NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A3605
SPONSOR: Seawright TITLE OF BILL:
An act to amend the elder law, in relation to establishing the expanded
pharmaceutical insurance coverage panel
PURPOSE OR GENERAL IDEA OF BILL:
This bill will establish the expanded pharmaceutical insurance coverage
panel to restore oversight and transparency to the function of the
program and allow for future decisions to be made in an accountable
fashion.
SUMMARY OF PROVISIONS:
This Bill Restores the EPIC panel and the advisory committee, 60% of the
later being composed of consumers and requires an annual report.
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
JUSTIFICATION:
THE EPIC program has made numerous changes administratively that have
negatively impacted enrollees without a public process to review
proposed changes. These changes include:•a change in the application
starting in 2020, that* requires enrollees to determine if they must
disclose asset, not otherwise a program requirement, if they fall into
the income category that would allow them to apply for the federal Low
Income Subsidy (LIS.) In prior years, an EPIC applicant was enrolled in
without an asset test and if the EPIC staff found that the self-reported
income could qualify for LIS (150% FPL,) the enrollee would be contacted
for additional information on assets so that an application to LIS was
completed on behalf of the enrollee. Additionally, while the current
statute includes a role for 'EPIC staff to assist enrollees who are
eligible for the Medicare Savings Program (MSP, 135% FPL,) which without
an asset test, will also qualify an enrollee for LIS, the EPIC program
does not assist with MSP enrollment or make a referral to an agency that
will.* a change implemented in October 2019 that eliminated the previous
benefit to include payment of any Medicare Part D late enrollment penal-
ty for certain enrollees.* a change in January 2020 that eliminates past
records of EPIC participation for any enrollee that failed to pay their
quarterly dues on time. Their EPIC number and all income information on
their records is now eradicated, and upon late payment of the dues an
enrollee must reap- ply for the program as if they were never a member.
In addition to making corrections to restore and improve program oper-
ations, the changes noted above are addressed in this bill. Further, in
order to improve transparency and accountability, the EPIC panel and
advisory committee are re-convened, along with a requirement for an
annual report to the Legislature.
PRIOR LEGISLATIVE HISTORY:
2023-2024: A6450/Kim, Referred to Aging S3005/Cleare, Referred to
Finance(24) Referred to Aging (24) Referred to Health (23) Referred to
Aging (23)2021-2022: A5422/Kim, Referred to Aging S4603/May, Referred to
Aging
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined
EFFECTIVE DATE:
This act shall take effect immediately
STATE OF NEW YORK
________________________________________________________________________
3605
2025-2026 Regular Sessions
IN ASSEMBLY
January 29, 2025
___________
Introduced by M. of A. SEAWRIGHT -- read once and referred to the
Committee on Aging
AN ACT to amend the elder law, in relation to establishing the expanded
pharmaceutical insurance coverage panel
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The elder law is amended by adding a new section 242-a to
2 read as follows:
3 § 242-a. Expanded pharmaceutical insurance coverage panel. 1. There
4 is hereby established within the executive department, a panel to be
5 known as the "expanded pharmaceutical insurance coverage panel". For the
6 purposes of this section, the term "the panel" shall mean the expanded
7 pharmaceutical insurance coverage panel.
8 2. The panel shall consist of the commissioners of the departments of
9 education and health, the superintendent of the department of financial
10 services, and the directors of the office for the aging and the division
11 of the budget. Each panel member may designate an officer of their
12 respective department, office, or division to represent and exercise all
13 the powers of such panel member at any meeting of the panel from which
14 such panel member may be absent.
15 3. The director of the office for the aging and the commissioner of
16 health shall serve as co-chairs of the panel.
17 4. The panel shall meet at such times as may be requested by the
18 co-chairs, provided that the panel shall meet at least two times a year.
19 5. The panel shall:
20 (a) subject to the approval of the director of the budget, promulgate
21 program regulations pursuant to section two hundred forty-six of this
22 title;
23 (b) determine the annual schedule of cost-sharing responsibilities of
24 eligible program participants pursuant to sections two hundred forty-
25 seven and two hundred forty-eight of this title;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00974-01-5
A. 3605 2
1 (c) enter into contracts pursuant to section two hundred forty-three
2 of this title;
3 (d) recommend and implement alternative program improvements for the
4 efficient and effective operation of the program in accordance with the
5 provisions of this title with the advice of the advisory committee as
6 defined in subdivision seven of this section;
7 (e) develop and implement, in cooperation with area offices for the
8 aging, an outreach program to inform eligible applicants of benefits
9 they may be entitled to pursuant to this title, and to make available
10 information concerning the program for expanded pharmaceutical insurance
11 coverage and benefits to which they may be entitled through a
12 prescription drug coverage program funded by the federal government; and
13 (f) prepare an annual report and submit such report to the governor,
14 the temporary president of the senate, and the speaker of the assembly
15 no later than the first day of January of each year. The panel shall
16 include in such report, at a minimum, annual statistical information
17 regarding the number of persons enrolled in the program by marital
18 status and income level and age, an estimate of the per cent of eligible
19 New York residents that are enrolled, the total number of enrollees that
20 receive an income-related subsidy under section 1860D-14 of the federal
21 social security act, and the number that so qualify through their
22 enrollment in the medicare savings program, the numbers of participating
23 provider pharmacies, recipients and payments by county, a summary of the
24 administrative cost containment initiatives completed during the year,
25 projections of program costs for the following two years, and an evalu-
26 ation of the performance of the program contractor or contractors and of
27 the cost effectiveness of all outreach efforts.
28 6. The panel members shall receive no compensation for their services
29 as panel members.
30 7. There shall be an advisory committee to the panel comprised of
31 twelve persons. Four members shall be appointed by the governor, three
32 members shall be appointed by the temporary president of the senate, one
33 member shall be appointed by the minority leader of the senate, three
34 members shall be appointed by the speaker of the assembly and one member
35 shall be appointed by the minority leader of the assembly. The commit-
36 tee members shall be representatives of consumers, pharmacists, pharma-
37 ceutical drug manufacturers and pharmaceutical wholesalers. No less than
38 sixty percent of the committee membership shall represent consumers.
39 Committee members shall receive no compensation for their services but
40 shall be allowed their actual and necessary expenses incurred in the
41 performance of their duties.
42 § 2. This act shall take effect immediately.
