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S02237 Summary:

BILL NOS02237A
 
SAME ASSAME AS A03020-A
 
SPONSORRIVERA
 
COSPNSRBAILEY, BRESLIN, BRISPORT, BROUK, CHU, CLEARE, COMRIE, COONEY, FERNANDEZ, GIANARIS, GONZALEZ, GOUNARDES, HARCKHAM, HINCHEY, HOYLMAN-SIGAL, JACKSON, KAVANAGH, KENNEDY, KRUEGER, LIU, MAY, MAYER, MYRIE, PARKER, PERSAUD, RAMOS, SALAZAR, SANDERS, SEPULVEDA, SERRANO, STAVISKY, THOMAS, WEBB
 
MLTSPNSR
 
Amd 369-ii, Soc Serv L
 
Provides for coverage for certain individuals under the 1332 state innovation program.
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S02237 Actions:

BILL NOS02237A
 
01/19/2023REFERRED TO HEALTH
01/31/2023REPORTED AND COMMITTED TO FINANCE
05/15/2023AMEND (T) AND RECOMMIT TO FINANCE
05/15/2023PRINT NUMBER 2237A
06/08/2023COMMITTEE DISCHARGED AND COMMITTED TO RULES
06/08/2023ORDERED TO THIRD READING CAL.1736
06/08/2023PASSED SENATE
06/08/2023DELIVERED TO ASSEMBLY
06/08/2023referred to ways and means
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S02237 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2237--A
 
                               2023-2024 Regular Sessions
 
                    IN SENATE
 
                                    January 19, 2023
                                       ___________
 
        Introduced  by  Sens.  RIVERA,  BRESLIN,  BRISPORT,  BROUK, CHU, CLEARE,
          COMRIE, COONEY, FERNANDEZ, GIANARIS,  GONZALEZ,  GOUNARDES,  HARCKHAM,
          HINCHEY,  HOYLMAN-SIGAL,  JACKSON, KAVANAGH, KENNEDY, LIU, MAY, MAYER,
          MYRIE, PARKER, PERSAUD, RAMOS, SALAZAR, SANDERS,  SEPULVEDA,  SERRANO,
          STAVISKY,  THOMAS,  WEBB  --  read twice and ordered printed, and when
          printed to be committed to the Committee on Health -- reported favora-
          bly from said committee and committed to the Committee on  Finance  --
          committee  discharged,  bill amended, ordered reprinted as amended and
          recommitted to said committee
 
        AN ACT to amend the social services law, in  relation  to  coverage  for
          certain individuals under the 1332 state innovation program
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 369-ii of the social  services  law,  as  added  by
     2  section  3  of  part  H of chapter 57 of the laws of 2023, is amended to
     3  read as follows:
     4    § 369-ii. 1332 state innovation program. 1. Authorization.    Notwith-
     5  standing  section  three hundred sixty-nine-gg of this title, subject to
     6  federal approval, if it is in the financial interest of the state to  do
     7  so,  the  commissioner of health is authorized, with the approval of the
     8  director of the budget, to establish a  1332  state  innovation  program
     9  pursuant  to  section 1332 of the patient protection and affordable care
    10  act (P.L. 111-148) and subdivision twenty-five of  section  two  hundred
    11  sixty-eight-c  of  the  public  health law. The commissioner of health's
    12  authority pursuant to this section  is  contingent  upon  obtaining  and
    13  maintaining  all  necessary  approvals  from the secretary of health and
    14  human services and the secretary of the treasury based on an application
    15  for a waiver for state innovation.  The  commissioner  of  health  [may]
    16  shall take all actions necessary to obtain such approvals.
    17    2. Definitions. For the purposes of this section:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04552-02-3

        S. 2237--A                          2
 
     1    (a)  "Eligible  organization"  means  an  insurer licensed pursuant to
     2  article thirty-two or forty-two of the insurance law, a  corporation  or
     3  an  organization  under  article forty-three of the insurance law, or an
     4  organization certified under article forty-four  of  the  public  health
     5  law,  including  providers  certified  under  section forty-four hundred
     6  three-e of the public health law.
     7    (b) "Approved organization" means an eligible organization approved by
     8  the commissioner of health to underwrite a 1332 state innovation  health
     9  insurance plan pursuant to this section.
    10    (c) "Health care services" means:
    11    (i) the services and supplies as defined by the commissioner of health
    12  in consultation with the superintendent of financial services, and shall
    13  be  consistent  with  and  subject  to  the essential health benefits as
    14  defined by the commissioner in accordance with  the  provisions  of  the
    15  patient protection and affordable care act (P.L. 111-148) and consistent
    16  with the benefits provided by the reference plan selected by the commis-
    17  sioner  of  health for the purposes of defining such benefits, and shall
    18  include coverage of and access to the services of  any  national  cancer
    19  institute-designated  cancer center licensed by the department of health
    20  within the service area of the approved organization that is willing  to
    21  agree  to  provide  cancer-related  inpatient,  outpatient  and  medical
    22  services to all enrollees  in  approved  organizations'  plans  in  such
    23  cancer  center's  service area under the prevailing terms and conditions
    24  that the approved organization requires of other similar providers to be
    25  included in the approved  organization's  network,  provided  that  such
    26  terms  shall  include  reimbursement  of such center at no less than the
    27  fee-for-service medicaid payment rate and methodology applicable to  the
    28  center's inpatient and outpatient services;
    29    (ii)  dental  and  vision  services  as defined by the commissioner of
    30  health, and
    31    (iii) as defined by the commissioner of health and subject to  federal
    32  approval,  certain  services and supports provided to enrollees who have
    33  functional limitations and/or chronic illnesses that  have  the  primary
    34  purpose of supporting the ability of the enrollee to live or work in the
    35  setting  of  their  choice,  which  may include the individual's home, a
    36  worksite, or a provider-owned or controlled residential setting.
    37    (d) "Qualified health plan" means a health plan that meets the  crite-
    38  ria  for  certification described in § 1311(c) of the patient protection
    39  and affordable care act (P.L. 111-148), and is  offered  to  individuals
    40  through  the  NY  State  of  Health, the official health Marketplace, or
    41  Marketplace, as defined  in  subdivision  two  of  section  two  hundred
    42  sixty-eight-a of the public health law.
    43    (e) "Basic health insurance plan" means a health plan providing health
    44  care  services,  separate and apart from qualified health plans, that is
    45  issued by an approved organization  and  certified  in  accordance  with
    46  section three hundred sixty-nine-gg of this title.
    47    (f)  "1332 state innovation plan" means a standard health plan provid-
    48  ing health care services, separate and apart  from  a  qualified  health
    49  plan  and  a  basic health insurance plan, that is issued by an approved
    50  organization and certified in accordance with this section.
    51    3. State innovation plan eligible individual. (a) A person is eligible
    52  to receive coverage for health care under this section if they:
    53    (i) reside in New York state and are under sixty-five  years  of  age,
    54  including  individuals  that are ineligible for the basic health program
    55  under 42 U.S.C.  section  18051  on  the  basis  of  immigration  status
    56  provided  they  are  determined eligible pursuant to subdivision nine of

        S. 2237--A                          3
 
     1  this section and are determined eligible through the waiver  process  to
     2  receive  coverage under this section regardless of direct federal finan-
     3  cial support for such individuals;
     4    (ii)  are  not  eligible  for medical assistance under title eleven of
     5  this article, excluding eligibility for limited medical  assistance  for
     6  the  treatment  of an emergency medical condition authorized pursuant to
     7  42 U.S.C. 1396, or for the child  health  insurance  plan  described  in
     8  title one-A of article twenty-five of the public health law;
     9    (iii)  are  not eligible for minimum essential coverage, as defined in
    10  section 5000A(f) of the Internal Revenue Service Code  of  1986,  or  is
    11  eligible  for  an  employer-sponsored  plan  that  is not affordable, in
    12  accordance with section 5000A(f) of such code; and
    13    (iv) have household income at or below two hundred  fifty  percent  of
    14  the  federal  poverty  line  defined  and annually revised by the United
    15  States department of health and human services for a  household  of  the
    16  same  size;  and  has  household income that exceeds one hundred thirty-
    17  three percent of the federal poverty line defined and  annually  revised
    18  by  the  United  States  department  of  health and human services for a
    19  household of the  same  size;  provided,  however,  that  MAGI  eligible
    20  noncitizens  lawfully present in the United States, and individuals that
    21  are ineligible for the basic health  program  under  42  U.S.C.  section
    22  18051  on  the  basis of immigration status with household incomes at or
    23  below one hundred thirty-three percent of the federal poverty line shall
    24  be eligible to receive coverage for health care services pursuant to the
    25  provisions of this section [if such noncitizen would be  ineligible  for
    26  medical assistance under title eleven of this article due to their immi-
    27  gration status].
    28    (b)  Subject to federal approval, a child born to an individual eligi-
    29  ble for and receiving coverage for health care services pursuant to this
    30  section who but for their eligibility under this section would be eligi-
    31  ble for coverage pursuant to subparagraphs two or four of paragraph  (b)
    32  of  subdivision  one of section three hundred sixty-six of this article,
    33  shall be administratively enrolled, as defined by  the  commissioner  of
    34  health,  in  medical assistance and to have been found eligible for such
    35  assistance on the date of such birth and to  remain  eligible  for  such
    36  assistance for a period of one year.
    37    (c) Subject to federal approval, an individual who is eligible for and
    38  receiving  coverage for health care services pursuant to this section is
    39  eligible to continue to receive health care services  pursuant  to  this
    40  section  during  the individual's pregnancy and for a period of one year
    41  following the end of the pregnancy without regard to any change  in  the
    42  income  of  the household that includes the pregnant individual, even if
    43  such change would render the pregnant individual ineligible  to  receive
    44  health care services pursuant to this section.
    45    (d)  For  the  purposes of this section, 1332 state innovation program
    46  eligible individuals are prohibited  from  being  treated  as  qualified
    47  individuals  under section 1312 of the Affordable Care Act and as eligi-
    48  ble individuals under section 1331 of the ACA and enrolling in qualified
    49  health plan through the Marketplace or standard health plan through  the
    50  Basic Health Program.
    51    4.  Enrollment.  (a)  Subject to federal approval, the commissioner of
    52  health is authorized to establish an application and  enrollment  proce-
    53  dure  for prospective enrollees. Such procedure will include a verifica-
    54  tion system for applicants, which must  be  consistent  with  42  USC  §
    55  1320b-7.

        S. 2237--A                          4
 
     1    (b) Such procedure shall allow for continuous enrollment for enrollees
     2  to  the  1332 state innovation program where an individual may apply and
     3  enroll for coverage at any point.
     4    (c)  Upon  an  applicant's enrollment in a 1332 state innovation plan,
     5  coverage for health care services pursuant to  the  provisions  of  this
     6  section  shall be retroactive to the first day of the month in which the
     7  individual was determined eligible, except in the case of program  tran-
     8  sitions within the Marketplace.
     9    (d)  A  person who has enrolled for coverage pursuant to this section,
    10  and who loses eligibility to enroll in the 1332 state innovation program
    11  for a reason other than [citizenship status,] lack of  state  residence,
    12  [failure  to  provide a valid social security number,] providing inaccu-
    13  rate information that would affect eligibility when requesting or renew-
    14  ing health coverage pursuant to this section,  or  failure  to  make  an
    15  applicable  premium  payment,  before  the  end of a twelve month period
    16  beginning on the effective date of the person's initial eligibility  for
    17  coverage,  or  before  the end of a twelve month period beginning on the
    18  date of any subsequent determination of eligibility,  shall  have  their
    19  eligibility  for  coverage  continued until the end of such twelve month
    20  period, provided that the state  receives  federal  approval  for  using
    21  funds under an approved 1332 waiver.
    22    5.  Premiums.  Subject to federal approval, the commissioner of health
    23  shall establish premium payments enrollees in a  1332  state  innovation
    24  plan  shall  pay  to  approved organizations for coverage of health care
    25  services pursuant to this section. Such premium payments shall be estab-
    26  lished in the following manner:
    27    (a) up to fifteen dollars monthly for an individual with  a  household
    28  income  above  two hundred percent of the federal poverty line but at or
    29  below two hundred fifty percent of the federal poverty line defined  and
    30  annually  revised  by  the  United States department of health and human
    31  services for a household of the same size; and
    32    (b) no payment is required for individuals with a household income  at
    33  or  below  two  hundred  percent of the federal poverty line defined and
    34  annually revised by the United States department  of  health  and  human
    35  services for a household of the same size.
    36    6. Cost-sharing. The commissioner of health shall establish cost-shar-
    37  ing  obligations  for  enrollees, subject to federal approval, including
    38  childbirth and newborn  care  consistent  with  the  medical  assistance
    39  program under title eleven of this article. There shall be no cost-shar-
    40  ing obligations for enrollees for:
    41    (a)  dental  and  vision  services  as defined in subparagraph (ii) of
    42  paragraph (c) of subdivision two of this section; and
    43    (b) services and supports as defined in subparagraph  (iii)  of  para-
    44  graph (c) of subdivision two of this section.
    45    7.  Rates  of payment. (a) The commissioner of health shall select the
    46  contract with an independent actuary to study and recommend  appropriate
    47  reimbursement methodologies for the cost of health care service coverage
    48  pursuant to this section. Such independent actuary shall review and make
    49  recommendations concerning appropriate actuarial assumptions relevant to
    50  the  establishment  of  reimbursement  methodologies,  including but not
    51  limited to; the adequacy of rates of payment in relation  to  the  popu-
    52  lation  to  be  served  adjusted  for case mix, the scope of health care
    53  services approved organizations must provide, the  utilization  of  such
    54  services and the network of providers required to meet state standards.
    55    (b)  Upon  consultation  with  the  independent  actuary  and entities
    56  representing approved organizations, the commissioner  of  health  shall

        S. 2237--A                          5
 
     1  develop  reimbursement  methodologies  and fee schedules for determining
     2  rates of payment, which rates shall be approved by the director  of  the
     3  division  of the budget, to be made by the department to approved organ-
     4  izations  for the cost of health care services coverage pursuant to this
     5  section. Such reimbursement methodologies and fee schedules may  include
     6  provisions for capitation arrangements.
     7    (c)  The commissioner of health shall have the authority to promulgate
     8  regulations, including emergency regulations,  necessary  to  effectuate
     9  the provisions of this subdivision.
    10    (d)  The  department  of  health shall require the independent actuary
    11  selected pursuant to paragraph (a) of  this  subdivision  to  provide  a
    12  complete actuarial report, along with all actuarial assumptions made and
    13  all  other  data, materials and methodologies used in the development of
    14  rates for the 1332 state innovation plan authorized under this  section.
    15  Such report shall be provided annually to the temporary president of the
    16  senate and the speaker of the assembly.
    17    8.  An  individual  who  is lawfully admitted for permanent residence,
    18  permanently residing in the United States under color of law, or who  is
    19  a  non-citizen  in  a  valid nonimmigrant status, as defined in 8 U.S.C.
    20  1101(a)(15), and who would be ineligible for  medical  assistance  under
    21  title  eleven  of  this  article  due to their immigration status if the
    22  provisions of section  one  hundred  twenty-two  of  this  chapter  were
    23  applied, shall be considered to be ineligible for medical assistance for
    24  purposes of paragraphs (b) and (c) of subdivision three of this section.
    25    9.  (a) In determining eligibility for residents of the state that are
    26  ineligible for the basic health program under 42 U.S.C. section 18051 on
    27  the basis of immigration status, the commissioner of  health  may  place
    28  limitations  on  enrollment  to  ensure  that  the costs associated with
    29  rendering services to this population do not exceed the revenues  antic-
    30  ipated  to  be  transferred  to  the 1332 state innovation program fund,
    31  pursuant to section ninety-eight-d of the state finance law.  In  estab-
    32  lishing any limitations pursuant to this subdivision the commissioner of
    33  health  shall enroll at least two hundred forty thousand individuals and
    34  may enroll additional individuals as reasonably practicable while ensur-
    35  ing continual coverage for such additional individuals based on  current
    36  and anticipated 1332 state innovation program fund reserves.
    37    (b)  In determining any limitations on enrollment, the commissioner of
    38  health shall determine income bands for such individuals  from  zero  to
    39  two  hundred fifty percent of the federal poverty line defined and annu-
    40  ally revised by  the  United  States  department  of  health  and  human
    41  services  for  a  household of the same size. The commissioner of health
    42  shall prioritize the enrollment of individuals from  the  lowest  income
    43  band first and then the remaining income bands in ascending order.
    44    (c)  Notwithstanding  the provisions of paragraph (b) of this subdivi-
    45  sion, the commissioner of health may also include subsets of  the  popu-
    46  lation  whose  continued health and well-being would be significantly at
    47  risk without routine access to health care.  Population  subsets  to  be
    48  prioritized  for  enrollment  shall be determined by the commissioner of
    49  health and shall include but not be limited  to:  (i)  individuals  with
    50  life threatening conditions, (ii) individuals in need of an organ trans-
    51  plant;  and  (iii) individuals with significant behavioral health issues
    52  including but not limited to serious mental  illness  or  substance  use
    53  disorder.
    54    10.  The  commissioner  of  health shall take all actions necessary to
    55  obtain all necessary  approvals  from the secretary of health and  human
    56  services and the secretary of the treasury to utilize moneys transferred

        S. 2237--A                          6
 
     1  to  the basic health program trust fund, pursuant to section ninety-sev-
     2  en-oooo of the state finance law, as added  by  section  fifty-three  of
     3  part  C of chapter sixty of the laws of two thousand fourteen, for costs
     4  associated  with  the  provision  of health care services to all persons
     5  eligible for coverage under the waiver. If approval is not  granted  for
     6  all  persons eligible for coverage under the waiver, the commissioner of
     7  health shall take all actions necessary to obtain approval for  the  use
     8  of  moneys  of  the basic health program trust fund for costs associated
     9  with the provision of health care  services  to  individuals  under  the
    10  waiver  that  would otherwise be eligible for participation in the basic
    11  health program, established pursuant to  section  three  hundred  sixty-
    12  nine-gg of this title.
    13    11. Reporting. The commissioner of health shall submit a report to the
    14  temporary  president of the senate and the speaker of the assembly annu-
    15  ally by December thirty-first. The report shall include, at  a  minimum,
    16  an  analysis  of the 1332 state innovation program and its impact on the
    17  financial interest of the state; its impact on the Marketplace including
    18  enrollment and premiums; its impact on the number of uninsured  individ-
    19  uals in the state; its impact on the Medicaid global cap; any enrollment
    20  limitations  established  pursuant  to  subdivision nine of this section
    21  including the rationale  and  supporting  fiscal  calculations  used  to
    22  justify  such  limitation,  including any historical data, if available,
    23  for the previous three years related  to  any  previous  limitations  of
    24  enrollment,  funds transferred to the 1332 state innovation program fund
    25  pursuant to section ninety-eight-d of the state finance law, and  totals
    26  on  any  savings  to the state due to coverage of residents of the state
    27  that are ineligible for the basic health program under 42 U.S.C. section
    28  18051 on the basis of immigration status; any moneys utilized  from  the
    29  basic  health  plan  trust  fund  to support the delivery of health care
    30  services to persons eligible for coverage  under  the  waiver;  and  the
    31  demographics  of  the  1332 state innovation program enrollees including
    32  age and immigration status.
    33    [10.] 12. Severability. If the secretary of health and human  services
    34  or  the  secretary  of  the treasury do not approve any provision of the
    35  application for a state innovation waiver, such decision shall in no way
    36  affect or impair any other provisions that the secretaries  may  approve
    37  under this section.
    38    § 2. Severability clause. If any clause, sentence, paragraph, subdivi-
    39  sion,  section  or  part  of  this act shall be adjudged by any court of
    40  competent jurisdiction to be invalid, such judgment  shall  not  affect,
    41  impair,  or  invalidate  the remainder thereof, but shall be confined in
    42  its operation to the clause, sentence, paragraph,  subdivision,  section
    43  or part thereof directly involved in the controversy in which such judg-
    44  ment shall have been rendered. It is hereby declared to be the intent of
    45  the  legislature  that  this  act  would  have been enacted even if such
    46  invalid provisions had not been included herein.
    47    § 3. This act shall take effect on the  same  date  and  in  the  same
    48  manner as section 3 of part H of chapter 57 of the laws of 2023 amending
    49  the  social  services law relating to enacting the 1332 state innovation
    50  program, takes effect.
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