A04738 Summary:

BILL NOA04738
 
SAME ASSAME AS S04840
 
SPONSORGottfried
 
COSPNSRAbinanti, Barron, Benedetto, Bichotte, Blake, Bronson, Carroll, Colton, Cook, Crespo, Cymbrowitz, Dilan, Dinowitz, Englebright, Gantt, Gjonaj, Hikind, Hunter, Hyndman, Jaffee, Jenne, Joyner, Kavanagh, Kim, Lavine, Lifton, Lupardo, Mayer, Miller MG, Mosley, Moya, Paulin, Peoples-Stokes, Perry, Pichardo, Ramos, Richardson, Rivera, Rodriguez, Rosenthal, Seawright, Sepulveda, Simotas, Steck, Stirpe, Thiele, Titone, Titus, Walker, Weinstein, Weprin, De La Rosa, D'Urso, Jean-Pierre, Wright, Harris, Williams, Vanel, Solages, Wallace, Barrett, Pheffer Amato, Niou, Ortiz, Dickens
 
MLTSPNSRAbbate, Arroyo, Aubry, Cahill, Davila, Fahy, Farrell, Glick, Gunther, Hooper, Lentol, Magee, Magnarelli, O'Donnell, Pretlow, Quart, Rozic, Simon, Skartados
 
Ren Art 50 5000 - 5003 to be Art 80 8000 - 8003, add Art 51 5100 - 5111, Art 49 Title 3 4920 - 4927, amd 270, Pub Health L; add 89-i, St Fin L
 
Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
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A04738 Actions:

BILL NOA04738
 
02/03/2017referred to health
02/14/2017reported referred to codes
03/01/2017reported referred to ways and means
05/09/2017reported
05/11/2017advanced to third reading cal.341
05/16/2017passed assembly
05/16/2017delivered to senate
05/16/2017REFERRED TO HEALTH
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A04738 Committee Votes:

HEALTH Chair:Gottfried DATE:02/14/2017AYE/NAY:16/8 Action: Favorable refer to committee Codes
GottfriedAyeRaiaNay
SchimmingerNayMcDonoughNay
GalefNayRaExcused
DinowitzAyeWalterNay
CahillAyeGarbarinoNay
PaulinAyeByrneNay
CymbrowitzAyeNorrisNay
GuntherAye
RosenthalExcused
HevesiAye
LavineAye
TitoneAye
MayerAye
JaffeeAye
SteckAye
AbinantiAye
BraunsteinAye
KimAye
SolagesAye

CODES Chair:Lentol DATE:03/01/2017AYE/NAY:13/8 Action: Favorable refer to committee Ways and Means
LentolAyeGrafNay
SchimmingerNayGiglioNay
WeinsteinExcusedMcKevittNay
PretlowAyeMontesanoNay
CookAyeRaNay
CymbrowitzAyeMorinelloNay
TitusAye
O'DonnellAye
LavineAye
PerryAye
ZebrowskiNay
AbinantiAye
WeprinAye
MosleyAye
HevesiAye
FahyAye

WAYS AND MEANS Chair:Farrell DATE:05/09/2017AYE/NAY:22/11 Action: Favorable
FarrellAyeOaksNay
LentolAyeCrouchNay
SchimmingerNayBarclayNay
GanttExcusedFitzpatrickNay
WeinsteinAyeHawleyNay
GlickAyeMalliotakisNay
NolanExcusedWalterNay
PretlowAyeMontesanoNay
PerryAyeCurranNay
ColtonAyeRaNay
CookAye
CahillAye
AubryAye
HooperAye
ThieleAye
CusickAye
OrtizAye
BenedettoAye
MoyaAye
WeprinAye
RodriguezAye
RamosAye
BraunsteinAye
McDonaldAye
RozicAye

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A04738 Floor Votes:

DATE:05/16/2017Assembly Vote  YEA/NAY: 94/46
AbbateYCrouchNOGoodellNOLiftonYO'DonnellYSimanowitzNO
AbinantiYCurranNOGottfriedYLopezNOOrtizYSimonY
ArroyoYCusickNOGrafNOLupardoYOtisYSimotasY
AubryYCymbrowitzERGuntherYLupinacciNOPalmesanoNOSkartadosY
BarclayNODavilaYHarrisYMageeYPalumboNOSkoufisY
BarnwellYDe La RosaYHawleyNOMagnarelliYPaulinYSolagesY
BarrettYDenDekkerYHevesiYMalliotakisNOPeoples-StokesYStecNO
BarronYDickensYHikindYMayerYPerryYSteckY
BenedettoYDilanYHooperYMcDonaldYPheffer AmatoYStirpeY
BichotteERDinowitzYHunterYMcDonoughNOPichardoYThieleY
BlakeERDiPietroNOHyndmanYMcKevittNOPretlowYTitoneY
BlankenbushNOD'UrsoYJaffeeYMcLaughlinNOQuartYTitusY
BrabenecNOEnglebrightYJean-PierreYMill B NORaNOVanelY
BraunsteinYErrigoNOJenneYMill MGYRaiaNOWalkerY
BrindisiYFahyYJohnsNOMill MLERRamosERWallaceY
BronsonYFarrellYJonesYMontesanoNORichardsonYWalshNO
BuchwaldYFinchNOJoynerYMorelleNORiveraERWalterNO
ButlerNOFitzpatrickNOKavanaghYMorinelloNORodriguezYWeinsteinY
ByrneNOFriendNOKearnsERMosleyYRosenthalYWeprinY
CahillYGalefYKimYMoyaYRozicYWilliamsY
CarrollYGanttERKolbNOMurrayNORyanYWoernerNO
CastorinaNOGarbarinoNOLalorERNiouYSantabarbaraNOWrightY
ColtonYGiglioNOLavineYNolanYSchimmingerNOZebrowskiY
CookYGjonajYLawrenceNONorrisNOSeawrightYMr SpkrY
CrespoYGlickYLentolYOaksNOSepulvedaY

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A04738 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4738
 
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the public health law and the state finance law, in relation to enacting the "New York health act" and to establishing New York Health   PURPOSE OR GENERAL IDEA OF BILL: This bill would create a universal single payer health plan -New York Health - to provide comprehensive health coverage for all New Yorkers.   SUMMARY OF SPECIFIC PROVISIONS: Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Cover- age would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc. - all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, and others added by the plan. Everyone would choose a primary care practitioner or other provider to provide care coordination - helping to get the care and follow-up the patient needs, referrals, and navigating the system. But there would be no "gatekeeper" obstacles to care. As with most health coverage, New York Health covers health care services when a member is out of state, either because health care is needed while the member is traveling or because there is a clinical reason for going to a particular out-of-state provider. A broadly representative Board of Trustees will advise the Commissioner of Health. Long-term care coverage is not included at the start, but the bill requires that the Board develop a plan for it within two years of passage. The Board shall also develop proposals relating to retiree health benefits and coverage of health care services covered under the workers' compensation law. In addition to the Board, there will be six regional advisory councils to represent the diverse needs and concerns of the region. The councils shall include but not be limited to representatives of health care consumers, providers, municipal and county government, and organized labor. The councils shall advise the Board, Commissioner, Governor, and Legislature on matters relating to the NY Health program and shall adopt community health improvement plans to promote health care access and quality in their regions. Health care providers, including those providing care coordination, would be paid in full by New York Health, with no co-pays or other charges to patients. The plan would develop alternative payment methods to replace old-style fee-for-service (which rewards volume but not qual- ity), and would negotiate rates with health care provider organizations. (Fee-for-service would continue until new methods are phased in.) The bill would authorize health care providers to form organizations to collectively negotiate with New York Health. Health care would no long- er be paid for by insurance companies charging a regressive "tax" - insurance premiums, deductibles and co-pays imposed regardless of abili- ty to pay. Instead, New York Health would be paid for based on ability to pay, through a progressively-graduated payroll-based premium (paid at least 80% by employers and not more than 20% by employees, and 100% by self-employed) and a progressively-graduated premium based on other taxable income, such as capital gains, interest and dividends. A specif- ic revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor. Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The "local share" of Medicaid funding - a major burden on local property taxes - would be ended. Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. (Existing retiree coverage could be phased out and replaced with New York Health.)   JUSTIFICATION: The state constitution states: "The protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefor shall be made by the state and by such of its subdi- visions and in such manner, and by such means as the legislature shall from time to time determine." (Article XVII, § 3.) All residents of the state have the right to health care. New Yorkers - as individuals, employers, and taxpayers - have experi- enced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured. Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated. Individuals often find that they are deprived of affordable care and choice because of deci- sions by health plans guided by the plan's economic needs rather than their health care needs. To address the fiscal crisis facing the health care system and the state and to assure New Yorkers can exercise their right to health care, this legislation would establish a comprehensive universal single-payer health care coverage program, funded by broad-based revenue based on ability to pay, for the benefit of all residents of the state of New York. The state will work to obtain waivers relating to Medicaid, Family Health Plus, Child Health Plus, Medicare, the Patient Protection and Affordable Care Act, and any other appropriate federal programs, under which federal funds and other subsidies that would otherwise be paid to New York State will be paid by the federal government to New York State and deposited in the New York Health trust fund. Under such a waiver, health coverage under those programs will be replaced and merged into New York Health, which will operate as a true single-payer program. If such a waiver is not obtained, the state shall use state plan amendments and seek waivers to maximize, and make as seamless as possible, the use of federally-matched health programs and federal health programs in New York Health, The goal of this legislation is that coverage be delivered by New York Health and, as much as possible, the multiple sources of funding will be pooled with other New York Health funds and not be apparent to New York Health members or participating providers. This program will promote movement away from fee-for-service payment, which tends to reward quantity and requires excessive administrative expense, and towards alternate payment methodologies, such a s global or capitat- ed payments to providers or health care organizations, that promote quality, efficiency, investment in primary and preventive care, and innovation and integration in the organizing of health care. This act does not create any employment benefit, nor does it require, prohibit, or limit the providing of any employment benefit. In order to promote improved quality of, and access to, health care services and promote improved clinical outcomes, it is the policy of the state to encourage cooperative, collaborative and integrative arrangements among health care providers who might otherwise be competitors, under the active supervision of the commissioner. It is the intent of the state to supplant competition with such arrangements and regulation only to the extent necessary to accomplish the purposes of this act, and to provide state action immunity under the state and federal antitrust laws to health care providers, particularly with respect to their relations with the single-payer New York Health plan created by this act.   PRIOR LEGISLATIVE HISTORY: 1992: A.8912-A passed Assembly 1993: A.5900 reported to Ways and Means 1994: A.5900 referred to Health Committee 1995-96: A.6801 reported to Ways and Means 1997-98: A.6172 reported to Ways and Means 1999-00: A.3571 reported to Ways and Means 2001-02: A.6779 reported to Ways and Means 2003-04: A.6952 reported to Ways and Means 2005: A.6576 reported to Ways and Means 2006: A.6576 referred to Health Committee 2007-08: A.7354 - reported to Ways and Means 2009-10: A.2356- referred to Health Committee 2011-12: A.7860-A - referred to Ways and Means 2013: A5389 referred to Health Committee 2014: A5389 - reported to Ways and Means 2015: A5062 - Passed Assembly 2016: A5062 - passed Assembly   FISCAL IMPLICATIONS: Full funding for New York Health would come from the revenue measures to be proposed by the Governor under guidelines in the bill, plus available federal funds. The revenue package would also replace: local share of Medicaid, the state share of Medicaid, state and local payments for public employee health coverage, and various other health care spending. Numerous analyses document that a single-payer system would be most effective for reducing and controlling costs, for taxpayers, employers and individuals.   EFFECTIVE DATE: Immediately. The program will actually begin functioning when the Commissioner of Health declares the beginning of the implementation period.
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A04738 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4738
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 3, 2017
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, ABINANTI, BARRON, BENEDETTO, BICHOTTE,
          BLAKE,  BRONSON,  CARROLL,  COLTON,  COOK,  CRESPO, CYMBROWITZ, DILAN,
          DINOWITZ, ENGLEBRIGHT, GANTT, GJONAJ, HIKIND, HUNTER, HYNDMAN, JAFFEE,
          JENNE,  JOYNER,  KAVANAGH,  KIM,  LAVINE,  LIFTON,   LUPARDO,   MAYER,
          M. G. MILLER,  MOSLEY,  MOYA, PAULIN, PEOPLES-STOKES, PERRY, PICHARDO,
          RAMOS, RICHARDSON, RIVERA, RODRIGUEZ, ROSENTHAL, SEAWRIGHT, SEPULVEDA,
          SIMOTAS, STECK, STIRPE,  THIELE,  TITONE,  TITUS,  WALKER,  WEINSTEIN,
          WEPRIN  --  Multi-Sponsored  by  --  M.  of  A. ABBATE, ARROYO, AUBRY,
          CAHILL, DAVILA, FAHY, FARRELL, GLICK, GUNTHER, HOOPER, LENTOL,  MAGEE,
          MAGNARELLI, O'DONNELL, ORTIZ, PRETLOW, QUART, ROZIC, SIMON, SKARTADOS,
          SOLAGES -- read once and referred to the Committee on Health
 
        AN  ACT  to  amend  the  public health law and the state finance law, in
          relation to enacting the "New York health act" and to establishing New
          York Health
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Short  title. This act shall be known and may be cited as
     2  the "New York health act".
     3    § 2. Legislative  findings  and  intent.  1.  The  state  constitution
     4  states:  "The  protection and promotion of the health of the inhabitants
     5  of the state are matters of public concern and provision therefor  shall
     6  be made by the state and by such of its subdivisions and in such manner,
     7  and by such means as the legislature shall from time to time determine."
     8  (Article  XVII,  §3.)  The legislature finds and declares that all resi-
     9  dents of the state have the right to health care.    While  the  federal
    10  Affordable  Care Act brought many improvements in health care and health
    11  coverage, it still leaves many New  Yorkers  without  coverage  or  with
    12  inadequate  coverage.  New  Yorkers  -  as  individuals,  employers, and
    13  taxpayers - have experienced a rise in  the  cost  of  health  care  and
    14  coverage  in  recent  years,  including rising premiums, deductibles and
    15  co-pays, restricted provider networks and high  out-of-network  charges.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09305-01-7

        A. 4738                             2
 
     1  Businesses  have  also experienced increases in the costs of health care
     2  benefits for their employees, and many employers are shifting  a  larger
     3  share  of  the  cost of coverage to their employees or dropping coverage
     4  entirely.   Health care providers are also affected by inadequate health
     5  coverage in New York state. A large  portion  of  voluntary  and  public
     6  hospitals, health centers and other providers now experience substantial
     7  losses  due  to the provision of care that is uncompensated. Individuals
     8  often find that they are deprived of affordable care and choice  because
     9  of  decisions by health plans guided by the plan's economic needs rather
    10  than their health care needs. To address the fiscal  crisis  facing  the
    11  health  care system and the state and to assure New Yorkers can exercise
    12  their right to health care, affordable and comprehensive health coverage
    13  must be provided. Pursuant to the state  constitution's  charge  to  the
    14  legislature  to  provide for the health of New Yorkers, this legislation
    15  is an enactment of state concern  for  the  purpose  of  establishing  a
    16  comprehensive  universal single-payer health care coverage program and a
    17  health care cost control system for the benefit of all residents of  the
    18  state of New York.
    19    2.  It  is the intent of the Legislature to create the New York Health
    20  program to provide a universal health plan for every New Yorker,  funded
    21  by broad-based revenue based on ability to pay.  The state shall work to
    22  obtain  waivers  and  other approvals relating to Medicaid, Child Health
    23  Plus, Medicare, the Affordable  Care  Act,  and  any  other  appropriate
    24  federal  programs,  under  which  federal funds and other subsidies that
    25  would otherwise be paid to New York State, New Yorkers, and health  care
    26  providers  for  health  coverage that will be equaled or exceeded by New
    27  York Health will be paid by the federal government to New York State and
    28  deposited in the New York Health  trust  fund,  and  for  other  program
    29  modifications  (including  elimination  of  cost  sharing  and insurance
    30  premiums).   Under such waivers and  approvals,  health  coverage  under
    31  those  programs  will be replaced and merged into New York Health, which
    32  will operate as a true single-payer program.
    33    If any necessary waiver or approval is not obtained, the  state  shall
    34  use  state  plan  amendments and seek waivers and approvals to maximize,
    35  and make as seamless as possible, the use  of  federally-matched  health
    36  programs  and  federal  health  programs in New York Health.  Thus, even
    37  where other programs such as Medicaid  or  Medicare  may  contribute  to
    38  paying  for  care,  it is the goal of this legislation that the coverage
    39  will be delivered by New York Health  and,  as  much  as  possible,  the
    40  multiple  sources  of  funding will be pooled with other New York Health
    41  funds and not be apparent to New York Health  members  or  participating
    42  providers.  This program will promote movement away from fee-for-service
    43  payment,  which tends to reward quantity and requires excessive adminis-
    44  trative expense, and towards alternate payment  methodologies,  such  as
    45  global  or capitated payments to providers or health care organizations,
    46  that promote quality, efficiency, investment in primary  and  preventive
    47  care, and innovation and integration in the organizing of health care.
    48    3.  This  act  does  not  create  any  employment benefit, nor does it
    49  require, prohibit, or limit the providing of any employment benefit.
    50    4. In order to promote improved quality of, and access to, health care
    51  services and promote improved clinical outcomes, it is the policy of the
    52  state to encourage cooperative, collaborative and  integrative  arrange-
    53  ments  among  health  care providers who might otherwise be competitors,
    54  under the active supervision of the commissioner of health.  It  is  the
    55  intent  of  the state to supplant competition with such arrangements and
    56  regulation only to the extent necessary to accomplish  the  purposes  of

        A. 4738                             3
 
     1  this  act,  and  to  provide  state  action immunity under the state and
     2  federal antitrust laws  to  health  care  providers,  particularly  with
     3  respect  to  their  relations with the single-payer New York Health plan
     4  created by this act.
     5    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
     6  health law are renumbered article 80 and sections 8000, 8001,  8002  and
     7  8003, respectively, and a new article 51 is added to read as follows:
     8                                  ARTICLE 51
     9                               NEW YORK HEALTH
    10  Section 5100. Definitions.
    11          5101. Program created.
    12          5102. Board of trustees.
    13          5103. Eligibility and enrollment.
    14          5104. Benefits.
    15          5105. Health  care providers; care coordination; payment method-
    16                  ologies.
    17          5106. Health care organizations.
    18          5107. Program standards.
    19          5108. Regulations.
    20          5109. Provisions relating to federal health programs.
    21          5110. Additional provisions.
    22          5111. Regional advisory councils.
    23    § 5100. Definitions. As used in  this  article,  the  following  terms
    24  shall  have  the following meanings, unless the context clearly requires
    25  otherwise:
    26    1. "Board" means the board of trustees of the New York Health  program
    27  created  by section fifty-one hundred two of this article, and "trustee"
    28  means a trustee of the board.
    29    2. "Care coordination" means services provided by a  care  coordinator
    30  under subdivision two of section fifty-one hundred five of this article.
    31    3.  "Care  coordinator"  means  an  individual  or  entity approved to
    32  provide care coordination under subdivision  two  of  section  fifty-one
    33  hundred five of this article.
    34    4. "Federally-matched public health program" means the medical assist-
    35  ance  program  under title eleven of article five of the social services
    36  law, the basic health program under section three hundred  sixty-nine-gg
    37  of  the  social  services  law,  and the child health plus program under
    38  title one-A of article twenty-five of this chapter.
    39    5. "Health care organization" means an entity that is approved by  the
    40  commissioner  under  section  fifty-one  hundred  six of this article to
    41  provide health care services to members under the program.
    42    6. "Health care service" means any health care service, including care
    43  coordination, included as a benefit under the program.
    44    7. "Implementation period" means the period under subdivision three of
    45  section fifty-one hundred one of this article during which  the  program
    46  will be subject to special eligibility and financing provisions until it
    47  is fully implemented under that section.
    48    8.  "Long  term  care"  means  long term care, treatment, maintenance,
    49  services and supports, with the exception of short term  rehabilitation,
    50  as defined by the commissioner.
    51    9.  "Medicaid"  or  "medical assistance" means title eleven of article
    52  five of the social services law and  the  program  thereunder.    "Child
    53  health  plus"  means  title one-A of article twenty-five of this chapter
    54  and the program thereunder. "Medicare" means title XVIII of the  federal
    55  social security act and the programs thereunder.  "Basic health program"

        A. 4738                             4
 
     1  means section three hundred sixty-nine-gg of the social services law and
     2  the program thereunder.
     3    10. "Member" means an individual who is enrolled in the program.
     4    11.  "New York Health trust fund" means the New York Health trust fund
     5  established under section eighty-nine-i of the state finance law.
     6    12. "Out-of-state health care service" means  a  health  care  service
     7  provided  to a member while the member is out of the state and (a) it is
     8  medically necessary that the health care service be provided  while  the
     9  member is out of the state, or (b) it is clinically appropriate that the
    10  health  care  service  be  provided by a particular health care provider
    11  located out of the state rather than in the state.  However, any  health
    12  care  service  provided  to  a New York Health enrollee by a health care
    13  provider qualified under paragraph (a) of subdivision three  of  section
    14  fifty-one hundred five of this article that is located outside the state
    15  shall  not be considered an out-of-state service and shall be covered as
    16  otherwise provided in this article.
    17    13. "Participating provider" means any individual or entity that is  a
    18  health  care  provider  qualified  under  subdivision  three  of section
    19  fifty-one hundred  five  of  this  article  that  provides  health  care
    20  services to members under the program, or a health care organization.
    21    14.  "Affordable  care  act"  means the federal patient protection and
    22  affordable care act, public law 111-148, as amended by the  health  care
    23  and  education  reconciliation  act  of 2010, public law 111-152, and as
    24  otherwise amended and any regulations or guidance issued thereunder.
    25    15. "Person" means any individual or natural person,  trust,  partner-
    26  ship,  association,  unincorporated  association,  corporation, company,
    27  limited liability company, proprietorship, joint  venture,  firm,  joint
    28  stock association, department, agency, authority, or other legal entity,
    29  whether for-profit, not-for-profit or governmental.
    30    16.  "Program"  means  the  New York Health program created by section
    31  fifty-one hundred one of this article.
    32    17. "Prescription and non-prescription drugs" means prescription drugs
    33  as defined in section two hundred seventy of this chapter, and non-pres-
    34  cription smoking cessation products or devices.
    35    18. "Resident" means an individual whose primary place of abode is  in
    36  the  state,  without  regard  to the individual's immigration status, as
    37  determined according to regulations of the commissioner.
    38    § 5101. Program created. 1. The New  York  Health  program  is  hereby
    39  created  in  the department. The commissioner shall establish and imple-
    40  ment the program under this article. The program shall  provide  compre-
    41  hensive health coverage to every resident who enrolls in the program.
    42    2.  The  commissioner shall, to the maximum extent possible, organize,
    43  administer and market the program and services as a single program under
    44  the name "New York Health" or such other name as the commissioner  shall
    45  determine,  regardless  of under which law or source the definition of a
    46  benefit is found including (on a voluntary basis) retiree  health  bene-
    47  fits.    In  implementing this subdivision, the commissioner shall avoid
    48  jeopardizing federal financial participation in these programs and shall
    49  take care to promote public understanding  and  awareness  of  available
    50  benefits and programs.
    51    3. The commissioner shall determine when individuals may begin enroll-
    52  ing in the program. There shall be an implementation period, which shall
    53  begin  on  the  date that individuals may begin enrolling in the program
    54  and shall end as determined by the commissioner.
    55    4. An insurer authorized to provide coverage pursuant to the insurance
    56  law or a health maintenance organization certified  under  this  chapter

        A. 4738                             5

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

        A. 4738                             6
 
     1    (iii) two of whom shall be representatives of  professional  organiza-
     2  tions  representing  licensed  or  registered  health care professionals
     3  other than physicians;
     4    (iv)  three of whom shall be representatives of general hospitals, one
     5  of whom shall be a representative of public general hospitals;
     6    (v) one of whom shall be a representative of community health centers;
     7    (vi) two of whom shall be representatives of long term care providers;
     8    (vii) two of whom shall be representatives  of  behavioral  or  mental
     9  health care providers;
    10    (viii)  two  of whom shall be representatives of health care organiza-
    11  tions;
    12    (ix) two of whom shall be representatives of organized labor;
    13    (x) two of whom shall  have  demonstrated  expertise  in  health  care
    14  finance; and
    15    (xi)  two  of  whom shall be employers or representatives of employers
    16  who pay the payroll tax under this article, or, prior to the tax  becom-
    17  ing effective, will pay the tax;
    18    (c)  fourteen  trustees  appointed by the governor; five of whom to be
    19  appointed on the recommendation of the speaker of the assembly; five  of
    20  whom to be appointed on the recommendation of the temporary president of
    21  the  senate;  two  of  whom to be appointed on the recommendation of the
    22  minority leader of the assembly; and two of whom to be appointed on  the
    23  recommendation of the minority leader of the senate.
    24    3.  After  the  end of the implementation period, no person shall be a
    25  trustee unless he or she is a member of the program, except the ex offi-
    26  cio trustees. Each trustee shall serve at the pleasure of the appointing
    27  officer, except the ex officio trustees.
    28    4. The chair of the board shall be appointed, and may  be  removed  as
    29  chair,  by the governor from among the trustees. The board shall meet at
    30  least four times each calendar year. Meetings shall  be  held  upon  the
    31  call  of  the  chair  and  as  provided  by the board. A majority of the
    32  appointed trustees shall be a quorum of the board, and  the  affirmative
    33  vote  of a majority of the trustees voting, but not less than ten, shall
    34  be necessary for any action to be taken by  the  board.  The  board  may
    35  establish an executive committee to exercise any powers or duties of the
    36  board as it may provide, and other committees to assist the board or the
    37  executive  committee.  The  chair of the board shall chair the executive
    38  committee and shall appoint the chair and members of all  other  commit-
    39  tees. The board of trustees may appoint one or more advisory committees.
    40  Members of advisory committees need not be members of the board of trus-
    41  tees.
    42    5.  Trustees  shall serve without compensation but shall be reimbursed
    43  for their necessary and actual expenses incurred while  engaged  in  the
    44  business of the board.
    45    6. Notwithstanding any provision of law to the contrary, no officer or
    46  employee of the state or any local government shall forfeit or be deemed
    47  to  have  forfeited his or her office or employment by reason of being a
    48  trustee.
    49    7. The board and its committees and advisory  committees  may  request
    50  and  receive  the  assistance  of  the department and any other state or
    51  local governmental entity in exercising its powers and duties.
    52    8. No later than two years after the effective date of this article:
    53    (a) The board shall develop a proposal, consistent with the principles
    54  of this article, for provision by the program of long-term  care  cover-
    55  age,  including the development of a proposal, consistent with the prin-
    56  ciples of this article, for its funding.   In developing  the  proposal,

        A. 4738                             7

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

        A. 4738                             8
 
     1    § 5105. Health care providers; care  coordination;  payment  methodol-
     2  ogies.   1. Choice of health care provider. (a) Any health care provider
     3  qualified to participate under this  section  may  provide  health  care
     4  services  under  the  program, provided that the health care provider is
     5  otherwise  legally authorized to perform the health care service for the
     6  individual and under the circumstances involved.
     7    (b) A member may choose to receive  health  care  services  under  the
     8  program  from  any participating provider, consistent with provisions of
     9  this article relating to care coordination  and  health  care  organiza-
    10  tions,  the  willingness  or  availability  of  the provider (subject to
    11  provisions of this article relating to discrimination), and  the  appro-
    12  priate clinically-relevant circumstances.
    13    2. Care coordination.
    14    (a)  Care coordination shall include, but not be limited to, managing,
    15  referring  to,  locating,  coordinating,  and  monitoring  health   care
    16  services  for  the  member to assure that all medically necessary health
    17  care services are made available to and  are  effectively  used  by  the
    18  member  in a timely manner, consistent with patient autonomy. Care coor-
    19  dination is not a requirement for prior authorization  for  health  care
    20  services  and  referral  shall not be required for a member to receive a
    21  health care service.
    22    (b) A care coordinator may be an individual or entity that is approved
    23  by the program that is:
    24    (i) a health care practitioner who is: (A) the member's  primary  care
    25  practitioner; (B) at the option of a female member, the member's provid-
    26  er  of  primary gynecological care; or (C) at the option of a member who
    27  has a chronic condition  that  requires  specialty  care,  a  specialist
    28  health  care  practitioner who regularly and continually provides treat-
    29  ment for that condition to the member;
    30    (ii) an entity licensed under article twenty-eight of this chapter  or
    31  certified  under article thirty-six of this chapter, a managed long term
    32  care plan under section forty-four hundred three-f of  this  chapter  or
    33  other  program  model  under  paragraph (b) of subdivision seven of such
    34  section, or, with respect to a member who receives chronic mental health
    35  care services, an entity licensed under article thirty-one of the mental
    36  hygiene law or other entity approved by the commissioner in consultation
    37  with the commissioner of mental health;
    38    (iii) a health care organization;
    39    (iv) a Taft-Hartley fund, with respect to its members and their family
    40  members; provided that this provision shall not preclude a  Taft-Hartley
    41  fund  from  becoming  a  care coordinator under subparagraph (v) of this
    42  paragraph or a health care organization under section fifty-one  hundred
    43  six of this article; or
    44    (v) any not-for-profit or governmental entity approved by the program.
    45    (c)  Health care services provided to a member shall not be subject to
    46  payment under the program unless the member  is  enrolled  with  a  care
    47  coordinator  at  the  time  the  health care service is provided, except
    48  where provided under subdivision three of section fifty-one hundred four
    49  of this article. Every member shall enroll with a care coordinator  that
    50  agrees  to  provide  care  coordination to the member prior to receiving
    51  health care services to be paid for under the program. The member  shall
    52  remain  enrolled  with  that  care  coordinator until the member becomes
    53  enrolled with a different care coordinator or ceases  to  be  a  member.
    54  Members  have  the  right  to  change their care coordinator on terms at
    55  least as permissive as the provisions of section  three  hundred  sixty-

        A. 4738                             9
 
     1  four-j of the social services law relating to an individual changing his
     2  or her primary care provider or managed care provider.
     3    (d)  Care coordination shall be provided to the member by the member's
     4  care coordinator.  A care coordinator may employ or utilize the services
     5  of other individuals or entities to assist  in  providing  care  coordi-
     6  nation for the member, consistent with regulations of the commissioner.
     7    (e)  A  health  care organization may establish rules relating to care
     8  coordination for members in the health care organization, different from
     9  this subdivision but otherwise consistent with this  article  and  other
    10  applicable  laws.  Nothing in this subdivision shall authorize any indi-
    11  vidual to engage in any act in violation of title eight of the education
    12  law.
    13    (f) The commissioner shall develop and implement procedures and stand-
    14  ards for an individual or entity to be approved to be a care coordinator
    15  in the program, including but not limited to  procedures  and  standards
    16  relating  to  the  revocation,  suspension,  limitation, or annulment of
    17  approval on a determination that the individual or entity is incompetent
    18  to be a care coordinator or has exhibited a course of conduct  which  is
    19  either  inconsistent  with  program  standards  and regulations or which
    20  exhibits an unwillingness to meet such standards and regulations, or  is
    21  a  potential  threat to the public health or safety. Such procedures and
    22  standards shall not limit approval to  be  a  care  coordinator  in  the
    23  program  for economic purposes and shall be consistent with good profes-
    24  sional practice. In developing the procedures and standards, the commis-
    25  sioner shall: (i) consider  existing  standards  developed  by  national
    26  accrediting  and  professional  organizations;  and  (ii)  consult  with
    27  national and local organizations working on care coordination or similar
    28  models, including health care  practitioners,  hospitals,  clinics,  and
    29  consumers  and  their  representatives. When developing and implementing
    30  standards of approval of care  coordinators  for  individuals  receiving
    31  chronic mental health care services, the commissioner shall consult with
    32  the  commissioner of mental health. An individual or entity may not be a
    33  care coordinator unless the services included in care  coordination  are
    34  within  the  individual's professional scope of practice or the entity's
    35  legal authority.
    36    (g) To maintain approval under the program, a care  coordinator  must:
    37  (i)  renew its status at a frequency determined by the commissioner; and
    38  (ii) provide data to the department as required by the  commissioner  to
    39  enable  the  commissioner to evaluate the impact of care coordinators on
    40  quality, outcomes and cost.
    41    3. Health care providers. (a) The  commissioner  shall  establish  and
    42  maintain procedures and standards for health care providers to be quali-
    43  fied  to participate in the program, including but not limited to proce-
    44  dures and standards relating to the revocation, suspension,  limitation,
    45  or annulment of qualification to participate on a determination that the
    46  health  care provider is an incompetent provider of specific health care
    47  services or has exhibited a course of conduct which is either inconsist-
    48  ent with program standards and regulations or which exhibits an  unwill-
    49  ingness to meet such standards and regulations, or is a potential threat
    50  to  the public health or safety. Such procedures and standards shall not
    51  limit health care provider participation in  the  program  for  economic
    52  purposes  and  shall  be consistent with good professional practice. Any
    53  health care provider who is qualified  to  participate  under  Medicaid,
    54  child health plus or Medicare shall be deemed to be qualified to partic-
    55  ipate in the program, and any health care provider's revocation, suspen-
    56  sion, limitation, or annulment of qualification to participate in any of

        A. 4738                            10
 
     1  those  programs  shall apply to the health care provider's qualification
     2  to participate in the program; provided  that  a  health  care  provider
     3  qualified  under  this  sentence  shall  follow the procedures to become
     4  qualified under the program by the end of the implementation period.
     5    (b) The commissioner shall establish and maintain procedures and stan-
     6  dards for recognizing health care providers located out of the state for
     7  purposes of providing coverage under the program for out-of-state health
     8  care services.
     9    4.  Payment  for health care services. (a) The commissioner may estab-
    10  lish by regulation payment methodologies for health  care  services  and
    11  care coordination provided to members under the program by participating
    12  providers,  care coordinators, and health care organizations.  There may
    13  be a variety of different payment methodologies, including those  estab-
    14  lished  on  a  demonstration  basis. All payment rates under the program
    15  shall be reasonable and reasonably related to the  cost  of  efficiently
    16  providing  the health care service and assuring an adequate and accessi-
    17  ble supply of health care service.   Until and  unless  another  payment
    18  methodology  is  established,  health  care services provided to members
    19  under the program shall be paid for on a fee-for-service  basis,  except
    20  for care coordination.
    21    (b)  The  program  shall engage in good faith negotiations with health
    22  care providers' representatives under title III of article forty-nine of
    23  this chapter, including, but not limited to, in  relation  to  rates  of
    24  payment and payment methodologies.
    25    (c)  Notwithstanding any provision of law to the contrary, payment for
    26  drugs provided by pharmacies under the program shall be made pursuant to
    27  title one of article two-A of this chapter. However, the  program  shall
    28  provide  for  payment  for  prescription drugs under section 340B of the
    29  federal public service act where applicable.  Payment  for  prescription
    30  drugs  provided  by health care providers other than pharmacies shall be
    31  pursuant to other provisions of this article.
    32    (d) Payment for health care services established  under  this  article
    33  shall  be considered payment in full. A participating provider shall not
    34  charge any rate in excess of the payment established under this  article
    35  for  any  health care service under the program provided to a member and
    36  shall not solicit or accept payment from any member or third  party  for
    37  any such service except as provided under section fifty-one hundred nine
    38  of this article.  However, this paragraph shall not preclude the program
    39  from  acting as a primary or secondary payer in conjunction with another
    40  third-party payer where permitted under section fifty-one  hundred  nine
    41  of this article.
    42    (e)  The  program may provide in payment methodologies for payment for
    43  capital related expenses for specifically  identified  capital  expendi-
    44  tures  incurred  by  not-for-profit  or  governmental entities certified
    45  under article twenty-eight of this chapter. Any capital related  expense
    46  generated  by  a  capital expenditure that requires or required approval
    47  under article twenty-eight of  this  chapter  must  have  received  that
    48  approval  for  the  capital  related  expense  to  be paid for under the
    49  program.
    50    (f) Payment methodologies and rates shall include a distinct component
    51  of reimbursement for direct and indirect graduate medical  education  as
    52  defined,  calculated  and  implemented  pursuant to section twenty-eight
    53  hundred seven-c of this chapter.
    54    (g) The commissioner shall provide by  regulation for payment  method-
    55  ologies and procedures for paying for out-of-state health care services.

        A. 4738                            11
 
     1    §  5106.  Health  care organizations. 1. A member may choose to enroll
     2  with and receive health care services under the program  from  a  health
     3  care organization.
     4    2.  A  health  care  organization shall be a not-for-profit or govern-
     5  mental entity that is approved by the commissioner that is:
     6    (a) an accountable care organization under  article  twenty-nine-E  of
     7  this chapter; or
     8    (b)  a  Taft-Hartley  fund  (i)  with respect to its members and their
     9  family members, and (ii) if allowed by applicable law  and  approved  by
    10  the  commissioner,  for  other members of the program; provided that the
    11  commissioner shall provide by regulation that where a Taft-Hartley  fund
    12  is  acting under this subparagraph there are protections for health care
    13  providers and patients comparable to  those  applicable  to  accountable
    14  care organizations.
    15    3.  A  health  care organization may be responsible for all or part of
    16  the health care services to which its members  are  entitled  under  the
    17  program, consistent with the terms of its approval by the commissioner.
    18    4.  (a)  The  commissioner  shall develop and implement procedures and
    19  standards for an entity to be approved to be a health care  organization
    20  in  the  program,  including but not limited to procedures and standards
    21  relating to the revocation,  suspension,  limitation,  or  annulment  of
    22  approval  on  a  determination  that  the  entity is incompetent to be a
    23  health care organization or has exhibited a course of conduct  which  is
    24  either  inconsistent  with  program  standards  and regulations or which
    25  exhibits an unwillingness to meet such standards and regulations, or  is
    26  a  potential  threat to the public health or safety. Such procedures and
    27  standards shall not limit approval to be a health care  organization  in
    28  the  program  for  economic  purposes  and shall be consistent with good
    29  professional practice. In developing the procedures and  standards,  the
    30  commissioner   shall:  (i)  consider  existing  standards  developed  by
    31  national accrediting and professional organizations;  and  (ii)  consult
    32  with  national  and  local  organizations working in the field of health
    33  care organizations,  including  health  care  practitioners,  hospitals,
    34  clinics,  and  consumers  and their representatives. When developing and
    35  implementing standards of approval of  health  care  organizations,  the
    36  commissioner  shall  consult  with the commissioner of mental health and
    37  the commissioner of developmental disabilities.
    38    (b) To maintain approval under the program, a health care organization
    39  must: (i) renew its status at a frequency determined by the  commission-
    40  er;  and  (ii) provide data to the department as required by the commis-
    41  sioner to enable the commissioner to evaluate the health care  organiza-
    42  tion  in  relation  to  quality  of  health  care  services, health care
    43  outcomes, and cost.
    44    5. The commissioner shall make regulations  relating  to  health  care
    45  organizations  consistent  with and to ensure compliance with this arti-
    46  cle.
    47    6. The provision of health care services directly or indirectly  by  a
    48  health  care  organization  through  health  care providers shall not be
    49  considered the practice of a profession under title eight of the  educa-
    50  tion law by the health care organization.
    51    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    52  requirements and standards for the program and for health care organiza-
    53  tions, care coordinators, and health  care  providers,  consistent  with
    54  this article, including requirements and standards for, as applicable:
    55    (a) the scope, quality and accessibility of health care services;

        A. 4738                            12
 
     1    (b) relations between health care organizations or health care provid-
     2  ers and members; and
     3    (c)  relations  between  health  care  organizations  and  health care
     4  providers, including (i) credentialing and participation in  the  health
     5  care organization; and (ii) terms, methods and rates of payment.
     6    2. Requirements and standards under the program shall include, but not
     7  be limited to, provisions to promote the following:
     8    (a)  simplification,  transparency, uniformity, and fairness in health
     9  care provider credentialing and participation in health  care  organiza-
    10  tion  networks, referrals, payment procedures and rates, claims process-
    11  ing, and approval of health care services, as applicable;
    12    (b) primary and preventive  care,  care  coordination,  efficient  and
    13  effective  health  care  services,  quality  assurance, coordination and
    14  integration of health care services, including use of appropriate  tech-
    15  nology, and promotion of public, environmental and occupational health;
    16    (c) elimination of health care disparities;
    17    (d) non-discrimination with respect to members and health care provid-
    18  ers on the basis of race, ethnicity, national origin, religion, disabil-
    19  ity,  age,  sex,  sexual  orientation, gender identity or expression, or
    20  economic circumstances; provided  that  health  care  services  provided
    21  under the program shall be appropriate to the patient's clinically-rele-
    22  vant circumstances; and
    23    (e)  accessibility  of  care  coordination,  health  care organization
    24  services and health care services, including  accessibility  for  people
    25  with disabilities and people with limited ability to speak or understand
    26  English,  and  the providing of care coordination, health care organiza-
    27  tion services and health care services in a culturally competent manner.
    28    3. Any participating provider or care coordinator that is organized as
    29  a for-profit entity shall be required to meet the same requirements  and
    30  standards as entities organized as not-for-profit entities, and payments
    31  under  the  program  paid  to  such  entities shall not be calculated to
    32  accommodate the generation of profit or revenue for dividends  or  other
    33  return on investment or the payment of taxes that would not be paid by a
    34  not-for-profit entity.
    35    4.  Every  participating  provider  shall  furnish to the program such
    36  information to, and permit examination of its records by,  the  program,
    37  as  may  be  reasonably required for purposes of reviewing accessibility
    38  and utilization of health care services,  quality  assurance,  and  cost
    39  containment, the making of payments, and statistical or other studies of
    40  the  operation of the program or for protection and promotion of public,
    41  environmental and occupational health.
    42    5. In developing requirements and standards and  making  other  policy
    43  determinations  under  this article, the commissioner shall consult with
    44  representatives of members, health care  providers,  care  coordinators,
    45  health care organizations and other interested parties.
    46    6.    The  program  shall maintain the confidentiality of all data and
    47  other information collected under the program when such  data  would  be
    48  normally  considered confidential data between a patient and health care
    49  provider.  Aggregate data of the program which is derived from confiden-
    50  tial data but does not violate patient confidentiality shall  be  public
    51  information.
    52    §  5108.  Regulations.  The  commissioner  may approve regulations and
    53  amendments thereto, under subdivision one of section  fifty-one  hundred
    54  two of this article. The commissioner may make regulations or amendments
    55  thereto  to effectuate the provisions and purposes of this article on an
    56  emergency basis under section two hundred two of the  state  administra-

        A. 4738                            13

     1  tive  procedure  act, provided that such regulations or amendments shall
     2  not become permanent unless adopted under  subdivision  one  of  section
     3  fifty-one hundred two of this article.
     4    § 5109. Provisions relating to federal health programs. 1. The commis-
     5  sioner  shall  seek  all federal waivers and other federal approvals and
     6  arrangements and submit state plan amendments necessary to  operate  the
     7  program consistent with this article.
     8    2.  (a)  The  commissioner  shall apply to the secretary of health and
     9  human services or other appropriate federal official for all waivers  of
    10  requirements,  and make other arrangements, under Medicare, any federal-
    11  ly-matched public health program, the affordable care act, and any other
    12  federal programs that provide federal funds for payment for health  care
    13  services,  that  are  necessary to enable all New York Health members to
    14  receive all benefits under the program through the program to enable the
    15  state to implement this article and to receive and deposit  all  federal
    16  payments  under  those programs (including funds that may be provided in
    17  lieu of premium tax credits, cost-sharing subsidies, and small  business
    18  tax  credits) in the state treasury to the credit of the New York Health
    19  trust fund created under section eighty-nine-i of the state finance  law
    20  and  to  use  those  funds  for  the  New  York Health program and other
    21  provisions under this article. To the extent possible, the  commissioner
    22  shall  negotiate  arrangements with the federal government in which bulk
    23  or lump-sum federal payments are paid to New York  Health  in  place  of
    24  federal  spending  or tax benefits for federally-matched health programs
    25  or federal health programs.
    26    (b) The commissioner may require members or applicants to  be  members
    27  to  provide  information  necessary  for  the program to comply with any
    28  waiver or arrangement under this subdivision.
    29    3. (a) If actions taken under subdivision two of this section  do  not
    30  accomplish all results intended under that subdivision, then this subdi-
    31  vision shall apply and shall authorize additional actions to effectively
    32  implement  New  York  Health to the maximum extent possible as a single-
    33  payer program consistent with this article.
    34    (b) The commissioner may take actions consistent with this article  to
    35  enable  New  York Health to administer Medicare in New York state and to
    36  be a provider of drug  coverage  under  Medicare  part  D  for  eligible
    37  members of New York Health.
    38    (c)  The  commissioner  may  waive  or  modify  the  applicability  of
    39  provisions of this section  relating  to  any  federally-matched  public
    40  health  program  or  Medicare  as  necessary  to implement any waiver or
    41  arrangement under this section or to maximize the  benefit  to  the  New
    42  York  Health program under this section, provided that the commissioner,
    43  in consultation with the director of the budget,  shall  determine  that
    44  such  waiver  or  modification  is  in the best interests of the members
    45  affected by the action and the state.
    46    (d) The commissioner may  apply  for  coverage  under  any  federally-
    47  matched  public  health  program  on behalf of any member and enroll the
    48  member in the federally-matched public health program or Medicare if the
    49  member is eligible for it.   Enrollment in  a  federally-matched  public
    50  health program or Medicare shall not cause any member to lose any health
    51  care  service  provided  by the program or diminish any right the member
    52  would otherwise have.
    53    (e) The commissioner shall by regulation increase the income eligibil-
    54  ity level, increase or eliminate  the  resource  test  for  eligibility,
    55  simplify any procedural or documentation requirement for enrollment, and
    56  increase  the  benefits for any federally-matched public health program,

        A. 4738                            14
 
     1  and for any program to reduce or eliminate an individual's  coinsurance,
     2  cost-sharing  or  premium obligations or increase an individual's eligi-
     3  bility for any federal financial support  related  to  Medicare  or  the
     4  affordable care act notwithstanding any law or regulation to the contra-
     5  ry.  The  commissioner  may  act  under  this  paragraph upon a finding,
     6  approved by the director of the budget, that the action (i) will help to
     7  increase the number of members who are  eligible  for  and  enrolled  in
     8  federally-matched  public  health programs, or for any program to reduce
     9  or eliminate an individual's coinsurance, cost-sharing or premium  obli-
    10  gations  or  increase an individual's eligibility for any federal finan-
    11  cial support related to Medicare or the affordable care act;  (ii)  will
    12  not diminish any individual's access to any health care service or right
    13  the  individual  would  otherwise  have; (iii) is in the interest of the
    14  program; and (iv) does not require or has received any necessary federal
    15  waivers or approvals to ensure federal financial participation.  Actions
    16  under this paragraph shall not apply to eligibility for payment for long
    17  term care.
    18    (f)  To enable the commissioner to apply for coverage under any feder-
    19  ally-matched public health program or Medicare on behalf of  any  member
    20  and  enroll the member in the federally-matched public health program or
    21  Medicare if the member is eligible for it, the commissioner may  require
    22  that  every member or applicant to be a member shall provide information
    23  to enable the commissioner to determine whether the applicant is  eligi-
    24  ble  for a federally-matched public health program and for Medicare (and
    25  any program or benefit under Medicare). The program shall make a reason-
    26  able effort to notify members of their obligations under this paragraph.
    27  After a reasonable effort has been  made  to  contact  the  member,  the
    28  member  shall  be  notified  in writing that he or she has sixty days to
    29  provide such required information. If such information is  not  provided
    30  within the sixty day period, the member's coverage under the program may
    31  be terminated.
    32    (g)  As  a condition of continued eligibility for health care services
    33  under the program, a member who is eligible for benefits under  Medicare
    34  shall enroll in Medicare, including parts A, B and D.
    35    (h)  The  program  shall  provide  premium  assistance for all members
    36  enrolling in a Medicare part D drug  coverage  under  section  1860D  of
    37  Title XVIII of the federal social security act limited to the low-income
    38  benchmark premium amount established by the federal centers for Medicare
    39  and Medicaid services and any other amount which such agency establishes
    40  under  its  de minimis premium policy, except that such payments made on
    41  behalf of members enrolled in a Medicare advantage plan may  exceed  the
    42  low-income  benchmark  premium amount if determined to be cost effective
    43  to the program.
    44    (i) If the commissioner has  reasonable  grounds  to  believe  that  a
    45  member  could  be  eligible  for an income-related subsidy under section
    46  1860D-14 of Title XVIII of the federal social security act,  the  member
    47  shall  provide,  and authorize the program to obtain, any information or
    48  documentation required to establish the member's  eligibility  for  such
    49  subsidy,  provided that the commissioner shall attempt to obtain as much
    50  of the information and documentation as possible from records  that  are
    51  available to him or her.
    52    (j)  The  program  shall make a reasonable effort to notify members of
    53  their obligations under this subdivision. After a reasonable effort  has
    54  been made to contact the member, the member shall be notified in writing
    55  that  he  or she has sixty days to provide such required information. If

        A. 4738                            15
 
     1  such information is not  provided  within  the  sixty  day  period,  the
     2  member's coverage under the program may be terminated.
     3    §  5110.  Additional  provisions.   1. The commissioner shall contract
     4  with not-for-profit organizations to provide:
     5    (a) consumer assistance to individuals with respect to selection of  a
     6  care  coordinator  or  health  care  organization,  enrolling, obtaining
     7  health care services, disenrolling, and other matters  relating  to  the
     8  program;
     9    (b) health care provider assistance to health care providers providing
    10  and  seeking  or  considering  whether  to provide, health care services
    11  under the program, with respect to participating in a health care organ-
    12  ization and dealing with a health care organization; and
    13    (c) care coordinator assistance to individuals and entities  providing
    14  and  seeking  or  considering  whether  to provide, care coordination to
    15  members.
    16    2. The commissioner shall provide grants from funds in  the  New  York
    17  Health  trust fund or otherwise appropriated for this purpose, to health
    18  systems agencies under section twenty-nine hundred four-b of this  chap-
    19  ter to support the operation of such health systems agencies.
    20    3. The commissioner shall provide funds from the New York Health trust
    21  fund  or  otherwise appropriated for this purpose to the commissioner of
    22  labor for a program for retraining  and  assisting  job  transition  for
    23  individuals  employed  or  previously  employed  in  the field of health
    24  insurance and other third-party payment for  health  care  or  providing
    25  services  to  health  care providers to deal with third-party payers for
    26  health care, whose jobs may be or have been ended as  a  result  of  the
    27  implementation of the New York Health program, consistent with otherwise
    28  applicable law.
    29    4. The commissioner shall, directly and through grants to not-for-pro-
    30  fit entities, conduct programs using data collected through the New York
    31  Health program, to promote and protect public, environmental and occupa-
    32  tional  health,  including  cooperation  with  other data collection and
    33  research programs of the department, consistent with  this  article  and
    34  otherwise applicable law.
    35    §  5111.  Regional advisory councils.  1. The New York Health regional
    36  advisory councils (each referred to in this article as a "regional advi-
    37  sory council") are hereby created in the department.
    38    2. There shall be a regional advisory council established in  each  of
    39  the following regions:
    40    (a) Long Island, consisting of Nassau and Suffolk counties;
    41    (b) New York City;
    42    (c)  Hudson  Valley, consisting of Delaware, Dutchess, Orange, Putnam,
    43  Rockland, Sullivan, Ulster, Westchester counties;
    44    (d) Northern, consisting of Albany, Clinton, Columbia,  Essex,  Frank-
    45  lin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga,
    46  Schenectady, Schoharie, Warren, Washington counties;
    47    (e)  Central,  consisting  of Broome, Cayuga, Chemung, Chenango, Cort-
    48  land, Herkimer, Jefferson, Lewis, Livingston, Madison,  Monroe,  Oneida,
    49  Onondaga,  Ontario,  Oswego,  Schuyler,  Seneca,  St. Lawrence, Steuben,
    50  Tioga, Tompkins, Wayne, Yates counties; and
    51    (f) Western, consisting of Allegany,  Cattaraugus,  Chautauqua,  Erie,
    52  Genesee, Niagara, Orleans, Wyoming counties.
    53    3.  Each regional advisory council shall be composed of not fewer than
    54  twenty-seven members, as determined by the commissioner and  the  board,
    55  as  necessary  to appropriately represent the diverse needs and concerns
    56  of the region. Members of a regional advisory council shall be residents

        A. 4738                            16
 
     1  of or have their principal place of business in the region served by the
     2  regional advisory council.
     3    4. Appointment of members of the regional advisory councils.
     4    (a) The twenty-seven members shall be appointed as follows:
     5    (i) nine members shall be appointed by the governor;
     6    (ii) six members shall be appointed by the governor on the recommenda-
     7  tion of the speaker of the assembly;
     8    (iii)  six members shall be appointed by the governor on the recommen-
     9  dation of the temporary president of the senate;
    10    (iv) three members shall be appointed by the governor on the recommen-
    11  dation of the minority leader of the assembly; and
    12    (v) three members shall be appointed by the governor on the  recommen-
    13  dation  of the minority leader of the senate.  Where a regional advisory
    14  council has more than twenty-seven members, the additional members shall
    15  be appointed and recommended by these officials in the  same  proportion
    16  as the twenty-seven members.
    17    Where  a regional advisory council has more than twenty-seven members,
    18  additional members shall be appointed and recommended by these officials
    19  in the same proportion as the twenty-seven members.
    20    (b) Regional advisory council membership  shall  include  but  not  be
    21  limited to:
    22    (i)  representatives  of  health  care consumer advocacy organizations
    23  with a regional constituency, who shall represent at least one third  of
    24  the membership of each regional council;
    25    (ii) representatives of professional organizations representing physi-
    26  cians;
    27    (iii)   representatives  of  professional  organizations  representing
    28  health care professionals other than physicians;
    29    (iv) representatives of general hospitals, including public hospitals;
    30    (v) representatives of community health centers;
    31    (vi) representatives of health care organizations;
    32    (vii) representatives of organized labor; and
    33    (viii) representatives of municipal and county government.
    34    5. Members of a regional advisory council shall be appointed for terms
    35  of three years provided, however, that of the members  first  appointed,
    36  one-third  shall  be appointed for one year terms and one-third shall be
    37  appointed for two year terms. Vacancies shall  be  filled  in  the  same
    38  manner as original appointments for the remainder of any unexpired term.
    39  No  person  shall  be an appointed member of a regional advisory council
    40  for more than six years in any period of twelve consecutive years.
    41    6. Members of the  regional  advisory  councils  shall  serve  without
    42  compensation  but  shall  be  reimbursed  for their necessary and actual
    43  expenses incurred while engaged in the business of  the  advisory  coun-
    44  cils.  The program shall provide financial support for such expenses and
    45  other expenses of the regional advisory councils.
    46    7. Each regional advisory council shall meet at least quarterly.  Each
    47  regional  advisory council may form committees to assist it in its work.
    48  Members of a committee need not be  members  of  the  regional  advisory
    49  council.    The  New  York  City  regional advisory council shall form a
    50  committee for each borough of New York  City,  to  assist  the  regional
    51  advisory council in its work as it relates particularly to that borough.
    52    8.  Each  regional  advisory council shall advise the commissioner,the
    53  board, the governor and the legislature on all matters relating  to  the
    54  development and implementation of the New York Health program.

        A. 4738                            17
 
     1    9.  Each  regional advisory council shall adopt, and from time to time
     2  revise, a community health improvement  plan  for  its  region  for  the
     3  purpose of:
     4    (a)  promoting  the  delivery  of  health care services in the region,
     5  improving the quality and  accessibility  of  care,  including  cultural
     6  competency,  clinical  integration  of  care  between  service providers
     7  including but not limited to physical, mental,  and  behavioral  health,
     8  physical and developmental disability services, and long-term care;
     9    (b) facility and health services planning in the region;
    10    (c) identifying gaps in regional health care services; and
    11    (d)  promoting increased public knowledge and responsibility regarding
    12  the availability and appropriate utilization of  health  care  services.
    13  Each community health improvement plan shall be submitted to the commis-
    14  sioner and the board and shall be posted on the department's website.
    15    10.  Each  regional  advisory  council shall hold at least four public
    16  hearings annually on matters relating to the New York Health program and
    17  the development and implementation of the community  health  improvement
    18  plan.
    19    11.  Each  regional advisory council shall publish an annual report to
    20  the commissioner and the board on the progress of the  community  health
    21  improvement  plan.  These  reports  shall  be posted on the department's
    22  website.
    23    12. All meetings of the  regional  advisory  councils  and  committees
    24  shall be subject to article six of the public officers law.
    25    § 4. Financing of New York Health. 1. The governor shall submit to the
    26  legislature  a  revenue plan and legislative bills to implement the plan
    27  (referred to collectively in this section as the "revenue proposal")  to
    28  provide the revenue necessary to finance the New York Health program, as
    29  created  by  article  51  of  the public health law (referred to in this
    30  section as the "program"), taking into consideration anticipated federal
    31  revenue available for the program. The revenue proposal shall be submit-
    32  ted to the legislature as part of the executive budget under article VII
    33  of the state constitution, for the fiscal year commencing on  the  first
    34  day  of April in the calendar year after this act shall become a law. In
    35  developing the revenue proposal, the governor shall consult with  appro-
    36  priate officials of the executive branch; the temporary president of the
    37  senate; the speaker of the assembly; the chairs of the fiscal and health
    38  committees  of the senate and assembly; and representatives of business,
    39  labor, consumers and local government.
    40    2. (a) Basic structure. The basic structure of  the  revenue  proposal
    41  shall  be as follows: Revenue for the program shall come from two premi-
    42  ums (referred to collectively in this section as the "premiums"). First,
    43  there shall be a progressively graduated  premium  on  all  payroll  and
    44  self-employed income (referred to in this section as the "payroll premi-
    45  um"),  paid  by  employers,  employees and self-employed, similar to the
    46  Medicare tax. Higher brackets of income subject to this premium shall be
    47  assessed at a higher marginal rate than lower brackets.   Second,  there
    48  shall  be  a  progressively graduated premium on taxable income (such as
    49  interest, dividends, and capital  gains)  not  subject  to  the  payroll
    50  premium  (referred to in this section as the "non-payroll premium"). The
    51  premiums will be set at levels anticipated to produce sufficient revenue
    52  to finance the program and other provisions of article 51 of the  public
    53  health  law,  to be scaled up as enrollment grows, taking into consider-
    54  ation anticipated federal revenue available for the  program.  Provision
    55  shall be made for state residents (who are eligible for the program) who

        A. 4738                            18
 
     1  are  employed  out-of-state, and non-residents (who are not eligible for
     2  the program) who are employed in the state.
     3    (b)  Payroll  premium. The income to be subject to the payroll premium
     4  shall be all income subject to the Medicare tax. The  premium  shall  be
     5  set  at a percentage of that income, which shall be progressively gradu-
     6  ated, so the percentage is higher on  higher  brackets  of  income.  For
     7  employed  individuals,  the  employer  shall  pay  eighty percent of the
     8  premium and the employee shall pay twenty percent of the premium, except
     9  that an employer may agree to pay all or part of the  employee's  share.
    10  A self-employed individual shall pay the full premium.
    11    (c)  Non-payroll  income  premium.  There shall be a premium on upper-
    12  bracket taxable personal income that  is  not  subject  to  the  payroll
    13  premium.  It shall be set at a percentage of that income, which shall be
    14  progressively graduated, so the percentage is higher on higher  brackets
    15  of income.
    16    (d) Phased-in rates. Early in the program, when enrollment is growing,
    17  the  amount  of the premiums shall be at an appropriate level, and shall
    18  be raised as anticipated enrollment grows, to cover the actual  cost  of
    19  the program and other provisions of article 51 of the public health law.
    20  The revenue proposal shall include a mechanism for determining the rates
    21  of the premiums.
    22    (e) Cross-border employees. (i) State residents employed out-of-state.
    23  If an individual is employed out-of-state by an employer that is subject
    24  to  New  York  state law, the employer and employee shall be required to
    25  pay the payroll premium as to that employee as if the employment were in
    26  the state. If an individual is employed out-of-state by an employer that
    27  is not subject to New York  state  law,  either  (A)  the  employer  and
    28  employee  shall  voluntarily comply with the premium or (B) the employee
    29  shall pay the premium as if he or she were self-employed.
    30    (ii) Out-of-state residents employed in the state.   (A)  The  payroll
    31  premium  shall  apply  to  any  out-of-state resident who is employed or
    32  self-employed in the state.  (B) In the case of an out-of-state resident
    33  who is employed or self-employed in the state, such individual and indi-
    34  vidual's employer shall be able to take a  credit  against  the  payroll
    35  premiums they would otherwise pay, as to the individual for amounts they
    36  spend  on  health  benefits  for  the individual that would otherwise be
    37  covered by the program if the individual were a member of  the  program.
    38  For  employers,  the credit shall be available regardless of the form of
    39  the health benefit (e.g., health insurance, a self-insured plan,  direct
    40  services,  or reimbursement for services), to make sure that the revenue
    41  proposal does not relate to employment  benefits  in  violation  of  the
    42  federal  ERISA.    For non-employment-based spending by individuals, the
    43  credit shall be available for and limited to spending for health  cover-
    44  age  (not  out-of-pocket health spending). The credit shall be available
    45  without regard to how little is spent or how  sparse  the  benefit.  The
    46  credit may only be taken against the payroll premiums. Any excess amount
    47  may  not  be applied to other tax liability. For employment-based health
    48  benefits, the credit shall  be  distributed  between  the  employer  and
    49  employee in the same proportion as the spending by each for the benefit.
    50  The employer and employee may each apply their respective portion of the
    51  credit  to  their respective portion of the premium. If any provision of
    52  this clause or any application of it shall be ruled to  violate  federal
    53  ERISA, the provision or the application of it shall be null and void and
    54  the  ruling  shall not affect any other provision or application of this
    55  section or the act that enacted it.

        A. 4738                            19
 
     1    3.  The  revenue  proposal  shall  include  a  plan  and   legislative
     2  provisions   for  ending  the  requirement  for  local  social  services
     3  districts to pay part of  the  cost  of  Medicaid  and  replacing  those
     4  payments with revenue from the premiums under the revenue proposal.
     5    4.  To  the extent that the revenue proposal differs from the terms of
     6  subdivision two of this section, the revenue proposal shall state how it
     7  differs from those terms and reasons for and the effects of the  differ-
     8  ences.
     9    5.  All  revenue  from the premiums shall be deposited in the New York
    10  Health trust fund account under section 89-i of the state finance law.
    11    § 5.  Article 49 of the public health law is amended by adding  a  new
    12  title 3 to read as follows:
    13                                  TITLE III
    14            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    15                               NEW YORK HEALTH
    16  Section 4920. Definitions.
    17          4921. Collective negotiation authorized.
    18          4922. Collective negotiation requirements.
    19          4923. Requirements for health care providers' representative.
    20          4924. Certain collective action prohibited.
    21          4925. Fees.
    22          4926. Confidentiality.
    23          4927. Severability and construction.
    24    § 4920. Definitions. For purposes of this title:
    25    1. "New York Health" means the program under article fifty-one of this
    26  chapter.
    27    2.  "Person"  means  an  individual,  association, corporation, or any
    28  other legal entity.
    29    3. "Health care providers' representative" means a third party that is
    30  authorized by health care providers to negotiate on  their  behalf  with
    31  New  York  Health  over terms and conditions affecting those health care
    32  providers.
    33    4. "Strike" means a work stoppage in part or in whole, direct or indi-
    34  rect, by a body of workers to gain compliance with demands  made  on  an
    35  employer.
    36    5.  "Health  care provider" means a person who is licensed, certified,
    37  registered or authorized to practice a health care  profession  pursuant
    38  to title eight of the education law and who practices that profession as
    39  a  health care provider as an independent contractor or who is an owner,
    40  officer, shareholder, or proprietor of a health  care  provider;  or  an
    41  entity  that employs or utilizes health care providers to provide health
    42  care services, including but not limited to a  hospital  licensed  under
    43  article twenty-eight of this chapter or an accountable care organization
    44  under  article  twenty-nine-E  of  this  chapter. A health care provider
    45  under title eight of the education law who practices as an employee of a
    46  health care provider shall not be deemed  a  health  care  provider  for
    47  purposes of this title.
    48    §  4921.  Collective  negotiation authorized. 1. Health care providers
    49  may meet and communicate for the  purpose  of  collectively  negotiating
    50  with  New York Health on any matter relating to New York Health, includ-
    51  ing but not limited to rates of payment and payment methodologies.
    52    2. Nothing in this section shall be construed to allow or authorize an
    53  alteration of the terms of the internal and external  review  procedures
    54  set forth in law.
    55    3. Nothing in this section shall be construed to allow a strike of New
    56  York Health by health care providers.

        A. 4738                            20
 
     1    4.  Nothing  in  this section shall be construed to allow or authorize
     2  terms or conditions which would impede the ability of New York Health to
     3  obtain or retain accreditation by the  national  committee  for  quality
     4  assurance or a similar body or to comply with applicable state or feder-
     5  al law.
     6    § 4922. Collective negotiation requirements. 1. Collective negotiation
     7  rights granted by this title must conform to the following requirements:
     8    (a)  health  care  providers  may  communicate  with other health care
     9  providers regarding the terms and conditions to be negotiated  with  New
    10  York Health;
    11    (b)  health care providers may communicate with health care providers'
    12  representatives;
    13    (c) a health care providers' representative is the only party  author-
    14  ized  to  negotiate  with  New  York Health on behalf of the health care
    15  providers as a group;
    16    (d) a health care provider can be bound by the  terms  and  conditions
    17  negotiated by the health care providers' representatives; and
    18    (e)  in  communicating  or negotiating with the health care providers'
    19  representative, New York Health is entitled to offer and provide differ-
    20  ent terms and conditions to individual competing health care providers.
    21    2. Nothing in this title shall affect or limit the right of  a  health
    22  care provider or group of health care providers to collectively petition
    23  a government entity for a change in a law, rule, or regulation.
    24    3.  Nothing  in  this title shall affect or limit collective action or
    25  collective bargaining on the part of any health care provider  with  his
    26  or  her  employer  or  any  other lawful collective action or collective
    27  bargaining.
    28    § 4923. Requirements for health care providers' representative. Before
    29  engaging in collective negotiations with New York Health  on  behalf  of
    30  health  care  providers,  a  health care providers' representative shall
    31  file with the commissioner, in the manner prescribed by the  commission-
    32  er,  information  identifying  the  representative, the representative's
    33  plan of operation, and the representative's procedures to ensure compli-
    34  ance with this title.
    35    § 4924. Certain collective action prohibited. 1.  This  title  is  not
    36  intended  to authorize competing health care providers to act in concert
    37  in response to a health care providers' representative's discussions  or
    38  negotiations with New York Health except as authorized by other law.
    39    2. No health care providers' representative shall negotiate any agree-
    40  ment  that  excludes,  limits  the participation or reimbursement of, or
    41  otherwise limits the scope of services to be provided by any health care
    42  provider or group of health care providers with respect to the  perform-
    43  ance  of  services  that  are within the health care provider's scope of
    44  practice, license, registration, or certificate.
    45    § 4925. Fees. Each person who acts as the representative of  negotiat-
    46  ing parties under this title shall pay to the department a fee to act as
    47  a  representative.  The commissioner, by rule, shall set fees in amounts
    48  deemed reasonable and necessary to  cover  the  costs  incurred  by  the
    49  department in administering this title.
    50    § 4926. Confidentiality. All reports and other information required to
    51  be  reported  to the department under this title shall not be subject to
    52  disclosure under article six of the public officers law or article thir-
    53  ty-one of the civil practice law and rules.
    54    § 4927. Severability and construction. If any provision or application
    55  of this title shall be held to be invalid, or to violate  or  be  incon-
    56  sistent  with  any  applicable federal law or regulation, that shall not

        A. 4738                            21
 
     1  affect other provisions or applications of this title which can be given
     2  effect without that provision or  application;  and  to  that  end,  the
     3  provisions  and applications of this title are severable. The provisions
     4  of  this  title  shall  be  liberally  construed  to  give effect to the
     5  purposes thereof.
     6    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
     7  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
     8  amended to read as follows:
     9    11. "State public health plan" means the  medical  assistance  program
    10  established  by  title eleven of article five of the social services law
    11  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
    12  insurance  coverage program established by title three of article two of
    13  the elder law (referred to in this article as "EPIC"), and  the  [family
    14  health  plus  program established by section three hundred sixty-nine-ee
    15  of the social services law to the extent that section provides that  the
    16  program shall be subject to this article] New York Health program estab-
    17  lished by article fifty-one of this chapter.
    18    §  7. The state finance law is amended by adding a new section 89-i to
    19  read as follows:
    20    § 89-i. New York Health trust fund. 1. There is hereby established  in
    21  the joint custody of the state comptroller and the commissioner of taxa-
    22  tion  and  finance  a  special revenue fund to be known as the "New York
    23  Health trust fund", hereinafter known as "the fund". The definitions  in
    24  section  fifty-one  hundred of the public health law shall apply to this
    25  section.
    26    2. The fund shall consist of:
    27    (a) all monies obtained from premiums pursuant to legislation  enacted
    28  as proposed under section three of the New York Health act;
    29    (b)  federal  payments  received as a result of any waiver of require-
    30  ments granted or other arrangements  agreed  to  by  the  United  States
    31  secretary  of  health  and  human  services or other appropriate federal
    32  officials for health  care  programs  established  under  Medicare,  any
    33  federally-matched public health program, or the affordable care act;
    34    (c)  the  amounts paid by the department of health that are equivalent
    35  to those amounts that are paid on behalf  of  residents  of  this  state
    36  under  Medicare,  any  federally-matched  public  health program, or the
    37  affordable care act for health benefits which are equivalent  to  health
    38  benefits covered under New York Health;
    39    (d)  federal and state funds for purposes of the provision of services
    40  authorized under title XX of the federal social security act that  would
    41  otherwise  be  covered under article fifty-one of the public health law;
    42  and
    43    (e) state monies that would otherwise be appropriated to  any  govern-
    44  mental  agency,  office,  program,  instrumentality or institution which
    45  provides health services, for services and benefits  covered  under  New
    46  York Health. Payments to the fund pursuant to this paragraph shall be in
    47  an  amount  equal  to  the  money  appropriated for such purposes in the
    48  fiscal year beginning immediately preceding the effective  date  of  the
    49  New York Health act.
    50    3.  Monies  in  the  fund  shall only be used for purposes established
    51  under article fifty-one of the public health law.
    52    § 8. Temporary commission on implementation. 1. There is hereby estab-
    53  lished a temporary commission on implementation of the New  York  Health
    54  program,  hereinafter  to  be  known  as  the  commission, consisting of
    55  fifteen members: five members, including the chair, shall  be  appointed
    56  by the governor; four members shall be appointed by the temporary presi-

        A. 4738                            22
 
     1  dent of the senate, one member shall be appointed by the senate minority
     2  leader;  four members shall be appointed by the speaker of the assembly,
     3  and one member shall be appointed by the assembly minority  leader.  The
     4  commissioner  of  health,  the superintendent of financial services, and
     5  the commissioner of taxation and finance, or their designees shall serve
     6  as non-voting ex-officio members of the commission.
     7    2. Members of the commission shall receive such assistance as  may  be
     8  necessary  from  other  state  agencies  and entities, and shall receive
     9  necessary expenses incurred in the  performance  of  their  duties.  The
    10  commission  may  employ staff as needed, prescribe their duties, and fix
    11  their compensation within amounts appropriated for the commission.
    12    3. The commission shall examine the laws and regulations of the  state
    13  and  make  such recommendations as are necessary to conform the laws and
    14  regulations of the state and article 51 of the public health law  estab-
    15  lishing the New York Health program and other provisions of law relating
    16  to  the  New  York  Health  program,  and  to  improve and implement the
    17  program. The commission shall report its recommendations to the governor
    18  and the legislature.  The commission shall immediately begin development
    19  of  proposals  consistent  with  the  principles  of  this  article  for
    20  provision of long-term care coverage; health care services covered under
    21  the workers' compensation law; and incorporation of retiree health bene-
    22  fits,  as  described  in paragraphs (a), (b) and (c) of subdivision 8 of
    23  section 5102 of the public health law.  The commission shall provide its
    24  work product and assistance to the board established pursuant to section
    25  5102 of the public health law upon completion of the appointment of  the
    26  board.
    27    §  9.  Severability. If any provision or application of this act shall
    28  be held to be invalid, or to violate or be inconsistent with any  appli-
    29  cable  federal law or regulation, that shall not affect other provisions
    30  or applications of this act which  can  be  given  effect  without  that
    31  provision  or  application; and to that end, the provisions and applica-
    32  tions of this act are severable.
    33    § 10. This act shall take effect immediately.
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A04738 LFIN:

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A04738 Chamber Video:

5-16-17 SessionVideo (@ 00:41:41)
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