Bill Text: NY S06466 | 2015-2016 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Expands the kinds of qualified wellness programs that can be offered to enrollees.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Passed) 2016-07-21 - SIGNED CHAP.180 [S06466 Detail]

Download: New_York-2015-S06466-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         6466--A
            Cal. No. 283
                    IN SENATE
                                    January 13, 2016
                                       ___________
        Introduced  by  Sens. KLEIN, CARLUCCI, SAVINO, VALESKY -- read twice and
          ordered printed, and when printed to be committed to the Committee  on
          Health -- reported favorably from said committee, ordered to first and
          second  report,  ordered  to  a  third  reading,  amended  and ordered
          reprinted, retaining its place in the order of third reading
        AN ACT to amend the public health law, in relation to including  certain
          respiratory  diseases  and  obesity  within  disease management demon-
          stration programs; to amend the social services law,  in  relation  to
          child day care facilities; and to amend the insurance law, in relation
          to  expanding  the  kinds  of  qualified wellness programs that can be
          offered to enrollees
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Subdivisions 2 and 4 of section 2111 of the public health
     2  law, as added by section 21 of part C of chapter 58 of the laws of 2004,
     3  are amended to read as follows:
     4    2. The department shall establish the criteria  by  which  individuals
     5  will  be  identified  as  eligible  for  enrollment in the demonstration
     6  programs.  Persons eligible for enrollment  in  the  disease  management
     7  demonstration  program  shall  be  limited  to  individuals who: receive
     8  medical assistance pursuant to title  eleven  of  article  five  of  the
     9  social  services  law and may be eligible for benefits pursuant to title
    10  18 of the social security act (Medicare); are not enrolled in a Medicaid
    11  managed care plan, including individuals who are  not  required  or  not
    12  eligible  to  participate  in Medicaid managed care programs pursuant to
    13  section three hundred sixty-four-j of the social services law; are diag-
    14  nosed with chronic health problems as may be  specified  by  the  entity
    15  undertaking the demonstration program, including, but not limited to one
    16  or  more of the following: congestive heart failure, chronic obstructive
    17  pulmonary disease, asthma, chronic bronchitis, other chronic respiratory
    18  diseases, diabetes, adult and childhood obesity, or other chronic health
    19  conditions as may be specified by the department; or have experienced or
    20  are likely to experience one or more hospitalizations or  are  otherwise
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13293-03-6
        S. 6466--A                          2
     1  expected  to  incur  excessive costs and high utilization of health care
     2  services.
     3    4.  The  demonstration program shall offer evidence-based services and
     4  interventions designed to ensure that the enrollees receive high  quali-
     5  ty, preventative and cost-effective care, aimed at reducing the necessi-
     6  ty  for hospitalization or emergency room care or at reducing lengths of
     7  stay when hospitalization is necessary. The  demonstration  program  may
     8  include  screening  of  eligible enrollees, developing an individualized
     9  care management plan for  each  enrollee  and  implementing  that  plan.
    10  Disease management demonstration programs that utilize information tech-
    11  nology  systems  that allow for continuous application of evidence-based
    12  guidelines to medical assistance claims data and other available data to
    13  identify specific instances in which clinical interventions  are  justi-
    14  fied  and communicate indicated interventions to physicians, health care
    15  providers and/or patients, and monitor physician and health care provid-
    16  er response to such interventions, shall have the enrollees,  or  groups
    17  of enrollees, approved by the department for participation. The services
    18  provided  by  the  demonstration  program as part of the care management
    19  plan may include, but are not limited to, case management, social  work,
    20  individualized  health  counselors, multi-behavioral goals plans, claims
    21  data management, health and self-care education, drug therapy management
    22  and oversight, personal emergency response systems and other  monitoring
    23  technologies,  systematic chronic health conditions identified for moni-
    24  toring, telehealth services and similar services designed to improve the
    25  quality and cost-effectiveness of health care services.
    26    § 2. Section 390-a of the social services law is amended by  adding  a
    27  new subdivision 6 to read as follows:
    28    6.  No  family  day  care home, group family day care home, school age
    29  child care program or child day care center shall discourage  activities
    30  relating  to  breast  feeding  a child or feeding a child with expressed
    31  breast milk.
    32    § 3. Subsections (b) and (c) of section 3239 of the insurance law,  as
    33  added  by  chapter  592  of  the  laws  of  2008,  paragraphs 6 and 7 of
    34  subsection  (b)  and  subparagraphs  (C)  and  (D)  of  paragraph  2  of
    35  subsection (c) as amended, and paragraph 8 of subsection (b) and subpar-
    36  agraphs (E) and (F) of paragraph 2 of subsection (c) as added by chapter
    37  519 of the laws of 2013, are amended to read as follows:
    38    (b) A wellness program may include, but is not limited to, the follow-
    39  ing programs or services:
    40    (1) the use of a health risk assessment tool;
    41    (2) a smoking cessation program;
    42    (3) a weight management program;
    43    (4) a stress and/or hypertension management program;
    44    (5) a worker injury prevention program;
    45    (6) a nutrition education program;
    46    (7) health or fitness incentive programs; [and]
    47    (8)  a coordinated weight management, nutrition, stress management and
    48  physical fitness program to combat  the  high  incidence  of  adult  and
    49  childhood obesity, asthma and other chronic respiratory conditions[.];
    50    (9) a substance or alcohol abuse cessation program; and
    51    (10) a program to manage and cope with chronic pain.
    52    (c)(1)  A  wellness program may use rewards and incentives for partic-
    53  ipation provided  that  where  the  group  health  insurance  policy  or
    54  subscriber  contract  is required to be community-rated, the rewards and
    55  incentives shall not include a discounted premium rate or  a  rebate  or
    56  refund of premium.
        S. 6466--A                          3
     1    (2) Permissible rewards and incentives may include:
     2    (A)  full  or  partial  reimbursement  of the cost of participating in
     3  smoking cessation [or], weight management, stress  and/or  hypertension,
     4  worker  injury  prevention,  nutrition  education,  substance or alcohol
     5  abuse cessation, or chronic pain management and coping programs;
     6    (B) full or partial reimbursement of  the  cost  of  membership  in  a
     7  health club or fitness center;
     8    (C) the waiver or reduction of copayments, coinsurance and deductibles
     9  for  preventive  services  covered  under the group policy or subscriber
    10  contract;
    11    (D) monetary rewards in the form of gift cards or  gift  certificates,
    12  so  long  as the recipient of the reward is encouraged to use the reward
    13  for a product or a service that promotes good health,  such  as  healthy
    14  cook books, over the counter vitamins or exercise equipment;
    15    (E)  full  or  partial reimbursement of the cost of participating in a
    16  stress management program or activity; and
    17    (F) full or partial reimbursement of the cost of  participating  in  a
    18  health or fitness program.
    19    (3)  Where  the  reward  involves a group member's meeting a specified
    20  standard based on a health condition, the wellness program must meet the
    21  requirements of 45 CFR Part 146.
    22    (4) A reward or incentive which involves a discounted premium rate  or
    23  a  rebate or refund of premium shall be based on actuarial demonstration
    24  that the wellness program can reasonably be expected to  result  in  the
    25  overall good health and well being of the group.
    26    § 4. This act shall take effect on the one hundred eightieth day after
    27  it  shall  have  become  a law; provided that, effective immediately any
    28  rules and regulations necessary to implement the provisions of this  act
    29  on  its  effective date are authorized and directed to be added, amended
    30  and/or repealed on or before such date.