Bill Text: NY S04840 | 2017-2018 | General Assembly | Amended


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) 2018-02-02 - PRINT NUMBER 4840A [S04840 Detail]

Download: New_York-2017-S04840-Amended.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                         4840--A
                               2017-2018 Regular Sessions
                    IN SENATE
                                      March 3, 2017
                                       ___________
        Introduced  by  Sens. RIVERA, ADDABBO, ALCANTARA, AVELLA, BAILEY, BENJA-
          MIN, BRESLIN, BROOKS, CARLUCCI,  COMRIE,  DILAN,  GIANARIS,  HAMILTON,
          HOYLMAN, KAMINSKY, KENNEDY, KLEIN, KRUEGER, MONTGOMERY, PARKER, PERAL-
          TA,  PERSAUD,  SANDERS,  SAVINO,  SERRANO,  STAVISKY, STEWART-COUSINS,
          VALESKY -- read twice and ordered printed,  and  when  printed  to  be
          committed  to  the Committee on Health -- recommitted to the Committee
          on Health in accordance with  Senate  Rule  6,  sec.  8  --  committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee
        AN  ACT  to  amend  the  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  Many New Yorkers go without health care because they cannot afford it or
    17  suffer  financial  hardship to get it.  Businesses have also experienced
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09305-05-8

        S. 4840--A                          2
     1  increases in the costs of health care benefits for their employees,  and
     2  many  employers  are  shifting a larger share of the cost of coverage to
     3  their employees or dropping coverage entirely.   Health  care  providers
     4  are  also  affected  by  inadequate health coverage in New York state. A
     5  large portion of hospitals, health centers and other providers now expe-
     6  rience substantial losses due to the provision of care that is uncompen-
     7  sated. Individuals often find that they are deprived of affordable  care
     8  and  choice  because  of  decisions by health plans guided by the plan's
     9  economic interests rather than the individual's health  care  needs.  To
    10  address  the  fiscal  crisis facing the health care system and the state
    11  and to assure New Yorkers can  exercise  their  right  to  health  care,
    12  affordable  and comprehensive health coverage must be provided. Pursuant
    13  to the state constitution's charge to the legislature to provide for the
    14  health of New Yorkers, this legislation is an enactment of state concern
    15  for the purpose of establishing  a  comprehensive  universal  guaranteed
    16  health  care  coverage program and a health care cost control system for
    17  the benefit of all residents of the state of New York.
    18    2. (a) It is the intent of the Legislature  to  create  the  New  York
    19  Health program to provide a universal single payer health plan for every
    20  New  Yorker, funded by broad-based revenue based on ability to pay.  The
    21  state shall work to obtain waivers and other approvals relating to Medi-
    22  caid, Child Health Plus, Medicare, the  Affordable  Care  Act,  and  any
    23  other  appropriate federal programs, under which federal funds and other
    24  subsidies that would otherwise be paid to New York State,  New  Yorkers,
    25  and  health  care  providers for health coverage that will be equaled or
    26  exceeded by New York Health will be paid by the  federal  government  to
    27  New  York State and deposited in the New York Health trust fund, or paid
    28  to health care providers and individuals in combination  with  New  York
    29  Health trust fund payments, and for other program modifications (includ-
    30  ing  elimination  of  cost  sharing and insurance premiums).  Under such
    31  waivers and approvals, health coverage under those programs will, to the
    32  maximum extent possible, be replaced and merged into  New  York  Health,
    33  which will operate as a true single-payer program.
    34    (b)  If  any  necessary  waiver or approval is not obtained, the state
    35  shall use state plan amendments and seek waivers and approvals to  maxi-
    36  mize,  and  make  as  seamless as possible, the use of federally-matched
    37  health programs and federal health programs in New York Health.    Thus,
    38  even where other programs such as Medicaid or Medicare may contribute to
    39  paying  for  care,  it is the goal of this legislation that the coverage
    40  will be delivered by New York Health  and,  as  much  as  possible,  the
    41  multiple  sources  of  funding will be pooled with other New York Health
    42  funds and not be apparent to New York Health  members  or  participating
    43  providers.
    44    (c)  This  program  will  promote  movement  away from fee-for-service
    45  payment, which tends to reward quantity and requires excessive  adminis-
    46  trative  expense,  and  towards alternate payment methodologies, such as
    47  global or capitated payments to providers or health care  organizations,
    48  that  promote  quality, efficiency, investment in primary and preventive
    49  care, and innovation and integration in the organizing of health care.
    50    (d) The program shall promote the use of clinical data to improve  the
    51  quality  of health care and public health, consistent with protection of
    52  patient confidentiality. The program shall maximize patient autonomy  in
    53  choice of health care providers and health care decision making.
    54    3.  This  act  does  not  create  any  employment benefit, nor does it
    55  require, prohibit, or limit the providing of any employment benefit.

        S. 4840--A                          3
     1    4. In order to promote improved quality of, and access to, health care
     2  services and promote improved clinical outcomes, it is the policy of the
     3  state to encourage cooperative, collaborative and  integrative  arrange-
     4  ments  among  health  care providers who might otherwise be competitors,
     5  under  the  active  supervision of the commissioner of health. It is the
     6  intent of the state to supplant competition with such  arrangements  and
     7  regulation  only  to  the extent necessary to accomplish the purposes of
     8  this act, and to provide state  action  immunity  under  the  state  and
     9  federal  antitrust  laws  to  health  care  providers, particularly with
    10  respect to their relations with the single-payer New  York  Health  plan
    11  created by this act.
    12    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
    13  health law are renumbered article 80 and sections 8000, 8001,  8002  and
    14  8003, respectively, and a new article 51 is added to read as follows:
    15                                 ARTICLE 51
    16                               NEW YORK HEALTH
    17  Section 5100. Definitions.
    18          5101. Program created.
    19          5102. Board of trustees.
    20          5103. Eligibility and enrollment.
    21          5104. Benefits.
    22          5105. Health  care providers; care coordination; payment method-
    23                  ologies.
    24          5106. Health care organizations.
    25          5107. Program standards.
    26          5108. Regulations.
    27          5109. Provisions relating to federal health programs.
    28          5110. Additional provisions.
    29          5111. Regional advisory councils.
    30    § 5100. Definitions. As used in  this  article,  the  following  terms
    31  shall  have  the following meanings, unless the context clearly requires
    32  otherwise:
    33    1. "Board" means the board of trustees of the New York Health  program
    34  created  by section fifty-one hundred two of this article, and "trustee"
    35  means a trustee of the board.
    36    2. "Care coordination" means, but is not limited to, managing,  refer-
    37  ring to, locating, coordinating, and monitoring health care services for
    38  the  member  to assure that all medically necessary health care services
    39  are made available to and are effectively used by the member in a timely
    40  manner, consistent with patient autonomy.  Care  coordination  does  not
    41  include  a  requirement for prior authorization for health care services
    42  or for referral for a member to receive a health care service.
    43    3. "Care coordinator"  means  an  individual  or  entity  approved  to
    44  provide  care  coordination  under  subdivision two of section fifty-one
    45  hundred five of this article.
    46    4. "Federally-matched public health program" means the medical assist-
    47  ance program under title eleven of article five of the  social  services
    48  law,  the basic health program under section three hundred sixty-nine-gg
    49  of the social services law, and the  child  health  plus  program  under
    50  title one-A of article twenty-five of this chapter.
    51    5.  "Health care organization" means an entity that is approved by the
    52  commissioner under section fifty-one hundred  six  of  this  article  to
    53  provide health care services to members under the program.
    54    6.  "Health  care  provider"  means  any  individual or entity legally
    55  authorized to provide a health care service under Medicaid  or  Medicare
    56  or this article. "Health care professional" means a health care provider

        S. 4840--A                          4
     1  that  is  an  individual  licensed,  certified,  registered or otherwise
     2  authorized to practice under title eight of the education law to provide
     3  such health care service, acting within his or her lawful scope of prac-
     4  tice.
     5    7. "Health care service" means any health care service, including care
     6  coordination, included as a benefit under the program.
     7    8. "Implementation period" means the period under subdivision three of
     8  section  fifty-one  hundred one of this article during which the program
     9  will be subject to special eligibility and financing provisions until it
    10  is fully implemented under that section.
    11    9. "Long term care" means  long  term  care,  treatment,  maintenance,
    12  services  and  supports, with the exception of short term rehabilitation
    13  and short term home care, as defined by the commissioner.
    14    10. "Medicaid" or "medical assistance" means title eleven  of  article
    15  five  of  the  social  services  law and the program thereunder.  "Child
    16  health plus" means title one-A of article twenty-five  of  this  chapter
    17  and  the program thereunder. "Medicare" means title XVIII of the federal
    18  social security act and the programs thereunder.  "Affordable care  act"
    19  means the federal patient protection and affordable care act, public law
    20  111-148,  as amended by the health care and education reconciliation act
    21  of 2010, public law 111-152, and as  otherwise  amended  and  any  regu-
    22  lations  or  guidance  issued thereunder.   "Basic health program" means
    23  section three hundred sixty-nine-gg of the social services law  and  the
    24  program thereunder.
    25    11. "Member" means an individual who is enrolled in the program.
    26    12.  "New  York Health", "New York Health program", and "program" mean
    27  the New York Health program created by section fifty-one hundred one  of
    28  this article.
    29    13.  "New York Health trust fund" means the New York Health trust fund
    30  established under section eighty-nine-i of the state finance law.
    31    14. "Out-of-state health care service" means  a  health  care  service
    32  provided  to  a  member while the member is temporarily out of the state
    33  and (a) it is medically  necessary  that  the  health  care  service  be
    34  provided  while  the member is out of the state, or (b) it is clinically
    35  appropriate that the health care service be  provided  by  a  particular
    36  health  care provider located out of the state rather than in the state.
    37  However, any health care service provided to a New York Health  enrollee
    38  by  a  health care provider qualified under paragraph (a) of subdivision
    39  three of section fifty-one hundred five of this article that is  located
    40  outside  the  state  shall not be considered an out-of-state service and
    41  shall be covered as otherwise provided in this article.
    42    15. "Participating provider" means any individual or entity that is  a
    43  health  care  provider  qualified  under  subdivision  three  of section
    44  fifty-one hundred  five  of  this  article  that  provides  health  care
    45  services to members under the program, or a health care organization.
    46    16.  "Person"  means any individual or natural person, trust, partner-
    47  ship, association,  unincorporated  association,  corporation,  company,
    48  limited  liability  company,  proprietorship, joint venture, firm, joint
    49  stock association, department, agency, authority, or other legal entity,
    50  whether for-profit, not-for-profit or governmental.
    51    17. "Prescription and non-prescription drugs" means prescription drugs
    52  as defined in section two hundred seventy of this chapter, and non-pres-
    53  cription smoking cessation products or devices.
    54    18. "Resident" means an individual whose primary place of abode is  in
    55  the  state,  without  regard  to the individual's immigration status, as
    56  determined according to regulations of the commissioner.

        S. 4840--A                          5
     1    § 5101. Program created. 1. The New  York  Health  program  is  hereby
     2  created  in  the department. The commissioner shall establish and imple-
     3  ment the program under this article. The program shall  provide  compre-
     4  hensive health coverage to every resident who enrolls in the program.
     5    2.  The  commissioner shall, to the maximum extent possible, organize,
     6  administer and market the program and services as a single program under
     7  the name "New York Health" or such other name as the commissioner  shall
     8  determine,  regardless  of under which law or source the definition of a
     9  benefit is found including (on a voluntary basis) retiree  health  bene-
    10  fits.  In  implementing this article, the commissioner shall avoid jeop-
    11  ardizing federal financial participation in  these  programs  and  shall
    12  take  care  to  promote  public understanding and awareness of available
    13  benefits and programs.
    14    3. The commissioner shall determine when individuals may begin enroll-
    15  ing in the program. There shall be an implementation period, which shall
    16  begin on the date that individuals may begin enrolling  in  the  program
    17  and shall end as determined by the commissioner.
    18    4. An insurer authorized to provide coverage pursuant to the insurance
    19  law  or  a  health maintenance organization certified under this chapter
    20  may, if otherwise authorized, offer  benefits  that  do  not  cover  any
    21  service  for which coverage is offered to individuals under the program,
    22  but may not offer benefits that cover any service for which coverage  is
    23  offered  to  individuals under the program. Provided, however, that this
    24  subdivision shall not prohibit (a) the offering of any  benefits  to  or
    25  for  individuals, including their families, who are employed or self-em-
    26  ployed in the state but who are not residents of the state, or  (b)  the
    27  offering of benefits during the implementation period to individuals who
    28  enrolled or may enroll as members of the program, or (c) the offering of
    29  retiree health benefits.
    30    5.  A  college, university or other institution of higher education in
    31  the state may purchase coverage under the program for  any  student,  or
    32  student's dependent, who is not a resident of the state.
    33    6.  To  the  extent any provision of this chapter, the social services
    34  law, the insurance law or the elder law:
    35    (a) is inconsistent with any provision of this article or the legisla-
    36  tive intent of the New York Health Act, this  article  shall  apply  and
    37  prevail, except where explicitly provided otherwise by this article; and
    38    (b) is consistent with the provisions of this article and the legisla-
    39  tive  intent of the New York Health Act, the provision of that law shall
    40  apply.
    41    7. The program shall be deemed to be a health care plan  for  purposes
    42  of  utilization  review  and external appeal under article forty-nine of
    43  this chapter.
    44    8. No member shall be required to  receive  any  health  care  service
    45  through  any  entity  organized, certified or operating under guidelines
    46  under article forty-four of this chapter,  or  specified  under  section
    47  three hundred sixty-four-j of the social services law, the insurance law
    48  or  the  elder law. No such entity shall receive payment for health care
    49  services (other than care coordination) from the program.  However, this
    50  subdivision shall not preclude  the  use  of  a  Medicare  managed  care
    51  ("Medicare advantage") entity under the program and otherwise consistent
    52  with this article.
    53    9.  The  program  shall  include  provision for an appropriate reserve
    54  fund.
    55    § 5102. Board of trustees. 1. The New York Health board of trustees is
    56  hereby created in the department. The board of trustees  shall,  at  the

        S. 4840--A                          6
     1  request  of  the  commissioner,  consider  any  matter to effectuate the
     2  provisions and purposes of this article, and may advise the commissioner
     3  thereon; and it may, from time to time, submit to the  commissioner  any
     4  recommendations  to effectuate the provisions and purposes of this arti-
     5  cle. The commissioner may propose regulations  under  this  article  and
     6  amendments thereto for consideration by the board. The board of trustees
     7  shall  have  no executive, administrative or appointive duties except as
     8  otherwise provided by law. The board of trustees  shall  have  power  to
     9  establish,  and  from  time to time, amend regulations to effectuate the
    10  provisions and purposes of this article,  subject  to  approval  by  the
    11  commissioner.
    12    2. The board shall be composed of:
    13    (a)  the  commissioner,  the superintendent of financial services, and
    14  the director of the budget, or their designees, as ex officio members;
    15    (b) twenty-six trustees appointed by the governor;
    16    (i) six of whom shall be representatives of health care consumer advo-
    17  cacy organizations which have a statewide or regional constituency,  who
    18  have been involved in activities related to health care consumer advoca-
    19  cy,  including  issues  of interest to low- and moderate-income individ-
    20  uals;
    21    (ii) two of whom shall be representatives  of  professional  organiza-
    22  tions representing physicians;
    23    (iii)  two  of whom shall be representatives of professional organiza-
    24  tions representing licensed  or  registered  health  care  professionals
    25  other than physicians;
    26    (iv)  three of whom shall be representatives of general hospitals, one
    27  of whom shall be a representative of public general hospitals;
    28    (v) one of whom shall be a representative of community health centers;
    29    (vi) two of whom shall be representatives of  rehabilitation  or  home
    30  care providers;
    31    (vii)  two  of  whom  shall be representatives of behavioral or mental
    32  health or disability service providers;
    33    (viii) two of whom shall be representatives of health  care  organiza-
    34  tions;
    35    (ix) two of whom shall be representatives of organized labor;
    36    (x)  two  of  whom  shall  have  demonstrated expertise in health care
    37  finance; and
    38    (xi) two of whom shall be employers or  representatives  of  employers
    39  who  pay the payroll tax under this article, or, prior to the tax becom-
    40  ing effective, will pay the tax;
    41    (c) fourteen trustees appointed by the governor; five of  whom  to  be
    42  appointed  on the recommendation of the speaker of the assembly; five of
    43  whom to be appointed on the recommendation of the temporary president of
    44  the senate; two of whom to be appointed on  the  recommendation  of  the
    45  minority  leader of the assembly; and two of whom to be appointed on the
    46  recommendation of the minority leader of the senate.
    47    3. After the end of the implementation period, no person  shall  be  a
    48  trustee unless he or she is a member of the program, except the ex offi-
    49  cio trustees. Each trustee shall serve at the pleasure of the appointing
    50  officer, except the ex officio trustees.
    51    4.  The  chair  of the board shall be appointed, and may be removed as
    52  chair, by the governor from among the trustees. The board shall meet  at
    53  least  four  times  each  calendar year. Meetings shall be held upon the
    54  call of the chair and as provided  by  the  board.  A  majority  of  the
    55  appointed  trustees  shall be a quorum of the board, and the affirmative
    56  vote of a majority of the trustees voting, but not less than ten,  shall

        S. 4840--A                          7
     1  be  necessary  for  any  action  to be taken by the board. The board may
     2  establish an executive committee to exercise any powers or duties of the
     3  board as it may provide, and other committees to assist the board or the
     4  executive  committee.  The  chair of the board shall chair the executive
     5  committee and shall appoint the chair and members of all  other  commit-
     6  tees. The board of trustees may appoint one or more advisory committees.
     7  Members of advisory committees need not be members of the board of trus-
     8  tees.
     9    5.  Trustees  shall serve without compensation but shall be reimbursed
    10  for their necessary and actual expenses incurred while  engaged  in  the
    11  business of the board.
    12    6. Notwithstanding any provision of law to the contrary, no officer or
    13  employee of the state or any local government shall forfeit or be deemed
    14  to  have  forfeited his or her office or employment by reason of being a
    15  trustee.
    16    7. The board and its committees and advisory  committees  may  request
    17  and  receive  the  assistance  of  the department and any other state or
    18  local governmental entity in exercising its powers and duties.
    19    8. No later than two years after the effective date of this article:
    20    (a) The board shall develop a proposal, consistent with the principles
    21  of this article, for provision by the program of long-term  care  cover-
    22  age,  including the development of a proposal, consistent with the prin-
    23  ciples of this article, for its funding.   In developing  the  proposal,
    24  the  board  shall  consult  with an advisory committee, appointed by the
    25  chair of the board, including representatives of consumers and potential
    26  consumers of long-term care, providers of  long-term  care,  labor,  and
    27  other  interested  parties.  The board shall present its proposal to the
    28  governor and the legislature.
    29    (b) The board shall develop proposals for: (i)  incorporating  retiree
    30  health  benefits into New York Health; (ii) accommodating employer reti-
    31  ree health benefits for people who have been members of New York  Health
    32  but  live as retirees out of the state; and (iii) accommodating employer
    33  retiree health benefits for people who earned or accrued  such  benefits
    34  while  residing  in  the  state  prior to the implementation of New York
    35  Health and live as retirees out of the state.  The board  shall  present
    36  its proposals to the governor and the legislature.
    37    (c) The board shall develop a proposal for New York Health coverage of
    38  health  care  services  covered  under  the  workers'  compensation law,
    39  including whether and how to continue funding for those  services  under
    40  that  law  and  whether  and how to incorporate an element of experience
    41  rating.
    42    § 5103. Eligibility and enrollment. 1. Every  resident  of  the  state
    43  shall be eligible and entitled to enroll as a member under the program.
    44    2.  No individual shall be required to pay any premium or other charge
    45  for enrolling in or being a member under the program.
    46    3. A newborn child shall be enrolled as of the  date  of  the  child's
    47  birth  if  enrollment is done prior to the child's birth or within sixty
    48  days after the child's birth.
    49    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
    50  coverage  to  every member, which shall include all health care services
    51  required to be covered under any of the  following,  without  regard  to
    52  whether  the  member  would  otherwise be eligible for or covered by the
    53  program or source referred to:
    54    (a) child health plus;
    55    (b) Medicaid;
    56    (c) Medicare;

        S. 4840--A                          8
     1    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
     2  forty-three of the insurance law;
     3    (e)  article  eleven of the civil service law, as of the date one year
     4  before the beginning of the implementation period;
     5    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
     6  section  fifty-one  hundred two of the insurance law, provided that this
     7  coverage shall not replace  coverage  under  article  fifty-one  of  the
     8  insurance law; and
     9    (g)  any  additional health care service authorized to be added to the
    10  program's benefits by the program;
    11    (h) provided that none of the above  shall  include  long  term  care,
    12  until  a  proposal  under  paragraph (a) of subdivision eight of section
    13  fifty-one hundred two of this article is enacted into law.
    14    2. No member shall be required to pay any premium, deductible, co-pay-
    15  ment or co-insurance under the program.
    16    3. The program shall provide for payment under the program for:
    17    (a) emergency and temporary health care services provided to a  member
    18  or  individual  entitled to become a member who has not had a reasonable
    19  opportunity to become a member or to enroll with a care coordinator; and
    20    (b) health care services provided in an emergency to an individual who
    21  is entitled to become a member or  enrolled  with  a  care  coordinator,
    22  regardless of having had an opportunity to do so.
    23    §  5105.  Health  care providers; care coordination; payment methodol-
    24  ogies.  1. Choice of health care provider. (a) Any health care  provider
    25  qualified  to  participate  under  this  section may provide health care
    26  services under the program, provided that the health  care  provider  is
    27  otherwise  legally authorized to perform the health care service for the
    28  individual and under the circumstances involved.
    29    (b) A member may choose to receive  health  care  services  under  the
    30  program  from  any participating provider, consistent with provisions of
    31  this article relating to care coordination  and  health  care  organiza-
    32  tions,  the  willingness  or  availability  of  the provider (subject to
    33  provisions of this article relating to discrimination), and  the  appro-
    34  priate clinically-relevant circumstances.
    35    2.  Care  coordination. (a) A care coordinator may be an individual or
    36  entity that is approved by the program that is:
    37    (i) a health care practitioner who is: (A) the member's  primary  care
    38  practitioner; (B) at the option of a female member, the member's provid-
    39  er  of  primary gynecological care; or (C) at the option of a member who
    40  has a chronic condition  that  requires  specialty  care,  a  specialist
    41  health  care  practitioner who regularly and continually provides treat-
    42  ment for that condition to the member;
    43    (ii) an entity licensed under article twenty-eight of this chapter  or
    44  certified  under article thirty-six of this chapter, or, with respect to
    45  a member who receives chronic mental health  care  services,  an  entity
    46  licensed  under  article  thirty-one  of the mental hygiene law or other
    47  entity approved by the commissioner in consultation with the commission-
    48  er of mental health;
    49    (iii) a health care organization;
    50    (iv) a Taft-Hartley fund, with respect to its members and their family
    51  members; provided that this provision shall not preclude a  Taft-Hartley
    52  fund  from  becoming  a  care coordinator under subparagraph (v) of this
    53  paragraph or a health care organization under section fifty-one  hundred
    54  six of this article; or
    55    (v) any not-for-profit or governmental entity approved by the program.

        S. 4840--A                          9
     1    (b)(i)  Every  member shall enroll with a care coordinator that agrees
     2  to provide care coordination to the member  prior  to  receiving  health
     3  care  services  to  be paid for under the program.  Health care services
     4  provided to a member shall not be subject to payment under  the  program
     5  unless  the  member  is enrolled with a care coordinator at the time the
     6  health care service is provided.
     7    (ii) This paragraph shall not apply to health care  services  provided
     8  under  subdivision three of section fifty-one hundred four of this arti-
     9  cle.
    10    (iii) The member shall remain  enrolled  with  that  care  coordinator
    11  until  the  member becomes enrolled with a different care coordinator or
    12  ceases to be a member. Members have the right to change their care coor-
    13  dinator on terms at least as permissive as  the  provisions  of  section
    14  three  hundred  sixty-four-j  of  the social services law relating to an
    15  individual changing his or her primary care  provider  or  managed  care
    16  provider.
    17    (c)  Care coordination shall be provided to the member by the member's
    18  care coordinator.  A care coordinator may employ or utilize the services
    19  of other individuals or entities to assist  in  providing  care  coordi-
    20  nation for the member, consistent with regulations of the commissioner.
    21    (d)  A  health  care organization may establish rules relating to care
    22  coordination for members in the health care organization, different from
    23  this subdivision but otherwise consistent with this  article  and  other
    24  applicable laws.
    25    (e) The commissioner shall develop and implement procedures and stand-
    26  ards for an individual or entity to be approved to be a care coordinator
    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 individual or entity is not compe-
    30  tent to be a care coordinator or has exhibited a course of conduct which
    31  is 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 care coordinator in the
    35  program for economic purposes and shall be consistent with good  profes-
    36  sional practice. In developing the procedures and standards, the commis-
    37  sioner  shall:  (i)  consider  existing  standards developed by national
    38  accrediting  and  professional  organizations;  and  (ii)  consult  with
    39  national and local organizations working on care coordination or similar
    40  models,  including  health  care  practitioners, hospitals, clinics, and
    41  consumers and their representatives. When  developing  and  implementing
    42  standards  of  approval  of  care coordinators for individuals receiving
    43  chronic mental health care services, the commissioner shall consult with
    44  the commissioner of mental health. An individual or entity may not be  a
    45  care  coordinator  unless the services included in care coordination are
    46  within the individual's professional scope of practice or  the  entity's
    47  legal authority.
    48    (f)  To  maintain approval under the program, a care coordinator must:
    49  (i) renew its status at a frequency determined by the commissioner;  and
    50  (ii)  provide  data to the department as required by the commissioner to
    51  enable the commissioner to evaluate the impact of care  coordinators  on
    52  quality, outcomes and cost.
    53    (g)  Nothing  in  this  subdivision  shall authorize any individual to
    54  engage in any act in violation of title eight of the education law.
    55    3. Health care providers. (a) The  commissioner  shall  establish  and
    56  maintain procedures and standards for health care providers to be quali-

        S. 4840--A                         10
     1  fied  to participate in the program, including but not limited to proce-
     2  dures and standards relating to the revocation, suspension,  limitation,
     3  or annulment of qualification to participate on a determination that the
     4  health  care  provider  is  not  competent  to be a provider of specific
     5  health care services or has exhibited  a  course  of  conduct  which  is
     6  either  inconsistent  with  program  standards  and regulations or which
     7  exhibits an unwillingness to meet such standards and regulations, or  is
     8  a  potential  threat to the public health or safety. Such procedures and
     9  standards shall not limit health  care  provider  participation  in  the
    10  program  for economic purposes and shall be consistent with good profes-
    11  sional practice.  Such procedures and standards  may  be  different  for
    12  different  types of health care providers and health care professionals.
    13  Any health care provider who is qualified to participate under Medicaid,
    14  child health plus or Medicare shall be deemed to be qualified to partic-
    15  ipate in the program, and any health care provider's revocation, suspen-
    16  sion, limitation, or annulment of qualification to participate in any of
    17  those programs shall apply to the health care  provider's  qualification
    18  to  participate  in  the  program;  provided that a health care provider
    19  qualified under this sentence shall  follow  the  procedures  to  become
    20  qualified under the program by the end of the implementation period.
    21    (b) The commissioner shall establish and maintain procedures and stan-
    22  dards for recognizing health care providers located out of the state for
    23  purposes of providing coverage under the program for out-of-state health
    24  care services.
    25    (c)  Procedures  and  standards  under  this subdivision shall include
    26  provisions for expedited temporary qualification to participate  in  the
    27  program for health care professionals who are (i) temporarily authorized
    28  to  practice  in  the state or (ii) are recently arrived in the state or
    29  recently authorized to practice in the state.
    30    4. Payment for health care services. (a) The commissioner  may  estab-
    31  lish  by  regulation  payment methodologies for health care services and
    32  care coordination provided to members under the program by participating
    33  providers, care coordinators, and health care organizations.  There  may
    34  be  a variety of different payment methodologies, including those estab-
    35  lished on a demonstration basis. All payment  rates  under  the  program
    36  shall  be  reasonable  and reasonably related to the cost of efficiently
    37  providing the health care service and assuring an adequate and  accessi-
    38  ble supply of the health care service.  Until and unless another payment
    39  methodology  is  established,  health  care services provided to members
    40  under the program shall be paid for on a fee-for-service  basis,  except
    41  for care coordination.
    42    (b)  The  program  shall engage in good faith negotiations with health
    43  care providers' representatives under title III of article forty-nine of
    44  this chapter, including, but not limited to, in  relation  to  rates  of
    45  payment and payment methodologies.
    46    (c)  Notwithstanding any provision of law to the contrary, payment for
    47  drugs provided by pharmacies under the program shall be made pursuant to
    48  title one of article two-A of this chapter. However, the  program  shall
    49  provide  for  payment  for  prescription drugs under section 340B of the
    50  federal public service act where applicable.  Payment  for  prescription
    51  drugs  provided  by health care providers other than pharmacies shall be
    52  pursuant to other provisions of this article.
    53    (d) Payment for health care services established  under  this  article
    54  shall  be considered payment in full. A participating provider shall not
    55  charge any rate in excess of the payment established under this  article
    56  for  any  health  care  service provided under the program and shall not

        S. 4840--A                         11
     1  solicit or accept payment from any member or third party  for  any  such
     2  service  except as provided under section fifty-one hundred nine of this
     3  article.  However, this paragraph shall not preclude  the  program  from
     4  acting  as  a  primary  or  secondary  payer in conjunction with another
     5  third-party payer where permitted under section fifty-one  hundred  nine
     6  of this article.
     7    (e)  The  program may provide in payment methodologies for payment for
     8  capital related expenses for specifically  identified  capital  expendi-
     9  tures  incurred  by  not-for-profit  or  governmental entities certified
    10  under article twenty-eight of this chapter. Any capital related  expense
    11  generated  by  a  capital expenditure that requires or required approval
    12  under article twenty-eight of  this  chapter  must  have  received  that
    13  approval  for  the  capital  related  expense  to  be paid for under the
    14  program.
    15    (f) Payment methodologies and rates shall include a distinct component
    16  of reimbursement for direct and indirect graduate medical  education  as
    17  defined,  calculated  and  implemented  pursuant to section twenty-eight
    18  hundred seven-c of this chapter.
    19    (g) The commissioner shall provide by  regulation for payment  method-
    20  ologies and procedures for paying for out-of-state health care services.
    21    §  5106.  Health  care organizations. 1. A member may choose to enroll
    22  with and receive health care services under the program  from  a  health
    23  care organization.
    24    2.  A  health  care  organization shall be a not-for-profit or govern-
    25  mental entity that is approved by the commissioner that is:
    26    (a) an accountable care organization under  article  twenty-nine-E  of
    27  this chapter; or
    28    (b)  a  Taft-Hartley  fund  (i)  with respect to its members and their
    29  family members, and (ii) if allowed by applicable law  and  approved  by
    30  the commissioner, for other members of the program.
    31    3.  A health care organization may be responsible for providing all or
    32  part of the health care services to which its members are entitled under
    33  the program, consistent with the terms of its approval  by  the  commis-
    34  sioner.
    35    4.  (a)  The  commissioner  shall develop and implement procedures and
    36  standards for an entity to be approved to be a health care  organization
    37  in  the  program,  including but not limited to procedures and standards
    38  relating to the revocation,  suspension,  limitation,  or  annulment  of
    39  approval  on  a  determination  that the entity is not competent to be a
    40  health care organization or has exhibited a course of conduct  which  is
    41  either  inconsistent  with  program  standards  and regulations or which
    42  exhibits an unwillingness to meet such standards and regulations, or  is
    43  a  potential  threat to the public health or safety. Such procedures and
    44  standards shall not limit approval to be a health care  organization  in
    45  the  program  for  economic  purposes  and shall be consistent with good
    46  professional practice. In developing the procedures and  standards,  the
    47  commissioner   shall:  (i)  consider  existing  standards  developed  by
    48  national accrediting and professional organizations;  and  (ii)  consult
    49  with  national  and  local  organizations working in the field of health
    50  care organizations,  including  health  care  practitioners,  hospitals,
    51  clinics,  and  consumers  and their representatives. When developing and
    52  implementing standards of approval of  health  care  organizations,  the
    53  commissioner  shall  consult with the commissioner of mental health, the
    54  commissioner of developmental disabilities and the commissioner  of  the
    55  office of alcoholism and substance abuse services.

        S. 4840--A                         12
     1    (b) To maintain approval under the program, a health care organization
     2  must:  (i) renew its status at a frequency determined by the commission-
     3  er; and (ii) provide data to the department as required by  the  commis-
     4  sioner  to enable the commissioner to evaluate the health care organiza-
     5  tion  in  relation  to  quality  of  health  care  services, health care
     6  outcomes, and cost.
     7    5. The commissioner shall make regulations  relating  to  health  care
     8  organizations  consistent  with and to ensure compliance with this arti-
     9  cle.
    10    6. The provision of health care services directly or indirectly  by  a
    11  health  care  organization  through  health  care providers shall not be
    12  considered the practice of a profession under title eight of the  educa-
    13  tion law by the health care organization.
    14    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    15  requirements and standards for the program and for health care organiza-
    16  tions, care coordinators, and health  care  providers,  consistent  with
    17  this article, including requirements and standards for, as applicable:
    18    (a) the scope, quality and accessibility of health care services;
    19    (b) relations between health care organizations or health care provid-
    20  ers and members; and
    21    (c)  relations  between  health  care  organizations  and  health care
    22  providers, including (i) credentialing and participation in  the  health
    23  care organization; and (ii) terms, methods and rates of payment.
    24    2. Requirements and standards under the program shall include, but not
    25  be limited to, provisions to promote the following:
    26    (a)  simplification,  transparency, uniformity, and fairness in health
    27  care provider credentialing and participation in health  care  organiza-
    28  tion  networks, referrals, payment procedures and rates, claims process-
    29  ing, and approval of health care services, as applicable;
    30    (b) primary and preventive  care,  care  coordination,  efficient  and
    31  effective  health  care  services,  quality  assurance, coordination and
    32  integration of health care services, including use of appropriate  tech-
    33  nology, and promotion of public, environmental and occupational health;
    34    (c) elimination of health care disparities;
    35    (d) non-discrimination with respect to members and health care provid-
    36  ers on the basis of race, ethnicity, national origin, religion, disabil-
    37  ity,  age,  sex,  sexual  orientation, gender identity or expression, or
    38  economic circumstances; provided  that  health  care  services  provided
    39  under the program shall be appropriate to the patient's clinically-rele-
    40  vant circumstances; and
    41    (e)  accessibility  of  care  coordination,  health  care organization
    42  services and health care services, including  accessibility  for  people
    43  with disabilities and people with limited ability to speak or understand
    44  English,  and  the providing of care coordination, health care organiza-
    45  tion services and health care services in a culturally competent manner.
    46    3. Any participating provider or care coordinator that is organized as
    47  a for-profit entity (other than a professional practice of one  or  more
    48  health  care  professionals) shall be required to meet the same require-
    49  ments and standards as entities organized  as  not-for-profit  entities,
    50  and payments under the program paid to such entities shall not be calcu-
    51  lated  to  accommodate the generation of profit or revenue for dividends
    52  or other return on investment or the payment of taxes that would not  be
    53  paid by a not-for-profit entity.
    54    4.  Every  participating  provider  shall  furnish to the program such
    55  information to, and permit examination of its records by,  the  program,
    56  as  may  be  reasonably required for purposes of reviewing accessibility

        S. 4840--A                         13
     1  and utilization of health care services,  quality  assurance,  promoting
     2  improved  patient outcomes and cost containment, the making of payments,
     3  and statistical or other studies of the operation of the program or  for
     4  protection  and  promotion  of  public,  environmental  and occupational
     5  health.
     6    5. In developing requirements and standards and  making  other  policy
     7  determinations  under  this article, the commissioner shall consult with
     8  representatives of members, health care  providers,  care  coordinators,
     9  health  care organizations  employers, organized labor, and other inter-
    10  ested parties.
    11    6. The program shall maintain the security and confidentiality of  all
    12  data  and  other  information collected under the program when such data
    13  would be normally considered confidential patient data.  Aggregate  data
    14  of  the  program  which  is  derived from confidential data but does not
    15  violate patient confidentiality shall be  public  information  including
    16  for purposes of article six of the public officers law.
    17    §  5108. Regulations. The commissioner may make regulations under this
    18  article by approving regulations and amendments thereto, under  subdivi-
    19  sion  one  of section fifty-one hundred two of this article. The commis-
    20  sioner may make regulations or amendments thereto under this article  on
    21  an  emergency  basis under section two hundred two of the state adminis-
    22  trative procedure act, provided  that  such  regulations  or  amendments
    23  shall  not  become  permanent  unless  adopted  under subdivision one of
    24  section fifty-one hundred two of this article.
    25    § 5109. Provisions relating to federal health programs. 1. The commis-
    26  sioner shall seek all federal waivers and other  federal  approvals  and
    27  arrangements  and  submit state plan amendments necessary to operate the
    28  program consistent with this article to the maximum extent possible.
    29    2. (a) The commissioner shall apply to the  secretary  of  health  and
    30  human  services or other appropriate federal official for all waivers of
    31  requirements, and make other arrangements, under Medicare, any  federal-
    32  ly-matched public health program, the affordable care act, and any other
    33  federal  programs that provide federal funds for payment for health care
    34  services, that are necessary to enable all New York  Health  members  to
    35  receive all benefits under the program through the program to enable the
    36  state  to  implement this article and to receive and deposit all federal
    37  payments under those programs (including funds that may be  provided  in
    38  lieu  of premium tax credits, cost-sharing subsidies, and small business
    39  tax credits) in the state treasury to the credit of the New York  Health
    40  trust  fund  and  to use those funds for the New York Health program and
    41  other provisions under this article. To the extent possible, the commis-
    42  sioner shall negotiate arrangements with the federal government in which
    43  bulk or lump-sum federal payments are paid to New York Health  in  place
    44  of  federal  spending  or  tax  benefits  for  federally-matched  health
    45  programs or federal health programs.
    46    (b) The commissioner may require members or applicants to  be  members
    47  to  provide  information  necessary  for  the program to comply with any
    48  waiver or arrangement under this subdivision.
    49    3. (a) The commissioner may take actions consistent with this  article
    50  to  enable  New York Health to administer Medicare in New York state, to
    51  create a Medicare managed care plan ("Medicare  Advantage")  that  would
    52  operate  consistent  with  this  article,  and  to be a provider of drug
    53  coverage under Medicare part D for eligible members of New York Health.
    54    (b)  The  commissioner  may  waive  or  modify  the  applicability  of
    55  provisions  of  this  section  relating  to any federally-matched public
    56  health program or Medicare as  necessary  to  implement  any  waiver  or

        S. 4840--A                         14
     1  arrangement  under  this  section  or to maximize the benefit to the New
     2  York Health program under this section, provided that the  commissioner,
     3  in  consultation  with  the director of the budget, shall determine that
     4  such  waiver  or  modification  is  in the best interests of the members
     5  affected by the action and the state.
     6    (c) The commissioner may  apply  for  coverage  under  any  federally-
     7  matched  public  health  program  on behalf of any member and enroll the
     8  member in the federally-matched public health program or Medicare if the
     9  member is eligible for it.   Enrollment in  a  federally-matched  public
    10  health program or Medicare shall not cause any member to lose any health
    11  care  service  provided  by the program or diminish any right the member
    12  would otherwise have.
    13    (d) The commissioner shall by regulation increase the income eligibil-
    14  ity level, increase or eliminate  the  resource  test  for  eligibility,
    15  simplify any procedural or documentation requirement for enrollment, and
    16  increase  the  benefits for any federally-matched public health program,
    17  and for any program to reduce or eliminate an individual's  coinsurance,
    18  cost-sharing  or  premium obligations or increase an individual's eligi-
    19  bility for any federal financial support  related  to  Medicare  or  the
    20  affordable care act notwithstanding any law or regulation to the contra-
    21  ry.  The  commissioner  may  act  under  this  paragraph upon a finding,
    22  approved by the director of the budget, that the action (i) will help to
    23  increase the number of members who are  eligible  for  and  enrolled  in
    24  federally-matched  public  health programs, or for any program to reduce
    25  or eliminate an individual's coinsurance, cost-sharing or premium  obli-
    26  gations  or  increase an individual's eligibility for any federal finan-
    27  cial support related to Medicare or the affordable care act;  (ii)  will
    28  not diminish any individual's access to any health care service, benefit
    29  or  right  the individual would otherwise have; (iii) is in the interest
    30  of the program; and (iv) does not require or has received any  necessary
    31  federal  waivers or approvals to ensure federal financial participation.
    32  Actions under this paragraph shall not apply to eligibility for  payment
    33  for long term care.
    34    (e)  To enable the commissioner to apply for coverage under any feder-
    35  ally-matched public health program or Medicare on behalf of  any  member
    36  and  enroll the member in the federally-matched public health program or
    37  Medicare if the member is eligible for it, the commissioner may  require
    38  that  every member or applicant to be a member shall provide information
    39  to enable the commissioner to determine whether the applicant is  eligi-
    40  ble  for a federally-matched public health program and for Medicare (and
    41  any program or benefit under Medicare). The program shall make a reason-
    42  able effort to notify members of their obligations under this paragraph.
    43  After a reasonable effort has been  made  to  contact  the  member,  the
    44  member  shall  be  notified  in writing that he or she has sixty days to
    45  provide such required information. If such information is  not  provided
    46  within the sixty day period, the member's coverage under the program may
    47  be terminated.
    48    (f)  To the extent necessary for purposes of this section, as a condi-
    49  tion of  continued  eligibility  for  health  care  services  under  the
    50  program,  a  member  who  is  eligible for benefits under Medicare shall
    51  enroll in Medicare, including parts A, B and D.
    52    (g) The program shall  provide  premium  assistance  for  all  members
    53  enrolling  in  a  Medicare  part  D drug coverage under section 1860D of
    54  Title XVIII of the federal social security act limited to the low-income
    55  benchmark premium amount established by the federal centers for Medicare
    56  and Medicaid services and any other amount which such agency establishes

        S. 4840--A                         15
     1  under its de minimis premium policy, except that such payments  made  on
     2  behalf  of  members enrolled in a Medicare advantage plan may exceed the
     3  low-income benchmark premium amount if determined to be  cost  effective
     4  to the program.
     5    (h)  If  the  commissioner  has  reasonable  grounds to believe that a
     6  member could be eligible for an  income-related  subsidy  under  section
     7  1860D-14  of  Title XVIII of the federal social security act, the member
     8  shall provide, and authorize the program to obtain, any  information  or
     9  documentation  required  to  establish the member's eligibility for such
    10  subsidy, provided that the commissioner shall attempt to obtain as  much
    11  of  the  information and documentation as possible from records that are
    12  available to him or her.
    13    (i) The program shall make a reasonable effort to  notify  members  of
    14  their  obligations under this subdivision. After a reasonable effort has
    15  been made to contact the member, the member shall be notified in writing
    16  that he or she has sixty days to provide such required  information.  If
    17  such  information  is  not  provided  within  the  sixty day period, the
    18  member's coverage under the program may be terminated.
    19    § 5110. Additional provisions.   1. The  commissioner  shall  contract
    20  with not-for-profit organizations to provide:
    21    (a)  consumer  assistance to individuals with respect to selection and
    22  changing selection of a care coordinator or  health  care  organization,
    23  enrolling, obtaining health care services, and other matters relating to
    24  the program;
    25    (b) health care provider assistance to health care providers providing
    26  and  seeking  or  considering  whether  to provide, health care services
    27  under the program, with respect to participating in a health care organ-
    28  ization and dealing with a health care organization; and
    29    (c) care coordinator assistance to individuals and entities  providing
    30  and  seeking  or  considering  whether  to provide, care coordination to
    31  members.
    32    2. The commissioner shall provide grants from funds in  the  New  York
    33  Health  trust fund or otherwise appropriated for this purpose, to health
    34  systems agencies under section twenty-nine hundred four-b of this  chap-
    35  ter to support the operation of such health systems agencies.
    36    3. The commissioner shall provide funds from the New York Health trust
    37  fund  or  otherwise appropriated for this purpose to the commissioner of
    38  labor for a program for retraining  and  assisting  job  transition  for
    39  individuals  employed  or  previously  employed  in  the field of health
    40  insurance and other third-party payment for  health  care  or  providing
    41  services  to  health  care providers to deal with third-party payers for
    42  health care, whose jobs may be or have been ended as  a  result  of  the
    43  implementation of the New York Health program, consistent with otherwise
    44  applicable law.
    45    4. The commissioner shall, directly and through grants to not-for-pro-
    46  fit entities, conduct programs using data collected through the New York
    47  Health  program,  to  promote  and  protect  the  quality of health care
    48  services, patient outcomes, and public, environmental  and  occupational
    49  health,  including  cooperation  with other data collection and research
    50  programs of the department, consistent with this article, the protection
    51  of the security and confidentiality of individually identifiable patient
    52  information, and otherwise applicable law.
    53    § 5111. Regional advisory councils.  1. The New York  Health  regional
    54  advisory councils (each referred to in this article as a "regional advi-
    55  sory council") are hereby created in the department.

        S. 4840--A                         16
     1    2.  There  shall be a regional advisory council established in each of
     2  the following regions:
     3    (a) Long Island, consisting of Nassau and Suffolk counties;
     4    (b) New York City;
     5    (c)  Hudson  Valley, consisting of Delaware, Dutchess, Orange, Putnam,
     6  Rockland, Sullivan, Ulster, Westchester counties;
     7    (d) Northern, consisting of Albany, Clinton, Columbia,  Essex,  Frank-
     8  lin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga,
     9  Schenectady, Schoharie, Warren, Washington counties;
    10    (e)  Central,  consisting  of Broome, Cayuga, Chemung, Chenango, Cort-
    11  land, Herkimer, Jefferson, Lewis, Livingston, Madison,  Monroe,  Oneida,
    12  Onondaga,  Ontario,  Oswego,  Schuyler,  Seneca,  St. Lawrence, Steuben,
    13  Tioga, Tompkins, Wayne, Yates counties; and
    14    (f) Western, consisting of Allegany,  Cattaraugus,  Chautauqua,  Erie,
    15  Genesee, Niagara, Orleans, Wyoming counties.
    16    3.  Each regional advisory council shall be composed of not fewer than
    17  twenty-seven members, as determined by the commissioner and  the  board,
    18  as  necessary  to appropriately represent the diverse needs and concerns
    19  of the region. Members of a regional advisory council shall be residents
    20  of or have their principal place of business in the region served by the
    21  regional advisory council.
    22    4. Appointment of members of the regional advisory councils.
    23    (a) The twenty-seven members shall be appointed as follows:
    24    (i) nine members shall be appointed by the governor;
    25    (ii) six members shall be appointed by the governor on the recommenda-
    26  tion of the speaker of the assembly;
    27    (iii) six members shall be appointed by the governor on the  recommen-
    28  dation of the temporary president of the senate;
    29    (iv) three members shall be appointed by the governor on the recommen-
    30  dation of the minority leader of the assembly; and
    31    (v)  three members shall be appointed by the governor on the recommen-
    32  dation of the minority leader of the senate.
    33    Where a regional advisory council has more than twenty-seven  members,
    34  additional members shall be appointed and recommended by these officials
    35  in the same proportion as the twenty-seven members.
    36    (b)  Regional  advisory  council  membership  shall include but not be
    37  limited to:
    38    (i) representatives of health  care  consumer  advocacy  organizations
    39  with  a regional constituency, who shall represent at least one third of
    40  the membership of each regional council;
    41    (ii) representatives of professional organizations representing physi-
    42  cians;
    43    (iii)  representatives  of  professional  organizations   representing
    44  health care professionals other than physicians;
    45    (iv) representatives of general hospitals, including public hospitals;
    46    (v) representatives of community health centers;
    47    (vi)  representatives  of  mental health, behavioral health (including
    48  substance use), physical disability, developmental disability, rehabili-
    49  tation, home care and other service providers;
    50    (vii) representatives of women's health service providers;
    51    (viii) representatives of health care organizations;
    52    (ix) representatives of organized labor;
    53    (x) representatives of employers; and
    54    (xi) representatives of municipal and county government.
    55    5. Members of a regional advisory council shall be appointed for terms
    56  of three years provided, however, that of the members  first  appointed,

        S. 4840--A                         17
     1  one-third  shall  be appointed for one year terms and one-third shall be
     2  appointed for two year terms. Vacancies shall  be  filled  in  the  same
     3  manner as original appointments for the remainder of any unexpired term.
     4  No person shall be a member of a regional advisory council for more than
     5  six years in any period of twelve consecutive years.
     6    6.  Members  of  the  regional  advisory  councils shall serve without
     7  compensation but shall be reimbursed  for  their  necessary  and  actual
     8  expenses  incurred  while  engaged in the business of the advisory coun-
     9  cils. The program shall provide financial support for such expenses  and
    10  other expenses of the regional advisory councils.
    11    7.  Each regional advisory council shall meet at least quarterly. Each
    12  regional advisory council may form committees to assist it in its  work.
    13  Members  of  a  committee  need  not be members of the regional advisory
    14  council.   The New York City regional  advisory  council  shall  form  a
    15  committee  for  each  borough  of  New York City, to assist the regional
    16  advisory council in its work as it relates particularly to that borough.
    17    8. Each regional advisory council shall  advise  the  commissioner,the
    18  board,  the  governor and the legislature on all matters relating to the
    19  development and implementation of the New York Health program.
    20    9. Each regional advisory council shall adopt, and from time  to  time
    21  revise,  a  community  health  improvement  plan  for its region for the
    22  purpose of:
    23    (a) promoting the delivery of health  care  services  in  the  region,
    24  improving  the  quality  and  accessibility  of care, including cultural
    25  competency, clinical  integration  of  care  between  service  providers
    26  including  but  not  limited to physical, mental, and behavioral health,
    27  physical and developmental disability services, and long-term care;
    28    (b) facility and health services planning in the region;
    29    (c) identifying gaps in regional health care services; and
    30    (d) promoting increased public knowledge and responsibility  regarding
    31  the  availability  and  appropriate utilization of health care services.
    32  Each community health improvement plan shall be submitted to the commis-
    33  sioner and the board and shall be posted on the department's website.
    34    10. Each regional advisory council shall hold  at  least  four  public
    35  hearings annually on matters relating to the New York Health program and
    36  the  development  and implementation of the community health improvement
    37  plan.
    38    11. Each regional advisory council shall publish an annual  report  to
    39  the  commissioner  and the board on the progress of the community health
    40  improvement plan. These reports shall  be  posted  on  the  department's
    41  website.
    42    12.  All  meetings  of  the  regional advisory councils and committees
    43  shall be subject to article six of the public officers law.
    44    § 4. Financing of New York Health. 1. The governor shall submit to the
    45  legislature a revenue plan and legislative bills to implement  the  plan
    46  (referred  to collectively in this section as the "revenue proposal") to
    47  provide the revenue necessary to finance the New York Health program, as
    48  created by article 51 of the public health law  and  all  provisions  of
    49  that article (referred to in this section as the "program"), taking into
    50  consideration anticipated federal revenue available for the program. The
    51  revenue  proposal  shall  be submitted to the legislature as part of the
    52  executive budget under article VII of the state  constitution,  for  the
    53  fiscal  year  commencing  on the first day of April in the calendar year
    54  after this act shall become a law. In developing the  revenue  proposal,
    55  the  governor  shall consult with appropriate officials of the executive
    56  branch; the temporary president of the senate; the speaker of the assem-

        S. 4840--A                         18
     1  bly; the chairs of the fiscal and health committees of  the  senate  and
     2  assembly;  and  representatives  of business, labor, consumers and local
     3  government.
     4    2.  (a)  Basic  structure. The basic structure of the revenue proposal
     5  shall be as follows: Revenue for the program shall come from  two  taxes
     6  (referred  to collectively in this section as the "taxes"). First, there
     7  shall be a progressively graduated tax on all payroll and  self-employed
     8  income  (referred  to  in  this  section  as the "payroll tax"), paid by
     9  employers, employees and self-employed individuals.  Second, there shall
    10  be a progressively graduated tax on taxable income  (such  as  interest,
    11  dividends,  and  capital gains) not subject to the payroll tax (referred
    12  to in this section as the "non-payroll tax").  Higher brackets of income
    13  subject to the taxes shall be assessed at a higher  marginal  rate  than
    14  lower brackets.  The taxes shall be set at levels anticipated to produce
    15  sufficient revenue to finance the program, to be scaled up as enrollment
    16  grows,  taking  into consideration anticipated federal revenue available
    17  for the program. Provision shall be made for state  residents  (who  are
    18  eligible  for  the program) who are employed out-of-state, and non-resi-
    19  dents (who are not eligible for the program) who  are  employed  in  the
    20  state.
    21    (b)  Payroll tax. The income to be subject to the payroll tax shall be
    22  all income subject to the Medicare Part A tax. The tax shall be set at a
    23  percentage of that income, which shall be  progressively  graduated,  so
    24  the  percentage  is  higher  on  higher brackets of income. For employed
    25  individuals, the employer shall pay eighty percent of the  tax  and  the
    26  employee  shall  pay  twenty percent of the tax, except that an employer
    27  may agree to pay all or part of the employee's share.   A  self-employed
    28  individual shall pay the full tax.
    29    (c)  Non-payroll  income  tax.  There shall be a tax on income that is
    30  subject to the personal income tax under article 22 of the tax  law  and
    31  is  not  subject  to the payroll tax. It shall be set at a percentage of
    32  that income, which shall be progressively graduated, so  the  percentage
    33  is higher on higher brackets of income.
    34    (d) Phased-in rates. Early in the program, when enrollment is growing,
    35  the  amount  of the taxes shall be at an appropriate level, and shall be
    36  changed as anticipated enrollment grows, to cover the actual cost of the
    37  program. The revenue proposal shall include a mechanism for  determining
    38  the rates of the taxes.
    39    (e) Cross-border employees. (i) State residents employed out-of-state.
    40  If an individual is employed out-of-state by an employer that is subject
    41  to  New  York  state law, the employer and employee shall be required to
    42  pay the payroll tax as to that employee as if the employment were in the
    43  state. If an individual is employed out-of-state by an employer that  is
    44  not  subject to New York state law, either (A) the employer and employee
    45  shall voluntarily comply with the tax or (B) the employee shall pay  the
    46  tax as if he or she were self-employed.
    47    (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
    48  tax shall apply to any out-of-state resident who is employed or self-em-
    49  ployed in the state.  (B) In the case of an out-of-state resident who is
    50  employed or self-employed in the state, such individual and individual's
    51  employer shall be able to take a credit against the payroll  taxes  each
    52  would otherwise pay as to that individual for amounts they spend respec-
    53  tively  on  health  benefits  for the individual that would otherwise be
    54  covered by the program if the individual were a member of  the  program.
    55  For  the  employer, the credit shall be available regardless of the form
    56  of the health benefit (e.g.,  health  insurance,  a  self-insured  plan,

        S. 4840--A                         19
     1  direct  services,  or reimbursement for services), to make sure that the
     2  revenue proposal does not relate to employment benefits in violation  of
     3  the federal ERISA.  For non-employment-based spending by the individual,
     4  the  credit  shall  be  available for and limited to spending for health
     5  coverage (not out-of-pocket health spending). The credit shall be avail-
     6  able without regard to how little is spent or how  sparse  the  benefit.
     7  The  credit may only be taken against the payroll tax. Any excess amount
     8  may not be applied to other tax liability. The credit shall be  distrib-
     9  uted  between  the  employer  and employee in the same proportion as the
    10  spending by each for the benefit and may be applied to their  respective
    11  portion  of  the  tax.  (C) If any provision of this subparagraph or any
    12  application of it shall be ruled to violate federal ERISA, the provision
    13  or the application of it shall be null and void and the ruling shall not
    14  affect any other provision or application of this  section  or  the  act
    15  that enacted it.
    16    3.  (a)  The  revenue  proposal  shall  include a plan and legislative
    17  provisions  for  ending  the  requirement  for  local  social   services
    18  districts  to  pay  part  of  the  cost  of Medicaid and replacing those
    19  payments with revenue from the taxes under the revenue proposal.
    20    (b) The taxes under this section shall not supplant  the  spending  of
    21  other  state  revenue to pay for the Medicaid program as it exists as of
    22  the enactment of the revenue proposal as  amended,  unless  the  revenue
    23  proposal as amended provides otherwise.
    24    4.  To  the extent that the revenue proposal differs from the terms of
    25  subdivision two or paragraph (b) of subdivision three of  this  section,
    26  the  revenue  proposal  shall  state how it differs from those terms and
    27  reasons for and the effects of the differences.
    28    5. All revenue from the taxes shall  be  deposited  in  the  New  York
    29  Health trust fund account under section 89-i of the state finance law.
    30    §  5.   Article 49 of the public health law is amended by adding a new
    31  title 3 to read as follows:
    32                                  TITLE III
    33            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    34                               NEW YORK HEALTH
    35  Section 4920. Definitions.
    36          4921. Collective negotiation authorized.
    37          4922. Collective negotiation requirements.
    38          4923. Requirements for health care providers' representative.
    39          4924. Certain collective action prohibited.
    40          4925. Fees.
    41          4926. Confidentiality.
    42          4927. Severability and construction.
    43    § 4920. Definitions. For purposes of this title:
    44    1. "New York Health" means the program under article fifty-one of this
    45  chapter.
    46    2. "Person" means an  individual,  association,  corporation,  or  any
    47  other legal entity.
    48    3. "Health care providers' representative" means a third party that is
    49  authorized  by  health  care providers to negotiate on their behalf with
    50  New York Health over terms and conditions affecting  those  health  care
    51  providers.
    52    4. "Strike" means a work stoppage in part or in whole, direct or indi-
    53  rect,  by  a  body of workers to gain compliance with demands made on an
    54  employer.
    55    5. "Health care provider" means a person who is  licensed,  certified,
    56  registered  or  authorized to practice a health care profession pursuant

        S. 4840--A                         20
     1  to title eight of the education law and who practices that profession as
     2  a health care provider as an independent contractor or who is an  owner,
     3  officer,  shareholder,  or  proprietor  of a health care provider; or an
     4  entity  that employs or utilizes health care providers to provide health
     5  care services, including but not limited to a  hospital  licensed  under
     6  article twenty-eight of this chapter or an accountable care organization
     7  under  article  twenty-nine-E  of  this  chapter. A health care provider
     8  under title eight of the education law who practices as an  employee  or
     9  independent  contractor  of  another  health  care provider shall not be
    10  deemed a health care provider for purposes of this title.
    11    § 4921. Collective negotiation authorized. 1.  Health  care  providers
    12  may  meet  and  communicate  for the purpose of collectively negotiating
    13  with New York Health on any matter relating to New York Health,  includ-
    14  ing but not limited to rates of payment and payment methodologies.
    15    2. Nothing in this section shall be construed to allow or authorize an
    16  alteration  of  the terms of the internal and external review procedures
    17  set forth in law.
    18    3. Nothing in this section shall be construed to allow a strike of New
    19  York Health by health care providers.
    20    4. Nothing in this section shall be construed to  allow  or  authorize
    21  terms or conditions which would impede the ability of New York Health to
    22  obtain  or  retain  accreditation  by the national committee for quality
    23  assurance or a similar body or to comply with applicable state or feder-
    24  al law.
    25    § 4922. Collective negotiation requirements. 1. Collective negotiation
    26  rights granted by this title must conform to the following requirements:
    27    (a) health care providers  may  communicate  with  other  health  care
    28  providers  regarding  the terms and conditions to be negotiated with New
    29  York Health;
    30    (b) health care providers may communicate with health care  providers'
    31  representatives;
    32    (c)  a health care providers' representative is the only party author-
    33  ized to negotiate with New York Health on  behalf  of  the  health  care
    34  providers as a group;
    35    (d)  a  health  care provider can be bound by the terms and conditions
    36  negotiated by the health care providers' representatives; and
    37    (e) in communicating or negotiating with the  health  care  providers'
    38  representative, New York Health is entitled to offer and provide differ-
    39  ent terms and conditions to individual competing health care providers.
    40    2.  Nothing  in this title shall affect or limit the right of a health
    41  care provider or group of health care providers to collectively petition
    42  a government entity for a change in a law, rule, or regulation.
    43    3. Nothing in this title shall affect or limit  collective  action  or
    44  collective  bargaining  on the part of any health care provider with his
    45  or her employer or any other  lawful  collective  action  or  collective
    46  bargaining.
    47    § 4923. Requirements for health care providers' representative. Before
    48  engaging  in  collective  negotiations with New York Health on behalf of
    49  health care providers, a health  care  providers'  representative  shall
    50  file  with the commissioner, in the manner prescribed by the commission-
    51  er, information identifying  the  representative,  the  representative's
    52  plan of operation, and the representative's procedures to ensure compli-
    53  ance with this title.
    54    §  4924.  Certain  collective  action prohibited. 1. This title is not
    55  intended to authorize competing health care providers to act in  concert

        S. 4840--A                         21
     1  in  response to a health care providers' representative's discussions or
     2  negotiations with New York Health except as authorized by other law.
     3    2. No health care providers' representative shall negotiate any agree-
     4  ment  that  excludes,  limits  the participation or reimbursement of, or
     5  otherwise limits the scope of services to be provided by any health care
     6  provider or group of health care providers with respect to the  perform-
     7  ance of services that are within the health care provider's lawful scope
     8  or terms of practice, license, registration, or certificate.
     9    §  4925. Fees. Each person who acts as the representative of negotiat-
    10  ing parties under this title shall pay to the department a fee to act as
    11  a representative. The commissioner, by regulation,  shall  set  fees  in
    12  amounts  deemed  reasonable and necessary to cover the costs incurred by
    13  the department in administering this title.
    14    § 4926. Confidentiality. All reports and other information required to
    15  be reported to the department under this title shall not be  subject  to
    16  disclosure under article six of the public officers law.
    17    § 4927. Severability and construction. If any provision or application
    18  of  this  title  shall be held to be invalid, or to violate or be incon-
    19  sistent with any applicable federal law or regulation,  that  shall  not
    20  affect other provisions or applications of this title which can be given
    21  effect  without  that  provision  or  application;  and to that end, the
    22  provisions and applications of this title are severable. The  provisions
    23  of  this  title  shall  be  liberally  construed  to  give effect to the
    24  purposes thereof.
    25    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
    26  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
    27  amended to read as follows:
    28    11. "State public health plan" means the  medical  assistance  program
    29  established  by  title eleven of article five of the social services law
    30  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
    31  insurance  coverage program established by title three of article two of
    32  the elder law (referred to in this article as "EPIC"), and  the  [family
    33  health  plus  program established by section three hundred sixty-nine-ee
    34  of the social services law to the extent that section provides that  the
    35  program shall be subject to this article] New York Health program estab-
    36  lished by article fifty-one of this chapter.
    37    §  7. The state finance law is amended by adding a new section 89-i to
    38  read as follows:
    39    § 89-i. New York Health trust fund. 1. There is hereby established  in
    40  the joint custody of the state comptroller and the commissioner of taxa-
    41  tion  and  finance  a  special revenue fund to be known as the "New York
    42  Health trust fund", referred to in this section as "the fund". The defi-
    43  nitions in section fifty-one hundred of  the  public  health  law  shall
    44  apply to this section.
    45    2. The fund shall consist of:
    46    (a)  all monies obtained from taxes pursuant to legislation enacted as
    47  proposed under section three of the New York Health act;
    48    (b) federal payments received as a  result  of  any  waiver  or  other
    49  arrangements  agreed  to  by  the  United States secretary of health and
    50  human services or other appropriate federal officials  for  health  care
    51  programs established under Medicare, any federally-matched public health
    52  program, or the affordable care act;
    53    (c)  the  amounts paid by the department of health that are equivalent
    54  to those amounts that are paid on behalf  of  residents  of  this  state
    55  under  Medicare,  any  federally-matched  public  health program, or the

        S. 4840--A                         22
     1  affordable care act for health benefits which are equivalent  to  health
     2  benefits covered under New York Health;
     3    (d)  federal and state funds for purposes of the provision of services
     4  authorized under title XX of the federal social security act that  would
     5  otherwise  be  covered under article fifty-one of the public health law;
     6  and
     7    (e) state monies that would otherwise be appropriated to  any  govern-
     8  mental  agency,  office,  program,  instrumentality or institution which
     9  provides health services, for services and benefits  covered  under  New
    10  York Health. Payments to the fund pursuant to this paragraph shall be in
    11  an  amount  equal  to  the  money  appropriated for such purposes in the
    12  fiscal year beginning immediately preceding the effective  date  of  the
    13  New York Health act.
    14    3.  Monies  in  the  fund  shall only be used for purposes established
    15  under article fifty-one of the public health law.
    16    § 8. Temporary commission on implementation. 1. There is hereby estab-
    17  lished a temporary commission on implementation of the New  York  Health
    18  program,  referred  to  in this section as the commission, consisting of
    19  fifteen members: five members, including the chair, shall  be  appointed
    20  by the governor; four members shall be appointed by the temporary presi-
    21  dent of the senate, one member shall be appointed by the senate minority
    22  leader;  four members shall be appointed by the speaker of the assembly,
    23  and one member shall be appointed by the assembly minority  leader.  The
    24  commissioner  of  health,  the superintendent of financial services, and
    25  the commissioner of taxation and finance, or their designees shall serve
    26  as non-voting ex-officio members of the commission.
    27    2. Members of the commission shall receive such assistance as  may  be
    28  necessary  from  other  state  agencies  and entities, and shall receive
    29  reasonable and necessary expenses incurred in the performance  of  their
    30  duties.  The  commission  may  employ  staff  as needed, prescribe their
    31  duties, and fix their compensation within amounts appropriated  for  the
    32  commission.
    33    3.  The commission shall examine the laws and regulations of the state
    34  and make such recommendations as are necessary to conform the  laws  and
    35  regulations  of the state and article 51 of the public health law estab-
    36  lishing the New York Health program and other provisions of law relating
    37  to the New York  Health  program,  and  to  improve  and  implement  the
    38  program. The commission shall report its recommendations to the governor
    39  and the legislature.  The commission shall immediately begin development
    40  of  proposals consistent with the principles of article 51 of the public
    41  health law  for  provision  of  long-term  care  coverage;  health  care
    42  services  covered under the workers' compensation law; and incorporation
    43  of retiree health benefits, as described in paragraphs (a), (b) and  (c)
    44  of  subdivision 8 of section 5102 of the public health law.  The commis-
    45  sion shall provide its work product and assistance to the  board  estab-
    46  lished pursuant to section 5102 of the public health law upon completion
    47  of the appointment of the board.
    48    §  9.  Severability. If any provision or application of this act shall
    49  be held to be invalid, or to violate or be inconsistent with any  appli-
    50  cable  federal law or regulation, that shall not affect other provisions
    51  or applications of this act which  can  be  given  effect  without  that
    52  provision  or  application; and to that end, the provisions and applica-
    53  tions of this act are severable.
    54    § 10. This act shall take effect immediately.
feedback