RETRIEVE BILL HMH - 0607
STATE OF NEW YORK
________________________________________________________________________
S. 6457 A. 9557
SENATE - ASSEMBLY
January 20, 2006
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means
AN ACT to amend the social services law, the public health law, the
penal law, the criminal procedure law, the labor law, the civil prac-
tice law and rules, the public health law, chapter 58 of the laws of
2005, amending the public health law and other laws relating to imple-
menting the state fiscal plan for the 2005-2006 state fiscal year,
chapter 66 of the laws of 1994, amending the public health law, the
general municipal law and the insurance law relating to the financing
of life care communities, chapter 81 of the laws of 1995, amending the
public health law and other laws relating to medical reimbursement and
welfare reform, chapter 639 of the laws of 1996 amending the public
health law and other laws relating to welfare reform, chapter 474 of
the laws of 1996, amending the education law and other laws relating
to rates for residential health care facilities, chapter 483 of the
laws of 1978, amending the public health law relating to rate of
payments for each residential health care facility to real property
costs, chapter 649 of the laws of 1996, amending the public health
law, the mental hygiene law and the social services law relating to
authorizing the establishment of special needs plans, chapter 710 of
the laws of 1988, amending the social services law and the education
law relating to medical assistance eligibility of certain persons and
providing for managed medical care demonstration programs, chapter 165
of the laws of 1991, amending the public health law and other laws
relating to establishing payments for medical assistance, chapter 19
of the laws of 1998, amending the social services law relating to
limiting the method of payment for prescription drugs under the
medical assistance program, chapter 659 of the laws of 1997, amending
the public health law and other laws relating to creation of continu-
ing care retirement communities, chapter 904 of the laws of 1984,
amending the public health law and the social services law relating to
encouraging comprehensive health services, in relation to health
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD12271-01-6
S. 6457 2 A. 9557
reform; and to repeal section 366-f of the social services law, subdi-
vision 11 of section 364-j of the social services law, paragraph (c)
of subdivision 3 of section 369-ee of the social services law, para-
graph (j) of subdivision 2 of section 365-a of the social services law
and subdivision (x) of section 165 of chapter 41 of the laws of 1992
amending the public health law and other laws relating to assessing
certain healthcare providers relating thereto (Part A); to amend the
insurance law and the public health law, in relation to early inter-
vention services; to amend the public health law, in relation to state
aid for municipalities; to amend the elder law, in relation to the
elderly pharmaceutical insurance coverage program; to amend chapter 62
of the laws of 2003 amending the public health law relating to allow-
ing for the use of funds of the office of professional medical conduct
for activities of the patient health information and quality improve-
ment act of 2000, in relation to the effectiveness of such provisions
of the public health law relating thereto; and repealing certain
provisions of the public health law relating thereto (Part B); to
establish a cost of living adjustment for designated human services
programs and providing for the repeal of such provisions upon expira-
tion thereof (Part C); to amend the public health law, in relation to
allocations for worker retraining, Roswell Park, anti-tobacco program,
public health programs, elderly pharmaceutical insurance coverage,
excess medical malpractice, nursing home financially distressed, phar-
macy, family health plus, healthcare efficiency and affordability law
for New Yorkers, to amend the public health law, in relation to HCRA
surcharges, assessments and covered lives assessment; bad debt and
charity care; high need indigent care; state planning and research
cooperative systems and the health care reform act pool reporting
requirements; to amend the state finance law, in relation to the area
health education centers; to amend the insurance law, the tax law and
chapter 235 of the laws of 1952 relating to enabling any city of the
state having a population of one million or more to adopt and amend
local laws, imposing certain specified types of taxes on cigarettes,
cigars and smoking tobacco which the legislature has or would have
power and authority to impose, to provide for the review of such
taxes, and to limit the application of such local laws, in relation to
the tax on cigarettes; to amend the public authorities law in relation
to the HCRA resources fund; and to repeal certain provisions of the
public health law relating thereto (Part D); to amend the state
finance law, in relation to the chemical dependence service fund (Part
E); to amend the mental hygiene law, in relation to funding of chemi-
cal dependence and compulsive gambling services (Part F); to amend the
public health law, in relation to eliminating mental health outpatient
services as services that can be considered specialized services under
section 2807 of the public health law (Part G); and to amend chapter
119 of the laws of 1997 relating to authorizing the department of
health to establish certain payments to general hospitals, in relation
to extending the authorization for the department of health to contin-
ue certain payments to general hospitals
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2006-2007
S. 6457 3 A. 9557
1 state fiscal year. Each component is wholly contained within a Part
2 identified as Parts A through H. The effective date for each particular
3 provision contained within such Part is set forth in the last section of
4 such Part. Any provision in any section contained within a Part, includ-
5 ing the effective date of the Part, which makes a reference to a section
6 "of this act", when used in connection with that particular component,
7 shall be deemed to mean and refer to the corresponding section of the
8 Part in which it is found. Section three of this act sets forth the
9 general effective date of this act.
10 PART A
11 Section 1. Subdivision 4 of section 365-a of the social services law,
12 is amended by adding a new paragraph (f) to read as follows:
13 (f) for eligible persons who are also beneficiaries under part D of
14 title XVIII of the federal social security act, drugs which are denomi-
15 nated as "covered part D drugs" under section 1860D-2(e) of such act;
16 provided however that, for purposes of this paragraph, "covered part D
17 drugs" shall not mean atypical anti-psychotics, anti-depressants, anti-
18 retrovirals used in the treatment of HIV/AIDS, or anti-rejection drugs
19 used for the treatment of organ and tissue transplants.
20 § 2. Section 2808 of the public health law is amended by adding a new
21 subdivision 24 to read as follows:
22 24. Notwithstanding any inconsistent provision of law or regulation to
23 the contrary, (a) The operating component of rates of payment by govern-
24 mental agencies for services provided by residential health care facili-
25 ties, except for residential health care facilities or discrete units of
26 residential health care facilities as identified in paragraphs (b) and
27 (c) of this subdivision, shall be computed in accordance with the
28 following base year cost data, as trended pursuant to applicable law to
29 the applicable rate period and as adjusted for case mix in accordance
30 with applicable regulations:
31 (i) for the period January first, two thousand seven through December
32 thirty-first, two thousand seven, eighty percent of each such rate shall
33 reflect utilization of the reported base year operating costs used to
34 set each facility's two thousand five rates, and twenty percent of each
35 such rate shall reflect utilization of each such facility's reported
36 base year operating costs for two thousand three;
37 (ii) for the period January first, two thousand eight through December
38 thirty-first, two thousand eight, sixty percent of each such rate shall
39 reflect utilization of the reported base year operating costs used to
40 set each facility's two thousand five rates, and forty percent of each
41 such rate shall reflect utilization of each such facility's reported
42 base year operating costs for two thousand three;
43 (iii) for the period January first, two thousand nine through December
44 thirty-first, two thousand nine, forty percent of each such rate shall
45 reflect utilization of the reported base year operating costs used to
46 set each facility's two thousand five rates, and sixty percent of each
47 such rate shall reflect utilization of each such facility's reported
48 base year operating costs for two thousand three;
49 (iv) for the period January first, two thousand ten through December
50 thirty-first, two thousand ten, twenty percent of each such rate shall
51 reflect utilization of the reported base year operating costs used to
52 set each facility's two thousand five rates, and eighty percent of each
53 such rate shall reflect utilization of each such facility's reported
54 base year operating costs for two thousand three; and
S. 6457 4 A. 9557
1 (v) for periods on and after January first, two thousand eleven, each
2 such rate shall reflect utilization of each such facility's reported
3 base year operating costs for two thousand three.
4 (b) Residential health care facilities receiving rates of payment
5 based on allowable operating costs for a period subsequent to January
6 first, two thousand three, shall continue to receive rates of payment
7 reflecting the allowable operating costs from such subsequent period.
8 (c) Paragraph (a) of this subdivision shall not apply to rates of
9 payment paid for services provided in the following residential health
10 care facilities or discrete units of such facilities if the application
11 of such paragraph would result in a lesser rate of payment:
12 (i) residential health care facilities or discrete units of such
13 facilities established for the care of AIDS patients, as approved by the
14 commissioner;
15 (ii) residential health facilities or discrete units of such facili-
16 ties established for the care of patients under the long-term inpatient
17 rehabilitation program for traumatic brain injured patients, as estab-
18 lished pursuant to applicable regulations;
19 (iii) residential health care facilities or discrete units of such
20 facilities established for the long-term care of ventilator dependent
21 residents, as approved by the commissioner;
22 (iv) residential health care facilities or discrete units of such
23 facilities specifically designated and approved by the commissioner for
24 the purpose of providing specialized programs for residents requiring
25 behavioral interventions; and
26 (v) residential health care facilities or discrete units of such
27 facilities which provide extensive nursing, medical, psychological and
28 counseling support services solely to children, as determined by the
29 commissioner.
30 § 3. Section 2808 of the public health law is amended by adding a new
31 subdivision 22 to read as follows:
32 22. Special provisions.
33 (a) Notwithstanding any inconsistent provision of law or regulation to
34 the contrary, residential health care facility rates of payment deter-
35 mined pursuant to this article for services provided on and after Janu-
36 ary first, two thousand seven, except for the establishment of any
37 statewide or any peer group base, mean, or ceiling prices per day, shall
38 be calculated utilizing only the number of residents properly assessed
39 and reported in each patient classification group and eligible for
40 medical assistance pursuant to title eleven of article five of the
41 social services law.
42 (b) Notwithstanding any inconsistent provision of law or regulation to
43 the contrary, for services provided on and after January first, two
44 thousand seven, the commissioner shall utilize the free-standing resi-
45 dential health care facility indirect peer group prices, as computed in
46 accordance with applicable regulations, in computing the allowable indi-
47 rect component of rates of payment for hospital based residential health
48 care facilities.
49 (c) Notwithstanding any inconsistent provision of law or regulation to
50 the contrary, for services provided on and after January first, two
51 thousand seven, for computing the indirect component of rates of payment
52 for residential health care facilities licensed under this article to
53 operate three hundred or more beds, the commissioner shall utilize the
54 indirect peer group prices for residential health care facilities
55 licensed under this article to operate less than three hundred beds.
S. 6457 5 A. 9557
1 § 4. Article 1 of the public health law is amended by adding a new
2 title III to read as follows:
3 TITLE III
4 OFFICE OF THE MEDICAID INSPECTOR GENERAL
5 Section 30. Definitions.
6 31. Establishment.
7 32. Functions, duties and responsibilities.
8 33. Cooperation of agency officials and employees.
9 34. Transfer of employees.
10 35. Reports required of the inspector.
11 36. Disclosure of information.
12 § 30. Definitions. For the purposes of this title, the following
13 definitions shall apply:
14 a. "Inspector" means the Medicaid inspector general created by this
15 section.
16 b. "Investigation" means investigations of fraud, waste, abuse, or
17 illegal acts perpetrated within the Medicaid program, by providers or
18 recipients of Medicaid care, services and supplies.
19 c. "Office" means the office of the Medicaid inspector general
20 created by this section.
21 § 31. Establishment. a. There is hereby created within the department
22 the office of Medicaid inspector general. The office shall undertake and
23 be responsible for the department's duties as the single state agency
24 for the administration of the Medicaid program in New York state with
25 respect to fraud, waste and abuse. This responsibility shall include
26 but not be limited to the Medicaid audit functions, pursuant to sections
27 three hundred sixty-four and three hundred sixty-eight-c of the social
28 services law, and the function of Medicaid fraud, waste and abuse
29 prevention, pursuant to sections one hundred forty-five-a and one
30 hundred forty-five-b of the social services law (transferred to the
31 New York state department of health from the former department of social
32 services pursuant to subdivision (e) of section one hundred twenty-two
33 of part B of chapter four hundred thirty-six of the chapter laws of
34 nineteen hundred ninety-seven).
35 b. The head of the office shall be the Medicaid inspector general who
36 shall be appointed by the governor by and with the advice and consent of
37 the senate. The inspector shall serve for a term of five years. The
38 inspector shall report directly to the secretary to the governor.
39 c. The inspector shall be compensated within the limits of funds
40 available therefor, provided, however, such salary shall be no less than
41 the salaries of certain state officers holding the positions indicated
42 in paragraph (a) of subdivision one of section one hundred sixty-nine of
43 the executive law.
44 § 32. Functions, duties and responsibilities. The inspector shall
45 have the following functions, duties and responsibilities:
46 a. to appoint such deputies, directors, assistants and other officers
47 and employees as may be needed for the performance of his or her duties
48 and may prescribe their duties and fix their compensation within the
49 amounts appropriated therefor;
50 b. to conduct and supervise activities to prevent, detect and investi-
51 gate Medicaid fraud, waste and abuse amongst the following: the depart-
52 ment; the offices of mental health, mental retardation and developmental
53 disabilities, alcoholism and substance abuse services, temporary disa-
S. 6457 6 A. 9557
1 bility assistance, and children and family services; the department of
2 education;
3 c. to coordinate, to the greatest extent possible, activities to
4 prevent, detect and investigate Medicaid fraud, waste and abuse amongst
5 the following: the department; the offices of mental health, mental
6 retardation and developmental disabilities, alcoholism and substance
7 abuse services, temporary disability assistance, and children and family
8 services; the department of education; the fiscal agent employed to
9 operate the Medicaid management information system; local governments
10 and entities, the deputy attorney general for Medicaid fraud control;
11 and the state comptroller;
12 d. to keep the governor, attorney general, state comptroller, tempo-
13 rary president and minority leader of the senate, the speaker and the
14 minority and majority leaders of the assembly, and the heads of agencies
15 with responsibility for the administration of the Medicaid program
16 apprised of efforts to prevent, detect, investigate, and prosecute
17 fraud, waste and abuse within the Medicaid program;
18 e. to pursue civil and administrative enforcement actions against
19 those who engage in fraud, waste, abuse or illegal or inappropriate acts
20 perpetrated within the Medicaid program, including providers, contrac-
21 tors, agents, recipients, individuals or other entities involved direct-
22 ly or indirectly with the provision of Medicaid care, services and
23 supplies;
24 f. to make information and evidence relating to suspected criminal
25 acts which he or she may obtain in carrying out his or her duties avail-
26 able to the Deputy Attorney General for Medicaid Fraud Control pursuant
27 to the requirements of federal law, as well as to other law enforcement
28 officials where appropriate, and consulting with the Deputy Attorney
29 General for Medicaid Fraud Control, federal prosecutors, and local
30 district attorneys to coordinate criminal investigations and prose-
31 cutions;
32 g. to subpoena and enforce the attendance of witnesses, administer
33 oaths or affirmations, examine witnesses under oath, and take testimo-
34 ny;
35 h. to require and compel the production of such books, papers, records
36 and documents as he or she may deem to be relevant or material to an
37 investigation, examination or review undertaken pursuant to this
38 section;
39 i. to examine and copy or remove documents or records of any kind
40 related to the Medicaid program or necessary for the Medicaid inspector
41 general to perform its duties and responsibilities that are prepared,
42 maintained or held by or available to any state agency or local govern-
43 mental entity the patients or clients of which are served by the Medi-
44 caid program, or which is otherwise responsible for the control of Medi-
45 caid fraud, waste and abuse;
46 j. to recommend and implement policies relating to the prevention and
47 detection of fraud, waste and abuse;
48 k. to monitor the implementation of any recommendations made by the
49 office of the Medicaid inspector general to agencies or other entities
50 with responsibility for administration of the Medicaid program;
51 l. to receive and to investigate complaints of alleged failures of
52 state and local officials to prevent, detect and prosecute fraud, waste,
53 and abuse; and
54 m. perform any other functions that are necessary or appropriate to
55 fulfill the duties and responsibilities of the office.
S. 6457 7 A. 9557
1 § 33. Cooperation of agency officials and employees. a. In addition
2 to the authority otherwise provided by this title, the inspector, in
3 carrying out the provisions of this title, is authorized to request such
4 information, assistance and cooperation from any federal, state or local
5 governmental department, board, bureau, commission, or other agency or
6 unit thereof as may be necessary for carrying out the duties and respon-
7 sibilities enjoined upon the inspector by this section. State and local
8 agencies or units thereof are hereby authorized and directed to provide
9 such information, assistance and cooperation. Executive agencies shall
10 coordinate and facilitate the transfer of appropriate functions and
11 positions to the Medicaid inspector general as necessary and in accord-
12 ance with applicable law.
13 b. Notwithstanding any other provision of law, rule or regulation to
14 the contrary, no person shall prevent, seek to prevent, interfere with,
15 obstruct or otherwise hinder any investigation being conducted pursuant
16 to this section. No provision of law shall in any way be construed to
17 restrict any person or governmental body from cooperating and assisting
18 the inspector or his or her employees in carrying out their duties under
19 this section. Any violation of this paragraph shall constitute cause
20 for suspension or removal from office or employment.
21 § 34. Transfer of employees. Upon the transfer of the Medicaid audit
22 and fraud, waste and abuse prevention functions from the department of
23 health, the office of mental retardation and developmental disabilities,
24 the office of mental health, and the office of alcohol and substance
25 abuse services to the office of Medicaid inspector general within the
26 department pursuant to section thirty-one of this title, provision shall
27 be made for the transfer of necessary officers and employees who are
28 substantially engaged in the performance of the function to be trans-
29 ferred, and any documents and records necessary and related to the
30 transfer of such functions. The heads of the departments or agencies
31 from which such function is to be transferred and the head of the office
32 of the Medicaid inspector general shall confer to determine the officers
33 and employees who are substantially engaged in the Medicaid audit and
34 fraud, waste, and abuse prevention function to be transferred. Officers
35 and employees so transferred shall be transferred without further exam-
36 ination or qualification, and shall retain their respective civil
37 service classification and status.
38 § 35. Reports required of the inspector. The inspector shall, no
39 later than October first of each year, submit to the governor, the state
40 comptroller, the attorney general and the legislature a report summariz-
41 ing the activities of the office during the preceding calendar year.
42 § 36. Disclosure of information. a. The inspector shall not publicly
43 disclose information which is specifically prohibited from disclosure by
44 any other provision of law.
45 b. Notwithstanding subdivision a of this section, any report under
46 this section may be disclosed to the public in a form which includes
47 information with respect to a part of an ongoing criminal investigation
48 if such information has been included in a public record.
49 § 5. The penal law is amended by adding a new article 159 to read as
50 follows:
51 ARTICLE 159
52 HEALTH CARE OFFENSES
53 Section 159.00 Definitions.
54 159.05 Health care fraud in the fifth degree.
55 159.10 Health care fraud in the fourth degree.
56 159.15 Health care fraud in the third degree.
S. 6457 8 A. 9557
1 159.20 Health care fraud in the second degree.
2 159.25 Health care fraud in the first degree.
3 159.30 Making false statements relating to health care in the
4 second degree.
5 159.35 Making false statements relating to health care in the
6 first degree.
7 § 159.00 Definitions.
8 The following definition is applicable to this article:
9 "Health plan" means any publicly funded plan or contract, under which
10 any medical benefit, item, or service is provided to any individual and
11 includes any individual or entity who is providing a medical benefit,
12 item, or service for which payment may be made under the plan or
13 contract.
14 § 159.05 Health care fraud in the fifth degree.
15 A person is guilty of health care fraud in the fifth degree when, with
16 intent to appropriate any benefit to himself, herself or another, he or
17 she knowingly executes or conspires to execute a scheme or artifice to:
18 (a) defraud any health plan in connection with the delivery of, or
19 payment for, health care benefits, items or services; or
20 (b) obtain money or anything of value in connection with the delivery
21 of, or payment for, health care benefits, items or services by means of
22 false or fraudulent pretense, representation, statement or promise, any
23 of which he or she knows to be false or fraudulent.
24 Health care fraud in the fifth degree is a class A misdemeanor.
25 § 159.10 Health care fraud in the fourth degree.
26 A person is guilty of health care fraud in the fourth degree when he
27 or she commits the crime of health care fraud in the fifth degree with
28 the intent to appropriate to himself, herself, or another a benefit
29 worth one thousand dollars or more in the aggregate.
30 Health care fraud in the fourth degree is a class E felony.
31 § 159.15 Health care fraud in the third degree.
32 A person is guilty of health care fraud in the third degree when he or
33 she commits the crime of health care fraud in the fifth degree with the
34 intent to appropriate to himself, herself, or another a benefit worth
35 three thousand dollars or more in the aggregate.
36 Health care fraud in the third degree is a class D felony.
37 § 159.20 Health care fraud in the second degree.
38 A person is guilty of health care fraud in the second degree when he
39 or she commits the crime of health care fraud in the fifth degree:
40 (a) with the intent to appropriate to himself, herself, or another
41 benefit worth fifty thousand dollars or more in the aggregate; or
42 (b) when commission of the offense results in serious physical injury,
43 as defined in subdivision ten of section 10.00 of this chapter.
44 Health care fraud in the second degree is a class C felony.
45 § 159.25 Health care fraud in the first degree.
46 A person is guilty of health care fraud in the first degree when he or
47 she commits the crime of health care fraud in the fifth degree:
48 (a) with the intent to appropriate to himself, herself, or another a
49 benefit worth one million dollars or more in the aggregate; or
50 (b) when commission of the offense results in death.
51 Health care fraud in the first degree is a class B felony.
52 § 159.30 Making false statements relating to health care in the second
53 degree.
54 A person is guilty of making false statements relating to health care
55 in the second degree when, in any matter related to a health plan, he or
S. 6457 9 A. 9557
1 she, in connection with the provision of health care or related
2 services, knowingly:
3 (a) falsifies, conceals, or omits by any trick, scheme, artifice, or
4 device a material fact; or
5 (b) makes or uses any false, fictitious, or fraudulent statements or
6 representations; or
7 (c) makes or uses any false writing or document, knowing the same to
8 contain any false, fictitious, or fraudulent statement or entry.
9 Making false statements relating to health care in the second degree
10 is a class A misdemeanor.
11 § 159.35 Making false statements relating to health care in the first
12 degree.
13 A person is guilty of making false statements relating to health care
14 in the first degree when he or she commits the crime of making false
15 statements relating to health care in the second degree with intent to
16 commit another crime or to aid or conceal the commission thereof.
17 Making false statements relating to health care in the first degree is
18 a class E felony.
19 § 5-a. Paragraph (a) of subdivision 1 of section 70.02 of the penal
20 law, as separately amended by chapters 764 and 765 of the laws of 2005,
21 is amended to read as follows:
22 (a) Class B violent felony offenses: an attempt to commit the class
23 A-I felonies of murder in the second degree as defined in section
24 125.25, kidnapping in the first degree as defined in section 135.25, and
25 arson in the first degree as defined in section 150.20; manslaughter in
26 the first degree as defined in section 125.20, aggravated manslaughter
27 in the first degree as defined in section 125.22, rape in the first
28 degree as defined in section 130.35, criminal sexual act in the first
29 degree as defined in section 130.50, aggravated sexual abuse in the
30 first degree as defined in section 130.70, course of sexual conduct
31 against a child in the first degree as defined in section 130.75;
32 assault in the first degree as defined in section 120.10, kidnapping in
33 the second degree as defined in section 135.20, burglary in the first
34 degree as defined in section 140.30, arson in the second degree as
35 defined in section 150.15, health care fraud in the first degree as
36 defined in subdivision (b) of section 159.25, robbery in the first
37 degree as defined in section 160.15, criminal possession of a weapon in
38 the first degree as defined in section 265.04, criminal use of a firearm
39 in the first degree as defined in section 265.09, criminal sale of a
40 firearm in the first degree as defined in section 265.13, aggravated
41 assault upon a police officer or a peace officer as defined in section
42 120.11, gang assault in the first degree as defined in section 120.07,
43 intimidating a victim or witness in the first degree as defined in
44 section 215.17, hindering prosecution of terrorism in the first degree
45 as defined in section 490.35, criminal possession of a chemical weapon
46 or biological weapon in the second degree as defined in section 490.40,
47 and criminal use of a chemical weapon or biological weapon in the third
48 degree as defined in section 490.47.
49 § 6. Paragraph (b) of subdivision 1 of section 70.02 of the penal law,
50 as separately amended by chapters 764 and 765 of the laws of 2005, is
51 amended to read as follows:
52 (b) Class C violent felony offenses: an attempt to commit any of the
53 class B felonies set forth in paragraph (a); aggravated criminally
54 negligent homicide as defined in section 125.11, aggravated manslaughter
55 in the second degree as defined in section 125.21, aggravated sexual
56 abuse in the second degree as defined in section 130.67, assault on a
S. 6457 10 A. 9557
1 peace officer, police officer, fireman or emergency medical services
2 professional as defined in section 120.08, gang assault in the second
3 degree as defined in section 120.06, burglary in the second degree as
4 defined in section 140.25, health care fraud in the second degree as
5 defined in subdivision (b) of section 159.20, robbery in the second
6 degree as defined in section 160.10, criminal possession of a weapon in
7 the second degree as defined in section 265.03, criminal use of a
8 firearm in the second degree as defined in section 265.08, criminal sale
9 of a firearm in the second degree as defined in section 265.12, criminal
10 sale of a firearm with the aid of a minor as defined in section 265.14,
11 soliciting or providing support for an act of terrorism in the first
12 degree as defined in section 490.15, hindering prosecution of terrorism
13 in the second degree as defined in section 490.30, and criminal
14 possession of a chemical weapon or biological weapon in the third degree
15 as defined in section 490.37.
16 § 7. Subparagraph (iv) of paragraph c of subdivision 1 of section
17 80.00 of the penal law, as added by chapter 338 of the laws of 1989, is
18 amended and a new paragraph d is added to read as follows:
19 (iv) for C felonies, fifteen thousand dollars[.]; or
20 d. if the conviction is for any felony defined in article one hundred
21 fifty-nine of this chapter, according to the following schedule:
22 (i) for B felonies, seventy-five thousand dollars;
23 (ii) for C felonies, fifty thousand dollars;
24 (iii) for D felonies, twenty-five thousand dollars;
25 (iv) for E felonies, ten thousand dollars.
26 § 8. Subdivision 1 of section 80.05 of the penal law, as amended by
27 chapter 669 of the laws of 1984, is amended to read as follows:
28 1. Class A misdemeanor. A sentence to pay a fine for a class A misde-
29 meanor shall be a sentence to pay an amount, fixed by the court, not
30 exceeding the higher of:
31 (a) one thousand dollars[, provided, however, that]; or
32 (b) for a sentence imposed for a violation of section 215.80 of this
33 chapter [may include], a fine in an amount equivalent to double the
34 value of the property unlawfully disposed of in the commission of the
35 crime; or
36 (c) for a sentence imposed for a misdemeanor defined in article one
37 hundred fifty-nine of this chapter, five thousand dollars.
38 § 9. Subdivision 1 of section 80.10 of the penal law is amended to
39 read as follows:
40 1. In general. A sentence to pay a fine, when imposed on a corporation
41 for an offense defined in this chapter or for an offense defined outside
42 this chapter for which no special corporate fine is specified, shall be
43 a sentence to pay an amount, fixed by the court, not exceeding:
44 (a) Ten thousand dollars, when the conviction is of a felony;
45 (b) Five thousand dollars, when the conviction is of a class A misde-
46 meanor or of an unclassified misdemeanor for which a term of imprison-
47 ment in excess of three months is authorized;
48 (c) Two thousand dollars, when the conviction is of a class B misde-
49 meanor or of an unclassified misdemeanor for which the authorized term
50 of imprisonment is not in excess of three months;
51 (d) Five hundred dollars, when the conviction is of a violation;
52 (e) Any higher amount not exceeding double the amount of the corpo-
53 ration's gain from the commission of the offense, provided, however,
54 that if the conviction is imposed under article one hundred fifty-nine
55 of this chapter, according to the following schedule:
S. 6457 11 A. 9557
1 (i) one hundred thousand dollars, when the conviction is of a felony;
2 and
3 (ii) fifty thousand dollars, when the conviction is of a misdemeanor.
4 § 10. Paragraphs (a) and (b) of subdivision 1 of section 460.10 of the
5 penal law, paragraph (a) as amended by chapter 489 of the laws of 2000
6 and paragraph (b) as added by chapter 516 of the laws of 1986, are
7 amended to read as follows:
8 (a) Any of the felonies set forth in this chapter: sections 120.05,
9 120.10 and 120.11 relating to assault; sections 125.10 to 125.27 relat-
10 ing to homicide; sections 130.25, 130.30 and 130.35 relating to rape;
11 sections 135.20 and 135.25 relating to kidnapping; section 135.65 relat-
12 ing to coercion; sections 140.20, 140.25 and 140.30 relating to
13 burglary; sections 145.05, 145.10 and 145.12 relating to criminal
14 mischief; article one hundred fifty relating to arson; sections 155.30,
15 155.35, 155.40 and 155.42 relating to grand larceny; sections 159.10,
16 159.15, 159.20, 159.25, and 159.35 relating to health care offenses;
17 article one hundred sixty relating to robbery; sections 165.45, 165.50,
18 165.52 and 165.54 relating to criminal possession of stolen property;
19 sections 170.10, 170.15, 170.25, 170.30, 170.40, 170.65 and 170.70
20 relating to forgery; sections 175.10, 175.25, 175.35, 175.40 and 210.40
21 relating to false statements; sections 176.15, 176.20, 176.25 and 176.30
22 relating to insurance fraud; sections 178.20 and 178.25 relating to
23 criminal diversion of prescription medications and prescriptions;
24 sections 180.03, 180.08, 180.15, 180.25, 180.40, 180.45, 200.00, 200.03,
25 200.04, 200.10, 200.11, 200.12, 200.20, 200.22, 200.25, 200.27, 215.00,
26 215.05 and 215.19 relating to bribery; sections 190.40 and 190.42 relat-
27 ing to criminal usury; section 190.65 relating to schemes to defraud;
28 sections 205.60 and 205.65 relating to hindering prosecution; sections
29 210.10, 210.15, and 215.51 relating to perjury and contempt; section
30 215.40 relating to tampering with physical evidence; sections 220.06,
31 220.09, 220.16, 220.18, 220.21, 220.31, 220.34, 220.39, 220.41, 220.43,
32 220.46, 220.55 and 220.60 relating to controlled substances; sections
33 225.10 and 225.20 relating to gambling; sections 230.25, 230.30, and
34 230.32 relating to promoting prostitution; sections 235.06, 235.07 and
35 235.21 relating to obscenity; section 263.10 relating to promoting an
36 obscene performance by a child; sections 265.02, 265.03, 265.04, 265.11,
37 265.12, 265.13 and the provisions of section 265.10 which constitute a
38 felony relating to firearms and other dangerous weapons; and sections
39 265.14 and 265.16 relating to criminal sale of a firearm; and section
40 275.10, 275.20, 275.30, or 275.40 relating to unauthorized recordings;
41 and sections 470.05, 470.10, 470.15 and 470.20 relating to money laun-
42 dering; or
43 (b) Any felony set forth elsewhere in the laws of this state and
44 defined by the tax law relating to alcoholic beverage, cigarette, gaso-
45 line and similar motor fuel taxes; [title] article seventy-one of the
46 environmental conservation law relating to water pollution, hazardous
47 waste or substances hazardous or acutely hazardous to public health or
48 safety of the environment; article [twenty-three-a] twenty-three-A of
49 the general business law relating to prohibited acts concerning stocks,
50 bonds and other securities [or], article twenty-two of the general busi-
51 ness law concerning monopolies or article five of the social services
52 law relating to bribery in health care services.
53 § 11. Paragraph (b) of subdivision 8 of section 700.05 of the criminal
54 procedure law, as amended by chapter 264 of the laws of 2003, is amended
55 to read as follows:
S. 6457 12 A. 9557
1 (b) Any of the following felonies: assault in the second degree as
2 defined in section 120.05 of the penal law, assault in the first degree
3 as defined in section 120.10 of the penal law, reckless endangerment in
4 the first degree as defined in section 120.25 of the penal law, promot-
5 ing a suicide attempt as defined in section 120.30 of the penal law,
6 criminally negligent homicide as defined in section 125.10 of the penal
7 law, manslaughter in the second degree as defined in section 125.15 of
8 the penal law, manslaughter in the first degree as defined in section
9 125.20 of the penal law, murder in the second degree as defined in
10 section 125.25 of the penal law, murder in the first degree as defined
11 in section 125.27 of the penal law, abortion in the second degree as
12 defined in section 125.40 of the penal law, abortion in the first degree
13 as defined in section 125.45 of the penal law, rape in the third degree
14 as defined in section 130.25 of the penal law, rape in the second degree
15 as defined in section 130.30 of the penal law, rape in the first degree
16 as defined in section 130.35 of the penal law, criminal sexual act in
17 the third degree as defined in section 130.40 of the penal law, criminal
18 sexual act in the second degree as defined in section 130.45 of the
19 penal law, criminal sexual act in the first degree as defined in section
20 130.50 of the penal law, sexual abuse in the first degree as defined in
21 section 130.65 of the penal law, unlawful imprisonment in the first
22 degree as defined in section 135.10 of the penal law, kidnapping in the
23 second degree as defined in section 135.20 of the penal law, kidnapping
24 in the first degree as defined in section 135.25 of the penal law,
25 custodial interference in the first degree as defined in section 135.50
26 of the penal law, coercion in the first degree as defined in section
27 135.65 of the penal law, criminal trespass in the first degree as
28 defined in section 140.17 of the penal law, burglary in the third degree
29 as defined in section 140.20 of the penal law, burglary in the second
30 degree as defined in section 140.25 of the penal law, burglary in the
31 first degree as defined in section 140.30 of the penal law, criminal
32 mischief in the third degree as defined in section 145.05 of the penal
33 law, criminal mischief in the second degree as defined in section 145.10
34 of the penal law, criminal mischief in the first degree as defined in
35 section 145.12 of the penal law, criminal tampering in the first degree
36 as defined in section 145.20 of the penal law, arson in the fourth
37 degree as defined in section 150.05 of the penal law, arson in the third
38 degree as defined in section 150.10 of the penal law, arson in the
39 second degree as defined in section 150.15 of the penal law, arson in
40 the first degree as defined in section 150.20 of the penal law, grand
41 larceny in the fourth degree as defined in section 155.30 of the penal
42 law, grand larceny in the third degree as defined in section 155.35 of
43 the penal law, grand larceny in the second degree as defined in section
44 155.40 of the penal law, grand larceny in the first degree as defined in
45 section 155.42 of the penal law, health care fraud in the fourth degree
46 as defined in section 159.10 of the penal law, health care fraud in the
47 third degree as defined in section 159.15 of the penal law, health care
48 fraud in the second degree as defined in section 159.20 of the penal
49 law, health care fraud in the first degree as defined in section 159.25
50 of the penal law, making false statements relating to health care in the
51 first degree as defined in section 159.35 of the penal law, bribery
52 relating to health care as defined in section three hundred sixty-six-d
53 of the social services law, robbery in the third degree as defined in
54 section 160.05 of the penal law, robbery in the second degree as defined
55 in section 160.10 of the penal law, robbery in the first degree as
56 defined in section 160.15 of the penal law, unlawful use of secret
S. 6457 13 A. 9557
1 scientific material as defined in section 165.07 of the penal law, crim-
2 inal possession of stolen property in the fourth degree as defined in
3 section 165.45 of the penal law, criminal possession of stolen property
4 in the third degree as defined in section 165.50 of the penal law, crim-
5 inal possession of stolen property in the second degree as defined by
6 section 165.52 of the penal law, criminal possession of stolen property
7 in the first degree as defined by section 165.54 of the penal law,
8 trademark counterfeiting in the first degree as defined in section
9 165.73 of the penal law, forgery in the second degree as defined in
10 section 170.10 of the penal law, forgery in the first degree as defined
11 in section 170.15 of the penal law, criminal possession of a forged
12 instrument in the second degree as defined in section 170.25 of the
13 penal law, criminal possession of a forged instrument in the first
14 degree as defined in section 170.30 of the penal law, criminal
15 possession of forgery devices as defined in section 170.40 of the penal
16 law, falsifying business records in the first degree as defined in
17 section 175.10 of the penal law, tampering with public records in the
18 first degree as defined in section 175.25 of the penal law, offering a
19 false instrument for filing in the first degree as defined in section
20 175.35 of the penal law, issuing a false certificate as defined in
21 section 175.40 of the penal law, criminal diversion of prescription
22 medications and prescriptions in the second degree as defined in section
23 178.20 of the penal law, criminal diversion of prescription medications
24 and prescriptions in the first degree as defined in section 178.25 of
25 the penal law, escape in the second degree as defined in section 205.10
26 of the penal law, escape in the first degree as defined in section
27 205.15 of the penal law, absconding from temporary release in the first
28 degree as defined in section 205.17 of the penal law, promoting prison
29 contraband in the first degree as defined in section 205.25 of the penal
30 law, hindering prosecution in the second degree as defined in section
31 205.60 of the penal law, hindering prosecution in the first degree as
32 defined in section 205.65 of the penal law, criminal possession of a
33 weapon in the third degree as defined in subdivisions two, three, four
34 and five of section 265.02 of the penal law, criminal possession of a
35 weapon in the second degree as defined in section 265.03 of the penal
36 law, criminal possession of a dangerous weapon in the first degree as
37 defined in section 265.04 of the penal law, manufacture, transport,
38 disposition and defacement of weapons and dangerous instruments and
39 appliances defined as felonies in subdivisions one, two, and three of
40 section 265.10 of the penal law, sections 265.11, 265.12 and 265.13 of
41 the penal law, or prohibited use of weapons as defined in subdivision
42 two of section 265.35 of the penal law, relating to firearms and other
43 dangerous weapons;
44 § 12. Section 366-d of the social services law, as added by chapter 41
45 of the laws of 1992, subdivision 2 as amended by chapter 2 of the laws
46 of 1998 and subdivision 3 as amended and subdivision 4 as added by chap-
47 ter 81 of the laws of 1995, is amended to read as follows:
48 § 366-d. [Medical assistance provider; prohibited practices] Bribery
49 relating to health care. 1. [Definitions. As used in this section,
50 "medical assistance provider" means any person, firm, partnership,
51 group, association, fiduciary, employer or representative thereof or
52 other entity who is furnishing care, services or supplies under title
53 eleven of article five of this chapter.
54 2.] No [medical assistance provider] person shall:
55 (a) solicit, receive, accept or agree to receive or accept any
56 payment or other consideration in any form from another person to the
S. 6457 14 A. 9557
1 extent such payment or other consideration is given to induce such
2 person to engage in or refrain from engaging in:
3 (i) [for] the referral of an individual to that person for the
4 furnishing or arranging for the furnishing of any item or services [for
5 which payment is made under title eleven of article five of this chap-
6 ter] in connection with a health plan; or
7 (ii) [to] the purchase, lease or order, or recommendation or arrange-
8 ment to purchase, lease or order, any good, facility, service or item
9 [for which payment is made under title eleven of article five of this
10 chapter] in connection with a health plan; or
11 (b) offer, agree to give or give any payment or other consideration
12 in any form to another person to the extent such payment or other
13 consideration is given to induce such person to engage in or refrain
14 from engaging in:
15 (i) [for] the referral of an individual to that person for the
16 furnishing or arranging for the furnishing of any item or services [for
17 which payment is made under title eleven of article five of this chap-
18 ter] in connection with a health plan; or
19 (ii) [to] the purchase, lease or order, or recommendation or arrange-
20 ment to purchase, lease or order any good, facility, service or item
21 [for which payment is made under title eleven of article five of this
22 chapter;] in connection with a health plan.
23 2. Definitions. [(c) as] As used in this section: (a) "person" shall
24 have the meaning set forth in subdivision seven of section 10.00 of the
25 penal law[.];
26 [(d) this subdivision] (b) "health plan" shall have the meaning set
27 forth in section 159.00 of the penal law.
28 3. Subdivision one of this section shall not apply to any activity
29 specifically exempt by federal statute or federal regulations promulgat-
30 ed thereunder.
31 [3.] 4. Any [medical assistance provider] person who violates the
32 provisions of this section is guilty of a misdemeanor punishable by:
33 (a) a term of imprisonment in accordance with the penal law; or
34 (b) a fine of not less than five hundred dollars nor more than ten
35 thousand dollars; or
36 (c) if the defendant has obtained money or property through a
37 violation of the provisions of this section, a fine in an amount, fixed
38 by the court, not to exceed double the amount of the defendant's gain
39 from a violation of such provisions. In such event, the provisions of
40 subdivision three of section 80.00 of the penal law shall be applicable
41 to the sentence; or
42 (d) both the imprisonment and the fine.
43 [4.] 5. Any [medical assistance provider] person who violates the
44 provisions of this section and thereby obtains money or property having
45 a value in excess of seven thousand five hundred dollars shall be guilty
46 of a class E felony.
47 § 13. Section 366-f of the social services law is REPEALED.
48 § 14. Paragraph (b) of subdivision 3 of section 178.00 of the penal
49 law, as added by chapter 81 of the laws of 1995, is amended and a new
50 subdivision 4 is added to read as follows:
51 (b) receives, in exchange for anything of pecuniary value, a
52 prescription medication or device with knowledge or reasonable grounds
53 to know that the [seller or transferor is not authorized by law to sell]
54 sale or transfer of such prescription medication or device is unlawful;
55 or
S. 6457 15 A. 9557
1 4. "Total pecuniary value" means the lawful fair market value of all
2 prescription medications or devices and prescriptions, in the aggregate,
3 that are the subject of an act or series of acts in violation of this
4 article.
5 § 15. Subdivision 1 of section 178.15 of the penal law, as added by
6 chapter 81 of the laws of 1995, is amended to read as follows:
7 1. commits a criminal diversion act, and the [value of the benefit
8 exchanged] total pecuniary value of the prescription medications or
9 devices and prescriptions is in excess of one thousand dollars; or
10 § 16. Section 178.20 of the penal law, as added by chapter 81 of the
11 laws of 1995, is amended to read as follows:
12 § 178.20 Criminal diversion of prescription medications and
13 prescriptions in the second degree.
14 A person is guilty of criminal diversion of prescription medications
15 and prescriptions in the second degree when he or she commits a criminal
16 diversion act, and the [value of the benefit exchanged] total pecuniary
17 value of the prescription medications or devices and prescriptions is in
18 excess of three thousand dollars.
19 Criminal diversion of prescription medications and prescriptions in
20 the second degree is a class D felony.
21 § 17. Section 178.25 of the penal law, as added by chapter 81 of the
22 laws of 1995, is amended to read as follows:
23 § 178.25 Criminal diversion of prescription medications and
24 prescriptions in the first degree.
25 A person is guilty of criminal diversion of prescription medications
26 and prescriptions in the first degree when he or she commits a criminal
27 diversion act, and the [value of the benefit exchanged] total pecuniary
28 value of the prescription medications or devices and prescriptions is in
29 excess of fifty thousand dollars.
30 Criminal diversion of prescription medications and prescriptions in
31 the first degree is a class C felony.
32 § 18. The penal law is amended by adding five new sections 178.30,
33 178.35, 178.40, 178.45 and 178.50 to read as follows:
34 § 178.30 Possession of criminally diverted prescription medications and
35 devices in the fourth degree.
36 A person is guilty of possession of criminally diverted prescription
37 medications and devices in the fourth degree when he or she knowingly
38 possesses a prescription medication or device with knowledge that such
39 medication or device was transferred or delivered as the result of a
40 criminal diversion act or under circumstances evincing an intent to
41 engage in a criminal diversion act.
42 Possession of criminally diverted prescription medications and devices
43 in the fourth degree is a class A misdemeanor.
44 § 178.35 Possession of criminally diverted prescription medications and
45 devices in the third degree.
46 A person is guilty of possession of criminally diverted prescription
47 medications and devices in the third degree when he or she commits the
48 crime of possession of criminally diverted prescription medications and
49 devices in the fourth degree and:
50 1. has previously been convicted of any crime defined in this article;
51 or
52 2. the total pecuniary value of the prescription medications or
53 devices possessed is in excess of one thousand dollars.
54 Possession of criminally diverted prescription medications and devices
55 in the third degree is a class E felony.
S. 6457 16 A. 9557
1 § 178.40 Possession of criminally diverted prescription medications and
2 devices in the second degree.
3 A person is guilty of possession of criminally diverted prescription
4 medications and devices in the second degree when he or she commits the
5 crime of criminally diverted prescription medications and devices in the
6 fourth degree and the total pecuniary value of the prescription medica-
7 tions or devices possessed is in excess of three thousand dollars.
8 Possession of criminally diverted prescription medications and devices
9 in the second degree is a class D felony.
10 § 178.45 Possession of criminally_ diverted prescription medications and
11 devices in the first degree.
12 A person is guilty of possession of criminally diverted prescription
13 medications and devices in the first degree when he or she commits the
14 crime of possession of criminally diverted prescription medications and
15 devices in the fourth degree and the total pecuniary value of the
16 prescription medications or devices possessed is in excess of fifty
17 thousand dollars.
18 Possession of criminally diverted prescription medications and devices
19 in the first degree is a class C felony.
20 § 178.50 Presumptions.
21 Possession of false, forged or stolen prescriptions by any person
22 other than a person in the lawful pursuit of his or her profession shall
23 be presumptive evidence of the intent to use such prescriptions to
24 commit a criminal act under this article.
25 § 19. Paragraph (b) of subdivision 4 of section 145-b of the social
26 services law, as amended by chapter 2 of the laws of 1998, is amended to
27 read as follows:
28 (b) Such penalty shall be in lieu of requiring a person to refund or
29 repay all or part of any payment from the medical assistance program
30 received by such person or caused to be received by another person as a
31 result of a violation of the terms of this subdivision. In no event
32 shall the monetary penalty imposed exceed [two] ten thousand dollars for
33 each item or service which was the subject of the determination herein,
34 except that where a penalty under this section has been imposed on a
35 person within the previous five years, such penalty shall not exceed
36 [seven] thirty thousand [five hundred] dollars for each item or service
37 which was the subject of the determination herein.
38 § 20. Subdivision 1 of section 740 of the labor law is amended by
39 adding a new paragraph (g) to read as follows:
40 (g) "Health care offense" means health care fraud or making false
41 statements relating to health care as defined by article one hundred
42 fifty-nine of the penal law, or bribery relating to health care as
43 defined in section three hundred sixty-six-d of the social services law.
44 § 21. Paragraph (a) of subdivision 2 of section 740 of the labor law,
45 as added by chapter 660 of the laws of 1984, is amended to read as
46 follows:
47 (a) discloses, or threatens to disclose to a supervisor or to a public
48 body an activity, policy or practice of the employer that is in
49 violation of law, rule or regulation which violation creates and
50 presents a substantial and specific danger to the public health or safe-
51 ty, or which constitutes a health care offense;
52 § 22. Paragraph 2 of subdivision (b) of section 506 of the civil prac-
53 tice law and rules, as amended by chapter 47 of the laws of 1992, is
54 amended to read as follows:
55 2. a proceeding against the regents of the university of the state of
56 New York, the commissioner of education, the commissioner of taxation
S. 6457 17 A. 9557
1 and finance, the tax appeals tribunal except as provided in section two
2 thousand sixteen of the tax law, the public service commission, the
3 commissioner or the department of transportation relating to articles
4 three, four, five, six, seven, eight, nine or ten of the transportation
5 law or to the railroad law, the water resources board, the comptroller
6 [or], the department of agriculture and markets or the commissioner of
7 the department of health to review a final administrative action against
8 a Medicaid provider, shall be commenced in the supreme court, Albany
9 county.
10 § 23. The social services law is amended by adding a new section 364-l
11 to read as follows:
12 § 364-l. Chemung county demonstration project. 1. Notwithstanding any
13 provision of law, rule or regulation to the contrary, the department and
14 the Chemung county department of social services are authorized to
15 conduct a Medicaid research and demonstration project for the purpose of
16 testing the use of innovative administrative techniques, new reimburse-
17 ment methods, and management of care models, so as to promote more effi-
18 cient use of health resources, a healthier population and containment of
19 Medicaid program costs.
20 2. The Chemung county department of social services is authorized to
21 contract with an entity for the purposes of, without limitation, devel-
22 oping and managing a provider of care network, establishing provider
23 payment rates and fees, paying provider claims, providing care manage-
24 ment services to project participants, and managing the utilization of
25 project services.
26 3. Participation in the project shall be mandatory for all persons
27 eligible for services under this title for whom the Chemung county
28 department of social services has fiscal responsibility pursuant to
29 section three hundred sixty-five of this title and who reside within the
30 project catchment area, as determined by the commissioner; provided,
31 however, that eligible persons who are also beneficiaries under title
32 XVIII of the federal social security act and persons who reside in resi-
33 dential health care facilities shall not be eligible to participate in
34 the project.
35 4. The provisions of this section shall not take effect unless all
36 necessary approvals under federal law and regulation have been obtained
37 to receive federal financial participation in the costs of health care
38 services provided pursuant to this section.
39 5. The commissioner is authorized to submit amendments to the state
40 plan for medical assistance and/or submit one or more applications for
41 waivers of the federal social security act as may be necessary to obtain
42 the federal approvals necessary to implement this section.
43 § 24. Paragraphs (b) and (c) of subdivision 3 of section 273 of the
44 public health law, as added by section 10 of part C of chapter 58 of the
45 laws of 2005, are amended to read as follows:
46 (b) In the event that the patient does not meet the criteria in para-
47 graph (a) of this subdivision, the prescriber may provide additional
48 information to the program to justify the use of a prescription drug
49 that is not on the preferred drug list. The program shall provide a
50 reasonable opportunity for a prescriber to reasonably present his or her
51 justification of prior authorization. [If, after consultation with the
52 program, the prescriber, in his or her reasonable professional judgment,
53 determines that the use of a prescription drug that is not on the
54 preferred drug list is warranted, the prescriber's determination shall
55 be final.]
S. 6457 18 A. 9557
1 (c) [If a prescriber meets the requirements of paragraph (a) or (b) of
2 this subdivision, the prescriber shall be granted prior authorization
3 under this section.] Prior authorization for the non-preferred drug
4 shall be denied if the prescriber fails to meet the requirements of
5 paragraph (a) of this subdivision or if, after consultation with the
6 program as described in paragraph (b) of this subdivision, the program
7 determines that the use of a prescription drug that is not on the
8 preferred drug list is not warranted.
9 § 25. Subdivision 7 of section 274 of the public health law, as added
10 by section 10 of part C of chapter 58 of the laws of 2005, is amended to
11 read as follows:
12 7. In the event that the patient does not meet the criteria for
13 approval established by the commissioner in subdivision six of this
14 section, the clinical drug review program shall provide a reasonable
15 opportunity for a prescriber to reasonably present his or her justifica-
16 tion for prior authorization. If, after the prescriber's consultation
17 with the program, the [prescriber, in his or her reasonable professional
18 judgment,] program determines that the use of the prescription drug is
19 warranted, [the prescriber's determination shall be final and] prior
20 authorization shall be granted under this section; provided, however,
21 that prior authorization may be denied in cases where, after consulta-
22 tion with the prescriber, the program determines that the use of the
23 prescription drug is not warranted, or where the department has substan-
24 tial evidence that the prescriber or patient is engaged in fraud or
25 abuse relating to the drug.
26 § 26. Subdivisions 7, 8 and 9 of section 272 of the public health law,
27 as added by section 10 of part C of chapter 58 of the laws of 2005, are
28 amended to read as follows:
29 7. The commissioner shall provide [thirty] ten days public notice on
30 the department's website prior to any meeting of the committee to devel-
31 op recommendations concerning the preferred drug program. Such notice
32 regarding meetings of the committee shall include a description of the
33 proposed therapeutic class to be reviewed, a listing of drug products in
34 the therapeutic class, and the proposals to be considered by the commit-
35 tee. The committee shall allow interested parties a reasonable opportu-
36 nity to make an oral presentation to the committee related to the prior
37 authorization of the therapeutic class to be reviewed. The committee
38 shall consider any information provided by any interested party, includ-
39 ing, but not limited to, prescribers, dispensers, patients, consumers
40 and manufacturers of the drug in developing their recommendations.
41 8. The commissioner shall provide notice of any recommendations devel-
42 oped by the committee regarding the preferred drug program, at least
43 [thirty] ten days before any final determination by the commissioner, by
44 making such information available on the department's website. Such
45 public notice shall include: a summary of the deliberations of the
46 committee; a summary of the positions of those making public comments at
47 meetings of the committee; the response of the committee to those
48 comments, if any; and the findings and recommendations of the committee.
49 9. Within [ten days of] a reasonable time after a final determination
50 regarding the preferred drug program, the commissioner shall provide
51 public notice on the department's website of such determinations,
52 including: the nature of the determination; [and] an analysis of the
53 impact of the commissioner's determination on state public health plan
54 populations and providers; and the projected fiscal impact to the state
55 public health plan programs of the commissioner's determination.
S. 6457 19 A. 9557
1 § 27. Section 274 of the public health law is amended by adding a new
2 subdivision 6-a to read as follows:
3 6-a. Notwithstanding the requirements of subdivisions four, five and
4 six of this section, the commissioner may require prior authorization
5 for a drug for a period not to exceed ninety days when the commissioner
6 determines that an emergency situation requires such action. For
7 purposes of this subdivision, an emergency includes, but is not limited
8 to, approval by the federal food and drug administration of a drug for
9 treatment which the commissioner determines is critical to the care of
10 patients but which should be subject to prior authorization. If the
11 committee fails to review and approve the drug for continued prior
12 authorization within such ninety day period, the prior authorization
13 requirement under this subdivision will lapse.
14 § 28. Paragraphs (b) and (c) of subdivision 3 of section 274 of the
15 public health law, as added by section 10 of part C of chapter 58 of the
16 laws of 2005, are amended to read as follows:
17 (b) the potential for, or a history of, overuse, abuse, drug diversion
18 or illegal utilization; [and]
19 (c) the potential for, or a history of, utilization inconsistent with
20 approved indications[.]; and
21 (d) the cost of the drug compared to other drug therapies for the same
22 disease. Where the commissioner finds that a drug meets at least one of
23 these criteria, in determining whether to make the drug subject to prior
24 authorization under the clinical drug review program, the commissioner
25 shall consider whether similarly effective alternatives are available
26 for the same disease state and the effect of that availability or lack
27 of availability.
28 § 29. Paragraphs (d) and (e) of subdivision 4 of section 365-a of the
29 social services law, paragraph (d) as amended and paragraph (e) as added
30 by chapter 645 of the laws of 2005 are amended and a new paragraph (f)
31 is added to read as follows:
32 (d) any medical care, services or supplies furnished outside the
33 state, except, when prior authorized in accordance with department regu-
34 lations or for care, services and supplies furnished: as a result of a
35 medical emergency; because the recipient's health would have been endan-
36 gered if he or she had been required to travel to the state; because the
37 care, services or supplies were more readily available in the other
38 state; or because it is the general practice for persons residing in the
39 locality wherein the recipient resides to use medical providers in the
40 other state; [or]
41 (e) drugs, procedures and supplies for the treatment of erectile
42 dysfunction when provided to, or prescribed for use by, a person who is
43 required to register as a sex offender pursuant to article six-C of the
44 correction law, provided that any denial of coverage pursuant to this
45 paragraph shall provide the patient with the means of obtaining addi-
46 tional information concerning both the denial and the means of challeng-
47 ing such denial[.]; or
48 (f) drugs for the treatment of sexual or erectile dysfunction, unless
49 such drugs are used to treat a condition, other than sexual or erectile
50 dysfunction, for which the drugs have been approved by the federal food
51 and drug administration.
52 § 30. Paragraph (e-1) of subdivision 1 of section 369-ee of the social
53 services law, as added by chapter 645 of the laws of 2005, is amended to
54 read as follows:
55 (e-1) "Health care services" shall not include: (i) drugs, procedures
56 and supplies for the treatment of erectile dysfunction when provided to,
S. 6457 20 A. 9557
1 or prescribed for use by, a person who is required to register as a sex
2 offender pursuant to article six-C of the correction law provided that
3 any denial of coverage pursuant to this paragraph shall provide the
4 patient with the means of obtaining additional information concerning
5 both the denial and the means of challenging such denial; (ii) drugs for
6 the treatment of sexual or erectile dysfunction, unless such drugs are
7 used to treat a condition, other than sexual or erectile dysfunction,
8 for which the drugs have been approved by the federal food and drug
9 administration.
10 § 31. Subparagraph (ii) of paragraph (b) of subdivision 9 of section
11 367-a of the social services law, as amended by section 3 of part C of
12 chapter 58 of the laws of 2004, is amended to read as follows:
13 (ii) if the drug dispensed is a multiple source prescription drug or a
14 brand-name prescription drug for which no specific upper limit has been
15 set by such federal agency, the lower of the estimated acquisition cost
16 of such drug to pharmacies, or the dispensing pharmacy's usual and
17 customary price charged to the general public. For sole and multiple
18 source brand name drugs, estimated acquisition cost means the average
19 wholesale price of a prescription drug based upon the package size
20 dispensed from, as reported by the prescription drug pricing service
21 used by the department, less [twelve and seventy-five hundredths of one]
22 fifteen percent thereof, and updated monthly by the department; or, for
23 a specialized HIV pharmacy, as defined in paragraph [(F)] (f) of this
24 subdivision, acquisition cost means the average wholesale price of a
25 prescription drug based upon the package size dispensed from, as
26 reported by the prescription drug pricing service used by the depart-
27 ment, less [twelve] fourteen percent thereof, and updated monthly by the
28 department. For multiple source generic drugs, estimated acquisition
29 cost means the lower of the average wholesale price of a prescription
30 drug based on the package size dispensed from, as reported by the
31 prescription drug pricing service used by the department, less [sixteen
32 and one-half] thirty percent thereof, or the maximum acquisition cost,
33 if any, established pursuant to paragraph (e) of this subdivision; or,
34 for a specialized HIV pharmacy, as defined in paragraph (f) of this
35 subdivision, acquisition cost means[,] the lower of the average whole-
36 sale price of a prescription drug based on the package size dispensed
37 from, as reported by the prescription drug pricing service used by the
38 department, less [twelve] twenty-two percent thereof, or the maximum
39 acquisition cost, if any, established pursuant to paragraph (e) of this
40 subdivision.
41 § 32. Subparagraphs (i) and (ii) of paragraph (d) of subdivision 25 of
42 section 2807-c of the public health law, as added by section 7 of part B
43 of chapter 58 of the laws of 2004, are amended to read as follows:
44 (i) For periods on and after April first, two thousand four, the
45 commissioner shall adjust inpatient medical assistance rates of payment
46 established pursuant to this section, including discrete rates of
47 payment calculated pursuant to paragraph a-three of subdivision one of
48 this section, for non-public general hospitals, and for periods on and
49 after April first, two thousand six, for public and non-public general
50 hospitals, in accordance with subparagraph (ii) of this paragraph, for
51 purposes of reimbursing graduate medical education costs based on the
52 following methodology:
53 (ii) Rate adjustments for each [non-public] general hospital shall be
54 based on the difference between the graduate medical education compo-
55 nent, direct and indirect, of the two thousand three medical assistance
56 inpatient rates of payment, including exempt unit per diem rates, and an
S. 6457 21 A. 9557
1 estimate of what the graduate medical education component, direct and
2 indirect, of such medical assistance inpatient rates of payment, includ-
3 ing exempt unit per diem rates would be, stated at two thousand three
4 levels and calculated as follows:
5 (A) Each [non-public] general hospital's total direct medical educa-
6 tion costs as reported in the two thousand one institutional cost report
7 submitted as of December thirty-first, two thousand three, and
8 (B) An estimate of the total indirect medical education costs for two
9 thousand one calculated in accordance with the methodology applicable
10 for purposes of determining an estimate of indirect medical education
11 costs pursuant to subparagraph (ii) of paragraph (c) of subdivision
12 seven of this section. The indirect medical education costs shall equal
13 the product of two thousand one hospital specific inpatient operating
14 costs, including exempt unit costs, and the indirect teaching cost
15 percentage determined by the following formula:
16 1-(1/(1+1.89(((1+r)-.405)-1)))
17 where r equals the ratio of residents and fellows to beds for two thou-
18 sand one adjusted to reflect the projected two thousand three resident
19 counts.
20 (C) Each hospital's rate adjustment shall be limited to seventy-five
21 percent of the graduate medical education component included in its two
22 thousand three medical assistance inpatient rates of payment, including
23 exempt unit rates. For periods on and after April first, two thousand
24 six, the seventy-five percent limit shall not apply to rate decreases
25 calculated pursuant to this paragraph.
26 (D) [No] For the period April first, two thousand four through March
27 thirty-first, two thousand six, no hospital shall receive a rate adjust-
28 ment pursuant to this paragraph if such rate adjustment would be a nega-
29 tive amount. For periods on and after April first, two thousand six, no
30 public general hospital shall receive a rate increase calculated pursu-
31 ant to this paragraph.
32 § 33. Section 17 of part C of chapter 58 of the laws of 2005, amending
33 the public health law and other laws relating to implementing the state
34 fiscal plan for the 2005-2006 state fiscal year, as added by section 21
35 of part E of chapter 63 of the laws of 2005, is amended to read as
36 follows:
37 § 17. 1. Notwithstanding any inconsistent provision of law, rule or
38 regulation, for payments made by a state governmental agency to a gener-
39 al hospital for [specialty] inpatient hospital services provided to
40 patients eligible for payments pursuant to title 11 of article 5 of the
41 social services law discharged on or after April 1, 2005 [through March
42 31, 2010], the commissioner of health, subject to the approval of the
43 director of the budget, may:
44 (a) after a hospital has agreed to participate in a program selected
45 pursuant to subdivision two of this section, establish rates of payment
46 or special payment rate methodologies for [specialty] inpatient hospital
47 services selected in accordance with subdivision two of this section
48 provided to patients eligible for payments pursuant to title 11 of arti-
49 cle 5 of the social services law through negotiations with hospitals in
50 any area of the state. Such negotiated rates, if any, shall be negoti-
51 ated with each individual selected hospital. Such negotiation shall
52 include a process for the commissioner of health and each selected
53 hospital to mutually identify services for which such negotiated rates
54 shall apply. [Such rates shall be reasonable and adequate to reimburse
55 the costs of an economically and efficiently operated provider of
56 services.] The commissioner of health may establish adjusted rates of
S. 6457 22 A. 9557
1 payment pursuant to an administrative rate appeal process to hospitals
2 that participate in such negotiations and agree to receive the negoti-
3 ated payment rates established under this paragraph for the patients
4 described in this paragraph in lieu of rates of payment otherwise appli-
5 cable pursuant to section 2807-c of the public health law without a
6 competitive bid or request for proposal process; and/or
7 (b) select among hospitals in any area of the state those eligible for
8 reimbursement for [specialty] inpatient hospital services selected in
9 accordance with subdivision two of this section and establish payments
10 for such services based on a competitive bidding process.
11 2. The commissioner of health shall select [a maximum of five
12 geographically defined] inpatient hospital sites within a geographically
13 defined region for which reimbursement may be negotiated for [a maximum
14 of five specialty] inpatient services that are selected based on the
15 following criteria:
16 (a) such services may be provided more efficiently and economically;
17 [and]
18 (b) [there is a correlation between the volume of such services or
19 procedures performed by an inpatient hospital and improved patient
20 outcomes that is accepted by medical experts in the field as evidenced
21 by inclusion in peer reviewed scientific literature published and/or
22 recognized by national organizations] such services are high volume
23 services which may be appropriately reduced or may have a significant
24 disparity in cost among hospitals in a region; [and]
25 (c) identification of such services and the implementation of this
26 section with respect to such services is consistent with other initi-
27 atives to enhance the quality and patient outcomes of inpatient services
28 and procedures that are or are being planned to be undertaken by the
29 department of health, including but not limited to projects that identi-
30 fy centers of excellence for particular services; [and]
31 (d) identification of such services for purposes of implementing this
32 section will not diminish access, including geographic access, which for
33 purposes of this section shall mean that a patient shall not be
34 prevented from accessing services in a timely fashion due to distance or
35 travel time; [and]
36 (e) such services have low utilization or are provided in units with
37 low occupancy; [and] or
38 (f) any other criteria determined by the commissioner of health to
39 promote the cost effective delivery of [specialty] inpatient hospital
40 services.
41 3. Selection of hospitals by the commissioner of health pursuant to
42 subdivision two of this section shall be made based on the following
43 criteria:
44 (a) Consultation with hospitals, hospital associations or other
45 provider organizations, and consumers; and
46 (b) Assurances of patient access, including geographic access, to the
47 selected [specialty] services; and
48 (c) Historical volume of services provided by the hospital; and
49 (d) Consistency with other quality and outcomes improvement initi-
50 atives being or planned to be pursued by the department of health,
51 including but not limited to, projects that identify centers of excel-
52 lence; and
53 (e) The order and timeline under which services identified pursuant to
54 this section shall be provided; and
55 (f) Such other criteria that the commissioner of health may deem
56 appropriate.
S. 6457 23 A. 9557
1 4. Inpatient hospital services not selected by the commissioner of
2 health pursuant to this section and not subject to negotiation under
3 paragraph (a) of subdivision one of this section provided to patients
4 eligible for payments pursuant to title 11 of article 5 of the social
5 services law shall be reimbursed pursuant to section 2807-c of the
6 public health law.
7 5. Notwithstanding any inconsistent provisions of law, rule or regu-
8 lation, for purposes of this program, no payments within a geograph-
9 ically defined [site] region shall be made for [specialty] inpatient
10 hospital services selected by the commissioner of health in accordance
11 with subdivision two of this section for which there is an adjusted rate
12 of payment with a hospital pursuant to paragraph (a) or (b) of subdivi-
13 sion one of this section when such services are provided to patients
14 eligible for payments pursuant to title 11 of article 5 of the social
15 services law by a hospital which has not received adjusted rates of
16 payment pursuant to paragraph (a) or (b) of subdivision one of this
17 section; provided, however, payments may be made to such hospital in
18 accordance with section 2807-c of the public health law if the provision
19 of such services has been prior approved by the commissioner of health,
20 or if the inpatient admission is a result of an emergency admission.
21 6. Payment of rates established pursuant to this section for purposes
22 of this program shall be contingent upon federal approval of a waiver
23 application submitted by the commissioner of health in order to receive
24 federal financial participation for services provided under this
25 section[; provided, however, the commissioner of health shall provide a
26 copy of such waiver application to the legislature prior to submission
27 for federal approval]. The commissioner of health may take any steps
28 necessary to implement this section prior to receiving federal approval
29 of such waiver application.
30 7. The commissioner of health shall report to the governor and the
31 legislature concerning the implementation of this section, including
32 available data regarding the cost effective delivery of [specialty]
33 inpatient services selected in accordance with this section, within
34 eighteen months from the date of issuance of adjusted rates of payment
35 entered into pursuant to paragraphs (a) and (b) of subdivision one of
36 this section.
37 § 34. Subdivision 9 of section 2807-c of the public health law is
38 amended by adding a new paragraph (i) to read as follows:
39 (i) Notwithstanding any law, rule or regulation to the contrary,
40 volume adjustments made pursuant to paragraphs (e) or (f) of this subdi-
41 vision to case based rates of payment by state governmental agencies for
42 inpatient services provided by a general hospital on and after April
43 first, two thousand six, shall not contain any adjustments to volume
44 attributable to rate periods on and after January first, two thousand
45 four, reflecting a reduction in such general hospital's case mix
46 adjusted patient length of stay for non-Medicare beneficiaries based on
47 a comparison of the rate year to such general hospital's volume adjusted
48 base year.
49 § 35. Subparagraph (i) of paragraph (g) of subdivision 2 of section
50 2807 of the public health law, as amended by chapter 170 of the laws of
51 1994, is amended to read as follows:
52 (i) During the period April first, nineteen hundred ninety-four
53 through December thirty-first, nineteen hundred ninety-four and for each
54 calendar year rate period commencing on January first thereafter, rates
55 of payment by governmental agencies for the operating cost component of
56 general hospital outpatient services shall be based on the operating
S. 6457 24 A. 9557
1 costs reported in the base year cost report adjusted by the trend factor
2 applicable to the general hospital in which the services were provided;
3 provided, however, that the maximum payment for the operating cost
4 component of outpatient services shall be sixty-seven dollars and fifty
5 cents plus the addition of the capital cost per visit. The capital cost
6 per visit shall be based on the base year cost report except that the
7 capital cost per visit may be adjusted for major outpatient capital
8 expenditures incurred subsequent to the reporting year, when such
9 expenditures have received the requisite approvals and the facility has
10 provided the commissioner with a certified statement of the expendi-
11 tures. The base year for the period April first, nineteen hundred nine-
12 ty-four through December thirty-first, nineteen hundred ninety-four
13 shall be nineteen hundred ninety-two and shall be advanced one year
14 thereafter for each subsequent calendar year rate period. Further, the
15 provisions of subdivision seven of this section shall not apply. The
16 commissioner may waive the maximum allowable payment and limitations on
17 the rate of payment as prescribed herein to provide for the reimburse-
18 ment of offering and arranging services eligible for ninety percent
19 federal funds as set forth in section nineteen hundred three of the
20 federal social security act, and to provide for the reimbursement of
21 specialized services having separately identifiable costs and statis-
22 tics, including but not limited to hemodialysis services and surgical
23 services provided on an outpatient basis, provided, however, that during
24 the period April first, two thousand six through December thirty-first,
25 two thousand six and for each calendar year rate period commencing ther-
26 eafter, such specialty services shall not include services for which the
27 rate of payment is established by the office of mental health pursuant
28 to section 43.02 of the mental hygiene law. Such waiver shall be grant-
29 ed only when the commissioner finds that the services are being provided
30 efficiently and at minimum cost. The commissioner shall promptly promul-
31 gate rules and regulations necessary to identify such services. Among
32 the criteria which the commissioner shall consider in the case of
33 specialized services are whether the services require highly specialized
34 staff, equipment or facilities, thereby generating a cost that substan-
35 tially exceeds that of more routine diagnostic or treatment services;
36 whether the facility in which the services are provided is presently
37 providing the services to the population in need; and, whether the
38 services may be provided safely and effectively on an outpatient basis
39 at a lower cost than through inpatient admission. In addition the
40 commissioner shall provide for a waiver of the maximum allowable payment
41 for those outpatient services medically necessary which include surgical
42 procedures where delay in surgical intervention would substantially
43 increase the medical risk associated with such surgical intervention.
44 Where the commissioner waives the maximum allowable payment for any
45 specified service he may, in accordance with the foregoing criteria and
46 such other criteria as he deems appropriate, establish a maximum allow-
47 able payment for such specified service.
48 § 36. Notwithstanding sections 2807 and 2807-c of the public health
49 law, section 1 of part C of chapter 58 of the laws of 2005, and any
50 other contrary provision of law and subject to the availability of
51 federal financial participation, for designated rate periods on and
52 after April 1, 2006:
53 (a) the commissioner of health, with the approval of the director of
54 the budget, may increase the capital cost components of rates of payment
55 by governmental agencies for inpatient and outpatient services provided
56 by public general hospitals, not including public general hospitals
S. 6457 25 A. 9557
1 operated by the state of New York or the state university of New York
2 but including public general hospitals operated by public benefit corpo-
3 rations, to reflect the difference between the current fair market value
4 of the fixed capital assets held by such hospitals and the amount of
5 capital cost reimbursement of such fixed capital assets as computed
6 pursuant to the provisions of section 2807-c of the public health law;
7 provided, however, that reimbursement by the state of the amount of such
8 increased capital cost reimbursement to such general hospitals, whether
9 made by the department of health on behalf of a social service district
10 or by a social services district directly, for general hospital inpa-
11 tient and outpatient hospital services provided in accordance with para-
12 graph (b) of subdivision 2 of section 365-a of the social services law,
13 shall be limited to the amount of federal funds properly received or to
14 be received on account of such expenditures; provided further, however,
15 that the social services district in which an eligible public general
16 hospital is physically located shall be responsible for the increased
17 payments provided herein for such public general hospital for all hospi-
18 tal inpatient and outpatient services provided by such general public
19 hospital in accordance with section 365-a of the social services law,
20 regardless of whether another social services district or the department
21 of health may otherwise be responsible for furnishing medical assistance
22 to the eligible persons receiving such services; and
23 (b) the commissioner of health, with the approval of the director of
24 the budget, may also increase the capital cost components of rates of
25 payment by governmental agencies for inpatient and outpatient services
26 provided by public general hospitals operated by the state of New York
27 and by the state university of New York, to reflect the difference
28 between the fair market value of the fixed capital assets held by such
29 hospitals and the amount of capital cost reimbursement of such fixed
30 capital assets as computed pursuant to the provisions of section 2807-c
31 of the public health law; further provided, however, that such payments
32 made to public general hospitals operated by the state of New York and
33 the state university of New York shall be the responsibility of the
34 state and shall not include a local share; and
35 (c) the commissioner of health shall issue regulations, and may issue
36 emergency regulations if deemed necessary by the commissioner of health,
37 to implement the adjustments to rates of payment authorized by this
38 section.
39 § 37. Subdivision 4 of section 2807-c of the public health law is
40 amended by adding a new paragraph (l) to read as follows:
41 (l) Notwithstanding any law or regulation to the contrary, rates of
42 payment to general hospitals for inpatient services provided to patients
43 discharged on and after April first, two thousand six, who are eligible
44 for payments made by state governmental agencies and who are determined
45 to be in diagnosis-related groups numbered seven hundred forty-three,
46 seven hundred forty-five, seven hundred forty-six, seven hundred forty-
47 eight, seven hundred forty-nine, or seven hundred fifty-one shall be
48 made in accordance with the following:
49 (i) for the period April first, two thousand six through December
50 thirty-first, two thousand six, such rates shall consist of the higher
51 of: (A) the sum of seventy-five percent of the operating component of
52 the case-based rate per discharge, as adjusted by applicable service
53 intensity weights, provided for pursuant to this section, plus capital
54 cost reimbursement as provided pursuant to this section and plus rate
55 adjustments as provided in subdivisions thirty, thirty-one and thirty-
56 two of this section, or, (B) the sum of an amount equal to one hundred
S. 6457 26 A. 9557
1 twenty percent of the fees paid in the same locality pursuant to section
2 43.02 of the mental hygiene law for community based detoxification
3 services provided in facilities licensed pursuant to article thirty-two
4 of the mental hygiene law, plus an amount equal to the rate adjustments
5 as provided in subdivisions thirty, thirty-one and thirty-two of this
6 section;
7 (ii) for the period January first, two thousand seven through December
8 thirty-first, two thousand seven, such rates shall consist of the higher
9 of: (A) the sum of fifty percent of the operating component of the case-
10 based rate per discharge, as adjusted by applicable service intensity
11 weights, provided for pursuant to this section, plus capital cost
12 reimbursement as provided for pursuant to this section and plus rate
13 adjustments as provided in subdivisions thirty, thirty-one and thirty-
14 two of this section, or, (B) the sum of an amount equal to one hundred
15 twenty percent of the fees paid in the same locality pursuant to section
16 43.02 of the mental hygiene law for medically supervised inpatient
17 crisis services provided in facilities licensed pursuant to article
18 thirty-two of the mental hygiene law, plus an amount equal to the rate
19 adjustments as provided in subdivisions thirty, thirty-one and thirty-
20 two of this section; and
21 (iii) for periods on and after January first, two thousand eight, the
22 commissioner shall develop, in consultation with the commissioner of the
23 office of alcoholism and substance abuse services, regulations providing
24 for appropriate per diem payment amounts.
25 § 38. Notwithstanding any law, rule or regulation to the contrary and
26 in accordance with the provisions of subdivision 10 of section 2807 of
27 the public health law, for the period April 1, 2006 through December 31,
28 2008, the commissioner of health, in consultation with the commissioner
29 of the office of alcoholism and substance abuse services, shall estab-
30 lish a demonstration program, to be administered by the office of alco-
31 holism and substance abuse services in conjunction with the department
32 of health, for adjustments to inpatient rates of payment to general
33 hospitals to provide supplemental Medicaid rates of payments to such
34 general hospitals to provide for enhanced discharge planning with regard
35 to inpatients who are determined to be at risk for multiple re-admission
36 for inpatient detoxification services, for the purpose of ensuring the
37 transitioning of such patients to community based chemical dependence
38 treatment programs certified pursuant to article 32 of the mental
39 hygiene law, and to reduce the rate of chemical dependence related
40 re-admission of such patients to general hospitals. In addition, the
41 commissioner of health, in consultation with the commissioner of the
42 office of alcoholism and substance abuse services, may seek authori-
43 zation from the federal government for additional Medicaid payments to
44 providers of chemical dependence treatment services to perform expedited
45 chemical dependence assessments of Medicaid eligible hospital inpatients
46 who are also potentially eligible for inclusion in the demonstration
47 program authorized by this section.
48 § 39. Section 2807-k of the public health law is amended by adding a
49 new subdivision 9-a to read as follows:
50 9-a. (a) As a condition for participation in pool distributions
51 authorized pursuant to this section and section twenty-eight hundred
52 seven-w of this article for periods on and after January first, two
53 thousand nine, general hospitals shall, effective for periods on and
54 after January first, two thousand seven, establish financial aid poli-
55 cies and procedures, in accordance with the provisions of this subdivi-
56 sion, for reducing charges otherwise applicable to low-income individ-
S. 6457 27 A. 9557
1 uals without health insurance, or who have exhausted their health
2 insurance benefits, and who can demonstrate an inability to pay full
3 charges, and also for reducing or discounting the collection of co-pays
4 and deductible payments from those individuals who can demonstrate an
5 inability to pay such amounts.
6 (b) Such policies and procedures shall be clear, understandable, in
7 writing and publicly available and each general hospital participating
8 in the pool shall ensure that every patient is made aware of the exist-
9 ence of such policies and procedures and is provided, in a timely
10 manner, with a written copy of such policies and procedures upon
11 request.
12 (c) Such policies and procedures shall include clear, objective crite-
13 ria for determining a patient's ability to pay and for providing such
14 adjustments to payment requirements as are necessary. Such adjustment
15 mechanisms may include sliding fee schedules, discounts to fixed stand-
16 ards and flexible or extended payment plans. Such policies and proce-
17 dures shall be applied consistently to all eligible patients.
18 (d) Such policies and procedures may require that patients seeking
19 payment adjustments provide appropriate financial information and
20 documentation in support of their application, provided, however, that
21 such application process shall not be unduly burdensome or complex.
22 General hospitals shall, upon request, assist patients in understanding
23 the hospital's policies and procedures and in applying for payment
24 adjustments. Decisions regarding such applications shall be made in a
25 timely manner.
26 (e) Such policies and procedures shall provide that patients with
27 incomes below two hundred percent of the federal poverty level are
28 deemed presumptively eligible for payment adjustments, provided, howev-
29 er, that nothing in this subdivision shall be interpreted as precluding
30 hospitals from extending such payment adjustments to other patients,
31 either generally or on a case by case basis.
32 (f) Such policies and procedures shall not permit the forced sale or
33 foreclosure of a patient's primary residence in order to collect an
34 outstanding medical bill.
35 (g) Reports required to be submitted to the department by each general
36 hospital as a condition for participation in the pools and which
37 contain, in accordance with applicable regulations, a certification from
38 an independent certified public accountant or independent licensed
39 public accountant that the hospital is in compliance with conditions of
40 participation in the pools, shall also contain, for reporting periods on
41 and after January first, two thousand seven, a certification from such
42 accountant that such hospital is in compliance with the provisions of
43 this subdivision.
44 § 40. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
45 the laws of 1996, amending the education law and other laws relating to
46 rates for residential health care facilities, as amended by chapter 161
47 of the laws of 2005, is amended to read as follows:
48 (a) Notwithstanding any inconsistent provision of law or regulation to
49 the contrary, effective beginning August 1, 1996, for the period April
50 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
51 1998 through March 31, 1999, August 1, 1999, for the period April 1,
52 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
53 through March 31, 2001, April 1, 2001, for the period April 1, 2001
54 through March 31, 2002, April 1, 2002, for the period April 1, 2002
55 through March 31, 2003, and for the state fiscal year beginning April 1,
56 2005 through March 31, 2006, and for the state fiscal year beginning
S. 6457 28 A. 9557
1 April 1, 2006 through March 31, 2007, and each state fiscal year there-
2 after, the department of health is authorized to pay public general
3 hospitals, as defined in subdivision 10 of section 2801 of the public
4 health law, operated by the state of New York or by the state university
5 of New York or by a county, which shall not include a city with a popu-
6 lation of over one million, of the state of New York, and those public
7 general hospitals located in the county of Westchester, the county of
8 Erie or the county of Nassau, additional payments for inpatient hospital
9 services as medical assistance payments pursuant to title 11 of article
10 5 of the social services law for patients eligible for federal financial
11 participation under title XIX of the federal social security act in
12 medical assistance pursuant to the federal laws and regulations govern-
13 ing disproportionate share payments to hospitals up to one hundred
14 percent of each such public general hospital's medical assistance and
15 uninsured patient losses after all other medical assistance, including
16 disproportionate share payments to such public general hospital for
17 1996, 1997, 1998, and 1999, based initially for 1996 on reported 1994
18 reconciled data as further reconciled to actual reported 1996 reconciled
19 data, and for 1997 based initially on reported 1995 reconciled data as
20 further reconciled to actual reported 1997 reconciled data, for 1998
21 based initially on reported 1995 reconciled data as further reconciled
22 to actual reported 1998 reconciled data, for 1999 based initially on
23 reported 1995 reconciled data as further reconciled to actual reported
24 1999 reconciled data, for 2000 based initially on reported 1995 recon-
25 ciled data as further reconciled to actual reported 2000 data, for 2001
26 based initially on reported 1995 reconciled data as further reconciled
27 to actual reported 2001 data, for 2002 based initially on reported 2000
28 reconciled data as further reconciled to actual reported 2002 data, and
29 for state fiscal years beginning on April 1, 2005, based initially on
30 reported 2000 reconciled data as further reconciled to actual reported
31 data for 2005, and to actual reported data for each respective succeed-
32 ing year. The payments may be added to rates of payment or made as
33 aggregate payments to an eligible public general hospital.
34 § 41. Paragraph (b) of subdivision 1 of section 211 of chapter 474 of
35 the laws of 1996, amending the education law and other laws relating to
36 rates for residential health care facilities, as amended by chapter 161
37 of the laws of 2005, is amended to read as follows:
38 (b) Notwithstanding any inconsistent provision of law or regulation to
39 the contrary, effective beginning April 1, 2000, the department of
40 health is authorized to pay public general hospitals, other than those
41 operated by the state of New York or the state university of New York,
42 as defined in subdivision 10 of section 2801 of the public health law,
43 located in a city with a population of over 1 million, additional
44 initial payments for inpatient hospital services of $120 million during
45 each state fiscal year until March 31, 2003, and up to $120 million
46 during the state fiscal year beginning April 1, 2005 through March 31,
47 2006 and during the state fiscal year beginning April 1, 2006 and each
48 state fiscal year thereafter, as medical assistance payments pursuant to
49 title 11 of article 5 of the social services law for patients eligible
50 for federal financial participation under title XIX of the federal
51 social security act in medical assistance pursuant to the federal laws
52 and regulations governing disproportionate share payments to hospitals
53 based on the relative share of each such non-state operated public
54 general hospital of medical assistance and uninsured patient losses
55 after all other medical assistance, including disproportionate share
56 payments to such public general hospitals for payments made during the
S. 6457 29 A. 9557
1 state fiscal year ending March 31, 2001, based initially on reported
2 1995 reconciled data as further reconciled to actual reported 2000 or
3 2001 data, for payments made during the state fiscal year ending March
4 31, 2002, based initially on reported 1995 reconciled data as further
5 reconciled to actual reported 2001 or 2002 data, for payments made
6 during the state fiscal year ending March 31, 2003, based initially on
7 reported 2000 reconciled data as further reconciled to actual reported
8 2002 or 2003 data, for payments made during state fiscal years ending on
9 and after March 31, 2006, based initially on reported 2000 reconciled
10 data as further reconciled to actual reported 2005 or 2006 data, and to
11 actual reported data for each respective succeeding year. The payments
12 may be added to rates of payment or made as aggregate payments to an
13 eligible public general hospital.
14 § 42. 1. Notwithstanding paragraph (c) of subdivision 10 of section
15 2807-c of the public health law and section 21 of chapter 1 of the laws
16 of 1999 and any other inconsistent provision of law or regulation to the
17 contrary, in determining rates of payments by state governmental agen-
18 cies effective for services provided beginning April 1, 2006, and there-
19 after for inpatient and outpatient services provided by general hospi-
20 tals and for inpatient and outpatient adult day health care services
21 provided by residential health care facilities pursuant to article 28 of
22 the public health law, the commissioner of health shall apply no trend
23 factor projections attributable to the period January 1, 2006 through
24 December 31, 2006.
25 2. The commissioner of health shall adjust rates of payment to reflect
26 the exclusion pursuant to this section of such specified trend factor
27 projections or adjustments.
28 § 43. Notwithstanding section 4 of chapter 81 of the laws of 1995, as
29 amended, and any other inconsistent provision of law or regulation to
30 the contrary, on and after October 1, 2006, rates of payment by govern-
31 mental agencies to residential health care facilities and diagnostic
32 and treatment centers licensed under article 28 of the public health law
33 for adult day health care services provided to registrants with acquired
34 immunodeficiency syndrome (AIDS) or other human immunodeficiency virus
35 (HIV) related illnesses, shall reflect trend factor adjustments computed
36 pursuant to paragraph (c) of subdivision 10 of section 2807-c of the
37 public health law to project for the effects of inflation attributable
38 to periods on and after October 1, 2006 through December 31, 2009.
39 § 44. Section 2808 of the public health law is amended by adding a new
40 subdivision 22-a to read as follows:
41 22-a. Modifications.
42 (a) Notwithstanding any inconsistent provision of law or regulation to
43 the contrary, effective April first, two thousand six and thereafter,
44 residential health care facility rates of payment determined pursuant to
45 this section for payments made by governmental agencies shall not
46 contain a payment factor for interest on current indebtedness if the
47 residential health care facility cost report utilized to determine such
48 payment factor also shows a withdrawal of equity, a transfer of assets,
49 or a positive net income.
50 (b) Notwithstanding any inconsistent provision of law or regulation to
51 the contrary, for residential health care facility rates of payment
52 determined pursuant to this article for services provided on and after
53 April first, two thousand six, the annual cost report filed by each
54 residential health care facility for two thousand five and for each year
55 thereafter shall be examined and in the event the operating costs
56 reported by each such facility in any such cost report is less than
S. 6457 30 A. 9557
1 ninety percent of the operating costs reported in the cost report which
2 is being utilized to set such facility's existing rates of payment
3 trended to two thousand five and each year thereafter, then such rates
4 of payment shall be recalculated utilizing the more recent reported
5 operating cost data.
6 (c) Notwithstanding any inconsistent provision of law or regulation to
7 the contrary, effective on and after April first, two thousand six, for
8 purposes of establishing rates of payment by governmental agencies for
9 residential health care facilities licensed pursuant to this article,
10 the operating component of the rate for any residential health care
11 facility that did not or does not achieve ninety percent or greater
12 occupancy for any year within five calendar years from the date of
13 commencing operation, shall be recalculated utilizing the facility's
14 most recently available reported allowable costs divided by patient days
15 imputed at ninety percent occupancy. Such recalculated rates of payment
16 shall be effective January first of the sixth calendar year following
17 the date the facility commenced operations or April first, two thousand
18 six, whichever is later.
19 § 45. Subparagraph (vi) of paragraph (b) of subdivision 2 of section
20 2807-d of the public health law, as amended by section 23 of part E of
21 chapter 63 of the laws of 2005, is amended to read as follows:
22 (vi) Notwithstanding any contrary provision of this paragraph or any
23 other provision of law or regulation to the contrary, for residential
24 health care facilities the assessment shall be six percent of each resi-
25 dential health care facility's gross receipts received from all patient
26 care services and other operating income on a cash basis for the period
27 April first, two thousand two through March thirty-first, two thousand
28 three for hospital or health-related services, including adult day
29 services; provided, however, that residential health care facilities'
30 gross receipts attributable to payments received pursuant to title XVIII
31 of the federal social security act (medicare) shall be excluded from the
32 assessment; provided, however, that for all such gross receipts received
33 on or after April first, two thousand three through March thirty-first,
34 two thousand five, such assessment shall be five percent, and further
35 provided that for all such gross receipts received on or after April
36 first, two thousand five [through March thirty-first, two thousand
37 seven], such assessment shall be six percent.
38 § 46. Section 2808 of the public health law is amended by adding a new
39 subdivision 23 to read as follows:
40 23. Notwithstanding any inconsistent provision of law or regulation to
41 the contrary:
42 (a) (i) For adult day health care services provided by residential
43 health care facilities, effective April first, two thousand six and
44 thereafter, the operating component of the rate of payment established
45 pursuant to this article for an adult day health care program which has
46 achieved an occupancy percentage of ninety percent or greater for a
47 calendar year prior to April first, two thousand six, shall be calcu-
48 lated utilizing allowable costs reported in the two thousand three, two
49 thousand four, or two thousand five calendar year residential health
50 care facility cost report filed by the sponsoring residential health
51 care facility, whichever is the earliest of such calendar year cost
52 reports in which the program has achieved an occupancy percentage of
53 ninety percent or greater, except that programs receiving rates of
54 payment based on allowable costs for a period prior to April first, two
55 thousand six shall continue to receive rates of payment based on such
56 period.
S. 6457 31 A. 9557
1 (ii) For such programs which achieved an occupancy percentage of nine-
2 ty percent or greater prior to calendar year two thousand three but
3 which did not maintain occupancy of ninety percent or greater in calen-
4 dar years two thousand three, two thousand four, or two thousand five,
5 the operating component of the rate of payment established pursuant to
6 this article shall be calculated utilizing allowable costs reported in
7 the two thousand three calendar year cost report divided by visits
8 imputed at ninety percent occupancy.
9 (iii) For such programs which have not achieved an occupancy percent-
10 age of ninety percent or greater for a calendar year prior to April
11 first, two thousand six, the operating component of the rate of payment
12 established pursuant to this article shall be calculated utilizing
13 allowable costs reported in the first calendar year after two thousand
14 five in which such a program achieves an occupancy percentage of ninety
15 percent or greater effective January first of such calendar year except
16 for calendar year two thousand six, effective no earlier than April
17 first of such year, provided, however, that effective January first, two
18 thousand eight, for programs that have not achieved an occupancy
19 percentage of ninety percent or greater for a calendar year prior to
20 January first, two thousand eight, the operating component of the rate
21 of payment established pursuant to this article shall be calculated
22 utilizing allowable costs reported in the two thousand eight cost report
23 filed by the sponsoring residential health care facility divided by
24 visits imputed at actual or ninety percent occupancy, whichever is
25 greater.
26 (b) For a residential health care facility approved to operate an
27 adult day health care program on or after April first, two thousand six,
28 rates of payment for such programs shall be computed based upon annual
29 budgeted allowable costs, as submitted by the residential health care
30 facility, and total estimated annual visits by adult day health care
31 registrants of not less than ninety percent of licensed occupancy, and
32 in accordance with the following:
33 (i) Each program shall be required to submit an individual budget.
34 Multiple programs operated by the same residential health care facility
35 shall submit a separate budget for each program. Multiple programs
36 operated by the same residential health care facility shall have sepa-
37 rate rates of payment.
38 (ii) Rates developed based upon budgets shall remain in effect for no
39 longer than two calendar years from the earlier of:
40 (A) the date the program commences operations; or
41 (B) the date the sponsoring residential health care facility submits a
42 full calendar year residential health care facility cost report in which
43 the program has achieved ninety percent or greater occupancy. If a
44 sponsoring residential health care facility submits such a cost report
45 within two years of the date the program commences operation, rates
46 shall then be computed utilizing such cost report.
47 (iii) If a program fails to achieve ninety percent or greater occupan-
48 cy within two calendar years of the date of its commencing operations,
49 rates shall be calculated utilizing allowable costs reported in such
50 second calendar year residential health care facility's cost report for
51 the applicable sponsoring residential health care facility divided by
52 visits imputed at ninety percent occupancy.
53 (c) Effective January first, two thousand seven, allowable costs shall
54 not include the costs of transportation.
55 (d) All rates of payment established pursuant to this subdivision are
56 subject to the maximum daily rate provided by law. Such maximum daily
S. 6457 32 A. 9557
1 rate of payment for adult day health care programs operated by residen-
2 tial health care facilities that undergo a change of ownership subse-
3 quent to nineteen hundred ninety shall be determined by utilizing the
4 inpatient rate of payment of the prior operator as in effect on January
5 first, nineteen hundred ninety. In the event a residential health care
6 facility establishes an off-site adult day health care program outside
7 the regional input price adjustment region in which it is located, the
8 computation of the maximum daily rate of payment for such program shall
9 utilize the weighted average of the inpatient rates of payments for
10 residential health care facilities in the region in which the program is
11 located, as in effect on January first, nineteen hundred ninety, in
12 place of the sponsoring residential health care facility's inpatient
13 rate of payment.
14 (e) Notwithstanding any inconsistent provision of the state adminis-
15 trative procedure act or any other law or regulation to the contrary,
16 the commissioner shall adopt or amend on an emergency basis any regu-
17 lations the commissioner shall determine necessary to implement any
18 provision of this subdivision.
19 § 47. Subdivision 1 of section 12-d of the public health law, as
20 amended by chapter 843 of the laws of 1992, is amended to read as
21 follows:
22 1. [In] Notwithstanding any contrary provision of law, in the event a
23 medical facility or other provider fails to file the required financial
24 and statistical reports, or specific additional data related to the rate
25 setting process, on or before the prescribed due dates, or as the same
26 may be extended by the commissioner, the commissioner shall reduce the
27 current rate established for payments by governmental agencies by [up to
28 two] ten percent for a period beginning on the first day of the calendar
29 month following the original due date of the required reports or addi-
30 tional data and continuing until the last day of the calendar month in
31 which said reports or data are filed.
32 § 48. Subdivision 4 of section 12-d of the public health law, as
33 amended by chapter 575 of the laws of 1992, is amended to read as
34 follows:
35 4. For the purposes of this section, "medical facility or other
36 provider" shall mean a residential health care facility, general hospi-
37 tal, free-standing ambulatory care facility, diagnostic and/or treatment
38 center and clinic authorized under article twenty-eight of this chap-
39 ter[, and]; a certified home health agency [and], a long term home
40 health care program and an AIDS home care program authorized under arti-
41 cle thirty-six of this chapter; and a personal care services provider
42 authorized under article five of the social services law.
43 § 49. Paragraph (a) of subdivision 3 of section 366 of the social
44 services law, as amended by chapter 110 of the laws of 1971, is amended
45 to read as follows:
46 (a) Medical assistance shall be furnished to applicants in cases
47 where, although such applicant has a responsible relative with suffi-
48 cient income and resources to provide medical assistance as determined
49 by the regulations of the department, the income and resources of the
50 responsible relative are not available to such applicant because of the
51 absence of such relative [or] and the refusal or failure of such absent
52 relative to provide the necessary care and assistance. In such cases,
53 however, the furnishing of such assistance shall create an implied
54 contract with such relative, and the cost thereof may be recovered from
55 such relative in accordance with title six of article three and other
56 applicable provisions of law.
S. 6457 33 A. 9557
1 § 50. Paragraph (d) of subdivision 5 of section 366 of the social
2 services law, as added by chapter 170 of the laws of 1994, is amended
3 and a new subparagraph 7 is added to read as follows:
4 (d) For transfers made after August tenth, nineteen hundred ninety-
5 three:
6 (1) (i) "assets" means all income and resources of an individual and
7 of the individual's spouse, including income or resources to which the
8 individual or the individual's spouse is entitled but which are not
9 received because of action by: the individual or the individual's
10 spouse; a person with legal authority to act in place of or on behalf of
11 the individual or the individual's spouse; a person acting at the direc-
12 tion or upon the request of the individual or the individual's spouse;
13 or by a court or administrative body with legal authority to act in
14 place of or on behalf of the individual or the individual's spouse or at
15 the direction or upon the request of the individual or the individual's
16 spouse.
17 (ii) "blind" has the same meaning given to such term in section
18 1614(a)(2) of the federal [social] social security act.
19 (iii) "disabled" has the same meaning given to such term in section
20 1614(a)(3) of the federal social security act.
21 (iv) "income" has the same meaning given to such term in section 1612
22 of the federal social security act.
23 (v) "resources" has the same meaning given to such term in section
24 1613 of the federal social security act, without regard, in the case of
25 an institutionalized individual, to the exclusion provided for in
26 subsection (a)(1) of such section.
27 (vi) "look-back period" means the thirty-six month period, or, in the
28 case of payments from a trust or portions of a trust which are treated
29 as assets disposed of by the individual pursuant to department regu-
30 lations, the sixty-month period, immediately preceding the date that an
31 institutionalized individual is both institutionalized and has applied
32 for medical assistance, or in the case of a non-institutionalized indi-
33 vidual, the date that such non-institutionalized individual applies for
34 medical assistance coverage of long term care services; provided, howev-
35 er, that the look-back period for all types of transfers shall be sixty
36 months if the commissioner of health obtains all necessary approvals
37 under federal law and regulation to implement such a look-back period;
38 provided further that the use of a sixty-month look-back period for all
39 types of transfers shall continue only if and for so long as the use of
40 such a look-back period does not prevent the receipt of federal finan-
41 cial participation under the medical assistance program; provided
42 further that the commissioner of health shall submit such waiver appli-
43 cations and/or state plan amendments as may be necessary to obtain
44 approval to implement a sixty-month look-back period for all types of
45 transfers and to ensure continued federal financial participation.
46 (vii) "institutionalized individual" means any individual who is an
47 in-patient in a nursing facility, including an intermediate care facili-
48 ty for the mentally retarded, or who is an in-patient in a medical
49 facility and is receiving a level of care provided in a nursing facili-
50 ty, or who is receiving care, services or supplies pursuant to a waiver
51 granted pursuant to subsection (c) of section 1915 of the federal social
52 security act.
53 (viii) "intermediate care facility for the mentally retarded" means a
54 facility certified under article sixteen of the mental hygiene law and
55 which has a valid agreement with the department for providing intermedi-
S. 6457 34 A. 9557
1 ate care facility services and receiving payment therefor under title
2 XIX of the federal social security act.
3 (ix) "nursing facility" means a nursing home as defined by section
4 twenty-eight hundred one of the public health law and an intermediate
5 care facility for the mentally retarded.
6 (x) "nursing facility services" means nursing care and health related
7 services provided in a nursing facility; a level of care provided in a
8 hospital which is equivalent to the care which is provided in a nursing
9 facility; and care, services or supplies provided pursuant to a waiver
10 granted pursuant to subsection (c) of section 1915 of the federal social
11 security act.
12 (xi) "non-institutionalized individual" means an individual who is not
13 an institutionalized individual, as defined in clause (vii) of this
14 subparagraph.
15 (xii) "long term care services" means home health care services,
16 personal care services, assisted living program services and such other
17 services for which medical assistance is otherwise available under this
18 chapter which are designated as long term care services in the regu-
19 lations of the department.
20 (2) The uncompensated value of an asset is the fair market value of
21 such asset at the time of transfer, minus the amount of the compensation
22 received in exchange for the asset.
23 (3) In determining the medical assistance eligibility of an institu-
24 tionalized individual, any transfer of an asset by the individual or the
25 individual's spouse for less than fair market value made within or after
26 the look-back period shall render the individual ineligible for nursing
27 facility services for the period of time specified in subparagraph four
28 of this paragraph. In determining the medical assistance eligibility of
29 a non-institutionalized individual, any transfer of an asset by the
30 individual or the individual's spouse for less than fair market value
31 made within or after the look-back period shall render the individual
32 ineligible for long term care services for the period of time specified
33 in subparagraph four of this paragraph. Notwithstanding the provisions
34 of this subparagraph, an individual shall not be ineligible for services
35 solely by reason of any such transfer to the extent that:
36 (i) [in the case of an institutionalized individual,] the asset trans-
37 ferred was a home and title to the home as transferred to: (A) the
38 spouse of the individual; or (B) a child of the individual who is under
39 the age of twenty-one years or blind or disabled; or (C) in the case of
40 an institutionalized individual, a sibling of the individual who has an
41 equity interest in such home and who resided in such home for a period
42 of at least one year immediately before the date the individual became
43 an institutionalized individual; or (D) in the case of an institutional-
44 ized individual, a child of the individual who was residing in such home
45 for a period of at least two years immediately before the date the indi-
46 vidual became an institutionalized individual, and who provided care to
47 the individual which permitted the individual to reside at home rather
48 than in an institution or facility; or
49 (ii) the assets: (A) were transferred to the individual's spouse, or
50 to another for the sole benefit of the individual's spouse; or (B) were
51 transferred from the individual's spouse to another for the sole benefit
52 of the individual's spouse; or (C) were transferred to the individual's
53 child who is blind or disabled, or to a trust established solely for the
54 benefit of such child; or (D) were transferred to a trust established
55 solely for the benefit of an individual under sixty-five years of age
56 who is disabled; or
S. 6457 35 A. 9557
1 (iii) a satisfactory showing is made that: (A) the individual or the
2 individual's spouse intended to dispose of the assets either at fair
3 market value, or for other valuable consideration; or (B) the assets
4 were transferred exclusively for a purpose other than to qualify for
5 medical assistance; or (C) all assets transferred for less than fair
6 market value have been returned to the individual; or
7 (iv) denial of eligibility would cause an undue hardship, as deter-
8 mined pursuant to the regulations of the department in accordance with
9 criteria established by the secretary of the federal department of
10 health and human services.
11 (4) (i) Any transfer made by an individual or the individual's spouse
12 under subparagraph three of this paragraph shall cause the person to be
13 ineligible for services for a period equal to the total, cumulative
14 uncompensated value of all assets transferred during or after the look-
15 back period, divided by the average monthly costs of nursing facility
16 services provided to a private patient for a given period of time at the
17 time of application, as determined pursuant to the regulations of the
18 department. The period of ineligibility shall begin with the first day
19 of the first month during or after which assets have been transferred
20 for less than fair market value, and which does not occur in any other
21 periods of ineligibility under this paragraph. For purposes of this
22 subparagraph, the average monthly costs of nursing facility services to
23 a private patient for a given period of time at the time of application
24 shall be presumed to be one hundred twenty percent of the average
25 medical assistance rate of payment as of the first day of January of
26 each year for nursing facilities within the region wherein the applicant
27 resides, as established pursuant to paragraph (b) of subdivision sixteen
28 of section twenty-eight hundred seven-c of the public health law.
29 (ii) Notwithstanding any provision of clause (i) of this subparagraph
30 to the contrary, the period of ineligibility described therein shall
31 begin on the first day the individual is receiving services for which
32 medical assistance coverage would be available but for the provisions of
33 subparagraph three of this paragraph, and which does not occur in any
34 other periods of ineligibility under this paragraph, if the commissioner
35 of health obtains all necessary approvals under federal law and regu-
36 lation to implement such a period of ineligibility. The use of such a
37 period of ineligibility shall continue only if and for so long as it
38 does not prevent the receipt of federal financial participation under
39 the medical assistance program. The commissioner of health shall submit
40 such waiver applications and/or state plan amendments as may be neces-
41 sary to obtain approval to implement the period of ineligibility
42 described in this clause and to ensure continued federal financial
43 participation.
44 (5) In the case of an asset held by an individual in common with
45 another person or persons in a joint tenancy, tenancy in common, or
46 similar arrangement, the asset, or the affected portion of the asset,
47 shall be considered to be transferred by such individual when any action
48 is taken, either by such individual or by any other person, that reduces
49 or eliminates such individual's ownership or control of such asset.
50 (6) In the case of a trust established by the individual, as deter-
51 mined pursuant to the regulations of the department, any payment, other
52 than a payment to or for the benefit of the individual, from a revocable
53 trust is considered to be a transfer of assets by the individual and any
54 payment, other than to or for the benefit of the individual, from the
55 portion of an irrevocable trust which, under any circumstance, could be
56 made available to the individual is considered to be a transfer of
S. 6457 36 A. 9557
1 assets by the individual and, further, the value of any portion of an
2 irrevocable trust from which no payment could be made to the individual
3 under any circumstances is considered to be a transfer of assets by the
4 individual for purposes of this section as of the date of establishment
5 of the trust, or, if later, the date on which payment to the individual
6 is foreclosed.
7 (7) In the case of a transfer by an individual which results in a
8 period of ineligibility for such individual or his or her spouse, such
9 period of ineligibility will continue without regard to the individual's
10 becoming an institutionalized individual if the transfer was made while
11 the individual was a non-institutionalized individual and without regard
12 to the individual's becoming a non-institutionalized individual if the
13 transfer was made while the individual was an institutionalized individ-
14 ual. In no event shall the total period of ineligibility for long term
15 care services and nursing facility services resulting from the same
16 transfer of assets exceed the period calculated pursuant to subparagraph
17 four of this paragraph.
18 § 51. Paragraph (b) of subdivision 5 of section 366-c of the social
19 services law as added by chapter 558 of the laws of 1989, is amended to
20 read as follows:
21 (b) An institutionalized spouse shall not be ineligible for medical
22 assistance by reason of excess resources determined under paragraph (a)
23 of this subdivision, if (i) the institutionalized spouse executes an
24 assignment of support from the community spouse in favor of the social
25 services district and the department, or the institutionalized spouse is
26 unable to execute such assignment due to physical or mental impairment,
27 [or] and (ii) to deny assistance would create an undue hardship, as
28 defined by the commissioner.
29 § 52. Subdivision 6 of section 369 of the social services law, as
30 added by chapter 170 of the laws of 1994, is amended to read as follows:
31 6. For purposes of this section, the term "estate" means all real and
32 personal property and other assets included within the individual's
33 estate and passing under the terms of a valid will or by intestacy, and
34 all real or personal property, tangible or intangible, in which the
35 individual at the time of his or her death had any right, title or
36 interest, including any property in which the individual had an interest
37 as a joint tenant, joint tenant with right of survivorship, life tenant
38 or beneficiary of a trust.
39 § 53. Subdivision 2-a of section 369-ee of the social services law, as
40 amended by section 26 of part E of chapter 63 of the laws of 2005, is
41 amended to read as follows:
42 2-a. Co-payments. Subject to federal approval pursuant to subdivision
43 six of this section, persons receiving family health plus coverage under
44 this section shall be responsible to make co-payments in accordance with
45 the terms of subdivision six of section three hundred sixty-seven-a of
46 this article, including those individuals who are otherwise exempted
47 under the provisions of subparagraph (iv) of paragraph (b) of subdivi-
48 sion six of section three hundred sixty-seven-a of this article,
49 provided however, that the limitations in paragraph (f) of such subdivi-
50 sion shall not apply and provided further, that notwithstanding the
51 provisions of paragraphs (c) and (d) of such subdivision:
52 (i) co-payments charged for each generic prescription drug dispensed
53 shall be three dollars and for each brand name prescription drug
54 dispensed shall be six dollars;
55 (ii) the co-payment charged for each dental service visit shall be
56 five dollars, provided that no enrollee shall be required to pay more
S. 6457 37 A. 9557
1 than twenty-five dollars per year in co-payments for dental services;
2 [and]
3 (iii) the co-payment for clinic services and physician services shall
4 be five dollars;
5 [and provided further that the limitations in paragraph (f) of such
6 subdivision shall not apply.]
7 (iv) the co-payments charged for emergency room services provided for
8 non-urgent or non-emergency medical care shall be twenty-five dollars;
9 and
10 (v) notwithstanding the provisions of paragraphs (a) and (g) of subdi-
11 vision six of section three hundred sixty-seven-a of this article, it
12 shall not be an unacceptable practice under the medical assistance
13 program for a provider to deny services to a person eligible for
14 services under this section based on such person's inability to pay a
15 co-payment amount required by this subdivision.
16 § 54. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
17 369-ee of the social services law, as amended by section 28 of part E of
18 chapter 63 of the laws of 2005, is amended to read as follows:
19 (iii) does not have equivalent health care coverage under insurance or
20 equivalent mechanisms, as defined by the commissioner in consultation
21 with the superintendent of insurance, is not employed by an employer
22 with more than one hundred employees, and is not a federal, state, coun-
23 ty, municipal or school district employee that is eligible for health
24 care coverage through his or her employer;
25 § 55. Subdivision 11 of section 364-j of the social services law is
26 REPEALED.
27 § 56. Paragraph (c) of subdivision 3 of section 369-ee of the social
28 services law is REPEALED.
29 § 57. Paragraph b of subdivision 4 of section 364-j of the social
30 services law, as amended by chapter 649 of the laws of 1996, is amended
31 to read as follows:
32 (b) Participants shall select a managed care provider from among those
33 designated under the managed care program, provided, however, a partic-
34 ipant shall be provided with a choice of no less than two managed care
35 providers. Notwithstanding the foregoing, a local social services
36 district designated a rural area as defined in 42 U.S.C. 1395ww may
37 limit a participant to one managed care provider. A managed care
38 provider in a rural area shall offer a participant a choice of at least
39 three physicians or case managers and permit the individual to obtain a
40 service or seek a provider outside of the managed care network where
41 such service or provider is not available from within the managed care
42 provider network.
43 § 58. Paragraph (j) of subdivision 2 of section 365-a of the social
44 services law is REPEALED.
45 § 59. Paragraph (iii) of subdivision (g) of section 1 of part C of
46 chapter 58 of the laws of 2005, amending the public health law and other
47 laws relating to implementing the state fiscal plan for the 2005--2006
48 state fiscal year is amended to read as follows:
49 (iii) During each state fiscal year subject to the provisions of this
50 section, the commissioner shall maintain an accounting, for each social
51 services district, of the net amounts that would have been expended by,
52 or on behalf of, such district had the social services district medical
53 assistance shares provisions in effect on January 1, 2005 been applied
54 to such district. For purposes of this paragraph, fifty percent of the
55 payments made by New York State to the secretary of the federal depart-
56 ment of health and human services pursuant to section 1935(c) of the
S. 6457 38 A. 9557
1 social security act shall be deemed to be payments made on behalf of
2 social services districts; such fifty percent share shall be apportioned
3 to each district in the same ratio as the number of "full-benefit dual
4 eligible individuals," as that term is defined in section 1935(c)(6) of
5 such act, for whom such district has fiscal responsibility pursuant to
6 section 365 of the social services law, relates to the total of such
7 individuals for whom districts have fiscal responsibility. As soon as
8 practicable after the conclusion of each such fiscal year, but in no
9 event later than six months after the conclusion of each such fiscal
10 year, the commissioner shall reconcile such net amounts with such fiscal
11 year's social services district expenditure cap amount. Such reconcil-
12 iation shall be based on actual expenditures made by or on behalf of
13 social services districts, and revenues received by social services
14 districts, during such fiscal year and shall be made without regard to
15 expenditures made, and revenues received, outside such fiscal year that
16 are related to services provided during, or prior to, such fiscal year.
17 The commissioner shall pay to each social services district the amount,
18 if any, by which such district's expenditure cap amount exceeds such net
19 amount.
20 § 60. Subdivision (a) of section 1 of part C of chapter 58 of the laws
21 of 2005, amending the public health law and other laws relating to
22 implementing the state fiscal plan for the 2005-2006 state fiscal year,
23 as amended by chapter 161 of the laws of 2005, is amended to read as
24 follows:
25 (a) Notwithstanding the provisions of section 368-a of the social
26 services law, or any other provision of law, the department of health
27 shall provide reimbursement for expenditures made by or on behalf of
28 social services districts for medical assistance for needy persons, and
29 the administration thereof, in accordance with the provisions of this
30 section; provided, however, that this section shall not apply to amounts
31 expended for health care services under section 369-ee of the social
32 services law, which amounts shall be reimbursed in accordance with para-
33 graph (t) of subdivision 1 of section 368-a of such law and shall be
34 excluded from all calculations made pursuant to this section; and
35 provided further that amounts paid to the public hospitals pursuant to
36 subdivision 14-f of section 2807-c of the public health law and amounts
37 expended pursuant to: subdivision 12 of section 2808 of the public
38 health law; sections 211 and 212 of chapter 474 of the laws of 1996, as
39 amended; and sections 11 through 14 of part A and sections 13 and 14 of
40 part B of chapter 1 of the laws of 2002, shall be excluded from all
41 calculations made pursuant to this section.
42 § 61. Any payments made on and after January 1, 2006: (i) by the
43 department of health to a social services district for the purpose of
44 providing such district with reimbursement for medical assistance
45 district share overpayments caused by miscategorization of persons
46 described in subdivision 5 of section 365 of the social services law, or
47 (ii) by a social services district to the department of health for the
48 purpose of providing the department with reimbursement for medical
49 assistance district share underpayments caused by miscategorization of
50 such persons, shall not be governed by the provisions of section 1 of
51 Part C of chapter 58 of the laws of 2005; provided, however, that any
52 portion of such payments that are made on or before June 1, 2006 and
53 that are attributable to shares adjustments for expenditures made in
54 calendar year 2005 shall be included in the base year calculation
55 required by subdivision (b) of such section 1.
S. 6457 39 A. 9557
1 § 62. Paragraph (e-1) of subdivision 12 of section 2808 of the public
2 health law, as added by section 39 of part C of chapter 58 of the laws
3 of 2005, is amended to read as follows:
4 (e-1) Notwithstanding any inconsistent provision of law or regulation,
5 the commissioner shall provide, in addition to payments established
6 pursuant to this article prior to application of this section, addi-
7 tional payments under the medical assistance program pursuant to title
8 eleven of article five of the social services law for non-state operated
9 public residential health care facilities, including public residential
10 health care facilities located in the county of Nassau, the county of
11 Westchester and the county of Erie, but excluding public residential
12 health care facilities operated by a town or city within a county, in an
13 aggregate amount of up to one hundred fifty million dollars in addi-
14 tional payments for state fiscal [year] years beginning April first, two
15 thousand five. The amount allocated to each eligible public residential
16 health care facility for this period shall be computed in accordance
17 with the provisions of paragraph (f) of this subdivision, provided,
18 however, that patient days shall be utilized for such computation
19 reflecting actual reported data for two thousand three and each repre-
20 sentative succeeding year as applicable.
21 § 63. Section 461-b of the social services law is amended by adding a
22 new subdivision 9 to read as follows:
23 9. No operator of an adult care facility, assisted living program or
24 assisted living residence that is licensed pursuant to this article or
25 article 46-b of the public health law shall, directly or indirectly,
26 make any charitable contribution of state monies, medical assistance
27 payments or social security or supplemental security income or any
28 interest or other income earned thereon, except as expressly authorized
29 by the commissioner; provided, however, the provisions of this subdivi-
30 sion shall not apply to receipts or donations from private or non-go-
31 vernmental sources and any interest or other income earned thereon.
32 § 64. Section 15 of chapter 66 of the laws of 1994, amending the
33 public health law, the general municipal law and the insurance law
34 relating to the financing of life care communities, as amended by chap-
35 ter 659 of the laws of 1997, is amended to read as follows:
36 § 15. This act shall take effect immediately, provided, however that
37 the amendment made to subdivision 4 of section 854 of the general munic-
38 ipal law by section eight of this act shall not affect the reversion of
39 such subdivision as provided by section 5 of chapter 905 of the laws of
40 1986, as amended and that where the [life care] continuing care retire-
41 ment community council is authorized to promulgate regulations by this
42 act, it is hereby authorized to implement the provisions of this act in
43 advance of such regulations[; and provided further that sections one,
44 three, seven, eight, nine, ten, eleven, twelve and thirteen of this act,
45 and paragraph m of subdivision 2 of section 4602 of the public health
46 law, as added by section two of this act, shall apply only to applicants
47 for a certificate of authority pursuant to article 46 of the public
48 health law that have been approved to receive and have received such
49 certificate of authority on or before July 1, 2005].
50 § 65. Section 364-j of the social services law, is amended by adding a
51 new subdivision 22 to read as follows:
52 22. (a) As a means of protecting the health, safety and welfare of
53 recipients, in addition to any other sanctions that may be imposed, the
54 commissioner shall appoint temporary management of a managed care
55 provider upon determining that the managed care provider has repeatedly
56 failed to meet the substantive requirements of sections 1903(m) and 1932
S. 6457 40 A. 9557
1 of the federal Social Security Act and regulations. A hearing shall not
2 be required prior to the appointment of temporary management.
3 (b) The commissioner and/or his or her designees, which may be indi-
4 viduals within the department or other individuals or entities with
5 appropriate knowledge and experience, may be appointed as temporary
6 management. The commissioner may appoint the superintendent of insurance
7 and/or his or her designees as temporary management of any managed care
8 provider which is subject to rehabilitation pursuant to article seven-
9 ty-four of the insurance law.
10 (c) The responsibilities of temporary management shall include over-
11 sight of the managed care provider for the purpose of removing the caus-
12 es and conditions which led to the determination requiring temporary
13 management, the imposition of improvements to remedy violations and,
14 where necessary, the orderly reorganization, termination or liquidation
15 of the managed care provider.
16 (d) Temporary management may hire and fire managed care provider
17 personnel and expend managed care provider funds in carrying out the
18 responsibilities imposed pursuant to this subsection, and shall only be
19 liable for acts or omissions that constitute gross, wilful or wanton
20 negligence.
21 (e) The commissioner, in consultation with the superintendent with
22 respect to any managed care provider subject to rehabilitation pursuant
23 to article seventy-four of the insurance law, may make available to
24 temporary management for the benefit of a managed care provider for the
25 maintenance of required reserves and deposits monies from such funds as
26 are appropriated for such purpose.
27 (f) The commissioner is authorized to establish in regulation
28 provisions for the payment of fees and expenses from funds appropriated
29 for such purpose for non-governmental individuals and entities appointed
30 as temporary management pursuant to this subdivision.
31 (g) The commissioner may not terminate temporary management prior to
32 his or her determination that the managed care provider has the capabil-
33 ity to ensure that the sanctioned behavior will not recur.
34 (h) During any period of temporary management individuals enrolled in
35 the managed care provider being managed may disenroll without cause.
36 Upon reaching a determination that requires temporary management of a
37 managed care provider, the commissioner shall notify all recipient
38 enrollees of such provider that they may terminate enrollment without
39 cause during the period of temporary management.
40 (i) The commissioner may adopt and amend rules and regulations to
41 effectuate the purposes and provisions of this subdivision.
42 § 66. Subdivision 2 of section 4900 of the public health law, as
43 amended by chapter 586 of the laws of 1998, is amended to read as
44 follows:
45 2. "Clinical peer reviewer" means for purposes of this article:
46 (a) [for purposes of title one of this article:
47 (i) a physician who possesses a current and valid non-restricted
48 license to practice medicine; or
49 (ii) a health care professional other than a licensed physician who:
50 (A) where applicable, possesses a current and valid non-restricted
51 license, certificate or registration or, where no provision for a
52 license, certificate or registration exists, is credentialed by the
53 national accrediting body appropriate to the profession; and
54 (B) is in the same profession and same or similar specialty as the
55 health care provider who typically manages the medical condition or
S. 6457 41 A. 9557
1 disease or provides the health care service or treatment under review;
2 and
3 (b) for purposes of title two of this article:
4 (i)] a physician who:
5 [(A)] (i) possesses a current and valid non-restricted license to
6 practice medicine;
7 [(B)] (ii) where applicable, is board certified or board eligible in
8 the same or similar specialty as the health care provider who typically
9 manages the medical condition or disease or provides the health care
10 service or treatment under appeal;
11 [(C)] (iii) has been practicing in such area of specialty for a period
12 of at least five years; and
13 [(D)] (iv) is knowledgeable about the health care service or treatment
14 under appeal; or
15 [(ii)] (b) a health care professional other than a licensed physician
16 who:
17 [(A)] (i) where applicable, possesses a current and valid non-res-
18 tricted license, certificate or registration;
19 [(B)] (ii) where applicable, is credentialed by the national accredit-
20 ing body appropriate to the profession in the same profession and same
21 or similar specialty as the health care provider who typically manages
22 the medical condition or disease or provides the health care service or
23 treatment under appeal;
24 [(C)] (iii) has been practicing in such area of specialty for a period
25 of at least five years;
26 [(D)] (iv) is knowledgeable about the health care service or treatment
27 under appeal; and
28 [(E)] (v) where applicable to such health care professional's scope of
29 practice, is clinically supported by a physician who possesses a current
30 and valid non-restricted license to practice medicine.
31 (c) Nothing herein shall be construed to change any statutorily-de-
32 fined scope of practice.
33 § 67. Subparagraph (v) of paragraph (e) of subdivision 4 of section
34 364-j of the social services law, as amended by section 14 of part C of
35 chapter 58 of the laws of 2004, is amended to read as follows:
36 (v) Upon delivery of the pre-enrollment information, the local
37 district or the enrollment organization shall certify the participant's
38 receipt of such information. Upon verification that the participant has
39 received the pre-enrollment education information, a managed care
40 provider, a local district or the enrollment organization may enroll a
41 participant into a managed care provider. Managed care providers must
42 submit enrollment forms to the local department of social services. Upon
43 enrollment, participants will sign an attestation that they have been
44 informed that: participants have a choice of managed care providers;
45 participants have a choice of primary care practitioners; and, except as
46 otherwise provided in this section, including but not limited to the
47 exceptions listed in subparagraph (iii) of paragraph (a) of this subdi-
48 vision, participants must exclusively use their primary care practition-
49 ers and plan providers. The commissioner of health [or with respect to a
50 managed care plan serving participants in a city with a population of
51 over two million, the local department of social services in such city,]
52 may suspend or curtail enrollment or impose sanctions for failure to
53 appropriately notify clients as required in this subparagraph.
54 § 68. Paragraphs (d), (e) and (f) of subdivision 5 of section 364-j of
55 the social services law, as added by section 15 of part C of chapter 58
56 of the laws of 2004, are amended to read as follows:
S. 6457 42 A. 9557
1 (d) Notwithstanding any inconsistent provision of this title and
2 section one hundred sixty-three of the state finance law, the commis-
3 sioner of health [or the local department of social services in a city
4 with a population of over two million] may contract with managed care
5 providers approved under paragraph (b) of this subdivision, without a
6 competitive bid or request for proposal process, to provide coverage for
7 participants pursuant to this title.
8 (e) Notwithstanding any inconsistent provision of this title and
9 section one hundred forty-three of the economic development law, no
10 notice in the procurement opportunities newsletter shall be required for
11 contracts awarded by the commissioner of health [or the local department
12 of social services in a city with a population of over two million], to
13 qualified managed care providers pursuant to this section.
14 (f) The care and services described in subdivision four of this
15 section will be furnished by a managed care provider pursuant to the
16 provisions of this section when such services are furnished in accord-
17 ance with an agreement with the department of health [or the local
18 department of social services in a city with a population of over two
19 million], and meet applicable federal law and regulations.
20 § 69. Subdivisions 2 and 4 of section 246 of chapter 81 of the laws of
21 1995, amending the public health law and other laws relating to medical
22 reimbursement and welfare reform, as amended by section 53 of part C of
23 chapter 58 of the laws of 2005 are amended to read as follows:
24 2. Sections five, seven through nine, twelve through fourteen, and
25 eighteen of this act shall be deemed to have been in full force and
26 effect on and after April 1, 1995 through March 31, 1999 and on and
27 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
28 through March 31, 2003 and on and after April 1, 2003 through March 31,
29 2006 and on and after April 1, 2006;
30 4. Section one of this act shall be deemed to have been in full force
31 and effect on and after April 1, 1995 through March 31, 1999 and on and
32 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
33 through March 31, 2003 and on and after April 1, 2003 through March 31,
34 2006 and on and after April 1, 2006.
35 § 70. Subparagraph (iii) of paragraph (f) of subdivision 4 of section
36 2807-c of the public health law, as amended by section 69 of part C of
37 chapter 58 of the laws of 2005, is amended to read as follows:
38 (iii) commencing April first, nineteen hundred ninety-seven through
39 March thirty-first, nineteen hundred ninety-nine and commencing July
40 first, nineteen hundred ninety-nine through March thirty-first, two
41 thousand and April first, two thousand through March thirty-first, two
42 thousand five and for periods commencing April first, two thousand five
43 through March thirty-first, two thousand six and for periods commencing
44 on and after April first, two thousand six, the reimbursable inpatient
45 operating cost component of case based rates of payment per diagnosis-
46 related group, excluding any operating cost components related to direct
47 and indirect expenses of graduate medical education, for patients eligi-
48 ble for payments made by state governmental agencies shall be reduced by
49 three and thirty-three hundredths percent to encourage improved produc-
50 tivity and efficiency. Such election shall not alter the calculation of
51 the group price component calculated pursuant to subparagraph (i) of
52 paragraph (a) of subdivision seven of this section;
53 § 71. Subparagraph (iii) of paragraph (k) of subdivision 4 of section
54 2807-c of the public health law, as amended by section 70 of part C of
55 chapter 58 of the laws of 2005, is amended to read as follows:
S. 6457 43 A. 9557
1 (iii) commencing April first, nineteen hundred ninety-seven through
2 March thirty-first, nineteen hundred ninety-nine and commencing July
3 first, nineteen hundred ninety-nine through March thirty-first, two
4 thousand and April first, two thousand through March thirty-first, two
5 thousand five and commencing April first, two thousand five through
6 March thirty-first, two thousand six, and for periods commencing on and
7 after April first, two thousand six, the operating cost component of
8 rates of payment, excluding any operating cost components related to
9 direct and indirect expenses of graduate medical education, for patients
10 eligible for payments made by a state governmental agency shall be
11 reduced by three and thirty-three hundredths percent to encourage
12 improved productivity and efficiency. The facility will be eligible to
13 receive the financial incentives for the physician specialty weighting
14 incentive towards primary care pursuant to subparagraph (ii) of para-
15 graph (a) of subdivision twenty-five of this section.
16 § 72. The opening paragraph of subparagraph (vi) of paragraph (b) of
17 subdivision 5 of section 2807-c of the public health law, as amended by
18 section 71 of part C of chapter 58 of the laws of 2005, is amended to
19 read as follows:
20 for discharges on or after April first, nineteen hundred ninety-seven
21 through March thirty-first, nineteen hundred ninety-nine and for
22 discharges on or after July first, nineteen hundred ninety-nine through
23 March thirty-first, two thousand and for discharges on or after April
24 first, two thousand through March thirty-first, two thousand five and
25 for discharges on or after April first, two thousand five through March
26 thirty-first, two thousand six, and for discharges on or after April
27 first, two thousand six, for purposes of reimbursement of inpatient
28 hospital services for patients eligible for payments made by state
29 governmental agencies, the average reimbursable inpatient operating cost
30 per discharge of a general hospital shall, to encourage improved produc-
31 tivity and efficiency, be the sum of:
32 § 73. The opening paragraph and subparagraph (i) of paragraph (c) of
33 subdivision 5 of section 2807-c of the public health law, as amended by
34 section 72 of part C of chapter 58 of the laws of 2005, is amended to
35 read as follows:
36 Notwithstanding any inconsistent provision of this section, commencing
37 July first, nineteen hundred ninety-six through March thirty-first,
38 nineteen hundred ninety-nine and July first, nineteen hundred ninety-
39 nine through March thirty-first, two thousand and April first, two thou-
40 sand through March thirty-first, two thousand five and for periods on
41 and after April first, two thousand five through March thirty-first, two
42 thousand six, and for periods on and after April first, two thousand
43 six, rates of payment for a general hospital for patients eligible for
44 payments made by state governmental agencies shall be further reduced by
45 the commissioner to encourage improved productivity and efficiency by
46 providers by a factor determined as follows:
47 (i) an aggregate reduction shall be calculated for each general hospi-
48 tal commencing July first, nineteen hundred ninety-six through March
49 thirty-first, nineteen hundred ninety-nine and July first, nineteen
50 hundred ninety-nine through March thirty-first, two thousand and April
51 first, two thousand through March thirty-first, two thousand five and
52 for periods on and after April first, two thousand five through March
53 thirty-first, two thousand six, and for periods on and after April
54 first, two thousand six, as the result of (A) eighty-nine million
55 dollars on an annualized basis for each year, multiplied by (B) the
56 ratio of patient days for patients eligible for payments made by state
S. 6457 44 A. 9557
1 governmental agencies provided in a base year two years prior to the
2 rate year by a general hospital, divided by the total of such patient
3 days summed for all general hospitals; and
4 § 74. Clause (B-1) of subparagraph (i) of paragraph (f) of subdivision
5 11 of section 2807-c of the public health law, as amended by section 73
6 of part C of chapter 58 of the laws of 2005, is amended to read as
7 follows:
8 (B-1) The increase in the statewide average case mix in the periods
9 January first, nineteen hundred ninety-seven through March thirty-first,
10 two thousand and on and after April first, two thousand through March
11 thirty-first, two thousand six and on and after April first, two thou-
12 sand six, from the statewide average case mix for the period January
13 first, nineteen hundred ninety-six through December thirty-first, nine-
14 teen hundred ninety-six shall not exceed one percent for nineteen
15 hundred ninety-seven, two percent for nineteen hundred ninety-eight,
16 three percent for the period January first, nineteen hundred ninety-nine
17 through September thirtieth, nineteen hundred ninety-nine, four percent
18 for the period October first, nineteen hundred ninety-nine through
19 December thirty-first, nineteen hundred ninety-nine, and four percent
20 for two thousand plus an additional one percent per year thereafter,
21 based on comparison of data only for patients that are eligible for
22 medical assistance pursuant to title eleven of article five of the
23 social services law, including such patients enrolled in health mainte-
24 nance organizations.
25 § 75. Subdivision 1 of section 46 of chapter 639 of the laws of 1996
26 amending the public health law and other laws relating to welfare
27 reform, as amended by section 74 of part C of chapter 58 of the laws of
28 2005, is amended to read as follows:
29 1. Notwithstanding any inconsistent provision of law or regulation to
30 the contrary, the trend factors used to project reimbursable operating
31 costs to the rate period for purposes of determining rates of payment
32 pursuant to article 28 of the public health law for general hospitals
33 for reimbursement of inpatient hospital services provided to patients
34 eligible for payments made by state governmental agencies on and after
35 April 1, 1996 through June 30, 1996 and on or after July 1, 1996 through
36 March 31, 1999 and on and after July 1, 1999 through March 31, 2000 and
37 on and after April 1, 2000 through March 31, 2005 and on and after April
38 1, 2005 through March [thirty-first, two thousand six] 31, 2006 and on
39 and after April 1, 2006, shall reflect no trend factor projections or
40 adjustments for the period April 1, 1996, through March 31, 1997.
41 § 76. Section 4 of chapter 81 of the laws of 1995, amending the public
42 health law and other laws relating to medical reimbursement and welfare
43 reform, as amended by section 54 of part C of chapter 58 of the laws of
44 2005, is amended to read as follows:
45 § 4. Notwithstanding any inconsistent provision of law, except subdi-
46 vision 15 of section 2807 of the public health law and section 364-j-2
47 of the social services law and section 32-g of part F of chapter 412 of
48 the laws of 1999, rates of payment for diagnostic and treatment centers
49 established in accordance with paragraphs (b) and (h) of subdivision 2
50 of section 2807 of the public health law for the period ending September
51 30, 1995 shall continue in effect through September 30, 2000 and for the
52 periods October 1, 2000 through September 30, 2003 and October 1, 2003
53 through September 30, 2006 and on and after October 1, 2006, and further
54 provided that rates in effect on March 31, 2003 as established in
55 accordance with paragraph (e) of subdivision 2 of section 2807 of the
56 public health law shall continue in effect for the period April 1, 2003
S. 6457 45 A. 9557
1 through September 30, 2006 and on and after October 1, 2006, provided
2 however that, subject to the approval of the director of the budget,
3 such rates may be adjusted to include expenditures in those components
4 of rates not subject to the ceilings of the corresponding rate methodol-
5 ogy.
6 § 77. Subdivision 5 of section 246 of chapter 81 of the laws of 1995,
7 amending the public health law and other laws relating to medical
8 reimbursement and welfare reform, as amended by section 55 of part C of
9 chapter 58 of the laws of 2005, is amended to read as follows:
10 5. Section three of this act shall be deemed to have been in full
11 force and effect on and after April 1, 1995 through March 31, 1999 and
12 on and after July 1, 1999 through March 31, 2000 and on and after April
13 1, 2000 through March 31, 2003 and on and after April 1, 2003 through
14 March 31, 2006 and on and after April 1, 2006;
15 § 78. Section 194 of chapter 474 of the laws of 1996, amending the
16 education law and other laws relating to rates for residential health
17 care facilities, as amended by section 56 of part C of chapter 58 of the
18 laws of 2005, is amended to read as follows:
19 § 194. 1. Notwithstanding any inconsistent provision of law or regu-
20 lation, the trend factors used to project reimbursable operating costs
21 to the rate period for purposes of determining rates of payment pursuant
22 to article 28 of the public health law for residential health care
23 facilities for reimbursement of inpatient services provided to patients
24 eligible for payments made by state governmental agencies on and after
25 April 1, 1996 through March 31, 1999 and for payments made on and after
26 July 1, 1999 through March 31, 2000 and on and after April 1, 2000
27 through March 31, 2003 and on and after April 1, 2003 through March 31,
28 2006 and on and after April 1, 2006 shall reflect no trend factor
29 projections or adjustments for the period April 1, 1996, through March
30 31, 1997.
31 2. The commissioner of health shall adjust such rates of payment to
32 reflect the exclusion pursuant to this section of such specified trend
33 factor projections or adjustments.
34 § 79. The opening paragraph and paragraph (a) of subdivision 16 of
35 section 2808 of the public health law, as amended by section 57 of part
36 C of chapter 58 of the laws of 2005, are amended to read as follows:
37 Notwithstanding any inconsistent provision of law or regulation to the
38 contrary, residential health care facility rates of payment determined
39 pursuant to this article for governmental agencies for services provided
40 on or after April first, nineteen hundred ninety-six through March thir-
41 ty-first, nineteen hundred ninety-nine and on or after July first, nine-
42 teen hundred ninety-nine through March thirty-first, two thousand and on
43 and after April first, two thousand through March thirty-first, two
44 thousand three and on and after April first, two thousand three through
45 March thirty-first, two thousand six and on and after April first, two
46 thousand six, shall be further reduced by the commissioner to encourage
47 improved productivity and efficiency by providers by a factor determined
48 as follows:
49 (a) an aggregate reduction shall be calculated for each residential
50 health care facility commencing April first, nineteen hundred ninety-six
51 through March thirty-first, nineteen hundred ninety-nine and on or after
52 July first, nineteen hundred ninety-nine through March thirty-first, two
53 thousand and on and after April first, two thousand through March thir-
54 ty-first, two thousand three and on and after April first, two thousand
55 three through March thirty-first, two thousand six and on and after
56 April first, two thousand six as the result of (i) fifty-six million
S. 6457 46 A. 9557
1 dollars on an annualized basis multiplied by (ii) the ratio of patient
2 days for patients eligible for payments made by governmental agencies
3 provided in a base year two years prior to the rate year by a residen-
4 tial health care facility, or for residential health care facility beds
5 not fully in operation in such base year by an estimate of projected
6 utilization for the rate year, divided by the total of such patient days
7 summed for all residential health care facilities; and
8 § 80. Paragraph (a) of subdivision 14 of section 2808 of the public
9 health law, as amended by section 58 of part C of chapter 58 of the laws
10 of 2005, is amended to read as follows:
11 (a) Notwithstanding any inconsistent provision of law or regulation to
12 the contrary, for purposes of establishing rates of payment by govern-
13 mental agencies for residential health care facilities for services
14 provided on or after April first, nineteen hundred ninety-five through
15 March thirty-first, nineteen hundred ninety-nine and for services
16 provided on or after July first, nineteen hundred ninety-nine through
17 March thirty-first, two thousand and on and after April first, two thou-
18 sand through March thirty-first, two thousand three and on and after
19 April first, two thousand three through March thirty-first, two thousand
20 six and on and after April first, two thousand six, the reimbursable
21 base year administrative services and fiscal services costs, as defined
22 in the New York state residential health care facility accounting and
23 reporting manual, of a residential health care facility, excluding a
24 provider of services reimbursed on an initial budget basis, shall,
25 except as otherwise provided in this subdivision, not exceed the state-
26 wide average of total reimbursable base year administrative and fiscal
27 services costs of residential health care facilities. For the purposes
28 of this subdivision, reimbursable base year administrative and fiscal
29 services costs shall mean those base year administrative and fiscal
30 services costs remaining after application of all other efficiency stan-
31 dards, including but not limited to, peer group cost ceilings or guide-
32 lines.
33 § 81. Paragraph (b) of subdivision 14 of section 2808 of the public
34 health law, as amended by section 59 of part C of chapter 58 of the laws
35 of 2005, is amended to read as follows:
36 (b) A separate statewide average of total reimbursable base year
37 administrative and fiscal services costs shall be determined for each of
38 those facilities wherein eighty percent or more of its patients are
39 classified with a patient acuity equal to or less than .83 which is used
40 as the basis for a facility's case mix adjustment. For the period July
41 first, two thousand through March thirty-first, two thousand one, the
42 total reimbursable base year administrative and fiscal services costs of
43 such facilities shall not exceed such separate statewide average plus
44 one and one-half percentage points. For annual periods thereafter
45 [through March thirty-first, two thousand six], the total reimbursable
46 base year administrative and fiscal services costs of such facilities
47 shall not exceed such separate statewide average. In no event shall the
48 calculation of such separate statewide average result in a change in the
49 statewide average determined under paragraph (a) of this subdivision.
50 § 82. Paragraph (f) of subdivision 1 of section 64 of chapter 81 of
51 the laws of 1995, amending the public health law and other laws relating
52 to medical reimbursement and welfare reform, as amended by section 60 of
53 part C of chapter 58 of the laws of 2005, is amended to read as follows:
54 (f) Prior to February 1, 2001, February 1, 2002, February 1, 2003,
55 February 1, 2004, February 1, 2005 [and], February 1, 2006, and February
56 1 of each year thereafter, the commissioner of health shall calculate
S. 6457 47 A. 9557
1 the result of the statewide total of residential health care facility
2 days of care provided to beneficiaries of title XVIII of the federal
3 social security act (medicare), divided by the sum of such days of care
4 plus days of care provided to residents eligible for payments pursuant
5 to title 11 of article 5 of the social services law minus the number of
6 days provided to residents receiving hospice care, expressed as a
7 percentage, for the period commencing January 1, through November 30, of
8 the prior year respectively, based on such data for such period. This
9 value shall be called the 2000, 2001, 2002, 2003, 2004, 2005 and 2006
10 each year thereafter statewide target percentage respectively.
11 § 83. Subparagraph (ii) of paragraph (b) of subdivision 3 of section
12 64 of chapter 81 of the laws of 1995, amending the public health law and
13 other laws relating to medical reimbursement and welfare reform, as
14 amended by section 61 of part C of chapter 58 of the laws of 2005, is
15 amended to read as follows:
16 (ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and]
17 2006, and each year thereafter statewide target percentages are not for
18 each year at least three percentage points higher than the statewide
19 base percentage, the commissioner of health shall determine the percent-
20 age by which the statewide target percentage for each year is not at
21 least three percentage points higher than the statewide base percentage.
22 The percentage calculated pursuant to this paragraph shall be called the
23 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each
24 year thereafter statewide reduction percentage respectively. If the
25 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each
26 year thereafter statewide target percentage for the respective year is
27 at least three percentage points higher than the statewide base percent-
28 age, the statewide reduction percentage for the respective year shall be
29 zero.
30 § 84. Subparagraph (iii) of paragraph (b) of subdivision 4 of section
31 64 of chapter 81 of the laws of 1995, amending the public health law and
32 other laws relating to medical reimbursement and welfare reform, as
33 amended by section 62 of part C of chapter 58 of the laws of 2005, is
34 amended to read as follows:
35 (iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and
36 each year thereafter statewide reduction percentage shall be multiplied
37 by one hundred two million dollars respectively to determine the 1998,
38 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each year thereafter
39 statewide aggregate reduction amount. If the 1998 and the 2000, 2001,
40 2002, 2003, 2004, 2005, [and] 2006, and each year thereafter statewide
41 reduction percentage shall be zero respectively, there shall be no 1998,
42 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each year thereafter
43 reduction amount.
44 § 85. Paragraph (b) of subdivision 5 of section 64 of chapter 81 of
45 the laws of 1995, amending the public health law and other laws relating
46 to medical reimbursement and welfare reform, as amended by section 63 of
47 part C of chapter 58 of the laws of 2005, is amended to read as follows:
48 (b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
49 [and] 2006, and each year thereafter statewide aggregate reduction
50 amounts shall for each year be allocated by the commissioner of health
51 among residential health care facilities that are eligible to provide
52 services to beneficiaries of title XVIII of the federal social security
53 act (medicare) and residents eligible for payments pursuant to title 11
54 of article 5 of the social services law on the basis of the extent of
55 each facility's failure to achieve a two percentage points increase in
56 the 1996 target percentage, a three percentage point increase in the
S. 6457 48 A. 9557
1 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each
2 year thereafter target percentage and a two and one-quarter percentage
3 point increase in the 1999 target percentage for each year, compared to
4 the base percentage, calculated on a facility specific basis for this
5 purpose, compared to the statewide total of the extent of each facili-
6 ty's failure to achieve a two percentage points increase in the 1996 and
7 a three percentage point increase in the 1997 and a three percentage
8 point increase in the 1998 and a two and one-quarter percentage point
9 increase in the 1999 target percentage and a three percentage point
10 increase in the 2000, 2001, 2002, 2003, 2004, 2005, [and] 2006, and each
11 year thereafter target percentage compared to the base percentage. These
12 amounts shall be called the 1996, 1997, 1998, 1999, 2000, 2001, 2002,
13 2003, 2004, 2005, [and] 2006, and each year thereafter facility specific
14 reduction amounts respectively.
15 § 86. Notwithstanding any inconsistent provision of law, rule or regu-
16 lation, the annual percentage reductions set forth in sections 82
17 through 85 and section 88 of this act shall be prorated by the commis-
18 sioner of health for the period April 1, 2006 through March 31, 2007 and
19 each respective year thereafter.
20 § 87. Section 3 of chapter 483 of the laws of 1978, amending the
21 public health law relating to rate of payment for each residential
22 health care facility to real property costs, as amended by section 75 of
23 part C of chapter 58 of the laws of 2005, is amended to read as follows:
24 § 3. This act shall take effect immediately provided, however, that
25 the provisions of subdivision 2-a of section 2808 of the public health
26 law, as added by section one of this act, shall remain in full force and
27 effect until December 31, 2006 and on and after January 1, 2007.
28 § 88. Section 228 of chapter 474 of the laws of 1996, amending the
29 education law and other laws relating to rates for residential health-
30 care facilities, as amended by section 66 of part C of chapter 58 of the
31 laws of 2005, is amended to read as follows:
32 § 228. 1. Definitions. (a) Regions, for purposes of this section,
33 shall mean a downstate region to consist of Kings, New York, Richmond,
34 Queens, Bronx, Nassau and Suffolk counties and an upstate region to
35 consist of all other New York state counties. A certified home health
36 agency or long term home health care program shall be located in the
37 same county utilized by the commissioner of health for the establishment
38 of rates pursuant to article 36 of the public health law.
39 (b) Certified home health agency (CHHA) shall mean such term as
40 defined in section 3602 of the public health law.
41 (c) Long term home health care program (LTHHCP) shall mean such term
42 as defined in subdivision 8 of section 3602 of the public health law.
43 (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
44 ly, located within a region.
45 (e) Medicaid revenue percentage, for purposes of this section, shall
46 mean CHHA and LTHHCP revenues attributable to services provided to
47 persons eligible for payments pursuant to title 11 of article 5 of the
48 social services law divided by such revenues plus CHHA and LTHHCP reven-
49 ues attributable to services provided to beneficiaries of Title XVIII of
50 the federal social security act (medicare).
51 (f) Base period, for purposes of this section, shall mean calendar
52 year 1995.
53 (g) Target period. For purposes of this section, the 1996 target peri-
54 od shall mean August 1, 1996 through March 31, 1997, the 1997 target
55 period shall mean January 1, 1997 through November 30, 1997, the 1998
56 target period shall mean January 1, 1998 through November 30, 1998, the
S. 6457 49 A. 9557
1 1999 target period shall mean January 1, 1999 through November 30, 1999,
2 the 2000 target period shall mean January 1, 2000 through November 30,
3 2000, the 2001 target period shall mean January 1, 2001 through November
4 30, 2001, the 2002 target period shall mean January 1, 2002 through
5 November 30, 2002, the 2003 target period shall mean January 1, 2003
6 through November 30, 2003, the 2004 target period shall mean January 1,
7 2004 through November 30, 2004, and the 2005 target period shall mean
8 January 1, 2005 through November 30, [2006] 2005, the 2006 target period
9 shall mean January 1, 2006 through November 30, 2006, and each year
10 thereafter the target period shall be January 1 through November 30, for
11 that respective year.
12 2. (a) Prior to February 1, 1997, for each regional group the commis-
13 sioner of health shall calculate the 1996 medicaid revenue percentages
14 for the period commencing August 1, 1996 to the last date for which such
15 data is available and reasonably accurate.
16 (b) Prior to February 1, 1998, prior to February 1, 1999, prior to
17 February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
18 prior to February 1, 2003, prior to February 1, 2004, prior to February
19 1, 2005, prior to February 1, 2006, and prior to February 1 of each year
20 thereafter for each regional group the commissioner of health shall
21 calculate the prior year's medicaid revenue percentages for the period
22 commencing January 1 through November 30 of such prior year.
23 3. By September 15, 1996, for each regional group the commissioner of
24 health shall calculate the base period medicaid revenue percentage.
25 4. (a) For each regional group, the 1996 target medicaid revenue
26 percentage shall be calculated by subtracting the 1996 medicaid revenue
27 reduction percentages from the base period medicaid revenue percentages.
28 The 1996 medicaid revenue reduction percentage, taking into account
29 regional and program differences in utilization of medicaid and medicare
30 services, for the following regional groups shall be equal to:
31 (i) one and one-tenth percentage points for CHHAs located within the
32 downstate region;
33 (ii) six-tenths of one percentage point for CHHAs located within the
34 upstate region;
35 (iii) one and eight-tenths percentage points for LTHHCPs located with-
36 in the downstate region; and
37 (iv) one and seven-tenths percentage points for LTHHCPs located within
38 the upstate region.
39 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006,
40 and each year thereafter for each regional group, the target medicaid
41 revenue percentage for the respective year shall be calculated by
42 subtracting the respective year's medicaid revenue reduction percentage
43 from the base period medicaid revenue percentage. The medicaid revenue
44 reduction percentages for 1997, 1998, 2000, 2001, 2002, 2003, 2004,
45 2005, [and] 2006, and each year thereafter taking into account regional
46 and program differences in utilization of medicaid and medicare
47 services, for the following regional groups shall be equal to for each
48 such year:
49 (i) one and one-tenth percentage points for CHHAs located within the
50 downstate region;
51 (ii) six-tenths of one percentage point for CHHAs located within the
52 upstate region;
53 (iii) one and eight-tenths percentage points for LTHHCPs located with-
54 in the downstate region; and
55 (iv) one and seven-tenths percentage points for LTHHCPs located within
56 the upstate region.
S. 6457 50 A. 9557
1 (c) For each regional group, the 1999 target medicaid revenue percent-
2 age shall be calculated by subtracting the 1999 medicaid revenue
3 reduction percentage from the base period medicaid revenue percentage.
4 The 1999 medicaid revenue reduction percentages, taking into account
5 regional and program differences in utilization of medicaid and medicare
6 services, for the following regional groups shall be equal to:
7 (i) eight hundred twenty-five thousandths (.825) of one percentage
8 point for CHHAs located within the downstate region;
9 (ii) forty-five hundredths (.45) of one percentage point for CHHAs
10 located within the upstate region;
11 (iii) one and thirty-five hundredths percentage points (1.35) for
12 LTHHCPs located within the downstate region; and
13 (iv) one and two hundred seventy-five thousandths percentage points
14 (1.275) for LTHHCPs located within the upstate region.
15 5. (a) For each regional group, if the 1996 medicaid revenue percent-
16 age is not equal to or less than the 1996 target medicaid revenue
17 percentage, the commissioner of health shall compare the 1996 medicaid
18 revenue percentage to the 1996 target medicaid revenue percentage to
19 determine the amount of the shortfall which, when divided by the 1996
20 medicaid revenue reduction percentage, shall be called the 1996
21 reduction factor. These amounts, expressed as a percentage, shall not
22 exceed one hundred percent. If the 1996 medicaid revenue percentage is
23 equal to or less than the 1996 target medicaid revenue percentage, the
24 1996 reduction factor shall be zero.
25 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and],
26 2006, and each year thereafter for each regional group, if the medicaid
27 revenue percentage for the respective year is not equal to or less than
28 the target medicaid revenue percentage for such respective year, the
29 commissioner of health shall compare such respective year's medicaid
30 revenue percentage to such respective year's target medicaid revenue
31 percentage to determine the amount of the shortfall which, when divided
32 by the respective year's medicaid revenue reduction percentage, shall be
33 called the reduction factor for such respective year. These amounts,
34 expressed as a percentage, shall not exceed one hundred percent. If the
35 medicaid revenue percentage for a particular year is equal to or less
36 than the target medicaid revenue percentage for that year, the reduction
37 factor for that year shall be zero.
38 6. (a) For each regional group, the 1996 reduction factor shall be
39 multiplied by the following amounts to determine each regional group's
40 applicable 1996 state share reduction amount:
41 (i) two million three hundred ninety thousand dollars ($2,390,000) for
42 CHHAs located within the downstate region;
43 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
44 within the upstate region;
45 (iii) one million two hundred seventy thousand dollars ($1,270,000)
46 for LTHHCPs located within the downstate region; and
47 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
48 located within the upstate region.
49 For each regional group reduction, if the 1996 reduction factor shall
50 be zero, there shall be no 1996 state share reduction amount.
51 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006,
52 and each year thereafter for each regional group, the reduction factor
53 for the respective year shall be multiplied by the following amounts to
54 determine each regional group's applicable state share reduction amount
55 for such respective year:
S. 6457 51 A. 9557
1 (i) two million three hundred ninety thousand dollars ($2,390,000) for
2 CHHAs located within the downstate region;
3 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
4 within the upstate region;
5 (iii) one million two hundred seventy thousand dollars ($1,270,000)
6 for LTHHCPs located within the downstate region; and
7 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
8 located within the upstate region.
9 For each regional group reduction, if the reduction factor for a
10 particular year shall be zero, there shall be no state share reduction
11 amount for such year.
12 (c) For each regional group, the 1999 reduction factor shall be multi-
13 plied by the following amounts to determine each regional group's appli-
14 cable 1999 state share reduction amount:
15 (i) one million seven hundred ninety-two thousand five hundred dollars
16 ($1,792,500) for CHHAs located within the downstate region;
17 (ii) five hundred sixty-two thousand five hundred dollars ($562,500)
18 for CHHAs located within the upstate region;
19 (iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
20 for LTHHCPs located within the downstate region; and
21 (iv) four hundred forty-two thousand five hundred dollars ($442,500)
22 for LTHHCPs located within the upstate region.
23 For each regional group reduction, if the 1999 reduction factor shall
24 be zero, there shall be no 1999 state share reduction amount.
25 7. (a) For each regional group, the 1996 state share reduction amount
26 shall be allocated by the commissioner of health among CHHAs and LTHHCPs
27 on the basis of the extent of each CHHA's and LTHHCP's failure to
28 achieve the 1996 target medicaid revenue percentage, calculated on a
29 provider specific basis utilizing revenues for this purpose, expressed
30 as a proportion of the total of each CHHA's and LTHHCP's failure to
31 achieve the 1996 target medicaid revenue percentage within the applica-
32 ble regional group. This proportion shall be multiplied by the applica-
33 ble 1996 state share reduction amount calculation pursuant to paragraph
34 (a) of subdivision 6 of this section. This amount shall be called the
35 1996 provider specific state share reduction amount.
36 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and],
37 2006, and each year thereafter for each regional group, the state share
38 reduction amount for the respective year shall be allocated by the
39 commissioner of health among CHHAs and LTHHCPs on the basis of the
40 extent of each CHHA's and LTHHCP's failure to achieve the target medi-
41 caid revenue percentage for the applicable year, calculated on a provid-
42 er specific basis utilizing revenues for this purpose, expressed as a
43 proportion of the total of each CHHA's and LTHHCP's failure to achieve
44 the target medicaid revenue percentage for the applicable year within
45 the applicable regional group. This proportion shall be multiplied by
46 the applicable year's state share reduction amount calculation pursuant
47 to paragraph (b) or (c) of subdivision 6 of this section. This amount
48 shall be called the provider specific state share reduction amount for
49 the applicable year.
50 8. (a) The 1996 provider specific state share reduction amount shall
51 be due to the state from each CHHA and LTHHCP and may be recouped by the
52 state by March 31, 1997 in a lump sum amount or amounts from payments
53 due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
54 social services law.
55 (b) The provider specific state share reduction amount for 1997, 1998,
56 1999, 2000, 2001, 2002, 2003, 2004, 2005 [and], 2006, and each year
S. 6457 52 A. 9557
1 thereafter respectively, shall be due to the state from each CHHA and
2 LTHHCP and each year the amount due for such year may be recouped by the
3 state by March 31 of the following year in a lump sum amount or amounts
4 from payments due to the CHHA and LTHHCP pursuant to title 11 of article
5 5 of the social services law.
6 9. CHHAs and LTHHCPs shall submit such data and information at such
7 times as the commissioner of health may require for purposes of this
8 section. The commissioner of health may use data available from third-
9 party payors.
10 10. On or about June 1, 1997, for each regional group the commissioner
11 of health shall calculate for the period August 1, 1996 through March
12 31, 1997 a medicaid revenue percentage, a reduction factor, a state
13 share reduction amount, and a provider specific state share reduction
14 amount in accordance with the methodology provided in paragraph (a) of
15 subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
16 sion 6 and paragraph (a) of subdivision 7 of this section. The provider
17 specific state share reduction amount calculated in accordance with this
18 subdivision shall be compared to the 1996 provider specific state share
19 reduction amount calculated in accordance with paragraph (a) of subdivi-
20 sion 7 of this section. Any amount in excess of the amount determined in
21 accordance with paragraph (a) of subdivision 7 of this section shall be
22 due to the state from each CHHA and LTHHCP and may be recouped in
23 accordance with paragraph (a) of subdivision 8 of this section. If the
24 amount is less than the amount determined in accordance with paragraph
25 (a) of subdivision 7 of this section, the difference shall be refunded
26 to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
27 and LTHHCPs shall submit data for the period August 1, 1996 through
28 March 31, 1997 to the commissioner of health by April 15, 1997.
29 11. If a CHHA or LTHHCP fails to submit data and information as
30 required for purposes of this section:
31 (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
32 caid revenue percentage between the applicable base period and the
33 applicable target period for purposes of the calculations pursuant to
34 this section; and
35 (b) the commissioner of health shall reduce the current rate paid to
36 such CHHA and such LTHHCP by state governmental agencies pursuant to
37 article 36 of the public health law by one percent for a period begin-
38 ning on the first day of the calendar month following the applicable due
39 date as established by the commissioner of health and continuing until
40 the last day of the calendar month in which the required data and infor-
41 mation are submitted.
42 12. The commissioner of health shall inform in writing the director of
43 the budget and the chair of the senate finance committee and the chair
44 of the assembly ways and means committee of the results of the calcu-
45 lations pursuant to this section.
46 § 89. Subdivision 5-a of section 246 of chapter 81 of the laws of
47 1995, amending the public health law and other laws relating to medical
48 reimbursement and welfare reform, as amended by section 64 of part C of
49 chapter 58 of the laws of 2005, is amended to read as follows:
50 [5-a. Section sixty-four-a of this act shall be deemed to have been in
51 full force and effect on and after April 1, 1995 through March 31, 1999
52 and on and after July 1, 1999 through March 31, 2000 and on and after
53 April 1, 2000 through March 31, 2003 and on and after April 1, 2003
54 through March 31, 2006;]
55 § 90. Section 64-b of chapter 81 of the laws of 1995, amending the
56 public health law and other laws relating to medical reimbursement and
S. 6457 53 A. 9557
1 welfare reform, as amended by section 65 of part C of chapter 58 of the
2 laws of 2005, is amended to read as follows:
3 [§ 64-b. Notwithstanding any inconsistent provision of law, the
4 provisions of subdivision 7 of section 3614 of the public health law, as
5 amended, shall remain and be in full force and effect on April 1, 1995
6 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
7 and after April 1, 2000 through March 31, 2003 and on and after April 1,
8 2003 through March 31, 2006.]
9 § 91. Subdivision 7-a of section 3614 of the public health law, as
10 added by section 28 of part C of chapter 58 of the laws of 2005, is
11 amended to read as follows:
12 7-a. Notwithstanding any inconsistent provision of law or regulation,
13 for the purposes of establishing rates of payment by governmental agen-
14 cies for long term home health care programs for the period April first,
15 two thousand five, through December thirty-first, two thousand five, and
16 for the period January first, two thousand six through March thirty-
17 first, two thousand six, and on and after April first, two thousand six,
18 the reimbursable base year administrative and general costs of a provid-
19 er of services shall not exceed the statewide average of total reimburs-
20 able base year administrative and general costs of such providers of
21 services.
22 No such limit shall be applied to a provider of services reimbursed on
23 an initial budget basis, or a new provider, excluding changes in owner-
24 ship or changes in name, who begins operations in the year prior to the
25 year which is used as a base year in determining rates of payment.
26 For the purposes of this subdivision, reimbursable base year opera-
27 tional costs shall mean those base year operational costs remaining
28 after application of all other efficiency standards, including, but not
29 limited to, cost guidelines.
30 The limitation on reimbursement for provider administrative and gener-
31 al expenses provided by this subdivision shall be expressed as a
32 percentage reduction for the rate promulgated by the commissioner to
33 each long term home health care program provider.
34 § 92. Section 10 of chapter 649 of the laws of 1996 amending the
35 public health law, the mental hygiene law and the social services law
36 relating to authorizing the establishment of special needs plans, as
37 amended by section 41 of part Z2 of chapter 62 of the laws of 2003, is
38 amended to read as follows:
39 § 10. This act shall take effect immediately and shall be deemed to
40 have been in full force and effect on and after July 1, 1996; provided,
41 however, that sections one, two and three of this act shall expire and
42 be deemed repealed on March 31, [2006] 2009 provided, however that the
43 amendments to section 364-j of the social services law made by section
44 four of this act shall not affect the expiration of such section and
45 shall be deemed to expire therewith and provided, further, that the
46 provisions of subdivisions 8, 9 and 10 of section 4401 of the public
47 health law, as added by section one of this act; section 4403-d of the
48 public health law as added by section two of this act and the provisions
49 of section seven of this act, except for the provisions relating to the
50 establishment of no more than twelve comprehensive HIV special needs
51 plans, shall expire and be deemed repealed on July 1, 2000.
52 § 93. Section 11 of chapter 710 of the laws of 1988, amending the
53 social services law and the education law relating to medical assistance
54 eligibility of certain persons and providing for managed medical care
55 demonstration programs, as amended by section 42 of part Z2 of chapter
56 62 of the laws of 2003, is amended to read as follows:
S. 6457 54 A. 9557
1 § 11. This act shall take effect immediately; except that the
2 provisions of sections one, two, three, four, eight and ten of this act
3 shall take effect on the ninetieth day after it shall have become a law;
4 and except that the provisions of sections five, six and seven of this
5 act shall take effect January 1, 1989; and except that effective imme-
6 diately, the addition, amendment and/or repeal of any rule or regulation
7 necessary for the implementation of this act on its effective date are
8 authorized and directed to be made and completed on or before such
9 effective date; [provided, however, that the provisions of section 364-j
10 of the social services law, as added by section one of this act shall
11 expire and be deemed repealed on and after March 31, 2006,] the
12 provisions of section 364-k of the social services law, as added by
13 section two of this act, except subdivision 10 of such section, shall
14 expire and be deemed repealed on and after January 1, 1994, and the
15 provisions of subdivision 10 of section 364-k of the social services
16 law, as added by section two of this act, shall expire and be deemed
17 repealed on January 1, 1995.
18 § 94. Subdivision (c) of section 62 of chapter 165 of the laws of
19 1991, amending the public health law and other laws relating to estab-
20 lishing payments for medical assistance, as amended by section 43 of
21 part Z2 of chapter 62 of the laws of 2003, is amended to read as
22 follows:
23 (c) [section 364-j of the social services law, as amended by section
24 eight of this act and subdivision 6 of section 367-a of the social
25 services law as added by section twelve of this act shall expire and be
26 deemed repealed on March 31 2006 and provided further, that] the amend-
27 ments to the provisions of [such] section 364-j of the social services
28 law shall only apply to managed care programs approved on or after the
29 effective date of this act;
30 § 95. Subdivision (x) of section 165 of chapter 41 of the laws of 1992
31 amending the public health law and other laws relating to assessing
32 certain healthcare providers is REPEALED.
33 § 96. Section 4 of chapter 19 of the laws of 1998, amending the social
34 services law relating to limiting the method of payment for prescription
35 drugs under the medical assistance program, as amended by section 46 of
36 part Z2 of chapter 62 of the laws of 2003, is amended to read as
37 follows:
38 § 4. This act shall take effect 120 days after it shall have become a
39 law and shall expire and be deemed repealed March 31, [2006] 2009.
40 § 97. Section 97 of chapter 659 of the laws of 1997, amending the
41 public health law and other laws relating to creation of continuing care
42 retirement communities is amended to read as follows:
43 § 97. This act shall take effect immediately, provided, however, that
44 the amendments to subdivision 4 of section 854 of the general municipal
45 law made by section seventy of this act shall not affect the expiration
46 of such subdivision and shall be deemed to expire therewith and provided
47 further that sections sixty-seven and sixty-eight of this act shall
48 apply to taxable years beginning on or after January 1, 1998 and
49 provided further that sections eighty-one [through], eighty-two, eight-
50 y-four, eighty-five, eighty-six and eighty-seven of this act shall
51 expire and be deemed repealed on December 31, [2006] 2009 and provided
52 further that the amendments made by section eighty-three of this act
53 shall expire and be deemed repealed on April 1, 2006 and provided
54 further, however, that the amendments to section ninety of this act
55 shall take effect January 1, 1998 and shall apply to all policies,
56 contracts, certificates, riders or other evidences of coverage of long
S. 6457 55 A. 9557
1 term care insurance issued, renewed, altered or modified pursuant to
2 section 3229 of the insurance law on or after such date.
3 § 98. Section 18 of chapter 904 of the laws of 1984, amending the
4 public health law and the social services law relating to encouraging
5 comprehensive health services, as amended by chapter 69 of the laws of
6 2004, is amended to read as follows:
7 § 18. This act shall take effect immediately, except that sections
8 six, nine, ten and eleven of this act shall take effect on the sixtieth
9 day after it shall have become a law, [sections two, three, four and
10 nine of this act shall expire and be of no further force or effect on or
11 after March 31, 2006,] section two of this act shall take effect on
12 April 1, 1985 or seventy-five days following the submission of the
13 report required by section one of this act, whichever is later, and
14 sections eleven and thirteen of this act shall expire and be of no
15 further force or effect on or after March 31, 1988.
16 § 99. The commissioner of health is authorized to promulgate or adopt
17 any rules or regulations necessary to implement the provisions of this
18 act and any procedures, forms, or instructions necessary for such imple-
19 mentation may be adopted and issued on or after the effective date of
20 this act. Notwithstanding any inconsistent provision of the state admin-
21 istrative procedure act or any other provision of law, rule or regu-
22 lation the commissioner of health and the superintendent of insurance
23 and any appropriate council is authorized to adopt or amend or promul-
24 gate on an emergency basis any regulation he or she or such council
25 determines necessary to implement any provision of this act on its
26 effective date.
27 § 100. If any clause, sentence, paragraph, section or part of this act
28 shall be adjudged by any court of competent jurisdiction to be invalid,
29 such judgment shall not affect, impair, or invalidate the remainder
30 thereof, but shall be confined in its operation to the clause, sentence,
31 paragraph, subdivision, section or part thereof directly involved in the
32 controversy in which such judgment shall have been rendered. It is here-
33 by declared to be the intent of the legislature that this act would have
34 been enacted even if such invalid provisions had not been included ther-
35 ein.
36 § 101. This act shall take effect immediately and shall be deemed to
37 have been in full force and effect on and after April 1, 2006; provided
38 however, that:
39 1. In the event any provision of law relating to cost containment set
40 forth in section three of this act is repealed or amended in such manner
41 as is deemed by the director of budget to negate the efficacy of such
42 provisions set forth therein, the provisions of section two of this act
43 shall be deemed repealed; upon the occurrence of the contingency set
44 forth above, the director of budget shall notify the legislative bill
45 drafting commission upon the occurrence of the enactment of the legis-
46 lation provided for in section three of this act in order that the
47 commission may maintain an accurate and timely effective data base of
48 the official text of the laws of the state of New York in furtherance of
49 effecting the provisions of section 44 of the legislative law and
50 section 70-b of the public officers law.
51 2. Section one of this act shall take effect July 1, 2006;
52 3. Section thirty-nine of this act shall take effect January 1, 2007;
53 4. Sections five through twenty-two of this act shall take effect
54 November 1, 2006;
55 5. Section thirty-one of this act shall take effect July 1, 2006;
S. 6457 56 A. 9557
1 6. Section forty-three of this act shall take effect October 1, 2006
2 and shall remain in full force and effect until December 31, 2009;
3 7. Sections fifty-three through fifty-seven of this act shall take
4 effect July 1, 2007;
5 8. Sections forty-nine through fifty-one of this act shall not take
6 effect unless and until the commissioner of health receives all neces-
7 sary approvals under federal law and regulation to implement its
8 provisions, and provided that such provisions do not prevent the receipt
9 of federal financial participation under the medical assistance program.
10 The commissioner of health shall submit such waiver applications and/or
11 state plan amendments as may be necessary to obtain such approvals and
12 to ensure continued federal financial participation;
13 9. No section of this act shall be required to be implemented sooner
14 than sixty days following receipt of all waivers and approvals necessary
15 under federal law and regulation to implement the provisions of this act
16 with federal financial participation; the commissioner of health shall
17 submit such waiver applications and/or state plan amendments as may be
18 necessary to obtain such approvals and to ensure continued federal
19 financial participation;
20 10. The amendments to paragraphs (b) and (c) of subdivision 3 of
21 section 273 of the public health law made by section twenty-four of this
22 act shall not affect the repeal of such section and shall be deemed
23 repealed therewith;
24 11. The amendments to section 274 of the public health law made by
25 sections twenty-five, twenty-seven and twenty-eight of this act shall
26 not affect the repeal of such section and shall be deemed repealed ther-
27 ewith;
28 12. The amendments to subdivisions 7, 8 and 9 of section 272 of the
29 public health law made by section twenty-six of this act shall not
30 affect the repeal of such section and shall be deemed repealed there-
31 with;
32 13. The amendments to subdivision 9 of section 367-a of the social
33 services law made by section thirty-one of this act shall not affect the
34 repeal of such subdivision and shall be deemed repealed therewith;
35 14. The amendments to paragraphs (f) and (k) of subdivision 4 of
36 section 2807-c of the public health law made by sections seventy and
37 seventy-one of this act shall not affect the expiration of such para-
38 graphs and shall be deemed to expire therewith;
39 15. The amendments to subparagraph (vi) of paragraph (b) of subdivi-
40 sion 5 of section 2807-c of the public health law made by section seven-
41 ty-two of this act shall not affect the expiration of such subparagraph
42 and shall be deemed to expire therewith; and
43 16. The amendments to paragraph (c) of subdivision 5 of section 2807-c
44 of the public health law made by section seventy-three of this act shall
45 not affect the expiration of such paragraph and shall be deemed to
46 expire therewith.
47 PART B
48 Section 1. Section 3235-a of the insurance law, as added by section 3
49 of part C of chapter 1 of the laws of 2002, is amended to read as
50 follows:
51 § 3235-a. Payment for early intervention services. (a) No policy of
52 accident and health insurance, including contracts issued pursuant to
53 article forty-three of this chapter, shall exclude coverage for other-
54 wise covered services solely on the basis that the services constitute
S. 6457 57 A. 9557
1 early intervention program services under title two-A of article twen-
2 ty-five of the public health law.
3 (b) Where a policy of accident and health insurance, including a
4 contract issued pursuant to article forty-three of this chapter,
5 provides coverage for [an early intervention program service,] the
6 following early intervention program services: evaluation services
7 covered under the policy or contract provided that a written order,
8 referral or recommendation for such evaluation is obtained when such
9 order, referral or recommendation is required pursuant to the education
10 law, nursing services, occupational therapy services, physical therapy
11 services, speech therapy services or other early intervention program
12 health services, such coverage shall not be applied against any maximum
13 annual or lifetime monetary limits set forth in such policy or contract.
14 Visit limitations [and other terms and conditions of the policy] will
15 continue to apply to early intervention program services. However, any
16 visits used for early intervention program services shall not reduce the
17 number of visits otherwise available under the policy or contract for
18 such services.
19 (c) Where a policy of accident and health insurance, including a
20 contract issued pursuant to article forty-three of this chapter,
21 provides coverage for the following early intervention program services:
22 evaluation services covered under the policy or contract provided that a
23 written order, referral or recommendation for such evaluation is
24 obtained when such order, referral or recommendation is required pursu-
25 ant to the education law, nursing services, occupational therapy
26 services, physical therapy services, speech therapy services or other
27 early intervention program health services, a written order, referral or
28 recommendation when required pursuant to the education law, signed by
29 the covered child's pediatrician or other primary care provider, includ-
30 ing where appropriate a speech pathologist acting within the scope of
31 his or her practice, shall be deemed to meet any pre-certification,
32 preauthorization and medical necessity requirements imposed on benefits
33 under the policy.
34 (d) No policy of accident and health insurance, including a contract
35 issued pursuant to article forty-three of this chapter, shall deny
36 coverage for early intervention program services on the following bases:
37 (i) the location where services are provided;
38 (ii) the duration of the child's condition and/or that the child's
39 condition is not amenable to significant improvement within a certain
40 period of time as specified in the policy; or
41 (iii) that the provider of services is not a participating provider in
42 the insurer's network unless the insurer maintains an adequate network
43 of participating providers who are approved under title two-A of article
44 twenty-five of the public health law to deliver early intervention
45 program services; provided however that an insurer shall not deny cover-
46 age on the basis that the provider of service is not a participating
47 provider in the insurer's network where the provider is approved under
48 title two-A of article twenty-five of the public health law and is
49 either a diagnostic and treatment center licensed under article twenty-
50 eight of the public health law which provides, as its principal mission,
51 services to individuals with developmental disabilities or mental retar-
52 dation, or a provider licensed under article sixteen of the mental
53 hygiene law which provides, as its principal mission, services to indi-
54 viduals with developmental disabilities or mental retardation, or a
55 provider approved under section forty-four hundred ten of the education
56 law to provide special education classes and/or special classes in an
S. 6457 58 A. 9557
1 integrated setting in accordance with section forty-four hundred ten of
2 the education law and section 200.16 (h) of title 8 of the New York
3 codes, rules and regulations.
4 (e) Where a policy of accident and health insurance, including a
5 contract issued pursuant to article forty-three of this chapter,
6 provides coverage for the following early intervention program services:
7 evaluation services covered under the policy or contract provided that a
8 written order, referral or recommendation for such evaluation is
9 obtained when such order, referral or recommendation is required pursu-
10 ant to the education law, nursing services, occupational therapy
11 services, speech therapy services, or other early intervention program
12 health services, reimbursement for such services shall be at rates
13 established by the commissioner of health for such services in accord-
14 ance with section 69-4.30 of title 10 of the New York codes, rules and
15 regulations; provided however that where an insurer maintains an
16 adequate network of participating providers who are approved under title
17 two-A of article twenty-five of the public health law to deliver such
18 early intervention program services and has negotiated rates of payment
19 with the providers of such services, then reimbursement shall be at such
20 negotiated rates; provided further that where the provider is approved
21 under title two-A of article twenty-five of the public health law and is
22 either a diagnostic and treatment center licensed under article twenty-
23 eight of the public health law which provides, as its principal mission,
24 services to individuals with developmental disabilities or mental retar-
25 dation, or a provider licensed under article sixteen of the mental
26 hygiene law which provides, as its principal mission, services to indi-
27 viduals with developmental disabilities or mental retardation, or a
28 provider approved under section forty-four hundred ten of the education
29 law to provide special education classes and/or special classes in an
30 integrated setting in accordance with section forty-four hundred ten of
31 the education law and section 200.16 (h) of title 8 of the New York
32 codes, rules and regulations, reimbursement for such early intervention
33 program services shall be at rates established by the commissioner of
34 health for such services in accordance with section 69-4.30 of title 10
35 of the New York codes, rules and regulations. Nothing in this section
36 shall prohibit an insurer from applying any deductible, co-payment or
37 coinsurance as set forth in the policy.
38 [(c)] (f) Any right of subrogation to benefits which a municipality is
39 entitled in accordance with paragraph (d) of subdivision three of
40 section twenty-five hundred fifty-nine of the public health law shall be
41 valid and enforceable to the extent benefits are available under any
42 accident and health insurance policy. The right of subrogation does not
43 attach to insurance benefits paid or provided under any accident and
44 health insurance policy prior to receipt by the insurer of written
45 notice from the municipality. Upon the insurer's receipt of written
46 notice from the municipality, the insurer shall provide the municipality
47 with information on the extent of benefits available to an insured under
48 the policy.
49 [(d)] (g) No insurer, including a health maintenance organization
50 issued a certificate of authority under article forty-four of the public
51 health law and a corporation organized under article forty-three of this
52 chapter, shall refuse to issue an accident and health insurance policy
53 or contract or refuse to renew an accident and health insurance policy
54 or contract solely because the applicant or insured is receiving
55 services under the early intervention program.
S. 6457 59 A. 9557
1 § 2. Subdivision 5 of section 4403 of the public health law, as added
2 by chapter 705 of the laws of 1996, paragraph (a) as amended by chapter
3 586 of the laws of 1998, is amended to read as follows:
4 5. (a) The commissioner, at the time of initial licensure, at least
5 every three years thereafter, and upon application for expansion of
6 service area, shall ensure that the health maintenance organization
7 maintains a network of health care providers adequate to meet the
8 comprehensive health needs of its enrollees and to provide an appropri-
9 ate choice of providers sufficient to provide the services covered under
10 its enrollee's contracts by determining that (i) there are a sufficient
11 number of geographically accessible participating providers; (ii) there
12 are opportunities to select from at least three primary care providers
13 pursuant to travel and distance time standards, providing that such
14 standards account for the conditions of accessing providers in rural
15 areas; (iii) there are sufficient providers in each area of specialty
16 practice to meet the needs of the enrollment population; (iv) there is
17 no exclusion of any appropriately licensed type of provider as a class;
18 and (v) contracts entered into with health care providers neither trans-
19 fer financial risk to providers, in a manner inconsistent with the
20 provisions of paragraph (c) of subdivision one of this section, nor
21 penalize providers for unfavorable case mix so as to jeopardize the
22 quality of or enrollees' appropriate access to medically necessary
23 services; provided, however, that payment at less than prevailing fee
24 for service rates or capitation shall not be deemed or presumed prima
25 facie to jeopardize quality or access.
26 (b) Upon the effective date of a chapter of the laws of two thousand
27 six which amended this subdivision, at the time of every three year
28 review by the commissioner as set forth in paragraph (a) of this subdi-
29 vision, and upon application for expansion of service area, the commis-
30 sioner shall ensure that the health maintenance organization maintains
31 an adequate network of providers who are approved to deliver early
32 intervention program services as set forth under title two-A of article
33 twenty-five of this chapter, by determining that (i) there are a suffi-
34 cient number of geographically accessible participating providers; (ii)
35 there are sufficient providers in each area of specialty of practice to
36 meet the needs of the enrollment population; (iii) there is no exclusion
37 of any appropriately licensed type of providers as a class; and (iv)
38 contracts entered into with health care providers neither transfer
39 financial risk to providers, in a manner inconsistent with the
40 provisions of paragraph (c) of subdivision one of this section, nor
41 penalize providers for unfavorable case mix so as to jeopardize the
42 quality of or enrollee's appropriate access to medically necessary
43 services; provided, however, that payment at less than prevailing fee
44 for service rates or capitation shall not be deemed or presumed prima
45 facie to jeopardize quality or access.
46 (c) The following criteria shall be considered by the commissioner at
47 the time of a review: (i) the availability of appropriate and timely
48 care that is provided in compliance with the standards of the Federal
49 Americans with Disability Act to assure access to health care for the
50 enrollee population; (ii) the network's ability to provide culturally
51 and linguistically competent care to meet the needs of the enrollee
52 population; and (iii) with the exception of initial licensure, the
53 number of grievances filed by enrollees relating to waiting times for
54 appointments, appropriateness of referrals and other indicators of plan
55 capacity.
S. 6457 60 A. 9557
1 [(c)] (d) Each organization shall report on an annual basis the number
2 of enrollees and the number of participating providers in each organiza-
3 tion. Each organization shall further report to the commissioner and to
4 municipalities on a quarterly basis the names of participating providers
5 in the organization's network who are approved to deliver early inter-
6 vention program services.
7 § 3. Section 4406 of the public health law is amended by adding a new
8 subdivision 5 to read as follows:
9 5.(a) No contract shall exclude coverage for otherwise covered
10 services solely on the basis that the services constitute early inter-
11 vention program services under title two-A of article twenty-five of
12 this chapter.
13 (b) Where a contract provides coverage for the following early inter-
14 vention program services: evaluation services covered under the contract
15 provided that a written order, referral or recommendation for such eval-
16 uation is obtained when such order, referral or recommendation is
17 required pursuant to the education law, occupational therapy services,
18 physical therapy services, speech therapy services or other early inter-
19 vention program health services, such coverage shall not be applied
20 against any maximum annual or lifetime monetary limits set forth in such
21 contract. Visit limitations as set forth in the contract will apply to
22 early intervention program services. However, any visits used for early
23 intervention program services shall not reduce the number of visits
24 otherwise available under the contract for such services.
25 (c) Where a contract provides coverage for the following early inter-
26 vention program services: evaluation services covered under the contract
27 provided that a written order, referral or recommendation for such eval-
28 uation is obtained when such order, referral or recommendation is
29 required pursuant to the education law, nursing services, occupational
30 therapy services, physical therapy services, speech therapy services or
31 other early intervention program health services, a written order,
32 referral or recommendation, when required for such service pursuant to
33 the education law, signed by the covered child's pediatrician or other
34 primary care provider, including where appropriate a speech pathologist
35 acting within the scope of his or her practice, shall be deemed to meet
36 any pre-certification, preauthorization and medical necessity require-
37 ments imposed on benefits under the contract.
38 (d) No contract shall deny or permit denial of coverage for early
39 intervention program services on the following bases:
40 (i) the location where services are provided;
41 (ii) the duration of the child's condition and/or that the child's
42 condition is not amenable to significant improvement within a certain
43 period of time as specified in the contract; or
44 (iii) that the provider of services is not a participating provider in
45 the organization's network unless it has been determined, pursuant to
46 subdivision five of section forty-four hundred three of this title, that
47 the organization maintains an adequate network of participating provid-
48 ers who are approved under title two-A of article twenty-five of this
49 chapter to deliver early intervention program services; provided however
50 that an organization shall not deny coverage on the basis that the
51 provider of service is not a participating provider in the organiza-
52 tion's network where the provider is approved under title two-A of arti-
53 cle twenty-five of this chapter and is either a diagnostic and treatment
54 center licensed under article twenty-eight of this chapter which
55 provides, as its principal mission, services to individuals with devel-
56 opmental disabilities or mental retardation, or a provider licensed
S. 6457 61 A. 9557
1 under article sixteen of the mental hygiene law which provides, as its
2 principal mission, services to individuals with developmental disabili-
3 ties or mental retardation, or a provider approved under section forty-
4 four hundred ten of the education law to provide special education
5 classes and/or special classes in an integrated setting in accordance
6 with section forty-four hundred ten of the education law and section
7 200.16 (h) of title 8 of the New York codes, rules and regulations.
8 (e) Where a contract provides coverage for the following early inter-
9 vention program services: evaluation services covered under the contract
10 provided that a written order, referral or recommendation for such eval-
11 uation is obtained when such order, referral or recommendation is
12 required pursuant to the education law, nursing services, occupational
13 therapy services, speech therapy services, or other early intervention
14 program health services, reimbursement for such services shall be at
15 rates established by the commissioner for such services in accordance
16 with section 69-4.30 of title 10 of the New York codes, rules and regu-
17 lations; provided however that where it has been determined, pursuant to
18 subdivision five of section forty-four hundred three of this title, that
19 the organization maintains an adequate network of participating provid-
20 ers who are approved under title two-A of article twenty-five of this
21 chapter to deliver early intervention program services and the organiza-
22 tion has negotiated rates of payment with the providers of such
23 services, then reimbursement shall be at such negotiated rates; provided
24 further that if the provider is approved under title two-A of article
25 twenty-five of this chapter and is either a diagnostic and treatment
26 center licensed under article twenty-eight of this chapter which
27 provides, as its principal mission, services to individuals with devel-
28 opmental disabilities or mental retardation, or a provider licensed
29 under article sixteen of the mental hygiene law which provides, as its
30 principal mission, services to individuals with developmental disabili-
31 ties or mental retardation, or a provider approved under section forty-
32 four hundred ten of the education law to provide special education
33 classes and/or special classes in an integrated setting in accordance
34 with section forty-four hundred ten of the education law and section
35 200.16 (h) of title 8 of the New York codes, rules and regulations,
36 reimbursement for such services shall be at rates established by the
37 commissioner for such services in accordance with section 69-4.30 of
38 title 10 of the New York codes, rules and regulations. Nothing herein
39 shall prohibit an organization from applying any deductible, co-payment
40 or coinsurance as set forth in the contract.
41 (f) Any right of subrogation to benefits which a municipality is enti-
42 tled in accordance with paragraph (d) of subdivision three of section
43 twenty-five hundred fifty-nine of this chapter shall be valid and
44 enforceable to the extent benefits are available under any contract. The
45 right of subrogation does not attach to benefits paid or provided under
46 any contract prior to receipt by the organization of written notice from
47 the municipality. Upon the organization's receipt of written notice from
48 the municipality, the organization shall provide the municipality with
49 information on the extent of benefits available to an enrollee under the
50 contract.
51 (g) No organization shall refuse to issue a contract or refuse to
52 renew a contract solely because the applicant or enrollee is receiving
53 services under the early intervention program.
54 § 4. The public health law is amended by adding a new section 2545-a
55 to read as follows:
S. 6457 62 A. 9557
1 § 2545-a. Use of network providers. 1. When an eligible child has
2 coverage through an insurance policy which maintains an adequate network
3 of participating providers who are approved under this title to deliver
4 such early intervention program services, or a health maintenance organ-
5 ization which has been determined, pursuant to subdivision five of
6 section forty-four hundred three of this chapter, to maintain an
7 adequate network of providers who are approved under this title to
8 deliver early intervention program services, who provide one or more of
9 the covered services set forth in the eligible child's IFSP, the early
10 intervention official shall select and the parent and eligible child
11 shall use a provider within the insurer's or health maintenance organ-
12 ization's network for the provision of services, but only to the extent
13 that:
14 (a) the network provider is available to receive the referral and to
15 begin providing services to the eligible child as set forth in the
16 eligible child's IFSP; and
17 (b) the network provider has received approval under this title to
18 provide early intervention program services and is under contract with
19 the municipality responsible for payment of the eligible child's early
20 intervention services when third party payment is not available or has
21 been exhausted.
22 2. If an eligible child has been receiving services from a non-network
23 provider and the early intervention official determines that the eligi-
24 ble child has coverage through an insurance policy which maintains an
25 adequate network of participating providers who are approved under this
26 title to deliver such early intervention program services or is enrolled
27 in a health maintenance organization which has been determined, pursuant
28 to subdivision five of section forty-four hundred three of this chapter,
29 to maintain an adequate network of providers who are approved under this
30 title to deliver early intervention program services, the early inter-
31 vention official shall require the eligible child to transfer to a
32 network provider at the time of the eligible child's next IFSP review or
33 evaluation, whichever is earlier.
34 3. Notwithstanding subdivisions one and two of this section, the
35 parent and eligible child shall not be required to use a provider within
36 the insurer's or health maintenance organization's network for the
37 provision of services if the eligible child receives services from a
38 provider who is approved under this title and is either a diagnostic and
39 treatment center licensed under article twenty-eight of this chapter
40 which provides, as its principal mission, services to individuals with
41 developmental disabilities or mental retardation, or from a provider
42 licensed under article sixteen of the mental hygiene law which provides,
43 as its principal mission, services to individuals with developmental
44 disabilities or mental retardation or a provider approved under section
45 forty-four hundred ten of the education law to provide special education
46 classes and/or special classes in an integrated setting in accordance
47 with section forty-four hundred ten of the education law and section
48 200.16 (h) of title 8 of the New York codes, rules and regulations.
49 § 5. Section 2545 of the public health law is amended by adding a new
50 subdivision 10 to read as follows:
51 10. Where a written order, referral or recommendation is required
52 pursuant to the education law for an early intervention program service,
53 the early intervention official shall ensure that such order, referral
54 or recommendation is obtained from the eligible child's primary care
55 physician or pediatrician, including where appropriate a speech patholo-
S. 6457 63 A. 9557
1 gist, acting within the scope of his or her practice, on a form to be
2 developed by the department.
3 § 6. Paragraphs (a) and (d) of subdivision 3 of section 2559 of the
4 public health law, paragraph (a) as amended and paragraph (d) as added
5 by chapter 231 of the laws of 1993, are amended to read as follows:
6 (a) (i) Providers of early intervention services and transportation
7 services shall in the first instance and where applicable, seek payment
8 from all third party payors including governmental agencies prior to
9 claiming payment from a given municipality for services rendered to
10 eligible children, provided that, for the purpose of seeking payment
11 from the medical assistance program or from other third party payors,
12 the municipality shall be deemed the provider of such early intervention
13 services to the extent that the provider has promptly furnished to the
14 municipality adequate and complete information necessary to support the
15 municipality billing, and provided further that the obligation to seek
16 payment shall not apply to a payment from a third party payor who is not
17 prohibited from applying such payment, and will apply such payment, to
18 an annual or lifetime limit specified in the insured's policy.
19 (ii) Notwithstanding any inconsistent provision of law, rule or regu-
20 lation, payments made to an approved early intervention provider by a
21 third party payor for early intervention services covered under an
22 insurance policy, comprehensive health services plan or health benefit
23 plan shall be at rates established under an agreement negotiated between
24 the provider and third party payor. Such payments shall be considered
25 payments in full for such services rendered to the eligible child and
26 the provider shall not seek additional payment from the municipality,
27 eligible child and his or her parents for any portion of the costs for
28 said services. Nothing in this section shall prohibit a third party
29 payor from applying a copayment, coinsurance or deductible as set forth
30 in the policy or plan. A provider shall not seek payment of a copayment,
31 coinsurance or deductible from the eligible child and his or her
32 parents. Payments for copayments, coinsurance or deductibles shall be
33 made in accordance with paragraph (b) of this subdivision.
34 (iii) Payments made to an approved early intervention provider by a
35 third party payor for early intervention services covered under an
36 insurance policy, comprehensive health services plan or health benefit
37 plan where there is no agreement negotiated between the provider and
38 third party payor shall be at rates established pursuant to section
39 69-4.30 of title 10 of the New York codes, rules and regulations.
40 (iv) Reimbursement for early intervention services provided by an
41 early intervention service provider who is approved under this title and
42 is either a diagnostic and treatment center licensed under article twen-
43 ty-eight of this chapter which provides, as its principal mission,
44 services to individuals with developmental disabilities or mental retar-
45 dation, or a provider licensed under article sixteen of the mental
46 hygiene law which provides, as its principal mission, services to indi-
47 viduals with developmental disabilities or mental retardation or a
48 provider approved under section forty-four hundred ten of the education
49 law to provide special education classes and/or special classes in an
50 integrated setting in accordance with section forty-four hundred ten of
51 the education law and section 200.16 (h) of title 8 of the New York
52 codes, rules and regulations shall be at rates established by the
53 commissioner for such services in accordance with section 69-4.30 of
54 title 10 of the New York codes, rules and regulations.
S. 6457 64 A. 9557
1 (v) When third party payment is not available or has been exhausted,
2 providers shall seek payment for services in accordance with subdivision
3 one of section twenty-five hundred fifty-seven of this title.
4 (d) A municipality, or its designee, when deemed the provider of the
5 early intervention service, shall be subrogated, to the extent of the
6 expenditures by such municipality for early intervention services
7 furnished to persons eligible for benefits under this title, to any
8 rights such person may have or be entitled to from third party
9 reimbursement. The right of subrogation does not attach to benefits paid
10 or provided under any health insurance policy, comprehensive health
11 services plan or health benefits plan prior to receipt of written notice
12 of the exercise of subrogation rights by the insurer or plan administra-
13 tor providing such benefits. A municipality, or its designee, when
14 deemed the provider of early intervention services, shall, immediately
15 upon receipt of the eligible child's third party payor coverage informa-
16 tion, file a notice of the exercise of subrogation rights with such
17 third party payor on a form to be developed by the department.
18 § 7. Subdivision 5 of section 2557 of the public health law is
19 REPEALED and two new subdivisions 5 and 6 are added to read as follows:
20 5. The commissioner may contract with an independent organization to
21 act as the fiscal agent for each of the municipalities and the depart-
22 ment and each municipality shall use such fiscal agent for early inter-
23 vention program fiscal management and claiming as determined by the
24 commissioner. Each municipality shall grant full authority to the fiscal
25 agent to act on the municipality's behalf with respect to all fiscal
26 management and claiming responsibilities and duties.
27 6. Municipalities and providers of services shall provide information
28 and documentation as required by the fiscal agent to carry out the
29 fiscal agent's duties.
30 § 8. Subdivision 2 of section 347 of the public health law is REPEALED
31 and a new subdivision 2 is added to read as follows:
32 2. The board of health of a county or part-county health district is
33 hereby authorized to enter into contracts with one or more counties for
34 mutual aid in the delivery of health services, including but not limited
35 to public health emergency responses such as disease surveillance, mass
36 immunization programs, mass antibiotic distribution, and handling of
37 mass casualties, provided approval of such contracts by the board of
38 supervisors of each county and of the commissioner is obtained.
39 § 9. Subdivision 1, paragraph (d) of subdivision 2 and subparagraph 2
40 of paragraph (b) of subdivision 3 of section 602 of the public health
41 law, as added by chapter 901 of the laws of 1986, are amended to read as
42 follows:
43 1. Every municipality shall [biennially] every four years, on such
44 dates as may be fixed by the commissioner, submit to the commissioner
45 for his or her approval a public health services plan.
46 (d) a projected [two-year] four-year plan of expenditures necessary to
47 implement the programs;
48 (2) disease control, which shall include activities to control and
49 mitigate the extent of non-infectious diseases, particularly those of a
50 chronic, degenerative nature, and infectious diseases. Such activities
51 shall include surveillance and epidemiological programs, and programs to
52 detect diseases in their early stages. Specific activities shall include
53 immunizations against infectious diseases [and], prevention and treat-
54 ment of sexually transmissible diseases, and arthropod vector-borne
55 disease prevention.
S. 6457 65 A. 9557
1 § 10. Subdivision 1 of section 605 of the public health law, as
2 amended by chapter 474 of the laws of 1996, is amended to read as
3 follows:
4 1. A state aid base grant shall be reimbursed to municipalities for
5 the base public health services identified in paragraph (b) of subdivi-
6 sion three of section six hundred two of this title, in an amount of the
7 greater of [forty-five] fifty-five cents per capita, for each person in
8 the municipality, or [four] five hundred fifty thousand dollars provided
9 that the municipality expends at least [four] five hundred fifty thou-
10 sand dollars for such base public health services. A municipality must
11 provide all the basic public health services identified in paragraph (b)
12 of subdivision three of section six hundred two of this title to qualify
13 for such base grant unless the municipality has the approval of the
14 commissioner to expend the base grant on a portion of such base public
15 health services. If any services in such paragraph (b) are not approved
16 in the plan or if no plan is submitted for such services, the commis-
17 sioner may limit the municipality's per capita or base grant to that
18 proportionate share which will fund those services that are submitted in
19 a plan and subsequently approved. The commissioner may use the propor-
20 tionate share that is not granted to contract with agencies, associ-
21 ations, or organizations to provide such services; or the health depart-
22 ment may use such proportionate share to provide the services upon
23 approval of the director of the division of the budget.
24 § 11. Subdivision 2 of section 605 of the public health law, as
25 amended by chapter 474 of the laws of 1996, is amended to read as
26 follows:
27 2. State aid reimbursement for public health services provided by a
28 municipality under this title, shall be made as follows:
29 (a) if the municipality is providing some or all of the basic public
30 health services identified in paragraph (b) of subdivision three of
31 section six hundred two of this title, pursuant to an approved plan, at
32 a rate of [up to fifty per centum but] no less than thirty-six per
33 centum of the difference between the amount of moneys expended by the
34 municipality for public health services required by paragraph (b) of
35 subdivision three of section six hundred two of this title during the
36 fiscal year and the base grant provided pursuant to subdivision one of
37 this section. No such reimbursement shall be provided for services if
38 they are not approved in a plan or if no plan is submitted for such
39 services.
40 (b) if the municipality is providing other public health services
41 within limits to be prescribed by regulation by the commissioner in
42 addition to some or all of the public health services required in para-
43 graph (b) of subdivision three of section six hundred two of this title,
44 pursuant to an approved plan, at a rate of [up to fifty per centum but]
45 not less than [thirty] thirty-six per centum of the moneys expended by
46 the municipality for such other services provided the municipality can
47 demonstrate a material new or materially increased allocation of
48 resources in one or more areas designated by the commissioner as areas
49 of particular public health significance. A municipality that cannot
50 demonstrate this will receive reimbursement at the rate of thirty per
51 centum. No such reimbursement shall be provided for services if they
52 are not approved in a community health assessment and plan or if no
53 community health assessment and plan is submitted for such services.
54 § 12. Section 611 of the public health law is REPEALED.
S. 6457 66 A. 9557
1 § 13. Subdivision 1 of section 616 of the public health law, as
2 amended by chapter 474 of the laws of 1996, is amended to read as
3 follows:
4 1. The total amount of state aid provided pursuant to this article
5 shall be limited to the amount of the annual appropriation made by the
6 legislature. In no event, however, shall such state aid be less than an
7 amount to provide the full base grant and, as otherwise provided by
8 paragraph (a) of subdivision two of section six hundred five of this
9 article, at least thirty-six per centum of the difference between the
10 amount of moneys expended by the municipality for public health services
11 required by paragraph (b) of subdivision three of section six hundred
12 two of this article during the fiscal year and the base grant provided
13 pursuant to subdivision one of section six hundred five of this article.
14 A municipality shall also receive at least thirty per centum of the
15 moneys expended for other public health services pursuant to paragraph
16 (b) of subdivision two of section six hundred five of this article, and,
17 at least the minimum amount so required for the services identified in
18 title two of this article, and thirty-six per centum for those munici-
19 palities meeting the conditions described in paragraph (b) of subdivi-
20 sion two of section six hundred five of this article. [Moreover, for
21 services provided during calendar year nineteen hundred ninety-six, no
22 county with a population of fifty thousand or less shall receive less
23 reimbursement pursuant to subdivision one and paragraphs (a) and (b) of
24 subdivision two of section six hundred five of this article than it
25 would have had a chapter of the laws of nineteen hundred ninety-six
26 amending these provisions as of August first, nineteen hundred ninety-
27 six not been enacted.]
28 § 14. The public health law is amended by adding a new section 621 to
29 read as follows:
30 § 621. State aid; public health emergencies. If the state commission-
31 er or a county health department or part-county department of health or
32 municipality, with the approval of the state commissioner, determines
33 that there is an imminent threat to public health, the department shall
34 reimburse counties or municipalities at fifty per centum for the cost of
35 emergency measures as approved by the department and subject to the
36 approval of the director of the budget. Such funds shall be made avail-
37 able from funds appropriated for public health emergencies, only to
38 those counties or municipalities, which have expended all other state
39 aid which may be available for related activities and have developed
40 measures to adequately address the emergency. Reimbursement is condi-
41 tioned upon availability of appropriated funds.
42 § 15. Article 27-I of the public health law is REPEALED.
43 § 16. Article 36-A of the public health law is REPEALED.
44 § 17. Section 276-a of the public health law is REPEALED.
45 § 18. Section 207 of the public health law is REPEALED.
46 § 19. Subdivision 1 of section 2701 of the public health law, as added
47 by chapter 821 of the laws of 1956, is amended to read as follows:
48 1. Plan and implement public health programs to aid in the prevention,
49 rehabilitation and control of degenerative diseases and chronic
50 illnesses.
51 § 20. Subdivisions 4, 5, 6 and 7 of section 460 of the public health
52 law are REPEALED and subdivisions 8 and 9 are renumbered 4 and 5.
53 § 21. Section 461 of the public health law, as added by chapter 562 of
54 the laws of 2001, is amended to read as follows:
55 § 461. [Permit required. 1. No person shall be a body piercing
56 specialist or tattooist and no person, firm, corporation, partnership,
S. 6457 67 A. 9557
1 or other association shall operate a body piercing studio or tattoo
2 studio without first obtaining a permit from the department.
3 2.] Promulgation of rules and regulations. All body piercing or
4 tattooing shall be performed in accordance with the rules and regu-
5 lations promulgated by the commissioner pursuant to [the public health
6 law] this chapter. Such rules and regulations shall include but are not
7 limited to operational standards and complaint investigation.
8 [3. The department shall issue a permit if the body piercing special-
9 ist and body piercing studio or tattooist and tattoo studio are in
10 compliance with this article, the penal law and the state sanitary code
11 and are not otherwise disqualified under this article.]
12 § 22. Section 462 of the public health law, as added by chapter 562 of
13 the laws of 2001, is amended to read as follows:
14 § 462. Application of article. 1. [This article shall not apply to or
15 affect a physician duly licensed under article one hundred thirty-one of
16 the education law or x-ray technicians.
17 2.] This article shall not apply to, affect, or restrict the ability
18 of a city, town, village, or county to enact a local law or ordinance
19 prohibiting or restricting body piercing or tattooing within such city,
20 town, village or county.
21 [3.] 2. Nothing contained in this article shall be construed to limit
22 the duty or power of an officer to act with regard to an immediate
23 threat to the health of the [customers of a body piercing specialist or
24 tattooist or body piercing studio or tattoo studio or the] community in
25 which [it] the body piercing or tattooing operation is located, or to
26 alter or abridge any of the duties and powers now or hereafter existing
27 in the commissioner, state district health officers, county boards of
28 health, county commissioners of health or local boards of health.
29 § 23. Sections 463, 464, 465, and 466 of the public health law are
30 REPEALED.
31 § 24. Subdivision 1 of section 241 of the elder law, as amended by
32 section 3 of chapter 645 of the laws of 2005, is amended to read as
33 follows:
34 1. "Covered drug" shall mean a drug dispensed subject to a legally
35 authorized prescription pursuant to section sixty-eight hundred ten of
36 the education law, and insulin, an insulin syringe, or an insulin
37 needle. Such term shall not include: (a) any drug determined by the
38 commissioner of the federal food and drug administration to be ineffec-
39 tive or unsafe; (b) any drug dispensed in a package, or form of dosage
40 or administration, as to which the commissioner of health finally deter-
41 mines in accordance with the provisions of section two hundred [fifty]
42 fifty-two of this title that a less expensive package, or form of dosage
43 or administration, is available that is pharmaceutically equivalent and
44 equivalent in its therapeutic effect for the general health character-
45 istics of the eligible program participant population; (c) any device
46 for the aid or correction of vision; (d) any drug, including vitamins,
47 which is generally available without a physician's prescription; and (e)
48 drugs for the treatment of [erectile dysfunction when prescribed for use
49 by a person who is required to register as a sex offender pursuant to
50 article six-C of the correction law, provided that any denial of cover-
51 age for such drugs shall provide the patient with the means of obtaining
52 additional information concerning both the denial and the means of chal-
53 lenging such denial] sexual or erectile dysfunction, unless such drugs
54 are used to treat a condition, other than sexual or erectile dysfunc-
55 tion, for which the drugs have been approved by the federal food and
56 drug administration. Any of the drugs enumerated in the preceding
S. 6457 68 A. 9557
1 sentence shall be considered a covered drug or a prescription drug for
2 purposes of this article if it is added to the preferred drug list under
3 article two-A of the public health law. For the purpose of this title,
4 except as otherwise provided in this section, a covered drug shall be
5 dispensed in quantities no greater than a thirty day supply or one
6 hundred units, whichever is greater. In the case of a drug dispensed in
7 a form of administration other than a tablet or capsule, the maximum
8 allowed quantity shall be a thirty day supply; the panel is authorized
9 to approve exceptions to these limits for specific products following
10 consideration of recommendations from pharmaceutical or medical experts
11 regarding commonly packaged quantities, unusual forms of administration,
12 length of treatment or cost effectiveness. In the case of a drug
13 prescribed pursuant to section thirty-three hundred thirty-two of the
14 public health law to treat one of the conditions that have been enumer-
15 ated by the commissioner of health pursuant to regulation as warranting
16 the prescribing of greater than a thirty day supply, such drug shall be
17 dispensed in quantities not to exceed a three month supply.
18 § 25. Subdivision 1 of section 241 of the elder law, as amended by
19 section 4 of chapter 645 of the laws of 2005, is amended to read as
20 follows:
21 1. "Covered drug" shall mean a drug dispensed subject to a legally
22 authorized prescription pursuant to section sixty-eight hundred ten of
23 the education law, and insulin, an insulin syringe, or an insulin
24 needle. Such term shall not include: (a) any drug determined by the
25 commissioner of the federal food and drug administration to be ineffec-
26 tive or unsafe; (b) any drug dispensed in a package, or form of dosage
27 or administration, as to which the commissioner of health finally deter-
28 mines in accordance with the provisions of section two hundred [fifty]
29 fifty-two of this title that a less expensive package, or form of dosage
30 or administration, is available that is pharmaceutically equivalent and
31 equivalent in its therapeutic effect for the general health character-
32 istics of the eligible program participant population; (c) any device
33 for the aid or correction of vision, or any drug, including vitamins,
34 which is generally available without a physician's prescription; and (d)
35 drugs for the treatment of [erectile dysfunction when prescribed for use
36 by a person who is required to register pursuant to article six-C of the
37 correction law, provided that any denial of coverage for such drugs
38 shall provide the patient with the means of obtaining additional infor-
39 mation concerning both the denial and the means of challenging such
40 denial] sexual or erectile dysfunction, unless such drugs are used to
41 treat a condition, other than sexual or erectile dysfunction, for which
42 the drugs have been approved by the federal food and drug
43 administration. For the purpose of this title, except as otherwise
44 provided in this section, a covered drug shall be dispensed in quanti-
45 ties no greater than a thirty day supply or one hundred units, whichever
46 is greater. In the case of a drug dispensed in a form of administration
47 other than a tablet or capsule, the maximum allowed quantity shall be a
48 thirty day supply; the panel is authorized to approve exceptions to
49 these limits for specific products following consideration of recommen-
50 dations from pharmaceutical or medical experts regarding commonly pack-
51 aged quantities, unusual forms of administration, length of treatment or
52 cost effectiveness. In the case of a drug prescribed pursuant to section
53 thirty-three hundred thirty-two of the public health law to treat one of
54 the conditions that have been enumerated by the commissioner of health
55 pursuant to regulation as warranting the prescribing of greater than a
S. 6457 69 A. 9557
1 thirty day supply, such drug shall be dispensed in quantities not to
2 exceed a three month supply.
3 § 26. Subdivision 2 of section 241 of the elder law is amended to read
4 as follows:
5 2. "Provider pharmacy" shall mean a pharmacy registered in the state
6 of New York pursuant to section sixty-eight hundred eight of the educa-
7 tion law or a pharmacy registered in a state bordering the state of New
8 York when certified as necessary by the executive director pursuant to
9 section two hundred [fifty] fifty-three of this title, for which an
10 agreement to provide pharmacy services for purposes of this program
11 pursuant to section two hundred forty-nine of this title is in effect.
12 § 27. Paragraph (b) of subdivision 1, paragraphs (a) and (b) of subdi-
13 vision 2 and paragraph (d) of subdivision 3 of section 242 of the elder
14 law, paragraph (d) of subdivision 3 as added by section 2 of part A of
15 chapter 49 of the laws of 2004, are amended to read as follows:
16 (b) any married resident who is at least sixty-five years of age and
17 whose income for the calendar year immediately preceding the effective
18 date of the annual coverage period when combined with the income in the
19 same calendar year of such married person's spouse beginning on or after
20 January first, two thousand [five] one, is less than or equal to twen-
21 ty-six thousand dollars. After the initial determination of eligibility,
22 each eligible individual must be redetermined eligible at least every
23 twenty-four months.
24 (a) any unmarried resident who is at least sixty-five years of age and
25 whose income for the calendar year immediately preceding the effective
26 date of the annual coverage period beginning on or after January first,
27 two thousand [five] one, is more than twenty thousand and less than or
28 equal to thirty-five thousand dollars. After the initial determination
29 of eligibility, each eligible individual must be redetermined eligible
30 at least every twenty-four months; and
31 (b) any married resident who is at least sixty-five years of age and
32 whose income for the calendar year immediately preceding the effective
33 date of the annual coverage period when combined with the income in the
34 same calendar year of such married person's spouse beginning on or after
35 January first, two thousand [five] one, is more than twenty-six thousand
36 dollars and less than or equal to fifty thousand dollars. After the
37 initial determination of eligibility, each eligible individual must be
38 redetermined eligible at least every twenty-four months.
39 (d) The elderly pharmaceutical insurance coverage program is author-
40 ized to apply for transitional assistance under the [medical] medicare
41 prescription drug discount program with a specific drug discount card
42 under title XVIII of the federal social security act on behalf of appli-
43 cants and eligible program participants under this [article] title. The
44 elderly pharmaceutical insurance coverage program shall provide appli-
45 cants and eligible program participants with prior written notice of,
46 and the opportunity to decline, such automatic enrollment.
47 § 28. Paragraphs (h), (i) and (j) of subdivision 5 of section 244 of
48 the elder law are amended to read as follows:
49 (h) prepare an evaluation report on the experience of the program for
50 the governor and the legislature no later than November first, [two
51 thousand five] nineteen hundred ninety-five. Such report should include
52 the recommendations of the panel concerning the continuation of the
53 program beyond its expiration;
54 (i) establish policies and procedures to allow individuals who partic-
55 ipate in the catastrophic deductible plan on December thirty-first, two
56 thousand [five] to continue to receive benefits under the provisions of
S. 6457 70 A. 9557
1 section two hundred forty-eight of this title in effect on December
2 thirty-first, two thousand [five], if and for as long as the enrollee so
3 chooses; and
4 (j) facilitate implementation of an expanded elderly pharmaceutical
5 insurance coverage program on January first, two thousand [six] one, by
6 commencing no later than October first, two thousand [five], outreach
7 activities, including but not limited to the dissemination of informa-
8 tion to local governments and senior citizen provider advocacy groups
9 regarding such expanded program. The panel shall make applications
10 available for the expanded elderly pharmaceutical insurance coverage
11 program on October first, two thousand [five].
12 § 29. Subdivision 4 of section 245 of the elder law is amended to read
13 as follows:
14 4. Establish procedures to prorate registration fees for any partic-
15 ipant's annual coverage period which began after January first, two
16 thousand [five] and before January first, two thousand [six] one. Such
17 proration shall be calculated on a daily basis and ensure that program
18 participants are afforded an equitable transition from the program
19 established pursuant to this title to the revised program to go into
20 effect on January first, two thousand [six] one.
21 § 30. Paragraphs (c) and (d) of subdivision 2 and paragraph (c) of
22 subdivision 4 of section 247 of the elder law are amended to read as
23 follows:
24 (c) In the event that the state expenditures per participant meeting
25 the registration fee requirements of this subdivision, exclusive of
26 expenditures for program administration, in the program year commencing
27 October first, [two thousand five] nineteen hundred ninety-eight, and in
28 each program year thereafter, exceed such expenditures in the previous
29 program year by a minimum of ten percent, the annual registration fees
30 set forth in this subdivision may, unless otherwise provided by law, be
31 increased, pro-rata, for the subsequent program year, provided that such
32 increase shall not exceed 7.5 percent of the prior year registration
33 fees as may have been adjusted in accordance with this paragraph.
34 (d) In the event that the state expenditures per such participant,
35 incurred pursuant to this subdivision, exclusive of expenditures for
36 program administration, in the program year commencing October first,
37 [two thousand five] nineteen hundred ninety-eight, and in each program
38 year thereafter, are less than such expenditures in the previous program
39 year by a minimum of ten percent, the annual registration fees set forth
40 in this subdivision may, unless otherwise provided by law, be decreased,
41 pro-rata, for the subsequent program year, provided that such decrease
42 shall not exceed 7.5 percent of the prior year registration fees as may
43 have been adjusted in accordance with this paragraph.
44 (c) Effective October first, [two thousand five] nineteen hundred
45 ninety-eight, the limits on point of sale co-payments as set forth in
46 this subdivision may be adjusted by the panel on the anniversary date of
47 each program participant's annual coverage period, and such adjustment
48 shall be in effect for the duration of that annual coverage period. Any
49 such annual adjustment shall be made using a percentage adjustment
50 factor which shall not exceed one-half of the difference between the
51 year-to-year percentage increase in the consumer price index for all
52 urban consumers, as published by the United States Department of Labor,
53 and, if larger, the year-to-year percentage increase in the aggregate
54 average cost of covered drugs purchased under this title, which year-to-
55 year percentage increase in such cost shall be determined by comparison
56 of such cost in the same month of each of the appropriate successive
S. 6457 71 A. 9557
1 years; provided, however, that for any such adjustment based wholly on
2 experience in the program year commencing October first, [two thousand
3 five] nineteen hundred ninety-eight, the year-to-year percentage
4 increase in such cost shall be determined by comparison of such cost in
5 each of two months no less than five months apart and within such
6 program year, which comparison shall be annualized. Such percentage
7 adjustment factor shall be the same as that used to determine any simi-
8 lar annual adjustment for the same annual coverage periods pursuant to
9 the provisions of subdivision [two] four of section two hundred forty-
10 eight of this title.
11 § 31. Paragraphs (c) and (d) of subdivision 2 and paragraph (c) of
12 subdivision 4 of section 248 of the elder law are amended to read as
13 follows:
14 (c) In the event that the state expenditures per participant electing
15 to meet the deductible requirements of this subdivision, exclusive of
16 expenditures for program administration, in the program year commencing
17 October first, [two thousand five] nineteen hundred ninety-eight, and in
18 each program year thereafter, exceed such expenditures in the previous
19 program year by a minimum of ten percent, the annual personal covered
20 drug expenditures set forth in this subdivision may, unless otherwise
21 provided by law, be increased, pro-rata, for the subsequent program
22 year, provided that such increase shall not exceed eight percent of the
23 prior year personal covered drug expenditures as may have been adjusted
24 in accordance with this paragraph.
25 (d) In the event that the state expenditures per such participant,
26 incurred pursuant to this subdivision, exclusive of expenditures for
27 program administration, in the program year commencing October first,
28 [two thousand five] nineteen hundred ninety-eight, and in each program
29 year thereafter, are less than such expenditures in the previous program
30 year by a minimum of ten percent, the annual personal covered drug
31 expenditures set forth in this subdivision may, unless otherwise
32 provided by law, be decreased, pro-rata, for the subsequent program
33 year, provided that such decrease shall not exceed eight percent of the
34 prior year personal covered drug expenditures as may have been adjusted
35 in accordance with this paragraph.
36 (c) Effective October first, [two thousand five] nineteen hundred
37 ninety-eight, the limits on point of sale co-payments as set forth in
38 this subdivision may be adjusted by the panel on the anniversary date of
39 each program participant's annual coverage period, and such adjustment
40 shall be in effect for the duration of that annual coverage period. Any
41 such annual adjustment shall be made using a percentage adjustment
42 factor which shall not exceed one-half of the difference between the
43 year-to-year percentage increase in the consumer price index for all
44 urban consumers, as published by the United States Department of Labor,
45 and, if larger, the year-to-year percentage increase in the aggregate
46 average cost of covered drugs purchased under this title, which year-to-
47 year percentage increase in such cost shall be determined by comparison
48 of such cost in the same month of each of the appropriate successive
49 years; provided, however, that for any such adjustment based wholly on
50 experience in the program year commencing October first, [two thousand
51 five] nineteen hundred ninety-eight, the year-to-year percentage
52 increase in such cost shall be determined by comparison of such cost in
53 each of two months no less than five months apart and within such
54 program year, which comparison shall be annualized. Such percentage
55 adjustment factor shall be the same as that used to determine any simi-
56 lar annual adjustment for the same annual coverage periods pursuant to
S. 6457 72 A. 9557
1 the provisions of subdivision four of section two hundred forty-seven of
2 this title. Such annual adjustments shall be calculated by multiplying
3 the percentage adjustment factor by (1) ten percent and applying the
4 resulting percentage to the upper income limitation of each income level
5 for unmarried individuals contained in this subdivision, and by (2)
6 seven and one-half percent and applying the resulting percentage to the
7 upper income limitation of each income level for married individuals
8 contained in this subdivision; each result of such calculations, minus
9 any applicable deductible increases made pursuant to subdivision two of
10 this section and plus the result of applying the percentage adjustment
11 factor to the sum of any such annual adjustments applicable thereto for
12 any prior annual coverage period, shall be the amount by which the limit
13 on co-payments for each such income level may be adjusted, and such
14 amount shall be in addition to any such amount or amounts applicable to
15 prior annual coverage periods.
16 § 32. Subparagraph 1 of paragraph (a) of subdivision 3 and subdivision
17 5 of section 250 of the elder law are amended to read as follows:
18 (1) any agreement between the program and a manufacturer entered into
19 before August first, [two thousand five] nineteen hundred ninety-one,
20 shall be deemed to have been entered into on April first, [two thousand
21 five] nineteen hundred ninety-one; and provided further, that if a
22 manufacturer has not entered into an agreement with the department
23 before August first, [two thousand five] nineteen hundred ninety-one,
24 such agreement shall not be effective until April first, [two thousand
25 five] nineteen hundred ninety-one, unless such agreement provides that
26 rebates will be retroactively calculated as if the agreement had been in
27 effect on April first, [two thousand five] nineteen hundred ninety-one;
28 and
29 5. Notwithstanding any other provision of law, the [commissioner of
30 the office of children and family services] panel shall maximize the
31 coordination of benefits for persons enrolled under Title XVIII of the
32 federal social security act (medicare) and enrolled under this title in
33 order to facilitate medicare payment of claims. The [commissioner of the
34 office of children and family services] panel may select an independent
35 contractor, through a request-for-proposal process, to implement a
36 centralized coordination of benefits system under this subdivision for
37 individuals qualified in both the [medical assistance] elderly pharma-
38 ceutical insurance coverage (EPIC) program and medicare programs who
39 receive[, including but not limited to,] medications[, sickroom
40 supplies] or other covered products from a pharmacy provider currently
41 enrolled in the [medical assistance] elderly pharmaceutical insurance
42 coverage (EPIC) program.
43 § 33. Subparagraph 2 of paragraph (a) of subdivision 1 of section 250
44 of the elder law, as amended by section 17 of part A of chapter 58 of
45 the laws of 2004, is amended to read as follows:
46 (2) The sum of the upper limit set by the centers for medicare and
47 medicaid services for such multiple source drug, or average wholesale
48 price discounted by [sixteen and one-half] thirty percent when no upper
49 limit has been established by the centers for [Medicare] medicare and
50 [Medicaid] medicaid services for such multiple source drug, plus a
51 dispensing fee as defined in paragraph (c) of this subdivision.
52 § 34. Subparagraph 1 of paragraph (b) of subdivision 1 of section 250
53 of the elder law, as amended by section 17 of part A of chapter 58 of
54 the laws of 2004, is amended to read as follows:
S. 6457 73 A. 9557
1 (1) Average wholesale price discounted by [twelve and seventy-five
2 hundredths of one] fifteen percent, plus a dispensing fee as defined in
3 paragraph (c) of this subdivision, or
4 § 35. Paragraph (e) of subdivision 3 of section 242 of the elder law,
5 as added by section 5 of part A of chapter 58 of the laws of 2005, is
6 amended to read as follows:
7 (e) As a condition of continued eligibility for benefits under this
8 title, a program participant is required to provide, and to authorize
9 the elderly pharmaceutical insurance program to obtain, any information
10 or documentation required to establish the participant's eligibility for
11 a full premium subsidy under section 1860D-14 of the federal social
12 security act. A program participant who is found eligible for such
13 subsidy must enroll in Part D as a condition of continued participation
14 in the program, unless such enrollment will result in significant addi-
15 tional financial liability on behalf of the participant. In order to
16 maximize prescription drug coverage under Part D of title XVIII of the
17 federal social security act, the elderly pharmaceutical insurance cover-
18 age program is authorized to represent program participants under this
19 title in the pursuit of such coverage. Such representation shall not
20 result in any additional financial liability on behalf of such program
21 participants and shall include, but not be limited to, the following
22 actions:
23 (i) application for the premium and cost-sharing subsidies on behalf
24 of eligible program participants;
25 (ii) enrollment in a prescription drug plan or MA-PD plan; the elderly
26 pharmaceutical insurance coverage program shall provide program partic-
27 ipants with prior written notice of, and the opportunity to decline,
28 such enrollment;
29 (iii) pursuit of appeals, grievances, or coverage determinations.
30 § 36. Section 4 of part X2 of chapter 62 of the laws of 2003, amend-
31 ing the public health law relating to allowing for the use of funds of
32 the office of professional medical conduct for activities of the patient
33 health information and quality improvement act of 2000, as amended by
34 section 8 of part A of chapter 58 of the laws of 2005, is amended to
35 read as follows:
36 § 4. This act shall take effect immediately; provided that the
37 provisions of section one of this act shall be deemed to have been in
38 full force and effect on and after April 1, 2003[, and shall expire
39 March 31, 2006 when upon such date the provisions of such section shall
40 be deemed repealed].
41 § 37. This act shall take effect immediately and shall be deemed to
42 have been in full force and effect on or after April 1, 2006; provided,
43 however, that sections ten through fourteen of this act, relating to
44 article VI of the public health law, shall take effect on January 1,
45 2007 and sections thirty-one through thirty-five of this act shall take
46 effect July 1, 2006; provided, further, that the amendments to subdivi-
47 sion 1 of section 241 of the elder law made by section twenty-four of
48 this act shall be subject to the expiration and reversion of such subdi-
49 vision pursuant to section 79 of part C of chapter 58 of the laws of
50 2005, as amended, when upon such date the provisions of section twenty-
51 five of this act shall take effect.
52 PART C
53 Section 1. 1. Subject to available appropriations, the commissioners
54 of the office of mental health, office of mental retardation and devel-
S. 6457 74 A. 9557
1 opmental disabilities, office of alcoholism and substance abuse
2 services, department of health, office of children and family services
3 and the state office for the aging shall establish an annual cost of
4 living adjustment (COLA), subject to the approval of the director of the
5 budget, effective April first of each state fiscal year, provided,
6 however, that in state fiscal year 2006-07, the cost of living adjust-
7 ment will be effective October first, to project for the effects of
8 inflation, for rates of payments, contracts or any other form of
9 reimbursement for the programs listed in paragraphs (i), (ii), (iii),
10 (iv), (v) and (vi) of subdivision four of this section. The COLA shall
11 be applied to the appropriate portion of reimbursable costs or contract
12 amounts.
13 2. In developing cost of living adjustments under this subdivision,
14 the commissioners shall use the most recent congressional budget office
15 estimate of the budget year's U. S. consumer price index for all urban
16 consumers published in the congressional budget office economic and
17 budget outlook after June first of the budget year prior to the year for
18 which rates of payments, contracts or any other form of reimbursement
19 are being developed.
20 3. After final U. S. consumer price index (CPI) for all urban consum-
21 ers published by the United States department of labor, bureau of labor
22 statistics, for a particular budget year, the commissioners shall recon-
23 cile such final CPI with the estimate used in subdivision two of this
24 section and any difference will be included in the next prospective cost
25 of living adjustment.
26 4. Programs eligible.
27 (i) Programs eligible for the cost of living adjustments under the
28 auspice of the office of mental health (OMH) include: comprehensive
29 outpatient program (COPS), non-COPS and community support program compo-
30 nents of the reimbursement for OMH licensed outpatient programs, pursu-
31 ant to part 592, part 588.13 and part 588.14 respectively of the office
32 of mental health regulations; disproportionate share payments made under
33 chapter 119 of the laws of 1997 as amended; partial hospitalization;
34 intensive psychiatric rehabilitation treatment; outreach; crisis resi-
35 dence; crisis/respite beds; comprehensive psychiatric emergency program
36 crisis outreach; comprehensive psychiatric emergency program crisis
37 beds; crisis intervention; home based crisis intervention; comprehensive
38 psychiatric emergency program crisis intervention; family care; family
39 based treatment; supported single room occupancy; supported housing;
40 supported housing community services; treatment congregate; supported
41 congregate; community residence - children & youth; treatment/apartment;
42 supported apartment; community residence single room occupancy; on-site
43 rehabilitation; sheltered workshop/satellite sheltered workshop; transi-
44 tional employment; recreation; respite care; transportation; psychoso-
45 cial club; assertive community treatment; case management; blended case
46 management; local government unit administration; monitoring and evalu-
47 ation; children and youth vocational services; enclave in industry;
48 single point of access; assisted competitive employment; school program
49 without clinic; family support children and youth; advocacy/support
50 services; drop in centers; intensive case management; transition manage-
51 ment services; bridger; home and community based waiver services pursu-
52 ant to subdivision 9 of section 366 of the social services law; affirma-
53 tive business industries; self-help programs; consumer service dollars;
54 intensive case management/supportive case management/blended case
55 management emergency and non-emergency service dollars; conference of
56 local mental hygiene directors; client worker; multicultural initiative;
S. 6457 75 A. 9557
1 ongoing integrated supported employment services; supported education;
2 MICA network; personalized recovery oriented service except for clinic
3 treatment fee component; supportive case management; assertive community
4 treatment team service dollars; and state aid funding provided pursuant
5 to article 41 of the mental hygiene law for residential treatment facil-
6 ity transition coordinator, inpatient psychiatric unit of a general
7 hospital, day treatment, clinic and continuing day treatment.
8 (ii) Programs eligible for the cost of living adjustments under the
9 auspice of the office of mental retardation and developmental disabili-
10 ties include: local/unified services; chapter 620; direct sheltered
11 workshop; long term sheltered employment; voluntary operated community
12 residences; article 16 clinics; day treatment; family support services;
13 100% day training; epilepsy services; and individual support services.
14 (iii) Programs eligible for the cost of living adjustments under the
15 auspice of the office of alcoholism and substance abuse services
16 include: chemical dependence crisis services; inpatient rehabilitation
17 services; residential services; outpatient services; chemotherapy
18 substance abuse programs; residential rehabilitation services for youth;
19 compulsive gambling programs; chemical dependence school and community-
20 based prevention and education programs; managed addiction treatment
21 services; case management; vocational and job placement services; recov-
22 ery services; and program support services, provided that such programs
23 receive state aid funding support from the office of alcoholism and
24 substance abuse services. State aid funding support, for purposes of
25 cost of living adjustment eligibility, is limited to the local assist-
26 ance account of the general fund, federal substance abuse prevention and
27 treatment block grant funds, and federal safe and drug-free schools and
28 communities grant funds appropriated to and administered by the office
29 of alcoholism and substance abuse services.
30 (iv) Programs eligible for the cost of living adjustments under the
31 auspice of the department of health include: adolescent services/ACT for
32 youth; adolescent services/general; adolescent services/schools; clin-
33 ical education; clinical guidelines development; clinical scholars;
34 clinical trials experimental treatment; community development initi-
35 ative; community HIV prevention and primary care; community services
36 programs; criminal justice; education and training; evaluation and
37 research; expanded syringe access program; families in transition; fami-
38 ly centered care; harm reduction/general; harm reduction/syringe
39 exchange; HIV health care and support services for women and kids; HIV
40 prevention/primary care/support services for substance abusers; homeless
41 shelters; legal services and advocacy; lesbian, gay, bisexual,
42 transgender/adolescent; lesbian, gay, bisexual, transgender/general;
43 lesbian, gay, bisexual, transgender/substance use; multiple service
44 agency; nutritional services; pediatric centers of excellence; permanen-
45 cy planning; racial and ethnic minority; social day care; specialized
46 care centers for youth; specialty; supportive housing; treatment adher-
47 ence; women's services/general; women's services/peer; women's
48 services/supportive services; youth access program; minority health;
49 center for community health program; red cross emergency preparedness;
50 nutrition outreach and education; obesity prevention; women, infants,
51 and children; hunger prevention and nutrition assistance; Indian health;
52 asthma; prenatal care assistance program; rape crisis; early inter-
53 vention; health and human services sexuality related; infertility;
54 maternity/early childhood foundation; abstinence education; family plan-
55 ning; school health; sudden infant death syndrome; childhood lead
56 poisoning prevention; enhanced services for kids; act for youth; chil-
S. 6457 76 A. 9557
1 dren with special health care needs; regional perinatal data centers;
2 migrant health; dental services; osteoporosis prevention; eating disor-
3 ders; cancer services; cancer registry; healthy heart; alzheimer's
4 disease assistance centers; alzheimer's disease - research and educa-
5 tion; diabetes screening, education and prevention; tobacco control;
6 rabies; tick-borne; immunization; public health campaign; sexually tran-
7 smitted disease; and tuberculosis control.
8 (v) Programs eligible for the cost of living adjustments under the
9 auspice of the state office for the aging include: community services
10 for the elderly; expanded in-home services for the elderly; and supple-
11 mental nutrition assistance program.
12 (vi) Programs eligible for cost of living adjustments under the
13 auspice of the office of children and family services include: programs
14 for which the office of children and family services establishes maximum
15 state aid rates pursuant to section 398-a of the social services law and
16 sections 4003 and 4405 of the education law, foster parents, adoptive
17 parents, and home and community based waiver services pursuant to subdi-
18 vision 9 of section 366 of the social services law for which social
19 services districts have chosen to use preventive services funds to
20 support a portion of the costs.
21 5. Furthermore, each provider receiving such funding shall submit a
22 written certification, in such form and at such time as each commission-
23 er shall prescribe, attesting how such funding will be or was used to
24 promote the recruitment and retention of staff or respond to other crit-
25 ical non-personal service costs during the State fiscal year in which
26 the cost of living adjustment was applied.
27 § 2. This act shall take effect immediately and shall be deemed to
28 have been in full force and effect on and after April 1, 2006, and shall
29 expire and be deemed repealed April 1, 2009.
30 PART D
31 Section 1. Paragraph (e) of subdivision 1 of section 2807-l of the
32 public health law, as amended by section 19 of part E of chapter 63 of
33 the laws of 2005, is amended to read as follows:
34 (e) Funds shall be reserved and accumulated from year to year and
35 shall be available, including income from invested funds, for purposes
36 of distributions to organizations to support the health workforce
37 retraining program established pursuant to section twenty-eight hundred
38 seven-g of this article from the respective health care initiatives
39 pools established for the following periods in the following amounts
40 from the pools during the period January first, nineteen hundred nine-
41 ty-seven through December thirty-first, nineteen hundred ninety-nine, up
42 to fifty million dollars on an annualized basis, up to thirty million
43 dollars for the period January first, two thousand through December
44 thirty-first, two thousand, up to forty million dollars for the period
45 January first, two thousand one through December thirty-first, two thou-
46 sand one, up to fifty million dollars for the period January first, two
47 thousand two through December thirty-first, two thousand two, up to
48 forty-one million one hundred fifty thousand dollars for the period
49 January first, two thousand three through December thirty-first, two
50 thousand three, up to forty-one million one hundred fifty thousand
51 dollars for the period January first, two thousand four through December
52 thirty-first, two thousand four, up to fifty-eight million three hundred
53 sixty thousand dollars for the period January first, two thousand five
54 through December thirty-first, two thousand five, up to [fifty-two
S. 6457 77 A. 9557
1 million three hundred sixty thousand] twenty-nine million two hundred
2 thousand dollars for the period January first, two thousand six through
3 December thirty-first, two thousand six and up to [twenty-nine million
4 one hundred eighty thousand] fourteen million six hundred thousand
5 dollars for the period January first, two thousand seven through June
6 thirtieth, two thousand seven, less the amount of funds available for
7 allocations for rate adjustments for workforce training programs for
8 payments by state governmental agencies for inpatient hospital services.
9 § 2. Subparagraphs (vii) and (viii) of paragraph (j) of subdivision 1
10 of section 2807-v of the public health law, subparagraph (vii) as added
11 and subparagraph (viii) as amended by section 3 of part B of chapter 58
12 of the laws of 2005, are amended to read as follows:
13 (vii) up to [forty] eighty-one million [six] nine hundred thousand
14 dollars for the period January first, two thousand six through December
15 thirty-first, two thousand six, provided, however, that within amounts
16 appropriated, a portion of such funds may be transferred to the Roswell
17 Park Cancer Institute Corporation to support costs associated with
18 cancer research; and
19 (viii) up to [twenty] forty-seven million [three] eight hundred thou-
20 sand dollars for the period January first, two thousand seven through
21 June thirtieth, two thousand seven, provided, however, that within
22 amounts appropriated, a portion of such funds may be transferred to the
23 Roswell Park Cancer Institute Corporation to support costs associated
24 with cancer research.
25 § 3. Subparagraphs (vii) and (viii) of paragraph (k) of subdivision 1
26 of section 2807-v of the public health law, subparagraph (vii) as added
27 and subparagraph (viii) as amended by section 3 of part B of chapter 58
28 of the laws of 2005, are amended to read as follows:
29 (vii) one hundred [forty-one] fifty-six million [eight] six hundred
30 thousand dollars, plus an additional five hundred thousand dollars, for
31 the period January first, two thousand six through December thirty-
32 first, two thousand six; and
33 (viii) [seventy] seventy-five million [six] seven hundred thousand
34 dollars, plus an additional two hundred fifty thousand dollars, for the
35 period January first, two thousand seven through June thirtieth, two
36 thousand seven.
37 § 4. Subparagraphs (vii) and (viii) of paragraph (n) of subdivision 1
38 of section 2807-v of the public health law, subparagraph (vii) as added
39 and subparagraph (viii) as amended by section 3 of part B of chapter 58
40 of the laws of 2005, are amended to read as follows:
41 (vii) [six hundred twenty] five hundred sixty million four hundred
42 thousand dollars for the period January first, two thousand six through
43 December thirty-first, two thousand six; and
44 (viii) three hundred [thirty-six] sixteen million one hundred thousand
45 dollars for the period January first, two thousand seven through June
46 thirtieth, two thousand seven.
47 § 5. Subparagraph (vii) of paragraph (o) of subdivision 1 of section
48 2807-v of the public health law, as added by section 3 of part B of
49 chapter 58 of the laws of 2005, is amended to read as follows:
50 (vii) [seventy-eight] ninety-one million dollars for the period Janu-
51 ary first, two thousand six through December thirty-first, two thousand
52 six; and
53 § 6. Subparagraphs (v) and (vi) of paragraph (v) of subdivision 1 of
54 section 2807-v of the public health law, subparagraph (v) as added and
55 subparagraph (vi) as amended by section 3 of part B of chapter 58 of the
56 laws of 2005, are amended to read as follows:
S. 6457 78 A. 9557
1 (v) up to [sixty-five] one hundred thirteen million eight hundred
2 thousand dollars for the period January first, two thousand six through
3 December thirty-first, two thousand six; and
4 (vi) up to [thirty-two] forty-eight million [five] eight hundred thou-
5 sand dollars for the period January first, two thousand seven through
6 June thirtieth, two thousand seven.
7 § 7. The opening paragraph of paragraph (hh) of subdivision 1 of
8 section 2807-v of the public health law, as amended by section 3 of part
9 B of chapter 58 of the laws of 2005, is amended to read as follows:
10 Funds shall be deposited by the commissioner, within amounts appropri-
11 ated, and the state comptroller is hereby authorized and directed to
12 receive for deposit to the credit of the special revenue fund - other,
13 HCRA transfer fund, [health care services] medical assistance account
14 for purposes of providing financial assistance to residential health
15 care facilities pursuant to subdivisions nineteen and twenty-one of
16 section twenty-eight hundred eight of this article, from the tobacco
17 control and insurance initiatives pool established for the following
18 periods in the following amounts:
19 § 8. Subparagraphs (v) and (vi) of paragraph (kk) of subdivision 1 of
20 section 2807-v of the public health law, subparagraph (v) as added and
21 subparagraph (vi) as amended by section 3 of part B of chapter 58 of the
22 laws of 2005, are amended to read as follows:
23 (v) up to [five] eight hundred [seventy] sixty-six million three
24 hundred thousand dollars for the period January first, two thousand six
25 through December thirty-first, two thousand six; and
26 (vi) up to [one] two hundred [thirty] twenty-eight million eight
27 hundred thousand dollars for the period January first, two thousand
28 seven through June thirtieth, two thousand seven.
29 § 9. Subparagraphs (iv) and (v) of paragraph (mm) of subdivision 1 of
30 section 2807-v of the public health law, subparagraph (iv) as added and
31 subparagraph (v) as amended by section 3 of part B of chapter 58 of the
32 laws of 2005, are amended to read as follows:
33 (iv) [three] two hundred [three] ninety-seven million one hundred
34 thousand dollars for the period January first, two thousand six through
35 December thirty-first, two thousand six; and
36 (v) one hundred [fifty-seven] fifty-five million dollars for the peri-
37 od January first, two thousand seven through June thirtieth, two thou-
38 sand seven.
39 § 10. Subparagraphs (ii) and (iii) of paragraph (zz) of subdivision 1
40 of section 2807-v of the public health law, as added by chapter 161 of
41 the laws of 2005, are amended to read as follows:
42 (ii) [sixteen million two hundred fifty] one hundred eight million
43 three hundred thousand dollars for the period January first, two thou-
44 sand six through December thirty-first, two thousand six, provided,
45 however, that within amounts appropriated, a portion of such funds may
46 be transferred to the Roswell Park Cancer Institute Corporation to fund
47 capital costs; and
48 (iii) [sixteen million two hundred fifty] eighty million eight hundred
49 thousand dollars for the period January first, two thousand seven
50 through June thirtieth, two thousand seven, provided, however, that
51 within amounts appropriated, a portion of such funds may be transferred
52 to the Roswell Park Cancer Institute Corporation to fund capital costs.
53 § 11. Section 2807-b of the public health law is REPEALED and a new
54 section 2807-b is added to read as follows:
55 § 2807-b. Outstanding payments and reports due under subdivision
56 eighteen of section twenty-eight hundred seven-c, sections twenty-eight
S. 6457 79 A. 9557
1 hundred seven-d, twenty-eight hundred seven-j, twenty-eight hundred
2 seven-s and twenty-eight hundred seven-t of this article. 1. If there
3 is a basis for estimating the amount of outstanding payments due in
4 accordance with subdivision eighteen of section twenty-eight hundred
5 seven-c of this article, and sections twenty-eight hundred seven-d,
6 twenty-eight hundred seven-j, twenty-eight hundred seven-s and twenty-
7 eight hundred seven-t of this article, the commissioner shall bill
8 applicable providers and payors for such payments, including any inter-
9 est and penalties set forth in this article, no later than ninety days
10 after each calendar quarter following enactment of this section.
11 2. If there is no basis for estimating the amount of outstanding
12 payments due in accordance with subdivision eighteen of section twenty-
13 eight hundred seven-c of this article, and sections twenty-eight hundred
14 seven-d, twenty-eight hundred seven-j, twenty-eight hundred seven-s and
15 twenty-eight hundred seven-t of this article, the commissioner shall
16 notify applicable providers and payors of outstanding reports and
17 payments no later than ninety days after each calendar quarter following
18 the effective date of this section. Such notice shall include informa-
19 tion regarding any interest, penalties or other sanctions which may be
20 implemented in accordance with this article.
21 § 12. Paragraph (d) of subdivision 18 of section 2807-c of the public
22 health law, as amended by chapter 1 of the laws of 1999, is amended to
23 read as follows:
24 (d) Gross revenue received shall mean all moneys received for or on
25 account of inpatient hospital service, provided, however, that subject
26 to the provisions of paragraph (e) of this subdivision gross revenue
27 received shall not include distributions from bad debt and charity care
28 regional pools, health care services pools, bad debt and charity care
29 for financially distressed hospitals statewide pools and bad debt and
30 charity care and capital statewide pools created in accordance with this
31 section or distributions from funds allocated in accordance with section
32 twenty-eight hundred seven-l, twenty-eight hundred seven-k, twenty-eight
33 hundred seven-v or twenty-eight hundred seven-w of this article and
34 shall not include the components of rates of payment or charges related
35 to the allowances provided in accordance with subdivisions fourteen,
36 fourteen-b and fourteen-c of this section, the adjustment provided in
37 accordance with subdivision fourteen-a of this section, the adjustment
38 provided in accordance with subdivision fourteen-d of this section, the
39 adjustment for health maintenance organization reimbursement rates
40 provided in accordance with former subdivision two-a of this section,
41 or, if effective, the adjustment provided in accordance with subdivision
42 fifteen of this section [or] the adjustment provided in accordance with
43 section eighteen of chapter two hundred sixty-six of the laws of nine-
44 teen hundred eighty-six as amended, revenue received from physician
45 practice or faculty practice plan discrete billings for private practic-
46 ing physician services, revenue from affiliation agreements or contracts
47 with public hospitals for the delivery of health care services at such
48 public hospitals, revenue received as disproportionate share hospital
49 payments in accordance with title nineteen of the federal social securi-
50 ty act, or revenue from government deficit financing.
51 § 13. Paragraph (a) of subdivision 3 of section 2807-d of the public
52 health law, as amended by chapter 161 of the laws of 2005, is amended to
53 read as follows:
54 (a) for general hospitals, all monies received for or on account of
55 inpatient hospital service, outpatient service, emergency service,
56 referred ambulatory service and ambulatory surgical service, or other
S. 6457 80 A. 9557
1 hospital or health-related services, excluding, subject to the
2 provisions of subdivision twelve of this section: distributions from bad
3 debt and charity care regional pools, primary health care services
4 regional pools, bad debt and charity care for financially distressed
5 hospitals statewide pools and bad debt and charity care and capital
6 statewide pools created in accordance with section twenty-eight hundred
7 seven-c of this article and the components of rates of payment or charg-
8 es related to the allowances provided in accordance with subdivisions
9 fourteen, fourteen-b and fourteen-c, the adjustment provided in accord-
10 ance with subdivision fourteen-a, the adjustment provided in accordance
11 with subdivision fourteen-d, the adjustment for health maintenance
12 organization reimbursement rates provided in accordance with section
13 twenty-eight hundred seven-f of this article, the adjustment for commer-
14 cial insurer reimbursement rates provided in accordance with paragraph
15 (i) of subdivision eleven of section twenty-eight hundred seven-c of
16 this article or, if effective, the adjustment provided in accordance
17 with subdivision fifteen of section twenty-eight hundred seven-c of this
18 article or the adjustment provided in accordance with section eighteen
19 of chapter two hundred sixty-six of the laws of nineteen hundred eight-
20 y-six as amended and physician practice or faculty practice plan revenue
21 received by a general hospital based on discrete billings for private
22 practicing physician services, revenue received by a general hospital
23 from a public hospital pursuant to an affiliation agreement contract for
24 the delivery of health care services to such public hospital, revenue
25 received pursuant to section twenty-eight hundred seven-w of this arti-
26 cle, all revenue received as disproportionate share hospital payments,
27 in accordance with title nineteen of the federal Social Security Act,
28 revenue received pursuant to sections eleven, twelve, thirteen and four-
29 teen of part A of chapter one of the laws of two thousand two, [and]
30 revenue received pursuant to sections thirteen and fourteen of part B of
31 chapter one of the laws of two thousand two, revenue from patient
32 personal fund allowances, revenue from income earned on patient funds,
33 investment income from externally restricted funds, revenue from invest-
34 ment sinking funds, revenue from investment operating escrow accounts,
35 investment income from funded depreciation, investment income from mort-
36 gage repayment escrow accounts, revenue derived from the operation of
37 schools leading to licensure, and revenue from the collection of sales
38 and excise taxes;
39 § 14. Subdivision 12 of section 2807-k of the public health law is
40 amended by adding a new paragraph (c) to read as follows:
41 (c) Such reports shall comply with the reporting requirements estab-
42 lished for receipt of bad debt and charity care pool payments as
43 provided in accordance with section twenty-eight hundred seven-c of this
44 article and regulations promulgated thereunder for periods prior to
45 January first, nineteen hundred ninety-seven.
46 § 15. Paragraph (f) of subdivision 18 of section 2807-c of the public
47 health law, as amended by section 42 of part B of chapter 58 of the laws
48 of 2005, is amended to read as follows:
49 (f) Payments of assessments and allowances required to be submitted by
50 general hospitals pursuant to this subdivision and subdivisions fourteen
51 and fourteen-b of this section and paragraph (a) of subdivision two of
52 section twenty-eight hundred seven-d of this article shall be subject to
53 audit by the commissioner for a period of six years following the close
54 of the calendar year in which such payments are due, after which such
55 payments shall be deemed final and not subject to further adjustment or
56 reconciliation, provided, however, that nothing herein shall be
S. 6457 81 A. 9557
1 construed as precluding the commissioner from pursuing collection of any
2 such assessments and allowances which are identified as delinquent with-
3 in such six year period, or which are identified as delinquent as a
4 result of an audit commenced within such six year audit period, or from
5 conducting an audit of any adjustment or reconciliation made by a gener-
6 al hospital within such six year period. General hospitals which, in
7 the course of such an audit, fail to produce data or documentation
8 requested in furtherance of such an audit, within thirty days of such
9 request may be assessed a civil penalty of up to ten thousand dollars
10 for each such failure, provided, however, that such civil penalty shall
11 not be imposed if the hospital demonstrates good cause for such failure.
12 The imposition of such civil penalties shall be subject to the
13 provisions of section twelve-a of this chapter.
14 § 16. Paragraph (a) of subdivision 8-a of section 2807-j of the public
15 health law, as added by section 43 of part B of chapter 58 of the laws
16 of 2005, is amended to read as follows:
17 (a) Payments and reports submitted or required to be submitted to the
18 commissioner or to the commissioner's designee pursuant to this section
19 and section twenty-eight hundred seven-s of this article by designated
20 providers of services and by third-party payors which have elected to
21 make payments directly to the commissioner or to the commissioner's
22 designee in accordance with subdivision five-a of this section, shall be
23 subject to audit by the commissioner for a period of six years following
24 the close of the calendar year in which such payments and reports are
25 due, after which such payments shall be deemed final and not subject to
26 further adjustment or reconciliation, provided, however, that nothing
27 herein shall be construed as precluding the commissioner from pursuing
28 collection of any such payments which are identified as delinquent with-
29 in such six year period, or which are identified as delinquent as a
30 result of an audit commenced within such six year period, or from
31 conducting an audit of any adjustment or reconciliation made by a desig-
32 nated provider of services or by a third party payor which has elected
33 to make such payments directly to the commissioner or the commissioner's
34 designee.
35 § 17. Paragraph (a) of subdivision 10 of section 2807-t of the public
36 health law, as added by section 45 of part B of chapter 58 of the laws
37 of 2005, is amended to read as follows:
38 (a) Payments and reports submitted or required to be submitted to the
39 commissioner or to the commissioner's designee pursuant to this section
40 by specified third-party payors shall be subject to audit by the commis-
41 sioner for a period of six years following the close of the calendar
42 year in which such payments and reports are due, after which such
43 payments shall be deemed final and not subject to further adjustment or
44 reconciliation, provided, however, that nothing herein shall be
45 construed as precluding the commissioner from pursuing collection of any
46 such payments which are identified as delinquent within such six year
47 period, or which are identified as delinquent as a result of an audit
48 commenced within such six year period, or from conducting an audit of
49 any adjustments and reconciliation made by a specified third party payor
50 within such six year period.
51 § 18. Section 2807-w of the public health law is amended by adding a
52 new subdivision 4 to read as follows:
53 4. In order for a general hospital to be eligible to participate in
54 the distribution of funds pursuant to this section, such general hospi-
55 tal must be in compliance with the provisions of subdivisions nine, ten
56 and twelve of section twenty-eight hundred seven-k of this article.
S. 6457 82 A. 9557
1 § 19. Paragraph (a) of subdivision 2 of section 2816 of the public
2 health law is amended by adding a new subparagraph (v) to read as
3 follows:
4 (v) all other ambulatory care data from general hospitals and diagnos-
5 tic and treatment centers licensed under this article, provided, howev-
6 er, that notwithstanding any contrary provision of law the commissioner
7 is authorized to promulgate or adopt any rules or regulations necessary
8 to implement the collection of data pursuant to this subparagraph.
9 § 20. Subdivision (c) of section 92-dd of the state finance law, as
10 amended by chapter 161 of the laws of 2005, is amended to read as
11 follows:
12 (c) The pool administrator shall, from appropriated funds transferred
13 to the pool administrator from the comptroller, continue to make
14 payments as required pursuant to sections twenty-eight hundred seven-k,
15 twenty-eight hundred seven-m (not including payments made pursuant to
16 subdivision seven of section twenty-eight hundred seven-m), and twenty-
17 eight hundred seven-w of the public health law, paragraph (e) of subdi-
18 vision twenty-five of section twenty-eight hundred seven-c of the public
19 health law, paragraphs (b) and (c) of subdivision thirty of section
20 twenty-eight hundred seven-c of the public health law, paragraph (b) of
21 subdivision eighteen of section twenty-eight hundred eight of the public
22 health law, subdivision seven of section twenty-five hundred-d of the
23 public health law and section eighty-eight of chapter one of the laws of
24 nineteen hundred ninety-nine.
25 § 21. Paragraph (c) of subdivision 1 of section 2807-s of the public
26 health law is REPEALED.
27 § 22. Subdivision 18 of section 2807-c of the public health law is
28 amended by adding a new paragraph (g) to read as follows:
29 (g) If a general hospital fails to produce data or documentation
30 requested in furtherance of an audit for a month to which an assessment
31 applies, the commissioner may estimate, based on available financial and
32 statistical data as determined by the commissioner, the amount due for
33 such month. If the impact of exemptions permitted pursuant to paragraph
34 (d) of this subdivision cannot be determined from such available finan-
35 cial and statistical data the estimated amount due may be calculated on
36 the basis of the general hospital's aggregate gross inpatient revenue
37 amount, as determined from such available financial and statistical data
38 for the year subject to audit. Estimated amounts due pursuant to this
39 paragraph shall be paid by a general hospital within sixty days or with-
40 in such other time period as agreed to by the commissioner and the
41 facility. Thereafter the commissioner shall take all necessary steps to
42 collect amounts owed pursuant to this paragraph, including by offset-
43 ting, or by directing the state comptroller to offset, such amounts due
44 from any other payments made by state governmental agencies to the
45 general hospital pursuant to this article. Interest and penalties shall
46 be applied to such amounts due in accordance with the provisions of
47 paragraph (c) of subdivision twenty of this section.
48 § 23. Paragraph (c) of subdivision 6 of section 2807-j of the public
49 health law, as added by chapter 639 of the laws of 1996, is amended to
50 read as follows:
51 (c) Upon receipt of notification from the commissioner of a designated
52 provider of services' deficiency under this section, the comptroller or
53 a fiscal intermediary designated by the director of the budget, or the
54 commissioner of social services, or a corporation organized and operat-
55 ing in accordance with article forty-three of the insurance law, or an
56 organization operating in accordance with article forty-four of this
S. 6457 83 A. 9557
1 chapter shall withhold from the amount of any payment to be made by the
2 state or by such article forty-three corporation or article forty-four
3 organization to the designated provider of services the amount of the
4 deficiency determined under paragraph (a), (b) or (e) of this subdivi-
5 sion or paragraph (d) of subdivision eight-a of this section. Upon with-
6 holding such amount, the comptroller or a designated fiscal interme-
7 diary, or the commissioner of [social services] the office of temporary
8 and disability assistance, or corporation organized and operating in
9 accordance with article forty-three of the insurance law or organization
10 operating in accordance with article forty-four of this chapter shall
11 pay the commissioner, or the commissioner's designee, such amount with-
12 held on behalf of the designated provider of services. Such amount shall
13 represent, in whole or in part, the amounts due from the designated
14 provider of services.
15 § 24. Paragraph (d) of subdivision 6 of section 2807-j of the public
16 health law, as added by chapter 639 of the laws of 1996, is amended to
17 read as follows:
18 (d) The commissioner shall provide a designated provider of services
19 with notice of any estimate of an amount due for an allowance pursuant
20 to paragraph (a) or (b) of this subdivision or paragraph (d) of subdivi-
21 sion eight-a of this section at least three days prior to collection of
22 such amount by the commissioner. Such notice shall contain the financial
23 basis for the commissioner's estimate.
24 § 25. Paragraph (e) of subdivision 6 of section 2807-j of the public
25 health law, as added by chapter 639 of the laws of 1996, is amended to
26 read as follows:
27 (e) In the event a designated provider of services objects to an esti-
28 mate by the commissioner pursuant to paragraph (a) or (b) of this subdi-
29 vision or paragraph (d) of subdivision eight-a of this section of the
30 amount due for an allowance, the designated provider of services, within
31 sixty days of notice of an amount due, may request a public hearing. If
32 a hearing is requested, the commissioner shall provide the designated
33 provider of services an opportunity to be heard and to present evidence
34 bearing on the amount due for an allowance within thirty days after
35 collection of an amount due or receipt of a request for a hearing,
36 whichever is later. An administrative hearing is not a prerequisite to
37 seeking judicial relief.
38 § 26. Subdivision 8-a of section 2807-j of the public health law is
39 amended by adding a new paragraph (d) to read as follows:
40 (d) If a designated provider of services or a third party payor fails
41 to produce data or documentation requested in furtherance of an audit
42 pursuant to this section or pursuant to section twenty-eight hundred
43 seven-s of this article, for a month to which an allowance applies, the
44 commissioner may estimate, based on available financial and statistical
45 data as determined by the commissioner, the amount due for such month.
46 If the impact of the patient services revenue exemptions specified
47 pursuant to this section, or pursuant to section twenty-eight hundred
48 seven-s of this article, cannot be determined from such available finan-
49 cial and statistical data, the amount due may be calculated on the basis
50 of the aggregate total of patient services revenue derived from such
51 data for the year subject to audit. The commissioner shall take all
52 necessary steps to collect amounts due as determined pursuant to this
53 paragraph, including directing the state comptroller to offset such
54 amounts due from any payments made by the state pursuant to this article
55 to a designated provider of services or a third party payor. Interest
S. 6457 84 A. 9557
1 and penalties shall be applied to such amounts due in accordance with
2 the provisions of subdivision eight of this section.
3 § 27. Subdivision 10 of section 2807-t of the public health law is
4 amended by adding a new paragraph (d) to read as follows:
5 (d) If a specified third-party payor fails to produce data or documen-
6 tation requested in furtherance of an audit pursuant to this section for
7 a month to which an assessment applies, the commissioner may estimate,
8 based on available financial and statistical data as determined by the
9 commissioner, the amount due for such month. If the impact of the
10 enrollment exemptions permitted pursuant to this section cannot be
11 determined from such available financial and statistical data, the esti-
12 mated amount due may be calculated on the basis of aggregate data
13 derived from such available data for the year subject to audit. The
14 commissioner shall take all necessary steps to collect amounts due as
15 determined pursuant to this paragraph, including directing the state
16 comptroller to offset such amounts due from any payments made by the
17 state to the third party payor pursuant to this article. Interest and
18 penalties shall be applied to such amounts due in accordance with the
19 provisions of subdivision eight of section twenty-eight hundred seven-j
20 of this article.
21 § 28. Paragraphs 1 and 2 of subsection (j) of section 4301 of the
22 insurance law, paragraph 1 as amended and paragraph 2 as added by
23 section 8 of part A of chapter 1 of the laws of 2002, are amended to
24 read as follows:
25 (1) [No] Except as provided in this subsection, every medical expense
26 indemnity corporation, dental expense indemnity corporation, health
27 service corporation, or hospital service corporation shall be [converted
28 into a corporation organized for pecuniary profit. Every such corpo-
29 ration shall be] maintained and operated for the benefit of its members
30 and subscribers as a co-operative corporation.
31 (2) An article forty-three corporation [which was the subject of an
32 initial opinion and decision issued by the superintendent on or before
33 December thirty-first, nineteen hundred ninety-nine, as the same may be
34 amended] and its not-for-profit subsidiaries (including, without limita-
35 tion, any such subsidiary licensed as a health service corporation
36 pursuant to this chapter or as a health maintenance organization organ-
37 ized pursuant to article forty-four of the public health law), may be
38 converted into [a corporation or other entity] one or more corporations
39 or other entities organized for pecuniary profit, or into [a for-profit
40 organization] one or more for-profit organizations, in any such case, in
41 accordance with the provisions of section seven thousand three hundred
42 seventeen of this chapter.
43 § 29. Paragraph 1 of subsection (a) of section 7317 of the insurance
44 law, as added by section 10 of part A of chapter 1 of the laws of 2002,
45 is amended to read as follows:
46 (1) An article forty-three corporation [which was the subject of an
47 initial opinion and decision issued by the superintendent on or before
48 December thirty-first, nineteen hundred ninety-nine, as the same may be
49 amended] and its not-for-profit subsidiaries (including, without limita-
50 tion, any such subsidiary licensed as a health service corporation
51 pursuant to this chapter or as a health maintenance organization organ-
52 ized pursuant to article forty-four of the public health law), which
53 seeks to convert into [a corporation or other entity] one or more corpo-
54 rations or other entities organized for pecuniary profit or into [a
55 for-profit organization] one or more for-profit organizations of any
S. 6457 85 A. 9557
1 kind shall submit a proposed plan of conversion to the superintendent
2 for approval pursuant to this section.
3 § 30. Subdivision 1 of section 471 of the tax law, as amended by
4 section 30 of part A of chapter 1 of the laws of 2002, is amended to
5 read as follows:
6 1. There is hereby imposed and shall be paid a tax on all cigarettes
7 possessed in the state by any person for sale, except that no tax shall
8 be imposed on cigarettes sold under such circumstances that this state
9 is without power to impose such tax or sold to the United States or sold
10 to or by a voluntary unincorporated organization of the armed forces of
11 the United States operating a place for the sale of goods pursuant to
12 regulations promulgated by the appropriate executive agency of the
13 United States, to the extent provided in such regulations and policy
14 statements of such an agency applicable to such sales. Such tax on ciga-
15 rettes shall be at the rate of [seventy-five] one dollar and twenty-five
16 cents for each ten cigarettes or fraction thereof, provided, however,
17 that if a package of cigarettes contains more than twenty cigarettes,
18 the rate of tax on the cigarettes in such package in excess of twenty
19 shall be [thirty-seven] sixty-two and one-half cents for each five ciga-
20 rettes or fraction thereof. Such tax is intended to be imposed upon only
21 one sale of the same package of cigarettes. It shall be presumed that
22 all cigarettes within the state are subject to tax until the contrary is
23 established, and the burden of proof that any cigarettes are not taxable
24 hereunder shall be upon the person in possession thereof.
25 § 31. Section 471-a of the tax law, as amended by section 31 of part A
26 of chapter 1 of the laws of 2002, is amended to read as follows:
27 § 471-a. Use tax on cigarettes. There is hereby imposed and shall be
28 paid a tax on all cigarettes used in the state by any person, except
29 that no tax shall be imposed (1) if the tax provided in section four
30 hundred seventy-one is paid, (2) on the use of cigarettes which are
31 exempt from the tax imposed by said section, or (3) on the use of four
32 hundred or less cigarettes, brought into the state on, or in the
33 possession of, any person. Such tax on cigarettes shall be at the rate
34 of [seventy-five] one dollar and twenty-five cents for each ten ciga-
35 rettes or fraction thereof, provided, however, that if a package of
36 cigarettes contains more than twenty cigarettes, the rate of tax on the
37 cigarettes in such package in excess of twenty shall be [thirty-seven]
38 sixty-two and one-half cents for each five cigarettes or fraction there-
39 of. Within twenty-four hours after liability for the tax accrues, each
40 such person shall file with the commissioner a return in such form as
41 the commissioner may prescribe together with a remittance of the tax
42 shown to be due thereon. For purposes of this article, the word "use"
43 means the exercise of any right or power actual or constructive and
44 shall include but is not limited to the receipt, storage or any keeping
45 or retention for any length of time, but shall not include possession
46 for sale. All other provisions of this article if not inconsistent shall
47 apply to the administration and enforcement of the tax imposed by this
48 section in the same manner as if the language of said provisions had
49 been incorporated in full into this section.
50 § 32. Section 482 of the tax law, as amended by section 53 of part J
51 of chapter 82 of the laws of 2002, is amended to read as follows:
52 § 482. Deposit and disposition of revenue. All taxes, fees, interest
53 and penalties collected or received by the commissioner under this arti-
54 cle and article twenty-A of this chapter shall be deposited and disposed
55 of pursuant to the provisions of section one hundred seventy-one-a of
56 this chapter. From the taxes and interest and penalties collected or
S. 6457 86 A. 9557
1 received by the commissioner under sections four hundred seventy-one and
2 four hundred seventy-one-a of this article, effective on and after March
3 first, two thousand, forty-nine and fifty-five hundredths; and effective
4 on and after February first, two thousand two, forty-three and seventy
5 hundredths; and effective on and after May first, two thousand two,
6 sixty-four and fifty-five hundredths; and effective on and after April
7 first, two thousand three, sixty-one and twenty-two hundredths percent;
8 and effective on and after June first, two thousand six, seventy-three
9 and twenty-six hundredths percent collected or received under such
10 sections shall be deposited to the credit of the tobacco control and
11 insurance initiatives pool to be established and distributed by the
12 commissioner of health in accordance with section twenty-eight hundred
13 seven-v of the public health law.
14 § 33. Paragraph (a) of subdivision 1 of section 1 of chapter 235 of
15 the laws of 1952 relating to enabling any city of the state having a
16 population of one million or more to adopt, and amend local laws, impos-
17 ing certain specified types of taxes on cigarettes, cigars and smoking
18 tobacco which the legislature has or would have power and authority to
19 impose, to provide for the review of such taxes, and to limit the appli-
20 cation of such local laws, as amended by section 1 of part E of chapter
21 93 of the laws of 2002, is amended to read as follows:
22 (a) The rate of such tax on cigarettes shall not exceed [seventy-five]
23 twenty-five cents for each ten cigarettes or fraction thereof, provided,
24 however, that if a package of cigarettes contains more than twenty ciga-
25 rettes, the rate of tax on the cigarettes in such package in excess of
26 twenty shall be [thirty-eight] thirteen cents for each five cigarettes
27 or fraction thereof. Such tax is intended to be imposed only once on the
28 same package of cigarettes.
29 § 34. Section 2 of chapter 235 of the laws of 1952 relating to enabl-
30 ing any city of the state having a population of one million or more to
31 adopt, and amend local laws, imposing certain specified types of taxes
32 on cigarettes, cigars and smoking tobacco which the legislature has or
33 would have power and authority to impose, to provide for the review of
34 such taxes, and to limit the application of such local laws, as amended
35 by section 4 of part E of chapter 93 of the laws of 2002, is amended to
36 read as follows:
37 § 2. Revenues resulting from the imposition of taxes authorized by
38 this act shall be paid into the treasury of any such city and shall be
39 credited to and deposited in the general fund of any such city, except
40 that, after the payment of refunds with respect to such taxes, effective
41 on and after July 2, 2002 and before April 1, 2003, 46.5 percent and,
42 effective on and after April 1, 2003 and before June 1, 2006, 46 percent
43 of such revenues (including taxes, interest and penalties) collected or
44 received shall be paid to the state comptroller. The state comptroller
45 is hereby authorized and directed to transfer all such amounts so paid
46 to the credit of the tobacco control and insurance initiatives pool to
47 be distributed by the commissioner of health in accordance with section
48 2807-v of the public health law.
49 § 35. Subdivision 3 of section 1680-j of the public authorities law,
50 as added by section 54 of part B of chapter 58 of the laws of 2005, is
51 amended to read as follows:
52 3. Notwithstanding any law in the contrary, and in accordance with
53 section four of the state finance law, the comptroller is hereby author-
54 ized and directed to transfer from the health care reform act (HCRA)
55 resources fund [(F04)] (061) to the general fund, upon the request of
56 the director of the budget, up to $6,500,000 on or before March 31,
S. 6457 87 A. 9557
1 2006, and the comptroller is further hereby authorized and directed to
2 transfer from the healthcare reform act (HCRA); Resources fund (061) to
3 the Capital Projects Fund, upon the request of the director of budget,
4 up to [$16,250,000] $138,800,000 for the period April 1, 2006 through
5 March 31, 2007 [and], up to [$32,500,000] $168,500,000 for the period
6 April 1, 2007 through March 31, 2008, and up to $188,000,000 for the
7 period April 1, 2008 through March 31, 2009.
8 § 36. Notwithstanding any inconsistent provision of law, rule or regu-
9 lation, for the purposes of implementing the provisions of the public
10 health law, tax law, state finance law, insurance law and the social
11 services law, references to titles XIX and XXI of the federal social
12 security act in the public health law and the social services law shall
13 be deemed to include and also to mean any successor titles thereto under
14 the federal social security act.
15 § 37. Notwithstanding any inconsistent provision of law, rule or regu-
16 lation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of section
17 2807 of the public health law and section 18 of chapter 2 of the laws of
18 1988, as they relate to time frames for notice, approval or certif-
19 ication of rates of payment, are hereby suspended and shall, for
20 purposes of implementing the provisions of this act, be deemed to have
21 been without any force or effect from and after November 1, 2005 for
22 such rates effective for the period January 1, 2006 through December 31,
23 2006.
24 § 38. Severability clause. If any clause, sentence, paragraph, subdi-
25 vision, section or part of this act shall be adjudged by any court of
26 competent jurisdiction to be invalid, such judgment shall not affect,
27 impair or invalidate the remainder thereof, but shall be confined in its
28 operation to the clause, sentence, paragraph, subdivision, section or
29 part thereof directly involved in the controversy in which such judgment
30 shall have been rendered. It is hereby declared to be the intent of the
31 legislature that this act would have been enacted even if such invalid
32 provisions had not been included herein.
33 § 39. This act shall take effect immediately provided, however, that:
34 1. Sections thirty through thirty-four of this act shall take effect
35 June 1, 2006; further provided that notwithstanding any other provision
36 of law to the contrary, the tax due on cigarettes possessed in New York
37 state as of the close of business on June 1, 2006 by any person for sale
38 solely attributable to the increase imposed by the amendments to section
39 471 of the tax law, made by section thirty of this act, may be paid in
40 two installments due on the twenty-first day of August and the twentieth
41 day of December, 2006, subject to such terms and conditions as the
42 commissioner of taxation and finance may prescribe; provided, however,
43 no less than 25 percent of each such tax due shall be paid by August 21,
44 2006;
45 2. Section twenty-one of this act shall be deemed to have been in full
46 force and effect on and after April 1, 2005;
47 3. The amendments to paragraph (d) of subdivision 18 of section 2807-c
48 of the public health law made by section twelve of this act shall not
49 affect the expiration of such paragraph and shall be deemed to expire
50 therewith;
51 4. The amendments to section 2807-j of the public health law made by
52 sections sixteen, twenty-three, twenty-four, twenty-five and twenty-six
53 of this act shall not affect the expiration of such section and shall be
54 deemed to expire therewith;
S. 6457 88 A. 9557
1 5. The amendments to section 2807-t of the public health law made by
2 sections seventeen and twenty-seven of this act shall not affect the
3 expiration of such section and shall be deemed to expire therewith;
4 6. The amendments to paragraph (a) of subdivision 1 of section 1 of
5 chapter 235 of the laws of 1952 made by section thirty-three of this act
6 shall not affect the expiration of such paragraph and shall be deemed to
7 expire therewith;
8 7. Any rules or regulations necessary to implement the provisions of
9 this act may be promulgated and any procedures, forms, or instructions
10 necessary for such implementation may be adopted and issued on or after
11 the date this act shall have become a law;
12 8. This act shall not be construed to alter, change, affect, impair or
13 defeat any rights, obligations, duties or interest accrued, incurred or
14 conferred prior to the enactment of this act;
15 9. The commissioner of health and superintendent of insurance and any
16 appropriate council may take any steps necessary to implement provisions
17 of this act prior to its effective date;
18 10. Notwithstanding any inconsistent provision of the state adminis-
19 trative procedure act or any other provision of law, rule or regulation,
20 the commissioner of health and the superintendent of insurance and any
21 appropriate council is authorized to adopt or amend or promulgate on an
22 emergency basis any regulation he or she or such council determines
23 necessary to implement any provision of this act on its effective date;
24 and
25 11. The provisions of this act shall become effective notwithstanding
26 the failure of the commissioner of health or the superintendent of
27 insurance or any council to adopt or amend or promulgate regulations
28 implementing this act.
29 PART E
30 Section 1. Section 97-w of the state finance law, as amended by chap-
31 ter 398 of the laws of 2004, is amended to read as follows:
32 § 97-w. Chemical dependence service fund. 1. There is hereby estab-
33 lished in the custody of the state comptroller a special fund to be
34 known as the chemical dependence service fund.
35 2. Such fund shall consist of all moneys appropriated for the purpose
36 of such fund, all moneys transferred to such fund pursuant to law,
37 penalties and fines received by the office of alcoholism and substance
38 abuse services, contributions consisting of promises or grants of any
39 money or property of any kind or value, or any other thing of value,
40 including grants or other financial assistance from any agency of
41 government and all moneys required by the provisions of this section or
42 any other law to be paid into or credited to this fund.
43 3. Moneys of the fund, when allocated, shall be available to the
44 commissioner of the office of alcoholism and substance abuse services
45 and shall be used to provide support for funded agencies approved by the
46 New York state office of alcoholism and substance abuse services, and
47 local school-based and community programs which provide chemical depend-
48 ence prevention and education services. Consideration shall be given to
49 innovative approaches to providing chemical dependence services.
50 4. Notwithstanding any other law to the contrary, moneys of the fund
51 generated from a penalty, fine or other enforcement action may be used
52 for expenses that arise from the assumption of operational responsibil-
53 ities by local governments, voluntary and for-profit providers of
54 services and/or the office of alcoholism and substance abuse services
S. 6457 89 A. 9557
1 for facilities operated under a receivership pursuant to section 19.41
2 of the mental hygiene law. Such moneys may also be used for state oper-
3 ations expenses of the office of alcoholism and substance abuse services
4 and/or any other state agency related to the staffing for, and associ-
5 ated costs of, enforcement and compliance activities.
6 5. Notwithstanding the provisions of any general or special law, no
7 moneys shall be available from such chemical dependence service fund
8 until a certificate of allocation and a schedule of amounts to be avail-
9 able therefor shall have been issued by the director of the budget, upon
10 the recommendation of the commissioner of the office of alcoholism and
11 substance abuse services, and a copy of such certificate filed with the
12 comptroller, the chairman of the senate finance committee and the chair-
13 man of the assembly ways and means committee. Such certificate may be
14 amended from time to time by the director of the budget, upon the recom-
15 mendation of the commissioner of the office of alcoholism and substance
16 abuse services, and a copy of such amendment shall be filed with the
17 comptroller, the chairman of the senate finance committee and the chair-
18 man of the assembly ways and means committee.
19 [5.]6. The moneys when allocated, shall be paid out of the fund on the
20 audit and warrant of the comptroller on vouchers certified or approved
21 by the commissioner of the office of alcoholism and substance abuse
22 services, or by an officer or employee of the office of alcoholism and
23 substance abuse services designated by the commissioner.
24 [6.]7. The commissioner of the office of alcoholism and substance
25 abuse services shall promulgate rules and regulations pertaining to the
26 allocation of moneys from this fund.
27 § 2. This act shall take effect immediately and shall be deemed to
28 have been in full force and effect on and after April 1, 2006.
29 PART F
30 Section 1. Section 26.00 of the mental hygiene law is amended by
31 adding a new subdivision (k) to read as follows:
32 (k) Notwithstanding any other law to the contrary, state aid may be
33 made available to fund a receiver, including a voluntary agency and/or a
34 for-profit corporation, appointed by a court or the commissioner pursu-
35 ant to section 19.41 of this chapter.
36 § 2. This act shall take effect immediately and shall be deemed to
37 have been in full force and effect on and after April 1, 2006.
38 PART G
39 Section 1. Subparagraph (i) of paragraph (g) of subdivision 2 of
40 section 2807 of the public health law, as amended by chapter 170 of the
41 laws of 1994, is amended to read as follows:
42 (i) During the period April first, nineteen hundred ninety-four
43 through December thirty-first, nineteen hundred ninety-four and for each
44 calendar year rate period commencing on January first thereafter, rates
45 of payment by governmental agencies for the operating cost component of
46 general hospital outpatient services shall be based on the operating
47 costs reported in the base year cost report adjusted by the trend factor
48 applicable to the general hospital in which the services were provided;
49 provided, however, that the maximum payment for the operating cost
50 component of outpatient services shall be sixty-seven dollars and fifty
51 cents plus the addition of the capital cost per visit. The capital cost
52 per visit shall be based on the base year cost report except that the
S. 6457 90 A. 9557
1 capital cost per visit may be adjusted for major outpatient capital
2 expenditures incurred subsequent to the reporting year, when such
3 expenditures have received the requisite approvals and the facility has
4 provided the commissioner with a certified statement of the expendi-
5 tures. The base year for the period April first, nineteen hundred nine-
6 ty-four through December thirty-first, nineteen hundred ninety-four
7 shall be nineteen hundred ninety-two and shall be advanced one year
8 thereafter for each subsequent calendar year rate period. Further, the
9 provisions of subdivision seven of this section shall not apply. The
10 commissioner may waive the maximum allowable payment and limitations on
11 the rate of payment as prescribed herein to provide for the reimburse-
12 ment of offering and arranging services eligible for ninety percent
13 federal funds as set forth in section nineteen hundred three of the
14 federal social security act, and to provide for the reimbursement of
15 specialized services having separately identifiable costs and statis-
16 tics, including but not limited to hemodialysis services and surgical
17 services provided on an outpatient basis, provided, however, that during
18 the period April first, two thousand six through December thirty-first,
19 two thousand six and for each calendar year rate period commencing ther-
20 eafter, such specialized services shall not include services for which
21 the rate of payment is established by the office of mental health pursu-
22 ant to section 43.02 of the mental hygiene law. Such waiver shall be
23 granted only when the commissioner finds that the services are being
24 provided efficiently and at minimum cost. The commissioner shall prompt-
25 ly promulgate rules and regulations necessary to identify such services.
26 Among the criteria which the commissioner shall consider in the case of
27 specialized services are whether the services require highly specialized
28 staff, equipment or facilities, thereby generating a cost that substan-
29 tially exceeds that of more routine diagnostic or treatment services;
30 whether the facility in which the services are provided is presently
31 providing the services to the population in need; and, whether the
32 services may be provided safely and effectively on an outpatient basis
33 at a lower cost than through inpatient admission. In addition the
34 commissioner shall provide for a waiver of the maximum allowable payment
35 for those outpatient services medically necessary which include surgical
36 procedures where delay in surgical intervention would substantially
37 increase the medical risk associated with such surgical intervention.
38 Where the commissioner waives the maximum allowable payment for any
39 specified service he may, in accordance with the foregoing criteria and
40 such other criteria as he deems appropriate, establish a maximum allow-
41 able payment for such specified service.
42 § 2. This act shall take effect immediately and shall be deemed to
43 have been in full force and effect on and after April 1, 2006.
44 PART H
45 Section 1. Section 3 of chapter 119 of the laws of 1997 relating to
46 authorizing the department of health to establish certain payments to
47 general hospitals, as amended by section 1 of part S2 of chapter 62 of
48 the laws of 2003, is amended to read as follows:
49 § 3. This act shall take effect immediately and shall be deemed to
50 have been in full force and effect on and after April 1, 1997. This act
51 shall expire [March 31, 2006] April 1, 2009.
52 § 2. This act shall take effect immediately and shall be deemed to
53 have been in full force and effect on and after April 1, 2006.
S. 6457 91 A. 9557
1 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
2 sion, section or part of this act shall be adjudged by any court of
3 competent jurisdiction to be invalid, such judgment shall not affect,
4 impair, or invalidate the remainder thereof, but shall be confined in
5 its operation to the clause, sentence, paragraph, subdivision, section
6 or part thereof directly involved in the controversy in which such judg-
7 ment shall have been rendered. It is hereby declared to be the intent of
8 the legislature that this act would have been enacted even if such
9 invalid provisions had not been included herein.
10 § 3. This act shall take effect immediately provided, however, that
11 the applicable effective date of Parts A through H of this act shall be
12 as specifically set forth in the last section of such Parts.
S. 6457 92 A. 9557
1 2006-2007 NEW YORK STATE EXECUTIVE BUDGET
2 HEALTH AND MENTAL HYGIENE
3 ARTICLE VII LEGISLATION
4 CONTENTS
5 STARTING
6 PAGE
7 PART DESCRIPTION NUMBER
8 A Ensure a seamless transition to the new Federal 3
9 Medicare prescription drug program (Part D);
10 restructure the nursing home reimbursement
11 methodology; implement saving measures to reduce
12 Medicaid costs and establish the Office of
13 Medicaid Inspector General to combat fraud, waste
14 and abuse.
15 B Improve public health services by eliminating 56
16 low-priority programs, implementing cost saving
17 measures, strengthen fiscal and programmatic
18 oversight and make new investments in local public
19 health programs.
20 C Provide a three year Cost of Living Adjustment 73
21 (COLA) for designated human services programs.
22 D Modify the Health Care Reform Act (HCRA) and 76
23 enact proposals to preserve its fiscal stability,
24 and authorize additional non-profit insurance
25 company conversions.
26 E Authorize regulatory enforcement action fines to 88
27 be deposited in the Chemical Dependency Service
28 Fund.
29 F Authorize OASAS to make State aid payments to 89
30 entities which assume either temporary or
31 permanent responsibility for certain chemical
32 dependency programs.
33 G Eliminate mental health outpatient services as 89
34 services that can be considered specialized under
35 section 2807 of the Public Health Law.
36 H Authorize OMH/OASAS voluntary hospitals to receive 90
37 Federal disproportionate share payments.