Bill Text: NY S04840 | 2017-2018 | 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 31-0)

Status: (Introduced) 2017-03-03 - REFERRED TO HEALTH [S04840 Detail]

Download: New_York-2017-S04840-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          4840
                               2017-2018 Regular Sessions
                    IN SENATE
                                      March 3, 2017
                                       ___________
        Introduced by Sens. RIVERA, ADDABBO, ALCANTARA, BAILEY, BRESLIN, BROOKS,
          COMRIE,  DILAN, GIANARIS, HAMILTON, HOYLMAN, KAMINSKY, KENNEDY, KRUEG-
          ER, LATIMER, MONTGOMERY, PARKER, PERALTA, PERSAUD,  SANDERS,  SERRANO,
          SQUADRON, STAVISKY, STEWART-COUSINS -- 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.  New  Yorkers  -  as  individuals,  employers, and
    13  taxpayers - have experienced a rise in  the  cost  of  health  care  and
    14  coverage  in  recent  years,  including rising premiums, deductibles and
    15  co-pays, restricted provider networks and high  out-of-network  charges.
    16  Businesses  have  also experienced increases in the costs of health care
    17  benefits for their employees, and many employers are shifting  a  larger
    18  share  of  the  cost of coverage to their employees or dropping coverage
    19  entirely.  Health care providers are also affected by inadequate  health
    20  coverage  in  New  York  state.  A large portion of voluntary and public
    21  hospitals, health centers and other providers now experience substantial
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09305-01-7

        S. 4840                             2
     1  losses due to the provision of care that is  uncompensated.  Individuals
     2  often  find that they are deprived of affordable care and choice because
     3  of decisions by health plans guided by the plan's economic needs  rather
     4  than  their  health  care needs. To address the fiscal crisis facing the
     5  health care system and the state and to assure New Yorkers can  exercise
     6  their right to health care, affordable and comprehensive health coverage
     7  must  be  provided.  Pursuant  to the state constitution's charge to the
     8  legislature to provide for the health of New Yorkers,  this  legislation
     9  is  an  enactment  of  state  concern  for the purpose of establishing a
    10  comprehensive universal single-payer health care coverage program and  a
    11  health  care cost control system for the benefit of all residents of the
    12  state of New York.
    13    2. It is the intent of the Legislature to create the New  York  Health
    14  program  to provide a universal health plan for every New Yorker, funded
    15  by broad-based revenue based on ability to pay.  The state shall work to
    16  obtain waivers and other approvals relating to  Medicaid,  Child  Health
    17  Plus,  Medicare,  the  Affordable  Care  Act,  and any other appropriate
    18  federal programs, under which federal funds  and  other  subsidies  that
    19  would  otherwise be paid to New York State, New Yorkers, and health care
    20  providers for health coverage that will be equaled or  exceeded  by  New
    21  York Health will be paid by the federal government to New York State and
    22  deposited  in  the  New  York  Health  trust fund, and for other program
    23  modifications (including  elimination  of  cost  sharing  and  insurance
    24  premiums).    Under  such  waivers  and approvals, health coverage under
    25  those programs will be replaced and merged into New York  Health,  which
    26  will operate as a true single-payer program.
    27    If  any  necessary waiver or approval is not obtained, the state shall
    28  use state plan amendments and seek waivers and  approvals  to  maximize,
    29  and  make  as  seamless as possible, the use of federally-matched health
    30  programs and federal health programs in New York  Health.    Thus,  even
    31  where  other  programs  such  as  Medicaid or Medicare may contribute to
    32  paying for care, it is the goal of this legislation  that  the  coverage
    33  will  be  delivered  by  New  York  Health and, as much as possible, the
    34  multiple sources of funding will be pooled with other  New  York  Health
    35  funds  and  not  be apparent to New York Health members or participating
    36  providers.  This program will promote movement away from fee-for-service
    37  payment, which tends to reward quantity and requires excessive  adminis-
    38  trative  expense,  and  towards alternate payment methodologies, such as
    39  global or capitated payments to providers or health care  organizations,
    40  that  promote  quality, efficiency, investment in primary and preventive
    41  care, and innovation and integration in the organizing of health care.
    42    3. This act does not  create  any  employment  benefit,  nor  does  it
    43  require, prohibit, or limit the providing of any employment benefit.
    44    4. In order to promote improved quality of, and access to, health care
    45  services and promote improved clinical outcomes, it is the policy of the
    46  state  to  encourage cooperative, collaborative and integrative arrange-
    47  ments among health care providers who might  otherwise  be  competitors,
    48  under  the  active  supervision of the commissioner of health. It is the
    49  intent of the state to supplant competition with such  arrangements  and
    50  regulation  only  to  the extent necessary to accomplish the purposes of
    51  this act, and to provide state  action  immunity  under  the  state  and
    52  federal  antitrust  laws  to  health  care  providers, particularly with
    53  respect to their relations with the single-payer New  York  Health  plan
    54  created by this act.

        S. 4840                             3
     1    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
     2  health law are renumbered article 80 and sections 8000, 8001,  8002  and
     3  8003, respectively, and a new article 51 is added to read as follows:
     4                                  ARTICLE 51
     5                               NEW YORK HEALTH
     6  Section 5100. Definitions.
     7          5101. Program created.
     8          5102. Board of trustees.
     9          5103. Eligibility and enrollment.
    10          5104. Benefits.
    11          5105. Health  care providers; care coordination; payment method-
    12                  ologies.
    13          5106. Health care organizations.
    14          5107. Program standards.
    15          5108. Regulations.
    16          5109. Provisions relating to federal health programs.
    17          5110. Additional provisions.
    18          5111. Regional advisory councils.
    19    § 5100. Definitions. As used in  this  article,  the  following  terms
    20  shall  have  the following meanings, unless the context clearly requires
    21  otherwise:
    22    1. "Board" means the board of trustees of the New York Health  program
    23  created  by section fifty-one hundred two of this article, and "trustee"
    24  means a trustee of the board.
    25    2. "Care coordination" means services provided by a  care  coordinator
    26  under subdivision two of section fifty-one hundred five of this article.
    27    3.  "Care  coordinator"  means  an  individual  or  entity approved to
    28  provide care coordination under subdivision  two  of  section  fifty-one
    29  hundred five of this article.
    30    4. "Federally-matched public health program" means the medical assist-
    31  ance  program  under title eleven of article five of the social services
    32  law, the basic health program under section three hundred  sixty-nine-gg
    33  of  the  social  services  law,  and the child health plus program under
    34  title one-A of article twenty-five of this chapter.
    35    5. "Health care organization" means an entity that is approved by  the
    36  commissioner  under  section  fifty-one  hundred  six of this article to
    37  provide health care services to members under the program.
    38    6. "Health care service" means any health care service, including care
    39  coordination, included as a benefit under the program.
    40    7. "Implementation period" means the period under subdivision three of
    41  section fifty-one hundred one of this article during which  the  program
    42  will be subject to special eligibility and financing provisions until it
    43  is fully implemented under that section.
    44    8.  "Long  term  care"  means  long term care, treatment, maintenance,
    45  services and supports, with the exception of short term  rehabilitation,
    46  as defined by the commissioner.
    47    9.  "Medicaid"  or  "medical assistance" means title eleven of article
    48  five of the social services law and  the  program  thereunder.    "Child
    49  health  plus"  means  title one-A of article twenty-five of this chapter
    50  and the program thereunder. "Medicare" means title XVIII of the  federal
    51  social security act and the programs thereunder.  "Basic health program"
    52  means section three hundred sixty-nine-gg of the social services law and
    53  the program thereunder.
    54    10. "Member" means an individual who is enrolled in the program.
    55    11.  "New York Health trust fund" means the New York Health trust fund
    56  established under section eighty-nine-i of the state finance law.

        S. 4840                             4
     1    12. "Out-of-state health care service" means  a  health  care  service
     2  provided  to a member while the member is out of the state and (a) it is
     3  medically necessary that the health care service be provided  while  the
     4  member is out of the state, or (b) it is clinically appropriate that the
     5  health  care  service  be  provided by a particular health care provider
     6  located out of the state rather than in the state.  However, any  health
     7  care  service  provided  to  a New York Health enrollee by a health care
     8  provider qualified under paragraph (a) of subdivision three  of  section
     9  fifty-one hundred five of this article that is located outside the state
    10  shall  not be considered an out-of-state service and shall be covered as
    11  otherwise provided in this article.
    12    13. "Participating provider" means any individual or entity that is  a
    13  health  care  provider  qualified  under  subdivision  three  of section
    14  fifty-one hundred  five  of  this  article  that  provides  health  care
    15  services to members under the program, or a health care organization.
    16    14.  "Affordable  care  act"  means the federal patient protection and
    17  affordable care act, public law 111-148, as amended by the  health  care
    18  and  education  reconciliation  act  of 2010, public law 111-152, and as
    19  otherwise amended and any regulations or guidance issued thereunder.
    20    15. "Person" means any individual or natural person,  trust,  partner-
    21  ship,  association,  unincorporated  association,  corporation, company,
    22  limited liability company, proprietorship, joint  venture,  firm,  joint
    23  stock association, department, agency, authority, or other legal entity,
    24  whether for-profit, not-for-profit or governmental.
    25    16.  "Program"  means  the  New York Health program created by section
    26  fifty-one hundred one of this article.
    27    17. "Prescription and non-prescription drugs" means prescription drugs
    28  as defined in section two hundred seventy of this chapter, and non-pres-
    29  cription smoking cessation products or devices.
    30    18. "Resident" means an individual whose primary place of abode is  in
    31  the  state,  without  regard  to the individual's immigration status, as
    32  determined according to regulations of the commissioner.
    33    § 5101. Program created. 1. The New  York  Health  program  is  hereby
    34  created  in  the department. The commissioner shall establish and imple-
    35  ment the program under this article. The program shall  provide  compre-
    36  hensive health coverage to every resident who enrolls in the program.
    37    2.  The  commissioner shall, to the maximum extent possible, organize,
    38  administer and market the program and services as a single program under
    39  the name "New York Health" or such other name as the commissioner  shall
    40  determine,  regardless  of under which law or source the definition of a
    41  benefit is found including (on a voluntary basis) retiree  health  bene-
    42  fits.    In  implementing this subdivision, the commissioner shall avoid
    43  jeopardizing federal financial participation in these programs and shall
    44  take care to promote public understanding  and  awareness  of  available
    45  benefits and programs.
    46    3. The commissioner shall determine when individuals may begin enroll-
    47  ing in the program. There shall be an implementation period, which shall
    48  begin  on  the  date that individuals may begin enrolling in the program
    49  and shall end as determined by the commissioner.
    50    4. An insurer authorized to provide coverage pursuant to the insurance
    51  law or a health maintenance organization certified  under  this  chapter
    52  may,  if  otherwise  authorized,  offer  benefits  that do not cover any
    53  service for which coverage is offered to individuals under the  program,
    54  but  may not offer benefits that cover any service for which coverage is
    55  offered to individuals under the program. Provided, however,  that  this
    56  subdivision  shall  not  prohibit (a) the offering of any benefits to or

        S. 4840                             5
     1  for individuals, including their families, who are employed or  self-em-
     2  ployed  in  the state but who are not residents of the state, or (b) the
     3  offering of benefits during the implementation period to individuals who
     4  enrolled or may enroll as members of the program, or (c) the offering of
     5  retiree health benefits.
     6    5.  A  college, university or other institution of higher education in
     7  the state may purchase coverage under the program for  any  student,  or
     8  student's dependent, who is not a resident of the state.
     9    6.  To  the  extent any provision of this chapter, the social services
    10  law or the insurance law:
    11    (a) is inconsistent with any provision of this article or the legisla-
    12  tive intent of the New York Health Act, this  article  shall  apply  and
    13  prevail, except where explicitly provided otherwise by this article; and
    14    (b) is consistent with the provisions of this article and the legisla-
    15  tive  intent of the New York Health Act, the provision of that law shall
    16  apply.
    17    7. The program shall be deemed to be a health care plan  for  purposes
    18  of  utilization  review  and external appeal under article forty-nine of
    19  this chapter.
    20    8. No member shall be required to  receive  any  health  care  service
    21  through  any  entity  organized, certified or operating under guidelines
    22  under article forty-four of this chapter,  or  specified  under  section
    23  three  hundred  sixty-four-j  of the social services law. No such entity
    24  shall receive payment for health care services (other than care  coordi-
    25  nation) from the program.
    26    § 5102. Board of trustees. 1. The New York Health board of trustees is
    27  hereby  created  in  the department. The board of trustees shall, at the
    28  request of the commissioner,  consider  any  matter  to  effectuate  the
    29  provisions and purposes of this article, and may advise the commissioner
    30  thereon;  and  it may, from time to time, submit to the commissioner any
    31  recommendations to effectuate the provisions and purposes of this  arti-
    32  cle.  The  commissioner  may  propose regulations under this article and
    33  amendments thereto for consideration by the board. The board of trustees
    34  shall have no executive, administrative or appointive duties  except  as
    35  otherwise  provided  by  law.  The board of trustees shall have power to
    36  establish, and from time to time, amend regulations  to  effectuate  the
    37  provisions  and  purposes  of  this  article, subject to approval by the
    38  commissioner.
    39    2. The board shall be composed of:
    40    (a) the commissioner, the superintendent of  financial  services,  and
    41  the director of the budget, or their designees, as ex officio members;
    42    (b) twenty-six trustees appointed by the governor;
    43    (i) six of whom shall be representatives of health care consumer advo-
    44  cacy  organizations which have a statewide or regional constituency, who
    45  have been involved in activities related to health care consumer advoca-
    46  cy, including issues of interest to low-  and  moderate-income  individ-
    47  uals;
    48    (ii)  two  of  whom shall be representatives of professional organiza-
    49  tions representing physicians;
    50    (iii) two of whom shall be representatives of  professional  organiza-
    51  tions  representing  licensed  or  registered  health care professionals
    52  other than physicians;
    53    (iv) three of whom shall be representatives of general hospitals,  one
    54  of whom shall be a representative of public general hospitals;
    55    (v) one of whom shall be a representative of community health centers;
    56    (vi) two of whom shall be representatives of long term care providers;

        S. 4840                             6
     1    (vii)  two  of  whom  shall be representatives of behavioral or mental
     2  health care providers;
     3    (viii)  two  of whom shall be representatives of health care organiza-
     4  tions;
     5    (ix) two of whom shall be representatives of organized labor;
     6    (x) two of whom shall  have  demonstrated  expertise  in  health  care
     7  finance; and
     8    (xi)  two  of  whom shall be employers or representatives of employers
     9  who pay the payroll tax under this article, or, prior to the tax  becom-
    10  ing effective, will pay the tax;
    11    (c)  fourteen  trustees  appointed by the governor; five of whom to be
    12  appointed on the recommendation of the speaker of the assembly; five  of
    13  whom to be appointed on the recommendation of the temporary president of
    14  the  senate;  two  of  whom to be appointed on the recommendation of the
    15  minority leader of the assembly; and two of whom to be appointed on  the
    16  recommendation of the minority leader of the senate.
    17    3.  After  the  end of the implementation period, no person shall be a
    18  trustee unless he or she is a member of the program, except the ex offi-
    19  cio trustees. Each trustee shall serve at the pleasure of the appointing
    20  officer, except the ex officio trustees.
    21    4. The chair of the board shall be appointed, and may  be  removed  as
    22  chair,  by the governor from among the trustees. The board shall meet at
    23  least four times each calendar year. Meetings shall  be  held  upon  the
    24  call  of  the  chair  and  as  provided  by the board. A majority of the
    25  appointed trustees shall be a quorum of the board, and  the  affirmative
    26  vote  of a majority of the trustees voting, but not less than ten, shall
    27  be necessary for any action to be taken by  the  board.  The  board  may
    28  establish an executive committee to exercise any powers or duties of the
    29  board as it may provide, and other committees to assist the board or the
    30  executive  committee.  The  chair of the board shall chair the executive
    31  committee and shall appoint the chair and members of all  other  commit-
    32  tees. The board of trustees may appoint one or more advisory committees.
    33  Members of advisory committees need not be members of the board of trus-
    34  tees.
    35    5.  Trustees  shall serve without compensation but shall be reimbursed
    36  for their necessary and actual expenses incurred while  engaged  in  the
    37  business of the board.
    38    6. Notwithstanding any provision of law to the contrary, no officer or
    39  employee of the state or any local government shall forfeit or be deemed
    40  to  have  forfeited his or her office or employment by reason of being a
    41  trustee.
    42    7. The board and its committees and advisory  committees  may  request
    43  and  receive  the  assistance  of  the department and any other state or
    44  local governmental entity in exercising its powers and duties.
    45    8. No later than two years after the effective date of this article:
    46    (a) The board shall develop a proposal, consistent with the principles
    47  of this article, for provision by the program of long-term  care  cover-
    48  age,  including the development of a proposal, consistent with the prin-
    49  ciples of this article, for its funding.   In developing  the  proposal,
    50  the  board  shall  consult  with an advisory committee, appointed by the
    51  chair of the board, including representatives of consumers and potential
    52  consumers of long-term care, providers of  long-term  care,  labor,  and
    53  other  interested  parties.  The board shall present its proposal to the
    54  governor and the legislature.
    55    (b) The board shall develop proposals for: (i)  incorporating  retiree
    56  health  benefits into New York Health; (ii) accommodating employer reti-

        S. 4840                             7
     1  ree health benefits for people who have been members of New York  Health
     2  but  live as retirees out of the state; and (iii) accommodating employer
     3  retiree health benefits for people who earned or accrued  such  benefits
     4  while  residing  in  the  state  prior to the implementation of New York
     5  Health and live as retirees out of the state.
     6    (c) The board shall develop a proposal for New York Health coverage of
     7  health care  services  covered  under  the  workers'  compensation  law,
     8  including  whether  and how to continue funding for those services under
     9  that law and whether and how to incorporate  an  element  of  experience
    10  rating.
    11    §  5103.  Eligibility  and  enrollment. 1. Every resident of the state
    12  shall be eligible and entitled to enroll as a member under the program.
    13    2. No member shall be required to pay any premium or other charge  for
    14  enrolling in or being a member under the program.
    15    3.  A  newborn  child  shall be enrolled as of the date of the child's
    16  birth if enrollment is done prior to the child's birth or  within  sixty
    17  days after the child's birth.
    18    4.  The  program  shall  provide  for payment for health care services
    19  provided to members or individuals entitled to become members  who  have
    20  not  had  a  reasonable  opportunity to enroll in the program, including
    21  newly arrived residents.
    22    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
    23  coverage  to  every member, which shall include all health care services
    24  required to be covered under any of the  following,  without  regard  to
    25  whether  the  member  would  otherwise be eligible for or covered by the
    26  program or source referred to:
    27    (a) child health plus;
    28    (b) Medicaid;
    29    (c) Medicare;
    30    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
    31  forty-three of the insurance law;
    32    (e)  article  eleven of the civil service law, as of the date one year
    33  before the beginning of the implementation period;
    34    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
    35  section  fifty-one  hundred two of the insurance law, provided that this
    36  coverage shall not replace  coverage  under  article  fifty-one  of  the
    37  insurance law; and
    38    (g)  any  additional health care service authorized to be added to the
    39  program's benefits by the program;
    40    (h) provided that none of the above  shall  include  long  term  care,
    41  until  a  proposal  under  paragraph (a) of subdivision eight of section
    42  fifty-one hundred two of this article is enacted into law.
    43    2. No member shall be required to pay any premium, deductible, co-pay-
    44  ment or co-insurance under the program.
    45    3. The program shall provide for payment under the program  for  emer-
    46  gency and temporary health care services provided to members or individ-
    47  uals  entitled  to become members who have not had a reasonable opportu-
    48  nity to become a member or to enroll with a care coordinator.
    49    § 5105. Health care providers; care  coordination;  payment  methodol-
    50  ogies.   1. Choice of health care provider. (a) Any health care provider
    51  qualified to participate under this  section  may  provide  health  care
    52  services  under  the  program, provided that the health care provider is
    53  otherwise legally authorized to perform the health care service for  the
    54  individual and under the circumstances involved.
    55    (b)  A  member  may  choose  to receive health care services under the
    56  program from any participating provider, consistent with  provisions  of

        S. 4840                             8
     1  this  article  relating  to  care coordination and health care organiza-
     2  tions, the willingness or  availability  of  the  provider  (subject  to
     3  provisions  of  this article relating to discrimination), and the appro-
     4  priate clinically-relevant circumstances.
     5    2. Care coordination.
     6    (a)  Care coordination shall include, but not be limited to, managing,
     7  referring  to,  locating,  coordinating,  and  monitoring  health   care
     8  services  for  the  member to assure that all medically necessary health
     9  care services are made available to and  are  effectively  used  by  the
    10  member  in a timely manner, consistent with patient autonomy. Care coor-
    11  dination is not a requirement for prior authorization  for  health  care
    12  services  and  referral  shall not be required for a member to receive a
    13  health care service.
    14    (b) A care coordinator may be an individual or entity that is approved
    15  by the program that is:
    16    (i) a health care practitioner who is: (A) the member's  primary  care
    17  practitioner; (B) at the option of a female member, the member's provid-
    18  er  of  primary gynecological care; or (C) at the option of a member who
    19  has a chronic condition  that  requires  specialty  care,  a  specialist
    20  health  care  practitioner who regularly and continually provides treat-
    21  ment for that condition to the member;
    22    (ii) an entity licensed under article twenty-eight of this chapter  or
    23  certified  under article thirty-six of this chapter, a managed long term
    24  care plan under section forty-four hundred three-f of  this  chapter  or
    25  other  program  model  under  paragraph (b) of subdivision seven of such
    26  section, or, with respect to a member who receives chronic mental health
    27  care services, an entity licensed under article thirty-one of the mental
    28  hygiene law or other entity approved by the commissioner in consultation
    29  with the commissioner of mental health;
    30    (iii) a health care organization;
    31    (iv) a Taft-Hartley fund, with respect to its members and their family
    32  members; provided that this provision shall not preclude a  Taft-Hartley
    33  fund  from  becoming  a  care coordinator under subparagraph (v) of this
    34  paragraph or a health care organization under section fifty-one  hundred
    35  six of this article; or
    36    (v) any not-for-profit or governmental entity approved by the program.
    37    (c)  Health care services provided to a member shall not be subject to
    38  payment under the program unless the member  is  enrolled  with  a  care
    39  coordinator  at  the  time  the  health care service is provided, except
    40  where provided under subdivision three of section fifty-one hundred four
    41  of this article. Every member shall enroll with a care coordinator  that
    42  agrees  to  provide  care  coordination to the member prior to receiving
    43  health care services to be paid for under the program. The member  shall
    44  remain  enrolled  with  that  care  coordinator until the member becomes
    45  enrolled with a different care coordinator or ceases  to  be  a  member.
    46  Members  have  the  right  to  change their care coordinator on terms at
    47  least as permissive as the provisions of section  three  hundred  sixty-
    48  four-j of the social services law relating to an individual changing his
    49  or her primary care provider or managed care provider.
    50    (d)  Care coordination shall be provided to the member by the member's
    51  care coordinator.  A care coordinator may employ or utilize the services
    52  of other individuals or entities to assist  in  providing  care  coordi-
    53  nation for the member, consistent with regulations of the commissioner.
    54    (e)  A  health  care organization may establish rules relating to care
    55  coordination for members in the health care organization, different from
    56  this subdivision but otherwise consistent with this  article  and  other

        S. 4840                             9
     1  applicable  laws.  Nothing in this subdivision shall authorize any indi-
     2  vidual to engage in any act in violation of title eight of the education
     3  law.
     4    (f) The commissioner shall develop and implement procedures and stand-
     5  ards for an individual or entity to be approved to be a care coordinator
     6  in  the  program,  including but not limited to procedures and standards
     7  relating to the revocation,  suspension,  limitation,  or  annulment  of
     8  approval on a determination that the individual or entity is incompetent
     9  to  be  a care coordinator or has exhibited a course of conduct which is
    10  either inconsistent with program  standards  and  regulations  or  which
    11  exhibits  an unwillingness to meet such standards and regulations, or is
    12  a potential threat to the public health or safety. Such  procedures  and
    13  standards  shall  not  limit  approval  to  be a care coordinator in the
    14  program for economic purposes and shall be consistent with good  profes-
    15  sional practice. In developing the procedures and standards, the commis-
    16  sioner  shall:  (i)  consider  existing  standards developed by national
    17  accrediting  and  professional  organizations;  and  (ii)  consult  with
    18  national and local organizations working on care coordination or similar
    19  models,  including  health  care  practitioners, hospitals, clinics, and
    20  consumers and their representatives. When  developing  and  implementing
    21  standards  of  approval  of  care coordinators for individuals receiving
    22  chronic mental health care services, the commissioner shall consult with
    23  the commissioner of mental health. An individual or entity may not be  a
    24  care  coordinator  unless the services included in care coordination are
    25  within the individual's professional scope of practice or  the  entity's
    26  legal authority.
    27    (g)  To  maintain approval under the program, a care coordinator must:
    28  (i) renew its status at a frequency determined by the commissioner;  and
    29  (ii)  provide  data to the department as required by the commissioner to
    30  enable the commissioner to evaluate the impact of care  coordinators  on
    31  quality, outcomes and cost.
    32    3.  Health  care  providers.  (a) The commissioner shall establish and
    33  maintain procedures and standards for health care providers to be quali-
    34  fied to participate in the program, including but not limited to  proce-
    35  dures  and standards relating to the revocation, suspension, limitation,
    36  or annulment of qualification to participate on a determination that the
    37  health care provider is an incompetent provider of specific health  care
    38  services or has exhibited a course of conduct which is either inconsist-
    39  ent  with program standards and regulations or which exhibits an unwill-
    40  ingness to meet such standards and regulations, or is a potential threat
    41  to the public health or safety. Such procedures and standards shall  not
    42  limit  health  care  provider  participation in the program for economic
    43  purposes and shall be consistent with good  professional  practice.  Any
    44  health  care  provider  who  is qualified to participate under Medicaid,
    45  child health plus or Medicare shall be deemed to be qualified to partic-
    46  ipate in the program, and any health care provider's revocation, suspen-
    47  sion, limitation, or annulment of qualification to participate in any of
    48  those programs shall apply to the health care  provider's  qualification
    49  to  participate  in  the  program;  provided that a health care provider
    50  qualified under this sentence shall  follow  the  procedures  to  become
    51  qualified under the program by the end of the implementation period.
    52    (b) The commissioner shall establish and maintain procedures and stan-
    53  dards for recognizing health care providers located out of the state for
    54  purposes of providing coverage under the program for out-of-state health
    55  care services.

        S. 4840                            10
     1    4.  Payment  for health care services. (a) The commissioner may estab-
     2  lish by regulation payment methodologies for health  care  services  and
     3  care coordination provided to members under the program by participating
     4  providers,  care coordinators, and health care organizations.  There may
     5  be  a variety of different payment methodologies, including those estab-
     6  lished on a demonstration basis. All payment  rates  under  the  program
     7  shall  be  reasonable  and reasonably related to the cost of efficiently
     8  providing the health care service and assuring an adequate and  accessi-
     9  ble  supply  of  health care service.   Until and unless another payment
    10  methodology is established, health care  services  provided  to  members
    11  under  the  program shall be paid for on a fee-for-service basis, except
    12  for care coordination.
    13    (b) The program shall engage in good faith  negotiations  with  health
    14  care providers' representatives under title III of article forty-nine of
    15  this  chapter,  including,  but  not limited to, in relation to rates of
    16  payment and payment methodologies.
    17    (c) Notwithstanding any provision of law to the contrary, payment  for
    18  drugs provided by pharmacies under the program shall be made pursuant to
    19  title  one  of article two-A of this chapter. However, the program shall
    20  provide for payment for prescription drugs under  section  340B  of  the
    21  federal  public  service  act where applicable. Payment for prescription
    22  drugs provided by health care providers other than pharmacies  shall  be
    23  pursuant to other provisions of this article.
    24    (d)  Payment  for  health care services established under this article
    25  shall be considered payment in full. A participating provider shall  not
    26  charge  any rate in excess of the payment established under this article
    27  for any health care service under the program provided to a  member  and
    28  shall  not  solicit or accept payment from any member or third party for
    29  any such service except as provided under section fifty-one hundred nine
    30  of this article.  However, this paragraph shall not preclude the program
    31  from acting as a primary or secondary payer in conjunction with  another
    32  third-party  payer  where permitted under section fifty-one hundred nine
    33  of this article.
    34    (e) The program may provide in payment methodologies for  payment  for
    35  capital  related  expenses  for specifically identified capital expendi-
    36  tures incurred by  not-for-profit  or  governmental  entities  certified
    37  under  article twenty-eight of this chapter. Any capital related expense
    38  generated by a capital expenditure that requires  or  required  approval
    39  under  article  twenty-eight  of  this  chapter  must have received that
    40  approval for the capital related  expense  to  be  paid  for  under  the
    41  program.
    42    (f) Payment methodologies and rates shall include a distinct component
    43  of  reimbursement  for direct and indirect graduate medical education as
    44  defined, calculated and implemented  pursuant  to  section  twenty-eight
    45  hundred seven-c of this chapter.
    46    (g)  The commissioner shall provide by  regulation for payment method-
    47  ologies and procedures for paying for out-of-state health care services.
    48    § 5106. Health care organizations. 1. A member may  choose  to  enroll
    49  with  and  receive  health care services under the program from a health
    50  care organization.
    51    2. A health care organization shall be  a  not-for-profit  or  govern-
    52  mental entity that is approved by the commissioner that is:
    53    (a)  an  accountable  care organization under article twenty-nine-E of
    54  this chapter; or
    55    (b) a Taft-Hartley fund (i) with respect  to  its  members  and  their
    56  family  members,  and  (ii) if allowed by applicable law and approved by

        S. 4840                            11
     1  the commissioner, for other members of the program;  provided  that  the
     2  commissioner  shall provide by regulation that where a Taft-Hartley fund
     3  is acting under this subparagraph there are protections for health  care
     4  providers  and  patients  comparable  to those applicable to accountable
     5  care organizations.
     6    3. A health care organization may be responsible for all  or  part  of
     7  the  health  care  services  to which its members are entitled under the
     8  program, consistent with the terms of its approval by the commissioner.
     9    4. (a) The commissioner shall develop  and  implement  procedures  and
    10  standards  for an entity to be approved to be a health care organization
    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  entity  is  incompetent  to  be  a
    14  health  care  organization or has exhibited a course of conduct which is
    15  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 health care organization in
    19  the program for economic purposes and  shall  be  consistent  with  good
    20  professional  practice.  In developing the procedures and standards, the
    21  commissioner  shall:  (i)  consider  existing  standards  developed   by
    22  national  accrediting  and  professional organizations; and (ii) consult
    23  with national and local organizations working in  the  field  of  health
    24  care  organizations,  including  health  care  practitioners, hospitals,
    25  clinics, and consumers and their representatives.  When  developing  and
    26  implementing  standards  of  approval  of health care organizations, the
    27  commissioner shall consult with the commissioner of  mental  health  and
    28  the commissioner of developmental disabilities.
    29    (b) To maintain approval under the program, a health care organization
    30  must:  (i) renew its status at a frequency determined by the commission-
    31  er; and (ii) provide data to the department as required by  the  commis-
    32  sioner  to enable the commissioner to evaluate the health care organiza-
    33  tion in relation  to  quality  of  health  care  services,  health  care
    34  outcomes, and cost.
    35    5.  The  commissioner  shall  make regulations relating to health care
    36  organizations consistent with and to ensure compliance with  this  arti-
    37  cle.
    38    6.  The  provision of health care services directly or indirectly by a
    39  health care organization through health  care  providers  shall  not  be
    40  considered  the practice of a profession under title eight of the educa-
    41  tion law by the health care organization.
    42    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    43  requirements and standards for the program and for health care organiza-
    44  tions,  care  coordinators,  and  health care providers, consistent with
    45  this article, including requirements and standards for, as applicable:
    46    (a) the scope, quality and accessibility of health care services;
    47    (b) relations between health care organizations or health care provid-
    48  ers and members; and
    49    (c) relations  between  health  care  organizations  and  health  care
    50  providers,  including  (i) credentialing and participation in the health
    51  care organization; and (ii) terms, methods and rates of payment.
    52    2. Requirements and standards under the program shall include, but not
    53  be limited to, provisions to promote the following:
    54    (a) simplification, transparency, uniformity, and fairness  in  health
    55  care  provider  credentialing and participation in health care organiza-

        S. 4840                            12
     1  tion networks, referrals, payment procedures and rates, claims  process-
     2  ing, and approval of health care services, as applicable;
     3    (b)  primary  and  preventive  care,  care coordination, efficient and
     4  effective health care  services,  quality  assurance,  coordination  and
     5  integration  of health care services, including use of appropriate tech-
     6  nology, and promotion of public, environmental and occupational health;
     7    (c) elimination of health care disparities;
     8    (d) non-discrimination with respect to members and health care provid-
     9  ers on the basis of race, ethnicity, national origin, religion, disabil-
    10  ity, age, sex, sexual orientation, gender  identity  or  expression,  or
    11  economic  circumstances;  provided  that  health  care services provided
    12  under the program shall be appropriate to the patient's clinically-rele-
    13  vant circumstances; and
    14    (e) accessibility  of  care  coordination,  health  care  organization
    15  services  and  health  care services, including accessibility for people
    16  with disabilities and people with limited ability to speak or understand
    17  English, and the providing of care coordination, health  care  organiza-
    18  tion services and health care services in a culturally competent manner.
    19    3. Any participating provider or care coordinator that is organized as
    20  a  for-profit entity shall be required to meet the same requirements and
    21  standards as entities organized as not-for-profit entities, and payments
    22  under the program paid to such  entities  shall  not  be  calculated  to
    23  accommodate  the  generation of profit or revenue for dividends or other
    24  return on investment or the payment of taxes that would not be paid by a
    25  not-for-profit entity.
    26    4. Every participating provider shall  furnish  to  the  program  such
    27  information  to,  and permit examination of its records by, the program,
    28  as may be reasonably required for purposes  of  reviewing  accessibility
    29  and  utilization  of  health  care services, quality assurance, and cost
    30  containment, the making of payments, and statistical or other studies of
    31  the operation of the program or for protection and promotion of  public,
    32  environmental and occupational health.
    33    5.  In  developing  requirements and standards and making other policy
    34  determinations under this article, the commissioner shall  consult  with
    35  representatives  of  members,  health care providers, care coordinators,
    36  health care organizations and other interested parties.
    37    6.  The program shall maintain the confidentiality  of  all  data  and
    38  other  information  collected  under the program when such data would be
    39  normally considered confidential data between a patient and health  care
    40  provider.  Aggregate data of the program which is derived from confiden-
    41  tial  data  but does not violate patient confidentiality shall be public
    42  information.
    43    § 5108. Regulations. The  commissioner  may  approve  regulations  and
    44  amendments  thereto,  under subdivision one of section fifty-one hundred
    45  two of this article. The commissioner may make regulations or amendments
    46  thereto to effectuate the provisions and purposes of this article on  an
    47  emergency  basis  under section two hundred two of the state administra-
    48  tive procedure act, provided that such regulations or  amendments  shall
    49  not  become  permanent  unless  adopted under subdivision one of section
    50  fifty-one hundred two of this article.
    51    § 5109. Provisions relating to federal health programs. 1. The commis-
    52  sioner shall seek all federal waivers and other  federal  approvals  and
    53  arrangements  and  submit state plan amendments necessary to operate the
    54  program consistent with this article.
    55    2. (a) The commissioner shall apply to the  secretary  of  health  and
    56  human  services or other appropriate federal official for all waivers of

        S. 4840                            13
     1  requirements, and make other arrangements, under Medicare, any  federal-
     2  ly-matched public health program, the affordable care act, and any other
     3  federal  programs that provide federal funds for payment for health care
     4  services,  that  are  necessary to enable all New York Health members to
     5  receive all benefits under the program through the program to enable the
     6  state to implement this article and to receive and deposit  all  federal
     7  payments  under  those programs (including funds that may be provided in
     8  lieu of premium tax credits, cost-sharing subsidies, and small  business
     9  tax  credits) in the state treasury to the credit of the New York Health
    10  trust fund created under section eighty-nine-i of the state finance  law
    11  and  to  use  those  funds  for  the  New  York Health program and other
    12  provisions under this article. To the extent possible, the  commissioner
    13  shall  negotiate  arrangements with the federal government in which bulk
    14  or lump-sum federal payments are paid to New York  Health  in  place  of
    15  federal  spending  or tax benefits for federally-matched health programs
    16  or federal health programs.
    17    (b) The commissioner may require members or applicants to  be  members
    18  to  provide  information  necessary  for  the program to comply with any
    19  waiver or arrangement under this subdivision.
    20    3. (a) If actions taken under subdivision two of this section  do  not
    21  accomplish all results intended under that subdivision, then this subdi-
    22  vision shall apply and shall authorize additional actions to effectively
    23  implement  New  York  Health to the maximum extent possible as a single-
    24  payer program consistent with this article.
    25    (b) The commissioner may take actions consistent with this article  to
    26  enable  New  York Health to administer Medicare in New York state and to
    27  be a provider of drug  coverage  under  Medicare  part  D  for  eligible
    28  members of New York Health.
    29    (c)  The  commissioner  may  waive  or  modify  the  applicability  of
    30  provisions of this section  relating  to  any  federally-matched  public
    31  health  program  or  Medicare  as  necessary  to implement any waiver or
    32  arrangement under this section or to maximize the  benefit  to  the  New
    33  York  Health program under this section, provided that the commissioner,
    34  in consultation with the director of the budget,  shall  determine  that
    35  such  waiver  or  modification  is  in the best interests of the members
    36  affected by the action and the state.
    37    (d) The commissioner may  apply  for  coverage  under  any  federally-
    38  matched  public  health  program  on behalf of any member and enroll the
    39  member in the federally-matched public health program or Medicare if the
    40  member is eligible for it.   Enrollment in  a  federally-matched  public
    41  health program or Medicare shall not cause any member to lose any health
    42  care  service  provided  by the program or diminish any right the member
    43  would otherwise have.
    44    (e) The commissioner shall by regulation increase the income eligibil-
    45  ity level, increase or eliminate  the  resource  test  for  eligibility,
    46  simplify any procedural or documentation requirement for enrollment, and
    47  increase  the  benefits for any federally-matched public health program,
    48  and for any program to reduce or eliminate an individual's  coinsurance,
    49  cost-sharing  or  premium obligations or increase an individual's eligi-
    50  bility for any federal financial support  related  to  Medicare  or  the
    51  affordable care act notwithstanding any law or regulation to the contra-
    52  ry.  The  commissioner  may  act  under  this  paragraph upon a finding,
    53  approved by the director of the budget, that the action (i) will help to
    54  increase the number of members who are  eligible  for  and  enrolled  in
    55  federally-matched  public  health programs, or for any program to reduce
    56  or eliminate an individual's coinsurance, cost-sharing or premium  obli-

        S. 4840                            14
     1  gations  or  increase an individual's eligibility for any federal finan-
     2  cial support related to Medicare or the affordable care act;  (ii)  will
     3  not diminish any individual's access to any health care service or right
     4  the  individual  would  otherwise  have; (iii) is in the interest of the
     5  program; and (iv) does not require or has received any necessary federal
     6  waivers or approvals to ensure federal financial participation.  Actions
     7  under this paragraph shall not apply to eligibility for payment for long
     8  term care.
     9    (f)  To enable the commissioner to apply for coverage under any feder-
    10  ally-matched public health program or Medicare on behalf of  any  member
    11  and  enroll the member in the federally-matched public health program or
    12  Medicare if the member is eligible for it, the commissioner may  require
    13  that  every member or applicant to be a member shall provide information
    14  to enable the commissioner to determine whether the applicant is  eligi-
    15  ble  for a federally-matched public health program and for Medicare (and
    16  any program or benefit under Medicare). The program shall make a reason-
    17  able effort to notify members of their obligations under this paragraph.
    18  After a reasonable effort has been  made  to  contact  the  member,  the
    19  member  shall  be  notified  in writing that he or she has sixty days to
    20  provide such required information. If such information is  not  provided
    21  within the sixty day period, the member's coverage under the program may
    22  be terminated.
    23    (g)  As  a condition of continued eligibility for health care services
    24  under the program, a member who is eligible for benefits under  Medicare
    25  shall enroll in Medicare, including parts A, B and D.
    26    (h)  The  program  shall  provide  premium  assistance for all members
    27  enrolling in a Medicare part D drug  coverage  under  section  1860D  of
    28  Title XVIII of the federal social security act limited to the low-income
    29  benchmark premium amount established by the federal centers for Medicare
    30  and Medicaid services and any other amount which such agency establishes
    31  under  its  de minimis premium policy, except that such payments made on
    32  behalf of members enrolled in a Medicare advantage plan may  exceed  the
    33  low-income  benchmark  premium amount if determined to be cost effective
    34  to the program.
    35    (i) If the commissioner has  reasonable  grounds  to  believe  that  a
    36  member  could  be  eligible  for an income-related subsidy under section
    37  1860D-14 of Title XVIII of the federal social security act,  the  member
    38  shall  provide,  and authorize the program to obtain, any information or
    39  documentation required to establish the member's  eligibility  for  such
    40  subsidy,  provided that the commissioner shall attempt to obtain as much
    41  of the information and documentation as possible from records  that  are
    42  available to him or her.
    43    (j)  The  program  shall make a reasonable effort to notify members of
    44  their obligations under this subdivision. After a reasonable effort  has
    45  been made to contact the member, the member shall be notified in writing
    46  that  he  or she has sixty days to provide such required information. If
    47  such information is not  provided  within  the  sixty  day  period,  the
    48  member's coverage under the program may be terminated.
    49    §  5110.  Additional  provisions.   1. The commissioner shall contract
    50  with not-for-profit organizations to provide:
    51    (a) consumer assistance to individuals with respect to selection of  a
    52  care  coordinator  or  health  care  organization,  enrolling, obtaining
    53  health care services, disenrolling, and other matters  relating  to  the
    54  program;
    55    (b) health care provider assistance to health care providers providing
    56  and  seeking  or  considering  whether  to provide, health care services

        S. 4840                            15
     1  under the program, with respect to participating in a health care organ-
     2  ization and dealing with a health care organization; and
     3    (c)  care coordinator assistance to individuals and entities providing
     4  and seeking or considering whether  to  provide,  care  coordination  to
     5  members.
     6    2.  The  commissioner  shall provide grants from funds in the New York
     7  Health trust fund or otherwise appropriated for this purpose, to  health
     8  systems  agencies under section twenty-nine hundred four-b of this chap-
     9  ter to support the operation of such health systems agencies.
    10    3. The commissioner shall provide funds from the New York Health trust
    11  fund or otherwise appropriated for this purpose to the  commissioner  of
    12  labor  for  a  program  for  retraining and assisting job transition for
    13  individuals employed or previously  employed  in  the  field  of  health
    14  insurance  and  other  third-party  payment for health care or providing
    15  services to health care providers to deal with  third-party  payers  for
    16  health  care,  whose  jobs  may be or have been ended as a result of the
    17  implementation of the New York Health program, consistent with otherwise
    18  applicable law.
    19    4. The commissioner shall, directly and through grants to not-for-pro-
    20  fit entities, conduct programs using data collected through the New York
    21  Health program, to promote and protect public, environmental and occupa-
    22  tional health, including cooperation  with  other  data  collection  and
    23  research  programs  of  the department, consistent with this article and
    24  otherwise applicable law.
    25    § 5111. Regional advisory councils.  1. The New York  Health  regional
    26  advisory councils (each referred to in this article as a "regional advi-
    27  sory council") are hereby created in the department.
    28    2.  There  shall be a regional advisory council established in each of
    29  the following regions:
    30    (a) Long Island, consisting of Nassau and Suffolk counties;
    31    (b) New York City;
    32    (c) Hudson Valley, consisting of Delaware, Dutchess,  Orange,  Putnam,
    33  Rockland, Sullivan, Ulster, Westchester counties;
    34    (d)  Northern,  consisting of Albany, Clinton, Columbia, Essex, Frank-
    35  lin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga,
    36  Schenectady, Schoharie, Warren, Washington counties;
    37    (e) Central, consisting of Broome, Cayuga,  Chemung,  Chenango,  Cort-
    38  land,  Herkimer,  Jefferson, Lewis, Livingston, Madison, Monroe, Oneida,
    39  Onondaga, Ontario, Oswego,  Schuyler,  Seneca,  St.  Lawrence,  Steuben,
    40  Tioga, Tompkins, Wayne, Yates counties; and
    41    (f)  Western,  consisting  of Allegany, Cattaraugus, Chautauqua, Erie,
    42  Genesee, Niagara, Orleans, Wyoming counties.
    43    3. Each regional advisory council shall be composed of not fewer  than
    44  twenty-seven  members,  as determined by the commissioner and the board,
    45  as necessary to appropriately represent the diverse needs  and  concerns
    46  of the region. Members of a regional advisory council shall be residents
    47  of or have their principal place of business in the region served by the
    48  regional advisory council.
    49    4. Appointment of members of the regional advisory councils.
    50    (a) The twenty-seven members shall be appointed as follows:
    51    (i) nine members shall be appointed by the governor;
    52    (ii) six members shall be appointed by the governor on the recommenda-
    53  tion of the speaker of the assembly;
    54    (iii)  six members shall be appointed by the governor on the recommen-
    55  dation of the temporary president of the senate;

        S. 4840                            16
     1    (iv) three members shall be appointed by the governor on the recommen-
     2  dation of the minority leader of the assembly; and
     3    (v)  three members shall be appointed by the governor on the recommen-
     4  dation of the minority leader of the senate.  Where a regional  advisory
     5  council has more than twenty-seven members, the additional members shall
     6  be  appointed  and recommended by these officials in the same proportion
     7  as the twenty-seven members.
     8    Where a regional advisory council has more than twenty-seven  members,
     9  additional members shall be appointed and recommended by these officials
    10  in the same proportion as the twenty-seven members.
    11    (b)  Regional  advisory  council  membership  shall include but not be
    12  limited to:
    13    (i) representatives of health  care  consumer  advocacy  organizations
    14  with  a regional constituency, who shall represent at least one third of
    15  the membership of each regional council;
    16    (ii) representatives of professional organizations representing physi-
    17  cians;
    18    (iii)  representatives  of  professional  organizations   representing
    19  health care professionals other than physicians;
    20    (iv) representatives of general hospitals, including public hospitals;
    21    (v) representatives of community health centers;
    22    (vi) representatives of health care organizations;
    23    (vii) representatives of organized labor; and
    24    (viii) representatives of municipal and county government.
    25    5. Members of a regional advisory council shall be appointed for terms
    26  of  three  years provided, however, that of the members first appointed,
    27  one-third shall be appointed for one year terms and one-third  shall  be
    28  appointed  for  two  year  terms.  Vacancies shall be filled in the same
    29  manner as original appointments for the remainder of any unexpired term.
    30  No person shall be an appointed member of a  regional  advisory  council
    31  for more than six years in any period of twelve consecutive years.
    32    6.  Members  of  the  regional  advisory  councils shall serve without
    33  compensation but shall be reimbursed  for  their  necessary  and  actual
    34  expenses  incurred  while  engaged in the business of the advisory coun-
    35  cils. The program shall provide financial support for such expenses  and
    36  other expenses of the regional advisory councils.
    37    7.  Each regional advisory council shall meet at least quarterly. Each
    38  regional advisory council may form committees to assist it in its  work.
    39  Members  of  a  committee  need  not be members of the regional advisory
    40  council.   The New York City regional  advisory  council  shall  form  a
    41  committee  for  each  borough  of  New York City, to assist the regional
    42  advisory council in its work as it relates particularly to that borough.
    43    8. Each regional advisory council shall  advise  the  commissioner,the
    44  board,  the  governor and the legislature on all matters relating to the
    45  development and implementation of the New York Health program.
    46    9. Each regional advisory council shall adopt, and from time  to  time
    47  revise,  a  community  health  improvement  plan  for its region for the
    48  purpose of:
    49    (a) promoting the delivery of health  care  services  in  the  region,
    50  improving  the  quality  and  accessibility  of care, including cultural
    51  competency, clinical  integration  of  care  between  service  providers
    52  including  but  not  limited to physical, mental, and behavioral health,
    53  physical and developmental disability services, and long-term care;
    54    (b) facility and health services planning in the region;
    55    (c) identifying gaps in regional health care services; and

        S. 4840                            17
     1    (d) promoting increased public knowledge and responsibility  regarding
     2  the  availability  and  appropriate utilization of health care services.
     3  Each community health improvement plan shall be submitted to the commis-
     4  sioner and the board and shall be posted on the department's website.
     5    10.  Each  regional  advisory  council shall hold at least four public
     6  hearings annually on matters relating to the New York Health program and
     7  the development and implementation of the community  health  improvement
     8  plan.
     9    11.  Each  regional advisory council shall publish an annual report to
    10  the commissioner and the board on the progress of the  community  health
    11  improvement  plan.  These  reports  shall  be posted on the department's
    12  website.
    13    12. All meetings of the  regional  advisory  councils  and  committees
    14  shall be subject to article six of the public officers law.
    15    § 4. Financing of New York Health. 1. The governor shall submit to the
    16  legislature  a  revenue plan and legislative bills to implement the plan
    17  (referred to collectively in this section as the "revenue proposal")  to
    18  provide the revenue necessary to finance the New York Health program, as
    19  created  by  article  51  of  the public health law (referred to in this
    20  section as the "program"), taking into consideration anticipated federal
    21  revenue available for the program. The revenue proposal shall be submit-
    22  ted to the legislature as part of the executive budget under article VII
    23  of the state constitution, for the fiscal year commencing on  the  first
    24  day  of April in the calendar year after this act shall become a law. In
    25  developing the revenue proposal, the governor shall consult with  appro-
    26  priate officials of the executive branch; the temporary president of the
    27  senate; the speaker of the assembly; the chairs of the fiscal and health
    28  committees  of the senate and assembly; and representatives of business,
    29  labor, consumers and local government.
    30    2. (a) Basic structure. The basic structure of  the  revenue  proposal
    31  shall  be as follows: Revenue for the program shall come from two premi-
    32  ums (referred to collectively in this section as the "premiums"). First,
    33  there shall be a progressively graduated  premium  on  all  payroll  and
    34  self-employed income (referred to in this section as the "payroll premi-
    35  um"),  paid  by  employers,  employees and self-employed, similar to the
    36  Medicare tax. Higher brackets of income subject to this premium shall be
    37  assessed at a higher marginal rate than lower brackets.   Second,  there
    38  shall  be  a  progressively graduated premium on taxable income (such as
    39  interest, dividends, and capital  gains)  not  subject  to  the  payroll
    40  premium  (referred to in this section as the "non-payroll premium"). The
    41  premiums will be set at levels anticipated to produce sufficient revenue
    42  to finance the program and other provisions of article 51 of the  public
    43  health  law,  to be scaled up as enrollment grows, taking into consider-
    44  ation anticipated federal revenue available for the  program.  Provision
    45  shall be made for state residents (who are eligible for the program) who
    46  are  employed  out-of-state, and non-residents (who are not eligible for
    47  the program) who are employed in the state.
    48    (b) Payroll premium. The income to be subject to the  payroll  premium
    49  shall  be  all  income subject to the Medicare tax. The premium shall be
    50  set at a percentage of that income, which shall be progressively  gradu-
    51  ated,  so  the  percentage  is  higher on higher brackets of income. For
    52  employed individuals, the employer  shall  pay  eighty  percent  of  the
    53  premium and the employee shall pay twenty percent of the premium, except
    54  that  an  employer may agree to pay all or part of the employee's share.
    55  A self-employed individual shall pay the full premium.

        S. 4840                            18
     1    (c) Non-payroll income premium. There shall be  a  premium  on  upper-
     2  bracket  taxable  personal  income  that  is  not subject to the payroll
     3  premium. It shall be set at a percentage of that income, which shall  be
     4  progressively  graduated, so the percentage is higher on higher brackets
     5  of income.
     6    (d) Phased-in rates. Early in the program, when enrollment is growing,
     7  the  amount  of the premiums shall be at an appropriate level, and shall
     8  be raised as anticipated enrollment grows, to cover the actual  cost  of
     9  the program and other provisions of article 51 of the public health law.
    10  The revenue proposal shall include a mechanism for determining the rates
    11  of the premiums.
    12    (e) Cross-border employees. (i) State residents employed out-of-state.
    13  If an individual is employed out-of-state by an employer that is subject
    14  to  New  York  state law, the employer and employee shall be required to
    15  pay the payroll premium as to that employee as if the employment were in
    16  the state. If an individual is employed out-of-state by an employer that
    17  is not subject to New York  state  law,  either  (A)  the  employer  and
    18  employee  shall  voluntarily comply with the premium or (B) the employee
    19  shall pay the premium as if he or she were self-employed.
    20    (ii) Out-of-state residents employed in the state.   (A)  The  payroll
    21  premium  shall  apply  to  any  out-of-state resident who is employed or
    22  self-employed in the state.  (B) In the case of an out-of-state resident
    23  who is employed or self-employed in the state, such individual and indi-
    24  vidual's employer shall be able to take a  credit  against  the  payroll
    25  premiums they would otherwise pay, as to the individual for amounts they
    26  spend  on  health  benefits  for  the individual that would otherwise be
    27  covered by the program if the individual were a member of  the  program.
    28  For  employers,  the credit shall be available regardless of the form of
    29  the health benefit (e.g., health insurance, a self-insured plan,  direct
    30  services,  or reimbursement for services), to make sure that the revenue
    31  proposal does not relate to employment  benefits  in  violation  of  the
    32  federal  ERISA.    For non-employment-based spending by individuals, the
    33  credit shall be available for and limited to spending for health  cover-
    34  age  (not  out-of-pocket health spending). The credit shall be available
    35  without regard to how little is spent or how  sparse  the  benefit.  The
    36  credit may only be taken against the payroll premiums. Any excess amount
    37  may  not  be applied to other tax liability. For employment-based health
    38  benefits, the credit shall  be  distributed  between  the  employer  and
    39  employee in the same proportion as the spending by each for the benefit.
    40  The employer and employee may each apply their respective portion of the
    41  credit  to  their respective portion of the premium. If any provision of
    42  this clause or any application of it shall be ruled to  violate  federal
    43  ERISA, the provision or the application of it shall be null and void and
    44  the  ruling  shall not affect any other provision or application of this
    45  section or the act that enacted it.
    46    3.  The  revenue  proposal  shall  include  a  plan  and   legislative
    47  provisions   for  ending  the  requirement  for  local  social  services
    48  districts to pay part of  the  cost  of  Medicaid  and  replacing  those
    49  payments with revenue from the premiums under the revenue proposal.
    50    4.  To  the extent that the revenue proposal differs from the terms of
    51  subdivision two of this section, the revenue proposal shall state how it
    52  differs from those terms and reasons for and the effects of the  differ-
    53  ences.
    54    5.  All  revenue  from the premiums shall be deposited in the New York
    55  Health trust fund account under section 89-i of the state finance law.

        S. 4840                            19
     1    § 5.  Article 49 of the public health law is amended by adding  a  new
     2  title 3 to read as follows:
     3                                  TITLE III
     4            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
     5                               NEW YORK HEALTH
     6  Section 4920. Definitions.
     7          4921. Collective negotiation authorized.
     8          4922. Collective negotiation requirements.
     9          4923. Requirements for health care providers' representative.
    10          4924. Certain collective action prohibited.
    11          4925. Fees.
    12          4926. Confidentiality.
    13          4927. Severability and construction.
    14    § 4920. Definitions. For purposes of this title:
    15    1. "New York Health" means the program under article fifty-one of this
    16  chapter.
    17    2.  "Person"  means  an  individual,  association, corporation, or any
    18  other legal entity.
    19    3. "Health care providers' representative" means a third party that is
    20  authorized by health care providers to negotiate on  their  behalf  with
    21  New  York  Health  over terms and conditions affecting those health care
    22  providers.
    23    4. "Strike" means a work stoppage in part or in whole, direct or indi-
    24  rect, by a body of workers to gain compliance with demands  made  on  an
    25  employer.
    26    5.  "Health  care provider" means a person who is licensed, certified,
    27  registered or authorized to practice a health care  profession  pursuant
    28  to title eight of the education law and who practices that profession as
    29  a  health care provider as an independent contractor or who is an owner,
    30  officer, shareholder, or proprietor of a health  care  provider;  or  an
    31  entity  that employs or utilizes health care providers to provide health
    32  care services, including but not limited to a  hospital  licensed  under
    33  article twenty-eight of this chapter or an accountable care organization
    34  under  article  twenty-nine-E  of  this  chapter. A health care provider
    35  under title eight of the education law who practices as an employee of a
    36  health care provider shall not be deemed  a  health  care  provider  for
    37  purposes of this title.
    38    §  4921.  Collective  negotiation authorized. 1. Health care providers
    39  may meet and communicate for the  purpose  of  collectively  negotiating
    40  with  New York Health on any matter relating to New York Health, includ-
    41  ing but not limited to rates of payment and payment methodologies.
    42    2. Nothing in this section shall be construed to allow or authorize an
    43  alteration of the terms of the internal and external  review  procedures
    44  set forth in law.
    45    3. Nothing in this section shall be construed to allow a strike of New
    46  York Health by health care providers.
    47    4.  Nothing  in  this section shall be construed to allow or authorize
    48  terms or conditions which would impede the ability of New York Health to
    49  obtain or retain accreditation by the  national  committee  for  quality
    50  assurance or a similar body or to comply with applicable state or feder-
    51  al law.
    52    § 4922. Collective negotiation requirements. 1. Collective negotiation
    53  rights granted by this title must conform to the following requirements:
    54    (a)  health  care  providers  may  communicate  with other health care
    55  providers regarding the terms and conditions to be negotiated  with  New
    56  York Health;

        S. 4840                            20
     1    (b)  health care providers may communicate with health care providers'
     2  representatives;
     3    (c)  a health care providers' representative is the only party author-
     4  ized to negotiate with New York Health on  behalf  of  the  health  care
     5  providers as a group;
     6    (d)  a  health  care provider can be bound by the terms and conditions
     7  negotiated by the health care providers' representatives; and
     8    (e) in communicating or negotiating with the  health  care  providers'
     9  representative, New York Health is entitled to offer and provide differ-
    10  ent terms and conditions to individual competing health care providers.
    11    2.  Nothing  in this title shall affect or limit the right of a health
    12  care provider or group of health care providers to collectively petition
    13  a government entity for a change in a law, rule, or regulation.
    14    3. Nothing in this title shall affect or limit  collective  action  or
    15  collective  bargaining  on the part of any health care provider with his
    16  or her employer or any other  lawful  collective  action  or  collective
    17  bargaining.
    18    § 4923. Requirements for health care providers' representative. Before
    19  engaging  in  collective  negotiations with New York Health on behalf of
    20  health care providers, a health  care  providers'  representative  shall
    21  file  with the commissioner, in the manner prescribed by the commission-
    22  er, information identifying  the  representative,  the  representative's
    23  plan of operation, and the representative's procedures to ensure compli-
    24  ance with this title.
    25    §  4924.  Certain  collective  action prohibited. 1. This title is not
    26  intended to authorize competing health care providers to act in  concert
    27  in  response to a health care providers' representative's discussions or
    28  negotiations with New York Health except as authorized by other law.
    29    2. No health care providers' representative shall negotiate any agree-
    30  ment that excludes, limits the participation  or  reimbursement  of,  or
    31  otherwise limits the scope of services to be provided by any health care
    32  provider  or group of health care providers with respect to the perform-
    33  ance of services that are within the health  care  provider's  scope  of
    34  practice, license, registration, or certificate.
    35    §  4925. Fees. Each person who acts as the representative of negotiat-
    36  ing parties under this title shall pay to the department a fee to act as
    37  a representative. The commissioner, by rule, shall set fees  in  amounts
    38  deemed  reasonable  and  necessary  to  cover  the costs incurred by the
    39  department in administering this title.
    40    § 4926. Confidentiality. All reports and other information required to
    41  be reported to the department under this title shall not be  subject  to
    42  disclosure under article six of the public officers law or article thir-
    43  ty-one of the civil practice law and rules.
    44    § 4927. Severability and construction. If any provision or application
    45  of  this  title  shall be held to be invalid, or to violate or be incon-
    46  sistent with any applicable federal law or regulation,  that  shall  not
    47  affect other provisions or applications of this title which can be given
    48  effect  without  that  provision  or  application;  and to that end, the
    49  provisions and applications of this title are severable. The  provisions
    50  of  this  title  shall  be  liberally  construed  to  give effect to the
    51  purposes thereof.
    52    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
    53  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
    54  amended to read as follows:
    55    11. "State public health plan" means the  medical  assistance  program
    56  established  by  title eleven of article five of the social services law

        S. 4840                            21
     1  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
     2  insurance  coverage program established by title three of article two of
     3  the elder law (referred to in this article as "EPIC"), and  the  [family
     4  health  plus  program established by section three hundred sixty-nine-ee
     5  of the social services law to the extent that section provides that  the
     6  program shall be subject to this article] New York Health program estab-
     7  lished by article fifty-one of this chapter.
     8    §  7. The state finance law is amended by adding a new section 89-i to
     9  read as follows:
    10    § 89-i. New York Health trust fund. 1. There is hereby established  in
    11  the joint custody of the state comptroller and the commissioner of taxa-
    12  tion  and  finance  a  special revenue fund to be known as the "New York
    13  Health trust fund", hereinafter known as "the fund". The definitions  in
    14  section  fifty-one  hundred of the public health law shall apply to this
    15  section.
    16    2. The fund shall consist of:
    17    (a) all monies obtained from premiums pursuant to legislation  enacted
    18  as proposed under section three of the New York Health act;
    19    (b)  federal  payments  received as a result of any waiver of require-
    20  ments granted or other arrangements  agreed  to  by  the  United  States
    21  secretary  of  health  and  human  services or other appropriate federal
    22  officials for health  care  programs  established  under  Medicare,  any
    23  federally-matched public health program, or the affordable care act;
    24    (c)  the  amounts paid by the department of health that are equivalent
    25  to those amounts that are paid on behalf  of  residents  of  this  state
    26  under  Medicare,  any  federally-matched  public  health program, or the
    27  affordable care act for health benefits which are equivalent  to  health
    28  benefits covered under New York Health;
    29    (d)  federal and state funds for purposes of the provision of services
    30  authorized under title XX of the federal social security act that  would
    31  otherwise  be  covered under article fifty-one of the public health law;
    32  and
    33    (e) state monies that would otherwise be appropriated to  any  govern-
    34  mental  agency,  office,  program,  instrumentality or institution which
    35  provides health services, for services and benefits  covered  under  New
    36  York Health. Payments to the fund pursuant to this paragraph shall be in
    37  an  amount  equal  to  the  money  appropriated for such purposes in the
    38  fiscal year beginning immediately preceding the effective  date  of  the
    39  New York Health act.
    40    3.  Monies  in  the  fund  shall only be used for purposes established
    41  under article fifty-one of the public health law.
    42    § 8. Temporary commission on implementation. 1. There is hereby estab-
    43  lished a temporary commission on implementation of the New  York  Health
    44  program,  hereinafter  to  be  known  as  the  commission, consisting of
    45  fifteen members: five members, including the chair, shall  be  appointed
    46  by the governor; four members shall be appointed by the temporary presi-
    47  dent of the senate, one member shall be appointed by the senate minority
    48  leader;  four members shall be appointed by the speaker of the assembly,
    49  and one member shall be appointed by the assembly minority  leader.  The
    50  commissioner  of  health,  the superintendent of financial services, and
    51  the commissioner of taxation and finance, or their designees shall serve
    52  as non-voting ex-officio members of the commission.
    53    2. Members of the commission shall receive such assistance as  may  be
    54  necessary  from  other  state  agencies  and entities, and shall receive
    55  necessary expenses incurred in the  performance  of  their  duties.  The

        S. 4840                            22
     1  commission  may  employ staff as needed, prescribe their duties, and fix
     2  their compensation within amounts appropriated for the commission.
     3    3.  The commission shall examine the laws and regulations of the state
     4  and make such recommendations as are necessary to conform the  laws  and
     5  regulations  of the state and article 51 of the public health law estab-
     6  lishing the New York Health program and other provisions of law relating
     7  to the New York  Health  program,  and  to  improve  and  implement  the
     8  program. The commission shall report its recommendations to the governor
     9  and the legislature.  The commission shall immediately begin development
    10  of  proposals  consistent  with  the  principles  of  this  article  for
    11  provision of long-term care coverage; health care services covered under
    12  the workers' compensation law; and incorporation of retiree health bene-
    13  fits, as described in paragraphs (a), (b) and (c) of  subdivision  8  of
    14  section 5102 of the public health law.  The commission shall provide its
    15  work product and assistance to the board established pursuant to section
    16  5102  of the public health law upon completion of the appointment of the
    17  board.
    18    § 9.  Severability. If any provision or application of this act  shall
    19  be  held to be invalid, or to violate or be inconsistent with any appli-
    20  cable federal law or regulation, that shall not affect other  provisions
    21  or  applications  of  this  act  which  can be given effect without that
    22  provision or application; and to that end, the provisions  and  applica-
    23  tions of this act are severable.
    24    § 10. This act shall take effect immediately.
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