Bill Text: NY A08515 | 2023-2024 | General Assembly | Introduced
Bill Title: Establishes the New York state adult cystic fibrosis program which consists of administrative support services for the provision of financial assistance for services such as prescription drug costs, device costs, medical care services, behavioral health services, and insurance premiums for the treatment of cystic fibrosis disease and its conditions.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2024-02-07 - signed chap.31 [A08515 Detail]
Download: New_York-2023-A08515-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8515 IN ASSEMBLY January 4, 2024 ___________ Introduced by M. of A. PHEFFER AMATO -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to the New York state adult cystic fibrosis program; and to amend a chapter of the laws of 2023, amending the public health law relating to the adult cystic fibrosis assistance program, as proposed in legislative bills numbers S. 6521 and A. 3089, in relation to the effectiveness thereof The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 2795 of the public health law, as added by a chap- 2 ter of the laws of 2023, amending the public health law relating to the 3 adult cystic fibrosis assistance program, as proposed in legislative 4 bills numbers S. 6521 and A. 3089, is amended to read as follows: 5 § 2795. [Adult] New York state adult cystic fibrosis assistance 6 program. 1. [The commissioner] Subject to available appropriation for 7 the purpose outlined in this article, the department shall establish [a] 8 an adult cystic fibrosis assistance program [to reimburse the cost of9providing health care or health insurance to eligible individuals who10have], which shall be known as the "New York State Adult Cystic Fibrosis 11 Assistance Program", and which shall consist of administrative support 12 services for the provision of financial assistance for services such as 13 prescription drug costs, device costs, medical care services, behavioral 14 health services, and insurance premiums for the treatment of cystic 15 fibrosis disease and its conditions. 16 2. [To be a fully eligible individual for whom health care will be17provided under this section, such individual:18(a) shall be at least twenty-one years old;19(b) shall have been diagnosed as having cystic fibrosis;20(c) shall have resided in the state for a minimum of twelve continuous21months immediately prior to application for services under this section;22(d) shall not be eligible for medical benefits under any group or23individual health insurance policy; and24(e) shall not be eligible for medical assistance pursuant to title25eleven of article five of the social services law solely due to earnedEXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06424-02-4A. 8515 2 1income] The commissioner shall enter into a contract for the operation 2 and promotion of the adult cystic fibrosis assistance program subject to 3 such terms and conditions as may be contained within such contract with 4 an organization that has experience and expertise improving access to 5 healthcare for patients who are underinsured by dispersing financial 6 assistance grants to cover costs of essential treatments and medica- 7 tions. The contractor may subcontract as needed for the effective 8 performance of the contract. All such subcontractors and the terms of 9 such subcontracts shall be subject to approval by the commissioner. 10 3. [To be a partially eligible individual for whom health care will be11provided under this section, such individual shall meet all the criteria12of a fully eligible individual except that a partially eligible individ-13ual shall be an individual who is eligible for medical benefits under14any group or individual health insurance policy but which does not cover15all services necessary for the care and treatment of cystic fibrosis.164. The commissioner shall require each fully eligible individual, upon17determination of eligibility, to make application to a private health18insurance provider as prescribed by the commissioner for an individual19health insurance policy. If and when such policy is granted, the commis-20sioner shall approve payment for the associated premium.215. The commissioner shall authorize payment for services related to22the care and treatment of cystic fibrosis not otherwise covered by a23health insurance policy. Providers of such services shall be reimbursed24at the same rate and claims for payment shall be made as if such indi-25vidual was eligible for benefits pursuant to title eleven of article26five of the social services law.276. All eligible individuals shall be required to contribute seven28percent of their net annual income toward the cost of care and/or the29cost of the annual health insurance premium.307. The commissioner shall, in consultation with the commissioner of31social services, promulgate rules and regulations necessary to implement32the provisions of this article] The duties of the contractor shall 33 include, but not be limited to, the following: 34 (a) verification of patient eligibility for financial assistance 35 grants allowable pursuant to paragraph (b) of this subdivision. To be 36 eligible for a financial assistance grant, a patient shall meet criteria 37 determined by the department, which shall include but not be limited to, 38 requiring the patient: 39 (i) be a New York state resident; 40 (ii) be at least twenty-one years of age or older; 41 (iii) have a diagnosis of cystic fibrosis; and 42 (iv) have some form of primary private health insurance or Medicare 43 and is not eligible for state Medicaid, and shall maintain health insur- 44 ance during the financial assistance award period; 45 (b) review of financial assistance grant applications submitted by 46 eligible patients for approval, for services including but not limited 47 to prescription drug costs, device costs, medical care services, behav- 48 ioral health services, and medical, vision and dental insurance premi- 49 ums, for patient treatment of cystic fibrosis; 50 (c) disbursement of grant funding for applications approved pursuant 51 to paragraph (b) of this subdivision related to the care and treatment 52 of cystic fibrosis not otherwise covered by a health insurance policy; 53 (d) preparation and submission of a monthly report to the department. 54 Such report shall include but not be limited to: 55 (i) new grants, which is the number of new grant recipients for 56 initial grant periods;A. 8515 3 1 (ii) renewal grants, which is the number of renewal grant recipients 2 for renewal grant periods; 3 (iii) total active grant recipient count, which is the total number of 4 active grant recipients; 5 (iv) grant recipients by insurance type, which is the number of active 6 grant recipients sorted by insurance type; 7 (v) program expenses, which is the total amount spent sorted by 8 assistance type but does not include administration fees; 9 (vi) application outcomes report, which is the number of grant recipi- 10 ents who have become inactive, sorted by reason; and 11 (vii) allotment used, which is the total amount of copayment assist- 12 ance provided to each grant recipient compared to what is currently used 13 by the grant recipient. 14 § 2. Section 2 of a chapter of the laws of 2023, amending the public 15 health law relating to the adult cystic fibrosis assistance program, as 16 proposed in legislative bills numbers S. 6521 and A. 3089, is amended to 17 read as follows: 18 § 2. This act shall take effect immediately and shall expire March 31, 19 2024 when upon such date the provisions of this act shall be deemed 20 repealed. 21 § 3. This act shall take effect immediately; provided, however, that 22 section one of this act shall take effect on the same date and in the 23 same manner as a chapter of the laws of 2023 amending the public health 24 law relating to the adult cystic fibrosis assistance program, as 25 proposed in legislative bills numbers S. 6521 and A. 3089, takes effect; 26 provided, further, that the amendments to section 2795 of the public 27 health law made by section one of this act shall not affect the repeal 28 of such section and shall be deemed repealed therewith.