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S05474 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          5474
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                      March 8, 2021
                                       ___________
 
        Introduced  by  Sens.  RIVERA, RAMOS, ADDABBO, BAILEY, BENJAMIN, BIAGGI,
          BRESLIN, BRISPORT, BROUK, COMRIE, COONEY, GIANARIS, GOUNARDES,  HARCK-
          HAM,  HINCHEY, HOYLMAN, JACKSON, KAVANAGH, KENNEDY, KRUEGER, LIU, MAY,
          MAYER, MYRIE, PARKER,  PERSAUD,  REICHLIN-MELNICK,  SALAZAR,  SANDERS,
          SEPULVEDA,  SERRANO, STAVISKY, THOMAS -- read twice and ordered print-
          ed, and when printed to be committed to the Committee on Health
 
        AN ACT to amend the public health law and  the  state  finance  law,  in
          relation  to  enacting  the "New York health act" and establishing New
          York Health
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Short  title. This act shall be known and may be cited as
     2  the "New York health act".
     3    § 2. Legislative  findings  and  intent.  1.  The  state  constitution
     4  states:  "The  protection and promotion of the health of the inhabitants
     5  of the state are matters of public concern and provision therefor  shall
     6  be made by the state and by such of its subdivisions and in such manner,
     7  and by such means as the legislature shall from time to time determine."
     8  (Article  XVII,  §3.)  The legislature finds and declares that all resi-
     9  dents of the state have the right to health care.    While  the  federal
    10  Affordable  Care Act brought many improvements in health care and health
    11  coverage, it still leaves many New  Yorkers  without  coverage  or  with
    12  inadequate coverage.  Millions of New Yorkers do not get the health care
    13  they  need  or face financial obstacles and hardships to get it. That is
    14  not acceptable.  There is no plan other than the  New  York  health  act
    15  that  will  enable  New  York state to meet that need.  New Yorkers - as
    16  individuals, employers, and taxpayers - have experienced a rise  in  the
    17  cost  of  health  care  and  coverage  in recent years, including rising
    18  premiums, deductibles and co-pays, restricted provider networks and high
    19  out-of-network charges.  Many New Yorkers go without health care because
    20  they cannot afford it or suffer financial hardship to  get  it.    Busi-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
        S                                                          LBD00273-03-1

        S. 5474                             2
 
     1  nesses have also experienced increases in the costs of health care bene-
     2  fits for their employees, and many employers are shifting a larger share
     3  of  the cost of coverage to their employees or dropping coverage entire-
     4  ly.  Including long-term services and supports (LTSS) in New York Health
     5  is  a major step forward for older adults, people with disabilities, and
     6  their families. Older adults and people with disabilities  often  cannot
     7  receive  the  services necessary to stay in the community or other LTSS.
     8  Even when older adults and people with disabilities receive LTSS,  espe-
     9  cially  services  in the community, it is often at the cost of unreason-
    10  able demands on unpaid family caregivers, depleting their own or  family
    11  resources,  or  impoverishing themselves to qualify for public coverage.
    12  Health care providers are also affected by inadequate health coverage in
    13  New York state. A large portion of hospitals, health centers  and  other
    14  providers now experience substantial losses due to the provision of care
    15  that  is  uncompensated.    Medicaid and Medicare often do not pay rates
    16  that are reasonably related to the cost of efficiently providing  health
    17  care services and sufficient to assure an adequate and accessible supply
    18  of  health  care  services, as guaranteed under the New York Health Act.
    19  Individuals often find that they are deprived  of  affordable  care  and
    20  choice because of decisions by health plans guided by the plan's econom-
    21  ic  interests rather than the individual's health care needs. To address
    22  the fiscal crisis facing the health care system and  the  state  and  to
    23  assure  New  Yorkers can exercise their right to health care, affordable
    24  and comprehensive health coverage must  be  provided.  Pursuant  to  the
    25  state constitution's charge to the legislature to provide for the health
    26  of  New  Yorkers,  this legislation is an enactment of state concern for
    27  the purpose of establishing a comprehensive universal guaranteed  health
    28  care  coverage  program  and  a  health care cost control system for the
    29  benefit of all residents of the state of New York.
    30    2. (a) It is the intent of the Legislature  to  create  the  New  York
    31  Health program to provide a universal single payer health plan for every
    32  New  Yorker, funded by broad-based revenue based on ability to pay.  The
    33  legislature intends that federal waivers and approvals be  sought  where
    34  they will improve the administration of the New York Health program, but
    35  the  legislature  intends  that  the  program be implemented even in the
    36  absence of such waivers or approvals.  The state shall  work  to  obtain
    37  waivers  and  other  approvals  relating to Medicaid, Child Health Plus,
    38  Medicare, the Affordable Care Act, and  any  other  appropriate  federal
    39  programs,  under  which  federal  funds  and  other subsidies that would
    40  otherwise be paid to New  York  State,  New  Yorkers,  and  health  care
    41  providers  for  health  coverage that will be equaled or exceeded by New
    42  York Health will be paid by the federal government to New York State and
    43  deposited in the New York Health trust fund,  or  paid  to  health  care
    44  providers and individuals in combination with New York Health trust fund
    45  payments,  and for other program modifications (including elimination of
    46  cost sharing and insurance premiums).  Under such waivers and approvals,
    47  health coverage under those programs will, to the maximum extent  possi-
    48  ble,  be replaced and merged into New York Health, which will operate as
    49  a true single-payer program.
    50    (b) If any necessary waiver or approval is  not  obtained,  the  state
    51  shall  use state plan amendments and seek waivers and approvals to maxi-
    52  mize, and make as seamless as possible,  the  use  of  federally-matched
    53  health  programs  and federal health programs in New York Health.  Thus,
    54  even where other programs such as Medicaid or Medicare may contribute to
    55  paying for care, it is the goal of this legislation  that  the  coverage
    56  will  be  delivered  by  New  York  Health and, as much as possible, the

        S. 5474                             3
 
     1  multiple sources of funding will be pooled with other  New  York  Health
     2  funds  and  not  be apparent to New York Health members or participating
     3  providers.
     4    (c)  This  program  will  promote  movement  away from fee-for-service
     5  payment, which tends to reward quantity and requires excessive  adminis-
     6  trative  expense,  and  towards alternate payment methodologies, such as
     7  global or capitated payments to providers or health care  organizations,
     8  that  promote  quality, efficiency, investment in primary and preventive
     9  care, and innovation and integration in the organizing of health care.
    10    (d) The program shall promote the use of clinical data to improve  the
    11  quality  of health care and public health, consistent with protection of
    12  patient confidentiality. The program shall maximize patient autonomy  in
    13  choice  of  health care providers and health care decision making.  Care
    14  coordination within the program shall ensure management and coordination
    15  among a patient's health care services, consistent with patient autonomy
    16  and person-centered service planning, rather than acting as a gatekeeper
    17  to needed services.
    18    (e) The program shall operate with care, skill,  prudence,  diligence,
    19  and professionalism, and for the best interests primarily of the members
    20  and health care providers.
    21    3.  This  act  does  not create or relate to any employment benefit or
    22  employment benefit plan, nor does it require,  prohibit,  or  limit  the
    23  providing of any employment benefit or employment benefit plan.
    24    4. In order to promote improved quality of, and access to, health care
    25  services and promote improved clinical outcomes, it is the policy of the
    26  state  to  encourage cooperative, collaborative and integrative arrange-
    27  ments among health care providers who might  otherwise  be  competitors,
    28  under  the  active  supervision of the commissioner of health. It is the
    29  intent of the state to supplant competition with such  arrangements  and
    30  regulation  only  to  the extent necessary to accomplish the purposes of
    31  this act, and to provide state  action  immunity  under  the  state  and
    32  federal  antitrust  laws  to  health  care  providers, particularly with
    33  respect to their relations with the single-payer New  York  Health  plan
    34  created by this act.
    35    5.  There  have  been numerous professional economic analyses of state
    36  and national single-payer  health  proposals,  including  the  New  York
    37  Health Act, by noted consulting firms and academic economists. They have
    38  almost  all  come  to  similar conclusions of net savings in the cost of
    39  health coverage and health care. These savings are driven by (a)  elimi-
    40  nating  the  administrative  bureaucracy costs, marketing, and profit of
    41  multiple health plans and replacing that  with  the  dramatically  lower
    42  costs  of  running a single-payer system; (b) substantially reducing the
    43  administrative costs borne by health care providers dealing  with  those
    44  health  plans; and (c) using the negotiating power of 20 million consum-
    45  ers to achieve lower drug prices. These savings will  more  than  offset
    46  costs primarily from (a) relieving patients of deductibles, co-pays, and
    47  out-of-network  charges;  (b)  covering  the  uninsured;  (c) increasing
    48  provider payment rates  above  Medicare  and  Medicaid  rates;  and  (d)
    49  replacing uncompensated home health care with paid care. Unlike premiums
    50  and out-of-pocket spending, the New York Health Act tax will be progres-
    51  sively  graduated  based  on  ability to pay.   The vast majority of New
    52  Yorkers today spend dramatically more in premiums, deductibles and other
    53  out-of-pocket costs than they will in New York Health Act taxes.    They
    54  will  have  broader  coverage  (including long-term care), no restricted
    55  provider networks or  out-of-network  charges,  and  no  deductibles  or
    56  co-pays.

        S. 5474                             4
 
     1    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
     2  health law are renumbered article 80 and sections 8000, 8001,  8002  and
     3  8003, respectively, and a new article 51 is added to read as follows:
     4                                 ARTICLE 51
     5                               NEW YORK HEALTH
     6  Section 5100. Definitions.
     7          5101. Program created.
     8          5102. Board of trustees.
     9          5103. Eligibility and enrollment.
    10          5104. Benefits.
    11          5105. Health  care providers; care coordination; payment method-
    12                  ologies.
    13          5106. Health care organizations.
    14          5107. Program standards.
    15          5108. Regulations.
    16          5109. Provisions relating to federal health programs.
    17          5110. Additional provisions.
    18          5111. Regional advisory councils.
    19    § 5100. Definitions. As used in  this  article,  the  following  terms
    20  shall  have  the following meanings, unless the context clearly requires
    21  otherwise:
    22    1. "Board" means the board of trustees of the New York Health  program
    23  created  by section fifty-one hundred two of this article, and "trustee"
    24  means a trustee of the board.
    25    2. "Care coordination" means, but is not limited to, managing,  refer-
    26  ring to, locating, coordinating, and monitoring health care services for
    27  the  member  to assure that all medically necessary health care services
    28  are made available to and are effectively used by the member in a timely
    29  manner, consistent with patient autonomy.  Care  coordination  does  not
    30  include  a  requirement for prior authorization for health care services
    31  or for referral for a member to receive a health care service.
    32    3. "Care coordinator"  means  an  individual  or  entity  approved  to
    33  provide  care  coordination  under  subdivision two of section fifty-one
    34  hundred five of this article.
    35    4. "Federally-matched public health program" means the medical assist-
    36  ance program under title eleven of article five of the  social  services
    37  law,  the basic health program under section three hundred sixty-nine-gg
    38  of the social services law, and the  child  health  plus  program  under
    39  title one-A of article twenty-five of this chapter.
    40    5.  "Health care organization" means an entity that is approved by the
    41  commissioner under section fifty-one hundred  six  of  this  article  to
    42  provide health care services to members under the program.
    43    6.  "Health  care  provider"  means  any  individual or entity legally
    44  authorized to provide a health care service under Medicaid  or  Medicare
    45  or this article. "Health care professional" means a health care provider
    46  that  is  an  individual  licensed,  certified,  registered or otherwise
    47  authorized to practice under title eight of the education law to provide
    48  such health care service, acting within his or her lawful scope of prac-
    49  tice.
    50    7. "Health care service" means any health care service, including care
    51  coordination, included as a benefit under the program.
    52    8. "Implementation period" means the period under subdivision three of
    53  section fifty-one hundred one of this article during which  the  program
    54  will be subject to special eligibility and financing provisions until it
    55  is fully implemented under that section.

        S. 5474                             5
 
     1    9.  "Medicaid"  or  "medical assistance" means title eleven of article
     2  five of the social services law and  the  program  thereunder.    "Child
     3  health  plus"  means  title one-A of article twenty-five of this chapter
     4  and the program thereunder. "Medicare" means title XVIII of the  federal
     5  social  security act and the programs thereunder.  "Affordable care act"
     6  means the federal patient protection and affordable care act, public law
     7  111-148, as amended by the health care and education reconciliation  act
     8  of  2010,  public  law  111-152,  and as otherwise amended and any regu-
     9  lations or guidance issued thereunder.   "Basic  health  program"  means
    10  section  three  hundred sixty-nine-gg of the social services law and the
    11  program thereunder.
    12    10. "Member" means an individual who is enrolled in the program.
    13    11. "New York Health", "New York Health program", and  "program"  mean
    14  the  New York Health program created by section fifty-one hundred one of
    15  this article.
    16    12. "New York Health trust fund" means the New York Health trust  fund
    17  established under section eighty-nine-j of the state finance law.
    18    13.  "Out-of-state  health  care  service" means a health care service
    19  provided to a member while the member is temporarily out  of  the  state
    20  and  (a)  it  is  medically  necessary  that  the health care service be
    21  provided while the member is out of the state, or (b) it  is  clinically
    22  appropriate  that  the  health  care service be provided by a particular
    23  health care provider located out of the state rather than in the  state.
    24  However,  any health care service provided to a New York Health enrollee
    25  by a health care provider qualified under paragraph (a)  of  subdivision
    26  three  of section fifty-one hundred five of this article that is located
    27  outside the state shall not be considered an  out-of-state  service  and
    28  shall be covered as otherwise provided in this article.
    29    14.  "Participating provider" means any individual or entity that is a
    30  health care  provider  qualified  under  subdivision  three  of  section
    31  fifty-one  hundred  five  of  this  article  that  provides  health care
    32  services to members under the program, or a health care organization.
    33    15. "Person" means any individual or natural person,  trust,  partner-
    34  ship,  association,  unincorporated  association,  corporation, company,
    35  limited liability company, proprietorship, joint  venture,  firm,  joint
    36  stock association, department, agency, authority, or other legal entity,
    37  whether for-profit, not-for-profit or governmental.
    38    16. "Prescription and non-prescription drugs" means prescription drugs
    39  as defined in section two hundred seventy of this chapter, and non-pres-
    40  cription smoking cessation products or devices.
    41    17.  "Resident" means an individual whose primary place of abode is in
    42  the state or, in the case of an individual whose primary place of  abode
    43  is  not  in the state, who is employed or self-employed full-time in the
    44  state, without regard to the individual's immigration status, as  deter-
    45  mined  according  to  regulations of the commissioner.  Such regulations
    46  shall include a process for appealing denials of residency.
    47    § 5101. Program created. 1. The New  York  Health  program  is  hereby
    48  created  in  the department. The commissioner shall establish and imple-
    49  ment the program under this article. The program shall  provide  compre-
    50  hensive health coverage to every resident who enrolls in the program.
    51    2.  The  commissioner shall, to the maximum extent possible, organize,
    52  administer and market the program and services as a single program under
    53  the name "New York Health" or such other name as the commissioner  shall
    54  determine,  regardless  of under which law or source the definition of a
    55  benefit is found including (on a voluntary basis) retiree  health  bene-
    56  fits.  In  implementing this article, the commissioner shall avoid jeop-

        S. 5474                             6
 
     1  ardizing federal financial participation in  these  programs  and  shall
     2  take  care  to  promote  public understanding and awareness of available
     3  benefits and programs.
     4    3. The commissioner shall determine when individuals may begin enroll-
     5  ing in the program. There shall be an implementation period, which shall
     6  begin  on  the  date that individuals may begin enrolling in the program
     7  and shall end as determined by the commissioner.   Individuals  may  not
     8  enroll  in the New York Health program until the legislature has enacted
     9  the revenue proposal, as amended, and as the legislature  shall  further
    10  provide.
    11    4. An insurer authorized to provide coverage pursuant to the insurance
    12  law  or  a  health maintenance organization certified under this chapter
    13  may, if otherwise authorized, offer  benefits  that  do  not  cover  any
    14  service  for which coverage is offered to individuals under the program,
    15  but may not offer benefits that cover any service for which coverage  is
    16  offered  to  individuals under the program. Provided, however, that this
    17  subdivision shall not prohibit (a) the offering of any  benefits  to  or
    18  for  individuals, including their families, who are employed or self-em-
    19  ployed in the state but who are not residents of the state, or  (b)  the
    20  offering of benefits during the implementation period to individuals who
    21  enrolled or may enroll as members of the program, or (c) the offering of
    22  retiree health benefits.
    23    5.  A  college, university or other institution of higher education in
    24  the state may purchase coverage under the program for  any  student,  or
    25  student's dependent, who is not a resident of the state.
    26    6.  To  the  extent any provision of this chapter, the social services
    27  law, the insurance law or the elder law:
    28    (a) is inconsistent with any provision of this article or the legisla-
    29  tive intent of the New York Health Act, this  article  shall  apply  and
    30  prevail,  except where explicitly provided otherwise by this article; or
    31  explicitly required by applicable federal law or regulations and
    32    (b) is consistent with the provisions of this article and the legisla-
    33  tive intent of the New York Health Act, the provision of that law  shall
    34  apply.
    35    7.    (a) (i) The program shall be deemed to be a health care plan for
    36  purposes of external appeal under article  forty-nine  of  this  chapter
    37  (referred  to  in  this subdivision as "article forty-nine"), subject to
    38  this subdivision and any other applicable provision of this article.
    39    (ii)  An external appeal shall not require utilization  review  or  an
    40  adverse  determination  under  title  one  of article forty-nine of this
    41  chapter.  Any reference in article forty-nine to utilization review or a
    42  universal review agent shall mean the program.  Where the program  makes
    43  an  adverse  determination, an external appeal shall be automatic unless
    44  specifically waived or withdrawn by the member or the member's designee.
    45  Services, including services provided  for  a  chronic  condition,  will
    46  continue  unchanged until the outcome of the external appeal decision is
    47  issued. Where  an  external  appeal  is  initiated  or  pursued  by  the
    48  patient's  health care provider, the provider shall notify the member or
    49  the member's designee, and it  shall  be  subject  to  the  member's  or
    50  member's  designee's right to waive or withdraw the external appeal.  No
    51  fee shall be required to be paid by any party  to  an  external  appeal,
    52  including the member's health care provider.
    53    (iii)    Where an external appeal is denied, the external appeal agent
    54  shall notify the member or the member's designee and, where appropriate,
    55  the member's health care provider,  within  two  business  days  of  the
    56  determination.    The  notice shall include a statement that the member,

        S. 5474                             7
 
     1  member's designee or health care provider has the right  to  appeal  the
     2  determination to a fair hearing under this subdivision and seek judicial
     3  review.
     4    (iv)  An enrollee may designate a person or entity, including, but not
     5  limited  to,  the  enrollee's  family member, care coordinator, a health
     6  care organization providing the service under review  or  appeal,  or  a
     7  labor union or an entity affiliated with and designated by a labor union
     8  of  which the enrollee or enrollee's family member is a member, to serve
     9  as the enrollee's designee for purposes of that article, if  the  person
    10  or entity agrees to be the designee.
    11    (b)  (i)  This paragraph applies where an external appeal is denied in
    12  whole or in part; or the program  denies  coverage  for  a  health  care
    13  service  on  any  grounds  other  than  under article forty-nine; or the
    14  program makes any other determination as to a member or individual seek-
    15  ing to become a member, contrary to the interest of the member or  indi-
    16  vidual (including but not limited to a denial of eligibility for lack of
    17  residence).
    18    (ii)  The  program  shall  notify  the  member or individual, member's
    19  designee or health care provider, as appropriate, that  the  person  has
    20  the  right  to  appeal  the  determination  to a fair hearing under this
    21  subdivision or seek judicial review.
    22    (iii)  The commissioner shall establish by regulation  a  process  for
    23  fair  hearings  under this subdivision.   The process shall at a minimum
    24  conform to the standards for fair hearings under section  twenty-two  of
    25  the social services law.
    26    (c)    Article seventy-eight of the civil practice law and rules shall
    27  apply to any matter under this article.
    28    8. (a) No member shall be required to receive any health care  service
    29  through  any  entity  organized, certified or operating under guidelines
    30  under article forty-four of this chapter,  or  specified  under  section
    31  three hundred sixty-four-j of the social services law, the insurance law
    32  or  the  elder law. No such entity shall receive payment for health care
    33  services (other than care coordination) from the program.
    34    (b) However, this subdivision shall not preclude the use of a Medicare
    35  managed care ("Medicare advantage") entity or other entity created by or
    36  under the direction of the program where reasonably necessary  to  maxi-
    37  mize  federal financial participation or other federal financial support
    38  under any federally-matched  public  health  program,  Medicare  or  the
    39  Affordable Care Act. Any entity under this paragraph shall, to the maxi-
    40  mum  extent  feasible,  operate  in the background, without burden on or
    41  interference with the member and health care provider, without depriving
    42  the member or health care provider of any right  or  benefit  under  the
    43  program and otherwise consistent with this article.
    44    9.  The  program  shall  include provisions for an appropriate reserve
    45  fund.
    46    10. (a) This subdivision applies to every person who is a retiree of a
    47  public employer, as defined in section two  hundred  one  of  the  civil
    48  service law, and any person who is a beneficiary of the retiree's public
    49  employee retiree health benefit. Any reference to the retiree shall mean
    50  and  include  any  beneficiary of the retiree. This subdivision does not
    51  create or increase any  eligibility  for  any  public  employee  retiree
    52  health  benefit that would not otherwise exist and does not diminish any
    53  public employee retiree health benefit.
    54    (b) This paragraph applies to the retiree while he or she is  a  resi-
    55  dent of New York state. The retiree shall enroll in the program.  If, by
    56  the  implementation  date,  the retiree has not enrolled in the program,

        S. 5474                             8
 
     1  the appropriate public employee retiree health benefit program  and  the
     2  commissioner shall enroll the retiree in the New York Health program. If
     3  the  retiree's  public  employee  retiree  health  benefit  includes any
     4  service  for  which  coverage  is  not offered under the New York Health
     5  program, the retiree shall continue to receive  that  benefit  from  the
     6  appropriate public employee retiree health benefit program.
     7    (c)  For  every retiree, while he or she is not a resident of New York
     8  state, the appropriate public employee retiree  health  benefit  program
     9  shall  maintain  the retiree's public employee retiree health benefit as
    10  if this article had not been enacted.
    11    § 5102. Board of trustees. 1. The New York Health board of trustees is
    12  hereby created in the department. The board of trustees  shall,  at  the
    13  request  of  the  commissioner,  consider  any  matter to effectuate the
    14  provisions and purposes of this article, and may advise the commissioner
    15  thereon; and it may, from time to time, submit to the  commissioner  any
    16  recommendations  to effectuate the provisions and purposes of this arti-
    17  cle. The commissioner may propose regulations  under  this  article  and
    18  amendments thereto for consideration by the board. The board of trustees
    19  shall  have  no executive, administrative or appointive duties except as
    20  otherwise provided by law. The board of trustees  shall  have  power  to
    21  establish,  and  from  time to time, amend regulations to effectuate the
    22  provisions and purposes of this article,  subject  to  approval  by  the
    23  commissioner.
    24    2. The board shall be composed of:
    25    (a)  the  commissioner,  the superintendent of financial services, and
    26  the director of the budget, or their designees, as ex officio members:
    27    (b) thirty-one trustees appointed by the governor;
    28    (i) six of whom shall be representatives of health care consumer advo-
    29  cacy organizations which have a statewide or regional constituency,  who
    30  have  been  involved  in  issues of interest to low- and moderate-income
    31  individuals, older adults, and people with disabilities; at least  three
    32  of whom shall represent organizations led by consumers in those groups;
    33    (ii)  three of whom shall be representatives of professional organiza-
    34  tions representing physicians;
    35    (iii) five of whom shall be representatives of professional  organiza-
    36  tions  representing  licensed  or  registered  health care professionals
    37  other than physicians;
    38    (iv) three of whom shall be representatives of general hospitals,  one
    39  of whom shall be a representative of public general hospitals;
    40    (v) one of whom shall be a representative of community health centers;
    41    (vi)  two  of  whom shall be representatives of rehabilitation or home
    42  care providers;
    43    (vii) two of whom shall be representatives  of  behavioral  or  mental
    44  health or disability service providers;
    45    (viii)  two  of whom shall be representatives of health care organiza-
    46  tions;
    47    (ix) three of whom shall be representatives of organized labor;
    48    (x) two of whom shall  have  demonstrated  expertise  in  health  care
    49  finance; and
    50    (xi)  two  of  whom shall be employers or representatives of employers
    51  who pay the payroll tax under this article, or, prior to the tax  becom-
    52  ing effective, will pay the tax; and
    53    (c)  fourteen  trustees  appointed by the governor; five of whom to be
    54  appointed on the recommendation of the speaker of the assembly; five  of
    55  whom to be appointed on the recommendation of the temporary president of
    56  the  senate;  two  of  whom to be appointed on the recommendation of the

        S. 5474                             9
 
     1  minority leader of the assembly; and two of whom to be appointed on  the
     2  recommendation of the minority leader of the senate.
     3    3.  (a) After the end of the implementation period, no person shall be
     4  a trustee unless he or she is a member of the program.
     5    (b) Each trustee shall serve at the pleasure of the  appointing  offi-
     6  cer, except the ex officio trustees.
     7    4.  The  chair  of the board shall be appointed, and may be removed as
     8  chair, by the governor from among the trustees. The board shall meet  at
     9  least  four  times  each  calendar year. Meetings shall be held upon the
    10  call of the chair and as provided  by  the  board.  A  majority  of  the
    11  appointed  trustees  shall be a quorum of the board, and the affirmative
    12  vote of a majority of the trustees voting, but  not  less  than  twelve,
    13  shall  be  necessary  for any action to be taken by the board. The board
    14  may establish an executive committee to exercise any powers or duties of
    15  the board as it may provide, and other committees to assist the board or
    16  the executive committee. The chair of the board shall chair  the  execu-
    17  tive  committee  and  shall  appoint  the chair and members of all other
    18  committees. The board of trustees  may  appoint  one  or  more  advisory
    19  committees.  Members  of  advisory committees need not be members of the
    20  board of trustees.
    21    5. Trustees shall serve without compensation but shall  be  reimbursed
    22  for  their  necessary  and actual expenses incurred while engaged in the
    23  business of the board.  However, the board may provide for  compensation
    24  in cases where a lack of compensation would limit the ability of a trus-
    25  tee or represented organization to participate in board business.
    26    6. Notwithstanding any provision of law to the contrary, no officer or
    27  employee of the state or any local government shall forfeit or be deemed
    28  to  have  forfeited his or her office or employment by reason of being a
    29  trustee.
    30    7. The board and its committees and advisory  committees  may  request
    31  and  receive  the  assistance  of  the department and any other state or
    32  local governmental entity in exercising its powers and duties.
    33    8. No later than two years after the effective date of this article:
    34    (a) The board shall develop proposals for: (i)  incorporating  retiree
    35  health  benefits into New York Health; (ii) accommodating employer reti-
    36  ree health benefits for people who have been members of New York  Health
    37  but  live as retirees out of the state; and (iii) accommodating employer
    38  retiree health benefits for people who earned or accrued  such  benefits
    39  while  residing  in  the  state  prior to the implementation of New York
    40  Health and live as retirees out of the state.  The board  shall  present
    41  its proposals to the governor and the legislature.
    42    (b) The board shall develop a proposal for New York Health coverage of
    43  health  care  services  covered  under  the  workers'  compensation law,
    44  including whether and how to continue funding for those  services  under
    45  that  law  and  whether  and how to incorporate an element of experience
    46  rating.
    47    (c) The board shall develop a proposal for New York  Health  coverage,
    48  for  members,  of  health  care  services covered under paragraph one of
    49  subsection (a) of section fifty-one hundred two  of  the  insurance  law
    50  relating  to  motor vehicle insurance reparations, including whether and
    51  how to continue funding for those services.
    52    (d) The board shall develop a  proposal  for  integration  of  federal
    53  veterans health administration programs with New York Health coverage of
    54  health care services; provided however that enrollment in or eligibility
    55  for  federal  veterans health administration programs shall not affect a
    56  resident's eligibility for New York Health coverage.

        S. 5474                            10
 
     1    § 5103. Eligibility and enrollment. 1. Every  resident  of  the  state
     2  shall be eligible and entitled to enroll as a member under the program.
     3    2.  No individual shall be required to pay any premium or other charge
     4  for enrolling in or being a member under the program.
     5    3. A newborn child shall be enrolled as of the  date  of  the  child's
     6  birth  if  enrollment is done prior to the child's birth or within sixty
     7  days after the child's birth.
     8    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
     9  coverage  to  every member, which shall include all health care services
    10  required to be covered under any of the  following,  without  regard  to
    11  whether  the  member  would  otherwise be eligible for or covered by the
    12  program or source referred to:
    13    (a) child health plus;
    14    (b) Medicaid, including but not limited  to  services  provided  under
    15  Medicaid  waiver  programs,  including  but not limited to those granted
    16  under section 1915 of the federal social security act  to  persons  with
    17  traumatic  brain  injuries  or qualifying for nursing home diversion and
    18  transition services;
    19    (c) Medicare;
    20    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
    21  forty-three of the insurance law;
    22    (e)  article  eleven of the civil service law, as of the date one year
    23  before the beginning of the implementation period;
    24    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
    25  section  fifty-one  hundred two of the insurance law, provided that this
    26  coverage shall not replace  coverage  under  article  fifty-one  of  the
    27  insurance law;
    28    (g)  any  additional health care service authorized to be added to the
    29  program's benefits by the program; and
    30    (h) provided that where any state law or  regulation  related  to  any
    31  federally-matched public health program states that a benefit is contin-
    32  gent  on  federal  financial participation, or words to that effect, the
    33  benefit shall be included under the  New  York  Health  program  without
    34  regard to federal financial participation.
    35    2. No member shall be required to pay any premium, deductible, co-pay-
    36  ment or co-insurance under the program.
    37    3. The program shall provide for payment under the program for:
    38    (a)  emergency and temporary health care services provided to a member
    39  or individual entitled to become a member who has not had  a  reasonable
    40  opportunity to become a member or to enroll with a care coordinator; and
    41    (b) health care services provided in an emergency to an individual who
    42  is  entitled  to  become  a  member or enrolled with a care coordinator,
    43  regardless of having had an opportunity to do so.
    44    § 5105. Health care providers; care  coordination;  payment  methodol-
    45  ogies.   1. Choice of health care provider. (a) Any health care provider
    46  qualified to participate under this  section  may  provide  health  care
    47  services  under  the  program, provided that the health care provider is
    48  otherwise legally authorized to perform the health care service for  the
    49  individual and under the circumstances involved.
    50    (b)  A  member  may  choose  to receive health care services under the
    51  program from any participating provider, consistent with  provisions  of
    52  this  article  relating  to  care coordination and health care organiza-
    53  tions, the willingness or  availability  of  the  provider  (subject  to
    54  provisions  of  this article relating to discrimination), and the appro-
    55  priate clinically-relevant circumstances.

        S. 5474                            11
 
     1    2. Care coordination. (a) A care coordinator may be an  individual  or
     2  entity that is approved by the program that is:
     3    (i)  a  health care practitioner who is: (A) the member's primary care
     4  practitioner; (B) at the option of a female member, the member's provid-
     5  er of primary gynecological care; or (C) at the option of a  member  who
     6  has  a  chronic  condition  that  requires  specialty care, a specialist
     7  health care practitioner who regularly and continually  provides  treat-
     8  ment for that condition to the member;
     9    (ii)  an entity licensed under article twenty-eight of this chapter or
    10  certified under article thirty-six of this chapter, or, with respect  to
    11  a  member  who  receives  chronic mental health care services, an entity
    12  licensed under article thirty-one of the mental  hygiene  law  or  other
    13  entity approved by the commissioner in consultation with the commission-
    14  er of mental health;
    15    (iii) a health care organization;
    16    (iv)  a  labor  union or an entity affiliated with and designated by a
    17  labor union of which the enrollee  or  enrollee's  family  member  is  a
    18  member,  with  respect to its members and their family members; provided
    19  that this provision shall not preclude such an entity  from  becoming  a
    20  care  coordinator  under  subparagraph (v) of this paragraph or a health
    21  care organization under section fifty-one hundred six of  this  article;
    22  or
    23    (v) any not-for-profit or governmental entity approved by the program.
    24    (b)(i)  Every  member shall enroll with a care coordinator that agrees
    25  to provide care coordination to the member  prior  to  receiving  health
    26  care  services  to  be paid for under the program.  Health care services
    27  provided to a member shall not be subject to payment under  the  program
    28  unless  the  member  is enrolled with a care coordinator at the time the
    29  health care service is provided.
    30    (ii) This paragraph shall not apply to health care  services  provided
    31  under  subdivision three of section fifty-one hundred four of this arti-
    32  cle (certain emergency or temporary services).
    33    (iii) The member shall remain  enrolled  with  that  care  coordinator
    34  until  the  member becomes enrolled with a different care coordinator or
    35  ceases to be a member. Members have the right to change their care coor-
    36  dinator on terms at least as permissive as  the  provisions  of  section
    37  three  hundred  sixty-four-j  of  the social services law relating to an
    38  individual changing his or her primary care  provider  or  managed  care
    39  provider.
    40    (c)  Care coordination shall be provided to the member by the member's
    41  care coordinator.  A care coordinator may employ or utilize the services
    42  of other individuals or entities to assist  in  providing  care  coordi-
    43  nation for the member, consistent with regulations of the commissioner.
    44    (d)  A  health  care organization may establish rules relating to care
    45  coordination for members in the health care organization, different from
    46  this subdivision but otherwise consistent with this  article  and  other
    47  applicable laws.
    48    (e) The commissioner shall develop and implement procedures and stand-
    49  ards for an individual or entity to be approved to be a care coordinator
    50  in  the  program,  including but not limited to procedures and standards
    51  relating to the revocation,  suspension,  limitation,  or  annulment  of
    52  approval  on a determination that the individual or entity is not quali-
    53  fied or competent to be a care coordinator or has exhibited a course  of
    54  conduct  which  is  either inconsistent with program standards and regu-
    55  lations or which exhibits an unwillingness to meet  such  standards  and
    56  regulations,  or  is  a potential threat to the public health or safety.

        S. 5474                            12

     1  Such procedures and standards shall not limit  approval  to  be  a  care
     2  coordinator  in  the  program  for  criteria other than those under this
     3  section and shall be consistent  with  good  professional  practice.  In
     4  developing  the  procedures  and  standards, the commissioner shall: (i)
     5  consider  existing  standards  developed  by  national  accrediting  and
     6  professional  organizations;  and  (ii)  consult with national and local
     7  organizations working on care coordination or similar models,  including
     8  health  care practitioners, hospitals, clinics, birth centers, long-term
     9  supports and service providers, consumers and their representatives, and
    10  labor organizations representing health care  workers.  When  developing
    11  and implementing standards of approval of care coordinators for individ-
    12  uals  receiving  chronic  mental  health care services, the commissioner
    13  shall consult with the commissioner of mental health. An  individual  or
    14  entity  may  not  be  a care coordinator unless the services included in
    15  care coordination are within  the  individual's  professional  scope  of
    16  practice or the entity's legal authority.
    17    (f)  To  maintain approval under the program, a care coordinator must:
    18  (i) renew its status at a frequency determined by the commissioner;  and
    19  (ii)  provide  data to the department as required by the commissioner to
    20  enable the commissioner to evaluate the impact of care  coordinators  on
    21  quality, outcomes, cost, and patient and provider satisfaction.
    22    (g)  Nothing  in  this  subdivision  shall authorize any individual to
    23  engage in any act in violation of title eight of the education law.
    24    3. Health care providers. (a) The  commissioner  shall  establish  and
    25  maintain procedures and standards for health care providers to be quali-
    26  fied  to participate in the program, including but not limited to proce-
    27  dures and standards relating to the revocation, suspension,  limitation,
    28  or annulment of qualification to participate on a determination that the
    29  health  care  provider is not qualified or competent to be a provider of
    30  specific health care services or has exhibited a course of conduct which
    31  is either inconsistent with program standards and regulations  or  which
    32  exhibits  an unwillingness to meet such standards and regulations, or is
    33  a potential threat to the public health or safety. Such  procedures  and
    34  standards  shall  not  limit  health  care provider participation in the
    35  program for criteria other than those under this section  and  shall  be
    36  consistent  with good professional practice.  Such procedures and stand-
    37  ards may be different for different types of health care  providers  and
    38  health  care  professionals.    The commissioner may require that health
    39  care providers and health care professionals  participate  in  Medicaid,
    40  child health plus, or Medicare to qualify to participate in the program.
    41  Any  health  care  provider that is qualified to participate under Medi-
    42  caid, child health plus or Medicare shall be deemed to be  qualified  to
    43  participate  in  the program, and any health care provider's revocation,
    44  suspension, limitation, or annulment of qualification to participate  in
    45  any  of  those programs shall apply to the health care provider's quali-
    46  fication to participate in the program;  provided  that  a  health  care
    47  provider  qualified  under  this sentence shall follow the procedures to
    48  become qualified under the program by  the  end  of  the  implementation
    49  period.
    50    (b) The commissioner shall establish and maintain procedures and stan-
    51  dards for recognizing health care providers located out of the state for
    52  purposes of providing coverage under the program for out-of-state health
    53  care services.
    54    (c)  Procedures  and  standards  under  this subdivision shall include
    55  provisions for expedited temporary qualification to participate  in  the
    56  program for health care professionals who are (i) temporarily authorized

        S. 5474                            13
 
     1  to  practice  in  the state or (ii) are recently arrived in the state or
     2  recently authorized to practice in the state.
     3    4.  Payment  for  health  care  services. (a) (i) The commissioner may
     4  establish by regulation payment methodologies for health  care  services
     5  and  care  coordination provided to members under the program by partic-
     6  ipating providers, care coordinators,  and  health  care  organizations.
     7  There  may  be  a  variety of different payment methodologies, including
     8  those established on a demonstration basis.
     9    (ii) All payment methodologies and rates under the  program  shall  be
    10  reasonable  and  reasonably related to the cost of efficiently providing
    11  the health care service and assuring an adequate and  accessible  supply
    12  of the health care service.
    13    (iii) In determining such payment methodologies and rates, the commis-
    14  sioner  shall consider factors including usual and customary rates imme-
    15  diately prior to the implementation of the program, reported in a bench-
    16  marking database maintained by a nonprofit organization specified by the
    17  superintendent of financial services, under section six hundred three of
    18  the financial services law; the level of training, education, and  expe-
    19  rience  of the health care provider or providers involved; and the scope
    20  of services, complexity, and circumstances of care including  geographic
    21  factors.  Until  and  unless  other applicable payment methodologies are
    22  established, health care services provided to members under the  program
    23  shall  be  paid  for on a fee-for-service basis, except for care coordi-
    24  nation.
    25    (b) The program shall engage in good faith  negotiations  with  health
    26  care providers' representatives under title III of article forty-nine of
    27  this  chapter,  including,  but  not limited to, in relation to rates of
    28  payment and payment methodologies.
    29    (c) (i) Prescription drugs eligible for reimbursement under this arti-
    30  cle and dispensed by a pharmacy shall be provided and paid for under the
    31  preferred drug program and the clinical drug review program under  title
    32  one  of  article  two-A of this chapter, except as otherwise provided in
    33  this paragraph.   As used in this  paragraph,  "managed  care  provider"
    34  means  an  entity  under  paragraph  (b) of subdivision eight of section
    35  fifty-one hundred one of this article that qualifies under  the  federal
    36  Public Health Services Act (the "340B program").
    37    (ii)  Where  the  member  is enrolled in a managed care provider and a
    38  prescription for the member is made under section 340B  of  the  federal
    39  Public Health Service Act (the "340B program") and under a memorandum of
    40  understanding  relating  to the 340B program between the New York Health
    41  program and the relevant 340B program covered entity, the  managed  care
    42  provider  shall  purchase,  pay  for and provide for the drugs under the
    43  340B program. However, the prescription shall be subject to section  two
    44  hundred  seventy-three  (preferred drug program prior authorization) and
    45  section two hundred seventy-four (clinical drug review program) of  this
    46  chapter.
    47    (iii)  The  New  York  Health  program shall enter into and maintain a
    48  memorandum of understanding relating to the 340B program with each  340B
    49  covered entity in the state that agrees to do so.
    50    (iv)  Where  prescription  drugs are not dispensed through a pharmacy,
    51  payment shall be made as otherwise provided in this  article,  including
    52  use of the 340B program as appropriate.
    53    (d)  Payment  for  health care services established under this article
    54  shall be considered payment in full. A participating provider shall  not
    55  charge  any rate in excess of the payment established under this article
    56  for any health care service provided under the  program  and  shall  not

        S. 5474                            14
 
     1  solicit  or  accept  payment from any member or third party for any such
     2  service except as provided under section fifty-one hundred nine of  this
     3  article.    However,  this paragraph shall not preclude the program from
     4  acting  as  a  primary  or  secondary  payer in conjunction with another
     5  third-party payer where permitted under section fifty-one  hundred  nine
     6  of this article.
     7    (e)  The  program may provide in payment methodologies for payment for
     8  capital related expenses for specifically  identified  capital  expendi-
     9  tures  incurred  by  not-for-profit  or  governmental entities certified
    10  under article twenty-eight of this chapter. Any capital related  expense
    11  generated  by  a  capital expenditure that requires or required approval
    12  under article twenty-eight of  this  chapter  must  have  received  that
    13  approval  for  the  capital  related  expense  to  be paid for under the
    14  program.
    15    (f) Payment methodologies and rates shall include a distinct component
    16  of reimbursement for direct and indirect graduate medical  education  as
    17  defined,  calculated  and  implemented  pursuant to section twenty-eight
    18  hundred seven-c of this chapter.
    19    (g) The commissioner shall provide by  regulation for payment  method-
    20  ologies and procedures for paying for out-of-state health care services.
    21    5.  Prior  authorization. The program shall not require prior authori-
    22  zation for any health care service in any  manner  more  restrictive  of
    23  access  to  or  payment  for  the service than would be required for the
    24  service under Medicare  Part  A  or  Part  B.  Prior  authorization  for
    25  prescription  drugs  provided  by  pharmacies under the program shall be
    26  under title one of article two-A of this chapter.
    27    § 5106. Health care organizations. 1. A member may  choose  to  enroll
    28  with  and  receive  health care services under the program from a health
    29  care organization.
    30    2. A health care organization shall be  a  not-for-profit  or  govern-
    31  mental entity that is approved by the commissioner that is:
    32    (a)  an  accountable  care organization under article twenty-nine-E of
    33  this chapter; or
    34    (b) a labor union or an entity affiliated with  and  designated  by  a
    35  labor  union  of  which  the  enrollee  or enrollee's family member is a
    36  member (i) with respect to its members and  their  family  members,  and
    37  (ii)  if allowed by applicable law and approved by the commissioner, for
    38  other members of the program.
    39    3. A health care organization may be responsible for providing all  or
    40  part of the health care services to which its members are entitled under
    41  the  program,  consistent  with the terms of its approval by the commis-
    42  sioner.
    43    4. (a) The commissioner shall develop  and  implement  procedures  and
    44  standards  for an entity to be approved to be a health care organization
    45  in the program, including but not limited to  procedures  and  standards
    46  relating  to  the  revocation,  suspension,  limitation, or annulment of
    47  approval on a determination that the entity is not  competent  to  be  a
    48  health  care  organization or has exhibited a course of conduct which is
    49  either inconsistent with program  standards  and  regulations  or  which
    50  exhibits  an unwillingness to meet such standards and regulations, or is
    51  a potential threat to the public health or safety. Such  procedures  and
    52  standards  shall  not limit approval to be a health care organization in
    53  the program for criteria other than those under this section  and  shall
    54  be  consistent with good professional practice. In developing the proce-
    55  dures and standards, the commissioner shall: (i) consider existing stan-
    56  dards developed by national accrediting and professional  organizations;

        S. 5474                            15

     1  and  (ii)  consult  with national and local organizations working in the
     2  field of health care organizations, including health care practitioners,
     3  hospitals,  clinics,  birth  centers,  long-term  supports  and  service
     4  providers,  consumers  and their representatives and labor organizations
     5  representing health care workers. When developing and implementing stan-
     6  dards of approval of health care organizations, the  commissioner  shall
     7  consult  with  the  commissioner  of  mental health, the commissioner of
     8  developmental disabilities, the director of the  state  office  for  the
     9  aging,  the  commissioner  of  the  office  of  addiction  services  and
    10  supports, and the commissioner of the division of human rights.
    11    (b) To maintain approval under the program, a health care organization
    12  must: (i) renew its status at a frequency determined by the  commission-
    13  er;  and  (ii) provide data to the department as required by the commis-
    14  sioner to enable the commissioner to evaluate the health care  organiza-
    15  tion  in  relation  to  quality  of  health  care  services, health care
    16  outcomes, cost, and patient and provider satisfaction.
    17    5. The commissioner shall make regulations  relating  to  health  care
    18  organizations  consistent  with and to ensure compliance with this arti-
    19  cle.
    20    6. The provision of health care services directly or indirectly  by  a
    21  health  care  organization  through  health  care providers shall not be
    22  considered the practice of a profession under title eight of the  educa-
    23  tion law by the health care organization.
    24    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    25  requirements and standards for the program and for health care organiza-
    26  tions, care coordinators, and health  care  providers,  consistent  with
    27  this article, including requirements and standards for, as applicable:
    28    (a) the scope, quality and accessibility of health care services;
    29    (b) relations between health care organizations or health care provid-
    30  ers and members; and
    31    (c)  relations  between  health  care  organizations  and  health care
    32  providers, including (i) credentialing and participation in  the  health
    33  care organization; and (ii) terms, methods and rates of payment.
    34    2. Requirements and standards under the program shall include, but not
    35  be limited to, provisions to promote the following:
    36    (a)  simplification,  transparency, uniformity, and fairness in health
    37  care provider credentialing and participation in health  care  organiza-
    38  tion  networks, referrals, payment procedures and rates, claims process-
    39  ing, and approval of health care services, as applicable;
    40    (b) primary and preventive  care,  care  coordination,  efficient  and
    41  effective  health  care  services,  quality  assurance, coordination and
    42  integration of health care services, including use of appropriate  tech-
    43  nology, and promotion of public, environmental and occupational health;
    44    (c) elimination of health care disparities;
    45    (d) non-discrimination with respect to members and health care provid-
    46  ers on the basis of race, ethnicity, national origin, religion, disabil-
    47  ity,  age,  sex,  sexual  orientation, gender identity or expression, or
    48  economic circumstances; provided  that  health  care  services  provided
    49  under the program shall be appropriate to the patient's clinically-rele-
    50  vant circumstances;
    51    (e)  accessibility  of  care  coordination,  health  care organization
    52  services and health care services, including  accessibility  for  people
    53  with disabilities and people with limited ability to speak or understand
    54  English,  and  the providing of care coordination, health care organiza-
    55  tion services and health care services in a culturally competent manner;
    56  and

        S. 5474                            16
 
     1    (f) especially in relation to long-term  supports  and  services,  the
     2  maximization  and  prioritization of the most integrated community-based
     3  supports and services.
     4    3. Any participating provider or care coordinator that is organized as
     5  a  for-profit  entity (other than a professional practice of one or more
     6  health care professionals) shall be required to meet the  same  require-
     7  ments  and  standards  as entities organized as not-for-profit entities,
     8  and payments under the program paid to such entities shall not be calcu-
     9  lated to accommodate the generation of profit or revenue  for  dividends
    10  or  other return on investment or the payment of taxes that would not be
    11  paid by a not-for-profit entity.
    12    4. Every participating provider shall  furnish  to  the  program  such
    13  information  to,  and permit examination of its records by, the program,
    14  as may be reasonably required for purposes  of  reviewing  accessibility
    15  and  utilization  of  health care services, quality assurance, promoting
    16  improved patient outcomes and cost containment, the making of  payments,
    17  and  statistical or other studies of the operation of the program or for
    18  protection and  promotion  of  public,  environmental  and  occupational
    19  health.
    20    5.  In  developing  requirements and standards and making other policy
    21  determinations under this article, the commissioner shall  consult  with
    22  the  commissioner  of  mental  health, the commissioner of developmental
    23  disabilities, the director of  the  state  office  for  the  aging,  the
    24  commissioner  of  the  office  of  addiction  services and supports, the
    25  commissioner  of  the  division  of  human  rights,  representatives  of
    26  members, health care providers, care coordinators, health care organiza-
    27  tions    employers,  organized labor including representatives of health
    28  care workers, and other interested parties.
    29    6. The program shall maintain the security and confidentiality of  all
    30  data  and  other  information collected under the program when such data
    31  would be normally considered confidential patient data.  Aggregate  data
    32  of  the  program  which  is  derived from confidential data but does not
    33  violate patient confidentiality shall be  public  information  including
    34  for purposes of article six of the public officers law.
    35    §  5108.  Regulations.  The  commissioner shall make regulations under
    36  this article by approving  regulations  and  amendments  thereto,  under
    37  subdivision  one  of  section fifty-one hundred two of this article. The
    38  commissioner may make regulations or amendments thereto under this arti-
    39  cle on an emergency basis under section two hundred  two  of  the  state
    40  administrative  procedure  act, provided that such regulations or amend-
    41  ments shall not become permanent unless adopted under subdivision one of
    42  section fifty-one hundred two of this article.
    43    § 5109. Provisions relating to federal health programs. 1. The commis-
    44  sioner shall seek all federal waivers and other  federal  approvals  and
    45  arrangements  and  submit state plan amendments necessary to operate the
    46  program consistent with this article to the maximum extent possible.  No
    47  provision of this article and no action under the program shall diminish
    48  any right or benefit the member would otherwise have under any  federal-
    49  ly-matched program or Medicare.
    50    2.  (a)  The  commissioner  shall apply to the secretary of health and
    51  human services or other appropriate federal official for all waivers  of
    52  requirements,  and make other arrangements, under Medicare, any federal-
    53  ly-matched public health program, the affordable care act, and any other
    54  federal programs that provide federal funds for payment for health  care
    55  services,  that  are  necessary to enable all New York Health members to
    56  receive all benefits under the program through the program to enable the

        S. 5474                            17
 
     1  state to implement this article and to receive and deposit  all  federal
     2  payments  under  those programs (including funds that may be provided in
     3  lieu of premium tax credits, cost-sharing subsidies, and small  business
     4  tax  credits) in the state treasury to the credit of the New York Health
     5  trust fund and to use those funds for the New York  Health  program  and
     6  other provisions under this article. To the extent possible, the commis-
     7  sioner shall negotiate arrangements with the federal government in which
     8  bulk  or  lump-sum federal payments are paid to New York Health in place
     9  of  federal  spending  or  tax  benefits  for  federally-matched  health
    10  programs  or  federal  health  programs.    The  commissioner shall take
    11  actions under paragraph (b) of subdivision eight  of  section  fifty-one
    12  hundred one of this article as reasonably necessary.
    13    (b)  The  commissioner may require members or applicants to be members
    14  to provide information necessary for the  program  to  comply  with  any
    15  waiver or arrangement under this subdivision.
    16    3.  (a) The commissioner may take actions consistent with this article
    17  to enable New York Health to administer Medicare in New York  state,  to
    18  create  a  Medicare  managed care plan ("Medicare Advantage") that would
    19  operate consistent with this article, and  to  be  a  provider  of  drug
    20  coverage under Medicare part D for eligible members of New York Health.
    21    (b)  The  commissioner  may  waive  or  modify  the  applicability  of
    22  provisions of this section  relating  to  any  federally-matched  public
    23  health  program  or  Medicare  as  necessary  to implement any waiver or
    24  arrangement under this section or to maximize the  benefit  to  the  New
    25  York  Health program under this section, provided that the commissioner,
    26  in consultation with the director of the budget,  shall  determine  that
    27  such  waiver  or  modification  is  in the best interests of the members
    28  affected by the action and the  state,  and  provided  further  that  no
    29  action  under  this  paragraph  shall  diminish any right or benefit the
    30  member would otherwise have under the program or  any  federally-matched
    31  public health program or Medicare.
    32    (c)  The  commissioner  may  apply  for  coverage under any federally-
    33  matched public health program on behalf of any  member  and  enroll  the
    34  member in the federally-matched public health program or Medicare if the
    35  member  is  eligible  for it.   Enrollment in a federally-matched public
    36  health program or Medicare shall not cause any member to lose any health
    37  care service provided by the program or diminish any  right  or  benefit
    38  the member would otherwise have.
    39    (d) The commissioner shall by regulation increase the income eligibil-
    40  ity  level,  increase  or  eliminate  the resource test for eligibility,
    41  simplify any procedural or documentation requirement for enrollment, and
    42  increase the benefits for any federally-matched public  health  program,
    43  and  for any program to reduce or eliminate an individual's coinsurance,
    44  cost-sharing or premium obligations or increase an  individual's  eligi-
    45  bility  for  any  federal  financial  support related to Medicare or the
    46  affordable care act notwithstanding any law or regulation to the contra-
    47  ry. The commissioner may  act  under  this  paragraph  upon  a  finding,
    48  approved by the director of the budget, that the action (i) will help to
    49  increase  the  number  of  members  who are eligible for and enrolled in
    50  federally-matched public health programs, or for any program  to  reduce
    51  or  eliminate an individual's coinsurance, cost-sharing or premium obli-
    52  gations or increase an individual's eligibility for any  federal  finan-
    53  cial  support  related to Medicare or the affordable care act; (ii) will
    54  not diminish any individual's access to any health care service, benefit
    55  or right the individual would otherwise have; (iii) is in  the  interest

        S. 5474                            18
 
     1  of  the program; and (iv) does not require or has received any necessary
     2  federal waivers or approvals to ensure federal financial participation.
     3    (e)  To  enable  the  commissioner  to apply for coverage or financial
     4  support under any federally-matched public health program, the  Afforda-
     5  ble  Care Act, or Medicare on behalf of any member and enroll the member
     6  in any such program, including an entity under paragraph (b) of subdivi-
     7  sion eight of section fifty-one hundred  one  of  this  article  if  the
     8  member  is  eligible  for  it,  the  commissioner may require that every
     9  member or applicant to be a member shall provide information  to  enable
    10  the commissioner to determine whether the applicant is eligible for such
    11  program.    The program shall make a reasonable effort to notify members
    12  of their obligations under this paragraph. After a reasonable effort has
    13  been made to contact the member, the member shall be notified in writing
    14  that he or she has sixty days to provide such required  information.  If
    15  such  information  is  not  provided  within  the  sixty day period, the
    16  member's coverage under the program may be terminated. Upon the member's
    17  satisfactory provision of the information, the member's  coverage  under
    18  the  program  shall be reinstated retroactive to the date upon which the
    19  coverage was terminated.
    20    (f) To the extent necessary for purposes of this section, as a  condi-
    21  tion  of  continued  eligibility  for  health  care  services  under the
    22  program, a member who is eligible  for  benefits  under  Medicare  shall
    23  enroll in Medicare, including parts A, B and D.
    24    (g)  The  program  shall  provide  premium  assistance for all members
    25  enrolling in a Medicare part D drug  coverage  under  section  1860D  of
    26  Title XVIII of the federal social security act limited to the low-income
    27  benchmark premium amount established by the federal centers for Medicare
    28  and Medicaid services and any other amount which such agency establishes
    29  under  its  de minimis premium policy, except that such payments made on
    30  behalf of members enrolled in a Medicare advantage plan may  exceed  the
    31  low-income  benchmark  premium amount if determined to be cost effective
    32  to the program.
    33    (h) If the commissioner has  reasonable  grounds  to  believe  that  a
    34  member  could  be  eligible  for an income-related subsidy under section
    35  1860D-14 of Title XVIII of the federal social security act,  the  member
    36  shall  provide,  and authorize the program to obtain, any information or
    37  documentation required to establish the member's  eligibility  for  such
    38  subsidy,  provided that the commissioner shall attempt to obtain as much
    39  of the information and documentation as possible from records  that  are
    40  available to him or her.
    41    (i)  The  program  shall make a reasonable effort to notify members of
    42  their obligations under this subdivision. After a reasonable effort  has
    43  been made to contact the member, the member shall be notified in writing
    44  that  he  or she has sixty days to provide such required information. If
    45  such information is not  provided  within  the  sixty  day  period,  the
    46  member's  coverage  under  the  program  may  be  terminated.   Upon the
    47  member's satisfactory provision of the information, the member's  cover-
    48  age  under  the program shall be reinstated retroactive to the date upon
    49  which the coverage was terminated.
    50    § 5110. Additional provisions.   1. The  commissioner  shall  contract
    51  with not-for-profit organizations to provide:
    52    (a)  consumer  assistance to individuals with respect to selection and
    53  changing selection of a care coordinator or  health  care  organization,
    54  enrolling, obtaining health care services, and other matters relating to
    55  the program;

        S. 5474                            19
 
     1    (b) health care provider assistance to health care providers providing
     2  and  seeking  or  considering  whether  to provide, health care services
     3  under the program, with respect to participating in a health care organ-
     4  ization and dealing with a health care organization; and
     5    (c)  care coordinator assistance to individuals and entities providing
     6  and seeking or considering whether  to  provide,  care  coordination  to
     7  members.
     8    2.  The  commissioner  shall provide grants from funds in the New York
     9  Health trust fund or otherwise appropriated for this purpose, to  health
    10  systems  agencies under section twenty-nine hundred four-b of this chap-
    11  ter to support the operation of such health systems agencies.
    12    3. Retraining and re-employment of impacted employees. (a) As used  in
    13  this subdivision:
    14    (i)  "Third  party  payer"  has  its ordinary meaning and includes any
    15  entity that provides or arranges reimbursement in whole or in  part  for
    16  the purchase of health care services.
    17    (ii)  "Health care provider administrative employee" means an employee
    18  of a health care provider primarily engaged  in  relations  or  dealings
    19  with  third  party payers or seeking payment or reimbursement for health
    20  care services from third party payers.
    21    (iii) "Impacted employee" means an individual who, at  any  time  from
    22  the date this section becomes a law until two years after the end of the
    23  implementation period, is employed by a third party payer or is a health
    24  care  provider  administrative employee, and whose employment ends or is
    25  reasonably anticipated to end as a result of the implementation  of  the
    26  New York Health program.
    27    (b)  Within  ninety  days  after  this section shall become a law, the
    28  commissioner of labor shall convene a retraining and re-employment  task
    29  force  including  but  not  limited  to:  representatives  of  potential
    30  impacted employees, human resource departments of third party payers and
    31  health care providers, individuals  with  experience  and  expertise  in
    32  retraining  and  re-employment programs relevant to the circumstances of
    33  impacted employees, and representatives of the  commissioner  of  labor.
    34  The commissioner of labor and the task force shall review and provide:
    35    (i)  analysis  of  potential  impacted  employees  by  job  title  and
    36  geography;
    37    (ii) competency mapping and labor market analysis of impacted employee
    38  occupations with job openings; and
    39    (iii) establishment of regional retraining and re-employment  systems,
    40  including  but  not  limited  to  job boards, outplacement services, job
    41  search services, career advisement services, and retraining  advisement,
    42  to  be coordinated with the regional advisory councils established under
    43  section fifty-one hundred eleven of this article.
    44    (c) (i) Three or more impacted employees, a recognized union of  work-
    45  ers  including  impacted employees, or an employer of impacted employees
    46  may file a petition with the  commissioner  of  labor  to  certify  such
    47  employees as being impacted employees.
    48    (ii) Impacted employees shall be eligible for:
    49    (A) up to two years of retraining at any training provider approved by
    50  the commissioner of labor; and
    51    (B)  up  to  two  years  of  unemployment  benefits, provided that the
    52  impacted employee is enrolled in a department of labor approved training
    53  program, is actively seeking employment, and is not  currently  employed
    54  full  time;  provided, however, that such impacted employee may maintain
    55  unemployment benefits for up to two years even if he  or  she  does  not

        S. 5474                            20
 
     1  meet  the  criteria set forth in this clause but is sixty-three years of
     2  age or older at the time of loss of employment as an impacted employee.
     3    (d)  The  commissioner  shall  provide  funds from the New York Health
     4  trust fund or otherwise appropriated for this purpose to the commission-
     5  er of labor for  retraining  and  re-employment  programs  for  impacted
     6  employees under this subdivision.
     7    (e)  The  commissioner  of labor shall make regulations and take other
     8  actions reasonably necessary to implement this subdivision. This  subdi-
     9  vision  shall  be  implemented  consistent with applicable law and regu-
    10  lations.
    11    4. The commissioner shall, directly and through grants to not-for-pro-
    12  fit entities, conduct programs using data collected through the New York
    13  Health program, to promote  and  protect  the  quality  of  health  care
    14  services,  patient  outcomes, and public, environmental and occupational
    15  health, including cooperation with other data  collection  and  research
    16  programs of the department, consistent with this article, the protection
    17  of the security and confidentiality of individually identifiable patient
    18  information, and otherwise applicable law.
    19    5.  Settlements  and  judgments.  This  subdivision  applies where any
    20  settlement, judgment or order  in  the  course  of  litigation,  or  any
    21  contract  or  agreement  made  as an alternative to litigation, provides
    22  that one party shall pay for health care coverage for another party  who
    23  is entitled to enroll in the program. Any party to the settlement, judg-
    24  ment, order, contract or agreement may apply to an appropriate court for
    25  modification  of the judgment, order, contract or agreement. The modifi-
    26  cation may provide that the paying party, instead of paying  for  health
    27  care  coverage, shall pay all or part of the New York Health tax that is
    28  owed by the other party, and may include other  or  further  provisions.
    29  The modifications shall be appropriate, consistent with the program, and
    30  in  the  interest  of  justice.  As  used in this subdivision, "New York
    31  Health tax" means the tax or taxes enacted by the legislature as part of
    32  the revenue proposal, as amended, to fund the program.
    33    § 5111. Regional advisory councils.  1. The New York  Health  regional
    34  advisory councils (each referred to in this article as a "regional advi-
    35  sory council") are hereby created in the department.
    36    2.  There  shall be a regional advisory council established in each of
    37  the following regions:
    38    (a) Long Island, consisting of Nassau and Suffolk counties;
    39    (b) New York City;
    40    (c) Hudson Valley, consisting of Delaware, Dutchess,  Orange,  Putnam,
    41  Rockland, Sullivan, Ulster, Westchester counties;
    42    (d)  Northern,  consisting of Albany, Clinton, Columbia, Essex, Frank-
    43  lin, Fulton, Greene, Hamilton, Herkimer, Jefferson,  Lewis,  Montgomery,
    44  Otsego,  Rensselaer,  Saratoga,  Schenectady,  Schoharie,  St. Lawrence,
    45  Warren, Washington counties;
    46    (e) Central, consisting of Broome, Cayuga,  Chemung,  Chenango,  Cort-
    47  land,  Livingston,  Madison,  Monroe, Oneida, Onondaga, Ontario, Oswego,
    48  Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates counties; and
    49    (f) Western, consisting of Allegany,  Cattaraugus,  Chautauqua,  Erie,
    50  Genesee, Niagara, Orleans, Wyoming counties.
    51    3.  Each regional advisory council shall be composed of not fewer than
    52  twenty-seven members, as determined by the commissioner and  the  board,
    53  as  necessary  to appropriately represent the diverse needs and concerns
    54  of the region. Members of a regional advisory council shall be residents
    55  of or have their principal place of business in the region served by the
    56  regional advisory council.

        S. 5474                            21
 
     1    4. Appointment of members of the regional advisory councils.
     2    (a) The twenty-seven members shall be appointed as follows:
     3    (i) nine members shall be appointed by the governor;
     4    (ii) six members shall be appointed by the governor on the recommenda-
     5  tion of the speaker of the assembly;
     6    (iii)  six members shall be appointed by the governor on the recommen-
     7  dation of the temporary president of the senate;
     8    (iv) three members shall be appointed by the governor on the recommen-
     9  dation of the minority leader of the assembly; and
    10    (v) three members shall be appointed by the governor on the  recommen-
    11  dation of the minority leader of the senate.
    12    Where  a regional advisory council has more than twenty-seven members,
    13  additional members shall be appointed and recommended by these officials
    14  in the same proportion as the twenty-seven members.
    15    (b) Regional advisory council membership  shall  include  but  not  be
    16  limited to:
    17    (i) representatives of organizations with a regional constituency that
    18  advocate  for health care consumers, older adults, and people with disa-
    19  bilities including organizations led by members  of  those  groups,  who
    20  shall  constitute  at least one third of the membership of each regional
    21  council;
    22    (ii) representatives of professional organizations representing physi-
    23  cians;
    24    (iii)  representatives  of  professional  organizations   representing
    25  health care professionals other than physicians;
    26    (iv) representatives of general hospitals, including public hospitals;
    27    (v) representatives of community health centers;
    28    (vi)  representatives  of  mental health, behavioral health (including
    29  substance use), physical disability, developmental disability, rehabili-
    30  tation, home care and other service providers;
    31    (vii) representatives of women's health service providers;
    32    (viii) representatives of health service  providers  serving  lesbian,
    33  gay,   bisexual,   transgender,  gender  non-conforming,  and  nonbinary
    34  patients;
    35    (ix) representatives of health care organizations;
    36    (x) representatives of organized labor  including  representatives  of
    37  health care workers;
    38    (xi) representatives of employers; and
    39    (xii) representatives of municipal and county government.
    40    5. Members of a regional advisory council shall be appointed for terms
    41  of  three  years provided, however, that of the members first appointed,
    42  one-third shall be appointed for one year terms and one-third  shall  be
    43  appointed  for  two  year  terms.  Vacancies shall be filled in the same
    44  manner as original appointments for the remainder of any unexpired term.
    45  No person shall be a member of a regional advisory council for more than
    46  six years in any period of twelve consecutive years.
    47    6. Members of the  regional  advisory  councils  shall  serve  without
    48  compensation  but  shall  be  reimbursed  for their necessary and actual
    49  expenses incurred while engaged in the business of  the  advisory  coun-
    50  cils.  The program shall provide financial support for such expenses and
    51  other expenses of the regional advisory councils. However, the board may
    52  provide for compensation in cases where a  lack  of  compensation  would
    53  limit  the  ability  of a trustee or represented organization to partic-
    54  ipate in council business.
    55    7. Each regional advisory council shall meet at least quarterly.  Each
    56  regional  advisory council may form committees to assist it in its work.

        S. 5474                            22
 
     1  Members of a committee need not be  members  of  the  regional  advisory
     2  council.    The  New  York  City  regional advisory council shall form a
     3  committee for each borough of New York  City,  to  assist  the  regional
     4  advisory council in its work as it relates particularly to that borough.
     5    8.  Each  regional advisory council shall advise the commissioner, the
     6  board, the governor and the legislature on all matters relating  to  the
     7  development and implementation of the New York Health program.
     8    9.  Each  regional advisory council shall adopt, and from time to time
     9  revise, a community health improvement  plan  for  its  region  for  the
    10  purpose of:
    11    (a)  promoting  the  delivery  of  health care services in the region,
    12  improving the quality and  accessibility  of  care,  including  cultural
    13  competency,  clinical  integration  of  care  between  service providers
    14  including but not limited to physical, mental,  and  behavioral  health,
    15  physical  and  developmental disability services, and long-term supports
    16  and services;
    17    (b) facility and health services planning in the region;
    18    (c) identifying gaps in regional health care services;
    19    (d) promoting increased public knowledge and responsibility  regarding
    20  the  availability  and  appropriate utilization of health care services.
    21  Each community health improvement plan shall be submitted to the commis-
    22  sioner and the board and shall be posted on the department's website;
    23    (e) identifying needs in professional and service  personnel  required
    24  to deliver health care services; and
    25    (f)  coordinating regional implementation of retraining and re-employ-
    26  ment programs for impacted employees under subdivision three of  section
    27  fifty-one hundred ten of this article.
    28    10.  Each  regional  advisory  council shall hold at least four public
    29  hearings annually on matters relating to the New York Health program and
    30  the development and implementation of the community  health  improvement
    31  plan.
    32    11.  Each  regional advisory council shall publish an annual report to
    33  the commissioner and the board on the progress of the  community  health
    34  improvement  plan.  These  reports  shall  be posted on the department's
    35  website.
    36    12. All meetings of the  regional  advisory  councils  and  committees
    37  shall be subject to article six of the public officers law.
    38    §  4.  Financing  of New York Health. 1.  (a) As used in this section,
    39  unless the context clearly requires otherwise:
    40    (i) "New York Health program" and the  "program"  mean  the  New  York
    41  Health  program,  as  created by article 51 of the public health law and
    42  all provisions of that article.
    43    (ii) "Revenue proposal" means the revenue plan and legislative  bills,
    44  as  proposed  and  enacted  under  this  section, to provide the revenue
    45  necessary to finance the New York Health program.
    46    (iii) "Tax" means the payroll tax or non-payroll  tax  to  be  enacted
    47  under  the  revenue  proposal.  "Payroll  tax"  means the tax on payroll
    48  income and self-employed income subject to  the  Medicare  Part  A  tax,
    49  provided for in subdivision two of this section. "Non-payroll tax" means
    50  the  tax  on  taxable  income  (such as interest, dividends, and capital
    51  gains) not subject to the payroll tax, provided for in  subdivision  two
    52  of this section.
    53    (b)  The  governor shall submit to the legislature a revenue proposal.
    54  The revenue proposal shall be submitted to the legislature  as  part  of
    55  the  executive  budget  under article VII of the state constitution, for
    56  the fiscal year commencing on the first day of  April  in  the  calendar

        S. 5474                            23
 
     1  year  after  this  act  shall  become  a  law. In developing the revenue
     2  proposal, the governor shall consult with appropriate officials  of  the
     3  executive  branch; the temporary president of the senate; the speaker of
     4  the  assembly;  the  chairs  of  the fiscal and health committees of the
     5  senate and assembly; and representatives of business,  labor,  consumers
     6  and local government.
     7    2.  (a)  Basic  structure. The basic structure of the revenue proposal
     8  shall be as follows: Revenue for the program shall come from two  taxes.
     9  First,  there  shall be a progressively graduated tax on all payroll and
    10  self-employed income, paid by  employers,  employees  and  self-employed
    11  individuals.    Second,  there shall be a progressively graduated tax on
    12  taxable income (such as interest,  dividends,  and  capital  gains)  not
    13  subject  to  the  payroll tax.   Income in the bracket below twenty-five
    14  thousand dollars per year shall be exempt from the taxes; provided  that
    15  for  individuals  enrolled in Medicare as defined in the program, income
    16  in the bracket below fifty thousand dollars per  year  shall  be  exempt
    17  from the taxes.  Higher brackets of income subject to the taxes shall be
    18  assessed at a higher marginal rate than lower brackets.  The taxes shall
    19  be  set  at  levels anticipated to produce sufficient revenue to finance
    20  the program, to be scaled up as enrollment grows, taking into  consider-
    21  ation  anticipated  federal revenue available for the program. Provision
    22  shall be made for state residents who  are  employed  out-of-state,  and
    23  non-residents  who  are  employed in the state (including those employed
    24  less than full-time).
    25    (b) Payroll tax. The income to be subject to the payroll tax shall  be
    26  all  income subject to the Medicare Part A tax. The payroll tax shall be
    27  set at a percentage of that income, which shall be progressively  gradu-
    28  ated,  so  the  percentage  is  higher on higher brackets of income. For
    29  employed individuals, the employer  shall  pay  eighty  percent  of  the
    30  payroll tax and the employee shall pay twenty percent of the tax, except
    31  that  an  employer may agree to pay all or part of the employee's share.
    32  A self-employed individual shall pay the full tax.
    33    (c) Non-payroll income tax. There shall be a tax  on  income  that  is
    34  subject  to  the personal income tax under article 22 of the tax law and
    35  is not subject to the payroll tax. It shall be set at  a  percentage  of
    36  that  income,  which shall be progressively graduated, so the percentage
    37  is higher on higher brackets of income.
    38    (d) Phased-in rates. Early in the program, when enrollment is growing,
    39  the amount of the taxes shall be at an appropriate level, and  shall  be
    40  changed as anticipated enrollment grows, to cover the actual cost of the
    41  program.  The revenue proposal shall include a mechanism for determining
    42  the rates of the taxes.
    43    (e) Cross-border employees. (i) State residents employed out-of-state.
    44  If an individual is employed out-of-state by an employer that is subject
    45  to New York state law, the employer and employee shall  be  required  to
    46  pay the payroll tax as to that employee as if the employment were in the
    47  state.  If an individual is employed out-of-state by an employer that is
    48  not subject to New York state law, either (A) the employer and  employee
    49  shall  voluntarily comply with the tax or (B) the employee shall pay the
    50  tax as if he or she were self-employed.
    51    (ii) Out-of-state residents employed in the state.   The  payroll  tax
    52  shall  apply  to  any  out-of-state resident who is employed or self-em-
    53  ployed in the state.  Such individual and individual's employer shall be
    54  able to take a credit against the payroll taxes each would otherwise pay
    55  as to that individual for amounts  they  spend  respectively  on  health
    56  benefits (A) for the individual, if the individual is not eligible to be

        S. 5474                            24
 
     1  a  member  of  the  program,  and (B) for any member of the individual's
     2  immediate family.   For the employer,  the  credit  shall  be  available
     3  regardless  of the form of the health benefit (e.g., health insurance, a
     4  self-insured  plan,  direct services, or reimbursement for services), to
     5  make sure that the revenue proposal does not relate to employment  bene-
     6  fits  in violation of any federal law. For non-employment-based spending
     7  by the individual, the credit shall be  available  for  and  limited  to
     8  spending  for  health  coverage (not out-of-pocket health spending). The
     9  credit shall be available without regard to how little is spent  or  how
    10  sparse  the  benefit.  The  credit may only be taken against the payroll
    11  tax. Any excess amount may not be applied to other  tax  liability.  The
    12  credit  shall  be  distributed  between the employer and employee in the
    13  same proportion as the spending by each  for  the  benefit  and  may  be
    14  applied to their respective portion of the tax. If any provision of this
    15  subparagraph  or any application of it shall be ruled to violate federal
    16  law, the provision or the application of it shall be null and  void  and
    17  the  ruling  shall not affect any other provision or application of this
    18  section or the act that enacted it.
    19    3. (a) The revenue proposal  shall  include  a  plan  and  legislative
    20  provisions   for  ending  the  requirement  for  local  social  services
    21  districts to pay part of  the  cost  of  Medicaid  and  replacing  those
    22  payments with revenue from the taxes under the revenue proposal.
    23    (b)  The  taxes  under this section shall not supplant the spending of
    24  other state revenue to pay for the Medicaid program as it exists  as  of
    25  the  enactment  of  the  revenue proposal as amended, unless the revenue
    26  proposal as amended provides otherwise.
    27    4. To the extent that the revenue proposal differs from the  terms  of
    28  subdivision  two  or paragraph (b) of subdivision three of this section,
    29  the revenue proposal shall state how it differs  from  those  terms  and
    30  reasons for and the effects of the differences.
    31    5.  All  revenue  from  the  taxes  shall be deposited in the New York
    32  Health trust fund account under section 89-j of the state finance law.
    33    § 5.  Article 49 of the public health law is amended by adding  a  new
    34  title 3 to read as follows:
    35                                  TITLE III
    36            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    37                               NEW YORK HEALTH
    38  Section 4920. Definitions.
    39          4921. Collective negotiation authorized.
    40          4922. Collective negotiation requirements.
    41          4923. Requirements for health care providers' representative.
    42          4924. Mediation.
    43          4925. Certain collective action prohibited.
    44          4926. Fees.
    45          4927. Confidentiality.
    46          4928. Severability and construction.
    47    § 4920. Definitions. For purposes of this title:
    48    1. "New York Health" means the program under article fifty-one of this
    49  chapter.
    50    2.  "Person"  means  an  individual,  association, corporation, or any
    51  other legal entity.
    52    3. "Health care providers' representative" means a third party that is
    53  authorized by health care providers to negotiate on  their  behalf  with
    54  New  York  Health  over terms and conditions affecting those health care
    55  providers.

        S. 5474                            25
 
     1    4. "Strike" means a work stoppage in part or in whole, direct or indi-
     2  rect, by a body of workers to gain compliance with demands  made  on  an
     3  employer.
     4    5.  "Health  care provider" means a health care provider under article
     5  fifty-one of this chapter. A health  care  professional  as  defined  in
     6  article  fifty-one of this chapter who practices as an employee or inde-
     7  pendent contractor of another health care provider shall not be deemed a
     8  health care provider for purposes of this title.
     9    § 4921. Collective negotiation authorized. 1.  Health  care  providers
    10  may  meet  and  communicate  for the purpose of collectively negotiating
    11  with New York Health on any matter relating to New York Health,  includ-
    12  ing but not limited to rates of payment and payment methodologies.
    13    2. Nothing in this section shall be construed to allow or authorize an
    14  alteration  of  the terms of the internal and external review procedures
    15  set forth in law.
    16    3. Nothing in this section shall be construed to allow a strike of New
    17  York Health by health care providers.
    18    4. Nothing in this section shall be construed to  allow  or  authorize
    19  terms or conditions which would impede the ability of New York Health to
    20  obtain  or  retain  accreditation  by the national committee for quality
    21  assurance or a similar body or to comply with applicable state or feder-
    22  al law.
    23    § 4922. Collective negotiation requirements. 1. Collective negotiation
    24  rights granted by this title must conform to the following requirements:
    25    (a) health care providers  may  communicate  with  other  health  care
    26  providers  regarding  the terms and conditions to be negotiated with New
    27  York Health;
    28    (b) health care providers may communicate with health care  providers'
    29  representatives;
    30    (c)  a health care providers' representative is the only party author-
    31  ized to negotiate with New York Health on  behalf  of  the  health  care
    32  providers as a group;
    33    (d)  a  health  care provider can be bound by the terms and conditions
    34  negotiated by the health care providers' representatives; and
    35    (e) in communicating or negotiating with the  health  care  providers'
    36  representative, New York Health is entitled to offer and provide differ-
    37  ent terms and conditions to individual competing health care providers.
    38    2.  Nothing  in this title shall affect or limit the right of a health
    39  care provider or group of health care providers to collectively petition
    40  a government entity for a change in a law, rule, or regulation.
    41    3. Nothing in this title shall affect or limit  collective  action  or
    42  collective  bargaining  on the part of any health care provider with his
    43  or her employer or any other  lawful  collective  action  or  collective
    44  bargaining.
    45    § 4923. Requirements for health care providers' representative. Before
    46  engaging  in  collective  negotiations with New York Health on behalf of
    47  health care providers, a health  care  providers'  representative  shall
    48  file  with the commissioner, in the manner prescribed by the commission-
    49  er, information identifying  the  representative,  the  representative's
    50  plan of operation, and the representative's procedures to ensure compli-
    51  ance with this title.
    52    § 4924. Mediation. 1. In the event the commissioner determines that an
    53  impasse  exists  in  the  negotiations,  the  commissioner  shall render
    54  assistance as follows:
    55    (a) to assist the parties to effect  a  voluntary  resolution  of  the
    56  negotiations,  the commissioner shall appoint a mediator who is mutually

        S. 5474                            26
 
     1  acceptable to both the health care  providers'  representative  and  the
     2  representative  of  New  York  Health.  If the mediator is successful in
     3  resolving the impasse, then the health  care  providers'  representative
     4  shall proceed as set forth in this article;
     5    (b)  if  an  impasse continues, the commissioner shall appoint a fact-
     6  finding board of not more than three members, who are mutually  accepta-
     7  ble  to both the health care providers' representative and the represen-
     8  tative of New  York  Health.  The  fact-finding  board  shall  have,  in
     9  addition  to  the powers delegated to it by the board, the power to make
    10  recommendations for the resolution of the dispute;
    11    (c) the fact-finding board, acting by a majority of its members, shall
    12  transmit its findings of fact and recommendations for resolution of  the
    13  dispute  to  the  commissioner, and may thereafter assist the parties to
    14  effect a voluntary resolution of the  dispute.  The  fact-finding  board
    15  shall  also  share  its  findings  of  fact and recommendations with the
    16  health care providers' representative and the representative of New York
    17  Health. If within twenty days after the submission of  the  findings  of
    18  fact  and recommendations, the impasse continues, the commissioner shall
    19  order a resolution to the negotiations based upon the findings  of  fact
    20  and recommendations submitted by the fact-finding board.
    21    §  4925.  Certain  collective  action prohibited. 1. This title is not
    22  intended to authorize competing health care providers to act in  concert
    23  in  response to a health care providers' representative's discussions or
    24  negotiations with New York Health except as authorized by other law.
    25    2. No health care providers' representative shall negotiate any agree-
    26  ment that excludes, limits the participation  or  reimbursement  of,  or
    27  otherwise limits the scope of services to be provided by any health care
    28  provider  or group of health care providers with respect to the perform-
    29  ance of services that are within the health care provider's lawful scope
    30  or terms of practice, license, registration, or certificate.
    31    § 4926. Fees. Each person who acts as the representative of  negotiat-
    32  ing parties under this title shall pay to the department a fee to act as
    33  a  representative.  The  commissioner,  by regulation, shall set fees in
    34  amounts deemed reasonable and necessary to cover the costs  incurred  by
    35  the department in administering this title.
    36    § 4927. Confidentiality. All reports and other information required to
    37  be  reported  to the department under this title shall not be subject to
    38  disclosure under article six of the public officers law.
    39    § 4928. Severability and construction. If any provision or application
    40  of this title shall be held to be invalid, or to violate  or  be  incon-
    41  sistent  with  any  applicable federal law or regulation, that shall not
    42  affect other provisions or applications of this title which can be given
    43  effect without that provision or  application;  and  to  that  end,  the
    44  provisions  and applications of this title are severable. The provisions
    45  of this title shall  be  liberally  construed  to  give  effect  to  the
    46  purposes thereof.
    47    §  6.  Subdivision  11  of  section  270  of the public health law, as
    48  amended by section 2-a of part C of chapter 58 of the laws of  2008,  is
    49  amended to read as follows:
    50    11.  "State  public  health plan" means the medical assistance program
    51  established by title eleven of article five of the social  services  law
    52  (referred  to in this article as "Medicaid"), the elderly pharmaceutical
    53  insurance coverage program established by title three of article two  of
    54  the  elder  law (referred to in this article as "EPIC"), and the [family
    55  health plus program established by section three  hundred  sixty-nine-ee
    56  of  the social services law to the extent that section provides that the

        S. 5474                            27

     1  program shall be subject to this article] New York Health program estab-
     2  lished by article fifty-one of this chapter.
     3    §  7. The state finance law is amended by adding a new section 89-j to
     4  read as follows:
     5    § 89-j. New York Health trust fund. 1. There is hereby established  in
     6  the joint custody of the state comptroller and the commissioner of taxa-
     7  tion  and  finance  a  special revenue fund to be known as the "New York
     8  Health trust fund", referred to in this section as "the fund". The defi-
     9  nitions in section fifty-one hundred of  the  public  health  law  shall
    10  apply to this section.
    11    2. The fund shall consist of:
    12    (a)  all monies obtained from taxes pursuant to legislation enacted as
    13  proposed under section three of the New York Health act;
    14    (b) federal payments received as a  result  of  any  waiver  or  other
    15  arrangements  agreed  to  by  the  United States secretary of health and
    16  human services or other appropriate federal officials  for  health  care
    17  programs established under Medicare, any federally-matched public health
    18  program, or the affordable care act;
    19    (c)  the  amounts paid by the department of health that are equivalent
    20  to those amounts that are paid on behalf  of  residents  of  this  state
    21  under  Medicare,  any  federally-matched  public  health program, or the
    22  affordable care act for health benefits which are equivalent  to  health
    23  benefits covered under New York Health;
    24    (d)  federal and state funds for purposes of the provision of services
    25  authorized under title XX of the federal social security act that  would
    26  otherwise  be  covered under article fifty-one of the public health law;
    27  and
    28    (e) state monies that would otherwise be appropriated to  any  govern-
    29  mental  agency,  office,  program,  instrumentality or institution which
    30  provides health services, for services and benefits  covered  under  New
    31  York Health. Payments to the fund pursuant to this paragraph shall be in
    32  an  amount  equal  to  the  money  appropriated for such purposes in the
    33  fiscal year beginning immediately preceding the effective  date  of  the
    34  New York Health act.
    35    3.  Monies  in  the  fund  shall only be used for purposes established
    36  under article fifty-one of the public health law.
    37    § 8. Temporary commission on implementation. 1. There is hereby estab-
    38  lished a temporary commission on implementation of the New  York  Health
    39  program,  referred  to  in this section as the commission, consisting of
    40  fifteen members: five members, including the chair, shall  be  appointed
    41  by the governor; four members shall be appointed by the temporary presi-
    42  dent of the senate, one member shall be appointed by the senate minority
    43  leader;  four members shall be appointed by the speaker of the assembly,
    44  and one member shall be appointed by the assembly minority  leader.  The
    45  commissioner  of  health,  the superintendent of financial services, and
    46  the commissioner of taxation and finance, or their designees shall serve
    47  as non-voting ex-officio members of the commission.
    48    2. Members of the commission shall receive such assistance as  may  be
    49  necessary  from  other  state  agencies  and entities, and shall receive
    50  reasonable and necessary expenses incurred in the performance  of  their
    51  duties.  The  commission  may  employ  staff  as needed, prescribe their
    52  duties, and fix their compensation within amounts appropriated  for  the
    53  commission.
    54    3.  The commission shall examine the laws and regulations of the state
    55  and consult with health care providers, consumers, and other  stakehold-
    56  ers  and  make such recommendations as are necessary to conform the laws

        S. 5474                            28
 
     1  and regulations of the state and article 51 of  the  public  health  law
     2  establishing  the  New  York  Health program and other provisions of law
     3  relating to the New York Health program, and to  improve  and  implement
     4  the  program.  The  commission  shall  report its recommendations to the
     5  governor and the legislature.   The commission shall  immediately  begin
     6  development of proposals consistent with the principles of article 51 of
     7  the  public  health  law  for  provision of health care services covered
     8  under the workers' compensation law; and incorporation of retiree health
     9  benefits, as described in paragraphs (a), (b) and (c) of  subdivision  8
    10  of  section 5102 of the public health law.  The commission shall provide
    11  its work product and assistance to the  board  established  pursuant  to
    12  section 5102 of the public health law upon completion of the appointment
    13  of the board.
    14    §  9.  Severability. If any provision or application of this act shall
    15  be held to be invalid, or to violate or be inconsistent with any  appli-
    16  cable  federal law or regulation, that shall not affect other provisions
    17  or applications of this act which  can  be  given  effect  without  that
    18  provision  or  application; and to that end, the provisions and applica-
    19  tions of this act are severable.
    20    § 10. This act shall take effect immediately.
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