Bill Text: NY A08807 | 2023-2024 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2024-2025 state fiscal year; requires the commissioner of health to provide a quarterly report on known and expected department of health state funds Medicaid expenditures (Part A); extends various provisions related to health and mental hygiene (Part B); relates to the provision of certain early intervention services for children with handicapping conditions (Part C); reduces the hospital capital rate add-on; relates to the payment of certain funds for uncompensated care; extends provisions relating to certain Medicaid management; increases operating cost component of rates of payment for general hospital outpatient services; authorizes the department of health to make Medicaid payment increases for county operated free-standing clinics (Part D); freezes the operating component of the rates for skilled nursing facilities; reduces the capital component of the rates for skilled nursing facilities by an additional ten percent; expands admission eligibility to the NYS veteran's home for certain veterans of the Persian Gulf conflict (Part E); provides that the program for individuals living with Alzheimer's disease and dementia who are not eligible for medical assistance and reside in a special needs assisted living residence shall, subject to appropriations, authorize vouchers to individuals (Part F); eliminates the one percent Medicaid rate increase to managed care organizations (Part H); relates to coverage and reimbursement of certain drugs under the Medicaid drug cap program and pharmacy cost reporting (Part I); renames the basic health program to the essential plan; extends provisions related to providing long-term services and supports under the essential plan; adds references to the 1332 state innovation waiver; provides a new subsidy to assist low and moderate income New Yorkers; adds the 1332 state innovation program to the functions of the marketplace (Part J); extends certain provisions of law relating to malpractice and professional medical conduct (Part K); authorizes continuous coverage under medical assistance for needy persons and child health plus for eligible children up to age six (Part M); expands financial assistance for medical debt; provides additional consumer protection for medical debt; restricts the applications for and use of credit cards and medical financial products (Part O); extends authorization for pharmacists to order and administer certain tests and perform collaborative drug therapy management with physicians in certain settings (Part P); establishes the healthcare safety net transformation program for the purpose of supporting the transformation of safety net hospitals to improve access, equity, quality, and outcomes while increasing the financial sustainability of safety net hospitals (Part S); extends the effectiveness of certain provisions relating to membership of subcommittees for mental health of community service boards and the duties of such subcommittees and the community mental health and workforce reinvestment account (Part Y); extends certain provisions clarifying the authority of the commissioners in the department of mental hygiene to design and implement time-limited demonstration programs (Part Z); provides for reimbursement insurance rates for the provision of outpatient, intensive outpatient, outpatient rehabilitation and opioid treatment (Part AA); extends certain provisions of law relating to psychiatric emergency programs (Part BB); extends provisions for the care and custody of funds belonging to patients in facilities operated by the office of mental health (Part DD); establishes a cost of living adjustment for certain human services programs (Part FF); provides contracting flexibility in relation to 1115 Medicaid waivers (Part GG); relates to statewide fiscal intermediaries; creates a registration process for statewide fiscal intermediaries (Part HH); establishes a New York managed care organization provider tax (Part II); provides that services provided in school-based health centers shall not be provided to medical assistance recipients through certain managed care programs before April 1, 2025 (Part JJ); establishes a community doula expansion grant program to support community-based doulas and community-based doula organizations; provides for the repeal of such program upon expiration thereof (Part KK); provides for Medicaid reimbursement rates for treatment of medically fragile children at pediatric diagnostic and treatment centers and repeals such provisions upon expiration thereof (Part LL); establishes the nine member community advisory board for the modernization and revitalization of SUNY downstate health sciences university; requires such advisory board to solicit recommendations from healthcare experts, county health departments, community-based organizations, state and regional health care industry associations, labor unions, experts in hospital operations, and other interested parties; requires recommendations and a report to the governor, the temporary president of the senate and the speaker of the assembly no later than April 1, 2025; makes related provisions (Part MM); extends certain provisions relating to certain Medicaid payments made for hospital services (Part NN).
Spectrum: Committee Bill
Status: (Introduced) 2024-04-19 - substituted by s8307c [A08807 Detail]
Download: New_York-2023-A08807-Amended.html
Bill Title: Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2024-2025 state fiscal year; requires the commissioner of health to provide a quarterly report on known and expected department of health state funds Medicaid expenditures (Part A); extends various provisions related to health and mental hygiene (Part B); relates to the provision of certain early intervention services for children with handicapping conditions (Part C); reduces the hospital capital rate add-on; relates to the payment of certain funds for uncompensated care; extends provisions relating to certain Medicaid management; increases operating cost component of rates of payment for general hospital outpatient services; authorizes the department of health to make Medicaid payment increases for county operated free-standing clinics (Part D); freezes the operating component of the rates for skilled nursing facilities; reduces the capital component of the rates for skilled nursing facilities by an additional ten percent; expands admission eligibility to the NYS veteran's home for certain veterans of the Persian Gulf conflict (Part E); provides that the program for individuals living with Alzheimer's disease and dementia who are not eligible for medical assistance and reside in a special needs assisted living residence shall, subject to appropriations, authorize vouchers to individuals (Part F); eliminates the one percent Medicaid rate increase to managed care organizations (Part H); relates to coverage and reimbursement of certain drugs under the Medicaid drug cap program and pharmacy cost reporting (Part I); renames the basic health program to the essential plan; extends provisions related to providing long-term services and supports under the essential plan; adds references to the 1332 state innovation waiver; provides a new subsidy to assist low and moderate income New Yorkers; adds the 1332 state innovation program to the functions of the marketplace (Part J); extends certain provisions of law relating to malpractice and professional medical conduct (Part K); authorizes continuous coverage under medical assistance for needy persons and child health plus for eligible children up to age six (Part M); expands financial assistance for medical debt; provides additional consumer protection for medical debt; restricts the applications for and use of credit cards and medical financial products (Part O); extends authorization for pharmacists to order and administer certain tests and perform collaborative drug therapy management with physicians in certain settings (Part P); establishes the healthcare safety net transformation program for the purpose of supporting the transformation of safety net hospitals to improve access, equity, quality, and outcomes while increasing the financial sustainability of safety net hospitals (Part S); extends the effectiveness of certain provisions relating to membership of subcommittees for mental health of community service boards and the duties of such subcommittees and the community mental health and workforce reinvestment account (Part Y); extends certain provisions clarifying the authority of the commissioners in the department of mental hygiene to design and implement time-limited demonstration programs (Part Z); provides for reimbursement insurance rates for the provision of outpatient, intensive outpatient, outpatient rehabilitation and opioid treatment (Part AA); extends certain provisions of law relating to psychiatric emergency programs (Part BB); extends provisions for the care and custody of funds belonging to patients in facilities operated by the office of mental health (Part DD); establishes a cost of living adjustment for certain human services programs (Part FF); provides contracting flexibility in relation to 1115 Medicaid waivers (Part GG); relates to statewide fiscal intermediaries; creates a registration process for statewide fiscal intermediaries (Part HH); establishes a New York managed care organization provider tax (Part II); provides that services provided in school-based health centers shall not be provided to medical assistance recipients through certain managed care programs before April 1, 2025 (Part JJ); establishes a community doula expansion grant program to support community-based doulas and community-based doula organizations; provides for the repeal of such program upon expiration thereof (Part KK); provides for Medicaid reimbursement rates for treatment of medically fragile children at pediatric diagnostic and treatment centers and repeals such provisions upon expiration thereof (Part LL); establishes the nine member community advisory board for the modernization and revitalization of SUNY downstate health sciences university; requires such advisory board to solicit recommendations from healthcare experts, county health departments, community-based organizations, state and regional health care industry associations, labor unions, experts in hospital operations, and other interested parties; requires recommendations and a report to the governor, the temporary president of the senate and the speaker of the assembly no later than April 1, 2025; makes related provisions (Part MM); extends certain provisions relating to certain Medicaid payments made for hospital services (Part NN).
Spectrum: Committee Bill
Status: (Introduced) 2024-04-19 - substituted by s8307c [A08807 Detail]
Download: New_York-2023-A08807-Amended.html
STATE OF NEW YORK ________________________________________________________________________ S. 8307--A A. 8807--A SENATE - ASSEMBLY January 17, 2024 ___________ IN SENATE -- A BUDGET BILL, submitted by the Governor pursuant to arti- cle seven of the Constitution -- read twice and ordered printed, and when printed to be committed to the Committee on Finance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee IN ASSEMBLY -- A BUDGET BILL, submitted by the Governor pursuant to article seven of the Constitution -- read once and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend part H of chapter 59 of the laws of 2011, amending the public health law and other laws relating to general hospital reimbursement for annual rates, in relation to known and projected department of health state fund medicaid expenditures (Part A); to amend the public health law, in relation to extending certain provisions related to the issuance of accountable care organization certifications and state oversight of antitrust provisions; and to amend part D of chapter 56 of the laws of 2013 amending the social services law relating to eligibility conditions, chapter 649 of the laws of 1996 amending the public health law, the mental hygiene law and the social services law relating to authorizing the establishment of special needs plans, part V of chapter 57 of the laws of 2022 amending the public health law and the insurance law relating to reimbursement for commercial and Medicaid services provided via tele- health, chapter 659 of the laws of 1997 amending the public health law and other laws relating to creation of continuing care retirement communities, part NN of chapter 57 of the laws of 2018 amending the public health law and the state finance law relating to enacting the opioid stewardship act, part II of chapter 54 of the laws of 2016 amending part C of chapter 58 of the laws of 2005 relating to author- izing reimbursements for expenditures made by or on behalf of social services districts for medical assistance for needy persons and admin- istration thereof, part B of chapter 57 of the laws of 2015 amending the social services law and other laws relating to energy audits and/or disaster preparedness reviews of residential healthcare facili- ties by the commissioner, and part H of chapter 57 of the laws of 2019 amending the public health law relating to waiver of certain regu- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD12671-02-4S. 8307--A 2 A. 8807--A lations, in relation to the effectiveness thereof (Part B); to amend the education law, in relation to removing the exemption for school psychologists to render early intervention services; and to amend chapter 217 of the laws of 2015, amending the education law relating to certified school psychologists and special education services and programs for preschool children with handicapping conditions, in relation to the effectiveness thereof (Part C); to amend the public health law, in relation to reducing the hospital capital rate add-on; to amend part ZZ of chapter 56 of the laws of 2020 amending the tax law and the social services law relating to certain Medicaid manage- ment, in relation to the effectiveness thereof; to amend part E of chapter 57 of the laws of 2015, amending the public health law relat- ing to the payment of certain funds for uncompensated care, in relation to certain payments being made as outpatient upper payment limit payments for outpatient hospital services during certain state fiscal years and calendar years; to amend part B of chapter 57 of the laws of 2015, amending the social services law relating to supple- mental rebates, in relation to authorizing the department of health to increase operating cost component of rates of payment for general hospital outpatient services and authorizing the department of health to pay a public hospital adjustment to public general hospitals during certain state fiscal years and calendar years; to amend the public health law, in relation to authorizing the commissioner to make addi- tional inpatient hospital payments during certain state fiscal years and calendar years; and to amend part B of chapter 58 of the laws of 2010, amending the social services law and the public health law relating to prescription drug coverage for needy persons and health care initiatives pools, in relation to authorizing the department of health to make Medicaid payment increases for county operated free- standing clinics during certain state fiscal years and calendar years (Part D); to amend the public health law, in relation to freezing the operating component of the rates for skilled nursing facilities, reducing the capital component of the rates for skilled nursing facil- ities by an additional ten percent, and eligibility for admission to the New York state veterans' home (Part E); to amend the social services law, in relation to making the special needs assisted living residence voucher program permanent; and to amend the public health law, in relation to assisted living quality improvement standards (Part F); to amend the public health law, in relation to home care worker wage parity; and to repeal certain provisions of the public health law relating thereto (Part G); to amend the financial services law, in relation to excluding managed care plans from the independent resolution process; to amend the social services law and the public health law, in relation to providing authority for the department of health to competitively procure managed care organizations participat- ing in medicaid managed care programs; to amend part I of chapter 57 of the laws of 2022, providing a one percent across the board payment increase to all qualifying fee-for-service Medicaid rates, in relation to eliminating the one percent rate increase to managed care organiza- tions; and to repeal certain provisions of the social services law relating thereto (Part H); to amend the social services law, in relation to copayments for drugs; to amend the public health law, in relation to prescriber prevails; to amend the public health law, in relation to the Medicaid drug cap and pharmacy cost reporting; and to repeal certain provisions of the social services law relating to coverage for certain prescription drugs (Part I); to amend the socialS. 8307--A 3 A. 8807--A services law, in relation to renaming the basic health program to the essential plan; to amend part H of chapter 57 of the laws of 2021, amending the social services law relating to eliminating consumer-paid premium payments in the basic health program, in relation to the effectiveness thereof; and to amend part BBB of chapter 56 of the laws of 2022, amending the public health law and other laws relating to permitting the commissioner of health to submit a waiver that expands eligibility for New York's basic health program and increases the federal poverty limit cap for basic health program eligibility from two hundred to two hundred fifty percent, in relation to extending certain provisions related to providing long-term services and supports under the essential plan; and to amend the public health law, in relation to adding references to the 1332 state innovation waiver, providing a new subsidy to assist low-income New Yorkers with the payment of premiums, cost sharing or both through the marketplace, and adding the 1332 state innovation program to the functions of the marketplace (Part J); to amend chapter 266 of the laws of 1986 amend- ing the civil practice law and rules and other laws relating to malp- ractice and professional medical conduct, in relation to insurance coverage paid for by funds from the hospital excess liability pool and extending the effectiveness of certain provisions thereof; to amend part J of chapter 63 of the laws of 2001 amending chapter 266 of the laws of 1986 amending the civil practice law and rules and other laws relating to malpractice and professional medical conduct, in relation to extending certain provisions concerning the hospital excess liabil- ity pool; and to amend part H of chapter 57 of the laws of 2017 amend- ing the New York Health Care Reform Act of 1996 and other laws relat- ing to extending certain provisions relating thereto, in relation to extending provisions relating to excess coverage (Part K); to amend the public health law and the state finance law, in relation to the discontinuation of the empire clinical research investigator program; to amend the public health law, in relation to the discontinuance of participation and membership during a three year demonstration period in a physician committee of the Medical Society of the State of New York or the New York State Osteopathic Society; to repeal subdivision 9 of section 2803 of the public health law, relating to the hospital audit program; to repeal section 461-s of the social services law, relating to enhancing the quality of adult living program for adult care facilities; to repeal paragraph (c) of subdivision 1 of section 461-b of the social services law, relating to an appropriation made available for the purposes of funding the operating assistance sub- program for enriched housing; to repeal article 27-H of the public health law, relating to the tick-borne disease institute; and to repeal paragraph (g) of subdivision 11 of section 230 of the public health law, relating to reporting of professional misconduct (Part L); to amend the social services law and the public health law, in relation to authorizing continuous coverage in Medicaid and child health plus, for eligible children ages zero to six (Part M); to amend the public health law, in relation to authorizing the commissioner of health to issue a statewide standing order for the provision of doula services, providing medical services to pregnant minors, and to the provision of contraception (Part N); to amend the public health law, in relation to expanding financial assistance; and to amend the gener- al business law, in relation to additional consumer protection for medical debt and restricting the applications for and use of credit cards and medical financial products (Part O); to amend part C ofS. 8307--A 4 A. 8807--A chapter 57 of the laws of 2022 amending the public health law and the education law relating to allowing pharmacists to direct limited service laboratories and order and administer COVID-19 and influenza tests and modernizing nurse practitioners, and chapter 21 of the laws of 2011 amending the education law relating to authorizing pharmacists to perform collaborative drug therapy management with physicians in certain settings, in relation to the effectiveness thereof (Part P); to amend the education law and the public health law, in relation to the scope of practice of physician assistants, certified nurse aides, medical assistants, dentists and dental hygienists (Part Q); to amend the education law, in relation to enacting the interstate medical licensure compact; and to amend the education law, in relation to enacting the nurse licensure compact (Part R); to amend the public health law, in relation to establishing the healthcare safety net transformation program (Part S); to amend the public health law and the education law, in relation to making necessary changes to end the HIV, HCV, HBV, syphilis and mpox epidemics; and to repeal certain provisions the public health law relating thereto (Part T); to amend the public health law, in relation to increasing prescription monitor- ing program data retention periods and allowing enhanced data sharing to combat the opioid crisis, updating controlled substance schedules to conform with those of the federal drug enforcement administration, permitting providers to distribute three-day supplies of buprenor- phine, and updating the term "addict" to "person with a substance use disorder" in certain provisions of such law; and to repeal section 3372 of such law relating to practitioner patient reporting (Part U); to amend the public health law, in relation to expanding hospital services and home care collaboration into the home and community; to amend the public health law and the education law, in relation to modernizing the state of New York's emergency medical system and work- force; to amend the public health law, in relation to establishing the paramedic urgent care program; and to amend chapter 137 of the laws of 2023 amending the public health law relating to establishing a commu- nity-based paramedicine demonstration program, in relation to extend- ing the effectiveness thereof (Part V); to amend the elder law, in relation to establishing the interagency elder justice coordinating council (Part W); intentionally omitted (Part X); to amend chapter 62 of the laws of 2003, amending the mental hygiene law and the state finance law relating to the community mental health support and work- force reinvestment program, the membership of subcommittees for mental health of community services boards and the duties of such subcommit- tees and creating the community mental health and workforce reinvest- ment account, in relation to the effectiveness thereof (Part Y); to amend part NN of chapter 58 of the laws of 2015, amending the mental hygiene law relating to clarifying the authority of the commissioners in the department of mental hygiene to design and implement time-lim- ited demonstration programs, in relation to making such provisions permanent (Part Z); to amend the insurance law, in relation to setting minimal reimbursement for behavioral health treatment (Part AA); to amend chapter 723 of the laws of 1989 amending the mental hygiene law and other laws relating to comprehensive psychiatric emergency programs, in relation to the effectiveness of certain provisions thereof (Part BB); to amend the social services law, in relation to clarifying the requirements related to referrals of substantiated reports of abuse or neglect from the justice center to the office of the Medicaid inspector general (Part CC); to amend part A of chapterS. 8307--A 5 A. 8807--A 111 of the laws of 2010 amending the mental hygiene law relating to the receipt of federal and state benefits received by individuals receiving care in facilities operated by an office of the department of mental hygiene, in relation to the effectiveness thereof (Part DD); to amend the education law, in relation to expanding the description of certain services which are not prohibited by statutes governing the practice of nursing (Part EE); to establish a cost of living adjust- ment for designated human services programs (Part FF); to amend the social services law, in relation to providing contracting flexibility in relation to 1115 medicaid waivers (Part GG); and to amend the social services law, in relation to the removal of the fiscal interme- diary procurement and replacing it with an authorization process; to amend the public health law, in relation to eliminating conflicts of interest between consumer directed personal assistance program fiscal intermediaries and licensed home care services agencies; to amend the social services law, in relation to the consumer directed personal assistance program; and to repeal certain provisions of the social services law relating thereto (Part HH) The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act enacts into law major components of legislation 2 necessary to implement the state health and mental hygiene budget for 3 the 2024-2025 state fiscal year. Each component is wholly contained 4 within a Part identified as Parts A through HH. The effective date for 5 each particular provision contained within such Part is set forth in the 6 last section of such Part. Any provision in any section contained within 7 a Part, including the effective date of the Part, which makes a refer- 8 ence to a section "of this act", when used in connection with that 9 particular component, shall be deemed to mean and refer to the corre- 10 sponding section of the Part in which it is found. Section three of this 11 act sets forth the general effective date of this act. 12 PART A 13 Section 1. Paragraph (a) of subdivision 1 of section 92 of part H of 14 chapter 59 of the laws of 2011, amending the public health law and other 15 laws relating to general hospital reimbursement for annual rates, as 16 amended by section 1 of part A of chapter 57 of the laws of 2023, is 17 amended to read as follows: 18 (a) For state fiscal years 2011-12 through [2024-25] 2025-26, the 19 director of the budget, in consultation with the commissioner of health 20 referenced as "commissioner" for purposes of this section, shall assess 21 on a quarterly basis, as reflected in quarterly reports pursuant to 22 subdivision five of this section known and projected department of 23 health state funds medicaid expenditures by category of service and by 24 geographic regions, as defined by the commissioner. 25 § 2. This act shall take effect immediately and shall be deemed to 26 have been in full force and effect on and after April 1, 2024. 27 PART B 28 Section 1. Subdivision p of section 76 of part D of chapter 56 of the 29 laws of 2013 amending the social services law relating to eligibilityS. 8307--A 6 A. 8807--A 1 conditions, as amended by section 2 of part E of chapter 57 of the laws 2 of 2019, is amended to read as follows: 3 p. the amendments to subparagraph 7 of paragraph (b) of subdivision 1 4 of section 366 of the social services law made by section one of this 5 act shall expire and be deemed repealed October 1, [2024] 2029. 6 § 2. Section 10 of chapter 649 of the laws of 1996 amending the public 7 health law, the mental hygiene law and the social services law relating 8 to authorizing the establishment of special needs plans, as amended by 9 section 21 of part E of chapter 57 of the laws of 2019, is amended to 10 read as follows: 11 § 10. This act shall take effect immediately and shall be deemed to 12 have been in full force and effect on and after July 1, 1996; provided, 13 however, that sections one, two and three of this act shall expire and 14 be deemed repealed [on] March 31, [2025] 2030 provided, however that the 15 amendments to section 364-j of the social services law made by section 16 four of this act shall not affect the expiration of such section and 17 shall be deemed to expire therewith and provided, further, that the 18 provisions of subdivisions 8, 9 and 10 of section 4401 of the public 19 health law, as added by section one of this act; section 4403-d of the 20 public health law as added by section two of this act and the provisions 21 of section seven of this act, except for the provisions relating to the 22 establishment of no more than twelve comprehensive HIV special needs 23 plans, shall expire and be deemed repealed on July 1, 2000. 24 § 3. Subdivision 3 of section 2999-p of the public health law, as 25 amended by section 8 of part BB of chapter 56 of the laws of 2020, is 26 amended to read as follows: 27 3. The commissioner may issue a certificate of authority to an entity 28 that meets conditions for ACO certification as set forth in regulations 29 made by the commissioner pursuant to section twenty-nine hundred nine- 30 ty-nine-q of this article. The commissioner shall not issue any new 31 certificate under this article after December thirty-first, two thousand 32 [twenty-four] twenty-eight. 33 § 4. Subdivision 1 of section 2999-aa of the public health law, as 34 amended by section 9 of part S of chapter 57 of the laws of 2021, is 35 amended to read as follows: 36 1. In order to promote improved quality and efficiency of, and access 37 to, health care services and to promote improved clinical outcomes to 38 the residents of New York, it shall be the policy of the state to 39 encourage, where appropriate, cooperative, collaborative and integrative 40 arrangements including but not limited to, mergers and acquisitions 41 among health care providers or among others who might otherwise be 42 competitors, under the active supervision of the commissioner. To the 43 extent such arrangements, or the planning and negotiations that precede 44 them, might be anti-competitive within the meaning and intent of the 45 state and federal antitrust laws, the intent of the state is to supplant 46 competition with such arrangements under the active supervision and 47 related administrative actions of the commissioner as necessary to 48 accomplish the purposes of this article, and to provide state action 49 immunity under the state and federal antitrust laws with respect to 50 activities undertaken by health care providers and others pursuant to 51 this article, where the benefits of such active supervision, arrange- 52 ments and actions of the commissioner outweigh any disadvantages likely 53 to result from a reduction of competition. The commissioner shall not 54 approve an arrangement for which state action immunity is sought under 55 this article without first consulting with, and receiving a recommenda- 56 tion from, the public health and health planning council. No arrangementS. 8307--A 7 A. 8807--A 1 under this article shall be approved after December thirty-first, two 2 thousand [twenty-four] twenty-eight. 3 § 5. Section 7 of part V of chapter 57 of the laws of 2022 amending 4 the public health law and the insurance law relating to reimbursement 5 for commercial and Medicaid services provided via telehealth, is amended 6 to read as follows: 7 § 7. This act shall take effect immediately and shall be deemed to 8 have been in full force and effect on and after April 1, 2022; provided, 9 however, this act shall expire and be deemed repealed on and after April 10 1, [2024] 2025. 11 § 6. Section 97 of chapter 659 of the laws of 1997 amending the public 12 health law and other laws relating to creation of continuing care 13 retirement communities, as amended by section 11 of part Z of chapter 57 14 of the laws of 2018, is amended to read as follows: 15 § 97. This act shall take effect immediately, provided, however, that 16 the amendments to subdivision 4 of section 854 of the general municipal 17 law made by section seventy of this act shall not affect the expiration 18 of such subdivision and shall be deemed to expire therewith and provided 19 further that sections sixty-seven and sixty-eight of this act shall 20 apply to taxable years beginning on or after January 1, 1998 and 21 provided further that sections eighty-one through eighty-seven of this 22 act shall expire and be deemed repealed on December 31, [2024] 2029 and 23 provided further, however, that the amendments to section ninety of this 24 act shall take effect January 1, 1998 and shall apply to all policies, 25 contracts, certificates, riders or other evidences of coverage of long 26 term care insurance issued, renewed, altered or modified pursuant to 27 section 3229 of the insurance law on or after such date. 28 § 7. Section 5 of part NN of chapter 57 of the laws of 2018 amending 29 the public health law and the state finance law relating to enacting the 30 opioid stewardship act, as amended by section 5 of part XX of chapter 59 31 of the laws of 2019, is amended to read as follows: 32 § 5. This act shall take effect July 1, 2018 and shall expire and be 33 deemed to be repealed on June 30, [2024] 2027, provided that, effective 34 immediately, the addition, amendment and/or repeal of any rule or regu- 35 lation necessary for the implementation of this act on its effective 36 date are authorized to be made and completed on or before such effective 37 date, and, provided that this act shall only apply to the sale or 38 distribution of opioids in the state of New York on or before December 39 31, 2018. 40 § 8. Section 2 of part II of chapter 54 of the laws of 2016 amending 41 part C of chapter 58 of the laws of 2005 relating to authorizing 42 reimbursements for expenditures made by or on behalf of social services 43 districts for medical assistance for needy persons and administration 44 thereof, as amended by section 6 of part CC of chapter 57 of the laws of 45 2022, is amended to read as follows: 46 § 2. This act shall take effect immediately and shall expire and be 47 deemed repealed March 31, [2024] 2026. 48 § 9. Subdivision 5 of section 60 of part B of chapter 57 of the laws 49 of 2015 amending the social services law and other laws relating to 50 energy audits and/or disaster preparedness reviews of residential 51 healthcare facilities by the commissioner, as amended by chapter 125 of 52 the laws of 2021, is amended to read as follows: 53 5. section thirty-eight of this act shall expire and be deemed 54 repealed July 1, [2024] 2027; 55 § 10. Section 7 of part H of chapter 57 of the laws of 2019, amending 56 the public health law relating to waiver of certain regulations, asS. 8307--A 8 A. 8807--A 1 amended by section 1 of part GG of chapter 57 of the laws of 2022, is 2 amended to read as follows: 3 § 7. This act shall take effect immediately and shall be deemed to 4 have been in full force and effect on and after April 1, 2019, provided, 5 however, that section two of this act shall expire on April 1, [2024] 6 2026. 7 § 11. This act shall take effect immediately. 8 PART C 9 Section 1. Paragraph d of subdivision 6 of section 4410 of the educa- 10 tion law, as amended by chapter 217 of the laws of 2015, is amended to 11 read as follows: 12 d. Notwithstanding any other provision of law to the contrary, the 13 exemption in subdivision one of section seventy-six hundred five of this 14 chapter shall apply to persons employed on a full-time or part-time 15 salary basis, which may include on an hourly, weekly, or monthly basis, 16 or on a fee for evaluation services basis provided that such person is 17 employed by and under the dominion and control of a center-based program 18 approved pursuant to subdivision nine of this section as a certified 19 school psychologist to provide activities, services and use of the title 20 psychologist to students enrolled in such approved center-based program; 21 and to certified school psychologists employed on a full-time or part- 22 time salary basis, which may include on an hourly, weekly, or monthly 23 basis, or on a fee for evaluation services basis provided that the 24 school psychologist is employed by and under the dominion and control of 25 a program that has been approved pursuant to paragraph b of subdivision 26 nine of this section, or subdivision nine-a of this section, to conduct 27 a multi-disciplinary evaluation of a preschool child having or suspected 28 of having a disability where authorized by paragraph a [or b] of subdi- 29 vision six of section sixty-five hundred three-b of this chapter[; and30to certified school psychologists employed on a full-time or part-time31salary basis, which may include on an hourly, weekly, or monthly basis,32or on a fee for evaluation services basis provided that such psychol-33ogist is employed by and under the dominion and control of an agency34approved in accordance with title two-A of article twenty-five of the35public health law to deliver early intervention program multidiscipli-36nary evaluations, service coordination services and early intervention37program services, where authorized by paragraph a or b of subdivision38six of section sixty-five hundred three-b of this chapter, each], in the 39 course of their employment. Nothing in this section shall be construed 40 to authorize a certified school psychologist or group of such school 41 psychologists to engage in independent practice or practice outside of 42 an employment relationship. 43 § 2. Subdivision 1 of section 7605 of the education law, as amended by 44 chapter 217 of the laws of 2015, is amended to read as follows: 45 1. The activities, services, and use of the title of psychologist, or 46 any derivation thereof, on the part of a person in the employ of a 47 federal, state, county or municipal agency, or other political subdivi- 48 sion, or a chartered elementary or secondary school or degree-granting 49 educational institution insofar as such activities and services are a 50 part of the duties of his salaried position; or on the part of a person 51 in the employ as a certified school psychologist on a full-time or part- 52 time salary basis, which may include on an hourly, weekly, or monthly 53 basis, or on a fee for evaluation services basis provided that such 54 person employed as a certified school psychologist is employed by andS. 8307--A 9 A. 8807--A 1 under the dominion and control of a preschool special education program 2 approved pursuant to paragraph b of subdivision nine or subdivision 3 nine-a of section forty-four hundred ten of this chapter to provide 4 activities, services and to use the title "certified school psychol- 5 ogist", so long as this shall not be construed to permit the use of the 6 title "licensed psychologist", to students enrolled in such approved 7 program or to conduct a multidisciplinary evaluation of a preschool 8 child having or suspected of having a disability[; or on the part of a9person in the employ as a certified school psychologist on a full-time10or part-time salary basis, which may include on an hourly, weekly or11monthly basis, or on a fee for evaluation services basis provided that12such person employed as a certified school psychologist is employed by13and under the dominion and control of an agency approved in accordance14with title two-A of article twenty-five of the public health law to15deliver early intervention program multidisciplinary evaluations,16service coordination services and early intervention program services], 17 where each such preschool special education program [or early inter-18vention provider] is authorized by paragraph a [or b] of subdivision six 19 of section sixty-five hundred [three] three-b of this title[, each] in 20 the course of their employment. Nothing in this subdivision shall be 21 construed to authorize a certified school psychologist or group of such 22 school psychologists to engage in independent practice or practice 23 outside of an employment relationship. 24 § 3. Section 3 of chapter 217 of the laws of 2015, amending the educa- 25 tion law relating to certified school psychologists and special educa- 26 tion services and programs for preschool children with handicapping 27 conditions, as amended by chapter 339 of the laws of 2022, is amended to 28 read as follows: 29 § 3. This act shall take effect immediately and shall be deemed to 30 have been in full force and effect on and after July 1, 2014, provided, 31 however that the provisions of this act shall expire and be deemed 32 repealed June 30, [2024] 2026. 33 § 4. This act shall take effect immediately and shall be deemed to 34 have been in full force and effect on and after April 1, 2024; provided, 35 however, that the amendments to paragraph d of subdivision 6 of section 36 4410 of the education law made by section one of this act shall not 37 affect the expiration of such paragraph and shall be deemed to expire 38 therewith; provided further, however, that the amendments to subdivision 39 1 of section 7605 of the education law made by section two of this act 40 shall not affect the expiration of such subdivision and shall be deemed 41 to expire therewith. 42 PART D 43 Section 1. Paragraph (c) of subdivision 8 of section 2807-c of the 44 public health law, as amended by section 1 of part D of chapter 57 of 45 the laws of 2021, is amended to read as follows: 46 (c) In order to reconcile capital related inpatient expenses included 47 in rates of payment based on a budget to actual expenses and statistics 48 for the rate period for a general hospital, rates of payment for a 49 general hospital shall be adjusted to reflect the dollar value of the 50 difference between capital related inpatient expenses included in the 51 computation of rates of payment for a prior rate period based on a budg- 52 et and actual capital related inpatient expenses for such prior rate 53 period, each as determined in accordance with paragraph (a) of this 54 subdivision, adjusted to reflect increases or decreases in volume ofS. 8307--A 10 A. 8807--A 1 service in such prior rate period compared to statistics applied in 2 determining the capital related inpatient expenses component of rates of 3 payment based on a budget for such prior rate period. 4 For rates effective April first, two thousand twenty through March 5 thirty-first, two thousand twenty-one, the budgeted capital-related 6 expenses add-on as described in paragraph (a) of this subdivision, based 7 on a budget submitted in accordance to paragraph (a) of this subdivi- 8 sion, shall be reduced by five percent relative to the rate in effect on 9 such date; and the actual capital expenses add-on as described in para- 10 graph (a) of this subdivision, based on actual expenses and statistics 11 through appropriate audit procedures in accordance with paragraph (a) of 12 this subdivision shall be reduced by five percent relative to the rate 13 in effect on such date. 14 For rates effective [on and after] April first, two thousand twenty- 15 one through September thirtieth, two thousand twenty-four, the budgeted 16 capital-related expenses add-on as described in paragraph (a) of this 17 subdivision, based on a budget submitted in accordance to paragraph (a) 18 of this subdivision, shall be reduced by ten percent relative to the 19 rate in effect on such date; and the actual capital expenses add-on as 20 described in paragraph (a) of this subdivision, based on actual expenses 21 and statistics through appropriate audit procedures in accordance with 22 paragraph (a) of this subdivision shall be reduced by ten percent rela- 23 tive to the rate in effect on such date. 24 For rates effective on and after October first, two thousand twenty- 25 four, the budgeted capital-related expenses add-on as described in para- 26 graph (a) of this subdivision, based on a budget submitted in accordance 27 with paragraph (a) of this subdivision, shall be reduced by twenty 28 percent relative to the rate in effect on such date; and the actual 29 capital expenses add-on as described in paragraph (a) of this subdivi- 30 sion shall be reduced by twenty percent relative to the rate in effect 31 on such date. 32 For any rate year, all reconciliation add-on amounts calculated [on33and after] for the period of April first, two thousand twenty through 34 September thirtieth, two thousand twenty-four shall be reduced by ten 35 percent, and all reconciliation recoupment amounts calculated [on or36after] for the period of April first, two thousand twenty through 37 September thirtieth, two thousand twenty-four shall increase by ten 38 percent. 39 For any rate year, all reconciliation add-on amounts calculated on and 40 after October first, two thousand twenty-four shall be reduced by twenty 41 percent, and all reconciliation recoupment amounts calculated on or 42 after October first, two thousand twenty-four shall increase by twenty 43 percent. 44 Notwithstanding any inconsistent provision of subparagraph (i) of 45 paragraph (e) of subdivision nine of this section, capital related inpa- 46 tient expenses of a general hospital included in the computation of 47 rates of payment based on a budget shall not be included in the computa- 48 tion of a volume adjustment made in accordance with such subparagraph. 49 Adjustments to rates of payment for a general hospital made pursuant to 50 this paragraph shall be made in accordance with paragraph (c) of subdi- 51 vision eleven of this section. Such adjustments shall not be carried 52 forward except for such volume adjustment as may be authorized in 53 accordance with subparagraph (i) of paragraph (e) of subdivision nine of 54 this section for such general hospital. 55 § 2. Section 5 of part ZZ of chapter 56 of the laws of 2020 amending 56 the tax law and the social services law relating to certain MedicaidS. 8307--A 11 A. 8807--A 1 management, as amended by section 3 of part RR of chapter 57 of the laws 2 of 2022, is amended to read as follows: 3 § 5. This act shall take effect immediately and shall be deemed 4 repealed [five] eight years after such effective date. 5 § 3. Section 2 of part E of chapter 57 of the laws of 2015, amending 6 the public health law relating to the payment of certain funds for 7 uncompensated care, is amended to read as follows: 8 § 2. Notwithstanding any inconsistent provision of law, rule or regu- 9 lation to the contrary, and subject to the availability of federal 10 financial participation pursuant to title XIX of the federal social 11 security act, effective for [periods on and after] each state fiscal 12 year from April 1, 2015, through December 31, 2024; and for the calendar 13 year January 1, 2025 through December 31, 2025; and for each calendar 14 year thereafter, payments pursuant to paragraph (i) of subdivision 35 of 15 section 2807-c of the public health law may be made as outpatient upper 16 payment limit payments for outpatient hospital services, not to exceed 17 an amount of three hundred thirty-nine million dollars annually between 18 payments authorized under this section and such section of the public 19 health law. Such payments shall be made as medical assistance payments 20 for outpatient services pursuant to title 11 of article 5 of the social 21 services law for patients eligible for federal financial participation 22 under title XIX of the federal social security act for general hospital 23 outpatient services and general hospital emergency room services issued 24 pursuant to paragraph (g) of subdivision 2 of section 2807 of the public 25 health law to general hospitals, other than major public general hospi- 26 tals, providing emergency room services and including safety net hospi- 27 tals, which shall, for the purpose of this paragraph, be defined as 28 having either: a Medicaid share of total inpatient hospital discharges 29 of at least thirty-five percent, including both fee-for-service and 30 managed care discharges for acute and exempt services; or a Medicaid 31 share of total discharges of at least thirty percent, including both 32 fee-for-service and managed care discharges for acute and exempt 33 services, and also providing obstetrical services. Eligibility to 34 receive such additional payments shall be based on data from the period 35 two years prior to the rate year, as reported on the institutional cost 36 report submitted to the department as of October first of the prior rate 37 year. No eligible general hospital's annual payment amount pursuant to 38 this section shall exceed the lower of the sum of the annual amounts due 39 that hospital pursuant to section twenty-eight hundred seven-k and 40 section twenty-eight hundred seven-w of the public health law; or the 41 hospital's facility specific projected disproportionate share hospital 42 payment ceiling established pursuant to federal law, provided, however, 43 that payment amounts to eligible hospitals in excess of the lower of 44 such sum or payment ceiling shall be reallocated to eligible hospitals 45 that do not have excess payment amounts. Such reallocations shall be 46 proportional to each such hospital's aggregate payment amount pursuant 47 to paragraph (i) of subdivision 35 of section 2807-c of the public 48 health law and this section to the total of all payment amounts for such 49 eligible hospitals. Such adjustment payment may be added to rates of 50 payment or made as aggregate payments to eligible general hospitals 51 other than major public general hospitals. The distribution of such 52 payments shall be pursuant to a methodology approved by the commissioner 53 of health in regulation. 54 § 4. Section 21 of part B of chapter 57 of the laws of 2015, amending 55 the social services law relating to supplemental rebates, is amended to 56 read as follows:S. 8307--A 12 A. 8807--A 1 § 21. Notwithstanding any inconsistent provision of law, rule or regu- 2 lation to the contrary, and subject to the availability of federal 3 financial participation pursuant to title XIX of the federal social 4 security act, effective for [the period] each state fiscal year from 5 April 1, 2011 through [March 31, 2012, and state fiscal years] December 6 31, 2024; and for the calendar year January 1, 2025 through December 31, 7 2025; and for each calendar year thereafter, the department of health is 8 authorized to increase the operating cost component of rates of payment 9 for general hospital outpatient services and general hospital emergency 10 room services issued pursuant to paragraph (g) of subdivision 2 of 11 section 2807 of the public health law for public general hospitals, as 12 defined in subdivision 10 of section 2801 of the public health law, 13 other than those operated by the state of New York or the state univer- 14 sity of New York, and located in a city with a population over one 15 million, up to two hundred eighty-seven million dollars annually as 16 medical assistance payments for outpatient services pursuant to title 11 17 of article 5 of the social services law for patients eligible for feder- 18 al financial participation under title XIX of the federal social securi- 19 ty act based on such criteria and methodologies as the commissioner may 20 from time to time set through a memorandum of understanding with the New 21 York city health and hospitals corporation, and such adjustments shall 22 be paid by means of one or more estimated payments, with such estimated 23 payments to be reconciled to the commissioner of health's final adjust- 24 ment determinations after the disproportionate share hospital payment 25 adjustment caps have been calculated for such period under sections 26 1923(f) and (g) of the federal social security act. Such adjustment 27 payment may be added to rates of payment or made as aggregate payments 28 to eligible public general hospitals. 29 § 5. The opening paragraph of subparagraph (i) of paragraph (i) of 30 subdivision 35 of section 2807-c of the public health law, as amended by 31 section 4 of part C of chapter 56 of the laws of 2013, is amended to 32 read as follows: 33 Notwithstanding any inconsistent provision of this subdivision or any 34 other contrary provision of law and subject to the availability of 35 federal financial participation, for [the period] each state fiscal year 36 from July first, two thousand ten through [March thirty-first, two thou-37sand eleven,] December thirty-first, two thousand twenty-four; and [each38state fiscal year period] for the calendar year January first, two thou- 39 sand twenty-five through December thirty-first, two thousand twenty- 40 five; and for each calendar year thereafter, the commissioner shall make 41 additional inpatient hospital payments up to the aggregate upper payment 42 limit for inpatient hospital services after all other medical assistance 43 payments, but not to exceed two hundred thirty-five million five hundred 44 thousand dollars for the period July first, two thousand ten through 45 March thirty-first, two thousand eleven, three hundred fourteen million 46 dollars for each state fiscal year beginning April first, two thousand 47 eleven, through March thirty-first, two thousand thirteen, and no less 48 than three hundred thirty-nine million dollars for each state fiscal 49 year [thereafter] until December thirty-first, two thousand twenty-four; 50 and then from calendar year January first, two thousand twenty-five 51 through December thirty-first, two thousand twenty-five; and for each 52 calendar year thereafter, to general hospitals, other than major public 53 general hospitals, providing emergency room services and including safe- 54 ty net hospitals, which shall, for the purpose of this paragraph, be 55 defined as having either: a Medicaid share of total inpatient hospital 56 discharges of at least thirty-five percent, including both fee-for-ser-S. 8307--A 13 A. 8807--A 1 vice and managed care discharges for acute and exempt services; or a 2 Medicaid share of total discharges of at least thirty percent, including 3 both fee-for-service and managed care discharges for acute and exempt 4 services, and also providing obstetrical services. Eligibility to 5 receive such additional payments shall be based on data from the period 6 two years prior to the rate year, as reported on the institutional cost 7 report submitted to the department as of October first of the prior rate 8 year. Such payments shall be made as medical assistance payments for 9 fee-for-service inpatient hospital services pursuant to title eleven of 10 article five of the social services law for patients eligible for feder- 11 al financial participation under title XIX of the federal social securi- 12 ty act and in accordance with the following: 13 § 6. Section 18 of part B of chapter 57 of the laws of 2015, amending 14 the social services law relating to supplemental rebates, is amended to 15 read as follows: 16 § 18. Notwithstanding any inconsistent provision of law or regulation 17 to the contrary, and subject to the availability of federal financial 18 participation pursuant to title XIX of the federal social security act, 19 effective for [the period] each state fiscal year from April 1, 2012, 20 through [March 31, 2013, and state fiscal years] December 31, 2024; and 21 for the calendar year from January 1, 2025 through December 31, 2025; 22 and for each calendar year thereafter, the department of health is 23 authorized to pay a public hospital adjustment to public general hospi- 24 tals, as defined in subdivision 10 of section 2801 of the public health 25 law, other than those operated by the state of New York or the state 26 university of New York, and located in a city with a population of over 27 1 million, of up to one billion eighty million dollars annually as 28 medical assistance payments for inpatient services pursuant to title 11 29 of article 5 of the social services law for patients eligible for feder- 30 al financial participation under title XIX of the federal social securi- 31 ty act based on such criteria and methodologies as the commissioner may 32 from time to time set through a memorandum of understanding with the New 33 York city health and hospitals corporation, and such adjustments shall 34 be paid by means of one or more estimated payments, with such estimated 35 payments to be reconciled to the commissioner of health's final adjust- 36 ment determinations after the disproportionate share hospital payment 37 adjustment caps have been calculated for such period under sections 38 1923(f) and (g) of the federal social security act. Such adjustment 39 payment may be added to rates of payment or made as aggregate payments 40 to eligible public general hospitals. 41 § 7. Subdivision 1 of section 3-a of part B of chapter 58 of the laws 42 of 2010, amending the social services law and the public health law 43 relating to prescription drug coverage for needy persons and health care 44 initiatives pools, is amended to read as follows: 45 1. Notwithstanding any inconsistent provision of law, rule or regu- 46 lation to the contrary, and subject to the availability of federal 47 financial participation, effective for [the period] each state fiscal 48 year from August 1, 2010 through [March 31, 2011, and each state fiscal49year] December 31, 2024; and for the calendar year from January 1, 2025 50 through December 31, 2025; and for each calendar year thereafter, the 51 department of health is authorized to make Medicaid payment increases 52 for diagnostic and treatment centers (DTC) services issued pursuant to 53 section 2807 of the public health law for public DTCs operated by the 54 New York City Health and Hospitals Corporation, at the election of the 55 social services district in which an eligible DTC is physically located, 56 of up to twelve million six hundred thousand dollars on an annualizedS. 8307--A 14 A. 8807--A 1 basis for DTC services pursuant to title 11 of article 5 of the social 2 services law for patients eligible for federal financial participation 3 under title XIX of the federal social security act based on each such 4 DTC's proportionate share of the sum of all clinic visits for all facil- 5 ities eligible for an adjustment pursuant to this section for the base 6 year two years prior to the rate year. Such proportionate share payments 7 may be added to rates of payment or made as aggregate payments to eligi- 8 ble DTCs. 9 § 8. Subdivision 1 of section 3-b of part B of chapter 58 of the laws 10 of 2010, amending the social services law and the public health law 11 relating to prescription drug coverage for needy persons and health care 12 initiatives pools, is amended to read as follows: 13 1. Notwithstanding any inconsistent provision of law, rule or regu- 14 lation to the contrary, and subject to the availability of federal 15 financial participation, effective for [the period] each state fiscal 16 year from August 1, 2010 through [March 31, 2011, and each state fiscal17year] December 31, 2024; and for the calendar year from January 1, 2025 18 through December 31, 2025; and for each calendar year thereafter, the 19 department of health, is authorized to make Medicaid payment increases 20 for county operated diagnostic and treatment centers (DTC) services 21 issued pursuant to section 2807 of the public health law and for 22 services provided by county operated free-standing clinics licensed 23 pursuant to articles 31 and 32 of the mental hygiene law, but not 24 including facilities operated by the New York City Health and Hospitals 25 Corporation, of up to five million four hundred thousand dollars on an 26 annualized basis for such services pursuant to title 11 of article 5 of 27 the social services law for patients eligible for federal financial 28 participation under title XIX of the federal social security act. Local 29 social services districts may decline such increased payments to their 30 sponsored DTCs and free-standing clinics, provided they provide written 31 notification to the commissioner of health, within thirty days following 32 receipt of notification of a payment pursuant to this section. Distrib- 33 utions pursuant to this section shall be based on each facility's 34 proportionate share of the sum of all DTC and clinic visits for all 35 facilities receiving payments pursuant to this section for the base year 36 two years prior to the rate year. Such proportionate share payments may 37 be added to rates or payment or made as aggregate payments to eligible 38 facilities. 39 § 9. Paragraph (e-1) of subdivision 12 of section 2808 of the public 40 health law, as amended by section 15 of part B of chapter 57 of the laws 41 of 2023, is amended to read as follows: 42 (e-1) Notwithstanding any inconsistent provision of law or regulation, 43 the commissioner shall provide, in addition to payments established 44 pursuant to this article prior to application of this section, addi- 45 tional payments under the medical assistance program pursuant to title 46 eleven of article five of the social services law for non-state operated 47 public residential health care facilities, including public residential 48 health care facilities located in the county of Nassau, the county of 49 Westchester and the county of Erie, but excluding public residential 50 health care facilities operated by a town or city within a county, in 51 aggregate annual amounts of up to one hundred fifty million dollars in 52 additional payments for the state fiscal year beginning April first, two 53 thousand six and for the state fiscal year beginning April first, two 54 thousand seven and for the state fiscal year beginning April first, two 55 thousand eight and of up to three hundred million dollars in such aggre- 56 gate annual additional payments for the state fiscal year beginningS. 8307--A 15 A. 8807--A 1 April first, two thousand nine, and for the state fiscal year beginning 2 April first, two thousand ten and for the state fiscal year beginning 3 April first, two thousand eleven, and for the state fiscal years begin- 4 ning April first, two thousand twelve and April first, two thousand 5 thirteen, and of up to five hundred million dollars in such aggregate 6 annual additional payments for the state fiscal years beginning April 7 first, two thousand fourteen, April first, two thousand fifteen and 8 April first, two thousand sixteen and of up to five hundred million 9 dollars in such aggregate annual additional payments for the state 10 fiscal years beginning April first, two thousand seventeen, April first, 11 two thousand eighteen, and April first, two thousand nineteen, and of up 12 to five hundred million dollars in such aggregate annual additional 13 payments for the state fiscal years beginning April first, two thousand 14 twenty, April first, two thousand twenty-one, and April first, two thou- 15 sand twenty-two, and of up to five hundred million dollars in such 16 aggregate annual additional payments for the state fiscal years begin- 17 ning April first, two thousand twenty-three, and from April first, two 18 thousand twenty-four until December thirty-first, two thousand twenty- 19 four, and [April first, two thousand twenty-five] for the calendar year 20 January first, two thousand twenty-five through December thirty-first, 21 two thousand twenty-five, and for each calendar year thereafter. The 22 amount allocated to each eligible public residential health care facili- 23 ty for this period shall be computed in accordance with the provisions 24 of paragraph (f) of this subdivision, provided, however, that patient 25 days shall be utilized for such computation reflecting actual reported 26 data for two thousand three and each representative succeeding year as 27 applicable, and provided further, however, that, in consultation with 28 impacted providers, of the funds allocated for distribution in the state 29 fiscal year beginning April first, two thousand thirteen, up to thirty- 30 two million dollars may be allocated in accordance with paragraph (f-1) 31 of this subdivision. 32 § 10. This act shall take effect immediately; provided, however, 33 section one of this act shall take effect October 1, 2024; and provided, 34 further, that sections three, four, five, six, seven, eight and nine of 35 this act shall take effect January 1, 2025. 36 PART E 37 Section 1. Subparagraph (ii) of paragraph (b) of subdivision 2-b of 38 section 2808 of the public health law, as added by section 47 of part C 39 of chapter 109 of the laws of 2006, is amended to read as follows: 40 (ii) (A) The operating component of rates shall be subject to case mix 41 adjustment through application of the relative resource utilization 42 groups system of patient classification (RUG-III) employed by the feder- 43 al government with regard to payments to skilled nursing facilities 44 pursuant to title XVIII of the federal social security act (Medicare), 45 as revised by regulation to reflect New York state wages and fringe 46 benefits, provided, however, that such RUG-III classification system 47 weights shall be increased in the following amounts for the following 48 categories of residents: [(A)] (1) thirty minutes for the impaired 49 cognition A category, [(B)] (2) forty minutes for the impaired cognition 50 B category, and [(C)] (3) twenty-five minutes for the reduced physical 51 functions B category. Such adjustments shall be made in January and 52 July of each calendar year. Such adjustments and related patient classi- 53 fications in each facility shall be subject to audit review in accord- 54 ance with regulations promulgated by the commissioner.S. 8307--A 16 A. 8807--A 1 (B) Effective April first, two thousand twenty-four, the case mix 2 adjustment from the operating component of the rates for skilled nursing 3 facilities shall remain unchanged from the July two thousand twenty- 4 three rates during the development and until full implementation of a 5 case mix methodology using the Patient Driven Payment Model. 6 § 2. Subparagraph (iv) of paragraph (b) of subdivision 2-b of section 7 2808 of the public health law, as amended by section 1 of part NN of 8 chapter 56 of the laws of 2020, is amended to read as follows: 9 (iv) The capital cost component of rates on and after January first, 10 two thousand nine shall: (A) fully reflect the cost of local property 11 taxes and payments made in lieu of local property taxes, as reported in 12 each facility's cost report submitted for the year two years prior to 13 the rate year; (B) provided, however, notwithstanding any inconsistent 14 provision of this article, commencing April first, two thousand twenty 15 for rates of payment for patients eligible for payments made by state 16 governmental agencies, the capital cost component determined in accord- 17 ance with this subparagraph and inclusive of any shared savings for 18 eligible facilities that elect to refinance their mortgage loans pursu- 19 ant to paragraph (d) of subdivision two-a of this section, shall be 20 reduced by the commissioner by five percent; and (C) provided, however, 21 notwithstanding any inconsistent provision of this article, commencing 22 April first, two thousand twenty-four for rates of payment for patients 23 eligible for payments made by state governmental agencies, the capital 24 cost component determined in accordance with this subparagraph and 25 inclusive of any shared savings for eligible facilities that elect to 26 refinance their mortgage loans pursuant to paragraph (d) of subdivision 27 two-a of this section, shall be reduced by the commissioner by an addi- 28 tional ten percent. 29 § 3. Paragraph (h) of subdivision 1 of section 2632 of the public 30 health law, as amended by chapter 414 of the laws of 2015, is amended to 31 read as follows: 32 (h) in the Persian Gulf conflict from the second day of August, nine- 33 teen hundred ninety to the end of such conflict including military 34 service in Operation Enduring Freedom, Operation Iraqi Freedom, Opera- 35 tion New Dawn or Operation Inherent Resolve and was the recipient of the 36 global war on terrorism expeditionary medal or the Iraq campaign medal 37 or the Afghanistan campaign medal; and who was a resident of the state 38 of New York at the time of entry upon such active duty or who shall have 39 been a resident of this state for [one year] six months next preceding 40 the application for admission shall be entitled to admission to said 41 home after the approval of the application by the board of visitors, 42 subject to the provisions of this article and to the conditions, limita- 43 tions and penalties prescribed by the regulations of the department. Any 44 such veteran or dependent, who otherwise fulfills the requirements set 45 forth in this section, may be admitted directly to the skilled nursing 46 facility or the health related facility provided such veteran or depend- 47 ent is certified by a physician designated or approved by the department 48 to require the type of care provided by such facilities. 49 § 4. This act shall take effect immediately and shall be deemed to 50 have been in full force and effect on and after April 1, 2024. 51 PART F 52 Section 1. Paragraph (n) of subdivision 3 of section 461-l of the 53 social services law, as amended by section 2 of part B of chapter 57 of 54 the laws of 2018, is amended to read as follows:S. 8307--A 17 A. 8807--A 1 (n) The commissioner of health is authorized to create a program to 2 subsidize the cost of assisted living for those individuals living with 3 Alzheimer's disease and dementia who are not eligible for medical 4 assistance pursuant to title eleven of article five of this chapter and 5 reside in a special needs assisted living residence certified under 6 section forty-six hundred fifty-five of the public health law. The 7 program shall authorize up to two hundred vouchers to individuals 8 through an application process and pay for up to seventy-five percent of 9 the average private pay rate in the respective region. The commissioner 10 of health may propose rules and regulations to effectuate this 11 provision. 12 § 2. Subdivisions 7 and 8 of section 4656 of the public health law, as 13 added by chapter 2 of the laws of 2004, are renumbered subdivisions 8 14 and 9 and a new subdivision 7 is added to read as follows: 15 7. (a) All assisted living residences, as defined in subdivision one 16 of section forty-six hundred fifty-one of this article, including those 17 licensed and certified as an assisted living residence, special needs 18 assisted living residence, or enhanced assisted living residence, shall: 19 (i) report annually on quality measures to be established by the 20 department, in the form and format prescribed by the department, with 21 the first report due no later than January thirty-first, two thousand 22 twenty-five; and 23 (ii) post the monthly service rate, staffing complement, approved 24 admission or residency agreement, and a consumer-friendly summary of all 25 service fees in a conspicuous place on the facility's website and in a 26 public space within the facility. Such information shall be made avail- 27 able to the public on forms developed by the department. Beginning on 28 January first, two thousand twenty-five, this information shall also be 29 reported to the department. 30 (b) The department shall score the results of the assisted living 31 quality reporting obtained pursuant to paragraph (a) of this subdivi- 32 sion. Top scoring facilities shall be granted the classification of 33 advanced standing on their annual surveillance schedules. 34 (i) Notwithstanding subparagraph one of paragraph (a) of subdivision 35 two of section four hundred sixty-one-a of the social services law, 36 facilities achieving an advanced standing classification shall be 37 surveyed every twelve to eighteen months. All other facilities shall be 38 surveyed on an unannounced basis no less than annually; provided, howev- 39 er, that this shall not apply to surveys, inspections or investigations 40 based on complaints received by the department under any other provision 41 of law. 42 (ii) Facilities may remain on advanced standing classification 43 provided they meet the scoring requirements in the assisted living qual- 44 ity reporting. 45 (c) Effective January thirty-first, two thousand twenty-five, the 46 department may post on its website the results of the assisted living 47 quality reporting collected pursuant to subparagraph (i) of paragraph 48 (a) of this subdivision. 49 § 3. Subparagraph 1 of paragraph (a) of subdivision 2 of section 461-a 50 of the social services law, as amended by chapter 735 of the laws of 51 1994, is amended and a new subparagraph 1-a is added to read as follows: 52 (1) Such facilities receiving the department's highest rating shall be 53 inspected at least once every eighteen months on an unannounced basis. 54 Such rating determination shall be made pursuant to an evaluation of 55 quality indicators as developed by the department and published on the 56 department's website.S. 8307--A 18 A. 8807--A 1 (1-a) (i) Adult care facilities dually licensed to provide assisted 2 living pursuant to the requirements specified in section forty-six 3 hundred fifty-three of the public health law may seek accreditation by 4 one or more nationally recognized accrediting agencies determined by the 5 commissioner. 6 (ii) Such accreditation agencies shall report data and information, in 7 a manner and form as determined by the department, pertaining to those 8 assisted living residences accredited by such agencies, those assisted 9 living residences that seek but do not receive such accreditation, and 10 those assisted living residences which obtain but lose such accredi- 11 tation. 12 (iii) Notwithstanding the provisions of subparagraph one of this para- 13 graph, or any other provision of law, assisted living residences which 14 have obtained accreditation from a nationally recognized accreditation 15 organization approved by the department and which meet eligibility 16 criteria, as determined by the department, may, at the discretion of the 17 commissioner, be exempt from the department inspection required in this 18 subdivision for the duration they maintain their accreditation in good 19 standing. The operator of an adult care facility that obtains but subse- 20 quently loses accreditation shall report such loss to the department 21 within ten business days in a manner and form determined by the depart- 22 ment and will no longer be exempt from the department inspection 23 required in this subdivision. The department shall post on its website a 24 list of all accredited assisted living residences. 25 § 4. This act shall take effect immediately and shall be deemed to 26 have been in full force and effect on and after April 1, 2024; provided, 27 however, the provisions of sections two and three of this act shall take 28 effect on the one hundred twentieth day after it shall have become a 29 law. 30 PART G 31 Section 1. Paragraph (i) of subdivision 1 of section 3614-c of the 32 public health law is REPEALED. 33 § 2. Paragraph (d) of subdivision 1, and subdivisions 2, 4, 5, 5-a, 6, 34 6-a, 7, 7-a, 9 and 10 of section 3614-c of the public health law, subdi- 35 visions 2, 4, 5, 6, 7, 9 and 10 as amended and subdivisions 6-a and 7-a 36 as added by section 1 and subdivision 5-a as added by section 1-a of 37 part OO of chapter 56 of the laws of 2020, are amended to read as 38 follows: 39 (d) "Home care aide" means a home health aide, personal care aide, 40 home attendant, [personal assistant performing consumer directed41personal assistance services pursuant to section three hundred sixty-42five-f of the social services law,] or other licensed or unlicensed 43 person whose primary responsibility includes the provision of in-home 44 assistance with activities of daily living, instrumental activities of 45 daily living or health-related tasks; provided, however, that home care 46 aide does not include any individual (i) working on a casual basis, or 47 (ii) [(except for a person employed under the consumer directed personal48assistance program under section three hundred sixty-five-f of the49social services law)] who is a relative through blood, marriage or 50 adoption of: (1) the employer; or (2) the person for whom the worker is 51 delivering services, under a program funded or administered by federal, 52 state or local government. 53 2. Notwithstanding any inconsistent provision of law, rule or regu- 54 lation, no payments by government agencies shall be made to certifiedS. 8307--A 19 A. 8807--A 1 home health agencies, long term home health care programs, managed care 2 plans, [fiscal intermediaries,] the nursing home transition and diver- 3 sion waiver program under section three hundred sixty-six of the social 4 services law, or the traumatic brain injury waiver program under section 5 twenty-seven hundred forty of this chapter for any episode of care 6 furnished, in whole or in part, by any home care aide who is compensated 7 at amounts less than the applicable minimum rate of home care aide total 8 compensation established pursuant to this section. 9 4. The terms of this section shall apply equally to services provided 10 by home care aides who work on episodes of care as direct employees of 11 certified home health agencies, long term home health care programs, or 12 managed care plans, or as employees of licensed home care services agen- 13 cies, limited licensed home care services agencies, [or fiscal interme-14diaries,] or under any other arrangement. 15 5. No payments by government agencies shall be made to certified home 16 health agencies, licensed home care services agencies, long term home 17 health care programs, managed care plans[, fiscal intermediaries] for 18 any episode of care without the certified home health agency, licensed 19 home care services agency, long term home health care program, or 20 managed care plan [or the fiscal intermediary], having delivered prior 21 written certification to the commissioner annually, at a time prescribed 22 by the commissioner, on forms prepared by the department in consultation 23 with the department of labor, that all services provided under each 24 episode of care during the period covered by the certification are in 25 full compliance with the terms of this section and any regulations 26 promulgated pursuant to this section and that no portion of the dollars 27 spent or to be spent to satisfy the wage or benefit portion under this 28 section shall be returned to the certified home health agency, licensed 29 home care services agency, long term home health care program, or 30 managed care plan, [or fiscal intermediary,] related persons or enti- 31 ties, other than to a home care aide as defined in this section to whom 32 the wage or benefits are due, as a refund, dividend, profit, or in any 33 other manner. Such written certification shall also verify that the 34 certified home health agency, long term home health care program, or 35 managed care plan has received from the licensed home care services 36 agency, [fiscal intermediary,] or other third party an annual statement 37 of wage parity hours and expenses on a form provided by the department 38 of labor accompanied by an independently-audited financial statement 39 verifying such expenses. 40 5-a. No portion of the dollars spent or to be spent to satisfy the 41 wage or benefit portion under this section shall be returned to the 42 certified home health agency, licensed home care services agency, long 43 term home health care program, or managed care plan, [or fiscal interme-44diary,] related persons or entities, other than to a home care aide as 45 defined in this section to whom the wage or benefits are due, as a 46 refund, dividend, profit, or in any other manner. 47 6. If a certified home health agency, long term home health care 48 program or managed care plan elects to provide home care aide services 49 through contracts with licensed home care services agencies, [fiscal50intermediaries,] or through other third parties, provided that the 51 episode of care on which the home care aide works is covered under the 52 terms of this section, the certified home health agency, long term home 53 health care program, or managed care plan shall include in its 54 contracts, a requirement that it be provided with a written certif- 55 ication, verified by oath, from the licensed home care services agency, 56 [fiscal intermediary,] or other third party, on forms prepared by theS. 8307--A 20 A. 8807--A 1 department in consultation with the department of labor, which attests 2 to the licensed home care services agency's, [fiscal intermediary's,] or 3 other third party's compliance with the terms of this section. Such 4 contracts shall also obligate the licensed home care services agency, 5 [fiscal intermediary,] or other third party to provide the certified 6 home health agency, long term home health care program, or managed care 7 plan all information from the licensed home care services agency, 8 [fiscal intermediary] or other third party necessary to verify compli- 9 ance with the terms of this section, which shall include an annual 10 compliance statement of wage parity hours and expenses on a form 11 provided by the department of labor accompanied by an independently-au- 12 dited financial statement verifying such expenses. Such annual state- 13 ments shall be available no less than annually for the previous calendar 14 year, at a time as prescribed by the commissioner. Such certifications, 15 the information necessary to verify compliance, and the annual compli- 16 ance statement and financial statements shall be retained by all certi- 17 fied home health agencies, long term home health care programs, or 18 managed care plans, and all licensed home care services agencies, 19 [fiscal intermediaries,] or other third parties for a period of no less 20 than ten years, and made available to the department upon request. Any 21 licensed home care services agency, [fiscal intermediary,] or other 22 third party who shall upon oath verify any statement required to be 23 transmitted under this section and any regulations promulgated pursuant 24 to this section which is known by such party to be false shall be guilty 25 of perjury and punishable as provided by the penal law. 26 6-a. The certified home health agency, long term home health care 27 program, or managed care plan shall review and assess the annual compli- 28 ance statement of wage parity hours and expenses and make a written 29 referral to the department of labor for any reasonably suspected fail- 30 ures of licensed home care services agencies, [fiscal intermediaries,] 31 or third parties to conform to the wage parity requirements of this 32 section. 33 7. The commissioner shall distribute to all certified home health 34 agencies, long term home health care programs, managed care plans, and 35 licensed home care services agencies[, and fiscal intermediaries] offi- 36 cial notice of the minimum rates of home care aide compensation at least 37 one hundred twenty days prior to the effective date of each minimum rate 38 for each social services district covered by the terms of this section. 39 7-a. Any certified home health agency, licensed home care services 40 agency, long term home health care program, managed care plan, [or41fiscal intermediary,] or other third party that willfully pays less than 42 such stipulated minimums regarding wages and supplements, as established 43 in this section, shall be guilty of a misdemeanor and upon conviction 44 shall be punished, for a first offense by a fine of five hundred dollars 45 or by imprisonment for not more than thirty days, or by both fine and 46 imprisonment; for a second offense by a fine of one thousand dollars, 47 and in addition thereto the contract on which the violation has occurred 48 shall be forfeited; and no such person or corporation shall be entitled 49 to receive any sum nor shall any officer, agent or employee of the state 50 pay the same or authorize its payment from the funds under his or her 51 charge or control to any person or corporation for work done upon any 52 contract, on which the certified home health agency, licensed home care 53 services agency, long term home health care program, managed care plan, 54 [or fiscal intermediary,] or other third party has been convicted of a 55 second offense in violation of the provisions of this section.S. 8307--A 21 A. 8807--A 1 9. Nothing in this section should be construed as applicable to any 2 service provided by certified home health agencies, licensed home care 3 services agencies, long term home health care programs[,] or managed 4 care plans[, or fiscal intermediaries] except for all episodes of care 5 reimbursed in whole or in part by the New York Medicaid program. 6 10. No certified home health agency, managed care plan, or long term 7 home health care program shall be liable for recoupment of payments or 8 any other penalty under this section for services provided through a 9 licensed home care services agency, [fiscal intermediary,] or other 10 third party with which the certified home health agency, long term home 11 health care program, or managed care plan has a contract because the 12 licensed agency, [fiscal intermediary,] or other third party failed to 13 comply with the provisions of this section if the certified home health 14 agency, long term home health care program, or managed care plan has 15 reasonably and in good faith collected certifications and all informa- 16 tion required pursuant to this section and conducts the monitoring and 17 reporting required by this section. 18 § 3. Paragraph (a) of subdivision 1 of section 3614-f of the public 19 health law, as added by section 3 of part NN of chapter 57 of the laws 20 of 2023, is amended to read as follows: 21 (a) "Home care aide" [shall have the same meaning as defined in22section thirty-six hundred fourteen-c of this article] means, for the 23 purpose of this section, a home health aide, personal care aide, home 24 attendant, personal assistant performing consumer directed personal 25 assistance services pursuant to section three hundred sixty-five-f of 26 the social services law, or other licensed or unlicensed person whose 27 primary responsibility includes the provision of in-home assistance with 28 activities of daily living, instrumental activities of daily living or 29 health-related tasks; provided, however, that home care aide does not 30 include any individual (i)working on a casual basis, or (ii) (except for 31 a person employed under the consumer directed personal assistance 32 program under section three hundred sixty-five-f of the social services 33 law) who is a relative through blood, marriage or adoption of: (1) the 34 employer; or (2) the person for whom the worker is delivering services, 35 under a program funded or administered by federal, state or local 36 government. 37 § 4. This act shall take effect October 1, 2024. 38 PART H 39 Section 1. Section 602 of the financial services law, as added by 40 section 26 of part H of chapter 60 of the laws of 2014, is amended to 41 read as follows: 42 § 602. Applicability. [(a)] This article shall not apply to health 43 care services, including emergency services, where physician fees are 44 subject to schedules or other monetary limitations under any other law, 45 including the workers' compensation law and article fifty-one of the 46 insurance law, and shall not preempt any such law. This article also 47 shall not apply to health care services, including emergency services, 48 subject to medical assistance program coverage provided pursuant to 49 section three hundred sixty-four-j of the social services law. 50 § 2. Subdivision 2 of section 364-j of the social services law is 51 amended by adding a new paragraph (e) to read as follows: 52 (e) Effective April first, two thousand twenty-four and expiring on 53 the date the commissioner publishes on the department's website a 54 request for proposals in accordance with paragraph (a) of subdivisionS. 8307--A 22 A. 8807--A 1 five of this section, the commissioner shall place a moratorium on the 2 processing and approval of applications seeking authority to establish a 3 managed care provider, including applications seeking authorization to 4 expand the scope of eligible enrollee populations. Such moratorium shall 5 not apply to: 6 (i) applications submitted to the department prior to January first, 7 two thousand twenty-four; 8 (ii) applications seeking approval to transfer ownership or control of 9 an existing managed care provider; 10 (iii) applications seeking authorization to expand an existing managed 11 care provider's approved service area; 12 (iv) applications seeking authorization to form or operate a managed 13 care provider through an entity certified under section forty-four 14 hundred three-c or forty-four hundred three-g of the public health law; 15 (v) applications demonstrating to the commissioner's satisfaction that 16 submission of the application for consideration would be appropriate to 17 address a serious concern with care delivery, such as a lack of adequate 18 access to managed care providers in a geographic area or a lack of 19 adequate and appropriate care, language and cultural competence, or 20 special needs services. 21 § 3. Subdivision 5 of section 364-j of the social services law, as 22 amended by section 15 of part C of chapter 58 of the laws of 2004, para- 23 graph (a) as amended by section 40 of part A of chapter 56 of the laws 24 of 2013, and paragraphs (d), (e) and (f) as amended by section 80 of 25 part H of chapter 59 of the laws of 2011, is amended to read as follows: 26 5. Managed care programs shall be conducted in accordance with the 27 requirements of this section and, to the extent practicable, encourage 28 the provision of comprehensive medical services, pursuant to this arti- 29 cle. 30 (a) Notwithstanding sections one hundred twelve and one hundred 31 sixty-three of the state finance law, sections one hundred forty-two and 32 one hundred forty-three of the economic development law, and any other 33 inconsistent provision of law, [The] the [managed care program] commis- 34 sioner of health shall, through a competitive bid process based on 35 proposals submitted to the department, provide for the selection of 36 qualified managed care providers [by the commissioner of health] to 37 participate in the managed care program pursuant to a contract with the 38 department, including [comprehensive HIV special needs plans and] 39 special needs managed care plans in accordance with the provisions of 40 section three hundred sixty-five-m of this title; provided, however, 41 [that] notwithstanding sections one hundred twelve and one hundred 42 sixty-three of the state finance law, sections one hundred forty-two and 43 one hundred forty-three of the economic development law, and any other 44 inconsistent provision of law, the commissioner of health may contract 45 directly with comprehensive HIV special needs plans [consistent with46standards set forth in this section] without a competitive bid process, 47 and assure that such providers are accessible taking into account the 48 needs of persons with disabilities and the differences between rural, 49 suburban, and urban settings, and in sufficient numbers to meet the 50 health care needs of participants, and shall consider the extent to 51 which major public hospitals are included within such providers' 52 networks[.]; and provided further that: 53 [(b) A proposal] (i) Proposals submitted by a managed care provider to 54 participate in the managed care program shall: 55 [(i)] (A) designate the geographic [area] areas, as defined by the 56 commissioner in the request for proposals, to be served [by the provid-S. 8307--A 23 A. 8807--A 1er], and estimate the number of eligible participants and actual partic- 2 ipants in such designated area; 3 [(ii)] (B) include a network of health care providers in sufficient 4 numbers and geographically accessible to service program participants; 5 [(iii)] (C) describe the procedures for marketing in the program 6 location, including the designation of other entities which may perform 7 such functions under contract with the organization; 8 [(iv)] (D) describe the quality assurance, utilization review and case 9 management mechanisms to be implemented; 10 [(v)] (E) demonstrate the applicant's ability to meet the data analy- 11 sis and reporting requirements of the program; 12 [(vi)] (F) demonstrate financial feasibility of the program; and 13 [(vii)] (G) include such other information as the commissioner of 14 health may deem appropriate. 15 [(c) The commissioner of health shall make a determination whether to16approve, disapprove or recommend modification of the proposal.17(d) Notwithstanding any inconsistent provision of this title and18section one hundred sixty-three of the state finance law, the commis-19sioner of health may contract with managed care providers approved under20paragraph (b) of this subdivision, without a competitive bid or request21for proposal process, to provide coverage for participants pursuant to22this title.23(e) Notwithstanding any inconsistent provision of this title and24section one hundred forty-three of the economic development law, no25notice in the procurement opportunities newsletter shall be required for26contracts awarded by the commissioner of health, to qualified managed27care providers pursuant to this section.28(f)] (ii) In addition to the criteria described in subparagraph (i) of 29 this paragraph, the commissioner shall also consider: 30 (A) accessibility and geographic distribution of network providers, 31 taking into account the needs of persons with disabilities and the 32 differences between rural, suburban, and urban settings; 33 (B) the extent to which major public hospitals are included in the 34 submitted provider network; 35 (C) demonstrated cultural and language competencies specific to the 36 population of participants; 37 (D) the corporate organization and status of the bidder as a charita- 38 ble corporation under the not-for-profit corporation law; 39 (E) the ability of a bidder to offer plans in multiple regions; 40 (F) the type and number of products the bidder proposes to operate, 41 including products bid for in accordance with the provisions of subdivi- 42 sion six of section forty-four hundred three-f of the public health law, 43 and other products determined by the commissioner, including but not 44 necessarily limited to those operated under title one-A of article twen- 45 ty-five of the public health law and section three hundred sixty-nine-gg 46 of this article; 47 (G) whether the bidder participates in products for integrated care 48 for participants who are dually eligible for Medicaid and medicare; 49 (H) whether the bidder participates in value based payment arrange- 50 ments as defined by the department, including the delegation of signif- 51 icant financial risk to clinically integrated provider networks; 52 (I) the bidder's commitment to participation in managed care in the 53 state; 54 (J) the bidder's commitment to quality improvement; 55 (K) the bidder's commitment to community reinvestment spending, as 56 shall be defined in the procurement;S. 8307--A 24 A. 8807--A 1 (L) for current or previously authorized managed care providers, past 2 performance in meeting managed care contract or federal or state 3 requirements, and if the commissioner issued any statements of findings, 4 statements of deficiency, intermediate sanctions or enforcement actions 5 to a bidder for non-compliance with such requirements, whether the 6 bidder addressed such issues in a timely manner; and 7 (M) any other criteria deemed appropriate by the commissioner. 8 (iii) Subparagraphs (i) and (ii) of this paragraph describing proposal 9 content and selection criteria requirements shall not be construed as 10 limiting or requiring the commissioner to evaluate such content or 11 criteria on a pass/fail scale, or other methodological basis; provided 12 however, that the commissioner must consider all such content and crite- 13 ria using methods determined by the commissioner in their discretion 14 and, as applicable, in consultation with the commissioners of the office 15 of mental health, the office for people with developmental disabilities, 16 the office of addiction services and supports, and the office of chil- 17 dren and family services. 18 (iv) The department shall post on its website: 19 (A) The request for proposals and a description of the proposed 20 services to be provided pursuant to contracts in accordance with this 21 subdivision; 22 (B) The criteria on which the department shall determine qualified 23 bidders and evaluate their proposals, including all criteria identified 24 in this subdivision; 25 (C) The manner by which a proposal may be submitted, which may include 26 submission by electronic means; 27 (D) The manner by which a managed care provider may continue to 28 participate in the managed care program pending award of managed care 29 providers through a competitive bid process pursuant to this subdivi- 30 sion; and 31 (E) Upon award, the managed care providers that the commissioner 32 intends to contract with pursuant to this subdivision, provided that the 33 commissioner shall update such list to indicate the final slate of 34 contracted managed care providers. 35 (v) Awards and contracting. (A) All responsible and responsive 36 submissions that are received from bidders in a timely fashion shall be 37 reviewed by the commissioner of health in consultation with the commis- 38 sioners of the office of mental health, the office for people with 39 developmental disabilities, the office of addiction services and 40 supports, and the office of children and family services, as applicable. 41 The commissioner shall consider comments resulting from the review of 42 proposals and make awards in consultation with such agencies. 43 (B) The commissioner may make awards under this subdivision for each 44 product, for which proposals were requested, to two or more managed care 45 providers in each geographic region defined by the commissioner in the 46 request for proposals for which at least two managed care providers have 47 submitted a proposal, and shall have discretion to offer more contracts 48 based on need for access. 49 (C) Managed care providers awarded under this subdivision shall be 50 entitled to enter into a contract with the department for the purpose of 51 participating in the managed care program. Such contracts shall run for 52 a term to be determined by the commissioner, which may be renewed or 53 modified from time to time without a new request for proposals, to 54 ensure consistency with changes in federal and state laws, regulations 55 and policies, including but not limited to the expansion or reduction ofS. 8307--A 25 A. 8807--A 1 medical assistance services available to the participants through a 2 managed care provider. 3 (D) Nothing in this paragraph or other provision of this section shall 4 be construed to limit in any way the ability of the department to termi- 5 nate awarded contracts for cause, which shall include but not be limited 6 to any violation of the terms of such contracts or violations of state 7 or federal laws and regulations and any loss of necessary state or 8 federal funding. 9 (E) Nothing in this paragraph or other provision of this section shall 10 be construed to limit in any way the ability of the department to issue 11 a new request for proposals for a term following an existing term of an 12 award. 13 (b) Transitioning the managed care program. (i) Within sixty-days of 14 the department issuing the request for proposals under paragraph (a) of 15 this subdivision, a managed care provider that was approved to partic- 16 ipate in the managed care program prior to the issuance of the request 17 for proposals, shall submit its intention to complete such proposal to 18 the department. (ii) A managed care provider that: (A) fails to submit 19 its intent timely, (B) indicates within the sixty-days its intent not to 20 complete such a proposal, (C) fails to submit a proposal within the 21 further timeframe specified by the commissioner in the request for 22 proposals, or (D) is not awarded the ability to participate in the 23 managed care program under paragraph (a) of this subdivision, shall, 24 upon direction from the commissioner, terminate its services and oper- 25 ations in accordance with the contract between the managed care provider 26 and the department and shall be additionally required to maintain cover- 27 age of participants for such period of time as determined necessary by 28 the commissioner to achieve the safe and orderly transfer of partic- 29 ipants. 30 (c) Addressing needs for additional managed care providers to ensure 31 participant access and choice. If necessary to ensure access to a suffi- 32 cient number of managed care providers on a geographic or other basis, 33 including a lack of adequate and appropriate care, language and cultural 34 competence, or special needs services, the commissioner may reissue a 35 request for proposals as provided for under paragraph (a) of this subdi- 36 vision, provided however that such request may be limited to the 37 geographic or other basis of need that the request for proposals is 38 seeking to address. Any awards made shall be subject to the requirements 39 of this section, including but not limited to the minimum and maximum 40 number of awards in a region. 41 (d) The care and services described in subdivision four of this 42 section will be furnished by a managed care provider pursuant to the 43 provisions of this section when such services are furnished in accord- 44 ance with an agreement with the department of health, and meet applica- 45 ble federal law and regulations. 46 [(g)] (e) The commissioner of health may delegate some or all of the 47 tasks identified in this section to the local districts. 48 [(h)] (f) Any delegation pursuant to paragraph [(g)] (e) of this 49 subdivision shall be reflected in the contract between a managed care 50 provider and the commissioner of health. 51 § 4. Subdivision 4 of section 365-m of the social services law is 52 REPEALED and a new subdivision 4 is added to read as follows: 53 4. The commissioner of health, jointly with the commissioners of the 54 office of mental health and the office of addiction services and 55 supports, shall select a limited number of special needs managed care 56 plans under section three hundred sixty-four-j of this title, in accord-S. 8307--A 26 A. 8807--A 1 ance with subdivision five of such section, capable of managing the 2 behavioral and physical health needs of medical assistance enrollees 3 with significant behavioral health needs. 4 § 5. The opening paragraph of subdivision 2 of section 4403-f of the 5 public health law, as amended by section 8 of part C of chapter 58 of 6 the laws of 2007, is amended to read as follows: 7 Certificate of Authority; form. An eligible applicant shall submit an 8 application for a certificate of authority to operate a managed long 9 term care plan upon forms prescribed by the commissioner, including any 10 such forms or processes as may be required or prescribed by the commis- 11 sioner in accordance with the competitive bid process under subdivision 12 six of this section. Such eligible applicant shall submit information 13 and documentation to the commissioner which shall include, but not be 14 limited to: 15 § 6. Subdivision 3 of section 4403-f of the public health law, as 16 amended by section 41-a of part H of chapter 59 of the laws of 2011, is 17 amended to read as follows: 18 3. Certificate of authority; approval. (a) The commissioner shall not 19 approve an application for a certificate of authority unless the appli- 20 cant demonstrates to the commissioner's satisfaction: 21 [(a)] (i) that it will have in place acceptable quality-assurance 22 mechanisms, grievance procedures, mechanisms to protect the rights of 23 enrollees and case management services to ensure continuity, quality, 24 appropriateness and coordination of care; 25 [(b)] (ii) that it will include an enrollment process which shall 26 ensure that enrollment in the plan is informed. The application shall 27 describe the disenrollment process, which shall provide that an other- 28 wise eligible enrollee shall not be involuntarily disenrolled on the 29 basis of health status; 30 [(c)] (iii) satisfactory evidence of the character and competence of 31 the proposed operators and reasonable assurance that the applicant will 32 provide high quality services to an enrolled population; 33 [(d)] (iv) sufficient management systems capacity to meet the require- 34 ments of this section and the ability to efficiently process payment for 35 covered services; 36 [(e)] (v) readiness and capability to maximize reimbursement of and 37 coordinate services reimbursed pursuant to title XVIII of the federal 38 social security act and all other applicable benefits, with such benefit 39 coordination including, but not limited to, measures to support sound 40 clinical decisions, reduce administrative complexity, coordinate access 41 to services, maximize benefits available pursuant to such title and 42 ensure that necessary care is provided; 43 [(f)] (vi) readiness and capability to arrange and manage covered 44 services and coordinate non-covered services which could include prima- 45 ry, specialty, and acute care services reimbursed pursuant to title XIX 46 of the federal social security act; 47 [(g)] (vii) willingness and capability of taking, or cooperating in, 48 all steps necessary to secure and integrate any potential sources of 49 funding for services provided by the managed long term care plan, 50 including, but not limited to, funding available under titles XVI, 51 XVIII, XIX and XX of the federal social security act, the federal older 52 Americans act of nineteen hundred sixty-five, as amended, or any succes- 53 sor provisions subject to approval of the director of the state office 54 for aging, and through financing options such as those authorized pursu- 55 ant to section three hundred sixty-seven-f of the social services law;S. 8307--A 27 A. 8807--A 1 [(h)] (viii) that the contractual arrangements for providers of health 2 and long term care services in the benefit package are sufficient to 3 ensure the availability and accessibility of such services to the 4 proposed enrolled population consistent with guidelines established by 5 the commissioner; with respect to individuals in receipt of such 6 services prior to enrollment, such guidelines shall require the managed 7 long term care plan to contract with agencies currently providing such 8 services, in order to promote continuity of care. In addition, such 9 guidelines shall require managed long term care plans to offer and cover 10 consumer directed personal assistance services for eligible individuals 11 who elect such services pursuant to section three hundred sixty-five-f 12 of the social services law; and 13 [(i)] (ix) that the applicant is financially responsible and may be 14 expected to meet its obligations to its enrolled members. 15 (b) Notwithstanding paragraph (a) of this subdivision, the approval of 16 any application for certification as a managed long term care plan under 17 this section for a plan that seeks to cover a population of enrollees 18 eligible for services under title XIX of the federal social security 19 act, shall be subject to and conditioned on selection through the 20 competitive bid process provided under subdivision six of this section. 21 § 7. Subdivision 6 of section 4403-f of the public health law, as 22 amended by section 41-b of part H of chapter 59 of the laws of 2011, 23 paragraph (a) as amended by section 2 of part I of chapter 57 of the 24 laws of 2023, paragraphs (d), (e), and (f) as added by section 5 of part 25 MM of chapter 56 of the laws of 2020, and the opening paragraph of 26 subparagraph (i) of paragraph (d) as amended by section 3 of part I of 27 chapter 57 of the laws of 2023, is amended to read as follows: 28 6. Approval authority. [(a)] An applicant shall be issued a certif- 29 icate of authority as a managed long term care plan upon a determination 30 by the commissioner that the applicant complies with the operating 31 requirements for a managed long term care plan under this section; 32 provided, however, that any managed long term care plan seeking to 33 provide health and long term care services to a population of enrollees 34 that are eligible under title XIX of the federal social security act 35 shall not receive a certificate of authority, nor be eligible for a 36 contract to provide such services with the department, unless selected 37 through the competitive bid process described in this subdivision. [The38commissioner shall issue no more than seventy-five certificates of39authority to managed long term care plans pursuant to this section.40(a-1) Nothing in this section shall be construed as requiring the41department to contract with or to contract for a particular line of42business with an entity certified under this section for the provision43of services available under title eleven of article five of the social44services law. A managed long term care plan that has been issued a45certificate of authority, or an applicant for a certificate of authority46as a managed long term care plan that has in any of the three calendar47years immediately preceding the application, met any of the following48criteria shall not be eligible for a contract for the provision of49services available under title eleven of article five of the social50services law: (i) classified as a poor performer, or substantially simi-51lar terminology, by the centers for medicare and medicaid services; or52(ii) an excessive volume of penalties, statements of findings, state-53ments of deficiency, intermediate sanctions or enforcement actions,54regardless of whether the applicant has addressed such issues in a time-55ly manner.S. 8307--A 28 A. 8807--A 1(b) An operating demonstration shall be issued a certificate of2authority as a managed long term care plan upon a determination by the3commissioner that such demonstration complies with the operating4requirements for a managed long term care plan under this section.5Nothing in this section shall be construed to affect the continued legal6authority of an operating demonstration to operate its previously7approved program.8(c) For the period beginning April first, two thousand twelve and9ending March thirty-first, two thousand fifteen, the majority leader of10the senate and the speaker of the assembly may each recommend to the11commissioner, in writing, up to four eligible applicants to convert to12be approved managed long term care plans. An applicant shall only be13approved and issued a certificate of authority if the commissioner14determines that the applicant meets the requirements of subdivision15three of this section. The majority leader of the senate or the speaker16of the assembly may assign their authority to recommend one or more17applicants under this section to the commissioner] 18 (a) Notwithstanding sections one hundred twelve and one hundred 19 sixty-three of the state finance law, sections one hundred forty-two and 20 one hundred forty-three of the economic development law, and any other 21 inconsistent provision of law, the commissioner shall, through a compet- 22 itive bid process based on proposals submitted to the department, 23 provide for the selection of qualified managed long term care plans to 24 provide health and long term care services to enrollees who are eligible 25 under title XIX of the federal social security act pursuant to a 26 contract with the department; provided, however, that: 27 (i) A proposal submitted by a managed long term care plan shall 28 include information sufficient to allow the commissioner to evaluate the 29 bidder in accordance with the requirements identified in subdivisions 30 two, three and four of this section. 31 (ii) In addition to the criteria described in subparagraph (i) of this 32 paragraph, the commissioner shall also consider: 33 (A) accessibility and geographic distribution of network providers, 34 taking into account the needs of persons with disabilities and the 35 differences between rural, suburban, and urban settings; 36 (B) the extent to which major public hospitals are included in the 37 submitted provider network; 38 (C) demonstrated cultural and language competencies specific to the 39 population of participants; 40 (D) the corporate organization and status of the bidder as a charita- 41 ble corporation under the not-for-profit corporation law; 42 (E) the ability of a bidder to offer plans in multiple regions; 43 (F) the type and number of products the bidder proposes to operate, 44 including products applied for in accordance with the provisions of 45 subdivision five of section three hundred sixty-four-j of the social 46 services law, and other products determined by the commissioner, includ- 47 ing but not necessarily limited to those operated under title one-A of 48 article twenty-five of this chapter and section three hundred sixty- 49 nine-gg of the social services law; 50 (G) whether the bidder participates in products for integrated care 51 for participants who are dually eligible for Medicaid and medicare; 52 (H) whether the bidder participates in value based payment arrange- 53 ments as defined by the department, including the delegation of signif- 54 icant financial risk to clinically integrated provider networks; 55 (I) the bidder's commitment to participation in managed care in the 56 state;S. 8307--A 29 A. 8807--A 1 (J) the bidder's commitment to quality improvement; 2 (K) the bidder's commitment to community reinvestment spending, as 3 shall be defined in the procurement; 4 (L) for current or previously authorized managed care providers, past 5 performance in meeting managed care contract or federal or state 6 requirements, and if the commissioner issued any statements of findings, 7 statements of deficiency, intermediate sanctions or enforcement actions 8 to a bidder for non-compliance with such requirements, whether the 9 bidder addressed such issues in a timely manner; and 10 (M) any other criteria deemed appropriate by the commissioner. 11 (iii) Subparagraphs (i) and (ii) of this paragraph describing proposal 12 content and selection criteria requirements shall not be construed as 13 limiting or requiring the commissioner to evaluate such content or 14 criteria on a pass/fail scale, or other particular methodological basis; 15 provided however, that the commissioner must consider all such content 16 and criteria using methods determined by the commissioner in their 17 discretion and, as applicable, in consultation with the commissioners of 18 the office of mental health, the office for people with developmental 19 disabilities, the office of addiction services and supports, and the 20 office of children and family services. 21 (iv) The department shall post on its website: 22 (A) The request for proposals and a description of the proposed 23 services to be provided pursuant to contracts in accordance with this 24 subdivision; 25 (B) The criteria on which the department shall determine qualified 26 bidders and evaluate their applications, including all criteria identi- 27 fied in this subdivision; 28 (C) The manner by which a proposal may be submitted, which may include 29 submission by electronic means; 30 (D) The manner by which a managed long term care plan may continue to 31 provide health and long term care services to enrollees who are eligible 32 under title XIX of the federal social security act pending awards to 33 managed long term care plans through a competitive bid process pursuant 34 to this subdivision; and 35 (E) Upon award, the managed long term care plans that the commissioner 36 intends to contract with pursuant to this subdivision, provided that the 37 commissioner shall update such list to indicate the final slate of 38 contracted managed long term care plans. 39 (v) Award and contracting. (A) All responsible and responsive 40 submissions that are received from bidders in a timely fashion shall be 41 reviewed by the commissioner in consultation with the commissioners of 42 the office of mental health, the office for people with developmental 43 disabilities, the office of addiction services and supports, and the 44 office of children and family services, as applicable. The commissioner 45 shall consider comments resulting from the review of proposals and make 46 awards in consultation with such agencies. 47 (B) The commissioner may make awards under this subdivision, for each 48 product for which proposals were requested, to two or more managed long 49 term care plans in each geographic region defined by the commissioner in 50 the request for proposals for which at least two managed long term care 51 plans have submitted a proposal, and shall have discretion to offer more 52 contracts based on need for access. 53 (C) Managed long term care plans awarded under this subdivision shall 54 be entitled to enter into a contract with the department for the purpose 55 of providing health and long term care services to enrollees who are 56 eligible under title XIX of the federal social security act. SuchS. 8307--A 30 A. 8807--A 1 contracts shall run for a term to be determined by the commissioner, 2 which may be renewed or modified from time to time without a new request 3 for proposals, to ensure consistency with changes in federal and state 4 laws, regulations and policies, including but not limited to the expan- 5 sion or reduction of medical assistance services available to the 6 participants through a managed long term care plan. 7 (D) Nothing in this paragraph or other provision of this section shall 8 be construed to limit in any way the ability of the department to termi- 9 nate awarded contracts for cause, which shall include but not be limited 10 to any violation of the terms of such contracts or violations of state 11 or federal laws and regulations and any loss of necessary state or 12 federal funding. 13 (E) Nothing in this paragraph or other provision of this section shall 14 be construed to limit in any way the ability of the department to issue 15 a new request for proposals for a term following an existing term of an 16 award. 17 (b) Transitioning enrollees who are eligible under title XIX of the 18 federal social security act (i) Within sixty-days of the department 19 issuing the request for proposals under paragraph (a) of this subdivi- 20 sion, a managed long term care plan that was approved to provide health 21 and long term care services to enrollees who are eligible under title 22 XIX of the federal social security act prior to the issuance of the 23 request for proposals, shall submit its intention to complete such 24 proposal to the department. 25 (ii) A managed long term care plan that: (A) fails to submit its 26 intent timely; (B) indicates within the sixty-days its intent not to 27 complete such a proposal, (C) fails to submit a proposal within the 28 further timeframe specified by the commissioner in the request for 29 proposals, or (D) is not awarded the ability to provide health and long 30 term care services to enrollees who are eligible under title XIX of the 31 federal social security act under paragraph (a) of this subdivision, 32 shall, upon direction from the commissioner, terminate its services and 33 operations in accordance with the contract between the managed long term 34 care plan and the department and shall be additionally required to main- 35 tain coverage of enrollees for such period of time as determined neces- 36 sary by the commissioner to achieve the safe and orderly transfer of 37 enrollees. 38 (c) Addressing needs for additional managed long term care plans to 39 ensure access and choice for enrollees eligible under title XIX of the 40 federal social security act. If necessary to ensure access to a suffi- 41 cient number of managed long term care plans on a geographic or other 42 basis, including a lack of adequate and appropriate care, language and 43 cultural competence, or special needs services, the commissioner may 44 reissue a request for proposals as provided for under paragraph (a) of 45 this subdivision, provided however that such request may be limited to 46 the geographic or other basis of need that the request for proposals 47 seeks to address. Any awards made shall be subject to the requirements 48 of this section, including but not limited to the minimum and maximum 49 number of awards in a region. 50 (d) (i) Effective April first, two thousand twenty, and expiring 51 [March thirty-first, two thousand twenty-seven] on the date the commis- 52 sioner publishes on the department's website a request for proposals in 53 accordance with subparagraph (iv) of paragraph (a) of this subdivision, 54 the commissioner shall place a moratorium on the processing and approval 55 of applications seeking a certificate of authority as a managed long 56 term care plan pursuant to this section, including applications seekingS. 8307--A 31 A. 8807--A 1 authorization to expand an existing managed long term care plan's 2 approved service area or scope of eligible enrollee populations. Such 3 moratorium shall not apply to: 4 (A) applications submitted to the department prior to January first, 5 two thousand twenty; 6 (B) applications seeking approval to transfer ownership or control of 7 an existing managed long term care plan; 8 (C) applications demonstrating to the commissioner's satisfaction that 9 submission of the application for consideration would be appropriate to 10 address a serious concern with care delivery, such as a lack of adequate 11 access to managed long term care plans in a geographic area or a lack of 12 adequate and appropriate care, language and cultural competence, or 13 special needs services; and 14 (D) applications seeking to operate under the PACE (Program of All-In- 15 clusive Care for the Elderly) model as authorized by federal public law 16 105-33, subtitle I of title IV of the Balanced Budget Act of 1997, or to 17 serve individuals dually eligible for services and benefits under titles 18 XVIII and XIX of the federal social security act in conjunction with an 19 affiliated Medicare Dual Eligible Special Needs Plan, based on the need 20 for such plans and the experience of applicants in serving dually eligi- 21 ble individuals as determined by the commissioner in their discretion. 22 (ii) For the duration of the moratorium, the commissioner shall assess 23 the public need for managed long term care plans that are not integrated 24 with an affiliated Medicare plan, the ability of such plans to provide 25 high quality and cost effective care for their membership, and based on 26 such assessment develop a process and conduct an orderly wind-down and 27 elimination of such plans, which shall coincide with the expiration of 28 the moratorium unless the commissioner determines that a longer wind- 29 down period is needed. 30 (e) [For the duration of the moratorium under paragraph (d) of this31subdivision] From April first, two thousand twenty, until March thirty- 32 first, two thousand twenty-four, the commissioner shall establish, and 33 enforce by means of a premium withholding equal to three percent of the 34 base rate, an annual cap on total enrollment (enrollment cap) for each 35 managed long term care plan, subject to subparagraphs (ii) and (iii) of 36 this paragraph, based on a percentage of each plan's reported enrollment 37 as of October first, two thousand twenty. 38 (i) The specific percentage of each plan's enrollment cap shall be 39 established by the commissioner based on: (A) the ability of individuals 40 eligible for such plans to access health and long term care services, 41 (B) plan quality of care scores, (C) historical plan disenrollment, (D) 42 the projected growth of individuals eligible for such plans in different 43 regions of the state, (E) historical plan enrollment of patients with 44 varying levels of need and acuity, and (F) other factors in the commis- 45 sioner's discretion to ensure compliance with federal requirements, 46 appropriate access to plan services, and choice by eligible individuals. 47 (ii) In the event that a plan exceeds its annual enrollment cap, the 48 commissioner is authorized under this paragraph to retain all or a 49 portion of the premium withheld based on the amount over which a plan 50 exceeds its enrollment cap. Penalties assessed pursuant to this subdivi- 51 sion shall be determined by regulation. 52 (iii) The commissioner may not establish an annual cap on total 53 enrollment under this paragraph for plans' lines of business operating 54 under the PACE (Program of All-Inclusive Care for the Elderly) model as 55 authorized by federal public law 105-33, subtitle I of title IV of the 56 Balanced Budget Act of 1997, or that serve individuals dually eligibleS. 8307--A 32 A. 8807--A 1 for services and benefits under titles XVIII and XIX of the federal 2 social security act in conjunction with an affiliated Medicare Dual 3 Eligible Special Needs Plan. 4 [(f) In implementing the provisions of paragraphs (d) and (e) of this5subdivision, the commissioner shall, to the extent practicable, consider6and select methodologies that seek to maximize continuity of care and7minimize disruption to the provider labor workforce, and shall, to the8extent practicable and consistent with the ratios set forth herein,9continue to support contracts between managed long term care plans and10licensed home care services agencies that are based on a commitment to11quality and value.] 12 § 8. Section 1 of part I of chapter 57 of the laws of 2022, providing 13 a one percent across the board payment increase to all qualifying fee- 14 for-service Medicaid rates, is amended by adding two new subdivisions 3 15 and 4 to read as follows: 16 3. For the state fiscal years beginning April 1, 2024, and thereafter, 17 all department of health Medicaid payments made to Medicaid managed care 18 organizations will no longer be subject to the uniform rate increase in 19 subdivision one of this section. 20 4. Rate adjustments made pursuant to subdivisions one through three of 21 this section shall not be subject to the notification requirements set 22 forth in subdivision 7 of section 2807 of the public health law. 23 § 9. Section 364-j of the social services law is amended by adding a 24 new subdivision 40 to read as follows: 25 40. (a) The commissioner shall be entitled to recover liquidated 26 damages from managed care organizations for failure to meet the contrac- 27 tual obligations and performance standards of their contract. 28 (b) The commissioner shall have sole discretion in determining whether 29 to impose a recovery of the financial loss and damages for noncompliance 30 with any provision of the contract. 31 (c) (i) Liquidated damages imposed by this subdivision against a 32 managed care organization shall be from two hundred fifty dollars up to 33 twenty-five thousand dollars per violation depending on the severity of 34 the noncompliance determined by the commissioner. 35 (ii) Any liquidated damages findings as a result of the review 36 required by this subdivision shall be due and payable sixty calendar 37 days from the issuance of a statement of damages regardless of any 38 dispute in the amount or interpretation of the amount due contained in 39 the statement of damages. 40 (iii) The commissioner may elect, in their sole discretion, to collect 41 damages imposed by this section from, and as a set off against, payments 42 due to the managed care organization, or payments that becomes due any 43 time after the calculation of liquidated damages. Deductions shall 44 continue until the full amount of the noticed damages are paid in full. 45 (iv) All liquidated damages imposed by this subdivision shall be paid 46 out of the administrative costs and profits of the managed care organ- 47 ization. 48 (v) The managed care organization shall not pass the liquidated 49 damages imposed under this subdivision through to any provider and/or 50 subcontractor. 51 (d)(i) managed care organization must submit a written request of its 52 dispute A managed care organization may dispute the imposition of liqui- 53 dated damages in writing, and in the form and manner prescribed by the 54 commissioner, within thirty calendar days from the date of the state- 55 ment of damages.S. 8307--A 33 A. 8807--A 1 (ii) Disputes that are not delivered in the format and timeframe spec- 2 ified by the department shall be denied by the department and deemed 3 waived by the managed care organization. 4 (iii) A managed care organization shall waive any arguments, materi- 5 als, data, and information not contained in or accompanying a timely 6 submitted written dispute, including for use in any subsequent legal or 7 administrative proceeding. 8 (iv) The commissioner or their designee shall decide the dispute, 9 reduce the decision to writing and issue their decision to the managed 10 care organization within ninety calendar days of receipt of the dispute. 11 This written decision shall be final. 12 (e) For the purposes of this subdivision a violation shall mean: (i) a 13 determination by the commissioner that the managed care organization 14 failed to act as required under the model contract or applicable federal 15 and state statutes, rules or regulations governing managed care organ- 16 ization; (ii) each instance of a managed care organization failing to 17 furnish necessary and/or required medical services or items to each 18 enrollee shall be a separate violation. For the purposes of this subdi- 19 vision, each day that an ongoing violation continues shall be a separate 20 violation. 21 (f) For purposes of this subdivision managed care organization shall 22 mean any managed care organizations subject to this section and article 23 forty-four of the public health law, including managed long term care 24 plans. 25 (g) Nothing in this subdivision shall prohibit the imposition of 26 damages, penalties or other relief, otherwise authorized by law, includ- 27 ing but not limited to cases of fraud, waste or abuse. 28 § 10. This act shall not be construed to prohibit managed care provid- 29 ers participating in the managed care program and managed long term care 30 plans approved to provide health and long term care services to enrol- 31 lees who are eligible under title XIX of the federal social security 32 act, that were so authorized as of the effective date of this act from 33 continuing operations as authorized until such time as awards are made 34 in accordance with this act and such additional time subject to direc- 35 tion from the commissioner of health to ensure the safe and orderly 36 transfer of participants. 37 § 11. This act shall take effect immediately and shall apply to 38 disputes filed with the superintendent of financial services pursuant to 39 article six of the financial services law on or after such effective 40 date; provided that: 41 (a) the amendments to section 364-j of the social services law made by 42 sections two, three and nine of this act shall not affect the repeal of 43 such section and shall be deemed repealed therewith; and 44 (b) the amendments to section 4403-f of the public health law made by 45 sections five, six and seven of this act shall not affect the repeal of 46 such section and shall be deemed repealed therewith. 47 PART I 48 Section 1. Paragraph (a) of subdivision 4 of section 365-a of the 49 social services law, as amended by chapter 493 of the laws of 2010, is 50 amended to read as follows: 51 (a) drugs which may be dispensed without a prescription as required by 52 section sixty-eight hundred ten of the education law; provided, however, 53 that the state commissioner of health may by regulation specify certain 54 of such drugs which may be reimbursed as an item of medical assistanceS. 8307--A 34 A. 8807--A 1 in accordance with the price schedule established by such commissioner. 2 Notwithstanding any other provision of law, [additions] modifications to 3 the list of drugs reimbursable under this paragraph may be filed as 4 regulations by the commissioner of health without prior notice and 5 comment; 6 § 2. Paragraph (b) of subdivision 3 of section 273 of the public 7 health law, as added by section 10 of part C of chapter 58 of the laws 8 of 2005, is amended to read as follows: 9 (b) In the event that the patient does not meet the criteria in para- 10 graph (a) of this subdivision, the prescriber may provide additional 11 information to the program to justify the use of a prescription drug 12 that is not on the preferred drug list. The program shall provide a 13 reasonable opportunity for a prescriber to reasonably present his or her 14 justification of prior authorization. [If, after consultation with the15program, the prescriber, in his or her reasonable professional judgment,16determines that] The program will consider the additional information 17 and the justification presented to determine whether the use of a 18 prescription drug that is not on the preferred drug list is warranted, 19 and the [prescriber's] program's determination shall be final. 20 § 3. Subdivisions 25 and 25-a of section 364-j of the social services 21 law are REPEALED. 22 § 4. Section 280 of the public health law, as amended by section 8 of 23 part D of chapter 57 of the laws of 2018, paragraph (b) of subdivision 2 24 as amended by section 5, subdivision 3 as amended by section 6, para- 25 graph (a) of subdivision 5 as amended by section 7, subparagraph (iii) 26 of paragraph (e) as amended by section 6-a and subdivision 8 as amended 27 by section 9 of part B of chapter 57 of the laws of 2019, paragraphs 28 (c) and (d) of subdivision 2 as amended and paragraph (e) of subdivision 29 2 as added by section 2 of part FFF of chapter 56 of the laws of 2020, 30 the opening paragraph of paragraph (a) of subdivision 6 and paragraph 31 (a) of subdivision 7 as amended by sections 3 and 4, respectively, of 32 part GG of chapter 56 of the laws of 2020, is amended to read as 33 follows: 34 § 280. Medicaid drug cap. 1. The legislature hereby finds and declares 35 that there is a significant public interest for the Medicaid program to 36 manage drug costs in a manner that ensures patient access while provid- 37 ing financial stability for the state and participating providers. 38 Since two thousand eleven, the state has taken significant steps to 39 contain costs in the Medicaid program by imposing a statutory limit on 40 annual growth. Drug expenditures, however, continually outpace other 41 cost components causing significant pressure on the state, providers, 42 and patient access operating under the Medicaid global cap. It is there- 43 fore intended that the department establish a [Medicaid drug cap as a44separate component within the Medicaid global cap] supplemental rebate 45 program as part of a focused and sustained effort to balance the growth 46 of drug expenditures with the growth of total Medicaid expenditures. 47 2. The commissioner shall [establish a year to year] review at least 48 annually the department of health state funds Medicaid drug [expenditure49growth target as follows:50(a) for state fiscal year two thousand seventeen--two thousand eigh-51teen, be limited to the ten-year rolling average of the medical compo-52nent of the consumer price index plus five percent and minus a pharmacy53savings target of fifty-five million dollars; and54(b) for state fiscal year two thousand eighteen--two thousand nine-55teen, be limited to the ten-year rolling average of the medical compo-S. 8307--A 35 A. 8807--A 1nent of the consumer price index plus four percent and minus a pharmacy2savings target of eighty-five million dollars;3(c) for state fiscal year two thousand nineteen--two thousand twenty,4be limited to the ten-year rolling average of the medical component of5the consumer price index plus four percent and minus a pharmacy savings6target of eighty-five million dollars;7(d) for state fiscal year two thousand twenty--two thousand twenty-8one, be limited to the ten-year rolling average of the medical component9of the consumer price index plus two percent; and10(e) for state fiscal year two thousand twenty-one--two thousand twen-11ty-two and fiscal years thereafter, be limited in accordance with subdi-12vision one of section ninety-one of part H of chapter fifty-nine of the13laws of two thousand eleven, as amended] expenditures to identify drugs, 14 including but not limited to, drugs in the eightieth percentile or high- 15 er of total spend, net of rebate or in the eightieth percentile or high- 16 er based on cost per claim, net of rebate. 17 3. (a) The [department and the division of the budget shall assess on18a quarterly basis the projected total amount to be expended in the year19on a cash basis by the Medicaid program for each drug, and the projected20annual amount of state funds Medicaid drug expenditures on a cash basis21for all drugs, which shall be a component of the projected department of22health state funds Medicaid expenditures calculated for purposes of23sections ninety-one and ninety-two of part H of chapter fifty-nine of24the laws of two thousand eleven. For purposes of this section, state25funds Medicaid drug expenditures include amounts expended for drugs in26both the Medicaid fee-for-service program and Medicaid managed care27programs, minus the amount of any drug rebates or supplemental drug28rebates received by the department, including rebates pursuant to subdi-29vision five of this section with respect to rebate targets. The depart-30ment and the division of the budget shall report in December of each31year, for the prior April through October, to the drug utilization32review board the projected state funds Medicaid drug expenditures33including the amounts, in aggregate thereof, attributable to the net34cost of: changes in the utilization of drugs by Medicaid recipients;35changes in the number of Medicaid recipients; changes to the cost of36brand name drugs and changes to the cost of generic drugs. The informa-37tion contained in the report shall not be publicly released in a manner38that allows for the identification of an individual drug or manufacturer39or that is likely to compromise the financial competitive, or proprie-40tary nature of the information.41(a) In the event the director of the budget determines, based on Medi-42caid drug expenditures for the previous quarter or other relevant infor-43mation, that the total department of health state funds Medicaid drug44expenditure is projected to exceed the annual growth limitation imposed45by subdivision two of this section, the] commissioner may identify and 46 refer drugs, including but not limited to, drugs in the eightieth 47 percentile or higher of total spend, net of rebate or in the eightieth 48 percentile or higher based on cost per claim, net of rebate, to the drug 49 utilization review board established by section three hundred sixty- 50 nine-bb of the social services law for a recommendation as to whether a 51 target supplemental Medicaid rebate should be paid by the manufacturer 52 of the drug to the department and the target amount of the rebate. 53 (b) If the department intends to refer a drug to the drug utilization 54 review board pursuant to paragraph (a) of this subdivision, the depart- 55 ment shall notify the manufacturer of such drug and shall attempt to 56 reach agreement with the manufacturer on a rebate for the drug prior toS. 8307--A 36 A. 8807--A 1 referring the drug to the drug utilization review board for review. 2 Such rebate may be based on evidence-based research, including, but not 3 limited to, such research operated or conducted by or for other state 4 governments, the federal government, the governments of other nations, 5 and third party payers or multi-state coalitions, provided however that 6 the department shall account for the effectiveness of the drug in treat- 7 ing the conditions for which it is prescribed or in improving a 8 patient's health, quality of life, or overall health outcomes, and the 9 likelihood that use of the drug will reduce the need for other medical 10 care, including hospitalization. 11 (c) In the event that the commissioner and the manufacturer have 12 previously agreed to a supplemental rebate for a drug pursuant to para- 13 graph (b) of this subdivision or paragraph (e) of subdivision seven of 14 section three hundred sixty-seven-a of the social services law, the drug 15 shall not be referred to the drug utilization review board for any 16 further supplemental rebate for the duration of the previous rebate 17 agreement, provided however, the commissioner may refer a drug to the 18 drug utilization review board if the commissioner determines there are 19 significant and substantiated utilization or market changes, new 20 evidence-based research, or statutory or federal regulatory changes that 21 warrant additional rebates. In such cases, the department shall notify 22 the manufacturer and provide evidence of the changes or research that 23 would warrant additional rebates, and shall attempt to reach agreement 24 with the manufacturer on a rebate for the drug prior to referring the 25 drug to the drug utilization review board for review. 26 (d) The department shall consider a drug's actual cost to the state, 27 including current rebate amounts, prior to seeking an additional rebate 28 pursuant to paragraph (b) or (c) of this subdivision. 29 (e) [The commissioner shall be authorized to take the actions30described in this section only so long as total Medicaid drug expendi-31tures are projected to exceed the annual growth limitation imposed by32subdivision two of this section.] If the commissioner is unsuccessful in 33 entering into a rebate arrangement with the manufacturer of the drug 34 satisfactory to the department, the drug manufacturer shall, in that 35 event be required to provide to the department, on a standard reporting 36 form developed by the department, the following information: 37 (i) the actual cost of developing, manufacturing, producing (including 38 the cost per dose of production), and distributing the drug; 39 (ii) research and development costs of the drug, including payments to 40 predecessor entities conducting research and development, such as 41 biotechnology companies, universities and medical schools, and private 42 research institutions; 43 (iii) administrative, marketing, and advertising costs for the drug, 44 apportioned by marketing activities that are directed to consumers, 45 marketing activities that are directed to prescribers, and the total 46 cost of all marketing and advertising that is directed primarily to 47 consumers and prescribers in New York, including but not limited to 48 prescriber detailing, copayment discount programs, and direct-to-consum- 49 er marketing; 50 (iv) the extent of utilization of the drug; 51 (v) prices for the drug that are charged to purchasers outside the 52 United States; 53 (vi) prices charged to typical purchasers in the state, including but 54 not limited to pharmacies, pharmacy chains, pharmacy wholesalers, or 55 other direct purchasers;S. 8307--A 37 A. 8807--A 1 (vii) the average rebates and discounts provided per payer type in the 2 state; and 3 (viii) the average profit margin of each drug over the prior five-year 4 period and the projected profit margin anticipated for such drug. 5 (f) All information disclosed pursuant to paragraph (e) of this subdi- 6 vision shall be considered confidential and shall not be disclosed by 7 the department in a form that identifies a specific manufacturer or 8 prices charged for drugs by such manufacturer. 9 4. In determining whether to recommend a target supplemental rebate 10 for a drug, the drug utilization review board shall consider the actual 11 cost of the drug to the Medicaid program, including federal and state 12 rebates, and may consider, among other things: 13 (a) the drug's impact on the Medicaid drug spending growth target and 14 the adequacy of capitation rates of participating Medicaid managed care 15 plans, and the drug's affordability and value to the Medicaid program; 16 or 17 (b) significant and unjustified increases in the price of the drug; or 18 (c) whether the drug may be priced disproportionately to its therapeu- 19 tic benefits. 20 5. (a) If the drug utilization review board recommends a target rebate 21 amount on a drug referred by the commissioner, the department shall 22 negotiate with the drug's manufacturer for a supplemental rebate to be 23 paid by the manufacturer in an amount not to exceed such target rebate 24 amount. [A rebate requirement shall apply beginning with the first day25of the state fiscal year during which the rebate was required without26regard to the date the department enters into the rebate agreement with27the manufacturer.] 28 (b) The supplemental rebate required by paragraph (a) of this subdivi- 29 sion shall apply to drugs dispensed to enrollees of managed care provid- 30 ers pursuant to section three hundred sixty-four-j of the social 31 services law and to drugs dispensed to Medicaid recipients who are not 32 enrollees of such providers. 33 (c) [If the drug utilization review board recommends a target rebate34amount for a drug and the department is unable to negotiate a rebate35from the manufacturer in an amount that is at least seventy-five percent36of the target rebate amount, the commissioner is authorized to waive the37provisions of paragraph (b) of subdivision three of section two hundred38seventy-three of this article and the provisions of subdivisions twen-39ty-five and twenty-five-a of section three hundred sixty-four-j of the40social services law with respect to such drug; however, this waiver41shall not be implemented in situations where it would prevent access by42a Medicaid recipient to a drug which is the only treatment for a partic-43ular disease or condition. Under no circumstances shall the commissioner44be authorized to waive such provisions with respect to more than two45drugs in a given time.46(d)] Where the department and a manufacturer enter into a rebate 47 agreement pursuant to this section, which may be in addition to existing 48 rebate agreements entered into by the manufacturer with respect to the 49 same drug, no additional rebates shall be required to be paid by the 50 manufacturer to a managed care provider or any of a managed care provid- 51 er's agents, including but not limited to any pharmacy benefit manager, 52 while the department is collecting the rebate pursuant to this section. 53 [(e)] (d) In formulating a recommendation concerning a target rebate 54 amount for a drug, the drug utilization review board may consider: 55 (i) publicly available information relevant to the pricing of the 56 drug;S. 8307--A 38 A. 8807--A 1 (ii) information supplied by the department relevant to the pricing of 2 the drug; 3 (iii) information relating to value-based pricing provided, however, 4 if the department directly invites any third party to provide cost-ef- 5 fectiveness analysis or research related to value-based pricing, and the 6 department receives and considers such analysis or research for use by 7 the board, such third party shall disclose any funding sources. The 8 department shall, if reasonably possible, make publicly available the 9 following documents in its possession that it relies upon to provide 10 cost effectiveness analyses or research related to value-based pricing: 11 (A) descriptions of underlying methodologies; (B) assumptions and limi- 12 tations of research findings; and (C) if available, data that presents 13 results in a way that reflects different outcomes for affected subpopu- 14 lations; 15 (iv) the seriousness and prevalence of the disease or condition that 16 is treated by the drug; 17 (v) the extent of utilization of the drug; 18 (vi) the effectiveness of the drug in treating the conditions for 19 which it is prescribed, or in improving a patient's health, quality of 20 life, or overall health outcomes; 21 (vii) the likelihood that use of the drug will reduce the need for 22 other medical care, including hospitalization; 23 (viii) the average wholesale price, wholesale acquisition cost, retail 24 price of the drug, and the cost of the drug to the Medicaid program 25 minus rebates received by the state; 26 (ix) in the case of generic drugs, the number of pharmaceutical 27 manufacturers that produce the drug; 28 (x) whether there are pharmaceutical equivalents to the drug; and 29 (xi) information supplied by the manufacturer, if any, explaining the 30 relationship between the pricing of the drug and the cost of development 31 of the drug and/or the therapeutic benefit of the drug, or that is 32 otherwise pertinent to the manufacturer's pricing decision; any such 33 information, including the information on the standard reporting form 34 requirement in paragraph (e) of subdivision three of this section, 35 provided shall be considered confidential and shall not be disclosed by 36 the drug utilization review board in a form that identifies a specific 37 manufacturer or prices charged for drugs by such manufacturer. 38 6. [(a) If the drug utilization review board recommends a target39rebate amount or if the commissioner identifies a drug as a high cost40drug pursuant to subparagraph (vii) of paragraph (e) of subdivision 7 of41section three hundred sixty-seven-a of the social services law and the42department is unsuccessful in entering into a rebate arrangement with43the manufacturer of the drug satisfactory to the department, the drug44manufacturer shall in that event be required to provide to the depart-45ment, on a standard reporting form developed by the department, the46following information:47(i) the actual cost of developing, manufacturing, producing (including48the cost per dose of production), and distributing the drug;49(ii) research and development costs of the drug, including payments to50predecessor entities conducting research and development, such as51biotechnology companies, universities and medical schools, and private52research institutions;53(iii) administrative, marketing, and advertising costs for the drug,54apportioned by marketing activities that are directed to consumers,55marketing activities that are directed to prescribers, and the total56cost of all marketing and advertising that is directed primarily toS. 8307--A 39 A. 8807--A 1consumers and prescribers in New York, including but not limited to2prescriber detailing, copayment discount programs, and direct-to-consum-3er marketing;4(iv) the extent of utilization of the drug;5(v) prices for the drug that are charged to purchasers outside the6United States;7(vi) prices charged to typical purchasers in the state, including but8not limited to pharmacies, pharmacy chains, pharmacy wholesalers, or9other direct purchasers;10(vii) the average rebates and discounts provided per payer type in the11State; and12(viii) the average profit margin of each drug over the prior five-year13period and the projected profit margin anticipated for such drug.14(b) All information disclosed pursuant to paragraph (a) of this subdi-15vision shall be considered confidential and shall not be disclosed by16the department in a form that identifies a specific manufacturer or17prices charged for drugs by such manufacturer.187.] (a) [If, after] After taking into account all rebates and supple- 19 mental rebates received by the department, including rebates received to 20 date pursuant to this section[, total Medicaid drug expenditures are21still projected to exceed the annual growth limitation imposed by subdi-22vision two of this section], the commissioner may: subject any drug of a 23 manufacturer referred to the drug utilization review board under this 24 section to prior approval in accordance with existing processes and 25 procedures when such manufacturer has not entered into a supplemental 26 rebate arrangement as required by this section; direct a managed care 27 plan to limit or reduce reimbursement for a drug provided by a medical 28 practitioner if the drug utilization review board recommends a target 29 rebate amount for such drug and the manufacturer has failed to enter 30 into a rebate arrangement required by this section; direct managed care 31 plans to remove from their Medicaid formularies any drugs of a manufac- 32 turer who has a drug that the drug utilization review board recommends a 33 target rebate amount for and the manufacturer has failed to enter into a 34 rebate arrangement required by this section; promote the use of cost 35 effective and clinically appropriate drugs other than those of a 36 manufacturer who has a drug that the drug utilization review board 37 recommends a target rebate amount and the manufacturer has failed to 38 enter into a rebate arrangement required by this section; allow manufac- 39 turers to accelerate rebate payments under existing rebate contracts; 40 and such other actions as authorized by law. [The commissioner shall41provide written notice to the legislature thirty days prior to taking42action pursuant to this paragraph, unless action is necessary in the43fourth quarter of a fiscal year to prevent total Medicaid drug expendi-44tures from exceeding the limitation imposed by subdivision two of this45section, in which case such notice to the legislature may be less than46thirty days.] 47 (b) The commissioner shall be authorized to take the actions described 48 in paragraph (a) of this subdivision [only so long as total Medicaid49drug expenditures are projected to exceed the annual growth limitation50imposed by subdivision two of this section]. In addition, no such 51 actions shall be deemed to supersede the provisions of paragraph (b) of 52 subdivision three of section two hundred seventy-three of this article 53 or the provisions of subdivisions twenty-five and twenty-five-a of 54 section three hundred sixty-four-j of the social services law[, except55as allowed by paragraph (c) of subdivision five of this section]; 56 provided further that nothing in this section shall prevent access by aS. 8307--A 40 A. 8807--A 1 Medicaid recipient to a drug which is the only treatment for a partic- 2 ular disease or condition. 3 [8.] 7. The commissioner, upon request of the chair of the drug utili- 4 zation review board, shall provide a report [by July first annually to5the drug utilization review board] on savings achieved through the drug 6 cap in the last fiscal year. Such report shall provide data on what 7 savings were achieved [through actions pursuant to subdivisions three,8five and seven of this section, respectively, and what savings were9achieved through other means] and how such savings were calculated and 10 implemented. 11 § 5. Paragraph (e) of subdivision 7 of section 367-a of the social 12 services law, as amended by section 1 of part GG of chapter 56 of the 13 laws of 2020, the opening paragraph as amended by section 24 of part B 14 of chapter 57 of the laws of 2023, is amended to read as follows: 15 (e) During the period from April first, two thousand fifteen through 16 March thirty-first, two thousand twenty-six, the commissioner may, in 17 lieu of a managed care provider or pharmacy benefit manager, negotiate 18 directly and enter into an arrangement with a pharmaceutical manufactur- 19 er for the provision of supplemental rebates relating to pharmaceutical 20 utilization by enrollees of managed care providers pursuant to section 21 three hundred sixty-four-j of this title and may also negotiate directly 22 and enter into such an agreement relating to pharmaceutical utilization 23 by medical assistance recipients not so enrolled. Such rebate arrange- 24 ments shall be limited to the following: antiretrovirals approved by the 25 FDA for the treatment of HIV/AIDS, accelerated approval drugs estab- 26 lished pursuant to subparagraph (ix) of this paragraph, opioid depend- 27 ence agents and opioid antagonists listed in a statewide formulary 28 established pursuant to subparagraph (vii) of this paragraph, hepatitis 29 C agents, high cost drugs as provided for in subparagraph (viii) of this 30 paragraph, gene therapies as provided for in subparagraph (ix) of this 31 paragraph, and any other class or drug designated by the commissioner 32 for which the pharmaceutical manufacturer has in effect a rebate 33 arrangement with the federal secretary of health and human services 34 pursuant to 42 U.S.C. § 1396r-8, and for which the state has established 35 standard clinical criteria. No agreement entered into pursuant to this 36 paragraph shall have an initial term or be extended beyond the expira- 37 tion or repeal of this paragraph. 38 (i) The manufacturer shall not enter into any rebate arrangements with 39 a managed care provider, or any of a managed care provider's agents, 40 including but not limited to any pharmacy benefit manager on the gene 41 therapy, drug, or drug classes subject to this paragraph when the state 42 has a rebate arrangement in place and standard clinical criteria are 43 imposed on the managed care provider. 44 (ii) The commissioner shall establish adequate rates of reimbursement 45 which shall take into account both the impact of the commissioner nego- 46 tiating such arrangements and any limitations imposed on the managed 47 care provider's ability to establish clinical criteria relating to the 48 utilization of such drugs. In developing the managed care provider's 49 reimbursement rate, the commissioner shall identify the amount of 50 reimbursement for such drugs as a separate and distinct component from 51 the reimbursement otherwise made for prescription drugs as prescribed by 52 this section. 53 (iii) [The commissioner shall submit a report to the temporary presi-54dent of the senate and the speaker of the assembly annually by December55thirty-first. The report shall analyze the adequacy of rates to managedS. 8307--A 41 A. 8807--A 1care providers for drug expenditures related to the classes under this2paragraph.3(iv)] Nothing in this paragraph shall be construed to require a phar- 4 maceutical manufacturer to enter into a rebate arrangement satisfactory 5 to the commissioner relating to pharmaceutical utilization by enrollees 6 of managed care providers pursuant to section three hundred sixty-four-j 7 of this title or relating to pharmaceutical utilization by medical 8 assistance recipients not so enrolled. 9 [(v)] (iv) All clinical criteria, including requirements for prior 10 approval, and all utilization review determinations established by the 11 state as described in this paragraph for the gene therapies, drugs, or 12 drug classes subject to this paragraph shall be developed using 13 evidence-based and peer-reviewed clinical review criteria in accordance 14 with article two-A of the public health law, as applicable. 15 [(vi)] (v) All prior authorization and utilization review determi- 16 nations related to the coverage of any drug subject to this paragraph 17 shall be subject to article forty-nine of the public health law, section 18 three hundred sixty-four-j of this title, and article forty-nine of the 19 insurance law, as applicable. Nothing in this paragraph shall diminish 20 any rights relating to access, prior authorization, or appeal relating 21 to any drug class or drug afforded to a recipient under any other 22 provision of law. 23 [(vii)] (vi) The department shall publish a statewide formulary of 24 opioid dependence agents and opioid antagonists, which shall include as 25 "preferred drugs" all drugs in such classes, which shall include all 26 subclasses of a given drug that have a different pharmacological route 27 of administration, provided that: 28 (A) for all drugs that are included as of the date of the enactment of 29 this subparagraph on a formulary of a managed care provider, as defined 30 in section three hundred sixty-four-j of this title, or in the Medicaid 31 fee-for-service preferred drug program pursuant to section two hundred 32 seventy-two of the public health law, the cost to the department for 33 such drug is equal to or less than the lowest cost paid for the drug by 34 any managed care provider or by the Medicaid fee-for-service program 35 after the application of any rebates, as of the date that the department 36 implements the statewide formulary established by this subparagraph. 37 Where there is a generic version of the drug approved by the Food and 38 Drug Administration as bioequivalent to a brand name drug pursuant to 21 39 U.S.C. § 355(j)(8)(B), the cost to the department for the brand and 40 generic versions shall be equal to or less than the lower of the two 41 maximum costs determined pursuant to the previous sentence; and 42 (B) for all drugs that are not included as of the date of the enact- 43 ment of this subparagraph on a formulary of a managed care provider, as 44 defined in section three hundred sixty-four-j of this title, or in the 45 Medicaid fee-for-service preferred drug program pursuant to section two 46 hundred seventy-two of the public health law, the department is able to 47 obtain the drug at a cost that is equal to or less than the lowest cost 48 to the department of other comparable drugs in the class, after the 49 application of any rebates. Where there is a generic version of the drug 50 approved by the Food and Drug Administration as bioequivalent to a brand 51 name drug pursuant to 21 U.S.C. § 355(j)(8)(B), the cost to the depart- 52 ment for the brand and generic versions shall be equal to or less than 53 the lower of the two maximum costs determined pursuant to the previous 54 sentence. 55 [(viii)] (vii) The commissioner may identify and refer high cost 56 drugs, as defined in clause (D) of this subparagraph, that are notS. 8307--A 42 A. 8807--A 1 included as of the date of the enactment of this subparagraph on a 2 formulary of a managed care provider or covered by the Medicaid fee for 3 service of program to the drug utilization review board established by 4 section three hundred sixty-nine-bb of this article for a recommendation 5 as to whether a target supplemental Medicaid rebate should be paid by 6 the manufacturer of the drug to the department and the target amount of 7 the rebate. 8 (A) If the commissioner intends to refer a high cost drug to the drug 9 utilization review board pursuant to this subparagraph, the commissioner 10 shall notify the manufacturer of such drug and shall attempt to reach 11 agreement with the manufacturer on a rebate arrangement satisfactory to 12 the commissioner for the drug prior to referring the drug to the drug 13 utilization review board for review. Such arrangement may be based on 14 evidence based research, including, but not limited to, such research 15 operated or conducted by or for other state governments, the federal 16 government, the governments of other nations, and third party payers or 17 multi-state coalitions, provided however that the department shall 18 account for the effectiveness of the drug in treating the conditions for 19 which it is prescribed or in improving a patient's health, quality of 20 life, or overall health outcomes, and the likelihood that use of the 21 drug will reduce the need for other medical care, including hospitaliza- 22 tion. 23 (B) In the event that the commissioner and the manufacturer have 24 previously agreed to a rebate arrangement for a drug pursuant to this 25 paragraph, the drug shall not be referred to the drug utilization review 26 board for any further rebate agreement for the duration of the previous 27 rebate agreement, provided however, the commissioner may refer a drug to 28 the drug utilization review board if the commissioner determines there 29 are significant and substantiated utilization or market changes, new 30 evidence-based research, or statutory or federal regulatory changes that 31 warrant additional rebates. In such cases, the department shall notify 32 the manufacturer and provide evidence of the changes or research that 33 would warrant additional rebates, and shall attempt to reach agreement 34 with the manufacturer on a rebate for the drug prior to referring the 35 drug to the drug utilization review board for review. 36 (C) If the commissioner is unsuccessful in entering into a rebate 37 arrangement with the manufacturer of the drug satisfactory to the 38 department, the drug manufacturer shall in that event be required to 39 provide to the department, on a standard reporting form developed by the 40 department, the information as described in paragraph (e) of subdivision 41 [six] three of section two hundred eighty of the public health law. All 42 information disclosed pursuant to this clause shall be considered confi- 43 dential and shall not be disclosed by the department in a form that 44 identifies a specific manufacturer or prices charged for drugs by such 45 manufacturer. 46 (D) For the purposes of this subparagraph, the term "high cost drug" 47 shall mean a brand name drug or biologic that has a launch wholesale 48 acquisition cost of thirty thousand dollars or more per year or course 49 of treatment, or a biosimilar drug that has a launch wholesale acquisi- 50 tion cost that is not at least fifteen percent lower than the referenced 51 brand biologic at the time the biosimilar is launched, or a generic drug 52 that has a wholesale acquisition cost of one hundred dollars or more for 53 a thirty day supply or recommended dosage approved for labeling by the 54 federal Food and Drug Administration, or a brand name drug or biologic 55 that has a wholesale acquisition cost increase of three thousand dollarsS. 8307--A 43 A. 8807--A 1 or more in any twelve-month period, or course of treatment if less than 2 twelve months. 3 [(ix)] (viii) For purposes of this paragraph, a "gene therapy" is a 4 drug (A) approved under section 505 of the Federal Food, Drug and 5 Cosmetics Act or licensed under subsection (a) or (k) of section 351 of 6 the Public Health Services Act; (B) that treats a rare disease or condi- 7 tion, as defined in 21 USC § 360bb(a)(2), that is life-threatening, as 8 defined in 42 CFR 321.18; (C) is considered a gene therapy by the feder- 9 al Food and Drug Administration for which a biologics license pursuant 10 to 21 CFR 600-680 is held; (D) if administered in accordance with the 11 labeling of such drug, is expected to result in either the cure of such 12 disease or condition or a reduction in the symptoms of such disease or 13 condition that materially improves the patient's length or quality of 14 life; and (E) is expected to achieve the result described in clause (D) 15 of this subparagraph after not more than three administrations. 16 (ix) For purposes of this paragraph, an "accelerated approval" is a 17 drug or labeled indication of a drug authorized by the Federal Food, 18 Drug and Cosmetic Act for drugs for serious conditions that fill an 19 unmet medical need based on whether the drug has an effect on a surro- 20 gate clinical endpoint, and contingent upon verification of clinical 21 benefit in confirmatory trials. 22 § 6. Paragraph (g) of subdivision 2 of section 365-a of the social 23 services law, as amended by section 21 of part A of chapter 56 of the 24 laws of 2013, is amended to read as follows: 25 (g) sickroom supplies, eyeglasses, prosthetic appliances and dental 26 prosthetic appliances furnished in accordance with the regulations of 27 the department; provided further that: (i) the commissioner of health is 28 authorized to implement a preferred diabetic supply program wherein the 29 department of health will receive enhanced rebates from preferred 30 manufacturers [of] for products and supplies, including but not limited 31 to, glucometers and test strips, and may subject non-preferred manufac- 32 turers' products and supplies, including but not limited to, glucometers 33 and test strips to prior authorization under section two hundred seven- 34 ty-three of the public health law; (ii) enteral formula therapy and 35 nutritional supplements are limited to coverage only for nasogastric, 36 jejunostomy, or gastrostomy tube feeding, for treatment of an inborn 37 metabolic disorder, or to address growth and development problems in 38 children, or, subject to standards established by the commissioner, for 39 persons with a diagnosis of HIV infection, AIDS or HIV-related illness 40 or other diseases and conditions; (iii) prescription footwear and 41 inserts are limited to coverage only when used as an integral part of a 42 lower limb orthotic appliance, as part of a diabetic treatment plan, or 43 to address growth and development problems in children; (iv) compression 44 and support stockings are limited to coverage only for pregnancy or 45 treatment of venous stasis ulcers; and (v) the commissioner of health is 46 authorized to implement an incontinence supply utilization management 47 program to reduce costs without limiting access through the existing 48 provider network, including but not limited to single or multiple source 49 contracts or, a preferred incontinence supply program wherein the 50 department of health will receive enhanced rebates from preferred 51 manufacturers of incontinence supplies, and may subject non-preferred 52 manufacturers' incontinence supplies to prior approval pursuant to regu- 53 lations of the department, provided any necessary approvals under feder- 54 al law have been obtained to receive federal financial participation in 55 the costs of incontinence supplies provided pursuant to this subpara- 56 graph;S. 8307--A 44 A. 8807--A 1 § 7. The public health law is amended by adding a new section 280-d to 2 read as follows: 3 § 280-d. Pharmacy cost reporting. 1. The department shall develop and 4 implement a cost reporting program for licensed pharmacies that partic- 5 ipate in the Medicaid program. Such program shall include a requirement 6 to submit an annual cost report on a form designated by the department. 7 Information shall include, but not be limited to, costs incurred during 8 procurement and dispensing of prescription drugs. 9 2. Such cost reports are subject to audit. In the event that any 10 information or data which a pharmacy has submitted to the department, on 11 the required reporting forms is inaccurate or incorrect, such pharmacy 12 shall within fifteen business days, submit to the department a 13 correction of such information or data. 14 3. Timely filing of such report is a requirement of participation in 15 the Medicaid pharmacy program. In the event that a pharmacy fails to 16 file the required reports on or before the required due date, such phar- 17 macy may be subject to removal as a provider from the fee-for-service 18 pharmacy program. 19 § 8. Paragraphs (a), (b) and (c) of subdivision 9 of section 367-a of 20 the social services law, paragraphs (a) and (c) as amended by chapter 19 21 of the laws of 1998, paragraph (b) as amended by section 3 of part C of 22 chapter 58 of the laws of 2004, subparagraphs (i) and (ii) of paragraph 23 (b) as amended by section 7 of part D of chapter 57 of the laws of 2017, 24 and subparagraph (iii) of paragraph (b) as added by section 29 of part E 25 of chapter 63 of the laws of 2005, are amended to read as follows: 26 (a) for drugs provided by medical practitioners and claimed separately 27 by the practitioners[, the actual cost of the drugs to the practition-28ers; and] the lower of: 29 (i) (1) an amount equal to the national average drug acquisition cost 30 set by the federal centers for medicare and medicaid services for the 31 drug, if any, or if such amount is not available, the wholesale acquisi- 32 tion cost of the drug based on the package size dispensed from, as 33 reported by the prescription drug pricing service used by the depart- 34 ment, (2) the federal upper limit, if any, established by the federal 35 centers for medicare and medicaid services; (3) the state maximum acqui- 36 sition cost, if any, established pursuant to paragraph (e) of this 37 subdivision; or (4) the actual cost of the drug to the practitioner. 38 (ii) Notwithstanding subparagraph (i) and paragraph (e) of this subdi- 39 vision, if a drug has been purchased from a manufacturer by a covered 40 entity pursuant to section 340B of the federal public health service act 41 (42 USCA § 256b), the actual amount paid by such covered entity. For 42 purposes of this subparagraph, a "covered entity" is an entity that 43 meets the requirements of paragraph four of subsection (a) of such 44 section, that elects to participate in the program established by such 45 section, and that causes claims for payment for drugs covered by this 46 subparagraph to be submitted to the medical assistance program, either 47 directly or through an authorized contract pharmacy. No medical assist- 48 ance payments may be made to a covered entity or to an authorized 49 contract pharmacy of a covered entity for drugs that are eligible for 50 purchase under the section 340B program and are dispensed on an outpa- 51 tient basis to patients of the covered entity, other than under the 52 provisions of this subparagraph. 53 (b) for drugs dispensed by pharmacies: 54 (i) (A) if the drug dispensed is a generic prescription drug, the 55 lower of: (1) an amount equal to the national average drug acquisition 56 cost set by the federal centers for medicare and medicaid services forS. 8307--A 45 A. 8807--A 1 the drug, if any, or if such amount if not available, the wholesale 2 acquisition cost of the drug based on the package size dispensed from, 3 as reported by the prescription drug pricing service used by the depart- 4 ment, less seventeen and one-half percent thereof; (2) the federal upper 5 limit, if any, established by the federal centers for medicare and medi- 6 caid services; (3) the state maximum acquisition cost, if any, estab- 7 lished pursuant to paragraph (e) of this subdivision; or (4) the 8 dispensing pharmacy's usual and customary price charged to the general 9 public; (B) if the drug dispensed is available without a prescription as 10 required by section sixty-eight hundred ten of the education law but is 11 reimbursed as an item of medical assistance pursuant to paragraph (a) of 12 subdivision four of section three hundred sixty-five-a of this title, 13 the lower of (1) an amount equal to the national average drug acquisi- 14 tion cost set by the federal centers for medicare and medicaid services 15 for the drug, if any, or if such amount is not available, the wholesale 16 acquisition cost of the drug based on the package size dispensed from, 17 as reported by the prescription drug pricing service used by the depart- 18 ment, (2) the federal upper limit, if any, established by the federal 19 centers for medicare and medicaid services; (3) the state maximum acqui- 20 sition cost if any, established pursuant to paragraph (e) of this subdi- 21 vision; or (4) the dispensing pharmacy's usual and customary price 22 charged to the general public; 23 (ii) if the drug dispensed is a brand-name prescription drug, the 24 lower of: 25 (A) an amount equal to the national average drug acquisition cost set 26 by the federal centers for medicare and medicaid services for the drug, 27 if any, or if such amount is not available, the wholesale acquisition 28 cost of the drug based on the package size dispensed from, as reported 29 by the prescription drug pricing service used by the department[, less30three and three-tenths percent thereof]; or (B) the dispensing pharma- 31 cy's usual and customary price charged to the general public; and 32 (iii) notwithstanding subparagraphs (i) and (ii) of this paragraph and 33 paragraphs (d) and (e) of this subdivision, if the drug dispensed is a 34 drug that has been purchased from a manufacturer by a covered entity 35 pursuant to section 340B of the federal public health service act (42 36 USCA § 256b), the actual amount paid by such covered entity pursuant to 37 such section, plus the reasonable administrative costs, as determined by 38 the commissioner, incurred by the covered entity or by an authorized 39 contract pharmacy in connection with the purchase and dispensing of such 40 drug and the tracking of such transactions. For purposes of this subpar- 41 agraph, a "covered entity" is an entity that meets the requirements of 42 paragraph four of subsection (a) of such section, that elects to partic- 43 ipate in the program established by such section, and that causes claims 44 for payment for drugs covered by this subparagraph to be submitted to 45 the medical assistance program, either directly or through an authorized 46 contract pharmacy. No medical assistance payments may be made to a 47 covered entity or to an authorized contract pharmacy of a covered entity 48 for drugs that are eligible for purchase under the section 340B program 49 and are dispensed on an outpatient basis to patients of the covered 50 entity, other than under the provisions of this subparagraph. Pharmacies 51 submitting claims for reimbursement of drugs purchased pursuant to 52 section 340B of the public health service act shall notify the depart- 53 ment that the claim is eligible for purchase under the 340B program, 54 consistent with claiming instructions issued by the department to iden- 55 tify such claims.S. 8307--A 46 A. 8807--A 1 (c) Notwithstanding subparagraph (i) of paragraph (b) of this subdivi- 2 sion, if a qualified prescriber certifies "brand medically necessary" or 3 "brand necessary" in his or her own handwriting directly on the face of 4 a prescription, or in the case of electronic prescriptions, inserts an 5 electronic direction to clarify "brand medically necessary" or "brand 6 necessary", for a multiple source drug for which a specific upper limit 7 of reimbursement has been established by the federal agency, in addition 8 to writing "d a w" in the box provided for such purpose on the 9 prescription form, payment under this title for such drug must be made 10 under the provisions of subparagraph (ii) of such paragraph. 11 § 9. This act shall take effect October 1, 2024; provided that 12 sections two and three of this act shall take effect January 1, 2025; 13 and provided however, that the amendments to paragraph (e) of subdivi- 14 sion 7 of section 367-a of the social services law made by section five 15 of this act shall not affect the repeal of such paragraph and shall be 16 deemed repealed therewith provided, further, that the amendments to 17 subdivision 9 of section 367-a of the social services law made by 18 section eight of this act shall not affect the expiration of such subdi- 19 vision pursuant to section 4 of chapter 19 of the laws of 1998, as 20 amended, and shall expire therewith. 21 PART J 22 Section 1. The title heading of title 11-D of article 5 of the social 23 services law, as amended by section 1 of part H of chapter 57 of the 24 laws of 2021, is amended to read as follows: 25 [BASIC HEALTH PROGRAM] ESSENTIAL PLAN 26 § 2. Section 3 of part H of chapter 57 of the laws of 2021, amending 27 the social services law relating to eliminating consumer-paid premium 28 payments in the basic health program, is amended to read as follows: 29 § 3. This act shall take effect June 1, 2021 [and]; provided, however, 30 section two of this act shall expire and be deemed repealed should 31 federal approval be withdrawn or 42 U.S.C. 18051 be repealed; provided 32 that the commissioner of health shall notify the legislative bill draft- 33 ing commission upon the withdrawal of federal approval or the repeal of 34 42 U.S.C. 18051 in order that the commission may maintain an accurate 35 and timely effective data base of the official text of the laws of the 36 state of New York in furtherance of effectuating the provisions of 37 section 44 of the legislative law and section 70-b of the public offi- 38 cers law. 39 § 3. Subdivisions (b) and (c) of section 8 of part BBB of chapter 56 40 of the laws of 2022, amending the public health law and other laws 41 relating to permitting the commissioner of health to submit a waiver 42 that expands eligibility for New York's basic health program and 43 increases the federal poverty limit cap for basic health program eligi- 44 bility from two hundred to two hundred fifty percent, are amended to 45 read as follows: 46 (b) section four of this act shall expire and be deemed repealed 47 December 31, [2024] 2025; provided, however, the amendments to paragraph 48 (c) of subdivision 1 of section 369-gg of the social services law made 49 by such section of this act shall be subject to the expiration and 50 reversion of such paragraph pursuant to section 2 of part H of chapter 51 57 of the laws of 2021 when upon such date, the provisions of section 52 five of this act shall take effect; provided, however, the amendments to 53 such paragraph made by section five of this act shall expire and be 54 deemed repealed December 31, [2024] 2025;S. 8307--A 47 A. 8807--A 1 (c) section six of this act shall take effect January 1, [2025] 2026; 2 provided, however, the amendments to paragraph (c) of subdivision 1 of 3 section 369-gg of the social services law made by such section of this 4 act shall be subject to the expiration and reversion of such paragraph 5 pursuant to section 2 of part H of chapter 57 of the laws of 2021 when 6 upon such date, the provisions of section seven of this act shall take 7 effect; and 8 § 4. Paragraph (a) of subdivision 1 of section 268-c of the public 9 health law, as added by section 2 of part T of chapter 57 of the laws of 10 2019, is amended to read as follows: 11 (a) Perform eligibility determinations for federal and state insurance 12 affordability programs including medical assistance in accordance with 13 section three hundred sixty-six of the social services law, child health 14 plus in accordance with section twenty-five hundred eleven of this chap- 15 ter, the basic health program in accordance with section three hundred 16 sixty-nine-gg of the social services law, the 1332 state innovation 17 program in accordance with section three hundred sixty-nine-ii of the 18 social services law, premium tax credits and cost-sharing reductions and 19 qualified health plans in accordance with applicable law and other 20 health insurance programs as determined by the commissioner; 21 § 5. Subdivision 16 of section 268-c of the public health law, as 22 added by section 2 of part T of chapter 57 of the laws of 2019, is 23 amended to read as follows: 24 16. In accordance with applicable federal and state law, inform indi- 25 viduals of eligibility requirements for the Medicaid program under title 26 XIX of the social security act and the social services law, the chil- 27 dren's health insurance program (CHIP) under title XXI of the social 28 security act and this chapter, the basic health program under section 29 three hundred sixty-nine-gg of the social services law, the 1332 state 30 innovation program in accordance with section three hundred sixty-nine- 31 ii of the social services law, or any applicable state or local public 32 health insurance program and if, through screening of the application by 33 the Marketplace, the Marketplace determines that such individuals are 34 eligible for any such program, enroll such individuals in such program. 35 § 6. Section 268-c of the public health law is amended by adding a new 36 subdivision 26 to read as follows: 37 26. Subject to federal approval if required, the use of state funds 38 and the availability of funds in the 1332 state innovation program fund 39 established pursuant to section ninety-eight-d of the state finance law, 40 the commissioner shall have the authority to establish a program to 41 provide subsidies for the payment of premium or cost sharing or both to 42 assist individuals who are eligible to purchase qualified health plans 43 through the marketplace, or take such other action as appropriate to 44 reduce or eliminate qualified health plan premiums or cost-sharing or 45 both. 46 § 7. Subparagraph (i) of paragraph (a) of subdivision 4 of section 47 268-e of the public health law, as added by section 2 of part T of chap- 48 ter 57 of the laws of 2019, is amended to read as follows: 49 (i) An initial determination of eligibility, including: 50 (A) eligibility to enroll in a qualified health plan; 51 (B) eligibility for Medicaid; 52 (C) eligibility for Child Health Plus; 53 (D) eligibility for the Basic Health Program; 54 (E) eligibility for the 1332 state innovation program; 55 (F) the amount of advance payments of the premium tax credit and level 56 of cost-sharing reductions;S. 8307--A 48 A. 8807--A 1 [(F)] (G) the amount of any other subsidy that may be available under 2 law; and 3 [(G)] (H) eligibility for such other health insurance programs as 4 determined by the commissioner; and 5 § 8. Section 268 of the public health law, as added by section 2 of 6 part T of chapter 57 of the laws of 2019, is amended to read as follows: 7 The purpose of this title is to codify the establishment of the health 8 benefit exchange in New York, known as NY State of Health, The Official 9 Health Plan Marketplace (Marketplace), in conformance with Executive 10 Order 42 (Cuomo) issued April 12, 2012. The Marketplace shall continue 11 to perform eligibility determinations for federal and state insurance 12 affordability programs including medical assistance in accordance with 13 section three hundred sixty-six of the social services law, child health 14 plus in accordance with section twenty-five hundred eleven of this chap- 15 ter, the basic health program in accordance with section three hundred 16 sixty-nine-gg of the social services law, the 1332 state innovation 17 program in accordance with section three hundred sixty-nine-ii of the 18 social service law, and premium tax credits and cost-sharing reductions, 19 together with performing eligibility determinations for qualified health 20 plans and such other health insurance programs as determined by the 21 commissioner. The Marketplace shall also facilitate enrollment in insur- 22 ance affordability programs, qualified health plans and other health 23 insurance programs as determined by the commissioner, the purchase and 24 sale of qualified health plans and/or other or additional health plans 25 certified by the Marketplace pursuant to this title, and shall continue 26 to have the authority to operate a small business health options program 27 ("SHOP") to assist eligible small employers in selecting qualified 28 health plans and/or other or additional health plans certified by the 29 Marketplace and to determine small employer eligibility for purposes of 30 small employer tax credits. It is the intent of the legislature, by 31 codifying the Marketplace in state statute, to continue to promote qual- 32 ity and affordable health coverage and care, reduce the number of unin- 33 sured persons, provide a transparent marketplace, educate consumers and 34 assist individuals with access to coverage, premium assistance tax cred- 35 its and cost-sharing reductions. In addition, the legislature declares 36 the intent that the Marketplace continue to be properly integrated with 37 insurance affordability programs, including Medicaid, child health plus 38 and the basic health program, the 1332 state innovation program, and 39 such other health insurance programs as determined by the commissioner. 40 § 9. Subdivision 8 of section 268-a of the public health law, as added 41 by section 2 of part T of chapter 57 of the laws of 2019, is amened to 42 read as follows: 43 8. "Insurance affordability program" means Medicaid, child health 44 plus, the basic health program, the 1332 state innovation program, post- 45 partum extended coverage and any other health insurance subsidy program 46 designated as such by the commissioner. 47 § 10. This act shall take effect immediately and shall be deemed to 48 have been in full force and effect on and after April 1, 2024; provided, 49 however, that section six of this act shall only take effect upon the 50 commissioner of health obtaining and maintaining all necessary approvals 51 from the secretary of health and human services and the secretary of the 52 treasury based on an amended application for a waiver for state inno- 53 vation pursuant to section 1332 of the patient protection and affordable 54 care act (P.L. 111-148) and subdivision 25 of section 268-c of the 55 public health law; and provided, further, that the commissioner of 56 health shall notify the legislative bill drafting commission upon theS. 8307--A 49 A. 8807--A 1 occurrence of the enactment of the legislation provided for in section 2 six of this act in order that the commission may maintain an accurate 3 and timely effective data base of the official text of the laws of the 4 state of New York in furtherance of effectuating the provisions of 5 section 44 of the legislative law and section 70-b of the public offi- 6 cers law. 7 PART K 8 Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266 9 of the laws of 1986, amending the civil practice law and rules and other 10 laws relating to malpractice and professional medical conduct, as 11 amended by section 1 of part F of chapter 57 of the laws of 2023, is 12 amended and a new subdivision 9 is added to read as follows: 13 (a) The superintendent of financial services and the commissioner of 14 health or their designee shall, from funds available in the hospital 15 excess liability pool created pursuant to subdivision 5 of this section, 16 purchase a policy or policies for excess insurance coverage, as author- 17 ized by paragraph 1 of subsection (e) of section 5502 of the insurance 18 law; or from an insurer, other than an insurer described in section 5502 19 of the insurance law, duly authorized to write such coverage and actual- 20 ly writing medical malpractice insurance in this state; or shall 21 purchase equivalent excess coverage in a form previously approved by the 22 superintendent of financial services for purposes of providing equiv- 23 alent excess coverage in accordance with section 19 of chapter 294 of 24 the laws of 1985, for medical or dental malpractice occurrences between 25 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988, 26 between July 1, 1988 and June 30, 1989, between July 1, 1989 and June 27 30, 1990, between July 1, 1990 and June 30, 1991, between July 1, 1991 28 and June 30, 1992, between July 1, 1992 and June 30, 1993, between July 29 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995, 30 between July 1, 1995 and June 30, 1996, between July 1, 1996 and June 31 30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998 32 and June 30, 1999, between July 1, 1999 and June 30, 2000, between July 33 1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002, 34 between July 1, 2002 and June 30, 2003, between July 1, 2003 and June 35 30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005 36 and June 30, 2006, between July 1, 2006 and June 30, 2007, between July 37 1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009, 38 between July 1, 2009 and June 30, 2010, between July 1, 2010 and June 39 30, 2011, between July 1, 2011 and June 30, 2012, between July 1, 2012 40 and June 30, 2013, between July 1, 2013 and June 30, 2014, between July 41 1, 2014 and June 30, 2015, between July 1, 2015 and June 30, 2016, 42 between July 1, 2016 and June 30, 2017, between July 1, 2017 and June 43 30, 2018, between July 1, 2018 and June 30, 2019, between July 1, 2019 44 and June 30, 2020, between July 1, 2020 and June 30, 2021, between July 45 1, 2021 and June 30, 2022, between July 1, 2022 and June 30, 2023, [and] 46 between July 1, 2023 and June 30, 2024, and between July 1, 2024 and 47 June 30, 2025 or reimburse the hospital where the hospital purchases 48 equivalent excess coverage as defined in subparagraph (i) of paragraph 49 (a) of subdivision 1-a of this section for medical or dental malpractice 50 occurrences between July 1, 1987 and June 30, 1988, between July 1, 1988 51 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July 52 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, 53 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June 54 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995S. 8307--A 50 A. 8807--A 1 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July 2 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999, 3 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June 4 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002 5 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July 6 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006, 7 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June 8 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009 9 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July 10 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013, 11 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June 12 30, 2015, between July 1, 2015 and June 30, 2016, between July 1, 2016 13 and June 30, 2017, between July 1, 2017 and June 30, 2018, between July 14 1, 2018 and June 30, 2019, between July 1, 2019 and June 30, 2020, 15 between July 1, 2020 and June 30, 2021, between July 1, 2021 and June 16 30, 2022, between July 1, 2022 and June 30, 2023, [and] between July 1, 17 2023 and June 30, 2024, and between July 1, 2024 and June 30, 2025 for 18 physicians or dentists certified as eligible for each such period or 19 periods pursuant to subdivision 2 of this section by a general hospital 20 licensed pursuant to article 28 of the public health law; provided that 21 no single insurer shall write more than fifty percent of the total 22 excess premium for a given policy year; and provided, however, that such 23 eligible physicians or dentists must have in force an individual policy, 24 from an insurer licensed in this state of primary malpractice insurance 25 coverage in amounts of no less than one million three hundred thousand 26 dollars for each claimant and three million nine hundred thousand 27 dollars for all claimants under that policy during the period of such 28 excess coverage for such occurrences or be endorsed as additional 29 insureds under a hospital professional liability policy which is offered 30 through a voluntary attending physician ("channeling") program previous- 31 ly permitted by the superintendent of financial services during the 32 period of such excess coverage for such occurrences. During such period, 33 such policy for excess coverage or such equivalent excess coverage 34 shall, when combined with the physician's or dentist's primary malprac- 35 tice insurance coverage or coverage provided through a voluntary attend- 36 ing physician ("channeling") program, total an aggregate level of two 37 million three hundred thousand dollars for each claimant and six million 38 nine hundred thousand dollars for all claimants from all such policies 39 with respect to occurrences in each of such years provided, however, if 40 the cost of primary malpractice insurance coverage in excess of one 41 million dollars, but below the excess medical malpractice insurance 42 coverage provided pursuant to this act, exceeds the rate of nine percent 43 per annum, then the required level of primary malpractice insurance 44 coverage in excess of one million dollars for each claimant shall be in 45 an amount of not less than the dollar amount of such coverage available 46 at nine percent per annum; the required level of such coverage for all 47 claimants under that policy shall be in an amount not less than three 48 times the dollar amount of coverage for each claimant; and excess cover- 49 age, when combined with such primary malpractice insurance coverage, 50 shall increase the aggregate level for each claimant by one million 51 dollars and three million dollars for all claimants; and provided 52 further, that, with respect to policies of primary medical malpractice 53 coverage that include occurrences between April 1, 2002 and June 30, 54 2002, such requirement that coverage be in amounts no less than one 55 million three hundred thousand dollars for each claimant and threeS. 8307--A 51 A. 8807--A 1 million nine hundred thousand dollars for all claimants for such occur- 2 rences shall be effective April 1, 2002. 3 (9) This subdivision shall apply only to excess insurance coverage or 4 equivalent excess coverage for physicians or dentists that is eligible 5 to be paid for from funds available in the hospital excess liability 6 pool. 7 (a) Notwithstanding any law to the contrary, for any policy period 8 beginning on or after July 1, 2023, excess coverage shall be purchased 9 by a physician or dentist directly from a provider of excess insurance 10 coverage or equivalent excess coverage. At the conclusion of the policy 11 period the superintendent of financial services and the commissioner of 12 health or their designee shall, from funds available in the hospital 13 excess liability pool created pursuant to subdivision 5 of this section, 14 pay fifty percent of the premium to the provider of excess insurance 15 coverage or equivalent excess coverage, and the remaining fifty percent 16 shall be paid one year thereafter. 17 (b) Notwithstanding any law to the contrary, for any policy period 18 beginning on or after July 1, 2024, excess coverage shall be purchased 19 by a physician or dentist directly from a provider of excess insurance 20 coverage or equivalent excess coverage. Such provider of excess insur- 21 ance coverage or equivalent excess coverage shall bill, in a manner 22 consistent with paragraph (f) of this subdivision, the physician or 23 dentist for an amount equal to fifty percent of the premium for such 24 coverage, as established pursuant to paragraph (d) of this subdivision, 25 during the policy period. At the conclusion of the policy period the 26 superintendent of financial services and the commissioner of health or 27 their designee shall, from funds available in the hospital excess 28 liability pool created pursuant to subdivision 5 of this section, pay 29 half of the remaining fifty percent of the premium to the provider of 30 excess insurance coverage or equivalent excess coverage, and the remain- 31 ing twenty-five percent shall be paid one year thereafter. If the funds 32 available in the hospital excess liability pool are insufficient to meet 33 the percent of the costs of the excess coverage, the provisions of 34 subdivision 8 of this section shall apply. 35 (c) If at the conclusion of the policy period, a physician or dentist, 36 eligible for excess coverage paid for from funds available in the hospi- 37 tal excess liability pool, has failed to pay an amount equal to fifty 38 percent of the premium as established pursuant to paragraph (d) of this 39 subdivision, such excess coverage shall be cancelled and shall be null 40 and void as of the first day on or after the commencement of a policy 41 period where the liability for payment pursuant to this subdivision has 42 not been met. The provider of excess coverage shall remit any portion of 43 premium paid by the eligible physician or dentist for such a policy 44 period. 45 (d) The superintendent of financial services shall establish a rate 46 consistent with subdivision 3 of this section that providers of excess 47 insurance coverage or equivalent excess coverage will charge for such 48 coverage for each policy period. For the policy period beginning July 1, 49 2024, the superintendent of financial services may direct that the 50 premium for that policy period be the same as it was for the policy 51 period that concluded June 30, 2023. 52 (e) No provider of excess insurance coverage or equivalent excess 53 coverage shall issue excess coverage to which this subdivision applies 54 to any physician or dentist unless that physician or dentist meets the 55 eligibility requirements for such coverage set forth in this section. 56 The superintendent of financial services and the commissioner of healthS. 8307--A 52 A. 8807--A 1 or their designee shall not make any payment under this subdivision to a 2 provider of excess insurance coverage or equivalent excess coverage for 3 excess coverage issued to a physician or dentist who does not meet the 4 eligibility requirements for participation in the hospital excess 5 liability pool program set forth in this section. 6 (f) A provider of excess insurance coverage or equivalent coverage 7 that issues excess coverage under this subdivision shall bill the physi- 8 cian or dentist for the portion of the premium required under paragraph 9 (a) of this subdivision in twelve equal monthly installments or in such 10 other manner as the physician or dentist may agree. 11 (g) The superintendent of financial services in consultation with the 12 commissioner of health may promulgate regulations giving effect to the 13 provisions of this subdivision. 14 § 2. Subdivision 3 of section 18 of chapter 266 of the laws of 1986, 15 amending the civil practice law and rules and other laws relating to 16 malpractice and professional medical conduct, as amended by section 2 of 17 part F of chapter 57 of the laws of 2023, is amended to read as follows: 18 (3)(a) The superintendent of financial services shall determine and 19 certify to each general hospital and to the commissioner of health the 20 cost of excess malpractice insurance for medical or dental malpractice 21 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988 22 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July 23 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, 24 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June 25 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995 26 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July 27 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999, 28 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June 29 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002 30 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July 31 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006, 32 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June 33 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009 34 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July 35 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013, 36 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June 37 30, 2015, between July 1, 2015 and June 30, 2016, between July 1, 2016 38 and June 30, 2017, between July 1, 2017 and June 30, 2018, between July 39 1, 2018 and June 30, 2019, between July 1, 2019 and June 30, 2020, 40 between July 1, 2020 and June 30, 2021, between July 1, 2021 and June 41 30, 2022, between July 1, 2022 and June 30, 2023, [and] between July 1, 42 2023 and June 30, 2024, and between July 1, 2024 and June 30, 2025 allo- 43 cable to each general hospital for physicians or dentists certified as 44 eligible for purchase of a policy for excess insurance coverage by such 45 general hospital in accordance with subdivision 2 of this section, and 46 may amend such determination and certification as necessary. 47 (b) The superintendent of financial services shall determine and 48 certify to each general hospital and to the commissioner of health the 49 cost of excess malpractice insurance or equivalent excess coverage for 50 medical or dental malpractice occurrences between July 1, 1987 and June 51 30, 1988, between July 1, 1988 and June 30, 1989, between July 1, 1989 52 and June 30, 1990, between July 1, 1990 and June 30, 1991, between July 53 1, 1991 and June 30, 1992, between July 1, 1992 and June 30, 1993, 54 between July 1, 1993 and June 30, 1994, between July 1, 1994 and June 55 30, 1995, between July 1, 1995 and June 30, 1996, between July 1, 1996 56 and June 30, 1997, between July 1, 1997 and June 30, 1998, between JulyS. 8307--A 53 A. 8807--A 1 1, 1998 and June 30, 1999, between July 1, 1999 and June 30, 2000, 2 between July 1, 2000 and June 30, 2001, between July 1, 2001 and June 3 30, 2002, between July 1, 2002 and June 30, 2003, between July 1, 2003 4 and June 30, 2004, between July 1, 2004 and June 30, 2005, between July 5 1, 2005 and June 30, 2006, between July 1, 2006 and June 30, 2007, 6 between July 1, 2007 and June 30, 2008, between July 1, 2008 and June 7 30, 2009, between July 1, 2009 and June 30, 2010, between July 1, 2010 8 and June 30, 2011, between July 1, 2011 and June 30, 2012, between July 9 1, 2012 and June 30, 2013, between July 1, 2013 and June 30, 2014, 10 between July 1, 2014 and June 30, 2015, between July 1, 2015 and June 11 30, 2016, between July 1, 2016 and June 30, 2017, between July 1, 2017 12 and June 30, 2018, between July 1, 2018 and June 30, 2019, between July 13 1, 2019 and June 30, 2020, between July 1, 2020 and June 30, 2021, 14 between July 1, 2021 and June 30, 2022, between July 1, 2022 and June 15 30, 2023, [and] between July 1, 2023 and June 30, 2024, and between July 16 1, 2024 and June 30, 2025 allocable to each general hospital for physi- 17 cians or dentists certified as eligible for purchase of a policy for 18 excess insurance coverage or equivalent excess coverage by such general 19 hospital in accordance with subdivision 2 of this section, and may amend 20 such determination and certification as necessary. The superintendent of 21 financial services shall determine and certify to each general hospital 22 and to the commissioner of health the ratable share of such cost alloca- 23 ble to the period July 1, 1987 to December 31, 1987, to the period Janu- 24 ary 1, 1988 to June 30, 1988, to the period July 1, 1988 to December 31, 25 1988, to the period January 1, 1989 to June 30, 1989, to the period July 26 1, 1989 to December 31, 1989, to the period January 1, 1990 to June 30, 27 1990, to the period July 1, 1990 to December 31, 1990, to the period 28 January 1, 1991 to June 30, 1991, to the period July 1, 1991 to December 29 31, 1991, to the period January 1, 1992 to June 30, 1992, to the period 30 July 1, 1992 to December 31, 1992, to the period January 1, 1993 to June 31 30, 1993, to the period July 1, 1993 to December 31, 1993, to the period 32 January 1, 1994 to June 30, 1994, to the period July 1, 1994 to December 33 31, 1994, to the period January 1, 1995 to June 30, 1995, to the period 34 July 1, 1995 to December 31, 1995, to the period January 1, 1996 to June 35 30, 1996, to the period July 1, 1996 to December 31, 1996, to the period 36 January 1, 1997 to June 30, 1997, to the period July 1, 1997 to December 37 31, 1997, to the period January 1, 1998 to June 30, 1998, to the period 38 July 1, 1998 to December 31, 1998, to the period January 1, 1999 to June 39 30, 1999, to the period July 1, 1999 to December 31, 1999, to the period 40 January 1, 2000 to June 30, 2000, to the period July 1, 2000 to December 41 31, 2000, to the period January 1, 2001 to June 30, 2001, to the period 42 July 1, 2001 to June 30, 2002, to the period July 1, 2002 to June 30, 43 2003, to the period July 1, 2003 to June 30, 2004, to the period July 1, 44 2004 to June 30, 2005, to the period July 1, 2005 and June 30, 2006, to 45 the period July 1, 2006 and June 30, 2007, to the period July 1, 2007 46 and June 30, 2008, to the period July 1, 2008 and June 30, 2009, to the 47 period July 1, 2009 and June 30, 2010, to the period July 1, 2010 and 48 June 30, 2011, to the period July 1, 2011 and June 30, 2012, to the 49 period July 1, 2012 and June 30, 2013, to the period July 1, 2013 and 50 June 30, 2014, to the period July 1, 2014 and June 30, 2015, to the 51 period July 1, 2015 and June 30, 2016, to the period July 1, 2016 and 52 June 30, 2017, to the period July 1, 2017 to June 30, 2018, to the peri- 53 od July 1, 2018 to June 30, 2019, to the period July 1, 2019 to June 30, 54 2020, to the period July 1, 2020 to June 30, 2021, to the period July 1, 55 2021 to June 30, 2022, to the period July 1, 2022 to June 30, 2023,S. 8307--A 54 A. 8807--A 1 [and] to the period July 1, 2023 to June 30, 2024, and to the period 2 July 1, 2024 to June 30, 2025. 3 § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section 4 18 of chapter 266 of the laws of 1986, amending the civil practice law 5 and rules and other laws relating to malpractice and professional 6 medical conduct, as amended by section 3 of part F of chapter 57 of the 7 laws of 2023, are amended to read as follows: 8 (a) To the extent funds available to the hospital excess liability 9 pool pursuant to subdivision 5 of this section as amended, and pursuant 10 to section 6 of part J of chapter 63 of the laws of 2001, as may from 11 time to time be amended, which amended this subdivision, are insuffi- 12 cient to meet the costs of excess insurance coverage or equivalent 13 excess coverage for coverage periods during the period July 1, 1992 to 14 June 30, 1993, during the period July 1, 1993 to June 30, 1994, during 15 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995 16 to June 30, 1996, during the period July 1, 1996 to June 30, 1997, 17 during the period July 1, 1997 to June 30, 1998, during the period July 18 1, 1998 to June 30, 1999, during the period July 1, 1999 to June 30, 19 2000, during the period July 1, 2000 to June 30, 2001, during the period 20 July 1, 2001 to October 29, 2001, during the period April 1, 2002 to 21 June 30, 2002, during the period July 1, 2002 to June 30, 2003, during 22 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004 23 to June 30, 2005, during the period July 1, 2005 to June 30, 2006, 24 during the period July 1, 2006 to June 30, 2007, during the period July 25 1, 2007 to June 30, 2008, during the period July 1, 2008 to June 30, 26 2009, during the period July 1, 2009 to June 30, 2010, during the period 27 July 1, 2010 to June 30, 2011, during the period July 1, 2011 to June 28 30, 2012, during the period July 1, 2012 to June 30, 2013, during the 29 period July 1, 2013 to June 30, 2014, during the period July 1, 2014 to 30 June 30, 2015, during the period July 1, 2015 to June 30, 2016, during 31 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017 32 to June 30, 2018, during the period July 1, 2018 to June 30, 2019, 33 during the period July 1, 2019 to June 30, 2020, during the period July 34 1, 2020 to June 30, 2021, during the period July 1, 2021 to June 30, 35 2022, during the period July 1, 2022 to June 30, 2023, [and] during the 36 period July 1, 2023 to June 30, 2024, and during the period July 1, 2024 37 to June 30, 2025 allocated or reallocated in accordance with paragraph 38 (a) of subdivision 4-a of this section to rates of payment applicable to 39 state governmental agencies, each physician or dentist for whom a policy 40 for excess insurance coverage or equivalent excess coverage is purchased 41 for such period shall be responsible for payment to the provider of 42 excess insurance coverage or equivalent excess coverage of an allocable 43 share of such insufficiency, based on the ratio of the total cost of 44 such coverage for such physician to the sum of the total cost of such 45 coverage for all physicians applied to such insufficiency. 46 (b) Each provider of excess insurance coverage or equivalent excess 47 coverage covering the period July 1, 1992 to June 30, 1993, or covering 48 the period July 1, 1993 to June 30, 1994, or covering the period July 1, 49 1994 to June 30, 1995, or covering the period July 1, 1995 to June 30, 50 1996, or covering the period July 1, 1996 to June 30, 1997, or covering 51 the period July 1, 1997 to June 30, 1998, or covering the period July 1, 52 1998 to June 30, 1999, or covering the period July 1, 1999 to June 30, 53 2000, or covering the period July 1, 2000 to June 30, 2001, or covering 54 the period July 1, 2001 to October 29, 2001, or covering the period 55 April 1, 2002 to June 30, 2002, or covering the period July 1, 2002 to 56 June 30, 2003, or covering the period July 1, 2003 to June 30, 2004, orS. 8307--A 55 A. 8807--A 1 covering the period July 1, 2004 to June 30, 2005, or covering the peri- 2 od July 1, 2005 to June 30, 2006, or covering the period July 1, 2006 to 3 June 30, 2007, or covering the period July 1, 2007 to June 30, 2008, or 4 covering the period July 1, 2008 to June 30, 2009, or covering the peri- 5 od July 1, 2009 to June 30, 2010, or covering the period July 1, 2010 to 6 June 30, 2011, or covering the period July 1, 2011 to June 30, 2012, or 7 covering the period July 1, 2012 to June 30, 2013, or covering the peri- 8 od July 1, 2013 to June 30, 2014, or covering the period July 1, 2014 to 9 June 30, 2015, or covering the period July 1, 2015 to June 30, 2016, or 10 covering the period July 1, 2016 to June 30, 2017, or covering the peri- 11 od July 1, 2017 to June 30, 2018, or covering the period July 1, 2018 to 12 June 30, 2019, or covering the period July 1, 2019 to June 30, 2020, or 13 covering the period July 1, 2020 to June 30, 2021, or covering the peri- 14 od July 1, 2021 to June 30, 2022, or covering the period July 1, 2022 to 15 June 30, 2023, or covering the period July 1, 2023 to June 30, 2024, or 16 covering the period July 1, 2024 to June 30, 2025 shall notify a covered 17 physician or dentist by mail, mailed to the address shown on the last 18 application for excess insurance coverage or equivalent excess coverage, 19 of the amount due to such provider from such physician or dentist for 20 such coverage period determined in accordance with paragraph (a) of this 21 subdivision. Such amount shall be due from such physician or dentist to 22 such provider of excess insurance coverage or equivalent excess coverage 23 in a time and manner determined by the superintendent of financial 24 services. 25 (c) If a physician or dentist liable for payment of a portion of the 26 costs of excess insurance coverage or equivalent excess coverage cover- 27 ing the period July 1, 1992 to June 30, 1993, or covering the period 28 July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to 29 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or 30 covering the period July 1, 1996 to June 30, 1997, or covering the peri- 31 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to 32 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or 33 covering the period July 1, 2000 to June 30, 2001, or covering the peri- 34 od July 1, 2001 to October 29, 2001, or covering the period April 1, 35 2002 to June 30, 2002, or covering the period July 1, 2002 to June 30, 36 2003, or covering the period July 1, 2003 to June 30, 2004, or covering 37 the period July 1, 2004 to June 30, 2005, or covering the period July 1, 38 2005 to June 30, 2006, or covering the period July 1, 2006 to June 30, 39 2007, or covering the period July 1, 2007 to June 30, 2008, or covering 40 the period July 1, 2008 to June 30, 2009, or covering the period July 1, 41 2009 to June 30, 2010, or covering the period July 1, 2010 to June 30, 42 2011, or covering the period July 1, 2011 to June 30, 2012, or covering 43 the period July 1, 2012 to June 30, 2013, or covering the period July 1, 44 2013 to June 30, 2014, or covering the period July 1, 2014 to June 30, 45 2015, or covering the period July 1, 2015 to June 30, 2016, or covering 46 the period July 1, 2016 to June 30, 2017, or covering the period July 1, 47 2017 to June 30, 2018, or covering the period July 1, 2018 to June 30, 48 2019, or covering the period July 1, 2019 to June 30, 2020, or covering 49 the period July 1, 2020 to June 30, 2021, or covering the period July 1, 50 2021 to June 30, 2022, or covering the period July 1, 2022 to June 30, 51 2023, or covering the period July 1, 2023 to June 30, 2024, or covering 52 the period July 1, 2024 to June 30, 2025 determined in accordance with 53 paragraph (a) of this subdivision fails, refuses or neglects to make 54 payment to the provider of excess insurance coverage or equivalent 55 excess coverage in such time and manner as determined by the superinten- 56 dent of financial services pursuant to paragraph (b) of this subdivi-S. 8307--A 56 A. 8807--A 1 sion, excess insurance coverage or equivalent excess coverage purchased 2 for such physician or dentist in accordance with this section for such 3 coverage period shall be cancelled and shall be null and void as of the 4 first day on or after the commencement of a policy period where the 5 liability for payment pursuant to this subdivision has not been met. 6 (d) Each provider of excess insurance coverage or equivalent excess 7 coverage shall notify the superintendent of financial services and the 8 commissioner of health or their designee of each physician and dentist 9 eligible for purchase of a policy for excess insurance coverage or 10 equivalent excess coverage covering the period July 1, 1992 to June 30, 11 1993, or covering the period July 1, 1993 to June 30, 1994, or covering 12 the period July 1, 1994 to June 30, 1995, or covering the period July 1, 13 1995 to June 30, 1996, or covering the period July 1, 1996 to June 30, 14 1997, or covering the period July 1, 1997 to June 30, 1998, or covering 15 the period July 1, 1998 to June 30, 1999, or covering the period July 1, 16 1999 to June 30, 2000, or covering the period July 1, 2000 to June 30, 17 2001, or covering the period July 1, 2001 to October 29, 2001, or cover- 18 ing the period April 1, 2002 to June 30, 2002, or covering the period 19 July 1, 2002 to June 30, 2003, or covering the period July 1, 2003 to 20 June 30, 2004, or covering the period July 1, 2004 to June 30, 2005, or 21 covering the period July 1, 2005 to June 30, 2006, or covering the peri- 22 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to 23 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009, or 24 covering the period July 1, 2009 to June 30, 2010, or covering the peri- 25 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to 26 June 30, 2012, or covering the period July 1, 2012 to June 30, 2013, or 27 covering the period July 1, 2013 to June 30, 2014, or covering the peri- 28 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to 29 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017, or 30 covering the period July 1, 2017 to June 30, 2018, or covering the peri- 31 od July 1, 2018 to June 30, 2019, or covering the period July 1, 2019 to 32 June 30, 2020, or covering the period July 1, 2020 to June 30, 2021, or 33 covering the period July 1, 2021 to June 30, 2022, or covering the peri- 34 od July 1, 2022 to June 30, 2023, or covering the period July 1, 2023 to 35 June 30, 2024, or covering the period July 1, 2024 to June 30, 2025 that 36 has made payment to such provider of excess insurance coverage or equiv- 37 alent excess coverage in accordance with paragraph (b) of this subdivi- 38 sion and of each physician and dentist who has failed, refused or 39 neglected to make such payment. 40 (e) A provider of excess insurance coverage or equivalent excess 41 coverage shall refund to the hospital excess liability pool any amount 42 allocable to the period July 1, 1992 to June 30, 1993, and to the period 43 July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June 44 30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the 45 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to 46 June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to 47 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000 48 to June 30, 2001, and to the period July 1, 2001 to October 29, 2001, 49 and to the period April 1, 2002 to June 30, 2002, and to the period July 50 1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30, 51 2004, and to the period July 1, 2004 to June 30, 2005, and to the period 52 July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June 53 30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the 54 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to 55 June 30, 2010, and to the period July 1, 2010 to June 30, 2011, and to 56 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012S. 8307--A 57 A. 8807--A 1 to June 30, 2013, and to the period July 1, 2013 to June 30, 2014, and 2 to the period July 1, 2014 to June 30, 2015, and to the period July 1, 3 2015 to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and 4 to the period July 1, 2017 to June 30, 2018, and to the period July 1, 5 2018 to June 30, 2019, and to the period July 1, 2019 to June 30, 2020, 6 and to the period July 1, 2020 to June 30, 2021, and to the period July 7 1, 2021 to June 30, 2022, and to the period July 1, 2022 to June 30, 8 2023, and to the period July 1, 2023 to June 30, 2024, and to the period 9 July 1, 2024 to June 30, 2025 received from the hospital excess liabil- 10 ity pool for purchase of excess insurance coverage or equivalent excess 11 coverage covering the period July 1, 1992 to June 30, 1993, and covering 12 the period July 1, 1993 to June 30, 1994, and covering the period July 13 1, 1994 to June 30, 1995, and covering the period July 1, 1995 to June 14 30, 1996, and covering the period July 1, 1996 to June 30, 1997, and 15 covering the period July 1, 1997 to June 30, 1998, and covering the 16 period July 1, 1998 to June 30, 1999, and covering the period July 1, 17 1999 to June 30, 2000, and covering the period July 1, 2000 to June 30, 18 2001, and covering the period July 1, 2001 to October 29, 2001, and 19 covering the period April 1, 2002 to June 30, 2002, and covering the 20 period July 1, 2002 to June 30, 2003, and covering the period July 1, 21 2003 to June 30, 2004, and covering the period July 1, 2004 to June 30, 22 2005, and covering the period July 1, 2005 to June 30, 2006, and cover- 23 ing the period July 1, 2006 to June 30, 2007, and covering the period 24 July 1, 2007 to June 30, 2008, and covering the period July 1, 2008 to 25 June 30, 2009, and covering the period July 1, 2009 to June 30, 2010, 26 and covering the period July 1, 2010 to June 30, 2011, and covering the 27 period July 1, 2011 to June 30, 2012, and covering the period July 1, 28 2012 to June 30, 2013, and covering the period July 1, 2013 to June 30, 29 2014, and covering the period July 1, 2014 to June 30, 2015, and cover- 30 ing the period July 1, 2015 to June 30, 2016, and covering the period 31 July 1, 2016 to June 30, 2017, and covering the period July 1, 2017 to 32 June 30, 2018, and covering the period July 1, 2018 to June 30, 2019, 33 and covering the period July 1, 2019 to June 30, 2020, and covering the 34 period July 1, 2020 to June 30, 2021, and covering the period July 1, 35 2021 to June 30, 2022, and covering the period July 1, 2022 to June 30, 36 2023 for, and covering the period July 1, 2023 to June 30, 2024, and 37 covering the period July 1, 2024 to June 30, 2025 a physician or dentist 38 where such excess insurance coverage or equivalent excess coverage is 39 cancelled in accordance with paragraph (c) of this subdivision. 40 § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil 41 practice law and rules and other laws relating to malpractice and 42 professional medical conduct, as amended by section 4 of part F of chap- 43 ter 57 of the laws of 2023, is amended to read as follows: 44 § 40. The superintendent of financial services shall establish rates 45 for policies providing coverage for physicians and surgeons medical 46 malpractice for the periods commencing July 1, 1985 and ending June 30, 47 [2024] 2025; provided, however, that notwithstanding any other provision 48 of law, the superintendent shall not establish or approve any increase 49 in rates for the period commencing July 1, 2009 and ending June 30, 50 2010. The superintendent shall direct insurers to establish segregated 51 accounts for premiums, payments, reserves and investment income attrib- 52 utable to such premium periods and shall require periodic reports by the 53 insurers regarding claims and expenses attributable to such periods to 54 monitor whether such accounts will be sufficient to meet incurred claims 55 and expenses. On or after July 1, 1989, the superintendent shall impose 56 a surcharge on premiums to satisfy a projected deficiency that isS. 8307--A 58 A. 8807--A 1 attributable to the premium levels established pursuant to this section 2 for such periods; provided, however, that such annual surcharge shall 3 not exceed eight percent of the established rate until July 1, [2024] 4 2025, at which time and thereafter such surcharge shall not exceed twen- 5 ty-five percent of the approved adequate rate, and that such annual 6 surcharges shall continue for such period of time as shall be sufficient 7 to satisfy such deficiency. The superintendent shall not impose such 8 surcharge during the period commencing July 1, 2009 and ending June 30, 9 2010. On and after July 1, 1989, the surcharge prescribed by this 10 section shall be retained by insurers to the extent that they insured 11 physicians and surgeons during the July 1, 1985 through June 30, [2024] 12 2025 policy periods; in the event and to the extent physicians and 13 surgeons were insured by another insurer during such periods, all or a 14 pro rata share of the surcharge, as the case may be, shall be remitted 15 to such other insurer in accordance with rules and regulations to be 16 promulgated by the superintendent. Surcharges collected from physicians 17 and surgeons who were not insured during such policy periods shall be 18 apportioned among all insurers in proportion to the premium written by 19 each insurer during such policy periods; if a physician or surgeon was 20 insured by an insurer subject to rates established by the superintendent 21 during such policy periods, and at any time thereafter a hospital, 22 health maintenance organization, employer or institution is responsible 23 for responding in damages for liability arising out of such physician's 24 or surgeon's practice of medicine, such responsible entity shall also 25 remit to such prior insurer the equivalent amount that would then be 26 collected as a surcharge if the physician or surgeon had continued to 27 remain insured by such prior insurer. In the event any insurer that 28 provided coverage during such policy periods is in liquidation, the 29 property/casualty insurance security fund shall receive the portion of 30 surcharges to which the insurer in liquidation would have been entitled. 31 The surcharges authorized herein shall be deemed to be income earned for 32 the purposes of section 2303 of the insurance law. The superintendent, 33 in establishing adequate rates and in determining any projected defi- 34 ciency pursuant to the requirements of this section and the insurance 35 law, shall give substantial weight, determined in his discretion and 36 judgment, to the prospective anticipated effect of any regulations 37 promulgated and laws enacted and the public benefit of stabilizing 38 malpractice rates and minimizing rate level fluctuation during the peri- 39 od of time necessary for the development of more reliable statistical 40 experience as to the efficacy of such laws and regulations affecting 41 medical, dental or podiatric malpractice enacted or promulgated in 1985, 42 1986, by this act and at any other time. Notwithstanding any provision 43 of the insurance law, rates already established and to be established by 44 the superintendent pursuant to this section are deemed adequate if such 45 rates would be adequate when taken together with the maximum authorized 46 annual surcharges to be imposed for a reasonable period of time whether 47 or not any such annual surcharge has been actually imposed as of the 48 establishment of such rates. 49 § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J of 50 chapter 63 of the laws of 2001, amending chapter 266 of the laws of 51 1986, amending the civil practice law and rules and other laws relating 52 to malpractice and professional medical conduct, as amended by section 5 53 of part F of chapter 57 of the laws of 2023, are amended to read as 54 follows: 55 § 5. The superintendent of financial services and the commissioner of 56 health shall determine, no later than June 15, 2002, June 15, 2003, JuneS. 8307--A 59 A. 8807--A 1 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008, 2 June 15, 2009, June 15, 2010, June 15, 2011, June 15, 2012, June 15, 3 2013, June 15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June 4 15, 2018, June 15, 2019, June 15, 2020, June 15, 2021, June 15, 2022, 5 June 15, 2023, [and] June 15, 2024, and June 15, 2025 the amount of 6 funds available in the hospital excess liability pool, created pursuant 7 to section 18 of chapter 266 of the laws of 1986, and whether such funds 8 are sufficient for purposes of purchasing excess insurance coverage for 9 eligible participating physicians and dentists during the period July 1, 10 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 11 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to 12 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 13 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30, 14 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 30, 15 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30, 16 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30, 17 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30, 18 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30, 19 2020, or July 1, 2020 to June 30, 2021, or July 1, 2021 to June 30, 20 2022, or July 1, 2022 to June 30, 2023, or July 1, 2023 to June 30, 21 2024, or July 1, 2024 to June 30, 2025 as applicable. 22 (a) This section shall be effective only upon a determination, pursu- 23 ant to section five of this act, by the superintendent of financial 24 services and the commissioner of health, and a certification of such 25 determination to the state director of the budget, the chair of the 26 senate committee on finance and the chair of the assembly committee on 27 ways and means, that the amount of funds in the hospital excess liabil- 28 ity pool, created pursuant to section 18 of chapter 266 of the laws of 29 1986, is insufficient for purposes of purchasing excess insurance cover- 30 age for eligible participating physicians and dentists during the period 31 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 32 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 33 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 34 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to 35 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 36 30, 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30, 37 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30, 38 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30, 39 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30, 40 2020, or July 1, 2020 to June 30, 2021, or July 1, 2021 to June 30, 41 2022, or July 1, 2022 to June 30, 2023, or July 1, 2023 to June 30, 2024 42 , or July 1, 2024 to June 30, 2025 as applicable. 43 (e) The commissioner of health shall transfer for deposit to the 44 hospital excess liability pool created pursuant to section 18 of chapter 45 266 of the laws of 1986 such amounts as directed by the superintendent 46 of financial services for the purchase of excess liability insurance 47 coverage for eligible participating physicians and dentists for the 48 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 49 2003, or July 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 50 2005, or July 1, 2005 to June 30, 2006, or July 1, 2006 to June 30, 51 2007, as applicable, and the cost of administering the hospital excess 52 liability pool for such applicable policy year, pursuant to the program 53 established in chapter 266 of the laws of 1986, as amended, no later 54 than June 15, 2002, June 15, 2003, June 15, 2004, June 15, 2005, June 55 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009, June 15, 2010, 56 June 15, 2011, June 15, 2012, June 15, 2013, June 15, 2014, June 15,S. 8307--A 60 A. 8807--A 1 2015, June 15, 2016, June 15, 2017, June 15, 2018, June 15, 2019, June 2 15, 2020, June 15, 2021, June 15, 2022, June 15, 2023, [and] June 15, 3 2024, and June 15, 2025 as applicable. 4 § 6. Section 20 of part H of chapter 57 of the laws of 2017, amending 5 the New York Health Care Reform Act of 1996 and other laws relating to 6 extending certain provisions thereto, as amended by section 6 of part F 7 of chapter 57 of the laws of 2023, is amended to read as follows: 8 § 20. Notwithstanding any law, rule or regulation to the contrary, 9 only physicians or dentists who were eligible, and for whom the super- 10 intendent of financial services and the commissioner of health, or their 11 designee, purchased, with funds available in the hospital excess liabil- 12 ity pool, a full or partial policy for excess coverage or equivalent 13 excess coverage for the coverage period ending the thirtieth of June, 14 two thousand [twenty-three] twenty-four, shall be eligible to apply for 15 such coverage for the coverage period beginning the first of July, two 16 thousand [twenty-three] twenty-four; provided, however, if the total 17 number of physicians or dentists for whom such excess coverage or equiv- 18 alent excess coverage was purchased for the policy year ending the thir- 19 tieth of June, two thousand [twenty-three] twenty-four exceeds the total 20 number of physicians or dentists certified as eligible for the coverage 21 period beginning the first of July, two thousand [twenty-three] twenty- 22 four, then the general hospitals may certify additional eligible physi- 23 cians or dentists in a number equal to such general hospital's propor- 24 tional share of the total number of physicians or dentists for whom 25 excess coverage or equivalent excess coverage was purchased with funds 26 available in the hospital excess liability pool as of the thirtieth of 27 June, two thousand [twenty-three] twenty-four, as applied to the differ- 28 ence between the number of eligible physicians or dentists for whom a 29 policy for excess coverage or equivalent excess coverage was purchased 30 for the coverage period ending the thirtieth of June, two thousand 31 [twenty-three] twenty-four and the number of such eligible physicians or 32 dentists who have applied for excess coverage or equivalent excess 33 coverage for the coverage period beginning the first of July, two thou- 34 sand [twenty-three] twenty-four. 35 § 7. This act shall take effect immediately and shall be deemed to 36 have been in full force and effect on and after April 1, 2024. 37 PART L 38 Section 1. Subdivision 9 of section 2803 of the public health law is 39 REPEALED. 40 § 2. Section 461-s of the social services law is REPEALED. 41 § 3. Subdivision 1, paragraph (f) of subdivision 3, paragraphs (a) and 42 (d) of subdivision 5 and subdivisions 5-a and 12 of section 2807-m of 43 the public health law, subdivision 1, paragraph (f) of subdivision 3, 44 paragraph (a) of subdivision 5 and subdivision 12 as amended and para- 45 graph (d) of subdivision 5 as added by section 6 of part Y of chapter 56 46 of the laws of 2020 and subdivision 5-a as amended by section 6 of part 47 C of chapter 57 of the laws of 2023, are amended to read as follows: 48 1. Definitions. For purposes of this section, the following defi- 49 nitions shall apply, unless the context clearly requires otherwise: 50 (a) ["Clinical research" means patient-oriented research, epidemiolog-51ic and behavioral studies, or outcomes research and health services52research that is approved by an institutional review board by the time53the clinical research position is filled.S. 8307--A 61 A. 8807--A 1(b) "Clinical research plan" means a plan submitted by a consortium or2teaching general hospital for a clinical research position which demon-3strates, in a form to be provided by the commissioner, the following:4(i) financial support for overhead, supervision, equipment and other5resources equal to the amount of funding provided pursuant to subpara-6graph (i) of paragraph (b) of subdivision five-a of this section by the7teaching general hospital or consortium for the clinical research posi-8tion;9(ii) experience the sponsor-mentor and teaching general hospital has10in clinical research and the medical field of the study;11(iii) methods, data collection and anticipated measurable outcomes of12the clinical research to be performed;13(iv) training goals, objectives and experience the researcher will be14provided to assess a future career in clinical research;15(v) scientific relevance, merit and health implications of the16research to be performed;17(vi) information on potential scientific meetings and peer review18journals where research results can be disseminated;19(vii) clear and comprehensive details on the clinical research posi-20tion;21(viii) qualifications necessary for the clinical research position and22strategy for recruitment;23(ix) non-duplication with other clinical research positions from the24same teaching general hospital or consortium;25(x) methods to track the career of the clinical researcher once the26term of the position is complete; and27(xi) any other information required by the commissioner to implement28subparagraph (i) of paragraph (b) of subdivision five-a of this section.29(xii) The clinical review plan submitted in accordance with this para-30graph may be reviewed by the commissioner in consultation with experts31outside the department of health.32(c) "Clinical research position" means a post-graduate residency posi-33tion which:34(i) shall not be required in order for the researcher to complete a35graduate medical education program;36(ii) may be reimbursed by other sources but only for costs in excess37of the funding distributed in accordance with subparagraph (i) of para-38graph (b) of subdivision five-a of this section;39(iii) shall exceed the minimum standards that are required by the40residency review committee in the specialty the researcher has trained41or is currently training;42(iv) shall not be previously funded by the teaching general hospital43or supported by another funding source at the teaching general hospital44in the past three years from the date the clinical research plan is45submitted to the commissioner;46(v) may supplement an existing research project;47(vi) shall be equivalent to a full-time position comprising of no less48than thirty-five hours per week for one or two years;49(vii) shall provide, or be filled by a researcher who has formalized50instruction in clinical research, including biostatistics, clinical51trial design, grant writing and research ethics;52(viii) shall be supervised by a sponsor-mentor who shall either (A) be53employed, contracted for employment or paid through an affiliated facul-54ty practice plan by a teaching general hospital which has received at55least one research grant from the National Institutes of Health in the56past five years from the date the clinical research plan is submitted toS. 8307--A 62 A. 8807--A 1the commissioner; (B) maintain a faculty appointment at a medical,2dental or podiatric school located in New York state that has received3at least one research grant from the National Institutes of Health in4the past five years from the date the clinical research plan is submit-5ted to the commissioner; or (C) be collaborating in the clinical6research plan with a researcher from another institution that has7received at least one research grant from the National Institutes of8Health in the past five years from the date the clinical research plan9is submitted to the commissioner; and10(ix) shall be filled by a researcher who is (A) enrolled or has11completed a graduate medical education program, as defined in paragraph12(i) of this subdivision; (B) a United States citizen, national, or13permanent resident of the United States; and (C) a graduate of a14medical, dental or podiatric school located in New York state, a gradu-15ate or resident in a graduate medical education program, as defined in16paragraph (i) of this subdivision, where the sponsoring institution, as17defined in paragraph (q) of this subdivision, is located in New York18state, or resides in New York state at the time the clinical research19plan is submitted to the commissioner.20(d)] "Consortium" means an organization or association, approved by 21 the commissioner in consultation with the council, of general hospitals 22 which provide graduate medical education, together with any affiliated 23 site; provided that such organization or association may also include 24 other providers of health care services, medical schools, payors or 25 consumers, and which meet other criteria pursuant to subdivision six of 26 this section. 27 [(e)] (b) "Council" means the New York state council on graduate 28 medical education. 29 [(f)] (c) "Direct medical education" means the direct costs of resi- 30 dents, interns and supervising physicians. 31 [(g)] (d) "Distribution period" means each calendar year set forth in 32 subdivision two of this section. 33 [(h)] (e) "Faculty" means persons who are employed by or under 34 contract for employment with a teaching general hospital or are paid 35 through a teaching general hospital's affiliated faculty practice plan 36 and maintain a faculty appointment at a medical school. Such persons 37 shall not be limited to persons with a degree in medicine. 38 [(i)] (f) "Graduate medical education program" means a post-graduate 39 medical education residency in the United States which has received 40 accreditation from a nationally recognized accreditation body or has 41 been approved by a nationally recognized organization for medical, 42 osteopathic, podiatric or dental residency programs including, but not 43 limited to, specialty boards. 44 [(j)] (g) "Indirect medical education" means the estimate of costs, 45 other than direct costs, of educational activities in teaching hospitals 46 as determined in accordance with the methodology applicable for purposes 47 of determining an estimate of indirect medical education costs for 48 reimbursement for inpatient hospital service pursuant to title XVIII of 49 the federal social security act (medicare). 50 [(k)] (h) "Medicare" means the methodology used for purposes of reim- 51 bursing inpatient hospital services provided to beneficiaries of title 52 XVIII of the federal social security act. 53 [(l)] (i) "Primary care" residents specialties shall include family 54 medicine, general pediatrics, primary care internal medicine, and prima- 55 ry care obstetrics and gynecology. In determining whether a residency is 56 in primary care, the commissioner shall consult with the council.S. 8307--A 63 A. 8807--A 1 [(m)] (j) "Regions", for purposes of this section, shall mean the 2 regions as defined in paragraph (b) of subdivision sixteen of section 3 twenty-eight hundred seven-c of this article as in effect on June thir- 4 tieth, nineteen hundred ninety-six. For purposes of distributions pursu- 5 ant to subdivision five-a of this section, except distributions made in 6 accordance with paragraph (a) of subdivision five-a of this section, 7 "regions" shall be defined as New York city and the rest of the state. 8 [(n)] (k) "Regional pool" means a professional education pool estab- 9 lished on a regional basis by the commissioner from funds available 10 pursuant to sections twenty-eight hundred seven-s and twenty-eight 11 hundred seven-t of this article. 12 [(o)] (l) "Resident" means a person in a graduate medical education 13 program which has received accreditation from a nationally recognized 14 accreditation body or in a program approved by any other nationally 15 recognized organization for medical, osteopathic or dental residency 16 programs including, but not limited to, specialty boards. 17 [(p) "Shortage specialty" means a specialty determined by the commis-18sioner, in consultation with the council, to be in short supply in the19state of New York.20(q)] (m) "Sponsoring institution" means the entity that has the over- 21 all responsibility for a program of graduate medical education. Such 22 institutions shall include teaching general hospitals, medical schools, 23 consortia and diagnostic and treatment centers. 24 [(r)] (n) "Weighted resident count" means a teaching general hospi- 25 tal's total number of residents as of July first, nineteen hundred nine- 26 ty-five, including residents in affiliated non-hospital ambulatory 27 settings, reported to the commissioner. Such resident counts shall 28 reflect the weights established in accordance with rules and regulations 29 adopted by the state hospital review and planning council and approved 30 by the commissioner for purposes of implementing subdivision twenty-five 31 of section twenty-eight hundred seven-c of this article and in effect on 32 July first, nineteen hundred ninety-five. Such weights shall not be 33 applied to specialty hospitals, specified by the commissioner, whose 34 primary care mission is to engage in research, training and clinical 35 care in specialty eye and ear, special surgery, orthopedic, joint 36 disease, cancer, chronic care or rehabilitative services. 37 [(s)] (o) "Adjustment amount" means an amount determined for each 38 teaching hospital for periods prior to January first, two thousand nine 39 by: 40 (i) determining the difference between (A) a calculation of what each 41 teaching general hospital would have been paid if payments made pursuant 42 to paragraph (a-3) of subdivision one of section twenty-eight hundred 43 seven-c of this article between January first, nineteen hundred ninety- 44 six and December thirty-first, two thousand three were based solely on 45 the case mix of persons eligible for medical assistance under the 46 medical assistance program pursuant to title eleven of article five of 47 the social services law who are enrolled in health maintenance organiza- 48 tions and persons paid for under the family health plus program enrolled 49 in approved organizations pursuant to title eleven-D of article five of 50 the social services law during those years, and (B) the actual payments 51 to each such hospital pursuant to paragraph (a-3) of subdivision one of 52 section twenty-eight hundred seven-c of this article between January 53 first, nineteen hundred ninety-six and December thirty-first, two thou- 54 sand three.S. 8307--A 64 A. 8807--A 1 (ii) reducing proportionally each of the amounts determined in subpar- 2 agraph (i) of this paragraph so that the sum of all such amounts totals 3 no more than one hundred million dollars; 4 (iii) further reducing each of the amounts determined in subparagraph 5 (ii) of this paragraph by the amount received by each hospital as a 6 distribution from funds designated in paragraph (a) of subdivision five 7 of this section attributable to the period January first, two thousand 8 three through December thirty-first, two thousand three, except that if 9 such amount was provided to a consortium then the amount of the 10 reduction for each hospital in the consortium shall be determined by 11 applying the proportion of each hospital's amount determined under 12 subparagraph (i) of this paragraph to the total of such amounts of all 13 hospitals in such consortium to the consortium award; 14 (iv) further reducing each of the amounts determined in subparagraph 15 (iii) of this paragraph by the amounts specified in paragraph [(t)] (p) 16 of this subdivision; and 17 (v) dividing each of the amounts determined in subparagraph (iii) of 18 this paragraph by seven. 19 [(t)] (p) "Extra reduction amount" shall mean an amount determined for 20 a teaching hospital for which an adjustment amount is calculated pursu- 21 ant to paragraph [(s)] (o) of this subdivision that is the hospital's 22 proportionate share of the sum of the amounts specified in paragraph 23 [(u)] (q) of this subdivision determined based upon a comparison of the 24 hospital's remaining liability calculated pursuant to paragraph [(s)] 25 (o) of this subdivision to the sum of all such hospital's remaining 26 liabilities. 27 [(u)] (q) "Allotment amount" shall mean an amount determined for 28 teaching hospitals as follows: 29 (i) for a hospital for which an adjustment amount pursuant to para- 30 graph [(s)] (o) of this subdivision does not apply, the amount received 31 by the hospital pursuant to paragraph (a) of subdivision five of this 32 section attributable to the period January first, two thousand three 33 through December thirty-first, two thousand three, or 34 (ii) for a hospital for which an adjustment amount pursuant to para- 35 graph [(s)] (o) of this subdivision applies and which received a 36 distribution pursuant to paragraph (a) of subdivision five of this 37 section attributable to the period January first, two thousand three 38 through December thirty-first, two thousand three that is greater than 39 the hospital's adjustment amount, the difference between the distrib- 40 ution amount and the adjustment amount. 41 (f) Effective January first, two thousand five through December thir- 42 ty-first, two thousand eight, each teaching general hospital shall 43 receive a distribution from the applicable regional pool based on its 44 distribution amount determined under paragraphs (c), (d) and (e) of this 45 subdivision and reduced by its adjustment amount calculated pursuant to 46 paragraph [(s)] (o) of subdivision one of this section and, for distrib- 47 utions for the period January first, two thousand five through December 48 thirty-first, two thousand five, further reduced by its extra reduction 49 amount calculated pursuant to paragraph [(t)] (p) of subdivision one of 50 this section. 51 (a) Up to thirty-one million dollars annually for the periods January 52 first, two thousand through December thirty-first, two thousand three, 53 and up to twenty-five million dollars plus the sum of the amounts speci- 54 fied in paragraph [(n)] (k) of subdivision one of this section for the 55 period January first, two thousand five through December thirty-first, 56 two thousand five, and up to thirty-one million dollars annually for theS. 8307--A 65 A. 8807--A 1 period January first, two thousand six through December thirty-first, 2 two thousand seven, shall be set aside and reserved by the commissioner 3 from the regional pools established pursuant to subdivision two of this 4 section for supplemental distributions in each such region to be made by 5 the commissioner to consortia and teaching general hospitals in accord- 6 ance with a distribution methodology developed in consultation with the 7 council and specified in rules and regulations adopted by the commis- 8 sioner. 9 (d) Notwithstanding any other provision of law or regulation, for the 10 period January first, two thousand five through December thirty-first, 11 two thousand five, the commissioner shall distribute as supplemental 12 payments the allotment specified in paragraph [(n)] (k) of subdivision 13 one of this section. 14 5-a. Graduate medical education innovations pool. (a) Supplemental 15 distributions. (i) Thirty-one million dollars for the period January 16 first, two thousand eight through December thirty-first, two thousand 17 eight, shall be set aside and reserved by the commissioner from the 18 regional pools established pursuant to subdivision two of this section 19 and shall be available for distributions pursuant to subdivision five of 20 this section and in accordance with section 86-1.89 of title 10 of the 21 codes, rules and regulations of the state of New York as in effect on 22 January first, two thousand eight[; provided, however, for purposes of23funding the empire clinical research investigation program (ECRIP) in24accordance with paragraph eight of subdivision (e) and paragraph two of25subdivision (f) of section 86-1.89 of title 10 of the codes, rules and26regulations of the state of New York, distributions shall be made using27two regions defined as New York city and the rest of the state and the28dollar amount set forth in subparagraph (i) of paragraph two of subdivi-29sion (f) of section 86-1.89 of title 10 of the codes, rules and regu-30lations of the state of New York shall be increased from sixty thousand31dollars to seventy-five thousand dollars]. 32 (ii) For periods on and after January first, two thousand nine, 33 supplemental distributions pursuant to subdivision five of this section 34 and in accordance with section 86-1.89 of title 10 of the codes, rules 35 and regulations of the state of New York shall no longer be made and the 36 provisions of section 86-1.89 of title 10 of the codes, rules and regu- 37 lations of the state of New York shall be null and void. 38 (b) [Empire clinical research investigator program (ECRIP). Nine39million one hundred twenty thousand dollars annually for the period40January first, two thousand nine through December thirty-first, two41thousand ten, and two million two hundred eighty thousand dollars for42the period January first, two thousand eleven, through March thirty-43first, two thousand eleven, nine million one hundred twenty thousand44dollars each state fiscal year for the period April first, two thousand45eleven through March thirty-first, two thousand fourteen, up to eight46million six hundred twelve thousand dollars each state fiscal year for47the period April first, two thousand fourteen through March thirty-48first, two thousand seventeen, up to eight million six hundred twelve49thousand dollars each state fiscal year for the period April first, two50thousand seventeen through March thirty-first, two thousand twenty, up51to eight million six hundred twelve thousand dollars each state fiscal52year for the period April first, two thousand twenty through March thir-53ty-first, two thousand twenty-three, and up to eight million six hundred54twelve thousand dollars each state fiscal year for the period April55first, two thousand twenty-three through March thirty-first, two thou-56sand twenty-six, shall be set aside and reserved by the commissionerS. 8307--A 66 A. 8807--A 1from the regional pools established pursuant to subdivision two of this2section to be allocated regionally with two-thirds of the available3funding going to New York city and one-third of the available funding4going to the rest of the state and shall be available for distribution5as follows:6Distributions shall first be made to consortia and teaching general7hospitals for the empire clinical research investigator program (ECRIP)8to help secure federal funding for biomedical research, train clinical9researchers, recruit national leaders as faculty to act as mentors, and10train residents and fellows in biomedical research skills based on11hospital-specific data submitted to the commissioner by consortia and12teaching general hospitals in accordance with clause (G) of this subpar-13agraph. Such distributions shall be made in accordance with the follow-14ing methodology:15(A) The greatest number of clinical research positions for which a16consortium or teaching general hospital may be funded pursuant to this17subparagraph shall be one percent of the total number of residents18training at the consortium or teaching general hospital on July first,19two thousand eight for the period January first, two thousand nine20through December thirty-first, two thousand nine rounded up to the near-21est one position.22(B) Distributions made to a consortium or teaching general hospital23shall equal the product of the total number of clinical research posi-24tions submitted by a consortium or teaching general hospital and25accepted by the commissioner as meeting the criteria set forth in para-26graph (b) of subdivision one of this section, subject to the reduction27calculation set forth in clause (C) of this subparagraph, times one28hundred ten thousand dollars.29(C) If the dollar amount for the total number of clinical research30positions in the region calculated pursuant to clause (B) of this31subparagraph exceeds the total amount appropriated for purposes of this32paragraph, including clinical research positions that continue from and33were funded in prior distribution periods, the commissioner shall elimi-34nate one-half of the clinical research positions submitted by each35consortium or teaching general hospital rounded down to the nearest one36position. Such reduction shall be repeated until the dollar amount for37the total number of clinical research positions in the region does not38exceed the total amount appropriated for purposes of this paragraph. If39the repeated reduction of the total number of clinical research posi-40tions in the region by one-half does not render a total funding amount41that is equal to or less than the total amount reserved for that region42within the appropriation, the funding for each clinical research posi-43tion in that region shall be reduced proportionally in one thousand44dollar increments until the total dollar amount for the total number of45clinical research positions in that region does not exceed the total46amount reserved for that region within the appropriation. Any reduction47in funding will be effective for the duration of the award. No clinical48research positions that continue from and were funded in prior distrib-49ution periods shall be eliminated or reduced by such methodology.50(D) Each consortium or teaching general hospital shall receive its51annual distribution amount in accordance with the following:52(I) Each consortium or teaching general hospital with a one-year ECRIP53award shall receive its annual distribution amount in full upon54completion of the requirements set forth in items (I) and (II) of clause55(G) of this subparagraph. The requirements set forth in items (IV) and56(V) of clause (G) of this subparagraph must be completed by the consor-S. 8307--A 67 A. 8807--A 1tium or teaching general hospital in order for the consortium or teach-2ing general hospital to be eligible to apply for ECRIP funding in any3subsequent funding cycle.4(II) Each consortium or teaching general hospital with a two-year5ECRIP award shall receive its first annual distribution amount in full6upon completion of the requirements set forth in items (I) and (II) of7clause (G) of this subparagraph. Each consortium or teaching general8hospital will receive its second annual distribution amount in full upon9completion of the requirements set forth in item (III) of clause (G) of10this subparagraph. The requirements set forth in items (IV) and (V) of11clause (G) of this subparagraph must be completed by the consortium or12teaching general hospital in order for the consortium or teaching gener-13al hospital to be eligible to apply for ECRIP funding in any subsequent14funding cycle.15(E) Each consortium or teaching general hospital receiving distrib-16utions pursuant to this subparagraph shall reserve seventy-five thousand17dollars to primarily fund salary and fringe benefits of the clinical18research position with the remainder going to fund the development of19faculty who are involved in biomedical research, training and clinical20care.21(F) Undistributed or returned funds available to fund clinical22research positions pursuant to this paragraph for a distribution period23shall be available to fund clinical research positions in a subsequent24distribution period.25(G) In order to be eligible for distributions pursuant to this subpar-26agraph, each consortium and teaching general hospital shall provide to27the commissioner by July first of each distribution period, the follow-28ing data and information on a hospital-specific basis. Such data and29information shall be certified as to accuracy and completeness by the30chief executive officer, chief financial officer or chair of the consor-31tium governing body of each consortium or teaching general hospital and32shall be maintained by each consortium and teaching general hospital for33five years from the date of submission:34(I) For each clinical research position, information on the type,35scope, training objectives, institutional support, clinical research36experience of the sponsor-mentor, plans for submitting research outcomes37to peer reviewed journals and at scientific meetings, including a meet-38ing sponsored by the department, the name of a principal contact person39responsible for tracking the career development of researchers placed in40clinical research positions, as defined in paragraph (c) of subdivision41one of this section, and who is authorized to certify to the commission-42er that all the requirements of the clinical research training objec-43tives set forth in this subparagraph shall be met. Such certification44shall be provided by July first of each distribution period;45(II) For each clinical research position, information on the name,46citizenship status, medical education and training, and medical license47number of the researcher, if applicable, shall be provided by December48thirty-first of the calendar year following the distribution period;49(III) Information on the status of the clinical research plan, accom-50plishments, changes in research activities, progress, and performance of51the researcher shall be provided upon completion of one-half of the52award term;53(IV) A final report detailing training experiences, accomplishments,54activities and performance of the clinical researcher, and data, meth-55ods, results and analyses of the clinical research plan shall be56provided three months after the clinical research position ends; andS. 8307--A 68 A. 8807--A 1(V) Tracking information concerning past researchers, including but2not limited to (A) background information, (B) employment history, (C)3research status, (D) current research activities, (E) publications and4presentations, (F) research support, and (G) any other information5necessary to track the researcher; and6(VI) Any other data or information required by the commissioner to7implement this subparagraph.8(H) Notwithstanding any inconsistent provision of this subdivision,9for periods on and after April first, two thousand thirteen, ECRIP grant10awards shall be made in accordance with rules and regulations promulgat-11ed by the commissioner. Such regulations shall, at a minimum:12(1) provide that ECRIP grant awards shall be made with the objective13of securing federal funding for biomedical research, training clinical14researchers, recruiting national leaders as faculty to act as mentors,15and training residents and fellows in biomedical research skills;16(2) provide that ECRIP grant applicants may include interdisciplinary17research teams comprised of teaching general hospitals acting in collab-18oration with entities including but not limited to medical centers,19hospitals, universities and local health departments;20(3) provide that applications for ECRIP grant awards shall be based on21such information requested by the commissioner, which shall include but22not be limited to hospital-specific data;23(4) establish the qualifications for investigators and other staff24required for grant projects eligible for ECRIP grant awards; and25(5) establish a methodology for the distribution of funds under ECRIP26grant awards.27(c)] Physician loan repayment program. One million nine hundred sixty 28 thousand dollars for the period January first, two thousand eight 29 through December thirty-first, two thousand eight, one million nine 30 hundred sixty thousand dollars for the period January first, two thou- 31 sand nine through December thirty-first, two thousand nine, one million 32 nine hundred sixty thousand dollars for the period January first, two 33 thousand ten through December thirty-first, two thousand ten, four 34 hundred ninety thousand dollars for the period January first, two thou- 35 sand eleven through March thirty-first, two thousand eleven, one million 36 seven hundred thousand dollars each state fiscal year for the period 37 April first, two thousand eleven through March thirty-first, two thou- 38 sand fourteen, up to one million seven hundred five thousand dollars 39 each state fiscal year for the period April first, two thousand fourteen 40 through March thirty-first, two thousand seventeen, up to one million 41 seven hundred five thousand dollars each state fiscal year for the peri- 42 od April first, two thousand seventeen through March thirty-first, two 43 thousand twenty, up to one million seven hundred five thousand dollars 44 each state fiscal year for the period April first, two thousand twenty 45 through March thirty-first, two thousand twenty-three, and up to one 46 million seven hundred five thousand dollars each state fiscal year for 47 the period April first, two thousand twenty-three through March thirty- 48 first, two thousand twenty-six, shall be set aside and reserved by the 49 commissioner from the regional pools established pursuant to subdivision 50 two of this section and shall be available for purposes of physician 51 loan repayment in accordance with subdivision ten of this section. 52 Notwithstanding any contrary provision of this section, sections one 53 hundred twelve and one hundred sixty-three of the state finance law, or 54 any other contrary provision of law, such funding shall be allocated 55 regionally with one-third of available funds going to New York city and 56 two-thirds of available funds going to the rest of the state and shallS. 8307--A 69 A. 8807--A 1 be distributed in a manner to be determined by the commissioner without 2 a competitive bid or request for proposal process as follows: 3 (i) Funding shall first be awarded to repay loans of up to twenty-five 4 physicians who train in primary care or specialty tracks in teaching 5 general hospitals, and who enter and remain in primary care or specialty 6 practices in underserved communities, as determined by the commissioner. 7 (ii) After distributions in accordance with subparagraph (i) of this 8 paragraph, all remaining funds shall be awarded to repay loans of physi- 9 cians who enter and remain in primary care or specialty practices in 10 underserved communities, as determined by the commissioner, including 11 but not limited to physicians working in general hospitals, or other 12 health care facilities. 13 (iii) In no case shall less than fifty percent of the funds available 14 pursuant to this paragraph be distributed in accordance with subpara- 15 graphs (i) and (ii) of this paragraph to physicians identified by gener- 16 al hospitals. 17 (iv) In addition to the funds allocated under this paragraph, for the 18 period April first, two thousand fifteen through March thirty-first, two 19 thousand sixteen, two million dollars shall be available for the 20 purposes described in subdivision ten of this section; 21 (v) In addition to the funds allocated under this paragraph, for the 22 period April first, two thousand sixteen through March thirty-first, two 23 thousand seventeen, two million dollars shall be available for the 24 purposes described in subdivision ten of this section; 25 (vi) Notwithstanding any provision of law to the contrary, and subject 26 to the extension of the Health Care Reform Act of 1996, sufficient funds 27 shall be available for the purposes described in subdivision ten of this 28 section in amounts necessary to fund the remaining year commitments for 29 awards made pursuant to subparagraphs (iv) and (v) of this paragraph. 30 [(d)] (c) Physician practice support. Four million nine hundred thou- 31 sand dollars for the period January first, two thousand eight through 32 December thirty-first, two thousand eight, four million nine hundred 33 thousand dollars annually for the period January first, two thousand 34 nine through December thirty-first, two thousand ten, one million two 35 hundred twenty-five thousand dollars for the period January first, two 36 thousand eleven through March thirty-first, two thousand eleven, four 37 million three hundred thousand dollars each state fiscal year for the 38 period April first, two thousand eleven through March thirty-first, two 39 thousand fourteen, up to four million three hundred sixty thousand 40 dollars each state fiscal year for the period April first, two thousand 41 fourteen through March thirty-first, two thousand seventeen, up to four 42 million three hundred sixty thousand dollars for each state fiscal year 43 for the period April first, two thousand seventeen through March thir- 44 ty-first, two thousand twenty, up to four million three hundred sixty 45 thousand dollars for each fiscal year for the period April first, two 46 thousand twenty through March thirty-first, two thousand twenty-three, 47 and up to four million three hundred sixty thousand dollars for each 48 fiscal year for the period April first, two thousand twenty-three 49 through March thirty-first, two thousand twenty-six, shall be set aside 50 and reserved by the commissioner from the regional pools established 51 pursuant to subdivision two of this section and shall be available for 52 purposes of physician practice support. Notwithstanding any contrary 53 provision of this section, sections one hundred twelve and one hundred 54 sixty-three of the state finance law, or any other contrary provision of 55 law, such funding shall be allocated regionally with one-third of avail- 56 able funds going to New York city and two-thirds of available fundsS. 8307--A 70 A. 8807--A 1 going to the rest of the state and shall be distributed in a manner to 2 be determined by the commissioner without a competitive bid or request 3 for proposal process as follows: 4 (i) Preference in funding shall first be accorded to teaching general 5 hospitals for up to twenty-five awards, to support costs incurred by 6 physicians trained in primary or specialty tracks who thereafter estab- 7 lish or join practices in underserved communities, as determined by the 8 commissioner. 9 (ii) After distributions in accordance with subparagraph (i) of this 10 paragraph, all remaining funds shall be awarded to physicians to support 11 the cost of establishing or joining practices in underserved communi- 12 ties, as determined by the commissioner, and to hospitals and other 13 health care providers to recruit new physicians to provide services in 14 underserved communities, as determined by the commissioner. 15 (iii) In no case shall less than fifty percent of the funds available 16 pursuant to this paragraph be distributed to general hospitals in 17 accordance with subparagraphs (i) and (ii) of this paragraph. 18 [(e)] (d) Work group. For funding available pursuant to paragraphs (b) 19 and (c)[, (d) and (e)] of this subdivision: 20 (i) The department shall appoint a work group from recommendations 21 made by associations representing physicians, general hospitals and 22 other health care facilities to develop a streamlined application proc- 23 ess by June first, two thousand twelve. 24 (ii) Subject to available funding, applications shall be accepted on a 25 continuous basis. The department shall provide technical assistance to 26 applicants to facilitate their completion of applications. An applicant 27 shall be notified in writing by the department within ten days of 28 receipt of an application as to whether the application is complete and 29 if the application is incomplete, what information is outstanding. The 30 department shall act on an application within thirty days of receipt of 31 a complete application. 32 [(f)] (e) Study on physician workforce. Five hundred ninety thousand 33 dollars annually for the period January first, two thousand eight 34 through December thirty-first, two thousand ten, one hundred forty-eight 35 thousand dollars for the period January first, two thousand eleven 36 through March thirty-first, two thousand eleven, five hundred sixteen 37 thousand dollars each state fiscal year for the period April first, two 38 thousand eleven through March thirty-first, two thousand fourteen, up to 39 four hundred eighty-seven thousand dollars each state fiscal year for 40 the period April first, two thousand fourteen through March thirty- 41 first, two thousand seventeen, up to four hundred eighty-seven thousand 42 dollars for each state fiscal year for the period April first, two thou- 43 sand seventeen through March thirty-first, two thousand twenty, up to 44 four hundred eighty-seven thousand dollars each state fiscal year for 45 the period April first, two thousand twenty through March thirty-first, 46 two thousand twenty-three, and up to four hundred eighty-seven thousand 47 dollars each state fiscal year for the period April first, two thousand 48 twenty-three through March thirty-first, two thousand twenty-six, shall 49 be set aside and reserved by the commissioner from the regional pools 50 established pursuant to subdivision two of this section and shall be 51 available to fund a study of physician workforce needs and solutions 52 including, but not limited to, an analysis of residency programs and 53 projected physician workforce and community needs. The commissioner 54 shall enter into agreements with one or more organizations to conduct 55 such study based on a request for proposal process.S. 8307--A 71 A. 8807--A 1 [(g)] (f) Diversity in medicine/post-baccalaureate program. Notwith- 2 standing any inconsistent provision of section one hundred twelve or one 3 hundred sixty-three of the state finance law or any other law, one 4 million nine hundred sixty thousand dollars annually for the period 5 January first, two thousand eight through December thirty-first, two 6 thousand ten, four hundred ninety thousand dollars for the period Janu- 7 ary first, two thousand eleven through March thirty-first, two thousand 8 eleven, one million seven hundred thousand dollars each state fiscal 9 year for the period April first, two thousand eleven through March thir- 10 ty-first, two thousand fourteen, up to one million six hundred five 11 thousand dollars each state fiscal year for the period April first, two 12 thousand fourteen through March thirty-first, two thousand seventeen, up 13 to one million six hundred five thousand dollars each state fiscal year 14 for the period April first, two thousand seventeen through March thir- 15 ty-first, two thousand twenty, up to one million six hundred five thou- 16 sand dollars each state fiscal year for the period April first, two 17 thousand twenty through March thirty-first, two thousand twenty-three, 18 and up to one million six hundred five thousand dollars each state 19 fiscal year for the period April first, two thousand twenty-three 20 through March thirty-first, two thousand twenty-six, shall be set aside 21 and reserved by the commissioner from the regional pools established 22 pursuant to subdivision two of this section and shall be available for 23 distributions to the Associated Medical Schools of New York to fund its 24 diversity program including existing and new post-baccalaureate programs 25 for minority and economically disadvantaged students and encourage 26 participation from all medical schools in New York. The associated 27 medical schools of New York shall report to the commissioner on an annu- 28 al basis regarding the use of funds for such purpose in such form and 29 manner as specified by the commissioner. 30 [(h)] (g) In the event there are undistributed funds within amounts 31 made available for distributions pursuant to this subdivision, such 32 funds may be reallocated and distributed in current or subsequent 33 distribution periods in a manner determined by the commissioner for any 34 purpose set forth in this subdivision. 35 12. Notwithstanding any provision of law to the contrary, applications 36 submitted on or after April first, two thousand sixteen, for the physi- 37 cian loan repayment program pursuant to paragraph [(c)] (b) of subdivi- 38 sion five-a of this section and subdivision ten of this section or the 39 physician practice support program pursuant to paragraph [(d)] (c) of 40 subdivision five-a of this section, shall be subject to the following 41 changes: 42 (a) Awards shall be made from the total funding available for new 43 awards under the physician loan repayment program and the physician 44 practice support program, with neither program limited to a specific 45 funding amount within such total funding available; 46 (b) An applicant may apply for an award for either physician loan 47 repayment or physician practice support, but not both; 48 (c) An applicant shall agree to practice for three years in an under- 49 served area and each award shall provide up to forty thousand dollars 50 for each of the three years; and 51 (d) To the extent practicable, awards shall be timed to be of use for 52 job offers made to applicants. 53 § 4. Subparagraph (xvi) of paragraph (a) of subdivision 7 of section 54 2807-s of the public health law, as amended by section 8 of part Y of 55 chapter 56 of the laws of 2020, is amended to read as follows:S. 8307--A 72 A. 8807--A 1 (xvi) provided further, however, for periods prior to July first, two 2 thousand nine, amounts set forth in this paragraph shall be reduced by 3 an amount equal to the actual distribution reductions for all facilities 4 pursuant to paragraph [(s)] (o) of subdivision one of section twenty- 5 eight hundred seven-m of this article. 6 § 5. Subdivision (c) of section 92-dd of the state finance law, as 7 amended by section 9 of part Y of chapter 56 of the laws of 2020, is 8 amended to read as follows: 9 (c) The pool administrator shall, from appropriated funds transferred 10 to the pool administrator from the comptroller, continue to make 11 payments as required pursuant to sections twenty-eight hundred seven-k, 12 twenty-eight hundred seven-m (not including payments made pursuant to 13 subdivision five-b and paragraphs (b), (c)[, (d),, (f)] and [(g)] (f) of 14 subdivision five-a of section twenty-eight hundred seven-m), and twen- 15 ty-eight hundred seven-w of the public health law, paragraph (e) of 16 subdivision twenty-five of section twenty-eight hundred seven-c of the 17 public health law, paragraphs (b) and (c) of subdivision thirty of 18 section twenty-eight hundred seven-c of the public health law, paragraph 19 (b) of subdivision eighteen of section twenty-eight hundred eight of the 20 public health law, subdivision seven of section twenty-five hundred-d of 21 the public health law and section eighty-eight of chapter one of the 22 laws of nineteen hundred ninety-nine. 23 § 6. Paragraph (c) of subdivision 1 of section 461-b of the social 24 services law is REPEALED. 25 § 7. Article 27-H of the public health law is REPEALED. 26 § 8. Paragraph (c) of subdivision 11 of section 230 of the public 27 health law, as amended by chapter 343 of the laws of 1980, subparagraph 28 (ii) as amended by section 10 of part B of chapter 57 of the laws of 29 2023, is amended to read as follows: 30 (c) Notwithstanding the foregoing, no physician shall be responsible 31 for reporting pursuant to paragraph (a) of this subdivision with respect 32 to any information discovered by such physician solely as a result of: 33 [(i)] Participation in a properly conducted mortality and/or morbidity 34 conference, departmental meeting or a medical or tissue committee 35 constituted pursuant to the by-laws of a hospital which is duly estab- 36 lished pursuant to article twenty-eight of the public health law, unless 37 the procedures of such conference, department or committee of such 38 hospital shall have been declared to be unacceptable for the purpose 39 hereof by the commissioner, and provided that the obligations of report- 40 ing such information when appropriate to do so shall be the responsibil- 41 ity of the chairperson of such conference, department or committee[,42or]. 43 [(ii) Participation and membership during a three year demonstration44period in a physician committee of the Medical Society of the State of45New York or the New York State Osteopathic Society whose purpose is to46confront and refer to treatment physicians who are thought to be suffer-47ing from alcoholism, drug abuse, or mental illness. Such demonstration48period shall commence on April first, nineteen hundred eighty and termi-49nate on May thirty-first, nineteen hundred eighty-three. An additional50demonstration period shall commence on June first, nineteen hundred51eighty-three and terminate on March thirty-first, nineteen hundred52eighty-six. An additional demonstration period shall commence on April53first, nineteen hundred eighty-six and terminate on March thirty-first,54nineteen hundred eighty-nine. An additional demonstration period shall55commence April first, nineteen hundred eighty-nine and terminate March56thirty-first, nineteen hundred ninety-two. An additional demonstrationS. 8307--A 73 A. 8807--A 1period shall commence April first, nineteen hundred ninety-two and2terminate March thirty-first, nineteen hundred ninety-five. An addi-3tional demonstration period shall commence on April first, nineteen4hundred ninety-five and terminate on March thirty-first, nineteen5hundred ninety-eight. An additional demonstration period shall commence6on April first, nineteen hundred ninety-eight and terminate on March7thirty-first, two thousand three. An additional demonstration period8shall commence on April first, two thousand three and terminate on March9thirty-first, two thousand thirteen. An additional demonstration period10shall commence April first, two thousand thirteen and terminate on March11thirty-first, two thousand eighteen. An additional demonstration period12shall commence April first, two thousand eighteen and terminate on July13first, two thousand twenty-eight provided, however, that the commission-14er may prescribe requirements for the continuation of such demonstration15program, including periodic reviews of such programs and submission of16any reports and data necessary to permit such reviews. During these17additional periods, the provisions of this subparagraph shall also apply18to a physician committee of a county medical society.] 19 § 9. Paragraph (g) of subdivision 11 of section 230 of the public 20 health law is REPEALED and paragraph (h) is relettered paragraph (g). 21 § 10. This act shall take effect immediately and shall be deemed to 22 have been in full force and effect on and after April 1, 2024; provided, 23 however, the amendments to subparagraph (xvi) of paragraph (a) of subdi- 24 vision 7 of section 2807-s of the public health law made by section four 25 of this act shall not affect the expiration of such section and shall be 26 deemed to expire therewith. 27 PART M 28 Section 1. Subparagraph 3 of paragraph (b) of subdivision 4 of section 29 366 of the social services law, as added by section 2 of part D of chap- 30 ter 56 of the laws of 2013, is amended to read as follows: 31 (3) (A) A child [under] between the [age] ages of six and nineteen who 32 is determined eligible for medical assistance under the provisions of 33 this section, shall, consistent with applicable federal requirements, 34 remain eligible for such assistance until [the earlier of:35(i)] the last day of the month which is twelve months following the 36 determination [or redetermination] or renewal of eligibility for such 37 assistance[; or38(ii) the last day of the month in which the child reaches the age of39nineteen]. 40 (B) A child under the age of six who is determined eligible for 41 medical assistance under the provisions of this section, shall, consist- 42 ent with applicable federal requirements, remain continuously eligible 43 for medical assistance coverage until the later of: 44 (i) the last day of the twelfth month following the determination or 45 renewal of eligibility for such assistance; or 46 (ii) the last day of the month in which the child reaches the age of 47 six. 48 § 2. Subdivision 6 of section 2510 of the public health law is amended 49 by adding a new paragraph (e) to read as follows: 50 (e) an eligible child under six years of age shall, consistent with 51 applicable federal requirements, remain continuously enrolled until the 52 later of: 53 (i) the last day of the twelfth month following the date of enrollment 54 or recertification in the child health insurance plan; orS. 8307--A 74 A. 8807--A 1 (ii) the last day of the month in which the child reaches the age of 2 six. 3 § 3. This act shall take effect January 1, 2025. 4 PART N 5 Section 1. Paragraph (d) of subdivision 4 of section 206 of the public 6 health law, as added by chapter 602 of the laws of 2007, is amended and 7 a new paragraph (e) is added to read as follows: 8 (d) assess civil penalties against a public water system which 9 provides water to the public for human consumption through pipes or 10 other constructed conveyances, as further defined in the state sanitary 11 code or, in the case of mass gatherings, the person who holds or 12 promotes the mass gathering as defined in subdivision five of section 13 two hundred twenty-five of this article not to exceed twenty-five thou- 14 sand dollars per day, for each violation of or failure to comply with 15 any term or provision of the state sanitary code as it relates to public 16 water systems that serve a population of five thousand or more persons 17 or any mass gatherings, which penalty may be assessed after a hearing or 18 an opportunity to be heard[.]; 19 (e) notwithstanding section sixty-five hundred thirty of the education 20 law, issue a non-patient specific statewide standing order for the 21 provision of doula services for pregnant, birthing, and postpartum indi- 22 viduals through twelve months postpartum. 23 § 2. Subdivision 3 of section 2504 of the public health law, as added 24 by chapter 976 of the laws of 1984, is amended to read as follows: 25 3. Any person, including a minor, who is pregnant may give effective 26 consent for any and all medical, dental, health and hospital services 27 relating to [prenatal] reproductive health care, including consent to 28 terminate a pregnancy for any reason. 29 § 3. The opening paragraph of section 2599-aa of the public health 30 law, as added by chapter 1 of the laws of 2019, is amended to read as 31 follows: 32 The legislature finds that comprehensive reproductive health care is a 33 fundamental component of every individual's health, privacy and 34 equality, including minors. Therefore, it is the policy of the state 35 that: 36 § 4. The public health law is amended by adding a new section 37 2599-bb-1 to read as follows: 38 § 2599-bb-1. Contraception. 1. A health care practitioner licensed, 39 certified, or authorized under title eight of the education law, acting 40 within their lawful scope of practice, may prescribe or distribute a 41 contraceptive device or medication when, according to the practitioner's 42 reasonable and good faith professional judgment based on the facts of 43 the patient's case, they determine the patient is able to medically 44 tolerate such treatment. 45 2. This article shall be construed and applied consistent with and 46 subject to applicable laws and applicable and authorized regulations 47 governing health care procedures. 48 § 5. Section 2504 of the public health law is amended by adding a new 49 subdivision 8 to read as follows: 50 8. Drug, cannabis, or alcohol testing for pregnant or postpartum indi- 51 viduals. 52 (a) Definition. As used in this subdivision, "test" shall mean a test 53 using a biological sample, including, but not limited to, urine, blood, 54 or hair, for the presence of drugs, cannabis, or alcohol.S. 8307--A 75 A. 8807--A 1 (b) Unless legally authorized to do so, no health care professional 2 licensed, certified, or authorized under title eight of the education 3 law shall: 4 (i) perform a drug, cannabis, or alcohol test on a person who is preg- 5 nant or up to one year postpartum unless: 6 (A) the pregnant or postpartum patient gives prior verbal or written 7 informed consent specific to the drug, cannabis, or alcohol test; and 8 (B) the performance of the drug, cannabis, or alcohol test is within 9 the scope of medical care being provided to the patient. 10 (c) Verbal or written informed consent to a drug, cannabis, or alcohol 11 test pursuant to this subdivision shall occur prior to administration, 12 in language understandable to the pregnant or postpartum patient, under 13 circumstances that provide such person sufficient opportunity to consid- 14 er whether or not to authorize the drug, cannabis, or alcohol test and 15 minimize the possibility of coercion or undue influence, and shall 16 consist of verbal authorization memorialized in the medical record or 17 written authorization that is dated and signed. Such authorization shall 18 include the following: 19 (i) a statement explaining that consenting to a drug, cannabis, or 20 alcohol test is voluntary and requires written or verbal informed 21 consent, except when conditions under subdivision four of this section 22 or paragraph (d) of this subdivision are met; 23 (ii) a statement that testing positive for drugs, cannabis, or alcohol 24 could have legal consequences; 25 (iii) a statement explaining the extent of confidentiality of the test 26 results; 27 (iv) a statement of the medical purpose of the test; and 28 (v) a general description of the test. 29 (d) Drug, cannabis, or alcohol testing pursuant to this subdivision 30 may be performed without consent of the patient when, in the health care 31 professional's judgment, an emergency exists and the patient is in imme- 32 diate need of medical attention, and an attempt to secure consent would 33 result in delay of treatment that could increase the risk to the 34 patient's life or health. In the case that drug, cannabis, or alcohol 35 testing is performed under these circumstances, the results shall be 36 discussed with the patient, in language understandable to the patient 37 and shall consist of verbal notification or written notification that is 38 dated, signed, and includes the following: 39 (i) a statement that testing positive for drugs, cannabis, or alcohol 40 could have legal consequences; 41 (ii) a statement in the medical record with a description of the emer- 42 gency that necessitated unconsented drug, cannabis, or alcohol testing; 43 and 44 (iii) a statement explaining the extent of confidentiality of the 45 results. 46 (e) Nothing in this section shall diminish any other requirement to 47 obtain informed consent for a drug, cannabis, or alcohol test or any 48 other procedure. 49 § 6. This act shall take effect immediately and shall be deemed to 50 have been in full force and effect on and after April 1, 2024. 51 PART O 52 Section 1. Subdivision 1 of section 2807-k of the public health law is 53 amended by adding a new paragraph (h) to read as follows:S. 8307--A 76 A. 8807--A 1 (h) "Underinsured" shall mean an individual with out of pocket medical 2 costs that amount to more than ten percent of such individual's gross 3 annual income for the past twelve months. 4 § 2. Subdivision 9-a of section 2807-k of the public health law, as 5 added by section 39-a of part A of chapter 57 of the laws of 2006 and 6 paragraph (k) as added by section 43 of part B of chapter 58 of the laws 7 of 2008, is amended to read as follows: 8 9-a. (a) As a condition for participation in pool distributions 9 authorized pursuant to this section and section twenty-eight hundred 10 seven-w of this article for periods on and after January first, two 11 thousand nine, general hospitals shall, effective for periods on and 12 after January first, two thousand seven, establish financial aid poli- 13 cies and procedures, in accordance with the provisions of this subdivi- 14 sion, for reducing charges otherwise applicable to low-income individ- 15 uals without health insurance or underinsured individuals, or who have 16 exhausted their health insurance benefits, and who can demonstrate an 17 inability to pay full charges, and also, at the hospital's discretion, 18 for reducing or discounting the collection of co-pays and deductible 19 payments from those individuals who can demonstrate an inability to pay 20 such amounts. 21 (b) Such reductions from charges for [uninsured] patients with incomes 22 below at least [three] four hundred percent of the federal poverty level 23 shall result in a charge to such individuals that does not exceed [the24greater of] the amount that would have been paid for the same services 25 [by the "highest volume payor" for such general hospital as defined in26subparagraph (v) of this paragraph, or for services provided pursuant to27title XVIII of the federal social security act (medicare), or for28services] provided pursuant to title XIX of the federal social security 29 act (medicaid), and provided further that such amounts shall be adjusted 30 according to income level as follows: 31 (i) For patients with incomes [at or] below at least [one] two hundred 32 percent of the federal poverty level, the hospital shall [collect no33more than a nominal payment amount, consistent with guidelines estab-34lished by the commissioner] waive all charges. No nominal payment shall 35 be collected; 36 (ii) For patients with incomes between at least [one] two hundred 37 [one] percent and [one] up to three hundred [fifty] percent of the 38 federal poverty level, the hospital shall collect no more than the 39 amount identified after application of a proportional sliding fee sched- 40 ule under which patients with lower incomes shall pay the lowest amount. 41 Such schedule shall provide that the amount the hospital may collect for 42 such patients increases [from the nominal amount described in subpara-43graph (i) of this paragraph] in equal increments as the income of the 44 patient increases, up to a maximum of [twenty] ten percent of the 45 [greater of the] amount that would have been paid for the same services 46 [by the "highest volume payor" for such general hospital, as defined in47subparagraph (v) of this paragraph, or for services provided pursuant to48title XVIII of the federal social security act (medicare) or for49services] provided pursuant to title XIX of the federal social security 50 act (medicaid), or for underinsured patients, up to a maximum of ten 51 percent of the amount that would have been paid pursuant to such 52 patient's insurance cost sharing; 53 (iii) For patients with incomes between at least [one] three hundred 54 [fifty-one] one percent and [two] four hundred [fifty] percent of the 55 federal poverty level, the hospital shall collect no more than the 56 amount identified after application of a proportional sliding fee sched-S. 8307--A 77 A. 8807--A 1 ule under which patients with lower income shall pay the lowest amounts. 2 Such schedule shall provide that the amount the hospital may collect for 3 such patients increases from the [twenty] ten percent figure described 4 in subparagraph (ii) of this paragraph in equal increments as the income 5 of the patient increases, up to a maximum of [the greater] twenty 6 percent of the amount that would have been paid for the same services 7 [by the "highest volume payor" for such general hospital, as defined in8subparagraph (v) of this paragraph, or for services provided pursuant to9title XVIII of the federal social security act (medicare) or for10services] provided pursuant to title XIX of the federal social security 11 act (medicaid), or for underinsured patients, up to a maximum of twenty 12 percent of the amount that would have been paid pursuant to such 13 patient's insurance cost sharing; [and14(iv) For patients with incomes between at least two hundred fifty-one15percent and three hundred percent of the federal poverty level, the16hospital shall collect no more than the greater of the amount that would17have been paid for the same services by the "highest volume payor" for18such general hospital as defined in subparagraph (v) of this paragraph,19or for services provided pursuant to title XVIII of the federal social20security act (medicare), or for services provided pursuant to title XIX21of the federal social security act (medicaid).22(v) For the purposes of this paragraph, "highest volume payor" shall23mean the insurer, corporation or organization licensed, organized or24certified pursuant to article thirty-two, forty-two or forty-three of25the insurance law or article forty-four of this chapter, or other third-26party payor, which has a contract or agreement to pay claims for27services provided by the general hospital and incurred the highest28volume of claims in the previous calendar year.29(vi) A hospital may implement policies and procedures to permit, but30not require, consideration on a case-by-case basis of exceptions to the31requirements described in subparagraphs (i) and (ii) of this paragraph32based upon the existence of significant assets owned by the patient that33should be taken into account in determining the appropriate payment34amount for that patient's care, provided, however, that such proposed35policies and procedures shall be subject to the prior review and36approval of the commissioner and, if approved, shall be included in the37hospital's financial assistance policy established pursuant to this38section, and provided further that, if such approval is granted, the39maximum amount that may be collected shall not exceed the greater of the40amount that would have been paid for the same services by the "highest41volume payor" for such general hospital as defined in subparagraph (v)42of this paragraph, or for services provided pursuant to title XVIII of43the federal social security act (medicare), or for services provided44pursuant to title XIX of the federal social security act (medicaid). In45the event that a general hospital reviews a patient's assets in deter-46mining payment adjustments such policies and procedures shall not47consider as assets a patient's primary residence, assets held in a tax-48deferred or comparable retirement savings account, college savings49accounts, or cars used regularly by a patient or immediate family50members.51(vii)] (iv) Nothing in this paragraph shall be construed to limit a 52 hospital's ability to establish patient eligibility for payment 53 discounts at income levels higher than those specified herein and/or to 54 provide greater payment discounts for eligible patients than those 55 required by this paragraph.S. 8307--A 78 A. 8807--A 1 (c) Such policies and procedures shall be clear, understandable, in 2 writing and publicly available in summary form and each general hospital 3 participating in the pool shall ensure that every patient is made aware 4 of the existence of such policies and procedures and is provided, in a 5 timely manner, with a summary of such policies and procedures [upon6request]. Any summary provided to patients shall, at a minimum, include 7 specific information as to income levels used to determine eligibility 8 for assistance, a description of the primary service area of the hospi- 9 tal and the means of applying for assistance. For general hospitals with 10 twenty-four hour emergency departments, such policies and procedures 11 shall require the written notification of patients during the intake and 12 registration process, and during discharge of the patient, and through 13 the conspicuous posting of language-appropriate information in the 14 general hospital, and information on bills and statements sent to 15 patients, that financial aid may be available to qualified patients and 16 how to obtain further information. For specialty hospitals without twen- 17 ty-four hour emergency departments, such notification shall take place 18 through written materials provided to patients during the intake and 19 registration process prior to the provision of any health care services 20 or procedures, and during discharge of the patient, and through informa- 21 tion on bills and statements sent to patients, that financial aid may be 22 available to qualified patients and how to obtain further information. 23 Application materials shall include a notice to patients that upon 24 submission of a completed application, including any information or 25 documentation needed to determine the patient's eligibility pursuant to 26 the hospital's financial assistance policy, the patient may disregard 27 any bills until the hospital has rendered a decision on the application 28 in accordance with this paragraph. 29 (d) Such policies and procedures shall include clear, objective crite- 30 ria for determining a patient's ability to pay and for providing such 31 adjustments to payment requirements as are necessary. In addition to 32 adjustment mechanisms such as sliding fee schedules and discounts to 33 fixed standards, such policies and procedures shall also provide for the 34 use of installment plans for the payment of outstanding balances by 35 patients pursuant to the provisions of the hospital's financial assist- 36 ance policy. The monthly payment under such a plan shall not exceed 37 [ten] five percent of the gross monthly income of the patient[,38provided, however, that if patient assets are considered under such a39policy, then patient assets which are not excluded assets pursuant to40subparagraph (vi) of paragraph (b) of this subdivision may be considered41in addition to the limit on monthly payments]. The rate of interest 42 charged to the patient on the unpaid balance, if any, shall not exceed 43 [the rate for a ninety-day security issued by the United States Depart-44ment of Treasury, plus .5] two percent and no plan shall include an 45 accelerator or similar clause under which a higher rate of interest is 46 triggered upon a missed payment. If such policies and procedures include 47 a requirement of a deposit prior to non-emergent, medically-necessary 48 care, such deposit must be included as part of any financial aid consid- 49 eration. Such policies and procedures shall be applied consistently to 50 all eligible patients. 51 (e) Such policies and procedures shall permit patients to apply for 52 assistance [within at least ninety days of the date of discharge or date53of service and provide at least twenty days for patients to submit a54completed application] at any time during the collection process. Such 55 policies and procedures may require that patients seeking payment 56 adjustments provide appropriate financial information and documentationS. 8307--A 79 A. 8807--A 1 in support of their application, provided, however, that such applica- 2 tion process shall not be unduly burdensome or complex. General hospi- 3 tals shall, upon request, assist patients in understanding the hospi- 4 tal's policies and procedures and in applying for payment adjustments. 5 Application forms shall be printed in the "primary languages" of 6 patients served by the general hospital. For the purposes of this para- 7 graph, "primary languages" shall include any language that is either (i) 8 used to communicate, during at least five percent of patient visits in a 9 year, by patients who cannot speak, read, write or understand the 10 English language at the level of proficiency necessary for effective 11 communication with health care providers, or (ii) spoken by non-English 12 speaking individuals comprising more than one percent of the primary 13 hospital service area population, as calculated using demographic infor- 14 mation available from the United States Bureau of the Census, supple- 15 mented by data from school systems. Decisions regarding such applica- 16 tions shall be made within thirty days of receipt of a completed 17 application. Such policies and procedures shall require that the hospi- 18 tal issue any denial/approval of such application in writing with infor- 19 mation on how to appeal the denial and shall require the hospital to 20 establish an appeals process under which it will evaluate the denial of 21 an application. Nothing in this subdivision shall be interpreted as 22 prohibiting a hospital from making the availability of financial assist- 23 ance contingent upon the patient first applying for coverage under title 24 XIX of the social security act (medicaid) or another insurance program 25 if, in the judgment of the hospital, the patient may be eligible for 26 medicaid or another insurance program, and upon the patient's cooper- 27 ation in following the hospital's financial assistance application 28 requirements, including the provision of information needed to make a 29 determination on the patient's application in accordance with the hospi- 30 tal's financial assistance policy. 31 (f) Such policies and procedures shall provide that patients with 32 incomes below [three] four hundred percent of the federal poverty level 33 are deemed presumptively eligible for payment adjustments and shall 34 conform to the requirements set forth in paragraph (b) of this subdivi- 35 sion, provided, however, that nothing in this subdivision shall be 36 interpreted as precluding hospitals from extending such payment adjust- 37 ments to other patients, either generally or on a case-by-case basis. 38 Such policies and procedures shall provide financial aid for emergency 39 hospital services, including emergency transfers pursuant to the federal 40 emergency medical treatment and active labor act (42 USC 1395dd), to 41 patients who reside in New York state and for medically necessary hospi- 42 tal services for patients who reside in the hospital's primary service 43 area as determined according to criteria established by the commission- 44 er. In developing such criteria, the commissioner shall consult with 45 representatives of the hospital industry, health care consumer advocates 46 and local public health officials. Such criteria shall be made available 47 to the public no less than thirty days prior to the date of implementa- 48 tion and shall, at a minimum: 49 (i) prohibit a hospital from developing or altering its primary 50 service area in a manner designed to avoid medically underserved commu- 51 nities or communities with high percentages of uninsured residents; 52 (ii) ensure that every geographic area of the state is included in at 53 least one general hospital's primary service area so that eligible 54 patients may access care and financial assistance; and 55 (iii) require the hospital to notify the commissioner upon making any 56 change to its primary service area, and to include a description of itsS. 8307--A 80 A. 8807--A 1 primary service area in the hospital's annual implementation report 2 filed pursuant to subdivision three of section twenty-eight hundred 3 three-l of this article. 4 (g) Nothing in this subdivision shall be interpreted as precluding 5 hospitals from extending payment adjustments for medically necessary 6 non-emergency hospital services to patients outside of the hospital's 7 primary service area. For patients determined to be eligible for finan- 8 cial aid under the terms of a hospital's financial aid policy, such 9 policies and procedures shall prohibit any limitations on financial aid 10 for services based on the medical condition of the applicant, other than 11 typical limitations or exclusions based on medical necessity or the 12 clinical or therapeutic benefit of a procedure or treatment. 13 (h) Such policies and procedures shall prohibit the denial of admis- 14 sion or denial of treatment for services that are reasonably anticipated 15 to be medically necessary because the patient has an unpaid medical 16 bill. Such policies and procedures shall [not permit] prohibit the 17 forced sale or foreclosure of a patient's primary residence in order to 18 collect an outstanding medical bill and shall require the hospital to 19 refrain from sending an account to collection if the patient has submit- 20 ted a completed application for financial aid, including any required 21 supporting documentation, while the hospital determines the patient's 22 eligibility for such aid. Such policies and procedures shall prohibit 23 the sale of medical debt accumulated pursuant to this section to a third 24 party, unless the third party explicitly purchases such medical debt in 25 order to relieve the debt of the patient. Such policies and procedures 26 shall provide for written notification, which shall include notification 27 on a patient bill, to a patient not less than thirty days prior to the 28 referral of debts for collection and shall require that the collection 29 agency obtain the hospital's written consent prior to commencing a legal 30 action. Such policies and procedures shall prohibit a hospital from 31 commencing a legal action related to the recovery of medical debt or 32 unpaid bills against patients with incomes below four hundred percent of 33 the federal poverty level. In any legal action related to the recovery 34 of medical debt or unpaid bills by or on behalf of a hospital, the 35 complaint shall be accompanied by an affidavit by the hospital's chief 36 financial officer stating that based upon the hospital's reasonable 37 effort to determine the patient's income, the patient whom they are 38 taking legal action against does not have an income below four hundred 39 percent of the federal poverty level. Such policies and procedures shall 40 require all general hospital staff who interact with patients or have 41 responsibility for billing and collections to be trained in such poli- 42 cies and procedures, and require the implementation of a mechanism for 43 the general hospital to measure its compliance with such policies and 44 procedures. Such policies and procedures shall require that any 45 collection agency under contract with a general hospital for the 46 collection of debts follow the hospital's financial assistance policy, 47 including providing information to patients on how to apply for finan- 48 cial assistance where appropriate. Such policies and procedures shall 49 prohibit collections from a patient who is determined to be eligible for 50 medical assistance pursuant to title XIX of the federal social security 51 act at the time services were rendered and for which services medicaid 52 payment is available. 53 (i) Reports required to be submitted to the department by each general 54 hospital as a condition for participation in the pools, and which 55 contain, in accordance with applicable regulations, a certification from 56 an independent certified public accountant or independent licensedS. 8307--A 81 A. 8807--A 1 public accountant or an attestation from a senior official of the hospi- 2 tal that the hospital is in compliance with conditions of participation 3 in the pools, shall also contain, for reporting periods on and after 4 January first, two thousand seven: 5 (i) a report on hospital costs incurred and uncollected amounts in 6 providing services to eligible patients without insurance[, including7the amount of care provided for a nominal payment amount,] during the 8 period covered by the report; 9 (ii) hospital costs incurred and uncollected amounts for deductibles 10 and coinsurance for eligible patients with insurance or other third-par- 11 ty payor coverage; 12 (iii) the number of patients, including their age, race, ethnicity, 13 gender and insurance status, organized according to United States postal 14 service zip code, who applied for financial assistance pursuant to the 15 hospital's financial assistance policy, and the number, organized 16 according to United States postal service zip code, whose applications 17 were approved and whose applications were denied; 18 (iv) the reimbursement received for indigent care from the pool estab- 19 lished pursuant to this section; 20 (v) the amount of funds that have been expended on charity care from 21 charitable bequests made or trusts established for the purpose of 22 providing financial assistance to patients who are eligible in accord- 23 ance with the terms of such bequests or trusts; 24 (vi) for hospitals located in social services districts in which the 25 district allows hospitals to assist patients with such applications, the 26 number of applications for eligibility under title XIX of the social 27 security act (medicaid) that the hospital assisted patients in complet- 28 ing and the number denied and approved; and 29 (vii) the hospital's financial losses resulting from services provided 30 under medicaid[; and31(viii) the number of liens placed on the primary residences of32patients through the collection process used by a hospital]. 33 (j) Within ninety days of the effective date of this subdivision each 34 hospital shall submit to the commissioner a written report on its poli- 35 cies and procedures for financial assistance to patients which are used 36 by the hospital on the effective date of this subdivision. Such report 37 shall include copies of its policies and procedures, including material 38 which is distributed to patients, and a description of the hospital's 39 financial aid policies and procedures. Such description shall include 40 the income levels of patients on which eligibility is based, the finan- 41 cial aid eligible patients receive and the means of calculating such 42 aid, and the service area, if any, used by the hospital to determine 43 eligibility. 44 (k) In the event it is determined by the commissioner that the state 45 will be unable to secure all necessary federal approvals to include, as 46 part of the state's approved state plan under title nineteen of the 47 federal social security act, a requirement, as set forth in paragraph 48 [one] (a) of this subdivision, that compliance with this subdivision is 49 a condition of participation in pool distributions authorized pursuant 50 to this section and section twenty-eight hundred seven-w of this arti- 51 cle, then such condition of participation shall be deemed null and void 52 and, notwithstanding section twelve of this chapter, failure to comply 53 with the provisions of this subdivision by a hospital on and after the 54 date of such determination shall make such hospital liable for a civil 55 penalty not to exceed ten thousand dollars for each such violation. TheS. 8307--A 82 A. 8807--A 1 imposition of such civil penalties shall be subject to the provisions of 2 section twelve-a of this chapter. 3 (l) A hospital or its collection agent shall not commence a civil 4 action against a patient or delegate a collection activity to a debt 5 collector for nonpayment for at least one hundred eighty days after the 6 first post-service bill is issued and until a hospital has made reason- 7 able efforts to determine whether a patient qualifies for financial 8 assistance. 9 § 3. The public health law is amended by adding a new section 18-c to 10 read as follows: 11 § 18-c. Separate patient consent for treatment and payment for health 12 care services. Informed consent from a patient to provide any treatment, 13 procedure, examination or other direct health care services shall be 14 obtained separately from such patient's consent to pay for the services. 15 Consent to pay for any health care services by a patient shall not be 16 given prior to the patient receiving such services and discussing treat- 17 ment costs. For purposes of this section, "consent" means an action 18 which: (a) clearly and conspicuously communicates the individual's 19 authorization of an act or practice; (b) is made in the absence of any 20 mechanism in the user interface that has the purpose or substantial 21 effect of obscuring, subverting, or impairing decision-making or choice 22 to obtain consent; and (c) cannot be inferred from inaction. 23 § 4. The general business law is amended by adding two new sections 24 349-g and 519-a to read as follows: 25 § 349-g. Restrictions on applications for and use of credit cards and 26 medical financial products. 1. For purposes of this section, the follow- 27 ing terms shall have the following meanings: 28 (a) "Medical financial products" shall mean medical credit cards and 29 third-party medical installment loans. 30 (b) "Health care provider" shall mean a health care professional 31 licensed, registered or certified pursuant to title eight of the educa- 32 tion law. 33 (c) "Provider offices" shall mean either of the following: 34 (i) An office of a health care provider in solo practice; or 35 (ii) An office in which services or goods are personally provided by 36 the health care provider or by employees in that office, or personally 37 by independent contractors in that office, in accordance with law. 38 Employees and independent contractors shall be licensed or certified 39 when licensure or certification is required by law. 40 2. It shall be prohibited for any individual to complete any portion 41 of an application for medical financial products for the patient or 42 otherwise arrange for or establish an application that is not completely 43 filled out by the patient. 44 § 519-a. Medical financial products; payment for health care services. 45 1. For purposes of this section, the following terms shall have the 46 following meanings: 47 (a) "Credit card" shall have the same meaning as in section five 48 hundred eleven of this article. 49 (b) "Medical credit card" means a credit card issued under an open-end 50 or closed-end plan offered specifically for the payment of health care 51 services, products, or devices provided to a person. 52 2. No health care provider shall require credit card pre-authorization 53 nor require the patient to have a credit card on file prior to providing 54 emergency or medically necessary medical services to such patient. 55 3. Health care providers shall notify all patients about the risks of 56 paying for medical services with a credit card. Such notification shallS. 8307--A 83 A. 8807--A 1 highlight the fact that by using a credit card to pay for medical 2 services, the patient is forgoing state and federal protections that 3 regard medical debt. The commissioner of health shall have the authori- 4 ty and sole discretion to set requirements for the contents of such 5 notices. 6 § 5. This act shall take effect six months after it shall have become 7 a law. 8 PART P 9 Section 1. Section 8 of part C of chapter 57 of the laws of 2022 10 amending the public health law and the education law relating to allow- 11 ing pharmacists to direct limited service laboratories and order and 12 administer COVID-19 and influenza tests and modernizing nurse practi- 13 tioners, is amended to read as follows: 14 § 8. This act shall take effect immediately and shall be deemed to 15 have been in full force and effect on and after April 1, 2022; provided, 16 however, that sections [one, two,] three[,] and four[, six and seven] of 17 this act shall expire and be deemed repealed [two years after it shall18have become a law] April 1, 2026. 19 § 2. Section 5 of chapter 21 of the laws of 2011 amending the educa- 20 tion law relating to authorizing pharmacists to perform collaborative 21 drug therapy management with physicians in certain settings, as amended 22 by section 5 of part CC of chapter 57 of the laws of 2022, is amended to 23 read as follows: 24 § 5. This act shall take effect on the one hundred twentieth day after 25 it shall have become a law[, provided, however, that the provisions of26sections two, three, and four of this act shall expire and be deemed27repealed July 1, 2024]; provided, however, that the amendments to subdi- 28 vision 1 of section 6801 of the education law made by section one of 29 this act shall be subject to the expiration and reversion of such subdi- 30 vision pursuant to section 8 of chapter 563 of the laws of 2008, when 31 upon such date the provisions of section one-a of this act shall take 32 effect; provided, further, that effective immediately, the addition, 33 amendment and/or repeal of any rule or regulation necessary for the 34 implementation of this act on its effective date are authorized and 35 directed to be made and completed on or before such effective date. 36 § 3. This act shall take effect immediately and shall be deemed to 37 have been in full force and effect on and after April 1, 2024. 38 PART Q 39 Section 1. Section 6542 of the education law, as amended by chapter 48 40 of the laws of 2012, subdivisions 3 and 5 as amended by section 1 of 41 part T of chapter 57 of the laws of 2013, is amended to read as follows: 42 § 6542. Performance of medical services. 1. Notwithstanding any other 43 provision of law, a physician assistant may perform medical services, 44 but only when under the supervision of a physician and only when such 45 acts and duties as are assigned to him or her are within the scope of 46 practice of such supervising physician unless otherwise permitted by 47 this section. 48 1-a. (a) A physician assistant may practice without the supervision of 49 a physician under the following circumstances: 50 (i) Where the physician assistant, licensed under section sixty-five 51 hundred forty-one of this article has practiced for more than eight 52 thousand hours; andS. 8307--A 84 A. 8807--A 1 (A) is practicing in primary care. For purposes of this clause, 2 "primary care" shall mean non-surgical care in the fields of general 3 pediatrics, general adult medicine, general geriatric medicine, general 4 internal medicine, obstetrics and gynecology, family medicine, or such 5 other related areas as determined by the commissioner of health; or 6 (B) is employed by a health system or hospital established under arti- 7 cle twenty-eight of the public health law, and the health system or 8 hospital determines the physician assistant meets the qualifications of 9 the medical staff bylaws and the health system or hospital gives the 10 physician assistant privileges; and 11 (ii) Where a physician assistant licensed under section sixty-five 12 hundred forty-one of this article has completed a program approved by 13 the department of health, in consultation with the department, when such 14 services are performed within the scope of such program. 15 (b) The department and the department of health are authorized to 16 promulgate and update regulations pursuant to this section. 17 2. [Supervision] Where supervision is required by this section, it 18 shall be continuous but shall not be construed as necessarily requiring 19 the physical presence of the supervising physician at the time and place 20 where such services are performed. 21 3. [No physician shall employ or supervise more than four physician22assistants in his or her private practice.234.] Nothing in this article shall prohibit a hospital from employing 24 physician assistants provided they [work under the supervision of a25physician designated by the hospital and not beyond the scope of prac-26tice of such physician. The numerical limitation of subdivision three of27this section shall not apply to services performed in a hospital.285. Notwithstanding any other provision of this article, nothing shall29prohibit a physician employed by or rendering services to the department30of corrections and community supervision under contract from supervising31no more than six physician assistants in his or her practice for the32department of corrections and community supervision.336. Notwithstanding any other provision of law, a trainee in an34approved program may perform medical services when such services are35performed within the scope of such program.] meet the qualifications of 36 the medical staff bylaws and are given privileges and otherwise meet the 37 requirements of this section. 38 4. A physician assistant shall be authorized to prescribe, dispense, 39 order, administer, or procure items necessary to commence or complete a 40 course of therapy. 41 5. A physician assistant may prescribe and order a patient specific 42 order or non-patient specific regimen to a licensed pharmacist or regis- 43 tered professional nurse, pursuant to regulations promulgated by the 44 commissioner of health, and consistent with the public health law, for 45 administering immunizations. Nothing in this subdivision shall authorize 46 unlicensed persons to administer immunizations, vaccines or other drugs. 47 [7] 6. Nothing in this article, or in article thirty-seven of the 48 public health law, shall be construed to authorize physician assistants 49 to perform those specific functions and duties specifically delegated by 50 law to those persons licensed as allied health professionals under the 51 public health law or this chapter. 52 § 2. Subdivision 1 of section 3701 of the public health law, as 53 amended by chapter 48 of the laws of 2012, is amended to read as 54 follows: 55 1. to promulgate regulations defining and restricting the duties 56 [which may be assigned to] of physician assistants [by their supervisingS. 8307--A 85 A. 8807--A 1physician, the degree of supervision required and the manner in which2such duties may be performed] consistent with section sixty-five hundred 3 forty-two of the education law.; 4 § 3. Section 3702 of the public health law, as amended by chapter 48 5 of the laws of 2012, is amended to read as follows: 6 § 3702. Special provisions. 1. Inpatient medical orders. A licensed 7 physician assistant employed or extended privileges by a hospital may, 8 if permissible under the bylaws, rules and regulations of the hospital, 9 write medical orders, including those for controlled substances and 10 durable medical equipment, for inpatients [under the care of the physi-11cian responsible for his or her supervision. Countersignature of such12orders may be required if deemed necessary and appropriate by the super-13vising physician or the hospital, but in no event shall countersignature14be required prior to execution]. 15 2. Withdrawing blood. A licensed physician assistant or certified 16 nurse practitioner acting within his or her lawful scope of practice may 17 supervise and direct the withdrawal of blood for the purpose of deter- 18 mining the alcoholic or drug content therein under subparagraph one of 19 paragraph (a) of subdivision four of section eleven hundred ninety-four 20 of the vehicle and traffic law, notwithstanding any provision to the 21 contrary in clause (ii) of such subparagraph. 22 3. Prescriptions for controlled substances. A licensed physician 23 assistant, in good faith and acting within his or her lawful scope of 24 practice, and to the extent assigned by his or her supervising physician 25 as applicable by section sixty-five hundred forty-two of the education 26 law, may prescribe controlled substances as a practitioner under article 27 thirty-three of this chapter, to patients under the care of such physi- 28 cian responsible for his or her supervision. The commissioner, in 29 consultation with the commissioner of education, may promulgate such 30 regulations as are necessary to carry out the purposes of this section. 31 § 4. Section 3703 of the public health law, as amended by chapter 48 32 of the laws of 2012, is amended to read as follows: 33 § 3703. Statutory construction. A physician assistant may perform any 34 function in conjunction with a medical service lawfully performed by the 35 physician assistant, in any health care setting, that a statute author- 36 izes or directs a physician to perform and that is appropriate to the 37 education, training and experience of the licensed physician assistant 38 and within the ordinary practice of the supervising physician, as appli- 39 cable pursuant to section sixty-five hundred forty-two of the education 40 law. This section shall not be construed to increase or decrease the 41 lawful scope of practice of a physician assistant under the education 42 law. 43 § 5. Paragraph a of subdivision 2 of section 902 of the education law, 44 as amended by chapter 376 of the laws of 2015, is amended to read as 45 follows: 46 a. The board of education, and the trustee or board of trustees of 47 each school district, shall employ, at a compensation to be agreed upon 48 by the parties, a qualified physician, a physician assistant, or a nurse 49 practitioner to the extent authorized by the nurse practice act and 50 consistent with subdivision three of section six thousand nine hundred 51 two of this chapter, to perform the duties of the director of school 52 health services, including any duties conferred on the school physician 53 or school medical inspector under any provision of law, to perform and 54 coordinate the provision of health services in the public schools and to 55 provide health appraisals of students attending the public schools in 56 the city or district. The physicians, physicians assistants or nurseS. 8307--A 86 A. 8807--A 1 practitioners so employed shall be duly licensed pursuant to applicable 2 law. 3 § 6. Subdivision 5 of section 6810 of the education law, as added by 4 chapter 881 of the laws of 1972, is amended to read as follows: 5 5. Records of all prescriptions filled or refilled shall be maintained 6 for a period of at least five years and upon request made available for 7 inspection and copying by a representative of the department. Such 8 records shall indicate date of filling or refilling, [doctor's] 9 prescriber's name, patient's name and address and the name or initials 10 of the pharmacist who prepared, compounded, or dispensed the 11 prescription. Records of prescriptions for controlled substances shall 12 be maintained pursuant to requirements of article thirty-three of the 13 public health law. 14 § 7. Subdivision 27 of section 3302 of the public health law, as 15 amended by chapter 92 of the laws of 2021, is amended to read as 16 follows: 17 27. "Practitioner" means: 18 A physician, physician assistant, dentist, podiatrist, veterinarian, 19 scientific investigator, or other person licensed, or otherwise permit- 20 ted to dispense, administer or conduct research with respect to a 21 controlled substance in the course of a licensed professional practice 22 or research licensed pursuant to this article. Such person shall be 23 deemed a "practitioner" only as to such substances, or conduct relating 24 to such substances, as is permitted by [his] their license, permit or 25 otherwise permitted by law. 26 § 8. Section 6908 of the education law is amended by adding a new 27 subdivision 3 to read as follows: 28 3. This article shall not be construed as prohibiting medication 29 related tasks provided by a certified medication aide working in a resi- 30 dential health care facility, as defined in section twenty-eight hundred 31 one of the public health law, in accordance with regulations developed 32 by the commissioner, in consultation with the commissioner of health. 33 The commissioner, in consultation with the commissioner of health, shall 34 adopt regulations governing certified medication aides that, at a mini- 35 mum, shall: 36 a. specify the medication-related tasks that may be performed by 37 certified medication aides pursuant to this subdivision. Such tasks 38 shall include the administration of medications which are routine and 39 pre-filled or otherwise packaged in a manner that promotes relative ease 40 of administration, provided that administration of medications by 41 injection, sterile procedures, and central line maintenance shall be 42 prohibited. Provided, however, such prohibition shall not apply to 43 injections of insulin or other injections for diabetes care, to 44 injections of low molecular weight heparin, and to pre-filled auto-in- 45 jections of naloxone and epinephrine for emergency purposes, and 46 provided, further, that entities employing certified medication aides 47 pursuant to this subdivision shall establish a systematic approach to 48 address drug diversion; 49 b. provide that medication-related tasks performed by certified medi- 50 cation aides may be performed only under the supervision of a registered 51 professional nurse licensed in New York state, as set forth in this 52 subdivision and subdivision twelve of section sixty-nine hundred nine of 53 this article; 54 c. establish a process by which a registered professional nurse may 55 assign medication-related tasks to a certified medication aide. Such 56 process shall include, but not be limited to:S. 8307--A 87 A. 8807--A 1 (i) allowing assignment of medication-related tasks to a certified 2 medication aide only where such certified medication aide has demon- 3 strated to the satisfaction of the supervising registered professional 4 nurse competency in every medication-related task that such certified 5 medication aide is authorized to perform, a willingness to perform such 6 medication-related tasks, and the ability to effectively and efficiently 7 communicate with the individual receiving services and understand such 8 individual's needs; 9 (ii) authorizing the supervising registered professional nurse to 10 revoke any assigned medication-related task from a certified medication 11 aide for any reason; and 12 (iii) authorizing multiple registered professional nurses to jointly 13 agree to assign medication-related tasks to a certified medication aide, 14 provided further that only one registered professional nurse shall be 15 required to determine if the certified medication aide has demonstrated 16 competency in the medication-related task to be performed; 17 d. provide that medication-related tasks may be performed only in 18 accordance with and pursuant to an authorized health practitioner's 19 ordered care; 20 e. provide that only a certified nurse aide may perform medication-re- 21 lated tasks as a certified medication aide when such aide has: 22 (i) a valid New York state nurse aide certificate; 23 (ii) a high school diploma, or its equivalent; 24 (iii) evidence of being at least eighteen years old; 25 (iv) at least one year of experience providing nurse aide services in 26 a residential health care facility licensed pursuant to article twenty- 27 eight of the public health law or a similarly licensed facility in 28 another state or United States territory; 29 (v) the ability to read, write, and speak English and to perform basic 30 math skills; 31 (vi) completed the requisite training and demonstrated competencies of 32 a certified medication aide as determined by the commissioner of health 33 in consultation with the commissioner; 34 (vii) successfully completed competency examinations satisfactory to 35 the commissioner of health in consultation with the commissioner; and 36 (viii) meets other appropriate qualifications as determined by the 37 commissioner of health in consultation with the commissioner; 38 f. prohibit a certified medication aide from holding themselves out, 39 or accepting employment as, a person licensed to practice nursing under 40 the provisions of this article; 41 g. provide that a certified medication aide is not required nor 42 permitted to assess the medication or medical needs of an individual; 43 h. provide that a certified medication aide shall not be authorized to 44 perform any medication-related tasks or activities pursuant to this 45 subdivision that are outside the scope of practice of a licensed practi- 46 cal nurse or any medication-related tasks that have not been appropri- 47 ately assigned by the supervising registered professional nurse; 48 i. provide that a certified medication aide shall document all medica- 49 tion-related tasks provided to an individual, including medication 50 administration to each individual through the use of a medication admin- 51 istration record; and 52 j. provide that the supervising registered professional nurse shall 53 retain the discretion to decide whether to assign medication-related 54 tasks to certified medication aides under this program and shall not be 55 subject to coercion, retaliation, or the threat of retaliation.S. 8307--A 88 A. 8807--A 1 § 9. Section 6909 of the education law is amended by adding two new 2 subdivisions 12 and 13 to read as follows: 3 12. A registered professional nurse, while working for a residential 4 health care facility licensed pursuant to article twenty-eight of the 5 public health law, may, in accordance with this subdivision, assign 6 certified medication aides to perform medication-related tasks for indi- 7 viduals pursuant to the provisions of subdivision three of section 8 sixty-nine hundred eight of this article and supervise certified medica- 9 tion aides who perform assigned medication-related tasks. 10 13. Notwithstanding subdivision seven of section sixty-five hundred 11 nine of this title, a certified nurse practitioner may directly assign 12 and supervise a medical assistant in an outpatient setting the task of 13 drawing and administering immunizations to patients, provided such 14 medical assistant receives appropriate training from the certified nurse 15 practitioner and the certified nurse practitioner remains responsible 16 for the actions of the medical assistant. 17 § 10. Paragraph (a) of subdivision 3 of section 2803-j of the public 18 health law, as added by chapter 717 of the laws of 1989, is amended to 19 read as follows: 20 (a) Identification of individuals who have successfully completed a 21 nurse aide training and competency evaluation program, [or] a nurse aide 22 competency evaluation program, or a medication aide program; 23 § 11. Section 6527 of the education law is amended by adding a new 24 subdivision 12 to read as follows: 25 12. Notwithstanding subdivision eleven of section sixty-five hundred 26 thirty of this title, a licensed physician may directly assign and 27 supervise a medical assistant in an outpatient setting the task of draw- 28 ing and administering immunizations to patients, provided such medical 29 assistant receives appropriate training from the licensed physician and 30 the licensed physician remains responsible for the actions of the 31 medical assistant. 32 § 12. Section 6545 of the education law, as amended by chapter 48 of 33 the laws of 2012, is amended to read as follows: 34 § 6545. [Emergency services rendered by physician assistant] Special 35 provisions. 1. Notwithstanding any inconsistent provision of any gener- 36 al, special or local law, any physician assistant properly licensed in 37 this state who voluntarily and without the expectation of monetary 38 compensation renders first aid or emergency treatment at the scene of an 39 accident or other emergency, outside a hospital, doctor's office or any 40 other place having proper and necessary medical equipment, to a person 41 who is unconscious, ill or injured, shall not be liable for damages for 42 injuries alleged to have been sustained by such person or for damages 43 for the death of such person alleged to have occurred by reason of an 44 act or omission in the rendering of such first aid or emergency treat- 45 ment unless it is established that such injuries were or such death was 46 caused by gross negligence on the part of such physician assistant. 47 Nothing in this section shall be deemed or construed to relieve a 48 licensed physician assistant from liability for damages for injuries or 49 death caused by an act or omission on the part of a physician assistant 50 while rendering professional services in the normal and ordinary course 51 of his or her practice. 52 2. Notwithstanding subdivision eleven of section sixty-five hundred 53 thirty of this title, a licensed physician assistant authorized pursuant 54 to section sixty-five hundred forty-two of this article to practice 55 without supervision of a physician, may directly assign and supervise a 56 medical assistant in an outpatient setting the task of drawing andS. 8307--A 89 A. 8807--A 1 administering immunizations to patients, provided such medical assistant 2 receives appropriate training from the licensed physician assistant and 3 the licensed physician assistant remains responsible for the actions of 4 the medical assistant. 5 § 13. Section 6601 of the education law, as amended by chapter 576 of 6 the laws of 2001, is amended to read as follows: 7 § 6601. Definition of practice of dentistry. The practice of the 8 profession of dentistry is defined as diagnosing, treating, operating, 9 or prescribing for any disease, pain, injury, deformity, or physical 10 condition of the oral and maxillofacial area related to restoring and 11 maintaining dental health. The practice of dentistry includes the 12 prescribing and fabrication of dental prostheses and appliances. The 13 practice of dentistry may include performing physical evaluations in 14 conjunction with the provision of dental treatment, including the admin- 15 istration of vaccinations against influenza, SARS-CoV-2, Human papillo- 16 mavirus (HPV), and vaccinations related to a declared public health 17 emergency. The practice of dentistry may also include offering of HIV, 18 hepatitis C, and hemoglobin A1C screening or diagnostic tests. 19 § 14. Section 6605-b of the education law, as added by chapter 437 of 20 the laws of 2001 and subdivision 1 as amended by chapter 198 of the laws 21 of 2022, is amended to read as follows: 22 § 6605-b. Dental hygiene restricted local infiltration and block 23 anesthesia/nitrous oxide analgesia certificate. 1. A dental hygienist 24 shall not administer or monitor nitrous oxide analgesia or local infil- 25 tration or block anesthesia in the practice of dental hygiene without a 26 dental hygiene restricted local infiltration and block 27 anesthesia/nitrous oxide analgesia certificate and except under the 28 personal supervision of a dentist and in accordance with regulations 29 promulgated by the commissioner. Personal supervision, for purposes of 30 this section, means that the supervising dentist remains in the dental 31 office where the local infiltration or block anesthesia or nitrous oxide 32 analgesia services are being performed, personally authorizes and 33 prescribes the use of local infiltration or block anesthesia or nitrous 34 oxide analgesia for the patient and, before dismissal of the patient, 35 personally examines the condition of the patient after the use of local 36 infiltration or block anesthesia or nitrous oxide analgesia is 37 completed. It is professional misconduct for a dentist to fail to 38 provide the supervision required by this section, and any dentist found 39 guilty of such misconduct under the procedures prescribed in section 40 sixty-five hundred ten of this title shall be subject to the penalties 41 prescribed in section sixty-five hundred eleven of this title. 42 2. The commissioner shall promulgate regulations establishing stand- 43 ards and procedures for the issuance of such certificate. Such standards 44 shall require completion of an educational program and/or course of 45 training or experience sufficient to ensure that a dental hygienist is 46 specifically trained in the administration and monitoring of nitrous 47 oxide analgesia and local infiltration or block anesthesia, the possible 48 effects of such use, and in the recognition of and response to possible 49 emergency situations. 50 3. The fee for a dental hygiene restricted local infiltration and 51 block anesthesia/nitrous oxide analgesia certificate shall be twenty- 52 five dollars and shall be paid on a triennial basis upon renewal of such 53 certificate. A certificate may be suspended or revoked in the same 54 manner as a license to practice dental hygiene. 55 § 15. Subdivision 1 of section 6606 of the education law, as amended 56 by chapter 239 of the laws of 2013, is amended to read as follows:S. 8307--A 90 A. 8807--A 1 1. The practice of the profession of dental hygiene is defined as the 2 performance of dental services which shall include removing calcareous 3 deposits, accretions and stains from the exposed surfaces of the teeth 4 which begin at the epithelial attachment and applying topical agents 5 indicated for a complete dental prophylaxis, removing cement, placing or 6 removing rubber dam, removing sutures, placing matrix band, providing 7 patient education, applying topical medication, placing pre-fit ortho- 8 dontic bands, using light-cure composite material, taking cephalometric 9 radiographs, taking two-dimensional and three-dimensional photography of 10 dentition, adjusting removable appliances including nightguards, bleach- 11 ing trays, retainers and dentures, placing and exposing diagnostic 12 dental X-ray films, performing topical fluoride applications and topical 13 anesthetic applications, polishing teeth, taking medical history, chart- 14 ing caries, taking impressions for study casts, placing and removing 15 temporary restorations, administering and monitoring nitrous oxide 16 analgesia and administering and monitoring local infiltration and block 17 anesthesia, subject to certification in accordance with section sixty- 18 six hundred five-b of this article, and any other function in the defi- 19 nition of the practice of dentistry as may be delegated by a licensed 20 dentist in accordance with regulations promulgated by the commissioner. 21 The practice of dental hygiene may be conducted in the office of any 22 licensed dentist or in any appropriately equipped school or public 23 institution but must be done either under the supervision of a licensed 24 dentist or, in the case of a registered dental hygienist working for a 25 hospital as defined in article twenty-eight of the public health law[,] 26 or pursuant to a collaborative arrangement with a licensed and regis- 27 tered dentist [who has a formal relationship with the same hospital] 28 pursuant to section sixty-six hundred seven-a of this article and in 29 accordance with regulations promulgated by the department in consulta- 30 tion with the department of health. [Such collaborative arrangement31shall not obviate or supersede any law or regulation which requires32identified services to be performed under the personal supervision of a33dentist. When dental hygiene services are provided pursuant to a colla-34borative agreement, such dental hygienist shall instruct individuals to35visit a licensed dentist for comprehensive examination or treatment.] 36 § 16. The education law is amended by adding a new section 6607-a to 37 read as follows: 38 § 6607-a. Practice of collaborative practice dental hygiene and use of 39 title "registered dental hygienist, collaborative practice" (RDH-CP). 1. 40 The practice of the profession of dental hygiene, as defined under this 41 article, may be performed in collaboration with a licensed dentist 42 provided such services are performed in accordance with a written prac- 43 tice agreement and written practice protocols to be known as a collabo- 44 rative practice agreement. Under a collaborative practice agreement, 45 dental hygienists may perform all services which are designated in regu- 46 lation without prior evaluation of a dentist or medical professional and 47 may be performed without supervision in a collaborative practice 48 setting. 49 2. (a) The collaborative practice agreement shall include consider- 50 ation for medically compromised patients, specific medical conditions, 51 and age-and procedure-specific practice protocols, including, but not 52 limited to recommended intervals for the performance of dental hygiene 53 services and a periodicity in which an examination by a dentist should 54 occur. 55 (b) The collaborative agreement shall be:S. 8307--A 91 A. 8807--A 1 (i) signed and maintained by the dentist, the dental hygienist, and 2 the facility, program, or organization; 3 (ii) reviewed annually by the collaborating dentist and dental hygien- 4 ist; and 5 (iii) made available to the department and other interested parties 6 upon request. 7 (c) Only one agreement between a collaborating dentist and registered 8 dental hygienist, collaborative practice (RDH-CP) may be in force at a 9 time. 10 3. Before performing any services authorized under this section, a 11 dental hygienist shall provide the patient with a written statement 12 advising the patient that the dental hygiene services provided are not a 13 substitute for a dental examination by a licensed dentist and instruct- 14 ing individuals to visit a licensed dentist for comprehensive examina- 15 tion or treatment. If the dental hygienist makes any referrals to the 16 patient for further dental procedures, the dental hygienist must fill 17 out a referral form and provide a copy of the form to the collaborating 18 dentist. 19 4. The collaborative practice dental hygienist may enter into a 20 contractual arrangement with any New York state licensed and registered 21 dentist, health care facility, program, and/or non-profit organization 22 to perform dental hygiene services in the following settings: dental 23 offices; long-term care facilities/skilled nursing facilities; public or 24 private schools; public health agencies/federally qualified health 25 centers; correctional facilities; public institutions/mental health 26 facilities; drug treatment facilities; and domestic violence shelters. 27 5. A collaborating dentist shall have collaborative agreements with no 28 more than six collaborative practice dental hygienists. The department 29 may grant exceptions to these limitations for public health settings on 30 a case-by-case basis. 31 6. A dental hygienist must make application to the department to prac- 32 tice as a registered dental hygienist, collaborative practice (RDH-CP) 33 and pay a fee set by the department. As a condition of collaborative 34 practice, the dental hygienist shall have been engaged in practice for 35 at least three years with a minimum of four thousand five hundred prac- 36 tice hours and shall complete an eight hour continuing education program 37 that includes instruction in medical emergency procedures, risk manage- 38 ment, dental hygiene jurisprudence and professional ethics. 39 § 17. This act shall take effect immediately and shall be deemed to 40 have been in full force and effect on and after April 1, 2024; provided, 41 however, that sections one through seven of this act shall take effect 42 one year after this act shall have become a law. 43 PART R 44 Section 1. The education law is amended by adding a new article 169 to 45 read as follows: 46 ARTICLE 169 47 INTERSTATE MEDICAL LICENSURE COMPACT 48 Section 8860. Short title. 49 8861. Purpose. 50 8862. Definitions. 51 8863. Eligibility. 52 8864. Designation of state of principal license. 53 8865. Application and issuance of expedited licensure. 54 8866. Fees for expedited licensure.S. 8307--A 92 A. 8807--A 1 8867. Renewal and continued participation. 2 8868. Coordinated information system. 3 8869. Joint investigations. 4 8870. Disciplinary actions. 5 8871. Interstate medical licensure compact commission. 6 8872. Powers and duties of the interstate commission. 7 8873. Finance powers. 8 8874. Organization and operation of the interstate commission. 9 8875. Rulemaking functions of the interstate commission. 10 8876. Oversight of interstate compact. 11 8877. Enforcement of interstate compact. 12 8878. Default procedures. 13 8879. Dispute resolution. 14 8880. Member states, effective date and amendment. 15 8881. Withdrawal. 16 8882. Dissolution. 17 8883. Severability and construction. 18 8884. Binding effect of compact and other laws. 19 § 8860. Short title. This article shall be known and may be cited as 20 the "interstate medical licensure compact". 21 § 8861. Purpose. In order to strengthen access to health care, and in 22 recognition of the advances in the delivery of health care, the member 23 states of the interstate medical licensure compact have allied in common 24 purpose to develop a comprehensive process that complements the existing 25 licensing and regulatory authority of state medical boards, provides a 26 streamlined process that allows physicians to become licensed in multi- 27 ple states, thereby enhancing the portability of a medical license and 28 ensuring the safety of patients. The compact creates another pathway 29 for licensure and does not otherwise change a state's existing medical 30 practice act. The compact also adopts the prevailing standard for licen- 31 sure and affirms that the practice of medicine occurs where the patient 32 is located at the time of the physician-patient encounter, and there- 33 fore, requires the physician to be under the jurisdiction of the state 34 medical board where the patient is located. State medical boards that 35 participate in the compact retain the jurisdiction to impose an adverse 36 action against a license to practice medicine in that state issued to a 37 physician through the procedures in the compact. 38 § 8862. Definitions. In this compact: 39 1. "Bylaws" means those bylaws established by the interstate commis- 40 sion pursuant to section eighty-eight hundred seventy-one of this arti- 41 cle for its governance, or for directing and controlling its actions and 42 conduct. 43 2. "Commissioner" means the voting representative appointed by each 44 member board pursuant to section eighty-eight hundred seventy-one of 45 this article. 46 3. "Conviction" means a finding by a court that an individual is guil- 47 ty of a criminal offense through adjudication, or entry of a plea of 48 guilt or no contest to the charge by the offender. Evidence of an entry 49 of a conviction of a criminal offense by the court shall be considered 50 final for purposes of disciplinary action by a member board. 51 4. "Expedited license" means a full and unrestricted medical license 52 granted by a member state to an eligible physician through the process 53 set forth in the compact. 54 5. "Interstate commission" means the interstate commission created 55 pursuant to section eighty-eight hundred seventy-one of this article.S. 8307--A 93 A. 8807--A 1 6. "License" means authorization by a member state for a physician to 2 engage in the practice of medicine, which would be unlawful without 3 authorization. 4 7. "Medical practice act" means laws and regulations governing the 5 practice of allopathic and osteopathic medicine within a member state. 6 8. "Member board" means a state agency in a member state that acts in 7 the sovereign interests of the state by protecting the public through 8 licensure, regulation, and education of physicians as directed by the 9 state government. 10 9. "Member state" means a state that has enacted the compact. 11 10. "Practice of medicine" means the clinical prevention, diagnosis, 12 or treatment of human disease, injury, or condition requiring a physi- 13 cian to obtain and maintain a license in compliance with the medical 14 practice act of a member state. 15 11. "Physician" means any person who: 16 (a) Is a graduate of a medical school accredited by the Liaison 17 Committee on Medical Education, the Commission on Osteopathic College 18 Accreditation, or a medical school listed in the International Medical 19 Education Directory or its equivalent; 20 (b) Passed each component of the United States Medical Licensing Exam- 21 ination (USMLE) or the Comprehensive Osteopathic Medical Licensing Exam- 22 ination (COMLEX-USA) within three attempts, or any of its predecessor 23 examinations accepted by a state medical board as an equivalent examina- 24 tion for licensure purposes; 25 (c) Successfully completed graduate medical education approved by the 26 Accreditation Council for Graduate Medical Education or the American 27 Osteopathic Association; 28 (d) Holds specialty certification or a time-unlimited specialty 29 certificate recognized by the American Board of Medical Specialties or 30 the American Osteopathic Association's Bureau of Osteopathic Special- 31 ists; 32 (e) Possesses a full and unrestricted license to engage in the prac- 33 tice of medicine issued by a member board; 34 (f) Has never been convicted, received adjudication, deferred adjudi- 35 cation, community supervision, or deferred disposition for any offense 36 by a court of appropriate jurisdiction; 37 (g) Has never held a license authorizing the practice of medicine 38 subjected to discipline by a licensing agency in any state, federal, or 39 foreign jurisdiction, excluding any action related to non-payment of 40 fees related to a license; 41 (h) Has never had a controlled substance license or permit suspended 42 or revoked by a state or the United States drug enforcement adminis- 43 tration; and 44 (i) Is not under active investigation by a licensing agency or law 45 enforcement authority in any state, federal, or foreign jurisdiction. 46 12. "Offense" means a felony, gross misdemeanor, or crime of moral 47 turpitude. 48 13. "Rule" means a written statement by the interstate commission 49 promulgated pursuant to section eighty-eight hundred seventy-two of this 50 article that is of general applicability, implements, interprets, or 51 prescribes a policy or provision of the compact, or an organizational, 52 procedural, or practice requirement of the interstate commission, and 53 has the force and effect of statutory law in a member state, and 54 includes the amendment, repeal, or suspension of an existing rule. 55 14. "State" means any state, commonwealth, district, or territory of 56 the United States.S. 8307--A 94 A. 8807--A 1 15. "State of principal license" means a member state where a physi- 2 cian holds a license to practice medicine and which has been designated 3 as such by the physician for purposes of registration and participation 4 in the compact. 5 § 8863. Eligibility. 1. A physician must meet the eligibility require- 6 ments as defined in subdivision eleven of section eighty-eight hundred 7 sixty-two of this article to receive an expedited license under the 8 terms and provisions of the compact. 9 2. A physician who does not meet the requirements of subdivision elev- 10 en of section eighty-eight hundred sixty-two of this article may obtain 11 a license to practice medicine in a member state if the individual 12 complies with all laws and requirements, other than the compact, relat- 13 ing to the issuance of a license to practice medicine in that state. 14 § 8864. Designation of state of principal license. 1. A physician 15 shall designate a member state as the state of principal license for 16 purposes of registration for expedited licensure through the compact if 17 the physician possesses a full and unrestricted license to practice 18 medicine in that state, and the state is: 19 (a) the state of principal residence for the physician, or 20 (b) the state where at least twenty-five percent of the practice of 21 medicine occurs, or 22 (c) the location of the physician's employer, or 23 (d) if no state qualifies under paragraph (a), (b), or (c) of this 24 subdivision, the state designated as state of residence for purpose of 25 federal income tax. 26 2. A physician may redesignate a member state as state of principal 27 license at any time, as long as the state meets the requirements of 28 subdivision one of this section. 29 3. The interstate commission is authorized to develop rules to facili- 30 tate redesignation of another member state as the state of principal 31 license. 32 § 8865. Application and issuance of expedited licensure. 1. A physi- 33 cian seeking licensure through the compact shall file an application for 34 an expedited license with the member board of the state selected by the 35 physician as the state of principal license. 36 2. Upon receipt of an application for an expedited license, the member 37 board within the state selected as the state of principal license shall 38 evaluate whether the physician is eligible for expedited licensure and 39 issue a letter of qualification, verifying or denying the physician's 40 eligibility, to the interstate commission. 41 (a) Static qualifications, which include verification of medical 42 education, graduate medical education, results of any medical or licens- 43 ing examination, and other qualifications as determined by the inter- 44 state commission through rule, shall not be subject to additional prima- 45 ry source verification where already primary source verified by the 46 state of principal license. 47 (b) The member board within the state selected as the state of princi- 48 pal license shall, in the course of verifying eligibility, perform a 49 criminal background check of an applicant, including the use of the 50 results of fingerprint or other biometric data checks compliant with the 51 requirements of the Federal Bureau of Investigation, with the exception 52 of federal employees who have suitability determination in accordance 53 with U.S. C.F.R. § 731.202. 54 (c) Appeal on the determination of eligibility shall be made to the 55 member state where the application was filed and shall be subject to the 56 law of that state.S. 8307--A 95 A. 8807--A 1 3. Upon verification under subdivision two of this section, physicians 2 eligible for an expedited license shall complete the registration proc- 3 ess established by the interstate commission to receive a license in a 4 member state selected pursuant to subdivision one of this section, 5 including the payment of any applicable fees. 6 4. After receiving verification of eligibility under subdivision two 7 of this section and any fees under subdivision three of this section, a 8 member board shall issue an expedited license to the physician. This 9 license shall authorize the physician to practice medicine in the issu- 10 ing state consistent with the medical practice act and all applicable 11 laws and regulations of the issuing member board and member state. 12 5. An expedited license shall be valid for a period consistent with 13 the licensure period in the member state and in the same manner as 14 required for other physicians holding a full and unrestricted license 15 within the member state. 16 6. An expedited license obtained though the compact shall be termi- 17 nated if a physician fails to maintain a license in the state of princi- 18 pal licensure for a non-disciplinary reason, without redesignation of a 19 new state of principal licensure. 20 7. The interstate commission is authorized to develop rules regarding 21 the application process, including payment of any applicable fees, and 22 the issuance of an expedited license. 23 § 8866. Fees for expedited licensure. 1. A member state issuing an 24 expedited license authorizing the practice of medicine in that state may 25 impose a fee for a license issued or renewed through the compact. 26 2. The interstate commission is authorized to develop rules regarding 27 fees for expedited licenses. 28 § 8867. Renewal and continued participation. 1. A physician seeking to 29 renew an expedited license granted in a member state shall complete a 30 renewal process with the interstate commission if the physician: 31 (a) Maintains a full and unrestricted license in a state of principal 32 license; 33 (b) Has not been convicted, received adjudication, deferred adjudi- 34 cation, community supervision, or deferred disposition for any offense 35 by a court of appropriate jurisdiction; 36 (c) Has not had a license authorizing the practice of medicine subject 37 to discipline by a licensing agency in any state, federal, or foreign 38 jurisdiction, excluding any action related to non-payment of fees 39 related to a license; and 40 (d) Has not had a controlled substance license or permit suspended or 41 revoked by a state or the United States drug enforcement administration. 42 2. Physicians shall comply with all continuing professional develop- 43 ment or continuing medical education requirements for renewal of a 44 license issued by a member state. 45 3. The interstate commission shall collect any renewal fees charged 46 for the renewal of a license and distribute the fees to the applicable 47 member board. 48 4. Upon receipt of any renewal fees collected in subdivision three of 49 this section, a member board shall renew the physician's license. 50 5. Physician information collected by the interstate commission during 51 the renewal process will be distributed to all member boards. 52 6. The interstate commission is authorized to develop rules to address 53 renewal of licenses obtained through the compact. 54 § 8868. Coordinated information system. 1. The interstate commission 55 shall establish a database of all physicians licensed, or who haveS. 8307--A 96 A. 8807--A 1 applied for licensure, under section eighty-eight hundred sixty-five of 2 this article. 3 2. Notwithstanding any other provision of law, member boards shall 4 report to the interstate commission any public action or complaints 5 against a licensed physician who has applied or received an expedited 6 license through the compact. 7 3. Member boards shall report disciplinary or investigatory informa- 8 tion determined as necessary and proper by rule of the interstate 9 commission. 10 4. Member boards may report any non-public complaint, disciplinary, or 11 investigatory information not required by subdivision three of this 12 section to the interstate commission. 13 5. Member boards shall share complaint or disciplinary information 14 about a physician upon request of another member board. 15 6. All information provided to the interstate commission or distrib- 16 uted by member boards shall be confidential, filed under seal, and used 17 only for investigatory or disciplinary matters. 18 7. The interstate commission is authorized to develop rules for 19 mandated or discretionary sharing of information by member boards. 20 § 8869. Joint investigations. 1. Licensure and disciplinary records of 21 physicians are deemed investigative. 22 2. In addition to the authority granted to a member board by its 23 respective medical practice act or other applicable state law, a member 24 board may participate with other member boards in joint investigations 25 of physicians licensed by the member boards. 26 3. A subpoena issued by a member state shall be enforceable in other 27 member states. 28 4. Member boards may share any investigative, litigation, or compli- 29 ance materials in furtherance of any joint or individual investigation 30 initiated under the compact. 31 5. Any member state may investigate actual or alleged violations of 32 the statutes authorizing the practice of medicine in any other member 33 state in which a physician holds a license to practice medicine. 34 § 8870. Disciplinary actions. 1. Any disciplinary action taken by any 35 member board against a physician licensed through the compact shall be 36 deemed unprofessional conduct which may be subject to discipline by 37 other member boards, in addition to any violation of the medical prac- 38 tice act or regulations in that state. 39 2. If a license granted to a physician by the member board in the 40 state of principal license is revoked, surrendered or relinquished in 41 lieu of discipline, or suspended, then all licenses issued to the physi- 42 cian by member boards shall automatically be placed, without further 43 action necessary by any member board, on the same status. If the member 44 board in the state of principal license subsequently reinstates the 45 physician's license, a license issued to the physician by any other 46 member board shall remain encumbered until that respective member board 47 takes action to reinstate the license in a manner consistent with the 48 medical practice act of that state. 49 3. If disciplinary action is taken against a physician by a member 50 board not in the state of principal license, any other member board may 51 deem the action conclusive as to matter of law and fact decided, and: 52 (a) impose the same or lesser sanction or sanctions against the physi- 53 cian so long as such sanctions are consistent with the medical practice 54 act of that state; orS. 8307--A 97 A. 8807--A 1 (b) pursue separate disciplinary action against the physician under 2 its respective medical practice act, regardless of the action taken in 3 other member states. 4 4. If a license granted to a physician by a member board is revoked, 5 surrendered, or relinquished in lieu of discipline, or suspended, then 6 any license or licenses issued to the physician by any other member 7 board or boards shall be suspended, automatically and immediately with- 8 out further action necessary by the other member board or boards, for 9 ninety days upon entry of the order by the disciplining board, to permit 10 the member board or boards to investigate the basis for the action under 11 the medical practice act of that state. A member board may terminate the 12 automatic suspension of the license it issued prior to the completion of 13 the ninety day suspension period in a manner consistent with the medical 14 practice act of that state. 15 § 8871. Interstate medical licensure compact commission. 1. The member 16 states hereby create the "interstate medical licensure compact commis- 17 sion". 18 2. The purpose of the interstate commission is the administration of 19 the interstate medical licensure compact, which is a discretionary state 20 function. 21 3. The interstate commission shall be a body corporate and joint agen- 22 cy of the member states and shall have all the responsibilities, powers, 23 and duties set forth in the compact, and such additional powers as may 24 be conferred upon it by a subsequent concurrent action of the respective 25 legislatures of the member states in accordance with the terms of the 26 compact. 27 4. The interstate commission shall consist of two voting represen- 28 tatives appointed by each member state who shall serve as commissioners. 29 In states where allopathic and osteopathic physicians are regulated by 30 separate member boards, or if the licensing and disciplinary authority 31 is split between multiple member boards within a member state, the 32 member state shall appoint one representative from each member board. A 33 commissioner shall be a or an: 34 (a) Allopathic or osteopathic physician appointed to a member board; 35 (b) Executive director, executive secretary, or similar executive of a 36 member board; or 37 (c) Member of the public appointed to a member board. 38 5. The interstate commission shall meet at least once each calendar 39 year. A portion of this meeting shall be a business meeting to address 40 such matters as may properly come before the commission, including the 41 election of officers. The chairperson may call additional meetings and 42 shall call for a meeting upon the request of a majority of the member 43 states. 44 6. The bylaws may provide for meetings of the interstate commission to 45 be conducted by telecommunication or electronic communication. 46 7. Each commissioner participating at a meeting of the interstate 47 commission is entitled to one vote. A majority of commissioners shall 48 constitute a quorum for the transaction of business, unless a larger 49 quorum is required by the bylaws of the interstate commission. A commis- 50 sioner shall not delegate a vote to another commissioner. In the absence 51 of its commissioner, a member state may delegate voting authority for a 52 specified meeting to another person from that state who shall meet the 53 requirements of subdivision four of this section. 54 8. The interstate commission shall provide public notice of all meet- 55 ings and all meetings shall be open to the public. The interstate 56 commission may close a meeting, in full or in portion, where it deter-S. 8307--A 98 A. 8807--A 1 mines by a two-thirds vote of the commissioners present that an open 2 meeting would be likely to: 3 (a) Relate solely to the internal personnel practices and procedures 4 of the interstate commission; 5 (b) Discuss matters specifically exempted from disclosure by federal 6 statute; 7 (c) Discuss trade secrets, commercial, or financial information that 8 is privileged or confidential; 9 (d) Involve accusing a person of a crime, or formally censuring a 10 person; 11 (e) Discuss information of a personal nature where disclosure would 12 constitute a clearly unwarranted invasion of personal privacy; 13 (f) Discuss investigative records compiled for law enforcement 14 purposes; or 15 (g) Specifically relate to the participation in a civil action or 16 other legal proceeding. 17 9. The interstate commission shall keep minutes which shall fully 18 describe all matters discussed in a meeting and shall provide a full and 19 accurate summary of actions taken, including record of any roll call 20 votes. 21 10. The interstate commission shall make its information and official 22 records, to the extent not otherwise designated in the compact or by its 23 rules, available to the public for inspection. 24 11. The interstate commission shall establish an executive committee, 25 which shall include officers, members, and others as determined by the 26 bylaws. The executive committee shall have the power to act on behalf of 27 the interstate commission, with the exception of rulemaking, during 28 periods when the interstate commission is not in session. When acting on 29 behalf of the interstate commission, the executive committee shall over- 30 see the administration of the compact including enforcement and compli- 31 ance with the provisions of the compact, its bylaws and rules, and other 32 such duties as necessary. 33 12. The interstate commission shall establish other committees for 34 governance and administration of the compact. 35 § 8872. Powers and duties of the interstate commission. The interstate 36 commission shall have the duty and power to: 37 1. Oversee and maintain the administration of the compact; 38 2. Promulgate rules which shall be binding to the extent and in the 39 manner provided for in the compact; 40 3. Issue, upon the request of a member state or member board, advisory 41 opinions concerning the meaning or interpretation of the compact, its 42 bylaws, rules, and actions; 43 4. Enforce compliance with compact provisions, the rules promulgated 44 by the interstate commission, and the bylaws, using all necessary and 45 proper means, including but not limited to the use of judicial process; 46 5. Establish and appoint committees including, but not limited to, an 47 executive committee as required by section eighty-eight hundred seven- 48 ty-one of this article, which shall have the power to act on behalf of 49 the interstate commission in carrying out its powers and duties; 50 6. Pay, or provide for the payment of the expenses related to the 51 establishment, organization, and ongoing activities of the interstate 52 commission; 53 7. Establish and maintain one or more offices; 54 8. Borrow, accept, hire, or contract for services of personnel; 55 9. Purchase and maintain insurance and bonds;S. 8307--A 99 A. 8807--A 1 10. Employ an executive director who shall have such powers to employ, 2 select or appoint employees, agents, or consultants, and to determine 3 their qualifications, define their duties, and fix their compensation; 4 11. Establish personnel policies and programs relating to conflicts of 5 interest, rates of compensation, and qualifications of personnel; 6 12. Accept donations and grants of money, equipment, supplies, materi- 7 als and services, and to receive, utilize, and dispose of it in a manner 8 consistent with the conflict of interest policies established by the 9 interstate commission; 10 13. Lease, purchase, accept contributions or donations of, or other- 11 wise to own, hold, improve, or use, any property, real, personal, or 12 mixed; 13 14. Sell, convey, mortgage, pledge, lease, exchange, abandon, or 14 otherwise dispose of any property, real, personal, or mixed; 15 15. Establish a budget and make expenditures; 16 16. Adopt a seal and bylaws governing the management and operation of 17 the interstate commission; 18 17. Report annually to the legislatures and governors of the member 19 states concerning the activities of the interstate commission during the 20 preceding year. Such reports shall also include reports of financial 21 audits and any recommendations that may have been adopted by the inter- 22 state commission; 23 18. Coordinate education, training, and public awareness regarding the 24 compact, its implementation, and its operation; 25 19. Maintain records in accordance with the bylaws; 26 20. Seek and obtain trademarks, copyrights, and patents; and 27 21. Perform such functions as may be necessary or appropriate to 28 achieve the purposes of the compact. 29 § 8873. Finance powers. 1. The interstate commission may levy on and 30 collect an annual assessment from each member state to cover the cost of 31 the operations and activities of the interstate commission and its 32 staff. The total assessment must be sufficient to cover the annual budg- 33 et approved each year for which revenue is not provided by other sourc- 34 es. The aggregate annual assessment amount shall be allocated upon a 35 formula to be determined by the interstate commission, which shall 36 promulgate a rule binding upon all member states. 37 2. The interstate commission shall not incur obligations of any kind 38 prior to securing the funds adequate to meet the same. 39 3. The interstate commission shall not pledge the credit of any of the 40 member states, except by, and with the authority of, the member state. 41 4. The interstate commission shall be subject to a yearly financial 42 audit conducted by a certified or licensed public accountant and the 43 report of the audit shall be included in the annual report of the inter- 44 state commission. 45 § 8874. Organization and operation of the interstate commission. 1. 46 The interstate commission shall, by a majority of commissioners present 47 and voting, adopt bylaws to govern its conduct as may be necessary or 48 appropriate to carry out the purposes of the compact within twelve 49 months of the first interstate commission meeting. 50 2. The interstate commission shall elect or appoint annually from 51 among its commissioners a chairperson, a vice-chairperson, and a treas- 52 urer, each of whom shall have such authority and duties as may be speci- 53 fied in the bylaws. The chairperson, or in the chairperson's absence or 54 disability, the vice-chairperson, shall preside at all meetings of the 55 interstate commission.S. 8307--A 100 A. 8807--A 1 3. Officers selected pursuant to subdivision two of this section shall 2 serve without remuneration from the interstate commission. 3 4. The officers and employees of the interstate commission shall be 4 immune from suit and liability, either personally or in their official 5 capacity, for a claim for damage to or loss of property or personal 6 injury or other civil liability caused or arising out of, or relating 7 to, an actual or alleged act, error, or omission that occurred, or that 8 such person had a reasonable basis for believing occurred, within the 9 scope of interstate commission employment, duties, or responsibilities; 10 provided that such person shall not be protected from suit or liability 11 for damage, loss, injury, or liability caused by the intentional or 12 willful and wanton misconduct of such person. 13 (a) The liability of the executive director and employees of the 14 interstate commission or representatives of the interstate commission, 15 acting within the scope of such person's employment or duties for acts, 16 errors, or omissions occurring within such person's state, may not 17 exceed the limits of liability set forth under the constitution and laws 18 of that state for state officials, employees, and agents. The interstate 19 commission is considered to be an instrumentality of the states for the 20 purposes of any such action. Nothing in this paragraph shall be 21 construed to protect such person from suit or liability for damage, 22 loss, injury, or liability caused by the intentional or willful and 23 wanton misconduct of such person. 24 (b) The interstate commission shall defend the executive director, its 25 employees, and subject to the approval of the attorney general or other 26 appropriate legal counsel of the member state represented by an inter- 27 state commission representative, shall defend such interstate commission 28 representative in any civil action seeking to impose liability arising 29 out of an actual or alleged act, error or omission that occurred within 30 the scope of interstate commission employment, duties or responsibil- 31 ities, or that the defendant had a reasonable basis for believing 32 occurred within the scope of interstate commission employment, duties, 33 or responsibilities, provided that the actual or alleged act, error, or 34 omission did not result from intentional or willful and wanton miscon- 35 duct on the part of such person. 36 (c) To the extent not covered by the state involved, member state, or 37 the interstate commission, the representatives or employees of the 38 interstate commission shall be held harmless in the amount of a settle- 39 ment or judgment, including attorney's fees and costs, obtained against 40 such persons arising out of an actual or alleged act, error, or omission 41 that occurred within the scope of interstate commission employment, 42 duties, or responsibilities, or that such persons had a reasonable basis 43 for believing occurred within the scope of interstate commission employ- 44 ment, duties, or responsibilities, provided that the actual or alleged 45 act, error, or omission did not result from intentional or willful and 46 wanton misconduct on the part of such persons. 47 § 8875. Rulemaking functions of the interstate commission. 1. The 48 interstate commission shall promulgate reasonable rules in order to 49 effectively and efficiently achieve the purposes of the compact. 50 Notwithstanding the foregoing, in the event the interstate commission 51 exercises its rulemaking authority in a manner that is beyond the scope 52 of the purposes of the compact, or the powers granted hereunder, then 53 such an action by the interstate commission shall be invalid and have no 54 force or effect. 55 2. Rules deemed appropriate for the operations of the interstate 56 commission shall be made pursuant to a rulemaking process that substan-S. 8307--A 101 A. 8807--A 1 tially conforms to the federal Model State Administrative Procedure Act 2 of 2010, and subsequent amendments thereto. 3 3. Not later than thirty days after a rule is promulgated, any person 4 may file a petition for judicial review of the rule in the United States 5 District Court for the District of Columbia or the federal district 6 where the interstate commission has its principal offices, provided that 7 the filing of such a petition shall not stay or otherwise prevent the 8 rule from becoming effective unless the court finds that the petitioner 9 has a substantial likelihood of success. The court shall give deference 10 to the actions of the interstate commission consistent with applicable 11 law and shall not find the rule to be unlawful if the rule represents a 12 reasonable exercise of the authority granted to the interstate commis- 13 sion. 14 § 8876. Oversight of interstate compact. 1. The executive, legisla- 15 tive, and judicial branches of state government in each member state 16 shall enforce the compact and shall take all actions necessary and 17 appropriate to effectuate the compact's purposes and intent. The 18 provisions of the compact and the rules promulgated hereunder shall have 19 standing as statutory law but shall not override existing state authori- 20 ty to regulate the practice of medicine. 21 2. All courts shall take judicial notice of the compact and the rules 22 in any judicial or administrative proceeding in a member state pertain- 23 ing to the subject matter of the compact which may affect the powers, 24 responsibilities or actions of the interstate commission. 25 3. The interstate commission shall be entitled to receive all service 26 of process in any such proceeding, and shall have standing to intervene 27 in the proceeding for all purposes. Failure to provide service of proc- 28 ess to the interstate commission shall render a judgment or order void 29 as to the interstate commission, the compact, or promulgated rules. 30 § 8877. Enforcement of interstate compact. 1. The interstate commis- 31 sion, in the reasonable exercise of its discretion, shall enforce the 32 provisions and rules of the compact. 33 2. The interstate commission may, by majority vote of the commission- 34 ers, initiate legal action in the United States District Court for the 35 District of Columbia, or, at the discretion of the interstate commis- 36 sion, in the federal district where the interstate commission has its 37 principal offices, to enforce compliance with the provisions of the 38 compact, and its promulgated rules and bylaws, against a member state in 39 default. The relief sought may include both injunctive relief and 40 damages. In the event judicial enforcement is necessary, the prevailing 41 party shall be awarded all costs of such litigation including reasonable 42 attorney's fees. 43 3. The remedies herein shall not be the exclusive remedies of the 44 interstate commission. The interstate commission may avail itself of 45 any other remedies available under state law or the regulation of a 46 profession. 47 § 8878. Default procedures. 1. The grounds for default include, but 48 are not limited to, failure of a member state to perform such obli- 49 gations or responsibilities imposed upon it by the compact, or the rules 50 and bylaws of the interstate commission promulgated under the compact. 51 2. If the interstate commission determines that a member state has 52 defaulted in the performance of its obligations or responsibilities 53 under the compact, or the bylaws or promulgated rules, the interstate 54 commission shall: 55 (a) Provide written notice to the defaulting state and other member 56 states, of the nature of the default, the means of curing the default,S. 8307--A 102 A. 8807--A 1 and any action taken by the interstate commission. The interstate 2 commission shall specify the conditions by which the defaulting state 3 must cure its default; and 4 (b) Provide remedial training and specific technical assistance 5 regarding the default. 6 3. If the defaulting state fails to cure the default, the defaulting 7 state shall be terminated from the compact upon an affirmative vote of a 8 majority of the commissioners and all rights, privileges, and benefits 9 conferred by the compact shall terminate on the effective date of termi- 10 nation. A cure of the default does not relieve the offending state of 11 obligations or liabilities incurred during the period of the default. 12 4. Termination of membership in the compact shall be imposed only 13 after all other means of securing compliance have been exhausted. Notice 14 of intent to terminate shall be given by the interstate commission to 15 the governor, the majority and minority leaders of the defaulting 16 state's legislature, and each of the member states. 17 5. The interstate commission shall establish rules and procedures to 18 address licenses and physicians that are materially impacted by the 19 termination of a member state, or the withdrawal of a member state. 20 6. The member state which has been terminated is responsible for all 21 dues, obligations, and liabilities incurred through the effective date 22 of termination including obligations, the performance of which extends 23 beyond the effective date of termination. 24 7. The interstate commission shall not bear any costs relating to any 25 state that has been found to be in default or which has been terminated 26 from the compact, unless otherwise mutually agreed upon in writing 27 between the interstate commission and the defaulting state. 28 8. The defaulting state may appeal the action of the interstate 29 commission by petitioning the United States District Court for the 30 District of Columbia or the federal district where the interstate 31 commission has its principal offices. The prevailing party shall be 32 awarded all costs of such litigation including reasonable attorney's 33 fees. 34 § 8879. Dispute resolution. 1. The interstate commission shall 35 attempt, upon the request of a member state, to resolve disputes which 36 are subject to the compact and which may arise among member states or 37 member boards. 38 2. The interstate commission shall promulgate rules providing for both 39 mediation and binding dispute resolution as appropriate. 40 § 8880. Member states, effective date and amendment. 1. Any state is 41 eligible to become a member state of the compact. 42 2. The compact shall become effective and binding upon legislative 43 enactment of the compact into law by no less than seven states. There- 44 after, it shall become effective and binding on a state upon enactment 45 of the compact into law by that state. 46 3. The governors of non-member states, or their designees, shall be 47 invited to participate in the activities of the interstate commission on 48 a non-voting basis prior to adoption of the compact by all states. 49 4. The interstate commission may propose amendments to the compact for 50 enactment by the member states. No amendment shall become effective and 51 binding upon the interstate commission and the member states unless and 52 until it is enacted into law by unanimous consent of the member states. 53 § 8881. Withdrawal. 1. Once effective, the compact shall continue in 54 force and remain binding upon each and every member state; provided that 55 a member state may withdraw from the compact by specifically repealing 56 the statute which enacted the compact into law.S. 8307--A 103 A. 8807--A 1 2. Withdrawal from the compact shall be by the enactment of a statute 2 repealing the same, but shall not take effect until one year after the 3 effective date of such statute and until written notice of the with- 4 drawal has been given by the withdrawing state to the governor of each 5 other member state. 6 3. The withdrawing state shall immediately notify the chairperson of 7 the interstate commission in writing upon the introduction of legis- 8 lation repealing the compact in the withdrawing state. 9 4. The interstate commission shall notify the other member states of 10 the withdrawing state's intent to withdraw within sixty days of its 11 receipt of notice provided under subdivision three of this section. 12 5. The withdrawing state is responsible for all dues, obligations and 13 liabilities incurred through the effective date of withdrawal, including 14 obligations, the performance of which extend beyond the effective date 15 of withdrawal. 16 6. Reinstatement following withdrawal of a member state shall occur 17 upon the withdrawing state reenacting the compact or upon such later 18 date as determined by the interstate commission. 19 7. The interstate commission is authorized to develop rules to address 20 the impact of the withdrawal of a member state on licenses granted in 21 other member states to physicians who designated the withdrawing member 22 state as the state of principal license. 23 § 8882. Dissolution. 1. The compact shall dissolve effective upon the 24 date of the withdrawal or default of the member state which reduces the 25 membership in the compact to one member state. 26 2. Upon the dissolution of the compact, the compact becomes null and 27 void and shall be of no further force or effect, and the business and 28 affairs of the interstate commission shall be concluded and surplus 29 funds shall be distributed in accordance with the bylaws. 30 § 8883. Severability and construction. 1. The provisions of the 31 compact shall be severable, and if any phrase, clause, sentence, or 32 provision is deemed unenforceable, the remaining provisions of the 33 compact shall be enforceable. 34 2. The provisions of the compact shall be liberally construed to 35 effectuate its purposes. 36 3. Nothing in the compact shall be construed to prohibit the applica- 37 bility of other interstate compacts to which the states are members. 38 § 8884. Binding effect of compact and other laws. 1. Nothing contained 39 in this article shall prevent the enforcement of any other law of a 40 member state that is not inconsistent with the compact. 41 2. All laws in a member state in conflict with the compact are super- 42 seded to the extent of the conflict. 43 3. All lawful actions of the interstate commission, including all 44 rules and bylaws promulgated by the commission, are binding upon the 45 member states. 46 4. All agreements between the interstate commission and the member 47 states are binding in accordance with their terms. 48 5. In the event any provision of the compact exceeds the constitu- 49 tional limits imposed on the legislature of any member state, such 50 provision shall be ineffective to the extent of the conflict with the 51 constitutional provision in question in that member state. 52 § 2. Article 170 of the education law is renumbered article 171 and a 53 new article 170 is added to title 8 of the education law to read as 54 follows: 55 ARTICLE 170 56 NURSE LICENSURE COMPACTS. 8307--A 104 A. 8807--A 1 Section 8900. Nurse licensure compact. 2 8901. Findings and declaration of purpose. 3 8902. Definitions. 4 8903. General provisions and jurisdiction. 5 8904. Applications for licensure in a party state. 6 8905. Additional authorities invested in party state licensing 7 boards. 8 8906. Coordinated licensure information system and exchange of 9 information. 10 8907. Establishment of the interstate commission of nurse licen- 11 sure compact administrators. 12 8908. Rulemaking. 13 8909. Oversight, dispute resolution and enforcement. 14 8910. Effective date, withdrawal and amendment. 15 8911. Construction and severability. 16 § 8900. Nurse licensure compact. The nurse license compact as set 17 forth in the article is hereby adopted and entered into with all party 18 states joining therein. 19 § 8901. Findings and declaration of purpose 1. Findings. The party 20 states find that: 21 a. The health and safety of the public are affected by the degree of 22 compliance with and the effectiveness of enforcement activities related 23 to state nurse licensure laws; 24 b. Violations of nurse licensure and other laws regulating the prac- 25 tice of nursing may result in injury or harm to the public; 26 c. The expanded mobility of nurses and the use of advanced communi- 27 cation technologies as part of our nation's health care delivery system 28 require greater coordination and cooperation among states in the areas 29 of nurse licensure and regulation; 30 d. New practice modalities and technology make compliance with indi- 31 vidual state nurse licensure laws difficult and complex; 32 e. The current system of duplicative licensure for nurses practicing 33 in multiple states is cumbersome and redundant for both nurses and 34 states; and 35 f. Uniformity of nurse licensure requirements throughout the states 36 promotes public safety and public health benefits. 37 2. Declaration of purpose. The general purposes of this compact are 38 to: 39 a. Facilitate the states' responsibility to protect the public's 40 health and safety; 41 b. Ensure and encourage the cooperation of party states in the areas 42 of nurse licensure and regulation; 43 c. Facilitate the exchange of information between party states in the 44 areas of nurse regulation, investigation and adverse actions; 45 d. Promote compliance with the laws governing the practice of nursing 46 in each jurisdiction; 47 e. Invest all party states with the authority to hold a nurse account- 48 able for meeting all state practice laws in the state in which the 49 patient is located at the time care is rendered through the mutual 50 recognition of party state licenses; 51 f. Decrease redundancies in the consideration and issuance of nurse 52 licenses; and 53 g. Provide opportunities for interstate practice by nurses who meet 54 uniform licensure requirements. 55 § 8902. Definitions. 1. Definitions. As used in this compact:S. 8307--A 105 A. 8807--A 1 a. "Adverse action" means any administrative, civil, equitable or 2 criminal action permitted by a state's laws which is imposed by a 3 licensing board or other authority against a nurse, including actions 4 against an individual's license or multistate licensure privilege such 5 as revocation, suspension, probation, monitoring of the licensee, limi- 6 tation on the licensee's practice, or any other encumbrance on licensure 7 affecting a nurse's authorization to practice, including issuance of a 8 cease and desist action. 9 b. "Alternative program" means a non-disciplinary monitoring program 10 approved by a licensing board. 11 c. "Coordinated licensure information system" means an integrated 12 process for collecting, storing and sharing information on nurse licen- 13 sure and enforcement activities related to nurse licensure laws that is 14 administered by a nonprofit organization composed of and controlled by 15 licensing boards. 16 d. "Commission" means the interstate commission of nurse licensure 17 compact administrators. 18 e. "Current significant investigative information" means: 19 1. Investigative information that a licensing board, after a prelimi- 20 nary inquiry that includes notification and an opportunity for the nurse 21 to respond, if required by state law, has reason to believe is not 22 groundless and, if proved true, would indicate more than a minor infrac- 23 tion; or 24 2. Investigative information that indicates that the nurse represents 25 an immediate threat to public health and safety regardless of whether 26 the nurse has been notified and had an opportunity to respond. 27 f. "Encumbrance" means a revocation or suspension of, or any limita- 28 tion on, the full and unrestricted practice of nursing imposed by a 29 licensing board. 30 g. "Home state" means the party state which is the nurse's primary 31 state of residence. 32 h. "Licensing board" means a party state's regulatory body responsible 33 for issuing nurse licenses. 34 i. "Multistate license" means a license to practice as a registered 35 nurse (RN) or as a licensed practical/vocational nurse (LPN/VN), which 36 is issued by a home state licensing board, and which authorizes the 37 licensed nurse to practice in all party states under a multistate licen- 38 sure privilege. 39 j. "Multistate licensure privilege" means a legal authorization asso- 40 ciated with a multistate license permitting the practice of nursing as 41 either a RN or a LPN/VN in a remote state. 42 k. "Nurse" means RN or LPN/VN, as those terms are defined by each 43 party state's practice laws. 44 l. "Party state" means any state that has adopted this compact. 45 m. "Remote state" means a party state, other than the home state. 46 n. "Single-state license" means a nurse license issued by a party 47 state that authorizes practice only within the issuing state and does 48 not include a multistate licensure privilege to practice in any other 49 party state. 50 o. "State" means a state, territory or possession of the United States 51 and the District of Columbia. 52 p. "State practice laws" means a party state's laws, rules and regu- 53 lations that govern the practice of nursing, define the scope of nursing 54 practice, and create the methods and grounds for imposing discipline. 55 "State practice laws" shall not include requirements necessary to obtainS. 8307--A 106 A. 8807--A 1 and retain a license, except for qualifications or requirements of the 2 home state. 3 § 8903. General provisions and jurisdiction. 1. General provisions and 4 jurisdiction. a. A multistate license to practice registered or licensed 5 practical/vocational nursing issued by a home state to a resident in 6 that state will be recognized by each party state as authorizing a nurse 7 to practice as a registered nurse (RN) or as a licensed 8 practical/vocational nurse (LPN/VN), under a multistate licensure privi- 9 lege, in each party state. 10 b. A state shall implement procedures for considering the criminal 11 history records of applicants for an initial multistate license or 12 licensure by endorsement. Such procedures shall include the submission 13 of fingerprints or other biometric-based information by applicants for 14 the purpose of obtaining an applicant's criminal history record informa- 15 tion from the federal bureau of investigation and the agency responsible 16 for retaining that state's criminal records. 17 c. Each party state shall require its licensing board to authorize an 18 applicant to obtain or retain a multistate license in the home state 19 only if the applicant: 20 i. Meets the home state's qualifications for licensure or renewal of 21 licensure, and complies with all other applicable state laws; 22 ii. (1) Has graduated or is eligible to graduate from a licensing 23 board-approved RN or LPN/VN prelicensure education program; or 24 (2) Has graduated from a foreign RN or LPN/VN prelicensure education 25 program that has been: (A) approved by the authorized accrediting body 26 in the applicable country, and (B) verified by an independent creden- 27 tials review agency to be comparable to a licensing board-approved prel- 28 icensure education program; 29 iii. Has, if a graduate of a foreign prelicensure education program 30 not taught in English or if English is not the individual's native 31 language, successfully passed an English proficiency examination that 32 includes the components of reading, speaking, writing and listening; 33 iv. Has successfully passed an NCLEX-RN or NCLEX-PN examination or 34 recognized predecessor, as applicable; 35 v. Is eligible for or holds an active, unencumbered license; 36 vi. Has submitted, in connection with an application for initial 37 licensure or licensure by endorsement, fingerprints or other biometric 38 data for the purpose of obtaining criminal history record information 39 from the federal bureau of investigation and the agency responsible for 40 retaining that state's criminal records; 41 vii. Has not been convicted or found guilty, or has entered into an 42 agreed disposition, of a felony offense under applicable state or feder- 43 al criminal law; 44 viii. Has not been convicted or found guilty, or has entered into an 45 agreed disposition, of a misdemeanor offense related to the practice of 46 nursing as determined on a case-by-case basis; 47 ix. Is not currently enrolled in an alternative program; 48 x. Is subject to self-disclosure requirements regarding current 49 participation in an alternative program; and 50 xi. Has a valid United States social security number. 51 d. All party states shall be authorized, in accordance with existing 52 state due process law, to take adverse action against a nurse's multi- 53 state licensure privilege such as revocation, suspension, probation or 54 any other action that affects a nurse's authorization to practice under 55 a multistate licensure privilege, including cease and desist actions. If 56 a party state takes such action, it shall promptly notify the adminis-S. 8307--A 107 A. 8807--A 1 trator of the coordinated licensure information system. The administra- 2 tor of the coordinated licensure information system shall promptly noti- 3 fy the home state of any such actions by remote states. 4 e. A nurse practicing in a party state shall comply with the state 5 practice laws of the state in which the client is located at the time 6 service is provided. The practice of nursing is not limited to patient 7 care but shall include all nursing practice as defined by the state 8 practice laws of the party state in which the client is located. The 9 practice of nursing in a party state under a multistate licensure privi- 10 lege will subject a nurse to the jurisdiction of the licensing board, 11 the courts and the laws of the party state in which the client is 12 located at the time service is provided. 13 f. Individuals not residing in a party state shall continue to be able 14 to apply for a party state's single-state license as provided under the 15 laws of each party state. However, the single-state license granted to 16 these individuals will not be recognized as granting the privilege to 17 practice nursing in any other party state. Nothing in this compact shall 18 affect the requirements established by a party state for the issuance of 19 a single-state license. 20 g. Any nurse holding a home state multistate license, on the effective 21 date of this compact, may retain and renew the multistate license issued 22 by the nurse's then-current home state, provided that: 23 i. A nurse, who changes primary state of residence after this 24 compact's effective date, shall meet all applicable requirements set 25 forth in this article to obtain a multistate license from a new home 26 state. 27 ii. A nurse who fails to satisfy the multistate licensure requirements 28 set forth in this article due to a disqualifying event occurring after 29 this compact's effective date shall be ineligible to retain or renew a 30 multistate license, and the nurse's multistate license shall be revoked 31 or deactivated in accordance with applicable rules adopted by the 32 commission. 33 § 8904. Applications for licensure in a party state. 1. Applications 34 for licensure in a party state. a. Upon application for a multistate 35 license, the licensing board in the issuing party state shall ascertain, 36 through the coordinated licensure information system, whether the appli- 37 cant has ever held, or is the holder of, a license issued by any other 38 state, whether there are any encumbrances on any license or multistate 39 licensure privilege held by the applicant, whether any adverse action 40 has been taken against any license or multistate licensure privilege 41 held by the applicant and whether the applicant is currently participat- 42 ing in an alternative program. 43 b. A nurse may hold a multistate license, issued by the home state, in 44 only one party state at a time. 45 c. If a nurse changes primary state of residence by moving between two 46 party states, the nurse must apply for licensure in the new home state, 47 and the multistate license issued by the prior home state will be deac- 48 tivated in accordance with applicable rules adopted by the commission. 49 i. The nurse may apply for licensure in advance of a change in primary 50 state of residence. 51 ii. A multistate license shall not be issued by the new home state 52 until the nurse provides satisfactory evidence of a change in primary 53 state of residence to the new home state and satisfies all applicable 54 requirements to obtain a multistate license from the new home state. 55 d. If a nurse changes primary state of residence by moving from a 56 party state to a non-party state, the multistate license issued by theS. 8307--A 108 A. 8807--A 1 prior home state will convert to a single-state license, valid only in 2 the former home state. 3 § 8905. Additional authorities invested in party state licensing 4 boards. 1. Licensing board authority. In addition to the other powers 5 conferred by state law, a licensing board shall have the authority to: 6 a. Take adverse action against a nurse's multistate licensure privi- 7 lege to practice within that party state. 8 i. Only the home state shall have the power to take adverse action 9 against a nurse's license issued by the home state. 10 ii. For purposes of taking adverse action, the home state licensing 11 board shall give the same priority and effect to reported conduct 12 received from a remote state as it would if such conduct had occurred 13 within the home state. In so doing, the home state shall apply its own 14 state laws to determine appropriate action. 15 b. Issue cease and desist orders or impose an encumbrance on a nurse's 16 authority to practice within that party state. 17 c. Complete any pending investigations of a nurse who changes primary 18 state of residence during the course of such investigations. The licens- 19 ing board shall also have the authority to take appropriate action or 20 actions and shall promptly report the conclusions of such investigations 21 to the administrator of the coordinated licensure information system. 22 The administrator of the coordinated licensure information system shall 23 promptly notify the new home state of any such actions. 24 d. Issue subpoenas for both hearings and investigations that require 25 the attendance and testimony of witnesses, as well as the production of 26 evidence. Subpoenas issued by a licensing board in a party state for the 27 attendance and testimony of witnesses or the production of evidence from 28 another party state shall be enforced in the latter state by any court 29 of competent jurisdiction, according to the practice and procedure of 30 that court applicable to subpoenas issued in proceedings pending before 31 it. The issuing authority shall pay any witness fees, travel expenses, 32 mileage and other fees required by the service statutes of the state in 33 which the witnesses or evidence are located. 34 e. Obtain and submit, for each nurse licensure applicant, fingerprint 35 or other biometric-based information to the federal bureau of investi- 36 gation for criminal background checks, receive the results of the feder- 37 al bureau of investigation record search on criminal background checks 38 and use the results in making licensure decisions. 39 f. If otherwise permitted by state law, recover from the affected 40 nurse the costs of investigations and disposition of cases resulting 41 from any adverse action taken against that nurse. 42 g. Take adverse action based on the factual findings of the remote 43 state, provided that the licensing board follows its own procedures for 44 taking such adverse action. 45 2. Adverse actions. a. If adverse action is taken by the home state 46 against a nurse's multistate license, the nurse's multistate licensure 47 privilege to practice in all other party states shall be deactivated 48 until all encumbrances have been removed from the multistate license. 49 All home state disciplinary orders that impose adverse action against a 50 nurse's multistate license shall include a statement that the nurse's 51 multistate licensure privilege is deactivated in all party states during 52 the pendency of the order. 53 b. Nothing in this compact shall override a party state's decision 54 that participation in an alternative program may be used in lieu of 55 adverse action. The home state licensing board shall deactivate theS. 8307--A 109 A. 8807--A 1 multistate licensure privilege under the multistate license of any nurse 2 for the duration of the nurse's participation in an alternative program. 3 § 8906. Coordinated licensure information system and exchange of 4 information. 1. Coordinated licensure information system and exchange 5 of information. a. All party states shall participate in a coordinated 6 licensure information system of all licensed registered nurses (RNs) and 7 licensed practical/vocational nurses (LPNs/VNs). This system will 8 include information on the licensure and disciplinary history of each 9 nurse, as submitted by party states, to assist in the coordination of 10 nurse licensure and enforcement efforts. 11 b. The commission, in consultation with the administrator of the coor- 12 dinated licensure information system, shall formulate necessary and 13 proper procedures for the identification, collection and exchange of 14 information under this compact. 15 c. All licensing boards shall promptly report to the coordinated 16 licensure information system any adverse action, any current significant 17 investigative information, denials of applications with the reasons for 18 such denials and nurse participation in alternative programs known to 19 the licensing board regardless of whether such participation is deemed 20 nonpublic or confidential under state law. 21 d. Current significant investigative information and participation in 22 nonpublic or confidential alternative programs shall be transmitted 23 through the coordinated licensure information system only to party state 24 licensing boards. 25 e. Notwithstanding any other provision of law, all party state licens- 26 ing boards contributing information to the coordinated licensure infor- 27 mation system may designate information that may not be shared with 28 non-party states or disclosed to other entities or individuals without 29 the express permission of the contributing state. 30 f. Any personally identifiable information obtained from the coordi- 31 nated licensure information system by a party state licensing board 32 shall not be shared with non-party states or disclosed to other entities 33 or individuals except to the extent permitted by the laws of the party 34 state contributing the information. 35 g. Any information contributed to the coordinated licensure informa- 36 tion system that is subsequently required to be expunged by the laws of 37 the party state contributing that information shall also be expunged 38 from the coordinated licensure information system. 39 h. The compact administrator of each party state shall furnish a 40 uniform data set to the compact administrator of each other party state, 41 which shall include, at a minimum: 42 i. Identifying information; 43 ii. Licensure data; 44 iii. Information related to alternative program participation; and 45 iv. Other information that may facilitate the administration of this 46 compact, as determined by commission rules. 47 i. The compact administrator of a party state shall provide all inves- 48 tigative documents and information requested by another party state. 49 § 8907. Establishment of the interstate commission of nurse licensure 50 compact administrators. 1. Commission of nurse licensure compact admin- 51 istrators. The party states hereby create and establish a joint public 52 entity known as the interstate commission of nurse licensure compact 53 administrators. The commission is an instrumentality of the party 54 states. 55 2. Venue. Venue is proper, and judicial proceedings by or against the 56 commission shall be brought solely and exclusively, in a court of compe-S. 8307--A 110 A. 8807--A 1 tent jurisdiction where the principal office of the commission is 2 located. The commission may waive venue and jurisdictional defenses to 3 the extent it adopts or consents to participate in alternative dispute 4 resolution proceedings. 5 3. Sovereign immunity. Nothing in this compact shall be construed to 6 be a waiver of sovereign immunity. 7 4. Membership, voting and meetings. a. Each party state shall have and 8 be limited to one administrator. The head of the state licensing board 9 or designee shall be the administrator of this compact for each party 10 state. Any administrator may be removed or suspended from office as 11 provided by the law of the state from which the administrator is 12 appointed. Any vacancy occurring in the commission shall be filled in 13 accordance with the laws of the party state in which the vacancy exists. 14 b. Each administrator shall be entitled to one vote with regard to the 15 promulgation of rules and creation of bylaws and shall otherwise have an 16 opportunity to participate in the business and affairs of the commis- 17 sion. An administrator shall vote in person or by such other means as 18 provided in the bylaws. The bylaws may provide for an administrator's 19 participation in meetings by telephone or other means of communication. 20 c. The commission shall meet at least once during each calendar year. 21 Additional meetings shall be held as set forth in the bylaws or rules of 22 the commission. 23 d. All meetings shall be open to the public, and public notice of 24 meetings shall be given in the same manner as required under the rule- 25 making provisions in section eighty-nine hundred eight of this article. 26 5. Closed meetings. a. The commission may convene in a closed, nonpub- 27 lic meeting if the commission shall discuss: 28 i. Noncompliance of a party state with its obligations under this 29 compact; 30 ii. The employment, compensation, discipline or other personnel 31 matters, practices or procedures related to specific employees or other 32 matters related to the commission's internal personnel practices and 33 procedures; 34 iii. Current, threatened or reasonably anticipated litigation; 35 iv. Negotiation of contracts for the purchase or sale of goods, 36 services or real estate; 37 v. Accusing any person of a crime or formally censuring any person; 38 vi. Disclosure of trade secrets or commercial or financial information 39 that is privileged or confidential; 40 vii. Disclosure of information of a personal nature where disclosure 41 would constitute a clearly unwarranted invasion of personal privacy; 42 viii. Disclosure of investigatory records compiled for law enforcement 43 purposes; 44 ix. Disclosure of information related to any reports prepared by or on 45 behalf of the commission for the purpose of investigation of compliance 46 with this compact; or 47 x. Matters specifically exempted from disclosure by federal or state 48 statute. 49 b. If a meeting, or portion of a meeting, is closed pursuant to this 50 paragraph the commission's legal counsel or designee shall certify that 51 the meeting may be closed and shall reference each relevant exempting 52 provision. The commission shall keep minutes that fully and clearly 53 describe all matters discussed in a meeting and shall provide a full and 54 accurate summary of actions taken, and the reasons therefor, including a 55 description of the views expressed. All documents considered in 56 connection with an action shall be identified in such minutes. AllS. 8307--A 111 A. 8807--A 1 minutes and documents of a closed meeting shall remain under seal, 2 subject to release by a majority vote of the commission or order of a 3 court of competent jurisdiction. 4 c. The commission shall, by a majority vote of the administrators, 5 prescribe bylaws or rules to govern its conduct as may be necessary or 6 appropriate to carry out the purposes and exercise the powers of this 7 compact, including but not limited to: 8 i. Establishing the fiscal year of the commission; 9 ii. Providing reasonable standards and procedures: 10 (1) For the establishment and meetings of other committees; and 11 (2) Governing any general or specific delegation of any authority or 12 function of the commission; 13 iii. Providing reasonable procedures for calling and conducting meet- 14 ings of the commission, ensuring reasonable advance notice of all meet- 15 ings and providing an opportunity for attendance of such meetings by 16 interested parties, with enumerated exceptions designed to protect the 17 public's interest, the privacy of individuals, and proprietary informa- 18 tion, including trade secrets. The commission may meet in closed session 19 only after a majority of the administrators vote to close a meeting in 20 whole or in part. As soon as practicable, the commission must make 21 public a copy of the vote to close the meeting revealing the vote of 22 each administrator, with no proxy votes allowed; 23 iv. Establishing the titles, duties and authority and reasonable 24 procedures for the election of the officers of the commission; 25 v. Providing reasonable standards and procedures for the establishment 26 of the personnel policies and programs of the commission. Notwithstand- 27 ing any civil service or other similar laws of any party state, the 28 bylaws shall exclusively govern the personnel policies and programs of 29 the commission; and 30 vi. Providing a mechanism for winding up the operations of the commis- 31 sion and the equitable disposition of any surplus funds that may exist 32 after the termination of this compact after the payment or reserving of 33 all of its debts and obligations. 34 6. General provisions. a. The commission shall publish its bylaws and 35 rules, and any amendments thereto, in a convenient form on the website 36 of the commission. 37 b. The commission shall maintain its financial records in accordance 38 with the bylaws. 39 c. The commission shall meet and take such actions as are consistent 40 with the provisions of this compact and the bylaws. 41 7. Powers of the commission. The commission shall have the following 42 powers: 43 a. To promulgate uniform rules to facilitate and coordinate implemen- 44 tation and administration of this compact. The rules shall have the 45 force and effect of law and shall be binding in all party states; 46 b. To bring and prosecute legal proceedings or actions in the name of 47 the commission, provided that the standing of any licensing board to sue 48 or be sued under applicable law shall not be affected; 49 c. To purchase and maintain insurance and bonds; 50 d. To borrow, accept or contract for services of personnel, including, 51 but not limited to, employees of a party state or nonprofit organiza- 52 tions; 53 e. To cooperate with other organizations that administer state 54 compacts related to the regulation of nursing, including but not limited 55 to sharing administrative or staff expenses, office space or other 56 resources;S. 8307--A 112 A. 8807--A 1 f. To hire employees, elect or appoint officers, fix compensation, 2 define duties, grant such individuals appropriate authority to carry out 3 the purposes of this compact, and to establish the commission's person- 4 nel policies and programs relating to conflicts of interest, qualifica- 5 tions of personnel and other related personnel matters; 6 g. To accept any and all appropriate donations, grants and gifts of 7 money, equipment, supplies, materials and services, and to receive, 8 utilize and dispose of the same; provided that at all times the commis- 9 sion shall avoid any appearance of impropriety or conflict of interest; 10 h. To lease, purchase, accept appropriate gifts or donations of, or 11 otherwise to own, hold, improve or use, any property, whether real, 12 personal or mixed; provided that at all times the commission shall avoid 13 any appearance of impropriety; 14 i. To sell, convey, mortgage, pledge, lease, exchange, abandon or 15 otherwise dispose of any property, whether real, personal or mixed; 16 j. To establish a budget and make expenditures; 17 k. To borrow money; 18 l. To appoint committees, including advisory committees comprised of 19 administrators, state nursing regulators, state legislators or their 20 representatives, and consumer representatives, and other such interested 21 persons; 22 m. To provide and receive information from, and to cooperate with, law 23 enforcement agencies; 24 n. To adopt and use an official seal; and 25 o. To perform such other functions as may be necessary or appropriate 26 to achieve the purposes of this compact consistent with the state regu- 27 lation of nurse licensure and practice. 28 8. Financing of the commission. a. The commission shall pay, or 29 provide for the payment of, the reasonable expenses of its establish- 30 ment, organization and ongoing activities. 31 b. The commission may also levy on and collect an annual assessment 32 from each party state to cover the cost of its operations, activities 33 and staff in its annual budget as approved each year. The aggregate 34 annual assessment amount, if any, shall be allocated based upon a formu- 35 la to be determined by the commission, which shall promulgate a rule 36 that is binding upon all party states. 37 c. The commission shall not incur obligations of any kind prior to 38 securing the funds adequate to meet the same; nor shall the commission 39 pledge the credit of any of the party states, except by, and with the 40 authority of, such party state. 41 d. The commission shall keep accurate accounts of all receipts and 42 disbursements. The receipts and disbursements of the commission shall be 43 subject to the audit and accounting procedures established under its 44 bylaws. However, all receipts and disbursements of funds handled by the 45 commission shall be audited yearly by a certified or licensed public 46 accountant, and the report of the audit shall be included in and become 47 part of the annual report of the commission. 48 9. Qualified immunity, defense and indemnification. a. The administra- 49 tors, officers, executive director, employees and representatives of the 50 commission shall be immune from suit and liability, either personally or 51 in their official capacity, for any claim for damage to or loss of prop- 52 erty or personal injury or other civil liability caused by or arising 53 out of any actual or alleged act, error or omission that occurred, or 54 that the person against whom the claim is made had a reasonable basis 55 for believing occurred, within the scope of the commission's employment, 56 duties or responsibilities; provided that nothing in this paragraphS. 8307--A 113 A. 8807--A 1 shall be construed to protect any such person from suit or liability for 2 any damage, loss, injury or liability caused by the intentional, willful 3 or wanton misconduct of that person. 4 b. The commission shall defend any administrator, officer, executive 5 director, employee or representative of the commission in any civil 6 action seeking to impose liability arising out of any actual or alleged 7 act, error or omission that occurred within the scope of the commis- 8 sion's employment, duties or responsibilities, or that the person 9 against whom the claim is made had a reasonable basis for believing 10 occurred within the scope of the commission's employment, duties or 11 responsibilities; provided that nothing herein shall be construed to 12 prohibit that person from retaining his or her own counsel; and provided 13 further that the actual or alleged act, error or omission did not result 14 from that person's intentional, willful or wanton misconduct. 15 c. The commission shall indemnify and hold harmless any administrator, 16 officer, executive director, employee or representative of the commis- 17 sion for the amount of any settlement or judgment obtained against that 18 person arising out of any actual or alleged act, error or omission that 19 occurred within the scope of the commission's employment, duties or 20 responsibilities, or that such person had a reasonable basis for believ- 21 ing occurred within the scope of the commission's employment, duties or 22 responsibilities, provided that the actual or alleged act, error or 23 omission did not result from the intentional, willful or wanton miscon- 24 duct of that person. 25 § 8908. Rulemaking. 1. Rulemaking. a. The commission shall exercise 26 its rulemaking powers pursuant to the criteria set forth in this article 27 and the rules adopted thereunder. Rules and amendments shall become 28 binding as of the date specified in each rule or amendment and shall 29 have the same force and effect as provisions of this compact. 30 b. Rules or amendments to the rules shall be adopted at a regular or 31 special meeting of the commission. 32 2. Notice. a. Prior to promulgation and adoption of a final rule or 33 rules by the commission, and at least sixty days in advance of the meet- 34 ing at which the rule will be considered and voted upon, the commission 35 shall file a notice of proposed rulemaking: 36 i. On the website of the commission; and 37 ii. On the website of each licensing board or the publication in which 38 each state would otherwise publish proposed rules. 39 b. The notice of proposed rulemaking shall include: 40 i. The proposed time, date and location of the meeting in which the 41 rule will be considered and voted upon; 42 ii. The text of the proposed rule or amendment, and the reason for the 43 proposed rule; 44 iii. A request for comments on the proposed rule from any interested 45 person; and 46 iv. The manner in which interested persons may submit notice to the 47 commission of their intention to attend the public hearing and any writ- 48 ten comments. 49 c. Prior to adoption of a proposed rule, the commission shall allow 50 persons to submit written data, facts, opinions and arguments, which 51 shall be made available to the public. 52 3. Public hearings on rules. a. The commission shall grant an opportu- 53 nity for a public hearing before it adopts a rule or amendment. 54 b. The commission shall publish the place, time and date of the sched- 55 uled public hearing.S. 8307--A 114 A. 8807--A 1 i. Hearings shall be conducted in a manner providing each person who 2 wishes to comment a fair and reasonable opportunity to comment orally or 3 in writing. All hearings will be recorded, and a copy will be made 4 available upon request. 5 ii. Nothing in this section shall be construed as requiring a separate 6 hearing on each rule. Rules may be grouped for the convenience of the 7 commission at hearings required by this section. 8 c. If no one appears at the public hearing, the commission may proceed 9 with promulgation of the proposed rule. 10 d. Following the scheduled hearing date, or by the close of business 11 on the scheduled hearing date if the hearing was not held, the commis- 12 sion shall consider all written and oral comments received. 13 4. Voting on rules. The commission shall, by majority vote of all 14 administrators, take final action on the proposed rule and shall deter- 15 mine the effective date of the rule, if any, based on the rulemaking 16 record and the full text of the rule. 17 5. Emergency rules. Upon determination that an emergency exists, the 18 commission may consider and adopt an emergency rule without prior 19 notice, opportunity for comment or hearing, provided that the usual 20 rulemaking procedures provided in this compact and in this section shall 21 be retroactively applied to the rule as soon as reasonably possible, in 22 no event later than ninety days after the effective date of the rule. 23 For the purposes of this provision, an emergency rule is one that must 24 be adopted immediately in order to: 25 a. Meet an imminent threat to public health, safety or welfare; 26 b. Prevent a loss of the commission or party state funds; or 27 c. Meet a deadline for the promulgation of an administrative rule that 28 is required by federal law or rule. 29 6. Revisions. The commission may direct revisions to a previously 30 adopted rule or amendment for purposes of correcting typographical 31 errors, errors in format, errors in consistency or grammatical errors. 32 Public notice of any revisions shall be posted on the website of the 33 commission. The revision shall be subject to challenge by any person for 34 a period of thirty days after posting. The revision may be challenged 35 only on grounds that the revision results in a material change to a 36 rule. A challenge shall be made in writing, and delivered to the 37 commission, prior to the end of the notice period. If no challenge is 38 made, the revision will take effect without further action. If the 39 revision is challenged, the revision may not take effect without the 40 approval of the commission. 41 § 8909. Oversight, dispute resolution and enforcement. 1. Oversight. 42 a. Each party state shall enforce this compact and take all actions 43 necessary and appropriate to effectuate this compact's purposes and 44 intent. 45 b. The commission shall be entitled to receive service of process in 46 any proceeding that may affect the powers, responsibilities or actions 47 of the commission, and shall have standing to intervene in such a 48 proceeding for all purposes. Failure to provide service of process in 49 such proceeding to the commission shall render a judgment or order void 50 as to the commission, this compact or promulgated rules. 51 2. Default, technical assistance and termination. a. If the commission 52 determines that a party state has defaulted in the performance of its 53 obligations or responsibilities under this compact or the promulgated 54 rules, the commission shall:S. 8307--A 115 A. 8807--A 1 i. Provide written notice to the defaulting state and other party 2 states of the nature of the default, the proposed means of curing the 3 default or any other action to be taken by the commission; and 4 ii. Provide remedial training and specific technical assistance 5 regarding the default. 6 b. If a state in default fails to cure the default, the defaulting 7 state's membership in this compact may be terminated upon an affirmative 8 vote of a majority of the administrators, and all rights, privileges and 9 benefits conferred by this compact may be terminated on the effective 10 date of termination. A cure of the default does not relieve the offend- 11 ing state of obligations or liabilities incurred during the period of 12 default. 13 c. Termination of membership in this compact shall be imposed only 14 after all other means of securing compliance have been exhausted. Notice 15 of intent to suspend or terminate shall be given by the commission to 16 the governor of the defaulting state and to the executive officer of the 17 defaulting state's licensing board and each of the party states. 18 d. A state whose membership in this compact has been terminated is 19 responsible for all assessments, obligations and liabilities incurred 20 through the effective date of termination, including obligations that 21 extend beyond the effective date of termination. 22 e. The commission shall not bear any costs related to a state that is 23 found to be in default or whose membership in this compact has been 24 terminated unless agreed upon in writing between the commission and the 25 defaulting state. 26 f. The defaulting state may appeal the action of the commission by 27 petitioning the U.S. District Court for the District of Columbia or the 28 federal district in which the commission has its principal offices. The 29 prevailing party shall be awarded all costs of such litigation, includ- 30 ing reasonable attorneys' fees. 31 3. Dispute resolution. a. Upon request by a party state, the commis- 32 sion shall attempt to resolve disputes related to the compact that arise 33 among party states and between party and non-party states. 34 b. The commission shall promulgate a rule providing for both mediation 35 and binding dispute resolution for disputes, as appropriate. 36 c. In the event the commission cannot resolve disputes among party 37 states arising under this compact: 38 i. The party states may submit the issues in dispute to an arbitration 39 panel, which will be comprised of individuals appointed by the compact 40 administrator in each of the affected party states, and an individual 41 mutually agreed upon by the compact administrators of all the party 42 states involved in the dispute. 43 ii. The decision of a majority of the arbitrators shall be final and 44 binding. 45 4. Enforcement. a. The commission, in the reasonable exercise of its 46 discretion, shall enforce the provisions and rules of this compact. 47 b. By majority vote, the commission may initiate legal action in the 48 U.S. District Court for the District of Columbia or the federal 49 district in which the commission has its principal offices against a 50 party state that is in default to enforce compliance with the provisions 51 of this compact and its promulgated rules and bylaws. The relief sought 52 may include both injunctive relief and damages. In the event judicial 53 enforcement is necessary, the prevailing party shall be awarded all 54 costs of such litigation, including reasonable attorneys' fees.S. 8307--A 116 A. 8807--A 1 c. The remedies herein shall not be the exclusive remedies of the 2 commission. The commission may pursue any other remedies available under 3 federal or state law. 4 § 8910. Effective date, withdrawal and amendment. 1. Effective date. 5 a. This compact shall become effective and binding on the earlier of 6 the date of legislative enactment of this compact into law by no less 7 than twenty-six states or the effective date of the chapter of the laws 8 of two thousand twenty-four that enacted this compact. Thereafter, the 9 compact shall become effective and binding as to any other compacting 10 state upon enactment of the compact into law by that state. All party 11 states to this compact, that also were parties to the prior nurse licen- 12 sure compact, superseded by this compact, (herein referred to as "prior 13 compact"), shall be deemed to have withdrawn from said prior compact 14 within six months after the effective date of this compact. 15 b. Each party state to this compact shall continue to recognize a 16 nurse's multistate licensure privilege to practice in that party state 17 issued under the prior compact until such party state has withdrawn from 18 the prior compact. 19 2. Withdrawal. a. Any party state may withdraw from this compact by 20 enacting a statute repealing the same. A party state's withdrawal shall 21 not take effect until six months after enactment of the repealing stat- 22 ute. 23 b. A party state's withdrawal or termination shall not affect the 24 continuing requirement of the withdrawing or terminated state's licens- 25 ing board to report adverse actions and significant investigations 26 occurring prior to the effective date of such withdrawal or termination. 27 c. Nothing contained in this compact shall be construed to invalidate 28 or prevent any nurse licensure agreement or other cooperative arrange- 29 ment between a party state and a non-party state that is made in accord- 30 ance with the other provisions of this compact. 31 3. Amendment. a. This compact may be amended by the party states. No 32 amendment to this compact shall become effective and binding upon the 33 party states unless and until it is enacted into the laws of all party 34 states. 35 b. Representatives of non-party states to this compact shall be 36 invited to participate in the activities of the commission, on a nonvot- 37 ing basis, prior to the adoption of this compact by all states. 38 § 8911. Construction and severability. 1. Construction and severabil- 39 ity. This compact shall be liberally construed so as to effectuate the 40 purposes thereof. The provisions of this compact shall be severable, and 41 if any phrase, clause, sentence or provision of this compact is declared 42 to be contrary to the constitution of any party state or of the United 43 States, or if the applicability thereof to any government, agency, 44 person or circumstance is held to be invalid, the validity of the 45 remainder of this compact and the applicability thereof to any govern- 46 ment, agency, person or circumstance shall not be affected thereby. If 47 this compact shall be held to be contrary to the constitution of any 48 party state, this compact shall remain in full force and effect as to 49 the remaining party states and in full force and effect as to the party 50 state affected as to all severable matters. 51 § 3. This act shall take effect immediately and shall be deemed to 52 have been in full force and effect on and after April 1, 2024. 53 PART SS. 8307--A 117 A. 8807--A 1 Section 1. The public health law is amended by adding a new section 2 2825-i to read as follows: 3 § 2825-i. Healthcare safety net transformation program. 1. A statewide 4 healthcare safety net transformation program shall be established within 5 the department for the purpose of supporting the transformation of safe- 6 ty net hospitals to improve access, equity, quality, and outcomes while 7 increasing the financial sustainability of safety net hospitals. Such 8 program may provide or utilize new or existing capital funding, or oper- 9 ating subsidies, or both. Any application for this program must be 10 jointly submitted by a safety net hospital and at least one partner 11 organization. 12 2. The commissioner shall enter an agreement with the president of the 13 dormitory authority of the state of New York pursuant to section sixteen 14 hundred eighty-r of the public authorities law, as required, which shall 15 apply to this agreement, subject to the approval of the director of the 16 division of the budget, for the purposes of the distribution and admin- 17 istration of available funds pursuant to such agreement and made avail- 18 able pursuant to this section and subject to appropriation. Such funds 19 may be awarded and distributed by the department to safety net hospi- 20 tals, or a partner organization, in the form of grants. To qualify as a 21 safety net hospital for purposes of this section, a hospital shall: 22 (a) be either a public hospital, a rural emergency hospital, critical 23 access hospital or sole community hospital; 24 (b) have at least thirty percent of its inpatient discharges made up 25 of medical assistance program eligible individuals, uninsured individ- 26 uals or medical assistance program dually eligible individuals and at 27 least thirty-five percent of its outpatient visits made up of medical 28 assistance program eligible individuals, uninsured individuals or 29 medical assistance program dually-eligible individuals; 30 (c) serve at least thirty percent of the residents of a county or a 31 multi-county area who are medical assistance program eligible individ- 32 uals, uninsured individuals or medical assistance program dually-eligi- 33 ble individuals; or 34 (d) in the discretion of the commissioner, serve a significant popu- 35 lation of medical assistance program eligible individuals, uninsured 36 individuals or medical assistance program dually-eligible individuals. 37 3. Partner organizations may include, but are not limited to, health 38 systems, hospitals, health plans, residential health care facilities, 39 physician groups, community-based organization, or other healthcare 40 entities who can serve as partners in the transformation of the safety 41 net hospital. The commissioner shall have the discretion to deem any 42 organization a partner organization upon a finding that deeming so will 43 advance the goals of this section. 44 4. Notwithstanding any law to the contrary, and in accordance with 45 section four of the state finance law, the comptroller is hereby author- 46 ized and directed to transfer, upon request of the director of budget, 47 on or before March thirty-first, two thousand twenty-five, up to five 48 hundred million dollars to the department from amounts appropriated to 49 administer the programs established in sections twenty-eight hundred 50 twenty-five-g and twenty-eight hundred twenty-five-h of this article to 51 support this program. Notwithstanding section one hundred sixty-three 52 of the state finance law, sections one hundred forty-two and one hundred 53 forty-three of the economic development law or any inconsistent 54 provisions of law to the contrary, awards may be provided without a 55 competitive bid or request for proposal process to safety net hospitals 56 or partner organizations for purposes of increasing access, equity,S. 8307--A 118 A. 8807--A 1 quality, outcomes, and long-term financial sustainability of such safety 2 net hospitals. 3 5. Notwithstanding any provision of law to the contrary, the commis- 4 sioner is authorized to waive any regulatory requirements to allow 5 applicants to more effectively or efficiently implement projects awarded 6 through the healthcare safety net transformation program, provided, 7 however, that regulations pertaining to patient safety, patient auton- 8 omy, patient privacy, patient rights, due process, scope of practice, 9 professional licensure, environmental protections, provider reimburse- 10 ment methodologies, or occupational standards and employee rights may 11 not be waived, nor shall any regulations be waived if such waiver would 12 risk patient safety. Such waiver shall not exceed the life of the 13 project or such shorter time periods as the commissioner may determine. 14 Any regulatory relief granted pursuant to this subdivision shall be 15 specifically described and requested within each project application and 16 be reviewed by the commissioner. The waiver of any regulatory require- 17 ments shall be made in the sole discretion of the commissioner. 18 6. Qualifying safety net hospitals and their designated partner organ- 19 ization or organizations shall provide, as part of the application, 20 which shall be in a manner as prescribed by the commissioner, a trans- 21 formation plan that includes at least a five-year strategic and opera- 22 tional plan outlining the roles and responsibilities of each entity and 23 specifically state any regulatory flexibility which may be required to 24 implement such plan. The transformation plan shall also include a time- 25 line of key metrics and goals related to improved access, equity, quali- 26 ty, outcomes, and increased financial sustainability of the safety net 27 hospital. The request for level and type of support shall be specific 28 and detailed in the application. Continued support shall be contingent 29 upon the implementation of the approved plan and key milestones. Appli- 30 cations may include a range of collaboration models, including but not 31 be limited to merger, acquisition, a management services contract, or a 32 clinical integration. 33 7. The release of any funding will be contingent upon compliance with 34 the transformation plan and a determination that acceptable progress has 35 been made with such plan. If key milestones and goals are not met, addi- 36 tional financial resources may be withheld and redirected, upon the 37 recommendation of the commissioner and approval by the director of budg- 38 et. 39 § 2. This act shall take effect immediately and shall be deemed to 40 have been in full force and effect on and after April 1, 2024. 41 PART T 42 Section 1. Subdivision 1 of section 2130 of the public health law, as 43 amended by chapter 308 of the laws of 2010, is amended to read as 44 follows: 45 1. (a) Every physician or other person authorized by law to order 46 diagnostic tests or make a medical diagnosis, or any laboratory perform- 47 ing such tests shall immediately [(a)] (i) upon determination that a 48 person is [infected] positive/reactive with human immunodeficiency virus 49 (HIV), [(b)] (ii) upon diagnosis [that a person is afflicted] with [the50disease known as] acquired immune deficiency syndrome (AIDS), [(c)] 51 (iii) upon diagnosis [that a person is afflicted] with HIV related 52 illness, and [(d)] (iv) upon periodic monitoring of HIV infection by any 53 laboratory tests report such case or data to the commissioner.S. 8307--A 119 A. 8807--A 1 (b) Any permitted clinical laboratory, as defined in section five 2 hundred seventy-one of this chapter, performing such diagnostic tests 3 shall also, upon determination that a test result is not 4 positive/reactive for HIV, report such negative HIV test result to the 5 commissioner. 6 § 2. Subdivision 1 of section 2102 of the public health law is amended 7 to read as follows: 8 1. Whenever any laboratory examination discloses evidence of communi- 9 cable disease, and for hepatitis B virus or syphilis upon determination 10 that a test result is not positive/reactive, the results of such exam- 11 ination together with all required pertinent facts, shall be immediately 12 reported by the person in charge of the laboratory or the person making 13 such examination to the local or state health official to whom the 14 attending physician is required to report such case. 15 § 3. The public health law is amended by adding a new section 2172 to 16 read as follows: 17 § 2172. HCV infection; duty to report. In addition to reporting that a 18 hepatitis C virus (HCV) clinical laboratory test is reactive/positive as 19 required by section twenty-one hundred two of this article, any permit- 20 ted clinical laboratory, as defined in section five hundred seventy-one 21 of this chapter, performing such tests shall also, upon determination 22 that a test result is not positive/reactive with HCV, report such nega- 23 tive HCV test result to the commissioner. 24 § 4. Section 2781 of the public health law, as amended by chapter 308 25 of the laws of 2010, subdivisions 1 and 2 as amended by chapter 502 of 26 the laws of 2016 and subdivision 4 as amended by section 2 of part A of 27 chapter 60 of the laws of 2014, is amended to read as follows: 28 § 2781. HIV related testing. 1. Except as provided in section three 29 thousand one hundred twenty-one of the civil practice law and rules, or 30 unless otherwise specifically authorized or required by a state or 31 federal law, no person shall order the performance of an HIV related 32 test without first, at a minimum, [orally advising] providing notice by 33 means readily accessible in multiple languages to the protected individ- 34 ual, or, when the protected individual lacks capacity to consent, a 35 person authorized to consent to health care for such individual, that an 36 HIV-related test is being performed, or over the objection of such indi- 37 vidual or authorized persons. Such [advisement and objection, when38applicable] notice may be provided orally, in writing, by prominently 39 displayed signage, or by electronic means or other appropriate form of 40 communication. Such notice shall include information that HIV testing is 41 voluntary. A refusal of an HIV related test shall be noted in the indi- 42 vidual's record. 43 2. A person ordering the performance of an HIV related test shall 44 provide either directly or through a representative to the subject of an 45 HIV related test or, if the subject lacks capacity to consent, to a 46 person authorized pursuant to law to consent to health care for the 47 subject, an explanation that: 48 (a) HIV causes AIDS and can be transmitted through sexual activities 49 and needle-sharing, by pregnant women to their fetuses, and through 50 breastfeeding infants; 51 (b) there is treatment for HIV that can help an individual stay heal- 52 thy; 53 (c) individuals with HIV or AIDS can adopt safe practices to protect 54 uninfected and infected people in their lives from becoming infected or 55 multiply infected with HIV;S. 8307--A 120 A. 8807--A 1 (d) testing is voluntary and can be done anonymously at a public test- 2 ing center; 3 (e) the law protects the confidentiality of HIV related test results; 4 (f) the law prohibits discrimination based on an individual's HIV 5 status and services are available to help with such consequences; and 6 (g) the law requires that an individual be advised before an HIV-re- 7 lated test is performed, and that no test shall be performed over his or 8 her objection. 9 Protocols shall be in place to ensure compliance with this section. 10 4. [A person authorized pursuant to law to order the performance of an11HIV related test shall provide directly or through a representative to12the person seeking such test, an opportunity to remain anonymous through13use of a coded system with no linking of individual identity to the test14request or results.] A health care provider who is not authorized by the 15 commissioner to provide HIV related tests on an anonymous basis shall 16 refer a person who requests an anonymous test to a test site which does 17 provide anonymous testing. The provisions of this subdivision shall not 18 apply to a health care provider ordering the performance of an HIV 19 related test on an individual proposed for insurance coverage. 20 5. At the time of communicating the test result to the subject of the 21 test, a person ordering the performance of an HIV related test shall, 22 directly or through a representative: 23 (a) in the case of a test indicating evidence of HIV infection, 24 provide the subject of the test or, if the subject lacks capacity to 25 consent, the person authorized pursuant to law to consent to health care 26 for the subject with counseling or referrals for counseling: 27 (i) for coping with the emotional consequences of learning the result; 28 (ii) regarding the discrimination problems that disclosure of the 29 result could cause; 30 (iii) for behavior change to prevent transmission or contraction of 31 HIV infection; 32 (iv) to inform such person of available medical treatments; [and] 33 (v) regarding the need to notify his or her contacts; and 34 (vi) regarding pre- and post-exposure prophylaxis medications avail- 35 able to sexual partners to prevent HIV infection; and 36 (b) in the case of a test not indicating evidence of HIV infection, 37 provide (in a manner which may consist of oral or written reference to 38 information previously provided) the subject of the test, or if the 39 subject lacks capacity to consent, the person authorized pursuant to law 40 to consent to health care for the subject, with information: 41 (i) concerning the risks of participating in high risk sexual or 42 needle-sharing behavior; and 43 (ii) regarding pre- and post-exposure prophylaxis medications avail- 44 able to prevent HIV infection. 45 5-a. With the consent of the subject of a test indicating evidence of 46 HIV infection or, if the subject lacks capacity to consent, with the 47 consent of the person authorized pursuant to law to consent to health 48 care for the subject, the person who ordered the performance of the HIV 49 related test, or such person's representative, shall provide or arrange 50 with a health care provider for an appointment for follow-up medical 51 care for HIV for such subject. 52 6. The provisions of this section shall not apply to the performance 53 of an HIV related test: 54 (a) by a health care provider or health facility in relation to the 55 procuring, processing, distributing or use of a human body or a human 56 body part, including organs, tissues, eyes, bones, arteries, blood,S. 8307--A 121 A. 8807--A 1 semen, or other body fluids, for use in medical research or therapy, or 2 for transplantation to individuals provided, however, that where the 3 test results are communicated to the subject, post-test counseling, as 4 described in subdivision five of this section, shall nonetheless be 5 required; or 6 (b) for the purpose of research if the testing is performed in a 7 manner by which the identity of the test subject is not known and may 8 not be retrieved by the researcher; or 9 (c) on a deceased person, when such test is conducted to determine the 10 cause of death or for epidemiological purposes; or 11 (d) conducted pursuant to section twenty-five hundred-f of this chap- 12 ter; or 13 (e) in situations involving occupational exposures which create a 14 significant risk of contracting or transmitting HIV infection, as 15 defined in regulations of the department and pursuant to protocols 16 adopted by the department, 17 (i) provided that: 18 (A) the person who is the source of the occupational exposure is 19 deceased, comatose or is determined by his or her attending health care 20 professional to lack mental capacity to consent to an HIV related test 21 and is not reasonably expected to recover in time for the exposed person 22 to receive appropriate medical treatment, as determined by the exposed 23 person's attending health care professional who would order or provide 24 such treatment; 25 (B) there is no person available or reasonably likely to become avail- 26 able who has the legal authority to consent to the HIV related test on 27 behalf of the source person in time for the exposed person to receive 28 appropriate medical treatment; and 29 (C) the exposed person will benefit medically by knowing the source 30 person's HIV test results, as determined by the exposed person's health 31 care professional and documented in the exposed person's medical record; 32 (ii) in which case 33 (A) a provider shall order an anonymous HIV test of the source person; 34 and 35 (B) the results of such anonymous test, but not the identity of the 36 source person, shall be disclosed only to the attending health care 37 professional of the exposed person solely for the purpose of assisting 38 the exposed person in making appropriate decisions regarding post-expo- 39 sure medical treatment; and 40 (C) the results of the test shall not be disclosed to the source 41 person or placed in the source person's medical record. 42 7. In the event that an HIV related test is ordered by a physician or 43 certified nurse practitioner pursuant to the provisions of the education 44 law providing for non-patient specific regimens, then for the purposes 45 of this section the individual administering the test shall be deemed to 46 be the individual ordering the test. 47 § 5. Subdivision 4 of section 6909 of the education law is amended by 48 adding a new paragraph (m) to read as follows: 49 (m) undertaking the collection of specimens necessary to test to 50 determine the presence of the hepatitis B virus. 51 § 6. Subdivision 6 of section 6527 of the education law is amended by 52 adding a new paragraph (m) to read as follows: 53 (m) undertaking the collection of specimens necessary to test to 54 determine the presence of the hepatitis B virus. 55 § 7. Section 6801 of the education law is amended by adding a new 56 subdivision 10 to read as follows:S. 8307--A 122 A. 8807--A 1 10. a. A licensed pharmacist may execute a non-patient specific order 2 for the dispensing of HIV Pre-exposure Prophylaxis (PrEP) prescribed or 3 ordered by the commissioner of health, a physician licensed in this 4 state or a nurse practitioner certified in this state pursuant to rules 5 and regulations promulgated by the commissioner. 6 b. Prior to dispensing HIV PrEP to a patient, and at a minimum of 7 every twelve months for each returning patient, the pharmacist shall: 8 (i) ensure that the patient is HIV negative, as documented by a nega- 9 tive HIV test result obtained within the previous seven days from an HIV 10 antigen/antibody test or antibody-only test or from a rapid, point-of- 11 care fingerstick blood test approved by the federal food and drug admin- 12 istration. If the patient does not provide evidence of a negative HIV 13 test in accordance with this paragraph, the pharmacist may recommend or 14 prescribe an HIV test. If the patient tests positive for HIV infection, 15 the pharmacist shall direct the patient to a licensed physician and 16 provide the patient with a list of health care service providers and 17 clinics within the county where the pharmacist is located or adjacent 18 counties; 19 (ii) provide the patient with a self-screening risk assessment ques- 20 tionnaire, developed by the commissioner of health in consultation with 21 the commissioner, to be reviewed by the pharmacist to identify any known 22 risk factors and assist the patient's selection of an appropriate PrEP 23 medication; and 24 (iii) provide the patient with a fact sheet, developed by the commis- 25 sioner of health, that includes but is not limited to, the clinical 26 considerations and recommendations for use of PrEP, the appropriate 27 method for using PrEP, information on the importance of follow-up health 28 care, health care referral information, and the ability of the patient 29 to opt out of practitioner reporting requirements. 30 c. No pharmacist shall dispense PrEP under this subdivision without 31 receiving training in accordance with regulations promulgated by the 32 commissioner of health in consultation with the commissioner. 33 d. A pharmacist shall notify the patient's primary health care practi- 34 tioner, unless the patient opts out of such notification, within seven- 35 ty-two hours of dispensing PrEP, that PrEP has been dispensed. If the 36 patient does not have a primary health care practitioner, or is unable 37 to provide contact information for their primary health care practition- 38 er, the pharmacist shall provide the patient with a written record of 39 the PrEP medications dispensed, and advise the patient to consult an 40 appropriate health care practitioner. 41 e. Nothing in this subdivision shall prevent a pharmacist from refus- 42 ing to dispense a non-patient specific order of PrEP pursuant to this 43 subdivision if, in their professional judgment, potential adverse 44 effects, interactions, or other therapeutic complications could endanger 45 the health of the patient. 46 § 8. Section 6801 of the education law is amended by adding a new 47 subdivision 11 to read as follows: 48 11. A licensed pharmacist within their lawful scope of practice may 49 administer to patients eighteen years of age or older, immunizing agents 50 to prevent mpox pursuant to a patient specific order or a non-patient 51 specific order. When a licensed pharmacist administers an mpox immuniz- 52 ing agent, they shall comply with subdivisions two, three and four of 53 this section. 54 § 9. Section 2307 of the public health law is REPEALED. 55 § 10. This act shall take effect immediately; provided, however, 56 sections one, two, and three of this act shall take effect on the oneS. 8307--A 123 A. 8807--A 1 hundred eightieth day after it shall have become a law. Effective imme- 2 diately, the addition, amendment and/or repeal of any rule or regulation 3 necessary for the implementation of this act on its effective date are 4 authorized to be made and completed on or before such effective date. 5 PART U 6 Section 1. Section 3302 of the public health law is amended by adding 7 a new subdivision 42 to read as follows: 8 42. "Public health surveillance" means the continuous, systematic 9 collection, analysis, and interpretation of health-related data needed 10 for the planning, implementation, and evaluation of public health prac- 11 tice. Public health surveillance may be used for all of the following 12 purposes: 13 (a) as an early warning system for impending public health emergen- 14 cies; 15 (b) to document the impact of an intervention; 16 (c) to track progress towards specified goals; 17 (d) to monitor and clarify the epidemiology of health outcomes; 18 (e) to establish public health priorities; and 19 (f) to inform public health policy and strategies. 20 § 2. Subparagraphs (ix) and (x) of paragraph (a) of subdivision 2 of 21 section 3343-a of the public health law, as added by section 2 of part A 22 of chapter 447 of the laws of 2012, are amended and a new subparagraph 23 (xi) is added to read as follows: 24 (ix) a situation where the registry is not operational as determined 25 by the department or where it cannot be accessed by the practitioner due 26 to a temporary technological or electrical failure, as set forth in 27 regulation; [or] 28 (x) a practitioner who has been granted a waiver due to technological 29 limitations that are not reasonably within the control of the practi- 30 tioner, or other exceptional circumstance demonstrated by the practi- 31 tioner, pursuant to a process established in regulation, and in the 32 discretion of the commissioner[.]; or 33 (xi) a practitioner prescribing or ordering a controlled substance for 34 use on the premises of a correctional facility, an inpatient mental 35 health facility licensed under the mental hygiene law, or a nursing home 36 licensed under article twenty-eight of this chapter. 37 § 3. Subdivision 4 of section 3370 of the public health law, as added 38 by chapter 965 of the laws of 1974 and as renumbered by chapter 178 of 39 the laws of 2010, is amended to read as follows: 40 4. The department shall cause to be expunged or otherwise destroyed, 41 within [five] ten years from the date of receipt thereof, any record of 42 the name of any patient received by it pursuant to the filing require- 43 ments of subdivision six of section thirty-three hundred thirty-one, 44 subdivision four of section thirty-three hundred thirty-three, and 45 subdivision four of section thirty-three hundred thirty-four of this 46 article. 47 § 4. Subdivision 1 of section 3371 of the public health law, as 48 amended by chapter 178 of the laws of 2010, paragraphs (d) and (e) as 49 amended and paragraphs (f), (g), (h), (i), and (j) as added by section 4 50 of part A of chapter 447 of the laws of 2012, is amended to read as 51 follows: 52 1. No person, who has knowledge by virtue of his or her office of the 53 identity of a particular patient or research subject, a manufacturingS. 8307--A 124 A. 8807--A 1 process, a trade secret or a formula shall disclose such knowledge, or 2 any report or record thereof, except: 3 (a) to another person employed by the department, for purposes of 4 executing provisions of this article; 5 (b) pursuant to judicial subpoena or court order in a criminal inves- 6 tigation or proceeding; 7 (c) to an agency, department of government, or official board author- 8 ized to regulate, license or otherwise supervise a person who is author- 9 ized by this article to deal in controlled substances, or in the course 10 of any investigation or proceeding by or before such agency, department 11 or board; 12 (d) to the prescription monitoring program registry and to authorized 13 users of such registry as set forth in subdivision two of this section; 14 (e) to a vendor or contractor, as authorized by the department as 15 necessary for the operation and maintenance of the prescription monitor- 16 ing program registry; 17 (f) to a practitioner to inform him or her that a patient may be under 18 treatment with a controlled substance by another practitioner for the 19 purposes of subdivision two of this section, and to facilitate the 20 department's review of individual challenges to the accuracy of 21 controlled substances histories pursuant to subdivision six of section 22 thirty-three hundred forty-three-a of this article; 23 [(f)] (g) to a pharmacist to provide information regarding 24 prescriptions for controlled substances presented to the pharmacist for 25 the purposes of subdivision two of this section and to facilitate the 26 department's review of individual challenges to the accuracy of 27 controlled substances histories pursuant to subdivision six of section 28 thirty-three hundred forty-three-a of this article; 29 [(g)] (h) to the deputy attorney general for medicaid fraud control, 30 or his or her designee, in furtherance of an investigation of fraud, 31 waste or abuse of the Medicaid program, pursuant to an agreement with 32 the department; 33 [(h)] (i) to a program area within the department for the purpose of 34 conducting public health research, public health surveillance, or educa- 35 tion with data contained in the prescription monitoring program registry 36 and not for patient-level outreach: 37 (i) pursuant to an agreement with the commissioner; 38 (ii) when the release of such information is deemed appropriate by the 39 commissioner; 40 (iii) for use in accordance with measures required by the commissioner 41 to ensure that the security and confidentiality of the data is 42 protected; 43 (iv) for use and retention no longer than ten years; and 44 (v) provided that disclosure is restricted to individuals within the 45 department who are engaged in public health research, public health 46 surveillance, or education; 47 (j) to a local health department for the purpose of conducting public 48 health research, public health surveillance, or education and not for 49 patient-level outreach: 50 (i) pursuant to an agreement with the commissioner; 51 (ii) when the release of such information is deemed appropriate by the 52 commissioner; 53 (iii) for use in accordance with measures required by the commissioner 54 to ensure that the security and confidentiality of the data is 55 protected; 56 (iv) for use and retention no longer than ten years; andS. 8307--A 125 A. 8807--A 1 [(iv)] (v) provided that disclosure is restricted to individuals with- 2 in the local health department who are engaged in the research or educa- 3 tion; 4 [(i)] (k) to a medical examiner or coroner who is an officer of or 5 employed by a state or local government, pursuant to his or her official 6 duties; and 7 [(j)] (l) to an individual for the purpose of providing such individ- 8 ual with his or her own controlled substance history or, in appropriate 9 circumstances, in the case of a patient who lacks capacity to make 10 health care decisions, a person who has legal authority to make such 11 decisions for the patient and who would have legal access to the 12 patient's health care records, if requested from the department pursuant 13 to subdivision six of section thirty-three hundred forty-three-a of this 14 article or from a treating practitioner pursuant to subparagraph (iv) of 15 paragraph (a) of subdivision two of this section. 16 § 5. Subdivision (b) of schedule I of section 3306 of the public 17 health law is amended by adding eleven new paragraphs 93, 94, 95, 96, 18 97, 98, 99, 100, 101, 102 and 103 to read as follows: 19 (93) 1-methoxy-3-{4-(2-methoxy-2-phenylethyl)piperazin-1-yl}-1-phenylp 20 ropan-2-ol. Other name: Zipeprol. 21 (94) N,N-diethyl-2-(2-(4-methoxybenzyl)-5-nitro-1H-benzimidazol-1-yl)e 22 than-1-amine. Other names: Metonitazene. 23 (95) meta-Fluorofentanyl (N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4 24 -yl)propionamide). 25 (96) meta-Fluoroisobutyryl fentanyl (N-(3-fluorophenyl)-N-(1-phenethy 26 lpiperidin-4-yl)isobutyramide). 27 (97) para-Methoxyfuranyl fentanyl (N-(4-methoxyphenyl)-N-(1-phenethyl 28 piperidin-4-yl)furan-2-carboxamide). 29 (98) 3-furanyl fentanyl (N-(1-phenethylpiperidin-4-yl)-N-phenylfuran- 30 3-carboxamide). 31 (99) 2',5'-Dimethoxyfentanyl (N-(1-(2,5-dimethoxyphenethyl)piperidin-4 32 -yl)-N-phenylpropionamide). 33 (100) Isovaleryl fentanyl (3-methyl-N-(1-phenethylpiperidin-4-yl)-N-ph 34 enylbutanamide). 35 (101) ortho-Fluorofuranyl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylp 36 iperidin-4-yl)furan-2-carboxamide). 37 (102) alpha'-Methyl butyryl fentanyl (2-methyl-N-(1-phenethylpiperidin 38 -4-yl)-N-phenylbutanamide). 39 (103) para-Methylcyclopropyl fentanyl (N-(4-methylphenyl)-N-(1-pheneth 40 ylpiperidin-4-yl)cyclopropanecarboxamide). 41 § 6. Paragraphs 11 and 36 of subdivision (d) of schedule I of section 42 3306 of the public health law, paragraph 11 as added by chapter 664 of 43 the laws of 1985 and paragraph 36 as added by section 5 of part BB of 44 chapter 57 of the laws of 2018, are amended to read as follows: 45 (11) [Ibogane] Ibogaine. Some trade and other names: [7-ethyl-6, 6&,467, 8, 9, 10, 12, 13-octahydro-2-methoxy-6, 9-methano-5h-pyrido47{1',2':1,2} azepino {5,4-b} indole: tabernanthe iboga.] 48 7-Ethyl-6,6&,7,8,9,10,12,13-octahydro-2-methoxy-6,9-methano-5H-pyriod{1' 49 ,2':1,2} azepino {5,4-b} indole; Tabernanthe iboga. 50 (36) 5-methoxy-N,N-dimethyltryptamine. Some trade or other names: 51 5-methoxy-3-{2-(dimethylamino)ethyl}indole; 5-MeO-DMT. 52 § 7. Subdivision (d) of schedule I of section 3306 of the public 53 health law is amended by adding nineteen new paragraphs 32, 39, 40, 41, 54 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 and 56 to read as 55 follows: 56 (32) 4-methyl-N-ethylcathinone. Some trade or other names: 4-MEC.S. 8307--A 126 A. 8807--A 1 (39) 4-methyl-alpha-pyrrolidinopropiophenone. Some trade or other 2 names: 4-MePPP. 3 (40) Alpha-pyrrolidinopentiophenone. Some trade or other names: @-PVP. 4 (41) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)butan-1-one. Some trade 5 or other names: Butylone; bk-MBDB. 6 (42) 2-(methylamino)-1-phenylpentan-1-one. Some trade or other names: 7 Pentedrone. 8 (43) 1-(1,3-benzodioxol-5-yl)-2-(methylamino)pentan-1-one. Some trade 9 or other names: Pentylone; bk-MBDP. 10 (44) 1-(naphthalen-2-yl)-2-(pyrrolidin-1-yl)pentan-1-one. Some trade 11 or other names: Naphyrone. 12 (45) Alpha-pyrrolidinobutiophenone. Some trade or other names: @-PBP. 13 (46) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)propan-1-one (ethylone). 14 (47) N-ethylpentylone. Some trade or other names: ephylone, 15 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)pentan-1-one). 16 (48) 1-(4-methoxyphenyl)-N-methylpropan-2-amine. Some trade or other 17 names: para-methoxymethamphetamine; PMMA. 18 (49) N-Ethylhexedrone. Some trade or other names: 19 @-ethylaminohexanophenone; 2-(ethylamino)-1-phenylhexan-1-one. 20 (50) alpha-Pyrrolidinohexanophenone. Some trade or other names: @-PHP; 21 alpha-pyrrolidinohexanophenone; 1-phenyl-2-(pyrrolidin-1-yl)hexan-1-one. 22 (51) 4-Methyl-alpha-ethylaminopentiophenone. Some trade or other 23 names: 4-MEAP; 2-(ethylamino)-1-(4-methylphenyl)pentan-1-one. 24 (52) 4'-Methyl-alpha-pyrrolidinohexiophenone. Some trade or other 25 names: MPHP; 4'-methyl-alpha-pyrrolidinohexanophenone; 26 1-(4-methylphenyl)-2-(pyrrolidin-1-yl)hexan-1-one. 27 (53) alpha-Pyrrolidinoheptaphenone. Some trade or other names: PV8; 28 1-phenyl-2-(pyrrolidin-1-yl)heptan-1-one. 29 (54) 4'-Chloro-alpha-pyrrolidinovalerophenone. Some trade or other 30 names: 4-chloro-@-PVP; 4'-chloro-alpha-pyrrolidinopentiophenone; 31 1-(4-chlorophenyl)-2-(pyrrolidin-1-yl)pentan-1-one. 32 (55) 2-(ethylamino)-2-(3-methoxyphenyl)cyclohexan-1-one (methoxetamin 33 e, MXE). 34 (56) 1-(1,3-benzodioxol-5-yl)-2-(ethylamino)butan-1-one. Some trade or 35 other names: eutylone; bk-EBDB. 36 § 8. Subdivision (e) of schedule I of section 3306 of the public 37 health law is amended by adding five new paragraphs 7, 8, 9, 10 and 11 38 to read as follows: 39 (7) 4-(2-chlorophenyl)-2-ethyl-9-methyl-6H-thieno{3,2-f}{1,2,4}triazol 40 o{4,3-{alpha}}{1,4}diazepine. Some trade or other names: etizolam. 41 (8) 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-benzo{f}{1,2,4}triazolo{4, 42 3-{alpha}}{1,4}diazepine. Some trade or other names: flualprazolam. 43 (9) 6-(2-chlorophenyl)-1-methyl-8-nitro-4H-benzo{f}{1,2,4}triazolo{4,3 44 -{alpha}}{1,4}diazepine. Some trade or other names: clonazolam. 45 (10) 8-bromo-6-(2-fluorophenyl)-1-methyl-4H-benzo{f}{1,2,4}triazolo{4, 46 3-{alpha}}{1,4}diazepine. Some trade or other names: flubromazolam. 47 (11) 7-chloro-5-(2-chlorophenyl)-1-methyl-1,3-dihydro-2H-benzo{e}{1,4} 48 diazepin-2-one. Some trade or other names: diclazepam. 49 § 9. Paragraphs 13 and 14 of subdivision (f) of schedule I of section 50 3306 of the public health law, as added by chapter 341 of the laws of 51 2013, are amended and four new paragraphs 25, 26, 27 and 28 are added to 52 read as follows: 53 (13) 3-Fluoromethcathinone. Some trade or other names: 3-fluoro-N 54 -methylcathinone; 3-FMC. 55 (14) 4-Fluoromethcathinone. Some trade or other names: 4-fluoro-N-me- 56 thylcathinone; 4-FMC; flephedrone.S. 8307--A 127 A. 8807--A 1 (25) 7-{(10,11-dihydro-5H-dibenzo{a,d}cyclohepten-5-yl)amino}heptanoic 2 acid. Other name: amineptine. 3 (26) N-phenyl-N'-(3-(1-phenylpropan-2-yl)-1,2,3-oxadiazol-3-ium-5-yl) 4 carbamimidate. Other name: mesocarb. 5 (27) N-methyl-1-(thiophen-2-yl)propan-2-amine. Other name: methiopro- 6 pamine. 7 (28) 4,4'-Dimethylaminorex. Some trade or other names: 4,4'-DMAR; 8 4,5-dihydro-4-methyl-5-(4-methylphenyl)-2-oxazolamine; 4-methyl-5-(4-met 9 hylphenyl)-4,5-dihydro-1,3-oxazol-2-amine. 10 § 10. Paragraphs 2, 6 and 10 of subdivision (g) of schedule I of 11 section 3306 of the public health law, as added by section 7 of part BB 12 of chapter 57 of the laws of 2018, are amended to read as follows: 13 (2) [{1-(5-fluro-pentyl)-1H-indol-3-yl}(2,2,3,3-tetramethylcyclopropyl)14methanone.] {1-(5-fluoro-pentyl)-1H-indol-3-yl}(2,2,3,3-tetramethyl 15 cyclopropyl)methone. Some trade names or other names: 16 5-fluoro-UR-144[,]; XLR11. 17 (6) [N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-indazo18[-]le-3-carboxamide.] N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(4-fluorob 19 enzyl)-1H-indazo[-]le-3-carboxamide. Some trade or other names: AB- 20 FUBINACA. 21 (10) [{1-(5-fluoropentyl)-1H-indazol-3-yl}(naphthalen-1- [y1] yl)meth- 22 anone.] {1-(5-fluoropentyl)-1H-indazol -3-yl}(naphthalen-1-[y123]yl)methanone. 24 Some trade or other names: THJ-2201. 25 § 11. Subdivision (g) of schedule I of section 3306 of the public 26 health law is amended by adding nineteen new paragraphs 11, 12, 13, 14, 27 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 and 29 to read as 28 follows: 29 (11) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H- 30 indazole-3-carboxamide. Some trade or other names: MAB-CHMINACA; 31 ADB-CHMINACA. 32 (12) methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylb 33 utanoate. Some trade or other names: FUB-AMB; MMB-FUBINACA; AMBFUBINACA. 34 (13) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3- 35 dimethylbutanoate. Some trade or other names: MDMB-CHMICA; MMB-CHMINACA. 36 (14) methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3,3- 37 dimethylbutanoate. Some trade or other names: MDMB-FUBINACA. 38 (15) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-in 39 dazole-3-carboxamide. Some trade or other names: ADB-FUBINACA. 40 (16) N-(adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide. 41 Some trade or other names: 5F-APINACA; 5F-AKB48. 42 (17) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-meth 43 ylbutanoate. Some trade or other names: 5F-AMB. 44 (18) methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3- 45 dimethylbutanoate. Some trade or other names: 5F-ADB; 5F-MDMB-PINACA. 46 (19) Naphthalen-1-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate. Some 47 trade or other names: NM2201; CBL2201. 48 (20) N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1H-indazol 49 e-3-car boxamide. Some trade or other names: 5F-AB-PINACA. 50 (21) 1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carboxamid 51 e. Some trade or other names: 4-CN-CUMYL-BUTINACA; 52 4-cyano-CUMYL-BUTINACA; 4-CN-CUMYL BINACA; CUMYL-4CN-BINACA; SGT-78. 53 (22) methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3-methyl 54 butanoate. Some trade or other names: MMB-CHMICA; AMB-CHMICA. 55 (23) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-pyrrolo{2,3-b}pyrid 56 ine-3-carboxamide. Some trade or other names: 5F-CUMYL-P7AICA.S. 8307--A 128 A. 8807--A 1 (24) methyl 2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimet 2 hylbutanoate. Some trade or other names: 4F-MDMB-BINACA; 3 4F-MDMB-BUTINACA. 4 (25) ethyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimet 5 hylbutanoate. Some trade or other names: 5F-EDMB-PINACA. 6 (26) methyl 2-(1-(5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimeth 7 ylbutanoate. Some trade or other names: 5F-MDMB-PICA; 5F-MDMB-2201. 8 (27) N-(adamantan-1-yl)-1-(4-fluorobenzyl)-1H-indazole-3-carboxamide. 9 Some trade or other names: FUB-AKB48; FUB-APINACA; AKB48 10 N-(4-FLUOROBENZYL). 11 (28) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carbox 12 amide. Some trade or other names: 5F-CUMYL-PINACA; SGT-25. 13 (29) (1-4-fluorobenzyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl) 14 methanone. Some trade or other names: FUB-144. 15 § 12. Paragraph 1 of subdivision (b) of schedule II of section 3306 of 16 the public health law, as amended by section 1 of part C of chapter 447 17 of the laws of 2012, is amended to read as follows: 18 (1) Opium and opiate, and any salt, compound, derivative, or prepara- 19 tion of opium or opiate, excluding apomorphine, dextrorphan, nalbuphine, 20 naldemedine, nalmefene, naloxegol, naloxone, [and] 6&-naltrexol, 21 naltrexone, and samidorphan, and their respective salts, but including 22 the following: 23 1. Raw opium. 24 2. Opium extracts. 25 3. Opium fluid. 26 4. Powdered opium. 27 5. Granulated opium. 28 6. Tincture of opium. 29 7. Codeine. 30 8. Ethylmorphine. 31 9. Etorphine hydrochloride. 32 10. Hydrocodone (also known as dihydrocodeinone). 33 11. Hydromorphone. 34 12. Metopon. 35 13. Morphine. 36 14. Oxycodone. 37 15. Oxymorphone. 38 16. Thebaine. 39 17. Dihydroetorphine. 40 18. Oripavine. 41 19. Noroxymorphone. 42 § 13. Subdivision (c) of schedule II of section 3306 of the public 43 health law is amended by adding a new paragraph 30 to read as follows: 44 (30) Oliceridine. (N-{(3-methoxythiophen-2-yl)methyl}({2-{(9R)-9- 45 (pyridin-2-yl)-6-oxaspiro{4.5}decan-9-yl}ethyl})amine). 46 § 14. Subdivision (f) of schedule II of section 3306 of the public 47 health law, as amended by chapter 589 of the laws of 1996, the undesig- 48 nated paragraph as amended by chapter 575 of the laws of 2001, is 49 amended to read as follows: 50 (f) Hallucinogenic substances. 51 (1) [Nabilone: Another name for nabilone: (+,-)-trans52-3-(1,1-dimethylheptyl)-6, 6a, 7, 8, 10, 10a-hexahydro-1-hydroxy-6,536-dimethyl-9H-dibenzo{b,d}pyran-9-one.] Nabilone. Another name for nabi- 54 lone. +,-)-trans-3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a-hex ahydro-1-hyd 55 roxy-6,6-dimethyl-9H-dibenzo{b,d}pyran-9-one.S. 8307--A 129 A. 8807--A 1 (2) Dronabinol {(-)-delta-9-trans tetrahydrocannabinol} in an oral 2 solution in a drug product approved for marketing by the United States 3 Food and Drug Administration. 4 § 15. Subparagraph (i) of paragraph 3 of subdivision (g) of schedule 5 II of section 3306 of the public health law, as amended by section 2 of 6 part BB of chapter 57 of the laws of 2023, is amended to read as 7 follows: 8 (i) [4-anilino-N-phenenethylpiperidine] [(ANPP)] 4-anilino-N-phen 9 ethylpiperidine (ANPP).. 10 § 16. Subdivision (h) of schedule II of section 3306 of the public 11 health law, as amended by section 8 of part C of chapter 447 of the laws 12 of 2012, is amended to read as follows: 13 (h) (1) Anabolic steroids. Unless specifically excepted or unless 14 listed in another schedule, "anabolic steroid" shall mean any drug or 15 hormonal substance, chemically and pharmacologically related to testos- 16 terone (other than estrogens, progestins, corticosteroids and dehydroe- 17 piandrosterone) and includes: 18 [(1)] (i) [3{beta}, 17-dihydroxy-5a-androstane] 3{beta},17{beta}-dihyd 19 roxy-5{alpha}-androstane. 20 [(2)] (ii) [3{alpha}, 17{beta}-dihydroxy-5a-androstane] 3{alpha},17 21 {beta}-dihydroxy-5{alpha}-androstane. 22 [(3)] (iii) 5{alpha}-androstan-3,17-dione. 23 [(4)] (iv) 1-androstenediol (3{beta},17{beta}-dihydroxy-5 24 {alpha}-androst-1- ene). 25 [(5)] (v) 1-androstenediol (3{alpha},17{beta}-dihydroxy-5 26 {alpha}-androst-1- ene). 27 [(6)] (vi) 4-androstenediol [(3{beta}, 17{beta}-dihydroxy-androst28-4-ene)] (3{beta},17{beta}-dihydroxy-androst-4-ene). 29 [(7)] (vii) 5-androstenediol [(3{beta}, 17{beta}-dihydroxy- androst-305-ene)] (3{beta},17{beta}-dihydroxy-androst-5-ene). 31 [(8)] (viii) 1-androstenedione [({5{alpha}}-androst-1-en-3, 17-dione)] 32 (5{alpha}-androst-1-en-3,17-dione). 33 [(9)] (ix) 4-androstenedione (androst-4-en-3,17-dione). 34 [(10)] (x) 5-androstenedione (androst-5-en-3,17-dione). 35 [(11)] (xi) Bolasterone [(7{alpha},17{alpha}-dimethyl-17{beta}-36hydroxyandrost-4-en-3-one)] (7{alpha},17{alpha}-dimethyl-17{beta}-hydro 37 xyandrost-4-en-3-one). 38 [(12)] (xii) Boldenone [(17{beta}-hydroxyandrost-1, 4,-diene-3-one)] 39 (17{beta}-hydroxyandrost-1,4,-diene-3-one). 40 [(13)] (xiii) Boldione (androsta-1,4-diene-3,17-dione). 41 [(14)] (xiv) Calusterone [(7{beta}, 17{alpha}-dimethyl-17{b -hydrox-42yandrost-4-en-3-one)] (7{beta},17{alpha}-dimethyl-17{beta}-hydroxyandr 43 ost-4-en-3-one). 44 [(15)] (xv) Clostebol [(4-chloro-17{beta}-hydroxyandrost-4-en-3-o ne)] 45 (4-chloro-17{beta}-hydroxyandrost-4-en-3-one). 46 [(16)] (xvi) Dehydrochloromethyltestosterone (4-chloro-17 47 {beta}-hydroxy-17{alpha}-methyl-androst-1, 4-dien- 3-one). 48 [(17)] (xvii) [{Delta} 1-dihydrotestosterone] {Delta}1-dihydrotestost 49 erone (a.k.a. '1-testosterone') (17{beta}-hydroxy-5{alpha}-androst-1-en- 50 3-one). 51 [(18)] (xviii) 4-dihydrotestosterone (17{beta}-hydroxy- 52 androstan-3-one). 53 [(19)] (xix) Drostanolone (17{beta}-hydroxy-2{alpha}-methyl 54 -5{alpha} -androstan-3-one). 55 [(20)] (xx) Ethylestrenol (17{alpha}-ethyl-17{beta}-hydroxy 56 estr-4-ene).S. 8307--A 130 A. 8807--A 1 [(21)] (xxi) Fluoxymesterone [(9-fluoro-17{alpha}-methyl-11{beta},217 {beta}-dihydroxyandrost-4-en-3-one)] (9-fluoro-17{alpha}-methyl- 3 11{beta},17{beta}-dihydroxyandrost-4-en-3-one). 4 [(22)] (xxii) Formebolone [(2-formyl-17{alpha}-methyl-11{alpha},517{beta}-dihydroxyandrost-1, 4-dien-3-one)] (2-formyl-17{alpha}-methyl 6 -11{alpha},17{beta}-dihydroxyandrost-1,4-dien-3-one). 7 [(23)] (xxiii) Furazabol [(17{alpha}-methyl-17{beta}-hydroxyandro8stano {2, 3-c}-furazan)] (17{alpha}-methyl-17{beta}-hydroxyandrostano 9 {2,3-c}-furazan). 10 [(24)] (xxiv) [13{beta}-ethyl-17{beta}-hyroxygon-4-en-3-one] 13{beta}- 11 ethyl-17{beta}-hydroxygon-4-en-3-one. 12 [(25)] (xxv) 4-hydroxytestosterone [(4, 17{beta}-dihydroxy-andros13t-4-en-3-one)] (4,17{beta}-dihydroxy-androst-4-en-3-one). 14 [(26)] (xxvi) 4-hydroxy-19-nortestosterone [(4,17{beta}-dihydroxy15-estr-4-en-3-one)] (4,17{beta}-dihydroxyestr-4-en-3-one). 16 [(27)] (xxvii) [desoxymethyltestosterone] Desoxymethyltestosterone 17 (17{alpha}-methyl-5 {alpha}-androst-2-en-17{beta}-ol) (a.k.a., [madol)] 18 'madol'). 19 [(28)] (xxviii) Mestanolone [(17{alpha}-methyl-17{beta}-hydroxy-205-androstan-3-one)] (17{alpha}-methyl-17{beta}-hydroxy-5-androstan 21 -3-one). 22 [(29)] (xxix) Mesterolone [(1{alpha}methyl-17{beta}-hydroxy-23{5{alpha}}-androstan-3-one)] (1{alpha}-methyl-17{beta}-hydroxy-5{alpha} 24 -androstan-3-one). 25 [(30)] (xxx) Methandienone [(17{alpha}-methyl-17{beta}-hydroxyand26rost-1, 4-dien-3-one)] (17{alpha}-methyl-17{beta}-hydroxyandrost-1, 27 4-dien-3-one. 28 [(31)] (xxxi) Methandriol [(17{alpha}-methyl-3{beta}, 1729{beta}-dihydroxyandrost-5-ene)] (17{alpha}-methyl-3{beta},17{beta}- 30 dihydroxyandrost-5-ene). 31 [(32)] (xxxii) Methenolone [(1-methyl- 17{beta}-hydroxy-5 {alpha}32-androst- 1-en-3-one)] (1-methyl-17{beta}-hydroxy-5 {alpha}-androst-1- 33 en-3-one). 34 [(33)] (xxxiii) [17{alpha}-methyl-3{beta},17{beta}-dihydroxydroxy35oxy- 5a-androstane] 17{alpha}-methyl-3{beta},17{beta}-dihydroxy-5a 36 {alpha}-androstane. 37 [(34)] (xxxiv) [17{alpha}-methyl-3{alpha}, 17{beta}- dihydroxy- 5a-an-38drostane] 17{alpha}-methyl-3{alpha},17{beta}-dihydroxy5a{alpha}-andros 39 tane 40 [(35)] (xxxv) [17{alpha}-methyl-3{beta}, 17{beta}-dihyd41roxyandrost-4-ene.] 17{alpha}-methyl-3{beta},17{beta}-dihydroxyandrost 42 -4-ene. 43 [(36)] (xxxvi) [17{alpha}-methyl-4-hydroxynandrolone(17{alpha}-44methyl-4-hydroxy-17{beta}-hydroxyestr-4-en-3-one).] 17{alpha}-methyl 45 -4-hydroxynandrolone(17{alpha}-methyl-4-hydroxy-17{beta}-hydroxyestr-4- 46 en-3-one). 47 [(37)] (xxxvii) Methyldienolone [(17{alpha}-methyl-17{beta} -hydrox-48yestra- 4,9(10)-dien-3-one).] (17{alpha}-methyl-17{beta}-hydroxyes-tr 49 a-4,9(10)-dien-3-one). 50 [(38)] (xxxviii) Methyltrienolone [(17{alpha}-methyl-17{beta}-hydroxy51estra-4,9-11-trien-3-one).] (17{alpha}-methyl-17{beta}-hydroxyestra-4, 52 9-11-trien-3-one). 53 [(39)] (xxxix) Methyltestosterone(17{alpha}-methyl-17{beta} -hydrox- 54 yandrost-4-en-3-one). 55 [(40)] (xl) Mibolerone (7{alpha},17{alpha}-dimethyl-17 56 {beta}-hydroxyestr-4-en-3-one).S. 8307--A 131 A. 8807--A 1 [(41)] (xli) [17{alpha}-methyl-{Delta} 1-dihydrotestosterone(17b{beta}2-hydroxy-17{alpha}-methyl-5{alpha}-androst-1-en-3-one)] 17{alpha}- 3 methyl-{Delta}1-dihydrotestosterone(17{beta}-hydroxy-17{alpha}-methyl-5{ 4 alpha}-androst-1-en-3-one) (a.k.a. '17-{alpha}-methyl-1-testosterone'). 5 [(42)] (xlii) [Nandrolone(17{beta}-hydroxyestr-4-en-3-one).] Nandro- 6 lone (17{beta}-hydroxyestr-4-en-3-one). 7 [(43)] (xliii) 19-nor-4-androstenediol [(3{beta},17{beta}-dihydro8xyestr- 4-ene).] (3{beta},17{beta}-dihydroxyestr-4-ene). 9 [(44)] (xliv) 19-nor-4-androstenediol [(3{alpha},17{beta}-dihydrox-10yestr-4-ene).] (3{alpha},17{beta}-dihydroxyestr-4 -ene). 11 [(45)] (xlv) 19-nor-5-androstenediol [(3{beta},17{bet a}.ct-12dihydroxyestr -5-ene).] (3{beta},17{beta}-dihydroxyestr-5- ene). 13 [(46)] (xlvi) 19-nor-5-androstenediol [(3{alpha},17{beta}-dihydrox-14yestr-5-ene).] (3{alpha},17{beta}-dihydroxyestr-5-ene). 15 [(47)] (xlvii) [19-nor-4,9(10)-androstadienedione (estra-4,9(10)-16diene-3,17-dione).] 19-nor-4,9(10)-androstadienedione(estra-4,9(10) 17 -diene-3,17-dione). 18 [(48)] (xlviii) 19-nor-4-androstenedione (estr-4-en-3,17-dione). 19 [(49)] (xlix) 19-nor-5-androstenedione (estr-5-en-3,17-dione). 20 [(50)] (l) Norbolethone [(13{beta}, 17{alpha}-diethyl-1721{beta} -hydroxygon-4-en-3-one).] 22 (13{beta},17{alpha}-diethyl-17{beta}-hydroxygon-4-en-3-one). 23 [(51)] (li) Norclostebol [(4-chloro-17{beta}-hydroxyestr-4-24en-3-one).] (4-chloro-17{beta}-hydroxyestr-4-en-3-one). 25 [(52)] (lii) Norethandrolone (17{alpha}-ethyl-17{beta}-hydroxyes 26 tr-4-en-3-one). 27 [(53)] (liii) Normethandrolone [(17 {alpha}-methyl-17{beta}-hydrox28estr-4-en-3-one).] (17{alpha}-methyl-17{beta}-hydroxyestr-4-en-3-one). 29 [(54)] (liv) Oxandrolone [(17{alpha}-methyl-17{beta}-hydroxy-2-30oxa- {5{alpha}}-androstan-3-one).] 31 (17{alpha}-methyl-17{beta}-hydroxy-2-oxa-5{alpha}-androstan-3-one). 32 [(55)] (lv) Oxymesterone [(17{alpha}-methyl-4, 17 {beta}-dihydroxy33androst-4-en-3-one).] 34 (17{alpha}-methyl-4,17{beta}-dihydroxyandrost-4-en-3-one). 35 [(56)] (lvi) Oxymetholone [(17 {alpha}-methyl-2-hydroxymet36hylene-17 {beta}-hydroxy-{5{alpha}}- androstan-3-one).] (17{alpha}- 37 methyl-2-hydroxymethylene-17{beta}-hydroxy-5{alpha}-androst an-3-one). 38 [(57)] (lvii) Stanozolol [(17{alpha}-methyl-17{beta}-hydro39xy-{5{alpha}}- androst-2-eno{3, 2-c}-pyrazole).] 40 (17{alpha}-methyl-17{beta}-hydroxy-5{alpha}-androst-2-eno{3,2-c}-pyraz 41 ole). 42 [(58)] (lviii) Stenbolone [(17{beta}-hydroxy-2-methyl-{5{alpha}}-43androst- 1-en-3- one).] (17{beta}-hydroxy-2-methyl-5{alpha} -androst-1- 44 en-3-one). 45 [(59)] (lix) Testolactone [(13-hydroxy-3-oxo-13, 17-secoandrosta-461, 4-dien-17-oic acid lactone).] (13-hydroxy-3-oxo-13,17- 47 secoandrosta1,4-dien-17-oic acid lactone). 48 [(60)] (lx) Testosterone (17{beta}-hydroxyandrost-4-en-3-one). 49 [(61)] (lxi) Tetrahydrogestrinone [(13{beta}, 17{alpha}50-diethyl-17{beta}-hydroxygon-4, 9, 11 -trien-3-one).] 51 (13{beta}, 17{alpha}-diethyl-17{beta}-hydroxygon-4,9,11-trien-3-one). 52 [(62)] (lxii) Trenbolone [(17{beta}-hydroxyestr-4, 9, 11-trien-533-one).] (17{beta}-hydroxyestr-4,9,11-trien-3-one). 54 [(63)] (lxiii)5{alpha}-androstan-3,6,17-trione. 55 (lxiv) 6-bromo-androsta-1,4-diene-3,17-dione. 56 (lxv) 6-bromo-androstan-3,17-dione.S. 8307--A 132 A. 8807--A 1 (lxvi) 4-chloro-17{alpha}-methyl-androsta-1,4-diene-3,17{beta}-diol. 2 (lxvii) 4-chloro-17{alpha}-methyl-androst-4-ene-3{beta},17{beta}-diol. 3 (lxviii) 4-chloro-17{alpha}-methyl-17{beta}hydroxy-androst-4-en-3-one. 4 (lxix) 4-chloro-17{alpha}-methyl-17{beta}hydroxy-androst-4-ene-3,11-di 5 one. 6 (lxx) 2{alpha},17{alpha}-dimethyl-17{beta}-hydroxy-5{beta}-androstan- 7 3-one. 8 (lxxi) 2{alpha},3{alpha}-epithio-17{alpha}-methyl-5{alpha}androstan-17 9 {beta}-ol. 10 (lxxii) estra-4,9,11-triene-3,17-dione. 11 (lxxiii) {3,2-c}furazan-5{alpha}-androstan-17{beta}-ol. 12 (lxxiv) 18a-homo-3-hydroxy-estra-2,5(10)-dien-17-one. 13 (lxxv) 4-hydroxy-androst-4-ene-3,17-dione. 14 (lxxvi) 17{beta}-hydroxy-androstano{2,3-d}isoxazole. 15 (lxxvii) 17{beta}-hydroxy-androstano{3,2-c}isoxazole. 16 (lxxviii) 3{beta}-hydroxy-estra-4,9,11-trien-17-one. 17 (lxxix) Methasterone (2{alpha},17{alpha}-dimethyl-5{alpha}-androstan-1 18 7{beta}-ol3-one or 2{alpha},17{alpha}-dimethyl-17{beta}-hydroxy-5{alpha} 19 -androstan-3-one). 20 (lxxx) 17{alpha}-methyl-androsta-1,4-diene-3,17{beta}-diol. 21 (lxxxi) 17{alpha}-methyl-5{alpha}-androstan-17{beta}-ol. 22 (lxxxii) 17{alpha}-methyl-androstan-3-hydroxyimine-17{beta}-ol. 23 (lxxxiii) 6{alpha}-methyl-androst-4-ene-3,17-dione. 24 (lxxxiv) 17{alpha}-methyl-androst-2-ene-3,17{beta}diol. 25 (lxxxv) Prostanozol (17{beta}-hydroxy-5{alpha}-androstano{3,2-c}pyrazole) or 26 {3,2-c}pyrazole-5{alpha}-androstan-17{beta}-ol. 27 (lxxxvi) {3,2-c}pyrazole-androst-4-en-17{beta}-ol. 28 (lxxxvii) Any salt, ester or ether of a drug or substance described or 29 listed in this subdivision. 30 (2) (i) Subject to subparagraph (ii) of this paragraph, a drug or 31 hormonal substance, other than estrogens, progestins, corticosteroids, 32 and dehydroepiandrosterone, that is not listed in paragraph one of this 33 subdivision and is derived from, or has a chemical structure substan- 34 tially similar to, one or more anabolic steroids listed in paragraph one 35 of this subdivision shall be considered to be an anabolic steroid for 36 purposes of this schedule if: 37 (A) the drug or substance has been created or manufactured with the 38 intent of producing a drug or other substance that either: 39 1. promotes muscle growth; or 40 2. otherwise causes a pharmacological effect similar to that of 41 testosterone; or 42 (B) the drug or substance has been, or is intended to be, marketed or 43 otherwise promoted in any manner suggesting that consuming it will 44 promote muscle growth or any other pharmacological effect similar to 45 that of testosterone. 46 (ii) A substance shall not be considered to be a drug or hormonal 47 substance for purposes of this subdivision if: 48 (A) it is: 49 1. an herb or other botanical; 50 2. a concentrate, metabolite, or extract of, or a constituent isolated 51 directly from, an herb or other botanical; or 52 3. a combination of two or more substances described in clause one or 53 two of this item; 54 (B) it is a dietary ingredient for purposes of the Federal Food, Drug, 55 and Cosmetic Act (21 U.S.C. 301 et seq.); and 56 (C) it is not anabolic or androgenic.S. 8307--A 133 A. 8807--A 1 (iii) In accordance with subdivision one of section thirty-three 2 hundred ninety-six of this article, any person claiming the benefit of 3 an exemption or exception under subparagraph (ii) of this paragraph 4 shall bear the burden of going forward with the evidence with respect to 5 such exemption or exception. 6 § 17. Subdivision (c) of schedule III of section 3306 of the public 7 health law is amended by adding two new paragraphs 15 and 16 to read as 8 follows: 9 (15) Perampanel, its salts, isomers and salts of isomers. 10 (16) Xylazine, its salts, isomers and salts of isomers, except when 11 expressly intended for use by a veterinarian in the course of the 12 professional practice of veterinary medicine; provided, however, that 13 such substance stocks shall be at all times properly safeguarded and 14 secured, and access shall be limited to the minimum number of employees 15 actually required to efficiently handle the custody, dispensing, admin- 16 istration or other handling of such substance; and further provided, 17 however, that all veterinarians shall maintain records, orders and 18 prescriptions of the substance for a period of five years from the date 19 of transaction, which shall be readily available and promptly produced, 20 in electronic or hardcopy format that is readily understandable, for 21 inspection and copying upon request by authorized representatives of the 22 department. Any individual who knowingly and willfully administers them- 23 selves or another person, prescribes, dispenses or distributes such 24 substance when any such substance is intended for human consumption or 25 for any purpose other than the normal course of practice of veterinary 26 medicine shall be subject to the same penalties as any individual or 27 practitioner who violates the provisions of this section and any other 28 penalties prescribed by law. 29 § 18. Subdivision (c) of schedule IV of section 3306 of the public 30 health law is amended by adding seven new paragraphs 54, 55, 56, 57, 58, 31 59 and 60 to read as follows: 32 (54) Alfaxalone. 33 (55) Brexanolone. 34 (56) Daridorexant. 35 (57) Lemborexant. 36 (58) Remimazolam. 37 (59) Suvorexant. 38 (60) Zuranolone. 39 § 19. Subdivision (e) of schedule IV of section 3306 of the public 40 health law is amended by amending paragraph 10 and adding two new para- 41 graphs 13 and 14 to read as follows: 42 (10) SPA((-)[)]-1-dimethylamino-1,2-diphenylethane). 43 (13) Serdexmethylphenidate. 44 (14) Solriamfetol.(2-amino-3-phenylpropyl carbamate; benzenepropanol, 45 beta-amino-, carbamate(ester)). 46 § 20. Subdivision (f) of schedule IV of section 3306 of the public 47 health law, as added by chapter 664 of the laws of 1985, paragraph 2 as 48 added by chapter 457 of the laws of 2006 and paragraph 3 as added by 49 section 14 of part C of chapter 447 of the laws of 2012, is amended to 50 read as follows: 51 (f) Other substances. Unless specifically excepted or unless listed in 52 another schedule, any material, compound, mixture or preparation which 53 contains any quantity of the following substances, including its salts, 54 isomers, and salts of such isomers, whenever the existence of such 55 salts, isomers, and salts of isomers is possible: 56 (1) Pentazocine.S. 8307--A 134 A. 8807--A 1 (2) Butorphanol (including its optical isomers). 2 (3) Tramadol in any quantities. 3 (4) Eluxadoline. (5-{{{(2S))-2-amino-3-{4-aminocarbonyl)-2,6-dimethyl 4 phenyl}-1-oxopropyl}{(1S)-1-(4-phenyl-1H-imidazol-2-yl)ethyl}amino}meth 5 yl}-2-methoxybenzoic acid) (including its optical isomers) and its 6 salts, isomers, and salts of isomers. 7 (5) Lorcaserin. 8 § 21. Subdivision (d) of schedule V of section 3306 of the public 9 health law is amended by adding four new paragraphs 4, 5, 6 and 7 to 10 read as follows: 11 (4) Brivaracetam ( (2S)-2-{ (4R) -2-oxo-4-propylpyrrolidin-1-yl} 12 butanamide). Some trade or other names: BRV; UCB-34714; Briviact) 13 (including its salts). 14 (5) Cenobamate ({1R)-1-(2-chlorophenyl)-2-(tetrazol-2-yl)ethyl} 15 carbamate; 2H-tetrazole-2-ethanol, alpha-(2-chlorophenyl)-, carbamate 16 (ester), (alphaR)-; carbamic acid(R)-(+)-1-(2-chlorophenyl) -2- (2H-te- 17 tra zol-2-yl)ethyl ester). 18 (6) Ganaxolone. 3{alpha}-hydroxy-3{beta}-methyl-5{alpha}-pregnan-20- 19 one. 20 (7) Lasmiditan 21 {2,4,6-trifluoro-N-(6-(1-methylpiperidine-4-carbonyl)pyridine-2-yl-benzam 22 ide}. 23 § 22. Subdivision 2 of section 3342 of the public health law, as 24 amended by chapter 692 of the laws of 1976, is amended to read as 25 follows: 26 2. An institutional dispenser may dispense controlled substances for 27 use off its premises only pursuant to a prescription, prepared and filed 28 in conformity with this title, provided, however, that, in an emergency 29 situation as defined by rule or regulation of the department, a practi- 30 tioner in a hospital without a full-time pharmacy may dispense 31 controlled substances to a patient in a hospital emergency room for use 32 off the premises of the institutional dispenser for a period not to 33 exceed twenty-four hours, unless the federal drug enforcement adminis- 34 tration has authorized a longer time period for the purpose of initiat- 35 ing maintenance treatment, detoxification treatment, or both. 36 § 23. Subdivision 1 of section 3302 of the public health law, as 37 amended by chapter 92 of the laws of 2021, is amended to read as 38 follows: 39 1. "[Addict] Person with a substance use disorder" means a person who 40 habitually uses a controlled substance for a non-legitimate or unlawful 41 use, and who by reason of such use is dependent thereon. 42 § 24. Subdivision 1 of section 3331 of the public health law, as added 43 by chapter 878 of the laws of 1972, is amended to read as follows: 44 1. Except as provided in titles III or V of this article, no substance 45 in schedules II, III, IV, or V may be prescribed for or dispensed or 46 administered to [an addict] a person with a substance use disorder or 47 habitual user. 48 § 25. The title heading of title 5 of article 33 of the public health 49 law, as added by chapter 878 of the laws of 1972, is amended to read as 50 follows: 51 DISPENSING TO [ADDICTS] PERSONS WITH A SUBSTANCE USE 52 DISORDER AND HABITUAL USERSS. 8307--A 135 A. 8807--A 1 § 26. Section 3350 of the public health law, as added by chapter 878 of 2 the laws of 1972, is amended to read as follows: 3 § 3350. Dispensing prohibition. Controlled substances may not be 4 prescribed for, or administered or dispensed to [addicts] persons with a 5 substance use disorder or habitual users of controlled substances, 6 except as provided by this title or title III. 7 § 27. Section 3351 of the public health law, as added by chapter 878 8 of the laws of 1972, subdivision 5 as amended by chapter 558 of the laws 9 of 1999, is amended to read as follows: 10 § 3351. Dispensing for medical use. 1. Controlled substances may be 11 prescribed for, or administered or dispensed to [an addict] a person 12 with a substance use disorder or habitual user: 13 (a) during emergency medical treatment unrelated to [abuse] such 14 substance use disorder or habitual use of controlled substances; 15 (b) who is a bona fide patient suffering from an incurable and fatal 16 disease such as cancer or advanced tuberculosis; 17 (c) who is aged, infirm, or suffering from serious injury or illness 18 and the withdrawal from controlled substances would endanger the life or 19 impede or inhibit the recovery of such person. 20 1-a. A practitioner may prescribe, order and dispense any schedule 21 III, IV, or V narcotic drug approved by the federal food and drug admin- 22 istration specifically for use in maintenance or detoxification treat- 23 ment to a person with a substance use disorder or habitual user. 24 2. Controlled substances may be ordered for use by [an addict] a 25 person with a substance use disorder or habitual user by a practitioner 26 and administered by a practitioner [or], registered nurse, or paramedic 27 to relieve acute withdrawal symptoms. 28 3. Methadone, or such other controlled substance designated by the 29 commissioner as appropriate for such use, may be ordered for use of [an30addict] a person with a substance use disorder by a practitioner and 31 dispensed or administered by a practitioner or his designated agent as 32 interim treatment for [an addict on a waiting list for admission to an33authorized maintenance program] a person with a substance use disorder 34 while arrangements are being made for referral to treatment for such 35 addiction to controlled substances. 36 4. Methadone, or such other controlled substance designated by the 37 commissioner as appropriate for such use, may be administered to [an38addict] a person with a substance use disorder by a practitioner or by 39 [his] their designated agent acting under the direction and supervision 40 of a practitioner, as part of a [regime] regimen designed and intended 41 as maintenance or detoxification treatment or to withdraw a patient from 42 addiction to controlled substances. 43 5. [Methadone] Notwithstanding any other law and consistent with 44 federal requirements, methadone, or such other controlled substance 45 designated by the commissioner as appropriate for such use, may be 46 administered or dispensed directly to [an addict] a person with a 47 substance use disorder by a practitioner or by [his] their designated 48 agent acting under the direction and supervision of a practitioner, as 49 part of a substance [abuse or chemical dependence] use disorder program 50 approved pursuant to article [twenty-three or] thirty-two of the mental 51 hygiene law. 52 § 28. Section 3372 of the public health law is REPEALED. 53 § 29. This act shall take effect immediately. 54 PART VS. 8307--A 136 A. 8807--A 1 Section 1. Section 2805-x of the public health law, as added by 2 section 48 of part B of chapter 57 of the laws of 2015, paragraph (d) of 3 subdivision 4 as added by chapter 697 of the laws of 2023, is amended to 4 read as follows: 5 § 2805-x. [Hospital-home care-physician] Health care delivery collab- 6 oration program. 1. The purpose of this section shall be to facilitate 7 innovation in [hospital, home care agency and physician collaboration in8meeting] collaborations between licensed and certified health care 9 providers and agencies, including: hospitals, home care agencies, emer- 10 gency medical services, skilled nursing facilities, and hospices, as 11 well as payors and other interdisciplinary providers, practitioners and 12 service entities, to meet the community's evolving health care needs in 13 a changing health care delivery landscape. It shall provide a framework 14 to support voluntary initiatives in collaboration to improve patient 15 care access and management, patient health outcomes, cost-effectiveness 16 in the use of health care services and community population health. 17 [Such collaborative initiatives may also include payors, skilled nursing18facilities and other interdisciplinary providers, practitioners and19service entities.] 20 2. For purposes of this section: 21 (a) "Hospital" shall include a general hospital as defined in this 22 article or other inpatient facility for rehabilitation or specialty care 23 within the definition of hospital in this article. 24 (b) "Home care agency" shall mean a certified home health agency, long 25 term home health care program or licensed home care services agency as 26 defined in article thirty-six of this chapter. 27 (c) "Payor" shall mean a health plan approved pursuant to article 28 forty-four of this chapter, or article thirty-two or forty-three of the 29 insurance law. 30 (d) "Practitioner" shall mean any of the health, mental health or 31 health related professions licensed pursuant to title eight of the 32 education law. 33 (e) "Physician" shall mean a person duly licensed pursuant to article 34 one hundred thirty-one of the education law. 35 (f) "Hospice" shall mean an agency approved under article forty of 36 this chapter. 37 (g) "Emergency medical services" shall mean an agency approved under 38 article thirty of this chapter. 39 (h) "Skilled nursing facility" shall mean a residential health care 40 facility or nursing home licensed pursuant to article twenty-eight of 41 this chapter. 42 3. The commissioner is authorized to provide financing including, but 43 not limited to, grants or positive adjustments in medical assistance 44 rates or premium payments, to the extent of funds available and allo- 45 cated or appropriated therefor, including funds provided to the state 46 through federal waivers, funds made available through state appropri- 47 ations and/or funding through section twenty-eight hundred seven-v of 48 this article, as well as waivers of regulations under title ten of the 49 New York codes, rules and regulations, to support the voluntary initi- 50 atives and objectives of this section. 51 4. [Hospital-home care-physician] Health care delivery collaborative 52 initiatives under this section may include, but shall not be limited to: 53 (a) [Hospital-home care-physician integration] Integration initiatives 54 between at least two of the following: hospitals, home care agencies, 55 physician, physicians' group, emergency medical services, hospice, and 56 skilled nursing facilities, including but not limited to:S. 8307--A 137 A. 8807--A 1 (i) transitions in care initiatives to help effectively transition 2 patients to post-acute care at home, coordinate follow-up care and 3 address issues critical to care plan success and readmission avoidance; 4 (ii) clinical pathways for specified conditions, guiding patients' 5 progress and outcome goals, as well as effective health services use; 6 (iii) application of telehealth/telemedicine services in monitoring 7 and managing patient conditions, and promoting self-care/management, 8 improved outcomes and effective services use; 9 (iv) facilitation of physician house calls to homebound patients 10 and/or to patients for whom such home visits are determined necessary 11 and effective for patient care management; 12 (v) additional models for prevention of avoidable hospital readmis- 13 sions and emergency room visits; 14 (vi) health home development; 15 (vii) development and demonstration of new models of integrated or 16 collaborative care and care management not otherwise achievable through 17 existing models; and 18 (viii) bundled payment demonstrations for hospital-to-post-acute-care 19 for specified conditions or categories of conditions, in particular, 20 conditions predisposed to high prevalence of readmission, including 21 those currently subject to federal/state penalty, and other discharges 22 with extensive post-acute needs; 23 (b) Recruitment, training and retention of hospital/home care direct 24 care staff and physicians, in geographic or clinical areas of demon- 25 strated need. Such initiatives may include, but are not limited to, the 26 following activities: 27 (i) outreach and public education about the need and value of service 28 in health occupations; 29 (ii) training/continuing education and regulatory facilitation for 30 cross-training to maximize flexibility in the utilization of staff, 31 including: 32 (A) training of hospital nurses in home care; 33 (B) dual certified nurse aide/home health aide certification; and 34 (C) dual personal care aide/HHA certification; 35 (iii) salary/benefit enhancement; 36 (iv) career ladder development; and 37 (v) other incentives to practice in shortage areas; and 38 (c) [Hospital - home care - physician] Health care delivery collabora- 39 tives for the care and management of special needs, high-risk and high- 40 cost patients, including but not limited to best practices, and training 41 and education of direct care practitioners and service employees. 42 (d) Collaborative programs to address disparities in health care 43 access or treatment, and/or conditions of higher prevalence, in certain 44 populations, where such collaborative programs could provide and manage 45 services in a more effective, person-centered and cost-efficient manner 46 for reduction or elimination of such disparities. 47 (i) Such programs may target one or more disparate conditions, or 48 areas of under-service, evidenced in defined populations, including but 49 not be limited to: 50 (A) cardiovascular disease; 51 (B) hypertension; 52 (C) diabetes; 53 (D) chronic kidney disease; 54 (E) obesity; 55 (F) asthma; 56 (G) sickle cell disease;S. 8307--A 138 A. 8807--A 1 (H) sepsis; 2 (I) lupus; 3 (J) breast, lung, prostate and colorectal cancers; 4 (K) geographic shortage of primary care, prenatal/obstetric care, 5 specialty medical care, home health care, or culturally and linguis- 6 tically compatible care; 7 (L) alcohol, tobacco, or substance abuse; 8 (M) post-traumatic stress disorder and other conditions more prevalent 9 among veterans of the United States military services; 10 (N) attracting members of minority populations to the field and prac- 11 tice of medicine; and 12 (O) such other areas approved by the commissioner. 13 (ii) Collaborative [hospital-home care-physician] health care 14 delivery, and as applicable additional partner, models may include under 15 such disparities programs: 16 (A) service planning and design; 17 (B) recruitment of specialty personnel and/or specialty training of 18 professionals or other direct care personnel (including physicians, home 19 care and hospital staffs), patients and informal caregivers; 20 (C) continuing medical education and clinical training for physicians, 21 follow-up evaluations, and supporting educational materials; 22 (D) use of evidenced-based approaches and/or best practices to treat- 23 ment; 24 (E) reimbursement of uncovered services; 25 (F) bundled or other integrated payment methods to support the neces- 26 sary, coordinated and cost-effective services; 27 (G) regulatory waivers to facilitate flexibility in provider collab- 28 oration and person-centered care; 29 (H) patient/family peer support and education; 30 (I) data collection, research and evaluation of efficacy; and/or 31 (J) other components or innovations satisfactory to the commissioner. 32 (iii) Nothing contained in this paragraph shall prevent a physician, 33 [physicians] physicians' group, home care agency, or hospital from indi- 34 vidually applying for said grant. 35 (iv) The commissioner shall consult with physicians, home care agen- 36 cies, hospitals, consumers, statewide associations representative of 37 such participants, and other experts in health care disparities, in 38 developing an application process for grant funding or rate adjustment, 39 and for request of state regulatory waivers, to facilitate implementa- 40 tion of disparities programs under this paragraph. 41 5. At a minimum, applications for collaborative initiatives under 42 this section must specifically identify the service gaps and/or communi- 43 ty need the collaboration seeks to address, and outline a projected 44 timeline for implementation and deliverable data to demonstrate mile- 45 stones to success. 46 6. Hospitals and home care agencies which are provided financing or 47 waivers pursuant to this section shall report to the commissioner on the 48 patient, service and cost experiences pursuant to this section, includ- 49 ing the extent to which the project goals are achieved. The commissioner 50 shall compile and make such reports available on the department's 51 website. 52 § 2. Subdivision 2 of section 3602 of the public health law, as added 53 by chapter 895 of the laws of 1977, is amended to read as follows: 54 2. "Home care services agency" means an organization primarily engaged 55 in arranging and/or providing directly or through contract arrangement 56 one or more of the following: Nursing services, home health aideS. 8307--A 139 A. 8807--A 1 services, and other therapeutic and related services which may include, 2 but shall not be limited to, physical, speech and occupational therapy, 3 nutritional services, medical social services, personal care services, 4 homemaker services, and housekeeper or chore services, which may be of a 5 preventive, therapeutic, rehabilitative, health guidance, and/or 6 supportive nature to persons at home. For the purposes of this article, 7 a general hospital licensed pursuant to article twenty-eight of this 8 chapter shall not be considered "primarily engaged in arranging and/or 9 providing" nursing, home health, or other therapeutic services notwith- 10 standing that such services may be provided in a patient's residence, 11 provided that at least fifty-one percent of patient care hours for such 12 general hospital is generated from the treatment of patients within the 13 hospital, and that any patients treated in their residence have a preex- 14 isting clinical relationship with the general hospital. 15 § 3. Section 2803 of the public health law is amended by adding a new 16 subdivision 15 to read as follows: 17 15. Subject to the availability of federal financial participation and 18 notwithstanding any contrary provision of this article, or any rule or 19 regulation to the contrary, the commissioner shall allow general hospi- 20 tals to provide off-site acute care medical services, that are: 21 (a) not home care services defined in subdivision one of section thir- 22 ty-six hundred two of this chapter or the professional services enumer- 23 ated in subdivision two of such section; 24 (b) provided by a medical professional, including a physician, regis- 25 tered nurse, nurse practitioner, or physician assistant, to a patient 26 with a pre-existing clinical relationship with the general hospital, or 27 with the health care professional providing the service; and 28 (c) provided to a patient for whom a medical professional has deter- 29 mined is appropriate to receive acute medical services at their resi- 30 dence. 31 (d) Nothing in this subdivision shall preclude a federally qualified 32 health center from providing off-site services in accordance with 33 department regulations. 34 (e) The department is authorized to establish medical assistance 35 program rates to effectuate this subdivision. For the purposes of the 36 department determining the applicable rates pursuant to such authority, 37 any general hospital approved pursuant to this subdivision shall report 38 to the department, in the form and format required by the department, 39 its annual operating costs, specifically for such off-site acute 40 services. Failure to timely submit such cost data to the department may 41 result in revocation of authority to participate in a program under this 42 section due to the inability to establish appropriate reimbursement 43 rates. 44 § 4. Subdivision 3 of section 3018 of the public health law, as added 45 by chapter 137 of the laws of 2023, is amended to read as follows: 46 3. (a) This program shall authorize mobile integrated and community 47 paramedicine programs presently operating and approved by the department 48 as of May eleventh, two thousand twenty-three, under the authority of 49 Executive Order Number 4 of two thousand twenty-one, entitled "Declaring 50 a Statewide Disaster Emergency Due to Healthcare staffing shortages in 51 the State of New York" to continue in the same manner and capacity as 52 currently approved [for a period of two years following the effective53date of this section] through March thirty-first, two thousand thirty- 54 one. 55 (b) Any program not currently approved and operating in accordance 56 with paragraph (a) of this subdivision may apply to the department forS. 8307--A 140 A. 8807--A 1 approval to operate a mobile integrated and community paramedicine 2 program, and any program currently operating pursuant to paragraph (a) 3 of this subdivision for a limited purpose, including but not limited to 4 vaccination administration, may apply to the department for approval to 5 modify its existing community paramedicine program. The department may 6 approve up to two hundred new or modified programs pursuant to this 7 paragraph. Such applications must be submitted in the form and format 8 prescribed by the department. Programs approved pursuant to this para- 9 graph may be permitted to operate through March thirty-first, two thou- 10 sand thirty-one. 11 § 5. Section 2 of chapter 137 of the laws of 2023 amending the public 12 health law relating to establishing a community-based paramedicine 13 demonstration program, is amended to read as follows: 14 § 2. This act shall take effect immediately and shall expire and be 15 deemed repealed [2 years after such date] March 31, 2031; provided, 16 however, that if this act shall have become a law on or after May 22, 17 2023 this act shall take effect immediately and shall be deemed to have 18 been in full force and effect on and after May 22, 2023. 19 § 6. Subdivision 1 of section 3001 of the public health law, as 20 amended by chapter 804 of the laws of 1992, is amended to read as 21 follows: 22 1. "Emergency medical service" means [initial emergency medical23assistance including, but not limited to, the treatment of trauma,24burns, respiratory, circulatory and obstetrical emergencies] a coordi- 25 nated system of healthcare delivery that responds to the needs of sick 26 and injured individuals, by providing: essential emergency, non-emergen- 27 cy, specialty need or public event medical care; community education and 28 prevention programs; ground and air ambulance services; emergency 29 medical dispatch; training for emergency medical services practitioners; 30 medical first response; mobile trauma care systems; mass casualty 31 management; and medical direction. 32 § 7. Section 6909 of the education law is amended by adding a new 33 subdivision 12 to read as follows: 34 12. A certified nurse practitioner may prescribe and order a non-pa- 35 tient specific regimen to an emergency medical services practitioner 36 licensed by the department of health pursuant to article thirty of the 37 public health law, pursuant to regulations promulgated by the commis- 38 sioner, and consistent with the public health law, for administering 39 immunizations. Nothing in this subdivision shall authorize unlicensed 40 persons to administer immunizations, vaccines or other drugs. 41 § 8. Section 6527 of the education law is amended by adding a new 42 subdivision 12 to read as follows: 43 12. A licensed physician may prescribe and order a non-patient specif- 44 ic regimen to an emergency medical services practitioner licensed by the 45 department of health pursuant to article thirty of the public health 46 law, pursuant to regulations promulgated by the commissioner, and 47 consistent with the public health law, for administering immunizations. 48 Nothing in this subdivision shall authorize unlicensed persons to admin- 49 ister immunizations, vaccines or other drugs. 50 § 9. The public health law is amended by adding a new article 30-D to 51 read as follows: 52 ARTICLE 30-D 53 EMERGENCY MEDICAL SERVICES ESSENTIAL SERVICES ACT 54 Section 3080. Declaration of purpose. 55 3081. Application of article. 56 3082. Definitions.S. 8307--A 141 A. 8807--A 1 3083. Designation of medical emergency response and emergency 2 medical dispatch agencies as essential services. 3 3084. Provision of emergency medical dispatch. 4 3085. Rules and regulations. 5 § 3080. Declaration of purpose. 1. The provision of prompt, efficient, 6 and effective emergency medical services and emergency medical dispatch 7 is crucial to the health and safety of the residents of New York state. 8 2. The establishment of a comprehensive and standardized system for 9 medical emergency response is essential to address life-threatening 10 conditions and ensure the well-being of individuals in need of urgent 11 medical care. 12 3. Ensuring that every county within New York state has the necessary 13 resources, trained personnel, and operational capabilities to provide 14 medical emergency response is a matter of public interest and state 15 priority. 16 4. It is imperative to standardize the approach to medical emergency 17 response and dispatch services to enhance the quality of care, maximize 18 efficiency, and improve outcomes for patients experiencing medical emer- 19 gencies. 20 5. The designation of medical emergency response and emergency medical 21 dispatch as essential services will ensure a uniform, effective, and 22 coordinated response to medical emergencies across the state. 23 6. This article aims to establish a framework for the provision, oper- 24 ation, and regulation of medical emergency response and dispatch 25 services, thereby safeguarding the health and safety of New York state's 26 residents and visitors. 27 § 3081. Application of article. This article shall apply to every 28 county except a county wholly contained within a city. 29 § 3082. Definitions. As used in this article, the following terms 30 shall have the following meanings: 31 1. "Medical emergency response" shall mean the rapid deployment of 32 ambulance services, advanced life support first response services, and 33 other first response services authorized by the department to provide 34 emergency medical services, as defined in section three thousand one of 35 this chapter, for the purpose of providing immediate emergency medical 36 care in response to emergency calls for acute conditions where rapid 37 intervention is vital to prevent death or serious harm. 38 2. "Emergency medical dispatch" means a protocol-driven system 39 approved by the department designed to manage, assess, and prioritize 40 medical emergency calls, provide critical pre-arrival instructions, and 41 dispatch medical emergency response services by an EMS medical dispatch 42 agency or provide referral to appropriate non-emergency medical services 43 where appropriate. 44 3. "EMS medical dispatch agency" means any individual, partnership, 45 association, corporation, municipality or any legal or public entity or 46 subdivision thereof licensed by the department who is engaged in receiv- 47 ing requests for emergency medical assistance from the public and 48 dispatching medical emergency response services as needed, except for 49 any such individual or entity that is subject to minimum standards 50 promulgated under section three-hundred twenty-eight of County Law. 51 4. "Medical emergency readiness assessment" means the rating system 52 evaluating the preparedness, efficiency, and effectiveness of medical 53 emergency response within a community. 54 § 3083. Designation of medical emergency response and emergency 55 medical dispatch agencies as essential services. 1. Medical emergencyS. 8307--A 142 A. 8807--A 1 response and emergency medical dispatch agencies are hereby declared 2 essential services within New York state. 3 2. Every county, acting individually or jointly with any other county, 4 city, town, and village, shall ensure that an emergency medical service, 5 ambulance service, advanced life support first response service, other 6 first response services authorized by the department to provide emergen- 7 cy medical services, or a combination of such services are provided for 8 the purposes of effectuating medical emergency response within the boun- 9 daries of the county. 10 3. Every county acting individually or jointly with any other county, 11 city, town, and village, shall develop, implement, and maintain a 12 comprehensive county medical emergency response plan approved by the 13 department, ensuring the effective operation, coordination, utilization 14 of existing ambulance services licensed by the Department, and funding 15 of medical emergency response. In furtherance of that purpose, the coun- 16 ty shall designate one or more primary medical emergency response agen- 17 cies that shall respond to all calls and demands for such medical emer- 18 gency response to persons entitled thereto, subject to any limitations 19 upon such service specified in an agreement, within the boundaries of 20 the county. Any proposed permanent changes, including a full closure or 21 significant modification of coverage of a primary medical emergency 22 response agency designated by a county shall be submitted in writing to 23 the county and the department no later than 180 days before the change. 24 Such changes shall not be made until receipt of the appropriate depart- 25 ment approval. No county shall remove or reassign an area served by an 26 existing medical emergency response agency where that agency is compli- 27 ant with all statutory and regulatory requirements of the department, 28 and that has agreed to the provision of approved plan. No medical emer- 29 gency response agency, designated by the county in the plan, may refuse 30 to respond to a request for service unless they can prove, to the satis- 31 faction of the department, that they are unable to respond because of 32 capacity limitations. 33 4. Notwithstanding the provisions of section three thousand eight of 34 this chapter, any county acting individually or jointly with any other 35 county, city, town, and village, that provides, either directly or 36 through agreement with existing services, an emergency medical service 37 or general ambulance service in accordance with section one hundred 38 twenty-two-b of the general municipal law, for the purpose of effectuat- 39 ing medical emergency response, upon meeting or exceeding all adminis- 40 trative and operational standards set by the department, and upon filing 41 written notice to the department in a manner prescribed by the depart- 42 ment, shall be deemed to have satisfied any and all requirements for 43 determination of public need for the establishment of additional emer- 44 gency medical services and the department shall issue a non-transfera- 45 ble, permanent municipal ambulance service operating certificate. Noth- 46 ing in this article shall be deemed to exclude any county issued a 47 municipal ambulance service operating certificate from complying with 48 any other requirement of article thirty of this chapter or any other 49 applicable provision of law or regulations promulgated thereunder. 50 5. Any county acting individually or jointly with any other county, 51 city, town, and village, that provides, either directly or through 52 agreement with an existing service, an emergency medical service or 53 general ambulance service in accordance with section one hundred twen- 54 ty-two-b of the general municipal law, for the purpose of effectuating 55 medical emergency response may establish a special district, after nine- 56 ty days notice to the department, as defined in subdivision sixteen ofS. 8307--A 143 A. 8807--A 1 section one hundred two of the real property tax law, for the financing 2 and operation of such emergency medical service or general ambulance 3 service in accordance with section one hundred twenty-two-b of the 4 general municipal law with an emergency medical services agency licensed 5 by the department to provide emergency medical services in the state. 6 Such special district shall be exempt from the provisions of section 7 three-c of the general municipal law until five years after the estab- 8 lishment of the special district. 9 6. The department shall establish standards, with the advice from the 10 state emergency medical services council, the state emergency medical 11 advisory committee and the state trauma advisory committee, establishing 12 minimum standards for the provision of emergency medical services by 13 first aid squads, basic life support first response services, special 14 event medical services, and other first response services not otherwise 15 defined in article thirty of this chapter. 16 § 3084. Provision of emergency medical dispatch. 1. Every EMS medical 17 dispatch agency, as defined in this section, operating within New York 18 state shall provide emergency medical dispatch services in accordance 19 with emergency medical dispatch protocols approved by the department. 20 2. All EMS medical dispatch agencies may be required to be licensed by 21 the department. The department, in consultation with the State Interop- 22 erable Emergency Communications Board, may establish criteria for the 23 licensing of EMS medical dispatch agencies, as defined in this section, 24 to ensure compliance with EMS medical dispatch standards. 25 3. All emergency medical dispatchers with a primary role of providing 26 emergency medical dispatch services while employed by EMS medical 27 dispatch agencies, as defined in this section, must complete an emergen- 28 cy medical dispatch certification training course approved by the 29 department, in consultation with the State Interoperable Emergency 30 Communications Board, and maintain continuous certification while 31 employed by the EMS medical dispatch agency, as defined in this section, 32 with a primary role as an emergency medical dispatcher, and may be 33 required to be licensed by the department. The department, in consulta- 34 tion with the State Interoperable Emergency Communications Board, may 35 establish minimum standards for emergency medical dispatch certification 36 training courses and dispatcher licensure. 37 § 3085. Rules and regulations. The commissioner may promulgate rules 38 and regulations to effectuate the purposes of this article. 39 § 10. The public health law is amended by adding a new section 3019 to 40 read as follows: 41 § 3019. Emergency medical services demonstration programs. 1. The 42 purpose of this section shall be to facilitate innovation in medical 43 care provided by emergency medical service practitioners in meeting the 44 community's health care needs, including collaboration with other health 45 care organizations operating under the provisions of section twenty- 46 eight hundred five-x of this chapter. It shall provide a framework to 47 support voluntary initiatives to improve patient care access and manage- 48 ment, patient health outcomes, and cost-effectiveness in the use of 49 health care services and community population health. 50 2. The commissioner is authorized to provide financing including, to 51 the extent of funds available and allocated or appropriated therefor, as 52 well as waivers of certain parts of this article, article thirty-A of 53 this chapter, and regulations under title ten of the New York codes, 54 rules and regulations, to support the voluntary initiatives and objec- 55 tives of this section.S. 8307--A 144 A. 8807--A 1 § 11. The public health law is amended by adding a new section 3055 to 2 read as follows: 3 § 3055. EMS licensure and credentialing. 1. The department, with the 4 approval of the state emergency medical services council, may establish 5 minimum standards for the licensure of emergency medical services prac- 6 titioners including but not limited to emergency medical technicians and 7 advanced emergency medical technicians by the department. 8 2. The department, with the approval of the state emergency medical 9 services council, may establish minimum standards for specialized 10 credentialing of emergency medical service practitioners which shall 11 include, but not be limited to, emergency vehicle operator, critical 12 care paramedic, emergency medical dispatcher, emergency medical services 13 field training officer, emergency medical services administrator, emer- 14 gency medical control physician, and emergency medical services agency 15 medical director. 16 § 12. The public health law is amended by adding a new section 3029 to 17 read as follows: 18 § 3029. Paramedic urgent care program. 1. The department shall estab- 19 lish a paramedic urgent care program to effectuate the role of emergency 20 medical services personnel in the delivery of health care services in 21 rural counties of New York state. 22 2. Any organization that is authorized to provide advanced life 23 support services, in accordance with section three thousand thirty of 24 this article, may apply to the department for approval to operate a 25 paramedic urgent care. 26 3. Any paramedic urgent care programs approved by the department under 27 this section shall: (a) be under the overall supervision and direction 28 of a qualified physician; (b) be staffed by qualified medical and health 29 personnel, physician assistants, or nurse practitioners; (c) utilize 30 advanced emergency medical technicians whose scope of practice is appro- 31 priate for the medical services provided; (d) maintain a treatment-man- 32 agement record for each patient; and (e) be integrated with a hospital 33 or other appropriate healthcare organization. 34 4. Paramedic urgent care programs may integrate telehealth provided by 35 a telehealth provider, as those terms are defined in section twenty-nine 36 hundred ninety-nine-cc of this chapter. The commissioner may specify in 37 regulation additional acceptable modalities for the delivery of health 38 care services by paramedic care programs via telehealth, including but 39 not limited to audio-only or video-only telephone communications, online 40 portals and survey applications. 41 5. Nothing in this section shall be deemed to allow a person to 42 provide any service for which a license, registration, certification or 43 other authorization under title eight of the education law is required 44 and which the person does not possess, provided that any service being 45 excluded pursuant to this subdivision shall not include a service that 46 is within the scope of practice for the respective emergency medical 47 services personnel. 48 § 13. This act shall take effect immediately and shall be deemed to 49 have been in full force and effect on and after April 1, 2024; provided, 50 however, that the amendments to subdivision 3 of section 3018 of the 51 public health law made by section four of this act shall not affect the 52 repeal of such section and shall be deemed repealed therewith. 53 PART WS. 8307--A 145 A. 8807--A 1 Section 1. The elder law is amended by adding a new section 226 to 2 read as follows: 3 § 226. Interagency elder justice coordinating council. 1. There is 4 hereby created within the office an elder justice coordinating council 5 consisting of representatives of state agencies whose work involves 6 elder justice to create greater collaboration and develop overarching 7 strategies, systems, and programs to be carried out in accordance with 8 the governor's elder justice priorities, with a goal of protecting older 9 adults from abuse and mistreatment. The council shall collaborate to 10 identify and support consistent policies and program operation, facili- 11 tate communication among state agencies, foster collaborative relation- 12 ships, and help state agencies keep informed of local, state, and 13 national developments in elder justice. 14 2. The council shall be chaired by the director of the office for the 15 aging, and shall include representation from the office of victims 16 services, the office of children and family services, the department of 17 financial services, the division of criminal justice services, the 18 office of mental health, the office for the prevention of domestic 19 violence, the department of health, the office for people with develop- 20 mental disabilities, the New York state police, the justice center for 21 the protection of people with special needs, and the department of 22 state's division of consumer protection. Additionally, the council shall 23 request input from stakeholders, advocates, experts, and coalitions. 24 3. The council shall: 25 (a) develop and implement a cohesive, comprehensive state plan on 26 elder justice that aligns state elder justice policy and programs across 27 state agency responsibilities; 28 (b) develop plans for a coordinated and comprehensive response from 29 state and local government and other entities when elder abuse is 30 reported; 31 (c) facilitate interagency planning and policy development on elder 32 justice; 33 (d) review and propose specific agency initiatives for their impact on 34 systems and services related to elder justice; 35 (e) coordinate activities for world elder abuse awareness day and 36 other events; and 37 (f) make recommendations to the governor that will improve New York's 38 elder abuse prevention and intervention efforts. 39 4. Each member agency shall maintain control over, and responsibility 40 for, its own programs and policies. The council shall not take the place 41 of any existing interagency councils and committees. The council shall 42 serve to focus attention on elder justice comprehensively and create a 43 multidisciplinary mechanism to work toward alignment across agencies to 44 help achieve the governor's elder justice priorities. 45 5. The council shall meet regularly and shall submit a report on its 46 activities to the governor and the legislature no later than December 47 thirty-first, two thousand twenty-five and annually thereafter. 48 § 2. This act shall take effect immediately. 49 PART X 50 Intentionally Omitted. 51 PART YS. 8307--A 146 A. 8807--A 1 Section 1. Section 7 of part R2 of chapter 62 of the laws of 2003, 2 amending the mental hygiene law and the state finance law relating to 3 the community mental health support and workforce reinvestment program, 4 the membership of subcommittees for mental health of community services 5 boards and the duties of such subcommittees and creating the community 6 mental health and workforce reinvestment account, as amended by section 7 1 of part W of chapter 57 of the laws of 2021, is amended to read as 8 follows: 9 § 7. This act shall take effect immediately [and shall expire March1031, 2024 when upon such date the provisions of this act shall be deemed11repealed]. 12 § 2. This act shall take effect immediately. 13 PART Z 14 Section 1. Section 2 of part NN of chapter 58 of the laws of 2015, 15 amending the mental hygiene law relating to clarifying the authority of 16 the commissioners in the department of mental hygiene to design and 17 implement time-limited demonstration programs, as amended by section 1 18 of part V of chapter 57 of the laws of 2021, is amended to read as 19 follows: 20 § 2. This act shall take effect immediately [and shall expire and be21deemed repealed March 31, 2024]. 22 § 2. This act shall take effect immediately. 23 PART AA 24 Section 1. Paragraph 31 of subsection (i) of section 3216 of the 25 insurance law is amended by adding a new subparagraph (J) to read as 26 follows: 27 (J) This subparagraph shall apply to facilities in this state that are 28 licensed, certified, or otherwise authorized by the office of addiction 29 services and supports for the provision of outpatient, intensive outpa- 30 tient, outpatient rehabilitation and opioid treatment that are partic- 31 ipating in the insurer's provider network. Reimbursement for covered 32 outpatient treatment provided by such facilities shall be at a rate that 33 is not less than the rate that would be paid for such treatment pursuant 34 to the medical assistance program under title eleven of article five of 35 the social services law. 36 § 2. Paragraph 35 of subsection (i) of section 3216 of the insurance 37 law is amended by adding a new subparagraph (K) to read as follows: 38 (K) This subparagraph shall apply to outpatient treatment provided in 39 a facility issued an operating certificate by the commissioner of mental 40 health pursuant to the provisions of article thirty-one of the mental 41 hygiene law, or in a facility operated by the office of mental health, 42 or in a crisis stabilization center licensed pursuant to section 36.01 43 of the mental hygiene law, that is participating in the insurer's 44 provider network. Reimbursement for covered outpatient treatment 45 provided by such a facility shall be at a rate that is not less than the 46 rate that would be paid for such treatment pursuant to the medical 47 assistance program under title eleven of article five of the social 48 services law. 49 § 3. Paragraph 5 of subsection (l) of section 3221 of the insurance 50 law is amended by adding a new subparagraph (K) to read as follows: 51 (K) This subparagraph shall apply to outpatient treatment provided in 52 a facility issued an operating certificate by the commissioner of mentalS. 8307--A 147 A. 8807--A 1 health pursuant to the provisions of article thirty-one of the mental 2 hygiene law, or in a facility operated by the office of mental health, 3 or in a crisis stabilization center licensed pursuant to section 36.01 4 of the mental hygiene law, that is participating in the insurer's 5 provider network. Reimbursement for covered outpatient treatment 6 provided by such a facility shall be at a rate that is not less than the 7 rate that would be paid for such treatment pursuant to the medical 8 assistance program under title eleven of article five of the social 9 services law. 10 § 4. Paragraph 7 of subsection (l) of section 3221 of the insurance 11 law is amended by adding a new subparagraph (J) to read as follows: 12 (J) This subparagraph shall apply to facilities in this state that are 13 licensed, certified, or otherwise authorized by the office of addiction 14 services and supports for the provision of outpatient, intensive outpa- 15 tient, outpatient rehabilitation and opioid treatment that are partic- 16 ipating in the insurer's provider network. Reimbursement for covered 17 outpatient treatment provided by such facilities shall be at a rate that 18 is not less than the rate that would be paid for such treatment pursuant 19 to the medical assistance program under title eleven of article five of 20 the social services law. 21 § 5. Subsection (g) of section 4303 of the insurance law is amended by 22 adding a new paragraph 12 to read as follows: 23 (12) This paragraph shall apply to outpatient treatment provided in a 24 facility issued an operating certificate by the commissioner of mental 25 health pursuant to the provisions of article thirty-one of the mental 26 hygiene law, or in a facility operated by the office of mental health, 27 or in a crisis stabilization center licensed pursuant to section 36.01 28 of the mental hygiene law, that is participating in the corporation's 29 provider network. Reimbursement for covered outpatient treatment 30 provided by such facility shall be at a rate that is not less than the 31 rate that would be paid for such treatment pursuant to the medical 32 assistance program under title eleven of article five of the social 33 services law. 34 § 6. Subsection (l) of section 4303 of the insurance law is amended by 35 adding a new paragraph 10 to read as follows: 36 (10) This paragraph shall apply to facilities in this state that are 37 licensed, certified, or otherwise authorized by the office of addiction 38 services and supports for the provision of outpatient, intensive outpa- 39 tient, outpatient rehabilitation and opioid treatment that are partic- 40 ipating in the corporation's provider network. Reimbursement for covered 41 outpatient treatment provided by such facilities shall be at a rate that 42 is not less than the rate that would be paid for such treatment pursuant 43 to the medical assistance program under title eleven of article five of 44 the social services law. 45 § 7. This act shall take effect January 1, 2025 and shall apply to 46 policies and contracts issued, renewed, modified, altered, or amended on 47 and after such date. 48 PART BB 49 Section 1. Sections 19 and 21 of chapter 723 of the laws of 1989 50 amending the mental hygiene law and other laws relating to comprehensive 51 psychiatric emergency programs, as amended by section 1 of part PPP of 52 chapter 58 of the laws of 2020, are amended to read as follows: 53 § 19. Notwithstanding any other provision of law, the commissioner of 54 mental health shall[, until July 1, 2024,] be solely authorized, in hisS. 8307--A 148 A. 8807--A 1 or her discretion, to designate those general hospitals, local govern- 2 mental units and voluntary agencies which may apply and be considered 3 for the approval and issuance of an operating certificate pursuant to 4 article 31 of the mental hygiene law for the operation of a comprehen- 5 sive psychiatric emergency program. 6 § 21. This act shall take effect immediately[, and sections one, two7and four through twenty of this act shall remain in full force and8effect, until July 1, 2024, at which time the amendments and additions9made by such sections of this act shall be deemed to be repealed, and10any provision of law amended by any of such sections of this act shall11revert to its text as it existed prior to the effective date of this12act]. 13 § 2. This act shall take effect immediately. 14 PART CC 15 Section 1. Subdivision 2 of section 493 of the social services law, as 16 added by section 1 of part B of chapter 501 of the laws of 2012, is 17 amended to read as follows: 18 2. For substantiated reports of abuse or neglect in facilities or 19 provider agencies in receipt of medical assistance and which are no 20 longer subject to amendment or appeal pursuant to section four hundred 21 ninety-four of this article, such information shall also be forwarded by 22 the justice center to the office of the Medicaid inspector general when 23 such abuse or neglect may [be relevant to an investigation of unaccepta-24ble practices as such practices are defined] result in [regulations of] 25 possible exclusion or other sanction by the office of the Medicaid 26 inspector general as determined in consultation with the office of the 27 Medicaid inspector general. 28 § 2. This act shall take effect immediately. 29 PART DD 30 Section 1. Section 3 of part A of chapter 111 of the laws of 2010 31 amending the mental hygiene law relating to the receipt of federal and 32 state benefits received by individuals receiving care in facilities 33 operated by an office of the department of mental hygiene, as amended by 34 section 1 of part T of chapter 57 of the laws of 2021, is amended to 35 read as follows: 36 § 3. This act shall take effect immediately[; and shall expire and be37deemed repealed June 30, 2024]. 38 § 2. This act shall take effect immediately. 39 PART EE 40 Section 1. Subparagraph (v) of paragraph (a) of subdivision 1 of 41 section 6908 of the education law is renumbered subparagraph (vi) and a 42 new subparagraph (v) is added to read as follows: 43 (v) tasks provided by a direct support staff in non-facility based 44 programs certified, authorized or approved by the office for people with 45 developmental disabilities, so long as such staff does not hold themself 46 out as one who accepts employment solely for performing such care, and 47 where nursing services are under the instruction of a service recipient 48 or family or household member determined by a registered professional 49 nurse to be capable of providing such instruction. In the event that 50 the registered nurse determines that the service recipient, family, orS. 8307--A 149 A. 8807--A 1 household member is not capable of providing such instruction, nursing 2 tasks may be performed by direct support staff pursuant to subparagraph 3 (vi) of this paragraph subject to the requirements set forth therein; or 4 § 2. This act shall take effect immediately and shall be deemed to 5 have been in full force and effect on and after April 1, 2024. 6 PART FF 7 Section 1. 1. Subject to available appropriations and approval of the 8 director of the budget, the commissioners of the office of mental 9 health, office for people with developmental disabilities, office of 10 addiction services and supports, office of temporary and disability 11 assistance, office of children and family services, and the state office 12 for the aging shall establish a state fiscal year 2024-2025 cost of 13 living adjustment (COLA), effective April 1, 2024, for projecting for 14 the effects of inflation upon rates of payments, contracts, or any other 15 form of reimbursement for the programs and services listed in paragraphs 16 (i), (ii), (iii), (iv), (v), and (vi) of subdivision four of this 17 section. The COLA established herein shall be applied to the appropriate 18 portion of reimbursable costs or contract amounts. Where appropriate, 19 transfers to the department of health (DOH) shall be made as reimburse- 20 ment for the state share of medical assistance. 21 2. Notwithstanding any inconsistent provision of law, subject to the 22 approval of the director of the budget and available appropriations 23 therefore, for the period of April 1, 2024 through March 31, 2025, the 24 commissioners shall provide funding to support a one and five-tenths 25 percent (1.5%) cost of living adjustment under this section for all 26 eligible programs and services as determined pursuant to subdivision 27 four of this section. 28 3. Notwithstanding any inconsistent provision of law, and as approved 29 by the director of the budget, the 1.5 percent cost of living adjustment 30 (COLA) established herein shall be inclusive of all other cost of living 31 type increases, inflation factors, or trend factors that are newly 32 applied effective April 1, 2024. Except for the 1.5 percent cost of 33 living adjustment (COLA) established herein, for the period commencing 34 on April 1, 2024 and ending March 31, 2025 the commissioners shall not 35 apply any other new cost of living adjustments for the purpose of estab- 36 lishing rates of payments, contracts or any other form of reimbursement. 37 The phrase "all other cost of living type increases, inflation factors, 38 or trend factors" as defined in this subdivision shall not include 39 payments made pursuant to the American Rescue Plan Act or other federal 40 relief programs related to the Coronavirus Disease 2019 (COVID-19) 41 pandemic public health emergency. This subdivision shall not prevent the 42 office of children and family services from applying additional trend 43 factors or staff retention factors to eligible programs and services 44 under paragraph (v) of subdivision four of this section. 45 4. Eligible programs and services. (i) Programs and services funded, 46 licensed, or certified by the office of mental health (OMH) eligible for 47 the cost of living adjustment established herein, pending federal 48 approval where applicable, include: office of mental health licensed 49 outpatient programs, pursuant to parts 587 and 599 of title 14 CRR-NY of 50 the office of mental health regulations including clinic, continuing day 51 treatment, day treatment, intensive outpatient programs and partial 52 hospitalization; outreach; crisis residence; crisis stabilization, 53 crisis/respite beds; mobile crisis, part 590 comprehensive psychiatric 54 emergency program services; crisis intervention; home based crisisS. 8307--A 150 A. 8807--A 1 intervention; family care; supported single room occupancy; supported 2 housing; supported housing community services; treatment congregate; 3 supported congregate; community residence - children and youth; 4 treatment/apartment; supported apartment; community residence single 5 room occupancy; on-site rehabilitation; employment programs; recreation; 6 respite care; transportation; psychosocial club; assertive community 7 treatment; case management; care coordination, including health home 8 plus services; local government unit administration; monitoring and 9 evaluation; children and youth vocational services; single point of 10 access; school-based mental health program; family support children and 11 youth; advocacy/support services; drop in centers; recovery centers; 12 transition management services; bridger; home and community based waiver 13 services; behavioral health waiver services authorized pursuant to the 14 section 1115 MRT waiver; self-help programs; consumer service dollars; 15 conference of local mental hygiene directors; multicultural initiative; 16 ongoing integrated supported employment services; supported education; 17 mentally ill/chemical abuse (MICA) network; personalized recovery 18 oriented services; children and family treatment and support services; 19 residential treatment facilities operating pursuant to part 584 of title 20 14-NYCRR; geriatric demonstration programs; community-based mental 21 health family treatment and support; coordinated children's service 22 initiative; homeless services; and promises zone. 23 (ii) Programs and services funded, licensed, or certified by the 24 office for people with developmental disabilities (OPWDD) eligible for 25 the cost of living adjustment established herein, pending federal 26 approval where applicable, include: local/unified services; chapter 620 27 services; voluntary operated community residential services; article 16 28 clinics; day treatment services; family support services; 100% day 29 training; epilepsy services; traumatic brain injury services; hepatitis 30 B services; independent practitioner services for individuals with 31 intellectual and/or developmental disabilities; crisis services for 32 individuals with intellectual and/or developmental disabilities; family 33 care residential habilitation; supervised residential habilitation; 34 supportive residential habilitation; respite; day habilitation; prevoca- 35 tional services; supported employment; community habilitation; interme- 36 diate care facility day and residential services; specialty hospital; 37 pathways to employment; intensive behavioral services; community transi- 38 tion services; family education and training; fiscal intermediary; 39 support broker; and personal resource accounts. 40 (iii) Programs and services funded, licensed, or certified by the 41 office of addiction services and supports (OASAS) eligible for the cost 42 of living adjustment established herein, pending federal approval where 43 applicable, include: medically supervised withdrawal services - residen- 44 tial; medically supervised withdrawal services - outpatient; medically 45 managed detoxification; medically monitored withdrawal; inpatient reha- 46 bilitation services; outpatient opioid treatment; residential opioid 47 treatment; KEEP units outpatient; residential opioid treatment to absti- 48 nence; problem gambling treatment; medically supervised outpatient; 49 outpatient rehabilitation; specialized services substance abuse 50 programs; home and community based waiver services pursuant to subdivi- 51 sion 9 of section 366 of the social services law; children and family 52 treatment and support services; continuum of care rental assistance case 53 management; NY/NY III post-treatment housing; NY/NY III housing for 54 persons at risk for homelessness; permanent supported housing; youth 55 clubhouse; recovery community centers; recovery community organizing 56 initiative; residential rehabilitation services for youth (RRSY); inten-S. 8307--A 151 A. 8807--A 1 sive residential; community residential; supportive living; residential 2 services; job placement initiative; case management; family support 3 navigator; local government unit administration; peer engagement; voca- 4 tional rehabilitation; support services; HIV early intervention 5 services; dual diagnosis coordinator; problem gambling resource centers; 6 problem gambling prevention; prevention resource centers; primary 7 prevention services; other prevention services; and community services. 8 (iv) Programs and services funded, licensed, or certified by the 9 office of temporary and disability assistance (OTDA) eligible for the 10 cost of living adjustment established herein, pending federal approval 11 where applicable, include: nutrition outreach and education program 12 (NOEP). 13 (v) Programs and services funded, licensed, or certified by the office 14 of children and family services (OCFS) eligible for the cost of living 15 adjustment established herein, pending federal approval where applica- 16 ble, include: programs for which the office of children and family 17 services establishes maximum state aid rates pursuant to section 398-a 18 of the social services law and section 4003 of the education law; emer- 19 gency foster homes; foster family boarding homes and therapeutic foster 20 homes; supervised settings as defined by subdivision twenty-two of 21 section 371 of the social services law; adoptive parents receiving 22 adoption subsidy pursuant to section 453 of the social services law; and 23 congregate and scattered supportive housing programs and supportive 24 services provided under the NY/NY III supportive housing agreement to 25 young adults leaving or having recently left foster care. 26 (vi) Programs and services funded, licensed, or certified by the state 27 office for the aging (SOFA) eligible for the cost of living adjustment 28 established herein, pending federal approval where applicable, include: 29 community services for the elderly; expanded in-home services for the 30 elderly; and supplemental nutrition assistance program. 31 5. Each local government unit or direct contract provider receiving 32 funding for the cost of living adjustment established herein shall 33 submit a written certification, in such form and at such time as each 34 commissioner shall prescribe, attesting how such funding will be or was 35 used to first promote the recruitment and retention of non-executive 36 direct care staff, non-executive direct support professionals, non-exe- 37 cutive clinical staff, or respond to other critical non-personal service 38 costs prior to supporting any salary increases or other compensation for 39 executive level job titles. 40 6. Notwithstanding any inconsistent provision of law to the contrary, 41 agency commissioners shall be authorized to recoup funding from a local 42 governmental unit or direct contract provider for the cost of living 43 adjustment established herein determined to have been used in a manner 44 inconsistent with the appropriation, or any other provision of this 45 section. Such agency commissioners shall be authorized to employ any 46 legal mechanism to recoup such funds, including an offset of other funds 47 that are owed to such local governmental unit or direct contract provid- 48 er. 49 § 2. This act shall take effect immediately and shall be deemed to 50 have been in full force and effect on and after April 1, 2024. 51 PART GG 52 Section 1. Subdivision 29 of section 364-j of the social services law, 53 as added by section 49 of part C of chapter 60 of the laws of 2014, is 54 amended to read as follows:S. 8307--A 152 A. 8807--A 1 29. In the event that the department receives approval from the 2 Centers for Medicare and Medicaid Services to amend its 1115 waiver 3 [known as the Partnership Plan] or receives approval for a new 1115 4 waiver [for the purpose of reinvesting savings resulting from the rede-5sign of the medical assistance program] prior to or following the effec- 6 tive date of this subdivision, the commissioner is authorized to enter 7 into contracts[, and/or] and to amend the terms of contracts awarded 8 prior to [the effective date of this subdivision] April first, two thou- 9 sand twenty-four, for the purpose of assisting the department of health 10 with implementing projects authorized under such waiver approval. 11 Notwithstanding the provisions of sections one hundred twelve and one 12 hundred sixty-three of the state finance law, or sections one hundred 13 forty-two and one hundred forty-three of the economic development law, 14 or any contrary provision of law, contracts may be entered or contract 15 amendments may be made pursuant to this subdivision without a compet- 16 itive bid or request for proposal process [if the term of any such17contract or contract amendment does not extend beyond March thirty-18first, two thousand nineteen]; provided, however, in the case of a 19 contract entered into after the effective date of this subdivision, 20 that: 21 (a) The department of health shall post on its website, for a period 22 of no less than thirty days: 23 (i) A description of the proposed services to be provided pursuant to 24 the contract or contracts; 25 (ii) The criteria for selection of a contractor or contractors; 26 (iii) The period of time during which a prospective contractor may 27 seek selection, which shall be no less than thirty days after such 28 information is first posted on the website; and 29 (iv) The manner by which a prospective contractor may seek such 30 selection, which may include submission by electronic means; 31 (b) All reasonable and responsive submissions that are received from 32 prospective contractors in timely fashion shall be reviewed by the 33 commissioner of health; and 34 (c) The commissioner of health shall select such contractor or 35 contractors that, in [his or her] such commissioner's discretion, are 36 best suited to serve the purposes of this section. 37 § 2. This act shall take effect immediately; provided, however, that 38 the amendments to section 364-j of the social services law made by 39 section one of this act shall not affect the repeal of such section and 40 shall be deemed repealed therewith. 41 PART HH 42 Section 1. Subparagraphs (i) and (ii) of paragraph (a) of subdivision 43 4-a of section 365-f of the social services law, as amended by section 3 44 of part G of chapter 57 of the laws of 2019, the opening paragraph of 45 subparagraph (i) as amended by section 2 of part PP of chapter 57 of the 46 laws of 2022, are amended to read as follows: 47 (i) "Fiscal intermediary" means an entity that provides fiscal inter- 48 mediary services and has a contract for providing such services with 49 [the department of health and is selected through the procurement proc-50ess described in paragraphs (b), (b-1), (b-2) and (b-3) of this subdivi-51sion. Eligible applicants for contracts shall be entities that are capa-52ble of appropriately providing fiscal intermediary services, performing53the responsibilities of a fiscal intermediary, and complying with this54section, including but not limited to entities that:S. 8307--A 153 A. 8807--A 1(A) are a service center for independent living under section one2thousand one hundred twenty-one of the education law; or3(B) have been established as fiscal intermediaries prior to January4first, two thousand twelve and have been continuously providing such5services for eligible individuals under this section.]: 6 (A) a local department of social services; 7 (B) an organization licensed under article forty-four of the public 8 health law; or 9 (C) an accountable care organization certified under article twenty- 10 nine-E of the public health law or an integrated delivery system 11 composed primarily of health care providers recognized by the department 12 as a performing provider system under the delivery system reform incen- 13 tive payment program. 14 (ii) Fiscal intermediary services shall include the following 15 services, performed on behalf of the consumer to facilitate [his or her] 16 the consumer's role as the employer: 17 (A) wage and benefit processing for consumer directed personal assist- 18 ants; 19 (B) processing all income tax and other required wage withholdings; 20 (C) complying with workers' compensation, disability and unemployment 21 requirements; 22 (D) maintaining personnel records for each consumer directed personal 23 assistant, including time records and other documentation needed for 24 wages and benefit processing and a copy of the medical documentation 25 required pursuant to regulations established by the commissioner; 26 (E) ensuring that the health status of each consumer directed personal 27 assistant is assessed prior to service delivery pursuant to regulations 28 issued by the commissioner; 29 (F) maintaining records of service authorizations or reauthorizations; 30 (G) monitoring the consumer's or, if applicable, the designated repre- 31 sentative's continuing ability to fulfill the consumer's responsibil- 32 ities under the program and promptly notifying the authorizing entity of 33 any circumstance that may affect the consumer's or, if applicable, the 34 designated representative's ability to fulfill such responsibilities; 35 (H) complying with regulations established by the commissioner speci- 36 fying the responsibilities of fiscal intermediaries providing services 37 under this title; and 38 (I) entering into a department approved memorandum of understanding 39 with the consumer that describes the parties' responsibilities under 40 this program[; and41(J) other related responsibilities which may include, as determined by42the commissioner, assisting consumers to perform the consumers' respon-43sibilities under this section and department regulations in a manner44that does not infringe upon the consumer's responsibilities and self-di-45rection]. 46 § 2. Paragraphs (b) and (c) of subdivision 4-a of section 365-f of the 47 social services law are REPEALED and two new paragraphs (b) and (c) are 48 added to read as follows: 49 (b) As of January first, two thousand twenty-five no entity shall 50 provide, directly or through contract, fiscal intermediary services 51 without an authorization as a fiscal intermediary issued by the commis- 52 sioner in accordance with this subdivision. In establishing authori- 53 zation standards and processes, the commissioner may consider demon- 54 strated compliance with all applicable federal and state laws and 55 regulations, including but not limited to, marketing and labor prac- 56 tices, cost reporting, and electronic visit verification requirements;S. 8307--A 154 A. 8807--A 1 provided, however, that this shall not be construed to limit the commis- 2 sioner's discretion in establishing such standards and processes. 3 Notwithstanding the preceding requirement for authorization, a fiscal 4 intermediary that is in operation prior to January first, two thousand 5 twenty-four may continue to provide fiscal intermediary services without 6 an authorization until such time as the commissioner determines that the 7 continued provision of services through unauthorized fiscal interme- 8 diaries is no longer necessary to ensure access to services; such deter- 9 mination may be made on a statewide, regional, or county basis. 10 (c) The commissioner is authorized to determine the maximum number of 11 fiscal intermediaries a local department of social services or an organ- 12 ization licensed under article forty-four of the public health law, or 13 an accountable care organization certified under article twenty-nine-E 14 of the public health law or an integrated delivery system composed 15 primarily of health care providers recognized by the department as a 16 performing provider system under the delivery system reform incentive 17 payment program may contract with, provided it is determined that there 18 remains adequate access to services; such determination may be made on a 19 statewide, regional or county level basis. 20 § 3. Paragraphs (b-1), (b-2) and (b-3) of subdivision 4-a of section 21 365-f of the social services law are REPEALED. 22 § 4. Subdivision 4-b of section 365-f of the social services law, as 23 amended by section 8 of part G of chapter 57 of the laws of 2019, is 24 amended to read as follows: 25 4-b. Actions involving the authorization of a fiscal intermediary. 26 (a) [The department may terminate a fiscal intermediary's contract27under this section or suspend or limit the fiscal intermediary's rights28and privileges under the contract upon thirty day's written notice to29the fiscal intermediary, if the commissioner finds that the fiscal30intermediary has failed to comply with the provisions of this section or31regulations promulgated hereunder. The written notice shall include:32(i) A description of the conduct and the issues related thereto that33have been identified as failure of compliance; and34(ii) the time frame of the conduct that fails compliance] A fiscal 35 intermediary's authorization may be revoked, suspended, limited, or 36 annulled upon thirty days' written notice to the fiscal intermediary, if 37 the commissioner finds that the fiscal intermediary has failed to comply 38 with the provisions of this subdivision or regulations promulgated here- 39 under. 40 (b) Notwithstanding the foregoing, upon determining that the public 41 health or safety would be imminently endangered by the continued opera- 42 tion or actions of the fiscal intermediary, the commissioner may [termi-43nate] revoke, suspend, limit, or annul the fiscal intermediary's 44 [contract or suspend or limit the fiscal intermediary's rights and priv-45ileges under the contract] authorization immediately [upon written46notice]. 47 (c) The commissioner may issue orders and take other actions as neces- 48 sary and appropriate to prohibit and prevent the provision of fiscal 49 intermediary services by an unauthorized entity. 50 (d) All orders or determinations under this subdivision shall be 51 subject to review as provided in article seventy-eight of the civil 52 practice law and rules. 53 § 5. Paragraph (c) of subdivision 4-d of section 365-f of the social 54 services law, as added by section 7 of part G of chapter 57 of the laws 55 of 2019, is amended to read as follows:S. 8307--A 155 A. 8807--A 1 (c) Where a fiscal intermediary is suspending or ceasing operation 2 pursuant to an order under subdivision four-b of this section, or has 3 failed to [submit an offer for a contract] apply for authorization, or 4 has been denied [a contract] authorization under this section, all the 5 provisions of this subdivision shall apply except subparagraph (i) of 6 paragraph (a) of this subdivision, notice of which to all parties shall 7 be provided by the department, with the assistance of any local social 8 services districts or managed care plans with which the fiscal interme- 9 diary contracts, as appropriate. 10 § 6. Paragraph (d) of subdivision 4-d of section 365-f of the social 11 services law is REPEALED. 12 § 7. Paragraph (b) of subdivision 5 of section 365-f of the social 13 services law, as added by chapter 81 of the laws of 1995, is amended to 14 read as follows: 15 (b) Notwithstanding any other provision of law, the commissioner is 16 authorized to waive any provision of section three hundred sixty-seven-b 17 of this title related to payment and may promulgate regulations, includ- 18 ing emergency regulations, necessary to carry out the objectives of the 19 program including minimum selection criteria and training requirements 20 for personal assistants, the establishment of limitations on the number 21 of hours a personal assistant may work on a daily and weekly basis, and 22 which describe the responsibilities of the eligible individuals in 23 arranging and paying for services and the protections assured such indi- 24 viduals if they are unable or no longer desire to continue in the 25 program, the fiscal intermediary authorization process, standards, and 26 time frames, and those regulations necessary to ensure adequate access 27 to services, including but not limited to the maximum number of fiscal 28 intermediaries a local department of social services or an organization 29 licensed under article forty-four of the public health law, or an 30 accountable care organization certified under article twenty-nine-E of 31 the public health law or integrated delivery systems composed primarily 32 of health care providers recognized by the department as a performing 33 provider system under the delivery system reform incentive payment 34 program may contract with; such determination may be made on a state- 35 wide, regional, or county basis. 36 § 8. Paragraphs (e) and (f) of subdivision 2 of section 3605-c of the 37 public health law, as added by section 10 of part MM of chapter 56 of 38 the laws of 2020, are amended and a new paragraph (g) is added to read 39 as follows: 40 (e) the commissioner may institute a continuous recruitment process 41 provided that the information required under paragraph (a) of this 42 subdivision remains on the department's website for the entire duration 43 of the recruitment process, until such date as the commissioner may 44 determine upon no less than ten days notice being posted on the website; 45 [and] 46 (f) the commissioner may reoffer contracts under the same terms of 47 this subdivision, if determined necessary by the commissioner, on a 48 statewide or regional basis[.]; and 49 (g) on and after April first, two thousand twenty-four, the department 50 shall not allow the enrollment or re-enrollment of a LHCSA into the 51 medical assistance program if such LHCSA is majority owned by a company 52 which provides fiscal intermediary services, or is majority owned by a 53 company which also has majority ownership over a company that provides 54 fiscal intermediary services, or itself provides fiscal intermediary 55 services in the state consumer directed personal assistance program, or 56 is the majority owner of a company that provides fiscal intermediaryS. 8307--A 156 A. 8807--A 1 services, as defined in section three hundred sixty-five-f of the social 2 services law. For the purposes of this section, "majority owned" or 3 "majority ownership" shall be defined as controlling interest in a 4 company, or being the largest holder of the common stock or ordinary 5 shares of a company. 6 § 9. Paragraphs (g) and (h) of subdivision 1 of section 4403 of the 7 public health law, paragraph (g) as added by chapter 938 of the laws of 8 1976 and paragraph (h) as amended by chapter 805 of the laws of 1984, 9 are amended and two new paragraphs (i) and (j) are added to read as 10 follows: 11 (g) approved mechanisms exist to resolve complaints and grievances 12 initiated by any enrolled member; [and] 13 (h) the contract between the enrollee and the organization meet the 14 requirements of the superintendent as set forth in section forty-four 15 hundred six of this article, as to the provisions contained therein for 16 health services, the procedures for offering, renewing, converting and 17 terminating contracts to enrollees, and the rates for such contracts 18 including but not limited to, compliance with the provisions of section 19 one thousand one hundred nine of the insurance law[.]; 20 (i) that the applicant is not controlled, as defined under regulation, 21 by an entity which provides fiscal intermediary services, is not 22 controlled by an entity which also has control over an entity that 23 provides fiscal intermediary services, does not itself provide fiscal 24 intermediary services in the state consumer directed personal assistance 25 program, and does not control an entity that provides fiscal interme- 26 diary services, as defined in section three hundred sixty-five-f of the 27 social services law; and 28 (j) that the applicant is not controlled, as defined under regulation, 29 by an entity which provides licensed home care services, is not 30 controlled by an entity which also has control over a company that 31 provides licensed home care services, does not itself provide licensed 32 home care services, and does not control an entity that provides 33 licensed home care services. 34 § 10. Section 4403 of the public health law is amended by adding a new 35 subdivision 1-a to read as follows: 36 1-a. (a) By April first, two thousand twenty-five, any health mainte- 37 nance organization which provides fiscal intermediary services or 38 licensed home care services, is controlled by an entity which provides 39 fiscal intermediary services or licensed home care services, has control 40 over an entity which provides fiscal intermediary services or licensed 41 home care services, or is controlled by an entity which also has control 42 over an entity that provides fiscal intermediary services or licensed 43 home care services, shall be required to resubmit an application for a 44 certificate of authority pursuant to section four thousand four hundred 45 two of this article. 46 (b) After April first, two thousand twenty-five, no health maintenance 47 organization which provides fiscal intermediary services or licensed 48 home care services, is controlled by an entity which provides fiscal 49 intermediary services or licensed home care services, has control over 50 an entity which provides fiscal intermediary services or licensed home 51 care services, or is controlled by an entity which also has control over 52 an entity that provides fiscal intermediary services or licensed home 53 care services, may maintain certification to operate as a health mainte- 54 nance organization. 55 (c) For the purposes of this subdivision, "control" shall be defined 56 in regulation.S. 8307--A 157 A. 8807--A 1 § 11. Paragraphs (h) and (i) of subdivision 3 of section 4403-f of the 2 public health law, as amended by section 41-a of part H of chapter 59 of 3 the laws of 2011, are amended and two new paragraphs (j) and (k) are 4 added to read as follows: 5 (h) that the contractual arrangements for providers of health and long 6 term care services in the benefit package are sufficient to ensure the 7 availability and accessibility of such services to the proposed enrolled 8 population consistent with guidelines established by the commissioner; 9 with respect to individuals in receipt of such services prior to enroll- 10 ment, such guidelines shall require the managed long term care plan to 11 contract with agencies currently providing such services, in order to 12 promote continuity of care. In addition, such guidelines shall require 13 managed long term care plans to offer and cover consumer directed 14 personal assistance services for eligible individuals who elect such 15 services pursuant to section three hundred sixty-five-f of the social 16 services law; [and] 17 (i) that the applicant is financially responsible and may be expected 18 to meet its obligations to its enrolled members[.]; 19 (j) that the applicant is not controlled, as defined under regulation, 20 by an entity which provides fiscal intermediary services, is not 21 controlled by an entity which also has control over an entity that 22 provides fiscal intermediary services, does not itself provide fiscal 23 intermediary services in the state consumer directed personal assistance 24 program, and does not control an entity that provides fiscal interme- 25 diary services, as defined in section three hundred sixty-five-f of the 26 social services law; and 27 (k) that the applicant is not controlled, as defined under regulation, 28 by an entity which provides licensed home care services, is not 29 controlled by an entity which also has control over a company that 30 provides licensed home care services, does not itself provide licensed 31 home care services, and does not control an entity that provides 32 licensed home care services. 33 § 12. Section 4403-f of the public health law is amended by adding a 34 new subdivision 3-a to read as follows: 35 3-a. (a) By April first, two thousand twenty-five, any managed long 36 term care plan which provides fiscal intermediary services or licensed 37 home care services, is controlled by an entity which provides fiscal 38 intermediary services or licensed home care services, has control over 39 an entity which provides fiscal intermediary services or licensed home 40 care services, or is controlled by an entity which also has control over 41 an entity that provides fiscal intermediary services or licensed home 42 care services, shall be required to resubmit an application for a 43 certificate of authority pursuant to subdivision two of this section. 44 (b) After April first, two thousand twenty-five, no managed long term 45 care plan which provides fiscal intermediary services or licensed home 46 care services, is controlled by an entity which provides fiscal interme- 47 diary services or licensed home care services, has control over an enti- 48 ty which provides fiscal intermediary services or licensed home care 49 services, or is controlled by an entity which also has control over an 50 entity that provides fiscal intermediary services or licensed home care 51 services, may maintain certification to operate as a managed long term 52 care plan. 53 (c) For the purposes of this subdivision, "control" shall have the 54 same meaning as defined in regulation.S. 8307--A 158 A. 8807--A 1 § 13. Subparagraphs (v) and (vi) of paragraph (e) of subdivision 2 of 2 section 365-a of the social services law are renumbered subparagraphs 3 (vi) and (vii) and a new subparagraph (v) is added to read as follows: 4 (v) the commissioner of health may issue regulations, including emer- 5 gency regulations, to establish the maximum daily and weekly hours any 6 individual aide providing personal care services available pursuant to 7 this paragraph shall work; 8 § 14. Paragraph (c) of subdivision 2 of section 365-f of the social 9 services law, as amended by section 3 of part MM of chapter 56 of the 10 laws of 2020, is amended to read as follows: 11 (c) has been determined by the social services district, pursuant to 12 an assessment of the person's appropriateness for the program, conducted 13 with an appropriate long term home health care program, a certified home 14 health agency, or an AIDS home care program or pursuant to the personal 15 care program, as being in need of home care services or private duty 16 nursing and as needing at least limited assistance with physical maneu- 17 vering with more than two activities of daily living, or for persons 18 with a dementia or Alzheimer's diagnosis, as needing at least super- 19 vision with more than one activity of daily living, provided that the 20 provisions related to activities of daily living in this paragraph shall 21 only apply to persons who initially seek eligibility for the program on 22 or after October first, two thousand twenty, and who is able and willing 23 [or has a designated representative, including a legal guardian able and24willing] to make informed choices, [or a designated relative or other25adult who is able and willing to assist in making informed choices,] as 26 to the type and quality of services, including but not limited to such 27 services as nursing care, personal care, transportation and respite 28 services; and 29 § 15. Subdivision 3 of section 365-f of the social services law, as 30 amended by section 9 of part QQ of chapter 56 of the laws of 2020, is 31 amended to read as follows: 32 3. Division of responsibilities. (a) Eligible individuals who elect to 33 participate in the program assume the responsibility for services under 34 such program as mutually agreed to by the eligible individual and 35 provider and as documented in the eligible individual's record, includ- 36 ing, but not limited to, recruiting, hiring and supervising their 37 personal assistants. [For the purposes of this section,] 38 (b) A personal assistant [shall mean], for the purposes of this 39 section, is an adult who: 40 (1) has obtained an individual unique identifier from the state by or 41 before a date determined by the commissioner of health in consultation 42 with the Medicaid inspector general[,]; and 43 (2) provides services under this section to the eligible individual 44 under the eligible individual's instruction, supervision, and direction 45 [or under the instruction, supervision and direction of the eligible46individual's designated representative, provided that a]. 47 (c) A person legally responsible for an eligible individual's care and 48 support, an eligible individual's spouse [or designated representative], 49 may not be the personal assistant for the eligible individual; however, 50 a personal assistant may include any other adult relative of the eligi- 51 ble individual, provided, however, that the program determines that the 52 services provided by such relative are consistent with an individual's 53 plan of care and that the aggregate cost for such services does not 54 exceed the aggregate costs for equivalent services provided by a non-re- 55 lative personal assistant.S. 8307--A 159 A. 8807--A 1 (d) Any personal information submitted to obtain [such] a unique iden- 2 tifier under this subdivision shall be maintained as confidential pursu- 3 ant to article six-A of the public officers law ("New York state privacy 4 protection law"). Such individuals shall be assisted as appropriate with 5 service coverage, supervision, advocacy and management. 6 (e) Providers shall not be liable for fulfillment of responsibilities 7 agreed to be undertaken by the eligible individual. This subdivision, 8 however, shall not diminish the participating provider's liability for 9 failure to exercise reasonable care in properly carrying out its respon- 10 sibilities under this program, which shall include monitoring such indi- 11 vidual's continuing ability to fulfill those responsibilities documented 12 in his or her records. Failure of the individual to carry out his or her 13 agreed to responsibilities may be considered in determining such indi- 14 vidual's continued appropriateness for the program. 15 § 16. Clause (G) of subparagraph (ii) of paragraph (a) of subdivision 16 4-a of section 365-f of the social services law, as amended by section 3 17 of part G of chapter 57 of the laws of 2019, is amended to read as 18 follows: 19 (G) monitoring the consumer's [or, if applicable, the designated20representative's] continuing ability to fulfill the consumer's responsi- 21 bilities under the program and promptly notifying the authorizing entity 22 of any circumstance that may affect the consumer's [or, if applicable,23the designated representative's] ability to fulfill such responsibil- 24 ities; 25 § 17. Subparagraph (iii) of paragraph (a) subdivision 4-a of section 26 365-f of the social services law, as added by section 1 of part E of 27 chapter 57 of the laws of 2017, is amended to read as follows: 28 (iii) Fiscal intermediaries are not responsible for, and fiscal inter- 29 mediary services shall not include, fulfillment of the responsibilities 30 of the consumer [or, if applicable, the consumer's designated represen-31tative] as established by the commissioner. A fiscal intermediary's 32 responsibilities shall not include, and a fiscal intermediary shall not 33 engage in: managing the plan of care including recruiting and hiring a 34 sufficient number of individuals who meet the definition of consumer 35 directed personal assistant, as such term is defined by the commission- 36 er, to provide authorized services that are included on the consumer's 37 plan of care; training, supervising and scheduling each consumer 38 directed personal assistant; terminating the consumer directed personal 39 assistant's employment; or assuring that each consumer directed personal 40 assistant competently and safely performs the personal care services, 41 home health aide services and skilled nursing tasks that are included on 42 the consumer's plan of care. A fiscal intermediary shall exercise 43 reasonable care in properly carrying out its responsibilities under the 44 program. 45 § 18. This act shall take effect immediately and shall be deemed to 46 have been in full force and effect on and after April 1, 2024; provided, 47 however, that sections thirteen, fourteen, fifteen, sixteen and seven- 48 teen of this act shall take effect October 1, 2024; and provided, 49 further, that the amendments to section 4403-f of the public health law 50 made by sections eleven and twelve of this act shall not affect the 51 repeal of such section and shall be deemed repealed therewith. 52 § 2. Severability clause. If any clause, sentence, paragraph, subdivi- 53 sion, section or part of this act shall be adjudged by any court of 54 competent jurisdiction to be invalid, such judgment shall not affect, 55 impair, or invalidate the remainder thereof, but shall be confined in 56 its operation to the clause, sentence, paragraph, subdivision, sectionS. 8307--A 160 A. 8807--A 1 or part thereof directly involved in the controversy in which such judg- 2 ment shall have been rendered. It is hereby declared to be the intent of 3 the legislature that this act would have been enacted even if such 4 invalid provisions had not been included herein. 5 § 3. This act shall take effect immediately provided, however, that 6 the applicable effective date of Parts A through HH of this act shall be 7 as specifically set forth in the last section of such Parts.
