A05062 Summary:

BILL NOA05062A
 
SAME ASSAME AS S03525-A
 
SPONSORGottfried
 
COSPNSRAbinanti, Barron, Benedetto, Bichotte, Blake, Bronson, Colton, Cook, Crespo, Cymbrowitz, Dinowitz, Englebright, Gantt, Hikind, Jaffee, Jean-Pierre, Joyner, Kavanagh, Kim, Lavine, Lifton, Linares, Lupardo, Mosley, Peoples-Stokes, Perry, Pichardo, Ramos, Rodriguez, Rosenthal, Russell, Schimel, Seawright, Sepulveda, Steck, Stirpe, Titone, Titus, Walker, Weinstein, Weprin, Dilan, Gjonaj, Richardson, Moya, Simotas, Hunter, Miller, Hyndman, Rivera
 
MLTSPNSRAbbate, Arroyo, Aubry, Brennan, Cahill, Davila, Fahy, Farrell, Glick, Gunther, Hooper, Lentol, Magee, Magnarelli, Markey, Mayer, McDonald, O'Donnell, Ortiz, Paulin, Pretlow, Quart, Robinson, Rozic, Simon, Skartados, Solages, Thiele, Wright
 
Ren Art 50 5000 - 5003 to be Art 80 8000 - 8003, add Art 51 5100 - 5111, Art 49 Title 3 4920 - 4927, amd 270, Pub Health L; add 89-i, St Fin L
 
Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
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A05062 Actions:

BILL NOA05062A
 
02/11/2015referred to health
02/26/2015reported referred to codes
05/19/2015reported referred to ways and means
05/19/2015reported
05/21/2015advanced to third reading cal.415
05/27/2015passed assembly
05/27/2015delivered to senate
05/27/2015REFERRED TO HEALTH
01/06/2016DIED IN SENATE
01/06/2016RETURNED TO ASSEMBLY
01/06/2016ordered to third reading cal.199
01/20/2016committed to health
04/29/2016amend and recommit to health
04/29/2016print number 5062a
05/10/2016reported referred to codes
05/17/2016reported referred to ways and means
05/24/2016reported
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A05062 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A5062A
 
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the public health law and the state finance law, in relation to enacting the "New York health act" and to establishing New York Health   PURPOSE OR GENERAL IDEA OF BILL: This bill would create a universal single payer health plan -New York Health - to provide comprehensive health coverage for all New Yorkers.   SUMMARY OF SPECIFIC PROVISIONS: Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Cover- age would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc. - all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, and others added by the plan. Everyone would choose a primary care practitioner or other provider to provide care coordination - helping to get the care and follow-up the patient needs, referrals, and navigating the system. But there would be no "gatekeeper" obstacles to care. As with most health coverage, New York Health covers health care services when a member is out of state, either because health care is needed while the member is traveling or because there is a clinical reason for going to a particular out-of-state provider. A broadly representative Board of Trustees will advise the Commissioner of Health. Long-term care coverage is not included at the start, but the bill requires that the Board develop a plan for it within five years of passage. The Board shall also develop proposals relating to retiree health benefits and coverage of health care services covered under the workers' compensation law. In addition to the Board, there will be six regional advisory councils to represent the diverse needs and concerns of the region. The councils shall include but not be limited to representatives of health care consumers, providers, municipal and county government, and organized labor. The councils shall advise the Board, Commissioner, Governor, and Legislature on matters relating to the NY Health program and shall adopt community health improvement plans to promote health care access and quality in their regions. Health care providers, including those providing care coordination, would be paid in full by New York Health, with no co-pays or other charges to patients. The plan would develop alternative payment methods to replace old-style fee-for-service (which rewards volume but not qual- ity), and would negotiate rates with health care provider organizations. (Fee-for-service would continue until new methods are phased in.) The bill would authorize health care providers to form organizations to collectively negotiate with New York Health. Health care would no longer be paid for by insurance companies charging a regressive "tax" - insurance premiums, deductibles and co-pays - imposed regardless of ability to pay. Instead, New York Health would be paid for based on ability to pay, through a progressively-graduated payroll-based premium (paid at least 80% by employers and not more than 20% by employees, and 100% by self-employed) and a progressively-gradu- ated premium based on other taxable income, such as capital gains, interest and dividends. A specific revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor. Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The "local share" of Medicaid funding - a major burden on local property taxes - would be ended. Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. (Existing retiree coverage could be phased out and replaced with New York Health.)   JUSTIFICATION: The state constitution states: "The protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefor shall be made by the state and by such of its subdi- visions and in such manner, and by such means as the legislature shall from time to time determine." (Article XVII, § 3.) All residents of the state have the right to health care. New Yorkers - as individuals, employers, and taxpayers - have experi- enced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured. Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated. Individuals often find that they are deprived of affordable care and choice because of deci- sions by health plans guided by the plan's economic needs rather than their health care needs. To address the fiscal crisis facing the health care system and the state and to assure New Yorkers can exercise their right to health care, this legislation would establish a comprehensive universal single-payer health care coverage program, funded by broad-based revenue based on ability to pay, for the benefit of all residents of the state of New York. The state will work to obtain waivers relating to Medicaid, Family Health Plus, Child Health Plus, Medicare, the Patient Protection and Affordable Care Act, and any other appropriate federal programs, under which federal funds and other subsidies that would otherwise be paid to New York State will be paid by the federal government to New York State and deposited in the New York Health trust fund. Under such a waiver, health coverage under those programs will be replaced and merged into New York Health, which will operate as a true single-payer program. If such a waiver is not obtained, the state shall use state plan amendments and seek waivers to maximize, and make as seamless as possible, the use of federally-matched health programs and federal health programs in New York Health, The goal of this legislation is that coverage be delivered by New York Health and, as much as possible, the multiple sources of funding will be pooled with other New York Health funds and not be apparent to New York Health members or participating providers. This program will promote movement away from fee-for-service payment, which tends to reward quantity and requires excessive administrative expense, and towards alternate payment methodologies, such as global or capitated payments to providers or health care organizations, that promote quali- ty, efficiency, investment in primary and preventive care, and inno- vation and integration in the organizing of health care. This act does not create any employment benefit, nor does it require, prohibit, or limit the providing of any employment benefit. In order to promote improved quality of, and access to, health care services and promote improved clinical outcomes, it is the policy of the state to encourage cooperative, collaborative and integrative arrangements among health care providers who might otherwise be competitors, under the active supervision of the commissioner. It is the intent of the state to supplant competition with such arrangements and regulation only to the extent necessary to accomplish the purposes of this act, and to provide state action immunity under the state and federal antitrust laws to health care providers, particularly with respect to their relations with the single-payer New York Health plan created by this act.   PRIOR LEGISLATIVE HISTORY: 1992: A.8912-A passed Assembly 1993: A.5900 reported to Ways and Means 1994: A.5900 referred to Health Committee 1995-96: A.6801 reported to Ways and Means 1997-98: A.6172 reported to Ways and Means 1999-00: A.3571 reported to Ways and Means 2001-02: A.6779 reported to Ways and Means 2003-04: A.6952 reported to Ways and Means 2005: A.6576 reported to Ways and Means 2006: A.6576 referred to Health Committee 2007-08: A.7354 - reported to Ways and Means 2009-10: A.2356- referred to Health Committee 2011-12: A.7860-A - referred to Ways and Means 2013: A5389 referred to Health Committee 2014: A5389 - reported to Ways and Means 2015: A5062 - Passed Assembly   FISCAL IMPLICATIONS: Full funding for New York Health would come from the revenue measures to be proposed by the Governor under guidelines in the bill, plus available federal funds. The revenue package would also replace: local share of Medicaid, the state share of Medicaid, state and local payments for public employee health coverage, and various other health care spending. Numerous analyses document that a single-payer system would be most effective for reducing and controlling costs, for taxpayers, employers and individuals.   EFFECTIVE DATE: Immediately. The program will actually begin functioning when the Commissioner of Health declares the beginning of the implementation period.
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A05062 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         5062--A
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 11, 2015
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, ABINANTI, BARRON, BENEDETTO, BICHOTTE,
          BLAKE,  BRONSON,  COLTON,  COOK,  CRESPO, CYMBROWITZ, DINOWITZ, ENGLE-
          BRIGHT, GANTT, HIKIND, JAFFEE,  JEAN-PIERRE,  JOYNER,  KAVANAGH,  KIM,
          LAVINE,  LIFTON,  LINARES,  LUPARDO,  MOSLEY,  PEOPLES-STOKES,  PERRY,
          PICHARDO, RAMOS, RODRIGUEZ, ROSENTHAL,  RUSSELL,  SCHIMEL,  SEAWRIGHT,
          SEPULVEDA,  STECK,  STIRPE,  TITONE, TITUS, WALKER, WEINSTEIN, WEPRIN,
          DILAN, GJONAJ, RICHARDSON, MOYA,  SIMOTAS,  HUNTER,  MILLER,  HYNDMAN,
          RIVERA  -- Multi-Sponsored by -- M. of A. ABBATE, ARROYO, AUBRY, BREN-
          NAN, CAHILL, DAVILA, FAHY, FARRELL, GLICK,  GUNTHER,  HOOPER,  LENTOL,
          MAGEE,  MAGNARELLI, MARKEY, MAYER, McDONALD, O'DONNELL, ORTIZ, PAULIN,
          PRETLOW, QUART, ROBINSON, ROZIC, SIMON,  SKARTADOS,  SOLAGES,  THIELE,
          WRIGHT -- read once and referred to the Committee on Health -- ordered
          to  a  third  reading  --  recommitted  to  the Committee on Health in
          accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee
 
        AN ACT to amend the public health law and  the  state  finance  law,  in
          relation to enacting the "New York health act" and to establishing New
          York Health
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Short title. This act shall be known and may  be  cited  as
     2  the "New York health act".
     3    §  2.  Legislative  findings  and  intent.  1.  The state constitution
     4  states: "The protection and promotion of the health of  the  inhabitants
     5  of  the state are matters of public concern and provision therefor shall
     6  be made by the state and by such of its subdivisions and in such manner,
     7  and by such means as the legislature shall from time to time determine."
     8  (Article XVII, §3.) The legislature finds and declares  that  all  resi-
     9  dents  of  the  state  have the right to health care.  While the federal
    10  Affordable Care Act brought many improvements in health care and  health

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07764-05-6

        A. 5062--A                          2
 
     1  coverage,  it  still  leaves  many  New Yorkers without coverage or with
     2  inadequate coverage.  New  Yorkers  -  as  individuals,  employers,  and
     3  taxpayers  -  have  experienced  a  rise  in the cost of health care and
     4  coverage  in  recent  years,  including rising premiums, deductibles and
     5  co-pays, restricted provider networks and high  out-of-network  charges.
     6  Businesses  have  also experienced increases in the costs of health care
     7  benefits for their employees, and many employers are shifting  a  larger
     8  share  of  the  cost of coverage to their employees or dropping coverage
     9  entirely.  Health care providers are also affected by inadequate  health
    10  coverage  in  New  York  state.  A large portion of voluntary and public
    11  hospitals, health centers and other providers now experience substantial
    12  losses due to the provision of care that is  uncompensated.  Individuals
    13  often  find that they are deprived of affordable care and choice because
    14  of decisions by health plans guided by the plan's economic needs  rather
    15  than  their  health  care needs. To address the fiscal crisis facing the
    16  health care system and the state and to assure New Yorkers can  exercise
    17  their right to health care, affordable and comprehensive health coverage
    18  must  be  provided.  Pursuant  to the state constitution's charge to the
    19  legislature to provide for the health of New Yorkers,  this  legislation
    20  is  an  enactment  of  state  concern  for the purpose of establishing a
    21  comprehensive universal single-payer health care coverage program and  a
    22  health  care cost control system for the benefit of all residents of the
    23  state of New York.
    24    2. It is the intent of the Legislature to create the New  York  Health
    25  program  to provide a universal health plan for every New Yorker, funded
    26  by broad-based revenue based on ability to pay.  The state shall work to
    27  obtain waivers and other approvals relating to  Medicaid,  Child  Health
    28  Plus,  Medicare,  the  Affordable  Care  Act,  and any other appropriate
    29  federal programs, under which federal funds  and  other  subsidies  that
    30  would  otherwise be paid to New York State, New Yorkers, and health care
    31  providers for health coverage that will be equaled or  exceeded  by  New
    32  York Health will be paid by the federal government to New York State and
    33  deposited  in  the  New  York  Health  trust fund, and for other program
    34  modifications (including  elimination  of  cost  sharing  and  insurance
    35  premiums).    Under  such  waivers  and approvals, health coverage under
    36  those programs will be replaced and merged into New York  Health,  which
    37  will operate as a true single-payer program.
    38    If  any  necessary waiver or approval is not obtained, the state shall
    39  use state plan amendments and seek waivers and  approvals  to  maximize,
    40  and  make  as  seamless as possible, the use of federally-matched health
    41  programs and federal health programs in New York  Health.    Thus,  even
    42  where  other  programs  such  as  Medicaid or Medicare may contribute to
    43  paying for care, it is the goal of this legislation  that  the  coverage
    44  will  be  delivered  by  New  York  Health and, as much as possible, the
    45  multiple sources of funding will be pooled with other  New  York  Health
    46  funds  and  not  be apparent to New York Health members or participating
    47  providers.  This program will promote movement away from fee-for-service
    48  payment, which tends to reward quantity and requires excessive  adminis-
    49  trative  expense,  and  towards alternate payment methodologies, such as
    50  global or capitated payments to providers or health care  organizations,
    51  that  promote  quality, efficiency, investment in primary and preventive
    52  care, and innovation and integration in the organizing of health care.
    53    3. This act does not  create  any  employment  benefit,  nor  does  it
    54  require, prohibit, or limit the providing of any employment benefit.
    55    4. In order to promote improved quality of, and access to, health care
    56  services and promote improved clinical outcomes, it is the policy of the

        A. 5062--A                          3

     1  state  to  encourage cooperative, collaborative and integrative arrange-
     2  ments among health care providers who might  otherwise  be  competitors,
     3  under  the  active  supervision of the commissioner of health. It is the
     4  intent  of  the state to supplant competition with such arrangements and
     5  regulation only to the extent necessary to accomplish  the  purposes  of
     6  this  act,  and  to  provide  state  action immunity under the state and
     7  federal antitrust laws  to  health  care  providers,  particularly  with
     8  respect  to  their  relations with the single-payer New York Health plan
     9  created by this act.
    10    § 3. Article 50 and sections 5000, 5001, 5002 and 5003 of  the  public
    11  health  law  are renumbered article 80 and sections 8000, 8001, 8002 and
    12  8003, respectively, and a new article 51 is added to read as follows:
    13                                  ARTICLE 51
    14                               NEW YORK HEALTH
    15  Section 5100. Definitions.
    16          5101. Program created.
    17          5102. Board of trustees.
    18          5103. Eligibility and enrollment.
    19          5104. Benefits.
    20          5105. Health care providers; care coordination; payment  method-
    21                  ologies.
    22          5106. Health care organizations.
    23          5107. Program standards.
    24          5108. Regulations.
    25          5109. Provisions relating to federal health programs.
    26          5110. Additional provisions.
    27          5111. Regional advisory councils.
    28    §  5100.  Definitions.  As  used  in this article, the following terms
    29  shall have the following meanings, unless the context  clearly  requires
    30  otherwise:
    31    1.  "Board" means the board of trustees of the New York Health program
    32  created by section fifty-one hundred two of this article, and  "trustee"
    33  means a trustee of the board.
    34    2.  "Care  coordination" means services provided by a care coordinator
    35  under subdivision two of section fifty-one hundred five of this article.
    36    3. "Care coordinator"  means  an  individual  or  entity  approved  to
    37  provide  care  coordination  under  subdivision two of section fifty-one
    38  hundred five of this article.
    39    4. "Federally-matched public health program" means the medical assist-
    40  ance program under title eleven of article five of the  social  services
    41  law,  the basic health program under section three hundred sixty-nine-gg
    42  of the social services law, and the  child  health  plus  program  under
    43  title one-A of article twenty-five of this chapter.
    44    5.  "Health care organization" means an entity that is approved by the
    45  commissioner under section fifty-one hundred  six  of  this  article  to
    46  provide health care services to members under the program.
    47    6. "Health care service" means any health care service, including care
    48  coordination, included as a benefit under the program.
    49    7. "Implementation period" means the period under subdivision three of
    50  section  fifty-one  hundred one of this article during which the program
    51  will be subject to special eligibility and financing provisions until it
    52  is fully implemented under that section.
    53    8. "Long term care" means long term care, treatment,  maintenance,  or
    54  services  not  covered under child health plus, as appropriate, with the
    55  exception of short term rehabilitation, as defined by the commissioner.

        A. 5062--A                          4
 
     1    9. "Medicaid" or "medical assistance" means title  eleven  of  article
     2  five  of  the  social  services  law and the program thereunder.  "Child
     3  health plus" means title one-A of article twenty-five  of  this  chapter
     4  and  the program thereunder. "Medicare" means title XVIII of the federal
     5  social security act and the programs thereunder.  "Basic health program"
     6  means section three hundred sixty-nine-gg of the social services law and
     7  the program thereunder.
     8    10. "Member" means an individual who is enrolled in the program.
     9    11.  "New York Health trust fund" means the New York Health trust fund
    10  established under section eighty-nine-i of the state finance law.
    11    12. "Out-of-state health care service" means  a  health  care  service
    12  provided  to a member while the member is out of the state and (a) it is
    13  medically necessary that the health care service be provided  while  the
    14  member is out of the state, or (b) it is clinically appropriate that the
    15  health  care  service  be  provided by a particular health care provider
    16  located out of the state rather than in the state.  However, any  health
    17  care  service  provided  to  a New York Health enrollee by a health care
    18  provider qualified under paragraph (a) of subdivision three  of  section
    19  fifty-one hundred five of this article that is located outside the state
    20  shall  not be considered an out-of-state service and shall be covered as
    21  otherwise provided in this article.
    22    13. "Participating provider" means any individual or entity that is  a
    23  health  care  provider  qualified  under  subdivision  three  of section
    24  fifty-one hundred  five  of  this  article  that  provides  health  care
    25  services to members under the program, or a health care organization.
    26    14.  "Affordable  care  act"  means the federal patient protection and
    27  affordable care act, public law 111-148, as amended by the  health  care
    28  and  education  reconciliation  act  of 2010, public law 111-152, and as
    29  otherwise amended and any regulations or guidance issued thereunder.
    30    15. "Person" means any individual or natural person,  trust,  partner-
    31  ship,  association,  unincorporated  association,  corporation, company,
    32  limited liability company, proprietorship, joint  venture,  firm,  joint
    33  stock association, department, agency, authority, or other legal entity,
    34  whether for-profit, not-for-profit or governmental.
    35    16.  "Program"  means  the  New York Health program created by section
    36  fifty-one hundred one of this article.
    37    17. "Prescription and non-prescription drugs" means prescription drugs
    38  as defined in section two hundred seventy of this chapter, and non-pres-
    39  cription smoking cessation products or devices.
    40    18. "Resident" means an individual whose primary place of abode is  in
    41  the  state,  without  regard  to the individual's immigration status, as
    42  determined according to regulations of the commissioner.
    43    § 5101. Program created. 1. The New  York  Health  program  is  hereby
    44  created  in  the department. The commissioner shall establish and imple-
    45  ment the program under this article. The program shall  provide  compre-
    46  hensive health coverage to every resident who enrolls in the program.
    47    2.  The  commissioner shall, to the maximum extent possible, organize,
    48  administer and market the program and services as a single program under
    49  the name "New York Health" or such other name as the commissioner  shall
    50  determine,  regardless  of under which law or source the definition of a
    51  benefit is found including (on a voluntary basis) retiree  health  bene-
    52  fits.    In  implementing this subdivision, the commissioner shall avoid
    53  jeopardizing federal financial participation in these programs and shall
    54  take care to promote public understanding  and  awareness  of  available
    55  benefits and programs.

        A. 5062--A                          5
 
     1    3. The commissioner shall determine when individuals may begin enroll-
     2  ing in the program. There shall be an implementation period, which shall
     3  begin  on  the  date that individuals may begin enrolling in the program
     4  and shall end as determined by the commissioner.
     5    4. An insurer authorized to provide coverage pursuant to the insurance
     6  law  or  a  health maintenance organization certified under this chapter
     7  may, if otherwise authorized, offer  benefits  that  do  not  cover  any
     8  service  for which coverage is offered to individuals under the program,
     9  but may not offer benefits that cover any service for which coverage  is
    10  offered  to  individuals under the program. Provided, however, that this
    11  subdivision shall not prohibit (a) the offering of any  benefits  to  or
    12  for  individuals, including their families, who are employed or self-em-
    13  ployed in the state but who are not residents of the state, or  (b)  the
    14  offering of benefits during the implementation period to individuals who
    15  enrolled or may enroll as members of the program, or (c) the offering of
    16  retiree health benefits.
    17    5.  A  college, university or other institution of higher education in
    18  the state may purchase coverage under the program for  any  student,  or
    19  student's dependent, who is not a resident of the state.
    20    6.  To  the  extent any provision of this chapter, the social services
    21  law or the insurance law:
    22    (a) is inconsistent with any provision of this article or the legisla-
    23  tive intent of the New York Health Act, this  article  shall  apply  and
    24  prevail, except where explicitly provided otherwise by this article; and
    25    (b) is consistent with the provisions of this article and the legisla-
    26  tive  intent of the New York Health Act, the provision of that law shall
    27  apply.
    28    § 5102. Board of trustees. 1. The New York Health board of trustees is
    29  hereby created in the department. The board of trustees  shall,  at  the
    30  request  of  the  commissioner,  consider  any  matter to effectuate the
    31  provisions and purposes of this article, and may advise the commissioner
    32  thereon; and it may, from time to time, submit to the  commissioner  any
    33  recommendations  to effectuate the provisions and purposes of this arti-
    34  cle. The commissioner may propose regulations  under  this  article  and
    35  amendments thereto for consideration by the board. The board of trustees
    36  shall  have  no executive, administrative or appointive duties except as
    37  otherwise provided by law. The board of trustees  shall  have  power  to
    38  establish,  and  from  time to time, amend regulations to effectuate the
    39  provisions and purposes of this article,  subject  to  approval  by  the
    40  commissioner.
    41    2. The board shall be composed of:
    42    (a)  the  commissioner,  the superintendent of financial services, and
    43  the director of the budget, or their designees, as ex officio members;
    44    (b) nineteen trustees appointed by the governor;
    45    (i) five of whom shall be  representatives  of  health  care  consumer
    46  advocacy  organizations which have a statewide or regional constituency,
    47  who have been involved in activities related  to  health  care  consumer
    48  advocacy, including issues of interest to low- and moderate-income indi-
    49  viduals;
    50    (ii)  two  of  whom shall be representatives of professional organiza-
    51  tions representing physicians;
    52    (iii) two of whom shall be representatives of  professional  organiza-
    53  tions  representing  licensed  or  registered  health care professionals
    54  other than physicians;
    55    (iv) three of whom shall be representatives of hospitals, one of  whom
    56  shall be a representative of public hospitals;

        A. 5062--A                          6

     1    (v) one of whom shall be representative of community health centers;
     2    (vi)  two  of  whom  shall be representatives of health care organiza-
     3  tions; and
     4    (vii) two of whom shall be representatives of organized labor;
     5    (viii) two of whom shall have demonstrated expertise  in  health  care
     6  finance;
     7    (c)  ten  trustees  appointed  by  the  governor;  four  of whom to be
     8  appointed on the recommendation of the speaker of the assembly; four  of
     9  whom to be appointed on the recommendation of the temporary president of
    10  the  senate;  one  of  whom to be appointed on the recommendation of the
    11  minority leader of the assembly; and one of whom to be appointed on  the
    12  recommendation of the minority leader of the senate.
    13    3.  After  the  end of the implementation period, no person shall be a
    14  trustee unless he or she is a member of the program, except the ex offi-
    15  cio trustees. Each trustee shall serve at the pleasure of the appointing
    16  officer, except the ex officio trustees.
    17    4. The chair of the board shall be appointed, and may  be  removed  as
    18  chair,  by the governor from among the trustees. The board shall meet at
    19  least four times each calendar year. Meetings shall  be  held  upon  the
    20  call  of  the  chair  and  as  provided  by the board. A majority of the
    21  appointed trustees shall be a quorum of the board, and  the  affirmative
    22  vote  of a majority of the trustees voting, but not less than ten, shall
    23  be necessary for any action to be taken by  the  board.  The  board  may
    24  establish an executive committee to exercise any powers or duties of the
    25  board as it may provide, and other committees to assist the board or the
    26  executive  committee.  The  chair of the board shall chair the executive
    27  committee and shall appoint the chair and members of all  other  commit-
    28  tees. The board of trustees may appoint one or more advisory committees.
    29  Members of advisory committees need not be members of the board of trus-
    30  tees.
    31    5.  Trustees  shall serve without compensation but shall be reimbursed
    32  for their necessary and actual expenses incurred while  engaged  in  the
    33  business of the board.
    34    6. Notwithstanding any provision of law to the contrary, no officer or
    35  employee of the state or any local government shall forfeit or be deemed
    36  to  have  forfeited his or her office or employment by reason of being a
    37  trustee.
    38    7. The board and its committees and advisory  committees  may  request
    39  and  receive  the  assistance  of  the department and any other state or
    40  local governmental entity in exercising its powers and duties.
    41    8. No later than two years after the effective date of this article:
    42    (a) The board shall develop a proposal, consistent with the principles
    43  of this article, for provision by the program of long-term  care  cover-
    44  age,  including the development of a proposal, consistent with the prin-
    45  ciples of this article, for its funding.   In developing  the  proposal,
    46  the  board  shall  consult  with an advisory committee, appointed by the
    47  chair of the board, including representatives of consumers and potential
    48  consumers of long-term care, providers of  long-term  care,  labor,  and
    49  other  interested  parties.  The board shall present its proposal to the
    50  governor and the legislature.
    51    (b) The board shall develop proposals for: (i)  incorporating  retiree
    52  health  benefits into New York Health; (ii) accommodating employer reti-
    53  ree health benefits for people who have been members of New York  Health
    54  but  live as retirees out of the state; and (iii) accommodating employer
    55  retiree health benefits for people who earned or accrued  such  benefits

        A. 5062--A                          7
 
     1  while  residing  in  the  state  prior to the implementation of New York
     2  Health and live as retirees out of the state.
     3    (c) The board shall develop a proposal for New York Health coverage of
     4  health  care  services  covered  under  the  workers'  compensation law,
     5  including whether and how to continue funding for those  services  under
     6  that  law  and  whether  and how to incorporate an element of experience
     7  rating.
     8    § 5103. Eligibility and enrollment. 1. Every  resident  of  the  state
     9  shall be eligible and entitled to enroll as a member under the program.
    10    2.  No member shall be required to pay any premium or other charge for
    11  enrolling in or being a member under the program.
    12    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
    13  coverage  to  every member, which shall include all health care services
    14  required to be covered under any of the  following,  without  regard  to
    15  whether  the  member  would  otherwise be eligible for or covered by the
    16  program or source referred to:
    17    (a) child health plus;
    18    (b) Medicaid;
    19    (c) Medicare;
    20    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
    21  forty-three of the insurance law;
    22    (e)  article  eleven of the civil service law, as of the date one year
    23  before the beginning of the implementation period;
    24    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
    25  section  fifty-one  hundred two of the insurance law, provided that this
    26  coverage shall not replace  coverage  under  article  fifty-one  of  the
    27  insurance law;
    28    (g)  any  additional health care service authorized to be added to the
    29  program's benefits by the program; and
    30    (h) provided that none of the above  shall  include  long  term  care,
    31  until  a  proposal  under  paragraph (a) of subdivision eight of section
    32  fifty-one hundred two of this article is enacted into law.
    33    2. No member shall be required to pay any premium, deductible, co-pay-
    34  ment or co-insurance under the program.
    35    3. The program shall provide for payment under the program  for  emer-
    36  gency and temporary health care services provided to members or individ-
    37  uals  entitled  to become members who have not had a reasonable opportu-
    38  nity to become a member or to enroll with a care coordinator.
    39    § 5105. Health care providers; care  coordination;  payment  methodol-
    40  ogies.   1. Choice of health care provider. (a) Any health care provider
    41  qualified to participate under this  section  may  provide  health  care
    42  services  under  the  program, provided that the health care provider is
    43  otherwise legally authorized to perform the health care service for  the
    44  individual and under the circumstances involved.
    45    (b)  A  member  may  choose  to receive health care services under the
    46  program from any participating provider, consistent with  provisions  of
    47  this  article  relating  to  care coordination and health care organiza-
    48  tions, the willingness or  availability  of  the  provider  (subject  to
    49  provisions  of  this article relating to discrimination), and the appro-
    50  priate clinically-relevant circumstances.
    51    2. Care coordination.
    52    (a) Care coordination shall include, but not be limited to,  managing,
    53  referring   to,  locating,  coordinating,  and  monitoring  health  care
    54  services for the member to assure that all  medically  necessary  health
    55  care  services  are  made  available  to and are effectively used by the
    56  member in a timely manner, consistent with patient autonomy. Care  coor-

        A. 5062--A                          8
 
     1  dination  is  not  a requirement for prior authorization for health care
     2  services and referral shall not be required for a member  to  receive  a
     3  health care service.
     4    (b) A care coordinator may be an individual or entity that is approved
     5  by the program that is:
     6    (i)  a  health care practitioner who is: (A) the member's primary care
     7  practitioner; (B) at the option of a female member, the member's provid-
     8  er of primary gynecological care; or (C) at the option of a  member  who
     9  has  a  chronic  condition  that  requires  specialty care, a specialist
    10  health care practitioner who regularly and continually  provides  treat-
    11  ment for that condition to the member;
    12    (ii)  an entity licensed under article twenty-eight of this chapter or
    13  certified under article thirty-six of this chapter, a managed long  term
    14  care  plan  under  section forty-four hundred three-f of this chapter or
    15  other program model under paragraph (b) of  subdivision  seven  of  such
    16  section, or, with respect to a member who receives chronic mental health
    17  care services, an entity licensed under article thirty-one of the mental
    18  hygiene law or other entity approved by the commissioner in consultation
    19  with the commissioner of mental health;
    20    (iii) a health care organization;
    21    (iv) a Taft-Hartley fund, with respect to its members and their family
    22  members;  provided that this provision shall not preclude a Taft-Hartley
    23  fund from becoming a care coordinator under  subparagraph  (v)  of  this
    24  paragraph  or a health care organization under section fifty-one hundred
    25  six of this article; or
    26    (v) any not-for-profit or governmental entity approved by the program.
    27    (c) Health care services provided to a member shall not be subject  to
    28  payment  under  the  program  unless  the member is enrolled with a care
    29  coordinator at the time the health  care  service  is  provided,  except
    30  where provided under subdivision three of section fifty-one hundred four
    31  of  this article. Every member shall enroll with a care coordinator that
    32  agrees to provide care coordination to the  member  prior  to  receiving
    33  health  care services to be paid for under the program. The member shall
    34  remain enrolled with that care  coordinator  until  the  member  becomes
    35  enrolled  with  a  different  care coordinator or ceases to be a member.
    36  Members have the right to change their  care  coordinator  on  terms  at
    37  least  as  permissive  as the provisions of section three hundred sixty-
    38  four-j of the social services law relating to an individual changing his
    39  or her primary care provider or managed care provider.
    40    (d) Care coordination shall be provided to the member by the  member's
    41  care coordinator.  A care coordinator may employ or utilize the services
    42  of  other  individuals  or  entities to assist in providing care coordi-
    43  nation for the member, consistent with regulations of the commissioner.
    44    (e) A health care organization may establish rules  relating  to  care
    45  coordination for members in the health care organization, different from
    46  this  subdivision  but  otherwise consistent with this article and other
    47  applicable laws. Nothing in this subdivision shall authorize  any  indi-
    48  vidual to engage in any act in violation of title eight of the education
    49  law.
    50    (f) The commissioner shall develop and implement procedures and stand-
    51  ards for an individual or entity to be approved to be a care coordinator
    52  in  the  program,  including but not limited to procedures and standards
    53  relating to the revocation,  suspension,  limitation,  or  annulment  of
    54  approval on a determination that the individual or entity is incompetent
    55  to  be  a care coordinator or has exhibited a course of conduct which is
    56  either inconsistent with program  standards  and  regulations  or  which

        A. 5062--A                          9
 
     1  exhibits  an unwillingness to meet such standards and regulations, or is
     2  a potential threat to the public health or safety. Such  procedures  and
     3  standards  shall  not  limit  approval  to  be a care coordinator in the
     4  program  for economic purposes and shall be consistent with good profes-
     5  sional practice. In developing the procedures and standards, the commis-
     6  sioner shall: (i) consider  existing  standards  developed  by  national
     7  accrediting  and  professional  organizations;  and  (ii)  consult  with
     8  national and local organizations working on care coordination or similar
     9  models, including health care  practitioners,  hospitals,  clinics,  and
    10  consumers  and  their  representatives. When developing and implementing
    11  standards of approval of care  coordinators  for  individuals  receiving
    12  chronic mental health care services, the commissioner shall consult with
    13  the  commissioner of mental health. An individual or entity may not be a
    14  care coordinator unless the services included in care  coordination  are
    15  within  the  individual's professional scope of practice or the entity's
    16  legal authority.
    17    (g) To maintain approval under the program, a care  coordinator  must:
    18  (i)  renew its status at a frequency determined by the commissioner; and
    19  (ii) provide data to the department as required by the  commissioner  to
    20  enable  the  commissioner to evaluate the impact of care coordinators on
    21  quality, outcomes and cost.
    22    3. Health care providers. (a) The  commissioner  shall  establish  and
    23  maintain procedures and standards for health care providers to be quali-
    24  fied  to participate in the program, including but not limited to proce-
    25  dures and standards relating to the revocation, suspension,  limitation,
    26  or annulment of qualification to participate on a determination that the
    27  health  care provider is an incompetent provider of specific health care
    28  services or has exhibited a course of conduct which is either inconsist-
    29  ent with program standards and regulations or which exhibits an  unwill-
    30  ingness to meet such standards and regulations, or is a potential threat
    31  to  the public health or safety. Such procedures and standards shall not
    32  limit health care provider participation in  the  program  for  economic
    33  purposes  and  shall  be consistent with good professional practice. Any
    34  health care provider who is qualified  to  participate  under  Medicaid,
    35  child health plus or Medicare shall be deemed to be qualified to partic-
    36  ipate in the program, and any health care provider's revocation, suspen-
    37  sion, limitation, or annulment of qualification to participate in any of
    38  those  programs  shall apply to the health care provider's qualification
    39  to participate in the program; provided  that  a  health  care  provider
    40  qualified  under  this  sentence  shall  follow the procedures to become
    41  qualified under the program by the end of the implementation period.
    42    (b) The commissioner shall establish and maintain procedures and stan-
    43  dards for recognizing health care providers located out of the state for
    44  purposes of providing coverage under the program for out-of-state health
    45  care services.
    46    4. Payment for health care services. (a) The commissioner  may  estab-
    47  lish  by  regulation  payment methodologies for health care services and
    48  care coordination provided to members under the program by participating
    49  providers, care coordinators, and health care organizations.  There  may
    50  be  a variety of different payment methodologies, including those estab-
    51  lished on a demonstration basis. All payment  rates  under  the  program
    52  shall  be  reasonable  and reasonably related to the cost of efficiently
    53  providing the health care service and assuring an adequate and  accessi-
    54  ble  supply  of  health care service.   Until and unless another payment
    55  methodology is established, health care  services  provided  to  members

        A. 5062--A                         10
 
     1  under  the  program shall be paid for on a fee-for-service basis, except
     2  for care coordination.
     3    (b)  The  program  shall engage in good faith negotiations with health
     4  care providers' representatives under title III of article forty-nine of
     5  this chapter, including, but not limited to, in  relation  to  rates  of
     6  payment and payment methodologies.
     7    (c)  Notwithstanding any provision of law to the contrary, payment for
     8  drugs provided by pharmacies under the program shall be made pursuant to
     9  title one of article two-A of this chapter. However, the  program  shall
    10  provide  for  payment  for  prescription drugs under section 340B of the
    11  federal public service act where applicable.  Payment  for  prescription
    12  drugs  provided  by health care providers other than pharmacies shall be
    13  pursuant to other provisions of this article.
    14    (d) Payment for health care services established  under  this  article
    15  shall  be considered payment in full. A participating provider shall not
    16  charge any rate in excess of the payment established under this  article
    17  for  any  health care service under the program provided to a member and
    18  shall not solicit or accept payment from any member or third  party  for
    19  any such service except as provided under section fifty-one hundred nine
    20  of this article.  However, this paragraph shall not preclude the program
    21  from  acting as a primary or secondary payer in conjunction with another
    22  third-party payer where permitted under section fifty-one  hundred  nine
    23  of this article.
    24    (e)  The  program may provide in payment methodologies for payment for
    25  capital related expenses for specifically  identified  capital  expendi-
    26  tures  incurred  by  not-for-profit  or  governmental entities certified
    27  under article twenty-eight of this chapter. Any capital related  expense
    28  generated  by  a  capital expenditure that requires or required approval
    29  under article twenty-eight of  this  chapter  must  have  received  that
    30  approval  for  the  capital  related  expense  to  be paid for under the
    31  program.
    32    (f) Payment methodologies and rates shall include a distinct component
    33  of reimbursement for direct and indirect graduate medical  education  as
    34  defined,  calculated  and  implemented  pursuant to section twenty-eight
    35  hundred seven-c of this chapter.
    36    (g) The commissioner shall provide by  regulation for payment  method-
    37  ologies and procedures for paying for out-of-state health care services.
    38    §  5106.  Health  care organizations. 1. A member may choose to enroll
    39  with and receive health care services under the program  from  a  health
    40  care organization.
    41    2.  A  health  care  organization shall be a not-for-profit or govern-
    42  mental entity that is approved by the commissioner that is:
    43    (a) an accountable care organization under  article  twenty-nine-E  of
    44  this chapter; or
    45    (b)  a  Taft-Hartley  fund  (i)  with respect to its members and their
    46  family members, and (ii) if allowed by applicable law  and  approved  by
    47  the  commissioner,  for  other members of the program; provided that the
    48  commissioner shall provide by regulation that where a Taft-Hartley  fund
    49  is  acting under this subparagraph there are protections for health care
    50  providers and patients comparable to  those  applicable  to  accountable
    51  care organizations.
    52    3.  A  health  care organization may be responsible for all or part of
    53  the health care services to which its members  are  entitled  under  the
    54  program, consistent with the terms of its approval by the commissioner.
    55    4.  (a)  The  commissioner  shall develop and implement procedures and
    56  standards for an entity to be approved to be a health care  organization

        A. 5062--A                         11
 
     1  in  the  program,  including but not limited to procedures and standards
     2  relating to the revocation,  suspension,  limitation,  or  annulment  of
     3  approval  on  a  determination  that  the  entity is incompetent to be a
     4  health  care  organization or has exhibited a course of conduct which is
     5  either inconsistent with program  standards  and  regulations  or  which
     6  exhibits  an unwillingness to meet such standards and regulations, or is
     7  a potential threat to the public health or safety. Such  procedures  and
     8  standards  shall  not limit approval to be a health care organization in
     9  the program for economic purposes and  shall  be  consistent  with  good
    10  professional  practice.  In developing the procedures and standards, the
    11  commissioner  shall:  (i)  consider  existing  standards  developed   by
    12  national  accrediting  and  professional organizations; and (ii) consult
    13  with national and local organizations working in  the  field  of  health
    14  care  organizations,  including  health  care  practitioners, hospitals,
    15  clinics, and consumers and their representatives.  When  developing  and
    16  implementing  standards  of  approval  of health care organizations, the
    17  commissioner shall consult with the commissioner of  mental  health  and
    18  the commissioner of developmental disabilities.
    19    (b) To maintain approval under the program, a health care organization
    20  must:  (i) renew its status at a frequency determined by the commission-
    21  er; and (ii) provide data to the department as required by  the  commis-
    22  sioner  to enable the commissioner to evaluate the health care organiza-
    23  tion in relation  to  quality  of  health  care  services,  health  care
    24  outcomes, and cost.
    25    5.  The  commissioner  shall  make regulations relating to health care
    26  organizations consistent with and to ensure compliance with  this  arti-
    27  cle.
    28    6.  The  provision of health care services directly or indirectly by a
    29  health care organization through health  care  providers  shall  not  be
    30  considered  the practice of a profession under title eight of the educa-
    31  tion law by the health care organization.
    32    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    33  requirements and standards for the program and for health care organiza-
    34  tions,  care  coordinators,  and  health care providers, consistent with
    35  this article, including requirements and standards for, as applicable:
    36    (a) the scope, quality and accessibility of health care services;
    37    (b) relations between health care organizations or health care provid-
    38  ers and members; and
    39    (c) relations  between  health  care  organizations  and  health  care
    40  providers,  including  (i) credentialing and participation in the health
    41  care organization; and (ii) terms, methods and rates of payment.
    42    2. Requirements and standards under the program shall include, but not
    43  be limited to, provisions to promote the following:
    44    (a) simplification, transparency, uniformity, and fairness  in  health
    45  care  provider  credentialing and participation in health care organiza-
    46  tion networks, referrals, payment procedures and rates, claims  process-
    47  ing, and approval of health care services, as applicable;
    48    (b)  primary  and  preventive  care,  care coordination, efficient and
    49  effective health care  services,  quality  assurance,  coordination  and
    50  integration  of health care services, including use of appropriate tech-
    51  nology, and promotion of public, environmental and occupational health;
    52    (c) elimination of health care disparities;
    53    (d) non-discrimination with respect to members and health care provid-
    54  ers on the basis of race, ethnicity, national origin, religion, disabil-
    55  ity, age, sex, sexual orientation, gender  identity  or  expression,  or
    56  economic  circumstances;  provided  that  health  care services provided

        A. 5062--A                         12
 
     1  under the program shall be appropriate to the patient's clinically-rele-
     2  vant circumstances; and
     3    (e)  accessibility  of  care  coordination,  health  care organization
     4  services and health care services, including  accessibility  for  people
     5  with disabilities and people with limited ability to speak or understand
     6  English,  and  the providing of care coordination, health care organiza-
     7  tion services and health care services in a culturally competent manner.
     8    3. Any participating provider or care coordinator that is organized as
     9  a for-profit entity shall be required to meet the same requirements  and
    10  standards as entities organized as not-for-profit entities, and payments
    11  under  the  program  paid  to  such  entities shall not be calculated to
    12  accommodate the generation of profit or revenue for dividends  or  other
    13  return on investment or the payment of taxes that would not be paid by a
    14  not-for-profit entity.
    15    4.  Every  participating  provider  shall  furnish to the program such
    16  information to, and permit examination of its records by,  the  program,
    17  as  may  be  reasonably required for purposes of reviewing accessibility
    18  and utilization of health care services,  quality  assurance,  and  cost
    19  containment, the making of payments, and statistical or other studies of
    20  the  operation of the program or for protection and promotion of public,
    21  environmental and occupational health.
    22    5. In developing requirements and standards and  making  other  policy
    23  determinations  under  this article, the commissioner shall consult with
    24  representatives of members, health care  providers,  care  coordinators,
    25  health care organizations and other interested parties.
    26    6.    The  program  shall maintain the confidentiality of all data and
    27  other information collected under the program when such  data  would  be
    28  normally  considered confidential data between a patient and health care
    29  provider.  Aggregate data of the program which is derived from confiden-
    30  tial data but does not violate patient confidentiality shall  be  public
    31  information.
    32    §  5108.  Regulations.  The  commissioner  may approve regulations and
    33  amendments thereto, under subdivision one of section  fifty-one  hundred
    34  two of this article. The commissioner may make regulations or amendments
    35  thereto  to effectuate the provisions and purposes of this article on an
    36  emergency basis under section two hundred two of the  state  administra-
    37  tive  procedure  act, provided that such regulations or amendments shall
    38  not become permanent unless adopted under  subdivision  one  of  section
    39  fifty-one hundred two of this article.
    40    § 5109. Provisions relating to federal health programs. 1. The commis-
    41  sioner  shall  seek  all federal waivers and other federal approvals and
    42  arrangements and submit state plan amendments necessary to  operate  the
    43  program consistent with this article.
    44    2.  (a)  The  commissioner  shall apply to the secretary of health and
    45  human services or other appropriate federal official for all waivers  of
    46  requirements,  and make other arrangements, under Medicare, any federal-
    47  ly-matched public health program, the affordable care act, and any other
    48  federal programs that provide federal funds for payment for health  care
    49  services,  that  are  necessary to enable all New York Health members to
    50  receive all benefits under the program through the program to enable the
    51  state to implement this article and to receive and deposit  all  federal
    52  payments  under  those programs (including funds that may be provided in
    53  lieu of premium tax credits, cost-sharing subsidies, and small  business
    54  tax  credits) in the state treasury to the credit of the New York Health
    55  trust fund created under section eighty-nine-i of the state finance  law
    56  and  to  use  those  funds  for  the  New  York Health program and other

        A. 5062--A                         13
 
     1  provisions under this article. To the extent possible, the  commissioner
     2  shall  negotiate  arrangements with the federal government in which bulk
     3  or lump-sum federal payments are paid to New York  Health  in  place  of
     4  federal  spending  or tax benefits for federally-matched health programs
     5  or federal health programs.
     6    (b) The commissioner may require members or applicants to  be  members
     7  to  provide  information  necessary  for  the program to comply with any
     8  waiver or arrangement under this subdivision.
     9    3. (a) If actions taken under subdivision two of this section  do  not
    10  accomplish all results intended under that subdivision, then this subdi-
    11  vision shall apply and shall authorize additional actions to effectively
    12  implement  New  York  Health to the maximum extent possible as a single-
    13  payer program consistent with this article.
    14    (b) The commissioner may take actions consistent with this article  to
    15  enable  New  York Health to administer Medicare in New York state and to
    16  be a provider of drug  coverage  under  Medicare  part  D  for  eligible
    17  members of New York Health.
    18    (c)  The  commissioner  may  waive  or  modify  the  applicability  of
    19  provisions of this section  relating  to  any  federally-matched  public
    20  health  program  or  Medicare  as  necessary  to implement any waiver or
    21  arrangement under this section or to maximize the  benefit  to  the  New
    22  York  Health program under this section, provided that the commissioner,
    23  in consultation with the director of the budget,  shall  determine  that
    24  such  waiver  or  modification  is  in the best interests of the members
    25  affected by the action and the state.
    26    (d) The commissioner may  apply  for  coverage  under  any  federally-
    27  matched  public  health  program  on behalf of any member and enroll the
    28  member in the federally-matched public health program or Medicare if the
    29  member is eligible for it.   Enrollment in  a  federally-matched  public
    30  health program or Medicare shall not cause any member to lose any health
    31  care  service  provided  by the program or diminish any right the member
    32  would otherwise have.
    33    (e) The commissioner shall by regulation increase the income eligibil-
    34  ity level, increase or eliminate  the  resource  test  for  eligibility,
    35  simplify any procedural or documentation requirement for enrollment, and
    36  increase  the  benefits for any federally-matched public health program,
    37  and for any program to reduce or eliminate an individual's  coinsurance,
    38  cost-sharing  or  premium obligations or increase an individual's eligi-
    39  bility for any federal financial support  related  to  Medicare  or  the
    40  affordable care act notwithstanding any law or regulation to the contra-
    41  ry.  The  commissioner  may  act  under  this  paragraph upon a finding,
    42  approved by the director of the budget, that the action (i) will help to
    43  increase the number of members who are  eligible  for  and  enrolled  in
    44  federally-matched  public  health programs, or for any program to reduce
    45  or eliminate an individual's coinsurance, cost-sharing or premium  obli-
    46  gations  or  increase an individual's eligibility for any federal finan-
    47  cial support related to Medicare or the affordable care act;  (ii)  will
    48  not diminish any individual's access to any health care service or right
    49  the  individual  would  otherwise  have; (iii) is in the interest of the
    50  program; and (iv) does not require or has received any necessary federal
    51  waivers or approvals to ensure federal financial participation.  Actions
    52  under this paragraph shall not apply to eligibility for payment for long
    53  term care.
    54    (f)  To enable the commissioner to apply for coverage under any feder-
    55  ally-matched public health program or Medicare on behalf of  any  member
    56  and  enroll the member in the federally-matched public health program or

        A. 5062--A                         14
 
     1  Medicare if the member is eligible for it, the commissioner may  require
     2  that  every member or applicant to be a member shall provide information
     3  to enable the commissioner to determine whether the applicant is  eligi-
     4  ble  for a federally-matched public health program and for Medicare (and
     5  any program or benefit under Medicare). The program shall make a reason-
     6  able effort to notify members of their obligations under this paragraph.
     7  After a reasonable effort has been  made  to  contact  the  member,  the
     8  member  shall  be  notified  in writing that he or she has sixty days to
     9  provide such required information. If such information is  not  provided
    10  within the sixty day period, the member's coverage under the program may
    11  be terminated.
    12    (g)  As  a condition of continued eligibility for health care services
    13  under the program, a member who is eligible for benefits under  Medicare
    14  shall enroll in Medicare, including parts A, B and D.
    15    (h)  The  program  shall  provide  premium  assistance for all members
    16  enrolling in a Medicare part D drug  coverage  under  section  1860D  of
    17  Title XVIII of the federal social security act limited to the low-income
    18  benchmark premium amount established by the federal centers for Medicare
    19  and Medicaid services and any other amount which such agency establishes
    20  under  its  de minimis premium policy, except that such payments made on
    21  behalf of members enrolled in a Medicare advantage plan may  exceed  the
    22  low-income  benchmark  premium amount if determined to be cost effective
    23  to the program.
    24    (i) If the commissioner has  reasonable  grounds  to  believe  that  a
    25  member  could  be  eligible  for an income-related subsidy under section
    26  1860D-14 of Title XVIII of the federal social security act,  the  member
    27  shall  provide,  and authorize the program to obtain, any information or
    28  documentation required to establish the member's  eligibility  for  such
    29  subsidy,  provided that the commissioner shall attempt to obtain as much
    30  of the information and documentation as possible from records  that  are
    31  available to him or her.
    32    (j)  The  program  shall make a reasonable effort to notify members of
    33  their obligations under this subdivision. After a reasonable effort  has
    34  been made to contact the member, the member shall be notified in writing
    35  that  he  or she has sixty days to provide such required information. If
    36  such information is not  provided  within  the  sixty  day  period,  the
    37  member's coverage under the program may be terminated.
    38    §  5110.  Additional  provisions.   1. The commissioner shall contract
    39  with not-for-profit organizations to provide:
    40    (a) consumer assistance to individuals with respect to selection of  a
    41  care  coordinator  or  health  care  organization,  enrolling, obtaining
    42  health care services, disenrolling, and other matters  relating  to  the
    43  program;
    44    (b) health care provider assistance to health care providers providing
    45  and  seeking  or  considering  whether  to provide, health care services
    46  under the program, with respect to participating in a health care organ-
    47  ization and dealing with a health care organization; and
    48    (c) care coordinator assistance to individuals and entities  providing
    49  and  seeking  or  considering  whether  to provide, care coordination to
    50  members.
    51    2. The commissioner shall provide grants from funds in  the  New  York
    52  Health  trust fund or otherwise appropriated for this purpose, to health
    53  systems agencies under section twenty-nine hundred four-b of this  chap-
    54  ter to support the operation of such health systems agencies.
    55    3. The commissioner shall provide funds from the New York Health trust
    56  fund  or  otherwise appropriated for this purpose to the commissioner of

        A. 5062--A                         15

     1  labor for a program for retraining  and  assisting  job  transition  for
     2  individuals  employed  or  previously  employed  in  the field of health
     3  insurance and other third-party payment for  health  care  or  providing
     4  services  to  health  care providers to deal with third-party payers for
     5  health care, whose jobs may be or have been ended as  a  result  of  the
     6  implementation of the New York Health program, consistent with otherwise
     7  applicable law.
     8    4. The commissioner shall, directly and through grants to not-for-pro-
     9  fit entities, conduct programs using data collected through the New York
    10  Health program, to promote and protect public, environmental and occupa-
    11  tional  health,  including  cooperation  with  other data collection and
    12  research programs of the department, consistent with  this  article  and
    13  otherwise applicable law.
    14    §  5111.  Regional advisory councils.  1. The New York Health regional
    15  advisory councils (each referred to in this article as a "regional advi-
    16  sory council") are hereby created in the department.
    17    2. There shall be a regional advisory council established in  each  of
    18  the following regions:
    19    (a) Long Island, consisting of Nassau and Suffolk counties;
    20    (b) New York City;
    21    (c)  Hudson  Valley, consisting of Delaware, Dutchess, Orange, Putnam,
    22  Rockland, Sullivan, Ulster, Westchester counties;
    23    (d) Northern, consisting of Albany, Clinton, Columbia,  Essex,  Frank-
    24  lin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga,
    25  Schenectady, Schoharie, Warren, Washington counties;
    26    (e)  Central,  consisting  of Broome, Cayuga, Chemung, Chenango, Cort-
    27  land, Herkimer, Jefferson, Lewis, Livingston, Madison,  Monroe,  Oneida,
    28  Onondaga,  Ontario,  Oswego,  Schuyler,  Seneca,  St. Lawrence, Steuben,
    29  Tioga, Tompkins, Wayne, Yates counties; and
    30    (f) Western, consisting of Allegany,  Cattaraugus,  Chautauqua,  Erie,
    31  Genesee, Niagara, Orleans, Wyoming counties.
    32    3.  Each regional advisory council shall be composed of not fewer than
    33  twenty-seven members, as determined by the commissioner and  the  board,
    34  as  necessary  to appropriately represent the diverse needs and concerns
    35  of the region. Members of a regional advisory council shall be residents
    36  of or have their principal place of business in the region served by the
    37  regional advisory council.
    38    4. Appointment of members of the regional advisory councils.
    39    (a) The twenty-seven members shall be appointed as follows:
    40    (i) nine members shall be appointed by the governor;
    41    (ii) six members shall be appointed by the governor on the recommenda-
    42  tion of the speaker of the assembly;
    43    (iii) six members shall be appointed by the governor on the  recommen-
    44  dation of the temporary president of the senate;
    45    (iv) three members shall be appointed by the governor on the recommen-
    46  dation of the minority leader of the assembly; and
    47    (v)  three members shall be appointed by the governor on the recommen-
    48  dation of the minority leader of the senate.  Where a regional  advisory
    49  council has more than twenty-seven members, the additional members shall
    50  be  appointed  and recommended by these officials in the same proportion
    51  as the twenty-seven members.
    52    Where a regional advisory council has more than twenty-seven  members,
    53  additional members shall be appointed and recommended by these officials
    54  in the same proportion as the twenty-seven members.
    55    (b)  Regional  advisory  council  membership  shall include but not be
    56  limited to:

        A. 5062--A                         16

     1    (i) representatives of health  care  consumer  advocacy  organizations
     2  with  a regional constituency, who shall represent at least one third of
     3  the membership of each regional council;
     4    (ii) representatives of professional organizations representing physi-
     5  cians;
     6    (iii)   representatives  of  professional  organizations  representing
     7  health care professionals other than physicians;
     8    (iv) representatives of general hospitals, including public hospitals;
     9    (v) representatives of community health centers;
    10    (vi) representatives of health care organizations;
    11    (vii) representatives of organized labor; and
    12    (viii) representatives of municipal and county government.
    13    5. Members of a regional advisory council shall be appointed for terms
    14  of three years provided, however, that of the members  first  appointed,
    15  one-third  shall  be appointed for one year terms and one-third shall be
    16  appointed for two year terms. Vacancies shall  be  filled  in  the  same
    17  manner as original appointments for the remainder of any unexpired term.
    18  No  person  shall  be an appointed member of a regional advisory council
    19  for more than six years in any period of twelve consecutive years.
    20    6. Members of the  regional  advisory  councils  shall  serve  without
    21  compensation  but  shall  be  reimbursed  for their necessary and actual
    22  expenses incurred while engaged in the business of  the  advisory  coun-
    23  cils.  The program shall provide financial support for such expenses and
    24  other expenses of the regional advisory councils.
    25    7. Each regional advisory council shall meet at least quarterly.  Each
    26  regional  advisory council may form committees to assist it in its work.
    27  Members of a committee need not be  members  of  the  regional  advisory
    28  council.    The  New  York  City  regional advisory council shall form a
    29  committee for each borough of New York  City,  to  assist  the  regional
    30  advisory council in its work as it relates particularly to that borough.
    31    8.  Each  regional  advisory council shall advise the commissioner,the
    32  board, the governor and the legislature on all matters relating  to  the
    33  development and implementation of the New York Health program.
    34    9.  Each  regional advisory council shall adopt, and from time to time
    35  revise, a community health improvement  plan  for  its  region  for  the
    36  purpose of:
    37    (a)  promoting  the  delivery  of  health care services in the region,
    38  improving the quality and  accessibility  of  care,  including  cultural
    39  competency,  clinical  integration  of  care  between  service providers
    40  including but not limited to physical, mental,  and  behavioral  health,
    41  physical and developmental disability services, and long-term care;
    42    (b) facility and health services planning in the region;
    43    (c) identifying gaps in regional health care services; and
    44    (d)  promoting increased public knowledge and responsibility regarding
    45  the availability and appropriate utilization of  health  care  services.
    46  Each community health improvement plan shall be submitted to the commis-
    47  sioner and the board and shall be posted on the department's website.
    48    10.  Each  regional  advisory  council shall hold at least four public
    49  hearings annually on matters relating to the New York Health program and
    50  the development and implementation of the community  health  improvement
    51  plan.
    52    11.  Each  regional advisory council shall publish an annual report to
    53  the commissioner and the board on the progress of the  community  health
    54  improvement  plan.  These  reports  shall  be posted on the department's
    55  website.

        A. 5062--A                         17
 
     1    12. All meetings of the  regional  advisory  councils  and  committees
     2  shall be subject to article six of the public officers law.
     3    § 4. Financing of New York Health. 1. The governor shall submit to the
     4  legislature  a  revenue plan and legislative bills to implement the plan
     5  (referred to collectively in this section as the "revenue proposal")  to
     6  provide the revenue necessary to finance the New York Health program, as
     7  created  by  article  51  of  the public health law (referred to in this
     8  section as the "program"), taking into consideration anticipated federal
     9  revenue available for the program. The revenue proposal shall be submit-
    10  ted to the legislature as part of the executive budget under article VII
    11  of the state constitution, for the fiscal year commencing on  the  first
    12  day  of April in the calendar year after this act shall become a law. In
    13  developing the revenue proposal, the governor shall consult with  appro-
    14  priate officials of the executive branch; the temporary president of the
    15  senate; the speaker of the assembly; the chairs of the fiscal and health
    16  committees  of the senate and assembly; and representatives of business,
    17  labor, consumers and local government.
    18    2. (a) Basic structure. The basic structure of  the  revenue  proposal
    19  shall  be as follows: Revenue for the program shall come from two premi-
    20  ums (referred to collectively in this section as the "premiums"). First,
    21  there shall be a progressively graduated  premium  on  all  payroll  and
    22  self-employed income (referred to in this section as the "payroll premi-
    23  um"),  paid  by  employers,  employees and self-employed, similar to the
    24  Medicare tax. Higher brackets of income subject to this premium shall be
    25  assessed at a higher marginal rate than lower brackets.   Second,  there
    26  shall  be  a  progressively graduated premium on taxable income (such as
    27  interest, dividends, and capital  gains)  not  subject  to  the  payroll
    28  premium  (referred to in this section as the "non-payroll premium"). The
    29  premiums will be set at levels anticipated to produce sufficient revenue
    30  to finance the program and other provisions of article 51 of the  public
    31  health  law,  to be scaled up as enrollment grows, taking into consider-
    32  ation anticipated federal revenue available for the  program.  Provision
    33  shall be made for state residents (who are eligible for the program) who
    34  are  employed  out-of-state, and non-residents (who are not eligible for
    35  the program) who are employed in the state.
    36    (b) Payroll premium. The income to be subject to the  payroll  premium
    37  shall  be  all  income subject to the Medicare tax. The premium shall be
    38  set at a percentage of that income, which shall be progressively  gradu-
    39  ated,  so  the  percentage  is  higher on higher brackets of income. For
    40  employed individuals, the employer  shall  pay  eighty  percent  of  the
    41  premium and the employee shall pay twenty percent of the premium, except
    42  that  an  employer may agree to pay all or part of the employee's share.
    43  A self-employed individual shall pay the full premium.
    44    (c) Non-payroll income premium. There shall be  a  premium  on  upper-
    45  bracket  taxable  personal  income  that  is  not subject to the payroll
    46  premium. It shall be set at a percentage of that income, which shall  be
    47  progressively  graduated, so the percentage is higher on higher brackets
    48  of income.
    49    (d) Phased-in rates. Early in the program, when enrollment is growing,
    50  the amount of the premiums shall be at an appropriate level,  and  shall
    51  be  raised  as anticipated enrollment grows, to cover the actual cost of
    52  the program and other provisions of article 51 of the public health law.
    53  The revenue proposal shall include a mechanism for determining the rates
    54  of the premiums.
    55    (e) Cross-border employees. (i) State residents employed out-of-state.
    56  If an individual is employed out-of-state by an employer that is subject

        A. 5062--A                         18
 
     1  to New York state law, the employer and employee shall  be  required  to
     2  pay the payroll premium as to that employee as if the employment were in
     3  the state. If an individual is employed out-of-state by an employer that
     4  is  not  subject  to  New  York  state  law, either (A) the employer and
     5  employee shall voluntarily comply with the premium or (B)  the  employee
     6  shall pay the premium as if he or she were self-employed.
     7    (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
     8  premium shall apply to any out-of-state  resident  who  is  employed  or
     9  self-employed in the state.  (B) In the case of an out-of-state resident
    10  who is employed or self-employed in the state, such individual and indi-
    11  vidual's  employer  shall  be  able to take a credit against the payroll
    12  premiums they would otherwise pay, as to the individual for amounts they
    13  spend on health benefits for the  individual  that  would  otherwise  be
    14  covered  by  the program if the individual were a member of the program.
    15  For employers, the credit shall be available regardless of the  form  of
    16  the  health benefit (e.g., health insurance, a self-insured plan, direct
    17  services, or reimbursement for services), to make sure that the  revenue
    18  proposal  does  not  relate  to  employment benefits in violation of the
    19  federal ERISA.  For non-employment-based spending  by  individuals,  the
    20  credit  shall be available for and limited to spending for health cover-
    21  age (not out-of-pocket health spending). The credit shall  be  available
    22  without  regard  to  how  little is spent or how sparse the benefit. The
    23  credit may only be taken against the payroll premiums. Any excess amount
    24  may not be applied to other tax liability. For  employment-based  health
    25  benefits,  the  credit  shall  be  distributed  between the employer and
    26  employee in the same proportion as the spending by each for the benefit.
    27  The employer and employee may each apply their respective portion of the
    28  credit to their respective portion of the premium. If any  provision  of
    29  this  clause  or any application of it shall be ruled to violate federal
    30  ERISA, the provision or the application of it shall be null and void and
    31  the ruling shall not affect any other provision or application  of  this
    32  section or the act that enacted it.
    33    3.   The  revenue  proposal  shall  include  a  plan  and  legislative
    34  provisions  for  ending  the  requirement  for  local  social   services
    35  districts  to  pay  part  of  the  cost  of Medicaid and replacing those
    36  payments with revenue from the premiums under the revenue proposal.
    37    4. To the extent that the revenue proposal differs from the  terms  of
    38  subdivision two of this section, the revenue proposal shall state how it
    39  differs  from those terms and reasons for and the effects of the differ-
    40  ences.
    41    5. All revenue from the premiums shall be deposited in  the  New  York
    42  Health trust fund account under section 89-i of the state finance law.
    43    §  5.   Article 49 of the public health law is amended by adding a new
    44  title 3 to read as follows:
    45                                  TITLE III
    46            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    47                               NEW YORK HEALTH
    48  Section 4920. Definitions.
    49          4921. Collective negotiation authorized.
    50          4922. Collective negotiation requirements.
    51          4923. Requirements for health care providers' representative.
    52          4924. Certain collective action prohibited.
    53          4925. Fees.
    54          4926. Confidentiality.
    55          4927. Severability and construction.
    56    § 4920. Definitions. For purposes of this title:

        A. 5062--A                         19
 
     1    1. "New York Health" means the program under article fifty-one of this
     2  chapter.
     3    2.  "Person"  means  an  individual,  association, corporation, or any
     4  other legal entity.
     5    3. "Health care providers' representative" means a third party that is
     6  authorized by health care providers to negotiate on  their  behalf  with
     7  New  York  Health  over terms and conditions affecting those health care
     8  providers.
     9    4. "Strike" means a work stoppage in part or in whole, direct or indi-
    10  rect, by a body of workers to gain compliance with demands  made  on  an
    11  employer.
    12    5.  "Health  care provider" means a person who is licensed, certified,
    13  registered or authorized to practice a health care  profession  pursuant
    14  to title eight of the education law and who practices that profession as
    15  a  health care provider as an independent contractor or who is an owner,
    16  officer, shareholder, or proprietor of a health  care  provider;  or  an
    17  entity  that employs or utilizes health care providers to provide health
    18  care services, including but not limited to a  hospital  licensed  under
    19  article twenty-eight of this chapter or an accountable care organization
    20  under  article  twenty-nine-E  of  this  chapter. A health care provider
    21  under title eight of the education law who practices as an employee of a
    22  health care provider shall not be deemed  a  health  care  provider  for
    23  purposes of this title.
    24    §  4921.  Collective  negotiation authorized. 1. Health care providers
    25  may meet and communicate for the  purpose  of  collectively  negotiating
    26  with  New York Health on any matter relating to New York Health, includ-
    27  ing but not limited to rates of payment and payment methodologies.
    28    2. Nothing in this section shall be construed to allow or authorize an
    29  alteration of the terms of the internal and external  review  procedures
    30  set forth in law.
    31    3. Nothing in this section shall be construed to allow a strike of New
    32  York Health by health care providers.
    33    4.  Nothing  in  this section shall be construed to allow or authorize
    34  terms or conditions which would impede the ability of New York Health to
    35  obtain or retain accreditation by the  national  committee  for  quality
    36  assurance or a similar body or to comply with applicable state or feder-
    37  al law.
    38    § 4922. Collective negotiation requirements. 1. Collective negotiation
    39  rights granted by this title must conform to the following requirements:
    40    (a)  health  care  providers  may  communicate  with other health care
    41  providers regarding the terms and conditions to be negotiated  with  New
    42  York Health;
    43    (b)  health care providers may communicate with health care providers'
    44  representatives;
    45    (c) a health care providers' representative is the only party  author-
    46  ized  to  negotiate  with  New  York Health on behalf of the health care
    47  providers as a group;
    48    (d) a health care provider can be bound by the  terms  and  conditions
    49  negotiated by the health care providers' representatives; and
    50    (e)  in  communicating  or negotiating with the health care providers'
    51  representative, New York Health is entitled to offer and provide differ-
    52  ent terms and conditions to individual competing health care providers.
    53    2. Nothing in this title shall affect or limit the right of  a  health
    54  care provider or group of health care providers to collectively petition
    55  a government entity for a change in a law, rule, or regulation.

        A. 5062--A                         20
 
     1    3.  Nothing  in  this title shall affect or limit collective action or
     2  collective bargaining on the part of any health care provider  with  his
     3  or  her  employer  or  any  other lawful collective action or collective
     4  bargaining.
     5    § 4923. Requirements for health care providers' representative. Before
     6  engaging  in  collective  negotiations with New York Health on behalf of
     7  health care providers, a health  care  providers'  representative  shall
     8  file  with the commissioner, in the manner prescribed by the commission-
     9  er, information identifying  the  representative,  the  representative's
    10  plan of operation, and the representative's procedures to ensure compli-
    11  ance with this title.
    12    §  4924.  Certain  collective  action prohibited. 1. This title is not
    13  intended to authorize competing health care providers to act in  concert
    14  in  response to a health care providers' representative's discussions or
    15  negotiations with New York Health except as authorized by other law.
    16    2. No health care providers' representative shall negotiate any agree-
    17  ment that excludes, limits the participation  or  reimbursement  of,  or
    18  otherwise limits the scope of services to be provided by any health care
    19  provider  or group of health care providers with respect to the perform-
    20  ance of services that are within the health  care  provider's  scope  of
    21  practice, license, registration, or certificate.
    22    §  4925. Fees. Each person who acts as the representative of negotiat-
    23  ing parties under this title shall pay to the department a fee to act as
    24  a representative. The commissioner, by rule, shall set fees  in  amounts
    25  deemed  reasonable  and  necessary  to  cover  the costs incurred by the
    26  department in administering this title.
    27    § 4926. Confidentiality. All reports and other information required to
    28  be reported to the department under this title shall not be  subject  to
    29  disclosure under article six of the public officers law or article thir-
    30  ty-one of the civil practice law and rules.
    31    § 4927. Severability and construction. If any provision or application
    32  of  this  title  shall be held to be invalid, or to violate or be incon-
    33  sistent with any applicable federal law or regulation,  that  shall  not
    34  affect other provisions or applications of this title which can be given
    35  effect  without  that  provision  or  application;  and to that end, the
    36  provisions and applications of this title are severable. The  provisions
    37  of  this  title  shall  be  liberally  construed  to  give effect to the
    38  purposes thereof.
    39    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
    40  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
    41  amended to read as follows:
    42    11. "State public health plan" means the  medical  assistance  program
    43  established  by  title eleven of article five of the social services law
    44  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
    45  insurance  coverage program established by title three of article two of
    46  the elder law (referred to in this article as "EPIC"), and  the  [family
    47  health  plus  program established by section three hundred sixty-nine-ee
    48  of the social services law to the extent that section provides that  the
    49  program shall be subject to this article] New York Health program estab-
    50  lished by article fifty-one of this chapter.
    51    §  7. The state finance law is amended by adding a new section 89-i to
    52  read as follows:
    53    § 89-i. New York Health trust fund. 1. There is hereby established  in
    54  the joint custody of the state comptroller and the commissioner of taxa-
    55  tion  and  finance  a  special revenue fund to be known as the "New York
    56  Health trust fund", hereinafter known as "the fund". The definitions  in

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

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     1  provide its work product and assistance to the board established  pursu-
     2  ant  to section fifty-one hundred two of this article upon completion of
     3  the appointment of the board.
     4    §  9.  Severability. If any provision or application of this act shall
     5  be held to be invalid, or to violate or be inconsistent with any  appli-
     6  cable  federal law or regulation, that shall not affect other provisions
     7  or applications of this act which  can  be  given  effect  without  that
     8  provision  or  application; and to that end, the provisions and applica-
     9  tions of this act are severable.
    10    § 10. This act shall take effect immediately.
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