Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2022-2023 state fiscal year; relates to the implementation of the nurses across New York (NANY) program (Part A); allows pharmacists to direct limited service laboratories and order and administer COVID-19 and influenza tests; modernizes nurse practitioners; allows certain individuals to administer tests to determine the presence of COVID-19 or its antibodies or influenza virus in certain situations; relates to enacting the "nurse practitioners modernization act"; provides for the repeal of certain provisions upon the expiration thereof (Part C); relates to increasing general public health work base grants for both full-service and partial-service counties and allow for local health departments to claim up to fifty percent of personnel service costs (Part E); relates to general hospital reimbursement for annual rates, in relation to the cap on local Medicaid expenditures (Part H); provides a one percent across the board payment increase to all qualifying fee-for-service Medicaid rates (Part I); relates to extending the statutory requirement to reweight and rebase acute hospital rates (Part J); relates to the creation of a new statewide health care facility transformation program (Part K); relates to the definition of revenue in the minimum spending statute for nursing homes and the rates of payment and rates of reimbursement for residential health care facilities, in relation to making a temporary payment to facilities in severe financial distress; requires certain percentages of revenue be spent on direct resident care and resident-facing staffing (Part M); relates to private duty nursing services reimbursement for nurses servicing adult members; relates to rates of payment for continuous nursing services for certain adults; directs the department of health to establish or procure the services of an independent panel of clinical professionals and to develop and implement a uniform task-based assessment tool; directs the department of health to develop guidelines and standards for the use of tasking tools (Part O); relates to the essential plan and qualified health plans to contract with national cancer institute-designated cancer centers, where such centers agree to certain terms and conditions; requires the department of health to select an independent contractor to generate a report that reviews and makes recommendations concerning the status of services offered by managed care organizations contracting with the state to manage services provided under the Medicaid program (Part P); requires private insurance plans to cover abortion services without cost-sharing (Part R); relates to reimbursement for commercial and Medicaid services provided via telehealth; provides for the repeal of such provisions upon the expiration thereof (Part V); eliminates unnecessary requirements from the utilization threshold program (Part W); relates to marriage certificates (Part Y); relates to malpractice and professional medical conduct; relates to malpractice and professional medical conduct; extends certain provisions concerning the hospital excess liability pool; amends the New York Health Care Reform Act of 1996 and other laws relating to extending certain provisions; extends provisions relating to excess coverage (Part Z); relates to clarifying provisions regarding emergency medical services and surprise bills (Subpart A); relates to the federal no surprises act (Subpart B); relates to administrative simplification (Subpart C) (Part AA); extends various provisions relating to health and mental hygiene; relates to payment by governmental agencies for general hospital inpatient services; relates to the general public health work program; relates to rates for residential health care facilities; authorizes pharmacists to perform collaborative drug therapy management with physicians in certain settings; authorizes reimbursements for expenditures made by or on behalf of social services districts for medical assistance for needy persons and administration thereof; directs the department of health to convene a work group on rare diseases; creates the radon task force (Part CC); establishes a cost of living adjustment for designated human services programs (Part DD); relates to a 9-8-8 suicide prevention and behavioral health crisis hotline system (Part EE); relates to reinvesting savings recouped from behavioral health transition into managed care back into behavioral health services (Part FF); relates to waiver of certain regulations (Part GG); relates to community residences for addiction (Part II); relates to general hospital reimbursement for annual rates; extends government rates for behavioral services; references the office of addiction services and supports; increases Medicaid payments to providers through managed care organizations; provides equivalent fees through an ambulatory patient group methodology; extends government rates for behavioral services referencing the office of addiction services and supports (Part LL); relates to rental and mortgage payments for the mentally ill (Part NN); relates to the appointment of temporary operators for the continued operation of programs and the provision of services for persons with serious mental illness and/or developmental disabilities and/or chemical dependence (Part OO); relates to the process for the selection of fiscal intermediary services contractors for the consumer directed personal assistance program; relates to certain surveys and to the award of contracts (Part PP); relates to health homes and penalties for managed care providers; directs the department of health to establish or procure the services of an independent panel of clinical professionals and to develop and implement a uniform task-based assessment tool, in relation to prohibiting the extension of certain contracts (Part QQ); relates to the deposit of certain revenues from taxes into the New York state agency trust fund, distressed provider assistance account; relates to certain Medicaid management; repeals certain provisions relating to financially distressed hospitals (Part RR); directs the department of health to conduct a study within Kings county to determine ways to improve access to health services and facilities (Part SS); relates to general hospital inpatient reimbursement for annual rates, in relation to supplemental Medicaid managed care payments (Part TT)
STATE OF NEW YORK
________________________________________________________________________
S. 8007--C A. 9007--C
SENATE - ASSEMBLY
January 19, 2022
___________
IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti-
cle seven of the Constitution -- read twice and ordered printed, and
when printed to be committed to the Committee on Finance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to
article seven of the Constitution -- read once and referred to the
Committee on Ways and Means -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
again reported from said committee with amendments, ordered reprinted
as amended and recommitted to said committee -- again reported from
said committee with amendments, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the public health law, in relation to the implementation
of the nurses across New York (NANY) program (Part A); intentionally
omitted (Part B); to amend the public health law and the education
law, in relation to allowing pharmacists to direct limited service
laboratories and order and administer COVID-19 and influenza tests and
modernizing nurse practitioners; to amend the education law, in
relation to allowing for certain individuals to administer tests to
determine the presence of COVID-19 or its antibodies or influenza
virus in certain situations; to amend part D of chapter 56 of the laws
of 2014, amending the education law relating to enacting the "nurse
practitioners modernization act", in relation to the effectiveness
thereof; and providing for the repeal of certain provisions upon the
expiration thereof (Part C); intentionally omitted (Part D); to amend
the public health law, in relation to increasing general public health
work base grants for both full-service and partial-service counties
and allow for local health departments to claim up to fifty percent of
personnel service costs (Part E); intentionally omitted (Part F);
intentionally omitted (Part G); to amend part H of chapter 59 of the
laws of 2011, amending the public health law and other laws relating
to general hospital reimbursement for annual rates, in relation to the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD12671-06-2
S. 8007--C 2 A. 9007--C
cap on local Medicaid expenditures (Part H); to provide a one percent
across the board payment increase to all qualifying fee-for-service
Medicaid rates (Part I); to amend the public health law, in relation
to extending the statutory requirement to reweight and rebase acute
hospital rates (Part J); to amend the public health law, in relation
to the creation of a new statewide health care facility transformation
program (Part K); intentionally omitted (Part L); to amend the public
health law, in relation to the definition of revenue in the minimum
spending statute for nursing homes and the rates of payment and rates
of reimbursement for residential health care facilities, in relation
to making a temporary payment to facilities in severe financial
distress, and in relation to requiring certain percentages of revenue
be spent on direct resident care and resident-facing staffing (Part
M); intentionally omitted (Part N); to amend the social services law,
in relation to private duty nursing services reimbursement for nurses
servicing adult members; to amend the public health law, in relation
to rates of payment for continuous nursing services for certain
adults; and to amend part MM of chapter 56 of the laws of 2020 direct-
ing the department of health to establish or procure the services of
an independent panel of clinical professionals and to develop and
implement a uniform task-based assessment tool, in relation to direct-
ing the department of health to develop guidelines and standards for
the use of tasking tools (Part O); to amend the social services law
and the public health law, in relation to the essential plan and qual-
ified health plans to contract with national cancer institute-desig-
nated cancer centers, where such centers agree to certain terms and
conditions; and to require the department of health to select an inde-
pendent contractor to generate a report that reviews and makes recom-
mendations concerning the status of services offered by managed care
organizations contracting with the state to manage services provided
under the Medicaid program (Part P); intentionally omitted (Part Q);
to amend the insurance law, in relation to requiring private insurance
plans to cover abortion services without cost-sharing (Part R); inten-
tionally omitted (Part S); intentionally omitted (Part T); inten-
tionally omitted (Part U); to amend the public health law and the
insurance law, in relation to reimbursement for commercial and Medi-
caid services provided via telehealth; and providing for the repeal of
such provisions upon the expiration thereof (Part V); to amend the
social services law, in relation to eliminating unnecessary require-
ments from the utilization threshold program (Part W); intentionally
omitted (Part X); to amend the domestic relations law, in relation to
marriage certificates (Part Y); to amend chapter 266 of the laws of
1986 amending the civil practice law and rules and other laws relating
to malpractice and professional medical conduct, in relation to
extending the effectiveness of certain provisions thereof; to amend
part J of chapter 63 of the laws of 2001 amending chapter 266 of the
laws of 1986, amending the civil practice law and rules and other laws
relating to malpractice and professional medical conduct, relating to
the effectiveness of certain provisions of such chapter, in relation
to extending certain provisions concerning the hospital excess liabil-
ity pool; and to amend part H of chapter 57 of the laws of 2017,
amending the New York Health Care Reform Act of 1996 and other laws
relating to extending certain provisions relating thereto, in relation
to extending provisions relating to excess coverage (Part Z); to amend
the financial services law, the insurance law and the public health
law, in relation to clarifying provisions regarding emergency medical
S. 8007--C 3 A. 9007--C
services and surprise bills; and to repeal certain provisions of the
financial services law relating thereto (Subpart A); to amend the
insurance law and the public health law, in relation the the federal
no surprises act (Subpart B); and to amend the insurance law and the
public health law, in relation to administrative simplification
(Subpart C) (Part AA); intentionally omitted (Part BB); to amend the
social services law, the executive law and the public health law, in
relation to extending various provisions relating to health and mental
hygiene; to amend part C of chapter 58 of the laws of 2009, amending
the public health law relating to payment by governmental agencies for
general hospital inpatient services, in relation to the effectiveness
thereof; to amend part E of chapter 56 of the laws of 2013, amending
the public health law relating to the general public health work
program, in relation to the effectiveness thereof; to amend chapter
474 of the laws of 1996, amending the education law and other laws
relating to rates for residential health care facilities, in relation
to the effectiveness thereof; to amend chapter 21 of the laws of 2011,
amending the education law relating to authorizing pharmacists to
perform collaborative drug therapy management with physicians in
certain settings, in relation to the effectiveness thereof; to amend
part II of chapter 54 of the laws of 2016, amending part C of chapter
58 of the laws of 2005 relating to authorizing reimbursements for
expenditures made by or on behalf of social services districts for
medical assistance for needy persons and administration thereof, in
relation to the effectiveness thereof; to amend chapter 74 of the laws
of 2020, relating to directing the department of health to convene a
work group on rare diseases, in relation to the effectiveness thereof;
and to amend chapter 414 of the laws of 2018, creating the radon task
force, in relation to the effectiveness thereof (Part CC); establish-
ing a cost of living adjustment for designated human services programs
(Part DD); to amend the mental hygiene law, in relation to a 9-8-8
suicide prevention and behavioral health crisis hotline system (Part
EE); to amend the social services law, in relation to reinvesting
savings recouped from behavioral health transition into managed care
back into behavioral health services (Part FF); to amend part H of
chapter 57 of the laws of 2019 amending the public health law relating
to waiver of certain regulations, in relation to the effectiveness
thereof (Part GG); intentionally omitted (Part HH); to amend the
mental hygiene law, in relation to community residences for addiction
(Part II); intentionally omitted (Part JJ); intentionally omitted
(Part KK); to amend chapter 56 of the laws of 2013 amending the public
health law and other laws relating to general hospital reimbursement
for annual rates, in relation to extending government rates for behav-
ioral services and referencing the office of addiction services and
supports; to amend part H of chapter 111 of the laws of 2010 relating
to increasing Medicaid payments to providers through managed care
organizations and providing equivalent fees through an ambulatory
patient group methodology, in relation to extending government rates
for behavioral services referencing the office of addiction services
and supports and in relation to the effectiveness thereof (Part LL);
intentionally omitted (Part MM); to amend the mental hygiene law, in
relation to rental and mortgage payments for the mentally ill (Part
NN); to amend part L of chapter 59 of the laws of 2016, amending the
mental hygiene law relating to the appointment of temporary operators
for the continued operation of programs and the provision of
services for persons with serious mental illness and/or developmental
S. 8007--C 4 A. 9007--C
disabilities and/or chemical dependence, in relation to the effec-
tiveness thereof (Part OO); to amend the social services law, in
relation to the process for the selection of fiscal intermediary
services contractors for the consumer directed personal assistance
program; to repeal subdivision 4 and paragraphs (b-2) and (b-3) of
subdivision 4-a of section 365-f of the social services law relating
to certain surveys and to the award of contracts (Part PP); to amend
the social services law, part C of chapter 57 of the laws of 2018,
amending the social services law and the public health law relating to
health homes and penalties for managed care providers, and part MM of
chapter 56 of the laws of 2020, directing the department of health to
establish or procure the services of an independent panel of clinical
professionals and to develop and implement a uniform task-based
assessment tool, in relation to prohibiting the extension of certain
contracts (Part QQ); to amend the tax law, in relation to the deposit
of certain revenues from taxes into the New York state agency trust
fund, distressed provider assistance account; to amend part ZZ of
chapter 56 of the laws of 2020 amending the tax law and the social
services law relating to certain Medicaid management, in relation to
the effectiveness thereof; and to repeal certain provisions of the tax
law relating to financially distressed hospitals (Part RR); directing
the department of health to conduct a study within Kings county to
determine ways to improve access to health services and facilities
(Part SS); and to amend part H of chapter 59 of the laws of 2011,
amending the public health law and other laws, relating to general
hospital inpatient reimbursement for annual rates, in relation to
supplemental Medicaid managed care payments (Part TT)
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act enacts into law major components of legislation
2 necessary to implement the state health and mental hygiene budget for
3 the 2022-2023 state fiscal year. Each component is wholly contained
4 within a Part identified as Parts A through TT. The effective date for
5 each particular provision contained within such Part is set forth in the
6 last section of such Part. Any provision in any section contained within
7 a Part, including the effective date of the Part, which makes a refer-
8 ence to a section "of this act", when used in connection with that
9 particular component, shall be deemed to mean and refer to the corre-
10 sponding section of the Part in which it is found. Section three of this
11 act sets forth the general effective date of this act.
12 PART A
13 Section 1. Short title. This act shall be known and may be cited as
14 the "nurses across New York (NANY) program".
15 § 2. The public health law is amended by adding a new section 2807-aa
16 to read as follows:
17 § 2807-aa. Nurse loan repayment program. 1.(a) Monies shall be made
18 available, subject to appropriations, for purposes of loan repayment
19 awards in accordance with the provisions of this section for registered
20 professional nurses licensed to practice under section sixty-nine
21 hundred five of the education law and licensed practical nurses licensed
22 under section sixty-nine hundred six of the education law. Notwithstand-
S. 8007--C 5 A. 9007--C
1 ing sections one hundred twelve and one hundred sixty-three of the state
2 finance law and sections one hundred forty-two and one hundred forty-
3 three of the economic development law, or any other contrary provision
4 of law, such funding shall be allocated regionally with one-third of
5 available funds going to New York city and two-thirds of available funds
6 going to the rest of the state and shall be distributed in a manner to
7 be determined by the commissioner without a competitive bid or request
8 for proposals.
9 (i) Loan repayment awards made under this section shall be awarded to
10 repay student loans of nurses who work in areas determined to be under-
11 served areas in New York state and who agree to work in such areas for a
12 period of three consecutive years. A nurse may be deemed to be practic-
13 ing in an underserved area if they practice in a facility, physician's
14 office, nurse practitioner's office, or physician assistant's office
15 that primarily serves an underserved population, without regard to
16 whether the population or the facility or office is located in an under-
17 served area. For purposes of this section, "underserved areas" shall be
18 located in New York state and shall include, but not be limited to,
19 areas designated by the federal government as a health professional
20 shortage area, a medically underserved area, or medically underserved
21 population, non-profit diagnostic and treatment centers which primarily
22 serve Medicaid eligible or uninsured patients, and other areas and popu-
23 lations as determined by the commissioner.
24 (ii) Loan repayment awards made under this section shall not exceed
25 the total qualifying outstanding debt of the nurse from student loans to
26 cover tuition and other related educational expenses, made by or guaran-
27 teed by the federal or state government, or made by a lending or educa-
28 tional institution approved under title IV of the federal higher educa-
29 tion act. Loan repayment awards shall be used solely to repay such
30 outstanding debt.
31 (iii) Nurses shall be eligible for a loan repayment award to be deter-
32 mined by the commissioner over a three-year period distributed as
33 follows: thirty percent of total award for the first year; thirty
34 percent of total award for the second year; and any unpaid balance of
35 the total award not to exceed the maximum award amount for the third
36 year.
37 (iv) In the event that a three-year commitment under this section is
38 not fulfilled, the recipient shall be responsible for repayment of
39 amounts paid which shall be calculated in accordance with the formula
40 set forth in subdivision (b) of section two hundred fifty-four-o of
41 title forty-two of the United States Code, as amended, or any regu-
42 lations made thereunder.
43 (b) The commissioner may postpone, change or waive the service obli-
44 gation and repayment amounts set forth in subparagraphs (i) and (iv) of
45 paragraph (a) of this subdivision in individual circumstances where
46 there is compelling need or hardship.
47 2. To develop a streamlined application process for the nurse loan
48 repayment program set forth under this section, the department shall
49 appoint a stakeholder work group from recommendations made by associ-
50 ations representing nurses, general hospitals and other health care
51 facilities. Such recommendations shall be made by September thirtieth,
52 two thousand twenty-two.
53 3. In the event there are undistributed funds within amounts made
54 available for distributions under this section, such funds shall be
55 reallocated and distributed in current or subsequent distribution peri-
S. 8007--C 6 A. 9007--C
1 ods in a manner determined by the commissioner for the purpose set forth
2 in this section.
3 § 3. This act shall take effect immediately; provided, however, that
4 section two of this act shall be deemed to have been in full force and
5 effect on and after April 1, 2022.
6 PART B
7 Intentionally Omitted
8 PART C
9 Section 1. Subdivision 6 of section 571 of the public health law, as
10 amended by chapter 444 of the laws of 2013, is amended to read as
11 follows:
12 6. "Qualified health care professional" means a physician, dentist,
13 podiatrist, optometrist performing a clinical laboratory test that does
14 not use an invasive modality as defined in section seventy-one hundred
15 one of the education law, pharmacist administering COVID-19 and influen-
16 za tests pursuant to subdivision seven of section sixty-eight hundred
17 one of the education law, physician assistant, specialist assistant,
18 nurse practitioner, or midwife, who is licensed and registered with the
19 state education department.
20 § 2. Section 6801 of the education law, is amended by adding a new
21 subdivision 7 to read as follows:
22 7. A licensed pharmacist is a qualified health care professional under
23 section five hundred seventy-one of the public health law for the
24 purposes of directing a limited service laboratory and ordering and
25 administering COVID-19 and influenza tests authorized by the Food and
26 Drug Administration (FDA), subject to certificate of waiver requirements
27 established pursuant to the federal clinical laboratory improvement act
28 of nineteen hundred eighty-eight.
29 § 3. Subparagraph (iv) of paragraph (a) of subdivision 3 of section
30 6902 of the education law, as amended by section 2 of part D of chapter
31 56 of the laws of 2014, is amended to read as follows:
32 (iv) The practice protocol shall reflect current accepted medical and
33 nursing practice[. The protocols shall be filed with the department
34 within ninety days of the commencement of the practice] and may be
35 updated periodically. The commissioner shall make regulations establish-
36 ing the procedure for the review of protocols and the disposition of any
37 issues arising from such review.
38 § 4. Paragraph (b) of subdivision 3 of section 6902 of the education
39 law, as added by section 2 of part D of chapter 56 of the laws of 2014,
40 is amended to read as follows:
41 (b) Notwithstanding subparagraph (i) of paragraph (a) of this subdivi-
42 sion, a nurse practitioner, certified under section sixty-nine hundred
43 ten of this article and practicing for more than three thousand six
44 hundred hours [may comply with this paragraph in lieu of complying]
45 shall not be required to comply with the requirements of paragraph (a)
46 of this subdivision relating to collaboration with a physician, a writ-
47 ten practice agreement and written practice protocols. [A nurse practi-
48 tioner complying with this paragraph shall have collaborative relation-
49 ships with one or more licensed physicians qualified to collaborate in
50 the specialty involved or a hospital, licensed under article twenty-
51 eight of the public health law, that provides services through licensed
S. 8007--C 7 A. 9007--C
1 physicians qualified to collaborate in the specialty involved and having
2 privileges at such institution. As evidence that the nurse practitioner
3 maintains collaborative relationships, the nurse practitioner shall
4 complete and maintain a form, created by the department, to which the
5 nurse practitioner shall attest, that describes such collaborative
6 relationships. For purposes of this paragraph, "collaborative relation-
7 ships" shall mean that the nurse practitioner shall communicate, whether
8 in person, by telephone or through written (including electronic) means,
9 with a licensed physician qualified to collaborate in the specialty
10 involved or, in the case of a hospital, communicate with a licensed
11 physician qualified to collaborate in the specialty involved and having
12 privileges at such hospital, for the purposes of exchanging information,
13 as needed, in order to provide comprehensive patient care and to make
14 referrals as necessary. Such form shall also reflect the nurse practi-
15 tioner's acknowledgement that if reasonable efforts to resolve any
16 dispute that may arise with the collaborating physician or, in the case
17 of a collaboration with a hospital, with a licensed physician qualified
18 to collaborate in the specialty involved and having privileges at such
19 hospital, about a patient's care are not successful, the recommendation
20 of the physician shall prevail. Such form shall be updated as needed and
21 may be subject to review by the department. The nurse practitioner shall
22 maintain documentation that supports such collaborative relationships.
23 Failure to comply with the requirements found in this paragraph by a
24 nurse practitioner who is not complying with such provisions of para-
25 graph (a) of this subdivision, shall be subject to professional miscon-
26 duct provisions as set forth in article one hundred thirty of this
27 title.]
28 § 5. Section 3 of part D of chapter 56 of the laws of 2014, amending
29 the education law relating to enacting the "nurse practitioners modern-
30 ization act", as amended by section 10 of part S of chapter 57 of the
31 laws of 2021, is amended to read as follows:
32 § 3. This act shall take effect on the first of January after it shall
33 have become a law [and shall expire June 30 of the seventh year after it
34 shall have become a law, when upon such date the provisions of this act
35 shall be deemed repealed]; provided, however, that effective immediate-
36 ly, the addition, amendment and/or repeal of any rule or regulation
37 necessary for the implementation of this act on its effective date is
38 authorized and directed to be made and completed on or before such
39 effective date.
40 § 6. Subdivision 6 of section 6527 of the education law is amended by
41 adding a new paragraph (h) to read as follows:
42 (h) administering tests to determine the presence of COVID-19 or its
43 antibodies or influenza virus.
44 § 7. Subdivision 4 of section 6909 of the education law is amended by
45 adding a new paragraph (h) to read as follows:
46 (h) administering tests to determine the presence of COVID-19 or its
47 antibodies or influenza virus.
48 § 8. This act shall take effect immediately and shall be deemed to
49 have been in full force and effect on and after April 1, 2022; provided,
50 however, that sections one, two, three, four, six and seven of this act
51 shall expire and be deemed repealed two years after it shall have become
52 a law.
53 PART D
54 Intentionally Omitted
S. 8007--C 8 A. 9007--C
1 PART E
2 Section 1. Subdivision 1 of section 605 of the public health law, as
3 amended by section 20 of part E of chapter 56 of the laws of 2013, is
4 amended to read as follows:
5 1. A state aid base grant shall be reimbursed to municipalities for
6 the core public health services identified in section six hundred two of
7 this title, in an amount of the greater of [sixty-five] one dollar and
8 thirty cents per capita, for each person in the municipality, or [six
9 hundred fifty thousand dollars] seven hundred fifty thousand dollars,
10 provided that the municipality expends at least [six hundred fifty thou-
11 sand dollars] seven hundred fifty thousand dollars, for such core public
12 health services. A municipality must provide all the core public health
13 services identified in section six hundred two of this title to qualify
14 for such base grant unless the municipality has the approval of the
15 commissioner to expend the base grant on a portion of such core public
16 health services. If any services in such section are not provided, the
17 commissioner [may] shall limit the municipality's per capita or base
18 grant to reflect the scope of the reduced services, in an amount not to
19 exceed five hundred seventy-seven thousand five hundred dollars. The
20 commissioner may use the amount that is not granted to contract with
21 agencies, associations, or organizations to provide such services; or
22 the health department may use such proportionate share to provide the
23 services upon approval of the director of the division of the budget.
24 § 2. Subdivision 2 of section 605 of the public health law, as amended
25 by section 1 of part O of chapter 57 of the laws of 2019, is amended to
26 read as follows:
27 2. State aid reimbursement for public health services provided by a
28 municipality under this title, shall be made if the municipality is
29 providing some or all of the core public health services identified in
30 section six hundred two of this title, pursuant to an approved applica-
31 tion for state aid, at a rate of no less than thirty-six per centum,
32 except for the city of New York which shall receive no less than twenty
33 per centum, of the difference between the amount of moneys expended by
34 the municipality for public health services required by section six
35 hundred two of this title during the fiscal year and the base grant
36 provided pursuant to subdivision one of this section. Provided, however,
37 that a municipality's documented fringe benefit costs submitted under an
38 application for state aid and otherwise eligible for reimbursement under
39 this article shall not exceed fifty per centum of the municipality's
40 eligible personnel services. No such reimbursement shall be provided for
41 services that are not eligible for state aid pursuant to this article.
42 § 3. Subdivision 2 of section 616 of the public health law, as added
43 by chapter 901 of the laws of 1986, is amended and a new subdivision 4
44 is added to read as follows:
45 2. No payments shall be made from moneys appropriated for the purpose
46 of this article to a municipality for contributions by the municipality
47 for indirect costs [and fringe benefits, including but not limited to,
48 employee retirement funds, health insurance and federal old age and
49 survivors insurance].
50 4. Moneys appropriated for the purposes of this article to a munici-
51 pality may include reimbursement of a municipality's fringe benefits,
52 including but not limited to employee retirement funds, health insurance
53 and federal old age and survivor's insurance. However, costs submitted
54 under an application for state aid must be consistent with a munici-
S. 8007--C 9 A. 9007--C
1 pality's documented fringe benefit costs and shall not exceed fifty per
2 centum of the municipality's eligible personnel services.
3 § 4. This act shall take effect immediately and shall be deemed to
4 have been in full force and effect on and after April 1, 2022.
5 PART F
6 Intentionally Omitted
7 PART G
8 Intentionally Omitted
9 PART H
10 Section 1. Subdivision 1 of section 91 of part H of chapter 59 of the
11 laws of 2011, amending the public health law and other laws relating to
12 general hospital reimbursement for annual rates, as amended by section 2
13 of part A of chapter 56 of the laws of 2013, is amended to read as
14 follows:
15 1. Notwithstanding any inconsistent provision of state law, rule or
16 regulation to the contrary, subject to federal approval, the year to
17 year rate of growth of department of health state funds Medicaid spend-
18 ing shall not exceed the [ten] five year rolling average of the [medical
19 component of the consumer price index as published by the United States
20 department of labor, bureau of labor statistics,] Medicaid spending
21 annual growth rate projections within the National Health Expenditure
22 Accounts produced by the office of the actuary in the federal Centers
23 for Medicare and Medicaid services for the preceding [ten] five years;
24 provided, however, that for state fiscal year 2013-14 and for each
25 fiscal year thereafter, the maximum allowable annual increase in the
26 amount of department of health state funds Medicaid spending shall be
27 calculated by multiplying the department of health state funds Medicaid
28 spending for the previous year, minus the amount of any department of
29 health state operations spending included therein, by such [ten] five
30 year rolling average.
31 § 2. Paragraph (a) of subdivision 1 of section 92 of part H of chapter
32 59 of the laws of 2011, amending the public health law and other laws
33 relating to general hospital reimbursement for annual rates, as amended
34 by section 1 of part A of chapter 57 of the laws of 2021, is amended to
35 read as follows:
36 (a) For state fiscal years 2011-12 through [2021-22] 2023-24, the
37 director of the budget, in consultation with the commissioner of health
38 referenced as "commissioner" for purposes of this section, shall assess
39 on a quarterly basis, as reflected in quarterly reports pursuant to
40 subdivision five of this section known and projected department of
41 health state funds medicaid expenditures by category of service and by
42 geographic regions, as defined by the commissioner.
43 § 3. Subdivision 5 of section 92 of part H of chapter 59 of the laws
44 of 2011, amending the public health law and other laws relating to
45 general hospital reimbursement for annual rates, as amended by section 2
46 of part A of chapter 57 of the laws of 2021, is amended to read as
47 follows:
48 5. The commissioner of health, in consultation with the director of
49 budget, shall prepare a quarterly report that sets forth:
S. 8007--C 10 A. 9007--C
1 (a) known and projected department of health medicaid expenditures as
2 described in subdivision one of this section, and factors that could
3 result in medicaid disbursements for the relevant state fiscal year to
4 exceed the projected department of health state funds disbursements in
5 the enacted budget financial plan pursuant to subdivision 3 of section
6 23 of the state finance law, including spending increases or decreases
7 due to: enrollment fluctuations, rate changes, utilization changes, MRT
8 investments, [and] shift of beneficiaries to managed care; [and] vari-
9 ations in offline medicaid payments; the methodology by which such
10 projections are compiled or determined; and for periods following April
11 1, 2022, the projected savings or investment from the enacted budget
12 that implemented the program or initiative, along with the actual or
13 known savings or investment from such program or initiative;
14 (b) the actions taken to implement any medicaid savings allocation
15 adjustment implemented pursuant to subdivisions one and four of this
16 section, including information concerning the impact of such actions on
17 each category of service and each geographic region of the state.
18 (c) The price, to include the base rate plus any upcoming rate adjust-
19 ment; utilization, to include current enrollment, projected enrollment
20 changes and acuity; and, to the extent practicable, Medicaid Redesign
21 Team initiatives, one-time initiatives and other initiatives describing
22 the proposed budget action impact, any prior year initiative with
23 current and future year impacts for the following categories of spend-
24 ing:
25 (i) inpatient;
26 (ii) outpatient;
27 (iii) emergency room;
28 (iv) clinic;
29 (v) nursing homes;
30 (vi) other long term care;
31 (vii) medicaid managed care;
32 (viii) family health plus;
33 (ix) pharmacy;
34 (x) transportation;
35 (xi) dental;
36 (xii) non-institutional and all other categories;
37 (xiii) affordable housing;
38 (xiv) vital access provider services;
39 (xv) behavioral health vital access provider services;
40 (xvi) health home establishment grants;
41 (xvii) grants for facilitating transition of behavioral health service
42 to managed care;
43 (xviii) Finger Lakes health services agency;
44 (xix) the transition of vulnerable populations to managed care;
45 (xx) audit recoveries and settlements; [and]
46 (xxi) vital access provider assurance program;
47 (xxii) home care;
48 (xxiii) personal care, including consumer directed personal assistance
49 program;
50 (xxiv) any programs that were instituted subsequent to the last report
51 issued under this subdivision and not reported; and
52 (d) where price and utilization are not applicable, detail shall be
53 provided on spending, to include but not be limited to:
54 (i) demographic information of targeted recipients;
55 (ii) number of recipients;
56 (iii) award amounts;
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1 (iv) timing of awards; and
2 (v) the impact of Medicaid Redesign Team and/or one-time initiatives.
3 Information required by paragraphs (a) and (b) of this subdivision
4 shall be provided to the chairs of the senate finance and the assembly
5 ways and means committees, and shall be posted on the department of
6 health's website in the timely manner.
7 (e) Beginning on July 1, 2014, additional information required by
8 paragraphs (c) and (d) of this subdivision shall be provided to the
9 governor, the temporary president of the senate, the speaker of the
10 assembly, the chair of the senate finance committee, the chair of the
11 assembly ways and means committee, and the chairs of the senate and
12 assembly health committees.
13 (f) any projected Medicaid savings determined by the commissioner of
14 health pursuant to section 34 of part C of a chapter of the laws of
15 2014, relating to the implementation of the health and mental hygiene
16 budget, and the proposed allocation plan spending adjustment with regard
17 to such savings.
18 (g) any material impact to the global cap annual projection, along
19 with an explanation of the variance from the projection at the time of
20 the enacted budget. Such material impacts shall include, but not be
21 limited to, policy and programmatic changes, significant transactions,
22 and any actions taken, administrative or otherwise, which would mate-
23 rially impact expenditures under the global cap. Reporting requirements
24 under this paragraph shall include material impacts from the preceding
25 quarter and any anticipated material impacts for the quarter in which
26 the report required under this subdivision is issued, as well as antic-
27 ipated material impacts for the quarter subsequent to such report. The
28 report will also include, to the extent practicable, an appendix that
29 will provide, including but not limited to: (1) the methodology by which
30 projections for such material impacts are compiled or determined; (2)
31 program trends, including enrollment actuals and projections; (3) detail
32 on the anticipated spending outside of the Global Cap relating to DOH
33 Medicaid; (4) detail on the anticipated and projected mental hygiene
34 stabalization fund transfer; (5) the number of fiscal intermediaries
35 contracted with the Department of Health; (6) links to the approved
36 fee-for-service rates for general hospitals, inclusive of any rate
37 appeals and rate adjustments; and (7) links to the approved fee-for-ser-
38 vice rates of pharmaceutical drugs on the preferred drug list.
39 § 4. This act shall take effect immediately and shall be deemed to
40 have been in full force and effect on and after April 1, 2022.
41 PART I
42 Section 1. 1. Notwithstanding any provision of law to the contrary,
43 for the state fiscal years beginning April 1, 2022, and thereafter, all
44 department of health Medicaid payments made for services provided on and
45 after April 1, 2022, shall be subject to a uniform rate increase of one
46 percent, subject to the approval of the commissioner of the department
47 of health and director of the budget. Such rate increase shall be
48 subject to federal financial participation.
49 2. The following types of payments shall be exempt from increases
50 pursuant to this section:
51 (a) payments that would violate federal law including, but not limited
52 to, hospital disproportionate share payments that would be in excess of
53 federal statutory caps;
S. 8007--C 12 A. 9007--C
1 (b) payments made by other state agencies including, but not limited
2 to, those made pursuant to articles 16, 31 and 32 of the mental hygiene
3 law;
4 (c) payments the state is obligated to make pursuant to court orders
5 or judgments;
6 (d) payments for which the non-federal share does not reflect any
7 state funding; and
8 (e) at the discretion of the commissioner of health and the director
9 of the budget, payments with regard to which it is determined that
10 application of increases pursuant to this section would result, by oper-
11 ation of federal law, in a lower federal medical assistance percentage
12 applicable to such payments.
13 § 2. This act shall take effect immediately and shall be deemed to
14 have been in full force and effect on and after April 1, 2022.
15 PART J
16 Section 1. Paragraph (c) of subdivision 35 of section 2807-c of the
17 public health law, as amended by section 32 of part C of chapter 60 of
18 the laws of 2014, is amended to read as follows:
19 (c) 1. The base period reported costs and statistics used for rate-
20 setting for operating cost components, including the weights assigned to
21 diagnostic related groups, shall be updated no less frequently than
22 every four years and the new base period shall be no more than four
23 years prior to the first applicable rate period that utilizes such new
24 base period provided, however, that the first updated base period shall
25 begin on or after April first, two thousand fourteen, but no later than
26 July first, two thousand fourteen; and further provided that the updated
27 base period subsequent to July first, two thousand eighteen shall begin
28 on or after January first, two thousand twenty-four.
29 2. In the event of a declaration of a federal public health emergency,
30 as defined in 42 USC § 247d, or a state disaster emergency, as defined
31 in section twenty of the executive law, that severely impacts general
32 hospitals within the state, the department may exclude, for purposes of
33 this paragraph, the audited reported costs and statistics during such
34 declaration.
35 § 2. This act shall take effect immediately and shall be deemed to
36 have been in full force and effect on and after April 1, 2022.
37 PART K
38 Section 1. The public health law is amended by adding a new section
39 2825-g to read as follows:
40 § 2825-g. Health care facility transformation program: statewide IV.
41 1. A statewide health care facility transformation program is hereby
42 established within the department for the purpose of transforming, rede-
43 signing, and strengthening quality health care services in alignment
44 with statewide and regional health care needs, and in the ongoing
45 pandemic response. The program shall also provide funding, subject to
46 lawful appropriation, in support of capital projects that facilitate
47 furthering such transformational goals.
48 2. The commissioner shall enter into an agreement with the president
49 of the dormitory authority of the state of New York pursuant to section
50 sixteen hundred eighty-r of the public authorities law, which shall
51 apply to this agreement, subject to the approval of the director of the
52 division of the budget, for the purposes of the distribution and admin-
S. 8007--C 13 A. 9007--C
1 istration of available funds pursuant to such agreement, and made avail-
2 able pursuant to this section and appropriation. Such funds may be
3 awarded and distributed by the department for grants to health care
4 providers including but not limited to, hospitals, residential health
5 care facilities, adult care facilities licensed under title two of arti-
6 cle seven of the social services law, diagnostic and treatment centers
7 licensed or granted an operating certificate under this chapter, clin-
8 ics, including but not limited to those licensed or granted an operating
9 certificate under this chapter or the mental hygiene law, children's
10 residential treatment facilities licensed under article thirty-one of
11 the mental hygiene law, assisted living programs approved by the depart-
12 ment pursuant to section four hundred sixty-one-l of the social services
13 law, behavioral health facilities licensed or granted an operating
14 certificate pursuant to articles thirty-one and thirty-two of the mental
15 hygiene law, home care providers certified or licensed under article
16 thirty-six of this chapter, primary care providers, hospices licensed or
17 granted an operating certificate pursuant to article forty of this chap-
18 ter, community-based programs funded under the office of mental health,
19 the office of addiction services and supports, the office for people
20 with developmental disabilities, or through local governmental units as
21 defined under article forty-one of the mental hygiene law, independent
22 practice associations or organizations, and residential facilities or
23 day program facilities licensed or granted an operating certificate
24 under article sixteen of the mental hygiene law. A copy of such agree-
25 ment, and any amendments thereto, shall be provided by the department to
26 the chair of the senate finance committee, the chair of the assembly
27 ways and means committee, and the director of the division of the budget
28 no later than thirty days after such agreement is finalized. Projects
29 awarded, in whole or part, under sections twenty-eight hundred twenty-
30 five-a and twenty-eight hundred twenty-five-b of this article shall not
31 be eligible for grants or awards made available under this section.
32 3. Notwithstanding subdivision two of this section or any inconsistent
33 provision of law to the contrary, and upon approval of the director of
34 the budget, the commissioner may, subject to the availability of lawful
35 appropriation, award up to four hundred fifty million dollars of the
36 funds made available pursuant to this section for unfunded project
37 applications submitted in response to the request for application number
38 18406 issued by the department on September thirtieth, two thousand
39 twenty-one pursuant to section twenty-eight hundred twenty-five-f of
40 this article. Authorized amounts to be awarded pursuant to applications
41 submitted in response to the request for application number 18406 shall
42 be awarded no later than December thirty-first, two thousand twenty-two.
43 Provided, however, that a minimum of:
44 (a) twenty-five million dollars of total awarded funds shall be made
45 to community-based health care providers, which for purposes of this
46 section shall be defined as diagnostic and treatment centers licensed or
47 granted an operating certificate under this chapter; independent prac-
48 tice associations or organizations; home care providers certified or
49 licensed pursuant to article thirty-six of this chapter; and hospices
50 licensed or granted an operating certificate pursuant to article forty
51 of this chapter;
52 (b) twenty-five million dollars of total awarded funds shall be made
53 to a mental health clinic licensed or granted an operating certificate
54 under article thirty-one of the mental hygiene law; alcohol and
55 substance use disorder treatment clinics licensed or granted an operat-
56 ing certificate under article thirty-two of the mental hygiene law;
S. 8007--C 14 A. 9007--C
1 clinics licensed or granted an operating certificate under article
2 sixteen of the mental hygiene law; and community-based programs funded
3 under the office of mental health or the office of addiction services
4 and supports or through local governmental units as defined under arti-
5 cle forty-one of the mental hygiene law; and
6 (c) fifty million dollars of total awarded funds shall be made to
7 residential health care facilities or adult care facilities licensed
8 under title two of article seven of the social services law.
9 4. Notwithstanding sections one hundred twelve and one hundred sixty-
10 three of the state finance law, sections one hundred forty-two and one
11 hundred forty-three of the economic development law, or any inconsistent
12 provision of law to the contrary, up to two hundred million dollars of
13 the funds appropriated for this program shall be awarded, without a
14 competitive bid or request for proposal process, for grants to health
15 care providers for purposes of modernization of an emergency department
16 of regional significance. For purposes of this subdivision, an emergency
17 department shall be considered to have regional significance if it: (a)
18 serves as Level 1 trauma center with the highest volume in its region;
19 (b) includes the capacity to segregate patients with communicable
20 diseases, trauma or severe behavioral health issues from other patients
21 in the emergency department; (c) provides training in emergency care and
22 trauma care to residents from multiple hospitals in the region; and (d)
23 serves a high proportion of Medicaid patients.
24 5. (a) Notwithstanding sections one hundred twelve and one hundred
25 sixty-three of the state finance law, sections one hundred forty-two and
26 one hundred forty-three of the economic development law, or any incon-
27 sistent provision of law to the contrary, up to seven hundred fifty
28 million dollars of the funds appropriated for this program shall be
29 awarded, without a competitive bid or request for proposal process, for
30 grants to health care providers, as defined in subdivision two of this
31 section.
32 (b) Awards made pursuant to this subdivision shall provide funding
33 only for capital projects, to the extent lawful appropriation and fund-
34 ing is available, to build innovative, patient-centered models of care,
35 increase access to care, to improve the quality of care and to ensure
36 financial sustainability of health care providers.
37 (c) Provided, however, that a minimum of:
38 (i) twenty-five million dollars of total awarded funds shall be made
39 to community-based health care providers, which for purposes of this
40 section shall be defined as diagnostic and treatment centers licensed or
41 granted an operating certificate pursuant to this chapter; independent
42 practice associations or organizations; home care providers certified or
43 licensed pursuant to article thirty-six of this chapter; and hospices
44 licensed or granted an operating certificate pursuant to article forty
45 of this chapter;
46 (ii) twenty-five million dollars of total awarded funds shall be made
47 to a mental health clinic licensed or granted an operating certificate
48 under article thirty-one of the mental hygiene law; alcohol and
49 substance use disorder treatment clinics licensed or granted an operat-
50 ing certificate under article thirty-two of the mental hygiene law;
51 clinics licensed or granted an operating certificate under article
52 sixteen of the mental hygiene law; and community-based programs funded
53 under the office of mental health or the office of addiction services
54 and supports or through local governmental units as defined under arti-
55 cle forty-one of the mental hygiene law; and
S. 8007--C 15 A. 9007--C
1 (iii) twenty-five million dollars of total awarded funds shall be made
2 to residential health care facilities or adult care facilities licensed
3 under title two of article seven of the social services law.
4 6. Notwithstanding sections one hundred twelve and one hundred sixty-
5 three of the state finance law, sections one hundred forty-two and one
6 hundred forty-three of the economic development law, or any inconsistent
7 provision of law to the contrary, up to one hundred fifty million
8 dollars of the funds appropriated for this program shall be awarded,
9 without a competitive bid or request for proposal process, for techno-
10 logical and telehealth transformation projects.
11 7. Notwithstanding sections one hundred twelve and one hundred sixty-
12 three of the state finance law, sections one hundred forty-two and one
13 hundred forty-three of the economic development law, or any inconsistent
14 provision of law to the contrary, up to fifty million dollars of the
15 funds appropriated for this program shall be awarded, without a compet-
16 itive bid or a request for proposal process, to residential and communi-
17 ty-based alternatives to the traditional model of nursing home care.
18 8. Selection of awards made by the department pursuant to subdivisions
19 three, four, five, six and seven of this section shall be contingent on
20 an evaluation process acceptable to the commissioner and approved by the
21 director of the division of the budget. Disbursement of awards may be
22 contingent on the health care provider as defined in subdivision two of
23 this section achieving certain process and performance metrics and
24 milestones that are structured to ensure that the goals of the project
25 are achieved.
26 9. The department shall provide a report on a quarterly basis to the
27 chairs of the senate finance, assembly ways and means, and senate and
28 assembly health committees, until such time as the department determines
29 that the projects that receive funding pursuant to this section are
30 substantially complete. Such reports shall be submitted no later than
31 sixty days after the close of the quarter, and shall include, for each
32 award, the name of the health care provider as defined in subdivision
33 two of this section, a description of the project or purpose, the amount
34 of the award, disbursement date, and status of achievement of process
35 and performance metrics and milestones pursuant to subdivision six of
36 this section.
37 § 2. This act shall take effect immediately and shall be deemed to
38 have been in full force and effect on and after April 1, 2022.
39 PART L
40 Intentionally Omitted
41 PART M
42 Section 1. Paragraph (a) of subdivision 2 of section 2828 of the
43 public health law, as added by section 1 of part GG of chapter 57 of the
44 laws of 2021, is amended to read as follows:
45 (a) "Revenue" shall mean the total operating revenue from or on behalf
46 of residents of the residential health care facility, government payers,
47 or third-party payers, to pay for a resident's occupancy of the residen-
48 tial health care facility, resident care, and the operation of the resi-
49 dential health care facility as reported in the residential health care
50 facility cost reports submitted to the department; provided, however,
51 that revenue shall exclude:
S. 8007--C 16 A. 9007--C
1 (i) the average increase in the capital portion of the Medicaid
2 reimbursement rate from the prior three years;
3 (ii) funding received as reimbursement for the assessment under
4 subparagraph (vi) of paragraph (b) of subdivision two of section twen-
5 ty-eight hundred seven-d of this article, as reconciled pursuant to
6 paragraph (c) of subdivision ten of section twenty-eight hundred seven-d
7 of this article;
8 (iii) the capital per diem portion of the reimbursement rate for nurs-
9 ing homes that have an overall four- or five-star rating assigned pursu-
10 ant to the inspection rating system of the U.S. Centers for Medicare and
11 Medicaid Services (CMS rating), provided however that such exclusion
12 shall not apply to any amount of the capital per diem portion of the
13 reimbursement rate that is attributable to a capital expenditure made to
14 a corporation, other entity, or individual, with a common or familial
15 ownership to the operator or the facility as reported under subdivision
16 one of section twenty-eight hundred three-x of this chapter; and
17 (iv) any grant funds from the federal government for reimbursement of
18 COVID-19 pandemic-related expenses, including but not limited to funds
19 received from the federal emergency management agency or health
20 resources and services administration.
21 § 2. Paragraph (d) of subdivision 2-c of section 2808 of the public
22 health law, as amended by section 26-a of part C of chapter 60 of the
23 laws of 2014, is amended to read as follows:
24 (d) The commissioner shall promulgate regulations, and may promulgate
25 emergency regulations, to implement the provisions of this subdivision.
26 Such regulations shall be developed in consultation with the nursing
27 home industry and advocates for residential health care facility resi-
28 dents and, further, the commissioner shall provide notification concern-
29 ing such regulations to the chairs of the senate and assembly health
30 committees, the chair of the senate finance committee and the chair of
31 the assembly ways and means committee. Such regulations shall include
32 provisions for rate adjustments or payment enhancements to facilitate a
33 minimum four-year transition of facilities to the rate-setting methodol-
34 ogy established by this subdivision and may also include, but not be
35 limited to, provisions for facilitating quality improvements in residen-
36 tial health care facilities. For purposes of facilitating quality
37 improvements through the establishment of a nursing home quality pool to
38 be funded at the discretion of the commissioner by (i) adjustments in
39 medical assistance rates, (ii) funds made available through state appro-
40 priations, or (iii) a combination thereof, those facilities that
41 contribute to the quality pool, but are deemed ineligible for quality
42 pool payments due exclusively to a specific case of employee misconduct,
43 shall nevertheless be eligible for a quality pool payment if the facili-
44 ty properly reported the incident, did not receive a survey citation
45 from the commissioner or the Centers for Medicare and Medicaid Services
46 establishing the facility's culpability with regard to such misconduct
47 and, but for the specific case of employee misconduct, the facility
48 would have otherwise received a quality pool payment. Regulations
49 pertaining to the facilitation of quality improvement may be made effec-
50 tive for periods on and after January first, two thousand thirteen.
51 § 3. The opening paragraph and paragraph (i) of subdivision (g) of
52 section 2826 of the public health law, as added by section 6 of part J
53 of chapter 60 of the laws of 2015, are amended to read as follows:
54 Notwithstanding subdivision (a) of this section, and within amounts
55 appropriated for such purposes as described herein, for the period of
56 April first, two thousand [fifteen] twenty-two through March thirty-
S. 8007--C 17 A. 9007--C
1 first, two thousand [sixteen] twenty-three, the commissioner may award a
2 temporary adjustment to the non-capital components of rates, or make
3 temporary lump-sum Medicaid payments to eligible [general hospitals]
4 facilities in severe financial distress to enable such facilities to
5 maintain operations and vital services while such facilities establish
6 long term solutions to achieve sustainable health services. Provided,
7 however, the commissioner is authorized to make such a temporary adjust-
8 ment or make such temporary lump sum payment only pursuant to criteria,
9 an evaluation process, and transformation plan acceptable to the commis-
10 sioner in consultation with the director of the division of the budget.
11 The department shall publish on its website the criteria, evaluation
12 process and guidance for transformation plans and notification of any
13 award recipients.
14 (i) Eligible [general hospitals] facilities shall include:
15 (A) a public hospital, which for purposes of this subdivision, shall
16 mean a general hospital operated by a county or municipality, but shall
17 exclude any such hospital operated by a public benefit corporation;
18 (B) a federally designated critical access hospital;
19 (C) a federally designated sole community hospital; [or]
20 (D) a residential health care facility;
21 (E) a general hospital that is a safety net hospital, which for
22 purpose of this subdivision shall mean:
23 (1) such hospital has at least thirty percent of its inpatient
24 discharges made up of Medicaid eligible individuals, uninsured individ-
25 uals or Medicaid dually eligible individuals and with at least thirty-
26 five percent of its outpatient visits made up of Medicaid eligible indi-
27 viduals, uninsured individuals or Medicaid dually-eligible individuals;
28 or
29 (2) such hospital serves at least thirty percent of the residents of a
30 county or a multi-county area who are Medicaid eligible individuals,
31 uninsured individuals or Medicaid dually-eligible individuals; or
32 (F) an independent practice association or accountable care organiza-
33 tion authorized under applicable regulations that participate in managed
34 care provider network arrangements with any of the provider types in
35 subparagraphs (A) through (F) of this paragraph.
36 § 4. Paragraph (c) of subdivision 1 of section 2828 of the public
37 health law, as added by section 1 of part GG of chapter 57 of the laws
38 of 2021, is amended to read as follows:
39 (c) Such regulations shall further include at a minimum that any resi-
40 dential health care facility for which total operating revenue exceeds
41 total operating and non-operating expenses by more than five percent of
42 total operating and non-operating expenses or that fails to spend the
43 minimum amount necessary to comply with the minimum spending standards
44 for resident-facing staffing or direct resident care, calculated on an
45 annual basis, or for the year two thousand twenty-two, on a pro-rata
46 basis for only that portion of the year during which the failure of a
47 residential health care facility to spend a minimum of seventy percent
48 of revenue on direct resident care, and forty percent of revenue on
49 resident-facing staffing, may be held to be a violation of this chapter,
50 shall remit such excess revenue, or the difference between the minimum
51 spending requirement and the actual amount of spending on resident-fac-
52 ing staffing or direct care staffing, as the case may be, to the state,
53 with such excess revenue which shall be payable, in a manner to be
54 determined by such regulations, by November first in the year following
55 the year in which the expenses are incurred. The department shall
56 collect such payments by methods including, but not limited to, bringing
S. 8007--C 18 A. 9007--C
1 suit in a court of competent jurisdiction on its own behalf after giving
2 notice of such suit to the attorney general, deductions or offsets from
3 payments made pursuant to the Medicaid program, and shall deposit such
4 recouped funds into the nursing home quality pool, as set forth in para-
5 graph d of subdivision two-c of section two thousand eight hundred eight
6 of this article. Provided further that such payments of excess revenue
7 shall be in addition to and shall not affect a residential health care
8 facility's obligations to make any other payments required by state or
9 federal law into the nursing home quality pool, including but not limit-
10 ed to medicaid rate reductions required pursuant to paragraph g of
11 subdivision two-c of section two thousand eight hundred eight of this
12 article and department regulations promulgated pursuant thereto. The
13 commissioner or their designees shall have authority to audit the resi-
14 dential health care facilities' reports for compliance in accordance
15 with this section.
16 § 5. This act shall take effect immediately and shall be deemed to
17 have been in full force and effect on and after April 1, 2022.
18 PART N
19 Intentionally Omitted
20 PART O
21 Section 1. Subdivisions 2 and 3 of section 367-r of the social
22 services law, subdivision 2 as amended and subdivision 3 as added by
23 section 2 of part PP of chapter 56 of the laws of 2020, are amended to
24 read as follows:
25 2. Medically fragile children and medically fragile adults. (a) In
26 addition, the commissioner shall further increase rates for private duty
27 nursing services that are provided to medically fragile children to
28 ensure the availability of such services to such children. Furthermore,
29 no later than sixty days after the effective date of the chapter of the
30 laws of two thousand twenty-two that amended this subdivision, increased
31 rates shall be extended for private duty nursing services provided to
32 medically fragile adults. In establishing rates of payment under this
33 subdivision, the commissioner shall consider the cost neutrality of such
34 rates as related to the cost effectiveness of caring for medically frag-
35 ile children and medically fragile adults in a non-institutional setting
36 as compared to an institutional setting. Medically fragile children
37 shall, for the purposes of this subdivision, have the same meaning as in
38 subdivision three-a of section thirty-six hundred fourteen of the public
39 health law. For purposes of this subdivision, "medically fragile adult"
40 shall be defined as including but not limited to any individual who
41 previously qualified as a medically fragile child but no longer meets
42 the age requirement. Such increased rates for services rendered to such
43 children and adults may take into consideration the elements of cost,
44 geographical differentials in the elements of cost considered, economic
45 factors in the area in which the private duty nursing service is
46 provided, costs associated with the provision of private duty nursing
47 services to medically fragile children and medically fragile adults, and
48 the need for incentives to improve services and institute economies and
49 such increased rates shall be payable only to those private duty nurses
50 who can demonstrate, to the satisfaction of the department of health,
51 satisfactory training and experience to provide services to such chil-
S. 8007--C 19 A. 9007--C
1 dren and medically fragile adults. Such increased rates shall be deter-
2 mined based on application of the case mix adjustment factor for AIDS
3 home care program services rates as determined pursuant to applicable
4 regulations of the department of health. The commissioner may promulgate
5 regulations to implement the provisions of this subdivision.
6 (b) Private duty nursing services providers which have their rates
7 adjusted pursuant to paragraph (b) of subdivision one of this section
8 and paragraph (a) of this subdivision shall use such funds solely for
9 the purposes of recruitment and retention of private duty nurses or to
10 ensure the delivery of private duty nursing services to medically frag-
11 ile children and medically fragile adults and are prohibited from using
12 such funds for any other purpose. Funds provided under paragraph (b) of
13 subdivision one of this section and paragraph (a) of this subdivision
14 are not intended to supplant support provided by a local government.
15 Each such provider, with the exception of self-employed private duty
16 nurses, shall submit, at a time and in a manner to be determined by the
17 commissioner of health, a written certification attesting that such
18 funds will be used solely for the purpose of recruitment and retention
19 of private duty nurses or to ensure the delivery of private duty nursing
20 services to medically fragile children and medically fragile adults.
21 The commissioner of health is authorized to audit each such provider to
22 ensure compliance with the written certification required by this subdi-
23 vision and shall recoup all funds determined to have been used for
24 purposes other than recruitment and retention of private duty nurses or
25 the delivery of private duty nursing services to medically fragile chil-
26 dren and medically fragile adults. Such recoupment shall be in addition
27 to any other penalties provided by law.
28 (c) The commissioner of health shall, subject to the provisions of
29 paragraph (b) of this subdivision, and the provisions of subdivision
30 three of this section, and subject to the availability of federal finan-
31 cial participation, annually increase fees for the fee-for-service
32 reimbursement of private duty nursing services provided to medically
33 fragile children by fee-for-service private duty nursing services
34 providers who enroll and participate in the provider directory pursuant
35 to subdivision three of this section, over a period of three years,
36 commencing October first, two thousand twenty, by one-third annual
37 increments, until such fees for reimbursement equal the final benchmark
38 payment designed to ensure adequate access to the service. In developing
39 such benchmark the commissioner of health may utilize the average two
40 thousand eighteen Medicaid managed care payments for reimbursement of
41 such private duty nursing services. The commissioner may promulgate
42 regulations to implement the provisions of this paragraph.
43 (d) The commissioner of health shall, subject to the provisions of
44 paragraph (b) of this subdivision, and the provisions of subdivision
45 three of this section, and subject to the availability of federal finan-
46 cial participation, increase fees for the fee-for-service reimbursement
47 of private duty nursing services provided to medically fragile adults by
48 fee-for-service private duty nursing services providers who enroll and
49 participate in the provider directory pursuant to subdivision three of
50 this section, no later than sixty days after the effective date of the
51 chapter of the laws of two thousand twenty-two that amended this subdi-
52 vision, so such fees for reimbursement equal the benchmark payment
53 designed to ensure adequate access to the service. In developing such
54 benchmark the commissioner of health may utilize the average two thou-
55 sand twenty Medicaid managed care payments for reimbursement of such
S. 8007--C 20 A. 9007--C
1 private duty nursing services. The commissioner may promulgate regu-
2 lations to implement the provisions of this paragraph.
3 3. Provider directory for fee-for-service private duty nursing
4 services provided to medically fragile children and medically fragile
5 adults. The commissioner of health is authorized to establish a direc-
6 tory of qualified providers for the purpose of promoting the availabili-
7 ty and ensuring delivery of fee-for-service private duty nursing
8 services to medically fragile children [and individuals transitioning
9 out of such category of care] and medically fragile adults. Qualified
10 providers enrolling in the directory shall ensure the availability and
11 delivery of and shall provide such services to those individuals as are
12 in need of such services, and shall receive increased reimbursement for
13 such services pursuant to [paragraph] paragraphs (c) and (d) of subdivi-
14 sion two of this section. The directory shall offer enrollment to all
15 private duty nursing services providers to promote and ensure the
16 participation in the directory of all nursing services providers avail-
17 able to serve medically fragile children and medically fragile adults.
18 § 2. Subdivision 3-a of section 3614 of the public health law, as
19 amended by section 9 of part C of chapter 109 of the laws of 2006, is
20 amended to read as follows:
21 3-a. Medically fragile children and medically fragile adults. Rates
22 of payment for continuous nursing services for medically fragile chil-
23 dren and medically fragile adults provided by a certified home health
24 agency, a licensed home care services agency or a long term home health
25 care program shall be established to ensure the availability of such
26 services, whether provided by registered nurses or licensed practical
27 nurses who are employed by or under contract with such agencies or
28 programs, and shall be established at a rate that is at least equal to
29 rates of payment for such services rendered to patients eligible for
30 AIDS home care programs; provided, however, that a certified home health
31 agency, a licensed home care services agency or a long term home health
32 care program that receives such enhanced rates for continuous nursing
33 services for medically fragile children and medically fragile adults
34 shall use such enhanced rates to increase payments to registered nurses
35 and licensed practical nurses who provide such services. In the case of
36 services provided by certified home health agencies and long term home
37 health care programs through contracts with licensed home care services
38 agencies, rate increases received by such certified home health agencies
39 and long term home health care programs pursuant to this subdivision
40 shall be reflected in payments made to the registered nurses or licensed
41 practical nurses employed by such licensed home care services agencies
42 to render services to these children and medically fragile adults. In
43 establishing rates of payment under this subdivision, the commissioner
44 shall consider the cost neutrality of such rates as related to the cost
45 effectiveness of caring for medically fragile children and medically
46 fragile adults in a non-institutional setting as compared to an institu-
47 tional setting. For the purposes of this subdivision, a medically frag-
48 ile child shall mean a child who is at risk of hospitalization or insti-
49 tutionalization, including but not limited to children who are
50 technologically-dependent for life or health-sustaining functions,
51 require complex medication regimen or medical interventions to maintain
52 or to improve their health status or are in need of ongoing assessment
53 or intervention to prevent serious deterioration of their health status
54 or medical complications that place their life, health or development at
55 risk, but who are capable of being cared for at home if provided with
56 appropriate home care services, including but not limited to case
S. 8007--C 21 A. 9007--C
1 management services and continuous nursing services. The commissioner
2 shall promulgate regulations to implement provisions of this subdivision
3 and may also direct the providers specified in this subdivision to
4 provide such additional information and in such form as the commissioner
5 shall determine is reasonably necessary to implement the provisions of
6 this subdivision.
7 § 3. Section 21 of part MM of chapter 56 of the laws of 2020, direct-
8 ing the department of health to establish or procure the services of
9 an independent panel of clinical professionals and to develop and imple-
10 ment a uniform task-based assessment tool, is amended to read as
11 follows:
12 § 21. The department of health shall develop[, directly or through
13 procurement, and shall implement an evidenced based validated uniform
14 task-based assessment tool no later than April 1, 2021,] guidelines and
15 standards in consultation with subject matter experts for the use of
16 tasking tools to assist managed care plans and local departments of
17 social services to make appropriate and individualized determinations
18 for utilization of home care services in accordance with applicable
19 state and federal law and regulations, including the number of personal
20 care services and consumer directed personal assistance hours of care
21 each day[,] provided pursuant to the state's medical assistance program,
22 and how Medicaid recipients' needs for assistance with activities of
23 daily living can be met, such as through telehealth, provided that
24 services rendered via telehealth meet equivalent quality and safety
25 standards of services provided through non-electronic means, and other
26 available alternatives, including family and social supports. [Notwith-
27 standing the provisions of section 163 of the state finance law, or
28 sections 142 and 143 of the economic development law, or any contrary
29 provision of law, a contract may be entered without a competitive bid or
30 request for proposal process if such contract is for the purpose of
31 developing the evidence based validated uniform task-based assessment
32 tool described in this section, provided that:
33 (a) The department of health shall post on its website, for a period
34 of no less than 30 days:
35 (i) A description of the evidence based validated uniform task-based
36 assessment tool to be developed pursuant to the contract;
37 (ii) The criteria for contractor selection;
38 (iii) The period of time during which a prospective contractor may
39 seek to be selected by the department of health, which shall be no less
40 than 30 days after such information is first posted on the website; and
41 (iv) The manner by which a prospective contractor may submit a
42 proposal for selection, which may include submission by electronic
43 means;
44 (b) All reasonable and responsive submissions that are received from
45 prospective contractors in a timely fashion shall be reviewed by the
46 commissioner of health;
47 (c) The commissioner of health shall select such contractor that is
48 best suited to serve the purposes of this section and the needs of
49 recipients; and
50 (d) All decisions made and approaches taken pursuant to this section
51 shall be documented in a procurement record as defined in section one
52 hundred sixty-three of the state finance law.]
53 § 4. Severability clause. If any clause, sentence, paragraph, subdivi-
54 sion, section or part of this act shall be adjudged by any court of
55 competent jurisdiction to be invalid, such judgment shall not affect,
56 impair, or invalidate the remainder thereof, but shall be confined in
S. 8007--C 22 A. 9007--C
1 its operation to the clause, sentence, paragraph, subdivision, section
2 or part thereof directly involved in the controversy in which such judg-
3 ment shall have been rendered. It is hereby declared to be the intent of
4 the legislature that this act would have been enacted even if such
5 invalid provisions had not been included herein.
6 § 5. This act shall take effect immediately and shall be deemed to
7 have been in full force and effect on and after April 1, 2022.
8 PART P
9 Section 1. Notwithstanding sections 112 and 163 of the state finance
10 law, the department of health shall select an independent contractor to
11 generate a report that reviews and makes recommendations concerning the
12 status of services offered by managed care organizations contracting
13 with the state to manage services provided under the Medicaid program.
14 Such report shall be provided to the governor, the temporary president
15 of the senate and the speaker of the assembly no later than October 31,
16 2022, and shall be for the purpose of informing the development of a
17 plan to reform the delivery of services offered by managed care organ-
18 izations in the Medicaid program. The report shall include the follow-
19 ing: 1. A market assessment of the managed care organizations offering
20 products in each market, including the appropriate number of managed
21 care organizations to each region to address member needs; 2. Analysis
22 of areas of potential improvements or challenges as they relate to
23 healthcare access, delivery, outcomes, administrative costs, efficien-
24 cies and oversight that may result from competitive procurement; 3. Cost
25 savings analysis that may result from a competitive procurement, if
26 any; 4. The current approach for addressing Person Centered care for
27 people with behavioral health needs enrolled with Medicaid managed care
28 plans, including but not limited to special needs managed care organ-
29 izations authorized to offer Health and Recovery Plans (HARPs) and the
30 integration of those benefits with Mainstream Medicaid Managed Care
31 (MMMC); 5. Provider network access that may result from competitively
32 procuring plans in each region and potential improvements in standards
33 governing network adequacy; 6. Managed care enrollee service
34 disruptions that may result from competitively procuring managed care
35 plans in each region; 7. Impacts to providers that contract or are
36 affiliated with Medicaid managed care organizations that may result
37 from a competitive procurement; 8. An evaluation of new performance
38 standards or requirements that could be imposed upon Medicaid managed
39 care organizations that participate in the managed care program pursu-
40 ant to a contract with the department of health; and 9. An assessment
41 of current mechanisms for enforcement of performance requirements,
42 including but not limited to oversight of Medicaid managed care organ-
43 izations and penalties.
44 § 2. Subparagraphs (v) and (vi) of paragraph (b) of subdivision 1 of
45 section 268-d of the public health law, as added by section 2 of part T
46 of chapter 57 of the laws of 2019, are amended to read as follows:
47 (v) meets standards specified and determined by the Marketplace,
48 provided that the standards do not conflict with or prevent the applica-
49 tion of federal requirements; [and]
50 (vi) contracts with any national cancer institute-designated cancer
51 center licensed by the department within the health plan's service area
52 that is willing to agree to provide cancer-related inpatient, outpatient
53 and medical services to enrollees in all health plans offering coverage
54 through the Marketplace in such cancer center's service area under the
S. 8007--C 23 A. 9007--C
1 prevailing terms and conditions that the plan requires of other similar
2 providers to be included in the plan's provider network, provided that
3 such terms shall include reimbursement of such center at no less than
4 the fee-for-service medicaid payment rate and methodology applicable to
5 the center's inpatient and outpatient services; and
6 (vii) complies with the insurance law and this chapter requirements
7 applicable to health insurance issued in this state and any regulations
8 promulgated pursuant thereto that do not conflict with or prevent the
9 application of federal requirements; and
10 § 3. Subdivision 4 of section 364-j of the social services law is
11 amended by adding a new paragraph (w) to read as follows:
12 (w) A managed care provider shall provide or arrange, directly or
13 indirectly, including by referral, for access to and coverage of
14 services provided by any national cancer institute-designated cancer
15 center licensed by the department of health within the managed care
16 provider's service area that is willing to agree to provide cancer-re-
17 lated inpatient, outpatient and medical services to participants in all
18 managed care providers offering coverage to medical assistance recipi-
19 ents in such cancer center's service area under the prevailing terms and
20 conditions that the managed care provider requires of other similar
21 providers to be included in the managed care provider's network,
22 provided that such terms shall include reimbursement of such center at
23 no less than the fee-for-service medicaid payment rate and methodology
24 applicable to the center's inpatient and outpatient services.
25 § 4. Paragraph (c) of subdivision 1 of section 369-gg of the social
26 services law, as amended by section 2 of part H of chapter 57 of the
27 laws of 2021, is amended to read as follows:
28 (c) "Health care services" means (i) the services and supplies as
29 defined by the commissioner in consultation with the superintendent of
30 financial services, and shall be consistent with and subject to the
31 essential health benefits as defined by the commissioner in accordance
32 with the provisions of the patient protection and affordable care act
33 (P.L. 111-148) and consistent with the benefits provided by the refer-
34 ence plan selected by the commissioner for the purposes of defining such
35 benefits, and shall include coverage of and access to the services of
36 any national cancer institute-designated cancer center licensed by the
37 department of health within the service area of the approved organiza-
38 tion that is willing to agree to provide cancer-related inpatient,
39 outpatient and medical services to all enrollees in approved organiza-
40 tions' plans in such cancer center's service area under the prevailing
41 terms and conditions that the approved organization requires of other
42 similar providers to be included in the approved organization's network,
43 provided that such terms shall include reimbursement of such center at
44 no less than the fee-for-service medicaid payment rate and methodology
45 applicable to the center's inpatient and outpatient services; and (ii)
46 dental and vision services as defined by the commissioner;
47 § 5. Severability. If any clause, sentence, paragraph, section or part
48 of this act shall be adjudged by any court of competent jurisdiction to
49 be invalid and after exhaustion of all further judicial review, the
50 judgment shall not affect, impair or invalidate the remainder thereof,
51 but shall be confined in its operation to the clause, sentence, para-
52 graph, section or part of this act directly involved in the controversy
53 in which the judgment shall have been rendered.
54 § 6. Sections one and five of this act shall take effect immediately
55 and shall be deemed to have been in full force and effect on and after
56 April 1, 2022. Sections two, three, and four of this act shall take
S. 8007--C 24 A. 9007--C
1 effect on the first of January next succeeding the date on which it
2 shall have become a law and shall apply to all coverage or policies
3 issued or renewed on or after such effective date and shall expire and
4 be deemed repealed five years after such date; provided, however, that
5 the amendments to section 364-j of the social services law made by
6 section three of this act, and the amendments to paragraph (c) of subdi-
7 vision 1 of section 369-gg of the social services law made by section
8 four of this act shall not affect the repeal of such sections or such
9 paragraph and shall be deemed repealed therewith.
10 PART Q
11 Intentionally Omitted
12 PART R
13 Section 1. Subsection (i) of section 3216 of the insurance law is
14 amended by adding a new paragraph 36 to read as follows:
15 (36) (A) Every policy which provides hospital, surgical, or medical
16 coverage and which offers maternity coverage pursuant to paragraph ten
17 of this subsection shall also provide coverage for abortion services for
18 an enrollee.
19 (B) Coverage for abortion shall not be subject to annual deductibles
20 or coinsurance, including co-payments, unless the policy is a high
21 deductible health plan as defined in section 223(c)(2) of the internal
22 revenue code of 1986, in which case coverage for abortion may be subject
23 to the plan's annual deductible.
24 § 2. Subsection (k) of section 3221 of the insurance law is amended by
25 adding a new paragraph 22 to read as follows:
26 (22) (A) Every policy which provides hospital, surgical, or medical
27 coverage and which offers maternity care coverage pursuant to paragraph
28 five of this subsection shall also provide coverage for abortion
29 services for an enrollee.
30 (B) Coverage for abortion shall not be subject to annual deductibles
31 or coinsurance, including co-payments, unless the policy is a high
32 deductible health plan as defined in section 223(c)(2) of the internal
33 revenue code of 1986, in which case coverage for abortion may be subject
34 to the plan's annual deductible.
35 (C) Notwithstanding any other provision, a group policy that provides
36 hospital, surgical, or medical expense coverage delivered or issued for
37 delivery in this state to a religious employer, as defined in item one
38 of subparagraph (E) of paragraph sixteen of subsection (l) of this
39 section, may exclude coverage for abortion only if the insurer:
40 (i) obtains an annual certification from the group policyholder that
41 the policyholder is a religious employer and that the religious employer
42 requests a policy without coverage for abortion;
43 (ii) issues a rider to each certificate holder at no premium to be
44 charged to the certificate holder or religious employer for the rider,
45 that provides coverage for abortion subject to the same rules as would
46 have been applied to the same category of treatment in the policy issued
47 to the religious employer. The rider shall clearly and conspicuously
48 specify that the religious employer does not administer abortion bene-
49 fits, but that the insurer is issuing a rider for coverage of abortion,
50 and shall provide the insurer's contact information for questions; and
S. 8007--C 25 A. 9007--C
1 (iii) provides notice of the issuance of the policy and rider to the
2 superintendent in a form and manner acceptable to the superintendent.
3 § 3. Section 4303 of the insurance law is amended by adding a new
4 subsection (ss) to read as follows:
5 (ss)(1) Every policy which provides hospital, surgical, or medical
6 coverage and which offers maternity care coverage pursuant to subsection
7 (c) of this section shall also provide coverage for abortion services
8 for an enrollee.
9 (2) Coverage for abortion shall not be subject to annual deductibles
10 or coinsurance, including co-payments, unless the policy is a high
11 deductible health plan as defined in section 223(c)(2) of the internal
12 revenue code of 1986, in which case coverage for abortion may be subject
13 to the plan's annual deductible.
14 (3) Notwithstanding any other provision, a group policy that provides
15 hospital, surgical, or medical expense coverage delivered or issued for
16 delivery in this state to a religious employer, as defined in paragraph
17 five of subsection (cc) of this section, may exclude coverage for
18 abortion only if the insurer:
19 (A) obtains an annual certification from the group policy holder that
20 the policy holder is a religious employer and that the religious employ-
21 er requests a contract without coverage for abortion;
22 (B) issues a rider to each certificate holder at no premium to be
23 charged to the certificate holder or religious employer for the rider,
24 that provides coverage for abortions subject to the same rules as would
25 have been applied to the same category of treatment in the policy issued
26 to the religious employer. The rider shall clearly and conspicuously
27 specify that the religious employer does not administer abortion bene-
28 fits, but that the insurer is issuing a rider for coverage of abortion,
29 and shall provide the insurer's contact information for questions; and
30 (C) provides notice of the issuance of the policy and rider to the
31 superintendent in a form and manner acceptable to the superintendent.
32 § 4. Severability. If any provision of this act, or any application of
33 any provision of this act, is held to be invalid, or to violate or be
34 inconsistent with any federal law or regulation, that shall not affect
35 the validity or effectiveness of any other provision of this act, or of
36 any other application of any provision of this act, which can be given
37 effect without that provision or application; and to that end, the
38 provisions and applications of this act are severable.
39 § 5. This act shall take effect on the first of January next succeed-
40 ing the date on which it shall have become a law and shall apply to all
41 policies and contracts issued, renewed, modified, altered, or amended on
42 or after such date. Effective immediately, the addition, amendment, or
43 repeal of any rule or regulation necessary for the implementation of
44 this act on its effective date are authorized to be made and completed
45 on or before such effective date.
46 PART S
47 Intentionally Omitted
48 PART T
49 Intentionally Omitted
S. 8007--C 26 A. 9007--C
1 PART U
2 Intentionally omitted
3 PART V
4 Section 1. Paragraphs (x) and (y) of subdivision 2 of section 2999-cc
5 of the public health law, as amended by section 3 of part F of chapter
6 57 of the laws of 2021, are amended to read as follows:
7 (x) certified peer recovery advocate services providers certified by
8 the commissioner of addiction services and supports pursuant to section
9 19.18-b of the mental hygiene law, peer providers credentialed by the
10 commissioner of addiction services and supports and peers certified or
11 credentialed by the office of mental health; [and]
12 (y) a mental health practitioner licensed pursuant to article one
13 hundred sixty-three of the education law; and
14 (z) any other provider as determined by the commissioner pursuant to
15 regulation or, in consultation with the commissioner, by the commission-
16 er of the office of mental health, the commissioner of the office of
17 addiction services and supports, or the commissioner of the office for
18 people with developmental disabilities pursuant to regulation.
19 § 2. Subdivision 1 of section 2999-dd of the public health law, as
20 amended by chapter 124 of the laws of 2020, is amended to read as
21 follows:
22 1. Health care services delivered by means of telehealth shall be
23 entitled to reimbursement under section three hundred sixty-seven-u of
24 the social services law on the same basis, at the same rate, and to the
25 same extent the equivalent services, as may be defined in regulations
26 promulgated by the commissioner, are reimbursed when delivered in
27 person; provided, however, that health care services delivered by means
28 of telehealth shall not require reimbursement to a telehealth provider
29 for certain costs, including but not limited to facility fees or costs
30 reimbursed through ambulatory patient groups or other clinic reimburse-
31 ment methodologies set forth in section twenty-eight hundred seven of
32 this chapter, if such costs were not incurred in the provision of tele-
33 health services due to neither the originating site nor the distant site
34 occurring within a facility or other clinic setting; and further
35 provided, however, reimbursement for additional modalities, provider
36 categories and originating sites specified in accordance with section
37 twenty-nine hundred ninety-nine-ee of this article, and audio-only tele-
38 phone communication defined in regulations promulgated pursuant to
39 subdivision four of section twenty-nine hundred ninety-nine-cc of this
40 article, shall be contingent upon federal financial participation.
41 Notwithstanding the provisions of this subdivision, for services
42 licensed, certified or otherwise authorized pursuant to article sixteen,
43 article thirty-one or article thirty-two of the mental hygiene law, such
44 services provided by telehealth, as deemed appropriate by the relevant
45 commissioner, shall be reimbursed at the applicable in person rates or
46 fees established by law, or otherwise established or certified by the
47 office for people with developmental disabilities, office of mental
48 health, or the office of addiction services and supports pursuant to
49 article forty-three of the mental hygiene law.
50 § 3. Subsection (a) of section 3217-h of the insurance law, as added
51 by chapter 6 of the laws of 2015, is amended to read as follows:
S. 8007--C 27 A. 9007--C
1 (a) (1) An insurer shall not exclude from coverage a service that is
2 otherwise covered under a policy that provides comprehensive coverage
3 for hospital, medical or surgical care because the service is delivered
4 via telehealth, as that term is defined in subsection (b) of this
5 section; provided, however, that an insurer may exclude from coverage a
6 service by a health care provider where the provider is not otherwise
7 covered under the policy. An insurer may subject the coverage of a
8 service delivered via telehealth to co-payments, coinsurance or deduct-
9 ibles provided that they are at least as favorable to the insured as
10 those established for the same service when not delivered via tele-
11 health. An insurer may subject the coverage of a service delivered via
12 telehealth to reasonable utilization management and quality assurance
13 requirements that are consistent with those established for the same
14 service when not delivered via telehealth.
15 (2) An insurer that provides comprehensive coverage for hospital,
16 medical or surgical care shall reimburse covered services delivered by
17 means of telehealth on the same basis, at the same rate, and to the same
18 extent that such services are reimbursed when delivered in person;
19 provided that reimbursement of covered services delivered via telehealth
20 shall not require reimbursement of costs not actually incurred in the
21 provision of the telehealth services, including charges related to the
22 use of a clinic or other facility when neither the originating site nor
23 distant site occur within the clinic or other facility.
24 (3) An insurer that provides comprehensive coverage for hospital,
25 medical, or surgical care with a network of health care providers shall
26 ensure that such network is adequate to meet the telehealth needs of
27 insured individuals for services covered under the policy when medically
28 appropriate.
29 § 4. Subsection (a) of section 4306-g of the insurance law, as added
30 by chapter 6 of the laws of 2015, is amended to read as follows:
31 (a) (1) A corporation shall not exclude from coverage a service that
32 is otherwise covered under a contract that provides comprehensive cover-
33 age for hospital, medical or surgical care because the service is deliv-
34 ered via telehealth, as that term is defined in subsection (b) of this
35 section; provided, however, that a corporation may exclude from coverage
36 a service by a health care provider where the provider is not otherwise
37 covered under the contract. A corporation may subject the coverage of a
38 service delivered via telehealth to co-payments, coinsurance or deduct-
39 ibles provided that they are at least as favorable to the insured as
40 those established for the same service when not delivered via tele-
41 health. A corporation may subject the coverage of a service delivered
42 via telehealth to reasonable utilization management and quality assur-
43 ance requirements that are consistent with those established for the
44 same service when not delivered via telehealth.
45 (2) A corporation that provides comprehensive coverage for hospital,
46 medical or surgical care shall reimburse covered services delivered by
47 means of telehealth on the same basis, at the same rate, and to the same
48 extent that such services are reimbursed when delivered in person;
49 provided that reimbursement of covered services delivered via tele-
50 health shall not require reimbursement of costs not actually incurred
51 in the provision of the telehealth services, including charges related
52 to the use of a clinic or other facility when neither the originating
53 site nor the distant site occur within the clinic or other facility. The
54 superintendent may promulgate regulations to implement the provisions
55 of this section.
S. 8007--C 28 A. 9007--C
1 (3) A corporation that provides comprehensive coverage for hospital,
2 medical, or surgical care with a network of health care providers shall
3 ensure that such network is adequate to meet the telehealth needs of
4 insured individuals for services covered under the policy when medically
5 appropriate.
6 § 5. Section 4406-g of the public health law is amended by adding two
7 new subdivisions 3 and 4 to read as follows:
8 3. A health maintenance organization that provides comprehensive
9 coverage for hospital, medical or surgical care shall reimburse covered
10 services delivered via telehealth on the same basis, at the same rate,
11 and to the extent that such services are reimbursed when delivered in
12 person; provided that reimbursement of covered services delivered by
13 means of telehealth shall not require reimbursement of costs not actu-
14 ally incurred in the provision of the telehealth services, including
15 charges related to the use of a clinic or other facility when neither
16 the originating site nor the distant site occur within the clinic or
17 other facility. The commissioner, in consultation with the superinten-
18 dent, may promulgate regulations to implement the provisions of this
19 section.
20 4. A health maintenance organization that provides comprehensive
21 coverage for hospital, medical, or surgical care with a network of
22 health care providers shall ensure that such network is adequate to meet
23 the telehealth needs of insured individuals for services covered under
24 the policy when medically appropriate.
25 § 6. The superintendent of financial services, in collaboration with
26 the commissioner of health, shall report on the impact of reimbursement
27 for telehealth services that, pursuant to the insurance law and public
28 health law, will be reimbursed by an accident and health insurer and a
29 corporation subject to article 43 of the insurance law, including a
30 health maintenance organization, on the same basis, at the same rate,
31 and to the same extent the equivalent services are reimbursed when
32 delivered in person. The report shall, at a minimum, and to the extent
33 possible, contain information regarding the use of telehealth services
34 broken down by: social service district or county; age and gender of
35 patients; procedure codes, diagnosis codes, and associated descriptions
36 or modifiers; claims paid amount totals; claims information such as
37 categories of services, specialty or type codes; and trends in the types
38 of telehealth services used such as primary care, behavioral and mental
39 health care, and the number of telehealth visits by provider type. The
40 report shall include such utilization information dating from the effec-
41 tive date of this act and ending on the one-year anniversary of such
42 effective date, and shall be submitted to the governor, the temporary
43 president of the senate, and the speaker of the assembly by December 31,
44 2023.
45 § 7. This act shall take effect immediately and shall be deemed to
46 have been in full force and effect on and after April 1, 2022; provided,
47 however, this act shall expire and be deemed repealed on and after April
48 1, 2024.
49 PART W
50 Section 1. Section 365-g of the social services law, as added by chap-
51 ter 938 of the laws of 1990, subdivisions 1 and 3 as amended by chapter
52 165 of the laws of 1991, subdivisions 2 and 4 as amended by section 31
53 of part C of chapter 58 of the laws of 2008, clause (B) of subparagraph
54 (iii) of paragraph (b) of subdivision 3 as amended by chapter 59 of the
55 laws of 1993, subparagraphs (vi) and (vii) of paragraph (b) of subdivi-
S. 8007--C 29 A. 9007--C
1 sion 3 as amended and subparagraph (viii) as added by section 31-b of
2 part C of chapter 58 of the laws of 2008, subdivision 5 as amended by
3 chapter 41 of the laws of 1992, paragraphs (f) and (g) of subdivision 5
4 as amended by and paragraphs (h) and (i) as added by section 31-a of
5 part C of chapter 58 of the laws of 2008, is amended to read as follows:
6 § 365-g. Utilization [thresholds] review for certain care, services
7 and supplies. 1. The department may implement a system for utilization
8 [controls] review, pursuant to this section, for persons eligible for
9 benefits under this title, [including annual service limitations or
10 utilization thresholds above which the department may not pay for addi-
11 tional care, services or supplies, unless such care, services or
12 supplies have been previously approved by the department or unless such
13 care, services or supplies were provided pursuant to subdivision three,
14 four or five of this section] to evaluate the appropriateness and quali-
15 ty of medical assistance, and safeguard against unnecessary utilization
16 of care and services, which shall include a post-payment review process
17 to develop and review beneficiary utilization profiles, provider service
18 profiles, and exceptions criteria to correct misutilization practices of
19 beneficiaries and providers; and for referral to the office of Medicaid
20 inspector general where suspected fraud, waste or abuse are identified
21 in the unnecessary or inappropriate use of care, services or supplies
22 furnished under this title.
23 2. The department may [implement] review utilization [thresholds] by
24 provider service type, medical procedure and patient, in consultation
25 with the state department of mental hygiene, other appropriate state
26 agencies, and other stakeholders including provider and consumer repre-
27 sentatives. In [developing] reviewing utilization [thresholds], the
28 department shall consider historical recipient utilization patterns,
29 patient-specific diagnoses and burdens of illness, and the anticipated
30 recipient needs in order to maintain good health. The system for utili-
31 zation review shall not be used to determine a recipient's medical care,
32 services or supplies under this section.
33 3. [If the department implements a utilization threshold program, at a
34 minimum, such program must include:
35 (a) prior notice to the recipients affected by the utilization thresh-
36 old program, which notice must describe:
37 (i) the nature and extent of the utilization program, the procedures
38 for obtaining an exemption from or increase in a utilization threshold,
39 the recipients' fair hearing rights, and referral to an informational
40 toll-free hot-line operated by the department; and
41 (ii) alternatives to the utilization threshold program such as enroll-
42 ment in managed care programs and referral to preferred primary care
43 providers designated pursuant to subdivision twelve of section twenty-
44 eight hundred seven of the public health law; and
45 (b) procedures for:
46 (i) requesting an increase in amount of authorized services;
47 (ii) extending amount of authorized services when an application for
48 an increase in the amount of authorized services is pending;
49 (iii) requesting an exemption from utilization thresholds, which
50 procedure must:
51 (A) allow the recipient, or a provider on behalf of a recipient, to
52 apply to the department for an exemption from one or more utilization
53 thresholds based upon documentation of the medical necessity for
54 services in excess of the threshold,
55 (B) provided for exemptions consistent with department guidelines for
56 approving exemptions, which guidelines must be established by the
S. 8007--C 30 A. 9007--C
1 department in consultation with the department of health and, as appro-
2 priate, with the department of mental hygiene, and consistent with the
3 current regulations of the office of mental health governing outpatient
4 treatment.
5 (C) provide for an exemption when medical and clinical documentation
6 substantiates a condition of a chronic medical nature which requires
7 ongoing and frequent use of medical care, services or supplies such that
8 an increase in the amount of authorized services is not sufficient to
9 meet the medical needs of the recipient;
10 (iv) reimbursing a provider, regardless of the recipient's previous
11 use of services, when care, services or supplies are provided in a case
12 of urgent medical need, as defined by the department, or when provided
13 on an emergency basis, as defined by the department;
14 (v) notifying recipients of and referring recipients to appropriate
15 and accessible managed care programs and to preferred primary care
16 providers designated pursuant to subdivision twelve of section twenty-
17 eight hundred seven of the public health law at the same time such
18 recipients are notified that they are nearing or have reached the utili-
19 zation threshold for each specific provider type;
20 (vi) notifying recipients at the same time such recipients are noti-
21 fied that they have received an exemption from a utilization threshold,
22 an increase in the amount of authorized services, or that they are near-
23 ing or have reached their utilization threshold, of their possible
24 eligibility for federal disability benefits and directing such recipi-
25 ents to their social services district for information and assistance in
26 securing such benefits;
27 (vii) cooperating with social services districts in sharing informa-
28 tion collected and developed by the department regarding recipients'
29 medical records; and
30 (viii) assuring that no request for an increase in amount of author-
31 ized services or for an exemption from utilization thresholds shall be
32 denied unless the request is first reviewed by a health care profes-
33 sional possessing appropriate clinical expertise.
34 4.] The utilization [thresholds] review established pursuant to this
35 section shall not apply to [mental retardation and] developmental disa-
36 bilities services provided in clinics certified under article twenty-
37 eight of the public health law, or article twenty-two or article thir-
38 ty-one of the mental hygiene law.
39 [5.] 4. Utilization [thresholds] review established pursuant to this
40 section shall not apply to services, even though such services might
41 otherwise be subject to utilization [thresholds] review, when provided
42 as follows:
43 (a) through a managed care program;
44 (b) subject to prior approval or prior authorization;
45 (c) as family planning services;
46 (d) as methadone maintenance services;
47 (e) on a fee-for-services basis to in-patients in general hospitals
48 certified under article twenty-eight of the public health law or article
49 thirty-one of the mental hygiene law and residential health care facili-
50 ties, with the exception of podiatrists' services;
51 (f) for hemodialysis;
52 (g) through or by referral from a preferred primary care provider
53 designated pursuant to subdivision twelve of section twenty-eight
54 hundred seven of the public health law;
55 (h) pursuant to a court order; or
S. 8007--C 31 A. 9007--C
1 (i) as a condition of eligibility for any other public program,
2 including but not limited to public assistance.
3 [6.] 5. The department shall consult with representatives of medical
4 assistance providers, social services districts, voluntary organizations
5 that represent or advocate on behalf of recipients, the managed care
6 advisory council and other state agencies regarding the ongoing opera-
7 tion of a utilization [threshold] review system.
8 [7.] 6. On or before February first, nineteen hundred ninety-two, the
9 commissioner shall submit to the governor, the temporary president of
10 the senate and the speaker of the assembly a report detailing the imple-
11 mentation of the utilization threshold program and evaluating the
12 results of establishing utilization thresholds. Such report shall
13 include, but need not be limited to, a description of the program as
14 implemented; the number of requests for increases in service above the
15 threshold amounts by provider and type of service; the number of exten-
16 sions granted; the number of claims that were submitted for emergency
17 care or urgent care above the threshold level; the number of recipients
18 referred to managed care; an estimate of the fiscal savings to the
19 medical assistance program as a result of the program; recommendations
20 for medical condition that may be more appropriately served through
21 managed care programs; and the costs of implementing the program.
22 § 2. This act shall take effect July 1, 2022; provided, however, that:
23 a. the amendments to subdivision 5 of section 365-g of the social
24 services law made by section one of this act shall not affect the expi-
25 ration and reversion of paragraphs (f) and (g) of such subdivision
26 pursuant to subdivision (i-1) of section 79 of part C of chapter 58 of
27 the laws of 2008, as amended; and
28 b. the amendments to subdivision 5 of section 365-g of the social
29 services law made by section one of this act shall not affect the repeal
30 of paragraphs (h) and (i) of such subdivision pursuant to subdivision
31 (i-1) of section 79 of part C of chapter 58 of the laws of 2008, as
32 amended.
33 PART X
34 Intentionally Omitted
35 PART Y
36 Section 1. The domestic relations law is amended by adding a new
37 section 20-c to read as follows:
38 § 20-c. Certification of marriage; new certificate in case of subse-
39 quent change of name or gender. 1. A new marriage certificate shall be
40 issued by the town or city clerk where the marriage license and certif-
41 icate was issued, upon receipt of proper proof of a change of name or
42 gender designation. Proper proof shall consist of: (a) a judgment, order
43 or decree affirming a change of name or gender designation of either
44 party to a marriage; (b) an amended birth certificate demonstrating a
45 change of name or gender designation; (c) in the case of a change of
46 gender designation, a notarized affidavit from the individual attesting
47 to their change of gender designation; or (d) such other proof as may be
48 established by the commissioner of health.
49 2. When a new marriage certificate is made pursuant to this section,
50 the town or city clerk shall substitute such new certificate for the
51 marriage certificate then on file, if any, and shall send the state
S. 8007--C 32 A. 9007--C
1 commissioner of health a digital copy of the new marriage certificate in
2 a format prescribed by the commissioner, with the exception of the city
3 clerk of New York who shall retain their copy. The town or city clerk
4 shall make a copy of the new marriage certificate for the local record
5 and hold the contents of the original marriage certificate confidential
6 along with all supporting documentation, papers and copies pertaining
7 thereto. It shall not be released or otherwise divulged except by order
8 of a court of competent jurisdiction.
9 3. The town or city clerk shall be entitled to a fee of ten dollars
10 for the amendment and certified copy of any marriage certificate in
11 accordance with the provisions of this section.
12 4. The state commissioner of health may, in their discretion, report
13 to the attorney general any town or city clerk that, without cause,
14 fails to issue a new marriage certificate upon receipt of proper proof
15 of a change of name or gender designation in accordance with this
16 section. The attorney general shall thereupon, in the name of the state
17 commissioner of health or the people of the state, institute such action
18 or proceeding as may be necessary to compel the issuance of such new
19 marriage certificate.
20 § 2. This act shall take effect six months after it shall have become
21 a law.
22 PART Z
23 Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266
24 of the laws of 1986, amending the civil practice law and rules and other
25 laws relating to malpractice and professional medical conduct, as
26 amended by section 1 of part K of chapter 57 of the laws of 2021, is
27 amended to read as follows:
28 (a) The superintendent of financial services and the commissioner of
29 health or their designee shall, from funds available in the hospital
30 excess liability pool created pursuant to subdivision 5 of this section,
31 purchase a policy or policies for excess insurance coverage, as author-
32 ized by paragraph 1 of subsection (e) of section 5502 of the insurance
33 law; or from an insurer, other than an insurer described in section 5502
34 of the insurance law, duly authorized to write such coverage and actual-
35 ly writing medical malpractice insurance in this state; or shall
36 purchase equivalent excess coverage in a form previously approved by the
37 superintendent of financial services for purposes of providing equiv-
38 alent excess coverage in accordance with section 19 of chapter 294 of
39 the laws of 1985, for medical or dental malpractice occurrences between
40 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988,
41 between July 1, 1988 and June 30, 1989, between July 1, 1989 and June
42 30, 1990, between July 1, 1990 and June 30, 1991, between July 1, 1991
43 and June 30, 1992, between July 1, 1992 and June 30, 1993, between July
44 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995,
45 between July 1, 1995 and June 30, 1996, between July 1, 1996 and June
46 30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998
47 and June 30, 1999, between July 1, 1999 and June 30, 2000, between July
48 1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002,
49 between July 1, 2002 and June 30, 2003, between July 1, 2003 and June
50 30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005
51 and June 30, 2006, between July 1, 2006 and June 30, 2007, between July
52 1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009,
53 between July 1, 2009 and June 30, 2010, between July 1, 2010 and June
54 30, 2011, between July 1, 2011 and June 30, 2012, between July 1, 2012
S. 8007--C 33 A. 9007--C
1 and June 30, 2013, between July 1, 2013 and June 30, 2014, between July
2 1, 2014 and June 30, 2015, between July 1, 2015 and June 30, 2016,
3 between July 1, 2016 and June 30, 2017, between July 1, 2017 and June
4 30, 2018, between July 1, 2018 and June 30, 2019, between July 1, 2019
5 and June 30, 2020, between July 1, 2020 and June 30, 2021, [and] between
6 July 1, 2021 and June 30, 2022, and between July 1, 2022 and June 30,
7 2023 or reimburse the hospital where the hospital purchases equivalent
8 excess coverage as defined in subparagraph (i) of paragraph (a) of
9 subdivision 1-a of this section for medical or dental malpractice occur-
10 rences between July 1, 1987 and June 30, 1988, between July 1, 1988 and
11 June 30, 1989, between July 1, 1989 and June 30, 1990, between July 1,
12 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, between
13 July 1, 1992 and June 30, 1993, between July 1, 1993 and June 30, 1994,
14 between July 1, 1994 and June 30, 1995, between July 1, 1995 and June
15 30, 1996, between July 1, 1996 and June 30, 1997, between July 1, 1997
16 and June 30, 1998, between July 1, 1998 and June 30, 1999, between July
17 1, 1999 and June 30, 2000, between July 1, 2000 and June 30, 2001,
18 between July 1, 2001 and June 30, 2002, between July 1, 2002 and June
19 30, 2003, between July 1, 2003 and June 30, 2004, between July 1, 2004
20 and June 30, 2005, between July 1, 2005 and June 30, 2006, between July
21 1, 2006 and June 30, 2007, between July 1, 2007 and June 30, 2008,
22 between July 1, 2008 and June 30, 2009, between July 1, 2009 and June
23 30, 2010, between July 1, 2010 and June 30, 2011, between July 1, 2011
24 and June 30, 2012, between July 1, 2012 and June 30, 2013, between July
25 1, 2013 and June 30, 2014, between July 1, 2014 and June 30, 2015,
26 between July 1, 2015 and June 30, 2016, between July 1, 2016 and June
27 30, 2017, between July 1, 2017 and June 30, 2018, between July 1, 2018
28 and June 30, 2019, between July 1, 2019 and June 30, 2020, between July
29 1, 2020 and June 30, 2021, [and] between July 1, 2021 and June 30, 2022,
30 and between July 1, 2022 and June 30, 2023 for physicians or dentists
31 certified as eligible for each such period or periods pursuant to subdi-
32 vision 2 of this section by a general hospital licensed pursuant to
33 article 28 of the public health law; provided that no single insurer
34 shall write more than fifty percent of the total excess premium for a
35 given policy year; and provided, however, that such eligible physicians
36 or dentists must have in force an individual policy, from an insurer
37 licensed in this state of primary malpractice insurance coverage in
38 amounts of no less than one million three hundred thousand dollars for
39 each claimant and three million nine hundred thousand dollars for all
40 claimants under that policy during the period of such excess coverage
41 for such occurrences or be endorsed as additional insureds under a
42 hospital professional liability policy which is offered through a volun-
43 tary attending physician ("channeling") program previously permitted by
44 the superintendent of financial services during the period of such
45 excess coverage for such occurrences. During such period, such policy
46 for excess coverage or such equivalent excess coverage shall, when
47 combined with the physician's or dentist's primary malpractice insurance
48 coverage or coverage provided through a voluntary attending physician
49 ("channeling") program, total an aggregate level of two million three
50 hundred thousand dollars for each claimant and six million nine hundred
51 thousand dollars for all claimants from all such policies with respect
52 to occurrences in each of such years provided, however, if the cost of
53 primary malpractice insurance coverage in excess of one million dollars,
54 but below the excess medical malpractice insurance coverage provided
55 pursuant to this act, exceeds the rate of nine percent per annum, then
56 the required level of primary malpractice insurance coverage in excess
S. 8007--C 34 A. 9007--C
1 of one million dollars for each claimant shall be in an amount of not
2 less than the dollar amount of such coverage available at nine percent
3 per annum; the required level of such coverage for all claimants under
4 that policy shall be in an amount not less than three times the dollar
5 amount of coverage for each claimant; and excess coverage, when combined
6 with such primary malpractice insurance coverage, shall increase the
7 aggregate level for each claimant by one million dollars and three
8 million dollars for all claimants; and provided further, that, with
9 respect to policies of primary medical malpractice coverage that include
10 occurrences between April 1, 2002 and June 30, 2002, such requirement
11 that coverage be in amounts no less than one million three hundred thou-
12 sand dollars for each claimant and three million nine hundred thousand
13 dollars for all claimants for such occurrences shall be effective April
14 1, 2002.
15 § 2. Subdivision 3 of section 18 of chapter 266 of the laws of 1986,
16 amending the civil practice law and rules and other laws relating to
17 malpractice and professional medical conduct, as amended by section 2 of
18 part K of chapter 57 of the laws of 2021, is amended to read as follows:
19 (3)(a) The superintendent of financial services shall determine and
20 certify to each general hospital and to the commissioner of health the
21 cost of excess malpractice insurance for medical or dental malpractice
22 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988
23 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July
24 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992,
25 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June
26 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995
27 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July
28 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999,
29 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June
30 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002
31 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July
32 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006,
33 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June
34 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009
35 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July
36 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013,
37 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June
38 30, 2015, between July 1, 2015 and June 30, 2016, between July 1, 2016
39 and June 30, 2017, between July 1, 2017 and June 30, 2018, between July
40 1, 2018 and June 30, 2019, between July 1, 2019 and June 30, 2020,
41 between July 1, 2020 and June 30, 2021, [and] between July 1, 2021 and
42 June 30, 2022, and between July 1, 2022 and June 30, 2023 allocable to
43 each general hospital for physicians or dentists certified as eligible
44 for purchase of a policy for excess insurance coverage by such general
45 hospital in accordance with subdivision 2 of this section, and may amend
46 such determination and certification as necessary.
47 (b) The superintendent of financial services shall determine and
48 certify to each general hospital and to the commissioner of health the
49 cost of excess malpractice insurance or equivalent excess coverage for
50 medical or dental malpractice occurrences between July 1, 1987 and June
51 30, 1988, between July 1, 1988 and June 30, 1989, between July 1, 1989
52 and June 30, 1990, between July 1, 1990 and June 30, 1991, between July
53 1, 1991 and June 30, 1992, between July 1, 1992 and June 30, 1993,
54 between July 1, 1993 and June 30, 1994, between July 1, 1994 and June
55 30, 1995, between July 1, 1995 and June 30, 1996, between July 1, 1996
56 and June 30, 1997, between July 1, 1997 and June 30, 1998, between July
S. 8007--C 35 A. 9007--C
1 1, 1998 and June 30, 1999, between July 1, 1999 and June 30, 2000,
2 between July 1, 2000 and June 30, 2001, between July 1, 2001 and June
3 30, 2002, between July 1, 2002 and June 30, 2003, between July 1, 2003
4 and June 30, 2004, between July 1, 2004 and June 30, 2005, between July
5 1, 2005 and June 30, 2006, between July 1, 2006 and June 30, 2007,
6 between July 1, 2007 and June 30, 2008, between July 1, 2008 and June
7 30, 2009, between July 1, 2009 and June 30, 2010, between July 1, 2010
8 and June 30, 2011, between July 1, 2011 and June 30, 2012, between July
9 1, 2012 and June 30, 2013, between July 1, 2013 and June 30, 2014,
10 between July 1, 2014 and June 30, 2015, between July 1, 2015 and June
11 30, 2016, between July 1, 2016 and June 30, 2017, between July 1, 2017
12 and June 30, 2018, between July 1, 2018 and June 30, 2019, between July
13 1, 2019 and June 30, 2020, between July 1, 2020 and June 30, 2021, [and]
14 between July 1, 2021 and June 30, 2022, and between July 1, 2022 and
15 June 30, 2023 allocable to each general hospital for physicians or
16 dentists certified as eligible for purchase of a policy for excess
17 insurance coverage or equivalent excess coverage by such general hospi-
18 tal in accordance with subdivision 2 of this section, and may amend such
19 determination and certification as necessary. The superintendent of
20 financial services shall determine and certify to each general hospital
21 and to the commissioner of health the ratable share of such cost alloca-
22 ble to the period July 1, 1987 to December 31, 1987, to the period Janu-
23 ary 1, 1988 to June 30, 1988, to the period July 1, 1988 to December 31,
24 1988, to the period January 1, 1989 to June 30, 1989, to the period July
25 1, 1989 to December 31, 1989, to the period January 1, 1990 to June 30,
26 1990, to the period July 1, 1990 to December 31, 1990, to the period
27 January 1, 1991 to June 30, 1991, to the period July 1, 1991 to December
28 31, 1991, to the period January 1, 1992 to June 30, 1992, to the period
29 July 1, 1992 to December 31, 1992, to the period January 1, 1993 to June
30 30, 1993, to the period July 1, 1993 to December 31, 1993, to the period
31 January 1, 1994 to June 30, 1994, to the period July 1, 1994 to December
32 31, 1994, to the period January 1, 1995 to June 30, 1995, to the period
33 July 1, 1995 to December 31, 1995, to the period January 1, 1996 to June
34 30, 1996, to the period July 1, 1996 to December 31, 1996, to the period
35 January 1, 1997 to June 30, 1997, to the period July 1, 1997 to December
36 31, 1997, to the period January 1, 1998 to June 30, 1998, to the period
37 July 1, 1998 to December 31, 1998, to the period January 1, 1999 to June
38 30, 1999, to the period July 1, 1999 to December 31, 1999, to the period
39 January 1, 2000 to June 30, 2000, to the period July 1, 2000 to December
40 31, 2000, to the period January 1, 2001 to June 30, 2001, to the period
41 July 1, 2001 to June 30, 2002, to the period July 1, 2002 to June 30,
42 2003, to the period July 1, 2003 to June 30, 2004, to the period July 1,
43 2004 to June 30, 2005, to the period July 1, 2005 and June 30, 2006, to
44 the period July 1, 2006 and June 30, 2007, to the period July 1, 2007
45 and June 30, 2008, to the period July 1, 2008 and June 30, 2009, to the
46 period July 1, 2009 and June 30, 2010, to the period July 1, 2010 and
47 June 30, 2011, to the period July 1, 2011 and June 30, 2012, to the
48 period July 1, 2012 and June 30, 2013, to the period July 1, 2013 and
49 June 30, 2014, to the period July 1, 2014 and June 30, 2015, to the
50 period July 1, 2015 and June 30, 2016, to the period July 1, 2016 and
51 June 30, 2017, to the period July 1, 2017 to June 30, 2018, to the peri-
52 od July 1, 2018 to June 30, 2019, to the period July 1, 2019 to June 30,
53 2020, to the period July 1, 2020 to June 30, 2021, [and] to the period
54 July 1, 2021 to June 30, 2022, and to the period July 1, 2022 to June
55 30, 2023.
S. 8007--C 36 A. 9007--C
1 § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section
2 18 of chapter 266 of the laws of 1986, amending the civil practice law
3 and rules and other laws relating to malpractice and professional
4 medical conduct, as amended by section 3 of part K of chapter 57 of the
5 laws of 2021, are amended to read as follows:
6 (a) To the extent funds available to the hospital excess liability
7 pool pursuant to subdivision 5 of this section as amended, and pursuant
8 to section 6 of part J of chapter 63 of the laws of 2001, as may from
9 time to time be amended, which amended this subdivision, are insuffi-
10 cient to meet the costs of excess insurance coverage or equivalent
11 excess coverage for coverage periods during the period July 1, 1992 to
12 June 30, 1993, during the period July 1, 1993 to June 30, 1994, during
13 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995
14 to June 30, 1996, during the period July 1, 1996 to June 30, 1997,
15 during the period July 1, 1997 to June 30, 1998, during the period July
16 1, 1998 to June 30, 1999, during the period July 1, 1999 to June 30,
17 2000, during the period July 1, 2000 to June 30, 2001, during the period
18 July 1, 2001 to October 29, 2001, during the period April 1, 2002 to
19 June 30, 2002, during the period July 1, 2002 to June 30, 2003, during
20 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004
21 to June 30, 2005, during the period July 1, 2005 to June 30, 2006,
22 during the period July 1, 2006 to June 30, 2007, during the period July
23 1, 2007 to June 30, 2008, during the period July 1, 2008 to June 30,
24 2009, during the period July 1, 2009 to June 30, 2010, during the period
25 July 1, 2010 to June 30, 2011, during the period July 1, 2011 to June
26 30, 2012, during the period July 1, 2012 to June 30, 2013, during the
27 period July 1, 2013 to June 30, 2014, during the period July 1, 2014 to
28 June 30, 2015, during the period July 1, 2015 to June 30, 2016, during
29 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017
30 to June 30, 2018, during the period July 1, 2018 to June 30, 2019,
31 during the period July 1, 2019 to June 30, 2020, during the period July
32 1, 2020 to June 30, 2021, [and] during the period July 1, 2021 to June
33 30, 2022, and during the period July 1, 2022 to June 30, 2023 allocated
34 or reallocated in accordance with paragraph (a) of subdivision 4-a of
35 this section to rates of payment applicable to state governmental agen-
36 cies, each physician or dentist for whom a policy for excess insurance
37 coverage or equivalent excess coverage is purchased for such period
38 shall be responsible for payment to the provider of excess insurance
39 coverage or equivalent excess coverage of an allocable share of such
40 insufficiency, based on the ratio of the total cost of such coverage for
41 such physician to the sum of the total cost of such coverage for all
42 physicians applied to such insufficiency.
43 (b) Each provider of excess insurance coverage or equivalent excess
44 coverage covering the period July 1, 1992 to June 30, 1993, or covering
45 the period July 1, 1993 to June 30, 1994, or covering the period July 1,
46 1994 to June 30, 1995, or covering the period July 1, 1995 to June 30,
47 1996, or covering the period July 1, 1996 to June 30, 1997, or covering
48 the period July 1, 1997 to June 30, 1998, or covering the period July 1,
49 1998 to June 30, 1999, or covering the period July 1, 1999 to June 30,
50 2000, or covering the period July 1, 2000 to June 30, 2001, or covering
51 the period July 1, 2001 to October 29, 2001, or covering the period
52 April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to
53 June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, or
54 covering the period July 1, 2004 to June 30, 2005, or covering the peri-
55 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to
56 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or
S. 8007--C 37 A. 9007--C
1 covering the period July 1, 2008 to June 30, 2009, or covering the peri-
2 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to
3 June 30, 2011, or covering the period July 1, 2011 to June 30, 2012, or
4 covering the period July 1, 2012 to June 30, 2013, or covering the peri-
5 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to
6 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016, or
7 covering the period July 1, 2016 to June 30, 2017, or covering the peri-
8 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to
9 June 30, 2019, or covering the period July 1, 2019 to June 30, 2020, or
10 covering the period July 1, 2020 to June 30, 2021, or covering the peri-
11 od July 1, 2021 to June 30, 2022, or covering the period July 1, 2022 to
12 June 30, 2023 shall notify a covered physician or dentist by mail,
13 mailed to the address shown on the last application for excess insurance
14 coverage or equivalent excess coverage, of the amount due to such
15 provider from such physician or dentist for such coverage period deter-
16 mined in accordance with paragraph (a) of this subdivision. Such amount
17 shall be due from such physician or dentist to such provider of excess
18 insurance coverage or equivalent excess coverage in a time and manner
19 determined by the superintendent of financial services.
20 (c) If a physician or dentist liable for payment of a portion of the
21 costs of excess insurance coverage or equivalent excess coverage cover-
22 ing the period July 1, 1992 to June 30, 1993, or covering the period
23 July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to
24 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or
25 covering the period July 1, 1996 to June 30, 1997, or covering the peri-
26 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to
27 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or
28 covering the period July 1, 2000 to June 30, 2001, or covering the peri-
29 od July 1, 2001 to October 29, 2001, or covering the period April 1,
30 2002 to June 30, 2002, or covering the period July 1, 2002 to June 30,
31 2003, or covering the period July 1, 2003 to June 30, 2004, or covering
32 the period July 1, 2004 to June 30, 2005, or covering the period July 1,
33 2005 to June 30, 2006, or covering the period July 1, 2006 to June 30,
34 2007, or covering the period July 1, 2007 to June 30, 2008, or covering
35 the period July 1, 2008 to June 30, 2009, or covering the period July 1,
36 2009 to June 30, 2010, or covering the period July 1, 2010 to June 30,
37 2011, or covering the period July 1, 2011 to June 30, 2012, or covering
38 the period July 1, 2012 to June 30, 2013, or covering the period July 1,
39 2013 to June 30, 2014, or covering the period July 1, 2014 to June 30,
40 2015, or covering the period July 1, 2015 to June 30, 2016, or covering
41 the period July 1, 2016 to June 30, 2017, or covering the period July 1,
42 2017 to June 30, 2018, or covering the period July 1, 2018 to June 30,
43 2019, or covering the period July 1, 2019 to June 30, 2020, or covering
44 the period July 1, 2020 to June 30, 2021, or covering the period July 1,
45 2021 to June 30, 2022, or covering the period July 1, 2022 to June 30,
46 2023 determined in accordance with paragraph (a) of this subdivision
47 fails, refuses or neglects to make payment to the provider of excess
48 insurance coverage or equivalent excess coverage in such time and manner
49 as determined by the superintendent of financial services pursuant to
50 paragraph (b) of this subdivision, excess insurance coverage or equiv-
51 alent excess coverage purchased for such physician or dentist in accord-
52 ance with this section for such coverage period shall be cancelled and
53 shall be null and void as of the first day on or after the commencement
54 of a policy period where the liability for payment pursuant to this
55 subdivision has not been met.
S. 8007--C 38 A. 9007--C
1 (d) Each provider of excess insurance coverage or equivalent excess
2 coverage shall notify the superintendent of financial services and the
3 commissioner of health or their designee of each physician and dentist
4 eligible for purchase of a policy for excess insurance coverage or
5 equivalent excess coverage covering the period July 1, 1992 to June 30,
6 1993, or covering the period July 1, 1993 to June 30, 1994, or covering
7 the period July 1, 1994 to June 30, 1995, or covering the period July 1,
8 1995 to June 30, 1996, or covering the period July 1, 1996 to June 30,
9 1997, or covering the period July 1, 1997 to June 30, 1998, or covering
10 the period July 1, 1998 to June 30, 1999, or covering the period July 1,
11 1999 to June 30, 2000, or covering the period July 1, 2000 to June 30,
12 2001, or covering the period July 1, 2001 to October 29, 2001, or cover-
13 ing the period April 1, 2002 to June 30, 2002, or covering the period
14 July 1, 2002 to June 30, 2003, or covering the period July 1, 2003 to
15 June 30, 2004, or covering the period July 1, 2004 to June 30, 2005, or
16 covering the period July 1, 2005 to June 30, 2006, or covering the peri-
17 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to
18 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009, or
19 covering the period July 1, 2009 to June 30, 2010, or covering the peri-
20 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to
21 June 30, 2012, or covering the period July 1, 2012 to June 30, 2013, or
22 covering the period July 1, 2013 to June 30, 2014, or covering the peri-
23 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to
24 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017, or
25 covering the period July 1, 2017 to June 30, 2018, or covering the peri-
26 od July 1, 2018 to June 30, 2019, or covering the period July 1, 2019 to
27 June 30, 2020, or covering the period July 1, 2020 to June 30, 2021, or
28 covering the period July 1, 2021 to June 30, 2022, or covering the peri-
29 od July 1, 2022 to June 1, 2023 that has made payment to such provider
30 of excess insurance coverage or equivalent excess coverage in accordance
31 with paragraph (b) of this subdivision and of each physician and dentist
32 who has failed, refused or neglected to make such payment.
33 (e) A provider of excess insurance coverage or equivalent excess
34 coverage shall refund to the hospital excess liability pool any amount
35 allocable to the period July 1, 1992 to June 30, 1993, and to the period
36 July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June
37 30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the
38 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to
39 June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to
40 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000
41 to June 30, 2001, and to the period July 1, 2001 to October 29, 2001,
42 and to the period April 1, 2002 to June 30, 2002, and to the period July
43 1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30,
44 2004, and to the period July 1, 2004 to June 30, 2005, and to the period
45 July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June
46 30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the
47 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to
48 June 30, 2010, and to the period July 1, 2010 to June 30, 2011, and to
49 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012
50 to June 30, 2013, and to the period July 1, 2013 to June 30, 2014, and
51 to the period July 1, 2014 to June 30, 2015, and to the period July 1,
52 2015 to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and
53 to the period July 1, 2017 to June 30, 2018, and to the period July 1,
54 2018 to June 30, 2019, and to the period July 1, 2019 to June 30, 2020,
55 and to the period July 1, 2020 to June 30, 2021, and to the period July
56 1, 2021 to June 30, 2022, and to the period July 1, 2022 to June 30,
S. 8007--C 39 A. 9007--C
1 2023 received from the hospital excess liability pool for purchase of
2 excess insurance coverage or equivalent excess coverage covering the
3 period July 1, 1992 to June 30, 1993, and covering the period July 1,
4 1993 to June 30, 1994, and covering the period July 1, 1994 to June 30,
5 1995, and covering the period July 1, 1995 to June 30, 1996, and cover-
6 ing the period July 1, 1996 to June 30, 1997, and covering the period
7 July 1, 1997 to June 30, 1998, and covering the period July 1, 1998 to
8 June 30, 1999, and covering the period July 1, 1999 to June 30, 2000,
9 and covering the period July 1, 2000 to June 30, 2001, and covering the
10 period July 1, 2001 to October 29, 2001, and covering the period April
11 1, 2002 to June 30, 2002, and covering the period July 1, 2002 to June
12 30, 2003, and covering the period July 1, 2003 to June 30, 2004, and
13 covering the period July 1, 2004 to June 30, 2005, and covering the
14 period July 1, 2005 to June 30, 2006, and covering the period July 1,
15 2006 to June 30, 2007, and covering the period July 1, 2007 to June 30,
16 2008, and covering the period July 1, 2008 to June 30, 2009, and cover-
17 ing the period July 1, 2009 to June 30, 2010, and covering the period
18 July 1, 2010 to June 30, 2011, and covering the period July 1, 2011 to
19 June 30, 2012, and covering the period July 1, 2012 to June 30, 2013,
20 and covering the period July 1, 2013 to June 30, 2014, and covering the
21 period July 1, 2014 to June 30, 2015, and covering the period July 1,
22 2015 to June 30, 2016, and covering the period July 1, 2016 to June 30,
23 2017, and covering the period July 1, 2017 to June 30, 2018, and cover-
24 ing the period July 1, 2018 to June 30, 2019, and covering the period
25 July 1, 2019 to June 30, 2020, and covering the period July 1, 2020 to
26 June 30, 2021, and covering the period July 1, 2021 to June 30, 2022,
27 and covering the period July 1, 2022 to June 30, 2023 for a physician or
28 dentist where such excess insurance coverage or equivalent excess cover-
29 age is cancelled in accordance with paragraph (c) of this subdivision.
30 § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil
31 practice law and rules and other laws relating to malpractice and
32 professional medical conduct, as amended by section 4 of part K of chap-
33 ter 57 of the laws of 2021, is amended to read as follows:
34 § 40. The superintendent of financial services shall establish rates
35 for policies providing coverage for physicians and surgeons medical
36 malpractice for the periods commencing July 1, 1985 and ending June 30,
37 [2022] 2023; provided, however, that notwithstanding any other provision
38 of law, the superintendent shall not establish or approve any increase
39 in rates for the period commencing July 1, 2009 and ending June 30,
40 2010. The superintendent shall direct insurers to establish segregated
41 accounts for premiums, payments, reserves and investment income attrib-
42 utable to such premium periods and shall require periodic reports by the
43 insurers regarding claims and expenses attributable to such periods to
44 monitor whether such accounts will be sufficient to meet incurred claims
45 and expenses. On or after July 1, 1989, the superintendent shall impose
46 a surcharge on premiums to satisfy a projected deficiency that is
47 attributable to the premium levels established pursuant to this section
48 for such periods; provided, however, that such annual surcharge shall
49 not exceed eight percent of the established rate until July 1, [2022]
50 2023, at which time and thereafter such surcharge shall not exceed twen-
51 ty-five percent of the approved adequate rate, and that such annual
52 surcharges shall continue for such period of time as shall be sufficient
53 to satisfy such deficiency. The superintendent shall not impose such
54 surcharge during the period commencing July 1, 2009 and ending June 30,
55 2010. On and after July 1, 1989, the surcharge prescribed by this
56 section shall be retained by insurers to the extent that they insured
S. 8007--C 40 A. 9007--C
1 physicians and surgeons during the July 1, 1985 through June 30, [2022]
2 2023 policy periods; in the event and to the extent physicians and
3 surgeons were insured by another insurer during such periods, all or a
4 pro rata share of the surcharge, as the case may be, shall be remitted
5 to such other insurer in accordance with rules and regulations to be
6 promulgated by the superintendent. Surcharges collected from physicians
7 and surgeons who were not insured during such policy periods shall be
8 apportioned among all insurers in proportion to the premium written by
9 each insurer during such policy periods; if a physician or surgeon was
10 insured by an insurer subject to rates established by the superintendent
11 during such policy periods, and at any time thereafter a hospital,
12 health maintenance organization, employer or institution is responsible
13 for responding in damages for liability arising out of such physician's
14 or surgeon's practice of medicine, such responsible entity shall also
15 remit to such prior insurer the equivalent amount that would then be
16 collected as a surcharge if the physician or surgeon had continued to
17 remain insured by such prior insurer. In the event any insurer that
18 provided coverage during such policy periods is in liquidation, the
19 property/casualty insurance security fund shall receive the portion of
20 surcharges to which the insurer in liquidation would have been entitled.
21 The surcharges authorized herein shall be deemed to be income earned for
22 the purposes of section 2303 of the insurance law. The superintendent,
23 in establishing adequate rates and in determining any projected defi-
24 ciency pursuant to the requirements of this section and the insurance
25 law, shall give substantial weight, determined in his discretion and
26 judgment, to the prospective anticipated effect of any regulations
27 promulgated and laws enacted and the public benefit of stabilizing
28 malpractice rates and minimizing rate level fluctuation during the peri-
29 od of time necessary for the development of more reliable statistical
30 experience as to the efficacy of such laws and regulations affecting
31 medical, dental or podiatric malpractice enacted or promulgated in 1985,
32 1986, by this act and at any other time. Notwithstanding any provision
33 of the insurance law, rates already established and to be established by
34 the superintendent pursuant to this section are deemed adequate if such
35 rates would be adequate when taken together with the maximum authorized
36 annual surcharges to be imposed for a reasonable period of time whether
37 or not any such annual surcharge has been actually imposed as of the
38 establishment of such rates.
39 § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J of
40 chapter 63 of the laws of 2001, amending chapter 266 of the laws of
41 1986, amending the civil practice law and rules and other laws relating
42 to malpractice and professional medical conduct, as amended by section 5
43 of part K of chapter 57 of the laws of 2021, are amended to read as
44 follows:
45 § 5. The superintendent of financial services and the commissioner of
46 health shall determine, no later than June 15, 2002, June 15, 2003, June
47 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008,
48 June 15, 2009, June 15, 2010, June 15, 2011, June 15, 2012, June 15,
49 2013, June 15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June
50 15, 2018, June 15, 2019, June 15, 2020, June 15, 2021, [and] June 15,
51 2022, and June 15, 2023 the amount of funds available in the hospital
52 excess liability pool, created pursuant to section 18 of chapter 266 of
53 the laws of 1986, and whether such funds are sufficient for purposes of
54 purchasing excess insurance coverage for eligible participating physi-
55 cians and dentists during the period July 1, 2001 to June 30, 2002, or
56 July 1, 2002 to June 30, 2003, or July 1, 2003 to June 30, 2004, or July
S. 8007--C 41 A. 9007--C
1 1, 2004 to June 30, 2005, or July 1, 2005 to June 30, 2006, or July 1,
2 2006 to June 30, 2007, or July 1, 2007 to June 30, 2008, or July 1, 2008
3 to June 30, 2009, or July 1, 2009 to June 30, 2010, or July 1, 2010 to
4 June 30, 2011, or July 1, 2011 to June 30, 2012, or July 1, 2012 to June
5 30, 2013, or July 1, 2013 to June 30, 2014, or July 1, 2014 to June 30,
6 2015, or July 1, 2015 to June 30, 2016, or July 1, 2016 to June 30,
7 2017, or July 1, 2017 to June 30, 2018, or July 1, 2018 to June 30,
8 2019, or July 1, 2019 to June 30, 2020, or July 1, 2020 to June 30,
9 2021, or July 1, 2021 to June 30, 2022, or July 1, 2022 to June 30, 2023
10 as applicable.
11 (a) This section shall be effective only upon a determination, pursu-
12 ant to section five of this act, by the superintendent of financial
13 services and the commissioner of health, and a certification of such
14 determination to the state director of the budget, the chair of the
15 senate committee on finance and the chair of the assembly committee on
16 ways and means, that the amount of funds in the hospital excess liabil-
17 ity pool, created pursuant to section 18 of chapter 266 of the laws of
18 1986, is insufficient for purposes of purchasing excess insurance cover-
19 age for eligible participating physicians and dentists during the period
20 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July
21 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1,
22 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007
23 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to
24 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June
25 30, 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30,
26 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30,
27 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30,
28 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30,
29 2020, or July 1, 2020 to June 30, 2021, or July 1, 2021 to June 30,
30 2022, or July 1, 2022 to June 30, 2023 as applicable.
31 (e) The commissioner of health shall transfer for deposit to the
32 hospital excess liability pool created pursuant to section 18 of chapter
33 266 of the laws of 1986 such amounts as directed by the superintendent
34 of financial services for the purchase of excess liability insurance
35 coverage for eligible participating physicians and dentists for the
36 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30,
37 2003, or July 1, 2003 to June 30, 2004, or July 1, 2004 to June 30,
38 2005, or July 1, 2005 to June 30, 2006, or July 1, 2006 to June 30,
39 2007, as applicable, and the cost of administering the hospital excess
40 liability pool for such applicable policy year, pursuant to the program
41 established in chapter 266 of the laws of 1986, as amended, no later
42 than June 15, 2002, June 15, 2003, June 15, 2004, June 15, 2005, June
43 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009, June 15, 2010,
44 June 15, 2011, June 15, 2012, June 15, 2013, June 15, 2014, June 15,
45 2015, June 15, 2016, June 15, 2017, June 15, 2018, June 15, 2019, June
46 15, 2020, June 15, 2021, [and] June 15, 2022, and June 15, 2023 as
47 applicable.
48 § 6. Section 20 of part H of chapter 57 of the laws of 2017, amending
49 the New York Health Care Reform Act of 1996 and other laws relating to
50 extending certain provisions thereto, as amended by section 6 of part K
51 of chapter 57 of the laws of 2021, is amended to read as follows:
52 § 20. Notwithstanding any law, rule or regulation to the contrary,
53 only physicians or dentists who were eligible, and for whom the super-
54 intendent of financial services and the commissioner of health, or their
55 designee, purchased, with funds available in the hospital excess liabil-
56 ity pool, a full or partial policy for excess coverage or equivalent
S. 8007--C 42 A. 9007--C
1 excess coverage for the coverage period ending the thirtieth of June,
2 two thousand [twenty-one] twenty-two, shall be eligible to apply for
3 such coverage for the coverage period beginning the first of July, two
4 thousand [twenty-one] twenty-two; provided, however, if the total number
5 of physicians or dentists for whom such excess coverage or equivalent
6 excess coverage was purchased for the policy year ending the thirtieth
7 of June, two thousand [twenty-one] twenty-two exceeds the total number
8 of physicians or dentists certified as eligible for the coverage period
9 beginning the first of July, two thousand [twenty-one] twenty-two, then
10 the general hospitals may certify additional eligible physicians or
11 dentists in a number equal to such general hospital's proportional share
12 of the total number of physicians or dentists for whom excess coverage
13 or equivalent excess coverage was purchased with funds available in the
14 hospital excess liability pool as of the thirtieth of June, two thousand
15 [twenty-one] twenty-two, as applied to the difference between the number
16 of eligible physicians or dentists for whom a policy for excess coverage
17 or equivalent excess coverage was purchased for the coverage period
18 ending the thirtieth of June, two thousand [twenty-one] twenty-two and
19 the number of such eligible physicians or dentists who have applied for
20 excess coverage or equivalent excess coverage for the coverage period
21 beginning the first of July, two thousand [twenty-one] twenty-two.
22 § 7. This act shall take effect immediately and shall be deemed to
23 have been in full force and effect on and after April 1, 2022.
24 PART AA
25 Section 1. This act enacts into law major components of legislation
26 relating to the federal no surprises act and administrative simplifi-
27 cation. Each component is wholly contained within a Subpart identified
28 as Subparts A through C. The effective date for each particular
29 provision contained within such Subpart is set forth in the last section
30 of such Subpart. Any provision in any section contained within a
31 Subpart, including the effective date of the Subpart, which makes a
32 reference to a section "of this act", when used in connection with that
33 particular component, shall be deemed to mean and refer to the corre-
34 sponding section of the Subpart in which it is found. Section three of
35 this act sets forth the general effective date of this act.
36 SUBPART A
37 Section 1. Section 601 of the financial services law, as added by
38 section 26 of part H of chapter 60 of the laws of 2014, is amended to
39 read as follows:
40 § 601. Dispute resolution process established. The superintendent
41 shall establish a dispute resolution process by which a dispute for a
42 bill for emergency services or a surprise bill may be resolved. The
43 superintendent shall have the power to grant and revoke certifications
44 of independent dispute resolution entities to conduct the dispute resol-
45 ution process. The superintendent shall promulgate regulations estab-
46 lishing standards for the dispute resolution process, including a proc-
47 ess for certifying and selecting independent dispute resolution
48 entities. An independent dispute resolution entity shall use licensed
49 physicians in active practice in the same or similar specialty as the
50 physician providing the service that is subject to the dispute resol-
51 ution process of this article for disputes that involve physician
52 services. To the extent practicable, the physician shall be licensed in
S. 8007--C 43 A. 9007--C
1 this state. Disputes shall be submitted to an independent dispute
2 resolution entity within three years of the date the health care plan
3 made the original payment on the claim that is the subject of the
4 dispute.
5 § 2. Subsection (b) of section 602 of the financial services law is
6 REPEALED.
7 § 3. Subsection (h) of section 603 of the financial services law, as
8 added by section 26 of part H of chapter 60 of the laws of 2014, is
9 amended to read as follows:
10 (h) "Surprise bill" means a bill for health care services, other than
11 emergency services, [received by] with respect to:
12 (1) an insured for services rendered by a non-participating [physi-
13 cian] provider at a participating hospital or ambulatory surgical
14 center, where a participating [physician] provider is unavailable or a
15 non-participating [physician] provider renders services without the
16 insured's knowledge, or unforeseen medical services arise at the time
17 the health care services are rendered; provided, however, that a
18 surprise bill shall not mean a bill received for health care services
19 when a participating [physician] provider is available and the insured
20 has elected to obtain services from a non-participating [physician]
21 provider;
22 (2) an insured for services rendered by a non-participating provider,
23 where the services were referred by a participating physician to a non-
24 participating provider without explicit written consent of the insured
25 acknowledging that the participating physician is referring the insured
26 to a non-participating provider and that the referral may result in
27 costs not covered by the health care plan; or
28 (3) a patient who is not an insured for services rendered by a physi-
29 cian at a hospital or ambulatory surgical center, where the patient has
30 not timely received all of the disclosures required pursuant to section
31 twenty-four of the public health law.
32 § 4. Section 604 of the financial services law, as amended by chapter
33 377 of the laws of 2019, is amended to read as follows:
34 § 604. Criteria for determining a reasonable fee. In determining the
35 appropriate amount to pay for a health care service, an independent
36 dispute resolution entity shall consider all relevant factors, includ-
37 ing:
38 (a) whether there is a gross disparity between the fee charged by the
39 [physician or hospital] provider for services rendered as compared to:
40 (1) fees paid to the involved [physician or hospital] provider for the
41 same services rendered by the [physician or hospital] provider to other
42 patients in health care plans in which the [physician or hospital]
43 provider is not participating, and
44 (2) in the case of a dispute involving a health care plan, fees paid
45 by the health care plan to reimburse similarly qualified [physicians or
46 hospitals] providers for the same services in the same region who are
47 not participating with the health care plan;
48 (b) the level of training, education and experience of the [physician]
49 health care professional, and in the case of a hospital, the teaching
50 staff, scope of services and case mix;
51 (c) the [physician's and hospital's] provider's usual charge for
52 comparable services with regard to patients in health care plans in
53 which the [physician or hospital] provider is not participating;
54 (d) the circumstances and complexity of the particular case, including
55 time and place of the service;
S. 8007--C 44 A. 9007--C
1 (e) individual patient characteristics; [and, with regard to physician
2 services,]
3 (f) the median of the rate recognized by the health care plan to reim-
4 burse similarly qualified providers for the same or similar services in
5 the same region that are participating with the health care plan; and
6 (g) with regard to physician services, the usual and customary cost of
7 the service.
8 § 5. Subsections (a) and (c) of section 605 of the financial services
9 law, as amended by chapter 377 of the laws of 2019, paragraphs 1 and 2
10 of subsection (a) as amended by section 1 of part YY of chapter 56 of
11 the laws of 2020, are amended to read as follows:
12 (a) Emergency services for an insured. (1) When a health care plan
13 receives a bill for emergency services from a non-participating [physi-
14 cian or hospital] provider, including a bill for inpatient services
15 which follow an emergency room visit, the health care plan shall pay an
16 amount that it determines is reasonable for the emergency services,
17 including inpatient services which follow an emergency room visit,
18 rendered by the non-participating [physician or hospital] provider, in
19 accordance with section three thousand two hundred twenty-four-a of the
20 insurance law, except for the insured's co-payment, coinsurance or
21 deductible, if any, and shall ensure that the insured shall incur no
22 greater out-of-pocket costs for the emergency services, including inpa-
23 tient services which follow an emergency room visit, than the insured
24 would have incurred with a participating [physician or hospital] provid-
25 er. [If an insured assigns benefits to a non-participating physician or
26 hospital in relation to emergency services, including inpatient services
27 which follow an emergency room visit, provided by such non-participating
28 physician or hospital, the] The non-participating [physician or hospi-
29 tal] provider may bill the health care plan for the services rendered.
30 Upon receipt of the bill, the health care plan shall pay the non-parti-
31 cipating [physician or hospital] provider the amount prescribed by this
32 section and any subsequent amount determined to be owed to the [physi-
33 cian or hospital] provider in relation to the emergency services
34 provided, including inpatient services which follow an emergency room
35 visit.
36 (2) A non-participating [physician or hospital] provider or a health
37 care plan may submit a dispute regarding a fee or payment for emergency
38 services, including inpatient services which follow an emergency room
39 visit, for review to an independent dispute resolution entity.
40 (3) The independent dispute resolution entity shall make a determi-
41 nation within thirty business days of receipt of the dispute for review.
42 (4) In determining a reasonable fee for the services rendered, an
43 independent dispute resolution entity shall select either the health
44 care plan's payment or the non-participating [physician's or hospital's]
45 provider's fee. The independent dispute resolution entity shall deter-
46 mine which amount to select based upon the conditions and factors set
47 forth in section six hundred four of this article. If an independent
48 dispute resolution entity determines, based on the health care plan's
49 payment and the non-participating [physician's or hospital's] provider's
50 fee, that a settlement between the health care plan and non-participat-
51 ing [physician or hospital] provider is reasonably likely, or that both
52 the health care plan's payment and the non-participating [physician's or
53 hospital's] provider's fee represent unreasonable extremes, then the
54 independent dispute resolution entity may direct both parties to attempt
55 a good faith negotiation for settlement. The health care plan and non-
56 participating [physician or hospital] provider may be granted up to ten
S. 8007--C 45 A. 9007--C
1 business days for this negotiation, which shall run concurrently with
2 the thirty business day period for dispute resolution.
3 (c) The determination of an independent dispute resolution entity
4 shall be binding on the health care plan, [physician or hospital]
5 provider and patient, and shall be admissible in any court proceeding
6 between the health care plan, [physician or hospital] provider or
7 patient, or in any administrative proceeding between this state and the
8 [physician or hospital] provider.
9 § 6. Subsection (d) of section 605 of the financial services law is
10 REPEALED and subsection (e) of section 605 of the financial services law
11 is relettered subsection (d).
12 § 7. Section 606 of the financial services law, as amended by section
13 3 of part YY of chapter 56 of the laws of 2020, is amended to read as
14 follows:
15 § 606. Hold harmless [and assignment of benefits] for insureds from
16 bills for emergency services and surprise bills. (a) [When an insured
17 assigns benefits for a surprise bill in writing to a non-participating
18 physician that knows the insured is insured under a health care plan,
19 the] A non-participating [physician] provider shall not bill [the] an
20 insured for a surprise bill except for any applicable copayment, coinsu-
21 rance or deductible that would be owed if the insured utilized a partic-
22 ipating [physician] provider.
23 (b) [When an insured assigns benefits for emergency services, includ-
24 ing inpatient services which follow an emergency room visit, to a non-
25 participating physician or hospital that knows the insured is insured
26 under a health care plan, the] A non-participating [physician or hospi-
27 tal] provider shall not bill [the] an insured for emergency services,
28 including inpatient services which follow an emergency room visit,
29 except for any applicable copayment, coinsurance or deductible that
30 would be owed if the insured utilized a participating [physician or
31 hospital] provider.
32 § 8. Subsections (a), (b) and (c) of section 607 of the financial
33 services law, as added by section 26 of part H of chapter 60 of the laws
34 of 2014, are amended to read as follows:
35 (a) Surprise bill [received by] involving an insured [who assigns
36 benefits]. (1) [If] For a surprise bill involving an insured [assigns
37 benefits to a non-participating physician], the health care plan shall
38 pay the non-participating [physician] provider in accordance with para-
39 graphs two and three of this subsection.
40 (2) The non-participating [physician] provider may bill the health
41 care plan for the health care services rendered, and the health care
42 plan shall pay the non-participating [physician] provider the billed
43 amount or attempt to negotiate reimbursement with the non-participating
44 [physician] provider.
45 (3) If the health care plan's attempts to negotiate reimbursement for
46 health care services provided by a non-participating [physician] provid-
47 er does not result in a resolution of the payment dispute between the
48 non-participating [physician] provider and the health care plan, the
49 health care plan shall pay the non-participating [physician] provider an
50 amount the health care plan determines is reasonable for the health care
51 services rendered, except for the insured's copayment, coinsurance or
52 deductible, in accordance with section three thousand two hundred twen-
53 ty-four-a of the insurance law, and shall ensure that the insured shall
54 incur no greater out-of-pocket costs for the surprise bill than the
55 insured would have incurred with a participating provider.
S. 8007--C 46 A. 9007--C
1 (4) Either the health care plan or the non-participating [physician]
2 provider may submit the dispute regarding the surprise bill for review
3 to an independent dispute resolution entity, provided however, the
4 health care plan may not submit the dispute unless it has complied with
5 the requirements of paragraphs one, two and three of this subsection.
6 (5) The independent dispute resolution entity shall make a determi-
7 nation within thirty business days of receipt of the dispute for review.
8 (6) When determining a reasonable fee for the services rendered, the
9 independent dispute resolution entity shall select either the health
10 care plan's payment or the non-participating [physician's] provider's
11 fee. An independent dispute resolution entity shall determine which
12 amount to select based upon the conditions and factors set forth in
13 section six hundred four of this article. If an independent dispute
14 resolution entity determines, based on the health care plan's payment
15 and the non-participating [physician's] provider's fee, that a settle-
16 ment between the health care plan and non-participating [physician]
17 provider is reasonably likely, or that both the health care plan's
18 payment and the non-participating [physician's] provider's fee represent
19 unreasonable extremes, then the independent dispute resolution entity
20 may direct both parties to attempt a good faith negotiation for settle-
21 ment. The health care plan and non-participating [physician] provider
22 may be granted up to ten business days for this negotiation, which shall
23 run concurrently with the thirty business day period for dispute resol-
24 ution.
25 (b) Surprise bill received by [an insured who does not assign benefits
26 or by] a patient who is not an insured.
27 (1) [An insured who does not assign benefits in accordance with
28 subsection (a) of this section or a] A patient who is not an insured and
29 who receives a surprise bill may submit a dispute regarding the surprise
30 bill for review to an independent dispute resolution entity.
31 (2) The independent dispute resolution entity shall determine a
32 reasonable fee for the services rendered based upon the conditions and
33 factors set forth in section six hundred four of this article.
34 (3) A patient [or insured who does not assign benefits in accordance
35 with subsection (a) of this section] shall not be required to pay the
36 physician's fee to be eligible to submit the dispute for review to the
37 independent dispute resolution entity.
38 (c) The determination of an independent dispute resolution entity
39 shall be binding on the patient, [physician] provider and health care
40 plan, and shall be admissible in any court proceeding between the
41 patient or insured, [physician] provider or health care plan, or in any
42 administrative proceeding between this state and the [physician] provid-
43 er.
44 § 9. Subsection (a) of section 608 of the financial services law, as
45 amended by chapter 375 of the laws of 2019, is amended to read as
46 follows:
47 (a) For disputes involving an insured, when the independent dispute
48 resolution entity determines the health care plan's payment is reason-
49 able, payment for the dispute resolution process shall be the responsi-
50 bility of the non-participating [physician or hospital] provider. When
51 the independent dispute resolution entity determines the non-participat-
52 ing [physician's or hospital's] provider's fee is reasonable, payment
53 for the dispute resolution process shall be the responsibility of the
54 health care plan. When a good faith negotiation directed by the inde-
55 pendent dispute resolution entity pursuant to paragraph four of
56 subsection (a) of section six hundred five of this article, or paragraph
S. 8007--C 47 A. 9007--C
1 six of subsection (a) of section six hundred seven of this article
2 results in a settlement between the health care plan and non-participat-
3 ing [physician or hospital] provider, the health care plan and the non-
4 participating [physician or hospital] provider shall evenly divide and
5 share the prorated cost for dispute resolution.
6 § 10. Subparagraph (A) of paragraph 1 of subsection (b) of section
7 4910 of the insurance law, as amended by chapter 219 of the laws of
8 2011, is amended to read as follows:
9 (A) the insured has had coverage of the health care service, which
10 would otherwise be a covered benefit under a subscriber contract or
11 governmental health benefit program, denied on appeal, in whole or in
12 part, pursuant to title one of this article on the grounds that such
13 health care service does not meet the health care plan's requirements
14 for medical necessity, appropriateness, health care setting, level of
15 care, [or] effectiveness of a covered benefit, or other ground consist-
16 ent with 42 U.S.C. § 300gg-19 as determined by the superintendent, and
17 § 11. Subparagraph (i) of paragraph (a) of subdivision 2 of section
18 4910 of the public health law, as amended by chapter 219 of the laws of
19 2011, is amended to read as follows:
20 (i) the enrollee has had coverage of a health care service, which
21 would otherwise be a covered benefit under a subscriber contract or
22 governmental health benefit program, denied on appeal, in whole or in
23 part, pursuant to title one of this article on the grounds that such
24 health care service does not meet the health care plan's requirements
25 for medical necessity, appropriateness, health care setting, level of
26 care, [or] effectiveness of a covered benefit, or other ground consist-
27 ent with 42 U.S.C. § 300gg-19 as determined by the commissioner in
28 consultation with the superintendent of financial services, and
29 § 12. This act shall take effect immediately.
30 SUBPART B
31 Section 1. Paragraph 1 of subsection (c) of section 109 of the insur-
32 ance law, as amended by section 55 of part A of chapter 62 of the laws
33 of 2011, is amended to read as follows:
34 (1) If the superintendent finds after notice and hearing that any
35 authorized insurer, representative of the insurer, licensed insurance
36 agent, licensed insurance broker, licensed adjuster, or any other person
37 or entity licensed, certified, registered, or authorized pursuant to
38 this chapter, has [wilfully] willfully violated the provisions of this
39 chapter or any regulation promulgated thereunder or with respect to
40 accident and health insurance, any provision of titles one or two of
41 division BB of the Consolidated Appropriations Act of 2021 (Pub. L. No.
42 116-260), as may be amended from time-to-time, and any regulations
43 promulgated thereunder, then the superintendent may order the person or
44 entity to pay to the people of this state a penalty in a sum not exceed-
45 ing one thousand dollars for each offense.
46 § 2. Paragraph 17 of subsection (a) of section 3217-a of the insur-
47 ance law, as amended by section 9 of subpart A of part BB of chapter 57
48 of the laws of 2019, is amended to read as follows:
49 (17) where applicable, a listing by specialty, which may be in a sepa-
50 rate document that is updated annually, of the name, address, [and]
51 telephone number, and digital contact information of all participating
52 providers, including facilities, and: (A) whether the provider is
53 accepting new patients; (B) in the case of mental health or substance
54 use disorder services providers, any affiliations with participating
S. 8007--C 48 A. 9007--C
1 facilities certified or authorized by the office of mental health or the
2 office of [alcoholism] addiction services and [substance abuse services]
3 supports, and any restrictions regarding the availability of the indi-
4 vidual provider's services; and (C) in the case of physicians, board
5 certification, languages spoken and any affiliations with participating
6 hospitals. The listing shall also be posted on the insurer's website and
7 the insurer shall update the website within fifteen days of the addition
8 or termination of a provider from the insurer's network or a change in a
9 physician's hospital affiliation;
10 § 3. Section 3217-b of the insurance law is amended by adding two new
11 subsections (m) and (n) to read as follows:
12 (m) A contract between an insurer and a health care provider shall
13 include a provision that requires the health care provider to have in
14 place business processes to ensure the timely provision of provider
15 directory information to the insurer. A health care provider shall
16 submit such provider directory information to an insurer, at a minimum,
17 when a provider begins or terminates a network agreement with an insur-
18 er, when there are material changes to the content of the provider
19 directory information of the health care provider, and at any other
20 time, including upon the insurer's request, as the health care provider
21 determines to be appropriate. For purposes of this subsection, "provid-
22 er directory information" shall include the name, address, specialty,
23 telephone number, and digital contact information of such health care
24 provider; whether the provider is accepting new patients; for mental
25 health and substance use disorder services providers, any affiliations
26 with participating facilities certified or authorized by the office of
27 mental health or the office of addiction services and supports, and any
28 restrictions regarding the availability of the individual provider's
29 services; and in the case of physicians, board certification, languages
30 spoken, and any affiliations with participating hospitals.
31 (n) A contract between an insurer and a health care provider shall
32 include a provision that states that the provider shall reimburse the
33 insured for the full amount paid by the insured in excess of the in-net-
34 work cost-sharing amount, plus interest at an interest rate determined
35 by the superintendent in accordance with 42 U.S.C. § 300gg-139(b), for
36 the services involved when the insured is provided with inaccurate
37 network status information by the insurer in a provider directory or in
38 response to a request that stated that the provider was a participating
39 provider when the provider was not a participating provider. In the
40 event the insurer provides inaccurate network status information to the
41 insured indicating the provider was a participating provider when such
42 provider was not a participating provider, the insurer shall reimburse
43 the provider for the out-of-network services regardless of whether the
44 insured's coverage includes out-of-network services. Nothing in this
45 subsection shall prohibit a health care provider from requiring in the
46 terms of a contract with an insurer that the insurer remove, at the time
47 of termination of such contract, the provider from the insurer's provid-
48 er directory or that the insurer bear financial responsibility for
49 providing inaccurate network status information to an insured.
50 § 4. Paragraph 17 of subsection (a) of section 4324 of the insurance
51 law, as amended by section 34 of subpart A of part BB of chapter 57 of
52 the laws of 2019, is amended to read as follows:
53 (17) where applicable, a listing by specialty, which may be in a sepa-
54 rate document that is updated annually, of the name, address, [and]
55 telephone number, and digital contact information of all participating
56 providers, including facilities, and: (A) whether the provider is
S. 8007--C 49 A. 9007--C
1 accepting new patients; (B) in the case of mental health or substance
2 use disorder services providers, any affiliations with participating
3 facilities certified or authorized by the office of mental health or the
4 office of [alcoholism] addiction services and [substance abuse services]
5 supports, and any restrictions regarding the availability of the indi-
6 vidual provider's services; (C) in the case of physicians, board certif-
7 ication, languages spoken and any affiliations with participating hospi-
8 tals. The listing shall also be posted on the corporation's website and
9 the corporation shall update the website within fifteen days of the
10 addition or termination of a provider from the corporation's network or
11 a change in a physician's hospital affiliation;
12 § 5. Section 4325 of the insurance law is amended by adding two new
13 subsections (n) and (o) to read as follows:
14 (n) A contract between a corporation and a health care provider shall
15 include a provision that requires the health care provider to have in
16 place business processes to ensure the timely provision of provider
17 directory information to the corporation. A health care provider shall
18 submit such provider directory information to a corporation, at a mini-
19 mum, when a provider begins or terminates a network agreement with a
20 corporation, when there are material changes to the content of the
21 provider directory information of the health care provider, and at any
22 other time, including upon the corporation's request, as the health care
23 provider determines to be appropriate. For purposes of this subsection,
24 "provider directory information" shall include the name, address,
25 specialty, telephone number, and digital contact information of such
26 health care provider; whether the provider is accepting new patients;
27 for mental health and substance use disorder services providers, any
28 affiliations with participating facilities certified or authorized by
29 the office of mental health or the office of addiction services and
30 supports, and any restrictions regarding the availability of the indi-
31 vidual provider's services; and in the case of physicians, board certif-
32 ication, languages spoken, and any affiliations with participating
33 hospitals.
34 (o) A contract between a corporation and a health care provider shall
35 include a provision that states that the provider shall reimburse the
36 insured for the full amount paid by the insured in excess of the in-net-
37 work cost-sharing amount, plus interest at an interest rate determined
38 by the superintendent in accordance with 42 U.S.C. § 300gg-139(b), for
39 the services involved when the insured is provided with inaccurate
40 network status information by the corporation in a provider directory or
41 in response to a request that stated that the provider was a participat-
42 ing provider when the provider was not a participating provider. In the
43 event the corporation provides inaccurate network status information to
44 the insured indicating the provider was a participating provider when
45 such provider was not a participating provider, the corporation shall
46 reimburse the provider for the out-of-network services regardless of
47 whether the insured's coverage includes out-of-network services. Noth-
48 ing in this subsection shall prohibit a health care provider from
49 requiring in the terms of a contract with a corporation that the corpo-
50 ration remove, at the time of termination of such contract, the provider
51 from the corporation's provider directory or that the corporation bear
52 financial responsibility for providing inaccurate network status infor-
53 mation to an insured.
54 § 6. Section 4406-c of the public health law is amended by adding two
55 new subdivisions 11 and 12 to read as follows:
S. 8007--C 50 A. 9007--C
1 11. A contract between a health care plan and a health care provider
2 shall include a provision that requires the health care provider to have
3 in place business processes to ensure the timely provision of provider
4 directory information to the health care plan. A health care provider
5 shall submit such provider directory information to a health care plan,
6 at a minimum, when a provider begins or terminates a network agreement
7 with a health care plan, when there are material changes to the content
8 of the provider directory information of such health care provider, and
9 at any other time, including upon the health care plan's request, as the
10 health care provider determines to be appropriate. For purposes of this
11 subsection, "provider directory information" shall include the name,
12 address, specialty, telephone number, and digital contact information of
13 such health care provider; whether the provider is accepting new
14 patients; for mental health and substance use disorder services provid-
15 ers, any affiliations with participating facilities certified or author-
16 ized by the office of mental health or the office of addiction services
17 and supports, and any restrictions regarding the availability of the
18 individual provider's services; and in the case of physicians, board
19 certification, languages spoken, and any affiliations with participating
20 hospitals.
21 12. A contract between a health care plan and a health care provider
22 shall include a provision that states that the provider shall reimburse
23 the enrollee for the full amount paid by the enrollee in excess of the
24 in-network cost-sharing amount, plus interest at an interest rate deter-
25 mined by the commissioner in accordance with 42 U.S.C. § 300gg-139(b),
26 for the services involved when the enrollee is provided with inaccurate
27 network status information by the health care plan in a provider direc-
28 tory or in response to a request that stated that the provider was a
29 participating provider when the provider was not a participating provid-
30 er. In the event the health care plan provides inaccurate network
31 status information to the enrollee indicating the provider was a partic-
32 ipating provider when such provider was not a participating provider,
33 the health care plan shall reimburse the provider for the out-of-network
34 services regardless of whether the enrollee's coverage includes out-of-
35 network services. Nothing in this subdivision shall prohibit a health
36 care provider from requiring in the terms of a contract with a health
37 care plan that the health care plan remove, at the time of termination
38 of such contract, the provider from the health care plan's provider
39 directory or that the health care plan bear financial responsibility for
40 providing inaccurate network status information to an enrollee.
41 § 7. Paragraph (r) of subdivision 1 of section 4408 of the public
42 health law, as amended by section 41 of subpart A of part BB of chapter
43 57 of the laws of 2019, is amended to read as follows:
44 (r) a listing by specialty, which may be in a separate document that
45 is updated annually, of the name, address [and], telephone number, and
46 digital contact information of all participating providers, including
47 facilities, and: (i) whether the provider is accepting new patients;
48 (ii) in the case of mental health or substance use disorder services
49 providers, any affiliations with participating facilities certified or
50 authorized by the office of mental health or the office of [alcoholism]
51 addiction services and [substance abuse services] supports, and any
52 restrictions regarding the availability of the individual provider's
53 services; and (iii) in the case of physicians, board certification,
54 languages spoken and any affiliations with participating hospitals. The
55 listing shall also be posted on the health maintenance organization's
56 website and the health maintenance organization shall update the website
S. 8007--C 51 A. 9007--C
1 within fifteen days of the addition or termination of a provider from
2 the health maintenance organization's network or a change in a physi-
3 cian's hospital affiliation;
4 § 8. Subdivision 8 of section 24 of the public health law is renum-
5 bered subdivision 9 and a new subdivision 8 is added to read as follows:
6 8. A health care professional, or a group practice of health care
7 professionals, a diagnostic and treatment center or a health center
8 defined under 42 U.S.C. § 254b on behalf of health care professionals
9 rendering services at the group practice, diagnostic and treatment
10 center or health center, and a hospital shall make publicly available,
11 and if applicable, post on their public websites, and provide to indi-
12 viduals who are enrollees of health care plans, a one-page written
13 notice, in clear and understandable language, containing information on
14 the requirements and prohibitions under 42 U.S.C. §§ 300gg-131 and
15 300gg-132 and article six of the financial services law relating to
16 prohibitions on balance billing for emergency services and surprise
17 bills, and information on contacting appropriate state and federal agen-
18 cies if an individual believes a health care provider has violated any
19 requirement described in 42 U.S.C. §§ 300gg-131 and 300gg-132 or article
20 six of the financial services law.
21 § 9. Subsection (e) of section 4804 of the insurance law, as added by
22 chapter 705 of the laws of 1996, is amended to read as follows:
23 (e) (1) If an insured's health care provider leaves the insurer's
24 in-network benefits portion of its network of providers for a managed
25 care product for reasons other than those for which the provider would
26 not be eligible to receive a hearing pursuant to paragraph one of
27 subsection (b) of section forty-eight hundred three of this chapter, the
28 insurer shall provide written notice to the insured of the provider's
29 disaffiliation and permit the insured to continue an ongoing course of
30 treatment with the insured's current health care provider during a tran-
31 sitional period of [(i) up to]: (A) ninety days from the later of the
32 date of the notice to the insured of the provider's disaffiliation from
33 the insurer's network or the effective date of the provider's disaffil-
34 iation from the insurer's network; or [(ii)] (B) if the insured [has
35 entered the second trimester of pregnancy] is pregnant at the time of
36 the provider's disaffiliation, [for a transitional period that includes]
37 the [provision of] duration of the pregnancy and post-partum care
38 directly related to the delivery.
39 (2) [Notwithstanding the provisions of paragraph one of this
40 subsection, such care shall be authorized by the insurer during] During
41 the transitional period [only if] the health care provider [agrees (i)
42 to] shall: (A) continue to accept reimbursement from the insurer at the
43 rates applicable prior to the start of the transitional period, and
44 continue to accept the in-network cost-sharing from the insured, if any,
45 as payment in full; [(ii) to] (B) adhere to the insurer's quality assur-
46 ance requirements and [to] provide to the insurer necessary medical
47 information related to such care; and [(iii) to] (C) otherwise adhere to
48 the insurer's policies and procedures including, but not limited to,
49 procedures regarding referrals and obtaining pre-authorization and a
50 treatment plan approved by the insurer.
51 § 10. Paragraph (e) of subdivision 6 of section 4403 of the public
52 health law, as added by chapter 705 of the laws of 1996, is amended to
53 read as follows:
54 (e) (1) If an enrollee's health care provider leaves the health main-
55 tenance organization's network of providers for reasons other than those
56 for which the provider would not be eligible to receive a hearing pursu-
S. 8007--C 52 A. 9007--C
1 ant to paragraph a of subdivision two of section forty-four hundred
2 six-d of this chapter, the health maintenance organization shall provide
3 written notice to the enrollee of the provider's disaffiliation and
4 permit the enrollee to continue an ongoing course of treatment with the
5 enrollee's current health care provider during a transitional period of:
6 (i) [up to] ninety days from the later of the date of the notice to the
7 enrollee of the provider's disaffiliation from the organization's
8 network or the effective date of the provider's disaffiliation from the
9 organization's network; or (ii) if the enrollee [has entered the second
10 trimester of pregnancy] is pregnant at the time of the provider's disaf-
11 filiation, [for a transitional period that includes] the [provision of]
12 duration of the pregnancy and post-partum care directly related to the
13 delivery.
14 (2) [Notwithstanding the provisions of subparagraph one of this para-
15 graph, such care shall be authorized by the health maintenance organiza-
16 tion during] During the transitional period [only if] the health care
17 provider [agrees] shall: (i) [to] continue to accept reimbursement from
18 the health maintenance organization at the rates applicable prior to the
19 start of the transitional period, and continue to accept the in-network
20 cost-sharing from the enrollee, if any, as payment in full; (ii) [to]
21 adhere to the organization's quality assurance requirements and to
22 provide to the organization necessary medical information related to
23 such care; and (iii) [to] otherwise adhere to the organization's poli-
24 cies and procedures, including but not limited to procedures regarding
25 referrals and obtaining pre-authorization and a treatment plan approved
26 by the organization.
27 § 11. This act shall take effect immediately.
28 SUBPART C
29 Section 1. Section 3217-d of the insurance law is amended by adding a
30 new subsection (e) to read as follows:
31 (e) An insurer that issues a comprehensive policy that uses a network
32 of providers and is not a managed care health insurance contract, as
33 defined in subsection (c) of section four thousand eight hundred one of
34 this chapter, shall establish and maintain procedures for health care
35 professional applications and terminations consistent with the require-
36 ments of section four thousand eight hundred three of this chapter and
37 procedures for health care facility applications consistent with section
38 four thousand eight hundred six of this chapter.
39 § 2. Section 4306-c of the insurance law is amended by adding a new
40 subsection (e) to read as follows:
41 (e) A corporation, including a municipal cooperative health benefit
42 plan certified pursuant to article forty-seven of this chapter and a
43 student health plan established or maintained pursuant to section one
44 thousand one hundred twenty-four of this chapter as added by chapter 246
45 of the laws of 2012, that issues a comprehensive policy that uses a
46 network of providers and is not a managed care health insurance
47 contract, as defined in subsection (c) of section four thousand eight
48 hundred one of this chapter, shall establish and maintain procedures for
49 health care professional applications and terminations consistent with
50 the requirements of section four thousand eight hundred three of this
51 chapter and procedures for health care facility applications consistent
52 with section four thousand eight hundred six of this chapter.
53 § 3. The insurance law is amended by adding a new section 4806 to read
54 as follows:
S. 8007--C 53 A. 9007--C
1 § 4806. Health care facility applications. (a) An insurer that offers
2 a managed care product shall, upon request, make available and disclose
3 to facilities written application procedures and minimum qualification
4 requirements that a facility must meet in order to be considered by the
5 insurer for participation in the in-network benefits portion of the
6 insurer's network for the managed care product. The insurer shall
7 consult with appropriately qualified facilities in developing its quali-
8 fication requirements for participation in the in-network benefits
9 portion of the insurer's network for the managed care product. An
10 insurer shall complete review of the facility's application to partic-
11 ipate in the in-network portion of the insurer's network and, within
12 sixty days of receiving a facility's completed application to partic-
13 ipate in the insurer's network, shall notify the facility as to: (1)
14 whether the facility is credentialed; or (2) whether additional time is
15 necessary to make a determination because of a failure of a third party
16 to provide necessary documentation. In such instances where additional
17 time is necessary because of a lack of necessary documentation, an
18 insurer shall make every effort to obtain such information as soon as
19 possible and shall make a final determination within twenty-one days of
20 receiving the necessary documentation.
21 (b) For the purposes of this section, "facility" shall mean a health
22 care provider that is licensed or certified pursuant to article five,
23 twenty-eight, thirty-six, forty, forty-four, or forty-seven of the
24 public health law or article sixteen, nineteen, thirty-one, thirty-two,
25 or thirty-six of the mental hygiene law.
26 § 4. The public health law is amended by adding a new section 4406-h
27 to read as follows:
28 § 4406-h. Health care facility applications. 1. A health care plan
29 shall, upon request, make available and disclose to facilities written
30 application procedures and minimum qualification requirements that a
31 facility must meet in order to be considered by the health care plan for
32 participation in the in-network benefits portion of the health care
33 plan's network. The health care plan shall consult with appropriately
34 qualified facilities in developing its qualification requirements. A
35 health care plan shall complete review of the facility's application to
36 participate in the in-network portion of the health care plan's network
37 and shall, within sixty days of receiving a facility's completed appli-
38 cation to participate in the health care plan's network, notify the
39 facility as to: (a) whether the facility is credentialed; or (b) wheth-
40 er additional time is necessary to make a determination because of a
41 failure of a third party to provide necessary documentation. In such
42 instances where additional time is necessary because of a lack of neces-
43 sary documentation, a health care plan shall make every effort to obtain
44 such information as soon as possible and shall make a final determi-
45 nation within twenty-one days of receiving the necessary documentation.
46 2. For the purposes of this section, "facility" shall mean a health
47 care provider entity or organization that is licensed or certified
48 pursuant to article five, twenty-eight, thirty-six, forty, forty-four,
49 or forty-seven of this chapter or article sixteen, nineteen, thirty-one,
50 thirty-two, or thirty-six of the mental hygiene law.
51 § 5. Subsection (g) of section 4905 of the insurance law, as added by
52 chapter 705 of the laws of 1996, is amended to read as follows:
53 (g) When making prospective, concurrent and retrospective determi-
54 nations, utilization review agents shall collect only such information
55 as is necessary to make such determination and shall not routinely
56 require health care providers to numerically code diagnoses or proce-
S. 8007--C 54 A. 9007--C
1 dures to be considered for certification or routinely request copies of
2 medical records of all patients reviewed. During prospective or concur-
3 rent review, copies of medical records shall only be required when
4 necessary to verify that the health care services subject to such review
5 are medically necessary. In such cases, only the necessary or relevant
6 sections of the medical record shall be required. A utilization review
7 agent may request copies of partial or complete medical records retros-
8 pectively. [This subsection shall not apply to health maintenance organ-
9 izations licensed pursuant to article forty-three of this chapter or
10 certified pursuant to article forty-four of the public health law.]
11 § 6. Subdivision 7 of section 4905 of the public health law, as added
12 by chapter 705 of the laws of 1996, is amended to read as follows:
13 7. When making prospective, concurrent and retrospective determi-
14 nations, utilization review agents shall collect only such information
15 as is necessary to make such determination and shall not routinely
16 require health care providers to numerically code diagnoses or proce-
17 dures to be considered for certification or routinely request copies of
18 medical records of all patients reviewed. During prospective or concur-
19 rent review, copies of medical records shall only be required when
20 necessary to verify that the health care services subject to such review
21 are medically necessary. In such cases, only the necessary or relevant
22 sections of the medical record shall be required. A utilization review
23 agent may request copies of partial or complete medical records retros-
24 pectively. [This subdivision shall not apply to health maintenance
25 organizations licensed pursuant to article forty-three of the insurance
26 law or certified pursuant to article forty-four of this chapter.]
27 § 7. This act shall take effect immediately; provided, however, that
28 sections one through four of this act shall apply to credentialing
29 applications received on or after the ninetieth day after this act shall
30 have become a law; and provided further, that sections five and six of
31 this act shall apply to health care services performed on or after the
32 ninetieth day after this act shall have become a law.
33 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
34 sion, section or subpart of this act shall be adjudged by any court of
35 competent jurisdiction to be invalid, such judgment shall not affect,
36 impair, or invalidate the remainder thereof, but shall be confined in
37 its operation to the clause, sentence, paragraph, subdivision, section
38 or subpart thereof directly involved in the controversy in which such
39 judgment shall have been rendered. It is hereby declared to be the
40 intent of the legislature that this act would have been enacted even if
41 such invalid provisions had not been included herein.
42 § 3. This act shall take effect immediately, provided, however, that
43 the applicable effective dates of Subparts A through C of this act shall
44 be as specifically set forth in the last section of such Subparts.
45 PART BB
46 Intentionally Omitted
47 PART CC
48 Section 1. Paragraph (m) of subdivision 3 of section 461-l of the
49 social services law, as added by section 2 of part B of chapter 57 of
50 the laws of 2018, is amended to read as follows:
S. 8007--C 55 A. 9007--C
1 (m) Beginning April first, two thousand [twenty-three] twenty-five,
2 additional assisted living program beds shall be approved on a case by
3 case basis whenever the commissioner of health is satisfied that public
4 need exists at the time and place and under circumstances proposed by
5 the applicant.
6 (i) The consideration of public need may take into account factors
7 such as, but not limited to, regional occupancy rates for adult care
8 facilities and assisted living program occupancy rates and the extent to
9 which the project will serve individuals receiving medical assistance.
10 (ii) Existing assisted living program providers may apply for approval
11 to add up to nine additional assisted living program beds that do not
12 require major renovation or construction under an expedited review proc-
13 ess. The expedited review process is available to applicants that are in
14 good standing with the department of health, and are in compliance with
15 appropriate state and local requirements as determined by the department
16 of health. The expedited review process shall allow certification of the
17 additional beds for which the commissioner of health is satisfied that
18 public need exists within ninety days of such department's receipt of a
19 satisfactory application.
20 § 2. Subdivision (f) of section 129 of part C of chapter 58 of the
21 laws of 2009, amending the public health law relating to payment by
22 governmental agencies for general hospital inpatient services, as
23 amended by section 6 of part E of chapter 57 of the laws of 2019, is
24 amended to read as follows:
25 (f) section twenty-five of this act shall expire and be deemed
26 repealed April 1, [2022] 2025;
27 § 3. Subdivision (c) of section 122 of part E of chapter 56 of the
28 laws of 2013 amending the public health law relating to the general
29 public health work program, as amended by section 7 of part E of chapter
30 57 of the laws of 2019, is amended to read as follows:
31 (c) section fifty of this act shall take effect immediately and shall
32 expire [nine years after it becomes law] and be deemed repealed April 1,
33 2031;
34 § 4. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of
35 the laws of 1996, amending the education law and other laws relating to
36 rates for residential healthcare facilities, as amended by section 22 of
37 part E of chapter 57 of the laws of 2019, is amended to read as follows:
38 (a) Notwithstanding any inconsistent provision of law or regulation to
39 the contrary, effective beginning August 1, 1996, for the period April
40 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1,
41 1998 through March 31, 1999, August 1, 1999, for the period April 1,
42 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000
43 through March 31, 2001, April 1, 2001, for the period April 1, 2001
44 through March 31, 2002, April 1, 2002, for the period April 1, 2002
45 through March 31, 2003, and for the state fiscal year beginning April 1,
46 2005 through March 31, 2006, and for the state fiscal year beginning
47 April 1, 2006 through March 31, 2007, and for the state fiscal year
48 beginning April 1, 2007 through March 31, 2008, and for the state fiscal
49 year beginning April 1, 2008 through March 31, 2009, and for the state
50 fiscal year beginning April 1, 2009 through March 31, 2010, and for the
51 state fiscal year beginning April 1, 2010 through March 31, 2016, and
52 for the state fiscal year beginning April 1, 2016 through March 31,
53 2019, and for the state fiscal year beginning April 1, 2019 through
54 March 31, 2022, and for the state fiscal year beginning April 1, 2022
55 through March 31, 2025, the department of health is authorized to pay
56 public general hospitals, as defined in subdivision 10 of section 2801
S. 8007--C 56 A. 9007--C
1 of the public health law, operated by the state of New York or by the
2 state university of New York or by a county, which shall not include a
3 city with a population of over one million, of the state of New York,
4 and those public general hospitals located in the county of Westchester,
5 the county of Erie or the county of Nassau, additional payments for
6 inpatient hospital services as medical assistance payments pursuant to
7 title 11 of article 5 of the social services law for patients eligible
8 for federal financial participation under title XIX of the federal
9 social security act in medical assistance pursuant to the federal laws
10 and regulations governing disproportionate share payments to hospitals
11 up to one hundred percent of each such public general hospital's medical
12 assistance and uninsured patient losses after all other medical assist-
13 ance, including disproportionate share payments to such public general
14 hospital for 1996, 1997, 1998, and 1999, based initially for 1996 on
15 reported 1994 reconciled data as further reconciled to actual reported
16 1996 reconciled data, and for 1997 based initially on reported 1995
17 reconciled data as further reconciled to actual reported 1997 reconciled
18 data, for 1998 based initially on reported 1995 reconciled data as
19 further reconciled to actual reported 1998 reconciled data, for 1999
20 based initially on reported 1995 reconciled data as further reconciled
21 to actual reported 1999 reconciled data, for 2000 based initially on
22 reported 1995 reconciled data as further reconciled to actual reported
23 2000 data, for 2001 based initially on reported 1995 reconciled data as
24 further reconciled to actual reported 2001 data, for 2002 based initial-
25 ly on reported 2000 reconciled data as further reconciled to actual
26 reported 2002 data, and for state fiscal years beginning on April 1,
27 2005, based initially on reported 2000 reconciled data as further recon-
28 ciled to actual reported data for 2005, and for state fiscal years
29 beginning on April 1, 2006, based initially on reported 2000 reconciled
30 data as further reconciled to actual reported data for 2006, for state
31 fiscal years beginning on and after April 1, 2007 through March 31,
32 2009, based initially on reported 2000 reconciled data as further recon-
33 ciled to actual reported data for 2007 and 2008, respectively, for state
34 fiscal years beginning on and after April 1, 2009, based initially on
35 reported 2007 reconciled data, adjusted for authorized Medicaid rate
36 changes applicable to the state fiscal year, and as further reconciled
37 to actual reported data for 2009, for state fiscal years beginning on
38 and after April 1, 2010, based initially on reported reconciled data
39 from the base year two years prior to the payment year, adjusted for
40 authorized Medicaid rate changes applicable to the state fiscal year,
41 and further reconciled to actual reported data from such payment year,
42 and to actual reported data for each respective succeeding year. The
43 payments may be added to rates of payment or made as aggregate payments
44 to an eligible public general hospital.
45 § 5. Section 5 of chapter 21 of the laws of 2011, amending the educa-
46 tion law relating to authorizing pharmacists to perform collaborative
47 drug therapy management with physicians in certain settings, as amended
48 by section 20 of part BB of chapter 56 of the laws of 2020, is amended
49 to read as follows:
50 § 5. This act shall take effect on the one hundred twentieth day after
51 it shall have become a law, provided, however, that the provisions of
52 sections two, three, and four of this act shall expire and be deemed
53 repealed July 1, [2022] 2024; provided, however, that the amendments to
54 subdivision 1 of section 6801 of the education law made by section one
55 of this act shall be subject to the expiration and reversion of such
56 subdivision pursuant to section 8 of chapter 563 of the laws of 2008,
S. 8007--C 57 A. 9007--C
1 when upon such date the provisions of section one-a of this act shall
2 take effect; provided, further, that effective immediately, the addi-
3 tion, amendment and/or repeal of any rule or regulation necessary for
4 the implementation of this act on its effective date are authorized and
5 directed to be made and completed on or before such effective date.
6 § 6. Section 2 of part II of chapter 54 of the laws of 2016, amending
7 part C of chapter 58 of the laws of 2005 relating to authorizing
8 reimbursements for expenditures made by or on behalf of social services
9 districts for medical assistance for needy persons and administration
10 thereof, as amended by section 1 of item C of subpart H of part XXX of
11 chapter 58 of the laws of 2020, is amended to read as follows:
12 § 2. This act shall take effect immediately and shall expire and be
13 deemed repealed March 31, [2022] 2024.
14 § 7. Paragraph (c) of subdivision 6 of section 958 of the executive
15 law, as added by chapter 337 of the laws of 2018, is amended to read as
16 follows:
17 (c) prepare and issue a report on the working group's findings and
18 recommendations by May first, two thousand [nineteen] twenty-three to
19 the governor, the temporary president of the senate and the speaker of
20 the assembly.
21 § 8. Subdivision 2 of section 207-a of the public health law, as added
22 by chapter 364 of the laws of 2018, is amended to read as follows:
23 2. Such report shall be submitted to the temporary president of the
24 senate and the speaker of the assembly no later than October first, two
25 thousand [nineteen] twenty-two. The department and the commissioner of
26 mental health may engage stakeholders in the compilation of the report,
27 including but not limited to, medical research institutions, health care
28 practitioners, mental health providers, county and local government, and
29 advocates.
30 § 9. Sections 2 and 3 of chapter 74 of the laws of 2020 relating to
31 directing the department of health to convene a work group on rare
32 diseases, as amended by chapter 199 of the laws of 2021, are amended to
33 read as follows:
34 § 2. The department of health, in collaboration with the department of
35 financial services, shall convene a workgroup of individuals with exper-
36 tise in rare diseases, including physicians, nurses and other health
37 care professionals with experience researching, diagnosing or treating
38 rare diseases; members of the scientific community engaged in rare
39 disease research; representatives from the health insurance industry;
40 individuals who have a rare disease or caregivers of a person with a
41 rare disease; and representatives of rare disease patient organizations.
42 The workgroup's focus shall include, but not be limited to: identifying
43 best practices that could improve the awareness of rare diseases and
44 referral of people with potential rare diseases to specialists and eval-
45 uating barriers to treatment, including financial barriers on access to
46 care. The department of health shall prepare a written report summariz-
47 ing opinions and recommendations from the workgroup which includes a
48 list of existing, publicly accessible resources on research, diagnosis,
49 treatment, coverage options and education relating to rare diseases. The
50 workgroup shall convene no later than December twentieth, two thousand
51 twenty-one and this report shall be submitted to the governor, speaker
52 of the assembly and temporary president of the senate no later than
53 [three] four years following the effective date of this act and shall be
54 posted on the department of health's website.
55 § 3. This act shall take effect on the same date and in the same
56 manner as a chapter of the laws of 2019, amending the public health law
S. 8007--C 58 A. 9007--C
1 relating to establishing the rare disease advisory council, as proposed
2 in legislative bills numbers S. 4497 and A. 5762; provided, however,
3 that the provisions of section two of this act shall expire and be
4 deemed repealed [three] four years after such effective date.
5 § 10. Sections 5 and 6 of chapter 414 of the laws of 2018, creating
6 the radon task force, as amended by section 1 of item M of subpart B of
7 part XXX of chapter 58 of the laws of 2020, are amended to read as
8 follows:
9 § 5. A report of the findings and recommendations of the task force
10 and any proposed legislation necessary to implement such findings shall
11 be filed with the governor, the temporary president of the senate, the
12 speaker of the assembly, the minority leader of the senate, and the
13 minority leader of the assembly on or before November first, two thou-
14 sand [twenty-one] twenty-two.
15 § 6. This act shall take effect immediately and shall expire and be
16 deemed repealed December 31, [2021] 2022.
17 § 11. This act shall take effect immediately and shall be deemed to
18 have been in full force and effect on and after April 1, 2022; provided,
19 however, that section ten of this act shall be deemed to have been in
20 full force and effect on and after December 31, 2021; and provided,
21 further, that the amendments to section 2 of chapter 74 of the laws of
22 2020 made by section nine of this act and the amendments to section 5 of
23 chapter 414 of the laws of 2018 made by section ten of this act, shall
24 not affect the repeal of such sections and shall be deemed repealed
25 therewith.
26 PART DD
27 Section 1. 1. Subject to available appropriations and approval of the
28 director of the budget, the commissioners of the office of mental
29 health, office for people with developmental disabilities, office of
30 addiction services and supports, office of temporary and disability
31 assistance, office of children and family services, and the state office
32 for the aging shall establish a state fiscal year 2022-23 cost of living
33 adjustment (COLA), effective April 1, 2022, for projecting for the
34 effects of inflation upon rates of payments, contracts, or any other
35 form of reimbursement for the programs and services listed in paragraphs
36 (i), (ii), (iii), (iv), (v), and (vi) of subdivision four of this
37 section. The COLA established herein shall be applied to the appropri-
38 ate portion of reimbursable costs or contract amounts. Where appropri-
39 ate, transfers to the department of health (DOH) shall be made as
40 reimbursement for the state share of medical assistance.
41 2. Notwithstanding any inconsistent provision of law, subject to the
42 approval of the director of the budget and available appropriations
43 therefore, for the period of April 1, 2022 through March 31, 2023, the
44 commissioners shall provide funding to support a five and four-tenths
45 percent (5.4%) cost of living adjustment under this section for all
46 eligible programs and services as determined pursuant to subdivision
47 four of this section.
48 3. Notwithstanding any inconsistent provision of law, and as approved
49 by the director of the budget, the 5.4 percent cost of living adjustment
50 (COLA) established herein shall be inclusive of all other cost of living
51 type increases, inflation factors, or trend factors that are newly
52 applied effective April 1, 2022. Except for the 5.4 percent cost of
53 living adjustment (COLA) established herein, for the period commencing
54 on April 1, 2022 and ending March 31, 2023 the commissioners shall not
S. 8007--C 59 A. 9007--C
1 apply any other new cost of living adjustments for the purpose of estab-
2 lishing rates of payments, contracts or any other form of reimbursement.
3 The phrase "all other cost of living type increases, inflation factors,
4 or trend factors" as defined in this subdivision shall not include
5 payments made pursuant to the American Rescue Plan Act or other federal
6 relief programs related to the Coronavirus Disease 2019 (COVID-19)
7 pandemic Public Health Emergency.
8 4. Eligible programs and services. (i) Programs and services funded,
9 licensed, or certified by the office of mental health (OMH) eligible for
10 the cost of living adjustment established herein, pending federal
11 approval where applicable, include: office of mental health licensed
12 outpatient programs, pursuant to parts 587 and 599 of title 14 CRR-NY of
13 the office of mental health regulations including clinic, continuing day
14 treatment, day treatment, intensive outpatient programs and partial
15 hospitalization; outreach; crisis residence; crisis stabilization,
16 crisis/respite beds; mobile crisis, part 590 comprehensive psychiatric
17 emergency program services; crisis intervention; home based crisis
18 intervention; family care; supported single room occupancy; supported
19 housing; supported housing community services; treatment congregate;
20 supported congregate; community residence - children and youth;
21 treatment/apartment; supported apartment; community residence single
22 room occupancy; on-site rehabilitation; employment programs; recreation;
23 respite care; transportation; psychosocial club; assertive community
24 treatment; case management; care coordination, including health home
25 plus services; local government unit administration; monitoring and
26 evaluation; children and youth vocational services; single point of
27 access; school-based mental health program; family support children and
28 youth; advocacy/support services; drop in centers; recovery centers;
29 transition management services; bridger; home and community based waiver
30 services; behavioral health waiver services authorized pursuant to the
31 section 1115 MRT waiver; self-help programs; consumer service dollars;
32 conference of local mental hygiene directors; multicultural initiative;
33 ongoing integrated supported employment services; supported education;
34 mentally ill/chemical abuse (MICA) network; personalized recovery
35 oriented services; children and family treatment and support services;
36 residential treatment facilities operating pursuant to part 584 of title
37 14-NYCRR; geriatric demonstration programs; community-based mental
38 health family treatment and support; coordinated children's service
39 initiative; homeless services; and promises zone.
40 (ii) Programs and services funded, licensed, or certified by the
41 office for people with developmental disabilities (OPWDD) eligible for
42 the cost of living adjustment established herein, pending federal
43 approval where applicable, include: local/unified services; chapter 620
44 services; voluntary operated community residential services; article 16
45 clinics; day treatment services; family support services; 100% day
46 training; epilepsy services; traumatic brain injury services; hepatitis
47 B services; independent practitioner services for individuals with
48 intellectual and/or developmental disabilities; crisis services for
49 individuals with intellectual and/or developmental disabilities; family
50 care residential habilitation; supervised residential habilitation;
51 supportive residential habilitation; respite; day habilitation; prevoca-
52 tional services; supported employment; community habilitation; interme-
53 diate care facility day and residential services; specialty hospital;
54 pathways to employment; intensive behavioral services; basic home and
55 community based services (HCBS) plan support; health home services
56 provided by care coordination organizations; community transition
S. 8007--C 60 A. 9007--C
1 services; family education and training; fiscal intermediary; support
2 broker; and personal resource accounts.
3 (iii) Programs and services funded, licensed, or certified by the
4 office of addiction services and supports (OASAS) eligible for the cost
5 of living adjustment established herein, pending federal approval where
6 applicable, include: medically supervised withdrawal services - residen-
7 tial; medically supervised withdrawal services - outpatient; medically
8 managed detoxification; medically monitored withdrawal; inpatient reha-
9 bilitation services; outpatient opioid treatment; residential opioid
10 treatment; KEEP units outpatient; residential opioid treatment to absti-
11 nence; problem gambling treatment; medically supervised outpatient;
12 outpatient rehabilitation; specialized services substance abuse
13 programs; home and community based waiver services pursuant to subdivi-
14 sion 9 of section 366 of the social services law; children and family
15 treatment and support services; continuum of care rental assistance case
16 management; NY/NY III post-treatment housing; NY/NY III housing for
17 persons at risk for homelessness; permanent supported housing; youth
18 clubhouse; recovery community centers; recovery community organizing
19 initiative; residential rehabilitation services for youth (RRSY); inten-
20 sive residential; community residential; supportive living; residential
21 services; job placement initiative; case management; family support
22 navigator; local government unit administration; peer engagement; voca-
23 tional rehabilitation; support services; HIV early intervention
24 services; dual diagnosis coordinator; problem gambling resource centers;
25 problem gambling prevention; prevention resource centers; primary
26 prevention services; other prevention services; and community services.
27 (iv) Programs and services funded, licensed, or certified by the
28 office of temporary and disability assistance (OTDA) eligible for the
29 cost of living adjustment established herein, pending federal approval
30 where applicable, include: nutrition outreach and education program
31 (NOEP).
32 (v) Programs and services funded, licensed, or certified by the office
33 of children and family services (OCFS) eligible for the cost of living
34 adjustment established herein, pending federal approval where applica-
35 ble, include: programs for which the office of children and family
36 services establishes maximum state aid rates pursuant to section 398-a
37 of the social services law and section 4003 of the education law; emer-
38 gency foster homes; foster family boarding homes and therapeutic foster
39 homes as defined by the regulations of the office of children and family
40 services; supervised settings as defined by subdivision twenty-two of
41 section 371 of the social services law; adoptive parents receiving
42 adoption subsidy pursuant to section 453 of the social services law; and
43 congregate and scattered supportive housing programs and supportive
44 services provided under the NY/NY III supportive housing agreement to
45 young adults leaving or having recently left foster care.
46 (vi) Programs and services funded, licensed, or certified by the state
47 office for the aging (SOFA) eligible for the cost of living adjustment
48 established herein, pending federal approval where applicable, include:
49 community services for the elderly; expanded in-home services for the
50 elderly; and supplemental nutrition assistance program.
51 5. Each local government unit or direct contract provider receiving
52 funding for the cost of living adjustment established herein shall
53 submit a written certification, in such form and at such time as each
54 commissioner shall prescribe, attesting how such funding will be or was
55 used to first promote the recruitment and retention of non-executive
56 direct care staff, non-executive direct support professionals, non-exe-
S. 8007--C 61 A. 9007--C
1 cutive clinical staff, or respond to other critical non-personal service
2 costs prior to supporting any salary increases or other compensation for
3 executive level job titles.
4 6. Notwithstanding any inconsistent provision of law to the contrary,
5 agency commissioners shall be authorized to recoup funding from a local
6 governmental unit or direct contract provider for the cost of living
7 adjustment established herein determined to have been used in a manner
8 inconsistent with the appropriation, or any other provision of this
9 section. Such agency commissioners shall be authorized to employ any
10 legal mechanism to recoup such funds, including an offset of other funds
11 that are owed to such local governmental unit or direct contract provid-
12 er.
13 § 2. This act shall take effect immediately and shall be deemed to
14 have been in full force and effect on and after April 1, 2022.
15 PART EE
16 Section 1. Short title. This act shall be known and may be cited as
17 the "9-8-8 suicide prevention and behavioral health crisis hotline act".
18 § 2. The mental hygiene law is amended by adding a new section 36.03
19 to read as follows:
20 § 36.03 9-8-8 suicide prevention and behavioral health crisis hotline
21 system.
22 (a) Definitions. When used in this article, the following words and
23 phrases shall have the following meanings unless the specific context
24 clearly indicates otherwise:
25 (1) "9-8-8" means the three digit phone number designated by the
26 federal communications commission for the purpose of connecting individ-
27 uals experiencing a behavioral health crisis with suicide prevention and
28 behavioral health crisis counselors, mobile crisis teams, and crisis
29 stabilization services and other behavioral health crises services
30 through the national suicide prevention lifeline.
31 (2) "9-8-8 crisis hotline center" means a state-identified and funded
32 center participating in the National Suicide Prevention Lifeline Network
33 to respond to statewide or regional 9-8-8 calls.
34 (3) "Crisis stabilization centers" means facilities providing short-
35 term observation and crisis stabilization services jointly licensed by
36 the office of mental health and the office of addiction services and
37 supports under section 36.01 of this article.
38 (4) "Crisis residential services" means a short-term residential
39 program designed to provide residential and support services to persons
40 with symptoms of mental illness who are at risk of or experiencing a
41 psychiatric crisis.
42 (5) "Crisis intervention services" means the continuum to address
43 crisis intervention, crisis stabilization, and crisis residential treat-
44 ment needs that are wellness, resiliency, and recovery oriented. Crisis
45 intervention services include but not limited to: crisis stabilization
46 centers, mobile crisis teams, and crisis residential services.
47 (6) "Behavioral health professional" shall mean any of the following,
48 but shall not be limited to:
49 (i) a licensed clinical social worker, licensed under article one
50 hundred fifty-four of the education law;
51 (ii) a licensed psychologist, licensed under article one hundred
52 fifty-three of the education law;
53 (iii) a registered professional nurse, licensed under article one
54 hundred thirty-nine of the education law;
S. 8007--C 62 A. 9007--C
1 (iv) a licensed master social worker, licensed under article one
2 hundred fifty-four of the education law, under the supervision of a
3 physician, psychologist or licensed clinical social worker;
4 (v) a licensed mental health counselor, licensed under article one
5 hundred sixty-three of the education law; or
6 (vi) a credentialed alcoholism and substance use counselor with a
7 valid credential issued or approved by the office of addiction services
8 and supports.
9 (7) "Certified peer specialist" means an individual who is certified
10 as a peer in New York state from a certifying authority recognized by
11 the commissioner of the office of mental health.
12 (8) "Certified recovery peer advocate" means an individual who holds a
13 certification issued by an entity approved and recognized by the commis-
14 sioner of the office of addiction services and supports.
15 (9) "Credentialed family peer advocate" means an individual who is
16 credentialed as a peer in New York state from a certifying authority
17 recognized by the commissioner of the office of mental health or the
18 commissioner of the office of addiction services and supports.
19 (10) "Credentialed youth peer advocate" means an individual who is
20 credentialed as a peer in New York state from a certifying authority
21 recognized by the commissioner of the office of mental health or the
22 commissioner of the office of addiction services and supports.
23 (11) "Mobile crisis teams" means a team licensed, certified, or
24 authorized by the office of mental health and the office of addiction
25 services and supports to provide community-based mental health or
26 substance use disorder interventions for individuals who are experienc-
27 ing a mental health or substance use disorder crisis. Members of a
28 mobile crisis team may include, but not be limited to: behavioral health
29 professionals, certified peer specialists, certified recovery peer advo-
30 cates, credentialed family peer advocates, and credentialed youth peer
31 advocates.
32 (12) "National suicide prevention lifeline" or "NSPL" means the
33 national network of local crisis centers that provide free and confiden-
34 tial emotional support to people in suicidal crisis or emotional
35 distress twenty-four hours a day, seven days a week via a toll-free
36 hotline number, which receives calls made through the 9-8-8 system. The
37 toll-free number is maintained by the Assistant Secretary for Mental
38 Health and Substance Use under Section 50-E-3 of the Public Health
39 Service Act, Section 290bb-36c of Title 42 of the United States Code.
40 (b) The commissioner of the office of mental health, in conjunction
41 with the commissioner of the office of addiction services and supports,
42 shall have joint oversight of the 9-8-8 suicide prevention and behav-
43 ioral health crisis hotline and shall work in concert with NSPL for the
44 purposes of ensuring consistency of public messaging.
45 (c) The commissioner of the office of mental health, in conjunction
46 with the commissioner of the office of addiction services and supports,
47 shall, on or before July sixteenth, two thousand twenty-two, designate a
48 crisis hotline center or centers to provide or arrange for crisis inter-
49 vention services to individuals accessing the 9-8-8 suicide prevention
50 and behavioral health crisis hotline from anywhere within the state
51 twenty-four hours a day, seven days a week. Each 9-8-8 crisis hotline
52 center shall do all of the following:
53 (1) A designated hotline center shall have an active agreement with
54 the administrator of the National Suicide Prevention Lifeline for
55 participation within the network.
S. 8007--C 63 A. 9007--C
1 (2) A designated hotline center shall meet NSPL requirements and best
2 practices guidelines for operation and clinical standards.
3 (3) A designated hotline center may utilize technology, including but
4 not limited to, chat and text that is interoperable between and across
5 the 9-8-8 suicide prevention and behavioral health crisis hotline system
6 and the administrator of the National Suicide Prevention Lifeline.
7 (4) A designated hotline center shall accept transfers of any call
8 from 9-1-1 pertaining to a behavioral health crisis.
9 (5) A designated hotline center shall ensure coordination between the
10 9-8-8 crisis hotline centers, 9-1-1, behavioral health crisis services,
11 and, when appropriate, other specialty behavioral health warm lines and
12 hotlines and other emergency services. If a law enforcement, medical,
13 or fire response is also needed, 9-8-8 and 9-1-1 operators shall coordi-
14 nate the simultaneous deployment of those services with mobile crisis
15 services.
16 (6) A designated hotline center shall have the authority to deploy
17 crisis intervention services, including but not limited to mobile crisis
18 teams, and coordinate access to crisis stabilization centers, and other
19 crisis intervention services, as appropriate, and according to guide-
20 lines and best practices established by New York State and the NSPL.
21 (7) A designated hotline center shall meet the requirements set forth
22 by New York State and the NSPL for serving high risk and specialized
23 populations including but not limited to: Black, African American,
24 Hispanic, Latino, Asian, Pacific Islander, Native American, Alaskan
25 Native; lesbian, gay, bisexual, transgender, nonbinary, queer, and ques-
26 tioning individuals; veterans; members of rural communities; individuals
27 with intellectual and developmental disabilities; individuals experienc-
28 ing homelessness or housing instability; immigrants and refugees; chil-
29 dren and youth; older adults; and religious communities as identified by
30 the federal Substance Abuse and Mental Health Services Administration,
31 including training requirements and policies for providing linguis-
32 tically and culturally competent care.
33 (8) A designated hotline center shall provide follow-up services as
34 needed to individuals accessing the 9-8-8 suicide prevention and behav-
35 ioral health crisis hotline consistent with guidance and policies estab-
36 lished by New York State and the NSPL.
37 (9) A designated hotline center shall provide data, and reports, and
38 participate in evaluations and quality improvement activities as
39 required by the office of mental health and the office of addiction
40 services and supports.
41 (d) The commissioner of the office of mental health, in conjunction
42 with the commissioner of the office of addiction services and supports,
43 shall establish a comprehensive list of reporting metrics regarding the
44 9-8-8 suicide prevention and behavioral health crisis hotline's usage,
45 services and impact which, to the maximum extent practicable, shall
46 include, at a minimum:
47 (1) The volume of requests for assistance that the 9-8-8 suicide
48 prevention and behavioral health crisis hotline received;
49 (2) The average length of time taken to respond to each request for
50 assistance, and the aggregate rates of call abandonment;
51 (3) The types of requests for assistance that the 9-8-8 suicide
52 prevention and behavioral health crisis hotline received;
53 (4) The number of mobile crisis teams dispatched;
54 (5) The number of individuals engaged by mobile crisis teams;
55 (6) The number of individuals transported by mobile crisis teams to
56 crisis intervention services or other behavioral health crisis services;
S. 8007--C 64 A. 9007--C
1 (7) The number of individuals engaged by mobile crisis teams trans-
2 ported to an emergency room;
3 (8) The number of individuals transferred by mobile crisis teams to
4 the custody of law enforcement;
5 (9) The number of times a mobile crisis team was the first responder
6 to a behavioral health crisis and the mobile crisis team had to request
7 deployment of law enforcement; and
8 (10) The age, gender, race, and ethnicity of the individual, if
9 reasonably ascertainable, of individuals contacted, transported, or
10 transferred by each mobile crisis team.
11 (e) The commissioner of the office of mental health, in conjunction
12 with the commissioner of the office of addiction services and supports,
13 shall submit an annual report on or by December thirty-first, two thou-
14 sand twenty-three and annually thereafter, regarding the comprehensive
15 list of reporting metrics to the governor, the temporary president of
16 the senate, the speaker of the assembly, the minority leader of the
17 senate and the minority leader of the assembly.
18 (f) Moneys allocated for the payment of costs determined in consulta-
19 tion with the commissioners of mental health and the office of addiction
20 services and supports associated with the administration, design,
21 installation, construction, operation, or maintenance of a 9-8-8 suicide
22 prevention and behavioral health crisis hotline system serving the
23 state, including, but not limited to: staffing, hardware, software,
24 consultants, financing and other administrative costs to operate crisis
25 call-centers throughout the state and the provision of acute and crisis
26 services for mental health and substance use disorder by directly
27 responding to the 9-8-8 hotline established pursuant to the National
28 Suicide Hotline Designation Act of 2020 (47 U.S.C. § 251a) and rules
29 adopted by the Federal Communications Commission, including such costs
30 incurred by the state, shall not supplant any separate existing, future
31 appropriations, or future funding sources dedicated to the 9-8-8 crisis
32 response system.
33 § 3. This act shall take effect immediately.
34 PART FF
35 Section 1. Subdivision 5 of section 365-m of the social services law,
36 as added by section 11 of part C of chapter 60 of the laws of 2014, is
37 amended to read as follows:
38 5. (a) Pursuant to appropriations within the offices of mental health
39 or addiction services and supports, the department of health shall rein-
40 vest [funds allocated for behavioral health services, which are general
41 fund savings directly related to] savings realized through the transi-
42 tion of populations covered by this section from the applicable Medicaid
43 fee-for-service system to a managed care model, including savings
44 [resulting from the reduction of inpatient and outpatient behavioral
45 health services provided under the Medicaid programs licensed or certi-
46 fied pursuant to article thirty-one or thirty-two of the mental hygiene
47 law, or programs that are licensed pursuant to both article thirty-one
48 of the mental hygiene law and article twenty-eight of the public health
49 law, or certified under both article thirty-two of the mental hygiene
50 law and article twenty-eight of the public health law] realized through
51 the recovery of premiums from managed care providers which represent a
52 reduction of spending on qualifying behavioral health services against
53 established premium targets for behavioral health services and the
54 medical loss ratio applicable to special needs managed care plans, for
S. 8007--C 65 A. 9007--C
1 the purpose of increasing investment in community based behavioral
2 health services, including residential services certified by the office
3 of [alcoholism and substance abuse] addiction services and supports.
4 The methodologies used to calculate the savings shall be developed by
5 the commissioner of health and the director of the budget in consulta-
6 tion with the commissioners of the office of mental health and the
7 office of [alcoholism and substance abuse] addiction services and
8 supports. In no event shall the full annual value of the [community
9 based behavioral health service] reinvestment [savings attributable to
10 the transition to managed care] pursuant to this subdivision exceed the
11 [twelve month value of the department of health general fund reductions
12 resulting from such transition] value of the premiums recovered from
13 managed care providers which represent a reduction of spending on quali-
14 fying behavioral health services. Within any fiscal year where appropri-
15 ation increases are recommended for reinvestment, insofar as managed
16 care transition savings do not occur as estimated, [and general fund
17 savings do not result,] then spending for such reinvestment may be
18 reduced in the next year's annual budget itemization. [The commissioner
19 of health shall promulgate regulations, and prior to October first, two
20 thousand fifteen, may promulgate emergency regulations as required to
21 distribute funds pursuant to this subdivision; provided, however, that
22 any emergency regulations promulgated pursuant to this section shall
23 expire no later than December thirty-first, two thousand fifteen.]
24 (b) Beginning April first, two thousand twenty-two, the department
25 shall post on its website information about the recovery of premiums
26 from managed care providers which represent a reduction of spending on
27 qualifying behavioral health services against established premium
28 targets for behavioral health services and the medical loss ratio appli-
29 cable to special needs managed care plans. Such information shall
30 include at a minimum: (i) a copy of the department's notification to
31 each managed care provider that seeks a recovery of such premiums; and
32 (ii) a list of managed care providers by name that have been subject to
33 a recovery of such premiums, specifying the amount of premium that has
34 been recovered from each managed care provider and year. In the initial
35 posting, the department shall include all premiums recovered to date as
36 required by this subdivision, by named managed care provider, amount and
37 year.
38 (c) The commissioner shall include [detailed descriptions of the meth-
39 odology used to calculate savings] information regarding the funds
40 available for reinvestment[, the results of applying such methodologies,
41 the details regarding implementation of such reinvestment], including
42 how savings are calculated and how the reinvestment was utilized pursu-
43 ant to this section[, and any regulations promulgated under this subdi-
44 vision,] in the annual report required under section forty-five-c of
45 part A of chapter fifty-six of the laws of two thousand thirteen.
46 § 2. This act shall take effect immediately.
47 PART GG
48 Section 1. Section 7 of part H of chapter 57 of the laws of 2019,
49 amending the public health law relating to waiver of certain regu-
50 lations, as amended by section 7 of part S of chapter 57 of the laws of
51 2021, is amended to read as follows:
52 § 7. This act shall take effect immediately and shall be deemed to
53 have been in full force and effect on and after April 1, 2019, provided,
S. 8007--C 66 A. 9007--C
1 however, that section two of this act shall expire on April 1, [2022]
2 2024.
3 § 2. This act shall take effect immediately and shall be deemed to
4 have been in full force and effect on and after April 1, 2022.
5 PART HH
6 Intentionally Omitted
7 PART II
8 Section 1. Subdivision 38 of section 1.03 of the mental hygiene law,
9 as amended by chapter 281 of the laws of 2019, is amended and a new
10 subdivision 59 is added to read as follows:
11 38. "Residential services facility" or "Alcoholism community resi-
12 dence" means any facility licensed or operated pursuant to article thir-
13 ty-two of this chapter which provides residential services for the
14 treatment of an addiction disorder and a homelike environment, including
15 room, board and responsible supervision as part of an overall service
16 delivery system. Provided however, "certified recovery residence" as
17 defined in subdivision fifty-nine of this section shall not be consid-
18 ered a residential services facility for the purposes of this chapter.
19 59. "Certified recovery residence" means a shared living environment
20 in the state that has been certified by the office of addiction services
21 and supports and utilizes connection to services to promote sustained
22 recovery from a substance use disorder.
23 § 2. Subdivision (a) of section 32.05 of the mental hygiene law is
24 amended by adding a new paragraph 1-a to read as follows:
25 1-a. operation of a certified recovery residence in accordance with
26 section 32.05-a of this article for the promotion of sustained recovery
27 of persons suffering from a substance use disorder;
28 § 3. The mental hygiene law is amended by adding a new section 32.05-a
29 to read as follows:
30 § 32.05-a Certified recovery residences.
31 1. The commissioner shall promulgate regulations consistent with this
32 section for the voluntary certification of certified recovery resi-
33 dences.
34 2. Such regulations shall be evidence-based, utilizing information
35 from sources with expertise in treatment and recovery. Such regulations
36 shall, at a minimum, provide guidance for:
37 (a) staffing;
38 (b) referrals to and coordination with community and peer based
39 supports including support related to co-occurring disorders;
40 (c) resident safety;
41 (d) resident rights;
42 (e) confidentiality;
43 (f) reoccurance support;
44 (g) application of tenants rights;
45 (h) administrative and operational policies and procedures; and
46 (i) housing standards which shall meet or exceed the housing quality
47 standards for safe and habitual housing which are established by local
48 housing codes.
49 3. Once the commissioner has certified a location as a certified
50 recovery residence, such certified recovery residence shall be included
S. 8007--C 67 A. 9007--C
1 on the office's website as an available option for individuals seeking
2 such an environment.
3 4. The commissioner shall regulate and ensure that residences which
4 are certified to be certified recovery residences are continuing to meet
5 the requirements of this section. The commissioner has the authority to
6 inspect such certified recovery residences and impose penalties, includ-
7 ing limiting, revoking or suspending a certification, as appropriate,
8 for failure to comply with the provisions of this section.
9 § 4. Subdivisions 1, 2 and 3 of section 32.06 of the mental hygiene
10 law, as added by chapter 223 of the laws of 2018, are amended to read as
11 follows:
12 1. For purposes of this section, unless the context clearly requires
13 otherwise, "provider" shall mean any person, firm, partnership, group,
14 practice association, fiduciary, employer, representative thereof or any
15 other entity who is providing or purporting to provide substance use
16 disorder services or operating or purporting to operate a certified
17 recovery residence. Provided, however, that "provider" shall not
18 include a person receiving substance use disorder services from the
19 provider.
20 2. No provider shall intentionally solicit, receive, accept or agree
21 to receive or accept any payment, benefit or other consideration in any
22 form to the extent such payment, benefit or other consideration is given
23 for the referral of a person as a potential patient for substance use
24 disorder services or as a resident at a certified recovery residence.
25 3. No provider providing or purporting to provide substance use disor-
26 der services or operating or purporting to operate a certified recovery
27 residence pursuant to this chapter, shall intentionally make, offer,
28 give, or agree to make, offer, or give any payment, benefit or other
29 consideration in any form to the extent such payment, benefit or other
30 consideration is given for the referral of a person as a potential
31 patient for substance use disorder services.
32 § 5. This act shall take effect on the one hundred eightieth day after
33 it shall have become a law. Effective immediately, the addition, amend-
34 ment and/or repeal of any rule or regulation necessary for the implemen-
35 tation of this act on its effective date are authorized to be made and
36 completed on or before such effective date.
37 PART JJ
38 Intentionally Omitted
39 PART KK
40 Intentionally Omitted
41 PART LL
42 Section 1. Section 48-a of part A of chapter 56 of the laws of 2013
43 amending the public health law and other laws relating to general hospi-
44 tal reimbursement for annual rates, as amended by section 18 of part E
45 of chapter 57 of the laws of 2019, is amended to read as follows:
46 § 48-a. 1. Notwithstanding any contrary provision of law, the commis-
47 sioners of the office of [alcoholism and substance abuse] addiction
48 services and supports and the office of mental health are authorized,
S. 8007--C 68 A. 9007--C
1 subject to the approval of the director of the budget, to transfer to
2 the commissioner of health state funds to be utilized as the state share
3 for the purpose of increasing payments under the medicaid program to
4 managed care organizations licensed under article 44 of the public
5 health law or under article 43 of the insurance law. Such managed care
6 organizations shall utilize such funds for the purpose of reimbursing
7 providers licensed pursuant to article 28 of the public health law or
8 article 36, 31 or 32 of the mental hygiene law for ambulatory behavioral
9 health services, as determined by the commissioner of health, in consul-
10 tation with the commissioner of [alcoholism and substance abuse]
11 addiction services and supports and the commissioner of the office of
12 mental health, provided to medicaid enrolled outpatients and for all
13 other behavioral health services except inpatient included in New York
14 state's Medicaid redesign waiver approved by the centers for medicare
15 and Medicaid services (CMS). Such reimbursement shall be in the form of
16 fees for such services which are equivalent to the payments established
17 for such services under the ambulatory patient group (APG) rate-setting
18 methodology as utilized by the department of health, the office of
19 [alcoholism and substance abuse] addiction services and supports, or the
20 office of mental health for rate-setting purposes or any such other fees
21 pursuant to the Medicaid state plan or otherwise approved by CMS in the
22 Medicaid redesign waiver; provided, however, that the increase to such
23 fees that shall result from the provisions of this section shall not, in
24 the aggregate and as determined by the commissioner of health, in
25 consultation with the commissioner of [alcoholism and substance abuse]
26 addiction services and supports and the commissioner of the office of
27 mental health, be greater than the increased funds made available pursu-
28 ant to this section. The increase of such ambulatory behavioral health
29 fees to providers available under this section shall be for all rate
30 periods on and after the effective date of section [1] 18 of part [P] E
31 of chapter 57 of the laws of [2017] 2019 through March 31, [2023] 2027
32 for patients in the city of New York, for all rate periods on and after
33 the effective date of section [1] 18 of part [P] E of chapter 57 of the
34 laws of [2017] 2019 through March 31, [2023] 2027 for patients outside
35 the city of New York, and for all rate periods on and after the effec-
36 tive date of such chapter through March 31, [2023] 2027 for all services
37 provided to persons under the age of twenty-one; provided, however, the
38 commissioner of health, in consultation with the commissioner of [alco-
39 holism and substance abuse] addiction services and supports and the
40 commissioner of mental health, may require, as a condition of approval
41 of such ambulatory behavioral health fees, that aggregate managed care
42 expenditures to eligible providers meet the alternative payment method-
43 ology requirements as set forth in attachment I of the New York state
44 medicaid section one thousand one hundred fifteen medicaid redesign team
45 waiver as approved by the centers for medicare and medicaid services.
46 The commissioner of health shall, in consultation with the commissioner
47 of [alcoholism and substance abuse] addiction services and supports and
48 the commissioner of mental health, waive such conditions if a sufficient
49 number of providers, as determined by the commissioner, suffer a finan-
50 cial hardship as a consequence of such alternative payment methodology
51 requirements, or if he or she shall determine that such alternative
52 payment methodologies significantly threaten individuals access to ambu-
53 latory behavioral health services. Such waiver may be applied on a
54 provider specific or industry wide basis. Further, such conditions may
55 be waived, as the commissioner determines necessary, to comply with
56 federal rules or regulations governing these payment methodologies.
S. 8007--C 69 A. 9007--C
1 Nothing in this section shall prohibit managed care organizations and
2 providers from negotiating different rates and methods of payment during
3 such periods described above, subject to the approval of the department
4 of health. The department of health shall consult with the office of
5 [alcoholism and substance abuse] addiction services and supports and the
6 office of mental health in determining whether such alternative rates
7 shall be approved. The commissioner of health may, in consultation with
8 the commissioner of [alcoholism and substance abuse] addiction services
9 and supports and the commissioner of the office of mental health,
10 promulgate regulations, including emergency regulations promulgated
11 prior to October 1, 2015 to establish rates for ambulatory behavioral
12 health services, as are necessary to implement the provisions of this
13 section. Rates promulgated under this section shall be included in the
14 report required under section 45-c of part A of this chapter.
15 2. Notwithstanding any contrary provision of law, the fees paid by
16 managed care organizations licensed under article 44 of the public
17 health law or under article 43 of the insurance law, to providers
18 licensed pursuant to article 28 of the public health law or article 36,
19 31 or 32 of the mental hygiene law, for ambulatory behavioral health
20 services provided to patients enrolled in the child health insurance
21 program pursuant to title 1-A of article 25 of the public health law,
22 shall be in the form of fees for such services which are equivalent to
23 the payments established for such services under the ambulatory patient
24 group (APG) rate-setting methodology or any such other fees established
25 pursuant to the Medicaid state plan. The commissioner of health shall
26 consult with the commissioner of [alcoholism and substance abuse]
27 addiction services and supports and the commissioner of the office of
28 mental health in determining such services and establishing such fees.
29 Such ambulatory behavioral health fees to providers available under this
30 section shall be for all rate periods on and after the effective date of
31 this chapter through March 31, [2023] 2027, provided, however, that
32 managed care organizations and providers may negotiate different rates
33 and methods of payment during such periods described above, subject to
34 the approval of the department of health. The department of health
35 shall consult with the office of [alcoholism and substance abuse]
36 addiction services and supports and the office of mental health in
37 determining whether such alternative rates shall be approved. The
38 report required under section 16-a of part C of chapter 60 of the laws
39 of 2014 shall also include the population of patients enrolled in the
40 child health insurance program pursuant to title 1-A of article 25 of
41 the public health law in its examination on the transition of behavioral
42 health services into managed care.
43 § 2. Section 1 of part H of chapter 111 of the laws of 2010 relating
44 to increasing Medicaid payments to providers through managed care organ-
45 izations and providing equivalent fees through an ambulatory patient
46 group methodology, as amended by section 19 of part E of chapter 57 of
47 the laws of 2019, is amended to read as follows:
48 Section 1. a. Notwithstanding any contrary provision of law, the
49 commissioners of mental health and [alcoholism and substance abuse]
50 addiction services and supports are authorized, subject to the approval
51 of the director of the budget, to transfer to the commissioner of health
52 state funds to be utilized as the state share for the purpose of
53 increasing payments under the medicaid program to managed care organiza-
54 tions licensed under article 44 of the public health law or under arti-
55 cle 43 of the insurance law. Such managed care organizations shall
56 utilize such funds for the purpose of reimbursing providers licensed
S. 8007--C 70 A. 9007--C
1 pursuant to article 28 of the public health law, or pursuant to article
2 36, 31 or article 32 of the mental hygiene law for ambulatory behavioral
3 health services, as determined by the commissioner of health in consul-
4 tation with the commissioner of mental health and commissioner of [alco-
5 holism and substance abuse] addiction services and supports, provided to
6 medicaid enrolled outpatients and for all other behavioral health
7 services except inpatient included in New York state's Medicaid redesign
8 waiver approved by the centers for medicare and Medicaid services (CMS).
9 Such reimbursement shall be in the form of fees for such services which
10 are equivalent to the payments established for such services under the
11 ambulatory patient group (APG) rate-setting methodology as utilized by
12 the department of health or by the office of mental health or office of
13 [alcoholism and substance abuse] addiction services and supports for
14 rate-setting purposes or any such other fees pursuant to the Medicaid
15 state plan or otherwise approved by CMS in the Medicaid redesign waiver;
16 provided, however, that the increase to such fees that shall result from
17 the provisions of this section shall not, in the aggregate and as deter-
18 mined by the commissioner of health in consultation with the commission-
19 ers of mental health and [alcoholism and substance abuse] addiction
20 services and supports, be greater than the increased funds made avail-
21 able pursuant to this section. The increase of such behavioral health
22 fees to providers available under this section shall be for all rate
23 periods on and after the effective date of section [2] 19 of part [P] E
24 of chapter 57 of the laws of [2017] 2019 through March 31, [2023] 2027
25 for patients in the city of New York, for all rate periods on and after
26 the effective date of section [2] 19 of part [P] E of chapter 57 of the
27 laws of [2017] 2019 through March 31, [2023] 2027 for patients outside
28 the city of New York, and for all rate periods on and after the effec-
29 tive date of section [2] 19 of part [P] E of chapter 57 of the laws of
30 [2017] 2019 through March 31, [2023] 2027 for all services provided to
31 persons under the age of twenty-one; provided, however, the commissioner
32 of health, in consultation with the commissioner of [alcoholism and
33 substance abuse] addiction services and supports and the commissioner of
34 mental health, may require, as a condition of approval of such ambulato-
35 ry behavioral health fees, that aggregate managed care expenditures to
36 eligible providers meet the alternative payment methodology requirements
37 as set forth in attachment I of the New York state medicaid section one
38 thousand one hundred fifteen medicaid redesign team waiver as approved
39 by the centers for medicare and medicaid services. The commissioner of
40 health shall, in consultation with the commissioner of [alcoholism and
41 substance abuse] addiction services and supports and the commissioner of
42 mental health, waive such conditions if a sufficient number of provid-
43 ers, as determined by the commissioner, suffer a financial hardship as a
44 consequence of such alternative payment methodology requirements, or if
45 he or she shall determine that such alternative payment methodologies
46 significantly threaten individuals access to ambulatory behavioral
47 health services. Such waiver may be applied on a provider specific or
48 industry wide basis. Further, such conditions may be waived, as the
49 commissioner determines necessary, to comply with federal rules or regu-
50 lations governing these payment methodologies. Nothing in this section
51 shall prohibit managed care organizations and providers from negotiating
52 different rates and methods of payment during such periods described,
53 subject to the approval of the department of health. The department of
54 health shall consult with the office of [alcoholism and substance abuse]
55 addiction services and supports and the office of mental health in
56 determining whether such alternative rates shall be approved. The
S. 8007--C 71 A. 9007--C
1 commissioner of health may, in consultation with the commissioners of
2 mental health and [alcoholism and substance abuse] addiction services
3 and supports, promulgate regulations, including emergency regulations
4 promulgated prior to October 1, 2013 that establish rates for behavioral
5 health services, as are necessary to implement the provisions of this
6 section. Rates promulgated under this section shall be included in the
7 report required under section 45-c of part A of chapter 56 of the laws
8 of 2013.
9 b. Notwithstanding any contrary provision of law, the fees paid by
10 managed care organizations licensed under article 44 of the public
11 health law or under article 43 of the insurance law, to providers
12 licensed pursuant to article 28 of the public health law or article 36,
13 31 or 32 of the mental hygiene law, for ambulatory behavioral health
14 services provided to patients enrolled in the child health insurance
15 program pursuant to title 1-A of article 25 of the public health law,
16 shall be in the form of fees for such services which are equivalent to
17 the payments established for such services under the ambulatory patient
18 group (APG) rate-setting methodology. The commissioner of health shall
19 consult with the commissioner of [alcoholism and substance abuse]
20 addiction services and supports and the commissioner of the office of
21 mental health in determining such services and establishing such fees.
22 Such ambulatory behavioral health fees to providers available under this
23 section shall be for all rate periods on and after the effective date of
24 this chapter through March 31, [2023] 2027, provided, however, that
25 managed care organizations and providers may negotiate different rates
26 and methods of payment during such periods described above, subject to
27 the approval of the department of health. The department of health shall
28 consult with the office of [alcoholism and substance abuse] addiction
29 services and supports and the office of mental health in determining
30 whether such alternative rates shall be approved. The report required
31 under section 16-a of part C of chapter 60 of the laws of 2014 shall
32 also include the population of patients enrolled in the child health
33 insurance program pursuant to title 1-A of article 25 of the public
34 health law in its examination on the transition of behavioral health
35 services into managed care.
36 § 3. Section 2 of part H of chapter 111 of the laws of 2010, relating
37 to increasing Medicaid payments to providers through managed care organ-
38 izations and providing equivalent fees through an ambulatory patient
39 group methodology, as amended by section 20 of part E of chapter 57 of
40 the laws of 2019, is amended to read as follows:
41 § 2. This act shall take effect immediately and shall be deemed to
42 have been in full force and effect on and after April 1, 2010, and shall
43 expire on March 31, [2023] 2027.
44 § 4. This act shall take effect immediately; provided, however that
45 the amendments to section 1 of part H of chapter 111 of the laws of
46 2010, relating to increasing Medicaid payments to providers through
47 managed care organizations and providing equivalent fees through an
48 ambulatory patient group methodology, made by section two of this act
49 shall not affect the expiration of such section and shall expire there-
50 with.
51 PART MM
52 Intentionally Omitted
S. 8007--C 72 A. 9007--C
1 PART NN
2 Section 1. Section 41.38 of the mental hygiene law, as amended by
3 chapter 218 of the laws of 1988, is amended to read as follows:
4 § 41.38 Rental and mortgage payments of community residential facilities
5 for the mentally ill.
6 (a) "Supportive housing" shall mean, for the purpose of this section
7 only, the method by which the commissioner contracts to provide rental
8 support and funding for non-clinical support services in order to main-
9 tain recipient stability.
10 (b) Notwithstanding any inconsistent provision of this article, the
11 commissioner may reimburse voluntary agencies for the reasonable cost of
12 rental of or the reasonable mortgage payment or the reasonable principal
13 and interest payment on a loan for the purpose of financing an ownership
14 interest in, and proprietary lease from, an organization formed for the
15 purpose of the cooperative ownership of real estate, together with other
16 necessary costs associated with rental or ownership of property, for a
17 community residence [or], a residential care center for adults, or
18 supportive housing, under [his] their jurisdiction less any income
19 received from a state or federal agency or third party insurer which is
20 specifically intended to offset the cost of rental of the facility or
21 housing a client at the facility, subject to the availability of appro-
22 priations therefor and such commissioner's certification of the reason-
23 ableness of the rental cost, mortgage payment, principal and interest
24 payment on a loan as provided in this section or other necessary costs
25 associated with rental or ownership of property, with the approval of
26 the director of the budget.
27 § 2. This act shall take effect April 1, 2022.
28 PART OO
29 Section 1. Section 4 of part L of chapter 59 of the laws of 2016,
30 amending the mental hygiene law relating to the appointment of temporary
31 operators for the continued operation of programs and the provision of
32 services for persons with serious mental illness and/or developmental
33 disabilities and/or chemical dependence, as amended by section 1 of part
34 U of chapter 57 of the laws of 2021, is amended to read as follows:
35 § 4. This act shall take effect immediately and shall be deemed to
36 have been in full force and effect on and after April 1, 2016; provided,
37 however, that sections one and two of this act shall expire and be
38 deemed repealed on March 31, [2022] 2025.
39 § 2. This act shall take effect immediately.
40 PART PP
41 Section 1. Subdivision 4 of section 365-f of the social services law
42 is REPEALED.
43 § 2. The opening paragraph of subparagraph (i) of paragraph (a) of
44 subdivision 4-a of section 365-f of the social services law, as amended
45 by section 3 of part G of chapter 57 of the laws of 2019, is amended to
46 read as follows:
47 "Fiscal intermediary" means an entity that provides fiscal interme-
48 diary services and has a contract for providing such services with the
49 department of health and is selected through the procurement process
50 described in [paragraph] paragraphs (b), (b-1), (b-2) and (b-3) of this
51 subdivision. Eligible applicants for contracts shall be entities that
S. 8007--C 73 A. 9007--C
1 are capable of appropriately providing fiscal intermediary services,
2 performing the responsibilities of a fiscal intermediary, and complying
3 with this section, including but not limited to entities that:
4 § 3. Paragraph (b-1) of subdivision 4-a of section 365-f of the social
5 services law, as added by section 2 of part LL of chapter 57 of the laws
6 of 2021, is amended to read as follows:
7 (b-1) Following the initial selection of contractors on February elev-
8 enth, two thousand twenty-one, pursuant to the commissioner's request
9 for offers #20039 ("RFO") in accordance with this subdivision, the
10 commissioner is instructed to [survey for information relating to the
11 additional selection criteria under this paragraph and paragraph (b-2)
12 of this subdivision, in writing in a manner determined by the commis-
13 sioner, from] accept the offer to enter into contracts with all appli-
14 cants that were not initially selected on February eleventh, two thou-
15 sand twenty-one, but that were qualified by the commissioner as meeting
16 minimum requirements of the [procurement process described in paragraph
17 (b) of this subdivision including those that were not awarded contracts
18 under that process] RFO, provided that such qualified applicants that
19 were not initially selected attest that:
20 (i) [whether the applicant is formed as a charitable corporation under
21 article two of the not-for-profit corporation law or authorized as a
22 foreign corporation under article thirteen of the not-for-profit corpo-
23 ration law;
24 (ii) was the applicant performing administrative services as a fiscal
25 intermediary prior to January first, two thousand twelve and has it
26 continuously provided such services for eligible individuals pursuant to
27 this section since that date;
28 (iii) the address the applicant listed as its primary mailing address
29 on its most recently filed state corporate tax return or its Federal
30 Return of Organization Exempt From Income Tax form (form 990);
31 (iv) whether the applicant is currently authorized, funded, approved
32 or certified to deliver state plan or home and community-based waiver
33 supports and services to individuals with intellectual and developmental
34 disabilities by the office for people with developmental disabilities;
35 (v) whether the applicant has historically provided fiscal interme-
36 diary administrative services to racial and ethnic minority residents or
37 new Americans, as defined in section ninety-four-b of the executive law,
38 in such consumers' primary language, as evidenced by information and
39 materials provided to consumers in the consumers' primary language or
40 languages; and
41 (vi) whether the applicant is verified as a minority or woman-owned
42 business enterprise pursuant to section three hundred fourteen of the
43 executive law] the applicant was providing fiscal intermediary services
44 for at least two hundred consumers in a city with a population of more
45 than one million at any time between January first, two thousand twenty
46 and March thirty-first, two thousand twenty; or
47 (ii) the applicant was providing fiscal intermediary services for at
48 least fifty consumers in another area of the state at any time between
49 January first, two thousand twenty and March thirty-first, two thousand
50 twenty.
51 § 4. Paragraphs (b-2) and (b-3) of subdivision 4-a of section 365-f of
52 the social services law are REPEALED and two new paragraphs (b-2) and
53 (b-3) are added to read as follows:
54 (b-2) Upon the publication of an attestation form or process to the
55 department's website, the remaining qualified applicants described in
56 paragraph (b-1) of this subdivision shall have sixty days to submit an
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1 attestation and all required supporting documentation to the commission-
2 er.
3 (i) Any late submission shall disqualify the applicant from receiving
4 a contract award under paragraph (b-1) of this subdivision.
5 (ii) The number of consumers served by an applicant during the period
6 between January first, two thousand twenty and March thirty-first, two
7 thousand twenty may be measured by the greatest number of consumers
8 served in the specified region by the applicant on any day during that
9 period.
10 (iii) Applicant attestations shall be audited by the office of Medi-
11 caid inspector general, and any false or inaccurate attestation shall
12 render any contract awarded under paragraph (b-1) of this subdivision
13 null and void; this provision shall not be construed to limit or super-
14 sede any other applicable sanctions or penalties that may be imposed
15 under the medical assistance program.
16 (b-3) Contracts awarded under paragraph (b-1) of this subdivision
17 shall be limited to the service areas indicated on the applicants'
18 submission to the RFO.
19 § 5. This act shall take effect immediately.
20 PART QQ
21 Section 1. Subdivision 10 of section 365-a of the social services law,
22 as added by section 11 of part MM of chapter 56 of the laws of 2020, is
23 amended to read as follows:
24 10. The department of health shall establish or procure the services
25 of an independent assessor or assessors no later than October 1, 2022,
26 in a manner and schedule as determined by the commissioner of health, to
27 take over from local departments of social services, Medicaid Managed
28 Care providers, and Medicaid managed long term care plans performance of
29 assessments and reassessments required for determining individuals'
30 needs for personal care services, including as provided through the
31 consumer directed personal assistance program, and other services or
32 programs available pursuant to the state's medical assistance program as
33 determined by such commissioner for the purpose of improving efficiency,
34 quality, and reliability in assessment and to determine individuals'
35 eligibility for Medicaid managed long term care plans. Notwithstanding
36 the provisions of section one hundred sixty-three of the state finance
37 law, or sections one hundred forty-two and one hundred forty-three of
38 the economic development law, or any contrary provision of law,
39 contracts may be entered or the commissioner may amend and extend the
40 terms of [a contract awarded prior to the effective date and entered
41 into pursuant to subdivision twenty-four of section two hundred six of
42 the public health law, as added by section thirty-nine of part C of
43 chapter fifty-eight of the laws of two thousand eight, and] a contract
44 awarded prior to the effective date and entered into to conduct enroll-
45 ment broker and conflict-free evaluation services for the Medicaid
46 program, if such contract or contract amendment is for the purpose of
47 procuring such assessment services from an independent assessor[;
48 provided, however, in the case of a contract entered into after the
49 effective date of this section, that:
50 (a) The department of health shall post on its website, for a period
51 of no less than thirty days:
52 (i) A description of the proposed services to be provided pursuant to
53 the contract or contracts;
S. 8007--C 75 A. 9007--C
1 (ii) The criteria for selection of a contractor or contractors includ-
2 ing, but not limited to, being unaffiliated with any entity certified
3 under article forty-four of the public health law or any service provid-
4 er licensed under article thirty-six of the public health law, demon-
5 strated cultural and linguistic competence, experience in evaluating the
6 service needs of individuals with disabilities seeking to live in the
7 community, and demonstrated compliance with all applicable state and
8 federal laws. Furthermore, the selection criteria shall consider and
9 give preference to whether a prospective contractor is a not-for-profit
10 organization;
11 (iii) The period of time during which a prospective contractor may
12 seek selection, which shall be no less than thirty days after such
13 information is first posted on the website; and
14 (iv) The manner by which a prospective contractor may submit a
15 proposal for selection, which may include submission by electronic
16 means;
17 (b) All reasonable and responsive submissions that are received from
18 prospective contractors in a timely fashion shall be reviewed by the
19 commissioner of health;
20 (c) The commissioner of health shall select such contractor or
21 contractors that are best suited to serve the purposes of this section
22 and the needs of recipients; and
23 (d) All decisions made and approaches taken pursuant to this section
24 shall be documented in a procurement record as defined in section one
25 hundred sixty-three of the state finance law]. Contracts entered into,
26 amended, or extended pursuant to this subdivision shall not remain in
27 force beyond September 30, 2025.
28 § 2. Section 8 of part C of chapter 57 of the laws of 2018, amending
29 the social services law and the public health law relating to health
30 homes and penalties for managed care providers, as amended by section 12
31 of part MM of chapter 56 of the laws of 2020, is amended to read as
32 follows:
33 § 8. Notwithstanding any inconsistent provision of [section] sections
34 112 and 163 of the state finance law, or sections 142 and 143 of the
35 economic development law, or any other contrary provision of law,
36 excepting the 13 responsible vendor requirements of the state finance
37 law, including, but not limited to, sections 163 and 139-k of the state
38 finance law, the commissioner of health is authorized to amend or other-
39 wise extend the terms of a contract awarded prior to the effective date
40 and entered into pursuant to subdivision 24 of section 206 of the public
41 health law, as added by section 39 of part C of chapter 58 of the laws
42 of 2008[, and a contract awarded prior to the effective date and entered
43 into to conduct enrollment broker and conflict-free evaluation services
44 for the Medicaid program, both for a period of three years], without a
45 competitive bid or request for proposal process, upon determination that
46 the existing contractor is qualified to continue to provide such
47 services, and provided that efficiency savings are achieved during the
48 period of extension; and provided, further, that the department of
49 health shall submit a request for applications for such contract during
50 the time period specified in this section and may terminate the contract
51 identified herein prior to expiration of the extension authorized by
52 this section. Contracts entered into, amended, or extended pursuant to
53 this section shall not remain in force beyond August 19, 2026.
54 § 3. Section 20 of part MM of chapter 56 of the laws of 2020, direct-
55 ing the department of health to establish or procure the services of an
S. 8007--C 76 A. 9007--C
1 independent panel of clinical professionals and to develop and implement
2 a uniform task-based assessment tool, is amended to read as follows:
3 § 20. The department of health shall establish or procure services of
4 an independent panel or panels of clinical professionals no later than
5 October 1, 2022, in a manner and schedule as determined by the commis-
6 sioner of health, to provide as appropriate independent physician or
7 other applicable clinician orders for personal care services, including
8 as provided through the consumer directed personal assistance program,
9 available pursuant to the state's medical assistance program and to
10 determine eligibility for the consumer directed personal assistance
11 program. Notwithstanding the provisions of section 163 of the state
12 finance law, or sections 142 and 143 of the economic development law, or
13 any contrary provision of law, contracts may be entered or the commis-
14 sioner of health may amend and extend the terms of [a contract awarded
15 prior to the effective date and entered into pursuant to subdivision
16 twenty-four of section two hundred six of the public health law, as
17 added by section thirty-nine of part C of chapter fifty-eight of the
18 laws of two thousand eight, and] a contract awarded prior to the effec-
19 tive date and entered into to conduct enrollment broker and conflict-
20 free evaluation services for the Medicaid program, if such contract or
21 contract amendment is for the purpose of establishing an independent
22 panel or panels of clinical professionals as described in this section[;
23 provided, however, in the case of a contract entered into after the
24 effective date of this section, that:
25 (a) The department of health shall post on its website, for a period
26 of no less than 30 days:
27 (i) A description of the proposed services to be provided pursuant to
28 the contract or contracts;
29 (ii) The criteria for selection of a contractor or contractors;
30 (iii) The period of time during which a prospective contractor may
31 seek to be selected by the department of health, which shall be no less
32 than 30 days after such information is first posted on the website; and
33 (iv) The manner by which a prospective contractor may submit a
34 proposal for selection, which may include submission by electronic
35 means;
36 (b) All reasonable and responsive submissions that are received from
37 prospective contractors in timely fashion shall be reviewed by the
38 commissioner of health; and
39 (c) The commissioner of health shall select such contractor or
40 contractors that, in such commissioner's discretion, are best suited to
41 serve the purposes of this section and the needs of recipients; and
42 (d) all decisions made and approaches taken pursuant to this section
43 shall be documented in a procurement record as defined in section one
44 hundred sixty-three of the state finance law]. Contracts entered into,
45 amended, or extended pursuant to this section shall not remain in force
46 beyond September 30, 2025.
47 § 4. This act shall take effect immediately and shall be deemed to
48 have been in full force and effect on and after April 1, 2022 and shall
49 apply to all contracts entered into, amended, or extended on or after it
50 shall have taken effect.
51 PART RR
52 Section 1. Paragraph 7 of subdivision (c) of section 1261 of the tax
53 law is REPEALED.
S. 8007--C 77 A. 9007--C
1 § 2. Subparagraph (ii) of paragraph 5 of subdivision (c) of section
2 1261 of the tax law, as amended by section 2 of part ZZ of chapter 56 of
3 the laws of 2020, is amended to read as follows:
4 (ii) After withholding the taxes, penalties and interest imposed by
5 the city of New York on and after August first, two thousand eight as
6 provided in subparagraph (i) of this paragraph, the comptroller shall
7 withhold a portion of such taxes, penalties and interest sufficient to
8 deposit annually into the central business district tolling capital
9 lockbox established pursuant to section five hundred fifty-three-j of
10 the public authorities law: (A) in state fiscal year two thousand nine-
11 teen - two thousand twenty, one hundred twenty-seven million five
12 hundred thousand dollars; (B) in state fiscal year two thousand twenty -
13 two thousand twenty-one, one hundred seventy million dollars; (C) in
14 state fiscal year two thousand twenty-one - two thousand twenty-two and
15 every succeeding state fiscal year, an amount equal to one hundred one
16 percent of the amount deposited in the immediately preceding state
17 fiscal year. The funds shall be deposited monthly in equal installments.
18 During the period that the comptroller is required to withhold amounts
19 and make payments described in this paragraph, the city of New York has
20 no right, title or interest in or to those taxes, penalties and interest
21 required to be paid into the above referenced central business district
22 tolling capital lockbox. In addition, the comptroller shall withhold a
23 portion of such taxes, penalties and interest in the amount of [two] one
24 hundred fifty million dollars, to be withheld in four quarterly install-
25 ments on January fifteenth, April fifteenth, July fifteenth and October
26 fifteenth of each year, and shall deposit such amounts into the New York
27 State Agency Trust Fund, Distressed Provider Assistance Account.
28 § 3. Section 5 of part ZZ of chapter 56 of the laws of 2020 amending
29 the tax law and the social services law relating to certain Medicaid
30 management, is amended to read as follows:
31 § 5. This act shall take effect immediately and shall be deemed
32 repealed [two] five years after such effective date.
33 § 4. This act shall take effect immediately; provided that the amend-
34 ments to subparagraph (ii) of paragraph 5 of subdivision (c) of section
35 1261 of the tax law made by section two of this act shall not affect the
36 expiration of such subparagraph and shall be deemed expired therewith.
37 PART SS
38 Section 1. 1. The department of health shall conduct a study within
39 Kings county to determine ways to improve access to health services and
40 facilities.
41 (a) In reviewing accessibility to services and facilities in Kings
42 county, the study shall consider inequities in the health care system in
43 such county, including, but not limited to, racial, ethnic, sex, immi-
44 gration status, and socio-economic status disparities that may impose
45 barriers to care.
46 (b) The study shall also consider the need for medical services for
47 women and children in Kings county, including the need for construction
48 of medical facilities serving women and children, or capital improve-
49 ments to existing regional perinatal centers.
50 2. The department of health shall complete a report based on such
51 study, which shall provide recommendations for the improvement of acces-
52 sibility to health services and facilities in Kings county.
53 3. The study shall be completed within eighteen months of the effec-
54 tive date of this act and a report of the findings from the study shall
S. 8007--C 78 A. 9007--C
1 be presented to the governor, the speaker of the assembly and the tempo-
2 rary president of the senate within ninety days of the completion of the
3 study.
4 § 2. This act shall take effect immediately.
5 PART TT
6 Section 1. Section 26 of part H of chapter 59 of the laws of 2011,
7 amending the public health law and other laws, relating to targeted
8 Medicaid reimbursement rate reductions, is amended to read as follows:
9 § 26. Notwithstanding any provision of law to the contrary and subject
10 to the availability of federal financial participation, for periods on
11 and after April 1, 2011, clinics certified pursuant to [articles 16,]
12 article 31 or 32 of the mental hygiene law shall be subject to targeted
13 Medicaid reimbursement rate reductions in accordance with the provisions
14 of this section. Such reductions shall be based on utilization thresh-
15 olds which may be established either as provider-specific or patient-
16 specific thresholds. Provider-specific thresholds shall be based on
17 average patient utilization for a given provider in comparison to a peer
18 based standard to be determined for each service. The commissioners of
19 the office of mental health[, the office for persons with developmental
20 disabilities,] and the office of [alcoholism and substance abuse]
21 addiction services and supports, in consultation with the commissioner
22 of health, are authorized to waive utilization thresholds for patients
23 of clinics certified pursuant to article [16,] 31[,] or 32 of the mental
24 hygiene law who are enrolled in specific treatment programs or otherwise
25 meet criteria as may be specified by such commissioners. When applying
26 a provider-specific threshold, rates will be reduced on a prospective
27 basis based on the amount any provider is over the determined threshold
28 level. Patient-specific thresholds will be based on annual thresholds
29 determined for each service over which the per visit payment for each
30 visit in excess of the standard during a twelve month period shall be
31 reduced by a pre-determined amount. The thresholds, peer based standards
32 and the payment reductions shall be determined by the department of
33 health, with the approval of the division of the budget, and in consul-
34 tation with the office of mental health[, the office for people with
35 developmental disabilities] and the office of [alcoholism and substance
36 abuse] addiction services and supports, and any such resulting rates
37 shall be subject to certification by the appropriate commissioners
38 pursuant to subdivision (a) of section 43.02 of the mental hygiene law.
39 The base period used to establish the thresholds shall be the 2009
40 calendar year. The total annualized reduction in payments shall be not
41 more than $10,900,000 for Article 31 clinics[, not more than $2,400,000
42 for Article 16 clinics,] and not more than $13,250,000 for Article 32
43 clinics. The commissioner of health may promulgate regulations to imple-
44 ment the provisions of this section.
45 § 2. This act shall take effect immediately.
46 § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
47 sion, section or part of this act shall be adjudged by any court of
48 competent jurisdiction to be invalid, such judgment shall not affect,
49 impair, or invalidate the remainder thereof, but shall be confined in
50 its operation to the clause, sentence, paragraph, subdivision, section
51 or part thereof directly involved in the controversy in which such judg-
52 ment shall have been rendered. It is hereby declared to be the intent of
53 the legislature that this act would have been enacted even if such
54 invalid provisions had not been included herein.
S. 8007--C 79 A. 9007--C
1 § 3. This act shall take effect immediately provided, however, that
2 the applicable effective date of Parts A through TT of this act shall be
3 as specifically set forth in the last section of such Parts.
