and unrestricted license in a state of principal
32 license;
33 (b) Has not been convicted, received adjudication, deferred adjudi-
34 cation, community supervision, or deferred disposition for any offense
35 by a court of appropriate jurisdiction;
36 (c) Has not had a license authorizing the practice of medicine subject
37 to discipline by a licensing agency in any state, federal, or foreign
38 jurisdiction, excluding any action related to non-payment of fees
39 related to a license; and
40 (d) Has not had a controlled substance license or permit suspended or
41 revoked by a state or the United States drug enforcement administration.
42 2. Physicians shall comply with all continuing professional develop-
43 ment or continuing medical education requirements for renewal of a
44 license issued by a member state.
45 3. The interstate commission shall collect any renewal fees charged
46 for the renewal of a license and distribute the fees to the applicable
47 member board.
48 4. Upon receipt of any renewal fees collected in subdivision three of
49 this section, a member board shall renew the physician's license.
50 5. Physician information collected by the interstate commission during
51 the renewal process will be distributed to all member boards.
52 6. The interstate commission is authorized to develop rules to address
53 renewal of licenses obtained through the compact.
54 § 8868. Coordinated information system. 1. The interstate commission
55 shall establish a database of all physicians licensed, or who have
S. 8307--A 96 A. 8807--A
1 applied for licensure, under section eighty-eight hundred sixty-five of
2 this article.
3 2. Notwithstanding any other provision of law, member boards shall
4 report to the interstate commission any public action or complaints
5 against a licensed physician who has applied or received an expedited
6 license through the compact.
7 3. Member boards shall report disciplinary or investigatory informa-
8 tion determined as necessary and proper by rule of the interstate
9 commission.
10 4. Member boards may report any non-public complaint, disciplinary, or
11 investigatory information not required by subdivision three of this
12 section to the interstate commission.
13 5. Member boards shall share complaint or disciplinary information
14 about a physician upon request of another member board.
15 6. All information provided to the interstate commission or distrib-
16 uted by member boards shall be confidential, filed under seal, and used
17 only for investigatory or disciplinary matters.
18 7. The interstate commission is authorized to develop rules for
19 mandated or discretionary sharing of information by member boards.
20 § 8869. Joint investigations. 1. Licensure and disciplinary records of
21 physicians are deemed investigative.
22 2. In addition to the authority granted to a member board by its
23 respective medical practice act or other applicable state law, a member
24 board may participate with other member boards in joint investigations
25 of physicians licensed by the member boards.
26 3. A subpoena issued by a member state shall be enforceable in other
27 member states.
28 4. Member boards may share any investigative, litigation, or compli-
29 ance materials in furtherance of any joint or individual investigation
30 initiated under the compact.
31 5. Any member state may investigate actual or alleged violations of
32 the statutes authorizing the practice of medicine in any other member
33 state in which a physician holds a license to practice medicine.
34 § 8870. Disciplinary actions. 1. Any disciplinary action taken by any
35 member board against a physician licensed through the compact shall be
36 deemed unprofessional conduct which may be subject to discipline by
37 other member boards, in addition to any violation of the medical prac-
38 tice act or regulations in that state.
39 2. If a license granted to a physician by the member board in the
40 state of principal license is revoked, surrendered or relinquished in
41 lieu of discipline, or suspended, then all licenses issued to the physi-
42 cian by member boards shall automatically be placed, without further
43 action necessary by any member board, on the same status. If the member
44 board in the state of principal license subsequently reinstates the
45 physician's license, a license issued to the physician by any other
46 member board shall remain encumbered until that respective member board
47 takes action to reinstate the license in a manner consistent with the
48 medical practice act of that state.
49 3. If disciplinary action is taken against a physician by a member
50 board not in the state of principal license, any other member board may
51 deem the action conclusive as to matter of law and fact decided, and:
52 (a) impose the same or lesser sanction or sanctions against the physi-
53 cian so long as such sanctions are consistent with the medical practice
54 act of that state; or
S. 8307--A 97 A. 8807--A
1 (b) pursue separate disciplinary action against the physician under
2 its respective medical practice act, regardless of the action taken in
3 other member states.
4 4. If a license granted to a physician by a member board is revoked,
5 surrendered, or relinquished in lieu of discipline, or suspended, then
6 any license or licenses issued to the physician by any other member
7 board or boards shall be suspended, automatically and immediately with-
8 out further action necessary by the other member board or boards, for
9 ninety days upon entry of the order by the disciplining board, to permit
10 the member board or boards to investigate the basis for the action under
11 the medical practice act of that state. A member board may terminate the
12 automatic suspension of the license it issued prior to the completion of
13 the ninety day suspension period in a manner consistent with the medical
14 practice act of that state.
15 § 8871. Interstate medical licensure compact commission. 1. The member
16 states hereby create the "interstate medical licensure compact commis-
17 sion".
18 2. The purpose of the interstate commission is the administration of
19 the interstate medical licensure compact, which is a discretionary state
20 function.
21 3. The interstate commission shall be a body corporate and joint agen-
22 cy of the member states and shall have all the responsibilities, powers,
23 and duties set forth in the compact, and such additional powers as may
24 be conferred upon it by a subsequent concurrent action of the respective
25 legislatures of the member states in accordance with the terms of the
26 compact.
27 4. The interstate commission shall consist of two voting represen-
28 tatives appointed by each member state who shall serve as commissioners.
29 In states where allopathic and osteopathic physicians are regulated by
30 separate member boards, or if the licensing and disciplinary authority
31 is split between multiple member boards within a member state, the
32 member state shall appoint one representative from each member board. A
33 commissioner shall be a or an:
34 (a) Allopathic or osteopathic physician appointed to a member board;
35 (b) Executive director, executive secretary, or similar executive of a
36 member board; or
37 (c) Member of the public appointed to a member board.
38 5. The interstate commission shall meet at least once each calendar
39 year. A portion of this meeting shall be a business meeting to address
40 such matters as may properly come before the commission, including the
41 election of officers. The chairperson may call additional meetings and
42 shall call for a meeting upon the request of a majority of the member
43 states.
44 6. The bylaws may provide for meetings of the interstate commission to
45 be conducted by telecommunication or electronic communication.
46 7. Each commissioner participating at a meeting of the interstate
47 commission is entitled to one vote. A majority of commissioners shall
48 constitute a quorum for the transaction of business, unless a larger
49 quorum is required by the bylaws of the interstate commission. A commis-
50 sioner shall not delegate a vote to another commissioner. In the absence
51 of its commissioner, a member state may delegate voting authority for a
52 specified meeting to another person from that state who shall meet the
53 requirements of subdivision four of this section.
54 8. The interstate commission shall provide public notice of all meet-
55 ings and all meetings shall be open to the public. The interstate
56 commission may close a meeting, in full or in portion, where it deter-
S. 8307--A 98 A. 8807--A
1 mines by a two-thirds vote of the commissioners present that an open
2 meeting would be likely to:
3 (a) Relate solely to the internal personnel practices and procedures
4 of the interstate commission;
5 (b) Discuss matters specifically exempted from disclosure by federal
6 statute;
7 (c) Discuss trade secrets, commercial, or financial information that
8 is privileged or confidential;
9 (d) Involve accusing a person of a crime, or formally censuring a
10 person;
11 (e) Discuss information of a personal nature where disclosure would
12 constitute a clearly unwarranted invasion of personal privacy;
13 (f) Discuss investigative records compiled for law enforcement
14 purposes; or
15 (g) Specifically relate to the participation in a civil action or
16 other legal proceeding.
17 9. The interstate commission shall keep minutes which shall fully
18 describe all matters discussed in a meeting and shall provide a full and
19 accurate summary of actions taken, including record of any roll call
20 votes.
21 10. The interstate commission shall make its information and official
22 records, to the extent not otherwise designated in the compact or by its
23 rules, available to the public for inspection.
24 11. The interstate commission shall establish an executive committee,
25 which shall include officers, members, and others as determined by the
26 bylaws. The executive committee shall have the power to act on behalf of
27 the interstate commission, with the exception of rulemaking, during
28 periods when the interstate commission is not in session. When acting on
29 behalf of the interstate commission, the executive committee shall over-
30 see the administration of the compact including enforcement and compli-
31 ance with the provisions of the compact, its bylaws and rules, and other
32 such duties as necessary.
33 12. The interstate commission shall establish other committees for
34 governance and administration of the compact.
35 § 8872. Powers and duties of the interstate commission. The interstate
36 commission shall have the duty and power to:
37 1. Oversee and maintain the administration of the compact;
38 2. Promulgate rules which shall be binding to the extent and in the
39 manner provided for in the compact;
40 3. Issue, upon the request of a member state or member board, advisory
41 opinions concerning the meaning or interpretation of the compact, its
42 bylaws, rules, and actions;
43 4. Enforce compliance with compact provisions, the rules promulgated
44 by the interstate commission, and the bylaws, using all necessary and
45 proper means, including but not limited to the use of judicial process;
46 5. Establish and appoint committees including, but not limited to, an
47 executive committee as required by section eighty-eight hundred seven-
48 ty-one of this article, which shall have the power to act on behalf of
49 the interstate commission in carrying out its powers and duties;
50 6. Pay, or provide for the payment of the expenses related to the
51 establishment, organization, and ongoing activities of the interstate
52 commission;
53 7. Establish and maintain one or more offices;
54 8. Borrow, accept, hire, or contract for services of personnel;
55 9. Purchase and maintain insurance and bonds;
S. 8307--A 99 A. 8807--A
1 10. Employ an executive director who shall have such powers to employ,
2 select or appoint employees, agents, or consultants, and to determine
3 their qualifications, define their duties, and fix their compensation;
4 11. Establish personnel policies and programs relating to conflicts of
5 interest, rates of compensation, and qualifications of personnel;
6 12. Accept donations and grants of money, equipment, supplies, materi-
7 als and services, and to receive, utilize, and dispose of it in a manner
8 consistent with the conflict of interest policies established by the
9 interstate commission;
10 13. Lease, purchase, accept contributions or donations of, or other-
11 wise to own, hold, improve, or use, any property, real, personal, or
12 mixed;
13 14. Sell, convey, mortgage, pledge, lease, exchange, abandon, or
14 otherwise dispose of any property, real, personal, or mixed;
15 15. Establish a budget and make expenditures;
16 16. Adopt a seal and bylaws governing the management and operation of
17 the interstate commission;
18 17. Report annually to the legislatures and governors of the member
19 states concerning the activities of the interstate commission during the
20 preceding year. Such reports shall also include reports of financial
21 audits and any recommendations that may have been adopted by the inter-
22 state commission;
23 18. Coordinate education, training, and public awareness regarding the
24 compact, its implementation, and its operation;
25 19. Maintain records in accordance with the bylaws;
26 20. Seek and obtain trademarks, copyrights, and patents; and
27 21. Perform such functions as may be necessary or appropriate to
28 achieve the purposes of the compact.
29 § 8873. Finance powers. 1. The interstate commission may levy on and
30 collect an annual assessment from each member state to cover the cost of
31 the operations and activities of the interstate commission and its
32 staff. The total assessment must be sufficient to cover the annual budg-
33 et approved each year for which revenue is not provided by other sourc-
34 es. The aggregate annual assessment amount shall be allocated upon a
35 formula to be determined by the interstate commission, which shall
36 promulgate a rule binding upon all member states.
37 2. The interstate commission shall not incur obligations of any kind
38 prior to securing the funds adequate to meet the same.
39 3. The interstate commission shall not pledge the credit of any of the
40 member states, except by, and with the authority of, the member state.
41 4. The interstate commission shall be subject to a yearly financial
42 audit conducted by a certified or licensed public accountant and the
43 report of the audit shall be included in the annual report of the inter-
44 state commission.
45 § 8874. Organization and operation of the interstate commission. 1.
46 The interstate commission shall, by a majority of commissioners present
47 and voting, adopt bylaws to govern its conduct as may be necessary or
48 appropriate to carry out the purposes of the compact within twelve
49 months of the first interstate commission meeting.
50 2. The interstate commission shall elect or appoint annually from
51 among its commissioners a chairperson, a vice-chairperson, and a treas-
52 urer, each of whom shall have such authority and duties as may be speci-
53 fied in the bylaws. The chairperson, or in the chairperson's absence or
54 disability, the vice-chairperson, shall preside at all meetings of the
55 interstate commission.
S. 8307--A 100 A. 8807--A
1 3. Officers selected pursuant to subdivision two of this section shall
2 serve without remuneration from the interstate commission.
3 4. The officers and employees of the interstate commission shall be
4 immune from suit and liability, either personally or in their official
5 capacity, for a claim for damage to or loss of property or personal
6 injury or other civil liability caused or arising out of, or relating
7 to, an actual or alleged act, error, or omission that occurred, or that
8 such person had a reasonable basis for believing occurred, within the
9 scope of interstate commission employment, duties, or responsibilities;
10 provided that such person shall not be protected from suit or liability
11 for damage, loss, injury, or liability caused by the intentional or
12 willful and wanton misconduct of such person.
13 (a) The liability of the executive director and employees of the
14 interstate commission or representatives of the interstate commission,
15 acting within the scope of such person's employment or duties for acts,
16 errors, or omissions occurring within such person's state, may not
17 exceed the limits of liability set forth under the constitution and laws
18 of that state for state officials, employees, and agents. The interstate
19 commission is considered to be an instrumentality of the states for the
20 purposes of any such action. Nothing in this paragraph shall be
21 construed to protect such person from suit or liability for damage,
22 loss, injury, or liability caused by the intentional or willful and
23 wanton misconduct of such person.
24 (b) The interstate commission shall defend the executive director, its
25 employees, and subject to the approval of the attorney general or other
26 appropriate legal counsel of the member state represented by an inter-
27 state commission representative, shall defend such interstate commission
28 representative in any civil action seeking to impose liability arising
29 out of an actual or alleged act, error or omission that occurred within
30 the scope of interstate commission employment, duties or responsibil-
31 ities, or that the defendant had a reasonable basis for believing
32 occurred within the scope of interstate commission employment, duties,
33 or responsibilities, provided that the actual or alleged act, error, or
34 omission did not result from intentional or willful and wanton miscon-
35 duct on the part of such person.
36 (c) To the extent not covered by the state involved, member state, or
37 the interstate commission, the representatives or employees of the
38 interstate commission shall be held harmless in the amount of a settle-
39 ment or judgment, including attorney's fees and costs, obtained against
40 such persons arising out of an actual or alleged act, error, or omission
41 that occurred within the scope of interstate commission employment,
42 duties, or responsibilities, or that such persons had a reasonable basis
43 for believing occurred within the scope of interstate commission employ-
44 ment, duties, or responsibilities, provided that the actual or alleged
45 act, error, or omission did not result from intentional or willful and
46 wanton misconduct on the part of such persons.
47 § 8875. Rulemaking functions of the interstate commission. 1. The
48 interstate commission shall promulgate reasonable rules in order to
49 effectively and efficiently achieve the purposes of the compact.
50 Notwithstanding the foregoing, in the event the interstate commission
51 exercises its rulemaking authority in a manner that is beyond the scope
52 of the purposes of the compact, or the powers granted hereunder, then
53 such an action by the interstate commission shall be invalid and have no
54 force or effect.
55 2. Rules deemed appropriate for the operations of the interstate
56 commission shall be made pursuant to a rulemaking process that substan-
S. 8307--A 101 A. 8807--A
1 tially conforms to the federal Model State Administrative Procedure Act
2 of 2010, and subsequent amendments thereto.
3 3. Not later than thirty days after a rule is promulgated, any person
4 may file a petition for judicial review of the rule in the United States
5 District Court for the District of Columbia or the federal district
6 where the interstate commission has its principal offices, provided that
7 the filing of such a petition shall not stay or otherwise prevent the
8 rule from becoming effective unless the court finds that the petitioner
9 has a substantial likelihood of success. The court shall give deference
10 to the actions of the interstate commission consistent with applicable
11 law and shall not find the rule to be unlawful if the rule represents a
12 reasonable exercise of the authority granted to the interstate commis-
13 sion.
14 § 8876. Oversight of interstate compact. 1. The executive, legisla-
15 tive, and judicial branches of state government in each member state
16 shall enforce the compact and shall take all actions necessary and
17 appropriate to effectuate the compact's purposes and intent. The
18 provisions of the compact and the rules promulgated hereunder shall have
19 standing as statutory law but shall not override existing state authori-
20 ty to regulate the practice of medicine.
21 2. All courts shall take judicial notice of the compact and the rules
22 in any judicial or administrative proceeding in a member state pertain-
23 ing to the subject matter of the compact which may affect the powers,
24 responsibilities or actions of the interstate commission.
25 3. The interstate commission shall be entitled to receive all service
26 of process in any such proceeding, and shall have standing to intervene
27 in the proceeding for all purposes. Failure to provide service of proc-
28 ess to the interstate commission shall render a judgment or order void
29 as to the interstate commission, the compact, or promulgated rules.
30 § 8877. Enforcement of interstate compact. 1. The interstate commis-
31 sion, in the reasonable exercise of its discretion, shall enforce the
32 provisions and rules of the compact.
33 2. The interstate commission may, by majority vote of the commission-
34 ers, initiate legal action in the United States District Court for the
35 District of Columbia, or, at the discretion of the interstate commis-
36 sion, in the federal district where the interstate commission has its
37 principal offices, to enforce compliance with the provisions of the
38 compact, and its promulgated rules and bylaws, against a member state in
39 default. The relief sought may include both injunctive relief and
40 damages. In the event judicial enforcement is necessary, the prevailing
41 party shall be awarded all costs of such litigation including reasonable
42 attorney's fees.
43 3. The remedies herein shall not be the exclusive remedies of the
44 interstate commission. The interstate commission may avail itself of
45 any other remedies available under state law or the regulation of a
46 profession.
47 § 8878. Default procedures. 1. The grounds for default include, but
48 are not limited to, failure of a member state to perform such obli-
49 gations or responsibilities imposed upon it by the compact, or the rules
50 and bylaws of the interstate commission promulgated under the compact.
51 2. If the interstate commission determines that a member state has
52 defaulted in the performance of its obligations or responsibilities
53 under the compact, or the bylaws or promulgated rules, the interstate
54 commission shall:
55 (a) Provide written notice to the defaulting state and other member
56 states, of the nature of the default, the means of curing the default,
S. 8307--A 102 A. 8807--A
1 and any action taken by the interstate commission. The interstate
2 commission shall specify the conditions by which the defaulting state
3 must cure its default; and
4 (b) Provide remedial training and specific technical assistance
5 regarding the default.
6 3. If the defaulting state fails to cure the default, the defaulting
7 state shall be terminated from the compact upon an affirmative vote of a
8 majority of the commissioners and all rights, privileges, and benefits
9 conferred by the compact shall terminate on the effective date of termi-
10 nation. A cure of the default does not relieve the offending state of
11 obligations or liabilities incurred during the period of the default.
12 4. Termination of membership in the compact shall be imposed only
13 after all other means of securing compliance have been exhausted. Notice
14 of intent to terminate shall be given by the interstate commission to
15 the governor, the majority and minority leaders of the defaulting
16 state's legislature, and each of the member states.
17 5. The interstate commission shall establish rules and procedures to
18 address licenses and physicians that are materially impacted by the
19 termination of a member state, or the withdrawal of a member state.
20 6. The member state which has been terminated is responsible for all
21 dues, obligations, and liabilities incurred through the effective date
22 of termination including obligations, the performance of which extends
23 beyond the effective date of termination.
24 7. The interstate commission shall not bear any costs relating to any
25 state that has been found to be in default or which has been terminated
26 from the compact, unless otherwise mutually agreed upon in writing
27 between the interstate commission and the defaulting state.
28 8. The defaulting state may appeal the action of the interstate
29 commission by petitioning the United States District Court for the
30 District of Columbia or the federal district where the interstate
31 commission has its principal offices. The prevailing party shall be
32 awarded all costs of such litigation including reasonable attorney's
33 fees.
34 § 8879. Dispute resolution. 1. The interstate commission shall
35 attempt, upon the request of a member state, to resolve disputes which
36 are subject to the compact and which may arise among member states or
37 member boards.
38 2. The interstate commission shall promulgate rules providing for both
39 mediation and binding dispute resolution as appropriate.
40 § 8880. Member states, effective date and amendment. 1. Any state is
41 eligible to become a member state of the compact.
42 2. The compact shall become effective and binding upon legislative
43 enactment of the compact into law by no less than seven states. There-
44 after, it shall become effective and binding on a state upon enactment
45 of the compact into law by that state.
46 3. The governors of non-member states, or their designees, shall be
47 invited to participate in the activities of the interstate commission on
48 a non-voting basis prior to adoption of the compact by all states.
49 4. The interstate commission may propose amendments to the compact for
50 enactment by the member states. No amendment shall become effective and
51 binding upon the interstate commission and the member states unless and
52 until it is enacted into law by unanimous consent of the member states.
53 § 8881. Withdrawal. 1. Once effective, the compact shall continue in
54 force and remain binding upon each and every member state; provided that
55 a member state may withdraw from the compact by specifically repealing
56 the statute which enacted the compact into law.
S. 8307--A 103 A. 8807--A
1 2. Withdrawal from the compact shall be by the enactment of a statute
2 repealing the same, but shall not take effect until one year after the
3 effective date of such statute and until written notice of the with-
4 drawal has been given by the withdrawing state to the governor of each
5 other member state.
6 3. The withdrawing state shall immediately notify the chairperson of
7 the interstate commission in writing upon the introduction of legis-
8 lation repealing the compact in the withdrawing state.
9 4. The interstate commission shall notify the other member states of
10 the withdrawing state's intent to withdraw within sixty days of its
11 receipt of notice provided under subdivision three of this section.
12 5. The withdrawing state is responsible for all dues, obligations and
13 liabilities incurred through the effective date of withdrawal, including
14 obligations, the performance of which extend beyond the effective date
15 of withdrawal.
16 6. Reinstatement following withdrawal of a member state shall occur
17 upon the withdrawing state reenacting the compact or upon such later
18 date as determined by the interstate commission.
19 7. The interstate commission is authorized to develop rules to address
20 the impact of the withdrawal of a member state on licenses granted in
21 other member states to physicians who designated the withdrawing member
22 state as the state of principal license.
23 § 8882. Dissolution. 1. The compact shall dissolve effective upon the
24 date of the withdrawal or default of the member state which reduces the
25 membership in the compact to one member state.
26 2. Upon the dissolution of the compact, the compact becomes null and
27 void and shall be of no further force or effect, and the business and
28 affairs of the interstate commission shall be concluded and surplus
29 funds shall be distributed in accordance with the bylaws.
30 § 8883. Severability and construction. 1. The provisions of the
31 compact shall be severable, and if any phrase, clause, sentence, or
32 provision is deemed unenforceable, the remaining provisions of the
33 compact shall be enforceable.
34 2. The provisions of the compact shall be liberally construed to
35 effectuate its purposes.
36 3. Nothing in the compact shall be construed to prohibit the applica-
37 bility of other interstate compacts to which the states are members.
38 § 8884. Binding effect of compact and other laws. 1. Nothing contained
39 in this article shall prevent the enforcement of any other law of a
40 member state that is not inconsistent with the compact.
41 2. All laws in a member state in conflict with the compact are super-
42 seded to the extent of the conflict.
43 3. All lawful actions of the interstate commission, including all
44 rules and bylaws promulgated by the commission, are binding upon the
45 member states.
46 4. All agreements between the interstate commission and the member
47 states are binding in accordance with their terms.
48 5. In the event any provision of the compact exceeds the constitu-
49 tional limits imposed on the legislature of any member state, such
50 provision shall be ineffective to the extent of the conflict with the
51 constitutional provision in question in that member state.
52 § 2. Article 170 of the education law is renumbered article 171 and a
53 new article 170 is added to title 8 of the education law to read as
54 follows:
55 ARTICLE 170
56 NURSE LICENSURE COMPACT
S. 8307--A 104 A. 8807--A
1 Section 8900. Nurse licensure compact.
2 8901. Findings and declaration of purpose.
3 8902. Definitions.
4 8903. General provisions and jurisdiction.
5 8904. Applications for licensure in a party state.
6 8905. Additional authorities invested in party state licensing
7 boards.
8 8906. Coordinated licensure information system and exchange of
9 information.
10 8907. Establishment of the interstate commission of nurse licen-
11 sure compact administrators.
12 8908. Rulemaking.
13 8909. Oversight, dispute resolution and enforcement.
14 8910. Effective date, withdrawal and amendment.
15 8911. Construction and severability.
16 § 8900. Nurse licensure compact. The nurse license compact as set
17 forth in the article is hereby adopted and entered into with all party
18 states joining therein.
19 § 8901. Findings and declaration of purpose 1. Findings. The party
20 states find that:
21 a. The health and safety of the public are affected by the degree of
22 compliance with and the effectiveness of enforcement activities related
23 to state nurse licensure laws;
24 b. Violations of nurse licensure and other laws regulating the prac-
25 tice of nursing may result in injury or harm to the public;
26 c. The expanded mobility of nurses and the use of advanced communi-
27 cation technologies as part of our nation's health care delivery system
28 require greater coordination and cooperation among states in the areas
29 of nurse licensure and regulation;
30 d. New practice modalities and technology make compliance with indi-
31 vidual state nurse licensure laws difficult and complex;
32 e. The current system of duplicative licensure for nurses practicing
33 in multiple states is cumbersome and redundant for both nurses and
34 states; and
35 f. Uniformity of nurse licensure requirements throughout the states
36 promotes public safety and public health benefits.
37 2. Declaration of purpose. The general purposes of this compact are
38 to:
39 a. Facilitate the states' responsibility to protect the public's
40 health and safety;
41 b. Ensure and encourage the cooperation of party states in the areas
42 of nurse licensure and regulation;
43 c. Facilitate the exchange of information between party states in the
44 areas of nurse regulation, investigation and adverse actions;
45 d. Promote compliance with the laws governing the practice of nursing
46 in each jurisdiction;
47 e. Invest all party states with the authority to hold a nurse account-
48 able for meeting all state practice laws in the state in which the
49 patient is located at the time care is rendered through the mutual
50 recognition of party state licenses;
51 f. Decrease redundancies in the consideration and issuance of nurse
52 licenses; and
53 g. Provide opportunities for interstate practice by nurses who meet
54 uniform licensure requirements.
55 § 8902. Definitions. 1. Definitions. As used in this compact:
S. 8307--A 105 A. 8807--A
1 a. "Adverse action" means any administrative, civil, equitable or
2 criminal action permitted by a state's laws which is imposed by a
3 licensing board or other authority against a nurse, including actions
4 against an individual's license or multistate licensure privilege such
5 as revocation, suspension, probation, monitoring of the licensee, limi-
6 tation on the licensee's practice, or any other encumbrance on licensure
7 affecting a nurse's authorization to practice, including issuance of a
8 cease and desist action.
9 b. "Alternative program" means a non-disciplinary monitoring program
10 approved by a licensing board.
11 c. "Coordinated licensure information system" means an integrated
12 process for collecting, storing and sharing information on nurse licen-
13 sure and enforcement activities related to nurse licensure laws that is
14 administered by a nonprofit organization composed of and controlled by
15 licensing boards.
16 d. "Commission" means the interstate commission of nurse licensure
17 compact administrators.
18 e. "Current significant investigative information" means:
19 1. Investigative information that a licensing board, after a prelimi-
20 nary inquiry that includes notification and an opportunity for the nurse
21 to respond, if required by state law, has reason to believe is not
22 groundless and, if proved true, would indicate more than a minor infrac-
23 tion; or
24 2. Investigative information that indicates that the nurse represents
25 an immediate threat to public health and safety regardless of whether
26 the nurse has been notified and had an opportunity to respond.
27 f. "Encumbrance" means a revocation or suspension of, or any limita-
28 tion on, the full and unrestricted practice of nursing imposed by a
29 licensing board.
30 g. "Home state" means the party state which is the nurse's primary
31 state of residence.
32 h. "Licensing board" means a party state's regulatory body responsible
33 for issuing nurse licenses.
34 i. "Multistate license" means a license to practice as a registered
35 nurse (RN) or as a licensed practical/vocational nurse (LPN/VN), which
36 is issued by a home state licensing board, and which authorizes the
37 licensed nurse to practice in all party states under a multistate licen-
38 sure privilege.
39 j. "Multistate licensure privilege" means a legal authorization asso-
40 ciated with a multistate license permitting the practice of nursing as
41 either a RN or a LPN/VN in a remote state.
42 k. "Nurse" means RN or LPN/VN, as those terms are defined by each
43 party state's practice laws.
44 l. "Party state" means any state that has adopted this compact.
45 m. "Remote state" means a party state, other than the home state.
46 n. "Single-state license" means a nurse license issued by a party
47 state that authorizes practice only within the issuing state and does
48 not include a multistate licensure privilege to practice in any other
49 party state.
50 o. "State" means a state, territory or possession of the United States
51 and the District of Columbia.
52 p. "State practice laws" means a party state's laws, rules and regu-
53 lations that govern the practice of nursing, define the scope of nursing
54 practice, and create the methods and grounds for imposing discipline.
55 "State practice laws" shall not include requirements necessary to obtain
S. 8307--A 106 A. 8807--A
1 and retain a license, except for qualifications or requirements of the
2 home state.
3 § 8903. General provisions and jurisdiction. 1. General provisions and
4 jurisdiction. a. A multistate license to practice registered or licensed
5 practical/vocational nursing issued by a home state to a resident in
6 that state will be recognized by each party state as authorizing a nurse
7 to practice as a registered nurse (RN) or as a licensed
8 practical/vocational nurse (LPN/VN), under a multistate licensure privi-
9 lege, in each party state.
10 b. A state shall implement procedures for considering the criminal
11 history records of applicants for an initial multistate license or
12 licensure by endorsement. Such procedures shall include the submission
13 of fingerprints or other biometric-based information by applicants for
14 the purpose of obtaining an applicant's criminal history record informa-
15 tion from the federal bureau of investigation and the agency responsible
16 for retaining that state's criminal records.
17 c. Each party state shall require its licensing board to authorize an
18 applicant to obtain or retain a multistate license in the home state
19 only if the applicant:
20 i. Meets the home state's qualifications for licensure or renewal of
21 licensure, and complies with all other applicable state laws;
22 ii. (1) Has graduated or is eligible to graduate from a licensing
23 board-approved RN or LPN/VN prelicensure education program; or
24 (2) Has graduated from a foreign RN or LPN/VN prelicensure education
25 program that has been: (A) approved by the authorized accrediting body
26 in the applicable country, and (B) verified by an independent creden-
27 tials review agency to be comparable to a licensing board-approved prel-
28 icensure education program;
29 iii. Has, if a graduate of a foreign prelicensure education program
30 not taught in English or if English is not the individual's native
31 language, successfully passed an English proficiency examination that
32 includes the components of reading, speaking, writing and listening;
33 iv. Has successfully passed an NCLEX-RN or NCLEX-PN examination or
34 recognized predecessor, as applicable;
35 v. Is eligible for or holds an active, unencumbered license;
36 vi. Has submitted, in connection with an application for initial
37 licensure or licensure by endorsement, fingerprints or other biometric
38 data for the purpose of obtaining criminal history record information
39 from the federal bureau of investigation and the agency responsible for
40 retaining that state's criminal records;
41 vii. Has not been convicted or found guilty, or has entered into an
42 agreed disposition, of a felony offense under applicable state or feder-
43 al criminal law;
44 viii. Has not been convicted or found guilty, or has entered into an
45 agreed disposition, of a misdemeanor offense related to the practice of
46 nursing as determined on a case-by-case basis;
47 ix. Is not currently enrolled in an alternative program;
48 x. Is subject to self-disclosure requirements regarding current
49 participation in an alternative program; and
50 xi. Has a valid United States social security number.
51 d. All party states shall be authorized, in accordance with existing
52 state due process law, to take adverse action against a nurse's multi-
53 state licensure privilege such as revocation, suspension, probation or
54 any other action that affects a nurse's authorization to practice under
55 a multistate licensure privilege, including cease and desist actions. If
56 a party state takes such action, it shall promptly notify the adminis-
S. 8307--A 107 A. 8807--A
1 trator of the coordinated licensure information system. The administra-
2 tor of the coordinated licensure information system shall promptly noti-
3 fy the home state of any such actions by remote states.
4 e. A nurse practicing in a party state shall comply with the state
5 practice laws of the state in which the client is located at the time
6 service is provided. The practice of nursing is not limited to patient
7 care but shall include all nursing practice as defined by the state
8 practice laws of the party state in which the client is located. The
9 practice of nursing in a party state under a multistate licensure privi-
10 lege will subject a nurse to the jurisdiction of the licensing board,
11 the courts and the laws of the party state in which the client is
12 located at the time service is provided.
13 f. Individuals not residing in a party state shall continue to be able
14 to apply for a party state's single-state license as provided under the
15 laws of each party state. However, the single-state license granted to
16 these individuals will not be recognized as granting the privilege to
17 practice nursing in any other party state. Nothing in this compact shall
18 affect the requirements established by a party state for the issuance of
19 a single-state license.
20 g. Any nurse holding a home state multistate license, on the effective
21 date of this compact, may retain and renew the multistate license issued
22 by the nurse's then-current home state, provided that:
23 i. A nurse, who changes primary state of residence after this
24 compact's effective date, shall meet all applicable requirements set
25 forth in this article to obtain a multistate license from a new home
26 state.
27 ii. A nurse who fails to satisfy the multistate licensure requirements
28 set forth in this article due to a disqualifying event occurring after
29 this compact's effective date shall be ineligible to retain or renew a
30 multistate license, and the nurse's multistate license shall be revoked
31 or deactivated in accordance with applicable rules adopted by the
32 commission.
33 § 8904. Applications for licensure in a party state. 1. Applications
34 for licensure in a party state. a. Upon application for a multistate
35 license, the licensing board in the issuing party state shall ascertain,
36 through the coordinated licensure information system, whether the appli-
37 cant has ever held, or is the holder of, a license issued by any other
38 state, whether there are any encumbrances on any license or multistate
39 licensure privilege held by the applicant, whether any adverse action
40 has been taken against any license or multistate licensure privilege
41 held by the applicant and whether the applicant is currently participat-
42 ing in an alternative program.
43 b. A nurse may hold a multistate license, issued by the home state, in
44 only one party state at a time.
45 c. If a nurse changes primary state of residence by moving between two
46 party states, the nurse must apply for licensure in the new home state,
47 and the multistate license issued by the prior home state will be deac-
48 tivated in accordance with applicable rules adopted by the commission.
49 i. The nurse may apply for licensure in advance of a change in primary
50 state of residence.
51 ii. A multistate license shall not be issued by the new home state
52 until the nurse provides satisfactory evidence of a change in primary
53 state of residence to the new home state and satisfies all applicable
54 requirements to obtain a multistate license from the new home state.
55 d. If a nurse changes primary state of residence by moving from a
56 party state to a non-party state, the multistate license issued by the
S. 8307--A 108 A. 8807--A
1 prior home state will convert to a single-state license, valid only in
2 the former home state.
3 § 8905. Additional authorities invested in party state licensing
4 boards. 1. Licensing board authority. In addition to the other powers
5 conferred by state law, a licensing board shall have the authority to:
6 a. Take adverse action against a nurse's multistate licensure privi-
7 lege to practice within that party state.
8 i. Only the home state shall have the power to take adverse action
9 against a nurse's license issued by the home state.
10 ii. For purposes of taking adverse action, the home state licensing
11 board shall give the same priority and effect to reported conduct
12 received from a remote state as it would if such conduct had occurred
13 within the home state. In so doing, the home state shall apply its own
14 state laws to determine appropriate action.
15 b. Issue cease and desist orders or impose an encumbrance on a nurse's
16 authority to practice within that party state.
17 c. Complete any pending investigations of a nurse who changes primary
18 state of residence during the course of such investigations. The licens-
19 ing board shall also have the authority to take appropriate action or
20 actions and shall promptly report the conclusions of such investigations
21 to the administrator of the coordinated licensure information system.
22 The administrator of the coordinated licensure information system shall
23 promptly notify the new home state of any such actions.
24 d. Issue subpoenas for both hearings and investigations that require
25 the attendance and testimony of witnesses, as well as the production of
26 evidence. Subpoenas issued by a licensing board in a party state for the
27 attendance and testimony of witnesses or the production of evidence from
28 another party state shall be enforced in the latter state by any court
29 of competent jurisdiction, according to the practice and procedure of
30 that court applicable to subpoenas issued in proceedings pending before
31 it. The issuing authority shall pay any witness fees, travel expenses,
32 mileage and other fees required by the service statutes of the state in
33 which the witnesses or evidence are located.
34 e. Obtain and submit, for each nurse licensure applicant, fingerprint
35 or other biometric-based information to the federal bureau of investi-
36 gation for criminal background checks, receive the results of the feder-
37 al bureau of investigation record search on criminal background checks
38 and use the results in making licensure decisions.
39 f. If otherwise permitted by state law, recover from the affected
40 nurse the costs of investigations and disposition of cases resulting
41 from any adverse action taken against that nurse.
42 g. Take adverse action based on the factual findings of the remote
43 state, provided that the licensing board follows its own procedures for
44 taking such adverse action.
45 2. Adverse actions. a. If adverse action is taken by the home state
46 against a nurse's multistate license, the nurse's multistate licensure
47 privilege to practice in all other party states shall be deactivated
48 until all encumbrances have been removed from the multistate license.
49 All home state disciplinary orders that impose adverse action against a
50 nurse's multistate license shall include a statement that the nurse's
51 multistate licensure privilege is deactivated in all party states during
52 the pendency of the order.
53 b. Nothing in this compact shall override a party state's decision
54 that participation in an alternative program may be used in lieu of
55 adverse action. The home state licensing board shall deactivate the
S. 8307--A 109 A. 8807--A
1 multistate licensure privilege under the multistate license of any nurse
2 for the duration of the nurse's participation in an alternative program.
3 § 8906. Coordinated licensure information system and exchange of
4 information. 1. Coordinated licensure information system and exchange
5 of information. a. All party states shall participate in a coordinated
6 licensure information system of all licensed registered nurses (RNs) and
7 licensed practical/vocational nurses (LPNs/VNs). This system will
8 include information on the licensure and disciplinary history of each
9 nurse, as submitted by party states, to assist in the coordination of
10 nurse licensure and enforcement efforts.
11 b. The commission, in consultation with the administrator of the coor-
12 dinated licensure information system, shall formulate necessary and
13 proper procedures for the identification, collection and exchange of
14 information under this compact.
15 c. All licensing boards shall promptly report to the coordinated
16 licensure information system any adverse action, any current significant
17 investigative information, denials of applications with the reasons for
18 such denials and nurse participation in alternative programs known to
19 the licensing board regardless of whether such participation is deemed
20 nonpublic or confidential under state law.
21 d. Current significant investigative information and participation in
22 nonpublic or confidential alternative programs shall be transmitted
23 through the coordinated licensure information system only to party state
24 licensing boards.
25 e. Notwithstanding any other provision of law, all party state licens-
26 ing boards contributing information to the coordinated licensure infor-
27 mation system may designate information that may not be shared with
28 non-party states or disclosed to other entities or individuals without
29 the express permission of the contributing state.
30 f. Any personally identifiable information obtained from the coordi-
31 nated licensure information system by a party state licensing board
32 shall not be shared with non-party states or disclosed to other entities
33 or individuals except to the extent permitted by the laws of the party
34 state contributing the information.
35 g. Any information contributed to the coordinated licensure informa-
36 tion system that is subsequently required to be expunged by the laws of
37 the party state contributing that information shall also be expunged
38 from the coordinated licensure information system.
39 h. The compact administrator of each party state shall furnish a
40 uniform data set to the compact administrator of each other party state,
41 which shall include, at a minimum:
42 i. Identifying information;
43 ii. Licensure data;
44 iii. Information related to alternative program participation; and
45 iv. Other information that may facilitate the administration of this
46 compact, as determined by commission rules.
47 i. The compact administrator of a party state shall provide all inves-
48 tigative documents and information requested by another party state.
49 § 8907. Establishment of the interstate commission of nurse licensure
50 compact administrators. 1. Commission of nurse licensure compact admin-
51 istrators. The party states hereby create and establish a joint public
52 entity known as the interstate commission of nurse licensure compact
53 administrators. The commission is an instrumentality of the party
54 states.
55 2. Venue. Venue is proper, and judicial proceedings by or against the
56 commission shall be brought solely and exclusively, in a court of compe-
S. 8307--A 110 A. 8807--A
1 tent jurisdiction where the principal office of the commission is
2 located. The commission may waive venue and jurisdictional defenses to
3 the extent it adopts or consents to participate in alternative dispute
4 resolution proceedings.
5 3. Sovereign immunity. Nothing in this compact shall be construed to
6 be a waiver of sovereign immunity.
7 4. Membership, voting and meetings. a. Each party state shall have and
8 be limited to one administrator. The head of the state licensing board
9 or designee shall be the administrator of this compact for each party
10 state. Any administrator may be removed or suspended from office as
11 provided by the law of the state from which the administrator is
12 appointed. Any vacancy occurring in the commission shall be filled in
13 accordance with the laws of the party state in which the vacancy exists.
14 b. Each administrator shall be entitled to one vote with regard to the
15 promulgation of rules and creation of bylaws and shall otherwise have an
16 opportunity to participate in the business and affairs of the commis-
17 sion. An administrator shall vote in person or by such other means as
18 provided in the bylaws. The bylaws may provide for an administrator's
19 participation in meetings by telephone or other means of communication.
20 c. The commission shall meet at least once during each calendar year.
21 Additional meetings shall be held as set forth in the bylaws or rules of
22 the commission.
23 d. All meetings shall be open to the public, and public notice of
24 meetings shall be given in the same manner as required under the rule-
25 making provisions in section eighty-nine hundred eight of this article.
26 5. Closed meetings. a. The commission may convene in a closed, nonpub-
27 lic meeting if the commission shall discuss:
28 i. Noncompliance of a party state with its obligations under this
29 compact;
30 ii. The employment, compensation, discipline or other personnel
31 matters, practices or procedures related to specific employees or other
32 matters related to the commission's internal personnel practices and
33 procedures;
34 iii. Current, threatened or reasonably anticipated litigation;
35 iv. Negotiation of contracts for the purchase or sale of goods,
36 services or real estate;
37 v. Accusing any person of a crime or formally censuring any person;
38 vi. Disclosure of trade secrets or commercial or financial information
39 that is privileged or confidential;
40 vii. Disclosure of information of a personal nature where disclosure
41 would constitute a clearly unwarranted invasion of personal privacy;
42 viii. Disclosure of investigatory records compiled for law enforcement
43 purposes;
44 ix. Disclosure of information related to any reports prepared by or on
45 behalf of the commission for the purpose of investigation of compliance
46 with this compact; or
47 x. Matters specifically exempted from disclosure by federal or state
48 statute.
49 b. If a meeting, or portion of a meeting, is closed pursuant to this
50 paragraph the commission's legal counsel or designee shall certify that
51 the meeting may be closed and shall reference each relevant exempting
52 provision. The commission shall keep minutes that fully and clearly
53 describe all matters discussed in a meeting and shall provide a full and
54 accurate summary of actions taken, and the reasons therefor, including a
55 description of the views expressed. All documents considered in
56 connection with an action shall be identified in such minutes. All
S. 8307--A 111 A. 8807--A
1 minutes and documents of a closed meeting shall remain under seal,
2 subject to release by a majority vote of the commission or order of a
3 court of competent jurisdiction.
4 c. The commission shall, by a majority vote of the administrators,
5 prescribe bylaws or rules to govern its conduct as may be necessary or
6 appropriate to carry out the purposes and exercise the powers of this
7 compact, including but not limited to:
8 i. Establishing the fiscal year of the commission;
9 ii. Providing reasonable standards and procedures:
10 (1) For the establishment and meetings of other committees; and
11 (2) Governing any general or specific delegation of any authority or
12 function of the commission;
13 iii. Providing reasonable procedures for calling and conducting meet-
14 ings of the commission, ensuring reasonable advance notice of all meet-
15 ings and providing an opportunity for attendance of such meetings by
16 interested parties, with enumerated exceptions designed to protect the
17 public's interest, the privacy of individuals, and proprietary informa-
18 tion, including trade secrets. The commission may meet in closed session
19 only after a majority of the administrators vote to close a meeting in
20 whole or in part. As soon as practicable, the commission must make
21 public a copy of the vote to close the meeting revealing the vote of
22 each administrator, with no proxy votes allowed;
23 iv. Establishing the titles, duties and authority and reasonable
24 procedures for the election of the officers of the commission;
25 v. Providing reasonable standards and procedures for the establishment
26 of the personnel policies and programs of the commission. Notwithstand-
27 ing any civil service or other similar laws of any party state, the
28 bylaws shall exclusively govern the personnel policies and programs of
29 the commission; and
30 vi. Providing a mechanism for winding up the operations of the commis-
31 sion and the equitable disposition of any surplus funds that may exist
32 after the termination of this compact after the payment or reserving of
33 all of its debts and obligations.
34 6. General provisions. a. The commission shall publish its bylaws and
35 rules, and any amendments thereto, in a convenient form on the website
36 of the commission.
37 b. The commission shall maintain its financial records in accordance
38 with the bylaws.
39 c. The commission shall meet and take such actions as are consistent
40 with the provisions of this compact and the bylaws.
41 7. Powers of the commission. The commission shall have the following
42 powers:
43 a. To promulgate uniform rules to facilitate and coordinate implemen-
44 tation and administration of this compact. The rules shall have the
45 force and effect of law and shall be binding in all party states;
46 b. To bring and prosecute legal proceedings or actions in the name of
47 the commission, provided that the standing of any licensing board to sue
48 or be sued under applicable law shall not be affected;
49 c. To purchase and maintain insurance and bonds;
50 d. To borrow, accept or contract for services of personnel, including,
51 but not limited to, employees of a party state or nonprofit organiza-
52 tions;
53 e. To cooperate with other organizations that administer state
54 compacts related to the regulation of nursing, including but not limited
55 to sharing administrative or staff expenses, office space or other
56 resources;
S. 8307--A 112 A. 8807--A
1 f. To hire employees, elect or appoint officers, fix compensation,
2 define duties, grant such individuals appropriate authority to carry out
3 the purposes of this compact, and to establish the commission's person-
4 nel policies and programs relating to conflicts of interest, qualifica-
5 tions of personnel and other related personnel matters;
6 g. To accept any and all appropriate donations, grants and gifts of
7 money, equipment, supplies, materials and services, and to receive,
8 utilize and dispose of the same; provided that at all times the commis-
9 sion shall avoid any appearance of impropriety or conflict of interest;
10 h. To lease, purchase, accept appropriate gifts or donations of, or
11 otherwise to own, hold, improve or use, any property, whether real,
12 personal or mixed; provided that at all times the commission shall avoid
13 any appearance of impropriety;
14 i. To sell, convey, mortgage, pledge, lease, exchange, abandon or
15 otherwise dispose of any property, whether real, personal or mixed;
16 j. To establish a budget and make expenditures;
17 k. To borrow money;
18 l. To appoint committees, including advisory committees comprised of
19 administrators, state nursing regulators, state legislators or their
20 representatives, and consumer representatives, and other such interested
21 persons;
22 m. To provide and receive information from, and to cooperate with, law
23 enforcement agencies;
24 n. To adopt and use an official seal; and
25 o. To perform such other functions as may be necessary or appropriate
26 to achieve the purposes of this compact consistent with the state regu-
27 lation of nurse licensure and practice.
28 8. Financing of the commission. a. The commission shall pay, or
29 provide for the payment of, the reasonable expenses of its establish-
30 ment, organization and ongoing activities.
31 b. The commission may also levy on and collect an annual assessment
32 from each party state to cover the cost of its operations, activities
33 and staff in its annual budget as approved each year. The aggregate
34 annual assessment amount, if any, shall be allocated based upon a formu-
35 la to be determined by the commission, which shall promulgate a rule
36 that is binding upon all party states.
37 c. The commission shall not incur obligations of any kind prior to
38 securing the funds adequate to meet the same; nor shall the commission
39 pledge the credit of any of the party states, except by, and with the
40 authority of, such party state.
41 d. The commission shall keep accurate accounts of all receipts and
42 disbursements. The receipts and disbursements of the commission shall be
43 subject to the audit and accounting procedures established under its
44 bylaws. However, all receipts and disbursements of funds handled by the
45 commission shall be audited yearly by a certified or licensed public
46 accountant, and the report of the audit shall be included in and become
47 part of the annual report of the commission.
48 9. Qualified immunity, defense and indemnification. a. The administra-
49 tors, officers, executive director, employees and representatives of the
50 commission shall be immune from suit and liability, either personally or
51 in their official capacity, for any claim for damage to or loss of prop-
52 erty or personal injury or other civil liability caused by or arising
53 out of any actual or alleged act, error or omission that occurred, or
54 that the person against whom the claim is made had a reasonable basis
55 for believing occurred, within the scope of the commission's employment,
56 duties or responsibilities; provided that nothing in this paragraph
S. 8307--A 113 A. 8807--A
1 shall be construed to protect any such person from suit or liability for
2 any damage, loss, injury or liability caused by the intentional, willful
3 or wanton misconduct of that person.
4 b. The commission shall defend any administrator, officer, executive
5 director, employee or representative of the commission in any civil
6 action seeking to impose liability arising out of any actual or alleged
7 act, error or omission that occurred within the scope of the commis-
8 sion's employment, duties or responsibilities, or that the person
9 against whom the claim is made had a reasonable basis for believing
10 occurred within the scope of the commission's employment, duties or
11 responsibilities; provided that nothing herein shall be construed to
12 prohibit that person from retaining his or her own counsel; and provided
13 further that the actual or alleged act, error or omission did not result
14 from that person's intentional, willful or wanton misconduct.
15 c. The commission shall indemnify and hold harmless any administrator,
16 officer, executive director, employee or representative of the commis-
17 sion for the amount of any settlement or judgment obtained against that
18 person arising out of any actual or alleged act, error or omission that
19 occurred within the scope of the commission's employment, duties or
20 responsibilities, or that such person had a reasonable basis for believ-
21 ing occurred within the scope of the commission's employment, duties or
22 responsibilities, provided that the actual or alleged act, error or
23 omission did not result from the intentional, willful or wanton miscon-
24 duct of that person.
25 § 8908. Rulemaking. 1. Rulemaking. a. The commission shall exercise
26 its rulemaking powers pursuant to the criteria set forth in this article
27 and the rules adopted thereunder. Rules and amendments shall become
28 binding as of the date specified in each rule or amendment and shall
29 have the same force and effect as provisions of this compact.
30 b. Rules or amendments to the rules shall be adopted at a regular or
31 special meeting of the commission.
32 2. Notice. a. Prior to promulgation and adoption of a final rule or
33 rules by the commission, and at least sixty days in advance of the meet-
34 ing at which the rule will be considered and voted upon, the commission
35 shall file a notice of proposed rulemaking:
36 i. On the website of the commission; and
37 ii. On the website of each licensing board or the publication in which
38 each state would otherwise publish proposed rules.
39 b. The notice of proposed rulemaking shall include:
40 i. The proposed time, date and location of the meeting in which the
41 rule will be considered and voted upon;
42 ii. The text of the proposed rule or amendment, and the reason for the
43 proposed rule;
44 iii. A request for comments on the proposed rule from any interested
45 person; and
46 iv. The manner in which interested persons may submit notice to the
47 commission of their intention to attend the public hearing and any writ-
48 ten comments.
49 c. Prior to adoption of a proposed rule, the commission shall allow
50 persons to submit written data, facts, opinions and arguments, which
51 shall be made available to the public.
52 3. Public hearings on rules. a. The commission shall grant an opportu-
53 nity for a public hearing before it adopts a rule or amendment.
54 b. The commission shall publish the place, time and date of the sched-
55 uled public hearing.
S. 8307--A 114 A. 8807--A
1 i. Hearings shall be conducted in a manner providing each person who
2 wishes to comment a fair and reasonable opportunity to comment orally or
3 in writing. All hearings will be recorded, and a copy will be made
4 available upon request.
5 ii. Nothing in this section shall be construed as requiring a separate
6 hearing on each rule. Rules may be grouped for the convenience of the
7 commission at hearings required by this section.
8 c. If no one appears at the public hearing, the commission may proceed
9 with promulgation of the proposed rule.
10 d. Following the scheduled hearing date, or by the close of business
11 on the scheduled hearing date if the hearing was not held, the commis-
12 sion shall consider all written and oral comments received.
13 4. Voting on rules. The commission shall, by majority vote of all
14 administrators, take final action on the proposed rule and shall deter-
15 mine the effective date of the rule, if any, based on the rulemaking
16 record and the full text of the rule.
17 5. Emergency rules. Upon determination that an emergency exists, the
18 commission may consider and adopt an emergency rule without prior
19 notice, opportunity for comment or hearing, provided that the usual
20 rulemaking procedures provided in this compact and in this section shall
21 be retroactively applied to the rule as soon as reasonably possible, in
22 no event later than ninety days after the effective date of the rule.
23 For the purposes of this provision, an emergency rule is one that must
24 be adopted immediately in order to:
25 a. Meet an imminent threat to public health, safety or welfare;
26 b. Prevent a loss of the commission or party state funds; or
27 c. Meet a deadline for the promulgation of an administrative rule that
28 is required by federal law or rule.
29 6. Revisions. The commission may direct revisions to a previously
30 adopted rule or amendment for purposes of correcting typographical
31 errors, errors in format, errors in consistency or grammatical errors.
32 Public notice of any revisions shall be posted on the website of the
33 commission. The revision shall be subject to challenge by any person for
34 a period of thirty days after posting. The revision may be challenged
35 only on grounds that the revision results in a material change to a
36 rule. A challenge shall be made in writing, and delivered to the
37 commission, prior to the end of the notice period. If no challenge is
38 made, the revision will take effect without further action. If the
39 revision is challenged, the revision may not take effect without the
40 approval of the commission.
41 § 8909. Oversight, dispute resolution and enforcement. 1. Oversight.
42 a. Each party state shall enforce this compact and take all actions
43 necessary and appropriate to effectuate this compact's purposes and
44 intent.
45 b. The commission shall be entitled to receive service of process in
46 any proceeding that may affect the powers, responsibilities or actions
47 of the commission, and shall have standing to intervene in such a
48 proceeding for all purposes. Failure to provide service of process in
49 such proceeding to the commission shall render a judgment or order void
50 as to the commission, this compact or promulgated rules.
51 2. Default, technical assistance and termination. a. If the commission
52 determines that a party state has defaulted in the performance of its
53 obligations or responsibilities under this compact or the promulgated
54 rules, the commission shall:
S. 8307--A 115 A. 8807--A
1 i. Provide written notice to the defaulting state and other party
2 states of the nature of the default, the proposed means of curing the
3 default or any other action to be taken by the commission; and
4 ii. Provide remedial training and specific technical assistance
5 regarding the default.
6 b. If a state in default fails to cure the default, the defaulting
7 state's membership in this compact may be terminated upon an affirmative
8 vote of a majority of the administrators, and all rights, privileges and
9 benefits conferred by this compact may be terminated on the effective
10 date of termination. A cure of the default does not relieve the offend-
11 ing state of obligations or liabilities incurred during the period of
12 default.
13 c. Termination of membership in this compact shall be imposed only
14 after all other means of securing compliance have been exhausted. Notice
15 of intent to suspend or terminate shall be given by the commission to
16 the governor of the defaulting state and to the executive officer of the
17 defaulting state's licensing board and each of the party states.
18 d. A state whose membership in this compact has been terminated is
19 responsible for all assessments, obligations and liabilities incurred
20 through the effective date of termination, including obligations that
21 extend beyond the effective date of termination.
22 e. The commission shall not bear any costs related to a state that is
23 found to be in default or whose membership in this compact has been
24 terminated unless agreed upon in writing between the commission and the
25 defaulting state.
26 f. The defaulting state may appeal the action of the commission by
27 petitioning the U.S. District Court for the District of Columbia or the
28 federal district in which the commission has its principal offices. The
29 prevailing party shall be awarded all costs of such litigation, includ-
30 ing reasonable attorneys' fees.
31 3. Dispute resolution. a. Upon request by a party state, the commis-
32 sion shall attempt to resolve disputes related to the compact that arise
33 among party states and between party and non-party states.
34 b. The commission shall promulgate a rule providing for both mediation
35 and binding dispute resolution for disputes, as appropriate.
36 c. In the event the commission cannot resolve disputes among party
37 states arising under this compact:
38 i. The party states may submit the issues in dispute to an arbitration
39 panel, which will be comprised of individuals appointed by the compact
40 administrator in each of the affected party states, and an individual
41 mutually agreed upon by the compact administrators of all the party
42 states involved in the dispute.
43 ii. The decision of a majority of the arbitrators shall be final and
44 binding.
45 4. Enforcement. a. The commission, in the reasonable exercise of its
46 discretion, shall enforce the provisions and rules of this compact.
47 b. By majority vote, the commission may initiate legal action in the
48 U.S. District Court for the District of Columbia or the federal
49 district in which the commission has its principal offices against a
50 party state that is in default to enforce compliance with the provisions
51 of this compact and its promulgated rules and bylaws. The relief sought
52 may include both injunctive relief and damages. In the event judicial
53 enforcement is necessary, the prevailing party shall be awarded all
54 costs of such litigation, including reasonable attorneys' fees.
S. 8307--A 116 A. 8807--A
1 c. The remedies herein shall not be the exclusive remedies of the
2 commission. The commission may pursue any other remedies available under
3 federal or state law.
4 § 8910. Effective date, withdrawal and amendment. 1. Effective date.
5 a. This compact shall become effective and binding on the earlier of
6 the date of legislative enactment of this compact into law by no less
7 than twenty-six states or the effective date of the chapter of the laws
8 of two thousand twenty-four that enacted this compact. Thereafter, the
9 compact shall become effective and binding as to any other compacting
10 state upon enactment of the compact into law by that state. All party
11 states to this compact, that also were parties to the prior nurse licen-
12 sure compact, superseded by this compact, (herein referred to as "prior
13 compact"), shall be deemed to have withdrawn from said prior compact
14 within six months after the effective date of this compact.
15 b. Each party state to this compact shall continue to recognize a
16 nurse's multistate licensure privilege to practice in that party state
17 issued under the prior compact until such party state has withdrawn from
18 the prior compact.
19 2. Withdrawal. a. Any party state may withdraw from this compact by
20 enacting a statute repealing the same. A party state's withdrawal shall
21 not take effect until six months after enactment of the repealing stat-
22 ute.
23 b. A party state's withdrawal or termination shall not affect the
24 continuing requirement of the withdrawing or terminated state's licens-
25 ing board to report adverse actions and significant investigations
26 occurring prior to the effective date of such withdrawal or termination.
27 c. Nothing contained in this compact shall be construed to invalidate
28 or prevent any nurse licensure agreement or other cooperative arrange-
29 ment between a party state and a non-party state that is made in accord-
30 ance with the other provisions of this compact.
31 3. Amendment. a. This compact may be amended by the party states. No
32 amendment to this compact shall become effective and binding upon the
33 party states unless and until it is enacted into the laws of all party
34 states.
35 b. Representatives of non-party states to this compact shall be
36 invited to participate in the activities of the commission, on a nonvot-
37 ing basis, prior to the adoption of this compact by all states.
38 § 8911. Construction and severability. 1. Construction and severabil-
39 ity. This compact shall be liberally construed so as to effectuate the
40 purposes thereof. The provisions of this compact shall be severable, and
41 if any phrase, clause, sentence or provision of this compact is declared
42 to be contrary to the constitution of any party state or of the United
43 States, or if the applicability thereof to any government, agency,
44 person or circumstance is held to be invalid, the validity of the
45 remainder of this compact and the applicability thereof to any govern-
46 ment, agency, person or circumstance shall not be affected thereby. If
47 this compact shall be held to be contrary to the constitution of any
48 party state, this compact shall remain in full force and effect as to
49 the remaining party states and in full force and effect as to the party
50 state affected as to all severable matters.
51 § 3. This act shall take effect immediately and shall be deemed to
52 have been in full force and effect on and after April 1, 2024.
53 PART S
S. 8307--A 117 A. 8807--A
1 Section 1. The public health law is amended by adding a new section
2 2825-i to read as follows:
3 § 2825-i. Healthcare safety net transformation program. 1. A statewide
4 healthcare safety net transformation program shall be established within
5 the department for the purpose of supporting the transformation of safe-
6 ty net hospitals to improve access, equity, quality, and outcomes while
7 increasing the financial sustainability of safety net hospitals. Such
8 program may provide or utilize new or existing capital funding, or oper-
9 ating subsidies, or both. Any application for this program must be
10 jointly submitted by a safety net hospital and at least one partner
11 organization.
12 2. The commissioner shall enter an agreement with the president of the
13 dormitory authority of the state of New York pursuant to section sixteen
14 hundred eighty-r of the public authorities law, as required, which shall
15 apply to this agreement, subject to the approval of the director of the
16 division of the budget, for the purposes of the distribution and admin-
17 istration of available funds pursuant to such agreement and made avail-
18 able pursuant to this section and subject to appropriation. Such funds
19 may be awarded and distributed by the department to safety net hospi-
20 tals, or a partner organization, in the form of grants. To qualify as a
21 safety net hospital for purposes of this section, a hospital shall:
22 (a) be either a public hospital, a rural emergency hospital, critical
23 access hospital or sole community hospital;
24 (b) have at least thirty percent of its inpatient discharges made up
25 of medical assistance program eligible individuals, uninsured individ-
26 uals or medical assistance program dually eligible individuals and at
27 least thirty-five percent of its outpatient visits made up of medical
28 assistance program eligible individuals, uninsured individuals or
29 medical assistance program dually-eligible individuals;
30 (c) serve at least thirty percent of the residents of a county or a
31 multi-county area who are medical assistance program eligible individ-
32 uals, uninsured individuals or medical assistance program dually-eligi-
33 ble individuals; or
34 (d) in the discretion of the commissioner, serve a significant popu-
35 lation of medical assistance program eligible individuals, uninsured
36 individuals or medical assistance program dually-eligible individuals.
37 3. Partner organizations may include, but are not limited to, health
38 systems, hospitals, health plans, residential health care facilities,
39 physician groups, community-based organization, or other healthcare
40 entities who can serve as partners in the transformation of the safety
41 net hospital. The commissioner shall have the discretion to deem any
42 organization a partner organization upon a finding that deeming so will
43 advance the goals of this section.
44 4. Notwithstanding any law to the contrary, and in accordance with
45 section four of the state finance law, the comptroller is hereby author-
46 ized and directed to transfer, upon request of the director of budget,
47 on or before March thirty-first, two thousand twenty-five, up to five
48 hundred million dollars to the department from amounts appropriated to
49 administer the programs established in sections twenty-eight hundred
50 twenty-five-g and twenty-eight hundred twenty-five-h of this article to
51 support this program. Notwithstanding section one hundred sixty-three
52 of the state finance law, sections one hundred forty-two and one hundred
53 forty-three of the economic development law or any inconsistent
54 provisions of law to the contrary, awards may be provided without a
55 competitive bid or request for proposal process to safety net hospitals
56 or partner organizations for purposes of increasing access, equity,
S. 8307--A 118 A. 8807--A
1 quality, outcomes, and long-term financial sustainability of such safety
2 net hospitals.
3 5. Notwithstanding any provision of law to the contrary, the commis-
4 sioner is authorized to waive any regulatory requirements to allow
5 applicants to more effectively or efficiently implement projects awarded
6 through the healthcare safety net transformation program, provided,
7 however, that regulations pertaining to patient safety, patient auton-
8 omy, patient privacy, patient rights, due process, scope of practice,
9 professional licensure, environmental protections, provider reimburse-
10 ment methodologies, or occupational standards and employee rights may
11 not be waived, nor shall any regulations be waived if such waiver would
12 risk patient safety. Such waiver shall not exceed the life of the
13 project or such shorter time periods as the commissioner may determine.
14 Any regulatory relief granted pursuant to this subdivision shall be
15 specifically described and requested within each project application and
16 be reviewed by the commissioner. The waiver of any regulatory require-
17 ments shall be made in the sole discretion of the commissioner.
18 6. Qualifying safety net hospitals and their designated partner organ-
19 ization or organizations shall provide, as part of the application,
20 which shall be in a manner as prescribed by the commissioner, a trans-
21 formation plan that includes at least a five-year strategic and opera-
22 tional plan outlining the roles and responsibilities of each entity and
23 specifically state any regulatory flexibility which may be required to
24 implement such plan. The transformation plan shall also include a time-
25 line of key metrics and goals related to improved access, equity, quali-
26 ty, outcomes, and increased financial sustainability of the safety net
27 hospital. The request for level and type of support shall be specific
28 and detailed in the application. Continued support shall be contingent
29 upon the implementation of the approved plan and key milestones. Appli-
30 cations may include a range of collaboration models, including but not
31 be limited to merger, acquisition, a management services contract, or a
32 clinical integration.
33 7. The release of any funding will be contingent upon compliance with
34 the transformation plan and a determination that acceptable progress has
35 been made with such plan. If key milestones and goals are not met, addi-
36 tional financial resources may be withheld and redirected, upon the
37 recommendation of the commissioner and approval by the director of budg-
38 et.
39 § 2. This act shall take effect immediately and shall be deemed to
40 have been in full force and effect on and after April 1, 2024.
41 PART T
42 Section 1. Subdivision 1 of section 2130 of the public health law, as
43 amended by chapter 308 of the laws of 2010, is amended to read as
44 follows:
45 1. (a) Every physician or other person authorized by law to order
46 diagnostic tests or make a medical diagnosis, or any laboratory perform-
47 ing such tests shall immediately [(a)] (i) upon determination that a
48 person is [infected] positive/reactive with human immunodeficiency virus
49 (HIV), [(b)] (ii) upon diagnosis [that a person is afflicted] with [the
50 disease known as] acquired immune deficiency syndrome (AIDS), [(c)]
51 (iii) upon diagnosis [that a person is afflicted] with HIV related
52 illness, and [(d)] (iv) upon periodic monitoring of HIV infection by any
53 laboratory tests report such case or data to the commissioner.
S. 8307--A 119 A. 8807--A
1 (b) Any permitted clinical laboratory, as defined in section five
2 hundred seventy-one of this chapter, performing such diagnostic tests
3 shall also, upon determination that a test result is not
4 positive/reactive for HIV, report such negative HIV test result to the
5 commissioner.
6 § 2. Subdivision 1 of section 2102 of the public health law is amended
7 to read as follows:
8 1. Whenever any laboratory examination discloses evidence of communi-
9 cable disease, and for hepatitis B virus or syphilis upon determination
10 that a test result is not positive/reactive, the results of such exam-
11 ination together with all required pertinent facts, shall be immediately
12 reported by the person in charge of the laboratory or the person making
13 such examination to the local or state health official to whom the
14 attending physician is required to report such case.
15 § 3. The public health law is amended by adding a new section 2172 to
16 read as follows:
17 § 2172. HCV infection; duty to report. In addition to reporting that a
18 hepatitis C virus (HCV) clinical laboratory test is reactive/positive as
19 required by section twenty-one hundred two of this article, any permit-
20 ted clinical laboratory, as defined in section five hundred seventy-one
21 of this chapter, performing such tests shall also, upon determination
22 that a test result is not positive/reactive with HCV, report such nega-
23 tive HCV test result to the commissioner.
24 § 4. Section 2781 of the public health law, as amended by chapter 308
25 of the laws of 2010, subdivisions 1 and 2 as amended by chapter 502 of
26 the laws of 2016 and subdivision 4 as amended by section 2 of part A of
27 chapter 60 of the laws of 2014, is amended to read as follows:
28 § 2781. HIV related testing. 1. Except as provided in section three
29 thousand one hundred twenty-one of the civil practice law and rules, or
30 unless otherwise specifically authorized or required by a state or
31 federal law, no person shall order the performance of an HIV related
32 test without first, at a minimum, [orally advising] providing notice by
33 means readily accessible in multiple languages to the protected individ-
34 ual, or, when the protected individual lacks capacity to consent, a
35 person authorized to consent to health care for such individual, that an
36 HIV-related test is being performed, or over the objection of such indi-
37 vidual or authorized persons. Such [advisement and objection, when
38 applicable] notice may be provided orally, in writing, by prominently
39 displayed signage, or by electronic means or other appropriate form of
40 communication. Such notice shall include information that HIV testing is
41 voluntary. A refusal of an HIV related test shall be noted in the indi-
42 vidual's record.
43 2. A person ordering the performance of an HIV related test shall
44 provide either directly or through a representative to the subject of an
45 HIV related test or, if the subject lacks capacity to consent, to a
46 person authorized pursuant to law to consent to health care for the
47 subject, an explanation that:
48 (a) HIV causes AIDS and can be transmitted through sexual activities
49 and needle-sharing, by pregnant women to their fetuses, and through
50 breastfeeding infants;
51 (b) there is treatment for HIV that can help an individual stay heal-
52 thy;
53 (c) individuals with HIV or AIDS can adopt safe practices to protect
54 uninfected and infected people in their lives from becoming infected or
55 multiply infected with HIV;
S. 8307--A 120 A. 8807--A
1 (d) testing is voluntary and can be done anonymously at a public test-
2 ing center;
3 (e) the law protects the confidentiality of HIV related test results;
4 (f) the law prohibits discrimination based on an individual's HIV
5 status and services are available to help with such consequences; and
6 (g) the law requires that an individual be advised before an HIV-re-
7 lated test is performed, and that no test shall be performed over his or
8 her objection.
9 Protocols shall be in place to ensure compliance with this section.
10 4. [A person authorized pursuant to law to order the performance of an
11 HIV related test shall provide directly or through a representative to
12 the person seeking such test, an opportunity to remain anonymous through
13 use of a coded system with no linking of individual identity to the test
14 request or results.] A health care provider who is not authorized by the
15 commissioner to provide HIV related tests on an anonymous basis shall
16 refer a person who requests an anonymous test to a test site which does
17 provide anonymous testing. The provisions of this subdivision shall not
18 apply to a health care provider ordering the performance of an HIV
19 related test on an individual proposed for insurance coverage.
20 5. At the time of communicating the test result to the subject of the
21 test, a person ordering the performance of an HIV related test shall,
22 directly or through a representative:
23 (a) in the case of a test indicating evidence of HIV infection,
24 provide the subject of the test or, if the subject lacks capacity to
25 consent, the person authorized pursuant to law to consent to health care
26 for the subject with counseling or referrals for counseling:
27 (i) for coping with the emotional consequences of learning the result;
28 (ii) regarding the discrimination problems that disclosure of the
29 result could cause;
30 (iii) for behavior change to prevent transmission or contraction of
31 HIV infection;
32 (iv) to inform such person of available medical treatments; [and]
33 (v) regarding the need to notify his or her contacts; and
34 (vi) regarding pre- and post-exposure prophylaxis medications avail-
35 able to sexual partners to prevent HIV infection; and
36 (b) in the case of a test not indicating evidence of HIV infection,
37 provide (in a manner which may consist of oral or written reference to
38 information previously provided) the subject of the test, or if the
39 subject lacks capacity to consent, the person authorized pursuant to law
40 to consent to health care for the subject, with information:
41 (i) concerning the risks of participating in high risk sexual or
42 needle-sharing behavior; and
43 (ii) regarding pre- and post-exposure prophylaxis medications avail-
44 able to prevent HIV infection.
45 5-a. With the consent of the subject of a test indicating evidence of
46 HIV infection or, if the subject lacks capacity to consent, with the
47 consent of the person authorized pursuant to law to consent to health
48 care for the subject, the person who ordered the performance of the HIV
49 related test, or such person's representative, shall provide or arrange
50 with a health care provider for an appointment for follow-up medical
51 care for HIV for such subject.
52 6. The provisions of this section shall not apply to the performance
53 of an HIV related test:
54 (a) by a health care provider or health facility in relation to the
55 procuring, processing, distributing or use of a human body or a human
56 body part, including organs, tissues, eyes, bones, arteries, blood,
S. 8307--A 121 A. 8807--A
1 semen, or other body fluids, for use in medical research or therapy, or
2 for transplantation to individuals provided, however, that where the
3 test results are communicated to the subject, post-test counseling, as
4 described in subdivision five of this section, shall nonetheless be
5 required; or
6 (b) for the purpose of research if the testing is performed in a
7 manner by which the identity of the test subject is not known and may
8 not be retrieved by the researcher; or
9 (c) on a deceased person, when such test is conducted to determine the
10 cause of death or for epidemiological purposes; or
11 (d) conducted pursuant to section twenty-five hundred-f of this chap-
12 ter; or
13 (e) in situations involving occupational exposures which create a
14 significant risk of contracting or transmitting HIV infection, as
15 defined in regulations of the department and pursuant to protocols
16 adopted by the department,
17 (i) provided that:
18 (A) the person who is the source of the occupational exposure is
19 deceased, comatose or is determined by his or her attending health care
20 professional to lack mental capacity to consent to an HIV related test
21 and is not reasonably expected to recover in time for the exposed person
22 to receive appropriate medical treatment, as determined by the exposed
23 person's attending health care professional who would order or provide
24 such treatment;
25 (B) there is no person available or reasonably likely to become avail-
26 able who has the legal authority to consent to the HIV related test on
27 behalf of the source person in time for the exposed person to receive
28 appropriate medical treatment; and
29 (C) the exposed person will benefit medically by knowing the source
30 person's HIV test results, as determined by the exposed person's health
31 care professional and documented in the exposed person's medical record;
32 (ii) in which case
33 (A) a provider shall order an anonymous HIV test of the source person;
34 and
35 (B) the results of such anonymous test, but not the identity of the
36 source person, shall be disclosed only to the attending health care
37 professional of the exposed person solely for the purpose of assisting
38 the exposed person in making appropriate decisions regarding post-expo-
39 sure medical treatment; and
40 (C) the results of the test shall not be disclosed to the source
41 person or placed in the source person's medical record.
42 7. In the event that an HIV related test is ordered by a physician or
43 certified nurse practitioner pursuant to the provisions of the education
44 law providing for non-patient specific regimens, then for the purposes
45 of this section the individual administering the test shall be deemed to
46 be the individual ordering the test.
47 § 5. Subdivision 4 of section 6909 of the education law is amended by
48 adding a new paragraph (m) to read as follows:
49 (m) undertaking the collection of specimens necessary to test to
50 determine the presence of the hepatitis B virus.
51 § 6. Subdivision 6 of section 6527 of the education law is amended by
52 adding a new paragraph (m) to read as follows:
53 (m) undertaking the collection of specimens necessary to test to
54 determine the presence of the hepatitis B virus.
55 § 7. Section 6801 of the education law is amended by adding a new
56 subdivision 10 to read as follows:
S. 8307--A 122 A. 8807--A
1 10. a. A licensed pharmacist may execute a non-patient specific order
2 for the dispensing of HIV Pre-exposure Prophylaxis (PrEP) prescribed or
3 ordered by the commissioner of health, a physician licensed in this
4 state or a nurse practitioner certified in this state pursuant to rules
5 and regulations promulgated by the commissioner.
6 b. Prior to dispensing HIV PrEP to a patient, and at a minimum of
7 every twelve months for each returning patient, the pharmacist shall:
8 (i) ensure that the patient is HIV negative, as documented by a nega-
9 tive HIV test result obtained within the previous seven days from an HIV
10 antigen/antibody test or antibody-only test or from a rapid, point-of-
11 care fingerstick blood test approved by the federal food and drug admin-
12 istration. If the patient does not provide evidence of a negative HIV
13 test in accordance with this paragraph, the pharmacist may recommend or
14 prescribe an HIV test. If the patient tests positive for HIV infection,
15 the pharmacist shall direct the patient to a licensed physician and
16 provide the patient with a list of health care service providers and
17 clinics within the county where the pharmacist is located or adjacent
18 counties;
19 (ii) provide the patient with a self-screening risk assessment ques-
20 tionnaire, developed by the commissioner of health in consultation with
21 the commissioner, to be reviewed by the pharmacist to identify any known
22 risk factors and assist the patient's selection of an appropriate PrEP
23 medication; and
24 (iii) provide the patient with a fact sheet, developed by the commis-
25 sioner of health, that includes but is not limited to, the clinical
26 considerations and recommendations for use of PrEP, the appropriate
27 method for using PrEP, information on the importance of follow-up health
28 care, health care referral information, and the ability of the patient
29 to opt out of practitioner reporting requirements.
30 c. No pharmacist shall dispense PrEP under this subdivision without
31 receiving training in accordance with regulations promulgated by the
32 commissioner of health in consultation with the commissioner.
33 d. A pharmacist shall notify the patient's primary health care practi-
34 tioner, unless the patient opts out of such notification, within seven-
35 ty-two hours of dispensing PrEP, that PrEP has been dispensed. If the
36 patient does not have a primary health care practitioner, or is unable
37 to provide contact information for their primary health care practition-
38 er, the pharmacist shall provide the patient with a written record of
39 the PrEP medications dispensed, and advise the patient to consult an
40 appropriate health care practitioner.
41 e. Nothing in this subdivision shall prevent a pharmacist from refus-
42 ing to dispense a non-patient specific order of PrEP pursuant to this
43 subdivision if, in their professional judgment, potential adverse
44 effects, interactions, or other therapeutic complications could endanger
45 the health of the patient.
46 § 8. Section 6801 of the education law is amended by adding a new
47 subdivision 11 to read as follows:
48 11. A licensed pharmacist within their lawful scope of practice may
49 administer to patients eighteen years of age or older, immunizing agents
50 to prevent mpox pursuant to a patient specific order or a non-patient
51 specific order. When a licensed pharmacist administers an mpox immuniz-
52 ing agent, they shall comply with subdivisions two, three and four of
53 this section.
54 § 9. Section 2307 of the public health law is REPEALED.
55 § 10. This act shall take effect immediately; provided, however,
56 sections one, two, and three of this act shall take effect on the one
S. 8307--A 123 A. 8807--A
1 hundred eightieth day after it shall have become a law. Effective imme-
2 diately, the addition, amendment and/or repeal of any rule or regulation
3 necessary for the implementation of this act on its effective date are
4 authorized to be made and completed on or before such effective date.
5 PART U
6 Section 1. Section 3302 of the public health law is amended by adding
7 a new subdivision 42 to read as follows:
8 42. "Public health surveillance" means the continuous, systematic
9 collection, analysis, and interpretation of health-related data needed
10 for the planning, implementation, and evaluation of public health prac-
11 tice. Public health surveillance may be used for all of the following
12 purposes:
13 (a) as an early warning system for impending public health emergen-
14 cies;
15 (b) to document the impact of an intervention;
16 (c) to track progress towards specified goals;
17 (d) to monitor and clarify the epidemiology of health outcomes;
18 (e) to establish public health priorities; and
19 (f) to inform public health policy and strategies.
20 § 2. Subparagraphs (ix) and (x) of paragraph (a) of subdivision 2 of
21 section 3343-a of the public health law, as added by section 2 of part A
22 of chapter 447 of the laws of 2012, are amended and a new subparagraph
23 (xi) is added to read as follows:
24 (ix) a situation where the registry is not operational as determined
25 by the department or where it cannot be accessed by the practitioner due
26 to a temporary technological or electrical failure, as set forth in
27 regulation; [or]
28 (x) a practitioner who has been granted a waiver due to technological
29 limitations that are not reasonably within the control of the practi-
30 tioner, or other exceptional circumstance demonstrated by the practi-
31 tioner, pursuant to a process established in regulation, and in the
32 discretion of the commissioner[.]; or
33 (xi) a practitioner prescribing or ordering a controlled substance for
34 use on the premises of a correctional facility, an inpatient mental
35 health facility licensed under the mental hygiene law, or a nursing home
36 licensed under article twenty-eight of this chapter.
37 § 3. Subdivision 4 of section 3370 of the public health law, as added
38 by chapter 965 of the laws of 1974 and as renumbered by chapter 178 of
39 the laws of 2010, is amended to read as follows:
40 4. The department shall cause to be expunged or otherwise destroyed,
41 within [five] ten years from the date of receipt thereof, any record of
42 the name of any patient received by it pursuant to the filing require-
43 ments of subdivision six of section thirty-three hundred thirty-one,
44 subdivision four of section thirty-three hundred thirty-three, and
45 subdivision four of section thirty-three hundred thirty-four of this
46 article.
47 § 4. Subdivision 1 of section 3371 of the public health law, as
48 amended by chapter 178 of the laws of 2010, paragraphs (d) and (e) as
49 amended and paragraphs (f), (g), (h), (i), and (j) as added by section 4
50 of part A of chapter 447 of the laws of 2012, is amended to read as
51 follows:
52 1. No person, who has knowledge by virtue of his or her office of the
53 identity of a particular patient or research subject, a manufacturing
S. 8307--A 124 A. 8807--A
1 process, a trade secret or a formula shall disclose such knowledge, or
2 any report or record thereof, except:
3 (a) to another person employed by the department, for purposes of
4 executing provisions of this article;
5 (b) pursuant to judicial subpoena or court order in a criminal inves-
6 tigation or proceeding;
7 (c) to an agency, department of government, or official board author-
8 ized to regulate, license or otherwise supervise a person who is author-
9 ized by this article to deal in controlled substances, or in the course
10 of any investigation or proceeding by or before such agency, department
11 or board;
12 (d) to the prescription monitoring program registry and to authorized
13 users of such registry as set forth in subdivision two of this section;
14 (e) to a vendor or contractor, as authorized by the department as
15 necessary for the operation and maintenance of the prescription monitor-
16 ing program registry;
17 (f) to a practitioner to inform him or her that a patient may be under
18 treatment with a controlled substance by another practitioner for the
19 purposes of subdivision two of this section, and to facilitate the
20 department's review of individual challenges to the accuracy of
21 controlled substances histories pursuant to subdivision six of section
22 thirty-three hundred forty-three-a of this article;
23 [(f)] (g) to a pharmacist to provide information regarding
24 prescriptions for controlled substances presented to the pharmacist for
25 the purposes of subdivision two of this section and to facilitate the
26 department's review of individual challenges to the accuracy of
27 controlled substances histories pursuant to subdivision six of section
28 thirty-three hundred forty-three-a of this article;
29 [(g)] (h) to the deputy attorney general for medicaid fraud control,
30 or his or her designee, in furtherance of an investigation of fraud,
31 waste or abuse of the Medicaid program, pursuant to an agreement with
32 the department;
33 [(h)] (i) to a program area within the department for the purpose of
34 conducting public health research, public health surveillance, or educa-
35 tion with data contained in the prescription monitoring program registry
36 and not for patient-level outreach:
37 (i) pursuant to an agreement with the commissioner;
38 (ii) when the release of such information is deemed appropriate by the
39 commissioner;
40 (iii) for use in accordance with measures required by the commissioner
41 to ensure that the security and confidentiality of the data is
42 protected;
43 (iv) for use and retention no longer than ten years; and
44 (v) provided that disclosure is restricted to individuals within the
45 department who are engaged in public health research, public health
46 surveillance, or education;
47 (j) to a local health department for the purpose of conducting public
48 health research, public health surveillance, or education and not for
49 patient-level outreach:
50 (i) pursuant to an agreement with the commissioner;
51 (ii) when the release of such information is deemed appropriate by the
52 commissioner;
53 (iii) for use in accordance with measures required by the commissioner
54 to ensure that the security and confidentiality of the data is
55 protected;
56 (iv) for use and retention no longer than ten years; and
S. 8307--A 125 A. 8807--A
1 [(iv)] (v) provided that disclosure is restricted to individuals with-
2 in the local health department who are engaged in the research or educa-
3 tion;
4 [(i)] (k) to a medical examiner or coroner who is an officer of or
5 employed by a state or local government, pursuant to his or her official
6 duties; and
7 [(j)] (l) to an individual for the purpose of providing such individ-
8 ual with his or her own controlled substance history or, in appropriate
9 circumstances, in the case of a patient who lacks capacity to make
10 health care decisions, a person who has legal authority to make such
11 decisions for the patient and who would have legal access to the
12 patient's health care records, if requested from the department pursuant
13 to subdivision six of section thirty-three hundred forty-three-a of this
14 article or from a treating practitioner pursuant to subparagraph (iv) of
15 paragraph (a) of subdivision two of this section.
16 § 5. Subdivision (b) of schedule I of section 3306 of the public
17 health law is amended by adding eleven new paragraphs 93, 94, 95, 96,
18 97, 98, 99, 100, 101, 102 and 103 to read as follows:
19 (93) 1-methoxy-3-{4-(2-methoxy-2-phenylethyl)piperazin-1-yl}-1-phenylp
20 ropan-2-ol. Other name: Zipeprol.
21 (94) N,N-diethyl-2-(2-(4-methoxybenzyl)-5-nitro-1H-benzimidazol-1-yl)e
22 than-1-amine. Other names: Metonitazene.
23 (95) meta-Fluorofentanyl (N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4
24 -yl)propionamide).
25 (96) meta-Fluoroisobutyryl fentanyl (N-(3-fluorophenyl)-N-(1-phenethy
26 lpiperidin-4-yl)isobutyramide).
27 (97) para-Methoxyfuranyl fentanyl (N-(4-methoxyphenyl)-N-(1-phenethyl
28 piperidin-4-yl)furan-2-carboxamide).
29 (98) 3-furanyl fentanyl (N-(1-phenethylpiperidin-4-yl)-N-phenylfuran-
30 3-carboxamide).
31 (99) 2',5'-Dimethoxyfentanyl (N-(1-(2,5-dimethoxyphenethyl)piperidin-4
32 -yl)-N-phenylpropionamide).
33 (100) Isovaleryl fentanyl (3-methyl-N-(1-phenethylpiperidin-4-yl)-N-ph
34 enylbutanamide).
35 (101) ortho-Fluorofuranyl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylp
36 iperidin-4-yl)furan-2-carboxamide).
37 (102) alpha'-Methyl butyryl fentanyl (2-methyl-N-(1-phenethylpiperidin
38 -4-yl)-N-phenylbutanamide).
39 (103) para-Methylcyclopropyl fentanyl (N-(4-methylphenyl)-N-(1-pheneth
40 ylpiperidin-4-yl)cyclopropanecarboxamide).
41 § 6. Paragraphs 11 and 36 of subdivision (d) of schedule I of section
42 3306 of the public health law, paragraph 11 as added by chapter 664 of
43 the laws of 1985 and paragraph 36 as added by section 5 of part BB of
44 chapter 57 of the laws of 2018, are amended to read as follows:
45 (11) [Ibogane] Ibogaine. Some trade and other names: [7-ethyl-6, 6&,
46 7, 8, 9, 10, 12, 13-octahydro-2-methoxy-6, 9-methano-5h-pyrido
47 {1',2':1,2} azepino {5,4-b} indole: tabernanthe iboga.]
48 7-Ethyl-6,6&,7,8,9,10,12,13-octahydro-2-methoxy-6,9-methano-5H-pyriod{1'
49 ,2':1,2} azepino {5,4-b} indole; Tabernanthe iboga.
50 (36) 5-methoxy-N,N-dimethyltryptamine. Some trade or other names:
51 5-methoxy-3-{2-(dimethylamino)ethyl}indole; 5-MeO-DMT.
52 § 7. Subdivision (d) of schedule I of section 3306 of the public
53 health law is amended by adding nineteen new paragraphs 32, 39, 40, 41,
54 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 and 56 to read as
55 follows:
56 (32) 4-methyl-N-ethylcathinone. Some trade or other names: 4-MEC.
S. 8307--A 126 A. 8807--A
1 (39) 4-methyl-alpha-pyrrolidinopropiophenone. Some trade or other
2 names: 4-MePPP.
3 (40) Alpha-pyrrolidinopentiophenone. Some trade or other names: @-PVP.
4 (41) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)butan-1-one. Some trade
5 or other names: Butylone; bk-MBDB.
6 (42) 2-(methylamino)-1-phenylpentan-1-one. Some trade or other names:
7 Pentedrone.
8 (43) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)pentan-1-one. Some trade
9 or other names: Pentylone; bk-MBDP.
10 (44) 1-(naphthalen-2-yl)-2-(pyrrolidin-1-yl)pentan-1-one. Some trade
11 or other names: Naphyrone.
12 (45) Alpha-pyrrolidinobutiophenone. Some trade or other names: @-PBP.
13 (46) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)propan-1-one (ethylone).
14 (47) N-ethylpentylone. Some trade or other names: ephylone,
15 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)pentan-1-one).
16 (48) 1-(4-methoxyphenyl)-N-methylpropan-2-amine. Some trade or other
17 names: para-methoxymethamphetamine; PMMA.
18 (49) N-Ethylhexedrone. Some trade or other names:
19 @-ethylaminohexanophenone; 2-(ethylamino)-1-phenylhexan-1-one.
20 (50) alpha-Pyrrolidinohexanophenone. Some trade or other names: @-PHP;
21 alpha-pyrrolidinohexanophenone; 1-phenyl-2-(pyrrolidin-1-yl)hexan-1-one.
22 (51) 4-Methyl-alpha-ethylaminopentiophenone. Some trade or other
23 names: 4-MEAP; 2-(ethylamino)-1-(4-methylphenyl)pentan-1-one.
24 (52) 4'-Methyl-alpha-pyrrolidinohexiophenone. Some trade or other
25 names: MPHP; 4'-methyl-alpha-pyrrolidinohexanophenone;
26 1-(4-methylphenyl)-2-(pyrrolidin-1-yl)hexan-1-one.
27 (53) alpha-Pyrrolidinoheptaphenone. Some trade or other names: PV8;
28 1-phenyl-2-(pyrrolidin-1-yl)heptan-1-one.
29 (54) 4'-Chloro-alpha-pyrrolidinovalerophenone. Some trade or other
30 names: 4-chloro-@-PVP; 4'-chloro-alpha-pyrrolidinopentiophenone;
31 1-(4-chlorophenyl)-2-(pyrrolidin-1-yl)pentan-1-one.
32 (55) 2-(ethylamino)-2-(3-methoxyphenyl)cyclohexan-1-one (methoxetamin
33 e, MXE).
34 (56) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)butan-1-one. Some trade or
35 other names: eutylone; bk-EBDB.
36 § 8. Subdivision (e) of schedule I of section 3306 of the public
37 health law is amended by adding five new paragraphs 7, 8, 9, 10 and 11
38 to read as follows:
39 (7) 4-(2-chlorophenyl)-2-ethyl-9-methyl-6H-thieno{3,2-f}{1,2,4}triazol
40 o{4,3-{alpha}}{1,4}diazepine. Some trade or other names: etizolam.
41 (8) 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-benzo{f}{1,2,4}triazolo{4,
42 3-{alpha}}{1,4}diazepine. Some trade or other names: flualprazolam.
43 (9) 6-(2-chlorophenyl)-1-methyl-8-nitro-4H-benzo{f}{1,2,4}triazolo{4,3
44 -{alpha}}{1,4}diazepine. Some trade or other names: clonazolam.
45 (10) 8-bromo-6-(2-fluorophenyl)-1-methyl-4H-benzo{f}{1,2,4}triazolo{4,
46 3-{alpha}}{1,4}diazepine. Some trade or other names: flubromazolam.
47 (11) 7-chloro-5-(2-chlorophenyl)-1-methyl-1,3-dihydro-2H-benzo{e}{1,4}
48 diazepin-2-one. Some trade or other names: diclazepam.
49 § 9. Paragraphs 13 and 14 of subdivision (f) of schedule I of section
50 3306 of the public health law, as added by chapter 341 of the laws of
51 2013, are amended and four new paragraphs 25, 26, 27 and 28 are added to
52 read as follows:
53 (13) 3-Fluoromethcathinone. Some trade or other names: 3-fluoro-N
54 -methylcathinone; 3-FMC.
55 (14) 4-Fluoromethcathinone. Some trade or other names: 4-fluoro-N-me-
56 thylcathinone; 4-FMC; flephedrone.
S. 8307--A 127 A. 8807--A
1 (25) 7-{(10,11-dihydro-5H-dibenzo{a,d}cyclohepten-5-yl)amino}heptanoic
2 acid. Other name: amineptine.
3 (26) N-phenyl-N'-(3-(1-phenylpropan-2-yl)-1,2,3-oxadiazol-3-ium-5-yl)
4 carbamimidate. Other name: mesocarb.
5 (27) N-methyl-1-(thiophen-2-yl)propan-2-amine. Other name: methiopro-
6 pamine.
7 (28) 4,4'-Dimethylaminorex. Some trade or other names: 4,4'-DMAR;
8 4,5-dihydro-4-methyl-5-(4-methylphenyl)-2-oxazolamine; 4-methyl-5-(4-met
9 hylphenyl)-4,5-dihydro-1,3-oxazol-2-amine.
10 § 10. Paragraphs 2, 6 and 10 of subdivision (g) of schedule I of
11 section 3306 of the public health law, as added by section 7 of part BB
12 of chapter 57 of the laws of 2018, are amended to read as follows:
13 (2) [{1-(5-fluro-pentyl)-1H-indol-3-yl}(2,2,3,3-tetramethylcyclopropyl)
14 methanone.] {1-(5-fluoro-pentyl)-1H-indol-3-yl}(2,2,3,3-tetramethyl
15 cyclopropyl)methone. Some trade names or other names:
16 5-fluoro-UR-144[,]; XLR11.
17 (6) [N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-indazo
18 [-]le-3-carboxamide.] N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(4-fluorob
19 enzyl)-1H-indazo[-]le-3-carboxamide. Some trade or other names: AB-
20 FUBINACA.
21 (10) [{1-(5-fluoropentyl)-1H-indazol-3-yl}(naphthalen-1- [y1] yl)meth-
22 anone.] {1-(5-fluoropentyl)-1H-indazol -3-yl}(naphthalen-1-[y1
23 ]yl)methanone.
24 Some trade or other names: THJ-2201.
25 § 11. Subdivision (g) of schedule I of section 3306 of the public
26 health law is amended by adding nineteen new paragraphs 11, 12, 13, 14,
27 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 and 29 to read as
28 follows:
29 (11) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-
30 indazole-3-carboxamide. Some trade or other names: MAB-CHMINACA;
31 ADB-CHMINACA.
32 (12) methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylb
33 utanoate. Some trade or other names: FUB-AMB; MMB-FUBINACA; AMBFUBINACA.
34 (13) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-
35 dimethylbutanoate. Some trade or other names: MDMB-CHMICA; MMB-CHMINACA.
36 (14) methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3,3-
37 dimethylbutanoate. Some trade or other names: MDMB-FUBINACA.
38 (15) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-in
39 dazole-3-carboxamide. Some trade or other names: ADB-FUBINACA.
40 (16) N-(adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide.
41 Some trade or other names: 5F-APINACA; 5F-AKB48.
42 (17) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-meth
43 ylbutanoate. Some trade or other names: 5F-AMB.
44 (18) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-
45 dimethylbutanoate. Some trade or other names: 5F-ADB; 5F-MDMB-PINACA.
46 (19) Naphthalen-1-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate. Some
47 trade or other names: NM2201; CBL2201.
48 (20) N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1H-indazol
49 e-3-car boxamide. Some trade or other names: 5F-AB-PINACA.
50 (21) 1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carboxamid
51 e. Some trade or other names: 4-CN-CUMYL-BUTINACA;
52 4-cyano-CUMYL-BUTINACA; 4-CN-CUMYL BINACA; CUMYL-4CN-BINACA; SGT-78.
53 (22) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3-methyl
54 butanoate. Some trade or other names: MMB-CHMICA; AMB-CHMICA.
55 (23) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-pyrrolo{2,3-b}pyrid
56 ine-3-carboxamide. Some trade or other names: 5F-CUMYL-P7AICA.
S. 8307--A 128 A. 8807--A
1 (24) methyl 2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimet
2 hylbutanoate. Some trade or other names: 4F-MDMB-BINACA;
3 4F-MDMB-BUTINACA.
4 (25) ethyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimet
5 hylbutanoate. Some trade or other names: 5F-EDMB-PINACA.
6 (26) methyl 2-(1-(5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimeth
7 ylbutanoate. Some trade or other names: 5F-MDMB-PICA; 5F-MDMB-2201.
8 (27) N-(adamantan-1-yl)-1-(4-fluorobenzyl)-1H-indazole-3-carboxamide.
9 Some trade or other names: FUB-AKB48; FUB-APINACA; AKB48
10 N-(4-FLUOROBENZYL).
11 (28) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carbox
12 amide. Some trade or other names: 5F-CUMYL-PINACA; SGT-25.
13 (29) (1-4-fluorobenzyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)
14 methanone. Some trade or other names: FUB-144.
15 § 12. Paragraph 1 of subdivision (b) of schedule II of section 3306 of
16 the public health law, as amended by section 1 of part C of chapter 447
17 of the laws of 2012, is amended to read as follows:
18 (1) Opium and opiate, and any salt, compound, derivative, or prepara-
19 tion of opium or opiate, excluding apomorphine, dextrorphan, nalbuphine,
20 naldemedine, nalmefene, naloxegol, naloxone, [and] 6&-naltrexol,
21 naltrexone, and samidorphan, and their respective salts, but including
22 the following:
23 1. Raw opium.
24 2. Opium extracts.
25 3. Opium fluid.
26 4. Powdered opium.
27 5. Granulated opium.
28 6. Tincture of opium.
29 7. Codeine.
30 8. Ethylmorphine.
31 9. Etorphine hydrochloride.
32 10. Hydrocodone (also known as dihydrocodeinone).
33 11. Hydromorphone.
34 12. Metopon.
35 13. Morphine.
36 14. Oxycodone.
37 15. Oxymorphone.
38 16. Thebaine.
39 17. Dihydroetorphine.
40 18. Oripavine.
41 19. Noroxymorphone.
42 § 13. Subdivision (c) of schedule II of section 3306 of the public
43 health law is amended by adding a new paragraph 30 to read as follows:
44 (30) Oliceridine. (N-{(3-methoxythiophen-2-yl)methyl}({2-{(9R)-9-
45 (pyridin-2-yl)-6-oxaspiro{4.5}decan-9-yl}ethyl})amine).
46 § 14. Subdivision (f) of schedule II of section 3306 of the public
47 health law, as amended by chapter 589 of the laws of 1996, the undesig-
48 nated paragraph as amended by chapter 575 of the laws of 2001, is
49 amended to read as follows:
50 (f) Hallucinogenic substances.
51 (1) [Nabilone: Another name for nabilone: (+,-)-trans
52 -3-(1,1-dimethylheptyl)-6, 6a, 7, 8, 10, 10a-hexahydro-1-hydroxy-6,
53 6-dimethyl-9H-dibenzo{b,d}pyran-9-one.] Nabilone. Another name for nabi-
54 lone. +,-)-trans-3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a-hex ahydro-1-hyd
55 roxy-6,6-dimethyl-9H-dibenzo{b,d}pyran-9-one.
S. 8307--A 129 A. 8807--A
1 (2) Dronabinol {(-)-delta-9-trans tetrahydrocannabinol} in an oral
2 solution in a drug product approved for marketing by the United States
3 Food and Drug Administration.
4 § 15. Subparagraph (i) of paragraph 3 of subdivision (g) of schedule
5 II of section 3306 of the public health law, as amended by section 2 of
6 part BB of chapter 57 of the laws of 2023, is amended to read as
7 follows:
8 (i) [4-anilino-N-phenenethylpiperidine] [(ANPP)] 4-anilino-N-phen
9 ethylpiperidine (ANPP)..
10 § 16. Subdivision (h) of schedule II of section 3306 of the public
11 health law, as amended by section 8 of part C of chapter 447 of the laws
12 of 2012, is amended to read as follows:
13 (h) (1) Anabolic steroids. Unless specifically excepted or unless
14 listed in another schedule, "anabolic steroid" shall mean any drug or
15 hormonal substance, chemically and pharmacologically related to testos-
16 terone (other than estrogens, progestins, corticosteroids and dehydroe-
17 piandrosterone) and includes:
18 [(1)] (i) [3{beta}, 17-dihydroxy-5a-androstane] 3{beta},17{beta}-dihyd
19 roxy-5{alpha}-androstane.
20 [(2)] (ii) [3{alpha}, 17{beta}-dihydroxy-5a-androstane] 3{alpha},17
21 {beta}-dihydroxy-5{alpha}-androstane.
22 [(3)] (iii) 5{alpha}-androstan-3,17-dione.
23 [(4)] (iv) 1-androstenediol (3{beta},17{beta}-dihydroxy-5
24 {alpha}-androst-1- ene).
25 [(5)] (v) 1-androstenediol (3{alpha},17{beta}-dihydroxy-5
26 {alpha}-androst-1- ene).
27 [(6)] (vi) 4-androstenediol [(3{beta}, 17{beta}-dihydroxy-androst
28 -4-ene)] (3{beta},17{beta}-dihydroxy-androst-4-ene).
29 [(7)] (vii) 5-androstenediol [(3{beta}, 17{beta}-dihydroxy- androst-
30 5-ene)] (3{beta},17{beta}-dihydroxy-androst-5-ene).
31 [(8)] (viii) 1-androstenedione [({5{alpha}}-androst-1-en-3, 17-dione)]
32 (5{alpha}-androst-1-en-3,17-dione).
33 [(9)] (ix) 4-androstenedione (androst-4-en-3,17-dione).
34 [(10)] (x) 5-androstenedione (androst-5-en-3,17-dione).
35 [(11)] (xi) Bolasterone [(7{alpha},17{alpha}-dimethyl-17{beta}-
36 hydroxyandrost-4-en-3-one)] (7{alpha},17{alpha}-dimethyl-17{beta}-hydro
37 xyandrost-4-en-3-one).
38 [(12)] (xii) Boldenone [(17{beta}-hydroxyandrost-1, 4,-diene-3-one)]
39 (17{beta}-hydroxyandrost-1,4,-diene-3-one).
40 [(13)] (xiii) Boldione (androsta-1,4-diene-3,17-dione).
41 [(14)] (xiv) Calusterone [(7{beta}, 17{alpha}-dimethyl-17{b -hydrox-
42 yandrost-4-en-3-one)] (7{beta},17{alpha}-dimethyl-17{beta}-hydroxyandr
43 ost-4-en-3-one).
44 [(15)] (xv) Clostebol [(4-chloro-17{beta}-hydroxyandrost-4-en-3-o ne)]
45 (4-chloro-17{beta}-hydroxyandrost-4-en-3-one).
46 [(16)] (xvi) Dehydrochloromethyltestosterone (4-chloro-17
47 {beta}-hydroxy-17{alpha}-methyl-androst-1, 4-dien- 3-one).
48 [(17)] (xvii) [{Delta} 1-dihydrotestosterone] {Delta}1-dihydrotestost
49 erone (a.k.a. '1-testosterone') (17{beta}-hydroxy-5{alpha}-androst-1-en-
50 3-one).
51 [(18)] (xviii) 4-dihydrotestosterone (17{beta}-hydroxy-
52 androstan-3-one).
53 [(19)] (xix) Drostanolone (17{beta}-hydroxy-2{alpha}-methyl
54 -5{alpha} -androstan-3-one).
55 [(20)] (xx) Ethylestrenol (17{alpha}-ethyl-17{beta}-hydroxy
56 estr-4-ene).
S. 8307--A 130 A. 8807--A
1 [(21)] (xxi) Fluoxymesterone [(9-fluoro-17{alpha}-methyl-11{beta},
2 17 {beta}-dihydroxyandrost-4-en-3-one)] (9-fluoro-17{alpha}-methyl-
3 11{beta},17{beta}-dihydroxyandrost-4-en-3-one).
4 [(22)] (xxii) Formebolone [(2-formyl-17{alpha}-methyl-11{alpha},
5 17{beta}-dihydroxyandrost-1, 4-dien-3-one)] (2-formyl-17{alpha}-methyl
6 -11{alpha},17{beta}-dihydroxyandrost-1,4-dien-3-one).
7 [(23)] (xxiii) Furazabol [(17{alpha}-methyl-17{beta}-hydroxyandro
8 stano {2, 3-c}-furazan)] (17{alpha}-methyl-17{beta}-hydroxyandrostano
9 {2,3-c}-furazan).
10 [(24)] (xxiv) [13{beta}-ethyl-17{beta}-hyroxygon-4-en-3-one] 13{beta}-
11 ethyl-17{beta}-hydroxygon-4-en-3-one.
12 [(25)] (xxv) 4-hydroxytestosterone [(4, 17{beta}-dihydroxy-andros
13 t-4-en-3-one)] (4,17{beta}-dihydroxy-androst-4-en-3-one).
14 [(26)] (xxvi) 4-hydroxy-19-nortestosterone [(4,17{beta}-dihydroxy
15 -estr-4-en-3-one)] (4,17{beta}-dihydroxyestr-4-en-3-one).
16 [(27)] (xxvii) [desoxymethyltestosterone] Desoxymethyltestosterone
17 (17{alpha}-methyl-5 {alpha}-androst-2-en-17{beta}-ol) (a.k.a., [madol)]
18 'madol').
19 [(28)] (xxviii) Mestanolone [(17{alpha}-methyl-17{beta}-hydroxy-
20 5-androstan-3-one)] (17{alpha}-methyl-17{beta}-hydroxy-5-androstan
21 -3-one).
22 [(29)] (xxix) Mesterolone [(1{alpha}methyl-17{beta}-hydroxy-
23 {5{alpha}}-androstan-3-one)] (1{alpha}-methyl-17{beta}-hydroxy-5{alpha}
24 -androstan-3-one).
25 [(30)] (xxx) Methandienone [(17{alpha}-methyl-17{beta}-hydroxyand
26 rost-1, 4-dien-3-one)] (17{alpha}-methyl-17{beta}-hydroxyandrost-1,
27 4-dien-3-one.
28 [(31)] (xxxi) Methandriol [(17{alpha}-methyl-3{beta}, 17
29 {beta}-dihydroxyandrost-5-ene)] (17{alpha}-methyl-3{beta},17{beta}-
30 dihydroxyandrost-5-ene).
31 [(32)] (xxxii) Methenolone [(1-methyl- 17{beta}-hydroxy-5 {alpha}
32 -androst- 1-en-3-one)] (1-methyl-17{beta}-hydroxy-5 {alpha}-androst-1-
33 en-3-one).
34 [(33)] (xxxiii) [17{alpha}-methyl-3{beta},17{beta}-dihydroxydroxy
35 oxy- 5a-androstane] 17{alpha}-methyl-3{beta},17{beta}-dihydroxy-5a
36 {alpha}-androstane.
37 [(34)] (xxxiv) [17{alpha}-methyl-3{alpha}, 17{beta}- dihydroxy- 5a-an-
38 drostane] 17{alpha}-methyl-3{alpha},17{beta}-dihydroxy5a{alpha}-andros
39 tane
40 [(35)] (xxxv) [17{alpha}-methyl-3{beta}, 17{beta}-dihyd
41 roxyandrost-4-ene.] 17{alpha}-methyl-3{beta},17{beta}-dihydroxyandrost
42 -4-ene.
43 [(36)] (xxxvi) [17{alpha}-methyl-4-hydroxynandrolone(17{alpha}-
44 methyl-4-hydroxy-17{beta}-hydroxyestr-4-en-3-one).] 17{alpha}-methyl
45 -4-hydroxynandrolone(17{alpha}-methyl-4-hydroxy-17{beta}-hydroxyestr-4-
46 en-3-one).
47 [(37)] (xxxvii) Methyldienolone [(17{alpha}-methyl-17{beta} -hydrox-
48 yestra- 4,9(10)-dien-3-one).] (17{alpha}-methyl-17{beta}-hydroxyes-tr
49 a-4,9(10)-dien-3-one).
50 [(38)] (xxxviii) Methyltrienolone [(17{alpha}-methyl-17{beta}-hydroxy
51 estra-4,9-11-trien-3-one).] (17{alpha}-methyl-17{beta}-hydroxyestra-4,
52 9-11-trien-3-one).
53 [(39)] (xxxix) Methyltestosterone(17{alpha}-methyl-17{beta} -hydrox-
54 yandrost-4-en-3-one).
55 [(40)] (xl) Mibolerone (7{alpha},17{alpha}-dimethyl-17
56 {beta}-hydroxyestr-4-en-3-one).
S. 8307--A 131 A. 8807--A
1 [(41)] (xli) [17{alpha}-methyl-{Delta} 1-dihydrotestosterone(17b{beta}
2 -hydroxy-17{alpha}-methyl-5{alpha}-androst-1-en-3-one)] 17{alpha}-
3 methyl-{Delta}1-dihydrotestosterone(17{beta}-hydroxy-17{alpha}-methyl-5{
4 alpha}-androst-1-en-3-one) (a.k.a. '17-{alpha}-methyl-1-testosterone').
5 [(42)] (xlii) [Nandrolone(17{beta}-hydroxyestr-4-en-3-one).] Nandro-
6 lone (17{beta}-hydroxyestr-4-en-3-one).
7 [(43)] (xliii) 19-nor-4-androstenediol [(3{beta},17{beta}-dihydro
8 xyestr- 4-ene).] (3{beta},17{beta}-dihydroxyestr-4-ene).
9 [(44)] (xliv) 19-nor-4-androstenediol [(3{alpha},17{beta}-dihydrox-
10 yestr-4-ene).] (3{alpha},17{beta}-dihydroxyestr-4 -ene).
11 [(45)] (xlv) 19-nor-5-androstenediol [(3{beta},17{bet a}.ct-
12 dihydroxyestr -5-ene).] (3{beta},17{beta}-dihydroxyestr-5- ene).
13 [(46)] (xlvi) 19-nor-5-androstenediol [(3{alpha},17{beta}-dihydrox-
14 yestr-5-ene).] (3{alpha},17{beta}-dihydroxyestr-5-ene).
15 [(47)] (xlvii) [19-nor-4,9(10)-androstadienedione (estra-4,9(10)-
16 diene-3,17-dione).] 19-nor-4,9(10)-androstadienedione(estra-4,9(10)
17 -diene-3,17-dione).
18 [(48)] (xlviii) 19-nor-4-androstenedione (estr-4-en-3,17-dione).
19 [(49)] (xlix) 19-nor-5-androstenedione (estr-5-en-3,17-dione).
20 [(50)] (l) Norbolethone [(13{beta}, 17{alpha}-diethyl-17
21 {beta} -hydroxygon-4-en-3-one).]
22 (13{beta},17{alpha}-diethyl-17{beta}-hydroxygon-4-en-3-one).
23 [(51)] (li) Norclostebol [(4-chloro-17{beta}-hydroxyestr-4-
24 en-3-one).] (4-chloro-17{beta}-hydroxyestr-4-en-3-one).
25 [(52)] (lii) Norethandrolone (17{alpha}-ethyl-17{beta}-hydroxyes
26 tr-4-en-3-one).
27 [(53)] (liii) Normethandrolone [(17 {alpha}-methyl-17{beta}-hydrox
28 estr-4-en-3-one).] (17{alpha}-methyl-17{beta}-hydroxyestr-4-en-3-one).
29 [(54)] (liv) Oxandrolone [(17{alpha}-methyl-17{beta}-hydroxy-2-
30 oxa- {5{alpha}}-androstan-3-one).]
31 (17{alpha}-methyl-17{beta}-hydroxy-2-oxa-5{alpha}-androstan-3-one).
32 [(55)] (lv) Oxymesterone [(17{alpha}-methyl-4, 17 {beta}-dihydroxy
33 androst-4-en-3-one).]
34 (17{alpha}-methyl-4,17{beta}-dihydroxyandrost-4-en-3-one).
35 [(56)] (lvi) Oxymetholone [(17 {alpha}-methyl-2-hydroxymet
36 hylene-17 {beta}-hydroxy-{5{alpha}}- androstan-3-one).] (17{alpha}-
37 methyl-2-hydroxymethylene-17{beta}-hydroxy-5{alpha}-androst an-3-one).
38 [(57)] (lvii) Stanozolol [(17{alpha}-methyl-17{beta}-hydro
39 xy-{5{alpha}}- androst-2-eno{3, 2-c}-pyrazole).]
40 (17{alpha}-methyl-17{beta}-hydroxy-5{alpha}-androst-2-eno{3,2-c}-pyraz
41 ole).
42 [(58)] (lviii) Stenbolone [(17{beta}-hydroxy-2-methyl-{5{alpha}}-
43 androst- 1-en-3- one).] (17{beta}-hydroxy-2-methyl-5{alpha} -androst-1-
44 en-3-one).
45 [(59)] (lix) Testolactone [(13-hydroxy-3-oxo-13, 17-secoandrosta-
46 1, 4-dien-17-oic acid lactone).] (13-hydroxy-3-oxo-13,17-
47 secoandrosta1,4-dien-17-oic acid lactone).
48 [(60)] (lx) Testosterone (17{beta}-hydroxyandrost-4-en-3-one).
49 [(61)] (lxi) Tetrahydrogestrinone [(13{beta}, 17{alpha}
50 -diethyl-17{beta}-hydroxygon-4, 9, 11 -trien-3-one).]
51 (13{beta}, 17{alpha}-diethyl-17{beta}-hydroxygon-4,9,11-trien-3-one).
52 [(62)] (lxii) Trenbolone [(17{beta}-hydroxyestr-4, 9, 11-trien-
53 3-one).] (17{beta}-hydroxyestr-4,9,11-trien-3-one).
54 [(63)] (lxiii)5{alpha}-androstan-3,6,17-trione.
55 (lxiv) 6-bromo-androsta-1,4-diene-3,17-dione.
56 (lxv) 6-bromo-androstan-3,17-dione.
S. 8307--A 132 A. 8807--A
1 (lxvi) 4-chloro-17{alpha}-methyl-androsta-1,4-diene-3,17{beta}-diol.
2 (lxvii) 4-chloro-17{alpha}-methyl-androst-4-ene-3{beta},17{beta}-diol.
3 (lxviii) 4-chloro-17{alpha}-methyl-17{beta}hydroxy-androst-4-en-3-one.
4 (lxix) 4-chloro-17{alpha}-methyl-17{beta}hydroxy-androst-4-ene-3,11-di
5 one.
6 (lxx) 2{alpha},17{alpha}-dimethyl-17{beta}-hydroxy-5{beta}-androstan-
7 3-one.
8 (lxxi) 2{alpha},3{alpha}-epithio-17{alpha}-methyl-5{alpha}androstan-17
9 {beta}-ol.
10 (lxxii) estra-4,9,11-triene-3,17-dione.
11 (lxxiii) {3,2-c}furazan-5{alpha}-androstan-17{beta}-ol.
12 (lxxiv) 18a-homo-3-hydroxy-estra-2,5(10)-dien-17-one.
13 (lxxv) 4-hydroxy-androst-4-ene-3,17-dione.
14 (lxxvi) 17{beta}-hydroxy-androstano{2,3-d}isoxazole.
15 (lxxvii) 17{beta}-hydroxy-androstano{3,2-c}isoxazole.
16 (lxxviii) 3{beta}-hydroxy-estra-4,9,11-trien-17-one.
17 (lxxix) Methasterone (2{alpha},17{alpha}-dimethyl-5{alpha}-androstan-1
18 7{beta}-ol3-one or 2{alpha},17{alpha}-dimethyl-17{beta}-hydroxy-5{alpha}
19 -androstan-3-one).
20 (lxxx) 17{alpha}-methyl-androsta-1,4-diene-3,17{beta}-diol.
21 (lxxxi) 17{alpha}-methyl-5{alpha}-androstan-17{beta}-ol.
22 (lxxxii) 17{alpha}-methyl-androstan-3-hydroxyimine-17{beta}-ol.
23 (lxxxiii) 6{alpha}-methyl-androst-4-ene-3,17-dione.
24 (lxxxiv) 17{alpha}-methyl-androst-2-ene-3,17{beta}diol.
25 (lxxxv) Prostanozol (17{beta}-hydroxy-5{alpha}-androstano{3,2-c}pyrazole) or
26 {3,2-c}pyrazole-5{alpha}-androstan-17{beta}-ol.
27 (lxxxvi) {3,2-c}pyrazole-androst-4-en-17{beta}-ol.
28 (lxxxvii) Any salt, ester or ether of a drug or substance described or
29 listed in this subdivision.
30 (2) (i) Subject to subparagraph (ii) of this paragraph, a drug or
31 hormonal substance, other than estrogens, progestins, corticosteroids,
32 and dehydroepiandrosterone, that is not listed in paragraph one of this
33 subdivision and is derived from, or has a chemical structure substan-
34 tially similar to, one or more anabolic steroids listed in paragraph one
35 of this subdivision shall be considered to be an anabolic steroid for
36 purposes of this schedule if:
37 (A) the drug or substance has been created or manufactured with the
38 intent of producing a drug or other substance that either:
39 1. promotes muscle growth; or
40 2. otherwise causes a pharmacological effect similar to that of
41 testosterone; or
42 (B) the drug or substance has been, or is intended to be, marketed or
43 otherwise promoted in any manner suggesting that consuming it will
44 promote muscle growth or any other pharmacological effect similar to
45 that of testosterone.
46 (ii) A substance shall not be considered to be a drug or hormonal
47 substance for purposes of this subdivision if:
48 (A) it is:
49 1. an herb or other botanical;
50 2. a concentrate, metabolite, or extract of, or a constituent isolated
51 directly from, an herb or other botanical; or
52 3. a combination of two or more substances described in clause one or
53 two of this item;
54 (B) it is a dietary ingredient for purposes of the Federal Food, Drug,
55 and Cosmetic Act (21 U.S.C. 301 et seq.); and
56 (C) it is not anabolic or androgenic.
S. 8307--A 133 A. 8807--A
1 (iii) In accordance with subdivision one of section thirty-three
2 hundred ninety-six of this article, any person claiming the benefit of
3 an exemption or exception under subparagraph (ii) of this paragraph
4 shall bear the burden of going forward with the evidence with respect to
5 such exemption or exception.
6 § 17. Subdivision (c) of schedule III of section 3306 of the public
7 health law is amended by adding two new paragraphs 15 and 16 to read as
8 follows:
9 (15) Perampanel, its salts, isomers and salts of isomers.
10 (16) Xylazine, its salts, isomers and salts of isomers, except when
11 expressly intended for use by a veterinarian in the course of the
12 professional practice of veterinary medicine; provided, however, that
13 such substance stocks shall be at all times properly safeguarded and
14 secured, and access shall be limited to the minimum number of employees
15 actually required to efficiently handle the custody, dispensing, admin-
16 istration or other handling of such substance; and further provided,
17 however, that all veterinarians shall maintain records, orders and
18 prescriptions of the substance for a period of five years from the date
19 of transaction, which shall be readily available and promptly produced,
20 in electronic or hardcopy format that is readily understandable, for
21 inspection and copying upon request by authorized representatives of the
22 department. Any individual who knowingly and willfully administers them-
23 selves or another person, prescribes, dispenses or distributes such
24 substance when any such substance is intended for human consumption or
25 for any purpose other than the normal course of practice of veterinary
26 medicine shall be subject to the same penalties as any individual or
27 practitioner who violates the provisions of this section and any other
28 penalties prescribed by law.
29 § 18. Subdivision (c) of schedule IV of section 3306 of the public
30 health law is amended by adding seven new paragraphs 54, 55, 56, 57, 58,
31 59 and 60 to read as follows:
32 (54) Alfaxalone.
33 (55) Brexanolone.
34 (56) Daridorexant.
35 (57) Lemborexant.
36 (58) Remimazolam.
37 (59) Suvorexant.
38 (60) Zuranolone.
39 § 19. Subdivision (e) of schedule IV of section 3306 of the public
40 health law is amended by amending paragraph 10 and adding two new para-
41 graphs 13 and 14 to read as follows:
42 (10) SPA((-)[)]-1-dimethylamino-1,2-diphenylethane).
43 (13) Serdexmethylphenidate.
44 (14) Solriamfetol.(2-amino-3-phenylpropyl carbamate; benzenepropanol,
45 beta-amino-, carbamate(ester)).
46 § 20. Subdivision (f) of schedule IV of section 3306 of the public
47 health law, as added by chapter 664 of the laws of 1985, paragraph 2 as
48 added by chapter 457 of the laws of 2006 and paragraph 3 as added by
49 section 14 of part C of chapter 447 of the laws of 2012, is amended to
50 read as follows:
51 (f) Other substances. Unless specifically excepted or unless listed in
52 another schedule, any material, compound, mixture or preparation which
53 contains any quantity of the following substances, including its salts,
54 isomers, and salts of such isomers, whenever the existence of such
55 salts, isomers, and salts of isomers is possible:
56 (1) Pentazocine.
S. 8307--A 134 A. 8807--A
1 (2) Butorphanol (including its optical isomers).
2 (3) Tramadol in any quantities.
3 (4) Eluxadoline. (5-{{{(2S))-2-amino-3-{4-aminocarbonyl)-2,6-dimethyl
4 phenyl}-1-oxopropyl}{(1S)-1-(4-phenyl-1H-imidazol-2-yl)ethyl}amino}meth
5 yl}-2-methoxybenzoic acid) (including its optical isomers) and its
6 salts, isomers, and salts of isomers.
7 (5) Lorcaserin.
8 § 21. Subdivision (d) of schedule V of section 3306 of the public
9 health law is amended by adding four new paragraphs 4, 5, 6 and 7 to
10 read as follows:
11 (4) Brivaracetam ( (2S)-2-{ (4R) -2-oxo-4-propylpyrrolidin-1-yl}
12 butanamide). Some trade or other names: BRV; UCB-34714; Briviact)
13 (including its salts).
14 (5) Cenobamate ({1R)-1-(2-chlorophenyl)-2-(tetrazol-2-yl)ethyl}
15 carbamate; 2H-tetrazole-2-ethanol, alpha-(2-chlorophenyl)-, carbamate
16 (ester), (alphaR)-; carbamic acid(R)-(+)-1-(2-chlorophenyl) -2- (2H-te-
17 tra zol-2-yl)ethyl ester).
18 (6) Ganaxolone. 3{alpha}-hydroxy-3{beta}-methyl-5{alpha}-pregnan-20-
19 one.
20 (7) Lasmiditan
21 {2,4,6-trifluoro-N-(6-(1-methylpiperidine-4-carbonyl)pyridine-2-yl-benzam
22 ide}.
23 § 22. Subdivision 2 of section 3342 of the public health law, as
24 amended by chapter 692 of the laws of 1976, is amended to read as
25 follows:
26 2. An institutional dispenser may dispense controlled substances for
27 use off its premises only pursuant to a prescription, prepared and filed
28 in conformity with this title, provided, however, that, in an emergency
29 situation as defined by rule or regulation of the department, a practi-
30 tioner in a hospital without a full-time pharmacy may dispense
31 controlled substances to a patient in a hospital emergency room for use
32 off the premises of the institutional dispenser for a period not to
33 exceed twenty-four hours, unless the federal drug enforcement adminis-
34 tration has authorized a longer time period for the purpose of initiat-
35 ing maintenance treatment, detoxification treatment, or both.
36 § 23. Subdivision 1 of section 3302 of the public health law, as
37 amended by chapter 92 of the laws of 2021, is amended to read as
38 follows:
39 1. "[Addict] Person with a substance use disorder" means a person who
40 habitually uses a controlled substance for a non-legitimate or unlawful
41 use, and who by reason of such use is dependent thereon.
42 § 24. Subdivision 1 of section 3331 of the public health law, as added
43 by chapter 878 of the laws of 1972, is amended to read as follows:
44 1. Except as provided in titles III or V of this article, no substance
45 in schedules II, III, IV, or V may be prescribed for or dispensed or
46 administered to [an addict] a person with a substance use disorder or
47 habitual user.
48 § 25. The title heading of title 5 of article 33 of the public health
49 law, as added by chapter 878 of the laws of 1972, is amended to read as
50 follows:
51 DISPENSING TO [ADDICTS] PERSONS WITH A SUBSTANCE USE
52 DISORDER AND HABITUAL USERS
S. 8307--A 135 A. 8807--A
1 § 26. Section 3350 of the public health law, as added by chapter 878 of
2 the laws of 1972, is amended to read as follows:
3 § 3350. Dispensing prohibition. Controlled substances may not be
4 prescribed for, or administered or dispensed to [addicts] persons with a
5 substance use disorder or habitual users of controlled substances,
6 except as provided by this title or title III.
7 § 27. Section 3351 of the public health law, as added by chapter 878
8 of the laws of 1972, subdivision 5 as amended by chapter 558 of the laws
9 of 1999, is amended to read as follows:
10 § 3351. Dispensing for medical use. 1. Controlled substances may be
11 prescribed for, or administered or dispensed to [an addict] a person
12 with a substance use disorder or habitual user:
13 (a) during emergency medical treatment unrelated to [abuse] such
14 substance use disorder or habitual use of controlled substances;
15 (b) who is a bona fide patient suffering from an incurable and fatal
16 disease such as cancer or advanced tuberculosis;
17 (c) who is aged, infirm, or suffering from serious injury or illness
18 and the withdrawal from controlled substances would endanger the life or
19 impede or inhibit the recovery of such person.
20 1-a. A practitioner may prescribe, order and dispense any schedule
21 III, IV, or V narcotic drug approved by the federal food and drug admin-
22 istration specifically for use in maintenance or detoxification treat-
23 ment to a person with a substance use disorder or habitual user.
24 2. Controlled substances may be ordered for use by [an addict] a
25 person with a substance use disorder or habitual user by a practitioner
26 and administered by a practitioner [or], registered nurse, or paramedic
27 to relieve acute withdrawal symptoms.
28 3. Methadone, or such other controlled substance designated by the
29 commissioner as appropriate for such use, may be ordered for use of [an
30 addict] a person with a substance use disorder by a practitioner and
31 dispensed or administered by a practitioner or his designated agent as
32 interim treatment for [an addict on a waiting list for admission to an
33 authorized maintenance program] a person with a substance use disorder
34 while arrangements are being made for referral to treatment for such
35 addiction to controlled substances.
36 4. Methadone, or such other controlled substance designated by the
37 commissioner as appropriate for such use, may be administered to [an
38 addict] a person with a substance use disorder by a practitioner or by
39 [his] their designated agent acting under the direction and supervision
40 of a practitioner, as part of a [regime] regimen designed and intended
41 as maintenance or detoxification treatment or to withdraw a patient from
42 addiction to controlled substances.
43 5. [Methadone] Notwithstanding any other law and consistent with
44 federal requirements, methadone, or such other controlled substance
45 designated by the commissioner as appropriate for such use, may be
46 administered or dispensed directly to [an addict] a person with a
47 substance use disorder by a practitioner or by [his] their designated
48 agent acting under the direction and supervision of a practitioner, as
49 part of a substance [abuse or chemical dependence] use disorder program
50 approved pursuant to article [twenty-three or] thirty-two of the mental
51 hygiene law.
52 § 28. Section 3372 of the public health law is REPEALED.
53 § 29. This act shall take effect immediately.
54 PART V
S. 8307--A 136 A. 8807--A
1 Section 1. Section 2805-x of the public health law, as added by
2 section 48 of part B of chapter 57 of the laws of 2015, paragraph (d) of
3 subdivision 4 as added by chapter 697 of the laws of 2023, is amended to
4 read as follows:
5 § 2805-x. [Hospital-home care-physician] Health care delivery collab-
6 oration program. 1. The purpose of this section shall be to facilitate
7 innovation in [hospital, home care agency and physician collaboration in
8 meeting] collaborations between licensed and certified health care
9 providers and agencies, including: hospitals, home care agencies, emer-
10 gency medical services, skilled nursing facilities, and hospices, as
11 well as payors and other interdisciplinary providers, practitioners and
12 service entities, to meet the community's evolving health care needs in
13 a changing health care delivery landscape. It shall provide a framework
14 to support voluntary initiatives in collaboration to improve patient
15 care access and management, patient health outcomes, cost-effectiveness
16 in the use of health care services and community population health.
17 [Such collaborative initiatives may also include payors, skilled nursing
18 facilities and other interdisciplinary providers, practitioners and
19 service entities.]
20 2. For purposes of this section:
21 (a) "Hospital" shall include a general hospital as defined in this
22 article or other inpatient facility for rehabilitation or specialty care
23 within the definition of hospital in this article.
24 (b) "Home care agency" shall mean a certified home health agency, long
25 term home health care program or licensed home care services agency as
26 defined in article thirty-six of this chapter.
27 (c) "Payor" shall mean a health plan approved pursuant to article
28 forty-four of this chapter, or article thirty-two or forty-three of the
29 insurance law.
30 (d) "Practitioner" shall mean any of the health, mental health or
31 health related professions licensed pursuant to title eight of the
32 education law.
33 (e) "Physician" shall mean a person duly licensed pursuant to article
34 one hundred thirty-one of the education law.
35 (f) "Hospice" shall mean an agency approved under article forty of
36 this chapter.
37 (g) "Emergency medical services" shall mean an agency approved under
38 article thirty of this chapter.
39 (h) "Skilled nursing facility" shall mean a residential health care
40 facility or nursing home licensed pursuant to article twenty-eight of
41 this chapter.
42 3. The commissioner is authorized to provide financing including, but
43 not limited to, grants or positive adjustments in medical assistance
44 rates or premium payments, to the extent of funds available and allo-
45 cated or appropriated therefor, including funds provided to the state
46 through federal waivers, funds made available through state appropri-
47 ations and/or funding through section twenty-eight hundred seven-v of
48 this article, as well as waivers of regulations under title ten of the
49 New York codes, rules and regulations, to support the voluntary initi-
50 atives and objectives of this section.
51 4. [Hospital-home care-physician] Health care delivery collaborative
52 initiatives under this section may include, but shall not be limited to:
53 (a) [Hospital-home care-physician integration] Integration initiatives
54 between at least two of the following: hospitals, home care agencies,
55 physician, physicians' group, emergency medical services, hospice, and
56 skilled nursing facilities, including but not limited to:
S. 8307--A 137 A. 8807--A
1 (i) transitions in care initiatives to help effectively transition
2 patients to post-acute care at home, coordinate follow-up care and
3 address issues critical to care plan success and readmission avoidance;
4 (ii) clinical pathways for specified conditions, guiding patients'
5 progress and outcome goals, as well as effective health services use;
6 (iii) application of telehealth/telemedicine services in monitoring
7 and managing patient conditions, and promoting self-care/management,
8 improved outcomes and effective services use;
9 (iv) facilitation of physician house calls to homebound patients
10 and/or to patients for whom such home visits are determined necessary
11 and effective for patient care management;
12 (v) additional models for prevention of avoidable hospital readmis-
13 sions and emergency room visits;
14 (vi) health home development;
15 (vii) development and demonstration of new models of integrated or
16 collaborative care and care management not otherwise achievable through
17 existing models; and
18 (viii) bundled payment demonstrations for hospital-to-post-acute-care
19 for specified conditions or categories of conditions, in particular,
20 conditions predisposed to high prevalence of readmission, including
21 those currently subject to federal/state penalty, and other discharges
22 with extensive post-acute needs;
23 (b) Recruitment, training and retention of hospital/home care direct
24 care staff and physicians, in geographic or clinical areas of demon-
25 strated need. Such initiatives may include, but are not limited to, the
26 following activities:
27 (i) outreach and public education about the need and value of service
28 in health occupations;
29 (ii) training/continuing education and regulatory facilitation for
30 cross-training to maximize flexibility in the utilization of staff,
31 including:
32 (A) training of hospital nurses in home care;
33 (B) dual certified nurse aide/home health aide certification; and
34 (C) dual personal care aide/HHA certification;
35 (iii) salary/benefit enhancement;
36 (iv) career ladder development; and
37 (v) other incentives to practice in shortage areas; and
38 (c) [Hospital - home care - physician] Health care delivery collabora-
39 tives for the care and management of special needs, high-risk and high-
40 cost patients, including but not limited to best practices, and training
41 and education of direct care practitioners and service employees.
42 (d) Collaborative programs to address disparities in health care
43 access or treatment, and/or conditions of higher prevalence, in certain
44 populations, where such collaborative programs could provide and manage
45 services in a more effective, person-centered and cost-efficient manner
46 for reduction or elimination of such disparities.
47 (i) Such programs may target one or more disparate conditions, or
48 areas of under-service, evidenced in defined populations, including but
49 not be limited to:
50 (A) cardiovascular disease;
51 (B) hypertension;
52 (C) diabetes;
53 (D) chronic kidney disease;
54 (E) obesity;
55 (F) asthma;
56 (G) sickle cell disease;
S. 8307--A 138 A. 8807--A
1 (H) sepsis;
2 (I) lupus;
3 (J) breast, lung, prostate and colorectal cancers;
4 (K) geographic shortage of primary care, prenatal/obstetric care,
5 specialty medical care, home health care, or culturally and linguis-
6 tically compatible care;
7 (L) alcohol, tobacco, or substance abuse;
8 (M) post-traumatic stress disorder and other conditions more prevalent
9 among veterans of the United States military services;
10 (N) attracting members of minority populations to the field and prac-
11 tice of medicine; and
12 (O) such other areas approved by the commissioner.
13 (ii) Collaborative [hospital-home care-physician] health care
14 delivery, and as applicable additional partner, models may include under
15 such disparities programs:
16 (A) service planning and design;
17 (B) recruitment of specialty personnel and/or specialty training of
18 professionals or other direct care personnel (including physicians, home
19 care and hospital staffs), patients and informal caregivers;
20 (C) continuing medical education and clinical training for physicians,
21 follow-up evaluations, and supporting educational materials;
22 (D) use of evidenced-based approaches and/or best practices to treat-
23 ment;
24 (E) reimbursement of uncovered services;
25 (F) bundled or other integrated payment methods to support the neces-
26 sary, coordinated and cost-effective services;
27 (G) regulatory waivers to facilitate flexibility in provider collab-
28 oration and person-centered care;
29 (H) patient/family peer support and education;
30 (I) data collection, research and evaluation of efficacy; and/or
31 (J) other components or innovations satisfactory to the commissioner.
32 (iii) Nothing contained in this paragraph shall prevent a physician,
33 [physicians] physicians' group, home care agency, or hospital from indi-
34 vidually applying for said grant.
35 (iv) The commissioner shall consult with physicians, home care agen-
36 cies, hospitals, consumers, statewide associations representative of
37 such participants, and other experts in health care disparities, in
38 developing an application process for grant funding or rate adjustment,
39 and for request of state regulatory waivers, to facilitate implementa-
40 tion of disparities programs under this paragraph.
41 5. At a minimum, applications for collaborative initiatives under
42 this section must specifically identify the service gaps and/or communi-
43 ty need the collaboration seeks to address, and outline a projected
44 timeline for implementation and deliverable data to demonstrate mile-
45 stones to success.
46 6. Hospitals and home care agencies which are provided financing or
47 waivers pursuant to this section shall report to the commissioner on the
48 patient, service and cost experiences pursuant to this section, includ-
49 ing the extent to which the project goals are achieved. The commissioner
50 shall compile and make such reports available on the department's
51 website.
52 § 2. Subdivision 2 of section 3602 of the public health law, as added
53 by chapter 895 of the laws of 1977, is amended to read as follows:
54 2. "Home care services agency" means an organization primarily engaged
55 in arranging and/or providing directly or through contract arrangement
56 one or more of the following: Nursing services, home health aide
S. 8307--A 139 A. 8807--A
1 services, and other therapeutic and related services which may include,
2 but shall not be limited to, physical, speech and occupational therapy,
3 nutritional services, medical social services, personal care services,
4 homemaker services, and housekeeper or chore services, which may be of a
5 preventive, therapeutic, rehabilitative, health guidance, and/or
6 supportive nature to persons at home. For the purposes of this article,
7 a general hospital licensed pursuant to article twenty-eight of this
8 chapter shall not be considered "primarily engaged in arranging and/or
9 providing" nursing, home health, or other therapeutic services notwith-
10 standing that such services may be provided in a patient's residence,
11 provided that at least fifty-one percent of patient care hours for such
12 general hospital is generated from the treatment of patients within the
13 hospital, and that any patients treated in their residence have a preex-
14 isting clinical relationship with the general hospital.
15 § 3. Section 2803 of the public health law is amended by adding a new
16 subdivision 15 to read as follows:
17 15. Subject to the availability of federal financial participation and
18 notwithstanding any contrary provision of this article, or any rule or
19 regulation to the contrary, the commissioner shall allow general hospi-
20 tals to provide off-site acute care medical services, that are:
21 (a) not home care services defined in subdivision one of section thir-
22 ty-six hundred two of this chapter or the professional services enumer-
23 ated in subdivision two of such section;
24 (b) provided by a medical professional, including a physician, regis-
25 tered nurse, nurse practitioner, or physician assistant, to a patient
26 with a pre-existing clinical relationship with the general hospital, or
27 with the health care professional providing the service; and
28 (c) provided to a patient for whom a medical professional has deter-
29 mined is appropriate to receive acute medical services at their resi-
30 dence.
31 (d) Nothing in this subdivision shall preclude a federally qualified
32 health center from providing off-site services in accordance with
33 department regulations.
34 (e) The department is authorized to establish medical assistance
35 program rates to effectuate this subdivision. For the purposes of the
36 department determining the applicable rates pursuant to such authority,
37 any general hospital approved pursuant to this subdivision shall report
38 to the department, in the form and format required by the department,
39 its annual operating costs, specifically for such off-site acute
40 services. Failure to timely submit such cost data to the department may
41 result in revocation of authority to participate in a program under this
42 section due to the inability to establish appropriate reimbursement
43 rates.
44 § 4. Subdivision 3 of section 3018 of the public health law, as added
45 by chapter 137 of the laws of 2023, is amended to read as follows:
46 3. (a) This program shall authorize mobile integrated and community
47 paramedicine programs presently operating and approved by the department
48 as of May eleventh, two thousand twenty-three, under the authority of
49 Executive Order Number 4 of two thousand twenty-one, entitled "Declaring
50 a Statewide Disaster Emergency Due to Healthcare staffing shortages in
51 the State of New York" to continue in the same manner and capacity as
52 currently approved [for a period of two years following the effective
53 date of this section] through March thirty-first, two thousand thirty-
54 one.
55 (b) Any program not currently approved and operating in accordance
56 with paragraph (a) of this subdivision may apply to the department for
S. 8307--A 140 A. 8807--A
1 approval to operate a mobile integrated and community paramedicine
2 program, and any program currently operating pursuant to paragraph (a)
3 of this subdivision for a limited purpose, including but not limited to
4 vaccination administration, may apply to the department for approval to
5 modify its existing community paramedicine program. The department may
6 approve up to two hundred new or modified programs pursuant to this
7 paragraph. Such applications must be submitted in the form and format
8 prescribed by the department. Programs approved pursuant to this para-
9 graph may be permitted to operate through March thirty-first, two thou-
10 sand thirty-one.
11 § 5. Section 2 of chapter 137 of the laws of 2023 amending the public
12 health law relating to establishing a community-based paramedicine
13 demonstration program, is amended to read as follows:
14 § 2. This act shall take effect immediately and shall expire and be
15 deemed repealed [2 years after such date] March 31, 2031; provided,
16 however, that if this act shall have become a law on or after May 22,
17 2023 this act shall take effect immediately and shall be deemed to have
18 been in full force and effect on and after May 22, 2023.
19 § 6. Subdivision 1 of section 3001 of the public health law, as
20 amended by chapter 804 of the laws of 1992, is amended to read as
21 follows:
22 1. "Emergency medical service" means [initial emergency medical
23 assistance including, but not limited to, the treatment of trauma,
24 burns, respiratory, circulatory and obstetrical emergencies] a coordi-
25 nated system of healthcare delivery that responds to the needs of sick
26 and injured individuals, by providing: essential emergency, non-emergen-
27 cy, specialty need or public event medical care; community education and
28 prevention programs; ground and air ambulance services; emergency
29 medical dispatch; training for emergency medical services practitioners;
30 medical first response; mobile trauma care systems; mass casualty
31 management; and medical direction.
32 § 7. Section 6909 of the education law is amended by adding a new
33 subdivision 12 to read as follows:
34 12. A certified nurse practitioner may prescribe and order a non-pa-
35 tient specific regimen to an emergency medical services practitioner
36 licensed by the department of health pursuant to article thirty of the
37 public health law, pursuant to regulations promulgated by the commis-
38 sioner, and consistent with the public health law, for administering
39 immunizations. Nothing in this subdivision shall authorize unlicensed
40 persons to administer immunizations, vaccines or other drugs.
41 § 8. Section 6527 of the education law is amended by adding a new
42 subdivision 12 to read as follows:
43 12. A licensed physician may prescribe and order a non-patient specif-
44 ic regimen to an emergency medical services practitioner licensed by the
45 department of health pursuant to article thirty of the public health
46 law, pursuant to regulations promulgated by the commissioner, and
47 consistent with the public health law, for administering immunizations.
48 Nothing in this subdivision shall authorize unlicensed persons to admin-
49 ister immunizations, vaccines or other drugs.
50 § 9. The public health law is amended by adding a new article 30-D to
51 read as follows:
52 ARTICLE 30-D
53 EMERGENCY MEDICAL SERVICES ESSENTIAL SERVICES ACT
54 Section 3080. Declaration of purpose.
55 3081. Application of article.
56 3082. Definitions.
S. 8307--A 141 A. 8807--A
1 3083. Designation of medical emergency response and emergency
2 medical dispatch agencies as essential services.
3 3084. Provision of emergency medical dispatch.
4 3085. Rules and regulations.
5 § 3080. Declaration of purpose. 1. The provision of prompt, efficient,
6 and effective emergency medical services and emergency medical dispatch
7 is crucial to the health and safety of the residents of New York state.
8 2. The establishment of a comprehensive and standardized system for
9 medical emergency response is essential to address life-threatening
10 conditions and ensure the well-being of individuals in need of urgent
11 medical care.
12 3. Ensuring that every county within New York state has the necessary
13 resources, trained personnel, and operational capabilities to provide
14 medical emergency response is a matter of public interest and state
15 priority.
16 4. It is imperative to standardize the approach to medical emergency
17 response and dispatch services to enhance the quality of care, maximize
18 efficiency, and improve outcomes for patients experiencing medical emer-
19 gencies.
20 5. The designation of medical emergency response and emergency medical
21 dispatch as essential services will ensure a uniform, effective, and
22 coordinated response to medical emergencies across the state.
23 6. This article aims to establish a framework for the provision, oper-
24 ation, and regulation of medical emergency response and dispatch
25 services, thereby safeguarding the health and safety of New York state's
26 residents and visitors.
27 § 3081. Application of article. This article shall apply to every
28 county except a county wholly contained within a city.
29 § 3082. Definitions. As used in this article, the following terms
30 shall have the following meanings:
31 1. "Medical emergency response" shall mean the rapid deployment of
32 ambulance services, advanced life support first response services, and
33 other first response services authorized by the department to provide
34 emergency medical services, as defined in section three thousand one of
35 this chapter, for the purpose of providing immediate emergency medical
36 care in response to emergency calls for acute conditions where rapid
37 intervention is vital to prevent death or serious harm.
38 2. "Emergency medical dispatch" means a protocol-driven system
39 approved by the department designed to manage, assess, and prioritize
40 medical emergency calls, provide critical pre-arrival instructions, and
41 dispatch medical emergency response services by an EMS medical dispatch
42 agency or provide referral to appropriate non-emergency medical services
43 where appropriate.
44 3. "EMS medical dispatch agency" means any individual, partnership,
45 association, corporation, municipality or any legal or public entity or
46 subdivision thereof licensed by the department who is engaged in receiv-
47 ing requests for emergency medical assistance from the public and
48 dispatching medical emergency response services as needed, except for
49 any such individual or entity that is subject to minimum standards
50 promulgated under section three-hundred twenty-eight of County Law.
51 4. "Medical emergency readiness assessment" means the rating system
52 evaluating the preparedness, efficiency, and effectiveness of medical
53 emergency response within a community.
54 § 3083. Designation of medical emergency response and emergency
55 medical dispatch agencies as essential services. 1. Medical emergency
S. 8307--A 142 A. 8807--A
1 response and emergency medical dispatch agencies are hereby declared
2 essential services within New York state.
3 2. Every county, acting individually or jointly with any other county,
4 city, town, and village, shall ensure that an emergency medical service,
5 ambulance service, advanced life support first response service, other
6 first response services authorized by the department to provide emergen-
7 cy medical services, or a combination of such services are provided for
8 the purposes of effectuating medical emergency response within the boun-
9 daries of the county.
10 3. Every county acting individually or jointly with any other county,
11 city, town, and village, shall develop, implement, and maintain a
12 comprehensive county medical emergency response plan approved by the
13 department, ensuring the effective operation, coordination, utilization
14 of existing ambulance services licensed by the Department, and funding
15 of medical emergency response. In furtherance of that purpose, the coun-
16 ty shall designate one or more primary medical emergency response agen-
17 cies that shall respond to all calls and demands for such medical emer-
18 gency response to persons entitled thereto, subject to any limitations
19 upon such service specified in an agreement, within the boundaries of
20 the county. Any proposed permanent changes, including a full closure or
21 significant modification of coverage of a primary medical emergency
22 response agency designated by a county shall be submitted in writing to
23 the county and the department no later than 180 days before the change.
24 Such changes shall not be made until receipt of the appropriate depart-
25 ment approval. No county shall remove or reassign an area served by an
26 existing medical emergency response agency where that agency is compli-
27 ant with all statutory and regulatory requirements of the department,
28 and that has agreed to the provision of approved plan. No medical emer-
29 gency response agency, designated by the county in the plan, may refuse
30 to respond to a request for service unless they can prove, to the satis-
31 faction of the department, that they are unable to respond because of
32 capacity limitations.
33 4. Notwithstanding the provisions of section three thousand eight of
34 this chapter, any county acting individually or jointly with any other
35 county, city, town, and village, that provides, either directly or
36 through agreement with existing services, an emergency medical service
37 or general ambulance service in accordance with section one hundred
38 twenty-two-b of the general municipal law, for the purpose of effectuat-
39 ing medical emergency response, upon meeting or exceeding all adminis-
40 trative and operational standards set by the department, and upon filing
41 written notice to the department in a manner prescribed by the depart-
42 ment, shall be deemed to have satisfied any and all requirements for
43 determination of public need for the establishment of additional emer-
44 gency medical services and the department shall issue a non-transfera-
45 ble, permanent municipal ambulance service operating certificate. Noth-
46 ing in this article shall be deemed to exclude any county issued a
47 municipal ambulance service operating certificate from complying with
48 any other requirement of article thirty of this chapter or any other
49 applicable provision of law or regulations promulgated thereunder.
50 5. Any county acting individually or jointly with any other county,
51 city, town, and village, that provides, either directly or through
52 agreement with an existing service, an emergency medical service or
53 general ambulance service in accordance with section one hundred twen-
54 ty-two-b of the general municipal law, for the purpose of effectuating
55 medical emergency response may establish a special district, after nine-
56 ty days notice to the department, as defined in subdivision sixteen of
S. 8307--A 143 A. 8807--A
1 section one hundred two of the real property tax law, for the financing
2 and operation of such emergency medical service or general ambulance
3 service in accordance with section one hundred twenty-two-b of the
4 general municipal law with an emergency medical services agency licensed
5 by the department to provide emergency medical services in the state.
6 Such special district shall be exempt from the provisions of section
7 three-c of the general municipal law until five years after the estab-
8 lishment of the special district.
9 6. The department shall establish standards, with the advice from the
10 state emergency medical services council, the state emergency medical
11 advisory committee and the state trauma advisory committee, establishing
12 minimum standards for the provision of emergency medical services by
13 first aid squads, basic life support first response services, special
14 event medical services, and other first response services not otherwise
15 defined in article thirty of this chapter.
16 § 3084. Provision of emergency medical dispatch. 1. Every EMS medical
17 dispatch agency, as defined in this section, operating within New York
18 state shall provide emergency medical dispatch services in accordance
19 with emergency medical dispatch protocols approved by the department.
20 2. All EMS medical dispatch agencies may be required to be licensed by
21 the department. The department, in consultation with the State Interop-
22 erable Emergency Communications Board, may establish criteria for the
23 licensing of EMS medical dispatch agencies, as defined in this section,
24 to ensure compliance with EMS medical dispatch standards.
25 3. All emergency medical dispatchers with a primary role of providing
26 emergency medical dispatch services while employed by EMS medical
27 dispatch agencies, as defined in this section, must complete an emergen-
28 cy medical dispatch certification training course approved by the
29 department, in consultation with the State Interoperable Emergency
30 Communications Board, and maintain continuous certification while
31 employed by the EMS medical dispatch agency, as defined in this section,
32 with a primary role as an emergency medical dispatcher, and may be
33 required to be licensed by the department. The department, in consulta-
34 tion with the State Interoperable Emergency Communications Board, may
35 establish minimum standards for emergency medical dispatch certification
36 training courses and dispatcher licensure.
37 § 3085. Rules and regulations. The commissioner may promulgate rules
38 and regulations to effectuate the purposes of this article.
39 § 10. The public health law is amended by adding a new section 3019 to
40 read as follows:
41 § 3019. Emergency medical services demonstration programs. 1. The
42 purpose of this section shall be to facilitate innovation in medical
43 care provided by emergency medical service practitioners in meeting the
44 community's health care needs, including collaboration with other health
45 care organizations operating under the provisions of section twenty-
46 eight hundred five-x of this chapter. It shall provide a framework to
47 support voluntary initiatives to improve patient care access and manage-
48 ment, patient health outcomes, and cost-effectiveness in the use of
49 health care services and community population health.
50 2. The commissioner is authorized to provide financing including, to
51 the extent of funds available and allocated or appropriated therefor, as
52 well as waivers of certain parts of this article, article thirty-A of
53 this chapter, and regulations under title ten of the New York codes,
54 rules and regulations, to support the voluntary initiatives and objec-
55 tives of this section.
S. 8307--A 144 A. 8807--A
1 § 11. The public health law is amended by adding a new section 3055 to
2 read as follows:
3 § 3055. EMS licensure and credentialing. 1. The department, with the
4 approval of the state emergency medical services council, may establish
5 minimum standards for the licensure of emergency medical services prac-
6 titioners including but not limited to emergency medical technicians and
7 advanced emergency medical technicians by the department.
8 2. The department, with the approval of the state emergency medical
9 services council, may establish minimum standards for specialized
10 credentialing of emergency medical service practitioners which shall
11 include, but not be limited to, emergency vehicle operator, critical
12 care paramedic, emergency medical dispatcher, emergency medical services
13 field training officer, emergency medical services administrator, emer-
14 gency medical control physician, and emergency medical services agency
15 medical director.
16 § 12. The public health law is amended by adding a new section 3029 to
17 read as follows:
18 § 3029. Paramedic urgent care program. 1. The department shall estab-
19 lish a paramedic urgent care program to effectuate the role of emergency
20 medical services personnel in the delivery of health care services in
21 rural counties of New York state.
22 2. Any organization that is authorized to provide advanced life
23 support services, in accordance with section three thousand thirty of
24 this article, may apply to the department for approval to operate a
25 paramedic urgent care.
26 3. Any paramedic urgent care programs approved by the department under
27 this section shall: (a) be under the overall supervision and direction
28 of a qualified physician; (b) be staffed by qualified medical and health
29 personnel, physician assistants, or nurse practitioners; (c) utilize
30 advanced emergency medical technicians whose scope of practice is appro-
31 priate for the medical services provided; (d) maintain a treatment-man-
32 agement record for each patient; and (e) be integrated with a hospital
33 or other appropriate healthcare organization.
34 4. Paramedic urgent care programs may integrate telehealth provided by
35 a telehealth provider, as those terms are defined in section twenty-nine
36 hundred ninety-nine-cc of this chapter. The commissioner may specify in
37 regulation additional acceptable modalities for the delivery of health
38 care services by paramedic care programs via telehealth, including but
39 not limited to audio-only or video-only telephone communications, online
40 portals and survey applications.
41 5. Nothing in this section shall be deemed to allow a person to
42 provide any service for which a license, registration, certification or
43 other authorization under title eight of the education law is required
44 and which the person does not possess, provided that any service being
45 excluded pursuant to this subdivision shall not include a service that
46 is within the scope of practice for the respective emergency medical
47 services personnel.
48 § 13. This act shall take effect immediately and shall be deemed to
49 have been in full force and effect on and after April 1, 2024; provided,
50 however, that the amendments to subdivision 3 of section 3018 of the
51 public health law made by section four of this act shall not affect the
52 repeal of such section and shall be deemed repealed therewith.
53 PART W
S. 8307--A 145 A. 8807--A
1 Section 1. The elder law is amended by adding a new section 226 to
2 read as follows:
3 § 226. Interagency elder justice coordinating council. 1. There is
4 hereby created within the office an elder justice coordinating council
5 consisting of representatives of state agencies whose work involves
6 elder justice to create greater collaboration and develop overarching
7 strategies, systems, and programs to be carried out in accordance with
8 the governor's elder justice priorities, with a goal of protecting older
9 adults from abuse and mistreatment. The council shall collaborate to
10 identify and support consistent policies and program operation, facili-
11 tate communication among state agencies, foster collaborative relation-
12 ships, and help state agencies keep informed of local, state, and
13 national developments in elder justice.
14 2. The council shall be chaired by the director of the office for the
15 aging, and shall include representation from the office of victims
16 services, the office of children and family services, the department of
17 financial services, the division of criminal justice services, the
18 office of mental health, the office for the prevention of domestic
19 violence, the department of health, the office for people with develop-
20 mental disabilities, the New York state police, the justice center for
21 the protection of people with special needs, and the department of
22 state's division of consumer protection. Additionally, the council shall
23 request input from stakeholders, advocates, experts, and coalitions.
24 3. The council shall:
25 (a) develop and implement a cohesive, comprehensive state plan on
26 elder justice that aligns state elder justice policy and programs across
27 state agency responsibilities;
28 (b) develop plans for a coordinated and comprehensive response from
29 state and local government and other entities when elder abuse is
30 reported;
31 (c) facilitate interagency planning and policy development on elder
32 justice;
33 (d) review and propose specific agency initiatives for their impact on
34 systems and services related to elder justice;
35 (e) coordinate activities for world elder abuse awareness day and
36 other events; and
37 (f) make recommendations to the governor that will improve New York's
38 elder abuse prevention and intervention efforts.
39 4. Each member agency shall maintain control over, and responsibility
40 for, its own programs and policies. The council shall not take the place
41 of any existing interagency councils and committees. The council shall
42 serve to focus attention on elder justice comprehensively and create a
43 multidisciplinary mechanism to work toward alignment across agencies to
44 help achieve the governor's elder justice priorities.
45 5. The council shall meet regularly and shall submit a report on its
46 activities to the governor and the legislature no later than December
47 thirty-first, two thousand twenty-five and annually thereafter.
48 § 2. This act shall take effect immediately.
49 PART X
50 Intentionally Omitted.
51 PART Y
S. 8307--A 146 A. 8807--A
1 Section 1. Section 7 of part R2 of chapter 62 of the laws of 2003,
2 amending the mental hygiene law and the state finance law relating to
3 the community mental health support and workforce reinvestment program,
4 the membership of subcommittees for mental health of community services
5 boards and the duties of such subcommittees and creating the community
6 mental health and workforce reinvestment account, as amended by section
7 1 of part W of chapter 57 of the laws of 2021, is amended to read as
8 follows:
9 § 7. This act shall take effect immediately [and shall expire March
10 31, 2024 when upon such date the provisions of this act shall be deemed
11 repealed].
12 § 2. This act shall take effect immediately.
13 PART Z
14 Section 1. Section 2 of part NN of chapter 58 of the laws of 2015,
15 amending the mental hygiene law relating to clarifying the authority of
16 the commissioners in the department of mental hygiene to design and
17 implement time-limited demonstration programs, as amended by section 1
18 of part V of chapter 57 of the laws of 2021, is amended to read as
19 follows:
20 § 2. This act shall take effect immediately [and shall expire and be
21 deemed repealed March 31, 2024].
22 § 2. This act shall take effect immediately.
23 PART AA
24 Section 1. Paragraph 31 of subsection (i) of section 3216 of the
25 insurance law is amended by adding a new subparagraph (J) to read as
26 follows:
27 (J) This subparagraph shall apply to facilities in this state that are
28 licensed, certified, or otherwise authorized by the office of addiction
29 services and supports for the provision of outpatient, intensive outpa-
30 tient, outpatient rehabilitation and opioid treatment that are partic-
31 ipating in the insurer's provider network. Reimbursement for covered
32 outpatient treatment provided by such facilities shall be at a rate that
33 is not less than the rate that would be paid for such treatment pursuant
34 to the medical assistance program under title eleven of article five of
35 the social services law.
36 § 2. Paragraph 35 of subsection (i) of section 3216 of the insurance
37 law is amended by adding a new subparagraph (K) to read as follows:
38 (K) This subparagraph shall apply to outpatient treatment provided in
39 a facility issued an operating certificate by the commissioner of mental
40 health pursuant to the provisions of article thirty-one of the mental
41 hygiene law, or in a facility operated by the office of mental health,
42 or in a crisis stabilization center licensed pursuant to section 36.01
43 of the mental hygiene law, that is participating in the insurer's
44 provider network. Reimbursement for covered outpatient treatment
45 provided by such a facility shall be at a rate that is not less than the
46 rate that would be paid for such treatment pursuant to the medical
47 assistance program under title eleven of article five of the social
48 services law.
49 § 3. Paragraph 5 of subsection (l) of section 3221 of the insurance
50 law is amended by adding a new subparagraph (K) to read as follows:
51 (K) This subparagraph shall apply to outpatient treatment provided in
52 a facility issued an operating certificate by the commissioner of mental
S. 8307--A 147 A. 8807--A
1 health pursuant to the provisions of article thirty-one of the mental
2 hygiene law, or in a facility operated by the office of mental health,
3 or in a crisis stabilization center licensed pursuant to section 36.01
4 of the mental hygiene law, that is participating in the insurer's
5 provider network. Reimbursement for covered outpatient treatment
6 provided by such a facility shall be at a rate that is not less than the
7 rate that would be paid for such treatment pursuant to the medical
8 assistance program under title eleven of article five of the social
9 services law.
10 § 4. Paragraph 7 of subsection (l) of section 3221 of the insurance
11 law is amended by adding a new subparagraph (J) to read as follows:
12 (J) This subparagraph shall apply to facilities in this state that are
13 licensed, certified, or otherwise authorized by the office of addiction
14 services and supports for the provision of outpatient, intensive outpa-
15 tient, outpatient rehabilitation and opioid treatment that are partic-
16 ipating in the insurer's provider network. Reimbursement for covered
17 outpatient treatment provided by such facilities shall be at a rate that
18 is not less than the rate that would be paid for such treatment pursuant
19 to the medical assistance program under title eleven of article five of
20 the social services law.
21 § 5. Subsection (g) of section 4303 of the insurance law is amended by
22 adding a new paragraph 12 to read as follows:
23 (12) This paragraph shall apply to outpatient treatment provided in a
24 facility issued an operating certificate by the commissioner of mental
25 health pursuant to the provisions of article thirty-one of the mental
26 hygiene law, or in a facility operated by the office of mental health,
27 or in a crisis stabilization center licensed pursuant to section 36.01
28 of the mental hygiene law, that is participating in the corporation's
29 provider network. Reimbursement for covered outpatient treatment
30 provided by such facility shall be at a rate that is not less than the
31 rate that would be paid for such treatment pursuant to the medical
32 assistance program under title eleven of article five of the social
33 services law.
34 § 6. Subsection (l) of section 4303 of the insurance law is amended by
35 adding a new paragraph 10 to read as follows:
36 (10) This paragraph shall apply to facilities in this state that are
37 licensed, certified, or otherwise authorized by the office of addiction
38 services and supports for the provision of outpatient, intensive outpa-
39 tient, outpatient rehabilitation and opioid treatment that are partic-
40 ipating in the corporation's provider network. Reimbursement for covered
41 outpatient treatment provided by such facilities shall be at a rate that
42 is not less than the rate that would be paid for such treatment pursuant
43 to the medical assistance program under title eleven of article five of
44 the social services law.
45 § 7. This act shall take effect January 1, 2025 and shall apply to
46 policies and contracts issued, renewed, modified, altered, or amended on
47 and after such date.
48 PART BB
49 Section 1. Sections 19 and 21 of chapter 723 of the laws of 1989
50 amending the mental hygiene law and other laws relating to comprehensive
51 psychiatric emergency programs, as amended by section 1 of part PPP of
52 chapter 58 of the laws of 2020, are amended to read as follows:
53 § 19. Notwithstanding any other provision of law, the commissioner of
54 mental health shall[, until July 1, 2024,] be solely authorized, in his
S. 8307--A 148 A. 8807--A
1 or her discretion, to designate those general hospitals, local govern-
2 mental units and voluntary agencies which may apply and be considered
3 for the approval and issuance of an operating certificate pursuant to
4 article 31 of the mental hygiene law for the operation of a comprehen-
5 sive psychiatric emergency program.
6 § 21. This act shall take effect immediately[, and sections one, two
7 and four through twenty of this act shall remain in full force and
8 effect, until July 1, 2024, at which time the amendments and additions
9 made by such sections of this act shall be deemed to be repealed, and
10 any provision of law amended by any of such sections of this act shall
11 revert to its text as it existed prior to the effective date of this
12 act].
13 § 2. This act shall take effect immediately.
14 PART CC
15 Section 1. Subdivision 2 of section 493 of the social services law, as
16 added by section 1 of part B of chapter 501 of the laws of 2012, is
17 amended to read as follows:
18 2. For substantiated reports of abuse or neglect in facilities or
19 provider agencies in receipt of medical assistance and which are no
20 longer subject to amendment or appeal pursuant to section four hundred
21 ninety-four of this article, such information shall also be forwarded by
22 the justice center to the office of the Medicaid inspector general when
23 such abuse or neglect may [be relevant to an investigation of unaccepta-
24 ble practices as such practices are defined] result in [regulations of]
25 possible exclusion or other sanction by the office of the Medicaid
26 inspector general as determined in consultation with the office of the
27 Medicaid inspector general.
28 § 2. This act shall take effect immediately.
29 PART DD
30 Section 1. Section 3 of part A of chapter 111 of the laws of 2010
31 amending the mental hygiene law relating to the receipt of federal and
32 state benefits received by individuals receiving care in facilities
33 operated by an office of the department of mental hygiene, as amended by
34 section 1 of part T of chapter 57 of the laws of 2021, is amended to
35 read as follows:
36 § 3. This act shall take effect immediately[; and shall expire and be
37 deemed repealed June 30, 2024].
38 § 2. This act shall take effect immediately.
39 PART EE
40 Section 1. Subparagraph (v) of paragraph (a) of subdivision 1 of
41 section 6908 of the education law is renumbered subparagraph (vi) and a
42 new subparagraph (v) is added to read as follows:
43 (v) tasks provided by a direct support staff in non-facility based
44 programs certified, authorized or approved by the office for people with
45 developmental disabilities, so long as such staff does not hold themself
46 out as one who accepts employment solely for performing such care, and
47 where nursing services are under the instruction of a service recipient
48 or family or household member determined by a registered professional
49 nurse to be capable of providing such instruction. In the event that
50 the registered nurse determines that the service recipient, family, or
S. 8307--A 149 A. 8807--A
1 household member is not capable of providing such instruction, nursing
2 tasks may be performed by direct support staff pursuant to subparagraph
3 (vi) of this paragraph subject to the requirements set forth therein; or
4 § 2. This act shall take effect immediately and shall be deemed to
5 have been in full force and effect on and after April 1, 2024.
6 PART FF
7 Section 1. 1. Subject to available appropriations and approval of the
8 director of the budget, the commissioners of the office of mental
9 health, office for people with developmental disabilities, office of
10 addiction services and supports, office of temporary and disability
11 assistance, office of children and family services, and the state office
12 for the aging shall establish a state fiscal year 2024-2025 cost of
13 living adjustment (COLA), effective April 1, 2024, for projecting for
14 the effects of inflation upon rates of payments, contracts, or any other
15 form of reimbursement for the programs and services listed in paragraphs
16 (i), (ii), (iii), (iv), (v), and (vi) of subdivision four of this
17 section. The COLA established herein shall be applied to the appropriate
18 portion of reimbursable costs or contract amounts. Where appropriate,
19 transfers to the department of health (DOH) shall be made as reimburse-
20 ment for the state share of medical assistance.
21 2. Notwithstanding any inconsistent provision of law, subject to the
22 approval of the director of the budget and available appropriations
23 therefore, for the period of April 1, 2024 through March 31, 2025, the
24 commissioners shall provide funding to support a one and five-tenths
25 percent (1.5%) cost of living adjustment under this section for all
26 eligible programs and services as determined pursuant to subdivision
27 four of this section.
28 3. Notwithstanding any inconsistent provision of law, and as approved
29 by the director of the budget, the 1.5 percent cost of living adjustment
30 (COLA) established herein shall be inclusive of all other cost of living
31 type increases, inflation factors, or trend factors that are newly
32 applied effective April 1, 2024. Except for the 1.5 percent cost of
33 living adjustment (COLA) established herein, for the period commencing
34 on April 1, 2024 and ending March 31, 2025 the commissioners shall not
35 apply any other new cost of living adjustments for the purpose of estab-
36 lishing rates of payments, contracts or any other form of reimbursement.
37 The phrase "all other cost of living type increases, inflation factors,
38 or trend factors" as defined in this subdivision shall not include
39 payments made pursuant to the American Rescue Plan Act or other federal
40 relief programs related to the Coronavirus Disease 2019 (COVID-19)
41 pandemic public health emergency. This subdivision shall not prevent the
42 office of children and family services from applying additional trend
43 factors or staff retention factors to eligible programs and services
44 under paragraph (v) of subdivision four of this section.
45 4. Eligible programs and services. (i) Programs and services funded,
46 licensed, or certified by the office of mental health (OMH) eligible for
47 the cost of living adjustment established herein, pending federal
48 approval where applicable, include: office of mental health licensed
49 outpatient programs, pursuant to parts 587 and 599 of title 14 CRR-NY of
50 the office of mental health regulations including clinic, continuing day
51 treatment, day treatment, intensive outpatient programs and partial
52 hospitalization; outreach; crisis residence; crisis stabilization,
53 crisis/respite beds; mobile crisis, part 590 comprehensive psychiatric
54 emergency program services; crisis intervention; home based crisis
S. 8307--A 150 A. 8807--A
1 intervention; family care; supported single room occupancy; supported
2 housing; supported housing community services; treatment congregate;
3 supported congregate; community residence - children and youth;
4 treatment/apartment; supported apartment; community residence single
5 room occupancy; on-site rehabilitation; employment programs; recreation;
6 respite care; transportation; psychosocial club; assertive community
7 treatment; case management; care coordination, including health home
8 plus services; local government unit administration; monitoring and
9 evaluation; children and youth vocational services; single point of
10 access; school-based mental health program; family support children and
11 youth; advocacy/support services; drop in centers; recovery centers;
12 transition management services; bridger; home and community based waiver
13 services; behavioral health waiver services authorized pursuant to the
14 section 1115 MRT waiver; self-help programs; consumer service dollars;
15 conference of local mental hygiene directors; multicultural initiative;
16 ongoing integrated supported employment services; supported education;
17 mentally ill/chemical abuse (MICA) network; personalized recovery
18 oriented services; children and family treatment and support services;
19 residential treatment facilities operating pursuant to part 584 of title
20 14-NYCRR; geriatric demonstration programs; community-based mental
21 health family treatment and support; coordinated children's service
22 initiative; homeless services; and promises zone.
23 (ii) Programs and services funded, licensed, or certified by the
24 office for people with developmental disabilities (OPWDD) eligible for
25 the cost of living adjustment established herein, pending federal
26 approval where applicable, include: local/unified services; chapter 620
27 services; voluntary operated community residential services; article 16
28 clinics; day treatment services; family support services; 100% day
29 training; epilepsy services; traumatic brain injury services; hepatitis
30 B services; independent practitioner services for individuals with
31 intellectual and/or developmental disabilities; crisis services for
32 individuals with intellectual and/or developmental disabilities; family
33 care residential habilitation; supervised residential habilitation;
34 supportive residential habilitation; respite; day habilitation; prevoca-
35 tional services; supported employment; community habilitation; interme-
36 diate care facility day and residential services; specialty hospital;
37 pathways to employment; intensive behavioral services; community transi-
38 tion services; family education and training; fiscal intermediary;
39 support broker; and personal resource accounts.
40 (iii) Programs and services funded, licensed, or certified by the
41 office of addiction services and supports (OASAS) eligible for the cost
42 of living adjustment established herein, pending federal approval where
43 applicable, include: medically supervised withdrawal services - residen-
44 tial; medically supervised withdrawal services - outpatient; medically
45 managed detoxification; medically monitored withdrawal; inpatient reha-
46 bilitation services; outpatient opioid treatment; residential opioid
47 treatment; KEEP units outpatient; residential opioid treatment to absti-
48 nence; problem gambling treatment; medically supervised outpatient;
49 outpatient rehabilitation; specialized services substance abuse
50 programs; home and community based waiver services pursuant to subdivi-
51 sion 9 of section 366 of the social services law; children and family
52 treatment and support services; continuum of care rental assistance case
53 management; NY/NY III post-treatment housing; NY/NY III housing for
54 persons at risk for homelessness; permanent supported housing; youth
55 clubhouse; recovery community centers; recovery community organizing
56 initiative; residential rehabilitation services for youth (RRSY); inten-
S. 8307--A 151 A. 8807--A
1 sive residential; community residential; supportive living; residential
2 services; job placement initiative; case management; family support
3 navigator; local government unit administration; peer engagement; voca-
4 tional rehabilitation; support services; HIV early intervention
5 services; dual diagnosis coordinator; problem gambling resource centers;
6 problem gambling prevention; prevention resource centers; primary
7 prevention services; other prevention services; and community services.
8 (iv) Programs and services funded, licensed, or certified by the
9 office of temporary and disability assistance (OTDA) eligible for the
10 cost of living adjustment established herein, pending federal approval
11 where applicable, include: nutrition outreach and education program
12 (NOEP).
13 (v) Programs and services funded, licensed, or certified by the office
14 of children and family services (OCFS) eligible for the cost of living
15 adjustment established herein, pending federal approval where applica-
16 ble, include: programs for which the office of children and family
17 services establishes maximum state aid rates pursuant to section 398-a
18 of the social services law and section 4003 of the education law; emer-
19 gency foster homes; foster family boarding homes and therapeutic foster
20 homes; supervised settings as defined by subdivision twenty-two of
21 section 371 of the social services law; adoptive parents receiving
22 adoption subsidy pursuant to section 453 of the social services law; and
23 congregate and scattered supportive housing programs and supportive
24 services provided under the NY/NY III supportive housing agreement to
25 young adults leaving or having recently left foster care.
26 (vi) Programs and services funded, licensed, or certified by the state
27 office for the aging (SOFA) eligible for the cost of living adjustment
28 established herein, pending federal approval where applicable, include:
29 community services for the elderly; expanded in-home services for the
30 elderly; and supplemental nutrition assistance program.
31 5. Each local government unit or direct contract provider receiving
32 funding for the cost of living adjustment established herein shall
33 submit a written certification, in such form and at such time as each
34 commissioner shall prescribe, attesting how such funding will be or was
35 used to first promote the recruitment and retention of non-executive
36 direct care staff, non-executive direct support professionals, non-exe-
37 cutive clinical staff, or respond to other critical non-personal service
38 costs prior to supporting any salary increases or other compensation for
39 executive level job titles.
40 6. Notwithstanding any inconsistent provision of law to the contrary,
41 agency commissioners shall be authorized to recoup funding from a local
42 governmental unit or direct contract provider for the cost of living
43 adjustment established herein determined to have been used in a manner
44 inconsistent with the appropriation, or any other provision of this
45 section. Such agency commissioners shall be authorized to employ any
46 legal mechanism to recoup such funds, including an offset of other funds
47 that are owed to such local governmental unit or direct contract provid-
48 er.
49 § 2. This act shall take effect immediately and shall be deemed to
50 have been in full force and effect on and after April 1, 2024.
51 PART GG
52 Section 1. Subdivision 29 of section 364-j of the social services law,
53 as added by section 49 of part C of chapter 60 of the laws of 2014, is
54 amended to read as follows:
S. 8307--A 152 A. 8807--A
1 29. In the event that the department receives approval from the
2 Centers for Medicare and Medicaid Services to amend its 1115 waiver
3 [known as the Partnership Plan] or receives approval for a new 1115
4 waiver [for the purpose of reinvesting savings resulting from the rede-
5 sign of the medical assistance program] prior to or following the effec-
6 tive date of this subdivision, the commissioner is authorized to enter
7 into contracts[, and/or] and to amend the terms of contracts awarded
8 prior to [the effective date of this subdivision] April first, two thou-
9 sand twenty-four, for the purpose of assisting the department of health
10 with implementing projects authorized under such waiver approval.
11 Notwithstanding the provisions of sections one hundred twelve and one
12 hundred sixty-three of the state finance law, or sections one hundred
13 forty-two and one hundred forty-three of the economic development law,
14 or any contrary provision of law, contracts may be entered or contract
15 amendments may be made pursuant to this subdivision without a compet-
16 itive bid or request for proposal process [if the term of any such
17 contract or contract amendment does not extend beyond March thirty-
18 first, two thousand nineteen]; provided, however, in the case of a
19 contract entered into after the effective date of this subdivision,
20 that:
21 (a) The department of health shall post on its website, for a period
22 of no less than thirty days:
23 (i) A description of the proposed services to be provided pursuant to
24 the contract or contracts;
25 (ii) The criteria for selection of a contractor or contractors;
26 (iii) The period of time during which a prospective contractor may
27 seek selection, which shall be no less than thirty days after such
28 information is first posted on the website; and
29 (iv) The manner by which a prospective contractor may seek such
30 selection, which may include submission by electronic means;
31 (b) All reasonable and responsive submissions that are received from
32 prospective contractors in timely fashion shall be reviewed by the
33 commissioner of health; and
34 (c) The commissioner of health shall select such contractor or
35 contractors that, in [his or her] such commissioner's discretion, are
36 best suited to serve the purposes of this section.
37 § 2. This act shall take effect immediately; provided, however, that
38 the amendments to section 364-j of the social services law made by
39 section one of this act shall not affect the repeal of such section and
40 shall be deemed repealed therewith.
41 PART HH
42 Section 1. Subparagraphs (i) and (ii) of paragraph (a) of subdivision
43 4-a of section 365-f of the social services law, as amended by section 3
44 of part G of chapter 57 of the laws of 2019, the opening paragraph of
45 subparagraph (i) as amended by section 2 of part PP of chapter 57 of the
46 laws of 2022, are amended to read as follows:
47 (i) "Fiscal intermediary" means an entity that provides fiscal inter-
48 mediary services and has a contract for providing such services with
49 [the department of health and is selected through the procurement proc-
50 ess described in paragraphs (b), (b-1), (b-2) and (b-3) of this subdivi-
51 sion. Eligible applicants for contracts shall be entities that are capa-
52 ble of appropriately providing fiscal intermediary services, performing
53 the responsibilities of a fiscal intermediary, and complying with this
54 section, including but not limited to entities that:
S. 8307--A 153 A. 8807--A
1 (A) are a service center for independent living under section one
2 thousand one hundred twenty-one of the education law; or
3 (B) have been established as fiscal intermediaries prior to January
4 first, two thousand twelve and have been continuously providing such
5 services for eligible individuals under this section.]:
6 (A) a local department of social services;
7 (B) an organization licensed under article forty-four of the public
8 health law; or
9 (C) an accountable care organization certified under article twenty-
10 nine-E of the public health law or an integrated delivery system
11 composed primarily of health care providers recognized by the department
12 as a performing provider system under the delivery system reform incen-
13 tive payment program.
14 (ii) Fiscal intermediary services shall include the following
15 services, performed on behalf of the consumer to facilitate [his or her]
16 the consumer's role as the employer:
17 (A) wage and benefit processing for consumer directed personal assist-
18 ants;
19 (B) processing all income tax and other required wage withholdings;
20 (C) complying with workers' compensation, disability and unemployment
21 requirements;
22 (D) maintaining personnel records for each consumer directed personal
23 assistant, including time records and other documentation needed for
24 wages and benefit processing and a copy of the medical documentation
25 required pursuant to regulations established by the commissioner;
26 (E) ensuring that the health status of each consumer directed personal
27 assistant is assessed prior to service delivery pursuant to regulations
28 issued by the commissioner;
29 (F) maintaining records of service authorizations or reauthorizations;
30 (G) monitoring the consumer's or, if applicable, the designated repre-
31 sentative's continuing ability to fulfill the consumer's responsibil-
32 ities under the program and promptly notifying the authorizing entity of
33 any circumstance that may affect the consumer's or, if applicable, the
34 designated representative's ability to fulfill such responsibilities;
35 (H) complying with regulations established by the commissioner speci-
36 fying the responsibilities of fiscal intermediaries providing services
37 under this title; and
38 (I) entering into a department approved memorandum of understanding
39 with the consumer that describes the parties' responsibilities under
40 this program[; and
41 (J) other related responsibilities which may include, as determined by
42 the commissioner, assisting consumers to perform the consumers' respon-
43 sibilities under this section and department regulations in a manner
44 that does not infringe upon the consumer's responsibilities and self-di-
45 rection].
46 § 2. Paragraphs (b) and (c) of subdivision 4-a of section 365-f of the
47 social services law are REPEALED and two new paragraphs (b) and (c) are
48 added to read as follows:
49 (b) As of January first, two thousand twenty-five no entity shall
50 provide, directly or through contract, fiscal intermediary services
51 without an authorization as a fiscal intermediary issued by the commis-
52 sioner in accordance with this subdivision. In establishing authori-
53 zation standards and processes, the commissioner may consider demon-
54 strated compliance with all applicable federal and state laws and
55 regulations, including but not limited to, marketing and labor prac-
56 tices, cost reporting, and electronic visit verification requirements;
S. 8307--A 154 A. 8807--A
1 provided, however, that this shall not be construed to limit the commis-
2 sioner's discretion in establishing such standards and processes.
3 Notwithstanding the preceding requirement for authorization, a fiscal
4 intermediary that is in operation prior to January first, two thousand
5 twenty-four may continue to provide fiscal intermediary services without
6 an authorization until such time as the commissioner determines that the
7 continued provision of services through unauthorized fiscal interme-
8 diaries is no longer necessary to ensure access to services; such deter-
9 mination may be made on a statewide, regional, or county basis.
10 (c) The commissioner is authorized to determine the maximum number of
11 fiscal intermediaries a local department of social services or an organ-
12 ization licensed under article forty-four of the public health law, or
13 an accountable care organization certified under article twenty-nine-E
14 of the public health law or an integrated delivery system composed
15 primarily of health care providers recognized by the department as a
16 performing provider system under the delivery system reform incentive
17 payment program may contract with, provided it is determined that there
18 remains adequate access to services; such determination may be made on a
19 statewide, regional or county level basis.
20 § 3. Paragraphs (b-1), (b-2) and (b-3) of subdivision 4-a of section
21 365-f of the social services law are REPEALED.
22 § 4. Subdivision 4-b of section 365-f of the social services law, as
23 amended by section 8 of part G of chapter 57 of the laws of 2019, is
24 amended to read as follows:
25 4-b. Actions involving the authorization of a fiscal intermediary.
26 (a) [The department may terminate a fiscal intermediary's contract
27 under this section or suspend or limit the fiscal intermediary's rights
28 and privileges under the contract upon thirty day's written notice to
29 the fiscal intermediary, if the commissioner finds that the fiscal
30 intermediary has failed to comply with the provisions of this section or
31 regulations promulgated hereunder. The written notice shall include:
32 (i) A description of the conduct and the issues related thereto that
33 have been identified as failure of compliance; and
34 (ii) the time frame of the conduct that fails compliance] A fiscal
35 intermediary's authorization may be revoked, suspended, limited, or
36 annulled upon thirty days' written notice to the fiscal intermediary, if
37 the commissioner finds that the fiscal intermediary has failed to comply
38 with the provisions of this subdivision or regulations promulgated here-
39 under.
40 (b) Notwithstanding the foregoing, upon determining that the public
41 health or safety would be imminently endangered by the continued opera-
42 tion or actions of the fiscal intermediary, the commissioner may [termi-
43 nate] revoke, suspend, limit, or annul the fiscal intermediary's
44 [contract or suspend or limit the fiscal intermediary's rights and priv-
45 ileges under the contract] authorization immediately [upon written
46 notice].
47 (c) The commissioner may issue orders and take other actions as neces-
48 sary and appropriate to prohibit and prevent the provision of fiscal
49 intermediary services by an unauthorized entity.
50 (d) All orders or determinations under this subdivision shall be
51 subject to review as provided in article seventy-eight of the civil
52 practice law and rules.
53 § 5. Paragraph (c) of subdivision 4-d of section 365-f of the social
54 services law, as added by section 7 of part G of chapter 57 of the laws
55 of 2019, is amended to read as follows:
S. 8307--A 155 A. 8807--A
1 (c) Where a fiscal intermediary is suspending or ceasing operation
2 pursuant to an order under subdivision four-b of this section, or has
3 failed to [submit an offer for a contract] apply for authorization, or
4 has been denied [a contract] authorization under this section, all the
5 provisions of this subdivision shall apply except subparagraph (i) of
6 paragraph (a) of this subdivision, notice of which to all parties shall
7 be provided by the department, with the assistance of any local social
8 services districts or managed care plans with which the fiscal interme-
9 diary contracts, as appropriate.
10 § 6. Paragraph (d) of subdivision 4-d of section 365-f of the social
11 services law is REPEALED.
12 § 7. Paragraph (b) of subdivision 5 of section 365-f of the social
13 services law, as added by chapter 81 of the laws of 1995, is amended to
14 read as follows:
15 (b) Notwithstanding any other provision of law, the commissioner is
16 authorized to waive any provision of section three hundred sixty-seven-b
17 of this title related to payment and may promulgate regulations, includ-
18 ing emergency regulations, necessary to carry out the objectives of the
19 program including minimum selection criteria and training requirements
20 for personal assistants, the establishment of limitations on the number
21 of hours a personal assistant may work on a daily and weekly basis, and
22 which describe the responsibilities of the eligible individuals in
23 arranging and paying for services and the protections assured such indi-
24 viduals if they are unable or no longer desire to continue in the
25 program, the fiscal intermediary authorization process, standards, and
26 time frames, and those regulations necessary to ensure adequate access
27 to services, including but not limited to the maximum number of fiscal
28 intermediaries a local department of social services or an organization
29 licensed under article forty-four of the public health law, or an
30 accountable care organization certified under article twenty-nine-E of
31 the public health law or integrated delivery systems composed primarily
32 of health care providers recognized by the department as a performing
33 provider system under the delivery system reform incentive payment
34 program may contract with; such determination may be made on a state-
35 wide, regional, or county basis.
36 § 8. Paragraphs (e) and (f) of subdivision 2 of section 3605-c of the
37 public health law, as added by section 10 of part MM of chapter 56 of
38 the laws of 2020, are amended and a new paragraph (g) is added to read
39 as follows:
40 (e) the commissioner may institute a continuous recruitment process
41 provided that the information required under paragraph (a) of this
42 subdivision remains on the department's website for the entire duration
43 of the recruitment process, until such date as the commissioner may
44 determine upon no less than ten days notice being posted on the website;
45 [and]
46 (f) the commissioner may reoffer contracts under the same terms of
47 this subdivision, if determined necessary by the commissioner, on a
48 statewide or regional basis[.]; and
49 (g) on and after April first, two thousand twenty-four, the department
50 shall not allow the enrollment or re-enrollment of a LHCSA into the
51 medical assistance program if such LHCSA is majority owned by a company
52 which provides fiscal intermediary services, or is majority owned by a
53 company which also has majority ownership over a company that provides
54 fiscal intermediary services, or itself provides fiscal intermediary
55 services in the state consumer directed personal assistance program, or
56 is the majority owner of a company that provides fiscal intermediary
S. 8307--A 156 A. 8807--A
1 services, as defined in section three hundred sixty-five-f of the social
2 services law. For the purposes of this section, "majority owned" or
3 "majority ownership" shall be defined as controlling interest in a
4 company, or being the largest holder of the common stock or ordinary
5 shares of a company.
6 § 9. Paragraphs (g) and (h) of subdivision 1 of section 4403 of the
7 public health law, paragraph (g) as added by chapter 938 of the laws of
8 1976 and paragraph (h) as amended by chapter 805 of the laws of 1984,
9 are amended and two new paragraphs (i) and (j) are added to read as
10 follows:
11 (g) approved mechanisms exist to resolve complaints and grievances
12 initiated by any enrolled member; [and]
13 (h) the contract between the enrollee and the organization meet the
14 requirements of the superintendent as set forth in section forty-four
15 hundred six of this article, as to the provisions contained therein for
16 health services, the procedures for offering, renewing, converting and
17 terminating contracts to enrollees, and the rates for such contracts
18 including but not limited to, compliance with the provisions of section
19 one thousand one hundred nine of the insurance law[.];
20 (i) that the applicant is not controlled, as defined under regulation,
21 by an entity which provides fiscal intermediary services, is not
22 controlled by an entity which also has control over an entity that
23 provides fiscal intermediary services, does not itself provide fiscal
24 intermediary services in the state consumer directed personal assistance
25 program, and does not control an entity that provides fiscal interme-
26 diary services, as defined in section three hundred sixty-five-f of the
27 social services law; and
28 (j) that the applicant is not controlled, as defined under regulation,
29 by an entity which provides licensed home care services, is not
30 controlled by an entity which also has control over a company that
31 provides licensed home care services, does not itself provide licensed
32 home care services, and does not control an entity that provides
33 licensed home care services.
34 § 10. Section 4403 of the public health law is amended by adding a new
35 subdivision 1-a to read as follows:
36 1-a. (a) By April first, two thousand twenty-five, any health mainte-
37 nance organization which provides fiscal intermediary services or
38 licensed home care services, is controlled by an entity which provides
39 fiscal intermediary services or licensed home care services, has control
40 over an entity which provides fiscal intermediary services or licensed
41 home care services, or is controlled by an entity which also has control
42 over an entity that provides fiscal intermediary services or licensed
43 home care services, shall be required to resubmit an application for a
44 certificate of authority pursuant to section four thousand four hundred
45 two of this article.
46 (b) After April first, two thousand twenty-five, no health maintenance
47 organization which provides fiscal intermediary services or licensed
48 home care services, is controlled by an entity which provides fiscal
49 intermediary services or licensed home care services, has control over
50 an entity which provides fiscal intermediary services or licensed home
51 care services, or is controlled by an entity which also has control over
52 an entity that provides fiscal intermediary services or licensed home
53 care services, may maintain certification to operate as a health mainte-
54 nance organization.
55 (c) For the purposes of this subdivision, "control" shall be defined
56 in regulation.
S. 8307--A 157 A. 8807--A
1 § 11. Paragraphs (h) and (i) of subdivision 3 of section 4403-f of the
2 public health law, as amended by section 41-a of part H of chapter 59 of
3 the laws of 2011, are amended and two new paragraphs (j) and (k) are
4 added to read as follows:
5 (h) that the contractual arrangements for providers of health and long
6 term care services in the benefit package are sufficient to ensure the
7 availability and accessibility of such services to the proposed enrolled
8 population consistent with guidelines established by the commissioner;
9 with respect to individuals in receipt of such services prior to enroll-
10 ment, such guidelines shall require the managed long term care plan to
11 contract with agencies currently providing such services, in order to
12 promote continuity of care. In addition, such guidelines shall require
13 managed long term care plans to offer and cover consumer directed
14 personal assistance services for eligible individuals who elect such
15 services pursuant to section three hundred sixty-five-f of the social
16 services law; [and]
17 (i) that the applicant is financially responsible and may be expected
18 to meet its obligations to its enrolled members[.];
19 (j) that the applicant is not controlled, as defined under regulation,
20 by an entity which provides fiscal intermediary services, is not
21 controlled by an entity which also has control over an entity that
22 provides fiscal intermediary services, does not itself provide fiscal
23 intermediary services in the state consumer directed personal assistance
24 program, and does not control an entity that provides fiscal interme-
25 diary services, as defined in section three hundred sixty-five-f of the
26 social services law; and
27 (k) that the applicant is not controlled, as defined under regulation,
28 by an entity which provides licensed home care services, is not
29 controlled by an entity which also has control over a company that
30 provides licensed home care services, does not itself provide licensed
31 home care services, and does not control an entity that provides
32 licensed home care services.
33 § 12. Section 4403-f of the public health law is amended by adding a
34 new subdivision 3-a to read as follows:
35 3-a. (a) By April first, two thousand twenty-five, any managed long
36 term care plan which provides fiscal intermediary services or licensed
37 home care services, is controlled by an entity which provides fiscal
38 intermediary services or licensed home care services, has control over
39 an entity which provides fiscal intermediary services or licensed home
40 care services, or is controlled by an entity which also has control over
41 an entity that provides fiscal intermediary services or licensed home
42 care services, shall be required to resubmit an application for a
43 certificate of authority pursuant to subdivision two of this section.
44 (b) After April first, two thousand twenty-five, no managed long term
45 care plan which provides fiscal intermediary services or licensed home
46 care services, is controlled by an entity which provides fiscal interme-
47 diary services or licensed home care services, has control over an enti-
48 ty which provides fiscal intermediary services or licensed home care
49 services, or is controlled by an entity which also has control over an
50 entity that provides fiscal intermediary services or licensed home care
51 services, may maintain certification to operate as a managed long term
52 care plan.
53 (c) For the purposes of this subdivision, "control" shall have the
54 same meaning as defined in regulation.
S. 8307--A 158 A. 8807--A
1 § 13. Subparagraphs (v) and (vi) of paragraph (e) of subdivision 2 of
2 section 365-a of the social services law are renumbered subparagraphs
3 (vi) and (vii) and a new subparagraph (v) is added to read as follows:
4 (v) the commissioner of health may issue regulations, including emer-
5 gency regulations, to establish the maximum daily and weekly hours any
6 individual aide providing personal care services available pursuant to
7 this paragraph shall work;
8 § 14. Paragraph (c) of subdivision 2 of section 365-f of the social
9 services law, as amended by section 3 of part MM of chapter 56 of the
10 laws of 2020, is amended to read as follows:
11 (c) has been determined by the social services district, pursuant to
12 an assessment of the person's appropriateness for the program, conducted
13 with an appropriate long term home health care program, a certified home
14 health agency, or an AIDS home care program or pursuant to the personal
15 care program, as being in need of home care services or private duty
16 nursing and as needing at least limited assistance with physical maneu-
17 vering with more than two activities of daily living, or for persons
18 with a dementia or Alzheimer's diagnosis, as needing at least super-
19 vision with more than one activity of daily living, provided that the
20 provisions related to activities of daily living in this paragraph shall
21 only apply to persons who initially seek eligibility for the program on
22 or after October first, two thousand twenty, and who is able and willing
23 [or has a designated representative, including a legal guardian able and
24 willing] to make informed choices, [or a designated relative or other
25 adult who is able and willing to assist in making informed choices,] as
26 to the type and quality of services, including but not limited to such
27 services as nursing care, personal care, transportation and respite
28 services; and
29 § 15. Subdivision 3 of section 365-f of the social services law, as
30 amended by section 9 of part QQ of chapter 56 of the laws of 2020, is
31 amended to read as follows:
32 3. Division of responsibilities. (a) Eligible individuals who elect to
33 participate in the program assume the responsibility for services under
34 such program as mutually agreed to by the eligible individual and
35 provider and as documented in the eligible individual's record, includ-
36 ing, but not limited to, recruiting, hiring and supervising their
37 personal assistants. [For the purposes of this section,]
38 (b) A personal assistant [shall mean], for the purposes of this
39 section, is an adult who:
40 (1) has obtained an individual unique identifier from the state by or
41 before a date determined by the commissioner of health in consultation
42 with the Medicaid inspector general[,]; and
43 (2) provides services under this section to the eligible individual
44 under the eligible individual's instruction, supervision, and direction
45 [or under the instruction, supervision and direction of the eligible
46 individual's designated representative, provided that a].
47 (c) A person legally responsible for an eligible individual's care and
48 support, an eligible individual's spouse [or designated representative],
49 may not be the personal assistant for the eligible individual; however,
50 a personal assistant may include any other adult relative of the eligi-
51 ble individual, provided, however, that the program determines that the
52 services provided by such relative are consistent with an individual's
53 plan of care and that the aggregate cost for such services does not
54 exceed the aggregate costs for equivalent services provided by a non-re-
55 lative personal assistant.
S. 8307--A 159 A. 8807--A
1 (d) Any personal information submitted to obtain [such] a unique iden-
2 tifier under this subdivision shall be maintained as confidential pursu-
3 ant to article six-A of the public officers law ("New York state privacy
4 protection law"). Such individuals shall be assisted as appropriate with
5 service coverage, supervision, advocacy and management.
6 (e) Providers shall not be liable for fulfillment of responsibilities
7 agreed to be undertaken by the eligible individual. This subdivision,
8 however, shall not diminish the participating provider's liability for
9 failure to exercise reasonable care in properly carrying out its respon-
10 sibilities under this program, which shall include monitoring such indi-
11 vidual's continuing ability to fulfill those responsibilities documented
12 in his or her records. Failure of the individual to carry out his or her
13 agreed to responsibilities may be considered in determining such indi-
14 vidual's continued appropriateness for the program.
15 § 16. Clause (G) of subparagraph (ii) of paragraph (a) of subdivision
16 4-a of section 365-f of the social services law, as amended by section 3
17 of part G of chapter 57 of the laws of 2019, is amended to read as
18 follows:
19 (G) monitoring the consumer's [or, if applicable, the designated
20 representative's] continuing ability to fulfill the consumer's responsi-
21 bilities under the program and promptly notifying the authorizing entity
22 of any circumstance that may affect the consumer's [or, if applicable,
23 the designated representative's] ability to fulfill such responsibil-
24 ities;
25 § 17. Subparagraph (iii) of paragraph (a) subdivision 4-a of section
26 365-f of the social services law, as added by section 1 of part E of
27 chapter 57 of the laws of 2017, is amended to read as follows:
28 (iii) Fiscal intermediaries are not responsible for, and fiscal inter-
29 mediary services shall not include, fulfillment of the responsibilities
30 of the consumer [or, if applicable, the consumer's designated represen-
31 tative] as established by the commissioner. A fiscal intermediary's
32 responsibilities shall not include, and a fiscal intermediary shall not
33 engage in: managing the plan of care including recruiting and hiring a
34 sufficient number of individuals who meet the definition of consumer
35 directed personal assistant, as such term is defined by the commission-
36 er, to provide authorized services that are included on the consumer's
37 plan of care; training, supervising and scheduling each consumer
38 directed personal assistant; terminating the consumer directed personal
39 assistant's employment; or assuring that each consumer directed personal
40 assistant competently and safely performs the personal care services,
41 home health aide services and skilled nursing tasks that are included on
42 the consumer's plan of care. A fiscal intermediary shall exercise
43 reasonable care in properly carrying out its responsibilities under the
44 program.
45 § 18. This act shall take effect immediately and shall be deemed to
46 have been in full force and effect on and after April 1, 2024; provided,
47 however, that sections thirteen, fourteen, fifteen, sixteen and seven-
48 teen of this act shall take effect October 1, 2024; and provided,
49 further, that the amendments to section 4403-f of the public health law
50 made by sections eleven and twelve of this act shall not affect the
51 repeal of such section and shall be deemed repealed therewith.
52 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
53 sion, section or part of this act shall be adjudged by any court of
54 competent jurisdiction to be invalid, such judgment shall not affect,
55 impair, or invalidate the remainder thereof, but shall be confined in
56 its operation to the clause, sentence, paragraph, subdivision, section
S. 8307--A 160 A. 8807--A
1 or part thereof directly involved in the controversy in which such judg-
2 ment shall have been rendered. It is hereby declared to be the intent of
3 the legislature that this act would have been enacted even if such
4 invalid provisions had not been included herein.
5 § 3. This act shall take effect immediately provided, however, that
6 the applicable effective date of Parts A through HH of this act shall be
7 as specifically set forth in the last section of such Parts.