Enacts into law major components of legislation necessary to implement the health, mental health budget for the 2006-07 state fiscal year; relates generally to public health; health reform; directs the commissioner of health to develop statewide areas/regional benchmarks regarding racial/ethnic disparities and to develop and implement the public health leaders of tomorrow program; early intervention services; state aid for municipalities; elderly pharmaceutical insurance coverage program; establish a cost of living adjustment for designated human services programs; additional state payments for certain eligible individuals; allocations for worker retraining, Roswell Park, anti-tobacco program, public health programs, EPIC; excess medical malpractice, nursing home financially distressed, pharmacy, family health plus, health care efficiency and affordability law for New Yorkers; HCRA surcharges, assessments and covered lives assessment; bad debt and charity care; high need indigent care; state planning and research cooperative systems and the health care reform act pool reporting requirements; personal care services and worker recruitment and retention program; area health education centers; HCRA resources fund; establish the office of health e-links New York; implementing the state fiscal plan for the 2006-2007 state fiscal year; economically sustainable transportation; Medicaid rate or fee reimbursement for certain alcohol primary care detoxification providers; authorize the dormitory authority of the state of New York to sell certain lands in the county of Queens to the Indian Cultural and Community Center, Inc.; eliminating designation of suburban/rural comprehensive psychiatric emergency programs and to continue such programs as urban programs; extends various provisions of law relating generally to public health and mental health; repeals certain provisions of law relating thereto.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9557B
SPONSOR: Budget TITLE OF BILL: An act to amend the social services law, the public
health law, chapter 58 of the laws of 2005, amending the public health
law and other laws relating to implementing the state fiscal plan for
the 2005-2006 state fiscal year, chapter 66 of the laws of 1994, amend-
ing the public health law, the general municipal law and the insurance
law relating to the financing of life care communities, chapter 81 of
the laws of 1995, amending the public health law and other laws relating
to medical reimbursement and welfare reform, chapter 639 of the laws of
1996 amending the public health law and other laws relating to welfare
reform, chapter 474 of the laws of 1996, amending the education law and
other laws relating to rates for residential health care facilities,
chapter 483 of the laws of 1978, amending the public health law relating
to rate of payment for each residential health care facility to real
property costs, chapter 649 of the laws of 1996, amending the public
health law, the mental hygiene law and the social services law relating
to authorizing the establishment of special needs plans, chapter 710 of
the laws of 1988, amending the social services law and the education law
relating to medical assistance eligibility of certain persons and
providing for managed medical care demonstration programs, chapter 165
of the laws of 1991, amending the public health law and other laws
relating to establishing payments for medical assistance, chapter 19 of
the laws of 1998, amending the social services law relating to limiting
the method of payment for prescription drugs under the medical assist-
ance program, chapter 659 of the laws of 1997, amending the public
health law and other laws relating to creation of continuing care
retirement communities; to amend chapter 629 of the laws of 1986 amend-
ing the social services law relating to establishing a demonstration
program for the delivery of long term home health care services to
certain persons, and chapter 41 of the laws of 1992 amending the public
health law and other laws relating to health care providers; to amend
chapter 535 of the laws of 1983, amending the social services law relat-
ing to eligibility of certain enrollees for medical assistance, chapter
904 of the laws of 1984, amending the public health law and the social
services law relating to encouraging comprehensive health services, in
relation to health reform; and to repeal subdivision 1 of section 2808
of the public health law; and providing for the repeal of certain
provisions of the social services law upon expiration thereof (Part A);
to direct the commissioner of health to develop statewide areas/regional
benchmarks regarding racial/ethnic disparities and to develop and imple-
ment the public health leaders of tomorrow program; to amend the public
health law, in relation to early intervention services; to amend the
public health law, in relation to state aid for municipalities; to amend
the elder law, in relation to the elderly pharmaceutical insurance
coverage program; to amend chapter 62 of the laws of 2003 amending the
public health law relating to allowing for the use of funds of the
office of professional medical conduct for activities of the patient
health information and quality improvement act of 2000, in relation to
the effectiveness of such provisions of the public health law relating
thereto; and repealing certain provisions of the public health law
relating thereto (Part B); to establish a cost of living adjustment for
designated human services programs; to amend the social services law in
relation to additional state payments for certain eligible individuals;
and providing for the repeal of such provisions upon expiration thereof
(Part C); to amend the public health law, in relation to allocations for
worker retraining, Roswell Park, anti-tobacco program, public health
programs, elderly pharmaceutical insurance coverage, excess medical
malpractice, nursing home financially distressed, pharmacy, family
health plus, healthcare efficiency and affordability law for New York-
ers, to amend the public health law, in relation to HCRA surcharges,
assessments and covered lives assessment; bad debt and charity care;
high need indigent care; state planning and research cooperative systems
and the health care reform act pool reporting requirements; to amend the
social services law, in relation to personal care services worker
recruitment and retention program; to amend the state finance law, in
relation to the area health education centers; to amend the public
authorities law, in relation to the HCRA resources fund; and to repeal
certain provisions of the public health law relating thereto (Part D);
Intentionally omitted (Part E); Intentionally omitted (Part F); to
establish the office of health e-links New York (Part G); to amend chap-
ter 119 of the laws of 1997 relating to authorizing the department of
health to establish certain payments to general hospitals, in relation
to extending the authorization for the department of health to continue
certain payments to general hospitals (Part H); Intentionally omitted
(Part I); to amend the elder law, in relation to implementing the state
fiscal plan for the 2006-2007 state fiscal year and in relation to
economically sustainable transportation and providing for the repeal of
certain provisions upon expiration thereof (Part J); in relation to
Medicaid rate or fee reimbursement for certain alcohol primary care
detoxification providers (Part K); to authorize the dormitory authority
of the state of New York to sell certain land in the county of Queens to
the Indian Cultural and Community Center, Inc. (Part L); and to amend
the mental hygiene law, in relation to eliminating the designation of
suburban/rural comprehensive psychiatric emergency programs and to
continue such programs as urban programs; and to repeal paragraph 7 of
subdivision (a) of section 31.27 of such law relating thereto (Part M)
SUMMARY:
Part A
Medicaid Program
Section 1 continues Medicaid "wrap-around" pharmacy coverage for indi-
viduals with both Medicaid and Medicare Part D through January 14, 2007,
and provides a permanent coverage for anti-psychotics, anti-retroviral,
and anti-rejection drugs.
Section 1-A establishes the Nursing Home Quality Incentive Program.
Section 1-B establishes the Nursing Home Pay for Performance Program.
Sections 2 - 2-B implements nursing home rebasing with a hold harmless
provision.
Sections 3 - 22 are intentionally omitted.
Section 23 establishes the Chemung County Medicaid Research and Demon-
stration Project.
Sections 24 - 28 are intentionally omitted.
Sections 29 - 30 eliminate Medicaid and Family Health Plus coverage for
drugs to treat erectile dysfunction.
Sections 31-35 are intentionally omitted.
Section 36 reduces hospital capital costs to the fair market value.
Sections 37 - 38 implement reforms related to patient detoxification
services.
Sections 39 - 39-A establish new standards for the state's $850 million
Indigent Care Program that would require hospitals to provide financial
assistance to low-income, uninsured patients, curb abusive debt
collection practices and improve accountability. Continue hospital
IGT/UPL.
Sections 40 - 41 continue hospital IGT/UPL payments for one year.
Section 42 is intentionally omitted.
Section 43 implements the AIDS adult day health care and diagnostic and
treatment center annual cost of living adjustments.
Section 44 changes the nursing home working capital interest reimburse-
ment, requires nursing home rates be calculated based on cost (after 5
years), and allows a review of nursing home base year costs.
Sections 45-46 are intentionally omitted.
Section 47 increases the Medicaid rate for AIDS Adult Day Health Care
providers.
Sections 50 - 50-C implement changes to the long tem care benefit under
Medicaid as mandated by the Federal Deficit Reduction Act of 2005 and
make these changes contingent on the enactment of the federal statute.
Sections 51 - 56 are intentionally omitted.
Section 57 changes the Medicaid Managed Care mandatory enrollment
requirement from a minimum of two plans per county to one plan per coun-
ty.
Sections 58 - 58-B implement increased Medicaid rates for services
related to the treatment of medically fragile children.
Sections 59 - 61 contain technical clean-up items related to the local
Medicaid cap.
Section 62 makes technical changes to allow the continuation of nursing
home IGT payments.
Sections 63 - 64 are intentionally omitted.
Section 65 allows for the temporary management of managed care providers
for certain violations.
Section 65-A makes technical corrections related to supplemental Medi-
caid payments for emergency medical transportation services.
Sections 65 - 65-H extend the Managed long Term Care Program for nine
years and make various changes to the program.
Section 66 authorized the Commissioner of health to develop demon-
stration programs authorized under the Federal Deficit Reduction Act of
2005.
Section 67 implements supplemental transition payments for community
health centers and academic dental clinics.
Section 68 extends provisions of a nursing home amnesty program.
Sections 68-A - 68-B are intentionally omitted.
Section 68-C requires the Commissioner of Health to convene regular
meetings with other state agencies and departments to maintain and
improve management of the Medicaid program.
Section 68-D extends the Long Term Care Home Health Care Program through
March 31, 2009.
Section 68-F extends Payments for Claims Service provisions March 31,
2009.
Section 68-F increases the reimbursement cap on emergency room services
from $95 to $150.
Section 68-G increases the fee for emergency room physicians from $17 to
$25.
Sections 69 - 90 extend various prior years Medicaid cost containments
for one year.
Section 91 is intentionally omitted.
Sections 92 - 98 extend various provisions related to Medicaid Managed
care.
Section 99 establishes time frames of notice and emergency rule promul-
gation.
Section 100 is the severability clause.
Section 101 establishes the effective dates of the various sections of
Part A.
Part B
Public Health Program
Section 1 requires the Commissioner of Health to develop statewide
benchmarks for racial and ethnic disparities in access to healthcare by
minority populations.
Section 2 establishes an Early Intervention Demonstration Program.
Section 3 establishes the Public Management Leaders of Tomorrow Program.
Sections 4-10 implement various changes to the General Public Health
Works (Article 6) program including: an increase in county base grants;
an increase reimbursement for optional services; authorization for coun-
ty collaborations; and implementation of an emergency fund to be used at
the discretion of the Commissioner of Health.
Sections 11-12 eliminate EPIC coverage for drugs to treat erectile
dysfunction.
Sections 13 - 18 make technical corrections to the EPIC statute in Elder
Law.
Sections 19 - 20 establish the process for mandatory enrollment of low
income EPIC enrollees in Medicare Part D and defines patient protections
associated with this process.
Section 21 extends the Office of Professional Medical Conduct (OPMC)
funding from fees for one year.
Section 22 sets the effective dates for Part B.
Part C
Authorizes a cost of living adjustment (COLA), indexed to the federal
consumer price index (CPI), to be provided to programs licensed and
funded by the Office of Alcoholism and Substance Abuse Services (OASAS),
the Office of Mental Health (OMH) or the Office of Mental Retardation
and Developmental Disabilities (OMRDD) for each of three years beginning
in State Fiscal Year (SFY) 2006-07.
It also implements a COLA on the SSI State supplemental payment.
Part D
Health Care Reform Act
Section 1 increases anti-tobacco program allocation to $95 million.
Section 2 is intentionally omitted.
Section 3 adjusts Public Health Program allocation to pay for avian flu
vaccine and reflects funding of the entire $12.1 million for Family
Planning shifted from TANF.
Section 4 decreases EPIC allocations to reflect facilitation of enroll-
ment of low income EPIC enrollees in Part D.
Section 5 adjusts the allocations for Roswell Park Cancer Institute.
Section 5-A - 5-B establishes the Nursing Home Quality Improvement
Program.
Section 6 increases the Excess Medical Malpractice allocation to reflect
a doubling in the funding from $65 million to $130 million.
Section 7 makes a technical change to the allocation language regarding
Financially Distressed Nursing Homes, to authorize its use as the state
share of a Medicaid payment and not a HCRA payment.
Section 8 increases the Pharmacy General Fund offload allocations.
Section 9 modifies the Family Health Plus (FHP) allocations to reflect
the restoration of FHP related Medicaid cuts with HCRA funding.
Section 9 increases HEAL NY transfer from HCRA to Capital Projects Fund
by $100M annually.
Section 10-A establishes HCRA allocations for the Individual Subsidy
Program.
Section 10-A establishes HCRA allocations for additional state grants to
improve access to infertility services, treatments, and procedures.
Section 10-B establishes HCRA allocations for the Medicaid Policy Insti-
tute at the United Hospital Fund.
Section 10-C establishes HCRA allocations for funding of school based
health centers and air conditioning for adult home residents' resident
rooms.
Sections 10-C-1 - 10-C-2 allocate additional HCRA resources to the Indi-
gent Care Pool for diagnostic and treatment centers.
Section 10-D establishes an allocation for a program of recruitment,
training and retention for home care workers.
Section 10-E establishes an allocation for increased upstate home care
rates.
Section 10-F establishes a program of recruitment, training and
retention for home care workers.
Section 10-G increases the upstate allocation for personal care train-
ing.
Section 10-G-l establishes an allocation for the Center for Functional
Genomics.
Sections 10-H - 10-I implement the workforce managed care differential
for recruitment and retention payments.
Section 10-J concerns the reallocation of workforce money regarding
hospital closures and ties it to the region where a hospital closes.
Section 11 requires DOH delinquency billings of all outstanding reports
and payments regarding 1% assessment within defined time-frame.
Sections 12 - 13 clarify the categories of revenue excluded from the 1%
assessment.
Section 14 clarifies general hospital indigent care reporting require-
ments.
Sections 15 - 17 clarify that 6 year audit limit does not apply to DOH
pursuing hospital delinquencies or a refund request.
Section 18 requires hospitals to comply with Bad Debt and Charity Care
requirements of General Hospital Indigent Care Pool in order to partic-
ipate in High Need Indigent Care Pool fund distribution.
Section 19 allows for the collection of ambulatory care data from Gener-
al Hospitals and Diagnostic and Treatment Centers to be included in
SPARCS.
Section 20 removes AHEC as a formulaic program from HCRA on-budget
provisions in State Finance Law.
Section 21 is intentionally omitted.
Section 22 allows DOH to estimate monthly assessments due if a general
hospital fails to produce data or documentation requested in furtherance
of an audit.
Sections 23 - 27 allow DOH to estimate and bill providers for underpay-
ments to HCRA if they fail to produce required data or documentation
during an audit.
Sections 28 - 29 are intentionally omitted.
Section 30 adjust Public Authority Law in relation to HEAL NY transfers
to the Capital Projects Fund.
Section 30-A implements changes that provide flexibility to the HEAL NY
program.
Sections 31-34 include standard language and establish time frames of
notice, the severability clause; and effective dates for Part D.
Part E & F Intentionally omitted.
Part G Establishes the Health E-Links New York Program to facilitate the
establishment of an interoperable regional health information exchange
and technology infrastructure to improve quality, reduce the cost of
health care, ensure patient privacy and security, enhance public health
reporting including bioterrorism surveillance and facilitate health care
research in the State of New York.
Part H Extends until 2009 legislation authorizing certain Article 28
hospitals to replace General Fund State aid with federal dispropor-
tionate share payments to cover the cost of mental health outpatient
services.
Part I Intentionally omitted.
Part J New York State Office for the Aging
Sections 1-2 establish the process by which the additional EISEP money
would be distributed to the counties and defines the requirements placed
on the counties for spending the additional money.
Section 3 establishes the Economically Sustainable Transportation Demon-
stration Program.
Section 4 sets the effective dates of Part J.
Part K Extends until April 1, 2007, the expiration date of legislation
authorizing certain providers of inpatient medically supervised with-
drawal services, licensed by the Office of Alcoholism and Substance
Abuse Services, to receive Medicaid reimbursement at a rate equal to the
rate received on April 1, 2005.
Part L Authorizes the Dormitory Authority of the State of New York to
sell, at fair market value, two parcels of land located within the
grounds of the Creedmoor Psychiatric Center, in Queens, New York, to the
Indian Culture and Community Center, Incorporated.
Part M Amends the Mental Hygiene Law to eliminate the "suburban / rural"
Comprehensive Psychiatric Emergency Program (CPEP) designation, so that
all providers of emergency psychiatric observation services under the
CPEP program will be designated as "urban" providers. The change impacts
two of the 18 hospitals that operate 19 CPEP programs Statewide.
JUSTIFICATION:
This bill is necessary for the enactment of portions of the State Fiscal
Year 2006-07 Budget contained in the Health and Mental Hygiene Budget
Bill.
FISCAL IMPACT:
The provisions contained in this legislation are related to the appro-
priations contained in the Health and Mental Hygiene Budget Bill.
EFFECTIVE DATE:
Effective April 1, 2006, with certain exceptions.
STATE OF NEW YORK
________________________________________________________________________
S. 6457--C A. 9557--B
Cal. No. 499
SENATE - ASSEMBLY
January 20, 2006
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee -- reported
favorably from said committee, ordered to a third reading, passed by
Senate and delivered to the Assembly, recalled, vote reconsidered,
restored to third reading, recommitted to the committee on Finance,
amended and ordered reprinted, retaining its place in the order of
third reading
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
again reported from said committee with amendments, ordered reprinted
as amended and recommitted to said committee
AN ACT to amend the social services law, the public health law, chapter
58 of the laws of 2005, amending the public health law and other laws
relating to implementing the state fiscal plan for the 2005-2006 state
fiscal year, chapter 66 of the laws of 1994, amending the public
health law, the general municipal law and the insurance law relating
to the financing of life care communities, chapter 81 of the laws of
1995, amending the public health law and other laws relating to
medical reimbursement and welfare reform, chapter 639 of the laws of
1996 amending the public health law and other laws relating to welfare
reform, chapter 474 of the laws of 1996, amending the education law
and other laws relating to rates for residential health care facili-
ties, chapter 483 of the laws of 1978, amending the public health law
relating to rate of payment for each residential health care facility
to real property costs, chapter 649 of the laws of 1996, amending the
public health law, the mental hygiene law and the social services law
relating to authorizing the establishment of special needs plans,
chapter 710 of the laws of 1988, amending the social services law and
the education law relating to medical assistance eligibility of
certain persons and providing for managed medical care demonstration
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD12271-04-6
S. 6457--C 2 A. 9557--B
programs, chapter 165 of the laws of 1991, amending the public health
law and other laws relating to establishing payments for medical
assistance, chapter 19 of the laws of 1998, amending the social
services law relating to limiting the method of payment for
prescription drugs under the medical assistance program, chapter 659
of the laws of 1997, amending the public health law and other laws
relating to creation of continuing care retirement communities; to
amend chapter 629 of the laws of 1986 amending the social services law
relating to establishing a demonstration program for the delivery of
long term home health care services to certain persons, and chapter 41
of the laws of 1992 amending the public health law and other laws
relating to health care providers; to amend chapter 535 of the laws of
1983, amending the social services law relating to eligibility of
certain enrollees for medical assistance, chapter 904 of the laws of
1984, amending the public health law and the social services law
relating to encouraging comprehensive health services, in relation to
health reform; and to repeal subdivision 1 of section 2808 of the
public health law; and providing for the repeal of certain provisions
of the social services law upon expiration thereof (Part A); to direct
the commissioner of health to develop statewide areas/regional bench-
marks regarding racial/ethnic disparities and to develop and implement
the public health leaders of tomorrow program; to amend the public
health law, in relation to early intervention services; to amend the
public health law, in relation to state aid for municipalities; to
amend the elder law, in relation to the elderly pharmaceutical insur-
ance coverage program; to amend chapter 62 of the laws of 2003 amend-
ing the public health law relating to allowing for the use of funds of
the office of professional medical conduct for activities of the
patient health information and quality improvement act of 2000, in
relation to the effectiveness of such provisions of the public health
law relating thereto; and repealing certain provisions of the public
health law relating thereto (Part B); to establish a cost of living
adjustment for designated human services programs; to amend the social
services law in relation to additional state payments for certain
eligible individuals; and providing for the repeal of such provisions
upon expiration thereof (Part C); to amend the public health law, in
relation to allocations for worker retraining, Roswell Park, anti-to-
bacco program, public health programs, elderly pharmaceutical insur-
ance coverage, excess medical malpractice, nursing home financially
distressed, pharmacy, family health plus, healthcare efficiency and
affordability law for New Yorkers, to amend the public health law, in
relation to HCRA surcharges, assessments and covered lives assessment;
bad debt and charity care; high need indigent care; state planning and
research cooperative systems and the health care reform act pool
reporting requirements; to amend the social services law, in relation
to personal care services worker recruitment and retention program; to
amend the state finance law, in relation to the area health education
centers; to amend the public authorities law, in relation to the HCRA
resources fund; and to repeal certain provisions of the public health
law relating thereto (Part D); Intentionally omitted (Part E); Inten-
tionally omitted (Part F); to establish the office of health e-links
New York (Part G); to amend chapter 119 of the laws of 1997 relating
to authorizing the department of health to establish certain payments
to general hospitals, in relation to extending the authorization for
the department of health to continue certain payments to general
hospitals (Part H); Intentionally omitted (Part I); to amend the elder
S. 6457--C 3 A. 9557--B
law, in relation to implementing the state fiscal plan for the
2006-2007 state fiscal year and in relation to economically sustaina-
ble transportation and providing for the repeal of certain provisions
upon expiration thereof (Part J); in relation to Medicaid rate or fee
reimbursement for certain alcohol primary care detoxification provid-
ers (Part K); to authorize the dormitory authority of the state of New
York to sell certain land in the county of Queens to the Indian
Cultural and Community Center, Inc. (Part L); and to amend the mental
hygiene law, in relation to eliminating the designation of
suburban/rural comprehensive psychiatric emergency programs and to
continue such programs as urban programs; and to repeal paragraph 7 of
subdivision (a) of section 31.27 of such law relating thereto (Part M)
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2006-2007
3 state fiscal year. Each component is wholly contained within a Part
4 identified as Parts A through M. The effective date for each particular
5 provision contained within such Part is set forth in the last section of
6 such Part. Any provision in any section contained within a Part, includ-
7 ing the effective date of the Part, which makes a reference to a section
8 "of this act", when used in connection with that particular component,
9 shall be deemed to mean and refer to the corresponding section of the
10 Part in which it is found. Section three of this act sets forth the
11 general effective date of this act.
12 PART A
13 Section 1. Subdivision 4 of section 365-a of the social services law
14 is amended by adding a new paragraph (f) to read as follows:
15 (f) for eligible persons who are also beneficiaries under part D of
16 title XVIII of the federal social security act, drugs which are denomi-
17 nated as "covered part D drugs" under section 1860D-2(e) of such act;
18 provided however that, for purposes of this paragraph, "covered part D
19 drugs" shall not mean atypical anti-psychotics, anti-depressants, anti-
20 retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
21 used for the treatment of organ and tissue transplants.
22 § 1-a. The public health law is amended by adding a new section 2801-f
23 to read as follows:
24 § 2801-f. Residential health care facility quality incentive payment
25 program. Subject to amounts appropriated for the residential health care
26 facility quality incentive payment program, the department may make a
27 payment to operators of residential health care facilities, located in
28 social services districts which do not include a city with a population
29 of over one million persons, that are in compliance with applicable
30 statutes and regulations in order to enhance the quality of patient care
31 and patient safety. Provided that prior to receiving quality incentive
32 payment program funds, the facility shall submit an expenditure plan to
33 the department. Such plan shall detail how the quality incentive payment
34 program funds will be used to improve the physical environment of the
35 facility or the quality of care and services rendered to residents.
36 § 1-b. Section 2808 of the public health law is amended by adding a
37 new subdivision 22 to read as follows:
S. 6457--C 4 A. 9557--B
1 22. Nursing home incentives for improved performance in patient care.
2 Pursuant to such program, and within amounts as are appropriated there-
3 for, the commissioner shall investigate adjusted quality indicators and
4 quality measures including those defined by the federal centers for
5 medicare and medicaid services (CMS) with respect to nursing home quali-
6 ty and quality benchmarks. The commissioner shall award rate enhance-
7 ments to those residential health care facilities who demonstrate to the
8 satisfaction of the commissioner, they can meet or exceed such defined
9 quality measures. Such quality measures may include, but not be limited
10 to, outcomes from state survey data, performance measures, and resident
11 outcomes based upon Minimum Data Sets as defined by CMS. The commission-
12 er shall consult with associations representing residential health care
13 facilities and associations representing nursing home residents, and
14 shall by July first, two thousand seven, adopt rules and regulations
15 that incorporate payment incentives, related to such quality indicators
16 and measures, including, but not limited to programs to improve patient
17 care outcomes and performance outcomes. Such programs may include but
18 not be limited to, clinician-centric electronic medical records imple-
19 mentation, automation of assessments and care plans, improved data
20 collection, and the provision of accessible consumer information as well
21 as patient satisfaction, into rates of payment.
22 § 2. Subdivision 1 of section 2808 of the public health law is
23 REPEALED and a new subdivision 1 is added to read as follows:
24 1. Notwithstanding any inconsistent law or regulation, the rates of
25 payment by governmental agencies to residential health care facilities
26 on and after January first, two thousand seven shall be based on the
27 payment methodology in effect for the period January first, two thousand
28 six through December thirty-first, two thousand six as modified by this
29 subdivision and subdivisions seventeen and twenty-two of this section,
30 such subdivision seventeen as amended by section two-a of part A of the
31 chapter of the laws of two thousand six that added this subdivision. The
32 modifications to the methodology made pursuant to this section shall be
33 for the purposes of providing for an updated and more accurate profile
34 of residential health care facility costs in order to address the over-
35 all increases in input costs borne by such facilities. Such modifica-
36 tions shall also be primarily intended to promote the provision of qual-
37 ity health care, quality operation through updated technology and
38 improved staff development and support, support for basic facility main-
39 tenance, clinical operations and quality residential life, and for other
40 allowable input costs borne by such facilities.
41 Revenue received by a residential health care facility attributable to
42 an increase in the rate of payment by governmental agencies from the
43 utilization of each such facility's reported base year operating costs
44 for two thousand two pursuant to this subdivision compared to what that
45 facility would have received utilizing only the reported base year oper-
46 ating costs used to set each facility's two thousand six rates shall be
47 used primarily for purposes which result in an improvement in the quali-
48 ty of patient care in that facility. To ensure funds are utilized in a
49 manner that improves quality of patient care, the commissioner shall
50 establish a minimum standard for investment in the recruitment and
51 retention of non-supervisory staff or staff with direct patient care
52 responsibilities equal to the proportion of amounts expended for such
53 purposes in the nursing home quality improvement demonstration program,
54 pursuant to section twenty-eight hundred eight-d of this article,
55 provided, however, in no circumstance shall facilities be required to
56 spend more than seventy-five percent of revenue received pursuant to
S. 6457--C 5 A. 9557--B
1 this paragraph for the recruitment and retention of non-supervisory
2 staff or staff with direct patient care responsibilities. Notwithstand-
3 ing the provisions of this subdivision, upon application from a facili-
4 ty, the commissioner may waive the thresholds established pursuant to
5 this paragraph to allow funds to be utilized to correct deficiencies
6 that threaten the life and/or safety of residents. Before waiving such
7 thresholds pursuant to this subdivision, the commissioner shall estab-
8 lish that other funds are not available to correct such deficiencies.
9 (a) The operating portion of the rate shall consist of the sum of the
10 direct, indirect and noncomparable components of the payment rate based
11 on two thousand two costs as reported on the facility's annual cost
12 report trended to two thousand seven in accordance with the appropriate
13 trend factors previously applied by the commissioner to rates of payment
14 for residential health care facilities, with such sum trended to the
15 rate year by the applicable trend factor; provided however, that the
16 base year shall be updated to be current at least every six years. For
17 the purposes of this paragraph, the term "current" shall mean that the
18 components of the operating portion of the rate shall be based on costs
19 as reported on the facility's annual cost report for the period two
20 years prior to the first year of the applicable updated rate period.
21 (b) Direct therapy costs and overhead costs of therapy shall be
22 included in determining the direct component of the rate. The costs for
23 facility property, casualty and liability insurance and property taxes
24 and payments in lieu of taxes shall be reimbursed based on reported
25 costs for the year two years prior to the rate year. The commissioner
26 shall modify the cost reports for residential health care facilities or
27 otherwise collect adequate data on payments in lieu of taxes beginning
28 with calendar year two thousand five.
29 (c) For purposes of establishing the allowable direct component of the
30 rate, as well as the allowable indirect component of the rate, facili-
31 ties shall be combined into peer groups as follows:
32 (1) Free-standing, less than three hundred beds;
33 (2) Free-standing, three hundred or more beds; and
34 (3) Hospital-based, all sizes.
35 (d) For each peer group, a corridor shall be developed around the
36 statewide mean direct price per day and the statewide mean indirect
37 price per day. The corridor around each mean direct price per day shall
38 have a base (floor) equal to eighty-eight percent of each mean direct
39 price per day and a ceiling equal to one hundred fourteen percent of
40 each mean direct price per day. The corridor around each mean indirect
41 price per day shall have a base (floor) equal to eighty-eight percent of
42 each mean indirect price per day and a ceiling equal to one hundred ten
43 percent of each mean indirect price per day.
44 (e) A public residential health care facility or a residential health
45 care facility with fewer than eighty beds having a facility specific
46 direct adjusted payment price per day equal to the ceiling direct price
47 per day calculated pursuant to paragraph (d) of this subdivision shall
48 have such direct adjusted payment price per day further adjusted through
49 the addition of fifty percent of the difference between the facility's
50 specific direct cost per day and the ceiling direct price per day. A
51 public residential health care facility or a residential health care
52 facility with fewer than eighty beds having a facility specific indirect
53 adjusted payment price per day equal to the ceiling indirect price per
54 day calculated pursuant to paragraph (d) of this subdivision shall have
55 such indirect adjusted payment price per day further adjusted through
56 the addition of fifty percent of the difference between the facility's
S. 6457--C 6 A. 9557--B
1 specific indirect cost per day and the ceiling indirect price per day.
2 Such amount shall be increased to the rate year by the applicable trend
3 factor and adjusted by the regional direct and indirect input price
4 adjustment factors calculated pursuant to subdivision seventeen of this
5 section, as amended by section two-a of part A of the chapter of the
6 laws of two thousand six that added this subdivision.
7 (f) The patient classification system shall be the relative resource
8 utilization groups utilized for purposes of determining rates of payment
9 for skilled nursing facilities for patients eligible for payments as
10 beneficiaries of title XVIII of the federal social security act (medi-
11 care), known as RUG-III. Case mix indices shall be based on the resource
12 utilization group weights utilized for patients eligible for payments as
13 beneficiaries of title XVIII of the federal social security act (medi-
14 care), as adjusted by the commissioner pursuant to emergency regulations
15 to reflect New York state wages and fringe benefits for registered nurs-
16 es, certified nurse aides, and therapy staff and New York state therapy
17 minutes as reported in two thousand two. Furthermore, the RUG-III
18 weights shall be increased for residents classified in the following
19 categories to reflect added certified nurse aide staff time as follows:
20 (1) thirty minutes for the Impaired Cognition A category;
21 (2) forty minutes for the Impaired Cognition B category; and
22 (3) twenty-five minutes for the Reduced Physical Functions B category.
23 (g) Patient assessments to reflect the case mix intensity of facili-
24 ties for the purpose of determining and adjusting reimbursement rates
25 shall be based on data contained in the comprehensive assessment and
26 review of assessments required to be completed by facilities in accord-
27 ance with federal regulations and known as the Minimum Data Set (MDS).
28 Payment shall be based on the case mix intensity for all patients.
29 (h) A per diem amount of eight dollars, increased to the rate year by
30 the trend factor determined in accordance with paragraph (l) of this
31 subdivision and adjusted by the regional direct input price adjustment
32 factor calculated pursuant to subdivision seventeen of this section, as
33 amended by section two-a of part A of the chapter of the laws of two
34 thousand six that added this subdivision shall be added to each facili-
35 ty's payment rate for each patient who:
36 (1) would qualify for both the RUG-III Impaired Cognition and Behav-
37 ioral Problems hierarchies; or
38 (2) has an Alzheimer's Disease or dementia diagnosis, is classified in
39 the Reduced Physical Functions A, B, or C or Behavioral Problems A or B
40 categories, and has an activities of daily living index score of ten or
41 less.
42 (i) A per diem amount of seventeen dollars, increased to the rate year
43 by the applicable trend factor and adjusted by the regional direct input
44 price adjustment factor calculated pursuant to subdivision seventeen of
45 this section, as amended by section two-a of part A of the chapter of
46 the laws of two thousand six that added this subdivision, shall be added
47 to each facility's payment rate for each patient whose body mass index
48 is greater than thirty-five as determined from the MDS assessment infor-
49 mation.
50 (j) Rates of payment as modified pursuant to this section for residen-
51 tial health care facilities on and after January first, two thousand
52 seven shall not include certain incremental per diem adjustments to the
53 rates that will be reflected in the updated cost base year including,
54 but not limited to, the nursing salary adjustment, the base year adjust-
55 ment for facilities that have had bed conversions, the adjustment for
56 additional federal requirements as added by the Omnibus Budget Reconcil-
S. 6457--C 7 A. 9557--B
1 iation Act of 1987 and recalibration. Provided, however, that certain
2 adjustments not adequately reflected in the new base year shall be
3 continued including, but not limited to, the adjustment for recruitment
4 and retention of health care workers authorized pursuant to subdivision
5 eighteen of this section, the adjustment for financially disadvantaged
6 nursing homes authorized pursuant to subdivisions nineteen and twenty-
7 one of this section, grants and adjustments made under the nursing home
8 quality improvement and supplemental quality improvement demonstration
9 program authorized pursuant to section twenty-eight hundred eight-D of
10 this article, the adjustment for extended care of residents with trau-
11 matic brain injury, the adjustment for hepatitis B vaccinations and OSHA
12 universal precautions, reimbursement for the cash receipts assessment
13 pursuant to section twenty-eight hundred seven-d of this article, and
14 reimbursement for the cost of criminal history records checks.
15 (k) Notwithstanding any inconsistent provision of this subdivision,
16 and subject to the use of the Minimum Data Set patient assessment and
17 application of the RUG-III patient classification system effective Janu-
18 ary first, two thousand seven, rates of payment for the following types
19 of specialty facilities and units shall be calculated in accordance with
20 the methodology for such facilities and units in place prior to January
21 first, two thousand seven.
22 (1) AIDS facilities or discrete AIDS units approved by the commission-
23 er;
24 (2) discrete units for the care of patients under the long-term inpa-
25 tient rehabilitation program for traumatic brain injured patients estab-
26 lished pursuant to department regulations;
27 (3) department approved discrete units for the care of long-term
28 ventilator dependent residents;
29 (4) department approved discrete units specifically designated for the
30 purpose of providing specialized programs for residents requiring behav-
31 ioral interventions; or
32 (5) residential health care facilities or discrete units which provide
33 extensive nursing, medical, psychological and counseling support
34 services solely to children, as determined by the commissioner.
35 For rate periods on and after January first, two thousand seven, such
36 rates shall be trended to the rate period by the applicable trend
37 factor. The commissioner shall adopt emergency regulations effective
38 January first, two thousand seven to ensure that reimbursement for resi-
39 dents residing in these speciality facilities and units based on the use
40 of the Minimum Data Set and the RUG-III classification system is equiv-
41 alent to such reimbursement had it been calculated based on the Patient
42 Review Instrument and the RUG-II classification system.
43 (1) Notwithstanding section three of chapter four hundred eighty-three
44 of the laws of nineteen hundred seventy-eight, as amended, after the
45 expiration of the useful facility life (land, building, improvements and
46 nonmoveable equipment), a facility shall be paid seventy percent of the
47 average regional capital costs for such capital costs. For purposes of
48 this paragraph, the regions shall be those regions utilized for the
49 calculations governed by subdivision seventeen of this section as
50 amended by section two-a of part A of the chapter of the laws of two
51 thousand six that added this subdivision.
52 (m) Notwithstanding any inconsistent provision of this subdivision,
53 rates of payment based upon the methodology established in accordance
54 with this subdivision shall be phased in as follows: rates of payment in
55 effect January first, two thousand seven through December thirty-first,
56 two thousand seven shall be based fifty percent on the new methodology
S. 6457--C 8 A. 9557--B
1 (hereinafter the "new rate") and fifty percent on the rate of payment in
2 effect December thirty-first, two thousand six, inclusive of all adjust-
3 ments required by law and regulation through that date (hereinafter the
4 "existing rate"), rates of payment in effect January first, two thousand
5 eight through December thirty-first, two thousand eight, shall be based
6 seventy-five percent on the new rate and twenty-five percent on existing
7 rate; and rates of payment in effect on and after January first, two
8 thousand nine shall be based one hundred percent on the new rate.
9 For each facility for which the old rate, trended to two thousand
10 seven exceeds the new rate trended to two thousand seven, the commis-
11 sioner shall determine the absolute difference between the two rates.
12 The rate resulting from the new methodology shall be increased by a hold
13 harmless adjustment equal to fifty percent of such difference in rates
14 for the period January first, two thousand seven through December thir-
15 ty-first, two thousand seven; seventy-five percent of such difference in
16 rates for the period January first, two thousand eight through December
17 thirty-first, two thousand eight, and one hundred percent of such
18 difference in rates for rates of payment in effect on and after January
19 first, two thousand nine. For rate periods on or after January first,
20 two thousand eight, such hold harmless adjustment shall be trended to
21 the rate year by the applicable trend factor.
22 (n) The council, in consultation with associations representing resi-
23 dential health care facilities, shall adopt rules and regulations
24 subject to approval of the commissioner to effectuate the provisions of
25 this subdivision.
26 (o) The appointment of a receiver or the establishment of a new opera-
27 tor or replacement/renovation of an ongoing facility shall not result in
28 a revision in the operating portion of the rate as defined in paragraph
29 (a) of this subdivision.
30 (p) Notwithstanding any inconsistent provision of law, if in any rate
31 year on and after January first, two thousand seven, the total increase
32 in medical assistance payments to public residential health care facili-
33 ties resulting from the calculation of rates pursuant to this subdivi-
34 sion exceeds the applicable federal upper payment limit, such public
35 facilities shall receive:
36 (1) the rate adjustments resulting from the calculation of rates
37 pursuant to this subdivision to the extent they are eligible for federal
38 financial participation based on application of the upper payment limit;
39 plus
40 (2) the non-federal share of any remaining rate adjustments which
41 would have resulted from the calculation of rates pursuant to this
42 subdivision but for the application of the upper payment limit.
43 § 2-a. Subdivision 17 of section 2808 of the public health law, as
44 amended by section 24 of part C of chapter 58 of the laws of 2004, is
45 amended to read as follows:
46 17. Notwithstanding any inconsistent provision of law or regulation to
47 the contrary, for purposes of establishing rates of payment by govern-
48 mental agencies for residential health care facilities for services
49 provided on and after January first, nineteen hundred ninety-eight, the
50 regional direct and indirect input price adjustment factors to be
51 applied to any such facility's rate calculation shall be based upon the
52 utilization of either nineteen hundred eighty-three, nineteen hundred
53 eighty-seven or nineteen hundred ninety-three calendar year financial
54 and statistical data and for periods beginning April first, two thousand
55 four [and thereafter] through December thirty-first, two thousand six
56 based on either nineteen hundred eighty-three, nineteen hundred eighty-
S. 6457--C 9 A. 9557--B
1 seven, nineteen hundred ninety-three or two thousand one calendar year
2 financial and statistical data; provided, however, the state share
3 amount for the utilization of two thousand one calendar year data shall
4 be no more than twenty-two million dollars on a pro rata basis per
5 calendar year. The determination of which calendar year's data to
6 utilize shall be based upon a methodology that ensures that the partic-
7 ular year chosen by each facility results in a factor that yields no
8 less reimbursement to the facility than would result from the use of any
9 of the other three years' data. Such methodology shall utilize the nine-
10 teen hundred eighty-three and nineteen hundred eighty-seven regional
11 direct and indirect input price adjustment factor corridor percentages
12 in existence on January first, nineteen hundred ninety-seven as well as
13 nineteen hundred ninety-three regional direct and indirect input price
14 adjustment factor corridor percentage in existence on January first, two
15 thousand four as well as a two thousand one regional direct and indirect
16 input price adjustment factor corridor percentage calculated in the same
17 manner as the nineteen hundred ninety-three direct and indirect input
18 price adjustment factor corridor percentages in existence on January
19 first, two thousand four provided however, that for purposes of comput-
20 ing the nineteen hundred eighty-three, nineteen hundred eighty-seven and
21 nineteen hundred ninety-three regional input price adjustment factors
22 for rate periods beginning April first, two thousand four through Decem-
23 ber thirty-first two thousand six, any facility that was adversely
24 impacted by having its nineteen hundred eighty-three, nineteen hundred
25 eighty-seven and/or nineteen hundred ninety-three regional input price
26 adjustment factor recomputed in connection with the implementation of
27 section twenty-four of part C of chapter fifty-eight of the laws of two
28 thousand four to reflect the imposition of a maximum statewide average
29 variable corridor percentage of plus or minus ten percent shall have
30 such input price adjustment factors calculated without regard to such
31 maximum statewide average variable corridor percentage. For rate periods
32 on and after January first, two thousand seven, the regional input price
33 adjustment factors shall be based on the case mix predicted staffing for
34 registered nurses, licensed practical nurses, nurses' aides, licensed
35 therapists and therapist aides. For periods beginning January first, two
36 thousand seven through December thirty-first, two thousand nine, the
37 regional direct and indirect input price adjustment factors to be
38 applied to a facility's rate calculation shall be based upon the utili-
39 zation of two thousand two calendar year financial and statistical data.
40 Such methodology shall utilize two thousand two regional direct and
41 indirect input price adjustment factor corridor percentages calculated
42 in the same manner as the two thousand one regional direct and indirect
43 input price adjustment factor corridor percentages in existence on
44 December thirty-first, two thousand six except that every region shall
45 receive a corridor to reflect the region's actual variation without
46 regard to any maximum statewide average variable corridor percentage.
47 For the three year period beginning January first, two thousand ten and
48 every three year period thereafter, the regional direct price and indi-
49 rect input price adjustment factors and the regional direct and indirect
50 input price adjustment factor corridor percentages shall be based upon
51 the utilization of calendar year financial and statistical data from two
52 years prior to the first year of each three year period. The commission-
53 er shall modify the cost reports for residential health care facilities
54 beginning with calendar year two thousand five to ensure reporting of
55 adequate data on agency staffing costs and hours by occupation.
S. 6457--C 10 A. 9557--B
1 § 2-b. Section 2808 of the public health law is amended by adding a
2 new subdivision 1-a to read as follows:
3 1-a. a. Notwithstanding sections one hundred twelve and one hundred
4 sixty-three of the state finance law and any other inconsistent
5 provision of law, the commissioner shall make grants to public residen-
6 tial health care facilities without a competitive bid or request for
7 proposal process for the purposes of addressing the overall increases in
8 input costs borne by such facilities. Such modifications shall also be
9 primarily intended to promote the provision of quality health care,
10 quality operation, updated technology and improved staff development and
11 support by such facilities. Such grants shall be in the following aggre-
12 gate amounts for the following periods: thirty-three million three
13 hundred thirty-three thousand dollars on an annualized basis for the
14 period January first, two thousand seven through December thirty-first,
15 two thousand seven; sixty-six million six hundred sixty-six thousand
16 dollars on an annualized basis for the period January first, two thou-
17 sand eight through December thirty-first, two thousand eight; and one
18 hundred million dollars on an annualized basis for annual periods on and
19 after January first, two thousand nine.
20 b. The amount allocated to each eligible public residential health
21 care facility for each period shall be calculated as the result of (i)
22 the total payment for each period multiplied by (ii) the ratio of
23 patient days for patients eligible for medical assistance pursuant to
24 title eleven of article five of the social services law provided by the
25 public residential health care facility, divided by the total of such
26 patient days summed for all eligible public residential health care
27 facilities. Grants under this subdivision shall be made on a quarterly
28 basis.
29 § 3. Intentionally omitted.
30 § 4. Intentionally omitted.
31 § 5. Intentionally omitted.
32 § 5-a. Intentionally omitted.
33 § 6. Intentionally omitted.
34 § 7. Intentionally omitted.
35 § 8. Intentionally omitted.
36 § 9. Intentionally omitted.
37 § 10. Intentionally omitted.
38 § 11. Intentionally omitted.
39 § 12. Intentionally omitted.
40 § 13. Intentionally omitted.
41 § 14. Intentionally omitted.
42 § 15. Intentionally omitted.
43 § 16. Intentionally omitted.
44 § 17. Intentionally omitted.
45 § 18. Intentionally omitted.
46 § 19. Intentionally omitted.
47 § 20. Intentionally omitted.
48 § 21. Intentionally omitted.
49 § 22. Intentionally omitted.
50 § 23. Section 364-j of the social services law is amended by adding a
51 new subdivision 22 to read as follows:
52 22. Chemung county demonstration project. (a) The legislature finds
53 that the particular circumstances of Chemung county warrant authorizing
54 this demonstration project, including the rural nature of the county,
55 the absence of a comprehensive medicaid managed care provider serving
S. 6457--C 11 A. 9557--B
1 the area at this time, patient care needs, and aspects of the health
2 care provider base.
3 (b) within all or part of Chemung county (referred to in this subdivi-
4 sion as "the catchment area"), the department of health and the Chemung
5 county department of social services are authorized to conduct a Medi-
6 caid research and demonstration project (referred to in this subdivision
7 as the "demonstration project") for the purpose of testing the use of
8 innovative administrative techniques, new reimbursement methods, and
9 management of care models, so as to promote more efficient use of health
10 resources, a healthier population and containment of Medicaid program
11 costs.
12 (c) As part of the demonstration project, the Chemung county depart-
13 ment of social services is authorized to contract with a managed care
14 provider for the purposes of, without limitation, developing and manag-
15 ing a provider of care network, establishing provider payment rates and
16 fees, paying provider claims, providing care management services to
17 project participants, and managing the utilization of project services.
18 (d) The demonstration project shall be consistent with the provisions
19 of this section, except:
20 (i) The department may waive any rules or regulations, as necessary to
21 implement and consistent with this subdivision.
22 (ii) The demonstration project shall not be subject to:
23 (A) paragraph (b) of subdivision four of this section;
24 (B) subparagraphs (i), (ii), (iii) (v) and (viii) of paragraph (e) of
25 subdivision four of this section;
26 (C) paragraph (f) of subdivision four of this section;
27 (D) paragraph (g) of subdivision four of this section;
28 (E) subdivision five of this section; provided that in approving the
29 demonstration project or modifications to it, the department shall
30 consider the criteria in that subdivision;
31 (F) sections two hundred seventy-two and two hundred seventy-three of
32 the public health law;
33 (G) section three hundred sixty-five-i of this title.
34 (iii) Notwithstanding subdivision three of this section, participation
35 in the project shall be mandatory for all or any specified categories of
36 persons eligible for services under this title for whom the Chemung
37 county department of social services has fiscal responsibility pursuant
38 to section three hundred sixty-five of this title and who reside within
39 the demonstration project catchment area, as determined by the commis-
40 sioner of health; provided, however, that eligible persons who are also
41 beneficiaries under title XVIII of the federal social security act and
42 persons who reside in residential health care facilities shall not be
43 eligible to participate in the project.
44 (e)(i) Persons who are enrolled in or apply for medical assistance on
45 or before the date the demonstration project takes effect shall receive
46 sixty days written notice prior to participating in the demonstration
47 project, including an explanation of the demonstration project and the
48 participant's rights and responsibilities. Persons who apply for medical
49 assistance thereafter shall receive such notice at the time of applying
50 for medical assistance.
51 (ii) The demonstration project shall provide adequate services to
52 overcome language barriers for participants.
53 (iii) Participants in the demonstration project whose participation in
54 a managed care program would not otherwise be mandatory under subdivi-
55 sion three of this section, who, at the time they enter the demon-
56 stration project, have an established relationship with and are receiv-
S. 6457--C 12 A. 9557--B
1 ing services from one or more medical services providers that are not
2 included in the demonstration project's provider network (an "out-of-
3 network provider"), shall be permitted to continue to receive services
4 from such providers until their course of treatment is complete, or in
5 the case of a pregnant woman, while pregnant and for sixty days post-
6 partum. Out-of-network providers that provide services pursuant to this
7 subparagraph shall be subject to the utilization review and care manage-
8 ment procedures prescribed by the managed care provider and shall be
9 reimbursed at the rate that would be paid to such providers by the
10 medical assistance program on a fee for service basis pursuant to this
11 title, and shall accept such reimbursement as payment in full.
12 (f) The provisions of this subdivision shall not apply unless all
13 necessary approvals under federal law and regulation have been obtained
14 to receive federal financial participation in the costs of health care
15 services provided pursuant to this subdivision.
16 (g) The commissioner of health is authorized to submit amendments to
17 the state plan for medical assistance and/or submit one or more applica-
18 tions for waivers of the federal social security act as may be necessary
19 to obtain the federal approvals necessary to implement this subdivision.
20 (h) The demonstration project shall terminate five years after it is
21 approved by the department and all necessary approvals under federal law
22 and regulations under paragraph (f) of this subdivision have been
23 obtained, unless terminated sooner by the Chemung county department of
24 social services.
25 § 24. Intentionally omitted.
26 § 25. Intentionally omitted.
27 § 26. Intentionally omitted.
28 § 27. Intentionally omitted.
29 § 28. Intentionally omitted.
30 § 29. Paragraphs (d) and (e) of subdivision 4 of section 365-a of the
31 social services law, paragraph (d) as amended and paragraph (e) as added
32 by chapter 645 of the laws of 2005, are amended and a new paragraph (f)
33 is added to read as follows:
34 (d) any medical care, services or supplies furnished outside the
35 state, except, when prior authorized in accordance with department regu-
36 lations or for care, services and supplies furnished: as a result of a
37 medical emergency; because the recipient's health would have been endan-
38 gered if he or she had been required to travel to the state; because the
39 care, services or supplies were more readily available in the other
40 state; or because it is the general practice for persons residing in the
41 locality wherein the recipient resides to use medical providers in the
42 other state; [or]
43 (e) drugs, procedures and supplies for the treatment of erectile
44 dysfunction when provided to, or prescribed for use by, a person who is
45 required to register as a sex offender pursuant to article six-C of the
46 correction law, provided that any denial of coverage pursuant to this
47 paragraph shall provide the patient with the means of obtaining addi-
48 tional information concerning both the denial and the means of challeng-
49 ing such denial[.]; or
50 (f) drugs for the treatment of sexual or erectile dysfunction, unless
51 such drugs are used to treat a condition, other than sexual or erectile
52 dysfunction, for which the drugs have been approved by the federal food
53 and drug administration.
54 § 30. Paragraph (e-1) of subdivision 1 of section 369-ee of the social
55 services law, as added by chapter 645 of the laws of 2005, is amended to
56 read as follows:
S. 6457--C 13 A. 9557--B
1 (e-1) "Health care services" shall not include: (i) drugs, procedures
2 and supplies for the treatment of erectile dysfunction when provided to,
3 or prescribed for use by, a person who is required to register as a sex
4 offender pursuant to article six-C of the correction law provided that
5 any denial of coverage pursuant to this paragraph shall provide the
6 patient with the means of obtaining additional information concerning
7 both the denial and the means of challenging such denial; (ii) drugs for
8 the treatment of sexual or erectile dysfunction, unless such drugs are
9 used to treat a condition, other than sexual or erectile dysfunction,
10 for which the drugs have been approved by the federal food and drug
11 administration.
12 § 31. Intentionally omitted.
13 § 32. Intentionally omitted.
14 § 33. Intentionally omitted.
15 § 34. Intentionally omitted.
16 § 35. Intentionally omitted.
17 § 36. Notwithstanding sections 2807 and 2807-c of the public health
18 law, section 1 of part C of chapter 58 of the laws of 2005, and any
19 other contrary provision of law and subject to the availability of
20 federal financial participation, for designated rate periods on and
21 after April 1, 2006:
22 (a) the commissioner of health, with the approval of the director of
23 the budget, may increase the capital cost components of rates of payment
24 by governmental agencies for inpatient and outpatient services provided
25 by public general hospitals, not including public general hospitals
26 operated by the state of New York or the state university of New York
27 but including public general hospitals operated by public benefit corpo-
28 rations, to reflect the difference between the current fair market value
29 of the fixed capital assets held by such hospitals and the amount of
30 capital cost reimbursement of such fixed capital assets as computed
31 pursuant to the provisions of section 2807-c of the public health law;
32 provided, however, that reimbursement by the state of the amount of such
33 increased capital cost reimbursement to such general hospitals, whether
34 made by the department of health on behalf of a social service district
35 or by a social services district directly, for general hospital inpa-
36 tient and outpatient hospital services provided in accordance with para-
37 graph (b) of subdivision 2 of section 365-a of the social services law,
38 shall be limited to the amount of federal funds properly received or to
39 be received on account of such expenditures; provided further, however,
40 that the social services district in which an eligible public general
41 hospital is physically located shall be responsible for the increased
42 payments provided herein for such public general hospital for all hospi-
43 tal inpatient and outpatient services provided by such general public
44 hospital in accordance with section 365-a of the social services law,
45 regardless of whether another social services district or the department
46 of health may otherwise be responsible for furnishing medical assistance
47 to the eligible persons receiving such services; and
48 (b) the commissioner of health, with the approval of the director of
49 the budget, may also increase the capital cost components of rates of
50 payment by governmental agencies for inpatient and outpatient services
51 provided by public general hospitals operated by the state of New York
52 and by the state university of New York, to reflect the difference
53 between the fair market value of the fixed capital assets held by such
54 hospitals and the amount of capital cost reimbursement of such fixed
55 capital assets as computed pursuant to the provisions of section 2807-c
56 of the public health law; further provided, however, that such payments
S. 6457--C 14 A. 9557--B
1 made to public general hospitals operated by the state of New York and
2 the state university of New York shall be the responsibility of the
3 state and shall not include a local share; and
4 (c) the commissioner of health shall issue regulations, and may issue
5 emergency regulations if deemed necessary by the commissioner of health,
6 to implement the adjustments to rates of payment authorized by this
7 section.
8 § 37. Subdivision 4 of section 2807-c of the public health law is
9 amended by adding two new paragraphs (l) and (m) to read as follows:
10 (l) Notwithstanding any law or regulation to the contrary, for general
11 hospitals which are certified pursuant to article thirty-two of the
12 mental hygiene law and regulations promulgated thereunder to provide
13 chemical dependence related crisis services and which are certified to
14 provide short stay outlier services and receive a short stay outlier
15 rate pursuant to paragraph (m) of this subdivision, inpatient payments
16 for and services provided to patients who are determined to be in diag-
17 nosis-related groups numbered seven hundred forty-three, seven hundred
18 forty-four, seven hundred forty-five, seven hundred forty-six, seven
19 hundred forty-seven, seven hundred forty-eight, seven hundred forty-
20 nine, seven hundred fifty, or seven hundred fifty-one shall be subject
21 to subsequent review by the office of alcoholism and substance abuse
22 services and the retention by such general hospitals of payments for
23 such patients shall be conditioned upon a determination by such office
24 that services provided by such hospitals to such patients, and the
25 assignment by such hospitals of such patients to the appropriate diagno-
26 sis-related groups, are in compliance with standards and criteria set
27 forth in article thirty-two of the mental hygiene law and applicable
28 regulations promulgated thereunder with regard to the provision of
29 medically managed withdrawal services. If after such review the office
30 of alcoholism and substance abuse determines that based upon clinical
31 criteria developed pursuant to subdivision (h) of section 32.05 of the
32 mental hygiene law for treatment in short stay outlier status, that the
33 patient should have received short stay outlier services, the commis-
34 sioner may recoup the difference between the payment applicable to the
35 hospital under paragraph (m) of this subdivision and the payment under
36 the diagnosis-related group to which the patient had been assigned by
37 the hospital. Such adjustments shall not be made in cases where the
38 hospital was unable to secure an appropriate discharge placement for the
39 patient after making reasonable efforts to secure such placement and the
40 unavailability of such placement is documented in the patient medical
41 record.
42 (m) The commissioner shall promulgate rates of payment to qualified
43 general hospitals for patients equal to the average of the hospital-spe-
44 cific short-stay per diem payment rates pursuant to paragraph (d) of
45 this subdivision applicable to diagnosis-related groups seven hundred
46 forty-five, seven hundred forty-eight, and seven hundred fifty-one,
47 provided that for short stay outlier patients no longer needing
48 medically managed or medically supervised chemical dependence crisis
49 services, payment shall be made at the per diem rate specified in this
50 subdivision, and for patients requiring medically managed or medically
51 supervised chemical dependence crisis services in a general hospital
52 after transfer from a short-stay outlier bed, payments for such patients
53 shall be made in accordance with the provisions of this section other-
54 wise applicable to the operating, capital, and add-on components of
55 inpatient case-based payments, provided, however, in no instance shall a
56 hospital receive a short-stay outlier payment for a patient that
S. 6457--C 15 A. 9557--B
1 requires medically managed or medically supervised chemical dependence
2 crisis services in a general hospital after transfer from a short-stay
3 outlier bed to a medically managed or medically supervised inpatient
4 bed.
5 § 37-a. Section 32.05 of the mental hygiene law is amended by adding
6 two new subdivisions (g) and (h) to read as follows:
7 (g) The commissioner of the office of alcoholism and substance abuse
8 services shall promulgate regulations for the licensure of extended
9 observation beds for up to forty-eight hours of care for alcoholism and
10 substance abuse services provided in general hospitals licensed under
11 this article. The regulations may require that hospitals licensed under
12 this article also be licensed for short stay outlier beds. The rates of
13 payment for such services shall be those stipulated under paragraph (m)
14 of subdivision four of section twenty-eight hundred seven-c of the
15 public health law. The continued need for such regulations shall be
16 evaluated when the commissioner of health implements regulations to
17 update the base year used to calculate the diagnosis-related group
18 service intensity weights, average lengths of stay, and trimpoints to a
19 more current base year. Such evaluation shall consider the recommenda-
20 tions of the joint task force on the continuum of care for alcoholism
21 and substance abuse services in New York state with respect to the clin-
22 ical efficacy and need for maintaining such extended observation
23 services.
24 (h) The commissioner of the office of alcoholism and substance abuse
25 services shall in consultation with representatives of providers of
26 inpatient hospital detoxification services, including the hospital asso-
27 ciations representing such providers, develop clinical criteria to be
28 used to determine appropriate placement in short stay outlier beds
29 pursuant to paragraph (l) of subdivision four of section twenty-eight
30 hundred seven-c of the public health law and this section.
31 § 37-b. Joint task force on the continuum of care for alcoholism and
32 substance abuse services in New York state. The commissioner of the
33 office of alcoholism and substance abuse services shall establish a
34 joint task force comprised of representatives from the hospital industry
35 and community-based alcoholism and substance abuse service providers to
36 study the availability of substance abuse services in New York state and
37 make recommendations with respect to improving the continuum of care for
38 substance abuse services. Such recommendations shall address needed
39 levels of patient care within the continuum of alcoholism and substance
40 abuse services, including the need for short stay outlier beds, consider
41 ways to improve linkages between inpatient hospital and community-based
42 residential and outpatient programs, as well as other social services,
43 and the appropriateness of the payments provided for such services. The
44 joint task force shall issue a report on its findings and recommenda-
45 tions to the legislature by June 30, 2007.
46 § 38. Notwithstanding any law, rule or regulation to the contrary and
47 in accordance with the provisions of subdivision 10 of section 2807 of
48 the public health law, and subject to the availability of federal finan-
49 cial participation for the period April 1, 2006 through December 31,
50 2008, the commissioner of health, in consultation with the commissioner
51 of the office of alcoholism and substance abuse services, shall estab-
52 lish a demonstration program, to be administered by the office of alco-
53 holism and substance abuse services in conjunction with the department
54 of health, for adjustments to inpatient rates of payment to general
55 hospitals to provide supplemental Medicaid rates of payments to such
56 general hospitals to provide for enhanced discharge planning with regard
S. 6457--C 16 A. 9557--B
1 to inpatients who are determined to be at risk for multiple re-admission
2 for inpatient detoxification services, for the purpose of ensuring the
3 transitioning of such patients to community based chemical dependence
4 treatment programs certified pursuant to article 32 of the mental
5 hygiene law, and to reduce the rate of chemical dependence related
6 re-admission of such patients to general hospitals. In addition, the
7 commissioner of health, in consultation with the commissioner of the
8 office of alcoholism and substance abuse services, may seek authori-
9 zation from the federal government for additional Medicaid payments to
10 providers of chemical dependence treatment services to perform expedited
11 chemical dependence assessments of Medicaid eligible hospital inpatients
12 who are also potentially eligible for inclusion in the demonstration
13 program authorized by this section.
14 § 39. It shall be the policy of the state of New York that a compre-
15 hensive law be enacted for the purpose of creating a uniform, statewide
16 system of standards, procedures and reporting for financial aid policies
17 of general hospitals. Currently, there is a wide discrepancy in how
18 general hospitals apply financial aid policies to low-income individuals
19 without health insurance, or who have exhausted their health insurance.
20 In addition, there is a need for consistent reporting related to such
21 policies and levels of uncompensated care. Such uniform policies and
22 reporting requirements are needed in order to ensure that low income
23 individuals without health insurance or who have exhausted their health
24 insurance are treated similarly throughout the state.
25 § 39-a. Section 2807-k of the public health law is amended by adding
26 a new subdivision 9-a to read as follows:
27 9-a. (a) As a condition for participation in pool distributions
28 authorized pursuant to this section and section twenty-eight hundred
29 seven-w of this article for periods on and after January first, two
30 thousand nine, general hospitals shall, effective for periods on and
31 after January first, two thousand seven, establish financial aid poli-
32 cies and procedures, in accordance with the provisions of this subdivi-
33 sion, for reducing charges otherwise applicable to low-income individ-
34 uals without health insurance, or who have exhausted their health
35 insurance benefits, and who can demonstrate an inability to pay full
36 charges, and also, at the hospital's discretion, for reducing or
37 discounting the collection of co-pays and deductible payments from those
38 individuals who can demonstrate an inability to pay such amounts.
39 (b) Such reductions from charges for uninsured patients with incomes
40 below at least three hundred percent of the federal poverty level shall
41 result in a charge to such individuals that does not exceed the greater
42 of the amount that would have been paid for the same services by the
43 "highest volume payor" for such general hospital as defined in subpara-
44 graph (v) of this paragraph, or for services provided pursuant to title
45 XVIII of the federal social security act (medicare), or for services
46 provided pursuant to title XIX of the federal social security act (medi-
47 caid), and provided further that such amounts shall be adjusted accord-
48 ing to income level as follows:
49 (i) For patients with incomes at or below at least one hundred percent
50 of the federal poverty level, the hospital shall collect no more than a
51 nominal payment amount, consistent with guidelines established by the
52 commissioner;
53 (ii) For patients with incomes between at least one hundred one
54 percent and one hundred fifty percent of the federal poverty level, the
55 hospital shall collect no more than the amount identified after applica-
56 tion of a proportional sliding fee schedule under which patients with
S. 6457--C 17 A. 9557--B
1 lower incomes shall pay the lowest amount. Such schedule shall provide
2 that the amount the hospital may collect for such patients increases
3 from the nominal amount described in subparagraph (i) of this paragraph
4 in equal increments as the income of the patient increases, up to a
5 maximum of twenty percent of the greater of the amount that would have
6 been paid for the same services by the "highest volume payor" for such
7 general hospital, as defined in subparagraph (v) of this paragraph, or
8 for services provided pursuant to title XVIII of the federal social
9 security act (medicare) or for services provided pursuant to title XIX
10 of the federal social security act (medicaid);
11 (iii) For patients with incomes between at least one hundred fifty-one
12 percent and two hundred fifty percent of the federal poverty level, the
13 hospital shall collect no more than the amount identified after applica-
14 tion of a proportional sliding fee schedule under which patients with
15 lower income shall pay the lowest amounts. Such schedule shall provide
16 that the amount the hospital may collect for such patients increases
17 from the twenty percent figure described in subparagraph (ii) of this
18 paragraph in equal increments as the income of the patient increases, up
19 to a maximum of the greater of the amount that would have been paid for
20 the same services by the "highest volume payor" for such general hospi-
21 tal, as defined in subparagraph (v) of this paragraph, or for services
22 provided pursuant to title XVIII of the federal social security act
23 (medicare) or for services provided pursuant to title XIX of the federal
24 social security act (medicaid); and
25 (iv) For patients with incomes between at least two hundred fifty-one
26 percent and three hundred percent of the federal poverty level, the
27 hospital shall collect no more than the greater of the amount that would
28 have been paid for the same services by the "highest volume payor" for
29 such general hospital as defined in subparagraph (v) of this paragraph,
30 or for services provided pursuant to title XVIII of the federal social
31 security act (medicare), or for services provided pursuant to title XIX
32 of the federal social security act (medicaid).
33 (v) For the purposes of this paragraph, "highest volume payor" shall
34 mean the insurer, corporation or organization licensed, organized or
35 certified pursuant to article thirty-two, forty-two or forty-three of
36 the insurance law or article forty-four of this chapter, or other third-
37 party payor, which has a contract or agreement to pay claims for
38 services provided by the general hospital and incurred the highest
39 volume of claims in the previous calendar year.
40 (vi) A hospital may implement policies and procedures to permit, but
41 not require, consideration on a case-by-case basis of exceptions to the
42 requirements described in subparagraphs (i) and (ii) of this paragraph
43 based upon the existence of significant assets owned by the patient that
44 should be taken into account in determining the appropriate payment
45 amount for that patient's care, provided, however, that such proposed
46 policies and procedures shall be subject to the prior review and
47 approval of the commissioner and, if approved, shall be included in the
48 hospital's financial assistance policy established pursuant to this
49 section, and provided further that, if such approval is granted, the
50 maximum amount that may be collected shall not exceed the greater of the
51 amount that would have been paid for the same services by the "highest
52 volume payor" for such general hospital as defined in subparagraph (v)
53 of this paragraph, or for services provided pursuant to title XVIII of
54 the federal social security act (medicare), or for services provided
55 pursuant to title XIX of the federal social security act (medicaid). In
56 the event that a general hospital reviews a patient's assets in deter-
S. 6457--C 18 A. 9557--B
1 mining payment adjustments such policies and procedures shall not
2 consider as assets a patient's primary residence, assets held in a tax-
3 deferred or comparable retirement savings account, college savings
4 accounts, or cars used regularly by a patient or immediate family
5 members.
6 (vii) Nothing in this paragraph shall be construed to limit a hospi-
7 tal's ability to establish patient eligibility for payment discounts at
8 income levels higher than those specified herein and/or to provide
9 greater payment discounts for eligible patients than those required by
10 this paragraph.
11 (c) Such policies and procedures shall be clear, understandable, in
12 writing and publicly available in summary form and each general hospital
13 participating in the pool shall ensure that every patient is made aware
14 of the existence of such policies and procedures and is provided, in a
15 timely manner, with a summary of such policies and procedures upon
16 request. Any summary provided to patients shall, at a minimum, include
17 specific information as to income levels used to determine eligibility
18 for assistance, a description of the primary service area of the hospi-
19 tal and the means of applying for assistance. For general hospitals
20 with twenty-four hour emergency departments, such policies and proce-
21 dures shall require the notification of patients during the intake and
22 registration process, through the conspicuous posting of language-appro-
23 priate information in the general hospital, and information on bills and
24 statements sent to patients, that financial aid may be available to
25 qualified patients and how to obtain further information. For specialty
26 hospitals without twenty-four hour emergency departments, such notifica-
27 tion shall take place through written materials provided to patients
28 during the intake and registration process prior to the provision of any
29 health care services or procedures, and through information on bills and
30 statements sent to patients, that financial aid may be available to
31 qualified patients and how to obtain further information. Application
32 materials shall include a notice to patients that upon submission of a
33 completed application, including any information or documentation needed
34 to determine the patient's eligibility pursuant to the hospital's finan-
35 cial assistance policy, the patient may disregard any bills until the
36 hospital has rendered a decision on the application in accordance with
37 this paragraph.
38 (d) Such policies and procedures shall include clear, objective crite-
39 ria for determining a patient's ability to pay and for providing such
40 adjustments to payment requirements as are necessary. In addition to
41 adjustment mechanisms such as sliding fee schedules and discounts to
42 fixed standards, such policies and procedures shall also provide for the
43 use of installment plans for the payment of outstanding balances by
44 patients pursuant to the provisions of the hospital's financial assist-
45 ance policy. The monthly payment under such a plan shall not exceed ten
46 percent of the gross monthly income of the patient, provided, however,
47 that if patient assets are considered under such a policy, then patient
48 assets which are not excluded assets pursuant to subparagraph (vi) of
49 paragraph (b) of this subdivision may be considered in addition to the
50 limit on monthly payments. The rate of interest charged to the patient
51 on the unpaid balance, if any, shall not exceed the rate for a ninety-
52 day security issued by the United States Department of Treasury, plus .5
53 percent and no plan shall include an accelerator or similar clause under
54 which a higher rate of interest is triggered upon a missed payment. If
55 such policies and procedures include a requirement of a deposit prior to
56 non-emergent, medically-necessary care, such deposit must be included as
S. 6457--C 19 A. 9557--B
1 part of any financial aid consideration. Such policies and procedures
2 shall be applied consistently to all eligible patients.
3 (e) Such policies and procedures shall permit patients to apply for
4 assistance within at least ninety days of the date of discharge or date
5 of service and provide at least twenty days for patients to submit a
6 completed application. Such policies and procedures may require that
7 patients seeking payment adjustments provide appropriate financial
8 information and documentation in support of their application, provided,
9 however, that such application process shall not be unduly burdensome or
10 complex. General hospitals shall, upon request, assist patients in
11 understanding the hospital's policies and procedures and in applying for
12 payment adjustments. Application forms shall be printed in the "primary
13 languages" of patients served by the general hospital. For the purposes
14 of this paragraph, "primary languages" shall include any language that
15 is either (i) used to communicate, during at least five percent of
16 patient visits in a year, by patients who cannot speak, read, write or
17 understand the English language at the level of proficiency necessary
18 for effective communication with health care providers, or (ii) spoken
19 by non-English speaking individuals comprising more than one percent of
20 the primary hospital service area population, as calculated using demo-
21 graphic information available from the United States Bureau of the
22 Census, supplemented by data from school systems. Decisions regarding
23 such applications shall be made within thirty days of receipt of a
24 completed application. Such policies and procedures shall require that
25 the hospital issue any denial/approval of such application in writing
26 with information on how to appeal the denial and shall require the
27 hospital to establish an appeals process under which it will evaluate
28 the denial of an application. Nothing in this subdivision shall be
29 interpreted as prohibiting a hospital from making the availability of
30 financial assistance contingent upon the patient first applying for
31 coverage under title XIX of the social security act (medicaid) or anoth-
32 er insurance program if, in the judgment of the hospital, the patient
33 may be eligible for medicaid or another insurance program, and upon the
34 patient's cooperation in following the hospital's financial assistance
35 application requirements, including the provision of information needed
36 to make a determination on the patient's application in accordance with
37 the hospital's financial assistance policy.
38 (f) Such policies and procedures shall provide that patients with
39 incomes below three hundred percent of the federal poverty level are
40 deemed presumptively eligible for payment adjustments and shall conform
41 to the requirements set forth in paragraph (b) of this subdivision,
42 provided, however, that nothing in this subdivision shall be interpreted
43 as precluding hospitals from extending such payment adjustments to other
44 patients, either generally or on a case-by-case basis. Such policies and
45 procedures shall provide financial aid for emergency hospital services,
46 including emergency transfers pursuant to the federal emergency medical
47 treatment and active labor act (42 USC 1395dd), to patients who reside
48 in New York state and for medically necessary hospital services for
49 patients who reside in the hospital's primary service area as determined
50 according to criteria established by the commissioner. In developing
51 such criteria, the commissioner shall consult with representatives of
52 the hospital industry, health care consumer advocates and local public
53 health officials. Such criteria shall be made available to the public no
54 less than thirty days prior to the date of implementation and shall, at
55 a minimum:
S. 6457--C 20 A. 9557--B
1 (i) prohibit a hospital from developing or altering its primary
2 service area in a manner designed to avoid medically underserved commu-
3 nities or communities with high percentages of uninsured residents;
4 (ii) ensure that every geographic area of the state is included in at
5 least one general hospital's primary service area so that eligible
6 patients may access care and financial assistance; and
7 (iii) require the hospital to notify the commissioner upon making any
8 change to its primary service area, and to include a description of its
9 primary service area in the hospital's annual implementation report
10 filed pursuant to subdivision three of section twenty-eight hundred
11 three-l of this article.
12 (g) Nothing in this subdivision shall be interpreted as precluding
13 hospitals from extending payment adjustments for medically necessary
14 non-emergency hospital services to patients outside of the hospital's
15 primary service area. For patients determined to be eligible for finan-
16 cial aid under the terms of a hospital's financial aid policy, such
17 policies and procedures shall prohibit any limitations on financial aid
18 for services based on the medical condition of the applicant, other than
19 typical limitations or exclusions based on medical necessity or the
20 clinical or therapeutic benefit of a procedure or treatment.
21 (h) Such policies and procedures shall not permit the forced sale or
22 foreclosure of a patient's primary residence in order to collect an
23 outstanding medical bill and shall require the hospital to refrain from
24 sending an account to collection if the patient has submitted a
25 completed application for financial aid, including any required support-
26 ing documentation, while the hospital determines the patient's eligibil-
27 ity for such aid. Such policies and procedures shall provide for written
28 notification, which shall include notification on a patient bill, to a
29 patient not less than thirty days prior to the referral of debts for
30 collection and shall require that the collection agency obtain the
31 hospital's written consent prior to commencing a legal action. Such
32 policies and procedures shall require all general hospital staff who
33 interact with patients or have responsibility for billing and
34 collections to be trained in such policies and procedures, and require
35 the implementation of a mechanism for the general hospital to measure
36 its compliance with such policies and procedures. Such policies and
37 procedures shall require that any collection agency under contract with
38 a general hospital for the collection of debts follow the hospital's
39 financial assistance policy, including providing information to patients
40 on how to apply for financial assistance where appropriate. Such poli-
41 cies and procedures shall prohibit collections from a patient who is
42 determined to be eligible for medical assistance pursuant to title XIX
43 of the federal social security act at the time services were rendered
44 and for which services medicaid payment is available.
45 (i) Reports required to be submitted to the department by each general
46 hospital as a condition for participation in the pools, and which
47 contain, in accordance with applicable regulations, a certification from
48 an independent certified public accountant or independent licensed
49 public accountant or an attestation from a senior official of the hospi-
50 tal that the hospital is in compliance with conditions of participation
51 in the pools, shall also contain, for reporting periods on and after
52 January first, two thousand seven:
53 (i) a report on hospital costs incurred and uncollected amounts in
54 providing services to eligible patients without insurance, including the
55 amount of care provided for a nominal payment amount, during the period
56 covered by the report;
S. 6457--C 21 A. 9557--B
1 (ii) hospital costs incurred and uncollected amounts for deductibles
2 and coinsurance for eligible patients with insurance or other third-par-
3 ty payor coverage;
4 (iii) the number of patients, organized according to United States
5 postal service zip code, who applied for financial assistance pursuant
6 to the hospital's financial assistance policy, and the number, organized
7 according to United States postal service zip code, whose applications
8 were approved and whose applications were denied;
9 (iv) the reimbursement received for indigent care from the pool estab-
10 lished pursuant to this section;
11 (v) the amount of funds that have been expended on charity care from
12 charitable bequests made or trusts established for the purpose of
13 providing financial assistance to patients who are eligible in accord-
14 ance with the terms of such bequests or trusts;
15 (vi) for hospitals located in social services districts in which the
16 district allows hospitals to assist patients with such applications, the
17 number of applications for eligibility under title XIX of the social
18 security act (medicaid) that the hospital assisted patients in complet-
19 ing and the number denied and approved;
20 (vii) the hospital's financial losses resulting from services provided
21 under medicaid; and
22 (viii) the number of liens placed on the primary residences of
23 patients through the collection process used by a hospital.
24 (j) Within ninety days of the effective date of this subdivision each
25 hospital shall submit to the commissioner a written report on its poli-
26 cies and procedures for financial assistance to patients which are used
27 by the hospital on the effective date of this subdivision. Such report
28 shall include copies of its policies and procedures, including material
29 which is distributed to patients, and a description of the hospital's
30 financial aid policies and procedures. Such description shall include
31 the income levels of patients on which eligibility is based, the finan-
32 cial aid eligible patients receive and the means of calculating such
33 aid, and the service area, if any, used by the hospital to determine
34 eligibility.
35 § 40. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
36 the laws of 1996, amending the education law and other laws relating to
37 rates for residential health care facilities, as amended by chapter 161
38 of the laws of 2005, is amended to read as follows:
39 (a) Notwithstanding any inconsistent provision of law or regulation to
40 the contrary, effective beginning August 1, 1996, for the period April
41 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
42 1998 through March 31, 1999, August 1, 1999, for the period April 1,
43 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
44 through March 31, 2001, April 1, 2001, for the period April 1, 2001
45 through March 31, 2002, April 1, 2002, for the period April 1, 2002
46 through March 31, 2003, and for the state fiscal year beginning April 1,
47 2005 through March 31, 2006, and for the state fiscal year beginning
48 April 1, 2006 through March 31, 2007, the department of health is
49 authorized to pay public general hospitals, as defined in subdivision 10
50 of section 2801 of the public health law, operated by the state of New
51 York or by the state university of New York or by a county, which shall
52 not include a city with a population of over one million, of the state
53 of New York, and those public general hospitals located in the county of
54 Westchester, the county of Erie or the county of Nassau, additional
55 payments for inpatient hospital services as medical assistance payments
56 pursuant to title 11 of article 5 of the social services law for
S. 6457--C 22 A. 9557--B
1 patients eligible for federal financial participation under title XIX of
2 the federal social security act in medical assistance pursuant to the
3 federal laws and regulations governing disproportionate share payments
4 to hospitals up to one hundred percent of each such public general
5 hospital's medical assistance and uninsured patient losses after all
6 other medical assistance, including disproportionate share payments to
7 such public general hospital for 1996, 1997, 1998, and 1999, based
8 initially for 1996 on reported 1994 reconciled data as further recon-
9 ciled to actual reported 1996 reconciled data, and for 1997 based
10 initially on reported 1995 reconciled data as further reconciled to
11 actual reported 1997 reconciled data, for 1998 based initially on
12 reported 1995 reconciled data as further reconciled to actual reported
13 1998 reconciled data, for 1999 based initially on reported 1995 recon-
14 ciled data as further reconciled to actual reported 1999 reconciled
15 data, for 2000 based initially on reported 1995 reconciled data as
16 further reconciled to actual reported 2000 data, for 2001 based initial-
17 ly on reported 1995 reconciled data as further reconciled to actual
18 reported 2001 data, for 2002 based initially on reported 2000 reconciled
19 data as further reconciled to actual reported 2002 data, and for state
20 fiscal years beginning on April 1, 2005, based initially on reported
21 2000 reconciled data as further reconciled to actual reported data for
22 2005, and for state fiscal years beginning on April 1, 2006, based
23 initially on reported 2000 reconciled data as further reconciled to
24 actual reported data for 2006. The payments may be added to rates of
25 payment or made as aggregate payments to an eligible public general
26 hospital.
27 § 41. Paragraph (b) of subdivision 1 of section 211 of chapter 474 of
28 the laws of 1996, amending the education law and other laws relating to
29 rates for residential health care facilities, as amended by chapter 161
30 of the laws of 2005, is amended to read as follows:
31 (b) Notwithstanding any inconsistent provision of law or regulation to
32 the contrary, effective beginning April 1, 2000, the department of
33 health is authorized to pay public general hospitals, other than those
34 operated by the state of New York or the state university of New York,
35 as defined in subdivision 10 of section 2801 of the public health law,
36 located in a city with a population of over 1 million, additional
37 initial payments for inpatient hospital services of $120 million during
38 each state fiscal year until March 31, 2003, and up to $120 million
39 during the state fiscal year beginning April 1, 2005 through March 31,
40 2006 and during the state fiscal year beginning April 1, 2006 through
41 March 31, 2007, as medical assistance payments pursuant to title 11 of
42 article 5 of the social services law for patients eligible for federal
43 financial participation under title XIX of the federal social security
44 act in medical assistance pursuant to the federal laws and regulations
45 governing disproportionate share payments to hospitals based on the
46 relative share of each such non-state operated public general hospital
47 of medical assistance and uninsured patient losses after all other
48 medical assistance, including disproportionate share payments to such
49 public general hospitals for payments made during the state fiscal year
50 ending March 31, 2001, based initially on reported 1995 reconciled data
51 as further reconciled to actual reported 2000 or 2001 data, for
52 payments made during the state fiscal year ending March 31, 2002, based
53 initially on reported 1995 reconciled data as further reconciled to
54 actual reported 2001 or 2002 data, for payments made during the state
55 fiscal year ending March 31, 2003, based initially on reported 2000
56 reconciled data as further reconciled to actual reported 2002 or 2003
S. 6457--C 23 A. 9557--B
1 data, for payments made during state fiscal years ending on and after
2 March 31, 2006, based initially on reported 2000 reconciled data as
3 further reconciled to actual reported 2005 or 2006 data, for payments
4 made during state fiscal years ending on and after March 31, 2007, based
5 initially on reported 2000 reconciled data as further reconciled to
6 actual reported 2006 or 2007 data. The payments may be added to rates
7 of payment or made as aggregate payments to an eligible public general
8 hospital.
9 § 42. Intentionally omitted.
10 § 43. Notwithstanding section 4 of chapter 81 of the laws of 1995, as
11 amended, and any other inconsistent provision of law or regulation to
12 the contrary, on and after October 1, 2006, rates of payment by govern-
13 mental agencies to residential health care facilities and diagnostic
14 and treatment centers licensed under article 28 of the public health law
15 for adult day health care services provided to registrants with acquired
16 immunodeficiency syndrome (AIDS) or other human immunodeficiency virus
17 (HIV) related illnesses, shall reflect trend factor adjustments computed
18 pursuant to paragraph (c) of subdivision 10 of section 2807-c of the
19 public health law to project for the effects of inflation attributable
20 to periods on and after October 1, 2006 through December 31, 2009.
21 § 44. Section 2808 of the public health law is amended by adding a new
22 subdivision 22-a to read as follows:
23 22-a. Modifications. (a) Notwithstanding any inconsistent provision
24 of law or regulation to the contrary, effective April first, two thou-
25 sand six and thereafter, residential health care facility rates of
26 payment determined pursuant to this section for payments made by govern-
27 mental agencies shall not contain a payment factor for interest on
28 current indebtedness if the residential health care facility cost report
29 utilized to determine such payment factor also shows a withdrawal of
30 equity, a transfer of assets, or a positive net income.
31 (b) Notwithstanding any inconsistent provision of law or regulation to
32 the contrary, for residential health care facility rates of payment
33 determined pursuant to this article for services provided on and after
34 April first, two thousand six, the annual cost report filed by each
35 residential health care facility for two thousand five and for each year
36 thereafter shall be examined and in the event the operating costs
37 reported by each such facility in any such cost report is less than
38 ninety percent of the operating costs reported in the cost report which
39 is being utilized to set such facility's existing rates of payment
40 trended to two thousand five and each year thereafter, then such rates
41 of payment shall be recalculated utilizing the more recent reported
42 operating cost data.
43 (c) Notwithstanding any inconsistent provision of law or regulation to
44 the contrary, effective on and after April first, two thousand six, for
45 purposes of establishing rates of payment by governmental agencies for
46 residential health care facilities licensed pursuant to this article,
47 the operating component of the rate for any residential health care
48 facility that did not or does not achieve ninety percent or greater
49 occupancy for any year within five calendar years from the date of
50 commencing operation, shall be recalculated utilizing the facility's
51 most recently available reported allowable costs divided by patient days
52 imputed at ninety percent occupancy. Such recalculated rates of payment
53 shall be effective January first of the sixth calendar year following
54 the date the facility commenced operations or April first, two thousand
55 six, whichever is later.
56 § 45. Intentionally omitted.
S. 6457--C 24 A. 9557--B
1 § 46. Intentionally omitted.
2 § 47. Notwithstanding section 448 of chapter 170 of the laws of 1994
3 and section 4 of chapter 81 of the laws of 1995, as amended, and any
4 other inconsistent provision of law or regulation, for rate periods on
5 and after April first, two thousand six, medical assistance rates of
6 payment to residential health care facilities and diagnostic treatment
7 centers licensed under article 28 of the public health law for adult day
8 health care services provided to registrants with acquired immunodefici-
9 ency syndrome (AIDS) or other human immunodeficiency virus (HIV) related
10 illnesses, shall be increased by an annual amount of two million eight
11 hundred thousand dollars in the aggregate. Such amount shall be allo-
12 cated among such providers of adult day health services as an increase
13 in the daily rate of payment for services to such registrants. Medical
14 assistance adjustments under this section shall be subject to the avail-
15 ability of federal financial participation under title XIX of the feder-
16 al social security act.
17 § 48. Intentionally omitted.
18 § 49. Intentionally omitted.
19 § 50. Subparagraph 1 of paragraph (a) of subdivision 2 of section 366
20 of the social services law, as amended by chapter 184 of the laws of
21 1969, is amended to read as follows:
22 (1) (i) for applications for medical assistance filed on or before
23 December thirty-first, two thousand five, a homestead which is essential
24 and appropriate to the needs of the household;
25 (ii) for applications for medical assistance filed on or after January
26 first, two thousand six, a homestead which is essential and appropriate
27 to the needs of the household; provided, however, that in determining
28 eligibility of an individual for medical assistance for nursing facility
29 services, the individual shall not be eligible for such assistance if
30 the individual's equity interest in the homestead exceeds seven hundred
31 fifty thousand dollars; provided further, that the dollar amount speci-
32 fied in this clause shall be increased, beginning with the year two
33 thousand eleven, from year to year, based on the percentage increase in
34 the consumer price index for all urban consumers, rounded to the nearest
35 one thousand dollars. Nothing in this clause shall be construed as
36 preventing an individual from using a reverse mortgage or home equity
37 loan to reduce the individual's total equity interest in the homestead.
38 The home equity limitation established by this clause shall be waived in
39 the case of a demonstrated hardship, as determined pursuant to criteria
40 established by the Secretary of Health and Human Services. The home
41 equity limitation shall not apply if one or more of the following
42 persons is lawfully residing in the individual's homestead at the time
43 of application for medical assistance: (A) the spouse of the individual;
44 or (B) the individual's child who is under the age of twenty-one, or is
45 blind or permanently or totally disabled.
46 § 50-a. Paragraph (e) of subdivision 5 of section 366 of the social
47 services law, as relettered by chapter 170 of the laws of 1994, is
48 relettered paragraph (f) and a new paragraph (e) is added to read as
49 follows:
50 (e) For transfers made on or after February eighth, two thousand six:
51 (1) (i) "assets" means all income and resources of an individual and
52 of the individual's spouse, including income or resources to which the
53 individual or the individual's spouse is entitled but which are not
54 received because of action by: the individual or the individual's
55 spouse; a person with legal authority to act in place of or on behalf of
56 the individual or the individual's spouse; a person acting at the direc-
S. 6457--C 25 A. 9557--B
1 tion or upon the request of the individual or the individual's spouse;
2 or by a court or administrative body with legal authority to act in
3 place of or on behalf of the individual or the individual's spouse or at
4 the direction or upon the request of the individual or the individual's
5 spouse.
6 (ii) "blind" has the same meaning given to such term in section
7 1614(a)(2) of the federal social security act.
8 (iii) "disabled" has the same meaning given to such term in section
9 1614(a)(3) of the federal social security act.
10 (iv) "income" has the same meaning given to such term in section 1612
11 of the federal social security act.
12 (v) "resources" has the same meaning given to such term in section
13 1613 of the federal social security act, without regard, in the case of
14 an institutionalized individual, to the exclusion provided for in
15 subsection (a)(1) of such section.
16 (vi) "look-back period" means the sixty-month period immediately
17 preceding the date that an institutionalized individual is both institu-
18 tionalized and has applied for medical assistance.
19 (vii) "institutionalized individual" means any individual who is an
20 in-patient in a nursing facility, including an intermediate care facili-
21 ty for the mentally retarded, or who is an in-patient in a medical
22 facility and is receiving a level of care provided in a nursing facili-
23 ty, or who is receiving care, services or supplies pursuant to a waiver
24 granted pursuant to subsection (c) of section 1915 of the federal social
25 security act.
26 (viii) "intermediate care facility for the mentally retarded" means a
27 facility certified under article sixteen of the mental hygiene law and
28 which has a valid agreement with the department for providing intermedi-
29 ate care facility services and receiving payment therefor under title
30 XIX of the federal social security act.
31 (ix) "nursing facility" means a nursing home as defined by section
32 twenty-eight hundred one of the public health law and an intermediate
33 care facility for the mentally retarded.
34 (x) "nursing facility services" means nursing care and health related
35 services provided in a nursing facility; a level of care provided in a
36 hospital which is equivalent to the care which is provided in a nursing
37 facility; and care, services or supplies provided pursuant to a waiver
38 granted pursuant to subsection (c) of section 1915 of the federal social
39 security act.
40 (2) The uncompensated value of an asset is the fair market value of
41 such asset at the time of transfer, minus the amount of the compensation
42 received in exchange for the asset.
43 (3) In determining the medical assistance eligibility of an institu-
44 tionalized individual, any transfer of an asset by the individual or the
45 individual's spouse for less than fair market value made within or after
46 the look-back period shall render the individual ineligible for nursing
47 facility services for the period of time specified in subparagraph four
48 of this paragraph. For purposes of this paragraph:
49 (i) the purchase of an annuity shall be treated as the disposal of an
50 asset for less than fair market value unless: the state is named as a
51 beneficiary in the first position for at least the total amount of
52 medical assistance paid on behalf of the annuitant, or the state is
53 named in the second position after the community spouse or minor or
54 disabled child and is named in the first position if such spouse or
55 representative of such child disposes of any such remainder for less
S. 6457--C 26 A. 9557--B
1 than fair market value; and the annuity meets the requirements of
2 section 1917(c)(1)(G) of the federal social security act;
3 (ii) the purchase of a life estate interest in another person's home
4 shall be treated as the disposal of an asset for less than fair market
5 value unless the purchaser resided in such home for a period of at least
6 one year after the date of purchase.
7 (iii) the purchase of a promissory note, loan, or mortgage shall be
8 treated as the disposal of an asset for less than fair market value
9 unless such note, loan, or mortgage meets the requirements of section
10 1917(c)(1)(I) of the federal social security act.
11 (4) Notwithstanding the provisions of this paragraph, an individual
12 shall not be ineligible for services solely by reason of any such trans-
13 fer to the extent that:
14 (i) in the case of an institutionalized individual, the asset trans-
15 ferred was a home and title to the home as transferred to:
16 (A) the spouse of the individual; or (B) a child of the individual who
17 is under the age of twenty-one years or blind or disabled; or (C) a
18 sibling of the individual who has an equity interest in such home and
19 who resided in such home for a period of at least one year immediately
20 before the date the individual became an institutionalized individual;
21 or (D) a child of the individual who was residing in such home for a
22 period of at least two years immediately before the date the individual
23 became an institutionalized individual, and who provided care to the
24 individual which permitted the individual to reside at home rather than
25 in an institution or facility; or
26 (ii) the assets: (A) were transferred to the individual's spouse, or
27 to another for the sole benefit of the individual's spouse; or (B) were
28 transferred from the individual's spouse to another for the sole benefit
29 of the individual's spouse; or (C) were transferred to the individual's
30 child who is blind or disabled, or to a trust established solely for the
31 benefit of such child; or (D) were transferred to a trust established
32 solely for the benefit of an individual under sixty-five years of age
33 who is disabled; or
34 (iii) a satisfactory showing is made that: (A) the individual or the
35 individual's spouse intended to dispose of the assets either at fair
36 market value, or for other valuable consideration; or (B) the assets
37 were transferred exclusively for a purpose other than to qualify for
38 medical assistance; or (C) all assets transferred for less than fair
39 market value have been returned to the individual; or
40 (iv) denial of eligibility would cause an undue hardship, such that
41 application of the transfer of assets provision under this section would
42 deprive the individual of medical care, such that the individual's life
43 or health would be in danger, or would deprive the individual of food,
44 clothing, shelter, or other necessities of life. The commissioner of the
45 office of temporary and disability assistance shall develop a hardship
46 waiver process which shall include a timely process for determining
47 whether an undue hardship waiver will be granted and a timely process
48 under which an adverse determination can be appealed. The commissioner
49 of the office of temporary and disability assistance shall provide
50 notice of the hardship waiver process in writing to those individuals
51 who are required to comply with the transfer of assets provision under
52 this section. If such an individual is an institutionalized individual,
53 the facility in which he or she is residing shall be permitted to file
54 an undue hardship waiver application on behalf of such individual with
55 the consent of the individual or the personal representative of the
56 individual. If the application for an undue hardship waiver for such
S. 6457--C 27 A. 9557--B
1 individual is pending and meets certain criteria specified by the secre-
2 tary of health and human services, the commissioner of health may
3 provide for payments for nursing facility services in order to hold the
4 bed for the individual at the facility, but not in excess of payments
5 for thirty days.
6 (5) Any transfer made by an individual or the individual's spouse
7 under subparagraph three of this paragraph shall cause the person to be
8 ineligible for services for a period equal to the total, cumulative
9 uncompensated value of all assets transferred during or after the look-
10 back period, divided by the average monthly costs of nursing facility
11 services provided to a private patient for a given period of time at the
12 time of application, as determined pursuant to the regulations of the
13 office of temporary and disability assistance. The period of ineligibil-
14 ity shall begin the first day of a month during or after which assets
15 have been transferred for less than fair market value, or the first day
16 the individual is receiving services for which medical assistance cover-
17 age would be available based on an approved application for such care
18 but for the provisions of subparagraph three of this paragraph, whichev-
19 er is later, and which does not occur in any other periods of ineligi-
20 bility under this paragraph. For purposes of this subparagraph, the
21 average monthly costs of nursing facility services to a private patient
22 for a given period of time at the time of application shall be presumed
23 to be one hundred twenty percent of the average medical assistance rate
24 of payment as of the first day of January of each year for nursing
25 facilities within the region wherein the applicant resides, as estab-
26 lished pursuant to paragraph (b) of subdivision sixteen of section twen-
27 ty-eight hundred seven-c of the public health law.
28 (6) In the case of an asset held by an individual in common with
29 another person or persons in a joint tenancy, tenancy in common, or
30 similar arrangement, the asset, or the affected portion of the asset,
31 shall be considered to be transferred by such individual when any action
32 is taken, either by such individual or by any other person, that reduces
33 or eliminates such individual's ownership or control of such asset.
34 (7) In the case of a trust established by the individual, as deter-
35 mined pursuant to the regulations of the office of temporary and disa-
36 bility assistance, any payment, other than a payment to or for the bene-
37 fit of the individual, from a revocable trust is considered to be a
38 transfer of assets by the individual and any payment, other than to or
39 for the benefit of the individual, from the portion of an irrevocable
40 trust which, under any circumstance, could be made available to the
41 individual is considered to be a transfer of assets by the individual
42 and, further, the value of any portion of an irrevocable trust from
43 which no payment could be made to the individual under any circumstances
44 is considered to be a transfer of assets by the individual for purposes
45 of this section as of the date of establishment of the trust, or, if
46 later, the date on which payment to the individual is foreclosed.
47 (f) The commissioner of the office of temporary and disability assist-
48 ance shall promulgate such rules and regulations as may be necessary to
49 carry out the provisions of this subdivision.
50 § 50-b. Section 366-a of the social services law is amended by adding
51 a new subdivision 10 to read as follows:
52 (10) As a condition for the provision of medical assistance for nurs-
53 ing facility services, the application of an individual for such assist-
54 ance, including any recertification of eligibility for such assistance,
55 shall disclose a description of any interest the individual or community
56 spouse has in an annuity or similar financial instrument, regardless of
S. 6457--C 28 A. 9557--B
1 whether the annuity is irrevocable or is treated as an asset. Such
2 application or recertification form shall include a statement that the
3 state of New York becomes a remainder beneficiary under such annuity or
4 similar financial instrument by virtue of the provision of such medical
5 assistance.
6 § 50-c. Applicability of certain limitations on eligibility for
7 medical assistance. 1. The federal deficit reduction act of 2005
8 mandates that New York state enact certain limitations on eligibility
9 for medical assistance as a condition of receiving federal financial
10 participation for that medical assistance. The amendments made to
11 subparagraph (1) of paragraph (a) of subdivision 2 of section 366 of the
12 social services law and paragraphs (e) and (f) of subdivision 5 of
13 section 366 of the social services law and the new subdivision 10 of
14 section 366-a of the social services law, enacted respectively by
15 sections 50, 50-a, and 50-b of the chapter of the laws of 2006 (referred
16 to in this section as the "limitations on eligibility"), to the extent
17 they limit eligibility for medical assistance, shall only be effective
18 and apply as and when they are and continue to be mandated by applicable
19 federal law as a condition for the state receiving federal financial
20 participation for that medical assistance. If at any time a court of
21 competent jurisdiction finds that any provision of the limitations on
22 eligibility, or any application thereof, is not so mandated by applica-
23 ble federal law, then that provision, or that application of that
24 provision, shall have no legal force or effect and the relevant
25 provision of the social services law in effect immediately prior to this
26 section becoming law shall apply.
27 2. If any provision of the limitations on eligibility, or any applica-
28 tion thereof, is found under this section to have no legal force and
29 effect, that finding shall not affect the legal force and effect of any
30 other provision of the limitations on eligibility or any other applica-
31 tion thereof.
32 § 51. Intentionally omitted.
33 § 52. Intentionally omitted.
34 § 53. Intentionally omitted.
35 § 54. Intentionally omitted.
36 § 55. Intentionally omitted.
37 § 56. Intentionally omitted.
38 § 57. Paragraph (b) of subdivision 4 of section 364-j of the social
39 services law, as amended by chapter 649 of the laws of 1996, is amended
40 to read as follows:
41 (b) Participants shall select a managed care provider from among those
42 designated under the managed care program, provided, however, a partic-
43 ipant shall be provided with a choice of no less than two managed care
44 providers. Notwithstanding the foregoing, a local social services
45 district designated a rural area as defined in 42 U.S.C. 1395ww may
46 limit a participant to one managed care provider, if the commissioner
47 and the local social services district find that only one managed care
48 provider is available. A managed care provider in a rural area shall
49 offer a participant a choice of at least three primary care practition-
50 ers and permit the individual to obtain a service or seek a provider
51 outside of the managed care network where such service or provider is
52 not available from within the managed care provider network.
53 § 58. Section 3614 of the public health law, is amended by adding a
54 new subdivision 3-a to read as follows:
55 3-a. Medically fragile children. Rates of payment for continuous nurs-
56 ing services for medically fragile children provided by a certified home
S. 6457--C 29 A. 9557--B
1 health agency, a licensed home care services agency or a long term home
2 health care program shall be established to ensure the availability of
3 such services, whether provided by registered nurses or licensed practi-
4 cal nurses who are employed by or under contract with such agencies or
5 programs, and shall be established at a rate that is at least equal to
6 rates of payment for such services rendered to patients eligible for
7 AIDS home care programs; provided, however, that a certified home health
8 agency, a licensed home care services agency or a long term home health
9 care program that receives such enhanced rates for continuous nursing
10 services for medically fragile children shall use such enhanced rates to
11 increase payments to registered nurses and licensed practical nurses who
12 provide such services. In the case of services provided by certified
13 home health agencies and long term home health care programs through
14 contracts with licensed home care services agencies, rate increases
15 received by such certified home health agencies and long term home
16 health care programs pursuant to this subdivision shall be reflected in
17 payments made to the registered nurses or licensed practical nurses
18 employed by such licensed home care services agencies to render services
19 to these children. In establishing rates of payment under this subdivi-
20 sion, the commissioner shall consider the cost neutrality of such rates
21 as related to the cost effectiveness of caring for medically fragile
22 children in a non-institutional setting as compared to an institutional
23 setting. For the purposes of this subdivision, a medically fragile
24 child shall mean a child who is at risk of hospitalization or institu-
25 tionalization, including but not limited to children who are technologi-
26 cally-dependent for life or health-sustaining functions, require complex
27 medication regimen or medical interventions to maintain or to improve
28 their health status or are in need of ongoing assessment or intervention
29 to prevent serious deterioration of their health status or medical
30 complications that place their life, health or development at risk, but
31 who are capable of being cared for at home if provided with appropriate
32 home care services, including but not limited to case management
33 services and continuous nursing services.
34 § 58-a. Section 367-r of the social services law, as added by section
35 44 of part J of chapter 82 of the laws of 2002, is amended to read as
36 follows:
37 § 367-r. Private duty nursing services worker recruitment and
38 retention program. 1. The commissioner of health shall, subject to the
39 provisions of subdivision two of this section and to the availability of
40 federal financial participation, increase medical assistance rates of
41 payment by three percent for services provided on and after December
42 first, two thousand two, for private duty nursing services for the
43 purposes of improving recruitment and retention of private duty nurses.
44 1-a. Medically fragile children. In addition, the commissioner shall
45 further increase rates for private duty nursing services that are
46 provided to medically fragile children to ensure the availability of
47 such services to such children. In establishing rates of payment under
48 this subdivision, the commissioner shall consider the cost neutrality of
49 such rates as related to the cost effectiveness of caring for medically
50 fragile children in a non-institutional setting as compared to an insti-
51 tutional setting. Medically fragile children shall, for the purposes of
52 this subdivision, have the same meaning as in subdivision three of
53 section thirty-six hundred fourteen of the public health law. Such
54 increased rates for services rendered to such children shall take into
55 consideration the elements of cost, geographical differentials in the
56 elements of cost considered, economic factors in the area in which the
S. 6457--C 30 A. 9557--B
1 private duty nursing service is provided, costs associated with the
2 provision of private duty nursing services to medically fragile chil-
3 dren, and the need for incentives to improve services and institute
4 economies and shall be payable only to those private duty nurses who can
5 demonstrate, to the satisfaction of the department of health, satisfac-
6 tory training and experience to provide services to such children.
7 2. Private duty nursing services providers which have their rates
8 adjusted pursuant to this section shall use such funds solely for the
9 purposes of recruitment and retention of private duty nurses or to
10 ensure the delivery of private duty nursing services to medically frag-
11 ile children and are prohibited from using such funds for any other
12 purpose. Funds provided under this section are not intended to supplant
13 support provided by a local government. Each such provider, with the
14 exception of self-employed private duty nurses, shall submit, at a time
15 and in a manner to be determined by the commissioner of health, a writ-
16 ten certification attesting that such funds will be used solely for the
17 purpose of recruitment and retention of private duty nurses or to ensure
18 the delivery of private duty nursing services to medically fragile chil-
19 dren. The commissioner of health is authorized to audit each such
20 provider to ensure compliance with the written certification required by
21 this subdivision and shall recoup all funds determined to have been used
22 for purposes other than recruitment and retention of private duty nurses
23 or the delivery of private duty nursing services to medically fragile
24 children. Such recoupment shall be in addition to any other penalties
25 provided by law.
26 § 58-b. Subdivision 2 of section 365-a of the social services law is
27 amended by adding a new paragraph (p) to read as follows:
28 (p) targeted case management services provided to children who
29 (i) are eighteen years of age or under; and
30 (ii) either
31 (1) are physically disabled, according to the federal supplemental
32 security income program criteria, including but not limited to a person
33 who is multiply disabled; or
34 (2) have a developmental disability, as defined in subdivision twen-
35 ty-two of section 1.03 of the mental hygiene law and demonstrate complex
36 health needs as defined in paragraph c of subdivision seven of section
37 three hundred sixty-six of this title; or
38 (3) have a mental illness, as defined in subdivision twenty of section
39 1.03 of the mental hygiene law and demonstrate complex health or mental
40 health care needs as defined in paragraph d of subdivision nine of
41 section three hundred sixty-six of this title; and
42 (iii) require the level of care provided by an intermediate care
43 facility for the developmentally disabled, a nursing facility, a hospi-
44 tal or any other institution; and
45 (iv) are capable of being cared for in the community if provided with
46 case management services and/or other services provided under this
47 title; and
48 (v) are capable of being cared for in the community at less cost than
49 in the appropriate institutional setting; and
50 (vi) are not receiving services under section three hundred sixty-sev-
51 en-c of this title and for whom services provided under section three
52 hundred sixty-seven-a of this title are not available or sufficient to
53 support the children's care in the community.
54 § 59. Paragraph (iii) of subdivision (g) of section 1 of part C of
55 chapter 58 of the laws of 2005, amending the public health law and other
S. 6457--C 31 A. 9557--B
1 laws relating to implementing the state fiscal plan for the 2005--2006
2 state fiscal year, is amended to read as follows:
3 (iii) During each state fiscal year subject to the provisions of this
4 section, the commissioner shall maintain an accounting, for each social
5 services district, of the net amounts that would have been expended by,
6 or on behalf of, such district had the social services district medical
7 assistance shares provisions in effect on January 1, 2005 been applied
8 to such district. For purposes of this paragraph, fifty percent of the
9 payments made by New York State to the secretary of the federal depart-
10 ment of health and human services pursuant to section 1935(c) of the
11 social security act shall be deemed to be payments made on behalf of
12 social services districts; such fifty percent share shall be apportioned
13 to each district in the same ratio as the number of "full-benefit dual
14 eligible individuals," as that term is defined in section 1935(c)(6) of
15 such act, for whom such district has fiscal responsibility pursuant to
16 section 365 of the social services law, relates to the total of such
17 individuals for whom districts have fiscal responsibility. As soon as
18 practicable after the conclusion of each such fiscal year, but in no
19 event later than six months after the conclusion of each such fiscal
20 year, the commissioner shall reconcile such net amounts with such fiscal
21 year's social services district expenditure cap amount. Such reconcil-
22 iation shall be based on actual expenditures made by or on behalf of
23 social services districts, and revenues received by social services
24 districts, during such fiscal year and shall be made without regard to
25 expenditures made, and revenues received, outside such fiscal year that
26 are related to services provided during, or prior to, such fiscal year.
27 The commissioner shall pay to each social services district the amount,
28 if any, by which such district's expenditure cap amount exceeds such net
29 amount.
30 § 60. Subdivision (a) of section 1 of part C of chapter 58 of the laws
31 of 2005, amending the public health law and other laws relating to
32 implementing the state fiscal plan for the 2005-2006 state fiscal year,
33 as amended by chapter 161 of the laws of 2005, is amended to read as
34 follows:
35 (a) Notwithstanding the provisions of section 368-a of the social
36 services law, or any other provision of law, the department of health
37 shall provide reimbursement for expenditures made by or on behalf of
38 social services districts for medical assistance for needy persons, and
39 the administration thereof, in accordance with the provisions of this
40 section; provided, however, that this section shall not apply to amounts
41 expended for health care services under section 369-ee of the social
42 services law, which amounts shall be reimbursed in accordance with para-
43 graph (t) of subdivision 1 of section 368-a of such law and shall be
44 excluded from all calculations made pursuant to this section; and
45 provided further that amounts paid to the public hospitals pursuant to
46 subdivision 14-f of section 2807-c of the public health law and amounts
47 expended pursuant to: subdivision 12 of section 2808 of the public
48 health law; sections 211 and 212 of chapter 474 of the laws of 1996, as
49 amended; and sections 11 through 14 of part A and sections 13 and 14 of
50 part B of chapter 1 of the laws of 2002, shall be excluded from all
51 calculations made pursuant to this section.
52 § 61. Any payments made on and after January 1, 2006: (i) by the
53 department of health to a social services district for the purpose of
54 providing such district with reimbursement for medical assistance
55 district share overpayments caused by miscategorization of persons
56 described in subdivision 5 of section 365 of the social services law, or
S. 6457--C 32 A. 9557--B
1 (ii) by a social services district to the department of health for the
2 purpose of providing the department with reimbursement for medical
3 assistance district share underpayments caused by miscategorization of
4 such persons, shall not be governed by the provisions of section 1 of
5 Part C of chapter 58 of the laws of 2005; provided, however, that any
6 portion of such payments that are made on or before June 1, 2006 and
7 that are attributable to shares adjustments for expenditures made in
8 calendar year 2005 shall be included in the base year calculation
9 required by subdivision (b) of such section 1.
10 § 62. Paragraph (e-1) of subdivision 12 of section 2808 of the public
11 health law, as added by section 39 of part C of chapter 58 of the laws
12 of 2005, is amended to read as follows:
13 (e-1) Notwithstanding any inconsistent provision of law or regulation,
14 the commissioner shall provide, in addition to payments established
15 pursuant to this article prior to application of this section, addi-
16 tional payments under the medical assistance program pursuant to title
17 eleven of article five of the social services law for non-state operated
18 public residential health care facilities, including public residential
19 health care facilities located in the county of Nassau, the county of
20 Westchester and the county of Erie, but excluding public residential
21 health care facilities operated by a town or city within a county, in an
22 aggregate amount of up to one hundred fifty million dollars in addi-
23 tional payments for state fiscal year beginning April first, two thou-
24 sand [five] six. The amount allocated to each eligible public residen-
25 tial health care facility for this period shall be computed in
26 accordance with the provisions of paragraph (f) of this subdivision,
27 provided, however, that patient days shall be utilized for such computa-
28 tion reflecting actual reported data for two thousand three and each
29 representative succeeding year as applicable.
30 § 63. Intentionally omitted.
31 § 64. Intentionally omitted.
32 § 65. Section 364-j of the social services law is amended by adding a
33 new subdivision 23 to read as follows:
34 23. (a) As a means of protecting the health, safety and welfare of
35 recipients, in addition to any other sanctions that may be imposed, the
36 commissioner shall appoint temporary management of a managed care
37 provider upon determining that the managed care provider has repeatedly
38 failed to meet the substantive requirements of sections 1903(m) and 1932
39 of the federal Social Security Act and regulations. A hearing shall not
40 be required prior to the appointment of temporary management.
41 (b) The commissioner and/or his or her designees, which may be indi-
42 viduals within the department or other individuals or entities with
43 appropriate knowledge and experience, may be appointed as temporary
44 management. The commissioner may appoint the superintendent of insurance
45 and/or his or her designees as temporary management of any managed care
46 provider which is subject to rehabilitation pursuant to article seven-
47 ty-four of the insurance law.
48 (c) The responsibilities of temporary management shall include over-
49 sight of the managed care provider for the purpose of removing the caus-
50 es and conditions which led to the determination requiring temporary
51 management, the imposition of improvements to remedy violations and,
52 where necessary, the orderly reorganization, termination or liquidation
53 of the managed care provider.
54 (d) Temporary management may hire and fire managed care provider
55 personnel and expend managed care provider funds in carrying out the
56 responsibilities imposed pursuant to this subdivision.
S. 6457--C 33 A. 9557--B
1 (e) The commissioner, in consultation with the superintendent with
2 respect to any managed care provider subject to rehabilitation pursuant
3 to article seventy-four of the insurance law, may make available to
4 temporary management for the benefit of a managed care provider for the
5 maintenance of required reserves and deposits monies from such funds as
6 are appropriated for such purpose.
7 (f) The commissioner is authorized to establish in regulation
8 provisions for the payment of fees and expenses from funds appropriated
9 for such purpose for non-governmental individuals and entities appointed
10 as temporary management pursuant to this subdivision.
11 (g) The commissioner may not terminate temporary management prior to
12 his or her determination that the managed care provider has the capabil-
13 ity to ensure that the sanctioned behavior will not recur.
14 (h) During any period of temporary management individuals enrolled in
15 the managed care provider being managed may disenroll without cause.
16 Upon reaching a determination that requires temporary management of a
17 managed care provider, the commissioner shall notify all recipient
18 enrollees of such provider that they may terminate enrollment without
19 cause during the period of temporary management.
20 (i) The commissioner may adopt and amend rules and regulations to
21 effectuate the purposes and provisions of this subdivision.
22 § 65-a. Section 367-s of the social services law, as added by section
23 30 of part E of chapter 63 of the laws of 2005, is amended to read as
24 follows:
25 § 367-s. Emergency medical transportation services. 1. Notwithstanding
26 any provision of law to the contrary, a supplemental medical assistance
27 payment shall be made on an annual basis to providers of emergency
28 medical transportation services in an aggregate amount not to exceed
29 four million dollars for two thousand six and six million dollars for
30 two thousand seven pursuant to the following methodology:
31 (a) For each emergency medical transportation services provider that
32 receives medical assistance [payments] reimbursement processed through
33 the state Medicaid payment system, the department of health shall deter-
34 mine the ratio of such provider's [payments] state-processed reimburse-
35 ment to the total such [payments] reimbursement made during each quarter
36 of the applicable calendar year, expressed as a percentage;
37 (b) For each such provider, the department of health shall multiply
38 the percentage obtained pursuant to paragraph (a) of this subdivision by
39 one-quarter of the applicable aggregate amount specified in the opening
40 paragraph of this subdivision. The result of such calculation shall
41 represent the "emergency medical transportation service supplemental
42 payment" and shall be paid expeditiously to such provider on a quarterly
43 basis;
44 [(c) Provided however that aggregate payments to providers within any
45 social services district cannot exceed twenty-five percent of the aggre-
46 gate supplemental payment provided for in the opening paragraph.]
47 2. The amount disbursed to emergency medical transportation services
48 providers whose area of operation is within the city of New York will be
49 twenty-five percent of the applicable aggregate amount, with the remain-
50 ing seventy-five percent to be disbursed to all other emergency medical
51 transportation services providers.
52 3. If all necessary approvals under federal law and regulation are not
53 obtained to receive federal financial participation in the payments
54 authorized by this section, payments under this section shall be made in
55 an aggregate amount not to exceed two million dollars for two thousand
56 six and three million dollars for two thousand seven. In such case, the
S. 6457--C 34 A. 9557--B
1 multiplier set forth in paragraph (b) of subdivision one of this section
2 shall be deemed to be two million dollars or three million dollars as
3 applicable to the annual period.
4 [3.] 4. Notwithstanding any inconsistent provisions of section three
5 hundred sixty-eight-a of this title, or of any other law, to the contra-
6 ry, the department of health shall pay one hundred per centum of the
7 non-federal share of any payments made pursuant to this section.
8 § 65-b. Section 97 of chapter 659 of the laws of 1997, amending the
9 public health law and other laws relating to creation of continuing care
10 retirement communities, is amended to read as follows:
11 § 97. This act shall take effect immediately, provided, however, that
12 the amendments to subdivision 4 of section 854 of the general municipal
13 law made by section seventy of this act shall not affect the expiration
14 of such subdivision and shall be deemed to expire therewith and provided
15 further that sections sixty-seven and sixty-eight of this act shall
16 apply to taxable years beginning on or after January 1, 1998 and
17 provided further that sections eighty-one through eighty-seven of this
18 act shall expire and be deemed repealed on December 31, [2006] 2015 and
19 provided further, however, that the amendments to section ninety of this
20 act shall take effect January 1, 1998 and shall apply to all policies,
21 contracts, certificates, riders or other evidences of coverage of long
22 term care insurance issued, renewed, altered or modified pursuant to
23 section 3229 of the insurance law on or after such date.
24 § 65-c. Subdivision 7 of section 4403-f of the public health law is
25 amended by adding a new paragraph (k) to read as follows:
26 (k) (i) Managed long term care plans and demonstrations may enroll
27 eligible persons in the plan or demonstration upon the completion of a
28 comprehensive assessment that shall include, but not be limited to, an
29 evaluation of the medical, social and environmental needs of each
30 prospective enrollee in such program. This assessment shall also serve
31 as the basis for the development and provision of an appropriate plan of
32 care for the prospective enrollee.
33 (ii) The assessment shall be completed by a representative of the
34 managed long term care plan or demonstration, in consultation with the
35 prospective enrollee's health care practitioner. The commissioner shall
36 prescribe the forms on which the assessment shall be made.
37 (iii) The completed assessment and documentation of the enrollment
38 shall be submitted by the managed long term care plan or demonstration
39 to the local department of social services prior to the commencement of
40 services under the managed long term care plan or demonstration. For
41 purposes of reimbursement of the managed long term care plan or demon-
42 stration, if the completed assessment and documentation are submitted on
43 or before the twentieth day of the month, the enrollment shall commence
44 on the first day of the month following the completion and submission
45 and if the completed assessment and documentation are submitted after
46 the twentieth day of the month, the enrollment shall commence on the
47 first day of the second month following submission. Enrollments
48 conducted by a plan or demonstration shall be subject to review and
49 audit by the department and the local social services district.
50 (iv) Continued enrollment in a managed long term care plan or demon-
51 stration paid for by government funds shall be based upon a comprehen-
52 sive assessment of the medical, social and environmental needs of the
53 recipient of the services. Such assessment shall be performed at least
54 annually by the managed long term care plan serving the enrollee. The
55 commissioner shall prescribe the forms on which the assessment will be
56 made.
S. 6457--C 35 A. 9557--B
1 § 65-d. Paragraph (f) of subdivision 1 of section 4403-f of the public
2 health law, as added by chapter 659 of the laws of 1997, is amended to
3 read as follows:
4 (f) "Health and long term care services" means services including, but
5 not limited to primary care, acute care, home and community-based and
6 institution-based long term care and ancillary services (that shall
7 include medical supplies and nutritional supplements) that are necessary
8 to meet the needs of persons whom the plan is authorized to enroll.
9 § 65-e. Paragraph (a) of subdivision 1 of section 4403-f of the public
10 health law, as added by chapter 659 of the laws of 1997, is amended to
11 read as follows:
12 (a) "Managed long term care plan" means an entity that has received a
13 certificate of authority pursuant to this section to provide, or arrange
14 for, health and long term care services, on a capitated basis in accord-
15 ance with this section, for a population, age eighteen and over, which
16 the plan is authorized to enroll.
17 § 65-f. Subdivision 7 of section 4403-f of the public health law is
18 amended by adding a new paragraph (l) to read as follows:
19 (l) The commissioner shall, upon request by a managed long term care
20 plan, approved managed long term care demonstration, or operating demon-
21 stration, and consistent with federal regulations promulgated pursuant
22 to the Health Insurance Portability and Accountability Act, share with
23 such plan or demonstration the following data if it is available:
24 (i) information concerning utilization of services and providers by
25 each of its enrollees prior to and during enrollment, including but not
26 limited to utilization of emergency department services, prescription
27 drugs, and hospital and nursing facility admissions.
28 (ii) aggregate data concerning utilization and costs for enrollees and
29 for comparable cohorts served through the Medicaid fee-for-service
30 program.
31 § 65-g. Subdivision 8 of section 4403-f of the public health law, as
32 added by chapter 659 of the laws of 1997, is amended to read as follows:
33 8. Payment rates for managed long term care plan enrollees eligible
34 for medical assistance. The commissioner, in consultation with the
35 superintendent of insurance, shall establish payment rates for services
36 provided to enrollees eligible under title XIX of the federal social
37 security act. Such payment rates shall be subject to approval by the
38 director of the division of the budget and shall reflect savings to both
39 state and local governments when compared to costs which would be
40 incurred by such program if enrollees were to receive comparable health
41 and long term care services on a fee-for-service basis in the geographic
42 region in which such services are proposed to be provided. Payment rates
43 [may] shall be risk-adjusted to take into account the characteristics of
44 enrollees, or proposed enrollees, including, but not limited to: frail-
45 ty, disability level, health and functional status, age, gender, the
46 nature of services provided to such enrollees, and other factors as
47 determined by the commissioner in consultation with the superintendent
48 of insurance. [Any such] The risk adjusted premiums may also be combined
49 with disincentives or requirements designed to mitigate any incentives
50 to obtain higher payment categories.
51 § 65-h. Paragraph (e) of subdivision 6 of section 4403-f of the public
52 health law, as amended by section 16 of part E of chapter 63 of the laws
53 of 2005, is amended to read as follows:
54 (e) The majority leader of the senate and the speaker of the assembly
55 may each designate in writing up to [six] ten eligible applicants as
56 approved managed long term care demonstrations. The commissioner may
S. 6457--C 36 A. 9557--B
1 designate in writing up to two eligible applicants as approved managed
2 long term care demonstrations. Subsequent to such designation, the
3 commissioner and the superintendent of insurance shall impose terms and
4 conditions pursuant to a written agreement with each such demonstration,
5 not inconsistent with this section, under which such demonstrations
6 shall be authorized to operate. If any such demonstration has not
7 commenced operations by January first, two thousand four, the majority
8 leader of the senate or the speaker of the assembly, as the case may be,
9 may, consistent with this paragraph, rescind its designation as an
10 approved managed long term care demonstration and its authorization to
11 operate, and, consistent with this paragraph, designate an alternate
12 applicant as an approved managed long term care demonstration.
13 § 66. The commissioner of health is hereby directed to examine and
14 develop proposals for authorization from the federal government to
15 establish, under the medical assistance program, a health opportunity
16 account demonstration program and a self directed personal assistance
17 demonstration program pursuant to the federal deficit reduction act of
18 2005. Pursuant to a chapter of the laws of 2006 the commissioner of
19 health shall provide written recommendations to the legislature concern-
20 ing such proposals within 30 days of the effective date of this section.
21 Such recommendations shall be public documents.
22 § 67. Subdivisions 2 and 5 of section 364-j-2 of the social services
23 law, as amended by chapter 12 of the laws of 2005, are amended to read
24 as follows:
25 2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of
26 section twenty-eight hundred seven of the public health law, the commis-
27 sioner of health shall make supplemental payments of nine million eight
28 hundred twenty-four thousand dollars ($9,824,000), to covered providers
29 described in subdivision one of this section who are qualified providers
30 as described in paragraph (a) of subdivision three of this section,
31 based on adjustments to fee-for-service rates for the period February
32 first through March thirty-first, two thousand two and nine million
33 eight hundred twenty-four thousand dollars ($9,824,000) for the period
34 October first through December thirty-first, two thousand two and four
35 million nine hundred twelve thousand dollars ($4,912,000) for the period
36 October first through December thirty-first, two thousand three and an
37 additional amount of four million nine hundred twelve thousand dollars
38 ($4,912,000) for the period October first through December thirty-first,
39 two thousand three and nine million eight hundred twenty-four thousand
40 dollars ($9,824,000) for the period April first through June thirtieth,
41 two thousand five, and nine million eight hundred twenty-four thousand
42 dollars ($9,824,000) for the period October first through December thir-
43 ty-first, two thousand five, and nine million eight hundred twenty-four
44 thousand dollars ($9,824,000) for the period October first through
45 December thirty-first, two thousand six, as medical assistance payments
46 for services provided pursuant to this title for persons eligible for
47 federal financial participation under title XIX of the federal social
48 security act to reflect additional costs associated with the transition
49 to a managed care environment. There shall be no local share in these
50 payments. The director of the budget shall allocate the non-federal
51 share of such payments from an appropriation for the miscellaneous
52 special revenue fund - 339 community service provider assistance program
53 account for the two thousand one--two thousand two state fiscal year for
54 adjustments for the period February first through March thirty-first,
55 two thousand two. Adjustments for the period October first, two thousand
56 two through December thirty-first, two thousand two shall be within
S. 6457--C 37 A. 9557--B
1 amounts appropriated for the two thousand two--two thousand three state
2 fiscal year and adjustments for the period October first, two thousand
3 three through December thirty-first, two thousand three shall be within
4 amounts appropriated for the two thousand three--two thousand four state
5 fiscal year and adjustments for the non-federal share of the additional
6 amount of four million nine hundred twelve thousand dollars ($4,912,000)
7 for such period shall be allocated by the director of the budget from an
8 appropriation for maintenance undistributed general fund community
9 projects fund - 007 account for the two thousand three--two thousand
10 four state fiscal year. The director of the budget shall allocate the
11 non-federal share of adjustments for the period April first, two thou-
12 sand five through June thirtieth, two thousand five from an appropri-
13 ation for the maintenance undistributed general fund community projects
14 fund - 007 account for the two thousand four--two thousand five state
15 fiscal year. The director of the budget shall allocate the non-federal
16 share of adjustments for the period October first, two thousand five
17 through December thirty-first, two thousand five from an appropriation
18 for the maintenance undistributed, general fund, community projects fund
19 - 007 account for the two thousand five--two thousand six state fiscal
20 year. The director of the budget shall allocate the non-federal share
21 of adjustments for the period October first, two thousand six through
22 December thirty-first, two thousand six from the medical assistance
23 local assistance appropriation for the two thousand six--two thousand
24 seven state fiscal year. Such adjustments to fee for service rates shall
25 not be subject to subsequent adjustment or reconciliation. Alternative-
26 ly, such payments may be made as aggregate payments to eligible provid-
27 ers.
28 (a-1) Notwithstanding the provisions of paragraph (a) of this subdivi-
29 sion, for facilities licensed under article twenty-eight of the public
30 health law that are sponsored by a university or dental school which has
31 been granted an operating certificate pursuant to article twenty-eight
32 of the public health law and which provides dental services as its prin-
33 cipal mission, two hundred twenty-four thousand dollars ($224,000) in
34 the aggregate for use pursuant to this section shall be allocated for
35 distribution to such facilities pursuant to the methodology described in
36 paragraph (b) of subdivision two and subparagraph (i) of paragraph (b)
37 of subdivision four of section two thousand eight hundred seven-p of the
38 public health law for services provided for the period February first,
39 two thousand two through March thirty-first, two thousand two to persons
40 eligible for federal financial participation under title XIX of the
41 federal social security act, provided, however, that the amount paid
42 pursuant to this paragraph for each such facility shall equal the facil-
43 ity's proportional share of the total nominal payment amounts calculated
44 under this section of all such facilities multiplied by the total funds
45 allocated for such payments. There shall be no local share in these
46 payments. The director of the budget shall allocate the non-federal
47 share of such payments from an appropriation for the miscellaneous
48 special revenue fund - 339 community service provider assistance program
49 account for the two thousand one--two thousand two state fiscal year.
50 Such adjustments to fee for service rates shall not be subject to subse-
51 quent adjustment or reconciliation. Alternatively, such payments may be
52 made as aggregate payments to eligible providers.
53 (a-2) (i) Notwithstanding the provisions of paragraph (a) of this
54 subdivision, for facilities licensed under article twenty-eight of the
55 public health law that are sponsored by a university or dental school
56 which has been granted an operating certificate pursuant to article
S. 6457--C 38 A. 9557--B
1 twenty-eight of the public health law and which provides dental services
2 as its principal mission, two hundred twenty-four thousand dollars
3 ($224,000) in the aggregate of the amount appropriated for the two thou-
4 sand two--two thousand three state fiscal year for use pursuant to this
5 section shall be allocated for the period October first through December
6 thirty-first, two thousand two and one hundred twelve thousand dollars
7 ($112,000) in the aggregate of the amount appropriated for the two thou-
8 sand three--two thousand four state fiscal year, and an additional
9 amount of one hundred twelve thousand dollars ($112,000) in the aggre-
10 gate for use pursuant to this section shall be allocated for the period
11 October first through December thirty-first, two thousand three and two
12 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
13 amount appropriated for the two thousand four--two thousand five state
14 fiscal year shall be allocated for the period April first, two thousand
15 five through June thirtieth, two thousand five, and two hundred twenty-
16 four thousand dollars ($224,000) in the aggregate of the amount appro-
17 priated for the two thousand five--two thousand six state fiscal year
18 shall be allocated for the period October first, two thousand five
19 through December thirty-first, two thousand five, and two hundred twen-
20 ty-four thousand dollars ($224,000) in the aggregate of the amount
21 appropriated for the two thousand six--two thousand seven state fiscal
22 year shall be allocated for the period October first, two thousand six
23 through December thirty-first, two thousand six, for distribution to
24 such facilities pursuant to subparagraphs (ii) and (iii) of this para-
25 graph. Adjustments for the non-federal share of the additional amount of
26 one hundred twelve thousand dollars ($112,000) for the period October
27 first, two thousand three through December thirty-first, two thousand
28 three shall be allocated by the director of the budget from an appropri-
29 ation for maintenance undistributed general fund community projects fund
30 - 007 account for the two thousand three--two thousand four state fiscal
31 year. The non-federal share of adjustments for the period April first,
32 two thousand five through June thirtieth, two thousand five shall be
33 allocated by the director of the budget from an appropriation for the
34 maintenance undistributed general fund community projects fund - 007
35 account for the two thousand four--two thousand five state fiscal year.
36 The non-federal share of adjustments for the period October first, two
37 thousand five through December thirty-first, two thousand five shall be
38 allocated by the director of the budget from an appropriation for the
39 maintenance undistributed, general fund, community projects fund - 007
40 account for the two thousand five--two thousand six state fiscal year.
41 The non-federal share of adjustments for the period October first, two
42 thousand six through December thirty-first, two thousand six shall,
43 subject to the availability of funds, be allocated by the director of
44 the budget from the medical assistance local assistance appropriation
45 for the two thousand six--two thousand seven state fiscal year.
46 (ii) Forty percent shall be allocated for equal distribution to such
47 facilities, reduced by the amount, if any, that a distribution exceeds
48 forty percent of a facility's uncompensated care need as defined in
49 paragraph (b) of subdivision two of section two thousand eight hundred
50 seven-p of the public health law. Any funds allocated but not distrib-
51 uted in accordance with this subparagraph shall be added to those
52 amounts distributed in accordance with subparagraph (iii) of this para-
53 graph.
54 (iii) Sixty percent, plus any funds allocated and not distributed in
55 accordance with subparagraph (ii) of this paragraph, shall be allocated
56 for distribution to such facilities pursuant to the methodology
S. 6457--C 39 A. 9557--B
1 described in paragraph (b) of subdivision two and subparagraph (i) of
2 paragraph (b) of subdivision four of section two thousand eight hundred
3 seven-p of the public health law, provided, however, that the amount
4 paid pursuant to this allocation for each such facility shall equal the
5 facility's proportional share of the total nominal payment amounts
6 calculated under this section of all such facilities multiplied by the
7 total funds allocated for such payments.
8 (iv) There shall be no local share in these payments.
9 (b) Notwithstanding the provisions of subdivision one of section three
10 hundred sixty-eight-a of this title, there shall be paid to each social
11 services district the full amount expended on behalf of the department
12 of health for medical assistance furnished pursuant to the provisions of
13 this section, after first deducting therefrom any federal funds properly
14 received or to be received on account thereof.
15 5. (a) The commissioner of health shall make medical assistance
16 payments to qualified providers from funds made available pursuant to
17 the provisions of this section contingent upon the receipt of all feder-
18 al approvals necessary and subject to the availability of federal finan-
19 cial participation under title XIX of the federal social security act
20 for the transitional supplemental payments. In the event such federal
21 approval is not received prior to March thirty-first, two thousand two,
22 for adjustments for the period February first, two thousand two through
23 March thirty-first, two thousand two and prior to October first, two
24 thousand two for adjustments for the period October first, two thousand
25 two through December thirty-first, two thousand two and prior to October
26 first, two thousand three for adjustments for the period October first,
27 two thousand three through December thirty-first, two thousand three,
28 and prior to October first, two thousand five for adjustments for the
29 period April first, two thousand five through June thirtieth, two thou-
30 sand five, and prior to October first, two thousand five for adjustments
31 for the period October first, two thousand five through December thir-
32 ty-first, two thousand five, and prior to October first, two thousand
33 six for adjustments for the period October first, two thousand six
34 through December thirty-first, two thousand six, the commissioner of
35 health shall make medical assistance payments to qualified providers
36 consisting of the state share amount available for purposes of this
37 section and apportioned in accordance with subdivisions two and three of
38 this section. In the event such federal approval is denied, such state
39 share amount payments shall be deemed to be grants to such qualified
40 providers and such qualified providers shall not be eligible to receive
41 any other payments pursuant to this section.
42 (b) The commissioner of health shall take all steps necessary and
43 shall use best efforts to secure federal financial participation under
44 title XIX of the social security act, for the purposes of this section,
45 including the prompt submission of appropriate amendments to the title
46 XIX state plan.
47 § 68. Notwithstanding any provision of law, rule or regulation to the
48 contrary, monthly assessments due for any period commencing March 1,
49 2005 and ending February 28, 2006 which are paid in full and accompanied
50 by appropriate reports pursuant to section 2807-d of the public health
51 law, and which are received on or before December 31, 2006, shall not be
52 subject to interest or penalties as otherwise provided in section 2807-d
53 of the public health law, provided, however, that with regard to all
54 assessment, interest and penalty amounts collected by the commissioner
55 of health by the effective date of the chapter of the laws of 2006 which
56 added this section, the interest and penalty provisions of section
S. 6457--C 40 A. 9557--B
1 2807-d of the public health law shall remain in full force and effect
2 and such amounts collected shall not be subject to further reconcil-
3 iation or adjustment.
4 § 68-a. Intentionally omitted.
5 § 68-b. Intentionally omitted.
6 § 68-c. The social services law is amended by adding a new section
7 363-c to read as follows:
8 § 363-c. Medicaid management. 1. The commissioner of the department
9 periodically shall convene, but not less than quarterly and no more than
10 monthly, meetings of the directors and commissioners of all state agen-
11 cies and departments receiving general fund appropriations for the
12 purpose of state matching funds for medicaid services and appropriate
13 representation of local departments of social services. The purpose of
14 these meetings is to identify, without limitation:
15 (a) methods to contain the growth of medicaid spending;
16 (b) methods to improve the quality of and recipient satisfaction with
17 medicaid state agency and department services;
18 (c) opportunities for consolidation and methods to improve the effi-
19 ciency and effectiveness of existing service delivery;
20 (d) opportunities for education and prevention;
21 (e) annually the number of persons on waiting lists to receive
22 services and the type of services for each list; and
23 (f) the collective priority of critical needs for the medicaid popu-
24 lation.
25 2. The department annually shall compile the results of these meetings
26 and provide them to the governor, the senate finance committee, the
27 assembly ways and means committee, the senate health committee, the
28 assembly health committee, the senate social services, children and
29 families committee, and the assembly social services committee.
30 3. By December thirty-first of each year, the department shall submit
31 to the governor, the senate finance committee, the assembly ways and
32 means committee, the senate health committee, the assembly health
33 committee, the senate social services, children and families committee,
34 and the assembly social services committee medicaid expenditures made to
35 other state agencies in the preceding state fiscal year. The report
36 shall include, but is not limited to:
37 (a) amounts paid to each agency according to category of service; and
38 (b) rates paid to each state agency and the associated methodology
39 used in developing those rates.
40 § 68-d. Section 3 of chapter 629 of the laws of 1986, amending the
41 social services law relating to establishing a demonstration program for
42 the delivery of long term home health care services to certain persons,
43 as amended by chapter 38 of the laws of 2003, is amended to read as
44 follows:
45 § 3. This act shall take effect July 1, 1986, and shall remain in
46 effect until March 31, [2006] 2009, when upon such date the provisions
47 of this act shall be deemed repealed.
48 § 68-e. Subdivision (x) of section 165 of chapter 41 of the laws of
49 1992, amending the public health law and other laws relating to health
50 care providers, as amended by chapter 38 of the laws of 2003, is amended
51 to read as follows:
52 (x) provided further that the provisions of paragraphs (a), (b), (d),
53 (e), (f) and (g) of subdivision 6 of section 367-a of the social
54 services law, as added by, and the amendatory language of paragraph (c)
55 of such subdivision as added by section ninety-one of this act, shall
56 expire and be deemed repealed on and after March 31, [2006] 2009 and on
S. 6457--C 41 A. 9557--B
1 such date the provisions of paragraph (c) shall be read as set out imme-
2 diately preceding the effective date of this act;
3 § 68-f. Subparagraph (ii) of paragraph (g) of subdivision 2 of section
4 2807 of the public health law, as amended by chapter 170 of the laws of
5 1994, is amended to read as follows:
6 (ii) During the period [April] October first, [nineteen hundred nine-
7 ty-four] two thousand six through December thirty-first, [nineteen
8 hundred ninety-four and for each calendar year rate period commencing on
9 January first thereafter] two thousand six and each calendar year there-
10 after, rates of payment by governmental agencies for the operating cost
11 component of general hospital emergency services shall be based on the
12 operating costs reported in the base year cost report adjusted by the
13 trend factor applicable to the general hospital in which the services
14 were provided, [and in addition shall include that portion of the
15 reasonable incremental emergency service operating costs incurred by
16 such hospital in excess of emergency service costs reported in the nine-
17 teen hundred eighty-eight cost report, after application of the trend
18 factor, attributable to meeting additional quality of care standards for
19 emergency services that became effective on or after January first,
20 nineteen hundred eighty-nine;] provided, however, that the maximum
21 payment for the operating component shall be [ninety-five dollars] one
22 hundred fifty dollars. A capital cost per visit shall be based on the
23 base year cost report except that the capital cost per visit may be
24 adjusted for the major outpatient capital expenditures incurred subse-
25 quent to the report year, when such expenditures have received the
26 requisite approvals and the facility has provided the commissioner with
27 a certified statement of expenditures. The base year for the period
28 [April] October first, [nineteen hundred ninety-four] two thousand six
29 through December thirty-first, [nineteen hundred ninety-four] two thou-
30 sand six shall be [nineteen hundred ninety-two] two thousand four and
31 shall be advanced one year thereafter for each subsequent calendar year
32 rate period. Further, the provisions of subdivision seven of this
33 section shall not apply prior to January first, two thousand seven.
34 § 68-g. The social services law is amended by adding a new section
35 367-t to read as follows:
36 § 367-t. Payment for emergency physician services. Amounts payable
37 under this title for medical assistance for items and services provided
38 to eligible persons by qualified emergency physicians, provided in an
39 emergency room or inpatient unit of an entity certified pursuant to
40 article twenty-eight of the public health law to treat an emergency
41 condition, as defined in subdivision three of section forty-nine hundred
42 of the public health law, which are authorized pursuant to section three
43 hundred sixty-five-a of this title shall be no less than twenty-five
44 dollars per visit. For the purpose of this section eligible persons
45 shall not include persons provided items and services by the medicaid
46 managed care program.
47 § 69. Subdivisions 2 and 4 of section 246 of chapter 81 of the laws of
48 1995, amending the public health law and other laws relating to medical
49 reimbursement and welfare reform, as amended by section 53 of part C of
50 chapter 58 of the laws of 2005 are amended to read as follows:
51 2. Sections five, seven through nine, twelve through fourteen, and
52 eighteen of this act shall be deemed to have been in full force and
53 effect on and after April 1, 1995 through March 31, 1999 and on and
54 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
55 through March 31, 2003 and on and after April 1, 2003 through March 31,
56 2006 and on and after April 1, 2006 through March 31, 2007;
S. 6457--C 42 A. 9557--B
1 4. Section one of this act shall be deemed to have been in full force
2 and effect on and after April 1, 1995 through March 31, 1999 and on and
3 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
4 through March 31, 2003 and on and after April 1, 2003 through March 31,
5 2006 and on and after April 1, 2006 through March 31, 2007.
6 § 70. Subparagraph (iii) of paragraph (f) of subdivision 4 of section
7 2807-c of the public health law, as amended by section 69 of part C of
8 chapter 58 of the laws of 2005, is amended to read as follows:
9 (iii) commencing April first, nineteen hundred ninety-seven through
10 March thirty-first, nineteen hundred ninety-nine and commencing July
11 first, nineteen hundred ninety-nine through March thirty-first, two
12 thousand and April first, two thousand through March thirty-first, two
13 thousand five and for periods commencing April first, two thousand five
14 through March thirty-first, two thousand six and for periods commencing
15 on and after April first, two thousand six through March thirty-first,
16 two thousand seven, the reimbursable inpatient operating cost component
17 of case based rates of payment per diagnosis-related group, excluding
18 any operating cost components related to direct and indirect expenses of
19 graduate medical education, for patients eligible for payments made by
20 state governmental agencies shall be reduced by three and thirty-three
21 hundredths percent to encourage improved productivity and efficiency.
22 Such election shall not alter the calculation of the group price compo-
23 nent calculated pursuant to subparagraph (i) of paragraph (a) of subdi-
24 vision seven of this section;
25 § 71. Subparagraph (iii) of paragraph (k) of subdivision 4 of section
26 2807-c of the public health law, as amended by section 70 of part C of
27 chapter 58 of the laws of 2005, is amended to read as follows:
28 (iii) commencing April first, nineteen hundred ninety-seven through
29 March thirty-first, nineteen hundred ninety-nine and commencing July
30 first, nineteen hundred ninety-nine through March thirty-first, two
31 thousand and April first, two thousand through March thirty-first, two
32 thousand five and commencing April first, two thousand five through
33 March thirty-first, two thousand six, and for periods commencing on and
34 after April first, two thousand six through March thirty-first, two
35 thousand seven, the operating cost component of rates of payment,
36 excluding any operating cost components related to direct and indirect
37 expenses of graduate medical education, for patients eligible for
38 payments made by a state governmental agency shall be reduced by three
39 and thirty-three hundredths percent to encourage improved productivity
40 and efficiency. The facility will be eligible to receive the financial
41 incentives for the physician specialty weighting incentive towards
42 primary care pursuant to subparagraph (ii) of paragraph (a) of subdivi-
43 sion twenty-five of this section.
44 § 72. The opening paragraph of subparagraph (vi) of paragraph (b) of
45 subdivision 5 of section 2807-c of the public health law, as amended by
46 section 71 of part C of chapter 58 of the laws of 2005, is amended to
47 read as follows:
48 for discharges on or after April first, nineteen hundred ninety-seven
49 through March thirty-first, nineteen hundred ninety-nine and for
50 discharges on or after July first, nineteen hundred ninety-nine through
51 March thirty-first, two thousand and for discharges on or after April
52 first, two thousand through March thirty-first, two thousand five and
53 for discharges on or after April first, two thousand five through March
54 thirty-first, two thousand six, and for discharges on or after April
55 first, two thousand six through March thirty-first, two thousand seven,
56 for purposes of reimbursement of inpatient hospital services for
S. 6457--C 43 A. 9557--B
1 patients eligible for payments made by state governmental agencies, the
2 average reimbursable inpatient operating cost per discharge of a general
3 hospital shall, to encourage improved productivity and efficiency, be
4 the sum of:
5 § 73. The opening paragraph and subparagraph (i) of paragraph (c) of
6 subdivision 5 of section 2807-c of the public health law, as amended by
7 section 72 of part C of chapter 58 of the laws of 2005, is amended to
8 read as follows:
9 Notwithstanding any inconsistent provision of this section, commencing
10 July first, nineteen hundred ninety-six through March thirty-first,
11 nineteen hundred ninety-nine and July first, nineteen hundred ninety-
12 nine through March thirty-first, two thousand and April first, two thou-
13 sand through March thirty-first, two thousand five and for periods on
14 and after April first, two thousand five through March thirty-first, two
15 thousand six, and for periods on and after April first, two thousand six
16 through March thirty-first, two thousand seven, rates of payment for a
17 general hospital for patients eligible for payments made by state
18 governmental agencies shall be further reduced by the commissioner to
19 encourage improved productivity and efficiency by providers by a factor
20 determined as follows:
21 (i) an aggregate reduction shall be calculated for each general hospi-
22 tal commencing July first, nineteen hundred ninety-six through March
23 thirty-first, nineteen hundred ninety-nine and July first, nineteen
24 hundred ninety-nine through March thirty-first, two thousand and April
25 first, two thousand through March thirty-first, two thousand five and
26 for periods on and after April first, two thousand five through March
27 thirty-first, two thousand six, and for periods on and after April
28 first, two thousand six through March thirty-first, two thousand seven,
29 as the result of (A) eighty-nine million dollars on an annualized basis
30 for each year, multiplied by (B) the ratio of patient days for patients
31 eligible for payments made by state governmental agencies provided in a
32 base year two years prior to the rate year by a general hospital,
33 divided by the total of such patient days summed for all general hospi-
34 tals; and
35 § 74. Clause (B-1) of subparagraph (i) of paragraph (f) of subdivision
36 11 of section 2807-c of the public health law, as amended by section 73
37 of part C of chapter 58 of the laws of 2005, is amended to read as
38 follows:
39 (B-1) The increase in the statewide average case mix in the periods
40 January first, nineteen hundred ninety-seven through March thirty-first,
41 two thousand and on and after April first, two thousand through March
42 thirty-first, two thousand six and on and after April first, two thou-
43 sand six through March thirty-first, two thousand seven, from the state-
44 wide average case mix for the period January first, nineteen hundred
45 ninety-six through December thirty-first, nineteen hundred ninety-six
46 shall not exceed one percent for nineteen hundred ninety-seven, two
47 percent for nineteen hundred ninety-eight, three percent for the period
48 January first, nineteen hundred ninety-nine through September thirtieth,
49 nineteen hundred ninety-nine, four percent for the period October first,
50 nineteen hundred ninety-nine through December thirty-first, nineteen
51 hundred ninety-nine, and four percent for two thousand plus an addi-
52 tional one percent per year thereafter, based on comparison of data only
53 for patients that are eligible for medical assistance pursuant to title
54 eleven of article five of the social services law, including such
55 patients enrolled in health maintenance organizations.
S. 6457--C 44 A. 9557--B
1 § 75. Subdivision 1 of section 46 of chapter 639 of the laws of 1996
2 amending the public health law and other laws relating to welfare
3 reform, as amended by section 74 of part C of chapter 58 of the laws of
4 2005, is amended to read as follows:
5 1. Notwithstanding any inconsistent provision of law or regulation to
6 the contrary, the trend factors used to project reimbursable operating
7 costs to the rate period for purposes of determining rates of payment
8 pursuant to article 28 of the public health law for general hospitals
9 for reimbursement of inpatient hospital services provided to patients
10 eligible for payments made by state governmental agencies on and after
11 April 1, 1996 through June 30, 1996 and on or after July 1, 1996 through
12 March 31, 1999 and on and after July 1, 1999 through March 31, 2000 and
13 on and after April 1, 2000 through March 31, 2005 and on and after April
14 1, 2005 through March [thirty-first, two thousand six] 31, 2006 and on
15 and after April 1, 2006 through March 31, 2007, shall reflect no trend
16 factor projections or adjustments for the period April 1, 1996, through
17 March 31, 1997.
18 § 76. Section 4 of chapter 81 of the laws of 1995, amending the public
19 health law and other laws relating to medical reimbursement and welfare
20 reform, as amended by section 54 of part C of chapter 58 of the laws of
21 2005, is amended to read as follows:
22 § 4. Notwithstanding any inconsistent provision of law, except subdi-
23 vision 15 of section 2807 of the public health law and section 364-j-2
24 of the social services law and section 32-g of part F of chapter 412 of
25 the laws of 1999, rates of payment for diagnostic and treatment centers
26 established in accordance with paragraphs (b) and (h) of subdivision 2
27 of section 2807 of the public health law for the period ending September
28 30, 1995 shall continue in effect through September 30, 2000 and for the
29 periods October 1, 2000 through September 30, 2003 and October 1, 2003
30 through September 30, [2006] 2007, and further provided that rates in
31 effect on March 31, 2003 as established in accordance with paragraph (e)
32 of subdivision 2 of section 2807 of the public health law shall continue
33 in effect for the period April 1, 2003 through September 30, [2006]
34 2007, provided however that, subject to the approval of the director of
35 the budget, such rates may be adjusted to include expenditures in those
36 components of rates not subject to the ceilings of the corresponding
37 rate methodology.
38 § 77. Subdivision 5 of section 246 of chapter 81 of the laws of 1995,
39 amending the public health law and other laws relating to medical
40 reimbursement and welfare reform, as amended by section 55 of part C of
41 chapter 58 of the laws of 2005, is amended to read as follows:
42 5. Section three of this act shall be deemed to have been in full
43 force and effect on and after April 1, 1995 through March 31, 1999 and
44 on and after July 1, 1999 through March 31, 2000 and on and after April
45 1, 2000 through March 31, 2003 and on and after April 1, 2003 through
46 March 31, [2006] 2007;
47 § 78. Section 194 of chapter 474 of the laws of 1996, amending the
48 education law and other laws relating to rates for residential health
49 care facilities, as amended by section 56 of part C of chapter 58 of the
50 laws of 2005, is amended to read as follows:
51 § 194. 1. Notwithstanding any inconsistent provision of law or regu-
52 lation, the trend factors used to project reimbursable operating costs
53 to the rate period for purposes of determining rates of payment pursuant
54 to article 28 of the public health law for residential health care
55 facilities for reimbursement of inpatient services provided to patients
56 eligible for payments made by state governmental agencies on and after
S. 6457--C 45 A. 9557--B
1 April 1, 1996 through March 31, 1999 and for payments made on and after
2 July 1, 1999 through March 31, 2000 and on and after April 1, 2000
3 through March 31, 2003 and on and after April 1, 2003 through March 31,
4 [2006] 2007 shall reflect no trend factor projections or adjustments for
5 the period April 1, 1996, through March 31, 1997.
6 2. The commissioner of health shall adjust such rates of payment to
7 reflect the exclusion pursuant to this section of such specified trend
8 factor projections or adjustments.
9 § 79. Intentionally omitted.
10 § 80. Intentionally omitted.
11 § 81. Intentionally omitted.
12 § 82. Paragraph (f) of subdivision 1 of section 64 of chapter 81 of
13 the laws of 1995, amending the public health law and other laws relating
14 to medical reimbursement and welfare reform, as amended by section 60 of
15 part C of chapter 58 of the laws of 2005, is amended to read as follows:
16 (f) Prior to February 1, 2001, February 1, 2002, February 1, 2003,
17 February 1, 2004, February 1, 2005 [and], February 1, 2006, and February
18 1, 2007, the commissioner of health shall calculate the result of the
19 statewide total of residential health care facility days of care
20 provided to beneficiaries of title XVIII of the federal social security
21 act (medicare), divided by the sum of such days of care plus days of
22 care provided to residents eligible for payments pursuant to title 11 of
23 article 5 of the social services law minus the number of days provided
24 to residents receiving hospice care, expressed as a percentage, for the
25 period commencing January 1, through November 30, of the prior year
26 respectively, based on such data for such period. This value shall be
27 called the 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006 and 2007
28 statewide target percentage respectively.
29 § 83. Subparagraph (ii) of paragraph (b) of subdivision 3 of section
30 64 of chapter 81 of the laws of 1995, amending the public health law and
31 other laws relating to medical reimbursement and welfare reform, as
32 amended by section 61 of part C of chapter 58 of the laws of 2005, is
33 amended to read as follows:
34 (ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and]
35 2006, and 2007 statewide target percentages are not for each year at
36 least three percentage points higher than the statewide base percentage,
37 the commissioner of health shall determine the percentage by which the
38 statewide target percentage for each year is not at least three percent-
39 age points higher than the statewide base percentage. The percentage
40 calculated pursuant to this paragraph shall be called the 1997, 1998,
41 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and 2007 statewide
42 reduction percentage respectively. If the 1997, 1998, 2000, 2001, 2002,
43 2003, 2004, 2005, [and] 2006, and 2007 statewide target percentage for
44 the respective year is at least three percentage points higher than the
45 statewide base percentage, the statewide reduction percentage for the
46 respective year shall be zero.
47 § 84. Subparagraph (iii) of paragraph (b) of subdivision 4 of section
48 64 of chapter 81 of the laws of 1995, amending the public health law and
49 other laws relating to medical reimbursement and welfare reform, as
50 amended by section 62 of part C of chapter 58 of the laws of 2005, is
51 amended to read as follows:
52 (iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and
53 2007 statewide reduction percentage shall be multiplied by one hundred
54 two million dollars respectively to determine the 1998, 2000, 2001,
55 2002, 2003, 2004, 2005, [and] 2006, and 2007 statewide aggregate
56 reduction amount. If the 1998 and the 2000, 2001, 2002, 2003, 2004,
S. 6457--C 46 A. 9557--B
1 2005, [and] 2006, and 2007 statewide reduction percentage shall be zero
2 respectively, there shall be no 1998, 2000, 2001, 2002, 2003, 2004,
3 2005, [and] 2006, and 2007 reduction amount.
4 § 85. Paragraph (b) of subdivision 5 of section 64 of chapter 81 of
5 the laws of 1995, amending the public health law and other laws relating
6 to medical reimbursement and welfare reform, as amended by section 63 of
7 part C of chapter 58 of the laws of 2005, is amended to read as follows:
8 (b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
9 [and] 2006, and 2007 statewide aggregate reduction amounts shall for
10 each year be allocated by the commissioner of health among residential
11 health care facilities that are eligible to provide services to benefi-
12 ciaries of title XVIII of the federal social security act (medicare) and
13 residents eligible for payments pursuant to title 11 of article 5 of the
14 social services law on the basis of the extent of each facility's fail-
15 ure to achieve a two percentage points increase in the 1996 target
16 percentage, a three percentage point increase in the 1997, 1998, 2000,
17 2001, 2002, 2003, 2004, 2005, [and] 2006, and 2007 target percentage and
18 a two and one-quarter percentage point increase in the 1999 target
19 percentage for each year, compared to the base percentage, calculated on
20 a facility specific basis for this purpose, compared to the statewide
21 total of the extent of each facility's failure to achieve a two percent-
22 age points increase in the 1996 and a three percentage point increase in
23 the 1997 and a three percentage point increase in the 1998 and a two and
24 one-quarter percentage point increase in the 1999 target percentage and
25 a three percentage point increase in the 2000, 2001, 2002, 2003, 2004,
26 2005, [and] 2006, and 2007 target percentage compared to the base
27 percentage. These amounts shall be called the 1996, 1997, 1998, 1999,
28 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and 2007 facility
29 specific reduction amounts respectively.
30 § 86. Notwithstanding any inconsistent provision of law, rule or regu-
31 lation, the annual percentage reductions set forth in sections 82
32 through 85 and section 88 of this act shall be prorated by the commis-
33 sioner of health for the period April 1, 2006 through March 31, 2007.
34 § 87. Section 3 of chapter 483 of the laws of 1978, amending the
35 public health law relating to rate of payment for each residential
36 health care facility to real property costs, as amended by section 75 of
37 part C of chapter 58 of the laws of 2005, is amended to read as follows:
38 § 3. This act shall take effect immediately provided, however, that
39 the provisions of subdivision 2-a of section 2808 of the public health
40 law, as added by section one of this act, shall remain in full force and
41 effect until December 31, [2006] 2007.
42 § 87-a. Notwithstanding any inconsistent provision of law, rule or
43 regulation to the contrary, the provisions of section 1 of chapter 41 of
44 the laws of 1992, as amended, shall remain and be in full force and
45 effect on and after April 1, 2000 through March 31, 2003 and on and
46 after April 1, 2003 through March 31, 2005 and on and after April 1,
47 2005 through March 31, 2006 and on and after April 1, 2006 through March
48 31, 2007.
49 § 88. Section 228 of chapter 474 of the laws of 1996, amending the
50 education law and other laws relating to rates for residential health-
51 care facilities, as amended by section 66 of part C of chapter 58 of the
52 laws of 2005, is amended to read as follows:
53 § 228. 1. Definitions. (a) Regions, for purposes of this section,
54 shall mean a downstate region to consist of Kings, New York, Richmond,
55 Queens, Bronx, Nassau and Suffolk counties and an upstate region to
56 consist of all other New York state counties. A certified home health
S. 6457--C 47 A. 9557--B
1 agency or long term home health care program shall be located in the
2 same county utilized by the commissioner of health for the establishment
3 of rates pursuant to article 36 of the public health law.
4 (b) Certified home health agency (CHHA) shall mean such term as
5 defined in section 3602 of the public health law.
6 (c) Long term home health care program (LTHHCP) shall mean such term
7 as defined in subdivision 8 of section 3602 of the public health law.
8 (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
9 ly, located within a region.
10 (e) Medicaid revenue percentage, for purposes of this section, shall
11 mean CHHA and LTHHCP revenues attributable to services provided to
12 persons eligible for payments pursuant to title 11 of article 5 of the
13 social services law divided by such revenues plus CHHA and LTHHCP reven-
14 ues attributable to services provided to beneficiaries of Title XVIII of
15 the federal social security act (medicare).
16 (f) Base period, for purposes of this section, shall mean calendar
17 year 1995.
18 (g) Target period. For purposes of this section, the 1996 target peri-
19 od shall mean August 1, 1996 through March 31, 1997, the 1997 target
20 period shall mean January 1, 1997 through November 30, 1997, the 1998
21 target period shall mean January 1, 1998 through November 30, 1998, the
22 1999 target period shall mean January 1, 1999 through November 30, 1999,
23 the 2000 target period shall mean January 1, 2000 through November 30,
24 2000, the 2001 target period shall mean January 1, 2001 through November
25 30, 2001, the 2002 target period shall mean January 1, 2002 through
26 November 30, 2002, the 2003 target period shall mean January 1, 2003
27 through November 30, 2003, the 2004 target period shall mean January 1,
28 2004 through November 30, 2004, and the 2005 target period shall mean
29 January 1, 2005 through November 30, [2006] 2005, the 2006 target period
30 shall mean January 1, 2006 through November 30, 2006, and the 2007
31 target period shall mean January 1, 2007 through November 30, 2007.
32 2. (a) Prior to February 1, 1997, for each regional group the commis-
33 sioner of health shall calculate the 1996 medicaid revenue percentages
34 for the period commencing August 1, 1996 to the last date for which such
35 data is available and reasonably accurate.
36 (b) Prior to February 1, 1998, prior to February 1, 1999, prior to
37 February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
38 prior to February 1, 2003, prior to February 1, 2004, prior to February
39 1, 2005, prior to February 1, 2006, and prior to February 1, 2007 for
40 each regional group the commissioner of health shall calculate the prior
41 year's medicaid revenue percentages for the period commencing January 1
42 through November 30 of such prior year.
43 3. By September 15, 1996, for each regional group the commissioner of
44 health shall calculate the base period medicaid revenue percentage.
45 4. (a) For each regional group, the 1996 target medicaid revenue
46 percentage shall be calculated by subtracting the 1996 medicaid revenue
47 reduction percentages from the base period medicaid revenue percentages.
48 The 1996 medicaid revenue reduction percentage, taking into account
49 regional and program differences in utilization of medicaid and medicare
50 services, for the following regional groups shall be equal to:
51 (i) one and one-tenth percentage points for CHHAs located within the
52 downstate region;
53 (ii) six-tenths of one percentage point for CHHAs located within the
54 upstate region;
55 (iii) one and eight-tenths percentage points for LTHHCPs located with-
56 in the downstate region; and
S. 6457--C 48 A. 9557--B
1 (iv) one and seven-tenths percentage points for LTHHCPs located within
2 the upstate region.
3 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006,
4 and 2007 for each regional group, the target medicaid revenue percentage
5 for the respective year shall be calculated by subtracting the respec-
6 tive year's medicaid revenue reduction percentage from the base period
7 medicaid revenue percentage. The medicaid revenue reduction percentages
8 for 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and 2007
9 taking into account regional and program differences in utilization of
10 medicaid and medicare services, for the following regional groups shall
11 be equal to for each such year:
12 (i) one and one-tenth percentage points for CHHAs located within the
13 downstate region;
14 (ii) six-tenths of one percentage point for CHHAs located within the
15 upstate region;
16 (iii) one and eight-tenths percentage points for LTHHCPs located with-
17 in the downstate region; and
18 (iv) one and seven-tenths percentage points for LTHHCPs located within
19 the upstate region.
20 (c) For each regional group, the 1999 target medicaid revenue percent-
21 age shall be calculated by subtracting the 1999 medicaid revenue
22 reduction percentage from the base period medicaid revenue percentage.
23 The 1999 medicaid revenue reduction percentages, taking into account
24 regional and program differences in utilization of medicaid and medicare
25 services, for the following regional groups shall be equal to:
26 (i) eight hundred twenty-five thousandths (.825) of one percentage
27 point for CHHAs located within the downstate region;
28 (ii) forty-five hundredths (.45) of one percentage point for CHHAs
29 located within the upstate region;
30 (iii) one and thirty-five hundredths percentage points (1.35) for
31 LTHHCPs located within the downstate region; and
32 (iv) one and two hundred seventy-five thousandths percentage points
33 (1.275) for LTHHCPs located within the upstate region.
34 5. (a) For each regional group, if the 1996 medicaid revenue percent-
35 age is not equal to or less than the 1996 target medicaid revenue
36 percentage, the commissioner of health shall compare the 1996 medicaid
37 revenue percentage to the 1996 target medicaid revenue percentage to
38 determine the amount of the shortfall which, when divided by the 1996
39 medicaid revenue reduction percentage, shall be called the 1996
40 reduction factor. These amounts, expressed as a percentage, shall not
41 exceed one hundred percent. If the 1996 medicaid revenue percentage is
42 equal to or less than the 1996 target medicaid revenue percentage, the
43 1996 reduction factor shall be zero.
44 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and],
45 2006, and 2007 for each regional group, if the medicaid revenue percent-
46 age for the respective year is not equal to or less than the target
47 medicaid revenue percentage for such respective year, the commissioner
48 of health shall compare such respective year's medicaid revenue percent-
49 age to such respective year's target medicaid revenue percentage to
50 determine the amount of the shortfall which, when divided by the respec-
51 tive year's medicaid revenue reduction percentage, shall be called the
52 reduction factor for such respective year. These amounts, expressed as a
53 percentage, shall not exceed one hundred percent. If the medicaid reven-
54 ue percentage for a particular year is equal to or less than the target
55 medicaid revenue percentage for that year, the reduction factor for that
56 year shall be zero.
S. 6457--C 49 A. 9557--B
1 6. (a) For each regional group, the 1996 reduction factor shall be
2 multiplied by the following amounts to determine each regional group's
3 applicable 1996 state share reduction amount:
4 (i) two million three hundred ninety thousand dollars ($2,390,000) for
5 CHHAs located within the downstate region;
6 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
7 within the upstate region;
8 (iii) one million two hundred seventy thousand dollars ($1,270,000)
9 for LTHHCPs located within the downstate region; and
10 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
11 located within the upstate region.
12 For each regional group reduction, if the 1996 reduction factor shall
13 be zero, there shall be no 1996 state share reduction amount.
14 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006,
15 and 2007 for each regional group, the reduction factor for the respec-
16 tive year shall be multiplied by the following amounts to determine each
17 regional group's applicable state share reduction amount for such
18 respective year:
19 (i) two million three hundred ninety thousand dollars ($2,390,000) for
20 CHHAs located within the downstate region;
21 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
22 within the upstate region;
23 (iii) one million two hundred seventy thousand dollars ($1,270,000)
24 for LTHHCPs located within the downstate region; and
25 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
26 located within the upstate region.
27 For each regional group reduction, if the reduction factor for a
28 particular year shall be zero, there shall be no state share reduction
29 amount for such year.
30 (c) For each regional group, the 1999 reduction factor shall be multi-
31 plied by the following amounts to determine each regional group's appli-
32 cable 1999 state share reduction amount:
33 (i) one million seven hundred ninety-two thousand five hundred dollars
34 ($1,792,500) for CHHAs located within the downstate region;
35 (ii) five hundred sixty-two thousand five hundred dollars ($562,500)
36 for CHHAs located within the upstate region;
37 (iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
38 for LTHHCPs located within the downstate region; and
39 (iv) four hundred forty-two thousand five hundred dollars ($442,500)
40 for LTHHCPs located within the upstate region.
41 For each regional group reduction, if the 1999 reduction factor shall
42 be zero, there shall be no 1999 state share reduction amount.
43 7. (a) For each regional group, the 1996 state share reduction amount
44 shall be allocated by the commissioner of health among CHHAs and LTHHCPs
45 on the basis of the extent of each CHHA's and LTHHCP's failure to
46 achieve the 1996 target medicaid revenue percentage, calculated on a
47 provider specific basis utilizing revenues for this purpose, expressed
48 as a proportion of the total of each CHHA's and LTHHCP's failure to
49 achieve the 1996 target medicaid revenue percentage within the applica-
50 ble regional group. This proportion shall be multiplied by the applica-
51 ble 1996 state share reduction amount calculation pursuant to paragraph
52 (a) of subdivision 6 of this section. This amount shall be called the
53 1996 provider specific state share reduction amount.
54 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and],
55 2006, and 2007 for each regional group, the state share reduction amount
56 for the respective year shall be allocated by the commissioner of health
S. 6457--C 50 A. 9557--B
1 among CHHAs and LTHHCPs on the basis of the extent of each CHHA's and
2 LTHHCP's failure to achieve the target medicaid revenue percentage for
3 the applicable year, calculated on a provider specific basis utilizing
4 revenues for this purpose, expressed as a proportion of the total of
5 each CHHA's and LTHHCP's failure to achieve the target medicaid revenue
6 percentage for the applicable year within the applicable regional group.
7 This proportion shall be multiplied by the applicable year's state share
8 reduction amount calculation pursuant to paragraph (b) or (c) of subdi-
9 vision 6 of this section. This amount shall be called the provider
10 specific state share reduction amount for the applicable year.
11 8. (a) The 1996 provider specific state share reduction amount shall
12 be due to the state from each CHHA and LTHHCP and may be recouped by the
13 state by March 31, 1997 in a lump sum amount or amounts from payments
14 due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
15 social services law.
16 (b) The provider specific state share reduction amount for 1997, 1998,
17 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006, and 2007 respec-
18 tively, shall be due to the state from each CHHA and LTHHCP and each
19 year the amount due for such year may be recouped by the state by March
20 31 of the following year in a lump sum amount or amounts from payments
21 due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
22 social services law.
23 9. CHHAs and LTHHCPs shall submit such data and information at such
24 times as the commissioner of health may require for purposes of this
25 section. The commissioner of health may use data available from third-
26 party payors.
27 10. On or about June 1, 1997, for each regional group the commissioner
28 of health shall calculate for the period August 1, 1996 through March
29 31, 1997 a medicaid revenue percentage, a reduction factor, a state
30 share reduction amount, and a provider specific state share reduction
31 amount in accordance with the methodology provided in paragraph (a) of
32 subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
33 sion 6 and paragraph (a) of subdivision 7 of this section. The provider
34 specific state share reduction amount calculated in accordance with this
35 subdivision shall be compared to the 1996 provider specific state share
36 reduction amount calculated in accordance with paragraph (a) of subdivi-
37 sion 7 of this section. Any amount in excess of the amount determined in
38 accordance with paragraph (a) of subdivision 7 of this section shall be
39 due to the state from each CHHA and LTHHCP and may be recouped in
40 accordance with paragraph (a) of subdivision 8 of this section. If the
41 amount is less than the amount determined in accordance with paragraph
42 (a) of subdivision 7 of this section, the difference shall be refunded
43 to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
44 and LTHHCPs shall submit data for the period August 1, 1996 through
45 March 31, 1997 to the commissioner of health by April 15, 1997.
46 11. If a CHHA or LTHHCP fails to submit data and information as
47 required for purposes of this section:
48 (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
49 caid revenue percentage between the applicable base period and the
50 applicable target period for purposes of the calculations pursuant to
51 this section; and
52 (b) the commissioner of health shall reduce the current rate paid to
53 such CHHA and such LTHHCP by state governmental agencies pursuant to
54 article 36 of the public health law by one percent for a period begin-
55 ning on the first day of the calendar month following the applicable due
56 date as established by the commissioner of health and continuing until
S. 6457--C 51 A. 9557--B
1 the last day of the calendar month in which the required data and infor-
2 mation are submitted.
3 12. The commissioner of health shall inform in writing the director of
4 the budget and the chair of the senate finance committee and the chair
5 of the assembly ways and means committee of the results of the calcu-
6 lations pursuant to this section.
7 § 89. Subdivision 5-a of section 246 of chapter 81 of the laws of
8 1995, amending the public health law and other laws relating to medical
9 reimbursement and welfare reform, as amended by section 64 of part C of
10 chapter 58 of the laws of 2005, is amended to read as follows:
11 5-a. Section sixty-four-a of this act shall be deemed to have been in
12 full force and effect on and after April 1, 1995 through March 31, 1999
13 and on and after July 1, 1999 through March 31, 2000 and on and after
14 April 1, 2000 through March 31, 2003 and on and after April 1, 2003
15 through March 31, [2006] 2007;
16 § 90. Section 64-b of chapter 81 of the laws of 1995, amending the
17 public health law and other laws relating to medical reimbursement and
18 welfare reform, as amended by section 65 of part C of chapter 58 of the
19 laws of 2005, is amended to read as follows:
20 § 64-b. Notwithstanding any inconsistent provision of law, the
21 provisions of subdivision 7 of section 3614 of the public health law, as
22 amended, shall remain and be in full force and effect on April 1, 1995
23 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
24 and after April 1, 2000 through March 31, 2003 and on and after April 1,
25 2003 through March 31, [2006] 2007.
26 § 91. Intentionally omitted.
27 § 92. Section 10 of chapter 649 of the laws of 1996 amending the
28 public health law, the mental hygiene law and the social services law
29 relating to authorizing the establishment of special needs plans, as
30 amended by section 41 of part Z2 of chapter 62 of the laws of 2003, is
31 amended to read as follows:
32 § 10. This act shall take effect immediately and shall be deemed to
33 have been in full force and effect on and after July 1, 1996; provided,
34 however, that sections one, two and three of this act shall expire and
35 be deemed repealed on March 31, [2006] 2009 provided, however that the
36 amendments to section 364-j of the social services law made by section
37 four of this act shall not affect the expiration of such section and
38 shall be deemed to expire therewith and provided, further, that the
39 provisions of subdivisions 8, 9 and 10 of section 4401 of the public
40 health law, as added by section one of this act; section 4403-d of the
41 public health law as added by section two of this act and the provisions
42 of section seven of this act, except for the provisions relating to the
43 establishment of no more than twelve comprehensive HIV special needs
44 plans, shall expire and be deemed repealed on July 1, 2000.
45 § 93. Section 11 of chapter 710 of the laws of 1988, amending the
46 social services law and the education law relating to medical assistance
47 eligibility of certain persons and providing for managed medical care
48 demonstration programs, as amended by section 42 of part Z2 of chapter
49 62 of the laws of 2003, is amended to read as follows:
50 § 11. This act shall take effect immediately; except that the
51 provisions of sections one, two, three, four, eight and ten of this act
52 shall take effect on the ninetieth day after it shall have become a law;
53 and except that the provisions of sections five, six and seven of this
54 act shall take effect January 1, 1989; and except that effective imme-
55 diately, the addition, amendment and/or repeal of any rule or regulation
56 necessary for the implementation of this act on its effective date are
S. 6457--C 52 A. 9557--B
1 authorized and directed to be made and completed on or before such
2 effective date; provided, however, that the provisions of section 364-j
3 of the social services law, as added by section one of this act shall
4 expire and be deemed repealed on and after March 31, [2006] 2009, the
5 provisions of section 364-k of the social services law, as added by
6 section two of this act, except subdivision 10 of such section, shall
7 expire and be deemed repealed on and after January 1, 1994, and the
8 provisions of subdivision 10 of section 364-k of the social services
9 law, as added by section two of this act, shall expire and be deemed
10 repealed on January 1, 1995.
11 § 94. Subdivision (c) of section 62 of chapter 165 of the laws of
12 1991, amending the public health law and other laws relating to estab-
13 lishing payments for medical assistance, as amended by section 43 of
14 part Z2 of chapter 62 of the laws of 2003, is amended to read as
15 follows:
16 (c) section 364-j of the social services law, as amended by section
17 eight of this act and subdivision 6 of section 367-a of the social
18 services law as added by section twelve of this act shall expire and be
19 deemed repealed on March 31 [2006], 2009 and provided further, that the
20 amendments to the provisions of such section 364-j shall only apply to
21 managed care programs approved on or after the effective date of this
22 act;
23 § 95. Intentionally omitted.
24 § 96. Section 4 of chapter 19 of the laws of 1998, amending the social
25 services law relating to limiting the method of payment for prescription
26 drugs under the medical assistance program, as amended by section 46 of
27 part Z2 of chapter 62 of the laws of 2003, is amended to read as
28 follows:
29 § 4. This act shall take effect 120 days after it shall have become a
30 law and shall expire and be deemed repealed March 31, [2006] 2009.
31 § 96-a. Section 2 of chapter 535 of the laws of 1983, amending the
32 social services law relating to eligibility of certain enrollees for
33 medical assistance, as amended by section 45 of part Z2 of chapter 62 of
34 the laws of 2003, is amended to read as follows:
35 § 2. This act shall take effect immediately and shall remain in full
36 force and effect through March 31, [2006] 2009.
37 § 97. Intentionally omitted.
38 § 98. Section 18 of chapter 904 of the laws of 1984, amending the
39 public health law and the social services law relating to encouraging
40 comprehensive health services, as amended by chapter 69 of the laws of
41 2004, is amended to read as follows:
42 § 18. This act shall take effect immediately, except that sections
43 six, nine, ten and eleven of this act shall take effect on the sixtieth
44 day after it shall have become a law, sections two, three, four and nine
45 of this act shall expire and be of no further force or effect on or
46 after March 31, [2006] 2009, section two of this act shall take effect
47 on April 1, 1985 or seventy-five days following the submission of the
48 report required by section one of this act, whichever is later, and
49 sections eleven and thirteen of this act shall expire and be of no
50 further force or effect on or after March 31, 1988.
51 § 99. The commissioner of health is authorized to promulgate or adopt
52 any rules or regulations necessary to implement the provisions of this
53 act and any procedures, forms, or instructions necessary for such imple-
54 mentation may be adopted and issued on or after the effective date of
55 this act. Notwithstanding any inconsistent provision of the state admin-
56 istrative procedure act or any other provision of law, rule or regu-
S. 6457--C 53 A. 9557--B
1 lation the commissioner of health and the superintendent of insurance
2 and any appropriate council is authorized to adopt or amend or promul-
3 gate on an emergency basis any regulation he or she or such council
4 determines necessary to implement any provision of this act on its
5 effective date.
6 § 100. If any clause, sentence, paragraph, section or part of this act
7 shall be adjudged by any court of competent jurisdiction to be invalid,
8 such judgment shall not affect, impair, or invalidate the remainder
9 thereof, but shall be confined in its operation to the clause, sentence,
10 paragraph, subdivision, section or part thereof directly involved in the
11 controversy in which such judgment shall have been rendered. It is here-
12 by declared to be the intent of the legislature that this act would have
13 been enacted even if such invalid provisions had not been included ther-
14 ein.
15 § 101. This act shall take effect immediately and shall be deemed to
16 have been in full force and effect on and after April 1, 2006; provided
17 however, that:
18 1. Intentionally omitted.
19 2. Section one of this act shall take effect January 15, 2007;
20 3. Intentionally omitted.
21 4. Intentionally omitted.
22 5. Intentionally omitted.
23 6. Section forty-three of this act shall take effect October 1, 2006
24 and shall remain in full force and effect until December 31, 2009;
25 6-a. Sections fifty, fifty-a, fifty-b and fifty-c of this act shall
26 take effect July 1, 2006;
27 7. Section fifty-seven of this act shall take effect July 1, 2006;
28 7-a. Sections fifty-eight, fifty-eight-a and fifty-eight-b shall take
29 effect January 1, 2007 and shall expire and be deemed repealed January
30 1, 2009.
31 8. Section fifty of this act shall not take effect unless and until
32 the commissioner of health receives all necessary approvals under feder-
33 al law and regulation to implement its provisions, and provided that
34 such provisions do not prevent the receipt of federal financial partic-
35 ipation under the medical assistance program. The commissioner of health
36 shall submit such waiver applications and/or state plan amendments as
37 may be necessary to obtain such approvals and to ensure continued feder-
38 al financial participation;
39 9. No section of this act shall be required to be implemented sooner
40 than sixty days following receipt of all waivers and approvals necessary
41 under federal law and regulation to implement the provisions of this act
42 with federal financial participation; the commissioner of health shall
43 submit such waiver applications and/or state plan amendments as may be
44 necessary to obtain such approvals and to ensure continued federal
45 financial participation;
46 9-a. Section sixty-eight-c of this act shall take effect on the one
47 hundred twentieth day after it shall have become a law; provided, howev-
48 er, that effective immediately, the addition, amendment and/or repeal of
49 any rule or regulation necessary for the implementation of this act on
50 its effective date are authorized and directed to be made and completed
51 on or before such effective date;
52 10. Section sixty-eight-g of this act shall take effect October 1,
53 2006;
54 11. Intentionally omitted.
55 12. Intentionally omitted.
56 13. Intentionally omitted.
S. 6457--C 54 A. 9557--B
1 13-a. The amendments to section 4403-f of the public health law made
2 by sections sixty-five-c, sixty-five-d, sixty-five-e, sixty-five-f,
3 sixty-five-g and sixty-five-h of this act shall not affect the repeal of
4 such section and shall be deemed repealed therewith.
5 14. The amendments to paragraphs (f) and (k) of subdivision 4 of
6 section 2807-c of the public health law made by sections seventy and
7 seventy-one of this act shall not affect the expiration of such para-
8 graphs and shall be deemed to expire therewith;
9 15. The amendments to subparagraph (vi) of paragraph (b) of subdivi-
10 sion 5 of section 2807-c of the public health law made by section seven-
11 ty-two of this act shall not affect the expiration of such subparagraph
12 and shall be deemed to expire therewith; and
13 16. The amendments to paragraph (c) of subdivision 5 of section 2807-c
14 of the public health law made by section seventy-three of this act shall
15 not affect the expiration of such paragraph and shall be deemed to
16 expire therewith.
17 17. Sections sixty-eight-d and sixty-eight-e of this act shall be
18 deemed to have been in full force and effect on and after March 31,
19 2006; and
20 18. The amendments to section 364-j of the social services law, made
21 by sections twenty-three, fifty-seven and sixty-five of this act shall
22 not affect the repeal of such section and shall be deemed repealed ther-
23 ewith.
24 PART B
25 Section 1. The commissioner of health shall develop statewide and
26 suburban areas/regional benchmarks regarding racial/ethnic disparities
27 in access to health care by minority populations for certain preventable
28 hospitalizations including, but not limited to, diabetes, asthma, chron-
29 ic obstructive pulmonary disease, hypertension and congestive heart
30 failure. Such disparity index benchmarks shall provide information about
31 the level of disease disparities between population groups in such
32 suburban areas/regions. In suburban areas/regions where rates of
33 preventable hospitalizations by minorities exceed statewide benchmark
34 indices, such regions shall be eligible to participate in a racial
35 disparities program designed by one or more organizations broadly repre-
36 sentative of physicians licensed in this state from funds made available
37 for this purpose to foster the elimination of racial/ethnic disparities
38 in health status and health care delivery.
39 § 2. Section 2559 of the public health law is amended by adding a new
40 subdivision 5 to read as follows:
41 5. Notwithstanding any law to the contrary, there is hereby estab-
42 lished an early intervention demonstration project to be conducted in
43 Albany, Montgomery, Rensselaer, Saratoga and Schenectady Counties. Such
44 project shall be for the purposes of facilitating coverage eligibility
45 determinations and claims submissions for early intervention services.
46 The commissioner is hereby authorized and directed to facilitate and,
47 within the amounts appropriated, shall award grant funds for the imple-
48 mentation and operation of such demonstration project which shall be
49 conducted by an association representative of health maintenance organ-
50 izations licensed under article forty-four of this chapter and article
51 forty-three of the insurance law in conjunction with the counties speci-
52 fied in this subdivision.
53 Such demonstration shall include the development of an integrated web
54 portal enabling access to health plan data bases to facilitate coverage
S. 6457--C 55 A. 9557--B
1 eligibility, benefit determinations and claims submission and process-
2 ing. Such access shall be subject to all federal and state laws for the
3 confidentiality of personal and medical record information. The demon-
4 stration will develop technology solutions to facilitate coverage deter-
5 minations and streamline and monitor claims processes and payment.
6 The association conducting the demonstration, with input from the
7 participating counties, shall submit a report to the commissioner, the
8 temporary president of the senate and the speaker of the assembly, not
9 later than one year following the commencement of the program's opera-
10 tion, describing the experiences, feasibility and advisability of repli-
11 cation, and any additional recommendations for continuation, modifica-
12 tion or cessation of the program.
13 § 3. The commissioner of health, in conjunction with the deans of the
14 State University at Albany School of Public Health and Nelson A. Rocke-
15 feller College of Public Affairs and Policy, shall develop and implement
16 an academic year-long experiential Public Health Management Leaders of
17 Tomorrow program to provide ten matriculated graduate students with
18 opportunities to gain practical experience and knowledge of state
19 governmental health care policy administration. The program shall
20 include at least three rotations within the various divisions and
21 bureaus of the department of health with cross-assignments from other
22 bureaus in a curricula tailored to meet the unique skills, needs and
23 interest of both students and the department of health. The program can
24 include, at the discretion of the department of health and the schools,
25 and subject to the availability of funding, a stipend of $25,000 for the
26 ten selected students.
27 § 4. Subdivision 2 of section 347 of the public health law is REPEALED
28 and a new subdivision 2 is added to read as follows:
29 2. The board of health of a county or part-county health district is
30 hereby authorized to enter into contracts with one or more counties for
31 mutual aid in the delivery of health services, including but not limited
32 to public health emergency responses such as disease surveillance, mass
33 immunization programs, mass antibiotic distribution, and handling of
34 mass casualties, provided approval of such contracts by the legislative
35 body of each county and of the commissioner is obtained. Each county or
36 part-county health district shall be liable for acts or omissions of its
37 employees or agents when acting pursuant to such a contract in the same
38 manner and to the same extent as if such acts or omissions occurred
39 within the county or part-county health district; and such employees or
40 agents shall have immunities and privileges for their acts or omissions
41 when acting pursuant to such a contract in the same manner and to the
42 same extent as if such acts or omissions occurred within the county or
43 part-county health district; except that such a contract may apportion
44 liability otherwise between or among the county or part-county health
45 districts.
46 § 5. Subdivision 1, paragraph (d) of subdivision 2 and subparagraph 2
47 of paragraph (b) of subdivision 3 of section 602 of the public health
48 law, as added by chapter 901 of the laws of 1986, are amended to read as
49 follows:
50 1. Every municipality shall [biennially] every four years, on such
51 dates as may be fixed by the commissioner, submit to the commissioner
52 for his or her approval a public health services plan.
53 (d) a projected [two-year] four-year plan of expenditures necessary to
54 implement the programs;
55 (2) disease control, which shall include activities to control and
56 mitigate the extent of non-infectious diseases, particularly those of a
S. 6457--C 56 A. 9557--B
1 chronic, degenerative nature, and infectious diseases. Such activities
2 shall include surveillance and epidemiological programs, and programs to
3 detect diseases in their early stages. Specific activities shall include
4 immunizations against infectious diseases [and], prevention and treat-
5 ment of sexually transmissible diseases, and arthropod vector-borne
6 disease prevention.
7 § 6. Subdivision 1 of section 605 of the public health law, as amended
8 by chapter 474 of the laws of 1996, is amended to read as follows:
9 1. A state aid base grant shall be reimbursed to municipalities for
10 the base public health services identified in paragraph (b) of subdivi-
11 sion three of section six hundred two of this title, in an amount of the
12 greater of [forty-five] fifty-five cents per capita, for each person in
13 the municipality, or [four] five hundred fifty thousand dollars provided
14 that the municipality expends at least [four] five hundred fifty thou-
15 sand dollars for such base public health services. A municipality must
16 provide all the basic public health services identified in paragraph (b)
17 of subdivision three of section six hundred two of this title to qualify
18 for such base grant unless the municipality has the approval of the
19 commissioner to expend the base grant on a portion of such base public
20 health services. If any services in such paragraph (b) are not approved
21 in the plan or if no plan is submitted for such services, the commis-
22 sioner may limit the municipality's per capita or base grant to that
23 proportionate share which will fund those services that are submitted in
24 a plan and subsequently approved. The commissioner may use the propor-
25 tionate share that is not granted to contract with agencies, associ-
26 ations, or organizations to provide such services; or the health depart-
27 ment may use such proportionate share to provide the services upon
28 approval of the director of the division of the budget.
29 § 7. Subdivision 2 of section 605 of the public health law, as amended
30 by chapter 474 of the laws of 1996, is amended to read as follows:
31 2. State aid reimbursement for public health services provided by a
32 municipality under this title, shall be made as follows:
33 (a) if the municipality is providing some or all of the basic public
34 health services identified in paragraph (b) of subdivision three of
35 section six hundred two of this title, pursuant to an approved plan, at
36 a rate of [up to fifty per centum but] no less than thirty-six per
37 centum of the difference between the amount of moneys expended by the
38 municipality for public health services required by paragraph (b) of
39 subdivision three of section six hundred two of this title during the
40 fiscal year and the base grant provided pursuant to subdivision one of
41 this section. No such reimbursement shall be provided for services if
42 they are not approved in a plan or if no plan is submitted for such
43 services.
44 (b) if the municipality is providing other public health services
45 within limits to be prescribed by regulation by the commissioner in
46 addition to some or all of the public health services required in para-
47 graph (b) of subdivision three of section six hundred two of this title,
48 pursuant to an approved plan, at a rate of [up to fifty per centum but]
49 not less than [thirty] thirty-six per centum of the moneys expended by
50 the municipality for such other services. No such reimbursement shall be
51 provided for services if they are not approved in a plan or if no plan
52 is submitted for such services.
53 § 8. Section 611 of the public health law is REPEALED.
54 § 9. Subdivision 1 of section 616 of the public health law, as amended
55 by chapter 474 of the laws of 1996, is amended to read as follows:
S. 6457--C 57 A. 9557--B
1 1. The total amount of state aid provided pursuant to this article
2 shall be limited to the amount of the annual appropriation made by the
3 legislature. In no event, however, shall such state aid be less than an
4 amount to provide the full base grant and, as otherwise provided by
5 paragraph (a) of subdivision two of section six hundred five of this
6 article, at least thirty-six per centum of the difference between the
7 amount of moneys expended by the municipality for public health services
8 required by paragraph (b) of subdivision three of section six hundred
9 two of this article during the fiscal year and the base grant provided
10 pursuant to subdivision one of section six hundred five of this article.
11 A municipality shall also receive [at least thirty] not less than thir-
12 ty-six per centum of the moneys expended for other public health
13 services pursuant to paragraph (b) of subdivision two of section six
14 hundred five of this article, and, at least the minimum amount so
15 required for the services identified in title two of this article.
16 [Moreover, for services provided during calendar year nineteen hundred
17 ninety-six, no county with a population of fifty thousand or less shall
18 receive less reimbursement pursuant to subdivision one and paragraphs
19 (a) and (b) of subdivision two of section six hundred five of this arti-
20 cle than it would have had a chapter of the laws of nineteen hundred
21 ninety-six amending these provisions as of August first, nineteen
22 hundred ninety-six not been enacted.]
23 § 10. The public health law is amended by adding a new section 621 to
24 read as follows:
25 § 621. State aid; public health emergencies. If the state commission-
26 er or a county health department or part-county department of health or
27 municipality, with the approval of the state commissioner, determines
28 that there is an imminent threat to public health, the department shall
29 reimburse counties or municipalities at fifty per centum for the cost of
30 emergency measures as approved by the department and subject to the
31 approval of the director of the budget. Such funds shall be made avail-
32 able from funds appropriated for public health emergencies, only to
33 those counties or municipalities, which have expended all other state
34 aid which may be available for related activities and have developed
35 measures to adequately address the emergency. Reimbursement is condi-
36 tioned upon availability of appropriated funds.
37 § 11. Subdivision 1 of section 241 of the elder law, as amended by
38 section 3 of chapter 645 of the laws of 2005, is amended to read as
39 follows:
40 1. "Covered drug" shall mean a drug dispensed subject to a legally
41 authorized prescription pursuant to section sixty-eight hundred ten of
42 the education law, and insulin, an insulin syringe, or an insulin
43 needle. Such term shall not include: (a) any drug determined by the
44 commissioner of the federal food and drug administration to be ineffec-
45 tive or unsafe; (b) any drug dispensed in a package, or form of dosage
46 or administration, as to which the commissioner of health finally deter-
47 mines in accordance with the provisions of section two hundred [fifty]
48 fifty-two of this title that a less expensive package, or form of dosage
49 or administration, is available that is pharmaceutically equivalent and
50 equivalent in its therapeutic effect for the general health character-
51 istics of the eligible program participant population; (c) any device
52 for the aid or correction of vision; (d) any drug, including vitamins,
53 which is generally available without a physician's prescription; and (e)
54 drugs for the treatment of [erectile dysfunction when prescribed for use
55 by a person who is required to register as a sex offender pursuant to
56 article six-C of the correction law, provided that any denial of cover-
S. 6457--C 58 A. 9557--B
1 age for such drugs shall provide the patient with the means of obtaining
2 additional information concerning both the denial and the means of chal-
3 lenging such denial] sexual or erectile dysfunction, unless such drugs
4 are used to treat a condition, other than sexual or erectile dysfunc-
5 tion, for which the drugs have been approved by the federal food and
6 drug administration. Any of the drugs enumerated in the preceding
7 sentence shall be considered a covered drug or a prescription drug for
8 purposes of this article if it is added to the preferred drug list under
9 article two-A of the public health law. For the purpose of this title,
10 except as otherwise provided in this section, a covered drug shall be
11 dispensed in quantities no greater than a thirty day supply or one
12 hundred units, whichever is greater. In the case of a drug dispensed in
13 a form of administration other than a tablet or capsule, the maximum
14 allowed quantity shall be a thirty day supply; the panel is authorized
15 to approve exceptions to these limits for specific products following
16 consideration of recommendations from pharmaceutical or medical experts
17 regarding commonly packaged quantities, unusual forms of administration,
18 length of treatment or cost effectiveness. In the case of a drug
19 prescribed pursuant to section thirty-three hundred thirty-two of the
20 public health law to treat one of the conditions that have been enumer-
21 ated by the commissioner of health pursuant to regulation as warranting
22 the prescribing of greater than a thirty day supply, such drug shall be
23 dispensed in quantities not to exceed a three month supply.
24 § 12. Subdivision 1 of section 241 of the elder law, as amended by
25 section 4 of chapter 645 of the laws of 2005, is amended to read as
26 follows:
27 1. "Covered drug" shall mean a drug dispensed subject to a legally
28 authorized prescription pursuant to section sixty-eight hundred ten of
29 the education law, and insulin, an insulin syringe, or an insulin
30 needle. Such term shall not include: (a) any drug determined by the
31 commissioner of the federal food and drug administration to be ineffec-
32 tive or unsafe; (b) any drug dispensed in a package, or form of dosage
33 or administration, as to which the commissioner of health finally deter-
34 mines in accordance with the provisions of section two hundred [fifty]
35 fifty-two of this title that a less expensive package, or form of dosage
36 or administration, is available that is pharmaceutically equivalent and
37 equivalent in its therapeutic effect for the general health character-
38 istics of the eligible program participant population; (c) any device
39 for the aid or correction of vision, or any drug, including vitamins,
40 which is generally available without a physician's prescription; and (d)
41 drugs for the treatment of [erectile dysfunction when prescribed for use
42 by a person who is required to register pursuant to article six-C of the
43 correction law, provided that any denial of coverage for such drugs
44 shall provide the patient with the means of obtaining additional infor-
45 mation concerning both the denial and the means of challenging such
46 denial] sexual or erectile dysfunction, unless such drugs are used to
47 treat a condition, other than sexual or erectile dysfunction, for which
48 the drugs have been approved by the federal food and drug
49 administration. For the purpose of this title, except as otherwise
50 provided in this section, a covered drug shall be dispensed in quanti-
51 ties no greater than a thirty day supply or one hundred units, whichever
52 is greater. In the case of a drug dispensed in a form of administration
53 other than a tablet or capsule, the maximum allowed quantity shall be a
54 thirty day supply; the panel is authorized to approve exceptions to
55 these limits for specific products following consideration of recommen-
56 dations from pharmaceutical or medical experts regarding commonly pack-
S. 6457--C 59 A. 9557--B
1 aged quantities, unusual forms of administration, length of treatment or
2 cost effectiveness. In the case of a drug prescribed pursuant to section
3 thirty-three hundred thirty-two of the public health law to treat one of
4 the conditions that have been enumerated by the commissioner of health
5 pursuant to regulation as warranting the prescribing of greater than a
6 thirty day supply, such drug shall be dispensed in quantities not to
7 exceed a three month supply.
8 § 13. Subdivision 2 of section 241 of the elder law is amended to read
9 as follows:
10 2. "Provider pharmacy" shall mean a pharmacy registered in the state
11 of New York pursuant to section sixty-eight hundred eight of the educa-
12 tion law or a pharmacy registered in a state bordering the state of New
13 York when certified as necessary by the executive director pursuant to
14 section two hundred [fifty] fifty-three of this title, for which an
15 agreement to provide pharmacy services for purposes of this program
16 pursuant to section two hundred forty-nine of this title is in effect.
17 § 14. Paragraph (b) of subdivision 1, paragraphs (a) and (b) of subdi-
18 vision 2 and paragraph (d) of subdivision 3 of section 242 of the elder
19 law, paragraph (d) of subdivision 3 as added by section 2 of part A of
20 chapter 49 of the laws of 2004, are amended to read as follows:
21 (b) any married resident who is at least sixty-five years of age and
22 whose income for the calendar year immediately preceding the effective
23 date of the annual coverage period when combined with the income in the
24 same calendar year of such married person's spouse beginning on or after
25 January first, two thousand [five] one, is less than or equal to twen-
26 ty-six thousand dollars. After the initial determination of eligibility,
27 each eligible individual must be redetermined eligible at least every
28 twenty-four months.
29 (a) any unmarried resident who is at least sixty-five years of age and
30 whose income for the calendar year immediately preceding the effective
31 date of the annual coverage period beginning on or after January first,
32 two thousand [five] one, is more than twenty thousand and less than or
33 equal to thirty-five thousand dollars. After the initial determination
34 of eligibility, each eligible individual must be redetermined eligible
35 at least every twenty-four months; and
36 (b) any married resident who is at least sixty-five years of age and
37 whose income for the calendar year immediately preceding the effective
38 date of the annual coverage period when combined with the income in the
39 same calendar year of such married person's spouse beginning on or after
40 January first, two thousand [five] one, is more than twenty-six thousand
41 dollars and less than or equal to fifty thousand dollars. After the
42 initial determination of eligibility, each eligible individual must be
43 redetermined eligible at least every twenty-four months.
44 (d) The elderly pharmaceutical insurance coverage program is author-
45 ized to apply for transitional assistance under the [medical] medicare
46 prescription drug discount program with a specific drug discount card
47 under title XVIII of the federal social security act on behalf of appli-
48 cants and eligible program participants under this [article] title. The
49 elderly pharmaceutical insurance coverage program shall provide appli-
50 cants and eligible program participants with prior written notice of,
51 and the opportunity to decline, such automatic enrollment.
52 § 15. Paragraphs (h), (i) and (j) of subdivision 5 of section 244 of
53 the elder law are amended to read as follows:
54 (h) prepare an evaluation report on the experience of the program for
55 the governor and the legislature no later than November first, [two
56 thousand five] nineteen hundred ninety-five. Such report should include
S. 6457--C 60 A. 9557--B
1 the recommendations of the panel concerning the continuation of the
2 program beyond its expiration;
3 (i) establish policies and procedures to allow individuals who partic-
4 ipate in the catastrophic deductible plan on December thirty-first, two
5 thousand [five] to continue to receive benefits under the provisions of
6 section two hundred forty-eight of this title in effect on December
7 thirty-first, two thousand [five], if and for as long as the enrollee so
8 chooses; and
9 (j) facilitate implementation of an expanded elderly pharmaceutical
10 insurance coverage program on January first, two thousand [six] one, by
11 commencing no later than October first, two thousand [five], outreach
12 activities, including but not limited to the dissemination of informa-
13 tion to local governments and senior citizen provider advocacy groups
14 regarding such expanded program. The panel shall make applications
15 available for the expanded elderly pharmaceutical insurance coverage
16 program on October first, two thousand [five].
17 § 16. Subdivision 4 of section 245 of the elder law is amended to read
18 as follows:
19 4. Establish procedures to prorate registration fees for any partic-
20 ipant's annual coverage period which began after January first, two
21 thousand [five] and before January first, two thousand [six] one. Such
22 proration shall be calculated on a daily basis and ensure that program
23 participants are afforded an equitable transition from the program
24 established pursuant to this title to the revised program to go into
25 effect on January first, two thousand [six] one.
26 § 17. Paragraphs (c) and (d) of subdivision 2 and paragraph (c) of
27 subdivision 4 of section 247 of the elder law are amended to read as
28 follows:
29 (c) In the event that the state expenditures per participant meeting
30 the registration fee requirements of this subdivision, exclusive of
31 expenditures for program administration, in the program year commencing
32 October first, [two thousand five] nineteen hundred eighty-eight, and in
33 each program year thereafter, exceed such expenditures in the previous
34 program year by a minimum of ten percent, the annual registration fees
35 set forth in this subdivision may, unless otherwise provided by law, be
36 increased, pro-rata, for the subsequent program year, provided that such
37 increase shall not exceed 7.5 percent of the prior year registration
38 fees as may have been adjusted in accordance with this paragraph.
39 (d) In the event that the state expenditures per such participant,
40 incurred pursuant to this subdivision, exclusive of expenditures for
41 program administration, in the program year commencing October first,
42 [two thousand five] nineteen hundred eighty-eight, and in each program
43 year thereafter, are less than such expenditures in the previous program
44 year by a minimum of ten percent, the annual registration fees set forth
45 in this subdivision may, unless otherwise provided by law, be decreased,
46 pro-rata, for the subsequent program year, provided that such decrease
47 shall not exceed 7.5 percent of the prior year registration fees as may
48 have been adjusted in accordance with this paragraph.
49 (c) Effective October first, [two thousand five] nineteen hundred
50 eighty-eight, the limits on point of sale co-payments as set forth in
51 this subdivision may be adjusted by the panel on the anniversary date of
52 each program participant's annual coverage period, and such adjustment
53 shall be in effect for the duration of that annual coverage period. Any
54 such annual adjustment shall be made using a percentage adjustment
55 factor which shall not exceed one-half of the difference between the
56 year-to-year percentage increase in the consumer price index for all
S. 6457--C 61 A. 9557--B
1 urban consumers, as published by the United States Department of Labor,
2 and, if larger, the year-to-year percentage increase in the aggregate
3 average cost of covered drugs purchased under this title, which year-to-
4 year percentage increase in such cost shall be determined by comparison
5 of such cost in the same month of each of the appropriate successive
6 years; provided, however, that for any such adjustment based wholly on
7 experience in the program year commencing October first, [two thousand
8 five] nineteen hundred eighty-seven, the year-to-year percentage
9 increase in such cost shall be determined by comparison of such cost in
10 each of two months no less than five months apart and within such
11 program year, which comparison shall be annualized. Such percentage
12 adjustment factor shall be the same as that used to determine any simi-
13 lar annual adjustment for the same annual coverage periods pursuant to
14 the provisions of subdivision [two] four of section two hundred forty-
15 eight of this title.
16 § 18. Paragraphs (c) and (d) of subdivision 2 and paragraph (c) of
17 subdivision 4 of section 248 of the elder law are amended to read as
18 follows:
19 (c) In the event that the state expenditures per participant electing
20 to meet the deductible requirements of this subdivision, exclusive of
21 expenditures for program administration, in the program year commencing
22 October first, [two thousand five] nineteen hundred eighty-eight, and in
23 each program year thereafter, exceed such expenditures in the previous
24 program year by a minimum of ten percent, the annual personal covered
25 drug expenditures set forth in this subdivision may, unless otherwise
26 provided by law, be increased, pro-rata, for the subsequent program
27 year, provided that such increase shall not exceed eight percent of the
28 prior year personal covered drug expenditures as may have been adjusted
29 in accordance with this paragraph.
30 (d) In the event that the state expenditures per such participant,
31 incurred pursuant to this subdivision, exclusive of expenditures for
32 program administration, in the program year commencing October first,
33 [two thousand five] nineteen hundred eighty-eight, and in each program
34 year thereafter, are less than such expenditures in the previous program
35 year by a minimum of ten percent, the annual personal covered drug
36 expenditures set forth in this subdivision may, unless otherwise
37 provided by law, be decreased, pro-rata, for the subsequent program
38 year, provided that such decrease shall not exceed eight percent of the
39 prior year personal covered drug expenditures as may have been adjusted
40 in accordance with this paragraph.
41 (c) Effective October first, [two thousand five] nineteen hundred
42 eighty-eight, the limits on point of sale co-payments as set forth in
43 this subdivision may be adjusted by the panel on the anniversary date of
44 each program participant's annual coverage period, and such adjustment
45 shall be in effect for the duration of that annual coverage period. Any
46 such annual adjustment shall be made using a percentage adjustment
47 factor which shall not exceed one-half of the difference between the
48 year-to-year percentage increase in the consumer price index for all
49 urban consumers, as published by the United States Department of Labor,
50 and, if larger, the year-to-year percentage increase in the aggregate
51 average cost of covered drugs purchased under this title, which year-to-
52 year percentage increase in such cost shall be determined by comparison
53 of such cost in the same month of each of the appropriate successive
54 years; provided, however, that for any such adjustment based wholly on
55 experience in the program year commencing October first, [two thousand
56 five] nineteen hundred eighty-seven, the year-to-year percentage
S. 6457--C 62 A. 9557--B
1 increase in such cost shall be determined by comparison of such cost in
2 each of two months no less than five months apart and within such
3 program year, which comparison shall be annualized. Such percentage
4 adjustment factor shall be the same as that used to determine any simi-
5 lar annual adjustment for the same annual coverage periods pursuant to
6 the provisions of subdivision four of section two hundred forty-seven of
7 this title. Such annual adjustments shall be calculated by multiplying
8 the percentage adjustment factor by (1) ten percent and applying the
9 resulting percentage to the upper income limitation of each income level
10 for unmarried individuals contained in this subdivision, and by (2)
11 seven and one-half percent and applying the resulting percentage to the
12 upper income limitation of each income level for married individuals
13 contained in this subdivision; each result of such calculations, minus
14 any applicable deductible increases made pursuant to subdivision two of
15 this section and plus the result of applying the percentage adjustment
16 factor to the sum of any such annual adjustments applicable thereto for
17 any prior annual coverage period, shall be the amount by which the limit
18 on co-payments for each such income level may be adjusted, and such
19 amount shall be in addition to any such amount or amounts applicable to
20 prior annual coverage periods.
21 § 19. Subparagraph 1 of paragraph (a) of subdivision 3 and subdivision
22 5 of section 250 of the elder law are amended to read as follows:
23 (1) any agreement between the program and a manufacturer entered into
24 before August first, [two thousand five] nineteen hundred ninety-one,
25 shall be deemed to have been entered into on April first, [two thousand
26 five] nineteen hundred ninety-one; and provided further, that if a
27 manufacturer has not entered into an agreement with the department
28 before August first, [two thousand five] nineteen hundred ninety-one,
29 such agreement shall not be effective until April first, [two thousand
30 five] nineteen hundred ninety-two, unless such agreement provides that
31 rebates will be retroactively calculated as if the agreement had been in
32 effect on April first, [two thousand five] nineteen hundred ninety-one;
33 and
34 5. Notwithstanding any other provision of law, the [commissioner of
35 the office of children and family services] panel shall maximize the
36 coordination of benefits for persons enrolled under Title XVIII of the
37 federal social security act (medicare) and enrolled under this title in
38 order to facilitate medicare payment of claims. The [commissioner of the
39 office of children and family services] panel may select an independent
40 contractor, through a request-for-proposal process, to implement a
41 centralized coordination of benefits system under this subdivision for
42 individuals qualified in both the [medical assistance] elderly pharma-
43 ceutical insurance coverage (EPIC) program and medicare programs who
44 receive[, including but not limited to,] medications[, sickroom
45 supplies] or other covered products from a pharmacy provider currently
46 enrolled in the [medical assistance] elderly pharmaceutical insurance
47 coverage (EPIC) program.
48 § 20. Paragraph (e) of subdivision 3 of section 242 of the elder law,
49 as added by section 5 of part A of chapter 58 of the laws of 2005, is
50 amended to read as follows:
51 (e) As a condition of continued eligibility for benefits under this
52 title, if a program participant's income indicates that the participant
53 could be eligible for a full premium subsidy under section 1860D-14 of
54 the federal social security act, a program participant is required to
55 provide, and to authorize the elderly pharmaceutical insurance coverage
56 program to obtain, any information or documentation required to estab-
S. 6457--C 63 A. 9557--B
1 lish the participant's eligibility for such subsidy. The elderly phar-
2 maceutical insurance coverage program shall make a reasonable effort to
3 notify the program participant of his or her need to provide any of the
4 above required information. After a reasonable effort has been made to
5 contact the participant, a participant shall be notified in writing that
6 he or she has sixty days to provide such required information. If such
7 information is not provided within the sixty day period, the partic-
8 ipant's coverage may be terminated. The elderly pharmaceutical insurance
9 coverage program is authorized and directed to conduct an enrollment
10 program to identify, encourage and facilitate, in as prompt and stream-
11 lined a fashion as possible, the enrollment of program participants who
12 are found eligible for such subsidy for enrollment into part D of such
13 act, unless such enrollment will result in significant additional finan-
14 cial liability on behalf of the participant or in the loss of any health
15 coverage through a union or employer plan for the participant, the
16 participant's spouse or other dependent. Provided, however, that an
17 eligible program participant's decision to disenroll from a prescription
18 drug plan or MA-PD plan shall not impact their continued eligibility for
19 benefits under this title. Provided further, however, a participant
20 shall not be prevented from receiving his or her drugs immediately at
21 the pharmacy under the elderly pharmaceutical insurance coverage program
22 as a result of such participant's enrollment in Medicare part D. In
23 order to maximize prescription drug coverage under Part D of title XVIII
24 of the federal social security act, the elderly pharmaceutical insurance
25 coverage program is authorized to represent program participants under
26 this title in the pursuit of such coverage. Such representation shall
27 not result in any additional financial liability on behalf of such
28 program participants and shall include, but not be limited to, the
29 following actions:
30 (i) application for the premium and cost-sharing subsidies on behalf
31 of eligible program participants;
32 (ii) enrollment in a prescription drug plan or MA-PD plan; the elderly
33 pharmaceutical insurance coverage program shall provide program partic-
34 ipants with prior written notice of, and the opportunity to decline,
35 such enrollment;
36 (iii) pursuit of appeals, grievances, or coverage determinations.
37 § 21. Section 4 of part X2 of chapter 62 of the laws of 2003, amend-
38 ing the public health law relating to allowing for the use of funds of
39 the office of professional medical conduct for activities of the patient
40 health information and quality improvement act of 2000, as amended by
41 section 8 of part A of chapter 58 of the laws of 2005, is amended to
42 read as follows:
43 § 4. This act shall take effect immediately; provided that the
44 provisions of section one of this act shall be deemed to have been in
45 full force and effect on and after April 1, 2003, and shall expire March
46 31, [2006] 2007 when upon such date the provisions of such section shall
47 be deemed repealed.
48 § 22. This act shall take effect immediately and shall be deemed to
49 have been in full force and effect on or after April 1, 2006; provided,
50 however, that sections six through ten of this act, relating to article
51 VI of the public health law, shall take effect on January 1, 2007 and
52 section twenty of this act shall take effect July 1, 2006; provided,
53 further, that the amendments to subdivision 1 of section 241 of the
54 elder law made by section eleven of this act shall be subject to the
55 expiration and reversion of such subdivision pursuant to section 79 of
S. 6457--C 64 A. 9557--B
1 part C of chapter 58 of the laws of 2005, as amended, when upon such
2 date the provisions of section twelve of this act shall take effect.
3 PART C
4 Section 1. 1. Subject to available appropriations, the commissioners
5 of the office of mental health, office of mental retardation and devel-
6 opmental disabilities, office of alcoholism and substance abuse
7 services, department of health, office of children and family services
8 and the state office for the aging shall establish an annual cost of
9 living adjustment (COLA), subject to the approval of the director of the
10 budget, effective April first of each state fiscal year, provided,
11 however, that in state fiscal year 2006-07, the cost of living adjust-
12 ment will be effective October first, to project for the effects of
13 inflation, for rates of payments, contracts or any other form of
14 reimbursement for the programs listed in paragraphs (i), (ii), (iii),
15 (iv), (v) and (vi) of subdivision four of this section. The COLA shall
16 be applied to the appropriate portion of reimbursable costs or contract
17 amounts.
18 Subdivision 1-a. The commissioners of the offices of mental health,
19 mental retardation and developmental disabilities and alcoholism and
20 substance abuse services shall develop guidelines, including but not
21 limited to, requiring that a local government unit or provider agency
22 develop a plan of implementation to ensure that such cost of living
23 adjustment when used for recruitment and retention of staff shall be
24 directed at support and direct care staff.
25 2. In developing cost of living adjustments under this subdivision,
26 the commissioners shall use the most recent congressional budget office
27 estimate of the budget year's U. S. consumer price index for all urban
28 consumers published in the congressional budget office economic and
29 budget outlook after June first of the budget year prior to the year for
30 which rates of payments, contracts or any other form of reimbursement
31 are being developed.
32 3. After final U. S. consumer price index (CPI) for all urban consum-
33 ers published by the United States department of labor, bureau of labor
34 statistics, for a particular budget year, the commissioners shall recon-
35 cile such final CPI with the estimate used in subdivision two of this
36 section and any difference will be included in the next prospective cost
37 of living adjustment.
38 4. Programs eligible. (i) Programs eligible for the cost of living
39 adjustments under the auspice of the office of mental health (OMH)
40 include: comprehensive outpatient program (COPS), non-COPS and community
41 support program components of the reimbursement for OMH licensed outpa-
42 tient programs, pursuant to part 592, part 588.13 (g) and part 588.14
43 respectively of the office of mental health regulations; dispropor-
44 tionate share payments made under chapter 119 of the laws of 1997 as
45 amended; partial hospitalization; intensive psychiatric rehabilitation
46 treatment; outreach; crisis residence; crisis/respite beds; comprehen-
47 sive psychiatric emergency program crisis outreach; comprehensive
48 psychiatric emergency program crisis beds; crisis intervention; home
49 based crisis intervention; comprehensive psychiatric emergency program
50 crisis intervention; family care; family based treatment; supported
51 single room occupancy; supported housing; supported housing community
52 services; treatment congregate; supported congregate; community resi-
53 dence - children & youth; treatment/apartment; supported apartment;
54 community residence single room occupancy; on-site rehabilitation; shel-
S. 6457--C 65 A. 9557--B
1 tered workshop/satellite sheltered workshop; transitional employment;
2 recreation; respite care; transportation; psychosocial club; assertive
3 community treatment; case management; blended case management; local
4 government unit administration; monitoring and evaluation; children and
5 youth vocational services; enclave in industry; single point of access;
6 assisted competitive employment; school program without clinic; family
7 support children and youth; advocacy/support services; drop in centers;
8 intensive case management; transition management services; bridger; home
9 and community based waiver services pursuant to subdivision 9 of section
10 366 of the social services law; affirmative business industries; self-
11 help programs; consumer service dollars; intensive case
12 management/supportive case management/blended case management emergency
13 and non-emergency service dollars; conference of local mental hygiene
14 directors; client worker; multicultural initiative; ongoing integrated
15 supported employment services; supported education; MICA network;
16 personalized recovery oriented service except for clinic treatment fee
17 component; supportive case management; assertive community treatment
18 team service dollars; and state aid funding provided pursuant to article
19 41 of the mental hygiene law for residential treatment facility transi-
20 tion coordinator, inpatient psychiatric unit of a general hospital, day
21 treatment, clinic and continuing day treatment.
22 (ii) Programs eligible for the cost of living adjustments under the
23 auspice of the office of mental retardation and developmental disabili-
24 ties include: local/unified services; chapter 620; direct sheltered
25 workshop; long term sheltered employment; voluntary operated community
26 residences; article 16 clinics; day treatment; family support services;
27 100% day training; epilepsy services; and individual support services.
28 (iii) Programs eligible for the cost of living adjustments under the
29 auspice of the office of alcoholism and substance abuse services
30 include: chemical dependence crisis services; inpatient rehabilitation
31 services; residential services; outpatient services; chemotherapy
32 substance abuse programs; residential rehabilitation services for youth;
33 compulsive gambling programs; chemical dependence school and community-
34 based prevention and education programs; managed addiction treatment
35 services; case management; vocational and job placement services; recov-
36 ery services; and program support services, provided that such programs
37 receive state aid funding support from the office of alcoholism and
38 substance abuse services. State aid funding support, for purposes of
39 cost of living adjustment eligibility, is limited to the local assist-
40 ance account of the general fund, federal substance abuse prevention and
41 treatment block grant funds, and federal safe and drug-free schools and
42 communities grant funds appropriated to and administered by the office
43 of alcoholism and substance abuse services.
44 (iv) Programs eligible for the cost of living adjustments under the
45 auspice of the department of health include: HIV/AIDS adolescent
46 services/ACT for youth; HIV/AIDS adolescent service/general; HIV/AIDS
47 adolescent services/schools; HIV/AIDS clinical education; HIV/AIDS clin-
48 ical guidelines development; HIV/AIDS clinical scholars; HIV/AIDS clin-
49 ical trials experimental treatment; HIV/AIDS community development
50 initiative; HIV/AIDS community HIV prevention and primary care; HIV/AIDS
51 community services programs; HIV/AIDS criminal justice; HIV/AIDS educa-
52 tion and training; HIV/AIDS evaluation and research; HIV/AIDS expanded
53 syringe access program; HIV/AIDS families in transition; HIV/AIDS family
54 centered care; HIV/AIDS harm reduction/general; HIV/AIDS harm
55 reduction/syringe exchange; HIV/AIDS HIV health care and support
56 services for women and kids; HIV/AIDS HIV prevention/primary
S. 6457--C 66 A. 9557--B
1 care/support services for substance abusers; HIV/AIDS homeless shelters;
2 HIV/AIDS legal services and advocacy; HIV/AIDS lesbian, gay, bisexual,
3 transgender/adolescent; HIV/AIDS lesbian, gay, bisexual, transgender/
4 general; HIV/AIDS lesbian, gay, bisexual, transgender/substance use;
5 HIV/AIDS multiple service agency; HIV/AIDS nutritional services;
6 HIV/AIDS pediatric centers of excellence; HIV/AIDS permanency planning;
7 HIV/AIDS racial and ethnic minority; HIV/AIDS social day care; HIV/AIDS
8 specialized care centers for youth; HIV/AIDS specialty; HIV/AIDS
9 supportive housing; HIV/AIDS treatment adherence; HIV/AIDS women's
10 services/general; HIV/AIDS women's services/peer; HIV/AIDS women's
11 services/supportive services; HIV/AIDS youth access program, office of
12 minority health; center for community health program; red cross emergen-
13 cy preparedness; nutrition outreach and education; obesity prevention;
14 women, infants, and children; hunger prevention and nutrition assist-
15 ance; Indian health; asthma; prenatal care assistance program; rape
16 crisis; early intervention; health and human services sexuality related;
17 maternity/early childhood foundation; abstinence education; family plan-
18 ning; school health; sudden infant death syndrome; childhood lead
19 poisoning prevention; enhanced services for kids; act for youth; chil-
20 dren with special health care needs; regional perinatal data centers;
21 migrant health; dental services; osteoporosis prevention; eating disor-
22 ders; cancer services; cancer registry; healthy heart; alzheimer's
23 disease assistance centers; alzheimer's disease - research and educa-
24 tion; diabetes screening, education and prevention; tobacco control;
25 rabies; tick-borne; immunization; public health campaign; sexually tran-
26 smitted disease; and tuberculosis control.
27 (v) Programs eligible for the cost of living adjustments under the
28 auspice of the state office for the aging include: community services
29 for the elderly; expanded in-home services for the elderly; and supple-
30 mental nutrition assistance program.
31 (vi) Programs eligible for cost of living adjustments under the
32 auspice of the office of children and family services include: programs
33 for which the office of children and family services establishes maximum
34 state aid rates pursuant to section 398-a of the social services law and
35 sections 4003 and 4405 of the education law, foster parents, adoptive
36 parents, and home and community based waiver services pursuant to subdi-
37 vision 9 of section 366 of the social services law for which social
38 services districts have chosen to use preventive services funds to
39 support a portion of the costs.
40 5. Furthermore, each local government unit or direct contract provider
41 receiving such funding shall submit a written certification, in such
42 form and at such time as each commissioner shall prescribe, attesting
43 how such funding will be or was used to promote the recruitment and
44 retention of staff or respond to other critical non-personal service
45 costs during the State fiscal year in which the cost of living adjust-
46 ment was applied.
47 § 2. Paragraph (g) of subdivision 2 of section 209 of the social
48 services law, as amended by chapter 713 of the laws of 2005, is amended
49 to read as follows:
50 (g) (i) The amounts set forth in paragraphs (a) through (d) of this
51 subdivision and the amounts set forth in subparagraph (ii) of paragraph
52 (e) and subparagraph (ii) of paragraph (f) of this subdivision as added
53 by section forty-six of part C of chapter fifty-eight of the laws of two
54 thousand five shall be increased to reflect any increases in federal
55 supplemental security income benefits for individuals or couples which
56 become effective on or after January first, two thousand six but prior
S. 6457--C 67 A. 9557--B
1 to June thirtieth, two thousand six; provided, however, that the amounts
2 set forth in paragraphs (c), (d) and (f) of this subdivision with
3 respect to eligible couples shall be increased by an amount sufficient
4 to establish standards for couples that are equal to twice the increase
5 hereunder for eligible individuals.
6 (ii) In addition to the amounts set forth in subparagraph (i) of this
7 paragraph, on and after January first, two thousand seven, the amounts
8 set forth in subparagraph (iii) of paragraph (e) and subparagraph (iii)
9 of paragraph (f) of this subdivision shall be annually increased to
10 reflect an increase in the state supplementation equal to the annual
11 consumer price index for the previous calendar year.
12 § 3. Paragraph (e) of subdivision 1 of section 131-o of the social
13 services law, as added by section 45 of part C of chapter 58 of the laws
14 of 2005, is amended to read as follows:
15 (e) in the case of each individual receiving enhanced residential
16 care, (i) an amount equal to at least $144.00 for each month beginning
17 on or after January first, two thousand six, and (ii) an amount equal to
18 $159.00 for each month beginning on or after January first, two thousand
19 seven. On and after January first, two thousand seven, the amount set
20 forth in subparagraph (ii) of this paragraph shall be annually increased
21 by an amount equal to the consumer price index for the previous calendar
22 year, provided that there has been an increase in state supplementation
23 pursuant to subparagraph (ii) of paragraph (g) of section two hundred
24 nine of this chapter.
25 § 4. This act shall take effect immediately and shall be deemed to
26 have been in full force and effect on and after April 1, 2006, provided
27 section one of this act shall expire and be deemed repealed April 1,
28 2009 provided, further, that sections two and three of this act shall
29 expire and be deemed repealed December 31, 2009.
30 PART D
31 Section 1. Subparagraphs (vii) and (viii) of paragraph (j) of subdi-
32 vision 1 of section 2807-v of the public health law, subparagraph (vii)
33 as added and subparagraph (viii) as amended by section 3 of part B of
34 chapter 58 of the laws of 2005, are amended to read as follows:
35 (vii) up to [forty] eighty-one million [six] nine hundred thousand
36 dollars for the period January first, two thousand six through December
37 thirty-first, two thousand six, provided, however, that within amounts
38 appropriated, a portion of such funds may be transferred to the Roswell
39 Park Cancer Institute Corporation to support costs associated with
40 cancer research; and
41 (viii) up to [twenty] forty-seven million [three] eight hundred thou-
42 sand dollars for the period January first, two thousand seven through
43 June thirtieth, two thousand seven, provided, however, that within
44 amounts appropriated, a portion of such funds may be transferred to the
45 Roswell Park Cancer Institute Corporation to support costs associated
46 with cancer research.
47 § 2. Intentionally omitted.
48 § 3. Subparagraphs (vii) and (viii) of paragraph (k) of subdivision 1
49 of section 2807-v of the public health law, subparagraph (vii) as added
50 and subparagraph (viii) as amended by section 3 of part B of chapter 58
51 of the laws of 2005, are amended to read as follows:
52 (vii) one hundred [forty-one] fifty-six million [eight] six hundred
53 thousand dollars, plus an additional five hundred thousand dollars, for
S. 6457--C 68 A. 9557--B
1 the period January first, two thousand six through December thirty-
2 first, two thousand six; and
3 (viii) [seventy] seventy-five million [six] seven hundred thousand
4 dollars, plus an additional two hundred fifty thousand dollars, for the
5 period January first, two thousand seven through June thirtieth, two
6 thousand seven.
7 § 4. Subparagraphs (vii) and (viii) of paragraph (n) of subdivision 1
8 of section 2807-v of the public health law, subparagraph (vii) as added
9 and subparagraph (viii) as amended by section 3 of part B of chapter 58
10 of the laws of 2005, are amended to read as follows:
11 (vii) six hundred [twenty] three million one hundred fifty thousand
12 dollars for the period January first, two thousand six through December
13 thirty-first, two thousand six; and
14 (viii) three hundred [thirty-six] thirty million four hundred thousand
15 dollars for the period January first, two thousand seven through June
16 thirtieth, two thousand seven.
17 § 5. Subparagraph (vii) of paragraph (o) of subdivision 1 of section
18 2807-v of the public health law, as added by section 3 of part B of
19 chapter 58 of the laws of 2005, is amended to read as follows:
20 (vii) [seventy-eight] ninety-one million dollars for the period Janu-
21 ary first, two thousand six through December thirty-first, two thousand
22 six; and
23 § 5-a. Subparagraphs (iii) and (iv) of paragraph (u) of subdivision 1
24 of section 2807-v of the public health law, as amended by section 3 of
25 part B of chapter 58 of the laws of 2005, are amended to read as
26 follows:
27 (iii) up to [twelve] fifty-six million five hundred thousand dollars
28 for the period January first, two thousand six through December thirty-
29 first, two thousand six; and
30 (iv) up to [six] twenty-eight million two hundred fifty thousand
31 dollars for the period January first, two thousand seven through June
32 thirtieth, two thousand seven.
33 § 5-b. Subdivisions 1, 4 and 6 of section 2808-d of the public health
34 law, subdivision 1 as added by section 5 of part A of chapter 1 of the
35 laws of 2002, subdivision 4 as amended by chapter 161 of the laws of
36 2005, and subdivision 6 as added by section 14 of part B of chapter 58
37 of the laws of 2005, are amended to read as follows:
38 1. Notwithstanding any law, rule or regulation to the contrary, the
39 commissioner shall, within amounts appropriated and subject to the
40 availability of federal financial participation, establish a demon-
41 stration program to improve the quality of care for nursing home resi-
42 dents through the increase or improvement of direct care staff at nurs-
43 ing homes. In furtherance of such demonstration program the commissioner
44 shall adjust the Medicaid rates of payment to nursing homes, selected
45 pursuant to a competitive process, provided, however, that payments made
46 pursuant to this section to public residential health care facilities
47 shall be made as grants and shall not be deemed medical assistance
48 payments. Requests for proposals for eligible projects shall be issued
49 by the commissioner, provided however that the commissioner shall not
50 issue any new requests for proposals after December thirty-first, two
51 thousand four and all awards for subsequent annual periods shall be
52 distributed on the same proportional basis as the most recent available
53 distribution. After December thirty-first, two thousand four, awardees
54 may use funds received for any of the purposes listed in subdivision two
55 of this section, without restriction.
S. 6457--C 69 A. 9557--B
1 4. Grants and adjustments to Medicaid rates of payment made pursuant
2 to this section shall not, in aggregate, exceed sixty-two million five
3 hundred thousand dollars for the period beginning April first, two thou-
4 sand two and ending December thirty-first, two thousand two, and, on an
5 annualized basis, for each annual period thereafter beginning January
6 first, two thousand three and ending December thirty-first, two thousand
7 four, and shall not, in aggregate, exceed forty-six million eight
8 hundred seventy-five thousand dollars for the period July first, two
9 thousand five through December thirty-first, two thousand five and shall
10 not, in aggregate, on an annualized basis, exceed [thirty-one] seventy-
11 eight million one hundred twenty-five thousand dollars for the period
12 January first, two thousand six through December thirty-first, two thou-
13 sand six and sixty-two million [two] five hundred [fifty] thousand
14 dollars for the period January first, two thousand [six] seven through
15 June thirtieth, two thousand seven.
16 6. Notwithstanding any other provisions of this section or any other
17 contrary provision of law, the commissioner may, from funds allocated
18 pursuant to subparagraph (ii) or (iii) or (iv) of paragraph (u) of
19 subdivision one of section twenty-eight hundred seven-v of this article,
20 in calendar year two thousand five, make grants in an aggregate amount
21 not to exceed twelve million five hundred thousand dollars, to residen-
22 tial health care facilities in support of projects or programs designed
23 to improve specific areas of quality of care, as determined by the
24 commissioner using established measures of such quality of care, and
25 provided further the commissioner may, from funds allocated pursuant to
26 paragraph (u) of subdivision one of section twenty-eight hundred seven-v
27 of this article, for the period January first, two thousand six through
28 June thirtieth two thousand seven, make grants in an aggregate amount
29 not to exceed thirty-five million dollars on an annualized basis, to
30 residential health care facilities that have an arbitrator's decision
31 rendered before April first, two thousand six, requiring payments
32 related to the recruitment and retention of direct care staff, including
33 salary and benefits. Each eligible facility shall receive a payment
34 amount proportional to the amount each such facility owes pursuant to
35 the arbitrator's decision compared to such amounts owed by all eligible
36 facilities.
37 § 6. Subparagraphs (v) and (vi) of paragraph (v) of subdivision 1 of
38 section 2807-v of the public health law, subparagraph (v) as added and
39 subparagraph (vi) as amended by section 3 of part B of chapter 58 of the
40 laws of 2005, are amended to read as follows:
41 (v) up to [sixty-five] one hundred thirteen million eight hundred
42 thousand dollars for the period January first, two thousand six through
43 December thirty-first, two thousand six; and
44 (vi) up to [thirty-two] forty-eight million [five] eight hundred thou-
45 sand dollars for the period January first, two thousand seven through
46 June thirtieth, two thousand seven.
47 § 7. The opening paragraph of paragraph (hh) of subdivision 1 of
48 section 2807-v of the public health law, as amended by section 3 of part
49 B of chapter 58 of the laws of 2005, is amended to read as follows:
50 Funds shall be deposited by the commissioner, within amounts appropri-
51 ated, and the state comptroller is hereby authorized and directed to
52 receive for deposit to the credit of the special revenue fund - other,
53 HCRA transfer fund, [health care services] medical assistance account
54 for purposes of providing financial assistance to residential health
55 care facilities pursuant to subdivisions nineteen and twenty-one of
56 section twenty-eight hundred eight of this article, from the tobacco
S. 6457--C 70 A. 9557--B
1 control and insurance initiatives pool established for the following
2 periods in the following amounts:
3 § 8. Subparagraphs (v) and (vi) of paragraph (kk) of subdivision 1 of
4 section 2807-v of the public health law, subparagraph (v) as added and
5 subparagraph (vi) as amended by section 3 of part B of chapter 58 of the
6 laws of 2005, are amended to read as follows:
7 (v) up to [five] eight hundred [seventy] sixty-six million three
8 hundred thousand dollars for the period January first, two thousand six
9 through December thirty-first, two thousand six; and
10 (vi) up to [one] two hundred [thirty] twenty-eight million eight
11 hundred thousand dollars for the period January first, two thousand
12 seven through June thirtieth, two thousand seven.
13 § 9. Subparagraphs (iv) and (v) of paragraph (mm) of subdivision 1 of
14 section 2807-v of the public health law, subparagraph (iv) as added and
15 subparagraph (v) as amended by section 3 of part B of chapter 58 of the
16 laws of 2005, are amended to read as follows:
17 (iv) three hundred [three] eighteen million seven hundred seventy-five
18 thousand dollars for the period January first, two thousand six through
19 December thirty-first, two thousand six; and
20 (v) one hundred [fifty-seven] sixty-two million two hundred twenty-
21 five thousand dollars for the period January first, two thousand seven
22 through June thirtieth, two thousand seven.
23 § 10. Subparagraphs (ii) and (iii) of paragraph (zz) of subdivision 1
24 of section 2807-v of the public health law, as added by chapter 161 of
25 the laws of 2005, are amended to read as follows:
26 (ii) [sixteen million two hundred fifty] one hundred eight million
27 three hundred thousand dollars for the period January first, two thou-
28 sand six through December thirty-first, two thousand six, provided,
29 however, that within amounts appropriated in the two thousand six
30 through two thousand seven state fiscal year, a portion of such funds
31 may be transferred to the Roswell Park Cancer Institute Corporation to
32 fund capital costs; and
33 (iii) [sixteen million two hundred fifty] eighty million eight hundred
34 thousand dollars for the period January first, two thousand seven
35 through June thirtieth, two thousand seven, provided, however, that
36 within amounts appropriated in the two thousand six through two thousand
37 seven state fiscal year, a portion of such funds may be transferred to
38 the Roswell Park Cancer Institute Corporation to fund capital costs.
39 § 10-a. Clause (A) of subparagraph (i) of paragraph (b) of subdivision
40 1 of section 2807-l of the public health law, as amended by section 19
41 of part B of chapter 58 of the laws of 2005, is amended to read as
42 follows:
43 (A) an amount not to exceed six million dollars on an annualized basis
44 for the periods January first, nineteen hundred ninety-seven through
45 December thirty-first, nineteen hundred ninety-nine; up to six million
46 dollars for the period January first, two thousand through December
47 thirty-first, two thousand; up to five million dollars for the period
48 January first, two thousand one through December thirty-first, two thou-
49 sand one; up to four million dollars for the period January first, two
50 thousand two through December thirty-first, two thousand two; up to two
51 million six hundred thousand dollars for the period January first, two
52 thousand three through December thirty-first, two thousand three; up to
53 one million three hundred thousand dollars for the period January first,
54 two thousand four through December thirty-first, two thousand four;
55 [and] up to six hundred seventy thousand dollars for the period January
56 first, two thousand five through June thirtieth, two thousand five; and
S. 6457--C 71 A. 9557--B
1 up to one million three hundred thousand dollars for the period April
2 first, two thousand six through March thirty-first, two thousand seven
3 shall be allocated to individual subsidy programs; and
4 § 10-b. Paragraph (jj) of subdivision 1 of section 2807-v of the
5 public health law, as amended by section 3 of part B of chapter 58 of
6 the laws of 2005, is amended to read as follows:
7 (jj) Funds shall be reserved and accumulated from year to year and
8 shall be available, including income from invested funds, for the
9 purposes of a grant program to improve access to infertility services,
10 treatments and procedures, from the tobacco control and insurance initi-
11 atives pool established for the period January first, two thousand two
12 through December thirty-first, two thousand two in the amount of nine
13 million one hundred seventy-five thousand dollars and for the period
14 April first, two thousand six through March thirty-first, two thousand
15 seven in the amount of five million dollars.
16 § 10-c. Subdivision 1 of section 2807-v of the public health law is
17 amended by adding two new paragraphs (aaa) and (bbb) to read as follows:
18 (aaa) Funds shall be reserved and accumulated from year to year and
19 shall be available, including income from invested funds, for services
20 and expenses related to school based health centers, in an amount up to
21 three million five hundred thousand dollars for the period April first,
22 two thousand six through March thirty-first, two thousand seven. The
23 total amount of funds provided herein shall be distributed as grants
24 based on the ratio of each provider's total enrollment for all sites to
25 the total enrollment of all providers. This formula shall be applied to
26 the total amount provided herein.
27 (bbb) Funds shall be reserved and accumulated from year to year and
28 shall be available, including income from invested funds, for purposes
29 of awarding grants to operators of adult homes, enriched housing
30 programs and residences through the enhancing abilities and life experi-
31 ence (EnAbLe) program to provide for the installation, operation and
32 maintenance of air conditioning in resident rooms in an amount up to two
33 million dollars for the period April first, two thousand six through
34 March thirty-first, two thousand seven.
35 § 10-c-1. Section 2807-p of the public health law is amended by adding
36 a new subdivision 4-c to read as follows:
37 4-c Notwithstanding any provision of law to the contrary, the commis-
38 sioner shall make additional payments for uncompensated care to volun-
39 tary non-profit diagnostic and treatment centers that are eligible for
40 distributions under subdivision four of this section in the following
41 amounts: for the period January first, two thousand six through December
42 thirty-first, two thousand six, in the amount of seven million five
43 hundred thousand dollars, and for the period January first, two thousand
44 seven through June thirtieth, two thousand seven, three million seven
45 hundred fifty thousand dollars. In the event that federal financial
46 participation is available for rate adjustments pursuant to this
47 section, the commissioner shall shall make such payments as additional
48 adjustments to rates of payment for voluntary non-profit diagnostic and
49 treatment centers that are eligible for distributions under subdivision
50 four-a of this section in the following amounts: for the period January
51 first, two thousand six thorough December thirty-first, two thousand
52 six, fifteen million dollars in the aggregate, and for the period Janu-
53 ary first, two thousand seven through June thirtieth, two thousand
54 seven, seven million five hundred thousand dollars in the aggregate. The
55 amounts allocated pursuant to this paragraph shall be aggregated with
56 and distributed pursuant to the same methodology applicable to the
S. 6457--C 72 A. 9557--B
1 amounts allocated to such diagnostic and treatment centers for such
2 periods pursuant to subdivision four of this section if federal finan-
3 cial participation is not available, or pursuant to subdivision four-a
4 of this section if federal financial participation is available.
5 Notwithstanding section three hundred sixty-eight-a of the social
6 services law, there shall be no local share in a medical assistance
7 payment adjustment under this subdivision.
8 § 10-c-2. Subparagraph (v) of paragraph (k) of subdivision 1 of
9 section 2807-1 of the public health law, as amended by section 19 of
10 part B of chapter 58 of the laws of 2005, is amended to read as follows:
11 (v) (A) from the pool for the period July first, two thousand three
12 through December thirty-first, two thousand three, up to six million
13 dollars, for the period January first, two thousand four through Decem-
14 ber thirty-first, two thousand six, up to twelve million dollars annual-
15 ly, and for the period January first, two thousand seven through June
16 thirtieth, two thousand seven, up to six million dollars; provided that
17 if federal financial participation is not available for rate adjustments
18 made pursuant to section twenty-eight hundred seven-p of this article
19 then the foregoing amounts shall be increased to the following: for the
20 period July first, two thousand three through December thirty-first, two
21 thousand three, twenty-four million dollars, for the period January
22 first, two thousand four through December thirty-first, two thousand
23 six, forty-eight million dollars annually, and for the period January
24 first, two thousand seven through June thirtieth, two thousand seven,
25 twenty-four million dollars;
26 (B) from the pool for the period January first, two thousand six
27 through December thirty-first, two thousand six, an additional seven
28 million five hundred thousand dollars and for the period January first,
29 two thousand seven through June thirtieth, two thousand seven, an addi-
30 tional three million seven hundred fifty thousand dollars for voluntary
31 non-profit diagnostic and treatment center uncompensated care in accord-
32 ance with subdivision four-c of section twenty-eight hundred seven-p of
33 this article;
34 § 10-d. Subdivision 1 of section 2807-v of the public health law is
35 amended by adding a new paragraph (ccc) to read as follows:
36 (ccc) Funds shall be deposited by the commissioner, within amounts
37 appropriated, and the state comptroller is hereby authorized and
38 directed to receive for the deposit to the credit of the state special
39 revenue funds - other, HCRA transfer fund, medical assistance account,
40 or any successor fund or account, for purposes of funding the state
41 share of increases in the rates for certified home health agencies, long
42 term home health care programs, AIDS home care programs, hospice
43 programs and managed long term care programs for recruitment and
44 retention of health care workers pursuant to subdivisions nine and ten
45 of section thirty-six hundred fourteen of this chapter from the tobacco
46 control and insurance initiatives pool established for the following
47 periods in the following amounts:
48 (i) twenty-five million dollars for the period April first, two thou-
49 sand six through December thirty-first, two thousand six; and
50 (ii) twenty-five million dollars for the period January first, two
51 thousand seven through June thirtieth, two thousand seven.
52 § 10-e. Subdivision 1 of section 2807-v of the public health law is
53 amended by adding a new paragraph (ddd) to read as follows:
54 (ddd) Funds shall be deposited by the commissioner, within amounts
55 appropriated, and the state comptroller is hereby authorized and
56 directed to receive for the deposit to the credit of the state special
S. 6457--C 73 A. 9557--B
1 revenue funds - other, HCRA transfer fund, medical assistance account,
2 or any successor fund or account, for purposes of funding the state
3 share of increases in the medical assistance rates for providers for
4 purposes of enhancing the provision, quality and/or efficiency of home
5 care services pursuant to subdivision eleven of section thirty-six
6 hundred fourteen of this chapter from the tobacco control and insurance
7 initiatives pool established for the following periods in the following
8 amounts:
9 (i) eight million dollars for the period April first, two thousand six
10 through December thirty-first, two thousand six; and
11 (ii) four million dollars for the period January first, two thousand
12 seven through June thirtieth, two thousand seven.
13 § 10-f. Section 3614 of the public health law is amended by adding
14 three new subdivisions 9, 10, and 11 to read as follows:
15 9. Notwithstanding any law to the contrary, the commissioner shall,
16 subject to the availability of federal financial participation, adjust
17 medical assistance rates of payment for certified home health agencies,
18 long term home health care programs, AIDS home care programs established
19 pursuant to this article, hospice programs established under article
20 forty of this chapter and for managed long term care programs authorized
21 pursuant to article forty-four of this chapter. Such adjustments shall
22 be for purposes of improving recruitment, training and retention of home
23 health aides or other personnel with direct patient care responsibility
24 in the following aggregate amounts for the following periods:
25 (a) for the period April first, two thousand six through December
26 thirty-first, two thousand six, fifty million dollars;
27 (b) for the period January first, two thousand seven through June
28 thirtieth, two thousand seven, fifty million dollars;
29 10. (a) Such adjustments to rates of payments shall be allocated
30 proportionally based on each certified home health agency's, long term
31 home health care program, AIDS home care and hospice program's home
32 health aide or other direct care services total annual hours of service
33 provided, as reported in each such agency's cost report as submitted to
34 the department prior to November first, two thousand five or for the
35 purpose of the managed long term care program a suitable proxy developed
36 by the department in consultation with the interested parties. Payments
37 made pursuant to this section shall not be subject to subsequent adjust-
38 ment or reconciliation.
39 (b) Programs which have their rates adjusted pursuant to this subdivi-
40 sion shall use such funds solely for the purposes of recruitment, train-
41 ing and retention of non-supervisory home care services workers or other
42 personnel with direct patient care responsibility. Such purpose shall
43 include the recruitment, training and retention of non-supervisory home
44 care services workers or any worker with direct patient care responsi-
45 bility employed in licensed home care services agencies under contract
46 with such agencies. Such agencies are prohibited from using such fund
47 for any other purpose. For purposes of the long term home health care
48 program, such payment shall be treated as supplemental payments and not
49 effect any current cost cap requirement. Each such agency shall submit,
50 at a time and in a manner determined by the commissioner, a written
51 certification attesting that such funds will be used solely for the
52 purpose of recruitment, training and retention of non-supervisory home
53 health aides or any personnel with direct patient care responsibility.
54 The commissioner is authorized to audit each such agency or program to
55 ensure compliance with the written certification required by this subdi-
56 vision and shall recoup any funds determined to have been used for
S. 6457--C 74 A. 9557--B
1 purposes other than recruitment and retention of non-supervisory home
2 health aids or other personnel with direct patient care responsibility.
3 Such recoupment shall be in addition to any other penalties provided by
4 law.
5 (c) In the case of services provided by such agencies or programs
6 through contracts with licensed home care services agencies, rate
7 increases received by such agencies or programs pursuant to this subdi-
8 vision shall be reflected, consistent with the purposes of this subdivi-
9 sion, in either the fees paid or benefits or other supports, including
10 training, provided to non-supervisory home health aides or any other
11 personnel with direct patient care responsibility of such contracted
12 licensed home care services agencies and such fees, benefits or other
13 supports shall be proportionate to the contracted volume of services
14 attributable to each contracted agency. Such agencies or programs shall
15 submit to providers with which they contract written certifications
16 attesting that such funds will be used solely for the purposes of
17 recruitment, training and retention of non-supervisory home health aides
18 or other personnel with direct patient care responsibility and shall
19 maintain in their files expenditure plans specifying how such funds will
20 be used for such purposes. The commissioner is authorized to audit such
21 agencies or programs to ensure compliance with such certifications and
22 expenditure plans and shall recoup any funds determined to have been
23 used for purposes other than those set forth in this subdivision. Such
24 recoupment shall be in addition to any other penalties provided by law.
25 (d) Funds under this subdivision are not intended to supplant support
26 provided by local government.
27 11. (a) Notwithstanding any inconsistent provision of law, rule or
28 regulation and subject to the availability of federal financial partic-
29 ipation, the commissioner is authorized and directed to implement a
30 program whereby he or she shall adjust medical assistance rates of
31 payment for services provided by certified home health agencies, long
32 term home health care programs, AIDS home care programs and providers of
33 personal care services and/or providers of private duty nursing services
34 under the social services law in accordance with this subdivision for
35 purposes of enhancing the provision, accessibility, quality and/or effi-
36 ciency of home care services. Such rate adjustments shall be for the
37 purposes of assisting such providers, located in social services
38 districts which do not include a city with a population of over one
39 million persons, in meeting the cost of:
40 (i) Increased use of technology in the delivery of services, including
41 telehealth and clinical and administrative management information
42 system;
43 (ii) Specialty training of direct service personnel in dementia care,
44 pediatric care and/or the care of other conditions or populations with
45 complex needs;
46 (iii) Increased auto and travel expenses associated with rising fuel
47 prices, including the increased cost of providing services in remote
48 areas; and/or
49 (v) Providing enhanced access to care for high need populations;
50 (vi) Such other purposes related to the provision of quality, accessi-
51 ble home care services as the commissioner may deem appropriate.
52 (b) The commissioner shall increase the medical assistance rates of
53 payment pursuant to this subdivision in an amount up to an aggregate of
54 sixteen million dollars for the period April first, two thousand six
55 through March thirty-first, two thousand seven, provided however that if
56 federal financial participation is not available for rate adjustments
S. 6457--C 75 A. 9557--B
1 pursuant to this subdivision such aggregate amount shall not exceed
2 eight million dollars, and provided, further, however, that for purposes
3 of long term home health care programs, such payments provided pursuant
4 to this subdivision shall be treated as supplemental payments and shall
5 not effect any current cost cap requirement.
6 § 10-g. Paragraph (e) of subdivision 1 of section 367-q of the social
7 services law, as added by section 12 of part B of chapter 58 of the laws
8 of 2005, is amended to read as follows:
9 (e) for the period January first, two thousand six through December
10 thirty-first, two thousand six, [twenty-seven] thirty-one million
11 dollars; and
12 § 10-g-1. Subdivision 1 of section 2807-v of the public health law is
13 amended by adding a new paragraph (eee) to read as follows:
14 (eee) Funds shall be reserved and accumulated from year to year and
15 shall be available, including income from invested funds, to the Center
16 for Functional Genomics at the State University of New York at Albany,
17 for the purposes of the Adirondack network for cancer education and
18 research in rural communities grant program to improve access to health
19 care and shall be made available from the tobacco control and insurance
20 initiatives pool established for the following periods in the following
21 amounts:
22 (i) up to five million dollars for the period January first, two thou-
23 sand six through December thirty-first, two thousand six;
24 (ii) up to two million five hundred thousand dollars for the period
25 January first, two thousand seven through June thirtieth, two thousand
26 seven.
27 § 10-h. Subparagraph (iii) of paragraph (a) of subdivision 30 of
28 section 2807-c of the public health law, as amended by section 3 of part
29 E of chapter 63 of the laws of 2005, is amended to read as follows:
30 (iii) The commissioner shall establish, subject to the approval of the
31 director of the budget, discrete rates of payment for non-public general
32 hospitals for payments under the medical assistance program pursuant to
33 titles eleven and eleven-D of article five of the social services law
34 for persons eligible for medical assistance and family health plus who
35 are enrolled in health maintenance organizations based upon the calcu-
36 lation set forth in subparagraph (ii) of this paragraph for such non-
37 public general hospitals. If discrete rates of payment under this
38 subparagraph are not established, the commissioner shall adjust the
39 calculation established pursuant to subparagraph (ii) of this paragraph
40 to account for medical assistance utilization described under this
41 subparagraph for such non-public general hospital.
42 § 10-i. Subparagraphs (iii) and (iv) of paragraph (e) of subdivision
43 30 of section 2807-c of the public health law, as added by section 3 of
44 part E of chapter 63 of the laws of 2005, are amended to read as
45 follows:
46 (iii) The commissioner shall establish, subject to the approval of the
47 director of the budget, discrete rates of payment for general hospitals
48 for payments under the medical assistance program pursuant to titles
49 eleven and eleven-D of article five of the social services law for
50 persons eligible for medical assistance and family health plus who are
51 enrolled in health maintenance organizations based on the calculation
52 set forth in subparagraph (ii) of this paragraph for such general hospi-
53 tals. If discrete rates of payment under this subparagraph are not
54 established, the commissioner shall adjust the calculation established
55 pursuant to subparagraph (ii) of this paragraph to account for medical
S. 6457--C 76 A. 9557--B
1 assistance utilization described under this subparagraph for such non-
2 public general hospital.
3 (iv) Payment of the non-federal share of the medical assistance
4 payments made pursuant to this paragraph shall be the responsibility of
5 the state and shall not include a local share. Payments made pursuant to
6 this paragraph or pursuant to paragraph (a) of this subdivision may be
7 added to rates of payment or made as aggregate payments to eligible
8 general hospitals.
9 § 10-j. Subdivision 30 of section 2807-c of the public health law is
10 amended by adding a new paragraph (f) to read as follows:
11 (f) In the event that a hospital entitled to an adjustment pursuant to
12 paragraph (a) or (e) of this subdivision closes or otherwise experiences
13 a change in status that eliminates its ability to continue to receive
14 such adjustments, the commissioner shall allocate the amount determined
15 under subparagraph (ii) of paragraph (a) and subparagraph (ii) of para-
16 graph (e) of this subdivision for such hospital to hospitals in the
17 immediate region of the closing hospital based upon the remaining hospi-
18 tals' reported gross salary and fringe benefit costs as reported on
19 exhibit eleven of the two thousand four institutional cost report
20 submitted as of November first, two thousand five to the total of such
21 reported costs for all general hospitals in the region. The commissioner
22 shall define the immediate region as the county or counties within which
23 workers displaced from the closing hospital are likely to seek re-em-
24 ployment.
25 § 11. Section 2807-b of the public health law is REPEALED and a new
26 section 2807-b is added to read as follows:
27 § 2807-b. Outstanding payments and reports due under subdivision
28 eighteen of section twenty-eight hundred seven-c, sections twenty-eight
29 hundred seven-d, twenty-eight hundred seven-j, twenty-eight hundred
30 seven-s and twenty-eight hundred seven-t of this article. 1. If there
31 is a basis for estimating the amount of outstanding payments due in
32 accordance with subdivision eighteen of section twenty-eight hundred
33 seven-c of this article, and sections twenty-eight hundred seven-d,
34 twenty-eight hundred seven-j, twenty-eight hundred seven-s and twenty-
35 eight hundred seven-t of this article, the commissioner shall bill
36 applicable providers and payors for such payments, including any inter-
37 est and penalties set forth in this article, no later than ninety days
38 after each calendar quarter following enactment of this section.
39 2. If there is no basis for estimating the amount of outstanding
40 payments due in accordance with subdivision eighteen of section twenty-
41 eight hundred seven-c of this article, and sections twenty-eight hundred
42 seven-d, twenty-eight hundred seven-j, twenty-eight hundred seven-s and
43 twenty-eight hundred seven-t of this article, the commissioner shall
44 notify applicable providers and payors of outstanding reports and
45 payments no later than ninety days after each calendar quarter following
46 the effective date of this section. Such notice shall include informa-
47 tion regarding any interest, penalties or other sanctions which may be
48 implemented in accordance with this article.
49 § 12. Paragraph (d) of subdivision 18 of section 2807-c of the public
50 health law, as amended by chapter 1 of the laws of 1999, is amended to
51 read as follows:
52 (d) Gross revenue received shall mean all moneys received for or on
53 account of inpatient hospital service, provided, however, that subject
54 to the provisions of paragraph (e) of this subdivision gross revenue
55 received shall not include distributions from bad debt and charity care
56 regional pools, health care services pools, bad debt and charity care
S. 6457--C 77 A. 9557--B
1 for financially distressed hospitals statewide pools and bad debt and
2 charity care and capital statewide pools created in accordance with this
3 section or distributions from funds allocated in accordance with section
4 twenty-eight hundred seven-l, twenty-eight hundred seven-k, twenty-eight
5 hundred seven-v or twenty-eight hundred seven-w of this article and
6 shall not include the components of rates of payment or charges related
7 to the allowances provided in accordance with subdivisions fourteen,
8 fourteen-b and fourteen-c of this section, the adjustment provided in
9 accordance with subdivision fourteen-a of this section, the adjustment
10 provided in accordance with subdivision fourteen-d of this section, the
11 adjustment for health maintenance organization reimbursement rates
12 provided in accordance with former subdivision two-a of this section,
13 or, if effective, the adjustment provided in accordance with subdivision
14 fifteen of this section [or] the adjustment provided in accordance with
15 section eighteen of chapter two hundred sixty-six of the laws of nine-
16 teen hundred eighty-six as amended, revenue received from physician
17 practice or faculty practice plan discrete billings for private practic-
18 ing physician services, revenue from affiliation agreements or contracts
19 with public hospitals for the delivery of health care services at such
20 public hospitals, revenue received as disproportionate share hospital
21 payments in accordance with title nineteen of the federal social securi-
22 ty act, or revenue from government deficit financing.
23 § 13. Paragraph (a) of subdivision 3 of section 2807-d of the public
24 health law, as amended by chapter 161 of the laws of 2005, is amended to
25 read as follows:
26 (a) for general hospitals, all monies received for or on account of
27 inpatient hospital service, outpatient service, emergency service,
28 referred ambulatory service and ambulatory surgical service, or other
29 hospital or health-related services, excluding, subject to the
30 provisions of subdivision twelve of this section: distributions from bad
31 debt and charity care regional pools, primary health care services
32 regional pools, bad debt and charity care for financially distressed
33 hospitals statewide pools and bad debt and charity care and capital
34 statewide pools created in accordance with section twenty-eight hundred
35 seven-c of this article and the components of rates of payment or charg-
36 es related to the allowances provided in accordance with subdivisions
37 fourteen, fourteen-b and fourteen-c, the adjustment provided in accord-
38 ance with subdivision fourteen-a, the adjustment provided in accordance
39 with subdivision fourteen-d, the adjustment for health maintenance
40 organization reimbursement rates provided in accordance with section
41 twenty-eight hundred seven-f of this article, the adjustment for commer-
42 cial insurer reimbursement rates provided in accordance with paragraph
43 (i) of subdivision eleven of section twenty-eight hundred seven-c of
44 this article or, if effective, the adjustment provided in accordance
45 with subdivision fifteen of section twenty-eight hundred seven-c of this
46 article or the adjustment provided in accordance with section eighteen
47 of chapter two hundred sixty-six of the laws of nineteen hundred eight-
48 y-six as amended and physician practice or faculty practice plan revenue
49 received by a general hospital based on discrete billings for private
50 practicing physician services, revenue received by a general hospital
51 from a public hospital pursuant to an affiliation agreement contract for
52 the delivery of health care services to such public hospital, revenue
53 received pursuant to section twenty-eight hundred seven-w of this arti-
54 cle, all revenue received as disproportionate share hospital payments,
55 in accordance with title nineteen of the federal Social Security Act,
56 revenue received pursuant to sections eleven, twelve, thirteen and four-
S. 6457--C 78 A. 9557--B
1 teen of part A of chapter one of the laws of two thousand two, [and]
2 revenue received pursuant to sections thirteen and fourteen of part B of
3 chapter one of the laws of two thousand two, revenue from patient
4 personal fund allowances, revenue from income earned on patient funds,
5 investment income from externally restricted funds, revenue from invest-
6 ment sinking funds, revenue from investment operating escrow accounts,
7 investment income from funded depreciation, investment income from mort-
8 gage repayment escrow accounts, revenue derived from the operation of
9 schools leading to licensure, and revenue from the collection of sales
10 and excise taxes;
11 § 14. Subdivision 12 of section 2807-k of the public health law is
12 amended by adding a new paragraph (c) to read as follows:
13 (c) Such reports shall comply with the reporting requirements estab-
14 lished for receipt of bad debt and charity care pool payments as
15 provided in accordance with section twenty-eight hundred seven-c of this
16 article and regulations promulgated thereunder for periods prior to
17 January first, nineteen hundred ninety-seven.
18 § 15. Paragraph (f) of subdivision 18 of section 2807-c of the public
19 health law, as added by section 42 of part B of chapter 58 of the laws
20 of 2005, is amended to read as follows:
21 (f) Payments of assessments and allowances required to be submitted by
22 general hospitals pursuant to this subdivision and subdivisions fourteen
23 and fourteen-b of this section and paragraph (a) of subdivision two of
24 section twenty-eight hundred seven-d of this article shall be subject to
25 audit by the commissioner for a period of six years following the close
26 of the calendar year in which such payments are due, after which such
27 payments shall be deemed final and not subject to further adjustment or
28 reconciliation, provided, however, that nothing herein shall be
29 construed as precluding the commissioner from pursuing collection of any
30 such assessments and allowances which are identified as delinquent with-
31 in such six year period, or which are identified as delinquent as a
32 result of an audit commenced within such six year audit period, or from
33 conducting an audit of any adjustment or reconciliation made by a gener-
34 al hospital within such six year period. General hospitals which, in
35 the course of such an audit, fail to produce data or documentation
36 requested in furtherance of such an audit, within thirty days of such
37 request may be assessed a civil penalty of up to ten thousand dollars
38 for each such failure, provided, however, that such civil penalty shall
39 not be imposed if the hospital demonstrates good cause for such failure.
40 The imposition of such civil penalties shall be subject to the
41 provisions of section twelve-a of this chapter.
42 § 16. Paragraph (a) of subdivision 8-a of section 2807-j of the public
43 health law, as added by section 43 of part B of chapter 58 of the laws
44 of 2005, is amended to read as follows:
45 (a) Payments and reports submitted or required to be submitted to the
46 commissioner or to the commissioner's designee pursuant to this section
47 and section twenty-eight hundred seven-s of this article by designated
48 providers of services and by third-party payors which have elected to
49 make payments directly to the commissioner or to the commissioner's
50 designee in accordance with subdivision five-a of this section, shall be
51 subject to audit by the commissioner for a period of six years following
52 the close of the calendar year in which such payments and reports are
53 due, after which such payments shall be deemed final and not subject to
54 further adjustment or reconciliation, provided, however, that nothing
55 herein shall be construed as precluding the commissioner from pursuing
56 collection of any such payments which are identified as delinquent with-
S. 6457--C 79 A. 9557--B
1 in such six year period, or which are identified as delinquent as a
2 result of an audit commenced within such six year period, or from
3 conducting an audit of any adjustment or reconciliation made by a desig-
4 nated provider of services or by a third party payor which has elected
5 to make such payments directly to the commissioner or the commissioner's
6 designee.
7 § 17. Paragraph (a) of subdivision 10 of section 2807-t of the public
8 health law, as added by section 45 of part B of chapter 58 of the laws
9 of 2005, is amended to read as follows:
10 (a) Payments and reports submitted or required to be submitted to the
11 commissioner or to the commissioner's designee pursuant to this section
12 by specified third-party payors shall be subject to audit by the commis-
13 sioner for a period of six years following the close of the calendar
14 year in which such payments and reports are due, after which such
15 payments shall be deemed final and not subject to further adjustment or
16 reconciliation, provided, however, that nothing herein shall be
17 construed as precluding the commissioner from pursuing collection of any
18 such payments which are identified as delinquent within such six year
19 period, or which are identified as delinquent as a result of an audit
20 commenced within such six year period, or from conducting an audit of
21 any adjustments and reconciliation made by a specified third party payor
22 within such six year period.
23 § 18. Section 2807-w of the public health law is amended by adding a
24 new subdivision 4 to read as follows:
25 4. In order for a general hospital to be eligible to participate in
26 the distribution of funds pursuant to this section, such general hospi-
27 tal must be in compliance with the provisions of subdivisions nine, ten
28 and twelve of section twenty-eight hundred seven-k of this article.
29 § 19. Paragraph (a) of subdivision 2 of section 2816 of the public
30 health law, as amended by chapter 225 of the laws of 2001 and subpara-
31 graph (iii) as amended and subparagraph (iv) as added by chapter 440 of
32 the laws of 2005, is amended to read as follows:
33 (a) Specification of patient and other data elements and format to be
34 reported including data related to:
35 (i) inpatient hospitalization data from general hospitals;
36 (ii) ambulatory surgery data from hospital-based ambulatory surgery
37 services and all other ambulatory surgery facilities licensed under this
38 article;
39 (iii) emergency department data from general hospitals; [and]
40 (iv) outpatient clinic data from general hospitals and diagnostic and
41 treatment centers licensed under this article, provided, however, that
42 notwithstanding subdivision one of this section the commissioner, in
43 consultation with the health care industry, is authorized to promulgate
44 or adopt any rules or regulations necessary to implement the collection
45 of data pursuant to this subparagraph; and
46 (v) the data specified in this paragraph shall include the identifica-
47 tion of patients transferred, admitted or treated subsequent to a
48 medical, surgical or diagnostic procedure by a licensed health care
49 professional at a site or facility other than those specified in subpar-
50 agraph (i), (ii), [or] (iii) or (iv) of this paragraph.
51 § 20. Subdivision (c) of section 92-dd of the state finance law, as
52 amended by chapter 161 of the laws of 2005, is amended to read as
53 follows:
54 (c) The pool administrator shall, from appropriated funds transferred
55 to the pool administrator from the comptroller, continue to make
56 payments as required pursuant to sections twenty-eight hundred seven-k,
S. 6457--C 80 A. 9557--B
1 twenty-eight hundred seven-m (not including payments made pursuant to
2 subdivision seven of section twenty-eight hundred seven-m), and twenty-
3 eight hundred seven-w of the public health law, paragraph (e) of subdi-
4 vision twenty-five of section twenty-eight hundred seven-c of the public
5 health law, paragraphs (b) and (c) of subdivision thirty of section
6 twenty-eight hundred seven-c of the public health law, paragraph (b) of
7 subdivision eighteen of section twenty-eight hundred eight of the public
8 health law, subdivision seven of section twenty-five hundred-d of the
9 public health law and section eighty-eight of chapter one of the laws of
10 nineteen hundred ninety-nine.
11 § 21. Intentionally omitted.
12 § 22. Subdivision 18 of section 2807-c of the public health law is
13 amended by adding a new paragraph (g) to read as follows:
14 (g) If a general hospital fails to produce data or documentation
15 requested in furtherance of an audit for a month to which an assessment
16 applies, the commissioner may estimate, based on available financial and
17 statistical data as determined by the commissioner, the amount due for
18 such month. If the impact of exemptions permitted pursuant to paragraph
19 (d) of this subdivision cannot be determined from such available finan-
20 cial and statistical data the estimated amount due may be calculated on
21 the basis of the general hospital's aggregate gross inpatient revenue
22 amount, as determined from such available financial and statistical data
23 for the year subject to audit. Estimated amounts due pursuant to this
24 paragraph shall be paid by a general hospital within sixty days or with-
25 in such other time period as agreed to by the commissioner and the
26 facility. Thereafter the commissioner shall take all necessary steps to
27 collect amounts owed pursuant to this paragraph, including by offset-
28 ting, or by directing the state comptroller to offset, such amounts due
29 from any other payments made by state governmental agencies to the
30 general hospital pursuant to this article. Interest and penalties shall
31 be applied to such amounts due in accordance with the provisions of
32 paragraph (c) of subdivision twenty of this section.
33 § 23. Paragraph (c) of subdivision 6 of section 2807-j of the public
34 health law, as added by chapter 639 of the laws of 1996, is amended to
35 read as follows:
36 (c) Upon receipt of notification from the commissioner of a designated
37 provider of services' deficiency under this section, the comptroller or
38 a fiscal intermediary designated by the director of the budget, or the
39 commissioner of [social services] the office of temporary and disability
40 assistance, or a corporation organized and operating in accordance with
41 article forty-three of the insurance law, or an organization operating
42 in accordance with article forty-four of this chapter shall withhold
43 from the amount of any payment to be made by the state or by such arti-
44 cle forty-three corporation or article forty-four organization to the
45 designated provider of services the amount of the deficiency determined
46 under paragraph (a), (b) or (e) of this subdivision or paragraph (d) of
47 subdivision eight-a of this section. Upon withholding such amount, the
48 comptroller or a designated fiscal intermediary, or the commissioner of
49 [social services] the office of temporary and disability assistance, or
50 corporation organized and operating in accordance with article forty-
51 three of the insurance law or organization operating in accordance with
52 article forty-four of this chapter shall pay the commissioner, or the
53 commissioner's designee, such amount withheld on behalf of the desig-
54 nated provider of services. Such amount shall represent, in whole or in
55 part, the amounts due from the designated provider of services.
S. 6457--C 81 A. 9557--B
1 § 24. Paragraph (d) of subdivision 6 of section 2807-j of the public
2 health law, as added by chapter 639 of the laws of 1996, is amended to
3 read as follows:
4 (d) The commissioner shall provide a designated provider of services
5 with notice of any estimate of an amount due for an allowance pursuant
6 to paragraph (a) or (b) of this subdivision or paragraph (d) of subdivi-
7 sion eight-a of this section at least three days prior to collection of
8 such amount by the commissioner. Such notice shall contain the financial
9 basis for the commissioner's estimate.
10 § 25. Paragraph (e) of subdivision 6 of section 2807-j of the public
11 health law, as added by chapter 639 of the laws of 1996, is amended to
12 read as follows:
13 (e) In the event a designated provider of services objects to an esti-
14 mate by the commissioner pursuant to paragraph (a) or (b) of this subdi-
15 vision or paragraph (d) of subdivision eight-a of this section of the
16 amount due for an allowance, the designated provider of services, within
17 sixty days of notice of an amount due, may request a public hearing. If
18 a hearing is requested, the commissioner shall provide the designated
19 provider of services an opportunity to be heard and to present evidence
20 bearing on the amount due for an allowance within thirty days after
21 collection of an amount due or receipt of a request for a hearing,
22 whichever is later. An administrative hearing is not a prerequisite to
23 seeking judicial relief.
24 § 26. Subdivision 8-a of section 2807-j of the public health law is
25 amended by adding a new paragraph (d) to read as follows:
26 (d) If a designated provider of services or a third party payor fails
27 to produce data or documentation requested in furtherance of an audit
28 pursuant to this section or pursuant to section twenty-eight hundred
29 seven-s of this article, for a month to which an allowance applies, the
30 commissioner may estimate, based on available financial and statistical
31 data as determined by the commissioner, the amount due for such month.
32 If the impact of the patient services revenue exemptions specified
33 pursuant to this section, or pursuant to section twenty-eight hundred
34 seven-s of this article, cannot be determined from such available finan-
35 cial and statistical data, the amount due may be calculated on the basis
36 of the aggregate total of patient services revenue derived from such
37 data for the year subject to audit. The commissioner shall take all
38 necessary steps to collect amounts due as determined pursuant to this
39 paragraph, including directing the state comptroller to offset such
40 amounts due from any payments made by the state pursuant to this article
41 to a designated provider of services or a third party payor. Interest
42 and penalties shall be applied to such amounts due in accordance with
43 the provisions of subdivision eight of this section.
44 § 27. Subdivision 10 of section 2807-t of the public health law is
45 amended by adding a new paragraph (d) to read as follows:
46 (d) If a specified third-party payor fails to produce data or documen-
47 tation requested in furtherance of an audit pursuant to this section for
48 a month to which an assessment applies, the commissioner may estimate,
49 based on available financial and statistical data as determined by the
50 commissioner, the amount due for such month. If the impact of the
51 enrollment exemptions permitted pursuant to this section cannot be
52 determined from such available financial and statistical data, the esti-
53 mated amount due may be calculated on the basis of aggregate data
54 derived from such available data for the year subject to audit. The
55 commissioner shall take all necessary steps to collect amounts due as
56 determined pursuant to this paragraph, including directing the state
S. 6457--C 82 A. 9557--B
1 comptroller to offset such amounts due from any payments made by the
2 state to the third party payor pursuant to this article. Interest and
3 penalties shall be applied to such amounts due in accordance with the
4 provisions of subdivision eight of section twenty-eight hundred seven-j
5 of this article.
6 § 28. Intentionally omitted
7 § 29. Intentionally omitted
8 § 30. Subdivision 3 of section 1680-j of the public authorities law,
9 as added by section 54 of part B of chapter 58 of the laws of 2005, is
10 amended to read as follows:
11 3. Notwithstanding any law in the contrary, and in accordance with
12 section four of the state finance law, the comptroller is hereby author-
13 ized and directed to transfer from the health care reform act (HCRA)
14 resources fund [(F04)] (061) to the general fund, upon the request of
15 the director of the budget, up to $6,500,000 on or before March 31,
16 2006, and the comptroller is further hereby authorized and directed to
17 transfer from the healthcare reform act (HCRA); Resources fund (061) to
18 the Capital Projects Fund, upon the request of the director of budget,
19 up to [$16,250,000] $139,000,000 for the period April 1, 2006 through
20 March 31, 2007 [and], up to [$32,500,000] $170,976,000 for the period
21 April 1, 2007 through March 31, 2008, and up to $198,408,000 for the
22 period April 1, 2008 through March 31, 2009.
23 § 30-a. The five undesignated paragraphs of section 2818 of the public
24 health law, are designated subdivision 1 and a new subdivision 2 is
25 added to read as follows:
26 2. Notwithstanding the provisions of subdivision one of this section,
27 the commissioner and the director of the dormitory authority may award,
28 in an amount not to exceed twenty-five percent of the health care system
29 improvement capital grant program allocation in any given fiscal year,
30 grants to eligible applicants without the process set forth in subdivi-
31 sion one of this section. With respect to the process for the awarding
32 of such funds without the process set forth in subdivision one of this
33 section, the commissioner and the director of the dormitory authority
34 shall determine eligible awardees based solely on an applicant's ability
35 to meet the following criteria:
36 (i) Have a loss from operations for each of the three consecutive
37 preceding years as evidenced by audited financial statements; and
38 (ii) Have a negative fund balance or negative equity position in each
39 of the three preceding years as evidenced by audited financial state-
40 ments; and
41 (iii) Have a current ratio of less than 1:1 for each of three consec-
42 utive preceding years; or
43 (iv) Be deemed to the satisfaction of the commissioner to be a provid-
44 er that fulfills an unmet health care need for the community as deter-
45 mined by the department through consideration of the volume of Medicaid
46 and medically indigent patients served; the service volume and mix,
47 including but not limited to maternity, pediatrics, trauma, behavioral
48 and neurobehavioral, ventilator, and emergency room volume; and, the
49 significance of the institution in ensuring health care services access
50 as measured by market share within the region.
51 (c) Prior to an award being granted to an eligible applicant without a
52 competitive bid or request for proposal process, the commissioner and
53 the director of the dormitory authority shall notify the chair of the
54 senate finance committee, the chair of the assembly ways and means
55 committee and the director of the division of budget of the intent to
56 grant such an award. Such notice shall include information regarding how
S. 6457--C 83 A. 9557--B
1 the eligible applicant meets criteria established pursuant to this
2 section.
3 § 31. Notwithstanding any inconsistent provision of law, rule or regu-
4 lation, for the purposes of implementing the provisions of the public
5 health law, tax law, state finance law, insurance law and the social
6 services law, references to titles XIX and XXI of the federal social
7 security act in the public health law and the social services law shall
8 be deemed to include and also to mean any successor titles thereto under
9 the federal social security act.
10 § 32. Notwithstanding any inconsistent provision of law, rule or regu-
11 lation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of section
12 2807 of the public health law and section 18 of chapter 2 of the laws of
13 1988, as they relate to time frames for notice, approval or certif-
14 ication of rates of payment, are hereby suspended and shall, for
15 purposes of implementing the provisions of this act, be deemed to have
16 been without any force or effect from and after November 1, 2005 for
17 such rates effective for the period January 1, 2006 through December 31,
18 2006.
19 § 33. Severability clause. If any clause, sentence, paragraph, subdi-
20 vision, section or part of this act shall be adjudged by any court of
21 competent jurisdiction to be invalid, such judgment shall not affect,
22 impair or invalidate the remainder thereof, but shall be confined in its
23 operation to the clause, sentence, paragraph, subdivision, section or
24 part thereof directly involved in the controversy in which such judgment
25 shall have been rendered. It is hereby declared to be the intent of the
26 legislature that this act would have been enacted even if such invalid
27 provisions had not been included herein.
28 § 34. This act shall take effect immediately provided, however, that:
29 1. Intentionally omitted.
30 2. The amendments to paragraph (d) of subdivision 18 of section 2807-c
31 of the public health law made by section twelve of this act shall not
32 affect the expiration of such paragraph and shall be deemed to expire
33 therewith;
34 3. The amendments to section 2807-j of the public health law made by
35 sections sixteen, twenty-three, twenty-four, twenty-five and twenty-six
36 of this act shall not affect the expiration of such section and shall be
37 deemed to expire therewith;
38 4. The amendments to section 2807-t of the public health law made by
39 sections seventeen and twenty-seven of this act shall not affect the
40 expiration of such section and shall be deemed to expire therewith;
41 5. Any rules or regulations necessary to implement the provisions of
42 this act may be promulgated and any procedures, forms, or instructions
43 necessary for such implementation may be adopted and issued on or after
44 the date this act shall have become a law;
45 6. This act shall not be construed to alter, change, affect, impair or
46 defeat any rights, obligations, duties or interest accrued, incurred or
47 conferred prior to the enactment of this act;
48 7. The commissioner of health and superintendent of insurance and any
49 appropriate council may take any steps necessary to implement provisions
50 of this act prior to its effective date;
51 8. Notwithstanding any inconsistent provision of the state administra-
52 tive procedure act or any other provision of law, rule or regulation,
53 the commissioner of health and the superintendent of insurance and any
54 appropriate council is authorized to adopt or amend or promulgate on an
55 emergency basis any regulation he or she or such council determines
S. 6457--C 84 A. 9557--B
1 necessary to implement any provision of this act on its effective date;
2 and
3 9. The provisions of this act shall become effective notwithstanding
4 the failure of the commissioner of health or the superintendent of
5 insurance or any council to adopt or amend or promulgate regulations
6 implementing this act.
7 PART E
8 Intentionally omitted.
9 PART F
10 Intentionally omitted.
11 PART G
12 Section 1. There shall be established the office of Health e-Links
13 New York within the New York state department of health, which shall be
14 headed by a state coordinator to enhance the adoption of an interopera-
15 ble regional health information exchange and technology infrastructure
16 that will improve quality, reduce the cost of health care, ensure
17 patient privacy and security, enhance public health reporting including
18 bioterrorism surveillance and facilitate health care research in the
19 state of New York.
20 § 2. This act shall take effect immediately.
21 PART H
22 Section 1. Section 3 of chapter 119 of the laws of 1997 relating to
23 authorizing the department of health to establish certain payments to
24 general hospitals, as amended by section 1 of part S2 of chapter 62 of
25 the laws of 2003, is amended to read as follows:
26 § 3. This act shall take effect immediately and shall be deemed to
27 have been in full force and effect on and after April 1, 1997. This act
28 shall expire [March 31, 2006] April 1, 2009.
29 § 2. This act shall take effect immediately and shall be deemed to
30 have been in full force and effect on and after April 1, 2006.
31 PART I
32 Intentionally omitted.
33 PART J
34 Section 1. Paragraph (j) of subdivision 4 of section 214 of the elder
35 law, as amended by section 3 of part E of chapter 58 of the laws of
36 2005, is amended to read as follows:
37 (j) Within the amounts appropriated therefor, counties authorized to
38 provide expanded non-medical in-home services, non-institutional respite
39 services, case management services, and ancillary services pursuant to
40 paragraph (i) of this subdivision shall be eligible for reimbursement by
41 the state of up to seventy-five percent of allowable expenditures for
42 approved services pursuant to this section up to the level authorized by
43 the director. The director shall not authorize a level of state
44 reimbursement pursuant to this paragraph which exceeds the sum of nine-
S. 6457--C 85 A. 9557--B
1 ty-one thousand two hundred fifty dollars or seven dollars thirty cents
2 for each elderly person residing in the county, whichever is greater,
3 and shall proportionately reduce such sum for each county in any years
4 for which appropriations are not sufficient to fully fund approved
5 expanded non-medical in-home services, non-institutional respite
6 services, case management services, and ancillary services for func-
7 tionally impaired elderly in all counties with approved home care plans;
8 provided however that in state fiscal years beginning on or after the
9 first day of April, two thousand five, the director, with the approval
10 of the director of the budget, may authorize state reimbursement in
11 excess of these levels to the extent appropriations are available there-
12 for, and further provided that within the amounts appropriated for such
13 expanded in-home, case management and ancillary community services for
14 the elderly (EISEP) in the 2005-2006 fiscal year, any contrary provision
15 of this section notwithstanding, the sum of ten million dollars shall be
16 available for reimbursement to counties at ninety percent of allowable
17 expenditures for liabilities heretofore or hereafter to accrue, and
18 further provided that within the amounts appropriated for such expanded
19 in-home, case management and ancillary community services for the elder-
20 ly (EISEP) in the 2006-2007 fiscal year, any contrary provision of this
21 section notwithstanding, the sum of twenty-five million dollars shall be
22 available for reimbursement to counties at ninety percent of allowable
23 expenditures for liabilities heretofore or hereafter to accrue.
24 § 2. Paragraph (j) of subdivision 4 of section 214 of the elder law is
25 amended to read as follows:
26 (j) Within the amounts appropriated therefor, counties authorized to
27 provide expanded non-medical in-home services, non-institutional respite
28 services, case management services, and ancillary services pursuant to
29 paragraph (i) of this subdivision shall be eligible for reimbursement by
30 the state of up to seventy-five percent of allowable expenditures for
31 approved services pursuant to this section up to the level authorized by
32 the director. The director shall not authorize a level of state
33 reimbursement pursuant to this paragraph which exceeds the sum of nine-
34 ty-one thousand two hundred fifty dollars or seven dollars thirty cents
35 for each elderly person residing in the county, whichever is greater,
36 and shall proportionately reduce such sum for each county in any years
37 for which appropriations are not sufficient to fully fund approved
38 expanded non-medical in-home services, non-institutional respite
39 services, case management services, and ancillary services for func-
40 tionally impaired elderly in all counties with approved home care plans;
41 provided however that in state fiscal years beginning on or after the
42 first day of April, two thousand five, the director, with the approval
43 of the director of the budget, may authorize state reimbursement in
44 excess of these levels to the extent appropriations are available there-
45 for, and further provided that within the amounts appropriated for such
46 expanded in-home, case management and ancillary community services for
47 the elderly (EISEP) in the 2006-2007 fiscal year, any contrary provision
48 of this section notwithstanding, the sum of twenty-five million dollars
49 shall be available for reimbursement to counties at ninety percent of
50 allowable expenditures for liabilities heretofore or hereafter to
51 accrue.
52 § 3. The elder law is amended by adding a new section 223 to read as
53 follows:
54 § 223. Economically sustainable transportation demonstration program.
55 1. Definitions. As used in this section:
S. 6457--C 86 A. 9557--B
1 (a) "Economically sustainable transportation provider" shall mean a
2 non-profit provider of transportation services that submits to the
3 director and obtains approval of a plan demonstrating that the provider
4 is capable of providing economically sustainable transportation
5 services.
6 (b) "Economically sustainable transportation services" shall mean
7 demand-responsive transportation services that are provided:
8 (1) by automobile;
9 (2) to qualified individuals;
10 (3) twenty-four hours a day, seven days a week; and
11 (4) by volunteer or paid drivers.
12 (c) "Qualified individual" shall mean an individual who is:
13 (1) an older individual, as defined in section 102 of the Older Ameri-
14 cans Act of 1965 (42 U.S.C. 3002); or
15 (2) an individual who is blind, within the meaning of the Rehabili-
16 tation Act of 1973 (29 U.S.C. 701 et seq.), an individual who has
17 significant visual impairment described in section 751 of the Rehabili-
18 tation Act of 1973 (29 U.S.C. 796j), or an individual who is eligible
19 for benefits under title II or XVI of the Social Security Act (42 U.S.C.
20 401 et seq., 1381 et seq.) on the basis of blindness.
21 (d) "Qualified transportation account" shall mean an account estab-
22 lished for a qualified individual for the purpose of acquiring transpor-
23 tation services from an economically sustainable transportation provid-
24 er.
25 (e) "Director" shall mean the director of the New York state office
26 for the aging.
27 (f) "Eligible entity" shall mean a private non-profit organization
28 with experience in establishing and replicating the independent trans-
29 portation network to provide economically sustainable transportation
30 services for qualified individuals.
31 2. The director shall establish the economically sustainable transpor-
32 tation demonstration program for the purpose of enabling seniors to
33 remain independent and mobile in their community. The program would
34 provide an on demand transit service for seniors that would use automo-
35 biles driven by volunteer and paid drivers to transport seniors to where
36 they need and want to go. After a period of five years, the program
37 would no longer be eligible for state funding and would be completely
38 self-sustaining, relying on consumer fares and voluntary community
39 support to remain operational.
40 3. Before carrying out the economically sustainable transportation
41 demonstration program, the director shall enter into a contract or a
42 cooperative agreement with an eligible entity to provide recommendations
43 and support to the director regarding the administration of such a
44 program.
45 (a) The eligible entity that enters into a contract or agreement under
46 subdivision three of this section shall:
47 (1) Provide initial and ongoing technical assistance and support to
48 the director for the administration of the sustainable transportation
49 demonstration program.
50 (2) Provide initial and ongoing technical assistance to economically
51 sustainable transportation providers.
52 (3) Provide recommendation to the director about the establishment of,
53 and requirements concerning locations where the economically sustainable
54 transportation services will be provided in the state.
S. 6457--C 87 A. 9557--B
1 (4) Provide recommendations to the director for the creation and use
2 of qualified transportation accounts for the transportation services,
3 including the provisions that such an account:
4 (i) may be funded with credits or funds equal to the value of a vehi-
5 cle traded to an economically sustainable transportation provider by, or
6 on behalf of, a qualified individual, or by other means;
7 (ii) shall be used only to provide transportation services to the
8 qualified individual;
9 (iii) shall have a designated beneficiary; and
10 (iv) shall be transferable to an individual other than the qualified
11 individual.
12 (5) Provide recommendations to the director regarding participation in
13 any federal grant program for an economically sustainable transportation
14 program.
15 4. After receiving the recommendations and support described in subdi-
16 vision three of this section, the director shall develop a request for
17 proposal to carry out the economically sustainable demonstration
18 program.
19 5. Copyrights and trademarks. Nothing in this section shall affect the
20 rights of the eligible entity under the copyright or trademark laws of
21 the United States. Nothing in this section shall require the disclosure
22 of information to which Federal law relating to trade secrets (including
23 section 552(b)(4) of title 5, United States Code) applies. In entering
24 into a contract or cooperative agreement under this section, the direc-
25 tor shall not establish any conditions that affect such rights or
26 require such disclosure.
27 6. Within amounts appropriated, the director shall make grants avail-
28 able to qualified economically sustainable transportation providers of
29 no less than fifty-five thousand dollars per grantee in the first year
30 of the operation of the program. Such providers shall be eligible to
31 receive funding under this section annually for up to five years. After
32 such time, providers must be able to provide economically sustainable
33 transportation services without receiving further public financial
34 assistance for operating or capital expenses.
35 7. To be eligible to receive a grant under this section, an econom-
36 ically sustainable transportation provider shall commit to raising
37 matching funds from non-state sources equal to fifty percent of the
38 state grant. Up to ten percent of the provider match may be provided
39 in-kind.
40 8. The office may use up to twelve percent of the total of any funding
41 appropriated pursuant to this section for administration.
42 § 4. This act shall take effect immediately and shall be deemed to
43 have been in full force and effect on and after April 1, 2006, provided
44 that section two of this act shall take effect upon the expiration and
45 reversion of paragraph (j) of subdivision 4 of section 214 of the elder
46 law, as amended by section one of this act and as provided pursuant to
47 section 4 of part E of chapter 58 of the laws of 2005; provided, howev-
48 er, that the amendments made to paragraph (j) of subdivision 4 of
49 section 214 of the elder law made by sections one and two of this act
50 shall apply only to funds appropriated in the 2006-2007 state fiscal
51 year; provided, that the amendments to paragraph (j) of subdivision 4 of
52 section 214 of the elder law made by section two of this act shall
53 expire and be deemed repealed on September 15, 2007.
54 PART K
S. 6457--C 88 A. 9557--B
1 Section 1. Notwithstanding any other provision of law, alcohol primary
2 care detoxification providers licensed and certified by the office of
3 alcoholism and substance abuse services under part 381.2 of the NYCRR
4 who have converted to the inpatient medically supervised withdrawal
5 service model regulations on or before January 1, 2006 shall receive
6 Medicaid rate or fee reimbursements at an amount equal to the previously
7 established Medicaid rate or fee for alcohol primary care detoxification
8 providers as of April 1, 2005. Retention of such rate or fee shall be
9 conditioned upon approval of an amended provider-specific fee transition
10 plan submitted to the commissioner of the office of alcoholism and
11 substance abuse services no later than six months from April 1, 2006.
12 Such Medicaid reimbursement shall expire on April 1, 2007, and a new
13 rate implemented as outlined in the transition plan.
14 § 2. This act shall take effect immediately and shall be deemed to
15 have been in full force and effect on and after April 1, 2006.
16 PART L
17 Section 1. Notwithstanding the provisions of any other law to the
18 contrary, the dormitory authority of the state of New York is authorized
19 to sell and convey to the Indian Cultural and Community Center, Inc. two
20 parcels of land situated in the City of New York, Borough of Queens,
21 State of New York, constituting a portion of the Creedmoor Psychiatric
22 Center, specifically described as follows:
23 (a) All that certain tract, piece or parcel of land situate, lying and
24 being in the City of New York, Borough of Queens, State of New York,
25 lying generally Southerly of Union Turnpike and being shown on a map
26 entitled "Two Lot subdivision Creedmoor Psychiatric Center," prepared by
27 C.T. Male Associates, P.C., dated August 8, 2002 and last revised March
28 7, 2006, bearing Drawing No. 02-482, and being more particularly bounded
29 and described as follows: Beginning at the point on the Easterly line of
30 Creedmoor Psychiatric Center, said point being situate the following
31 three (3) courses from the point of intersection of the Southerly margin
32 of Union Turnpike with the Southwesterly margin of 243rd Street: 1)
33 along the Southwesterly margin of 243rd Street, South 49 deg. 30 min. 38
34 sec. West 44.26 feet: 2) along the common line between the lands of
35 Creedmoor Psychiatric Center heading Northwest and Lot 93 on the South-
36 east as shown on the above described map South 64 deg. 19 min. 30 sec.
37 West 69.27 feet; and 3) along the Easterly line of Creedmoor Psychiatric
38 Center, South 13 deg. 27 min. 42 sec. East 82.45 feet and runs thence
39 from said point of point of beginning along said Easterly line South 13
40 deg. 27 min. 42 sec. East, a distance of 506.34 feet to a point; thence
41 along the Southerly line of Creedmoor Psychiatric Center, South 81 deg.
42 59 min. 26 sec. West, a distance of 81.01 feet to a point; thence
43 through the lands of Creedmoor Psychiatric center the following seven
44 (7) courses: 1) South 62 deg. 54 min. 51 sec. West a distance of 75.04
45 feet to a point; 2) North 16 deg. 08 min. 06 sec. East, a distance of
46 79.37 feet to a point; 3) North 03 deg. 34 min. 47 sec. West, a distance
47 of 98.67 feet to a point of curve; 4) thence Northwesterly along a curve
48 to the left radius of 26.64 feet, an arc distance of 31.65 feet to a
49 point of tangency, the chord to the above described curve being North 37
50 deg. 14 min. 53 sec. West 29.83 feet; 5) North 73 deg. 29 min. 00 sec.
51 West, a distance of 177.88 feet to a point; 6) North 16 deg. 19 min. 30
52 sec. East, a distance of 287.20 feet to a point; and 7) North 83 deg.
53 46 min. 08 sec. East, a distance of 121.85 feet to the point or place
54 of beginning, containing 1.93± acres of lands.
S. 6457--C 89 A. 9557--B
1 (b) All that certain tract, piece or parcel of land situate, lying and
2 being in the City of New York, Borough of Queens, State of New York,
3 lying generally Southerly of Union Turnpike and being shown on a map
4 entitled "Two Lot subdivision Creedmoor Psychiatric Center," prepared by
5 C.T. Male Associates, P.C., dated August 8, 2002 and last revised March
6 7, 2006, bearing Drawing No. 02-482, and being more particularly bounded
7 and described as follows: Beginning at the point of intersection of a
8 Southerly line and the Easterly line of Creedmoor Psychiatric Center,
9 said point being situate the following four (4) courses from the point
10 of intersection of the Southerly margin of Union Turnpike with the
11 Southwesterly margin of 243rd Street: 1) along the Southwesterly margin
12 of 243rd Street, South 49 deg. 30 min. 38 sec. East 44.26 feet; 2) along
13 the common line between Creedmoor Psychiatric Center on the Northwest
14 and Lot 93 on the Southeast as shown on the above described map South 64
15 deg. 19 min. 30 sec. West 69.27 feet; 3) along the Easterly line of
16 Creedmoor Psychiatric Center, South 13 deg. 27 min. 42 sec. East 588.79
17 feet; and 4) along a Southerly line of Creedmoor Psychiatric Center,
18 South 81 deg. 59 min. 26 sec. West 81.01 feet and runs thence from said
19 point of beginning along the Easterly line of Creedmoor Psychiatric
20 Center, South 17 deg. 30 min. 53 sec. East, a distance of 403.41 feet to
21 a point; thence through the lands of Creedmoor Psychiatric Center the
22 following ten (10) courses: 1) North 87 deg. 20 min. 28 sec. West, a
23 distance of 461.17 feet to a point; 2) North 40 deg. 24 min. 14 sec.
24 East, a distance of 17.24 feet to a point; 3) North 40 deg. 55 min. 57
25 sec. East, a distance of 50.29 feet to a point; 4) North 34 deg. 29
26 min. 28 sec. East, a distance of 15.43 feet to a point; 5) North 15 deg.
27 35 min. 53 sec. East, a distance of 95.44 feet to a point; 6) thence
28 Northerly along a curve to the left of radius 66.19 feet, an arc
29 distance of 30.79 feet to a point, the chord for the above described
30 curve being North 01 deg. 29 min. 41 sec. West 30.52 feet; 7) North 16
31 deg. 55 min. 29 sec. West, a distance of 50.91 feet to a point; 8)
32 North 49 deg. 24 min. 48 sec. East, a distance of 76.41 feet to a point;
33 9) North 73 deg. 38 min. 43 sec. East, a distance of 157.92 feet to a
34 point; and 10) North 62 deg. 54 min. 51 sec. East, a distance of 75.04
35 feet to the point or place of beginning, containing 2.56± acres of land.
36 § 2. The dormitory authority of the state of New York is authorized to
37 fix and determine the terms and conditions of each conveyance, provided,
38 however, that each sales price shall be not less than the fair market
39 value of each parcel, as determined by two or more independent
40 appraisals. Each conveyance shall take place within one year from the
41 effective date of this act; and the proceeds of each sale shall be
42 deposited in the mental hygiene facilities improvement fund income
43 account established pursuant to section 9 of the facilities development
44 corporation act, as added by chapter 359 of the laws of 1968.
45 § 3. This act shall take effect immediately.
46 PART M
47 Section 1. Paragraph 5 of subdivision (a) of section 31.27 of the
48 mental hygiene law, as amended by chapter 306 of the laws of 1995, is
49 amended to read as follows:
50 (5) "Extended observation bed" means an inpatient bed which is in or
51 adjacent to an emergency room located within a general hospital,
52 designed to provide a safe environment for an individual who, in the
53 opinion of the examining physician, requires extensive evaluation,
54 assessment, or stabilization of the person's acute psychiatric symptoms,
S. 6457--C 90 A. 9557--B
1 except that, if the commissioner determines that the program can provide
2 for the privacy and safety of all patients receiving services in a
3 hospital, he or she may approve the location of one or more such beds
4 within another unit of the hospital [and, in a suburban/rural program,
5 he may approve a location in any unit of that hospital or another gener-
6 al hospital].
7 § 2. Paragraph 1 of subdivision (b) of section 31.27 of the mental
8 hygiene law, as amended by chapter 598 of the laws of 1994, is amended
9 to read as follows:
10 (1) The commissioner [of mental health] may license the operation of
11 comprehensive psychiatric emergency programs by general hospitals which
12 are operated by state or local governments or voluntary agencies[,
13 provided that the commissioner may license suburban/rural programs oper-
14 ated by local governmental units or voluntary agencies and not by gener-
15 al hospitals, if such local governmental unit or voluntary agency has an
16 affiliation or agreement with one or more general hospitals for the
17 provision of extended observation beds and other necessary psychiatric
18 emergency services as determined by the commissioner. For suburban/rural
19 programs, the]. The provision of such services in general hospitals may
20 be located either within the state or, with the approval of the commis-
21 sioner and the director of the budget and to the extent consistent with
22 state and federal law, in a contiguous state. The commissioner is
23 further authorized to enter into interstate agreements for the purpose
24 of facilitating the development of [suburban/rural] programs which
25 provide services in another state. A comprehensive psychiatric emergency
26 program shall serve as a primary psychiatric emergency service provider
27 within a defined catchment area for persons in need of psychiatric emer-
28 gency services including persons who require immediate observation, care
29 and treatment in accordance with section 9.40 of this chapter. Each
30 comprehensive psychiatric emergency program shall provide or contract to
31 provide psychiatric emergency services twenty-four hours per day, seven
32 days per week, including but not limited to: crisis intervention
33 services, crisis outreach services, crisis residence services, extended
34 observation beds, and triage and referral services.
35 § 3. Paragraph 7 of subdivision (a) of section 31.27 of the mental
36 hygiene law is REPEALED.
37 § 4. Notwithstanding the provisions of this act or any other provision
38 of law, any suburban/rural comprehensive psychiatric emergency program
39 licensed and operating on the effective date of this act shall continue
40 in existence and shall be deemed to be licensed and operated as an urban
41 comprehensive psychiatric emergency program.
42 § 5. This act shall take effect immediately; provided that the amend-
43 ments to section 31.27 of the mental hygiene law made by sections one
44 and two of this act shall not affect the repeal of such section and
45 shall be deemed repealed therewith.
46 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
47 sion, section or part of this act shall be adjudged by any court of
48 competent jurisdiction to be invalid, such judgment shall not affect,
49 impair, or invalidate the remainder thereof, but shall be confined in
50 its operation to the clause, sentence, paragraph, subdivision, section
51 or part thereof directly involved in the controversy in which such judg-
52 ment shall have been rendered. It is hereby declared to be the intent of
53 the legislature that this act would have been enacted even if such
54 invalid provisions had not been included herein.
S. 6457--C 91 A. 9557--B
1 § 3. This act shall take effect immediately provided, however, that
2 the applicable effective date of Parts A through M of this act shall be
3 as specifically set forth in the last section of such Parts.
