S. 6058 / A. 9558
STATE OF NEW YORK
________________________________________________________________________
S. 6058 A. 9558
SENATE - ASSEMBLY
January 21, 2004
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means
AN ACT to amend the state finance law, in relation to appropriations to
the Alzheimer's disease assistance fund; to amend the public health
law, in relation to the patient health information and quality
improvement act; to amend the public health law and the penal law, in
relation to control of forged and altered prescriptions; to amend the
public health law, in relation to general public health work
reimbursement; to amend the public health law, in relation to direct-
ing the comptroller to establish the quality of care improvement
account; to amend the public health law, in relation to the clinical
reference fee paid by clinical laboratories and blood banks for
permitting and evaluation activities; to amend the executive law, in
relation to the elderly pharmaceutical insurance coverage program; to
amend the public health law and the insurance law, in relation to
early intervention program parental fees, provider fees and other
local cost efficiencies; and to repeal chapter 438 of the laws of 2002
relating to providing for a study by the department of health of
infection control in endoscopy; and to repeal certain provisions of
the public health law relating thereto (Part A); to amend the mental
hygiene law, in relation to the reinvestment of funds into state oper-
ated community-based programs for persons with serious mental illness,
including children and adolescents with serious emotional disturb-
ances, based upon inpatient bed closures and the closure of state-op-
erated psychiatric centers (Part B); to amend part R2 of chapter 62 of
the laws of 2003, amending the mental hygiene law and the state
finance law relating to the community mental health support and work-
force reinvestment program, and the membership of subcommittees for
mental health of community services boards and the duties of such
subcommittees and creating the community mental health and workforce
reinvestment account, in relation to extending the effectiveness of
the provisions thereof; and in relation to the creation of the commis-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12131-01-4
S. 6058 2 A. 9558
sion for the closure of state psychiatric centers for the purpose of
recommending future closures of state psychiatric centers (Part C); to
amend the social services law, the public health law and the insurance
law, in relation to hospital payments and reimbursements from certain
pool distributions; to amend chapter 2 of the laws of 1998 amending
the public health law, the social services law and the insurance law
relating to expanding the child health insurance plan, in relation to
the effectiveness thereof; to amend chapter 703 of the laws of 1988
relating to enacting the expanded health care coverage act of nineteen
hundred eighty-eight and amending the insurance law and other laws
relating to expanded health care and catastrophic health care cover-
age, in relation to the effectiveness thereof; to amend chapter 383 of
the laws of 2001, amending the tax law and other laws relating to
authorizing the division of the lottery to conduct a pilot program
involving the operation of video lottery terminals at certain race-
tracks; and to repeal subparagraphs (xi) and (xii) of paragraph (e) of
subdivision 1 and subdivision 4 of section 369-ee and title 11-A of
article 5 of the social services law, clause (I) of subparagraph (i)
of paragraph (b) of subdivision 1 of section 2807-l of the public
health law and section 7 of part J of chapter 63 of the laws of 2001
amending chapter 20 of the laws of 2001 amending the military law and
other laws relating to making appropriations for the support of
government, relating thereto (Part D); in relation to requiring the
commissioner of mental health to review the rates of payment for
services at outpatient mental health facilities subject to licensure
by the office of mental health and the department of health and to
determine if modification of such rate methodology is appropriate
(Part E); to address inequities in medical assistance reimbursement
rates for methadone maintenance treatment services licensed in accord-
ance with article 28 of the public health law (Part F); and to amend
the social services law and the public health law, in relation to
reimbursement rate for certain services; to amend the public health
law and the social services law, in relation to hospital and personal
care assessments; to establish a medicaid long term care task force;
to amend the social services law, in relation to reimbursement for
certain services; to amend the public health law, the social services
law and the executive law, in relation to creating the preferred drug
program; to amend chapter 433 of the laws of 1997 amending the public
health law and other laws relating to the rate of reimbursement paid
to hospitals and residential health care facilities, in relation to
the applicability of certain provisions of such chapter; to amend the
social services law, in relation to medical assistance; to amend the
social services law, in relation to co-payments for prescription
drugs; to amend the social services law, in relation to temporary
management of health maintenance organization and prescription drug
coverage for dual eligibles; to amend chapter 474 of the laws of 1996
amending the education law and other laws relating to rates for resi-
dential health care facilities, in relation to certain periods of
effectiveness; to amend chapter 1 of the laws of 2002 amending the
public health law, the social services law and the tax law relating to
the Health Care Reform Act of 2000, in relation to the certain time
periods within which certain funds are transferred; to amend chapter
659 of the laws of 1997 constituting the Long Term Care Integration
and Finance Act of 1997, in relation to the effectiveness of certain
provisions of such act; to amend the social services law, in relation
to definition of medical assistance; to amend the public health law,
S. 6058 3 A. 9558
in relation to certain research and demonstration projects regarding
reimbursement, delivery or eligibility for medical assistance; and to
amend the public health law, in relation to powers of the commissioner
of health; and to repeal certain provisions of the social services law
and section 3-a of part Z2 of chapter 62 of the laws of 2003, amending
the general business law and other laws relating to implementing the
state fiscal plan for the 2003-2004 state fiscal year relating there-
to; and providing for the repeal of certain provisions upon expiration
thereof (Part G)
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2004-2005
3 state fiscal year. Each component is wholly contained within a Part
4 identified as Parts A through G. The effective date for each particular
5 provision contained within such Part is set forth in the last section of
6 such Part. Any provision in any section contained within a Part, includ-
7 ing the effective date of the Part, which makes reference to a section
8 "of this act", when used in connection with that particular component,
9 shall be deemed to mean and refer to the corresponding section of the
10 Part in which it is found. Section three of this act sets forth the
11 general effective date of this act.
12 PART A
13 Section 1. Subdivision 2 of section 89-e of the state finance law, as
14 amended by chapter 359 of the laws of 2002, is amended to read as
15 follows:
16 2. Such fund shall consist of all revenues received by the department
17 of taxation and finance, pursuant to the provisions of section six
18 hundred twenty-nine of the tax law and all other moneys appropriated,
19 credited, or transferred thereto from any other fund or source pursuant
20 to law. [For each state fiscal year, there shall be appropriated to the
21 fund by the state, in addition to all other moneys required to be depos-
22 ited into such fund, an amount equal to the amounts of monies collected
23 and deposited into the fund pursuant to section six hundred twenty-nine
24 of the tax law during the preceding calendar year, as certified by the
25 comptroller.] Nothing contained herein shall prevent the state from
26 receiving grants, gifts or bequests for the purposes of the fund as
27 defined in this section and depositing them into the fund according to
28 law.
29 § 2. Chapter 438 of the laws of 2002 relating to providing for a study
30 by the department of health of infection control in endoscopy is
31 REPEALED.
32 § 3. Article 27-I of the public health law is REPEALED.
33 § 4. Title 5 of article 2 of the public health law, as added by chap-
34 ter 538 of the laws of 2002, is REPEALED.
35 § 5. Article 4-A of the public health law is REPEALED.
36 § 6. Article 36-A of the public health law is REPEALED.
37 § 7. Paragraph (a) of subdivision 1 of section 2995 of the public
38 health law, as added by chapter 542 of the laws of 2000, is amended to
39 read as follows:
S. 6058 4 A. 9558
1 (a) The department shall undertake an initiative for the purposes of
2 increasing the information available to patients about health care
3 providers and health care plans, and improving the quality of health
4 care in this state, by creating a statewide health information system,
5 collecting health information for dissemination by means of such system,
6 and studying additional uses of such information. Such moneys as may be
7 necessary to effect the purpose of this section may be appropriated to
8 the department for its expenses[, but in no event shall funds be
9 diverted from existing uses of the office of professional medical
10 conduct in order to fulfill the purposes of this section].
11 § 8. The public health law is amended by adding a new section 21 to
12 read as follows:
13 § 21. New York state prescription forms. 1. Notwithstanding any
14 inconsistent provision of section sixty-eight hundred ten of the educa-
15 tion law or article thirty-three of this chapter, all prescriptions
16 written in this state shall be on New York state prescription forms
17 provided by the department. Such forms shall be furnished to practition-
18 ers authorized to write prescriptions and to institutional dispensers,
19 and shall be non-reproducible, serialized, and non-transferable. The
20 commissioner may promulgate regulations for the electronic transmission
21 of prescriptions from prescribers to pharmacists for prescriptions writ-
22 ten for recipients eligible for medical assistance pursuant to title
23 eleven of article five of the social services law, for participants in
24 the program for elderly pharmaceutical insurance coverage pursuant to
25 article nineteen-K of the executive law and for prescriptions written
26 pursuant to article thirty-three of this chapter. Nothing in this
27 section shall prohibit the commissioner from permitting, pursuant to
28 emergency regulation, different formats of the prescription blank for
29 different types of prescribers or from permitting the use of both the
30 New York state prescription form and prescriptions written pursuant to
31 the requirements of section sixty-eight hundred ten of the education law
32 or article thirty-three of this chapter for a period not longer than
33 eighteen months after the effective date of this section.
34 2. The commissioner is authorized and empowered to make any rules,
35 regulations and determinations which in his or her judgment may be
36 necessary or proper to supplement the provisions of this section to
37 effectuate its purposes and intent thereof, or to clarify its provisions
38 so as to provide the procedure or details to secure effective and proper
39 enforcement of its provisions, including, but not limited to, the manner
40 in which the department shall furnish such prescription blanks to prac-
41 titioners and institutional dispensers.
42 § 9. Subdivision 31 of section 3302 of the public health law, as added
43 by chapter 878 of the laws of 1972 and as renumbered by chapter 537 of
44 the laws of 1998, is amended to read as follows:
45 31. "Prescription" shall mean an official New York state prescription,
46 an electronic prescription, a written prescription, an oral
47 prescription, or any one[.], including:
48 (i) "Official New York state prescription" shall mean a prescription
49 issued pursuant to this article uniquely identified for the purpose of
50 prescribing and dispensing of controlled substances in accordance with
51 the provisions of this article.
52 (ii) "Electronic prescription" shall mean an electronic prescription
53 approved by the commissioner pursuant to regulation.
54 (iii) "Written prescription" shall mean a separate New York state
55 prescription, issued pursuant to section twenty-one of this chapter.
S. 6058 5 A. 9558
1 § 10. Section 3308 of the public health law is amended by adding two
2 new subdivisions 5 and 6 to read as follows:
3 5. Notwithstanding any inconsistent provision of this article, the
4 commissioner is authorized to promulgate regulations regarding the use
5 and transmission of electronic prescriptions, which may be prescribed
6 and dispensed in lieu of an official New York state prescription or
7 written prescription.
8 6. The commissioner is authorized to promulgate regulations regarding
9 the dispensing of prescriptions issued by practitioners authorized to
10 prescribe controlled substances outside this state.
11 § 11. Subdivision 6 of section 3331 of the public health law, as
12 amended by chapter 537 of the laws of 1998, is amended to read as
13 follows:
14 6. A practitioner dispensing a controlled substance which may be
15 prescribed only upon an official New York state prescription [must at
16 the time of such dispensing prepare an official New York state
17 prescription in the manner set forth in subdivision two of section thir-
18 ty-three hundred thirty-two of this article. The practitioner shall
19 retain the original for a period of five years. The practitioner shall
20 file a copy of such prescription with the department or, solely at his
21 or her option,] shall file [such prescription] information pursuant to
22 such dispensing with the department by electronic means in such a manner
23 and detail as the commissioner shall, by regulation, require. Such [copy
24 or prescription] information shall be filed by not later than the
25 fifteenth day of the next month following the month in which the
26 controlled substance was delivered. This requirement shall not apply to
27 the dispensing by a practitioner pursuant to subdivision five of section
28 thirty-three hundred fifty-one of this article.
29 § 12. Subdivisions 1, 3, 4 and 5 of section 3333 of the public health
30 law, subdivisions 1, 3 and 4 as amended and subdivision 5 as added by
31 chapter 537 of the laws of 1998, are amended to read as follows:
32 1. A licensed pharmacist may, in good faith and in the course of his
33 or her professional practice, sell and dispense to an ultimate user
34 controlled substances for which an official New York state prescription
35 is required only upon the delivery to such pharmacist, within thirty
36 days of the date such prescription was signed by an authorized practi-
37 tioner, [of the original and one copy] of such official New York state
38 prescription; provided, however, a pharmacist may dispense a part or
39 portion of such prescription in accordance with regulations of the
40 commissioner. No pharmacy or pharmacist may sell or dispense greater
41 than a thirty day supply of a controlled substance to an ultimate user
42 unless and until the ultimate user has exhausted all but a seven day
43 supply of the controlled substance provided pursuant to any previously
44 issued official New York state prescription, except that a pharmacy or
45 pharmacist may sell or dispense up to a three month supply of a
46 controlled substance if there appears, on the face of the official New
47 York state prescription, a statement that the controlled substance has
48 been prescribed to treat one of the conditions that have been enumerated
49 by the regulations of the commissioner as warranting the prescribing of
50 greater than a thirty day supply of a controlled substance. A pharmacy
51 or pharmacist may sell or dispense up to a six month supply of any
52 substance listed in subdivision (h) [or subdivision (j)] of Schedule II
53 of section three thousand three hundred six of this article if there
54 appears, on the face of the official New York state prescription, a
55 statement that the substance has been prescribed to treat one of the
S. 6058 6 A. 9558
1 conditions that have been enumerated by the regulations of the commis-
2 sioner as warranting the prescribing of a specified greater supply.
3 3. The pharmacist filling the prescription shall endorse upon the
4 original the date of delivery[,] and his or her signature[, and the
5 Federal registration number of the pharmacy].
6 4. The endorsed original prescription shall be retained by the propri-
7 etor of the pharmacy for a period of five years. The proprietor of the
8 pharmacy shall file [a copy of such prescription with the department or,
9 solely at his or her option, file such] prescription information with
10 the department by electronic means in such manner and detail as the
11 commissioner shall, by regulation, require. Such [copy or] prescription
12 information shall be filed by not later than the fifteenth day of the
13 next month following the month in which the substance was delivered.
14 5. [If] When filing prescription information electronically pursuant
15 to subdivision four of this section, the proprietor of the pharmacy
16 shall dispose of any electronically recorded prescription information in
17 such manner as the commissioner shall by regulation require.
18 § 13. Subdivision 1 of section 3334 of the public health law, as added
19 by chapter 878 of the laws of 1972, is amended to read as follows:
20 1. In an emergency situation, as defined by rule or regulation of the
21 department, a practitioner may orally prescribe and a pharmacist may
22 dispense to an ultimate user controlled substances in schedule II or
23 those schedule III or schedule IV controlled substances which the
24 commissioner may, by regulation, require; provided however the pharma-
25 cist shall:
26 (a) contemporaneously reduce such prescription to writing;
27 (b) dispense the substance in conformity with the labeling require-
28 ments applicable to the type of prescription which would be required but
29 for the emergency; and
30 (c) make a good faith effort to verify the practitioner's identity, if
31 the practitioner is unknown to the pharmacist.
32 § 14. Subdivision 1 of section 3338 of the public health law, as
33 amended by chapter 537 of the laws of 1998, is amended to read as
34 follows:
35 1. Official New York state prescription forms shall be prepared and
36 issued by the department [in groups of twenty-five or one hundred
37 forms], each form serially numbered. Such forms shall be furnished [at a
38 cost of twelve dollars and fifty cents per group of twenty-five forms or
39 fifty dollars per group of one hundred forms] to practitioners author-
40 ized to write such prescriptions and to institutional dispensers. Such
41 prescription blanks shall not be transferable.
42 § 15. Paragraph (a) of subdivision 1 of section 3343 of the public
43 health law, as amended by chapter 537 of the laws of 1998, is amended to
44 read as follows:
45 (a) dispensing practitioners [shall preserve the original official New
46 York state prescription in a separate file maintained exclusively for
47 such records. If] filing prescription information electronically pursu-
48 ant to subdivision six of section thirty-three hundred thirty-one of
49 this [article] title, [the dispensing practitioner] shall dispose of any
50 electronically recorded [prescription] information in such manner as the
51 commissioner shall by regulation require;
52 § 16. Subdivision 1 of section 3371 of the public health law is
53 amended by adding a new paragraph (e) to read as follows:
54 (e) to a practitioner to inform him or her that a person under his or
55 her treatment with controlled substances also may be under treatment
56 with controlled substances by another practitioner.
S. 6058 7 A. 9558
1 § 17. Section 155.35 of the penal law, as amended by chapter 515 of
2 the laws of 1986, is amended to read as follows:
3 § 155.35 Grand larceny in the third degree.
4 A person is guilty of grand larceny in the third degree when he or she
5 steals property and when the value of the property exceeds three thou-
6 sand dollars or where the property is an official New York state
7 prescription form as provided in section twenty-one or article thirty-
8 three of the public health law.
9 Grand larceny in the third degree is a class D felony.
10 § 18. Section 155.40 of the penal law, as amended by chapter 515 of
11 the laws of 1986, is amended to read as follows:
12 § 155.40 Grand larceny in the second degree.
13 A person is guilty of grand larceny in the second degree when he or
14 she steals property and when:
15 1. The value of the property exceeds fifty thousand dollars; or
16 2. The property, regardless of its nature and value, is obtained by
17 extortion committed by instilling in the victim a fear that the actor or
18 another person will (a) cause physical injury to some person in the
19 future, or (b) cause damage to property, or (c) use or abuse his or her
20 position as a public servant by engaging in conduct within or related to
21 his or her official duties, or by failing or refusing to perform an
22 official duty, in such manner as to affect some person adversely; or
23 3. The property is ten or more official New York state prescription
24 forms, as provided pursuant to section twenty-one or article thirty-
25 three of the public health law.
26 Grand larceny in the second degree is a class C felony.
27 § 19. Section 170.15 of the penal law is amended to read as follows:
28 § 170.15 Forgery in the first degree.
29 A person is guilty of forgery in the first degree when, with intent to
30 defraud, deceive or injure another, he or she falsely makes, completes
31 or alters a written instrument which is or purports to be, or which is
32 calculated to become or to represent if completed:
33 1. Part of an issue of money, stamps, securities or other valuable
34 instruments issued by a government or governmental instrumentality; or
35 2. Part of an issue of stock, bonds or other instruments representing
36 interests in or claims against a corporate or other organization or its
37 property; or
38 3. Ten or more official New York state prescription forms, as provided
39 pursuant to section twenty-one or article thirty-three of the public
40 health law.
41 Forgery in the first degree is a class C felony.
42 § 20. Sections 178.00, 178.15, 178.20 and 178.25 of the penal law, as
43 added by chapter 81 of the laws of 1995, are amended and five new
44 sections 178.30, 178.35, 178.40, 178.45 and 178.50 are added to read as
45 follows:
46 § 178.00 Criminal diversion of prescription medications and
47 prescriptions; definitions.
48 The following definitions are applicable to this article:
49 1. "Prescription medication or device" means any article or articles
50 for which a prescription is or for which prescriptions are required in
51 order to be lawfully sold, delivered or distributed by any person or
52 persons authorized by law to engage in the practice of the profession of
53 pharmacy.
54 2. "Prescription" means a direction or authorization by means of a
55 written prescription form or an oral prescription which permits a person
S. 6058 8 A. 9558
1 to lawfully obtain a prescription medication or device from any person
2 authorized to dispense such prescription medication or device.
3 3. "Criminal diversion act" means an act or acts in which a person
4 knowingly:
5 (a) transfers or delivers, in exchange for anything of pecuniary
6 value, a prescription medication or device with knowledge or reasonable
7 grounds to know that the recipient has no medical need for it; or
8 (b) receives, in exchange for anything of pecuniary value, a
9 prescription medication or device with knowledge or reasonable grounds
10 to know that the [seller or transferor is not authorized by law to sell]
11 sale or transfer of such prescription medication or device is unlawful
12 and in violation of the law; or
13 (c) transfers or delivers a prescription or prescriptions in exchange
14 for anything of pecuniary value; or
15 (d) receives a prescription or prescriptions in exchange for anything
16 of pecuniary value.
17 4. "Total pecuniary value of the prescription medication or device or
18 prescription or prescriptions" means the lawful market value of all
19 prescription medications or devices or prescription or prescriptions
20 resulting from an act or series of acts which is in violation of this
21 article.
22 § 178.15 Criminal diversion of prescription medications and
23 prescriptions in the third degree.
24 A person is guilty of criminal diversion of prescription medications
25 and prescriptions in the third degree when he or she:
26 1. commits a criminal diversion act, and the [value of the benefit
27 exchanged] total pecuniary value of the prescription medication or
28 device or prescription or prescriptions is in excess of one thousand
29 dollars; or
30 2. commits the crime of criminal diversion of prescription medications
31 and prescriptions in the fourth degree, and has previously been
32 convicted of the crime of criminal diversion of prescription medications
33 and prescriptions in the fourth degree.
34 Criminal diversion of prescription medications and prescriptions in
35 the third degree is a class E felony.
36 § 178.20 Criminal diversion of prescription medications and
37 prescriptions in the second degree.
38 A person is guilty of criminal diversion of prescription medications
39 and prescriptions in the second degree when he or she commits a criminal
40 diversion act, and the [value of the benefit exchanged] total pecuniary
41 value of the prescription medication or device or prescription or
42 prescriptions is in excess of three thousand dollars.
43 Criminal diversion of prescription medications and prescriptions in
44 the second degree is a class D felony.
45 § 178.25 Criminal diversion of prescription medications and
46 prescriptions in the first degree.
47 A person is guilty of criminal diversion of prescription medications
48 and prescriptions in the first degree when he or she commits a criminal
49 diversion act, and the [value of the benefit exchanged] total pecuniary
50 value of the prescription medication or device or prescription or
51 prescriptions is in excess of fifty thousand dollars.
52 Criminal diversion of prescription medications and prescriptions in
53 the first degree is a class C felony.
54 § 178.30 Criminal possession of criminally diverted prescription medica-
55 tions and devices in the fourth degree.
S. 6058 9 A. 9558
1 A person is guilty of criminal possession of criminally diverted
2 prescription medications and devices in the fourth degree when he or she
3 knowingly possesses a prescription medication or device with knowledge
4 that such medication or device was transferred or delivered as the
5 result of a criminal diversion act or with intent to engage in a crimi-
6 nal diversion act.
7 Criminal possession of criminally diverted prescription medications
8 and devices in the fourth degree is a class A misdemeanor.
9 § 178.35 Criminal possession of criminally diverted prescription medica-
10 tions and devices in the third degree.
11 A person is guilty of criminal possession of criminally diverted
12 prescription medications and devices in the third degree when he or she
13 commits the crime of criminal possession of criminally diverted
14 prescription medications and devices in the fourth degree and:
15 1. has previously been convicted of any crime defined in this article;
16 or
17 2. the total pecuniary value of the prescription medication or device
18 possessed is in excess of one thousand dollars.
19 Criminal possession of criminally diverted prescription medications
20 and devices in the third degree is a class E felony.
21 § 178.40 Criminal possession of criminally diverted prescription medi-
22 cations and devices in the second degree.
23 A person is guilty of criminal possession of criminally diverted
24 prescription medications and devices in the second degree when he or she
25 commits the crime of criminal possession of criminally diverted
26 prescription medications and devices in the fourth degree and the total
27 pecuniary value of the prescription medication or device possessed is in
28 excess of three thousand dollars.
29 Criminal possession of criminally diverted prescription medications
30 and devices in the second degree is a class D felony.
31 § 178.45 Criminal possession of criminally diverted prescription medi-
32 cations and devices in the first degree.
33 A person is guilty of criminal possession of criminally diverted
34 prescription medications and devices in the first degree when he or she
35 commits the crime of criminal possession of criminally diverted
36 prescription medications and devices in the fourth degree and the total
37 pecuniary value of the prescription medication or device possessed is in
38 excess of fifty thousand dollars.
39 Criminal possession of criminally diverted prescription medications
40 and devices in the first degree is a class C felony.
41 § 178.50 Presumption.
42 Possession of a false, forged or stolen prescription by any person
43 other than a person in the lawful pursuit of their profession shall be
44 presumptive evidence of the intent to use the same to commit a criminal
45 act under this article.
46 § 21. Subdivision 3 of section 190.26 of the penal law, as added by
47 chapter 2 of the laws of 1998, is amended to read as follows:
48 3. Pretending to be a duly licensed physician or other person author-
49 ized to issue a prescription for any drug or any instrument or device
50 used in the taking or administering of drugs for which a prescription is
51 required by law, communicates to a pharmacist an oral prescription which
52 is required to be reduced to writing pursuant to [section] article thir-
53 ty-three [hundred thirty-two] of the public health law.
54 § 22. Paragraph (b) of subdivision 2 of section 605 of the public
55 health law, as amended by chapter 474 of the laws of 1996, is amended to
56 read as follows:
S. 6058 10 A. 9558
1 (b) if the municipality is providing other public health services
2 within limits to be prescribed by regulation by the commissioner in
3 addition to some or all of the public health services required in para-
4 graph (b) of subdivision three of section six hundred two of this title,
5 pursuant to an approved plan, at a rate of up to fifty per centum but
6 not less than [thirty] twenty per centum of the moneys expended by the
7 municipality for such other services; provided, however, that the muni-
8 cipality may request reimbursement in an amount not to exceed fifty per
9 centum of such other public health services subject to the approval of
10 the commissioner, except that aggregate reimbursement for such other
11 public health services shall not exceed an amount which equals twenty
12 per centum of all the municipality's services under this paragraph less
13 grants and revenues. No such reimbursement shall be provided for
14 services if they are not approved in a plan and its related community
15 health assessment or if no plan is submitted for such services.
16 § 23. Section 2803 of the public health law is amended by adding a new
17 subdivision 10 to read as follows:
18 10. (a) All civil penalties assessed and collected pursuant to section
19 twelve of this chapter for violations of this article and regulations
20 promulgated thereunder related to the operation of residential health
21 care facilities, and all civil monetary penalties related to the opera-
22 tion of nursing facilities received from the federal government in
23 accordance with subdivision (h) of section nineteen hundred nineteen of
24 the federal social security act, shall be deposited by the commissioner
25 and credited to the quality of care improvement account which shall be
26 established by the comptroller in the special revenue fund-other. To the
27 extent of funds appropriated therefor, funds shall be made available to
28 the department for expenditures related to the protection of the health
29 or property of residents of residential health care facilities that are
30 found to be deficient.
31 (b) Funds available pursuant to paragraph (a) of this subdivision may
32 be used, at the commissioner's discretion, to support activities and
33 initiatives intended to improve resident quality of care at residential
34 health care facilities found to be deficient. Such activities may
35 include, but are not limited to, relocation of residents to other facil-
36 ities and the maintenance and operation of a facility pending correction
37 of deficiencies or closure. The commissioner may also make grants to
38 residential health care facilities that support facilities' activities
39 and initiatives intended to improve residential quality of care.
40 Notwithstanding any inconsistent provision of section one hundred twelve
41 or one hundred sixty-three of the state finance law or any other law,
42 funds available for distribution pursuant to this subdivision may be
43 allocated and distributed without a competitive bid or request for
44 proposal process.
45 § 24. Subdivision 4 of section 576 of the public health law, as
46 amended by chapter 436 of the laws of 1993, is amended to read as
47 follows:
48 4. (a) The department [may adopt and amend rules and regulations to
49 effectuate the provisions and purposes of this title. Such rules and
50 regulations shall establish inspection and reference fees for clinical
51 laboratories and blood banks in amounts not exceeding the cost of the
52 inspection and reference program for clinical laboratories and blood
53 banks and shall be subject to the approval of the director of the budg-
54 et] shall charge clinical laboratories and blood banks an assessment on
55 their gross annual receipts from the performance of tests or examination
56 of specimens pursuant to a permit issued by the department in accordance
S. 6058 11 A. 9558
1 with the provisions of section five hundred seventy-five of this title.
2 Each such clinical laboratory and blood bank shall submit to the depart-
3 ment in such form and at such times as the department may require, a
4 report containing information regarding such gross receipts. The depart-
5 ment may require additional information and audit and review such infor-
6 mation to verify its accuracy.
7 (b) [In determining the fee charges to be assessed, the department
8 shall, on or before May first of each year, compute the total actual
9 costs for the preceding state fiscal year which were expended to operate
10 and administer the duties of the department pursuant to this title. The
11 department shall, at such time or times and pursuant to such procedure
12 as it shall determine by regulation, bill and collect from each clinical
13 laboratory and blood bank an amount computed by multiplying such total
14 computed operating expenses of the department by a fraction the numera-
15 tor of which is the gross annual receipts of such clinical laboratory or
16 blood bank during such twelve month period preceding the date of compu-
17 tation as the department shall designate by regulation, and the denomi-
18 nator of which is the total gross annual receipts of all clinical labo-
19 ratories or blood banks operating in the state during such period] The
20 assessment to be charged in the two thousand four--two thousand five
21 state fiscal year and each subsequent state fiscal year shall be a
22 percentage of each clinical laboratory's and blood bank's annual gross
23 receipts for the preceding calendar year. Such percentage shall be
24 determined by dividing the amount appropriated by the legislature to the
25 clinical laboratory reference system assessment account for the preced-
26 ing state fiscal year by the total of the annual gross receipts for all
27 clinical laboratories and blood banks filing reports of annual gross
28 receipts.
29 (c) [Each such clinical laboratory and blood bank shall submit to the
30 department, in such form and at such times as the department may
31 require, a report containing information regarding its gross annual
32 receipts from the performance of tests or examination of specimens
33 pursuant to a permit issued by the department in accordance with the
34 provisions of section five hundred seventy-five of this title. The
35 department may require additional information and audit and review such
36 information to verify its accuracy] Payment of the assessment shall be
37 made within thirty days of receipt of the department's bill for the
38 assessment except that partial payments equal to one-quarter of the
39 assessment billed, may be made on or before June thirtieth, September
40 thirtieth, December thirty-first and March tenth of the fiscal year to
41 which the billing relates.
42 (d) [Partial payments equal to one-quarter of the total amount billed,
43 may be made on or before June thirtieth, September thirtieth, December
44 thirty-first and March tenth of the fiscal year to which the billing
45 relates] The commissioner may waive all or any part of such fee charged
46 for clinical laboratories or blood banks operated by local governments
47 and for nonprofit clinical laboratories or blood banks performing exam-
48 inations and analyses or providing services under contract with the
49 state or its local governments.
50 (e) [On or before September fifteenth of each year, the department
51 shall recompute the actual costs and expenses of the department for the
52 preceding state fiscal year and shall, on or before October fifteenth
53 send to each clinical laboratory and blood bank, a statement setting
54 forth the amount due and payable by, or the amount computed to the cred-
55 it of, such clinical laboratory or blood bank, computed on the basis of
56 the above stated formula, except that for the purposes of such computa-
S. 6058 12 A. 9558
1 tion the fraction shall be multiplied against the total recomputed actu-
2 al expenses of the department for such fiscal year. Any amount due shall
3 be payable not later than thirty days following the date of such state-
4 ment. Any credit shall be applied against any succeeding payment due]
5 Subject to the approval of the director of the budget, the commissioner
6 shall charge adequate and reasonable fees for the periodic inspection of
7 out-of-state clinical laboratories and blood banks, not exceeding the
8 estimated additional costs incurred for out-of-state inspections under
9 this title.
10 (f) [The commissioner may waive all or any part of such fee charges
11 for clinical laboratories or blood banks operated by local governments
12 and for nonprofit clinical laboratories or blood banks performing exam-
13 inations and analyses or providing services under contract with the
14 state or its local governments] Each clinical laboratory and blood bank
15 shall be charged the following assessments on its annual gross receipts
16 earned during the following calendar years:
17 1998 - .6632055 percent;
18 1999 - .6959189 percent;
19 2000 - .6604233 percent;
20 2001 - .6113507 percent;
21 2002 - .6071487 percent.
22 (g) [Subject to the approval of the director of the budget, the
23 commissioner shall charge adequate and reasonable fees for the periodic
24 inspection of out-of-state clinical laboratories and blood banks, not
25 exceeding the estimated additional costs incurred for out-of-state
26 inspections under this title] For the calendar years set forth in para-
27 graph (f) of this subdivision, each clinical laboratory and blood bank
28 shall receive a credit against these assessments equal to the fees paid
29 by each clinical laboratory and blood bank on each year's gross receipts
30 pursuant to former paragraph (b) of this subdivision.
31 § 25. Subdivision 7 of section 576 of the public health law, as added
32 by chapter 436 of the laws of 1993, is amended to read as follows:
33 7. The department may adopt and amend rules and regulations to effec-
34 tuate the provisions and purposes of this title. However, the depart-
35 ment may adopt rules or regulations applicable only to or in the city of
36 New York which are designed to address special needs or circumstances
37 existing in such city. The department shall consider the recommendations
38 of the city of New York, or the department of health and mental hygiene
39 or board of health of such city, concerning the adoption or amendment of
40 any such rules or regulations.
41 § 26. Paragraphs (a) and (b) of subdivision 1 of section 547-j of the
42 executive law, paragraph (a) as amended by section 6 of part C of chap-
43 ter 1 of the laws of 2002, paragraph (b) as amended by section 12 of
44 part J of chapter 82 of the laws of 2002 and subparagraph (i) of para-
45 graph (b) as amended by section 1 of part Y2 of chapter 62 of the laws
46 of 2003, are amended to read as follows:
47 (a) Multiple source covered drugs. Except for brand name drugs that
48 are required by the prescriber to be dispensed as written, the allowed
49 amount for a multiple source covered drug shall equal the lower of: (i)
50 The pharmacy's usual and customary charge to the general public, taking
51 into consideration any quantity and promotional discounts to the general
52 public at the time of purchase, or (ii) The sum of the upper limit set
53 by the centers for medicare and medicaid services for such multiple
54 source drug, or average wholesale price discounted by thirty percent
55 when no upper limit has been established by the centers for Medicare and
S. 6058 13 A. 9558
1 Medicaid services for such multiple source drug, plus a dispensing fee
2 as defined in paragraph (c) of this subdivision.
3 (b) Other covered drugs. The allowed amount for brand name drugs
4 required by the prescriber to be dispensed as written, for covered drugs
5 other than multiple source drugs and for multiple source drugs for which
6 no specific upper limit has been established by the federal centers for
7 medicare and medicaid services shall be determined by applying the lower
8 of: (i) Average wholesale price discounted by [twelve] fifteen percent,
9 plus a dispensing fee as defined in paragraph (c) of this subdivision,
10 or (ii) The pharmacy's usual and customary charge to the general public,
11 taking into consideration any quantity and promotional discounts to the
12 general public at the time of purchase.
13 § 27. Paragraph (c) of subdivision 3 of section 547-b of the executive
14 law, as amended by section 1 of part J of chapter 57 of the laws of
15 2000, is amended to read as follows:
16 (c) The fact that some of an individual's prescription drug expenses
17 are paid or reimbursable under the provisions of the medicare program
18 shall not disqualify an individual, if he or she is otherwise eligible,
19 from receiving assistance under this article. In such cases, the state
20 shall pay the portion of the cost of those prescriptions for qualified
21 drugs for which no payment or reimbursement is made by the medicare
22 program or any federally funded prescription drug benefit, less the
23 participant's co-payment required on the amount not paid by the medicare
24 program. In addition, the participant registration fee charged to eligi-
25 ble program participants for comprehensive coverage pursuant to section
26 five hundred forty-seven-g of this article shall be waived for the
27 portion of the annual coverage period that the participant is also
28 enrolled as a transitional assistance beneficiary in the medicare
29 prescription drug discount card program authorized pursuant to title
30 XVIII of the federal social security act.
31 § 28. Subsections (b), (c) and (d) of section 3235-a of the insurance
32 law, as added by section 3 of part C of chapter 1 of the laws of 2002,
33 are amended to read as follows:
34 (b) Where a policy of accident and health insurance, including a
35 contract issued pursuant to article forty-three of this chapter,
36 provides coverage for an early intervention program service, such cover-
37 age shall not be applied against any maximum annual or lifetime monetary
38 limits set forth in such policy or contract. Visit limitations [and
39 other terms and conditions of the policy] will continue to apply to
40 early intervention services. However, any visits used for early inter-
41 vention program services shall not reduce the number of visits otherwise
42 available under the policy or contract for such services. Where such
43 policy provides coverage for an early intervention program service, the
44 individualized family services plan certified by the early intervention
45 official, as defined in section twenty-five hundred forty-one of the
46 public health law, or such official's designee, shall be deemed to meet
47 any precertification, preauthorization, and medical necessity require-
48 ments imposed on benefits under the policy.
49 (c) Coverage shall not be denied based upon the following:
50 (i) the location where services are provided;
51 (ii) the duration of the child's condition and/or that the child's
52 condition is not amenable to significant improvement within a certain
53 period of time as specified in the policy; or
54 (iii) that the provider of services is not a participating provider in
55 the insurer's network.
S. 6058 14 A. 9558
1 (d) Any right of subrogation to benefits which a municipality is enti-
2 tled in accordance with paragraph (d) of subdivision three of section
3 twenty-five hundred fifty-nine of the public health law shall be valid
4 and enforceable to the extent benefits are available under any accident
5 and health insurance policy. The right of subrogation does not attach to
6 insurance benefits paid or provided under any accident and health insur-
7 ance policy prior to receipt by the insurer of written notice from the
8 municipality. Upon the insurer's receipt of written notice from the
9 municipality, the insurer shall provide the municipality with informa-
10 tion on the extent of benefits available to an insured under the policy.
11 [(d)] (e) No insurer, including a health maintenance organization
12 issued a certificate of authority under article forty-four of the public
13 health law and a corporation organized under article forty-three of this
14 chapter, shall refuse to issue an accident and health insurance policy
15 or contract or refuse to renew an accident and health insurance policy
16 or contract solely because the applicant or insured is receiving
17 services under the early intervention program.
18 § 29. Subdivision 9 of section 2544 of the public health law is
19 REPEALED and a new subdivision 9 is added to read as follows:
20 9. Notwithstanding any inconsistent provision of law, rule or regu-
21 lation, upon receipt of the results of an evaluation, the early inter-
22 vention official shall review the evaluation report and the eligibility
23 or ongoing eligibility determination and may request additional diagnos-
24 tic or other information be provided in support of the eligibility or
25 ongoing eligibility determination. The early intervention official may
26 require that a second evaluation be completed by another approved evalu-
27 ator selected by such official when the early intervention official
28 disagrees with the evaluation's determination of eligibility or ongoing
29 eligibility. The results of the second evaluation shall be binding. A
30 parent who disagrees with the results of the evaluation shall have the
31 due process rights set forth in section twenty-five hundred forty-nine
32 of this title.
33 § 29-a. Subdivision 4 of section 2545 of the public health law, as
34 added by chapter 428 of the laws of 1992, is amended to read as follows:
35 4. If the early intervention official and the parent agree on the
36 IFSP, the IFSP shall be deemed final and the service coordinator shall
37 be authorized to implement the plan, except, however, if seven or more
38 billable encounters per week are proposed by the early intervention
39 official and parent, approval by the commissioner or the commissioner's
40 designee must be obtained before finalization and implementation of the
41 IFSP.
42 § 30. Subdivision 8 of section 2545 of the public health law is
43 REPEALED and a new subdivision 8 is added to read as follows:
44 8. If, at the six month review, annual evaluation or other IFSP
45 review, there is a question as to whether the child continues to be
46 eligible for early intervention program services, the early intervention
47 official may require, with parental consent, that the child be evaluated
48 by an approved evaluator selected by the early intervention official to
49 determine the child's ongoing eligibility for the program. If the parent
50 does not consent to the evaluation, and the child's ongoing eligibility
51 is not determined, the child will no longer be eligible for early inter-
52 vention program services.
53 § 31. The public health law is amended by adding a new section 2550-a
54 to read as follows:
55 § 2550-a. Providers of evaluations, service coordination services and
56 early intervention services. 1. All persons providing evaluations,
S. 6058 15 A. 9558
1 service coordination services and early intervention services shall
2 apply to the department for approval to provide such services. All indi-
3 viduals applying for approval and reapproval shall pay a fee of two
4 hundred seventy-five dollars to the department upon submission of the
5 application. All applicants, other than individuals, applying for
6 approval and reapproval shall pay a fee of nine hundred dollars to the
7 department upon submission of the application. The comptroller is hereby
8 authorized and directed to deposit the fee for each application and
9 reapproval application into a special revenue fund-other account enti-
10 tled "early intervention program account" for the purpose of offsetting
11 any expenditures made pursuant to this title. Nothing in this section
12 shall prohibit a program or provider of services who has obtained
13 approval under section forty-four hundred ten of the education law or
14 intends to apply for approval to provide services under section forty-
15 four hundred ten of the education law, which also plans to provide early
16 intervention services, from applying to the commissioner of education
17 for approval to provide such early intervention services as set forth in
18 section twenty-five hundred fifty-one of this title; provided, however
19 that the program or provider approved or applying for approval under
20 section forty-four hundred ten of the education law which applies to the
21 commissioner of education for approval to provide early intervention
22 services must, at the time of submission of the application to the
23 commissioner of education, also submit to the department a copy of the
24 application submitted to the commissioner of education, together with
25 the appropriate fee as set forth in this section.
26 2. An applicant for approval or reapproval to provide evaluations,
27 service coordination and early intervention services must submit with
28 the application, proof that the applicant has a commitment from a muni-
29 cipality or an approved early intervention provider that the munici-
30 pality or approved early intervention provider will either enter into a
31 contract or employ the applicant upon the applicant's receipt of depart-
32 ment approval. No application shall be deemed complete unless it is
33 accompanied by a letter of intent as specified in this section.
34 3. No approved provider of evaluations, service coordination services
35 and/or early intervention services shall advertise or cause to be adver-
36 tised information which is false, misleading, deceptive or fraudulent
37 with respect to services to be provided to children and their families.
38 The commissioner is authorized to issue guidelines as to appropriate
39 advertising content, and to require approved providers of evaluations,
40 service coordination services and early intervention services to period-
41 ically submit copies of advertising for review.
42 § 32. Subdivision 2 of section 2557 of the public health law, as added
43 by chapter 428 of the laws of 1992, is amended and two new subdivisions
44 6 and 7 are added to read as follows:
45 2. The department shall reimburse the approved costs paid by a munici-
46 pality for the purposes of this title, other than those reimbursable by
47 the medical assistance program or by third party payors, in an amount of
48 fifty percent of the amount expended in accordance with the rules and
49 regulations of the commissioner, less fifty percent of the amount
50 collected by the municipality from parents pursuant to section twenty-
51 five hundred fifty-seven-a of this title. Such state reimbursement to
52 the municipality shall not be paid prior to April first of the year in
53 which the approved costs are paid by the municipality.
54 6. Each municipality may negotiate rates, except medical assistance
55 rates of payment, which are lower than the rates established by the
56 department for evaluations and approved early intervention services
S. 6058 16 A. 9558
1 provided to eligible children who reside within the municipality. The
2 municipality must ensure that there are sufficient providers to provide
3 service coordination services, evaluations and/or early intervention
4 services.
5 7. A municipality which has negotiated rates for early intervention
6 services and evaluations shall not seek reimbursement from the depart-
7 ment in an amount exceeding fifty percent of the rate negotiated and
8 actually paid to the provider. A municipality shall provide such infor-
9 mation as is requested by the department relative to the rates negoti-
10 ated with providers for early intervention services and evaluations.
11 § 33. The public health law is amended by adding a new section 2557-a
12 to read as follows:
13 § 2557-a. Parental fees. 1. Notwithstanding any other provisions of
14 law, rule or regulation, there is hereby created a system of payments by
15 parents, including a sliding schedule of fees as set forth in subdivi-
16 sion two of this section. The system of payments, called parental fees,
17 shall be structured on a sliding scale based upon household gross yearly
18 income. The parental fee obligation shall be established for each family
19 on an annual basis and shall be a monthly fee to be paid by parents to
20 the municipality. No parental fees, however, may be charged for: imple-
21 menting child find, evaluation and assessment, service coordination,
22 development, review and evaluation of Individualized Family Services
23 Plans, or the implementation of procedural safeguards and other adminis-
24 trative components of the early intervention system. Parental fees
25 shall apply without regard to whether payment for services is available
26 under a private insurance plan or policy. Parents shall pay one monthly
27 fee as determined by the schedule of fees set forth in subdivision two
28 of this section regardless of the number of children in the family
29 receiving early intervention services.
30 2. Parental fees for the early intervention program are as follows:
31 Household Gross Income Parental Fee Per Month
32 251% Federal Poverty Level (FPL) to 350% FPL $25.00
33 351% FPL to 400% FPL $40.00
34 401% FPL to 500% FPL $80.00
35 501% FPL to 600% FPL $150.00
36 601% FPL to 700% FPL $185.00
37 701% FPL and above $215.00
38 3. At the written request of the parent, the parental fee obligation
39 may be adjusted prospectively at any point during the year upon proof of
40 a change in household gross income.
41 4. The inability of the parents of an eligible child to pay parental
42 fees due to catastrophic circumstances or extraordinary expenses shall
43 not result in the denial of services to the child or the child's family.
44 (a) Parents must document extraordinary expenses or other catastrophic
45 circumstances by providing documentation of one of the following:
46 (i) out-of-pocket medical expenses in excess of fifteen percent of
47 gross income; or
48 (ii) other extraordinary expenses or catastrophic circumstances caus-
49 ing direct out-of-pocket losses in excess of fifteen percent of gross
50 income.
51 (b) Parents must present proof of loss to the early intervention offi-
52 cial who shall document it. The early intervention official shall deter-
53 mine whether the parental fee obligation shall be reduced, forgiven, or
54 suspended within ten business days after receipt of the parent's request
55 and supporting documentation. A parent who disagrees with the determi-
56 nation of the early intervention official shall have the due process
S. 6058 17 A. 9558
1 rights set forth in section twenty-five hundred forty-nine of this
2 title.
3 5. Parents shall provide such information and documentation as is
4 necessary and sufficient for the municipality to determine the parents'
5 gross household income. The municipality shall document a parental fee
6 obligation and collect the same from the parents. The municipality shall
7 provide the department with such information as may be requested by the
8 department. The municipality shall deduct fifty percent of the amount
9 collected from parents from the amount of reimbursement for approved
10 costs to be paid by the department as set forth in subdivision two of
11 section twenty-five hundred fifty-seven of this title.
12 Notwithstanding any inconsistent law, rule or regulation, effective on
13 and after July first, two thousand four, home and community-based
14 individual/collateral visit shall mean the provision by appropriate
15 qualified personnel of early intervention services to an eligible child
16 and/or parent or parents or other designated caregiver at the child's
17 home or other natural setting in which children under three years of age
18 are typically found (including day care centers, other than those
19 located at the same premises as the early intervention provider, and
20 family day care homes). The definitions of basic and extended visits as
21 established in regulation are hereby eliminated and the rate for home
22 and community-based individual/collateral visits shall be determined
23 annually by the commissioner in accordance with section 69-4.30 of title
24 10 of the New York codes, rules and regulations. The billing limits set
25 forth in regulation, as applicable to basic and extended visits or as
26 may be amended, shall continue to apply to home and community-based
27 individual/collateral visits defined by this section.
28 § 34. This act shall take effect immediately and shall be deemed to
29 have been in full force and effect on and after April 1, 2004; and
30 provided, however, that section one of this act shall take effect on the
31 same date as chapter 359 of the laws of 2002 takes effect; provided
32 further that section seven of this act shall take effect on the same
33 date as the reversion of paragraph (a) of subdivision 1 of section 2995
34 of the public health law, as provided in section 4 of part X2 of chapter
35 62 of the laws of 2003, as amended; and sections eight, nine, ten, elev-
36 en, twelve, thirteen, fifteen and sixteen of this act shall take effect
37 on the sixtieth day after it shall have become a law; provided, however,
38 notwithstanding the provisions of the state administrative procedure act
39 or sections eight, nine, ten, eleven, twelve, thirteen, fifteen and
40 sixteen of this act the commissioner of health is authorized to adopt,
41 amend or promulgate on an emergency basis any regulation he or she
42 determines necessary to implement the provisions of such sections,
43 including authority to permit prescriptions written in this state to be
44 written without regard to the provisions of section eight of this act
45 for a period not to exceed eighteen months after section one of this act
46 takes effect; provided, further, that sections seventeen, eighteen,
47 nineteen, twenty and twenty-one of this act shall take effect on the
48 first of November next succeeding the date on which this act shall have
49 become a law; provided, further, that the amendments to subdivision 6 of
50 section 3331 of the public health law, made by section eleven of this
51 act and the amendments to subdivision 4 of section 3333 of the public
52 health law, made by section twelve of this act, shall not be implemented
53 until the commissioner of health has promulgated regulations relating
54 thereto, and the commissioner of health shall notify the legislative
55 bill drafting commission upon the promulgation of such regulations in
56 order that such commission may maintain an accurate and timely effective
S. 6058 18 A. 9558
1 data base of the official text of the laws of the state of New York in
2 furtherance of effecting the provisions of section 44 of the legislative
3 law and section 70-b of the public officers law; provided further that
4 the amendments to subdivision 1 of section 3338 of the public health
5 law, made by section fourteen of this act, shall take effect April 1,
6 2005; and further provided that section twenty-two of this act shall be
7 deemed to have been in full force and effect on and after December 31,
8 2003; and section thirty-three of this act shall take effect nine months
9 after it shall have become a law.
10 PART B
11 Section 1. Paragraph 3 of subdivision (b) of section 5.07 of the
12 mental hygiene law, as amended by chapter 223 of the laws of 1992 and as
13 renumbered by chapter 322 of the laws of 1992, is amended as follows:
14 (3) The commissioners of each of the offices shall be responsible for
15 the development of such statewide five-year plan for services within the
16 jurisdiction of their respective offices and after giving due notice
17 shall conduct one or more public hearings on such plan. The advisory
18 council of each office shall review the statewide five year plan devel-
19 oped by such office and report its recommendations thereon to such
20 commissioner. Each commissioner shall submit the plan, with appropriate
21 modifications, to the governor [no later than the first day of October
22 of each year in order that such plan may be considered with the esti-
23 mates of the offices for the preparation of the executive budget of the
24 state of New York for the next succeeding state fiscal year], on a date
25 coinciding with the release of the executive budget.
26 Each commissioner shall also submit such plan to the legislature on a
27 date coinciding with the release of the executive budget. The statewide
28 plan shall be reassessed and updated at least annually to encompass the
29 next ensuing five years to ensure responsiveness to changing needs and
30 goals and to reflect the development of new information and the
31 completion of program evaluations. An interim report detailing the
32 commissioner's actions in fulfilling the requirements of this section in
33 preparation of the plan and modifications in the plan of services being
34 considered by the commissioner shall be submitted to the governor and
35 the legislature [on or before the fifteenth day of February] thirty days
36 after enactment of the executive budget of each year. Such interim
37 report shall include, but need not be limited to:
38 (a) actions to include participation of consumers, consumer groups,
39 providers of services and departmental facilities, as required by this
40 subdivision; and
41 (b) any modifications in the plan of services being considered by the
42 commissioner, to include: (i) compelling budgetary, programmatic or
43 clinical justifications or other major appropriate reason for any
44 significant new statewide programs or policy changes from a prior
45 (approved) five year comprehensive plan; and (ii) procedures to involve
46 or inform local governmental units of such actions or plans.
47 § 2. Subdivision (b) of section 7.17 of the mental hygiene law, as
48 amended by chapter 564 of the laws of 2003, is amended to read as
49 follows:
50 (b) There shall be in the office the hospitals named below for the
51 care, treatment and rehabilitation of the mentally disabled and for
52 research and teaching in the science and skills required for the care,
53 treatment and rehabilitation of such mentally disabled.
54 Greater Binghamton Health Center
S. 6058 19 A. 9558
1 Bronx Psychiatric Center
2 Buffalo Psychiatric Center
3 Capital District Psychiatric Center
4 Central New York Psychiatric Center
5 Creedmoor Psychiatric Center
6 Elmira Psychiatric Center
7 Hudson River Psychiatric Center
8 Kingsboro Psychiatric Center
9 Kirby Forensic Psychiatric Center
10 Manhattan Psychiatric Center
11 [Middletown Psychiatric Center]
12 Mid-Hudson Forensic Psychiatric Center
13 Mohawk Valley Psychiatric Center
14 Nathan S. Kline Institute for Psychiatric Research
15 New York State Psychiatric Institute
16 Pilgrim Psychiatric Center
17 Richard H. Hutchings Psychiatric Center
18 Rochester Psychiatric Center
19 Rockland Psychiatric Center
20 St. Lawrence Psychiatric Center
21 South Beach Psychiatric Center
22 Bronx Children's Psychiatric Center
23 Brooklyn Children's Psychiatric Center
24 Queens Children's Psychiatric Center
25 Rockland Children's Psychiatric Center
26 Sagamore Children's Psychiatric Center
27 Western New York Children's Psychiatric Center
28 The New York State Psychiatric Institute and The Nathan S. Kline
29 Institute for Psychiatric Research are designated as institutes for the
30 conduct of medical research and other scientific investigation directed
31 towards furthering knowledge of the etiology, diagnosis, treatment and
32 prevention of mental illness.
33 § 3. Subdivisions (e), (h), (i) and (l) of section 41.55 of the mental
34 hygiene law, as added by section 2 of part R2 of chapter 62 of the laws
35 of 2003, subdivision (e) as amended by section 1 of part N1 of chapter
36 63 of the laws of 2003, are amended to read as follows:
37 (e) The amount of community mental health support and workforce rein-
38 vestment funds for the office of mental health shall be determined in
39 the annual budget and shall include the amount of actual state oper-
40 ations general fund appropriation reductions, including personal service
41 savings and other than personal service savings directly attributed to
42 each child and adult non-geriatric inpatient bed closure. For the
43 purposes of this section a bed shall be considered to be closed upon the
44 elimination of funding for such beds in the executive budget. The
45 appropriation reductions as a result of inpatient bed closures shall be
46 no less than seventy thousand dollars per bed on a full annual basis, as
47 annually recommended by the commissioner, subject to the approval of the
48 director of the budget, in the executive budget request prior to the
49 fiscal year for which the executive budget is being submitted. The
50 commissioner shall report to the governor, the temporary president of
51 the senate and the speaker of the assembly [no later than October first,
52 two thousand three, and annually thereafter, with], on a date coinciding
53 with the release of the executive budget, an explanation of the method-
54 ologies used to calculate the per bed closure savings. The methodologies
55 shall be developed by the commissioner and the director of the budget.
56 In no event shall the full annual value of community mental health
S. 6058 20 A. 9558
1 support and workforce reinvestment programs attributable to beds closed
2 as a result of net inpatient census decline exceed the twelve month
3 value of the office of mental health state operations general fund
4 reductions resulting from such census decline. Such reinvestment amount
5 shall be made available in the same proportion by which the office of
6 mental health's state operations general fund appropriations are reduced
7 each year as a result of child and adult non-geriatric inpatient bed
8 closures due to census decline.
9 (h) The commissioner shall report to the governor, the temporary pres-
10 ident of the senate and the speaker of the assembly, [no later than
11 October first, two thousand four, and annually thereafter, with] on a
12 date coinciding with the release of the executive budget, a long term
13 capital plan for the future uses of all state mental health facilities,
14 and shall include recommendations of the state interagency council on
15 mental hygiene property utilization and local facility task forces on
16 future uses of local state-operated hospital property, as established
17 pursuant to sections twenty-two and twenty-three, respectively, of chap-
18 ter seven hundred twenty-three of the laws of nineteen hundred ninety-
19 three. Such plan shall, consistent with the provisions of section 5.07
20 of this chapter, include any proposed state mental health facility
21 closures or consolidations. Further, such plan shall include the amount
22 of actual state operation general fund appropriation reductions antic-
23 ipated to be directly related to each proposed facility closure or
24 consolidation approved by the legislature.
25 (i) (1) Amounts made available to the community mental health support
26 and workforce reinvestment program of the office of mental health shall
27 be subject to annual appropriations therefor. Up to fifteen percent of
28 the amounts so appropriated shall be made available for staffing at
29 state mental health facilities and at least seven percent of the remain-
30 ing funds may be allocated for state operated community services pursu-
31 ant to this section.
32 (2) Fifty percent of the amounts made available for appropriation as a
33 result of facility co-locations or closures, pursuant to subdivision (f)
34 of this section, shall be allocated for state operated community
35 services located within such facility catchment areas, and such allo-
36 cation shall be deemed to satisfy the seven percent allocation pursuant
37 to paragraph one of this subdivision.
38 (l) The commissioner of mental health shall report to the governor,
39 the temporary president of the senate and the speaker of the assembly,
40 [no later than October first, two thousand four, and annually thereaft-
41 er, with] on a date coinciding with the release of the executive budget,
42 a long-term plan for state employee utilization and their role in the
43 provision of an integrated and comprehensive system of treatment and
44 rehabilitation for persons with mental illness.
45 § 4. This act shall take effect immediately and shall be deemed to
46 have been in full force and effect on and after April 1, 2004; provided,
47 however, the amendments to subdivisions (e), (h), (i) and (l) of section
48 41.55 of the mental hygiene law made by section three of this act shall
49 not affect the repeal of such section and shall be deemed repealed ther-
50 ewith; provided, further, however, section two of this act shall take
51 effect April 1, 2005.
52 PART C
53 Section 1. Legislative findings and intent. (a) The legislature finds
54 that it is the policy of the state to provide services to persons with
S. 6058 21 A. 9558
1 serious mental illness in the most integrated setting possible. As a
2 result of recent advances in the treatment of serious mental illness, as
3 well as the establishment of services in the community as an alternative
4 to inpatient psychiatric care, more individuals with serious mental
5 illness can be and are being served in the community than has histor-
6 ically been the case. This increase in community-based services has
7 resulted in an excess of capacity in the state-operated inpatient
8 psychiatric hospital system. The legislature finds that the continued
9 funding of costly and unnecessary state-operated inpatient psychiatric
10 capacity reduces the flexibility of the state to develop and fund mental
11 health services in community settings, and that the state should adjust
12 the capacity of the state-operated inpatient psychiatric hospital system
13 to reflect the current and future needs of persons with serious mental
14 illness.
15 (b) The legislature further finds that in order to adjust the capacity
16 of the state-operated inpatient psychiatric system to reflect current
17 and future needs, it will be necessary to close inpatient psychiatric
18 hospitals in the state-operated inpatient psychiatric hospital system,
19 and a means for accomplishing such closures would be through the estab-
20 lishment of a commission to make recommendations to the governor and the
21 legislature as to which state hospitals should be closed. The legisla-
22 ture finds that in order to effectuate the necessary reduction of inpa-
23 tient psychiatric capacity, any recommendations made by the commission
24 should be implemented unless a majority of both houses of the legisla-
25 ture pass resolutions prohibiting such actions.
26 § 2. Section 7 of part R2 of chapter 62 of the laws of 2003, amending
27 the mental hygiene law and the state finance law relating to the commu-
28 nity mental health support and workforce reinvestment program, and the
29 membership of subcommittees for mental health of community services
30 boards and the duties of such subcommittees and creating the community
31 mental health and workforce reinvestment account, is amended to read as
32 follows:
33 § 7. This act shall take effect immediately and shall expire March 31,
34 [2007] 2010 when upon such date the provisions of this act shall be
35 deemed repealed.
36 § 3. (a) There is hereby created in the executive department a commis-
37 sion to be known as the "commission for the closure of state psychiatric
38 centers", hereafter referred to as the "commission".
39 (b) The commission shall carry out the duties specified for it in this
40 act.
41 (c) The commission shall be appointed by the governor, and shall be
42 composed of eight voting members, plus the commissioner of the office of
43 mental health, two of whom shall be appointed on the recommendation of
44 the temporary president of the senate, and two of whom shall be
45 appointed on the recommendation of the speaker of the assembly.
46 (d) The temporary president of the senate and the speaker of the
47 assembly shall submit their recommendations for commission members to
48 the governor by not later than thirty days after the effective date of
49 this act.
50 (e) The governor shall make the appointments not later than thirty
51 days from the governor's receipt of the recommendations from the legis-
52 lature.
53 (f) Vacancies in the commission shall be filled in the same manner as
54 the member whose vacancy is being filled was appointed.
S. 6058 22 A. 9558
1 (g) The commissioner of the office of mental health shall serve as the
2 chairperson of the commission, and shall serve as a voting member only
3 in the event of a tie.
4 (h) The members of the commission shall receive no compensation for
5 their services as members, but shall be allowed their actual and neces-
6 sary expenses incurred in the performance of their duties.
7 (i) The commission shall be authorized to hold public hearings and
8 meetings to enable it to accomplish its duties.
9 (j) Upon request of the commission, the commissioner of mental health
10 shall designate an employee of the office of mental health to provide
11 necessary secretarial support services to the commission, shall appoint
12 one or more representatives of the office of mental health to serve as
13 liaison between such office and the commission, and may assign such
14 other employees as the commission may request.
15 (k) The term of the commission shall end upon the transmittal to the
16 governor and the legislature the recommendations of the commission,
17 pursuant to section four of this act, provided, however, that nothing in
18 this act shall prohibit the governor from extending the term of the
19 commission upon the determination by the governor of a continuing need
20 for such commission.
21 (l) Members of the commission shall be considered public officers for
22 purposes of section 17 of the public officers law.
23 § 4. (a) The commissioner of mental health shall submit to the commis-
24 sion not later than sixty days following the effective date of this act,
25 selection criteria for the closure of state-operated psychiatric hospi-
26 tals.
27 (1) The selection criteria shall include, but not be limited to: an
28 evaluation of the geographic need for inpatient psychiatric capacity in
29 the state-operated hospital system; the inpatient psychiatric capacity
30 currently existing in the state-operated and licensed hospital systems;
31 the maximization of anticipated savings resulting from closures, includ-
32 ing operating and capital cost avoidance; the administrative feasibility
33 of effectuating closure; capital investments already made in the state-
34 operated infrastructure; and the existence of alternative community-
35 based mental health and other support services.
36 (2) The commissioner of mental health shall also submit to the commis-
37 sion a description of current need for state-operated inpatient psychi-
38 atric capacity, a projection of the future need for state-operated inpa-
39 tient psychiatric capacity, and the total state-operated inpatient
40 psychiatric capacity which shall be eliminated. The commissioner of
41 mental health shall also be authorized to periodically update his or her
42 projection of the future need for inpatient psychiatric capacity in the
43 state-operated hospital system and resulting changes in the total state-
44 operated inpatient psychiatric capacity which shall be eliminated.
45 (b) No later than April 1, 2005, the commission shall transmit to the
46 governor and the legislature a report containing:
47 (1) The commission's recommendations for closures of state-operated
48 psychiatric hospitals and the elimination of excess inpatient psychiat-
49 ric capacity in the existing system. Such recommendations shall be
50 limited to a listing of state-operated inpatient psychiatric hospitals
51 which the commission is recommending for closure, and such recommenda-
52 tions shall include no other conditions or limitations regarding such
53 closures. Such recommendations shall provide that closures shall
54 commence not later than during the fiscal year commencing April 1, 2006
55 and shall be completed not later than the end of the fiscal year ending
56 March 31, 2010. In each such fiscal year not less than ten percent and
S. 6058 23 A. 9558
1 not more than forty percent of the total capacity to be eliminated shall
2 be recommended to be eliminated.
3 (2) The commission's justification for its recommendations for
4 closures, showing with specificity the methodology used by the commis-
5 sion, as well as the application of the selection criteria provided by
6 the commissioner of mental health pursuant to paragraph 1 of subdivision
7 (a) of this section, in order to ensure that excess state-operated inpa-
8 tient psychiatric capacity as determined by the commissioner shall be
9 eliminated, and closures will be achieved in the most efficient manner
10 possible.
11 (3) The commission's recommendations for future closures of state-op-
12 erated psychiatric hospitals to ensure that future capacity is consist-
13 ent with the commissioner's projection of future need.
14 § 5. (a) Notwithstanding the provisions of section 7.17 of the mental
15 hygiene law or any other law to the contrary, the commissioner of mental
16 health shall be authorized to take all actions necessary to close and
17 shall close all state-operated psychiatric hospitals recommended for
18 closure by the commission, pursuant to section four of this act, within
19 the time period recommended by the commission, provided, however that
20 such closures shall commence not later than during the fiscal year
21 commencing April 1, 2006, and shall be completed not later than the end
22 of the fiscal year ending March 31, 2010, and provided further that not
23 less than ten percent and not more than forty percent of the total
24 capacity to be eliminated shall be eliminated in each such fiscal year.
25 (b) The commissioner shall not carry out any recommendation for
26 closure transmitted by the commission pursuant to section four of this
27 act, if a majority of both houses of the legislature shall pass resol-
28 utions rejecting all such recommendations in their entirety within
29 forty-five days of such transmittal.
30 § 6. This act shall take effect immediately.
31 PART D
32 Section 1. Section 369-ee of the social services law is amended by
33 adding a new subdivision 2-a to read as follows:
34 2-a. Co-payments. (a) Subject to federal approval pursuant to subdivi-
35 sion six of this section, all persons receiving family health plus
36 coverage under this section shall be responsible to make co-payments for
37 the health care services, and in the amounts, set forth in paragraph (b)
38 of this subdivision.
39 (b) Co-payments shall apply to the following services:
40 (i) the services of physicians, nurse practitioners and other related
41 personnel that are provided on an outpatient basis, including outpatient
42 mental health and alcohol and substance abuse services, shall require a
43 co-payment of ten dollars;
44 (ii) inpatient services provided by: a general hospital; a facility
45 operated by the office of mental health under section 7.17 of the mental
46 hygiene law; and a facility issued an operating certificate pursuant to
47 the provisions of articles twenty-two or thirty-one of the mental
48 hygiene law, shall require a co-payment of fifty dollars for each
49 discharge;
50 (iii) emergency room services shall require a co-payment of twenty-
51 five dollars;
52 (iv) ambulance services shall require a co-payment of twenty-five
53 dollars;
S. 6058 24 A. 9558
1 (v) prescription drugs, excepting psychotropic drugs and drugs with
2 FDA approved indications for the treatment of tuberculosis as specified
3 by the department, shall require a co-payment of three dollars for each
4 generic prescription dispensed and a co-payment of five dollars for each
5 brand name prescription dispensed.
6 § 2. Subparagraph (ii) of paragraph (a) of subdivision 2 of section
7 369-ee of the social services law, as added by chapter 1 of the laws of
8 1999, is amended to read as follows:
9 (ii) is not eligible for medical assistance under title eleven of this
10 article solely due to income [or resources] or is eligible for medical
11 assistance under title eleven of this article only through the applica-
12 tion of excess income toward the costs of medical care and services
13 pursuant to subdivision two of section three hundred sixty-six [of title
14 eleven] of this article;
15 § 3. Paragraph (b) of subdivision 2 of section 369-ee of the social
16 services law, as added by chapter 1 of the laws of 1999, is amended to
17 read as follows:
18 (b) [In order to establish eligibility under this subdivision, which
19 shall be determined without regard to resources, an] An individual shall
20 provide such documentation as is necessary and sufficient to initially,
21 and annually thereafter, determine an applicant's eligibility for cover-
22 age under this title. Such documentation shall include, but not be
23 limited to the following, if needed to verify eligibility:
24 (i) paycheck stubs; or
25 (ii) written documentation of income from all employers; or
26 (iii) other documentation of income (earned or unearned) as determined
27 by the commissioner, provided however, such documentation shall set
28 forth the source of such income; and
29 (iv) proof of identity and residence as determined by the commission-
30 er.
31 § 4. Subparagraph (iv) of paragraph (a) of subdivision 2 of section
32 369-ee of the social services law, as added by chapter 1 of the laws of
33 1999, is amended to read as follows:
34 (iv) [(A)] was not covered by a group health plan based upon his or
35 her employment or a family member's employment, as defined by the
36 commissioner in consultation with the superintendent of insurance,
37 during the [six month] twelve-month period prior to the date of the
38 application under this title, except in the case of:
39 [(I)] (A) loss of employment due to factors other than voluntary sepa-
40 ration;
41 [(II)] (B) death of a family member which results in termination of
42 the applicant's coverage under the group health plan;
43 [(III)] (C) change to a new employer that does not provide an option
44 for comprehensive health benefits coverage;
45 [(IV)] (D) change of residence so that no employer-based comprehensive
46 health benefits coverage is available;
47 [(V) discontinuation of comprehensive health benefits coverage to all
48 employees of the applicant's employer;
49 (VI)] (E) expiration of the coverage periods established by COBRA or
50 the provisions of subsection (m) of section three thousand two hundred
51 twenty-one, subsection (k) of section four thousand three hundred four
52 and subsection (e) of section four thousand three hundred five of the
53 insurance law;
54 [(VII)] (F) termination of comprehensive health benefits coverage due
55 to long-term disability; or
S. 6058 25 A. 9558
1 [(VIII)] (G) loss of employment due to need to care for a child or
2 disabled household member or relative[; or].
3 [(IX) reduction in wages or hours or an increase in the cost of cover-
4 age so that coverage is no longer affordable or available.
5 (B) the implementation of this subparagraph shall take effect only
6 upon the commissioner's finding that insurance provided under this title
7 is substituting for coverage under group health plans in excess of a
8 percentage specified pursuant to subparagraph (ii) of paragraph (d) of
9 subdivision two of section twenty-five hundred eleven of the public
10 health law.]
11 § 5. Subparagraphs (xi) and (xii) of paragraph (e) of subdivision 1 of
12 section 369-ee of the social services law are REPEALED.
13 § 6. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
14 369-ee of the social services law, as added by chapter 1 of the laws of
15 1999, is amended to read as follows:
16 (iii) does not have [equivalent] health care coverage under insurance
17 or equivalent mechanisms, as defined by the commissioner in consultation
18 with the superintendent of insurance, is not a federal, state, county or
19 municipal employee, and is not employed by an employer with more than
20 fifty employees;
21 § 7. Subparagraph (i) of paragraph (d) of subdivision 3 of section
22 369-ee of the social services law, as added by chapter 1 of the laws of
23 1999, is amended to read as follows:
24 (i) approved organizations shall adhere to marketing [and enrollment]
25 guidelines established by the commissioner, which shall include but not
26 be limited to marketing [and enrollment] encounters between approved
27 organizations and prospective enrollees, locations for such encounters,
28 and prohibitions against telephone cold-calling and door-to-door solic-
29 itation at the homes of prospective enrollees. [Approved organizations
30 shall be permitted to assist prospective enrollees in completion of
31 enrollment forms at approved health care provider sites and other
32 approved locations. In no case may an emergency room be deemed an
33 approved location. Approved organizations shall submit enrollment forms
34 to the local department of social services.]
35 § 8. Subdivision 4 of section 369-ee of the social services law is
36 REPEALED.
37 § 9. Subdivisions 4 and 6 of section 47 of chapter 2 of the laws of
38 1998, amending the public health law, the social services law and the
39 insurance law relating to expanding the child health insurance plan, as
40 amended by section 21 of part A3 of chapter 62 of the laws of 2003, are
41 amended to read as follows:
42 4. sections two, three, four, seven, eight, nine, fourteen, fifteen,
43 sixteen, eighteen, eighteen-a, twenty-three, twenty-four, [twenty-five]
44 and twenty-nine of this act shall take effect January 1, 1999 and shall
45 expire on July 1, 2005; section twenty-five of this act shall take
46 effect on January 1, 1999 and shall expire on July 1, 2004;
47 6. sections twenty-four-a, twenty-six and twenty-six-a of this act
48 shall expire on July 1, [2005] 2004.
49 § 10. Notwithstanding the operation of subdivisions 4 and 6 of section
50 47 of chapter 2 of the laws of 1998, as amended by section nine of this
51 act, a person who would be otherwise ineligible for medical assistance
52 due solely to the expiration of paragraphs (t) or (u) of subdivision 4
53 of section three hundred sixty-six of the social services law shall
54 remain eligible for medical assistance until such time as such person's
55 eligibility is redetermined by the social services district pursuant to
56 such person's next scheduled recertification.
S. 6058 26 A. 9558
1 § 11. Subdivision 25 of section 2807-c of the public health law is
2 amended by adding a new paragraph (d) to read as follows:
3 (d) Notwithstanding any inconsistent provision of this section and
4 subject to the availability of federal financial participation:
5 (i) For periods on and after April first, two thousand four, the
6 commissioner shall adjust inpatient medical assistance rates of payment
7 established pursuant to this section, including discrete rates of
8 payment calculated pursuant to paragraph a-three of subdivision one of
9 this section, for non-public general hospitals in accordance with
10 subparagraph (ii) of this paragraph, for purposes of reimbursing gradu-
11 ate medical education costs based on the following methodology:
12 (ii) Rate adjustments for each non-public general hospital shall be
13 based on the difference between the graduate medical education compo-
14 nent, direct and indirect, of the two thousand three medical assistance
15 inpatient rates of payment, including exempt unit per diem rates, and
16 the sum of direct and indirect medical education costs stated at two
17 thousand three levels and calculated as follows:
18 (A) Each non-public general hospital's total direct medical education
19 costs as reported in the two thousand one institutional cost report
20 submitted as of December thirty-first, two thousand three, and
21 (B) An estimate of the total indirect medical education costs for two
22 thousand one calculated in accordance with the methodology applicable
23 for purposes of determining an estimate of indirect medical education
24 costs pursuant to subparagraph (ii) of paragraph (c) of subdivision
25 seven of this section. The indirect medical education costs shall equal
26 the product of two thousand one hospital specific inpatient operating
27 costs, including exempt unit costs, and the indirect teaching cost
28 percentage determined by the following formula:
29 1-(1/(1+1.89(((1+r)^.405)-1)))
30 where r equals the ratio of residents and fellows to beds for two thou-
31 sand one adjusted to reflect the projected two thousand three resident
32 counts.
33 (C) Each hospital's rate adjustment shall be limited to seventy-five
34 percent of the graduate medical education component included in its two
35 thousand three medical assistance inpatient rates of payment, including
36 exempt unit rates.
37 (D) No hospital shall receive a rate adjustment pursuant to this para-
38 graph if its two thousand one graduate medical education costs calcu-
39 lated in accordance with this subdivision is less than the graduate
40 medical education component of their two thousand three medical assist-
41 ance inpatient rates of payment, including exempt unit rates.
42 (iii) If the aggregate amount of rate adjustments calculated pursuant
43 to this paragraph exceeds the upper payment limit calculated pursuant to
44 federal regulations, such rate adjustments shall be reduced propor-
45 tionally by the amount in excess of the federal upper payment limit.
46 Such reduction, if applicable, shall be calculated on an annual basis.
47 (iv) Such rate adjustment shall be included as an add-on to medical
48 assistance inpatient rates of payment, excluding exempt unit rates, but
49 including inpatient rates of payment established in accordance with
50 paragraph a-three of subdivision one of this section. Such rate add-on
51 shall be based on medical assistance data reported in each hospital's
52 annual cost report submitted for the period two years prior to the rate
53 year and filed with the department by November first of the year prior
54 to the rate year. Such amounts shall not be reconciled to reflect chang-
55 es in medical assistance utilization between the year two years prior to
56 the rate year and the rate year.
S. 6058 27 A. 9558
1 § 12. Subdivision 3 of section 2807-m of the public health law is
2 amended by adding a new paragraph (e) to read as follows:
3 (e)(i) Effective April first, two thousand four, the distribution
4 amount calculated pursuant to paragraphs (c) and (d) of this subdivision
5 for each non-public teaching general hospital shall be reduced by the
6 amount calculated and included in rates pursuant to paragraph (d) of
7 subdivision twenty-five of section twenty-eight hundred seven-c of this
8 article.
9 (ii) If federal financial participation is not available for rate
10 adjustments made pursuant to paragraph (d) of subdivision twenty-five of
11 section twenty-eight hundred seven-c of this article, subparagraph (i)
12 of this paragraph shall be null and void as of April first, two thousand
13 four and distribution amounts to non-public teaching general hospitals
14 shall be calculated pursuant to paragraphs (c) and (d) of this subdivi-
15 sion.
16 § 13. Paragraph (a) of subdivision 7 of section 2807-s of the public
17 health law is amended by adding a new subparagraph (vii) to read as
18 follows:
19 (vii) provided further, however, amounts set forth in this paragraph
20 shall be reduced by the total amount calculated and included in medical
21 assistance inpatient rates of payment pursuant to paragraph (d) of
22 subdivision twenty-five of section twenty-eight hundred seven-c of this
23 article.
24 § 14. Paragraphs 1 and 2 of subsection (j) of section 4301 of the
25 insurance law, paragraph 1 as amended and paragraph 2 as added by
26 section 8 of part A of chapter 1 of the laws of 2002, are amended to
27 read as follows:
28 (1) [No] Except as provided in this subsection, every medical expense
29 indemnity corporation, dental expense indemnity corporation, health
30 service corporation, or hospital service corporation shall be [converted
31 into a corporation organized for pecuniary profit. Every such corpo-
32 ration shall be] maintained and operated for the benefit of its members
33 and subscribers as a co-operative corporation.
34 (2) An article forty-three corporation [which was the subject of an
35 initial opinion and decision issued by the superintendent on or before
36 December thirty-first, nineteen hundred ninety-nine, as the same may be
37 amended,] and its not-for-profit subsidiaries (including, without limi-
38 tation, any such subsidiary licensed as a health service corporation
39 pursuant to this chapter or as a health maintenance corporation organ-
40 ized pursuant to article forty-four of the public health law) may be
41 converted into [a corporation or other entity] one or more corporations
42 or other entities organized for pecuniary profit, or into [a for-profit
43 organization] one or more for-profit organizations, in any such case, in
44 accordance with the provisions of section seven thousand three hundred
45 seventeen of this chapter.
46 § 15. Subparagraph (O) of paragraph 4 of subsection (j) of section
47 4301 of the insurance law, as added by section 8 of part A of chapter 1
48 of the laws of 2002, is amended to read as follows:
49 (O) Notwithstanding any other provision of law, for any conversion
50 that occurs prior to January first, two thousand four, the board shall
51 direct that such proceeds of the public asset [are] shall be disbursed
52 in accordance with direction from the director of the division of the
53 budget and transferred to the credit of the tobacco control and insur-
54 ance initiatives pool, or its successor to be used for the exclusive
55 purposes provided therein; provided, however, for any conversion that
56 occurs after January first, two thousand four, the proceeds of the
S. 6058 28 A. 9558
1 public asset obtained therefrom shall be held in a separate special
2 account to be held by the public asset fund and the board may disburse
3 such proceeds only in such manner as determined by statute; provided
4 further, that up to four hundred million dollars of such proceeds shall
5 be transferred, at the direction of the director of the budget, to the
6 credit of the tobacco control and insurance initiatives pool prior to
7 June thirtieth, two thousand five.
8 § 16. Paragraph 1 of subsection (a) of section 7317 of the insurance
9 law, as added by section 10 of part A of chapter 1 of the laws of 2002,
10 is amended to read as follows:
11 (1) An article forty-three corporation [which was the subject of an
12 initial opinion and decision issued by the superintendent on or before
13 December thirty-first, nineteen hundred ninety-nine, as the same may be
14 amended,] which seeks to convert into a corporation or other entity
15 organized for pecuniary profit or into a for-profit organization of any
16 kind shall submit a proposed plan of conversion to the superintendent
17 for approval pursuant to this section.
18 § 17. Paragraph 6 of subsection (k) of section 7317 of the insurance
19 law, as added by section 10 of part A of chapter 1 of the laws of 2002,
20 is amended to read as follows:
21 (6) The affirmative vote of all three voting members of the board of
22 directors of the charitable organization shall be necessary for the
23 transaction of any business or the exercise of any power or function of
24 such board; provided, however, for any conversion that occurs after
25 January first, two thousand four, the proceeds of the charitable asset
26 obtained therefrom shall be held in a separate special account to be
27 held by the charitable organization and the board may disburse such
28 proceeds only in such manner as determined by statute. Such board may
29 delegate to one or more of its members, or its agents, such powers and
30 duties as it may deem proper.
31 § 18. Paragraph (e) of subdivision 2 of section 4 of section 1 of
32 chapter 703 of the laws of 1988, relating to enacting the expanded
33 health care coverage act of nineteen hundred eighty-eight and amending
34 the insurance law and other laws relating to expanded health care and
35 catastrophic health care coverage, as amended by section 37 of part A3
36 of chapter 62 of the laws of 2003, is amended to read as follows:
37 (e) Applications for enrollment in the individual subsidy program will
38 not be accepted on and after January first, two thousand one; provided,
39 however, individuals and families who are otherwise eligible to receive
40 benefits under such program and are enrolled prior to January first, two
41 thousand one, may remain enrolled in such program until [December] March
42 thirty-first, two thousand [five] four.
43 § 19. Paragraph (f) of subdivision 1 and subdivision 10 of section 206
44 of the public health law, paragraph (f) of subdivision 1 as amended by
45 chapter 474 of the laws of 1996 and subdivision 10 as amended by chapter
46 703 of the laws of 1988, are amended to read as follows:
47 (f) enforce the public health law, the sanitary code and the
48 provisions of the medical assistance program, or its successor, pursuant
49 to titles eleven[, eleven-A] and eleven-B of article five of the social
50 services law, as amended by this chapter;
51 10. The commissioner, with the approval of the state director of the
52 budget, shall establish and promulgate a schedule of proportional shares
53 for cost sharing [under subdivision one of section three hundred sixty-
54 nine-d of the social services law]. In developing such a schedule, the
55 commissioner shall take into consideration various options available for
56 obtaining health care services, the availability of such services, and
S. 6058 29 A. 9558
1 the impact of cost sharing on prudent utilization and efficient
2 provision of services [without undue barriers to care for persons eligi-
3 ble for assistance under the catastrophic health care expense program
4 established by section three hundred sixty-nine-c of the social services
5 law].
6 § 20. Subdivisions 1 and 6 of section 2 of the social services law, as
7 amended by chapter 474 of the laws of 1996, are amended to read as
8 follows:
9 1. Department means the [state] department of [social services] family
10 assistance, provided however that for purposes of titles eleven[,
11 eleven-A] and eleven-B of article five of this chapter, department means
12 the state department of health, except that in subdivisions two and
13 three of section three hundred sixty-four-i, clause (d) of subparagraph
14 three of paragraph (b) of subdivision two of section three hundred
15 sixty-six, paragraph (b) of subdivision four of section three hundred
16 sixty-six, subdivisions one through five of section three hundred
17 sixty-six-a, subdivision seven of section three hundred sixty-six-a, and
18 section three hundred sixty-eight-c of this chapter and where the
19 context thereof clearly requires otherwise, department means the [state]
20 department of [social services] family assistance.
21 6. Commissioner means the state commissioner of social services,
22 provided however that for purposes of titles eleven[, eleven-A] and
23 eleven-B of article five of this chapter, commissioner means the state
24 commissioner of health, except that in clause (c) of subparagraph three
25 of paragraph (b) of subdivision two of section three hundred sixty-six
26 of this chapter and where the context thereof clearly requires other-
27 wise, commissioner means the state commissioner of social services.
28 § 21. Title 11-A of article 5 of the social services law is REPEALED.
29 § 22. Notwithstanding the repeal of title 11-A of article 5 of the
30 social services law made by section twenty-one of this act, and within
31 the amounts specifically allocated to the catastrophic health care
32 expense program prior to the effective date of such repeal, participat-
33 ing social services districts are authorized to provide reimbursement to
34 families that, prior to such effective date, incur health care expenses
35 eligible for reimbursement under such program and provided further that
36 districts are authorized to expend amounts within such allocation neces-
37 sary to administer such reimbursement.
38 § 23. Clauses (C) and (D) of subparagraph (ii) of paragraph (b) of
39 subdivision 1 of section 2807-l of the public health law, as amended by
40 section 16 of part A3 of chapter 62 of the laws of 2003, are amended to
41 read as follows:
42 (C) an amount not to exceed six million dollars on an annualized basis
43 for the periods January first, nineteen hundred ninety-seven through
44 December thirty-first, nineteen hundred ninety-nine; up to six million
45 dollars for the period January first, two thousand through December
46 thirty-first, two thousand; up to five million dollars for the period
47 January first, two thousand one through December thirty-first, two thou-
48 sand one; up to four million dollars for the period January first, two
49 thousand two through December thirty-first, two thousand two; [and] up
50 to two million six hundred thousand dollars for the period January
51 first, two thousand three through December thirty-first, two thousand
52 three; and up to [two million] six hundred fifty thousand dollars for
53 the period January first, two thousand four through December thirty-
54 first, two thousand four[; and up to one million three hundred thousand
55 dollars for the period January first, two thousand five through June
S. 6058 30 A. 9558
1 thirtieth, two thousand five] shall be allocated to individual subsidy
2 programs; and
3 (D) an amount not to exceed seven million dollars on an annualized
4 basis for the periods during the period January first, nineteen hundred
5 ninety-seven through December thirty-first, nineteen hundred ninety-nine
6 and four million dollars annually for the periods January first, two
7 thousand through December thirty-first, two thousand two, and four
8 million dollars for the period January first, two thousand three through
9 December thirty-first, two thousand three[, and four million dollars for
10 the period January first, two thousand four through December thirty-
11 first, two thousand four, and two million dollars for the period January
12 first, two thousand five through June thirtieth, two thousand five]
13 shall be allocated to the catastrophic health care expense program.
14 § 24. Clause (H) of subparagraph (i) of paragraph (b) of subdivision 1
15 of section 2807-l of the public health law, as added by section 1 of
16 part M1 of chapter 63 of the laws of 2003, is amended to read as
17 follows:
18 (H) from the pool for the period January first, two thousand four
19 through the period December thirty-first, two thousand four, up to [six
20 million] six hundred fifty thousand dollars; and
21 § 25. Clause (I) of subparagraph (i) of paragraph (b) of subdivision 1
22 of section 2807-l of the public health law is REPEALED.
23 § 26. Subparagraphs (v) and (vi) of paragraph (k) of subdivision 1 of
24 section 2807-v of the public health law, as amended by section 17 of
25 part A3 of chapter 62 of the laws of 2003, are amended to read as
26 follows:
27 (v) [eighty-one] one hundred eight million five hundred seventy-five
28 thousand dollars for the period January first, two thousand four through
29 December thirty-first, two thousand four; and
30 (vi) [thirty-five] seventy-five million four hundred seventy-five
31 thousand dollars for the period January first, two thousand five through
32 June thirtieth, two thousand five.
33 § 27. Subparagraphs (v) and (vi) of paragraph (n) of subdivision 1 of
34 section 2807-v of the public health law, as amended by section 17 of
35 part A3 of chapter 62 of the laws of 2003, are amended to read as
36 follows:
37 (v) four hundred [fifty-eight] eighty-seven million [five] two hundred
38 thousand dollars for the period January first, two thousand four through
39 December thirty-first, two thousand four; and
40 (vi) two hundred [fifty] ninety-two million [seven] five hundred thou-
41 sand dollars for the period January first, two thousand five through
42 June thirtieth, two thousand five.
43 § 28. Subparagraphs (v) and (vi) of paragraph (o) of subdivision 1 of
44 section 2807-v of the public health law, as amended by section 17 of
45 part A3 of chapter 62 of the laws of 2003, are amended to read as
46 follows:
47 (v) [eighty-two] seventy-eight million [seven hundred fifty thousand]
48 dollars for the period January first, two thousand four through December
49 thirty-first, two thousand four; and
50 (vi) [forty-one] thirty-nine million [three hundred seventy-five thou-
51 sand] dollars for the period January first, two thousand five through
52 June thirtieth, two thousand five.
53 § 29. Subparagraphs (ii) and (iii) of paragraph (mm) of subdivision 1
54 of section 2807-v of the public health law, as amended by section 17 of
55 part A3 of chapter 62 of the laws of 2003, are amended to read as
56 follows:
S. 6058 31 A. 9558
1 (ii) two hundred [sixty-seven] thirty-three million [six] seven
2 hundred seventy-five thousand dollars for the period January first, two
3 thousand four through December thirty-first, two thousand four; and
4 (iii) one hundred [fifty-six] thirty million [eight hundred] nine
5 hundred twenty-five thousand dollars for the period January first, two
6 thousand five through June thirtieth, two thousand five.
7 § 30. Subdivision 1 of section 2807-v of the public health law is
8 amended by adding three new paragraphs (oo), (pp) and (qq) to read as
9 follows:
10 (oo) Funds shall be reserved and accumulated from year to year by the
11 commissioner and shall be available, including income from invested
12 funds, for the purpose of supporting the long term care insurance cover-
13 age demonstration program established pursuant to section thirty-two
14 hundred twenty-nine-a of the insurance law for the following periods in
15 the following amounts:
16 (i) up to ten million dollars for the period January first, two thou-
17 sand four through December thirty-first, two thousand four; and
18 (ii) up to five million dollars for the period January first, two
19 thousand five through June thirtieth, two thousand five.
20 (pp) Funds shall be reserved and accumulated from year to year by the
21 commissioner and shall be available, including income from invested
22 funds, for the purpose of supporting public education and marketing
23 associated with the long term care insurance coverage demonstration
24 program established pursuant to section thirty-two hundred twenty-nine-a
25 of the insurance law and the partnership for long term care program
26 under section three hundred sixty-seven-f of the social services law for
27 the following periods in the following amounts:
28 (i) up to five million dollars for the period January first, two thou-
29 sand four through December thirty-first, two thousand four; and
30 (ii) up to two million five hundred thousand dollars for the period
31 January first, two thousand five through June thirtieth, two thousand
32 five.
33 (qq) Funds shall be reserved and accumulated from year to year by the
34 commissioner and shall be available, including income from invested
35 funds, for the purpose of supporting technology related demonstration
36 programs authorized pursuant to subdivision twenty of section two
37 hundred six of this chapter, for the following periods in the following
38 amounts:
39 (i) up to five million dollars for the period January first, two thou-
40 sand four through December thirty-first, two thousand four; and
41 (ii) up to two million five hundred thousand dollars for the period
42 January first, two thousand five through June thirtieth, two thousand
43 five.
44 § 31. The insurance law is amended by adding a new section 3229-a to
45 read as follows:
46 § 3229-a. Demonstration to foster the availability of affordable long
47 term care insurance coverage. (a) The legislature intends to encourage
48 planning to maintain financial independence and personal responsibility
49 in meeting long term care needs.
50 (b) The superintendent is authorized to establish one or more demon-
51 stration programs for the purpose of evaluating mechanisms to provide,
52 maintain or subsidize long term care insurance in order to foster the
53 purchase of such coverage by New York citizens including those of moder-
54 ate means. To assist in the evaluation of such mechanisms the super-
55 intendent may establish a stop loss fund designed to examine the impact
56 of reinsurance upon the affordability and availability of long term care
S. 6058 32 A. 9558
1 insurance coverage in New York. Long term care insurance coverage eligi-
2 ble for participation in the demonstrations can be written on a group or
3 individual basis by an insurer organized or licensed under article
4 forty-two of this chapter or a corporation organized under article
5 forty-three of this chapter.
6 (c) The superintendent, in consultation with the commissioner of
7 health and the director of the office for the aging, may determine the
8 level of benefits to be included in long term care contracts or certif-
9 icates eligible for participation in the long term care demonstration
10 project. The superintendent may establish income and resources tests for
11 eligibility under the demonstration programs.
12 (d) Ten million dollars is available for the purposes of this section.
13 No demonstration program may be commenced unless the superintendent, in
14 consultation with the commissioner of health and the director of the
15 budget, estimates that the aggregate state expenditures under the
16 program would be less than the aggregate state expenditures without the
17 program.
18 (e) The commissioner of health shall apply for waivers pursuant to
19 federal law as necessary and appropriate to secure federal financial
20 assistance with the costs of the long term care demonstration programs.
21 § 32. Paragraph 3 of subsection (a) of section 3229 of the insurance
22 law, as amended by chapter 659 of the laws of 1997, is amended to read
23 as follows:
24 (3) a duration of benefits not less than [thirty six] twelve months[,
25 provided, however, if not feasible, for not less than twenty-four
26 months]; and
27 § 33. Paragraph (a) of subdivision 1 of section 367-f of the social
28 services law, as added by chapter 659 of the laws of 1997, is amended to
29 read as follows:
30 (a) "Medicaid extended coverage" shall mean eligibility for medical
31 assistance (i) without regard to the resource requirements of section
32 three hundred sixty-six of this article, or in the case of an individual
33 covered under an insurance policy or certificate described in subdivi-
34 sion two of this section that provided a residential health care facili-
35 ty benefit less than three years in duration, without consideration of
36 an amount of resources equivalent to the value of benefits received by
37 the individual under such policy or certificate, as determined under the
38 rules of the partnership for long term care program, and (ii) without
39 regard to the recovery of medical assistance from the estates of indi-
40 viduals and the imposition of liens on the homes of persons pursuant to
41 section three hundred sixty-nine of this article; provided, however,
42 that nothing herein shall prevent the imposition of a lien or recovery
43 against property of an individual on account of medical assistance
44 incorrectly paid.
45 § 34. Subdivisions (b) and (c) of section 6 of part T of chapter 383
46 of the laws of 2001, amending the tax law and other laws relating to
47 authorizing the division of the lottery to conduct a pilot program
48 involving the operation of video lottery terminals at certain race-
49 tracks, are amended to read as follows:
50 (b) Notwithstanding any law or regulation to the contrary, upon the
51 determination and certification made pursuant to subdivision (a) of this
52 section, the commissioner of health shall be authorized and directed to
53 [borrow] utilize for the purpose of transferring the amount specified in
54 subdivision (e) of this section from funds accumulated and pooled pursu-
55 ant to subdivision 14-b of section 2807-c of the public health law. If
56 however, at any time, the commissioner of health determines that the
S. 6058 33 A. 9558
1 funds pooled pursuant to subdivision 14-b of section 2807-c of the
2 public health law are insufficient to make payments which would have
3 been made except for the transfer authorized by this section, such
4 commissioner shall be authorized to transfer such amounts that shall be
5 necessary from any of the pooled funds established pursuant to the
6 following: chapters 536, 537 and 538 of the laws of 1982, chapters 807
7 and 906 of the laws of 1985, chapters 2 and 605 of the laws of 1988,
8 chapters 922 and 923 of the laws of 1990, chapter 731 of the laws of
9 1993 and chapter 81 of the laws of 1995, but in no event shall such
10 transfers exceed thirty-four million five hundred thousand dollars.
11 (c) Notwithstanding any law or regulation to the contrary, upon the
12 determination and certification made pursuant to subdivision (a) of this
13 section, the commissioner of health shall be authorized and directed to
14 [borrow] utilize for the purpose of transferring the amount specified in
15 subdivision (e) of this section from interest earnings associated with
16 the pooled funds established pursuant to the following: chapters 536,
17 537 and 538 of the laws of 1982, chapters 807 and 906 of the laws of
18 1985, chapters 2 and 605 of the laws of 1988, chapters 922 and 923 of
19 the laws of 1990, chapter 731 of the laws of 1993 and chapter 81 of the
20 laws of 1995, but in no event shall such transfers exceed ten million
21 three hundred thousand dollars.
22 § 35. Section 7 of part J of chapter 63 of the laws of 2001, amending
23 chapter 20 of the laws of 2001 amending the military law and other laws
24 relating to making appropriations for the support of government is
25 REPEALED.
26 § 36. Notwithstanding any inconsistent provision of law, rule or regu-
27 lation, for purposes of implementing the provisions of article 28 of the
28 public health law, references to titles XIX and XXI of the federal
29 social security act in article 28 of the public health law shall be
30 deemed to include and also to mean any successor titles thereto under
31 the federal social security act.
32 § 37. Notwithstanding any inconsistent provision of law, rule or regu-
33 lation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of section
34 2807 of the public health law and section 18 of chapter 2 of the laws of
35 1998, as they relate to time frames for notice, approval or certif-
36 ication of rates of payment, and to the requirement of prior notice of
37 rates of payment, are hereby suspended and shall, for purposes of imple-
38 menting the provisions of this act, be deemed to have been without force
39 and effect from and after November 1, 2003 for such rates effective for
40 the period January 1, 2004 through December 31, 2004.
41 § 38. Severability clause. If any clause, sentence, paragraph, subdi-
42 vision, section or part of this act shall be adjudged by any court of
43 competent jurisdiction to be invalid, such judgment shall not affect,
44 impair or invalidate the remainder thereof, but shall be confined in its
45 operation to the clause, sentence, paragraph, subdivision, section or
46 part thereof directly involved in the controversy in which such judgment
47 shall have been rendered. It is hereby declared to be the intent of the
48 legislature that this act would have been enacted even if such invalid
49 provisions had not be included herein.
50 § 39. This act shall take effect immediately, provided, however, that:
51 1. Sections one and five of this act shall take effect July 1, 2004;
52 sections two through four and six of this act shall take effect November
53 1, 2004; sections seven and eight of this act shall take effect April 1,
54 2004; provided however, that none of the aforementioned sections of this
55 act shall be required to be implemented sooner than sixty days following
56 the receipt of all waivers and approvals necessary under federal law and
S. 6058 34 A. 9558
1 regulation to implement the provisions of this act with federal finan-
2 cial participation;
3 2. The amendments made to paragraph (a) of subdivision 7 of section
4 2807-s of the public health law made by section thirteen of this act
5 shall not affect the expiration of such section and shall be deemed to
6 expire therewith;
7 3. Sections fourteen through seventeen of this act shall take effect
8 immediately and shall be deemed to have been in full force and effect on
9 April 1, 2002;
10 4. Provided, however, that any rules or regulations necessary to
11 implement the provisions of this act may be promulgated and any proce-
12 dures, forms, or instructions necessary for such implementation may be
13 adopted and issued on or after the date this act shall have become law;
14 5. This act shall not be construed to alter, change, affect, impair or
15 defeat any rights, obligations, duties or interests accrued, incurred or
16 conferred prior to the enactment of this act;
17 6. The commissioner of health and the superintendent of insurance and
18 any appropriate council may take any steps necessary to implement this
19 act prior to its effective dates;
20 7. Notwithstanding any inconsistent provision of the state administra-
21 tive procedure act or any other provision of law, rule or regulation,
22 the commissioner of health and the superintendent of insurance and any
23 appropriate council is authorized to adopt or amend or promulgate on an
24 emergency basis any regulation he or she or such council determines
25 necessary to implement any provision of this act on its effective date;
26 8. The provisions of this act shall be effective notwithstanding the
27 failure of the commissioner of health or the superintendent of insurance
28 or any council to adopt or amend or promulgate regulations implementing
29 this act; and
30 9. Nothing contained in this act shall be deemed to affect the appli-
31 cation, qualification, expiration, reversion or repeal of any provision
32 of law amended by any section of this act and the provisions of this act
33 shall be applied or qualified or shall expire or revert or be deemed
34 repealed in the same manner, to the same extent and on the same date as
35 the case may be as otherwise provided by law.
36 PART E
37 Section 1. The commissioner of the office of mental health shall
38 review the rates of payment for services at outpatient mental health
39 facilities subject to licensure by the office of mental health and the
40 department of health. The commissioner of the office of mental health
41 shall also determine if modification of such rate setting methodology,
42 subject to the approval of the division of the budget, is appropriate.
43 § 2. Notwithstanding any other provision of law to the contrary, the
44 commissioner of the office of mental health shall be deemed to have
45 annually certified rates of payment for services at outpatient mental
46 health facilities subject to licensure by the office of mental health
47 and the department of health, pursuant to section 43.02 of the mental
48 hygiene law, through December 31, 2003, provided, however, that subse-
49 quent to December 31, 2003, the requirements of section 43.02 of the
50 mental hygiene law pertaining to certification of rates shall continue
51 to apply. Providers of service shall have 120 days from the effective
52 date of the chapter of the laws of 2004 which added this section to
53 request a revision of such rates, provided, however, that the commis-
54 sioner of the office of mental health shall only be required to consider
S. 6058 35 A. 9558
1 requests for revisions of such rates due to errors made by the office of
2 mental health in the calculation of such rates.
3 § 3. This act shall take effect immediately.
4 PART F
5 Section 1. Notwithstanding any inconsistent provision of law or regu-
6 lation to the contrary, beginning April 1, 2004, and thereafter, rates
7 for methadone maintenance treatment services provided by diagnostic and
8 treatment centers to patients eligible for payments made by governmental
9 agencies shall equal the weekly payment made for general hospital outpa-
10 tient methadone maintenance treatment services for such patients.
11 § 2. This act shall take effect immediately and shall be deemed to
12 have been in full force and effect on and after April 1, 2004.
13 PART G
14 Section 1. Subdivision 1 of section 368-a of the social services law
15 is amended by adding a new paragraph (g-1) to read as follows:
16 (g-1) Notwithstanding any other provision of law except for section
17 two hundred twenty-one of chapter four hundred seventy-four of the laws
18 of nineteen hundred ninety-six, reimbursement for the services listed in
19 paragraph (g) of this subdivision, and for the following services:
20 managed long term care plan and managed long term care demonstration
21 services provided pursuant to paragraph (o) of subdivision two of
22 section three hundred sixty-five-a of this title; assisted living
23 program services provided pursuant to section four hundred sixty-one-l
24 of this chapter; and adult day health care program services provided
25 pursuant to the regulations of the department, shall be made as follows:
26 (i) for services provided on or after January first, two thousand five
27 through December thirty-first, two thousand five, eighty-three and one
28 hundred twelve thousandths per centum after first deducting therefrom
29 any federal funds properly received or to be received on account there-
30 of;
31 (ii) for services provided on or after January first, two thousand six
32 through December thirty-first, two thousand six, eighty-four and nine
33 hundred eighty-eight thousandths per centum after first deducting there-
34 from any federal funds properly received or to be received on account
35 thereof;
36 (iii) for services provided on or after January first, two thousand
37 seven through December thirty-first, two thousand seven, eighty-six and
38 eight hundred sixty-five thousandths per centum after first deducting
39 therefrom any federal funds properly received or to be received on
40 account thereof;
41 (iv) for services provided on or after January first, two thousand
42 eight through December thirty-first, two thousand eight, eighty-eight
43 and seven hundred forty-one thousandths per centum after first deducting
44 therefrom any federal funds properly received or to be received on
45 account thereof;
46 (v) for services provided on or after January first, two thousand nine
47 through December thirty-first, two thousand nine, ninety and six hundred
48 seventeen thousandths per centum after first deducting therefrom any
49 federal funds properly received or to be received on account thereof;
50 (vi) for services provided on or after January first, two thousand ten
51 through December thirty-first, two thousand ten, ninety-two and four
52 hundred ninety-four thousandths per centum after first deducting there-
S. 6058 36 A. 9558
1 from any federal funds properly received or to be received on account
2 thereof;
3 (vii) for services provided on or after January first, two thousand
4 eleven through December thirty-first, two thousand eleven, ninety-four
5 and three hundred seventy-one thousandths per centum after first deduct-
6 ing therefrom any federal funds properly received or to be received on
7 account thereof;
8 (viii) for services provided on or after January first, two thousand
9 twelve through December thirty-first, two thousand twelve, ninety-six
10 and two hundred forty-seven thousandths per centum after first deducting
11 therefrom any federal funds properly received or to be received on
12 account thereof;
13 (ix) for services provided on or after January first, two thousand
14 thirteen through December thirty-first, two thousand thirteen, ninety-
15 eight and one hundred twenty-four thousandths per centum after first
16 deducting therefrom any federal funds properly received or to be
17 received on account thereof;
18 (x) for services provided on or after January first, two thousand
19 fourteen through December thirty-first, two thousand fourteen, one
20 hundred per centum after first deducting therefrom any federal funds
21 properly received or to be received on account thereof.
22 § 1-a. The provisions of sections one, two, three and four of this act
23 shall be of no force and effect and shall be deemed null and void if any
24 of the following sections of this act are, subsequent to the effective
25 date of this act, amended or repealed: sections fourteen through twen-
26 ty-six, twenty-eight through thirty-one.
27 § 2. Subparagraph (iv) of paragraph (g) of subdivision 1 of section
28 368-a of the social services law, as amended by chapter 81 of the laws
29 of 1995, is amended to read as follows:
30 (iv) for services provided on or after April first, nineteen hundred
31 ninety-four through December thirty-first, two thousand four, eighty-one
32 and two hundred thirty-five thousandths per centum after first deducting
33 therefrom any federal funds properly received or to be received on
34 account thereof.
35 § 3. Paragraph (j) of subdivision 1 of section 368-a of the social
36 services law, as added by chapter 710 of the laws of 1988, is amended to
37 read as follows:
38 (j) Notwithstanding any other provision of law, but in conjunction
39 with the provisions of [paragraph] paragraphs (g) and (g-1) of this
40 subdivision [one of this section], reimbursement for the care and
41 services provided to those persons eligible pursuant to subparagraph
42 seven of paragraph (a) of subdivision one of section three hundred
43 sixty-six of this title shall be seventy-five per centum after first
44 deducting therefrom any federal funds properly received or to be
45 received on account thereof.
46 § 4. Section 97 of chapter 659 of the laws of 1997, constituting the
47 Long Term Care Integration and Finance Act of 1997, is amended to read
48 as follows:
49 § 97. This act shall take effect immediately, provided, however, that
50 the amendments to subdivision 4 of section 854 of the general municipal
51 law made by section seventy of this act shall not affect the expiration
52 of such subdivision and shall be deemed to expire therewith and provided
53 further that sections sixty-seven and sixty-eight of this act shall
54 apply to taxable years beginning on or after January 1, 1998 and
55 provided further that sections eighty-one [through], eighty-two, eight-
56 y-four, eighty-six, and eighty-seven of this act shall expire and be
S. 6058 37 A. 9558
1 deemed repealed [on] December 31, 2006 and provided further that section
2 eighty-three of this act shall expire and be deemed repealed April 1,
3 2004 and provided further that section eighty-five of this act shall
4 expire and be deemed repealed January 1, 2005 provided further, however,
5 that the amendments to section ninety of this act shall take effect
6 January 1, 1998 and shall apply to all policies, contracts, certif-
7 icates, riders or other evidences of coverage of long term care insur-
8 ance issued, renewed, altered or modified pursuant to section 3229 of
9 the insurance law on or after such date.
10 § 5. Paragraph (b) of subdivision 9 of section 367-a of the social
11 services law, as amended by chapter 19 of the laws of 1998, subparagraph
12 (ii) as amended by section 1 of part Z2 of chapter 62 of the laws of
13 2003, is amended and a new paragraph (e) is added to read as follows:
14 (b) for drugs dispensed by pharmacies:
15 (i) if the drug dispensed is a multiple source prescription drug for
16 which an upper limit has been set by the federal [health care financing
17 administration] centers for medicare and medicaid services, an amount
18 equal to the specific upper limit set by such federal agency for the
19 multiple source prescription drug, and
20 (ii) if the drug dispensed is a multiple source prescription drug or a
21 brand-name prescription drug for which no specific upper limit has been
22 set by such federal agency, the lower of the estimated acquisition cost
23 of such drug to pharmacies, or the dispensing pharmacy's usual and
24 customary price charged to the general public. [Estimated] For sole and
25 multiple source brand name drugs, estimated acquisition cost means the
26 average wholesale price of a prescription drug based upon the package
27 size dispensed from, as reported by the prescription drug pricing
28 service used by the department, less [twelve] fifteen percent thereof,
29 and updated monthly by the department. For multiple source generic
30 drugs, estimated acquisition cost means the lower of the average whole-
31 sale price of a prescription drug based on the package size dispensed
32 from, as reported by the prescription drug pricing service used by the
33 department, less thirty percent thereof, or the maximum acquisition
34 cost, if any, established pursuant to paragraph (e) of this subdivision.
35 (e) For a multiple source generic drug for which no specific upper
36 payment limit has been established by the federal centers for medicare
37 and medicaid services, the commissioner of health may establish a maxi-
38 mum acquisition cost for such drug. For this purpose, the department of
39 health is authorized to enter into a contract with an entity to provide
40 technical and administrative support to the commissioner.
41 § 6. The public health law is amended by adding a new article 2-A to
42 read as follows:
43 ARTICLE 2-A
44 PREFERRED DRUG PROGRAM
45 Section 270. Definitions.
46 271. Pharmacy and therapeutics committee.
47 272. Preferred drug program.
48 273. Prior authorization.
49 274. Clinical drug review program.
50 275. Education and outreach.
51 276. Review and reports.
52 § 270. Definitions. As used in this article, unless the context clear-
53 ly requires otherwise:
S. 6058 38 A. 9558
1 1. "Administrator" means an entity with which the commissioner
2 contracts for the purpose of administering elements of the preferred
3 drug program, as established under section two hundred seventy-two of
4 this article.
5 2. "Clinical drug review program" means the clinical drug review
6 program created by section two hundred seventy-four of this article.
7 3. "Committee" or "pharmacy and therapeutics committee" means the
8 pharmacy and therapeutics committee created by section two hundred
9 seventy-one of this article.
10 4. "Emergency condition" means a medical or behavioral condition as
11 determined by the prescriber or pharmacist, the onset of which is
12 sudden, that manifests itself by symptoms of sufficient severity,
13 including severe pain, and for which delay in beginning treatment
14 prescribed by the patient's health care practitioner would result in:
15 (a) placing the health or safety of the person afflicted with such
16 condition or other person or persons in serious jeopardy;
17 (b) serious impairment to such person's bodily functions;
18 (c) serious dysfunction of any bodily organ or part of such person;
19 (d) serious disfigurement of such person; or
20 (e) severe discomfort.
21 5. "Preferred drug program" means the preferred drug program estab-
22 lished under section two hundred seventy-two of this article.
23 6. "Prescription drug" or "drug" means a drug defined in subdivision
24 seven of section sixty-eight hundred two of the education law, for which
25 a prescription is required under the federal food, drug and cosmetic
26 act. Any drug that does not require a prescription under such act, and
27 that is reimbursed as an item of medical assistance pursuant to para-
28 graph (a) of subdivision four of section three hundred sixty-five-a of
29 the social services law, but which would otherwise meet the criteria
30 under this article for inclusion on the preferred drug list may be added
31 to the preferred drug list under this article and, if so included, shall
32 be considered to be a prescription drug for purposes of this article.
33 7. "Prior authorization" means a process requiring the prescriber or
34 the dispenser to verify with the medical assistance program or its
35 authorized agent that the drug is appropriate for the needs of the
36 specific patient.
37 8. "Supplemental rebate" means a supplemental rebate under subdivision
38 ten of section two hundred seventy-two of this article.
39 9. "Alternative rebate demonstration program" means as an alternative
40 or in addition to supplemental rebates or price discounts, the commis-
41 sioner may enter into written agreements for a demonstration program on
42 a regional basis with manufacturers or other parties to fund program
43 benefits that are guaranteed by the manufacturer to provide equivalent
44 medical assistance savings in the same state fiscal year as any savings
45 that would have been achieved had the manufacturer provided supplemental
46 rebates in order to compete under the preferred drug program. Alterna-
47 tive rebates are subject to the following restrictions:
48 (a) In no case shall the manufacturer's drugs be added to the
49 preferred drug list until after equivalent savings or supplemental
50 rebates have been received by the department.
51 (b) The required amount of equivalent savings to be achieved through
52 allowable programs shall be determined by the department, in conjunction
53 with the division of the budget, prior to any agreement being signed.
54 Calculation of such equivalent savings shall include:
55 (i) projected revenue that would have been received from supplemental
56 rebate payments and medicaid savings from market shifts and changes in
S. 6058 39 A. 9558
1 utilization which would have occurred had the manufacturer provided
2 supplemental rebates under the preferred drug program; and
3 (ii) any federal offsets which are required as a result of manufactur-
4 er funding being considered supplemental rebates under section 1927 of
5 the Social Security Act; and
6 (iii) all costs incurred by the department for an independent party to
7 evaluate the net savings achieved by allowable benefits compared to the
8 equivalent savings established under paragraph (c) of this subdivision.
9 (c) The evaluation of whether equivalent savings have been achieved
10 through allowable program benefits shall be determined by an independent
11 party selected and supervised by the department.
12 (d) Allowable program benefits may include, but are not limited to,
13 disease management programs, similar programs that reduce and contain
14 costs by redirecting care to lower cost settings, drug product donation
15 programs, drug utilization review programs, prescriber and beneficiary
16 counseling and education, fraud and abuse initiatives, and other
17 services or administrative investments that are determined by the
18 commissioner to yield the equivalent demonstrable savings in medical
19 assistance expenditures as the manufacturers provision of supplemental
20 rebates under the preferred drug program.
21 If the commissioner enters into such written agreements with a
22 manufacturer or other party to fund program benefits that result in
23 equivalent medical assistance savings, the commissioner may add selected
24 manufacturer's drugs to selected therapeutic categories of the preferred
25 drug list. Such addition of drugs to selected therapeutic categories of
26 the preferred drug list is limited to circumstances where the manufac-
27 turer provides allowable program benefits, and guaranteed equivalent
28 savings, which are: (i) in the same therapeutic categories for which the
29 drug addition is approved, or (ii) provide allowable program benefits
30 for the improved management for categories of drugs which are excluded
31 from the preferred drug program. All such additions shall be in accord-
32 ance with this section and the criteria and process set forth in section
33 two hundred seventy-two of this article. The commissioner is authorized
34 to submit the appropriate waivers, state plan amendments and federal
35 applications, including, but not limited to, waiver requests authorized
36 pursuant to sections eleven hundred fifteen and nineteen hundred fifteen
37 of the federal social security act, or successor provisions, as the
38 commissioner shall deem necessary to secure appropriate federal finan-
39 cial support for the costs of such program benefits.
40 10. "Therapeutic class" means a group of prescription drugs that
41 produce a particular intended clinical outcome and are grouped together
42 as a therapeutic class by the pharmacy and therapeutics committee.
43 § 271. Pharmacy and therapeutics committee. 1. There is hereby estab-
44 lished in the department a pharmacy and therapeutics committee. The
45 committee shall consist of thirteen members, who shall be appointed by
46 the commissioner and who shall serve three year terms; except that for
47 the initial appointments to the committee, four members shall serve one
48 year terms, five shall serve two year terms, and four shall serve three
49 year terms. Committee members may be reappointed upon the completion of
50 their terms.
51 2. The membership shall be composed as follows:
52 (a) five persons licensed and actively engaged in the practice of
53 medicine in the state;
54 (b) one person licensed and actively engaged in the practice of nurs-
55 ing as a nurse practitioner, or in the practice of midwifery in the
56 state;
S. 6058 40 A. 9558
1 (c) five persons licensed and actively engaged in the practice of
2 pharmacy in the state;
3 (d) one person with expertise in drug utilization review who is either
4 a health care professional, licensed under title eight of the education
5 law, is a pharmacologist or has a doctorate in pharmacology; and
6 (e) one person who shall be a consumer or representative of an organ-
7 ization with a regional or statewide constituency and who has been
8 involved in activities related to health care consumer advocacy.
9 3. The committee shall, at the request of the commissioner, consider
10 any matter relating to the preferred drug program established pursuant
11 to section two hundred seventy-two of this article, and may advise the
12 commissioner thereon. The committee may, from time to time, submit to
13 the commissioner recommendations relating to such preferred drug
14 program. The committee may also evaluate and provide recommendations to
15 the commissioner on other issues relating to pharmacy services under the
16 medical assistance program authorized pursuant to title eleven of arti-
17 cle five of the social services law, including, but not limited to:
18 therapeutic comparisons; enhanced use of generic drug products; enhanced
19 targeting of physician prescribing patterns; prior authorization of
20 drugs subject to the clinical drug review program established pursuant
21 to section two hundred seventy-four of this article; fraud, waste and
22 abuse prevention; negotiations for additional rebates; pharmacy benefit
23 management activity by an administrator; and negotiation of lower
24 initial drug pricing.
25 4. The committee shall elect a chairperson from among its members, who
26 shall serve a one year term as chairperson. The chairperson may serve
27 consecutive terms.
28 5. The members of the committee shall receive no compensation for
29 their services but shall be reimbursed for expenses actually and neces-
30 sarily incurred in the performance of their duties.
31 6. The committee shall be a public body under article seven of the
32 public officers law (the open meetings law) and subject to article six
33 of the public officers law (the freedom of information law). In addition
34 to the matters listed in section one hundred five of the public officers
35 law, the committee may conduct an executive session for the purpose of
36 receiving and evaluating drug pricing information related to supple-
37 mental rebates or the alternative rebate demonstration program, or
38 receiving and evaluating, trade secrets, marketing plans or other infor-
39 mation which, if disclosed, would cause substantial injury to the
40 competitive position of the manufacturer.
41 7. Committee members shall be deemed to be employees of the department
42 for the purposes of section seventeen of the public officers law, and
43 shall not participate in any matter for which a conflict of interest
44 exists.
45 8. The department shall provide administrative support to the commit-
46 tee.
47 § 272. Preferred drug program. 1. There is hereby established a
48 preferred drug program to promote access to the most effective
49 prescription drugs while reducing the cost of prescription drugs for
50 persons in the medical assistance program authorized pursuant to title
51 eleven of article five of the social services law.
52 2. When a prescriber prescribes a non-preferred drug, medicaid
53 reimbursement shall be denied unless prior authorization is obtained,
54 unless no prior authorization is required under this article.
55 3. The commissioner shall establish performance standards for the
56 program that, at a minimum, ensure that the program provides sufficient
S. 6058 41 A. 9558
1 technical support and timely responses to consumers, prescribers and
2 pharmacists.
3 4. The pharmacy and therapeutics committee shall consider and make
4 recommendations to the commissioner for the adoption of a preferred drug
5 program. (a) In developing the preferred drug program, the committee
6 shall, without limitation: (i) identify therapeutic classes of drugs to
7 be included in the preferred drug program; (ii) identify preferred drugs
8 in each of the chosen therapeutic classes; (iii) evaluate the clinical
9 effectiveness and safety of drugs considering the latest peer-reviewed
10 research and may consider studies submitted to the federal food and drug
11 administration in connection with its drug approval system; (iv) consid-
12 er the potential impact on patient care and the potential fiscal impact
13 that may result from making such a drug therapeutic class subject to
14 prior authorization; and (v) consider the potential impact of the
15 preferred drug program on the health of special populations such as
16 children, the elderly, the chronically ill, persons with HIV/AIDS and
17 persons with mental health conditions.
18 (b) In developing the preferred drug program, the committee may
19 consider preferred drug programs or evidence based research designed by
20 multi-state coalitions, or operated by or for other state governments or
21 the federal government. The department is authorized to enter into
22 contractual agreements with organizations to provide technical and clin-
23 ical support to the committee and the department in researching and
24 recommending drugs to be placed on the preferred drug list.
25 (c) The committee shall from time to time review all therapeutic
26 classes included in the preferred drug program, and may recommend that
27 the commissioner add or delete drugs or classes of drugs to or from the
28 preferred drug program, subject to this subdivision.
29 (d) The committee shall establish procedures to promptly review
30 prescription drugs newly approved by the federal food and drug adminis-
31 tration.
32 5. The committee shall recommend a procedure and criteria for the
33 approval of non-preferred drugs as part of the prior authorization proc-
34 ess. In developing these criteria, the committee shall include consider-
35 ation of the following:
36 (a) the preferred drug has been tried by the patient and has failed to
37 produce the desired health outcomes;
38 (b) the patient has tried the preferred drug and has experienced unac-
39 ceptable side effects;
40 (c) the patient has been stabilized on a non-preferred drug and tran-
41 sition to the preferred drug would be medically contraindicated; and
42 (d) the medical needs of special populations including children, the
43 elderly, the chronically ill, persons with mental health conditions, and
44 persons affected by HIV/AIDS.
45 6. The commissioner shall provide thirty days public notice on the
46 department's website prior to any meeting of the committee to develop
47 recommendations concerning the preferred drug program. Such notice
48 regarding meetings of the committee shall include a description of the
49 proposed therapeutic class to be reviewed, a listing of drug products in
50 the therapeutic class, and the proposals to be considered by the commit-
51 tee. The committee shall allow interested parties to request an opportu-
52 nity to make an oral presentation to the committee related to the prior
53 authorization of the drug therapeutic class to be reviewed. The commit-
54 tee shall consider any information provided by any interested party,
55 including, but not limited to, prescribers, dispensers, patients,
S. 6058 42 A. 9558
1 consumers and manufacturers of the drug in developing their recommenda-
2 tions.
3 7. The commissioner shall provide notice of any recommendations devel-
4 oped by the committee regarding the preferred drug program, at least
5 thirty days before any final determination by the commissioner, by
6 making such information available on the department's website. Such
7 public notice shall include: a summary of the deliberations of the
8 committee; a summary of the positions of those making public comments at
9 meetings of the committee; the response of the committee to those
10 comments, if any; and the findings and recommendations of the committee.
11 8. Within ten days of a final determination regarding the preferred
12 drug program, the commissioner shall provide public notice on the
13 department's website of such determinations, including: the nature of
14 the determination; and an analysis of the impact of the commissioner's
15 determination on the medicaid population and medicaid providers; and the
16 projected fiscal impact to the medicaid program of the commissioner's
17 determination.
18 9. (a) The commissioner shall adopt amendments to the list of
19 preferred drugs and add therapeutic categories for the preferred drug
20 program after considering the recommendations from the committee and any
21 comments received from prescribers, dispensers, patients, consumers and
22 manufacturers of the drug.
23 (b) Any therapeutic class included in the preferred drug program shall
24 be developed based on an evaluation of the clinical effectiveness, safe-
25 ty, patient outcomes initially, followed by consideration of the cost-
26 effectiveness of the drugs.
27 10. The commissioner shall provide an opportunity for pharmaceutical
28 manufacturers to provide supplemental rebates to the department; such
29 supplemental rebates shall be taken into consideration by the committee
30 and the commissioner in determining the cost-effectiveness of drugs
31 within a preferred drug class under the medical assistance program. Such
32 supplemental rebates or guaranteed savings from the alternative rebate
33 demonstration program shall be in addition to those required by applica-
34 ble federal law in effect as of the effective date of this section and
35 subdivision seven of section three hundred sixty-seven-a of the social
36 services law. In order to be considered in connection with the preferred
37 drug program, such supplemental rebates or guaranteed savings from the
38 alternative rebate demonstration program shall also apply to the drug
39 products dispensed under the elderly pharmaceutical insurance coverage
40 (EPIC) program, as well as the medical assistance for needy persons
41 program pursuant to title eleven of article five of the social services
42 law.
43 11. No prior authorization shall be required under the preferred drug
44 program for: (a) atypical anti-psychotics; (b) anti-depressants; (c)
45 anti-retrovirals used in the treatment of HIV/AIDS; and (d) drugs asso-
46 ciated with organ and tissue transplants.
47 12. The commissioner may implement all or a portion of the preferred
48 drug program through contracts with administrators with expertise in
49 management of pharmacy services, subject to applicable laws.
50 § 273. Prior authorization. 1. For the purposes of this section, a
51 prescription drug shall not be considered to be a preferred drug if it
52 is in a therapeutic class that is included on the preferred drug list
53 and is not one of the drugs on the preferred list in that class.
54 2. The program shall make available a twenty-four hour per day, seven
55 day a week telephone call center that includes a toll-free telephone
56 line and dedicated facsimile line to respond to requests for prior
S. 6058 43 A. 9558
1 authorization. The call center shall include qualified health care
2 professionals who shall be available to consult with prescribers
3 concerning prescription drugs that are not on the preferred drug list. A
4 prescriber seeking prior authorization shall consult with the program
5 call line to reasonably present his or her justification for the
6 prescription and give the program's qualified health care professional a
7 reasonable opportunity to respond.
8 3. (a) When a patient's health care provider prescribes a prescription
9 drug that is not on the preferred drug list, the prescriber shall
10 consult with the program to confirm that in his or her reasonable
11 professional judgment, the patient's clinical condition is consistent
12 with the criteria for approval of the non-preferred drug. Such criteria
13 shall include:
14 (i) the preferred drug has been tried by the patient and has failed to
15 produce the desired health outcomes;
16 (ii) the patient has tried the preferred drug and has experienced
17 unacceptable side effects;
18 (iii) the patient has been stabilized on a non-preferred drug and
19 transition to the preferred drug would be medically contraindicated; or
20 (iv) other clinical indications for the patient's use of the non-pre-
21 ferred drug.
22 (b) In the event that the patient does not meet the criteria described
23 in paragraph (a) of this subdivision, the prescriber may provide addi-
24 tional information to the program to justify the use of a prescription
25 drug that is not on the preferred drug list. The program shall provide a
26 reasonable opportunity for a prescriber to reasonably present his or her
27 justification and respond to a request for prior authorization.
28 (c) In the instance where a prior authorization determination cannot
29 be completed within twenty-four hours of the original request, a seven-
30 ty-two hour supply of the medication will be approved by the program.
31 4. When, in the judgment of the prescriber or the pharmacist, an emer-
32 gency condition exists, and the prescriber or pharmacist consults with
33 the program to confirm such an emergency, a seventy-two hour emergency
34 supply of the drug prescribed shall be authorized immediately by the
35 program.
36 5. In the event that a patient presents a prescription to a pharmacist
37 for a prescription drug that is not on the preferred drug list and for
38 which the prescriber has not obtained a prior authorization, the pharma-
39 cist shall, as soon as practicable, notify the prescriber. The prescri-
40 ber shall, as soon as practicable, either seek prior authorization or
41 shall contact the pharmacist and amend the prescription.
42 6. No prior authorization under the program shall be required when a
43 prescriber prescribes a drug on the preferred drug list.
44 7. The department shall monitor the prior authorization process for
45 prescribing patterns which are suspected of endangering the health and
46 safety of the patient or which demonstrate a likelihood of fraud or
47 abuse. The department shall take any and all actions otherwise permitted
48 by law to investigate such prescribing patterns, to take remedial action
49 including, but not limited to, a restriction of a prescriber's authority
50 under paragraph (b) of subdivision three of this section, and to enforce
51 the laws of this state.
52 § 274. Clinical drug review program. 1. In addition to the preferred
53 drug program established by this article, the commissioner may establish
54 a clinical drug review program. The commissioner may, from time to time,
55 require prior authorization under such program for prescription drugs
56 under title eleven of article five of the social services law. When a
S. 6058 44 A. 9558
1 prescriber prescribes a drug which requires prior authorization under
2 this section, medicaid reimbursement shall be denied unless such prior
3 authorization is obtained.
4 2. The program shall make available a twenty-four hour per day, seven
5 day a week response system.
6 3. In establishing a prior authorization requirement for a drug under
7 the clinical drug review program, the commissioner shall consider the
8 following:
9 (a) whether the drug requires monitoring of prescribing protocols to
10 protect both the long-term efficacy of the drug and the public health;
11 (b) the potential for, or a history of, overuse, abuse, drug diversion
12 or other illegal utilization;
13 (c) the cost of the drug compared to other drug therapies for the same
14 disease state; and
15 (d) whether a drug appears to be used in Medicaid in amounts incon-
16 sistent with non-medicaid usage patterns, after adjusting for population
17 characteristics.
18 4. The commissioner shall obtain an evaluation of the factors
19 contained in subdivision three of this section and a recommendation as
20 to the establishment of a prior authorization requirement for a drug
21 under the clinical drug review program from the pharmacy and therapeu-
22 tics committee established pursuant to section two hundred seventy-one
23 of this article. For this purpose, the commissioner and the committee,
24 as applicable, shall comply with the following meeting and notice proc-
25 esses established by this article:
26 (a) the open meetings law and freedom of information law provisions of
27 subdivision six of section two hundred seventy-one of this article; and
28 (b) the public notice and interested party provisions of subdivisions
29 eight, nine and ten of section two hundred seventy-two of this article.
30 5. The committee shall recommend a procedure and criteria for the
31 approval of drugs subject to prior authorization under the clinical drug
32 review program. Such criteria shall include the specific approved clin-
33 ical indications for use of the drug.
34 6. The commissioner shall identify a drug for which prior authori-
35 zation is required, as well as the procedures and criteria for approval
36 of use of the drug, under the clinical drug review program after consid-
37 ering the recommendations from the committee and any comments received
38 from prescribers, dispensers, consumers and manufacturers of the drug.
39 7. In the event that the patient does not meet the criteria estab-
40 lished by the commissioner in subdivision six of this section, the pres-
41 criber may provide additional information to the program to justify the
42 use of the drug. The clinical drug review program shall provide a
43 reasonable opportunity for a prescriber to reasonably present his or her
44 justification and respond to a request for prior authorization.
45 8. In the instance where a prior authorization determination cannot be
46 completed within twenty-four hours of the original request, a seventy-
47 two hour supply of the medication will be approved by the program.
48 9. When, in the judgment of the prescriber or the pharmacist, an emer-
49 gency condition exists, and the prescriber or pharmacist consults with
50 the program to confirm such an emergency, a seventy-two hour emergency
51 supply of the drug prescribed shall be authorized immediately by the
52 program.
53 10. The department shall monitor the prior authorization process for
54 prescribing patterns which are suspected of endangering the health and
55 safety of the patient or which demonstrate a likelihood of fraud or
56 abuse. The department shall take any and all actions otherwise permitted
S. 6058 45 A. 9558
1 by law to investigate such prescribing patterns, to take remedial action
2 including, but not limited to, a restriction of a prescriber's authority
3 under subdivision seven of this section, and to enforce the laws of this
4 state.
5 11. The commissioner may implement all or a portion of the clinical
6 drug review program through contracts with administrators with expertise
7 in management of pharmacy services, subject to applicable laws.
8 § 275. Education and outreach. The department may conduct education
9 and outreach programs for consumers and health care providers relating
10 to the safe, therapeutic and cost-effective use of prescription drugs
11 and appropriate treatment practices for containing prescription drug
12 costs. The department shall provide information as to how prescribers,
13 pharmacists, patients and other interested parties can obtain informa-
14 tion regarding drugs included on the preferred drug list, whether any
15 change has been made to the preferred drug list since it was last
16 issued, and the process by which prior authorization may be obtained.
17 § 276. Review and reports. 1. The commissioner, in consultation with
18 the pharmacy and therapeutics committee, shall undertake periodic
19 reviews, at least annually, of the preferred drug program which shall
20 include consideration of:
21 (a) the volume of prior authorizations being handled;
22 (b) the quality of the program's responsiveness, including the quality
23 of the administrator's responsiveness;
24 (c) complaints received from patients and providers;
25 (d) the savings attributable to the state, and to each county and the
26 city of New York, due to the provisions of this article;
27 (e) the aggregate amount of supplemental rebates received in the
28 previous fiscal year and in the current fiscal year, to date; such
29 amounts are to be broken out by fiscal year and by month;
30 (f) the savings and payments attributable to the alternative rebate
31 demonstration program by program; and
32 (g) the education and outreach program established by section two
33 hundred seventy-five of this article.
34 2. The commissioner shall, beginning March first, two thousand five
35 and annually thereafter, submit a report to the governor and the legis-
36 lature concerning each of the items subject to periodic review under
37 subdivision one of this section.
38 3. The commissioner shall, beginning with the commencement of the
39 preferred drug program and monthly thereafter, submit a report to the
40 governor and the legislature concerning the amount of supplemental
41 rebates received, and the savings and payments attributable to alterna-
42 tive supplemental rebates by the program.
43 § 7. Paragraph (a-1) of subdivision 4 of section 365-a of the social
44 services law, as added by section 5 of part B of chapter 1 of the laws
45 of 2002, is amended to read as follows:
46 (a-1) A brand name drug for which a multi-source therapeutically and
47 generically equivalent drug, as determined by the federal food and drug
48 administration, is available, unless previously authorized by the
49 department of health. The commissioner of health is authorized to
50 exempt, for good cause shown, any brand name drug from the restrictions
51 imposed by this paragraph[;]. This paragraph shall not apply to any
52 drug that is in a therapeutic class included on the preferred drug list
53 under section two hundred seventy-two of the public health law or is in
54 the clinical drug review program under section two hundred seventy-four
55 of the public health law.
S. 6058 46 A. 9558
1 § 8. Subdivision 4 of section 365-a of the social services law is
2 amended by adding a new paragraph (a-2) to read as follows:
3 (a-2) Drugs which may not be dispensed without a prescription as
4 required by section sixty-eight hundred ten of the education law, and
5 which are non-preferred drugs in a therapeutic class subject to the
6 preferred drug program pursuant to section two hundred seventy-two of
7 the public health law, or the clinical drug review program under section
8 two hundred seventy-four of the public health law, unless prior authori-
9 zation is granted or not required.
10 § 9. Subdivision 5 of section 547-d of the executive law is amended by
11 adding a new paragraph (k) to read as follows:
12 (k) implement a preferred drug program in accordance with the
13 provisions of article two-A of the public health law.
14 § 10. The department of health shall report on the preferred drug
15 program established pursuant to section 272 of article 2-A of the public
16 health law, as added by section six of this act, including an examina-
17 tion of the feasibility of extending such program to the participants of
18 other state health programs. The study shall be completed and a report
19 submitted thereon by January 1, 2006, to the governor and the legisla-
20 ture.
21 § 11. Section 3-a of part Z2 of chapter 62 of the laws of 2003 amend-
22 ing the general business law and other laws relating to implementing the
23 state fiscal plan for the 2003-2004 state fiscal year is REPEALED.
24 § 12. Notwithstanding any inconsistent provision of section 271 of the
25 public health law, as added by section six of this act, any pharmacy and
26 therapeutics committee appointed by the commissioner of health in exist-
27 ence on the effective date of this act shall continue to function and
28 shall be authorized to carry out the same duties and powers as
29 prescribed pursuant to article 2-A of the public health law, as added by
30 section six of this act, until such committee is duly appointed pursuant
31 to such section 271 of the public health law.
32 § 13. Paragraph (a) of subdivision 2 of section 2807-d of the public
33 health law is amended by adding a new subparagraph (v) to read as
34 follows:
35 (v) Notwithstanding any contrary provisions of this paragraph or any
36 other provision of law or regulation, for general hospitals the assess-
37 ment shall be seven-tenths of one percent of each general hospital's
38 gross receipts received from all patient care services and other operat-
39 ing income on a cash basis beginning April first, two thousand four for
40 hospital or health-related services, including, but not limited to inpa-
41 tient service, outpatient service, emergency service, referred ambulato-
42 ry service and ambulatory surgical services, but not including residen-
43 tial health care facilities services or home health care services.
44 § 14. Subparagraph (vi) of paragraph (b) of subdivision 2 of section
45 2807-d of the public health law, as amended by section 36 of part Z2 of
46 chapter 62 of the laws of 2003, is amended to read as follows:
47 (vi) Notwithstanding any contrary provision of this paragraph or any
48 other provision of law or regulation to the contrary, for residential
49 health care facilities the assessment shall be six percent of each resi-
50 dential health care facility's gross receipts received from all patient
51 care services and other operating income on a cash basis for the period
52 April first, two thousand two through March thirty-first, two thousand
53 three for hospital or health-related services, including adult day
54 services; provided, however, that residential health care facilities'
55 gross receipts attributable to payments received pursuant to title XVIII
56 of the federal social security act (medicare) shall be excluded from the
S. 6058 47 A. 9558
1 assessment; provided, however, that for all such gross receipts received
2 on or after April first, two thousand three through March thirty-first,
3 two thousand four, such assessment shall be five percent, and further
4 provided that for all such gross receipts received on or after April
5 first, two thousand four [through March thirty-first, two thousand
6 five,] such assessment shall be [two and five-tenths] six percent[, and
7 further provided that such assessment shall expire and be of no further
8 effect for all such gross receipts received on or after April first, two
9 thousand five].
10 § 15. Paragraph (b) of subdivision 9 of section 2807-d of the public
11 health law, as amended by section 25 of part J of chapter 82 of the laws
12 of 2002, is amended to read as follows:
13 (b) provided, however, that funds accumulated, including income from
14 invested funds, from the [further additional assessment] assessments
15 provided in accordance with subparagraph (v) of paragraph (a) and
16 subparagraphs (iii), (iv), (v) and (vi) of paragraph (b) of subdivision
17 two of this section, including interest and penalties, shall be deposit-
18 ed by the commissioner and credited to [a] the special [revenue-other]
19 revenue fund-other, miscellaneous special revenue fund (339), medical
20 assistance account [to be established by the comptroller]. To the extent
21 of funds appropriated therefor, funds shall be made available for
22 payments under the medical assistance program provided pursuant to title
23 eleven of article five of the social services law;
24 § 16. Notwithstanding subdivision 20 of section 2808 of the public
25 health law and any other inconsistent provision of law or regulation to
26 the contrary, each residential health care facility established under
27 the nursing home companies law and designated as an acquired immune
28 deficiency syndrome (AIDS) facility or having a discrete AIDS unit
29 approved by the commissioner of health shall refinance its capital mort-
30 gage on or before August 1, 2004 or 150 days immediately after the
31 effective date of this section, whichever is later, and shall forward
32 the results of such refinancing to the commissioner of health; provided
33 however, no such residential health care facility shall be required to
34 refinance its capital mortgage if the department of health, in consulta-
35 tion with the dormitory authority of the state of New York, determines
36 that such refinancing could not be accomplished on an economic basis or
37 is otherwise not feasible. Notwithstanding any inconsistent provision of
38 law or regulation to the contrary, in the event that any such residen-
39 tial health care facility does not refinance its capital mortgage and
40 the department of health has not made a determination that a refinancing
41 was not economic or feasible, then the capital cost component of rates
42 of payment determined pursuant to article 28 of the public health law
43 for such facilities beginning August 1, 2004 or 150 days immediately
44 after the effective date of this section, whichever is later, shall
45 reflect the capital interest cost equivalent to the lower of: (i) the
46 prevailing market borrowing rates available for refinancing capital
47 mortgages for their remaining term on or about August 1, 2004 or 150
48 days immediately after the effective date of this section, whichever is
49 later; or (ii) the existing rate being paid by the facility on its capi-
50 tal mortgage or mortgages as of such date. The commissioner of health
51 shall determine, in consultation with the dormitory authority of the
52 state of New York, the prevailing market borrowing rates available to
53 residential health care facilities to refinance capital mortgages for
54 purposes of this section.
S. 6058 48 A. 9558
1 § 17. Paragraph (a) of subdivision 2 of section 3614-a of the public
2 health law is amended by adding a new subparagraph (iv) to read as
3 follows:
4 (iv) Notwithstanding any contrary provisions of this paragraph or any
5 other provision of law or regulation to the contrary, for certified home
6 health agencies the assessment shall be seven-tenths of one percent of
7 each certified home health agency's gross receipts received from all
8 patient care services and other operating income on a cash basis begin-
9 ning April first, two thousand four for home care services.
10 § 18. Paragraph (b) of subdivision 2 of section 3614-a of the public
11 health law is amended by adding a new subparagraph (iv) to read as
12 follows:
13 (iv) Notwithstanding any contrary provisions of this paragraph or any
14 other provision of law or regulation to the contrary, for long term home
15 health care programs the assessment shall be seven-tenths of one percent
16 of each long term home health care program's gross receipts received
17 from all patient care services and other operating income on a cash
18 basis beginning April first, two thousand four for long term home health
19 care services.
20 § 19. Subdivision 4 of section 3614-a of the public health law, as
21 added by chapter 938 of the laws of 1990, is amended to read as follows:
22 4. The commissioner is authorized to contract with the article forty-
23 three insurance law plans, or such other administrators as the commis-
24 sioner shall designate, to receive and distribute home care provider
25 assessment funds and personal care services provider assessment funds
26 assessed pursuant to section three hundred sixty-seven-i of the social
27 services law. In the event contracts with the article forty-three insur-
28 ance law plans or other commissioner's designees are effectuated, the
29 commissioner shall conduct annual audits of the receipt and distribution
30 of the assessment funds. The reasonable costs and expenses of an admin-
31 istrator as approved by the commissioner, not to exceed for personnel
32 services on an annual basis [two] four hundred thousand dollars for all
33 assessments established pursuant to this section and the personal care
34 services provider assessment established pursuant to section three
35 hundred sixty-seven-i of the social services law, shall be paid from the
36 assessment funds.
37 § 20. Subdivision 9 of section 3614-a of the public health law, as
38 added by chapter 938 of the laws of 1990, is amended to read as follows:
39 9. (a) Funds accumulated, including income from invested funds, from
40 the assessments specified in this section, including interest and penal-
41 ties, shall be deposited by the commissioner and credited to the general
42 fund[.];
43 (b) Provided, however, that funds accumulated, including income from
44 invested funds, from the assessment provided in accordance with subpara-
45 graph (iv) of paragraph (a) and subparagraph (iv) of paragraph (b) of
46 subdivision two of this section, including interest and penalties, shall
47 be deposited by the commissioner and credited to the special revenue
48 fund-other, miscellaneous special revenue fund (339), medical assistance
49 account. To the extent of funds appropriated therefor, funds shall be
50 made available for payments under the medical assistance program
51 provided pursuant to title eleven of article five of the social services
52 law.
53 § 21. Subdivision 2 of section 3614-b of the public health law, as
54 amended by section 9 of part CC of chapter 407 of the laws of 1999, is
55 amended to read as follows:
S. 6058 49 A. 9558
1 2. (a) The assessment shall be six-tenths of one percent of such
2 licensed home care services agency's gross receipts received from all
3 patient care services and other operating income on a cash basis begin-
4 ning April first, nineteen hundred ninety-two; provided, however, that
5 for all such gross receipts received on or after April first, nineteen
6 hundred ninety-nine, such assessment shall be two-tenths of one percent,
7 and further provided that such assessment shall expire and be of no
8 further effect for all such gross receipts received on or after January
9 first, two thousand.
10 (b) Notwithstanding any contrary provisions of this subdivision or any
11 other provision of law or regulation to the contrary and subject to the
12 provisions of subdivision thirteen of this section, for licensed home
13 care services agencies the assessment shall be seven-tenths of one
14 percent of each such agency's gross receipts received from all patient
15 care services and other operating income on a cash basis beginning April
16 first, two thousand four for home care services.
17 § 22. Subdivision 13 of section 3614-b of the public health law, as
18 added by chapter 41 of the laws of 1992, is amended to read as follows:
19 13. This section shall be of no force and effect upon either: (a) a
20 waiver that is granted pursuant to federal law and regulation; or (b)
21 consistent with federal law and regulation, a waiver that is not
22 required by the secretary of the department of health and human services
23 for the exclusion of the home care services agencies assessed pursuant
24 to this section from such assessment; in order for the assessments
25 pursuant to section thirty-six hundred fourteen-a of this article and
26 section three hundred sixty-seven-i of the social services law to be
27 qualified as a broad-based health care related tax for purposes of the
28 revenues received by the state pursuant to section thirty-six hundred
29 fourteen-a of this article and section three hundred sixty-seven-i of
30 the social services law not reducing the amount expended by the state as
31 medical assistance for purposes of federal financial participation. The
32 commissioner shall not collect the assessments under this section, pend-
33 ing any contrary action by the secretary of the department of health and
34 human services. In the event the secretary of the department of health
35 and human services determines that the assessments pursuant to section
36 thirty-six hundred fourteen-a of this [chapter] article or section three
37 hundred sixty-seven-i of the social services law do not so qualify based
38 on the exclusion of licensed home care services agencies from assess-
39 ments, then the exclusion shall be deemed to have been null and void as
40 of April first, [nineteen hundred ninety-two] two thousand four, and the
41 commissioner shall collect any retroactive amount due as a result, with-
42 out interest or penalty provided the licensed home care services agency
43 pays the retroactive amount due within ninety days of notice from the
44 commissioner to the agency that the exclusion is null and void. Interest
45 and penalties shall be measured from the due date of ninety days follow-
46 ing notice from the commissioner to the agency.
47 § 23. Subdivision 9 of section 3614-b of the public health law, as
48 added by chapter 41 of the laws of 1992, is amended to read as follows:
49 9. (a) Funds accumulated, including income from invested funds, from
50 the assessments specified in this section, including interest and penal-
51 ties, shall be deposited by the commissioner and credited to the general
52 fund[.];
53 (b) Provided, however, that funds accumulated, including income from
54 invested funds, from the assessment provided in accordance with para-
55 graph (b) of subdivision two of this section, including interest and
56 penalties, shall be deposited by the commissioner and credited to the
S. 6058 50 A. 9558
1 special revenue fund-other, miscellaneous special revenue fund (339),
2 medical assistance account. To the extent of funds appropriated there-
3 for, funds shall be made available for payments under the medical
4 assistance program provided pursuant to title eleven of article five of
5 the social services law.
6 § 24. Subdivision 2 of section 367-i of the social services law, as
7 amended by section 10 of part CC of chapter 407 of the laws of 1999, is
8 amended to read as follows:
9 2. (a) The assessment shall be six-tenths of one percent of each such
10 provider's gross receipts received from all personal care services and
11 other operating income on a cash basis beginning January first, nineteen
12 hundred ninety-one; provided, however, that for all such gross receipts
13 received on or after April first, nineteen hundred ninety-nine, such
14 assessment shall be two-tenths of one percent, and further provided that
15 such assessment shall expire and be of no further effect for all such
16 gross receipts received on or after January first, two thousand.
17 (b) Notwithstanding paragraph (a) of this subdivision, the assessment
18 shall be seven-tenths of one percent of each such provider's gross
19 receipts received from all personal care services and other operating
20 income on a cash basis beginning April first, two thousand four.
21 § 25. Subdivision 8 of section 367-i of the social services law, as
22 added by chapter 938 of the laws of 1990, is amended to read as follows:
23 8. (a) Funds accumulated, including income from invested funds, from
24 the assessments specified in this section, including interest and penal-
25 ties, shall be deposited by the commissioner of health and credited to
26 the general fund[.];
27 (b) Provided, however, that funds accumulated, including income from
28 invested funds, from the assessment provided in accordance with para-
29 graph (b) of subdivision two of this section, including interest and
30 penalties, shall be deposited by the commissioner of health and credited
31 to a special revenue fund-other, miscellaneous special revenue fund
32 (339), medical assistance account. To the extent of funds appropriated
33 therefor, funds shall be made available for payments under the medical
34 assistance program provided pursuant to this title.
35 § 26. The opening paragraph and subdivisions 2, 3, 4, 5 and 6 of
36 section 36 of chapter 433 of the laws of 1997, amending the public
37 health law and other laws relating to the rate of reimbursement paid to
38 hospitals and residential health care facilities, as amended by section
39 26 of part Z2 of chapter 62 of the laws of 2003, are amended to read as
40 follows:
41 Notwithstanding any provision of law to the contrary, for the period
42 commencing July 1, 2000 and ending March 31, 2001 and for each year
43 thereafter [through March 31, 2005]:
44 (2)(a) For the purposes of developing district-specific targets to
45 enhance incentives for the efficient management of home care services,
46 the department of health shall employ a methodology which includes the
47 following components:
48 (i) districts shall be assigned to one of two peer groups for the
49 purpose of creating standards for the comparison of home care utiliza-
50 tion across districts, the first group being comprised of the districts
51 of Rockland, Suffolk, Westchester, Nassau and New York city and the
52 second group being comprised of all districts not assigned to the first
53 group;
54 (ii) a base period which shall be defined, for target calculation
55 purposes, as July 1, 1996 through March 31, 1997;
S. 6058 51 A. 9558
1 (iii) target periods, which shall be defined as July 1, 2000 through
2 March 31, 2001 and each year thereafter [through March 31, 2005];
3 (iv) each district's home care services expenditures per recipient in
4 the base period shall be arrayed within each peer group as established
5 pursuant to subparagraph (i) of this paragraph;
6 (v) standards of efficiency, which shall be defined as the median of
7 each peer group's array, provided that no standard of efficiency shall
8 be less than one hundred seventy-five percent of the statewide median
9 and provided, further, that no standard of efficiency shall exceed two
10 hundred fifty percent of the statewide median; and
11 (vi) a district-specific expenditure per recipient variance, which
12 shall be defined, for those districts whose home care services expendi-
13 tures per recipient exceed the applicable standard of efficiency, as the
14 difference between each district's expenditures per recipient and the
15 standard of efficiency.
16 (b) The district-specific expenditure per recipient variance shall be
17 multiplied by the number of home care services recipients in that
18 district in the base period and the product of that calculation shall be
19 trended forward to the target period to account for projected price and
20 recipient changes by a trend factor to be determined by the department
21 of health in consultation with the director of the division of the budg-
22 et.
23 (c) The state share of the product obtained by the calculation made
24 pursuant to paragraph (b) of this subdivision shall be reduced in an
25 amount equal to sixty percent of the state share of the savings attrib-
26 utable to the amount by which the district's utilization of long term
27 nursing facility beds by Medicaid recipients is below the national aver-
28 age (adjusted for population age sixty-five or older). For the purpose
29 of this calculation, the department of health may utilize the same data
30 utilized by the department of social services in its calculation of the
31 nursing facility adjustment for savings targets for the target period of
32 July 1, 1996 through March 31, 1997.
33 (d) The department of health shall calculate savings targets by
34 adjusting all products obtained by the calculation made pursuant to
35 paragraph (c) of this subdivision by an implementation factor such that
36 the sum of all such products equals [thirty-three million five hundred
37 sixty-five thousand dollars]:
38 (i) for target periods July 1, 2000 through March 31, 2001 and each
39 year thereafter through March 31, 2004, thirty-three million five
40 hundred sixty-five thousand dollars;
41 (ii) for target periods July 1, 2004 through March 31, 2005 and each
42 year thereafter, forty-four million dollars; after first reducing any
43 such sums which are less than twenty thousand dollars to zero.
44 (e) Notwithstanding the calculation of savings targets made pursuant
45 to paragraph (d) of this subdivision, any district for which a savings
46 target is calculated pursuant to such paragraph and which was not
47 assigned a savings target pursuant to the provisions of section 226 of
48 chapter 474 of the laws of 1996 shall be assigned a savings target equal
49 to twenty-five percent of the amount calculated pursuant to such para-
50 graph.
51 (3) On or about January 1, 2001 and on and about January 1 of each
52 year thereafter [through January 1, 2005], the department of health
53 shall notify districts as to the progress made toward reaching the
54 savings targets. Such notice shall provide districts with aggregate data
55 accumulated by such department from the beginning of each target period
56 through the most recent full calendar month for which data is available
S. 6058 52 A. 9558
1 and shall include information on the number of recipients in receipt of
2 home care services, the type of home care services provided and the cost
3 of such services.
4 (4)(a) On or before March 1, 2001 and on or before March 1 of each
5 year thereafter [through March 1, 2005], the department of health shall
6 notify districts as to: the progress made toward reaching the savings
7 targets; the amount, if any, by which the department projects, pursuant
8 to paragraph (b) of this subdivision, the district will not achieve the
9 savings targets; and the amount of state payments, if any, to be inter-
10 cepted by the department pursuant to subdivision five of this section.
11 (b) For purposes of the assessment as to achievement of savings
12 targets required by paragraph (a) of this subdivision, the department of
13 health shall take the following steps:
14 (i) calculate the state share district-specific home care expenditures
15 per recipient from the beginning of the target period through the most
16 recent full calendar month for which data is available and project such
17 calculation to the full target period; provided, however, that such
18 calculation shall exclude any expenditures during such period caused
19 solely by adjustments to rates of payment for service periods prior to
20 the target period;
21 (ii) calculate the state share district-specific home care expendi-
22 tures per recipient for the base period trended forward by the price
23 projection factor utilized pursuant to paragraph (b) of subdivision 2 of
24 this section;
25 (iii) the district-specific projected savings shall be determined by
26 subtracting the result of the calculation performed pursuant to subpara-
27 graph (i) of this paragraph from the result of the calculation performed
28 pursuant to subparagraph (ii) of this paragraph and, where the result of
29 such subtraction is a positive number, multiplying the difference by the
30 number of home care services recipients in the base period as projected
31 forward by the utilization projection factor used pursuant to paragraph
32 (b) of subdivision 2 of this section to the target period;
33 (5)(a) The department of health is authorized and directed to inter-
34 cept, on or before March 31, 2001 and on or before March 31 of each year
35 thereafter [through March 31, 2005], state payments for public assist-
36 ance and care, and any other payments otherwise to be made, to any
37 district which the department projects, pursuant to subdivision 4 of
38 this section, will fail to achieve the savings target calculated pursu-
39 ant to subdivision 2 of this section.
40 (b)(i) The department of health shall intercept the amount by which
41 the savings calculated pursuant to subparagraph (iii) of paragraph (b)
42 of subdivision 4 of this section is less than the savings targets calcu-
43 lated pursuant to subdivision 2 of this section.
44 (ii) Notwithstanding the provisions of subparagraph (i) of this para-
45 graph, the commissioner of health, in consultation with the director of
46 the division of the budget, may exercise discretion not to intercept
47 from a district if the commissioner of health reasonably anticipates
48 that the district's projected additional savings through the end of the
49 target period will exceed the amount otherwise subject to interception
50 pursuant to this paragraph.
51 (c) Payments intercepted pursuant to this subdivision shall be paid to
52 the state general fund and credited to the aid to localities, medical
53 assistance program.
54 (6) As soon as practicable after March 31, 2001 and as soon as possi-
55 ble after March 31 of each year thereafter [up to and including March
56 31, 2005], the department of health shall determine the actual home care
S. 6058 53 A. 9558
1 services state share medical assistance savings achieved by a district.
2 The department shall calculate actual savings in the same manner set
3 forth in subdivision 4 of this section, except that the calculation as
4 to actual home care services expenditures per recipient set forth in
5 subparagraph (i) of paragraph (b) of subdivision 4 of this section shall
6 be based on data for the entire target period. If the department deter-
7 mines that payments to any district were intercepted, pursuant to subdi-
8 visions 4 and 5 of this section, in an amount greater than was necessary
9 to reimburse the department for the savings target, the department shall
10 authorize payment of such amount to such district as soon as possible,
11 but in no event later than three months after the end of the target
12 period. In the case of a district for which, pursuant to subdivisions 4
13 and 5 of this section, either no intercept, or an insufficient inter-
14 cept, of state funds was made, if the department determines that such
15 district failed to achieve savings sufficient to meet its home care
16 services state share medical assistance savings target, the department
17 shall as soon as possible, but in no event later than three months after
18 the end of the target period, intercept state payments for public
19 assistance and care and any other payments otherwise to be made to such
20 district in an amount sufficient to reimburse the state for the savings
21 target.
22 § 27. It is the intent of the legislature, in conjunction with the
23 enactment of comprehensive legislation containing medical assistance
24 expenditures, that the payment schedule for medical assistance claims be
25 adjusted, as specified in this section, in order to assist in effectuat-
26 ing such cost containment with the 2004 - 2005 state fiscal plan.
27 Accordingly, notwithstanding any law, rule or regulation to the contra-
28 ry, the commissioner of health is hereby authorized and directed to take
29 such steps as necessary to adjust the schedule of medical assistance
30 payments to providers of services so that the final such payment that
31 would otherwise be made in the 2004 - 2005 state fiscal year, shall
32 instead be made on the first day of the 2005 - 2006 state fiscal year.
33 § 28. Paragraph (a) of subdivision 3 of section 366 of the social
34 services law, as amended by chapter 110 of the laws of 1971, is amended
35 to read as follows:
36 (a) Medical assistance shall be furnished to applicants in cases
37 where, although such applicant has a responsible relative with suffi-
38 cient income and resources to provide medical assistance as determined
39 by the regulations of the department, the income and resources of the
40 responsible relative are not available to such applicant because of the
41 absence of such relative [or] and the refusal or failure of such absent
42 relative to provide the necessary care and assistance. In such cases,
43 however, the furnishing of such assistance shall create an implied
44 contract with such relative, and the cost thereof may be recovered from
45 such relative in accordance with title six of article three of this
46 chapter and other applicable provisions of law.
47 § 29. Paragraph (d) of subdivision 5 of section 366 of the social
48 services law, as added by chapter 170 of the laws of 1994, is amended to
49 read as follows:
50 (d) For transfers made after August tenth, nineteen hundred ninety-
51 three:
52 (1) (i) "assets" means all income and resources of an individual and
53 of the individual's spouse, including income or resources to which the
54 individual or the individual's spouse is entitled but which are not
55 received because of action by: the individual or the individual's
56 spouse; a person with legal authority to act in place of or on behalf of
S. 6058 54 A. 9558
1 the individual or the individual's spouse; a person acting at the direc-
2 tion or upon the request of the individual or the individual's spouse;
3 or by a court or administrative body with legal authority to act in
4 place of or on behalf of the individual or the individual's spouse or at
5 the direction or upon the request of the individual or the individual's
6 spouse.
7 (ii) "blind" has the same meaning given to such term in section
8 1614(a)(2) of the federal social [social] security act.
9 (iii) "disabled" has the same meaning given to such term in section
10 1614(a)(3) of the federal social security act.
11 (iv) "income" has the same meaning given to such term in section 1612
12 of the federal social security act.
13 (v) "resources" has the same meaning given to such term in section
14 1613 of the federal social security act, without regard, in the case of
15 an institutionalized individual, to the exclusion provided for in
16 subsection (a)(1) of such section.
17 (vi) "look-back period" means the thirty-six month period, or, in the
18 case of payments from a trust or portions of a trust which are treated
19 as assets disposed of by the individual pursuant to department regu-
20 lations, the sixty-month period, immediately preceding the date that an
21 institutionalized individual is both institutionalized and has applied
22 for medical assistance, or in the case of a non-institutionalized indi-
23 vidual, the date that such non-institutionalized individual applies for
24 medical assistance coverage of long term care services; provided, howev-
25 er, that the look-back period for all types of transfers shall be sixty
26 months if the commissioner of health obtains all necessary approvals
27 under federal law and regulation to implement such a look-back period;
28 provided further that the use of a sixty-month look-back period for all
29 types of transfers shall continue only if and for so long as the use of
30 such a look-back period does not prevent the receipt of federal finan-
31 cial participation under the medical assistance program; provided
32 further that the commissioner of health shall submit such waiver appli-
33 cations and/or state plan amendments as may be necessary to obtain
34 approval to implement a sixty-month look-back period for all types of
35 transfers and to ensure continued federal financial participation.
36 (vii) "institutionalized individual" means any individual who is an
37 in-patient in a nursing facility, including an intermediate care facili-
38 ty for the mentally retarded, or who is an in-patient in a medical
39 facility and is receiving a level of care provided in a nursing facili-
40 ty, or who is receiving care, services or supplies pursuant to a waiver
41 granted pursuant to subsection (c) of section 1915 of the federal social
42 security act.
43 (viii) "intermediate care facility for the mentally retarded" means a
44 facility certified under article sixteen of the mental hygiene law and
45 which has a valid agreement with the department for providing intermedi-
46 ate care facility services and receiving payment therefor under title
47 XIX of the federal social security act.
48 (ix) "nursing facility" means a nursing home as defined by section
49 twenty-eight hundred one of the public health law and an intermediate
50 care facility for the mentally retarded.
51 (x) "nursing facility services" means nursing care and health related
52 services provided in a nursing facility; a level of care provided in a
53 hospital which is equivalent to the care which is provided in a nursing
54 facility; and care, services or supplies provided pursuant to a waiver
55 granted pursuant to subsection (c) of section 1915 of the federal social
56 security act.
S. 6058 55 A. 9558
1 (xi) "non-institutionalized individual" means an individual who is not
2 an institutionalized individual, as defined in clause (vii) of this
3 subparagraph.
4 (xii) "long term care services" means home health care services,
5 personal care services, assisted living program services and such other
6 services for which medical assistance is otherwise available under this
7 chapter which are designated as long term care services in the regu-
8 lations of the department.
9 (2) The uncompensated value of an asset is the fair market value of
10 such asset at the time of transfer, minus the amount of the compensation
11 received in exchange for the asset.
12 (3) In determining the medical assistance eligibility of an institu-
13 tionalized individual, any transfer of an asset by the individual or the
14 individual's spouse for less than fair market value made within or after
15 the look-back period shall render the individual ineligible for nursing
16 facility services for the period of time specified in subparagraph four
17 of this paragraph. In determining the medical assistance eligibility of
18 a non-institutionalized individual, any transfer of an asset by the
19 individual or the individual's spouse for less than fair market value
20 made within or after the look-back period shall render the individual
21 ineligible for long term care services for the period of time specified
22 in subparagraph four of this paragraph. Notwithstanding the provisions
23 of this subparagraph, an individual shall not be ineligible for services
24 solely by reason of any such transfer to the extent that:
25 (i) [in the case of an institutionalized individual,] the asset trans-
26 ferred was a home and title to the home [as] was transferred to: (A) the
27 spouse of the individual; or (B) a child of the individual who is under
28 the age of twenty-one years or blind or disabled; or (C) in the case of
29 an institutionalized individual, a sibling of the individual who has an
30 equity interest in such home and who resided in such home for a period
31 of at least one year immediately before the date the individual became
32 an institutionalized individual; or (D) in the case of an institutional-
33 ized individual, a child of the individual who was residing in such home
34 for a period of at least two years immediately before the date the indi-
35 vidual became an institutionalized individual, and who provided care to
36 the individual which permitted the individual to reside at home rather
37 than in an institution or facility; or
38 (ii) the assets: (A) were transferred to the individual's spouse, or
39 to another for the sole benefit of the individual's spouse; or (B) were
40 transferred from the individual's spouse to another for the sole benefit
41 of the individual's spouse; or (C) were transferred to the individual's
42 child who is blind or disabled, or to a trust established solely for the
43 benefit of such child; or (D) were transferred to a trust established
44 solely for the benefit of an individual under sixty-five years of age
45 who is disabled; or
46 (iii) a satisfactory showing is made that: (A) the individual or the
47 individual's spouse intended to dispose of the assets either at fair
48 market value, or for other valuable consideration; or (B) the assets
49 were transferred exclusively for a purpose other than to qualify for
50 medical assistance; or (C) all assets transferred for less than fair
51 market value have been returned to the individual; or
52 (iv) denial of eligibility would cause an undue hardship, as deter-
53 mined pursuant to the regulations of the department in accordance with
54 criteria established by the secretary of the federal department of
55 health and human services.
S. 6058 56 A. 9558
1 (4) (i) Any transfer made by an individual or the individual's spouse
2 under subparagraph three of this paragraph shall cause the person to be
3 ineligible for services for a period equal to the total, cumulative
4 uncompensated value of all assets transferred during or after the look-
5 back period, divided by the average monthly costs of nursing facility
6 services provided to a private patient for a given period of time at the
7 time of application, as determined pursuant to the regulations of the
8 department. The period of ineligibility shall begin with the first day
9 of the first month during or after which assets have been transferred
10 for less than fair market value, and which does not occur in any other
11 periods of ineligibility under this paragraph. For purposes of this
12 subparagraph, the average monthly costs of nursing facility services to
13 a private patient for a given period of time at the time of application
14 shall be presumed to be one hundred twenty percent of the average
15 medical assistance rate of payment as of the first day of January of
16 each year for nursing facilities within the region wherein the applicant
17 resides, as established pursuant to paragraph (b) of subdivision sixteen
18 of section twenty-eight hundred seven-c of the public health law.
19 (ii) Notwithstanding any provision of clause (i) of this subparagraph
20 to the contrary, the period of ineligibility described therein shall
21 begin on the first day the individual is receiving services for which
22 medical assistance coverage would be available but for the provisions of
23 subparagraph three of this paragraph, and which does not occur in any
24 other periods of ineligibility under this paragraph, if the commissioner
25 of health obtains all necessary approvals under federal law and regu-
26 lation to implement such a period of ineligibility. The use of such a
27 period of ineligibility shall continue only if and for so long as it
28 does not prevent the receipt of federal financial participation under
29 the medical assistance program. The commissioner of health shall submit
30 such waiver applications and/or state plan amendments as may be neces-
31 sary to obtain approval to implement the period of ineligibility
32 described in this clause and to ensure continued federal financial
33 participation.
34 (5) In the case of an asset held by an individual in common with
35 another person or persons in a joint tenancy, tenancy in common, or
36 similar arrangement, the asset, or the affected portion of the asset,
37 shall be considered to be transferred by such individual when any action
38 is taken, either by such individual or by any other person, that reduces
39 or eliminates such individual's ownership or control of such asset.
40 (6) In the case of a trust established by the individual, as deter-
41 mined pursuant to the regulations of the department, any payment, other
42 than a payment to or for the benefit of the individual, from a revocable
43 trust is considered to be a transfer of assets by the individual and any
44 payment, other than to or for the benefit of the individual, from the
45 portion of an irrevocable trust which, under any circumstance, could be
46 made available to the individual is considered to be a transfer of
47 assets by the individual and, further, the value of any portion of an
48 irrevocable trust from which no payment could be made to the individual
49 under any circumstances is considered to be a transfer of assets by the
50 individual for purposes of this section as of the date of establishment
51 of the trust, or, if later, the date on which payment to the individual
52 is foreclosed.
53 (7) In the case of a transfer by an individual which results in a
54 period of ineligibility for such individual or his or her spouse, such
55 period of ineligibility will continue without regard to the individual's
56 becoming an institutionalized individual if the transfer was made while
S. 6058 57 A. 9558
1 the individual was a non-institutionalized individual and without regard
2 to the individual's becoming a non-institutionalized individual if the
3 transfer was made while the individual was an institutionalized individ-
4 ual. In no event shall the total period of ineligibility for long term
5 care services and nursing facility services resulting from the same
6 transfer of assets exceed the period calculated pursuant to subparagraph
7 four of this paragraph.
8 § 30. Paragraph (b) of subdivision 5 of section 366-c of the social
9 services law, as added by chapter 558 of the laws of 1989, is amended to
10 read as follows:
11 (b) An institutionalized spouse shall not be ineligible for medical
12 assistance by reason of excess resources determined under paragraph (a)
13 of this subdivision, if (i) the institutionalized spouse executes an
14 assignment of support from the community spouse in favor of the social
15 services district and the department, or the institutionalized spouse is
16 unable to execute such assignment due to physical or mental impairment,
17 [or] and (ii) to deny assistance would create an undue hardship, as
18 defined by the commissioner.
19 § 31. Section thirty of this act shall not take effect unless and
20 until the commissioner of health receives all necessary approvals under
21 federal law and regulation to implement its provisions, and provided
22 that such provisions do not prevent the receipt of federal financial
23 participation under the medical assistance program. The commissioner of
24 health shall submit such waiver applications and/or state plan amend-
25 ments as may be necessary to obtain such approvals and to ensure contin-
26 ued federal financial participation.
27 § 32. Notwithstanding the provisions of paragraph (h) of subdivision 1
28 of section 368-a of the social services law, total payments made to
29 districts pursuant to such paragraph (h) for medical assistance for
30 individuals with mental disabilities who are eligible under section 366
31 of the social services law during the period - January 1, 2005 through
32 March 31, 2005, shall be reduced by $19.5 million. Such reductions shall
33 be distributed to districts proportional to each district's share of aid
34 pursuant to such paragraph (h) provided in the 2004 calendar year.
35 § 33. Paragraph (c) of subdivision 6 of section 367-a of the social
36 services law is amended by adding a new subparagraph (iii) to read as
37 follows:
38 (iii) Notwithstanding any other provision of this paragraph, co-pay-
39 ments charged for each generic prescription drug dispensed shall be one
40 dollar and for each brand name prescription drug dispensed shall be
41 three dollars.
42 § 34. Paragraph (f) of subdivision 6 of section 367-a of the social
43 services law, as added by chapter 41 of the laws of 1992, is amended to
44 read as follows:
45 (f) (i) In the year commencing April first, nineteen hundred ninety-
46 three and for each year thereafter, and ending in the year concluding on
47 March thirty-first, two thousand four, no recipient shall be required to
48 pay more than a total of one hundred dollars in co-payments required by
49 this subdivision, nor shall reductions in payments as a result of such
50 co-payments exceed one hundred dollars for any recipient.
51 (ii) In the year commencing April first, two thousand four and for
52 each year thereafter, no recipient shall be required to pay more than a
53 total of one hundred fifty dollars in co-payments required by this
54 subdivision, nor shall reductions in payments as a result of such
55 co-payments exceed one hundred fifty dollars for any recipient.
S. 6058 58 A. 9558
1 § 35. Subparagraph (iv) of paragraph (b) of subdivision 6 of section
2 367-a of the social services law, as added by chapter 41 of the laws of
3 1992, is amended to read as follows:
4 (iv) individuals enrolled in health maintenance organizations or other
5 entities which provide comprehensive health services, or other managed
6 care programs for services covered by such programs, except that such
7 persons, other than persons otherwise exempted from co-payments pursuant
8 to subparagraphs (i), (ii), (iii) and (v) of this paragraph, shall be
9 subject to co-payments as described in subparagraph (v) of paragraph (d)
10 of this subdivision; and
11 § 36. Section 364-jj of the social services law is REPEALED.
12 § 37. Subdivision 1 of section 365-c of the social services law, as
13 amended by chapter 477 of the laws of 1972, is amended to read as
14 follows:
15 1. A medical advisory committee is hereby established to consist of
16 twenty members who shall be appointed by the governor, by and with the
17 advice and consent of the senate, for the following terms: seven shall
18 be appointed for a term to expire on May thirty-first, nineteen hundred
19 seventy-four: seven shall be appointed for a term to expire on May
20 thirty-first, nineteen hundred seventy-five: and six shall be appointed
21 for a term to expire on May thirty-first, nineteen hundred seventy-six.
22 Thereafter members appointed upon expiration of a term of office shall
23 be appointed for a term of three years. Vacancies caused by death,
24 resignation or refusal to act or by removal from the state shall be
25 filled for the unexpired term only. At least seven members of such
26 committee shall be duly licensed physicians. The governor shall desig-
27 nate a chairman from among the members of the medical advisory commit-
28 tee, to serve as such at the pleasure of the governor. In appointing
29 the members of the medical advisory committee, the governor shall give
30 consideration to professional qualifications and experience and to
31 achieving representation of the professions of medicine, osteopathy,
32 podiatry, mental health, social work, dentistry, optometry, chiroprac-
33 tic, physical therapy, pharmacy, nursing, hospital and health adminis-
34 tration and education for the health professions, of public and private
35 agencies in the field of medical assistance, of entities certified under
36 article forty-four of the public health law or article forty-three of
37 the insurance law and provide services pursuant to section three hundred
38 sixty-four-j of this title, and of recipients and consumers of medical
39 assistance for needy persons.
40 § 38. Subdivision 2 of section 365-c of the social services law, as
41 added by chapter 256 of the laws of 1966, is amended to read as follows:
42 2. The medical advisory committee shall advise the commissioner with
43 respect to health and medical care services provided pursuant to this
44 title. Provided further, the medical advisory committee shall limit its
45 recommendations pertaining to managed care programs authorized under
46 section three hundred sixty-four-j of this title, to the following
47 areas: quality of care, marketing and enrollment, capacity of managed
48 care providers to accept managed care enrollees, and enrollee satisfac-
49 tion with managed care providers.
50 § 39. Section 364-j of the social services law is amended by adding a
51 new subdivision 22 to read as follows:
52 22. (a) As a means of protecting the health, safety and welfare of
53 recipients, in addition to any other sanctions that may be imposed, the
54 commissioner of health shall appoint temporary management of a managed
55 care provider upon determining that the managed care provider has
56 repeatedly failed to meet the substantive requirements of sections
S. 6058 59 A. 9558
1 1903(m) and 1932 of the federal Social Security Act and regulations. A
2 hearing shall not be required prior to the appointment of temporary
3 management.
4 (b) The commissioner of health and/or his or her designees, which may
5 be individuals within the department or other individuals or entities
6 with appropriate knowledge and experience, may be appointed as temporary
7 management. The commissioner of health may appoint the superintendent of
8 insurance and/or his or her designees as temporary management of a
9 managed care provider which is subject to rehabilitation pursuant to
10 article seventy-four of the insurance law.
11 (c) The responsibilities of temporary management shall include over-
12 sight of the managed care provider for the purpose of removing the caus-
13 es and conditions which led to the determination requiring temporary
14 management, the imposition of improvements to remedy violations and,
15 where necessary, the orderly reorganization, termination or liquidation
16 of the managed care provider.
17 (d) Temporary management may hire and fire managed care provider
18 personnel and expend managed care provider funds in carrying out the
19 responsibilities imposed pursuant to this subdivision, and shall only be
20 liable for acts or omissions that constitute gross, wilful or wanton
21 negligence.
22 (e) The commissioner of health, in consultation with the superinten-
23 dent of insurance with respect to any managed care provider subject to
24 rehabilitation pursuant to article seventy-four of the insurance law,
25 may make available to temporary management for the benefit of a managed
26 care provider for the maintenance of required reserves and deposits
27 monies from such funds as are appropriated for such purpose.
28 (f) The commissioner of health is authorized to establish in regu-
29 lation provisions for the payment of fees and expenses from funds appro-
30 priated for such purpose for non-governmental individuals and entities
31 appointed as temporary management pursuant to this subdivision.
32 (g) The commissioner of health may not terminate temporary management
33 prior to his or her determination that the managed care provider has the
34 capability to ensure that the sanctioned behavior will not recur.
35 (h) During any period of temporary management individuals enrolled in
36 the managed care provider being managed may disenroll without cause.
37 Upon reaching a determination that requires temporary management of a
38 managed care provider, the commissioner of health shall notify all
39 recipient enrollees of such provider that they may terminate enrollment
40 without cause during the period of temporary management.
41 (i) The commissioner of health may adopt and amend rules and regu-
42 lations to effectuate the purposes and provisions of this subdivision.
43 § 40. Subparagraph (i) of paragraph (e) of subdivision 4 of section
44 364-j of the social services law, as amended by chapter 433 of the laws
45 of 1997, is amended to read as follows:
46 (i) In any social services district which has not implemented a manda-
47 tory managed care program pursuant to this section, the commissioner of
48 health shall establish marketing and enrollment guidelines, including
49 but not limited to regulations governing face-to-face marketing and
50 enrollment encounters between managed care providers and recipients of
51 medical assistance and locations for such encounters. Such regulations
52 shall prohibit, at a minimum, telephone cold-calling and door-to-door
53 solicitation at the homes of medical assistance recipients. The regu-
54 lations shall also require the commissioner of health to approve any
55 local district marketing guidelines. Managed care providers shall be
56 permitted to assist participants in completion of enrollment forms at
S. 6058 60 A. 9558
1 approved health care provider sites and other approved locations. In no
2 case may an emergency room be deemed an approved location. Upon enroll-
3 ment, participants will sign an attestation that: they have been
4 informed that managed care is a voluntary program; participants have a
5 choice of managed care providers; participants have a choice of primary
6 care practitioners; and participants must exclusively use their primary
7 care practitioner and plan providers except as otherwise provided in
8 this section including but not limited to the exceptions listed in
9 subparagraph (iii) of paragraph (a) of this subdivision. Managed care
10 providers must submit enrollment forms to the local department of social
11 services. The local department of social services will provide or
12 arrange for an audit of managed care provider enrollment forms; includ-
13 ing telephone contacts to determine if participants were provided with
14 the information required by this subparagraph. The commissioner of
15 health or the local department of social services may suspend or curtail
16 enrollment or impose sanctions for failure to appropriately notify
17 clients as required in this subparagraph.
18 § 41. Subparagraph (v) of paragraph (e) of subdivision 4 of section
19 364-j of the social services law, as amended by chapter 433 of the laws
20 of 1997, is amended to read as follows:
21 (v) Upon delivery of the pre-enrollment information, the local
22 district or the enrollment organization shall certify the participant's
23 receipt of such information. Upon verification that the participant has
24 received the pre-enrollment education information, a managed care
25 provider, a local district or the enrollment organization may enroll a
26 participant into a managed care plan. Managed care providers must submit
27 enrollment forms to the local department of social services. Upon
28 enrollment, participants will sign an attestation that they have been
29 informed that: participants have a choice of managed care providers;
30 participants have a choice of primary care practitioners; and, except as
31 otherwise provided in this section, including but not limited to the
32 exceptions listed in subparagraph (iii) of paragraph (a) of this subdi-
33 vision, participants must exclusively use their primary care practition-
34 ers and plan providers. The commissioner of health or the local depart-
35 ment of social services may suspend or curtail enrollment or impose
36 sanctions for failure to appropriately notify clients as required in
37 this subparagraph.
38 § 42. Subdivision 19 of section 364-j of the social services law, as
39 amended by chapter 649 of the laws of 1996, is amended to read as
40 follows:
41 19. [(a)] The commissioner of health[, in consultation with the
42 commissioner,] shall promulgate such regulations as are necessary to
43 implement the provisions of this section, including regulations to
44 suspend or curtail enrollment or impose sanctions on a managed care
45 provider, including imposition of civil penalties, for failure to comply
46 with the provisions of this section; provided, however, that the
47 provisions of this subdivision shall not limit specific actions taken by
48 the department of health or the department in order to ensure federal
49 financial participation.
50 § 43. Paragraphs (c), (s), (t), (u), (v) and (w) of subdivision 1 of
51 section 364-j of the social services law, paragraph (c) as amended by
52 chapter 649 of the laws of 1996, paragraphs (s), (u), (v) and (w) as
53 added by chapter 433 of the laws of 1997 and paragraph (t) as amended by
54 section 24 of part E of chapter 58 of the laws of 1998, are amended to
55 read as follows:
S. 6058 61 A. 9558
1 (c) "Managed care program". A statewide program [in a social services
2 district] in which medical assistance recipients enroll on a voluntary
3 or mandatory basis to receive medical assistance services, including
4 case management, directly and indirectly (including by referral) from a
5 managed care provider, and as applicable, a mental health special needs
6 plan or a comprehensive HIV special needs plan, under this section.
7 (s) "Existing rates". The rates paid pursuant to the most recent
8 executed contract between a local social services district or the state
9 and a managed care provider[, which shall include any increase effective
10 January first, nineteen hundred ninety-seven, except those rate
11 increases resulting from subdivision twenty-one of this section; and
12 further provided that any adjustments made pursuant to a chapter of the
13 laws of nineteen hundred ninety-seven, related to pharmacy benefits, if
14 any, shall be reflected in such rates].
15 (t) ["Competitive bidding process". The health plan procurement proc-
16 ess undertaken by the department of health to select managed care
17 providers under the Partnership Plan RFP released November fourteenth,
18 nineteen hundred ninety-five, and with respect to any rate adjustments
19 made under this section for any period commencing on or after April
20 first, nineteen hundred ninety-eight, the health plan procurement proc-
21 ess undertaken by Westchester county to select managed care providers
22 pursuant to an RFP released September twelfth, nineteen hundred ninety-
23 six.
24 (u)] "Managed care rating regions". The regions established [pursuant
25 to the competitive bidding process] by the department of health for the
26 purpose of setting regional premium rates for managed care providers.
27 [(v)] (u) "Premium group". The various demographic, gender and recipi-
28 ent categories utilized for rate-setting purposes by the department of
29 health [in the competitive bidding process].
30 [(w)] (v) "Upper payment limit". The maximum reimbursement that the
31 department of health may pay a managed care provider for providing or
32 arranging for medical services to participants in a managed care program
33 in accordance with the federal social security act and regulations
34 promulgated thereunder.
35 § 44. Paragraphs (a) and (b) of subdivision 3 of section 364-j of the
36 social services law, as amended by chapter 649 of the laws of 1996,
37 subparagraph (iii) of paragraph (b) as amended by section 4 of part B of
38 chapter 57 of the laws of 2000, are amended to read as follows:
39 (a) Every person eligible for or receiving medical assistance under
40 this article, who resides in a social services district providing
41 medical assistance [under a managed care program approved by the commis-
42 sioner of health in cooperation with the commissioner and the commis-
43 sioner of the responsible special care agencies pursuant to this
44 section], which has implemented the state's managed care program shall
45 participate in the program authorized by this section. Provided, howev-
46 er, that participation in a comprehensive HIV special needs plan also
47 shall be in accordance with article forty-four of the public health law
48 and participation in a mental health special needs plan shall also be in
49 accordance with article forty-four of the public health law and article
50 thirty-one of the mental hygiene law.
51 (b) A medical assistance recipient shall not be required to partic-
52 ipate in, and shall be permitted to withdraw from [a] the managed care
53 program upon a showing that:
54 (i) a managed care provider is not geographically accessible to the
55 person so as to reasonably provide services to the person, or upon a
56 showing of other good cause as defined in regulation. A managed care
S. 6058 62 A. 9558
1 provider is not geographically accessible if the person cannot access
2 its services in a timely fashion due to distance or travel time;
3 (ii) a pregnant woman with an established relationship, as defined by
4 the commissioner of health, with a comprehensive prenatal primary care
5 provider, including a prenatal care assistance program as defined in
6 title two of article twenty-five of the public health law, that is not
7 associated with a managed care provider in the [managed care program of
8 the] participant's social services district, may defer participation in
9 the managed care program while pregnant and for sixty days post-partum;
10 (iii) an individual with a chronic medical condition being treated by
11 a specialist physician that is not associated with a managed care
12 provider in the [managed care program of the] participant's social
13 services district, may defer participation in the managed care program
14 until the course of treatment is complete; and
15 (iv) a participant cannot be served by a managed care provider who
16 participates in a managed care program due to a language barrier.
17 § 45. The opening paragraph and paragraphs (a), (e), (f) and (g) of
18 subdivision 4 of section 364-j of the social services law, the opening
19 paragraph and paragraphs (a), (e) and (f) as amended by chapter 649 of
20 the laws of 1996, subparagraph (i) of paragraph (a) as amended by chap-
21 ter 558 of the laws of 1999, clause (D) of subparagraph (iii) of para-
22 graph (a) as added and clause (E) of subparagraph (iii) of paragraph (a)
23 as relettered by chapter 697 of the laws of 2003, subparagraphs (i) and
24 (v) of paragraph (e) and paragraph (g) as amended and subparagraph
25 (viii) of paragraph (e) as added by chapter 433 of the laws of 1997 and
26 subparagraph (iv) of paragraph (e) as amended by section 6 of part B of
27 chapter 57 of the laws of 2000, are amended to read as follows:
28 [Managed care programs] The managed care program shall provide partic-
29 ipants access to comprehensive and coordinated health care delivered in
30 a cost effective manner consistent with the following provisions:
31 (a) (i) a managed care provider shall arrange for access to and
32 enrollment of primary care practitioners and other medical services
33 providers. Each managed care provider shall possess the expertise and
34 sufficient resources to assure the delivery of quality medical care to
35 participants in an appropriate and timely manner and may include physi-
36 cians, nurse practitioners, county health departments, providers of
37 comprehensive health service plans licensed pursuant to article forty-
38 four of the public health law, and hospitals and diagnostic and treat-
39 ment centers licensed pursuant to article twenty-eight of the public
40 health law or otherwise authorized by law to offer comprehensive health
41 services or facilities licensed pursuant to articles sixteen, [twenty-
42 three,] thirty-one and thirty-two of the mental hygiene law.
43 (ii) provided, however, if a major public hospital, as defined in the
44 public health law, is designated by [a social services district] the
45 commissioner of health as a managed care provider[, the] in a social
46 services district the commissioner of health shall designate at least
47 one other managed care provider which is not a major public hospital or
48 facility operated by a major public hospital; and
49 (iii) under a managed care program, not all managed care providers
50 must be required to provide the same set of medical assistance services.
51 [A] The managed care program shall establish procedures through which
52 participants will be assured access to all medical assistance services
53 to which they are otherwise entitled, other than through the managed
54 care provider, where:
55 (A) the service is not reasonably available directly or indirectly
56 from the managed care provider,
S. 6058 63 A. 9558
1 (B) it is necessary because of emergency or geographic unavailability,
2 or
3 (C) the services provided are family planning services; or
4 (D) the services are dental services and are provided by a diagnostic
5 and treatment center licensed under article twenty-eight of the public
6 health law which is affiliated with an academic dental center and which
7 has been granted an operating certificate pursuant to article twenty-
8 eight of the public health law to provide such dental services. Any
9 diagnostic and treatment center providing dental services pursuant to
10 this clause shall prior to June first of each year report to the gover-
11 nor, temporary president of the senate and speaker of the assembly on
12 the following: the total number of visits made by medical assistance
13 recipients during the immediately preceding calendar year; the number of
14 visits made by medical assistance recipients during the immediately
15 preceding calendar year by recipients who were enrolled in managed care
16 programs; the number of visits made by medical assistance recipients
17 during the immediately preceding calendar year by recipients who were
18 enrolled in managed care programs that provide dental benefits as a
19 covered service; and the number of visits made by the uninsured during
20 the immediately preceding calendar year; or
21 (E) other services as defined by the commissioner of health.
22 (e) (i) In any social services district which has not implemented a
23 mandatory managed care program pursuant to this section, the commission-
24 er of health shall establish marketing and enrollment guidelines,
25 including but not limited to regulations governing face-to-face market-
26 ing and enrollment encounters between managed care providers and recipi-
27 ents of medical assistance and locations for such encounters. Such regu-
28 lations shall prohibit, at a minimum, telephone cold-calling and
29 door-to-door solicitation at the homes of medical assistance recipients.
30 The regulations shall also require the commissioner of health to approve
31 any local district marketing guidelines. Managed care providers shall be
32 permitted to assist participants in completion of enrollment forms at
33 approved health care provider sites and other approved locations. In no
34 case may an emergency room be deemed an approved location. Upon enroll-
35 ment, participants will sign an attestation that: they have been
36 informed that managed care is a voluntary program; participants have a
37 choice of managed care providers; participants have a choice of primary
38 care practitioners; and participants must exclusively use their primary
39 care practitioner and plan providers except as otherwise provided in
40 this section including but not limited to the exceptions listed in
41 subparagraph (iii) of paragraph (a) of this subdivision. Managed care
42 providers must submit enrollment forms to the local department of social
43 services. The local department of social services will provide or
44 arrange for an audit of managed care provider enrollment forms; includ-
45 ing telephone contacts to determine if participants were provided with
46 the information required by this subparagraph. The [local department of
47 social services] commissioner of health may suspend or curtail enroll-
48 ment or impose sanctions for failure to appropriately notify clients as
49 required in this subparagraph.
50 (ii) In any social services district which has implemented a mandatory
51 managed care program pursuant to this section, the requirements of this
52 subparagraph shall apply to the extent consistent with federal law and
53 regulations. The department of health, may contract with one or more
54 independent organizations to provide enrollment counseling and enroll-
55 ment services, for participants required to enroll in managed care
56 programs, for each social services district requesting the services of
S. 6058 64 A. 9558
1 an enrollment broker. To select such organizations, the department of
2 health shall issue a request for proposals (RFP), shall evaluate
3 proposals submitted in response to such RFP and, pursuant to such RFP,
4 shall award a contract to one or more qualified and responsive organiza-
5 tions. Such organizations shall not be owned, operated, or controlled by
6 any governmental agency, managed care provider, comprehensive HIV
7 special needs plan, mental health special needs plan, or medical
8 services provider.
9 (iii) Such independent organizations shall develop enrollment guides
10 for participants which shall be approved by the department of health
11 prior to distribution.
12 (iv) Local social services districts or enrollment organizations
13 through their enrollment counselors shall provide participants with the
14 opportunity for face to face counseling including individual counseling
15 upon request of the participant. Local social services districts or
16 enrollment organizations through their enrollment counselors shall also
17 provide participants with information in a culturally and linguistically
18 appropriate and understandable manner, in light of the participant's
19 needs, circumstances and language proficiency, sufficient to enable the
20 participant to make an informed selection of a managed care provider.
21 Such information shall include, but shall not be limited to: how to
22 access care within the program; a description of the medical assistance
23 services that can be obtained other than through a managed care provid-
24 er, mental health special needs plan or comprehensive HIV special needs
25 plan; the available managed care providers, mental health special needs
26 plans and comprehensive HIV special needs plans and the scope of
27 services covered by each; a listing of the medical services providers
28 associated with each managed care provider; the participants' rights
29 within the managed care program; and how to exercise such rights.
30 Enrollment counselors shall inquire into each participant's existing
31 relationships with medical services providers and explain whether and
32 how such relationships may be maintained within the managed care
33 program. For enrollments made during face to face counseling, if the
34 participant has a preference for particular medical services providers,
35 enrollment counselors shall verify with the medical services providers
36 that such medical services providers whom the participant prefers
37 participate in the managed care provider's network and are available to
38 serve the participant.
39 (v) Upon delivery of the pre-enrollment information, the local
40 district or the enrollment organization shall certify the participant's
41 receipt of such information. Upon verification that the participant has
42 received the pre-enrollment education information, a managed care
43 provider, a local district or the enrollment organization may enroll a
44 participant into a managed care [plan] provider. Managed care providers
45 must submit enrollment forms to the local department of social services.
46 Upon enrollment, participants will sign an attestation that they have
47 been informed that: participants have a choice of managed care provid-
48 ers; participants have a choice of primary care practitioners; and,
49 except as otherwise provided in this section, including but not limited
50 to the exceptions listed in subparagraph (iii) of paragraph (a) of this
51 subdivision, participants must exclusively use their primary care prac-
52 titioners and plan providers. The [local department of social services]
53 commissioner of health may suspend or curtail enrollment or impose sanc-
54 tions for failure to appropriately notify clients as required in this
55 subparagraph.
S. 6058 65 A. 9558
1 (vi) Enrollment counselors or local social services districts shall
2 further inquire into each participant's health status in order to iden-
3 tify physical or behavioral conditions that require immediate attention
4 or continuity of care, and provide to participants information regarding
5 health care options available to persons with HIV and other illnesses or
6 conditions under the managed care program. Any information disclosed to
7 counselors shall be kept confidential in accordance with applicable
8 provisions of the public health law, and as appropriate, the mental
9 hygiene law.
10 (vii) Any marketing materials developed by a managed care provider,
11 comprehensive HIV special needs plan or mental health special needs plan
12 shall be approved by the department of health or the local social
13 services district and the commissioner of mental health, where appropri-
14 ate, within sixty days prior to distribution to recipients of medical
15 assistance. All marketing materials shall be reviewed within sixty days
16 of submission.
17 (viii) In any social services district which has implemented a manda-
18 tory managed care program pursuant to this section, the commissioner of
19 health shall establish marketing and enrollment guidelines, including
20 but not limited to regulations governing face-to-face marketing and
21 enrollment encounters between managed care providers and recipients of
22 medical assistance and locations for such encounters. Such regulations
23 shall prohibit, at a minimum, telephone cold-calling and door-to-door
24 solicitation at the homes of medical assistance recipients. The regu-
25 lations shall also require the commissioner of health to approve any
26 local district marketing guidelines.
27 (f) (i) Participants shall have no less than sixty days from the date
28 selected by the district to enroll in [its] the managed care program to
29 select a managed care provider, and as appropriate, a mental health
30 special needs plan, and shall be provided with information to make an
31 informed choice. Where a participant has not selected such a provider or
32 mental health special needs plan, [a social services official] the
33 commissioner of health shall assign such participant to a managed care
34 provider, and as appropriate, to a mental health special needs plan,
35 taking into account capacity and geographic accessibility. The commis-
36 sioner may after the period of time established in subparagraph (ii) of
37 this paragraph assign participants to a managed care provider taking
38 into account quality performance criteria and cost. Provided however,
39 cost criteria shall not be of greater value than quality criteria in
40 assigning participants.
41 (ii) The commissioner may assign participants pursuant to such crite-
42 ria on a weighted basis, provided however that for twelve months follow-
43 ing implementation of a mandatory program, pursuant to a federal waiver,
44 twenty-five percent of the participants that do not choose a managed
45 care provider shall be assigned to managed care providers that satisfy
46 the criteria set forth in subparagraph (i) of this paragraph, and are
47 controlled by, sponsored by, or otherwise affiliated through a common
48 governance or through a parent corporation with, one or more private
49 not-for-profit or public general hospitals or diagnostic and treatment
50 centers licensed pursuant to article twenty-eight of the public health
51 law.
52 (iii) For twelve months following the twelve months described in
53 subparagraph (ii) of this paragraph twenty-two and one-half percent of
54 the participants that do not choose a managed care provider shall be
55 assigned to managed care providers, that satisfy the criteria set forth
56 in subparagraph (i) of this paragraph and are controlled by, sponsored
S. 6058 66 A. 9558
1 by, or otherwise affiliated through a common governance or through a
2 parent corporation with, one or more private not-for-profit or public
3 general hospitals or diagnostic and treatment centers licensed pursuant
4 to article twenty-eight of the public health law.
5 (iv) For twelve months following the twelve months described in
6 subparagraph (iii) of this paragraph twenty percent of the participants
7 that do not choose a managed care provider shall be assigned equally
8 among each of the managed care providers, that satisfy the criteria set
9 forth in subparagraph (i) of this paragraph and are controlled by, spon-
10 sored by, or otherwise affiliated through a common governance or through
11 a parent corporation with one or more private not-for-profit or public
12 general hospitals or diagnostic and treatment centers licensed pursuant
13 to article twenty-eight of the public health law.
14 (v) The commissioner shall assign all participants not otherwise
15 assigned to a managed care plan pursuant to subparagraphs (ii), (iii)
16 and (iv) of this paragraph equally among each of the managed care
17 providers that meet the criteria established in subparagraph (i) of this
18 paragraph.
19 (g) If another managed care provider, mental health special needs plan
20 or comprehensive HIV special needs plan is available, participants may
21 change such provider or plan without cause within thirty days of notifi-
22 cation of enrollment or the effective date of enrollment, whichever is
23 later with a managed care provider, mental health special needs plan or
24 comprehensive HIV special needs plan by making a request of the local
25 social services district except that such period shall be forty-five
26 days for participants who have been assigned to a provider by [a social
27 services official] the commissioner of health. However, after such thir-
28 ty or forty-five day period, whichever is applicable, a participant may
29 be prohibited from changing managed care providers more frequently than
30 once every twelve months, as permitted by federal law except for good
31 cause as determined by the commissioner of health through regulations.
32 § 46. Subdivision 5 of section 364-j of the social services law, as
33 amended by chapter 649 of the laws of 1996, paragraph (b) as amended by
34 chapter 433 of the laws of 1997, is amended to read as follows:
35 5. Managed care programs shall be conducted [only] in accordance with
36 [plans submitted by a social services district or any combination of
37 social services districts and approved by the commissioner of health, in
38 consultation with the commissioner and the commissioner of the responsi-
39 ble special care agency. Such plans shall be consistent with] the
40 requirements of this section and, to the extent practicable, encourage
41 the provision of comprehensive medical services, pursuant to this arti-
42 cle[, and shall:].
43 (a) [identify and document the specific problems which the managed
44 care program is designed to address including the current primary care
45 and specialist network actually available to medical assistance recipi-
46 ents within the district and a reasonable estimate of the program's
47 local cost effectiveness;
48 (b)] The managed care program shall provide for the selection of qual-
49 ified managed care providers by the commissioner of health and, as
50 appropriate, mental health special needs plans and comprehensive HIV
51 special needs plans to participate in the program, provided, however,
52 that the commissioner of health may contract directly with comprehensive
53 HIV special needs plans consistent with standards set forth in this
54 section, and assure that such providers are accessible taking into
55 account the needs of persons with disabilities and the differences
56 between rural, suburban, and urban settings, and in sufficient numbers
S. 6058 67 A. 9558
1 to meet the health care needs of participants, and shall consider the
2 extent to which major public hospitals are included within such provid-
3 ers' networks[;
4 (c) demonstrate that health care providers, managed care providers,
5 insurers, medical assistance recipients and the general public were
6 provided the opportunity to participate in the development of the plan;
7 (d) describe the enrollment process and any marketing materials and
8 indicate whether enrollment will be conducted by the social services
9 district or some other entity;
10 (e) demonstrate that medical assistance recipients who are eligible to
11 participate in a managed care program shall be fully informed of how
12 services are provided through managed care programs, and provided suffi-
13 cient information, in reasonably understandable and culturally and
14 linguistically appropriate form, to assure that such recipients can make
15 an informed choice of managed care and primary care providers].
16 (b) A proposal submitted by a managed care provider to participate in
17 the managed care program shall:
18 (i) designate the geographic area to be served by the provider, and
19 estimate the number of eligible participants and actual participants in
20 such designated area;
21 (ii) include a network of health care providers in sufficient numbers
22 and geographically accessible to service program participants;
23 (iii) describe the procedures for marketing in the program location,
24 including the designation of other entities which may perform such func-
25 tions under contract with the organization;
26 (iv) describe the quality assurance, utilization review and case
27 management mechanisms to be implemented;
28 (v) demonstrate the applicant's ability to meet the data analysis and
29 reporting requirements of the program;
30 (vi) demonstrate financial feasibility of the program; and
31 (vii) include such other information as the commissioner of health may
32 deem appropriate.
33 (c) The commissioner of health shall make a determination whether to
34 approve, disapprove or recommend modification of the proposal.
35 (d) Notwithstanding any inconsistent provision of this title and
36 section one hundred sixty-three of the state finance law, the commis-
37 sioner of health may contract with managed care providers approved under
38 paragraph (b) of this subdivision, without a competitive bid or request
39 for proposal process, to provide coverage for participants pursuant to
40 this title.
41 (e) Notwithstanding any inconsistent provision of this title and
42 section one hundred forty-three of the economic development law, no
43 notice in the procurement opportunities newsletter shall be required for
44 contracts awarded by the commissioner of health to qualified managed
45 care providers pursuant to this section.
46 (f) The care and services described in subdivision four of this
47 section will be furnished by a managed care provider pursuant to the
48 provisions of this section when such services are furnished in accord-
49 ance with an agreement with the department of health and meet applicable
50 federal law and regulations.
51 (g) The commissioner of health may delegate some or all of the tasks
52 identified in this section to the local districts.
53 (h) Any delegation pursuant to paragraph (g) of this subdivision shall
54 be reflected in the contract between a managed care provider and the
55 commissioner of health.
S. 6058 68 A. 9558
1 § 47. Paragraph (a) of subdivision 13 of section 364-j of the social
2 services law, as amended by chapter 649 of the laws of 1996, is amended
3 to read as follows:
4 (a) Notwithstanding any inconsistent provisions of this section,
5 participation in a managed care program will not diminish a recipient's
6 medical assistance eligibility or the scope of available medical
7 services to which he or she is entitled. Once a [plan] program is imple-
8 mented [by] in the district, medical assistance for persons who require
9 such assistance, who are eligible for or in receipt of such assistance
10 in the district and who are covered by the [plan] program shall be
11 limited to payment of the cost of care, services and supplies covered by
12 the managed care program, only when furnished, prescribed, ordered or
13 approved by a managed care provider, mental health special needs plan or
14 comprehensive HIV special needs plan and otherwise under the [plan]
15 program, together with the costs of medically necessary medical and
16 remedial care, services or supplies which are not available to partic-
17 ipants under the [plan] program, but which would otherwise be available
18 to such persons under this title and the regulations of the department
19 provided, however, that the [plan] program may contain provision for
20 payment to be made for non-emergent care furnished in hospital emergency
21 rooms consistent with subdivision ten of this section.
22 § 48. Subdivision 21 of section 364-j of the social services law is
23 REPEALED.
24 § 49. Subdivision 1 of section 364-j of the social services law is
25 amended by adding two new paragraphs (x) and (y) to read as follows:
26 (x) "Persons with serious mental illness". Individuals who meet
27 criteria established by the commissioner of mental health, which shall
28 include persons who have a designated diagnosis of mental illness under
29 the most recent edition of the diagnostic and statistical manual of
30 mental disorders, and (i) whose severity and duration of mental illness
31 results in substantial functional disability or (ii) who require mental
32 health services on more than an incidental basis.
33 (y) "Children and adolescents with serious emotional disturbances".
34 Individuals under eighteen years of age who meet criteria established by
35 the commissioner of mental health, which shall include children and
36 adolescents who have a designated diagnosis of mental illness under the
37 most recent edition of the diagnostic and statistical manual of mental
38 disorders, and (i) whose severity and duration of mental illness results
39 in substantial functional disability or (ii) who require mental health
40 services on more than an incidental basis.
41 § 50. Section 365-i of the social services law, as added by chapter 19
42 of the laws of 1998, is amended to read as follows:
43 § 365-i. Prescription drug payments. Payments for drugs which may not
44 be dispensed without a prescription as required by section sixty-eight
45 hundred ten of the education law and for which payment is authorized
46 pursuant to paragraph (g) of subdivision two of section three hundred
47 sixty-five-a of this title shall not be included in the capitation
48 payment for services or supplies provided to medical assistance recipi-
49 ents by a health maintenance organization or other entity which is
50 certified under article forty-four of the public health law or licensed
51 pursuant to article forty-three of the insurance law or otherwise
52 authorized by law to offer comprehensive health services plans to
53 medical assistance recipients; provided, however, this section shall not
54 prohibit inclusion of payment for prescription drugs for
55 Medicare/Medicaid dually eligible individuals in the capitation payment
56 for services or supplies provided to medical assistance recipients by a
S. 6058 69 A. 9558
1 health maintenance organization or other entity which is certified under
2 article forty-four of the public health law or licensed pursuant to
3 article forty-three of the insurance law or otherwise authorized by law
4 to offer comprehensive health services plans to medical assistance
5 recipients.
6 § 51. Paragraph (a) of subdivision 2 of section 365-a of the social
7 services law, as amended by chapter 47 of the laws of 1996, is amended
8 to read as follows:
9 (a) services of qualified physicians, [dentists, nurses, and private
10 duty nursing services shall be further subject to the provisions of
11 section three hundred sixty-seven-o of this chapter,] optometrists,
12 nurse midwives, nurse practitioners, and other related professional
13 personnel;
14 § 52. Paragraph (f) of subdivision 2 of section 365-a of the social
15 services law, as added by chapter 184 of the laws of 1969 and as relet-
16 tered by chapter 478 of the laws of 1980, is amended to read as follows:
17 (f) preventive, prophylactic and other routine dental care, services
18 and supplies provided in a hospital outpatient or clinic facility
19 referred to in paragraph (c) of this subdivision;
20 § 53. Paragraph (g) of subdivision 2 of section 365-a of the social
21 services law, as amended by chapter 710 of the laws of 1988, is amended
22 to read as follows:
23 (g) sickroom supplies, eyeglasses, and prosthetic appliances [and
24 dental prosthetic appliances] furnished in accordance with the regu-
25 lations of the department; drugs provided on an in-patient basis, those
26 drugs contained on the list established by regulation of the commission-
27 er of health pursuant to subdivision four of this section, and those
28 drugs which may not be dispensed without a prescription as required by
29 section sixty-eight hundred ten of the education law and which the
30 commissioner of health shall determine to be reimbursable based upon
31 such factors as the availability of such drugs or alternatives at low
32 cost if purchased by a medicaid recipient, or the essential nature of
33 such drugs as described by such commissioner in regulations, provided,
34 however, that such drugs, exclusive of long-term maintenance drugs,
35 shall be dispensed in quantities no greater than a thirty day supply or
36 one hundred doses, whichever is greater, and provided further that such
37 commissioner is authorized to require prior approval of any prescription
38 drug that is prescribed for a resident of a nursing home and that is not
39 reimbursed as part of the nursing home's Medicaid rate; medical assist-
40 ance shall not include any drug provided on other than an in-patient
41 basis for which a recipient is charged or a claim is made in the case of
42 a prescription drug, in excess of the maximum reimbursable amounts to be
43 established by department regulations in accordance with standards
44 established by the secretary of the United States department of health
45 and human services, or, in the case of a drug not requiring a
46 prescription, in excess of the maximum reimbursable amount established
47 by the commissioner of health pursuant to paragraph (a) of subdivision
48 four of this section;
49 § 54. Paragraph (l) of subdivision 2 of section 365-a of the social
50 services law, as amended by chapter 81 of the laws of 1995, is amended
51 to read as follows:
52 (l) care and services of podiatrists, clinical psychologists, nurses
53 and audiologists, including such care and services provided in a hospi-
54 tal out-patient or clinic facility referred to in paragraph (c) of this
55 subdivision, and dentists, which care and services shall only be
56 provided upon referral by a physician, nurse practitioner or certified
S. 6058 70 A. 9558
1 nurse midwife in accordance with the program of early and periodic
2 screening and diagnosis established pursuant to subdivision three of
3 this section or to persons eligible for benefits under title XVIII of
4 the federal social security act as qualified medicare beneficiaries in
5 accordance with federal requirements therefor [and private duty nurses
6 which care and services shall only be provided in accordance with regu-
7 lations of the department of health; provided, however, that private
8 duty nursing services shall not be restricted when such services are
9 more appropriate and cost-effective than nursing services provided by a
10 home health agency pursuant to section three hundred sixty-seven-l];
11 § 55. Paragraph (n) of subdivision 2 of section 365-a of the social
12 services law, as added by chapter 556 of the laws of 1986, is REPEALED.
13 § 56. Subdivision 2 of section 365-a of the social services law is
14 amended by adding a new paragraph (p) to read as follows:
15 (p) enteral nutritional therapy provided that such therapy: (i) is an
16 integral component of a documented medical treatment plan, and (ii) is
17 ordered in writing by an authorized prescriber, and (iii) is provided
18 for tube feeding, or is provided for oral liquid administration when
19 there is a documented diagnosis of inborn metabolic disease such that
20 caloric and dietary nutrients from food cannot be absorbed or metabol-
21 ized.
22 § 57. Paragraph (e) of subdivision 6 of section 4403-f of the public
23 health law, as added by chapter 659 of the laws of 1997, is amended to
24 read as follows:
25 (e) The majority leader of the senate and the speaker of the assembly
26 may each designate in writing up to four eligible applicants as approved
27 managed long term care demonstrations. Subsequent to such designation,
28 the commissioner and the superintendent of insurance shall impose terms
29 and conditions pursuant to a written agreement with each such demon-
30 stration, not inconsistent with this section, under which such demon-
31 strations shall be authorized to operate. If any such demonstration has
32 not commenced operations by January first, two thousand four, the
33 commissioner and the superintendent of insurance may rescind its desig-
34 nation as an approved managed long term care demonstration and its
35 authorization to operate and designate an alternate applicant as an
36 approved managed long term care demonstration. Subsequent to designation
37 of any such alternate applicant, the commissioner and the superintendent
38 of insurance shall impose terms and conditions pursuant to a written
39 agreement with each such demonstration, not inconsistent with this
40 section, under which such demonstration shall be authorized to operate.
41 § 58. Section 206 of the public health law is amended by adding a new
42 subdivision 20 to read as follows:
43 20. The commissioner is authorized to sponsor, conduct and participate
44 in research and demonstration projects designed to provide additional
45 knowledge and experience and to collect information concerning improving
46 the use of technologies, including the use of telemedicine, telehomecare
47 and other innovative technologies for the purposes of improving the
48 quality of medical services. In connection therewith, the commissioner
49 is authorized to waive such provisions of this chapter and title eleven
50 of article five of the social services law as are necessary to implement
51 such projects when such waiver shall promote the efficient delivery of
52 appropriate, quality, cost effective services and when the health, safe-
53 ty and general welfare of patients shall not be impaired.
54 § 59. Notwithstanding any inconsistent provision of law or regulation,
55 for residential health care facilities possessing a valid operating
56 certificate for 300 or more beds, the department of health shall in
S. 6058 71 A. 9558
1 establishing the allowable indirect component of residential health care
2 facility rates of payment determined pursuant to article 28 of the
3 public health law utilize for the period April 1, 2004 to March 31,
4 2005, 25 percent of the indirect peer group prices for residential
5 health care facilities of less than 300 beds and 75 percent of the indi-
6 rect peer group prices for residential health care facilities of 300 or
7 more beds; for the period April 1, 2005 to March 31, 2006, 50 percent of
8 the indirect peer group prices for residential health care facilities of
9 less than 300 beds and 50 percent of the indirect peer group prices for
10 residential health care facilities of 300 or more beds; for the period,
11 April 1, 2006 to March 31, 2007, 75 percent of the indirect peer group
12 prices for residential health care facilities of less than 300 beds and
13 25 percent of the indirect peer group prices for residential health care
14 facilities of 300 or more beds; and for the period beginning April 1,
15 2007 and thereafter, the indirect peer group prices for residential
16 health care facilities of less than 300 beds in lieu of the indirect
17 peer group prices for residential health care facilities of 300 or more
18 beds.
19 § 60. Notwithstanding any inconsistent provision of law or regulation
20 to the contrary, for hospital-based residential health care facilities,
21 for services provided beginning April 1, 2004, and thereafter the
22 department of health shall utilize the free-standing residential health
23 care facility indirect peer group prices in lieu of the hospital-based
24 residential health care facility indirect peer group prices in estab-
25 lishing the allowable indirect component of residential health care
26 facility rates of payment determined pursuant to article 28 of the
27 public health law provided, however, that for such services provided
28 beginning April 1, 2004 and thereafter, a separate statewide average of
29 total reimbursable base year administrative and fiscal services costs
30 shall be determined for hospital-based residential health care facili-
31 ties and the reimbursable base year administrative and fiscal services
32 costs of such facilities shall not exceed such separate statewide aver-
33 age. In no event, shall the calculation of such separate statewide aver-
34 age result in a change in the statewide average determined pursuant to
35 the public health law for all residential health care facilities.
36 § 61. Subdivision 17 of section 2808 of the public health law, as
37 added by section 1 of chapter 433 of the laws of 1997, is amended to
38 read as follows:
39 17. Notwithstanding any inconsistent provision of law or regulation to
40 the contrary, for purposes of establishing rates of payment by govern-
41 mental agencies for residential health care facilities for services
42 provided on and after January first, nineteen hundred ninety-eight, the
43 regional direct and indirect input price adjustment factors to be
44 applied to any such facility's rate calculation shall be based upon the
45 utilization of either nineteen hundred eighty-three, nineteen hundred
46 eighty-seven or nineteen hundred ninety-three calendar year financial
47 and statistical data and for periods beginning April first, two thousand
48 four and thereafter also based on two thousand one calendar year finan-
49 cial and statistical data provided, however, the state share amount for
50 the utilization of two thousand one calendar year data shall be no more
51 than nineteen million dollars on a pro rata basis per calendar year.
52 The determination of which calendar year's data to utilize shall be
53 based upon a methodology that ensures that the particular year chosen by
54 each facility results in a factor that yields no less reimbursement to
55 the facility than would result from the use [of either] of the other
56 [two] three years' data. Such methodology shall utilize the nineteen
S. 6058 72 A. 9558
1 hundred eighty-three and nineteen hundred eighty-seven regional direct
2 and indirect input price adjustment factor corridor percentages in
3 existence on January first, nineteen hundred ninety-seven as well as
4 nineteen hundred ninety-three regional direct and indirect input price
5 adjustment factor corridor percentage [calculated in the same manner as
6 the nineteen hundred eighty-three and nineteen hundred eighty-seven
7 direct and indirect input price adjustment factor corridor percentages
8 in existence on January first, nineteen hundred ninety-seven] in exist-
9 ence on January first, two thousand four as well as a two thousand one
10 regional direct and indirect input price adjustment factor corridor
11 percentage calculated in the same manner as the nineteen hundred nine-
12 ty-three direct and indirect input price adjustment factor corridor
13 percentages in existence on January first, two thousand four.
14 § 61-a. The provisions of section sixty-one of this act shall be of no
15 force and effect and shall be deemed null and void if any of the follow-
16 ing sections of this act are, subsequent to the effective date of this
17 act, amended or repealed: section fifty-nine and section sixty.
18 § 62. Section 217 of chapter 474 of the laws of 1996, amending the
19 education law and other laws relating to rates for residential health
20 care facilities, as amended by chapter 433 of the laws of 1997, is
21 amended to read as follows:
22 § 217. Notwithstanding any inconsistent provision of law or regulation
23 to the contrary, [beginning] for the period April 1, 1997, [and there-
24 after] through January 31, 2004, a county or the city of New York in
25 which a public general hospital, other than a public general hospital
26 operated by the state of New York or state university of New York, is
27 participating in a payment pursuant to sections two hundred eleven and
28 two hundred twelve of this act shall, on or before a date specified by
29 the department of health, in each year in which such county shall
30 participate in such payments, transfer by electronic funds transfer to
31 or through the state comptroller, a total amount equal to forty percent
32 of the projected amount reconciled to the actual amount of such payments
33 for such period for such public general hospital.
34 § 63. Section 222 of chapter 474 of the laws of 1996, amending the
35 education law and other laws relating to rates for residential health
36 care facilities, as amended by section 16 of part F of chapter 412 of
37 the laws of 1999, is amended to read as follows:
38 § 222. Notwithstanding any inconsistent provision of law or regulation
39 to the contrary, [beginning] for the period April 1, 1997, [and there-
40 after] through January 31, 2004, a county or the city of New York in
41 which a public residential health care facility is participating in a
42 payment pursuant to subdivision 12 of section 2808 of the public health
43 law shall, on or before a date specified by the department of health, in
44 each year in which such county shall participate in such payments,
45 transfer by electronic funds transfer to or through the state comp-
46 troller, a total amount equal to forty percent of the projected payments
47 pursuant to subdivision 12 of section 2808 of the public health law for
48 such period for such public residential health care facility.
49 § 64. Section 19 of part A of chapter 1 of the laws of 2002 amending
50 the public health law, the social services law and the tax law relating
51 to the Health Care Reform Act of 2000, is amended to read as follows:
52 § 19. Notwithstanding any law, rule or regulation to the contrary, for
53 the state fiscal year beginning April 1, 2002 and ending March 31, 2003,
54 the following specified counties and the city of New York shall, on or
55 before a date specified by the department of health, transfer by elec-
56 tronic funds transfer, to or through the state comptroller, up to the
S. 6058 73 A. 9558
1 following annual amounts: the city of New York: five hundred twenty-
2 eight million two hundred thousand dollars; county of Erie: nine million
3 one hundred thousand dollars; the county of Nassau: twenty-nine million
4 one hundred thousand dollars; the county of Westchester: eighteen
5 million dollars; the county of Lewis: seven hundred thousand dollars;
6 the county of Rockland: two million two hundred thousand dollars; and
7 the county of Wyoming: one million two hundred thousand dollars.
8 For the [state fiscal year beginning] period April 1, 2003 [and each
9 state fiscal year thereafter] through January 31, 2004, the following
10 specified counties and the city of New York shall, on or before a date
11 specified by the department of health, transfer by electronic funds
12 transfer, to or through the state comptroller, up to the following
13 [annual] amounts: the city of New York: three hundred forty-four million
14 two hundred thousand dollars; the county of Erie: four million seven
15 hundred thousand dollars; the county of Nassau: nineteen million four
16 hundred thousand dollars; county of Westchester: twelve million eight
17 hundred thousand dollars; the county of Lewis: six hundred thousand
18 dollars; the county of Rockland: one million four hundred thousand
19 dollars; and the county of Wyoming: eight hundred sixty thousand
20 dollars.
21 § 65. Section 20 of part A of chapter 1 of the laws of 2002, amending
22 the public health law, the social services law and the tax law relating
23 to the Health Care Reform Act of 2000, as amended by section 6 of part
24 Z2 of chapter 62 of the laws of 2003, is amended to read as follows:
25 § 20. Notwithstanding any law, rule or regulation to the contrary, the
26 commissioner of health shall credit, from the funds collected pursuant
27 to the provisions of sections nineteen and twenty-one of this act, up to
28 five hundred thirty-four million dollars for the state fiscal year
29 beginning April 1, 2002 and ending March 31, 2003 to the tobacco control
30 and insurance initiatives pool as established pursuant to section 2807-v
31 of the public health law, and up to three hundred fifty-six million
32 dollars [annually] for [state fiscal years on and after] the period
33 April 1, 2003 through January 31, 2004, to the medical assistance
34 program, general fund/aid to localities, local assistance account-001,
35 provided, however, that for the state fiscal year beginning April 1,
36 2002 and ending March 31, 2003, all funds collected pursuant to sections
37 nineteen and twenty-one of this act which are not credited to the tobac-
38 co control and insurance initiatives pool shall be credited to the
39 medical assistance program, general fund/aid to localities, local
40 assistance account - 001.
41 § 66. Section 17 of part B of chapter 1 of the laws of 2002 amending
42 the public health law, the social services law and the tax law relating
43 to the Health Care Reform Act of 2000, as amended by section 21 of part
44 J of chapter 82 of the laws of 2002, is amended to read as follows:
45 § 17. Notwithstanding any law, rule or regulation to the contrary, for
46 the state fiscal year beginning April 1, 2002 and ending March 31, 2003,
47 the city of New York shall, on or before a date specified by the depart-
48 ment of health, transfer by electronic funds transfer, to or through the
49 state comptroller, up to one hundred fifty-four million dollars.
50 For the [state fiscal year beginning] period April 1, 2003 [and each
51 state fiscal year thereafter] through January 31, 2004, the city of New
52 York shall, on or before a date specified by the department of health,
53 transfer by electronic funds transfer, to or through the state comp-
54 troller, up to one hundred forty-eight million dollars. For the state
55 fiscal year beginning April 1, 2002 and each state fiscal year thereaft-
56 er, all funds collected pursuant to this section and section nineteen of
S. 6058 74 A. 9558
1 this act shall be credited to the medical assistance program, general
2 fund/aid to localities, local assistance account - 001.
3 § 67. Notwithstanding the provisions of section 368-a of the social
4 services law or any other law, during the state fiscal year ending March
5 31, 2004, the commissioner of health, upon the approval of the division
6 of the budget, shall have the authority to adjust the local shares of
7 Medicaid expenditures by increasing such shares in amounts up to the
8 amounts set forth in the following schedule: city of New York: two
9 hundred fifty million dollars; and all other counties located outside
10 the city of New York: fifty million dollars.
11 § 68. Notwithstanding the provisions of section 368-a of the social
12 services law or any other law, during the state fiscal year commencing
13 April 1, 2004 and ending March 31, 2005, the commissioner of health,
14 upon the approval of the division of the budget, shall have the authori-
15 ty to adjust the local shares of Medicaid expenditures by increasing
16 such shares in amounts up to the amounts set forth in the following
17 schedule: city of New York: six hundred fifty million dollars; and all
18 other counties located outside the city of New York: two hundred million
19 dollars.
20 § 69. Notwithstanding any inconsistent provision of law, rule or
21 regulation, the effectiveness of subdivisions 4, 7 and 7-a of section
22 2807 of the public health law and section 18 of chapter 2 of the laws of
23 1998, as such provisions relate to time frames of notice, approval of
24 certification of rates of payment, and to the requirement of prior
25 notice of rates of payment, are hereby suspended and shall, for purposes
26 of implementing the provisions of this act, be deemed to have been with-
27 out any force or effect from and after November 1, 2003 for such rates
28 effective for the period January 1, 2004 through December 31, 2004.
29 § 70. The commissioner of health is authorized to promulgate or adopt
30 any rules or regulations necessary to implement the provisions of this
31 act and any procedures, forms, or instructions necessary for such imple-
32 mentation may be adopted and issued on or after the effective date of
33 this act. Notwithstanding any inconsistent provision of the state admin-
34 istrative procedure act or any other provision of law, rule or regu-
35 lation, the commissioner of health and the superintendent of insurance
36 and any appropriate council is authorized to adopt or amend or promul-
37 gate on an emergency basis any regulation he or she or such council
38 determines necessary to implement any provision of this act on its
39 effective date.
40 § 71. If any clause, sentence, paragraph, section or part of this act
41 shall be adjudged by any court of competent jurisdiction to be invalid,
42 such judgment shall not affect, impair or invalidate the remainder ther-
43 eof, but shall be confined in its operation to the clause, sentence,
44 paragraph, section or part thereof directly involved in the controversy
45 in which such judgment shall have been rendered.
46 § 72. This act shall take effect immediately and shall be deemed to
47 have been in full force and effect on and after April 1, 2004; provided,
48 however, that:
49 1. notwithstanding any other provision of law, any contract and
50 related rates in effect between a county and a managed care provider
51 pursuant to section 364-j of the social services law on the effective
52 date of this act shall remain in effect until the effective date of a
53 successor contract between the commissioner of health and such managed
54 care provider authorized pursuant to subdivision 5 of such section;
55 2. the provisions of sections one, two, three and four of this act
56 shall be of no force and effect and shall be deemed null and void if any
S. 6058 75 A. 9558
1 of the following sections of this act are, subsequent to the effective
2 date of this act, amended or repealed: sections fourteen through twen-
3 ty-six, twenty-eight through thirty-one;
4 3. section five of this act shall take effect May 1, 2004 and sections
5 twenty-eight through thirty-one of this act shall take effect July 1,
6 2004;
7 4. sections six through ten and twelve of this act shall expire and be
8 deemed repealed June 15, 2009; and provided further that subdivision 9
9 of section 270 of the public health law, as added by section six of this
10 act, shall expire and be deemed repealed January 1, 2006;
11 5. the amendments made to paragraph (b) of subdivision 9 of section
12 367-a of the social services law by section five of this act shall not
13 affect the expiration and reversion of such subdivision pursuant to
14 section 4 of chapter 19 of the laws of 1998, as amended, and shall be
15 deemed to expire therewith;
16 6. the amendments made to subdivision 6 of section 367-a of the social
17 services law by sections thirty-three, thirty-four and thirty-five of
18 this act shall not affect the repeal of such subdivision pursuant to
19 chapter 41 of the laws of 1992, as amended, and shall be deemed repealed
20 therewith;
21 7. the amendments to section 364-j of the social services law made by
22 sections thirty-nine through forty-seven and forty-nine of this act
23 shall not affect the repeal of such section pursuant to chapter 710 of
24 the laws of 1988, as amended, and shall be deemed repealed therewith;
25 8. the amendments to section 365-i of the social services law made by
26 section fifty of this act shall not affect the repeal of such section
27 pursuant to chapter 19 of the laws of 1998, as amended, and shall be
28 deemed repealed therewith;
29 9. the amendments made to section 4403-f of the public health law made
30 by section fifty-seven of this act shall not affect the repeal of such
31 section and shall be deemed repealed therewith;
32 10. the provisions of section sixty-one of this act shall be of no
33 force and effect and shall be deemed null and void if any of the follow-
34 ing sections of this act are, subsequent to the effective date of this
35 act, amended or repealed: section fifty-nine and section sixty; and
36 11. the commissioner of health shall notify the legislative bill
37 drafting commission upon the occurrence of the enactment of the legis-
38 lation provided for in subdivisions 2 and 10 of this section and the
39 approvals required under section thirty-one of this act in order that
40 the commission may maintain an accurate and timely effective data base
41 for the official text of the laws of the state of New York in further-
42 ance of effecting the provisions of section 44 of the legislative law
43 and section 70-b of the public officers law.
44 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
45 sion, section or part of this act shall be adjudged by any court of
46 competent jurisdiction to be invalid, such judgment shall not affect,
47 impair, or invalidate the remainder thereof, but shall be confined in
48 its operation to the clause, sentence, paragraph, subdivision, section
49 or part thereof directly involved in the controversy in which such judg-
50 ment shall have been rendered. It is hereby declared to be the intent of
51 the legislature that this act would have been enacted even if such
52 invalid provisions had not been included herein.
53 § 3. This act shall take effect immediately provided, however, that
54 the applicable effective date of Parts A through G of this act shall be
55 as specifically set forth in the last section of such Parts.
S. 6058 76 A. 9558
2004-2005 NEW YORK STATE EXECUTIVE BUDGET
HEALTH AND MENTAL HYGIENE ARTICLE VII LEGISLATION
CONTENTS
STARTING
PAGE
PART DESCRIPTION NUMBER
A Enact public health initiatives to eliminate
low-priority programs, strengthen pharmacy fraud
prevention, achieve cost savings and facilitate
access to new Medicare Discount Card for low-income
EPIC enrollees. 3
B Close the Middletown Psychiatric Center on April 1,
2005 and require that 50 percent of the savings from
facility closures be reinvested into State-operated
community services. 18
C Establish the bipartisan Commission for the Closure
of State Psychiatric Centers and extend the Community
Mental Health Support and Workforce Reinvestment Act
to 2010. 20
D Amend the Health Care Reform Act (HCRA) and amend
Insurance Law to authorize additional non-profit
insurance company conversions to for-profit entities
and invest a portion of proceeds from such conversions
in HCRA. 23
E Authorize the Commissioner of the Office of Mental
Health to review and retroactively certify the rate
methodology for dually licensed mental health
outpatient programs. 34
F Re-establish reimbursement parity among Methadone
Maintenance Treatment Programs certified in
accordance with Article 28 of the Public Health Law. 35
G Restructure the State's Medicaid program through
initiatives to reduce costs, enhance revenues and
maintain access to health care services. 35