S T A T E   O F   N E W   Y O R K
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                                 3525--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 11, 2015
                               ___________

Introduced  by  Sens.  PERKINS, ADDABBO, AVELLA, BRESLIN, COMRIE, DILAN,
  ESPAILLAT,  HAMILTON,  HASSELL-THOMPSON,  HOYLMAN,  KRUEGER,  LATIMER,
  MONTGOMERY,  PANEPINTO,  PARKER,  PERALTA,  PERSAUD,  RIVERA, SANDERS,
  SERRANO, SQUADRON, STAVISKY -- read twice  and  ordered  printed,  and
  when printed to be committed to the Committee on Health -- recommitted
  to the Committee on Health in accordance with Senate Rule 6, sec. 8 --
  committee  discharged,  bill amended, ordered reprinted as amended and
  recommitted to said committee

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:

  Section 1. Short title. This act shall be known and may  be  cited  as
the "New York health act".
  S  2.  Legislative  findings  and  intent.  1.  The state constitution
states: "The protection and promotion of the health of  the  inhabitants
of  the state are matters of public concern and provision therefor shall
be made by the state and by such of its subdivisions and in such manner,
and by such means as the legislature shall from time to time determine."
(Article XVII, S3.) The legislature finds and declares  that  all  resi-
dents  of  the  state  have the right to health care.  While the federal
Affordable Care Act brought many improvements in health care and  health
coverage,  it  still  leaves  many  New Yorkers without coverage or with
inadequate coverage.  New  Yorkers  -  as  individuals,  employers,  and
taxpayers  -  have  experienced  a  rise  in the cost of health care and
coverage in recent years, including  rising  premiums,  deductibles  and
co-pays,  restricted  provider networks and high out-of-network charges.
Businesses have also experienced increases in the costs of  health  care
benefits  for  their employees, and many employers are shifting a larger
share of the cost of coverage to their employees  or  dropping  coverage
entirely.   Health care providers are also affected by inadequate health
coverage in New York state. A large  portion  of  voluntary  and  public
hospitals, health centers and other providers now experience substantial

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07764-06-6

S. 3525--A                          2

losses  due  to the provision of care that is uncompensated. Individuals
often find that they are deprived of affordable care and choice  because
of  decisions by health plans guided by the plan's economic needs rather
than  their  health  care needs. To address the fiscal crisis facing the
health care system and the state and to assure New Yorkers can  exercise
their right to health care, affordable and comprehensive health coverage
must  be  provided.  Pursuant  to the state constitution's charge to the
legislature to provide for the health of New Yorkers,  this  legislation
is  an  enactment  of  state  concern  for the purpose of establishing a
comprehensive universal single-payer health care coverage program and  a
health  care cost control system for the benefit of all residents of the
state of New York.
  2. It is the intent of the Legislature to create the New  York  Health
program  to provide a universal health plan for every New Yorker, funded
by broad-based revenue based on ability to pay.  The state shall work to
obtain waivers and other approvals relating to  Medicaid,  Child  Health
Plus,  Medicare,  the  Affordable  Care  Act,  and any other appropriate
federal programs, under which federal funds  and  other  subsidies  that
would  otherwise be paid to New York State, New Yorkers, and health care
providers for health coverage that will be equaled or  exceeded  by  New
York Health will be paid by the federal government to New York State and
deposited  in  the  New  York  Health  trust fund, and for other program
modifications (including  elimination  of  cost  sharing  and  insurance
premiums).    Under  such  waivers  and approvals, health coverage under
those programs will be replaced and merged into New York  Health,  which
will operate as a true single-payer program.
  If  any  necessary waiver or approval is not obtained, the state shall
use state plan amendments and seek waivers and  approvals  to  maximize,
and  make  as  seamless as possible, the use of federally-matched health
programs and federal health programs in New York  Health.    Thus,  even
where  other  programs  such  as  Medicaid or Medicare may contribute to
paying for care, it is the goal of this legislation  that  the  coverage
will  be  delivered  by  New  York  Health and, as much as possible, the
multiple sources of funding will be pooled with other  New  York  Health
funds  and  not  be apparent to New York Health members or participating
providers.  This program will promote movement away from fee-for-service
payment, which tends to reward quantity and requires excessive  adminis-
trative  expense,  and  towards alternate payment methodologies, such as
global or capitated payments to providers or health care  organizations,
that  promote  quality, efficiency, investment in primary and preventive
care, and innovation and integration in the organizing of health care.
  3. This act does not  create  any  employment  benefit,  nor  does  it
require, prohibit, or limit the providing of any employment benefit.
  4. In order to promote improved quality of, and access to, health care
services and promote improved clinical outcomes, it is the policy of the
state  to  encourage cooperative, collaborative and integrative arrange-
ments among health care providers who might  otherwise  be  competitors,
under  the  active  supervision of the commissioner of health. It is the
intent of the state to supplant competition with such  arrangements  and
regulation  only  to  the extent necessary to accomplish the purposes of
this act, and to provide state  action  immunity  under  the  state  and
federal  antitrust  laws  to  health  care  providers, particularly with
respect to their relations with the single-payer New  York  Health  plan
created by this act.

S. 3525--A                          3

  S  3.  Article 50 and sections 5000, 5001, 5002 and 5003 of the public
health law are renumbered article 80 and sections 8000, 8001,  8002  and
8003, respectively, and a new article 51 is added to read as follows:
                                ARTICLE 51
                             NEW YORK HEALTH
SECTION 5100. DEFINITIONS.
        5101. PROGRAM CREATED.
        5102. BOARD OF TRUSTEES.
        5103. ELIGIBILITY AND ENROLLMENT.
        5104. BENEFITS.
        5105. HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHOD-
                OLOGIES.
        5106. HEALTH CARE ORGANIZATIONS.
        5107. PROGRAM STANDARDS.
        5108. REGULATIONS.
        5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS.
        5110. ADDITIONAL PROVISIONS.
        5111. REGIONAL ADVISORY COUNCILS.
  S 5100. DEFINITIONS. AS USED IN  THIS  ARTICLE,  THE  FOLLOWING  TERMS
SHALL  HAVE  THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES
OTHERWISE:
  1. "BOARD" MEANS THE BOARD OF TRUSTEES OF THE NEW YORK HEALTH  PROGRAM
CREATED  BY SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE, AND "TRUSTEE"
MEANS A TRUSTEE OF THE BOARD.
  2. "CARE COORDINATION" MEANS SERVICES PROVIDED BY A  CARE  COORDINATOR
UNDER SUBDIVISION TWO OF SECTION FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE.
  3.  "CARE  COORDINATOR"  MEANS  AN  INDIVIDUAL  OR  ENTITY APPROVED TO
PROVIDE CARE COORDINATION UNDER SUBDIVISION  TWO  OF  SECTION  FIFTY-ONE
HUNDRED FIVE OF THIS ARTICLE.
  4. "FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM" MEANS THE MEDICAL ASSIST-
ANCE  PROGRAM  UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES
LAW, THE BASIC HEALTH PROGRAM UNDER SECTION THREE HUNDRED  SIXTY-NINE-GG
OF  THE  SOCIAL  SERVICES  LAW,  AND THE CHILD HEALTH PLUS PROGRAM UNDER
TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  5. "HEALTH CARE ORGANIZATION" MEANS AN ENTITY THAT IS APPROVED BY  THE
COMMISSIONER  UNDER  SECTION  FIFTY-ONE  HUNDRED  SIX OF THIS ARTICLE TO
PROVIDE HEALTH CARE SERVICES TO MEMBERS UNDER THE PROGRAM.
  6. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
  7. "IMPLEMENTATION PERIOD" MEANS THE PERIOD UNDER SUBDIVISION THREE OF
SECTION FIFTY-ONE HUNDRED ONE OF THIS ARTICLE DURING WHICH  THE  PROGRAM
WILL BE SUBJECT TO SPECIAL ELIGIBILITY AND FINANCING PROVISIONS UNTIL IT
IS FULLY IMPLEMENTED UNDER THAT SECTION.
  8.  "LONG  TERM CARE" MEANS LONG TERM CARE, TREATMENT, MAINTENANCE, OR
SERVICES NOT COVERED UNDER CHILD HEALTH PLUS, AS APPROPRIATE,  WITH  THE
EXCEPTION OF SHORT TERM REHABILITATION, AS DEFINED BY THE COMMISSIONER.
  9.  "MEDICAID"  OR  "MEDICAL ASSISTANCE" MEANS TITLE ELEVEN OF ARTICLE
FIVE OF THE SOCIAL SERVICES LAW AND  THE  PROGRAM  THEREUNDER.    "CHILD
HEALTH  PLUS"  MEANS  TITLE ONE-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER
AND THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF THE  FEDERAL
SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.  "BASIC HEALTH PROGRAM"
MEANS SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW AND
THE PROGRAM THEREUNDER.
  10. "MEMBER" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE PROGRAM.
  11.  "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST FUND
ESTABLISHED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE LAW.

S. 3525--A                          4

  12. "OUT-OF-STATE HEALTH CARE SERVICE" MEANS  A  HEALTH  CARE  SERVICE
PROVIDED  TO A MEMBER WHILE THE MEMBER IS OUT OF THE STATE AND (A) IT IS
MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE BE PROVIDED  WHILE  THE
MEMBER IS OUT OF THE STATE, OR (B) IT IS CLINICALLY APPROPRIATE THAT THE
HEALTH  CARE  SERVICE  BE  PROVIDED BY A PARTICULAR HEALTH CARE PROVIDER
LOCATED OUT OF THE STATE RATHER THAN IN THE STATE.  HOWEVER, ANY  HEALTH
CARE  SERVICE  PROVIDED  TO  A NEW YORK HEALTH ENROLLEE BY A HEALTH CARE
PROVIDER QUALIFIED UNDER PARAGRAPH (A) OF SUBDIVISION THREE  OF  SECTION
FIFTY-ONE HUNDRED FIVE OF THIS ARTICLE THAT IS LOCATED OUTSIDE THE STATE
SHALL  NOT BE CONSIDERED AN OUT-OF-STATE SERVICE AND SHALL BE COVERED AS
OTHERWISE PROVIDED IN THIS ARTICLE.
  13. "PARTICIPATING PROVIDER" MEANS ANY INDIVIDUAL OR ENTITY THAT IS  A
HEALTH  CARE  PROVIDER  QUALIFIED  UNDER  SUBDIVISION  THREE  OF SECTION
FIFTY-ONE HUNDRED  FIVE  OF  THIS  ARTICLE  THAT  PROVIDES  HEALTH  CARE
SERVICES TO MEMBERS UNDER THE PROGRAM, OR A HEALTH CARE ORGANIZATION.
  14.  "AFFORDABLE  CARE  ACT"  MEANS THE FEDERAL PATIENT PROTECTION AND
AFFORDABLE CARE ACT, PUBLIC LAW 111-148, AS AMENDED BY THE  HEALTH  CARE
AND  EDUCATION  RECONCILIATION  ACT  OF 2010, PUBLIC LAW 111-152, AND AS
OTHERWISE AMENDED AND ANY REGULATIONS OR GUIDANCE ISSUED THEREUNDER.
  15. "PERSON" MEANS ANY INDIVIDUAL OR NATURAL PERSON,  TRUST,  PARTNER-
SHIP,  ASSOCIATION,  UNINCORPORATED  ASSOCIATION,  CORPORATION, COMPANY,
LIMITED LIABILITY COMPANY, PROPRIETORSHIP, JOINT  VENTURE,  FIRM,  JOINT
STOCK ASSOCIATION, DEPARTMENT, AGENCY, AUTHORITY, OR OTHER LEGAL ENTITY,
WHETHER FOR-PROFIT, NOT-FOR-PROFIT OR GOVERNMENTAL.
  16.  "PROGRAM"  MEANS  THE  NEW YORK HEALTH PROGRAM CREATED BY SECTION
FIFTY-ONE HUNDRED ONE OF THIS ARTICLE.
  17. "PRESCRIPTION AND NON-PRESCRIPTION DRUGS" MEANS PRESCRIPTION DRUGS
AS DEFINED IN SECTION TWO HUNDRED SEVENTY OF THIS CHAPTER, AND NON-PRES-
CRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
  18. "RESIDENT" MEANS AN INDIVIDUAL WHOSE PRIMARY PLACE OF ABODE IS  IN
THE  STATE,  WITHOUT  REGARD  TO THE INDIVIDUAL'S IMMIGRATION STATUS, AS
DETERMINED ACCORDING TO REGULATIONS OF THE COMMISSIONER.
  S 5101. PROGRAM CREATED. 1. THE NEW  YORK  HEALTH  PROGRAM  IS  HEREBY
CREATED  IN  THE DEPARTMENT. THE COMMISSIONER SHALL ESTABLISH AND IMPLE-
MENT THE PROGRAM UNDER THIS ARTICLE. THE PROGRAM SHALL  PROVIDE  COMPRE-
HENSIVE HEALTH COVERAGE TO EVERY RESIDENT WHO ENROLLS IN THE PROGRAM.
  2.  THE  COMMISSIONER SHALL, TO THE MAXIMUM EXTENT POSSIBLE, ORGANIZE,
ADMINISTER AND MARKET THE PROGRAM AND SERVICES AS A SINGLE PROGRAM UNDER
THE NAME "NEW YORK HEALTH" OR SUCH OTHER NAME AS THE COMMISSIONER  SHALL
DETERMINE,  REGARDLESS  OF UNDER WHICH LAW OR SOURCE THE DEFINITION OF A
BENEFIT IS FOUND INCLUDING (ON A VOLUNTARY BASIS) RETIREE  HEALTH  BENE-
FITS.    IN  IMPLEMENTING THIS SUBDIVISION, THE COMMISSIONER SHALL AVOID
JEOPARDIZING FEDERAL FINANCIAL PARTICIPATION IN THESE PROGRAMS AND SHALL
TAKE CARE TO PROMOTE PUBLIC UNDERSTANDING  AND  AWARENESS  OF  AVAILABLE
BENEFITS AND PROGRAMS.
  3. THE COMMISSIONER SHALL DETERMINE WHEN INDIVIDUALS MAY BEGIN ENROLL-
ING IN THE PROGRAM. THERE SHALL BE AN IMPLEMENTATION PERIOD, WHICH SHALL
BEGIN  ON  THE  DATE THAT INDIVIDUALS MAY BEGIN ENROLLING IN THE PROGRAM
AND SHALL END AS DETERMINED BY THE COMMISSIONER.
  4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE PURSUANT TO THE INSURANCE
LAW OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED  UNDER  THIS  CHAPTER
MAY,  IF  OTHERWISE  AUTHORIZED,  OFFER  BENEFITS  THAT DO NOT COVER ANY
SERVICE FOR WHICH COVERAGE IS OFFERED TO INDIVIDUALS UNDER THE  PROGRAM,
BUT  MAY NOT OFFER BENEFITS THAT COVER ANY SERVICE FOR WHICH COVERAGE IS
OFFERED TO INDIVIDUALS UNDER THE PROGRAM. PROVIDED, HOWEVER,  THAT  THIS
SUBDIVISION  SHALL  NOT  PROHIBIT (A) THE OFFERING OF ANY BENEFITS TO OR

S. 3525--A                          5

FOR INDIVIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR  SELF-EM-
PLOYED  IN  THE STATE BUT WHO ARE NOT RESIDENTS OF THE STATE, OR (B) THE
OFFERING OF BENEFITS DURING THE IMPLEMENTATION PERIOD TO INDIVIDUALS WHO
ENROLLED OR MAY ENROLL AS MEMBERS OF THE PROGRAM, OR (C) THE OFFERING OF
RETIREE HEALTH BENEFITS.
  5.  A  COLLEGE, UNIVERSITY OR OTHER INSTITUTION OF HIGHER EDUCATION IN
THE STATE MAY PURCHASE COVERAGE UNDER THE PROGRAM FOR  ANY  STUDENT,  OR
STUDENT'S DEPENDENT, WHO IS NOT A RESIDENT OF THE STATE.
  6.  TO  THE  EXTENT ANY PROVISION OF THIS CHAPTER, THE SOCIAL SERVICES
LAW OR THE INSURANCE LAW:
  (A) IS INCONSISTENT WITH ANY PROVISION OF THIS ARTICLE OR THE LEGISLA-
TIVE INTENT OF THE NEW YORK HEALTH ACT, THIS  ARTICLE  SHALL  APPLY  AND
PREVAIL, EXCEPT WHERE EXPLICITLY PROVIDED OTHERWISE BY THIS ARTICLE; AND
  (B) IS CONSISTENT WITH THE PROVISIONS OF THIS ARTICLE AND THE LEGISLA-
TIVE  INTENT OF THE NEW YORK HEALTH ACT, THE PROVISION OF THAT LAW SHALL
APPLY.
  S 5102. BOARD OF TRUSTEES. 1. THE NEW YORK HEALTH BOARD OF TRUSTEES IS
HEREBY CREATED IN THE DEPARTMENT. THE BOARD OF TRUSTEES  SHALL,  AT  THE
REQUEST  OF  THE  COMMISSIONER,  CONSIDER  ANY  MATTER TO EFFECTUATE THE
PROVISIONS AND PURPOSES OF THIS ARTICLE, AND MAY ADVISE THE COMMISSIONER
THEREON; AND IT MAY, FROM TIME TO TIME, SUBMIT TO THE  COMMISSIONER  ANY
RECOMMENDATIONS  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTI-
CLE. THE COMMISSIONER MAY PROPOSE REGULATIONS  UNDER  THIS  ARTICLE  AND
AMENDMENTS THERETO FOR CONSIDERATION BY THE BOARD. THE BOARD OF TRUSTEES
SHALL  HAVE  NO EXECUTIVE, ADMINISTRATIVE OR APPOINTIVE DUTIES EXCEPT AS
OTHERWISE PROVIDED BY LAW. THE BOARD OF TRUSTEES  SHALL  HAVE  POWER  TO
ESTABLISH,  AND  FROM  TIME TO TIME, AMEND REGULATIONS TO EFFECTUATE THE
PROVISIONS AND PURPOSES OF THIS ARTICLE,  SUBJECT  TO  APPROVAL  BY  THE
COMMISSIONER.
  2. THE BOARD SHALL BE COMPOSED OF:
  (A)  THE  COMMISSIONER,  THE SUPERINTENDENT OF FINANCIAL SERVICES, AND
THE DIRECTOR OF THE BUDGET, OR THEIR DESIGNEES, AS EX OFFICIO MEMBERS;
  (B) NINETEEN TRUSTEES APPOINTED BY THE GOVERNOR;
  (I) FIVE OF WHOM SHALL BE  REPRESENTATIVES  OF  HEALTH  CARE  CONSUMER
ADVOCACY  ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY,
WHO HAVE BEEN INVOLVED IN ACTIVITIES RELATED  TO  HEALTH  CARE  CONSUMER
ADVOCACY, INCLUDING ISSUES OF INTEREST TO LOW- AND MODERATE-INCOME INDI-
VIDUALS;
  (II)  TWO  OF  WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL ORGANIZA-
TIONS REPRESENTING PHYSICIANS;
  (III) TWO OF WHOM SHALL BE REPRESENTATIVES OF  PROFESSIONAL  ORGANIZA-
TIONS  REPRESENTING  LICENSED  OR  REGISTERED  HEALTH CARE PROFESSIONALS
OTHER THAN PHYSICIANS;
  (IV) THREE OF WHOM SHALL BE REPRESENTATIVES OF HOSPITALS, ONE OF  WHOM
SHALL BE A REPRESENTATIVE OF PUBLIC HOSPITALS;
  (V) ONE OF WHOM SHALL BE REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
  (VI)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
TIONS; AND
  (VII) TWO OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
  (VIII) TWO OF WHOM SHALL HAVE DEMONSTRATED EXPERTISE  IN  HEALTH  CARE
FINANCE;
  (C)  TEN  TRUSTEES  APPOINTED  BY  THE  GOVERNOR;  FOUR  OF WHOM TO BE
APPOINTED ON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; FOUR  OF
WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
THE  SENATE;  ONE  OF  WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE

S. 3525--A                          6

MINORITY LEADER OF THE ASSEMBLY; AND ONE OF WHOM TO BE APPOINTED ON  THE
RECOMMENDATION OF THE MINORITY LEADER OF THE SENATE.
  3.  AFTER  THE  END OF THE IMPLEMENTATION PERIOD, NO PERSON SHALL BE A
TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM, EXCEPT THE EX OFFI-
CIO TRUSTEES. EACH TRUSTEE SHALL SERVE AT THE PLEASURE OF THE APPOINTING
OFFICER, EXCEPT THE EX OFFICIO TRUSTEES.
  4. THE CHAIR OF THE BOARD SHALL BE APPOINTED, AND MAY  BE  REMOVED  AS
CHAIR,  BY THE GOVERNOR FROM AMONG THE TRUSTEES. THE BOARD SHALL MEET AT
LEAST FOUR TIMES EACH CALENDAR YEAR. MEETINGS SHALL  BE  HELD  UPON  THE
CALL  OF  THE  CHAIR  AND  AS  PROVIDED  BY THE BOARD. A MAJORITY OF THE
APPOINTED TRUSTEES SHALL BE A QUORUM OF THE BOARD, AND  THE  AFFIRMATIVE
VOTE  OF A MAJORITY OF THE TRUSTEES VOTING, BUT NOT LESS THAN TEN, SHALL
BE NECESSARY FOR ANY ACTION TO BE TAKEN BY  THE  BOARD.  THE  BOARD  MAY
ESTABLISH AN EXECUTIVE COMMITTEE TO EXERCISE ANY POWERS OR DUTIES OF THE
BOARD AS IT MAY PROVIDE, AND OTHER COMMITTEES TO ASSIST THE BOARD OR THE
EXECUTIVE  COMMITTEE.  THE  CHAIR OF THE BOARD SHALL CHAIR THE EXECUTIVE
COMMITTEE AND SHALL APPOINT THE CHAIR AND MEMBERS OF ALL  OTHER  COMMIT-
TEES. THE BOARD OF TRUSTEES MAY APPOINT ONE OR MORE ADVISORY COMMITTEES.
MEMBERS OF ADVISORY COMMITTEES NEED NOT BE MEMBERS OF THE BOARD OF TRUS-
TEES.
  5.  TRUSTEES  SHALL SERVE WITHOUT COMPENSATION BUT SHALL BE REIMBURSED
FOR THEIR NECESSARY AND ACTUAL EXPENSES INCURRED WHILE  ENGAGED  IN  THE
BUSINESS OF THE BOARD.
  6. NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, NO OFFICER OR
EMPLOYEE OF THE STATE OR ANY LOCAL GOVERNMENT SHALL FORFEIT OR BE DEEMED
TO  HAVE  FORFEITED HIS OR HER OFFICE OR EMPLOYMENT BY REASON OF BEING A
TRUSTEE.
  7. THE BOARD AND ITS COMMITTEES AND ADVISORY  COMMITTEES  MAY  REQUEST
AND  RECEIVE  THE  ASSISTANCE  OF  THE DEPARTMENT AND ANY OTHER STATE OR
LOCAL GOVERNMENTAL ENTITY IN EXERCISING ITS POWERS AND DUTIES.
  8. NO LATER THAN TWO YEARS AFTER THE EFFECTIVE DATE OF THIS ARTICLE:
  (A) THE BOARD SHALL DEVELOP A PROPOSAL, CONSISTENT WITH THE PRINCIPLES
OF THIS ARTICLE, FOR PROVISION BY THE PROGRAM OF LONG-TERM  CARE  COVER-
AGE,  INCLUDING THE DEVELOPMENT OF A PROPOSAL, CONSISTENT WITH THE PRIN-
CIPLES OF THIS ARTICLE, FOR ITS FUNDING.   IN DEVELOPING  THE  PROPOSAL,
THE  BOARD  SHALL  CONSULT  WITH AN ADVISORY COMMITTEE, APPOINTED BY THE
CHAIR OF THE BOARD, INCLUDING REPRESENTATIVES OF CONSUMERS AND POTENTIAL
CONSUMERS OF LONG-TERM CARE, PROVIDERS OF  LONG-TERM  CARE,  LABOR,  AND
OTHER  INTERESTED  PARTIES.  THE BOARD SHALL PRESENT ITS PROPOSAL TO THE
GOVERNOR AND THE LEGISLATURE.
  (B) THE BOARD SHALL DEVELOP PROPOSALS FOR: (I)  INCORPORATING  RETIREE
HEALTH  BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER RETI-
REE HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK  HEALTH
BUT  LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING EMPLOYER
RETIREE HEALTH BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED  SUCH  BENEFITS
WHILE  RESIDING  IN  THE  STATE  PRIOR TO THE IMPLEMENTATION OF NEW YORK
HEALTH AND LIVE AS RETIREES OUT OF THE STATE.
  (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK HEALTH COVERAGE OF
HEALTH CARE  SERVICES  COVERED  UNDER  THE  WORKERS'  COMPENSATION  LAW,
INCLUDING  WHETHER  AND HOW TO CONTINUE FUNDING FOR THOSE SERVICES UNDER
THAT LAW AND WHETHER AND HOW TO INCORPORATE  AN  ELEMENT  OF  EXPERIENCE
RATING.
  S  5103.  ELIGIBILITY  AND  ENROLLMENT. 1. EVERY RESIDENT OF THE STATE
SHALL BE ELIGIBLE AND ENTITLED TO ENROLL AS A MEMBER UNDER THE PROGRAM.
  2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM OR OTHER CHARGE  FOR
ENROLLING IN OR BEING A MEMBER UNDER THE PROGRAM.

S. 3525--A                          7

  S  5104.  BENEFITS.  1. THE PROGRAM SHALL PROVIDE COMPREHENSIVE HEALTH
COVERAGE TO EVERY MEMBER, WHICH SHALL INCLUDE ALL HEALTH  CARE  SERVICES
REQUIRED  TO  BE  COVERED  UNDER ANY OF THE FOLLOWING, WITHOUT REGARD TO
WHETHER THE MEMBER WOULD OTHERWISE BE ELIGIBLE FOR  OR  COVERED  BY  THE
PROGRAM OR SOURCE REFERRED TO:
  (A) CHILD HEALTH PLUS;
  (B) MEDICAID;
  (C) MEDICARE;
  (D)  ARTICLE  FORTY-FOUR  OF  THIS  CHAPTER  OR  ARTICLE THIRTY-TWO OR
FORTY-THREE OF THE INSURANCE LAW;
  (E) ARTICLE ELEVEN OF THE CIVIL SERVICE LAW, AS OF THE DATE  ONE  YEAR
BEFORE THE BEGINNING OF THE IMPLEMENTATION PERIOD;
  (F)  ANY  COST  INCURRED DEFINED IN PARAGRAPH ONE OF SUBSECTION (A) OF
SECTION FIFTY-ONE HUNDRED TWO OF THE INSURANCE LAW, PROVIDED  THAT  THIS
COVERAGE  SHALL  NOT  REPLACE  COVERAGE  UNDER  ARTICLE FIFTY-ONE OF THE
INSURANCE LAW;
  (G) ANY ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED  TO  THE
PROGRAM'S BENEFITS BY THE PROGRAM; AND
  (H)  PROVIDED  THAT  NONE  OF  THE ABOVE SHALL INCLUDE LONG TERM CARE,
UNTIL A PROPOSAL UNDER PARAGRAPH (A) OF  SUBDIVISION  EIGHT  OF  SECTION
FIFTY-ONE HUNDRED TWO OF THIS ARTICLE IS ENACTED INTO LAW.
  2. NO MEMBER SHALL BE REQUIRED TO PAY ANY PREMIUM, DEDUCTIBLE, CO-PAY-
MENT OR CO-INSURANCE UNDER THE PROGRAM.
  3.  THE  PROGRAM SHALL PROVIDE FOR PAYMENT UNDER THE PROGRAM FOR EMER-
GENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO MEMBERS OR INDIVID-
UALS ENTITLED TO BECOME MEMBERS WHO HAVE NOT HAD A  REASONABLE  OPPORTU-
NITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR.
  S  5105.  HEALTH  CARE PROVIDERS; CARE COORDINATION; PAYMENT METHODOL-
OGIES.  1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE  PROVIDER
QUALIFIED  TO  PARTICIPATE  UNDER  THIS  SECTION MAY PROVIDE HEALTH CARE
SERVICES UNDER THE PROGRAM, PROVIDED THAT THE HEALTH  CARE  PROVIDER  IS
OTHERWISE  LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR THE
INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.
  (B) A MEMBER MAY CHOOSE TO RECEIVE  HEALTH  CARE  SERVICES  UNDER  THE
PROGRAM  FROM  ANY PARTICIPATING PROVIDER, CONSISTENT WITH PROVISIONS OF
THIS ARTICLE RELATING TO CARE COORDINATION  AND  HEALTH  CARE  ORGANIZA-
TIONS,  THE  WILLINGNESS  OR  AVAILABILITY  OF  THE PROVIDER (SUBJECT TO
PROVISIONS OF THIS ARTICLE RELATING TO DISCRIMINATION), AND  THE  APPRO-
PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
  2. CARE COORDINATION.
  (A)  CARE COORDINATION SHALL INCLUDE, BUT NOT BE LIMITED TO, MANAGING,
REFERRING  TO,  LOCATING,  COORDINATING,  AND  MONITORING  HEALTH   CARE
SERVICES  FOR  THE  MEMBER TO ASSURE THAT ALL MEDICALLY NECESSARY HEALTH
CARE SERVICES ARE MADE AVAILABLE TO AND  ARE  EFFECTIVELY  USED  BY  THE
MEMBER  IN A TIMELY MANNER, CONSISTENT WITH PATIENT AUTONOMY. CARE COOR-
DINATION IS NOT A REQUIREMENT FOR PRIOR AUTHORIZATION  FOR  HEALTH  CARE
SERVICES  AND  REFERRAL  SHALL NOT BE REQUIRED FOR A MEMBER TO RECEIVE A
HEALTH CARE SERVICE.
  (B) A CARE COORDINATOR MAY BE AN INDIVIDUAL OR ENTITY THAT IS APPROVED
BY THE PROGRAM THAT IS:
  (I) A HEALTH CARE PRACTITIONER WHO IS: (A) THE MEMBER'S  PRIMARY  CARE
PRACTITIONER; (B) AT THE OPTION OF A FEMALE MEMBER, THE MEMBER'S PROVID-
ER  OF  PRIMARY GYNECOLOGICAL CARE; OR (C) AT THE OPTION OF A MEMBER WHO
HAS A CHRONIC CONDITION  THAT  REQUIRES  SPECIALTY  CARE,  A  SPECIALIST
HEALTH  CARE  PRACTITIONER WHO REGULARLY AND CONTINUALLY PROVIDES TREAT-
MENT FOR THAT CONDITION TO THE MEMBER;

S. 3525--A                          8

  (II) AN ENTITY LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER  OR
CERTIFIED  UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER, A MANAGED LONG TERM
CARE PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF  THIS  CHAPTER  OR
OTHER  PROGRAM  MODEL  UNDER  PARAGRAPH (B) OF SUBDIVISION SEVEN OF SUCH
SECTION, OR, WITH RESPECT TO A MEMBER WHO RECEIVES CHRONIC MENTAL HEALTH
CARE SERVICES, AN ENTITY LICENSED UNDER ARTICLE THIRTY-ONE OF THE MENTAL
HYGIENE LAW OR OTHER ENTITY APPROVED BY THE COMMISSIONER IN CONSULTATION
WITH THE COMMISSIONER OF MENTAL HEALTH;
  (III) A HEALTH CARE ORGANIZATION;
  (IV) A TAFT-HARTLEY FUND, WITH RESPECT TO ITS MEMBERS AND THEIR FAMILY
MEMBERS;  PROVIDED THAT THIS PROVISION SHALL NOT PRECLUDE A TAFT-HARTLEY
FUND FROM BECOMING A CARE COORDINATOR UNDER  SUBPARAGRAPH  (V)  OF  THIS
PARAGRAPH  OR A HEALTH CARE ORGANIZATION UNDER SECTION FIFTY-ONE HUNDRED
SIX OF THIS ARTICLE; OR
  (V) ANY NOT-FOR-PROFIT OR GOVERNMENTAL ENTITY APPROVED BY THE PROGRAM.
  (C) HEALTH CARE SERVICES PROVIDED TO A MEMBER SHALL NOT BE SUBJECT  TO
PAYMENT  UNDER  THE  PROGRAM  UNLESS  THE MEMBER IS ENROLLED WITH A CARE
COORDINATOR AT THE TIME THE HEALTH  CARE  SERVICE  IS  PROVIDED,  EXCEPT
WHERE PROVIDED UNDER SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR
OF  THIS ARTICLE. EVERY MEMBER SHALL ENROLL WITH A CARE COORDINATOR THAT
AGREES TO PROVIDE CARE COORDINATION TO THE  MEMBER  PRIOR  TO  RECEIVING
HEALTH  CARE SERVICES TO BE PAID FOR UNDER THE PROGRAM. THE MEMBER SHALL
REMAIN ENROLLED WITH THAT CARE  COORDINATOR  UNTIL  THE  MEMBER  BECOMES
ENROLLED  WITH  A  DIFFERENT  CARE COORDINATOR OR CEASES TO BE A MEMBER.
MEMBERS HAVE THE RIGHT TO CHANGE THEIR  CARE  COORDINATOR  ON  TERMS  AT
LEAST   AS  PERMISSIVE  AS  THE  PROVISIONS  OF  SECTION  THREE  HUNDRED
SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW RELATING TO AN INDIVIDUAL CHANG-
ING HIS OR HER PRIMARY CARE PROVIDER OR MANAGED CARE PROVIDER.
  (D) CARE COORDINATION SHALL BE PROVIDED TO THE MEMBER BY THE  MEMBER'S
CARE COORDINATOR.  A CARE COORDINATOR MAY EMPLOY OR UTILIZE THE SERVICES
OF  OTHER  INDIVIDUALS  OR  ENTITIES TO ASSIST IN PROVIDING CARE COORDI-
NATION FOR THE MEMBER, CONSISTENT WITH REGULATIONS OF THE COMMISSIONER.
  (E) A HEALTH CARE ORGANIZATION MAY ESTABLISH RULES  RELATING  TO  CARE
COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
THIS  SUBDIVISION  BUT  OTHERWISE CONSISTENT WITH THIS ARTICLE AND OTHER
APPLICABLE LAWS. NOTHING IN THIS SUBDIVISION SHALL AUTHORIZE  ANY  INDI-
VIDUAL TO ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION
LAW.
  (F) THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT PROCEDURES AND STAND-
ARDS FOR AN INDIVIDUAL OR ENTITY TO BE APPROVED TO BE A CARE COORDINATOR
IN  THE  PROGRAM,  INCLUDING BUT NOT LIMITED TO PROCEDURES AND STANDARDS
RELATING TO THE REVOCATION,  SUSPENSION,  LIMITATION,  OR  ANNULMENT  OF
APPROVAL ON A DETERMINATION THAT THE INDIVIDUAL OR ENTITY IS INCOMPETENT
TO  BE  A CARE COORDINATOR OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
STANDARDS  SHALL  NOT  LIMIT  APPROVAL  TO  BE A CARE COORDINATOR IN THE
PROGRAM FOR ECONOMIC PURPOSES AND SHALL BE CONSISTENT WITH GOOD  PROFES-
SIONAL PRACTICE. IN DEVELOPING THE PROCEDURES AND STANDARDS, THE COMMIS-
SIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS DEVELOPED BY NATIONAL
ACCREDITING  AND  PROFESSIONAL  ORGANIZATIONS;  AND  (II)  CONSULT  WITH
NATIONAL AND LOCAL ORGANIZATIONS WORKING ON CARE COORDINATION OR SIMILAR
MODELS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS, CLINICS, AND
CONSUMERS AND THEIR REPRESENTATIVES. WHEN  DEVELOPING  AND  IMPLEMENTING
STANDARDS  OF  APPROVAL  OF  CARE COORDINATORS FOR INDIVIDUALS RECEIVING

S. 3525--A                          9

CHRONIC MENTAL HEALTH CARE SERVICES, THE COMMISSIONER SHALL CONSULT WITH
THE COMMISSIONER OF MENTAL HEALTH. AN INDIVIDUAL OR ENTITY MAY NOT BE  A
CARE  COORDINATOR  UNLESS THE SERVICES INCLUDED IN CARE COORDINATION ARE
WITHIN  THE  INDIVIDUAL'S PROFESSIONAL SCOPE OF PRACTICE OR THE ENTITY'S
LEGAL AUTHORITY.
  (G) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A CARE  COORDINATOR  MUST:
(I)  RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE COMMISSIONER; AND
(II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY THE  COMMISSIONER  TO
ENABLE  THE  COMMISSIONER TO EVALUATE THE IMPACT OF CARE COORDINATORS ON
QUALITY, OUTCOMES AND COST.
  3. HEALTH CARE PROVIDERS. (A) THE  COMMISSIONER  SHALL  ESTABLISH  AND
MAINTAIN PROCEDURES AND STANDARDS FOR HEALTH CARE PROVIDERS TO BE QUALI-
FIED  TO PARTICIPATE IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO PROCE-
DURES AND STANDARDS RELATING TO THE REVOCATION, SUSPENSION,  LIMITATION,
OR ANNULMENT OF QUALIFICATION TO PARTICIPATE ON A DETERMINATION THAT THE
HEALTH  CARE PROVIDER IS AN INCOMPETENT PROVIDER OF SPECIFIC HEALTH CARE
SERVICES OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS EITHER INCONSIST-
ENT WITH PROGRAM STANDARDS AND REGULATIONS OR WHICH EXHIBITS AN  UNWILL-
INGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS A POTENTIAL THREAT
TO  THE PUBLIC HEALTH OR SAFETY. SUCH PROCEDURES AND STANDARDS SHALL NOT
LIMIT HEALTH CARE PROVIDER PARTICIPATION IN  THE  PROGRAM  FOR  ECONOMIC
PURPOSES  AND  SHALL  BE CONSISTENT WITH GOOD PROFESSIONAL PRACTICE. ANY
HEALTH CARE PROVIDER WHO IS QUALIFIED  TO  PARTICIPATE  UNDER  MEDICAID,
CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE QUALIFIED TO PARTIC-
IPATE IN THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION, SUSPEN-
SION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE IN ANY OF
THOSE  PROGRAMS  SHALL APPLY TO THE HEALTH CARE PROVIDER'S QUALIFICATION
TO PARTICIPATE IN THE PROGRAM; PROVIDED  THAT  A  HEALTH  CARE  PROVIDER
QUALIFIED  UNDER  THIS  SENTENCE  SHALL  FOLLOW THE PROCEDURES TO BECOME
QUALIFIED UNDER THE PROGRAM BY THE END OF THE IMPLEMENTATION PERIOD.
  (B) THE COMMISSIONER SHALL ESTABLISH AND MAINTAIN PROCEDURES AND STAN-
DARDS FOR RECOGNIZING HEALTH CARE PROVIDERS LOCATED OUT OF THE STATE FOR
PURPOSES OF PROVIDING COVERAGE UNDER THE PROGRAM FOR OUT-OF-STATE HEALTH
CARE SERVICES.
  4. PAYMENT FOR HEALTH CARE SERVICES. (A) THE COMMISSIONER  MAY  ESTAB-
LISH  BY  REGULATION  PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES AND
CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM BY PARTICIPATING
PROVIDERS, CARE COORDINATORS, AND HEALTH CARE ORGANIZATIONS.  THERE  MAY
BE  A VARIETY OF DIFFERENT PAYMENT METHODOLOGIES, INCLUDING THOSE ESTAB-
LISHED ON A DEMONSTRATION BASIS. ALL PAYMENT  RATES  UNDER  THE  PROGRAM
SHALL  BE  REASONABLE  AND REASONABLY RELATED TO THE COST OF EFFICIENTLY
PROVIDING THE HEALTH CARE SERVICE AND ASSURING AN ADEQUATE AND  ACCESSI-
BLE  SUPPLY  OF  HEALTH CARE SERVICE.   UNTIL AND UNLESS ANOTHER PAYMENT
METHODOLOGY IS ESTABLISHED, HEALTH CARE  SERVICES  PROVIDED  TO  MEMBERS
UNDER  THE  PROGRAM SHALL BE PAID FOR ON A FEE-FOR-SERVICE BASIS, EXCEPT
FOR CARE COORDINATION.
  (B) THE PROGRAM SHALL ENGAGE IN GOOD FAITH  NEGOTIATIONS  WITH  HEALTH
CARE PROVIDERS' REPRESENTATIVES UNDER TITLE III OF ARTICLE FORTY-NINE OF
THIS  CHAPTER,  INCLUDING,  BUT  NOT LIMITED TO, IN RELATION TO RATES OF
PAYMENT AND PAYMENT METHODOLOGIES.
  (C) NOTWITHSTANDING ANY PROVISION OF LAW TO THE CONTRARY, PAYMENT  FOR
DRUGS PROVIDED BY PHARMACIES UNDER THE PROGRAM SHALL BE MADE PURSUANT TO
TITLE  ONE  OF ARTICLE TWO-A OF THIS CHAPTER. HOWEVER, THE PROGRAM SHALL
PROVIDE FOR PAYMENT FOR PRESCRIPTION DRUGS UNDER  SECTION  340B  OF  THE
FEDERAL  PUBLIC  SERVICE  ACT WHERE APPLICABLE. PAYMENT FOR PRESCRIPTION

S. 3525--A                         10

DRUGS PROVIDED BY HEALTH CARE PROVIDERS OTHER THAN PHARMACIES  SHALL  BE
PURSUANT TO OTHER PROVISIONS OF THIS ARTICLE.
  (D)  PAYMENT  FOR  HEALTH CARE SERVICES ESTABLISHED UNDER THIS ARTICLE
SHALL BE CONSIDERED PAYMENT IN FULL. A PARTICIPATING PROVIDER SHALL  NOT
CHARGE  ANY RATE IN EXCESS OF THE PAYMENT ESTABLISHED UNDER THIS ARTICLE
FOR ANY HEALTH CARE SERVICE UNDER THE PROGRAM PROVIDED TO A  MEMBER  AND
SHALL  NOT  SOLICIT OR ACCEPT PAYMENT FROM ANY MEMBER OR THIRD PARTY FOR
ANY SUCH SERVICE EXCEPT AS PROVIDED UNDER SECTION FIFTY-ONE HUNDRED NINE
OF THIS ARTICLE.  HOWEVER, THIS PARAGRAPH SHALL NOT PRECLUDE THE PROGRAM
FROM ACTING AS A PRIMARY OR SECONDARY PAYER IN CONJUNCTION WITH  ANOTHER
THIRD-PARTY  PAYER  WHERE PERMITTED UNDER SECTION FIFTY-ONE HUNDRED NINE
OF THIS ARTICLE.
  (E) THE PROGRAM MAY PROVIDE IN PAYMENT METHODOLOGIES FOR  PAYMENT  FOR
CAPITAL  RELATED  EXPENSES  FOR SPECIFICALLY IDENTIFIED CAPITAL EXPENDI-
TURES INCURRED BY  NOT-FOR-PROFIT  OR  GOVERNMENTAL  ENTITIES  CERTIFIED
UNDER  ARTICLE TWENTY-EIGHT OF THIS CHAPTER. ANY CAPITAL RELATED EXPENSE
GENERATED BY A CAPITAL EXPENDITURE THAT REQUIRES  OR  REQUIRED  APPROVAL
UNDER  ARTICLE  TWENTY-EIGHT  OF  THIS  CHAPTER  MUST HAVE RECEIVED THAT
APPROVAL FOR THE CAPITAL RELATED  EXPENSE  TO  BE  PAID  FOR  UNDER  THE
PROGRAM.
  (F) PAYMENT METHODOLOGIES AND RATES SHALL INCLUDE A DISTINCT COMPONENT
OF  REIMBURSEMENT  FOR DIRECT AND INDIRECT GRADUATE MEDICAL EDUCATION AS
DEFINED, CALCULATED AND IMPLEMENTED  PURSUANT  TO  SECTION  TWENTY-EIGHT
HUNDRED SEVEN-C OF THIS CHAPTER.
  (G)  THE COMMISSIONER SHALL PROVIDE BY  REGULATION FOR PAYMENT METHOD-
OLOGIES AND PROCEDURES FOR PAYING FOR OUT-OF-STATE HEALTH CARE SERVICES.
  S 5106. HEALTH CARE ORGANIZATIONS. 1. A MEMBER MAY  CHOOSE  TO  ENROLL
WITH  AND  RECEIVE  HEALTH CARE SERVICES UNDER THE PROGRAM FROM A HEALTH
CARE ORGANIZATION.
  2. A HEALTH CARE ORGANIZATION SHALL BE  A  NOT-FOR-PROFIT  OR  GOVERN-
MENTAL ENTITY THAT IS APPROVED BY THE COMMISSIONER THAT IS:
  (A)  AN  ACCOUNTABLE  CARE ORGANIZATION UNDER ARTICLE TWENTY-NINE-E OF
THIS CHAPTER; OR
  (B) A TAFT-HARTLEY FUND (I) WITH RESPECT  TO  ITS  MEMBERS  AND  THEIR
FAMILY  MEMBERS,  AND  (II) IF ALLOWED BY APPLICABLE LAW AND APPROVED BY
THE COMMISSIONER, FOR OTHER MEMBERS OF THE PROGRAM;  PROVIDED  THAT  THE
COMMISSIONER  SHALL PROVIDE BY REGULATION THAT WHERE A TAFT-HARTLEY FUND
IS ACTING UNDER THIS SUBPARAGRAPH THERE ARE PROTECTIONS FOR HEALTH  CARE
PROVIDERS  AND  PATIENTS  COMPARABLE  TO THOSE APPLICABLE TO ACCOUNTABLE
CARE ORGANIZATIONS.
  3. A HEALTH CARE ORGANIZATION MAY BE RESPONSIBLE FOR ALL  OR  PART  OF
THE  HEALTH  CARE  SERVICES  TO WHICH ITS MEMBERS ARE ENTITLED UNDER THE
PROGRAM, CONSISTENT WITH THE TERMS OF ITS APPROVAL BY THE COMMISSIONER.
  4. (A) THE COMMISSIONER SHALL DEVELOP  AND  IMPLEMENT  PROCEDURES  AND
STANDARDS  FOR AN ENTITY TO BE APPROVED TO BE A HEALTH CARE ORGANIZATION
IN THE PROGRAM, INCLUDING BUT NOT LIMITED TO  PROCEDURES  AND  STANDARDS
RELATING  TO  THE  REVOCATION,  SUSPENSION,  LIMITATION, OR ANNULMENT OF
APPROVAL ON A DETERMINATION THAT THE  ENTITY  IS  INCOMPETENT  TO  BE  A
HEALTH  CARE  ORGANIZATION OR HAS EXHIBITED A COURSE OF CONDUCT WHICH IS
EITHER INCONSISTENT WITH PROGRAM  STANDARDS  AND  REGULATIONS  OR  WHICH
EXHIBITS  AN UNWILLINGNESS TO MEET SUCH STANDARDS AND REGULATIONS, OR IS
A POTENTIAL THREAT TO THE PUBLIC HEALTH OR SAFETY. SUCH  PROCEDURES  AND
STANDARDS  SHALL  NOT LIMIT APPROVAL TO BE A HEALTH CARE ORGANIZATION IN
THE PROGRAM FOR ECONOMIC PURPOSES AND  SHALL  BE  CONSISTENT  WITH  GOOD
PROFESSIONAL  PRACTICE.  IN DEVELOPING THE PROCEDURES AND STANDARDS, THE
COMMISSIONER  SHALL:  (I)  CONSIDER  EXISTING  STANDARDS  DEVELOPED   BY

S. 3525--A                         11

NATIONAL  ACCREDITING  AND  PROFESSIONAL ORGANIZATIONS; AND (II) CONSULT
WITH NATIONAL AND LOCAL ORGANIZATIONS WORKING IN  THE  FIELD  OF  HEALTH
CARE  ORGANIZATIONS,  INCLUDING  HEALTH  CARE  PRACTITIONERS, HOSPITALS,
CLINICS,  AND  CONSUMERS  AND THEIR REPRESENTATIVES. WHEN DEVELOPING AND
IMPLEMENTING STANDARDS OF APPROVAL OF  HEALTH  CARE  ORGANIZATIONS,  THE
COMMISSIONER  SHALL  CONSULT  WITH THE COMMISSIONER OF MENTAL HEALTH AND
THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES.
  (B) TO MAINTAIN APPROVAL UNDER THE PROGRAM, A HEALTH CARE ORGANIZATION
MUST: (I) RENEW ITS STATUS AT A FREQUENCY DETERMINED BY THE  COMMISSION-
ER;  AND  (II) PROVIDE DATA TO THE DEPARTMENT AS REQUIRED BY THE COMMIS-
SIONER TO ENABLE THE COMMISSIONER TO EVALUATE THE HEALTH CARE  ORGANIZA-
TION  IN  RELATION  TO  QUALITY  OF  HEALTH  CARE  SERVICES, HEALTH CARE
OUTCOMES, AND COST.
  5. THE COMMISSIONER SHALL MAKE REGULATIONS  RELATING  TO  HEALTH  CARE
ORGANIZATIONS  CONSISTENT  WITH AND TO ENSURE COMPLIANCE WITH THIS ARTI-
CLE.
  6. THE PROVISION OF HEALTH CARE SERVICES DIRECTLY OR INDIRECTLY  BY  A
HEALTH  CARE  ORGANIZATION  THROUGH  HEALTH  CARE PROVIDERS SHALL NOT BE
CONSIDERED THE PRACTICE OF A PROFESSION UNDER TITLE EIGHT OF THE  EDUCA-
TION LAW BY THE HEALTH CARE ORGANIZATION.
  S  5107.  PROGRAM  STANDARDS.  1.  THE  COMMISSIONER  SHALL  ESTABLISH
REQUIREMENTS AND STANDARDS FOR THE PROGRAM AND FOR HEALTH CARE ORGANIZA-
TIONS, CARE COORDINATORS, AND HEALTH  CARE  PROVIDERS,  CONSISTENT  WITH
THIS ARTICLE, INCLUDING REQUIREMENTS AND STANDARDS FOR, AS APPLICABLE:
  (A) THE SCOPE, QUALITY AND ACCESSIBILITY OF HEALTH CARE SERVICES;
  (B) RELATIONS BETWEEN HEALTH CARE ORGANIZATIONS OR HEALTH CARE PROVID-
ERS AND MEMBERS; AND
  (C)  RELATIONS  BETWEEN  HEALTH  CARE  ORGANIZATIONS  AND  HEALTH CARE
PROVIDERS, INCLUDING (I) CREDENTIALING AND PARTICIPATION IN  THE  HEALTH
CARE ORGANIZATION; AND (II) TERMS, METHODS AND RATES OF PAYMENT.
  2. REQUIREMENTS AND STANDARDS UNDER THE PROGRAM SHALL INCLUDE, BUT NOT
BE LIMITED TO, PROVISIONS TO PROMOTE THE FOLLOWING:
  (A)  SIMPLIFICATION,  TRANSPARENCY, UNIFORMITY, AND FAIRNESS IN HEALTH
CARE PROVIDER CREDENTIALING AND PARTICIPATION IN HEALTH  CARE  ORGANIZA-
TION  NETWORKS, REFERRALS, PAYMENT PROCEDURES AND RATES, CLAIMS PROCESS-
ING, AND APPROVAL OF HEALTH CARE SERVICES, AS APPLICABLE;
  (B) PRIMARY AND PREVENTIVE  CARE,  CARE  COORDINATION,  EFFICIENT  AND
EFFECTIVE  HEALTH  CARE  SERVICES,  QUALITY  ASSURANCE, COORDINATION AND
INTEGRATION OF HEALTH CARE SERVICES, INCLUDING USE OF APPROPRIATE  TECH-
NOLOGY, AND PROMOTION OF PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL HEALTH;
  (C) ELIMINATION OF HEALTH CARE DISPARITIES;
  (D) NON-DISCRIMINATION WITH RESPECT TO MEMBERS AND HEALTH CARE PROVID-
ERS ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, RELIGION, DISABIL-
ITY,  AGE,  SEX,  SEXUAL  ORIENTATION, GENDER IDENTITY OR EXPRESSION, OR
ECONOMIC CIRCUMSTANCES; PROVIDED  THAT  HEALTH  CARE  SERVICES  PROVIDED
UNDER THE PROGRAM SHALL BE APPROPRIATE TO THE PATIENT'S CLINICALLY-RELE-
VANT CIRCUMSTANCES; AND
  (E)  ACCESSIBILITY  OF  CARE  COORDINATION,  HEALTH  CARE ORGANIZATION
SERVICES AND HEALTH CARE SERVICES, INCLUDING  ACCESSIBILITY  FOR  PEOPLE
WITH DISABILITIES AND PEOPLE WITH LIMITED ABILITY TO SPEAK OR UNDERSTAND
ENGLISH,  AND  THE PROVIDING OF CARE COORDINATION, HEALTH CARE ORGANIZA-
TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER.
  3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
A FOR-PROFIT ENTITY SHALL BE REQUIRED TO MEET THE SAME REQUIREMENTS  AND
STANDARDS AS ENTITIES ORGANIZED AS NOT-FOR-PROFIT ENTITIES, AND PAYMENTS
UNDER  THE  PROGRAM  PAID  TO  SUCH  ENTITIES SHALL NOT BE CALCULATED TO

S. 3525--A                         12

ACCOMMODATE THE GENERATION OF PROFIT OR REVENUE FOR DIVIDENDS  OR  OTHER
RETURN ON INVESTMENT OR THE PAYMENT OF TAXES THAT WOULD NOT BE PAID BY A
NOT-FOR-PROFIT ENTITY.
  4.  EVERY  PARTICIPATING  PROVIDER  SHALL  FURNISH TO THE PROGRAM SUCH
INFORMATION TO, AND PERMIT EXAMINATION OF ITS RECORDS BY,  THE  PROGRAM,
AS  MAY  BE  REASONABLY REQUIRED FOR PURPOSES OF REVIEWING ACCESSIBILITY
AND UTILIZATION OF HEALTH CARE SERVICES,  QUALITY  ASSURANCE,  AND  COST
CONTAINMENT, THE MAKING OF PAYMENTS, AND STATISTICAL OR OTHER STUDIES OF
THE  OPERATION OF THE PROGRAM OR FOR PROTECTION AND PROMOTION OF PUBLIC,
ENVIRONMENTAL AND OCCUPATIONAL HEALTH.
  5. IN DEVELOPING REQUIREMENTS AND STANDARDS AND  MAKING  OTHER  POLICY
DETERMINATIONS  UNDER  THIS ARTICLE, THE COMMISSIONER SHALL CONSULT WITH
REPRESENTATIVES OF MEMBERS, HEALTH CARE  PROVIDERS,  CARE  COORDINATORS,
HEALTH CARE ORGANIZATIONS AND OTHER INTERESTED PARTIES.
  6.    THE  PROGRAM  SHALL MAINTAIN THE CONFIDENTIALITY OF ALL DATA AND
OTHER INFORMATION COLLECTED UNDER THE PROGRAM WHEN SUCH  DATA  WOULD  BE
NORMALLY  CONSIDERED CONFIDENTIAL DATA BETWEEN A PATIENT AND HEALTH CARE
PROVIDER.  AGGREGATE DATA OF THE PROGRAM WHICH IS DERIVED FROM CONFIDEN-
TIAL DATA BUT DOES NOT VIOLATE PATIENT CONFIDENTIALITY SHALL  BE  PUBLIC
INFORMATION.
  S  5108.  REGULATIONS.  THE  COMMISSIONER  MAY APPROVE REGULATIONS AND
AMENDMENTS THERETO, UNDER SUBDIVISION ONE OF SECTION  FIFTY-ONE  HUNDRED
TWO OF THIS ARTICLE. THE COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS
THERETO  TO EFFECTUATE THE PROVISIONS AND PURPOSES OF THIS ARTICLE ON AN
EMERGENCY BASIS UNDER SECTION TWO HUNDRED TWO OF THE  STATE  ADMINISTRA-
TIVE  PROCEDURE  ACT, PROVIDED THAT SUCH REGULATIONS OR AMENDMENTS SHALL
NOT BECOME PERMANENT UNLESS ADOPTED UNDER  SUBDIVISION  ONE  OF  SECTION
FIFTY-ONE HUNDRED TWO OF THIS ARTICLE.
  S 5109. PROVISIONS RELATING TO FEDERAL HEALTH PROGRAMS. 1. THE COMMIS-
SIONER  SHALL  SEEK  ALL FEDERAL WAIVERS AND OTHER FEDERAL APPROVALS AND
ARRANGEMENTS AND SUBMIT STATE PLAN AMENDMENTS NECESSARY TO  OPERATE  THE
PROGRAM CONSISTENT WITH THIS ARTICLE.
  2.  (A)  THE  COMMISSIONER  SHALL APPLY TO THE SECRETARY OF HEALTH AND
HUMAN SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS  OF
REQUIREMENTS,  AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY FEDERAL-
LY-MATCHED PUBLIC HEALTH PROGRAM, THE AFFORDABLE CARE ACT, AND ANY OTHER
FEDERAL PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH  CARE
SERVICES,  THAT  ARE  NECESSARY TO ENABLE ALL NEW YORK HEALTH MEMBERS TO
RECEIVE ALL BENEFITS UNDER THE PROGRAM THROUGH THE PROGRAM TO ENABLE THE
STATE TO IMPLEMENT THIS ARTICLE AND TO RECEIVE AND DEPOSIT  ALL  FEDERAL
PAYMENTS  UNDER  THOSE PROGRAMS (INCLUDING FUNDS THAT MAY BE PROVIDED IN
LIEU OF PREMIUM TAX CREDITS, COST-SHARING SUBSIDIES, AND SMALL  BUSINESS
TAX  CREDITS) IN THE STATE TREASURY TO THE CREDIT OF THE NEW YORK HEALTH
TRUST FUND CREATED UNDER SECTION EIGHTY-NINE-I OF THE STATE FINANCE  LAW
AND  TO  USE  THOSE  FUNDS  FOR  THE  NEW  YORK HEALTH PROGRAM AND OTHER
PROVISIONS UNDER THIS ARTICLE. TO THE EXTENT POSSIBLE, THE  COMMISSIONER
SHALL  NEGOTIATE  ARRANGEMENTS WITH THE FEDERAL GOVERNMENT IN WHICH BULK
OR LUMP-SUM FEDERAL PAYMENTS ARE PAID TO NEW YORK  HEALTH  IN  PLACE  OF
FEDERAL  SPENDING  OR TAX BENEFITS FOR FEDERALLY-MATCHED HEALTH PROGRAMS
OR FEDERAL HEALTH PROGRAMS.
  (B) THE COMMISSIONER MAY REQUIRE MEMBERS OR APPLICANTS TO  BE  MEMBERS
TO  PROVIDE  INFORMATION  NECESSARY  FOR  THE PROGRAM TO COMPLY WITH ANY
WAIVER OR ARRANGEMENT UNDER THIS SUBDIVISION.
  3. (A) IF ACTIONS TAKEN UNDER SUBDIVISION TWO OF THIS SECTION  DO  NOT
ACCOMPLISH ALL RESULTS INTENDED UNDER THAT SUBDIVISION, THEN THIS SUBDI-
VISION SHALL APPLY AND SHALL AUTHORIZE ADDITIONAL ACTIONS TO EFFECTIVELY

S. 3525--A                         13

IMPLEMENT   NEW  YORK  HEALTH  TO  THE  MAXIMUM  EXTENT  POSSIBLE  AS  A
SINGLE-PAYER PROGRAM CONSISTENT WITH THIS ARTICLE.
  (B)  THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS ARTICLE TO
ENABLE NEW YORK HEALTH TO ADMINISTER MEDICARE IN NEW YORK STATE  AND  TO
BE  A  PROVIDER  OF  DRUG  COVERAGE  UNDER  MEDICARE PART D FOR ELIGIBLE
MEMBERS OF NEW YORK HEALTH.
  (C)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
PROVISIONS  OF  THIS  SECTION  RELATING  TO ANY FEDERALLY-MATCHED PUBLIC
HEALTH PROGRAM OR MEDICARE AS  NECESSARY  TO  IMPLEMENT  ANY  WAIVER  OR
ARRANGEMENT  UNDER  THIS  SECTION  OR TO MAXIMIZE THE BENEFIT TO THE NEW
YORK HEALTH PROGRAM UNDER THIS SECTION, PROVIDED THAT THE  COMMISSIONER,
IN  CONSULTATION  WITH  THE DIRECTOR OF THE BUDGET, SHALL DETERMINE THAT
SUCH WAIVER OR MODIFICATION IS IN THE  BEST  INTERESTS  OF  THE  MEMBERS
AFFECTED BY THE ACTION AND THE STATE.
  (D)    THE   COMMISSIONER   MAY   APPLY   FOR   COVERAGE   UNDER   ANY
FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM ON  BEHALF  OF  ANY  MEMBER  AND
ENROLL  THE  MEMBER  IN  THE  FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
MEDICARE  IF  THE  MEMBER  IS  ELIGIBLE  FOR  IT.     ENROLLMENT  IN   A
FEDERALLY-MATCHED  PUBLIC HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE ANY
MEMBER TO LOSE ANY HEALTH CARE SERVICE PROVIDED BY THE PROGRAM OR DIMIN-
ISH ANY RIGHT THE MEMBER WOULD OTHERWISE HAVE.
  (E) THE COMMISSIONER SHALL BY REGULATION INCREASE THE INCOME ELIGIBIL-
ITY LEVEL, INCREASE OR ELIMINATE  THE  RESOURCE  TEST  FOR  ELIGIBILITY,
SIMPLIFY ANY PROCEDURAL OR DOCUMENTATION REQUIREMENT FOR ENROLLMENT, AND
INCREASE  THE  BENEFITS FOR ANY FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM,
AND FOR ANY PROGRAM TO REDUCE OR ELIMINATE AN INDIVIDUAL'S  COINSURANCE,
COST-SHARING  OR  PREMIUM OBLIGATIONS OR INCREASE AN INDIVIDUAL'S ELIGI-
BILITY FOR ANY FEDERAL FINANCIAL SUPPORT  RELATED  TO  MEDICARE  OR  THE
AFFORDABLE CARE ACT NOTWITHSTANDING ANY LAW OR REGULATION TO THE CONTRA-
RY.  THE  COMMISSIONER  MAY  ACT  UNDER  THIS  PARAGRAPH UPON A FINDING,
APPROVED BY THE DIRECTOR OF THE BUDGET, THAT THE ACTION (I) WILL HELP TO
INCREASE THE NUMBER OF MEMBERS WHO ARE  ELIGIBLE  FOR  AND  ENROLLED  IN
FEDERALLY-MATCHED  PUBLIC  HEALTH PROGRAMS, OR FOR ANY PROGRAM TO REDUCE
OR ELIMINATE AN INDIVIDUAL'S COINSURANCE, COST-SHARING OR PREMIUM  OBLI-
GATIONS  OR  INCREASE AN INDIVIDUAL'S ELIGIBILITY FOR ANY FEDERAL FINAN-
CIAL SUPPORT RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT;  (II)  WILL
NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY HEALTH CARE SERVICE OR RIGHT
THE  INDIVIDUAL  WOULD  OTHERWISE  HAVE; (III) IS IN THE INTEREST OF THE
PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS RECEIVED ANY NECESSARY FEDERAL
WAIVERS OR APPROVALS TO ENSURE FEDERAL FINANCIAL PARTICIPATION.  ACTIONS
UNDER THIS PARAGRAPH SHALL NOT APPLY TO ELIGIBILITY FOR PAYMENT FOR LONG
TERM CARE.
  (F)  TO ENABLE THE COMMISSIONER TO APPLY FOR COVERAGE UNDER ANY FEDER-
ALLY-MATCHED PUBLIC HEALTH PROGRAM OR MEDICARE ON BEHALF OF  ANY  MEMBER
AND  ENROLL THE MEMBER IN THE FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM OR
MEDICARE IF THE MEMBER IS ELIGIBLE FOR IT, THE COMMISSIONER MAY  REQUIRE
THAT  EVERY MEMBER OR APPLICANT TO BE A MEMBER SHALL PROVIDE INFORMATION
TO ENABLE THE COMMISSIONER TO DETERMINE WHETHER THE APPLICANT IS  ELIGI-
BLE  FOR A FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM AND FOR MEDICARE (AND
ANY PROGRAM OR BENEFIT UNDER MEDICARE). THE PROGRAM SHALL MAKE A REASON-
ABLE EFFORT TO NOTIFY MEMBERS OF THEIR OBLIGATIONS UNDER THIS PARAGRAPH.
AFTER A REASONABLE EFFORT HAS BEEN  MADE  TO  CONTACT  THE  MEMBER,  THE
MEMBER  SHALL  BE  NOTIFIED  IN WRITING THAT HE OR SHE HAS SIXTY DAYS TO
PROVIDE SUCH REQUIRED INFORMATION. IF SUCH INFORMATION IS  NOT  PROVIDED
WITHIN THE SIXTY DAY PERIOD, THE MEMBER'S COVERAGE UNDER THE PROGRAM MAY
BE TERMINATED.

S. 3525--A                         14

  (G)  AS  A CONDITION OF CONTINUED ELIGIBILITY FOR HEALTH CARE SERVICES
UNDER THE PROGRAM, A MEMBER WHO IS ELIGIBLE FOR BENEFITS UNDER  MEDICARE
SHALL ENROLL IN MEDICARE, INCLUDING PARTS A, B AND D.
  (H)  THE  PROGRAM  SHALL  PROVIDE  PREMIUM  ASSISTANCE FOR ALL MEMBERS
ENROLLING IN A MEDICARE PART D DRUG  COVERAGE  UNDER  SECTION  1860D  OF
TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT LIMITED TO THE LOW-INCOME
BENCHMARK PREMIUM AMOUNT ESTABLISHED BY THE FEDERAL CENTERS FOR MEDICARE
AND MEDICAID SERVICES AND ANY OTHER AMOUNT WHICH SUCH AGENCY ESTABLISHES
UNDER  ITS  DE MINIMIS PREMIUM POLICY, EXCEPT THAT SUCH PAYMENTS MADE ON
BEHALF OF MEMBERS ENROLLED IN A MEDICARE ADVANTAGE PLAN MAY  EXCEED  THE
LOW-INCOME  BENCHMARK  PREMIUM AMOUNT IF DETERMINED TO BE COST EFFECTIVE
TO THE PROGRAM.
  (I) IF THE COMMISSIONER HAS  REASONABLE  GROUNDS  TO  BELIEVE  THAT  A
MEMBER  COULD  BE  ELIGIBLE  FOR AN INCOME-RELATED SUBSIDY UNDER SECTION
1860D-14 OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT,  THE  MEMBER
SHALL  PROVIDE,  AND AUTHORIZE THE PROGRAM TO OBTAIN, ANY INFORMATION OR
DOCUMENTATION REQUIRED TO ESTABLISH THE MEMBER'S  ELIGIBILITY  FOR  SUCH
SUBSIDY,  PROVIDED THAT THE COMMISSIONER SHALL ATTEMPT TO OBTAIN AS MUCH
OF THE INFORMATION AND DOCUMENTATION AS POSSIBLE FROM RECORDS  THAT  ARE
AVAILABLE TO HIM OR HER.
  (J)  THE  PROGRAM  SHALL MAKE A REASONABLE EFFORT TO NOTIFY MEMBERS OF
THEIR OBLIGATIONS UNDER THIS SUBDIVISION. AFTER A REASONABLE EFFORT  HAS
BEEN MADE TO CONTACT THE MEMBER, THE MEMBER SHALL BE NOTIFIED IN WRITING
THAT  HE  OR SHE HAS SIXTY DAYS TO PROVIDE SUCH REQUIRED INFORMATION. IF
SUCH INFORMATION IS NOT  PROVIDED  WITHIN  THE  SIXTY  DAY  PERIOD,  THE
MEMBER'S COVERAGE UNDER THE PROGRAM MAY BE TERMINATED.
  S  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
  (A) CONSUMER ASSISTANCE TO INDIVIDUALS WITH RESPECT TO SELECTION OF  A
CARE  COORDINATOR  OR  HEALTH  CARE  ORGANIZATION,  ENROLLING, OBTAINING
HEALTH CARE SERVICES, DISENROLLING, AND OTHER MATTERS  RELATING  TO  THE
PROGRAM;
  (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, HEALTH CARE SERVICES
UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
  (C) CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES  PROVIDING
AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, CARE COORDINATION TO
MEMBERS.
  2. THE COMMISSIONER SHALL PROVIDE GRANTS FROM FUNDS IN  THE  NEW  YORK
HEALTH  TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO HEALTH
SYSTEMS AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS  CHAP-
TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
  3. THE COMMISSIONER SHALL PROVIDE FUNDS FROM THE NEW YORK HEALTH TRUST
FUND  OR  OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSIONER OF
LABOR FOR A PROGRAM FOR RETRAINING  AND  ASSISTING  JOB  TRANSITION  FOR
INDIVIDUALS  EMPLOYED  OR  PREVIOUSLY  EMPLOYED  IN  THE FIELD OF HEALTH
INSURANCE AND OTHER THIRD-PARTY PAYMENT FOR  HEALTH  CARE  OR  PROVIDING
SERVICES  TO  HEALTH  CARE PROVIDERS TO DEAL WITH THIRD-PARTY PAYERS FOR
HEALTH CARE, WHOSE JOBS MAY BE OR HAVE BEEN ENDED AS  A  RESULT  OF  THE
IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM, CONSISTENT WITH OTHERWISE
APPLICABLE LAW.
  4. THE COMMISSIONER SHALL, DIRECTLY AND THROUGH GRANTS TO NOT-FOR-PRO-
FIT ENTITIES, CONDUCT PROGRAMS USING DATA COLLECTED THROUGH THE NEW YORK
HEALTH PROGRAM, TO PROMOTE AND PROTECT PUBLIC, ENVIRONMENTAL AND OCCUPA-
TIONAL  HEALTH,  INCLUDING  COOPERATION  WITH  OTHER DATA COLLECTION AND

S. 3525--A                         15

RESEARCH PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH  THIS  ARTICLE  AND
OTHERWISE APPLICABLE LAW.
  S  5111.  REGIONAL ADVISORY COUNCILS.  1. THE NEW YORK HEALTH REGIONAL
ADVISORY COUNCILS (EACH REFERRED TO IN THIS ARTICLE AS A "REGIONAL ADVI-
SORY COUNCIL") ARE HEREBY CREATED IN THE DEPARTMENT.
  2. THERE SHALL BE A REGIONAL ADVISORY COUNCIL ESTABLISHED IN  EACH  OF
THE FOLLOWING REGIONS:
  (A) LONG ISLAND, CONSISTING OF NASSAU AND SUFFOLK COUNTIES;
  (B) NEW YORK CITY;
  (C)  HUDSON  VALLEY, CONSISTING OF DELAWARE, DUTCHESS, ORANGE, PUTNAM,
ROCKLAND, SULLIVAN, ULSTER, WESTCHESTER COUNTIES;
  (D) NORTHERN, CONSISTING OF ALBANY, CLINTON, COLUMBIA,  ESSEX,  FRANK-
LIN, FULTON, GREENE, HAMILTON, MONTGOMERY, OTSEGO, RENSSELAER, SARATOGA,
SCHENECTADY, SCHOHARIE, WARREN, WASHINGTON COUNTIES;
  (E)  CENTRAL,  CONSISTING  OF BROOME, CAYUGA, CHEMUNG, CHENANGO, CORT-
LAND, HERKIMER, JEFFERSON, LEWIS, LIVINGSTON, MADISON,  MONROE,  ONEIDA,
ONONDAGA,  ONTARIO,  OSWEGO,  SCHUYLER,  SENECA,  ST. LAWRENCE, STEUBEN,
TIOGA, TOMPKINS, WAYNE, YATES COUNTIES; AND
  (F) WESTERN, CONSISTING OF ALLEGANY,  CATTARAUGUS,  CHAUTAUQUA,  ERIE,
GENESEE, NIAGARA, ORLEANS, WYOMING COUNTIES.
  3.  EACH REGIONAL ADVISORY COUNCIL SHALL BE COMPOSED OF NOT FEWER THAN
TWENTY-SEVEN MEMBERS, AS DETERMINED BY THE COMMISSIONER AND  THE  BOARD,
AS  NECESSARY  TO APPROPRIATELY REPRESENT THE DIVERSE NEEDS AND CONCERNS
OF THE REGION. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE RESIDENTS
OF OR HAVE THEIR PRINCIPAL PLACE OF BUSINESS IN THE REGION SERVED BY THE
REGIONAL ADVISORY COUNCIL.
  4. APPOINTMENT OF MEMBERS OF THE REGIONAL ADVISORY COUNCILS.
  (A) THE TWENTY-SEVEN MEMBERS SHALL BE APPOINTED AS FOLLOWS:
  (I) NINE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR;
  (II) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMENDA-
TION OF THE SPEAKER OF THE ASSEMBLY;
  (III) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE  RECOMMEN-
DATION OF THE TEMPORARY PRESIDENT OF THE SENATE;
  (IV) THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
DATION OF THE MINORITY LEADER OF THE ASSEMBLY; AND
  (V)  THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
DATION OF THE MINORITY LEADER OF THE SENATE.  WHERE A REGIONAL  ADVISORY
COUNCIL HAS MORE THAN TWENTY-SEVEN MEMBERS, THE ADDITIONAL MEMBERS SHALL
BE  APPOINTED  AND RECOMMENDED BY THESE OFFICIALS IN THE SAME PROPORTION
AS THE TWENTY-SEVEN MEMBERS.
  WHERE A REGIONAL ADVISORY COUNCIL HAS MORE THAN TWENTY-SEVEN  MEMBERS,
ADDITIONAL MEMBERS SHALL BE APPOINTED AND RECOMMENDED BY THESE OFFICIALS
IN THE SAME PROPORTION AS THE TWENTY-SEVEN MEMBERS.
  (B)  REGIONAL  ADVISORY  COUNCIL  MEMBERSHIP  SHALL INCLUDE BUT NOT BE
LIMITED TO:
  (I) REPRESENTATIVES OF HEALTH  CARE  CONSUMER  ADVOCACY  ORGANIZATIONS
WITH  A REGIONAL CONSTITUENCY, WHO SHALL REPRESENT AT LEAST ONE THIRD OF
THE MEMBERSHIP OF EACH REGIONAL COUNCIL;
  (II) REPRESENTATIVES OF PROFESSIONAL ORGANIZATIONS REPRESENTING PHYSI-
CIANS;
  (III)  REPRESENTATIVES  OF  PROFESSIONAL  ORGANIZATIONS   REPRESENTING
HEALTH CARE PROFESSIONALS OTHER THAN PHYSICIANS;
  (IV) REPRESENTATIVES OF GENERAL HOSPITALS, INCLUDING PUBLIC HOSPITALS;
  (V) REPRESENTATIVES OF COMMUNITY HEALTH CENTERS;
  (VI) REPRESENTATIVES OF HEALTH CARE ORGANIZATIONS;
  (VII) REPRESENTATIVES OF ORGANIZED LABOR; AND

S. 3525--A                         16

  (VIII) REPRESENTATIVES OF MUNICIPAL AND COUNTY GOVERNMENT.
  5. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE APPOINTED FOR TERMS
OF  THREE  YEARS PROVIDED, HOWEVER, THAT OF THE MEMBERS FIRST APPOINTED,
ONE-THIRD SHALL BE APPOINTED FOR ONE YEAR TERMS AND ONE-THIRD  SHALL  BE
APPOINTED  FOR  TWO  YEAR  TERMS.  VACANCIES SHALL BE FILLED IN THE SAME
MANNER AS ORIGINAL APPOINTMENTS FOR THE REMAINDER OF ANY UNEXPIRED TERM.
NO PERSON SHALL BE AN APPOINTED MEMBER OF A  REGIONAL  ADVISORY  COUNCIL
FOR MORE THAN SIX YEARS IN ANY PERIOD OF TWELVE CONSECUTIVE YEARS.
  6.  MEMBERS  OF  THE  REGIONAL  ADVISORY  COUNCILS SHALL SERVE WITHOUT
COMPENSATION BUT SHALL BE REIMBURSED  FOR  THEIR  NECESSARY  AND  ACTUAL
EXPENSES  INCURRED  WHILE  ENGAGED IN THE BUSINESS OF THE ADVISORY COUN-
CILS. THE PROGRAM SHALL PROVIDE FINANCIAL SUPPORT FOR SUCH EXPENSES  AND
OTHER EXPENSES OF THE REGIONAL ADVISORY COUNCILS.
  7.  EACH REGIONAL ADVISORY COUNCIL SHALL MEET AT LEAST QUARTERLY. EACH
REGIONAL ADVISORY COUNCIL MAY FORM COMMITTEES TO ASSIST IT IN ITS  WORK.
MEMBERS  OF  A  COMMITTEE  NEED  NOT BE MEMBERS OF THE REGIONAL ADVISORY
COUNCIL.   THE NEW YORK CITY REGIONAL  ADVISORY  COUNCIL  SHALL  FORM  A
COMMITTEE  FOR  EACH  BOROUGH  OF  NEW YORK CITY, TO ASSIST THE REGIONAL
ADVISORY COUNCIL IN ITS WORK AS IT RELATES PARTICULARLY TO THAT BOROUGH.
  8. EACH REGIONAL ADVISORY COUNCIL SHALL  ADVISE  THE  COMMISSIONER,THE
BOARD,  THE  GOVERNOR AND THE LEGISLATURE ON ALL MATTERS RELATING TO THE
DEVELOPMENT AND IMPLEMENTATION OF THE NEW YORK HEALTH PROGRAM.
  9. EACH REGIONAL ADVISORY COUNCIL SHALL ADOPT, AND FROM TIME  TO  TIME
REVISE,  A  COMMUNITY  HEALTH  IMPROVEMENT  PLAN  FOR ITS REGION FOR THE
PURPOSE OF:
  (A) PROMOTING THE DELIVERY OF HEALTH  CARE  SERVICES  IN  THE  REGION,
IMPROVING  THE  QUALITY  AND  ACCESSIBILITY  OF CARE, INCLUDING CULTURAL
COMPETENCY, CLINICAL  INTEGRATION  OF  CARE  BETWEEN  SERVICE  PROVIDERS
INCLUDING  BUT  NOT  LIMITED TO PHYSICAL, MENTAL, AND BEHAVIORAL HEALTH,
PHYSICAL AND DEVELOPMENTAL DISABILITY SERVICES, AND LONG-TERM CARE;
  (B) FACILITY AND HEALTH SERVICES PLANNING IN THE REGION;
  (C) IDENTIFYING GAPS IN REGIONAL HEALTH CARE SERVICES; AND
  (D) PROMOTING INCREASED PUBLIC KNOWLEDGE AND RESPONSIBILITY  REGARDING
THE  AVAILABILITY  AND  APPROPRIATE UTILIZATION OF HEALTH CARE SERVICES.
EACH COMMUNITY HEALTH IMPROVEMENT PLAN SHALL BE SUBMITTED TO THE COMMIS-
SIONER AND THE BOARD AND SHALL BE POSTED ON THE DEPARTMENT'S WEBSITE.
  10. EACH REGIONAL ADVISORY COUNCIL SHALL HOLD  AT  LEAST  FOUR  PUBLIC
HEARINGS ANNUALLY ON MATTERS RELATING TO THE NEW YORK HEALTH PROGRAM AND
THE  DEVELOPMENT  AND IMPLEMENTATION OF THE COMMUNITY HEALTH IMPROVEMENT
PLAN.
  11. EACH REGIONAL ADVISORY COUNCIL SHALL PUBLISH AN ANNUAL  REPORT  TO
THE  COMMISSIONER  AND THE BOARD ON THE PROGRESS OF THE COMMUNITY HEALTH
IMPROVEMENT PLAN. THESE REPORTS SHALL  BE  POSTED  ON  THE  DEPARTMENT'S
WEBSITE.
  12.  ALL  MEETINGS  OF  THE  REGIONAL ADVISORY COUNCILS AND COMMITTEES
SHALL BE SUBJECT TO ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
  S 4. Financing of New York Health. 1. The governor shall submit to the
legislature a revenue plan and legislative bills to implement  the  plan
(referred  to collectively in this section as the "revenue proposal") to
provide the revenue necessary to finance the New York Health program, as
created by article 51 of the public health  law  (referred  to  in  this
section as the "program"), taking into consideration anticipated federal
revenue available for the program. The revenue proposal shall be submit-
ted to the legislature as part of the executive budget under article VII
of  the  state constitution, for the fiscal year commencing on the first
day of April in the calendar year after this act shall become a law.  In

S. 3525--A                         17

developing  the revenue proposal, the governor shall consult with appro-
priate officials of the executive branch; the temporary president of the
senate; the speaker of the assembly; the chairs of the fiscal and health
committees  of the senate and assembly; and representatives of business,
labor, consumers and local government.
  2. (a) Basic structure. The basic structure of  the  revenue  proposal
shall  be as follows: Revenue for the program shall come from two premi-
ums (referred to collectively in this section as the "premiums"). First,
there shall be a progressively graduated  premium  on  all  payroll  and
self-employed income (referred to in this section as the "payroll premi-
um"),  paid  by  employers,  employees and self-employed, similar to the
Medicare tax. Higher brackets of income subject to this premium shall be
assessed at a higher marginal rate than lower brackets.   Second,  there
shall  be  a  progressively graduated premium on taxable income (such as
interest, dividends, and capital  gains)  not  subject  to  the  payroll
premium  (referred to in this section as the "non-payroll premium"). The
premiums will be set at levels anticipated to produce sufficient revenue
to finance the program and other provisions of article 51 of the  public
health  law,  to be scaled up as enrollment grows, taking into consider-
ation anticipated federal revenue available for the  program.  Provision
shall be made for state residents (who are eligible for the program) who
are  employed  out-of-state, and non-residents (who are not eligible for
the program) who are employed in the state.
  (b) Payroll premium. The income to be subject to the  payroll  premium
shall  be  all  income subject to the Medicare tax. The premium shall be
set at a percentage of that income, which shall be progressively  gradu-
ated,  so  the  percentage  is  higher on higher brackets of income. For
employed individuals, the employer  shall  pay  eighty  percent  of  the
premium and the employee shall pay twenty percent of the premium, except
that  an  employer may agree to pay all or part of the employee's share.
A self-employed individual shall pay the full premium.
  (c) Non-payroll income premium. There shall be  a  premium  on  upper-
bracket  taxable  personal  income  that  is  not subject to the payroll
premium. It shall be set at a percentage of that income, which shall  be
progressively  graduated, so the percentage is higher on higher brackets
of income.
  (d) Phased-in rates. Early in the program, when enrollment is growing,
the amount of the premiums shall be at an appropriate level,  and  shall
be  raised  as anticipated enrollment grows, to cover the actual cost of
the program and other provisions of article 51 of the public health law.
The revenue proposal shall include a mechanism for determining the rates
of the premiums.
  (e) Cross-border employees. (i) State residents employed out-of-state.
If an individual is employed out-of-state by an employer that is subject
to New York state law, the employer and employee shall  be  required  to
pay the payroll premium as to that employee as if the employment were in
the state. If an individual is employed out-of-state by an employer that
is  not  subject  to  New  York  state  law, either (A) the employer and
employee shall voluntarily comply with the premium or (B)  the  employee
shall pay the premium as if he or she were self-employed.
  (ii)  Out-of-state  residents  employed in the state.  (A) The payroll
premium shall apply to any out-of-state  resident  who  is  employed  or
self-employed in the state.  (B) In the case of an out-of-state resident
who is employed or self-employed in the state, such individual and indi-
vidual's  employer  shall  be  able to take a credit against the payroll
premiums they would otherwise pay, as to the individual for amounts they

S. 3525--A                         18

spend on health benefits for the  individual  that  would  otherwise  be
covered  by  the program if the individual were a member of the program.
For employers, the credit shall be available regardless of the  form  of
the  health benefit (e.g., health insurance, a self-insured plan, direct
services, or reimbursement for services), to make sure that the  revenue
proposal  does  not  relate  to  employment benefits in violation of the
federal ERISA.  For non-employment-based spending  by  individuals,  the
credit  shall be available for and limited to spending for health cover-
age (not out-of-pocket health spending). The credit shall  be  available
without  regard  to  how  little is spent or how sparse the benefit. The
credit may only be taken against the payroll premiums. Any excess amount
may not be applied to other tax liability. For  employment-based  health
benefits,  the  credit  shall  be  distributed  between the employer and
employee in the same proportion as the spending by each for the benefit.
The employer and employee may each apply their respective portion of the
credit to their respective portion of the premium. If any  provision  of
this  clause  or any application of it shall be ruled to violate federal
ERISA, the provision or the application of it shall be null and void and
the ruling shall not affect any other provision or application  of  this
section or the act that enacted it.
  3.   The  revenue  proposal  shall  include  a  plan  and  legislative
provisions  for  ending  the  requirement  for  local  social   services
districts  to  pay  part  of  the  cost  of Medicaid and replacing those
payments with revenue from the premiums under the revenue proposal.
  4. To the extent that the revenue proposal differs from the  terms  of
subdivision two of this section, the revenue proposal shall state how it
differs  from those terms and reasons for and the effects of the differ-
ences.
  5. All revenue from the premiums shall be deposited in  the  New  York
Health trust fund account under section 89-i of the state finance law.
  S  5.   Article 49 of the public health law is amended by adding a new
title 3 to read as follows:
                                TITLE III
          COLLECTIVE NEGOTIATIONS BY HEALTH CARE PROVIDERS WITH
                             NEW YORK HEALTH
SECTION 4920. DEFINITIONS.
        4921. COLLECTIVE NEGOTIATION AUTHORIZED.
        4922. COLLECTIVE NEGOTIATION REQUIREMENTS.
        4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE.
        4924. CERTAIN COLLECTIVE ACTION PROHIBITED.
        4925. FEES.
        4926. CONFIDENTIALITY.
        4927. SEVERABILITY AND CONSTRUCTION.
  S 4920. DEFINITIONS. FOR PURPOSES OF THIS TITLE:
  1. "NEW YORK HEALTH" MEANS THE PROGRAM UNDER ARTICLE FIFTY-ONE OF THIS
CHAPTER.
  2. "PERSON" MEANS AN  INDIVIDUAL,  ASSOCIATION,  CORPORATION,  OR  ANY
OTHER LEGAL ENTITY.
  3. "HEALTH CARE PROVIDERS' REPRESENTATIVE" MEANS A THIRD PARTY THAT IS
AUTHORIZED  BY  HEALTH  CARE PROVIDERS TO NEGOTIATE ON THEIR BEHALF WITH
NEW YORK HEALTH OVER TERMS AND CONDITIONS AFFECTING  THOSE  HEALTH  CARE
PROVIDERS.
  4. "STRIKE" MEANS A WORK STOPPAGE IN PART OR IN WHOLE, DIRECT OR INDI-
RECT,  BY  A  BODY OF WORKERS TO GAIN COMPLIANCE WITH DEMANDS MADE ON AN
EMPLOYER.

S. 3525--A                         19

  5. "HEALTH CARE PROVIDER" MEANS A PERSON WHO IS  LICENSED,  CERTIFIED,
REGISTERED  OR  AUTHORIZED TO PRACTICE A HEALTH CARE PROFESSION PURSUANT
TO TITLE EIGHT OF THE EDUCATION LAW AND WHO PRACTICES THAT PROFESSION AS
A HEALTH CARE PROVIDER AS AN INDEPENDENT CONTRACTOR OR WHO IS AN  OWNER,
OFFICER,  SHAREHOLDER,  OR  PROPRIETOR  OF A HEALTH CARE PROVIDER; OR AN
ENTITY THAT EMPLOYS OR UTILIZES HEALTH CARE PROVIDERS TO PROVIDE  HEALTH
CARE  SERVICES,  INCLUDING  BUT NOT LIMITED TO A HOSPITAL LICENSED UNDER
ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR AN ACCOUNTABLE CARE ORGANIZATION
UNDER ARTICLE TWENTY-NINE-E OF THIS  CHAPTER.  A  HEALTH  CARE  PROVIDER
UNDER TITLE EIGHT OF THE EDUCATION LAW WHO PRACTICES AS AN EMPLOYEE OF A
HEALTH  CARE  PROVIDER  SHALL  NOT  BE DEEMED A HEALTH CARE PROVIDER FOR
PURPOSES OF THIS TITLE.
  S 4921. COLLECTIVE NEGOTIATION AUTHORIZED. 1.  HEALTH  CARE  PROVIDERS
MAY  MEET  AND  COMMUNICATE  FOR THE PURPOSE OF COLLECTIVELY NEGOTIATING
WITH NEW YORK HEALTH ON ANY MATTER RELATING TO NEW YORK HEALTH,  INCLUD-
ING BUT NOT LIMITED TO RATES OF PAYMENT AND PAYMENT METHODOLOGIES.
  2. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW OR AUTHORIZE AN
ALTERATION  OF  THE TERMS OF THE INTERNAL AND EXTERNAL REVIEW PROCEDURES
SET FORTH IN LAW.
  3. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO ALLOW A STRIKE OF NEW
YORK HEALTH BY HEALTH CARE PROVIDERS.
  4. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  ALLOW  OR  AUTHORIZE
TERMS OR CONDITIONS WHICH WOULD IMPEDE THE ABILITY OF NEW YORK HEALTH TO
OBTAIN  OR  RETAIN  ACCREDITATION  BY THE NATIONAL COMMITTEE FOR QUALITY
ASSURANCE OR A SIMILAR BODY OR TO COMPLY WITH APPLICABLE STATE OR FEDER-
AL LAW.
  S 4922. COLLECTIVE NEGOTIATION REQUIREMENTS. 1. COLLECTIVE NEGOTIATION
RIGHTS GRANTED BY THIS TITLE MUST CONFORM TO THE FOLLOWING REQUIREMENTS:
  (A) HEALTH CARE PROVIDERS  MAY  COMMUNICATE  WITH  OTHER  HEALTH  CARE
PROVIDERS  REGARDING  THE TERMS AND CONDITIONS TO BE NEGOTIATED WITH NEW
YORK HEALTH;
  (B) HEALTH CARE PROVIDERS MAY COMMUNICATE WITH HEALTH CARE  PROVIDERS'
REPRESENTATIVES;
  (C)  A HEALTH CARE PROVIDERS' REPRESENTATIVE IS THE ONLY PARTY AUTHOR-
IZED TO NEGOTIATE WITH NEW YORK HEALTH ON  BEHALF  OF  THE  HEALTH  CARE
PROVIDERS AS A GROUP;
  (D)  A  HEALTH  CARE PROVIDER CAN BE BOUND BY THE TERMS AND CONDITIONS
NEGOTIATED BY THE HEALTH CARE PROVIDERS' REPRESENTATIVES; AND
  (E) IN COMMUNICATING OR NEGOTIATING WITH THE  HEALTH  CARE  PROVIDERS'
REPRESENTATIVE, NEW YORK HEALTH IS ENTITLED TO OFFER AND PROVIDE DIFFER-
ENT TERMS AND CONDITIONS TO INDIVIDUAL COMPETING HEALTH CARE PROVIDERS.
  2.  NOTHING  IN THIS TITLE SHALL AFFECT OR LIMIT THE RIGHT OF A HEALTH
CARE PROVIDER OR GROUP OF HEALTH CARE PROVIDERS TO COLLECTIVELY PETITION
A GOVERNMENT ENTITY FOR A CHANGE IN A LAW, RULE, OR REGULATION.
  3. NOTHING IN THIS TITLE SHALL AFFECT OR LIMIT  COLLECTIVE  ACTION  OR
COLLECTIVE  BARGAINING  ON THE PART OF ANY HEALTH CARE PROVIDER WITH HIS
OR HER EMPLOYER OR ANY OTHER  LAWFUL  COLLECTIVE  ACTION  OR  COLLECTIVE
BARGAINING.
  S 4923. REQUIREMENTS FOR HEALTH CARE PROVIDERS' REPRESENTATIVE. BEFORE
ENGAGING  IN  COLLECTIVE  NEGOTIATIONS WITH NEW YORK HEALTH ON BEHALF OF
HEALTH CARE PROVIDERS, A HEALTH  CARE  PROVIDERS'  REPRESENTATIVE  SHALL
FILE  WITH THE COMMISSIONER, IN THE MANNER PRESCRIBED BY THE COMMISSION-
ER, INFORMATION IDENTIFYING  THE  REPRESENTATIVE,  THE  REPRESENTATIVE'S
PLAN OF OPERATION, AND THE REPRESENTATIVE'S PROCEDURES TO ENSURE COMPLI-
ANCE WITH THIS TITLE.

S. 3525--A                         20

  S  4924.  CERTAIN  COLLECTIVE  ACTION PROHIBITED. 1. THIS TITLE IS NOT
INTENDED TO AUTHORIZE COMPETING HEALTH CARE PROVIDERS TO ACT IN  CONCERT
IN  RESPONSE TO A HEALTH CARE PROVIDERS' REPRESENTATIVE'S DISCUSSIONS OR
NEGOTIATIONS WITH NEW YORK HEALTH EXCEPT AS AUTHORIZED BY OTHER LAW.
  2. NO HEALTH CARE PROVIDERS' REPRESENTATIVE SHALL NEGOTIATE ANY AGREE-
MENT  THAT  EXCLUDES,  LIMITS  THE PARTICIPATION OR REIMBURSEMENT OF, OR
OTHERWISE LIMITS THE SCOPE OF SERVICES TO BE PROVIDED BY ANY HEALTH CARE
PROVIDER OR GROUP OF HEALTH CARE PROVIDERS WITH RESPECT TO THE  PERFORM-
ANCE  OF  SERVICES  THAT  ARE WITHIN THE HEALTH CARE PROVIDER'S SCOPE OF
PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
  S 4925. FEES. EACH PERSON WHO ACTS AS THE REPRESENTATIVE OF  NEGOTIAT-
ING PARTIES UNDER THIS TITLE SHALL PAY TO THE DEPARTMENT A FEE TO ACT AS
A  REPRESENTATIVE.  THE COMMISSIONER, BY RULE, SHALL SET FEES IN AMOUNTS
DEEMED REASONABLE AND NECESSARY TO  COVER  THE  COSTS  INCURRED  BY  THE
DEPARTMENT IN ADMINISTERING THIS TITLE.
  S 4926. CONFIDENTIALITY. ALL REPORTS AND OTHER INFORMATION REQUIRED TO
BE  REPORTED  TO THE DEPARTMENT UNDER THIS TITLE SHALL NOT BE SUBJECT TO
DISCLOSURE UNDER ARTICLE SIX OF THE PUBLIC OFFICERS LAW OR ARTICLE THIR-
TY-ONE OF THE CIVIL PRACTICE LAW AND RULES.
  S 4927. SEVERABILITY AND CONSTRUCTION. IF ANY PROVISION OR APPLICATION
OF THIS TITLE SHALL BE HELD TO BE INVALID, OR TO VIOLATE  OR  BE  INCON-
SISTENT  WITH  ANY  APPLICABLE FEDERAL LAW OR REGULATION, THAT SHALL NOT
AFFECT OTHER PROVISIONS OR APPLICATIONS OF THIS TITLE WHICH CAN BE GIVEN
EFFECT WITHOUT THAT PROVISION OR  APPLICATION;  AND  TO  THAT  END,  THE
PROVISIONS  AND APPLICATIONS OF THIS TITLE ARE SEVERABLE. THE PROVISIONS
OF THIS TITLE SHALL  BE  LIBERALLY  CONSTRUED  TO  GIVE  EFFECT  TO  THE
PURPOSES THEREOF.
  S  6.  Subdivision  11  of  section  270  of the public health law, as
amended by section 2-a of part C of chapter 58 of the laws of  2008,  is
amended to read as follows:
  11.  "State  public  health plan" means the medical assistance program
established by title eleven of article five of the social  services  law
(referred  to in this article as "Medicaid"), the elderly pharmaceutical
insurance coverage program established by title three of article two  of
the  elder  law (referred to in this article as "EPIC"), and the [family
health plus program established by section three  hundred  sixty-nine-ee
of  the social services law to the extent that section provides that the
program shall be subject to this article] NEW YORK HEALTH PROGRAM ESTAB-
LISHED BY ARTICLE FIFTY-ONE OF THIS CHAPTER.
  S 7. The state finance law is amended by adding a new section 89-i  to
read as follows:
  S  89-I. NEW YORK HEALTH TRUST FUND. 1. THERE IS HEREBY ESTABLISHED IN
THE JOINT CUSTODY OF THE STATE COMPTROLLER AND THE COMMISSIONER OF TAXA-
TION AND FINANCE A SPECIAL REVENUE FUND TO BE KNOWN  AS  THE  "NEW  YORK
HEALTH  TRUST FUND", HEREINAFTER KNOWN AS "THE FUND". THE DEFINITIONS IN
SECTION FIFTY-ONE HUNDRED OF THE PUBLIC HEALTH LAW SHALL APPLY  TO  THIS
SECTION.
  2. THE FUND SHALL CONSIST OF:
  (A)  ALL MONIES OBTAINED FROM PREMIUMS PURSUANT TO LEGISLATION ENACTED
AS PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
  (B) FEDERAL PAYMENTS RECEIVED AS A RESULT OF ANY  WAIVER  OF  REQUIRE-
MENTS  GRANTED  OR  OTHER  ARRANGEMENTS  AGREED  TO BY THE UNITED STATES
SECRETARY OF HEALTH AND HUMAN  SERVICES  OR  OTHER  APPROPRIATE  FEDERAL
OFFICIALS  FOR  HEALTH  CARE  PROGRAMS  ESTABLISHED  UNDER MEDICARE, ANY
FEDERALLY-MATCHED PUBLIC HEALTH PROGRAM, OR THE AFFORDABLE CARE ACT;

S. 3525--A                         21

  (C) THE AMOUNTS PAID BY THE DEPARTMENT OF HEALTH THAT  ARE  EQUIVALENT
TO  THOSE  AMOUNTS  THAT  ARE  PAID ON BEHALF OF RESIDENTS OF THIS STATE
UNDER MEDICARE, ANY FEDERALLY-MATCHED  PUBLIC  HEALTH  PROGRAM,  OR  THE
AFFORDABLE  CARE  ACT FOR HEALTH BENEFITS WHICH ARE EQUIVALENT TO HEALTH
BENEFITS COVERED UNDER NEW YORK HEALTH;
  (D)  FEDERAL AND STATE FUNDS FOR PURPOSES OF THE PROVISION OF SERVICES
AUTHORIZED UNDER TITLE XX OF THE FEDERAL SOCIAL SECURITY ACT THAT  WOULD
OTHERWISE  BE  COVERED UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW;
AND
  (E) STATE MONIES THAT WOULD OTHERWISE BE APPROPRIATED TO  ANY  GOVERN-
MENTAL  AGENCY,  OFFICE,  PROGRAM,  INSTRUMENTALITY OR INSTITUTION WHICH
PROVIDES HEALTH SERVICES, FOR SERVICES AND BENEFITS  COVERED  UNDER  NEW
YORK HEALTH. PAYMENTS TO THE FUND PURSUANT TO THIS PARAGRAPH SHALL BE IN
AN  AMOUNT  EQUAL  TO  THE  MONEY  APPROPRIATED FOR SUCH PURPOSES IN THE
FISCAL YEAR BEGINNING IMMEDIATELY PRECEDING THE EFFECTIVE  DATE  OF  THE
NEW YORK HEALTH ACT.
  3.  MONIES  IN  THE  FUND  SHALL ONLY BE USED FOR PURPOSES ESTABLISHED
UNDER ARTICLE FIFTY-ONE OF THE PUBLIC HEALTH LAW.
  S 8. Temporary commission on implementation. 1. There is hereby estab-
lished a temporary commission on implementation of the New  York  Health
program,  hereinafter  to  be  known  as  the  commission, consisting of
fifteen members: five members, including the chair, shall  be  appointed
by the governor; four members shall be appointed by the temporary presi-
dent of the senate, one member shall be appointed by the senate minority
leader;  four members shall be appointed by the speaker of the assembly,
and one member shall be appointed by the assembly minority  leader.  The
commissioner  of  health,  the superintendent of financial services, and
the commissioner of taxation and finance, or their designees shall serve
as non-voting ex-officio members of the commission.
  2. Members of the commission shall receive such assistance as  may  be
necessary  from  other  state  agencies  and entities, and shall receive
necessary expenses incurred in the  performance  of  their  duties.  The
commission  may  employ staff as needed, prescribe their duties, and fix
their compensation within amounts appropriated for the commission.
  3. The commission shall examine the laws and regulations of the  state
and  make  such recommendations as are necessary to conform the laws and
regulations of the state and article 51 of the public health law  estab-
lishing the New York Health program and other provisions of law relating
to  the  New  York  Health  program,  and  to  improve and implement the
program. The commission shall report its recommendations to the governor
and the legislature.  The commission shall immediately begin development
of  proposals  consistent  with  the  principles  of  this  article  for
provision of long-term care coverage; health care services covered under
the workers' compensation law; and incorporation of retiree health bene-
fits,  as  described in paragraphs (a), (b) and (c) of subdivision eight
of section fifty-one hundred two of this article. The  commission  shall
provide  its work product and assistance to the board established pursu-
ant to section fifty-one hundred two of this article upon completion  of
the appointment of the board.
  S  9.  Severability. If any provision or application of this act shall
be held to be invalid, or to violate or be inconsistent with any  appli-
cable  federal law or regulation, that shall not affect other provisions
or applications of this act which  can  be  given  effect  without  that
provision  or  application; and to that end, the provisions and applica-
tions of this act are severable.
  S 10. This act shall take effect immediately.