NY State Senate Bill 2023-S3005

Current Bill Status - In Senate Committee Finance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 20, 2024	print number 3005b
May 20, 2024	amend (t) and recommit to finance
Jan 23, 2024	reported and committed to finance
Jan 10, 2024	print number 3005a
Jan 10, 2024	amend and recommit to aging
Jan 03, 2024	referred to aging
May 09, 2023	reported and committed to health
Jan 26, 2023	referred to aging

Votes

- Jan 23, 2024 - Aging Committee Vote
  S3005
  
  6
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Aging Committee Vote: Jan 23, 2024
      
      aye (6)
      
      Ashby
      
      Brisport
      
      Cleare
      
      Felder
      
      May
      
      Serrano
      
      aye wr (1)
      
      Rolison
  May 9, 2023 - Aging Committee Vote
  S3005
  
  6
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Aging Committee Vote: May 9, 2023
      
      aye (6)
      
      Ashby
      
      Brisport
      
      Cleare
      
      Felder
      
      May
      
      Serrano
      
      aye wr (1)
      
      Rolison

Bill Amendments

Original

B (Active)

2023-S3005 - Details

See Assembly Version of this Bill:: A6450
Current Committee:: Senate Finance
Law Section:: Elder Law
Laws Affected:: Amd §§240, 241, 242 & 250, add §242-a, Eld L
Versions Introduced in 2021-2022 Legislative Session:: S4603, A5422

2023-S3005 - Summary

Creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.

2023-S3005 - Sponsor Memo

                                 
BILL NUMBER: S3005

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the elder law, in relation to improving and expanding
the pharmaceutical insurance coverage program for certain medicare
enrollees

 
PURPOSE:

The Elderly Pharmaceutical Insurance Coverage program has changed
dramatically since it was created. This bill will restore oversight and
transparency to the function of the program and expand it to phase in
coverage for persons younger than age 65 who are enrolled in Medicare
Part D. The bill also changes the name of the program to be known as the
Expanded Pharmaceutical Insurance Coverage program.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Changes the name from the Elderly Pharmaceutical Insurance
Coverage program to the Expanded Pharmaceutical Insurance Coverage

program.

Section 2. Prohibits income derived from any increase in the calculation
of a cost of living benefit in social security income or pension bene-
fits from being used to determine enrollee eligibility for the program
or for benefits defined based on income, and provides that EPIC shall
include medical marijuana as a covered drug.

Section 3. Restores the EPIC panel and the advisory committee, 60% of
the later being composed of consumers, and requires an annual report.

Section 4. Re-defines the age of eligibility to 'phase-in persons under
the age of 65 who are enrolled in Medicare Part D.

Section 5. Restores the enrollment process so that the burden of screen-
ing for potential eligibility for the federal Low Income Subsidy (also
known as Extra Help) rests with the EPIC program and not the enrollee,
ensures that EPIC applicants are enrolled in the program and eligible
for its benefits while additional information is collected to qualify
them for LIS if applicable, and restores the EPIC program responsibility
for offsetting any Part D late enrollment penalty costs within limits.

Section 6. Requires the EPIC program to post the manufacturers and drugs
that are covered under an agreed to rebate program.

 
JUSTIFICATION:

THE EPIC program has made numerous changes administratively that have
negatively impacted enrollees without a public process to review
proposed changes. These changes include: òa change in the application
starting in 2020, that* requires enrollees to determine if they must
disclose asset, not otherwise a program requirement, if they fall into
the income category that would allow them to apply for the federal Low
Income Subsidy (LIS.) In prior years, an EPIC applicant was enrolled in
without an asset test and if the EPIC staff found that the self-reported
income could qualify for LIS (150% FPL,) the enrollee would be contacted
for additional information on assets so that an application to LIS was
completed on behalf of the enrollee.  Additionally, while the current
statute includes a role for EPIC staff to assist enrollees who are
eligible for the Medicare Savings Program (MSP, 135% FPL,) which without
an asset test, will also qualify an enrollee for LIS, the EPIC program
does not assist with MSP enrollment or make a referral to an agency that
will.

* a change implemented in October 2019 that eliminated the previous
benefit to include payment of any Medicare Part D late enrollment penal-
ty for certain enrollees.

* a change in January 2020 that eliminates past records of EPIC partic-
ipation for any enrollee that failed to pay their quarterly dues on
time. Their EPIC number and all income information on their records is
now eradicated, and upon late payment of the dues an enrollee must reap-
ply for the program as if they were never a member.  In addition to
making corrections to restore and improve program operations, the chang-
es noted above are addressed in this bill.  Further, in order to improve
transparency and accountability, the EPIC panel and advisory committee
are re-convened, along with a requirement for an annual report to the
Legislature.

During SFY 2019-20, the Executive enacted a reduction in funding for the
EPIC program, derived from savings due to provisions in the Affordable
Care Act that covered more of the costs of Medicare Part D drugs in the
coverage gap, also known as the "donut hole." In SFY 2020-21, the Execu-
tive has proposed a further reduction attributed to continuing savings
due to the federal expansion of donut hole coverage. Rather than concur
with the savings proposed, the Legislature finds that it is time to
expand the EPIC program to offer benefits to residents with Medicare
Part D who are under age 65. The bill does that incrementally, starting
by lowering the age to 60 in 2021, and continuing to bring the age limit
down in five year brackets in successive years.

The legislation also addresses the need to have the EPIC program provide
assistance with out of pocket costs for medical marijuana, which is not
covered by Medicare. The legislation also incorporates provisions of
another bill that exempts from income to be considered by the EPIC
program that which is derived from a cost of living adjustment to social
security or pension payments. The EPIC program requires drug manufactur-
ers to participate in the state's rebate program in order for their drug
to be covered. While this public policy has been well established, EPIC
enrollees are unaware about whether they will have coverage until they
get a refusal at their pharmacy. This information would be particularly
important to have during open enrollment when an enrollee is choosing
Medicare Part D coverage. The tools to compare plans indicate how much
out or pocket costs will be, and the EPIC guideline provides coverage
for drugs covered by a Part D plan, unless the drug manufacturer does
not participate in the rebate program. Medicare counsellors assist
enrollees in understanding what their future out of pocket costs will be
when choosing a Part D plan, but cannot give a full picture without
knowing whether a manufacturer is excluded from EPIC. This bill will
require the list of manufacturers and drugs participating in the rebate
program.

 
FISCAL IMPLICATIONS:


To be determined, but has been made difficult without publicly available
annual reports on the program. In part, costs associated with program
expansion to a lower age limit will be offset by rejecting the proposed
program savings of $16.5m proposed for SFY 2020-21.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S3005 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3005
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 26, 2023
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Aging
 
 AN ACT to amend the elder law, in relation to  improving  and  expanding
   the  pharmaceutical  insurance  coverage  program for certain medicare
   enrollees

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 240 of the elder law is amended to read as follows:
   §  240. Short title. This title shall be known and may be cited as the
 "program for [elderly] EXPANDED pharmaceutical insurance coverage".
   § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
 8 as added by section 2 of part A of chapter 59 of the laws of 2011  and
 as  renumbered by section 3 of part T of chapter 56 of the laws of 2012,
 are amended to read as follows:
   3. "Income" shall mean "household gross income" as defined in the real
 property tax circuit breaker credit program,  pursuant  to  subparagraph
 (C) of paragraph one of subsection (e) of section six hundred six of the
 tax  law,  but  only  shall include the income of program applicants and
 spouses and shall exclude the income of other members of the  household,
 BUT SHALL NOT INCLUDE ANY INCREASE IN INCOME DERIVED FROM SOCIAL SECURI-
 TY  INCOME  OR PENSION BENEFITS THAT INCREASE OVER THE PREVIOUS YEAR DUE
 SOLELY TO A COST OF LIVING ADJUSTMENT PROVIDED BY THE  PROGRAM  ADMINIS-
 TRATORS.
   8.  "Medicare  part  D  excluded drug classes" shall mean any drugs or
 classes of drugs, or their medical uses, which are described in  section
 1927(d)(2)  or  1927(d)(3)  of the federal social security act, with the
 exception of smoking cessation agents AND MEDICAL MARIJUANA DISPENSED IN
 THE STATE OF NEW YORK.
   § 3. The elder law is amended by adding a new section 242-a to read as
 follows:

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01416-01-3
 S. 3005                             2

 
   § 242-A. EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL.   1.  THERE
 IS  HEREBY  ESTABLISHED  WITHIN  THE EXECUTIVE DEPARTMENT, A PANEL TO BE
 KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
 PURPOSES OF THIS SECTION, THE TERM "THE PANEL" SHALL MEAN  THE  EXPANDED
 PHARMACEUTICAL INSURANCE COVERAGE PANEL.
   2.  THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS OF
 EDUCATION AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF  FINANCIAL
 SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
 OF  THE BUDGET. EACH PANEL MEMBER MAY DESIGNATE AN OFFICER OF HIS OR HER
 RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
 THE POWERS OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL  FROM  WHICH
 SUCH PANEL MEMBER MAY BE ABSENT.
   3.  THE  DIRECTOR  OF THE OFFICE FOR THE AGING AND THE COMMISSIONER OF
 HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
   4. THE PANEL SHALL MEET AT SUCH TIMES  AS  MAY  BE  REQUESTED  BY  THE
 CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
   5. THE PANEL SHALL:
   (A)  SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, PROMULGATE
 PROGRAM REGULATIONS PURSUANT TO SECTION TWO HUNDRED  FORTY-SIX  OF  THIS
 TITLE;
   (B)  DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES OF
 ELIGIBLE PROGRAM PARTICIPANTS PURSUANT TO SECTIONS  TWO  HUNDRED  FORTY-
 SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
   (C)  ENTER  INTO CONTRACTS PURSUANT TO SECTION TWO HUNDRED FORTY-THREE
 OF THIS TITLE;
   (D) RECOMMEND AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS  FOR  THE
 EFFICIENT  AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH THE
 PROVISIONS OF THIS TITLE WITH THE ADVICE OF THE  ADVISORY  COMMITTEE  AS
 DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
   (E)  DEVELOP  AND  IMPLEMENT, IN COOPERATION WITH AREA OFFICES FOR THE
 AGING, AN OUTREACH PROGRAM TO INFORM  ELIGIBLE  APPLICANTS  OF  BENEFITS
 THEY  MAY  BE  ENTITLED TO PURSUANT TO THIS TITLE, AND TO MAKE AVAILABLE
 INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
 COVERAGE  AND  BENEFITS  TO  WHICH  THEY  MAY  BE  ENTITLED  THROUGH   A
 PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
   (F)  PREPARE  AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO THE GOVERNOR,
 THE TEMPORARY PRESIDENT OF THE SENATE, AND THE SPEAKER OF  THE  ASSEMBLY
 NO  LATER  THAN  THE  FIRST DAY OF JANUARY OF EACH YEAR. THE PANEL SHALL
 INCLUDE IN SUCH REPORT, AT A  MINIMUM,  ANNUAL  STATISTICAL  INFORMATION
 REGARDING  THE  NUMBER  OF  PERSONS  ENROLLED  IN THE PROGRAM BY MARITAL
 STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
 NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
 RECEIVE AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE  FEDERAL
 SOCIAL  SECURITY  ACT,  AND  THE  NUMBER  THAT  SO QUALIFY THROUGH THEIR
 ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
 PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
 ADMINISTRATIVE COST CONTAINMENT INITIATIVES COMPLETED DURING  THE  YEAR,
 PROJECTIONS  OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN EVALU-
 ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
 THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
   6. THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES
 AS PANEL MEMBERS.
   7.  THERE  SHALL  BE  AN  ADVISORY COMMITTEE TO THE PANEL COMPRISED OF
 TWELVE PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR,  THREE
 MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
 MEMBER  SHALL  BE  APPOINTED BY THE MINORITY LEADER OF THE SENATE, THREE
 S. 3005                             3
 
 MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
 SHALL BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.  THE  COMMIT-
 TEE  MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS, PHARMA-
 CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
 SIXTY  PERCENT  OF  THE  COMMITTEE MEMBERSHIP SHALL REPRESENT CONSUMERS.
 COMMITTEE MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES  BUT
 SHALL  BE  ALLOWED  THEIR  ACTUAL AND NECESSARY EXPENSES INCURRED IN THE
 PERFORMANCE OF THEIR DUTIES.
   § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
 1 as amended by section 4 of part T of chapter 56 of the laws  of  2012,
 and  subdivision  2  as amended by section 12 of part A of chapter 60 of
 the laws of 2014, are amended to read as follows:
   1. Persons eligible  for  comprehensive  coverage  under  section  two
 hundred forty-seven of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-TWO, DURING  THE
 YEAR  TWO  THOUSAND  TWENTY-THREE IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FIFTY-FIVE YEARS  OF  AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY YEARS OF AGE,
 DURING  THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FORTY-FIVE YEARS OF
 AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST  FORTY  YEARS
 OF  AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST THIRTY-
 FIVE YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT  LEAST
 THIRTY  YEARS  OF  AGE,  DURING THE YEAR TWO THOUSAND THIRTY IS AT LEAST
 TWENTY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-ONE  IS
 AT  LEAST  EIGHTEEN YEARS OF AGE; and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 beginning  on or after January first, two thousand five, is less than or
 equal to twenty thousand dollars.   After the initial  determination  of
 eligibility,  each  eligible individual must be redetermined eligible at
 least every twenty-four months; and
   (b) any married resident who IS ENROLLED IN MEDICARE AND is  at  least
 sixty-five  years of age IN THE YEAR TWO THOUSAND TWENTY-TWO, DURING THE
 YEAR TWO THOUSAND TWENTY-THREE IS AT LEAST SIXTY YEARS  OF  AGE,  DURING
 THE  YEAR  TWO THOUSAND TWENTY-FOUR IS AT LEAST FIFTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FORTY-FIVE YEARS  OF
 AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST FORTY YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-EIGHT IS  AT  LEAST  THIRTY-
 FIVE  YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND  THIRTY  IS  AT  LEAST
 TWENTY-FIVE  YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-ONE IS
 AT LEAST EIGHTEEN YEARS OF AGE; and whose income for the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 when combined with the income in the same calendar year of such  married
 person's  spouse  beginning on or after January first, two thousand one,
 is less than or equal to twenty-six thousand dollars. After the  initial
 determination  of eligibility, each eligible individual must be redeter-
 mined eligible at least every twenty-four months.
   2. Persons  eligible  for  catastrophic  coverage  under  section  two
 hundred forty-eight of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-TWO, DURING  THE
 YEAR  TWO  THOUSAND  TWENTY-THREE IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FIFTY-FIVE YEARS  OF  AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY YEARS OF AGE,
 S. 3005                             4
 
 DURING  THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FORTY-FIVE YEARS OF
 AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST  FORTY  YEARS
 OF  AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST THIRTY-
 FIVE  YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND  THIRTY  IS  AT  LEAST
 TWENTY-FIVE  YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-ONE IS
 AT LEAST EIGHTEEN YEARS OF AGE; and whose income for the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 beginning on or after January first, two  thousand  one,  is  more  than
 twenty thousand and less than or equal to seventy-five thousand dollars.
 After the initial determination of eligibility, each eligible individual
 must be redetermined eligible at least every twenty-four months; and
   (b)  any  married  resident  who  is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO THOUSAND TWENTY-TWO, DURING  THE
 YEAR  TWO  THOUSAND  TWENTY-THREE IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST FIFTY-FIVE YEARS  OF  AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY YEARS OF AGE,
 DURING  THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FORTY-FIVE YEARS OF
 AGE, DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST  FORTY  YEARS
 OF  AGE,  DURING  THE YEAR TWO THOUSAND TWENTY-EIGHT IS AT LEAST THIRTY-
 FIVE YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT  LEAST
 THIRTY  YEARS  OF  AGE,  DURING THE YEAR TWO THOUSAND THIRTY IS AT LEAST
 TWENTY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-ONE  IS
 AT  LEAST  EIGHTEEN YEARS OF AGE; and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 when  combined with the income in the same calendar year of such married
 person's spouse beginning on or after January first, two  thousand  one,
 is  more  than twenty-six thousand dollars and less than or equal to one
 hundred thousand dollars. After the initial determination  of  eligibil-
 ity,  each  eligible  individual  must be redetermined eligible at least
 every twenty-four months.
   § 5. Paragraphs (e) and (f) of subdivision 3 of  section  242  of  the
 elder  law, paragraph (e) as amended by section 3-d of part A of chapter
 59 of the laws of 2011, and paragraph (f) as amended  by  section  1  of
 part  T  of  chapter  56  of  the  laws  of 2012, are amended to read as
 follows:
   (e) As a condition of eligibility for benefits under this title, if  a
 program  participant's  income  indicates  that the participant could be
 eligible for an income-related subsidy under  section  1860D-14  of  the
 federal  social  security  act by either applying for such subsidy or by
 enrolling in a medicare savings program as a qualified medicare  benefi-
 ciary  (QMB),  a  specified low-income medicare beneficiary (SLMB), or a
 qualifying  individual  (QI),  a  program  participant  is  required  to
 provide,  and  to authorize the [elderly] EXPANDED pharmaceutical insur-
 ance coverage  program  to  obtain,  any  information  or  documentation
 required  to  establish  the participant's eligibility for such subsidy,
 and to authorize the [elderly] EXPANDED pharmaceutical insurance  cover-
 age program to apply on behalf of the participant for the subsidy or the
 medicare  savings  program.  [The elderly] UPON RECEIPT OF AN ENROLLMENT
 APPLICATION, OR AT ANY TIME AFTER ENROLLMENT WHEN THE PROGRAM HAS INFOR-
 MATION THAT INDICATES AN  ENROLLEE  IS  ELIGIBLE  FOR  A  SUBSIDY  UNDER
 SECTION  1860D-14  OF  THE  FEDERAL SOCIAL SECURITY ACT OR IN A MEDICARE
 SAVINGS PROGRAM, THE EXPANDED pharmaceutical insurance coverage  program
 shall  make a reasonable effort to notify the program participant of his
 or her need to provide any of the above required  information.  After  a
 reasonable  effort  has  been made to contact the participant, a partic-
 S. 3005                             5
 
 ipant shall be notified in writing that he or  she  has  sixty  days  to
 provide  such  required information. If such information is not provided
 within the sixty day period, the participant's coverage  may  be  termi-
 nated.   A PROGRAM PARTICIPANT WHO IS ELIGIBLE TO ENROLL IN THE MEDICARE
 SAVINGS PROGRAM SHALL BE ASSISTED TO DO SO, AND THEIR  EXPANDED  PHARMA-
 CEUTICAL  INSURANCE  COVERAGE  PROGRAM  ENROLLMENT  SHALL  BE  IN  PLACE
 THROUGHOUT THE MEDICARE SAVINGS PROGRAM APPLICATION PROCESS.
   (f) As a condition of eligibility for benefits  under  this  title,  a
 program participant is required to be enrolled in Medicare part D and to
 maintain  such  enrollment.  For  unmarried participants with individual
 annual income less than or equal to twenty-three  thousand  dollars  and
 married  participants  with  joint  annual  income less than or equal to
 twenty-nine thousand  dollars,  the  [elderly]  EXPANDED  pharmaceutical
 insurance  coverage  program  shall  pay  for  the portion of the part D
 monthly premium, AND ANY LATE ENROLLMENT  PENALTY  THAT  MAY  HAVE  BEEN
 ASSESSED,  that  is  the  responsibility  of the participant. Such TOTAL
 payment shall be limited to  the  low-income  benchmark  premium  amount
 established  by  the  federal centers for medicare and medicaid services
 and any other amount which such agency establishes under its de  minimus
 premium policy.
   §  6.  Subdivision  3  of  section  250 of the elder law is amended by
 adding a new paragraph (f) to read as follows:
   (F) THE EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PROGRAM SHALL  POST
 TO ITS WEBSITE THE NAMES OF MANUFACTURERS THAT HAVE A REBATE PROGRAM AND
 LIST  THE DRUGS THAT ARE COVERED BY SUCH REBATE PROGRAM IN A MANNER THAT
 PROVIDES ENROLLEES WITH ACCESS TO SUCH INFORMATION PRIOR TO  THE  ANNUAL
 MEDICARE OPEN ENROLLMENT PERIOD.
   § 7. This act shall take effect immediately.

2023-S3005A - Details

See Assembly Version of this Bill:: A6450
Current Committee:: Senate Finance
Law Section:: Elder Law
Laws Affected:: Amd §§240, 241, 242 & 250, add §242-a, Eld L
Versions Introduced in 2021-2022 Legislative Session:: S4603, A5422

2023-S3005A - Summary

Creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.

2023-S3005A - Sponsor Memo

                                 
BILL NUMBER: S3005A

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the elder law, in relation to improving and expanding
the pharmaceutical insurance coverage program for certain medicare
enrollees

 
PURPOSE:

The Elderly Pharmaceutical Insurance Coverage program has changed
dramatically since it was created. This bill will restore oversight and
transparency to the function of the program and expand it to phase in
coverage for persons younger than age 65 who are enrolled in Medicare
Part D. The bill also changes the name of the program to be known as the
Expanded Pharmaceutical Insurance Coverage program.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Changes the name from the Elderly Pharmaceutical Insurance
Coverage program to the Expanded Pharmaceutical Insurance Coverage

program.

Section 2. Prohibits income derived from any increase in the calculation
of a cost of living benefit in social security income or pension bene-
fits from being used to determine enrollee eligibility for the program
or for benefits defined based on income, and provides that EPIC shall
include medical marijuana as a covered drug.

Section 3. Restores the EPIC panel and the advisory committee, 60% of
the later being composed of consumers, and requires an annual report.

Section 4. Re-defines the age of eligibility to 'phase-in persons under
the age of 65 who are enrolled in Medicare Part D.

Section 5. Restores the enrollment process so that the burden of screen-
ing for potential eligibility for the federal Low Income Subsidy (also
known as Extra Help) rests with the EPIC program and not the enrollee,
ensures that EPIC applicants are enrolled in the program and eligible
for its benefits while additional information is collected to qualify
them for LIS if applicable, and restores the EPIC program responsibility
for offsetting any Part D late enrollment penalty costs within limits.

Section 6. Requires the EPIC program to post the manufacturers and drugs
that are covered under an agreed to rebate program.

 
JUSTIFICATION:

THE EPIC program has made numerous changes administratively that have
negatively impacted enrollees without a public process to review
proposed changes. These changes include: òa change in the application
starting in 2020, that* requires enrollees to determine if they must
disclose asset, not otherwise a program requirement, if they fall into
the income category that would allow them to apply for the federal Low
Income Subsidy (LIS.) In prior years, an EPIC applicant was enrolled in
without an asset test and if the EPIC staff found that the self-reported
income could qualify for LIS (150% FPL,) the enrollee would be contacted
for additional information on assets so that an application to LIS was
completed on behalf of the enrollee.  Additionally, while the current
statute includes a role for'EPIC staff to assist enrollees who are
eligible for the Medicare Savings Program (MSP, 135% FPL,) which without
an asset test, will also qualify an enrollee for LIS, the EPIC program
does not assist with MSP enrollment or make a referral to an agency that
will.

* a change implemented in October 2019 that eliminated the previous
benefit to include payment of any Medicare Part D late enrollment penal-
ty for certain enrollees.

* a change in January 2020 that eliminates past records of EPIC partic-
ipation for any enrollee that failed to pay their quarterly dues on
time. Their EPIC number and all income information on their records is
now eradicated, and upon late payment of the dues an enrollee must reap-
ply for the program as if they were never a member.  In addition to
making corrections to restore and improve program operations, the chang-
es noted above are addressed in this bill.  Further, in order to improve
transparency and accountability, the EPIC panel and advisory committee
are re-convened, along with a requirement for an annual report to the
Legislature.

During SFY 2019-20, the Executive enacted a reduction in funding for the
EPIC program, derived from savings due to provisions in the Affordable
Care Act that covered more of the costs of Medicare Part D drugs in the
coverage gap, also known as the "donut hole." In SFY 2020-21, the Execu-
tive has proposed a further reduction attributed to continuing savings
due to the federal expansion of donut hole coverage. Rather than concur
with the savings proposed, the Legislature finds that it is time to
expand the EPIC program to offer benefits to residents with Medicare
Part D who are under age 65. The bill does that incrementally, starting
by lowering the age to 60 in 2023, and continuing to bring the age limit
down in five year brackets in successive years.

The legislation also addresses the need to have the EPIC program provide
assistance with out of pocket costs for medical marijuana, which is not
covered by Medicare. The legislation also incorporates provisions of
another bill that exempts from income to be considered by the EPIC
program that which is derived from a cost of living adjustment to social
security or pension payments. The EPIC program requires drug manufactur-
ers to participate in the state's rebate program in order for their drug
to be covered. While this public policy has been well established, EPIC
enrollees are unaware about whether they will have coverage until they
get a refusal at their pharmacy. This information would be particularly
important to have during open enrollment when an enrollee is choosing

Medicare Part D coverage. The tools to compare plans indicate how much
out or pocket costs will be, and the EPIC guideline provides coverage
for drugs covered by a Part D plan, unless the drug manufacturer does
not participate in the rebate program. Medicare counsellors assist
enrollees in understanding what their future out of pocket costs will be
when choosing a Part D plan, but cannot give a full picture without
knowing whether a manufacturer is excluded from EPIC. This bill will
require the list of manufacturers and drugs participating in the rebate
program.

 
FISCAL IMPLICATIONS:

To be determined, but has been made difficult without publicly available
annual reports on the program. In part, costs associated with program
expansion to a lower age limit will be offset by rejecting the proposed
program savings of $16.5m proposed for SFY 2020-21.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S3005A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  3005--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 26, 2023
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Aging  --  recommitted  to
   the  Committee  on  Aging  in accordance with Senate Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee

 AN  ACT  to  amend the elder law, in relation to improving and expanding
   the pharmaceutical insurance coverage  program  for  certain  medicare
   enrollees
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 240 of the elder law is amended to read as follows:
   § 240. Short title. This title shall be known and may be cited as  the
 "program for [elderly] EXPANDED pharmaceutical insurance coverage".
   § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
 8  as added by section 2 of part A of chapter 59 of the laws of 2011 and
 as renumbered by section 3 of part T of chapter 56 of the laws of  2012,
 are amended to read as follows:
   3. "Income" shall mean "household gross income" as defined in the real
 property  tax  circuit  breaker credit program, pursuant to subparagraph
 (C) of paragraph one of subsection (e) of section six hundred six of the
 tax law, but only shall include the income  of  program  applicants  and
 spouses  and shall exclude the income of other members of the household,
 BUT SHALL NOT INCLUDE ANY INCREASE IN INCOME DERIVED FROM SOCIAL SECURI-
 TY INCOME OR PENSION BENEFITS THAT INCREASE OVER THE PREVIOUS  YEAR  DUE
 SOLELY  TO  A COST-OF-LIVING ADJUSTMENT PROVIDED BY THE PROGRAM ADMINIS-
 TRATORS.
   8. "Medicare part D excluded drug classes" shall  mean  any  drugs  or
 classes  of drugs, or their medical uses, which are described in section
 1927(d)(2) or 1927(d)(3) of the federal social security  act,  with  the
 exception of smoking cessation agents AND MEDICAL MARIJUANA DISPENSED IN
 THE STATE OF NEW YORK.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01416-02-4

 S. 3005--A                          2
 
   § 3. The elder law is amended by adding a new section 242-a to read as
 follows:
   §  242-A.  EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL.  1. THERE
 IS HEREBY ESTABLISHED WITHIN THE EXECUTIVE DEPARTMENT,  A  PANEL  TO  BE
 KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
 PURPOSES  OF  THIS SECTION, THE TERM "THE PANEL" SHALL MEAN THE EXPANDED
 PHARMACEUTICAL INSURANCE COVERAGE PANEL.
   2. THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS  OF
 EDUCATION  AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF FINANCIAL
 SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
 OF THE BUDGET. EACH PANEL MEMBER MAY DESIGNATE AN OFFICER OF HIS OR  HER
 RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
 THE  POWERS  OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL FROM WHICH
 SUCH PANEL MEMBER MAY BE ABSENT.
   3. THE DIRECTOR OF THE OFFICE FOR THE AGING AND  THE  COMMISSIONER  OF
 HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
   4.  THE  PANEL  SHALL  MEET  AT  SUCH TIMES AS MAY BE REQUESTED BY THE
 CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
   5. THE PANEL SHALL:
   (A) SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET,  PROMULGATE
 PROGRAM  REGULATIONS  PURSUANT  TO SECTION TWO HUNDRED FORTY-SIX OF THIS
 TITLE;
   (B) DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES  OF
 ELIGIBLE  PROGRAM  PARTICIPANTS  PURSUANT TO SECTIONS TWO HUNDRED FORTY-
 SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
   (C) ENTER INTO CONTRACTS PURSUANT TO SECTION TWO  HUNDRED  FORTY-THREE
 OF THIS TITLE;
   (D)  RECOMMEND  AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS FOR THE
 EFFICIENT AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH  THE
 PROVISIONS  OF  THIS  TITLE WITH THE ADVICE OF THE ADVISORY COMMITTEE AS
 DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
   (E) DEVELOP AND IMPLEMENT, IN COOPERATION WITH AREA  OFFICES  FOR  THE
 AGING,  AN  OUTREACH  PROGRAM  TO INFORM ELIGIBLE APPLICANTS OF BENEFITS
 THEY MAY BE ENTITLED TO PURSUANT TO THIS TITLE, AND  TO  MAKE  AVAILABLE
 INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
 COVERAGE   AND  BENEFITS  TO  WHICH  THEY  MAY  BE  ENTITLED  THROUGH  A
 PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
   (F) PREPARE AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO  THE  GOVERNOR,
 THE  TEMPORARY  PRESIDENT OF THE SENATE, AND THE SPEAKER OF THE ASSEMBLY
 NO LATER THAN THE FIRST DAY OF JANUARY OF EACH  YEAR.  THE  PANEL  SHALL
 INCLUDE  IN  SUCH  REPORT,  AT A MINIMUM, ANNUAL STATISTICAL INFORMATION
 REGARDING THE NUMBER OF PERSONS  ENROLLED  IN  THE  PROGRAM  BY  MARITAL
 STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
 NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
 RECEIVE  AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE FEDERAL
 SOCIAL SECURITY ACT, AND  THE  NUMBER  THAT  SO  QUALIFY  THROUGH  THEIR
 ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
 PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
 ADMINISTRATIVE  COST  CONTAINMENT INITIATIVES COMPLETED DURING THE YEAR,
 PROJECTIONS OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN  EVALU-
 ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
 THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
   6.  THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES
 AS PANEL MEMBERS.
   7. THERE SHALL BE AN ADVISORY COMMITTEE  TO  THE  PANEL  COMPRISED  OF
 TWELVE  PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR, THREE
 S. 3005--A                          3
 
 MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
 MEMBER SHALL BE APPOINTED BY THE MINORITY LEADER OF  THE  SENATE,  THREE
 MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
 SHALL  BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.  THE COMMIT-
 TEE MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS,  PHARMA-
 CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
 SIXTY  PERCENT  OF  THE  COMMITTEE MEMBERSHIP SHALL REPRESENT CONSUMERS.
 COMMITTEE MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES  BUT
 SHALL  BE  ALLOWED  THEIR  ACTUAL AND NECESSARY EXPENSES INCURRED IN THE
 PERFORMANCE OF THEIR DUTIES.
   § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
 1 as amended by section 4 of part T of chapter 56 of the laws  of  2012,
 and  subdivision  2  as amended by section 12 of part A of chapter 60 of
 the laws of 2014, are amended to read as follows:
   1. Persons eligible  for  comprehensive  coverage  under  section  two
 hundred forty-seven of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO  THOUSAND  TWENTY-THREE,  DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE  YEAR  TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY YEARS OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST FORTY-FIVE YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND  TWENTY-EIGHT  IS  AT  LEAST  FORTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST THIR-
 TY-FIVE  YEARS  OF  AGE, DURING THE YEAR TWO THOUSAND THIRTY IS AT LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST
 TWENTY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-TWO  IS
 AT  LEAST  EIGHTEEN YEARS OF AGE; and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 beginning  on or after January first, two thousand five, is less than or
 equal to twenty thousand dollars.   After the initial  determination  of
 eligibility,  each  eligible individual must be redetermined eligible at
 least every twenty-four months; and
   (b) any married resident who IS ENROLLED IN MEDICARE AND is  at  least
 sixty-five  years  of  age IN THE YEAR TWO THOUSAND TWENTY-THREE, DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE YEAR TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY-FIVE YEARS  OF  AGE,
 DURING  THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST  FORTY-FIVE  YEARS
 OF  AGE,  DURING  THE  YEAR  TWO THOUSAND TWENTY-EIGHT IS AT LEAST FORTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST THIR-
 TY-FIVE YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY  IS  AT  LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST
 TWENTY-FIVE  YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-TWO IS
 AT LEAST EIGHTEEN YEARS OF AGE; and whose income for the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 when combined with the income in the same calendar year of such  married
 person's  spouse  beginning on or after January first, two thousand one,
 is less than or equal to twenty-six thousand dollars. After the  initial
 determination  of eligibility, each eligible individual must be redeter-
 mined eligible at least every twenty-four months.
   2. Persons  eligible  for  catastrophic  coverage  under  section  two
 hundred forty-eight of this title shall include:
   (a)  any  unmarried  resident who is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO  THOUSAND  TWENTY-THREE,  DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST SIXTY YEARS OF AGE, DURING
 S. 3005--A                          4
 
 THE  YEAR  TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY YEARS OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST FORTY-FIVE YEARS
 OF  AGE,  DURING  THE  YEAR  TWO THOUSAND TWENTY-EIGHT IS AT LEAST FORTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST THIR-
 TY-FIVE YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY  IS  AT  LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST
 TWENTY-FIVE  YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-TWO IS
 AT LEAST EIGHTEEN YEARS OF AGE; and whose income for the  calendar  year
 immediately  preceding  the effective date of the annual coverage period
 beginning on or after January first, two  thousand  one,  is  more  than
 twenty thousand and less than or equal to seventy-five thousand dollars.
 After the initial determination of eligibility, each eligible individual
 must be redetermined eligible at least every twenty-four months; and
   (b)  any  married  resident  who  is ENROLLED IN MEDICARE AND at least
 sixty-five years of age IN THE YEAR TWO  THOUSAND  TWENTY-THREE,  DURING
 THE YEAR TWO THOUSAND TWENTY-FOUR IS AT LEAST SIXTY YEARS OF AGE, DURING
 THE  YEAR  TWO THOUSAND TWENTY-FIVE IS AT LEAST FIFTY-FIVE YEARS OF AGE,
 DURING THE YEAR TWO THOUSAND TWENTY-SIX IS AT LEAST FIFTY YEARS OF  AGE,
 DURING  THE  YEAR TWO THOUSAND TWENTY-SEVEN IS AT LEAST FORTY-FIVE YEARS
 OF AGE, DURING THE YEAR TWO THOUSAND  TWENTY-EIGHT  IS  AT  LEAST  FORTY
 YEARS OF AGE, DURING THE YEAR TWO THOUSAND TWENTY-NINE IS AT LEAST THIR-
 TY-FIVE  YEARS  OF  AGE, DURING THE YEAR TWO THOUSAND THIRTY IS AT LEAST
 THIRTY YEARS OF AGE, DURING THE YEAR TWO THOUSAND THIRTY-ONE IS AT LEAST
 TWENTY-FIVE YEARS OF AGE, OR DURING THE YEAR TWO THOUSAND THIRTY-TWO  IS
 AT  LEAST  EIGHTEEN YEARS OF AGE; and whose income for the calendar year
 immediately preceding the effective date of the annual  coverage  period
 when  combined with the income in the same calendar year of such married
 person's spouse beginning on or after January first, two  thousand  one,
 is  more  than twenty-six thousand dollars and less than or equal to one
 hundred thousand dollars. After the initial determination  of  eligibil-
 ity,  each  eligible  individual  must be redetermined eligible at least
 every twenty-four months.
   § 5. Paragraphs (e) and (f) of subdivision 3 of  section  242  of  the
 elder  law, paragraph (e) as amended by section 3-d of part A of chapter
 59 of the laws of 2011, and paragraph (f) as amended  by  section  1  of
 part  T  of  chapter  56  of  the  laws  of 2012, are amended to read as
 follows:
   (e) As a condition of eligibility for benefits under this title, if  a
 program  participant's  income  indicates  that the participant could be
 eligible for an income-related subsidy under  section  1860D-14  of  the
 federal  social  security  act by either applying for such subsidy or by
 enrolling in a medicare savings program as a qualified medicare  benefi-
 ciary  (QMB),  a  specified low-income medicare beneficiary (SLMB), or a
 qualifying  individual  (QI),  a  program  participant  is  required  to
 provide,  and  to authorize the [elderly] EXPANDED pharmaceutical insur-
 ance coverage  program  to  obtain,  any  information  or  documentation
 required  to  establish  the participant's eligibility for such subsidy,
 and to authorize the [elderly] EXPANDED pharmaceutical insurance  cover-
 age program to apply on behalf of the participant for the subsidy or the
 medicare  savings  program.  [The elderly] UPON RECEIPT OF AN ENROLLMENT
 APPLICATION, OR AT ANY TIME AFTER ENROLLMENT WHEN THE PROGRAM HAS INFOR-
 MATION THAT INDICATES AN  ENROLLEE  IS  ELIGIBLE  FOR  A  SUBSIDY  UNDER
 SECTION  1860D-14  OF  THE  FEDERAL SOCIAL SECURITY ACT OR IN A MEDICARE
 SAVINGS PROGRAM, THE EXPANDED pharmaceutical insurance coverage  program
 shall  make a reasonable effort to notify the program participant of his
 S. 3005--A                          5

 or her need to provide any of the above required  information.  After  a
 reasonable  effort  has  been made to contact the participant, a partic-
 ipant shall be notified in writing that he or  she  has  sixty  days  to
 provide  such  required information. If such information is not provided
 within the sixty day period, the participant's coverage  may  be  termi-
 nated.   A PROGRAM PARTICIPANT WHO IS ELIGIBLE TO ENROLL IN THE MEDICARE
 SAVINGS PROGRAM SHALL BE ASSISTED TO DO SO, AND THEIR  EXPANDED  PHARMA-
 CEUTICAL  INSURANCE  COVERAGE  PROGRAM  ENROLLMENT  SHALL  BE  IN  PLACE
 THROUGHOUT THE MEDICARE SAVINGS PROGRAM APPLICATION PROCESS.
   (f) As a condition of eligibility for benefits  under  this  title,  a
 program participant is required to be enrolled in Medicare part D and to
 maintain  such  enrollment.  For  unmarried participants with individual
 annual income less than or equal to twenty-three  thousand  dollars  and
 married  participants  with  joint  annual  income less than or equal to
 twenty-nine thousand  dollars,  the  [elderly]  EXPANDED  pharmaceutical
 insurance  coverage  program  shall  pay  for  the portion of the part D
 monthly premium, AND ANY LATE ENROLLMENT  PENALTY  THAT  MAY  HAVE  BEEN
 ASSESSED,  that  is  the  responsibility  of the participant. Such TOTAL
 payment shall be limited to  the  low-income  benchmark  premium  amount
 established  by  the  federal centers for medicare and medicaid services
 and any other amount which such agency establishes under its de  minimus
 premium policy.
   §  6.  Subdivision  3  of  section  250 of the elder law is amended by
 adding a new paragraph (f) to read as follows:
   (F) THE EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PROGRAM SHALL  POST
 TO ITS WEBSITE THE NAMES OF MANUFACTURERS THAT HAVE A REBATE PROGRAM AND
 LIST  THE DRUGS THAT ARE COVERED BY SUCH REBATE PROGRAM IN A MANNER THAT
 PROVIDES ENROLLEES WITH ACCESS TO SUCH INFORMATION PRIOR TO  THE  ANNUAL
 MEDICARE OPEN ENROLLMENT PERIOD.
   § 7. This act shall take effect immediately.

2023-S3005B (ACTIVE) - Details

See Assembly Version of this Bill:: A6450
Current Committee:: Senate Finance
Law Section:: Elder Law
Laws Affected:: Amd §§240, 241, 242 & 250, add §242-a, Eld L
Versions Introduced in 2021-2022 Legislative Session:: S4603, A5422

2023-S3005B (ACTIVE) - Summary

Creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.

2023-S3005B (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3005B

SPONSOR: CLEARE
 
TITLE OF BILL:

An act to amend the elder law, in relation to establishing the expanded
pharmaceutical insurance coverage panel

 
PURPOSE:

This bill will establish the expanded pharmaceutical insurance coverage
panel to restore oversight and transparency to the function of the
program and allow for future decisions to be made in an accountable
fashion.

 
SUMMARY OF SPECIFIC PROVISIONS:

This Bill Restores the EPIC panel and the advisory committee, 60% of the
later being composed of consumers, and requires an annual report.

 
JUSTIFICATION:

THE EPIC program has made numerous changes administratively that have
negatively impacted enrollees without a public process to review
proposed changes. These changes include: òa change in the application
starting in 2020, that* requires enrollees to determine if they must
disclose asset, not otherwise a program requirement, if they fall into
the income category that would allow them to apply for the federal Low
Income Subsidy (LIS.) In prior years, an EPIC applicant was enrolled in
without an asset test and if the EPIC staff found that the self-reported
income could qualify for LIS (150% FPL,) the enrollee would be contacted
for additional information on assets so that an application to LIS was
completed on behalf of the enrollee.  Additionally, while the current
statute includes a role for'EPIC staff to assist enrollees who are
eligible for the Medicare Savings Program (MSP, 135% FPL,) which without
an asset test, will also qualify an enrollee for LIS, the EPIC program
does not assist with MSP enrollment or make a referral to an agency that
will.

* a change implemented in October 2019 that eliminated the previous
benefit to include payment of any Medicare Part D late enrollment penal-
ty for certain enrollees.

* a change in January 2020 that eliminates past records of EPIC partic-
ipation for any enrollee that failed to pay their quarterly dues on
time. Their EPIC number and all income information on their records is
now eradicated, and upon late payment of the dues an enrollee must reap-
ply for the program as if they were never a member. In addition to
making corrections to restore and improve program operations, the chang-
es noted above are addressed in this bill. Further, in order to improve
transparency and accountability, the EPIC panel and advisory committee
are re-convened, along with a requirement for an annual report to the
Legislature.

 
FISCAL IMPLICATIONS:

To be determined, but has been made difficult without publicly available
annual reports on the program. In part, costs associated with prograth

expansion to a lower age limit will be offset by rejecting the proposed
program savings of $16.5m proposed for SFY 2020-21.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S3005B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  3005--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 26, 2023
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Aging  --  recommitted  to
   the  Committee  on  Aging  in accordance with Senate Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted  to said committee -- reported favorably from said commit-
   tee and committed to the Committee on Finance -- committee discharged,
   bill amended, ordered reprinted as amended  and  recommitted  to  said
   committee
 
 AN  ACT to amend the elder law, in relation to establishing the expanded
   pharmaceutical insurance coverage panel
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The elder law is amended by adding a new section 242-a to
 read as follows:
   § 242-A. EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL.   1.  THERE
 IS  HEREBY  ESTABLISHED  WITHIN  THE EXECUTIVE DEPARTMENT, A PANEL TO BE
 KNOWN AS THE "EXPANDED PHARMACEUTICAL INSURANCE COVERAGE PANEL". FOR THE
 PURPOSES OF THIS SECTION, THE TERM "THE PANEL" SHALL MEAN  THE  EXPANDED
 PHARMACEUTICAL INSURANCE COVERAGE PANEL.
   2.  THE PANEL SHALL CONSIST OF THE COMMISSIONERS OF THE DEPARTMENTS OF
 EDUCATION AND HEALTH, THE SUPERINTENDENT OF THE DEPARTMENT OF  FINANCIAL
 SERVICES, AND THE DIRECTORS OF THE OFFICE FOR THE AGING AND THE DIVISION
 OF  THE  BUDGET.  EACH  PANEL  MEMBER  MAY DESIGNATE AN OFFICER OF THEIR
 RESPECTIVE DEPARTMENT, OFFICE, OR DIVISION TO REPRESENT AND EXERCISE ALL
 THE POWERS OF SUCH PANEL MEMBER AT ANY MEETING OF THE PANEL  FROM  WHICH
 SUCH PANEL MEMBER MAY BE ABSENT.
   3.  THE  DIRECTOR  OF THE OFFICE FOR THE AGING AND THE COMMISSIONER OF
 HEALTH SHALL SERVE AS CO-CHAIRS OF THE PANEL.
   4. THE PANEL SHALL MEET AT SUCH TIMES  AS  MAY  BE  REQUESTED  BY  THE
 CO-CHAIRS, PROVIDED THAT THE PANEL SHALL MEET AT LEAST TWO TIMES A YEAR.
   5. THE PANEL SHALL:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01416-04-4

 S. 3005--B                          2
 
   (A)  SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, PROMULGATE
 PROGRAM REGULATIONS PURSUANT TO SECTION TWO HUNDRED  FORTY-SIX  OF  THIS
 TITLE;
   (B)  DETERMINE THE ANNUAL SCHEDULE OF COST-SHARING RESPONSIBILITIES OF
 ELIGIBLE PROGRAM PARTICIPANTS PURSUANT TO SECTIONS  TWO  HUNDRED  FORTY-
 SEVEN AND TWO HUNDRED FORTY-EIGHT OF THIS TITLE;
   (C)  ENTER  INTO CONTRACTS PURSUANT TO SECTION TWO HUNDRED FORTY-THREE
 OF THIS TITLE;
   (D) RECOMMEND AND IMPLEMENT ALTERNATIVE PROGRAM IMPROVEMENTS  FOR  THE
 EFFICIENT  AND EFFECTIVE OPERATION OF THE PROGRAM IN ACCORDANCE WITH THE
 PROVISIONS OF THIS TITLE WITH THE ADVICE OF THE  ADVISORY  COMMITTEE  AS
 DEFINED IN SUBDIVISION SEVEN OF THIS SECTION;
   (E)  DEVELOP  AND  IMPLEMENT, IN COOPERATION WITH AREA OFFICES FOR THE
 AGING, AN OUTREACH PROGRAM TO INFORM  ELIGIBLE  APPLICANTS  OF  BENEFITS
 THEY  MAY  BE  ENTITLED TO PURSUANT TO THIS TITLE, AND TO MAKE AVAILABLE
 INFORMATION CONCERNING THE PROGRAM FOR EXPANDED PHARMACEUTICAL INSURANCE
 COVERAGE  AND  BENEFITS  TO  WHICH  THEY  MAY  BE  ENTITLED  THROUGH   A
 PRESCRIPTION DRUG COVERAGE PROGRAM FUNDED BY THE FEDERAL GOVERNMENT; AND
   (F)  PREPARE  AN ANNUAL REPORT AND SUBMIT SUCH REPORT TO THE GOVERNOR,
 THE TEMPORARY PRESIDENT OF THE SENATE, AND THE SPEAKER OF  THE  ASSEMBLY
 NO  LATER  THAN  THE  FIRST DAY OF JANUARY OF EACH YEAR. THE PANEL SHALL
 INCLUDE IN SUCH REPORT, AT A  MINIMUM,  ANNUAL  STATISTICAL  INFORMATION
 REGARDING  THE  NUMBER  OF  PERSONS  ENROLLED  IN THE PROGRAM BY MARITAL
 STATUS AND INCOME LEVEL AND AGE, AN ESTIMATE OF THE PER CENT OF ELIGIBLE
 NEW YORK RESIDENTS THAT ARE ENROLLED, THE TOTAL NUMBER OF ENROLLEES THAT
 RECEIVE AN INCOME-RELATED SUBSIDY UNDER SECTION 1860D-14 OF THE  FEDERAL
 SOCIAL  SECURITY  ACT,  AND  THE  NUMBER  THAT  SO QUALIFY THROUGH THEIR
 ENROLLMENT IN THE MEDICARE SAVINGS PROGRAM, THE NUMBERS OF PARTICIPATING
 PROVIDER PHARMACIES, RECIPIENTS AND PAYMENTS BY COUNTY, A SUMMARY OF THE
 ADMINISTRATIVE COST CONTAINMENT INITIATIVES COMPLETED DURING  THE  YEAR,
 PROJECTIONS  OF PROGRAM COSTS FOR THE FOLLOWING TWO YEARS, AND AN EVALU-
 ATION OF THE PERFORMANCE OF THE PROGRAM CONTRACTOR OR CONTRACTORS AND OF
 THE COST EFFECTIVENESS OF ALL OUTREACH EFFORTS.
   6. THE PANEL MEMBERS SHALL RECEIVE NO COMPENSATION FOR THEIR  SERVICES
 AS PANEL MEMBERS.
   7.  THERE  SHALL  BE  AN  ADVISORY COMMITTEE TO THE PANEL COMPRISED OF
 TWELVE PERSONS.  FOUR MEMBERS SHALL BE APPOINTED BY THE GOVERNOR,  THREE
 MEMBERS SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE, ONE
 MEMBER  SHALL  BE  APPOINTED BY THE MINORITY LEADER OF THE SENATE, THREE
 MEMBERS SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE MEMBER
 SHALL BE APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY.  THE  COMMIT-
 TEE  MEMBERS SHALL BE REPRESENTATIVES OF CONSUMERS, PHARMACISTS, PHARMA-
 CEUTICAL DRUG MANUFACTURERS AND PHARMACEUTICAL WHOLESALERS. NO LESS THAN
 SIXTY PERCENT OF THE COMMITTEE  MEMBERSHIP  SHALL  REPRESENT  CONSUMERS.
 COMMITTEE  MEMBERS  SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES BUT
 SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY  EXPENSES  INCURRED  IN  THE
 PERFORMANCE OF THEIR DUTIES.
   § 2. This act shall take effect immediately.

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Senate Bill S3005

Sponsored By

Current Bill Status - In Senate Committee Finance Committee

Jan 23, 2024 - Aging Committee Vote

Aging Committee Vote: Jan 23, 2024

May 9, 2023 - Aging Committee Vote

Aging Committee Vote: May 9, 2023

Bill Amendments

2023-S3005 - Details

2023-S3005 - Summary

2023-S3005 - Sponsor Memo

2023-S3005 - Bill Text download pdf

2023-S3005A - Details

2023-S3005A - Summary

2023-S3005A - Sponsor Memo

2023-S3005A - Bill Text download pdf

2023-S3005B (ACTIVE) - Details

2023-S3005B (ACTIVE) - Summary

2023-S3005B (ACTIVE) - Sponsor Memo

2023-S3005B (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S3005

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Sponsored By

Cordell Cleare

Current Bill Status - In Senate Committee Finance Committee

Bill Amendments

2023-S3005 - Details

2023-S3005 - Summary

2023-S3005 - Sponsor Memo

2023-S3005 - Bill Text download pdf

2023-S3005A - Details

2023-S3005A - Summary

2023-S3005A - Sponsor Memo

2023-S3005A - Bill Text download pdf

2023-S3005B (ACTIVE) - Details

2023-S3005B (ACTIVE) - Summary

2023-S3005B (ACTIVE) - Sponsor Memo

2023-S3005B (ACTIVE) - Bill Text download pdf

Comments