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A05248 Summary:

BILL NOA05248
 
SAME ASSAME AS S03577
 
SPONSORGottfried (MS)
 
COSPNSRAbinanti, Barrett, Barron, Benedetto, Bichotte, Blake, Bronson, Burke, Cahill, Carroll, Colton, Cook, Crespo, Cruz, Cymbrowitz, De La Rosa, Dickens, Dilan, Dinowitz, D'Urso, Englebright, Epstein, Fernandez, Frontus, Gantt, Hunter, Hyndman, Jaffee, Jean-Pierre, Joyner, Kim, Lavine, Lifton, Lupardo, Miller MG, Mosley, Niou, Ortiz, Paulin, Peoples-Stokes, Perry, Pheffer Amato, Pichardo, Ramos, Reyes, Richardson, Rivera, Rodriguez, Rosenthal L, Seawright, Simon, Simotas, Solages, Steck, Stirpe, Taylor, Thiele, Titus, Vanel, Walker, Wallace, Weinstein, Weprin, Williams, Wright, Zebrowski, Sayegh, Fall
 
MLTSPNSRArroyo, Aubry, Davila, DenDekker, Fahy, Galef, Glick, Gunther, Lentol, Magnarelli, O'Donnell, Pretlow, Quart, Rozic
 
Ren Art 50 5000 - 5003 to be Art 80 8000 - 8003, add Art 51 5100 - 5111, Art 49 Title 3 4920 - 4928, amd 270, Pub Health L; add 89-j, 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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A05248 Actions:

BILL NOA05248
 
02/08/2019referred to health
02/28/2019reported referred to codes
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A05248 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          5248
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 8, 2019
                                       ___________
 
        Introduced  by M. of A. GOTTFRIED, ABINANTI, BARRETT, BARRON, BENEDETTO,
          BICHOTTE, BLAKE, BRONSON, BURKE, CAHILL, CARROLL, COLTON, COOK,  CRES-
          PO,  CRUZ,  CYMBROWITZ,  DE LA ROSA, DICKENS, DILAN, DINOWITZ, D'URSO,
          ENGLEBRIGHT, EPSTEIN,  FERNANDEZ,  FRONTUS,  GANTT,  HUNTER,  HYNDMAN,
          JAFFEE, JEAN-PIERRE, JOYNER, KIM, LAVINE, LIFTON, LUPARDO, M. G. MILL-
          ER, MOSLEY, NIOU, ORTIZ, PAULIN, PEOPLES-STOKES, PERRY, PHEFFER AMATO,
          PICHARDO,  RAMOS,  REYES, RICHARDSON, RIVERA, RODRIGUEZ, L. ROSENTHAL,
          SEAWRIGHT, SIMON, SIMOTAS, SOLAGES,  STECK,  STIRPE,  TAYLOR,  THIELE,
          TITUS,  VANEL, WALKER, WALLACE, WEINSTEIN, WEPRIN, WILLIAMS, WRIGHT --
          Multi-Sponsored by -- M. of A. ABBATE, ARROYO, AUBRY, DAVILA, DenDEKK-
          ER, FAHY, GALEF, GLICK, GUNTHER, LENTOL, MAGNARELLI, O'DONNELL,  PRET-
          LOW, QUART, ROZIC -- read once and referred to the Committee on Health
 
        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.  Millions of New Yorkers do not get the health care
    13  they  need  or face financial obstacles and hardships to get it. That is
    14  not acceptable.  There is no plan other than the  New  York  health  act
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09777-01-9

        A. 5248                             2
 
     1  that  will  enable  New  York state to meet that need.  New Yorkers - as
     2  individuals, employers, and taxpayers - have experienced a rise  in  the
     3  cost  of  health  care  and  coverage  in recent years, including rising
     4  premiums, deductibles and co-pays, restricted provider networks and high
     5  out-of-network charges.  Many New Yorkers go without health care because
     6  they  cannot  afford  it  or suffer financial hardship to get it.  Busi-
     7  nesses have also experienced increases in the costs of health care bene-
     8  fits for their employees, and many employers are shifting a larger share
     9  of the cost of coverage to their employees or dropping coverage  entire-
    10  ly.  Including long-term services and supports (LTSS) in New York Health
    11  is  a major step forward for older adults, people with disabilities, and
    12  their families. Older adults and people with disabilities  often  cannot
    13  receive  the  services necessary to stay in the community or other LTSS.
    14  Even when older adults and people with disabilities receive LTSS,  espe-
    15  cially  services  in the community, it is often at the cost of unreason-
    16  able demands on unpaid family caregivers, depleting their own or  family
    17  resources,  or  impoverishing themselves to qualify for public coverage.
    18  Health care providers are also affected by inadequate health coverage in
    19  New York state. A large portion of hospitals, health centers  and  other
    20  providers now experience substantial losses due to the provision of care
    21  that  is uncompensated. Individuals often find that they are deprived of
    22  affordable care and choice because of decisions by health  plans  guided
    23  by  the  plan's  economic  interests rather than the individual's health
    24  care needs. To address the fiscal crisis facing the health  care  system
    25  and  the  state  and  to  assure New Yorkers can exercise their right to
    26  health care,  affordable  and  comprehensive  health  coverage  must  be
    27  provided. Pursuant to the state constitution's charge to the legislature
    28  to  provide for the health of New Yorkers, this legislation is an enact-
    29  ment of state concern for the purpose of  establishing  a  comprehensive
    30  universal guaranteed health care coverage program and a health care cost
    31  control  system  for  the  benefit  of all residents of the state of New
    32  York.
    33    2. (a) It is the intent of the Legislature  to  create  the  New  York
    34  Health program to provide a universal single payer health plan for every
    35  New  Yorker, funded by broad-based revenue based on ability to pay.  The
    36  legislature intends that federal waivers and approvals be  sought  where
    37  they will improve the administration of the New York Health program, but
    38  the  legislature  intends  that  the  program be implemented even in the
    39  absence of such waivers or approvals.  The state shall  work  to  obtain
    40  waivers  and  other  approvals  relating to Medicaid, Child Health Plus,
    41  Medicare, the Affordable Care Act, and  any  other  appropriate  federal
    42  programs,  under  which  federal  funds  and  other subsidies that would
    43  otherwise be paid to New  York  State,  New  Yorkers,  and  health  care
    44  providers  for  health  coverage that will be equaled or exceeded by New
    45  York Health will be paid by the federal government to New York State and
    46  deposited in the New York Health trust fund,  or  paid  to  health  care
    47  providers and individuals in combination with New York Health trust fund
    48  payments,  and for other program modifications (including elimination of
    49  cost sharing and insurance premiums).  Under such waivers and approvals,
    50  health coverage under those programs will, to the maximum extent  possi-
    51  ble,  be replaced and merged into New York Health, which will operate as
    52  a true single-payer program.
    53    (b) If any necessary waiver or approval is  not  obtained,  the  state
    54  shall  use state plan amendments and seek waivers and approvals to maxi-
    55  mize, and make as seamless as possible,  the  use  of  federally-matched
    56  health  programs  and federal health programs in New York Health.  Thus,

        A. 5248                             3
 
     1  even where other programs such as Medicaid or Medicare may contribute to
     2  paying for care, it is the goal of this legislation  that  the  coverage
     3  will  be  delivered  by  New  York  Health and, as much as possible, the
     4  multiple  sources  of  funding will be pooled with other New York Health
     5  funds and not be apparent to New York Health  members  or  participating
     6  providers.
     7    (c)  This  program  will  promote  movement  away from fee-for-service
     8  payment, which tends to reward quantity and requires excessive  adminis-
     9  trative  expense,  and  towards alternate payment methodologies, such as
    10  global or capitated payments to providers or health care  organizations,
    11  that  promote  quality, efficiency, investment in primary and preventive
    12  care, and innovation and integration in the organizing of health care.
    13    (d) The program shall promote the use of clinical data to improve  the
    14  quality  of health care and public health, consistent with protection of
    15  patient confidentiality. The program shall maximize patient autonomy  in
    16  choice  of  health care providers and health care decision making.  Care
    17  coordination within the program shall ensure management and coordination
    18  among a patient's health care services, consistent with patient autonomy
    19  and person-centered service planning, rather than acting as a gatekeeper
    20  to needed services.
    21    3. This act does not  create  any  employment  benefit,  nor  does  it
    22  require, prohibit, or limit the providing of any employment benefit.
    23    4. In order to promote improved quality of, and access to, health care
    24  services and promote improved clinical outcomes, it is the policy of the
    25  state  to  encourage cooperative, collaborative and integrative arrange-
    26  ments among health care providers who might  otherwise  be  competitors,
    27  under  the  active  supervision of the commissioner of health. It is the
    28  intent of the state to supplant competition with such  arrangements  and
    29  regulation  only  to  the extent necessary to accomplish the purposes of
    30  this act, and to provide state  action  immunity  under  the  state  and
    31  federal  antitrust  laws  to  health  care  providers, particularly with
    32  respect to their relations with the single-payer New  York  Health  plan
    33  created by this act.
    34    §  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
    35  health law are renumbered article 80 and sections 8000, 8001,  8002  and
    36  8003, respectively, and a new article 51 is added to read as follows:
    37                                 ARTICLE 51
    38                               NEW YORK HEALTH
    39  Section 5100. Definitions.
    40          5101. Program created.
    41          5102. Board of trustees.
    42          5103. Eligibility and enrollment.
    43          5104. Benefits.
    44          5105. Health  care providers; care coordination; payment method-
    45                  ologies.
    46          5106. Health care organizations.
    47          5107. Program standards.
    48          5108. Regulations.
    49          5109. Provisions relating to federal health programs.
    50          5110. Additional provisions.
    51          5111. Regional advisory councils.
    52    § 5100. Definitions. As used in  this  article,  the  following  terms
    53  shall  have  the following meanings, unless the context clearly requires
    54  otherwise:

        A. 5248                             4
 
     1    1. "Board" means the board of trustees of the New York Health  program
     2  created  by section fifty-one hundred two of this article, and "trustee"
     3  means a trustee of the board.
     4    2.  "Care coordination" means, but is not limited to, managing, refer-
     5  ring to, locating, coordinating, and monitoring health care services for
     6  the member to assure that all medically necessary health  care  services
     7  are made available to and are effectively used by the member in a timely
     8  manner,  consistent  with  patient  autonomy. Care coordination does not
     9  include a requirement for prior authorization for health  care  services
    10  or for referral for a member to receive a health care service.
    11    3.  "Care  coordinator"  means  an  individual  or  entity approved to
    12  provide care coordination under subdivision  two  of  section  fifty-one
    13  hundred five of this article.
    14    4. "Federally-matched public health program" means the medical assist-
    15  ance  program  under title eleven of article five of the social services
    16  law, the basic health program under section three hundred  sixty-nine-gg
    17  of  the  social  services  law,  and the child health plus program under
    18  title one-A of article twenty-five of this chapter.
    19    5. "Health care organization" means an entity that is approved by  the
    20  commissioner  under  section  fifty-one  hundred  six of this article to
    21  provide health care services to members under the program.
    22    6. "Health care provider"  means  any  individual  or  entity  legally
    23  authorized  to  provide a health care service under Medicaid or Medicare
    24  or this article. "Health care professional" means a health care provider
    25  that is an  individual  licensed,  certified,  registered  or  otherwise
    26  authorized to practice under title eight of the education law to provide
    27  such health care service, acting within his or her lawful scope of prac-
    28  tice.
    29    7. "Health care service" means any health care service, including care
    30  coordination, included as a benefit under the program.
    31    8. "Implementation period" means the period under subdivision three of
    32  section  fifty-one  hundred one of this article during which the program
    33  will be subject to special eligibility and financing provisions until it
    34  is fully implemented under that section.
    35    10. "Medicaid" or "medical assistance" means title eleven  of  article
    36  five  of  the  social  services  law and the program thereunder.  "Child
    37  health plus" means title one-A of article twenty-five  of  this  chapter
    38  and  the program thereunder. "Medicare" means title XVIII of the federal
    39  social security act and the programs thereunder.  "Affordable care  act"
    40  means the federal patient protection and affordable care act, public law
    41  111-148,  as amended by the health care and education reconciliation act
    42  of 2010, public law 111-152, and as  otherwise  amended  and  any  regu-
    43  lations  or  guidance  issued thereunder.   "Basic health program" means
    44  section three hundred sixty-nine-gg of the social services law  and  the
    45  program thereunder.
    46    11. "Member" means an individual who is enrolled in the program.
    47    12.  "New  York Health", "New York Health program", and "program" mean
    48  the New York Health program created by section fifty-one hundred one  of
    49  this article.
    50    13.  "New York Health trust fund" means the New York Health trust fund
    51  established under section eighty-nine-j of the state finance law.
    52    14. "Out-of-state health care service" means  a  health  care  service
    53  provided  to  a  member while the member is temporarily out of the state
    54  and (a) it is medically  necessary  that  the  health  care  service  be
    55  provided  while  the member is out of the state, or (b) it is clinically
    56  appropriate that the health care service be  provided  by  a  particular

        A. 5248                             5
 
     1  health  care provider located out of the state rather than in the state.
     2  However, any health care service provided to a New York Health  enrollee
     3  by  a  health care provider qualified under paragraph (a) of subdivision
     4  three  of section fifty-one hundred five of this article that is located
     5  outside the state shall not be considered an  out-of-state  service  and
     6  shall be covered as otherwise provided in this article.
     7    15.  "Participating provider" means any individual or entity that is a
     8  health care  provider  qualified  under  subdivision  three  of  section
     9  fifty-one  hundred  five  of  this  article  that  provides  health care
    10  services to members under the program, or a health care organization.
    11    16. "Person" means any individual or natural person,  trust,  partner-
    12  ship,  association,  unincorporated  association,  corporation, company,
    13  limited liability company, proprietorship, joint  venture,  firm,  joint
    14  stock association, department, agency, authority, or other legal entity,
    15  whether for-profit, not-for-profit or governmental.
    16    17. "Prescription and non-prescription drugs" means prescription drugs
    17  as defined in section two hundred seventy of this chapter, and non-pres-
    18  cription smoking cessation products or devices.
    19    18.  "Resident" means an individual whose primary place of abode is in
    20  the state, without regard to the  individual's  immigration  status,  as
    21  determined according to regulations of the commissioner.
    22    §  5101.  Program  created.  1.  The New York Health program is hereby
    23  created in the department. The commissioner shall establish  and  imple-
    24  ment  the  program under this article. The program shall provide compre-
    25  hensive health coverage to every resident who enrolls in the program.
    26    2. The commissioner shall, to the maximum extent  possible,  organize,
    27  administer and market the program and services as a single program under
    28  the  name "New York Health" or such other name as the commissioner shall
    29  determine, regardless of under which law or source the definition  of  a
    30  benefit  is  found including (on a voluntary basis) retiree health bene-
    31  fits. In implementing this article, the commissioner shall  avoid  jeop-
    32  ardizing  federal  financial  participation  in these programs and shall
    33  take care to promote public understanding  and  awareness  of  available
    34  benefits and programs.
    35    3. The commissioner shall determine when individuals may begin enroll-
    36  ing in the program. There shall be an implementation period, which shall
    37  begin  on  the  date that individuals may begin enrolling in the program
    38  and shall end as determined by the commissioner.
    39    4. An insurer authorized to provide coverage pursuant to the insurance
    40  law or a health maintenance organization certified  under  this  chapter
    41  may,  if  otherwise  authorized,  offer  benefits  that do not cover any
    42  service for which coverage is offered to individuals under the  program,
    43  but  may not offer benefits that cover any service for which coverage is
    44  offered to individuals under the program. Provided, however,  that  this
    45  subdivision  shall  not  prohibit (a) the offering of any benefits to or
    46  for individuals, including their families, who are employed or  self-em-
    47  ployed  in  the state but who are not residents of the state, or (b) the
    48  offering of benefits during the implementation period to individuals who
    49  enrolled or may enroll as members of the program, or (c) the offering of
    50  retiree health benefits.
    51    5. A college, university or other institution of higher  education  in
    52  the  state  may  purchase coverage under the program for any student, or
    53  student's dependent, who is not a resident of the state.
    54    6. To the extent any provision of this chapter,  the  social  services
    55  law, the insurance law or the elder law:

        A. 5248                             6
 
     1    (a) is inconsistent with any provision of this article or the legisla-
     2  tive  intent  of  the  New York Health Act, this article shall apply and
     3  prevail, except where explicitly provided otherwise by this article; and
     4    (b) is consistent with the provisions of this article and the legisla-
     5  tive  intent of the New York Health Act, the provision of that law shall
     6  apply.
     7    7. The program shall be deemed to be a health care plan  for  purposes
     8  of  utilization  review  and external appeal under article forty-nine of
     9  this chapter.  An enrollee may designate a person or entity,  including,
    10  but not limited to, a representative of the enrollee's care coordinator,
    11  a health care organization providing the service under review or appeal,
    12  or  a  labor  union  or  Taft-Hartley  fund  of  which  such enrollee or
    13  enrollee's family member is a member to serve as the enrollee's designee
    14  for purposes of that article, if the person or entity agrees to  be  the
    15  designee.
    16    8.  (a) No member shall be required to receive any health care service
    17  through any entity organized, certified or  operating  under  guidelines
    18  under  article  forty-four  of  this chapter, or specified under section
    19  three hundred sixty-four-j of the social services law, the insurance law
    20  or the elder law. No such entity shall receive payment for  health  care
    21  services (other than care coordination) from the program.
    22    (b) However, this subdivision shall not preclude the use of a Medicare
    23  managed care ("Medicare advantage") entity or other entity created by or
    24  under  the  direction of the program where reasonably necessary to maxi-
    25  mize federal financial participation or other federal financial  support
    26  under  any  federally-matched  public  health  program,  Medicare or the
    27  Affordable Care Act. Any entity under this paragraph shall, to the maxi-
    28  mum extent feasible, operate in the background,  without  burden  on  or
    29  interference with the member and health care provider, without depriving
    30  the  member  or  health  care provider of any right or benefit under the
    31  program and otherwise consistent with this article.
    32    9. The program shall include provisions  for  an  appropriate  reserve
    33  fund.
    34    10. (a) This subdivision applies to every person who is a retiree of a
    35  public  employer,  as  defined  in  section two hundred one of the civil
    36  service law, and any person who is a beneficiary of the retiree's public
    37  employee retiree health benefit. Any reference to the retiree shall mean
    38  and include any beneficiary of the retiree. This  subdivision  does  not
    39  create  or  increase  any  eligibility  for  any public employee retiree
    40  health benefit that would not otherwise exist and does not diminish  any
    41  public employee retiree health benefit.
    42    (b)  This  paragraph applies to the retiree while he or she is a resi-
    43  dent of New York state. The retiree shall enroll in the program.  If, by
    44  the implementation date, the retiree has not enrolled  in  the  program,
    45  the  appropriate  public employee retirement system and the commissioner
    46  shall enroll the  retiree  in  the  New  York  Health  program.  If  the
    47  retiree's  public  employee  retiree health benefit includes any service
    48  for which coverage is not offered under the New York Health program, the
    49  retiree shall continue to receive that benefit from the public  employee
    50  retirement program.
    51    (c)  For  every retiree, while he or she is not a resident of New York
    52  state, the appropriate public employee retirement system shall  maintain
    53  the  retiree's public employee retiree health benefit as if this article
    54  had not been enacted.
    55    § 5102. Board of trustees. 1. The New York Health board of trustees is
    56  hereby created in the department. The board of trustees  shall,  at  the

        A. 5248                             7
 
     1  request  of  the  commissioner,  consider  any  matter to effectuate the
     2  provisions and purposes of this article, and may advise the commissioner
     3  thereon; and it may, from time to time, submit to the  commissioner  any
     4  recommendations  to effectuate the provisions and purposes of this arti-
     5  cle. The commissioner may propose regulations  under  this  article  and
     6  amendments thereto for consideration by the board. The board of trustees
     7  shall  have  no executive, administrative or appointive duties except as
     8  otherwise provided by law. The board of trustees  shall  have  power  to
     9  establish,  and  from  time to time, amend regulations to effectuate the
    10  provisions and purposes of this article,  subject  to  approval  by  the
    11  commissioner.
    12    2. The board shall be composed of:
    13    (a)  the  commissioner,  the superintendent of financial services, and
    14  the director of the budget, or their designees, as ex officio members;
    15    (b) twenty-six trustees appointed by the governor;
    16    (i) six of whom shall be representatives of health care consumer advo-
    17  cacy organizations which have a statewide or regional constituency,  who
    18  have  been  involved  in  issues of interest to low- and moderate-income
    19  individuals, older adults, and people with disabilities; at least  three
    20  of whom shall represent organizations led by consumers in those groups;
    21    (ii)  two  of  whom shall be representatives of professional organiza-
    22  tions representing physicians;
    23    (iii) two of whom shall be representatives of  professional  organiza-
    24  tions  representing  licensed  or  registered  health care professionals
    25  other than physicians;
    26    (iv) three of whom shall be representatives of general hospitals,  one
    27  of whom shall be a representative of public general hospitals;
    28    (v) one of whom shall be a representative of community health centers;
    29    (vi)  two  of  whom shall be representatives of rehabilitation or home
    30  care providers;
    31    (vii) two of whom shall be representatives  of  behavioral  or  mental
    32  health or disability service providers;
    33    (viii)  two  of whom shall be representatives of health care organiza-
    34  tions;
    35    (ix) two of whom shall be representatives of organized labor;
    36    (x) two of whom shall  have  demonstrated  expertise  in  health  care
    37  finance; and
    38    (xi)  two  of  whom shall be employers or representatives of employers
    39  who pay the payroll tax under this article, or, prior to the tax  becom-
    40  ing effective, will pay the tax;
    41    (c)  fourteen  trustees  appointed by the governor; five of whom to be
    42  appointed on the recommendation of the speaker of the assembly; five  of
    43  whom to be appointed on the recommendation of the temporary president of
    44  the  senate;  two  of  whom to be appointed on the recommendation of the
    45  minority leader of the assembly; and two of whom to be appointed on  the
    46  recommendation of the minority leader of the senate.
    47    3.  After  the  end of the implementation period, no person shall be a
    48  trustee unless he or she is a member of the program, except the ex offi-
    49  cio trustees. Each trustee shall serve at the pleasure of the appointing
    50  officer, except the ex officio trustees.
    51    4. The chair of the board shall be appointed, and may  be  removed  as
    52  chair,  by the governor from among the trustees. The board shall meet at
    53  least four times each calendar year. Meetings shall  be  held  upon  the
    54  call  of  the  chair  and  as  provided  by the board. A majority of the
    55  appointed trustees shall be a quorum of the board, and  the  affirmative
    56  vote  of a majority of the trustees voting, but not less than ten, shall

        A. 5248                             8
 
     1  be necessary for any action to be taken by  the  board.  The  board  may
     2  establish an executive committee to exercise any powers or duties of the
     3  board as it may provide, and other committees to assist the board or the
     4  executive  committee.  The  chair of the board shall chair the executive
     5  committee and shall appoint the chair and members of all  other  commit-
     6  tees. The board of trustees may appoint one or more advisory committees.
     7  Members of advisory committees need not be members of the board of trus-
     8  tees.
     9    5.  Trustees  shall serve without compensation but shall be reimbursed
    10  for their necessary and actual expenses incurred while  engaged  in  the
    11  business of the board.
    12    6. Notwithstanding any provision of law to the contrary, no officer or
    13  employee of the state or any local government shall forfeit or be deemed
    14  to  have  forfeited his or her office or employment by reason of being a
    15  trustee.
    16    7. The board and its committees and advisory  committees  may  request
    17  and  receive  the  assistance  of  the department and any other state or
    18  local governmental entity in exercising its powers and duties.
    19    8. No later than two years after the effective date of this article:
    20    (a) The board shall develop proposals for: (i)  incorporating  retiree
    21  health  benefits into New York Health; (ii) accommodating employer reti-
    22  ree health benefits for people who have been members of New York  Health
    23  but  live as retirees out of the state; and (iii) accommodating employer
    24  retiree health benefits for people who earned or accrued  such  benefits
    25  while  residing  in  the  state  prior to the implementation of New York
    26  Health and live as retirees out of the state.  The board  shall  present
    27  its proposals to the governor and the legislature.
    28    (b) The board shall develop a proposal for New York Health coverage of
    29  health  care  services  covered  under  the  workers'  compensation law,
    30  including whether and how to continue funding for those  services  under
    31  that  law  and  whether  and how to incorporate an element of experience
    32  rating.
    33    § 5103. Eligibility and enrollment. 1. Every  resident  of  the  state
    34  shall be eligible and entitled to enroll as a member under the program.
    35    2.  No individual shall be required to pay any premium or other charge
    36  for enrolling in or being a member under the program.
    37    3. A newborn child shall be enrolled as of the  date  of  the  child's
    38  birth  if  enrollment is done prior to the child's birth or within sixty
    39  days after the child's birth.
    40    § 5104. Benefits. 1. The program shall  provide  comprehensive  health
    41  coverage  to  every member, which shall include all health care services
    42  required to be covered under any of the  following,  without  regard  to
    43  whether  the  member  would  otherwise be eligible for or covered by the
    44  program or source referred to:
    45    (a) child health plus;
    46    (b) Medicaid;
    47    (c) Medicare;
    48    (d) article forty-four  of  this  chapter  or  article  thirty-two  or
    49  forty-three of the insurance law;
    50    (e)  article  eleven of the civil service law, as of the date one year
    51  before the beginning of the implementation period;
    52    (f) any cost incurred defined in paragraph one of  subsection  (a)  of
    53  section  fifty-one  hundred two of the insurance law, provided that this
    54  coverage shall not replace  coverage  under  article  fifty-one  of  the
    55  insurance law;

        A. 5248                             9
 
     1    (g)  any  additional health care service authorized to be added to the
     2  program's benefits by the program; and
     3    (h)  provided  that  where  any state law or regulation related to any
     4  federally-matched public health program states that a benefit is contin-
     5  gent on federal financial participation, or words to  that  effect,  the
     6  benefit  shall  be  included  under  the New York Health program without
     7  regard to federal financial participation.
     8    2. No member shall be required to pay any premium, deductible, co-pay-
     9  ment or co-insurance under the program.
    10    3. The program shall provide for payment under the program for:
    11    (a) emergency and temporary health care services provided to a  member
    12  or  individual  entitled to become a member who has not had a reasonable
    13  opportunity to become a member or to enroll with a care coordinator; and
    14    (b) health care services provided in an emergency to an individual who
    15  is entitled to become a member or  enrolled  with  a  care  coordinator,
    16  regardless of having had an opportunity to do so.
    17    §  5105.  Health  care providers; care coordination; payment methodol-
    18  ogies.  1. Choice of health care provider. (a) Any health care  provider
    19  qualified  to  participate  under  this  section may provide health care
    20  services under the program, provided that the health  care  provider  is
    21  otherwise  legally authorized to perform the health care service for the
    22  individual and under the circumstances involved.
    23    (b) A member may choose to receive  health  care  services  under  the
    24  program  from  any participating provider, consistent with provisions of
    25  this article relating to care coordination  and  health  care  organiza-
    26  tions,  the  willingness  or  availability  of  the provider (subject to
    27  provisions of this article relating to discrimination), and  the  appro-
    28  priate clinically-relevant circumstances.
    29    2.  Care  coordination. (a) A care coordinator may be an individual or
    30  entity that is approved by the program that is:
    31    (i) a health care practitioner who is: (A) the member's  primary  care
    32  practitioner; (B) at the option of a female member, the member's provid-
    33  er  of  primary gynecological care; or (C) at the option of a member who
    34  has a chronic condition  that  requires  specialty  care,  a  specialist
    35  health  care  practitioner who regularly and continually provides treat-
    36  ment for that condition to the member;
    37    (ii) an entity licensed under article twenty-eight of this chapter  or
    38  certified  under article thirty-six of this chapter, or, with respect to
    39  a member who receives chronic mental health  care  services,  an  entity
    40  licensed  under  article  thirty-one  of the mental hygiene law or other
    41  entity approved by the commissioner in consultation with the commission-
    42  er of mental health;
    43    (iii) a health care organization;
    44    (iv) a Taft-Hartley fund or labor union, with respect to  its  members
    45  and  their  family  members;  provided  that  this  provision  shall not
    46  preclude a Taft-Hartley fund or labor union from becoming a care coordi-
    47  nator under subparagraph (v) of this paragraph or a health  care  organ-
    48  ization under section fifty-one hundred six of this article; or
    49    (v) any not-for-profit or governmental entity approved by the program.
    50    (b)(i)  Every  member shall enroll with a care coordinator that agrees
    51  to provide care coordination to the member  prior  to  receiving  health
    52  care  services  to  be paid for under the program.  Health care services
    53  provided to a member shall not be subject to payment under  the  program
    54  unless  the  member  is enrolled with a care coordinator at the time the
    55  health care service is provided.

        A. 5248                            10
 
     1    (ii) This paragraph shall not apply to health care  services  provided
     2  under  subdivision three of section fifty-one hundred four of this arti-
     3  cle.
     4    (iii)  The  member  shall  remain  enrolled with that care coordinator
     5  until the member becomes enrolled with a different care  coordinator  or
     6  ceases to be a member. Members have the right to change their care coor-
     7  dinator  on  terms  at  least as permissive as the provisions of section
     8  three hundred sixty-four-j of the social services  law  relating  to  an
     9  individual  changing  his  or  her primary care provider or managed care
    10  provider.
    11    (c) Care coordination shall be provided to the member by the  member's
    12  care coordinator.  A care coordinator may employ or utilize the services
    13  of  other  individuals  or  entities to assist in providing care coordi-
    14  nation for the member, consistent with regulations of the commissioner.
    15    (d) A health care organization may establish rules  relating  to  care
    16  coordination for members in the health care organization, different from
    17  this  subdivision  but  otherwise consistent with this article and other
    18  applicable laws.
    19    (e) The commissioner shall develop and implement procedures and stand-
    20  ards for an individual or entity to be approved to be a care coordinator
    21  in the program, including but not limited to  procedures  and  standards
    22  relating  to  the  revocation,  suspension,  limitation, or annulment of
    23  approval on a determination that the individual or entity is not  compe-
    24  tent to be a care coordinator or has exhibited a course of conduct which
    25  is  either  inconsistent with program standards and regulations or which
    26  exhibits an unwillingness to meet such standards and regulations, or  is
    27  a  potential  threat to the public health or safety. Such procedures and
    28  standards shall not limit approval to  be  a  care  coordinator  in  the
    29  program  for economic purposes and shall be consistent with good profes-
    30  sional practice. In developing the procedures and standards, the commis-
    31  sioner shall: (i) consider  existing  standards  developed  by  national
    32  accrediting  and  professional  organizations;  and  (ii)  consult  with
    33  national and local organizations working on care coordination or similar
    34  models, including health care  practitioners,  hospitals,  clinics,  and
    35  consumers  and  their  representatives. When developing and implementing
    36  standards of approval of care  coordinators  for  individuals  receiving
    37  chronic mental health care services, the commissioner shall consult with
    38  the  commissioner of mental health. An individual or entity may not be a
    39  care coordinator unless the services included in care  coordination  are
    40  within  the  individual's professional scope of practice or the entity's
    41  legal authority.
    42    (f) To maintain approval under the program, a care  coordinator  must:
    43  (i)  renew its status at a frequency determined by the commissioner; and
    44  (ii) provide data to the department as required by the  commissioner  to
    45  enable  the  commissioner to evaluate the impact of care coordinators on
    46  quality, outcomes and cost.
    47    (g) Nothing in this subdivision  shall  authorize  any  individual  to
    48  engage in any act in violation of title eight of the education law.
    49    3.  Health  care  providers.  (a) The commissioner shall establish and
    50  maintain procedures and standards for health care providers to be quali-
    51  fied to participate in the program, including but not limited to  proce-
    52  dures  and standards relating to the revocation, suspension, limitation,
    53  or annulment of qualification to participate on a determination that the
    54  health care provider is not competent  to  be  a  provider  of  specific
    55  health  care  services  or  has  exhibited  a course of conduct which is
    56  either inconsistent with program  standards  and  regulations  or  which

        A. 5248                            11
 
     1  exhibits  an unwillingness to meet such standards and regulations, or is
     2  a potential threat to the public health or safety. Such  procedures  and
     3  standards  shall  not  limit  health  care provider participation in the
     4  program  for economic purposes and shall be consistent with good profes-
     5  sional practice.  Such procedures and standards  may  be  different  for
     6  different  types of health care providers and health care professionals.
     7  Any health care provider who is qualified to participate under Medicaid,
     8  child health plus or Medicare shall be deemed to be qualified to partic-
     9  ipate in the program, and any health care provider's revocation, suspen-
    10  sion, limitation, or annulment of qualification to participate in any of
    11  those programs shall apply to the health care  provider's  qualification
    12  to  participate  in  the  program;  provided that a health care provider
    13  qualified under this sentence shall  follow  the  procedures  to  become
    14  qualified under the program by the end of the implementation period.
    15    (b) The commissioner shall establish and maintain procedures and stan-
    16  dards for recognizing health care providers located out of the state for
    17  purposes of providing coverage under the program for out-of-state health
    18  care services.
    19    (c)  Procedures  and  standards  under  this subdivision shall include
    20  provisions for expedited temporary qualification to participate  in  the
    21  program for health care professionals who are (i) temporarily authorized
    22  to  practice  in  the state or (ii) are recently arrived in the state or
    23  recently authorized to practice in the state.
    24    4. Payment for health care services. (a) The commissioner  may  estab-
    25  lish  by  regulation  payment methodologies for health care services and
    26  care coordination provided to members under the program by participating
    27  providers, care coordinators, and health care organizations.  There  may
    28  be  a variety of different payment methodologies, including those estab-
    29  lished on a demonstration basis. All payment  rates  under  the  program
    30  shall  be  reasonable  and reasonably related to the cost of efficiently
    31  providing the health care service and assuring an adequate and  accessi-
    32  ble supply of the health care service.  Until and unless another payment
    33  methodology  is  established,  health  care services provided to members
    34  under the program shall be paid for on a fee-for-service  basis,  except
    35  for care coordination.
    36    (b)  The  program  shall engage in good faith negotiations with health
    37  care providers' representatives under title III of article forty-nine of
    38  this chapter, including, but not limited to, in  relation  to  rates  of
    39  payment and payment methodologies.
    40    (c)  Notwithstanding any provision of law to the contrary, payment for
    41  drugs provided by pharmacies under the program shall be made pursuant to
    42  title one of article two-A of this chapter. However, the  program  shall
    43  provide  for  payment  for  prescription drugs under section 340B of the
    44  federal public service act where applicable.  Payment  for  prescription
    45  drugs  provided  by health care providers other than pharmacies shall be
    46  pursuant to other provisions of this article.
    47    (d) Payment for health care services established  under  this  article
    48  shall  be considered payment in full. A participating provider shall not
    49  charge any rate in excess of the payment established under this  article
    50  for  any  health  care  service provided under the program and shall not
    51  solicit or accept payment from any member or third party  for  any  such
    52  service  except as provided under section fifty-one hundred nine of this
    53  article.  However, this paragraph shall not preclude  the  program  from
    54  acting  as  a  primary  or  secondary  payer in conjunction with another
    55  third-party payer where permitted under section fifty-one  hundred  nine
    56  of this article.

        A. 5248                            12
 
     1    (e)  The  program may provide in payment methodologies for payment for
     2  capital related expenses for specifically  identified  capital  expendi-
     3  tures  incurred  by  not-for-profit  or  governmental entities certified
     4  under article twenty-eight of this chapter. Any capital related  expense
     5  generated  by  a  capital expenditure that requires or required approval
     6  under article twenty-eight of  this  chapter  must  have  received  that
     7  approval  for  the  capital  related  expense  to  be paid for under the
     8  program.
     9    (f) Payment methodologies and rates shall include a distinct component
    10  of reimbursement for direct and indirect graduate medical  education  as
    11  defined,  calculated  and  implemented  pursuant to section twenty-eight
    12  hundred seven-c of this chapter.
    13    (g) The commissioner shall provide by  regulation for payment  method-
    14  ologies and procedures for paying for out-of-state health care services.
    15    5.  Prior  authorization. The program shall not require prior authori-
    16  zation for any health care service in any  manner  more  restrictive  of
    17  access  to  or  payment  for  the service than would be required for the
    18  service under Medicare  Part  A  or  Part  B.  Prior  authorization  for
    19  prescription  drugs  provided  by  pharmacies under the program shall be
    20  under title one of article two-A of this chapter.
    21    § 5106. Health care organizations. 1. A member may  choose  to  enroll
    22  with  and  receive  health care services under the program from a health
    23  care organization.
    24    2. A health care organization shall be  a  not-for-profit  or  govern-
    25  mental entity that is approved by the commissioner that is:
    26    (a)  an  accountable  care organization under article twenty-nine-E of
    27  this chapter; or
    28    (b) a Taft-Hartley fund (i) with respect  to  its  members  and  their
    29  family  members,  and  (ii) if allowed by applicable law and approved by
    30  the commissioner, for other members of the program.
    31    3. A health care organization may be responsible for providing all  or
    32  part of the health care services to which its members are entitled under
    33  the  program,  consistent  with the terms of its approval by the commis-
    34  sioner.
    35    4. (a) The commissioner shall develop  and  implement  procedures  and
    36  standards  for an entity to be approved to be a health care organization
    37  in the program, including but not limited to  procedures  and  standards
    38  relating  to  the  revocation,  suspension,  limitation, or annulment of
    39  approval on a determination that the entity is not  competent  to  be  a
    40  health  care  organization or has exhibited a course of conduct which is
    41  either inconsistent with program  standards  and  regulations  or  which
    42  exhibits  an unwillingness to meet such standards and regulations, or is
    43  a potential threat to the public health or safety. Such  procedures  and
    44  standards  shall  not limit approval to be a health care organization in
    45  the program for economic purposes and  shall  be  consistent  with  good
    46  professional  practice.  In developing the procedures and standards, the
    47  commissioner  shall:  (i)  consider  existing  standards  developed   by
    48  national  accrediting  and  professional organizations; and (ii) consult
    49  with national and local organizations working in  the  field  of  health
    50  care  organizations,  including  health  care  practitioners, hospitals,
    51  clinics, long-term supports and service providers, consumers  and  their
    52  representatives  and  labor organizations representing health care work-
    53  ers. When developing and implementing standards of  approval  of  health
    54  care organizations, the commissioner shall consult with the commissioner
    55  of  mental  health,  the commissioner of developmental disabilities, the

        A. 5248                            13
 
     1  director of the state office for the aging and the commissioner  of  the
     2  office of alcoholism and substance abuse services.
     3    (b) To maintain approval under the program, a health care organization
     4  must:  (i) renew its status at a frequency determined by the commission-
     5  er; and (ii) provide data to the department as required by  the  commis-
     6  sioner  to enable the commissioner to evaluate the health care organiza-
     7  tion in relation  to  quality  of  health  care  services,  health  care
     8  outcomes, and cost.
     9    5.  The  commissioner  shall  make regulations relating to health care
    10  organizations consistent with and to ensure compliance with  this  arti-
    11  cle.
    12    6.  The  provision of health care services directly or indirectly by a
    13  health care organization through health  care  providers  shall  not  be
    14  considered  the practice of a profession under title eight of the educa-
    15  tion law by the health care organization.
    16    §  5107.  Program  standards.  1.  The  commissioner  shall  establish
    17  requirements and standards for the program and for health care organiza-
    18  tions,  care  coordinators,  and  health care providers, consistent with
    19  this article, including requirements and standards for, as applicable:
    20    (a) the scope, quality and accessibility of health care services;
    21    (b) relations between health care organizations or health care provid-
    22  ers and members; and
    23    (c) relations  between  health  care  organizations  and  health  care
    24  providers,  including  (i) credentialing and participation in the health
    25  care organization; and (ii) terms, methods and rates of payment.
    26    2. Requirements and standards under the program shall include, but not
    27  be limited to, provisions to promote the following:
    28    (a) simplification, transparency, uniformity, and fairness  in  health
    29  care  provider  credentialing and participation in health care organiza-
    30  tion networks, referrals, payment procedures and rates, claims  process-
    31  ing, and approval of health care services, as applicable;
    32    (b)  primary  and  preventive  care,  care coordination, efficient and
    33  effective health care  services,  quality  assurance,  coordination  and
    34  integration  of health care services, including use of appropriate tech-
    35  nology, and promotion of public, environmental and occupational health;
    36    (c) elimination of health care disparities;
    37    (d) non-discrimination with respect to members and health care provid-
    38  ers on the basis of race, ethnicity, national origin, religion, disabil-
    39  ity, age, sex, sexual orientation, gender  identity  or  expression,  or
    40  economic  circumstances;  provided  that  health  care services provided
    41  under the program shall be appropriate to the patient's clinically-rele-
    42  vant circumstances;
    43    (e) accessibility  of  care  coordination,  health  care  organization
    44  services  and  health  care services, including accessibility for people
    45  with disabilities and people with limited ability to speak or understand
    46  English, and the providing of care coordination, health  care  organiza-
    47  tion services and health care services in a culturally competent manner;
    48  and
    49    (f)  especially  in  relation  to long-term supports and services, the
    50  maximization and prioritization of the most  integrated  community-based
    51  supports and services.
    52    3. Any participating provider or care coordinator that is organized as
    53  a  for-profit  entity (other than a professional practice of one or more
    54  health care professionals) shall be required to meet the  same  require-
    55  ments  and  standards  as entities organized as not-for-profit entities,
    56  and payments under the program paid to such entities shall not be calcu-

        A. 5248                            14
 
     1  lated to accommodate the generation of profit or revenue  for  dividends
     2  or  other return on investment or the payment of taxes that would not be
     3  paid by a not-for-profit entity.
     4    4.  Every  participating  provider  shall  furnish to the program such
     5  information to, and permit examination of its records by,  the  program,
     6  as  may  be  reasonably required for purposes of reviewing accessibility
     7  and utilization of health care services,  quality  assurance,  promoting
     8  improved  patient outcomes and cost containment, the making of payments,
     9  and statistical or other studies of the operation of the program or  for
    10  protection  and  promotion  of  public,  environmental  and occupational
    11  health.
    12    5. In developing requirements and standards and  making  other  policy
    13  determinations  under  this article, the commissioner shall consult with
    14  representatives of members, health care  providers,  care  coordinators,
    15  health  care organizations   employers, organized labor including repre-
    16  sentatives of health care workers, and other interested parties.
    17    6. The program shall maintain the security and confidentiality of  all
    18  data  and  other  information collected under the program when such data
    19  would be normally considered confidential patient data.  Aggregate  data
    20  of  the  program  which  is  derived from confidential data but does not
    21  violate patient confidentiality shall be  public  information  including
    22  for purposes of article six of the public officers law.
    23    §  5108. Regulations. The commissioner may make regulations under this
    24  article by approving regulations and amendments thereto, under  subdivi-
    25  sion  one  of section fifty-one hundred two of this article. The commis-
    26  sioner may make regulations or amendments thereto under this article  on
    27  an  emergency  basis under section two hundred two of the state adminis-
    28  trative procedure act, provided  that  such  regulations  or  amendments
    29  shall  not  become  permanent  unless  adopted  under subdivision one of
    30  section fifty-one hundred two of this article.
    31    § 5109. Provisions relating to federal health programs. 1. The commis-
    32  sioner shall seek all federal waivers and other  federal  approvals  and
    33  arrangements  and  submit state plan amendments necessary to operate the
    34  program consistent with this article to the maximum extent possible.
    35    2. (a) The commissioner shall apply to the  secretary  of  health  and
    36  human  services or other appropriate federal official for all waivers of
    37  requirements, and make other arrangements, under Medicare, any  federal-
    38  ly-matched public health program, the affordable care act, and any other
    39  federal  programs that provide federal funds for payment for health care
    40  services, that are necessary to enable all New York  Health  members  to
    41  receive all benefits under the program through the program to enable the
    42  state  to  implement this article and to receive and deposit all federal
    43  payments under those programs (including funds that may be  provided  in
    44  lieu  of premium tax credits, cost-sharing subsidies, and small business
    45  tax credits) in the state treasury to the credit of the New York  Health
    46  trust  fund  and  to use those funds for the New York Health program and
    47  other provisions under this article. To the extent possible, the commis-
    48  sioner shall negotiate arrangements with the federal government in which
    49  bulk or lump-sum federal payments are paid to New York Health  in  place
    50  of  federal  spending  or  tax  benefits  for  federally-matched  health
    51  programs or federal  health  programs.    The  commissioner  shall  take
    52  actions  under  paragraph  (b) of subdivision eight of section fifty-one
    53  hundred one of this article as reasonably necessary.
    54    (b) The commissioner may require members or applicants to  be  members
    55  to  provide  information  necessary  for  the program to comply with any
    56  waiver or arrangement under this subdivision.

        A. 5248                            15
 
     1    3. (a) The commissioner may take actions consistent with this  article
     2  to  enable  New York Health to administer Medicare in New York state, to
     3  create a Medicare managed care plan ("Medicare  Advantage")  that  would
     4  operate  consistent  with  this  article,  and  to be a provider of drug
     5  coverage under Medicare part D for eligible members of New York Health.
     6    (b)  The  commissioner  may  waive  or  modify  the  applicability  of
     7  provisions of this section  relating  to  any  federally-matched  public
     8  health  program  or  Medicare  as  necessary  to implement any waiver or
     9  arrangement under this section or to maximize the  benefit  to  the  New
    10  York  Health program under this section, provided that the commissioner,
    11  in consultation with the director of the budget,  shall  determine  that
    12  such  waiver  or  modification  is  in the best interests of the members
    13  affected by the action and the state.
    14    (c) The commissioner may  apply  for  coverage  under  any  federally-
    15  matched  public  health  program  on behalf of any member and enroll the
    16  member in the federally-matched public health program or Medicare if the
    17  member is eligible for it.   Enrollment in  a  federally-matched  public
    18  health program or Medicare shall not cause any member to lose any health
    19  care  service  provided  by the program or diminish any right the member
    20  would otherwise have.
    21    (d) The commissioner shall by regulation increase the income eligibil-
    22  ity level, increase or eliminate  the  resource  test  for  eligibility,
    23  simplify any procedural or documentation requirement for enrollment, and
    24  increase  the  benefits for any federally-matched public health program,
    25  and for any program to reduce or eliminate an individual's  coinsurance,
    26  cost-sharing  or  premium obligations or increase an individual's eligi-
    27  bility for any federal financial support  related  to  Medicare  or  the
    28  affordable care act notwithstanding any law or regulation to the contra-
    29  ry.  The  commissioner  may  act  under  this  paragraph upon a finding,
    30  approved by the director of the budget, that the action (i) will help to
    31  increase the number of members who are  eligible  for  and  enrolled  in
    32  federally-matched  public  health programs, or for any program to reduce
    33  or eliminate an individual's coinsurance, cost-sharing or premium  obli-
    34  gations  or  increase an individual's eligibility for any federal finan-
    35  cial support related to Medicare or the affordable care act;  (ii)  will
    36  not diminish any individual's access to any health care service, benefit
    37  or  right  the individual would otherwise have; (iii) is in the interest
    38  of the program; and (iv) does not require or has received any  necessary
    39  federal waivers or approvals to ensure federal financial participation.
    40    (e)  To  enable  the  commissioner  to apply for coverage or financial
    41  support under any federally-matched public health program, the  Afforda-
    42  ble  Care Act, or Medicare on behalf of any member and enroll the member
    43  in any such program, including an entity under paragraph (b) of subdivi-
    44  sion eight of section fifty-one hundred  one  of  this  article  if  the
    45  member  is  eligible  for  it,  the  commissioner may require that every
    46  member or applicant to be a member shall provide information  to  enable
    47  the commissioner to determine whether the applicant is eligible for such
    48  program.    The program shall make a reasonable effort to notify members
    49  of their obligations under this paragraph. After a reasonable effort has
    50  been made to contact the member, the member shall be notified in writing
    51  that he or she has sixty days to provide such required  information.  If
    52  such  information  is  not  provided  within  the  sixty day period, the
    53  member's coverage under the program may be terminated.
    54    (f) To the extent necessary for purposes of this section, as a  condi-
    55  tion  of  continued  eligibility  for  health  care  services  under the

        A. 5248                            16
 
     1  program, a member who is eligible  for  benefits  under  Medicare  shall
     2  enroll in Medicare, including parts A, B and D.
     3    (g)  The  program  shall  provide  premium  assistance for all members
     4  enrolling in a Medicare part D drug  coverage  under  section  1860D  of
     5  Title XVIII of the federal social security act limited to the low-income
     6  benchmark premium amount established by the federal centers for Medicare
     7  and Medicaid services and any other amount which such agency establishes
     8  under  its  de minimis premium policy, except that such payments made on
     9  behalf of members enrolled in a Medicare advantage plan may  exceed  the
    10  low-income  benchmark  premium amount if determined to be cost effective
    11  to the program.
    12    (h) If the commissioner has  reasonable  grounds  to  believe  that  a
    13  member  could  be  eligible  for an income-related subsidy under section
    14  1860D-14 of Title XVIII of the federal social security act,  the  member
    15  shall  provide,  and authorize the program to obtain, any information or
    16  documentation required to establish the member's  eligibility  for  such
    17  subsidy,  provided that the commissioner shall attempt to obtain as much
    18  of the information and documentation as possible from records  that  are
    19  available to him or her.
    20    (i)  The  program  shall make a reasonable effort to notify members of
    21  their obligations under this subdivision. After a reasonable effort  has
    22  been made to contact the member, the member shall be notified in writing
    23  that  he  or she has sixty days to provide such required information. If
    24  such information is not  provided  within  the  sixty  day  period,  the
    25  member's coverage under the program may be terminated.
    26    §  5110.  Additional  provisions.   1. The commissioner shall contract
    27  with not-for-profit organizations to provide:
    28    (a) consumer assistance to individuals with respect to  selection  and
    29  changing  selection  of  a care coordinator or health care organization,
    30  enrolling, obtaining health care services, and other matters relating to
    31  the program;
    32    (b) health care provider assistance to health care providers providing
    33  and seeking or considering whether  to  provide,  health  care  services
    34  under the program, with respect to participating in a health care organ-
    35  ization and dealing with a health care organization; and
    36    (c)  care coordinator assistance to individuals and entities providing
    37  and seeking or considering whether  to  provide,  care  coordination  to
    38  members.
    39    2.  The  commissioner  shall provide grants from funds in the New York
    40  Health trust fund or otherwise appropriated for this purpose, to  health
    41  systems  agencies under section twenty-nine hundred four-b of this chap-
    42  ter to support the operation of such health systems agencies.
    43    3. Retraining and re-employment of impacted employees. (a) As used  in
    44  this subdivision:
    45    (i)  "Third party payer" means an insurer authorized to provide health
    46  coverage under the insurance  law,  a  health  maintenance  organization
    47  under  article forty-four of this chapter, a self-insured plan providing
    48  health coverage,  or  any  other  third  party  payer  for  health  care
    49  services.
    50    (ii)  "Health care provider administrative employee" means an employee
    51  of a health care provider primarily engaged  in  relations  or  dealings
    52  with  third  party payers or seeking payment or reimbursement for health
    53  care services from third party payers.
    54    (iii) "Impacted employee" means an individual who, at  any  time  from
    55  the date this section becomes a law until two years after the end of the
    56  implementation period, is employed by a third party payer or is a health

        A. 5248                            17
 
     1  care  provider  administrative  employee, and whose employment ends as a
     2  result of the implementation of the New York Health program.
     3    (b)  Within  ninety  days  after  this section shall become a law, the
     4  commissioner of labor shall convene a retraining and re-employment  task
     5  force  including  but  not  limited  to:  representatives  of  potential
     6  impacted employees, human resource departments of third party payers and
     7  health care providers, individuals  with  experience  and  expertise  in
     8  retraining  and  re-employment programs relevant to the circumstances of
     9  impacted employees, and representatives of the  commissioner  of  labor.
    10  The commissioner of labor and the task force shall review and provide:
    11    (i)  analysis  of  potential  impacted  employees  by  job  title  and
    12  geography;
    13    (ii) competency mapping and labor market analysis of impacted employee
    14  occupations with job openings; and
    15    (iii) establishment of regional retraining and re-employment  systems,
    16  including  but  not  limited  to  job boards, outplacement services, job
    17  search services, career advisement services, and retraining  advisement,
    18  to  be coordinated with the regional advisory councils established under
    19  section fifty-one hundred eleven of this article.
    20    (c) (i) Three or more impacted employees, a recognized union of  work-
    21  ers  including  impacted employees, or an employer of impacted employees
    22  may file a petition with the  commissioner  of  labor  to  certify  such
    23  employees as being impacted employees.
    24    (ii) Impacted employees shall be eligible for:
    25    (A) up to two years of retraining at any training provider approved by
    26  the commissioner of labor; and
    27    (B)  up  to  two  years  of  unemployment  benefits, provided that the
    28  impacted employee is enrolled in a department of labor approved training
    29  program, is actively seeking employment, and is not  currently  employed
    30  full  time;  provided, however, that such impacted employee may maintain
    31  unemployment benefits for up to two years even if he  or  she  does  not
    32  meet  the  criteria set forth in this clause but is sixty-three years of
    33  age or older at the time of loss of employment as an impacted employee.
    34    (d) The commissioner shall provide funds  from  the  New  York  Health
    35  trust fund or otherwise appropriated for this purpose to the commission-
    36  er  of  labor  for  retraining  and  re-employment programs for impacted
    37  employees under this subdivision.
    38    (e) The commissioner of labor shall make regulations  and  take  other
    39  actions  reasonably necessary to implement this subdivision. This subdi-
    40  vision shall be implemented consistent with  applicable  law  and  regu-
    41  lations.
    42    4. The commissioner shall, directly and through grants to not-for-pro-
    43  fit entities, conduct programs using data collected through the New York
    44  Health  program,  to  promote  and  protect  the  quality of health care
    45  services, patient outcomes, and public, environmental  and  occupational
    46  health,  including  cooperation  with other data collection and research
    47  programs of the department, consistent with this article, the protection
    48  of the security and confidentiality of individually identifiable patient
    49  information, and otherwise applicable law.
    50    § 5111. Regional advisory councils.  1. The New York  Health  regional
    51  advisory councils (each referred to in this article as a "regional advi-
    52  sory council") are hereby created in the department.
    53    2.  There  shall be a regional advisory council established in each of
    54  the following regions:
    55    (a) Long Island, consisting of Nassau and Suffolk counties;
    56    (b) New York City;

        A. 5248                            18

     1    (c) Hudson Valley, consisting of Delaware, Dutchess,  Orange,  Putnam,
     2  Rockland, Sullivan, Ulster, Westchester counties;
     3    (d)  Northern,  consisting of Albany, Clinton, Columbia, Essex, Frank-
     4  lin, Fulton, Greene, Hamilton, Herkimer, Jefferson,  Lewis,  Montgomery,
     5  Otsego,  Rensselaer,  Saratoga,  Schenectady,  Schoharie,  St. Lawrence,
     6  Warren, Washington counties;
     7    (e) Central, consisting of Broome, Cayuga,  Chemung,  Chenango,  Cort-
     8  land,  Livingston,  Madison,  Monroe, Oneida, Onondaga, Ontario, Oswego,
     9  Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, Yates counties; and
    10    (f) Western, consisting of Allegany,  Cattaraugus,  Chautauqua,  Erie,
    11  Genesee, Niagara, Orleans, Wyoming counties.
    12    3.  Each regional advisory council shall be composed of not fewer than
    13  twenty-seven members, as determined by the commissioner and  the  board,
    14  as  necessary  to appropriately represent the diverse needs and concerns
    15  of the region. Members of a regional advisory council shall be residents
    16  of or have their principal place of business in the region served by the
    17  regional advisory council.
    18    4. Appointment of members of the regional advisory councils.
    19    (a) The twenty-seven members shall be appointed as follows:
    20    (i) nine members shall be appointed by the governor;
    21    (ii) six members shall be appointed by the governor on the recommenda-
    22  tion of the speaker of the assembly;
    23    (iii) six members shall be appointed by the governor on the  recommen-
    24  dation of the temporary president of the senate;
    25    (iv) three members shall be appointed by the governor on the recommen-
    26  dation of the minority leader of the assembly; and
    27    (v)  three members shall be appointed by the governor on the recommen-
    28  dation of the minority leader of the senate.
    29    Where a regional advisory council has more than twenty-seven  members,
    30  additional members shall be appointed and recommended by these officials
    31  in the same proportion as the twenty-seven members.
    32    (b)  Regional  advisory  council  membership  shall include but not be
    33  limited to:
    34    (i) representatives of organizations with a regional constituency that
    35  advocate for health care consumers, older adults, and people with  disa-
    36  bilities  including  organizations  led  by members of those groups, who
    37  shall constitute at least one third of the membership of  each  regional
    38  council;
    39    (ii) representatives of professional organizations representing physi-
    40  cians;
    41    (iii)   representatives  of  professional  organizations  representing
    42  health care professionals other than physicians;
    43    (iv) representatives of general hospitals, including public hospitals;
    44    (v) representatives of community health centers;
    45    (vi) representatives of mental health,  behavioral  health  (including
    46  substance use), physical disability, developmental disability, rehabili-
    47  tation, home care and other service providers;
    48    (vii) representatives of women's health service providers;
    49    (viii) representatives of health care organizations;
    50    (ix)  representatives  of organized labor including representatives of
    51  health care workers;
    52    (x) representatives of employers; and
    53    (xi) representatives of municipal and county government.
    54    5. Members of a regional advisory council shall be appointed for terms
    55  of three years provided, however, that of the members  first  appointed,
    56  one-third  shall  be appointed for one year terms and one-third shall be

        A. 5248                            19
 
     1  appointed for two year terms. Vacancies shall  be  filled  in  the  same
     2  manner as original appointments for the remainder of any unexpired term.
     3  No person shall be a member of a regional advisory council for more than
     4  six years in any period of twelve consecutive years.
     5    6.  Members  of  the  regional  advisory  councils shall serve without
     6  compensation but shall be reimbursed  for  their  necessary  and  actual
     7  expenses  incurred  while  engaged in the business of the advisory coun-
     8  cils. The program shall provide financial support for such expenses  and
     9  other expenses of the regional advisory councils.
    10    7.  Each regional advisory council shall meet at least quarterly. Each
    11  regional advisory council may form committees to assist it in its  work.
    12  Members  of  a  committee  need  not be members of the regional advisory
    13  council.   The New York City regional  advisory  council  shall  form  a
    14  committee  for  each  borough  of  New York City, to assist the regional
    15  advisory council in its work as it relates particularly to that borough.
    16    8. Each regional advisory council shall advise the  commissioner,  the
    17  board,  the  governor and the legislature on all matters relating to the
    18  development and implementation of the New York Health program.
    19    9. Each regional advisory council shall adopt, and from time  to  time
    20  revise,  a  community  health  improvement  plan  for its region for the
    21  purpose of:
    22    (a) promoting the delivery of health  care  services  in  the  region,
    23  improving  the  quality  and  accessibility  of care, including cultural
    24  competency, clinical  integration  of  care  between  service  providers
    25  including  but  not  limited to physical, mental, and behavioral health,
    26  physical and developmental disability services, and  long-term  supports
    27  and services;
    28    (b) facility and health services planning in the region;
    29    (c) identifying gaps in regional health care services;
    30    (d)  promoting increased public knowledge and responsibility regarding
    31  the availability and appropriate utilization of  health  care  services.
    32  Each community health improvement plan shall be submitted to the commis-
    33  sioner and the board and shall be posted on the department's website;
    34    (e)  identifying  needs in professional and service personnel required
    35  to deliver health care services; and
    36    (f) coordinating regional implementation of retraining and  re-employ-
    37  ment  programs for impacted employees under subdivision three of section
    38  fifty-one hundred ten of this article.
    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 the

        A. 5248                            20
 
     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").  Income in the bracket
    18  below twenty-five thousand dollars per year shall  be  exempt  from  the
    19  taxes.  Higher brackets of income subject to the taxes shall be assessed
    20  at  a  higher marginal rate than lower brackets.  The taxes shall be set
    21  at levels anticipated to  produce  sufficient  revenue  to  finance  the
    22  program,  to be scaled up as enrollment grows, taking into consideration
    23  anticipated federal revenue available for the program.  Provision  shall
    24  be  made  for state residents (who are eligible for the program) who are
    25  employed out-of-state, and non-residents (who are not eligible  for  the
    26  program) who are employed in the state.
    27    (b)  Payroll tax. The income to be subject to the payroll tax shall be
    28  all income subject to the Medicare Part A tax. The tax shall be set at a
    29  percentage of that income, which shall be  progressively  graduated,  so
    30  the  percentage  is  higher  on  higher brackets of income. For employed
    31  individuals, the employer shall pay eighty percent of the  tax  and  the
    32  employee  shall  pay  twenty percent of the tax, except that an employer
    33  may agree to pay all or part of the employee's share.   A  self-employed
    34  individual shall pay the full tax.
    35    (c)  Non-payroll  income  tax.  There shall be a tax on income that is
    36  subject to the personal income tax under article 22 of the tax  law  and
    37  is  not  subject  to the payroll tax. It shall be set at a percentage of
    38  that income, which shall be progressively graduated, so  the  percentage
    39  is higher on higher brackets of income.
    40    (d) Phased-in rates. Early in the program, when enrollment is growing,
    41  the  amount  of the taxes shall be at an appropriate level, and shall be
    42  changed as anticipated enrollment grows, to cover the actual cost of the
    43  program. The revenue proposal shall include a mechanism for  determining
    44  the rates of the taxes.
    45    (e) Cross-border employees. (i) State residents employed out-of-state.
    46  If an individual is employed out-of-state by an employer that is subject
    47  to  New  York  state law, the employer and employee shall be required to
    48  pay the payroll tax as to that employee as if the employment were in the
    49  state. If an individual is employed out-of-state by an employer that  is
    50  not  subject to New York state law, either (A) the employer and employee
    51  shall voluntarily comply with the tax or (B) the employee shall pay  the
    52  tax as if he or she were self-employed.
    53    (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
    54  tax shall apply to any out-of-state resident who is employed or self-em-
    55  ployed in the state.  (B) In the case of an out-of-state resident who is
    56  employed or self-employed in the state, such individual and individual's

        A. 5248                            21
 
     1  employer shall be able to take a credit against the payroll  taxes  each
     2  would otherwise pay as to that individual for amounts they spend respec-
     3  tively  on  health  benefits  for the individual that would otherwise be
     4  covered  by  the program if the individual were a member of the program.
     5  For the employer, the credit shall be available regardless of  the  form
     6  of  the  health  benefit  (e.g.,  health insurance, a self-insured plan,
     7  direct services, or reimbursement for services), to make sure  that  the
     8  revenue  proposal does not relate to employment benefits in violation of
     9  the federal ERISA.  For non-employment-based spending by the individual,
    10  the credit shall be available for and limited  to  spending  for  health
    11  coverage (not out-of-pocket health spending). The credit shall be avail-
    12  able  without  regard  to how little is spent or how sparse the benefit.
    13  The credit may only be taken against the payroll tax. Any excess  amount
    14  may  not be applied to other tax liability. The credit shall be distrib-
    15  uted between the employer and employee in the  same  proportion  as  the
    16  spending  by each for the benefit and may be applied to their respective
    17  portion of the tax. (C) If any provision of  this  subparagraph  or  any
    18  application of it shall be ruled to violate federal ERISA, the provision
    19  or the application of it shall be null and void and the ruling shall not
    20  affect  any  other  provision  or application of this section or the act
    21  that enacted it.
    22    3. (a) The revenue proposal  shall  include  a  plan  and  legislative
    23  provisions   for  ending  the  requirement  for  local  social  services
    24  districts to pay part of  the  cost  of  Medicaid  and  replacing  those
    25  payments with revenue from the taxes under the revenue proposal.
    26    (b)  The  taxes  under this section shall not supplant the spending of
    27  other state revenue to pay for the Medicaid program as it exists  as  of
    28  the  enactment  of  the  revenue proposal as amended, unless the revenue
    29  proposal as amended provides otherwise.
    30    4. To the extent that the revenue proposal differs from the  terms  of
    31  subdivision  two  or paragraph (b) of subdivision three of this section,
    32  the revenue proposal shall state how it differs  from  those  terms  and
    33  reasons for and the effects of the differences.
    34    5.  All  revenue  from  the  taxes  shall be deposited in the New York
    35  Health trust fund account under section 89-j of the state finance law.
    36    § 5.  Article 49 of the public health law is amended by adding  a  new
    37  title 3 to read as follows:
    38                                  TITLE III
    39            COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
    40                               NEW YORK HEALTH
    41  Section 4920. Definitions.
    42          4921. Collective negotiation authorized.
    43          4922. Collective negotiation requirements.
    44          4923. Requirements for health care providers' representative.
    45          4924. Mediation.
    46          4925. Certain collective action prohibited.
    47          4926. Fees.
    48          4927. Confidentiality.
    49          4928. Severability and construction.
    50    § 4920. Definitions. For purposes of this title:
    51    1. "New York Health" means the program under article fifty-one of this
    52  chapter.
    53    2.  "Person"  means  an  individual,  association, corporation, or any
    54  other legal entity.
    55    3. "Health care providers' representative" means a third party that is
    56  authorized by health care providers to negotiate on  their  behalf  with

        A. 5248                            22

     1  New  York  Health  over terms and conditions affecting those health care
     2  providers.
     3    4. "Strike" means a work stoppage in part or in whole, direct or indi-
     4  rect,  by  a  body of workers to gain compliance with demands made on an
     5  employer.
     6    5. "Health care provider" means a health care provider  under  article
     7  fifty-one  of  this  chapter.  A  health care professional as defined in
     8  article fifty-one of this chapter who practices as an employee or  inde-
     9  pendent contractor of another health care provider shall not be deemed a
    10  health care provider for purposes of this title.
    11    §  4921.  Collective  negotiation authorized. 1. Health care providers
    12  may meet and communicate for the  purpose  of  collectively  negotiating
    13  with  New York Health on any matter relating to New York Health, includ-
    14  ing but not limited to rates of payment and payment methodologies.
    15    2. Nothing in this section shall be construed to allow or authorize an
    16  alteration of the terms of the internal and external  review  procedures
    17  set forth in law.
    18    3. Nothing in this section shall be construed to allow a strike of New
    19  York Health by health care providers.
    20    4.  Nothing  in  this section shall be construed to allow or authorize
    21  terms or conditions which would impede the ability of New York Health to
    22  obtain or retain accreditation by the  national  committee  for  quality
    23  assurance or a similar body or to comply with applicable state or feder-
    24  al law.
    25    § 4922. Collective negotiation requirements. 1. Collective negotiation
    26  rights granted by this title must conform to the following requirements:
    27    (a)  health  care  providers  may  communicate  with other health care
    28  providers regarding the terms and conditions to be negotiated  with  New
    29  York Health;
    30    (b)  health care providers may communicate with health care providers'
    31  representatives;
    32    (c) a health care providers' representative is the only party  author-
    33  ized  to  negotiate  with  New  York Health on behalf of the health care
    34  providers as a group;
    35    (d) a health care provider can be bound by the  terms  and  conditions
    36  negotiated by the health care providers' representatives; and
    37    (e)  in  communicating  or negotiating with the health care providers'
    38  representative, New York Health is entitled to offer and provide differ-
    39  ent terms and conditions to individual competing health care providers.
    40    2. Nothing in this title shall affect or limit the right of  a  health
    41  care provider or group of health care providers to collectively petition
    42  a government entity for a change in a law, rule, or regulation.
    43    3.  Nothing  in  this title shall affect or limit collective action or
    44  collective bargaining on the part of any health care provider  with  his
    45  or  her  employer  or  any  other lawful collective action or collective
    46  bargaining.
    47    § 4923. Requirements for health care providers' representative. Before
    48  engaging in collective negotiations with New York Health  on  behalf  of
    49  health  care  providers,  a  health care providers' representative shall
    50  file with the commissioner, in the manner prescribed by the  commission-
    51  er,  information  identifying  the  representative, the representative's
    52  plan of operation, and the representative's procedures to ensure compli-
    53  ance with this title.
    54    § 4924. Mediation. 1. In the event the commissioner determines that an
    55  impasse exists  in  the  negotiations,  the  commissioner  shall  render
    56  assistance as follows:

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     1    (a)  to  assist  the  parties  to effect a voluntary resolution of the
     2  negotiations, the commissioner shall appoint a mediator who is  mutually
     3  acceptable  to  both  the  health care providers' representative and the
     4  representative of New York Health. If  the  mediator  is  successful  in
     5  resolving  the  impasse,  then the health care providers' representative
     6  shall proceed as set forth in this article;
     7    (b) if an impasse continues, the commissioner shall  appoint  a  fact-
     8  finding  board of not more than three members, who are mutually accepta-
     9  ble to both the health care providers' representative and the  represen-
    10  tative  of  New  York  Health.  The  fact-finding  board  shall have, in
    11  addition to the powers delegated to it by the board, the power  to  make
    12  recommendations for the resolution of the dispute;
    13    (c) the fact-finding board, acting by a majority of its members, shall
    14  transmit  its findings of fact and recommendations for resolution of the
    15  dispute to the commissioner, and may thereafter assist  the  parties  to
    16  effect  a  voluntary  resolution  of the dispute. The fact-finding board
    17  shall also share its findings  of  fact  and  recommendations  with  the
    18  health care providers' representative and the representative of New York
    19  Health.  If  within  twenty days after the submission of the findings of
    20  fact and recommendations, the impasse continues, the commissioner  shall
    21  order  a  resolution to the negotiations based upon the findings of fact
    22  and recommendations submitted by the fact-finding board.
    23    § 4925. Certain collective action prohibited. 1.  This  title  is  not
    24  intended  to authorize competing health care providers to act in concert
    25  in response to a health care providers' representative's discussions  or
    26  negotiations with New York Health except as authorized by other law.
    27    2. No health care providers' representative shall negotiate any agree-
    28  ment  that  excludes,  limits  the participation or reimbursement of, or
    29  otherwise limits the scope of services to be provided by any health care
    30  provider or group of health care providers with respect to the  perform-
    31  ance of services that are within the health care provider's lawful scope
    32  or terms of practice, license, registration, or certificate.
    33    §  4926. Fees. Each person who acts as the representative of negotiat-
    34  ing parties under this title shall pay to the department a fee to act as
    35  a representative. The commissioner, by regulation,  shall  set  fees  in
    36  amounts  deemed  reasonable and necessary to cover the costs incurred by
    37  the department in administering this title.
    38    § 4927. Confidentiality. All reports and other information required to
    39  be reported to the department under this title shall not be  subject  to
    40  disclosure under article six of the public officers law.
    41    § 4928. Severability and construction. If any provision or application
    42  of  this  title  shall be held to be invalid, or to violate or be incon-
    43  sistent with any applicable federal law or regulation,  that  shall  not
    44  affect other provisions or applications of this title which can be given
    45  effect  without  that  provision  or  application;  and to that end, the
    46  provisions and applications of this title are severable. The  provisions
    47  of  this  title  shall  be  liberally  construed  to  give effect to the
    48  purposes thereof.
    49    § 6. Subdivision 11 of section  270  of  the  public  health  law,  as
    50  amended  by  section 2-a of part C of chapter 58 of the laws of 2008, is
    51  amended to read as follows:
    52    11. "State public health plan" means the  medical  assistance  program
    53  established  by  title eleven of article five of the social services law
    54  (referred to in this article as "Medicaid"), the elderly  pharmaceutical
    55  insurance  coverage program established by title three of article two of
    56  the elder law (referred to in this article as "EPIC"), and  the  [family

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     1  health  plus  program established by section three hundred sixty-nine-ee
     2  of the social services law to the extent that section provides that  the
     3  program shall be subject to this article] New York Health program estab-
     4  lished by article fifty-one of this chapter.
     5    §  7. The state finance law is amended by adding a new section 89-j to
     6  read as follows:
     7    § 89-j. New York Health trust fund. 1. There is hereby established  in
     8  the joint custody of the state comptroller and the commissioner of taxa-
     9  tion  and  finance  a  special revenue fund to be known as the "New York
    10  Health trust fund", referred to in this section as "the fund". The defi-
    11  nitions in section fifty-one hundred of  the  public  health  law  shall
    12  apply to this section.
    13    2. The fund shall consist of:
    14    (a)  all monies obtained from taxes pursuant to legislation enacted as
    15  proposed under section three of the New York Health act;
    16    (b) federal payments received as a  result  of  any  waiver  or  other
    17  arrangements  agreed  to  by  the  United States secretary of health and
    18  human services or other appropriate federal officials  for  health  care
    19  programs established under Medicare, any federally-matched public health
    20  program, or the affordable care act;
    21    (c)  the  amounts paid by the department of health that are equivalent
    22  to those amounts that are paid on behalf  of  residents  of  this  state
    23  under  Medicare,  any  federally-matched  public  health program, or the
    24  affordable care act for health benefits which are equivalent  to  health
    25  benefits covered under New York Health;
    26    (d)  federal and state funds for purposes of the provision of services
    27  authorized under title XX of the federal social security act that  would
    28  otherwise  be  covered under article fifty-one of the public health law;
    29  and
    30    (e) state monies that would otherwise be appropriated to  any  govern-
    31  mental  agency,  office,  program,  instrumentality or institution which
    32  provides health services, for services and benefits  covered  under  New
    33  York Health. Payments to the fund pursuant to this paragraph shall be in
    34  an  amount  equal  to  the  money  appropriated for such purposes in the
    35  fiscal year beginning immediately preceding the effective  date  of  the
    36  New York Health act.
    37    3.  Monies  in  the  fund  shall only be used for purposes established
    38  under article fifty-one of the public health law.
    39    § 8. Temporary commission on implementation. 1. There is hereby estab-
    40  lished a temporary commission on implementation of the New  York  Health
    41  program,  referred  to  in this section as the commission, consisting of
    42  fifteen members: five members, including the chair, shall  be  appointed
    43  by the governor; four members shall be appointed by the temporary presi-
    44  dent of the senate, one member shall be appointed by the senate minority
    45  leader;  four members shall be appointed by the speaker of the assembly,
    46  and one member shall be appointed by the assembly minority  leader.  The
    47  commissioner  of  health,  the superintendent of financial services, and
    48  the commissioner of taxation and finance, or their designees shall serve
    49  as non-voting ex-officio members of the commission.
    50    2. Members of the commission shall receive such assistance as  may  be
    51  necessary  from  other  state  agencies  and entities, and shall receive
    52  reasonable and necessary expenses incurred in the performance  of  their
    53  duties.  The  commission  may  employ  staff  as needed, prescribe their
    54  duties, and fix their compensation within amounts appropriated  for  the
    55  commission.

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     1    3.  The commission shall examine the laws and regulations of the state
     2  and make such recommendations as are necessary to conform the  laws  and
     3  regulations  of the state and article 51 of the public health law estab-
     4  lishing the New York Health program and other provisions of law relating
     5  to  the  New  York  Health  program,  and  to  improve and implement the
     6  program. The commission shall report its recommendations to the governor
     7  and the legislature.  The commission shall immediately begin development
     8  of proposals consistent with the principles of article 51 of the  public
     9  health law for provision of health care services covered under the work-
    10  ers'  compensation law; and incorporation of retiree health benefits, as
    11  described in paragraphs (a), (b) and (c) of  subdivision  8  of  section
    12  5102  of  the  public health law.  The commission shall provide its work
    13  product and assistance to the board established pursuant to section 5102
    14  of the public health law upon  completion  of  the  appointment  of  the
    15  board.
    16    §  9.  Severability. If any provision or application of this act shall
    17  be held to be invalid, or to violate or be inconsistent with any  appli-
    18  cable  federal law or regulation, that shall not affect other provisions
    19  or applications of this act which  can  be  given  effect  without  that
    20  provision  or  application; and to that end, the provisions and applica-
    21  tions of this act are severable.
    22    § 10. This act shall take effect immediately.
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