S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5422
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 16, 2021
                                ___________
 
 Introduced by M. of A. KIM -- read once and referred to the Committee on
   Aging
 
 AN  ACT  to  amend the elder law, in relation to improving and expanding
   the pharmaceutical insurance coverage  program  for  certain  medicare
   enrollees
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 240 of  the  elder  law,  is  amended  to  read  as
 follows:
   §  240. Short title. This title shall be known and may be cited as the
 "program for [elderly] EXPANDED pharmaceutical insurance coverage".
   § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
 8 as added by section 2 of part A of chapter 59 of the laws of 2011  and
 as  renumbered by section 3 of part T of chapter 56 of the laws of 2012,
 are amended to read as follows:
   3. "Income" shall mean "household gross income" as defined in the real
 property tax circuit breaker credit program,  pursuant  to  subparagraph
 (C) of paragraph one of subsection (e) of section six hundred six of the
 tax  law,  but  only  shall include the income of program applicants and
 spouses and shall exclude the income of other members of the  household,
 BUT SHALL NOT INCLUDE ANY INCREASE IN INCOME DERIVED FROM SOCIAL SECURI-
 TY  INCOME  OR PENSION BENEFITS THAT INCREASE OVER THE PREVIOUS YEAR DUE
 SOLELY TO A COST OF LIVING ADJUSTMENT PROVIDED BY THE  PROGRAM  ADMINIS-
 TRATORS.
   8.  "Medicare  part  D  excluded drug classes" shall mean any drugs or
 classes of drugs, or their medical uses, which are described in  section
 1927(d)(2)  or  1927(d)(3)  of the federal social security act, with the
 exception of smoking cessation agents AND MEDICAL MARIJUANA DISPENSED IN
 THE STATE OF NEW YORK.
   § 3. The elder law is amended by adding a new section 242-a to read as
 follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD08041-01-1

 A. 5422                             2
 
   § 242-A. EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL.   1.  THERE
 IS  HEREBY  ESTABLISHED  WITHIN  THE EXECUTIVE DEPARTMENT, A PANEL TO BE
 KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
 PURPOSES OF THIS SECTION, THE TERM "THE PANEL" SHALL MEAN  THE  EXPANDED
 PHARMACEUTICAL INSURANCE COVERAGE PANEL.
   2.  THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS OF
 EDUCATION AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF  FINANCIAL
 SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
 OF  THE BUDGET. EACH PANEL MEMBER MAY DESIGNATE AN OFFICER OF HIS OR HER
 RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
 THE POWERS OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL  FROM  WHICH
 SUCH PANEL MEMBER MAY BE ABSENT.
   3.  THE  DIRECTOR  OF THE OFFICE FOR THE AGING AND THE COMMISSIONER OF
 HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
   4. THE PANEL SHALL MEET AT SUCH TIMES  AS  MAY  BE  REQUESTED  BY  THE
 CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
   5. THE PANEL SHALL:
   (A)  SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, PROMULGATE
 PROGRAM REGULATIONS PURSUANT TO SECTION TWO HUNDRED  FORTY-SIX  OF  THIS
 TITLE;
   (B)  DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES OF
 ELIGIBLE PROGRAM PARTICIPANTS PURSUANT TO SECTIONS  TWO  HUNDRED  FORTY-
 SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
   (C)  ENTER  INTO CONTRACTS PURSUANT TO SECTION TWO HUNDRED FORTY-THREE
 OF THIS TITLE;
   (D) RECOMMEND AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS  FOR  THE
 EFFICIENT  AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH THE
 PROVISIONS OF THIS TITLE WITH THE ADVICE OF THE  ADVISORY  COMMITTEE  AS
 DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
   (E)  DEVELOP  AND  IMPLEMENT, IN COOPERATION WITH AREA OFFICES FOR THE
 AGING, AN OUTREACH PROGRAM TO INFORM  ELIGIBLE  APPLICANTS  OF  BENEFITS
 THEY  MAY  BE  ENTITLED TO PURSUANT TO THIS TITLE, AND TO MAKE AVAILABLE
 INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
 COVERAGE  AND  BENEFITS  TO  WHICH  THEY  MAY  BE  ENTITLED  THROUGH   A
 PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
   (F)  PREPARE  AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO THE GOVERNOR,
 THE TEMPORARY PRESIDENT OF THE SENATE, AND THE SPEAKER OF  THE  ASSEMBLY
 NO  LATER  THAN  THE  FIRST DAY OF JANUARY OF EACH YEAR. THE PANEL SHALL
 INCLUDE IN SUCH REPORT, AT A  MINIMUM,  ANNUAL  STATISTICAL  INFORMATION
 REGARDING  THE  NUMBER  OF  PERSONS  ENROLLED  IN THE PROGRAM BY MARITAL
 STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
 NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
 RECEIVE AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE  FEDERAL
 SOCIAL  SECURITY  ACT,  AND  THE  NUMBER  THAT  SO QUALIFY THROUGH THEIR
 ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
 PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
 ADMINISTRATIVE COST CONTAINMENT INITIATIVES COMPLETED DURING  THE  YEAR,
 PROJECTIONS  OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN EVALU-
 ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
 THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
   6. THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES
 AS PANEL MEMBERS.
   7.  THERE  SHALL  BE  AN  ADVISORY COMMITTEE TO THE PANEL COMPRISED OF
 TWELVE PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR,  THREE
 MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
 MEMBER  SHALL  BE  APPOINTED BY THE MINORITY LEADER OF THE SENATE, THREE

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 MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
 SHALL BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.  THE  COMMIT-
 TEE  MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS, PHARMA-
 CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
 SIXTY  PERCENT  OF  THE  COMMITTEE MEMBERSHIP SHALL REPRESENT CONSUMERS.
 COMMITTEE MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES  BUT
 SHALL  BE  ALLOWED  THEIR  ACTUAL AND NECESSARY EXPENSES INCURRED IN THE
 PERFORMANCE OF THEIR DUTIES.
   § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
 1 as amended by section 4 of part T of chapter 56 of the laws  of  2012,
 and  subdivision  2  as amended by section 12 of part A of chapter 60 of
 the laws of 2014, are amended to read as follows:
   1. Persons eligible  for  comprehensive  coverage  under  section  two
 hundred forty-seven of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
 TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE  YEAR
 TWO  THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS  OF  AGE,  DURING
 THE  YEAR  TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
 AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY  YEARS
 OF  AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
 FIVE YEARS OF AGE, OR DURING THE YEAR TWO  THOUSAND  TWENTY-NINE  IS  AT
 LEAST  EIGHTEEN  YEARS  OF  AGE;  and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 beginning  on or after January first, two thousand five, is less than or
 equal to twenty thousand dollars.   After the initial  determination  of
 eligibility,  each  eligible individual must be redetermined eligible at
 least every twenty-four months; and
   (b) any married resident who IS ENROLLED IN MEDICARE AND is  at  least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
 TWO  THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE YEAR
 TWO THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING  THE
 YEAR  TWO  THOUSAND  TWENTY-THREE IS AT LEAST FIFTY YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS  OF  AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
 AGE,  DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS  AT  LEAST  TWENTY-
 FIVE  YEARS  OF  AGE,  OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
 LEAST EIGHTEEN YEARS OF AGE; and whose  income  for  the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 when combined with the income in the same calendar year of such  married
 person's  spouse  beginning on or after January first, two thousand one,
 is less than or equal to twenty-six thousand dollars. After the  initial
 determination  of eligibility, each eligible individual must be redeter-
 mined eligible at least every twenty-four months.
   2. Persons  eligible  for  catastrophic  coverage  under  section  two
 hundred forty-eight of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
 TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE  YEAR
 TWO  THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS  OF  AGE,  DURING

 A. 5422                             4
 
 THE  YEAR  TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
 AGE,  DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS  AT  LEAST  TWENTY-
 FIVE  YEARS  OF  AGE,  OR DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT
 LEAST EIGHTEEN YEARS OF AGE; and whose  income  for  the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 beginning on or after January first, two  thousand  one,  is  more  than
 twenty thousand and less than or equal to seventy-five thousand dollars.
 After the initial determination of eligibility, each eligible individual
 must be redetermined eligible at least every twenty-four months; and
   (b)  any  married  resident  who  is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY, DURING THE YEAR
 TWO THOUSAND TWENTY-ONE IS AT LEAST SIXTY YEARS OF AGE, DURING THE  YEAR
 TWO  THOUSAND TWENTY-TWO IS AT LEAST FIFTY-FIVE YEARS OF AGE, DURING THE
 YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST FIFTY YEARS  OF  AGE,  DURING
 THE  YEAR  TWO THOUSAND TWENTY-FOUR IS AT LEAST FORTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FORTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST THIRTY-FIVE YEARS OF
 AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST THIRTY  YEARS
 OF  AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST TWENTY-
 FIVE YEARS OF AGE, OR DURING THE YEAR TWO  THOUSAND  TWENTY-NINE  IS  AT
 LEAST  EIGHTEEN  YEARS  OF  AGE;  and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 when  combined with the income in the same calendar year of such married
 person's spouse beginning on or after January first, two  thousand  one,
 is  more  than twenty-six thousand dollars and less than or equal to one
 hundred thousand dollars. After the initial determination  of  eligibil-
 ity,  each  eligible  individual  must be redetermined eligible at least
 every twenty-four months.
   § 5. Paragraphs (e) and (f) of subdivision 3 of  section  242  of  the
 elder  law, paragraph (e) as amended by section 3-d of part A of chapter
 59 of the laws of 2011, and paragraph (f) as amended  by  section  1  of
 part  T  of  chapter  56  of  the  laws  of 2012, are amended to read as
 follows:
   (e) As a condition of eligibility for benefits under this title, if  a
 program  participant's  income  indicates  that the participant could be
 eligible for an income-related subsidy under  section  1860D-14  of  the
 federal  social  security  act by either applying for such subsidy or by
 enrolling in a medicare savings program as a qualified medicare  benefi-
 ciary  (QMB),  a  specified low-income medicare beneficiary (SLMB), or a
 qualifying  individual  (QI),  a  program  participant  is  required  to
 provide,  and  to authorize the [elderly] EXPANDED pharmaceutical insur-
 ance coverage  program  to  obtain,  any  information  or  documentation
 required  to  establish  the participant's eligibility for such subsidy,
 and to authorize the [elderly] EXPANDED pharmaceutical insurance  cover-
 age program to apply on behalf of the participant for the subsidy or the
 medicare  savings  program.  [The elderly] UPON RECEIPT OF AN ENROLLMENT
 APPLICATION, OR AT ANY TIME AFTER ENROLLMENT WHEN THE PROGRAM HAS INFOR-
 MATION THAT INDICATES AN  ENROLLEE  IS  ELIGIBLE  FOR  A  SUBSIDY  UNDER
 SECTION  1860D-14  OF  THE  FEDERAL SOCIAL SECURITY ACT OR IN A MEDICARE
 SAVINGS PROGRAM, THE EXPANDED pharmaceutical insurance coverage  program
 shall  make a reasonable effort to notify the program participant of his
 or her need to provide any of the above required  information.  After  a
 reasonable  effort  has  been made to contact the participant, a partic-

 A. 5422                             5
 
 ipant 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 participant's coverage  may  be  termi-
 nated.   A PROGRAM PARTICIPANT WHO IS ELIGIBLE TO ENROLL IN THE MEDICARE
 SAVINGS PROGRAM SHALL BE ASSISTED TO DO SO, AND THEIR  EXPANDED  PHARMA-
 CEUTICAL  INSURANCE  COVERAGE  PROGRAM  ENROLLMENT  SHALL  BE  IN  PLACE
 THROUGHOUT THE MEDICARE SAVINGS PROGRAM APPLICATION PROCESS.
   (f) As a condition of eligibility for benefits  under  this  title,  a
 program participant is required to be enrolled in Medicare part D and to
 maintain  such  enrollment.  For  unmarried participants with individual
 annual income less than or equal to twenty-three  thousand  dollars  and
 married  participants  with  joint  annual  income less than or equal to
 twenty-nine thousand  dollars,  the  [elderly]  EXPANDED  pharmaceutical
 insurance  coverage  program  shall  pay  for  the portion of the part D
 monthly premium, AND ANY LATE ENROLLMENT  PENALTY  THAT  MAY  HAVE  BEEN
 ASSESSED,  that  is  the  responsibility  of the participant. Such TOTAL
 payment shall be 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  minimus
 premium policy.
   §  6.  Subdivision  3  of  section  250 of the elder law is amended by
 adding a new paragraph (f) to read as follows:
   (F) THE EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PROGRAM SHALL  POST
 TO ITS WEBSITE THE NAMES OF MANUFACTURERS THAT HAVE A REBATE PROGRAM AND
 LIST  THE DRUGS THAT ARE COVERED BY SUCH REBATE PROGRAM IN A MANNER THAT
 PROVIDES ENROLLEES WITH ACCESS TO SUCH INFORMATION PRIOR TO  THE  ANNUAL
 MEDICARE OPEN ENROLLMENT PERIOD.
   § 7. This act shall take effect immediately.