Amd §2795, Pub Health L; amd §2, Chap of 2023 (as proposed in S.6521 & A.3089)
 
Establishes the New York state adult cystic fibrosis program which consists of administrative support services for the provision of financial assistance for services such as prescription drug costs, device costs, medical care services, behavioral health services, and insurance premiums for the treatment of cystic fibrosis disease and its conditions.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8515
SPONSOR: Pheffer Amato
 
TITLE OF BILL:
An act to amend the public health law, in relation to the New York state
adult cystic fibrosis program; and to amend a chapter of the laws of
2023, amending the public health law relating to the adult cystic fibro-
sis assistance program, as proposed in legislative bills numbers S. 6521
and A. 3089, in relation to the effectiveness thereof
 
PURPOSE:
To clarify the criteria under the Adult Cystic Fibrosis Assistance
program.
 
SUMMARY OF PROVISIONS:
This bill amends Chapter 769 of the Laws of 2023 by reflecting the
current criteria under which the Adult Cystic Fibrosis Assistance
Program is run. This includes information about contracting with an
entity with experience and expertise improving access to healthcare for
patients who are underinsured. These amendments also list the duties of
the contractor in administering the program in statute, including the
review of financial assistance grant applications, the disbursement of
grant funding for applications, and the submission of a monthly grant
report. This bill also includes a sunset date of March 31, 2024, align-
ing with the current funds allocated for the establishment and operation
of the Adult Cystic Fibrosis Assistance Program from the SFY23-24 legis-
lative appropriations.
 
JUSTIFICATION:
Cystic fibrosis (CF) is a rare genetic disease that damages the lungs
and digestive system, which affects approximately 1600 New Yorkers.
Many CF patients rely on several prescription drugs and targeted,
specific care plans for treatment.
Prior to 2020, the Adult Cystic Fibrosis Assistance Program (ACFAP)
existed as part of the annual New York State budget. ACFAP has histor-
ically provided reimbursements for out-of-pocket costs. These costs
helped enrollees to cover inpatient and outpatient care, prescription
drugs, lab and X-ray services, home health care, and physical therapy.
Enrollees in ACFAP must maintain their own healthcare coverage which
provides the most comprehensive coverage for their cystic fibrosis
needs. ACFAP allows adults with CF to maintain private insurance cover-
age and access the care and treatments required for them to stay heal-
thy. This amendment re-establishes the Adult Cystic Fibrosis Assistance
Program under the criteria currently used to administer the program,
including provisions related to contracting and qualification of indi-
viduals. The funding, provided by the Legislature in their SFY23-24
appropriations, will serve to establish and operate the program under a
contract with a national not-for-profit that specializes in financial
assistance programs and billing. Through this funding and this amend-
ment, New York State once again has an Adult Cystic Fibrosis Assistance
Program which will serve to assist hundreds of New Yorkers who require
financial assistance to cover necessary medical expenses.
 
LEGISLATIVE HISTORY:
This is a new bill.
 
BUDGET IMPLICATIONS:
None noted.
 
EFFECTIVE DATE:
This act shall take effect immediately; provided, however, that section
one of this act shall take effect on the same date and in the same
manner as a chapter of the laws of 2023 amending the public health law
relating to the adult cystic fibrosis assistance program, as proposed in
legislative bills number 5.6521 and A.3089, takes effect; provided,
further, that the amendments to section 2795 of the public health law
made by section one of this act shall not affect the repeal of such
sections and shall be deemed repealed therewith.
STATE OF NEW YORK
________________________________________________________________________
8515
IN ASSEMBLY
January 4, 2024
___________
Introduced by M. of A. PHEFFER AMATO -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, in relation to the New York state
adult cystic fibrosis program; and to amend a chapter of the laws of
2023, amending the public health law relating to the adult cystic
fibrosis assistance program, as proposed in legislative bills numbers
S. 6521 and A. 3089, in relation to the effectiveness thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 2795 of the public health law, as added by a chap-
2 ter of the laws of 2023, amending the public health law relating to the
3 adult cystic fibrosis assistance program, as proposed in legislative
4 bills numbers S. 6521 and A. 3089, is amended to read as follows:
5 § 2795. [Adult] New York state adult cystic fibrosis assistance
6 program. 1. [The commissioner] Subject to available appropriation for
7 the purpose outlined in this article, the department shall establish [a]
8 an adult cystic fibrosis assistance program [to reimburse the cost of
9 providing health care or health insurance to eligible individuals who
10 have], which shall be known as the "New York State Adult Cystic Fibrosis
11 Assistance Program", and which shall consist of administrative support
12 services for the provision of financial assistance for services such as
13 prescription drug costs, device costs, medical care services, behavioral
14 health services, and insurance premiums for the treatment of cystic
15 fibrosis disease and its conditions.
16 2. [To be a fully eligible individual for whom health care will be
17 provided under this section, such individual:
18 (a) shall be at least twenty-one years old;
19 (b) shall have been diagnosed as having cystic fibrosis;
20 (c) shall have resided in the state for a minimum of twelve continuous
21 months immediately prior to application for services under this section;
22 (d) shall not be eligible for medical benefits under any group or
23 individual health insurance policy; and
24 (e) shall not be eligible for medical assistance pursuant to title
25 eleven of article five of the social services law solely due to earned
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06424-02-4
A. 8515 2
1 income] The commissioner shall enter into a contract for the operation
2 and promotion of the adult cystic fibrosis assistance program subject to
3 such terms and conditions as may be contained within such contract with
4 an organization that has experience and expertise improving access to
5 healthcare for patients who are underinsured by dispersing financial
6 assistance grants to cover costs of essential treatments and medica-
7 tions. The contractor may subcontract as needed for the effective
8 performance of the contract. All such subcontractors and the terms of
9 such subcontracts shall be subject to approval by the commissioner.
10 3. [To be a partially eligible individual for whom health care will be
11 provided under this section, such individual shall meet all the criteria
12 of a fully eligible individual except that a partially eligible individ-
13 ual shall be an individual who is eligible for medical benefits under
14 any group or individual health insurance policy but which does not cover
15 all services necessary for the care and treatment of cystic fibrosis.
16 4. The commissioner shall require each fully eligible individual, upon
17 determination of eligibility, to make application to a private health
18 insurance provider as prescribed by the commissioner for an individual
19 health insurance policy. If and when such policy is granted, the commis-
20 sioner shall approve payment for the associated premium.
21 5. The commissioner shall authorize payment for services related to
22 the care and treatment of cystic fibrosis not otherwise covered by a
23 health insurance policy. Providers of such services shall be reimbursed
24 at the same rate and claims for payment shall be made as if such indi-
25 vidual was eligible for benefits pursuant to title eleven of article
26 five of the social services law.
27 6. All eligible individuals shall be required to contribute seven
28 percent of their net annual income toward the cost of care and/or the
29 cost of the annual health insurance premium.
30 7. The commissioner shall, in consultation with the commissioner of
31 social services, promulgate rules and regulations necessary to implement
32 the provisions of this article] The duties of the contractor shall
33 include, but not be limited to, the following:
34 (a) verification of patient eligibility for financial assistance
35 grants allowable pursuant to paragraph (b) of this subdivision. To be
36 eligible for a financial assistance grant, a patient shall meet criteria
37 determined by the department, which shall include but not be limited to,
38 requiring the patient:
39 (i) be a New York state resident;
40 (ii) be at least twenty-one years of age or older;
41 (iii) have a diagnosis of cystic fibrosis; and
42 (iv) have some form of primary private health insurance or Medicare
43 and is not eligible for state Medicaid, and shall maintain health insur-
44 ance during the financial assistance award period;
45 (b) review of financial assistance grant applications submitted by
46 eligible patients for approval, for services including but not limited
47 to prescription drug costs, device costs, medical care services, behav-
48 ioral health services, and medical, vision and dental insurance premi-
49 ums, for patient treatment of cystic fibrosis;
50 (c) disbursement of grant funding for applications approved pursuant
51 to paragraph (b) of this subdivision related to the care and treatment
52 of cystic fibrosis not otherwise covered by a health insurance policy;
53 (d) preparation and submission of a monthly report to the department.
54 Such report shall include but not be limited to:
55 (i) new grants, which is the number of new grant recipients for
56 initial grant periods;
A. 8515 3
1 (ii) renewal grants, which is the number of renewal grant recipients
2 for renewal grant periods;
3 (iii) total active grant recipient count, which is the total number of
4 active grant recipients;
5 (iv) grant recipients by insurance type, which is the number of active
6 grant recipients sorted by insurance type;
7 (v) program expenses, which is the total amount spent sorted by
8 assistance type but does not include administration fees;
9 (vi) application outcomes report, which is the number of grant recipi-
10 ents who have become inactive, sorted by reason; and
11 (vii) allotment used, which is the total amount of copayment assist-
12 ance provided to each grant recipient compared to what is currently used
13 by the grant recipient.
14 § 2. Section 2 of a chapter of the laws of 2023, amending the public
15 health law relating to the adult cystic fibrosis assistance program, as
16 proposed in legislative bills numbers S. 6521 and A. 3089, is amended to
17 read as follows:
18 § 2. This act shall take effect immediately and shall expire March 31,
19 2024 when upon such date the provisions of this act shall be deemed
20 repealed.
21 § 3. This act shall take effect immediately; provided, however, that
22 section one of this act shall take effect on the same date and in the
23 same manner as a chapter of the laws of 2023 amending the public health
24 law relating to the adult cystic fibrosis assistance program, as
25 proposed in legislative bills numbers S. 6521 and A. 3089, takes effect;
26 provided, further, that the amendments to section 2795 of the public
27 health law made by section one of this act shall not affect the repeal
28 of such section and shall be deemed repealed therewith.