|SAME AS||SAME AS UNI. S05425-A|
|COSPNSR||Benedetto, Bronson, Brook-Krasny, Cymbrowitz, Englebright, Gantt, Hikind, Jaffee, Jacobs, Kellner, Lavine, Maisel, Peoples-Stokes, Sweeney, Titus, Kavanagh, Dinowitz, Abinanti, Lifton, Stevenson, Linares, Roberts, Schimel, Barron, Skartados|
|MLTSPNSR||Abbate, Aubry, Boyland, Brennan, Cahill, Camara, Clark, Colton, Cook, Farrell, Glick, Gunther, Heastie, Hooper, Jeffries, Latimer, Lentol, Lopez V, Lupardo, Magee, Magnarelli, Markey, McEneny, Millman, O'Donnell, Ortiz, Paulin, Perry, Pretlow, Raia, Ramos, Reilly, Rivera J, Rivera N, Rivera P, Robinson, Rosenthal, Scarborough, Thiele, Titone, Weisenberg, Weprin, Wright|
|Ren Art 50 SS5000 - 5003 to be Art 80 SS8000 - 8003, add Art 51 SS5100 - 5110, add Art 49 Title 3 SS4920 - 4927, amd S270, Pub Health L; add S89-h, 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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STATE OF NEW YORK ________________________________________________________________________ S. 5425--A A. 7860--A 2011-2012 Regular Sessions SENATE - ASSEMBLY May 19, 2011 ___________ IN SENATE -- Introduced by Sens. DUANE, PERKINS, DILAN, ESPAILLAT, KRUEGER, MONTGOMERY, OPPENHEIMER, RIVERA, SERRANO -- read twice and ordered printed, and when printed to be committed to the Committee on Finance -- recommitted to the Committee on Finance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee IN ASSEMBLY -- Introduced by M. of A. GOTTFRIED, BENEDETTO, BRONSON, BROOK-KRASNY, CYMBROWITZ, ENGLEBRIGHT, GANTT, HIKIND, JAFFEE, JACOBS, KELLNER, LAVINE, MAISEL, PEOPLES-STOKES, SWEENEY, TITUS, KAVANAGH, DINOWITZ, ABINANTI, LIFTON, STEVENSON, LINARES, ROBERTS, SCHIMEL, BARRON -- Multi-Sponsored by -- M. of A. ABBATE, AUBRY, BOYLAND, BREN- NAN, CAHILL, CAMARA, CLARK, COLTON, COOK, FARRELL, GLICK, GUNTHER, HEASTIE, HOOPER, JEFFRIES, LATIMER, LENTOL, V. LOPEZ, LUPARDO, MAGEE, MAGNARELLI, MARKEY, McENENY, MILLMAN, O'DONNELL, ORTIZ, PAULIN, PERRY, PRETLOW, RAMOS, REILLY, J. RIVERA, N. RIVERA, P. RIVERA, ROBINSON, ROSENTHAL, SCARBOROUGH, THIELE, WEISENBERG, WEPRIN, WRIGHT -- read once and referred to the Committee on Health -- 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 committee AN ACT to amend the public health law and the state finance law, in relation 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. Legislative findings and intent. 1. The state constitution 2 states: "The protection and promotion of the health of the inhabitants 3 of the state are matters of public concern and provision therefor shall 4 be made by the state and by such of its subdivisions and in such manner, 5 and by such means as the legislature shall from time to time determine." 6 (Article XVII, §3.) The legislature finds and declares that all resi- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02490-03-2S. 5425--A 2 A. 7860--A 1 dents of the state have the right to health care. New Yorkers - as indi- 2 viduals, employers, and taxpayers - have experienced a rapid rise in the 3 cost of health care and coverage in recent years. This increase has 4 resulted in a large number of people without health coverage. Businesses 5 have also experienced extraordinary increases in the costs of health 6 care benefits for their employees. An unacceptable number of New Yorkers 7 have no health coverage, and many more are severely underinsured. Health 8 care providers are also affected by inadequate health coverage in New 9 York state. A large portion of voluntary and public hospitals, health 10 centers and other providers now experience substantial losses due to the 11 provision of care that is uncompensated. Individuals often find that 12 they are deprived of affordable care and choice because of decisions by 13 health plans guided by the plan's economic needs rather than their 14 health care needs. To address the fiscal crisis facing the health care 15 system and the state and to assure New Yorkers can exercise their right 16 to health care, affordable and comprehensive health coverage must be 17 provided. Pursuant to the state constitution's charge to the legislature 18 to provide for the health of New Yorkers, this legislation is an enact- 19 ment of state concern for the purpose of establishing a comprehensive 20 universal single-payer health care coverage program and a health care 21 cost control system for the benefit of all residents of the state of New 22 York. 23 2. It is the intent of the Legislature to create the New York Health 24 program to provide a universal health plan for every New Yorker, funded 25 by broad-based revenue based on ability to pay. The state shall work to 26 obtain waivers relating to Medicaid, Family Health Plus, Child Health 27 Plus, Medicare, the Patient Protection and Affordable Care Act, and any 28 other appropriate federal programs, under which federal funds and other 29 subsidies that would otherwise be paid to New York State and New Yorkers 30 for health coverage that will be equaled or exceeded by New York Health 31 will be paid by the federal government to New York State and deposited 32 in the New York Health trust fund. Under such a waiver, health coverage 33 under those programs will be replaced and merged into New York Health, 34 which will operate as a true single-payer program. 35 If such a waiver is not obtained, the state shall use state plan 36 amendments and seek waivers to maximize, and make as seamless as possi- 37 ble, the use of federally-matched health programs and federal health 38 programs in New York Health. Thus, even where other programs such as 39 Medicaid or Medicare may contribute to paying for care, it is the goal 40 of this legislation that the coverage will be delivered by New York 41 Health and, as much as possible, the multiple sources of funding will be 42 pooled with other New York Health funds and not be apparent to New York 43 Health members or participating providers. This program will promote 44 movement away from fee-for-service payment, which tends to reward quan- 45 tity and requires excessive administrative expense, and towards alter- 46 nate payment methodologies, such as global or capitated payments to 47 providers or health care organizations, that promote quality, efficien- 48 cy, investment in primary and preventive care, and innovation and inte- 49 gration in the organizing of health care. 50 3. This act does not create any employment benefit, nor does is 51 require, prohibit, or limit the providing of any employment benefit. 52 4. In order to promote improved quality of, and access to, health care 53 services and promote improved clinical outcomes, it is the policy of the 54 state to encourage cooperative, collaborative and integrative arrange- 55 ments among health care providers who might otherwise be competitors, 56 under the active supervision of the commissioner of health. It is theS. 5425--A 3 A. 7860--A 1 intent of the state to supplant competition with such arrangements and 2 regulation only to the extent necessary to accomplish the purposes of 3 this act, and to provide state action immunity under the state and 4 federal antitrust laws to health care providers, particularly with 5 respect to their relations with the single-payer New York Health plan 6 created by this act. 7 § 2. Article 50 and sections 5000, 5001, 5002 and 5003 of the public 8 health law are renumbered article 80 and sections 8000, 8001, 8002 and 9 8003, respectively, and a new article 51 is added to read as follows: 10 ARTICLE 51 11 NEW YORK HEALTH 12 Section 5100. Definitions. 13 5101. Program created. 14 5102. Board of trustees. 15 5103. Eligibility and enrollment. 16 5104. Benefits. 17 5105. Health care providers; care coordination; payment method- 18 ologies. 19 5106. Health care organizations. 20 5107. Program standards. 21 5108. Regulations. 22 5109. Provisions relating to federal health programs. 23 5110. Additional provisions. 24 § 5100. Definitions. As used in this article, the following terms 25 shall have the following meanings, unless the context clearly requires 26 otherwise: 27 1. "Board" means the board of trustees of the New York Health program 28 created by section fifty-one hundred two of this article, and "trustee" 29 means a trustee of the board. 30 2. "Care coordination" means services provided by a care coordinator 31 under paragraph (b) of subdivision two of section fifty-one hundred five 32 of this article. 33 3. "Care coordinator" means an individual or entity approved to 34 provide care coordination under paragraph (b) of subdivision two of 35 section fifty-one hundred five of this article. 36 4. "Federally-matched public health program" means the medical assist- 37 ance program under title eleven of article five of the social services 38 law, the family health plus program under title eleven-D of article five 39 of the social services law, and the child health plus program under 40 title one-A of article twenty-five of this chapter. 41 5. "Health care organization" means an entity that is approved by the 42 commissioner under section fifty-one hundred six of this article to 43 provide health care services to members under the program. 44 6. "Health care service" means any health care service, including care 45 coordination, included as a benefit under the program. 46 7. "Implementation period" means the period under subdivision three of 47 section fifty-one hundred one of this article during which the program 48 will be subject to special eligibility and financing provisions until it 49 is fully implemented under that section. 50 8. "Long term care" means long term care, treatment, maintenance, or 51 services not covered under family health plus or child health plus, as 52 appropriate, with the exception of short term rehabilitation, as defined 53 by the commissioner. 54 9. "Medicaid" or "medical assistance" means title eleven of article 55 five of the social services law and the program thereunder. "Family 56 health plus" means title eleven-D of the social services law and theS. 5425--A 4 A. 7860--A 1 program thereunder. "Child health plus" means title one-A of article 2 twenty-five of this chapter and the program thereunder. "Medicare" means 3 title XVIII of the federal social security act and the programs there- 4 under. 5 10. "Member" means an individual who is enrolled in the program. 6 11. "New York Health trust fund" means the New York Health trust fund 7 established under section eighty-nine-h of the state finance law. 8 12. "Participating provider" means any individual or entity that is a 9 health care provider that provides health care services to members under 10 the program, or a health care organization. 11 13. "Patient protection and affordable care act" means the federal 12 patient protection and affordable care act, public law 111-148, as 13 amended by the health care and education reconciliation act of 2010, 14 public law 111-152, and any regulations or guidance issued thereunder. 15 14. "Person" means any individual or natural person, trust, partner- 16 ship, association, unincorporated association, corporation, company, 17 limited liability company, proprietorship, joint venture, firm, joint 18 stock association, department, agency, authority, or other legal entity, 19 whether for-profit, not-for-profit or governmental. 20 15. "Program" means the New York Health program created by section 21 fifty-one hundred one of this article. 22 16. "Prescription and non-prescription drugs" shall mean prescription 23 drugs as defined in section two hundred seventy of this chapter, and 24 non-prescription smoking cessation products or devices. 25 17. "Resident" means an individual whose primary place of abode is in 26 the state, as determined according to regulations of the commissioner. 27 § 5101. Program created. 1. The New York Health program is hereby 28 created in the department. The commissioner shall establish and imple- 29 ment the program under this article. The program shall provide compre- 30 hensive health coverage to every resident who enrolls in the program. 31 2. The commissioner shall, to the maximum extent possible, organize, 32 administer and market the program and services as a single program under 33 the name "New York Health" or such other name as the commissioner shall 34 determine, regardless of under which law or source the definition of a 35 benefit is found including (on a voluntary basis) retiree health bene- 36 fits. In implementing this subdivision, the commissioner shall avoid 37 jeopardizing federal financial participation in these programs and shall 38 take care to promote public understanding and awareness of available 39 benefits and programs. 40 3. The commissioner shall determine when individuals may begin enroll- 41 ing in the program. There shall be an implementation period, which shall 42 begin on the date that individuals may begin enrolling in the program 43 and shall end as determined by the commissioner. 44 4. An insurer authorized to provide coverage pursuant to the insurance 45 law or a health maintenance organization certified under this chapter 46 may, if otherwise authorized, offer benefits that do not duplicate 47 coverage offered to an individual under the program, but may not offer 48 benefits that duplicate coverage offered to an individual under the 49 program. Provided, however, that this subdivision shall not prohibit (a) 50 the offering of any benefits to or for individuals, including their 51 families, who are employed or self-employed in the state but who are not 52 residents of the state, or (b) the offering of benefits during the 53 implementation period to individuals who enrolled as members of the 54 program, or (c) the offering of retiree health benefits.S. 5425--A 5 A. 7860--A 1 5. A college, university or other institution of higher education in 2 the state may purchase coverage under the program for any student, or 3 student's dependent, who is not a resident of the state. 4 § 5102. Board of trustees. 1. The New York Health board of trustees is 5 hereby created in the department. The board of trustees shall, at the 6 request of the commissioner, consider any matter to effectuate the 7 provisions and purposes of this article, and may advise the commissioner 8 thereon; and it may, from time to time, submit to the commissioner any 9 recommendations to effectuate the provisions and purposes of this arti- 10 cle. The commissioner may propose regulations under this article and 11 amendments thereto for consideration by the board. The board of trustees 12 shall have no executive, administrative or appointive duties except as 13 otherwise provided by law. The board of trustees shall have power to 14 establish, and from time to time, amend regulations to effectuate the 15 provisions and purposes of this article, subject to approval by the 16 commissioner. 17 2. The board shall be composed of: 18 (a) the commissioner, the superintendent of financial services, and 19 the director of the budget, or their designees, as ex officio members; 20 (b) seventeen trustees appointed by the governor; 21 (i) five of whom shall be representatives of health care consumer 22 advocacy organizations which have a statewide or regional constituency, 23 who have been involved in activities related to health care consumer 24 advocacy, including issues of interest to low- and moderate-income indi- 25 viduals; 26 (ii) two of whom shall be representatives of professional organiza- 27 tions representing physicians; 28 (iii) two of whom shall be representatives of professional organiza- 29 tions representing licensed or registered health care professionals 30 other than physicians; 31 (iv) three of whom shall be representatives of hospitals, one of whom 32 shall be a representative of public hospitals; 33 (v) one of whom shall be representative of community health centers; 34 (vi) two of whom shall be representatives of health care organiza- 35 tions; and 36 (viii) two of whom shall be representatives of organized labor; 37 (c) three trustees appointed by the speaker of the assembly; three 38 trustees appointed by the temporary president of the senate; one trustee 39 appointed by the minority leader of the assembly; and one trustee 40 appointed by the minority leader of the senate. 41 After the end of the implementation period, no person shall be a trus- 42 tee unless he or she is a member of the program, except the ex officio 43 trustees. Each trustee shall serve at the pleasure of the appointing 44 officer, except the ex officio trustees. 45 3. The chair of the board shall be appointed, and may be removed as 46 chair, by the governor from among the trustees. The board shall meet at 47 least four times each calendar year. Meetings shall be held upon the 48 call of the chair and as provided by the board. A majority of the 49 appointed trustees shall be a quorum of the board, and the affirmative 50 vote of a majority of the trustees voting, but not less than ten, shall 51 be necessary for any action to be taken by the board. The board may 52 establish an executive committee to exercise any powers or duties of the 53 board as it may provide, and other committees to assist the board or the 54 executive committee. The chair of the board shall chair the executive 55 committee and shall appoint the chair and members of all other commit- 56 tees. The board of trustees may appoint one or more advisory committees.S. 5425--A 6 A. 7860--A 1 Members of advisory committees need not be members of the board of trus- 2 tees. 3 4. Trustees shall serve without compensation but shall be reimbursed 4 for their necessary and actual expenses incurred while engaged in the 5 business of the board. 6 5. Notwithstanding any provision of law to the contrary, no officer or 7 employee of the state or any local government shall forfeit or be deemed 8 to have forfeited his or her office or employment by reason of being a 9 trustee. 10 6. The board and its committees and advisory committees may request 11 and receive the assistance of the department and any other state or 12 local governmental entity in exercising its powers and duties. 13 7. No later than five years after the effective date of this article: 14 (a) The board shall develop a proposal, consistent with the principles 15 of this article, for provision by the program of long-term care cover- 16 age, including the development of a proposal, consistent with the prin- 17 ciples of this article, for its funding. In developing the proposal, 18 the board shall consult with an advisory committee, appointed by the 19 chair of the board, including representatives of consumers and potential 20 consumers of long-term care, providers of long-term care, labor, and 21 other interested parties. The board shall present its proposal to the 22 governor and the legislature. 23 (b) The board shall develop a proposal for incorporating retiree 24 health benefits into New York Health. 25 § 5103. Eligibility and enrollment. 1. Every resident of the state 26 shall be eligible and entitled to enroll as a member under the program. 27 2. No member shall be required to pay any premium or other charge for 28 enrolling in or being a member under the program. 29 § 5104. Benefits. 1. The program shall provide comprehensive health 30 coverage to every member, which shall include all health care services 31 required to be covered under any of the following, without regard to 32 whether the member would otherwise be eligible for or covered by the 33 program or source referred to: 34 (a) family health plus; 35 (b) for every member under the age of twenty-one, child health plus; 36 (c) Medicaid; 37 (d) Medicare; 38 (e) article forty-four of this chapter or article thirty-two or 39 forty-three of the insurance law; 40 (f) article eleven of the civil service law, as of the date one year 41 before the beginning of the implementation period; 42 (g) any additional health care service authorized to be added to the 43 program's benefits by the program; and 44 (h) provided that none of the above shall include long term care, 45 until a proposal under paragraph (a) of subdivision seven of section 46 fifty-one hundred two of this article is enacted into law. 47 2. No member shall be required to pay any deductible, co-payment or 48 co-insurance under the program. 49 3. The program shall provide for payment under the program for emer- 50 gency and temporary health care services provided to members or individ- 51 uals entitled to become members who have not had a reasonable opportu- 52 nity to become a member or to enroll with a care coordinator. 53 § 5105. Health care providers; care coordination; payment methodol- 54 ogies. 1. Choice of health care provider. (a) Any health care provider 55 qualified to participate under this section may provide health care 56 services under the program, provided that the health care provider isS. 5425--A 7 A. 7860--A 1 otherwise legally authorized to perform the health care service for the 2 individual and under the circumstances involved. 3 (b) A member may choose to receive health care services under the 4 program from any participating provider, consistent with provisions of 5 this article relating to care coordination and health care organiza- 6 tions, the willingness or availability of the provider (subject to 7 provisions of this article relating to discrimination), and the appro- 8 priate clinically-relevant circumstances. 9 2. Care coordination. (a) Health care services provided to a member 10 shall not be subject to payment under the program unless the member is 11 enrolled with a care coordinator at the time the health care service is 12 provided, except where provided under subdivision three of section 13 fifty-one hundred four of this article. Every member shall enroll with a 14 care coordinator that agrees to provide care coordination to the member 15 prior to receiving health care services to be paid for under the 16 program. The member shall remain enrolled with that care coordinator 17 until the member becomes enrolled with a different care coordinator or 18 ceases to be a member. The commissioner shall provide, by regulation, 19 that members have the right to change their care coordinator on terms at 20 least as permissive as the provisions of section three hundred sixty- 21 four-j of the social services law relating to an individual changing his 22 or her primary care provider or managed care provider. 23 (b) Care coordination shall be provided to the member by the member's 24 care coordinator. A care coordinator may employ or utilize the services 25 of other individuals or entities to assist in providing care coordi- 26 nation for the member, consistent with regulations of the commissioner. 27 Care coordination shall include, but not be limited to, managing, refer- 28 ring to, locating, coordinating, and monitoring health care services for 29 the member to assure that all medically necessary health care services 30 are made available to and are effectively used by the member in a timely 31 manner, consistent with patient autonomy. Care coordination is not a 32 requirement for prior authorization for health care services and refer- 33 ral shall not be required for a member to receive a health care service. 34 However: (i) a health care organization may establish rules relating to 35 care coordination for members in the health care organization, different 36 from this subdivision but otherwise consistent with this article and 37 other applicable laws; and (ii) nothing in this subdivision shall 38 authorize any individual to engage in any act in violation of title 39 eight of the education law. 40 (c) Where a member receives chronic mental health care services, at 41 the option of the member, the member may enroll with a care coordinator 42 for his or her mental health care services and another care coordinator 43 approved for his or her other health care services, consistent with 44 standards established by the commissioner in consultation with the 45 commissioner of mental health. In such a case, the two care coordinators 46 shall work in close consultation with each other. 47 (d) A care coordinator may be an individual or entity that is approved 48 by the program that is: 49 (i) a health care practitioner who is: (A) the member's primary care 50 practitioner; (B) at the option of a female member, the member's provid- 51 er of primary gynecological care; or (C) at the option of a member who 52 has a chronic condition that requires specialty care, a specialist 53 health care practitioner who regularly and continually provides treat- 54 ment for that condition to the member; 55 (ii) an entity licensed under article twenty-eight of this chapter or 56 certified under article thirty-six of this chapter, a managed long termS. 5425--A 8 A. 7860--A 1 care plan under section forty-four hundred three-f of this chapter or 2 other program model under paragraph (b) of subdivision seven of such 3 section, or, with respect to a member who receives chronic mental health 4 care services, an entity licensed under article thirty-one of the mental 5 hygiene law or other entity approved by the commissioner in consultation 6 with the commissioner of mental health; 7 (iii) a health care organization; 8 (iv) a Taft-Hartley fund, with respect to its members and their family 9 members; provided that this provision shall not preclude a Taft-Hartley 10 fund from becoming a care coordinator under subparagraph (v) of this 11 paragraph or a health care organization under section fifty-one hundred 12 six of this article; or 13 (v) any not-for-profit or governmental entity approved by the program. 14 (e) The commissioner shall develop and implement procedures and stand- 15 ards for an individual or entity to be approved to be a care coordinator 16 in the program, including but not limited to procedures and standards 17 relating to the revocation, suspension, limitation, or annulment of 18 approval on a determination that the individual or entity is incompetent 19 to be a care coordinator or has exhibited a course of conduct which is 20 either inconsistent with program standards and regulations or which 21 exhibits an unwillingness to meet such standards and regulations, or is 22 a potential threat to the public health or safety. Such procedures and 23 standards shall not limit approval to be a care coordinator in the 24 program for economic purposes and shall be consistent with good profes- 25 sional practice. In developing the procedures and standards, the commis- 26 sioner shall: (i) consider existing standards developed by national 27 accrediting and professional organizations; and (ii) consult with 28 national and local organizations working on care coordination or similar 29 models, including health care practitioners, hospitals, clinics, and 30 consumers and their representatives. When developing and implementing 31 standards of approval of care coordinators for individuals receiving 32 chronic mental health care services, the commissioner shall consult with 33 the commissioner of mental health. An individual or entity may not be a 34 care coordinator unless the services included in care coordination are 35 within the individual's professional scope of practice or the entity's 36 legal authority. 37 (f) To maintain approval under the program, a care coordinator must: 38 (i) renew its status at a frequency determined by the commissioner; and 39 (ii) provide data to the department as required by the commissioner to 40 enable the commissioner to evaluate the impact of care coordinators on 41 quality, outcomes and cost. 42 3. Health care providers. The commissioner shall establish and main- 43 tain procedures and standards for health care providers to be qualified 44 to participate in the program, including but not limited to procedures 45 and standards relating to the revocation, suspension, limitation, or 46 annulment of qualification to participate on a determination that the 47 health care provider is an incompetent provider of specific health care 48 services or has exhibited a course of conduct which is either inconsist- 49 ent with program standards and regulations or which exhibits an unwill- 50 ingness to meet such standards and regulations, or is a potential threat 51 to the public health or safety. Such procedures and standards shall not 52 limit health care provider participation in the program for economic 53 purposes and shall be consistent with good professional practice. Any 54 health care provider who is qualified to participate under Medicaid, 55 family health plus, child health plus or Medicare shall be deemed to be 56 qualified to participate in the program, and any health care provider'sS. 5425--A 9 A. 7860--A 1 revocation, suspension, limitation, or annulment of qualification to 2 participate in any of those programs shall apply to the health care 3 provider's qualification to participate in the program; provided that a 4 health care provider qualified under this sentence shall follow the 5 procedures to become qualified under the program by the end of the 6 implementation period. 7 4. Payment for health care services. (a) Health care services provided 8 to members under the program shall be paid for on a fee-for-service 9 basis, except for care coordination. However, the commissioner may 10 establish by regulation other payment methodologies for health care 11 services and care coordination provided to members under the program by 12 participating providers, care coordinators, and health care organiza- 13 tions. There may be a variety of different payment methodologies, 14 including those established on a demonstration basis. All payment rates 15 under the program shall be reasonable and reasonably related to the cost 16 of efficiently providing the health care service and assuring an 17 adequate and accessible supply of health care service. 18 (b) The program shall engage in good faith negotiations with health 19 care providers' representatives under title III of article forty-nine of 20 this chapter, including, but not limited to, in relation to rates of 21 payment and payment methodologies. 22 (c) Notwithstanding any provision of law to the contrary, payment for 23 drugs provided by pharmacies under the program shall be made pursuant to 24 article two-A of this chapter and subdivision four of section three 25 hundred sixty-five-a of the social services law. However, the program 26 shall provide for payment for prescription drugs under section 340B of 27 the federal public service act where applicable. Payment for 28 prescription drugs provided by health care providers other than pharma- 29 cies shall be pursuant to other provisions of this article. 30 (d) Payment for health care services established under this article 31 shall be considered payment in full. A participating provider shall not 32 charge any rate in excess of the payment established under this article 33 for any health care service under the program provided to a member and 34 shall not solicit or accept payment from any member or third party for 35 any such service except as provided under this article. However, this 36 paragraph shall not preclude the program from acting as a primary or 37 secondary payer in conjunction with another third-party payer where 38 permitted under this article. 39 (e) The program may provide in payment methodologies for payment for 40 capital related expenses for specifically identified capital expendi- 41 tures incurred by not-for-profit or governmental entities certified 42 under article twenty-eight of this chapter. Any capital related expense 43 generated by a capital expenditure that requires or required approval 44 under article twenty-eight of this chapter must have received that 45 approval for the capital related expense to be paid for under the 46 program. 47 5. (a) For purposes of this subdivision, "income-eligible member" 48 means a member who is enrolled in a federally-matched public health 49 program and (i) there is federal financial participation in the individ- 50 ual's health coverage, or (ii) the member is eligible to enroll in the 51 federally-matched public health program by reason of income, age, and 52 resources (where applicable) under state law in effect on the effective 53 date of this section, but there is no federal financial participation in 54 the individual's health coverage. A person who is eligible to enroll in 55 a federally-matched public health program solely by reason of sectionS. 5425--A 10 A. 7860--A 1 three hundred sixty-nine-ff of the social services law (employer part- 2 nerships for family health plus) is not an income-eligible member. 3 (b) The program, with respect to income-eligible members, shall be 4 considered a federally-matched public health program or government payor 5 under article twenty-eight of this chapter with respect to the following 6 provisions, and with respect to those members who are not income-eligi- 7 ble members, shall not be considered a federally-matched public health 8 program or governmental payor under article twenty-eight of this chapter 9 with respect to the following provisions: 10 (i) patient services payments in accordance with section twenty-eight 11 hundred seven-j of this chapter; 12 (ii) professional education pool funding under section twenty-eight 13 hundred seven-s of this chapter; or 14 (iii) assessments on covered lives under section twenty-eight hundred 15 seven-t of this chapter. 16 § 5106. Health care organizations. 1. A member may choose to enroll 17 with and receive health care services under the program from a health 18 care organization. 19 2. A health care organization shall be a not-for-profit or govern- 20 mental entity that is approved by the commissioner that is: 21 (a) an accountable care organization under article twenty-nine-E of 22 this chapter; or 23 (b) a Taft-Hartley fund (i) with respect to its members and their 24 family members, and (ii) if allowed by applicable law and approved by 25 the commissioner, for other members of the program; provided that the 26 commissioner shall provide by regulation that where a Taft-Hartley fund 27 is acting under this subparagraph there are protections for health care 28 providers and patients comparable to those applicable to accountable 29 care organizations. 30 3. A health care organization may be responsible for all or part of 31 the health care services to which its members are entitled under the 32 program, consistent with the terms of its approval by the commissioner. 33 4. (a) The commissioner shall develop and implement procedures and 34 standards for an entity to be approved to be a health care organization 35 in the program, including but not limited to procedures and standards 36 relating to the revocation, suspension, limitation, or annulment of 37 approval on a determination that the entity is incompetent to be a 38 health care organization or has exhibited a course of conduct which is 39 either inconsistent with program standards and regulations or which 40 exhibits an unwillingness to meet such standards and regulations, or is 41 a potential threat to the public health or safety. Such procedures and 42 standards shall not limit approval to be a health care organization in 43 the program for economic purposes and shall be consistent with good 44 professional practice. In developing the procedures and standards, the 45 commissioner shall: (i) consider existing standards developed by 46 national accrediting and professional organizations; and (ii) consult 47 with national and local organizations working in the field of health 48 care organizations, including health care practitioners, hospitals, 49 clinics, and consumers and their representatives. When developing and 50 implementing standards of approval of health care organizations, the 51 commissioner shall consult with the commissioner of mental health and 52 the commissioner of developmental disabilities. 53 (b) To maintain approval under the program, a health care organization 54 must: (i) renew its status at a frequency determined by the commission- 55 er; and (ii) provide data to the department as required by the commis- 56 sioner to enable the commissioner to evaluate the health care organiza-S. 5425--A 11 A. 7860--A 1 tion in relation to quality of health care services, health care 2 outcomes, and cost. 3 5. The commissioner shall make regulations relating to health care 4 organizations consistent with and to ensure compliance with this arti- 5 cle. 6 6. The provision of health care services directly or indirectly by a 7 health care organization through health care providers shall not be 8 considered the practice of a profession under title eight of the educa- 9 tion law by the health care organization. 10 § 5107. Program standards. 1. The commissioner shall establish 11 requirements and standards for the program and for health care organiza- 12 tions, care coordinators, and health care providers, including require- 13 ments and standards for, as applicable: 14 (a) the scope, quality and accessibility of health care services; 15 (b) relations between health care organizations or health care provid- 16 ers and members, including approval of health care services; and 17 (c) relations between health care organizations and health care 18 providers, including (i) credentialing and participation in health care 19 organization networks; and (ii) terms, methods and rates of payment. 20 2. Requirements and standards under the program shall include, but not 21 be limited to, provisions to promote the following: 22 (a) simplification, transparency, uniformity, and fairness in health 23 care provider credentialing and participation in health care organiza- 24 tion networks, referrals, payment procedures and rates, claims process- 25 ing, and approval of health care services, as applicable; 26 (b) primary and preventive care, care coordination, efficient and 27 effective health care services, quality assurance, and coordination and 28 integration of health care services, including use of appropriate tech- 29 nology; 30 (c) elimination of health care disparities; 31 (d) non-discrimination with respect to members and health care provid- 32 ers on the basis of race, ethnicity, national origin, religion, disabil- 33 ity, age, sex, sexual orientation, gender identity or expression, or 34 economic circumstances; provided that health care services provided 35 under the program shall be appropriate to the patient's clinically-rele- 36 vant circumstances; and 37 (e) accessibility of care coordination, health care organization 38 services and health care services, including accessibility for people 39 with disabilities and people with limited ability to speak or understand 40 English, and the providing of health care organization services and 41 health care services in a culturally competent manner. 42 3. Any participating provider or care coordinator that is organized as 43 a for-profit entity shall be required to meet the same requirements and 44 standards as entities organized as not-for-profit entities, and payments 45 under the program paid to such entities shall not be calculated to 46 accommodate the generation of profit or revenue for dividends or other 47 return on investment or the payment of taxes that would not be paid by a 48 not-for-profit entity. 49 4. Every participating provider shall furnish to the program such 50 information to, and permit examination of its records by, the program, 51 as may be reasonably required for purposes of utilization review, quali- 52 ty assurance, and cost containment, for the making of payments, and for 53 statistical or other studies of the operation of the program. 54 5. In developing requirements and standards and making other policy 55 determinations under this article, the commissioner shall consult withS. 5425--A 12 A. 7860--A 1 representatives of members, health care providers, health care organiza- 2 tions and other interested parties. 3 6. The program shall maintain the confidentiality of all data and 4 other information collected under the program when such data would be 5 normally considered confidential data between a patient and health care 6 provider. Aggregate data of the program which is derived from confiden- 7 tial data but does not violate patient confidentiality shall be public 8 information. 9 § 5108. Regulations. The commissioner may approve regulations and 10 amendments thereto, under subdivision one of section fifty-one hundred 11 two of this article. The commissioner may make regulations or amendments 12 thereto to effectuate the provisions and purposes of this article on an 13 emergency basis under section two hundred two of the state administra- 14 tive procedure act, provided that such regulations or amendments shall 15 not become permanent unless adopted under subdivision one of section 16 fifty-one hundred two of this article. 17 § 5109. Provisions relating to federal health programs. 1. The commis- 18 sioner shall seek all federal waivers and other federal approvals and 19 arrangements and submit state plan amendments necessary to operate the 20 program consistent with this article. 21 2. (a) The commissioner shall apply to the secretary of health and 22 human services or other appropriate federal official for all waivers of 23 requirements, and make other arrangements, under Medicare, any federal- 24 ly-matched public health program, the patient protection and affordable 25 care act, and any other federal programs that provide federal funds for 26 payment for health care services, that are necessary to enable all New 27 York Health members to receive all benefits under the program through 28 the program to enable the state to implement this article and to receive 29 and deposit all federal payments under those programs (including funds 30 that may be provided in lieu of premium tax credits, cost-sharing subsi- 31 dies, and small business tax credits) in the state treasury to the cred- 32 it of the New York Health trust fund created under section eighty-nine-h 33 of the state finance law and to use those funds for the New York Health 34 program and other provisions under this article. To the extent possible, 35 the commissioner shall negotiate arrangements with the federal govern- 36 ment in which bulk or lump-sum federal payments are paid to New York 37 Health in place of federal spending or tax benefits for federally- 38 matched health programs or federal health programs. 39 (b) The commissioner may require members or applicants to be members 40 to provide information necessary for the program to comply with any 41 waiver or arrangement under this subdivision. 42 3. (a) If actions taken under subdivision two of this section do not 43 accomplish all results intended under that subdivision, then this subdi- 44 vision shall apply and shall authorize additional actions to effectively 45 implement New York Health to the maximum extent possible as a single- 46 payer program consistent with this article. 47 (b) The commissioner may take actions consistent with this article to 48 enable New York Health to administer Medicare in New York state and to 49 be a provider of drug coverage under Medicare part D for eligible 50 members of New York Health. 51 (c) The commissioner may waive or modify the applicability of 52 provisions of this section relating to any federally-matched public 53 health program or Medicare as necessary to implement any waiver or 54 arrangement under this section or to maximize the benefit to the New 55 York Health program under this section, provided that the commissioner, 56 in consultation with the director of the budget, shall determine thatS. 5425--A 13 A. 7860--A 1 such waiver or modification is in the best interests of the members 2 affected by the action and the state. 3 (d) The commissioner may apply for coverage under any federally- 4 matched public health program on behalf of any member and enroll the 5 member in the federally-matched public health program if the member is 6 eligible for it. Enrollment in a federally-matched public health 7 program shall not cause any member to lose any health care service 8 provided by the program. 9 (e) The commissioner shall by regulation increase the income eligibil- 10 ity level, increase or eliminate the resource test for eligibility, 11 simplify any procedural or documentation requirement for enrollment, and 12 increase the benefits for any federally-matched public health program, 13 notwithstanding any law or regulation to the contrary. The commissioner 14 may act under this paragraph upon a finding, approved by the director of 15 the budget, that the action (i) will help to increase the number of 16 members who are eligible for and enrolled in federally-matched public 17 health programs; (ii) will not diminish any individual's access to any 18 health care service; and (iii) does not require or has received any 19 necessary federal waivers or approvals to ensure federal financial 20 participation. Actions under this paragraph shall not apply to eligibil- 21 ity for payment for long term care. 22 (f) To enable the commissioner to apply for coverage under any feder- 23 ally-matched public health program on behalf of any member and enroll 24 the member in the federally-matched public health program if the member 25 is eligible for it, the commissioner may require that every member or 26 applicant to be a member shall provide information to enable the commis- 27 sioner to determine whether the applicant is eligible for a federally- 28 matched public health program and for Medicare (and any program or bene- 29 fit under Medicare). The program shall make a reasonable effort to 30 notify members of their obligations under this paragraph. After a 31 reasonable effort has been made to contact the member, the member shall 32 be notified in writing that he or she has sixty days to provide such 33 required information. If such information is not provided within the 34 sixty day period, the member's coverage under the program may be termi- 35 nated. 36 (g) As a condition of continued eligibility for health care services 37 under the program, a member who is eligible for benefits under Medicare 38 shall enroll in Medicare, including parts A, B and D. 39 (h) The program shall provide premium assistance for all members 40 enrolling in a Medicare part D drug coverage under section 1860D of 41 Title XVIII of the federal social security act limited to the low-income 42 benchmark premium amount established by the federal centers for Medicare 43 and Medicaid services and any other amount which such agency establishes 44 under its de minimus premium policy, except that such payments made on 45 behalf of members enrolled in a Medicare advantage plan may exceed the 46 low-income benchmark premium amount if determined to be cost effective 47 to the program. 48 (i) If the commissioner has reasonable grounds to believe that a 49 member could be eligible for an income-related subsidy under section 50 1860D-14 of Title XVIII of the federal social security act, the member 51 shall provide, and authorize the program to obtain, any information or 52 documentation required to establish the member's eligibility for such 53 subsidy, provided that the commissioner shall attempt to obtain as much 54 of the information and documentation as possible from records that are 55 available to him or her.S. 5425--A 14 A. 7860--A 1 (j) The program shall make a reasonable effort to notify members of 2 their obligations under this subdivision. After a reasonable effort has 3 been made to contact the member, the member shall be notified in writing 4 that he or she has sixty days to provide such required information. If 5 such information is not provided within the sixty day period, the 6 member's coverage under the program may be terminated. 7 § 5110. Additional provisions. 1. The commissioner shall contract 8 with not-for-profit organizations to provide: 9 (a) consumer assistance to individuals with respect to selection of a 10 care coordinator or health care organization, enrolling, obtaining 11 health care services, disenrolling, and other matters relating to the 12 program; 13 (b) health care provider assistance to health care providers providing 14 and seeking or considering whether to provide, health care services 15 under the program, with respect to participating in a health care organ- 16 ization and dealing with a health care organization; and 17 (c) care coordinator assistance to individuals and entities providing 18 and seeking or considering whether to provide, care coordination to 19 members. 20 2. The commissioner shall provide grants from funds in the New York 21 Health trust fund or otherwise appropriated for this purpose, to health 22 systems agencies under section twenty-nine hundred four-b of this chap- 23 ter to support the operation of such health systems agencies. 24 § 3. Financing of New York Health. 1. The governor shall submit to the 25 legislature a plan and legislative bills to implement the plan (referred 26 to collectively in this section as the "revenue proposal") to provide 27 the revenue necessary to finance the New York Health program, as created 28 by article 51 of the public health law (referred to in this section as 29 the "program"), taking into consideration anticipated federal revenue 30 available for the program. The revenue proposal shall be submitted to 31 the legislature as part of the executive budget under article VII of the 32 state constitution, for the fiscal year commencing on the first day of 33 April in the calendar year after this act shall become a law. In devel- 34 oping the revenue proposal, the governor shall consult with appropriate 35 officials of the executive branch; the temporary president of the 36 senate; the speaker of the assembly; the chairs of the fiscal and health 37 committees of the senate and assembly; and representatives of business, 38 labor, consumers and local government. 39 2. (a) Basic structure. The basic structure of the revenue proposal 40 shall be as follows: Revenue for the program shall come from two assess- 41 ments (referred to collectively in this section as the "assessments"). 42 First, there shall be an assessment on all payroll and self-employed 43 income (referred to in this section as the "payroll assessment"), paid 44 by employers, employees and self-employed, similar to the Medicare tax. 45 Higher brackets of income subject to this assessment shall be assessed 46 at a higher marginal rate than lower brackets. Second, there shall be a 47 progressively-graduated assessment on taxable income (such as interest, 48 dividends, and capital gains) not subject to the payroll assessment 49 (referred to in this section as the "non-payroll assessment"). The 50 assessments will be set at levels anticipated to produce sufficient 51 revenue to finance the program and other provisions of article 51 of the 52 public health law, to be scaled up as enrollment grows, taking into 53 consideration anticipated federal revenue available for the program. 54 Provision shall be made for state residents (who are eligible for the 55 program) who are employed out-of-state, and non-residents (who are not 56 eligible for the program) who are employed in the state.S. 5425--A 15 A. 7860--A 1 (b) Payroll assessment. The income to be subject to the payroll 2 assessment shall be all income subject to the Medicare tax. The assess- 3 ment shall be set at a particular percentage of that income, which shall 4 be progressively graduated, so the percentage is higher on higher brack- 5 ets of income. For employed individuals, the employer shall pay eighty 6 percent of the assessment and the employee shall pay twenty percent 7 (unless the employer agrees to pay a higher percentage). A self-employed 8 individual shall pay the full assessment. 9 (c) Non-payroll income assessment. There shall be a second assessment, 10 on upper-bracket taxable income that is not subject to the payroll 11 assessment. It shall be progressively graduated and structured as a 12 percentage of the personal income tax on that income. 13 (d) Phased-in rates. Early in the program, when enrollment is growing, 14 the amount of the assessments shall be at an appropriate level, and 15 shall be raised as anticipated enrollment grows, to cover the actual 16 cost of the program and other provisions of article 51 of the public 17 health law. The revenue proposal shall include a mechanism for determin- 18 ing the rates of the assessments. 19 (e) Cross-border employees. (i) State residents employed out-of-state. 20 If an individual is employed out-of-state by an employer that is subject 21 to New York state law, the employer and employee shall be required to 22 pay the payroll assessment as if the employment were in the state. If an 23 individual is employed out-of-state by an employer that is not subject 24 to New York state law, either (A) the employer and employee shall volun- 25 tarily comply with the assessment or (B) the employee shall pay the 26 assessment as if he or she were self-employed. 27 (ii) Out-of-state residents employed in the state. (A) The payroll 28 assessment shall apply to any out-of-state resident who is employed or 29 self-employed in the state. (B) In the case of an out-of-state resident 30 who is employed or self-employed in the state, such individual's employ- 31 er (which term shall include a Taft-Hartley fund) shall be able to take 32 a credit against the payroll assessments they would otherwise pay, for 33 amounts they spend on health benefits that would otherwise be covered by 34 the program. For employers, the credit shall be available regardless of 35 the form of the health benefit (e.g., health insurance, a self-insured 36 plan, direct services, or reimbursement for services), to make sure that 37 the revenue proposal does not relate to employment benefits in violation 38 of the federal ERISA. An employee may take the credit for his or her 39 contribution to an employment-based health benefit. For non-employment- 40 based spending by individuals, the credit shall be available for and 41 limited to spending for health coverage (not out-of-pocket health spend- 42 ing). The credit shall be available without regard to how little is 43 spent or how sparse the benefit. The credit may only be taken against 44 the payroll assessments. Any excess amount may not be applied to other 45 tax liability. For employment-based health benefits, the credit shall be 46 distributed between the employer and employee in the same proportion as 47 the spending by each for the benefit. The employer and employee may each 48 apply their respective portion of the credit to their respective portion 49 of the assessment. If any provision of this clause (B) or any applica- 50 tion of it shall be ruled to violate federal ERISA, the provision or the 51 application of it shall be null and void and the ruling shall not affect 52 any other provision or application of this section or the act that 53 enacted it. 54 3. The revenue proposal shall include a plan and legislative 55 provisions for ending the requirement for local social servicesS. 5425--A 16 A. 7860--A 1 districts to pay part of the cost of Medicaid and replacing those 2 payments with revenue from the assessments under the revenue proposal. 3 4. To the extent that the revenue proposal differs from the terms of 4 subdivision 2 of this section, the revenue proposal shall state how it 5 differs from those terms and reasons for and the effects of the differ- 6 ences. 7 5. All revenue from the assessments shall be deposited in the New York 8 Health trust fund account under section 89-h of the state finance law. 9 § 4. Article 49 of the public health law is amended by adding a new 10 title 3 to read as follows: 11 TITLE III 12 COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH 13 NEW YORK HEALTH 14 Section 4920. Definitions. 15 4921. Collective negotiation authorized. 16 4922. Collective negotiation requirements. 17 4923. Requirements for health care providers' representative. 18 4924. Certain collective action prohibited. 19 4925. Fees. 20 4926. Confidentiality. 21 4927. Severability and construction. 22 § 4920. Definitions. For purposes of this title: 23 1. "New York Health" means the program under article fifty-one of this 24 chapter. 25 2. "Person" means an individual, association, corporation, or any 26 other legal entity. 27 3. "Health care providers' representative" means a third party who is 28 authorized by health care providers to negotiate on their behalf with 29 New York Health over terms and conditions affecting those health care 30 providers. 31 4. "Strike" means a work stoppage in part or in whole, direct or indi- 32 rect, by a body of workers to gain compliance with demands made on an 33 employer. 34 5. "Health care provider" means a person who is licensed, certified, 35 or registered pursuant to title eight of the education law and who prac- 36 tices as a health care provider as an independent contractor or who is 37 an owner, officer, shareholder, or proprietor of a health care provider; 38 or an entity that employs or utilizes health care providers to provide 39 health care services, including but not limited to a hospital licensed 40 under article twenty-eight of this chapter or an accountable care organ- 41 ization under article twenty-nine-E of this chapter. A health care 42 provider under title eight of the education law who practices as an 43 employee of a health care provider shall not be deemed a health care 44 provider for purposes of this title. 45 § 4921. Collective negotiation authorized. 1. Health care providers 46 may meet and communicate for the purpose of collectively negotiating the 47 following terms and conditions of provider contracts with New York 48 Health: 49 (a) the details of the utilization review plan as defined pursuant to 50 subdivision ten of section forty-nine hundred of this article; 51 (b) the definition of medical necessity; 52 (c) the clinical practice guidelines used to make medical necessity 53 and utilization review determinations; 54 (d) preventive care and other medical coordination practices; 55 (e) drug formularies and standards and procedures for prescribing 56 off-formulary drugs;S. 5425--A 17 A. 7860--A 1 (f) the details of risk transfer arrangements with providers; 2 (g) administrative procedures; 3 (h) procedures to be utilized to resolve disputes between New York 4 Health and health care providers; 5 (i) patient referral procedures; 6 (j) the formulation and application of health care provider reimburse- 7 ment procedures; 8 (k) quality assurance programs; 9 (l) the process for rendering utilization review determinations 10 including: establishment of a process for rendering utilization review 11 determinations which shall, at a minimum, include: written procedures to 12 assure that utilization reviews and determinations are conducted within 13 the timeframes established in this article; procedures to notify an 14 enrollee, an enrollee's designee and/or an enrollee's health care 15 provider of adverse determinations; and procedures for appeal of adverse 16 determinations, including the establishment of an expedited appeals 17 process for denials of continued inpatient care or where there is immi- 18 nent or serious threat to the health of the enrollee; 19 (m) health care provider selection and termination criteria used by 20 New York Health; 21 (n) the fees assessed by New York Health for services, including fees 22 established through the application of reimbursement procedures; 23 (o) the conversion factors used by New York Health in a resource-based 24 relative value scale reimbursement methodology or other similar method- 25 ology; provided the same are not otherwise established by state or 26 federal law or regulation; 27 (p) the amount of any discount granted by New York Health on the fee 28 of health care services to be rendered by health care providers; 29 (q) the dollar amount of capitation or fixed payment for health care 30 services rendered by health care providers to New York Health members; 31 (r) the procedure code or other description of a health care service 32 covered by a payment and the appropriate grouping of the procedure 33 codes; and 34 (s) the amount of any other component of the reimbursement methodology 35 for a health care service. 36 2. Nothing in this section shall be construed to allow or authorize an 37 alteration of the terms of the internal and external review procedures 38 set forth in law. 39 3. Nothing in this section shall be construed to allow a strike of New 40 York Health by health care providers. 41 4. Nothing in this section shall be construed to allow or authorize 42 terms or conditions which would impede the ability of New York Health to 43 obtain or retain accreditation by the national committee for quality 44 assurance or a similar body or to comply with applicable state or feder- 45 al law. 46 5. Nothing in this section shall be deemed to affect or limit the 47 right of a health care provider or group of health care providers to 48 collectively petition a government entity for a change in a law, rule, 49 or regulation. 50 § 4922. Collective negotiation requirements. 1. Collective negotiation 51 rights granted by this title must conform to the following requirements: 52 (a) health care providers may communicate with other health care 53 providers regarding the terms and conditions to be negotiated with New 54 York Health; 55 (b) health care providers may communicate with health care providers' 56 representatives;S. 5425--A 18 A. 7860--A 1 (c) a health care providers' representative is the only party author- 2 ized to negotiate with New York Health on behalf of the health care 3 providers as a group; 4 (d) a health care provider can be bound by the terms and conditions 5 negotiated by the health care providers' representatives; and 6 (e) in communicating or negotiating with the health care providers' 7 representative, New York Health is entitled to offer and provide differ- 8 ent terms and conditions to individual competing health care providers. 9 2. Nothing in this title shall be construed to prohibit or limit 10 collective action or collective bargaining on the part of any health 11 care provider with his or her employer or any other lawful collective 12 action or collective bargaining. 13 § 4923. Requirements for health care providers' representative. Before 14 engaging in collective negotiations with New York Health on behalf of 15 health care providers, a health care providers' representative shall 16 file with the commissioner, in the manner prescribed by the commission- 17 er, information identifying the representative, the representative's 18 plan of operation, and the representative's procedures to ensure compli- 19 ance with this title. 20 § 4924. Certain collective action prohibited. 1. This title is not 21 intended to authorize competing health care providers to act in concert 22 in response to a health care providers' representative's discussions or 23 negotiations with New York Health. 24 2. No health care providers' representative shall negotiate any agree- 25 ment that excludes, limits the participation or reimbursement of, or 26 otherwise limits the scope of services to be provided by any health care 27 provider or group of health care providers with respect to the perform- 28 ance of services that are within the health care provider's scope of 29 practice, license, registration, or certificate. 30 § 4925. Fees. Each person who acts as the representative or negotiat- 31 ing parties under this title shall pay to the department a fee to act as 32 a representative. The commissioner, by rule, shall set fees in amounts 33 deemed reasonable and necessary to cover the costs incurred by the 34 department in administering this title. 35 § 4926. Confidentiality. All reports and other information required to 36 be reported to the department under this title shall not be subject to 37 disclosure under article six of the public officers law or article thir- 38 ty-one of the civil practice law and rules. 39 § 4927. Severability and construction. If any provision or application 40 of this title shall be held to be invalid, or to violate or be incon- 41 sistent with any applicable federal law or regulation, that shall not 42 affect other provisions or applications of this title which can be given 43 effect without that provision or application; and to that end, the 44 provisions and applications of this title are severable. The provisions 45 of this title shall be liberally construed to give effect to the 46 purposes thereof. 47 § 5. Subdivision 11 of section 270 of the public health law, as 48 amended by section 2-a of part C of chapter 58 of the laws of 2008, is 49 amended to read as follows: 50 11. "State public health plan" means the medical assistance program 51 established by title eleven of article five of the social services law 52 (referred to in this article as "Medicaid"), the elderly pharmaceutical 53 insurance coverage program established by title three of article two of 54 the elder law (referred to in this article as "EPIC"), [ and] the family 55 health plus program established by section three hundred sixty-nine-ee 56 of the social services law to the extent that section provides that theS. 5425--A 19 A. 7860--A 1 program shall be subject to this article, and the New York Health 2 program established by article fifty-one of this chapter. 3 § 6. The state finance law is amended by adding a new section 89-h to 4 read as follows: 5 § 89-h. New York Health trust fund. 1. There is hereby established in 6 the joint custody of the state comptroller and the commissioner of taxa- 7 tion and finance a special revenue fund to be known as the "New York 8 Health trust fund", hereinafter known as "the fund". The definitions in 9 section fifty-one hundred of the public health law shall apply to this 10 section. 11 2. The fund shall consist of: 12 (a) all monies obtained from assessments pursuant to legislation 13 enacted as proposed under section three of the act that added this 14 section; 15 (b) federal payments received as a result of any waiver of require- 16 ments granted or other arrangements agreed to by the United States 17 secretary of health and human services or other appropriate federal 18 officials for health care programs established under Medicare, any 19 federally-matched public health program, or the patient protection and 20 affordable care act; 21 (c) the amounts paid by the department of health and by local social 22 services districts that are equivalent to those amounts that are paid on 23 behalf of residents of this state under Medicare, any federally-matched 24 public health program, or the patient protection and affordable care act 25 for health benefits which are equivalent to health benefits covered 26 under New York Health; 27 (d) all surcharges that are imposed on residents of this state to 28 replace payments made by the residents under the cost-sharing provisions 29 of Medicare; 30 (e) federal, state and local funds for purposes of the provision of 31 services authorized under title XX of the federal social security act 32 that would otherwise be covered under article fifty-one of the public 33 health law; and 34 (f) state and local government monies that would otherwise be appro- 35 priated to any governmental agency, office, program, instrumentality or 36 institution which provides health services, for services and benefits 37 covered under New York Health. Payments to the fund pursuant to this 38 paragraph shall be in an amount equal to the money appropriated for such 39 purposes in the fiscal year immediately preceding the effective date of 40 article fifty-one of the public health law. 41 3. Monies in the fund shall only be used for purposes established 42 under article fifty-one of the public health law. 43 § 7. Temporary commission on implementation. 1. There is hereby estab- 44 lished a temporary commission on implementation of the New York Health 45 program, hereinafter to be known as the commission, consisting of 46 fifteen members: five members, including the chair, shall be appointed 47 by the governor; four members shall be appointed by the temporary presi- 48 dent of the senate, one member shall be appointed by the senate minority 49 leader; four members shall be appointed by the speaker of the assembly, 50 and one member shall be appointed by the assembly minority leader. The 51 commissioner of health, the superintendent of financial services, and 52 the commissioner of taxation and finance, or their designees shall serve 53 as non-voting ex-officio members of the commission. 54 2. Members of the commission shall receive such assistance as may be 55 necessary from other state agencies and entities, and shall receive 56 necessary expenses incurred in the performance of their duties. TheS. 5425--A 20 A. 7860--A 1 commission may employ staff as needed, prescribe their duties, and fix 2 their compensation within amounts appropriate for the commission. 3 3. The commission shall examine the laws and regulations of the state 4 and make such recommendations as are necessary to conform the laws and 5 regulations of the state and article 51 of the public health law estab- 6 lishing the New York Health program and other provisions of law relating 7 to the New York Health program, and to improve and implement the 8 program. The commission shall report its recommendations to the governor 9 and the legislature. 10 § 8. Severability. If any provision or application of this act shall 11 be held to be invalid, or to violate or be inconsistent with any appli- 12 cable federal law or regulation, that shall not affect other provisions 13 or applications of this act which can be given effect without that 14 provision or application; and to that end, the provisions and applica- 15 tions of this act are severable. 16 § 9. This act shall take effect immediately.