Bill Text: NY S03577 | 2019-2020 | General Assembly | Introduced


Bill Title: Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.

Spectrum: Partisan Bill (Democrat 28-0)

Status: (Introduced) 2019-02-11 - REFERRED TO HEALTH [S03577 Detail]

Download: New_York-2019-S03577-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          3577
                               2019-2020 Regular Sessions
                    IN SENATE
                                    February 11, 2019
                                       ___________
        Introduced  by  Sens.  RIVERA, RAMOS, ADDABBO, BAILEY, BENJAMIN, BIAGGI,
          BRESLIN,  CARLUCCI,  COMRIE,  HARCKHAM,  HOYLMAN,  JACKSON,  KAVANAGH,
          KRUEGER, MAY, MONTGOMERY, MYRIE, PERSAUD, SALAZAR, SANDERS, SEPULVEDA,
          SERRANO  --  read  twice  and  ordered printed, and when printed to be
          committed to the Committee on Health
        AN ACT to amend the public health law and  the  state  finance  law,  in
          relation to enacting the "New York health act" and to establishing New
          York Health
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Short title. This act shall be known and may  be  cited  as
     2  the "New York health act".
     3    §  2.  Legislative  findings  and  intent.  1.  The state constitution
     4  states: "The protection and promotion of the health of  the  inhabitants
     5  of  the state are matters of public concern and provision therefor shall
     6  be made by the state and by such of its subdivisions and in such manner,
     7  and by such means as the legislature shall from time to time determine."
     8  (Article XVII, §3.) The legislature finds and declares  that  all  resi-
     9  dents  of  the  state  have the right to health care.  While the federal
    10  Affordable Care Act brought many improvements in health care and  health
    11  coverage,  it  still  leaves  many  New Yorkers without coverage or with
    12  inadequate coverage.  Millions of New Yorkers do not get the health care
    13  they need or face financial obstacles and hardships to get it.  That  is
    14  not  acceptable.    There  is no plan other than the New York health act
    15  that will enable New York state to meet that need.   New  Yorkers  -  as
    16  individuals,  employers,  and taxpayers - have experienced a rise in the
    17  cost of health care and  coverage  in  recent  years,  including  rising
    18  premiums, deductibles and co-pays, restricted provider networks and high
    19  out-of-network charges.  Many New Yorkers go without health care because
    20  they  cannot  afford  it  or suffer financial hardship to get it.  Busi-
    21  nesses have also experienced increases in the costs of health care bene-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09777-01-9

        S. 3577                             2
     1  fits for their employees, and many employers are shifting a larger share
     2  of the cost of coverage to their employees or dropping coverage  entire-
     3  ly.  Including long-term services and supports (LTSS) in New York Health
     4  is  a major step forward for older adults, people with disabilities, and
     5  their families. Older adults and people with disabilities  often  cannot
     6  receive  the  services necessary to stay in the community or other LTSS.
     7  Even when older adults and people with disabilities receive LTSS,  espe-
     8  cially  services  in the community, it is often at the cost of unreason-
     9  able demands on unpaid family caregivers, depleting their own or  family
    10  resources,  or  impoverishing themselves to qualify for public coverage.
    11  Health care providers are also affected by inadequate health coverage in
    12  New York state. A large portion of hospitals, health centers  and  other
    13  providers now experience substantial losses due to the provision of care
    14  that  is uncompensated. Individuals often find that they are deprived of
    15  affordable care and choice because of decisions by health  plans  guided
    16  by  the  plan's  economic  interests rather than the individual's health
    17  care needs. To address the fiscal crisis facing the health  care  system
    18  and  the  state  and  to  assure New Yorkers can exercise their right to
    19  health care,  affordable  and  comprehensive  health  coverage  must  be
    20  provided. Pursuant to the state constitution's charge to the legislature
    21  to  provide for the health of New Yorkers, this legislation is an enact-
    22  ment of state concern for the purpose of  establishing  a  comprehensive
    23  universal guaranteed health care coverage program and a health care cost
    24  control  system  for  the  benefit  of all residents of the state of New
    25  York.
    26    2. (a) It is the intent of the Legislature  to  create  the  New  York
    27  Health program to provide a universal single payer health plan for every
    28  New  Yorker, funded by broad-based revenue based on ability to pay.  The
    29  legislature intends that federal waivers and approvals be  sought  where
    30  they will improve the administration of the New York Health program, but
    31  the  legislature  intends  that  the  program be implemented even in the
    32  absence of such waivers or approvals.  The state shall  work  to  obtain
    33  waivers  and  other  approvals  relating to Medicaid, Child Health Plus,
    34  Medicare, the Affordable Care Act, and  any  other  appropriate  federal
    35  programs,  under  which  federal  funds  and  other subsidies that would
    36  otherwise be paid to New  York  State,  New  Yorkers,  and  health  care
    37  providers  for  health  coverage that will be equaled or exceeded by New
    38  York Health will be paid by the federal government to New York State and
    39  deposited in the New York Health trust fund,  or  paid  to  health  care
    40  providers and individuals in combination with New York Health trust fund
    41  payments,  and for other program modifications (including elimination of
    42  cost sharing and insurance premiums).  Under such waivers and approvals,
    43  health coverage under those programs will, to the maximum extent  possi-
    44  ble,  be replaced and merged into New York Health, which will operate as
    45  a true single-payer program.
    46    (b) If any necessary waiver or approval is  not  obtained,  the  state
    47  shall  use state plan amendments and seek waivers and approvals to maxi-
    48  mize, and make as seamless as possible,  the  use  of  federally-matched
    49  health  programs  and federal health programs in New York Health.  Thus,
    50  even where other programs such as Medicaid or Medicare may contribute to
    51  paying for care, it is the goal of this legislation  that  the  coverage
    52  will  be  delivered  by  New  York  Health and, as much as possible, the
    53  multiple sources of funding will be pooled with other  New  York  Health
    54  funds  and  not  be apparent to New York Health members or participating
    55  providers.

        S. 3577                             3
     1    (c) This program  will  promote  movement  away  from  fee-for-service
     2  payment,  which tends to reward quantity and requires excessive adminis-
     3  trative expense, and towards alternate payment  methodologies,  such  as
     4  global  or capitated payments to providers or health care organizations,
     5  that  promote  quality, efficiency, investment in primary and preventive
     6  care, and innovation and integration in the organizing of health care.
     7    (d) The program shall promote the use of clinical data to improve  the
     8  quality  of health care and public health, consistent with protection of
     9  patient confidentiality. The program shall maximize patient autonomy  in
    10  choice  of  health care providers and health care decision making.  Care
    11  coordination within the program shall ensure management and coordination
    12  among a patient's health care services, consistent with patient autonomy
    13  and person-centered service planning, rather than acting as a gatekeeper
    14  to needed services.
    15    3. This act does not  create  any  employment  benefit,  nor  does  it
    16  require, prohibit, or limit the providing of any employment benefit.
    17    4. In order to promote improved quality of, and access to, health care
    18  services and promote improved clinical outcomes, it is the policy of the
    19  state  to  encourage cooperative, collaborative and integrative arrange-
    20  ments among health care providers who might  otherwise  be  competitors,
    21  under  the  active  supervision of the commissioner of health. It is the
    22  intent of the state to supplant competition with such  arrangements  and
    23  regulation  only  to  the extent necessary to accomplish the purposes of
    24  this act, and to provide state  action  immunity  under  the  state  and
    25  federal  antitrust  laws  to  health  care  providers, particularly with
    26  respect to their relations with the single-payer New  York  Health  plan
    27  created by this act.
    28    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
    29  health law are renumbered article 80 and sections 8000, 8001,  8002  and
    30  8003, respectively, and a new article 51 is added to read as follows:
    31                                 ARTICLE 51
    32                               NEW YORK HEALTH
    33  Section 5100. Definitions.
    34          5101. Program created.
    35          5102. Board of trustees.
    36          5103. Eligibility and enrollment.
    37          5104. Benefits.
    38          5105. Health  care providers; care coordination; payment method-
    39                  ologies.
    40          5106. Health care organizations.
    41          5107. Program standards.
    42          5108. Regulations.
    43          5109. Provisions relating to federal health programs.
    44          5110. Additional provisions.
    45          5111. Regional advisory councils.
    46    § 5100. Definitions. As used in  this  article,  the  following  terms
    47  shall  have  the following meanings, unless the context clearly requires
    48  otherwise:
    49    1. "Board" means the board of trustees of the New York Health  program
    50  created  by section fifty-one hundred two of this article, and "trustee"
    51  means a trustee of the board.
    52    2. "Care coordination" means, but is not limited to, managing,  refer-
    53  ring to, locating, coordinating, and monitoring health care services for
    54  the  member  to assure that all medically necessary health care services
    55  are made available to and are effectively used by the member in a timely
    56  manner, consistent with patient autonomy.  Care  coordination  does  not

        S. 3577                             4
     1  include  a  requirement for prior authorization for health care services
     2  or for referral for a member to receive a health care service.
     3    3.  "Care  coordinator"  means  an  individual  or  entity approved to
     4  provide care coordination under subdivision  two  of  section  fifty-one
     5  hundred five of this article.
     6    4. "Federally-matched public health program" means the medical assist-
     7  ance  program  under title eleven of article five of the social services
     8  law, the basic health program under section three hundred  sixty-nine-gg
     9  of  the  social  services  law,  and the child health plus program under
    10  title one-A of article twenty-five of this chapter.
    11    5. "Health care organization" means an entity that is approved by  the
    12  commissioner  under  section  fifty-one  hundred  six of this article to
    13  provide health care services to members under the program.
    14    6. "Health care provider"  means  any  individual  or  entity  legally
    15  authorized  to  provide a health care service under Medicaid or Medicare
    16  or this article. "Health care professional" means a health care provider
    17  that is an  individual  licensed,  certified,  registered  or  otherwise
    18  authorized to practice under title eight of the education law to provide
    19  such health care service, acting within his or her lawful scope of prac-
    20  tice.
    21    7. "Health care service" means any health care service, including care
    22  coordination, included as a benefit under the program.
    23    8. "Implementation period" means the period under subdivision three of
    24  section  fifty-one  hundred one of this article during which the program
    25  will be subject to special eligibility and financing provisions until it
    26  is fully implemented under that section.
    27    10. "Medicaid" or "medical assistance" means title eleven  of  article
    28  five  of  the  social  services  law and the program thereunder.  "Child
    29  health plus" means title one-A of article twenty-five  of  this  chapter
    30  and  the program thereunder. "Medicare" means title XVIII of the federal
    31  social security act and the programs thereunder.  "Affordable care  act"
    32  means the federal patient protection and affordable care act, public law
    33  111-148,  as amended by the health care and education reconciliation act
    34  of 2010, public law 111-152, and as  otherwise  amended  and  any  regu-
    35  lations  or  guidance  issued thereunder.   "Basic health program" means
    36  section three hundred sixty-nine-gg of the social services law  and  the
    37  program thereunder.
    38    11. "Member" means an individual who is enrolled in the program.
    39    12.  "New  York Health", "New York Health program", and "program" mean
    40  the New York Health program created by section fifty-one hundred one  of
    41  this article.
    42    13.  "New York Health trust fund" means the New York Health trust fund
    43  established under section eighty-nine-j of the state finance law.
    44    14. "Out-of-state health care service" means  a  health  care  service
    45  provided  to  a  member while the member is temporarily out of the state
    46  and (a) it is medically  necessary  that  the  health  care  service  be
    47  provided  while  the member is out of the state, or (b) it is clinically
    48  appropriate that the health care service be  provided  by  a  particular
    49  health  care provider located out of the state rather than in the state.
    50  However, any health care service provided to a New York Health  enrollee
    51  by  a  health care provider qualified under paragraph (a) of subdivision
    52  three of section fifty-one hundred five of this article that is  located
    53  outside  the  state  shall not be considered an out-of-state service and
    54  shall be covered as otherwise provided in this article.
    55    15. "Participating provider" means any individual or entity that is  a
    56  health  care  provider  qualified  under  subdivision  three  of section

        S. 3577                             5
     1  fifty-one hundred  five  of  this  article  that  provides  health  care
     2  services to members under the program, or a health care organization.
     3    16.  "Person"  means any individual or natural person, trust, partner-
     4  ship, association,  unincorporated  association,  corporation,  company,
     5  limited  liability  company,  proprietorship, joint venture, firm, joint
     6  stock association, department, agency, authority, or other legal entity,
     7  whether for-profit, not-for-profit or governmental.
     8    17. "Prescription and non-prescription drugs" means prescription drugs
     9  as defined in section two hundred seventy of this chapter, and non-pres-
    10  cription smoking cessation products or devices.
    11    18. "Resident" means an individual whose primary place of abode is  in
    12  the  state,  without  regard  to the individual's immigration status, as
    13  determined according to regulations of the commissioner.
    14    § 5101. Program created. 1. The New  York  Health  program  is  hereby
    15  created  in  the department. The commissioner shall establish and imple-
    16  ment the program under this article. The program shall  provide  compre-
    17  hensive health coverage to every resident who enrolls in the program.
    18    2.  The  commissioner shall, to the maximum extent possible, organize,
    19  administer and market the program and services as a single program under
    20  the name "New York Health" or such other name as the commissioner  shall
    21  determine,  regardless  of under which law or source the definition of a
    22  benefit is found including (on a voluntary basis) retiree  health  bene-
    23  fits.  In  implementing this article, the commissioner shall avoid jeop-
    24  ardizing federal financial participation in  these  programs  and  shall
    25  take  care  to  promote  public understanding and awareness of available
    26  benefits and programs.
    27    3. The commissioner shall determine when individuals may begin enroll-
    28  ing in the program. There shall be an implementation period, which shall
    29  begin on the date that individuals may begin enrolling  in  the  program
    30  and shall end as determined by the commissioner.
    31    4. An insurer authorized to provide coverage pursuant to the insurance
    32  law  or  a  health maintenance organization certified under this chapter
    33  may, if otherwise authorized, offer  benefits  that  do  not  cover  any
    34  service  for which coverage is offered to individuals under the program,
    35  but may not offer benefits that cover any service for which coverage  is
    36  offered  to  individuals under the program. Provided, however, that this
    37  subdivision shall not prohibit (a) the offering of any  benefits  to  or
    38  for  individuals, including their families, who are employed or self-em-
    39  ployed in the state but who are not residents of the state, or  (b)  the
    40  offering of benefits during the implementation period to individuals who
    41  enrolled or may enroll as members of the program, or (c) the offering of
    42  retiree health benefits.
    43    5.  A  college, university or other institution of higher education in
    44  the state may purchase coverage under the program for  any  student,  or
    45  student's dependent, who is not a resident of the state.
    46    6.  To  the  extent any provision of this chapter, the social services
    47  law, the insurance law or the elder law:
    48    (a) is inconsistent with any provision of this article or the legisla-
    49  tive intent of the New York Health Act, this  article  shall  apply  and
    50  prevail, except where explicitly provided otherwise by this article; and
    51    (b) is consistent with the provisions of this article and the legisla-
    52  tive  intent of the New York Health Act, the provision of that law shall
    53  apply.
    54    7. The program shall be deemed to be a health care plan  for  purposes
    55  of  utilization  review  and external appeal under article forty-nine of
    56  this chapter.  An enrollee may designate a person or entity,  including,

        S. 3577                             6
     1  but not limited to, a representative of the enrollee's care coordinator,
     2  a health care organization providing the service under review or appeal,
     3  or  a  labor  union  or  Taft-Hartley  fund  of  which  such enrollee or
     4  enrollee's family member is a member to serve as the enrollee's designee
     5  for  purposes  of that article, if the person or entity agrees to be the
     6  designee.
     7    8. (a) No member shall be required to receive any health care  service
     8  through  any  entity  organized, certified or operating under guidelines
     9  under article forty-four of this chapter,  or  specified  under  section
    10  three hundred sixty-four-j of the social services law, the insurance law
    11  or  the  elder law. No such entity shall receive payment for health care
    12  services (other than care coordination) from the program.
    13    (b) However, this subdivision shall not preclude the use of a Medicare
    14  managed care ("Medicare advantage") entity or other entity created by or
    15  under the direction of the program where reasonably necessary  to  maxi-
    16  mize  federal financial participation or other federal financial support
    17  under any federally-matched  public  health  program,  Medicare  or  the
    18  Affordable Care Act. Any entity under this paragraph shall, to the maxi-
    19  mum  extent  feasible,  operate  in the background, without burden on or
    20  interference with the member and health care provider, without depriving
    21  the member or health care provider of any right  or  benefit  under  the
    22  program and otherwise consistent with this article.
    23    9.  The  program  shall  include provisions for an appropriate reserve
    24  fund.
    25    10. (a) This subdivision applies to every person who is a retiree of a
    26  public employer, as defined in section two  hundred  one  of  the  civil
    27  service law, and any person who is a beneficiary of the retiree's public
    28  employee retiree health benefit. Any reference to the retiree shall mean
    29  and  include  any  beneficiary of the retiree. This subdivision does not
    30  create or increase any  eligibility  for  any  public  employee  retiree
    31  health  benefit that would not otherwise exist and does not diminish any
    32  public employee retiree health benefit.
    33    (b) This paragraph applies to the retiree while he or she is  a  resi-
    34  dent of New York state. The retiree shall enroll in the program.  If, by
    35  the  implementation  date,  the retiree has not enrolled in the program,
    36  the appropriate public employee retirement system and  the  commissioner
    37  shall  enroll  the  retiree  in  the  New  York  Health  program. If the
    38  retiree's public employee retiree health benefit  includes  any  service
    39  for which coverage is not offered under the New York Health program, the
    40  retiree  shall continue to receive that benefit from the public employee
    41  retirement program.
    42    (c) For every retiree, while he or she is not a resident of  New  York
    43  state,  the appropriate public employee retirement system shall maintain
    44  the retiree's public employee retiree health benefit as if this  article
    45  had not been enacted.
    46    § 5102. Board of trustees. 1. The New York Health board of trustees is
    47  hereby  created  in  the department. The board of trustees shall, at the
    48  request of the commissioner,  consider  any  matter  to  effectuate  the
    49  provisions and purposes of this article, and may advise the commissioner
    50  thereon;  and  it may, from time to time, submit to the commissioner any
    51  recommendations to effectuate the provisions and purposes of this  arti-
    52  cle.  The  commissioner  may  propose regulations under this article and
    53  amendments thereto for consideration by the board. The board of trustees
    54  shall have no executive, administrative or appointive duties  except  as
    55  otherwise  provided  by  law.  The board of trustees shall have power to
    56  establish, and from time to time, amend regulations  to  effectuate  the

        S. 3577                             7
     1  provisions  and  purposes  of  this  article, subject to approval by the
     2  commissioner.
     3    2. The board shall be composed of:
     4    (a)  the  commissioner,  the superintendent of financial services, and
     5  the director of the budget, or their designees, as ex officio members;
     6    (b) twenty-six trustees appointed by the governor;
     7    (i) six of whom shall be representatives of health care consumer advo-
     8  cacy organizations which have a statewide or regional constituency,  who
     9  have  been  involved  in  issues of interest to low- and moderate-income
    10  individuals, older adults, and people with disabilities; at least  three
    11  of whom shall represent organizations led by consumers in those groups;
    12    (ii)  two  of  whom shall be representatives of professional organiza-
    13  tions representing physicians;
    14    (iii) two of whom shall be representatives of  professional  organiza-
    15  tions  representing  licensed  or  registered  health care professionals
    16  other than physicians;
    17    (iv) three of whom shall be representatives of general hospitals,  one
    18  of whom shall be a representative of public general hospitals;
    19    (v) one of whom shall be a representative of community health centers;
    20    (vi)  two  of  whom shall be representatives of rehabilitation or home
    21  care providers;
    22    (vii) two of whom shall be representatives  of  behavioral  or  mental
    23  health or disability service providers;
    24    (viii)  two  of whom shall be representatives of health care organiza-
    25  tions;
    26    (ix) two of whom shall be representatives of organized labor;
    27    (x) two of whom shall  have  demonstrated  expertise  in  health  care
    28  finance; and
    29    (xi)  two  of  whom shall be employers or representatives of employers
    30  who pay the payroll tax under this article, or, prior to the tax  becom-
    31  ing effective, will pay the tax;
    32    (c)  fourteen  trustees  appointed by the governor; five of whom to be
    33  appointed on the recommendation of the speaker of the assembly; five  of
    34  whom to be appointed on the recommendation of the temporary president of
    35  the  senate;  two  of  whom to be appointed on the recommendation of the
    36  minority leader of the assembly; and two of whom to be appointed on  the
    37  recommendation of the minority leader of the senate.
    38    3.  After  the  end of the implementation period, no person shall be a
    39  trustee unless he or she is a member of the program, except the ex offi-
    40  cio trustees. Each trustee shall serve at the pleasure of the appointing
    41  officer, except the ex officio trustees.
    42    4. The chair of the board shall be appointed, and may  be  removed  as
    43  chair,  by the governor from among the trustees. The board shall meet at
    44  least four times each calendar year. Meetings shall  be  held  upon  the
    45  call  of  the  chair  and  as  provided  by the board. A majority of the
    46  appointed trustees shall be a quorum of the board, and  the  affirmative
    47  vote  of a majority of the trustees voting, but not less than ten, shall
    48  be necessary for any action to be taken by  the  board.  The  board  may
    49  establish an executive committee to exercise any powers or duties of the
    50  board as it may provide, and other committees to assist the board or the
    51  executive  committee.  The  chair of the board shall chair the executive
    52  committee and shall appoint the chair and members of all  other  commit-
    53  tees. The board of trustees may appoint one or more advisory committees.
    54  Members of advisory committees need not be members of the board of trus-
    55  tees.

        S. 3577                             8
     1    5.  Trustees  shall serve without compensation but shall be reimbursed
     2  for their necessary and actual expenses incurred while  engaged  in  the
     3  business of the board.
     4    6. Notwithstanding any provision of law to the contrary, no officer or
     5  employee of the state or any local government shall forfeit or be deemed
     6  to  have  forfeited his or her office or employment by reason of being a
     7  trustee.
     8    7. The board and its committees and advisory  committees  may  request
     9  and  receive  the  assistance  of  the department and any other state or
    10  local governmental entity in exercising its powers and duties.
    11    8. No later than two years after the effective date of this article:
    12    (a) The board shall develop proposals for: (i)  incorporating  retiree
    13  health  benefits into New York Health; (ii) accommodating employer reti-
    14  ree health benefits for people who have been members of New York  Health
    15  but  live as retirees out of the state; and (iii) accommodating employer
    16  retiree health benefits for people who earned or accrued  such  benefits
    17  while  residing  in  the  state  prior to the implementation of New York
    18  Health and live as retirees out of the state.  The board  shall  present
    19  its proposals to the governor and the legislature.
    20    (b) The board shall develop a proposal for New York Health coverage of
    21  health  care  services  covered  under  the  workers'  compensation law,
    22  including whether and how to continue funding for those  services  under
    23  that  law  and  whether  and how to incorporate an element of experience
    24  rating.
    25    § 5103. Eligibility and enrollment. 1. Every  resident  of  the  state
    26  shall be eligible and entitled to enroll as a member under the program.
    27    2.  No individual shall be required to pay any premium or other charge
    28  for enrolling in or being a member under the program.
    29    3. A newborn child shall be enrolled as of the  date  of  the  child's
    30  birth  if  enrollment is done prior to the child's birth or within sixty
    31  days after the child's birth.
    32    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
    33  coverage  to  every member, which shall include all health care services
    34  required to be covered under any of the  following,  without  regard  to
    35  whether  the  member  would  otherwise be eligible for or covered by the
    36  program or source referred to:
    37    (a) child health plus;
    38    (b) Medicaid;
    39    (c) Medicare;
    40    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
    41  forty-three of the insurance law;
    42    (e)  article  eleven of the civil service law, as of the date one year
    43  before the beginning of the implementation period;
    44    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
    45  section  fifty-one  hundred two of the insurance law, provided that this
    46  coverage shall not replace  coverage  under  article  fifty-one  of  the
    47  insurance law;
    48    (g)  any  additional health care service authorized to be added to the
    49  program's benefits by the program; and
    50    (h) provided that where any state law or  regulation  related  to  any
    51  federally-matched public health program states that a benefit is contin-
    52  gent  on  federal  financial participation, or words to that effect, the
    53  benefit shall be included under the  New  York  Health  program  without
    54  regard to federal financial participation.
    55    2. No member shall be required to pay any premium, deductible, co-pay-
    56  ment or co-insurance under the program.

        S. 3577                             9
     1    3. The program shall provide for payment under the program for:
     2    (a)  emergency and temporary health care services provided to a member
     3  or individual entitled to become a member who has not had  a  reasonable
     4  opportunity to become a member or to enroll with a care coordinator; and
     5    (b) health care services provided in an emergency to an individual who
     6  is  entitled  to  become  a  member or enrolled with a care coordinator,
     7  regardless of having had an opportunity to do so.
     8    § 5105. Health care providers; care  coordination;  payment  methodol-
     9  ogies.   1. Choice of health care provider. (a) Any health care provider
    10  qualified to participate under this  section  may  provide  health  care
    11  services  under  the  program, provided that the health care provider is
    12  otherwise legally authorized to perform the health care service for  the
    13  individual and under the circumstances involved.
    14    (b)  A  member  may  choose  to receive health care services under the
    15  program from any participating provider, consistent with  provisions  of
    16  this  article  relating  to  care coordination and health care organiza-
    17  tions, the willingness or  availability  of  the  provider  (subject  to
    18  provisions  of  this article relating to discrimination), and the appro-
    19  priate clinically-relevant circumstances.
    20    2. Care coordination. (a) A care coordinator may be an  individual  or
    21  entity that is approved by the program that is:
    22    (i)  a  health care practitioner who is: (A) the member's primary care
    23  practitioner; (B) at the option of a female member, the member's provid-
    24  er of primary gynecological care; or (C) at the option of a  member  who
    25  has  a  chronic  condition  that  requires  specialty care, a specialist
    26  health care practitioner who regularly and continually  provides  treat-
    27  ment for that condition to the member;
    28    (ii)  an entity licensed under article twenty-eight of this chapter or
    29  certified under article thirty-six of this chapter, or, with respect  to
    30  a  member  who  receives  chronic mental health care services, an entity
    31  licensed under article thirty-one of the mental  hygiene  law  or  other
    32  entity approved by the commissioner in consultation with the commission-
    33  er of mental health;
    34    (iii) a health care organization;
    35    (iv)  a  Taft-Hartley fund or labor union, with respect to its members
    36  and their  family  members;  provided  that  this  provision  shall  not
    37  preclude a Taft-Hartley fund or labor union from becoming a care coordi-
    38  nator  under  subparagraph (v) of this paragraph or a health care organ-
    39  ization under section fifty-one hundred six of this article; or
    40    (v) any not-for-profit or governmental entity approved by the program.
    41    (b)(i) Every member shall enroll with a care coordinator  that  agrees
    42  to  provide  care  coordination  to the member prior to receiving health
    43  care services to be paid for under the program.   Health  care  services
    44  provided  to  a member shall not be subject to payment under the program
    45  unless the member is enrolled with a care coordinator at  the  time  the
    46  health care service is provided.
    47    (ii)  This  paragraph shall not apply to health care services provided
    48  under subdivision three of section fifty-one hundred four of this  arti-
    49  cle.
    50    (iii)  The  member  shall  remain  enrolled with that care coordinator
    51  until the member becomes enrolled with a different care  coordinator  or
    52  ceases to be a member. Members have the right to change their care coor-
    53  dinator  on  terms  at  least as permissive as the provisions of section
    54  three hundred sixty-four-j of the social services  law  relating  to  an
    55  individual  changing  his  or  her primary care provider or managed care
    56  provider.

        S. 3577                            10
     1    (c) Care coordination shall be provided to the member by the  member's
     2  care coordinator.  A care coordinator may employ or utilize the services
     3  of  other  individuals  or  entities to assist in providing care coordi-
     4  nation for the member, consistent with regulations of the commissioner.
     5    (d)  A  health  care organization may establish rules relating to care
     6  coordination for members in the health care organization, different from
     7  this subdivision but otherwise consistent with this  article  and  other
     8  applicable laws.
     9    (e) The commissioner shall develop and implement procedures and stand-
    10  ards for an individual or entity to be approved to be a care coordinator
    11  in  the  program,  including but not limited to procedures and standards
    12  relating to the revocation,  suspension,  limitation,  or  annulment  of
    13  approval  on a determination that the individual or entity is not compe-
    14  tent to be a care coordinator or has exhibited a course of conduct which
    15  is either inconsistent with program standards and regulations  or  which
    16  exhibits  an unwillingness to meet such standards and regulations, or is
    17  a potential threat to the public health or safety. Such  procedures  and
    18  standards  shall  not  limit  approval  to  be a care coordinator in the
    19  program for economic purposes and shall be consistent with good  profes-
    20  sional practice. In developing the procedures and standards, the commis-
    21  sioner  shall:  (i)  consider  existing  standards developed by national
    22  accrediting  and  professional  organizations;  and  (ii)  consult  with
    23  national and local organizations working on care coordination or similar
    24  models,  including  health  care  practitioners, hospitals, clinics, and
    25  consumers and their representatives. When  developing  and  implementing
    26  standards  of  approval  of  care coordinators for individuals receiving
    27  chronic mental health care services, the commissioner shall consult with
    28  the commissioner of mental health. An individual or entity may not be  a
    29  care  coordinator  unless the services included in care coordination are
    30  within the individual's professional scope of practice or  the  entity's
    31  legal authority.
    32    (f)  To  maintain approval under the program, a care coordinator must:
    33  (i) renew its status at a frequency determined by the commissioner;  and
    34  (ii)  provide  data to the department as required by the commissioner to
    35  enable the commissioner to evaluate the impact of care  coordinators  on
    36  quality, outcomes and cost.
    37    (g)  Nothing  in  this  subdivision  shall authorize any individual to
    38  engage in any act in violation of title eight of the education law.
    39    3. Health care providers. (a) The  commissioner  shall  establish  and
    40  maintain procedures and standards for health care providers to be quali-
    41  fied  to participate in the program, including but not limited to proce-
    42  dures and standards relating to the revocation, suspension,  limitation,
    43  or annulment of qualification to participate on a determination that the
    44  health  care  provider  is  not  competent  to be a provider of specific
    45  health care services or has exhibited  a  course  of  conduct  which  is
    46  either  inconsistent  with  program  standards  and regulations or which
    47  exhibits an unwillingness to meet such standards and regulations, or  is
    48  a  potential  threat to the public health or safety. Such procedures and
    49  standards shall not limit health  care  provider  participation  in  the
    50  program  for economic purposes and shall be consistent with good profes-
    51  sional practice.  Such procedures and standards  may  be  different  for
    52  different  types of health care providers and health care professionals.
    53  Any health care provider who is qualified to participate under Medicaid,
    54  child health plus or Medicare shall be deemed to be qualified to partic-
    55  ipate in the program, and any health care provider's revocation, suspen-
    56  sion, limitation, or annulment of qualification to participate in any of

        S. 3577                            11
     1  those programs shall apply to the health care  provider's  qualification
     2  to  participate  in  the  program;  provided that a health care provider
     3  qualified under this sentence shall  follow  the  procedures  to  become
     4  qualified under the program by the end of the implementation period.
     5    (b) The commissioner shall establish and maintain procedures and stan-
     6  dards for recognizing health care providers located out of the state for
     7  purposes of providing coverage under the program for out-of-state health
     8  care services.
     9    (c)  Procedures  and  standards  under  this subdivision shall include
    10  provisions for expedited temporary qualification to participate  in  the
    11  program for health care professionals who are (i) temporarily authorized
    12  to  practice  in  the state or (ii) are recently arrived in the state or
    13  recently authorized to practice in the state.
    14    4. Payment for health care services. (a) The commissioner  may  estab-
    15  lish  by  regulation  payment methodologies for health care services and
    16  care coordination provided to members under the program by participating
    17  providers, care coordinators, and health care organizations.  There  may
    18  be  a variety of different payment methodologies, including those estab-
    19  lished on a demonstration basis. All payment  rates  under  the  program
    20  shall  be  reasonable  and reasonably related to the cost of efficiently
    21  providing the health care service and assuring an adequate and  accessi-
    22  ble supply of the health care service.  Until and unless another payment
    23  methodology  is  established,  health  care services provided to members
    24  under the program shall be paid for on a fee-for-service  basis,  except
    25  for care coordination.
    26    (b)  The  program  shall engage in good faith negotiations with health
    27  care providers' representatives under title III of article forty-nine of
    28  this chapter, including, but not limited to, in  relation  to  rates  of
    29  payment and payment methodologies.
    30    (c)  Notwithstanding any provision of law to the contrary, payment for
    31  drugs provided by pharmacies under the program shall be made pursuant to
    32  title one of article two-A of this chapter. However, the  program  shall
    33  provide  for  payment  for  prescription drugs under section 340B of the
    34  federal public service act where applicable.  Payment  for  prescription
    35  drugs  provided  by health care providers other than pharmacies shall be
    36  pursuant to other provisions of this article.
    37    (d) Payment for health care services established  under  this  article
    38  shall  be considered payment in full. A participating provider shall not
    39  charge any rate in excess of the payment established under this  article
    40  for  any  health  care  service provided under the program and shall not
    41  solicit or accept payment from any member or third party  for  any  such
    42  service  except as provided under section fifty-one hundred nine of this
    43  article.  However, this paragraph shall not preclude  the  program  from
    44  acting  as  a  primary  or  secondary  payer in conjunction with another
    45  third-party payer where permitted under section fifty-one  hundred  nine
    46  of this article.
    47    (e)  The  program may provide in payment methodologies for payment for
    48  capital related expenses for specifically  identified  capital  expendi-
    49  tures  incurred  by  not-for-profit  or  governmental entities certified
    50  under article twenty-eight of this chapter. Any capital related  expense
    51  generated  by  a  capital expenditure that requires or required approval
    52  under article twenty-eight of  this  chapter  must  have  received  that
    53  approval  for  the  capital  related  expense  to  be paid for under the
    54  program.
    55    (f) Payment methodologies and rates shall include a distinct component
    56  of reimbursement for direct and indirect graduate medical  education  as

        S. 3577                            12
     1  defined,  calculated  and  implemented  pursuant to section twenty-eight
     2  hundred seven-c of this chapter.
     3    (g)  The commissioner shall provide by  regulation for payment method-
     4  ologies and procedures for paying for out-of-state health care services.
     5    5. Prior authorization. The program shall not require  prior  authori-
     6  zation  for  any  health  care service in any manner more restrictive of
     7  access to or payment for the service than  would  be  required  for  the
     8  service  under  Medicare  Part  A  or  Part  B.  Prior authorization for
     9  prescription drugs provided by pharmacies under  the  program  shall  be
    10  under title one of article two-A of this chapter.
    11    §  5106.  Health  care organizations. 1. A member may choose to enroll
    12  with and receive health care services under the program  from  a  health
    13  care organization.
    14    2.  A  health  care  organization shall be a not-for-profit or govern-
    15  mental entity that is approved by the commissioner that is:
    16    (a) an accountable care organization under  article  twenty-nine-E  of
    17  this chapter; or
    18    (b)  a  Taft-Hartley  fund  (i)  with respect to its members and their
    19  family members, and (ii) if allowed by applicable law  and  approved  by
    20  the commissioner, for other members of the program.
    21    3.  A health care organization may be responsible for providing all or
    22  part of the health care services to which its members are entitled under
    23  the program, consistent with the terms of its approval  by  the  commis-
    24  sioner.
    25    4.  (a)  The  commissioner  shall develop and implement procedures and
    26  standards for an entity to be approved to be a health care  organization
    27  in  the  program,  including but not limited to procedures and standards
    28  relating to the revocation,  suspension,  limitation,  or  annulment  of
    29  approval  on  a  determination  that the entity is not competent to be a
    30  health care organization or has exhibited a course of conduct  which  is
    31  either  inconsistent  with  program  standards  and regulations or which
    32  exhibits an unwillingness to meet such standards and regulations, or  is
    33  a  potential  threat to the public health or safety. Such procedures and
    34  standards shall not limit approval to be a health care  organization  in
    35  the  program  for  economic  purposes  and shall be consistent with good
    36  professional practice. In developing the procedures and  standards,  the
    37  commissioner   shall:  (i)  consider  existing  standards  developed  by
    38  national accrediting and professional organizations;  and  (ii)  consult
    39  with  national  and  local  organizations working in the field of health
    40  care organizations,  including  health  care  practitioners,  hospitals,
    41  clinics,  long-term  supports and service providers, consumers and their
    42  representatives and labor organizations representing health  care  work-
    43  ers.  When  developing  and implementing standards of approval of health
    44  care organizations, the commissioner shall consult with the commissioner
    45  of mental health, the commissioner of  developmental  disabilities,  the
    46  director  of  the state office for the aging and the commissioner of the
    47  office of alcoholism and substance abuse services.
    48    (b) To maintain approval under the program, a health care organization
    49  must: (i) renew its status at a frequency determined by the  commission-
    50  er;  and  (ii) provide data to the department as required by the commis-
    51  sioner to enable the commissioner to evaluate the health care  organiza-
    52  tion  in  relation  to  quality  of  health  care  services, health care
    53  outcomes, and cost.
    54    5. The commissioner shall make regulations  relating  to  health  care
    55  organizations  consistent  with and to ensure compliance with this arti-
    56  cle.

        S. 3577                            13
     1    6. The provision of health care services directly or indirectly  by  a
     2  health  care  organization  through  health  care providers shall not be
     3  considered the practice of a profession under title eight of the  educa-
     4  tion law by the health care organization.
     5    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
     6  requirements and standards for the program and for health care organiza-
     7  tions, care coordinators, and health  care  providers,  consistent  with
     8  this article, including requirements and standards for, as applicable:
     9    (a) the scope, quality and accessibility of health care services;
    10    (b) relations between health care organizations or health care provid-
    11  ers and members; and
    12    (c)  relations  between  health  care  organizations  and  health care
    13  providers, including (i) credentialing and participation in  the  health
    14  care organization; and (ii) terms, methods and rates of payment.
    15    2. Requirements and standards under the program shall include, but not
    16  be limited to, provisions to promote the following:
    17    (a)  simplification,  transparency, uniformity, and fairness in health
    18  care provider credentialing and participation in health  care  organiza-
    19  tion  networks, referrals, payment procedures and rates, claims process-
    20  ing, and approval of health care services, as applicable;
    21    (b) primary and preventive  care,  care  coordination,  efficient  and
    22  effective  health  care  services,  quality  assurance, coordination and
    23  integration of health care services, including use of appropriate  tech-
    24  nology, and promotion of public, environmental and occupational health;
    25    (c) elimination of health care disparities;
    26    (d) non-discrimination with respect to members and health care provid-
    27  ers on the basis of race, ethnicity, national origin, religion, disabil-
    28  ity,  age,  sex,  sexual  orientation, gender identity or expression, or
    29  economic circumstances; provided  that  health  care  services  provided
    30  under the program shall be appropriate to the patient's clinically-rele-
    31  vant circumstances;
    32    (e)  accessibility  of  care  coordination,  health  care organization
    33  services and health care services, including  accessibility  for  people
    34  with disabilities and people with limited ability to speak or understand
    35  English,  and  the providing of care coordination, health care organiza-
    36  tion services and health care services in a culturally competent manner;
    37  and
    38    (f) especially in relation to long-term  supports  and  services,  the
    39  maximization  and  prioritization of the most integrated community-based
    40  supports and services.
    41    3. Any participating provider or care coordinator that is organized as
    42  a for-profit entity (other than a professional practice of one  or  more
    43  health  care  professionals) shall be required to meet the same require-
    44  ments and standards as entities organized  as  not-for-profit  entities,
    45  and payments under the program paid to such entities shall not be calcu-
    46  lated  to  accommodate the generation of profit or revenue for dividends
    47  or other return on investment or the payment of taxes that would not  be
    48  paid by a not-for-profit entity.
    49    4.  Every  participating  provider  shall  furnish to the program such
    50  information to, and permit examination of its records by,  the  program,
    51  as  may  be  reasonably required for purposes of reviewing accessibility
    52  and utilization of health care services,  quality  assurance,  promoting
    53  improved  patient outcomes and cost containment, the making of payments,
    54  and statistical or other studies of the operation of the program or  for
    55  protection  and  promotion  of  public,  environmental  and occupational
    56  health.

        S. 3577                            14
     1    5. In developing requirements and standards and  making  other  policy
     2  determinations  under  this article, the commissioner shall consult with
     3  representatives of members, health care  providers,  care  coordinators,
     4  health  care organizations   employers, organized labor including repre-
     5  sentatives of health care workers, and other interested parties.
     6    6.  The program shall maintain the security and confidentiality of all
     7  data and other information collected under the program  when  such  data
     8  would  be normally considered confidential patient data.  Aggregate data
     9  of the program which is derived from  confidential  data  but  does  not
    10  violate  patient  confidentiality  shall be public information including
    11  for purposes of article six of the public officers law.
    12    § 5108. Regulations. The commissioner may make regulations under  this
    13  article  by approving regulations and amendments thereto, under subdivi-
    14  sion one of section fifty-one hundred two of this article.  The  commis-
    15  sioner  may make regulations or amendments thereto under this article on
    16  an emergency basis under section two hundred two of the  state  adminis-
    17  trative  procedure  act,  provided  that  such regulations or amendments
    18  shall not become permanent  unless  adopted  under  subdivision  one  of
    19  section fifty-one hundred two of this article.
    20    § 5109. Provisions relating to federal health programs. 1. The commis-
    21  sioner  shall  seek  all federal waivers and other federal approvals and
    22  arrangements and submit state plan amendments necessary to  operate  the
    23  program consistent with this article to the maximum extent possible.
    24    2.  (a)  The  commissioner  shall apply to the secretary of health and
    25  human services or other appropriate federal official for all waivers  of
    26  requirements,  and make other arrangements, under Medicare, any federal-
    27  ly-matched public health program, the affordable care act, and any other
    28  federal programs that provide federal funds for payment for health  care
    29  services,  that  are  necessary to enable all New York Health members to
    30  receive all benefits under the program through the program to enable the
    31  state to implement this article and to receive and deposit  all  federal
    32  payments  under  those programs (including funds that may be provided in
    33  lieu of premium tax credits, cost-sharing subsidies, and small  business
    34  tax  credits) in the state treasury to the credit of the New York Health
    35  trust fund and to use those funds for the New York  Health  program  and
    36  other provisions under this article. To the extent possible, the commis-
    37  sioner shall negotiate arrangements with the federal government in which
    38  bulk  or  lump-sum federal payments are paid to New York Health in place
    39  of  federal  spending  or  tax  benefits  for  federally-matched  health
    40  programs  or  federal  health  programs.    The  commissioner shall take
    41  actions under paragraph (b) of subdivision eight  of  section  fifty-one
    42  hundred one of this article as reasonably necessary.
    43    (b)  The  commissioner may require members or applicants to be members
    44  to provide information necessary for the  program  to  comply  with  any
    45  waiver or arrangement under this subdivision.
    46    3.  (a) The commissioner may take actions consistent with this article
    47  to enable New York Health to administer Medicare in New York  state,  to
    48  create  a  Medicare  managed care plan ("Medicare Advantage") that would
    49  operate consistent with this article, and  to  be  a  provider  of  drug
    50  coverage under Medicare part D for eligible members of New York Health.
    51    (b)  The  commissioner  may  waive  or  modify  the  applicability  of
    52  provisions of this section  relating  to  any  federally-matched  public
    53  health  program  or  Medicare  as  necessary  to implement any waiver or
    54  arrangement under this section or to maximize the  benefit  to  the  New
    55  York  Health program under this section, provided that the commissioner,
    56  in consultation with the director of the budget,  shall  determine  that

        S. 3577                            15
     1  such  waiver  or  modification  is  in the best interests of the members
     2  affected by the action and the state.
     3    (c)  The  commissioner  may  apply  for  coverage under any federally-
     4  matched public health program on behalf of any  member  and  enroll  the
     5  member in the federally-matched public health program or Medicare if the
     6  member  is  eligible  for it.   Enrollment in a federally-matched public
     7  health program or Medicare shall not cause any member to lose any health
     8  care service provided by the program or diminish any  right  the  member
     9  would otherwise have.
    10    (d) The commissioner shall by regulation increase the income eligibil-
    11  ity  level,  increase  or  eliminate  the resource test for eligibility,
    12  simplify any procedural or documentation requirement for enrollment, and
    13  increase the benefits for any federally-matched public  health  program,
    14  and  for any program to reduce or eliminate an individual's coinsurance,
    15  cost-sharing or premium obligations or increase an  individual's  eligi-
    16  bility  for  any  federal  financial  support related to Medicare or the
    17  affordable care act notwithstanding any law or regulation to the contra-
    18  ry. The commissioner may  act  under  this  paragraph  upon  a  finding,
    19  approved by the director of the budget, that the action (i) will help to
    20  increase  the  number  of  members  who are eligible for and enrolled in
    21  federally-matched public health programs, or for any program  to  reduce
    22  or  eliminate an individual's coinsurance, cost-sharing or premium obli-
    23  gations or increase an individual's eligibility for any  federal  finan-
    24  cial  support  related to Medicare or the affordable care act; (ii) will
    25  not diminish any individual's access to any health care service, benefit
    26  or right the individual would otherwise have; (iii) is in  the  interest
    27  of  the program; and (iv) does not require or has received any necessary
    28  federal waivers or approvals to ensure federal financial participation.
    29    (e) To enable the commissioner to  apply  for  coverage  or  financial
    30  support  under any federally-matched public health program, the Afforda-
    31  ble Care Act, or Medicare on behalf of any member and enroll the  member
    32  in any such program, including an entity under paragraph (b) of subdivi-
    33  sion  eight  of  section  fifty-one  hundred  one of this article if the
    34  member is eligible for it,  the  commissioner  may  require  that  every
    35  member  or  applicant to be a member shall provide information to enable
    36  the commissioner to determine whether the applicant is eligible for such
    37  program.  The program shall make a reasonable effort to  notify  members
    38  of their obligations under this paragraph. After a reasonable effort has
    39  been made to contact the member, the member shall be notified in writing
    40  that  he  or she has sixty days to provide such required information. If
    41  such information is not  provided  within  the  sixty  day  period,  the
    42  member's coverage under the program may be terminated.
    43    (f)  To the extent necessary for purposes of this section, as a condi-
    44  tion of  continued  eligibility  for  health  care  services  under  the
    45  program,  a  member  who  is  eligible for benefits under Medicare shall
    46  enroll in Medicare, including parts A, B and D.
    47    (g) The program shall  provide  premium  assistance  for  all  members
    48  enrolling  in  a  Medicare  part  D drug coverage under section 1860D of
    49  Title XVIII of the federal social security act limited to the low-income
    50  benchmark premium amount established by the federal centers for Medicare
    51  and Medicaid services and any other amount which such agency establishes
    52  under its de minimis premium policy, except that such payments  made  on
    53  behalf  of  members enrolled in a Medicare advantage plan may exceed the
    54  low-income benchmark premium amount if determined to be  cost  effective
    55  to the program.

        S. 3577                            16
     1    (h)  If  the  commissioner  has  reasonable  grounds to believe that a
     2  member could be eligible for an  income-related  subsidy  under  section
     3  1860D-14  of  Title XVIII of the federal social security act, the member
     4  shall provide, and authorize the program to obtain, any  information  or
     5  documentation  required  to  establish the member's eligibility for such
     6  subsidy, provided that the commissioner shall attempt to obtain as  much
     7  of  the  information and documentation as possible from records that are
     8  available to him or her.
     9    (i) The program shall make a reasonable effort to  notify  members  of
    10  their  obligations under this subdivision. After a reasonable effort has
    11  been made to contact the member, the member shall be notified in writing
    12  that he or she has sixty days to provide such required  information.  If
    13  such  information  is  not  provided  within  the  sixty day period, the
    14  member's coverage under the program may be terminated.
    15    § 5110. Additional provisions.   1. The  commissioner  shall  contract
    16  with not-for-profit organizations to provide:
    17    (a)  consumer  assistance to individuals with respect to selection and
    18  changing selection of a care coordinator or  health  care  organization,
    19  enrolling, obtaining health care services, and other matters relating to
    20  the program;
    21    (b) health care provider assistance to health care providers providing
    22  and  seeking  or  considering  whether  to provide, health care services
    23  under the program, with respect to participating in a health care organ-
    24  ization and dealing with a health care organization; and
    25    (c) care coordinator assistance to individuals and entities  providing
    26  and  seeking  or  considering  whether  to provide, care coordination to
    27  members.
    28    2. The commissioner shall provide grants from funds in  the  New  York
    29  Health  trust fund or otherwise appropriated for this purpose, to health
    30  systems agencies under section twenty-nine hundred four-b of this  chap-
    31  ter to support the operation of such health systems agencies.
    32    3.  Retraining and re-employment of impacted employees. (a) As used in
    33  this subdivision:
    34    (i) "Third party payer" means an insurer authorized to provide  health
    35  coverage  under  the  insurance  law,  a health maintenance organization
    36  under article forty-four of this chapter, a self-insured plan  providing
    37  health  coverage,  or  any  other  third  party  payer  for  health care
    38  services.
    39    (ii) "Health care provider administrative employee" means an  employee
    40  of  a  health  care  provider primarily engaged in relations or dealings
    41  with third party payers or seeking payment or reimbursement  for  health
    42  care services from third party payers.
    43    (iii)  "Impacted  employee"  means an individual who, at any time from
    44  the date this section becomes a law until two years after the end of the
    45  implementation period, is employed by a third party payer or is a health
    46  care provider administrative employee, and whose employment  ends  as  a
    47  result of the implementation of the New York Health program.
    48    (b)  Within  ninety  days  after  this section shall become a law, the
    49  commissioner of labor shall convene a retraining and re-employment  task
    50  force  including  but  not  limited  to:  representatives  of  potential
    51  impacted employees, human resource departments of third party payers and
    52  health care providers, individuals  with  experience  and  expertise  in
    53  retraining  and  re-employment programs relevant to the circumstances of
    54  impacted employees, and representatives of the  commissioner  of  labor.
    55  The commissioner of labor and the task force shall review and provide:

        S. 3577                            17
     1    (i)  analysis  of  potential  impacted  employees  by  job  title  and
     2  geography;
     3    (ii) competency mapping and labor market analysis of impacted employee
     4  occupations with job openings; and
     5    (iii)  establishment of regional retraining and re-employment systems,
     6  including but not limited to  job  boards,  outplacement  services,  job
     7  search  services, career advisement services, and retraining advisement,
     8  to be coordinated with the regional advisory councils established  under
     9  section fifty-one hundred eleven of this article.
    10    (c)  (i) Three or more impacted employees, a recognized union of work-
    11  ers including impacted employees, or an employer of  impacted  employees
    12  may  file  a  petition  with  the  commissioner of labor to certify such
    13  employees as being impacted employees.
    14    (ii) Impacted employees shall be eligible for:
    15    (A) up to two years of retraining at any training provider approved by
    16  the commissioner of labor; and
    17    (B) up to two  years  of  unemployment  benefits,  provided  that  the
    18  impacted employee is enrolled in a department of labor approved training
    19  program,  is  actively seeking employment, and is not currently employed
    20  full time; provided, however, that such impacted employee  may  maintain
    21  unemployment  benefits  for  up  to two years even if he or she does not
    22  meet the criteria set forth in this clause but is sixty-three  years  of
    23  age or older at the time of loss of employment as an impacted employee.
    24    (d)  The  commissioner  shall  provide  funds from the New York Health
    25  trust fund or otherwise appropriated for this purpose to the commission-
    26  er of labor for  retraining  and  re-employment  programs  for  impacted
    27  employees under this subdivision.
    28    (e)  The  commissioner  of labor shall make regulations and take other
    29  actions reasonably necessary to implement this subdivision. This  subdi-
    30  vision  shall  be  implemented  consistent with applicable law and regu-
    31  lations.
    32    4. The commissioner shall, directly and through grants to not-for-pro-
    33  fit entities, conduct programs using data collected through the New York
    34  Health program, to promote  and  protect  the  quality  of  health  care
    35  services,  patient  outcomes, and public, environmental and occupational
    36  health, including cooperation with other data  collection  and  research
    37  programs of the department, consistent with this article, the protection
    38  of the security and confidentiality of individually identifiable patient
    39  information, and otherwise applicable law.
    40    §  5111.  Regional advisory councils.  1. The New York Health regional
    41  advisory councils (each referred to in this article as a "regional advi-
    42  sory council") are hereby created in the department.
    43    2. There shall be a regional advisory council established in  each  of
    44  the following regions:
    45    (a) Long Island, consisting of Nassau and Suffolk counties;
    46    (b) New York City;
    47    (c)  Hudson  Valley, consisting of Delaware, Dutchess, Orange, Putnam,
    48  Rockland, Sullivan, Ulster, Westchester counties;
    49    (d) Northern, consisting of Albany, Clinton, Columbia,  Essex,  Frank-
    50  lin,  Fulton,  Greene, Hamilton, Herkimer, Jefferson, Lewis, Montgomery,
    51  Otsego, Rensselaer,  Saratoga,  Schenectady,  Schoharie,  St.  Lawrence,
    52  Warren, Washington counties;
    53    (e)  Central,  consisting  of Broome, Cayuga, Chemung, Chenango, Cort-
    54  land, Livingston, Madison, Monroe, Oneida,  Onondaga,  Ontario,  Oswego,
    55  Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates counties; and

        S. 3577                            18
     1    (f)  Western,  consisting  of Allegany, Cattaraugus, Chautauqua, Erie,
     2  Genesee, Niagara, Orleans, Wyoming counties.
     3    3.  Each regional advisory council shall be composed of not fewer than
     4  twenty-seven members, as determined by the commissioner and  the  board,
     5  as  necessary  to appropriately represent the diverse needs and concerns
     6  of the region. Members of a regional advisory council shall be residents
     7  of or have their principal place of business in the region served by the
     8  regional advisory council.
     9    4. Appointment of members of the regional advisory councils.
    10    (a) The twenty-seven members shall be appointed as follows:
    11    (i) nine members shall be appointed by the governor;
    12    (ii) six members shall be appointed by the governor on the recommenda-
    13  tion of the speaker of the assembly;
    14    (iii) six members shall be appointed by the governor on the  recommen-
    15  dation of the temporary president of the senate;
    16    (iv) three members shall be appointed by the governor on the recommen-
    17  dation of the minority leader of the assembly; and
    18    (v)  three members shall be appointed by the governor on the recommen-
    19  dation of the minority leader of the senate.
    20    Where a regional advisory council has more than twenty-seven  members,
    21  additional members shall be appointed and recommended by these officials
    22  in the same proportion as the twenty-seven members.
    23    (b)  Regional  advisory  council  membership  shall include but not be
    24  limited to:
    25    (i) representatives of organizations with a regional constituency that
    26  advocate for health care consumers, older adults, and people with  disa-
    27  bilities  including  organizations  led  by members of those groups, who
    28  shall constitute at least one third of the membership of  each  regional
    29  council;
    30    (ii) representatives of professional organizations representing physi-
    31  cians;
    32    (iii)   representatives  of  professional  organizations  representing
    33  health care professionals other than physicians;
    34    (iv) representatives of general hospitals, including public hospitals;
    35    (v) representatives of community health centers;
    36    (vi) representatives of mental health,  behavioral  health  (including
    37  substance use), physical disability, developmental disability, rehabili-
    38  tation, home care and other service providers;
    39    (vii) representatives of women's health service providers;
    40    (viii) representatives of health care organizations;
    41    (ix)  representatives  of organized labor including representatives of
    42  health care workers;
    43    (x) representatives of employers; and
    44    (xi) representatives of municipal and county government.
    45    5. Members of a regional advisory council shall be appointed for terms
    46  of three years provided, however, that of the members  first  appointed,
    47  one-third  shall  be appointed for one year terms and one-third shall be
    48  appointed for two year terms. Vacancies shall  be  filled  in  the  same
    49  manner as original appointments for the remainder of any unexpired term.
    50  No person shall be a member of a regional advisory council for more than
    51  six years in any period of twelve consecutive years.
    52    6.  Members  of  the  regional  advisory  councils shall serve without
    53  compensation but shall be reimbursed  for  their  necessary  and  actual
    54  expenses  incurred  while  engaged in the business of the advisory coun-
    55  cils. The program shall provide financial support for such expenses  and
    56  other expenses of the regional advisory councils.

        S. 3577                            19
     1    7.  Each regional advisory council shall meet at least quarterly. Each
     2  regional advisory council may form committees to assist it in its  work.
     3  Members  of  a  committee  need  not be members of the regional advisory
     4  council.   The New York City regional  advisory  council  shall  form  a
     5  committee  for  each  borough  of  New York City, to assist the regional
     6  advisory council in its work as it relates particularly to that borough.
     7    8. Each regional advisory council shall advise the  commissioner,  the
     8  board,  the  governor and the legislature on all matters relating to the
     9  development and implementation of the New York Health program.
    10    9. Each regional advisory council shall adopt, and from time  to  time
    11  revise,  a  community  health  improvement  plan  for its region for the
    12  purpose of:
    13    (a) promoting the delivery of health  care  services  in  the  region,
    14  improving  the  quality  and  accessibility  of care, including cultural
    15  competency, clinical  integration  of  care  between  service  providers
    16  including  but  not  limited to physical, mental, and behavioral health,
    17  physical and developmental disability services, and  long-term  supports
    18  and services;
    19    (b) facility and health services planning in the region;
    20    (c) identifying gaps in regional health care services;
    21    (d)  promoting increased public knowledge and responsibility regarding
    22  the availability and appropriate utilization of  health  care  services.
    23  Each community health improvement plan shall be submitted to the commis-
    24  sioner and the board and shall be posted on the department's website;
    25    (e)  identifying  needs in professional and service personnel required
    26  to deliver health care services; and
    27    (f) coordinating regional implementation of retraining and  re-employ-
    28  ment  programs for impacted employees under subdivision three of section
    29  fifty-one hundred ten of this article.
    30    10. Each regional advisory council shall hold  at  least  four  public
    31  hearings annually on matters relating to the New York Health program and
    32  the  development  and implementation of the community health improvement
    33  plan.
    34    11. Each regional advisory council shall publish an annual  report  to
    35  the  commissioner  and the board on the progress of the community health
    36  improvement plan. These reports shall  be  posted  on  the  department's
    37  website.
    38    12.  All  meetings  of  the  regional advisory councils and committees
    39  shall be subject to article six of the public officers law.
    40    § 4. Financing of New York Health. 1. The governor shall submit to the
    41  legislature a revenue plan and legislative bills to implement  the  plan
    42  (referred  to collectively in this section as the "revenue proposal") to
    43  provide the revenue necessary to finance the New York Health program, as
    44  created by article 51 of the public health law  and  all  provisions  of
    45  that article (referred to in this section as the "program"), taking into
    46  consideration anticipated federal revenue available for the program. The
    47  revenue  proposal  shall  be submitted to the legislature as part of the
    48  executive budget under article VII of the state  constitution,  for  the
    49  fiscal  year  commencing  on the first day of April in the calendar year
    50  after this act shall become a law. In developing the  revenue  proposal,
    51  the  governor  shall consult with appropriate officials of the executive
    52  branch; the temporary president of the senate; the speaker of the assem-
    53  bly; the chairs of the fiscal and health committees of  the  senate  and
    54  assembly;  and  representatives  of business, labor, consumers and local
    55  government.

        S. 3577                            20
     1    2. (a) Basic structure. The basic structure of  the  revenue  proposal
     2  shall  be  as follows: Revenue for the program shall come from two taxes
     3  (referred to collectively in this section as the "taxes"). First,  there
     4  shall  be a progressively graduated tax on all payroll and self-employed
     5  income  (referred  to  in  this  section  as the "payroll tax"), paid by
     6  employers, employees and self-employed individuals.  Second, there shall
     7  be a progressively graduated tax on taxable income  (such  as  interest,
     8  dividends,  and  capital gains) not subject to the payroll tax (referred
     9  to in this section as the "non-payroll tax").   Income  in  the  bracket
    10  below  twenty-five  thousand  dollars  per year shall be exempt from the
    11  taxes.  Higher brackets of income subject to the taxes shall be assessed
    12  at a higher marginal rate than lower brackets.  The taxes shall  be  set
    13  at  levels  anticipated  to  produce  sufficient  revenue to finance the
    14  program, to be scaled up as enrollment grows, taking into  consideration
    15  anticipated  federal  revenue available for the program. Provision shall
    16  be made for state residents (who are eligible for the program)  who  are
    17  employed  out-of-state,  and non-residents (who are not eligible for the
    18  program) who are employed in the state.
    19    (b) Payroll tax. The income to be subject to the payroll tax shall  be
    20  all income subject to the Medicare Part A tax. The tax shall be set at a
    21  percentage  of  that  income, which shall be progressively graduated, so
    22  the percentage is higher on higher  brackets  of  income.  For  employed
    23  individuals,  the  employer  shall pay eighty percent of the tax and the
    24  employee shall pay twenty percent of the tax, except  that  an  employer
    25  may  agree  to pay all or part of the employee's share.  A self-employed
    26  individual shall pay the full tax.
    27    (c) Non-payroll income tax. There shall be a tax  on  income  that  is
    28  subject  to  the personal income tax under article 22 of the tax law and
    29  is not subject to the payroll tax. It shall be set at  a  percentage  of
    30  that  income,  which shall be progressively graduated, so the percentage
    31  is higher on higher brackets of income.
    32    (d) Phased-in rates. Early in the program, when enrollment is growing,
    33  the amount of the taxes shall be at an appropriate level, and  shall  be
    34  changed as anticipated enrollment grows, to cover the actual cost of the
    35  program.  The revenue proposal shall include a mechanism for determining
    36  the rates of the taxes.
    37    (e) Cross-border employees. (i) State residents employed out-of-state.
    38  If an individual is employed out-of-state by an employer that is subject
    39  to New York state law, the employer and employee shall  be  required  to
    40  pay the payroll tax as to that employee as if the employment were in the
    41  state.  If an individual is employed out-of-state by an employer that is
    42  not subject to New York state law, either (A) the employer and  employee
    43  shall  voluntarily comply with the tax or (B) the employee shall pay the
    44  tax as if he or she were self-employed.
    45    (ii) Out-of-state residents employed in the state.   (A)  The  payroll
    46  tax shall apply to any out-of-state resident who is employed or self-em-
    47  ployed in the state.  (B) In the case of an out-of-state resident who is
    48  employed or self-employed in the state, such individual and individual's
    49  employer  shall  be able to take a credit against the payroll taxes each
    50  would otherwise pay as to that individual for amounts they spend respec-
    51  tively on health benefits for the individual  that  would  otherwise  be
    52  covered  by  the program if the individual were a member of the program.
    53  For the employer, the credit shall be available regardless of  the  form
    54  of  the  health  benefit  (e.g.,  health insurance, a self-insured plan,
    55  direct services, or reimbursement for services), to make sure  that  the
    56  revenue  proposal does not relate to employment benefits in violation of

        S. 3577                            21
     1  the federal ERISA.  For non-employment-based spending by the individual,
     2  the credit shall be available for and limited  to  spending  for  health
     3  coverage (not out-of-pocket health spending). The credit shall be avail-
     4  able  without  regard  to how little is spent or how sparse the benefit.
     5  The credit may only be taken against the payroll tax. Any excess  amount
     6  may  not be applied to other tax liability. The credit shall be distrib-
     7  uted between the employer and employee in the  same  proportion  as  the
     8  spending  by each for the benefit and may be applied to their respective
     9  portion of the tax. (C) If any provision of  this  subparagraph  or  any
    10  application of it shall be ruled to violate federal ERISA, the provision
    11  or the application of it shall be null and void and the ruling shall not
    12  affect  any  other  provision  or application of this section or the act
    13  that enacted it.
    14    3. (a) The revenue proposal  shall  include  a  plan  and  legislative
    15  provisions   for  ending  the  requirement  for  local  social  services
    16  districts to pay part of  the  cost  of  Medicaid  and  replacing  those
    17  payments with revenue from the taxes under the revenue proposal.
    18    (b)  The  taxes  under this section shall not supplant the spending of
    19  other state revenue to pay for the Medicaid program as it exists  as  of
    20  the  enactment  of  the  revenue proposal as amended, unless the revenue
    21  proposal as amended provides otherwise.
    22    4. To the extent that the revenue proposal differs from the  terms  of
    23  subdivision  two  or paragraph (b) of subdivision three of this section,
    24  the revenue proposal shall state how it differs  from  those  terms  and
    25  reasons for and the effects of the differences.
    26    5.  All  revenue  from  the  taxes  shall be deposited in the New York
    27  Health trust fund account under section 89-j of the state finance law.
    28    § 5.  Article 49 of the public health law is amended by adding  a  new
    29  title 3 to read as follows:
    30                                  TITLE III
    31            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    32                               NEW YORK HEALTH
    33  Section 4920. Definitions.
    34          4921. Collective negotiation authorized.
    35          4922. Collective negotiation requirements.
    36          4923. Requirements for health care providers' representative.
    37          4924. Mediation.
    38          4925. Certain collective action prohibited.
    39          4926. Fees.
    40          4927. Confidentiality.
    41          4928. Severability and construction.
    42    § 4920. Definitions. For purposes of this title:
    43    1. "New York Health" means the program under article fifty-one of this
    44  chapter.
    45    2.  "Person"  means  an  individual,  association, corporation, or any
    46  other legal entity.
    47    3. "Health care providers' representative" means a third party that is
    48  authorized by health care providers to negotiate on  their  behalf  with
    49  New  York  Health  over terms and conditions affecting those health care
    50  providers.
    51    4. "Strike" means a work stoppage in part or in whole, direct or indi-
    52  rect, by a body of workers to gain compliance with demands  made  on  an
    53  employer.
    54    5.  "Health  care provider" means a health care provider under article
    55  fifty-one of this chapter. A health  care  professional  as  defined  in
    56  article  fifty-one of this chapter who practices as an employee or inde-

        S. 3577                            22
     1  pendent contractor of another health care provider shall not be deemed a
     2  health care provider for purposes of this title.
     3    §  4921.  Collective  negotiation authorized. 1. Health care providers
     4  may meet and communicate for the  purpose  of  collectively  negotiating
     5  with  New York Health on any matter relating to New York Health, includ-
     6  ing but not limited to rates of payment and payment methodologies.
     7    2. Nothing in this section shall be construed to allow or authorize an
     8  alteration of the terms of the internal and external  review  procedures
     9  set forth in law.
    10    3. Nothing in this section shall be construed to allow a strike of New
    11  York Health by health care providers.
    12    4.  Nothing  in  this section shall be construed to allow or authorize
    13  terms or conditions which would impede the ability of New York Health to
    14  obtain or retain accreditation by the  national  committee  for  quality
    15  assurance or a similar body or to comply with applicable state or feder-
    16  al law.
    17    § 4922. Collective negotiation requirements. 1. Collective negotiation
    18  rights granted by this title must conform to the following requirements:
    19    (a)  health  care  providers  may  communicate  with other health care
    20  providers regarding the terms and conditions to be negotiated  with  New
    21  York Health;
    22    (b)  health care providers may communicate with health care providers'
    23  representatives;
    24    (c) a health care providers' representative is the only party  author-
    25  ized  to  negotiate  with  New  York Health on behalf of the health care
    26  providers as a group;
    27    (d) a health care provider can be bound by the  terms  and  conditions
    28  negotiated by the health care providers' representatives; and
    29    (e)  in  communicating  or negotiating with the health care providers'
    30  representative, New York Health is entitled to offer and provide differ-
    31  ent terms and conditions to individual competing health care providers.
    32    2. Nothing in this title shall affect or limit the right of  a  health
    33  care provider or group of health care providers to collectively petition
    34  a government entity for a change in a law, rule, or regulation.
    35    3.  Nothing  in  this title shall affect or limit collective action or
    36  collective bargaining on the part of any health care provider  with  his
    37  or  her  employer  or  any  other lawful collective action or collective
    38  bargaining.
    39    § 4923. Requirements for health care providers' representative. Before
    40  engaging in collective negotiations with New York Health  on  behalf  of
    41  health  care  providers,  a  health care providers' representative shall
    42  file with the commissioner, in the manner prescribed by the  commission-
    43  er,  information  identifying  the  representative, the representative's
    44  plan of operation, and the representative's procedures to ensure compli-
    45  ance with this title.
    46    § 4924. Mediation. 1. In the event the commissioner determines that an
    47  impasse exists  in  the  negotiations,  the  commissioner  shall  render
    48  assistance as follows:
    49    (a)  to  assist  the  parties  to effect a voluntary resolution of the
    50  negotiations, the commissioner shall appoint a mediator who is  mutually
    51  acceptable  to  both  the  health care providers' representative and the
    52  representative of New York Health. If  the  mediator  is  successful  in
    53  resolving  the  impasse,  then the health care providers' representative
    54  shall proceed as set forth in this article;
    55    (b) if an impasse continues, the commissioner shall  appoint  a  fact-
    56  finding  board of not more than three members, who are mutually accepta-

        S. 3577                            23
     1  ble to both the health care providers' representative and the  represen-
     2  tative  of  New  York  Health.  The  fact-finding  board  shall have, in
     3  addition to the powers delegated to it by the board, the power  to  make
     4  recommendations for the resolution of the dispute;
     5    (c) the fact-finding board, acting by a majority of its members, shall
     6  transmit  its findings of fact and recommendations for resolution of the
     7  dispute to the commissioner, and may thereafter assist  the  parties  to
     8  effect  a  voluntary  resolution  of the dispute. The fact-finding board
     9  shall also share its findings  of  fact  and  recommendations  with  the
    10  health care providers' representative and the representative of New York
    11  Health.  If  within  twenty days after the submission of the findings of
    12  fact and recommendations, the impasse continues, the commissioner  shall
    13  order  a  resolution to the negotiations based upon the findings of fact
    14  and recommendations submitted by the fact-finding board.
    15    § 4925. Certain collective action prohibited. 1.  This  title  is  not
    16  intended  to authorize competing health care providers to act in concert
    17  in response to a health care providers' representative's discussions  or
    18  negotiations with New York Health except as authorized by other law.
    19    2. No health care providers' representative shall negotiate any agree-
    20  ment  that  excludes,  limits  the participation or reimbursement of, or
    21  otherwise limits the scope of services to be provided by any health care
    22  provider or group of health care providers with respect to the  perform-
    23  ance of services that are within the health care provider's lawful scope
    24  or terms of practice, license, registration, or certificate.
    25    §  4926. Fees. Each person who acts as the representative of negotiat-
    26  ing parties under this title shall pay to the department a fee to act as
    27  a representative. The commissioner, by regulation,  shall  set  fees  in
    28  amounts  deemed  reasonable and necessary to cover the costs incurred by
    29  the department in administering this title.
    30    § 4927. Confidentiality. All reports and other information required to
    31  be reported to the department under this title shall not be  subject  to
    32  disclosure under article six of the public officers law.
    33    § 4928. Severability and construction. If any provision or application
    34  of  this  title  shall be held to be invalid, or to violate or be incon-
    35  sistent with any applicable federal law or regulation,  that  shall  not
    36  affect other provisions or applications of this title which can be given
    37  effect  without  that  provision  or  application;  and to that end, the
    38  provisions and applications of this title are severable. The  provisions
    39  of  this  title  shall  be  liberally  construed  to  give effect to the
    40  purposes thereof.
    41    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
    42  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
    43  amended to read as follows:
    44    11. "State public health plan" means the  medical  assistance  program
    45  established  by  title eleven of article five of the social services law
    46  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
    47  insurance  coverage program established by title three of article two of
    48  the elder law (referred to in this article as "EPIC"), and  the  [family
    49  health  plus  program established by section three hundred sixty-nine-ee
    50  of the social services law to the extent that section provides that  the
    51  program shall be subject to this article] New York Health program estab-
    52  lished by article fifty-one of this chapter.
    53    §  7. The state finance law is amended by adding a new section 89-j to
    54  read as follows:
    55    § 89-j. New York Health trust fund. 1. There is hereby established  in
    56  the joint custody of the state comptroller and the commissioner of taxa-

        S. 3577                            24
     1  tion  and  finance  a  special revenue fund to be known as the "New York
     2  Health trust fund", referred to in this section as "the fund". The defi-
     3  nitions in section fifty-one hundred of  the  public  health  law  shall
     4  apply to this section.
     5    2. The fund shall consist of:
     6    (a)  all monies obtained from taxes pursuant to legislation enacted as
     7  proposed under section three of the New York Health act;
     8    (b) federal payments received as a  result  of  any  waiver  or  other
     9  arrangements  agreed  to  by  the  United States secretary of health and
    10  human services or other appropriate federal officials  for  health  care
    11  programs established under Medicare, any federally-matched public health
    12  program, or the affordable care act;
    13    (c)  the  amounts paid by the department of health that are equivalent
    14  to those amounts that are paid on behalf  of  residents  of  this  state
    15  under  Medicare,  any  federally-matched  public  health program, or the
    16  affordable care act for health benefits which are equivalent  to  health
    17  benefits covered under New York Health;
    18    (d)  federal and state funds for purposes of the provision of services
    19  authorized under title XX of the federal social security act that  would
    20  otherwise  be  covered under article fifty-one of the public health law;
    21  and
    22    (e) state monies that would otherwise be appropriated to  any  govern-
    23  mental  agency,  office,  program,  instrumentality or institution which
    24  provides health services, for services and benefits  covered  under  New
    25  York Health. Payments to the fund pursuant to this paragraph shall be in
    26  an  amount  equal  to  the  money  appropriated for such purposes in the
    27  fiscal year beginning immediately preceding the effective  date  of  the
    28  New York Health act.
    29    3.  Monies  in  the  fund  shall only be used for purposes established
    30  under article fifty-one of the public health law.
    31    § 8. Temporary commission on implementation. 1. There is hereby estab-
    32  lished a temporary commission on implementation of the New  York  Health
    33  program,  referred  to  in this section as the commission, consisting of
    34  fifteen members: five members, including the chair, shall  be  appointed
    35  by the governor; four members shall be appointed by the temporary presi-
    36  dent of the senate, one member shall be appointed by the senate minority
    37  leader;  four members shall be appointed by the speaker of the assembly,
    38  and one member shall be appointed by the assembly minority  leader.  The
    39  commissioner  of  health,  the superintendent of financial services, and
    40  the commissioner of taxation and finance, or their designees shall serve
    41  as non-voting ex-officio members of the commission.
    42    2. Members of the commission shall receive such assistance as  may  be
    43  necessary  from  other  state  agencies  and entities, and shall receive
    44  reasonable and necessary expenses incurred in the performance  of  their
    45  duties.  The  commission  may  employ  staff  as needed, prescribe their
    46  duties, and fix their compensation within amounts appropriated  for  the
    47  commission.
    48    3.  The commission shall examine the laws and regulations of the state
    49  and make such recommendations as are necessary to conform the  laws  and
    50  regulations  of the state and article 51 of the public health law estab-
    51  lishing the New York Health program and other provisions of law relating
    52  to the New York  Health  program,  and  to  improve  and  implement  the
    53  program. The commission shall report its recommendations to the governor
    54  and the legislature.  The commission shall immediately begin development
    55  of  proposals consistent with the principles of article 51 of the public
    56  health law for provision of health care services covered under the work-

        S. 3577                            25
     1  ers' compensation law; and incorporation of retiree health benefits,  as
     2  described  in  paragraphs  (a),  (b) and (c) of subdivision 8 of section
     3  5102 of the public health law.  The commission shall  provide  its  work
     4  product and assistance to the board established pursuant to section 5102
     5  of  the  public  health  law  upon  completion of the appointment of the
     6  board.
     7    § 9.  Severability. If any provision or application of this act  shall
     8  be  held to be invalid, or to violate or be inconsistent with any appli-
     9  cable federal law or regulation, that shall not affect other  provisions
    10  or  applications  of  this  act  which  can be given effect without that
    11  provision or application; and to that end, the provisions  and  applica-
    12  tions of this act are severable.
    13    § 10. This act shall take effect immediately.
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