Amd §2795, Pub Health L; amd §2, Chap of 2023 (as proposed in S.6521 & A.3089)
Establishes the New York state adult cystic fibrosis program which consists of administrative support services for the provision of financial assistance for services such as prescription drug costs, device costs, medical care services, behavioral health services, and insurance premiums for the treatment of cystic fibrosis disease and its conditions.
STATE OF NEW YORK
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8002
IN SENATE
January 5, 2024
___________
Introduced by Sen. THOMAS -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the public health law, in relation to the New York state
adult cystic fibrosis program; and to amend a chapter of the laws of
2023, amending the public health law relating to the adult cystic
fibrosis assistance program, as proposed in legislative bills numbers
S. 6521 and A. 3089, in relation to the effectiveness thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 2795 of the public health law, as added by a chap-
2 ter of the laws of 2023, amending the public health law relating to the
3 adult cystic fibrosis assistance program, as proposed in legislative
4 bills numbers S. 6521 and A. 3089, is amended to read as follows:
5 § 2795. [Adult] New York state adult cystic fibrosis assistance
6 program. 1. [The commissioner] Subject to available appropriation for
7 the purpose outlined in this article, the department shall establish [a]
8 an adult cystic fibrosis assistance program [to reimburse the cost of
9 providing health care or health insurance to eligible individuals who
10 have], which shall be known as the "New York State Adult Cystic Fibrosis
11 Assistance Program", and which shall consist of administrative support
12 services for the provision of financial assistance for services such as
13 prescription drug costs, device costs, medical care services, behavioral
14 health services, and insurance premiums for the treatment of cystic
15 fibrosis disease and its conditions.
16 2. [To be a fully eligible individual for whom health care will be
17 provided under this section, such individual:
18 (a) shall be at least twenty-one years old;
19 (b) shall have been diagnosed as having cystic fibrosis;
20 (c) shall have resided in the state for a minimum of twelve continuous
21 months immediately prior to application for services under this section;
22 (d) shall not be eligible for medical benefits under any group or
23 individual health insurance policy; and
24 (e) shall not be eligible for medical assistance pursuant to title
25 eleven of article five of the social services law solely due to earned
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06424-02-4
S. 8002 2
1 income] The commissioner shall enter into a contract for the operation
2 and promotion of the adult cystic fibrosis assistance program subject to
3 such terms and conditions as may be contained within such contract with
4 an organization that has experience and expertise improving access to
5 healthcare for patients who are underinsured by dispersing financial
6 assistance grants to cover costs of essential treatments and medica-
7 tions. The contractor may subcontract as needed for the effective
8 performance of the contract. All such subcontractors and the terms of
9 such subcontracts shall be subject to approval by the commissioner.
10 3. [To be a partially eligible individual for whom health care will be
11 provided under this section, such individual shall meet all the criteria
12 of a fully eligible individual except that a partially eligible individ-
13 ual shall be an individual who is eligible for medical benefits under
14 any group or individual health insurance policy but which does not cover
15 all services necessary for the care and treatment of cystic fibrosis.
16 4. The commissioner shall require each fully eligible individual, upon
17 determination of eligibility, to make application to a private health
18 insurance provider as prescribed by the commissioner for an individual
19 health insurance policy. If and when such policy is granted, the commis-
20 sioner shall approve payment for the associated premium.
21 5. The commissioner shall authorize payment for services related to
22 the care and treatment of cystic fibrosis not otherwise covered by a
23 health insurance policy. Providers of such services shall be reimbursed
24 at the same rate and claims for payment shall be made as if such indi-
25 vidual was eligible for benefits pursuant to title eleven of article
26 five of the social services law.
27 6. All eligible individuals shall be required to contribute seven
28 percent of their net annual income toward the cost of care and/or the
29 cost of the annual health insurance premium.
30 7. The commissioner shall, in consultation with the commissioner of
31 social services, promulgate rules and regulations necessary to implement
32 the provisions of this article] The duties of the contractor shall
33 include, but not be limited to, the following:
34 (a) verification of patient eligibility for financial assistance
35 grants allowable pursuant to paragraph (b) of this subdivision. To be
36 eligible for a financial assistance grant, a patient shall meet criteria
37 determined by the department, which shall include but not be limited to,
38 requiring the patient:
39 (i) be a New York state resident;
40 (ii) be at least twenty-one years of age or older;
41 (iii) have a diagnosis of cystic fibrosis; and
42 (iv) have some form of primary private health insurance or Medicare
43 and is not eligible for state Medicaid, and shall maintain health insur-
44 ance during the financial assistance award period;
45 (b) review of financial assistance grant applications submitted by
46 eligible patients for approval, for services including but not limited
47 to prescription drug costs, device costs, medical care services, behav-
48 ioral health services, and medical, vision and dental insurance premi-
49 ums, for patient treatment of cystic fibrosis;
50 (c) disbursement of grant funding for applications approved pursuant
51 to paragraph (b) of this subdivision related to the care and treatment
52 of cystic fibrosis not otherwise covered by a health insurance policy;
53 (d) preparation and submission of a monthly report to the department.
54 Such report shall include but not be limited to:
55 (i) new grants, which is the number of new grant recipients for
56 initial grant periods;
S. 8002 3
1 (ii) renewal grants, which is the number of renewal grant recipients
2 for renewal grant periods;
3 (iii) total active grant recipient count, which is the total number of
4 active grant recipients;
5 (iv) grant recipients by insurance type, which is the number of active
6 grant recipients sorted by insurance type;
7 (v) program expenses, which is the total amount spent sorted by
8 assistance type but does not include administration fees;
9 (vi) application outcomes report, which is the number of grant recipi-
10 ents who have become inactive, sorted by reason; and
11 (vii) allotment used, which is the total amount of copayment assist-
12 ance provided to each grant recipient compared to what is currently used
13 by the grant recipient.
14 § 2. Section 2 of a chapter of the laws of 2023, amending the public
15 health law relating to the adult cystic fibrosis assistance program, as
16 proposed in legislative bills numbers S. 6521 and A. 3089, is amended to
17 read as follows:
18 § 2. This act shall take effect immediately and shall expire March 31,
19 2024 when upon such date the provisions of this act shall be deemed
20 repealed.
21 § 3. This act shall take effect immediately; provided, however, that
22 section one of this act shall take effect on the same date and in the
23 same manner as a chapter of the laws of 2023 amending the public health
24 law relating to the adult cystic fibrosis assistance program, as
25 proposed in legislative bills numbers S. 6521 and A. 3089, takes effect;
26 provided, further, that the amendments to section 2795 of the public
27 health law made by section one of this act shall not affect the repeal
28 of such section and shall be deemed repealed therewith.
