S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7897
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               July 19, 2023
                                ___________
 
 Introduced   by   M.   of  A.  PAULIN,  DINOWITZ,  L. ROSENTHAL,  STECK,
   BICHOTTE HERMELYN, SAYEGH, REYES, GONZALEZ-ROJAS,  RAJKUMAR,  FORREST,
   KELLES,   ANDERSON,  ARDILA,  BARRETT,  BENEDETTO,  BRONSON,  BURDICK,
   BURGOS,  BURKE,  CARROLL,  CLARK,   COLTON,   COOK,   CRUZ,   DARLING,
   DE LOS SANTOS, DICKENS, DILAN, EPSTEIN, FALL, GALLAGHER, HUNTER, HYND-
   MAN,  JACKSON, JEAN-PIERRE, JOYNER, KIM, LAVINE, LEE, LUNSFORD, LUPAR-
   DO, MAMDANI, MEEKS, MITAYNES, OTIS, PEOPLES-STOKES,  RAGA,  SEAWRIGHT,
   SEPTIMO,  SHRESTHA,  SILLITTI,  SIMON, SIMONE, STIRPE, TAYLOR, THIELE,
   VANEL, WALKER, WALLACE, WEPRIN, WILLIAMS, ZINERMAN --  Multi-Sponsored
   by  -- M. of A. AUBRY, DAVILA, FAHY, GLICK, GUNTHER, MAGNARELLI, PRET-
   LOW, ROZIC -- read once and referred to the Committee on Health
 
 AN ACT to amend the public health law and  the  state  finance  law,  in
   relation  to  enacting  the "New York health act" and 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.  Millions of New Yorkers do not get the health care
 they  need  or face financial obstacles and hardships to get it. That is
 not acceptable.  There is no plan that has been put forward  other  than
 the  New  York  health  act that will enable New York state to meet that
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02408-02-3
              

 A. 7897                             2
 
 need.  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.  Many New Yorkers go
 without health care because they cannot afford it or suffer  significant
 financial  hardship  to  get  it.    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.    Including  long-term
 services  and supports (LTSS) in New York Health is a major step forward
 for older adults, people with disabilities, and  their  families.  Older
 adults  and  people  with disabilities often cannot receive the services
 necessary to stay in the community or other LTSS. Even when older adults
 and people with disabilities receive LTSS, especially  services  in  the
 community, it is often at great cost and creates unreasonable demands on
 unpaid  family  caregivers,  depleting their own or family resources, or
 impoverishing themselves to qualify for public coverage.    Health  care
 providers  are  also  affected by inadequate health coverage in New York
 state. A large portion of hospitals, health centers and other  providers
 now  experience  substantial losses due to the provision of care that is
 uncompensated.  Medicaid and Medicare often do not pay  rates  that  are
 reasonably  related  to  the  cost  of efficiently providing health care
 services and sufficient to assure an adequate and accessible  supply  of
 health  care  services,  as  guaranteed  under  the New York Health Act.
 Individuals often find that they are deprived  of  affordable  care  and
 choice because of decisions by health plans guided by the plan's econom-
 ic  interests rather than the individual's 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 guaranteed  health
 care  coverage  program  and  a  health care cost control system for the
 benefit of all residents of the state of New York.
   2. (a) It is the intent of the Legislature  to  create  the  New  York
 Health program to provide a universal single payer health plan for every
 resident of the state, funded by broad-based revenue based on ability to
 pay.    The  legislature  intends  that federal waivers and approvals be
 sought where they will improve the administration of the New York Health
 program, but the legislature intends that  the  program  be  implemented
 even  in the absence of such waivers or approvals.  The state shall work
 to obtain waivers and other approvals relating to Medicaid, Child Health
 Plus, Medicare, the Basic Health Plan (Essential Plan),  the  Affordable
 Care Act, and any other appropriate federal programs, under which feder-
 al  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, or paid to health care providers and individuals in
 combination with New York Health trust  fund  payments,  and  for  other
 program  modifications (including elimination of cost sharing and insur-
 ance premiums).  Under such waivers and approvals, health coverage under
 those programs will, to the maximum extent  possible,  be  replaced  and
 merged  into  New York Health, which will operate as a true single-payer
 program.
 A. 7897                             3
 
   (b) If any necessary waiver or approval is  not  obtained,  the  state
 shall  use state plan amendments and seek waivers and approvals to maxi-
 mize, and make as seamless as possible, the use of  federally-subsidized
 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.
   (c)  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.
   (d) The program shall promote the use of clinical data to improve  the
 quality  of health care and public health, consistent with protection of
 patient confidentiality. The program shall maximize patient autonomy  in
 choice  of  health care providers and health care decision making.  Care
 coordination within the program shall ensure management and coordination
 among a patient's health care services, consistent with patient autonomy
 and person-centered service planning, rather than acting as a gatekeeper
 to needed services.
   (e) The program shall operate with care, skill,  prudence,  diligence,
 and professionalism, and for the best interests primarily of the members
 and health care providers.
   3.  This  act  does  not create or relate to any employment benefit or
 employment benefit plan, nor does it require,  prohibit,  or  limit  the
 providing of any employment benefit or employment benefit plan.
   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.
   5.  There  have  been numerous professional economic analyses of state
 and national single-payer  health  proposals,  including  the  New  York
 Health Act, by noted consulting firms and academic economists. They have
 almost  all  come  to  similar conclusions of net savings in the cost of
 health coverage and health care. These savings are driven by (a)  elimi-
 nating  the  administrative  bureaucracy costs, marketing, and profit of
 multiple health plans and replacing that  with  the  dramatically  lower
 costs  of  running a single-payer system; (b) substantially reducing the
 administrative costs borne by health care providers dealing  with  those
 health  plans; and (c) using the negotiating power of 20 million consum-
 ers to achieve lower drug prices. These savings will  more  than  offset
 costs primarily from (a) relieving patients of deductibles, co-pays, and
 out-of-network  charges;  (b)  covering  the  uninsured;  (c) increasing
 provider payment rates  above  Medicare  and  Medicaid  rates;  and  (d)
 replacing uncompensated home health care with paid care. Unlike premiums
 A. 7897                             4
 
 and out-of-pocket spending, the New York Health Act tax will be progres-
 sively  graduated  based  on  ability to pay.   The vast majority of New
 Yorkers today spend dramatically more in premiums, deductibles and other
 out-of-pocket  costs  than they will in New York Health Act taxes.  They
 will have broader coverage (including  long-term  care),  no  restricted
 provider  networks  or  out-of-network  charges,  and  no deductibles or
 co-pays.
   § 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, BUT IS NOT LIMITED TO, MANAGING, REFER-
 RING 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 COORDINATION DOES NOT
 INCLUDE A REQUIREMENT FOR PRIOR AUTHORIZATION FOR HEALTH  CARE  SERVICES
 OR FOR REFERRAL FOR A MEMBER TO RECEIVE A HEALTH CARE SERVICE.
   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-SUBSIDIZED  PUBLIC  HEALTH  PROGRAM"  MEANS THE MEDICAL
 ASSISTANCE 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  PROVIDER"  MEANS  ANY  INDIVIDUAL OR ENTITY LEGALLY
 AUTHORIZED TO PROVIDE A HEALTH CARE SERVICE UNDER MEDICAID  OR  MEDICARE
 OR THIS ARTICLE. "HEALTH CARE PROFESSIONAL" MEANS A HEALTH CARE PROVIDER
 THAT  IS  AN  INDIVIDUAL  LICENSED,  CERTIFIED,  REGISTERED OR OTHERWISE
 AUTHORIZED TO PRACTICE UNDER TITLE EIGHT OF THE EDUCATION LAW  OR  UNDER
 THIS  CHAPTER  TO  PROVIDE SUCH HEALTH CARE SERVICE, ACTING WITHIN THEIR
 LAWFUL SCOPE OF PRACTICE.
 A. 7897                             5
 
   7. "HEALTH CARE SERVICE" MEANS ANY HEALTH CARE SERVICE, INCLUDING CARE
 COORDINATION, INCLUDED AS A BENEFIT UNDER THE PROGRAM.
   8. "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.
   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.  "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  REGU-
 LATIONS  OR  GUIDANCE  ISSUED THEREUNDER.   "BASIC HEALTH PROGRAM" MEANS
 SECTION THREE HUNDRED SIXTY-NINE-GG OF THE SOCIAL SERVICES LAW  AND  THE
 PROGRAM THEREUNDER.
   10.  "MEMBER" OR "ENROLLEE" MEANS AN INDIVIDUAL WHO IS ENROLLED IN THE
 PROGRAM.
   11. "NEW YORK HEALTH", "NEW YORK HEALTH PROGRAM", AND  "PROGRAM"  MEAN
 THE  NEW YORK HEALTH PROGRAM CREATED BY SECTION FIFTY-ONE HUNDRED ONE OF
 THIS ARTICLE.
   12. "NEW YORK HEALTH TRUST FUND" MEANS THE NEW YORK HEALTH TRUST  FUND
 ESTABLISHED UNDER SECTION EIGHTY-NINE-K OF THE STATE FINANCE LAW.
   13.  "OUT-OF-STATE  HEALTH  CARE  SERVICE" MEANS A HEALTH CARE SERVICE
 PROVIDED TO A MEMBER: (A) WHILE THE MEMBER IS  TEMPORARILY  OUT  OF  THE
 STATE  AND (I) IT IS MEDICALLY NECESSARY THAT THE HEALTH CARE SERVICE BE
 PROVIDED WHILE THE MEMBER IS OUT OF THE STATE, OR (II) 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;
 OR  (B)  PROVIDED  TO A MEMBER DEEMED TO BE A "RESIDENT" UNDER PARAGRAPH
 (B) OF SUBDIVISION SEVENTEEN  OF  THIS  SECTION  IN  THE  STATE  OF  THE
 MEMBER'S  PRIMARY  PLACE  OF  ABODE.  HOWEVER,  ANY  HEALTH CARE SERVICE
 PROVIDED TO A NEW YORK HEALTH ENROLLEE BY A HEALTH CARE PROVIDER  QUALI-
 FIED  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.
   14.  "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.
   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.  "PRESCRIPTION  DRUGS"  MEANS  PRESCRIPTION  DRUGS  AS  DEFINED IN
 SECTION TWO HUNDRED SEVENTY OF THIS  CHAPTER,  AND  SHALL  ALSO  INCLUDE
 NON-PRESCRIPTION SMOKING CESSATION PRODUCTS OR DEVICES.
   17. "RESIDENT" MEANS AN INDIVIDUAL (A) WHOSE PRIMARY PLACE OF ABODE IS
 IN THE STATE; OR (B) IN THE CASE OF AN INDIVIDUAL WHOSE PRIMARY PLACE OF
 ABODE IS NOT IN THE STATE, WHO IS EMPLOYED OR SELF-EMPLOYED FULL-TIME IN
 THE  STATE.    RESIDENT STATUS SHALL BE DETERMINED WITHOUT REGARD TO THE
 INDIVIDUAL'S IMMIGRATION STATUS, AND ACCORDING  TO  REGULATIONS  OF  THE
 A. 7897                             6
 
 COMMISSIONER.    SUCH  REGULATIONS SHALL INCLUDE A PROCESS FOR APPEALING
 DENIALS OF RESIDENCY.
   §  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 RETIREE HEALTH BENEFITS UNDER THIS ARTICLE.
 IN IMPLEMENTING THIS ARTICLE, 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.  INDIVIDUALS MAY NOT
 ENROLL IN THE NEW YORK HEALTH PROGRAM UNTIL THE LEGISLATURE HAS  ENACTED
 THE  REVENUE  PROPOSAL, AS AMENDED, AND AS THE LEGISLATURE SHALL FURTHER
 PROVIDE.
   4. AN INSURER AUTHORIZED TO PROVIDE COVERAGE UNDER 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 SUBDIVI-
 SION SHALL NOT PROHIBIT (A) THE OFFERING OF ANY BENEFITS TO OR FOR INDI-
 VIDUALS, INCLUDING THEIR FAMILIES, WHO ARE EMPLOYED OR SELF-EMPLOYED  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, THE INSURANCE LAW OR THE ELDER 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;  OR
 EXPLICITLY REQUIRED BY APPLICABLE FEDERAL LAW OR REGULATIONS; 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.  (A) (I) THE PROGRAM SHALL BE DEEMED TO BE A HEALTH CARE  PLAN  FOR
 PURPOSES  OF  EXTERNAL  APPEAL  UNDER ARTICLE FORTY-NINE OF THIS CHAPTER
 (REFERRED TO IN THIS SUBDIVISION AS "ARTICLE  FORTY-NINE"),  SUBJECT  TO
 THIS SUBDIVISION AND ANY OTHER APPLICABLE PROVISION OF THIS ARTICLE.
   (II)    AN  EXTERNAL APPEAL SHALL NOT REQUIRE UTILIZATION REVIEW OR AN
 ADVERSE DETERMINATION UNDER TITLE ONE  OF  ARTICLE  FORTY-NINE  OF  THIS
 CHAPTER.  ANY REFERENCE IN ARTICLE FORTY-NINE TO UTILIZATION REVIEW OR A
 UNIVERSAL  REVIEW AGENT SHALL MEAN THE PROGRAM.  WHERE THE PROGRAM MAKES
 AN ADVERSE DETERMINATION, AN EXTERNAL APPEAL SHALL BE  AUTOMATIC  UNLESS
 SPECIFICALLY WAIVED OR WITHDRAWN BY THE MEMBER OR THE MEMBER'S DESIGNEE.
 A. 7897                             7
 
 SERVICES,  INCLUDING  SERVICES  PROVIDED  FOR  A CHRONIC CONDITION, WILL
 CONTINUE UNCHANGED UNTIL THE OUTCOME OF THE EXTERNAL APPEAL DECISION  IS
 ISSUED.  WHERE  AN  EXTERNAL  APPEAL  IS  INITIATED  OR  PURSUED  BY THE
 PATIENT'S  HEALTH CARE PROVIDER, THE PROVIDER SHALL NOTIFY THE MEMBER OR
 THE MEMBER'S DESIGNEE, AND IT  SHALL  BE  SUBJECT  TO  THE  MEMBER'S  OR
 MEMBER'S  DESIGNEE'S RIGHT TO WAIVE OR WITHDRAW THE EXTERNAL APPEAL.  NO
 FEE SHALL BE REQUIRED TO BE PAID BY ANY  PARTY  IN  CONNECTION  WITH  AN
 EXTERNAL APPEAL, INCLUDING THE MEMBER'S HEALTH CARE PROVIDER.
   (III)    WHERE AN EXTERNAL APPEAL IS DENIED, THE EXTERNAL APPEAL AGENT
 SHALL NOTIFY THE MEMBER OR THE MEMBER'S DESIGNEE AND, WHERE APPROPRIATE,
 THE MEMBER'S HEALTH CARE PROVIDER,  WITHIN  TWO  BUSINESS  DAYS  OF  THE
 DETERMINATION.    THE  NOTICE SHALL INCLUDE A STATEMENT THAT THE MEMBER,
 MEMBER'S DESIGNEE OR HEALTH CARE PROVIDER HAS THE RIGHT  TO  APPEAL  THE
 DETERMINATION TO A FAIR HEARING UNDER THIS SUBDIVISION AND SEEK JUDICIAL
 REVIEW.
   (IV)  AN ENROLLEE MAY DESIGNATE A PERSON OR ENTITY, INCLUDING, BUT NOT
 LIMITED  TO,  THE  ENROLLEE'S  FAMILY MEMBER, CARE COORDINATOR, A HEALTH
 CARE ORGANIZATION PROVIDING THE SERVICE UNDER REVIEW  OR  APPEAL,  OR  A
 LABOR UNION OR AN ENTITY AFFILIATED WITH AND DESIGNATED BY A LABOR UNION
 OF  WHICH THE ENROLLEE OR ENROLLEE'S FAMILY MEMBER IS A MEMBER, TO SERVE
 AS THE ENROLLEE'S DESIGNEE FOR PURPOSES OF THAT ARTICLE, IF  THE  PERSON
 OR ENTITY AGREES TO BE THE DESIGNEE.
   (B)  (I)  THIS PARAGRAPH APPLIES WHERE AN EXTERNAL APPEAL IS DENIED IN
 WHOLE OR IN PART; OR THE PROGRAM  DENIES  COVERAGE  FOR  A  HEALTH  CARE
 SERVICE  ON  ANY  GROUNDS  OTHER  THAN  UNDER ARTICLE FORTY-NINE; OR THE
 PROGRAM MAKES ANY OTHER DETERMINATION AS TO A MEMBER OR INDIVIDUAL SEEK-
 ING TO BECOME A MEMBER, CONTRARY TO THE INTEREST OF THE MEMBER OR  INDI-
 VIDUAL (INCLUDING BUT NOT LIMITED TO A DENIAL OF ELIGIBILITY FOR LACK OF
 RESIDENCE).
   (II)  THE  PROGRAM  SHALL  NOTIFY  THE  MEMBER OR INDIVIDUAL, MEMBER'S
 DESIGNEE OR HEALTH CARE PROVIDER, AS APPROPRIATE, THAT  THE  PERSON  HAS
 THE  RIGHT  TO  APPEAL  THE  DETERMINATION  TO A FAIR HEARING UNDER THIS
 SUBDIVISION OR SEEK JUDICIAL REVIEW.
   (III)  THE COMMISSIONER SHALL ESTABLISH BY REGULATION  A  PROCESS  FOR
 FAIR  HEARINGS  UNDER THIS SUBDIVISION.   THE PROCESS SHALL AT A MINIMUM
 CONFORM TO THE STANDARDS FOR FAIR HEARINGS UNDER SECTION  TWENTY-TWO  OF
 THE SOCIAL SERVICES LAW.
   (C)    ARTICLE SEVENTY-EIGHT OF THE CIVIL PRACTICE LAW AND RULES SHALL
 APPLY TO ANY MATTER UNDER THIS ARTICLE.
   8. (A) 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, THE INSURANCE LAW
 OR  THE  ELDER LAW. NO SUCH ENTITY SHALL RECEIVE PAYMENT FOR HEALTH CARE
 SERVICES (OTHER THAN CARE COORDINATION) FROM THE PROGRAM.
   (B) HOWEVER, THIS SUBDIVISION  SHALL  NOT  PRECLUDE  THE  USE  OF  ANY
 PROGRAM  OR ENTITY WHERE REASONABLY NECESSARY TO MAXIMIZE FEDERAL FINAN-
 CIAL PARTICIPATION OR OTHER FEDERAL FINANCIAL SUPPORT UNDER ANY FEDERAL-
 LY-SUBSIDIZED PUBLIC HEALTH PROGRAM, INCLUDING BUT NOT LIMITED TO  MEDI-
 CAID,  MEDICARE,  OR THE AFFORDABLE CARE ACT, PROVIDED THAT SUCH PROGRAM
 OR ENTITY SHALL NOT DEPRIVE ANY MEMBER OR HEALTH CARE  PROVIDER  OF  ANY
 RIGHT   OR   BENEFIT UNDER  THE PROGRAM UNDER THIS ARTICLE AND OTHERWISE
 CONSISTENT WITH THIS ARTICLE (INCLUDING BUT NOT LIMITED TO THE SCOPE  OF
 BENEFITS;  CHOICE  OF  HEALTH CARE PROVIDER; PROHIBITION OF DEDUCTIBLES,
 COPAYMENTS OR OTHER CO-INSURANCE, OR OUT-OF-NETWORK CHARGES; AND PAYMENT
 FOR SERVICES) AND SHALL, TO THE MAXIMUM EXTENT FEASIBLE, OPERATE IN  THE
 A. 7897                             8
 
 BACKGROUND, WITHOUT BURDEN ON OR INTERFERENCE WITH THE MEMBER AND HEALTH
 CARE PROVIDER.
   9. THE PROGRAM SHALL INCLUDE PROVISIONS FOR APPROPRIATE RESERVES WITH-
 IN  THE  NEW  YORK  HEALTH  TRUST FUND ACCOUNT ESTABLISHED UNDER SECTION
 EIGHTY-NINE-K OF THE STATE FINANCE LAW.
   10. (A) THIS SUBDIVISION APPLIES TO EVERY PERSON WHO IS A RETIREE OF A
 PUBLIC EMPLOYER, AS DEFINED IN SECTION TWO  HUNDRED  ONE  OF  THE  CIVIL
 SERVICE LAW, AND ANY PERSON WHO IS A BENEFICIARY OF THE RETIREE'S PUBLIC
 EMPLOYEE RETIREE HEALTH BENEFIT. ANY REFERENCE TO THE RETIREE SHALL MEAN
 AND  INCLUDE  ANY  BENEFICIARY OF THE RETIREE. THIS SUBDIVISION DOES NOT
 CREATE OR INCREASE ANY  ELIGIBILITY  FOR  ANY  PUBLIC  EMPLOYEE  RETIREE
 HEALTH  BENEFIT THAT WOULD NOT OTHERWISE EXIST AND DOES NOT DIMINISH ANY
 PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT.
   (B) THIS PARAGRAPH APPLIES TO THE RETIREE WHILE HE OR SHE IS  A  RESI-
 DENT OF NEW YORK STATE. THE RETIREE SHALL ENROLL IN THE PROGRAM.  IF, BY
 THE  END  OF  THE IMPLEMENTATION PERIOD, THE RETIREE HAS NOT ENROLLED IN
 THE PROGRAM, THE COMMISSIONER SHALL ENROLL THE RETIREE IN THE  NEW  YORK
 HEALTH  PROGRAM. IF THE RETIREE'S PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT
 INCLUDES ANY SERVICE FOR WHICH COVERAGE IS NOT  OFFERED  UNDER  THE  NEW
 YORK  HEALTH PROGRAM, THE RETIREE SHALL CONTINUE TO RECEIVE THAT BENEFIT
 FROM THE APPROPRIATE PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT PROGRAM.
   (C) FOR EVERY RETIREE, WHILE HE OR SHE IS NOT A RESIDENT OF  NEW  YORK
 STATE,  THE  APPROPRIATE  PUBLIC EMPLOYEE RETIREE HEALTH BENEFIT PROGRAM
 SHALL MAINTAIN THE RETIREE'S PUBLIC EMPLOYEE RETIREE HEALTH  BENEFIT  AS
 IF THIS ARTICLE HAD NOT BEEN ENACTED.
   § 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) THIRTY-ONE 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 ISSUES OF INTEREST  TO  LOW-  AND  MODERATE-INCOME
 INDIVIDUALS,  OLDER ADULTS, AND PEOPLE WITH DISABILITIES; AT LEAST THREE
 OF WHOM SHALL REPRESENT ORGANIZATIONS LED BY CONSUMERS IN THOSE GROUPS;
   (II) THREE OF WHOM SHALL BE REPRESENTATIVES OF PROFESSIONAL  ORGANIZA-
 TIONS REPRESENTING PHYSICIANS;
   (III)  FIVE 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;
 A. 7897                             9

   (VI) TWO OF WHOM SHALL BE REPRESENTATIVES OF  REHABILITATION  OR  HOME
 CARE PROVIDERS;
   (VII)  TWO  OF  WHOM  SHALL BE REPRESENTATIVES OF BEHAVIORAL OR MENTAL
 HEALTH OR DISABILITY SERVICE PROVIDERS;
   (VIII) TWO OF WHOM SHALL BE REPRESENTATIVES OF HEALTH  CARE  ORGANIZA-
 TIONS;
   (IX) THREE 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; AND
   (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. (A) AFTER THE END OF THE IMPLEMENTATION PERIOD, NO PERSON SHALL  BE
 A TRUSTEE UNLESS HE OR SHE IS A MEMBER OF THE PROGRAM.
   (B)  EACH  TRUSTEE SHALL SERVE AT THE PLEASURE OF THE APPOINTING OFFI-
 CER, 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 TWELVE,
 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 EXECU-
 TIVE COMMITTEE AND SHALL APPOINT THE CHAIR  AND  MEMBERS  OF  ALL  OTHER
 COMMITTEES.  THE  BOARD  OF  TRUSTEES  MAY  APPOINT ONE OR MORE ADVISORY
 COMMITTEES. MEMBERS OF ADVISORY COMMITTEES NEED NOT BE  MEMBERS  OF  THE
 BOARD OF TRUSTEES.
   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.  HOWEVER, THE BOARD MAY PROVIDE FOR COMPENSATION
 IN CASES WHERE A LACK OF COMPENSATION WOULD LIMIT THE ABILITY OF A TRUS-
 TEE OR REPRESENTED ORGANIZATION TO PARTICIPATE IN BOARD BUSINESS.
   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 THEIR OFFICE OR EMPLOYMENT BY REASON OF BEING A  TRUS-
 TEE.
   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  EIGHTEEN  MONTHS AFTER THE EFFECTIVE DATE OF THIS
 ARTICLE:
   (A) THE BOARD SHALL DEVELOP PROPOSALS FOR: (I)  INCORPORATING  RETIREE
 HEALTH  BENEFITS INTO NEW YORK HEALTH; (II) ACCOMMODATING EMPLOYER RETI-
 REE HEALTH BENEFITS FOR PEOPLE WHO HAVE BEEN MEMBERS OF NEW YORK  HEALTH
 BUT  LIVE AS RETIREES OUT OF THE STATE; AND (III) ACCOMMODATING EMPLOYER
 RETIREE HEALTH BENEFITS FOR PEOPLE WHO EARNED OR ACCRUED  SUCH  BENEFITS
 A. 7897                            10

 WHILE  RESIDING  IN  THE  STATE  PRIOR TO THE IMPLEMENTATION OF NEW YORK
 HEALTH AND LIVE AS RETIREES OUT OF THE STATE.
   (B) 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.
   (C) THE BOARD SHALL DEVELOP A PROPOSAL FOR NEW YORK  HEALTH  COVERAGE,
 FOR  MEMBERS,  OF  HEALTH  CARE  SERVICES COVERED UNDER PARAGRAPH ONE OF
 SUBSECTION (A) OF SECTION FIFTY-ONE HUNDRED TWO  OF  THE  INSURANCE  LAW
 RELATING  TO  MOTOR VEHICLE INSURANCE REPARATIONS, INCLUDING WHETHER AND
 HOW TO CONTINUE FUNDING FOR THOSE SERVICES.
   (D) THE BOARD SHALL DEVELOP A  PROPOSAL  FOR  INTEGRATION  OF  FEDERAL
 VETERANS HEALTH ADMINISTRATION PROGRAMS WITH NEW YORK HEALTH COVERAGE OF
 HEALTH CARE SERVICES; PROVIDED HOWEVER THAT ENROLLMENT IN OR ELIGIBILITY
 FOR  FEDERAL  VETERANS HEALTH ADMINISTRATION PROGRAMS SHALL NOT AFFECT A
 RESIDENT'S ELIGIBILITY FOR NEW YORK HEALTH COVERAGE.
   (E) THE BOARD   SHALL   PRESENT ALL  PROPOSALS  DEVELOPED  UNDER  THIS
 SUBDIVISION TO THE GOVERNOR AND THE LEGISLATURE.
   §  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 INDIVIDUAL 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.
   §  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,  INCLUDING  BUT  NOT LIMITED TO SERVICES PROVIDED UNDER
 MEDICAID WAIVER PROGRAMS, INCLUDING BUT NOT  LIMITED  TO  THOSE  GRANTED
 UNDER  SECTION  1915  OF THE FEDERAL SOCIAL SECURITY ACT TO PERSONS WITH
 TRAUMATIC BRAIN INJURIES OR QUALIFYING FOR NURSING  HOME  DIVERSION  AND
 TRANSITION SERVICES;
   (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, AND ANY EMPLOYEE OR RETI-
 REE HEALTH BENEFIT PLAN OF ANY PUBLIC EMPLOYER AS DEFINED IN SECTION TWO
 HUNDRED ONE OF THE CIVIL SERVICE LAW, AS OF THE DATE ONE YEAR BEFORE THE
 BEGINNING OF THE IMPLEMENTATION PERIOD;
   (F) THE BASIC HEALTH PLAN;
   (G) REIMBURSEMENT FOR ANY COSTS OR EXPENSES  INCURRED  AS  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;
   (H)  ANY  ADDITIONAL HEALTH CARE SERVICE AUTHORIZED TO BE ADDED TO THE
 PROGRAM'S BENEFITS BY THE PROGRAM; AND
   (I) PROVIDED THAT WHERE ANY STATE LAW OR  REGULATION  RELATED  TO  ANY
 FEDERALLY-SUBSIDIZED  PUBLIC  HEALTH  PROGRAM  STATES  THAT A BENEFIT IS
 CONTINGENT ON FEDERAL FINANCIAL PARTICIPATION, OR WORDS TO THAT  EFFECT,
 THE  BENEFIT SHALL BE INCLUDED UNDER THE NEW YORK HEALTH PROGRAM WITHOUT
 REGARD TO FEDERAL FINANCIAL PARTICIPATION.
 A. 7897                            11

   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:
   (A)  EMERGENCY AND TEMPORARY HEALTH CARE SERVICES PROVIDED TO A MEMBER
 OR INDIVIDUAL ENTITLED TO BECOME A MEMBER WHO HAS NOT HAD  A  REASONABLE
 OPPORTUNITY TO BECOME A MEMBER OR TO ENROLL WITH A CARE COORDINATOR; AND
   (B) HEALTH CARE SERVICES PROVIDED IN AN EMERGENCY TO AN INDIVIDUAL WHO
 IS  ENTITLED  TO  BECOME  A  MEMBER OR ENROLLED WITH A CARE COORDINATOR,
 REGARDLESS OF HAVING HAD AN OPPORTUNITY TO DO SO.
   § 5105. HEALTH CARE PROVIDERS; CARE  COORDINATION;  PAYMENT  METHODOL-
 OGIES.   1. CHOICE OF HEALTH CARE PROVIDER. (A) ANY HEALTH CARE PROVIDER
 QUALIFIED TO PARTICIPATE UNDER THIS  SECTION  MAY  PROVIDE  HEALTH  CARE
 SERVICES  UNDER  THE  PROGRAM, PROVIDED THAT THE HEALTH CARE PROVIDER IS
 OTHERWISE LEGALLY AUTHORIZED TO PERFORM THE HEALTH CARE SERVICE FOR  THE
 INDIVIDUAL AND UNDER THE CIRCUMSTANCES INVOLVED.
   (B)  A  MEMBER  MAY  CHOOSE  TO RECEIVE HEALTH CARE SERVICES UNDER THE
 PROGRAM FROM ANY PARTICIPATING PROVIDER, CONSISTENT WITH  PROVISIONS  OF
 THIS  ARTICLE  RELATING  TO  CARE COORDINATION AND HEALTH CARE ORGANIZA-
 TIONS, THE WILLINGNESS OR  AVAILABILITY  OF  THE  PROVIDER  (SUBJECT  TO
 PROVISIONS  OF  THIS ARTICLE RELATING TO DISCRIMINATION), AND THE APPRO-
 PRIATE CLINICALLY-RELEVANT CIRCUMSTANCES.
   2. CARE COORDINATION. (A) 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, 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 COMMISSION-
 ER OF MENTAL HEALTH;
   (III) A HEALTH CARE ORGANIZATION;
   (IV)  A  LABOR  UNION OR AN ENTITY AFFILIATED WITH AND DESIGNATED BY A
 LABOR UNION OF WHICH THE ENROLLEE  OR  ENROLLEE'S  FAMILY  MEMBER  IS  A
 MEMBER,  WITH  RESPECT TO ITS MEMBERS AND THEIR FAMILY MEMBERS; PROVIDED
 THAT THIS PROVISION SHALL NOT PRECLUDE SUCH AN ENTITY  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.
   (B)(I)  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.  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.
   (II) THIS PARAGRAPH SHALL NOT APPLY TO HEALTH CARE  SERVICES  PROVIDED
 UNDER  SUBDIVISION THREE OF SECTION FIFTY-ONE HUNDRED FOUR OF THIS ARTI-
 CLE (CERTAIN EMERGENCY OR TEMPORARY SERVICES).
   (III) 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 COOR-
 A. 7897                            12
 
 DINATOR 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 THEIR PRIMARY CARE PROVIDER OR MANAGED CARE  PROVID-
 ER.
   (C)  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.
   (D)  A  HEALTH  CARE ORGANIZATION MAY ESTABLISH RULES RELATING TO CARE
 COORDINATION FOR MEMBERS IN THE HEALTH CARE ORGANIZATION, DIFFERENT FROM
 THIS SUBDIVISION BUT OTHERWISE CONSISTENT WITH THIS  ARTICLE  AND  OTHER
 APPLICABLE LAWS.
   (E) 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 NOT QUALI-
 FIED OR COMPETENT TO BE A CARE COORDINATOR OR HAS EXHIBITED A COURSE  OF
 CONDUCT  WHICH  IS  EITHER INCONSISTENT WITH PROGRAM STANDARDS AND REGU-
 LATIONS 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  CRITERIA OTHER THAN THOSE UNDER THIS
 SECTION 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 ON CARE COORDINATION OR SIMILAR MODELS,  INCLUDING
 HEALTH  CARE PRACTITIONERS, HOSPITALS, CLINICS, BIRTH CENTERS, LONG-TERM
 SUPPORTS AND SERVICE PROVIDERS, CONSUMERS AND THEIR REPRESENTATIVES, AND
 LABOR ORGANIZATIONS REPRESENTING HEALTH CARE  WORKERS.  WHEN  DEVELOPING
 AND IMPLEMENTING STANDARDS OF APPROVAL OF CARE COORDINATORS FOR INDIVID-
 UALS  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.
   (F)  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, COST, AND PATIENT AND PROVIDER SATISFACTION.
   (G)  NOTHING  IN  THIS  SUBDIVISION  SHALL AUTHORIZE ANY INDIVIDUAL OR
 ENTITY TO ENGAGE IN ANY ACT IN VIOLATION OF TITLE EIGHT OF THE EDUCATION
 LAW.
   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 NOT QUALIFIED OR COMPETENT TO BE A PROVIDER OF
 SPECIFIC HEALTH CARE SERVICES 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  HEALTH  CARE PROVIDER PARTICIPATION IN THE
 A. 7897                            13
 
 PROGRAM FOR CRITERIA OTHER THAN THOSE UNDER THIS SECTION  AND  SHALL  BE
 CONSISTENT  WITH GOOD PROFESSIONAL PRACTICE.  SUCH PROCEDURES AND STAND-
 ARDS MAY BE DIFFERENT FOR DIFFERENT TYPES OF HEALTH CARE  PROVIDERS  AND
 HEALTH  CARE  PROFESSIONALS.    THE COMMISSIONER MAY REQUIRE THAT HEALTH
 CARE PROVIDERS AND HEALTH CARE PROFESSIONALS  PARTICIPATE  IN  MEDICAID,
 CHILD HEALTH PLUS, OR MEDICARE TO QUALIFY TO PARTICIPATE IN THE PROGRAM.
 ANY  HEALTH  CARE  PROVIDER THAT IS QUALIFIED TO PARTICIPATE UNDER MEDI-
 CAID, CHILD HEALTH PLUS OR MEDICARE SHALL BE DEEMED TO BE  QUALIFIED  TO
 PARTICIPATE  IN  THE PROGRAM, AND ANY HEALTH CARE PROVIDER'S REVOCATION,
 SUSPENSION, LIMITATION, OR ANNULMENT OF QUALIFICATION TO PARTICIPATE  IN
 ANY  OF  THOSE PROGRAMS SHALL APPLY TO THE HEALTH CARE PROVIDER'S QUALI-
 FICATION 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.
   (C)  PROCEDURES  AND  STANDARDS  UNDER  THIS SUBDIVISION SHALL INCLUDE
 PROVISIONS FOR EXPEDITED TEMPORARY QUALIFICATION TO PARTICIPATE  IN  THE
 PROGRAM FOR HEALTH CARE PROFESSIONALS WHO ARE (I) TEMPORARILY AUTHORIZED
 TO  PRACTICE  IN  THE STATE OR (II) ARE RECENTLY ARRIVED IN THE STATE OR
 RECENTLY AUTHORIZED TO PRACTICE IN THE STATE.
   4. PAYMENT FOR HEALTH CARE SERVICES.  (A)  (I)  THE  COMMISSIONER  MAY
 ESTABLISH  BY  REGULATION PAYMENT METHODOLOGIES FOR HEALTH CARE SERVICES
 AND CARE COORDINATION PROVIDED TO MEMBERS UNDER THE PROGRAM  BY  PARTIC-
 IPATING  PROVIDERS,  CARE  COORDINATORS,  AND HEALTH CARE ORGANIZATIONS.
 THERE MAY BE A VARIETY OF  DIFFERENT  PAYMENT  METHODOLOGIES,  INCLUDING
 THOSE ESTABLISHED ON A DEMONSTRATION BASIS.
   (II)  ALL  PAYMENT  METHODOLOGIES AND 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 ACCESSIBLE SUPPLY
 OF THE HEALTH CARE SERVICE.
   (III) IN DETERMINING SUCH PAYMENT METHODOLOGIES AND RATES, THE COMMIS-
 SIONER SHALL CONSIDER FACTORS INCLUDING USUAL AND CUSTOMARY RATES  IMME-
 DIATELY PRIOR TO THE IMPLEMENTATION OF THE PROGRAM, REPORTED IN A BENCH-
 MARKING DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE
 SUPERINTENDENT OF FINANCIAL SERVICES, UNDER SECTION SIX HUNDRED THREE OF
 THE  FINANCIAL SERVICES LAW; THE LEVEL OF TRAINING, EDUCATION, AND EXPE-
 RIENCE OF THE HEALTH CARE PROVIDER OR PROVIDERS INVOLVED; AND THE  SCOPE
 OF  SERVICES, COMPLEXITY, AND CIRCUMSTANCES OF CARE INCLUDING GEOGRAPHIC
 FACTORS. UNTIL AND UNLESS OTHER  APPLICABLE  PAYMENT  METHODOLOGIES  ARE
 ESTABLISHED,  HEALTH CARE SERVICES PROVIDED TO MEMBERS UNDER THE PROGRAM
 SHALL BE PAID FOR ON A FEE-FOR-SERVICE BASIS, EXCEPT  FOR  CARE  COORDI-
 NATION.
   (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) (I) PRESCRIPTION DRUGS ELIGIBLE FOR REIMBURSEMENT UNDER THIS ARTI-
 CLE AND DISPENSED BY A PHARMACY SHALL BE PROVIDED AND PAID FOR UNDER THE
 PREFERRED  DRUG PROGRAM AND THE CLINICAL DRUG REVIEW PROGRAM UNDER TITLE
 ONE OF ARTICLE TWO-A OF THIS CHAPTER, EXCEPT AS  OTHERWISE  PROVIDED  IN
 THIS PARAGRAPH.
 A. 7897                            14
 
   (II)  WHERE  PRESCRIPTION  DRUGS ARE NOT DISPENSED THROUGH A PHARMACY,
 PAYMENT SHALL BE MADE AS OTHERWISE PROVIDED IN THIS  ARTICLE,  INCLUDING
 USE OF THE 340B PROGRAM AS APPROPRIATE.
   (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 PROVIDED UNDER THE  PROGRAM  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.
   (F) PAYMENT METHODOLOGIES AND RATES SHALL INCLUDE A DISTINCT COMPONENT
 OF REIMBURSEMENT FOR DIRECT AND INDIRECT GRADUATE MEDICAL  EDUCATION  AS
 DEFINED,  CALCULATED  AND IMPLEMENTED UNDER 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.
   5.  PRIOR  AUTHORIZATION. THE PROGRAM SHALL NOT REQUIRE PRIOR AUTHORI-
 ZATION FOR ANY HEALTH CARE SERVICE IN ANY  MANNER  MORE  RESTRICTIVE  OF
 ACCESS  TO  OR  PAYMENT  FOR  THE SERVICE THAN WOULD BE REQUIRED FOR THE
 SERVICE UNDER MEDICARE  PART  A  OR  PART  B.  PRIOR  AUTHORIZATION  FOR
 PRESCRIPTION  DRUGS  PROVIDED  BY  PHARMACIES UNDER THE PROGRAM SHALL BE
 UNDER TITLE ONE OF ARTICLE TWO-A OF THIS CHAPTER.
   § 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 LABOR UNION OR AN ENTITY AFFILIATED WITH  AND  DESIGNATED  BY  A
 LABOR  UNION  OF  WHICH  THE  ENROLLEE  OR ENROLLEE'S FAMILY MEMBER IS A
 MEMBER (I) WITH RESPECT TO ITS MEMBERS AND  THEIR  FAMILY  MEMBERS,  AND
 (II)  IF ALLOWED BY APPLICABLE LAW AND APPROVED BY THE COMMISSIONER, FOR
 OTHER MEMBERS OF THE PROGRAM.
   3. A HEALTH CARE ORGANIZATION MAY BE RESPONSIBLE FOR PROVIDING 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 COMMIS-
 SIONER.
   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 NOT  COMPETENT  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 CRITERIA OTHER THAN THOSE UNDER THIS SECTION  AND  SHALL
 BE  CONSISTENT WITH GOOD PROFESSIONAL PRACTICE. IN DEVELOPING THE PROCE-
 A. 7897                            15
 
 DURES AND STANDARDS, THE COMMISSIONER SHALL: (I) CONSIDER EXISTING STAN-
 DARDS 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,  BIRTH  CENTERS,  LONG-TERM  SUPPORTS  AND  SERVICE
 PROVIDERS, CONSUMERS AND THEIR REPRESENTATIVES AND  LABOR  ORGANIZATIONS
 REPRESENTING HEALTH CARE WORKERS. WHEN DEVELOPING AND IMPLEMENTING STAN-
 DARDS  OF  APPROVAL OF HEALTH CARE ORGANIZATIONS, THE COMMISSIONER SHALL
 CONSULT WITH THE COMMISSIONER OF  MENTAL  HEALTH,  THE  COMMISSIONER  OF
 DEVELOPMENTAL  DISABILITIES,  THE  DIRECTOR  OF THE STATE OFFICE FOR THE
 AGING,  THE  COMMISSIONER  OF  THE  OFFICE  OF  ADDICTION  SERVICES  AND
 SUPPORTS, AND THE COMMISSIONER OF THE DIVISION OF HUMAN RIGHTS.
   (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, COST, AND PATIENT AND PROVIDER SATISFACTION.
   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-
 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;
   (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-
 A. 7897                            16
 
 TION SERVICES AND HEALTH CARE SERVICES IN A CULTURALLY COMPETENT MANNER;
 AND
   (F)  ESPECIALLY  IN  RELATION  TO LONG-TERM SUPPORTS AND SERVICES, THE
 MAXIMIZATION AND PRIORITIZATION OF THE MOST  INTEGRATED  COMMUNITY-BASED
 SUPPORTS AND SERVICES.
   3. ANY PARTICIPATING PROVIDER OR CARE COORDINATOR THAT IS ORGANIZED AS
 A  FOR-PROFIT  ENTITY (OTHER THAN A PROFESSIONAL PRACTICE OF ONE OR MORE
 HEALTH CARE PROFESSIONALS) SHALL BE REQUIRED TO MEET THE  SAME  REQUIRE-
 MENTS  AND  STANDARDS  AS ENTITIES ORGANIZED AS NOT-FOR-PROFIT ENTITIES,
 AND PAYMENTS UNDER THE PROGRAM PAID TO SUCH ENTITIES SHALL NOT BE CALCU-
 LATED 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, PROMOTING
 IMPROVED PATIENT OUTCOMES 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
 THE  COMMISSIONER  OF  MENTAL  HEALTH, THE COMMISSIONER OF DEVELOPMENTAL
 DISABILITIES, THE DIRECTOR OF  THE  STATE  OFFICE  FOR  THE  AGING,  THE
 COMMISSIONER  OF  THE  OFFICE  OF  ADDICTION  SERVICES AND SUPPORTS, THE
 COMMISSIONER  OF  THE  DIVISION  OF  HUMAN  RIGHTS,  REPRESENTATIVES  OF
 MEMBERS, HEALTH CARE PROVIDERS, CARE COORDINATORS, HEALTH CARE ORGANIZA-
 TIONS    EMPLOYERS,  ORGANIZED LABOR INCLUDING REPRESENTATIVES OF HEALTH
 CARE WORKERS, AND OTHER INTERESTED PARTIES.
   6. THE PROGRAM SHALL MAINTAIN THE SECURITY AND CONFIDENTIALITY OF  ALL
 DATA  AND  OTHER  INFORMATION COLLECTED UNDER THE PROGRAM WHEN SUCH DATA
 WOULD BE NORMALLY CONSIDERED CONFIDENTIAL PATIENT DATA.  AGGREGATE  DATA
 OF  THE  PROGRAM  WHICH  IS  DERIVED FROM CONFIDENTIAL DATA BUT DOES NOT
 VIOLATE PATIENT CONFIDENTIALITY SHALL BE  PUBLIC  INFORMATION  INCLUDING
 FOR PURPOSES OF ARTICLE SIX OF THE PUBLIC OFFICERS LAW.
   §  5108.  REGULATIONS.  THE  COMMISSIONER SHALL MAKE REGULATIONS UNDER
 THIS ARTICLE BY APPROVING  REGULATIONS  AND  AMENDMENTS  THERETO,  UNDER
 SUBDIVISION  ONE  OF  SECTION FIFTY-ONE HUNDRED TWO OF THIS ARTICLE. THE
 COMMISSIONER MAY MAKE REGULATIONS OR AMENDMENTS THERETO UNDER THIS ARTI-
 CLE ON AN EMERGENCY BASIS UNDER SECTION TWO HUNDRED  TWO  OF  THE  STATE
 ADMINISTRATIVE  PROCEDURE  ACT, PROVIDED THAT SUCH REGULATIONS OR AMEND-
 MENTS 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 APPROPRIATE TO OPERATE THE
 PROGRAM CONSISTENT WITH THIS ARTICLE TO THE MAXIMUM EXTENT POSSIBLE.  NO
 PROVISION OF THIS ARTICLE AND NO ACTION UNDER THE PROGRAM SHALL DIMINISH
 ANY  RIGHT OR BENEFIT THE MEMBER OR HEALTH CARE PROVIDER WOULD OTHERWISE
 HAVE UNDER ANY FEDERALLY-SUBSIDIZED PUBLIC HEALTH PROGRAM OR MEDICARE.
   2. (A) THE COMMISSIONER SHALL APPLY TO THE  SECRETARY  OF  HEALTH  AND
 HUMAN  SERVICES OR OTHER APPROPRIATE FEDERAL OFFICIAL FOR ALL WAIVERS OF
 REQUIREMENTS, AND MAKE OTHER ARRANGEMENTS, UNDER MEDICARE, ANY  FEDERAL-
 LY-SUBSIDIZED  PUBLIC  HEALTH  PROGRAM, THE AFFORDABLE CARE ACT, AND ANY
 OTHER FEDERAL PROGRAMS THAT PROVIDE FEDERAL FUNDS FOR PAYMENT FOR HEALTH
 A. 7897                            17
 
 CARE SERVICES, THAT ARE  APPROPRIATE  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 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-
 SUBSIDIZED PUBLIC HEALTH PROGRAMS  OR  FEDERAL  HEALTH  PROGRAMS.    THE
 COMMISSIONER SHALL TAKE ACTIONS UNDER PARAGRAPH (B) OF SUBDIVISION EIGHT
 OF  SECTION  FIFTY-ONE  HUNDRED ONE OF THIS ARTICLE AS REASONABLY NECES-
 SARY.
   (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) THE COMMISSIONER MAY TAKE ACTIONS CONSISTENT WITH THIS  ARTICLE
 TO  ENABLE  NEW  YORK  HEALTH  TO ADMINISTER MEDICARE IN NEW YORK STATE,
 INCLUDING BUT NOT LIMITED TO ACTIONS NECESSARY TO BE A PROVIDER OF  DRUG
 COVERAGE UNDER MEDICARE PART D FOR ELIGIBLE MEMBERS OF NEW YORK HEALTH.
   (B)  THE  COMMISSIONER  MAY  WAIVE  OR  MODIFY  THE  APPLICABILITY  OF
 PROVISIONS OF THIS SECTION RELATING TO ANY  FEDERALLY-SUBSIDIZED  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.
   (C) THE COMMISSIONER MAY APPLY FOR COVERAGE UNDER ANY FEDERALLY-SUBSI-
 DIZED PUBLIC HEALTH PROGRAM ON BEHALF  OF  ANY  MEMBER  AND  ENROLL  THE
 MEMBER  IN THE FEDERALLY-SUBSIDIZED PUBLIC HEALTH PROGRAM OR MEDICARE IF
 THE MEMBER IS ELIGIBLE FOR IT.   ENROLLMENT  IN  A  FEDERALLY-SUBSIDIZED
 PUBLIC HEALTH PROGRAM OR MEDICARE SHALL NOT CAUSE ANY MEMBER TO LOSE ANY
 HEALTH  CARE  SERVICE  PROVIDED  BY THE PROGRAM OR DIMINISH ANY RIGHT OR
 BENEFIT THE MEMBER WOULD OTHERWISE HAVE.
   (D) 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-SUBSIDIZED  PUBLIC  HEALTH
 PROGRAM, AND FOR ANY PROGRAM TO  REDUCE  OR  ELIMINATE  AN  INDIVIDUAL'S
 COINSURANCE, COST-SHARING OR PREMIUM OBLIGATIONS OR INCREASE AN INDIVID-
 UAL'S  ELIGIBILITY FOR ANY FEDERAL FINANCIAL SUPPORT RELATED TO MEDICARE
 OR THE AFFORDABLE CARE ACT NOTWITHSTANDING ANY LAW OR REGULATION TO  THE
 CONTRARY.  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-SUBSIDIZED  PUBLIC  HEALTH  PROGRAMS,  OR  FOR  ANY PROGRAM TO
 REDUCE OR ELIMINATE AN INDIVIDUAL'S COINSURANCE, COST-SHARING OR PREMIUM
 OBLIGATIONS OR INCREASE AN  INDIVIDUAL'S  ELIGIBILITY  FOR  ANY  FEDERAL
 FINANCIAL  SUPPORT  RELATED TO MEDICARE OR THE AFFORDABLE CARE ACT; (II)
 WILL NOT DIMINISH ANY INDIVIDUAL'S ACCESS TO ANY  HEALTH  CARE  SERVICE,
 BENEFIT  OR  RIGHT  THE INDIVIDUAL WOULD OTHERWISE HAVE; (III) IS IN THE
 INTEREST OF THE PROGRAM; AND (IV) DOES NOT REQUIRE OR HAS  RECEIVED  ANY
 A. 7897                            18
 
 NECESSARY  FEDERAL  WAIVERS  OR  APPROVALS  TO  ENSURE FEDERAL FINANCIAL
 PARTICIPATION.
   (E)  TO  ENABLE  THE  COMMISSIONER  TO APPLY FOR COVERAGE OR FINANCIAL
 SUPPORT  UNDER  ANY  FEDERALLY-SUBSIDIZED  PUBLIC  HEALTH  PROGRAM,  THE
 AFFORDABLE  CARE ACT, OR MEDICARE ON BEHALF OF ANY MEMBER AND ENROLL THE
 MEMBER IN ANY SUCH PROGRAM, INCLUDING AN ENTITY UNDER PARAGRAPH  (B)  OF
 SUBDIVISION  EIGHT  OF  SECTION FIFTY-ONE HUNDRED ONE OF THIS ARTICLE 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 ELIGIBLE FOR SUCH
 PROGRAM.  THE PROGRAM SHALL MAKE A REASONABLE 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. UPON THE MEMBER'S
 SATISFACTORY  PROVISION  OF THE INFORMATION, THE MEMBER'S COVERAGE UNDER
 THE PROGRAM SHALL BE REINSTATED RETROACTIVE TO THE DATE UPON  WHICH  THE
 COVERAGE WAS TERMINATED.
   (F)  TO THE EXTENT NECESSARY FOR PURPOSES OF THIS SECTION, AS A CONDI-
 TION 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.
   (G) 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  MAY
 EXCEED  THE LOW-INCOME BENCHMARK PREMIUM AMOUNT IF DETERMINED TO BE COST
 EFFECTIVE TO THE PROGRAM.
   (H) 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.
   (I)  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.   UPON THE
 MEMBER'S SATISFACTORY PROVISION OF THE INFORMATION, THE MEMBER'S  COVER-
 AGE  UNDER  THE PROGRAM SHALL BE REINSTATED RETROACTIVE TO THE DATE UPON
 WHICH THE COVERAGE WAS TERMINATED.
   4.  NO ACTION UNDER THIS SECTION SHALL DEPRIVE ANY  MEMBER  OR  HEALTH
 CARE PROVIDER OF ANY RIGHT OR BENEFIT UNDER THE PROGRAM AND SHALL OTHER-
 WISE  BE  CONSISTENT  WITH  THIS ARTICLE (INCLUDING, BUT NOT LIMITED TO,
 COMPLYING WITH PROVISIONS  OF  THIS  ARTICLE  RELATING  TO  HEALTH  CARE
 PROVIDER  PAYMENT  LEVELS;  BARRING  PREMIUMS,  DEDUCTIBLES, COPAYMENTS,
 OTHER COINSURANCE AND RESTRICTED PROVIDER NETWORKS;  AND  PROVIDING  FOR
 CHOICE OF PROVIDER AND PRESCRIPTION DRUG COVERAGE).
 A. 7897                            19
 
   §  5110.  ADDITIONAL  PROVISIONS.   1. THE COMMISSIONER SHALL CONTRACT
 WITH NOT-FOR-PROFIT ORGANIZATIONS TO PROVIDE:
   (A)  CONSUMER  ASSISTANCE TO INDIVIDUALS WITH RESPECT TO SELECTION AND
 CHANGING SELECTION OF A CARE COORDINATOR OR  HEALTH  CARE  ORGANIZATION,
 ENROLLING, OBTAINING HEALTH CARE SERVICES, AND OTHER MATTERS RELATING TO
 THE PROGRAM;
   (B) HEALTH CARE PROVIDER ASSISTANCE TO HEALTH CARE PROVIDERS PROVIDING
 AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, HEALTH CARE SERVICES
 UNDER THE PROGRAM, WITH RESPECT TO PARTICIPATING IN A HEALTH CARE ORGAN-
 IZATION AND DEALING WITH A HEALTH CARE ORGANIZATION; AND
   (C) CARE COORDINATOR ASSISTANCE TO INDIVIDUALS AND ENTITIES  PROVIDING
 AND  SEEKING  OR  CONSIDERING  WHETHER  TO PROVIDE, CARE COORDINATION TO
 MEMBERS.
   2. THE COMMISSIONER SHALL PROVIDE GRANTS FROM FUNDS IN  THE  NEW  YORK
 HEALTH  TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE, TO HEALTH
 SYSTEMS AGENCIES UNDER SECTION TWENTY-NINE HUNDRED FOUR-B OF THIS  CHAP-
 TER TO SUPPORT THE OPERATION OF SUCH HEALTH SYSTEMS AGENCIES.
   3.  RETRAINING AND RE-EMPLOYMENT OF IMPACTED EMPLOYEES. (A) AS USED IN
 THIS SUBDIVISION:
   (I) "THIRD PARTY PAYER" HAS ITS  ORDINARY  MEANING  AND  INCLUDES  ANY
 ENTITY  THAT  PROVIDES OR ARRANGES REIMBURSEMENT IN WHOLE OR IN PART FOR
 THE PURCHASE OF HEALTH CARE SERVICES.
   (II) "HEALTH CARE PROVIDER ADMINISTRATIVE EMPLOYEE" MEANS AN  EMPLOYEE
 OF  A  HEALTH  CARE  PROVIDER PRIMARILY ENGAGED IN RELATIONS OR DEALINGS
 WITH THIRD PARTY PAYERS OR SEEKING PAYMENT OR REIMBURSEMENT  FOR  HEALTH
 CARE SERVICES FROM THIRD PARTY PAYERS.
   (III)  "IMPACTED  EMPLOYEE"  MEANS AN INDIVIDUAL WHO, AT ANY TIME FROM
 THE DATE THIS SECTION BECOMES A LAW UNTIL TWO YEARS AFTER THE END OF THE
 IMPLEMENTATION PERIOD, IS EMPLOYED BY A THIRD PARTY PAYER OR IS A HEALTH
 CARE PROVIDER ADMINISTRATIVE EMPLOYEE, AND WHOSE EMPLOYMENT ENDS  OR  IS
 REASONABLY  ANTICIPATED  TO END AS A RESULT OF THE IMPLEMENTATION OF THE
 NEW YORK HEALTH PROGRAM.
   (B) WITHIN NINETY DAYS AFTER THIS SECTION  SHALL  BECOME  A  LAW,  THE
 COMMISSIONER  OF LABOR SHALL CONVENE A RETRAINING AND RE-EMPLOYMENT TASK
 FORCE  INCLUDING  BUT  NOT  LIMITED  TO:  REPRESENTATIVES  OF  POTENTIAL
 IMPACTED EMPLOYEES, HUMAN RESOURCE DEPARTMENTS OF THIRD PARTY PAYERS AND
 HEALTH  CARE  PROVIDERS,  INDIVIDUALS  WITH  EXPERIENCE AND EXPERTISE IN
 RETRAINING AND RE-EMPLOYMENT PROGRAMS RELEVANT TO THE  CIRCUMSTANCES  OF
 IMPACTED  EMPLOYEES,  AND  REPRESENTATIVES OF THE COMMISSIONER OF LABOR.
 THE COMMISSIONER OF LABOR AND THE TASK FORCE SHALL REVIEW AND PROVIDE:
   (I)  ANALYSIS  OF  POTENTIAL  IMPACTED  EMPLOYEES  BY  JOB  TITLE  AND
 GEOGRAPHY;
   (II) COMPETENCY MAPPING AND LABOR MARKET ANALYSIS OF IMPACTED EMPLOYEE
 OCCUPATIONS WITH JOB OPENINGS; AND
   (III)  ESTABLISHMENT OF REGIONAL RETRAINING AND RE-EMPLOYMENT SYSTEMS,
 INCLUDING BUT NOT LIMITED TO  JOB  BOARDS,  OUTPLACEMENT  SERVICES,  JOB
 SEARCH  SERVICES, CAREER ADVISEMENT SERVICES, AND RETRAINING ADVISEMENT,
 TO BE COORDINATED WITH THE REGIONAL ADVISORY COUNCILS ESTABLISHED  UNDER
 SECTION FIFTY-ONE HUNDRED ELEVEN OF THIS ARTICLE.
   (C)  (I) THREE OR MORE IMPACTED EMPLOYEES, A RECOGNIZED UNION OF WORK-
 ERS INCLUDING IMPACTED EMPLOYEES, OR AN EMPLOYER OF  IMPACTED  EMPLOYEES
 MAY  FILE  A  PETITION  WITH  THE  COMMISSIONER OF LABOR TO CERTIFY SUCH
 EMPLOYEES AS BEING IMPACTED EMPLOYEES.
   (II) IMPACTED EMPLOYEES SHALL BE ELIGIBLE FOR:
   (A) UP TO TWO YEARS OF RETRAINING AT ANY TRAINING PROVIDER APPROVED BY
 THE COMMISSIONER OF LABOR; AND
 A. 7897                            20
 
   (B) UP TO TWO  YEARS  OF  UNEMPLOYMENT  BENEFITS,  PROVIDED  THAT  THE
 IMPACTED EMPLOYEE IS ENROLLED IN A DEPARTMENT OF LABOR APPROVED TRAINING
 PROGRAM,  IS  ACTIVELY SEEKING EMPLOYMENT, AND IS NOT CURRENTLY EMPLOYED
 FULL TIME; PROVIDED, HOWEVER, THAT SUCH IMPACTED EMPLOYEE  MAY  MAINTAIN
 UNEMPLOYMENT  BENEFITS  FOR  UP  TO TWO YEARS EVEN IF HE OR SHE DOES NOT
 MEET THE CRITERIA SET FORTH IN THIS CLAUSE BUT IS SIXTY-THREE  YEARS  OF
 AGE OR OLDER AT THE TIME OF LOSS OF EMPLOYMENT AS AN IMPACTED EMPLOYEE.
   (D)  THE  COMMISSIONER  SHALL  PROVIDE  FUNDS FROM THE NEW YORK HEALTH
 TRUST FUND OR OTHERWISE APPROPRIATED FOR THIS PURPOSE TO THE COMMISSION-
 ER OF LABOR FOR  RETRAINING  AND  RE-EMPLOYMENT  PROGRAMS  FOR  IMPACTED
 EMPLOYEES UNDER THIS SUBDIVISION.
   (E)  THE  COMMISSIONER  OF LABOR SHALL MAKE REGULATIONS AND TAKE OTHER
 ACTIONS REASONABLY NECESSARY TO IMPLEMENT THIS SUBDIVISION. THIS  SUBDI-
 VISION  SHALL  BE  IMPLEMENTED  CONSISTENT WITH APPLICABLE LAW AND REGU-
 LATIONS.
   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  THE  QUALITY  OF  HEALTH  CARE
 SERVICES,  PATIENT  OUTCOMES, AND PUBLIC, ENVIRONMENTAL AND OCCUPATIONAL
 HEALTH, INCLUDING COOPERATION WITH OTHER DATA  COLLECTION  AND  RESEARCH
 PROGRAMS OF THE DEPARTMENT, CONSISTENT WITH THIS ARTICLE, THE PROTECTION
 OF THE SECURITY AND CONFIDENTIALITY OF INDIVIDUALLY IDENTIFIABLE PATIENT
 INFORMATION, AND OTHERWISE APPLICABLE LAW.
   5.  SETTLEMENTS  AND  JUDGMENTS.  THIS  SUBDIVISION  APPLIES WHERE ANY
 SETTLEMENT, JUDGMENT OR ORDER  IN  THE  COURSE  OF  LITIGATION,  OR  ANY
 CONTRACT  OR  AGREEMENT  MADE  AS AN ALTERNATIVE TO LITIGATION, PROVIDES
 THAT ONE PARTY SHALL PAY FOR HEALTH CARE COVERAGE FOR ANOTHER PARTY  WHO
 IS ENTITLED TO ENROLL IN THE PROGRAM. ANY PARTY TO THE SETTLEMENT, JUDG-
 MENT, ORDER, CONTRACT OR AGREEMENT MAY APPLY TO AN APPROPRIATE COURT FOR
 MODIFICATION  OF THE JUDGMENT, ORDER, CONTRACT OR AGREEMENT. THE MODIFI-
 CATION MAY PROVIDE THAT THE PAYING PARTY, INSTEAD OF PAYING  FOR  HEALTH
 CARE  COVERAGE, SHALL PAY ALL OR PART OF THE NEW YORK HEALTH TAX THAT IS
 OWED BY THE OTHER PARTY, AND MAY INCLUDE OTHER  OR  FURTHER  PROVISIONS.
 THE MODIFICATIONS SHALL BE APPROPRIATE, CONSISTENT WITH THE PROGRAM, AND
 IN  THE  INTEREST  OF  JUSTICE.  AS  USED IN THIS SUBDIVISION, "NEW YORK
 HEALTH TAX" MEANS THE TAX OR TAXES ENACTED BY THE LEGISLATURE AS PART OF
 THE REVENUE PROPOSAL, AS AMENDED, TO FUND THE PROGRAM.
   § 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, HERKIMER, JEFFERSON,  LEWIS,  MONTGOMERY,
 OTSEGO,  RENSSELAER,  SARATOGA,  SCHENECTADY,  SCHOHARIE,  ST. LAWRENCE,
 WARREN, WASHINGTON COUNTIES;
   (E) CENTRAL, CONSISTING OF BROOME, CAYUGA,  CHEMUNG,  CHENANGO,  CORT-
 LAND,  LIVINGSTON,  MADISON,  MONROE, ONEIDA, ONONDAGA, ONTARIO, OSWEGO,
 SCHUYLER, SENECA, STEUBEN, TIOGA, TOMPKINS, WAYNE, YATES COUNTIES; AND
   (F) WESTERN, CONSISTING OF ALLEGANY,  CATTARAUGUS,  CHAUTAUQUA,  ERIE,
 GENESEE, NIAGARA, ORLEANS, WYOMING COUNTIES.
 A. 7897                            21
 
   3.  EACH REGIONAL ADVISORY COUNCIL SHALL BE COMPOSED OF NOT FEWER THAN
 TWENTY-SEVEN MEMBERS, AS DETERMINED BY THE COMMISSIONER AND  THE  BOARD,
 AS  NECESSARY  TO APPROPRIATELY REPRESENT THE DIVERSE NEEDS AND CONCERNS
 OF THE REGION. MEMBERS OF A REGIONAL ADVISORY COUNCIL SHALL BE RESIDENTS
 OF OR HAVE THEIR PRINCIPAL PLACE OF BUSINESS IN THE REGION SERVED BY THE
 REGIONAL ADVISORY COUNCIL.
   4. APPOINTMENT OF MEMBERS OF THE REGIONAL ADVISORY COUNCILS.
   (A) THE TWENTY-SEVEN MEMBERS SHALL BE APPOINTED AS FOLLOWS:
   (I) NINE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR;
   (II) SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMENDA-
 TION OF THE SPEAKER OF THE ASSEMBLY;
   (III)  SIX MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
 DATION OF THE TEMPORARY PRESIDENT OF THE SENATE;
   (IV) THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE RECOMMEN-
 DATION OF THE MINORITY LEADER OF THE ASSEMBLY; AND
   (V) THREE MEMBERS SHALL BE APPOINTED BY THE GOVERNOR ON THE  RECOMMEN-
 DATION OF THE MINORITY LEADER OF THE SENATE.
   WHERE  A REGIONAL ADVISORY COUNCIL HAS MORE THAN TWENTY-SEVEN MEMBERS,
 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 ORGANIZATIONS WITH A REGIONAL CONSTITUENCY THAT
 ADVOCATE  FOR HEALTH CARE CONSUMERS, OLDER ADULTS, AND PEOPLE WITH DISA-
 BILITIES INCLUDING ORGANIZATIONS LED BY MEMBERS  OF  THOSE  GROUPS,  WHO
 SHALL  CONSTITUTE  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  MENTAL HEALTH, BEHAVIORAL HEALTH (INCLUDING
 SUBSTANCE USE), PHYSICAL DISABILITY, DEVELOPMENTAL DISABILITY, REHABILI-
 TATION, HOME CARE AND OTHER SERVICE PROVIDERS;
   (VII) REPRESENTATIVES OF WOMEN'S HEALTH SERVICE PROVIDERS;
   (VIII) REPRESENTATIVES OF HEALTH SERVICE  PROVIDERS  SERVING  LESBIAN,
 GAY,   BISEXUAL,   TRANSGENDER,  GENDER  NON-CONFORMING,  AND  NONBINARY
 PATIENTS;
   (IX) REPRESENTATIVES OF HEALTH CARE ORGANIZATIONS;
   (X) REPRESENTATIVES OF ORGANIZED LABOR  INCLUDING  REPRESENTATIVES  OF
 HEALTH CARE WORKERS;
   (XI) REPRESENTATIVES OF EMPLOYERS; AND
   (XII) 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 A 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
 A. 7897                            22
 
 OTHER EXPENSES OF THE REGIONAL ADVISORY COUNCILS. HOWEVER, THE BOARD MAY
 PROVIDE FOR COMPENSATION IN CASES WHERE A  LACK  OF  COMPENSATION  WOULD
 LIMIT  THE  ABILITY  OF A TRUSTEE OR REPRESENTED ORGANIZATION TO PARTIC-
 IPATE IN COUNCIL BUSINESS.
   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  SUPPORTS
 AND SERVICES;
   (B) FACILITY AND HEALTH SERVICES PLANNING IN THE REGION;
   (C) IDENTIFYING GAPS IN REGIONAL HEALTH CARE SERVICES;
   (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;
   (E)  IDENTIFYING  NEEDS IN PROFESSIONAL AND SERVICE PERSONNEL REQUIRED
 TO DELIVER HEALTH CARE SERVICES; AND
   (F) COORDINATING REGIONAL IMPLEMENTATION OF RETRAINING AND  RE-EMPLOY-
 MENT  PROGRAMS FOR IMPACTED EMPLOYEES UNDER SUBDIVISION THREE OF SECTION
 FIFTY-ONE HUNDRED TEN OF THIS ARTICLE.
   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. (a) As  used  in  this  section,
 unless the context clearly requires otherwise:
   (i)  "New  York  Health  program"  and the "program" mean the New York
 Health program, as created by article 51 of the public  health  law  and
 all provisions of that article.
   (ii)  "Revenue proposal" means the revenue plan and legislative bills,
 as proposed and enacted under  this  section,  to  provide  the  revenue
 necessary to finance the New York Health program.
   (iii)  "Tax"  means  the  payroll tax or non-payroll tax to be enacted
 under the revenue proposal. "Payroll  tax"  means  the  tax  on  payroll
 income  and  self-employed  income  subject  to the Medicare Part A tax,
 provided for in subdivision two of this section. "Non-payroll tax" means
 the tax on taxable income (such  as  interest,  dividends,  and  capital
 A. 7897                            23
 
 gains)  not  subject to the payroll tax, provided for in subdivision two
 of this section.
   (b)  The  governor shall submit to the legislature a revenue proposal.
 The revenue proposal shall be submitted 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 appropriate 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 taxes.
 First, there shall be a progressively graduated tax on all  payroll  and
 self-employed  income,  paid  by  employers, employees and self-employed
 individuals.  Second, there shall be a progressively  graduated  tax  on
 taxable  income  (such  as  interest,  dividends, and capital gains) not
 subject to the payroll tax.   Income in the  bracket  below  twenty-five
 thousand  dollars per year shall be exempt from the taxes; provided that
 for individuals enrolled in Medicare as defined in the  program,  income
 in  the  bracket  below  fifty thousand dollars per year shall be exempt
 from the taxes.  Higher brackets of income subject to the taxes shall be
 assessed at a higher marginal rate than lower brackets.  The taxes shall
 be set at levels anticipated to produce sufficient  revenue  to  finance
 the  program, 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 employed out-of-state, and
 non-residents who are employed in the state  (including  those  employed
 less than full-time).
   (b) Payroll tax. (i) The income to be subject to the payroll tax shall
 be  all income subject to the Medicare Part A tax. The payroll tax shall
 be set at a percentage of that  income,  which  shall  be  progressively
 graduated, so the percentage is higher on higher brackets of income. For
 employed  individuals,  the  employer  shall  pay  eighty percent of the
 payroll tax and the employee shall pay twenty percent of the tax, except
 that an employer may agree to pay all or part of the  employee's  share.
 A self-employed individual shall pay the full tax.
   (ii)  Each  public  employer,  as  defined in section 201 of the civil
 service law, shall pay a percentage of the payroll tax for each  of  its
 employees that is equal to at least the greater of (A) the percentage of
 the  cost  of the employee's health benefit that is paid by the employer
 as of January 1 immediately preceding the date  on  which  this  section
 becomes  a  law,  or  (B)  a  greater  percentage provided by collective
 bargaining, or (C) eighty percent.
   (c) Non-payroll income tax. There shall be a tax  on  income  that  is
 subject  to  the personal income tax under article 22 of the tax law and
 is not subject to the payroll tax. 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 taxes shall be at an appropriate level, and  shall  be
 changed as anticipated enrollment grows, to cover the actual cost of the
 program.  The revenue proposal shall include a mechanism for determining
 the rates of the taxes.
 A. 7897                            24

   (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 tax 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 tax or (B) the employee shall pay the
 tax as if he or she were self-employed.
   (ii) Out-of-state residents employed in the state.   The  payroll  tax
 shall  apply  to  any  out-of-state resident who is employed or self-em-
 ployed in the state.  Such individual and individual's employer shall be
 able to take a credit against the payroll taxes each would otherwise pay
 as to that individual for amounts  they  spend  respectively  on  health
 benefits (A) for the individual, if the individual is not eligible to be
 a  member  of  the  program,  and (B) for any member of the individual's
 immediate family.   For the employer,  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 bene-
 fits in violation of any federal law. For non-employment-based  spending
 by  the  individual,  the  credit  shall be available for and limited to
 spending for health coverage (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
 tax.  Any  excess  amount may not be applied to other tax liability. The
 credit shall be distributed between the employer  and  employee  in  the
 same  proportion  as  the  spending  by  each for the benefit and may be
 applied to their respective portion of the tax. If any provision of this
 subparagraph or any application of it shall be ruled to violate  federal
 law,  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.  (a)  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 taxes under the revenue proposal.
   (b) The taxes under this section shall not supplant  the  spending  of
 other  state  revenue to pay for the Medicaid program as it exists as of
 the enactment of the revenue proposal as  amended,  unless  the  revenue
 proposal as amended provides otherwise.
   4.  To  the extent that the revenue proposal differs from the terms of
 subdivision two or paragraph (b) of subdivision three of  this  section,
 the  revenue  proposal  shall  state how it differs from those terms and
 reasons for and the effects of the differences.
   5. All revenue from the taxes shall  be  deposited  in  the  New  York
 Health trust fund account under section 89-k of the state finance law.
   §  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. MEDIATION.
 A. 7897                            25
 
         4925. CERTAIN COLLECTIVE ACTION PROHIBITED.
         4926. FEES.
         4927. CONFIDENTIALITY.
         4928. 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 HEALTH CARE PROVIDER UNDER ARTICLE
 FIFTY-ONE OF THIS CHAPTER.
   § 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;
   (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
 A. 7897                            26
 
 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. MEDIATION. 1. IN THE EVENT THE COMMISSIONER, OR A HEALTH CARE
 PROVIDERS' REPRESENTATIVE THAT IS PARTY TO THE  NEGOTIATION,  DETERMINES
 THAT  AN  IMPASSE  EXISTS  IN  THE  NEGOTIATIONS, THE COMMISSIONER SHALL
 RENDER ASSISTANCE AS FOLLOWS:
   (A) TO ASSIST THE PARTIES TO EFFECT  A  VOLUNTARY  RESOLUTION  OF  THE
 NEGOTIATIONS,  THE COMMISSIONER SHALL APPOINT A MEDIATOR WHO IS MUTUALLY
 ACCEPTABLE TO BOTH THE HEALTH CARE  PROVIDERS'  REPRESENTATIVE  AND  THE
 REPRESENTATIVE  OF  NEW  YORK  HEALTH.  IF THE MEDIATOR IS SUCCESSFUL IN
 RESOLVING THE IMPASSE, THEN THE HEALTH  CARE  PROVIDERS'  REPRESENTATIVE
 SHALL PROCEED AS SET FORTH IN THIS ARTICLE;
   (B)  IF  AN  IMPASSE CONTINUES, THE COMMISSIONER SHALL APPOINT A FACT-
 FINDING BOARD OF NOT MORE THAN THREE MEMBERS, WHO ARE MUTUALLY  ACCEPTA-
 BLE  TO BOTH THE HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE REPRESEN-
 TATIVE OF NEW  YORK  HEALTH.  THE  FACT-FINDING  BOARD  SHALL  HAVE,  IN
 ADDITION  TO  THE POWERS DELEGATED TO IT BY THE BOARD, THE POWER TO MAKE
 RECOMMENDATIONS FOR THE RESOLUTION OF THE DISPUTE;
   (C) THE FACT-FINDING BOARD, ACTING BY A MAJORITY OF ITS MEMBERS, SHALL
 TRANSMIT ITS FINDINGS OF FACT AND RECOMMENDATIONS FOR RESOLUTION OF  THE
 DISPUTE  TO  THE  COMMISSIONER, AND MAY THEREAFTER ASSIST THE PARTIES TO
 EFFECT A VOLUNTARY RESOLUTION OF THE  DISPUTE.  THE  FACT-FINDING  BOARD
 SHALL  ALSO  SHARE  ITS  FINDINGS  OF  FACT AND RECOMMENDATIONS WITH THE
 HEALTH CARE PROVIDERS' REPRESENTATIVE AND THE REPRESENTATIVE OF NEW YORK
 HEALTH. IF WITHIN TWENTY DAYS AFTER THE SUBMISSION OF  THE  FINDINGS  OF
 FACT  AND RECOMMENDATIONS, THE IMPASSE CONTINUES, THE COMMISSIONER SHALL
 ORDER A RESOLUTION TO THE NEGOTIATIONS BASED UPON THE FINDINGS  OF  FACT
 AND RECOMMENDATIONS SUBMITTED BY THE FACT-FINDING BOARD.
   §  4925.  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 LAWFUL SCOPE
 OR TERMS OF PRACTICE, LICENSE, REGISTRATION, OR CERTIFICATE.
   § 4926. 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 REGULATION, SHALL SET FEES IN
 AMOUNTS DEEMED REASONABLE AND NECESSARY TO COVER THE COSTS  INCURRED  BY
 THE DEPARTMENT IN ADMINISTERING THIS TITLE.
   § 4927. 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.
   § 4928. 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
 A. 7897                            27
 
 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
 (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-k  to
 read as follows:
   §  89-K. 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", REFERRED TO IN THIS SECTION AS "THE FUND". THE DEFI-
 NITIONS  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  TAXES  UNDER  LEGISLATION  ENACTED  AS
 PROPOSED UNDER SECTION THREE OF THE NEW YORK HEALTH ACT;
   (B)  FEDERAL  PAYMENTS  RECEIVED  AS  A  RESULT OF ANY WAIVER 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-SUBSIDIZED  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-SUBSIDIZED 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 UNDER 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, referred to in this section 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
 A. 7897                            28
 
 commissioner of health, the superintendent of  financial  services,  the
 commissioner of taxation and finance, and the director of the budget, 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
 reasonable  and  necessary expenses incurred in the performance of their
 duties. The commission may  employ  staff  as  needed,  prescribe  their
 duties,  and  fix their compensation within amounts appropriated for the
 commission.
   3. The commission shall examine the laws and regulations of the  state
 and  consult with health care providers, consumers, and other stakehold-
 ers and make such recommendations as are necessary to conform  the  laws
 and  regulations  of  the  state and article 51 of the public health law
 establishing 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 article 51 of
 the public health law for provision  of  health  care  services  covered
 under the workers' compensation law; and incorporation of retiree health
 benefits,  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 under 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.