S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4371
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             February 10, 2017
                                ___________
 
 Introduced  by  Sens.  PERKINS,  ADDABBO,  ALCANTARA,  AVELLA,  BRESLIN,
   COMRIE, DILAN, HAMILTON, HOYLMAN, KRUEGER, LATIMER, MONTGOMERY,  PARK-
   ER,  PERALTA, PERSAUD, RIVERA, SANDERS, SERRANO, SQUADRON, STAVISKY --
   read twice and ordered printed, and when printed to  be  committed  to
   the Committee on Health

 AN  ACT  to  amend  the  public health law and the state finance law, in
   relation to enacting the "New York health act" and to establishing New
   York Health
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "New York health act".
   § 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,  §3.)  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.
              

                                                            LBD09305-01-7

 S. 4371                             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. 4371                             3
 
   §  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.
   § 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,
 SERVICES AND SUPPORTS, 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. 4371                             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.
   § 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. 4371                             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.
   7. THE PROGRAM SHALL BE DEEMED TO BE A HEALTH CARE PLAN  FOR  PURPOSES
 OF  UTILIZATION  REVIEW  AND EXTERNAL APPEAL UNDER ARTICLE FORTY-NINE OF
 THIS CHAPTER.
   8. NO MEMBER SHALL BE REQUIRED TO  RECEIVE  ANY  HEALTH  CARE  SERVICE
 THROUGH  ANY  ENTITY  ORGANIZED, CERTIFIED OR OPERATING UNDER GUIDELINES
 UNDER ARTICLE FORTY-FOUR OF THIS CHAPTER,  OR  SPECIFIED  UNDER  SECTION
 THREE  HUNDRED  SIXTY-FOUR-J  OF THE SOCIAL SERVICES LAW. NO SUCH ENTITY
 SHALL RECEIVE PAYMENT FOR HEALTH CARE SERVICES (OTHER THAN CARE  COORDI-
 NATION) FROM THE PROGRAM.
   § 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) TWENTY-SIX TRUSTEES APPOINTED BY THE GOVERNOR;
   (I) SIX OF WHOM SHALL BE REPRESENTATIVES OF HEALTH CARE CONSUMER ADVO-
 CACY  ORGANIZATIONS WHICH HAVE A STATEWIDE OR REGIONAL CONSTITUENCY, WHO
 HAVE BEEN INVOLVED IN ACTIVITIES RELATED TO HEALTH CARE CONSUMER ADVOCA-
 CY, INCLUDING ISSUES OF INTEREST TO LOW-  AND  MODERATE-INCOME  INDIVID-
 UALS;
   (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 GENERAL HOSPITALS,  ONE
 OF WHOM SHALL BE A REPRESENTATIVE OF PUBLIC GENERAL HOSPITALS;
   (V) ONE OF WHOM SHALL BE A REPRESENTATIVE OF COMMUNITY HEALTH CENTERS;
   (VI) TWO OF WHOM SHALL BE REPRESENTATIVES OF LONG TERM CARE PROVIDERS;

 S. 4371                             6
 
   (VII)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF BEHAVIORAL OR MENTAL
 HEALTH CARE PROVIDERS;
   (VIII)  TWO  OF WHOM SHALL BE REPRESENTATIVES OF HEALTH CARE ORGANIZA-
 TIONS;
   (IX) TWO OF WHOM SHALL BE REPRESENTATIVES OF ORGANIZED LABOR;
   (X) TWO OF WHOM SHALL  HAVE  DEMONSTRATED  EXPERTISE  IN  HEALTH  CARE
 FINANCE; AND
   (XI)  TWO  OF  WHOM SHALL BE EMPLOYERS OR REPRESENTATIVES OF EMPLOYERS
 WHO PAY THE PAYROLL TAX UNDER THIS ARTICLE, OR, PRIOR TO THE TAX  BECOM-
 ING EFFECTIVE, WILL PAY THE TAX;
   (C)  FOURTEEN  TRUSTEES  APPOINTED BY THE GOVERNOR; FIVE OF WHOM TO BE
 APPOINTED ON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEMBLY; FIVE  OF
 WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
 THE  SENATE;  TWO  OF  WHOM TO BE APPOINTED ON THE RECOMMENDATION OF THE
 MINORITY LEADER OF THE ASSEMBLY; AND TWO 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-

 S. 4371                             7
 
 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.
   §  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.
   3.  A  NEWBORN  CHILD  SHALL BE ENROLLED AS OF THE DATE OF THE CHILD'S
 BIRTH IF ENROLLMENT IS DONE PRIOR TO THE CHILD'S BIRTH OR  WITHIN  SIXTY
 DAYS AFTER THE CHILD'S BIRTH.
   4.  THE  PROGRAM  SHALL  PROVIDE  FOR PAYMENT FOR HEALTH CARE SERVICES
 PROVIDED TO MEMBERS OR INDIVIDUALS ENTITLED TO BECOME MEMBERS  WHO  HAVE
 NOT  HAD  A  REASONABLE  OPPORTUNITY TO ENROLL IN THE PROGRAM, INCLUDING
 NEWLY ARRIVED RESIDENTS.
   § 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; AND
   (G)  ANY  ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED TO THE
 PROGRAM'S BENEFITS BY THE PROGRAM;
   (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.
   § 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

 S. 4371                             8
 
 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;
   (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 CHANGING 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

 S. 4371                             9
 
 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
 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.

 S. 4371                            10
 
   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
 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.
   § 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

 S. 4371                            11
 
 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
 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.
   §  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-

 S. 4371                            12
 
 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
 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.
   § 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.
   § 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

 S. 4371                            13
 
 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
 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 DIMINISH 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-

 S. 4371                            14
 
 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.
   (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.
   §  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

 S. 4371                            15
 
 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
 RESEARCH  PROGRAMS  OF  THE DEPARTMENT, CONSISTENT WITH THIS ARTICLE AND
 OTHERWISE APPLICABLE LAW.
   § 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;

 S. 4371                            16
 
   (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
   (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

 S. 4371                            17
 
   (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.
   § 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
 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.

 S. 4371                            18
 
   (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
 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. 4371                            19
 
   § 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.
   § 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.
   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.
   §  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.
   § 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;

 S. 4371                            20
 
   (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.
   § 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.
   §  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.
   §  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.
   § 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.
   § 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.
   § 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

 S. 4371                            21
 
 (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.
   §  7. The state finance law is amended by adding a new section 89-i to
 read as follows:
   § 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;
   (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.
   § 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

 S. 4371                            22
 
 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  8  of
 section 5102 of the public health law.  The commission shall provide its
 work product and assistance to the board established pursuant to section
 5102  of the public health law upon completion of the appointment of the
 board.
   § 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.
   § 10. This act shall take effect immediately.