Enacts into law major components of legislation necessary to implement the health and mental hygiene budget for the 2009-2010 state fiscal plan; relates to payment by governmental agencies for general hospital inpatient services, inpatient medical assistance rates for non-public general hospitals, grants to public general hospitals, tobacco control and insurance initiatives pool distributions, health care initiatives pool distributions and payments made on behalf of persons enrolled in Medicaid managed care or family health plus; to direct the commissioners of health and mental health to enhance funding of ambulatory patient group methodology and expand certain programs; to direct the commissioners of health, and mental retardation and developmental disabilities to enhance funding of the ambulatory patient group methodology; to amend the social services law, in relation to establishing the statewide patient-centered medical home; to amend the public health law, in relation to establishing the Adirondack medical home multipayor demonstration program; to amend the social services law, in relation to Medicaid coverage of smoking cessation, cardiac rehabilitation services and substance abuse intervention; to amend the social services law, in relation to the primary care case management program; to amend the public health law, in relation to establishing the state electronic health records loan program; to amend the public authorities law, in relation to the authorization of the dormitory authority to issue bonds for health care; to amend the public health law, in relation to defining certain terms and designating pharmaceutical manufacturers; to amend the social services law, in relation to directing the commissioner of health to negotiate pharmaceutical rebates, retrospective and prospective drug utilization review, and the duration of drug therapy, the development of clinical prescribing guidelines, drug coverage for persons who are beneficiaries under Part D; to amend the social services law, in relation to electronic transmission of prescriptions; to amend the social services law, in relation to eligibility for medical assistance and the family health plus program; to amend the welfare reform act of 1997, in relation to applicants for public assistance; to amend the public health law, in relation to child insurance pans; to amend the public health law, in relation to fees for the establishment of hospitals, approval of the construction of hospitals, licensure of home care services agencies, the establishment of certified home health agencies, changes in the ownership of a home health agency hospice construction, distribution of the professional education pools, the general hospital indigent care pool and the comprehensive diagnostic and treatment centers indigent care program; to amend the elder law, in relation to the program for elderly pharmaceutical insurance coverage; to amend the insurance law, in relation to examinations and appraisals of authorized insurers and employee welfare funds; to amend the tax law and the state finance law, in relation to the sales of cigarettes and tobacco products and the health care reform act (HCRA) resources fund; to repeal certain provisions of the public health law relating to the preferred drug program and the telemedicine demonstration program; to repeal certain provisions of chapter 62 of the laws of 2003, amending the social services law and the public health law relating to expanding Medicaid coverage and rates of payment for residential health care facilities, relating thereto; to repeal certain provisions of the social services law relating to specialized HIV pharmacies, the family health plus program, eligibility for medical assistance; to repeal certain provisions of the elder law relating to the program for elderly pharmaceutical insurance coverage; and providing for the repeal of certain provisions upon the expiration thereof; to repeal certain provisions of the insurance law relating to records made available by corporations (Part C).
STATE OF NEW YORK
________________________________________________________________________
S. 58--B A. 158--B
SENATE - ASSEMBLY(Prefiled)
January 7, 2009
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
again reported from said committee with amendments, ordered reprinted
as amended and recommitted to said committee
AN ACT to amend the public health law and the elder law, in relation to
the financing for certain provisions of the public health law, making
modifications to the childhood lead poisoning primary prevention
program and amending provisions relating to the long term care insur-
ance education and outreach program (Part A); to amend the public
health law and the social services law, in relation to long term home
health care programs; to amend part C of chapter 58 of the laws of
2007 amending the social services law and other laws relating to
enacting major components of legislation necessary to implement the
health and mental hygiene budget for the 2007-2008 state fiscal year,
in relation to the effectiveness of certain provisions of such chap-
ter; to amend the public health law, in relation to payments under the
medical assistance program; to amend the public health law and chapter
474 of the laws of 1996, amending the education law and other laws
relating to rates for residential health care facilities, in relation
to reimbursements; to amend chapter 884 of the laws of 1990, amending
the public health law relating to authorizing bad debt and charity
care allowances for certified home health agencies, in relation to the
effectiveness thereof; to amend chapter 81 of the laws of 1995, amend-
ing the public health law and other laws relating to medical
reimbursement and welfare reform, in relation to reimbursements and
the effectiveness thereof; to amend chapter 639 of the laws of 1996,
amending the public health law and other laws relating to welfare
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD12371-03-9
S. 58--B 2 A. 158--B
reform, in relation to reimbursements; to amend the public health law
and part C of chapter 58 of the laws of 2007 amending the social
services law and other laws relating to enacting the major components
of legislation necessary to implement the health and mental hygiene
budget for the 2007-2008 state fiscal year, in relation to rates of
payment by state governmental agencies; to amend chapter 629 of the
laws of 1986, amending the social services law relating to establish-
ing a demonstration program for the delivery of long term home health
care services to certain persons, in relation to extending the
provisions thereof; to amend chapter 451 of the laws of 2007 amending
the public health law, the social services law and the insurance law,
relating to providing enhanced consumer and provider protections, in
relation to extending the effectiveness of certain provisions thereof;
to amend chapter 55 of the laws of 1992, amending the tax law and
other laws relating to taxes, surcharges, fees and funding, in
relation to the effectiveness thereof; to amend chapter 942 of the
laws of 1983 and chapter 541 of the laws of 1984, relating to foster
family care demonstration programs, and to amend chapter 256 of the
laws of 1985, amending the social services law and other laws relating
to foster family care demonstration programs, in relation to extending
the expirations thereof; to amend chapter 693 of the laws of 1996,
amending the social services law relating to authorizing patient
discharge to hospices and residential health care facilities, under
the medical assistance presumptive eligibility program, in relation to
extending the provisions of such chapter; to amend chapter 631 of the
laws of 1997, amending the social services law relating to authorizing
medical assistance payments to certain clinics or diagnostic and
treatment centers, in relation to extending the effectiveness thereof;
to amend chapter 119 of the laws of 1997 relating to authorizing the
department of health to establish certain payments to general hospi-
tals, in relation to making such authorization permanent; to amend
chapter 519 of the laws of 1999, amending the alcoholic beverage
control law and the public health law relating to the sale of alcohol
and tobacco products to minors, in relation to the effectiveness ther-
eof; and to amend chapter 58 of the laws of 2008 amending the social
services law and the public health law relating to adjustments of
rates and the public health law, in relation to hospitals and the
distribution of monies; providing for rates of payment by state agen-
cies for certain health care services; to amend the public health law,
in relation to assessments on general hospitals and patient service
payments; to amend chapter 703 of the laws of 1988 relating to enact-
ing the expanded health care coverage act of nineteen hundred eighty-
eight and amending the insurance law and other laws relating to
expanded health care and catastrophic health care coverage, in
relation to extending certain provisions thereof; to amend part G of
chapter 56 of the laws of 2000, amending the public health law relat-
ing to the sale and possession of hypodermic syringes and needles, in
relation to making permanent the expanded syringe access demonstration
program; and to amend chapter 659 of the laws of 1997, constituting
the long term care integration and finance act of 1997, in relation to
extending the effectiveness thereof; and to repeal certain provisions
of part G of chapter 56 of the laws of 2000 amending the public health
law and other laws relating to the sale and possession of hypodermic
syringes and needles relating to the effectiveness thereof (Part B);
to amend the public health law, in relation to payment by governmental
agencies for general hospital inpatient services, inpatient medical
S. 58--B 3 A. 158--B
assistance rates for non-public general hospitals, grants to public
general hospitals, tobacco control and insurance initiatives pool
distributions, health care initiatives pool distributions and payments
made on behalf of persons enrolled in Medicaid managed care or family
health plus; to direct the commissioners of health and mental health
to enhance funding of the ambulatory patient group methodology and
expand certain programs; to direct the commissioners of health, and
mental retardation and developmental disabilities to enhance funding
of the ambulatory patient group methodology; to amend the social
services law, in relation to establishing the statewide patient-cen-
tered medical home; to amend the public health law, in relation to
establishing the Adirondack medical home multipayor demonstration
program; to amend the social services law, in relation to medicaid
coverage of smoking cessation, cardiac rehabilitation services and
substance abuse intervention; to amend the social services law, in
relation to the primary care case management program; to amend the
public health law, in relation to establishing the state electronic
health records loan program; to amend the public authorities law, in
relation to the authorization of the dormitory authority to issue
bonds for health care; to amend the public health law, in relation to
defining certain terms and designating pharmaceutical manufacturers;
to amend the social services law, in relation to directing the commis-
sioner of health to negotiate pharmaceutical rebates, retrospective
and prospective drug utilization review, and the duration of drug
therapy, the development of clinical prescribing guidelines, drug
coverage for persons who are beneficiaries under Part D; to amend the
social services law, in relation to electronic transmission of
prescriptions; to amend the social services law, in relation to eligi-
bility for medical assistance and the family health plus program; to
amend the welfare reform act of 1997, in relation to applicants for
public assistance; to amend the public health law, in relation to
child insurance plans; to amend the public health law, in relation to
fees for the establishment of hospitals, approval of the construction
of hospitals, licensure of home care services agencies, the establish-
ment of certified home health agencies, changes in the ownership of a
home health agency hospice construction, distribution of the profes-
sional education pools, the general hospital indigent care pool and
the comprehensive diagnostic and treatment centers indigent care
program; to amend the elder law, in relation to the program for elder-
ly pharmaceutical insurance coverage; to amend the insurance law, in
relation to examinations and appraisals of authorized insurers and
employee welfare funds; to amend the tax law and the state finance
law, in relation to the sales of cigarettes and tobacco products and
the health care reform act (HCRA) resources fund; to repeal certain
provisions of the public health law relating to the preferred drug
program and the telemedicine demonstration program; to repeal certain
provisions of chapter 62 of the laws of 2003, amending the social
services law and the public health law relating to expanding Medicaid
coverage and rates of payment for residential health care facilities,
relating thereto; to repeal certain provisions of the social services
law relating to specialized HIV pharmacies, the family health plus
program, eligibility for medical assistance; to repeal certain
provisions of the elder law relating to the program for elderly phar-
maceutical insurance coverage; and providing for the repeal of certain
provisions upon the expiration thereof; to repeal a certain provision
of the insurance law relating to records made available by corpo-
S. 58--B 4 A. 158--B
rations (Part C); to amend the public health law, in relation to
reimbursement to residential health care facilities, to community
service plans, to payments for certified home health agency services;
to amend chapter 109 of the laws of 2006, amending the social services
law and other laws relating to Medicaid reimbursement rate settings,
in relation to establishing a workgroup pertaining to Medicaid
reimbursement rate-setting for residential health care facilities for
future periods and providing for periodic reports by such group; to
amend the social services law, in relation to assisted living
programs, to payment for AIDS home care programs, to establishing
regional long-term care assessment centers, and in relation to Medi-
caid extended coverage for the partnership for long-term care program;
to amend the social services law, in relation to the consumer directed
personal assistance program; to amend chapter 58 of the laws of 2007,
amending the social services law and the public health law relating to
adjustments of rates, in relation to determination of eligibility; to
amend chapter 58 of the laws of 2008, amending the social services law
and the public health law relating to adjustments of rates, in
relation to determination of eligibility; to amend chapter 1 of the
laws of 1999, amending the public health law and other laws, relating
to enacting the New York Health Care Reform Act of 2000, in relation
to adult day health care services; and authorizing the commissioner of
health to expend certain funds to improve the working conditions of
certain pediatric facilities (Part D); Intentionally omitted (Part E);
in relation to the establishment of the authority of the office of
mental health to reduce inpatient capacity through the closure of such
wards or through the conversion of beds to develop transitional place-
ment programs, notwithstanding certain provisions of the mental
hygiene law (Part F); Intentionally omitted (Part G); to amend the
mental hygiene law, in relation to civil commitment of sex offenders
(Part H); Intentionally omitted (Part I); to amend the mental hygiene
law, in relation to the consolidation of certain developmental disa-
bilities services officers (Part J); to amend the mental hygiene law,
in relation to the closure of the Manhattan Addiction Treatment Center
(Part K); to amend chapter 57 of the laws of 2006, establishing a cost
of living adjustment for designated human services programs, in
relation to foregoing such adjustment during the 2009--2010 state
fiscal year (Part L); Intentionally omitted (Part M); to amend chapter
119 of the laws of 1997 authorizing the department of health to estab-
lish certain payments to general hospitals, in relation to extending
the authorization for the department of health to continue certain
payments to general hospitals (Part N); authorizing the commissioner
of mental health and the city of New York to extend the lease of
certain portions of Ward's Island; and to amend the administrative
code of the city of New York, in relation to permitting the extension
of such lease for a period not to exceed fifty years for the continued
purposes of the Manhattan psychiatric center and the Kirby forensic
psychiatric center and related programs (Part O); Intentionally omit-
ted (Part P); Intentionally omitted (Part Q); and to amend the social
services law, in relation to recertification for medical assistance
for a recipient of medicaid waiver services authorized by the office
of mental retardation and developmental disabilities (Part R)
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
S. 58--B 5 A. 158--B
1 Section 1. This act enacts into law major components of legislation
2 which are necessary to implement the state fiscal plan for the 2009-2010
3 state fiscal year. Each component is wholly contained within a Part
4 identified as Parts A through R. The effective date for each particular
5 provision contained within such Part is set forth in the last section of
6 such Part. Any provision in any section contained within a Part, includ-
7 ing the effective date of the Part, which makes a reference to a section
8 "of this act", when used in connection with that particular component,
9 shall be deemed to mean and refer to the corresponding section of the
10 Part in which it is found. Section three of this act sets forth the
11 general effective date of this act.
12 PART A
13 Section 1. Subdivisions 9 and 10 of section 225 of the public health
14 law, subdivision 9 as added by chapter 612 of the laws of 1990, and
15 subdivision 10 as added by chapter 446 of the laws of 1991, are amended
16 to read as follows:
17 9. Notwithstanding the provisions of any general, special or local law
18 to the contrary, in cities having a population of one million or more,
19 the sanitary code shall provide that any installation, service, mainte-
20 nance, testing, repair or modification of a backflow prevention device
21 or any related work shall be performed in conformance with the plumbing
22 code of any such city. All employees of a licensed plumber who perform
23 testing of backflow prevention devices shall satisfactorily complete an
24 approved course in backflow prevention device testing. Nothing in this
25 subdivision shall require the commissioner to certify the completion of
26 such approved course by such employees. For the purposes of this subdi-
27 vision, "backflow prevention device" means an acceptable air gap,
28 reduced pressure zone device, double check valve assembly or equivalent
29 protective device acceptable to the commissioner that is designed to
30 prevent or contain potential contamination of a public water system by
31 means of cross-connection control.
32 10. Notwithstanding the provisions of any general, special or local
33 law to the contrary, the sanitary code of the state of New York shall
34 provide that in any county, city having a population of less than one
35 million, town or village having a plumbing code, the installation,
36 service, maintenance, testing, repair or modification of a backflow
37 prevention device or any related work shall be performed in accordance
38 with such plumbing code. A person licensed under such plumbing code and
39 any of his employees who perform testing of backflow prevention devices
40 shall satisfactorily complete a course in backflow prevention device
41 testing that has been approved by the department. Nothing in this
42 subdivision shall require the commissioner to certify the completion of
43 such approved course by such licensee or employees. For the purposes of
44 this subdivision, "backflow prevention device" means an acceptable air
45 gap, reduced pressure zone device, double check valve assembly or equiv-
46 alent protective device acceptable to the commissioner that is designed
47 to prevent or contain potential contamination of a public water system
48 by means of cross-connection control.
49 § 2. Subdivision 4 of section 1352 of the public health law, as added
50 by chapter 635 of the laws of 2007, is amended to read as follows:
51 4. [The] To the extent that funds are available for the purposes set
52 forth in this subdivision, the commissioner shall require that the
53 following food service establishments: restaurants, bars, membership
54 organizations, fraternal organizations, and private clubs, excepting
S. 58--B 6 A. 158--B
1 establishments licensed pursuant to section sixty-four-a of the alcohol-
2 ic beverage control law, that are not regulated by the department of
3 agriculture and markets, at all times have in their employment at least
4 one individual who has been trained and certified by an organization,
5 approved by the commissioner, which specializes in and provides instruc-
6 tion concerning the safe and proper handling, preparation, cooking,
7 storage, serving, delivery, removal and disposal of food. Attendance at
8 any course established pursuant to this section shall be in person,
9 through distance learning methods, or through an Internet based online
10 program. Such training shall meet the standards set forth by the commis-
11 sioner pursuant to section thirteen hundred fifty-five of this title,
12 either: (a) pursuant to a program approved by the commissioner under
13 such section, or (b) pursuant to a course that shall address but not be
14 limited to the following topics:
15 (i) Contamination, food allergies and foodborne illness.
16 (ii) Purchasing and receiving safe food.
17 (iii) Keeping food safe in storage.
18 (iv) Protecting food during preparation.
19 (v) Protecting food during service.
20 (vi) Sanitary facilities and equipment.
21 (vii) Cleaning and sanitizing.
22 (viii) Integrated pest management.
23 (ix) Food-safety regulations and standards.
24 (x) Employee food-safety training.
25 The commissioner shall allow a licensee a period of up to thirty days
26 to come into compliance with this subdivision where an employee who has
27 been certified as having completed the approved food safety training
28 program separates from his or her place of employment.
29 § 3. Paragraph (m) of subdivision 1 of section 201 of the public
30 health law, as relettered by chapter 571 of the laws of 1976, is amended
31 to read as follows:
32 (m) supervise and regulate the sanitary aspects of camps, hotels,
33 boarding houses, public eating and drinking establishments, swimming
34 pools, bathing establishments and other businesses and activities
35 affecting public health and where inspections otherwise occur under the
36 state uniform fire prevention and building code, respond to complaints
37 relating to hotels, boarding houses and temporary residences as defined
38 in the state sanitary code and inspect such facilities when otherwise
39 necessary;
40 § 4. Paragraphs (a) and (c) of subdivision 2 and subdivision 3 of
41 section 1370-a of the public health law, paragraphs (a) and (c) of
42 subdivision 2 as added by chapter 485 of the laws of 1992 and subdivi-
43 sion 3 as added by section 23 of part B of chapter 58 of the laws of
44 2007, are amended to read as follows:
45 (a) promulgate and enforce regulations for screening children and
46 pregnant women, including requirements for blood lead testing, for lead
47 poisoning, and for follow up of children and pregnant women who have
48 elevated blood lead levels;
49 (c) establish a statewide registry of lead levels of children [with
50 elevated lead levels] provided such information is [monitored] main-
51 tained as confidential except for (i) disclosure for medical treatment
52 purposes; [and] (ii) disclosure of non-identifying epidemiological data;
53 and (iii) disclosure of information from such registry to the statewide
54 immunization information system established by section twenty-one
55 hundred sixty-eight of this chapter; and
S. 58--B 7 A. 158--B
1 3. The department shall identify and designate [a zip code in certain
2 counties] areas in the state with significant concentrations of children
3 identified with elevated blood lead levels as communities of concern for
4 purposes of implementing a [pilot] childhood lead poisoning primary
5 prevention program [to work in cooperation with local health officials
6 to develop a primary prevention plan for each such zip code identified
7 to prevent exposure to lead-based paint], and may, within amounts appro-
8 priated, provide grants to implement approved programs. The commissioner
9 of health of a county or part-county health district, a county health
10 director or a public health director and, in the city of New York, the
11 commissioner of the New York city department of health and mental
12 hygiene, shall develop and implement a childhood lead poisoning primary
13 prevention program to prevent exposure to lead-based paint hazards for
14 the communities of concern in their jurisdiction. The department shall
15 provide funding to the New York city department of health and mental
16 hygiene or county health departments to implement the approved work plan
17 for a childhood lead poisoning primary prevention program. The work plan
18 and budget, which shall be subject to the approval of the department,
19 shall include, but not be limited to: (a) identification and designation
20 of an area or areas of high risk within communities of concern; (b) a
21 housing inspection program that includes prioritization and inspection
22 of areas of high risk for lead hazards, correction of identified lead
23 hazards using effective lead-safe work practices and, appropriate over-
24 sight of remediation work; (c) partnerships with other county or munici-
25 pal agencies or community-based organizations to build community aware-
26 ness of the childhood lead poisoning primary prevention program and
27 activities, coordinate referrals for services, and support remediation
28 of housing that contains lead hazards; (d) a mechanism to provide educa-
29 tion and referral for lead testing for children and pregnant women to
30 families who are encountered in the course of conducting primary
31 prevention inspections and other outreach activities; and (e) a mech-
32 anism and outreach efforts to provide housing inspections for lead
33 hazards upon request. The commissioner of health of a county or part-
34 county health district, a county health director or a public health
35 director and, in the city of New York, the commissioner of the New York
36 city department of health and mental hygiene, shall also enter into an
37 agreement or subcontract with a municipal government regarding
38 inspection of the paint conditions in dwellings built prior to nineteen
39 hundred seventy-eight for the area defined as the community of concern
40 and may, when qualified staff exists, designate the local housing main-
41 tenance code enforcement agency in which the community of concern is
42 located as an agency authorized to administer the provisions of this
43 title pursuant to subdivision one of section thirteen hundred seventy-
44 five of this title. A portion of grant funding received to support the
45 local primary prevention plan may be used to reduce barriers to lead
46 testing of children and pregnant women within the communities of
47 concern, including the purchase of lead testing devices and supplies
48 when the need for such resources is identified within the community. The
49 commissioner, the commissioner of health of a county or part-county
50 health district, a county health director or a public health director
51 and, in the city of New York, the commissioner of the New York city
52 department of health and mental hygiene, is authorized to enter into
53 agreements, contracts, subcontracts or memoranda of understanding with,
54 and provide technical and other resources to, local health officials,
55 local building code officials, real property owners, and community
56 organizations in such areas to create and implement policies, education
S. 58--B 8 A. 158--B
1 and other forms of community outreach to address lead exposure,
2 detection and risk reduction. [Such primary] Primary prevention plans
3 shall target children less than six years of age living in the highest
4 risk housing in the [zip code] communities of concern identified. [Such
5 primary prevention] The plans shall also take into consideration the
6 extent the weatherization assistance [or] program and other such
7 programs can be used in [collaboration] conjunction with lead-based
8 paint hazard risk reduction. Funding provided for this program shall be
9 used for the activities described in this section and shall not be used
10 for other activities required by this title.
11 § 5. Subdivision 1 and paragraph (i) of subdivision 3 of section
12 1370-b of the public health law, as added by chapter 485 of the laws of
13 1992, is amended to read as follows:
14 1. The New York state advisory council on lead poisoning prevention is
15 hereby established in the department, to consist of the following, or
16 their designees: the commissioner; the commissioner of labor; the
17 commissioner of environmental conservation; the commissioner of housing
18 and community renewal; the commissioner of [social services] children
19 and family services; the commissioner of temporary and disability
20 assistance; the secretary of state; the superintendent of insurance; and
21 fifteen public members appointed by the governor. The public members
22 shall have a demonstrated expertise or interest in lead poisoning
23 prevention and at least one public member shall be representative of
24 each of the following: local government; community groups; labor unions;
25 real estate; industry; parents; educators; local housing authorities;
26 child health advocates; environmental groups; professional medical
27 organizations and hospitals. The public members of the council shall
28 have fixed terms of three years; except that five of the initial
29 appointments shall be for two years and five shall be for one year. The
30 council shall be chaired by the commissioner or his or her designee.
31 (i) To report on or before [January] December first of each year to
32 the governor and the legislature concerning the previous year's develop-
33 ment and implementation of the statewide plan and operation of the
34 program, together with recommendations it deems necessary and the most
35 currently available lead surveillance measures, including the actual
36 number and estimated percentage of children tested for lead in accord-
37 ance with New York state regulations, including age-specific testing
38 requirements, and the actual number and estimated percentage of children
39 identified with elevated blood lead levels. Such report shall be made
40 available on the department's website.
41 § 6. Subdivision 3 of section 1370-e of the public health law, as
42 added by chapter 485 of the laws of 1992, is amended to read as follows:
43 3. Whenever an analysis of a clinical specimen for lead is performed
44 by a laboratory or a physician or authorized practitioner, the director
45 of such laboratory or such physician or authorized practitioner shall,
46 within such period specified by the commissioner report the results and
47 any related information in connection therewith to the local and state
48 health officer to whom a physician or authorized practitioner is
49 required to report such cases pursuant to this section.
50 § 7. Section 2168 of the public health law, as added by chapter 544 of
51 the laws of 2006, is amended to read as follows:
52 § 2168. Statewide immunization [registry] information system. 1. The
53 department is hereby directed to establish a statewide automated and
54 electronic immunization [registry] information system that will serve,
55 and shall be administered consistent with, the following public health
56 purposes:
S. 58--B 9 A. 158--B
1 (a) collect reports of immunizations and thus reduce the incidence of
2 illness, disability and death due to vaccine preventable diseases and
3 collect results of blood lead analyses performed by physician office
4 laboratories to provide to the statewide registry of lead levels of
5 children established pursuant to section thirteen hundred seventy-a of
6 this chapter;
7 (b) establish the public health infrastructure necessary to obtain,
8 collect, preserve, and disclose information relating to vaccine prevent-
9 able disease as it may promote the health and well-being of all children
10 in this state;
11 (c) make available to an individual, or parents, guardians, or other
12 person in a custodial relation to a child or, to local health districts,
13 local social services districts responsible for the care and custody of
14 children, health care providers and their designees, schools, WIC
15 programs, and third party payers the immunization status of children;
16 and
17 (d) appropriately protecting the confidentiality of individual identi-
18 fying information and the privacy of persons included in the [registry]
19 statewide immunization information system and their families.
20 2. For the purposes of this section:
21 (a) The term "authorized user" shall mean any person or entity author-
22 ized to provide information to or to receive information from the state-
23 wide immunization [registry] information system and shall include health
24 care providers and their designees, as defined in paragraph (d) of this
25 subdivision, schools as defined in paragraph a of subdivision one of
26 section twenty-one hundred sixty-four of this title, [health maintenance
27 organizations certified under article forty-four of this chapter or
28 article forty-three of the insurance law,] third party payer as defined
29 in paragraph (f) of this subdivision, local health districts as defined
30 by paragraph (c) of subdivision one of section two of this chapter,
31 [and] local social services districts and the office of children and
32 family services with regard to children in their legal custody, and WIC
33 programs as defined in paragraph (g) of this subdivision. An authorized
34 user may be located outside New York state. An entity other than a local
35 health district shall be an authorized user only with respect to a
36 person seeking or receiving a health care service from the health care
37 provider, a person enrolled or seeking to be enrolled in the school, a
38 person insured by the [health maintenance organization] third party
39 payer, [or] a person in the custody of the local social services
40 district or the office of children and family services, or a person
41 seeking or receiving services through WIC programs, as the case may be.
42 (b) The term "statewide immunization [registry] information system" or
43 "system" shall mean a statewide-computerized database maintained by the
44 department capable of collecting, storing, and disclosing the electronic
45 and paper records of vaccinations received by persons under nineteen
46 years of age.
47 (c) The term "citywide immunization registry" shall mean the computer-
48 ized database maintained by the city of New York department of health
49 and mental hygiene capable of collecting, storing, and disclosing the
50 electronic and paper records of vaccinations received by persons [under]
51 less than nineteen years of age. The term "citywide immunization regis-
52 try" shall not include the childhood blood lead registry established
53 pursuant to the health code of the city of New York. For the purposes of
54 this section the term New York city department of health and mental
55 hygiene, shall mean such agency or any successor agency responsible for
56 the citywide immunization registry.
S. 58--B 10 A. 158--B
1 (d) The term "health care provider" shall mean any person authorized
2 by law to order [or administer] an immunization or analysis of a blood
3 sample for lead or any health care facility licensed under article twen-
4 ty-eight of this chapter or any certified home health agency established
5 under section thirty-six hundred six of this chapter; with respect to a
6 person seeking or receiving a health care service from the health care
7 provider.
8 (e) For purposes of this section a school is a public health authori-
9 ty, as defined in section 164.501 of part 45 of the federal code of
10 rules, responsible for screening the immunization status of each child
11 pursuant to section twenty-one hundred sixty-four of this article.
12 (f) The term "third party payer" shall mean health maintenance organ-
13 izations certified under article forty-four of this chapter, health
14 service corporations licensed pursuant to article forty-three of the
15 insurance law, self-insured plans that pay for health care services,
16 health insurance companies subject to article thirty-two of the insur-
17 ance law which offer preferred provider products, corporations subject
18 to article forty-three of the insurance law which offer preferred
19 provider products, municipal cooperative health benefit plans certified
20 pursuant to article forty-seven of the insurance law which offer
21 preferred provider products, and preferred provider organizations as
22 defined in section three hundred fifty-two of the workers' compensation
23 law.
24 (g) For purposes of this section the term "WIC program" shall mean a
25 state or local agency, as described pursuant to section 1786 of title 42
26 of the United States Code.
27 (h) The term "physician office laboratory" shall mean a laboratory
28 operated by a health care provider pursuant to subdivision one of
29 section five hundred seventy-nine of this chapter that is certified by
30 the Centers for Medicare and Medicaid Services under regulations imple-
31 menting the federal Clinical Laboratory Improvement Amendments of 1988
32 (CLIA).
33 3. (a) Any health care provider who administers any vaccine to a
34 person [under] less than nineteen years of age or, on or after September
35 first, two thousand nine, conducts a blood lead analysis of a sample
36 obtained from a person under eighteen years of age in accordance with
37 paragraph (h) of subdivision two of this section; and immunizations
38 received by a person [under] less than nineteen years of age in the past
39 if not already reported, shall report all such immunizations and the
40 results of any blood lead analysis to the department in a format
41 prescribed by the commissioner within fourteen days of administration of
42 such immunizations or of obtaining the results of any such blood lead
43 analysis. Health care providers administering immunizations to persons
44 [under] less than nineteen years of age in the city of New York shall
45 report, in a format prescribed by the city of New York commissioner of
46 health and mental hygiene, all such immunizations to the citywide immun-
47 ization registry. The commissioner, and for the city of New York the
48 commissioner of health and mental hygiene, shall have the discretion to
49 accept for inclusion in the [registry] system information regarding
50 immunizations administered to individuals nineteen years of age or older
51 with the express written consent of the vaccine. Health care providers
52 who conduct a blood lead analysis on a person under eighteen years of
53 age and who report the results of such analysis to the city of New York
54 commissioner of health and mental hygiene pursuant to New York city
55 reporting requirements shall be exempt from this requirement for report-
56 ing blood lead analysis results to the state commissioner of health;
S. 58--B 11 A. 158--B
1 provided, however, blood lead analysis data collected from physician
2 office laboratories by the commissioner of health and mental hygiene of
3 the city of New York pursuant to the health code of the city of New York
4 shall be provided to the department in a format prescribed by the
5 commissioner.
6 (b) The statewide immunization [registry] information system shall
7 provide a method for health care providers to determine when the regis-
8 trant is due or late for a recommended immunization and shall serve as a
9 means for authorized users to receive prompt and accurate information,
10 as reported to the [registry] system, about the vaccines that the regis-
11 trant has received.
12 4. (a) All information maintained by the department, or in the case of
13 the citywide immunization registry, the city of New York under the
14 provisions of this section shall be confidential except as necessary to
15 carry out the provisions of this section and shall not be released for
16 any other purpose.
17 (b) The department and for the city of New York the department of
18 health and mental hygiene may also disclose or provide such information
19 to an authorized user when (i) such person or agency provides sufficient
20 identifying information satisfactory to the department to identify such
21 registrant and (ii) such disclosure or provision of information is in
22 the best interests of the registrant or his or her family, or will
23 contribute to the protection of the public health.
24 (c) Any data collected by the department may be included in the state-
25 wide immunization [registry] information system and the statewide regis-
26 try of lead levels of children if collection, storage and access of such
27 data is otherwise authorized. Such data may be disclosed to the state-
28 wide immunization [registry] information system only if provided for in
29 statute and regulation, and shall be subject to any provisions in such
30 statute or regulation limiting the use or redisclosure of the data.
31 Nothing contained in this paragraph shall permit inclusion of data in
32 the statewide immunization [registry] information system if that data
33 could not otherwise be accessed or disclosed in the absence of the
34 [registry] system. For the city of New York the commissioner of health
35 and mental hygiene may include data collected in the citywide immuniza-
36 tion registry as provided in this paragraph.
37 (d) A person, institution or agency to whom such immunization [regis-
38 try] information is furnished or to whom, access to records or informa-
39 tion has been given, shall not divulge any part thereof so as to
40 disclose the identity of such person to whom such information or record
41 relates, except insofar as such disclosure is necessary for the best
42 interests of the person or other persons, consistent with the purposes
43 of this section.
44 5. (a) All health care providers and their designees, except for
45 providers reporting to the citywide immunization registry, shall submit
46 to the commissioner information about any vaccinee [under] less than
47 nineteen years of age and about each vaccination given after January
48 first, two thousand eight. The information provided to the [registry]
49 system or the citywide immunization registry shall include the national
50 immunization program data elements and other elements required by the
51 commissioner. For the city of New York the commissioner of health and
52 mental hygiene may require additional elements with prior notice to the
53 commissioner of any changes.
54 (b) In addition to the immunization administration information
55 required by this section, the operation of any immunization registry
56 established under chapter five hundred twenty-one of the laws of nine-
S. 58--B 12 A. 158--B
1 teen hundred ninety-four, section [11.04] 11.07 of title twenty-four of
2 volume eight of the compilation of the rules of the city of New York and
3 administered by a local health district collecting information from
4 health care providers about vaccinations previously administered to a
5 vaccinee prior to the effective date of this section shall provide the
6 commissioner access to such information.
7 (c) All health care providers shall provide the department or, as
8 appropriate, the city of New York with additional or clarifying informa-
9 tion upon request reasonably related to the purposes of this section.
10 (d) Notwithstanding the above, submission of incomplete information
11 shall not prohibit entry of incomplete but viable data into the [regis-
12 try database] statewide immunization information system.
13 (e) The commissioner of the department of health and mental hygiene
14 for the city of New York shall implement the requirements of this subdi-
15 vision.
16 (f) The immunization status of children exempt from immunizations
17 pursuant to subdivision eight of this section and a parent claiming
18 exemption pursuant to subdivision nine of section twenty-one hundred
19 sixty-four of this title shall be reported by the health care provider.
20 6. In the city of New York, the commissioner of the department of
21 health and mental hygiene of the city of New York may maintain its
22 existing registry consistent with the requirements of this section and
23 shall provide information to the commissioner and to authorized users.
24 7. Each parent or legal guardian of a newborn infant or a child newly
25 enrolled in the [registry] statewide immunization information system
26 shall receive information, developed by the department, describing the
27 [registry] enrollment process and how to review and correct information
28 and obtain a copy of the child's immunization record. The city of New
29 York will be responsible for providing information about the processes
30 for enrollment and access to the citywide immunization registry by a
31 parent or legal guardian of a newborn infant or newly enrolled child
32 residing in the city of New York.
33 8. Access and use of identifiable registrant information shall be
34 limited to authorized users consistent with this subdivision and the
35 purposes of this section. (a) The commissioner shall provide a method by
36 which authorized users apply for access to the [registry] system. For
37 the city of New York, the commissioner of health and mental hygiene
38 shall provide a method by which authorized users apply for access to the
39 citywide immunization registry.
40 (b) (i) The commissioner may use the statewide immunization [registry]
41 information system and the blood lead information in such system for
42 purposes of outreach, quality improvement and [vaccine] accountability,
43 research, epidemiological studies and disease control, and to obtain
44 blood lead test results from physician office laboratories for the
45 statewide registry of lead levels of children established pursuant to
46 subdivision two of section thirteen hundred seventy-a of this chapter;
47 (ii) the commissioner of health and mental hygiene for the city of New
48 York may use the immunization registry and the blood lead information in
49 such system for purposes of outreach, quality improvement and [vaccine]
50 accountability, research, epidemiological studies and disease control;
51 (iii) local health departments shall have access to the immunization
52 [registry] information system and the blood lead information in such
53 system for purposes of outreach, quality improvement and [vaccine]
54 accountability, epidemiological studies and disease control within their
55 county; and
S. 58--B 13 A. 158--B
1 (c) health care providers and their designees shall have access to the
2 statewide immunization [registry] information system and the blood lead
3 information in such system only for purposes of submission of informa-
4 tion about vaccinations received by a specific registrant, determination
5 of the immunization status of a specific registrant, determination of
6 the blood lead testing status of a specific registrant, submission of
7 the results from a blood lead analysis of a sample obtained from a
8 specific registrant in accordance with paragraph (h) of subdivision two
9 of this section, review of practice coverage, generation of reminder
10 notices, quality improvement and [vaccine] accountability and printing a
11 copy of the immunization or lead testing record for the registrant's
12 medical record, for the registrant's parent or guardian, or other person
13 in parental or custodial relation to a child, or for a registrant upon
14 reaching eighteen years of age.
15 (d) The following authorized users shall have access to the statewide
16 immunization [registry] information system and the blood lead informa-
17 tion in such system and the citywide immunization registry for the
18 purposes stated in this paragraph: (i) schools for verifying immuniza-
19 tion status for eligibility for admission; (ii) [health maintenance
20 organizations] third party payer for performing quality assurance,
21 accountability and outreach, relating to enrollees covered by the
22 [health maintenance organization] third party payer; (iii) commissioners
23 of local social services districts with regard to a child in his/her
24 legal custody; [and] (iv) the commissioner of the office of children and
25 family services with regard to children in their legal custody, and for
26 quality assurance and accountability of commissioners of local social
27 services districts, care and treatment of children in the custody of
28 commissioners of local social services districts; and (v) WIC programs
29 for the purposes of verifying immunization and lead testing status for
30 those seeking or receiving services.
31 9. The commissioner may judge the legitimacy of any request for immun-
32 ization [registry] system information and may refuse access to the
33 statewide immunization [registry] information system based on the
34 authenticity of the request, credibility of the authorized user or other
35 reasons as provided for in regulation. For the city of New York the
36 commissioner of health and mental hygiene may judge the legitimacy of
37 requests for access to the citywide immunization registry and refuse
38 access to the immunization registry based on the authenticity of the
39 request, credibility of the authorized user or other reasons as provided
40 for in regulation.
41 10. The person to whom any immunization record relates, or his or her
42 parent, or guardian, or other person in parental or custodial relation
43 to such person may request a copy of an immunization or lead testing
44 record from the registrant's healthcare provider, the statewide immuni-
45 zation [registry] information system or the citywide immunization regis-
46 try according to procedures established by the commissioner or, in the
47 case of the citywide immunization registry, by the city of New York
48 commissioner of the department of health and mental hygiene.
49 11. The commissioner, or in the city of New York, the commissioner of
50 the department of health and mental hygiene, may provide registrant
51 specific immunization records to other state registries pursuant to a
52 written agreement requiring that the [foreign] out-of-state registry
53 conform to national standards for maintaining the integrity of the data
54 and will not be used for purposes inconsistent with the provisions of
55 this section.
S. 58--B 14 A. 158--B
1 12. Information that would be provided upon the enrollment in the
2 [registry] statewide immunization information system of a child being
3 vaccinated, from birth records of all infants born in New York state on
4 or after January first, two thousand four shall be entered into the
5 statewide immunization [registry] information system, except in the city
6 of New York, where birth record information shall be entered into the
7 citywide immunization registry.
8 13. The commissioner shall promulgate regulations as necessary to
9 effectuate the provisions of this section. Such regulations shall
10 include provision for orderly implementation and operation of the
11 [registry] statewide immunization information system, including the
12 method by which each category of authorized user may access the [regis-
13 try] system. Access standards shall include at a minimum a method for
14 assigning and authenticating each user identification and password
15 assigned.
16 14. No authorized user shall be subjected to civil or criminal liabil-
17 ity, or be deemed to have engaged in unprofessional conduct for report-
18 ing to, receiving from, or disclosing information relating to the
19 [registry] statewide immunization information system when made reason-
20 ably and in good faith and in accordance with the provisions of this
21 section or any regulation adopted thereto.
22 § 8. Intentionally omitted.
23 § 9. Intentionally omitted.
24 § 10. Intentionally omitted.
25 § 11. Intentionally omitted.
26 § 12. Intentionally omitted.
27 § 13. Subdivisions 3, 4, 5 and 7 of section 217-a of the elder law, as
28 added by section 23 of part B of chapter 58 of the laws of 2004, are
29 amended to read as follows:
30 3. The commissioner of health, the superintendent of insurance and the
31 director of the office for the aging shall appoint a state program coor-
32 dinator to implement, administer and supervise the long term care insur-
33 ance education and outreach program, and coordinate the development of
34 the educational and informational materials. The state program coordina-
35 tor shall be [a full time] an employee of the office for the aging who
36 shall be selected from among individuals with expertise and experience
37 in the fields of long term care insurance, and with other qualifications
38 determined by the commissioner of health, the superintendent of insur-
39 ance and the director of the office for the aging to be appropriate for
40 the position. The state program coordinator shall, within amounts avail-
41 able, personally or through authorized representatives, be responsible
42 for training staff persons of the program, including staff persons of
43 the long term care insurance resource centers, and shall provide for the
44 collection and dissemination of timely and accurate long term care
45 insurance information to said staff persons.
46 4. The long term care insurance education and outreach program shall
47 [at a minimum], within amounts available, consist of the following
48 elements which shall be provided by the office for the aging:
49 (a) educational and informational materials in print, audio, visual,
50 electronic or other media;
51 (b) public service announcements, advertisements, media campaigns,
52 workshops, mass mailings, conferences or presentations;
53 (c) establishment of a toll-free telephone hotline and electronic
54 services to provide information; and
55 (d) establishment of long term care insurance resource centers within
56 each area agency on aging.
S. 58--B 15 A. 158--B
1 5. Long term care insurance resource centers shall, [at a minimum]
2 within amounts available, provide the general public with the following
3 items or services:
4 (a) educational and informational materials in print, audio, visual,
5 electronic or other media;
6 (b) public service announcements, advertisements, media campaigns,
7 workshops, mass mailings, conferences or presentations; and
8 (c) counseling, information, referral services, and direct assistance
9 in choosing and obtaining long term care insurance. Direct assistance
10 shall, within amounts available, include but not be limited to assist-
11 ance with the following:
12 (i) planning for the financing of long term care;
13 (ii) understanding policy options, benefits and appeal rights;
14 (iii) obtaining the coverage needed and the appropriate benefits; and
15 (iv) avoiding or reporting illegal billing, fraudulent practices or
16 scams.
17 Each long term care insurance resource center shall be responsible,
18 within amounts available, for providing a sufficient number of staff
19 positions (including volunteers) necessary to provide and carry out the
20 services of the long term care insurance education and outreach program,
21 provided that at least one position shall be filled by an individual who
22 is employed full time and paid by the area agency on aging. The long
23 term care insurance resource center shall be responsible for ensuring
24 that its staff persons have no conflict of interest in providing the
25 services described in subdivision four of this section.
26 7. The department of health shall produce, post on its website, make
27 available to others for reproduction, or contract with others to develop
28 such materials [mentioned in] required by this section [as the coordina-
29 tor deems appropriate]. The material produced pursuant to this section
30 shall be culturally and linguistically appropriate for the communities
31 served by the long term care insurance resource centers. These materials
32 shall be made available to the public free of charge.
33 § 14. This act shall take effect immediately.
34 PART B
35 Section 1. Subdivision 2 of section 3614-a of the public health law is
36 amended by adding a new paragraph (c) to read as follows:
37 (c) Notwithstanding any contrary provisions of this section or any
38 other contrary provision of law or regulation, for certified home health
39 agencies and for providers of long term home health care programs the
40 assessment shall be thirty-five hundredths of one percent of each agen-
41 cy's or provider's gross receipts received from all home health care
42 services and other operating income on a cash basis for periods on and
43 after April first, two thousand nine.
44 § 2. Subdivision 4 of section 3614-a of the public health law, as
45 amended by section 66 of part B of chapter 58 of the laws of 2005, is
46 amended to read as follows:
47 4. [For periods prior to January first, two thousand five, the] The
48 commissioner is authorized to contract with the article forty-three
49 insurance law plans, or such other administrators as the commissioner
50 shall designate, to receive and distribute home care provider assessment
51 funds and personal care services provider assessment funds assessed
52 pursuant to section three hundred sixty-seven-i of the social services
53 law. In the event contracts with the article forty-three insurance law
54 plans or other commissioner's designees are effectuated, the commission-
S. 58--B 16 A. 158--B
1 er shall conduct annual audits of the receipt and distribution of the
2 assessment funds. The reasonable costs and expenses of an administrator
3 as approved by the commissioner, not to exceed for personnel services on
4 an annual basis two hundred thousand dollars for all assessments estab-
5 lished pursuant to this section and the personal care services provider
6 assessment established pursuant to section three hundred sixty-seven-i
7 of the social services law, shall be paid from the assessment funds.
8 § 3. Subdivision 2 of section 3614-b of the public health law, as
9 amended by section 9 of part CC of chapter 407 of the laws of 1999, is
10 amended to read as follows:
11 2. (a) The assessment shall be six-tenths of one percent of such
12 licensed home care services agency's gross receipts received from all
13 patient care services and other operating income on a cash basis begin-
14 ning April first, nineteen hundred ninety-two; provided, however, that
15 for all such gross receipts received on or after April first, nineteen
16 hundred ninety-nine, such assessment shall be two-tenths of one percent,
17 and further provided that such assessment shall expire and be of no
18 further effect for all such gross receipts received on or after January
19 first, two thousand.
20 (b) Notwithstanding any contrary provisions of this section or any
21 other contrary provision of law or regulation, the assessment shall be
22 thirty-five hundredths of one percent of each such licensed home care
23 services agency's gross receipts received from all personal care
24 services and other operating income on a cash basis for periods on and
25 after April first, two thousand nine.
26 § 4. Subdivision 2 of section 367-i of the social services law, as
27 amended by section 10 of part CC of chapter 407 of the laws of 1999, is
28 amended to read as follows:
29 2. (a) The assessment shall be six-tenths of one percent of each such
30 provider's gross receipts received from all personal care services and
31 other operating income on a cash basis beginning January first, nineteen
32 hundred ninety-one; provided, however, that for all such gross receipts
33 received on or after April first, nineteen hundred ninety-nine, such
34 assessment shall be two-tenths of one percent, and further provided that
35 such assessment shall expire and be of no further effect for all such
36 gross receipts received on or after January first, two thousand.
37 (b) Notwithstanding any contrary provisions of this section or any
38 other contrary provision of law or regulation, the assessment shall be
39 thirty-five hundredths of one percent of each such provider's gross
40 receipts from all personal care services and other operating income on a
41 cash basis for periods on and after April first, two thousand nine.
42 § 5. (a) Notwithstanding any provision of law to the contrary, in the
43 event that certain "proposed or final regulations of the federal Centers
44 for Medicare and Medicaid Services," as defined in subdivision (b) of
45 this section, become final and enforceable, the commissioner of health,
46 in consultation with the director of the budget, may impose federal
47 financial participation contingency requirements on expenditures that
48 would otherwise be required to be made pursuant to state law but which,
49 as a result of such final and enforceable regulations, would be required
50 to be made entirely with non-federal funds. In such event, the commis-
51 sioner of health, in consultation with the director of the budget, may
52 make expenditures of such non-federal funds as he or she, in his or her
53 discretion, deems to be available for such purposes.
54 (b) For purposes of this section, "proposed or final regulations of
55 the Centers for Medicare and Medicaid Services" are regulations subject
56 to a moratorium in effect until July 1, 2009 pursuant to P.L. 110-252,
S. 58--B 17 A. 158--B
1 as amended by P.L. 111-5, specifically: (i) interim final regulation
2 dealing with case management and targeted case management published
3 December 4, 2007 (CMS-2237-IFC); (ii) final rule implementing changes to
4 Medicaid provider tax provisions published February 22, 2008
5 (CMS-2275-F); (iii) final rule dealing with public provider cost limits
6 published May 29, 2007 (CMS-2258-FC); (iv) proposed rule dealing with
7 Medicaid graduate medical education published May 23, 2007 (CMS-2279-P);
8 (v) proposed rule dealing with the Medicaid rehabilitation services
9 option published August 13, 2007 (CMS-2261-P); and (vi) final rule
10 concerning school-based services published December 28, 2007
11 (CMS-2287-F) and a regulation subject to a moratorium in effect until
12 June 30, 2009 pursuant to P.L. 111-5, specifically: final regulation
13 concerning outpatient hospital facility services published November 7,
14 2008 (73 Federal Register 66187).
15 § 6. Intentionally omitted.
16 § 7. Intentionally omitted.
17 § 8. Intentionally omitted.
18 § 9. Intentionally omitted.
19 § 10. Subdivision 2 of section 93 of part C of chapter 58 of the laws
20 of 2007 amending the social services law and other laws relating to
21 enacting the major components of legislation necessary to implement the
22 health and mental hygiene budget for the 2007-2008 fiscal year, is
23 amended to read as follows:
24 2. section two of this act shall expire and be deemed repealed on
25 March 31, [2010] 2013;
26 § 11. Paragraph (e-1) of subdivision 12 of section 2808 of the public
27 health law, as amended by section 64 of part C of chapter 58 of the laws
28 of 2007, is amended to read as follows:
29 (e-1) Notwithstanding any inconsistent provision of law or regulation,
30 the commissioner shall provide, in addition to payments established
31 pursuant to this article prior to application of this section, addi-
32 tional payments under the medical assistance program pursuant to title
33 eleven of article five of the social services law for non-state operated
34 public residential health care facilities, including public residential
35 health care facilities located in the county of Nassau, the county of
36 Westchester and the county of Erie, but excluding public residential
37 health care facilities operated by a town or city within a county, in
38 aggregate annual amounts of up to one hundred fifty million dollars in
39 additional payments for the state fiscal year beginning April first, two
40 thousand six and for the state fiscal year beginning April first, two
41 thousand seven and for the state fiscal year beginning April first, two
42 thousand eight and for the state fiscal year beginning April first, two
43 thousand nine, and for the state fiscal year beginning April first, two
44 thousand ten and for the state fiscal year beginning April first, two
45 thousand eleven. The amount allocated to each eligible public residen-
46 tial health care facility for this period shall be computed in accord-
47 ance with the provisions of paragraph (f) of this subdivision, provided,
48 however, that patient days shall be utilized for such computation
49 reflecting actual reported data for two thousand three and each repre-
50 sentative succeeding year as applicable.
51 § 12. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
52 the laws of 1996, amending the education law and other laws relating to
53 rates for residential health care facilities, as amended by section 65
54 of part C of chapter 58 of the laws of 2007, is amended to read as
55 follows:
S. 58--B 18 A. 158--B
1 (a) Notwithstanding any inconsistent provision of law or regulation to
2 the contrary, effective beginning August 1, 1996, for the period April
3 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
4 1998 through March 31, 1999, August 1, 1999, for the period April 1,
5 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
6 through March 31, 2001, April 1, 2001, for the period April 1, 2001
7 through March 31, 2002, April 1, 2002, for the period April 1, 2002
8 through March 31, 2003, and for the state fiscal year beginning April 1,
9 2005 through March 31, 2006, and for the state fiscal year beginning
10 April 1, 2006 through March 31, 2007, and for the state fiscal year
11 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
12 year beginning April 1, 2008 through March 31, 2009, and for the state
13 fiscal year beginning April 1, 2009 through March 31, 2010, and for the
14 state fiscal year beginning April 1, 2010 through March 31, 2011, the
15 department of health is authorized to pay public general hospitals, as
16 defined in subdivision 10 of section 2801 of the public health law,
17 operated by the state of New York or by the state university of New York
18 or by a county, which shall not include a city with a population of over
19 one million, of the state of New York, and those public general hospi-
20 tals located in the county of Westchester, the county of Erie or the
21 county of Nassau, additional payments for inpatient hospital services as
22 medical assistance payments pursuant to title 11 of article 5 of the
23 social services law for patients eligible for federal financial partic-
24 ipation under title XIX of the federal social security act in medical
25 assistance pursuant to the federal laws and regulations governing
26 disproportionate share payments to hospitals up to one hundred percent
27 of each such public general hospital's medical assistance and uninsured
28 patient losses after all other medical assistance, including dispropor-
29 tionate share payments to such public general hospital for 1996, 1997,
30 1998, and 1999, based initially for 1996 on reported 1994 reconciled
31 data as further reconciled to actual reported 1996 reconciled data, and
32 for 1997 based initially on reported 1995 reconciled data as further
33 reconciled to actual reported 1997 reconciled data, for 1998 based
34 initially on reported 1995 reconciled data as further reconciled to
35 actual reported 1998 reconciled data, for 1999 based initially on
36 reported 1995 reconciled data as further reconciled to actual reported
37 1999 reconciled data, for 2000 based initially on reported 1995 recon-
38 ciled data as further reconciled to actual reported 2000 data, for 2001
39 based initially on reported 1995 reconciled data as further reconciled
40 to actual reported 2001 data, for 2002 based initially on reported 2000
41 reconciled data as further reconciled to actual reported 2002 data, and
42 for state fiscal years beginning on April 1, 2005, based initially on
43 reported 2000 reconciled data as further reconciled to actual reported
44 data for 2005, and for state fiscal years beginning on April 1, 2006,
45 based initially on reported 2000 reconciled data as further reconciled
46 to actual reported data for 2006 [and], for state fiscal years beginning
47 on and after April 1, 2007 through March 31, 2009, based initially on
48 reported 2000 reconciled data as further reconciled to actual reported
49 data for 2007, for state fiscal years beginning on and after April 1,
50 2009, based initially on reported 2007 reconciled data, adjusted for
51 authorized Medicaid rate changes applicable to the state fiscal year,
52 and as further reconciled to actual reported data for 2009, and to actu-
53 al reported data for each respective succeeding year. The payments may
54 be added to rates of payment or made as aggregate payments to an eligi-
55 ble public general hospital.
S. 58--B 19 A. 158--B
1 § 13. Paragraph (b) of subdivision 1 of section 211 of chapter 474 of
2 the laws of 1996, amending the education law and other laws relating to
3 rates for residential health care facilities, as amended by section 66
4 of part C of chapter 58 of the laws of 2007, is amended to read as
5 follows:
6 (b) Notwithstanding any inconsistent provision of law or regulation to
7 the contrary, effective beginning April 1, 2000, the department of
8 health is authorized to pay public general hospitals, other than those
9 operated by the state of New York or the state university of New York,
10 as defined in subdivision 10 of section 2801 of the public health law,
11 located in a city with a population of over 1 million, additional
12 initial payments for inpatient hospital services of $120 million during
13 each state fiscal year until March 31, 2003, and up to $120 million
14 during the state fiscal year beginning April 1, 2005 through March 31,
15 2006 and during the state fiscal year beginning April 1, 2006 through
16 March 31, 2007 and during the state fiscal year beginning April 1, 2007
17 through March 31, 2008 and during the state fiscal year beginning April
18 1, 2008 through March 31, 2009, and up to four hundred twenty million
19 dollars annually for the state fiscal year beginning April 1, 2009
20 through March 31, 2010, and for the state fiscal year beginning April 1,
21 2010 through March 31, 2011 and up to one hundred twenty million dollars
22 annually for the state fiscal year beginning April 1, 2011, and annually
23 thereafter, as medical assistance payments pursuant to title 11 of arti-
24 cle 5 of the social services law for patients eligible for federal
25 financial participation under title XIX of the federal social security
26 act in medical assistance pursuant to the federal laws and regulations
27 governing disproportionate share payments to hospitals based on the
28 relative share of each such non-state operated public general hospital
29 of medical assistance and uninsured patient losses after all other
30 medical assistance, including disproportionate share payments to such
31 public general hospitals for payments made during the state fiscal year
32 ending March 31, 2001, based initially on reported 1995 reconciled data
33 as further reconciled to actual reported 2000 or 2001 data, for
34 payments made during the state fiscal year ending March 31, 2002, based
35 initially on reported 1995 reconciled data as further reconciled to
36 actual reported 2001 or 2002 data, for payments made during the state
37 fiscal year ending March 31, 2003, based initially on reported 2000
38 reconciled data as further reconciled to actual reported 2002 or 2003
39 data, for payments made during the state fiscal year ending on and after
40 March 31, 2006, based initially on reported 2000 reconciled data as
41 further reconciled to actual reported 2005 or 2006 data, for payments
42 made during the state fiscal year ending on and after March 31, 2007,
43 based initially on reported 2000 reconciled data as further reconciled
44 to actual reported 2006 or 2007 data for payments made during the state
45 fiscal years ending on and after March 31, 2008, based initially on
46 reported 2000 reconciled data as further reconciled to actual reported
47 2007 or 2008 data, for payments made during the state fiscal year ending
48 on and after March 31, 2010, based initially on reported 2007 reconciled
49 data, adjusted for authorized Medicaid rate changes applicable to the
50 state fiscal year, and as further reconciled to actual reported 2009
51 data, and to actual reported data for each respective succeeding year.
52 The payments may be added to rates of payment or made as aggregate
53 payments to an eligible public general hospital.
54 § 14. Section 11 of chapter 884 of the laws of 1990, amending the
55 public health law relating to authorizing bad debt and charity care
56 allowances for certified home health agencies, as amended by section 68
S. 58--B 20 A. 158--B
1 of part C of chapter 58 of the laws of 2007, is amended to read as
2 follows:
3 § 11. This act shall take effect immediately and:
4 (a) sections one and three shall expire on December 31, 1996,
5 (b) sections four through ten shall expire on June 30, [2009] 2011,
6 and
7 (c) provided that the amendment to section 2807-b of the public health
8 law by section two of this act shall not affect the expiration of such
9 section 2807-b as otherwise provided by law and shall be deemed to
10 expire therewith.
11 § 15. Subdivisions 2 and 4 of section 246 of chapter 81 of the laws of
12 1995, amending the public health law and other laws relating to medical
13 reimbursement and welfare reform, as amended by section 69 of part C of
14 chapter 58 of the laws of 2007, are amended to read as follows:
15 2. Sections five, seven through nine, twelve through fourteen, and
16 eighteen of this act shall be deemed to have been in full force and
17 effect on and after April 1, 1995 through March 31, 1999 and on and
18 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
19 through March 31, 2003 and on and after April 1, 2003 through March 31,
20 2006 and on and after April 1, 2006 through March 31, 2007 and on and
21 after April 1, 2007 through March 31, 2009 and on and after April 1,
22 2009 through March 31, 2011;
23 4. Section one of this act shall be deemed to have been in full force
24 and effect on and after April 1, 1995 through March 31, 1999 and on and
25 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000
26 through March 31, 2003 and on and after April 1, 2003 through March 31,
27 2006 and on and after April 1, 2006 through March 31, 2007 and on and
28 after April 1, 2007 through March 31, 2009 and on and after April 1,
29 2009 through March 31, 2011.
30 § 16. Subparagraph (iii) of paragraph (f) of subdivision 4 of section
31 2807-c of the public health law, as amended by section 70 of part C of
32 chapter 58 of the laws of 2007, is amended to read as follows:
33 (iii) commencing April first, nineteen hundred ninety-seven through
34 March thirty-first, nineteen hundred ninety-nine and commencing July
35 first, nineteen hundred ninety-nine through March thirty-first, two
36 thousand and April first, two thousand through March thirty-first, two
37 thousand five and for periods commencing April first, two thousand five
38 through March thirty-first, two thousand six and for periods commencing
39 on and after April first, two thousand six through March thirty-first,
40 two thousand seven, and for periods commencing on and after April first,
41 two thousand seven through March thirty-first, two thousand nine, and
42 for periods commencing on and after April first, two thousand nine
43 through March thirty-first, two thousand eleven, the reimbursable inpa-
44 tient operating cost component of case based rates of payment per diag-
45 nosis-related group, excluding any operating cost components related to
46 direct and indirect expenses of graduate medical education, for patients
47 eligible for payments made by state governmental agencies shall be
48 reduced by three and thirty-three hundredths percent to encourage
49 improved productivity and efficiency. Such election shall not alter the
50 calculation of the group price component calculated pursuant to subpara-
51 graph (i) of paragraph (a) of subdivision seven of this section;
52 § 17. Subparagraph (iii) of paragraph (k) of subdivision 4 of section
53 2807-c of the public health law, as amended by section 71 of part C of
54 chapter 58 of the laws of 2007, is amended to read as follows:
55 (iii) commencing April first, nineteen hundred ninety-seven through
56 March thirty-first, nineteen hundred ninety-nine and commencing July
S. 58--B 21 A. 158--B
1 first, nineteen hundred ninety-nine through March thirty-first, two
2 thousand and April first, two thousand through March thirty-first, two
3 thousand five and commencing April first, two thousand five through
4 March thirty-first, two thousand six, and for periods commencing on and
5 after April first, two thousand six through March thirty-first, two
6 thousand seven, and for periods commencing on and after April first, two
7 thousand seven through March thirty-first, two thousand nine, and for
8 periods commencing on and after April first, two thousand nine through
9 March thirty-first, two thousand eleven, the operating cost component of
10 rates of payment, excluding any operating cost components related to
11 direct and indirect expenses of graduate medical education, for patients
12 eligible for payments made by a state governmental agency shall be
13 reduced by three and thirty-three hundredths percent to encourage
14 improved productivity and efficiency. The facility will be eligible to
15 receive the financial incentives for the physician specialty weighting
16 incentive towards primary care pursuant to subparagraph (ii) of para-
17 graph (a) of subdivision twenty-five of this section.
18 § 18. The opening paragraph of subparagraph (vi) of paragraph (b) of
19 subdivision 5 of section 2807-c of the public health law, as amended by
20 section 72 of part C of chapter 58 of the laws of 2007, is amended to
21 read as follows:
22 for discharges on or after April first, nineteen hundred ninety-seven
23 through March thirty-first, nineteen hundred ninety-nine and for
24 discharges on or after July first, nineteen hundred ninety-nine through
25 March thirty-first, two thousand and for discharges on or after April
26 first, two thousand through March thirty-first, two thousand five and
27 for discharges on or after April first, two thousand five through March
28 thirty-first, two thousand six, and for discharges on or after April
29 first, two thousand six through March thirty-first, two thousand seven,
30 and for discharges on or after April first, two thousand seven through
31 March thirty-first, two thousand nine, and for discharges on or after
32 April first, two thousand nine through March thirty-first, two thousand
33 eleven, for purposes of reimbursement of inpatient hospital services for
34 patients eligible for payments made by state governmental agencies, the
35 average reimbursable inpatient operating cost per discharge of a general
36 hospital shall, to encourage improved productivity and efficiency, be
37 the sum of:
38 § 19. The opening paragraph and subparagraph (i) of paragraph (c) of
39 subdivision 5 of section 2807-c of the public health law, as amended by
40 section 73 of part C of chapter 58 of the laws of 2007, are amended to
41 read as follows:
42 Notwithstanding any inconsistent provision of this section, commencing
43 July first, nineteen hundred ninety-six through March thirty-first,
44 nineteen hundred ninety-nine and July first, nineteen hundred ninety-
45 nine through March thirty-first, two thousand and April first, two thou-
46 sand through March thirty-first, two thousand five and for periods on
47 and after April first, two thousand five through March thirty-first, two
48 thousand six, and for periods on and after April first, two thousand six
49 through March thirty-first, two thousand seven, and for periods on and
50 after April first, two thousand seven through March thirty-first, two
51 thousand nine, and for periods on and after April first, two thousand
52 nine through March thirty-first, two thousand eleven, rates of payment
53 for a general hospital for patients eligible for payments made by state
54 governmental agencies shall be further reduced by the commissioner to
55 encourage improved productivity and efficiency by providers by a factor
56 determined as follows:
S. 58--B 22 A. 158--B
1 (i) an aggregate reduction shall be calculated for each general hospi-
2 tal commencing July first, nineteen hundred ninety-six through March
3 thirty-first, nineteen hundred ninety-nine and July first, nineteen
4 hundred ninety-nine through March thirty-first, two thousand and April
5 first, two thousand through March thirty-first, two thousand five and
6 for periods on and after April first, two thousand five through March
7 thirty-first, two thousand six, and for periods on and after April
8 first, two thousand six through March thirty-first, two thousand seven,
9 and for periods on and after April first, two thousand seven through
10 March thirty-first, two thousand nine, and for periods on and after
11 April first, two thousand nine through March thirty-first, two thousand
12 eleven, as the result of (A) eighty-nine million dollars on an annual-
13 ized basis for each year, multiplied by (B) the ratio of patient days
14 for patients eligible for payments made by state governmental agencies
15 provided in a base year two years prior to the rate year by a general
16 hospital, divided by the total of such patient days summed for all
17 general hospitals; and
18 § 20. Clause (B-1) of subparagraph (i) of paragraph (f) of subdivision
19 11 of section 2807-c of the public health law, as amended by section 74
20 of part C of chapter 58 of the laws of 2007, is amended to read as
21 follows:
22 (B-1) The increase in the statewide average case mix in the periods
23 January first, nineteen hundred ninety-seven through March thirty-first,
24 two thousand and on and after April first, two thousand through March
25 thirty-first, two thousand six and on and after April first, two thou-
26 sand six through March thirty-first, two thousand seven, and on and
27 after April first, two thousand seven through March thirty-first, two
28 thousand nine, and on and after April first, two thousand nine through
29 March thirty-first, two thousand eleven, from the statewide average case
30 mix for the period January first, nineteen hundred ninety-six through
31 December thirty-first, nineteen hundred ninety-six shall not exceed one
32 percent for nineteen hundred ninety-seven, two percent for nineteen
33 hundred ninety-eight, three percent for the period January first, nine-
34 teen hundred ninety-nine through September thirtieth, nineteen hundred
35 ninety-nine, four percent for the period October first, nineteen hundred
36 ninety-nine through December thirty-first, nineteen hundred ninety-nine,
37 and four percent for two thousand plus an additional one percent per
38 year thereafter, based on comparison of data only for patients that are
39 eligible for medical assistance pursuant to title eleven of article five
40 of the social services law, including such patients enrolled in health
41 maintenance organizations.
42 § 21. Subdivision 1 of section 46 of chapter 639 of the laws of 1996
43 amending the public health law and other laws relating to welfare
44 reform, as amended by section 75 of part C of chapter 58 of the laws of
45 2007, is amended to read as follows:
46 1. Notwithstanding any inconsistent provision of law or regulation to
47 the contrary, the trend factors used to project reimbursable operating
48 costs to the rate period for purposes of determining rates of payment
49 pursuant to article 28 of the public health law for general hospitals
50 for reimbursement of inpatient hospital services provided to patients
51 eligible for payments made by state governmental agencies on and after
52 April 1, 1996 through June 30, 1996 and on or after July 1, 1996 through
53 March 31, 1999 and on and after July 1, 1999 through March 31, 2000 and
54 on and after April 1, 2000 through March 31, 2005 and on and after April
55 1, 2005 through March 31, 2006 and on and after April 1, 2006 through
56 March 31, 2007 and on and after April 1, 2007 through March 31, 2009,
S. 58--B 23 A. 158--B
1 and on and after April 1, 2009 through March 31, 2011, shall reflect no
2 trend factor projections or adjustments for the period April 1, 1996,
3 through March 31, 1997.
4 § 22. Section 4 of chapter 81 of the laws of 1995, amending the public
5 health law and other laws relating to medical reimbursement and welfare
6 reform, as amended by section 76 of part C of chapter 58 of the laws of
7 2007, is amended to read as follows:
8 § 4. Notwithstanding any inconsistent provision of law, except subdi-
9 vision 15 of section 2807 of the public health law and section 364-j-2
10 of the social services law and section 32-g of part F of chapter 412 of
11 the laws of 1999, rates of payment for diagnostic and treatment centers
12 established in accordance with paragraphs (b) and (h) of subdivision 2
13 of section 2807 of the public health law for the period ending September
14 30, 1995 shall continue in effect through September 30, 2000 and for the
15 periods October 1, 2000 through September 30, 2003 and October 1, 2003
16 through September 30, 2007 and October 1, 2007 through September 30,
17 2009, and on and after October 1, 2009 through September 30, 2011, and
18 further provided that rates in effect on March 31, 2003 as established
19 in accordance with paragraph (e) of subdivision 2 of section 2807 of the
20 public health law shall continue in effect for the period April 1, 2003
21 through September 30, 2007 and October 1, 2007 through September 30,
22 2009, and on and after October 1, 2009 through September 30, 2011,
23 provided however that, subject to the approval of the director of the
24 budget, such rates may be adjusted to include expenditures in those
25 components of rates not subject to the ceilings of the corresponding
26 rate methodology.
27 § 23. Subdivision 5 of section 246 of chapter 81 of the laws of 1995,
28 amending the public health law and other laws relating to medical
29 reimbursement and welfare reform, as amended by section 77 of part C of
30 chapter 58 of the laws of 2007, is amended to read as follows:
31 5. Section three of this act shall be deemed to have been in full
32 force and effect on and after April 1, 1995 through March 31, 1999 and
33 on and after July 1, 1999 through March 31, 2000 and on and after April
34 1, 2000 through March 31, 2003 and on and after April 1, 2003 through
35 March 31, 2007 and on and after April 1, 2007 through March 31, 2009,
36 and on and after April 1, 2009 through March 31, 2011;
37 § 24. Section 194 of chapter 474 of the laws of 1996, amending the
38 education law and other laws relating to rates of residential health
39 care facilities, as amended by section 78 of part C of chapter 58 of the
40 laws of 2007, is amended to read as follows:
41 § 194. 1. Notwithstanding any inconsistent provision of law or regu-
42 lation, the trend factors used to project reimbursable operating costs
43 to the rate period for purposes of determining rates of payment pursuant
44 to article 28 of the public health law for residential health care
45 facilities for reimbursement of inpatient services provided to patients
46 eligible for payments made by state governmental agencies on and after
47 April 1, 1996 through March 31, 1999 and for payments made on and after
48 July 1, 1999 through March 31, 2000 and on and after April 1, 2000
49 through March 31, 2003 and on and after April 1, 2003 through March 31,
50 2007 and on and after April 1, 2007 through March 31, 2009 and on and
51 after April 1, 2009 through March 31, 2011 shall reflect no trend factor
52 projections or adjustments for the period April 1, 1996, through March
53 31, 1997.
54 2. The commissioner of health shall adjust such rates of payment to
55 reflect the exclusion pursuant to this section of such specified trend
56 factor projections or adjustments.
S. 58--B 24 A. 158--B
1 § 25. Subdivision 1 of section 89-a of part C of chapter 58 of the
2 laws of 2007 amending the social services law and other laws relating to
3 enacting major components of legislation necessary to implement the
4 health and mental hygiene budget for the 2007-2008 fiscal year, is
5 amended to read as follows:
6 1. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c
7 of the public health law and section 21 of chapter 1 of the laws of
8 1999, as amended, and any other inconsistent provision of law or regu-
9 lation to the contrary, in determining rates of payments by state
10 governmental agencies effective for services provided beginning April 1,
11 2006, through March 31, 2009, and on and after April 1, 2009 through
12 March 31, 2011 for inpatient and outpatient services provided by general
13 hospitals and for inpatient services and outpatient adult day health
14 care services provided by residential health care facilities pursuant to
15 article 28 of the public health law, the commissioner of health shall
16 apply a trend factor projection of two and twenty-five hundredths
17 percent attributable to the period January 1, 2006 through December 31,
18 2006, and on and after January 1, 2007, provided, however, that on
19 reconciliation of such trend factor for the period January 1, 2006
20 through December 31, 2006 pursuant to paragraph (c) of subdivision 10 of
21 section 2807-c of the public health law, such trend factor shall be the
22 final US Consumer Price Index (CPI) for all urban consumers, as
23 published by the US Department of Labor, Bureau of Labor Statistics less
24 twenty-five hundredths of a percentage point.
25 § 26. Paragraph (f) of subdivision 1 of section 64 of chapter 81 of
26 the laws of 1995, amending the public health law and other laws relating
27 to medical reimbursement and welfare reform, as amended by section 79 of
28 part C of chapter 58 of the laws of 2007, is amended to read as follows:
29 (f) Prior to February 1, 2001, February 1, 2002, February 1, 2003,
30 February 1, 2004, February 1, 2005, February 1, 2006, February 1, 2007,
31 February 1, 2008 [and], February 1, 2009, February 1, 2010, and February
32 1, 2011 the commissioner of health shall calculate the result of the
33 statewide total of residential health care facility days of care
34 provided to beneficiaries of title XVIII of the federal social security
35 act (medicare), divided by the sum of such days of care plus days of
36 care provided to residents eligible for payments pursuant to title 11 of
37 article 5 of the social services law minus the number of days provided
38 to residents receiving hospice care, expressed as a percentage, for the
39 period commencing January 1, through November 30, of the prior year
40 respectively, based on such data for such period. This value shall be
41 called the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
42 2009, 2010 and 2011 statewide target percentage respectively.
43 § 27. Subparagraph (ii) of paragraph (b) of subdivision 3 of section
44 64 of chapter 81 of the laws of 1995, amending the public health law and
45 other laws relating to medical reimbursement and welfare reform, as
46 amended by section 80 of part C of chapter 58 of the laws of 2007, is
47 amended to read as follows:
48 (ii) If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
49 2007, 2008 [and], 2009, 2010 and 2011 statewide target percentages are
50 not for each year at least three percentage points higher than the
51 statewide base percentage, the commissioner of health shall determine
52 the percentage by which the statewide target percentage for each year is
53 not at least three percentage points higher than the statewide base
54 percentage. The percentage calculated pursuant to this paragraph shall
55 be called the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
56 2007, 2008 [and], 2009, 2010 and 2011 statewide reduction percentage
S. 58--B 25 A. 158--B
1 respectively. If the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005,
2 2006, 2007, 2008 [and], 2009, 2010 and 2011 statewide target percentage
3 for the respective year is at least three percentage points higher than
4 the statewide base percentage, the statewide reduction percentage for
5 the respective year shall be zero.
6 § 28. Subparagraph (iii) of paragraph (b) of subdivision 4 of section
7 64 of chapter 81 of the laws of 1995, amending the public health law and
8 other laws relating to medical reimbursement and welfare reform, as
9 amended by section 81 of part C of chapter 58 of the laws of 2007, is
10 amended to read as follows:
11 (iii) The 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
12 [and], 2009, 2010 and 2011 statewide reduction percentage shall be
13 multiplied by one hundred two million dollars respectively to determine
14 the 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
15 2009, 2010 and 2011 statewide aggregate reduction amount. If the 1998
16 and the 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and],
17 2009, 2010 and 2011 statewide reduction percentage shall be zero respec-
18 tively, there shall be no 1998, 2000, 2001, 2002, 2003, 2004, 2005,
19 2006, 2007, 2008 [and], 2009, 2010 and 2011 reduction amount.
20 § 29. Paragraph (b) of subdivision 5 of section 64 of chapter 81 of
21 the laws of 1995, amending the public health law and other laws relating
22 to medical reimbursement and welfare reform, as amended by section 82 of
23 part C of chapter 58 of the laws of 2007, is amended to read as follows:
24 (b) The 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005,
25 2006, 2007, 2008 [and], 2009, 2010 and 2011 statewide aggregate
26 reduction amounts shall for each year be allocated by the commissioner
27 of health among residential health care facilities that are eligible to
28 provide services to beneficiaries of title XVIII of the federal social
29 security act (medicare) and residents eligible for payments pursuant to
30 title 11 of article 5 of the social services law on the basis of the
31 extent of each facility's failure to achieve a two percentage points
32 increase in the 1996 target percentage, a three percentage point
33 increase in the 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
34 2007, 2008 [and], 2009, 2010 and 2011 target percentage and a two and
35 one-quarter percentage point increase in the 1999 target percentage for
36 each year, compared to the base percentage, calculated on a facility
37 specific basis for this purpose, compared to the statewide total of the
38 extent of each facility's failure to achieve a two percentage points
39 increase in the 1996 and a three percentage point increase in the 1997
40 and a three percentage point increase in the 1998 and a two and one-
41 quarter percentage point increase in the 1999 target percentage and a
42 three percentage point increase in the 2000, 2001, 2002, 2003, 2004,
43 2005, 2006, 2007, 2008 [and], 2009, 2010 and 2011 target percentage
44 compared to the base percentage. These amounts shall be called the 1996,
45 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
46 [and], 2009, 2010 and 2011 facility specific reduction amounts respec-
47 tively.
48 § 30. Section 228 of chapter 474 of the laws of 1996, amending the
49 education law and other laws relating to rates for residential health
50 care facilities, as amended by section 85 of part C of chapter 58 of the
51 laws of 2007, is amended to read as follows:
52 § 228. 1. Definitions. (a) Regions, for purposes of this section,
53 shall mean a downstate region to consist of Kings, New York, Richmond,
54 Queens, Bronx, Nassau and Suffolk counties and an upstate region to
55 consist of all other New York state counties. A certified home health
56 agency or long term home health care program shall be located in the
S. 58--B 26 A. 158--B
1 same county utilized by the commissioner of health for the establishment
2 of rates pursuant to article 36 of the public health law.
3 (b) Certified home health agency (CHHA) shall mean such term as
4 defined in section 3602 of the public health law.
5 (c) Long term home health care program (LTHHCP) shall mean such term
6 as defined in subdivision 8 of section 3602 of the public health law.
7 (d) Regional group shall mean all those CHHAs and LTHHCPs, respective-
8 ly, located within a region.
9 (e) Medicaid revenue percentage, for purposes of this section, shall
10 mean CHHA and LTHHCP revenues attributable to services provided to
11 persons eligible for payments pursuant to title 11 of article 5 of the
12 social services law divided by such revenues plus CHHA and LTHHCP reven-
13 ues attributable to services provided to beneficiaries of Title XVIII of
14 the federal social security act (medicare).
15 (f) Base period, for purposes of this section, shall mean calendar
16 year 1995.
17 (g) Target period. For purposes of this section, the 1996 target peri-
18 od shall mean August 1, 1996 through March 31, 1997, the 1997 target
19 period shall mean January 1, 1997 through November 30, 1997, the 1998
20 target period shall mean January 1, 1998 through November 30, 1998, the
21 1999 target period shall mean January 1, 1999 through November 30, 1999,
22 the 2000 target period shall mean January 1, 2000 through November 30,
23 2000, the 2001 target period shall mean January 1, 2001 through November
24 30, 2001, the 2002 target period shall mean January 1, 2002 through
25 November 30, 2002, the 2003 target period shall mean January 1, 2003
26 through November 30, 2003, the 2004 target period shall mean January 1,
27 2004 through November 30, 2004, and the 2005 target period shall mean
28 January 1, 2005 through November 30, 2005, the 2006 target period shall
29 mean January 1, 2006 through November 30, 2006, and the 2007 target
30 period shall mean January 1, 2007 through November 30, 2007 and the 2008
31 target period shall mean January 1, 2008 through November 30, 2008, and
32 the 2009 target period shall mean January 1, 2009 through November 30,
33 2009 and the 2010 target period shall mean January 1, 2010 through
34 November 30, 2010 and the 2011 target period shall mean January 1, 2011
35 through November 30, 2011.
36 2. (a) Prior to February 1, 1997, for each regional group the commis-
37 sioner of health shall calculate the 1996 medicaid revenue percentages
38 for the period commencing August 1, 1996 to the last date for which such
39 data is available and reasonably accurate.
40 (b) Prior to February 1, 1998, prior to February 1, 1999, prior to
41 February 1, 2000, prior to February 1, 2001, prior to February 1, 2002,
42 prior to February 1, 2003, prior to February 1, 2004, prior to February
43 1, 2005, prior to February 1, 2006, [and] prior to February 1, 2007,
44 [and] prior to February 1, 2008 [and], prior to February 1, 2009, prior
45 to February 1, 2010 and prior to February 1, 2011 for each regional
46 group the commissioner of health shall calculate the prior year's medi-
47 caid revenue percentages for the period commencing January 1 through
48 November 30 of such prior year.
49 3. By September 15, 1996, for each regional group the commissioner of
50 health shall calculate the base period medicaid revenue percentage.
51 4. (a) For each regional group, the 1996 target medicaid revenue
52 percentage shall be calculated by subtracting the 1996 medicaid revenue
53 reduction percentages from the base period medicaid revenue percentages.
54 The 1996 medicaid revenue reduction percentage, taking into account
55 regional and program differences in utilization of medicaid and medicare
56 services, for the following regional groups shall be equal to:
S. 58--B 27 A. 158--B
1 (i) one and one-tenth percentage points for CHHAs located within the
2 downstate region;
3 (ii) six-tenths of one percentage point for CHHAs located within the
4 upstate region;
5 (iii) one and eight-tenths percentage points for LTHHCPs located with-
6 in the downstate region; and
7 (iv) one and seven-tenths percentage points for LTHHCPs located within
8 the upstate region.
9 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
10 2008 [and], 2009, 2010 and 2011 for each regional group, the target
11 medicaid revenue percentage for the respective year shall be calculated
12 by subtracting the respective year's medicaid revenue reduction percent-
13 age from the base period medicaid revenue percentage. The medicaid
14 revenue reduction percentages for 1997, 1998, 2000, 2001, 2002, 2003,
15 2004, 2005, 2006, 2007, 2008 [and], 2009, 2010 and 2011 taking into
16 account regional and program differences in utilization of medicaid and
17 medicare services, for the following regional groups shall be equal to
18 for each such year:
19 (i) one and one-tenth percentage points for CHHAs located within the
20 downstate region;
21 (ii) six-tenths of one percentage point for CHHAs located within the
22 upstate region;
23 (iii) one and eight-tenths percentage points for LTHHCPs located with-
24 in the downstate region; and
25 (iv) one and seven-tenths percentage points for LTHHCPs located within
26 the upstate region.
27 (c) For each regional group, the 1999 target medicaid revenue percent-
28 age shall be calculated by subtracting the 1999 medicaid revenue
29 reduction percentage from the base period medicaid revenue percentage.
30 The 1999 medicaid revenue reduction percentages, taking into account
31 regional and program differences in utilization of medicaid and medicare
32 services, for the following regional groups shall be equal to:
33 (i) eight hundred twenty-five thousandths (.825) of one percentage
34 point for CHHAs located within the downstate region;
35 (ii) forty-five hundredths (.45) of one percentage point for CHHAs
36 located within the upstate region;
37 (iii) one and thirty-five hundredths percentage points (1.35) for
38 LTHHCPs located within the downstate region; and
39 (iv) one and two hundred seventy-five thousandths percentage points
40 (1.275) for LTHHCPs located within the upstate region.
41 5. (a) For each regional group, if the 1996 medicaid revenue percent-
42 age is not equal to or less than the 1996 target medicaid revenue
43 percentage, the commissioner of health shall compare the 1996 medicaid
44 revenue percentage to the 1996 target medicaid revenue percentage to
45 determine the amount of the shortfall which, when divided by the 1996
46 medicaid revenue reduction percentage, shall be called the 1996
47 reduction factor. These amounts, expressed as a percentage, shall not
48 exceed one hundred percent. If the 1996 medicaid revenue percentage is
49 equal to or less than the 1996 target medicaid revenue percentage, the
50 1996 reduction factor shall be zero.
51 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
52 2007, 2008 [and], 2009, 2010 and 2011 for each regional group, if the
53 medicaid revenue percentage for the respective year is not equal to or
54 less than the target medicaid revenue percentage for such respective
55 year, the commissioner of health shall compare such respective year's
56 medicaid revenue percentage to such respective year's target medicaid
S. 58--B 28 A. 158--B
1 revenue percentage to determine the amount of the shortfall which, when
2 divided by the respective year's medicaid revenue reduction percentage,
3 shall be called the reduction factor for such respective year. These
4 amounts, expressed as a percentage, shall not exceed one hundred
5 percent. If the medicaid revenue percentage for a particular year is
6 equal to or less than the target medicaid revenue percentage for that
7 year, the reduction factor for that year shall be zero.
8 6. (a) For each regional group, the 1996 reduction factor shall be
9 multiplied by the following amounts to determine each regional group's
10 applicable 1996 state share reduction amount:
11 (i) two million three hundred ninety thousand dollars ($2,390,000) for
12 CHHAs located within the downstate region;
13 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
14 within the upstate region;
15 (iii) one million two hundred seventy thousand dollars ($1,270,000)
16 for LTHHCPs located within the downstate region; and
17 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
18 located within the upstate region.
19 For each regional group reduction, if the 1996 reduction factor shall
20 be zero, there shall be no 1996 state share reduction amount.
21 (b) For 1997, 1998, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007,
22 2008 [and], 2009, 2010 and 2011 for each regional group, the reduction
23 factor for the respective year shall be multiplied by the following
24 amounts to determine each regional group's applicable state share
25 reduction amount for such respective year:
26 (i) two million three hundred ninety thousand dollars ($2,390,000) for
27 CHHAs located within the downstate region;
28 (ii) seven hundred fifty thousand dollars ($750,000) for CHHAs located
29 within the upstate region;
30 (iii) one million two hundred seventy thousand dollars ($1,270,000)
31 for LTHHCPs located within the downstate region; and
32 (iv) five hundred ninety thousand dollars ($590,000) for LTHHCPs
33 located within the upstate region.
34 For each regional group reduction, if the reduction factor for a
35 particular year shall be zero, there shall be no state share reduction
36 amount for such year.
37 (c) For each regional group, the 1999 reduction factor shall be multi-
38 plied by the following amounts to determine each regional group's appli-
39 cable 1999 state share reduction amount:
40 (i) one million seven hundred ninety-two thousand five hundred dollars
41 ($1,792,500) for CHHAs located within the downstate region;
42 (ii) five hundred sixty-two thousand five hundred dollars ($562,500)
43 for CHHAs located within the upstate region;
44 (iii) nine hundred fifty-two thousand five hundred dollars ($952,500)
45 for LTHHCPs located within the downstate region; and
46 (iv) four hundred forty-two thousand five hundred dollars ($442,500)
47 for LTHHCPs located within the upstate region.
48 For each regional group reduction, if the 1999 reduction factor shall
49 be zero, there shall be no 1999 state share reduction amount.
50 7. (a) For each regional group, the 1996 state share reduction amount
51 shall be allocated by the commissioner of health among CHHAs and LTHHCPs
52 on the basis of the extent of each CHHA's and LTHHCP's failure to
53 achieve the 1996 target medicaid revenue percentage, calculated on a
54 provider specific basis utilizing revenues for this purpose, expressed
55 as a proportion of the total of each CHHA's and LTHHCP's failure to
56 achieve the 1996 target medicaid revenue percentage within the applica-
S. 58--B 29 A. 158--B
1 ble regional group. This proportion shall be multiplied by the applica-
2 ble 1996 state share reduction amount calculation pursuant to paragraph
3 (a) of subdivision 6 of this section. This amount shall be called the
4 1996 provider specific state share reduction amount.
5 (b) For 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006,
6 2007, 2008 [and], 2009, 2010 and 2011 for each regional group, the state
7 share reduction amount for the respective year shall be allocated by the
8 commissioner of health among CHHAs and LTHHCPs on the basis of the
9 extent of each CHHA's and LTHHCP's failure to achieve the target medi-
10 caid revenue percentage for the applicable year, calculated on a provid-
11 er specific basis utilizing revenues for this purpose, expressed as a
12 proportion of the total of each CHHA's and LTHHCP's failure to achieve
13 the target medicaid revenue percentage for the applicable year within
14 the applicable regional group. This proportion shall be multiplied by
15 the applicable year's state share reduction amount calculation pursuant
16 to paragraph (b) or (c) of subdivision 6 of this section. This amount
17 shall be called the provider specific state share reduction amount for
18 the applicable year.
19 8. (a) The 1996 provider specific state share reduction amount shall
20 be due to the state from each CHHA and LTHHCP and may be recouped by the
21 state by March 31, 1997 in a lump sum amount or amounts from payments
22 due to the CHHA and LTHHCP pursuant to title 11 of article 5 of the
23 social services law.
24 (b) The provider specific state share reduction amount for 1997, 1998,
25 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 [and], 2009,
26 2010 and 2011 respectively, shall be due to the state from each CHHA and
27 LTHHCP and each year the amount due for such year may be recouped by the
28 state by March 31 of the following year in a lump sum amount or amounts
29 from payments due to the CHHA and LTHHCP pursuant to title 11 of article
30 5 of the social services law.
31 9. CHHAs and LTHHCPs shall submit such data and information at such
32 times as the commissioner of health may require for purposes of this
33 section. The commissioner of health may use data available from third-
34 party payors.
35 10. On or about June 1, 1997, for each regional group the commissioner
36 of health shall calculate for the period August 1, 1996 through March
37 31, 1997 a medicaid revenue percentage, a reduction factor, a state
38 share reduction amount, and a provider specific state share reduction
39 amount in accordance with the methodology provided in paragraph (a) of
40 subdivision 2, paragraph (a) of subdivision 5, paragraph (a) of subdivi-
41 sion 6 and paragraph (a) of subdivision 7 of this section. The provider
42 specific state share reduction amount calculated in accordance with this
43 subdivision shall be compared to the 1996 provider specific state share
44 reduction amount calculated in accordance with paragraph (a) of subdivi-
45 sion 7 of this section. Any amount in excess of the amount determined in
46 accordance with paragraph (a) of subdivision 7 of this section shall be
47 due to the state from each CHHA and LTHHCP and may be recouped in
48 accordance with paragraph (a) of subdivision 8 of this section. If the
49 amount is less than the amount determined in accordance with paragraph
50 (a) of subdivision 7 of this section, the difference shall be refunded
51 to the CHHA and LTHHCP by the state no later than July 15, 1997. CHHAs
52 and LTHHCPs shall submit data for the period August 1, 1996 through
53 March 31, 1997 to the commissioner of health by April 15, 1997.
54 11. If a CHHA or LTHHCP fails to submit data and information as
55 required for purposes of this section:
S. 58--B 30 A. 158--B
1 (a) such CHHA or LTHHCP shall be presumed to have no decrease in medi-
2 caid revenue percentage between the applicable base period and the
3 applicable target period for purposes of the calculations pursuant to
4 this section; and
5 (b) the commissioner of health shall reduce the current rate paid to
6 such CHHA and such LTHHCP by state governmental agencies pursuant to
7 article 36 of the public health law by one percent for a period begin-
8 ning on the first day of the calendar month following the applicable due
9 date as established by the commissioner of health and continuing until
10 the last day of the calendar month in which the required data and infor-
11 mation are submitted.
12 12. The commissioner of health shall inform in writing the director of
13 the budget and the chair of the senate finance committee and the chair
14 of the assembly ways and means committee of the results of the calcu-
15 lations pursuant to this section.
16 § 31. Notwithstanding any inconsistent provision of law, rule or regu-
17 lation, the annual percentage reductions set forth in sections twenty-
18 six through thirty of this act shall be prorated by the commissioner of
19 health for periods on and after April 1, 2009.
20 § 32. Subdivision 5-a 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 86 of part C of
23 chapter 58 of the laws of 2007, is amended to read as follows:
24 5-a. Section sixty-four-a of this act shall be deemed to have been in
25 full force and effect on and after April 1, 1995 through March 31, 1999
26 and on and after July 1, 1999 through March 31, 2000 and on and after
27 April 1, 2000 through March 31, 2003 and on and after April 1, 2003
28 through March 31, 2007, and on and after April 1, 2007 through March 31,
29 2009, and on and after April 1, 2009 through March 31, 2011;
30 § 33. Section 64-b of chapter 81 of the laws of 1995, amending the
31 public health law and other laws relating to medical reimbursement and
32 welfare reform, as amended by section 87 of part C of chapter 58 of the
33 laws of 2007, is amended to read as follows:
34 § 64-b. Notwithstanding any inconsistent provision of law, the
35 provisions of subdivision 7 of section 3614 of the public health law, as
36 amended, shall remain and be in full force and effect on April 1, 1995
37 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on
38 and after April 1, 2000 through March 31, 2003 and on and after April 1,
39 2003 through March 31, 2007, and on and after April 1, 2007 through
40 March 31, 2009, and on and after April 1, 2009 through March 31, 2011.
41 § 34. Intentionally omitted.
42 § 35. Section 3 of chapter 629 of the laws of 1986, amending the
43 social services law relating to establishing a demonstration program for
44 the delivery of long term home health care services to certain persons,
45 as amended by section 71 of part C of chapter 58 of the laws of 2008, is
46 amended to read as follows:
47 § 3. This act shall take effect July 1, 1986[, and shall remain in
48 effect until March 31, 2012, when upon such date the provisions of this
49 act shall be deemed repealed].
50 § 36. Subdivision 1 of section 2807-p of the public health law is
51 amended by adding two new paragraphs (c) and (d) to read as follows:
52 (c) Notwithstanding paragraph (a) of this subdivision, subdivision
53 four-c of this section or any other inconsistent provision of this
54 section, distributions made pursuant to this section for annual periods
55 on and after July first, two thousand nine shall be subject to a uniform
56 reduction of two percent.
S. 58--B 31 A. 158--B
1 (d) The commissioner may require facilities receiving distributions
2 pursuant to this section as a condition of participating in such
3 distributions, to provide reports and data to the department as the
4 commissioner deems necessary to adequately implement the provisions of
5 this section.
6 § 37. Intentionally omitted.
7 § 38. Subdivision 1 of section 20 of chapter 451 of the laws of 2007
8 amending the public health law, the social services law and the insur-
9 ance law, relating to providing enhanced consumer and provider
10 protections, is amended to read as follows:
11 1. sections four, eleven and thirteen of this act shall take effect
12 immediately and shall expire and be deemed repealed June 30, [2009]
13 2011;
14 § 39. Subdivision (r) of section 427 of chapter 55 of the laws of
15 1992, amending the tax law and other laws relating to taxes, surcharges,
16 fees and funding, as amended by section 15 of part C of chapter 56 of
17 the laws of 2007, is amended to read as follows:
18 (r) the provisions of sections two hundred eighty-six through two
19 hundred ninety-one of this act shall apply to all persons released on
20 medical parole [prior to September 1, 2009, and shall expire and be of
21 no further effect on September 1, 2009];
22 § 40. Section 3 of chapter 942 of the laws of 1983, relating to foster
23 family care demonstration programs, as amended by chapter 219 of the
24 laws of 2007, is amended to read as follows:
25 § 3. This act shall take effect immediately and shall expire December
26 31, [2009] 2013.
27 § 41. Section 3 of chapter 541 of the laws of 1984, relating to foster
28 family care demonstration programs, as amended by chapter 219 of the
29 laws of 2007, is amended to read as follows:
30 § 3. This section and subdivision two of section two of this act shall
31 take effect immediately and the remaining provisions of this act shall
32 take effect on the one hundred twentieth day next thereafter. This act
33 shall expire December 31, [2009] 2013.
34 § 42. Section 6 of chapter 256 of the laws of 1985, amending the
35 social services law and other laws relating to foster family care demon-
36 stration programs, as amended by chapter 219 of the laws of 2007, is
37 amended to read as follows:
38 § 6. This act shall take effect immediately and shall expire December
39 31, [2009] 2013 and upon such date the provisions of this act shall be
40 deemed to be repealed.
41 § 43. Section 2 of chapter 693 of the laws of 1996, amending the
42 social services law relating to authorizing patient discharge to hospic-
43 es and residential health care facilities, under the medical assistance
44 presumptive eligibility program, as amended by chapter 124 of the laws
45 of 2006, is amended to read as follows:
46 § 2. This act shall take effect immediately[ and shall be deemed
47 repealed on July 31, 2009].
48 § 44. Section 2 of chapter 631 of the laws of 1997, amending the
49 social services law relating to authorizing medical assistance payments
50 to certain clinics or diagnostic and treatment centers, as amended by
51 chapter 47 of the laws of 2007, is amended to read as follows:
52 § 2. This act shall take effect immediately and shall be deemed to
53 apply to claims for reimbursement payments whether submitted before, on
54 or after the effective date of this act[, and shall expire and be deemed
55 repealed July 1, 2009].
S. 58--B 32 A. 158--B
1 § 45. Section 4 of chapter 519 of the laws of 1999, amending the alco-
2 holic beverage control law and the public health law relating to the
3 sale of alcohol and tobacco products to minors, as amended by chapter
4 594 of the laws of 2007, is amended to read as follows:
5 § 4. This act shall take effect September 1, 1999[, and shall remain
6 in full force and effect until January 1, 2010 when upon such date the
7 provisions of this act shall expire and be deemed repealed]; provided,
8 however, the state liquor authority, state department of motor vehicles
9 and state department of health shall promulgate rules and regulations
10 necessary to implement the provisions of this act on or before such
11 date; [provided further that the provisions of this act shall apply
12 after such expiration date to any proceeding pursuant to the alcoholic
13 beverage control law or public health law to invoke or enforce the
14 provisions of this act which were commenced prior to such expiration
15 date;] and provided, further however, that the amendments to section
16 65-b of the alcoholic beverage control law made by section two of this
17 act shall not affect the repeal of such section and shall be deemed
18 repealed therewith.
19 § 46. The opening paragraph of subdivision 7-a of section 3614 of the
20 public health law, as amended by section 89 of part C of chapter 58 of
21 the laws of 2007, is amended to read as follows:
22 Notwithstanding any inconsistent provision of law or regulation, for
23 the purposes of establishing rates of payment by governmental agencies
24 for long term home health care programs for the period April first, two
25 thousand five, through December thirty-first, two thousand five, and for
26 the period January first, two thousand six through March thirty-first,
27 two thousand seven, and on and after April first, two thousand seven
28 through March thirty-first, two thousand nine, and on and after April
29 first, two thousand nine through March thirty-first, two thousand elev-
30 en, the reimbursable base year administrative and general costs of a
31 provider of services shall not exceed the statewide average of total
32 reimbursable base year administrative and general costs of such provid-
33 ers of services.
34 § 46-a. Section 365-a of the social services law is amended by adding
35 a new subdivision 8 to read as follows:
36 8. When a non-governmental entity is authorized by the department
37 pursuant to contract or subcontract to make prior authorization or prior
38 approval determinations that may be required for any item of medical
39 assistance, a recipient may challenge any action taken or failure to act
40 in connection with a prior authorization or prior approval determination
41 as if such determination were made by a government entity, and shall be
42 entitled to the same medical assistance benefits and standards and to
43 the same notice and procedural due process rights, including a right to
44 a fair hearing and aid continuing pursuant to section twenty-two of this
45 chapter, as if the prior authorization or prior approval determination
46 were made by a government entity.
47 § 47. Section 11 of part C of chapter 58 of the laws of 2008 amending
48 the social services law and the public health law relating to adjust-
49 ments of rates, as amended by section 1 of part I of chapter 2 of the
50 laws of 2009, is amended to read as follows:
51 § 11. 1. Notwithstanding paragraph (c) of subdivision 10 of section
52 2807-c of the public health law, subdivision 2-b of section 2808 of the
53 public health law, section 21 of chapter 1 of the laws of 1999, and any
54 other contrary provision of law, but subject to subparagraph (iii) of
55 paragraph [(b)] (a) of subdivision 33 of section 2807-c of the public
56 health law, in determining rates of payments by state governmental agen-
S. 58--B 33 A. 158--B
1 cies effective for services provided on and after April 1, 2008, for
2 inpatient and outpatient services provided by general hospitals, for
3 inpatient services and adult day health care outpatient services
4 provided by residential health care facilities pursuant to article 28 of
5 the public health law, except for residential health care facilities
6 that provide extensive nursing, medical, psychological and counseling
7 support services to children, for home health care services provided
8 pursuant to article 36 of the public health law by certified home health
9 agencies and long term home health care programs, other than for
10 services provided to home care patients diagnosed with AIDS as deter-
11 mined by applicable regulations, and personal care services provided
12 pursuant to paragraph (e) of subdivision two of section 365-a of the
13 social services law, the commissioner of health shall apply a trend
14 factor projection equal to sixty-five percent of the otherwise applica-
15 ble trend factor projection attributable to the period January 1, 2008
16 through December 31, 2008 in accordance with paragraph (c) of subdivi-
17 sion 10 of section 2807-c of the public health law, provided, however,
18 that for rates of payment effective for services provided on and after
19 January 1, 2009, the final trend factor projections attributable to the
20 2008 calendar year period shall be further adjusted such that any
21 increase to the average trend factor projections for the period April 1,
22 2008 through December 31, 2008 shall be reduced, on an annualized basis,
23 by one and three tenths percentage points and provided further, however,
24 that on and after April 1, 2009, such trend factor projections, includ-
25 ing services provided to home care patients diagnosed with AIDS as
26 determined by applicable regulations, shall be further reduced to zero,
27 and provided further, however, no retroactive adjustment to such 2008
28 trend factor projection shall be made for the period April 1, 2008
29 through December 31, 2008 pursuant to subparagraph 3 of paragraph (c) of
30 subdivision 10 of section 2807-c of the public health law and provided
31 further, however, that for rates of payment for assisted living program
32 services provided on and after April 1, 2009, trend factor projections
33 attributable to the 2008 calendar year shall be reduced to zero, and
34 further provided, however, that for rates of payment for personal care
35 services provided on and after April 1, 2009, in those social services
36 districts, including New York city, whose rates of payment for such
37 services are issued by such social services districts pursuant to a
38 rate-setting exemption issued by the commissioner of health to such
39 social services districts in accordance with applicable regulations,
40 trend factor projections attributable to the 2008 calendar year shall be
41 reduced to zero.
42 § 48. Notwithstanding paragraph (c) of subdivision 10 of section
43 2807-c of the public health law, subdivision 2-b of section 2808 of the
44 public health law, section 21 of chapter 1 of the laws of 1999, section
45 5 of part F of chapter 497 of the laws of 2008 and any other contrary
46 provision of law, in determining rates of payments by state governmental
47 agencies effective for services provided on and after [January] April 1,
48 2009, for inpatient and outpatient services provided by general hospi-
49 tals, for inpatient services and adult day health care outpatient
50 services provided by residential health care facilities pursuant to
51 article 28 of the public health law, except for residential health care
52 facilities that provide extensive nursing, medical, psychological and
53 counseling support services to children, for home health care services
54 provided pursuant to article 36 of the public health law by certified
55 home health agencies, long term home health care programs and AIDS home
56 care programs, and for personal care services provided pursuant to
S. 58--B 34 A. 158--B
1 section 367-i of the social services law, the commissioner of health
2 shall apply zero trend factor projections attributable to the 2009
3 calendar year in accordance with paragraph (c) of subdivision 10 of
4 section 2807-c of the public health law, provided, however, that such
5 zero trend factor projections for such 2009 calendar year shall also be
6 applied to rates of payment for personal care services provided in those
7 local social services districts, including New York city, whose rates of
8 payment for such services are established by such local social services
9 districts pursuant to a rate-setting exemption issued by the commission-
10 er of health to such local social services districts in accordance with
11 applicable regulations, and provided further, however, that for rates of
12 payment for assisted living program services provided on and after
13 [January] April 1, 2009, trend factor projections attributable to the
14 2009 calendar year shall be established at zero percent.
15 2. The commissioner of health shall adjust rates of payment to reflect
16 the exclusion pursuant to this section of such specified trend factor
17 projections or adjustments.
18 § 49. Paragraph (a) of subdivision 2 of section 2807-d of the public
19 health law is amended by adding a new subparagraph (vi) to read as
20 follows:
21 (vi) Notwithstanding any contrary provisions of this paragraph or any
22 other provision of law or regulation, for general hospitals the assess-
23 ment shall be thirty-five hundredths of one percent of each general
24 hospital's gross receipts received from all patient care services and
25 other operating income on a cash basis for periods on and after April
26 first, two thousand nine, for hospital or health-related services,
27 including, but not limited to inpatient services, outpatient services,
28 emergency services, referred ambulatory services and ambulatory surgical
29 services, but not including residential health care facilities services
30 or home health care services.
31 § 50. Paragraphs (b), (c), (d) and (e) of subdivision 2 of section
32 2807-j of the public health law, as amended by section 41 of part B of
33 chapter 58 of the laws of 2005, are amended to read as follows:
34 (b) The total percentage allowance for each payor, other than govern-
35 mental agencies, or health maintenance organizations for services
36 provided to subscribers eligible for medical assistance pursuant to
37 title eleven of article five of the social services law, or approved
38 organizations for services provided to subscribers eligible for the
39 family health plus program pursuant to title eleven-D of article five of
40 the social services law, and other than payments for a patient that has
41 no third-party coverage in whole or in part for services provided by a
42 designated provider of services, shall be:
43 (i) the sum of (A) eight and eighteen-hundredths percent, provided,
44 however, that for services provided on and after July first, two thou-
45 sand three, the percentage shall be eight and eighty-five hundredths
46 percent, and further provided that for services provided on and after
47 January first, two thousand six, the percentage shall be eight and nine-
48 ty-five hundredths percent, and further provided that for services
49 provided on and after April first, two thousand nine, the percentage
50 shall be nine and sixty-three hundredths percent, plus (B) twenty-four
51 percent, provided, however, that for services provided on and after July
52 first, two thousand three, the percentage shall be twenty-five and nine-
53 ty-seven hundredths percent, and further provided that for services
54 provided on and after January first, two thousand six, the percentage
55 shall be twenty-six and twenty-six hundredths percent, and further
56 provided that for services provided on and after April first, two thou-
S. 58--B 35 A. 158--B
1 sand nine, the percentage shall be twenty-eight and twenty-seven
2 hundredths percent, and plus (C) for a specified third-party payor as
3 defined in subdivision one-a of section twenty-eight hundred seven-s of
4 this article the percentage allowance applicable for a general hospital
5 for inpatient hospital services pursuant to subdivision two of section
6 twenty-eight hundred seven-s of this article;
7 (ii) unless (A) an election in accordance with paragraph (a) of subdi-
8 vision five of this section to pay the allowance directly to the commis-
9 sioner or the commissioner's designee is in effect for a third-party
10 payor, and in addition (B) for a specified third-party payor an election
11 to pay the assessment in accordance with section twenty-eight hundred
12 seven-t of this article is in effect.
13 (c) If an election in accordance with subdivision five of this section
14 is in effect for a third-party payor and in addition in accordance with
15 section twenty-eight hundred seven-t of this article for a specified
16 third-party payor, the total percentage allowance factor shall be
17 reduced to eight and eighteen-hundredths percent, provided, however,
18 that for services provided on and after July first, two thousand three
19 the total percentage allowance factor shall be reduced to eight and
20 eighty-five hundredths percent, and further provided that for services
21 provided on and after January first, two thousand six, the total
22 percentage allowance factor shall be reduced to eight and ninety-five
23 hundredths percent, and further provided that for services provided on
24 and after April first, two thousand nine, the total percentage allowance
25 factor shall be reduced to nine and sixty-three hundredths percent.
26 (d) The total percentage allowance for payments by governmental agen-
27 cies, as determined in accordance with paragraphs (a) and (a-1) of
28 subdivision one of section twenty-eight hundred seven-c of this article
29 as in effect on December thirty-first, nineteen hundred ninety-six, or
30 health maintenance organizations for services provided to subscribers
31 eligible for medical assistance pursuant to title eleven of article five
32 of the social services law, or approved organizations for services
33 provided to subscribers eligible for the family health plus program
34 pursuant to title eleven-D of article five of the social services law,
35 shall be five and ninety-eight-hundredths percent, provided, however,
36 that for services provided on and after July first, two thousand three
37 the total percentage allowance shall be six and forty-seven hundredths
38 percent, and further provided that for services provided on and after
39 January first, two thousand six, the total percentage allowance shall be
40 six and fifty-four hundredths percent, and further provided that for
41 services provided on and after April first, two thousand nine, the total
42 percentage allowance shall be seven and four hundredths percent.
43 (e) The total percentage allowance for payments for services provided
44 by designated providers of services for which there is no third-party
45 coverage in whole or in part shall be eight and eighteen-hundredths
46 percent, provided, however, that for services provided on and after July
47 first, two thousand three the total percentage allowance shall be eight
48 and eighty-five hundredths percent, and further provided that for
49 services provided on and after January first, two thousand six, the
50 total percentage allowance shall be eight and ninety-five hundredths
51 percent, and further provided that for services provided on and after
52 April first, two thousand nine, the total percentage allowance shall be
53 nine and sixty-three hundredths percent. This paragraph shall not apply
54 to patient deductibles and coinsurance amounts.
S. 58--B 36 A. 158--B
1 § 51. Clause (A) of subparagraph (i) of paragraph (b) of subdivision 1
2 of section 2807-1 of the public health law, as amended by section 4 of
3 part B of chapter 58 of the laws of 2008, is amended to read as follows:
4 (A) an amount not to exceed six million dollars on an annualized basis
5 for the periods January first, nineteen hundred ninety-seven through
6 December thirty-first, nineteen hundred ninety-nine; up to six million
7 dollars for the period January first, two thousand through December
8 thirty-first, two thousand; up to five million dollars for the period
9 January first, two thousand one through December thirty-first, two thou-
10 sand one; up to four million dollars for the period January first, two
11 thousand two through December thirty-first, two thousand two; up to two
12 million six hundred thousand dollars for the period January first, two
13 thousand three through December thirty-first, two thousand three; up to
14 one million three hundred thousand dollars for the period January first,
15 two thousand four through December thirty-first, two thousand four; up
16 to six hundred seventy thousand dollars for the period January first,
17 two thousand five through June thirtieth, two thousand five; up to one
18 million three hundred thousand dollars for the period April first, two
19 thousand six through March thirty-first, two thousand seven; and up to
20 one million three hundred thousand dollars annually for the period April
21 first, two thousand seven through March thirty-first, two thousand
22 [eleven] nine, shall be allocated to individual subsidy programs; and
23 § 52. Paragraph (e) of subdivision 2 of section 4 of section 1 of
24 chapter 703 of the laws of 1988, relating to enacting the expanded
25 health care coverage act of nineteen hundred eighty-eight and amending
26 the insurance law and other laws relating to expanded health care and
27 catastrophic health care coverage, as amended by section 20 of part B of
28 chapter 58 of the laws of 2008, is amended to read as follows:
29 (e) Applications for enrollment in the individual subsidy program will
30 not be accepted on and after January first, two thousand one; provided,
31 however, individuals and families who are otherwise eligible to receive
32 benefits under such program and are enrolled prior to January first, two
33 thousand one, may remain enrolled in such program until March thirty-
34 first, two thousand [eleven] nine.
35 § 53. Subdivision 1 of section 368-a of the social services law is
36 amended by adding a new paragraph (z) to read as follows:
37 (z) One hundred percent of the amount expended for health care
38 services described in sections three hundred sixty-eight-d and three
39 hundred sixty-eight-e of this title, after first deducting therefrom any
40 federal funds properly received or to be received on account thereof.
41 § 54. Section 368-d of the social services law, as amended by chapter
42 82 of the laws of 1995, is amended to read as follows:
43 § 368-d. Reimbursement to public school districts and state
44 operated/state supported schools which operate pursuant to article
45 eighty-five, eighty-seven or eighty-eight of the education law.
46 1. The department of health shall review claims for expenditures made
47 by or on behalf of local public school districts, and state
48 operated/state supported schools which operate pursuant to article
49 eighty-five, eighty-seven or eighty-eight of the education law, for
50 medical care, services and supplies which are furnished to children with
51 handicapping conditions or such children suspected of having handicap-
52 ping conditions, as such children are defined in the education law. If
53 approved by the department, payment for such medical care, services and
54 supplies which would otherwise qualify for reimbursement under this
55 title and which are furnished in accordance with this title and the
56 regulations of the department to such children, shall be made in accord-
S. 58--B 37 A. 158--B
1 ance with the department's approved medical assistance fee schedules by
2 payment to such local public school district, and state operated/state
3 supported schools which operate pursuant to article eighty-five, eight-
4 y-seven or eighty-eight of the education law, which furnished the care,
5 services or supplies either directly or by contract[, of the amount of
6 any federal funds properly received or to be received on account of such
7 expenditures].
8 2. Claims for payment under this section shall be made in such form
9 and manner, at such times, and for such periods as the department may
10 require.
11 3. [The department's liability for payment for expenditures by or on
12 behalf of local public school districts, and state operated/state
13 supported schools which operate pursuant to article eighty-five, eight-
14 y-seven or eighty-eight of the education law, for services furnished to
15 children under this section shall be limited solely to payment of the
16 federal funds received, or to be received, on account of such expendi-
17 tures. In the event of any subsequent disallowances or recoupment of
18 such funds by a federal governmental agency, upon notification by the
19 commissioner, the comptroller shall withhold or cause to be withheld the
20 amount of such disallowance or recoupment from moneys otherwise due the
21 local public school district, and state operated/state supported schools
22 which operate pursuant to article eighty-five, eighty-seven or eighty-
23 eight of the education law, as state aid pursuant to any provision of
24 the education law, and the comptroller shall transfer such amount to the
25 credit of the department of social services medical assistance program
26 local assistance account] The provisions of this section shall be of no
27 force and effect unless all necessary approvals under federal law and
28 regulation have been obtained to receive federal financial participation
29 in the costs of health care services provided pursuant to this section.
30 § 55. Section 368-e of the social services law, as added by chapter
31 558 of the laws of 1989, subdivision 1 as amended by chapter 631 of the
32 laws of 1997, is amended to read as follows:
33 § 368-e. Reimbursement to counties for pre-school children with handi-
34 capping conditions. 1. The department of health shall review claims for
35 expenditures made by counties and the city of New York for medical care,
36 services and supplies which are furnished to preschool children with
37 handicapping conditions or such preschool children suspected of having
38 handicapping conditions, as such children are defined in the education
39 law. If approved by the department, payment for such medical care,
40 services and supplies which would otherwise qualify for reimbursement
41 under this title and which are furnished in accordance with this title
42 and the regulations of the department to such children, shall be made in
43 accordance with the department's approved medical assistance fee sched-
44 ules by payment to such county or city which furnished the care,
45 services or supplies either directly or by contract[, of the amount of
46 any federal funds properly received or to be received on account of such
47 expenditures]. Notwithstanding any provisions of law, rule or regulation
48 to the contrary, any clinic or diagnostic and treatment center licensed
49 under article twenty-eight of the public health law, which as determined
50 by the state education department, in conjunction with the department of
51 health, has a less than arms length relationship with the provider
52 approved under section forty-four hundred ten of the education law
53 shall, subject to the approval of the department and based on standards
54 developed by the department, be authorized to directly submit such
55 claims for medical assistance, services or supplies so furnished for any
56 period beginning on or after July first, nineteen hundred ninety-seven.
S. 58--B 38 A. 158--B
1 The actual full cost of the individualized education program (IEP)
2 related services incurred by the clinic shall be reported on the New
3 York State Consolidated Fiscal Report in the education law section
4 forty-four hundred ten program cost center in which the student is
5 placed and the associated medical assistance revenue shall be reported
6 in the same manner.
7 2. Claims for payment under this section shall be made in such form
8 and manner, at such times, and for such periods as the department may
9 require.
10 [3. The department's liability for payment for expenditures by or on
11 behalf of such county or the city of New York for services furnished to
12 preschool children under this section shall be limited solely to payment
13 of the federal funds received, or to be received, on account of such
14 expenditures. In the event of any subsequent disallowances or recoupment
15 of such funds by a federal governmental agency, the commissioner shall
16 withhold such amount from any moneys otherwise due the county or city of
17 New York under this chapter] The provisions of this section shall be of
18 no force and effect unless all necessary approvals under federal law and
19 regulation have been obtained to receive federal financial participation
20 in the costs of health care services provided pursuant to this section.
21 § 56. Subdivision 1 of section 368-e of the social services law, as
22 amended by chapter 474 of the laws of 1996, is amended to read as
23 follows:
24 1. The department of health shall review claims for expenditures made
25 by counties and the city of New York for medical care, services and
26 supplies which are furnished to preschool children with handicapping
27 conditions or such preschool children suspected of having handicapping
28 conditions, as such children are defined in the education law. If
29 approved by the department, payment for such medical care, services and
30 supplies which would otherwise qualify for reimbursement under this
31 title and which are furnished in accordance with this title and the
32 regulations of the department to such children, shall be made in accord-
33 ance with the department's approved medical assistance fee schedules by
34 payment to such county or city which furnished the care, services or
35 supplies either directly or by contract[, of the amount of any federal
36 funds properly received or to be received on account of such expendi-
37 tures]. Notwithstanding any provisions of law, rule or regulation to the
38 contrary, any clinic or diagnostic and treatment center licensed under
39 article twenty-eight of the public health law, or articles sixteen and
40 thirty-one of the mental hygiene law, which submitted a claim for such
41 reimbursement payments on or before June thirtieth, nineteen hundred
42 ninety-five, shall, subject to the approval of the department and based
43 on standards developed by the department, continue to be authorized to
44 directly submit such claims for medical assistance, services or supplies
45 so furnished for any period thereafter until March thirty-first, nine-
46 teen hundred ninety-seven or such later date as the commissioner shall
47 authorize pursuant to regulation.
48 § 57. Section 5 of part G of chapter 56 of the laws of 2000, amending
49 the public health law and other laws relating to the sale and possession
50 of hypodermic syringes and needles, as amended by section 28 of part C
51 of chapter 56 of the laws of 2007, is REPEALED.
52 § 57-a. Section 5 of part G of chapter 56 of the laws of 2000, amend-
53 ing the public health law, and other laws relating to the sale and
54 possession of hypodermic syringes and needles, as amended by section 9
55 of part B of chapter 58 of the laws of 2007, is amended to read as
56 follows:
S. 58--B 39 A. 158--B
1 § 5. This act shall take effect January 1, 2001 [and shall remain in
2 full force and effect until September 1, 2011 when upon such date the
3 provisions of this act shall be deemed repealed]; provided, however,
4 that effective immediately the commissioner of health is authorized to
5 promulgate any rules and regulations necessary for the timely implemen-
6 tation of this act on such effective date.
7 § 58. Section 88 of chapter 659 of the laws of 1997, constituting the
8 long term care integration and finance act of 1997, as amended by
9 section 22-a of part C of chapter 58 of the laws of 2007, is amended to
10 read as follows:
11 § 88. Notwithstanding any provision of law to the contrary, all oper-
12 ating demonstrations, as such term is defined in paragraph [(d)] (c) of
13 subdivision 1 of section 4403-f of the public health law as added by
14 section eighty-two of this act, due to expire prior to January 1, 2001
15 shall be deemed to expire on December 31, [2009] 2011.
16 § 59. This act shall take effect immediately; provided however that
17 sections fifty-three through fifty-six of this act shall take effect
18 July 1, 2009 and shall apply to services provided on and after such
19 date; provided, however, that the amendments to section 2807-c of the
20 public health law made by sections sixteen, seventeen, eighteen, and
21 nineteen of this act shall not affect the expiration of such provisions
22 and shall be deemed to expire therewith; provided that the amendments to
23 section 2807-j of the public health law made by section fifty of this
24 act shall not affect the expiration of such section and shall be deemed
25 to expire therewith; and provided that the amendments to subdivision 1
26 of section 368-e of the social services law made by section fifty-five
27 of this act shall be subject to the expiration and reversion of such
28 subdivision pursuant to chapter 631 of the laws of 1997, as amended,
29 when upon such date the provisions of section fifty-six of this act
30 shall take effect.
31 PART C
32 Section 1. Legislative intent. The legislature finds that New York
33 leads the nation in Medicaid spending per capita and ranks third highest
34 in overall health care spending per capita. Despite this extraordinary
35 level of spending, 2.3 million New Yorkers are uninsured and New York's
36 health care system is ranked average among states and below average on
37 hospitalizations that could have been avoided if patients had timely
38 access to quality outpatient care. It is the intent of this legislation
39 to ensure that New Yorkers have access to a high-performing health
40 system and that New York Medicaid buys quality, cost-effective care by:
41 implementing a transparent and accurate inpatient reimbursement system
42 that rewards quality and efficiency; investing in ambulatory care
43 services and supporting the development of health care homes; supporting
44 providers that serve uninsured patients; increasing affordable coverage
45 in partnership with the federal government; investing in health informa-
46 tion technology; and more effectively and efficiently managing pharma-
47 ceutical benefits.
48 § 1-a. Short title. This act shall be known and may be cited as the
49 "health care improvement act".
50 § 1-b. Subparagraph (ii) of paragraph (a) of subdivision 33 of section
51 2807-c of the public health law, as added by section 12 of part C of
52 chapter 58 of the laws of 2008, is amended to read as follows:
53 (ii) for the period April first, two thousand nine through March thir-
54 ty-first, two thousand ten, such rates shall be revised pursuant to a
S. 58--B 40 A. 158--B
1 chapter of the laws of two thousand nine and as reflecting the findings
2 and recommendations of the commissioner as issued pursuant to the
3 provisions of paragraph (b) of this subdivision, provided, however, that
4 such revisions shall reflect an aggregate reduction in such rates of no
5 less than one hundred fifty-four million five hundred thousand dollars,
6 provided further, however, that, notwithstanding any contrary provision
7 of law, as determined by the commissioner, to the extent that a chapter
8 of the laws of two thousand nine is not enacted resulting in such an
9 aggregate annual reduction of no less than one hundred fifty-four
10 million five hundred thousand dollars in such rates, the commissioner
11 shall implement a uniform reduction of such rates in accordance with the
12 methodology described in subparagraph (i) of this paragraph to the
13 extent necessary, as determined by the commissioner, to achieve such an
14 aggregate reduction in such rates for the state fiscal year beginning
15 April first, two thousand nine and each state fiscal year thereafter;
16 and
17 § 2. Section 2807-c of the public health law is amended by adding a
18 new subdivision 35 to read as follows:
19 35. Notwithstanding any inconsistent provision of this section, or any
20 other contrary provision of law and subject to the availability of
21 federal financial participation, rates of payment by governmental agen-
22 cies for general hospital inpatient services with regard to discharges
23 occurring on and after December first, two thousand nine shall be in
24 accordance with the following:
25 (a) For periods on and after December first, two thousand nine the
26 operating cost component of such rates of payments shall reflect the use
27 of two thousand five operating costs as reported by each facility to the
28 department prior to July first, two thousand nine and as otherwise
29 computed in accordance with the provisions of this subdivision;
30 (b) The commissioner shall promulgate regulations, and may promulgate
31 emergency regulations, establishing methodologies for the computation of
32 general hospital inpatient rates and such regulations shall include, but
33 not be limited to, the following:
34 (i) The computation of a case-mix neutral statewide base price, appli-
35 cable to each rate period, but excluding adjustments for graduate
36 medical education costs, high cost outlier costs, costs related to
37 patient transfers, and other non-comparable costs as determined by the
38 commissioner, such statewide base prices may be periodically adjusted to
39 reflect changes in provider coding patterns and case-mix and such other
40 factors as may be determined by the commissioner;
41 (ii) Only those two thousand five base year costs which relate to the
42 cost of services provided to Medicaid inpatients, as determined by the
43 applicable ratio of costs to charges methodology, shall be utilized for
44 rate-setting purposes;
45 (iii) Such rates shall reflect the application of hospital specific
46 wage equalization factors reflecting differences in wage rates;
47 (iv) Such rates shall reflect the utilization of the all patient
48 refined (APR) case mix methodology, utilizing diagnostic related groups
49 with assigned weights that incorporate differing levels of severity of
50 patient condition and the associated risk of mortality, and as may be
51 periodically updated by the commissioner;
52 (v) Such regulations may incorporate quality related measures pertain-
53 ing to potentially preventable complications and re-admissions;
54 (vi) Such regulations shall address adjustments based on the costs of
55 high cost outlier patients;
S. 58--B 41 A. 158--B
1 (vii) Such rates shall continue to reflect trend factor adjustments as
2 otherwise provided in paragraph (c) of subdivision ten of this section;
3 (viii) Such rates shall not include any adjustments pursuant to subdi-
4 vision nine of this section;
5 (ix) Rates for non-public, not for profit general hospitals which have
6 not, as of the effective date of this subdivision, published an ancil-
7 lary charges schedule as provided in paragraph (j) of subdivision one of
8 section twenty-eight hundred three of this article shall have their
9 inlier payments increased by an amount equal to the average of cost
10 outlier payments for comparable hospitals or by a methodology that uses
11 a statewide or regional ratio of cost to charges applied to statewide or
12 regional comparable charges for those cases determined by the commis-
13 sioner;
14 (x) Such regulations shall provide for administrative rate appeals,
15 but only with regard to: (A) the correction of computational errors or
16 omissions of data, including with regard to the hospital specific compu-
17 tations pertaining to graduate medical education, wage equalization
18 factor adjustments, and (B) capital cost reimbursement;
19 (xi) Rates for teaching general hospitals shall include reimbursement
20 for direct and indirect graduate medical education as defined and calcu-
21 lated pursuant to such regulations. In addition, such regulations shall
22 specify the reports and information required by the commissioner to
23 assess the cost, quality and health system needs for medical education
24 provided.
25 (c) The base period reported costs and statistics used for rate-set-
26 ting for operating cost components, including the weights assigned to
27 diagnostic related groups, shall be updated no less frequently than
28 every four years and the new base period shall be no more than four
29 years prior to the first applicable rate period that utilizes such new
30 base period.
31 (d) Capital cost reimbursement for general hospitals otherwise subject
32 to the provisions of this subdivision shall remain subject to the
33 provisions of subdivision eight of this section.
34 (e) The provisions of this subdivision shall not apply to those gener-
35 al hospitals or distinct units of general hospitals whose inpatient
36 reimbursement does not, as of November thirtieth, two thousand nine,
37 reflect case based payment per diagnosis-related group or whose inpa-
38 tient reimbursement is, for periods on and after July first, two thou-
39 sand nine, governed by the provisions of paragraphs (e-1) or (e-2) of
40 subdivision four of this section.
41 (f) Notwithstanding section one hundred twelve or one hundred sixty-
42 three of the state finance law or any other law, rule or regulation to
43 the contrary, the commissioner may contract with a vendor for consider-
44 ation to develop the specifications for the diagnosis-related groups
45 methodology as provided for in regulations promulgated pursuant to para-
46 graph (b) of this subdivision if the commissioner certifies to the comp-
47 troller that such contract is in the best interest of the health of the
48 people of the state. Notwithstanding that such specifications shall be
49 available pursuant to article six of the public officers law, such
50 contract may provide that the specifications for such adjusted or addi-
51 tional diagnosis-related groups provided by the vendor shall be subject
52 to copyright protection pursuant to federal copyright law.
53 (g) Notwithstanding any inconsistent provision of this subdivision or
54 any other contrary provision of law, the commissioner may, for rate
55 periods on and after December first, two thousand nine and subject to
56 the availability of federal financial participation, make additional
S. 58--B 42 A. 158--B
1 adjustments to the inpatient rates of payment of eligible general hospi-
2 tals, to facilitate improvements in hospital operations and finances, in
3 accordance with the following:
4 (i) General hospitals eligible for distributions pursuant to this
5 paragraph shall be those non public hospitals with Medicaid discharges
6 equal to or greater than seventeen and one-half percent for two thousand
7 seven.
8 (ii) Funds distributed pursuant to this paragraph shall be allocated
9 to eligible hospitals pursuant to a formula such that, to the extent of
10 funds available, no hospital's reduction in Medicaid inpatient revenue
11 as a result of the application of the provisions of paragraphs (a) and
12 (b) of this subdivision exceeds a percentage reduction as determined by
13 the commissioner.
14 (iii) Funding pursuant to this paragraph shall be available for the
15 following periods and in the following amounts:
16 (A) for the period December first, two thousand nine through March
17 thirty-first, two thousand ten, up to seventy-five million dollars;
18 (B) for the period April first, two thousand ten through March thir-
19 ty-first, two thousand eleven, up to thirty-three million five hundred
20 thousand dollars;
21 (C) for the period April first, two thousand eleven through March
22 thirty-first, two thousand twelve, up to fifty million dollars;
23 (D) for the period April first, two thousand twelve through March
24 thirty-first, two thousand thirteen, up to twenty-five million dollars.
25 (iv) Payments made pursuant to this paragraph shall be added to rates
26 of payments and not be subject to retroactive adjustment or reconcil-
27 iation.
28 (v) Each hospital receiving funds pursuant to this paragraph shall, as
29 a condition for eligibility for such funds, adopt a resolution of the
30 board of directors of each such hospital setting forth its current
31 financial condition and a plan for reforming and improving such finan-
32 cial condition, including ongoing board oversight, and shall, after two
33 years, issue a report as adopted by each such board of directors setting
34 forth what progress has been achieved regarding such improvement,
35 provided, however, if such report is not issued and adopted by each such
36 board of directors, or if such report fails to set forth adequate
37 progress, as determined by the commissioner, the commissioner may deem
38 such facility ineligible for further distributions pursuant to this
39 paragraph and may redistribute such further distributions to other
40 eligible facilities in accordance with the provisions of this paragraph.
41 The commissioner shall be provided with copies of all such resolutions
42 and reports.
43 (h) Inpatient rate adjustments made pursuant to paragraphs (a) through
44 (f) of this subdivision after application of adjustments authorized
45 pursuant to subdivision thirty-three of this section shall result in a
46 net statewide decrease in aggregate Medicaid payments of no less than
47 seventy-five million dollars for the period December first, two thousand
48 nine through March thirty-first, two thousand ten, and no less than two
49 hundred twenty-five million dollars for the period April first, two
50 thousand ten through March thirty-first, two thousand eleven and each
51 state fiscal year thereafter, provided, however, that such reductions
52 shall be in addition to the reductions required pursuant to subparagraph
53 (ii) of paragraph (a) of subdivision thirty-three of this section.
54 § 3. Notwithstanding any contrary provision of law, if the commission-
55 er of health determines that federal financial participation will not be
56 available with regard to the provisions of subparagraph (ii) of para-
S. 58--B 43 A. 158--B
1 graph (g) of subdivision 35 of section 2807-c of the public health law,
2 such commissioner may deem such provision null and void and instead may
3 allocate funds pursuant to such paragraph (g) proportionally, based on
4 each eligible facility's relative share of Medicaid inpatient discharges
5 in the year two years prior to the distribution year.
6 § 4. Clause (A) of subparagraph (i) of paragraph (a) of subdivision 30
7 of section 2807-c of the public health law, as amended by section 22-b
8 of part B of chapter 58 of the laws of 2008, is amended to read as
9 follows:
10 (A) ninety-three million two hundred thousand dollars on an annualized
11 basis for the period April first, two thousand two through December
12 thirty-first, two thousand two; one hundred eighty-seven million eight
13 hundred thousand dollars on an annualized basis for the period January
14 first, two thousand three through December thirty-first, two thousand
15 three; two hundred sixty-two million one hundred thousand dollars on an
16 annualized basis for the period January first, two thousand four through
17 December thirty-first, two thousand six; one hundred thirty-one million
18 one hundred thousand dollars for the period January first, two thousand
19 seven through June thirtieth, two thousand seven, and two hundred
20 forty-three million five hundred thousand dollars for the period July
21 first, two thousand seven through March thirty-first, two thousand
22 eight, two hundred forty-three million five hundred thousand dollars for
23 the period April first, two thousand eight through March thirty-first,
24 two thousand nine; [two hundred forty-three] one hundred sixty-three
25 million [five] one hundred forty-five thousand dollars for the period
26 April first, two thousand nine through [March thirty-first] November
27 thirtieth, two thousand [ten; two hundred forty-three million five
28 hundred thousand dollars for the period April first, two thousand ten
29 through March thirty-first, two thousand eleven] nine.
30 § 5. Clause (A) of subparagraph (i) of paragraph (b) of subdivision 30
31 of section 2807-c of the public health law, as amended by section 22-b
32 of part B of chapter 58 of the laws of 2008, is amended to read as
33 follows:
34 (A) eighteen million five hundred thousand dollars on an annualized
35 basis for the period April first, two thousand two through December
36 thirty-first, two thousand two; thirty-seven million four hundred thou-
37 sand dollars on an annualized basis for the period January first, two
38 thousand three through December thirty-first, two thousand three;
39 fifty-two million two hundred thousand dollars on an annualized basis
40 for the period January first, two thousand four through December thir-
41 ty-first, two thousand six; twenty-six million one hundred thousand
42 dollars for the period January first, two thousand seven through June
43 thirtieth, two thousand seven[;], forty-nine million dollars for the
44 period July first, two thousand seven through March thirty-first, two
45 thousand eight[;], and forty-nine million dollars for the period April
46 first, two thousand eight through March thirty-first, two thousand
47 nine[; forty-nine million dollars for the period April first, two thou-
48 sand nine through March thirty-first, two thousand ten; and forty-nine
49 million dollars for the period April first, two thousand ten through
50 March thirty-first, two thousand eleven].
51 § 6. Paragraphs (x) and (y) of subdivision 1 of section 2807-v of the
52 public health law, as amended by section 5 of part B of chapter 58 of
53 the laws of 2008, are amended to read as follows:
54 (x) Funds shall be deposited by the commissioner, within amounts
55 appropriated, and the state comptroller is hereby authorized and
56 directed to receive for deposit to the credit of the state special
S. 58--B 44 A. 158--B
1 revenue funds - other, HCRA transfer fund, medical assistance account,
2 or any successor fund or account, for purposes of funding the state
3 share of the non-public general hospital rates increases for recruitment
4 and retention of health care workers from the tobacco control and insur-
5 ance initiatives pool established for the following periods in the
6 following amounts:
7 (i) twenty-seven million one hundred thousand dollars on an annualized
8 basis for the period January first, two thousand two through December
9 thirty-first, two thousand two;
10 (ii) fifty million eight hundred thousand dollars on an annualized
11 basis for the period January first, two thousand three through December
12 thirty-first, two thousand three;
13 (iii) sixty-nine million three hundred thousand dollars on an annual-
14 ized basis for the period January first, two thousand four through
15 December thirty-first, two thousand four;
16 (iv) sixty-nine million three hundred thousand dollars for the period
17 January first, two thousand five through December thirty-first, two
18 thousand five;
19 (v) sixty-nine million three hundred thousand dollars for the period
20 January first, two thousand six through December thirty-first, two thou-
21 sand six;
22 (vi) sixty-five million three hundred thousand dollars for the period
23 January first, two thousand seven through December thirty-first, two
24 thousand seven;
25 (vii) sixty-one million one hundred fifty thousand dollars for the
26 period January first, two thousand eight through December thirty-first,
27 two thousand eight; and
28 (viii) [fifty-three] forty-eight million [one] seven hundred [fifty]
29 twenty-one thousand dollars for the period January first, two thousand
30 nine through [December thirty-first] November thirtieth, two thousand
31 nine[;
32 (ix) thirty million twenty-five thousand dollars for the period Janu-
33 ary first, two thousand ten through December thirty-first, two thousand
34 ten; and
35 (x) eight million eight hundred thousand dollars for the period Janu-
36 ary first, two thousand eleven through March thirty-first, two thousand
37 eleven].
38 (y) Funds shall be reserved and accumulated from year to year and
39 shall be available, including income from invested funds, for purposes
40 of grants to public general hospitals for recruitment and retention of
41 health care workers pursuant to paragraph (b) of subdivision thirty of
42 section twenty-eight hundred seven-c of this article from the tobacco
43 control and insurance initiatives pool established for the following
44 periods in the following amounts:
45 (i) eighteen million five hundred thousand dollars on an annualized
46 basis for the period January first, two thousand two through December
47 thirty-first, two thousand two;
48 (ii) thirty-seven million four hundred thousand dollars on an annual-
49 ized basis for the period January first, two thousand three through
50 December thirty-first, two thousand three;
51 (iii) fifty-two million two hundred thousand dollars on an annualized
52 basis for the period January first, two thousand four through December
53 thirty-first, two thousand four;
54 (iv) fifty-two million two hundred thousand dollars for the period
55 January first, two thousand five through December thirty-first, two
56 thousand five;
S. 58--B 45 A. 158--B
1 (v) fifty-two million two hundred thousand dollars for the period
2 January first, two thousand six through December thirty-first, two thou-
3 sand six;
4 (vi) forty-nine million dollars for the period January first, two
5 thousand seven through December thirty-first, two thousand seven;
6 (vii) forty-nine million dollars for the period January first, two
7 thousand eight through December thirty-first, two thousand eight; and
8 (viii) [forty-nine] twelve million two hundred fifty thousand dollars
9 for the period January first, two thousand nine through [December] March
10 thirty-first, two thousand nine[;
11 (ix) forty-nine million dollars for the period January first, two
12 thousand ten through December thirty-first, two thousand ten; and
13 (x) twelve million two hundred fifty thousand dollars for the period
14 January first, two thousand eleven through March thirty-first, two thou-
15 sand eleven].
16 Provided, however, amounts pursuant to this paragraph may be reduced
17 in an amount to be approved by the director of the budget to reflect
18 amounts received from the federal government under the state's 1115
19 waiver which are directed under its terms and conditions to the health
20 workforce recruitment and retention program.
21 § 7. Paragraphs (ggg) and (hhh) of subdivision 1 of section 2807-v of
22 the public health law, as added by section 5 of part B of chapter 58 of
23 the laws of 2008, are amended to read as follows:
24 (ggg) Funds shall be deposited by the commissioner, within amounts
25 appropriated, and the state comptroller is hereby authorized and
26 directed to receive for deposit to the credit of the state special
27 revenue fund - other, HCRA transfer fund, medical assistance account, or
28 any successor fund or account, for the purpose of supporting the state
29 share of Medicaid expenditures for hospital translation services as
30 authorized pursuant to paragraph (k) of subdivision one of section twen-
31 ty-eight hundred seven-c of this article from the tobacco control and
32 initiatives pool established for the following periods in the following
33 amounts:
34 (i) sixteen million dollars for the period July first, two thousand
35 eight through December thirty-first, two thousand eight; and
36 (ii) [sixteen million] fourteen million seven hundred thousand dollars
37 for the period January first, two thousand nine through [December thir-
38 ty-first] November thirtieth, two thousand nine[;
39 (iii) sixteen million dollars for the period January first, two thou-
40 sand ten through December thirty-first, two thousand ten; and
41 (iv) four million dollars for the period January first, two thousand
42 eleven through March thirty-first, two thousand eleven].
43 (hhh) Funds shall be deposited by the commissioner, within amounts
44 appropriated, and the state comptroller is hereby authorized and
45 directed to receive for deposit to the credit of the state special
46 revenue fund - other, HCRA transfer fund, medical assistance account, or
47 any successor fund or account, for the purpose of supporting the state
48 share of Medicaid expenditures for adjustments to inpatient rates of
49 payment for general hospitals located in the counties of Nassau and
50 Suffolk as authorized pursuant to paragraph (l) of subdivision one of
51 section twenty-eight hundred seven-c of this article from the tobacco
52 control and initiatives pool established for the following periods in
53 the following amounts:
54 (i) two million five hundred thousand dollars for the period April
55 first, two thousand eight through December thirty-first, two thousand
56 eight; and
S. 58--B 46 A. 158--B
1 (ii) two million [five hundred thousand] two hundred ninety-two thou-
2 sand dollars for the period January first, two thousand nine through
3 [December thirty-first] November thirtieth, two thousand nine[;
4 (iii) two million five hundred thousand dollars for the period January
5 first, two thousand ten through December thirty-first, two thousand ten;
6 and
7 (iv) six hundred twenty-five thousand dollars for the period January
8 first, two thousand eleven through March thirty-first two thousand elev-
9 en].
10 § 8. Paragraph (s) of subdivision 1 of section 2807-v of the public
11 health law, as amended by section 5 of part B of chapter 58 of the laws
12 of 2008, is amended to read as follows:
13 (s) Funds shall be deposited by the commissioner within amounts appro-
14 priated, and the state comptroller is hereby authorized and directed to
15 receive for deposit to the credit of the state special revenue funds -
16 other, HCRA transfer fund, medical assistance account, or any successor
17 fund or account, for purposes of providing distributions pursuant to
18 paragraphs (s-5), (s-6), (s-7) and (s-8) of subdivision eleven of
19 section twenty-eight hundred seven-c of this article from the tobacco
20 control and insurance initiatives pool established for the following
21 periods in the following amounts:
22 (i) eighteen million dollars for the period January first, two thou-
23 sand through December thirty-first, two thousand;
24 (ii) twenty-four million dollars annually for the periods January
25 first, two thousand one through December thirty-first, two thousand two;
26 (iii) up to twenty-four million dollars for the period January first,
27 two thousand three through December thirty-first, two thousand three;
28 (iv) up to twenty-four million dollars for the period January first,
29 two thousand four through December thirty-first, two thousand four;
30 (v) up to twenty-four million dollars for the period January first,
31 two thousand five through December thirty-first, two thousand five;
32 (vi) up to twenty-four million dollars for the period January first,
33 two thousand six through December thirty-first, two thousand six;
34 (vii) up to twenty-four million dollars for the period January first,
35 two thousand seven through December thirty-first, two thousand seven;
36 (viii) up to twenty-four million dollars for the period January first,
37 two thousand eight through December thirty-first, two thousand eight;
38 and
39 (ix) up to [twenty-four] twenty-two million dollars for the period
40 January first, two thousand nine through [December thirty-first] Novem-
41 ber thirtieth, two thousand nine[;
42 (x) up to twenty-four million dollars for the period January first,
43 two thousand ten through December thirty-first, two thousand ten; and
44 (xi) up to six million dollars for the period January first, two thou-
45 sand eleven through March thirty-first, two thousand eleven].
46 § 9. Paragraph (n) of subdivision 1 of section 2807-l of the public
47 health law, as amended by section 4 of part B of chapter 58 of the laws
48 of 2008, is amended to read as follows:
49 (n) Funds shall be accumulated and transferred from the health care
50 reform act (HCRA) resources fund as follows: for the period April first,
51 two thousand seven through March thirty-first, two thousand eight, and
52 on an annual basis for the periods April first, two thousand eight
53 through [March thirty-first] November thirtieth, two thousand [eleven]
54 nine, funds within amounts appropriated shall be transferred and depos-
55 ited and credited to the credit of the state special revenue funds -
56 other, HCRA transfer fund, medical assistance account, for purposes of
S. 58--B 47 A. 158--B
1 funding the state share of rate adjustments made to public and voluntary
2 hospitals in accordance with paragraphs (i) and (j) of subdivision one
3 of section twenty-eight hundred seven-c of this article.
4 § 10. Paragraph (xx) of subdivision 1 of section 2807-v of the public
5 health law, as amended by section 5 of part B of chapter 58 of the laws
6 of 2008, is amended to read as follows:
7 (xx) Funds shall be deposited by the commissioner, within amounts
8 appropriated, and the state comptroller is hereby authorized and
9 directed to receive for the deposit to the credit of the state special
10 revenue funds - other, HCRA transfer fund, medical assistance account,
11 or any successor fund or account, for purposes of funding the state
12 share of the general hospital rates increases for rural hospitals pursu-
13 ant to subdivision thirty-two of section twenty-eight hundred seven-c of
14 this article from the tobacco control and insurance initiatives pool
15 established for the following periods in the following amounts:
16 (i) three million five hundred thousand dollars for the period January
17 first, two thousand five through December thirty-first, two thousand
18 five;
19 (ii) three million five hundred thousand dollars for the period Janu-
20 ary first, two thousand six through December thirty-first, two thousand
21 six;
22 (iii) three million five hundred thousand dollars for the period Janu-
23 ary first, two thousand seven through December thirty-first, two thou-
24 sand seven;
25 (iv) three million five hundred thousand dollars for the period Janu-
26 ary first, two thousand eight through December thirty-first, two thou-
27 sand eight; and
28 (v) three million [five hundred] two hundred eight thousand dollars
29 for the period January first, two thousand nine through [December thir-
30 ty-first] November thirtieth, two thousand nine[;
31 (vi) three million five hundred thousand dollars for the period Janu-
32 ary first, two thousand ten through December thirty-first, two thousand
33 ten; and
34 (vii) eight hundred seventy-five thousand dollars for the period Janu-
35 ary first, two thousand eleven through March thirty-first, two thousand
36 eleven; and
37 (viii) provided, however, in the event federal financial participation
38 is not available with regard to rate adjustments pursuant to subdivision
39 thirty-two of section twenty-eight hundred seven-c of this article,
40 allocations pursuant to this paragraph shall, on an annualized basis be
41 increased to seven million dollars for the period January first, two
42 thousand five through March thirty-first, two thousand eleven].
43 § 11. Paragraph (1) of subdivision 4 of section 2807-c of the public
44 health law, as added by section 15 of part C of chapter 58 of the laws
45 of 2008, is amended to read as follows:
46 (l) Notwithstanding any inconsistent provision of this section and
47 subject to the availability of federal financial participation, rates of
48 payment by governmental agencies for general hospitals which are certi-
49 fied by the office of alcoholism and substance abuse services to provide
50 inpatient detoxification and withdrawal services and, with regard to
51 inpatient services provided to patients discharged on and after December
52 first, two thousand eight and who are determined to be in diagnosis-re-
53 lated groups numbered seven hundred forty-three, seven hundred forty-
54 four, seven hundred forty-five, seven hundred forty-six, seven hundred
55 forty-seven, seven hundred forty-eight, seven hundred forty-nine, seven
S. 58--B 48 A. 158--B
1 hundred fifty, or seven hundred fifty-one, shall be made on a per diem
2 basis in accordance with the following:
3 (i) for the period December first, two thousand eight through [Decem-
4 ber thirty-first] March thirty-first, two thousand nine, seventy-five
5 percent of the operating cost component of such rates of payments shall
6 reflect the operating cost component of rates of payment effective for
7 December thirty-first, two thousand seven, as adjusted for inflation
8 pursuant to paragraph (c) of subdivision ten of this section, as other-
9 wise modified by any applicable statutes, and twenty-five percent of
10 such rates shall reflect the use of two thousand six operating costs as
11 reported by each facility to the department prior to two thousand eight
12 and as computed in accordance with the provisions of subparagraph [(v)]
13 (iv) of this paragraph;
14 (ii) for the period [January] April first, two thousand [ten] nine
15 through [December] March thirty-first, two thousand ten, [fifty] thir-
16 ty-seven and five tenths percent of the operating cost component of such
17 rates of payment shall reflect the operating cost component of rates of
18 payment effective December thirty-first, two thousand seven, as adjusted
19 for inflation pursuant to paragraph (c) of subdivision ten of this
20 section, as otherwise modified by any applicable statutes, and [fifty]
21 sixty-two and five tenths percent of such rates of payment shall reflect
22 the use of two thousand six operating costs as reported by each facility
23 to the department prior to two thousand eight and as computed in accord-
24 ance with the provisions of subparagraph [(v)] (iv) of this paragraph;
25 (iii) [for the period January first, two thousand eleven through
26 December thirty-first, two thousand eleven, twenty-five percent of the
27 operating cost component of such rates of payment shall reflect the
28 operating cost component of rates of payment effective December thirty-
29 first, two thousand seven, as adjusted for inflation pursuant to para-
30 graph (c) of subdivision ten of this section, as otherwise modified by
31 any applicable statutes, and seventy-five percent of such rates of
32 payment shall reflect the use of two thousand six operating costs as
33 reported by each facility to the department prior to two thousand eight
34 and as computed in accordance with the provisions of subparagraph (v) of
35 this paragraph; and
36 (iv)] for periods on and after [January] April first, two thousand
37 [twelve] ten, one hundred percent of the operating cost component of
38 such rates of payment shall reflect the use of two thousand six operat-
39 ing costs as reported to the department prior to two thousand eight and
40 as computed in accordance with the provisions of subparagraph [(v)] (iv)
41 of this paragraph.
42 [(v)] (iv) rates of payment computed in accordance with this paragraph
43 and reflecting the use of two thousand six base year operating costs
44 shall be in accord with the following, provided, however that the
45 commissioner may establish criteria under which reimbursement may be
46 provided at higher percentages and for longer periods.
47 (A) For each of the regions within the state as described in clause
48 (E) of this subparagraph the commissioner shall determine the average
49 per diem cost incurred by general hospitals in that region subject to
50 the provisions of this paragraph with regard to inpatients requiring
51 medically managed detoxification services, as defined by applicable
52 regulations promulgated by the office of alcoholism and substance abuse
53 services. In determining such costs the commissioner shall utilize two
54 thousand six costs and statistics as reported by such hospitals to the
55 department prior to two thousand eight.
S. 58--B 49 A. 158--B
1 (B) Per diem payments for inpatients requiring medically managed inpa-
2 tient detoxification services shall reflect one hundred percent of the
3 per diem amounts computed pursuant to clause (A) of this subparagraph
4 for the applicable region in which the facility is located and as trend-
5 ed forward to adjust for inflation, provided however, that such payments
6 shall be reduced by fifty percent for any such services provided on or
7 after the sixth day of services through the tenth day of services, and
8 further provided that no payments shall be made for any services
9 provided on or after the eleventh day.
10 (C) Per diem payments for inpatients requiring medically supervised
11 withdrawal services, as defined by applicable regulations promulgated by
12 the office of alcoholism and substance abuse services, shall reflect one
13 hundred percent of the per diem amounts computed pursuant to clause (A)
14 of this subparagraph for the applicable region in which the facility is
15 located for the period January first, two thousand nine through December
16 thirty-first, two thousand nine, and as trended forward to adjust for
17 inflation, and shall reflect seventy-five percent of such per diem
18 amounts for periods on and after January first, two thousand ten, as
19 trended forward to adjust for inflation, provided, however, that such
20 payments shall be reduced by fifty percent for any services provided on
21 or after the sixth day of services through the tenth day of services,
22 and further provided that no payments shall be made for any services
23 provided on and after the eleventh day.
24 (D) Per diem payments for inpatients placed in observation beds, as
25 defined by applicable regulations promulgated by the office of alcohol-
26 ism and substance abuse services, shall be at the same level as would be
27 paid pursuant to clause (A) of this paragraph, provided, however, that
28 such payments shall not apply for more than two days of care, after
29 which payments for such inpatients shall reflect their designation as
30 requiring either medically managed detoxification services or medically
31 supervised withdrawal services, and further provided that days of care
32 provided in such observation beds shall, for reimbursement purposes, be
33 fully reflected in the computation of the initial five days of care as
34 set forth in clauses (A) and (B) of this [paragraph] subparagraph.
35 (E) For the purposes of this paragraph, the regions of the state shall
36 be as follows:
37 (I) New York city, consisting of the counties of Bronx, New York,
38 Kings, Queens and Richmond;
39 (II) Long Island, consisting of the counties of Nassau and Suffolk;
40 (III) Northern metropolitan, consisting of the counties of Columbia,
41 Delaware, Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and West-
42 chester;
43 (IV) Northeast, consisting of the counties of Albany, Clinton, Essex,
44 Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady,
45 Schoharie, Warren and Washington;
46 (V) Utica/Watertown, consisting of the counties of Franklin, Herkimer,
47 Lewis, Oswego, Otsego, St. Lawrence, Jefferson, Chenango, Madison and
48 Oneida;
49 (VI) Central, consisting of the counties of Broome, Cayuga, Chemung,
50 Cortland, Onondaga, Schuyler, Seneca, Steuben, Tioga and Tompkins;
51 (VII) Rochester, consisting of Monroe, Ontario, Livingston, Wayne and
52 Yates;
53 (VIII) Western, consisting of the counties of Allegany, Cattaraugus,
54 Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming.
S. 58--B 50 A. 158--B
1 (F) Capital cost reimbursement for general hospitals otherwise subject
2 to the provisions of this paragraph shall remain subject to the
3 provisions of subdivision eight of this section.
4 § 12. Subdivision 4 of section 2807-c of the public health law is
5 amended by adding a new paragraph (e-1) to read as follows:
6 (e-1) Notwithstanding any inconsistent provision of paragraph (e) of
7 this subdivision or any other contrary provision of law and subject to
8 the availability of federal financial participation, per diem rates of
9 payment by governmental agencies for a general hospital or a distinct
10 unit of a general hospital for inpatient psychiatric services that would
11 otherwise be subject to the provisions of paragraph (e) of this subdivi-
12 sion, and rates of payment for outpatient psychiatric services provided
13 by such facilities as specified in this paragraph, shall, with regard to
14 days of service and visits occurring on and after December first, two
15 thousand nine, be in accordance with the following:
16 (i) For rate periods on and after December first, two thousand nine,
17 the commissioner, in consultation with the commissioner of the office of
18 mental health, shall promulgate regulations, and may promulgate emergen-
19 cy regulations, establishing methodologies for determining the operating
20 cost components of rates of payments for services described in this
21 paragraph. Such regulations shall utilize two thousand five operating
22 costs as submitted to the department prior to December first, two thou-
23 sand eight and shall provide for methodologies establishing per diem
24 inpatient rates that utilize case mix adjustment mechanisms and provide
25 for post-discharge referral to outpatient services. Such regulations
26 shall contain criteria for adjustments based on length of stay.
27 (ii) Rates of payment established pursuant to subparagraph (ii) of
28 this paragraph shall reflect an aggregate net statewide increase in
29 reimbursement for such services of up to twenty-five million dollars on
30 an annual basis.
31 (iii) Capital cost reimbursement for general hospitals otherwise
32 subject to the provisions of this paragraph shall remain subject to the
33 provisions of subdivision eight of this section.
34 § 13. Subdivision 4 of section 2807-c of the public health law is
35 amended by adding a new paragraph (e-2) to read as follows:
36 (e-2) Notwithstanding any inconsistent provision of paragraph (e) of
37 this subdivision or any other contrary provision of law and subject to
38 the availability of federal financial participation, per diem rates of
39 payment by governmental agencies for inpatient services provided by a
40 general hospital or a distinct unit of a general hospital for services,
41 as described below, that would otherwise be subject to the provisions of
42 paragraph (e) of this subdivision, shall, with regard to days of service
43 occurring on and after December first, two thousand nine, be in accord
44 with the following:
45 (i) For physical medical rehabilitation services and for chemical
46 dependency rehabilitation services, the operating cost component of such
47 rates shall reflect the use of two thousand five operating costs for
48 each respective category of services as reported by each facility to the
49 department prior to July first, two thousand nine and as adjusted for
50 inflation pursuant to paragraph (c) of subdivision ten of this section,
51 as otherwise modified by any applicable statute, provided, however, that
52 such two thousand five reported operating costs, but not including
53 reported direct medical education cost, shall, for rate-setting
54 purposes, be held to a ceiling of one hundred ten percent of the average
55 of such reported costs in the region in which the facility is located,
S. 58--B 51 A. 158--B
1 as determined pursuant to clause (E) of subparagraph (iii) of paragraph
2 (1) of this subdivision.
3 (ii) For services provided by rural hospitals designated as critical
4 access hospitals in accordance with title XVIII of the federal social
5 security act, the operating cost component of such rates shall reflect
6 the use of two thousand five operating costs as reported by each facili-
7 ty to the department prior to July first, two thousand nine and as
8 adjusted for inflation pursuant to paragraph (c) of subdivision ten of
9 this section, as otherwise modified by any applicable statutes,
10 provided, however, that such two thousand five reported operating costs
11 shall, for rate-setting purposes, be held to a ceiling of one hundred
12 ten percent of the average of such reported costs for all such desig-
13 nated hospitals statewide.
14 (iii) For inpatient services provided by specialty long term acute
15 care hospitals and for inpatient services provided by cancer hospitals
16 as so designated as of December thirty-first, two thousand eight, the
17 operating cost component of such rates shall reflect the use of two
18 thousand five operating costs for each respective category of facility
19 as reported by each facility to the department prior to July first, two
20 thousand nine and as adjusted for inflation pursuant to paragraph (c) of
21 subdivision ten of this section, as otherwise modified by any applicable
22 statutes.
23 (iv) For facilities designated by the federal department of health and
24 human services as exempt acute care children's hospitals as of December
25 thirty-first, two thousand eight, for which a discrete institutional
26 cost report was filed for the two thousand seven calendar year, and
27 which has reported Medicaid discharges greater than fifty percent of
28 total discharges in such cost report, shall be determined in accordance
29 with the following:
30 (A) The operating cost component of such rates shall reflect the use
31 of two thousand seven operating costs as reported by each facility to
32 the department prior to July first, two thousand nine and as adjusted
33 for the inflation pursuant to paragraph (c) of subdivision ten of this
34 section, as otherwise modified by any applicable statutes, and as
35 further adjusted as the commissioner deems appropriate, including tran-
36 sition adjustments. Such rates shall be determined on a per case basis
37 or per diem basis, as set forth in regulations promulgated by the
38 commissioner.
39 (B) The operating component of outpatient specialty rates of hospitals
40 subject to this subparagraph shall reflect the use of two thousand seven
41 operating costs as reported to the department prior to December first,
42 two thousand eight, and shall include such adjustments as the commis-
43 sioner deems appropriate.
44 (C) The base period reported operating costs used to establish inpa-
45 tient and outpatient rates determined pursuant to this subparagraph
46 shall be updated no less frequently than every two years and each such
47 hospital shall submit such additional data as the commissioner may
48 require to assist in the development of ambulatory patient groups (APGs)
49 rates for such hospitals' outpatient specialty services.
50 (v) Rates established pursuant to this paragraph shall be deemed as
51 excluding reimbursement for physician services for inpatient services
52 and claims for Medicaid fee payments for such physician services for
53 such inpatient care may be submitted separately from the rate in accord-
54 ance with otherwise applicable law.
S. 58--B 52 A. 158--B
1 (vi) Capital cost reimbursement for general hospitals otherwise
2 subject to the provisions of this paragraph shall remain subject to the
3 provisions of subdivision eight of this section.
4 (vii) The commissioner may promulgate regulations, including emergency
5 regulations, implementing the provisions of this paragraph.
6 (viii) The operating cost component of rates of payment pursuant to
7 this paragraph for a general hospital or distinct unit of a general
8 hospital without adequate cost experience shall be based on the lower of
9 the facility's or unit's inpatient budgeted operating costs per day,
10 adjusted to actual, or the applicable regional ceiling, if any.
11 (ix) The operating cost component of inpatient medicaid rates subject
12 to subparagraphs (i), (ii) and (iii) of this paragraph shall, with
13 regard to alternative level of care (ALC) days of care be subject to
14 computation pursuant to paragraph (h) of this subdivision.
15 § 13-a. Paragraph (s-8) of subdivision 11 of section 2807-c of the
16 public health law, as amended by section 57 of part C of chapter 58 of
17 the laws of 2008, is amended to read as follows:
18 (s-8) To the extent funds are available and otherwise notwithstanding
19 any inconsistent provision of law to the contrary, for rate periods on
20 and after April first, two thousand seven through [March thirty-first]
21 November thirtieth, two thousand nine, the commissioner shall increase
22 rates of payment for patients eligible for payments made by state
23 governmental agencies by an amount not to exceed sixty million dollars
24 annually in the aggregate. Such amount shall be allocated among those
25 voluntary non-profit general hospitals which continue to provide inpa-
26 tient services as of April first, two thousand seven through March thir-
27 ty-first, two thousand eight and which have medicaid inpatient
28 discharges percentages equal to or greater than thirty-five percent.
29 This percentage shall be computed based upon data reported to the
30 department in each hospital's two thousand four institutional cost
31 report, as submitted to the department on or before January first, two
32 thousand seven. The rate adjustments calculated in accordance with this
33 paragraph shall be allocated proportionally based on each eligible
34 hospital's total reported medicaid inpatient discharges in two thousand
35 four, to the total reported medicaid inpatient discharges for all such
36 eligible hospitals in two thousand four, provided, however, that such
37 rate adjustments shall be subject to reconciliation to ensure that each
38 hospital receives in the aggregate its proportionate share of the full
39 allocation to the extent allowable under federal law. Such payments may
40 be added to rates of payment or made as aggregate payments to eligible
41 hospitals, provided, however, that subject to the availability of feder-
42 al financial participation and solely for the period April first, two
43 thousand seven through March thirty-first, two thousand eight, six
44 million dollars in the aggregate of this sixty million dollars shall be
45 allocated to voluntary non-profit hospitals which continue to provide
46 inpatient services as of April first, two thousand seven through March
47 thirty-first, two thousand eight and which have Medicaid inpatient
48 discharge percentages of less than thirty-five percent and which had
49 previously qualified for distributions pursuant to paragraph (s-7) of
50 this subdivision. The rate adjustment calculated in accordance with this
51 paragraph shall be allocated proportionally based on the amount of money
52 the hospital had received in two thousand six.
53 § 13-b. The commissioner is hereby authorized to seek through a feder-
54 al waiver, or through the extension of a federal waiver, enhanced feder-
55 al financial participation in excess of that authorized by the American
56 Recovery and Reinvestment Act, in order to support state reform activ-
S. 58--B 53 A. 158--B
1 ities, including reimbursement reform, enacted by the legislature to
2 promote patient centered care and improve access to and quality of
3 primary and ambulatory care.
4 § 13-c. Subdivision 4-c of section 2807-p of the public health law, as
5 amended by section 28-a of part B of chapter 58 of the laws of 2008, is
6 amended to read as follows:
7 4-c. Notwithstanding any provision of law to the contrary, the commis-
8 sioner shall make additional payments for uncompensated care to volun-
9 tary non-profit diagnostic and treatment centers that are eligible for
10 distributions under subdivision four of this section in the following
11 amounts: for the period June first, two thousand six through December
12 thirty-first, two thousand six, in the amount of seven million five
13 hundred thousand dollars, for the period January first, two thousand
14 seven through December thirty-first, two thousand seven, seven million
15 five hundred thousand dollars, for the period January first, two thou-
16 sand eight through December thirty-first, two thousand eight, seven
17 million five hundred thousand dollars, for the period January first, two
18 thousand nine through December thirty-first, two thousand nine, [seven]
19 fifteen million five hundred thousand dollars, for the period January
20 first, two thousand ten through December thirty-first, two thousand ten,
21 seven million five hundred thousand dollars, and for the period January
22 first, two thousand eleven through March thirty-first, two thousand
23 eleven, in the amount of one million eight hundred seventy-five thousand
24 dollars, provided, however, that for periods on and after January first,
25 two thousand eight, such additional payments shall be distributed to
26 voluntary, non-profit diagnostic and treatment centers and to public
27 diagnostic and treatment centers in accordance with paragraph (g) of
28 subdivision four of this section. In the event that federal financial
29 participation is available for rate adjustments pursuant to this
30 section, the commissioner shall make such payments as additional adjust-
31 ments to rates of payment for voluntary non-profit diagnostic and treat-
32 ment centers that are eligible for distributions under subdivision
33 four-a of this section in the following amounts: for the period June
34 first, two thousand six through December thirty-first, two thousand six,
35 fifteen million dollars in the aggregate, and for the period January
36 first, two thousand seven through June thirtieth, two thousand seven,
37 seven million five hundred thousand dollars in the aggregate. The
38 amounts allocated pursuant to this paragraph shall be aggregated with
39 and distributed pursuant to the same methodology applicable to the
40 amounts allocated to such diagnostic and treatment centers for such
41 periods pursuant to subdivision four of this section if federal finan-
42 cial participation is not available, or pursuant to subdivision four-a
43 of this section if federal financial participation is available.
44 Notwithstanding section three hundred sixty-eight-a of the social
45 services law, there shall be no local share in a medical assistance
46 payment adjustment under this subdivision.
47 § 14. Paragraphs (a) and (b) of subdivision 2-a of section 2807 of the
48 public health law, as added by section 18 of part C of chapter 58 of the
49 laws of 2008, are amended to read as follows:
50 (a)(i) for the period December first, two thousand eight through
51 [December thirty-first] November thirtieth, two thousand nine, seventy-
52 five percent of such rates of payment for each general hospital's outpa-
53 tient services shall reflect the average Medicaid payment per claim, as
54 determined by the commissioner, for services provided by that facility
55 in the two thousand seven calendar year, but excluding any payments for
56 services covered by the facility's licensure, if any, under the mental
S. 58--B 54 A. 158--B
1 hygiene law, and twenty-five percent of such rates of payment shall, for
2 the operating cost component, reflect the utilization of the ambulatory
3 patient groups reimbursement methodology described in paragraph (e) of
4 this subdivision;
5 (ii) for the period [January] December first, two thousand [ten] nine
6 through December thirty-first, two thousand ten, fifty percent of such
7 rates for each facility shall reflect the average Medicaid payment per
8 claim, as determined by the commissioner, for services provided by that
9 facility in the two thousand seven calendar year, but excluding any
10 payments for services covered by the facility's licensure, if any, under
11 the mental hygiene law, and fifty percent of such rates of payment
12 shall, for the operating cost component, reflect the utilization of the
13 ambulatory patient groups reimbursement methodology described in para-
14 graph (e) of this subdivision;
15 (iii) for the period January first, two thousand eleven through Decem-
16 ber thirty-first, two thousand eleven, twenty-five percent of such rates
17 shall reflect the average Medicaid payment per claim, as determined by
18 the commissioner, for services provided by that facility for the two
19 thousand seven calendar year, but excluding any payments for services
20 covered by the facility's licensure, if any, under the mental hygiene
21 law, and seventy-five percent of such rates of payment shall, for the
22 operating cost component, reflect the utilization of the ambulatory
23 patient groups reimbursement methodology described in paragraph (e) of
24 this subdivision; and
25 (iv) for periods on and after January first, two thousand twelve, one
26 hundred percent of such rates of payment shall reflect the utilization
27 of the ambulatory patient groups reimbursement methodology described in
28 paragraph (e) of this subdivision.
29 (v) This paragraph shall be effective the later of: (i) December
30 first, two thousand eight, or (ii) after the commissioner receives final
31 approval of federal financial participation in payments made for benefi-
32 ciaries eligible for medical assistance under title XIX of the federal
33 social security act for the rate methodology established pursuant to
34 subparagraph (i) of paragraph (a) of subdivision thirty-three of section
35 twenty-eight hundred seven-c of this article.
36 (b)(i) for the period March first, two thousand nine through December
37 [thirty-first] first, two thousand nine, seventy-five percent of such
38 rates of payment for services provided by each diagnostic and treatment
39 center and each free-standing ambulatory surgery center shall reflect
40 the average Medicaid payment per claim, as determined by the commission-
41 er, for services provided by that facility in the two thousand seven
42 calendar year, but excluding any payments for services covered by the
43 facility's licensure, if any, under the mental hygiene law, and twenty-
44 five percent of such rates of payment shall, for the operating cost
45 component, reflect the utilization of the ambulatory patient groups
46 reimbursement methodology described in paragraph (e) of this subdivi-
47 sion;
48 (ii) for the period January first, two thousand ten through December
49 thirty-first, two thousand ten, fifty percent of such rates for each
50 facility shall reflect the average Medicaid payment per claim, as deter-
51 mined by the commissioner, for services provided by that facility in the
52 two thousand seven calendar year, but excluding any payments for
53 services covered by the facility's licensure, if any, under the mental
54 hygiene law, and fifty percent of such rates of payment shall, for the
55 operating cost component, reflect the utilization of the ambulatory
S. 58--B 55 A. 158--B
1 patient groups reimbursement methodology described in paragraph (e) of
2 this subdivision;
3 (iii) for the period January first, two thousand eleven through Decem-
4 ber thirty-first, two thousand eleven, twenty-five percent of such rates
5 for each facility shall reflect the average Medicaid payment per claim,
6 as determined by the commissioner, for services provided by that facili-
7 ty in the two thousand seven calendar year, but excluding any payments
8 for services covered by the facility's licensure, if any, under the
9 mental hygiene law, and seventy-five percent of such rates of payment
10 shall, for the operating cost component, reflect the utilization of the
11 ambulatory patient groups reimbursement methodology described in para-
12 graph (e) of this subdivision; and
13 (iv) for periods on and after January first, two thousand twelve, one
14 hundred percent of such rates of payment shall reflect the utilization
15 of the ambulatory patient groups reimbursement methodology described in
16 paragraph (e) of this subdivision.
17 § 15. Paragraph (e) subdivision 2-a of section 2807 of the public
18 health law, as added by section 18 of part C of chapter 58 of the laws
19 2008, is amended to read as follows:
20 (e) (i) notwithstanding any inconsistent provisions of this subdivi-
21 sion, the commissioner shall promulgate regulations establishing,
22 subject to the approval of the state director of the budget, methodol-
23 ogies for determining rates of payment for the services described in
24 this subdivision. Such regulations shall reflect utilization of the
25 ambulatory patient group (APG) methodology, in which patients are
26 grouped based on their diagnosis, the intensity of the services provided
27 and the medical procedures performed, and with each APG assigned a
28 weight reflecting the projected utilization of resources. Such regu-
29 lations shall provide for the development of one or more base rates and
30 the multiplication of such base rates by the assigned weight for each
31 APG to establish the appropriate payment level for each such APG. Such
32 regulations may also utilize bundling, packaging and discounting mech-
33 anisms.
34 If the commissioner determines that the use of the APG methodology is
35 not, or is not yet, appropriate or practical for specified services, the
36 commissioner may utilize existing payment methodologies for such
37 services or may promulgate regulations, and may promulgate emergency
38 regulations, establishing alternative payment methodologies for such
39 services.
40 (ii) Notwithstanding this subdivision and any other contrary provision
41 of law, the commissioner may incorporate within the payment methodology
42 described in subparagraph (i) of this paragraph payment for services
43 provided by facilities pursuant to licensure under the mental hygiene
44 law, provided, however, that such APG payment methodology may be phased
45 into effect in accordance with a schedule or schedules as jointly deter-
46 mined by the commissioner, the commissioner of mental health, the
47 commissioner of alcoholism and substance abuse services, and the commis-
48 sioner of mental retardation and developmental disabilities.
49 § 16. Paragraph (i) of subdivision 2-a of section 2807 of the public
50 health law, as added by section 19 of part OO of chapter 57 of the laws
51 of 2008, is amended to read as follows:
52 (i) Notwithstanding any provision of law to the contrary, rates of
53 payment by governmental agencies for general hospital outpatient
54 services, general hospital emergency services and ambulatory surgical
55 services provided by a general hospital established pursuant to para-
56 graphs (a), (c) and (d) of this subdivision shall result in an aggregate
S. 58--B 56 A. 158--B
1 increase in such rates of payment of fifty-six million dollars for the
2 period December first, two thousand eight through March thirty-first,
3 two thousand nine and one hundred seventy-eight million dollars for
4 periods after April first, two thousand nine, provided, however, that
5 for periods on and after April first, two thousand nine, such amounts
6 may be adjusted to reflect projected decreases in fee-for-service Medi-
7 caid utilization and changes in case-mix with regard to such services
8 from the two thousand seven calendar year to the applicable rate year,
9 and provided further, however, that funds made available as a result of
10 any such decreases may be utilized by the commissioner to increase capi-
11 tation rates paid to Medicaid managed care plans and family health plus
12 plans to cover increased payments to health care providers for ambulato-
13 ry care services and to increase such other ambulatory care payment
14 rates as the commissioner determines necessary to facilitate access to
15 quality ambulatory care services.
16 § 16-a. Subparagraph (ii) of paragraph (f) of subdivision 2-a of
17 section 2807 of the public health law, as added by section 18 of part C
18 of chapter 58 of the laws of 2008, is amended to read as follows:
19 (ii) notwithstanding the provisions of paragraphs (a) and (b) of this
20 subdivision, for periods on and after January first, two thousand nine,
21 the following services provided by general hospital outpatient depart-
22 ments and diagnostic and treatment centers shall be reimbursed with
23 rates of payment based entirely upon the ambulatory patient group meth-
24 odology as described in paragraph (e) of this subdivision, provided,
25 however, that the commissioner may utilize existing payment methodol-
26 ogies or may promulgate regulations establishing alternative payment
27 methodologies for one or more of the services specified in clauses (C)
28 and (D) of this subparagraph, effective for periods on and after March
29 first, two thousand nine:
30 (A) services provided in accordance with the provisions of paragraphs
31 (q) and (r) of subdivision two of section three hundred sixty-five-a of
32 the social services law; and
33 (B) all services, but only with regard to additional payment amounts,
34 as determined in accordance with regulations issued in accordance with
35 paragraph (e) of this subdivision, for the provision of such services
36 during times outside the facility's normal hours of operation, as deter-
37 mined in accordance with criteria set forth in such regulations; and
38 (C) individual psychotherapy services provided by licensed social
39 workers, in accordance with licensing criteria set forth in applicable
40 regulations, to persons under the age of nineteen and to persons requir-
41 ing such services as a result of or related to pregnancy or giving
42 birth[.]; and
43 (D) individual psychotherapy services provided by licensed social
44 workers, in accordance with licensing criteria set forth in applicable
45 regulations, at diagnostic and treatment centers that provided, billed
46 for, and received payment for these services between January first, two
47 thousand seven and December thirty-first, two thousand seven[.]; and
48 (E) services provided to pregnant women pursuant to paragraph (s) of
49 subdivision two of section three hundred sixty-five-a of the social
50 services law and, for periods on and after January first, two thousand
51 ten, all other services provided pursuant to such paragraph (s) and
52 services provided pursuant to paragraph (t) of subdivision two of
53 section three hundred sixty-five-a of the social services law.
54 § 17. Notwithstanding any contrary provision of law, except section
55 43.02 of the mental hygiene law, subject to availability of federal
56 financial participation, and within amounts appropriated therefore,
S. 58--B 57 A. 158--B
1 commencing on or after October 1, 2009 the commissioners of mental
2 health and health are jointly authorized to implement and enhance fund-
3 ing of the Ambulatory Patient Group (APG) reimbursement methodology, for
4 clinic services rendered by providers pursuant to their licensure under
5 article 31 of the mental hygiene law.
6 § 18. The commissioners of mental health and health, subject to the
7 approval of the state director of the budget, are jointly authorized to
8 implement and enhance funding of the Ambulatory Patient Group (APG)
9 reimbursement methodology for determining rates of payment for outpa-
10 tient clinic services rendered pursuant to providers' licensure under
11 article 31 of the mental hygiene law. The commissioner of mental health,
12 subject to the approval of the commissioner of health and the director
13 of the budget, shall promulgate regulations pursuant to article 31 of
14 the mental hygiene law which shall reflect utilization of the Ambulatory
15 Patient Group (APG) methodology, as described in subdivision 2-a of
16 section 2807 of the public health law, in which patients are grouped
17 based on their diagnosis, the intensity of the services provided and the
18 medical procedures performed, and with each APG assigned a weight
19 reflecting the projected utilization of resources. Such regulations
20 shall provide for the development of one or more base rates and the
21 multiplication of such base rates by the assigned weight for each APG to
22 establish the appropriate payment level for each such APG. Such regu-
23 lations may also utilize bundling, packaging and discounting mechanisms.
24 § 19. Intentionally omitted.
25 § 20. Notwithstanding any contrary provision of law, and subject to
26 federal financial participation under Title XIX of the Social Security
27 Act, and within amounts appropriated therefore, commencing on or after
28 October 1, 2009, the commissioners of health and mental retardation and
29 developmental disabilities are jointly authorized to implement the Ambu-
30 latory Patient Group (APG) reimbursement methodology, for clinic
31 services rendered by providers pursuant to their licensure under article
32 16 of the mental hygiene law.
33 § 21. The commissioners of mental retardation and developmental disa-
34 bilities, and health, subject to the approval of the state director of
35 the budget, are jointly authorized to implement the Ambulatory Patient
36 Group (APG) reimbursement methodology for determining rates of payment
37 for clinic services rendered pursuant to providers' licensure under
38 article 16 of the mental hygiene law. The commissioner of mental retar-
39 dation and developmental disabilities, subject to the approval of the
40 commissioner of health and director of the budget, shall promulgate
41 regulations pursuant to article 16 of the mental hygiene law which shall
42 reflect utilization of the Ambulatory Patient Group (APG) methodology,
43 as described in subdivision 2-a of section 2807 of the public health
44 law, in which patients are grouped based on their diagnosis, the inten-
45 sity of the services provided and the procedures performed, and with
46 each APG assigned a weight reflecting the projected utilization of
47 resources. Such regulations shall provide for the development of one or
48 more base rates and the multiplication of such base rates by the
49 assigned weight for each APG to establish the appropriate payment level
50 for each such APG. Such regulations may also utilize bundling, packaging
51 and discounting mechanisms.
52 § 22. Notwithstanding any contrary provision of law, subject to feder-
53 al financial participation under Title XIX of the Social Security Act,
54 and within amounts appropriated therefore, commencing on or after Octo-
55 ber 1, 2009 the commissioners of health, and alcoholism and substance
56 abuse services are authorized to implement and enhance funding of the
S. 58--B 58 A. 158--B
1 Ambulatory Patient Group (APG) reimbursement methodology for clinic
2 services rendered pursuant to providers' operating certificates under
3 article 32 of the mental hygiene law.
4 § 23. The commissioners of alcoholism and substance abuse services,
5 and health, subject to the approval of the state director of the budget,
6 are jointly authorized to implement and enhance funding of the Ambulato-
7 ry Patient Group (APG) reimbursement methodology for determining rates
8 of payment for outpatient clinic services rendered pursuant to provid-
9 ers' operating certificates under article 32 of the mental hygiene law.
10 The commissioner of alcoholism and substance abuse services, subject to
11 the approval of the commissioner of health and the director of the
12 budget, shall promulgate regulations pursuant to article 32 of the
13 mental hygiene law which shall reflect utilization of the Ambulatory
14 Patient Group (APG) methodology, as described in subdivision 2-a of
15 section 2807 of the public health law, in which patients are grouped
16 based on their diagnosis, the intensity of the services provided and the
17 procedures performed, and with each APG assigned a weight reflecting the
18 projected utilization of resources. Such regulations shall provide for
19 the development of one or more base rates and the multiplication of such
20 base rates by the assigned weight for each APG to establish the appro-
21 priate payment level for each such APG. Such regulations may also
22 utilize bundling, packaging and discounting mechanisms.
23 § 23-a. Notwithstanding any contrary provision of law, and within
24 amounts appropriated, commencing December 1, 2009 the commissioners of
25 alcoholism and substance abuse services, and health are jointly author-
26 ized to increase medical assistance fees for medically supervised with-
27 drawal services.
28 § 24. Section 2 of the social services law is amended by adding a new
29 subdivision 38 to read as follows:
30 38. When used in this chapter, the following terms shall have the
31 following meanings, unless otherwise expressly stated or unless the
32 context or subject matter requires a different interpretation:
33 (a) "Medicaid" or "medical assistance" means title eleven of article
34 five of this chapter and the program thereunder.
35 (b) "Family health plus" means title eleven-D of article five of this
36 chapter and the program thereunder.
37 (c) "Child health plus" means title one-A of article twenty-five of
38 the public health law and the program thereunder.
39 (d) "Medicaid managed care" means Medicaid provided under section
40 three hundred sixty-four-j of this chapter.
41 (e) "Medicaid fee-for-service" means Medicaid provided other than
42 under Medicaid managed care.
43 § 25. The social services law is amended by adding a new section 364-m
44 to read as follows:
45 § 364-m. Statewide patient centered medical home program. 1. The
46 commissioner of health is authorized to certify certain clinicians and
47 clinics as health care homes in order to improve health outcomes and
48 efficiency through patient care continuity and coordination of health
49 services. These providers will be eligible for enhanced payments for
50 services provided to: recipients eligible for Medicaid fee-for-service;
51 enrollees eligible for Medicaid managed care; enrollees eligible for and
52 enrolled in Family Health Plus organizations pursuant to title eleven-D
53 of this article ("Family Health Plus"); and enrollees eligible for and
54 enrolled in Child Health Plus. As used in this section "clinic" means a
55 general hospital providing outpatient care or a diagnostic and treatment
56 center, licensed under article twenty-eight of the public health law.
S. 58--B 59 A. 158--B
1 2. By December first, two thousand nine, the commissioner of health
2 shall develop and implement standards of certification for patient
3 centered medical homes for Medicaid fee-for-service and Medicaid managed
4 care, Family Health Plus and Child Health Plus programs. In developing
5 such standards, the commissioner of health shall: (a) consider existing
6 standards developed by national accrediting and professional organiza-
7 tions; and (b) consult with national and local organizations working on
8 medical home models, physicians, hospitals, clinics, health plans and
9 consumers and their representatives.
10 3. To maintain their certification, patient centered medical homes
11 must: (a) renew their certification at a frequency determined by the
12 commissioner of health; and (b) provide data to the department of health
13 and to health plans in which the patient is enrolled to permit the
14 commissioner of health to evaluate the impact of patient centered
15 medical homes on quality, outcomes and cost.
16 4. Subject to the availability of funding and federal financial
17 participation, the commissioner of health is authorized:
18 (a) To pay enhanced rates of payment to clinics and clinicians that
19 are certified as patient centered medical homes under this section. Such
20 enhancements may be tiered based on the level of standard achieved by
21 the clinician or clinic; and
22 (b) To pay additional amounts for patient centered medical homes that
23 meet specific process or outcome standards specified by the commissioner
24 of health.
25 5. By December thirty-first, two thousand twelve, the commissioner of
26 health shall report to the governor and the legislature on the impact of
27 the statewide patient centered medical home program on quality, cost and
28 outcomes for enrollees in Medicaid fee-for-service, Medicaid managed
29 care, Family Health Plus and Child Health Plus.
30 § 26. Sections 2950 through 2958 of article 29-A of the public health
31 law are designated title 1 and a new title heading is added to read as
32 follows:
33 RURAL HEALTH CARE ACCESS
34 § 26-a. Article 29-A of the public health law is amended by adding a
35 new title 2 to read as follows:
36 TITLE 2
37 ADIRONDACK MEDICAL HOME MULTIPAYOR
38 DEMONSTRATION PROGRAM
39 Section 2959. Adirondack medical home multipayor demonstration
40 program.
41 § 2959. Adirondack medical home multipayor demonstration program. 1.
42 The commissioner is authorized to establish an Adirondack medical home
43 multipayor demonstration program and may certify certain clinicians and
44 clinics in the upper northeastern region of New York as medical homes
45 eligible for enhanced payments for services provided to: recipients
46 eligible for medical assistance pursuant to title eleven of article five
47 of the social services law ("Medicaid fee-for-service"); enrollees
48 eligible for medical assistance pursuant to such title and enrolled in
49 approved managed care organizations pursuant to section three hundred
50 sixty-four-j of such title ("Medicaid managed care"); enrollees eligible
51 for Family Health Plus and enrolled in approved organizations pursuant
52 to title eleven-D of article five of the social services law ("Family
53 Health Plus"); enrollees eligible for the child health insurance program
54 and enrolled in approved organizations pursuant to title one-A of arti-
55 cle twenty-five of this chapter ("Child Health Plus Program"); enrollees
56 and subscribers of commercial managed care plans operating in accordance
S. 58--B 60 A. 158--B
1 with the provisions of article forty-four of this chapter or by health
2 maintenance organizations organized and operating in accordance with
3 article forty-three of the insurance law; enrollees and subscribers of
4 other commercial insurance products; and employees of employer-sponsored
5 self-insured plans. The purpose of this demonstration program is to
6 improve health care outcomes and efficiency through patient care conti-
7 nuity and coordination of health services.
8 2. (a) In order to promote improved quality of, and access to, health
9 care services and promote improved clinical outcomes to the residents in
10 the upper northeastern region of New York, it shall be the policy of the
11 state relating to the demonstration program to encourage cooperative,
12 collaborative and integrative arrangements between payors of health care
13 services and health care services providers who might otherwise be
14 competitors, under the active supervision of the commissioner. To the
15 extent such arrangements might be anti-competitive within the meaning
16 and intent of the federal antitrust laws, the intent of the state is to
17 supplant competition with such arrangement to the extent necessary to
18 accomplish the purposes of this article relating to the demonstration
19 program, and provide state action immunity under the state and federal
20 antitrust laws with respect to the planning, implementation and opera-
21 tion of the Adirondack medical home multipayor demonstration program and
22 payors of medical services and health care services providers.
23 (b) The commissioner or his or her duly authorized representative may
24 also engage in appropriate state supervision necessary to promote state
25 action immunity under the state and federal antitrust laws, and may
26 inspect or request additional documentation to verify that the demon-
27 stration is implemented in accordance with its intent and purpose.
28 3. The commissioner, for purpose of the demonstration program, is
29 authorized to participate in, actively supervise, facilitate and approve
30 a primary care medical home collaborative with health care services
31 providers, which may include hospitals, diagnostic and treatment
32 centers, and private practices, and payors of health care services,
33 including employers, health plans and insurers, to establish: (a) the
34 boundaries of the demonstration and the providers eligible to partic-
35 ipate; (b) practice standards for the medical home consistent with
36 existing standards developed by national accrediting and professional
37 organizations including the joint principles of the American College of
38 Physicians ("ACP"), the American Academy of Family Physicians ("AAFP"),
39 the American Academy of Pediatrics ("AAP"), the American Osteopathic
40 Association ("AOA"), and as further defined by "Patient Centered Medical
41 Home," as represented in certification programs developed by the
42 National Committee for Quality Assurance ("NCQA"); (c) methodologies by
43 which payors will provide enhanced rates of payment to certified medical
44 homes; and (d) methodologies to pay additional amounts for medical homes
45 that meet specific process or outcome standards established by the
46 Adirondack medical home collaborative.
47 4. Patient and health care services provider participation in the
48 Adirondack medical home multipayor demonstration program shall be on a
49 voluntary basis.
50 5. Clinics and clinicians participating in this demonstration are not
51 eligible for additional enhancements or bonuses under the statewide
52 medical home program, established pursuant to section three hundred
53 sixty-four-m of the social services law, for services provided to
54 participants in Medicaid fee-for-service, Medicaid managed care, Family
55 Health Plus or Child Health Plus.
S. 58--B 61 A. 158--B
1 6. Subject to the availability of funding and federal financial
2 participation, the commissioner is authorized:
3 (a) To pay enhanced rates of payment under Medicaid fee-for-service,
4 Medicaid managed care, Family Health Plus and Child Health Plus to clin-
5 ics and clinicians that are certified as medical homes under this title;
6 and
7 (b) To pay additional amounts for medical homes that meet specific
8 process or outcome standards specified by the commissioner, in consulta-
9 tion with the Adirondack medical home collaborative.
10 § 27. Subdivision 2 of section 365-a of the social services law is
11 amended by adding three new paragraphs (s), (t) and (u) to read as
12 follows:
13 (s) smoking cessation counseling services for pregnant women on any
14 day of pregnancy through the end of the month in which the one hundred
15 eightieth day following the end of the pregnancy occurs, and children
16 and adolescents ten to nineteen years of age, during a medical visit
17 when provided by a general hospital outpatient department or a free-
18 standing clinic, or by a physician, registered physician's assistant,
19 registered nurse practitioner or licensed midwife in office-based
20 settings; provided, however, that the provisions of this paragraph
21 relating to smoking cessation counseling services shall not take effect
22 unless all necessary approvals under federal law and regulation have
23 been obtained to receive federal financial participation in the costs of
24 such services.
25 (t) cardiac rehabilitation services when ordered by the attending
26 physician and provided in a hospital-based or free-standing clinic in an
27 area set aside for cardiac rehabilitation, or in a physician's office;
28 provided, however, that the provisions of this paragraph relating to
29 cardiac rehabilitation services shall not take effect unless all neces-
30 sary approvals under federal law and regulation have been obtained to
31 receive federal financial participation in the costs of such services.
32 (u) screening, brief intervention, and referral to treatment in hospi-
33 tal emergency departments of individuals at risk for substance abuse
34 including referral to the appropriate level of intervention and treat-
35 ment in a community setting; provided, however, that the provisions of
36 this paragraph relating to screening, brief intervention, and referral
37 to treatment services shall not take effect unless all necessary
38 approvals under federal law and regulation have been obtained to receive
39 federal financial participation in such costs.
40 § 28. Intentionally omitted.
41 § 28-a. Notwithstanding any contrary provision of section 14 of part B
42 of chapter 1 of the laws of 2002 or any other contrary provision of law,
43 distributions made pursuant to section 14 of part B of chapter 1 of the
44 laws of 2002, shall be based on each eligible hospital's proportionate
45 share of the sum of all Medicaid outpatient visits for all eligible
46 hospitals in the base year two years prior to the rate year.
47 § 29. Intentionally omitted.
48 § 30. Section 364-f of the social services law, as added by chapter
49 904 of the laws of 1984, is amended to read as follows:
50 § 364-f. [Physician] Primary care case management programs. 1. The
51 department is authorized to establish [physician] primary care case
52 management [demonstration] programs, under the medical assistance
53 program, in accordance with applicable federal law and regulations.
54 Primary care case management programs shall only be authorized in areas
55 of the state where comprehensive health services plans, as defined in
56 section forty-four hundred one of the public health law, are not yet
S. 58--B 62 A. 158--B
1 available. Subject to the approval of the director of the budget, the
2 commissioner is authorized to apply for the appropriate waivers under
3 federal law and regulation, and may waive any of the provisions of
4 sections three hundred sixty-five-a, three hundred sixty-six, three
5 hundred sixty-seven-b [and], three hundred sixty-eight-a and three
6 hundred sixty-four-j of this chapter or any regulation of the department
7 when such action would be necessary to assist in promoting the objec-
8 tives of this section.
9 2. (a) A [physician] primary care case management program shall
10 provide individuals eligible for medical assistance with the opportunity
11 to select [voluntarily] a primary care case [management provider] manag-
12 er who shall provide medical assistance services to such eligible indi-
13 viduals, either directly, or through referral [by a physician case
14 manager].
15 (b) [Physician] Primary care case managers shall be limited to quali-
16 fied, licensed primary care [physicians] practitioners, as defined in
17 paragraph (f) of subdivision one of section three hundred sixty-four-j
18 of this chapter, who meet standards established by the commissioner [of
19 health] for the purposes of this program.
20 (c) Services [for which a physician case manager will be responsible]
21 that may be covered by the primary care case management program are
22 defined by the commissioner in the benefit package. Covered services may
23 include all medical assistance services defined under section three
24 hundred sixty-five-a of this chapter, except:
25 (i) services excluded under paragraph (e) of subdivision three of
26 section three hundred sixty-four-j of this chapter shall be excluded
27 under this section;
28 (ii) services provided by residential health care facilities, long
29 term home health care programs, child care agencies, and entities offer-
30 ing comprehensive health services plans;
31 [(ii)] (iii) services provided by dentists and optometrists; and
32 [(iii)] (iv) eyeglasses, emergency care, mental health services and
33 family planning services.
34 (d) Case management services provided by [physician] primary care case
35 managers shall include, but need not be limited to:
36 (i) management of the medical and health care of each recipient to
37 assure that all services provided under paragraph (c) of this subdivi-
38 sion and which are found to be necessary, are made available in a timely
39 manner;
40 (ii) referral to, and coordination, monitoring and follow-up of,
41 appropriate providers for diagnosis and treatment, the need for which
42 has been identified by the [physician] primary care case manager but
43 which is not directly available from the [physician] primary care case
44 manager, and assisting medical assistance recipients in the prudent
45 selection of medical services;
46 (iii) arrangements for referral of recipients to appropriate provid-
47 ers; and
48 (iv) [services provided in accordance with child health assurance
49 program standards for individuals under twenty-one years of age] all
50 early periodic screening, diagnosis and treatment services, as well as
51 interperiodic screening and referral, to each participant under the age
52 of twenty-one at regular intervals.
53 3. (a) [Physician] Primary care case management programs may be
54 conducted only in accordance with [plans submitted by social services
55 districts and approved] guidelines established by the commissioner[,
56 after consultation with the commissioner of health, and only to the
S. 58--B 63 A. 158--B
1 extent and period for which such plans have been approved by the commis-
2 sioner. The commissioner shall not authorize the implementation of such
3 plans in more than ten social services districts. For the purpose of
4 implementing and administering the physician case management programs,
5 social services districts may]. For the purpose of implementing and
6 administering the primary care case management programs, the commission-
7 er may contract with private not-for-profit and public agencies as
8 defined in guidelines established by the commissioner for the management
9 and administration of [these plans provided, however, that such
10 contracts shall require prior approval by the commissioner] the primary
11 care case management program.
12 (b) The [commissioner shall only approve plans submitted pursuant to
13 this section which: (i) identify and document the specific problems
14 which the physician case management program is designed to address with-
15 in the social services district;] primary care case management program
16 must:
17 [(ii)] (i) assure access to and delivery of high quality, appropriate
18 medical services;
19 [(iii) include a description of the quality assurance mechanisms to be
20 implemented] (ii) participate in quality assurance activities as
21 required by the commissioner, as well as other mechanisms designed to
22 protect recipient rights under such program;
23 [(iv) designate the entity to be responsible for the administration of
24 the program within the social services district and describe the respon-
25 sibilities of this entity;
26 (v) include a fiscal impact statement which describes the anticipated
27 savings to federal, state and local governments, including an estimate
28 of those costs, including both inpatient and ambulatory costs, which
29 would have been incurred in the absence of the program and the projected
30 costs under the program;
31 (vi)] (iii) ensure that persons eligible for medical assistance will
32 be provided sufficient information regarding the program to make an
33 informed and voluntary choice whether to participate; and
34 [(vii)] (iv) provide for adequate safeguards to protect recipients
35 from being misled concerning the program and from being coerced into
36 participating in the [physician] primary care case management
37 program[;].
38 [(viii) assure adequate opportunity for public review and comment
39 prior to implementation of the program and provide adequate grievance
40 procedures for recipients who participate in the program; and
41 (ix) include any other information which the department shall deem
42 appropriate.]
43 4. (a) Individuals eligible [for medical assistance] to participate in
44 Medicaid managed care, [as defined in section three hundred sixty-six of
45 this chapter,] to participate in Medicaid managed care may [voluntarily]
46 participate in a [physician] primary care case management program,
47 subject to the availability of such a program within the applicable
48 social services district, except for individuals: (i) required by Medi-
49 caid managed care to be enrolled in an entity offering a comprehensive
50 health services plan as defined in paragraph (k) of subdivision two of
51 section three hundred sixty-five-a of this chapter; (ii) participating
52 in another medical assistance reimbursed demonstration or pilot project,
53 or (iii) receiving services as an inpatient from a nursing home or
54 intermediate care facility or residential services from a child care
55 agency or services from a long term home health care program.
S. 58--B 64 A. 158--B
1 (b) [All individuals eligible for medical assistance] Individuals
2 choosing to participate [voluntarily] in a [physician] primary care case
3 management program will be given thirty days from the effective date of
4 enrollment in the program to disenroll without cause. After this thirty
5 day disenrollment period, all individuals participating in the program
6 will be enrolled for a period of [six] twelve months, except that all
7 participants will be permitted to disenroll for good cause, as defined
8 in guidelines established by the commissioner [in regulation].
9 5. (a) [Physician] Primary care case management programs may include
10 provisions for innovative payment mechanisms, including, but not limited
11 to, [sharing of any savings with providers,] payment of case management
12 fees [and], capitation arrangements, and fee-for-service payments.
13 (b) Any new payment mechanisms and levels of payment implemented under
14 the [physician] primary care case management program shall be developed
15 [jointly] by the commissioner [and the commissioner of health] subject
16 to the approval of the director of the budget.
17 6. Notwithstanding any inconsistent provision of this section, partic-
18 ipation in a primary care case management program will not diminish the
19 scope of available medical services to which a recipient is entitled.
20 7. This section shall be effective if, and as long as, federal finan-
21 cial participation is available therefor.
22 § 31. The public health law is amended by adding a new section 2821 to
23 read as follows:
24 § 2821. State electronic health records (EHR) loan program. 1. Defi-
25 nitions. As used in this section, the following words and phrases shall
26 have the following meanings unless a different meaning is plainly
27 required by the context:
28 (a) "Authority" shall mean the dormitory authority of the state of New
29 York created by title four of article eight of the public authorities
30 law which has succeeded to the powers, functions and duties of the
31 medical care facilities finance agency pursuant to chapter eighty-three
32 of the laws of nineteen hundred ninety-five.
33 (b) "Eligible health care provider" shall mean any health care provid-
34 er organized under the laws of this state eligible to receive federal
35 funds, which has been approved for participation in this program by the
36 commissioner.
37 (c) "EHR loan fund" shall mean the certified electronic health records
38 technology loan fund authorized to be established by the authority
39 pursuant to this section.
40 2. The authority shall establish the EHR loan fund. Funds shall be
41 transferred or appropriated to the authority for deposit in the EHR loan
42 fund as authorized pursuant to any provision of law. Funds in the EHR
43 loan fund shall be held by the authority pursuant to this section as
44 custodian, administered by the authority pursuant to an agreement with
45 the commissioner and invested by the authority in accordance with the
46 investment guidelines of the authority. All investment income shall be
47 credited to, and any repayments of loans as hereinafter provided shall
48 be deposited in, the EHR loan fund, and spent therefrom only for the
49 purposes set forth in this section.
50 3. The commissioner and the authority shall enter into an agreement,
51 subject to the approval of the director of the division of the budget,
52 for the purpose of administering the moneys in the EHR loan fund in a
53 manner that will benefit the public health by encouraging improvements
54 in the health care delivery system through the use of information tech-
55 nology in the state. Such agreement shall include, but not be limited
56 to, the following provisions:
S. 58--B 65 A. 158--B
1 (a) for the receipt, management and expenditure of funds held in the
2 EHR loan fund by the authority;
3 (b) for the development of program components, including but not
4 limited to provider eligibility and terms and conditions of loans, and
5 for the development and implementation of strategic plans for eligible
6 health care providers, addressing the development of meaningful elec-
7 tronic health record improvements, including strategies for facilitating
8 the purchase of certified electronic health records technology, enhanc-
9 ing the utilization of certified electronic health records technology,
10 training personnel in the use of such technology and supporting the
11 secure exchange of electronic health information to and from electronic
12 health records; and
13 (c) other requirements set forth by the Secretary of the United States
14 Department of Health and Human Services with respect to the state EHR
15 loan fund for the expenditure by the authority from the EHR loan fund to
16 reimburse the authority and the department for the cost of administering
17 the loan fund.
18 4. Any eligible health care provider may apply for EHR loan funds to
19 the extent such funds are derived from deposits made pursuant to law by
20 the state. The commissioner and the authority shall consider the extent
21 to which an eligible health care provider can provide matching funds
22 that may be required by law.
23 5. To the extent funds are available from an eligible health care
24 provider, expenditures from the EHR loan fund shall be repaid to the EHR
25 loan fund from repayments received by the authority, from an eligible
26 health care provider pursuant to the terms of any financing agreement,
27 mortgage or loan document permitting the recovery from the eligible
28 health care provider of such expenditures. The authority shall record
29 the account for all such payments, which shall be deposited in the EHR
30 loan fund account.
31 6. Loans from the EHR loan fund shall be made pursuant to an agreement
32 with the eligible health care provider specifying the terms thereof,
33 including repayment terms. The authority shall record and account for
34 all such repayments, which shall be deposited in the EHR loan fund. The
35 authority shall report annually to the director of the division of budg-
36 et, the chair of the senate finance committee and the chair of the
37 assembly ways and means committee, on the transactions in the EHR loan
38 fund, including but not limited to deposits to the fund, loans made from
39 the fund, investment income, and the balance on hand as of the end of
40 each year.
41 7. The commissioner is authorized, with the assistance and cooperation
42 of the authority, to provide a program of technical assistance for
43 eligible health care providers.
44 8. The commissioner may promulgate regulations, including emergency
45 regulations, to implement the provisions of this section.
46 § 32. The commissioner is hereby authorized to submit such applica-
47 tions, strategic plans, reports to, and to comply with other require-
48 ments specified by, the federal secretary of health and human services
49 in order to obtain federal funding for the certified EHR technology loan
50 program.
51 § 33. Section 2818 of the public health law is amended by adding two
52 new subdivisions 4 and 5 to read as follows:
53 4. Notwithstanding the provisions of subdivision one of this section,
54 the commissioner and the director of the dormitory authority may award,
55 in an amount not to exceed twenty-five million dollars of the health
56 care system improvement capital grant program allocated in any given
S. 58--B 66 A. 158--B
1 fiscal year, grants to eligible applicants without the process set forth
2 in subdivision one of this section to provide necessary restructuring
3 support to hospitals for transition to a new reimbursement methodology.
4 (a) With respect to the process for the awarding of such funds without
5 the process set forth in subdivision one of this section, the commis-
6 sioner and director of the dormitory authority shall determine eligible
7 awardees based solely on an applicant's ability to meet the following
8 criteria:
9 (i) have a loss of operations for each of the three consecutive
10 preceding years as evidence by audited financial statements; and
11 (ii) have a negative fund balance or negative equity position in each
12 of the three preceding years as evidence by audited financial state-
13 ments; and
14 (iii) have a current ratio of less than 1:1 for each of three consec-
15 utive preceding days; or
16 (iv) be deemed to the satisfaction of the commissioner to be a provid-
17 er that fulfills an unmet health care need for the community as deter-
18 mined by the department through consideration of the volume of Medicaid
19 and medically indigent patients served; the service volume and mix,
20 including but not limited to maternity, pediatrics, trauma, behavior and
21 neurobehavioral, ventilator, and emergency room volume; and, the signif-
22 icance of the institution in ensuring health care services access as
23 measured by market share within the region; or
24 (v) be deemed to the satisfaction of the commissioner to have incurred
25 operating losses resulting from the implementation of reimbursement rate
26 reforms and other reductions enacted by a chapter of the laws of two
27 thousand nine, to provide for the continued financial viability of the
28 applicant.
29 (b) Prior to an award being granted to an eligible applicant without a
30 competitive bid or request for proposal process, the commissioner and
31 the director of the dormitory authority shall notify the chair of the
32 senate finance committee, the chair of the assembly ways and means
33 committee and the director of the budget of the intent to grant such an
34 award. Such notice shall include information regarding how the eligible
35 applicant meets criteria established pursuant to this section.
36 5. (a) Notwithstanding subdivision one, two or three of this section,
37 the commissioner, with the approval of the director of the budget, may
38 expend funds for the purpose of providing cost effective increased
39 access to the capital markets, including but not limited to through the
40 use of mortgage insurance, credit enhancement, letters of credit, bond
41 insurance or other arrangements, for capital projects that are deter-
42 mined to meet one or more of the following objectives for hospitals
43 licensed under this article:
44 (i) securing financing for facilities in a manner that will improve
45 the operation and efficiency of the health care delivery system within
46 the state;
47 (ii) securing financing for facilities in a manner consistent with the
48 objectives and determinations of the Commission on Health Care Facili-
49 ties in the Twenty-First Century, established pursuant to chapter
50 sixty-three of the laws of two thousand five;
51 (iii) securing financing for facilities in a manner that will help
52 rightsize the state's acute care infrastructure, including reducing
53 inpatient capacity, downsizing, restructuring, and closing facilities;
54 (iv) securing financing for facilities in a manner that advances the
55 reform of the long-term care system, including through rightsizing and
56 providing community-based services;
S. 58--B 67 A. 158--B
1 (v) securing financing for facilities in a manner that improves the
2 primary and ambulatory care system including programs undertaken in
3 collaboration with a local development corporation incorporated pursuant
4 to sections four hundred one and one thousand four hundred eleven of the
5 not-for-profit corporation law to foster the development and expansion
6 of high quality, cost effective primary health care services and related
7 ambulatory care and ancillary services benefiting medically underserved
8 communities, principally in the state, to increase access of community
9 residents to such services, to improve the health status of such resi-
10 dents and to lessen the burdens of government and act in the public
11 interest; and
12 (vi) such other objectives as the commissioner deems appropriate to
13 effectuate the intent of this subdivision.
14 (b) The commissioner may transfer funds to other state agencies or
15 public authorities, with the approval of the director of budget, to
16 effectuate the purposes of this subdivision.
17 § 34. Subdivision 3 of section 1680-j of the public authorities law,
18 as amended by section 7 of part B of chapter 58 of the laws of 2008, is
19 amended to read as follows:
20 3. Notwithstanding any law to the contrary, and in accordance with
21 section four of the state finance law, the comptroller is hereby author-
22 ized and directed to transfer from the health care reform act (HCRA)
23 resources fund (061) to the general fund, upon the request of the direc-
24 tor of the budget, up to $6,500,000 on or before March 31, 2006, and the
25 comptroller is further hereby authorized and directed to transfer from
26 the healthcare reform act (HCRA); Resources fund (061) to the Capital
27 Projects Fund, upon the request of the director of budget, up to
28 $139,000,000 for the period April 1, 2006 through March 31, 2007, up to
29 $171,100,000 for the period April 1, 2007 through March 31, 2008, up to
30 $208,100,000 for the period April 1, 2008 through March 31, 2009, up to
31 $151,600,000 for the period April 1, 2009 through March 31, 2010, and up
32 to [$182,000,000] $238,000,000 for the period April 1, 2010 through
33 March 31, 2011.
34 § 35. Subdivisions 5 and 7 of section 270 of the public health law, as
35 added by section 10 of part C of chapter 58 of the laws of 2005, are
36 amended and a new subdivision 14 is added to read as follows:
37 5. "Non preferred drug" means a prescription drug that is [in a thera-
38 peutic class that is] included in the preferred drug program and is not
39 one of the drugs on the preferred drug list [in that class] because it
40 is either: (a) in a therapeutic class that is included in the preferred
41 drug program and is not one of the drugs on the preferred drug list in
42 that class or (b) manufactured by a pharmaceutical manufacturer with
43 whom the commissioner is negotiating or has negotiated a manufacturer
44 agreement and is not a preferred drug under a manufacturer agreement.
45 7. "Preferred drug" means a prescription drug that is either (a) in a
46 therapeutic class that is included in the preferred drug program and is
47 one of the drugs on the preferred drug list in that class or (b) a
48 preferred drug under a manufacturer agreement.
49 14. "Manufacturer agreement" means an agreement between the commis-
50 sioner and a pharmaceutical manufacturer under paragraph (b) of subdivi-
51 sion eleven of section two hundred seventy-two of this article.
52 § 36. Subdivision 11 of section 272 of the public health law, as added
53 by section 10 of part C of chapter 58 of the laws of 2005, is amended to
54 read as follows:
55 11. (a) The commissioner shall provide an opportunity for pharmaceu-
56 tical manufacturers to provide supplemental rebates to the state public
S. 58--B 68 A. 158--B
1 health [plan] plans for drugs within a therapeutic class; such supple-
2 mental rebates shall be taken into consideration by the committee and
3 the commissioner in determining the cost-effectiveness of drugs within a
4 therapeutic class under the state public health plans.
5 (b) The commissioner may designate a pharmaceutical manufacturer as
6 one with whom the commissioner is negotiating or has negotiated a
7 manufacturer agreement, and all of the drugs it manufactures or markets
8 shall be included in the preferred drug program. The commissioner may
9 negotiate directly with a pharmaceutical manufacturer for rebates relat-
10 ing to any or all of the drugs it manufactures or markets. A manufactur-
11 er agreement shall designate any or all of the drugs manufactured or
12 marketed by the pharmaceutical manufacturer as being preferred or non
13 preferred drugs. When a pharmaceutical manufacturer has been designated
14 by the commissioner under this paragraph but has not reached a manufac-
15 turer agreement with the pharmaceutical manufacturer, then all of the
16 drugs manufactured or marketed by the pharmaceutical manufacturer shall
17 be non preferred drugs. However, notwithstanding this paragraph, any
18 drug that is selected to be on the preferred drug list under paragraph
19 (b) of subdivision ten of this section on grounds that it is signif-
20 icantly more clinically effective and safer than other drugs in its
21 therapeutic class shall be a preferred drug.
22 [Such supplemental] (c) Supplemental rebates under this subdivision
23 shall be in addition to those required by applicable federal law and
24 subdivision seven of section three hundred sixty-seven-a of the social
25 services law. In order to be considered in connection with the preferred
26 drug program, such supplemental rebates shall apply to the drug products
27 dispensed under the Medicaid program and the EPIC program. The commis-
28 sioner is prohibited from approving alternative rebate demonstrations,
29 value added programs or guaranteed savings from other program benefits
30 as a substitution for supplemental rebates.
31 § 37. Subdivision 1 of section 273 of the public health law, as added
32 by section 10 of part C of chapter 58 of the laws of 2005, is amended to
33 read as follows:
34 1. For the purposes of this article, a prescription drug shall be
35 considered to be not on the preferred drug list if it is [in a therapeu-
36 tic class that is included on the preferred drug list and is not one of
37 the drugs on the preferred list in that class] a non preferred drug.
38 § 38. Section 369-aa of the social services law is amended by adding a
39 new subdivision 16 to read as follows:
40 16. "Step therapy" shall mean the practice of beginning drug therapy
41 for a medical condition with the most medically appropriate and cost
42 effective therapy and progressing to other drugs as medically necessary.
43 § 39. Subdivision 3 of section 369-cc of the social services law, as
44 added by chapter 632 of the laws of 1992, is amended, and a new subdivi-
45 sion 4 is added to read as follows:
46 3. The prospective DUR program shall be based on the guidelines estab-
47 lished by the DUR board not in conflict with education or social
48 services laws and shall provide that prior to the prescription being
49 filled or delivered, a review will be conducted by the pharmacist at the
50 point of sale to screen for potential drug therapy problems resulting
51 from:
52 (a) Therapeutic duplication;
53 (b) Drug-drug interactions;
54 (c) Incorrect dosage/duration of treatment;
55 (d) Drug-allergy interactions;
56 (e) Clinical abuse/misuse.
S. 58--B 69 A. 158--B
1 In conducting the prospective DUR, the pharmacist may not alter the
2 prescribed outpatient drug therapy without the consent of the [physi-
3 cian] prescriber who prescribed that therapy.
4 4. (a) The commissioner, through the prospective DUR program, may
5 require step therapy when there is more than one drug appropriate to
6 treat a medical condition. The purpose of step therapy is to encourage
7 the use of medically appropriate, cost effective drugs when clinically
8 indicated and to limit use of alternative drug therapies unless certain
9 clinical requirements are met. The DUR board shall recommend guidelines
10 for specific diagnoses and therapy regimens within which practitioners
11 may prescribe drugs without the requirement for prior authorization of
12 those drugs. In establishing these guidelines, the board shall consider
13 clinical effectiveness, safety, and cost effectiveness. Prior authori-
14 zation under this paragraph shall be obtained under section two hundred
15 seventy-three of the public health law.
16 (b) The commissioner, through the prospective DUR program, may from
17 time to time limit the quantity, frequency, and duration of drug thera-
18 py, using guidelines developed by the DUR board. The DUR board shall
19 develop clinical prescribing guidelines relating to quantity, frequency,
20 and duration of drug therapy for the commissioner's use under this para-
21 graph. In establishing these guidelines, the board shall consider clin-
22 ical effectiveness, safety, and cost effectiveness. Prior authorization
23 under this paragraph shall be obtained under section two hundred seven-
24 ty-three of the public health law. Exceptions to any prior authorization
25 imposed as a result of these guidelines shall include, but need not be
26 limited to, provision for emergency circumstances where a medical condi-
27 tion requires alleviation of severe pain or which threatens to cause
28 disability or to take a life if not promptly treated.
29 § 40. Intentionally omitted.
30 § 41. Intentionally omitted.
31 § 42. Intentionally omitted.
32 § 43. Intentionally omitted.
33 § 44. Intentionally omitted.
34 § 45. Intentionally omitted.
35 § 46. Paragraph (a-1) of subdivision 4 of section 365-a of the social
36 services law, as amended by section 11 of part C of chapter 58 of the
37 laws of 2005, is amended to read as follows:
38 (a-1) (i) a brand name drug for which a multi-source therapeutically
39 and generically equivalent drug, as determined by the federal food and
40 drug administration, is available, unless previously authorized by the
41 department of health. The commissioner of health is authorized to
42 exempt, for good cause shown, any brand name drug from the restrictions
43 imposed by this [paragraph] subparagraph. This [paragraph] subparagraph
44 shall not apply to any drug that is in a therapeutic class included on
45 the preferred drug list under section two hundred seventy-two of the
46 public health law or is in the clinical drug review program under
47 section two hundred seventy-four of the public health law;
48 (ii) notwithstanding the provisions of subparagraph (i) of this para-
49 graph, the commissioner is authorized to deny reimbursement for a gener-
50 ic equivalent, including a generic equivalent that is on the preferred
51 drug list or the clinical drug review program, when the net cost of the
52 brand name drug, after consideration of all rebates, is less than the
53 cost of the generic equivalent, unless prior authorization is obtained
54 under section two hundred seventy-three of the public health law;
S. 58--B 70 A. 158--B
1 § 46-a. Paragraph (a-2) of subdivision 4 of section 365-a of the
2 social services law, as added by section 12 of part C of chapter 58 of
3 the laws of 2005, is amended to read as follows:
4 (a-2) drugs which may not be dispensed without a prescription as
5 required by section sixty-eight hundred ten of the education law, and
6 which are [non-preferred] non preferred drugs [in a therapeutic class
7 subject to the preferred drug program] pursuant to section two hundred
8 seventy-two of the public health law, or the clinical drug review
9 program under section two hundred seventy-four of the public health law,
10 unless prior authorization is granted or not required;
11 § 47. Subparagraph (iii) of paragraph (c) of subdivision 6 of section
12 367-a of the social services law, as amended by section 9 of part C of
13 chapter 58 of the laws of 2008, is amended to read as follows:
14 (iii) Notwithstanding any other provision of this paragraph, co-
15 payments charged for each generic prescription drug dispensed shall be
16 one dollar and for each brand name prescription drug dispensed shall be
17 three dollars; provided, however, that the co-payments charged for each
18 brand name prescription drug on the preferred drug list established
19 pursuant to section two hundred seventy-two of the public health law and
20 the co-payments charged for each brand name prescription drug reimbursed
21 pursuant to subparagraph (ii) of paragraph (a-1) of subdivision four of
22 section three hundred sixty-five-a of this title shall be one dollar.
23 § 48. Subparagraph (ii) of paragraph (d) of subdivision 9 of section
24 367-a of the social services law, as amended by chapter 19 of the laws
25 of 1998, is amended to read as follows:
26 (ii) for prescription drugs categorized as brand-name prescription
27 [drug] drugs by the prescription drug pricing service used by the
28 department, three dollars and fifty cents per prescription, provided,
29 however, that for brand name prescription drugs reimbursed pursuant to
30 subparagraph (ii) of paragraph (a-1) of subdivision four of section
31 three hundred sixty-five-a of this title, the dispensing fee shall be
32 four dollars and fifty cents per prescription.
33 § 49. Subdivision 9 of section 367-a of the social services law is
34 amended by adding a new paragraph (i) to read as follows:
35 (i)(i) The commissioner of health is authorized to pay financial
36 incentives to medical practitioners and to pharmacies for the purpose of
37 encouraging the electronic transmission of prescriptions for drugs for
38 which payments are made under this subdivision. Such payments shall be
39 in the following amounts: for medical practitioners, eighty cents per
40 dispensed electronic prescription; for dispensing pharmacies, twenty
41 cents per dispensed electronic prescription. (ii) Electronic prescribing
42 software shall not use any means or permit any other person to use any
43 means, including, but not limited to, advertising, instant messaging,
44 and pop-up ads, to influence or attempt to influence, through economic
45 incentives or otherwise, the prescribing decision of a prescribing prac-
46 titioner at the point of care. Such means shall not be triggered or in
47 specific response to the input, selection, or act of a prescribing prac-
48 titioner or his or her agent in prescribing a certain pharmaceutical or
49 directing a patient to a certain pharmacy. (iii) The provisions of this
50 paragraph shall not take effect unless all necessary approvals under
51 federal law and regulation have been obtained to receive federal finan-
52 cial participation in the costs of services provided under this para-
53 graph.
54 § 50. Intentionally omitted.
55 § 51. Intentionally omitted.
56 § 52. Intentionally omitted.
S. 58--B 71 A. 158--B
1 § 53. Intentionally omitted.
2 § 54. Intentionally omitted.
3 § 55. Intentionally omitted.
4 § 56. Intentionally omitted.
5 § 57. Intentionally omitted.
6 § 58. Clauses (ii) and (iii) of subparagraph 1 and subparagraphs 3 and
7 4 of paragraph (a) of subdivision 1 of section 366 of the social
8 services law, clauses (ii) and (iii) of subparagraph 1 as amended by
9 section 60 of part C of chapter 58 of the laws of 2008, subparagraph 3
10 as amended by chapter 309 of the laws of 1996, subparagraph 4 as amended
11 by chapter 1080 of the laws of 1974, are amended to read as follows:
12 (ii) such person [may have resources up to the amount specified in
13 subparagraph four of paragraph (a) of subdivision two of this section]
14 shall not be subject to a resource test;
15 (iii) a person whose income [and resources are] is within the [limits]
16 limit set forth in [clauses] clause (i) [and (ii)] of this subparagraph
17 shall be deemed to have unmet needs for purposes of the eligibility
18 requirements of the safety net program as it existed on the first day of
19 November, nineteen hundred ninety-seven;
20 (3) is a child under the age of twenty-one years receiving care (A)
21 away from his own home in accordance with title two of article six of
22 this chapter; (B) during the initial thirty days of placement with the
23 division for youth pursuant to section 353.3 of the family court act;
24 (C) in an authorized agency when placed pursuant to section seven
25 hundred fifty-six or 353.3 of the family court act; or (D) in residence
26 at a division foster family home or a division contract home, and has
27 not, according to the criteria promulgated by the department, sufficient
28 income [and resources], including available support from his parents, to
29 meet all costs of required medical care and services available under
30 this title; or
31 (4) is receiving care, in the case of and in connection with the birth
32 of an out of wedlock child, in accordance with title two of article six
33 of this chapter, and has not, according to the criteria promulgated by
34 the department, sufficient income [and resources], including available
35 support from responsible relatives, to meet all costs of required
36 medical care and services available under this title; or
37 § 59. Subparagraphs 5, 6 and 8 of paragraph (a) of subdivision 1 of
38 section 366 of the social services law, subparagraph 5 as amended by
39 section 55 of part B of chapter 436 of the laws of 1997, subparagraph 6
40 as amended by chapter 710 of the laws of 1988 and subparagraph 8 as
41 amended by section 60 of part C of chapter 58 of the laws of 2008, are
42 amended and a new subparagraph 5-a is added to read as follows:
43 (5) although not receiving public assistance or care for his or her
44 maintenance under other provisions of this chapter, has [not, according
45 to the criteria and standards established by this article or by action
46 of the department, sufficient] income and resources, including available
47 support from responsible relatives, [to meet all the costs of medical
48 care and services available under this title,] that does not exceed the
49 amounts set forth in paragraph (a) of subdivision two of this section,
50 and is (i) [under the age of twenty-one years, or] sixty-five years of
51 age or older, or certified blind or certified disabled or (ii) [a spouse
52 of a cash public assistance recipient living with him or her and essen-
53 tial or necessary to his or her welfare and whose needs are taken into
54 account in determining the amount of his or her cash payment or (iii)]
55 for reasons other than income or resources[: (A)], is eligible for
56 federal supplemental security income benefits and/or additional state
S. 58--B 72 A. 158--B
1 payments[, or (B) would meet the eligibility requirements of the aid to
2 dependent children program as it existed on the sixteenth day of July,
3 nineteen hundred ninety-six]; or
4 (5-a) although not receiving public assistance or care for his or her
5 maintenance under other provisions of this chapter, has income, includ-
6 ing available support from responsible relatives, that does not exceed
7 the amounts set forth in paragraph (a) of subdivision two of this
8 section, and is (i) under the age of twenty-one years, or (ii) a spouse
9 of a cash public assistance recipient living with him or her and essen-
10 tial or necessary to his or her welfare and whose needs are taken into
11 account in determining the amount of his or her cash payment, or (iii)
12 for reasons other than income or resources, would meet the eligibility
13 requirements of the aid to dependent children program as it existed on
14 the sixteenth day of July, nineteen hundred ninety-six; or
15 (6) is a resident of a home for adults operated by a social services
16 district or a residential care center for adults or community residence
17 operated or certified by the office of mental health, and has not,
18 according to criteria promulgated by the department consistent with this
19 title, sufficient income, or in the case of a person sixty-five years of
20 age or older, certified blind, or certified disabled, sufficient income
21 and resources, including available support from responsible relatives,
22 to meet all the costs of required medical care and services available
23 under this title; or
24 (8) is a member of a family which contains a dependent child living
25 with a caretaker relative, which has net available income not in excess
26 of one hundred thirty percent of the highest amount that ordinarily
27 would have been paid to a person without any income or resources under
28 the family assistance program as it existed on the first day of Novem-
29 ber, nineteen hundred ninety-seven, to be increased annually by the same
30 percentage as the percentage increase in the federal consumer price
31 index[, and which has net available resources not in excess of the
32 amount specified in subparagraph four of paragraph (a) of subdivision
33 two of this section]; for purposes of this subparagraph, the net avail-
34 able income [and resources] of a family shall be determined using the
35 methodology of the family assistance program as it exists on the first
36 day of November, nineteen hundred ninety-seven, except that no part of
37 the methodology of the family assistance program will be used which is
38 more restrictive than the methodology of the aid to dependent children
39 program as it existed on the sixteenth day of July, nineteen hundred
40 ninety-six; for purposes of this subparagraph, the term dependent child
41 means a person under twenty-one years of age who is deprived of parental
42 support or care by reason of the death, continued absence, or physical
43 or mental incapacity of a parent, or by reason of the unemployment of
44 the parent, as defined by the department of health; or
45 § 59-a. Subparagraph 10 of paragraph (a) of subdivision 1 of section
46 366 of the social services law, as amended by section 1 of part E of
47 chapter 57 of the laws of 2000, is amended to read as follows:
48 (10) is a child who is under twenty-one years of age, who is not
49 living with a caretaker relative, who has net available income not in
50 excess of the income standards of the family assistance program as it
51 existed on the first day of November, nineteen hundred ninety-seven[,
52 and who has net available resources not in excess of one thousand
53 dollars]; for purposes of this subparagraph, the child's net available
54 income [and resources] shall be determined using the methodology of the
55 family assistance program as it existed on the first day of November,
56 nineteen hundred ninety-seven, except that [(i) there shall be disre-
S. 58--B 73 A. 158--B
1 garded an additional amount of resources equal to the difference between
2 the applicable resource standard of the family assistance program as it
3 exists on the first day of November, nineteen hundred ninety-seven and
4 one thousand dollars and (ii)] no part of the methodology of the family
5 assistance program will be used which is more restrictive than the meth-
6 odology of the aid to dependent children program as it existed on the
7 sixteenth day of July, nineteen hundred ninety-six; or
8 § 59-b. Paragraph (i) of subdivision 1 of section 369-ee of the social
9 services law is REPEALED.
10 § 59-c. The opening paragraph of paragraph (b) of subdivision 2 of
11 section 369-ee of the social services law, as amended by section 45-d of
12 part C of chapter 58 of the laws of 2008, is amended to read as follows:
13 Subject to the provisions of paragraph (d) of this subdivision, in
14 order to establish [income] eligibility under this subdivision, which
15 shall be determined without regard to resources, an individual shall
16 provide such documentation as is necessary and sufficient to initially,
17 and annually thereafter, determine an applicant's eligibility for cover-
18 age under this title. Such documentation shall include, but not be
19 limited to the following, if needed to verify eligibility:
20 § 59-d. Paragraph (c) of subdivision 2 of section 369-ee of the social
21 services law is REPEALED.
22 § 60. Subdivision 1 and paragraph (a) of subdivision 2 of section
23 366-a of the social services law, subdivision 1 as amended by chapter
24 532 of the laws of 1972 and paragraph (a) of subdivision 2 as added by
25 section 51 of part A of chapter 1 of the laws of 2002, are amended to
26 read as follows:
27 1. Any person requesting medical assistance may make application
28 therefor in person, through another in his behalf or by mail to the
29 social services official of the county, city or town, or to the service
30 officer of the city or town in which the applicant resides or is found.
31 In addition, in the case of a person who is sixty-five years of age or
32 older and is a patient in a state hospital for tuberculosis or for the
33 mentally disabled, applications may be made to the department or to a
34 social services official designated as the agent of the department.
35 Notwithstanding any provision of law to the contrary, [in accordance
36 with department regulations, when an application is made by mail,] a
37 personal interview [shall be conducted] with the applicant or with the
38 person who made application [in] on his or her behalf [when the appli-
39 cant cannot be interviewed due to his physical or mental condition]
40 shall not be required as part of a determination of initial or continu-
41 ing eligibility pursuant to this title.
42 (a) Upon receipt of such application, the appropriate social services
43 official, or the department of health or its agent when the applicant is
44 a patient in a state hospital for the mentally disabled, shall verify
45 the eligibility of such applicant. In accordance with the regulations of
46 the department of health, it shall be the responsibility of the appli-
47 cant to provide information and documentation necessary for the determi-
48 nation of initial and ongoing eligibility for medical assistance. If an
49 applicant or recipient is unable to provide necessary documentation, the
50 public welfare official shall promptly cause an investigation to be
51 made. Where an investigation is necessary, sources of information other
52 than public records will be consulted only with permission of the appli-
53 cant or recipient. In the event that such permission is not granted by
54 the applicant or recipient, or necessary documentation cannot be
55 obtained, the social services official or the department of health or
56 its agent may suspend or deny medical assistance until such time as it
S. 58--B 74 A. 158--B
1 may be satisfied as to the applicant's or recipient's eligibility there-
2 for. [To the extent practicable, any interview conducted as a result of
3 an application for medical assistance shall be conducted in the home of
4 the person interviewed or in the institution in which such person is
5 receiving medical assistance.]
6 § 61. Paragraph (a) of subdivision 5 of section 369-ee of the social
7 services law, as added by chapter 1 of the laws of 1999, is amended to
8 read as follows:
9 (a) [Personal interviews, pursuant to section three hundred
10 sixty-six-a of this chapter, may be required upon initial application
11 only and may be conducted in community settings.] A personal interview
12 with the applicant or with the person who made application on his or her
13 behalf shall not be required as part of a determination of initial or
14 continuing eligibility pursuant to this title. Recertification of eligi-
15 bility shall take place on no more than an annual basis [and shall not
16 require a personal interview]. Nothing herein shall abridge the partic-
17 ipant's obligation to report changes in residency, financial circum-
18 stances or household composition.
19 § 62. Section 23-a of part B of chapter 436 of the laws of 1997,
20 constituting the welfare reform act of 1997, is amended to read as
21 follows:
22 § 23-a. Notwithstanding any contrary provision thereof, section 266 of
23 chapter 83 of the laws of 1995 shall apply to applicants for or recipi-
24 ents of public assistance and care[, including medical assistance];
25 provided, however, that [with respect to medical assistance, such
26 section shall apply only to persons who are subject to the photograph
27 identification requirements established by the commissioner of health
28 for] such section shall not apply to the medical assistance program.
29 § 63. Subparagraph 8 of paragraph (a) of subdivision 1 of section 366
30 of the social services law, as amended by section 60 of part C of chap-
31 ter 58 of the laws of 2008, is amended to read as follows:
32 (8) is a member of a family which contains a dependent child living
33 with a caretaker relative, which has: (i) subject to the approval of the
34 federal Centers for Medicare and Medicaid services, gross income not in
35 excess of one hundred percent of the federal income official poverty
36 line (as defined and annually revised by the federal office of manage-
37 ment and budget) for a family of the same size as the families that
38 include the children or (ii) in the absence of such approval, net avail-
39 able income not in excess of one hundred thirty percent of the highest
40 amount that ordinarily would have been paid to a person without any
41 income or resources under the family assistance program as it existed on
42 the first day of November, nineteen hundred ninety-seven, to be
43 increased annually by the same percentage as the percentage increase in
44 the federal consumer price index, and which has net available resources
45 not in excess of the amount specified in subparagraph four of paragraph
46 (a) of subdivision two of this section; for purposes of this subpara-
47 graph, the net available income and resources of a family shall be
48 determined using the methodology of the family assistance program as it
49 exists on the first day of November, nineteen hundred ninety-seven,
50 except that no part of the methodology of the family assistance program
51 will be used which is more restrictive than the methodology of the aid
52 to dependent children program as it existed on the sixteenth day of
53 July, nineteen hundred ninety-six; for purposes of this subparagraph,
54 the term dependent child means a person under twenty-one years of age
55 who is deprived of parental support or care by reason of the death,
56 continued absence, or physical or mental incapacity of a parent, or by
S. 58--B 75 A. 158--B
1 reason of the unemployment of the parent, as defined by the department
2 of health; or
3 § 64. Paragraph (a) of subdivision 1 of section 366 of the social
4 services law is amended by adding a new subparagraph 8-a to read as
5 follows:
6 (8-a) is an individual who is at least nineteen but under twenty-one
7 years of age and is a member of a household which has gross income not
8 in excess of one hundred percent of the federal income official poverty
9 line (as defined and annually revised by the federal office of manage-
10 ment and budget) for a household of the same size; or
11 § 65. Paragraph (p) of subdivision 4 of section 366 of the social
12 services law, as added by chapter 651 of the laws of 1990, subparagraph
13 2 as amended by section 97 of part B of chapter 436 of the laws of 1997,
14 is amended to read as follows:
15 (p) (1) Children who are at least one year of age but younger than
16 [six] nineteen years of age who are not otherwise eligible for medical
17 assistance and whose families have: (i) subject to the approval of the
18 federal Centers for Medicare and Medicaid services, gross incomes not in
19 excess of one hundred sixty percent of the federal income official
20 poverty line (as defined and annually revised by the federal office of
21 management and budget) for a family of the same size as the families
22 that include the children or (ii) in the absence of such approval, net
23 incomes equal to or less than one hundred thirty-three percent of the
24 federal income official poverty line (as defined and annually revised by
25 the federal office of management and budget) for a family of the same
26 size as the families that include the children shall be eligible for
27 medical assistance and shall remain eligible therefor as provided in
28 subparagraph three of this paragraph.
29 (2) For purposes of determining eligibility for medical assistance
30 under this paragraph, family income shall be determined by use of the
31 same methodology used to determine eligibility for the aid to dependent
32 children program as it existed on the sixteenth day of July, nineteen
33 hundred ninety-six provided, however, that costs incurred for medical or
34 remedial care shall not be considered and resources available to such
35 families shall not be considered nor required to be applied toward the
36 payment or part payment of the cost of medical care, services and
37 supplies available under this paragraph.
38 (3) An eligible child who is receiving medically necessary in-patient
39 services for which medical assistance is provided on the date the child
40 attains [six] nineteen years of age, and who, but for attaining such
41 age, would remain eligible for medical assistance under this paragraph,
42 shall continue to remain eligible until the end of the stay for which
43 in-patient services are being furnished.
44 § 65-a. Subparagraph 1 of paragraph (m) of subdivision 4 of section
45 366 of the social services law, as added by chapter 584 of the laws of
46 1989, is amended to read as follows:
47 (1) Pregnant women and infants younger than one year of age who are
48 not otherwise eligible for medical assistance and whose families have
49 net incomes equal to or less than one hundred percent of the [compara-
50 ble] federal [income official] poverty line (as defined and annually
51 revised by the [federal office of management and budget] United States
52 department of health and human services) for families of the same size
53 shall be eligible for medical assistance as provided in subparagraph
54 three of this paragraph. Subject to the approval of the federal Centers
55 for Medicare and Medicaid Services, financial eligibility pursuant to
S. 58--B 76 A. 158--B
1 this paragraph may be determined using an equivalent methodology based
2 on the family's gross income.
3 § 65-b. Subparagraph 1 of paragraph (n) of subdivision 4 of section
4 366 of the social services law, as amended by section 2 of part D of
5 chapter 57 of the laws of 2000, is amended to read as follows:
6 (1) Infants younger than one year who are not otherwise eligible for
7 medical assistance and whose families have: (i) subject to the approval
8 of the federal Centers for Medicare and Medicaid Services, gross incomes
9 not in excess of two hundred thirty percent of the federal poverty line
10 (as defined and annually revised by the United States department of
11 health and human services) for a family of the same size as the families
12 that include the children or (ii) in the absence of such approval, net
13 incomes equal to or less than two hundred percent of the federal [income
14 official] poverty line (as defined and annually revised by the United
15 States department of health and human services) for a family of the same
16 size as the families that include the infants, shall be eligible for
17 medical assistance as provided in subparagraph three of this paragraph.
18 For purposes of this paragraph, family income shall be determined by use
19 of the same methodology used to determine eligibility for the aid to
20 dependent children program as it existed on the sixteenth day of July,
21 nineteen hundred ninety-six.
22 § 65-c. Subparagraph 1 of paragraph (o) of subdivision 4 of section
23 366 of the social services law, as amended by section 3 of part D of
24 chapter 57 of the laws of 2000, is amended to read as follows:
25 (1) Pregnant women who are not otherwise eligible for medical assist-
26 ance [are eligible for services provided under the prenatal care assist-
27 ance program established pursuant to title two of article twenty-five of
28 the public health law if the income of the family that includes the
29 pregnant woman does not exceed] and whose families have: (i) subject to
30 the approval of the federal Centers for Medicare and Medicaid Services,
31 gross incomes not in excess of two hundred thirty percent of the federal
32 poverty line (as defined and annually revised by the United States
33 department of health and human services) for a family of the same size
34 as the families that include the children or (ii) in the absence of such
35 approval, net incomes equal to or less than two hundred percent of the
36 [comparable] federal [income official] poverty line (as defined and
37 annually revised by the United States department of health and human
38 services) for families of the same size, shall be eligible for coverage
39 of prenatal care services as provided in subparagraph three of this
40 paragraph.
41 § 65-d. Paragraph (a) of subdivision 2 of section 2529 of the public
42 health law, as amended by chapter 59 of the laws of 1993, is amended to
43 read as follows:
44 2. (a) Any inconsistent provision of law notwithstanding, a pregnant
45 woman shall be presumed to be an eligible service recipient beginning on
46 the date that a qualified provider determines, on the basis of prelimi-
47 nary information, that the pregnant woman's net household income does
48 not exceed the applicable income level of eligibility. Subject to the
49 approval of the federal Centers for Medicare and Medicaid Services,
50 financial eligibility pursuant to this subdivision may be determined
51 using an equivalent methodology based on the family's gross income.
52 § 66. Paragraph (q) of subdivision 4 of section 366 of the social
53 services law is REPEALED.
54 § 67. Subparagraph (v) of paragraph (a) of subdivision 2 of section
55 369-ee of the social services law, as amended by chapter 419 of the laws
56 of 2000, is amended to read as follows:
S. 58--B 77 A. 158--B
1 (v) (A) in the case of a parent or stepparent of a child under the age
2 of twenty-one who lives with such child, has gross family income equal
3 to or less than the applicable percent of the federal income official
4 poverty line (as defined and updated by the United States Department of
5 Health and Human Services) for a family of the same size; for purposes
6 of this clause, the applicable percent effective as of:
7 (I) January first, two thousand one, is one hundred twenty percent;
8 and
9 (II) October first, two thousand one, is one hundred thirty-three
10 percent; and
11 (III) October first, two thousand two, is one hundred fifty percent;
12 [or] and
13 (IV) April first, two thousand ten, is one hundred sixty percent; or
14 (B) in the case of an individual who is at least twenty-one years of
15 age and who is not a parent or stepparent living with his or her child
16 under the age of twenty-one, has gross family income equal to or less
17 than one hundred percent of the federal income official poverty line (as
18 defined and updated by the United States Department of Health and Human
19 Services) for a family of the same size[.]; or
20 (C) in the case of an individual who is at least nineteen but under
21 twenty-one years of age and who is not a parent or stepparent living
22 with his or her child under the age of twenty-one, has gross family
23 income equal to or less than one hundred sixty percent of the federal
24 income official poverty line (as defined and updated by the United
25 States Department of Health and Human Services) for a family of the same
26 size; or
27 (D) is not described in clause (A), (B) or (C) of this subparagraph
28 and has gross family income equal to or less than two hundred percent of
29 the federal income official poverty line (as defined and updated by the
30 United States Department of Health and Human Services) for a family of
31 the same size; provided, however, that eligibility under this clause is
32 subject to sources of federal and non-federal funding for such purpose
33 described in section sixty-seven-a of the chapter of the laws of two
34 thousand nine that added this clause or as may be available under the
35 waiver agreement entered into with the federal government under section
36 eleven hundred fifteen of the federal social security act, as jointly
37 determined by the commissioner and the director of the division of the
38 budget. In no case shall state funds be utilized to support the non-fed-
39 eral share of expenditures pursuant to this subparagraph, provided
40 however that the commissioner may demonstrate to the United States
41 department of health and human services the existence of non-federally
42 participating state expenditures as necessary to secure federal funding
43 under an eleven hundred fifteen waiver for the purposes herein. Eligi-
44 bility under this clause may be provided to residents of all counties
45 or, at the joint discretion of the commissioner and the director of the
46 division of the budget, a subset of counties of the state.
47 § 67-a. Notwithstanding any contrary provision of law, the commis-
48 sioner of health is authorized to enter into an agreement with the
49 United States department of health and human services establishing a
50 waiver agreement pursuant to section 1115 of the federal social security
51 act which may include the redirection of such Medicaid payments
52 described below, or a portion thereof, and the utilization of such funds
53 to fund services to uninsured persons and/or expand coverage under the
54 family health plus program to families with gross income equal to or
55 less than 200 percent of the federal poverty level, as provided in
56 clause (D) of subparagraph (v) of paragraph (a) of subdivision two of
S. 58--B 78 A. 158--B
1 section 369-ee of the social services law. Such waiver may include the
2 following:
3 1. Notwithstanding any inconsistent provisions of sections 211, 212,
4 213 and 214 of chapter 474 of the laws of 1996, as amended, sections 13,
5 14, 18 and 21 of part B of chapter 1 of the laws of 2002, as amended,
6 and sections 12, 14, 15 and 22 of part A of chapter 1 of the laws of
7 2002, as amended, or any other contrary provision of law, and subject to
8 the availability of federal financial participation and the receipt of
9 all necessary federal approvals, Medicaid payments authorized pursuant
10 to section 211 and paragraph (a) of subdivision 1 of section 212 of
11 chapter 474 of the laws of 1996, but not including any payments to
12 general hospitals operated by the state of New York or the university of
13 the state of New York, sections 13 and 14 of part B of chapter 1 of the
14 laws of 2002, and sections 12 and 14 of part A of chapter 1 of the laws
15 of 2002, shall be in accord with the provisions of this section.
16 2. Social services districts which voluntarily elect to participate in
17 such program to fund services to uninsured persons and/or expand family
18 health plus coverage may have the non-federal share of the payment
19 amounts described in subdivision one of this section, or a portion ther-
20 eof, redirected by the commissioner of health to support the non-federal
21 share of payments associated with such program to fund services to unin-
22 sured persons and/or expand family health plus coverage. Such elections
23 may be revoked effective 6 months after such local social services
24 district provides notice of revocation. Such elections by each social
25 services district shall be subject to the approval of the commissioner
26 of health and with the consent of the public hospitals which are located
27 within each such social services district and which are otherwise eligi-
28 ble to receive such redirected payments.
29 3. The non-federal share payment obligations of social services
30 districts that voluntarily elect to participate in such program to fund
31 services to uninsured persons and/or expand family health plus coverage
32 shall be established at 50 percent of the amount of final reconciled
33 Medicaid payments authorized pursuant to section 211 and paragraph (a)
34 of subdivision 1 of section 212 of chapter 474 of the laws of 1996, as
35 amended, for the social services district for the year two years prior
36 to the social services district's election to participate and shall not
37 be subject to further adjustment. Further non-federal share payment
38 obligations of social services districts that voluntarily elect to
39 participate in such program to fund services to uninsured persons and/or
40 expand family health plus coverage shall be established as follows: (a)
41 50 percent of the amount actually expended in state fiscal year
42 2007-2008 for Medicaid payments authorized pursuant to section 12 of
43 part A of chapter 1 of the laws of 2002 and pursuant to section 13 of
44 part B of chapter 1 of the laws of 2002, and, (b) 50 percent of the
45 amount actually expended in state fiscal year 2004-2005 for Medicaid
46 payments authorized pursuant to section 14 of part A of chapter 1 of the
47 laws of 2002, and pursuant to section 14 of part B of chapter 1 of the
48 laws of 2002.
49 4. For electing social services districts, the portion of each such
50 payment obligation to be utilized for such program to fund services to
51 uninsured persons and/or expand family health plus coverage shall be
52 determined by the commissioner of health.
53 5. Payments to public general hospitals, other than those operated by
54 the state of New York or the state university of New York, pursuant to
55 section 211 and paragraph (a) of subdivision 1 of section 212 of chapter
56 474 of the laws of 1996, sections 13 and 14 of part B of chapter 1 of
S. 58--B 79 A. 158--B
1 the laws of 2002 and sections 12 and 14 of part A of chapter 1 of the
2 laws of 2002, located in electing social services districts, shall be
3 reduced to an amount that can be supported by the non-federal share
4 payment obligations of such social services districts as reduced by the
5 portion of such payment obligations to be utilized for such program to
6 fund services to uninsured persons and/or expand family health plus
7 coverage as described above.
8 § 67-b. Notwithstanding any contrary provision of law, the commis-
9 sioner of health is authorized to enter into a waiver agreement with the
10 United States department of health and human services pursuant to
11 section 1115 of the federal social security act to utilize federal funds
12 available to the state under its federal disproportionate share hospital
13 allotment pursuant to section 1923(f) of the federal social security
14 act, that are projected to be in excess of the amounts necessary to
15 fully fund existing state authorized disproportionate share hospital
16 programs, to provide funding to fund services to the uninsured and/or
17 expand coverage under the family health plus program as provided in
18 clause (D) of subparagraph (v) of paragraph (a) of subdivision 2 of
19 section 369-ee of the social services law.
20 § 68. Subparagraph (iii) of paragraph (a) of subdivision 2 of section
21 369-ee of the social services law, as amended by section 28 of part E of
22 chapter 63 of the laws of 2005, is amended to read as follows:
23 (iii) does not have equivalent health care coverage under insurance or
24 equivalent mechanisms, as defined by the commissioner in consultation
25 with the superintendent of insurance[, and is not a federal, state,
26 county, municipal or school district employee that is eligible for
27 health care coverage through his or her employer];
28 § 69. Subdivision 24 of section 206 of the public health law, as
29 added by section 39 of part C of chapter 58 of the laws of 2008, is
30 amended to read as follows:
31 24. Notwithstanding any inconsistent provision of law to the contrary,
32 the commissioner is authorized to receive applications and to determine
33 initial and continuing eligibility for enrollment under the child health
34 plus program established under title I-A of article twenty-five of this
35 chapter, the medical assistance program established under title eleven
36 of article five of the social services law, and the family health plus
37 program established under title eleven-D of such article. The commis-
38 sioner may exercise such authority with respect to all residents, or a
39 subset of residents, of one or more local social services districts. The
40 commissioner is authorized to enter into one or more contracts, which
41 contracts shall be procured on a competitive basis pursuant to a request
42 for proposal process, for the purpose of exercising his or her authority
43 under this subdivision. State employees shall supervise and provide
44 oversight and quality assurance monitoring of contract staff activities.
45 Provided further, the department shall endeavor to use state employees
46 in exercising the commissioner's authority under this subdivision.
47 § 70. Intentionally omitted.
48 § 71. Intentionally omitted.
49 § 72. Intentionally omitted.
50 § 72-a. Subdivision 9 of section 2510 of the public health law is
51 amended by adding a new paragraph (d) to read as follows:
52 (d) for periods on or after July first, two thousand nine, amounts as
53 follows:
54 (i) no payments are required for eligible children whose family gross
55 household income is less than one hundred sixty percent of the non-farm
56 federal poverty level and for eligible children who are American Indians
S. 58--B 80 A. 158--B
1 or Alaskan Natives, as defined by the U.S. Department of Health and
2 Human Services, whose family gross household income is less than two
3 hundred fifty-one percent of the non-farm federal poverty level; and
4 (ii) nine dollars per month for each eligible child whose family gross
5 household income is between one hundred sixty percent and two hundred
6 twenty-two percent of the non-farm federal poverty level, but no more
7 than twenty-seven dollars per month per family; and
8 (iii) fifteen dollars per month for each eligible child whose family
9 gross household income is between two hundred twenty-three percent and
10 two hundred fifty percent of the non-farm federal poverty level, but no
11 more than forty-five dollars per month per family; and
12 (iv) thirty dollars per month for each eligible child whose family
13 gross household income is between two hundred fifty-one percent and
14 three hundred percent of the non-farm federal poverty level, but no more
15 than ninety dollars per month per family;
16 (v) forty-five dollars per month for each eligible child whose family
17 gross household income is between three hundred one percent and three
18 hundred fifty percent of the non-farm federal poverty level, but no more
19 than one hundred thirty-five dollars per month per family; and
20 (vi) sixty dollars per month for each eligible child whose family
21 gross household income is between three hundred fifty-one percent and
22 four hundred percent of the non-farm federal poverty level, but no more
23 than one hundred eighty dollars per month per family.
24 § 73. Intentionally omitted.
25 § 74. Intentionally omitted.
26 § 75. Intentionally omitted.
27 § 76. Intentionally omitted.
28 § 77. Intentionally omitted.
29 § 78. Subdivision 8 of section 2511 of the public health law is
30 amended by adding a new paragraph (d) to read as follows:
31 (d)(i) Effective April first, two thousand nine, payment for marketing
32 and facilitated enrollment activities set forth in subdivision nine of
33 this section and included in subsidy payments made to approved organiza-
34 tions providing such services pursuant to a contract with the state
35 shall be limited to an amount determined annually by the commissioner.
36 (ii) Such subsidy payments shall be adjusted by the commissioner to
37 remove any costs of approved organizations in excess of the amount
38 determined in accordance with subparagraph (i) of this paragraph based
39 on cost reports submitted to the department by approved organizations.
40 § 79. Intentionally omitted.
41 § 80. Intentionally omitted.
42 § 81. Intentionally omitted.
43 § 82. Intentionally omitted.
44 § 83. Intentionally omitted.
45 § 84. Intentionally omitted.
46 § 85. Intentionally omitted.
47 § 86. Section 2801-a of the public health law is amended by adding a
48 new subdivision 16 to read as follows:
49 16. (a) The commissioner shall charge to applicants for the establish-
50 ment of hospitals the following application fee:
51 (i) For general hospitals:$3,000
52 (ii) For nursing homes:$3,000
53 (iii) For safety net diagnostic
54 and treatment centers as
55 defined in paragraph (c) of
56 this subdivision:$1,000
S. 58--B 81 A. 158--B
1 (iv) For all other diagnostic
2 and treatment centers:$2,000
3 (b) An applicant for both establishment and construction of a hospital
4 shall not be subject to this subdivision and shall be subject to fees
5 and charges as set forth in section twenty-eight hundred two of this
6 article.
7 (c) The commissioner may designate a diagnostic and treatment center
8 or proposed diagnostic and treatment center as a "safety net diagnostic
9 and treatment center" if it is operated or proposes to be operated by a
10 not-for-profit corporation or local health department; participates or
11 intends to participate in the medical assistance program; demonstrates
12 or projects that a significant percentage of its visits, as determined
13 by the commissioner, were by uninsured individuals; and principally
14 provides primary care services as defined by the commissioner.
15 (d) The fees and charges paid by an applicant pursuant to this subdi-
16 vision for any application for establishment of a hospital approved in
17 accordance with this section shall be deemed allowable capital costs in
18 the determination of reimbursement rates established pursuant to this
19 article. The cost of such fees and charges shall not be subject to
20 reimbursement ceiling or other penalties used by the commissioner for
21 the purpose of establishing reimbursement rates pursuant to this arti-
22 cle. All fees pursuant to this section shall be payable to the depart-
23 ment of health for deposit into the special revenue funds - other,
24 miscellaneous special revenue fund - 339, certificate of need account.
25 § 87. Subdivision 7 of section 2802 of the public health law, as
26 amended by section 1 of part C of chapter 1 of the laws of 2002, is
27 amended to read as follows:
28 7. (a) The commissioner shall charge to applicants for construction of
29 hospitals the following fees and charges for administrative services so
30 as to recover departmental costs in performing these functions. Each
31 applicant for construction of a hospital shall pay to the department an
32 application fee of [one thousand two hundred fifty dollars] two thousand
33 dollars, provided, however, that diagnostic and treatment centers desig-
34 nated by the commissioner as safety net diagnostic and treatment
35 centers, as defined in paragraph (c) of subdivision sixteen of section
36 twenty-eight hundred one-a of this article, shall pay a fee of one thou-
37 sand two hundred fifty dollars.
38 (b) At such time as the commissioner's written approval of the
39 construction is granted, each applicant shall pay [an] the following
40 additional fee [of forty-five hundredths of one percent of the total
41 capital value of the application, provided that only those applications
42 requiring review by the State Hospital Review and Planning Council shall
43 be subject to such fee.]:
44 (i) for hospital, nursing home and diagnostic and treatment center
45 applications that require approval by the council, the additional fee
46 shall be fifty-five hundredths of one percent of the total capital value
47 of the application, provided however that applications for construction
48 of a safety net diagnostic and treatment center, as defined in paragraph
49 (c) of subdivision sixteen of section twenty-eight hundred one-a of this
50 article, shall be subject to a fee of forty-five hundredths of one
51 percent of the total capital value of the application; and
52 (ii) for hospital, nursing home and diagnostic and treatment center
53 applications that do not require approval by the council, the additional
54 fee shall be thirty hundredths of one percent of the total capital value
55 of the application, provided however that safety net diagnostic and
56 treatment center applications, as defined in paragraph (c) of subdivi-
S. 58--B 82 A. 158--B
1 sion sixteen of section twenty-eight hundred one-a of this article,
2 shall be subject to a fee of twenty-five hundredths of one percent of
3 the total capital value of the application.
4 (c) The commissioner is authorized to establish reduced fees for
5 applications subject to limited review, as described in regulation, that
6 do not require review by the council.
7 (d) The fees and charges paid by an applicant pursuant to this subdi-
8 vision for any application for construction of a hospital approved in
9 accordance with this section shall be deemed allowable capital costs in
10 the determination of reimbursement rates established pursuant to this
11 article. The cost of such fees and charges shall not be subject to
12 reimbursement ceiling or other penalties used by the commissioner for
13 the purpose of establishing reimbursement rates pursuant to this arti-
14 cle. All fees pursuant to this section shall be payable to the depart-
15 ment of health for deposit into the special revenue funds - other,
16 miscellaneous special revenue fund - 339, certificate of need account.
17 § 88. Section 3605 of the public health law is amended by adding a new
18 subdivision 13 to read as follows:
19 13. The commissioner shall charge to applicants for the licensure of
20 home care services agencies an application fee of two thousand dollars.
21 All fees pursuant to this section shall be payable to the department of
22 health for deposit into the special revenue funds - other, miscellaneous
23 special revenue fund - 339, certificate of need account.
24 § 89. Section 3606 of the public health law is amended by adding a new
25 subdivision 4 to read as follows:
26 4. (a) The commissioner shall charge to applicants for the establish-
27 ment of certified home health agencies an application fee of two thou-
28 sand dollars.
29 (b) An applicant for both establishment and construction of a certi-
30 fied home health agency shall not be subject to this subdivision and
31 shall be subject to fees and charges as set forth in section thirty-six
32 hundred six-a of this article.
33 (c) The fees and charges paid by an applicant pursuant to this subdi-
34 vision for any application approved in accordance with this section
35 shall be deemed allowable costs in the determination of reimbursement
36 rates established pursuant to this article. All fees pursuant to this
37 section shall be payable to the department of health for deposit into
38 the special revenue funds - other, miscellaneous special revenue fund -
39 339, certificate of need account.
40 § 90. Section 3606-a of the public health law is amended by adding a
41 new subdivision 9 to read as follows:
42 9. (a) The commissioner shall charge to applicants for construction of
43 certified home health agencies an application fee of two thousand
44 dollars. Each such applicant shall, at such time as the commissioner's
45 written approval of the construction is granted, pay an additional fee
46 of thirty hundredths of one percent of the total capital value of the
47 application.
48 (b) The fees and charges paid by an applicant pursuant to this subdi-
49 vision for any application approved in accordance with this section
50 shall be deemed allowable costs in the determination of reimbursement
51 rates established pursuant to this article. All fees pursuant to this
52 section shall be payable to the department of health for deposit into
53 the special revenue funds - other, miscellaneous special revenue fund -
54 339, certificate of need account.
55 § 91. Section 3610 of the public health law is amended by adding a
56 new subdivision 6 to read as follows:
S. 58--B 83 A. 158--B
1 6. (a) The commissioner shall charge to applicants for the authori-
2 zation or construction of long term home health care programs an appli-
3 cation fee of two thousand dollars. Each such applicant shall, at such
4 time as the commissioner's written approval of a construction applica-
5 tion is granted, pay an additional fee of thirty hundredths of one
6 percent of the total capital value of the application.
7 (b) The fees paid by an applicant pursuant to this subdivision for any
8 application approved in accordance with this section shall be deemed
9 allowable costs in the determination of reimbursement rates established
10 pursuant to this article. All fees pursuant to this section shall be
11 payable to the department of health for deposit into the special revenue
12 funds - other, miscellaneous special revenue fund - 339, certificate of
13 need account.
14 § 92. Section 3611-a of the public health law, as added by chapter 959
15 of the laws of 1984, is amended to read as follows:
16 § 3611-a. Change in the operator or owner. 1. Any change in the person
17 who, or any transfer, assignment, or other disposition of an interest or
18 voting rights of ten percent or more, or any transfer, assignment or
19 other disposition which results in the ownership or control of an inter-
20 est or voting rights of ten percent or more, in a limited liability
21 company or a partnership which is the operator of a licensed home care
22 services agency or a certified home health agency shall be approved by
23 the public health council in accordance with the provisions of subdivi-
24 sion four of section [three thousand six] thirty-six hundred five of
25 this [chapter] article relative to licensure or subdivision two of
26 section [three thousand six] thirty-six hundred six of this [chapter]
27 article relative to certificate of approval, except that:
28 (a) Public health council approval shall be required only with respect
29 to the person, or the member or partner that is acquiring the interest
30 or voting rights; and
31 (b) With respect to certified home health agencies, such change shall
32 not be subject to the public need assessment described in paragraph (a)
33 of subdivision two of section thirty-six hundred six of this article.
34 (c) No prior approval of the public health council shall be required
35 with respect to a transfer, assignment or disposition of:
36 (i) an interest or voting rights to any person previously approved by
37 the public health council for that operator; or
38 (ii) an interest or voting rights of less than ten percent in the
39 operator. However, no such transaction shall be effective unless at
40 least ninety days prior to the intended effective date thereof, the
41 partner or member completes and files with the public health council
42 notice on forms to be developed by the public health council, which
43 shall disclose such information as may reasonably be necessary for the
44 public health council to determine whether it should bar the trans-
45 action. Such transaction will be final as of the intended effective date
46 unless, prior thereto, the public health council shall state specific
47 reasons for barring such transactions under this paragraph and shall
48 notify each party to the proposed transaction.
49 2. Any transfer, assignment or other disposition of ten percent or
50 more of the stock or voting rights thereunder of a corporation which is
51 the operator of a licensed home care services agency or a certified home
52 health agency, or any transfer, assignment or other disposition of the
53 stock or voting rights thereunder of such a corporation which results in
54 the ownership or control of more than ten percent of the stock or voting
55 rights thereunder of such corporation by any person shall be subject to
56 approval by the public health council in accordance with the provisions
S. 58--B 84 A. 158--B
1 of subdivision four of section [three thousand six] thirty-six hundred
2 five of this [chapter] article relative to licensure or subdivision two
3 of section [three thousand six] thirty-six hundred six of this [chapter]
4 article relative to certificate of approval , except that:
5 (a) Public health council approval shall be required only with respect
6 to the person or entity acquiring such stock or voting rights; and
7 (b) With respect to certified home health agencies, such change shall
8 not be subject to the public need assessment described in paragraph (a)
9 of subdivision two of section thirty-six hundred six of this article.
10 In the absence of such approval, the license or certificate of approval
11 shall be subject to revocation or suspension.
12 (c) No prior approval of the public health council shall be required
13 with respect to a transfer, assignment or disposition of an interest or
14 voting rights to any person previously approved by the public health
15 council for that operator. However, no such transaction shall be effec-
16 tive unless at least one hundred twenty days prior to the intended
17 effective date thereof, the partner or member completes and files with
18 the public health council notice on forms to be developed by the public
19 health council, which shall disclose such information as may reasonably
20 be necessary for the public health council to determine whether it
21 should bar the transaction. Such transaction will be final as of the
22 intended effective date unless, prior thereto, the public health council
23 shall state specific reasons for barring such transactions under this
24 paragraph and shall notify each party to the proposed transaction.
25 3. (a) The commissioner shall charge to applicants for a change in
26 operator or owner of a licensed home care services agency or a certified
27 home health agency an application fee in the amount of two thousand
28 dollars.
29 (b) The fees paid by certified home health agencies pursuant to this
30 subdivision for any application approved in accordance with this section
31 shall be deemed allowable costs in the determination of reimbursement
32 rates established pursuant to this article. All fees pursuant to this
33 section shall be payable to the department of health for deposit into
34 the special revenue funds - other, miscellaneous special revenue fund -
35 339, certificate of need account.
36 § 93. Section 4004 of the public health law is amended by adding a new
37 subdivision 5 to read as follows:
38 5. (a) The commissioner shall charge to applicants for the establish-
39 ment of a hospice an application fee in the amount of two thousand
40 dollars.
41 (b) An applicant for both establishment and construction of a hospice
42 shall not be subject to this subdivision and shall be subject to fees
43 and charges as set forth in section four thousand six of this article.
44 (c) All fees pursuant to this section shall be payable to the depart-
45 ment of health for deposit into the special revenue funds - other,
46 miscellaneous special revenue fund - 339, certificate of need account.
47 § 94. Section 4006 of the public health law is amended by adding a new
48 subdivision 9 to read as follows:
49 9. (a) The commissioner shall charge to applicants for construction of
50 a hospice an application fee of two thousand dollars.
51 (b) At such time as the commissioner's written approval of the
52 construction is granted, each such applicant shall pay an additional fee
53 of thirty hundredths of one percent of the total capital value of the
54 application.
S. 58--B 85 A. 158--B
1 (c) All fees pursuant to this section shall be payable to the depart-
2 ment of health for deposit into the special revenue fund - other,
3 miscellaneous special revenue fund - 339, certificate of need account.
4 § 95. The opening paragraph of paragraph (s) of subdivision 1 of
5 section 2807-m of the public health law, as amended by section 16 of
6 part B of chapter 58 of the laws of 2008, is amended to read as follows:
7 "Adjustment amount" means an amount determined for each teaching
8 hospital for periods prior to January first, two thousand nine by:
9 § 96. Paragraph (b) of subdivision 2 of section 2807-m of the public
10 health law, as amended by chapter 1 of the laws of 1999, is amended to
11 read as follows:
12 (b) [Each] For periods prior to January first, two thousand nine, each
13 regional pool shall be distributed on a monthly basis to teaching gener-
14 al hospitals for costs associated with graduate medical education
15 provided by such teaching general hospitals in accordance with the
16 distribution methodology set forth in subdivision three of this section;
17 provided however, teaching general hospitals with a resident count of
18 zero as of July first of the year preceding the distribution period
19 shall not be eligible for distributions pursuant to this section.
20 General hospitals may elect to have their distribution paid through the
21 consortium.
22 § 97. Paragraphs (a), (c), (e) and (f) and the opening paragraphs of
23 paragraphs (b) and (d) of subdivision 3 of section 2807-m of the public
24 health law, paragraph (a) and the opening paragraph of paragraph (b) as
25 added by chapter 639 of the laws of 1996, paragraph (c) as amended by
26 chapter 419 of the laws of 2000, the opening paragraph of paragraph (d)
27 as amended by section 17 of part B of chapter 58 of the laws of 2008,
28 paragraph (e) as amended by section 11 of part OO of chapter 57 of the
29 laws of 2008 and paragraph (f) as amended by section 13 of part E of
30 chapter 63 of the laws of 2005, are amended to read as follows:
31 (a) Distributions to teaching general hospitals shall be made from the
32 regional pools described in subdivision two of this section for each
33 period prior to January first, two thousand nine, less amounts set aside
34 pursuant to subdivision five of this section. To be eligible to partic-
35 ipate in distributions pursuant to this section, a teaching general
36 hospital and consortium must be in compliance with graduate medical
37 education reporting requirements set forth in subdivision four of this
38 section.
39 [Each] For periods prior to January first, two thousand nine, each
40 teaching general hospital in a region shall have a proxy calculated for
41 its graduate medical education costs as follows:
42 (c) [A] For periods prior to January first, two thousand nine, a
43 distribution amount for each teaching general hospital shall be calcu-
44 lated from the applicable regional pool described in subdivision two of
45 this section as adjusted pursuant to paragraph (d) of this subdivision
46 based upon its percentage of the regional total of the graduate medical
47 education proxies, except that for purposes of this paragraph the state-
48 wide amount used to compute such distribution amounts shall be four
49 hundred ninety million dollars on an annual basis for the periods Janu-
50 ary first, two thousand through December thirty-first, two thousand two
51 and two hundred forty-five million dollars for the period January first,
52 two thousand three through June thirtieth, two thousand three, less
53 amounts set aside each period pursuant to subdivision seven of this
54 section.
55 [Each] For periods prior to January first, two thousand nine, each
56 teaching general hospital shall receive a distribution from the applica-
S. 58--B 86 A. 158--B
1 ble regional pool based on its distribution amount determined under
2 paragraph (c) of this subdivision adjusted by a reduction amount that is
3 determined as follows:
4 (e) Effective April first, two thousand four through December thirty-
5 first, two thousand eight, the distribution amount calculated pursuant
6 to paragraphs (c) and (d) of this subdivision for each non-public teach-
7 ing general hospital shall be reduced by the amount calculated and
8 included in rates pursuant to paragraph (d) of subdivision twenty-five
9 of section twenty-eight hundred seven-c of this article.
10 (f) Effective January first, two thousand five through December thir-
11 ty-first, two thousand eight, each teaching general hospital shall
12 receive a distribution from the applicable regional pool based on its
13 distribution amount determined under paragraphs (c), (d) and (e) of this
14 subdivision and reduced by its adjustment amount calculated pursuant to
15 paragraph [(1)] (s) of subdivision one of this section and, for distrib-
16 utions for the period January first, two thousand five through December
17 thirty-first, two thousand five, further reduced by its extra reduction
18 amount calculated pursuant to paragraph [(m)] (t) of subdivision one of
19 this section.
20 § 98. The opening paragraph of paragraph (b), paragraph (c), the open-
21 ing paragraphs of paragraphs (d) and (e) and paragraphs (f) and (g) of
22 subdivision 5-a of section 2807-m of the public health law, the opening
23 paragraph of paragraph (b), paragraph (c), the opening paragraph of
24 paragraph (e), and paragraphs (f) and (g) as added by section 75-c of
25 part C of chapter 58 of the laws of 2008 and the opening paragraph of
26 paragraph (d) as amended by section 15 of part OO of chapter 57 of the
27 laws of 2008, are amended to read as follows:
28 Empire clinical research investigator program (ECRIP) and other gradu-
29 ate medical education reforms. [Thirty-one] Thirty million four hundred
30 thousand dollars annually for the period January first, two thousand
31 nine through December thirty-first, two thousand ten, and seven million
32 [seven hundred fifty] six hundred thousand dollars for the period Janu-
33 ary first, two thousand eleven through March thirty-first, two thousand
34 eleven, shall be set aside and reserved by the commissioner from the
35 regional pools established pursuant to subdivision two of this section
36 to be allocated regionally with two-thirds of the available funding
37 going to New York city and one-third of the available funding going to
38 the rest of the state and shall be available for distribution as
39 follows:
40 (c) Ambulatory care training. [Five] Four million nine hundred thou-
41 sand dollars for the period January first, two thousand eight through
42 December thirty-first, two thousand eight, [five] four million nine
43 hundred thousand dollars for the period January first, two thousand nine
44 through December thirty-first, two thousand nine, [five] four million
45 nine hundred thousand dollars for the period January first, two thousand
46 ten through December thirty-first, two thousand ten, and one million two
47 hundred [fifty] twenty-five thousand dollars for the period January
48 first, two thousand eleven through March thirty-first, two thousand
49 eleven, shall be set aside and reserved by the commissioner from the
50 regional pools established pursuant to subdivision two of this section
51 and shall be available for distributions to sponsoring institutions to
52 be directed to support clinical training of medical students and resi-
53 dents in free-standing ambulatory care settings, including community
54 health centers and private practices. Such funding shall be allocated
55 regionally with two-thirds of the available funding going to New York
56 city and one-third of the available funding going to the rest of the
S. 58--B 87 A. 158--B
1 state and shall be distributed to sponsoring institutions in each region
2 pursuant to a request for application or request for proposal process
3 with preference being given to sponsoring institutions which provide
4 training in sites located in underserved rural or inner-city areas and
5 those that include medical students in such training.
6 [Two] One million nine hundred sixty thousand dollars for the period
7 January first, two thousand eight through December thirty-first, two
8 thousand eight, [two] one million nine hundred sixty thousand dollars
9 for the period January first, two thousand nine through December thir-
10 ty-first, two thousand nine, [two] one million nine hundred sixty thou-
11 sand dollars for the period January first, two thousand ten through
12 December thirty-first, two thousand ten, and [five] four hundred ninety
13 thousand dollars for the period January first, two thousand eleven
14 through March thirty-first, two thousand eleven, shall be set aside and
15 reserved by the commissioner from the regional pools established pursu-
16 ant to subdivision two of this section and shall be available for
17 purposes of physician loan repayment in accordance with subdivision ten
18 of this section. Such funding shall be allocated regionally with one-
19 third of available funds going to New York city and two-thirds of avail-
20 able funds going to the rest of the state and shall be distributed in a
21 manner to be determined by the commissioner as follows:
22 [Five] Four million nine hundred thousand dollars for the period Janu-
23 ary first, two thousand eight through December thirty-first, two thou-
24 sand eight, [five] four million nine hundred thousand dollars annually
25 for the period January first, two thousand nine through December thir-
26 ty-first, two thousand ten, and one million two hundred [fifty] twenty-
27 five thousand dollars for the period January first, two thousand eleven
28 through March thirty-first, two thousand eleven, shall be set aside and
29 reserved by the commissioner from the regional pools established pursu-
30 ant to subdivision two of this section and shall be available for
31 purposes of physician practice support. Such funding shall be allocated
32 regionally with one-third of available funds going to New York city and
33 two-thirds of available funds going to the rest of the state and shall
34 be distributed in a manner to be determined by the commissioner as
35 follows:
36 (f) Study on physician workforce. [Six] Five hundred ninety thousand
37 dollars annually for the period January first, two thousand eight
38 through December thirty-first, two thousand ten, and one hundred [fifty]
39 forty-eight thousand dollars for the period January first, two thousand
40 eleven through March thirty-first, two thousand eleven, shall be set
41 aside and reserved by the commissioner from the regional pools estab-
42 lished pursuant to subdivision two of this section and shall be avail-
43 able to fund a study of physician workforce needs and solutions includ-
44 ing, but not limited to, an analysis of residency programs and projected
45 physician workforce and community needs. The commissioner shall enter
46 into agreements with one or more organizations to conduct such study
47 based on a request for proposal process.
48 (g) Diversity in medicine/post-baccalaureate program. Notwithstanding
49 any inconsistent provision of section one hundred twelve or one hundred
50 sixty-three of the state finance law or any other law, [two] one million
51 nine hundred sixty thousand dollars annually for the period January
52 first, two thousand eight through December thirty-first, two thousand
53 ten, and [five] four hundred ninety thousand dollars for the period
54 January first, two thousand eleven through March thirty-first, two thou-
55 sand eleven shall be set aside and reserved by the commissioner from the
56 regional pools established pursuant to subdivision two of this section
S. 58--B 88 A. 158--B
1 and shall be available for distributions to the Associated Medical
2 Schools of New York to fund its diversity program including existing and
3 new post-baccalaureate programs for minority and economically disadvan-
4 taged students and encourage participation from all medical schools in
5 New York. The associated medical schools of New York shall report to the
6 commissioner on an annual basis regarding the use of funds for such
7 purpose in such form and manner as specified by the commissioner.
8 § 99. Subdivision 7 of section 2807-m of the public health law, as
9 amended by section 75-d of part C of chapter 58 of the laws of 2008, is
10 amended to read as follows:
11 7. Notwithstanding any inconsistent provision of section one hundred
12 twelve or one hundred sixty-three of the state finance law or any other
13 law, up to one million dollars for the period January first, two thou-
14 sand through December thirty-first, two thousand, one million six
15 hundred thousand dollars annually for the periods January first, two
16 thousand one through December thirty-first, two thousand [ten,] eight,
17 one million five hundred thousand dollars annually for the periods Janu-
18 ary first, two thousand nine through December thirty-first, two thousand
19 ten, and [four] three hundred seventy-five thousand dollars for the
20 period January first, two thousand eleven through March thirty-first,
21 two thousand eleven, shall be set aside and reserved by the commissioner
22 from the regional pools established pursuant to subdivision two of this
23 section and shall be available for distributions to the New York state
24 area health education center program for the purpose of expanding commu-
25 nity-based training of medical students. In addition, one million
26 dollars annually for the period January first, two thousand eight
27 through December thirty-first, two thousand ten, and two hundred fifty
28 thousand dollars for the period January first, two thousand eleven
29 through March thirty-first, two thousand eleven, shall be set aside and
30 reserved by the commissioner from the regional pools established pursu-
31 ant to subdivision two of this section and shall be available for
32 distributions to the New York state area health education center program
33 for the purpose of post-secondary training of health care professionals
34 who will achieve specific program outcomes within the New York state
35 area health education center program. The New York state area health
36 education center program shall report to the commissioner on an annual
37 basis regarding the use of funds for each purpose in such form and
38 manner as specified by the commissioner.
39 § 100. Paragraph (a) of subdivision 7 of section 2807-s of the public
40 health law, as amended by section 22 of part A of chapter 58 of the laws
41 of 2007, subparagraphs (viii), (ix) and (xii) as amended by section 14
42 of part B of chapter 58 of the laws of 2008, is amended to read as
43 follows:
44 (a) funds shall be accumulated in regional professional education
45 pools established by the commissioner or the healthcare reform act
46 (HCRA) resources fund established pursuant to section ninety-two-dd of
47 the state finance law, whichever is applicable, for distribution in
48 accordance with section twenty-eight hundred seven-m of this article, in
49 the following amounts:
50 (i) ninety-two and forty-five-hundredths percent of the funds accumu-
51 lated less seventy-six million dollars for the period January first,
52 nineteen hundred ninety-seven through December thirty-first, nineteen
53 hundred ninety-seven,
54 (ii) ninety-two and forty-five-hundredths percent of the funds accumu-
55 lated less seventy-six million dollars for the period January first,
S. 58--B 89 A. 158--B
1 nineteen hundred ninety-eight through December thirty-first, nineteen
2 hundred ninety-eight,
3 (iii) ninety-two and forty-five-hundredths percent of the funds accu-
4 mulated less one hundred one million dollars for the period January
5 first, nineteen hundred ninety-nine through December thirty-first, nine-
6 teen hundred ninety-nine,
7 (iv) four hundred ninety-four million dollars on an annual basis for
8 the periods January first, two thousand through December thirty-first,
9 two thousand three,
10 (v) four hundred sixty-three million dollars for the period January
11 first, two thousand four through December thirty-first, two thousand
12 four,
13 (vi) four hundred eighty-eight million dollars for the period January
14 first, two thousand five through December thirty-first, two thousand
15 five,
16 (vii) four hundred ninety-four million dollars for the period January
17 first, two thousand six through December thirty-first, two thousand six,
18 (viii) four hundred seventy million dollars [annually] for the period
19 January first, two thousand seven through December thirty-first, two
20 thousand [ten] seven, [and]
21 (ix) [one hundred seventeen] four hundred forty-six million six
22 hundred thousand dollars for the period January first, two thousand
23 eight through December thirty-first, two thousand eight,
24 (x) forty-seven million two hundred ten thousand dollars on an annual
25 basis for the periods January first, two thousand nine through December
26 thirty-first, two thousand ten; and
27 (xi) eleven million [five] eight hundred thousand dollars for the
28 period January first, two thousand eleven through March thirty-first,
29 two thousand eleven;
30 [(x)] (xii) provided, however, for periods prior to January first, two
31 thousand nine, amounts set forth in this paragraph may be reduced by the
32 commissioner in an amount to be approved by the director of the budget
33 to reflect the amount received from the federal government under the
34 state's 1115 waiver which is directed under its terms and conditions to
35 the graduate medical education program established pursuant to section
36 twenty-eight hundred seven-m of this article;
37 [(xi)] (xiii) provided further, however, for periods prior to July
38 first, two thousand nine, amounts set forth in this paragraph shall be
39 reduced by an amount equal to the total actual distribution reductions
40 for all facilities pursuant to paragraph (e) of subdivision three of
41 section twenty-eight hundred seven-m of this article; and
42 [(xii)] (xiv) provided further, however, for periods prior to July
43 first, two thousand nine, amounts set forth in this paragraph shall be
44 reduced by an amount equal to the actual distribution reductions for all
45 facilities pursuant to paragraph (s) of subdivision one of section twen-
46 ty-eight hundred seven-m of this article.
47 § 101. Section 2807-k of the public health law is amended by adding a
48 new subdivision 5-b to read as follows:
49 5-b. Notwithstanding any inconsistent provision of this section,
50 section twenty-eight hundred seven-w of this article or any other
51 contrary provision of law and subject to the availability of federal
52 financial participation, for periods on and after May first, two thou-
53 sand nine, funds as hereinafter described shall be reserved and set
54 aside and distributed in accordance with the following:
55 (a) For the period May first, two thousand nine through December thir-
56 ty-first, two thousand nine payments shall be made as follows:
S. 58--B 90 A. 158--B
1 (i) Ninety percent of funds available for the two thousand nine calen-
2 dar year pursuant to paragraph (a-1) of subdivision four of this section
3 shall be reserved and set aside and distributed as Medicaid dispropor-
4 tionate share (DSH) payments to the same hospitals and in the same
5 proportional amounts as received pursuant to such paragraph (a-1) in two
6 thousand eight;
7 (ii) Three hundred seven million dollars shall be distributed as Medi-
8 caid DSH payments to facilities designated by the department as teaching
9 hospitals as of December thirty-first, two thousand eight in accordance
10 with a schedule of payments to be set forth in regulations promulgated
11 by the commissioner to compensate such facilities for Medicaid and self-
12 pay losses reported in each facility's two thousand seven annual cost
13 report;
14 (iii) Sixteen million dollars shall be proportionally distributed as
15 Medicaid DSH payments to non-teaching hospitals based upon their propor-
16 tion of uninsured losses as defined in paragraph (c) of subdivision
17 five-a of this section to such losses of all non-teaching hospitals on a
18 statewide basis;
19 (iv) Twenty-five million dollars shall be distributed as Medicaid DSH
20 payments to non-major public hospitals having Medicaid discharges of
21 forty percent or greater as established by the commissioner from data
22 reported in each hospital's two thousand seven annual cost report, in
23 accordance with a schedule to be set forth in regulations promulgated by
24 the commissioner, to compensate such facilities for projected Medicaid
25 net losses, as determined by the commissioner, stemming from modifica-
26 tions to Medicaid payments made pursuant to a chapter of the laws of two
27 thousand nine.
28 (b) For annual periods beginning January first, two thousand ten
29 payments shall be made as follows:
30 (i) Two hundred sixty-nine million five hundred thousand dollars shall
31 be distributed as Medicaid DSH payments to non-major public teaching
32 hospitals, and such distributions shall be made on a regional basis to
33 cover, within amounts available for each region, each eligible facili-
34 ty's proportional regional share of unmet need for two thousand seven,
35 provided, however, that such regions and regional allocations and the
36 definition of unmet need shall be set forth in regulations promulgated
37 by the commissioner;
38 (ii) Twenty-five million dollars shall be distributed as Medicaid DSH
39 payments to hospitals eligible for payments made pursuant to subpara-
40 graph (iv) of paragraph (a) of this subdivision based upon each facili-
41 ty's proportion of uninsured losses, as defined in paragraph (c) of
42 subdivision five-a of this section, to such losses for all hospitals
43 eligible for such payments;
44 (iii) Sixteen million dollars shall be distributed in accordance with
45 the provisions of subparagraph (iii) of paragraph (a) of this subdivi-
46 sion;
47 (iv) Twenty-five million dollars shall be distributed in accordance
48 with the provisions of subparagraph (iv) of paragraph (a) of this subdi-
49 vision;
50 (v) Twenty-four million five hundred thousand dollars shall be
51 distributed as non-Medicaid grants to non-major public academic medical
52 centers pursuant to a schedule to be set forth in regulations promulgat-
53 ed by the commissioner, for funding for the following purposes:
54 (A) quality of care standards linked to the All Patient Refined (APR)
55 DRGs;
S. 58--B 91 A. 158--B
1 (B) best practices and evidence-based guidelines with particular focus
2 on obstetric, psychiatric and other high risk specialties;
3 (C) inpatient psychiatric case payment system and financial incentives
4 to divert admissions and improve linkages to outpatient programs;
5 (D) medical home standards and integrated delivery systems with a
6 particular focus on chronic care patients served in academic medical
7 centers and community-based settings; and
8 (E) reforms to residency training curriculum focusing on cultural
9 competency, quality of training programs, and physician supply in needed
10 specialties and geographic areas.
11 § 101-a. Paragraph (a-1) of subdivision four of section 2807-k of the
12 public health law, as amended by section 1 of part OO of chapter 57 of
13 the laws of 2008, is amended to read as follows:
14 (a-1) From funds in the pool for each year, twenty-seven million
15 dollars shall be reserved on an annual basis for the periods January
16 first, two thousand through December thirty-first, two thousand ten, for
17 distribution in accordance with subdivision sixteen of this section,
18 provided, however, that payments on and after January first, two thou-
19 sand nine through December thirty-first, two thousand nine shall be
20 subject to the provisions of [subdivision] subdivisions five-a and
21 five-b of this section, and shall be subject to the provisions of subdi-
22 vision five-b of this section for periods on and after January first,
23 two thousand ten.
24 § 101-b. Notwithstanding any contrary provision of law, if the commis-
25 sioner of health determines that federal financial participation will
26 not be available with regard to the provisions of subparagraph (ii) of
27 paragraph (a) of subdivision 5-b of section 2807-k of the public health
28 law, such commissioner may deem such provision null and void and instead
29 may allocate funds in accordance with the methodology set forth in
30 subparagraph (i) of paragraph (b) of subdivision 5-b of section 2807-k
31 of the public health law.
32 § 102. Paragraph (c) of subdivision 5-a of section 2807-k of the
33 public health law, as added by section 28-b of part B of chapter 58 of
34 the laws of 2008, is amended to read as follows:
35 (c) For the purposes of distributions in accordance with paragraphs
36 (a) and (b) of this subdivision, each facility's relative uncompensated
37 care need amount shall be determined [by multiplying reported inpatient
38 and outpatient units of service from the calendar year two years prior
39 to the distribution year, but excluding referred ambulatory services
40 units of service, for all uninsured patients by the applicable Medicaid
41 rates, but not including prospective rate adjustments and rate add-ons,
42 in effect for the calendar year two years prior to the distribution year
43 for such services, provided, however, that for distributions on and
44 after January first, two thousand ten, each facility's uncompensated
45 need amount shall be reduced by the sum of all payment amounts collected
46 from such patients. The total uncompensated care need for each facility
47 subject to paragraph (a) or (b) of this subdivision shall then be
48 adjusted by application of the nominal need scale set forth in subdivi-
49 sion five of this section.] in accordance with the following:
50 (i) inpatient units of services for all uninsured patients from the
51 calendar year two years prior to the distribution year, but excluding
52 referred ambulatory units of services, shall be multiplied by the appli-
53 cable Medicaid inpatient rates in effect for such prior year, but not
54 including prospective rate adjustments and rate add-ons, provided,
55 however, that for distributions on and after January first, two thousand
S. 58--B 92 A. 158--B
1 ten, the uncompensated amount for inpatient services shall utilize the
2 inpatient rates in effect as of July first of the prior year;
3 (ii) outpatient units of service for all uninsured patients from the
4 calendar year two years prior to the distribution year, including emer-
5 gency department services and ambulatory surgery services, but excluding
6 referred ambulatory services units of service, shall be multiplied by
7 Medicaid outpatient rates that reflect the exclusive utilization of the
8 ambulatory patient groups (APG) rate-setting methodology as set forth in
9 regulations promulgated pursuant to subdivision two-a of section twen-
10 ty-eight hundred seven of this article, as in effect for the distrib-
11 ution year, provided further, however, that for those services for which
12 APG rates are not available the applicable Medicaid outpatient rate
13 shall be the rate in effect for the calendar year two years prior to the
14 distribution year;
15 (iii) the uncompensated care need for each facility for periods on and
16 after January first, two thousand ten shall be reduced by the sum of all
17 payment amounts collected from such patients; and
18 (iv) the total uncompensated care need for each facility subject to
19 this subdivision shall then be adjusted by application of the nominal
20 need scale set forth in subdivision five of this section.
21 § 103. Section 2807-p of the public health law is amended by adding a
22 new subdivision 10 to read as follows:
23 10. (a) Notwithstanding any inconsistent provision of this section or
24 any other contrary provision of law, the commissioner is authorized to
25 seek a waiver from the federal department of health and human services
26 pursuant to section eleven hundred fifteen of the federal social securi-
27 ty act, or such other federal law provision as may be deemed appropri-
28 ate, seeking federal financial participation in payments made pursuant
29 to this section, in which case the state funding made available pursuant
30 to this section shall be utilized as the non-federal share of such
31 payments. To the extent as may be required, payments made pursuant to
32 this section and in accordance with this subdivision, may be deemed to
33 be disproportionate share hospital payments in accordance with the
34 provisions of the federal social security act.
35 (b) If federal financial participation in payments made pursuant to
36 this section are made available in accordance with the provisions of
37 this subdivision, free-standing clinics licensed solely pursuant to
38 article thirty-one of the mental hygiene law shall also be deemed eligi-
39 ble for participation in such payments to the same degree and in accord-
40 ance with the same distribution methodology otherwise provided in this
41 section, provided, however, that only those units of service provided by
42 such free-standing clinics that constitute medical services that are
43 otherwise eligible for consideration for Medicaid payments shall be
44 reflected in distributions made pursuant to this section, and further
45 provided, however, that the commissioner may, in consultation with the
46 commissioner of the office of mental health, require such clinics, as a
47 condition of receiving such distributions, to provide reports and data
48 to the department as the commissioner deems necessary to adequately
49 implement the provisions of this subdivision with regard to such clin-
50 ics.
51 § 104. Intentionally omitted.
52 § 105. Intentionally omitted.
53 § 106. Intentionally omitted.
54 § 107. Intentionally omitted.
55 § 107-a. Intentionally omitted.
56 § 108. Intentionally omitted.
S. 58--B 93 A. 158--B
1 § 109. Intentionally omitted.
2 § 110. Subdivision 2 of section 241 of the elder law, as amended by
3 section 13 of part B of chapter 57 of the laws of 2006, is amended to
4 read 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, a non-resident establishment registered pursuant to section
8 sixty-eight hundred eight-b of the education law, or a pharmacy regis-
9 tered in a state bordering the state of New York when certified as
10 necessary by the executive director pursuant to section two hundred
11 fifty-three of this title, for which an agreement to provide pharmacy
12 services for purposes of this program pursuant to section two hundred
13 forty-nine of this title is in effect.
14 § 111. Subdivision 1 of section 249 of the elder law is amended to
15 read as follows:
16 1. The state shall offer an opportunity to participate in this program
17 to all provider pharmacies as defined in section two hundred forty-one
18 of this title, provided, however, that the participation of pharmacies
19 registered in the state pursuant to section sixty-eight hundred eight-b
20 of the education law shall be limited to state assistance provided under
21 this title for prescription drugs covered by a program participant's
22 medicare or other drug plan.
23 § 112. Paragraph (e) of subdivision 3 of section 242 of the elder law,
24 as amended by section 3 of part B of chapter 58 of the laws of 2007, is
25 amended to read as follows:
26 (e) As a condition of continued eligibility for benefits under this
27 title, if a program participant's income indicates that the participant
28 could be eligible for an income-related subsidy under section 1860D-14
29 of the federal social security act by either applying for such subsidy
30 or by enrolling in a medicare savings program as a qualified medicare
31 beneficiary (QMB), a specified low-income medicare beneficiary (SLMB),
32 or a qualifying individual (QI), a program participant is required to
33 provide, and to authorize the elderly pharmaceutical insurance coverage
34 program to obtain, any information or documentation required to estab-
35 lish the participant's eligibility for such subsidy, and to authorize
36 the elderly pharmaceutical insurance coverage program to apply on behalf
37 of the participant for the subsidy or the medicare savings program. The
38 elderly pharmaceutical insurance coverage program shall make a reason-
39 able effort to notify the program participant of his or her need to
40 provide any of the above required information. After a reasonable effort
41 has been made to contact the participant, a participant shall be noti-
42 fied in writing that he or she has sixty days to provide such required
43 information. If such information is not provided within the sixty day
44 period, the participant's coverage may be terminated.
45 § 113. Intentionally omitted.
46 § 114. Paragraph (b) of subdivision 1-a of section 2807-s of the
47 public health law, as added by chapter 639 of the laws of 1996, is
48 amended to read as follows:
49 (b) "Specified third-party payors", for purposes of this section and
50 sections twenty-eight hundred seven-j and twenty-eight hundred seven-t
51 of this article, shall include corporations organized and operating in
52 accordance with article forty-three of the insurance law, organizations
53 operating in accordance with the provisions of article forty-four of
54 this chapter, self-insured funds and administrators acting on behalf of
55 self-insured funds, and commercial insurers [licensed to do business in
56 this state and] authorized to write accident and health insurance and
S. 58--B 94 A. 158--B
1 whose policy provides coverage on an expense incurred basis. Specified
2 third-party payors, for purposes of this section, shall not include
3 governmental agencies or providers of coverage pursuant to the compre-
4 hensive motor vehicle insurance reparations act, the workers' compen-
5 sation law, the volunteer firefighters' benefit law, or the volunteer
6 ambulance workers' benefit law.
7 § 115. Intentionally omitted.
8 § 116. Paragraph (b) of subdivision 2 of section 367-a of the social
9 services law, as amended by section 58 of part C of chapter 58 of the
10 laws of 2007, is amended to read as follows:
11 (b) Any inconsistent provision of this chapter or other law notwith-
12 standing, upon furnishing assistance under this title to any applicant
13 or recipient of medical assistance, the local social services district
14 or the department shall be subrogated, to the extent of the expenditures
15 by such district or department for medical care furnished, to any rights
16 such person may have to medical support or [third party reimbursement]
17 reimbursement from liable third parties, including but not limited to
18 health insurers, self-insured plans, group health plans, service benefit
19 plans, managed care organizations, pharmacy benefit managers, or other
20 parties that are, by statute, contract, or agreement, legally responsi-
21 ble for payment of a claim for a health care item or service. For
22 purposes of this section, the term medical support shall mean the right
23 to support specified as support for the purpose of medical care by a
24 court or administrative order. The right of subrogation does not attach
25 to insurance benefits paid or provided under any health insurance policy
26 prior to the receipt of written notice of the exercise of subrogation
27 rights by the carrier issuing such insurance, nor shall such right of
28 subrogation attach to any benefits which may be claimed by a social
29 services official or the department, by agreement or other established
30 procedure, directly from an insurance carrier. No right of subrogation
31 to insurance benefits available under any health insurance policy shall
32 be enforceable unless written notice of the exercise of such subrogation
33 right is received by the carrier within three years from the date
34 services for which benefits are provided under the policy or contract
35 are rendered. Liable third parties shall not deny a claim made by a
36 social services official or the department in conformance with this
37 paragraph solely on the basis of the date of submission of the claim,
38 the type or format of the claim form, or a failure to present proper
39 documentation at the point-of-sale that is the basis of the claim. The
40 local social services district or the department shall also notify the
41 carrier when the exercise of subrogation rights has terminated because a
42 person is no longer receiving assistance under this title. Such carrier
43 shall establish mechanisms to maintain the confidentiality of all indi-
44 vidually identifiable information or records. Such carrier shall limit
45 the use of such information or record to the specific purpose for which
46 such disclosure is made, and shall not further disclose such information
47 or records.
48 § 117. Paragraph (a) of subdivision 11 of section 367-a of the social
49 services law, as amended by chapter 170 of the laws of 1994, is amended
50 to read as follows:
51 (a) Any inconsistent provisions of this title or other law notwith-
52 standing, no health insurer, [health maintenance organization] self-in-
53 sured plan, managed care organization, pharmacy benefit manager, or
54 other [entity providing medical benefits] party that is, by statute,
55 contract, or agreement, legally responsible for payment of a claim for a
56 health care item or service, employer or organization who has a plan,
S. 58--B 95 A. 158--B
1 including an employee retirement income security act or service benefit
2 plan, providing care and other medical benefits for persons, whether by
3 insurance or otherwise, shall exclude a person from eligibility, cover-
4 age or entitlement to medical benefits by reason of the eligibility of
5 such person for medical assistance under this title, or by reason of the
6 fact that such person would, except for such plan, be eligible for bene-
7 fits under this title.
8 § 117-a. Subsections (a), (b), (d) and (e) of section 320 of the
9 insurance law, subsection (e) as amended by chapter 601 of the laws of
10 2007, are amended and a new subsection (f) is added to read as follows:
11 (a) Every insurer [doing an insurance business in this state or any
12 pension fund, retirement system or other organization required by law to
13 make reports to, or which is subject to examination by, the insurance
14 department, except any corporation subject to article forty-three of
15 this chapter,] shall, upon request of the state department of social
16 services or of a local social services district for any records, or any
17 information contained in such records, pertaining to the coverage of any
18 individual for such individual's medical costs under any individual or
19 group policy or other obligation made by such organizations, or the
20 medical benefits paid by or claims made to such organizations pursuant
21 to such policy or other obligation in accordance with the limitations of
22 subsection (c) hereof, make the requested records or information avail-
23 able upon a certification by the department of social services or the
24 social services district that such individual is an applicant for or
25 recipient of medical assistance, or is a person who is legally responsi-
26 ble for such an applicant or recipient, pursuant to the social services
27 law.
28 (b) The superintendent and the commissioner of the state department of
29 social services shall enter into a cooperative agreement setting forth
30 mutually agreeable procedures for requesting and furnishing appropriate
31 information, not inconsistent with any law pertaining to the confiden-
32 tiality and privacy of records, which procedures shall include financial
33 arrangements as may be necessary to reimburse [insurance corporations or
34 other] insurers [doing or authorized to do an insurance business in this
35 state or any pension fund, retirement system or other organization
36 subject to the provisions of this section] for necessary costs incurred
37 in furnishing requested information, and the time and manner such proce-
38 dures are to become effective. Such procedures may be added to [the
39 cooperative agreement which was entered into between the superintendent
40 and the commissioner of social services pursuant to the provisions of
41 section four thousand three hundred eleven of this chapter or the proce-
42 dures may be added to] a new cooperative agreement which shall supersede
43 the agreement currently in existence between the superintendent and the
44 commissioner of social services.
45 (d) Not later than the date upon which the procedures agreed to pursu-
46 ant to subsection (b) hereof become effective, the superintendent shall
47 establish guidelines to assure that information relating to an individ-
48 ual certified to be an applicant for or recipient of medical assistance,
49 furnished to any [insurance corporation,] insurer, [pension fund,
50 retirement system or other organization subject to the provisions of
51 this section] is used only for the purpose of identifying the records or
52 information requested in such manner so as not to violate the confiden-
53 tiality provisions of the social services law.
54 (e) (1) Every insurer [doing an insurance business in this state or
55 any pension fund, retirement system or other organization required by
56 law to make reports to, or which is subject to examination by, the
S. 58--B 96 A. 158--B
1 department] shall, upon request of an authorized representative of the
2 state office of temporary and disability assistance, or a social
3 services district child support enforcement unit established pursuant to
4 section one hundred eleven-c of the social services law, enter into an
5 agreement with the state office of temporary and disability assistance
6 or a social services district to develop and operate a data match
7 system, using automated data exchanges to the maximum extent feasible,
8 in which each such insurer, pension fund, retirement system or other
9 organization shall provide for each calendar quarter the name, record
10 address, social security number or other taxpayer identification number,
11 and other identifying information for each individual who maintains a
12 demand deposit account, checking or negotiable withdrawal order account,
13 savings account, time deposit account, or money-market mutual fund
14 account at such institution and who owes past-due support, as identified
15 by the state office of temporary and disability assistance or a social
16 services district child support enforcement unit by name and social
17 security number or other taxpayer identification number. Nothing herein
18 shall be deemed to limit the authority of a local social services
19 district support collection unit pursuant to section one hundred
20 eleven-h of the social services law.
21 (2) No insurer[, pension fund, retirement system or other organiza-
22 tion] which discloses information pursuant to paragraph one of this
23 subsection, or discloses any financial record to the state office of
24 temporary and disability assistance or a social services district child
25 support enforcement unit for the purpose of enforcing a child support
26 obligation of such person, shall be liable under any law to any person
27 for such disclosure, or for any other action taken in good faith to
28 comply with paragraph one of this subsection.
29 (f) "Insurer", as used in this section, means:
30 (1) (i) an insurer required to be licensed to do an insurance business
31 in this state under this chapter, including a corporation subject to
32 article forty-three or forty-seven of this chapter;
33 (ii) a pension fund, retirement system or other organization required
34 by law to make reports to, or which is subject to examination by, the
35 superintendent;
36 (iii) a health maintenance organization subject to article forty-four
37 of the public health law; or
38 (iv) a self-funded plan or any other insurer with respect to any
39 medical claim or benefit of a resident of this State; and
40 (2) any person or other entity acting on behalf of an insurer as
41 described in paragraph one of this subsection with respect to any
42 medical claim or benefit of a resident of this State.
43 § 117-b. Subparagraph (C) of paragraph 3 of subsection (e) of section
44 3212 of the insurance law, as amended by chapter 822 of the laws of
45 1987, is amended to read as follows:
46 (C) No right of subrogation to insurance benefits available under any
47 health insurance policy shall be enforceable unless written notice of
48 the exercise of such subrogation right is received by the carrier within
49 [two] three years from the date services for which benefits are provided
50 under the policy or contract are rendered. An insurer shall not deny a
51 claim made in conformance with paragraph (b) of subdivision two of
52 section three hundred sixty-seven-a of the social services law solely on
53 the basis of the date of submission of the claim, the type or format of
54 the claim form, or a failure to present proper documentation at the
55 point-of-sale that is the basis of the claim.
56 § 117-c. Section 4311 of the insurance law is REPEALED.
S. 58--B 97 A. 158--B
1 § 118. Intentionally omitted.
2 § 119. Intentionally omitted.
3 § 120. Subparagraphs (vi), (vii) and (viii) of paragraph (uu) of
4 subdivision 1 of section 2807-v of the public health law, as amended by
5 section 5 of part B of chapter 58 of the laws of 2008, are amended to
6 read as follows:
7 (vi) [nine] seven million [five] eight hundred thirty-three thousand
8 three hundred thirty-three dollars for the period January first, two
9 thousand nine through December thirty-first, two thousand nine, of which
10 seven million five hundred thousand dollars shall be available for
11 disease management demonstration programs and [two million] three
12 hundred thirty-three thousand three hundred thirty-three dollars shall
13 be available for telemedicine demonstration programs for the period
14 January first, two thousand nine through March first, two thousand nine;
15 (vii) [nine] seven million five hundred thousand dollars for the peri-
16 od January first, two thousand ten through December thirty-first, two
17 thousand ten[, of which seven million five hundred thousand dollars]
18 shall be available for disease management demonstration programs [and
19 two million dollars shall be available for telemedicine demonstration
20 programs]; and
21 (viii) [two] one million [three] eight hundred seventy-five thousand
22 dollars for the period January first, two thousand eleven through March
23 thirty-first, two thousand eleven[, of which one million eight hundred
24 seventy-five thousand dollars] shall be available for disease management
25 demonstration programs [and five hundred thousand dollars shall be
26 available for telemedicine demonstration programs].
27 § 121. Section 3621 of the public health law is REPEALED.
28 § 122. Intentionally omitted.
29 § 123. Intentionally omitted.
30 § 123-a. Intentionally omitted.
31 § 123-b. Intentionally omitted.
32 § 124. Paragraph (kk) of subdivision 1 of section 2807-v of the public
33 health law, as amended by section 5 of part B of chapter 58 of the laws
34 of 2008, is amended to read as follows:
35 (kk) Funds shall be deposited by the commissioner, within amounts
36 appropriated, and the state comptroller is hereby authorized and
37 directed to receive for deposit to the credit of the state special
38 revenue funds -- other, HCRA transfer fund, medical assistance account,
39 or any successor fund or account, for purposes of funding the state
40 share of [Medicaid] Medical Assistance Program expenditures [for pharma-
41 cy services] from the tobacco control and insurance initiatives pool
42 established for the following periods in the following amounts:
43 (i) thirty-eight million eight hundred thousand dollars for the period
44 January first, two thousand two through December thirty-first, two thou-
45 sand two;
46 (ii) up to two hundred ninety-five million dollars for the period
47 January first, two thousand three through December thirty-first, two
48 thousand three;
49 (iii) up to four hundred seventy-two million dollars for the period
50 January first, two thousand four through December thirty-first, two
51 thousand four;
52 (iv) up to nine hundred million dollars for the period January first,
53 two thousand five through December thirty-first, two thousand five;
54 (v) up to eight hundred sixty-six million three hundred thousand
55 dollars for the period January first, two thousand six through December
56 thirty-first, two thousand six;
S. 58--B 98 A. 158--B
1 (vi) up to six hundred sixteen million seven hundred thousand dollars
2 for the period January first, two thousand seven through December thir-
3 ty-first, two thousand seven;
4 (vii) up to five hundred seventy-eight million nine hundred twenty-
5 five thousand dollars for the period January first, two thousand eight
6 through December thirty-first, two thousand eight; and
7 (viii) [up to five hundred fifty-one million dollars for the period]
8 within amounts appropriated on and after January first, two thousand
9 nine [through December thirty-first, two thousand nine;
10 (ix) up to three hundred twenty million six hundred twenty-five thou-
11 sand dollars for the period January first, two thousand ten through
12 December thirty-first, two thousand ten; and
13 (x) up to sixty-one million one hundred twenty-five thousand dollars
14 for the period January first, two thousand eleven through March thirty-
15 first, two thousand eleven].
16 § 125. Paragraphs (a) and (b) of subdivision 2 of section 480-a of the
17 tax law, as added by chapter 190 of the laws of 1990, are amended to
18 read as follows:
19 (a) (i) Every retail dealer and every person owning or, if the owner
20 is not the operator, then any person operating one or more vending
21 machines through which cigarettes or tobacco products are sold in this
22 state, who is required under section eleven hundred thirty-six of this
23 chapter to file a return for the quarterly period ending on the last day
24 of August, nineteen hundred ninety or for the quarterly period ending on
25 the last day of August in any year thereafter, [shall] must file an
26 application for registration under this section with [such] that quar-
27 terly return, in such form as shall be prescribed by the commissioner
28 [of taxation and finance].
29 (ii) Each retail dealer [shall] must pay an application fee with
30 [such] the quarterly return [of one hundred dollars] described by
31 subparagraph (i) of this paragraph for each retail place of business in
32 this state through which it sells cigarettes or tobacco products, which
33 is based on gross sales of that place of business during the previous
34 calendar year. The application fee is: one thousand dollars for each
35 retail place of business with gross sales totaling less than one million
36 dollars; two thousand five hundred dollars for each retail place of
37 business with gross sales totaling at least one million dollars but less
38 than ten million dollars; and five thousand dollars for each retail
39 place of business with gross sales totaling at least ten million
40 dollars.
41 (iii) Every person who owns or, if the owner is not the operator, then
42 any person who operates one or more vending machines through which ciga-
43 rettes or tobacco products are sold in this state, regardless of whether
44 located on the premises of the vending machine owner or, if the owner is
45 not the operator, then the premises of the operator or the premises of
46 any other person, [shall] must pay an application fee with [such] the
47 quarterly return [of twenty-five dollars] described by subparagraph (i)
48 of this paragraph for each [such] vending machine, which is based on
49 gross sales of that vending machine during the previous calendar year.
50 The application fee is: two hundred fifty dollars for each vending
51 machine with gross sales totaling less than one hundred thousand
52 dollars; six hundred twenty-five dollars for each vending machine with
53 gross sales totaling at least one hundred thousand dollars but less than
54 one million dollars; and one thousand two hundred fifty dollars for each
55 vending machine with gross sales totaling at least one million dollars.
56 The department [shall] will issue a registration certificate, as
S. 58--B 99 A. 158--B
1 prescribed by the commissioner [of taxation and finance], after receipt
2 of a registration application and the appropriate registration fee,
3 prior to the next succeeding January first.
4 (b) Every retail dealer and every person who owns or, if the owner is
5 not the operator, then any person who operates one or more vending
6 machines through which cigarettes or tobacco products are sold in this
7 state who commences business after the last day of August, nineteen
8 hundred ninety, or who commences selling cigarettes or tobacco products
9 at retail through a new or different place of business in this state
10 after such date, or who commences selling cigarettes or tobacco products
11 through new or different vending machines after such date, [shall] must
12 file with the commissioner [of taxation and finance] an application for
13 registration, in a form prescribed by him or her, at least thirty days
14 prior to commencing [such] business or commencing [such] sales. Each
15 [such] application [shall] must be accompanied by an application fee [of
16 one hundred dollars] for each retail place of business [to be regis-
17 tered] and [twenty-five dollars for] each vending machine to be regis-
18 tered. The amount of the application fee is determined by subparagraphs
19 (ii) and (iii) of paragraph (a) of this subdivision, except that any
20 retail place of business or vending machine with zero dollars in gross
21 sales during the previous calendar year is subject to the lowest appli-
22 cation fee required by such subparagraphs. The department, within ten
23 days after receipt of an application for registration under this para-
24 graph and payment of the proper fee for application for registration,
25 [shall] will issue a registration certificate, as prescribed by the
26 commissioner, for each retail place of business or cigarette or tobacco
27 products vending machine registered.
28 § 125-a. Subdivision 3 of section 480-a of the tax law, as amended by
29 chapter 262 of the laws of 2000, is amended to read as follows:
30 3. In addition to any other penalty imposed by this chapter: (a) Any
31 retail dealer who violates the provisions of this section [shall], after
32 due notice and an opportunity for a hearing, for a first violation [be]
33 is liable for a civil fine not less than five [hundred] thousand dollars
34 but not to exceed [two] twenty-five thousand dollars and for a second or
35 subsequent violation within three years following a prior finding of
36 violation [be] is liable for a civil fine not less than [one] ten thou-
37 sand dollars but not to exceed [three thousand five hundred] thirty-five
38 thousand dollars; or
39 (b) Any person who owns or, if the owner is not the operator, then any
40 person who operates one or more vending machines through which ciga-
41 rettes or tobacco products are sold in this state and who violates the
42 provisions of this section [shall], after due notice and an opportunity
43 for a hearing, for a first violation [be] is liable for a civil fine not
44 less than [seventy-five] seven hundred fifty dollars but not to exceed
45 two [hundred] thousand dollars and for a second or subsequent violation
46 within three years following a prior finding of violation be liable for
47 a civil fine not less than two [hundred] thousand dollars but not to
48 exceed six [hundred] thousand dollars.
49 § 125-b. Section 482 of the tax law, as amended by section 3 of part
50 RR-1 of chapter 57 of the laws of 2008, is amended to read as follows:
51 § 482. Deposit and disposition of revenue. (a) All taxes, fees, inter-
52 est and penalties collected or received by the commissioner under this
53 article and article twenty-A of this chapter shall be deposited and
54 disposed of pursuant to the provisions of section one hundred seventy-
55 one-a of this chapter. (b) From the taxes, interest and penalties
56 collected or received by the commissioner under sections four hundred
S. 58--B 100 A. 158--B
1 seventy-one and four hundred seventy-one-a of this article, effective on
2 and after March first, two thousand, forty-nine and fifty-five
3 hundredths, and effective on and after February first, two thousand two,
4 forty-three and seventy hundredths; and effective on and after May
5 first, two thousand two, sixty-four and fifty-five hundredths; and
6 effective on and after April first, two thousand three, sixty-one and
7 twenty-two hundredths percent; and effective on and after June third,
8 two thousand eight, seventy and sixty-three hundredths percent collected
9 or received under [such] those sections [shall] must be deposited to the
10 credit of the tobacco control and insurance initiatives pool to be
11 established and distributed by the commissioner of health in accordance
12 with section twenty-eight hundred seven-v of the public health law. (c)
13 From the fees collected or received by the commissioner under subdivi-
14 sion two of section four hundred eighty-a of this article, effective on
15 or after September first, two thousand nine, any monies collected or
16 received under that section in excess of three million dollars must be
17 deposited to the credit of the tobacco control and insurance initiatives
18 pool to be distributed by the commissioner of health in accordance with
19 section twenty-eight hundred seven-v of the public health law.
20 § 125-c. Subdivisions (a) and (b) of section 92-dd of the state
21 finance law, as added by section 89 of part B of chapter 58 of the laws
22 of 2005, are amended to read as follows:
23 (a) On and after April first, two thousand five, such fund shall
24 consist of the revenues heretofore and hereafter collected or required
25 to be deposited pursuant to paragraph (a) of subdivision eighteen of
26 section twenty-eight hundred seven-c, and sections twenty-eight hundred
27 seven-j, twenty-eight hundred seven-s and twenty-eight hundred seven-t
28 of the public health law, subdivisions (b) and (c) of section four
29 hundred eighty-two of the tax law and required to be credited to the
30 tobacco control and insurance initiatives pool, subparagraph (O) of
31 paragraph four of subsection (j) of section four thousand three hundred
32 one of the insurance law, section twenty-seven of part A of chapter one
33 of the laws of two thousand two and all other moneys credited or trans-
34 ferred thereto from any other fund or source pursuant to law.
35 (b) The pool administrator under contract with the commissioner of
36 health pursuant to section twenty-eight hundred seven-y of the public
37 health law shall continue to collect moneys required to be collected or
38 deposited pursuant to paragraph (a) of subdivision eighteen of section
39 twenty-eight hundred seven-c, and sections twenty-eight hundred seven-j,
40 twenty-eight hundred seven-s and twenty-eight hundred seven-t of the
41 public health law, and shall deposit such moneys in the HCRA resources
42 fund. The comptroller shall deposit moneys collected or required to be
43 deposited pursuant to subdivisions (b) and (c) of section four hundred
44 eighty-two of the tax law and required to be credited to the tobacco
45 control and insurance initiatives pool, subparagraph (O) of paragraph
46 four of subsection (j) of section four thousand three hundred one of the
47 insurance law, section twenty-seven of part A of chapter one of the laws
48 of two thousand two and all other moneys credited or transferred thereto
49 from any other fund or source pursuant to law in the HCRA resources
50 fund.
51 § 125-d. The commissioner of health shall establish a home health care
52 reimbursement workgroup for the purposes of studying the home health
53 care reimbursement system. The commissioner of health is authorized to
54 appoint members to the workgroup, including representatives of certified
55 home health agencies, licensed home care services agencies, long term
56 home health care providers, hospice providers, consumers of home health
S. 58--B 101 A. 158--B
1 care services, local governments, labor organizations and other home
2 health care stakeholders.
3 Such study shall include but not be limited to an analysis of:
4 (a) the impact of episodic payments on high-utilization and outlier
5 thresholds, special needs populations, and dual eligible patients;
6 (b) the relationship between, or compatibility of, Medicare and Medi-
7 caid episodic payments;
8 (c) billing procedures related to cash flow of episodic payments;
9 (d) wage index factor adjustments; and
10 (e) subcontracting between certified home health agencies, long term
11 home health care agencies, and AIDS home care programs with licensed
12 home care services agencies.
13 The commissioner of health shall report to the temporary president of
14 the senate, the speaker of the assembly, the chairs of the senate
15 finance committee and assembly committee on ways and means, and the
16 chairs of the senate and assembly health committees. Such report shall
17 be submitted no later than December first, two thousand nine.
18 § 125-e. Section 364-j-2 of the social services law, as amended by
19 section 44-a of part C of chapter 58 of the laws of 2008, is amended to
20 read as follows:
21 § 364-j-2. Transitional supplemental payments. 1. As used in this
22 section, "covered provider" shall mean a voluntary not-for-profit health
23 care provider that is any of the following:
24 (a) a freestanding diagnostic and treatment center licensed under
25 article twenty-eight of the public health law that qualifies for a
26 distribution pursuant to section twenty-eight hundred seven-p of such
27 article, or section seven of chapter four hundred thirty-three of the
28 laws of nineteen hundred ninety-seven, or receives funding under section
29 three hundred thirty-three of the federal public health services act for
30 health care for the homeless; or
31 (b) a freestanding diagnostic and treatment center which operates an
32 approved program under the prenatal care assistance program established
33 pursuant to article twenty-five of the public health law; or
34 (c) a facility licensed under article twenty-eight of the public
35 health law that is sponsored by a university or dental school which has
36 been granted an operating certificate pursuant to article twenty-eight
37 of the public health law to provide dental services; or
38 (d) a freestanding family planning clinic licensed under article twen-
39 ty-eight of the public health law.
40 2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of
41 section twenty-eight hundred seven of the public health law, the commis-
42 sioner of health shall make supplemental payments of nine million eight
43 hundred twenty-four thousand dollars ($9,824,000), to covered providers
44 described in subdivision one of this section who are qualified providers
45 as described in paragraph (a) of subdivision three of this section,
46 based on adjustments to fee-for-service rates for the period February
47 first through March thirty-first, two thousand two and nine million
48 eight hundred twenty-four thousand dollars ($9,824,000) for the period
49 October first through December thirty-first, two thousand two and four
50 million nine hundred twelve thousand dollars ($4,912,000) for the period
51 October first through December thirty-first, two thousand three and an
52 additional amount of four million nine hundred twelve thousand dollars
53 ($4,912,000) for the period October first through December thirty-first,
54 two thousand three and nine million eight hundred twenty-four thousand
55 dollars ($9,824,000) for the period April first through June thirtieth,
56 two thousand five, and nine million eight hundred twenty-four thousand
S. 58--B 102 A. 158--B
1 dollars ($9,824,000) for the period October first through December thir-
2 ty-first, two thousand six, and an additional nine million eight hundred
3 twenty-four thousand dollars ($9,824,000) for the period October first
4 through December thirty-first, two thousand six, and nine million eight
5 hundred twenty-four thousand dollars ($9,824,000) for the period October
6 first through December thirty-first, two thousand seven, as medical
7 assistance payments for services provided pursuant to this title for
8 persons eligible for federal financial participation under title XIX of
9 the federal social security act to reflect additional costs associated
10 with the transition to a managed care environment, and nine million
11 eight hundred twenty-four thousand dollars ($9,824,000) for the period
12 October first through December thirty-first, two thousand eight, and
13 seven million three hundred eighty-eight thousand dollars ($7,388,000)
14 for the period October first through December thirty-first, two thousand
15 nine, as medical assistance payments for services provided pursuant to
16 this title for persons eligible for federal financial participation
17 under title XIX of the federal social security act to reflect additional
18 costs associated with the operation of electronic health record systems
19 that meet such standards as may be established by the commissioner of
20 health. There shall be no local share in these payments. The director of
21 the budget shall allocate the non-federal share of such payments from an
22 appropriation for the miscellaneous special revenue fund - 339 community
23 service provider assistance program account for the two thousand one--
24 two thousand two state fiscal year for adjustments for the period Febru-
25 ary first through March thirty-first, two thousand two. Adjustments for
26 the period October first, two thousand two through December thirty-
27 first, two thousand two shall be within amounts appropriated for the two
28 thousand two--two thousand three state fiscal year and adjustments for
29 the period October first, two thousand three through December thirty-
30 first, two thousand three shall be within amounts appropriated for the
31 two thousand three--two thousand four state fiscal year and adjustments
32 for the non-federal share of the additional amount of four million nine
33 hundred twelve thousand dollars ($4,912,000) for such period shall be
34 allocated by the director of the budget from an appropriation for main-
35 tenance undistributed general fund community projects fund - 007 account
36 for the two thousand three--two thousand four state fiscal year. The
37 director of the budget shall allocate the non-federal share of adjust-
38 ments for the period April first, two thousand five through June thirti-
39 eth, two thousand five from an appropriation for the maintenance undis-
40 tributed general fund community projects fund - 007 - cc account for the
41 two thousand four--two thousand five state fiscal year. The director of
42 the budget shall allocate the non-federal share of adjustments for the
43 period October first, two thousand six through December thirty-first,
44 two thousand six from an appropriation for the maintenance undistrib-
45 uted, general fund, community projects fund - 007-cc account for the two
46 thousand five--two thousand six state fiscal year. The director of the
47 budget shall allocate the non-federal share of the additional adjust-
48 ments for the period October first, two thousand six through December
49 thirty-first, two thousand six from such funds as may be made available
50 from an appropriation for the maintenance undistributed, general fund,
51 community projects fund - 007-cc account for the two thousand six--two
52 thousand seven state fiscal year. The director of the budget shall allo-
53 cate the non-federal share of the adjustments for the period October
54 first, two thousand seven through December thirty-first, two thousand
55 seven from an appropriation for the medical assistance program, general
56 fund, local assistance account - 001 for the two thousand seven--two
S. 58--B 103 A. 158--B
1 thousand eight state fiscal year. The director of the budget shall allo-
2 cate the non-federal share of the adjustments for the period October
3 first, two thousand eight through December thirty-first, two thousand
4 eight from an appropriation for the medical assistance program, general
5 fund, local assistance account - 001 for the two thousand eight--two
6 thousand nine state fiscal year. The director of the budget shall allo-
7 cate the non-federal share of the adjustments for the period October
8 first, two thousand nine through December thirty-first, two thousand
9 nine from an appropriation for the medical assistance program, general
10 fund, local assistance account - 001 for the two thousand nine--two
11 thousand ten state fiscal year. Such adjustments to fee for service
12 rates shall not be subject to subsequent adjustment or reconciliation.
13 Alternatively, such payments may be made as aggregate payments to eligi-
14 ble providers.
15 (a-1) Notwithstanding the provisions of paragraph (a) of this subdivi-
16 sion, for facilities licensed under article twenty-eight of the public
17 health law that are sponsored by a university or dental school which has
18 been granted an operating certificate pursuant to article twenty-eight
19 of the public health law and which provides dental services as its prin-
20 cipal mission, two hundred twenty-four thousand dollars ($224,000) in
21 the aggregate for use pursuant to this section shall be allocated for
22 distribution to such facilities pursuant to the methodology described in
23 paragraph (b) of subdivision two and subparagraph (i) of paragraph (b)
24 of subdivision four of section two thousand eight hundred seven-p of the
25 public health law for services provided for the period February first,
26 two thousand two through March thirty-first, two thousand two to persons
27 eligible for federal financial participation under title XIX of the
28 federal social security act, provided, however, that the amount paid
29 pursuant to this paragraph for each such facility shall equal the facil-
30 ity's proportional share of the total nominal payment amounts calculated
31 under this section of all such facilities multiplied by the total funds
32 allocated for such payments. There shall be no local share in these
33 payments. The director of the budget shall allocate the non-federal
34 share of such payments from an appropriation for the miscellaneous
35 special revenue fund - 339 community service provider assistance program
36 account for the two thousand one--two thousand two state fiscal year.
37 Such adjustments to fee for service rates shall not be subject to subse-
38 quent adjustment or reconciliation. Alternatively, such payments may be
39 made as aggregate payments to eligible providers.
40 (a-2) (i) Notwithstanding the provisions of paragraph (a) of this
41 subdivision, for facilities licensed under article twenty-eight of the
42 public health law that are sponsored by a university or dental school
43 which has been granted an operating certificate pursuant to article
44 twenty-eight of the public health law and which provides dental services
45 as its principal mission, two hundred twenty-four thousand dollars
46 ($224,000) in the aggregate of the amount appropriated for the two thou-
47 sand two--two thousand three state fiscal year for use pursuant to this
48 section shall be allocated for the period October first through December
49 thirty-first, two thousand two and one hundred twelve thousand dollars
50 ($112,000) in the aggregate of the amount appropriated for the two thou-
51 sand three--two thousand four state fiscal year, and an additional
52 amount of one hundred twelve thousand dollars ($112,000) in the aggre-
53 gate for use pursuant to this section shall be allocated for the period
54 October first through December thirty-first, two thousand three and two
55 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
56 amount appropriated for the two thousand four--two thousand five state
S. 58--B 104 A. 158--B
1 fiscal year shall be allocated for the period April first, two thousand
2 five through June thirtieth, two thousand five, and two hundred twenty-
3 four thousand dollars ($224,000) in the aggregate of the amount appro-
4 priated for the two thousand five--two thousand six state fiscal year
5 shall be allocated for the period October first, two thousand six
6 through December thirty-first, two thousand six, and an additional two
7 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
8 amount appropriated for the two thousand six--two thousand seven state
9 fiscal year shall be allocated for the period October first, two thou-
10 sand six through December thirty-first, two thousand six, and two
11 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
12 amount appropriated for the two thousand seven--two thousand eight state
13 fiscal year shall be allocated for the period October first, two thou-
14 sand seven through December thirty-first, two thousand seven, and two
15 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
16 amount appropriated for the two thousand eight--two thousand nine state
17 fiscal year shall be allocated for the period October first, two thou-
18 sand eight through December thirty-first, two thousand eight and two
19 hundred twenty-four thousand dollars ($224,000) in the aggregate of the
20 amount appropriated for the two thousand nine--two thousand ten state
21 fiscal year shall be allocated for the period October first, two thou-
22 sand nine through December thirty-first, two thousand nine for distrib-
23 ution to such facilities pursuant to subparagraphs (ii) and (iii) of
24 this paragraph. Adjustments for the non-federal share of the additional
25 amount of one hundred twelve thousand dollars ($112,000) for the period
26 October first, two thousand three through December thirty-first, two
27 thousand three shall be allocated by the director of the budget from an
28 appropriation for maintenance undistributed general fund community
29 projects fund - 007 account for the two thousand three--two thousand
30 four state fiscal year. The non-federal share of adjustments for the
31 period April first, two thousand five through June thirtieth, two thou-
32 sand five shall be allocated by the director of the budget from an
33 appropriation for the maintenance undistributed general fund community
34 projects fund - 007 account for the two thousand four--two thousand five
35 state fiscal year. The non-federal share of adjustments for the period
36 October first, two thousand six through December thirty-first, two thou-
37 sand six shall be allocated by the director of the budget from an appro-
38 priation for the maintenance undistributed, general fund, community
39 projects fund - 007-cc account for the two thousand five--two thousand
40 six state fiscal year. The non-federal share of the additional adjust-
41 ments for the period October first, two thousand six through December
42 thirty-first, two thousand six shall, subject to the availability of
43 funds, be allocated by the director of the budget from the medical
44 assistance local assistance appropriation for the two thousand six--two
45 thousand seven state fiscal year. The non-federal share of the adjust-
46 ments for the period October first, two thousand seven through December
47 thirty-first, two thousand seven shall be allocated by the director of
48 the budget from an appropriation for the medical assistance program,
49 general fund, local assistance account - 001 for the two thousand
50 seven--two thousand eight state fiscal year. The non-federal share of
51 the adjustments for the period October first, two thousand eight through
52 December thirty-first, two thousand eight shall be allocated by the
53 director of the budget from an appropriation for the medical assistance
54 program, general fund, local assistance account - 001 for the two thou-
55 sand eight--two thousand nine state fiscal year. The non-federal share
56 of the adjustments for the period October first, two thousand nine
S. 58--B 105 A. 158--B
1 through December thirty-first, two thousand nine shall be allocated by
2 the director of the budget from an appropriation for the medical assist-
3 ance program, general fund, local assistance account - 001 for the two
4 thousand nine--two thousand ten state fiscal year.
5 (ii) Forty percent shall be allocated for equal distribution to such
6 facilities, reduced by the amount, if any, that a distribution exceeds
7 forty percent of a facility's uncompensated care need as defined in
8 paragraph (b) of subdivision two of section two thousand eight hundred
9 seven-p of the public health law. Any funds allocated but not distrib-
10 uted in accordance with this subparagraph shall be added to those
11 amounts distributed in accordance with subparagraph (iii) of this para-
12 graph.
13 (iii) Sixty percent, plus any funds allocated and not distributed in
14 accordance with subparagraph (ii) of this paragraph, shall be allocated
15 for distribution to such facilities pursuant to the methodology
16 described in paragraph (b) of subdivision two and subparagraph (i) of
17 paragraph (b) of subdivision four of section two thousand eight hundred
18 seven-p of the public health law, provided, however, that the amount
19 paid pursuant to this allocation for each such facility shall equal the
20 facility's proportional share of the total nominal payment amounts
21 calculated under this section of all such facilities multiplied by the
22 total funds allocated for such payments.
23 (iv) There shall be no local share in these payments.
24 (b) Notwithstanding the provisions of subdivision one of section three
25 hundred sixty-eight-a of this title, there shall be paid to each social
26 services district the full amount expended on behalf of the department
27 of health for medical assistance furnished pursuant to the provisions of
28 this section, after first deducting therefrom any federal funds properly
29 received or to be received on account thereof.
30 3. (a) For periods prior to January first, two thousand eight, a
31 covered provider described in subdivision one of this section shall be
32 qualified to receive a supplemental payment only if its number of medi-
33 caid visits for patient care services in the base year described in
34 subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds
35 twenty-five percent of its total number of visits for patient care
36 services and its number of medicaid visits for patient care services for
37 medicaid managed care enrollees equals or exceeds three percent of its
38 total number of medicaid visits during the base year. For periods on and
39 after January first, two thousand eight, a covered provider described in
40 subdivision one of this section shall be qualified to receive a supple-
41 mental payment only if it has in place during such period an operational
42 electronic health record system that meets such standards as may be
43 established by the commissioner of health and its number of medicaid
44 visits for patient care services in the base year described in subpara-
45 graph (ii) of paragraph (b) of this subdivision equals or exceeds twen-
46 ty-five percent of its total number of visits for patient care services
47 during the base year or its number of medicaid visits combined with its
48 number of uninsured visits for patient care services in the base year
49 described in subparagraph (ii) of paragraph (b) of this subdivision
50 equals or exceeds thirty percent of its total number of visits for
51 patient care services during the base year.
52 (b) (i) For periods prior to January first, two thousand eight, each
53 qualified provider described in paragraph (a) of this subdivision shall
54 receive a supplemental payment equal to such provider's proportional
55 share of the total funds allocated pursuant to this section, based upon
56 the ratio of its visits from medical assistance recipients enrolled in
S. 58--B 106 A. 158--B
1 managed care during the base year to the total number of visits to all
2 such qualified providers by medical assistance recipients enrolled in
3 managed care during the base year. For periods on and after January
4 first, two thousand eight, each qualified provider described in para-
5 graph (a) of this subdivision shall receive a supplemental payment equal
6 to such provider's proportional share of the total funds allocated
7 pursuant to this section, based upon the ratio of its visits from
8 medical assistance recipients during the base year to the total number
9 of visits from medical assistance recipients to all such qualified
10 providers during the base year.
11 (ii) For periods prior to January first, two thousand eight, for
12 purposes of the calculation described in this subdivision, the base year
13 will be two thousand, and the commissioner of health shall utilize data
14 as reported on the 2000 AHCF-1 cost report initially submitted by
15 covered providers to the department of health on or about August seven-
16 teenth, two thousand one. For periods on and after January first, two
17 thousand eight, for purposes of the calculation described in this subdi-
18 vision, the base year will be two years prior to the grant year, and the
19 commissioner of health shall utilize data as reported on AHCF-1 cost
20 report submitted by covered providers to the department of health for
21 such base year.
22 4. Payments made pursuant to this section shall constitute additional
23 reimbursement to qualified providers and shall not be used to reduce
24 levels of other funding provided to qualified providers by governmental
25 agencies.
26 5. (a) The commissioner of health shall make medical assistance
27 payments to qualified providers from funds made available pursuant to
28 the provisions of this section contingent upon the receipt of all feder-
29 al approvals necessary and subject to the availability of federal finan-
30 cial participation under title XIX of the federal social security act
31 for the transitional supplemental payments. In the event such federal
32 approval is not received prior to March thirty-first, two thousand two,
33 for adjustments for the period February first, two thousand two through
34 March thirty-first, two thousand two and prior to October first, two
35 thousand two for adjustments for the period October first, two thousand
36 two through December thirty-first, two thousand two and prior to October
37 first, two thousand three for adjustments for the period October first,
38 two thousand three through December thirty-first, two thousand three,
39 and prior to October first, two thousand five for adjustments for the
40 period April first, two thousand five through June thirtieth, two thou-
41 sand five, and prior to October first, two thousand six for adjustments
42 for the period October first, two thousand six through December thirty-
43 first, two thousand six, and prior to October first, two thousand seven
44 for adjustments for the period October first, two thousand seven through
45 December thirty-first, two thousand seven, and prior to October first,
46 two thousand eight for adjustments for the period October first, two
47 thousand eight through December thirty-first, two thousand eight, and
48 prior to October first, two thousand nine for adjustments for the period
49 October first, two thousand nine through December thirty-first, two
50 thousand nine, the commissioner of health shall make medical assistance
51 payments to qualified providers consisting of the state share amount
52 available for purposes of this section and apportioned in accordance
53 with subdivisions two and three of this section. In the event such
54 federal approval is denied, such state share amount payments shall be
55 deemed to be grants to such qualified providers and such qualified
S. 58--B 107 A. 158--B
1 providers shall not be eligible to receive any other payments pursuant
2 to this section.
3 (b) The commissioner of health shall take all steps necessary and
4 shall use best efforts to secure federal financial participation under
5 title XIX of the social security act, for the purposes of this section,
6 including the prompt submission of appropriate amendments to the title
7 XIX state plan.
8 § 126. Notwithstanding any inconsistent provision of law, rule or
9 regulation, for purposes of implementing the provisions of the public
10 health law and the social services law, references to titles XIX and XXI
11 of the federal social security act in the public health law and the
12 social services law shall be deemed to include and also to mean any
13 successor titles thereto under the federal social security act.
14 § 127. Notwithstanding any inconsistent provision of law, rule or
15 regulation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of
16 section 2807 of the public health law and section 18 of chapter 2 of the
17 laws of 1988, as they relate to time frames for notice, approval or
18 certification of rates of payment, are hereby suspended and shall, for
19 purposes of implementing the provisions of this act, be deemed to have
20 been without any force or effect from and after October 1, 2008 for such
21 rates effective for the period January 1, 2008 through December 31,
22 2008.
23 § 128. Severability clause. If any clause, sentence, paragraph, subdi-
24 vision, section or part of this act shall be adjudged by any court of
25 competent jurisdiction to be invalid, such judgment shall not affect,
26 impair or invalidate the remainder thereof, but shall be confined in its
27 operation to the clause, sentence, paragraph, subdivision, section or
28 part thereof directly involved in the controversy in which such judgment
29 shall have been rendered. It is hereby declared to be the intent of the
30 legislature that this act would have been enacted even if such invalid
31 provisions had not been included herein.
32 § 129. This act shall take effect immediately and shall be deemed to
33 have been in full force and effect on and after April 1, 2009; provided
34 that:
35 (a) sections fifteen, sixteen and sixteen-a shall be deemed to be in
36 effect on and after March 1, 2009;
37 (b) sections twenty-five, twenty-six-a, sixty-two and one hundred ten
38 through one hundred twelve of this act shall take effect July 1, 2009;
39 (c) sections thirty-eight, thirty-nine, forty-six, forty-seven and
40 forty-eight of this act shall take effect September 1, 2009;
41 (d) sections fifty-eight, fifty-nine, fifty-nine-a, fifty-nine-b,
42 fifty-nine-c and fifty-nine-d of this act shall take effect October 1,
43 2009;
44 (e) sections sixty, sixty-one, sixty-three through sixty-seven,
45 sixty-seven-a and sixty-seven-b of this act shall take effect April 1,
46 2010;
47 (f) section twenty-five of this act shall expire and be deemed
48 repealed April 1, 2013;
49 (g) section twenty-six-a of this act shall expire and be deemed
50 repealed April 1, 2014;
51 (h-1) section one hundred twenty-five of this act applies only to fees
52 related to applications for registration for the 2010 calendar year and
53 thereafter;
54 (h-2) sections one hundred twenty-five-a, one hundred twenty-five-b,
55 and one hundred twenty-five-c of this act shall take effect September 1,
56 2009;
S. 58--B 108 A. 158--B
1 (i) any rules or regulations necessary to implement the provisions of
2 this act may be promulgated and any procedures, forms, or instructions
3 necessary for such implementation may be adopted and issued on or after
4 the date this act shall have become a law;
5 (j) this act shall not be construed to alter, change, affect, impair
6 or defeat any rights, obligations, duties or interests accrued, incurred
7 or conferred prior to the effective date of this act;
8 (k) the commissioner of health and the superintendent of insurance and
9 any appropriate council may take any steps necessary to implement this
10 act prior to its effective date;
11 (l) notwithstanding any inconsistent provision of the state adminis-
12 trative procedure act or any other provision of law, rule or regulation,
13 the commissioner of health and the superintendent of insurance and any
14 appropriate council is authorized to adopt or amend or promulgate on an
15 emergency basis any regulation he or she or such council determines
16 necessary to implement any provision of this act on its effective date;
17 (m) the provisions of this act shall become effective notwithstanding
18 the failure of the commissioner of health or the superintendent of
19 insurance or any council to adopt or amend or promulgate regulations
20 implementing this act;
21 (n) the amendments to section 364-f of the social services law made by
22 section thirty of this act shall not affect the expiration of such
23 section and shall be deemed to expire therewith;
24 (o) the amendments to paragraph (a-1) of subdivision 4 of section
25 365-a of the social services law made by section forty-six of this act
26 shall not affect the expiration of such paragraph and shall be deemed to
27 expire therewith;
28 (p) the amendments to subparagraph (iii) of paragraph (c) of subdivi-
29 sion 6 of section 367-a of the social services law made by section
30 forty-seven of this act shall not affect the expiration of such para-
31 graph and shall be deemed to expire therewith;
32 (q) the amendments to subdivision 9 of section 367-a of the social
33 services law made by sections forty-eight and forty-nine of this act
34 shall not affect the expiration of such subdivision and shall be deemed
35 to expire therewith;
36 (q-1) the amendments made to subdivisions 5 and 7 of section 270 of
37 the public health law by section thirty-five of this act shall not
38 affect the repeal of such section and shall be deemed to repeal there-
39 with;
40 (q-2) the amendments made to subdivision 11 of section 272 of the
41 public health law by section thirty-six of this act shall not affect the
42 repeal of such section and shall be deemed to repeal therewith;
43 (q-3) the amendments made to subdivision 1 of section 273 of the
44 public health law by section thirty-seven of this act shall not affect
45 the repeal of such section and shall be deemed to repeal therewith;
46 (q-4) the amendments made to paragraph (a-2) of subdivision 4 of
47 section 365-a of the social services law by section forty-six-a of this
48 act shall not affect the repeal of such section and shall be deemed to
49 repeal therewith;
50 (r) section sixty-eight of this act shall take effect on the same date
51 and in the same manner as the amendments made to subparagraph (iii) of
52 paragraph (a) of subdivision 2 of section 369-ee of the social services
53 law by section 28 of part E of chapter 63 of the laws of 2005, takes
54 effect;
55 (s) the amendments to section 2807-s of the public health law made by
56 sections one hundred and one hundred fourteen of this act shall not
S. 58--B 109 A. 158--B
1 affect the expiration of such section and shall be deemed to expire
2 therewith;
3 (t) the amendments to paragraph (c) of subdivision 5-a of section
4 2807-k of the public health law made by section one hundred two of this
5 act shall not affect the expiration of such subdivision and shall be
6 deemed to expire therewith; and
7 (u) section twenty-seven shall be deemed effective on and after Janu-
8 ary 1, 2010, provided, however, that with regard to smoking cessation
9 counseling services provided to pregnant women pursuant to paragraph (s)
10 of subdivision 2 of section 365-a of the social services law such
11 section twenty-seven shall be deemed effective on and after March 1,
12 2009, and with regard to screening, brief intervention, referral and
13 treatment provided pursuant to paragraph (u) of subdivision 2 of section
14 365-a of the social services law, such sections shall be deemed effec-
15 tive on and after April 1, 2009.
16 PART D
17 Section 1. The legislature finds that New York leads the nation in
18 Medicaid spending on long-term care services and that Medicaid spending
19 on home and personal care services are among the fastest growing areas
20 of Medicaid expenditure despite the fact that the number of benefici-
21 aries receiving these services has not increased. Current processes for
22 assessing the service needs of elderly and disabled beneficiaries do not
23 consistently result in appropriate placement and services and show wide
24 variation across the state. Current reimbursement levels and methodol-
25 ogies do not ensure quality or efficiency, with providers in the same
26 community serving comparable populations receiving markedly different
27 Medicaid payments. It is the intent of this legislation to ensure that
28 elderly and disabled beneficiaries have access to the right level of
29 care in the most appropriate setting; to implement transparent and accu-
30 rate reimbursement systems for nursing and home care services; and to
31 reward quality and efficiency as well as to make targeted investments to
32 improve long-term care services.
33 § 1-a. Short title. This act shall be known and may be cited as "The
34 Long-Term Care Reform Act".
35 § 2. Notwithstanding paragraph (b) of subdivision 2-b of section 2808
36 of the public health law or any other contrary provision of law, with
37 regard to adjustments to medicaid rates of payment for inpatient
38 services provided by residential health care facilities for the period
39 April 1, 2009 through March 31, 2010, made pursuant to paragraph (b) of
40 subdivision 2-b of section 2808 of the public health law, the commis-
41 sioner of health and the director of the budget shall, upon a determi-
42 nation that such adjustments, including the application of adjustments
43 authorized by the provisions of paragraph (g) of subdivision 2-b of
44 section 2808 of the public health law, shall result in an aggregate
45 increase in total Medicaid rates of payment for such services for such
46 period that is less than or more than two hundred ten million dollars
47 ($210,000,000), make such proportional adjustments to such rates as are
48 necessary to result in an increase of such aggregate expenditures of two
49 hundred ten million dollars ($210,000,000), and provided further, howev-
50 er, that the operating component of such rates for the period April 1,
51 2009 through March 31, 2010 shall not be subject to case mix adjustments
52 pursuant to subparagraph (ii) of paragraph (b) of subdivision 2-b of
53 section 2808 of the public health law, as otherwise scheduled pursuant
54 to such subparagraph for January of 2010, and provided further, however,
S. 58--B 110 A. 158--B
1 that notwithstanding subdivision 2-c of section 2808 of the public
2 health law or any other contrary provision of law, with regard to
3 adjustments to inpatient rates of payment made pursuant to subdivision
4 2-c of section 2808 of the public health law for inpatient services
5 provided by residential health care facilities for the period April 1,
6 2010 through March 31, 2011, the commissioner of health and the director
7 of the budget shall, upon a determination by such commissioner and such
8 director that such rate adjustments shall, prior to the application of
9 any applicable adjustment for inflation, result in an aggregate increase
10 in total Medicaid rates of payment for such services, make such propor-
11 tional adjustments to such rates as are necessary to reduce such total
12 aggregate rate adjustments such that the aggregate total reflects no
13 such increase. Adjustments made pursuant to this section shall not be
14 subject to subsequent correction or reconciliation.
15 § 3. Subparagraph (i) of paragraph (b) of subdivision 2-b of section
16 2808 of the public health law, as amended by section 3 of part I of
17 chapter 2 of the laws of 2009, is amended to read as follows:
18 (i) Subject to the provisions of subparagraphs (ii) through (xiv) of
19 this paragraph, for periods on and after April first, two thousand nine
20 through March thirty-first, two thousand ten the operating cost compo-
21 nent of rates of payment shall reflect allowable operating costs as
22 reported in each facility's cost report for the two thousand two calen-
23 dar year, as adjusted for inflation on an annual basis in accordance
24 with the methodology set forth in paragraph (c) of subdivision ten of
25 section twenty-eight hundred seven-c of this article, provided, however,
26 that for those facilities which do not receive a per diem add-on adjust-
27 ment pursuant to subparagraph (ii) of paragraph (a) of this subdivision,
28 rates shall be further adjusted to include the proportionate benefit, as
29 determined by the commissioner, of the expiration of the opening para-
30 graph and paragraph (a) of subdivision sixteen of this section and of
31 paragraph (a) of subdivision fourteen of this section, and provided
32 further that the operating cost component of rates of payment for those
33 facilities which did not receive a per diem adjustment in accordance
34 with subparagraph (ii) of paragraph (a) of this subdivision shall not be
35 less than the operating component such facilities received in the two
36 thousand eight rate period, as adjusted for inflation on an annual basis
37 in accordance with the methodology set forth in paragraph (c) of subdi-
38 vision ten of section twenty-eight hundred seven-c of this article and
39 further provided, however, that rates for facilities whose operating
40 cost component reflects base year costs subsequent to January first, two
41 thousand two shall have rates computed in accordance with this para-
42 graph, utilizing allowable operating costs as reported in such subse-
43 quent base year period, and trended forward to the rate year in accord-
44 ance with applicable inflation factors.
45 § 4. Subdivision 17-a of section 2808 of the public health law, as
46 amended by section 73 of part C of chapter 58 of the laws of 2008, is
47 amended to read as follows:
48 17-a. Notwithstanding any inconsistent provision of law or regulation
49 to the contrary, for purposes of establishing rates of payment by
50 governmental agencies for residential health care facilities for
51 services provided on and after January first, nineteen hundred ninety-
52 eight, the regional direct and indirect input price adjustment factors
53 to be applied to any such facility's rate calculation shall be based
54 upon the utilization of either nineteen hundred eighty-three, nineteen
55 hundred eighty-seven or nineteen hundred ninety-three calendar year
56 financial and statistical data and for periods beginning April first,
S. 58--B 111 A. 158--B
1 two thousand four through March thirty-first, two thousand nine based on
2 either nineteen hundred eighty-three, nineteen hundred eighty-seven,
3 nineteen hundred ninety-three or two thousand one calendar year finan-
4 cial and statistical data; provided, however, the state share amount for
5 the utilization of two thousand one calendar year data shall be no more
6 than twenty-two million dollars on a pro rata basis per calendar year.
7 The determination of which calendar year's data to utilize shall be
8 based upon a methodology that ensures that the particular year chosen by
9 each facility results in a factor that yields no less reimbursement to
10 the facility than would result from the use of any of the other three
11 years' data. Such methodology shall utilize the nineteen hundred eight-
12 y-three and nineteen hundred eighty-seven regional direct and indirect
13 input price adjustment factor corridor percentages in existence on Janu-
14 ary first, nineteen hundred ninety-seven as well as nineteen hundred
15 ninety-three regional direct and indirect input price adjustment factor
16 corridor percentage in existence on January first, two thousand four as
17 well as a two thousand one regional direct and indirect input price
18 adjustment factor corridor percentage calculated in the same manner as
19 the nineteen hundred ninety-three direct and indirect input price
20 adjustment factor corridor percentages in existence on January first,
21 two thousand four; provided, however, for rate periods on and after
22 April first, two thousand nine, the regional input price adjustment
23 factors shall be based on the case mix predicted staffing for registered
24 nurses, licensed practical nurses, nurses' aides, licensed therapists
25 and therapist aides. For the rate period beginning April first, two
26 thousand nine through [December thirty-first, two thousand nine] March
27 thirty-first, two thousand ten, the regional direct and indirect input
28 price adjustment factors to be applied to a facility's rate calculation
29 shall be based upon the utilization of two thousand two calendar year
30 financial and statistical data. Such methodology shall utilize two thou-
31 sand two regional direct and indirect input price adjustment factor
32 corridor percentages calculated in the same manner as the two thousand
33 one regional direct and indirect input price adjustment factor corridor
34 percentages in existence on December thirty-first, two thousand six
35 except that every region shall receive a corridor to reflect the
36 region's actual variation subject to a maximum statewide average vari-
37 able corridor percentage of ten percent. [For the rate periods beginning
38 January first, two thousand ten through December thirty-first, two thou-
39 sand eleven, the regional direct and indirect input price adjustment
40 factors to be applied to a facility's rate calculation shall be based
41 upon the utilization of two thousand eight calendar year financial and
42 statistical data. Such methodology shall utilize two thousand eight
43 regional direct and indirect input price adjustment factor corridor
44 percentages calculated in the same manner as the two thousand two
45 regional direct and indirect input price adjustment factor corridor
46 percentages, with every region receiving a corridor to reflect the
47 region's actual variation subject to a maximum statewide average vari-
48 able corridor percentage of ten percent. For the three year period
49 beginning January first, two thousand twelve, the regional direct price
50 and indirect input price adjustment factors and the regional direct and
51 indirect input price adjustment factor corridor percentages shall be
52 based upon the utilization of financial and statistical data from the
53 base period used for the operating component of rates for the two thou-
54 sand twelve rate period pursuant to paragraph (f) of subdivision two-b
55 of this section.]
S. 58--B 112 A. 158--B
1 § 5. Section 2808 of the public health law is amended by adding a new
2 subdivision 2-c to read as follows:
3 2-c. (a) Notwithstanding any inconsistent provision of this section or
4 any other contrary provision of law and subject to the availability of
5 federal financial participation, the operating costs of rates of payment
6 by governmental agencies for inpatient services provided by residential
7 health care facilities on and after April first, two thousand ten shall
8 be determined in accordance with the following:
9 (i) The direct and indirect components of the operating cost component
10 of such rates will be computed on a regional basis, using allowable
11 operating costs, as determined by the commissioner, from two thousand
12 seven certified cost reports on file with the department as of January
13 first, two thousand nine, as adjusted for inflation in accordance with
14 applicable statutes.
15 (ii) The non-comparable component of the operating component of such
16 rates shall be computed on a facility specific basis, using allowable
17 operating costs, as determined by the commissioner, from two thousand
18 seven certified cost report submitted by each facility and on file with
19 the department on January first, two thousand nine, as adjusted for
20 inflation in accordance with applicable statutes.
21 (iii) The capital component of rates computed pursuant to this section
22 shall fully reflect the cost of local property taxes and payments made
23 in lieu of local property taxes, as reported in each facility's cost
24 report submitted for the year two years prior to the rate year.
25 (iv) The direct component of the operating component of rates shall be
26 subject to case mix adjustment through application of the minimum data
27 set (MDS) classification employed by the federal government with regard
28 to payments to skilled nursing facilities pursuant to title XVIII of the
29 federal social security act (medicare) to reflect patient service inten-
30 sity, as may be adjusted by the commissioner. Such adjustments shall be
31 made semi-annually in each calendar year, and both the adjustments and
32 the related patient classifications in each facility shall be subject to
33 audit review in accordance with regulations promulgated by the commis-
34 sioner.
35 (v) Notwithstanding any contrary provision of this section or any
36 other contrary provision of law, rule or regulation, rates of payment
37 shall, except for the establishment of any regional prices, be calcu-
38 lated utilizing the number of patients reported in each patient classi-
39 fication group and eligible for medical assistance pursuant to title
40 eleven of article five of the social services law.
41 (vi) Notwithstanding subparagraph (i) of this paragraph, the operating
42 cost component of the rates, effective April first, two thousand ten for
43 the following categories of facilities, as established pursuant to
44 applicable regulations, shall reflect the rates in effect for such
45 facilities on March thirty-first, two thousand ten, as adjusted for
46 inflation in accordance with applicable statutes: (A) AIDS facilities or
47 discrete AIDS units within facilities, (B) discrete units for residents
48 receiving care in a long-term inpatient rehabilitation program for trau-
49 matic brain injured persons, (C) discrete units providing specialized
50 programs for residents requiring behavioral interventions, (D) discrete
51 units for long-term ventilator dependent residents, and (E) facilities
52 or discrete units within facilities that provide extensive nursing,
53 medical, psychological and counseling support services solely to chil-
54 dren. Such rate shall remain in effect until the department, in consul-
55 tation with representatives of the nursing home industry, as selected by
S. 58--B 113 A. 158--B
1 the commissioner, develops a regional pricing or alternative methodology
2 for determining such rates.
3 (vii) The operating component of rates of payment, as adjusted for
4 inflation in accordance with subparagraph (i) of this paragraph, shall,
5 by no later than the two thousand thirteen rate period, be based on
6 allowable costs, as reported on annual facility cost reports submitted
7 as required by the commissioner, from a base year period no earlier than
8 three years prior to the initial rate year. Thereafter, the base year
9 utilized for rate-setting purposes shall be updated to be current no
10 less frequently than every six years; provided, however, that for the
11 purposes of this paragraph, current shall mean that the operating compo-
12 nents of the initial rate year, utilizing such updated base year, shall
13 reflect allowable costs as reported in annual facility cost reports for
14 periods no earlier than three years prior to such initial rate year, as
15 adjusted for inflation in accordance with subparagraph (i) of this para-
16 graph.
17 (b) The operating component of rates may be adjusted to reflect a per
18 diem add-on, as determined by the commissioner, for the following
19 patients: (i) each patient whose body mass index is greater than thir-
20 ty-five; (ii) each patient who qualifies under the RUG-III impaired
21 cognition and behavioral problems categories, or has been diagnosed with
22 Alzheimer's disease or dementia, and is classified in the reduced physi-
23 cian functions A, B, or C, or in behavioral problems A or B categories,
24 and has an activities of daily living index score of less than ten; and
25 (iii) each patient who qualifies for extended care as a result of trau-
26 matic brain injury as defined by applicable regulations.
27 (c) The commissioner may promulgate regulations to implement the
28 provisions of this subdivision.
29 (d) (i) Subject to the availability of federal financial partic-
30 ipation, the commissioner is authorized to establish a quality of care
31 incentive pool or pools for eligible residential health care facilities
32 and increase Medicaid rates of payment for such eligible facilities from
33 this pool or pools. Within amounts available, payments will be deter-
34 mined by the commissioner by applying criteria, including, but not
35 limited to, the quality components of the minimum data set required
36 under federal law, survey information, direct care staffing, including
37 labor costs, and other facility data.
38 (ii) Facilities that fall within one or more of the categories below
39 during a review period will be excluded from award eligibility:
40 (A) any residential health care facility that is currently designated
41 by the centers for medicare and Medicaid services as a "special focus
42 facility";
43 (B) any residential health care facility for which the department has
44 issued a finding of immediate jeopardy during the most recently
45 completed federal fiscal year;
46 (C) any residential health care facility that has received a citation
47 for substandard quality of care in the areas of quality of life, quality
48 of care, resident behavior, and/or facility practices during the most
49 recently completed federal fiscal year;
50 (D) any residential health care facility that is part of a continuing
51 care retirement community;
52 (E) any residential health care facility that operates as a transi-
53 tional care unit; and
54 (F) any other exclusions as deemed appropriate by the commissioner.
55 (iii) Notwithstanding any inconsistent provision of law or regulation
56 to the contrary, in the event that the total amount of funding allocated
S. 58--B 114 A. 158--B
1 for a particular fiscal year is not distributed, funds shall be reserved
2 and accumulated from year to year so that any funds remaining at the end
3 of a particular fiscal year will be available for distribution during
4 the following fiscal year.
5 (e) Subject to the availability of federal financial participation and
6 within amounts available, the commissioner may make transition adjust-
7 ments to rates of payment for residential health care facilities for
8 state fiscal years beginning April first, two thousand ten to facilitate
9 improvements in residential health care facility operations and finances
10 in accordance with the following:
11 (i) Residential health care facilities eligible for distributions
12 pursuant to this paragraph shall be those non-public facilities and
13 state operated public residential health care facilities, which have an
14 average annual Medicaid utilization percentage of fifty percent or
15 greater for the two years prior to the rate year and which, as deter-
16 mined by the commissioner, experience a reduction in their Medicaid
17 revenue of a percentage as determined by the commissioner as a result of
18 the application of regional pricing as described in this subdivision.
19 (ii) Transition funds distributed pursuant to this paragraph shall be
20 allocated based on each eligible facility's relative need as determined
21 by the commissioner.
22 (iii) Payments made pursuant to this paragraph shall not be subject to
23 retroactive adjustment or reconciliation and may be added to rates of
24 payment or made as lump sum payments.
25 (iv) Each residential health care facility receiving funds pursuant to
26 this paragraph shall, as a condition for eligibility for such funds,
27 adopt a resolution of the board of directors or submit a report by the
28 owner acceptable to the commissioner setting forth its current financial
29 condition and a plan for reforming and improving such financial condi-
30 tion, including ongoing board or owner oversight, and shall, after two
31 years, issue a report as adopted by each such board or issue a further
32 report by the owner acceptable to the commissioner setting forth what
33 progress has been achieved regarding such improvement, provided, howev-
34 er, if such further report is not submitted to the commissioner, or if
35 such further report fails to set forth adequate progress, as determined
36 by the commissioner, the commissioner may deem such facility ineligible
37 for further distributions pursuant to this paragraph and may redistrib-
38 ute such further distributions to other eligible facilities in accord-
39 ance with the provisions of this paragraph. The commissioner shall be
40 provided with copies of all such resolutions and reports.
41 (f) Such rates shall be adjusted to reflect appropriate cost differen-
42 tials related to direct care staffing. Such adjustment may be made to
43 the direct component of the operating cost component of such rate,
44 through a quality of care incentive pool pursuant to paragraph (d) of
45 this subdivision or using such other mechanism as deemed appropriate by
46 the commissioner, after consideration of any recommendations and
47 discussions of the workgroup established by section forty-eight of part
48 C of chapter one hundred nine of the laws of two thousand six.
49 § 5-a. Subdivision 11 of section 2808 of the public health law, as
50 amended by chapter 474 of the laws of 1996, is amended to read as
51 follows:
52 11. Residential health care facility reimbursement rate promulgation.
53 With regard to a residential health care facility, the provisions of
54 [paragraph (a) of] subdivision seven of section twenty-eight hundred
55 seven of this article relating to advance notification of rates shall
56 not apply to prospective or retroactive adjustments to rates that are
S. 58--B 115 A. 158--B
1 based on rate appeals filed by such facility, audits, changes in patient
2 conditions or acuity levels, the correction of errors or omissions of
3 data or errors in the computations of such rates, the submission of cost
4 report data from facilities without an established cost basis, the judi-
5 cial annulment or invalidation of existing rates or changes in the meth-
6 odology used to compute rates which changes are promulgated following
7 the judicial annulment or invalidation of existing rates or as otherwise
8 authorized by law. Notwithstanding any inconsistent provision of law or
9 regulation, as of April first, two thousand nine, with regard to admin-
10 istrative rate appeals, the department will only review such appeals for
11 (a) the correction of computational errors or omissions of data by the
12 department in determining the operating rate based upon the information
13 provided to the department prior to the computation of the rate, (b)
14 capital cost reimbursement, or (c) such reasons as the commissioner
15 determines are appropriate. The department will not consider any
16 revisions made to a facility's annual cost report for operating rate
17 adjustment purpose later than the due date established by the commis-
18 sioner.
19 § 6. Section 48 of part C of chapter 109 of the laws of 2006, amending
20 the social services law and other laws relating to Medicaid reimburse-
21 ment rate settings, as amended by section 65-a of part A of chapter 58
22 of the laws of 2007, is amended to read as follows:
23 § 48. Notwithstanding any contrary provision of law, the commissioner
24 of health shall, by no later than May 15, 2007, establish a workgroup
25 [to investigate and develop recommendations] pertaining to Medicaid
26 reimbursement rate-setting for residential health care facilities for
27 future periods, including, but not limited to, the following areas:
28 (a) [the appropriate reimbursement for capital costs for those facili-
29 ties which have received reimbursement reflecting one hundred percent of
30 capital depreciation] operating costs that should be considered allow-
31 able in the development of regional prices;
32 (b) [potential mechanisms for reimbursement of costs incurred by
33 facilities with regard to the employment of nursing staff provided by
34 independent companies] identification of appropriate cost differentials
35 among facilities based on factors including, but not limited to, size,
36 affiliation, location, public versus non-public, facility layout,
37 culture exchange initiatives and labor costs, including the most appro-
38 priate mechanism to adjust rates of payment to reflect appropriate cost
39 differentials related to direct care staffing, including adjustments to
40 the direct component of the operating cost component of such rate,
41 establishment of a quality care incentive pool pursuant to subdivision
42 (2-c) of section 2808 of the public health law or other mechanisms;
43 (c) [reimbursement of costs related to insurance;
44 (d) conversion from the RUG II patient classification system to the
45 "minimum data set" (RUG-III) patient classification system;
46 (e)] reimbursement for facilities providing care to specialized popu-
47 lations with specialized care needs;
48 (d) the relationship between facility spending on various costs and
49 quality of care and patient outcomes;
50 (e) appropriate regions to be utilized;
51 (f) [corridors applicable to the statewide mean prices as utilized for
52 rate-setting purposes;
53 (g)] the reasons underlying the existing proportion of Medicaid
54 patients to non-Medicaid patients in New York facilities;
55 [(h)] (g) issues related to Medicare;
56 [(i)] (h) impact of planned rightsizing of the acute care system;
S. 58--B 116 A. 158--B
1 [(j)] (i) impact of planned rightsizing of nursing home system;
2 [(k)] (j) impact of using Medicaid only case mix; and
3 [(l)] (k) other issues as determined by the commissioner.
4 The members of the workgroup shall include department of health staff
5 and representatives of statewide associations representing the residen-
6 tial health care facility industry in New York, organizations represent-
7 ing employees, [and associations with less than a statewide membership
8 shall have the ability to present information to the workgroup and
9 participate in the discussions on the issues outlined in this section]
10 and, by May thirty-first, two thousand nine, advocates for residential
11 health care facility residents and representatives of regional associ-
12 ations representing the residential health care facility industry in New
13 York. The workgroup shall work in consultation with the assembly and
14 the senate. The commissioner of health shall appoint the chair of the
15 workgroup [An initial report setting forth the workgroup's conclusions
16 and recommendations shall be submitted to the commissioner of health by
17 no later than January 1, 2008 and a subsequent report shall be submitted
18 to the commissioner of health no later than June 15, 2008. Thereafter
19 such workgroup shall continue until January 1, 2009, or as determined by
20 the commissioner of health.] and designate such employees of the depart-
21 ment of health as are reasonably necessary to provide necessary data and
22 support services to the workgroup. The commissioner of health shall
23 submit an interim report summarizing the workgroup's deliberations and
24 the commissioner of health's recommendations to the governor, the tempo-
25 rary president of the senate, the speaker of the assembly, and the
26 minority leaders of the senate and the assembly by December fifteenth,
27 two thousand nine, and a subsequent report shall be submitted to these
28 individuals no later than February fifteenth, two thousand ten. The
29 workgroup shall continue until December thirty-first, two thousand ten
30 to evaluate the implementation of the new system.
31 § 6-a. Paragraph d of subdivision 20 of section 2808 of the public
32 health law is relettered paragraph e and a new paragraph d is added to
33 read as follows:
34 d. (i) Capital cost reimbursement for proprietary residential health
35 care facilities. Any proprietary facility which otherwise would be enti-
36 tled to residual reimbursement as provided under applicable regulation,
37 may have the capital cost component of its rate recalculated by the
38 department to take into account any capital improvements and/or reno-
39 vations made to the facility's existing infrastructure for the purpose
40 of converting beds to alternative long-term care uses or protecting the
41 health and safety of patients, subject to the approval of the commis-
42 sioner and all applicable certificate of need requirements.
43 (ii) The department shall evaluate the adequacy of current capital
44 cost reimbursement for voluntary residential health care facilities.
45 § 7. Notwithstanding any contrary provision of law, if the commission-
46 er of health determines that federal financial participation will not be
47 available with regard to the provisions of subparagraph (ii) of para-
48 graph (e) of subdivision 2-c of section twenty-eight hundred eight of
49 the public health law, the commissioner may deem such provision null and
50 void and instead may allocate funds pursuant to such subparagraph (ii)
51 proportionally, based on each eligible facility's relative share of
52 Medicaid days in the year two years prior to the distribution year.
53 § 8. Subdivision 21 of section 2808 of the public health law, as added
54 by section 27 of part C of chapter 58 of the laws of 2004 and paragraphs
55 (a), (b), (f), (g) and (h) as amended by chapter 746 of the laws of
56 2004, is amended to read as follows:
S. 58--B 117 A. 158--B
1 21. (a) Notwithstanding any inconsistent provision of law or regu-
2 lation to the contrary, for the purposes specified in subdivision nine-
3 teen of this section, the commissioner shall adjust medical assistance
4 rates of payment established pursuant to this article for services
5 provided on and after October first, two thousand four through December
6 thirty-first, two thousand four and annually thereafter for services
7 provided on and after January first, two thousand five, to include a
8 rate adjustment to assist qualifying facilities pursuant to this subdi-
9 vision, provided, however, that public residential health care facili-
10 ties shall not be eligible for rate adjustments pursuant to this subdi-
11 vision for rate periods on and after April first, two thousand nine.
12 (b) Eligibility for such rate adjustments shall be determined on the
13 basis of each residential health care facility's operating margin over
14 the most recent three-year period for which financial data are available
15 from the RHCF-4 cost report or the institutional cost report. For
16 purposes of the adjustments made for the period October first, two thou-
17 sand four through December thirty-first, two thousand four, financial
18 information for the calendar years two thousand through two thousand two
19 shall be utilized. For each subsequent rate year, the financial data for
20 the three-year period ending two years prior to the applicable rate year
21 shall be utilized for this purpose.
22 (c) Each facility's operating margin for the three-year period shall
23 be calculated by subtracting total operating expenses for the three-year
24 period from total operating revenues for the three-year period, and
25 dividing the result by the total operating revenues for the three-year
26 period, with the result expressed as a percentage. For hospital-based
27 residential health care facilities for which an operating margin cannot
28 be calculated on the basis of the submitted cost reports, the sponsoring
29 hospital's overall three-year operating margin, as reported in the
30 institutional cost report, shall be utilized for this purpose. All
31 facilities with negative operating margins calculated in this way over
32 the three-year period shall be arrayed into quartiles based on the
33 magnitude of the operating margin. Any facility with a positive operat-
34 ing margin for the most recent three-year period, a negative operating
35 margin that places the facility in the quartile of facilities with the
36 smallest negative operating margins, a positive total margin in the most
37 recent year of the three year period, or an average Medicaid utilization
38 percentage of fifty percent or less during the most recent year of the
39 three-year period shall be disqualified from receiving an adjustment
40 pursuant to this subdivision, provided, however, that for rate periods
41 on and after April first, two thousand nine, such disqualification:
42 (i) shall not be applied solely on the basis of a facility's having a
43 positive total margin in the most recent year of such three-year period;
44 (ii) shall be extended to those facilities in the quartile of facili-
45 ties with the second smallest negative operating margins; and
46 (iii) shall also be extended to those facilities with an average Medi-
47 caid utilization percentage of less than seventy percent during the most
48 recent year of the three-year period.
49 (d) For each facility remaining after the exclusions made pursuant to
50 paragraph (c) of this subdivision, the commissioner shall calculate the
51 average annual operating loss for the three-year period by subtracting
52 total operating expenses for the three-year period from total operating
53 revenues for the three-year period, and dividing the result by three,
54 provided, however, that for periods on and after April first, two thou-
55 sand nine, the amount of such average annual operating loss shall be
56 reduced by an amount equal to the amount received by such facility
S. 58--B 118 A. 158--B
1 pursuant to subparagraph (ii) of paragraph (a) of subdivision two-b of
2 this section. For this purpose, for hospital-based residential health
3 care facilities for which the average annual operating loss cannot be
4 calculated on the basis of the submitted cost reports, the sponsoring
5 hospital's overall average annual operating loss for the three-year
6 period shall be apportioned to the residential health care facility
7 based on the proportion the residential health care facility's total
8 revenues for the period bears to the total revenues reported by the
9 sponsoring hospital, and such apportioned average annual operating loss
10 shall then be reduced by an amount equal to the amount received by such
11 facility pursuant to subparagraph (ii) of paragraph (a) of subdivision
12 two-b of this section.
13 (e) [Each] For periods prior to April first, two thousand nine, each
14 such facility's qualifying operating loss shall be determined by multi-
15 plying the facility's average annual operating loss for the three-year
16 period as calculated pursuant to paragraph (d) of this subdivision by
17 the applicable percentage shown in the tables below for the quartile
18 within which the facility's negative operating margin for the three-year
19 period is assigned.
20 i. For a facility located in a county with a total population of two
21 hundred thousand or more as determined by the two thousand U.S. Census:
22 First Quartile (lowest operating margins): 30 percent
23 Second Quartile: 15 percent
24 Third Quartile: 7.5 percent
25 ii. For a facility located in a county with a total population of fewer
26 than two hundred thousand as determined by the two thousand U.S. Census:
27 First Quartile (lowest operating margins): 35 percent
28 Second Quartile: 20 percent
29 Third Quartile: 12.5 percent
30 (f) The amount of any facility's financially disadvantaged residential
31 health care facility distribution calculated in accordance with this
32 subdivision shall be reduced by the facility's estimated rate year bene-
33 fit of the two thousand one update to the regional input price adjust-
34 ment factors authorized pursuant to former subdivision seventeen of this
35 section as amended by section 24 of part C of chapter 58 of the laws of
36 2004, or as authorized by subdivision seventeen-a of this section, as
37 added by section 56 of part C of chapter 58 of the laws of 2007, if any,
38 provided, however, that such reduction shall not be applied with regard
39 to rate periods on and after April first, two thousand nine. After all
40 other adjustments to a facility's financially disadvantaged residential
41 health care facility distribution have been made in accordance with this
42 subdivision, the amount of each facility's distribution shall be limited
43 to no more than four hundred thousand dollars during the period October
44 first, two thousand four through December thirty-first, two thousand
45 four and [during any subsequent annual rate period], on an annualized
46 basis, for rate periods through March thirty-first, two thousand nine,
47 and no more than one million dollars for the period April first, two
48 thousand nine through December thirty-first, two thousand nine and for
49 each annual rate period thereafter.
50 (g) The adjustment made to each qualifying facility's medical assist-
51 ance rate of payment determined pursuant to this article shall be calcu-
52 lated by dividing the facility's financially disadvantaged residential
S. 58--B 119 A. 158--B
1 health care facility distribution calculated in accordance with this
2 subdivision by the facility's total medical assistance patient days
3 reported in the cost report submitted two years prior to the rate year,
4 provided however, that such rate adjustments for the period October
5 first, two thousand four through December thirty-first, two thousand
6 four shall be calculated based on twenty-five percent of each facility's
7 reported total medical assistance patient days as reported in the appli-
8 cable two thousand two cost report. Such amounts shall not be reconciled
9 to reflect changes in medical assistance utilization between the year
10 two years prior to the rate year and the rate year.
11 (h) The total amount of funds to be allocated and distributed as
12 medical assistance for financially disadvantaged residential health care
13 facility rate adjustments to eligible facilities for a rate period in
14 accordance with this subdivision shall be thirty million dollars for the
15 period October first, two thousand four through December thirty-first,
16 two thousand four and thirty million dollars [for annual] on an annual-
17 ized basis for rate periods on and after January first, two thousand
18 five through December thirty-first, two thousand eight and thirty
19 million dollars on an annualized basis on and after January first, two
20 thousand nine. The nonfederal share of such [total shall be fifteen
21 million dollars which] rate adjustments shall be paid by the state, with
22 no local share, from allocations made pursuant to paragraph (hh) of
23 subdivision one of section twenty-eight hundred seven-v of this [chap-
24 ter] article. In the event the statewide total of the annual rate
25 adjustments determined pursuant to paragraph (g) of this subdivision
26 varies from [thirty million dollars] the amounts set forth in this para-
27 graph, each qualifying facility's rate adjustment shall be proportion-
28 ately increased or decreased such that the total of the annual rate
29 adjustments made pursuant to this subdivision is equal to [thirty
30 million dollars] the amounts set forth in this paragraph on a statewide
31 basis.
32 (i) This subdivision shall be effective if, and as long as, federal
33 financial participation is available for expenditures made for benefici-
34 aries eligible for medical assistance under title XIX of the federal
35 social security act for the rate adjustments determined in accordance
36 with this subdivision.
37 (j) For periods on and after April first, two thousand nine, residen-
38 tial health care facilities which are otherwise eligible for rate
39 adjustments pursuant to this subdivision shall also, as a condition for
40 receipt of such rate adjustments, submit to the commissioner a written
41 restructuring plan that is acceptable to the commissioner and which is
42 in accord with the following:
43 (i) such an acceptable plan shall be submitted to the commissioner
44 within sixty days of the facility's receipt of rate adjustments pursuant
45 to this subdivision for a rate period subsequent to March thirty-first,
46 two thousand eight, provided, however, that facilities which are allo-
47 cated four hundred thousand dollars or less on an annualized basis shall
48 be required to submit such plans within one hundred twenty days, and
49 further provided that these periods may be extended by the commissioner
50 by no more than thirty days, for good cause shown; and
51 (ii) such plan shall provide a detailed description of the steps the
52 facility will take to improve operational efficiency and align its
53 expenditures with its revenues, and shall include a projected schedule
54 of quantifiable benchmarks to be achieved in the implementation of the
55 plan; and
S. 58--B 120 A. 158--B
1 (iii) such plan shall require periodic reports to the commissioner, in
2 accordance with a schedule acceptable to the commissioner, setting forth
3 the progress the facility has made in implementing its plan; and
4 (iv) such plan may include the facility's retention of a qualified
5 chief restructuring officer to assist in the implementation of the plan,
6 provided, however, that this requirement may be waived by the commis-
7 sioner, for good cause shown, upon written application by the facility.
8 (k) If a residential health care facility fails to submit an accepta-
9 ble restructuring plan in accordance with the provisions of paragraph
10 (j) of this subdivision, the facility shall, from that time forward, be
11 precluded from receipt of all further rate adjustments made pursuant to
12 this subdivision and shall be deemed ineligible from any future re-ap-
13 plication for such adjustments. Further, if the commissioner determines
14 that a facility has failed to make substantial progress in implementing
15 its plan or in achieving the benchmarks set forth in such plan, then the
16 commissioner may, upon thirty days notice to that facility, disqualify
17 the facility from further participation in the rate adjustments author-
18 ized by this subdivision and the commissioner may require the facility
19 to repay some or all of the previous rate adjustments.
20 § 9. Clause (A) of subparagraph (i) of paragraph (a) of subdivision 18
21 of section 2808 of the public health law, as amended by section 73-b of
22 part C of chapter 58 of the laws of 2008, is amended to read as follows:
23 (A) fifty-three million five hundred thousand dollars on an annualized
24 basis for the period April first, two thousand two through December
25 thirty-first, two thousand two; eighty-three million three hundred thou-
26 sand dollars on an annualized basis for the period January first, two
27 thousand three through December thirty-first, two thousand three; one
28 hundred fifteen million eight hundred thousand dollars on an annualized
29 basis for the period January first, two thousand four through December
30 thirty-first, two thousand six; fifty-seven million nine hundred thou-
31 sand dollars for the period January first, two thousand seven through
32 June thirtieth, two thousand seven, fifty-seven million nine hundred
33 thousand dollars for the period July first, two thousand seven through
34 March thirty-first, two thousand eight, and [sixty-four] fifty-nine
35 million [eight] four hundred thousand dollars for the period April
36 first, two thousand eight through March thirty-first, two thousand nine
37 [and twenty-six million two hundred thousand dollars for the period
38 April first, two thousand nine through March thirty-first, two thousand
39 ten and each state fiscal year thereafter].
40 § 10. Clause (A) of subparagraph (i) of paragraph (b) of subdivision
41 18 of section 2808 of the public health law, as amended by section 73-a
42 of part C of chapter 58 of the laws of 2008, is amended to read as
43 follows:
44 (A) seven million five hundred thousand dollars on an annualized basis
45 for the period April first, two thousand two through December thirty-
46 first, two thousand two; eleven million seven hundred thousand dollars
47 on an annualized basis for the period January first, two thousand three
48 through December thirty-first, two thousand three; sixteen million two
49 hundred thousand dollars on an annualized basis for the period January
50 first, two thousand four through December thirty-first, two thousand
51 six; and eight million one hundred thousand dollars for the period Janu-
52 ary first, two thousand seven through June thirtieth, two thousand
53 seven, eight million one hundred thousand dollars for the period July
54 first, two thousand seven through March thirty-first, two thousand
55 eight, [seven] six million [three] six hundred ninety thousand dollars
56 for the period April first, two thousand eight through March thirty-
S. 58--B 121 A. 158--B
1 first, two thousand nine [and one million nine hundred thousand dollars
2 for the period April first, two thousand nine through March thirty-
3 first, two thousand ten and each state fiscal year thereafter].
4 § 11. Subdivision 5 of section 2808 of the public health law is
5 amended by adding a new paragraph (c) to read as follows:
6 (c) Notwithstanding any inconsistent provision of this subdivision, on
7 and after April first, two thousand nine, no non-public residential
8 health care facility, whether operated as for-profit facility or as a
9 not-for-profit facility, may withdraw equity or transfer assets which in
10 the aggregate exceed three percent of such facility's total Medicaid
11 revenue in the prior calendar year, without the prior written approval
12 of the commissioner. The commissioner shall make a determination to
13 approve or disapprove a request for withdrawal of equity or assets under
14 this subdivision within sixty days of the date of the receipt of a writ-
15 ten request from the facility. Requests shall be made in a form accepta-
16 ble to the department by certified or registered mail. In reviewing such
17 requests the commissioner shall consider the facility's overall finan-
18 cial condition, any indications of financial distress, whether the
19 facility is delinquent in any payment owed to the department, whether
20 the facility has been cited for immediate jeopardy or substandard quali-
21 ty of care, and such other factors as the commissioner deems appropri-
22 ate. In addition to any other remedy or penalty available under this
23 chapter, and after opportunity for a hearing, the commissioner may
24 require replacement of the withdrawn equity or assets and may impose a
25 penalty for violation of the provisions of this subdivision in an amount
26 not to exceed ten percent of any amount withdrawn without prior
27 approval.
28 § 12. Notwithstanding any inconsistent provision of law or regulation,
29 effective April 1, 2009, for rates of payment by government agencies for
30 impatient services provided by residential health care facilities, in
31 determining the operating component of a facility's rate for care
32 provided for an AIDS patient in a residential health care facility
33 designated as an AIDS facility or having a discrete AIDS unit, the oper-
34 ating component shall not reflect an occupancy factor increase.
35 § 13. Intentionally omitted.
36 § 14. Intentionally omitted.
37 § 15. Intentionally omitted.
38 § 16. Subdivision 3 of section 461-l of the social services law is
39 amended by adding a new paragraph (i) to read as follows:
40 (i) The commissioner of health is authorized to add up to six thousand
41 assisted living program beds to the gross number of assisted living
42 program beds having been determined to be available as of April first,
43 two thousand nine, provided that, for each assisted living program bed
44 so added, a nursing home bed has been decertified upon the application
45 of the nursing home operator or that the commissioner of health has
46 found pursuant to subdivision six of section twenty-eight hundred six of
47 the public health law that any assisted living program bed so added
48 would serve as a more appropriate alternative to a certified nursing
49 home bed and has accordingly limited or revoked the operating certif-
50 icate of the nursing home providing that certified nursing home bed,
51 provided further that nothing herein shall be interpreted as prohibiting
52 any eligible applicant from submitting an application for any assisted
53 living program bed so added. The commissioner of health shall not be
54 required to review on a comparative basis applications submitted for
55 assisted living program beds made available under this paragraph. The
S. 58--B 122 A. 158--B
1 commissioner of health shall only authorize the addition of six thousand
2 beds pursuant to a five year plan.
3 § 17. Paragraph (a) of subdivision 6 of section 3614 of the public
4 health law, as amended by chapter 645 of the laws of 2003, is amended to
5 read as follows:
6 (a) The commissioner shall, subject to the approval of the state
7 director of the budget, establish capitated rates of payment for
8 services provided by assisted living programs as defined by paragraph
9 (a) of subdivision one of section four hundred sixty-one-l of the social
10 services law. Such rates of payment shall be related to costs incurred
11 by residential health care facilities. The rates shall reflect the wage
12 equalization factor established by the commissioner for residential
13 health care facilities in the region in which the assisted living
14 program is provided and real property capital construction costs associ-
15 ated with the construction of a free-standing assisted living program
16 such rate shall include a payment equal to the cost of interest owed and
17 depreciation costs of such construction. The rates shall also reflect
18 the efficient provision of a quality and quantity of services to
19 patients in such residential health care facilities, with needs compara-
20 ble to the needs of residents served in such assisted living programs.
21 Such rates of payment shall be equal to fifty percent of the amounts
22 which otherwise would have been expended, based upon the mean prices for
23 the first of July, nineteen hundred ninety-two (utilizing nineteen
24 hundred eighty-three costs) for freestanding, low intensity residential
25 health care facilities with less than three hundred beds, and for years
26 subsequent to nineteen hundred ninety-two, adjusted for inflation in
27 accordance with the provisions of subdivision ten of section twenty-
28 eight hundred seven-c of this chapter, to provide the appropriate level
29 of care for such residents in residential health care facilities in the
30 applicable wage equalization factor regions plus an amount equal to
31 capital construction costs associated with the construction of an
32 assisted living program facility as provided for in this subdivision.
33 § 18. Section 21 of chapter 1 of the laws of 1999 amending the public
34 health law and other laws relating to enacting the New York Health Care
35 Reform Act of 2000, as amended by section 8 of part A of chapter 57 of
36 the laws of 2000, is amended to read as follows:
37 § 21. Notwithstanding any inconsistent provision of law, effective
38 April 1, 2000, in determining rates of payment for residential health
39 care facilities pursuant to section 2808 of the public health law,
40 hospital outpatient services and diagnostic and treatment centers pursu-
41 ant to section 2807 of the public health law, unless otherwise subject
42 to the limits set forth in section 4 of chapter 81 of the laws of 1995,
43 as amended by this act, certified home health agencies and long term
44 home health care programs pursuant to section 3614-a of the public
45 health law and personal care services pursuant to section 367-i of the
46 social services law, and for periods on and after April 1, 2009, adult
47 day health care services provided to patients diagnosed with AIDS as
48 defined by applicable regulations, the commissioner of health shall
49 apply trend factors using the methodology described in paragraph (c) of
50 subdivision 10 of section 2807-c of the public health law, except that
51 such trend factors shall not be applied to services for which rates of
52 payment are established by the commissioners of the department of mental
53 hygiene. Nothing in this section is intended to reduce a change in any
54 existing provision of law establishing maximum reimbursement rates.
55 § 19. Intentionally omitted.
S. 58--B 123 A. 158--B
1 § 20. Subparagraph (iii) of paragraph (a) of subdivision 23 of section
2 2808 of the public health law, as added by section 29 of part C of chap-
3 ter 109 of the laws of 2006, is amended to read as follows:
4 (iii) For such programs which have not achieved an occupancy percent-
5 age of ninety percent or greater for a calendar year prior to April
6 first, two thousand seven, the operating component of the rate of
7 payment established pursuant to this article shall be calculated utiliz-
8 ing allowable costs reported in the first calendar year after two thou-
9 sand six in which such a program achieves an occupancy percentage of
10 ninety percent or greater effective January first of such calendar year
11 except for calendar year two thousand seven, effective no earlier than
12 April first of such year, provided, however, that effective January
13 first, two thousand nine, for programs that have not achieved an occu-
14 pancy percentage of ninety percent or greater for a calendar year prior
15 to January first, two thousand nine, the operating component of the rate
16 of payment established pursuant to this article shall be calculated
17 utilizing allowable costs reported in the two thousand nine cost report
18 filed by the sponsoring residential health care facility divided by
19 visits imputed at actual or ninety percent occupancy, whichever is
20 greater. This subparagraph shall also apply to programs which achieved
21 an occupancy percentage of ninety percent or greater prior to calendar
22 year two thousand four but in such year had an approved capacity that
23 was not the same as in calendar year two thousand four.
24 § 21. Paragraph (e-1) of subdivision 12 of section 2808 of the public
25 health law, as amended by section 64 of part C of chapter 58 of the laws
26 of 2007, is amended to read as follows:
27 (e-1) Notwithstanding any inconsistent provision of law or regulation,
28 the commissioner shall provide, in addition to payments established
29 pursuant to this article prior to application of this section, addi-
30 tional payments under the medical assistance program pursuant to title
31 eleven of article five of the social services law for non-state operated
32 public residential health care facilities, including public residential
33 health care facilities located in the county of Nassau, the county of
34 Westchester and the county of Erie, but excluding public residential
35 health care facilities operated by a town or city within a county, in
36 aggregate annual amounts of up to one hundred fifty million dollars in
37 additional payments for the state fiscal year beginning April first, two
38 thousand six and for the state fiscal year beginning April first, two
39 thousand seven and for the state fiscal year beginning April first, two
40 thousand eight and of up to three hundred million dollars in such aggre-
41 gate annual additional payments for the state fiscal year beginning
42 April first, two thousand nine. The amount allocated to each eligible
43 public residential health care facility for this period shall be
44 computed in accordance with the provisions of paragraph (f) of this
45 subdivision, provided, however, that patient days shall be utilized for
46 such computation reflecting actual reported data for two thousand three
47 and each representative succeeding year as applicable.
48 § 22. Intentionally omitted.
49 § 23. Paragraph (a) of subdivision 5 of section 3614 of the public
50 health law, as added by chapter 884 of the laws of 1990, is amended to
51 read as follows:
52 (a) During the period July first, nineteen hundred ninety through
53 December thirty-first, nineteen hundred ninety, the period January
54 first, nineteen hundred ninety-one through December thirty-first, nine-
55 teen hundred ninety-one and for each calendar year period commencing on
56 January first thereafter, rates of payment by governmental agencies
S. 58--B 124 A. 158--B
1 established in accordance with subdivision three of this section appli-
2 cable for services provided by certified home health agencies to indi-
3 viduals eligible for medical assistance pursuant to title eleven of
4 article five of the social services law for certified home health agen-
5 cies which can demonstrate, on forms provided by the commissioner, loss-
6 es from a disproportionate share of bad debt and charity care during the
7 base year period as used in determining such rates may include an allow-
8 ance determined in accordance with this subdivision to reflect the needs
9 of the certified home health agency for the financing of losses result-
10 ing from bad debt and the cost of charity care. Losses resulting from
11 bad debt and the delivery of charity care shall be determined by the
12 commissioner considering, but not limited to, such factors as the losses
13 resulting from bad debt and the costs of charity care provided by the
14 certified home health agency and the availability of other financial
15 support, including state local assistance public health aid, to meet the
16 losses resulting from bad debt and the costs of charity care of the
17 certified home health agency. The bad debt and charity care allowance
18 for a certified home health agency for a rate period shall be determined
19 by the commissioner in accordance with rules and regulations adopted by
20 the state hospital review and planning council and approved by the
21 commissioner, and shall be consistent with the purposes for which such
22 allowances are authorized for general hospitals pursuant to the
23 provisions of article twenty-eight of this chapter and rules and regu-
24 lations promulgated by the commissioner. For purposes of distribution of
25 bad debt and charity care allowances to eligible certified home health
26 agencies, the commissioner, in accordance with rules and regulations
27 adopted by the state hospital review and planning council and approved
28 by the commissioner, may limit application of a bad debt and charity
29 care allowance to a particular home care services unit or units of
30 service, such as nursing service. A certified home health agency apply-
31 ing for a bad debt and charity care allowance pursuant to this subdivi-
32 sion shall provide assurances satisfactory to the commissioner that it
33 shall undertake reasonable efforts to maintain financial support from
34 community and public funding sources and reasonable efforts to collect
35 payments for services from third party insurance payors, governmental
36 payors and self-paying patients. To be eligible for an allowance pursu-
37 ant to this subdivision, a certified home health agency shall: have
38 professional assistance available on a seven day per week, twenty-four
39 hour per day basis to all registered clients [and must]; demonstrate
40 compliance with minimum charity care certification obligation levels
41 established pursuant to rules and regulations adopted by the state
42 hospital review and planning council and approved by the commissioner;
43 and provide to the commissioner and maintain a community service plan
44 which outlines the agency's organizational mission and commitment to
45 meet the home care needs of the community, in accordance with paragraph
46 (h) of this subdivision.
47 § 24. Paragraph (h) of subdivision 5 of section 3614 of the public
48 health law is relettered paragraph (i) and a new paragraph (h) is added
49 to read as follows:
50 (h) Community service plans. (i) The governing body of a certified
51 home health agency shall issue an organizational mission statement iden-
52 tifying at a minimum the populations and communities served by the agen-
53 cy and the agency's commitment to meeting the home care needs of the
54 community. The commissioner shall take into consideration the limita-
55 tions of agency size and resources, and allow flexibility in complying
56 with the provisions of this section.
S. 58--B 125 A. 158--B
1 (ii) The governing body of the certified home health agency shall at
2 least once every three years:
3 (A) review and amend as necessary the agency's mission statement;
4 (B) solicit the views of the communities served by the agency on such
5 issues as the agency's performance and service priorities;
6 (C) demonstrate the agency's operational and financial commitment to
7 meeting community home care needs, to provide charity care service and
8 to improve access to home care services by the underserved; and
9 (D) prepare and make available to the public a statement showing the
10 provision of free, reduced charge and/or other services of a charitable
11 or community nature.
12 (iii) The governing body of the certified home health agency shall
13 annually make available to the public a review of the agency's perform-
14 ance in meeting the home care needs of the community, providing charity
15 care services, and improving access to home care services by the under-
16 served.
17 (iv) The governing body of the certified home health agency shall file
18 with the commissioner its mission statement, its annual performance
19 review, and at least every three years a report detailing amendments to
20 the statement reflecting changes in the agency's operational and finan-
21 cial commitment to meeting the home care needs of the community, provid-
22 ing charity care services, and improving access to home care services by
23 the underserved.
24 (v) The commissioner shall promulgate regulations establishing a
25 revised percentage for the charity care requirement.
26 § 25. Intentionally omitted.
27 § 26. Intentionally omitted.
28 § 27. Intentionally omitted.
29 § 28. Intentionally omitted.
30 § 29. The social services law is amended by adding a new section 367-w
31 to read as follows:
32 § 367-w. Regional long-term care assessment centers. 1. Notwithstand-
33 ing any provision of law to the contrary, the department of health is
34 authorized to establish a demonstration program, which shall be three
35 years in duration, under which the department shall designate two long-
36 term care assessment centers, the first of which shall be established in
37 a county within the city of New York and the second of which will be
38 established in another region consisting of one or more contiguous coun-
39 ties elsewhere in the state. Such centers shall serve the purpose of
40 transferring from the social services district to the regional long-term
41 care assessment centers responsibility for activities related to the
42 assessment of a person's need for, and the authorization of, long-term
43 care services and programs identified in subdivisions two, three and
44 four of this section. The department is authorized to contract with one
45 or more entities to operate regional long-term care assessment centers.
46 2. The regional long-term care assessment centers shall have responsi-
47 bility for assessment of long-term care needs of an applicant for, or
48 recipient of, medical assistance and for authorization of services and
49 participation in programs including: personal care services, including
50 personal emergency response services, under paragraph (e) of subdivision
51 two of section three hundred sixty-five-a of this title; consumer-di-
52 rected personal assistance services under section three hundred sixty-
53 five-f of this title; the assisted living program under section four
54 hundred sixty-one-l of this chapter; and participation in the long-term
55 home health care program under section three hundred sixty-seven-c of
56 this title and section thirty-six hundred sixteen of the public health
S. 58--B 126 A. 158--B
1 law, including the AIDS home care program under the provisions of
2 section three hundred sixty-seven-e of this title and section thirty-six
3 hundred twenty of the public health law.
4 3. Notwithstanding any provision of section forty-four hundred three-f
5 of the public health law to the contrary, the regional long-term care
6 assessment center shall have responsibility for reviewing assessments to
7 verify that an individual requires a nursing home level of care and,
8 after confirming that an enrollment is voluntary, for authorizing
9 participation in a managed long-term care plan or an approved managed
10 long-term care demonstration under paragraph (o) of subdivision two of
11 section three hundred sixty-five-a of this title.
12 4. The regional long-term care assessment centers shall have responsi-
13 bility for reviewing documentation from a person's physician and a
14 certified home health agency and for making the determination as to the
15 continuing need for home health services authorized under paragraph (d)
16 of subdivision two of section three hundred sixty-five-a of this title
17 beyond sixty days.
18 5. This section shall apply to those consumers who apply for the
19 services specified in this section on and after the later of January
20 first, two thousand ten or the date specified in the contract between
21 the department and the entity selected to be a regional long-term care
22 assessment center.
23 6. When a long-term care assessment center is authorized to assess
24 long-term care needs or authorize services pursuant to this section, an
25 applicant or recipient may challenge any action taken or failure to act
26 in connection therewith as if such assessment or authorization were made
27 by a government entity, and shall be entitled to the same medical
28 assistance benefits and standards and to the same notice and procedural
29 due process rights, including a right to a fair hearing and aid continu-
30 ing pursuant to section twenty-two of this chapter, as if the assessment
31 or authorization were made by a government entity.
32 7. The commissioner of health shall submit a report biannually to the
33 governor, temporary president of the senate, speaker of the assembly and
34 the minority leaders of the senate and the assembly. Such report shall
35 also be posted on the department's website. Such report shall include,
36 but not be limited to, an assessment of the project, an analysis of the
37 level and costs of services managed under the contracts, recipient
38 satisfaction and other matters as may be pertinent. In addition, the
39 commissioner shall convene an annual meeting of stakeholders to discuss
40 implementation of the demonstration program established pursuant to this
41 section.
42 § 30. Intentionally omitted.
43 § 31. Intentionally omitted.
44 § 32. Intentionally omitted.
45 § 33. Intentionally omitted.
46 § 34. Intentionally omitted.
47 § 35. Intentionally omitted.
48 § 36. Intentionally omitted.
49 § 37. Paragraph (a) of subdivision 1 of section 367-f of the social
50 services law, as amended by section 51 of part C of chapter 58 of the
51 laws of 2005, is amended to read as follows:
52 (a) "Medicaid extended coverage" shall mean eligibility for medical
53 assistance (i) without regard to the resource requirements of section
54 three hundred sixty-six of this title, or in the case of an individual
55 covered under an insurance policy or certificate described in subdivi-
56 sion two of this section that provided a residential health care facili-
S. 58--B 127 A. 158--B
1 ty benefit less than three years in duration, without consideration of
2 an amount of resources equivalent to the value of benefits received by
3 the individual under such policy or certificate, as determined under the
4 rules of the partnership for long-term care program[, and]; (ii) without
5 regard to the recovery of medical assistance from the estates of indi-
6 viduals and the imposition of liens on the homes of persons pursuant to
7 section three hundred sixty-nine of this title, with respect to
8 resources exempt from consideration pursuant to subparagraph (i) of this
9 paragraph; provided, however, that nothing [herein] in this section
10 shall prevent the imposition of a lien or recovery against property of
11 an individual on account of medical assistance incorrectly paid; and
12 (iii) based on an income eligibility standard for married couples equal
13 to the amount of the minimum monthly maintenance needs allowance defined
14 in paragraph (h) of subdivision two of section three hundred sixty-six-c
15 of this title, and for single individuals equal to one-half of such
16 amount; provided, however, that the commissioner of health shall not be
17 required to implement the provisions of this subparagraph if the use of
18 such income eligibility standards will result in a loss of federal
19 financial participation in the costs of Medicaid extended coverage
20 furnished in accordance with subparagraphs (i) and (ii) of this para-
21 graph.
22 § 38. Subdivision 1 and the opening paragraph of subdivision 2 of
23 section 365-f of the social services law, subdivision 1 as added by
24 chapter 81 of the laws of 1995, the opening paragraph of subdivision 2
25 as amended by chapter 474 of the laws of 1996, are amended to read as
26 follows:
27 1. Purpose and intent. The consumer directed personal assistance
28 program is intended to permit chronically ill and/or physically disabled
29 individuals receiving home care services under the medical assistance
30 program greater flexibility and freedom of choice in obtaining such
31 services. The department shall[, upon request of a social services
32 district or group of districts,] regularly monitor district partic-
33 ipation in the program by reviewing the implementation plans submitted
34 pursuant to this section. The department shall provide guidance to the
35 districts to improve compliance with implementation plans and promote
36 consistency among counties regarding approved service levels based on
37 the assessments required by this section. In addition, the department
38 shall provide technical assistance and such other assistance as may be
39 necessary to assist such districts in assuring access to the program for
40 eligible individuals.
41 All eligible individuals receiving home care shall be provided notice
42 of the availability of the program, and no less frequently than annually
43 thereafter, and shall have the opportunity to apply for participation in
44 the program. [On or before October first, nineteen hundred ninety-six
45 each] Each social services district shall file an implementation plan
46 with the commissioner of the department of health, which shall be
47 updated annually. Such updates shall be submitted no later than November
48 thirtieth of each year. Beginning on June thirtieth, two thousand nine,
49 the plans and updates submitted by districts shall require the approval
50 of the department. Implementation plans shall include district enroll-
51 ment targets, describe methods for the provision of notice and assist-
52 ance to interested individuals eligible for enrollment in the program,
53 and shall contain such other information as shall be required by the
54 department. An "eligible individual", for purposes of this section is a
55 person who:
S. 58--B 128 A. 158--B
1 § 39. Section 2807-x of the public health law, as added by section 6
2 of part D of chapter 58 of the laws of 2004, the opening paragraph of
3 subdivision 1 as amended by chapter 745 of the laws of 2004, is amended
4 to read as follows:
5 § 2807-x. Grants for long term care demonstration projects. 1. The
6 commissioner shall establish [two] three demonstration projects to
7 develop, evaluate and implement programs to test new models for the
8 organization and delivery of long term care services to encourage commu-
9 nity based programs and smaller residential health care models in order
10 to promote consumer choice, improve the efficiency and appropriateness
11 of the use of state and federal resources and ensure the recruitment,
12 retention and training of health care staff to adequately meet the needs
13 of a community and residential long term care system. Notwithstanding
14 the provisions of section one hundred twelve of the state finance law or
15 any other inconsistent provision of the state finance law or any other
16 law, funds available for distribution pursuant to this section may be
17 allocated and distributed by the commissioner without a competitive bid
18 or request for proposal process.
19 (a) The following factors shall be considered in approving each demon-
20 stration project respectively:
21 (i) Residential health care demonstration project. (A) the extent to
22 which there is a reduction in the need for skilled nursing beds for a
23 facility that is eligible to replace its existing skilled nursing facil-
24 ity; (B) the potential to design and develop more appropriate smaller
25 residential health care facilities as an alternative to replacing an
26 existing skilled nursing facility; (C) the extent to which the quality,
27 efficiency and continuity of care will be promoted and provided for by
28 the development of integrated long-term care services in the community;
29 (D) the extent to which the project will provide training to health care
30 workers to appropriately staff new community based models of long term
31 care; (E) demonstrate the involvement and support of workforce in the
32 program redesign; (F) the development of a new long-term care reimburse-
33 ment methodology that encourages care in the least restrictive setting
34 and adequately reflects the resources needed to serve consumers in each
35 level of long term care; (G) and the incorporation of a research compo-
36 nent designed to evaluate the project.
37 (ii) Community based care demonstration project. (A) the extent to
38 which there is a reduction in the need for skilled nursing facility beds
39 on a countywide basis; (B) the development of a new system to inform
40 recently admitted residents of skilled nursing facilities of the avail-
41 ability of community long-term care options; (C) the extent to which the
42 discharge planning program from skilled nursing facilities will inform,
43 assist and maximize freedom of choice to consumers who choose to move
44 back to the community; (D) the extent to which the project will develop
45 community based long term care services, including funding for the
46 recruitment and retention of direct care health care workers necessary
47 to increase community based services; (E) the extent to which the
48 project will provide training to health care staff; and (F) the incorpo-
49 ration of a research component designed to evaluate the projects.
50 (iii) Managed long term care project. (A) the extent to which a
51 current operator of skilled nursing facilities possesses the necessary
52 authorizations through a related entity to assume risk and receive capi-
53 tated payments, pursuant to titles 18 and 19 of the federal social secu-
54 rity act, for the purpose of providing and arranging for the care of
55 individuals eligible for admission to a skilled nursing facility, (B)
56 the extent to which such services to individuals eligible for benefits
S. 58--B 129 A. 158--B
1 pursuant to both titles 18 and 19 of the federal social security act
2 will be provided through the capitated rate, (C) the extent to which the
3 quality, efficiency and continuity of care will be promoted and provided
4 for by the development of integrated long-term care services in the
5 community, (D) the extent to which the project sponsor will directly or
6 indirectly in association with a joint labor management program, provide
7 for training of health care workers to appropriately staff community
8 based models of long-term care; and (E) the incorporation of a research
9 component designed to evaluate the project, with specific reference to
10 the determination of cost savings to the state, the quality of and
11 satisfaction with services provided to consumers and their families and
12 the satisfaction of direct care workers, with a report of the project's
13 progress and findings submitted annually to the commissioner.
14 2. The commissioner is authorized to waive, modify or suspend the
15 respective provisions of rules and regulations promulgated pursuant to
16 this chapter if the commissioner determines that such waiver is neces-
17 sary or appropriate for the successful implementation of a demonstration
18 project and when the health, safety, and general welfare of persons
19 receiving services under such demonstration project will not be impaired
20 as a result of such waiver, modification or suspension, provided howev-
21 er, that for the managed long term care project pursuant to subparagraph
22 (iii) of paragraph (a) of subdivision one of this section, the method
23 for setting the capitated rate of payment under title 19 of the federal
24 social security act shall be consistent with the method used for all
25 managed long term care plans authorized under subdivision eight of
26 section forty-four hundred three-f of the public health law.
27 3. The commissioner is authorized to seek federal waivers pursuant to
28 titles XVIII and XIX of the federal social security act when such waiv-
29 ers are necessary to develop cost-effective long term care demonstration
30 projects.
31 § 40. Subdivision 6-a of section 93 of part C of chapter 58 of the
32 laws of 2007 amending the social services law and the public health law
33 relating to adjustments of rates, is amended to read as follows:
34 6-a. section fifty-seven of this act shall expire and be deemed
35 repealed on [March] December 31, [2010] 2013; provided that the amend-
36 ments made by such section to subdivision 4 of section 366-c of the
37 social services law shall apply with respect to determining initial and
38 continuing eligibility for medical assistance, including the continued
39 eligibility of recipients originally determined eligible prior to the
40 effective date of this act, and provided further that such amendments
41 shall not apply to any person [as to whom] or group of persons if it is
42 subsequently determined by the Centers for Medicare and Medicaid
43 services or by a court of competent jurisdiction that medical assistance
44 with federal financial participation is available for the costs of
45 services provided to such person or persons under the provisions of
46 subdivision 4 of section 366-c of the social services law in effect
47 immediately prior to the effective date of this act.
48 § 41. Subdivision (m-1) of section 79 of part C of chapter 58 of the
49 laws of 2008 amending the social services law and the public health law
50 relating to adjustments of rates, is amended to read as follows:
51 (m-1) the amendments made by section fifty-two of this act to subdivi-
52 sion 4 of section 366-c of the social services law shall [not] apply
53 with respect to determining initial and continuing eligibility for
54 medical assistance, including the continued eligibility of recipients
55 originally determined eligible prior to the effective date of this act;
56 and provided further that such amendments shall not apply to any person
S. 58--B 130 A. 158--B
1 [as to whom] or group of persons if it is subsequently determined by the
2 Centers of Medicare and Medicaid services or by a court competent juris-
3 diction that medical assistance with federal financial participation is
4 available for the costs of services provided to such person or persons
5 under the provisions of subdivision 4 of section 366-c of the social
6 services law in effect immediately prior to the effective date of this
7 act;
8 § 42. The closing paragraph of subdivision 4 of section 366-c of the
9 social services law, as amended by section 52 of part C of chapter 58 of
10 the laws of 2008, is amended to read as follows:
11 provided, however, that, to the extent required by federal law, the
12 terms of this subdivision shall not apply to persons who are receiving
13 care, services and supplies pursuant to the following waivers under
14 section 1915(c) of the federal social security act: the nursing facility
15 transition and diversion waiver authorized pursuant to subdivision six-a
16 of section three hundred sixty-six of this title; [and] the traumatic
17 brain injury waiver authorized pursuant to section twenty-seven hundred
18 forty of the public health law, the long term home health care program
19 waiver authorized pursuant to section three hundred sixty-seven-c of
20 this title, and the home and community based services waiver for persons
21 with developmental disabilities administered by the office of mental
22 retardation and developmental disabilities pursuant to an agreement with
23 the federal centers for medicare and Medicaid services.
24 § 43. Notwithstanding any inconsistent provisions of section 112 or
25 section 163 of the state finance law, section 2808-d of the public
26 health law, or any other provision of law or regulation to the contrary,
27 with regard to funds previously awarded by the commissioner of health
28 pursuant to section 2808-d of the public health law to residential
29 health care facilities that provide extensive nursing, medical, psycho-
30 logical and counseling support services to children and that have not
31 yet been spent, the commissioner of health may, with the agreement of
32 such facilities, authorize in writing the expenditure of such unspent
33 funds for the alternative purpose of improving the work environment of
34 such facilities, including through building improvement or replacement
35 facilities, in such manner as the commissioner of health deems appropri-
36 ate.
37 § 44. Notwithstanding any inconsistent provision of law, rule or
38 regulation, for purposes of implementing the provisions of the public
39 health law and the social services law, references to titles XIX and XXI
40 of the federal social security act in the public health law and the
41 social services law shall be deemed to include and also to mean any
42 successor titles thereto under the federal social security act.
43 § 45. Notwithstanding any inconsistent provision of law, rule or regu-
44 lation, the effectiveness of subdivisions 4, 7, 7-a and 7-b of section
45 2807 of the public health law and section 18 of chapter 2 of the laws of
46 1988, as they relate to time frames for notice, approval or certif-
47 ication of rates of payment, are hereby suspended and shall, for
48 purposes of implementing the provisions of this act, be deemed to have
49 been without any force or effect from and after November 1, 2007 for
50 such rates effective for the period January 1, 2008 through December 31,
51 2008.
52 § 46. Severability clause. If any clause, sentence, paragraph, subdi-
53 vision, section or part of this act shall be adjudged by any court of
54 competent jurisdiction to be invalid, such judgment shall not affect,
55 impair or invalidate the remainder thereof, but shall be confined in its
56 operation to the clause, sentence, paragraph, subdivision, section or
S. 58--B 131 A. 158--B
1 part thereof directly involved in the controversy in which such judgment
2 shall have been rendered. It is hereby declared to be the intent of the
3 legislature that this act would have been enacted even if such invalid
4 provisions had not been included herein.
5 § 47. This act shall take effect on April 1, 2009; provided, however,
6 that:
7 1. Intentionally omitted.
8 2. 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 3. this act shall not be construed to alter, change, affect, impair or
13 defeat any rights, obligations, duties or interests accrued, incurred or
14 conferred prior to the effective date of this act;
15 4. the commissioner of health and the superintendent of insurance and
16 any appropriate council may take any steps necessary to implement this
17 act prior to its effective date;
18 5. notwithstanding any inconsistent provision of the state administra-
19 tive 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 6. the provisions of this act shall become effective notwithstanding
25 the failure of the commissioner of health or the superintendent of
26 insurance or any council to adopt or amend or promulgate regulations
27 implementing this act;
28 7. Intentionally omitted.
29 8. Intentionally omitted.
30 9. the amendments to subdivision 5 of section 3614 of the public
31 health law made by sections twenty-three and twenty-four of this act
32 shall not affect the expiration of such subdivision and shall expire
33 therewith;
34 10. Intentionally omitted.
35 11. Intentionally omitted.
36 12. the amendments to the closing paragraph of subdivision 4 of
37 section 366-c of the social services law made by section forty-two of
38 this act shall not affect the expiration of such subdivision and shall
39 be deemed expired therewith; provided, further, that the amendments to
40 the closing paragraph of subdivision 4 of section 366-c of the social
41 services law made by section forty-two of this act shall apply with
42 respect to determining initial and continuing eligibility for medical
43 assistance, including the continued eligibility of recipients originally
44 determined eligible prior to the effective date of this act; and
45 provided further that such changes shall not apply to any person or
46 group of persons if it is subsequently determined by the Centers for
47 Medicare and Medicaid services or a court of competent jurisdiction that
48 medical assistance with federal financial participation is available for
49 the cost of services provided to such person or persons under the
50 provisions of subdivision 4 of section 366-c of the social services law
51 in effect immediately prior to the effective date of this act.
52 PART E
53 Intentionally omitted.
S. 58--B 132 A. 158--B
1 PART F
2 Section 1. (a) Notwithstanding the provisions of subdivision (e) of
3 section 7.17 or section 41.55 of the mental hygiene law, or any other
4 law to the contrary, the office of mental health is authorized in state
5 fiscal year 2009-10 to reduce inpatient capacity in the aggregate by no
6 more than 450 beds, through closure of wards not to exceed 150 beds, or
7 through conversion of such beds to transitional placement programs,
8 provided, however, that nothing in this section shall be interpreted as
9 restricting the ability of the office of mental health to reduce inpa-
10 tient bed capacity beyond 450 beds in state fiscal year 2009-10, but
11 such reductions shall be subject to the provisions of subdivision (e) of
12 section 7.17 and section 41.55 of the mental hygiene law. Determinations
13 concerning the closure of such wards in fiscal year 2009-10 shall be
14 made by the office of mental health based on data related to inpatient
15 census, indicating nonutilization or under utilization of beds, and the
16 efficient operation of facilities. Determinations concerning the conver-
17 sion of such wards to transitional placement programs in fiscal year
18 2009-10 shall be made by the office of mental health based upon the
19 identification of patients who have received inpatient care and who are
20 clinically determined to be appropriate for a less restrictive level of
21 mental health treatment. The office of mental health shall provide
22 notice to the legislature as soon as possible, but no later than two
23 weeks prior to the anticipated closure or conversion of wards pursuant
24 to this act.
25 (b) For the purposes of this act, the term "transitional placement
26 program" shall be defined to include, but not limited to, a supervised
27 residential program that provides outpatient services, treatment and
28 training, and which supports the transition of patients to more inte-
29 grated community settings.
30 § 2. This act shall take effect immediately and shall be deemed to
31 have been in full force and effect on and after April 1, 2009.
32 PART G
33 Intentionally omitted.
34 PART H
35 Section 1. Subdivision (k) of section 10.06 of the mental hygiene law,
36 as added by chapter 7 of the laws of 2007, is amended to read as
37 follows:
38 (k) At the conclusion of the hearing, the court shall determine wheth-
39 er there is probable cause to believe that the respondent is a sex
40 offender requiring civil management. If the court determines that proba-
41 ble cause has not been established, the court shall issue an order
42 dismissing the petition, and the respondent's release shall be in
43 accordance with other applicable provisions of law. If the court deter-
44 mines that probable cause has been established: (i) the court shall
45 order that the respondent be committed to a secure treatment facility
46 designated by the commissioner for care, treatment and control upon his
47 or her release, provided, however, that a respondent who otherwise would
48 be required to be transferred to a secure treatment facility may, upon a
49 written consent signed by the respondent and his or her counsel, consent
50 to remain in the custody of the department of correctional services
51 pending the outcome of the proceedings under this article, and that such
S. 58--B 133 A. 158--B
1 consent may be revoked in writing at any time; (ii) the court shall set
2 a date for trial in accordance with subdivision (a) of section 10.07 of
3 this article; and (iii) the respondent shall not be released pending the
4 completion of such trial.
5 § 2. This act shall take effect immediately and shall be deemed to
6 have been in full force and effect on and after April 1, 2009.
7 PART I
8 Intentionally omitted.
9 PART J
10 Section 1. Subdivision (b) of section 13.17 of the mental hygiene law,
11 as amended by section 1 of part N of chapter 57 of the laws of 2000, is
12 amended to read as follows:
13 (b) There shall be in the office the developmental disabilities
14 services offices named below serving the areas either currently or
15 previously served by a school, for the care and treatment of the mental-
16 ly retarded and developmentally disabled and for research and teaching
17 in the science and skills required for the care and treatment of such
18 mentally retarded and developmentally disabled:
19 Bernard M. Fineson Developmental Disabilities Services Office
20 Brooklyn Developmental Disabilities Services Office
21 Broome Developmental Disabilities Services Office
22 Capital District Developmental Disabilities Services Office
23 Central New York Developmental Disabilities Services Office
24 Finger Lakes Developmental Disabilities Services Office
25 Institute for Basic Research in Developmental Disabilities
26 Hudson Valley Developmental Disabilities Services Office
27 Metro New York Developmental Disabilities Services Office
28 Long Island Developmental Disabilities Services Office
29 Sunmount Developmental Disabilities Services Office
30 Taconic Developmental Disabilities Services Office
31 Western New York Developmental Disabilities Services Office
32 Staten Island Developmental Disabilities Services Office
33 [Valley Ridge Center for Intensive Treatment]
34 The New York State Institute for Basic Research in Developmental Disa-
35 bilities is designated as an institute for the conduct of medical
36 research and other scientific investigation directed towards furthering
37 knowledge of the etiology, diagnosis, treatment and prevention of mental
38 retardation and developmental disabilities.
39 § 2. Notwithstanding any other provision of law to the contrary, the
40 commissioner of the office of mental retardation and developmental disa-
41 bilities is authorized to consolidate the Valley Ridge Center for Inten-
42 sive Treatment and the Broome Developmental Disabilities Services Office
43 for the purposes of administrative efficiencies, provided, however, that
44 the state shall continue to operate an intensive treatment facility at
45 the Valley Ridge site. The consolidated entity shall be known as the
46 Broome Developmental Disabilities Services Office.
47 § 3. This act shall take effect immediately and shall be deemed to
48 have been in full force and effect on and after April 1, 2009.
49 PART K
S. 58--B 134 A. 158--B
1 Section 1. Subdivision (f) of section 19.17 of the mental hygiene law,
2 as amended by section 3 of part E of chapter 405 of the laws of 1999, is
3 amended to read as follows:
4 (f) There shall be in the office the facilities named below for the
5 care, treatment and rehabilitation of the mentally disabled and for
6 clinical research and teaching in the science and skills required for
7 the care, treatment and rehabilitation of such mentally disabled.
8 R.E. Blaisdell Addiction Treatment Center
9 Bronx Addiction Treatment Center
10 C.K. Post Addiction Treatment Center
11 Creedmoor Addiction Treatment Center
12 Dick Van Dyke Addiction Treatment Center
13 Kingsboro Addiction Treatment Center
14 [Manhattan Addiction Treatment Center]
15 McPike Addiction Treatment Center
16 Richard C. Ward Addiction Treatment Center
17 J.L. Norris Addiction Treatment Center
18 South Beach Addiction Treatment Center
19 St. Lawrence Addiction Treatment Center
20 Stutzman Addiction Treatment Center
21 § 2. This act shall take effect immediately and shall be deemed to
22 have been in full force and effect on and after April 1, 2009.
23 PART L
24 Section 1. Subdivision 3-b of section 1 of part C of chapter 57 of the
25 laws of 2006, establishing a cost of living adjustment for designated
26 human services programs, as added by section 2 of part I of chapter 58
27 of the laws of 2008, is amended and a new subdivision 3-b is added to
28 read as follows:
29 3-b. Notwithstanding any inconsistent provision of law, beginning
30 April 1, 2009 and ending March 31, 2010, the commissioners shall not
31 include a COLA for the purpose of establishing rates of payments,
32 contracts or any other form of reimbursement.
33 [3-b] 3-c. Notwithstanding any inconsistent provision of law, begin-
34 ning April 1, [2009] 2010 and ending March 31, [2012] 2013, the commis-
35 sioners shall develop the COLA under this section using the actual U.S.
36 consumer price index for all urban consumers (CPI-U) published by the
37 United States department of labor, bureau of labor statistics for the
38 twelve month period ending in July of the budget year prior to such
39 state fiscal year, for the purpose of establishing rates of payments,
40 contracts or any other form of reimbursement.
41 § 2. This act shall take effect immediately and shall be deemed to
42 have been in full force and effect on and after April 1, 2009; provided,
43 however, that the amendments to section 1 of part C of chapter 57 of the
44 laws of 2006, made by section one of this act shall not affect the
45 repeal of such section and shall be deemed repealed therewith.
46 PART M
47 Intentionally omitted.
48 PART N
49 Section 1. Section 3 of chapter 119 of the laws of 1997 authorizing
50 the department of health to establish certain payments to general hospi-
S. 58--B 135 A. 158--B
1 tals, as amended by section 1 of part H of chapter 57 of the laws of
2 2006, is amended to read as follows:
3 § 3. This act shall take effect immediately and shall be deemed to
4 have been in full force and effect on and after April 1, 1997. This act
5 shall expire April 1, [2009] 2012.
6 § 2. This act shall take effect immediately and shall be deemed to
7 have been in full force and effect on and after April 1, 2009.
8 PART O
9 Section 1. The commissioner of mental health and the city of New York
10 are hereby authorized to extend, for a period not exceeding fifty years,
11 the lease of certain portions of Ward's Island authorized by chapter 2
12 of the laws of 1896, as amended by chapter 380 of the laws of 1900,
13 chapter 139 of the laws of 1908, chapter 696 of the laws of 1913, chap-
14 ter 101 of the laws of 1952, chapter 491 of the laws of 1952, and chap-
15 ter 524 of the laws of 1962 for the purposes of the Manhattan psychiat-
16 ric center, the Kirby forensic psychiatric center and the promotion of
17 the public health, welfare and safety.
18 § 2. Section 18-130 of the administrative code of the city of New York
19 is amended by adding a new subdivision g to read as follows:
20 g. Notwithstanding the provisions of subdivisions b, c, d, e, and f of
21 this section, in order that the state may reconstruct, modernize and
22 rebuild some or all of the buildings and facilities of the Manhattan
23 psychiatric center and the Kirby forensic psychiatric center on Ward's
24 Island, and continue to maintain said hospitals, so as to furnish modern
25 facilities for treatment and care of patients with mental illness of the
26 metropolitan district and to benefit the health, welfare and safety of
27 its residents, the city of New York is hereby authorized to enter into
28 an agreement for the renewal or further extension of the lease executed
29 between the city of New York and the state of New York pursuant to the
30 provisions of chapter one hundred one of the laws of nineteen hundred
31 fifty-two and chapter five hundred twenty-four of the laws of nineteen
32 hundred sixty-two, for a period not exceeding fifty years beyond its
33 present termination date with respect to any of the lands now occupied
34 by or used in connection with the Manhattan psychiatric center, the
35 Kirby forensic psychiatric center and related programs. Neither the
36 provisions of section one hundred ninety-seven-c of the New York city
37 charter, relating to a uniform land use review procedure, nor the
38 provisions of any other local law of like or similar import shall apply
39 to the renewal or extension of said lease.
40 § 3. This act shall take effect immediately and shall be deemed to
41 have been in full force and effect on and after April 1, 2009.
42 PART P
43 Intentionally omitted.
44 PART Q
45 Intentionally omitted.
46 PART R
S. 58--B 136 A. 158--B
1 Section 1. Paragraph (d) of subdivision 5 of section 366-a of the
2 social services law, as amended by section 49 of part C of chapter 58 of
3 the laws of 2008, is amended to read as follows:
4 (d) In order to establish place of residence and income eligibility
5 under this title at recertification, a recipient of assistance under
6 this title shall attest to place of residence and to all information
7 regarding the household's income that is necessary and sufficient to
8 determine such eligibility; provided, however, that this paragraph shall
9 not apply to persons described in subparagraph two of paragraph (a) of
10 subdivision one of section three hundred sixty-six of this title, or to
11 persons receiving long term care services, as defined in paragraph (b)
12 of subdivision two of this section; and provided, further, that a non-
13 applying legally responsible relative recertifying on behalf of a recip-
14 ient of assistance who is under the age of twenty-one years shall be
15 permitted to attest to household income under this paragraph only if the
16 social security numbers of all legally responsible relatives are
17 provided to the district. Provided, however, for purposes of recertif-
18 ication for assistance under this title for a recipient of medicaid
19 waiver services provided or authorized by the office of mental retarda-
20 tion and developmental disabilities, beginning on or after January
21 first, two thousand ten, such recipient may be permitted, as determined
22 by the commissioner of health, to attest to place of residence and to
23 all information regarding the household's income and/or resources that
24 are necessary to determine such eligibility.
25 § 2. This act shall take effect immediately, and be deemed to have
26 been in full force and effect on and after April 1, 2009.
27 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
28 sion, section or part of this act shall be adjudged by any court of
29 competent jurisdiction to be invalid, such judgment shall not affect,
30 impair, or invalidate the remainder thereof, but shall be confined in
31 its operation to the clause, sentence, paragraph, subdivision, section
32 or part thereof directly involved in the controversy in which such judg-
33 ment shall have been rendered. It is hereby declared to be the intent of
34 the legislature that this act would have been enacted even if such
35 invalid provisions had not been included herein.
36 § 3. This act shall take effect immediately provided, however, that
37 the applicable effective date of Parts A through R of this act shall be
38 as specifically set forth in the last section of such Parts.
