|SAME AS||SAME AS S03525-A|
|COSPNSR||Abinanti, 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|
|MLTSPNSR||Abbate, 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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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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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. LBD07764-05-6A. 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 theA. 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 benefitsA. 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 whichA. 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 membersA. 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 organizationA. 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 providedA. 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 otherA. 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 orA. 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 ofA. 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 subjectA. 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 [ family47 health plus program established by section three hundred sixty-nine-ee48 of the social services law to the extent that section provides that the49 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 inA. 5062--A 21 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 shallA. 5062--A 22 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.