|SAME AS||SAME AS S04840-A|
|COSPNSR||Abinanti, Barron, Benedetto, Bichotte, Blake, Bronson, Carroll, Colton, Cook, Crespo, Cymbrowitz, Dilan, Dinowitz, Englebright, Gantt, Hikind, Hunter, Hyndman, Jaffee, Jenne, Joyner, Kim, Lavine, Lifton, Lupardo, Mayer, Miller MG, Mosley, Paulin, Peoples-Stokes, Perry, Pichardo, Ramos, Richardson, Rivera, Rodriguez, Rosenthal L, Seawright, Sepulveda, Simotas, Steck, Stirpe, Thiele, Titone, Titus, Walker, Weinstein, Weprin, De La Rosa, D'Urso, Jean-Pierre, Wright, Williams, Vanel, Solages, Wallace, Barrett, Pheffer Amato, Niou, Ortiz, Dickens, Taylor, Pellegrino, Epstein, Simon, Fernandez, Espinal|
|MLTSPNSR||Abbate, Arroyo, Aubry, Cahill, Davila, DenDekker, Fahy, Galef, Glick, Gunther, Hooper, Lentol, Magee, Magnarelli, O'Donnell, Pretlow, Quart, Rozic, Skartados|
|Ren Art 50 §§5000 - 5003 to be Art 80 §§8000 - 8003, add Art 51 §§5100 - 5111, Art 49 Title 3 §§4920 - 4927, amd §270, Pub Health L; add §89-i, St Fin L|
|Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4738A SPONSOR: Gottfried (MS)
TITLE OF BILL: An act to amend the public health law and the state finance law, in relation to enacting the "New York health act" and to establishing New York Health   PURPOSE OR GENERAL IDEA OF BILL: This bill would create a universal single payer health plan -New York Health - to provide comprehensive health coverage for all New Yorkers.   SUMMARY OF SPECIFIC PROVISIONS: Every New York resident would be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Cover- age would be publicly funded. The benefits will include comprehensive outpatient and inpatient medical care, primary and preventive care, prescription drugs, laboratory tests, rehabilitative, dental, vision, hearing, etc. - all benefits required by current state insurance law or provided by the state public employee package, Family Health Plus, Child Health Plus, Medicare, or Medicaid, and others added by the plan. Everyone would choose a primary care practitioner or other provider to provide care coordination - helping to get the care and follow-up the patient needs, referrals, and navigating the system. But there would be no "gatekeeper" obstacles to care. As with most health coverage, New York Health covers health care services when a member is out of state, either because health care is needed while the member is traveling or because there is a clinical reason for going to a particular out-of-state provider. A broadly representative Board of Trustees will advise the Commissioner of Health. Long-term care coverage is not included at the start, but the bill requires that the Board develop a plan for it within two years of passage. The Board shall also develop proposals relating to retiree health benefits and coverage of health care services covered under the workers' compensation law. In addition to the Board, there will be six regional advisory councils to represent the diverse needs and concerns of the region. The councils shall include but not be limited to representatives of health care consumers, providers, municipal and county government, and organized labor. The councils shall advise the Board, Commissioner, Governor, and Legislature on matters relating to the NY Health program and shall adopt community health improvement plans to promote health care access and quality in their regions. Health care providers, including those providing care coordination, would be paid in full by New York Health, with no co-pays or other charges to patients. The plan would develop alternative payment methods to replace old-style fee-for-service (which rewards volume but not qual- ity), and would negotiate rates with health care provider organizations. (Fee-for-service would continue until new methods are phased in.) The bill would authorize health care providers to form organizations to collectively negotiate with New York Health. Health care would no longer be paid for by insurance companies charging a regressive "tax" insurance premiums, deductibles and co-pays imposed regardless of ability to pay. Instead, New York Health would be paid for based on ability to pay, through a progressively-graduated payroll-based tax (paid at least 80% by employers and not more than 20% by employees, and 100% by self-em- ployed) and a progressively-graduated tax based on other taxable income, such as capital gains, interest and dividends. A specific revenue plan, following guidelines in the bill, would be submitted to the Legislature by the Governor. Federal funds now received for Medicare, Medicaid, Family Health and Child Health Plus would be combined with the state revenue in a New York Health Trust Fund. New York would seek federal waivers that will allow New York to completely fold those programs into New York Health. The "local share" of Medicaid funding - a major burden on local property taxes - would be ended. Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. (Existing retiree coverage could be phased out and replaced with New York Health.)   JUSTIFICATION: The state constitution states: "The protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefor shall be made by the state and by such of its subdi- visions and in such manner, and by such means as the legislature shall from time to time determine." (Article XVII, § 3.) All residents of the state have the right to health care. New Yorkers - as individuals, employers, and taxpayers - have experi- enced a rapid rise in the cost of health care and coverage in recent years. This increase has resulted in a large number of people without health coverage. Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage, and many more are severely underinsured. Health care providers are also affected by inadequate health coverage in New York State. A large portion of voluntary and public hospitals, health centers and other providers now experience substantial losses due to the provision of care that is uncompensated. Individuals often find that they are deprived of affordable care and choice because of deci- sions by health plans guided by the plan's economic needs rather than their health care needs. To address the fiscal crisis facing the health care system and the state and to assure New Yorkers can exercise their right to health care, this legislation would establish a comprehensive universal single-payer health care coverage program, funded by broad-based revenue based on ability to pay, for the benefit of all residents of the state of New York. The state will work to obtain waivers relating to Medicaid, Family Health Plus, Child Health Plus, Medicare, the Patient Protection and Affordable Care Act, and any other appropriate federal programs, under which federal funds and other subsidies that would otherwise be paid to New York State will be paid by the federal government to New York State and deposited in the New York Health trust fund. Under such a waiver, health coverage under those programs will be replaced and merged into New York Health, which will operate as a true single-payer program. If such a waiver is not obtained, the state shall use state plan amendments and seek waivers to maximize, and make as seamless as possible, the use of federally-matched health programs and federal health programs in New York Health, The goal of this legislation is that coverage be delivered by New York Health and, as much as possible, the multiple sources of funding will be pooled with other New York Health funds and not be apparent to New York Health members or participating providers. This program will promote movement away from fee-for-service payment, which tends to reward quantity and requires excessive administrative expense, and towards alternate payment methodologies, such a s global or capitat- ed payments to providers or health care organizations, that promote quality, efficiency, investment in primary and preventive care, and innovation and integration in the organizing of health care. This act does not create any employment benefit, nor does it require, prohibit, or limit the providing of any employment benefit. In order to promote improved quality of, and access to, health care services and promote improved clinical outcomes, it is the policy of the state to encourage cooperative, collaborative and integrative arrangements among health care providers who might otherwise be competitors, under the active supervision of the commissioner. It is the intent of the state to supplant competition with such arrangements and regulation only to the extent necessary to accomplish the purposes of this act, and to provide state action immunity under the state and federal antitrust laws to health care providers, particularly with respect to their relations with the single-payer New York Health plan created by this act.   PRIOR LEGISLATIVE HISTORY: 1992: A.8912-A passed Assembly 1993: A.5900 reported to Ways and Means 1994: A.5900 referred to Health Committee 1995-96: A.6801 reported to Ways and Means 1997-98: A.6172 reported to Ways and Means 1999-00: A.3571 reported to Ways and Means 2001-02: A.6779 reported to Ways and Means 2003-04: A.6952 reported to Ways and Means 2005: A.6576 reported to Ways and Means 2006: A.6576 referred to Health Committee 2007-08: A.7354 - reported to Ways and Means 2009-10: A.2356- referred to Health Committee 2011-12: A.7860-A - referred to Ways and Means 2013: A5389 referred to Health Committee 2014: A5389 - reported to Ways and Means 2015: A5062 - Passed Assembly 2016: A5062 - passed Assembly 2017: A4738 - passed Assembly   FISCAL IMPLICATIONS: Full funding for New York Health would come from the revenue measures to be proposed by the Governor under guidelines in the bill, plus available federal funds. The revenue package would also replace: local share of Medicaid, the state share of Medicaid, state and local payments for public employee health coverage, and various other health care spending. Numerous analyses document that a single-payer system would be most effective for reducing and controlling costs, for taxpayers, employers and individuals.   EFFECTIVE DATE: Immediately. The program will actually begin functioning when the Commissioner of Health declares the beginning of the implementation period.
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STATE OF NEW YORK ________________________________________________________________________ 4738--A 2017-2018 Regular Sessions IN ASSEMBLY February 3, 2017 ___________ Introduced by M. of A. GOTTFRIED, ABINANTI, BARRON, BENEDETTO, BICHOTTE, BLAKE, BRONSON, CARROLL, COLTON, COOK, CRESPO, CYMBROWITZ, DILAN, DINOWITZ, ENGLEBRIGHT, GANTT, HIKIND, HUNTER, HYNDMAN, JAFFEE, JENNE, JOYNER, KIM, LAVINE, LIFTON, LUPARDO, MAYER, M. G. MILLER, MOSLEY, PAULIN, PEOPLES-STOKES, PERRY, PICHARDO, RAMOS, RICHARDSON, RIVERA, RODRIGUEZ, L. ROSENTHAL, SEAWRIGHT, SEPULVEDA, SIMOTAS, STECK, STIRPE, THIELE, TITONE, TITUS, WALKER, WEINSTEIN, WEPRIN, DE LA ROSA, D'URSO, JEAN-PIERRE, WRIGHT, HARRIS, WILLIAMS, VANEL, SOLAGES, WALLACE, BARRETT, PHEFFER AMATO, NIOU, ORTIZ, DICKENS, TAYLOR -- Multi-Spon- sored by -- M. of A. ABBATE, ARROYO, AUBRY, CAHILL, DAVILA, FAHY, GLICK, GUNTHER, HOOPER, LENTOL, MAGEE, MAGNARELLI, O'DONNELL, PRETLOW, QUART, ROZIC, SIMON, SKARTADOS -- read once and referred to the Committee on Health -- recommitted to the Committee on Health in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee AN ACT to amend the public health law and the state finance law, in relation to enacting the "New York health act" and to establishing New York Health The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "New York health act". 3 § 2. Legislative findings and intent. 1. The state constitution 4 states: "The protection and promotion of the health of the inhabitants 5 of the state are matters of public concern and provision therefor shall 6 be made by the state and by such of its subdivisions and in such manner, 7 and by such means as the legislature shall from time to time determine." 8 (Article XVII, §3.) The legislature finds and declares that all resi- 9 dents of the state have the right to health care. While the federal 10 Affordable Care Act brought many improvements in health care and health 11 coverage, it still leaves many New Yorkers without coverage or with 12 inadequate coverage. New Yorkers - as individuals, employers, and 13 taxpayers - have experienced a rise in the cost of health care and EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09305-04-8A. 4738--A 2 1 coverage in recent years, including rising premiums, deductibles and 2 co-pays, restricted provider networks and high out-of-network charges. 3 Many New Yorkers go without health care because they cannot afford it or 4 suffer financial hardship to get it. Businesses have also experienced 5 increases in the costs of health care benefits for their employees, and 6 many employers are shifting a larger share of the cost of coverage to 7 their employees or dropping coverage entirely. Health care providers 8 are also affected by inadequate health coverage in New York state. A 9 large portion of hospitals, health centers and other providers now expe- 10 rience substantial losses due to the provision of care that is uncompen- 11 sated. Individuals often find that they are deprived of affordable care 12 and choice because of decisions by health plans guided by the plan's 13 economic interests rather than the individual's health care needs. To 14 address the fiscal crisis facing the health care system and the state 15 and to assure New Yorkers can exercise their right to health care, 16 affordable and comprehensive health coverage must be provided. Pursuant 17 to the state constitution's charge to the legislature to provide for the 18 health of New Yorkers, this legislation is an enactment of state concern 19 for the purpose of establishing a comprehensive universal guaranteed 20 health care coverage program and a health care cost control system for 21 the benefit of all residents of the state of New York. 22 2. (a) It is the intent of the Legislature to create the New York 23 Health program to provide a universal single payer health plan for every 24 New Yorker, funded by broad-based revenue based on ability to pay. The 25 state shall work to obtain waivers and other approvals relating to Medi- 26 caid, Child Health Plus, Medicare, the Affordable Care Act, and any 27 other appropriate federal programs, under which federal funds and other 28 subsidies that would otherwise be paid to New York State, New Yorkers, 29 and health care providers for health coverage that will be equaled or 30 exceeded by New York Health will be paid by the federal government to 31 New York State and deposited in the New York Health trust fund, or paid 32 to health care providers and individuals in combination with New York 33 Health trust fund payments, and for other program modifications (includ- 34 ing elimination of cost sharing and insurance premiums). Under such 35 waivers and approvals, health coverage under those programs will, to the 36 maximum extent possible, be replaced and merged into New York Health, 37 which will operate as a true single-payer program. 38 (b) If any necessary waiver or approval is not obtained, the state 39 shall use state plan amendments and seek waivers and approvals to maxi- 40 mize, and make as seamless as possible, the use of federally-matched 41 health programs and federal health programs in New York Health. Thus, 42 even where other programs such as Medicaid or Medicare may contribute to 43 paying for care, it is the goal of this legislation that the coverage 44 will be delivered by New York Health and, as much as possible, the 45 multiple sources of funding will be pooled with other New York Health 46 funds and not be apparent to New York Health members or participating 47 providers. 48 (c) This program will promote movement away from fee-for-service 49 payment, which tends to reward quantity and requires excessive adminis- 50 trative expense, and towards alternate payment methodologies, such as 51 global or capitated payments to providers or health care organizations, 52 that promote quality, efficiency, investment in primary and preventive 53 care, and innovation and integration in the organizing of health care. 54 (d) The program shall promote the use of clinical data to improve the 55 quality of health care and public health, consistent with protection ofA. 4738--A 3 1 patient confidentiality. The program shall maximize patient autonomy in 2 choice of health care providers and health care decision making. 3 3. This act does not create any employment benefit, nor does it 4 require, prohibit, or limit the providing of any employment benefit. 5 4. In order to promote improved quality of, and access to, health care 6 services and promote improved clinical outcomes, it is the policy of the 7 state to encourage cooperative, collaborative and integrative arrange- 8 ments among health care providers who might otherwise be competitors, 9 under the active supervision of the commissioner of health. It is the 10 intent of the state to supplant competition with such arrangements and 11 regulation only to the extent necessary to accomplish the purposes of 12 this act, and to provide state action immunity under the state and 13 federal antitrust laws to health care providers, particularly with 14 respect to their relations with the single-payer New York Health plan 15 created by this act. 16 § 3. Article 50 and sections 5000, 5001, 5002 and 5003 of the public 17 health law are renumbered article 80 and sections 8000, 8001, 8002 and 18 8003, respectively, and a new article 51 is added to read as follows: 19 ARTICLE 51 20 NEW YORK HEALTH 21 Section 5100. Definitions. 22 5101. Program created. 23 5102. Board of trustees. 24 5103. Eligibility and enrollment. 25 5104. Benefits. 26 5105. Health care providers; care coordination; payment method- 27 ologies. 28 5106. Health care organizations. 29 5107. Program standards. 30 5108. Regulations. 31 5109. Provisions relating to federal health programs. 32 5110. Additional provisions. 33 5111. Regional advisory councils. 34 § 5100. Definitions. As used in this article, the following terms 35 shall have the following meanings, unless the context clearly requires 36 otherwise: 37 1. "Board" means the board of trustees of the New York Health program 38 created by section fifty-one hundred two of this article, and "trustee" 39 means a trustee of the board. 40 2. "Care coordination" means, but is not limited to, managing, refer- 41 ring to, locating, coordinating, and monitoring health care services for 42 the member to assure that all medically necessary health care services 43 are made available to and are effectively used by the member in a timely 44 manner, consistent with patient autonomy. Care coordination does not 45 include a requirement for prior authorization for health care services 46 or for referral for a member to receive a health care service. 47 3. "Care coordinator" means an individual or entity approved to 48 provide care coordination under subdivision two of section fifty-one 49 hundred five of this article. 50 4. "Federally-matched public health program" means the medical assist- 51 ance program under title eleven of article five of the social services 52 law, the basic health program under section three hundred sixty-nine-gg 53 of the social services law, and the child health plus program under 54 title one-A of article twenty-five of this chapter.A. 4738--A 4 1 5. "Health care organization" means an entity that is approved by the 2 commissioner under section fifty-one hundred six of this article to 3 provide health care services to members under the program. 4 6. "Health care provider" means any individual or entity legally 5 authorized to provide a health care service under Medicaid or Medicare 6 or this article. "Health care professional" means a health care provider 7 that is an individual licensed, certified, registered or otherwise 8 authorized to practice under title eight of the education law to provide 9 such health care service, acting within his or her lawful scope of prac- 10 tice. 11 7. "Health care service" means any health care service, including care 12 coordination, included as a benefit under the program. 13 8. "Implementation period" means the period under subdivision three of 14 section fifty-one hundred one of this article during which the program 15 will be subject to special eligibility and financing provisions until it 16 is fully implemented under that section. 17 9. "Long term care" means long term care, treatment, maintenance, 18 services and supports, with the exception of short term rehabilitation 19 and short term home care, as defined by the commissioner. 20 10. "Medicaid" or "medical assistance" means title eleven of article 21 five of the social services law and the program thereunder. "Child 22 health plus" means title one-A of article twenty-five of this chapter 23 and the program thereunder. "Medicare" means title XVIII of the federal 24 social security act and the programs thereunder. "Affordable care act" 25 means the federal patient protection and affordable care act, public law 26 111-148, as amended by the health care and education reconciliation act 27 of 2010, public law 111-152, and as otherwise amended and any regu- 28 lations or guidance issued thereunder. "Basic health program" means 29 section three hundred sixty-nine-gg of the social services law and the 30 program thereunder. 31 11. "Member" means an individual who is enrolled in the program. 32 12. "New York Health", "New York Health program", and "program" mean 33 the New York Health program created by section fifty-one hundred one of 34 this article. 35 13. "New York Health trust fund" means the New York Health trust fund 36 established under section eighty-nine-i of the state finance law. 37 14. "Out-of-state health care service" means a health care service 38 provided to a member while the member is temporarily out of the state 39 and (a) it is medically necessary that the health care service be 40 provided while the member is out of the state, or (b) it is clinically 41 appropriate that the health care service be provided by a particular 42 health care provider located out of the state rather than in the state. 43 However, any health care service provided to a New York Health enrollee 44 by a health care provider qualified under paragraph (a) of subdivision 45 three of section fifty-one hundred five of this article that is located 46 outside the state shall not be considered an out-of-state service and 47 shall be covered as otherwise provided in this article. 48 15. "Participating provider" means any individual or entity that is a 49 health care provider qualified under subdivision three of section 50 fifty-one hundred five of this article that provides health care 51 services to members under the program, or a health care organization. 52 16. "Person" means any individual or natural person, trust, partner- 53 ship, association, unincorporated association, corporation, company, 54 limited liability company, proprietorship, joint venture, firm, joint 55 stock association, department, agency, authority, or other legal entity, 56 whether for-profit, not-for-profit or governmental.A. 4738--A 5 1 17. "Prescription and non-prescription drugs" means prescription drugs 2 as defined in section two hundred seventy of this chapter, and non-pres- 3 cription smoking cessation products or devices. 4 18. "Resident" means an individual whose primary place of abode is in 5 the state, without regard to the individual's immigration status, as 6 determined according to regulations of the commissioner. 7 § 5101. Program created. 1. The New York Health program is hereby 8 created in the department. The commissioner shall establish and imple- 9 ment the program under this article. The program shall provide compre- 10 hensive health coverage to every resident who enrolls in the program. 11 2. The commissioner shall, to the maximum extent possible, organize, 12 administer and market the program and services as a single program under 13 the name "New York Health" or such other name as the commissioner shall 14 determine, regardless of under which law or source the definition of a 15 benefit is found including (on a voluntary basis) retiree health bene- 16 fits. In implementing this article, the commissioner shall avoid jeop- 17 ardizing federal financial participation in these programs and shall 18 take care to promote public understanding and awareness of available 19 benefits and programs. 20 3. The commissioner shall determine when individuals may begin enroll- 21 ing in the program. There shall be an implementation period, which shall 22 begin on the date that individuals may begin enrolling in the program 23 and shall end as determined by the commissioner. 24 4. An insurer authorized to provide coverage pursuant to the insurance 25 law or a health maintenance organization certified under this chapter 26 may, if otherwise authorized, offer benefits that do not cover any 27 service for which coverage is offered to individuals under the program, 28 but may not offer benefits that cover any service for which coverage is 29 offered to individuals under the program. Provided, however, that this 30 subdivision shall not prohibit (a) the offering of any benefits to or 31 for individuals, including their families, who are employed or self-em- 32 ployed in the state but who are not residents of the state, or (b) the 33 offering of benefits during the implementation period to individuals who 34 enrolled or may enroll as members of the program, or (c) the offering of 35 retiree health benefits. 36 5. A college, university or other institution of higher education in 37 the state may purchase coverage under the program for any student, or 38 student's dependent, who is not a resident of the state. 39 6. To the extent any provision of this chapter, the social services 40 law, the insurance law or the elder law: 41 (a) is inconsistent with any provision of this article or the legisla- 42 tive intent of the New York Health Act, this article shall apply and 43 prevail, except where explicitly provided otherwise by this article; and 44 (b) is consistent with the provisions of this article and the legisla- 45 tive intent of the New York Health Act, the provision of that law shall 46 apply. 47 7. The program shall be deemed to be a health care plan for purposes 48 of utilization review and external appeal under article forty-nine of 49 this chapter. 50 8. No member shall be required to receive any health care service 51 through any entity organized, certified or operating under guidelines 52 under article forty-four of this chapter, or specified under section 53 three hundred sixty-four-j of the social services law, the insurance law 54 or the elder law. No such entity shall receive payment for health care 55 services (other than care coordination) from the program. However, this 56 subdivision shall not preclude the use of a Medicare managed careA. 4738--A 6 1 ("Medicare advantage") entity under the program and otherwise consistent 2 with this article. 3 9. The program shall include provision for an appropriate reserve 4 fund. 5 § 5102. Board of trustees. 1. The New York Health board of trustees is 6 hereby created in the department. The board of trustees shall, at the 7 request of the commissioner, consider any matter to effectuate the 8 provisions and purposes of this article, and may advise the commissioner 9 thereon; and it may, from time to time, submit to the commissioner any 10 recommendations to effectuate the provisions and purposes of this arti- 11 cle. The commissioner may propose regulations under this article and 12 amendments thereto for consideration by the board. The board of trustees 13 shall have no executive, administrative or appointive duties except as 14 otherwise provided by law. The board of trustees shall have power to 15 establish, and from time to time, amend regulations to effectuate the 16 provisions and purposes of this article, subject to approval by the 17 commissioner. 18 2. The board shall be composed of: 19 (a) the commissioner, the superintendent of financial services, and 20 the director of the budget, or their designees, as ex officio members; 21 (b) twenty-six trustees appointed by the governor; 22 (i) six of whom shall be representatives of health care consumer advo- 23 cacy organizations which have a statewide or regional constituency, who 24 have been involved in activities related to health care consumer advoca- 25 cy, including issues of interest to low- and moderate-income individ- 26 uals; 27 (ii) two of whom shall be representatives of professional organiza- 28 tions representing physicians; 29 (iii) two of whom shall be representatives of professional organiza- 30 tions representing licensed or registered health care professionals 31 other than physicians; 32 (iv) three of whom shall be representatives of general hospitals, one 33 of whom shall be a representative of public general hospitals; 34 (v) one of whom shall be a representative of community health centers; 35 (vi) two of whom shall be representatives of rehabilitation or home 36 care providers; 37 (vii) two of whom shall be representatives of behavioral or mental 38 health or disability service providers; 39 (viii) two of whom shall be representatives of health care organiza- 40 tions; 41 (ix) two of whom shall be representatives of organized labor; 42 (x) two of whom shall have demonstrated expertise in health care 43 finance; and 44 (xi) two of whom shall be employers or representatives of employers 45 who pay the payroll tax under this article, or, prior to the tax becom- 46 ing effective, will pay the tax; 47 (c) fourteen trustees appointed by the governor; five of whom to be 48 appointed on the recommendation of the speaker of the assembly; five of 49 whom to be appointed on the recommendation of the temporary president of 50 the senate; two of whom to be appointed on the recommendation of the 51 minority leader of the assembly; and two of whom to be appointed on the 52 recommendation of the minority leader of the senate. 53 3. After the end of the implementation period, no person shall be a 54 trustee unless he or she is a member of the program, except the ex offi- 55 cio trustees. Each trustee shall serve at the pleasure of the appointing 56 officer, except the ex officio trustees.A. 4738--A 7 1 4. The chair of the board shall be appointed, and may be removed as 2 chair, by the governor from among the trustees. The board shall meet at 3 least four times each calendar year. Meetings shall be held upon the 4 call of the chair and as provided by the board. A majority of the 5 appointed trustees shall be a quorum of the board, and the affirmative 6 vote of a majority of the trustees voting, but not less than ten, shall 7 be necessary for any action to be taken by the board. The board may 8 establish an executive committee to exercise any powers or duties of the 9 board as it may provide, and other committees to assist the board or the 10 executive committee. The chair of the board shall chair the executive 11 committee and shall appoint the chair and members of all other commit- 12 tees. The board of trustees may appoint one or more advisory committees. 13 Members of advisory committees need not be members of the board of trus- 14 tees. 15 5. Trustees shall serve without compensation but shall be reimbursed 16 for their necessary and actual expenses incurred while engaged in the 17 business of the board. 18 6. Notwithstanding any provision of law to the contrary, no officer or 19 employee of the state or any local government shall forfeit or be deemed 20 to have forfeited his or her office or employment by reason of being a 21 trustee. 22 7. The board and its committees and advisory committees may request 23 and receive the assistance of the department and any other state or 24 local governmental entity in exercising its powers and duties. 25 8. No later than two years after the effective date of this article: 26 (a) The board shall develop a proposal, consistent with the principles 27 of this article, for provision by the program of long-term care cover- 28 age, including the development of a proposal, consistent with the prin- 29 ciples of this article, for its funding. In developing the proposal, 30 the board shall consult with an advisory committee, appointed by the 31 chair of the board, including representatives of consumers and potential 32 consumers of long-term care, providers of long-term care, labor, and 33 other interested parties. The board shall present its proposal to the 34 governor and the legislature. 35 (b) The board shall develop proposals for: (i) incorporating retiree 36 health benefits into New York Health; (ii) accommodating employer reti- 37 ree health benefits for people who have been members of New York Health 38 but live as retirees out of the state; and (iii) accommodating employer 39 retiree health benefits for people who earned or accrued such benefits 40 while residing in the state prior to the implementation of New York 41 Health and live as retirees out of the state. The board shall present 42 its proposals to the governor and the legislature. 43 (c) The board shall develop a proposal for New York Health coverage of 44 health care services covered under the workers' compensation law, 45 including whether and how to continue funding for those services under 46 that law and whether and how to incorporate an element of experience 47 rating. 48 § 5103. Eligibility and enrollment. 1. Every resident of the state 49 shall be eligible and entitled to enroll as a member under the program. 50 2. No individual shall be required to pay any premium or other charge 51 for enrolling in or being a member under the program. 52 3. A newborn child shall be enrolled as of the date of the child's 53 birth if enrollment is done prior to the child's birth or within sixty 54 days after the child's birth. 55 § 5104. Benefits. 1. The program shall provide comprehensive health 56 coverage to every member, which shall include all health care servicesA. 4738--A 8 1 required to be covered under any of the following, without regard to 2 whether the member would otherwise be eligible for or covered by the 3 program or source referred to: 4 (a) child health plus; 5 (b) Medicaid; 6 (c) Medicare; 7 (d) article forty-four of this chapter or article thirty-two or 8 forty-three of the insurance law; 9 (e) article eleven of the civil service law, as of the date one year 10 before the beginning of the implementation period; 11 (f) any cost incurred defined in paragraph one of subsection (a) of 12 section fifty-one hundred two of the insurance law, provided that this 13 coverage shall not replace coverage under article fifty-one of the 14 insurance law; and 15 (g) any additional health care service authorized to be added to the 16 program's benefits by the program; 17 (h) provided that none of the above shall include long term care, 18 until a proposal under paragraph (a) of subdivision eight of section 19 fifty-one hundred two of this article is enacted into law. 20 2. No member shall be required to pay any premium, deductible, co-pay- 21 ment or co-insurance under the program. 22 3. The program shall provide for payment under the program for: 23 (a) emergency and temporary health care services provided to a member 24 or individual entitled to become a member who has not had a reasonable 25 opportunity to become a member or to enroll with a care coordinator; and 26 (b) health care services provided in an emergency to an individual who 27 is entitled to become a member or enrolled with a care coordinator, 28 regardless of having had an opportunity to do so. 29 § 5105. Health care providers; care coordination; payment methodol- 30 ogies. 1. Choice of health care provider. (a) Any health care provider 31 qualified to participate under this section may provide health care 32 services under the program, provided that the health care provider is 33 otherwise legally authorized to perform the health care service for the 34 individual and under the circumstances involved. 35 (b) A member may choose to receive health care services under the 36 program from any participating provider, consistent with provisions of 37 this article relating to care coordination and health care organiza- 38 tions, the willingness or availability of the provider (subject to 39 provisions of this article relating to discrimination), and the appro- 40 priate clinically-relevant circumstances. 41 2. Care coordination. (a) A care coordinator may be an individual or 42 entity that is approved by the program that is: 43 (i) a health care practitioner who is: (A) the member's primary care 44 practitioner; (B) at the option of a female member, the member's provid- 45 er of primary gynecological care; or (C) at the option of a member who 46 has a chronic condition that requires specialty care, a specialist 47 health care practitioner who regularly and continually provides treat- 48 ment for that condition to the member; 49 (ii) an entity licensed under article twenty-eight of this chapter or 50 certified under article thirty-six of this chapter, or, with respect to 51 a member who receives chronic mental health care services, an entity 52 licensed under article thirty-one of the mental hygiene law or other 53 entity approved by the commissioner in consultation with the commission- 54 er of mental health; 55 (iii) a health care organization;A. 4738--A 9 1 (iv) a Taft-Hartley fund, with respect to its members and their family 2 members; provided that this provision shall not preclude a Taft-Hartley 3 fund from becoming a care coordinator under subparagraph (v) of this 4 paragraph or a health care organization under section fifty-one hundred 5 six of this article; or 6 (v) any not-for-profit or governmental entity approved by the program. 7 (b)(i) Every member shall enroll with a care coordinator that agrees 8 to provide care coordination to the member prior to receiving health 9 care services to be paid for under the program. Health care services 10 provided to a member shall not be subject to payment under the program 11 unless the member is enrolled with a care coordinator at the time the 12 health care service is provided. 13 (ii) This paragraph shall not apply to health care services provided 14 under subdivision three of section fifty-one hundred four of this arti- 15 cle. 16 (iii) The member shall remain enrolled with that care coordinator 17 until the member becomes enrolled with a different care coordinator or 18 ceases to be a member. Members have the right to change their care coor- 19 dinator on terms at least as permissive as the provisions of section 20 three hundred sixty-four-j of the social services law relating to an 21 individual changing his or her primary care provider or managed care 22 provider. 23 (c) Care coordination shall be provided to the member by the member's 24 care coordinator. A care coordinator may employ or utilize the services 25 of other individuals or entities to assist in providing care coordi- 26 nation for the member, consistent with regulations of the commissioner. 27 (d) A health care organization may establish rules relating to care 28 coordination for members in the health care organization, different from 29 this subdivision but otherwise consistent with this article and other 30 applicable laws. 31 (e) The commissioner shall develop and implement procedures and stand- 32 ards for an individual or entity to be approved to be a care coordinator 33 in the program, including but not limited to procedures and standards 34 relating to the revocation, suspension, limitation, or annulment of 35 approval on a determination that the individual or entity is not compe- 36 tent to be a care coordinator or has exhibited a course of conduct which 37 is either inconsistent with program standards and regulations or which 38 exhibits an unwillingness to meet such standards and regulations, or is 39 a potential threat to the public health or safety. Such procedures and 40 standards shall not limit approval to be a care coordinator in the 41 program for economic purposes and shall be consistent with good profes- 42 sional practice. In developing the procedures and standards, the commis- 43 sioner shall: (i) consider existing standards developed by national 44 accrediting and professional organizations; and (ii) consult with 45 national and local organizations working on care coordination or similar 46 models, including health care practitioners, hospitals, clinics, and 47 consumers and their representatives. When developing and implementing 48 standards of approval of care coordinators for individuals receiving 49 chronic mental health care services, the commissioner shall consult with 50 the commissioner of mental health. An individual or entity may not be a 51 care coordinator unless the services included in care coordination are 52 within the individual's professional scope of practice or the entity's 53 legal authority. 54 (f) To maintain approval under the program, a care coordinator must: 55 (i) renew its status at a frequency determined by the commissioner; and 56 (ii) provide data to the department as required by the commissioner toA. 4738--A 10 1 enable the commissioner to evaluate the impact of care coordinators on 2 quality, outcomes and cost. 3 (g) Nothing in this subdivision shall authorize any individual to 4 engage in any act in violation of title eight of the education law. 5 3. Health care providers. (a) The commissioner shall establish and 6 maintain procedures and standards for health care providers to be quali- 7 fied to participate in the program, including but not limited to proce- 8 dures and standards relating to the revocation, suspension, limitation, 9 or annulment of qualification to participate on a determination that the 10 health care provider is not competent to be a provider of specific 11 health care services or has exhibited a course of conduct which is 12 either inconsistent with program standards and regulations or which 13 exhibits an unwillingness to meet such standards and regulations, or is 14 a potential threat to the public health or safety. Such procedures and 15 standards shall not limit health care provider participation in the 16 program for economic purposes and shall be consistent with good profes- 17 sional practice. Such procedures and standards may be different for 18 different types of health care providers and health care professionals. 19 Any health care provider who is qualified to participate under Medicaid, 20 child health plus or Medicare shall be deemed to be qualified to partic- 21 ipate in the program, and any health care provider's revocation, suspen- 22 sion, limitation, or annulment of qualification to participate in any of 23 those programs shall apply to the health care provider's qualification 24 to participate in the program; provided that a health care provider 25 qualified under this sentence shall follow the procedures to become 26 qualified under the program by the end of the implementation period. 27 (b) The commissioner shall establish and maintain procedures and stan- 28 dards for recognizing health care providers located out of the state for 29 purposes of providing coverage under the program for out-of-state health 30 care services. 31 (c) Procedures and standards under this subdivision shall include 32 provisions for expedited temporary qualification to participate in the 33 program for health care professionals who are (i) temporarily authorized 34 to practice in the state or (ii) are recently arrived in the state or 35 recently authorized to practice in the state. 36 4. Payment for health care services. (a) The commissioner may estab- 37 lish by regulation payment methodologies for health care services and 38 care coordination provided to members under the program by participating 39 providers, care coordinators, and health care organizations. There may 40 be a variety of different payment methodologies, including those estab- 41 lished on a demonstration basis. All payment rates under the program 42 shall be reasonable and reasonably related to the cost of efficiently 43 providing the health care service and assuring an adequate and accessi- 44 ble supply of the health care service. Until and unless another payment 45 methodology is established, health care services provided to members 46 under the program shall be paid for on a fee-for-service basis, except 47 for care coordination. 48 (b) The program shall engage in good faith negotiations with health 49 care providers' representatives under title III of article forty-nine of 50 this chapter, including, but not limited to, in relation to rates of 51 payment and payment methodologies. 52 (c) Notwithstanding any provision of law to the contrary, payment for 53 drugs provided by pharmacies under the program shall be made pursuant to 54 title one of article two-A of this chapter. However, the program shall 55 provide for payment for prescription drugs under section 340B of the 56 federal public service act where applicable. Payment for prescriptionA. 4738--A 11 1 drugs provided by health care providers other than pharmacies shall be 2 pursuant to other provisions of this article. 3 (d) Payment for health care services established under this article 4 shall be considered payment in full. A participating provider shall not 5 charge any rate in excess of the payment established under this article 6 for any health care service provided under the program and shall not 7 solicit or accept payment from any member or third party for any such 8 service except as provided under section fifty-one hundred nine of this 9 article. However, this paragraph shall not preclude the program from 10 acting as a primary or secondary payer in conjunction with another 11 third-party payer where permitted under section fifty-one hundred nine 12 of this article. 13 (e) The program may provide in payment methodologies for payment for 14 capital related expenses for specifically identified capital expendi- 15 tures incurred by not-for-profit or governmental entities certified 16 under article twenty-eight of this chapter. Any capital related expense 17 generated by a capital expenditure that requires or required approval 18 under article twenty-eight of this chapter must have received that 19 approval for the capital related expense to be paid for under the 20 program. 21 (f) Payment methodologies and rates shall include a distinct component 22 of reimbursement for direct and indirect graduate medical education as 23 defined, calculated and implemented pursuant to section twenty-eight 24 hundred seven-c of this chapter. 25 (g) The commissioner shall provide by regulation for payment method- 26 ologies and procedures for paying for out-of-state health care services. 27 § 5106. Health care organizations. 1. A member may choose to enroll 28 with and receive health care services under the program from a health 29 care organization. 30 2. A health care organization shall be a not-for-profit or govern- 31 mental entity that is approved by the commissioner that is: 32 (a) an accountable care organization under article twenty-nine-E of 33 this chapter; or 34 (b) a Taft-Hartley fund (i) with respect to its members and their 35 family members, and (ii) if allowed by applicable law and approved by 36 the commissioner, for other members of the program. 37 3. A health care organization may be responsible for providing all or 38 part of the health care services to which its members are entitled under 39 the program, consistent with the terms of its approval by the commis- 40 sioner. 41 4. (a) The commissioner shall develop and implement procedures and 42 standards for an entity to be approved to be a health care organization 43 in the program, including but not limited to procedures and standards 44 relating to the revocation, suspension, limitation, or annulment of 45 approval on a determination that the entity is not competent to be a 46 health care organization or has exhibited a course of conduct which is 47 either inconsistent with program standards and regulations or which 48 exhibits an unwillingness to meet such standards and regulations, or is 49 a potential threat to the public health or safety. Such procedures and 50 standards shall not limit approval to be a health care organization in 51 the program for economic purposes and shall be consistent with good 52 professional practice. In developing the procedures and standards, the 53 commissioner shall: (i) consider existing standards developed by 54 national accrediting and professional organizations; and (ii) consult 55 with national and local organizations working in the field of health 56 care organizations, including health care practitioners, hospitals,A. 4738--A 12 1 clinics, and consumers and their representatives. When developing and 2 implementing standards of approval of health care organizations, the 3 commissioner shall consult with the commissioner of mental health, the 4 commissioner of developmental disabilities and the commissioner of the 5 office of alcoholism and substance abuse services. 6 (b) To maintain approval under the program, a health care organization 7 must: (i) renew its status at a frequency determined by the commission- 8 er; and (ii) provide data to the department as required by the commis- 9 sioner to enable the commissioner to evaluate the health care organiza- 10 tion in relation to quality of health care services, health care 11 outcomes, and cost. 12 5. The commissioner shall make regulations relating to health care 13 organizations consistent with and to ensure compliance with this arti- 14 cle. 15 6. The provision of health care services directly or indirectly by a 16 health care organization through health care providers shall not be 17 considered the practice of a profession under title eight of the educa- 18 tion law by the health care organization. 19 § 5107. Program standards. 1. The commissioner shall establish 20 requirements and standards for the program and for health care organiza- 21 tions, care coordinators, and health care providers, consistent with 22 this article, including requirements and standards for, as applicable: 23 (a) the scope, quality and accessibility of health care services; 24 (b) relations between health care organizations or health care provid- 25 ers and members; and 26 (c) relations between health care organizations and health care 27 providers, including (i) credentialing and participation in the health 28 care organization; and (ii) terms, methods and rates of payment. 29 2. Requirements and standards under the program shall include, but not 30 be limited to, provisions to promote the following: 31 (a) simplification, transparency, uniformity, and fairness in health 32 care provider credentialing and participation in health care organiza- 33 tion networks, referrals, payment procedures and rates, claims process- 34 ing, and approval of health care services, as applicable; 35 (b) primary and preventive care, care coordination, efficient and 36 effective health care services, quality assurance, coordination and 37 integration of health care services, including use of appropriate tech- 38 nology, and promotion of public, environmental and occupational health; 39 (c) elimination of health care disparities; 40 (d) non-discrimination with respect to members and health care provid- 41 ers on the basis of race, ethnicity, national origin, religion, disabil- 42 ity, age, sex, sexual orientation, gender identity or expression, or 43 economic circumstances; provided that health care services provided 44 under the program shall be appropriate to the patient's clinically-rele- 45 vant circumstances; and 46 (e) accessibility of care coordination, health care organization 47 services and health care services, including accessibility for people 48 with disabilities and people with limited ability to speak or understand 49 English, and the providing of care coordination, health care organiza- 50 tion services and health care services in a culturally competent manner. 51 3. Any participating provider or care coordinator that is organized as 52 a for-profit entity (other than a professional practice of one or more 53 health care professionals) shall be required to meet the same require- 54 ments and standards as entities organized as not-for-profit entities, 55 and payments under the program paid to such entities shall not be calcu- 56 lated to accommodate the generation of profit or revenue for dividendsA. 4738--A 13 1 or other return on investment or the payment of taxes that would not be 2 paid by a not-for-profit entity. 3 4. Every participating provider shall furnish to the program such 4 information to, and permit examination of its records by, the program, 5 as may be reasonably required for purposes of reviewing accessibility 6 and utilization of health care services, quality assurance, promoting 7 improved patient outcomes and cost containment, the making of payments, 8 and statistical or other studies of the operation of the program or for 9 protection and promotion of public, environmental and occupational 10 health. 11 5. In developing requirements and standards and making other policy 12 determinations under this article, the commissioner shall consult with 13 representatives of members, health care providers, care coordinators, 14 health care organizations employers, organized labor, and other inter- 15 ested parties. 16 6. The program shall maintain the security and confidentiality of all 17 data and other information collected under the program when such data 18 would be normally considered confidential patient data. Aggregate data 19 of the program which is derived from confidential data but does not 20 violate patient confidentiality shall be public information including 21 for purposes of article six of the public officers law. 22 § 5108. Regulations. The commissioner may make regulations under this 23 article by approving regulations and amendments thereto, under subdivi- 24 sion one of section fifty-one hundred two of this article. The commis- 25 sioner may make regulations or amendments thereto under this article on 26 an emergency basis under section two hundred two of the state adminis- 27 trative procedure act, provided that such regulations or amendments 28 shall not become permanent unless adopted under subdivision one of 29 section fifty-one hundred two of this article. 30 § 5109. Provisions relating to federal health programs. 1. The commis- 31 sioner shall seek all federal waivers and other federal approvals and 32 arrangements and submit state plan amendments necessary to operate the 33 program consistent with this article to the maximum extent possible. 34 2. (a) The commissioner shall apply to the secretary of health and 35 human services or other appropriate federal official for all waivers of 36 requirements, and make other arrangements, under Medicare, any federal- 37 ly-matched public health program, the affordable care act, and any other 38 federal programs that provide federal funds for payment for health care 39 services, that are necessary to enable all New York Health members to 40 receive all benefits under the program through the program to enable the 41 state to implement this article and to receive and deposit all federal 42 payments under those programs (including funds that may be provided in 43 lieu of premium tax credits, cost-sharing subsidies, and small business 44 tax credits) in the state treasury to the credit of the New York Health 45 trust fund and to use those funds for the New York Health program and 46 other provisions under this article. To the extent possible, the commis- 47 sioner shall negotiate arrangements with the federal government in which 48 bulk or lump-sum federal payments are paid to New York Health in place 49 of federal spending or tax benefits for federally-matched health 50 programs or federal health programs. 51 (b) The commissioner may require members or applicants to be members 52 to provide information necessary for the program to comply with any 53 waiver or arrangement under this subdivision. 54 3. (a) The commissioner may take actions consistent with this article 55 to enable New York Health to administer Medicare in New York state, to 56 create a Medicare managed care plan ("Medicare Advantage") that wouldA. 4738--A 14 1 operate consistent with this article, and to be a provider of drug 2 coverage under Medicare part D for eligible members of New York Health. 3 (b) The commissioner may waive or modify the applicability of 4 provisions of this section relating to any federally-matched public 5 health program or Medicare as necessary to implement any waiver or 6 arrangement under this section or to maximize the benefit to the New 7 York Health program under this section, provided that the commissioner, 8 in consultation with the director of the budget, shall determine that 9 such waiver or modification is in the best interests of the members 10 affected by the action and the state. 11 (c) The commissioner may apply for coverage under any federally- 12 matched public health program on behalf of any member and enroll the 13 member in the federally-matched public health program or Medicare if the 14 member is eligible for it. Enrollment in a federally-matched public 15 health program or Medicare shall not cause any member to lose any health 16 care service provided by the program or diminish any right the member 17 would otherwise have. 18 (d) The commissioner shall by regulation increase the income eligibil- 19 ity level, increase or eliminate the resource test for eligibility, 20 simplify any procedural or documentation requirement for enrollment, and 21 increase the benefits for any federally-matched public health program, 22 and for any program to reduce or eliminate an individual's coinsurance, 23 cost-sharing or premium obligations or increase an individual's eligi- 24 bility for any federal financial support related to Medicare or the 25 affordable care act notwithstanding any law or regulation to the contra- 26 ry. The commissioner may act under this paragraph upon a finding, 27 approved by the director of the budget, that the action (i) will help to 28 increase the number of members who are eligible for and enrolled in 29 federally-matched public health programs, or for any program to reduce 30 or eliminate an individual's coinsurance, cost-sharing or premium obli- 31 gations or increase an individual's eligibility for any federal finan- 32 cial support related to Medicare or the affordable care act; (ii) will 33 not diminish any individual's access to any health care service, benefit 34 or right the individual would otherwise have; (iii) is in the interest 35 of the program; and (iv) does not require or has received any necessary 36 federal waivers or approvals to ensure federal financial participation. 37 Actions under this paragraph shall not apply to eligibility for payment 38 for long term care. 39 (e) To enable the commissioner to apply for coverage under any feder- 40 ally-matched public health program or Medicare on behalf of any member 41 and enroll the member in the federally-matched public health program or 42 Medicare if the member is eligible for it, the commissioner may require 43 that every member or applicant to be a member shall provide information 44 to enable the commissioner to determine whether the applicant is eligi- 45 ble for a federally-matched public health program and for Medicare (and 46 any program or benefit under Medicare). The program shall make a reason- 47 able effort to notify members of their obligations under this paragraph. 48 After a reasonable effort has been made to contact the member, the 49 member shall be notified in writing that he or she has sixty days to 50 provide such required information. If such information is not provided 51 within the sixty day period, the member's coverage under the program may 52 be terminated. 53 (f) To the extent necessary for purposes of this section, as a condi- 54 tion of continued eligibility for health care services under the 55 program, a member who is eligible for benefits under Medicare shall 56 enroll in Medicare, including parts A, B and D.A. 4738--A 15 1 (g) The program shall provide premium assistance for all members 2 enrolling in a Medicare part D drug coverage under section 1860D of 3 Title XVIII of the federal social security act limited to the low-income 4 benchmark premium amount established by the federal centers for Medicare 5 and Medicaid services and any other amount which such agency establishes 6 under its de minimis premium policy, except that such payments made on 7 behalf of members enrolled in a Medicare advantage plan may exceed the 8 low-income benchmark premium amount if determined to be cost effective 9 to the program. 10 (h) If the commissioner has reasonable grounds to believe that a 11 member could be eligible for an income-related subsidy under section 12 1860D-14 of Title XVIII of the federal social security act, the member 13 shall provide, and authorize the program to obtain, any information or 14 documentation required to establish the member's eligibility for such 15 subsidy, provided that the commissioner shall attempt to obtain as much 16 of the information and documentation as possible from records that are 17 available to him or her. 18 (i) The program shall make a reasonable effort to notify members of 19 their obligations under this subdivision. After a reasonable effort has 20 been made to contact the member, the member shall be notified in writing 21 that he or she has sixty days to provide such required information. If 22 such information is not provided within the sixty day period, the 23 member's coverage under the program may be terminated. 24 § 5110. Additional provisions. 1. The commissioner shall contract 25 with not-for-profit organizations to provide: 26 (a) consumer assistance to individuals with respect to selection and 27 changing selection of a care coordinator or health care organization, 28 enrolling, obtaining health care services, and other matters relating to 29 the program; 30 (b) health care provider assistance to health care providers providing 31 and seeking or considering whether to provide, health care services 32 under the program, with respect to participating in a health care organ- 33 ization and dealing with a health care organization; and 34 (c) care coordinator assistance to individuals and entities providing 35 and seeking or considering whether to provide, care coordination to 36 members. 37 2. The commissioner shall provide grants from funds in the New York 38 Health trust fund or otherwise appropriated for this purpose, to health 39 systems agencies under section twenty-nine hundred four-b of this chap- 40 ter to support the operation of such health systems agencies. 41 3. The commissioner shall provide funds from the New York Health trust 42 fund or otherwise appropriated for this purpose to the commissioner of 43 labor for a program for retraining and assisting job transition for 44 individuals employed or previously employed in the field of health 45 insurance and other third-party payment for health care or providing 46 services to health care providers to deal with third-party payers for 47 health care, whose jobs may be or have been ended as a result of the 48 implementation of the New York Health program, consistent with otherwise 49 applicable law. 50 4. The commissioner shall, directly and through grants to not-for-pro- 51 fit entities, conduct programs using data collected through the New York 52 Health program, to promote and protect the quality of health care 53 services, patient outcomes, and public, environmental and occupational 54 health, including cooperation with other data collection and research 55 programs of the department, consistent with this article, the protectionA. 4738--A 16 1 of the security and confidentiality of individually identifiable patient 2 information, and otherwise applicable law. 3 § 5111. Regional advisory councils. 1. The New York Health regional 4 advisory councils (each referred to in this article as a "regional advi- 5 sory council") are hereby created in the department. 6 2. There shall be a regional advisory council established in each of 7 the following regions: 8 (a) Long Island, consisting of Nassau and Suffolk counties; 9 (b) New York City; 10 (c) Hudson Valley, consisting of Delaware, Dutchess, Orange, Putnam, 11 Rockland, Sullivan, Ulster, Westchester counties; 12 (d) Northern, consisting of Albany, Clinton, Columbia, Essex, Frank- 13 lin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, 14 Schenectady, Schoharie, Warren, Washington counties; 15 (e) Central, consisting of Broome, Cayuga, Chemung, Chenango, Cort- 16 land, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Oneida, 17 Onondaga, Ontario, Oswego, Schuyler, Seneca, St. Lawrence, Steuben, 18 Tioga, Tompkins, Wayne, Yates counties; and 19 (f) Western, consisting of Allegany, Cattaraugus, Chautauqua, Erie, 20 Genesee, Niagara, Orleans, Wyoming counties. 21 3. Each regional advisory council shall be composed of not fewer than 22 twenty-seven members, as determined by the commissioner and the board, 23 as necessary to appropriately represent the diverse needs and concerns 24 of the region. Members of a regional advisory council shall be residents 25 of or have their principal place of business in the region served by the 26 regional advisory council. 27 4. Appointment of members of the regional advisory councils. 28 (a) The twenty-seven members shall be appointed as follows: 29 (i) nine members shall be appointed by the governor; 30 (ii) six members shall be appointed by the governor on the recommenda- 31 tion of the speaker of the assembly; 32 (iii) six members shall be appointed by the governor on the recommen- 33 dation of the temporary president of the senate; 34 (iv) three members shall be appointed by the governor on the recommen- 35 dation of the minority leader of the assembly; and 36 (v) three members shall be appointed by the governor on the recommen- 37 dation of the minority leader of the senate. 38 Where a regional advisory council has more than twenty-seven members, 39 additional members shall be appointed and recommended by these officials 40 in the same proportion as the twenty-seven members. 41 (b) Regional advisory council membership shall include but not be 42 limited to: 43 (i) representatives of health care consumer advocacy organizations 44 with a regional constituency, who shall represent at least one third of 45 the membership of each regional council; 46 (ii) representatives of professional organizations representing physi- 47 cians; 48 (iii) representatives of professional organizations representing 49 health care professionals other than physicians; 50 (iv) representatives of general hospitals, including public hospitals; 51 (v) representatives of community health centers; 52 (vi) representatives of mental health, behavioral health (including 53 substance use), physical disability, developmental disability, rehabili- 54 tation, home care and other service providers; 55 (vii) representatives of women's health service providers; 56 (viii) representatives of health care organizations;A. 4738--A 17 1 (ix) representatives of organized labor; 2 (x) representatives of employers; and 3 (xi) representatives of municipal and county government. 4 5. Members of a regional advisory council shall be appointed for terms 5 of three years provided, however, that of the members first appointed, 6 one-third shall be appointed for one year terms and one-third shall be 7 appointed for two year terms. Vacancies shall be filled in the same 8 manner as original appointments for the remainder of any unexpired term. 9 No person shall be a member of a regional advisory council for more than 10 six years in any period of twelve consecutive years. 11 6. Members of the regional advisory councils shall serve without 12 compensation but shall be reimbursed for their necessary and actual 13 expenses incurred while engaged in the business of the advisory coun- 14 cils. The program shall provide financial support for such expenses and 15 other expenses of the regional advisory councils. 16 7. Each regional advisory council shall meet at least quarterly. Each 17 regional advisory council may form committees to assist it in its work. 18 Members of a committee need not be members of the regional advisory 19 council. The New York City regional advisory council shall form a 20 committee for each borough of New York City, to assist the regional 21 advisory council in its work as it relates particularly to that borough. 22 8. Each regional advisory council shall advise the commissioner,the 23 board, the governor and the legislature on all matters relating to the 24 development and implementation of the New York Health program. 25 9. Each regional advisory council shall adopt, and from time to time 26 revise, a community health improvement plan for its region for the 27 purpose of: 28 (a) promoting the delivery of health care services in the region, 29 improving the quality and accessibility of care, including cultural 30 competency, clinical integration of care between service providers 31 including but not limited to physical, mental, and behavioral health, 32 physical and developmental disability services, and long-term care; 33 (b) facility and health services planning in the region; 34 (c) identifying gaps in regional health care services; and 35 (d) promoting increased public knowledge and responsibility regarding 36 the availability and appropriate utilization of health care services. 37 Each community health improvement plan shall be submitted to the commis- 38 sioner and the board and shall be posted on the department's website. 39 10. Each regional advisory council shall hold at least four public 40 hearings annually on matters relating to the New York Health program and 41 the development and implementation of the community health improvement 42 plan. 43 11. Each regional advisory council shall publish an annual report to 44 the commissioner and the board on the progress of the community health 45 improvement plan. These reports shall be posted on the department's 46 website. 47 12. All meetings of the regional advisory councils and committees 48 shall be subject to article six of the public officers law. 49 § 4. Financing of New York Health. 1. The governor shall submit to the 50 legislature a revenue plan and legislative bills to implement the plan 51 (referred to collectively in this section as the "revenue proposal") to 52 provide the revenue necessary to finance the New York Health program, as 53 created by article 51 of the public health law and all provisions of 54 that article (referred to in this section as the "program"), taking into 55 consideration anticipated federal revenue available for the program. The 56 revenue proposal shall be submitted to the legislature as part of theA. 4738--A 18 1 executive budget under article VII of the state constitution, for the 2 fiscal year commencing on the first day of April in the calendar year 3 after this act shall become a law. In developing the revenue proposal, 4 the governor shall consult with appropriate officials of the executive 5 branch; the temporary president of the senate; the speaker of the assem- 6 bly; the chairs of the fiscal and health committees of the senate and 7 assembly; and representatives of business, labor, consumers and local 8 government. 9 2. (a) Basic structure. The basic structure of the revenue proposal 10 shall be as follows: Revenue for the program shall come from two taxes 11 (referred to collectively in this section as the "taxes"). First, there 12 shall be a progressively graduated tax on all payroll and self-employed 13 income (referred to in this section as the "payroll tax"), paid by 14 employers, employees and self-employed individuals. Second, there shall 15 be a progressively graduated tax on taxable income (such as interest, 16 dividends, and capital gains) not subject to the payroll tax (referred 17 to in this section as the "non-payroll tax"). Higher brackets of income 18 subject to the taxes shall be assessed at a higher marginal rate than 19 lower brackets. The taxes shall be set at levels anticipated to produce 20 sufficient revenue to finance the program, to be scaled up as enrollment 21 grows, taking into consideration anticipated federal revenue available 22 for the program. Provision shall be made for state residents (who are 23 eligible for the program) who are employed out-of-state, and non-resi- 24 dents (who are not eligible for the program) who are employed in the 25 state. 26 (b) Payroll tax. The income to be subject to the payroll tax shall be 27 all income subject to the Medicare Part A tax. The tax shall be set at a 28 percentage of that income, which shall be progressively graduated, so 29 the percentage is higher on higher brackets of income. For employed 30 individuals, the employer shall pay eighty percent of the tax and the 31 employee shall pay twenty percent of the tax, except that an employer 32 may agree to pay all or part of the employee's share. A self-employed 33 individual shall pay the full tax. 34 (c) Non-payroll income tax. There shall be a tax on income that is 35 subject to the personal income tax under article 22 of the tax law and 36 is not subject to the payroll tax. It shall be set at a percentage of 37 that income, which shall be progressively graduated, so the percentage 38 is higher on higher brackets of income. 39 (d) Phased-in rates. Early in the program, when enrollment is growing, 40 the amount of the taxes shall be at an appropriate level, and shall be 41 changed as anticipated enrollment grows, to cover the actual cost of the 42 program. The revenue proposal shall include a mechanism for determining 43 the rates of the taxes. 44 (e) Cross-border employees. (i) State residents employed out-of-state. 45 If an individual is employed out-of-state by an employer that is subject 46 to New York state law, the employer and employee shall be required to 47 pay the payroll tax as to that employee as if the employment were in the 48 state. If an individual is employed out-of-state by an employer that is 49 not subject to New York state law, either (A) the employer and employee 50 shall voluntarily comply with the tax or (B) the employee shall pay the 51 tax as if he or she were self-employed. 52 (ii) Out-of-state residents employed in the state. (A) The payroll 53 tax shall apply to any out-of-state resident who is employed or self-em- 54 ployed in the state. (B) In the case of an out-of-state resident who is 55 employed or self-employed in the state, such individual and individual's 56 employer shall be able to take a credit against the payroll taxes eachA. 4738--A 19 1 would otherwise pay as to that individual for amounts they spend respec- 2 tively on health benefits for the individual that would otherwise be 3 covered by the program if the individual were a member of the program. 4 For the employer, the credit shall be available regardless of the form 5 of the health benefit (e.g., health insurance, a self-insured plan, 6 direct services, or reimbursement for services), to make sure that the 7 revenue proposal does not relate to employment benefits in violation of 8 the federal ERISA. For non-employment-based spending by the individual, 9 the credit shall be available for and limited to spending for health 10 coverage (not out-of-pocket health spending). The credit shall be avail- 11 able without regard to how little is spent or how sparse the benefit. 12 The credit may only be taken against the payroll tax. Any excess amount 13 may not be applied to other tax liability. The credit shall be distrib- 14 uted between the employer and employee in the same proportion as the 15 spending by each for the benefit and may be applied to their respective 16 portion of the tax. (C) If any provision of this subparagraph or any 17 application of it shall be ruled to violate federal ERISA, the provision 18 or the application of it shall be null and void and the ruling shall not 19 affect any other provision or application of this section or the act 20 that enacted it. 21 3. (a) The revenue proposal shall include a plan and legislative 22 provisions for ending the requirement for local social services 23 districts to pay part of the cost of Medicaid and replacing those 24 payments with revenue from the taxes under the revenue proposal. 25 (b) The taxes under this section shall not supplant the spending of 26 other state revenue to pay for the Medicaid program as it exists as of 27 the enactment of the revenue proposal as amended, unless the revenue 28 proposal as amended provides otherwise. 29 4. To the extent that the revenue proposal differs from the terms of 30 subdivision two or paragraph (b) of subdivision three of this section, 31 the revenue proposal shall state how it differs from those terms and 32 reasons for and the effects of the differences. 33 5. All revenue from the taxes shall be deposited in the New York 34 Health trust fund account under section 89-i of the state finance law. 35 § 5. Article 49 of the public health law is amended by adding a new 36 title 3 to read as follows: 37 TITLE III 38 COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH 39 NEW YORK HEALTH 40 Section 4920. Definitions. 41 4921. Collective negotiation authorized. 42 4922. Collective negotiation requirements. 43 4923. Requirements for health care providers' representative. 44 4924. Certain collective action prohibited. 45 4925. Fees. 46 4926. Confidentiality. 47 4927. Severability and construction. 48 § 4920. Definitions. For purposes of this title: 49 1. "New York Health" means the program under article fifty-one of this 50 chapter. 51 2. "Person" means an individual, association, corporation, or any 52 other legal entity. 53 3. "Health care providers' representative" means a third party that is 54 authorized by health care providers to negotiate on their behalf with 55 New York Health over terms and conditions affecting those health care 56 providers.A. 4738--A 20 1 4. "Strike" means a work stoppage in part or in whole, direct or indi- 2 rect, by a body of workers to gain compliance with demands made on an 3 employer. 4 5. "Health care provider" means a person who is licensed, certified, 5 registered or authorized to practice a health care profession pursuant 6 to title eight of the education law and who practices that profession as 7 a health care provider as an independent contractor or who is an owner, 8 officer, shareholder, or proprietor of a health care provider; or an 9 entity that employs or utilizes health care providers to provide health 10 care services, including but not limited to a hospital licensed under 11 article twenty-eight of this chapter or an accountable care organization 12 under article twenty-nine-E of this chapter. A health care provider 13 under title eight of the education law who practices as an employee or 14 independent contractor of another health care provider shall not be 15 deemed a health care provider for purposes of this title. 16 § 4921. Collective negotiation authorized. 1. Health care providers 17 may meet and communicate for the purpose of collectively negotiating 18 with New York Health on any matter relating to New York Health, includ- 19 ing but not limited to rates of payment and payment methodologies. 20 2. Nothing in this section shall be construed to allow or authorize an 21 alteration of the terms of the internal and external review procedures 22 set forth in law. 23 3. Nothing in this section shall be construed to allow a strike of New 24 York Health by health care providers. 25 4. Nothing in this section shall be construed to allow or authorize 26 terms or conditions which would impede the ability of New York Health to 27 obtain or retain accreditation by the national committee for quality 28 assurance or a similar body or to comply with applicable state or feder- 29 al law. 30 § 4922. Collective negotiation requirements. 1. Collective negotiation 31 rights granted by this title must conform to the following requirements: 32 (a) health care providers may communicate with other health care 33 providers regarding the terms and conditions to be negotiated with New 34 York Health; 35 (b) health care providers may communicate with health care providers' 36 representatives; 37 (c) a health care providers' representative is the only party author- 38 ized to negotiate with New York Health on behalf of the health care 39 providers as a group; 40 (d) a health care provider can be bound by the terms and conditions 41 negotiated by the health care providers' representatives; and 42 (e) in communicating or negotiating with the health care providers' 43 representative, New York Health is entitled to offer and provide differ- 44 ent terms and conditions to individual competing health care providers. 45 2. Nothing in this title shall affect or limit the right of a health 46 care provider or group of health care providers to collectively petition 47 a government entity for a change in a law, rule, or regulation. 48 3. Nothing in this title shall affect or limit collective action or 49 collective bargaining on the part of any health care provider with his 50 or her employer or any other lawful collective action or collective 51 bargaining. 52 § 4923. Requirements for health care providers' representative. Before 53 engaging in collective negotiations with New York Health on behalf of 54 health care providers, a health care providers' representative shall 55 file with the commissioner, in the manner prescribed by the commission- 56 er, information identifying the representative, the representative'sA. 4738--A 21 1 plan of operation, and the representative's procedures to ensure compli- 2 ance with this title. 3 § 4924. Certain collective action prohibited. 1. This title is not 4 intended to authorize competing health care providers to act in concert 5 in response to a health care providers' representative's discussions or 6 negotiations with New York Health except as authorized by other law. 7 2. No health care providers' representative shall negotiate any agree- 8 ment that excludes, limits the participation or reimbursement of, or 9 otherwise limits the scope of services to be provided by any health care 10 provider or group of health care providers with respect to the perform- 11 ance of services that are within the health care provider's lawful scope 12 or terms of practice, license, registration, or certificate. 13 § 4925. Fees. Each person who acts as the representative of negotiat- 14 ing parties under this title shall pay to the department a fee to act as 15 a representative. The commissioner, by regulation, shall set fees in 16 amounts deemed reasonable and necessary to cover the costs incurred by 17 the department in administering this title. 18 § 4926. Confidentiality. All reports and other information required to 19 be reported to the department under this title shall not be subject to 20 disclosure under article six of the public officers law. 21 § 4927. Severability and construction. If any provision or application 22 of this title shall be held to be invalid, or to violate or be incon- 23 sistent with any applicable federal law or regulation, that shall not 24 affect other provisions or applications of this title which can be given 25 effect without that provision or application; and to that end, the 26 provisions and applications of this title are severable. The provisions 27 of this title shall be liberally construed to give effect to the 28 purposes thereof. 29 § 6. Subdivision 11 of section 270 of the public health law, as 30 amended by section 2-a of part C of chapter 58 of the laws of 2008, is 31 amended to read as follows: 32 11. "State public health plan" means the medical assistance program 33 established by title eleven of article five of the social services law 34 (referred to in this article as "Medicaid"), the elderly pharmaceutical 35 insurance coverage program established by title three of article two of 36 the elder law (referred to in this article as "EPIC"), and the [ family37 health plus program established by section three hundred sixty-nine-ee38 of the social services law to the extent that section provides that the39 program shall be subject to this article] New York Health program estab- 40 lished by article fifty-one of this chapter. 41 § 7. The state finance law is amended by adding a new section 89-i to 42 read as follows: 43 § 89-i. New York Health trust fund. 1. There is hereby established in 44 the joint custody of the state comptroller and the commissioner of taxa- 45 tion and finance a special revenue fund to be known as the "New York 46 Health trust fund", referred to in this section as "the fund". The defi- 47 nitions in section fifty-one hundred of the public health law shall 48 apply to this section. 49 2. The fund shall consist of: 50 (a) all monies obtained from taxes pursuant to legislation enacted as 51 proposed under section three of the New York Health act; 52 (b) federal payments received as a result of any waiver or other 53 arrangements agreed to by the United States secretary of health and 54 human services or other appropriate federal officials for health care 55 programs established under Medicare, any federally-matched public health 56 program, or the affordable care act;A. 4738--A 22 1 (c) the amounts paid by the department of health that are equivalent 2 to those amounts that are paid on behalf of residents of this state 3 under Medicare, any federally-matched public health program, or the 4 affordable care act for health benefits which are equivalent to health 5 benefits covered under New York Health; 6 (d) federal and state funds for purposes of the provision of services 7 authorized under title XX of the federal social security act that would 8 otherwise be covered under article fifty-one of the public health law; 9 and 10 (e) state monies that would otherwise be appropriated to any govern- 11 mental agency, office, program, instrumentality or institution which 12 provides health services, for services and benefits covered under New 13 York Health. Payments to the fund pursuant to this paragraph shall be in 14 an amount equal to the money appropriated for such purposes in the 15 fiscal year beginning immediately preceding the effective date of the 16 New York Health act. 17 3. Monies in the fund shall only be used for purposes established 18 under article fifty-one of the public health law. 19 § 8. Temporary commission on implementation. 1. There is hereby estab- 20 lished a temporary commission on implementation of the New York Health 21 program, referred to in this section as the commission, consisting of 22 fifteen members: five members, including the chair, shall be appointed 23 by the governor; four members shall be appointed by the temporary presi- 24 dent of the senate, one member shall be appointed by the senate minority 25 leader; four members shall be appointed by the speaker of the assembly, 26 and one member shall be appointed by the assembly minority leader. The 27 commissioner of health, the superintendent of financial services, and 28 the commissioner of taxation and finance, or their designees shall serve 29 as non-voting ex-officio members of the commission. 30 2. Members of the commission shall receive such assistance as may be 31 necessary from other state agencies and entities, and shall receive 32 reasonable and necessary expenses incurred in the performance of their 33 duties. The commission may employ staff as needed, prescribe their 34 duties, and fix their compensation within amounts appropriated for the 35 commission. 36 3. The commission shall examine the laws and regulations of the state 37 and make such recommendations as are necessary to conform the laws and 38 regulations of the state and article 51 of the public health law estab- 39 lishing the New York Health program and other provisions of law relating 40 to the New York Health program, and to improve and implement the 41 program. The commission shall report its recommendations to the governor 42 and the legislature. The commission shall immediately begin development 43 of proposals consistent with the principles of article 51 of the public 44 health law for provision of long-term care coverage; health care 45 services covered under the workers' compensation law; and incorporation 46 of retiree health benefits, as described in paragraphs (a), (b) and (c) 47 of subdivision 8 of section 5102 of the public health law. The commis- 48 sion shall provide its work product and assistance to the board estab- 49 lished pursuant to section 5102 of the public health law upon completion 50 of the appointment of the board. 51 § 9. Severability. If any provision or application of this act shall 52 be held to be invalid, or to violate or be inconsistent with any appli- 53 cable federal law or regulation, that shall not affect other provisions 54 or applications of this act which can be given effect without that 55 provision or application; and to that end, the provisions and applica- 56 tions of this act are severable.A. 4738--A 23 1 § 10. This act shall take effect immediately.