Bill Text: NY S03005 | 2023-2024 | General Assembly | Amended
Bill Title: Relates to improving and expanding the pharmaceutical insurance coverage program for certain medicare enrollees; creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-01-23 - REPORTED AND COMMITTED TO FINANCE [S03005 Detail]
Download: New_York-2023-S03005-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 3005--A 2023-2024 Regular Sessions IN SENATE January 26, 2023 ___________ Introduced by Sen. CLEARE -- read twice and ordered printed, and when printed to be committed to the Committee on Aging -- recommitted to the Committee on Aging in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the elder law, in relation to improving and expanding the pharmaceutical insurance coverage program for certain medicare enrollees The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 240 of the elder law is amended to read as follows: 2 § 240. Short title. This title shall be known and may be cited as the 3 "program for [elderly] expanded pharmaceutical insurance coverage". 4 § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision 5 8 as added by section 2 of part A of chapter 59 of the laws of 2011 and 6 as renumbered by section 3 of part T of chapter 56 of the laws of 2012, 7 are amended to read as follows: 8 3. "Income" shall mean "household gross income" as defined in the real 9 property tax circuit breaker credit program, pursuant to subparagraph 10 (C) of paragraph one of subsection (e) of section six hundred six of the 11 tax law, but only shall include the income of program applicants and 12 spouses and shall exclude the income of other members of the household, 13 but shall not include any increase in income derived from social securi- 14 ty income or pension benefits that increase over the previous year due 15 solely to a cost-of-living adjustment provided by the program adminis- 16 trators. 17 8. "Medicare part D excluded drug classes" shall mean any drugs or 18 classes of drugs, or their medical uses, which are described in section 19 1927(d)(2) or 1927(d)(3) of the federal social security act, with the 20 exception of smoking cessation agents and medical marijuana dispensed in 21 the state of New York. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01416-02-4S. 3005--A 2 1 § 3. The elder law is amended by adding a new section 242-a to read as 2 follows: 3 § 242-a. Expanded pharmaceutical insurance coverage panel. 1. There 4 is hereby established within the executive department, a panel to be 5 known as the "expanded pharmaceutical insurance coverage panel". For the 6 purposes of this section, the term "the panel" shall mean the expanded 7 pharmaceutical insurance coverage panel. 8 2. The panel shall consist of the commissioners of the departments of 9 education and health, the superintendent of the department of financial 10 services, and the directors of the office for the aging and the division 11 of the budget. Each panel member may designate an officer of his or her 12 respective department, office, or division to represent and exercise all 13 the powers of such panel member at any meeting of the panel from which 14 such panel member may be absent. 15 3. The director of the office for the aging and the commissioner of 16 health shall serve as co-chairs of the panel. 17 4. The panel shall meet at such times as may be requested by the 18 co-chairs, provided that the panel shall meet at least two times a year. 19 5. The panel shall: 20 (a) subject to the approval of the director of the budget, promulgate 21 program regulations pursuant to section two hundred forty-six of this 22 title; 23 (b) determine the annual schedule of cost-sharing responsibilities of 24 eligible program participants pursuant to sections two hundred forty- 25 seven and two hundred forty-eight of this title; 26 (c) enter into contracts pursuant to section two hundred forty-three 27 of this title; 28 (d) recommend and implement alternative program improvements for the 29 efficient and effective operation of the program in accordance with the 30 provisions of this title with the advice of the advisory committee as 31 defined in subdivision seven of this section; 32 (e) develop and implement, in cooperation with area offices for the 33 aging, an outreach program to inform eligible applicants of benefits 34 they may be entitled to pursuant to this title, and to make available 35 information concerning the program for expanded pharmaceutical insurance 36 coverage and benefits to which they may be entitled through a 37 prescription drug coverage program funded by the federal government; and 38 (f) prepare an annual report and submit such report to the governor, 39 the temporary president of the senate, and the speaker of the assembly 40 no later than the first day of January of each year. The panel shall 41 include in such report, at a minimum, annual statistical information 42 regarding the number of persons enrolled in the program by marital 43 status and income level and age, an estimate of the per cent of eligible 44 New York residents that are enrolled, the total number of enrollees that 45 receive an income-related subsidy under section 1860D-14 of the federal 46 social security act, and the number that so qualify through their 47 enrollment in the medicare savings program, the numbers of participating 48 provider pharmacies, recipients and payments by county, a summary of the 49 administrative cost containment initiatives completed during the year, 50 projections of program costs for the following two years, and an evalu- 51 ation of the performance of the program contractor or contractors and of 52 the cost effectiveness of all outreach efforts. 53 6. The panel members shall receive no compensation for their services 54 as panel members. 55 7. There shall be an advisory committee to the panel comprised of 56 twelve persons. Four members shall be appointed by the governor, threeS. 3005--A 3 1 members shall be appointed by the temporary president of the senate, one 2 member shall be appointed by the minority leader of the senate, three 3 members shall be appointed by the speaker of the assembly and one member 4 shall be appointed by the minority leader of the assembly. The commit- 5 tee members shall be representatives of consumers, pharmacists, pharma- 6 ceutical drug manufacturers and pharmaceutical wholesalers. No less than 7 sixty percent of the committee membership shall represent consumers. 8 Committee members shall receive no compensation for their services but 9 shall be allowed their actual and necessary expenses incurred in the 10 performance of their duties. 11 § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision 12 1 as amended by section 4 of part T of chapter 56 of the laws of 2012, 13 and subdivision 2 as amended by section 12 of part A of chapter 60 of 14 the laws of 2014, are amended to read as follows: 15 1. Persons eligible for comprehensive coverage under section two 16 hundred forty-seven of this title shall include: 17 (a) any unmarried resident who is enrolled in medicare and at least 18 sixty-five years of age in the year two thousand twenty-three, during 19 the year two thousand twenty-four is at least sixty years of age, during 20 the year two thousand twenty-five is at least fifty-five years of age, 21 during the year two thousand twenty-six is at least fifty years of age, 22 during the year two thousand twenty-seven is at least forty-five years 23 of age, during the year two thousand twenty-eight is at least forty 24 years of age, during the year two thousand twenty-nine is at least thir- 25 ty-five years of age, during the year two thousand thirty is at least 26 thirty years of age, during the year two thousand thirty-one is at least 27 twenty-five years of age, or during the year two thousand thirty-two is 28 at least eighteen years of age; and whose income for the calendar year 29 immediately preceding the effective date of the annual coverage period 30 beginning on or after January first, two thousand five, is less than or 31 equal to twenty thousand dollars. After the initial determination of 32 eligibility, each eligible individual must be redetermined eligible at 33 least every twenty-four months; and 34 (b) any married resident who is enrolled in medicare and is at least 35 sixty-five years of age in the year two thousand twenty-three, during 36 the year two thousand twenty-four is at least sixty years of age, during 37 the year two thousand twenty-five is at least fifty-five years of age, 38 during the year two thousand twenty-six is at least fifty years of age, 39 during the year two thousand twenty-seven is at least forty-five years 40 of age, during the year two thousand twenty-eight is at least forty 41 years of age, during the year two thousand twenty-nine is at least thir- 42 ty-five years of age, during the year two thousand thirty is at least 43 thirty years of age, during the year two thousand thirty-one is at least 44 twenty-five years of age, or during the year two thousand thirty-two is 45 at least eighteen years of age; and whose income for the calendar year 46 immediately preceding the effective date of the annual coverage period 47 when combined with the income in the same calendar year of such married 48 person's spouse beginning on or after January first, two thousand one, 49 is less than or equal to twenty-six thousand dollars. After the initial 50 determination of eligibility, each eligible individual must be redeter- 51 mined eligible at least every twenty-four months. 52 2. Persons eligible for catastrophic coverage under section two 53 hundred forty-eight of this title shall include: 54 (a) any unmarried resident who is enrolled in medicare and at least 55 sixty-five years of age in the year two thousand twenty-three, during 56 the year two thousand twenty-four is at least sixty years of age, duringS. 3005--A 4 1 the year two thousand twenty-five is at least fifty-five years of age, 2 during the year two thousand twenty-six is at least fifty years of age, 3 during the year two thousand twenty-seven is at least forty-five years 4 of age, during the year two thousand twenty-eight is at least forty 5 years of age, during the year two thousand twenty-nine is at least thir- 6 ty-five years of age, during the year two thousand thirty is at least 7 thirty years of age, during the year two thousand thirty-one is at least 8 twenty-five years of age, or during the year two thousand thirty-two is 9 at least eighteen years of age; and whose income for the calendar year 10 immediately preceding the effective date of the annual coverage period 11 beginning on or after January first, two thousand one, is more than 12 twenty thousand and less than or equal to seventy-five thousand dollars. 13 After the initial determination of eligibility, each eligible individual 14 must be redetermined eligible at least every twenty-four months; and 15 (b) any married resident who is enrolled in medicare and at least 16 sixty-five years of age in the year two thousand twenty-three, during 17 the year two thousand twenty-four is at least sixty years of age, during 18 the year two thousand twenty-five is at least fifty-five years of age, 19 during the year two thousand twenty-six is at least fifty years of age, 20 during the year two thousand twenty-seven is at least forty-five years 21 of age, during the year two thousand twenty-eight is at least forty 22 years of age, during the year two thousand twenty-nine is at least thir- 23 ty-five years of age, during the year two thousand thirty is at least 24 thirty years of age, during the year two thousand thirty-one is at least 25 twenty-five years of age, or during the year two thousand thirty-two is 26 at least eighteen years of age; and whose income for the calendar year 27 immediately preceding the effective date of the annual coverage period 28 when combined with the income in the same calendar year of such married 29 person's spouse beginning on or after January first, two thousand one, 30 is more than twenty-six thousand dollars and less than or equal to one 31 hundred thousand dollars. After the initial determination of eligibil- 32 ity, each eligible individual must be redetermined eligible at least 33 every twenty-four months. 34 § 5. Paragraphs (e) and (f) of subdivision 3 of section 242 of the 35 elder law, paragraph (e) as amended by section 3-d of part A of chapter 36 59 of the laws of 2011, and paragraph (f) as amended by section 1 of 37 part T of chapter 56 of the laws of 2012, are amended to read as 38 follows: 39 (e) As a condition of eligibility for benefits under this title, if a 40 program participant's income indicates that the participant could be 41 eligible for an income-related subsidy under section 1860D-14 of the 42 federal social security act by either applying for such subsidy or by 43 enrolling in a medicare savings program as a qualified medicare benefi- 44 ciary (QMB), a specified low-income medicare beneficiary (SLMB), or a 45 qualifying individual (QI), a program participant is required to 46 provide, and to authorize the [elderly] expanded pharmaceutical insur- 47 ance coverage program to obtain, any information or documentation 48 required to establish the participant's eligibility for such subsidy, 49 and to authorize the [elderly] expanded pharmaceutical insurance cover- 50 age program to apply on behalf of the participant for the subsidy or the 51 medicare savings program. [The elderly] Upon receipt of an enrollment 52 application, or at any time after enrollment when the program has infor- 53 mation that indicates an enrollee is eligible for a subsidy under 54 section 1860D-14 of the federal social security act or in a medicare 55 savings program, the expanded pharmaceutical insurance coverage program 56 shall make a reasonable effort to notify the program participant of hisS. 3005--A 5 1 or her need to provide any of the above required information. After a 2 reasonable effort has been made to contact the participant, a partic- 3 ipant shall be notified in writing that he or she has sixty days to 4 provide such required information. If such information is not provided 5 within the sixty day period, the participant's coverage may be termi- 6 nated. A program participant who is eligible to enroll in the medicare 7 savings program shall be assisted to do so, and their expanded pharma- 8 ceutical insurance coverage program enrollment shall be in place 9 throughout the medicare savings program application process. 10 (f) As a condition of eligibility for benefits under this title, a 11 program participant is required to be enrolled in Medicare part D and to 12 maintain such enrollment. For unmarried participants with individual 13 annual income less than or equal to twenty-three thousand dollars and 14 married participants with joint annual income less than or equal to 15 twenty-nine thousand dollars, the [elderly] expanded pharmaceutical 16 insurance coverage program shall pay for the portion of the part D 17 monthly premium, and any late enrollment penalty that may have been 18 assessed, that is the responsibility of the participant. Such total 19 payment shall be limited to the low-income benchmark premium amount 20 established by the federal centers for medicare and medicaid services 21 and any other amount which such agency establishes under its de minimus 22 premium policy. 23 § 6. Subdivision 3 of section 250 of the elder law is amended by 24 adding a new paragraph (f) to read as follows: 25 (f) The expanded pharmaceutical insurance coverage program shall post 26 to its website the names of manufacturers that have a rebate program and 27 list the drugs that are covered by such rebate program in a manner that 28 provides enrollees with access to such information prior to the annual 29 medicare open enrollment period. 30 § 7. This act shall take effect immediately.
