Bill Text: NY S01507 | 2019-2020 | 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 2019-2020 state fiscal year; extends and enhances the Medicaid drug cap and reduces unnecessary pharmacy benefit manager costs to the Medicaid program (Part B); relates to extension of the National Diabetes Prevention Program (Part C); amends chapter 59 of the laws of 2011 in relation to extending the Medicaid global cap (Part D); extends certain provisions of the public health law and the social services law relating to health facilities, certified home health agencies, the general public health work program, state fund medical expenditures, hospital assessments, residential health care facilities, administrative costs, welfare reform, Medicaid, and special needs plans (Part E); extends certain provisions relating to excess coverage (Part F); relates to fiscal intermediary services for the consumer directed personal assistance program; relates to payments to home care aides; establishes a residential health care facilities case mix adjustment workgroup; and repeals certain provisions of the social services law relating thereto (Part G); relates to waivers of certain regulations and to certain rates and payment methodologies; and repeals certain provisions of the public health law relating thereto (Part H); relates to guaranteed availability of health insurance and coverage for pre-existing conditions (Subpart A); relates to actuarial value requirements and essential health benefits (Subpart B); relates to prescription drug coverage (Subpart C); prohibits discrimination based on sex and gender identity (Subpart D)(Part J); relates to the effectiveness of certain provisions relating to payments from the medical indemnity fund (Part K); includes iatrogenic infertility under in-vitro fertilization insurance coverage (Part L); requires medical, major medical, or similar comprehensive type coverage health insurance policies to include certain reproductive health coverage; and clarifies the definition of voluntary sterilization procedures and over-the-counter contraceptive products (Part M); relates to the general public health work program (Part O); relates to lead levels (Part P); relates to the healthcare facility transformation program state III authorizing additional awards for statewide II applications (Part Q); codifies the creation of NY state of health, the official health plan marketplace (Part T); relates to private pay protocols for programs and services administered by the office for the aging (Part U); implements certain compliance requirements on managed care organizations and providers participating in the Medicaid program (Part V); relates to the recovery of exempt income by the office of mental health for community residence treatment programs (Part W); relates to a cost of living adjustment for designated human services programs (Part Y); relates to integrated services (Part Z); relates to mental health and substance use disorder health insurance parity (Subpart A); relates to hospital policies for substance use disorder treatment (Subpart B); relates to court ordered substance use disorder treatment (Subpart D)(Part BB); extends an exemption from requiring direct observation and evaluation of certain temporary employees (Part EE); extends provisions related to the New York state health insurance continuation assistance demonstration project (Part FF); provides funding to programs providing opioid treatment and other services operated by the New York state office of alcoholism and substance abuse services or certain agencies (Part GG); relates to grants awarded for classic NORC programs (Part HH); extends the operation and administration of legislative commissions (Part II); authorizes the dormitory authority to transfer certain funds repaid by borrowers relating to restructuring pool loans (Part JJ); and directs the department of health to conduct a study in relation to staffing enhancement and patient safety (Part KK).
Spectrum: Committee Bill
Status: (Passed) 2019-04-12 - SIGNED CHAP.57 [S01507 Detail]
Download: New_York-2019-S01507-Amended.html
Bill Title: Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2019-2020 state fiscal year; extends and enhances the Medicaid drug cap and reduces unnecessary pharmacy benefit manager costs to the Medicaid program (Part B); relates to extension of the National Diabetes Prevention Program (Part C); amends chapter 59 of the laws of 2011 in relation to extending the Medicaid global cap (Part D); extends certain provisions of the public health law and the social services law relating to health facilities, certified home health agencies, the general public health work program, state fund medical expenditures, hospital assessments, residential health care facilities, administrative costs, welfare reform, Medicaid, and special needs plans (Part E); extends certain provisions relating to excess coverage (Part F); relates to fiscal intermediary services for the consumer directed personal assistance program; relates to payments to home care aides; establishes a residential health care facilities case mix adjustment workgroup; and repeals certain provisions of the social services law relating thereto (Part G); relates to waivers of certain regulations and to certain rates and payment methodologies; and repeals certain provisions of the public health law relating thereto (Part H); relates to guaranteed availability of health insurance and coverage for pre-existing conditions (Subpart A); relates to actuarial value requirements and essential health benefits (Subpart B); relates to prescription drug coverage (Subpart C); prohibits discrimination based on sex and gender identity (Subpart D)(Part J); relates to the effectiveness of certain provisions relating to payments from the medical indemnity fund (Part K); includes iatrogenic infertility under in-vitro fertilization insurance coverage (Part L); requires medical, major medical, or similar comprehensive type coverage health insurance policies to include certain reproductive health coverage; and clarifies the definition of voluntary sterilization procedures and over-the-counter contraceptive products (Part M); relates to the general public health work program (Part O); relates to lead levels (Part P); relates to the healthcare facility transformation program state III authorizing additional awards for statewide II applications (Part Q); codifies the creation of NY state of health, the official health plan marketplace (Part T); relates to private pay protocols for programs and services administered by the office for the aging (Part U); implements certain compliance requirements on managed care organizations and providers participating in the Medicaid program (Part V); relates to the recovery of exempt income by the office of mental health for community residence treatment programs (Part W); relates to a cost of living adjustment for designated human services programs (Part Y); relates to integrated services (Part Z); relates to mental health and substance use disorder health insurance parity (Subpart A); relates to hospital policies for substance use disorder treatment (Subpart B); relates to court ordered substance use disorder treatment (Subpart D)(Part BB); extends an exemption from requiring direct observation and evaluation of certain temporary employees (Part EE); extends provisions related to the New York state health insurance continuation assistance demonstration project (Part FF); provides funding to programs providing opioid treatment and other services operated by the New York state office of alcoholism and substance abuse services or certain agencies (Part GG); relates to grants awarded for classic NORC programs (Part HH); extends the operation and administration of legislative commissions (Part II); authorizes the dormitory authority to transfer certain funds repaid by borrowers relating to restructuring pool loans (Part JJ); and directs the department of health to conduct a study in relation to staffing enhancement and patient safety (Part KK).
Spectrum: Committee Bill
Status: (Passed) 2019-04-12 - SIGNED CHAP.57 [S01507 Detail]
Download: New_York-2019-S01507-Amended.html
STATE OF NEW YORK ________________________________________________________________________ S. 1507--A A. 2007--A SENATE - ASSEMBLY January 18, 2019 ___________ 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 the social services law, in relation to reimbursement of transportation costs, reimbursement of emergency transportation services and supplemental transportation payments; and to repeal certain provisions of such law relating thereto (Part A); to amend the social services law and the public health law, in relation to updating copayments; to amend the public health law, in relation to extending and enhancing the Medicaid drug cap and to reduce unnecessary pharmacy benefit manager costs to the Medicaid program; and to repeal certain provisions of the social services law relating thereto (Part B); to amend the social services law, in relation to extension of the National Diabetes Prevention Program and in relation to supplemental medicaid managed care payments (Part C); to amend chapter 59 of the laws of 2011 amending the public health law and other laws relating to known and projected department of health state fund medicaid expendi- tures, in relation to extending the medicaid global cap (Part D); to amend chapter 505 of the laws of 1995, amending the public health law relating to the operation of department of health facilities, in relation to extending the provisions thereof; to amend chapter 56 of the laws of the laws of 2013, amending the social services law relat- ing to eligibility conditions, in relation to extending the provisions thereof; to amend chapter 884 of the laws of 1990, amending the public health law relating to authorizing bad debt and charity care allow- ances for certified home health agencies, in relation to extending the provisions thereof; to amend chapter 303 of the laws of 1999, amending the New York state medical care facilities finance agency act relating to financing health facilities, in relation to the effectiveness ther- eof; to amend chapter 109 of the laws of 2010, amending the social EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD12571-02-9S. 1507--A 2 A. 2007--A services law relating to transportation costs, in relation to the effectiveness thereof; to amend chapter 58 of the laws of 2009, amend- ing the public health law relating to payment by governmental agencies for general hospital inpatient services, in relation to the effective- ness thereof; to amend chapter 56 of the laws of 2013, amending the public health law relating to the general public health work program, in relation to the effectiveness thereof; to amend chapter 59 of the laws of 2011, amending the public health law and other laws relating to known and projected department of health state fund medical expend- itures, in relation to extending the provisions thereof; to amend the public health law, in relation to hospital assessments; to amend chap- ter 474 of the laws of 1996, amending the education law and other laws relating to rates for residential health care facilities, in relation to the effectiveness thereof; to amend chapter 58 of the laws of 2007, amending the social services law and other laws relating to enacting the major components of legislation necessary to implement the health and mental hygiene budget for the 2007-2008 state fiscal year, in relation to delay of certain administrative costs; to amend chapter 81 of the laws of 1995, amending the public health law and other laws relating to medical reimbursement and welfare reform, in relation to the effectiveness thereof; to amend chapter 56 of the laws of 2013, amending 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 rates of payments; to amend the public health law, in relation to reimbursement rate promulgation for residential health care facilities; to amend the public health law, in relation to residential health care facility, and certified home health agency services payments; to amend chapter 81 of the laws of 1995, amending the public health law and other laws relating to medical reimbursement and welfare reform, in relation to the effectiveness thereof; to amend chapter 56 of the laws of 2013 amending 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 extending government rates for behavioral services and adding an alternative payment methodology requirement; to amend chapter 111 of the laws of 2010 relating to increasing Medicaid payments to providers through managed care organizations and providing equivalent fees through an ambulatory patient group methodology, in relation to extending govern- ment rates for behavioral services and adding an alternative payment methodology requirement; to amend section 2 of part H of chapter 111 of the laws of 2010, relating to increasing Medicaid payments to providers through managed care organizations and providing equivalent fees through an ambulatory patient group methodology, in relation to transfer of funds and the effectiveness thereof; and to amend 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, in relation to the effectiveness thereof (Part E); to amend chapter 266 of the laws of 1986, amending the civil practice law and rules and other laws relating to malprac- tice and professional medical conduct, in relation to apportioning premium for certain policies; 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, relating to the effectiveness of certain provisions of such chapter, in relation to extending certain provisions concerning the hospital excess liability pool; and to amendS. 1507--A 3 A. 2007--A part H of chapter 57 of the laws of 2017, amending the New York Health Care Reform Act of 1996 and other laws relating to extending certain provisions relating thereto, in relation to extending provisions relating to excess coverage (Part F); to amend the social services law, in relation to eliminating the ability of legally responsible spouses to refuse to support non-institutionalized spouses; to create a state fiscal intermediary for the consumer directed personal assist- ance program; and to repeal certain provisions of such law relating thereto (Part G); to amend the public health law, in relation to waiv- er of certain regulations; to amend the public health law in relation to certain rates and payment methodologies; and to repeal certain provisions of such law relating thereto (Part H); to amend the insur- ance law, in relation to registration and licensing of pharmacy bene- fit managers (Part I); to amend the insurance law and the public health law, in relation to guaranteed availability, pre-existing conditions and employee welfare funds; and to repeal certain provisions of the insurance law relating thereto (Subpart A); to amend the insurance law, in relation to actuarial value requirements and essential health benefits (Subpart B); to amend the insurance law, in relation to coverage for medically necessary abortions, and exceptions thereto (Subpart C); to amend the insurance law, in relation to prescription drug coverage (Subpart D); to amend the insurance law, in relation to discrimination based on sex and gender identity (Subpart E); and to amend the insurance law, in relation to insurance certif- icate delivery (Subpart F) (Part J); to amend the public health law, in relation to the medical indemnity fund; and to amend chapter 517 of the laws of 2016 amending the public health law relating to payments from the New York state medical indemnity fund, in relation to the effectiveness thereof (Part K); to amend the insurance law, in relation to in-vitro fertilization (Part L); to amend the insurance law and the social services law, in relation to requiring health insurance policies to include coverage of all FDA-approved contracep- tive drugs, devices, and products, as well as voluntary sterilization procedures, contraceptive education and counseling, and related follow up services and prohibiting a health insurance policy from imposing any cost-sharing requirements or other restrictions or delays with respect to this coverage (Part M); to establish a universal access commission to consider the options for achieving universal access to health care (Part N); to amend the public health law, in relation to the general public health work program (Part O); to amend the public health law, in relation to lead levels in residential rental proper- ties (Part P); to amend the public health law, in relation to the healthcare facility transformation program state III authorizing addi- tional awards for statewide II applications (Part Q); to amend the public health law, in relation to maternal mortality review boards and the maternal mortality and morbidity advisory council (Part R); to amend the public health law, in relation to enacting the reproductive health act and revising existing provisions of law regarding abortion; to amend the penal law, the criminal procedure law, the county law and the judiciary law, in relation to abortion; to repeal certain provisions of the public health law relating to abortion; to repeal certain provisions of the education law relating to the sale of contraceptives; and to repeal certain provisions of the penal law relating to abortion (Part S); to amend the public health law, in relation to codifying the creation of NY State of Health, the official Health Plan Marketplace within the department of health (Part T); toS. 1507--A 4 A. 2007--A amend the elder law, in relation to the private pay program (Part U); to amend the social services law, in relation to compliance of managed care organizations and providers participating in the Medicaid program (Part V); to amend part D of chapter 111 of the laws of 2010 relating to the recovery of exempt income by the office of mental health for community residences and family-based treatment programs, in relation to the effectiveness thereof (Part W); to amend the criminal procedure law, in relation to authorizing restorations to competency within correctional facility based residential settings; and providing for the repeal of such provisions upon expiration thereof (Part X); to amend part C of chapter 57 of the laws of 2006, relating to establish- ing a cost of living adjustment for designated human services programs, in relation to the inclusion and development of certain cost of living adjustments (Part Y); to amend the public health law and the mental hygiene law, in relation to integrated services (Part Z); to amend the social services law, in relation to the definition of a facility or a provider agency (Part AA); to amend the insurance law, in relation to mental health and substance use disorder health insur- ance parity; to amend the public health law, in relation to health maintenance organizations; and to repeal certain provisions of the insurance law relating thereto (Subpart A); to amend the public health law, in relation to general hospital policies for substance use disor- der treatment (Subpart B); to repeal subparagraph (v) of paragraph (a) of subdivision 2 of section 3343-a of the public health law relating to general hospital prescription drug monitoring (Subpart C); to amend the social services law, in relation to court ordered substance use disorder treatment (Subpart D); and to amend the public health law, in relation to including fentanyl analogs as controlled substances (Subpart E)(Part BB); to amend the public health law, in relation to prescriber assistance in allowing unlicensed certified pharmacy tech- nicians to assist in dispensing of drugs (Part CC); and to authorize a uniform across the board reduction to the Department of Health Medi- caid claims (Part DD) 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 which are necessary to implement the state fiscal plan for the 2019-2020 3 state fiscal year. Each component is wholly contained within a Part 4 identified as Parts A through DD. The effective date for each particular 5 provision contained within such Part is set forth in the last section of 6 such Part. Any provision in any section contained within a Part, includ- 7 ing the effective date of the Part, which makes a reference to a section 8 "of this act", when used in connection with that particular component, 9 shall be deemed to mean and refer to the corresponding section of the 10 Part in which it is found. Section three of this act sets forth the 11 general effective date of this act. 12 PART A 13 Section 1. Subdivision 4 of section 365-h of the social services law, 14 as separately amended by section 50 of part B and section 24 of part D 15 of chapter 57 of the laws of 2015, is amended to read as follows:S. 1507--A 5 A. 2007--A 1 4. The commissioner of health is authorized to assume responsibility 2 from a local social services official for the provision and reimburse- 3 ment of transportation costs under this section. If the commissioner 4 elects to assume such responsibility, the commissioner shall notify the 5 local social services official in writing as to the election, the date 6 upon which the election shall be effective and such information as to 7 transition of responsibilities as the commissioner deems prudent. The 8 commissioner is authorized to contract with a transportation manager or 9 managers to manage transportation services in any local social services 10 district, other than transportation services provided or arranged for 11 enrollees of [managed long term care plans issued certificates of12authority under section forty-four hundred three-f of the public health13law] a program designated as a Program of All-Inclusive Care for the 14 Elderly (PACE) as authorized by Federal Public law 105-33, subtitle I of 15 title IV of the Balanced Budget Act of 1997. Any transportation manager 16 or managers selected by the commissioner to manage transportation 17 services shall have proven experience in coordinating transportation 18 services in a geographic and demographic area similar to the area in New 19 York state within which the contractor would manage the provision of 20 services under this section. Such a contract or contracts may include 21 responsibility for: review, approval and processing of transportation 22 orders; management of the appropriate level of transportation based on 23 documented patient medical need; and development of new technologies 24 leading to efficient transportation services. If the commissioner elects 25 to assume such responsibility from a local social services district, the 26 commissioner shall examine and, if appropriate, adopt quality assurance 27 measures that may include, but are not limited to, global positioning 28 tracking system reporting requirements and service verification mech- 29 anisms. Any and all reimbursement rates developed by transportation 30 managers under this subdivision shall be subject to the review and 31 approval of the commissioner. 32 § 2. The opening paragraph of subdivision 1 and subdivision 3 of 33 section 367-s of the social services law, as amended by section 53 of 34 part B of chapter 57 of the laws of 2015, are amended to read as 35 follows: 36 Notwithstanding any provision of law to the contrary, a supplemental 37 medical assistance payment shall be made on an annual basis to providers 38 of emergency medical transportation services in an aggregate amount not 39 to exceed four million dollars for two thousand six, six million dollars 40 for two thousand seven, six million dollars for two thousand eight, six 41 million dollars for the period May first, two thousand fourteen through 42 March thirty-first, two thousand fifteen, and six million dollars [annu-43ally beginning with] on an annual basis for the period April first, two 44 thousand fifteen through March thirty-first, two thousand [sixteen] 45 nineteen pursuant to the following methodology: 46 3. If all necessary approvals under federal law and regulation are not 47 obtained to receive federal financial participation in the payments 48 authorized by this section, payments under this section shall be made in 49 an aggregate amount not to exceed two million dollars for two thousand 50 six, three million dollars for two thousand seven, three million dollars 51 for two thousand eight, three million dollars for the period May first, 52 two thousand fourteen through March thirty-first, two thousand fifteen, 53 and three million dollars [annually beginning with] on an annual basis 54 for the period April first, two thousand fifteen through March thirty- 55 first, two thousand [sixteen] nineteen. In such case, the multiplier 56 set forth in paragraph (b) of subdivision one of this section shall beS. 1507--A 6 A. 2007--A 1 deemed to be two million dollars or three million dollars as applicable 2 to the annual period. 3 § 3. Subdivision 5 of section 365-h of the social services law is 4 REPEALED. 5 § 4. This act shall take effect immediately and shall be deemed to 6 have been in full force and effect on and after April 1, 2019; provided, 7 however, that section one of this act shall take effect October 1, 2019; 8 provided, further that the amendments to subdivision 4 of section 365-h 9 of the social services law made by section one of this act shall not 10 affect the repeal of such section and shall expire and be deemed 11 repealed therewith. 12 PART B 13 Section 1. Paragraph (a) of subdivision 4 of section 365-a of the 14 social services law, as amended by chapter 493 of the laws of 2010, is 15 amended to read as follows: 16 (a) drugs which may be dispensed without a prescription as required by 17 section sixty-eight hundred ten of the education law; provided, however, 18 that the state commissioner of health may by regulation specify certain 19 of such drugs which may be reimbursed as an item of medical assistance 20 in accordance with the price schedule established by such commissioner. 21 Notwithstanding any other provision of law, [additions] modifications to 22 the list of drugs reimbursable under this paragraph may be filed as 23 regulations by the commissioner of health without prior notice and 24 comment; 25 § 2. Paragraph (c) of subdivision 6 of section 367-a of the social 26 services law is amended by adding a new subparagraph (v) to read as 27 follows: 28 (v) Notwithstanding any other provision of this paragraph, co-payments 29 charged for drugs dispensed without a prescription as required by 30 section sixty-eight hundred ten of the education law but which are reim- 31 bursed as an item of medical assistance pursuant to paragraph (a) of 32 subdivision four of section three hundred sixty-five-a of this title 33 shall be one dollar. 34 § 3. Paragraph (b) of subdivision 3 of section 273 of the public 35 health law, as added by section 10 of part C of chapter 58 of the laws 36 of 2005, is amended to read as follows: 37 (b) In the event that the patient does not meet the criteria in para- 38 graph (a) of this subdivision, the prescriber may provide additional 39 information to the program to justify the use of a prescription drug 40 that is not on the preferred drug list. The program shall provide a 41 reasonable opportunity for a prescriber to reasonably present his or her 42 justification of prior authorization. [If, after consultation with the43program, the prescriber, in his or her reasonable professional judgment,44determines that the use of a prescription drug that is not on the45preferred drug list is warranted, the prescriber's determination shall46be final.] The program will consider the additional information and the 47 justification presented to determine whether the use of a prescription 48 drug that is not on the preferred drug list is warranted. 49 § 4. Subdivisions 25 and 25-a of section 364-j of the social services 50 law are REPEALED. 51 § 5. Paragraphs (b) and (c) of subdivision 2 of section 280 of the 52 public health law, paragraph (b) as amended and paragraph (c) as added 53 by section 8 of part D of chapter 57 of the laws of 2018, are amended 54 and a new paragraph (d) is added to read as follows:S. 1507--A 7 A. 2007--A 1 (b) for state fiscal year two thousand eighteen--two thousand nine- 2 teen, be limited to the ten-year rolling average of the medical compo- 3 nent of the consumer price index plus four percent and minus a pharmacy 4 savings target of eighty-five million dollars; [and] 5 (c) for state fiscal year two thousand nineteen--two thousand twenty, 6 be limited to the ten-year rolling average of the medical component of 7 the consumer price index plus four percent and minus a pharmacy savings 8 target of eighty-five million dollars[.]; and 9 (d) for state fiscal year two thousand twenty--two thousand twenty- 10 one, be limited to the ten-year rolling average of the medical component 11 of the consumer price index plus four percent and minus a pharmacy 12 savings target of eighty-five million dollars. 13 § 6. Subdivision 3 of section 280 of the public health law, as amended 14 by section 8 of part D of chapter 57 of the laws of 2018, is amended to 15 read as follows: 16 3. The department and the division of the budget shall assess on a 17 quarterly basis the projected total amount to be expended in the year on 18 a cash basis by the Medicaid program for each drug, and the projected 19 annual amount of state funds Medicaid drug expenditures on a cash basis 20 for all drugs, which shall be a component of the projected department of 21 health state funds Medicaid expenditures calculated for purposes of 22 sections ninety-one and ninety-two of part H of chapter fifty-nine of 23 the laws of two thousand eleven. For purposes of this section, state 24 funds Medicaid drug expenditures include amounts expended for drugs in 25 both the Medicaid fee-for-service program and Medicaid managed care 26 programs, minus the amount of any drug rebates or supplemental drug 27 rebates received by the department, including rebates pursuant to subdi- 28 vision five of this section with respect to rebate targets. [The depart-29ment and the division of the budget shall report quarterly to the drug30utilization review board the projected state funds Medicaid drug expend-31itures including the amounts, in aggregate thereof, attributable to the32net cost of: changes in the utilization of drugs by Medicaid recipients;33changes in the number of Medicaid recipients; changes to the cost of34brand name drugs and changes to the cost of generic drugs. The informa-35tion contained in the report shall not be publicly released in a manner36that allows for the identification of an individual drug or manufacturer37or that is likely to compromise the financial competitive, or proprie-38tary nature of the information.] 39 (a) In the event the director of the budget determines, based on Medi- 40 caid drug expenditures for the previous quarter or other relevant infor- 41 mation, that the total department of health state funds Medicaid drug 42 expenditure is projected to exceed the annual growth limitation imposed 43 by subdivision two of this section, the commissioner may identify and 44 refer drugs to the drug utilization review board established by section 45 three hundred sixty-nine-bb of the social services law for a recommenda- 46 tion as to whether a target supplemental Medicaid rebate should be paid 47 by the manufacturer of the drug to the department and the target amount 48 of the rebate. 49 (b) If the department intends to refer a drug to the drug utilization 50 review board pursuant to paragraph (a) of this subdivision, the depart- 51 ment shall notify the manufacturer of such drug and shall attempt to 52 reach agreement with the manufacturer on a rebate for the drug prior to 53 referring the drug to the drug utilization review board for review. 54 Such rebate may be based on evidence-based research, including, but not 55 limited to, such research operated or conducted by or for other stateS. 1507--A 8 A. 2007--A 1 governments, the federal government, the governments of other nations, 2 and third party payers or multi-state coalitions. 3 (c) [In the event that the commissioner and the manufacturer have4previously agreed to a supplemental rebate for a drug pursuant to para-5graph (b) of this subdivision or paragraph (e) of subdivision seven of6section three hundred sixty-seven-a of the social services law, the drug7shall not be referred to the drug utilization review board for any8further supplemental rebate for the duration of the previous rebate9agreement.10(d)] The department shall consider a drug's actual cost to the state, 11 including current rebate amounts, prior to seeking an additional rebate 12 pursuant to paragraph (b) [or (c)] of this subdivision [and shall take13into consideration whether the manufacturer of the drug is providing14significant discounts relative to other drugs covered by the Medicaid15program]. 16 [(e)] (d) The commissioner shall be authorized to take the actions 17 described in this section only so long as total Medicaid drug expendi- 18 tures are projected to exceed the annual growth limitation imposed by 19 subdivision two of this section. 20 § 7. Paragraph (a) of subdivision 5 of section 280 of the public 21 health law, as amended by section 8 of part D of chapter 57 of the laws 22 of 2018, is amended to read as follows: 23 (a) If the drug utilization review board recommends a target rebate 24 amount on a drug referred by the commissioner, the [commissioner shall25require] department shall negotiate with the drug's manufacturer for a 26 supplemental rebate to be paid by the [drug's] manufacturer in an amount 27 not to exceed such target rebate amount. [With respect to a] A rebate 28 [required in state fiscal year two thousand seventeen--two thousand29eighteen, the rebate] requirement shall apply beginning with the [month30of April, two thousand seventeen,] first day of the state fiscal year 31 during which the rebate was required without regard to the date the 32 department enters into the rebate agreement with the manufacturer. 33 § 8. Paragraph (a) of subdivision 7 of section 280 of the public 34 health law, as amended by section 8 of part D of chapter 57 of the laws 35 of 2018, is amended to read as follows: 36 (a) If, after taking into account all rebates and supplemental rebates 37 received by the department, including rebates received to date pursuant 38 to this section, total Medicaid drug expenditures are still projected to 39 exceed the annual growth limitation imposed by subdivision two of this 40 section, the commissioner may: subject any drug of a manufacturer 41 referred to the drug utilization review board under this section to 42 prior approval in accordance with existing processes and procedures when 43 such manufacturer has not entered into a supplemental rebate agreement 44 as required by this section; [directing] direct managed care plans to 45 remove from their Medicaid formularies those drugs that the drug utili- 46 zation review board recommends a target rebate amount for and the 47 manufacturer has failed to enter into a rebate agreement required by 48 this section; [promoting] promote the use of cost effective and clin- 49 ically appropriate drugs other than those of a manufacturer who has a 50 drug that the drug utilization review board recommends a target rebate 51 amount and the manufacturer has failed to enter into a rebate agreement 52 required by this section; [allowing] allow manufacturers to accelerate 53 rebate payments under existing rebate contracts; and such other actions 54 as authorized by law. The commissioner shall provide written notice to 55 the legislature thirty days prior to taking action pursuant to this 56 paragraph, unless action is necessary in the fourth quarter of a fiscalS. 1507--A 9 A. 2007--A 1 year to prevent total Medicaid drug expenditures from exceeding the 2 limitation imposed by subdivision two of this section, in which case 3 such notice to the legislature may be less than thirty days. 4 § 9. Subdivision 8 of section 280 of the public health law, as added 5 by section 8 of part D of chapter 57 of the laws of 2018, is amended to 6 read as follows: 7 8. The commissioner shall report by [February] July first annually to 8 the drug utilization review board on savings achieved through the drug 9 cap in the last fiscal year. Such report shall provide data on what 10 savings were achieved through actions pursuant to subdivisions three, 11 five and seven of this section, respectively, and what savings were 12 achieved through other means and how such savings were calculated and 13 implemented. 14 § 10. Section 4406-c of the public health law is amended by adding a 15 new subdivision 10 to read as follows: 16 10. (a) Any contract or other arrangement entered into by a health 17 care plan for pharmacy benefit management services on behalf of individ- 18 uals enrolled in a managed care provider as defined in section three 19 hundred sixty-four-j of the social services law shall include provisions 20 that ensure the following: 21 (i) Payment to the pharmacy benefit manager for pharmacy benefit 22 management services is limited to the actual ingredient costs, a 23 dispensing fee, and an administrative fee for each claim processed. The 24 department of health may establish a maximum administrative fee; 25 (ii) The pharmacy benefit manager identifies all sources of income 26 related to the provision of pharmacy benefit management services on 27 behalf of the health care plan, including, but not limited to, any 28 discounts or supplemental rebates, and that any portion of such income 29 is passed through to the health care plan in full to reduce the report- 30 able ingredient cost; and 31 (iii) The pharmacy benefit manager shall not retain any portion of 32 spread pricing. For purposes of this subdivision "spread pricing" means 33 any amount charged or claimed by the pharmacy benefit manager in excess 34 of the amount paid to pharmacies on behalf of the health care plan less 35 an administrative fee as described in this paragraph. Any such excess 36 amount shall be remitted to the health care plan on a quarterly basis. 37 (b) The commissioner may promulgate regulations as necessary to estab- 38 lish additional standards for contracts or other arrangements related to 39 the services described in this subdivision. 40 § 11. Health care plans subject to subdivision 10 of section 4406-c of 41 the public health law, as added by section ten of this act, shall 42 provide evidence of compliance with such section to the department of 43 health, and in a manner and form determined by the department of health, 44 within 90 days and again within 180 days of the effective date of this 45 act. The department of health shall take no enforcement action with 46 regards to the requirements of subdivision 10 of section 4406-c of the 47 public health law, as added by section ten of this act, prior to the 48 passage of 180 days from the effective date of this act, nor shall 49 enforcement action be taken related to any non-compliance occurring 50 prior to the passage of the same 180 days. 51 § 12. This act shall take effect immediately and shall be deemed to 52 have been in full force and effect on and after April 1, 2019; provided, 53 however, that sections one and two of this act shall take effect July 1, 54 2019; and provided further, however, that the amendments to paragraph 55 (c) of subdivision 6 of section 367-a of the social services law made byS. 1507--A 10 A. 2007--A 1 section two of this act shall not affect the repeal of such paragraph 2 and shall be deemed repealed therewith. 3 PART C 4 Section 1. Subdivision 2 of section 365-a of the social services law 5 is amended by adding a new paragraph (ff) to read as follows: 6 (ff) evidence-based prevention and support services recognized by the 7 federal Centers for Disease Control (CDC), provided by a community-based 8 organization, and designed to prevent individuals at risk of developing 9 diabetes from developing Type 2 diabetes. 10 § 2. Subparagraph (ii) of paragraph (d) of subdivision 1 of section 11 367-a of the social services law, as amended by section 1 of part J1 of 12 chapter 63 of the laws of 2003, is amended to read as follows: 13 (ii) Amounts payable under this title for medical assistance for items 14 and services provided to eligible persons who are also beneficiaries 15 under part B of title XVIII of the federal social security act and items 16 and services provided to qualified medicare beneficiaries under part B 17 of title XVIII of the federal social security act shall not [be less18than the amount of any deductible liability of such eligible persons or19for which such eligible persons or such qualified medicare beneficiaries20would be liable under federal law were they not eligible for medical21assistance or were they not qualified medicare beneficiaries with22respect to such benefits under such part B.] exceed the amount that 23 otherwise would be made under this title if provided to an eligible 24 person other than a person who is also a beneficiary under part B or is 25 a qualified medicare beneficiary minus the amount payable under part B. 26 § 3. Subparagraph (iii) of paragraph (d) of subdivision 1 of section 27 367-a of the social services law, as amended by section 31 of part B of 28 chapter 57 of the laws of 2015, is amended to read as follows: 29 (iii) With respect to items and services provided to eligible persons 30 who are also beneficiaries under part B of title XVIII of the federal 31 social security act and items and services provided to qualified medi- 32 care beneficiaries under part B of title XVIII of the federal social 33 security act, the amount payable for services covered under this title 34 shall be the amount of any co-insurance liability of such eligible 35 persons pursuant to federal law were they not eligible for medical 36 assistance or were they not qualified medicare beneficiaries with 37 respect to such benefits under such part B, but shall not exceed the 38 amount that otherwise would be made under this title if provided to an 39 eligible person other than a person who is also a beneficiary under part 40 B or is a qualified medicare beneficiary minus the amount payable under 41 part B; provided, however, amounts payable under this title for items 42 and services provided to eligible persons who are also beneficiaries 43 under part B or to qualified medicare beneficiaries by [an ambulance44service under the authority of an operating certificate issued pursuant45to article thirty of the public health law, a psychologist licensed46under article one hundred fifty-three of the education law, or] a facil- 47 ity under the authority of an operating certificate issued pursuant to 48 article sixteen, thirty-one or thirty-two of the mental hygiene law and 49 with respect to outpatient hospital and clinic items and services 50 provided by a facility under the authority of an operating certificate 51 issued pursuant to article twenty-eight of the public health law, shall 52 not be less than the amount of any co-insurance liability of such eligi- 53 ble persons or such qualified medicare beneficiaries, or for which such 54 eligible persons or such qualified medicare beneficiaries would beS. 1507--A 11 A. 2007--A 1 liable under federal law were they not eligible for medical assistance 2 or were they not qualified medicare beneficiaries with respect to such 3 benefits under part B. 4 § 4. This act shall take effect July 1, 2019. 5 PART D 6 Section 1. Subdivision 1 of section 92 of part H of chapter 59 of the 7 laws of 2011, amending the public health law and other laws relating to 8 known and projected department of health state fund medicaid expendi- 9 tures, as amended by section 2 of part K of chapter 57 of the laws of 10 2018, is amended to read as follows: 11 1. For state fiscal years 2011-12 through [2019-20] 2020-2021, the 12 director of the budget, in consultation with the commissioner of health 13 referenced as "commissioner" for purposes of this section, shall assess 14 on a monthly basis, as reflected in monthly reports pursuant to subdivi- 15 sion five of this section known and projected department of health state 16 funds medicaid expenditures by category of service and by geographic 17 regions, as defined by the commissioner, and if the director of the 18 budget determines that such expenditures are expected to cause medicaid 19 disbursements for such period to exceed the projected department of 20 health medicaid state funds disbursements in the enacted budget finan- 21 cial plan pursuant to subdivision 3 of section 23 of the state finance 22 law, the commissioner of health, in consultation with the director of 23 the budget, shall develop a medicaid savings allocation plan to limit 24 such spending to the aggregate limit level specified in the enacted 25 budget financial plan, provided, however, such projections may be 26 adjusted by the director of the budget to account for any changes in the 27 New York state federal medical assistance percentage amount established 28 pursuant to the federal social security act, changes in provider reven- 29 ues, reductions to local social services district medical assistance 30 administration, minimum wage increases, and beginning April 1, 2012 the 31 operational costs of the New York state medical indemnity fund and state 32 costs or savings from the basic health plan. Such projections may be 33 adjusted by the director of the budget to account for increased or expe- 34 dited department of health state funds medicaid expenditures as a result 35 of a natural or other type of disaster, including a governmental decla- 36 ration of emergency. 37 § 2. This act shall take effect immediately and shall be deemed to 38 have been in full force and effect on and after April 1, 2019. 39 PART E 40 Section 1. Section 4 of chapter 505 of the laws of 1995, amending the 41 public health law relating to the operation of department of health 42 facilities, as amended by section 27 of part D of chapter 57 of the laws 43 of 2015, is amended to read as follows: 44 § 4. This act shall take effect immediately; provided, however, that 45 the provisions of paragraph (b) of subdivision 4 of section 409-c of the 46 public health law, as added by section three of this act, shall take 47 effect January 1, 1996 and shall expire and be deemed repealed [twenty-48four] twenty-nine years from the effective date thereof. 49 § 2. Subdivision p of section 76 of part D of chapter 56 of the laws 50 of 2013, amending the social services law relating to eligibility condi- 51 tions, is amended to read as follows:S. 1507--A 12 A. 2007--A 1 p. the amendments [made] to subparagraph [(7)] 7 of paragraph (b) of 2 subdivision 1 of section 366 of the social services law made by section 3 one of this act shall expire and be deemed repealed October 1, [2019] 4 2024. 5 § 3. Section 11 of chapter 884 of the laws of 1990, amending the 6 public health law relating to authorizing bad debt and charity care 7 allowances for certified home health agencies, as amended by section 1 8 of part I of chapter 57 of the laws of 2017, is amended to read as 9 follows: 10 § 11. This act shall take effect immediately and: 11 (a) sections one and three shall expire on December 31, 1996, 12 (b) sections four through ten shall expire on June 30, [2019] 2024, 13 and 14 (c) provided that the amendment to section 2807-b of the public health 15 law by section two of this act shall not affect the expiration of such 16 section 2807-b as otherwise provided by law and shall be deemed to 17 expire therewith. 18 § 4. Section 3 of chapter 303 of the laws of 1999, amending the New 19 York state medical care facilities finance agency act relating to 20 financing health facilities, as amended by section 16 of part D of chap- 21 ter 57 of the laws of 2015, is amended to read as follows: 22 § 3. This act shall take effect immediately, provided, however, that 23 subdivision 15-a of section 5 of section 1 of chapter 392 of the laws of 24 1973, as added by section one of this act, shall expire and be deemed 25 repealed June 30, [2019] 2024; and provided further, however, that the 26 expiration and repeal of such subdivision 15-a shall not affect or 27 impair in any manner any health facilities bonds issued, or any lease or 28 purchase of a health facility executed, pursuant to such subdivision 29 15-a prior to its expiration and repeal and that, with respect to any 30 such bonds issued and outstanding as of June 30, [2019] 2024, the 31 provisions of such subdivision 15-a as they existed immediately prior to 32 such expiration and repeal shall continue to apply through the latest 33 maturity date of any such bonds, or their earlier retirement or redemp- 34 tion, for the sole purpose of authorizing the issuance of refunding 35 bonds to refund bonds previously issued pursuant thereto. 36 § 5. Subdivision (a) of section 40 of part B of chapter 109 of the 37 laws of 2010, amending the social services law relating to transporta- 38 tion costs, as amended by section 8 of part I of chapter 57 of the laws 39 of 2017, is amended to read as follows: 40 (a) sections two, three, three-a, three-b, three-c, three-d, three-e 41 and twenty-one of this act shall take effect July 1, 2010; sections 42 fifteen, sixteen, seventeen, eighteen and nineteen of this act shall 43 take effect January 1, 2011; and provided further that section twenty of 44 this act shall be deemed repealed [eight] thirteen years after the date 45 the contract entered into pursuant to section 365-h of the social 46 services law, as amended by section twenty of this act, is executed; 47 provided that the commissioner of health shall notify the legislative 48 bill drafting commission upon the execution of the contract entered into 49 pursuant to section 367-h of the social services law in order that the 50 commission may maintain an accurate and timely effective data base of 51 the official text of the laws of the state of New York in furtherance of 52 effectuating the provisions of section 44 of the legislative law and 53 section 70-b of the public officers law; 54 § 6. Subdivision (f) of section 129 of part C of chapter 58 of the 55 laws of 2009, amending the public health law relating to payment by 56 governmental agencies for general hospital inpatient services, asS. 1507--A 13 A. 2007--A 1 amended by section 4 of part D of chapter 59 of the laws of 2016, is 2 amended to read as follows: 3 (f) section twenty-five of this act shall expire and be deemed 4 repealed April 1, [2019] 2024; 5 § 7. Subdivision (c) of section 122 of part E of chapter 56 of the 6 laws of 2013 amending the public health law relating to the general 7 public health work program, as amended by section 5 of part D of chapter 8 59 of the laws of 2016, is amended to read as follows: 9 (c) section fifty of this act shall take effect immediately [and shall10expire six years after it becomes law]; 11 § 8. Subdivision (i) of section 111 of part H of chapter 59 of the 12 laws of 2011, amending the public health law and other laws relating to 13 known and projected department of health state fund medical expendi- 14 tures, as amended by section 19 of part D of chapter 57 of the laws of 15 2015, is amended to read as follows: 16 (i) the amendments to paragraph (b) and subparagraph (i) of paragraph 17 (g) of subdivision 7 of section 4403-f of the public health law made by 18 section forty-one-b of this act shall expire and be repealed April 1, 19 [2019] 2024; 20 § 9. Subparagraph (vi) of paragraph (b) of subdivision 2 of section 21 2807-d of the public health law, as amended by section 3 of part I of 22 chapter 57 of the laws of 2017, is amended to read as follows: 23 (vi) Notwithstanding any contrary provision of this paragraph or any 24 other provision of law or regulation to the contrary, for residential 25 health care facilities the assessment shall be six percent of each resi- 26 dential health care facility's gross receipts received from all patient 27 care services and other operating income on a cash basis for the period 28 April first, two thousand two through March thirty-first, two thousand 29 three for hospital or health-related services, including adult day 30 services; provided, however, that residential health care facilities' 31 gross receipts attributable to payments received pursuant to title XVIII 32 of the federal social security act (medicare) shall be excluded from the 33 assessment; provided, however, that for all such gross receipts received 34 on or after April first, two thousand three through March thirty-first, 35 two thousand five, such assessment shall be five percent, and further 36 provided that for all such gross receipts received on or after April 37 first, two thousand five through March thirty-first, two thousand nine, 38 and on or after April first, two thousand nine through March thirty- 39 first, two thousand eleven such assessment shall be six percent, and 40 further provided that for all such gross receipts received on or after 41 April first, two thousand eleven through March thirty-first, two thou- 42 sand thirteen such assessment shall be six percent, and further provided 43 that for all such gross receipts received on or after April first, two 44 thousand thirteen through March thirty-first, two thousand fifteen such 45 assessment shall be six percent, and further provided that for all such 46 gross receipts received on or after April first, two thousand fifteen 47 through March thirty-first, two thousand seventeen such assessment shall 48 be six percent, and further provided that for all such gross receipts 49 received on or after April first, two thousand seventeen through March 50 thirty-first, two thousand nineteen such assessment shall be six 51 percent, and further provided that for all such gross receipts received 52 on or after April first, two thousand nineteen through March thirty- 53 first, two thousand twenty-four such assessment shall be six percent. 54 § 10. Subdivision 1 of section 194 of chapter 474 of the laws of 1996, 55 amending the education law and other laws relating to rates for residen-S. 1507--A 14 A. 2007--A 1 tial health care facilities, as amended by section 4 of part I of chap- 2 ter 57 of the laws of 2017, is amended to read as follows: 3 1. Notwithstanding any inconsistent provision of law or regulation, 4 the trend factors used to project reimbursable operating costs to the 5 rate period for purposes of determining rates of payment pursuant to 6 article 28 of the public health law for residential health care facili- 7 ties for reimbursement of inpatient services provided to patients eligi- 8 ble for payments made by state governmental agencies on and after April 9 1, 1996 through March 31, 1999 and for payments made on and after July 10 1, 1999 through March 31, 2000 and on and after April 1, 2000 through 11 March 31, 2003 and on and after April 1, 2003 through March 31, 2007 and 12 on and after April 1, 2007 through March 31, 2009 and on and after April 13 1, 2009 through March 31, 2011 and on and after April 1, 2011 through 14 March 31, 2013 and on and after April 1, 2013 through March 31, 2015, 15 and on and after April 1, 2015 through March 31, 2017, and on and after 16 April 1, 2017 through March 31, 2019, and on and after April 1, 2019 17 through March 31, 2024 shall reflect no trend factor projections or 18 adjustments for the period April 1, 1996, through March 31, 1997. 19 § 11. Subdivision 1 of section 89-a of part C of chapter 58 of the 20 laws of 2007, amending the social services law and other laws relating 21 to enacting the major components of legislation necessary to implement 22 the health and mental hygiene budget for the 2007-2008 state fiscal 23 year, as amended by section 5 of part I of chapter 57 of the laws of 24 2017, is amended to read as follows: 25 1. Notwithstanding paragraph (c) of subdivision 10 of section 2807-c 26 of the public health law and section 21 of chapter 1 of the laws of 27 1999, as amended, and any other inconsistent provision of law or regu- 28 lation to the contrary, in determining rates of payments by state 29 governmental agencies effective for services provided beginning April 1, 30 2006, through March 31, 2009, and on and after April 1, 2009 through 31 March 31, 2011, and on and after April 1, 2011 through March 31, 2013, 32 and on and after April 1, 2013 through March 31, 2015, and on and after 33 April 1, 2015 through March 31, 2017, and on and after April 1, 2017 34 through March 31, 2019, and on and after April 1, 2019 through March 31, 35 2024 for inpatient and outpatient services provided by general hospitals 36 and for inpatient services and outpatient adult day health care services 37 provided by residential health care facilities pursuant to article 28 of 38 the public health law, the commissioner of health shall apply a trend 39 factor projection of two and twenty-five hundredths percent attributable 40 to the period January 1, 2006 through December 31, 2006, and on and 41 after January 1, 2007, provided, however, that on reconciliation of such 42 trend factor for the period January 1, 2006 through December 31, 2006 43 pursuant to paragraph (c) of subdivision 10 of section 2807-c of the 44 public health law, such trend factor shall be the final US Consumer 45 Price Index (CPI) for all urban consumers, as published by the US 46 Department of Labor, Bureau of Labor Statistics less twenty-five 47 hundredths of a percentage point. 48 § 12. Subdivision 5-a of section 246 of chapter 81 of the laws of 49 1995, amending the public health law and other laws relating to medical 50 reimbursement and welfare reform, as amended by section 6 of part I of 51 chapter 57 of the laws of 2017, is amended to read as follows: 52 5-a. Section sixty-four-a of this act shall be deemed to have been in 53 full force and effect on and after April 1, 1995 through March 31, 1999 54 and on and after July 1, 1999 through March 31, 2000 and on and after 55 April 1, 2000 through March 31, 2003 and on and after April 1, 2003 56 through March 31, 2007, and on and after April 1, 2007 through March 31,S. 1507--A 15 A. 2007--A 1 2009, and on and after April 1, 2009 through March 31, 2011, and on and 2 after April 1, 2011 through March 31, 2013, and on and after April 1, 3 2013 through March 31, 2015, and on and after April 1, 2015 through 4 March 31, 2017 and on and after April 1, 2017 through March 31, 2019, 5 and on and after April 1, 2019 through March 31, 2024; 6 § 13. Section 64-b of chapter 81 of the laws of 1995, amending the 7 public health law and other laws relating to medical reimbursement and 8 welfare reform, as amended by section 7 of part I of chapter 57 of the 9 laws of 2017, is amended to read as follows: 10 § 64-b. Notwithstanding any inconsistent provision of law, the 11 provisions of subdivision 7 of section 3614 of the public health law, as 12 amended, shall remain and be in full force and effect on April 1, 1995 13 through March 31, 1999 and on July 1, 1999 through March 31, 2000 and on 14 and after April 1, 2000 through March 31, 2003 and on and after April 1, 15 2003 through March 31, 2007, and on and after April 1, 2007 through 16 March 31, 2009, and on and after April 1, 2009 through March 31, 2011, 17 and on and after April 1, 2011 through March 31, 2013, and on and after 18 April 1, 2013 through March 31, 2015, and on and after April 1, 2015 19 through March 31, 2017 and on and after April 1, 2017 through March 31, 20 2019, and on and after April 1, 2019 through March 31, 2024. 21 § 14. Section 4-a of part A of chapter 56 of the laws of 2013, amend- 22 ing chapter 59 of the laws of 2011 amending the public health law and 23 other laws relating to general hospital reimbursement for annual rates, 24 as amended by section 5 of part T of chapter 57 of the laws of 2018, is 25 amended to read as follows: 26 § 4-a. Notwithstanding paragraph (c) of subdivision 10 of section 27 2807-c of the public health law, section 21 of chapter 1 of the laws of 28 1999, or any other contrary provision of law, in determining rates of 29 payments by state governmental agencies effective for services provided 30 on and after January 1, 2017 through March 31, [2019] 2024, for inpa- 31 tient and outpatient services provided by general hospitals, for inpa- 32 tient services and adult day health care outpatient services provided by 33 residential health care facilities pursuant to article 28 of the public 34 health law, except for residential health care facilities or units of 35 such facilities providing services primarily to children under twenty- 36 one years of age, for home health care services provided pursuant to 37 article 36 of the public health law by certified home health agencies, 38 long term home health care programs and AIDS home care programs, and for 39 personal care services provided pursuant to section 365-a of the social 40 services law, the commissioner of health shall apply no greater than 41 zero trend factors attributable to the 2017, 2018, [and] 2019, 2020, 42 2021, 2022, and 2023 calendar years in accordance with paragraph (c) of 43 subdivision 10 of section 2807-c of the public health law, provided, 44 however, that such no greater than zero trend factors attributable to 45 such 2017, 2018, [and] 2019, 2020, 2021, 2022, and 2023 calendar years 46 shall also be applied to rates of payment provided on and after January 47 1, 2017 through March 31, [2019] 2024 for personal care services 48 provided in those local social services districts, including New York 49 city, whose rates of payment for such services are established by such 50 local social services districts pursuant to a rate-setting exemption 51 issued by the commissioner of health to such local social services 52 districts in accordance with applicable regulations; and provided 53 further, however, that for rates of payment for assisted living program 54 services provided on and after January 1, 2017 through March 31, [2019] 55 2024, such trend factors attributable to the 2017, 2018, [and] 2019,S. 1507--A 16 A. 2007--A 1 2020, 2021, 2022, and 2023 calendar years shall be established at no 2 greater than zero percent. 3 § 15. Paragraph (b) of subdivision 17 of section 2808 of the public 4 health law, as amended by section 21 of part D of chapter 57 of the laws 5 of 2015, is amended to read as follows: 6 (b) Notwithstanding any inconsistent provision of law or regulation to 7 the contrary, for the state fiscal years beginning April first, two 8 thousand ten and ending March thirty-first, two thousand [nineteen] 9 twenty-four, the commissioner shall not be required to revise certified 10 rates of payment established pursuant to this article for rate periods 11 prior to April first, two thousand [nineteen] twenty-four, based on 12 consideration of rate appeals filed by residential health care facili- 13 ties or based upon adjustments to capital cost reimbursement as a result 14 of approval by the commissioner of an application for construction under 15 section twenty-eight hundred two of this article, in excess of an aggre- 16 gate annual amount of eighty million dollars for each such state fiscal 17 year provided, however, that for the period April first, two thousand 18 eleven through March thirty-first, two thousand twelve such aggregate 19 annual amount shall be fifty million dollars. In revising such rates 20 within such fiscal limit, the commissioner shall, in prioritizing such 21 rate appeals, include consideration of which facilities the commissioner 22 determines are facing significant financial hardship as well as such 23 other considerations as the commissioner deems appropriate and, further, 24 the commissioner is authorized to enter into agreements with such facil- 25 ities or any other facility to resolve multiple pending rate appeals 26 based upon a negotiated aggregate amount and may offset such negotiated 27 aggregate amounts against any amounts owed by the facility to the 28 department, including, but not limited to, amounts owed pursuant to 29 section twenty-eight hundred seven-d of this article; provided, however, 30 that the commissioner's authority to negotiate such agreements resolving 31 multiple pending rate appeals as hereinbefore described shall continue 32 on and after April first, two thousand [nineteen] twenty-four. Rate 33 adjustments made pursuant to this paragraph remain fully subject to 34 approval by the director of the budget in accordance with the provisions 35 of subdivision two of section twenty-eight hundred seven of this arti- 36 cle. 37 § 16. Paragraph (a) of subdivision 13 of section 3614 of the public 38 health law, as amended by section 22 of part D of chapter 57 of the laws 39 of 2015, is amended to read as follows: 40 (a) Notwithstanding any inconsistent provision of law or regulation 41 and subject to the availability of federal financial participation, 42 effective April first, two thousand twelve through March thirty-first, 43 two thousand [nineteen] twenty-four, payments by government agencies for 44 services provided by certified home health agencies, except for such 45 services provided to children under eighteen years of age and other 46 discreet groups as may be determined by the commissioner pursuant to 47 regulations, shall be based on episodic payments. In establishing such 48 payments, a statewide base price shall be established for each sixty day 49 episode of care and adjusted by a regional wage index factor and an 50 individual patient case mix index. Such episodic payments may be further 51 adjusted for low utilization cases and to reflect a percentage limita- 52 tion of the cost for high-utilization cases that exceed outlier thresh- 53 olds of such payments. 54 § 17. Subdivision 2 of section 246 of chapter 81 of the laws of 1995, 55 amending the public health law and other laws relating to medicalS. 1507--A 17 A. 2007--A 1 reimbursement and welfare reform, as amended by section 18 of part I of 2 chapter 57 of the laws of 2017, is amended to read as follows: 3 2. Sections five, seven through nine, twelve through fourteen, and 4 eighteen of this act shall be deemed to have been in full force and 5 effect on and after April 1, 1995 through March 31, 1999 and on and 6 after July 1, 1999 through March 31, 2000 and on and after April 1, 2000 7 through March 31, 2003 and on and after April 1, 2003 through March 31, 8 2006 and on and after April 1, 2006 through March 31, 2007 and on and 9 after April 1, 2007 through March 31, 2009 and on and after April 1, 10 2009 through March 31, 2011 and sections twelve, thirteen and fourteen 11 of this act shall be deemed to be in full force and effect on and after 12 April 1, 2011 through March 31, 2015 and on and after April 1, 2015 13 through March 31, 2017 and on and after April 1, 2017 through March 31, 14 2019, and on and after April 1, 2019 through March 31, 2024; 15 § 18. Section 48-a of part A of chapter 56 of the laws of 2013 amend- 16 ing chapter 59 of the laws of 2011 amending the public health law and 17 other laws relating to general hospital reimbursement for annual rates, 18 as amended by section 1 of part P of chapter 57 of the laws of 2017, is 19 amended to read as follows: 20 § 48-a. 1. Notwithstanding any contrary provision of law, the commis- 21 sioners of the office of alcoholism and substance abuse services and the 22 office of mental health are authorized, subject to the approval of the 23 director of the budget, to transfer to the commissioner of health state 24 funds to be utilized as the state share for the purpose of increasing 25 payments under the medicaid program to managed care organizations 26 licensed under article 44 of the public health law or under article 43 27 of the insurance law. Such managed care organizations shall utilize such 28 funds for the purpose of reimbursing providers licensed pursuant to 29 article 28 of the public health law or article 31 or 32 of the mental 30 hygiene law for ambulatory behavioral health services, as determined by 31 the commissioner of health, in consultation with the commissioner of 32 alcoholism and substance abuse services and the commissioner of the 33 office of mental health, provided to medicaid enrolled outpatients and 34 for all other behavioral health services except inpatient included in 35 New York state's Medicaid redesign waiver approved by the centers for 36 medicare and Medicaid services (CMS). Such reimbursement shall be in 37 the form of fees for such services which are equivalent to the payments 38 established for such services under the ambulatory patient group (APG) 39 rate-setting methodology as utilized by the department of health, the 40 office of alcoholism and substance abuse services, or the office of 41 mental health for rate-setting purposes or any such other fees pursuant 42 to the Medicaid state plan or otherwise approved by CMS in the Medicaid 43 redesign waiver; provided, however, that the increase to such fees that 44 shall result from the provisions of this section shall not, in the 45 aggregate and as determined by the commissioner of health, in consulta- 46 tion with the commissioner of alcoholism and substance abuse services 47 and the commissioner of the office of mental health, be greater than the 48 increased funds made available pursuant to this section. The increase 49 of such ambulatory behavioral health fees to providers available under 50 this section shall be for all rate periods on and after the effective 51 date of section [29] 1 of part [B] P of chapter [59] 57 of the laws of 52 [2016] 2017 through March 31, [2020] 2022 for patients in the city of 53 New York, for all rate periods on and after the effective date of 54 section [29] 1 of part [B] P of chapter [59] 57 of the laws of [2016] 55 2017 through [March 31, 2020] March 31, 2022 for patients outside the 56 city of New York, and for all rate periods on and after the effectiveS. 1507--A 18 A. 2007--A 1 date of such chapter through [March 31, 2020] March 31, 2022 for all 2 services provided to persons under the age of twenty-one; provided, 3 however, the commissioner of health, in consultation with the commis- 4 sioner of alcoholism and substance abuse services and the commissioner 5 of mental health, may require, as a condition of approval of such ambu- 6 latory behavioral health fees, that aggregate managed care expenditures 7 to eligible providers meet the alternative payment methodology require- 8 ments as set forth in attachment I of the New York state medicaid 9 section one thousand one hundred fifteen medicaid redesign team waiver 10 as approved by the centers for medicare and medicaid services. The 11 commissioner of health shall, in consultation with the commissioner of 12 alcoholism and substance abuse services and the commissioner of mental 13 health, waive such conditions if a sufficient number of providers, as 14 determined by the commissioner, suffer a financial hardship as a conse- 15 quence of such alternative payment methodology requirements, or if he or 16 she shall determine that such alternative payment methodologies signif- 17 icantly threaten individuals access to ambulatory behavioral health 18 services. Such waiver may be applied on a provider specific or industry 19 wide basis. Further, such conditions may be waived, as the commissioner 20 determines necessary, to comply with federal rules or regulations 21 governing these payment methodologies. Nothing in this section shall 22 prohibit managed care organizations and providers from negotiating 23 different rates and methods of payment during such periods described 24 above, subject to the approval of the department of health. The depart- 25 ment of health shall consult with the office of alcoholism and substance 26 abuse services and the office of mental health in determining whether 27 such alternative rates shall be approved. The commissioner of health 28 may, in consultation with the commissioner of alcoholism and substance 29 abuse services and the commissioner of the office of mental health, 30 promulgate regulations, including emergency regulations promulgated 31 prior to October 1, 2015 to establish rates for ambulatory behavioral 32 health services, as are necessary to implement the provisions of this 33 section. Rates promulgated under this section shall be included in the 34 report required under section 45-c of part A of this chapter. 35 2. Notwithstanding any contrary provision of law, the fees paid by 36 managed care organizations licensed under article 44 of the public 37 health law or under article 43 of the insurance law, to providers 38 licensed pursuant to article 28 of the public health law or article 31 39 or 32 of the mental hygiene law, for ambulatory behavioral health 40 services provided to patients enrolled in the child health insurance 41 program pursuant to title [one-A] 1-A of article 25 of the public health 42 law, shall be in the form of fees for such services which are equivalent 43 to the payments established for such services under the ambulatory 44 patient group (APG) rate-setting methodology or any such other fees 45 established pursuant to the Medicaid state plan. The commissioner of 46 health shall consult with the commissioner of alcoholism and substance 47 abuse services and the commissioner of the office of mental health in 48 determining such services and establishing such fees. Such ambulatory 49 behavioral health fees to providers available under this section shall 50 be for all rate periods on and after the effective date of this chapter 51 through [March 31, 2020] March 31, 2022, provided, however, that managed 52 care organizations and providers may negotiate different rates and meth- 53 ods of payment during such periods described above, subject to the 54 approval of the department of health. The department of health shall 55 consult with the office of alcoholism and substance abuse services and 56 the office of mental health in determining whether such alternativeS. 1507--A 19 A. 2007--A 1 rates shall be approved. The report required under section 16-a of part 2 C of chapter 60 of the laws of 2014 shall also include the population of 3 patients enrolled in the child health insurance program pursuant to 4 title [one-A] 1-A of article 25 of the public health law in its examina- 5 tion on the transition of behavioral health services into managed care. 6 § 19. Section 1 of part H of chapter 111 of the laws of 2010 relating 7 to increasing Medicaid payments to providers through managed care organ- 8 izations and providing equivalent fees through an ambulatory patient 9 group methodology, as amended by section 2 of part P of chapter 57 of 10 the laws of 2017, is amended to read as follows: 11 Section 1. a. Notwithstanding any contrary provision of law, the 12 commissioners of mental health and alcoholism and substance abuse 13 services are authorized, subject to the approval of the director of the 14 budget, to transfer to the commissioner of health state funds to be 15 utilized as the state share for the purpose of increasing payments under 16 the medicaid program to managed care organizations licensed under arti- 17 cle 44 of the public health law or under article 43 of the insurance 18 law. Such managed care organizations shall utilize such funds for the 19 purpose of reimbursing providers licensed pursuant to article 28 of the 20 public health law, or pursuant to article 31 or article 32 of the mental 21 hygiene law for ambulatory behavioral health services, as determined by 22 the commissioner of health in consultation with the commissioner of 23 mental health and commissioner of alcoholism and substance abuse 24 services, provided to medicaid enrolled outpatients and for all other 25 behavioral health services except inpatient included in New York state's 26 Medicaid redesign waiver approved by the centers for medicare and Medi- 27 caid services (CMS). Such reimbursement shall be in the form of fees for 28 such services which are equivalent to the payments established for such 29 services under the ambulatory patient group (APG) rate-setting methodol- 30 ogy as utilized by the department of health or by the office of mental 31 health or office of alcoholism and substance abuse services for rate- 32 setting purposes or any such other fees pursuant to the Medicaid state 33 plan or otherwise approved by CMS in the Medicaid redesign waiver; 34 provided, however, that the increase to such fees that shall result from 35 the provisions of this section shall not, in the aggregate and as deter- 36 mined by the commissioner of health in consultation with the commission- 37 ers of mental health and alcoholism and substance abuse services, be 38 greater than the increased funds made available pursuant to this 39 section. The increase of such behavioral health fees to providers avail- 40 able under this section shall be for all rate periods on and after the 41 effective date of section [30] 2 of part [B] P of chapter [59] 57 of the 42 laws of [2016] 2017 through March 31, [2020] 2022 for patients in the 43 city of New York, for all rate periods on and after the effective date 44 of section [30] 2 of part [B] P of chapter [59] 57 of the laws of [2016] 45 2017 through March 31, [2020] 2022 for patients outside the city of New 46 York, and for all rate periods on and after the effective date of 47 section [30] 2 of part [B] P of chapter [59] 57 of the laws of [2016] 48 2017 through March 31, [2020] 2022 for all services provided to persons 49 under the age of twenty-one; provided, however, the commissioner of 50 health, in consultation with the commissioner of alcoholism and 51 substance abuse services and the commissioner of mental health, may 52 require, as a condition of approval of such ambulatory behavioral health 53 fees, that aggregate managed care expenditures to eligible providers 54 meet the alternative payment methodology requirements as set forth in 55 attachment I of the New York state medicaid section one thousand one 56 hundred fifteen medicaid redesign team waiver as approved by the centersS. 1507--A 20 A. 2007--A 1 for medicare and medicaid services. The commissioner of health shall, in 2 consultation with the commissioner of alcoholism and substance abuse 3 services and the commissioner of mental health, waive such conditions if 4 a sufficient number of providers, as determined by the commissioner, 5 suffer a financial hardship as a consequence of such alternative payment 6 methodology requirements, or if he or she shall determine that such 7 alternative payment methodologies significantly threaten individuals 8 access to ambulatory behavioral health services. Such waiver may be 9 applied on a provider specific or industry wide basis. Further, such 10 conditions may be waived, as the commissioner determines necessary, to 11 comply with federal rules or regulations governing these payment method- 12 ologies. Nothing in this section shall prohibit managed care organiza- 13 tions and providers from negotiating different rates and methods of 14 payment during such periods described, subject to the approval of the 15 department of health. The department of health shall consult with the 16 office of alcoholism and substance abuse services and the office of 17 mental health in determining whether such alternative rates shall be 18 approved. The commissioner of health may, in consultation with the 19 commissioners of mental health and alcoholism and substance abuse 20 services, promulgate regulations, including emergency regulations 21 promulgated prior to October 1, 2013 that establish rates for behavioral 22 health services, as are necessary to implement the provisions of this 23 section. Rates promulgated under this section shall be included in the 24 report required under section 45-c of part A of chapter 56 of the laws 25 of 2013. 26 b. Notwithstanding any contrary provision of law, the fees paid by 27 managed care organizations licensed under article 44 of the public 28 health law or under article 43 of the insurance law, to providers 29 licensed pursuant to article 28 of the public health law or article 31 30 or 32 of the mental hygiene law, for ambulatory behavioral health 31 services provided to patients enrolled in the child health insurance 32 program pursuant to title [one-A] 1-A of article 25 of the public health 33 law, shall be in the form of fees for such services which are equivalent 34 to the payments established for such services under the ambulatory 35 patient group (APG) rate-setting methodology. The commissioner of health 36 shall consult with the commissioner of alcoholism and substance abuse 37 services and the commissioner of the office of mental health in deter- 38 mining such services and establishing such fees. Such ambulatory behav- 39 ioral health fees to providers available under this section shall be for 40 all rate periods on and after the effective date of this chapter through 41 March 31, [2020] 2022, provided, however, that managed care organiza- 42 tions and providers may negotiate different rates and methods of payment 43 during such periods described above, subject to the approval of the 44 department of health. The department of health shall consult with the 45 office of alcoholism and substance abuse services and the office of 46 mental health in determining whether such alternative rates shall be 47 approved. The report required under section 16-a of part C of chapter 48 60 of the laws of 2014 shall also include the population of patients 49 enrolled in the child health insurance program pursuant to title [one-A] 50 1-A of article 25 of the public health law in its examination on the 51 transition of behavioral health services into managed care. 52 § 20. Section 2 of part H of chapter 111 of the laws of 2010, relating 53 to increasing Medicaid payments to providers through managed care organ- 54 izations and providing equivalent fees through an ambulatory patient 55 group methodology, as amended by section 16 of part C of chapter 60 of 56 the laws of 2014, is amended to read as follows:S. 1507--A 21 A. 2007--A 1 § 2. This act shall take effect immediately and shall be deemed to 2 have been in full force and effect on and after April 1, 2010, and shall 3 expire on [January 1, 2018] March 31, 2022. 4 § 21. Section 10 of chapter 649 of the laws of 1996, amending the 5 public health law, the mental hygiene law and the social services law 6 relating to authorizing the establishment of special needs plans, as 7 amended by section 2 of part D of chapter 59 of the laws of 2016, is 8 amended to read as follows: 9 § 10. This act shall take effect immediately and shall be deemed to 10 have been in full force and effect on and after July 1, 1996; provided, 11 however, that sections one, two and three of this act shall expire and 12 be deemed repealed on March 31, [2020] 2025 provided, however that the 13 amendments to section 364-j of the social services law made by section 14 four of this act shall not affect the expiration of such section and 15 shall be deemed to expire therewith and provided, further, that the 16 provisions of subdivisions 8, 9 and 10 of section 4401 of the public 17 health law, as added by section one of this act; section 4403-d of the 18 public health law as added by section two of this act and the provisions 19 of section seven of this act, except for the provisions relating to the 20 establishment of no more than twelve comprehensive HIV special needs 21 plans, shall expire and be deemed repealed on July 1, 2000. 22 § 22. Paragraph (a) of subdivision 1 of section 212 of chapter 474 of 23 the laws of 1996, amending the education law and other laws relating to 24 rates for residential healthcare facilities, as amended by section 1 of 25 part D of chapter 59 of the laws of 2016, is amended to read as follows: 26 (a) Notwithstanding any inconsistent provision of law or regulation to 27 the contrary, effective beginning August 1, 1996, for the period April 28 1, 1997 through March 31, 1998, April 1, 1998 for the period April 1, 29 1998 through March 31, 1999, August 1, 1999, for the period April 1, 30 1999 through March 31, 2000, April 1, 2000, for the period April 1, 2000 31 through March 31, 2001, April 1, 2001, for the period April 1, 2001 32 through March 31, 2002, April 1, 2002, for the period April 1, 2002 33 through March 31, 2003, and for the state fiscal year beginning April 1, 34 2005 through March 31, 2006, and for the state fiscal year beginning 35 April 1, 2006 through March 31, 2007, and for the state fiscal year 36 beginning April 1, 2007 through March 31, 2008, and for the state fiscal 37 year beginning April 1, 2008 through March 31, 2009, and for the state 38 fiscal year beginning April 1, 2009 through March 31, 2010, and for the 39 state fiscal year beginning April 1, 2010 through March 31, 2016, and 40 for the state fiscal year beginning April 1, 2016 through March 31, 2019 41 and annually thereafter, the department of health is authorized to pay 42 public general hospitals, as defined in subdivision 10 of section 2801 43 of the public health law, operated by the state of New York or by the 44 state university of New York or by a county, which shall not include a 45 city with a population of over one million, of the state of New York, 46 and those public general hospitals located in the county of Westchester, 47 the county of Erie or the county of Nassau, additional payments for 48 inpatient hospital services as medical assistance payments pursuant to 49 title 11 of article 5 of the social services law for patients eligible 50 for federal financial participation under title XIX of the federal 51 social security act in medical assistance pursuant to the federal laws 52 and regulations governing disproportionate share payments to hospitals 53 up to one hundred percent of each such public general hospital's medical 54 assistance and uninsured patient losses after all other medical assist- 55 ance, including disproportionate share payments to such public general 56 hospital for 1996, 1997, 1998, and 1999, based initially for 1996 onS. 1507--A 22 A. 2007--A 1 reported 1994 reconciled data as further reconciled to actual reported 2 1996 reconciled data, and for 1997 based initially on reported 1995 3 reconciled data as further reconciled to actual reported 1997 reconciled 4 data, for 1998 based initially on reported 1995 reconciled data as 5 further reconciled to actual reported 1998 reconciled data, for 1999 6 based initially on reported 1995 reconciled data as further reconciled 7 to actual reported 1999 reconciled data, for 2000 based initially on 8 reported 1995 reconciled data as further reconciled to actual reported 9 2000 data, for 2001 based initially on reported 1995 reconciled data as 10 further reconciled to actual reported 2001 data, for 2002 based initial- 11 ly on reported 2000 reconciled data as further reconciled to actual 12 reported 2002 data, and for state fiscal years beginning on April 1, 13 2005, based initially on reported 2000 reconciled data as further recon- 14 ciled to actual reported data for 2005, and for state fiscal years 15 beginning on April 1, 2006, based initially on reported 2000 reconciled 16 data as further reconciled to actual reported data for 2006, for state 17 fiscal years beginning on and after April 1, 2007 through March 31, 18 2009, based initially on reported 2000 reconciled data as further recon- 19 ciled to actual reported data for 2007 and 2008, respectively, for state 20 fiscal years beginning on and after April 1, 2009, based initially on 21 reported 2007 reconciled data, adjusted for authorized Medicaid rate 22 changes applicable to the state fiscal year, and as further reconciled 23 to actual reported data for 2009, for state fiscal years beginning on 24 and after April 1, 2010, based initially on reported reconciled data 25 from the base year two years prior to the payment year, adjusted for 26 authorized Medicaid rate changes applicable to the state fiscal year, 27 and further reconciled to actual reported data from such payment year, 28 and to actual reported data for each respective succeeding year. The 29 payments may be added to rates of payment or made as aggregate payments 30 to an eligible public general hospital. 31 § 23. This act shall take effect immediately; provided that the amend- 32 ments to section 1 of part H of chapter 111 of the laws of 2010 made by 33 section nineteen of this act shall not affect the expiration of such 34 section and shall expire therewith; and provided further that section 35 twenty of this act shall be deemed to have been in full force and effect 36 on and after January 1, 2018. 37 PART F 38 Section 1. Paragraph (a) of subdivision 1 of section 18 of chapter 266 39 of the laws of 1986, amending the civil practice law and rules and other 40 laws relating to malpractice and professional medical conduct, as 41 amended by section 1 of part M of chapter 57 of the laws of 2018, is 42 amended to read as follows: 43 (a) The superintendent of financial services and the commissioner of 44 health or their designee shall, from funds available in the hospital 45 excess liability pool created pursuant to subdivision 5 of this section, 46 purchase a policy or policies for excess insurance coverage, as author- 47 ized by paragraph 1 of subsection (e) of section 5502 of the insurance 48 law; or from an insurer, other than an insurer described in section 5502 49 of the insurance law, duly authorized to write such coverage and actual- 50 ly writing medical malpractice insurance in this state; or shall 51 purchase equivalent excess coverage in a form previously approved by the 52 superintendent of financial services for purposes of providing equiv- 53 alent excess coverage in accordance with section 19 of chapter 294 of 54 the laws of 1985, for medical or dental malpractice occurrences betweenS. 1507--A 23 A. 2007--A 1 July 1, 1986 and June 30, 1987, between July 1, 1987 and June 30, 1988, 2 between July 1, 1988 and June 30, 1989, between July 1, 1989 and June 3 30, 1990, between July 1, 1990 and June 30, 1991, between July 1, 1991 4 and June 30, 1992, between July 1, 1992 and June 30, 1993, between July 5 1, 1993 and June 30, 1994, between July 1, 1994 and June 30, 1995, 6 between July 1, 1995 and June 30, 1996, between July 1, 1996 and June 7 30, 1997, between July 1, 1997 and June 30, 1998, between July 1, 1998 8 and June 30, 1999, between July 1, 1999 and June 30, 2000, between July 9 1, 2000 and June 30, 2001, between July 1, 2001 and June 30, 2002, 10 between July 1, 2002 and June 30, 2003, between July 1, 2003 and June 11 30, 2004, between July 1, 2004 and June 30, 2005, between July 1, 2005 12 and June 30, 2006, between July 1, 2006 and June 30, 2007, between July 13 1, 2007 and June 30, 2008, between July 1, 2008 and June 30, 2009, 14 between July 1, 2009 and June 30, 2010, between July 1, 2010 and June 15 30, 2011, between July 1, 2011 and June 30, 2012, between July 1, 2012 16 and June 30, 2013, between July 1, 2013 and June 30, 2014, between July 17 1, 2014 and June 30, 2015, between July 1, 2015 and June 30, 2016, 18 between July 1, 2016 and June 30, 2017, between July 1, 2017 and June 19 30, 2018, [and] between July 1, 2018 and June 30, 2019, and between July 20 1, 2019 and June 30, 2020 or reimburse the hospital where the hospital 21 purchases equivalent excess coverage as defined in subparagraph (i) of 22 paragraph (a) of subdivision 1-a of this section for medical or dental 23 malpractice occurrences between July 1, 1987 and June 30, 1988, between 24 July 1, 1988 and June 30, 1989, between July 1, 1989 and June 30, 1990, 25 between July 1, 1990 and June 30, 1991, between July 1, 1991 and June 26 30, 1992, between July 1, 1992 and June 30, 1993, between July 1, 1993 27 and June 30, 1994, between July 1, 1994 and June 30, 1995, between July 28 1, 1995 and June 30, 1996, between July 1, 1996 and June 30, 1997, 29 between July 1, 1997 and June 30, 1998, between July 1, 1998 and June 30 30, 1999, between July 1, 1999 and June 30, 2000, between July 1, 2000 31 and June 30, 2001, between July 1, 2001 and June 30, 2002, between July 32 1, 2002 and June 30, 2003, between July 1, 2003 and June 30, 2004, 33 between July 1, 2004 and June 30, 2005, between July 1, 2005 and June 34 30, 2006, between July 1, 2006 and June 30, 2007, between July 1, 2007 35 and June 30, 2008, between July 1, 2008 and June 30, 2009, between July 36 1, 2009 and June 30, 2010, between July 1, 2010 and June 30, 2011, 37 between July 1, 2011 and June 30, 2012, between July 1, 2012 and June 38 30, 2013, between July 1, 2013 and June 30, 2014, between July 1, 2014 39 and June 30, 2015, between July 1, 2015 and June 30, 2016, between July 40 1, 2016 and June 30, 2017, between July 1, 2017 and June 30, 2018, [and] 41 between July 1, 2018 and June 30, 2019, and between July 1, 2019 and 42 June 30, 2020 for physicians or dentists certified as eligible for each 43 such period or periods pursuant to subdivision 2 of this section by a 44 general hospital licensed pursuant to article 28 of the public health 45 law; provided that no single insurer shall write more than fifty percent 46 of the total excess premium for a given policy year; and provided, 47 however, that such eligible physicians or dentists must have in force an 48 individual policy, from an insurer licensed in this state of primary 49 malpractice insurance coverage in amounts of no less than one million 50 three hundred thousand dollars for each claimant and three million nine 51 hundred thousand dollars for all claimants under that policy during the 52 period of such excess coverage for such occurrences or be endorsed as 53 additional insureds under a hospital professional liability policy which 54 is offered through a voluntary attending physician ("channeling") 55 program previously permitted by the superintendent of financial services 56 during the period of such excess coverage for such occurrences. DuringS. 1507--A 24 A. 2007--A 1 such period, such policy for excess coverage or such equivalent excess 2 coverage shall, when combined with the physician's or dentist's primary 3 malpractice insurance coverage or coverage provided through a voluntary 4 attending physician ("channeling") program, total an aggregate level of 5 two million three hundred thousand dollars for each claimant and six 6 million nine hundred thousand dollars for all claimants from all such 7 policies with respect to occurrences in each of such years provided, 8 however, if the cost of primary malpractice insurance coverage in excess 9 of one million dollars, but below the excess medical malpractice insur- 10 ance coverage provided pursuant to this act, exceeds the rate of nine 11 percent per annum, then the required level of primary malpractice insur- 12 ance coverage in excess of one million dollars for each claimant shall 13 be in an amount of not less than the dollar amount of such coverage 14 available at nine percent per annum; the required level of such coverage 15 for all claimants under that policy shall be in an amount not less than 16 three times the dollar amount of coverage for each claimant; and excess 17 coverage, when combined with such primary malpractice insurance cover- 18 age, shall increase the aggregate level for each claimant by one million 19 dollars and three million dollars for all claimants; and provided 20 further, that, with respect to policies of primary medical malpractice 21 coverage that include occurrences between April 1, 2002 and June 30, 22 2002, such requirement that coverage be in amounts no less than one 23 million three hundred thousand dollars for each claimant and three 24 million nine hundred thousand dollars for all claimants for such occur- 25 rences shall be effective April 1, 2002. 26 § 2. Subdivision 3 of section 18 of chapter 266 of the laws of 1986, 27 amending the civil practice law and rules and other laws relating to 28 malpractice and professional medical conduct, as amended by section 2 of 29 part M of chapter 57 of the laws of 2018, is amended to read as follows: 30 (3)(a) The superintendent of financial services shall determine and 31 certify to each general hospital and to the commissioner of health the 32 cost of excess malpractice insurance for medical or dental malpractice 33 occurrences between July 1, 1986 and June 30, 1987, between July 1, 1988 34 and June 30, 1989, between July 1, 1989 and June 30, 1990, between July 35 1, 1990 and June 30, 1991, between July 1, 1991 and June 30, 1992, 36 between July 1, 1992 and June 30, 1993, between July 1, 1993 and June 37 30, 1994, between July 1, 1994 and June 30, 1995, between July 1, 1995 38 and June 30, 1996, between July 1, 1996 and June 30, 1997, between July 39 1, 1997 and June 30, 1998, between July 1, 1998 and June 30, 1999, 40 between July 1, 1999 and June 30, 2000, between July 1, 2000 and June 41 30, 2001, between July 1, 2001 and June 30, 2002, between July 1, 2002 42 and June 30, 2003, between July 1, 2003 and June 30, 2004, between July 43 1, 2004 and June 30, 2005, between July 1, 2005 and June 30, 2006, 44 between July 1, 2006 and June 30, 2007, between July 1, 2007 and June 45 30, 2008, between July 1, 2008 and June 30, 2009, between July 1, 2009 46 and June 30, 2010, between July 1, 2010 and June 30, 2011, between July 47 1, 2011 and June 30, 2012, between July 1, 2012 and June 30, 2013, and 48 between July 1, 2013 and June 30, 2014, between July 1, 2014 and June 49 30, 2015, between July 1, 2015 and June 30, 2016, and between July 1, 50 2016 and June 30, 2017, between July 1, 2017 and June 30, 2018, [and] 51 between July 1, 2018 and June 30, 2019, and between July 1, 2019 and 52 June 30, 2020 allocable to each general hospital for physicians or 53 dentists certified as eligible for purchase of a policy for excess 54 insurance coverage by such general hospital in accordance with subdivi- 55 sion 2 of this section, and may amend such determination and certif- 56 ication as necessary.S. 1507--A 25 A. 2007--A 1 (b) The superintendent of financial services shall determine and 2 certify to each general hospital and to the commissioner of health the 3 cost of excess malpractice insurance or equivalent excess coverage for 4 medical or dental malpractice occurrences between July 1, 1987 and June 5 30, 1988, between July 1, 1988 and June 30, 1989, between July 1, 1989 6 and June 30, 1990, between July 1, 1990 and June 30, 1991, between July 7 1, 1991 and June 30, 1992, between July 1, 1992 and June 30, 1993, 8 between July 1, 1993 and June 30, 1994, between July 1, 1994 and June 9 30, 1995, between July 1, 1995 and June 30, 1996, between July 1, 1996 10 and June 30, 1997, between July 1, 1997 and June 30, 1998, between July 11 1, 1998 and June 30, 1999, between July 1, 1999 and June 30, 2000, 12 between July 1, 2000 and June 30, 2001, between July 1, 2001 and June 13 30, 2002, between July 1, 2002 and June 30, 2003, between July 1, 2003 14 and June 30, 2004, between July 1, 2004 and June 30, 2005, between July 15 1, 2005 and June 30, 2006, between July 1, 2006 and June 30, 2007, 16 between July 1, 2007 and June 30, 2008, between July 1, 2008 and June 17 30, 2009, between July 1, 2009 and June 30, 2010, between July 1, 2010 18 and June 30, 2011, between July 1, 2011 and June 30, 2012, between July 19 1, 2012 and June 30, 2013, between July 1, 2013 and June 30, 2014, 20 between July 1, 2014 and June 30, 2015, between July 1, 2015 and June 21 30, 2016, between July 1, 2016 and June 30, 2017, between July 1, 2017 22 and June 30, 2018, [and] between July 1, 2018 and June 30, 2019, and 23 between July 1, 2019 and June 30, 2020 allocable to each general hospi- 24 tal for physicians or dentists certified as eligible for purchase of a 25 policy for excess insurance coverage or equivalent excess coverage by 26 such general hospital in accordance with subdivision 2 of this section, 27 and may amend such determination and certification as necessary. The 28 superintendent of financial services shall determine and certify to each 29 general hospital and to the commissioner of health the ratable share of 30 such cost allocable to the period July 1, 1987 to December 31, 1987, to 31 the period January 1, 1988 to June 30, 1988, to the period July 1, 1988 32 to December 31, 1988, to the period January 1, 1989 to June 30, 1989, to 33 the period July 1, 1989 to December 31, 1989, to the period January 1, 34 1990 to June 30, 1990, to the period July 1, 1990 to December 31, 1990, 35 to the period January 1, 1991 to June 30, 1991, to the period July 1, 36 1991 to December 31, 1991, to the period January 1, 1992 to June 30, 37 1992, to the period July 1, 1992 to December 31, 1992, to the period 38 January 1, 1993 to June 30, 1993, to the period July 1, 1993 to December 39 31, 1993, to the period January 1, 1994 to June 30, 1994, to the period 40 July 1, 1994 to December 31, 1994, to the period January 1, 1995 to June 41 30, 1995, to the period July 1, 1995 to December 31, 1995, to the period 42 January 1, 1996 to June 30, 1996, to the period July 1, 1996 to December 43 31, 1996, to the period January 1, 1997 to June 30, 1997, to the period 44 July 1, 1997 to December 31, 1997, to the period January 1, 1998 to June 45 30, 1998, to the period July 1, 1998 to December 31, 1998, to the period 46 January 1, 1999 to June 30, 1999, to the period July 1, 1999 to December 47 31, 1999, to the period January 1, 2000 to June 30, 2000, to the period 48 July 1, 2000 to December 31, 2000, to the period January 1, 2001 to June 49 30, 2001, to the period July 1, 2001 to June 30, 2002, to the period 50 July 1, 2002 to June 30, 2003, to the period July 1, 2003 to June 30, 51 2004, to the period July 1, 2004 to June 30, 2005, to the period July 1, 52 2005 and June 30, 2006, to the period July 1, 2006 and June 30, 2007, to 53 the period July 1, 2007 and June 30, 2008, to the period July 1, 2008 54 and June 30, 2009, to the period July 1, 2009 and June 30, 2010, to the 55 period July 1, 2010 and June 30, 2011, to the period July 1, 2011 and 56 June 30, 2012, to the period July 1, 2012 and June 30, 2013, to theS. 1507--A 26 A. 2007--A 1 period July 1, 2013 and June 30, 2014, to the period July 1, 2014 and 2 June 30, 2015, to the period July 1, 2015 and June 30, 2016, [and3between] to the period July 1, 2016 and June 30, 2017, [and] to the 4 period July 1, 2017 to June 30, 2018, [and] to the period July 1, 2018 5 to June 30, 2019, and to the period July 1, 2019 to June 30, 2020. 6 § 3. Paragraphs (a), (b), (c), (d) and (e) of subdivision 8 of section 7 18 of chapter 266 of the laws of 1986, amending the civil practice law 8 and rules and other laws relating to malpractice and professional 9 medical conduct, as amended by section 3 of part M of chapter 57 of the 10 laws of 2018, are amended to read as follows: 11 (a) To the extent funds available to the hospital excess liability 12 pool pursuant to subdivision 5 of this section as amended, and pursuant 13 to section 6 of part J of chapter 63 of the laws of 2001, as may from 14 time to time be amended, which amended this subdivision, are insuffi- 15 cient to meet the costs of excess insurance coverage or equivalent 16 excess coverage for coverage periods during the period July 1, 1992 to 17 June 30, 1993, during the period July 1, 1993 to June 30, 1994, during 18 the period July 1, 1994 to June 30, 1995, during the period July 1, 1995 19 to June 30, 1996, during the period July 1, 1996 to June 30, 1997, 20 during the period July 1, 1997 to June 30, 1998, during the period July 21 1, 1998 to June 30, 1999, during the period July 1, 1999 to June 30, 22 2000, during the period July 1, 2000 to June 30, 2001, during the period 23 July 1, 2001 to October 29, 2001, during the period April 1, 2002 to 24 June 30, 2002, during the period July 1, 2002 to June 30, 2003, during 25 the period July 1, 2003 to June 30, 2004, during the period July 1, 2004 26 to June 30, 2005, during the period July 1, 2005 to June 30, 2006, 27 during the period July 1, 2006 to June 30, 2007, during the period July 28 1, 2007 to June 30, 2008, during the period July 1, 2008 to June 30, 29 2009, during the period July 1, 2009 to June 30, 2010, during the period 30 July 1, 2010 to June 30, 2011, during the period July 1, 2011 to June 31 30, 2012, during the period July 1, 2012 to June 30, 2013, during the 32 period July 1, 2013 to June 30, 2014, during the period July 1, 2014 to 33 June 30, 2015, during the period July 1, 2015 to June 30, 2016, during 34 the period July 1, 2016 to June 30, 2017, during the period July 1, 2017 35 to June 30, 2018, [and] during the period July 1, 2018 to June 30, 2019, 36 and during the period July 1, 2019 to June 30, 2020 allocated or reallo- 37 cated in accordance with paragraph (a) of subdivision 4-a of this 38 section to rates of payment applicable to state governmental agencies, 39 each physician or dentist for whom a policy for excess insurance cover- 40 age or equivalent excess coverage is purchased for such period shall be 41 responsible for payment to the provider of excess insurance coverage or 42 equivalent excess coverage of an allocable share of such insufficiency, 43 based on the ratio of the total cost of such coverage for such physician 44 to the sum of the total cost of such coverage for all physicians applied 45 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. 1507--A 27 A. 2007--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 13 shall notify a covered physician or dentist by mail, mailed to the 14 address shown on the last application for excess insurance coverage or 15 equivalent excess coverage, of the amount due to such provider from such 16 physician or dentist for such coverage period determined in accordance 17 with paragraph (a) of this subdivision. Such amount shall be due from 18 such physician or dentist to such provider of excess insurance coverage 19 or equivalent excess coverage in a time and manner determined by the 20 superintendent of financial services. 21 (c) If a physician or dentist liable for payment of a portion of the 22 costs of excess insurance coverage or equivalent excess coverage cover- 23 ing the period July 1, 1992 to June 30, 1993, or covering the period 24 July 1, 1993 to June 30, 1994, or covering the period July 1, 1994 to 25 June 30, 1995, or covering the period July 1, 1995 to June 30, 1996, or 26 covering the period July 1, 1996 to June 30, 1997, or covering the peri- 27 od July 1, 1997 to June 30, 1998, or covering the period July 1, 1998 to 28 June 30, 1999, or covering the period July 1, 1999 to June 30, 2000, or 29 covering the period July 1, 2000 to June 30, 2001, or covering the peri- 30 od July 1, 2001 to October 29, 2001, or covering the period April 1, 31 2002 to June 30, 2002, or covering the period July 1, 2002 to June 30, 32 2003, or covering the period July 1, 2003 to June 30, 2004, or covering 33 the period July 1, 2004 to June 30, 2005, or covering the period July 1, 34 2005 to June 30, 2006, or covering the period July 1, 2006 to June 30, 35 2007, or covering the period July 1, 2007 to June 30, 2008, or covering 36 the period July 1, 2008 to June 30, 2009, or covering the period July 1, 37 2009 to June 30, 2010, or covering the period July 1, 2010 to June 30, 38 2011, or covering the period July 1, 2011 to June 30, 2012, or covering 39 the period July 1, 2012 to June 30, 2013, or covering the period July 1, 40 2013 to June 30, 2014, or covering the period July 1, 2014 to June 30, 41 2015, or covering the period July 1, 2015 to June 30, 2016, or covering 42 the period July 1, 2016 to June 30, 2017, or covering the period July 1, 43 2017 to June 30, 2018, or covering the period July 1, 2018 to June 30, 44 2019, or covering the period July 1, 2019 to June 30, 2020 determined in 45 accordance with paragraph (a) of this subdivision fails, refuses or 46 neglects to make payment to the provider of excess insurance coverage or 47 equivalent excess coverage in such time and manner as determined by the 48 superintendent of financial services pursuant to paragraph (b) of this 49 subdivision, excess insurance coverage or equivalent excess coverage 50 purchased for such physician or dentist in accordance with this section 51 for such coverage period shall be cancelled and shall be null and void 52 as of the first day on or after the commencement of a policy period 53 where the liability for payment pursuant to this subdivision has not 54 been met. 55 (d) Each provider of excess insurance coverage or equivalent excess 56 coverage shall notify the superintendent of financial services and theS. 1507--A 28 A. 2007--A 1 commissioner of health or their designee of each physician and dentist 2 eligible for purchase of a policy for excess insurance coverage or 3 equivalent excess coverage covering the period July 1, 1992 to June 30, 4 1993, or covering the period July 1, 1993 to June 30, 1994, or covering 5 the period July 1, 1994 to June 30, 1995, or covering the period July 1, 6 1995 to June 30, 1996, or covering the period July 1, 1996 to June 30, 7 1997, or covering the period July 1, 1997 to June 30, 1998, or covering 8 the period July 1, 1998 to June 30, 1999, or covering the period July 1, 9 1999 to June 30, 2000, or covering the period July 1, 2000 to June 30, 10 2001, or covering the period July 1, 2001 to October 29, 2001, or cover- 11 ing the period April 1, 2002 to June 30, 2002, or covering the period 12 July 1, 2002 to June 30, 2003, or covering the period July 1, 2003 to 13 June 30, 2004, or covering the period July 1, 2004 to June 30, 2005, or 14 covering the period July 1, 2005 to June 30, 2006, or covering the peri- 15 od July 1, 2006 to June 30, 2007, or covering the period July 1, 2007 to 16 June 30, 2008, or covering the period July 1, 2008 to June 30, 2009, or 17 covering the period July 1, 2009 to June 30, 2010, or covering the peri- 18 od July 1, 2010 to June 30, 2011, or covering the period July 1, 2011 to 19 June 30, 2012, or covering the period July 1, 2012 to June 30, 2013, or 20 covering the period July 1, 2013 to June 30, 2014, or covering the peri- 21 od July 1, 2014 to June 30, 2015, or covering the period July 1, 2015 to 22 June 30, 2016, or covering the period July 1, 2016 to June 30, 2017, or 23 covering the period July 1, 2017 to June 30, 2018, or covering the peri- 24 od July 1, 2018 to June 30, 2019, or covering the period July 1, 2019 to 25 June 30, 2020 that has made payment to such provider of excess insurance 26 coverage or equivalent excess coverage in accordance with paragraph (b) 27 of this subdivision and of each physician and dentist who has failed, 28 refused or neglected to make such payment. 29 (e) A provider of excess insurance coverage or equivalent excess 30 coverage shall refund to the hospital excess liability pool any amount 31 allocable to the period July 1, 1992 to June 30, 1993, and to the period 32 July 1, 1993 to June 30, 1994, and to the period July 1, 1994 to June 33 30, 1995, and to the period July 1, 1995 to June 30, 1996, and to the 34 period July 1, 1996 to June 30, 1997, and to the period July 1, 1997 to 35 June 30, 1998, and to the period July 1, 1998 to June 30, 1999, and to 36 the period July 1, 1999 to June 30, 2000, and to the period July 1, 2000 37 to June 30, 2001, and to the period July 1, 2001 to October 29, 2001, 38 and to the period April 1, 2002 to June 30, 2002, and to the period July 39 1, 2002 to June 30, 2003, and to the period July 1, 2003 to June 30, 40 2004, and to the period July 1, 2004 to June 30, 2005, and to the period 41 July 1, 2005 to June 30, 2006, and to the period July 1, 2006 to June 42 30, 2007, and to the period July 1, 2007 to June 30, 2008, and to the 43 period July 1, 2008 to June 30, 2009, and to the period July 1, 2009 to 44 June 30, 2010, and to the period July 1, 2010 to June 30, 2011, and to 45 the period July 1, 2011 to June 30, 2012, and to the period July 1, 2012 46 to June 30, 2013, and to the period July 1, 2013 to June 30, 2014, and 47 to the period July 1, 2014 to June 30, 2015, and to the period July 1, 48 2015 to June 30, 2016, to the period July 1, 2016 to June 30, 2017, and 49 to the period July 1, 2017 to June 30, 2018, and to the period July 1, 50 2018 to June 30, 2019, and to the period July 1, 2019 to June 30, 2020 51 received from the hospital excess liability pool for purchase of excess 52 insurance coverage or equivalent excess coverage covering the period 53 July 1, 1992 to June 30, 1993, and covering the period July 1, 1993 to 54 June 30, 1994, and covering the period July 1, 1994 to June 30, 1995, 55 and covering the period July 1, 1995 to June 30, 1996, and covering the 56 period July 1, 1996 to June 30, 1997, and covering the period July 1,S. 1507--A 29 A. 2007--A 1 1997 to June 30, 1998, and covering the period July 1, 1998 to June 30, 2 1999, and covering the period July 1, 1999 to June 30, 2000, and cover- 3 ing the period July 1, 2000 to June 30, 2001, and covering the period 4 July 1, 2001 to October 29, 2001, and covering the period April 1, 2002 5 to June 30, 2002, and covering the period July 1, 2002 to June 30, 2003, 6 and covering the period July 1, 2003 to June 30, 2004, and covering the 7 period July 1, 2004 to June 30, 2005, and covering the period July 1, 8 2005 to June 30, 2006, and covering the period July 1, 2006 to June 30, 9 2007, and covering the period July 1, 2007 to June 30, 2008, and cover- 10 ing the period July 1, 2008 to June 30, 2009, and covering the period 11 July 1, 2009 to June 30, 2010, and covering the period July 1, 2010 to 12 June 30, 2011, and covering the period July 1, 2011 to June 30, 2012, 13 and covering the period July 1, 2012 to June 30, 2013, and covering the 14 period July 1, 2013 to June 30, 2014, and covering the period July 1, 15 2014 to June 30, 2015, and covering the period July 1, 2015 to June 30, 16 2016, and covering the period July 1, 2016 to June 30, 2017, and cover- 17 ing the period July 1, 2017 to June 30, 2018, and covering the period 18 July 1, 2018 to June 30, 2019, and covering the period July 1, 2019 to 19 June 30, 2020 for a physician or dentist where such excess insurance 20 coverage or equivalent excess coverage is cancelled in accordance with 21 paragraph (c) of this subdivision. 22 § 4. Section 40 of chapter 266 of the laws of 1986, amending the civil 23 practice law and rules and other laws relating to malpractice and 24 professional medical conduct, as amended by section 4 of part M of chap- 25 ter 57 of the laws of 2018, is amended to read as follows: 26 § 40. The superintendent of financial services shall establish rates 27 for policies providing coverage for physicians and surgeons medical 28 malpractice for the periods commencing July 1, 1985 and ending June 30, 29 [2019;] 2020; provided, however, that notwithstanding any other 30 provision of law, the superintendent shall not establish or approve any 31 increase in rates for the period commencing July 1, 2009 and ending June 32 30, 2010. The superintendent shall direct insurers to establish segre- 33 gated accounts for premiums, payments, reserves and investment income 34 attributable to such premium periods and shall require periodic reports 35 by the insurers regarding claims and expenses attributable to such peri- 36 ods to monitor whether such accounts will be sufficient to meet incurred 37 claims and expenses. On or after July 1, 1989, the superintendent shall 38 impose a surcharge on premiums to satisfy a projected deficiency that is 39 attributable to the premium levels established pursuant to this section 40 for such periods; provided, however, that such annual surcharge shall 41 not exceed eight percent of the established rate until July 1, [2019,] 42 2020, at which time and thereafter such surcharge shall not exceed twen- 43 ty-five percent of the approved adequate rate, and that such annual 44 surcharges shall continue for such period of time as shall be sufficient 45 to satisfy such deficiency. The superintendent shall not impose such 46 surcharge during the period commencing July 1, 2009 and ending June 30, 47 2010. On and after July 1, 1989, the surcharge prescribed by this 48 section shall be retained by insurers to the extent that they insured 49 physicians and surgeons during the July 1, 1985 through June 30, [2019] 50 2020 policy periods; in the event and to the extent physicians and 51 surgeons were insured by another insurer during such periods, all or a 52 pro rata share of the surcharge, as the case may be, shall be remitted 53 to such other insurer in accordance with rules and regulations to be 54 promulgated by the superintendent. Surcharges collected from physicians 55 and surgeons who were not insured during such policy periods shall be 56 apportioned among all insurers in proportion to the premium written byS. 1507--A 30 A. 2007--A 1 each insurer during such policy periods; if a physician or surgeon was 2 insured by an insurer subject to rates established by the superintendent 3 during such policy periods, and at any time thereafter a hospital, 4 health maintenance organization, employer or institution is responsible 5 for responding in damages for liability arising out of such physician's 6 or surgeon's practice of medicine, such responsible entity shall also 7 remit to such prior insurer the equivalent amount that would then be 8 collected as a surcharge if the physician or surgeon had continued to 9 remain insured by such prior insurer. In the event any insurer that 10 provided coverage during such policy periods is in liquidation, the 11 property/casualty insurance security fund shall receive the portion of 12 surcharges to which the insurer in liquidation would have been entitled. 13 The surcharges authorized herein shall be deemed to be income earned for 14 the purposes of section 2303 of the insurance law. The superintendent, 15 in establishing adequate rates and in determining any projected defi- 16 ciency pursuant to the requirements of this section and the insurance 17 law, shall give substantial weight, determined in his discretion and 18 judgment, to the prospective anticipated effect of any regulations 19 promulgated and laws enacted and the public benefit of stabilizing 20 malpractice rates and minimizing rate level fluctuation during the peri- 21 od of time necessary for the development of more reliable statistical 22 experience as to the efficacy of such laws and regulations affecting 23 medical, dental or podiatric malpractice enacted or promulgated in 1985, 24 1986, by this act and at any other time. Notwithstanding any provision 25 of the insurance law, rates already established and to be established by 26 the superintendent pursuant to this section are deemed adequate if such 27 rates would be adequate when taken together with the maximum authorized 28 annual surcharges to be imposed for a reasonable period of time whether 29 or not any such annual surcharge has been actually imposed as of the 30 establishment of such rates. 31 § 5. Section 5 and subdivisions (a) and (e) of section 6 of part J of 32 chapter 63 of the laws of 2001, amending chapter 266 of the laws of 33 1986, amending the civil practice law and rules and other laws relating 34 to malpractice and professional medical conduct, relating to the effec- 35 tiveness of certain provisions of such chapter, as amended by section 5 36 of part M of chapter 57 of the laws of 2018, are amended to read as 37 follows: 38 § 5. The superintendent of financial services and the commissioner of 39 health shall determine, no later than June 15, 2002, June 15, 2003, June 40 15, 2004, June 15, 2005, June 15, 2006, June 15, 2007, June 15, 2008, 41 June 15, 2009, June 15, 2010, June 15, 2011, June 15, 2012, June 15, 42 2013, June 15, 2014, June 15, 2015, June 15, 2016, June 15, 2017, June 43 15, 2018, [and] June 15, 2019, and June 15, 2020 the amount of funds 44 available in the hospital excess liability pool, created pursuant to 45 section 18 of chapter 266 of the laws of 1986, and whether such funds 46 are sufficient for purposes of purchasing excess insurance coverage for 47 eligible participating physicians and dentists during the period July 1, 48 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 1, 2003 49 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 2005 to 50 June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 to June 51 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to June 30, 52 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 30, 53 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30, 54 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30, 55 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30,S. 1507--A 31 A. 2007--A 1 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30, 2020 2 as applicable. 3 (a) This section shall be effective only upon a determination, pursu- 4 ant to section five of this act, by the superintendent of financial 5 services and the commissioner of health, and a certification of such 6 determination to the state director of the budget, the chair of the 7 senate committee on finance and the chair of the assembly committee on 8 ways and means, that the amount of funds in the hospital excess liabil- 9 ity pool, created pursuant to section 18 of chapter 266 of the laws of 10 1986, is insufficient for purposes of purchasing excess insurance cover- 11 age for eligible participating physicians and dentists during the period 12 July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 2003, or July 13 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 2005, or July 1, 14 2005 to June 30, 2006, or July 1, 2006 to June 30, 2007, or July 1, 2007 15 to June 30, 2008, or July 1, 2008 to June 30, 2009, or July 1, 2009 to 16 June 30, 2010, or July 1, 2010 to June 30, 2011, or July 1, 2011 to June 17 30, 2012, or July 1, 2012 to June 30, 2013, or July 1, 2013 to June 30, 18 2014, or July 1, 2014 to June 30, 2015, or July 1, 2015 to June 30, 19 2016, or July 1, 2016 to June 30, 2017, or July 1, 2017 to June 30, 20 2018, or July 1, 2018 to June 30, 2019, or July 1, 2019 to June 30, 2020 21 as applicable. 22 (e) The commissioner of health shall transfer for deposit to the 23 hospital excess liability pool created pursuant to section 18 of chapter 24 266 of the laws of 1986 such amounts as directed by the superintendent 25 of financial services for the purchase of excess liability insurance 26 coverage for eligible participating physicians and dentists for the 27 policy year July 1, 2001 to June 30, 2002, or July 1, 2002 to June 30, 28 2003, or July 1, 2003 to June 30, 2004, or July 1, 2004 to June 30, 29 2005, or July 1, 2005 to June 30, 2006, or July 1, 2006 to June 30, 30 2007, as applicable, and the cost of administering the hospital excess 31 liability pool for such applicable policy year, pursuant to the program 32 established in chapter 266 of the laws of 1986, as amended, no later 33 than June 15, 2002, June 15, 2003, June 15, 2004, June 15, 2005, June 34 15, 2006, June 15, 2007, June 15, 2008, June 15, 2009, June 15, 2010, 35 June 15, 2011, June 15, 2012, June 15, 2013, June 15, 2014, June 15, 36 2015, June 15, 2016, June 15, 2017, June 15, 2018, [and] June 15, 2019, 37 and June 15, 2020 as applicable. 38 § 6. Section 20 of part H of chapter 57 of the laws of 2017, amending 39 the New York Health Care Reform Act of 1996 and other laws relating to 40 extending certain provisions thereto, as amended by section 6 of part M 41 of chapter 57 of the laws of 2018, is amended to read as follows: 42 § 20. Notwithstanding any law, rule or regulation to the contrary, 43 only physicians or dentists who were eligible, and for whom the super- 44 intendent of financial services and the commissioner of health, or their 45 designee, purchased, with funds available in the hospital excess liabil- 46 ity pool, a full or partial policy for excess coverage or equivalent 47 excess coverage for the coverage period ending the thirtieth of June, 48 two thousand [eighteen,] nineteen, shall be eligible to apply for such 49 coverage for the coverage period beginning the first of July, two thou- 50 sand [eighteen;] nineteen; provided, however, if the total number of 51 physicians or dentists for whom such excess coverage or equivalent 52 excess coverage was purchased for the policy year ending the thirtieth 53 of June, two thousand [eighteen] nineteen exceeds the total number of 54 physicians or dentists certified as eligible for the coverage period 55 beginning the first of July, two thousand [eighteen,] nineteen, then the 56 general hospitals may certify additional eligible physicians or dentistsS. 1507--A 32 A. 2007--A 1 in a number equal to such general hospital's proportional share of the 2 total number of physicians or dentists for whom excess coverage or 3 equivalent excess coverage was purchased with funds available in the 4 hospital excess liability pool as of the thirtieth of June, two thousand 5 [eighteen,] nineteen, as applied to the difference between the number of 6 eligible physicians or dentists for whom a policy for excess coverage or 7 equivalent excess coverage was purchased for the coverage period ending 8 the thirtieth of June, two thousand [eighteen] nineteen and the number 9 of such eligible physicians or dentists who have applied for excess 10 coverage or equivalent excess coverage for the coverage period beginning 11 the first of July, two thousand [eighteen] nineteen. 12 § 7. This act shall take effect immediately and shall be deemed to 13 have been in full force and effect on and after April 1, 2019. 14 PART G 15 Section 1. Paragraph (a) of subdivision 3 of section 366 of the social 16 services law is REPEALED and a new paragraph (a) is added to read as 17 follows: 18 (a) Medical assistance shall be furnished without consideration of the 19 income and resources of an applicant's legally responsible relative if 20 the applicant's eligibility would normally be determined by comparing 21 the amount of available income and/or resources of the applicant, 22 including amounts deemed available to the applicant from legally respon- 23 sible relatives, to an applicable eligibility standard, and: 24 (1) (i) the legally responsible relative is a community spouse, as 25 defined in section three hundred sixty-six-c of this title; 26 (ii) such relative is refusing to make his or her income and/or 27 resources available to meet the cost of necessary medical care, 28 services, and supplies; and 29 (iii) the applicant executes an assignment of support from the commu- 30 nity spouse in favor of the social services district and the department, 31 unless the applicant is unable to execute such assignment due to phys- 32 ical or mental impairment or to deny assistance would create an undue 33 hardship, as defined by the commissioner; or 34 (2) the legally responsible relative is absent from the applicant's 35 household, and fails or refuses to make his or her income and/or 36 resources available to meet the cost of necessary medical care, 37 services, and supplies. 38 In such cases, however, the furnishing of such assistance shall create 39 an implied contract with such relative, and the cost thereof may be 40 recovered from such relative in accordance with title six of article 41 three of this chapter and other applicable provisions of law. 42 § 2. Paragraphs (c), (d), (e), (f), (g), and (h) of subdivision 4-a 43 and subdivision 4-c of section 365-f of the social services law are 44 REPEALED, and paragraph (i) of subdivision 4-a is relettered paragraph 45 (c). 46 Section 3. Subdivision 4-a of section 365-f of the social services law 47 is redesignated as subdivision 5, and subparagraph (i) of paragraph (a) 48 of such subdivision is amended as follows: 49 [4-a] 5. Fiscal intermediary services. (a) For the purposes of this 50 section: 51 (i) "Fiscal intermediary" means an entity that provides fiscal inter- 52 mediary services and has a contract for providing such services with[:53(A) a local department of social services;S. 1507--A 33 A. 2007--A 1(B) an organization licensed under article forty-four of the public2health law; or3(C) an accountable care organization certified under article twenty-4nine-E of the public health law or an integrated delivery system5composed primarily of health care providers recognized by the department6as a performing provider system under the delivery system reform incen-7tive payment program] the department of health and is selected through 8 the procurement process described in paragraph (b) of this subdivision, 9 or by authorization upon application in accordance with such criteria as 10 the department may develop together with such other forms and informa- 11 tion prescribed by, or acceptable to, the commissioner. Eligible appli- 12 cants for authorization under this paragraph are limited to entities 13 that: 14 (A) are a service center for independent living under section one 15 thousand one hundred twenty-one of the education law; or 16 (B) have a history of providing fiscal intermediary services for 17 persons with disabilities, as demonstrated by having a continuous histo- 18 ry of arrangements with local departments of social services beginning 19 no later than January first, two thousand twelve. 20 § 4. Paragraph (b) of subdivision 4-a, redesignated as subdivision 5 21 pursuant to section 3 of this Part, of section 365-f of the social 22 services law is amended as follows: 23 (b) [No entity shall provide, directly or through contract, fiscal24intermediary services without an authorization as a fiscal intermediary25issued by the commissioner in accordance with this subdivision] Notwith- 26 standing any inconsistent provision of sections one hundred twelve and 27 one hundred sixty-three of the state finance law, or section one hundred 28 forty-two of the economic development law, or any other law, the commis- 29 sioner is authorized to enter into a contract or contracts under this 30 subdivision with an entity or entities without a competitive bid or 31 request for proposal process, provided, however, that: 32 (i) the department shall post on its website, for a period of no less 33 than thirty days: 34 (A) a description of the proposed services to be provided pursuant to 35 the contract or contracts; 36 (B) the criteria for selection of a contractor or contractors; 37 (C) the period of time during which a prospective contractor may seek 38 selection, which shall be no less than thirty days after such informa- 39 tion is first posted on the website; and 40 (D) the manner by which a prospective contractor may seek such 41 selection, which may include submission by electronic means; 42 (ii) all reasonable and responsive submissions that are received from 43 prospective contractors in timely fashion shall be reviewed by the 44 commissioner; and 45 (iii) the commissioner shall select such contractor or contractors 46 that, in the commissioner's discretion, are best suited to serve the 47 purposes of this section. 48 § 5. Subdivision 4-b of section 365-f of the social services law is 49 REPEALED and current subdivisions 5, 6, 7, 8 and 9 are redesigned as 50 subdivisions 6, 7, 8, 9, and 10. 51 § 6. This act shall take effect immediately and shall be deemed to 52 have been in full force and effect on and after April 1, 2019; provided 53 however, that sections three, four, and five of this act shall take 54 effect January 1, 2020. 55 PART HS. 1507--A 34 A. 2007--A 1 Section 1. Subparagraph (v) of paragraph (b) of subdivision 5-b of 2 section 2807-k of the public health law is REPEALED. 3 § 2. Section 2807 of the public health law is amended by adding a new 4 subdivision 20-a to read as follows: 5 20-a. Notwithstanding any provision of law to the contrary, the 6 commissioners of the department of health, the office of mental health, 7 the office of people with developmental disabilities, and the office of 8 alcoholism and substance abuse services are authorized to waive any 9 regulatory requirements as are necessary, consistent with applicable 10 law, to allow providers that are involved in DSRIP projects or repli- 11 cation and scaling activities, as approved by the authorizing commis- 12 sioner, to avoid duplication of requirements and to allow the efficient 13 scaling and replication of DSRIP promising practices, as determined by 14 the authorizing commissioner; provided however, that regulations 15 pertaining to patient safety may not be waived, nor shall any regu- 16 lations be waived if such waiver would risk patient safety. 17 § 3. Subparagraph (i) of paragraph (e-1) of subdivision 4 of section 18 2807-c of the public health law, as amended by section 29 of part C of 19 chapter 60 of the laws of 2014, is amended to read as follows: 20 (i) For rate periods on and after April first, two thousand ten, the 21 commissioner, in consultation with the commissioner of the office of 22 mental health, shall promulgate regulations, and may promulgate emergen- 23 cy regulations, establishing methodologies for determining the operating 24 cost components of rates of payments for services described in this 25 paragraph. Such regulations shall utilize two thousand five operating 26 costs as submitted to the department prior to July first, two thousand 27 nine and [shall] may provide for methodologies establishing per diem 28 inpatient rates that utilize case mix adjustment mechanisms. Such regu- 29 lations [shall] may contain criteria for adjustments based on length of 30 stay and may also provide for a base year update, provided, however, 31 that such base year update shall take effect no earlier than April 32 first, two thousand fifteen, and provided further, however, that the 33 commissioner may make such adjustments to such utilization and to the 34 methodology for computing such rates as is necessary to achieve no 35 aggregate, net growth in overall Medicaid expenditures related to such 36 rates, as compared to such aggregate expenditures from the prior year. 37 In determining the updated base year to be utilized pursuant to this 38 subparagraph, the commissioner shall take into account the base year 39 determined in accordance with paragraph (c) of subdivision thirty-five 40 of this section. 41 § 4. Subdivision 35 of section 2807-c of the public health law is 42 amended by adding a new paragraph (k) to read as follows: 43 (k) Notwithstanding any contrary provision of law, the commissioner 44 may make such adjustments to general hospital inpatient rates and to the 45 methodology for computing such rates as is necessary to reduce payments 46 to facilities with a higher percentage of potentially avoidable inpa- 47 tient services by instituting lower inpatient payment rates for both 48 fee-for-service and managed care to incentivize the provision of preven- 49 tative care to reduce preventable events and overall inpatient costs. A 50 portion of such savings derived from the implementation of such payment 51 methodologies shall be reinvested in initiatives to incentivize the 52 provision of preventative care, maternity services, and other ambulatory 53 care services to reduce preventable health care costs. 54 § 5. Social Services Law section 367-u, as amended by chapter 6 of the 55 laws of 2015, is amended to read as follows:S. 1507--A 35 A. 2007--A 1 § 367-u. Payment for home telehealth services. 1. Subject to the 2 approval of the state director of the budget, the commissioner may 3 authorize the payment of medical assistance funds for demonstration 4 rates or fees established for home telehealth services provided pursuant 5 to subdivision three-c of section thirty-six hundred fourteen of the 6 public health law. 7 2. Subject to federal financial participation and the approval of the 8 director of the budget, the commissioner shall not exclude from the 9 payment of medical assistance funds the delivery of health care services 10 through telehealth, as defined in subdivision four of section two thou- 11 sand nine hundred ninety-nine-cc of the public health law; provided, 12 however, for telehealth services provided to individuals dually enrolled 13 in Medicaid and Medicare, the commissioner is authorized to promulgate 14 regulations governing Medicaid coverage and reimbursement of such 15 services, including development of a covered services list which may be 16 limited to higher priority services and procedures. Such services shall 17 meet the requirements of federal law, rules and regulations for the 18 provision of medical assistance pursuant to this title. 19 § 6. Subdivision 5-d of section 2807-k of the public health law, as 20 amended by chapter 57 of the laws of 28, is amended to read as follows. 21 5-d. (a) Notwithstanding any inconsistent provision of this section, 22 section twenty-eight hundred seven-w of this article or any other 23 contrary provision of law, and subject to the availability of federal 24 financial participation, for periods on and after January first, two 25 thousand thirteen, through March thirty-first, two thousand [twenty] 26 twenty-one, all funds available for distribution pursuant to this 27 section, except for funds distributed pursuant to subparagraph (v) of 28 paragraph (b) of subdivision five-b of this section, and all funds 29 available for distribution pursuant to section twenty-eight hundred 30 seven-w of this article, shall be reserved and set aside and distributed 31 in accordance with the provisions of this subdivision. 32 (b) The commissioner shall promulgate regulations, and may promulgate 33 emergency regulations, establishing methodologies for the distribution 34 of funds as described in paragraph (a) of this subdivision and such 35 regulations shall include, but not be limited to, the following: 36 (i) Such regulations shall establish methodologies for determining 37 each facility's relative uncompensated care need amount based on unin- 38 sured inpatient and outpatient units of service from the cost reporting 39 year two years prior to the distribution year, multiplied by the appli- 40 cable medicaid rates in effect January first of the distribution year, 41 as summed and adjusted by a statewide cost adjustment factor and reduced 42 by the sum of all payment amounts collected from such uninsured 43 patients, and as further adjusted by application of a nominal need 44 computation that shall take into account each facility's medicaid inpa- 45 tient share. 46 (ii) Annual distributions pursuant to such regulations for the two 47 thousand thirteen through two thousand [nineteen] twenty calendar years 48 shall be in accord with the following: 49 (A) one hundred thirty-nine million four hundred thousand dollars 50 shall be distributed as Medicaid Disproportionate Share Hospital ("DSH") 51 payments to major public general hospitals; and 52 (B) [nine hundred ninety-four] seven hundred nineteen million [nine] 53 four hundred thousand dollars as Medicaid DSH payments to eligible 54 general hospitals, other than major public general hospitals; and 55 (C) provided, however, that notwithstanding any inconsistent provision 56 of this section, for all calendar years beginning on January first, twoS. 1507--A 36 A. 2007--A 1 thousand twenty, general hospitals located in a city with a population 2 of more than one million persons and/or in the counties of Westchester, 3 Suffolk and Nassau, that have, or that that are part of a system of 4 co-established general hospitals that collectively has, and average 5 operating margin greater than 2.98 where average operating margin is 6 calculated by subtracting total operating expenses from total operating 7 revenue and dividing the result by the total operating revenue, and that 8 also have, or that that are part of a system of co-established general 9 hospitals that collectively has, a net operating income of more than 10 sixty-eight million dollars, both as determined by the department pursu- 11 ant to the hospital institutional cost reports for year two thousand 12 seventeen, shall only be eligible for indigent care pool payments of a 13 maximum of ten thousand dollars. 14 (iii)(A) Such regulations shall establish transition adjustments to 15 the distributions made pursuant to clauses (A) and (B) of subparagraph 16 (ii) of this paragraph such that no facility experiences a reduction in 17 indigent care pool payments pursuant to this subdivision that is greater 18 than the percentages, as specified in clause (C) of this subparagraph as 19 compared to the average distribution that each such facility received 20 for the three calendar years prior to two thousand thirteen pursuant to 21 this section and section twenty-eight hundred seven-w of this article. 22 (B) Such regulations shall also establish adjustments limiting the 23 increases in indigent care pool payments experienced by facilities 24 pursuant to this subdivision by an amount that will be, as determined by 25 the commissioner and in conjunction with such other funding as may be 26 available for this purpose, sufficient to ensure full funding for the 27 transition adjustment payments authorized by clause (A) of this subpara- 28 graph. 29 (C) No facility shall experience a reduction in indigent care pool 30 payments pursuant to this subdivision that: for the calendar year begin- 31 ning January first, two thousand thirteen, is greater than two and one- 32 half percent; for the calendar year beginning January first, two thou- 33 sand fourteen, is greater than five percent; and, for the calendar year 34 beginning on January first, two thousand fifteen; is greater than seven 35 and one-half percent, and for the calendar year beginning on January 36 first, two thousand sixteen, is greater than ten percent; and for the 37 calendar year beginning on January first, two thousand seventeen, is 38 greater than twelve and one-half percent; and for the calendar year 39 beginning on January first, two thousand eighteen, is greater than 40 fifteen percent; and for the calendar year beginning on January first, 41 two thousand nineteen, is greater than seventeen and one-half percent. 42 (iv) Such regulations shall reserve one percent of the funds available 43 for distribution in the two thousand fourteen and two thousand fifteen 44 calendar years, and for calendar years thereafter, pursuant to this 45 subdivision, subdivision fourteen-f of section twenty-eight hundred 46 seven-c of this article, and sections two hundred eleven and two hundred 47 twelve of chapter four hundred seventy-four of the laws of nineteen 48 hundred ninety-six, in a "financial assistance compliance pool" and 49 shall establish methodologies for the distribution of such pool funds to 50 facilities based on their level of compliance, as determined by the 51 commissioner, with the provisions of subdivision nine-a of this section. 52 (c) The commissioner shall annually report to the governor and the 53 legislature on the distribution of funds under this subdivision includ- 54 ing, but not limited to: 55 (i) the impact on safety net providers, including community providers, 56 rural general hospitals and major public general hospitals;S. 1507--A 37 A. 2007--A 1 (ii) the provision of indigent care by units of services and funds 2 distributed by general hospitals; and 3 (iii) the extent to which access to care has been enhanced. 4 § 7. This act shall take effect immediately. 5 PART I 6 Section 1. The insurance law is amended by adding a new article 29 to 7 read as follows: 8 ARTICLE 29 9 PHARMACY BENEFIT MANAGERS 10 Section 2901. Definitions. 11 2902. Acting without a registration. 12 2903. Registration requirements for pharmacy benefit managers. 13 2904. Reporting requirements for pharmacy benefit managers. 14 2905. Acting without a license. 15 2906. Licensing of a pharmacy benefit manager. 16 2907. Revocation or suspension of a registration or license of a 17 pharmacy benefit manager. 18 2908. Penalties for violations. 19 2909. Stay or suspension of superintendent's determination. 20 2910. Revoked registration or licenses. 21 2911. Change of address. 22 2912. Applicability of other laws. 23 2913. Assessments. 24 § 2901. Definitions. For purposes of this article: 25 (a) "Controlling person" is any person or other entity who or which 26 directly or indirectly has the power to direct or cause to be directed 27 the management, control or activities of a pharmacy benefit manager. 28 (b) "Health insurer" means an insurance company authorized in this 29 state to write accident and health insurance, a company organized pursu- 30 ant to article forty-three of this chapter, a municipal cooperative 31 health benefit plan established pursuant to article forty-seven of this 32 chapter, an organization certified pursuant to article forty-four of the 33 public health law, an institution of higher education certified pursuant 34 to section one thousand one hundred twenty-four of this chapter, or the 35 New York state health insurance plan established under article eleven of 36 the civil service law. 37 (c) "Pharmacy benefit management services" means directly or through 38 an intermediary, managing the prescription drug coverage provided by a 39 health insurer under a contract or policy delivered or issued for deliv- 40 ery in this state or a plan subject to section three hundred 41 sixty-four-j of the social services law, including the processing and 42 payment of claims for prescription drugs, the performance of drug utili- 43 zation review, the processing of drug prior authorization requests, the 44 adjudication of appeals or grievances related to prescription drug 45 coverage, contracting with network pharmacies, negotiation of rebates, 46 and controlling the cost of covered prescription drugs. 47 (d) "Pharmacy benefit manager" means a person, firm, association, 48 corporation or other entity that, pursuant to a contract with a health 49 insurer provides pharmacy benefit management services, except that term 50 shall not include: 51 (1) an officer or employee of a registered or licensed pharmacy bene- 52 fit manager; or 53 (2) a health insurer, or any manager thereof, individual or corporate, 54 or any officer, director or regular salaried employee thereof, providingS. 1507--A 38 A. 2007--A 1 pharmacy benefit management services under a policy or contract issued 2 by the health insurer. 3 § 2902. Acting without a registration. (a) No person, firm, associ- 4 ation, corporation or other entity may act as a pharmacy benefits manag- 5 er prior to January first, two thousand twenty without having a valid 6 registration as a pharmacy benefit manager filed with the superintendent 7 in accordance with this article and any regulations promulgated there- 8 under. 9 (b) Prior to January first, two thousand twenty, no health insurer may 10 pay any fee or other compensation to any person, firm, association, 11 corporation or other entity for performing pharmacy benefit management 12 services unless the person, firm, association, corporation or other 13 entity is registered as a pharmacy benefit manager in accordance with 14 this article. 15 (c) Any person, firm, association, corporation or other entity that 16 violates this section shall, in addition to any other penalty provided 17 by law, be liable for restitution to any insurer or insured harmed by 18 the violation and shall also be subject to a penalty of the greater of 19 (1) one thousand dollars for the first violation and two thousand five 20 hundred dollars for each subsequent violation or (2) the aggregate 21 economic gross receipts attributable to all violations. 22 § 2903. Registration requirements for pharmacy benefit managers. (a) 23 Every pharmacy benefit manager that performs pharmacy benefit management 24 services prior to January first, two thousand twenty-one shall register 25 with the superintendent in a manner acceptable to the superintendent, 26 and shall pay a fee of one thousand dollars for each year or fraction of 27 a year in which the registration shall be valid. The superintendent, in 28 consultation with the commissioner of health, may establish, by regu- 29 lation, minimum registration standards required for a pharmacy benefit 30 manager. The superintendent can reject a registration application filed 31 by a pharmacy benefit manager that fails to comply with the minimum 32 registration standards. 33 (b) For each business entity, the officer or officers and director or 34 directors named in the application shall be designated responsible for 35 the business entity's compliance with the financial services and insur- 36 ance laws, rules and regulations of this state. 37 (c) Every registration will expire on December thirty-first, two thou- 38 sand twenty regardless of when registration was first made. 39 (d) Every pharmacy benefit manager that performs pharmacy benefit 40 management services at any time between January first, two thousand 41 nineteen and June first, two thousand nineteen, shall make the registra- 42 tion and fee payment required by subsection (a) of this section on or 43 before June first, two thousand nineteen. Any other pharmacy benefit 44 manager shall make the registration and fee payment required by 45 subsection (a) of this section prior to performing pharmacy benefit 46 management services. 47 (e) Registrants under this section shall be subject to examination by 48 the superintendent as often as the superintendent may deem it necessary. 49 The superintendent may promulgate regulations establishing methods and 50 procedures for facilitating and verifying compliance with the require- 51 ments of this article and such other regulations as necessary to enforce 52 the provisions of this article. 53 § 2904. Reporting requirements for pharmacy benefit managers. (a)(1) 54 On or before July first of each year, beginning in two thousand twenty, 55 every pharmacy benefit manager shall report to the superintendent, in a 56 statement subscribed and affirmed as true under penalties of perjury,S. 1507--A 39 A. 2007--A 1 the information requested by the superintendent including, without limi- 2 tation, disclosure of any financial incentive or benefit for promoting 3 the use of certain drugs and other financial arrangements affecting 4 health insurers or their policyholders or insureds and any information 5 relating to the business, financial condition, or market conduct of the 6 pharmacy benefit manager. The superintendent also may require the filing 7 of quarterly or other statements, which shall be in such form and shall 8 contain such matters as the superintendent shall prescribe. 9 (2) The superintendent also may address to any pharmacy benefit manag- 10 er or its officers any inquiry in relation to its provision of pharmacy 11 benefit management services or any matter connected therewith. Every 12 pharmacy benefit manager or person so addressed shall reply in writing 13 to such inquiry promptly and truthfully, and such reply shall be, if 14 required by the superintendent, subscribed by such individual, or by 15 such officer or officers of the pharmacy benefit manager, as the super- 16 intendent shall designate, and affirmed by them as true under the penal- 17 ties of perjury. 18 (b) In the event any pharmacy benefit manager or person does not 19 submit the report required by paragraph one of subsection (a) of this 20 section or does not provide a good faith response to an inquiry from the 21 superintendent pursuant to paragraph two of subsection (a) of this 22 section within a time period specified by the superintendent of not less 23 than fifteen business days, the superintendent is authorized to levy a 24 civil penalty, after notice and hearing, against such pharmacy benefit 25 manager or person not to exceed five hundred dollars per day for each 26 day beyond the date the report is due or the date specified by the 27 superintendent for response to the inquiry. 28 (c) All information disclosed by a pharmacy benefit manager shall be 29 deemed confidential and not subject to disclosure unless the superinten- 30 dent determines that such disclosure is in the public interest, or is 31 necessary to carry out this article or to allow the department to 32 perform examinations or investigations authorized by law. 33 § 2905. Acting without a license. (a) No person, firm, association, 34 corporation or other entity may act as a pharmacy benefit manager on or 35 after January first, two thousand twenty-one without having authority to 36 do so by virtue of a license issued in force pursuant to the provisions 37 of this article. 38 (b) No health insurer may pay any fee or other compensation to any 39 person, firm, association, corporation or other entity for performing 40 pharmacy benefit management services on or after January first, two 41 thousand twenty-one unless the person, firm, association, corporation or 42 other entity is licensed as a pharmacy benefit manager in accordance 43 with this article. 44 (c) Any person, firm, association, corporation or other entity that 45 violates this section shall, in addition to any other penalty provided 46 by law, be subject to a penalty of the greater of (1) one thousand 47 dollars for the first violation and two thousand five hundred dollars 48 for each subsequent violation or (2) the aggregate gross receipts 49 attributable to all violations. 50 § 2906. Licensing of a pharmacy benefit manager. (a) The superinten- 51 dent may issue a pharmacy benefit manager's license to any person, firm, 52 association or corporation who or that has complied with the require- 53 ments of this article, including regulations promulgated by the super- 54 intendent. The superintendent, in consultation with the commissioner of 55 health, may establish, by regulation, minimum standards for the issuance 56 of a license to a pharmacy benefit manager.S. 1507--A 40 A. 2007--A 1 (b) The minimum standards established under this subsection may 2 address, without limitation: 3 (1) conflicts of interest between pharmacy benefit managers and health 4 insurers; 5 (2) deceptive practices in connection with the performance of pharmacy 6 benefit management services; 7 (3) anti-competitive practices in connection with the performance of 8 pharmacy benefit management services; 9 (4) unfair claims practices in connection with the performance of 10 pharmacy benefit management services; and 11 (5) protection of consumers. 12 (c)(1) Any such license issued to a firm or association shall author- 13 ize all of the members of the firm or association and any designated 14 employees to act as pharmacy benefit managers under the license, and all 15 such persons shall be named in the application and supplements thereto. 16 (2) Any such license issued to a corporation shall authorize all of 17 the officers and any designated employees and directors thereof to act 18 as pharmacy benefit managers on behalf of such corporation, and all such 19 persons shall be named in the application and supplements thereto. 20 (3) For each business entity, the officer or officers and director or 21 directors named in the application shall be designated responsible for 22 the business entity's compliance with the insurance laws, rules and 23 regulations of this state. 24 (d)(1) Before a pharmacy benefit manager's license shall be issued or 25 renewed, the prospective licensee shall properly file in the office of 26 the superintendent a written application therefor in such form or forms 27 and supplements thereto as the superintendent prescribes, and pay a fee 28 of one thousand dollars for each year or fraction of a year in which a 29 license shall be valid. 30 (2) Every pharmacy benefit manager's license issued to a business 31 entity pursuant to this section shall expire on the thirtieth day of 32 November of even-numbered years. Every license issued pursuant to this 33 section to an individual pharmacy benefit manager who was born in an 34 odd-numbered year, shall expire on the individual's birthday in each 35 odd-numbered year. Every license issued pursuant to this section to an 36 individual pharmacy benefit manager who was born in an even-numbered 37 year, shall expire on the individual's birthday in each even-numbered 38 year. Every license issued pursuant to this section may be renewed for 39 the ensuing period of twenty-four months upon the filing of an applica- 40 tion in conformity with this subsection. 41 (e)(1) If an application for a renewal license shall have been filed 42 with the superintendent before October first of the year of expiration, 43 then the license sought to be renewed shall continue in full force and 44 effect either until the issuance by the superintendent of the renewal 45 license applied for or until five days after the superintendent shall 46 have refused to issue such renewal license and given notice of such 47 refusal to the applicant. 48 (2) Before refusing to renew any license pursuant to this section for 49 which a renewal application has been filed pursuant to paragraph one of 50 this subsection, the superintendent shall notify the applicant of the 51 superintendent's intention to do so and shall give such applicant a 52 hearing. 53 (f) The superintendent may refuse to issue a pharmacy benefit manag- 54 er's license if, in the superintendent's judgment, the applicant or any 55 member, principal, officer or director of the applicant, is not trust- 56 worthy and competent to act as or in connection with a pharmacy benefitS. 1507--A 41 A. 2007--A 1 manager, or that any of the foregoing has given cause for revocation or 2 suspension of such license, or has failed to comply with any prerequi- 3 site for the issuance of such license. 4 (g) Licensees and applicants for a license under this section shall be 5 subject to examination by the superintendent as often as the superinten- 6 dent may deem it expedient. The superintendent may promulgate regu- 7 lations establishing methods and procedures for facilitating and verify- 8 ing compliance with the requirements of this section and such other 9 regulations as necessary. 10 (h) The superintendent may issue a replacement for a currently 11 in-force license that has been lost or destroyed. Before the replacement 12 license shall be issued, there shall be on file in the office of the 13 superintendent a written application for the replacement license, 14 affirming under penalty of perjury that the original license has been 15 lost or destroyed, together with a fee of one hundred dollars. 16 § 2907. Revocation or suspension of a registration or license of a 17 pharmacy benefit manager. (a) The superintendent may refuse to renew, 18 may revoke, or may suspend for a period the superintendent determines 19 the registration or license of any pharmacy benefit manager if, after 20 notice and hearing, the superintendent determines that the registrant or 21 licensee or any member, principal, officer, director, or controlling 22 person of the registrant or licensee, has: 23 (1) violated any insurance laws, or violated any regulation, subpoena 24 or order of the superintendent or of another state's insurance commis- 25 sioner, or has violated any law in the course of his or her dealings in 26 such capacity; 27 (2) provided materially incorrect, materially misleading, materially 28 incomplete or materially untrue information in the registration or 29 license application; 30 (3) obtained or attempted to obtain a registration or license through 31 misrepresentation or fraud; 32 (4)(A) used fraudulent, coercive or dishonest practices; 33 (B) demonstrated incompetence; 34 (C) demonstrated untrustworthiness; or 35 (D) demonstrated financial irresponsibility in the conduct of business 36 in this state or elsewhere; 37 (5) improperly withheld, misappropriated or converted any monies or 38 properties received in the course of business in this state or else- 39 where; 40 (6) intentionally misrepresented the terms of an actual or proposed 41 insurance contract; 42 (7) been convicted of a felony; 43 (8) admitted or been found to have committed any insurance unfair 44 trade practice or fraud; 45 (9) had a pharmacy benefit manager registration or license, or its 46 equivalent, denied, suspended or revoked in any other state, province, 47 district or territory; 48 (10) failed to pay state income tax or comply with any administrative 49 or court order directing payment of state income tax; or 50 (11) ceased to meet the requirements for registration or licensure 51 under this article. 52 (b) Before revoking or suspending the registration or license of any 53 pharmacy benefit manager pursuant to the provisions of this article, the 54 superintendent shall give notice to the registrant or licensee and to 55 every sub-licensee and shall hold, or cause to be held, a hearing not 56 less than ten days after the giving of such notice.S. 1507--A 42 A. 2007--A 1 (c) If a registration or license pursuant to the provisions of this 2 article is revoked or suspended by the superintendent, then the super- 3 intendent shall forthwith give notice to the registrant or licensee. 4 (d) The revocation or suspension of any registration or license pursu- 5 ant to the provisions of this article shall terminate forthwith such 6 registration or license and the authority conferred thereby upon all 7 sub-licensees. For good cause shown, the superintendent may delay the 8 effective date of a revocation or suspension to permit the registrant or 9 licensee to satisfy some or all of its contractual obligations to 10 perform pharmacy benefit management services in the state. 11 (e)(1) No individual, corporation, firm or association whose registra- 12 tion or license as a pharmacy benefit manager has been revoked pursuant 13 to subsection (a) of this section, and no firm or association of which 14 such individual is a member, and no corporation of which such individual 15 is an officer or director, and no controlling person of the registrant 16 or licensee shall be entitled to obtain any registration or license 17 under the provisions of this article for a period of one year after such 18 revocation, or, if such revocation be judicially reviewed, for one year 19 after the final determination thereof affirming the action of the super- 20 intendent in revoking such license. 21 (2) If any such registration or license held by a firm, association or 22 corporation be revoked, no member of such firm or association and no 23 officer or director of such corporation or any controlling person of the 24 registrant or licensee shall be entitled to obtain any registration or 25 license, or to be named as a sub-licensee in any such license, under 26 this article for the same period of time, unless the superintendent 27 determines, after notice and hearing, that such member, officer or 28 director was not personally at fault in the matter on account of which 29 such registration or license was revoked. 30 (f) If any registered or licensed pharmacy benefit manager or any 31 person aggrieved shall file with the superintendent a verified complaint 32 setting forth facts tending to show sufficient ground for the revocation 33 or suspension of any pharmacy benefit manager's registration or license, 34 then the superintendent shall, after notice and a hearing, determine 35 whether such registration or license shall be suspended or revoked. 36 (g) The superintendent shall retain the authority to enforce the 37 provisions of and impose any penalty or remedy authorized by this chap- 38 ter against any person or entity who is under investigation for or 39 charged with a violation of this chapter, even if the person's or enti- 40 ty's registration or license has been surrendered, or has expired or has 41 lapsed by operation of law. 42 (h) A registrant or licensee subject to this article shall report to 43 the superintendent any administrative action taken against the regis- 44 trant or licensee in another jurisdiction or by another governmental 45 agency in this state within thirty days of the final disposition of the 46 matter. This report shall include a copy of the order, consent to order 47 or other relevant legal documents. 48 (i) Within thirty days of the initial pretrial hearing date, a regis- 49 trant or licensee subject to this article shall report to the super- 50 intendent any criminal prosecution of the registrant or licensee taken 51 in any jurisdiction. The report shall include a copy of the initial 52 complaint filed, the order resulting from the hearing and any other 53 relevant legal documents. 54 § 2908. Penalties for violations. (a) The superintendent, in lieu of 55 revoking or suspending the registration or license of a registrant or 56 licensee in accordance with the provisions of this article, may in anyS. 1507--A 43 A. 2007--A 1 one proceeding by order, require the registrant or licensee to pay to 2 the people of this state a penalty in a sum not exceeding the greater of 3 (1) one thousand dollars for each offense and two thousand five hundred 4 dollars for each subsequent violation or (2) the aggregate gross 5 receipts attributable to all offenses. 6 (b) Upon the failure of such a registrant or licensee to pay the 7 penalty ordered pursuant to subsection (a) of this section within twenty 8 days after the mailing of the order, postage prepaid, registered, and 9 addressed to the last known place of business of the licensee, unless 10 the order is stayed by an order of a court of competent jurisdiction, 11 the superintendent may revoke the registration or license of the regis- 12 trant or licensee or may suspend the same for such period as the super- 13 intendent determines. 14 § 2909. Stay or suspension of superintendent's determination. The 15 commencement of a proceeding under article seventy-eight of the civil 16 practice law and rules, to review the action of the superintendent in 17 suspending or revoking or refusing to renew any certificate under this 18 article, shall stay such action of the superintendent for a period of 19 thirty days. Such stay shall not be extended for a longer period unless 20 the court shall determine, after a preliminary hearing of which the 21 superintendent is notified forty-eight hours in advance, that a stay of 22 the superintendent's action pending the final determination or further 23 order of the court will not unduly injure the interests of the people of 24 the state. 25 § 2910. Revoked registrations or licenses. (a)(1) No person, firm, 26 association, corporation or other entity subject to the provisions of 27 this article whose registration or license under this article has been 28 revoked, or whose registration or license to engage in the business of 29 pharmacy benefit management in any capacity has been revoked by any 30 other state or territory of the United States shall become employed or 31 appointed by a pharmacy benefit manager as an officer, director, manag- 32 er, controlling person or for other services, without the prior written 33 approval of the superintendent, unless such services are for maintenance 34 or are clerical or ministerial in nature. 35 (2) No person, firm, association, corporation or other entity subject 36 to the provisions of this article shall knowingly employ or appoint any 37 person or entity whose registration or license issued under this article 38 has been revoked, or whose registration or license to engage in the 39 business of pharmacy benefit management in any capacity has been revoked 40 by any other state or territory of the United States, as an officer, 41 director, manager, controlling person or for other services, without the 42 prior written approval of the superintendent, unless such services are 43 for maintenance or are clerical or ministerial in nature. 44 (3) No corporation or partnership subject to the provisions of this 45 article shall knowingly permit any person whose registration or license 46 issued under this article has been revoked, or whose registration or 47 license to engage in the business of pharmacy benefit management in any 48 capacity has been revoked by any other state, or territory of the United 49 States, to be a shareholder or have an interest in such corporation or 50 partnership, nor shall any such person become a shareholder or partner 51 in such corporation or partnership, without the prior written approval 52 of the superintendent. 53 (b) The superintendent may approve the employment, appointment or 54 participation of any such person whose registration or license has been 55 revoked:S. 1507--A 44 A. 2007--A 1 (1) if the superintendent determines that the duties and responsibil- 2 ities of such person are subject to appropriate supervision and that 3 such duties and responsibilities will not have an adverse effect upon 4 the public, other registrants or licensees, or the registrant or licen- 5 see proposing employment or appointment of such person; or 6 (2) if such person has filed an application for reregistration or 7 relicensing pursuant to this article and the application for reregistra- 8 tion or relicensing has not been approved or denied within one hundred 9 twenty days following the filing thereof, unless the superintendent 10 determines within the said time that employment or appointment of such 11 person by a registrant or licensee in the conduct of a pharmacy benefit 12 management business would not be in the public interest. 13 (c) The provisions of this section shall not apply to the ownership of 14 shares of any corporation registered or licensed pursuant to this arti- 15 cle if the shares of such corporation are publicly held and traded in 16 the over-the-counter market or upon any national or regional securities 17 exchange. 18 § 2911. Change of address. A registrant or licensee under this article 19 shall inform the superintendent by a means acceptable to the superinten- 20 dent of a change of address within thirty days of the change. 21 § 2912. Applicability of other laws. Nothing in this article shall be 22 construed to exempt a pharmacy benefit manager from complying with the 23 provisions of articles twenty-one and forty-nine of this chapter and 24 article forty-nine of the public health law or any other provision of 25 this chapter or the financial services law. 26 § 2913. Assessments. Pharmacy benefit managers that file a registra- 27 tion with the department or are licensed by the department shall be 28 assessed by the superintendent for the operating expenses of the depart- 29 ment that are solely attributable to regulating such pharmacy benefit 30 managers in such proportions as the superintendent shall deem just and 31 reasonable. 32 § 2. Subsection (b) of section 2402 of the insurance law, as amended 33 by section 71 of part A of chapter 62 of the laws of 2011, is amended to 34 read as follows: 35 (b) "Defined violation" means the commission by a person of an act 36 prohibited by: subsection (a) of section one thousand one hundred two, 37 section one thousand two hundred fourteen, one thousand two hundred 38 seventeen, one thousand two hundred twenty, one thousand three hundred 39 thirteen, subparagraph (B) of paragraph two of subsection (i) of section 40 one thousand three hundred twenty-two, subparagraph (B) of paragraph two 41 of subsection (i) of section one thousand three hundred twenty-four, two 42 thousand one hundred two, two thousand one hundred seventeen, two thou- 43 sand one hundred twenty-two, two thousand one hundred twenty-three, 44 subsection (p) of section two thousand three hundred thirteen, section 45 two thousand three hundred twenty-four, two thousand five hundred two, 46 two thousand five hundred three, two thousand five hundred four, two 47 thousand six hundred one, two thousand six hundred two, two thousand six 48 hundred three, two thousand six hundred four, two thousand six hundred 49 six, two thousand seven hundred three, two thousand nine hundred two, 50 two thousand nine hundred five, three thousand one hundred nine, three 51 thousand two hundred twenty-four-a, three thousand four hundred twenty- 52 nine, three thousand four hundred thirty-three, paragraph seven of 53 subsection (e) of section three thousand four hundred twenty-six, four 54 thousand two hundred twenty-four, four thousand two hundred twenty-five, 55 four thousand two hundred twenty-six, seven thousand eight hundred nine, 56 seven thousand eight hundred ten, seven thousand eight hundred eleven,S. 1507--A 45 A. 2007--A 1 seven thousand eight hundred thirteen, seven thousand eight hundred 2 fourteen and seven thousand eight hundred fifteen of this chapter; or 3 section 135.60, 135.65, 175.05, 175.45, or 190.20, or article one 4 hundred five of the penal law. 5 § 3. This act shall take effect immediately and shall be deemed to 6 have been in full force and effect on and after April 1, 2019. 7 PART J 8 Section 1. This Part enacts into law major components of legislation 9 which are necessary to protect health care consumers; increase access to 10 more affordable quality health insurance coverage; and preserve and 11 foster New York's health insurance markets. Each component is wholly 12 contained within a Subpart identified as Subparts A through F. The 13 effective date for each particular provision contained within such 14 Subpart is set forth in the last section of such Subpart. Any provision 15 in any section contained within a Subpart, including the effective date 16 of the Subpart, which makes a reference to a section "of this act," when 17 used in connection with that particular component, shall be deemed to 18 mean and refer to the corresponding section of the Subpart in which it 19 is found. Section five of this Part sets forth the general effective 20 date of this Part. 21 SUBPART A 22 Section 1. Section 3221 of the insurance law is amended by adding a 23 new subsection (t) to read as follows: 24 (t) (1) Any insurer that delivers or issues for delivery in this state 25 hospital, surgical or medical expense group policies in the small group 26 or large group market shall offer to any employer in this state all such 27 policies in the applicable market, and shall accept at all times 28 throughout the year any employer that applies for any of those policies. 29 (2) The requirements of paragraph one of this subsection shall apply 30 with respect to an employer that applies for coverage either directly 31 from the insurer or through an association or trust to which the insurer 32 has issued coverage and in which the employer participates. 33 § 2. Paragraph 1 of subsection (g) of section 3231 of the insurance 34 law, as amended by section 70 of part D of chapter 56 of the laws of 35 2013, is amended to read as follows: 36 (1) This section shall also apply to policies issued to a group 37 defined in subsection (c) of section four thousand two hundred thirty- 38 five, including but not limited to an association or trust of employers, 39 if the group includes one or more member employers or other member 40 groups which have [fifty] one hundred or fewer employees or members 41 exclusive of spouses and dependents. For policies issued or renewed on 42 or after January first, two thousand fourteen, if the group includes one 43 or more member small group employers eligible for coverage subject to 44 this section, then such member employers shall be classified as small 45 groups for rating purposes and the remaining members shall be rated 46 consistent with the rating rules applicable to such remaining members 47 pursuant to paragraph two of this subsection. 48 § 3. Subsections (h) and (i) of section 3232 of the insurance law are 49 REPEALED. 50 § 4. Subsections (f) and (g) of section 3232 of the insurance law, as 51 added by chapter 219 of the laws of 2011, are amended to read as 52 follows:S. 1507--A 46 A. 2007--A 1 (f) [With respect to an individual under age nineteen, an insurer may2not impose any pre-existing condition exclusion in an individual or3group policy of hospital, medical, surgical or prescription drug expense4insurance pursuant to the requirements of section 2704 of the Public5Health Service Act, 42 U.S.C. § 300gg-3, as made effective by section61255(2) of the Affordable Care Act, except for an individual under age7nineteen covered under an individual policy of hospital, medical, surgi-8cal or prescription drug expense insurance that is a grandfathered9health plan.10(g) Beginning January first, two thousand fourteen, pursuant to11section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, an] 12 An insurer [may] shall not impose any pre-existing condition exclusion 13 in an individual or group policy of hospital, medical, surgical or 14 prescription drug expense insurance [except in an individual policy that15is a grandfathered health plan]. 16 § 5. Subparagraph (A) of paragraph 1 of subsection (c) of section 4235 17 of the insurance law, as amended by chapter 515 of the laws of 2010, is 18 amended to read as follows: 19 (A) A policy issued to an employer or to a trustee or trustees of a 20 fund established by an employer, which employer or trustee or trustees 21 shall be deemed the policyholder, insuring with or without evidence of 22 insurability satisfactory to the insurer, employees of such employer, 23 and insuring, except as hereinafter provided, all of such employees or 24 all of any class or classes thereof determined by conditions pertaining 25 to the employment or a combination of such conditions and conditions 26 pertaining to the family status of the employee, for insurance coverage 27 on each person insured based upon some plan [which] that will preclude 28 individual selection. However, such a plan may permit a limited number 29 of selections by employees if the selections offered utilize consistent 30 plans of coverage for individual group members so that the resulting 31 plans of coverage are reasonable. The premium for the policy shall be 32 paid by the policyholder, either from the employer's funds, or from 33 funds contributed by the insured employees, or from funds contributed 34 jointly by the employer and employees. If all or part of the premium is 35 to be derived from funds contributed by the insured employees, then 36 [such] the insurer issuing the policy [must insure not less than fifty37percent of such eligible employees or, if less, fifty or more] shall not 38 require a minimum number or minimum percentage of such employees be 39 insured when [such] the policy is providing coverage for group hospital, 40 medical, major medical or similar comprehensive types of expense reim- 41 bursed insurance and, for all other types of group accident and health 42 insurance, [must] the policy shall insure a minimum of fifty percent or 43 five of such eligible employees, whichever is fewer. 44 § 6. Section 4305 of the insurance law is amended by adding a new 45 subsection (n) to read as follows: 46 (n) (1) Any corporation subject to the provisions of this article that 47 issues hospital, surgical or medical expense contracts in the small 48 group or large group market in this state shall offer to any employer in 49 this state all such contracts in the applicable market, and shall accept 50 at all times throughout the year any employer that applies for any of 51 those contracts. 52 (2) The requirements of paragraph one of this subsection shall apply 53 with respect to an employer that applies for coverage either directly 54 from the corporation or through an association or trust to which the 55 corporation has issued coverage and in which the employer participates.S. 1507--A 47 A. 2007--A 1 § 7. Paragraph 1 of subsection (d) of section 4317 of the insurance 2 law, as amended by section 72 of part D of chapter 56 of the laws of 3 2013, is amended to read as follows: 4 (1) This section shall also apply to a contract issued to a group 5 defined in subsection (c) of section four thousand two hundred thirty- 6 five of this chapter, including but not limited to an association or 7 trust of employers, if the group includes one or more member employers 8 or other member groups which have [fifty] one hundred or fewer employees 9 or members exclusive of spouses and dependents. For contracts issued or 10 renewed on or after January first, two thousand fourteen, if the group 11 includes one or more member small group employers eligible for coverage 12 subject to this section, then such member employers shall be classified 13 as small groups for rating purposes and the remaining members shall be 14 rated consistent with the rating rules applicable to such remaining 15 members pursuant to paragraph two of this subsection. 16 § 8. Subsections (h) and (i) of section 4318 of the insurance law are 17 REPEALED. 18 § 9. Subsections (f) and (g) of section 4318 of the insurance law, as 19 added by chapter 219 of the laws of 2011, are amended to read as 20 follows: 21 (f) [With respect to an individual under age nineteen, a corporation22may not impose any pre-existing condition exclusion in an individual or23group contract of hospital, medical, surgical or prescription drug24expense insurance pursuant to the requirements of section 2704 of the25Public Health Service Act, 42 U.S.C. § 300gg-3, as made effective by26section 1255(2) of the Affordable Care Act, except for an individual27under age nineteen covered under an individual contract of hospital,28medical, surgical or prescription drug expense insurance that is a29grandfathered health plan.30(g) Beginning January first, two thousand fourteen, pursuant to31section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A 32 corporation [may] shall not impose any pre-existing condition exclusion 33 in an individual or group contract of hospital, medical, surgical or 34 prescription drug expense insurance [except in an individual contract35that is a grandfathered health plan]. 36 § 10. Section 4413 of the insurance law is amended by adding a new 37 subsection (h) to read as follows: 38 (h) (1) On or after June first, two thousand nineteen, an employee 39 welfare fund registered with the superintendent shall not provide 40 medical, surgical or hospital care or benefits in the event of sickness 41 or injury for employees or their families or dependents, or for both, 42 unless provided under a group comprehensive-type health insurance policy 43 or contract in accordance with the requirements of this chapter and 44 delivered or issued for delivery in this state by an authorized insurer 45 or a health maintenance organization issued a certificate of authority 46 under article forty-four of the public health law. 47 (2) Notwithstanding paragraph one of this subsection, an employee 48 welfare fund registered with the superintendent prior to June first, two 49 thousand nineteen, which, as of February first, two thousand nineteen 50 directly provided medical, surgical or hospital care or benefits in the 51 event of sickness or injury for employees or their families or depen- 52 dents, or for both, may continue to provide those benefits directly 53 rather than under a group comprehensive-type health insurance policy or 54 contract delivered or issued for delivery in this state by an authorized 55 insurer or a health maintenance organization issued a certificate of 56 authority under article forty-four of the public health law; provided,S. 1507--A 48 A. 2007--A 1 however, that, if the employee welfare fund ceases offering the benefits 2 directly, it may not resume providing the benefits directly. 3 § 11. Subdivision 1 of section 4406 of the public health law, as 4 amended by section 46-a of part D of chapter 56 of the laws of 2013, is 5 amended to read as follows: 6 1. The contract between a health maintenance organization and an 7 enrollee shall be subject to regulation by the superintendent as if it 8 were a health insurance subscriber contract, and shall include, but not 9 be limited to, all mandated benefits required by article forty-three of 10 the insurance law. Such contract shall fully and clearly state the bene- 11 fits and limitations therein provided or imposed, so as to facilitate 12 understanding and comparisons, and to exclude provisions which may be 13 misleading or unreasonably confusing. Such contract shall be issued to 14 any individual and dependents of such individual and any group of 15 [fifty] one hundred or fewer employees or members, exclusive of spouses 16 and dependents, or to any employee or member of the group, including 17 dependents, applying for such contract at any time throughout the year[,18and may include a pre-existing condition provision as provided for in19section four thousand three hundred eighteen of the insurance law,20provided, however, that, the]. An individual direct payment contract 21 shall be issued only in accordance with section four thousand three 22 hundred twenty-eight of the insurance law. The superintendent may, after 23 giving consideration to the public interest, exempt a health maintenance 24 organization from the requirements of this section provided that another 25 health insurer or health maintenance organization within the health 26 maintenance organization's same holding company system, as defined in 27 article fifteen of the insurance law, including a health maintenance 28 organization operated as a line of business of a health service corpo- 29 ration licensed under article forty-three of the insurance law, offers 30 coverage that, at a minimum, complies with this section and provides all 31 of the consumer protections required to be provided by a health mainte- 32 nance organization pursuant to this chapter and regulations, including 33 those consumer protections contained in sections four thousand four 34 hundred three and four thousand four hundred eight-a of this chapter. 35 The requirements shall not apply to a health maintenance organization 36 exclusively serving individuals enrolled pursuant to title eleven of 37 article five of the social services law, title eleven-D of article five 38 of the social services law, title one-A of article twenty-five of [the39public health law] this chapter or title eighteen of the federal Social 40 Security Act, and, further provided, that such health maintenance organ- 41 ization shall not discontinue a contract for an individual receiving 42 comprehensive-type coverage in effect prior to January first, two thou- 43 sand four who is ineligible to purchase policies offered after such date 44 pursuant to this section or section four thousand three hundred [twen-45ty-two of this article] twenty-eight of the insurance law due to the 46 provision of 42 U.S.C. 1395ss in effect prior to January first, two 47 thousand four. [Subject to the creditable coverage requirements of48subsection (a) of section four thousand three hundred eighteen of the49insurance law, the organization may, as an alternative to the use of a50pre-existing condition provision, elect to offer contracts without a51pre-existing condition provision to such groups but may require that52coverage shall not become effective until after a specified affiliation53period of not more than sixty days after the application for coverage is54submitted. The organization is not required to provide health care55services or benefits during such period and no premium shall be charged56for any coverage during the period. After January first, nineteenS. 1507--A 49 A. 2007--A 1hundred ninety-six, all individual direct payment contracts shall be2issued only pursuant to sections four thousand three hundred twenty-one3and four thousand three hundred twenty-two of the insurance law. Such4contracts may not, with respect to an eligible individual (as defined in5section 2741(b) of the federal Public Health Service Act, 42 U.S.C. §6300gg-41(b), impose any pre-existing condition exclusion.] 7 § 12. This act shall take effect immediately, provided that: 8 (1) sections one, three, four, five, six, eight and nine of this act 9 shall apply to all policies and contracts issued, renewed, modified, 10 altered or amended on or after January 1, 2020; and 11 (2) sections two and seven of this act shall take effect on the same 12 date as the reversion of paragraph 1 of subsection (g) of section 3231 13 and paragraph 1 of subsection (d) of section 4317 of the insurance law, 14 as provided in section 5 of chapter 588 of the laws of 2015, as amended. 15 SUBPART B 16 Section 1. Subparagraph (A) of paragraph 5 of subsection (c) of 17 section 3216 of the insurance law, as amended by chapter 388 of the laws 18 of 2014, is amended to read as follows: 19 (A) Any family policy providing hospital or surgical expense insurance 20 (but not including such insurance against accidental injury only) shall 21 provide that, in the event such insurance on any person, other than the 22 policyholder, is terminated because the person is no longer within the 23 definition of the family as set forth in the policy but before such 24 person has attained the limiting age, if any, for coverage of adults 25 specified in the policy, such person shall be entitled to have issued to 26 that person by the insurer, without evidence of insurability, upon 27 application therefor and payment of the first premium, within sixty days 28 after such insurance shall have terminated, an individual conversion 29 policy that contains the essential health benefits package described in 30 paragraph [one] three of subsection [(b)] (f) of section [four thousand31three hundred twenty-eight of this chapter. The insurer shall offer one32policy at each level of coverage as defined in section 1302(d) of the33affordable care act, 42 U.S.C. § 18022(d).] three thousand two hundred 34 seventeen-i of this article. The insurer shall offer one policy at each 35 level of coverage as defined in subsection (c) of section three thousand 36 two hundred seventeen-i of this article. The individual may choose any 37 such policy offered by the insurer. Provided, however, the superinten- 38 dent may, after giving due consideration to the public interest, approve 39 a request made by an insurer for the insurer to satisfy the requirements 40 of this subparagraph through the offering of policies that comply with 41 this subparagraph by another insurer, corporation or health maintenance 42 organization within the insurer's holding company system, as defined in 43 article fifteen of this chapter. The conversion privilege afforded here- 44 in shall also be available upon the divorce or annulment of the marriage 45 of the policyholder to the former spouse of such policyholder. 46 § 2. Subparagraph (E) of paragraph 2 of subsection (g) of section 3216 47 of the insurance law, as added by chapter 388 of the laws of 2014, is 48 amended to read as follows: 49 (E) The superintendent may, after giving due consideration to the 50 public interest, approve a request made by an insurer for the insurer to 51 satisfy the requirements of subparagraph (C) of this paragraph through 52 the offering of policies at each level of coverage as defined in 53 subsection (c) of section [1302(d) of the affordable care act, 42 U.S.C.54§ 18022(d)] three thousand two hundred seventeen-i of this article thatS. 1507--A 50 A. 2007--A 1 contains the essential health benefits package described in paragraph 2 [one] three of subsection [(b)] (f) of section [four thousand three3hundred twenty-eight of this chapter] three thousand two hundred seven- 4 teen-i of this article by another insurer, corporation or health mainte- 5 nance organization within the insurer's same holding company system, as 6 defined in article fifteen of this chapter. 7 § 3. Items (i) and (ii) of subparagraph (D) of paragraph 11 of 8 subsection (i) of section 3216 of the insurance law, as added by chapter 9 219 of the laws of 2011, are amended, and a new item (iii) is added to 10 read as follows: 11 (i) evidence-based items or services for mammography that have in 12 effect a rating of 'A' or 'B' in the current recommendations of the 13 United States preventive services task force; [and] 14 (ii) with respect to women, such additional preventive care and 15 screenings for mammography not described in item (i) of this subpara- 16 graph and as provided for in comprehensive guidelines supported by the 17 health resources and services administration[.]; and 18 (iii) any other preventive care and screenings designated by the 19 superintendent in a regulation that are consistent with current or 20 previous recommendations or guidelines identified in items (i) and (ii) 21 of this subparagraph. 22 § 4. Items (i) and (ii) of subparagraph (D) of paragraph 15 of 23 subsection (i) of section 3216 of the insurance law, as added by chapter 24 219 of the laws of 2011, are amended, and a new item (iii) is added to 25 read as follows: 26 (i) evidence-based items or services for cervical cytology that have 27 in effect a rating of 'A' or 'B' in the current recommendations of the 28 United States preventive services task force; [and] 29 (ii) with respect to women, such additional preventive care and 30 screenings for cervical cytology not described in item (i) of this 31 subparagraph and as provided for in comprehensive guidelines supported 32 by the health resources and services administration[.]; and 33 (iii) any other preventive care and screenings designated by the 34 superintendent in a regulation that are consistent with current or 35 previous recommendations or guidelines identified in items (i) and (ii) 36 of this subparagraph. 37 § 5. Items (iii) and (iv) of subparagraph (E) of paragraph 17 of 38 subsection (i) of section 3216 of the insurance law, as added by chapter 39 219 of the laws of 2011, are amended and a new item (v) is added to read 40 as follows: 41 (iii) with respect to children, including infants and adolescents, 42 evidence-informed preventive care and screenings provided for in compre- 43 hensive guidelines supported by the health resources and services admin- 44 istration; [and] 45 (iv) with respect to women, such additional preventive care and 46 screenings not described in item (i) of this subparagraph and as 47 provided for in comprehensive guidelines supported by the health 48 resources and services administration[.]; and 49 (v) any other preventive care and screenings designated by the super- 50 intendent in a regulation that are consistent with current or previous 51 recommendations or guidelines identified in items (i) through (iv) of 52 this subparagraph. 53 § 6. Paragraph 21 of subsection (i) of section 3216 of the insurance 54 law, as amended by chapter 469 of the laws of 2018, is amended to read 55 as follows:S. 1507--A 51 A. 2007--A 1 (21) Every policy [which] that provides coverage for prescription 2 drugs shall include coverage for the cost of enteral formulas for home 3 use, whether administered orally or via tube feeding, for which a physi- 4 cian or other licensed health care provider legally authorized to 5 prescribe under title eight of the education law has issued a written 6 order. Such written order shall state that the enteral formula is clear- 7 ly medically necessary and has been proven effective as a disease-spe- 8 cific treatment regimen. Specific diseases and disorders for which 9 enteral formulas have been proven effective shall include, but are not 10 limited to, inherited diseases of amino acid or organic acid metabolism; 11 Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal 12 motility such as chronic intestinal pseudo-obstruction; and multiple, 13 severe food allergies including, but not limited to immunoglobulin E and 14 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe 15 food protein induced enterocolitis syndrome; eosinophilic disorders; and 16 impaired absorption of nutrients caused by disorders affecting the 17 absorptive surface, function, length, and motility of the gastrointesti- 18 nal tract. Enteral formulas [which] that are medically necessary and 19 taken under written order from a physician for the treatment of specific 20 diseases shall be distinguished from nutritional supplements taken elec- 21 tively. Coverage for certain inherited diseases of amino acid and organ- 22 ic acid metabolism as well as severe protein allergic conditions shall 23 include modified solid food products that are low protein [or which], 24 contain modified protein, or are amino acid based [which] that are 25 medically necessary[, and such coverage for such modified solid food26products for any calendar year or for any continuous period of twelve27months for any insured individual shall not exceed two thousand five28hundred dollars]. 29 § 7. Paragraph 30 of subsection (i) of section 3216 of the insurance 30 law, as amended by chapter 377 of the laws of 2014, is amended to read 31 as follows: 32 (30) Every policy [which] that provides medical coverage that includes 33 coverage for physician services in a physician's office and every policy 34 [which] that provides major medical or similar comprehensive-type cover- 35 age shall include coverage for equipment and supplies used for the 36 treatment of ostomies, if prescribed by a physician or other licensed 37 health care provider legally authorized to prescribe under title eight 38 of the education law. Such coverage shall be subject to annual deduct- 39 ibles and coinsurance as deemed appropriate by the superintendent. The 40 coverage required by this paragraph shall be identical to, and shall not 41 enhance or increase the coverage required as part of essential health 42 benefits as [required pursuant to] defined in subsection (a) of section 43 [2707 (a) of the public health services act 42 U.S.C. 300 gg-6(a)] three 44 thousand two hundred seventeen-i of this article. 45 § 8. Subsection (l) of section 3216 of the insurance law, as added by 46 section 42 of part D of chapter 56 of the laws of 2013, is amended to 47 read as follows: 48 (l) [On and after October first, two thousand thirteen, an] An insurer 49 shall not offer individual hospital, medical or surgical expense insur- 50 ance policies unless the policies meet the requirements of subsection 51 (b) of section four thousand three hundred twenty-eight of this chapter. 52 Such policies that are offered within the health benefit exchange estab- 53 lished [pursuant to section 1311 of the affordable care act, 42 U.S.C. §5418031, or any regulations promulgated thereunder,] by this state also 55 shall meet any requirements established by the health benefit exchange.S. 1507--A 52 A. 2007--A 1 § 9. Subsection (m) of section 3216 of the insurance law, as added by 2 section 53 of part D of chapter 56 of the laws of 2013, is amended to 3 read as follows: 4 (m) An insurer shall not be required to offer the policyholder any 5 benefits that must be made available pursuant to this section if the 6 benefits must be covered as essential health benefits. For any policy 7 issued within the health benefit exchange established [pursuant to8section 1311 of the affordable care act, 42 U.S.C. § 18031] by this 9 state, an insurer shall not be required to offer the policyholder any 10 benefits that must be made available pursuant to this section. For 11 purposes of this subsection, "essential health benefits" shall have the 12 meaning set forth in subsection (a) of section [1302(b) of the afforda-13ble care act, 42 U.S.C. § 18022(b)] three thousand two hundred seven- 14 teen-i of this article. 15 § 10. The insurance law is amended by adding a new section 3217-i to 16 read as follows: 17 § 3217-i. Essential health benefits package and limit on cost-sharing. 18 (a) For purposes of this article, "essential health benefits" shall mean 19 the following categories of benefits: 20 (1) ambulatory patient services; 21 (2) emergency services; 22 (3) hospitalization; 23 (4) maternity and newborn care; 24 (5) mental health and substance use disorder services, including 25 behavioral health treatment; 26 (6) prescription drugs; 27 (7) rehabilitative and habilitative services and devices; 28 (8) laboratory services; 29 (9) preventive and wellness services and chronic disease management; 30 and 31 (10) pediatric services, including oral and vision care. 32 (b) The superintendent, in consultation with the commissioner of 33 health, may select as a benchmark, a plan or combination of plans that 34 together contain essential health benefits, in accordance with this 35 section and any applicable federal regulation. 36 (c) (1) Every individual and small group accident and health insurance 37 policy that provides hospital, surgical, or medical expense coverage and 38 is not a grandfathered health plan shall provide coverage that meets the 39 actuarial requirements of one of the following levels of coverage: 40 (A) Bronze Level. A plan in the bronze level shall provide a level of 41 coverage that is designed to provide benefits that are actuarially 42 equivalent to sixty percent of the full actuarial value of the benefits 43 provided under the plan; 44 (B) Silver Level. A plan in the silver level shall provide a level of 45 coverage that is designed to provide benefits that are actuarially 46 equivalent to seventy percent of the full actuarial value of the bene- 47 fits provided under the plan; 48 (C) Gold Level. A plan in the gold level shall provide a level of 49 coverage that is designed to provide benefits that are actuarially 50 equivalent to eighty percent of the full actuarial value of the benefits 51 provided under the plan; or 52 (D) Platinum Level. A plan in the platinum level shall provide a level 53 of coverage that is designed to provide benefits that are actuarially 54 equivalent to ninety percent of the full actuarial value of the benefits 55 provided under the plan.S. 1507--A 53 A. 2007--A 1 (2) The superintendent may provide for a variation in the actuarial 2 values used in determining the level of coverage of a plan to account 3 for the differences in actuarial estimates. 4 (3) Every student accident and health insurance policy shall provide 5 coverage that meets at least sixty percent of the full actuarial value 6 of the benefits provided under the policy. The policy's schedule of 7 benefits shall include the level as described in paragraph one of this 8 subsection nearest to, but below the actual actuarial value. 9 (d) Every individual or group accident and health insurance policy 10 that provides hospital, surgical, or medical expense coverage and is not 11 a grandfathered health plan, and every student accident and health 12 insurance policy shall limit the insured's cost-sharing for in-network 13 services in a policy year to not more than the maximum out-of-pocket 14 amount determined by the superintendent for all policies subject to this 15 section. Such amount shall not exceed any annual out-of-pocket limit on 16 cost-sharing set by the United States secretary of health and human 17 services, if available. 18 (e) The superintendent may require the use of model language describ- 19 ing the coverage requirements for any accident and health insurance 20 policy form that is subject to the superintendent's approval pursuant to 21 section three thousand two hundred one of this article. 22 (f) For purposes of this section: 23 (1) "actuarial value" means the percentage of the total expected 24 payments by the insurer for benefits provided to a standard population, 25 without regard to the population to whom the insurer actually provides 26 benefits; 27 (2) "cost-sharing" means annual deductibles, coinsurance, copayments, 28 or similar charges, for covered services; 29 (3) "essential health benefits package" means coverage that: 30 (A) provides for essential health benefits; 31 (B) limits cost-sharing for such coverage in accordance with 32 subsection (d) of this section; and 33 (C) provides one of the levels of coverage described in subsection (c) 34 of this section; 35 (4) "grandfathered health plan" means coverage provided by an insurer 36 in which an individual was enrolled on March twenty-third, two thousand 37 ten for as long as the coverage maintains grandfathered status in 38 accordance with section 1251(e) of the Affordable Care Act, 42 U.S.C. § 39 18011(e); 40 (5) "small group" means a group of one hundred or fewer employees or 41 members exclusive of spouses and dependents; and 42 (6) "student accident and health insurance" shall have the meaning set 43 forth in subsection (a) of section three thousand two hundred forty of 44 this article. 45 § 11. Subsection (g) of section 3221 of the insurance law, as amended 46 by chapter 388 of the laws of 2014, is amended to read as follows: 47 (g) For conversion purposes, an insurer shall offer to the employee or 48 member a policy at each level of coverage as defined in subsection (c) 49 of section [1302(d) of the affordable care act, 42 U.S.C. § 18022(d)] 50 three thousand two hundred seventeen-i of this article that contains the 51 essential health benefits package described in paragraph [one] three of 52 subsection [(b)] (f) of section [four thousand three hundred twenty-53eight of this chapter] three thousand two hundred seventeen-i of this 54 article. Provided, however, the superintendent may, after giving due 55 consideration to the public interest, approve a request made by an 56 insurer for the insurer to satisfy the requirements of this subsectionS. 1507--A 54 A. 2007--A 1 and subsections (e) and (f) of this section through the offering of 2 policies that comply with this subsection by another insurer, corpo- 3 ration or health maintenance organization within the insurer's holding 4 company system, as defined in article fifteen of this chapter. 5 § 12. Subsection (h) of section 3221 of the insurance law, as added by 6 section 54 of part D of chapter 56 of the laws of 2013, is amended to 7 read as follows: 8 (h) Every small group policy or association group policy delivered or 9 issued for delivery in this state that provides coverage for hospital, 10 medical or surgical expense insurance and is not a grandfathered health 11 plan shall provide coverage for the essential health [benefit] benefits 12 package [as required in section 2707(a) of the public health service13act, 42 U.S.C. § 300gg-6(a)]. For purposes of this subsection: 14 (1) "essential health benefits package" shall have the meaning set 15 forth in paragraph three of subsection (f) of section [1302(a) of the16affordable care act, 42 U.S.C. § 18022(a)] three thousand two hundred 17 seventeen-i of this article; 18 (2) "grandfathered health plan" means coverage provided by an insurer 19 in which an individual was enrolled on March twenty-third, two thousand 20 ten for as long as the coverage maintains grandfathered status in 21 accordance with section 1251(e) of the affordable care act, 42 U.S.C. § 22 18011(e); 23 (3) "small group" means a group of [fifty or fewer employees or24members exclusive of spouses and dependents; provided, however, that25beginning January first, two thousand sixteen, "small group" means a26group of] one hundred or fewer employees or members exclusive of spouses 27 and dependents; and 28 (4) "association group" means a group defined in subparagraphs (B), 29 (D), (H), (K), (L) or (M) of paragraph one of subsection (c) of section 30 four thousand two hundred thirty-five of this chapter, provided that: 31 (A) the group includes one or more individual members; or 32 (B) the group includes one or more member employers or other member 33 groups that are small groups. 34 § 13. Subsection (i) of section 3221 of the insurance law, as added by 35 section 54 of part D of chapter 56 of the laws of 2013, is amended to 36 read as follows: 37 (i) An insurer shall not be required to offer the policyholder any 38 benefits that must be made available pursuant to this section if the 39 benefits must be covered pursuant to subsection (h) of this section. For 40 any policy issued within the health benefit exchange established [pursu-41ant to section 1311 of the affordable care act, 42 U.S.C. § 18031] by 42 this state, an insurer shall not be required to offer the policyholder 43 any benefits that must be made available pursuant to this section. 44 § 14. Paragraph 11 of subsection (k) of section 3221 of the insurance 45 law, as amended by chapter 469 of the laws of 2018, is amended to read 46 as follows: 47 (11) Every policy [which] that provides coverage for prescription 48 drugs shall include coverage for the cost of enteral formulas for home 49 use, whether administered orally or via tube feeding, for which a physi- 50 cian or other licensed health care provider legally authorized to 51 prescribe under title eight of the education law has issued a written 52 order. Such written order shall state that the enteral formula is clear- 53 ly medically necessary and has been proven effective as a disease-spe- 54 cific treatment regimen. Specific diseases and disorders for which 55 enteral formulas have been proven effective shall include, but are not 56 limited to, inherited diseases of amino-acid or organic acid metabolism;S. 1507--A 55 A. 2007--A 1 Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal 2 motility such as chronic intestinal pseudo-obstruction; and multiple, 3 severe food allergies including, but not limited to immunoglobulin E and 4 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe 5 food protein induced enterocolitis syndrome; eosinophilic disorders and 6 impaired absorption of nutrients caused by disorders affecting the 7 absorptive surface, function, length, and motility of the gastrointesti- 8 nal tract. Enteral formulas [which] that are medically necessary and 9 taken under written order from a physician for the treatment of specific 10 diseases shall be distinguished from nutritional supplements taken elec- 11 tively. Coverage for certain inherited diseases of amino acid and organ- 12 ic acid metabolism as well as severe protein allergic conditions shall 13 include modified solid food products that are low protein [or which], 14 contain modified protein, or are amino acid based [which] that are 15 medically necessary[, and such coverage for such modified solid food16products for any calendar year or for any continuous period of twelve17months for any insured individual shall not exceed two thousand five18hundred dollars]. 19 § 15. Items (i) and (ii) of subparagraph (D) of paragraph 13 of 20 subsection (k) of section 3221 of the insurance law, as added by chapter 21 219 of the laws of 2011, are amended and a new item (iii) is added to 22 read as follows: 23 (i) evidence-based items or services for bone mineral density that 24 have in effect a rating of 'A' or 'B' in the current recommendations of 25 the United States preventive services task force; [and] 26 (ii) with respect to women, such additional preventive care and 27 screenings for bone mineral density not described in item (i) of this 28 subparagraph and as provided for in comprehensive guidelines supported 29 by the health resources and services administration[.]; and 30 (iii) any other preventive care and screenings designated by the 31 superintendent in a regulation that are consistent with current or 32 previous recommendations or guidelines identified in items (i) and (ii) 33 of this subparagraph. 34 § 16. Paragraph 19 of subsection (k) of section 3221 of the insurance 35 law, as amended by chapter 377 of the laws of 2014, is amended to read 36 as follows: 37 (19) Every group or blanket accident and health insurance policy 38 delivered or issued for delivery in this state [which] that provides 39 medical coverage that includes coverage for physician services in a 40 physician's office and every policy [which] that provides major medical 41 or similar comprehensive-type coverage shall include coverage for equip- 42 ment and supplies used for the treatment of ostomies, if prescribed by a 43 physician or other licensed health care provider legally authorized to 44 prescribe under title eight of the education law. Such coverage shall be 45 subject to annual deductibles and coinsurance as deemed appropriate by 46 the superintendent. The coverage required by this paragraph shall be 47 identical to, and shall not enhance or increase the coverage required as 48 part of essential health benefits as [required pursuant to] defined in 49 subsection (a) of section [2707 (a) of the public health services act 4250U.S.C. 300 gg-6(a)] three thousand two hundred seventeen-i of this 51 article. 52 § 17. Items (iii) and (iv) of subparagraph (E) of paragraph 8 of 53 subsection (l) of section 3221 of the insurance law, as added by chapter 54 219 of the laws of 2011, are amended and a new item (v) is added to read 55 as follows:S. 1507--A 56 A. 2007--A 1 (iii) with respect to children, including infants and adolescents, 2 evidence-informed preventive care and screenings provided for in compre- 3 hensive guidelines supported by the health resources and services admin- 4 istration; [and] 5 (iv) with respect to women, such additional preventive care and 6 screenings not described in item (i) of this subparagraph and as 7 provided for in comprehensive guidelines supported by the health 8 resources and services administration[.]; and 9 (v) any other preventive care and screenings designated by the super- 10 intendent in a regulation that are consistent with current or previous 11 recommendations or guidelines identified in items (i) through (iv) of 12 this subparagraph. 13 § 18. Items (i) and (ii) of subparagraph (D) of paragraph 11 of 14 subsection (l) of section 3221 of the insurance law, as added by chapter 15 219 of the laws of 2011, are amended and a new item (iii) is added to 16 read as follows: 17 (i) evidence-based items or services for mammography that have in 18 effect a rating of 'A' or 'B' in the current recommendations of the 19 United States preventive services task force; [and] 20 (ii) with respect to women, such additional preventive care and 21 screenings for mammography not described in item (i) of this subpara- 22 graph and as provided for in comprehensive guidelines supported by the 23 health resources and services administration[.]; and 24 (iii) any other preventive care and screenings designated by the 25 superintendent in a regulation that are consistent with current or 26 previous recommendations or guidelines identified in items (i) and (ii) 27 of this subparagraph. 28 § 19. Items (i) and (ii) of subparagraph (D) of paragraph 14 of 29 subsection (l) of section 3221 of the insurance law, as added by chapter 30 219 of the laws of 2011, are amended and a new item (iii) is added to 31 read as follows: 32 (i) evidence-based items or services for cervical cytology that have 33 in effect a rating of 'A' or 'B' in the current recommendations of the 34 United States preventive services task force; [and] 35 (ii) with respect to women, such additional preventive care and 36 screenings for cervical cytology not described in item (i) of this 37 subparagraph and as provided for in comprehensive guidelines supported 38 by the health resources and services administration[.]; and 39 (iii) any other preventive care and screenings designated by the 40 superintendent in a regulation that are consistent with current or 41 previous recommendations or guidelines identified in items (i) and (ii) 42 of this subparagraph. 43 § 20. Paragraph 4 of subsection (a) of section 3231 of the insurance 44 law, as amended by section 69 of part D of chapter 56 of the laws of 45 2013, is amended to read as follows: 46 (4) For the purposes of this section, "community rated" means a rating 47 methodology in which the premium for all persons covered by a policy 48 form is the same based on the experience of the entire pool of risks of 49 all individuals or small groups covered by the insurer without regard to 50 age, sex, health status, tobacco usage or occupation, excluding those 51 individuals or small groups covered by medicare supplemental insurance. 52 For medicare supplemental insurance coverage, "community rated" means a 53 rating methodology in which the premiums for all persons covered by a 54 policy or contract form is the same based on the experience of the 55 entire pool of risks covered by that policy or contract form without 56 regard to age, sex, health status, tobacco usage or occupation.S. 1507--A 57 A. 2007--A 1 [Catastrophic health insurance policies issued pursuant to section21302(e) of the affordable care act, 42 U.S.C. § 18022(e), shall be clas-3sified in a distinct community rating pool.] 4 § 21. Subsection (d) of section 3240 of the insurance law, as added by 5 section 41 of part D of chapter 56 of the laws of 2013, is amended to 6 read as follows: 7 (d) A student accident and health insurance policy or contract shall 8 provide coverage for essential health benefits as defined in subsection 9 (a) of section [1302(b) of the affordable care act, 42 U.S.C. §1018022(b)] three thousand two hundred seventeen-i or subsection (a) of 11 section four thousand three hundred six-h of this chapter, as 12 applicable. 13 § 22. Subparagraph (A) of paragraph 3 of subsection (d) of section 14 4235 of the insurance law, as added by section 60 of part D of chapter 15 56 of the laws of 2013, is amended to read as follows: 16 (A) "employee" shall have the meaning set forth in [section 2791 of17the public health service act, 42 U.S.C. § 300gg-91(d)(5) or any regu-18lations promulgated thereunder] the Employee Retirement Income Security 19 Act of 1974, 29 U.S.C. § 1002(6); and 20 § 23. Subparagraphs (C) and (D) of paragraph 3 of subsection (j) of 21 section 4303 of the insurance law, as added by chapter 219 of the laws 22 of 2011, are amended and a new subparagraph (E) is added to read as 23 follows: 24 (C) with respect to children, including infants and adolescents, 25 evidence-informed preventive care and screenings provided for in compre- 26 hensive guidelines supported by the health resources and services admin- 27 istration; [and] 28 (D) with respect to women, such additional preventive care and screen- 29 ings not described in subparagraph (A) of this paragraph and as provided 30 for in comprehensive guidelines supported by the health resources and 31 services administration[.]; and 32 (E) any other preventive care and screenings designated by the super- 33 intendent in a regulation that are consistent with current or previous 34 recommendations or guidelines identified in subparagraphs (A) through 35 (D) of this paragraph. 36 § 24. Subparagraphs (A) and (B) of paragraph 3 of subsection (p) of 37 section 4303 of the insurance law, as added by chapter 219 of the laws 38 of 2011, are amended and a new subparagraph (C) is added to read as 39 follows: 40 (A) evidence-based items or services for mammography that have in 41 effect a rating of 'A' or 'B' in the current recommendations of the 42 United States preventive services task force; [and] 43 (B) with respect to women, such additional preventive care and screen- 44 ings for mammography not described in subparagraph (A) of this paragraph 45 and as provided for in comprehensive guidelines supported by the health 46 resources and services administration[.]; and 47 (C) any other preventive care and screenings designated by the super- 48 intendent in a regulation that are consistent with current or previous 49 recommendations or guidelines identified in subparagraphs (A) and (B) of 50 this paragraph. 51 § 25. Subparagraphs (A) and (B) of paragraph 3 of subsection (t) of 52 section 4303 of the insurance law, as added by chapter 219 of the laws 53 of 2011, are amended and a new subparagraph (C) is added to read as 54 follows:S. 1507--A 58 A. 2007--A 1 (A) evidence-based items or services for cervical cytology that have 2 in effect a rating of 'A' or 'B' in the current recommendations of the 3 United States preventive services task force; [and] 4 (B) with respect to women, such additional preventive care and screen- 5 ings for cervical cytology not described in subparagraph (A) of this 6 paragraph and as provided for in comprehensive guidelines supported by 7 the health resources and services administration[.]; and 8 (C) any other preventive care and screenings designated by the super- 9 intendent in a regulation that are consistent with current or previous 10 recommendations or guidelines identified in subparagraphs (A) and (B) of 11 this paragraph. 12 § 26. Subsection (u-1) of section 4303 of the insurance law, as 13 amended by chapter 377 of the laws of 2014, is amended to read as 14 follows: 15 (u-1) A medical expense indemnity corporation or a health service 16 corporation which provides medical coverage that includes coverage for 17 physician services in a physician's office and every policy which 18 provides major medical or similar comprehensive-type coverage shall 19 include coverage for equipment and supplies used for the treatment of 20 ostomies, if prescribed by a physician or other licensed health care 21 provider legally authorized to prescribe under title eight of the educa- 22 tion law. Such coverage shall be subject to annual deductibles and coin- 23 surance as deemed appropriate by the superintendent. The coverage 24 required by this subsection shall be identical to, and shall not enhance 25 or increase the coverage required as part of essential health benefits 26 as [required pursuant to] defined in subsection (a) of section [2707(a)27of the public health services act 42 U.S.C. 300 gg-6(a)] four thousand 28 three hundred six-h of this article. 29 § 27. Subsection (y) of section 4303 of the insurance law, as amended 30 by chapter 469 of the laws of 2018, is amended to read as follows: 31 (y) Every contract [which] that provides coverage for prescription 32 drugs shall include coverage for the cost of enteral formulas for home 33 use, whether administered orally or via tube feeding, for which a physi- 34 cian or other licensed health care provider legally authorized to 35 prescribe under title eight of the education law has issued a written 36 order. Such written order shall state that the enteral formula is clear- 37 ly medically necessary and has been proven effective as a disease-spe- 38 cific treatment regimen. Specific diseases and disorders for which 39 enteral formulas have been proven effective shall include, but are not 40 limited to, inherited diseases of amino-acid or organic acid metabolism; 41 Crohn's Disease; gastroesophageal reflux; disorders of gastrointestinal 42 motility such as chronic intestinal pseudo-obstruction; and multiple, 43 severe food allergies including, but not limited to immunoglobulin E and 44 nonimmunoglobulin E-mediated allergies to multiple food proteins; severe 45 food protein induced enterocolitis syndrome; eosinophilic disorders; and 46 impaired absorption of nutrients caused by disorders affecting the 47 absorptive surface, function, length, and motility of the gastrointesti- 48 nal tract. Enteral formulas [which] that are medically necessary and 49 taken under written order from a physician for the treatment of specific 50 diseases shall be distinguished from nutritional supplements taken elec- 51 tively. Coverage for certain inherited diseases of amino acid and organ- 52 ic acid metabolism as well as severe protein allergic conditions shall 53 include modified solid food products that are low protein, [or which] 54 contain modified protein, or are amino acid based [which] that are 55 medically necessary[, and such coverage for such modified solid food56products for any calendar year or for any continuous period of twelveS. 1507--A 59 A. 2007--A 1months for any insured individual shall not exceed two thousand five2hundred dollars]. 3 § 28. Subparagraphs (A) and (B) of paragraph 4 of subsection (bb) of 4 section 4303 of the insurance law, as added by chapter 219 of the laws 5 of 2011, are amended and a new subparagraph (C) is added to read as 6 follows: 7 (A) evidence-based items or services for bone mineral density that 8 have in effect a rating of 'A' or 'B' in the current recommendations of 9 the United States preventive services task force; [and] 10 (B) with respect to women, such additional preventive care and screen- 11 ings for bone mineral density not described in subparagraph (A) of this 12 paragraph and as provided for in comprehensive guidelines supported by 13 the health resources and services administration[.]; and 14 (C) any other preventive care and screenings designated by the super- 15 intendent in a regulation that are consistent with current or previous 16 recommendations or guidelines identified in subparagraphs (A) and (B) of 17 this paragraph. 18 § 29. Subsection (ll) of section 4303 of the insurance law, as added 19 by section 55 of part D of chapter 56 of the laws of 2013, is amended to 20 read as follows: 21 (ll) Every small group contract or association group contract [deliv-22ered or issued for delivery in this state] issued by a corporation 23 subject to the provisions of this article that provides coverage for 24 hospital, medical or surgical expense insurance and is not a grandfa- 25 thered health plan shall provide coverage for the essential health 26 [benefit] benefits package [as required in section 2707(a) of the public27health service act, 42 U.S.C. § 300gg-6(a)]. For purposes of this 28 subsection: 29 (1) "essential health benefits package" shall have the meaning set 30 forth in paragraph three of subsection (f) of section [1302(a) of the31affordable care act, 42 U.S.C. § 18022(a)] four thousand three hundred 32 six-h of this article; 33 (2) "grandfathered health plan" means coverage provided by a corpo- 34 ration in which an individual was enrolled on March twenty-third, two 35 thousand ten for as long as the coverage maintains grandfathered status 36 in accordance with section 1251(e) of the affordable care act, 42 U.S.C. 37 § 18011(e); and 38 (3) "small group" means a group of [fifty or fewer employees or39members exclusive of spouses and dependents. Beginning January first,40two thousand sixteen, "small group" means a group of] one hundred or 41 fewer employees or members exclusive of spouses and dependents; and 42 (4) "association group" means a group defined in subparagraphs (B), 43 (D), (H), (K), (L) or (M) of paragraph one of subsection (c) of section 44 four thousand two hundred thirty-five of this chapter, provided that: 45 (A) the group includes one or more individual members; or 46 (B) the group includes one or more member employers or other member 47 groups that are small groups. 48 § 30. Subsection (mm) of section 4303 of the insurance law, as added 49 by section 55 of part D of chapter 56 of the laws of 2013, is amended to 50 read as follows: 51 (mm) A corporation shall not be required to offer the contract holder 52 any benefits that must be made available pursuant to this section if 53 such benefits must be covered pursuant to subsection (kk) of this 54 section. For any contract issued within the health benefit exchange 55 established [pursuant to section 1311 of the affordable care act, 4256U.S.C. § 18031] by this state, a corporation shall not be required toS. 1507--A 60 A. 2007--A 1 offer the contract holder any benefits that must be made available 2 pursuant to this section. 3 § 31. Item (i) of subparagraph (C) of paragraph 2 of subsection (c) of 4 section 4304 of the insurance law, as amended by chapter 317 of the laws 5 of 2017, is amended to read as follows: 6 (i) Discontinuance of a class of contract upon not less than ninety 7 days' prior written notice. In exercising the option to discontinue 8 coverage pursuant to this item, the corporation must act uniformly with- 9 out regard to any health status-related factor of enrolled individuals 10 or individuals who may become eligible for such coverage and must offer 11 to subscribers or group remitting agents, as may be appropriate, the 12 option to purchase all other individual health insurance coverage 13 currently being offered by the corporation to applicants in that market. 14 Provided, however, the superintendent may, after giving due consider- 15 ation to the public interest, approve a request made by a corporation 16 for the corporation to satisfy the requirements of this item through the 17 offering of contracts at each level of coverage as defined in subsection 18 (c) of section [1302(d) of the affordable care act, 42 U.S.C. §1918022(d)] four thousand three hundred six-h of this article that 20 contains the essential health benefits package described in paragraph 21 [one] three of subsection [(b)] (f) of section four thousand three 22 hundred [twenty-eight] six-h of this [chapter] article by another corpo- 23 ration, insurer or health maintenance organization within the corpo- 24 ration's same holding company system, as defined in article fifteen of 25 this chapter. 26 § 32. Paragraph 1 of subsection (e) of section 4304 of the insurance 27 law, as amended by chapter 388 of the laws of 2014, is amended to read 28 as follows: 29 (1) (A) If any such contract is terminated in accordance with the 30 provisions of paragraph one of subsection (c) of this section, or any 31 such contract is terminated because of a default by the remitting agent 32 in the payment of premiums not cured within the grace period and the 33 remitting agent has not replaced the contract with similar and contin- 34 uous coverage for the same group whether insured or self-insured, or any 35 such contract is terminated in accordance with the provisions of subpar- 36 agraph (E) of paragraph two of subsection (c) of this section, or if an 37 individual other than the contract holder is no longer covered under a 38 "family contract" because the individual is no longer within the defi- 39 nition set forth in the contract, or a spouse is no longer covered under 40 the contract because of divorce from the contract holder or annulment of 41 the marriage, or any such contract is terminated because of the death of 42 the contract holder, then such individual, former spouse, or in the case 43 of the death of the contract holder the surviving spouse or other depen- 44 dents of the deceased contract holder covered under the contract, as the 45 case may be, shall be entitled to convert, without evidence of insura- 46 bility, upon application therefor and the making of the first payment 47 thereunder within sixty days after the date of termination of such 48 contract, to a contract that contains the essential health benefits 49 package described in paragraph [one] three of subsection [(b)] (f) of 50 section four thousand three hundred [twenty-eight] six-h of this [chap-51ter] article. 52 (B) The corporation shall offer one contract at each level of coverage 53 as defined in subsection (c) of section [1302(d) of the affordable care54act, 42 U.S.C. § 18022(d)] four thousand three hundred six-h of this 55 article. The individual may choose any such contract offered by the 56 corporation. Provided, however, the superintendent may, after giving dueS. 1507--A 61 A. 2007--A 1 consideration to the public interest, approve a request made by a corpo- 2 ration for the corporation to satisfy the requirements of this paragraph 3 through the offering of contracts that comply with this paragraph by 4 another corporation, insurer or health maintenance organization within 5 the corporation's same holding company system, as defined in article 6 fifteen of this chapter. 7 (C) The effective date of the coverage provided by the converted 8 direct payment contract shall be the date of the termination of coverage 9 under the contract from which conversion was made. 10 § 33. Subsection (l) of section 4304 of the insurance law, as added by 11 section 43 of part D of chapter 56 of the laws of 2013, is amended to 12 read as follows: 13 (l) [On and after October first, two thousand thirteen, a] A corpo- 14 ration shall not offer individual hospital, medical, or surgical expense 15 insurance contracts unless the contracts meet the requirements of 16 subsection (b) of section four thousand three hundred twenty-eight of 17 this article. Such contracts that are offered within the health benefit 18 exchange established [pursuant to section 1311 of the affordable care19act, 42 U.S.C. § 18031, or any regulations promulgated thereunder,] by 20 this state also shall meet any requirements established by the health 21 benefit exchange. To the extent that a holder of a special purpose 22 certificate of authority issued pursuant to section four thousand four 23 hundred three-a of the public health law offers individual hospital, 24 medical, or surgical expense insurance contracts, the contracts shall 25 meet the requirements of subsection (b) of section four thousand three 26 hundred twenty-eight of this article. 27 § 34. Subparagraph (A) of paragraph 1 of subsection (d) of section 28 4305 of the insurance law, as amended by chapter 388 of the laws of 29 2014, is amended to read as follows: 30 (A) A group contract issued pursuant to this section shall contain a 31 provision to the effect that in case of a termination of coverage under 32 such contract of any member of the group because of (i) termination for 33 any reason whatsoever of the member's employment or membership, or (ii) 34 termination for any reason whatsoever of the group contract itself 35 unless the group contract holder has replaced the group contract with 36 similar and continuous coverage for the same group whether insured or 37 self-insured, the member shall be entitled to have issued to the member 38 by the corporation, without evidence of insurability, upon application 39 therefor and payment of the first premium made to the corporation within 40 sixty days after termination of the coverage, an individual direct 41 payment contract, covering such member and the member's eligible depen- 42 dents who were covered by the group contract, which provides coverage 43 that contains the essential health benefits package described in para- 44 graph [one] three of subsection [(b)] (f) of section four thousand three 45 hundred [twenty-eight] six-h of this [chapter] article. The corporation 46 shall offer one contract at each level of coverage as defined in 47 subsection (c) of section [1302(d) of the affordable care act, 42 U.S.C.48§ 18022(d)] four thousand three hundred six-h of this article. The 49 member may choose any such contract offered by the corporation. 50 Provided, however, the superintendent may, after giving due consider- 51 ation to the public interest, approve a request made by a corporation 52 for the corporation to satisfy the requirements of this subparagraph 53 through the offering of contracts that comply with this subparagraph by 54 another corporation, insurer or health maintenance organization within 55 the corporation's same holding company system, as defined in article 56 fifteen of this chapter.S. 1507--A 62 A. 2007--A 1 § 35. The insurance law is amended by adding a new section 4306-h to 2 read as follows: 3 § 4306-h. Essential health benefits package and limit on cost-sharing. 4 (a) For purposes of this article, "essential health benefits" shall mean 5 the following categories of benefits: 6 (1) ambulatory patient services; 7 (2) emergency services; 8 (3) hospitalization; 9 (4) maternity and newborn care; 10 (5) mental health and substance use disorder services, including 11 behavioral health treatment; 12 (6) prescription drugs; 13 (7) rehabilitative and habilitative services and devices; 14 (8) laboratory services; 15 (9) preventive and wellness services and chronic disease management; 16 and 17 (10) pediatric services, including oral and vision care. 18 (b) The superintendent, in consultation with the commissioner of 19 health, may select as a benchmark, a plan or combination of plans that 20 together contain essential health benefits, in accordance with this 21 section and any applicable federal regulation. 22 (c) (1) Every individual and small group contract that provides hospi- 23 tal, surgical, or medical expense coverage and is not a grandfathered 24 health plan shall provide coverage that meets the actuarial requirements 25 of one of the following levels of coverage: 26 (A) Bronze Level. A plan in the bronze level shall provide a level of 27 coverage that is designed to provide benefits that are actuarially 28 equivalent to sixty percent of the full actuarial value of the benefits 29 provided under the plan; 30 (B) Silver Level. A plan in the silver level shall provide a level of 31 coverage that is designed to provide benefits that are actuarially 32 equivalent to seventy percent of the full actuarial value of the bene- 33 fits provided under the plan; 34 (C) Gold Level. A plan in the gold level shall provide a level of 35 coverage that is designed to provide benefits that are actuarially 36 equivalent to eighty percent of the full actuarial value of the benefits 37 provided under the plan; or 38 (D) Platinum Level. A plan in the platinum level shall provide a level 39 of coverage that is designed to provide benefits that are actuarially 40 equivalent to ninety percent of the full actuarial value of the benefits 41 provided under the plan. 42 (2) The superintendent may provide for a variation in the actuarial 43 values used in determining the level of coverage of a plan to account 44 for the differences in actuarial estimates. 45 (3) Every student accident and health insurance contract shall provide 46 coverage that meets at least sixty percent of the full actuarial value 47 of the benefits provided under the contract. The contract's schedule of 48 benefits shall include the level as described in paragraph one of this 49 subsection nearest to, but below the actual actuarial value. 50 (d) Every individual or group contract that provides hospital, surgi- 51 cal, or medical expense coverage and is not a grandfathered health plan, 52 and every student accident and health insurance contract shall limit the 53 insured's cost-sharing for in-network services in a contract year to not 54 more than the maximum out-of-pocket amount determined by the superinten- 55 dent for all contracts subject to this section. Such amount shall notS. 1507--A 63 A. 2007--A 1 exceed any annual out-of-pocket limit on cost-sharing set by the United 2 States secretary of health and human services, if available. 3 (e) The superintendent may require the use of model language describ- 4 ing the coverage requirements for any form that is subject to the 5 approval of the superintendent pursuant to section four thousand three 6 hundred eight of this article. 7 (f) For purposes of this section: 8 (1) "actuarial value" means the percentage of the total expected 9 payments by the corporation for benefits provided to a standard popu- 10 lation, without regard to the population to whom the corporation actual- 11 ly provides benefits; 12 (2) "cost-sharing" means annual deductibles, coinsurance, copayments, 13 or similar charges, for covered services; 14 (3) "essential health benefits package" means coverage that: 15 (A) provides for essential health benefits; 16 (B) limits cost-sharing for such coverage in accordance with 17 subsection (d) of this section; and 18 (C) provides one of the levels of coverage described in subsection (c) 19 of this section; 20 (4) "grandfathered health plan" means coverage provided by a corpo- 21 ration in which an individual was enrolled on March twenty-third, two 22 thousand ten for as long as the coverage maintains grandfathered status 23 in accordance with section 1251(e) of the Affordable Care Act, 42 U.S.C. 24 § 18011(e); 25 (5) "small group" means a group of one hundred or fewer employees or 26 members exclusive of spouses and dependents; and 27 (6) "student accident and health insurance" shall have the meaning set 28 forth in subsection (a) of section three thousand two hundred forty of 29 this chapter. 30 § 36. Paragraph 4 of subsection (a) of section 4317 of the insurance 31 law, as amended by section 72 of part D of chapter 56 of the laws of 32 2013, is amended to read as follows: 33 (4) For the purposes of this section, "community rated" means a rating 34 methodology in which the premium for all persons covered by a policy or 35 contract form is the same, based on the experience of the entire pool of 36 risks of all individuals or small groups covered by the corporation 37 without regard to age, sex, health status, tobacco usage or occupation 38 excluding those individuals of small groups covered by Medicare supple- 39 mental insurance. For medicare supplemental insurance coverage, "commu- 40 nity rated" means a rating methodology in which the premiums for all 41 persons covered by a policy or contract form is the same based on the 42 experience of the entire pool of risks covered by that policy or 43 contract form without regard to age, sex, health status, tobacco usage 44 or occupation. [Catastrophic health insurance contracts issued pursuant45to section 1302(e) of the affordable care act, 42 U.S.C. § 18022(e),46shall be classified in a distinct community rating pool.] 47 § 37. Subsections (d), (e) and (j) of section 4326 of the insurance 48 law, as amended by section 56 of part D of chapter 56 of the laws of 49 2013, are amended to read as follows: 50 (d) A qualifying group health insurance contract shall provide cover- 51 age for the essential health [benefit] benefits package as [required in] 52 defined in paragraph three of subsection (f) of section [2707(a) of the53public health service act, 42 U.S.C. § 300gg-6(a). For purposes of this54subsection "essential health benefits package" shall have the meaning55set forth in section 1302(a) of the affordable care act, 42 U.S.C. §5618022(a)] four thousand three hundred six-h of this article.S. 1507--A 64 A. 2007--A 1 (e) A qualifying group health insurance contract [issued to a qualify-2ing small employer prior to January first, two thousand fourteen that3does not include all essential health benefits required pursuant to4section 2707(a) of the public health service act, 42 U.S.C. §5300gg-6(a), shall be discontinued, including grandfathered health plans.6For the purposes of this paragraph, "grandfathered health plans" means7coverage provided by a corporation to individuals who were enrolled on8March twenty-third, two thousand ten for as long as the coverage main-9tains grandfathered status in accordance with section 1251(e) of the10affordable care act, 42 U.S.C. § 18011(e). A qualifying small employer11shall be transitioned to a plan that provides: (1)] shall provide a 12 level of coverage that is designed to provide benefits that are actuari- 13 ally equivalent to eighty percent of the full actuarial value of the 14 benefits provided under the plan[; and (2) coverage for the essential15health benefit package as required in section 2707(a) of the public16health service act, 42 U.S.C. § 300gg-6(a)]. The superintendent shall 17 standardize the benefit package and cost sharing requirements of quali- 18 fied group health insurance contracts consistent with coverage offered 19 through the health benefit exchange established [pursuant to section201311 of the affordable care act, 42 U.S.C. § 18031] by this state. 21 (j) [Beginning January first, two thousand fourteen, pursuant to22section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3, a] A 23 corporation shall not impose any pre-existing condition limitation in a 24 qualifying group health insurance contract. 25 § 38. Subsection (m-1) of section 4327 of the insurance law, as 26 amended by section 58 of part D of chapter 56 of the laws of 2013, is 27 amended to read as follows: 28 (m-1) In the event that the superintendent suspends the enrollment of 29 new individuals for qualifying group health insurance contracts, the 30 superintendent shall ensure that small employers seeking to enroll in a 31 qualified group health insurance contract pursuant to section forty- 32 three hundred twenty-six of this article are provided information on and 33 directed to coverage options available through the health benefit 34 exchange established [pursuant to section 1311 of the affordable care35act, 42 U.S.C. § 18031] by this state. 36 § 39. Paragraphs 1, 2 and 3 of subsection (b) of section 4328 of the 37 insurance law, as added by section 46 of part D of chapter 56 of the 38 laws of 2013, are amended to read as follows: 39 (1) The individual enrollee direct payment contract offered pursuant 40 to this section shall provide coverage for the essential health [bene-41fit] benefits package as [required in] defined in paragraph three of 42 subsection (f) of section [2707(a) of the public health service act, 4243U.S.C. § 300gg-6(a). For purposes of this paragraph, "essential health44benefits package" shall have the meaning set forth in section 1302(a) of45the affordable care act, 42 U.S.C. § 18022(a)] four thousand three 46 hundred six-h of this article. 47 (2) A health maintenance organization shall offer at least one indi- 48 vidual enrollee direct payment contract at each level of coverage as 49 defined in subsection (c) of section [1302(d) of the affordable care50act, 42 U.S.C. § 18022(d)] four thousand three hundred six-h of this 51 article. A health maintenance organization also shall offer one child- 52 only plan, as required by section 1302(f) of the affordable care act, 42 53 U.S.C. § 18022(f), at each level of coverage [as required in section542707(c) of the public health service act, 42 U.S.C. § 300gg-6(c)]. 55 (3) Within the health benefit exchange established [pursuant to56section 1311 of the affordable care act, 42 U.S.C. § 18031] by thisS. 1507--A 65 A. 2007--A 1 state, a health maintenance organization may offer an individual enrol- 2 lee direct payment contract that is a catastrophic health plan as 3 defined in section 1302(e) of the affordable care act, 42 U.S.C. § 4 18022(e), or any regulations promulgated thereunder. 5 § 40. Subparagraph (A) of paragraph 4 of subsection (b) of section 6 4328 of the insurance law, as added by chapter 11 of the laws of 2016, 7 is amended to read as follows: 8 (A) The individual enrollee direct payment contract offered pursuant 9 to this section shall have the same enrollment periods, including 10 special enrollment periods, as required for an individual direct payment 11 contract offered within the health benefit exchange established [pursu-12ant to section 1311 of the affordable care act, 42 U.S.C. § 18031, or13any regulations promulgated thereunder] by this state. 14 § 41. Subsection (c) of section 4328 of the insurance law, as added by 15 section 46 of part D of chapter 56 of the laws of 2013, is amended to 16 read as follows: 17 (c) In addition to or in lieu of the individual enrollee direct 18 payment contracts required under this section, all health maintenance 19 organizations issued a certificate of authority under article forty-four 20 of the public health law or licensed under this article may offer indi- 21 vidual enrollee direct payment contracts within the health benefit 22 exchange established [pursuant to section 1311 of the affordable care23act, 42 U.S.C. § 18031, or any regulations promulgated thereunder] by 24 this state, subject to any requirements established by the health bene- 25 fit exchange. If a health maintenance organization satisfies the 26 requirements of subsection (a) of this section by offering individual 27 enrollee direct payment contracts, only within the health benefit 28 exchange, the health maintenance organization, not including a holder of 29 a special purpose certificate of authority issued pursuant to section 30 four thousand four hundred three-a of the public health law, shall also 31 offer at least one individual enrollee direct payment contract at each 32 level of coverage as defined in subsection (c) section [1302 (d) of the33affordable care act, 42 U.S.C. § 18022 (d)] four thousand three hundred 34 six-h of this article, outside the health benefit exchange. 35 § 42. This act shall take effect on the first of January next succeed- 36 ing the date on which it shall have become a law and shall apply to all 37 policies and contracts issued, renewed, modified, altered or amended on 38 or after such date. 39 SUBPART C 40 Section 1. Subsection (i) of section 3216 of the insurance law is 41 amended by adding a new paragraph 35 to read as follows: 42 (35) No policy delivered or issued for delivery in this state that 43 provides hospital, surgical, or medical expense coverage shall limit or 44 exclude coverage for abortions that are medically necessary. Coverage 45 for abortions that are medically necessary shall not be subject to annu- 46 al deductibles or coinsurance, including co-payments, unless the policy 47 is a high deductible health plan as defined in section 223(c)(2) of the 48 internal revenue code of 1986; in which case coverage for medically 49 necessary abortions may be subject to the plan's annual deductible. 50 § 2. Subsection (l) of section 3221 of the insurance law is amended by 51 adding a new paragraph 21 to read as follows: 52 (21) (A) No policy delivered or issued for delivery in this state that 53 provides hospital, surgical, or medical expense coverage shall limit or 54 exclude coverage for abortions that are medically necessary. CoverageS. 1507--A 66 A. 2007--A 1 for abortions that are medically necessary shall not be subject to annu- 2 al deductibles or coinsurance, including co-payments, unless the policy 3 is a high deductible health plan as defined in section 223(c)(2) of the 4 internal revenue code of 1986; in which case coverage for medically 5 necessary abortions may be subject to the plan's annual deductible. 6 (B) Notwithstanding any other provision, a group policy that provides 7 hospital, surgical, or medical expense coverage delivered or issued for 8 delivery in this state to a religious employer, as defined in paragraph 9 sixteen of this subsection, may exclude coverage for medically necessary 10 abortions only if the insurer: 11 (i) obtains an annual certification from the group policyholder that 12 the policyholder is a religious employer and that the religious employer 13 requests a policy without coverage for medically necessary abortions; 14 (ii) issues a rider to each certificateholder at no premium to be 15 charged to the certificateholder or religious employer for the rider, 16 that provides coverage for medically necessary abortions subject to the 17 same rules as would have been applied to the same category of treatment 18 in the policy issued to the religious employer. The rider shall clearly 19 and conspicuously specify that the religious employer does not adminis- 20 ter medically necessary abortion benefits, but that the insurer is issu- 21 ing a rider for coverage of medically necessary abortions, and shall 22 provide the insurer's contact information for questions; and 23 (iii) provides notice of the issuance of the policy and rider to the 24 superintendent in a form and manner acceptable to the superintendent. 25 § 3. Section 4303 of the insurance law is amended by adding a new 26 subsection (ss) to read as follows: 27 (ss) (1) No contract issued by a corporation subject to the provisions 28 of this article that provides hospital, surgical, or medical expense 29 coverage shall limit or exclude coverage for abortions that are 30 medically necessary. Coverage for abortions that are medically necessary 31 shall not be subject to annual deductibles or coinsurance, including 32 co-payments, unless the contract is a high deductible health plan as 33 defined in section 223(c)(2) of the internal revenue code of 1986 in 34 which case coverage for medically necessary abortions may be subject to 35 the contract's annual deductible. 36 (2) Notwithstanding any other provision, a group contract that 37 provides hospital, surgical, or medical expense coverage delivered or 38 issued for delivery in this state to a religious employer as defined in 39 subsection (cc) of this section may exclude coverage for medically 40 necessary abortions only if the corporation: 41 (A) obtains an annual certification from the group contractholder that 42 the contractholder is a religious employer and that the religious 43 employer requests a contract without coverage for medically necessary 44 abortions; 45 (B) issues a rider to each certificateholder at no premium to be 46 charged to the certificateholder or religious employer for the rider, 47 that provides coverage for medically necessary abortions subject to the 48 same rules as would have been applied to the same category of treatment 49 in the contract issued to the religious employer. The rider must clearly 50 and conspicuously specify that the religious employer does not adminis- 51 ter medically necessary abortion benefits, but that the corporation is 52 issuing a rider for coverage of medically necessary abortions, and shall 53 provide the corporation's contact information for questions; and 54 (C) provides notice of the issuance of the contract and rider to the 55 superintendent in a form and manner acceptable to the superintendent.S. 1507--A 67 A. 2007--A 1 § 4. This act shall take effect on the first of January next succeed- 2 ing the date on which it shall have become a law and shall apply to all 3 policies and contracts issued, renewed, modified, altered or amended on 4 or after such date. 5 SUBPART D 6 Section 1. The insurance law is amended by adding a new section 3242 7 to read as follows: 8 § 3242. Prescription drug coverage. (a) Every insurer that delivers 9 or issues for delivery in this state a policy that provides coverage for 10 prescription drugs shall, with respect to the prescription drug cover- 11 age, publish an up-to-date, accurate, and complete list of all covered 12 prescription drugs on its formulary drug list, including any tiering 13 structure that it has adopted and any restrictions on the manner in 14 which a prescription drug may be obtained, in a manner that is easily 15 accessible to insureds and prospective insureds. The formulary drug list 16 shall clearly identify the preventive prescription drugs that are avail- 17 able without annual deductibles or coinsurance, including co-payments. 18 (b) (1) Every policy delivered or issued for delivery in this state 19 that provides coverage for prescription drugs shall include in the poli- 20 cy a process that allows an insured, the insured's designee, or the 21 insured's prescribing health care provider to request a formulary excep- 22 tion. With respect to the process for such a formulary exception, an 23 insurer shall follow the process and procedures specified in article 24 forty-nine of this chapter and article forty-nine of the public health 25 law, except as otherwise provided in paragraphs two, three, four and 26 five of this subsection. 27 (2) (A) An insurer shall have a process for an insured, the insured's 28 designee, or the insured's prescribing health care provider to request a 29 standard review that is not based on exigent circumstances of a formu- 30 lary exception for a prescription drug that is not covered by the poli- 31 cy. 32 (B) An insurer shall make a determination on a standard exception 33 request that is not based on exigent circumstances and notify the 34 insured or the insured's designee and the insured's prescribing health 35 care provider by telephone of its coverage determination no later than 36 seventy-two hours following receipt of the request. 37 (C) An insurer that grants a standard exception request that is not 38 based on exigent circumstances shall provide coverage of the non-formu- 39 lary prescription drug for the duration of the prescription, including 40 refills. 41 (D) For the purpose of this subsection, "exigent circumstances" means 42 when an insured is suffering from a health condition that may seriously 43 jeopardize the insured's life, health, or ability to regain maximum 44 function or when an insured is undergoing a current course of treatment 45 using a non-formulary prescription drug. 46 (3) (A) An insurer shall have a process for an insured, the insured's 47 designee, or the insured's prescribing health care provider to request 48 an expedited review based on exigent circumstances of a formulary excep- 49 tion for a prescription drug that is not covered by the policy. 50 (B) An insurer shall make a determination on an expedited review 51 request based on exigent circumstances and notify the insured or the 52 insured's designee and the insured's prescribing health care provider by 53 telephone of its coverage determination no later than twenty-four hours 54 following receipt of the request.S. 1507--A 68 A. 2007--A 1 (C) An insurer that grants an exception based on exigent circumstances 2 shall provide coverage of the non-formulary prescription drug for the 3 duration of the exigent circumstances. 4 (4) An insurer that denies an exception request under paragraph two or 5 three of this subsection shall provide written notice of its determi- 6 nation to the insured or the insured's designee and the insured's 7 prescribing health care provider within three business days of receipt 8 of the exception request. The written notice shall be considered a final 9 adverse determination under section four thousand nine hundred four of 10 this chapter or section four thousand nine hundred four of the public 11 health law. Written notice shall also include the name or names of clin- 12 ically appropriate prescription drugs covered by the insurer to treat 13 the insured. 14 (5) (A) If an insurer denies a request for an exception under para- 15 graph two or three of this subsection, the insured, the insured's desig- 16 nee, or the insured's prescribing health care provider shall have the 17 right to request that such denial be reviewed by an external appeal 18 agent certified by the superintendent pursuant to section four thousand 19 nine hundred eleven of this chapter in accordance with article forty- 20 nine of this chapter or article forty-nine of the public health law. 21 (B) An external appeal agent shall make a determination on the 22 external appeal and notify the insurer, the insured or the insured's 23 designee, and the insured's prescribing health care provider by tele- 24 phone of its determination no later than seventy-two hours following the 25 external appeal agent's receipt of the request, if the original request 26 was a standard exception request under paragraph two of this subsection. 27 The external appeal agent shall notify the insurer, the insured or the 28 insured's designee, and the insured's prescribing health care provider 29 in writing of the external appeal determination within two business days 30 of rendering such determination. 31 (C) An external appeal agent shall make a determination on the 32 external appeal and notify the insurer, the insured or the insured's 33 designee, and the insured's prescribing health care provider by tele- 34 phone of its determination no later than twenty-four hours following the 35 external appeal agent's receipt of the request, if the original request 36 was an expedited exception request under paragraph three of this 37 subsection and the insured's prescribing health care provider attests 38 that exigent circumstances exist. The external appeal agent shall notify 39 the insurer, the insured or the insured's designee, and the insured's 40 prescribing health care provider in writing of the external appeal 41 determination within seventy-two hours of the external appeal agent's 42 receipt of the external appeal. 43 (D) An external appeal agent shall make a determination in accordance 44 with subparagraph (A) of paragraph four of subsection (b) of section 45 four thousand nine hundred fourteen of this chapter or subparagraph (A) 46 of paragraph (d) of subdivision two of section four thousand nine 47 hundred fourteen of the public health law. When making a determination, 48 the external appeal agent shall consider whether the formulary 49 prescription drug covered by the insurer will be or has been ineffec- 50 tive, would not be as effective as the non-formulary prescription drug, 51 or would have adverse effects. 52 (E) If an external appeal agent overturns the insurer's denial of a 53 standard exception request under paragraph two of this subsection, then 54 the insurer shall provide coverage of the non-formulary prescription 55 drug for the duration of the prescription, including refills. If an 56 external appeal agent overturns the insurer's denial of an expeditedS. 1507--A 69 A. 2007--A 1 exception request under paragraph three of this subsection, then the 2 insurer shall provide coverage of the non-formulary prescription drug 3 for the duration of the exigent circumstances. 4 § 2. The insurance law is amended by adding a new section 4329 to read 5 as follows: 6 § 4329. Prescription drug coverage. (a) Every corporation subject to 7 the provisions of this article that issues a contract that provides 8 coverage for prescription drugs shall, with respect to the prescription 9 drug coverage, publish an up-to-date, accurate, and complete list of all 10 covered prescription drugs on its formulary drug list, including any 11 tiering structure that it has adopted and any restrictions on the manner 12 in which a prescription drug may be obtained, in a manner that is easily 13 accessible to insureds and prospective insureds. The formulary drug list 14 shall clearly identify the preventive prescription drugs that are avail- 15 able without annual deductibles or coinsurance, including co-payments. 16 (b) (1) Every contract issued by a corporation subject to the 17 provisions of this article that provides coverage for prescription drugs 18 shall include in the contract a process that allows an insured, the 19 insured's designee, or the insured's prescribing health care provider to 20 request a formulary exception. With respect to the process for such a 21 formulary exception, a corporation shall follow the process and proce- 22 dures specified in article forty-nine of this chapter and article 23 forty-nine of the public health law, except as otherwise provided in 24 paragraphs two, three, four and five of this subsection. 25 (2) (A) A corporation shall have a process for an insured, the 26 insured's designee, or the insured's prescribing health care provider to 27 request a standard review that is not based on exigent circumstances of 28 a formulary exception for a prescription drug that is not covered by the 29 contract. 30 (B) A corporation shall make a determination on a standard exception 31 request that is not based on exigent circumstances and notify the 32 insured or the insured's designee and the insured's prescribing health 33 care provider by telephone of its coverage determination no later than 34 seventy-two hours following receipt of the request. 35 (C) A corporation that grants a standard exception request that is not 36 based on exigent circumstances shall provide coverage of the non-formu- 37 lary prescription drug for the duration of the prescription, including 38 refills. 39 (D) For the purpose of this subsection, "exigent circumstances" means 40 when an insured is suffering from a health condition that may seriously 41 jeopardize the insured's life, health, or ability to regain maximum 42 function or when an insured is undergoing a current course of treatment 43 using a non-formulary prescription drug. 44 (3) (A) A corporation shall have a process for an insured, the 45 insured's designee, or the insured's prescribing health care provider to 46 request an expedited review based on exigent circumstances of a formu- 47 lary exception for a prescription drug is not covered by the contract. 48 (B) A corporation shall make a determination on an expedited review 49 request based on exigent circumstances and notify the insured or the 50 insured's designee and the insured's prescribing health care provider by 51 telephone of its coverage determination no later than twenty-four hours 52 following receipt of the request. 53 (C) A corporation that grants an exception based on exigent circum- 54 stances shall provide coverage of the non-formulary prescription drug 55 for the duration of the exigent circumstances.S. 1507--A 70 A. 2007--A 1 (4) A corporation that denies an exception request under paragraph two 2 or three of this subsection shall provide written notice of its determi- 3 nation to the insured or the insured's designee and the insured's 4 prescribing health care provider within three business days of receipt 5 of the exception request. The written notice shall be considered a final 6 adverse determination under section four thousand nine hundred four of 7 this chapter or section four thousand nine hundred four of the public 8 health law. Written notice shall also include the name or names of clin- 9 ically appropriate prescription drugs covered by the corporation to 10 treat the insured. 11 (5) (A) If a corporation denies a request for an exception under para- 12 graph two or three of this subsection, the insured, the insured's desig- 13 nee, or the insured's prescribing health care provider shall have the 14 right to request that such denial be reviewed by an external appeal 15 agent certified by the superintendent pursuant to section four thousand 16 nine hundred eleven of this chapter in accordance with article forty- 17 nine of this chapter and article forty-nine of the public health law. 18 (B) An external appeal agent shall make a determination on the 19 external appeal and notify the corporation, the insured or the insured's 20 designee, and the insured's prescribing health care provider by tele- 21 phone of its determination no later than seventy-two hours following the 22 external appeal agent's receipt of the request, if the original request 23 was a standard exception request under paragraph two of this subsection. 24 The external appeal agent shall notify the corporation, the insured or 25 the insured's designee and the insured's prescribing health care provid- 26 er in writing of the external appeal determination within two business 27 days of rendering such determination. 28 (C) An external appeal agent shall make a determination on the 29 external appeal and notify the corporation, the insured or the insured's 30 designee, and the insured's prescribing health care provider by tele- 31 phone of its determination no later than twenty-four hours following the 32 external appeal agent's receipt of the request, if the original request 33 was an expedited exception request under paragraph three of this 34 subsection and the insured's prescribing health care provider attests 35 that exigent circumstances exist. The external appeal agent shall notify 36 the corporation, the insured or the insured's designee and the insured's 37 prescribing health care provider in writing of the external appeal 38 determination within seventy-two hours of the external appeal agent's 39 receipt of the external appeal. 40 (D) An external appeal agent shall make a determination in accordance 41 with subparagraph (A) of paragraph four of subsection (b) of section 42 four thousand nine hundred fourteen of this chapter and subparagraph (A) 43 of paragraph (d) of subdivision two of section four thousand nine 44 hundred fourteen of the public health law. When making a determination, 45 the external appeal agent shall consider whether the formulary 46 prescription drug covered by the corporation will be or has been inef- 47 fective, would not be as effective as the non-formulary prescription 48 drug, or would have adverse effects. 49 (E) If an external appeal agent overturns the corporation's denial of 50 a standard exception request under paragraph two of this subsection, 51 then the corporation shall provide coverage of the non-formulary 52 prescription drug for the duration of the prescription, including 53 refills. If an external appeal agent overturns the corporation's denial 54 of an expedited exception request under paragraph three of this 55 subsection, then the corporation shall provide coverage of the non-for- 56 mulary prescription drug for the duration of the exigent circumstances.S. 1507--A 71 A. 2007--A 1 § 3. This act shall take effect on the first of January next succeed- 2 ing the date on which it shall have become a law and shall apply to all 3 policies and contracts issued, renewed, modified, altered or amended on 4 or after such date. 5 SUBPART E 6 Section 1. Section 2607 of the insurance law is amended to read as 7 follows: 8 § 2607. Discrimination because of sex or marital status. (a) No indi- 9 vidual or entity shall refuse to issue any policy of insurance, or 10 cancel or decline to renew [such] the policy because of the sex or mari- 11 tal status of the applicant or policyholder or engage in sexual stere- 12 otyping. 13 (b) For the purposes of this section, "sex" shall include sexual 14 orientation, gender identity or expression, and transgender status. 15 § 2. The insurance law is amended by adding a new section 3243 to read 16 as follows: 17 § 3243. Discrimination because of sex or marital status in hospital, 18 surgical or medical expense insurance. (a) With regard to an accident 19 and health insurance policy that provides hospital, surgical, or medical 20 expense coverage or a policy of student accident and health insurance, 21 as defined in subsection (a) of section three thousand two hundred forty 22 of this article, delivered or issued for delivery in this state, no 23 insurer shall because of sex, marital status or based on pregnancy, 24 false pregnancy, termination of pregnancy, or recovery therefrom, child- 25 birth or related medical conditions: 26 (1) make any distinction or discrimination between persons as to the 27 premiums or rates charged for the policy or in any other manner whatev- 28 er; 29 (2) demand or require a greater premium from any person than it 30 requires at that time from others in similar cases; 31 (3) make or require any rebate, discrimination or discount upon the 32 amount to be paid or the service to be rendered on any policy; 33 (4) insert in the policy any condition, or make any stipulation, 34 whereby the insured binds his or herself, or his or her heirs, execu- 35 tors, administrators or assigns, to accept any sum or service less than 36 the full value or amount of such policy in case of a claim thereon 37 except such conditions and stipulations as are imposed upon others in 38 similar cases; and any such stipulation or condition so made or inserted 39 shall be void; 40 (5) reject any application for a policy issued or sold by it; 41 (6) cancel or refuse to issue, renew or sell such policy after appro- 42 priate application therefor; 43 (7) fix any lower rate or discriminate in the fees or commissions of 44 insurance agents or insurance brokers for writing or renewing such a 45 policy; or 46 (8) engage in sexual stereotyping. 47 (b) For the purposes of this section, "sex" shall include sexual 48 orientation, gender identity or expression, and transgender status. 49 § 3. The insurance law is amended by adding a new section 4330 to read 50 as follows: 51 § 4330. Discrimination because of sex or marital status in hospital, 52 surgical or medical expense insurance. (a) With regard to a contract 53 issued by a corporation subject to the provisions of this article that 54 provides hospital, surgical, or medical expense coverage or a contractS. 1507--A 72 A. 2007--A 1 of student accident and health insurance, as defined in subsection (a) 2 of section three thousand two hundred forty of this chapter, no corpo- 3 ration shall because of sex, marital status or based on pregnancy, false 4 pregnancy, termination of pregnancy, or recovery therefrom, childbirth 5 or related medical conditions: 6 (1) make any distinction or discrimination between persons as to the 7 premiums or rates charged for the contract or in any other manner what- 8 ever; 9 (2) demand or require a greater premium from any person than it 10 requires at that time from others in similar cases; 11 (3) make or require any rebate, discrimination or discount upon the 12 amount to be paid or the service to be rendered on any contract; 13 (4) insert in the contract any condition, or make any stipulation, 14 whereby the insured binds his or herself, or his or her heirs, execu- 15 tors, administrators or assigns, to accept any sum or service less than 16 the full value or amount of such contract in case of a claim thereon 17 except such conditions and stipulations as are imposed upon others in 18 similar cases; and any such stipulation or condition so made or inserted 19 shall be void; 20 (5) reject any application for a contract issued or sold by it; 21 (6) cancel or refuse to issue, renew or sell such contract after 22 appropriate application therefor; 23 (7) fix any lower rate or discriminate in the fees or commissions of 24 insurance agents or insurance brokers for writing or renewing such a 25 contract; or 26 (8) engage in sexual stereotyping. 27 (b) For purposes of this section, "sex" shall include sexual orien- 28 tation, gender identity or expression, and transgender status. 29 § 4. This act shall take effect on the first of January next succeed- 30 ing the date on which it shall have become a law and shall apply to all 31 policies and contracts issued, renewed, modified, altered or amended on 32 or after such date. 33 SUBPART F 34 Section 1. Subparagraph (B) of paragraph 2 of subsection (b) of 35 section 1101 of the insurance law, as amended by chapter 369 of the laws 36 of 1985, is amended to read as follows: 37 (B) transactions with respect to group life, group annuity, group 38 accident and health or blanket accident and health insurance (other than 39 any transaction with respect to a group annuity contract funding indi- 40 vidual retirement accounts or individual retirement annuities, as 41 defined in section four hundred eight of the Internal Revenue Code, 42 funding annuities in accordance with subdivision (b) of section four 43 hundred three of such code or providing a plan of retirement annuities 44 under which the payments are derived wholly from funds contributed by 45 the persons covered): 46 (i) where such groups conform to the definitions of eligibility 47 contained in[;]: 48 (I) the following paragraphs of subsection (b) of section four thou- 49 sand two hundred sixteen of this chapter: 50 (aa) paragraph (1) or (2); 51 (bb) paragraph (3), if, with respect to those credit transactions 52 entered into in this state, the policy fully conforms with the require- 53 ments of sections three thousand two hundred one, three thousand two 54 hundred twenty and four thousand two hundred sixteen of this chapter; orS. 1507--A 73 A. 2007--A 1 (cc) paragraphs (4), (5), (6), (7), (8), (9) [and] or (10)[.]; 2 (II) the following subparagraphs of paragraph (1) of subsection (c) of 3 section four thousand two hundred thirty-five of this chapter: 4 (aa) subparagraph (A), (B), (C) or (D), (except that with regard to 5 subparagraphs (A), (B), and (D), transactions with respect to an employ- 6 er that has established or participates in a fund to insure employees of 7 an employer or an employer to whom the policy is issued, where: (aaa) 8 the employer has its principal place of business in this state; or (bbb) 9 the lesser of twenty-five percent of employees work in this state or 10 twenty-five or more employers work in this state); 11 (bb) subparagraph (E), if, with respect to those credit transactions 12 entered into in this state, the policy fully conforms with the require- 13 ments of sections three thousand two hundred one, three thousand two 14 hundred twenty-one and four thousand two hundred thirty-five of this 15 chapter; 16 (cc) subparagraphs (F)[,] and (G) [and (H).]; 17 (III) section four thousand two hundred thirty-seven (except subpara- 18 graph (B) for transactions with respect to an employer to whom the poli- 19 cy is issued where the employer has its principal place of business in 20 this state or the lesser of twenty-five percent of employees work in 21 this state or twenty-five or more employees work in this state, (C), 22 (E), or (F) of paragraph three of subsection (a) thereof) or four thou- 23 sand two hundred thirty-eight (except paragraphs six and seven of 24 subsection (b) thereof) of this chapter; and 25 (ii) where the master policies or contracts were lawfully issued with- 26 out this state in a jurisdiction where the insurer was authorized to do 27 an insurance business; 28 § 2. Items (ii) and (iii) of subparagraph (A) of paragraph 8 of 29 subsection (b) of section 1101 of the insurance law, as added by chapter 30 449 of the laws of 2014, are amended to read as follows: 31 (ii) subparagraph (A), (B), (C), or (D) [(with respect to a policy32issued to a trustee or trustees of a fund established or participated in33by two or more employers, one or more labor unions, or by one or more34employers or labor unions, provided that all such employers or labor35unions are in the same industry)] of paragraph one of subsection (c) of 36 section four thousand two hundred thirty-five of this chapter (except 37 that with regard to subparagraphs (A), (B), and (D), transactions with 38 respect to an employer that has established or participates in a fund to 39 insure employees of an employer or an employer to whom the policy is 40 issued, where: (I) the employer has its principal place of business in 41 this state; or (II) the lesser of twenty-five percent of employees work 42 in this state or twenty-five or more employees work in this state); or 43 (iii) paragraphs one, two, three or four of subsection (b) of section 44 four thousand two hundred thirty-eight of this chapter, but not includ- 45 ing a group annuity contract: (I) funding individual retirement accounts 46 or individual retirement annuities, as defined in section four hundred 47 eight of the Internal Revenue Code; (II) funding annuities in accordance 48 with subdivision (b) of section four hundred three of such code; or 49 (III) providing a plan of retirement annuities under which the payments 50 are derived wholly from funds contributed by the persons covered[.]; 51 § 3. Subsection (b) of section 1101 of the insurance law is amended by 52 adding a new paragraph 9 to read as follows: 53 (9) For purposes of this subsection, "principal place of business" 54 shall mean the place where an employer maintains its headquarters or 55 where the employer's high-level officers direct, control, and coordinate 56 the business activities.S. 1507--A 74 A. 2007--A 1 § 4. Paragraph 1 of subsection (b) of section 3201 of the insurance 2 law, as amended by chapter 369 of the laws of 1985, is amended to read 3 as follows: 4 (1) (A) No policy form shall be delivered or issued for delivery in 5 this state unless it has been filed with and approved by the superinten- 6 dent as conforming to the requirements of this chapter and not incon- 7 sistent with law. 8 (B) A group life, group accident, group health, group accident and 9 health, blanket accident, blanket health, or blanket accident and health 10 insurance certificate evidencing insurance coverage on a resident of 11 this state shall be deemed to have been delivered in this state, regard- 12 less of the place of actual delivery[, unless the insured group] or the 13 type of group to which the group or blanket policy or contract is 14 issued. 15 (C) Notwithstanding subparagraph (B) of this paragraph, a certificate 16 shall not be deemed to have been delivered in this state when: (i) the 17 certificate is not actually delivered in this state; (ii) the insured 18 group is of the type described in[: (A)] section four thousand two 19 hundred sixteen of this chapter, except paragraph four where the group 20 policy is issued to a trustee or trustees of a fund established or 21 participated in by two or more employers not in the same industry with 22 respect to an employer principally located within the state, paragraph 23 twelve, thirteen or fourteen of subsection (b) thereof; and (iii) the 24 master policy or contract is lawfully issued without this state in a 25 jurisdiction where the insurer is authorized to do an insurance busi- 26 ness. 27 (D) Notwithstanding subparagraph (B) of this paragraph, where the 28 master policy or contract is lawfully issued without this state in a 29 jurisdiction where the insurer is authorized to do an insurance busi- 30 ness, a certificate shall not be deemed to have been delivered in this 31 state even if it is actually delivered in this state when the insured 32 group is of the type described in: 33 [(B)] (i) section four thousand two hundred thirty-five of this chap- 34 ter, except [subparagraph]: (I) subparagraphs (A), (B) and (D) [where35the group policy is issued to a trustee or trustees of a fund estab-36lished or participated in by two or more employers not in the same37industry with respect to an employer principally located within the38state, subparagraph] of paragraph one of subsection (c) thereof, with 39 respect to an employer that has established or participates in a fund to 40 insure employees of an employer or an employer to whom the policy is 41 issued, where the employer has its principal place of business in this 42 state or the lesser of twenty-five percent of employees work in this 43 state or twenty-five or more employees work in this state; or (II) 44 subparagraphs (H), (K), (L) or (M) of paragraph one of subsection (c) 45 thereof; or 46 [(C)] (ii) section four thousand two hundred thirty-seven [(] of this 47 chapter, except subparagraph (B) with respect to an employer to whom the 48 policy is issued where the employer has its principal place of business 49 in this state or the lesser of twenty-five percent of employees work in 50 this state or twenty-five or more employees work in this state, (C), (E) 51 or (F) of paragraph three of subsection (a) thereof[; of this chapter;52and where the master policies or contracts were lawfully issued without53this state in a jurisdiction where the insurer was authorized to do an54insurance business]. 55 (E)(i) With regard to any group life insurance certificate deemed to 56 have been delivered in this state by virtue of subparagraph (B) or (C)S. 1507--A 75 A. 2007--A 1 of this paragraph, the superintendent shall [(i)]: (I) require that the 2 premiums charged be reasonable in relation to the benefits provided, 3 except in cases where the policyholder pays the entire premium; [(ii)] 4 (II) have power to issue regulations prescribing the required, optional 5 and prohibited provisions in such certificates; [(iii)] and (III) estab- 6 lish an accelerated certificate form approval procedure available to an 7 insurer [which] that includes a statement in its policy form submission 8 letter that it is the company's opinion that the certificate form or 9 forms comply with applicable New York law and regulations. The super- 10 intendent, upon receipt of such a filing letter, shall grant conditional 11 approval of such certificate form or forms in reliance on the aforemen- 12 tioned statement by the company upon the condition that the company will 13 retroactively modify such certificate form or forms, to the extent 14 necessary, if it is found by the superintendent that the certificate 15 form fails to comply with applicable New York laws and regulations[.]; 16 (ii) The superintendent may, with regard to the approval of any group 17 life insurance certificate deemed to have been delivered in this state 18 by virtue of subparagraph (B) or (C) of this paragraph, approve such 19 certificate if the superintendent finds that the certificate affords 20 insureds protections substantially similar to those [which] that have 21 been provided by certificates delivered in this state[.]; and 22 (iii) Any regulations issued by the superintendent pursuant to this 23 [paragraph] subparagraph may not impose stricter requirements than those 24 applicable to similar policies and certificates actually delivered in 25 this state. 26 (F)(i) A group accident, group health, group accident and health, 27 blanket accident, blanket health, or blanket accident and health insur- 28 ance certificate deemed to have been delivered in this state pursuant to 29 subparagraph (B) or (D) of this paragraph, shall be subject to the same 30 provisions of this chapter as a certificate actually delivered or issued 31 for delivery in this state. 32 (ii) An insurer shall issue to the group or person in whose name the 33 policy or contract is issued, for delivery to each member of the insured 34 group, a certificate setting forth in summary form a statement of the 35 essential features of the insurance coverage. 36 (G) For purposes of this paragraph: 37 (i) "institution of higher education" shall have the meaning set forth 38 in paragraph two of subsection (a) of section three thousand two hundred 39 forty of this article; 40 (ii) "principal place of business" shall mean the place where an 41 employer maintains its headquarters or where the employer's high-level 42 officers direct, control, and coordinate the business activities; and 43 (iii) "resident of this state" shall include a student who is enrolled 44 in an institution of higher education in this state that offers coverage 45 to the student through a group or blanket policy or contract. 46 § 5. Subparagraph (E) of paragraph 3 of subsection (a) of section 4237 47 of the insurance law is amended to read as follows: 48 (E) Under a policy or contract issued to [and in the name of] an 49 [incorporated or unincorporated] association [of persons having a common50interest or calling, which association shall be deemed the policyholder,51having not less than fifty members, covering all the members of such52association or if part or all of] or the trustee or trustees of a trust 53 established, or participated in, by one or more associations, to insure 54 association members, subject to the following: 55 (i) Each association shall have:S. 1507--A 76 A. 2007--A 1 (I) a minimum of two hundred insured individuals at the policy or 2 contract's date of issue; 3 (II) been organized and maintained in good faith for purposes princi- 4 pally other than that of obtaining insurance; 5 (III) been in active existence for at least two years; and 6 (IV) a constitution and by-laws that provide that: 7 (aa) the association hold regular meetings not less than annually to 8 further the purposes of the association; 9 (bb) the association collect dues or solicit contributions from 10 members; and 11 (cc) the members have voting privileges and representation on the 12 governing board and committees; 13 (ii) the premium [is to be derived] for the policy or contract shall 14 be paid by the association or the trustees either wholly from funds 15 contributed by the association or by the insured [members and if the16opportunity to take such insurance is offered to all eligible] individ- 17 uals, or from funds contributed jointly by the association and insured 18 [members, then such] individuals. A policy [must cover not less than19seventy-five percent of any class or classes of members determined by20conditions pertaining to membership in the association] or contract on 21 which no part of the premium is to be derived from funds contributed by 22 the insured individuals specifically for their insurance shall insure 23 all eligible individuals, excluding any as to whom evidence of individ- 24 ual insurability is not satisfactory to the insurer to the extent 25 permitted by law; 26 (iii) The amount of insurance under the policy or contract shall be 27 based upon some plan precluding individual selection either by the 28 insured individuals or by the association. However, with respect to an 29 association, such a plan may permit a number of selections by the asso- 30 ciation if the selections offered utilize consistent plans of insurance 31 so that the resulting plans of coverage are reasonable. Furthermore, 32 such a plan may permit a limited number of selections by insured indi- 33 viduals if the selections offered utilize consistent plans of insurance 34 for insured individuals so that the resulting plans of coverage are 35 reasonable. 36 (iv) Except as provided in subsection (b) of this section, such policy 37 or contract shall provide for the payment of benefits to the person 38 insured or to some beneficiary or beneficiaries other than the associ- 39 ation or any officials, representatives, trustees or agents thereof and 40 shall provide for the issuance of a certificate to the association for 41 delivery to the insured individual or such beneficiary, as evidence of 42 such insurance. 43 (v) The premiums charged shall be reasonable in relation to the bene- 44 fits provided. 45 § 6. Subsection (d) of section 4237-a of the insurance law, as amended 46 by chapter 599 of the laws of 2003, is amended to read as follows: 47 (d) No stop-loss insurance contract shall be delivered or issued [or48renewed] for delivery in or outside this state by an insurer or health 49 service corporation: 50 (1) to a New York employer with one hundred or fewer employees, 51 provided that "New York employer" shall mean an employer who has at 52 least one employee that works in this state; or 53 (2) if issuance of the policy would be prohibited by section two thou- 54 sand six hundred thirteen, three thousand two hundred thirty-one, four 55 thousand three hundred seventeen or four thousand three hundred twenty 56 of this chapter.S. 1507--A 77 A. 2007--A 1 § 7. This act shall take effect on the one hundred eightieth day after 2 it shall have become a law and shall apply to all policies and contracts 3 issued, renewed, modified, altered, or amended on or after such date. 4 Effective immediately: 5 (1) the superintendent of financial services may promulgate any rules 6 or regulations necessary for the implementation of the provisions of 7 this act on its effective date; and 8 (2) insurers may submit to the superintendent and the superintendent 9 may approve filings necessary to comply with the provisions of this act 10 on its effective date. 11 § 2. Severability clause. If any clause, sentence, paragraph, subdivi- 12 sion, section or subpart of this act shall be adjudged by any court of 13 competent jurisdiction to be invalid, such judgment shall not affect, 14 impair, or invalidate the remainder thereof, but shall be confined in 15 its operation to the clause, sentence, paragraph, subdivision, section 16 or subpart thereof directly involved in the controversy in which such 17 judgment shall have been rendered. It is hereby declared to be the 18 intent of the legislature that this act would have been enacted even if 19 such invalid provisions had not been included herein. 20 § 3. Interpretations by the superintendent. The superintendent of 21 financial services has special expertise and experience in the regu- 22 lation of insurance in this state. As such his or her interpretations of 23 the insurance law shall be afforded the highest level of deference. 24 § 4. Legislative intent. It is hereby declared to be the intent of the 25 legislature in enacting this act, that the laws of this state provide 26 consumer and market protections at least as robust as those under the 27 federal Patient Protection and Affordable Care Act, public law 111-148, 28 as that law existed and was interpreted on January 19, 2017. In addition 29 to any other power conferred by law, the superintendent of financial 30 services is hereby specifically empowered to promulgate regulations 31 under, and issue interpretations of, this act as necessary to ensure 32 that the intent of the legislature as expressed in this section is real- 33 ized. 34 § 5. This act shall take effect immediately provided, however, that 35 the applicable effective date of Subparts A through F of this act shall 36 be as specifically set forth in the last section of such Subparts. 37 PART K 38 Section 1. Subdivisions 4 and 5 of section 2999-h of the public health 39 law, as added by section 52 of part H of chapter 59 of the laws of 2011, 40 are amended to read as follows: 41 4. "Qualified plaintiff" means every plaintiff or claimant who (i) has 42 been found by a jury or court to have sustained a birth-related neuro- 43 logical injury as the result of medical malpractice, or (ii) has 44 sustained a birth-related neurological injury as the result of alleged 45 medical malpractice, and has settled his or her lawsuit or claim there- 46 for; and (iii) has been ordered to be enrolled in the fund by a court in 47 New York state. 48 [5. Any reference to the "department of financial services" and the49"superintendent of financial services" in this title shall mean, prior50to October third, two thousand eleven, respectively, the "department of51insurance" and "superintendent of insurance."] 52 § 2. Section 2999-i of the public health law, as added by section 52 53 of part H of chapter 59 of the laws of 2011, subdivision 1 as amended byS. 1507--A 78 A. 2007--A 1 section 29 of part D of chapter 56 of the laws of 2012, is amended to 2 read as follows: 3 § 2999-i. Custody and administration of the fund. 1. (a) The commis- 4 sioner of taxation and finance shall be the custodian of the fund and 5 the special account established pursuant to section ninety-nine-t of the 6 state finance law. All payments from the fund shall be made by the 7 commissioner of taxation and finance upon certificates signed by the 8 [superintendent of financial services] commissioner, or his or her 9 designee, as hereinafter provided. The fund shall be separate and apart 10 from any other fund and from all other state monies; provided, however, 11 that monies of the fund may be invested as set forth in paragraph (b) of 12 this subdivision. No monies from the fund shall be transferred to any 13 other fund, nor shall any such monies be applied to the making of any 14 payment for any purpose other than the purpose set forth in this title. 15 (b) Any monies of the fund not required for immediate use may, at the 16 discretion of the commissioner [of financial services] in consultation 17 with [the commissioner of health and] the director of the budget, be 18 invested by the commissioner of taxation and finance in obligations of 19 the United States or the state or obligations the principal and interest 20 of which are guaranteed by the United States or the state. The proceeds 21 of any such investment shall be retained by the fund as assets to be 22 used for the purposes of the fund. 23 2. (a) The fund shall be administered by the [superintendent of finan-24cial services] commissioner or his or her designee in accordance with 25 the provisions of this article. 26 (b) The [superintendent of financial services] commissioner shall have 27 all powers necessary and proper to carry out the purposes of the fund. 28 (c) Notwithstanding any contrary provision of this section, sections 29 one hundred twelve and one hundred sixty-three of the state finance law 30 or any other contrary provision of law, the superintendent of financial 31 services is authorized to [enter into a contract or contracts without a32competitive bid or request for proposal process for purposes of adminis-33tering the fund for the first year of its operation and in preparation34therefor] assign and the commissioner is authorized to receive assign- 35 ment of any and all contracts entered into by the superintendent of 36 financial services to administer the fund for periods prior to October 37 first, two thousand nineteen. 38 (d) The department [of financial services and the department] shall 39 post on [their websites] its website information about the fund[, eligi-40bility for enrollment in the fund,] and the process for enrollment in 41 the fund. 42 3. The expense of administering the fund[, including the expenses43incurred by the department,] shall be paid from the fund. 44 4. Monies for the fund will be provided pursuant to this chapter. 45 5. For the state fiscal year beginning April first, two thousand elev- 46 en and ending March thirty-first, two thousand twelve, the state fiscal 47 year beginning April first, two thousand twelve and ending March thir- 48 ty-first, two thousand thirteen, and the state fiscal year beginning 49 April first, two thousand thirteen and ending March thirty-first, two 50 thousand fourteen, the superintendent of financial services shall cause 51 to be deposited into the fund for each such fiscal year the amount 52 appropriated for such purpose. Beginning April first, two thousand four- 53 teen and annually thereafter, the superintendent of financial services 54 or the commissioner, whoever is administering the fund for the applica- 55 ble period shall cause to be deposited into the fund, subject to avail- 56 able appropriations, an amount equal to the difference between theS. 1507--A 79 A. 2007--A 1 amount appropriated to the fund in the preceding fiscal year, as 2 increased by the adjustment factor defined in subdivision seven of this 3 section, and the assets of the fund at the conclusion of that fiscal 4 year. 5 6. (a) Following the deposit referenced in subdivision five of this 6 section, the [superintendent of financial services] commissioner shall 7 conduct an actuarial calculation of the estimated liabilities of the 8 fund for the coming year resulting from the qualified plaintiffs 9 enrolled in the fund. The administrator shall from time to time adjust 10 such calculation in accordance with subdivision seven of this section. 11 If the total of all estimates of current liabilities equals or exceeds 12 eighty percent of the fund's assets, then the fund shall not accept any 13 new enrollments until a new deposit has been made pursuant to subdivi- 14 sion five of this section. When, as a result of such new deposit, the 15 fund's liabilities no longer exceed eighty percent of the fund's assets, 16 the fund administrator shall enroll new qualified plaintiffs in the 17 order that an application for enrollment has been submitted in accord- 18 ance with subdivision seven of section twenty-nine hundred ninety-nine-j 19 of this title. 20 (b) Whenever enrollment is suspended pursuant to paragraph (a) of this 21 subdivision and until such time as enrollment resumes pursuant to such 22 paragraph: (i) notice of such suspension shall be promptly posted on the 23 department's website [and on the website of the department of financial24services]; (ii) the fund administrator shall deny each application for 25 enrollment that had been received but not accepted prior to the date of 26 suspension and each application for enrollment received after the date 27 of such suspension; and (iii) notification of each such denial shall be 28 made to the plaintiff or claimant or persons authorized to act on behalf 29 of such plaintiff or claimant and all defendants in regard to such 30 plaintiff or claimant, to the extent they are known to the fund adminis- 31 trator. Judgments and settlements for plaintiffs or claimants for whom 32 applications are denied under this paragraph or who are not eligible for 33 enrollment due to suspension pursuant to paragraph (a) of this subdivi- 34 sion shall be satisfied as if this title had not been enacted. 35 (c) Following a suspension, whenever enrollment resumes pursuant to 36 paragraph (a) of this subdivision, notice that enrollment has resumed 37 shall be promptly posted on the department's website [and on the website38of the department of financial services]. 39 (d) The suspension of enrollment pursuant to paragraph (a) of this 40 subdivision shall not impact payment under the fund for any qualified 41 plaintiffs already enrolled in the fund. 42 7. For purposes of this section, the adjustment factor referenced in 43 this section shall be the ten year rolling average medical component of 44 the consumer price index as published by the United States department of 45 labor, bureau of labor statistics, for the preceding ten years. 46 § 3. Subdivisions 2, 5, 6, 7, 9, 11, 12, 15 and 16 of section 2999-j 47 of the public health law, subdivision 2 as amended by chapter 517 of the 48 laws of 2016, paragraph (c) of subdivision 2 as amended by chapter 4 of 49 the laws of 2017, and subdivisions 5, 6, 7, 9, 11, 12, 15 and 16 as 50 added by section 52 of part H of chapter 59 of the laws of 2011, are 51 amended to read as follows: 52 2. The provision of qualifying health care costs to qualified plain- 53 tiffs shall not be subject to prior authorization, except as described 54 by the commissioner in regulation; provided, however:S. 1507--A 80 A. 2007--A 1 (a) such regulation shall not prevent qualified plaintiffs from 2 receiving care or assistance that would, at a minimum, be authorized 3 under the medicaid program; 4 (b) if any prior authorization is required by such regulation, the 5 regulation shall require that requests for prior authorization be proc- 6 essed within a reasonably prompt period of time and[, subject to the7provisions of subdivision two-a of this section,] shall identify a proc- 8 ess for prompt administrative review of any denial of a request for 9 prior authorization; and 10 (c) such regulations shall not prohibit qualifying health care costs 11 on the grounds that the qualifying health care cost may incidentally 12 benefit other members of the household, provided that whether the quali- 13 fying health care cost primarily benefits the patient may be considered. 14 5. Claims for the payment or reimbursement from the fund of qualifying 15 health care costs shall be made upon forms prescribed and furnished by 16 the fund administrator [in consultation with the commissioner and] in 17 conjunction with regulations establishing a mechanism for submission of 18 claims by health care providers directly to the fund, where practicable. 19 6. (a) Every settlement agreement for claims arising out of a 20 plaintiff's or claimant's birth related neurological injury subject to 21 this title, and that provides for the payment of future medical expenses 22 for the plaintiff or claimant, shall provide that [in the event the23administrator of the fund determines that the plaintiff or claimant is a24qualified plaintiff,] all payments for future medical expenses shall be 25 paid in accordance with this title[,] in lieu of that portion of the 26 settlement agreement that provides for payment of such expenses. The 27 plaintiff's or claimant's future medical expenses shall be paid in 28 accordance with this title. When such a settlement agreement does not so 29 provide, the court shall direct the modification of the agreement to 30 include such term as a condition of court approval. 31 (b) In any case where the jury or court has made an award for future 32 medical expenses arising out of a birth related neurological injury, any 33 party to such action or person authorized to act on behalf of such party 34 may make application to the court that the judgment reflect that, in 35 lieu of that portion of the award that provides for payment of such 36 expenses, [and upon a determination by the fund administrator that the37plaintiff is a qualified plaintiff,] the future medical expenses of the 38 plaintiff shall be paid out of the fund in accordance with this title. 39 Upon a finding by the court that the applicant has made a prima facie 40 showing that the plaintiff is a qualified plaintiff, the court shall 41 ensure that the judgment so provides. 42 7. A qualified plaintiff shall be enrolled when (a) such plaintiff or 43 person authorized to act on behalf of such person, upon notice to all 44 defendants, or any of the defendants in regard to the plaintiff's claim, 45 upon notice to such plaintiff, makes an application for enrollment by 46 providing the fund administrator with a certified copy of the judgment 47 or of the court approved settlement agreement; and (b) the fund adminis- 48 trator determines [upon the basis of such judgment or settlement agree-49ment and any additional information the fund administrator shall50request] that the relevant provisions of subdivision six of this section 51 have been met [and that the plaintiff is a qualified plaintiff]; 52 provided that no enrollment shall occur when the fund is closed to 53 enrollment pursuant to subdivision six of section twenty-nine hundred 54 ninety-nine-i of this title. 55 9. Payments from the fund shall be made by the commissioner of taxa- 56 tion and finance on the said certificate of the [superintendent ofS. 1507--A 81 A. 2007--A 1financial services] commissioner. No payment shall be made by the 2 commissioner of taxation and finance in excess of the amount certified. 3 Promptly upon receipt of the said certificate of the [superintendent of4financial services] commissioner, the commissioner of taxation and 5 finance shall pay the qualified plaintiff's health care provider or 6 reimburse the qualified plaintiff the amount so certified for payment. 7 11. All health care providers shall accept from qualified plaintiff's 8 or persons authorized to act on behalf of such plaintiff's assignments 9 of the right to receive payments from the fund for qualifying health 10 care costs. Such payments shall constitute payment in full for any 11 services provided to a qualified plaintiff in accordance with this arti- 12 cle. 13 12. Health insurers (other than medicare and Medicaid) shall be the 14 primary payers of qualifying health care costs of qualified plaintiffs. 15 Such costs shall be paid from the fund only to the extent that health 16 insurers or other collateral sources or other persons are not otherwise 17 obligated to make payments therefor. Health insurers that make payments 18 for qualifying health care costs to or on behalf of qualified plaintiffs 19 shall have no right of recovery against and shall have no lien upon the 20 fund or any person or entity nor shall the fund constitute an additional 21 payment source to offset the payments otherwise contractually required 22 to be made by such health insurers. The superintendent of financial 23 services shall have the authority to enforce the provisions of this 24 subdivision upon the referral of the commissioner. 25 15. The commissioner[, in consultation with the superintendent of26financial services,] shall promulgate, amend and enforce all rules and 27 regulations necessary for the proper administration of the fund in 28 accordance with the provisions of this section, including, but not 29 limited to, those concerning the payment of claims and concerning the 30 actuarial calculations necessary to determine, annually, the total 31 amount to be paid into the fund as provided herein, and as otherwise 32 needed to implement this title. 33 [16. The commissioner shall convene a consumer advisory committee for34the purpose of providing information, as requested by the commissioner,35in the development of the regulations authorized by subdivision fifteen36of this section.] 37 § 4. Section 5 of chapter 517 of the laws of 2016, amending the public 38 health law relating to payments from the New York state medical indem- 39 nity fund, as amended by chapter 4 of the laws of 2017, is amended to 40 read as follows: 41 § 5. This act shall take effect on the forty-fifth day after it shall 42 have become a law, provided that the amendments to subdivision 4 of 43 section 2999-j of the public health law made by section two of this act 44 shall take effect on June 30, 2017 and shall expire and be deemed 45 repealed December 31, [2019] 2020. 46 § 5. Section 99-t of the state finance law, as added by section 52-e 47 of part H of chapter 59 of the laws of 2011, is amended to read as 48 follows: 49 § 99-t. New York state medical indemnity fund account. 1. There is 50 hereby established in the custody of the commissioner of taxation and 51 finance a special account to be known as the "New York state medical 52 indemnity fund account". 53 2. All moneys received by the New York state medical indemnity fund 54 pursuant to title four of article twenty-nine-D of the public health law 55 from whatever source derived shall be deposited to the exclusive credit 56 of such fund account. Said moneys shall be kept separate and shall notS. 1507--A 82 A. 2007--A 1 be commingled with any other moneys in the custody of the commissioner 2 of taxation and finance. 3 3. The moneys in said account shall be retained by the fund and shall 4 be released by the commissioner of taxation and finance only upon 5 certificates signed by the [superintendent of financial services or the6head of any successor agency to the department of insurance] commission- 7 er of health or his or her designee and only for the purposes set forth 8 in title four of article twenty-nine-D of the public health law. 9 § 6. This act shall take effect October 1, 2019; provided however, on 10 and after April 1, 2019, the commissioner of health may take any steps 11 necessary to implement this act on its effective date; and notwithstand- 12 ing any inconsistent provision of the state administrative procedure act 13 or any other provision of law, rule or regulation, the commissioner of 14 health is authorized to adopt or amend or promulgate on an emergency 15 basis any regulation he or she determines necessary to implement any 16 provision of this act on its effective date. 17 PART L 18 Section 1. Subparagraph (C) of paragraph 6 of subsection (k) of 19 section 3221 of the insurance law, as amended by section 1 of part K of 20 chapter 82 of the laws of 2002, is amended to read as follows: 21 (C) Coverage of diagnostic and treatment procedures, including 22 prescription drugs, used in the diagnosis and treatment of infertility 23 as required by subparagraphs (A) and (B) of this paragraph shall be 24 provided in accordance with the provisions of this subparagraph. 25 (i) [Coverage] Except as provided in items (vi) and (vii) of this 26 subparagraph, coverage shall be provided for persons whose ages range 27 from twenty-one through forty-four years, provided that nothing herein 28 shall preclude the provision of coverage to persons whose age is below 29 or above such range. 30 (ii) Diagnosis and treatment of infertility shall be prescribed as 31 part of a physician's overall plan of care and consistent with the 32 guidelines for coverage as referenced in this subparagraph. 33 (iii) Coverage may be subject to co-payments, coinsurance and deduct- 34 ibles as may be deemed appropriate by the superintendent and as are 35 consistent with those established for other benefits within a given 36 policy. 37 (iv) [Coverage shall be limited to those individuals who have been38previously covered under the policy for a period of not less than twelve39months, provided that for the purposes of this subparagraph "period of40not less than twelve months" shall be determined by calculating such41time from either the date the insured was first covered under the exist-42ing policy or from the date the insured was first covered by a previous-43ly in-force converted policy, whichever is earlier.44(v) Coverage] Except as provided in items (vi) and (vii) of this 45 subparagraph, coverage shall not be required to include the diagnosis 46 and treatment of infertility in connection with: (I) in vitro fertiliza- 47 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube 48 transfers; (II) the reversal of elective sterilizations; (III) sex 49 change procedures; (IV) cloning; or (V) medical or surgical services or 50 procedures that are deemed to be experimental in accordance with clin- 51 ical guidelines referenced in [clause (vi)] item (v) of this subpara- 52 graph. 53 [(vi)] (v) The superintendent, in consultation with the commissioner 54 of health, shall promulgate regulations which shall stipulate the guide-S. 1507--A 83 A. 2007--A 1 lines and standards which shall be used in carrying out the provisions 2 of this subparagraph, which shall include: 3 (I) The determination of "infertility" in accordance with the stand- 4 ards and guidelines established and adopted by the American College of 5 Obstetricians and Gynecologists and the American Society for Reproduc- 6 tive Medicine including "iatrogenic infertility", which means an impair- 7 ment of fertility by surgery, radiation, chemotherapy or other medical 8 treatment affecting reproductive organs or processes; 9 (II) The identification of experimental procedures and treatments not 10 covered for the diagnosis and treatment of infertility determined in 11 accordance with the standards and guidelines established and adopted by 12 the American College of Obstetricians and Gynecologists and the American 13 Society for Reproductive Medicine; 14 (III) The identification of the required training, experience and 15 other standards for health care providers for the provision of proce- 16 dures and treatments for the diagnosis and treatment of infertility 17 determined in accordance with the standards and guidelines established 18 and adopted by the American College of Obstetricians and Gynecologists 19 and the American Society for Reproductive Medicine; and 20 (IV) The determination of appropriate medical candidates by the treat- 21 ing physician in accordance with the standards and guidelines estab- 22 lished and adopted by the American College of Obstetricians and Gynecol- 23 ogists and/or the American Society for Reproductive Medicine. 24 (vi) Coverage shall also include standard fertility preservation 25 services when a medical treatment may directly or indirectly cause 26 iatrogenic infertility to an insured. Coverage may be subject to annual 27 deductibles and coinsurance, including copayments, as may be deemed 28 appropriate by the superintendent and as are consistent with those 29 established for other benefits within a given policy. 30 (vii) Every large group policy delivered or issued for delivery in 31 this state that provides medical, major medical or similar comprehen- 32 sive-type coverage shall provide coverage for three cycles of in-vitro 33 fertilization used in the treatment of infertility as defined in clause 34 (I) of item (v) of this subparagraph. Coverage may be subject to annual 35 deductibles and coinsurance, including copayments, as may be deemed 36 appropriate by the superintendent and as are consistent with those 37 established for other benefits within a given policy. For purposes of 38 this item, a "cycle" is defined as either all treatment that starts 39 when: preparatory medications are administered for ovarian stimulation 40 for oocyte retrieval with the intent of undergoing in-vitro fertiliza- 41 tion using a fresh embryo transfer; or medications are administered for 42 endometrial preparation with the intent of undergoing in-vitro fertili- 43 zation using a frozen embryo transfer. No insurer providing coverage 44 under this item or item (vi) of this subparagraph shall discriminate 45 based on an insured's expected length of life, present of predicted 46 disability, degree of medical dependency, perceived quality of life, or 47 other health conditions, nor based on personal characteristics, includ- 48 ing age, sex, sexual orientation, marital status or gender identity. 49 § 2. Paragraph 3 of subsection (s) of section 4303 of the insurance 50 law, as amended by section 2 of part K of chapter 82 of the laws of 51 2002, is amended to read as follows: 52 (3) Coverage of diagnostic and treatment procedures, including 53 prescription drugs used in the diagnosis and treatment of infertility as 54 required by paragraphs one and two of this subsection shall be provided 55 in accordance with this paragraph.S. 1507--A 84 A. 2007--A 1 (A) [Coverage] Except as provided in subparagraphs (F) and (G) of this 2 paragraph, coverage shall be provided for persons whose ages range from 3 twenty-one through forty-four years, provided that nothing herein shall 4 preclude the provision of coverage to persons whose age is below or 5 above such range. 6 (B) Diagnosis and treatment of infertility shall be prescribed as part 7 of a physician's overall plan of care and consistent with the guidelines 8 for coverage as referenced in this paragraph. 9 (C) Coverage may be subject to co-payments, coinsurance and deduct- 10 ibles as may be deemed appropriate by the superintendent and as are 11 consistent with those established for other benefits within a given 12 policy. 13 (D) [Coverage shall be limited to those individuals who have been14previously covered under the policy for a period of not less than twelve15months, provided that for the purposes of this paragraph "period of not16less than twelve months" shall be determined by calculating such time17from either the date the insured was first covered under the existing18policy or from the date the insured was first covered by a previously19in-force converted policy, whichever is earlier.20(E) Coverage] Except as provided in subparagraphs (F) and (G) of this 21 paragraph, coverage shall not be required to include the diagnosis and 22 treatment of infertility in connection with: (i) in vitro fertilization, 23 gamete intrafallopian tube transfers or zygote intrafallopian tube 24 transfers; (ii) the reversal of elective sterilizations; (iii) sex 25 change procedures; (iv) cloning; or (v) medical or surgical services or 26 procedures that are deemed to be experimental in accordance with clin- 27 ical guidelines referenced in subparagraph [(F)] (E) of this paragraph. 28 [(F)] (E) The superintendent, in consultation with the commissioner of 29 health, shall promulgate regulations which shall stipulate the guide- 30 lines and standards which shall be used in carrying out the provisions 31 of this paragraph, which shall include: 32 (i) The determination of "infertility" in accordance with the stand- 33 ards and guidelines established and adopted by the American College of 34 Obstetricians and Gynecologists and the American Society for Reproduc- 35 tive Medicine; 36 (ii) The identification of experimental procedures and treatments not 37 covered for the diagnosis and treatment of infertility determined in 38 accordance with the standards and guidelines established and adopted by 39 the American College of Obstetricians and Gynecologists and the American 40 Society for Reproductive Medicine including "iatrogenic infertility", 41 which means an impairment of fertility by surgery, radiation, chemother- 42 apy or other medical treatment affecting reproductive organs or proc- 43 esses; 44 (iii) The identification of the required training, experience and 45 other standards for health care providers for the provision of proce- 46 dures and treatments for the diagnosis and treatment of infertility 47 determined in accordance with the standards and guidelines established 48 and adopted by the American College of Obstetricians and Gynecologists 49 and the American Society for Reproductive Medicine; and 50 (iv) The determination of appropriate medical candidates by the treat- 51 ing physician in accordance with the standards and guidelines estab- 52 lished and adopted by the American College of Obstetricians and Gynecol- 53 ogists and/or the American Society for Reproductive Medicine. 54 (F) Coverage shall also include standard fertility preservation 55 services when a medical treatment may directly or indirectly cause 56 iatrogenic infertility to an insured. Coverage may be subject to annualS. 1507--A 85 A. 2007--A 1 deductibles and coinsurance, including copayments, as may be deemed 2 appropriate by the superintendent and as are consistent with those 3 established for other benefits within a given contract. 4 (G) Every large group contract that provides medical, major medical or 5 similar comprehensive-type coverage shall provide coverage for three 6 cycles of in-vitro fertilization used in the treatment of infertility as 7 defined in item (i) of subparagraph (E) of this paragraph. Coverage may 8 be subject to annual deductibles and coinsurance, including copayments, 9 as may be deemed appropriate by the superintendent and as are consistent 10 with those established for other benefits within a given contract. For 11 purposes of this subparagraph, a "cycle" is defined as either all treat- 12 ment that starts when: preparatory medications are administered for 13 ovarian stimulation for oocyte retrieval with the intent of undergoing 14 in-vitro fertilization using a fresh embryo transfer; or medications are 15 administered for endometrial preparation with the intent of undergoing 16 in-vitro fertilization using a frozen embryo transfer. No corporation 17 providing coverage under subparagraphs (F) or (G) of this paragraph 18 shall discriminate based on an insured's expected length of life, pres- 19 ent or predicted disability, degree of medical dependency, perceived 20 quality of life, or other health conditions, nor based on personal char- 21 acteristics, including age, sex, sexual orientation, marital status or 22 gender identity. 23 § 3. Paragraph 13 of subsection (i) of section 3216 of the insurance 24 law is amended by adding a new subparagraph (C) to read as follows: 25 (C) Every policy that provides medical, major medical or similar 26 comprehensive-type coverage shall provide coverage for standard fertili- 27 ty preservation services when a medical treatment may directly or indi- 28 rectly cause iatrogenic infertility to an insured. Coverage may be 29 subject to annual deductibles and coinsurance, including copayments, as 30 may be deemed appropriate by the superintendent and as are consistent 31 with those established for other benefits within a given policy. 32 (i) For purposes of this subparagraph, "iatrogenic infertility" means 33 an impairment of fertility by surgery, radiation, chemotherapy or other 34 medical treatment affecting reproductive organs or processes. 35 (ii) No insurer providing coverage under this paragraph shall discrim- 36 inate based on an insured's expected length of life, present or 37 predicted disability, degree of medical dependency, perceived quality of 38 life, or other health conditions, nor based on personal characteristics, 39 including age, sex, sexual orientation, marital status or gender identi- 40 ty. 41 § 4. This act shall take effect January 1, 2020 and shall apply to 42 policies and contracts issued, renewed, modified, altered or amended on 43 or after such date. 44 PART M 45 Section 1. This act shall be known and may be cited as the "comprehen- 46 sive contraception coverage act". 47 § 2. Paragraph 16 of subsection (l) of section 3221 of the insurance 48 law, as added by chapter 554 of the laws of 2002, is amended to read as 49 follows: 50 (16) (A) Every group or blanket policy which [provides coverage for51prescription drugs shall include coverage for the cost of contraceptive52drugs or devices approved by the federal food and drug administration or53generic equivalents approved as substitutes by such food and drug admin-54istration under the prescription of a health care provider legallyS. 1507--A 86 A. 2007--A 1authorized to prescribe under title eight of the education law. The2coverage required by this section shall be included in policies and3certificates only through the addition of a rider.4(A)] provides medical, major medical or similar comprehensive-type 5 coverage shall provide coverage for all of the following services and 6 contraceptive methods: 7 (i) All FDA-approved contraceptive drugs, devices, and other products. 8 This includes all FDA-approved over-the-counter contraceptive drugs, 9 devices, and products as prescribed or as otherwise authorized under 10 state or federal law. Notwithstanding this paragraph, an insurer shall 11 not be required to provide coverage of male condoms. The following 12 applies to this coverage: 13 (I) where the FDA has approved one or more therapeutic and pharmaceu- 14 tical equivalent, as defined by the FDA, versions of a contraceptive 15 drug, device, or product, an insurer is not required to include all such 16 therapeutic and pharmaceutical equivalent versions in its formulary, so 17 long as at least one is included and covered without cost-sharing and in 18 accordance with this paragraph; 19 (II) if the covered therapeutic and pharmaceutical equivalent versions 20 of a drug, device, or product are not available or are deemed medically 21 inadvisable, the insurer shall provide coverage for an alternate thera- 22 peutic and pharmaceutical equivalent version of the contraceptive drug, 23 device, or product without cost-sharing upon the recommendation of the 24 insured's attending health care provider. An insurer shall defer to the 25 attending health care provider's determination of medical necessity. 26 The superintendent may develop a standard exception form with 27 instructions that an attending health care provider may use to recommend 28 a particular contraceptive drug, device, or product based upon a deter- 29 mination of medical necessity for an insured. The insurer shall accept 30 the standard exception form submitted by the insured's attending health 31 care provider; 32 (III) this coverage shall include emergency contraception without 33 cost-sharing when provided pursuant to prescription, order under section 34 sixty-eight hundred thirty-one of the education law, over-the-counter, 35 or when otherwise lawfully provided other than pursuant to a 36 prescription; and 37 (IV) this coverage shall allow for the dispensing of twelve months- 38 worth of a contraceptive at one time; 39 (ii) Voluntary sterilization procedures for women; 40 (iii) Patient education and counseling on contraception; and 41 (iv) Follow-up services related to the drugs, devices, products, and 42 procedures covered under this paragraph, including, but not limited to, 43 management of side effects, counseling for continued adherence, and 44 device insertion and removal. 45 (B) An insurer subject to this paragraph shall not impose a deduct- 46 ible, coinsurance, copayment or any other cost-sharing requirement on 47 the coverage provided pursuant to this paragraph. 48 (C) Except as otherwise authorized under this paragraph, an insurer 49 shall not impose any restrictions or delays on the coverage required 50 under this paragraph. 51 (D) Notwithstanding any other provision of this subsection, a reli- 52 gious employer may request a contract without coverage for federal food 53 and drug administration approved contraceptive methods that are contrary 54 to the religious employer's religious tenets. If so requested, such 55 contract shall be provided without coverage for contraceptive methods.S. 1507--A 87 A. 2007--A 1 This paragraph shall not be construed to deny an enrollee coverage of, 2 and timely access to, contraceptive methods. 3 (1) For purposes of this subsection, a "religious employer" is an 4 entity for which each of the following is true: 5 (a) The inculcation of religious values is the purpose of the entity. 6 (b) The entity primarily employs persons who share the religious 7 tenets of the entity. 8 (c) The entity serves primarily persons who share the religious tenets 9 of the entity. 10 (d) The entity is a nonprofit organization as described in Section 11 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 12 (2) Every religious employer that invokes the exemption provided under 13 this paragraph shall provide written notice to prospective enrollees 14 prior to enrollment with the plan, listing the contraceptive health care 15 services the employer refuses to cover for religious reasons. 16 [(B) (i)] (E) (1) Where a group policyholder makes an election not to 17 purchase coverage for contraceptive drugs or devices in accordance with 18 subparagraph [(A)] (D) of this paragraph each certificateholder covered 19 under the policy issued to that group policyholder shall have the right 20 to directly purchase the rider required by this paragraph from the 21 insurer which issued the group policy at the prevailing small group 22 community rate for such rider whether or not the employee is part of a 23 small group. 24 [(ii)] (2) Where a group policyholder makes an election not to 25 purchase coverage for contraceptive drugs or devices in accordance with 26 subparagraph [(A)] (D) of this paragraph, the insurer that provides such 27 coverage shall provide written notice to certificateholders upon enroll- 28 ment with the insurer of their right to directly purchase a rider for 29 coverage for the cost of contraceptive drugs or devices. The notice 30 shall also advise the certificateholders of the additional premium for 31 such coverage. 32 [(C)] (F) Nothing in this paragraph shall be construed as authorizing 33 a group or blanket policy which provides coverage for prescription drugs 34 to exclude coverage for prescription drugs prescribed for reasons other 35 than contraceptive purposes. 36 [(D) Such coverage may be subject to reasonable annual deductibles and37coinsurance as may be deemed appropriate by the superintendent and as38are consistent with those established for other drugs or devices covered39under the policy.] 40 § 3. Subsection (cc) of section 4303 of the insurance law, as added by 41 chapter 554 of the laws of 2002, is amended to read as follows: 42 (cc) (1) Every contract [which provides coverage for prescription43drugs shall include coverage for the cost of contraceptive drugs or44devices approved by the federal food and drug administration or generic45equivalents approved as substitutes by such food and drug administration46under the prescription of a health care provider legally authorized to47prescribe under title eight of the education law. The coverage required48by this section shall be included in contracts and certificates only49through the addition of a rider.50(1)] which provides medical, major medical, or similar comprehensive- 51 type coverage shall provide coverage for all of the following services 52 and contraceptive methods: 53 (A) All FDA-approved contraceptive drugs, devices, and other products. 54 This includes all FDA-approved over-the-counter contraceptive drugs, 55 devices, and products as prescribed or as otherwise authorized under 56 state or federal law. Notwithstanding this paragraph, a corporationS. 1507--A 88 A. 2007--A 1 shall not be required to provide coverage of male condoms. The follow- 2 ing applies to this coverage: 3 (i) where the FDA has approved one or more therapeutic and pharmaceu- 4 tical equivalent, as defined by the FDA, versions of a contraceptive 5 drug, device, or product, a corporation is not required to include all 6 such therapeutic and pharmaceutical equivalent versions in its formu- 7 lary, so long as at least one is included and covered without cost-shar- 8 ing and in accordance with this subsection; 9 (ii) if the covered therapeutic and pharmaceutical equivalent versions 10 of a drug, device, or product are not available or are deemed medically 11 inadvisable, a corporation shall provide coverage for an alternate ther- 12 apeutic and pharmaceutical equivalent version of the contraceptive drug, 13 device, or product without cost-sharing upon the recommendation of the 14 insured's attending health care provider. A corporation shall defer to 15 the attending health care provider's determination of medical necessity. 16 The superintendent may develop a standard exception form with 17 instructions that an attending health care provider may use to recommend 18 a particular contraceptive drug, device, or product based upon a deter- 19 mination of medical necessity for an insured. The insurer shall accept 20 the standard exception form submitted by the insured's attending health 21 care provider; 22 (iii) this coverage shall include emergency contraception without 23 cost-sharing when provided pursuant to a prescription, order under 24 section sixty-eight hundred thirty-one of the education law, over-the- 25 counter, or when otherwise lawfully provided other than through a 26 prescription; and 27 (iv) this coverage shall allow for the dispensing of twelve months 28 worth of a contraceptive at one time; 29 (B) Voluntary sterilization procedures for women; 30 (C) Patient education and counseling on contraception; and 31 (D) Follow-up services related to the drugs, devices, products, and 32 procedures covered under this subsection, including, but not limited to, 33 management of side effects, counseling for continued adherence, and 34 device insertion and removal. 35 (2) A corporation subject to this paragraph shall not impose a deduct- 36 ible, coinsurance, copayment or any other cost-sharing requirement on 37 the coverage provided pursuant to this subsection. 38 (3) Except as otherwise authorized under this subsection, a corpo- 39 ration shall not impose any restrictions or delays on the coverage 40 required under this subsection. 41 (4) Notwithstanding any other provision of this subsection, a reli- 42 gious employer may request a contract without coverage for federal food 43 and drug administration approved contraceptive methods that are contrary 44 to the religious employer's religious tenets. If so requested, such 45 contract shall be provided without coverage for contraceptive methods. 46 This paragraph shall not be construed to deny an enrollee coverage of, 47 and timely access to, contraceptive methods. 48 (A) For purposes of this subsection, a "religious employer" is an 49 entity for which each of the following is true: 50 (i) The inculcation of religious values is the purpose of the entity. 51 (ii) The entity primarily employs persons who share the religious 52 tenets of the entity. 53 (iii) The entity serves primarily persons who share the religious 54 tenets of the entity. 55 (iv) The entity is a nonprofit organization as described in Section 56 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.S. 1507--A 89 A. 2007--A 1 (B) Every religious employer that invokes the exemption provided under 2 this paragraph shall provide written notice to prospective enrollees 3 prior to enrollment with the plan, listing the contraceptive health care 4 services the employer refuses to cover for religious reasons. 5 [(2)](5) (A) Where a group contractholder makes an election not to 6 purchase coverage for contraceptive drugs or devices in accordance with 7 paragraph [one] four of this subsection, each enrollee covered under the 8 contract issued to that group contractholder shall have the right to 9 directly purchase the rider required by this subsection from the insurer 10 or health maintenance organization which issued the group contract at 11 the prevailing small group community rate for such rider whether or not 12 the employee is part of a small group. 13 (B) Where a group contractholder makes an election not to purchase 14 coverage for contraceptive drugs or devices in accordance with paragraph 15 [one] four of this subsection, the insurer or health maintenance organ- 16 ization that provides such coverage shall provide written notice to 17 enrollees upon enrollment with the insurer or health maintenance organ- 18 ization of their right to directly purchase a rider for coverage for the 19 cost of contraceptive drugs or devices. The notice shall also advise the 20 enrollees of the additional premium for such coverage. 21 [(3)](6) Nothing in this subsection shall be construed as authorizing 22 a contract which provides coverage for prescription drugs to exclude 23 coverage for prescription drugs prescribed for reasons other than 24 contraceptive purposes. 25 [(4) Such coverage may be subject to reasonable annual deductibles and26coinsurance as may be deemed appropriate by the superintendent and as27are consistent with those established for other drugs or devices covered28under the policy.] 29 § 4. Paragraph 17 of subsection (i) of section 3216 of the insurance 30 law is amended by adding a new subparagraph (G) to read as follows: 31 (G)(i) In addition to subparagraphs (A), (B), (C), (D), or (E) of this 32 paragraph, every policy that provides medical, major medical or similar 33 comprehensive-type coverage shall provide coverage for all of the 34 following services and contraceptive methods: 35 (I) All FDA-approved contraceptive drugs, devices, and other products. 36 This includes all FDA-approved over-the-counter contraceptive drugs, 37 devices, and products as prescribed or as otherwise authorized under 38 state or federal law. Notwithstanding this subparagraph, an insurer 39 shall not be required to provide coverage of male condoms. The following 40 applies to this coverage: 41 (aa) where the FDA has approved one or more therapeutic and pharmaceu- 42 tical equivalent, as defined by the FDA, versions of a contraceptive 43 drug, device, or product, an insurer is not required to include all such 44 therapeutic and pharmaceutical equivalent versions in its formulary, so 45 long as at least one is included and covered without cost-sharing in 46 accordance with this subparagraph; 47 (bb) if the covered therapeutic and pharmaceutical equivalent versions 48 of a drug, device, or product are not available or are deemed medically 49 inadvisable, the insurer shall provide coverage for an alternate thera- 50 peutic and pharmaceutical equivalent version of the contraceptive drug, 51 device, or product without cost-sharing. An insurer shall defer to the 52 attending health care provider's determination of medical necessity. 53 The superintendent may develop a standard exception form with 54 instructions that an attending health care provider may use to recommend 55 a particular contraceptive drug, device, procedure, service, or product 56 based upon a determination of medical necessity for an insured. TheS. 1507--A 90 A. 2007--A 1 insurer shall accept the standard exception form submitted by the 2 insured's attending health care provider; 3 (cc) this coverage shall include emergency contraception without cost- 4 sharing when provided pursuant to a prescription, order under section 5 sixty-eight hundred thirty-one of the education law, over-the-counter, 6 or when otherwise lawfully provided other than pursuant to a 7 prescription; and 8 (dd) this coverage shall allow for the dispensing of twelve months- 9 worth of a contraceptive at one time: 10 (II) Voluntary sterilization procedures for women; 11 (III) Patient education and counseling on contraception; and 12 (IV) Follow-up services related to the drugs, devices, products, and 13 procedures covered under this subparagraph, including management of side 14 effects, counseling for continued adherence, and device insertion and 15 removal. 16 (ii) An insurer subject to this subparagraph shall not impose a deduc- 17 tible, coinsurance, copayment or any other cost-sharing requirement on 18 the coverage provided pursuant to this subparagraph. 19 (iii) Except as otherwise authorized under this subparagraph, an 20 insurer shall not impose any restrictions or delays on the coverage 21 required under this subparagraph. 22 § 5. Paragraph (d) of subdivision 3 of section 365-a of the social 23 services law, as amended by chapter 909 of the laws of 1974 and as 24 relettered by chapter 82 of the laws of 1995, is amended to read as 25 follows: 26 (d) family planning services and supplies for eligible persons of 27 childbearing age, including children under twenty-one years of age who 28 can be considered sexually active, who desire such services and 29 supplies, in accordance with the requirements of federal law and regu- 30 lations and the regulations of the department. Prescription contracep- 31 tives, when prescribed based on generally accepted medical practice, may 32 be dispensed at one time or up to twelve times within one year from the 33 date of the prescription. No person shall be compelled or coerced to 34 accept such services or supplies. 35 § 6. This act shall take effect January 1, 2020; provided that 36 sections two, three and four of this act shall apply to policies and 37 contracts issued, renewed, modified, altered or amended on and after 38 such date. 39 PART N 40 Section 1. Universal access commission. 1. There is hereby created a 41 universal access commission, which shall consider and advise the commis- 42 sioner of health and the superintendent of financial services on options 43 for achieving universal access to health care in New York State. 44 2. The universal access commission shall consist of independent health 45 policy and insurance experts appointed by the commissioner and super- 46 intendent. The commission shall consult with the legislature and stake- 47 holder groups and convene at least one meeting for members of the public 48 to review and discuss options for achieving universal access to care. 49 3. The commissioner and superintendent shall select the chair of the 50 commission from among the members of such commission and shall designate 51 at least one employee from each department to assist the commission in 52 the performance of its duties under this section. The commissioner and 53 superintendent shall adopt rules for the governance of the commission, 54 which shall meet as frequently as its business may require and at suchS. 1507--A 91 A. 2007--A 1 other times as determined by the commissioner and superintendent to be 2 necessary. 3 4. Members of the commission shall serve without compensation for 4 their services as members, but each shall be allowed the necessary and 5 actual expenses incurred in the performance of his or her duties under 6 this section. 7 5. The commission shall provide a report to the Governor on the 8 options for achieving universal access to health care in New York State 9 by December 1, 2019. 10 § 2. This act shall take effect immediately. 11 PART O 12 Section 1. Subdivision 2 of section 605 of the public health law, as 13 amended by section 20 of part E of chapter 56 of the laws of 2013, is 14 amended to read as follows: 15 2. State aid reimbursement for public health services provided by a 16 municipality under this title, shall be made if the municipality is 17 providing some or all of the core public health services identified in 18 section six hundred two of this title, pursuant to an approved applica- 19 tion for state aid, at a rate of no less than thirty-six per centum, 20 except for the city of New York which shall receive no less than twenty 21 per centum, of the difference between the amount of moneys expended by 22 the municipality for public health services required by section six 23 hundred two of this title during the fiscal year and the base grant 24 provided pursuant to subdivision one of this section. No such reimburse- 25 ment shall be provided for services that are not eligible for state aid 26 pursuant to this article. 27 § 2. Subdivision 1 of section 616 of the public health law, as amended 28 by section 27 of part E of chapter 56 of the laws of 2013, is amended to 29 read as follows: 30 1. The total amount of state aid provided pursuant to this article 31 shall be limited to the amount of the annual appropriation made by the 32 legislature. In no event, however, shall such state aid be less than an 33 amount to provide the full base grant and, as otherwise provided by 34 [paragraph (a) of] subdivision two of section six hundred five of this 35 article, [at least] no less than thirty-six per centum, except for the 36 city of New York which shall receive no less than twenty per centum, of 37 the difference between the amount of moneys expended by the municipality 38 for eligible public health services pursuant to an approved application 39 for state aid during the fiscal year and the base grant provided pursu- 40 ant to subdivision one of section six hundred five of this article. 41 § 3. This act shall take effect July 1, 2019. 42 PART P 43 Section 1. Subdivision 6 of section 1370 of the public health law, as 44 amended by chapter 485 of the laws of 1992, is amended as follows: 45 6. "Elevated lead levels" means a blood lead level greater than or 46 equal to [ten] five micrograms of lead per deciliter of whole blood or 47 such lower blood lead level as may be established by the department 48 pursuant to rule or regulation. 49 § 2. The public health law is amended by adding a new section 1370-f 50 to read as follows: 51 § 1370-f. Lead safe residential rental properties. 1. Definitions. 52 For the purposes of this section:S. 1507--A 92 A. 2007--A 1 (a) "residential rental property" shall mean a dwelling which is 2 either rented, leased, let or hired out, to be occupied, or is occupied 3 as the home, residence or sleeping place of one or more persons other 4 than the owner's family. Residential rental property shall not include 5 short term rental properties during which guests do not stay in excess 6 of twenty-eight days. 7 (b) "lead safe" shall mean any residential rental property that: 8 (i) has been determined through a lead-based paint inspection 9 conducted in accordance with appropriate federal regulations not to 10 contain lead-based paint; or 11 (ii) meets the minimum standards set forth in regulations promulgated 12 by the commissioner pursuant to this section. 13 2. The commissioner shall promulgate rules and regulations establish- 14 ing minimum standards for the maintenance of lead safe residential 15 rental properties. Such rules and regulations shall include: 16 (a) Minimum standards for maintaining internal and external painted 17 surfaces that contain lead-based paint; and 18 (b) A schedule by which owners of residential rental property must 19 implement and comply with such minimum standards. 20 3. It shall be the responsibility of an owner of any residential 21 rental property to maintain such property in a lead safe condition in 22 accordance with rules and regulations promulgated by the commissioner 23 pursuant to this section. 24 4. All paint on any residential rental property on which the original 25 construction was completed prior to January first, nineteen hundred 26 seventy-eight, shall be presumed to be lead-based paint. This presump- 27 tion may be overcome by a certification issued by a federally certified 28 lead-based paint inspector or risk assessor that the property has been 29 determined not to contain lead-based paint, or by such other means as 30 may be prescribed by the rules and regulations adopted by the commis- 31 sioner pursuant to this section. 32 5. The commissioner, local health officer of a county and, in the City 33 of New York, the commissioner of the New York City department of health 34 and mental hygiene, may enter into an agreement or contract with a 35 municipal government regarding inspection of the lead conditions in 36 residential rental properties and such health department may designate 37 the local housing maintenance code enforcement agency in which the 38 residential rental property is located as an agency authorized to 39 administer and ensure compliance with the provisions of this section 40 and subsequent regulations pursuant to subdivision one of section thir- 41 teen hundred seventy-five of this title. 42 6. If the commissioner, or other officer having jurisdiction, deter- 43 mines that an owner of residential rental property is in violation of 44 this section or any rules or regulations promulgated pursuant to this 45 section, the commissioner or other officer having jurisdiction shall 46 have the authority to order the abatement of any lead condition present 47 at the residential rental property and assess fines not to exceed two 48 thousand dollars for each violation. 49 § 3. Subdivision one of section three hundred eighty-three of the 50 executive law, as added by chapter 707 of the laws of 1984, paragraph c 51 as amended by chapter 772 of the laws of 1986, is amended by adding a 52 new paragraph d, to read as follows: 53 d. The regulations promulgated by the commissioner of health pursuant 54 to subdivision two of section thirteen hundred seventy-f of the public 55 health lawS. 1507--A 93 A. 2007--A 1 (i) shall not be superseded by the provisions of this article, by the 2 provisions of the uniform fire prevention and building code, or by the 3 provisions of the building and fire prevention codes in effect in a city 4 with a population of over one million; 5 (ii) shall be applicable in addition to, and not in substitution for 6 or limitation of, the provisions of the uniform fire prevention and 7 building code and the provisions of building and fire prevention codes 8 in effect in cities with a population of over one million; and 9 (iii) shall be administered and enforced by commissioner of health, 10 the local health officer of a county, the commissioner of the New York 11 City department of health and mental hygiene, or a municipal government 12 entering into an agreement or contract authorized by subdivision five of 13 section thirteen hundred seventy-f of the public health law, in the 14 manner provided in said subdivision. 15 § 4. This act shall take effect immediately. 16 PART Q 17 Section 1. Section 2825-f of the public health law is amended by 18 adding two new subdivisions 4-a and 4-b to read as follows: 19 4-a. Notwithstanding subdivision two of this section or any inconsist- 20 ent provision of law to the contrary, and upon approval of the director 21 of the budget, the commissioner may, subject to the availability of 22 lawful appropriation, award up to three hundred million dollars of the 23 funds made available pursuant to this section for unfunded project 24 applications submitted in response to the request for applications 25 number 17648 issued by the department on January eighth, two thousand 26 eighteen pursuant to section twenty-eight hundred twenty-five-e of this 27 article, provided however that the provisions of subdivisions three and 28 four of this section shall apply. 29 4-b. Authorized amounts to be awarded pursuant to applications submit- 30 ted in response to the request for application number 17648 shall be 31 awarded no later than May first, two thousand nineteen. 32 § 2. This act shall take effect immediately. 33 PART R 34 Section 1. Legislative findings and intent. The legislature finds that 35 maternal mortality and morbidity is a serious public health concern and 36 has a serious family and societal impact. New York state has among the 37 highest maternal mortality rates in the country and racial disparities 38 remain significant. The U.S. Centers for Disease Control and Prevention 39 has determined that a regular process for professional, multi-discipli- 40 nary, confidential review of all maternal deaths can help identify the 41 causes of maternal mortality, and those findings can lead to clinical 42 and social change that can help prevent maternal mortality. The same is 43 true for severe maternal morbidity. Confidentiality is important to 44 ensure that full information is made available in the review process to 45 maximize protection of maternal health. 46 Section 3 of article 17 of the state constitution states: "The 47 protection and promotion of the health of the inhabitants of the state 48 are matters of public concern and provision therefor shall be made by 49 the state and by such of its subdivisions and in such manner, and by 50 such means as the legislature shall from time to time determine." The 51 legislature finds that the creation of a state maternal mortality review 52 board, and recognition and protection of any maternal mortality reviewS. 1507--A 94 A. 2007--A 1 board, including a New York city maternal mortality review board, are a 2 matter of state concern and an important exercise of the legislature's 3 constitutional mandate to protect the public health. 4 § 2. The public health law is amended by adding a new section 2509 to 5 read as follows: 6 § 2509. Maternal mortality review board. 1. (a) There is hereby estab- 7 lished in the department the maternal mortality review board for the 8 purpose of reviewing maternal deaths and severe maternal morbidity and 9 developing findings, recommendations, and best practices to the commis- 10 sioner to contribute to the prevention of maternal mortality and severe 11 maternal morbidity. The board shall assess the cause of death, factors 12 leading to death and preventability for each maternal death reviewed 13 and, at the discretion of the board, cases of severe maternal morbidity, 14 and shall develop strategies for reducing the risk of maternal mortality 15 and severe maternal morbidity, where cases of severe maternal morbidity 16 were reviewed, taking into account factors such as racial, economic, or 17 other disparities. The boards' findings, recommendations and best prac- 18 tices shall be given to the commissioner for dissemination. 19 (b) Any maternal mortality review board, including a New York city 20 maternal mortality review board, shall provide to the commissioner the 21 results and the findings of its reviews, including recommendations and 22 best practices and upon request information and data, including case 23 summaries, to support statewide surveillance and enforcement. 24 2. As used in this section: 25 (a) "Advisory council" and "council" mean the advisory council on 26 maternal mortality and severe maternal morbidity, established under this 27 section. 28 (b) "Board" means a maternal mortality review board established by 29 this section, referred to in this section as the "state board", or any 30 board operating, including a New York city maternal mortality review 31 board, under this section. 32 (c) "Maternal death" means the death of a woman during pregnancy or 33 within a year from the end of pregnancy. 34 (d) "Severe maternal morbidity" means unexpected outcomes of pregnan- 35 cy, labor, or delivery that result in significant short- or long-term 36 consequences to a woman's health. 37 3. (a) The members of the state board shall be comprised of multidis- 38 ciplinary experts in the field of maternal mortality, women's health and 39 public health, and shall include health care professionals and other 40 experts who serve and are representative of the racial and ethnic diver- 41 sity of the women and mothers of the state. 42 (b) The state board shall be composed of at least fifteen members, all 43 of whom shall be appointed by the commissioner. 44 (c) The terms of the state board members shall be three years. The 45 commissioner may choose to reappoint state board members to additional 46 three year terms. 47 (d) A majority of the appointed membership of the state board, no less 48 than three, shall constitute a quorum. 49 (e) When any member of the state board fails to attend three consec- 50 utive regular meetings, unless such absence is for good cause, that 51 membership may be deemed vacant for purposes of the appointment of a 52 successor. 53 (f) Meetings of the state board shall be held at least twice a year 54 but may be held more frequently as deemed necessary, subject to request 55 of the department.S. 1507--A 95 A. 2007--A 1 (g) Members of the state board shall be indemnified under section 2 seventeen of the public officers law. 3 (h) Members of the state board shall not be compensated for their 4 participation on the board but may receive reimbursement for their ordi- 5 nary and necessary expenses of participation. 6 (i) Membership on a board shall not disqualify any person from holding 7 any public office or employment. 8 (j) The board is not subject to Article 7 of the public officers law. 9 4. (a) The commissioner shall receive upon request from any depart- 10 ment, division, board, bureau, commission, local health departments or 11 other agency of the state or political subdivision thereof or any public 12 authority, as well as hospitals established pursuant to article twenty- 13 eight of this chapter, birthing facilities, medical examiners, coroners 14 and coroner physicians and any other facility providing services associ- 15 ated with maternal mortality, such information, including, but not 16 limited to, death records, medical records, autopsy reports, toxicology 17 reports, hospital discharge records, birth records and any other infor- 18 mation. 19 (b) The commissioner shall receive information, including oral or 20 written statements, relating to any maternal death and case of severe 21 maternal morbidity, from any family member or other interested party 22 (including the patient in a case of severe maternal morbidity) relating 23 to any case that may come before the board. Oral statements received 24 under this paragraph shall be transcribed or summarized in writing. The 25 commissioner and the city commissioner shall transmit that information 26 to the board considering the case. 27 (c) Before transmitting any information to the board, the commissioner 28 shall remove all personal identifying information of the woman, health 29 care practitioner or practitioners or anyone else individually named in 30 such information, as well as the hospital or facility that treated the 31 woman, and any other information such as geographic location that may 32 inadvertently identify the woman, practitioner or facility. This para- 33 graph shall not preclude the transmitting of information to the board 34 that is reasonably necessary to enable the board to perform an appropri- 35 ate review under this section. 36 5. Each board: 37 (a) shall make and report findings, recommendations and best practices 38 to the commissioner regarding the cause of death, factors leading to 39 death, and preventability of each maternal death case, and each case of 40 severe maternal morbidity reviewed by the board, by reviewing relevant 41 information for each case and consulting with experts as needed to eval- 42 uate the information for each death; and shall provide such de-identi- 43 fied findings and recommendations, including best practices and strate- 44 gies for reducing the risk of maternal mortality and severe maternal 45 morbidity, to the advisory council; provided that material provided to 46 the advisory council shall not include any information that would be 47 confidential under this section; 48 (b) shall develop recommendations to the commissioner for areas of 49 focus, including issues of severe maternal morbidity and issues of 50 racial, economic or other disparities in maternal outcomes; 51 (c) may, in addition to the findings, recommendations, and best prac- 52 tices made under this subdivision, and consistent with all applicable 53 confidentiality protections, bring any particular matter to the atten- 54 tion of the commissioner;S. 1507--A 96 A. 2007--A 1 (d) the state board shall issue a report every other year to the 2 commissioner on its findings, recommendations, and best practices, and 3 it shall be a public document. 4 6. The commissioner and boards shall each keep confidential any infor- 5 mation collected or received under this section that includes personal 6 identifying information of the woman, health care practitioner or prac- 7 titioners or anyone else individually named in such information, as well 8 as the hospital or facility that treated the woman, and any other infor- 9 mation such as geographic location that may inadvertently identify the 10 woman, practitioner or facility, and shall use the information provided 11 or received under this section solely for the purposes of improvement of 12 the quality of health care of women and to prevent maternal mortality 13 and severe maternal morbidity. This subdivision shall not preclude the 14 transmitting of information to the board that is reasonably necessary to 15 enable the board to perform an appropriate review under this section. 16 All information and records received, meetings conducted, reports and 17 records made and maintained and all books and papers obtained by the 18 commissioner as well as the board shall be confidential and shall not be 19 made open or available, including under article six of the public offi- 20 cers law, and shall be limited to board members as well as those author- 21 ized by the commissioner. Such information shall not be discoverable or 22 admissible as evidence in any action in any court or before any other 23 tribunal, board, agency or person. 24 7. (a) There is hereby established in the department an advisory coun- 25 cil on maternal mortality and severe maternal morbidity. 26 (b) The advisory council: 27 (i) may review the findings, recommendations and best practices of the 28 boards; 29 (ii) may use the boards findings, recommendations and best practices 30 to develop recommendations on policies, best practices, and strategies 31 to prevent maternal mortality and severe maternal morbidity; 32 (iii) may hold public hearings on those matters; and 33 (iv) may make findings and issue reports, including an annual report, 34 on such matters; 35 (c) The advisory council shall consist of at least twenty members, 36 representative of the racial and ethnic diversity of the women and moth- 37 ers of the state to be determined by the commissioner. Ten of the 38 members of the council shall be representative of the population and 39 health care system of the city of New York. The commissioner shall 40 appoint the chair of the council. 41 (d) The members of the council shall be comprised of multidisciplinary 42 experts and lay persons knowledgeable in the field of maternal mortal- 43 ity, women's health and public health and shall include members who 44 serve and are representative of the diversity of the women and mothers 45 in medically underserved areas of the state or areas of the state with 46 disproportionately high occurrences of maternal mortality or severe 47 maternal morbidity. 48 (e) The terms of the council members shall be three years. The commis- 49 sioner may choose to reappoint council members to additional three-year 50 terms. Vacancies on the council shall be filled by appointment by the 51 commissioner. A majority of the appointed membership of the council 52 shall constitute a quorum. When any member of the council fails to 53 attend three consecutive regular meetings, unless such absence is for 54 good cause, that membership may be deemed vacant for purposes of the 55 appointment of a successor. 56 (f) Meetings of the council shall be held at least twice a year.S. 1507--A 97 A. 2007--A 1 (g) Members of the council shall be indemnified under section seven- 2 teen of the public officers law. Members of the council shall not be 3 compensated for their participation on the council but shall receive 4 reimbursement for their ordinary and necessary expenses of partic- 5 ipation. Membership on the council shall not disqualify any person from 6 holding any public office or employment. 7 § 3. This act shall take effect immediately. 8 PART S 9 Section 1. Legislative intent. The legislature finds that comprehen- 10 sive reproductive health care, including contraception and abortion, is 11 a fundamental component of a woman's health, privacy and equality. The 12 New York Constitution and United States Constitution protect a woman's 13 fundamental right to access safe, legal abortion, courts have repeatedly 14 reaffirmed this right and further emphasized that states may not place 15 undue burdens on women seeking to access such right. 16 Moreover, the legislature finds, as with other medical procedures, the 17 safety of abortion is furthered by evidence-based practices developed 18 and supported by medical professionals. Abortion is one of the safest 19 medical procedures performed in the United States; the goal of medical 20 regulation should be to improve the quality and availability of health 21 care services. 22 Furthermore, the legislature declares that it is the public policy of 23 New York State that every individual possesses a fundamental right of 24 privacy and equality with respect to their personal reproductive deci- 25 sions and should be able to safely effectuate those decisions, including 26 by seeking and obtaining abortion care, free from discrimination in the 27 provision of health care. 28 Therefore, it is the intent of the legislature to prevent the enforce- 29 ment of laws or regulations that are not in furtherance of a legitimate 30 state interest in protecting a woman's health that burden abortion 31 access. 32 § 2. The public health law is amended by adding a new article 25-A to 33 read as follows: 34 ARTICLE 25-A 35 REPRODUCTIVE HEALTH ACT 36 Section 2599-aa. Policy and purpose. 37 2599-bb. Abortion. 38 § 2599-aa. Policy and purpose. The legislature finds that comprehen- 39 sive reproductive health care is a fundamental component of every indi- 40 vidual's health, privacy and equality. Therefore, it is the policy of 41 the state that: 42 1. Every individual has the fundamental right to choose or refuse 43 contraception or sterilization. 44 2. Every individual who becomes pregnant has the fundamental right to 45 choose to carry the pregnancy to term, to give birth to a child, or to 46 have an abortion, pursuant to this article. 47 3. The state shall not discriminate against, deny, or interfere with 48 the exercise of the rights set forth in this section in the regulation 49 or provision of benefits, facilities, services or information. 50 § 2599-bb. Abortion. 1. A health care practitioner licensed, certi- 51 fied, or authorized under title eight of the education law, acting with- 52 in his or her lawful scope of practice, may perform an abortion when, 53 according to the practitioner's reasonable and good faith professional 54 judgment based on the facts of the patient's case: the patient is withinS. 1507--A 98 A. 2007--A 1 twenty-four weeks from the commencement of pregnancy, or there is an 2 absence of fetal viability, or the abortion is necessary to protect the 3 patient's life or health. 4 2. This article shall be construed and applied consistent with and 5 subject to applicable laws and applicable and authorized regulations 6 governing health care procedures. 7 § 3. Section 4164 of the public health law is REPEALED. 8 § 4. Subdivision 8 of section 6811 of the education law is REPEALED. 9 § 5. Sections 125.40, 125.45, 125.50, 125.55 and 125.60 of the penal 10 law are REPEALED, and the article heading of article 125 of the penal 11 law is amended to read as follows: 12 HOMICIDE[, ABORTION] AND RELATED OFFENSES 13 § 6. Section 125.00 of the penal law is amended to read as follows: 14 § 125.00 Homicide defined. 15 Homicide means conduct which causes the death of a person [or an16unborn child with which a female has been pregnant for more than twen-17ty-four weeks] under circumstances constituting murder, manslaughter in 18 the first degree, manslaughter in the second degree, or criminally 19 negligent homicide[, abortion in the first degree or self-abortion in20the first degree]. 21 § 7. The section heading, opening paragraph and subdivision 1 of 22 section 125.05 of the penal law are amended to read as follows: 23 Homicide[, abortion] and related offenses; [definitions of terms] 24 definition. 25 The following [definitions are] definition is applicable to this arti- 26 cle: 27 [1.] "Person," when referring to the victim of a homicide, means a 28 human being who has been born and is alive. 29 § 7-a. Subdivisions 2 and 3 of section 125.05 of the penal law are 30 REPEALED. 31 § 8. Subdivision 2 of section 125.15 of the penal law is REPEALED. 32 § 9. Subdivision 3 of section 125.20 of the penal law is REPEALED. 33 § 10. Paragraph (b) of subdivision 8 of section 700.05 of the criminal 34 procedure law, as amended by chapter 189 of the laws of 2018, is amended 35 to read as follows: 36 (b) Any of the following felonies: assault in the second degree as 37 defined in section 120.05 of the penal law, assault in the first degree 38 as defined in section 120.10 of the penal law, reckless endangerment in 39 the first degree as defined in section 120.25 of the penal law, promot- 40 ing a suicide attempt as defined in section 120.30 of the penal law, 41 strangulation in the second degree as defined in section 121.12 of the 42 penal law, strangulation in the first degree as defined in section 43 121.13 of the penal law, criminally negligent homicide as defined in 44 section 125.10 of the penal law, manslaughter in the second degree as 45 defined in section 125.15 of the penal law, manslaughter in the first 46 degree as defined in section 125.20 of the penal law, murder in the 47 second degree as defined in section 125.25 of the penal law, murder in 48 the first degree as defined in section 125.27 of the penal law, 49 [abortion in the second degree as defined in section 125.40 of the penal50law, abortion in the first degree as defined in section 125.45 of the51penal law,] rape in the third degree as defined in section 130.25 of the 52 penal law, rape in the second degree as defined in section 130.30 of the 53 penal law, rape in the first degree as defined in section 130.35 of the 54 penal law, criminal sexual act in the third degree as defined in section 55 130.40 of the penal law, criminal sexual act in the second degree as 56 defined in section 130.45 of the penal law, criminal sexual act in theS. 1507--A 99 A. 2007--A 1 first degree as defined in section 130.50 of the penal law, sexual abuse 2 in the first degree as defined in section 130.65 of the penal law, 3 unlawful imprisonment in the first degree as defined in section 135.10 4 of the penal law, kidnapping in the second degree as defined in section 5 135.20 of the penal law, kidnapping in the first degree as defined in 6 section 135.25 of the penal law, labor trafficking as defined in section 7 135.35 of the penal law, aggravated labor trafficking as defined in 8 section 135.37 of the penal law, custodial interference in the first 9 degree as defined in section 135.50 of the penal law, coercion in the 10 first degree as defined in section 135.65 of the penal law, criminal 11 trespass in the first degree as defined in section 140.17 of the penal 12 law, burglary in the third degree as defined in section 140.20 of the 13 penal law, burglary in the second degree as defined in section 140.25 of 14 the penal law, burglary in the first degree as defined in section 140.30 15 of the penal law, criminal mischief in the third degree as defined in 16 section 145.05 of the penal law, criminal mischief in the second degree 17 as defined in section 145.10 of the penal law, criminal mischief in the 18 first degree as defined in section 145.12 of the penal law, criminal 19 tampering in the first degree as defined in section 145.20 of the penal 20 law, arson in the fourth degree as defined in section 150.05 of the 21 penal law, arson in the third degree as defined in section 150.10 of the 22 penal law, arson in the second degree as defined in section 150.15 of 23 the penal law, arson in the first degree as defined in section 150.20 of 24 the penal law, grand larceny in the fourth degree as defined in section 25 155.30 of the penal law, grand larceny in the third degree as defined in 26 section 155.35 of the penal law, grand larceny in the second degree as 27 defined in section 155.40 of the penal law, grand larceny in the first 28 degree as defined in section 155.42 of the penal law, health care fraud 29 in the fourth degree as defined in section 177.10 of the penal law, 30 health care fraud in the third degree as defined in section 177.15 of 31 the penal law, health care fraud in the second degree as defined in 32 section 177.20 of the penal law, health care fraud in the first degree 33 as defined in section 177.25 of the penal law, robbery in the third 34 degree as defined in section 160.05 of the penal law, robbery in the 35 second degree as defined in section 160.10 of the penal law, robbery in 36 the first degree as defined in section 160.15 of the penal law, unlawful 37 use of secret scientific material as defined in section 165.07 of the 38 penal law, criminal possession of stolen property in the fourth degree 39 as defined in section 165.45 of the penal law, criminal possession of 40 stolen property in the third degree as defined in section 165.50 of the 41 penal law, criminal possession of stolen property in the second degree 42 as defined by section 165.52 of the penal law, criminal possession of 43 stolen property in the first degree as defined by section 165.54 of the 44 penal law, trademark counterfeiting in the second degree as defined in 45 section 165.72 of the penal law, trademark counterfeiting in the first 46 degree as defined in section 165.73 of the penal law, forgery in the 47 second degree as defined in section 170.10 of the penal law, forgery in 48 the first degree as defined in section 170.15 of the penal law, criminal 49 possession of a forged instrument in the second degree as defined in 50 section 170.25 of the penal law, criminal possession of a forged instru- 51 ment in the first degree as defined in section 170.30 of the penal law, 52 criminal possession of forgery devices as defined in section 170.40 of 53 the penal law, falsifying business records in the first degree as 54 defined in section 175.10 of the penal law, tampering with public 55 records in the first degree as defined in section 175.25 of the penal 56 law, offering a false instrument for filing in the first degree asS. 1507--A 100 A. 2007--A 1 defined in section 175.35 of the penal law, issuing a false certificate 2 as defined in section 175.40 of the penal law, criminal diversion of 3 prescription medications and prescriptions in the second degree as 4 defined in section 178.20 of the penal law, criminal diversion of 5 prescription medications and prescriptions in the first degree as 6 defined in section 178.25 of the penal law, residential mortgage fraud 7 in the fourth degree as defined in section 187.10 of the penal law, 8 residential mortgage fraud in the third degree as defined in section 9 187.15 of the penal law, residential mortgage fraud in the second degree 10 as defined in section 187.20 of the penal law, residential mortgage 11 fraud in the first degree as defined in section 187.25 of the penal law, 12 escape in the second degree as defined in section 205.10 of the penal 13 law, escape in the first degree as defined in section 205.15 of the 14 penal law, absconding from temporary release in the first degree as 15 defined in section 205.17 of the penal law, promoting prison contraband 16 in the first degree as defined in section 205.25 of the penal law, 17 hindering prosecution in the second degree as defined in section 205.60 18 of the penal law, hindering prosecution in the first degree as defined 19 in section 205.65 of the penal law, sex trafficking as defined in 20 section 230.34 of the penal law, sex trafficking of a child as defined 21 in section 230.34-a of the penal law, criminal possession of a weapon in 22 the third degree as defined in subdivisions two, three and five of 23 section 265.02 of the penal law, criminal possession of a weapon in the 24 second degree as defined in section 265.03 of the penal law, criminal 25 possession of a weapon in the first degree as defined in section 265.04 26 of the penal law, manufacture, transport, disposition and defacement of 27 weapons and dangerous instruments and appliances defined as felonies in 28 subdivisions one, two, and three of section 265.10 of the penal law, 29 sections 265.11, 265.12 and 265.13 of the penal law, or prohibited use 30 of weapons as defined in subdivision two of section 265.35 of the penal 31 law, relating to firearms and other dangerous weapons, or failure to 32 disclose the origin of a recording in the first degree as defined in 33 section 275.40 of the penal law; 34 § 11. Subdivision 1 of section 673 of the county law, as added by 35 chapter 545 of the laws of 1965, is amended to read as follows: 36 1. A coroner or medical examiner has jurisdiction and authority to 37 investigate the death of every person dying within his county, or whose 38 body is found within the county, which is or appears to be: 39 (a) A violent death, whether by criminal violence, suicide or casual- 40 ty; 41 (b) A death caused by unlawful act or criminal neglect; 42 (c) A death occurring in a suspicious, unusual or unexplained manner; 43 (d) [A death caused by suspected criminal abortion;44(e)] A death while unattended by a physician, so far as can be discov- 45 ered, or where no physician able to certify the cause of death as 46 provided in the public health law and in form as prescribed by the 47 commissioner of health can be found; 48 [(f)] (e) A death of a person confined in a public institution other 49 than a hospital, infirmary or nursing home. 50 § 12. Section 4 of the judiciary law, as amended by chapter 264 of the 51 laws of 2003, is amended to read as follows: 52 § 4. Sittings of courts to be public. The sittings of every court 53 within this state shall be public, and every citizen may freely attend 54 the same, except that in all proceedings and trials in cases for 55 divorce, seduction, [abortion,] rape, assault with intent to commit 56 rape, criminal sexual act, bastardy or filiation, the court may, in itsS. 1507--A 101 A. 2007--A 1 discretion, exclude therefrom all persons who are not directly inter- 2 ested therein, excepting jurors, witnesses, and officers of the court. 3 § 13. Severability. If any provision of this act, or any application 4 of any provision of this act, is held to be invalid, that shall not 5 affect the validity or effectiveness of any other provision of this act, 6 or of any other application of any provision of this act, which can be 7 given effect without that provision or application; and to that end, the 8 provisions and applications of this act are severable. 9 § 14. This act shall take effect immediately. 10 PART T 11 Section 1. This act shall be known and may be cited as the "NY State 12 of Health, The Official Health Plan Marketplace Act". 13 § 2. Article 2 of the public health law is amended by adding a new 14 title VII to read as follows: 15 TITLE VII 16 NY STATE OF HEALTH 17 Section 268. Statement of policy and purposes. 18 268-a. Definitions. 19 268-b. Establishment of NY State of Health, The Official Health 20 Plan Marketplace. 21 268-c. Functions of the Marketplace. 22 268-d. Special functions of the Marketplace related to health 23 plan certification and qualified health plan oversight. 24 268-e. Appeals and appeal hearings; judicial review. 25 268-f. Marketplace advisory committee. 26 268-g. Funding of the Marketplace. 27 268-h. Construction. 28 § 268. Statement of policy and purposes. The purpose of this title is 29 to codify the establishment of the health benefit exchange in New York, 30 known as NY State of Health, The Official Health Plan Marketplace 31 (Marketplace), in conformance with Executive Order 42 (Cuomo) issued 32 April 12, 2012. The Marketplace shall continue to perform eligibility 33 determinations for federal and state insurance affordability programs 34 including medical assistance in accordance with section three hundred 35 sixty-six of the social services law, child health plus in accordance 36 with section twenty-five hundred eleven of this chapter, the basic 37 health program in accordance with section three hundred sixty-nine-gg of 38 the social services law, and premium tax credits and cost-sharing 39 reductions, together with performing eligibility determinations for 40 qualified health plans and such other health insurance programs as 41 determined by the commissioner. The Marketplace shall also facilitate 42 enrollment in insurance affordability programs, qualified health plans 43 and other health insurance programs as determined by the commissioner, 44 the purchase and sale of qualified health plans and/or other or addi- 45 tional health plans certified by the Marketplace pursuant to this title, 46 and shall continue to have the authority to operate a small business 47 health options program ("SHOP") to assist eligible small employers in 48 selecting qualified health plans and/or other or additional health plans 49 certified by the Marketplace and to determine small employer eligibility 50 for purposes of small employer tax credits. It is the intent of the 51 legislature, by codifying the Marketplace in state statute, to continue 52 to promote quality and affordable health coverage and care, reduce the 53 number of uninsured persons, provide a transparent marketplace, educate 54 consumers and assist individuals with access to coverage, premiumS. 1507--A 102 A. 2007--A 1 assistance tax credits and cost-sharing reductions. In addition, the 2 legislature declares the intent that the Marketplace continue to be 3 properly integrated with insurance affordability programs, including 4 Medicaid, child health plus and the basic health program, and such other 5 health insurance programs as determined by the commissioner. 6 § 268-a. Definitions. For purposes of this title, the following defi- 7 nitions shall apply: 8 1. "Commissioner" means the commissioner of health of the state of New 9 York. 10 2. "Marketplace" means the "NY State of Health, The official health 11 plan Marketplace" or "Marketplace" established as a health benefit 12 exchange or "marketplace" within the department of health pursuant to 13 Executive Order 42 (Cuomo) issued April 12, 2012 and this title. 14 3. "Federal act" means the patient protection and affordable care act, 15 public law 111-148, as amended by the health care and education recon- 16 ciliation act of 2010, public law 111-152, and any regulations or guid- 17 ance issued thereunder. 18 4. "Health plan" means a policy, contract or certificate, offered or 19 issued by an insurer to provide, deliver, arrange for, pay for or reim- 20 burse any of the costs of health care services. Health plan shall not 21 include the following: 22 (a) accident insurance or disability income insurance, or any combina- 23 tion thereof; 24 (b) coverage issued as a supplement to liability insurance; 25 (c) liability insurance, including general liability insurance and 26 automobile liability insurance; 27 (d) workers' compensation or similar insurance; 28 (e) automobile no-fault insurance; 29 (f) credit insurance; 30 (g) other similar insurance coverage, as specified in federal regu- 31 lations, under which benefits for medical care are secondary or inci- 32 dental to other insurance benefits; 33 (h) limited scope dental or vision benefits, benefits for long-term 34 care insurance, nursing home insurance, home care insurance, or any 35 combination thereof, or such other similar, limited benefits health 36 insurance as specified in federal regulations, if the benefits are 37 provided under a separate policy, certificate or contract of insurance 38 or are otherwise not an integral part of the plan; 39 (i) coverage only for a specified disease or illness, hospital indem- 40 nity, or other fixed indemnity coverage; 41 (j) Medicare supplemental insurance as defined in section 1882(g)(1) 42 of the federal social security act, coverage supplemental to the cover- 43 age provided under chapter 55 of title 10 of the United States Code, or 44 similar supplemental coverage provided under a group health plan if it 45 is offered as a separate policy, certificate or contract of insurance; 46 or 47 (k) the New York state medical indemnity fund established pursuant to 48 title four of article twenty-nine-D of the public health law. 49 5. "Insurer" means an insurance company subject to article forty-two 50 or a corporation subject to article forty-three of the insurance law, or 51 a health maintenance organization certified pursuant to article forty- 52 four of the public health law that contracts or offers to contract to 53 provide, deliver, arrange, pay or reimburse any of the costs of health 54 care services.S. 1507--A 103 A. 2007--A 1 6. "Stand-Alone dental plan" means a dental services plan that has 2 been issued pursuant to applicable law and certified by the Marketplace 3 in accordance with section two hundred sixty-eight-d of this title. 4 7. "Qualified health plan" means a health plan that is issued pursuant 5 to applicable law and certified by the Marketplace in accordance with 6 section two hundred sixty-eight-d of this title, including a stand-alone 7 dental plan. 8 8. "Insurance affordability program" means Medicaid, child health 9 plus, the basic health program and any other health insurance subsidy 10 program designated as such by the commissioner. 11 9. "Eligible individual" means an individual, including a minor, who 12 is eligible to enroll in an insurance affordability program or other 13 health insurance program as determined by the commissioner. 14 10. "Qualified individual" means, with respect to qualified health 15 plans, an individual, including a minor, who: 16 (a) is eligible to enroll in a qualified health plan offered to indi- 17 viduals through the Marketplace; 18 (b) resides in this state; 19 (c) at the time of enrollment, is not incarcerated, other than incar- 20 ceration pending the disposition of charges; and 21 (d) is, and is reasonably expected to be, for the entire period for 22 which enrollment is sought, a citizen or national of the United States 23 or an alien lawfully present in the United States. 24 11. "Secretary" means the secretary of the United States department of 25 health and human services. 26 12. "SHOP" means the small business health options program operated by 27 the Marketplace to assist eligible small employers in this state in 28 selecting qualified health plans and/or other or additional health plans 29 certified by the Marketplace and to determine small employer eligibility 30 for purposes of small employer tax credits in accordance with applicable 31 federal and state laws and regulations. 32 13. "Small employer" means an employer which offers coverage where the 33 coverage such employer offers would be considered small group coverage 34 under the insurance law and regulations promulgated thereunder, provided 35 that it is not otherwise prohibited under the federal act. 36 14. "Small group market" means the health insurance market under which 37 individuals receive health insurance coverage on behalf of themselves 38 and their dependents through a group health plan maintained by a small 39 employer. 40 15. "Superintendent" means the superintendent of financial services. 41 16. "Essential health benefits" shall mean the categories of benefits 42 defined in subsection (a) of section three thousand two hundred seven- 43 teen-i and subsection (a) of section four thousand three hundred six-h 44 of the insurance law. 45 § 268-b. Establishment of NY State of Health, The Official Health Plan 46 Marketplace. 1. There is hereby established an office within the depart- 47 ment of health to be known as the "NY State of Health, The official 48 health plan Marketplace". 49 2. The purpose of the Marketplace is to facilitate enrollment in 50 health coverage and the purchase and sale of qualified health plans and 51 other health plans certified by the Marketplace; enroll individuals in 52 coverage for which they are eligible in accordance with federal and 53 state law; enable eligible individuals to receive premium tax credits, 54 cost-sharing reductions, and to access insurance affordability programs 55 and other health insurance programs as determined by the commissioner; 56 assist eligible small employers in selecting qualified health plansS. 1507--A 104 A. 2007--A 1 and/or other, or additional health plans certified by the Marketplace 2 and to qualify for small employer tax credits in accordance with appli- 3 cable law; and to carry out other functions set forth in this title. 4 § 268-c. Functions of the Marketplace. The Marketplace shall: 5 1. (a) Perform eligibility determinations for federal and state insur- 6 ance affordability programs including medical assistance in accordance 7 with section three hundred sixty-six of the social services law, child 8 health plus in accordance with section twenty-five hundred eleven of 9 this chapter, the basic health program in accordance with section three 10 hundred sixty-nine-gg of the social services law, premium tax credits 11 and cost-sharing reductions and qualified health plans in accordance 12 with applicable law and other health insurance programs as determined by 13 the commissioner; 14 (b) certify and make available to qualified individuals, qualified 15 health plans, including dental plans, certified by the Marketplace 16 pursuant to applicable law, provided that coverage under such plans 17 shall not become effective prior to certification by the Marketplace; 18 and 19 (c) certify and/or make available to eligible individuals, health 20 plans certified by the Marketplace pursuant to applicable law, and/or 21 participating in an insurance affordability program pursuant to applica- 22 ble law, provided that coverage under such plans shall not become effec- 23 tive prior to certification by the Marketplace, and/or approval by the 24 commissioner. 25 2. Assign an actuarial value to each Marketplace certified plan 26 offered through the Marketplace in accordance with the criteria devel- 27 oped by the secretary pursuant to federal law or the superintendent 28 pursuant to the insurance law and/or requirements developed by the 29 Marketplace, and determine each health plan's level of coverage in 30 accordance with regulations issued by the secretary pursuant to federal 31 law or the superintendent pursuant to the insurance law. 32 3. Utilize a standardized format for presenting health benefit options 33 in the Marketplace, including the use of the uniform outline of coverage 34 established under section 2715 of the federal public health service act 35 or the insurance law. 36 4. Standardize the benefits available through the Marketplace at each 37 level of coverage defined by the superintendent in the insurance law. 38 5. Maintain enrollment periods in the best interest of qualified indi- 39 viduals consistent with federal and state law. 40 6. Implement procedures for the certification, recertification and 41 decertification of health plans as qualified health plans or health 42 plans approved for sale by the department of financial services or 43 department of health and certified by the Marketplace, consistent with 44 guidelines developed by the secretary pursuant to section 1311(c) of the 45 federal act and requirements developed by the Marketplace. 46 7. Contract for health care coverage offered to qualified individuals 47 through the Marketplace, and in doing so shall seek to provide health 48 care coverage choices that offer the optimal combination of choice, 49 value, quality, and service. 50 8. Contract for health care coverage offered to certain eligible indi- 51 viduals through the Marketplace, pursuant to health insurance programs 52 as determined by the commissioner, and in doing so shall seek to provide 53 health care coverage choices that offer the optimal combination of 54 choice, value, quality, and service;S. 1507--A 105 A. 2007--A 1 9. Provide the minimum requirements an insurer shall meet to partic- 2 ipate in the Marketplace, in the best interest of qualified individuals 3 or eligible individuals; 4 10. Require qualified health plans and/or other health plans certified 5 by the Marketplace to offer those benefits determined to be essential 6 health benefits pursuant to state law or as required by the Marketplace. 7 11. Ensure that insurers offering health plans through the Marketplace 8 do not charge an individual enrollee a fee or penalty for termination of 9 coverage. 10 12. Provide for the operation of a toll-free telephone hotline to 11 respond to requests for assistance. 12 13. Maintain an internet website through which enrollees and prospec- 13 tive enrollees of qualified health plans and health plans certified by 14 the Marketplace may obtain standardized comparative information on such 15 plans and insurance affordability programs. 16 14. Make available by electronic means a calculator to determine the 17 actual cost of coverage after the application of any premium tax credit 18 under section 36B of the Internal Revenue Code of 1986 or applicable 19 state law and any cost-sharing reduction under federal or applicable 20 state law. 21 15. Operate a program under which the Marketplace awards grants to 22 entities to serve as navigators in accordance with applicable federal 23 law and regulations adopted thereunder, and/or a program under which the 24 Marketplace awards grants to entities to provide community based enroll- 25 ment assistance in accordance with requirements developed by the Market- 26 place; and/or a program under which the Marketplace certifies New York 27 state licensed producers to provide assistance to eligible individuals 28 and/or small employers pursuant to federal or state law. 29 16. In accordance with applicable federal and state law, inform indi- 30 viduals of eligibility requirements for the Medicaid program under title 31 XIX of the social security act and the social services law, the chil- 32 dren's health insurance program (CHIP) under title XXI of the social 33 security act and this chapter, the basic health program under section 34 three hundred sixty-nine-gg of the social services law, or any applica- 35 ble state or local public health insurance program and if, through 36 screening of the application by the Marketplace, the Marketplace deter- 37 mines that such individuals are eligible for any such program, enroll 38 such individuals in such program. 39 17. Grant a certification that an individual is exempt from the 40 requirement to maintain minimum essential coverage pursuant to federal 41 or state law and from any penalties imposed by such requirements 42 because: 43 (a) there is no affordable health plan available covering the individ- 44 ual, as defined by applicable law; or 45 (b) the individual meets the requirements for any other such exemption 46 from the requirement to maintain minimum essential coverage or to pay 47 the penalty pursuant to applicable federal or state law. 48 18. Operate a small business health options program ("SHOP") pursuant 49 to section 1311 of the federal act and applicable state law, through 50 which eligible small employers may select marketplace-certified quali- 51 fied health plans offered in the small group market, and through which 52 eligible small employers may receive assistance in qualifying for small 53 business tax credits available pursuant to federal and state law. 54 19. Enter into agreements as necessary with federal and state agencies 55 and other state Marketplaces to carry out its responsibilities under 56 this title, provided such agreements include adequate protections withS. 1507--A 106 A. 2007--A 1 respect to the confidentiality of any information to be shared and 2 comply with all state and federal laws and regulations. 3 20. Perform duties required by the secretary, the secretary of the 4 United States department of the treasury or the commissioner related to 5 determining eligibility for premium tax credits or reduced cost-sharing 6 under applicable federal or state law. 7 21. Meet program integrity requirements under applicable law, includ- 8 ing keeping an accurate accounting of receipts and expenditures and 9 providing reports to the secretary regarding Marketplace related activ- 10 ities in accordance with applicable law. 11 22. Submit information provided by Marketplace applicants for verifi- 12 cation as required by section 1411(c) of the federal act and applicable 13 state law. 14 23. Establish rules and regulations that do not conflict with or 15 prevent the application of regulations promulgated by the secretary. 16 24. Determine eligibility, provide notices, and provide opportunities 17 for appeal and redetermination in accordance with the requirements of 18 federal and state law. 19 § 268-d. Special functions of the Marketplace related to health plan 20 certification and qualified health plan oversight. 1. Health plans 21 certified by the Marketplace shall meet the following requirements: 22 (a) The insurer offering the health plan: 23 (i) is licensed or certified by the superintendent or commissioner, in 24 good standing to offer health insurance coverage in this state, and 25 meets the requirements established by the Marketplace; 26 (ii) offers at least one qualified health plan and/or other or addi- 27 tional health plans authorized for sale by the department of financial 28 services or the department in each of the silver and gold levels as 29 required by state law, provided, however, that the Marketplace may 30 require additional benefit levels to be offered by all insurers partic- 31 ipating in the Marketplace; 32 (iii) has filed with and received approval from the superintendent of 33 its premium rates and policy or contract forms pursuant to the insurance 34 law and/or this chapter; 35 (iv) does not charge any cancellation fees or penalties for termi- 36 nation of coverage in violation of applicable law; and 37 (v) complies with the regulations developed by the secretary under 38 section 1311(c) of the federal act and such other requirements as the 39 Marketplace may establish. 40 (b) The health plan: (i) provides the essential health benefits pack- 41 age described in state law or required by the Marketplace and includes 42 such additional benefits as are mandated by state law, except that the 43 health plan shall not be required to provide essential benefits that 44 duplicate the minimum benefits of qualified dental plans if: 45 (A) the Marketplace has determined that at least one qualified dental 46 plan or dental plan approved by the department of financial services or 47 the department is available to supplement the health plan's coverage; 48 and 49 (B) the insurer makes prominent disclosure at the time it offers the 50 health plan, in a form approved by the Marketplace, that the plan does 51 not provide the full range of essential pediatric benefits, and that 52 qualified dental plans or dental plans approved by the department of 53 financial services or department of health providing those benefits and 54 other dental benefits not covered by the plan are offered through the 55 Marketplace;S. 1507--A 107 A. 2007--A 1 (ii) provides at least a bronze level of coverage as defined by state 2 law, unless the plan is certified as a qualified catastrophic plan, as 3 defined in section 1302(e) of the federal act and the insurance law, and 4 shall only be offered to individuals eligible for catastrophic coverage; 5 (iii) has cost-sharing requirements, including deductibles, which do 6 not exceed the limits established under section 1302(c) of the federal 7 act, state law and any requirements of the Marketplace; 8 (iv) complies with regulations promulgated by the secretary pursuant 9 to section 1311(c) of the federal act and applicable state law, which 10 include minimum standards in the areas of marketing practices, network 11 adequacy, essential community providers in underserved areas, accredi- 12 tation, quality improvement, uniform enrollment forms and descriptions 13 of coverage and information on quality measures for health benefit plan 14 performance; 15 (v) meets standards specified and determined by the Marketplace, 16 provided that the standards do not conflict with or prevent the applica- 17 tion of federal requirements; and 18 (vi) complies with the insurance law and this chapter requirements 19 applicable to health insurance issued in this state and any regulations 20 promulgated pursuant thereto that do not conflict with or prevent the 21 application of federal requirements; and 22 (c) The Marketplace determines that making the health plan available 23 through the Marketplace is in the interest of qualified individuals in 24 this state. 25 2. The Marketplace shall not exclude a health plan: 26 (a) on the basis that the health plan is a fee-for-service plan; 27 (b) through the imposition of premium price controls by the Market- 28 place; or 29 (c) on the basis that the health plan provides treatments necessary to 30 prevent patients' deaths in circumstances the Marketplace determines are 31 inappropriate or too costly. 32 3. The Marketplace shall require each insurer certified or seeking 33 certification of a health plan as a qualified health plan or plan 34 approved for sale by the department of financial services or the depart- 35 ment to: 36 (a) submit a justification for any premium increase pursuant to appli- 37 cable law prior to implementation of such increase. The insurer shall 38 prominently post the information on its internet website. Such rate 39 increases shall be subject to the prior approval of the superintendent 40 pursuant to the insurance law; 41 (b)(i) make available to the public and submit to the Marketplace, the 42 secretary and the superintendent, accurate and timely disclosure of: 43 (A) claims payment policies and practices; 44 (B) periodic financial disclosures; 45 (C) data on enrollment and disenrollment; 46 (D) data on the number of claims that are denied; 47 (E) data on rating practices; 48 (F) information on cost-sharing and payments with respect to any out- 49 of-network coverage; 50 (G) information on enrollee and participant rights under title I of 51 the federal act; and 52 (H) other information as determined appropriate by the secretary or 53 otherwise required by the Marketplace; 54 (ii) the information shall be provided in plain language, as that term 55 is defined in section 1311(e)(3)(B) of the federal act and state law,S. 1507--A 108 A. 2007--A 1 and in guidance jointly issued thereunder by the secretary and the 2 federal secretary of labor; and 3 (c) provide to individuals, in a timely manner upon the request of the 4 individual, the amount of cost-sharing, including deductibles, copay- 5 ments, and coinsurance, under the individual's health plan or coverage 6 that the individual would be responsible for paying with respect to the 7 furnishing of a specific item or service by a participating provider. At 8 a minimum, this information shall be made available to the individual 9 through an internet website and through other means for individuals 10 without access to the internet. 11 4. The Marketplace shall not exempt any insurer seeking certification 12 of a health plan, regardless of the type or size of the insurer, from 13 licensing or solvency requirements under the insurance law or this chap- 14 ter, and shall apply the criteria of this section in a manner that 15 ensures a level playing field for insurers participating in the Market- 16 place. 17 5. (a) The provisions of this article that apply to qualified health 18 plans and plans approved for sale by the department of financial 19 services and the department also shall apply to the extent relevant to 20 qualified dental plans approved for sale by the department of financial 21 services or the department, except as modified in accordance with the 22 provisions of paragraphs (b) and (c) of this subdivision or otherwise 23 required by the Marketplace. 24 (b) The qualified dental plan or dental plan approved for sale by the 25 department of financial services and/or the department shall be limited 26 to dental and oral health benefits, without substantially duplicating 27 the benefits typically offered by health benefit plans without dental 28 coverage, and shall include, at a minimum, the essential pediatric 29 dental benefits prescribed by the secretary pursuant to section 30 1302(b)(1)(J) of the federal act, and such other dental benefits as the 31 Marketplace or secretary may specify in regulations. 32 (c) Insurers may jointly offer a comprehensive plan through the 33 Marketplace in which an insurer provides the dental benefits through a 34 qualified dental plan or plan approved by the department of financial 35 services or the department and an insurer provides the other benefits 36 through a qualified health plan, provided that the plans are priced 37 separately and also are made available for purchase separately at the 38 same price. 39 § 268-e. Appeals and appeal hearings; judicial review. 1. Any appli- 40 cant or enrollee, or any individual authorized to act on behalf of any 41 such applicant or enrollee, may appeal to the department from determi- 42 nations of department officials or failures to make determinations upon 43 grounds specified in subdivision four of this section. The department 44 must review the appeal de novo and give such person an opportunity for 45 an appeal hearing. The department may also, on its own motion, review 46 any decision made or any case in which a decision has not been made by 47 the Marketplace or a social services official within the time specified 48 by law or regulations of the department. The department may make such 49 additional investigation as it may deem necessary, and the commissioner 50 must make such determination as is justified and in accordance with 51 applicable law. 52 2. Regarding any appeal pursuant to this section, with or without an 53 appeal hearing, the commissioner may designate and authorize one or more 54 appropriate members of his staff to consider and decide such appeals. 55 Any staff member so designated and authorized will have authority to 56 decide such appeals on behalf of the commissioner with the same forceS. 1507--A 109 A. 2007--A 1 and effect as if the commissioner had made the decisions. Appeal hear- 2 ings must be held on behalf of the commissioner by members of his staff 3 who are employed for such purposes or who have been designated and 4 authorized by the commissioner. 5 3. Persons entitled to appeal to the department pursuant to this 6 section must include: 7 (a) applicants for or enrollees in insurance affordability programs 8 and qualified health plans; and 9 (b) other persons entitled to an opportunity for an appeal hearing as 10 directed by the commissioner. 11 4. An applicant or enrollee has the right to appeal at least the 12 following issues: 13 (a) An eligibility determination made in accordance with this article 14 and applicable law, including: 15 (i) An initial determination of eligibility, including: 16 (A) eligibility to enroll in a qualified health plan; 17 (B) eligibility for Medicaid; 18 (C) eligibility for Child Health Plus; 19 (D) eligibility for the Basic Health Program; 20 (E) the amount of advance payments of the premium tax credit and level 21 of cost-sharing reductions; 22 (F) the amount of any other subsidy that may be available under law; 23 and 24 (G) eligibility for such other health insurance programs as determined 25 by the commissioner; and 26 (ii) a re-determination of eligibility of the programs under this 27 subdivision. 28 (b) An eligibility determination for an exemption for any mandate to 29 purchase health insurance. 30 (c) A failure by NY State of Health to provide timely written notice 31 of an eligibility determination made in accordance with applicable law. 32 5. The department may, subject to the discretion of the commissioner, 33 promulgate such regulations, consistent with federal or state law, as 34 may be necessary to implement the provisions of this section. 35 6. Regarding every decision of an appeal pursuant to this section, the 36 department must inform every party, and his or her representative, if 37 any, of the availability of judicial review and the time limitation to 38 pursue future review. 39 7. Applicants and enrollees of qualified health plans, with or without 40 advance payments of the premium tax credit and cost-sharing reductions, 41 also have the right to appeal to the United States Department of Health 42 and Human Services appeal entity: 43 (a) appeals decisions issued by NY State of Health upon the exhaustion 44 of the NY State of Health appeals process; and 45 (b) a denial of a request to vacate a dismissal made by the NY State 46 of Health appeals entity. 47 8. The department must include notice of the right to appeal as 48 provided by subdivision four of this section and instructions regarding 49 how to file an appeal in any eligibility determination issued to the 50 applicant or enrollee in accordance with applicable law. Such notice 51 shall include: 52 (a) an explanation of the applicant or enrollee's appeal rights; 53 (b) a description of the procedures by which the applicant or enrollee 54 may request an appeal;S. 1507--A 110 A. 2007--A 1 (c) information on the applicant or enrollee's right to represent 2 himself or herself, or to be represented by legal counsel or another 3 representative; 4 (d) an explanation of the circumstances under which the appellant's 5 eligibility may be maintained or reinstated pending an appeal decision; 6 and 7 (e) an explanation that an appeal decision for one household member 8 may result in a change in eligibility for other household members and 9 that such a change will be handled as a redetermination of eligibility 10 for all household members in accordance with the standards specified in 11 applicable law. 12 § 268-f. Marketplace advisory committee. 1. There is hereby created 13 the marketplace advisory committee, which shall consider and advise the 14 department and commissioner on matters concerning the provision of 15 health care coverage through the NY State of Health or Marketplace. 16 2. The marketplace advisory committee shall consist of up to twenty- 17 eight members appointed by the commissioner, representative of each 18 geographic area of the state and including: 19 (a) representatives from the following categories, but not more than 20 six from any single category: 21 (i) health plan consumer advocates; 22 (ii) small business consumer representatives; 23 (iii) health care provider representatives; 24 (iv) representatives of the health insurance industry; 25 (b) representatives from the following categories, but not more than 26 two from either category: 27 (i) licensed insurance producers; and 28 (ii) representatives of labor organizations. 29 3. The Marketplace shall select the chair of the advisory committee 30 from among the members of such committee and shall designate an officer 31 or employee of the department to assist the marketplace advisory commit- 32 tee in the performance of its duties under this section. The Marketplace 33 shall adopt rules for the governance of the advisory committee, which 34 shall meet as frequently as its business may require and at such other 35 times as determined by the Marketplace to be necessary. 36 4. Members of the advisory committee shall serve without compensation 37 for their services as members, but each shall be allowed the necessary 38 and actual expenses incurred in the performance of his or her duties 39 under this section. 40 § 268-g. Funding of the Marketplace. 1. The Marketplace shall be fund- 41 ed by state and federal sources as authorized by applicable law, includ- 42 ing but not limited to applicable law authorizing the respective insur- 43 ance affordability programs available through the Marketplace. 44 2. The accounts of the Marketplace shall be subject to supervision of 45 the comptroller and such accounts shall include receipts, expenditures, 46 contracts and other matters which pertain to the fiscal soundness of the 47 Marketplace. 48 3. Notwithstanding any law to the contrary, and in accordance with 49 section four of the state finance law, upon request of the director of 50 the budget, in consultation with the commissioner, the superintendent 51 and the executive director of the Marketplace, the comptroller is hereby 52 authorized and directed to sub-allocate or transfer special revenue 53 federal funds appropriated to the department for planning and implement- 54 ing various healthcare and insurance reform initiatives authorized by 55 applicable law. Marketplace moneys sub-allocated or transferred pursu- 56 ant to this section shall be paid out of the fund upon audit and warrantS. 1507--A 111 A. 2007--A 1 of the state comptroller on vouchers certified or approved by the 2 Marketplace. 3 § 268-h. Construction. Nothing in this article, and no action taken by 4 the Marketplace pursuant hereto, shall be construed to: 5 1. preempt or supersede the authority of the superintendent or the 6 commissioner; or 7 2. exempt insurers, insurance producers or qualified health plans from 8 this chapter or the insurance law and any regulations promulgated there- 9 under. 10 § 3. Severability. If any provision of this article, or the applica- 11 tion thereof to any person or circumstances is held invalid or unconsti- 12 tutional, that invalidity or unconstitutionality shall not affect other 13 provisions or applications of this article that can be given effect 14 without the invalid or unconstitutional provision or application, and to 15 this end the provisions and application of this article are severable. 16 § 4. This act shall take effect immediately. 17 PART U 18 Section 1. Section 203 of the elder law is amended by adding a new 19 subdivision 12 to read as follows: 20 12. The director is hereby authorized to implement private pay proto- 21 cols for all programs administered by the office. These protocols may be 22 implemented by area agencies on aging at their option and such protocols 23 may not be applied to clients whose services are paid for with federal 24 funds or funds designated as federal match. All private payments 25 received directly by an area agency on aging or indirectly by one of its 26 contractors shall be used to supplement, not supplant, funds by state, 27 federal, or county appropriations. Private pay payments received under 28 this subdivision shall be used by the area agency on aging to support 29 and enhance services or programs provided by the area agency on aging. 30 Participant payments under this subdivision shall not be required of 31 individuals with incomes below four hundred percent of the federal 32 poverty level. No participant, regardless of income, shall be required 33 to pay for any service that they are receiving at the time these proto- 34 cols are implemented by the area agency on aging. This subdivision shall 35 not prevent cost sharing for the programs established pursuant to 36 section two hundred fourteen of this title for individuals below four 37 hundred percent of the federal poverty level. 38 § 2. This act shall take effect immediately. 39 PART V 40 Section 1. Paragraph (d) of subdivision 32 of section 364-j of the 41 social services law, as amended by section 15 of part B of chapter 59 of 42 the laws of 2016, is amended to read as follows: 43 (d) (i) Penalties under this subdivision may be applied to any and all 44 circumstances described in paragraph (b) of this subdivision until the 45 managed care organization complies with the requirements for submission 46 of encounter data. 47 (ii) No penalties for late, incomplete or inaccurate encounter data 48 shall be assessed against managed care organizations in addition to 49 those provided for in this subdivision, provided, however, that nothing 50 in this paragraph shall prohibit the imposition of penalties, in cases 51 of fraud or abuse, otherwise authorized by law.S. 1507--A 112 A. 2007--A 1 § 2. Section 364-j of the social services law is amended by adding a 2 new subdivision 34 read as follows: 3 34. Any payment made pursuant to the state's managed care program, 4 including payments made by managed long term care plans, shall be deemed 5 a payment by the state's medical assistance program. 6 § 3. Section 364-j of the social services law is amended by adding a 7 new subdivision 36 to read as follows: 8 36. Medicaid Program Integrity Reviews. (a) For purposes of this 9 subdivision, managed care provider shall also include managed long term 10 care plans. 11 (b) The Medicaid inspector general shall conduct periodic reviews of 12 the contractual performance of each managed care provider as it relates 13 to the managed care provider's program integrity obligations under its 14 contract with the department. The Medicaid inspector general, in consul- 15 tation with the commissioner, shall publish a list of those contractual 16 obligations which may be subject to review and how they shall be evalu- 17 ated, including benchmarks, prior to commencing any review. 18 (c) If, as a result of his or her review, the Medicaid inspector 19 general determines that a managed care provider is not meeting its 20 program integrity obligations, the Medicaid inspector general may 21 recover from the managed care provider up to two percent of the Medicaid 22 premiums paid to the managed care provider for the period under review. 23 Any premium recovery under this subdivision shall be a percentage of the 24 administrative component of the Medicaid premium calculated by the 25 department and may be recovered by the department in the same manner it 26 recovers overpayments. 27 (d) The managed care provider shall be entitled to receive a draft 28 audit report and final audit report containing the results of the Medi- 29 caid inspector general's review. If the Medicaid inspector general 30 determines to recover a percentage of the premium as described in para- 31 graph (c) of this subdivision, the managed care provider shall have an 32 opportunity to be heard in accordance with section twenty-two of this 33 chapter. 34 § 4. Subdivision 3 of section 363-d of the social services law, as 35 amended by section 44 of part C of chapter 58 of the laws of 2007, is 36 amended to read as follows: 37 3. Upon enrollment in the medical assistance program, a provider shall 38 certify to the department that the provider satisfactorily meets the 39 requirements of this section. Additionally, the commissioner of health 40 and Medicaid inspector general shall have the authority to determine at 41 any time if a provider has a compliance program that satisfactorily 42 meets the requirements of this section. 43 (a) A compliance program that is accepted by the federal department of 44 health and human services office of inspector general and remains in 45 compliance with the standards promulgated by such office shall be deemed 46 in compliance with the provisions of this section, so long as such plans 47 adequately address medical assistance program risk areas and compliance 48 issues. 49 (b) A compliance program that meets Federal requirements for managed 50 care provider compliance programs, as specified in the contract or 51 contracts between the department and the Medicaid managed care provider 52 shall be deemed in compliance with the provisions in this section, so 53 long as such programs adequately address medical assistance program risk 54 areas and compliance issues. For purposes of this section, a managed 55 care provider is as defined in paragraph (c) of subdivision one ofS. 1507--A 113 A. 2007--A 1 section three hundred sixty-four-j of this chapter, and includes managed 2 long term care plans. 3 (c) In the event that the commissioner of health or the Medicaid 4 inspector general finds that the provider does not have a satisfactory 5 program within ninety days after the effective date of the regulations 6 issued pursuant to subdivision four of this section, the provider may be 7 subject to any sanctions or penalties permitted by federal or state laws 8 and regulations, including revocation of the provider's agreement to 9 participate in the medical assistance program. 10 § 5. Section 3613 of the public health law is amended by adding a new 11 subdivision 1-a to read as follows: 12 1-a. Each home care services worker shall obtain an individual 13 National Provider Identifier (NPI) number from the National Provider 14 Plan and Provider Enumeration System (NPPES). 15 § 6. Section 364-j of the social services law is amended by adding a 16 new subdivision 35 to read as follows: 17 35. Recovery of overpayments from network providers. (a) Where the 18 Medicaid inspector general during the course of an audit, investigation, 19 or review, or the deputy attorney general for the Medicaid fraud control 20 unit during the course of an investigation or prosecution for Medicaid 21 fraud, identifies medical assistance overpayments made by a managed care 22 provider or managed long term care plan to its subcontractor or subcon- 23 tractors or provider or providers, the state shall have the right to 24 recover the overpayment from the subcontractor or subcontractors, 25 provider or providers, or the managed care provider or managed long term 26 care plan. 27 (b) Where the state is unsuccessful in recovering an overpayment from 28 the subcontractor or subcontractors or provider or providers, the Medi- 29 caid inspector general may require the managed care provider or managed 30 long term care plan to recover the medical assistance overpayment iden- 31 tified in paragraph (a) of this subdivision on behalf of the state. The 32 managed care provider or managed long term care plan shall remit to the 33 state the full amount of the identified overpayment no later than six 34 months after receiving notice of the overpayment from the state. 35 § 7. This act shall take effect immediately; provided, however, that 36 the amendments to section 364-j of the social services law made by 37 sections one, two, three, and six of this act shall not affect the 38 repeal of such section and shall be deemed repealed therewith; provided 39 further, that section three of this act shall apply to a contract or 40 contracts in effect as of January 1, 2015 and any review period in 41 section three of this act shall not begin before January 1, 2018. 42 PART W 43 Section 1. Section 1 of part D of chapter 111 of the laws of 2010 44 relating to the recovery of exempt income by the office of mental health 45 for community residences and family-based treatment programs, as amended 46 by section 1 of part H of chapter 59 of the laws of 2016, is amended to 47 read as follows: 48 Section 1. The office of mental health is authorized to recover fund- 49 ing from community residences and family-based treatment providers 50 licensed by the office of mental health, consistent with contractual 51 obligations of such providers, and notwithstanding any other inconsist- 52 ent provision of law to the contrary, in an amount equal to 50 percent 53 of the income received by such providers which exceeds the fixed amount 54 of annual Medicaid revenue limitations, as established by the commis-S. 1507--A 114 A. 2007--A 1 sioner of mental health. Recovery of such excess income shall be for the 2 following fiscal periods: for programs in counties located outside of 3 the city of New York, the applicable fiscal periods shall be January 1, 4 2003 through December 31, 2009 and January 1, 2011 through December 31, 5 [2019] 2022; and for programs located within the city of New York, the 6 applicable fiscal periods shall be July 1, 2003 through June 30, 2010 7 and July 1, 2011 through June 30, [2019] 2022. 8 § 2. This act shall take effect immediately. 9 PART X 10 Section 1. Subdivision 9 of section 730.10 of the criminal procedure 11 law, as added by section 1 of part Q of chapter 56 of the laws of 2012, 12 is amended to read as follows: 13 9. "Appropriate institution" means: (a) a hospital operated by the 14 office of mental health or a developmental center operated by the office 15 for people with developmental disabilities; [or] (b) a hospital licensed 16 by the department of health which operates a psychiatric unit licensed 17 by the office of mental health, as determined by the commissioner 18 provided, however, that any such hospital that is not operated by the 19 state shall qualify as an "appropriate institution" only pursuant to the 20 terms of an agreement between the commissioner and the hospital; or (c) 21 a mental health unit operating within a local correctional facility 22 except those located within a city with a population of one million or 23 more; provided however, that any such mental health unit operating with- 24 in a local correctional facility shall qualify as an "appropriate insti- 25 tution" only pursuant to the terms of an agreement between the commis- 26 sioner of mental health, director of community services and the sheriff 27 for the respective locality. Nothing in this article shall be construed 28 as requiring a hospital or local correctional facility to consent to 29 providing care and treatment to an incapacitated person at such hospital 30 or local correctional facility. The commissioner of mental health shall 31 promulgate regulations for demonstration programs at no more than two 32 counties to implement restoration to competency within a local correc- 33 tional facility. Subject to annual appropriation, the commissioner of 34 mental health may, at such commissioner's discretion, make funds avail- 35 able for state aid grants to any county that develops and operates a 36 mental health unit within a local correctional facility pursuant to this 37 section. Nothing in this article shall be construed as requiring a 38 hospital or local correctional facility to consent to providing care and 39 treatment to an incapacitated person at such hospital or local correc- 40 tional facility. 41 § 2. This act shall take effect immediately and shall be deemed to 42 have been in full force and effect on and after April 1, 2019; provided, 43 however, that this act shall expire and be deemed repealed March 31, 44 2024; effective immediately, the addition, amendment and/or repeal of 45 any rule or regulation necessary for the implementation of this act on 46 its effective date are authorized to be made and completed on or before 47 such effective date. 48 PART Y 49 Section 1. Subdivisions 3-b and 3-c of section 1 of part C of chapter 50 57 of the laws of 2006, relating to establishing a cost of living 51 adjustment for designated human services programs, as amended by sectionS. 1507--A 115 A. 2007--A 1 1 of part AA of chapter 57 of the laws of 2018, are amended to read as 2 follows: 3 3-b. Notwithstanding any inconsistent provision of law, beginning 4 April 1, 2009 and ending March 31, 2016 and beginning April 1, 2017 and 5 ending March 31, [2019] 2020, the commissioners shall not include a COLA 6 for the purpose of establishing rates of payments, contracts or any 7 other form of reimbursement[, provided that the commissioners of the8office for people with developmental disabilities, the office of mental9health, and the office of alcoholism and substance abuse services shall10not include a COLA beginning April 1, 2017 and ending March 31, 2019]. 11 3-c. Notwithstanding any inconsistent provision of law, beginning 12 April 1, [2019] 2020 and ending March 31, [2022] 2023, the commissioners 13 shall develop the COLA under this section using the actual U.S. consumer 14 price index for all urban consumers (CPI-U) published by the United 15 States department of labor, bureau of labor statistics for the twelve 16 month period ending in July of the budget year prior to such state 17 fiscal year, for the purpose of establishing rates of payments, 18 contracts or any other form of reimbursement. 19 § 2. This act shall take effect immediately and shall be deemed to 20 have been in full force and effect on and after April 1, 2019; provided, 21 however, that the amendments to section 1 of part C of chapter 57 of the 22 laws of 2006 made by section one of this act shall not affect the repeal 23 of such section and shall be deemed repealed therewith. 24 PART Z 25 Section 1. Subdivision 1 of section 2801 of the public health law, as 26 amended by section 1 of subpart B of part S of chapter 57 of the laws of 27 2018, is amended to read as follows: 28 1. "Hospital" means a facility or institution engaged principally in 29 providing services by or under the supervision of a physician or, in the 30 case of a dental clinic or dental dispensary, of a dentist, or, in the 31 case of a midwifery birth center, of a midwife, for the prevention, 32 diagnosis or treatment of human disease, pain, injury, deformity or 33 physical condition, including, but not limited to, a general hospital, 34 public health center, diagnostic center, treatment center, dental clin- 35 ic, dental dispensary, rehabilitation center other than a facility used 36 solely for vocational rehabilitation, nursing home, tuberculosis hospi- 37 tal, chronic disease hospital, maternity hospital, midwifery birth 38 center, lying-in-asylum, out-patient department, out-patient lodge, 39 dispensary and a laboratory or central service facility serving one or 40 more such institutions, but the term hospital shall not include an 41 institution, sanitarium or other facility engaged principally in provid- 42 ing services for the prevention, diagnosis or treatment of mental disa- 43 bility and which is subject to the powers of visitation, examination, 44 inspection and investigation of the department of mental hygiene except 45 for those distinct parts of such a facility which provide hospital 46 service. The provisions of this article shall not apply to a facility or 47 institution engaged principally in providing services by or under the 48 supervision of the bona fide members and adherents of a recognized reli- 49 gious organization whose teachings include reliance on spiritual means 50 through prayer alone for healing in the practice of the religion of such 51 organization and where services are provided in accordance with those 52 teachings. No provision of this article or any other provision of law 53 shall be construed to: (a) limit the volume of mental health [or], 54 substance use disorder services or developmental disability servicesS. 1507--A 116 A. 2007--A 1 that can be provided by a provider of primary care services licensed 2 under this article and authorized to provide integrated services in 3 accordance with regulations issued by the commissioner in consultation 4 with the commissioner of the office of mental health [and], the commis- 5 sioner of the office of alcoholism and substance abuse services and the 6 commissioner of the office for people with developmental disabilities, 7 including regulations issued pursuant to subdivision seven of section 8 three hundred sixty-five-l of the social services law or part L of chap- 9 ter fifty-six of the laws of two thousand twelve; (b) require a provider 10 licensed pursuant to article thirty-one of the mental hygiene law or 11 certified pursuant to article sixteen or article thirty-two of the 12 mental hygiene law to obtain an operating certificate from the depart- 13 ment if such provider has been authorized to provide integrated services 14 in accordance with regulations issued by the commissioner in consulta- 15 tion with the commissioner of the office of mental health [and], the 16 commissioner of the office of alcoholism and substance abuse services 17 and the commissioner of the office for people with developmental disa- 18 bilities, including regulations issued pursuant to subdivision seven of 19 section three hundred sixty-five-l of the social services law or part L 20 of chapter fifty-six of the laws of two thousand twelve. 21 § 2. Subdivision (f) of section 31.02 of the mental hygiene law, as 22 added by section 2 of subpart B of part S of chapter 57 of the laws of 23 2018, is amended to read as follows: 24 (f) No provision of this article or any other provision of law shall 25 be construed to require a provider licensed pursuant to article twenty- 26 eight of the public health law or certified pursuant to article sixteen 27 or article thirty-two of this chapter to obtain an operating certificate 28 from the office of mental health if such provider has been authorized to 29 provide integrated services in accordance with regulations issued by the 30 commissioner of the office of mental health in consultation with the 31 commissioner of the department of health [and], the commissioner of the 32 office of alcoholism and substance abuse services and the commissioner 33 of the office for people with developmental disabilities, including 34 regulations issued pursuant to subdivision seven of section three 35 hundred sixty-five-l of the social services law or part L of chapter 36 fifty-six of the laws of two thousand twelve. 37 § 3. Subdivision (b) of section 32.05 of the mental hygiene law, as 38 amended by section 3 of subpart B of part S of chapter 57 of the laws of 39 2018, is amended to read as follow: 40 (b) (i) Methadone, or such other controlled substance designated by 41 the commissioner of health as appropriate for such use, may be adminis- 42 tered to an addict, as defined in section thirty-three hundred two of 43 the public health law, by individual physicians, groups of physicians 44 and public or private medical facilities certified pursuant to article 45 twenty-eight or thirty-three of the public health law as part of a chem- 46 ical dependence program which has been issued an operating certificate 47 by the commissioner pursuant to subdivision (b) of section 32.09 of this 48 article, provided, however, that such administration must be done in 49 accordance with all applicable federal and state laws and regulations. 50 Individual physicians or groups of physicians who have obtained authori- 51 zation from the federal government to administer buprenorphine to 52 addicts may do so without obtaining an operating certificate from the 53 commissioner. (ii) No provision of this article or any other provision 54 of law shall be construed to require a provider licensed pursuant to 55 article twenty-eight of the public health law or article thirty-one of 56 this chapter to obtain an operating certificate from the office of alco-S. 1507--A 117 A. 2007--A 1 holism and substance abuse services if such provider has been authorized 2 to provide integrated services in accordance with regulations issued by 3 the commissioner of alcoholism and substance abuse services in consulta- 4 tion with the commissioner of the department of health [and], the 5 commissioner of the office of mental health and the commissioner of the 6 office for people with developmental disabilities, including regulations 7 issued pursuant to subdivision seven of section three hundred sixty- 8 five-l of the social services law or part L of chapter fifty-six of the 9 laws of two thousand twelve. 10 § 4. Section 16.03 of the mental hygiene law is amended by adding a 11 new subdivision (g) to read as follows: 12 (g) No provision of this article or any other provision of law shall 13 be construed to require a provider licensed pursuant to article twenty- 14 eight of the public health law or certified pursuant to article thirty- 15 one or thirty-two of this chapter to obtain an operating certificate 16 from the office for people with developmental disabilities if such 17 provider has been authorized to provide integrated services in accord- 18 ance with regulations issued by the commissioner of the office for 19 people with developmental disabilities, in consultation with the commis- 20 sioner of the department of health, the commissioner and the commission- 21 er of the office of alcoholism and substance abuse services, including 22 regulations issued pursuant to subdivision seven of section three 23 hundred sixty-five-l of the social services law or part L of chapter 24 fifty-six of the laws of two thousand twelve. 25 § 5. This act shall take effect October 1, 2019; provided, however, 26 that the commissioner of the department of health, the commissioner of 27 the office of mental health, the commissioner of the office of alcohol- 28 ism and substance abuse services, and the commissioner of the office for 29 people with developmental disabilities are authorized to issue any rule 30 or regulation necessary for the implementation of this act on or before 31 its effective date. 32 PART AA 33 Section 1. Paragraph (a) of subdivision 4 of section 488 of the social 34 services law, as amended by section 2 of part MM of chapter 58 of the 35 laws of 2015, is amended to read as follows: 36 (a) a facility or program in which services are provided and which is 37 operated, licensed or certified by the office of mental health, the 38 office for people with developmental disabilities or the office of alco- 39 holism and substance abuse services, including but not limited to 40 psychiatric centers, [inpatient psychiatric units of a general hospi-41tal,] developmental centers, intermediate care facilities, community 42 residences, group homes and family care homes, provided, however, that 43 such term shall not include a secure treatment facility as defined in 44 section 10.03 of the mental hygiene law, services defined in subpara- 45 graph four of subdivision (a) of section 16.03 of the mental hygiene 46 law, [or] services provided in programs or facilities that are operated 47 by the office of mental health and located in state correctional facili- 48 ties under the jurisdiction of the department of corrections and commu- 49 nity supervision or services provided in a unit of a hospital, as 50 defined in subdivision one of section twenty-eight hundred one of the 51 public health law that is licensed or certified by the office of mental 52 health or the office of alcoholism and substance abuse services; 53 § 2. Paragraphs (c), (d) and (e) of subdivision 4 of section 488 of 54 the social services law, as added by section 1 of part B of chapter 501S. 1507--A 118 A. 2007--A 1 of the laws of 2012, paragraph (d) as amended by chapter 126 of the laws 2 of 2014, and paragraph (e) as amended by chapter 83 of the laws of 2013, 3 are amended to read as follows: 4 (c) adult care facilities, which shall mean adult homes or enriched 5 housing programs licensed pursuant to article seven of this chapter: (i) 6 (A) that have a licensed capacity of eighty or more beds; and (B) in 7 which at least twenty-five percent of the residents are persons with 8 serious mental illness as defined by subdivision fifty-two of section 9 1.03 of the mental hygiene law; (ii) but not including an adult home or 10 enriched housing program which is authorized to operate fifty-five 11 percent or more of its total licensed capacity of beds as assisted 12 living program beds pursuant to section four hundred sixty-one-l of this 13 chapter; or 14 (d) [any overnight, summer day and traveling summer day camps for15children with developmental disabilities as defined in regulations16promulgated by the commissioner of health; or17(e)] the New York state school for the blind and the New York state 18 school for the deaf, which operate pursuant to articles eighty-seven and 19 eighty-eight of the education law; an institution for the instruction of 20 the deaf and the blind which has a residential component and is subject 21 to the visitation of the commissioner of education pursuant to article 22 eighty-five of the education law with respect to its day and residential 23 components; special act school districts serving students with disabili- 24 ties; or in-state private schools which have been approved by the 25 commissioner of education for special education services or programs, 26 and which have a residential program. 27 § 3. This act shall take effect August 1, 2019 and shall apply to 28 reports of abuse or neglect made on or after such date; provided that, 29 any reports of abuse or neglect reported to the justice center prior to 30 the effective date of this act shall be completed by the justice center. 31 PART BB 32 Section 1. This part enacts into law major components of legislation 33 which are necessary to effectuate provisions relating to mental health 34 and substance use disorder treatment. Each component is wholly 35 contained within a Subpart identified as Subparts A through E. The 36 effective date for each particular provision contained within such 37 Subpart is set forth in the last section of such Subpart. Any provision 38 in any section contained within a Subpart, including the effective date 39 of the Subpart, which makes a reference to a section "of this act", when 40 used in connection with that particular component, shall be deemed to 41 mean and refer to the corresponding section of the Subpart in which it 42 is found. Section three of this Part sets forth the general effective 43 date of this Part. 44 SUBPART A 45 Section 1. Paragraph 4 of subsection (i) of section 3216 of the insur- 46 ance law is amended to read as follows: 47 (4) If a policy provides for reimbursement for psychiatric or psycho- 48 logical services or for diagnosis and treatment of mental[,nervous, or49emotional disorders or ailments,] health conditions however defined in 50 the policy, the insured shall be entitled to reimbursement for such 51 services, diagnosis or treatment whether performed by a physician, 52 psychiatrist [or], a certified and registered psychologist, or a nurseS. 1507--A 119 A. 2007--A 1 practitioner when the services rendered are within the lawful scope of 2 their practice. 3 § 2. Subparagraph (B) of paragraph 25 of subsection (i) of section 4 3216 of the insurance law, as amended by section 38 of part D of chapter 5 56 of the laws of 2013, is amended to read as follows: 6 (B) Every policy that provides physician services, medical, major 7 medical or similar comprehensive-type coverage shall provide coverage 8 for the screening, diagnosis and treatment of autism spectrum disorder 9 in accordance with this paragraph and shall not exclude coverage for the 10 screening, diagnosis or treatment of medical conditions otherwise 11 covered by the policy because the individual is diagnosed with autism 12 spectrum disorder. Such coverage may be subject to annual deductibles, 13 copayments and coinsurance as may be deemed appropriate by the super- 14 intendent and shall be consistent with those imposed on other benefits 15 under the policy. [Coverage for applied behavior analysis shall be16subject to a maximum benefit of six hundred eighty hours of treatment17per policy or calendar year per covered individual.] This paragraph 18 shall not be construed as limiting the benefits that are otherwise 19 available to an individual under the policy, provided however that such 20 policy shall not contain any limitations on visits that are solely 21 applied to the treatment of autism spectrum disorder. No insurer shall 22 terminate coverage or refuse to deliver, execute, issue, amend, adjust, 23 or renew coverage to an individual solely because the individual is 24 diagnosed with autism spectrum disorder or has received treatment for 25 autism spectrum disorder. Coverage shall be subject to utilization 26 review and external appeals of health care services pursuant to article 27 forty-nine of this chapter as well as[,] case management[,] and other 28 managed care provisions. 29 § 3. Items (i) and (iii) of subparagraph (C) of paragraph 25 of 30 subsection (i) of section 3216 of the insurance law, as amended by chap- 31 ter 596 of the laws of 2011, are amended to read as follows: 32 (i) "autism spectrum disorder" means any pervasive developmental 33 disorder as defined in the most recent edition of the diagnostic and 34 statistical manual of mental disorders[, including autistic disorder,35Asperger's disorder, Rett's disorder, childhood disintegrative disorder,36or pervasive developmental disorder not otherwise specified (PDD-NOS)]. 37 (iii) "behavioral health treatment" means counseling and treatment 38 programs, when provided by a licensed provider, and applied behavior 39 analysis, when provided [or supervised] by a [behavior analyst certified40pursuant to the behavior analyst certification board] person licensed, 41 certified or otherwise authorized to provide applied behavior analysis, 42 that are necessary to develop, maintain, or restore, to the maximum 43 extent practicable, the functioning of an individual. [Individuals that44provide behavioral health treatment under the supervision of a certified45behavior analyst pursuant to this paragraph shall be subject to stand-46ards of professionalism, supervision and relevant experience pursuant to47regulations promulgated by the superintendent in consultation with the48commissioners of health and education.] 49 § 4. Paragraph 25 of subsection (i) of section 3216 of the insurance 50 law is amended by adding four new subparagraphs (H), (I), (J), and (K) 51 to read as follows: 52 (H) Coverage under this paragraph shall not apply financial require- 53 ments or treatment limitations to autism spectrum disorder benefits that 54 are more restrictive than the predominant financial requirements and 55 treatment limitations applied to substantially all medical and surgical 56 benefits covered by the policy.S. 1507--A 120 A. 2007--A 1 (I) The criteria for medical necessity determinations under the policy 2 with respect to autism spectrum disorder benefits shall be made avail- 3 able by the insurer to any insured, prospective insured, or in-network 4 provider upon request. 5 (J) For purposes of this paragraph: 6 (i) "financial requirement" means deductible, copayments, coinsurance 7 and out-of-pocket expenses; 8 (ii) "predominant" means that a financial requirement or treatment 9 limitation is the most common or frequent of such type of limit or 10 requirement; and 11 (iii) "treatment limitation" means limits on the frequency of treat- 12 ment, number of visits, days of coverage, or other similar limits on the 13 scope or duration of treatment and includes nonquantitative treatment 14 limitations such as: medical management standards limiting or excluding 15 benefits based on medical necessity, or based on whether the treatment 16 is experimental or investigational; formulary design for prescription 17 drugs; network tier design; standards for provider admission to partic- 18 ipate in a network, including reimbursement rates; methods for deter- 19 mining usual, customary, and reasonable charges; fail-first or step 20 therapy protocols; exclusions based on failure to complete a course of 21 treatment; and restrictions based on geographic location, facility type, 22 provider specialty, and other criteria that limit the scope or duration 23 of benefits for services provided under the policy. 24 (K) An insurer shall provide coverage under this paragraph, at a mini- 25 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 26 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 27 § 5. Paragraph 30 of subsection (i) of section 3216 of the insurance 28 law, as amended by section 1 of part B of chapter 71 of the laws of 29 2016, is amended to read as follows: 30 (30)(A) Every policy that provides hospital, major medical or similar 31 comprehensive coverage [must] shall provide inpatient coverage for the 32 diagnosis and treatment of substance use disorder, including detoxifica- 33 tion and rehabilitation services. Such inpatient coverage shall include 34 unlimited medically necessary treatment for substance use disorder 35 treatment services provided in residential settings [as required by the36Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §371185a)]. Further, such inpatient coverage shall not apply financial 38 requirements or treatment limitations, including utilization review 39 requirements, to inpatient substance use disorder benefits that are more 40 restrictive than the predominant financial requirements and treatment 41 limitations applied to substantially all medical and surgical benefits 42 covered by the policy. [Further, such coverage shall be provided43consistent with the federal Paul Wellstone and Pete Domenici Mental44Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).] 45 (B) Coverage provided under this paragraph may be limited to facili- 46 ties in New York state [which are certified] that are licensed, certi- 47 fied or otherwise authorized by the office of alcoholism and substance 48 abuse services and, in other states, to those which are accredited by 49 the joint commission as alcoholism, substance abuse, or chemical depend- 50 ence treatment programs and are similarly licensed, certified or other- 51 wise authorized in the state in which the facility is located. 52 (C) Coverage provided under this paragraph may be subject to annual 53 deductibles and co-insurance as deemed appropriate by the superintendent 54 and that are consistent with those imposed on other benefits within a 55 given policy.S. 1507--A 121 A. 2007--A 1 (D) This subparagraph shall apply to facilities in this state that are 2 licensed, certified or otherwise authorized by the office of alcoholism 3 and substance abuse services that are participating in the insurer's 4 provider network. Coverage provided under this paragraph shall not be 5 subject to preauthorization. Coverage provided under this paragraph 6 shall also not be subject to concurrent utilization review during the 7 first [fourteen] twenty-one days of the inpatient admission provided 8 that the facility notifies the insurer of both the admission and the 9 initial treatment plan within [forty-eight hours] two business days of 10 the admission. The facility shall perform daily clinical review of the 11 patient, including the periodic consultation with the insurer to ensure 12 that the facility is using the evidence-based and peer reviewed clinical 13 review tool utilized by the insurer which is designated by the office of 14 alcoholism and substance abuse services and appropriate to the age of 15 the patient, to ensure that the inpatient treatment is medically neces- 16 sary for the patient. Any utilization review of treatment provided under 17 this subparagraph may include a review of all services provided during 18 such inpatient treatment, including all services provided during the 19 first [fourteen] twenty-one days of such inpatient treatment. Provided, 20 however, the insurer shall only deny coverage for any portion of the 21 initial [fourteen] twenty-one day inpatient treatment on the basis that 22 such treatment was not medically necessary if such inpatient treatment 23 was contrary to the evidence-based and peer reviewed clinical review 24 tool utilized by the insurer which is designated by the office of alco- 25 holism and substance abuse services. An insured shall not have any 26 financial obligation to the facility for any treatment under this 27 subparagraph other than any copayment, coinsurance, or deductible other- 28 wise required under the policy. 29 (E) An insurer shall make available to any insured, prospective 30 insured, or in-network provider, upon request, the criteria for medical 31 necessity determinations under the policy with respect to inpatient 32 substance use disorder benefits. 33 (F) For purposes of this paragraph: 34 (i) "financial requirement" means deductible, copayments, coinsurance 35 and out-of-pocket expenses; 36 (ii) "predominant" means that a financial requirement or treatment 37 limitation is the most common or frequent of such type of limit or 38 requirement; 39 (iii) "treatment limitation" means limits on the frequency of treat- 40 ment, number of visits, days of coverage, or other similar limits on the 41 scope or duration of treatment and includes nonquantitative treatment 42 limitations such as: medical management standards limiting or excluding 43 benefits based on medical necessity, or based on whether the treatment 44 is experimental or investigational; formulary design for prescription 45 drugs; network tier design; standards for provider admission to partic- 46 ipate in a network, including reimbursement rates; methods for determin- 47 ing usual, customary, and reasonable charges; fail-first or step therapy 48 protocols; exclusions based on failure to complete a course of treat- 49 ment; and restrictions based on geographic location, facility type, 50 provider specialty, and other criteria that limit the scope or duration 51 of benefits for services provided under the policy; and 52 (iv) "substance use disorder" shall have the meaning set forth in the 53 most recent edition of the diagnostic and statistical manual of mental 54 disorders or the most recent edition of another generally recognized 55 independent standard of current medical practice, such as the interna- 56 tional classification of diseases.S. 1507--A 122 A. 2007--A 1 (G) An insurer shall provide coverage under this paragraph, at a mini- 2 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 3 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 4 § 6. Paragraph 31 of subsection (i) of section 3216 of the insurance 5 law, as added by chapter 41 of the laws of 2014 and subparagraph (E) as 6 added by section 3 of part MM of chapter 57 of the laws of 2018, is 7 amended to read as follows: 8 (31) (A) Every policy that provides medical, major medical or similar 9 comprehensive-type coverage [must] shall provide outpatient coverage for 10 the diagnosis and treatment of substance use disorder, including detoxi- 11 fication and rehabilitation services. Such coverage shall not apply 12 financial requirements or treatment limitations to outpatient substance 13 use disorder benefits that are more restrictive than the predominant 14 financial requirements and treatment limitations applied to substantial- 15 ly all medical and surgical benefits covered by the policy. [Further,16such coverage shall be provided consistent with the federal Paul Well-17stone and Pete Domenici Mental Health Parity and Addiction Equity Act of182008 (29 U.S.C. § 1185a).] 19 (B) Coverage under this paragraph may be limited to facilities in New 20 York state [certified] that are licensed, certified or otherwise author- 21 ized by the office of alcoholism and substance abuse services [or22licensed by such office as outpatient clinics or medically supervised23ambulatory] to provide outpatient substance [abuse programs] use disor- 24 der services and, in other states, to those which are accredited by the 25 joint commission as alcoholism or chemical dependence substance abuse 26 treatment programs and are similarly licensed, certified, or otherwise 27 authorized in the state in which the facility is located. 28 (C) Coverage provided under this paragraph may be subject to annual 29 deductibles and co-insurance as deemed appropriate by the superintendent 30 and that are consistent with those imposed on other benefits within a 31 given policy. 32 (D) A policy providing coverage for substance use disorder services 33 pursuant to this paragraph shall provide up to twenty outpatient visits 34 per policy or calendar year to an individual who identifies him or 35 herself as a family member of a person suffering from substance use 36 disorder and who seeks treatment as a family member who is otherwise 37 covered by the applicable policy pursuant to this paragraph. The cover- 38 age required by this paragraph shall include treatment as a family 39 member pursuant to such family member's own policy provided such family 40 member: 41 (i) does not exceed the allowable number of family visits provided by 42 the applicable policy pursuant to this paragraph; and 43 (ii) is otherwise entitled to coverage pursuant to this paragraph and 44 such family member's applicable policy. 45 (E) This subparagraph shall apply to facilities in this state that are 46 licensed, certified or otherwise authorized by the office of alcoholism 47 and substance abuse services for the provision of outpatient, intensive 48 outpatient, outpatient rehabilitation and opioid treatment that are 49 participating in the insurer's provider network. Coverage provided under 50 this paragraph shall not be subject to preauthorization. Coverage 51 provided under this paragraph shall not be subject to concurrent review 52 for the first [two] three weeks of continuous treatment, not to exceed 53 [fourteen] twenty-one visits, provided the facility notifies the insurer 54 of both the start of treatment and the initial treatment plan within 55 [forty-eight hours] two business days. The facility shall perform clin- 56 ical assessment of the patient at each visit, including the periodicS. 1507--A 123 A. 2007--A 1 consultation with the insurer to ensure that the facility is using the 2 evidence-based and peer reviewed clinical review tool utilized by the 3 insurer which is designated by the office of alcoholism and substance 4 abuse services and appropriate to the age of the patient, to ensure that 5 the outpatient treatment is medically necessary for the patient. Any 6 utilization review of the treatment provided under this subparagraph may 7 include a review of all services provided during such outpatient treat- 8 ment, including all services provided during the first [two] three weeks 9 of continuous treatment, not to exceed [fourteen] twenty-one visits, of 10 such outpatient treatment. Provided, however, the insurer shall only 11 deny coverage for any portion of the initial [two] three weeks of 12 continuous treatment, not to exceed [fourteen] twenty-one visits, for 13 outpatient treatment on the basis that such treatment was not medically 14 necessary if such outpatient treatment was contrary to the evidence- 15 based and peer reviewed clinical review tool utilized by the insurer 16 which is designated by the office of alcoholism and substance abuse 17 services. An insured shall not have any financial obligation to the 18 facility for any treatment under this subparagraph other than any copay- 19 ment, coinsurance, or deductible otherwise required under the policy. 20 (F) The criteria for medical necessity determinations under the policy 21 with respect to outpatient substance use disorder benefits shall be made 22 available by the insurer to any insured, prospective insured, or in-net- 23 work provider upon request. 24 (G) For purposes of this paragraph: 25 (i) "financial requirement" means deductible, copayments, coinsurance 26 and out-of-pocket expenses; 27 (ii) "predominant" means that a financial requirement or treatment 28 limitation is the most common or frequent of such type of limit or 29 requirement; 30 (iii) "treatment limitation" means limits on the frequency of treat- 31 ment, number of visits, days of coverage, or other similar limits on the 32 scope or duration of treatment and includes nonquantitative treatment 33 limitations such as: medical management standards limiting or excluding 34 benefits based on medical necessity, or based on whether the treatment 35 is experimental or investigational; formulary design for prescription 36 drugs; network tier design; standards for provider admission to partic- 37 ipate in a network, including reimbursement rates; methods for determin- 38 ing usual, customary, and reasonable charges; fail-first or step therapy 39 protocols; exclusions based on failure to complete a course of treat- 40 ment; and restrictions based on geographic location, facility type, 41 provider specialty, and other criteria that limit the scope or duration 42 of benefits for services provided under the policy; and 43 (iv) "substance use disorder" shall have the meaning set forth in the 44 most recent edition of the diagnostic and statistical manual of mental 45 disorders or the most recent edition of another generally recognized 46 independent standard of current medical practice such as the interna- 47 tional classification of diseases. 48 (H) An insurer shall provide coverage under this paragraph, at a mini- 49 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 50 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 51 § 7. Paragraph 31-a of subsection (i) of section 3216 of the insurance 52 law, as added by section 1 of part B of chapter 69 of the laws of 2016, 53 is amended to read as follows: 54 (31-a) [(A)] Every policy that provides medical, major medical or 55 similar comprehensive-type coverage and provides coverage for 56 prescription drugs for medication for the treatment of a substance useS. 1507--A 124 A. 2007--A 1 disorder shall include immediate access, without prior authorization, to 2 [a five day emergency supply] the formulary forms of prescribed medica- 3 tions covered under the policy for the treatment of substance use disor- 4 der [where an emergency condition exists], including a prescribed drug 5 or medication associated with the management of opioid withdrawal and/or 6 stabilization, except where otherwise prohibited by law. Further, cover- 7 age [of an emergency supply] without prior authorization shall include 8 formulary forms of medication for opioid overdose reversal otherwise 9 covered under the policy prescribed or dispensed to an individual 10 covered by the policy. 11 [(B) For purposes of this paragraph, an "emergency condition" means a12substance use disorder condition that manifests itself by acute symptoms13of sufficient severity, including severe pain or the expectation of14severe pain, such that a prudent layperson, possessing an average know-15ledge of medicine and health, could reasonably expect the absence of16immediate medical attention to result in:17(i) placing the health of the person afflicted with such condition in18serious jeopardy, or in the case of a behavioral condition, placing the19health of such person or others in serious jeopardy;20(ii) serious impairment to such person's bodily functions;21(iii) serious dysfunction of any bodily organ or part of such person;22(iv) serious disfigurement of such person; or23(v) a condition described in clause (i), (ii), or (iii) of section241867(e)(1)(A) of the Social Security Act.25(C) Coverage provided under this paragraph may be subject to copay-26ments, coinsurance, and annual deductibles that are consistent with27those imposed on other benefits within the policy; provided, however, no28policy shall impose an additional copayment or coinsurance on an insured29who received an emergency supply of medication and then received up to a30thirty day supply of the same medication in the same thirty day period31in which the emergency supply of medication was dispensed. This subpara-32graph shall not preclude the imposition of a copayment or coinsurance on33the initial emergency supply of medication in an amount that is less34than the copayment or coinsurance otherwise applicable to a thirty day35supply of such medication, provided that the total sum of the copayments36or coinsurance for an entire thirty day supply of the medication does37not exceed the copayment or coinsurance otherwise applicable to a thirty38day supply of such medication.] 39 § 8. Subsection (i) of section 3216 of the insurance law is amended by 40 adding a new paragraph 35 to read as follows: 41 (35) (A) Every policy delivered or issued for delivery in this state 42 that provides coverage for inpatient hospital care or coverage for 43 physician services shall provide coverage for the diagnosis and treat- 44 ment of mental health conditions as follows: 45 (i) where the policy provides coverage for inpatient hospital care, 46 benefits for inpatient care in a hospital as defined by subdivision ten 47 of section 1.03 of the mental hygiene law and benefits for outpatient 48 care provided in a facility issued an operating certificate by the 49 commissioner of mental health pursuant to the provisions of article 50 thirty-one of the mental hygiene law, or in a facility operated by the 51 office of mental health, or, for care provided in other states, to simi- 52 larly licensed or certified hospitals or facilities; and 53 (ii) where the policy provides coverage for physician services, bene- 54 fits for outpatient care provided by a psychiatrist or psychologist 55 licensed to practice in this state, a licensed clinical social worker 56 who meets the requirements of subparagraph (D) of paragraph four ofS. 1507--A 125 A. 2007--A 1 subsection (1) of section three thousand two hundred twenty-one of this 2 article, a nurse practitioner licensed to practice in this state, or a 3 professional corporation or university faculty practice corporation 4 thereof. 5 (B) Coverage required by this paragraph may be subject to annual 6 deductibles, copayments and coinsurance as may be deemed appropriate by 7 the superintendent and shall be consistent with those imposed on other 8 benefits under the policy. 9 (C) Coverage under this paragraph shall not apply financial require- 10 ments or treatment limitations to mental health benefits that are more 11 restrictive than the predominant financial requirements and treatment 12 limitations applied to substantially all medical and surgical benefits 13 covered by the policy. 14 (D) The criteria for medical necessity determinations under the policy 15 with respect to mental health benefits shall be made available by the 16 insurer to any insured, prospective insured, or in-network provider upon 17 request. 18 (E) For purposes of this paragraph: 19 (i) "financial requirement" means deductible, copayments, coinsurance 20 and out-of-pocket expenses; 21 (ii) "predominant" means that a financial requirement or treatment 22 limitation is the most common or frequent of such type of limit or 23 requirement; 24 (iii) "treatment limitation" means limits on the frequency of treat- 25 ment, number of visits, days of coverage, or other similar limits on the 26 scope or duration of treatment and includes nonquantitative treatment 27 limitations such as: medical management standards limiting or excluding 28 benefits based on medical necessity, or based on whether the treatment 29 is experimental or investigational; formulary design for prescription 30 drugs; network tier design; standards for provider admission to partic- 31 ipate in a network, including reimbursement rates; methods for determin- 32 ing usual, customary, and reasonable charges; fail-first or step therapy 33 protocols; exclusions based on failure to complete a course of treat- 34 ment; and restrictions based on geographic location, facility type, 35 provider specialty, and other criteria that limit the scope or duration 36 of benefits for services provided under the policy; and 37 (iv) "mental health condition" means any mental health disorder as 38 defined in the most recent edition of the diagnostic and statistical 39 manual of mental disorders or the most recent edition of another gener- 40 ally recognized independent standard of current medical practice such as 41 the international classification of diseases. 42 (F) An insurer shall provide coverage under this paragraph, at a mini- 43 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 44 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 45 (G) This subparagraph shall apply to hospitals in this state that are 46 licensed by the office of mental health that are participating in the 47 insurer's provider network. Where the policy provides coverage for inpa- 48 tient hospital care, benefits for inpatient hospital care in a hospital 49 as defined by subdivision ten of section 1.03 of the mental hygiene law 50 provided to individuals who have not attained the age of eighteen shall 51 not be subject to preauthorization. Coverage provided under this para- 52 graph shall also not be subject to concurrent utilization review during 53 the first fourteen days of the inpatient admission, provided the facili- 54 ty notifies the insurer of both the admission and the initial treatment 55 plan within two business days of the admission, performs daily clinical 56 review of the patient, and participates in periodic consultation withS. 1507--A 126 A. 2007--A 1 the insurer to ensure that the facility is using the evidence-based and 2 peer reviewed clinical review criteria utilized by the insurer which is 3 approved by the office of mental health and appropriate to the age of 4 the patient, to ensure that the inpatient care is medically necessary 5 for the patient. All treatment provided under this subparagraph may be 6 reviewed retrospectively. Where care is denied retrospectively, an 7 insured shall not have any financial obligation to the facility for any 8 treatment under this subparagraph other than any copayment, coinsurance, 9 or deductible otherwise required under the policy. 10 § 9. Paragraphs 17, 19 and 20 of subsection 2 of section 3217-a of the 11 insurance law, paragraph 17 as amended and paragraphs 19 and 20 as added 12 by section 1 of part H of chapter 60 of the laws of 2014, are amended 13 and a new paragraph 21 is added to read as follows: 14 (17) where applicable, a listing by specialty, which may be in a sepa- 15 rate document that is updated annually, of the name, address, and tele- 16 phone number of all participating providers, including facilities, and: 17 (A) whether the provider is accepting new patients; (B) in the case of 18 mental health or substance use disorder services providers, any affil- 19 iations with participating facilities certified or authorized by the 20 office of mental health or the office of alcoholism and substance abuse 21 services, and any restrictions regarding the availability of the indi- 22 vidual provider's services; and [in addition,] (C) in the case of physi- 23 cians, board certification, languages spoken and any affiliations with 24 participating hospitals. The listing shall also be posted on the insur- 25 er's website and the insurer shall update the website within fifteen 26 days of the addition or termination of a provider from the insurer's 27 network or a change in a physician's hospital affiliation; 28 (19) with respect to out-of-network coverage: 29 (A) a clear description of the methodology used by the insurer to 30 determine reimbursement for out-of-network health care services; 31 (B) the amount that the insurer will reimburse under the methodology 32 for out-of-network health care services set forth as a percentage of the 33 usual and customary cost for out-of-network health care services; and 34 (C) examples of anticipated out-of-pocket costs for frequently billed 35 out-of-network health care services; [and] 36 (20) information in writing and through an internet website that 37 reasonably permits an insured or prospective insured to estimate the 38 anticipated out-of-pocket cost for out-of-network health care services 39 in a geographical area or zip code based upon the difference between 40 what the insurer will reimburse for out-of-network health care services 41 and the usual and customary cost for out-of-network health care 42 services[.]; and 43 (21) the most recent comparative analysis performed by the insurer to 44 assess the provision of its covered services in accordance with the Paul 45 Wellstone and Pete Domenici Mental Health Parity and Addiction Equity 46 Act of 2008, 42 U.S.C. 18031(j), and any amendments to, and federal 47 guidance or regulations issued under those acts. 48 § 10. Subsection (b) of section 3217-b of the insurance law, as added 49 by chapter 705 of the laws of 1996, is amended to read as follows: 50 (b) No insurer subject to this article shall by contract, written 51 policy [or], written procedure or practice prohibit or restrict any 52 health care provider from filing a complaint, making a report or 53 commenting to an appropriate governmental body regarding the policies or 54 practices of such insurer which the provider believes may negatively 55 impact upon the quality of, or access to, patient care. Nor shall an 56 insurer subject to this article take any adverse action, including butS. 1507--A 127 A. 2007--A 1 not limited to refusing to renew or execute a contract or agreement with 2 a health care provider as retaliation against a health care provider for 3 filing a complaint, making a report or commenting to an appropriate 4 governmental body regarding policies or practices of such insurer which 5 may violate this chapter including paragraphs thirty, as added by chap- 6 ter forty-one of the laws of 2014, thirty-one, thirty-one-a and thirty- 7 five of subsection (i) of section thirty-two hundred sixteen and para- 8 graphs five, six, seven, seven-a and seven-b of subsection (l) of 9 section thirty-two hundred twenty-one of this article. 10 § 11. Subparagraph (A) of paragraph 4 of subsection (l) of section 11 3221 of the insurance law, as amended by chapter 230 of the laws of 12 2004, is amended to read as follows: 13 (A) Every insurer delivering a group policy or issuing a group policy 14 for delivery, in this state, [which] that provides reimbursement for 15 psychiatric or psychological services or for the diagnosis and treatment 16 of mental[, nervous or emotional disorders and ailments] health condi- 17 tions, however defined in such policy, by physicians, psychiatrists or 18 psychologists, [must] shall make available and if requested by the poli- 19 cyholder provide the same coverage to insureds for such services when 20 performed by a licensed clinical social worker, within the lawful scope 21 of his or her practice, who is licensed pursuant to article one hundred 22 fifty-four of the education law. Written notice of the availability of 23 such coverage shall be delivered to the policyholder prior to inception 24 of such group policy and annually thereafter, except that this notice 25 shall not be required where a policy covers two hundred or more employ- 26 ees or where the benefit structure was the subject of collective 27 bargaining affecting persons who are employed in more than one state. 28 § 12. Subparagraph (D) of paragraph 4 of subsection (l) of section 29 3221 of the insurance law, as amended by section 50 of part D of chapter 30 56 of the laws of 2013, is amended to read as follows: 31 (D) In addition to the requirements of subparagraph (A) of this para- 32 graph, every insurer issuing a group policy for delivery in this state 33 where the policy provides reimbursement to insureds for psychiatric or 34 psychological services or for the diagnosis and treatment of mental[,35nervous or emotional disorders and ailments] health conditions, however 36 defined in such policy, by physicians, psychiatrists or psychologists, 37 shall provide the same coverage to insureds for such services when 38 performed by a licensed clinical social worker, within the lawful scope 39 of his or her practice, who is licensed pursuant to subdivision two of 40 section seven thousand seven hundred four of the education law and in 41 addition shall have either: (i) three or more additional years experi- 42 ence in psychotherapy, which for the purposes of this subparagraph shall 43 mean the use of verbal methods in interpersonal relationships with the 44 intent of assisting a person or persons to modify attitudes and behavior 45 that are intellectually, socially or emotionally maladaptive, under 46 supervision, satisfactory to the state board for social work, in a 47 facility, licensed or incorporated by an appropriate governmental 48 department, providing services for diagnosis or treatment of mental[,49nervous or emotional disorders or ailments] health conditions; (ii) 50 three or more additional years experience in psychotherapy under the 51 supervision, satisfactory to the state board for social work, of a 52 psychiatrist, a licensed and registered psychologist or a licensed clin- 53 ical social worker qualified for reimbursement pursuant to subsection 54 (e) of this section, or (iii) a combination of the experience specified 55 in items (i) and (ii) of this subparagraph totaling three years, satis- 56 factory to the state board for social work.S. 1507--A 128 A. 2007--A 1 § 13. Subparagraphs (A) and (B) of paragraph 5 of subsection (l) of 2 section 3221 of the insurance law, as amended by chapter 502 of the laws 3 of 2007, are amended to read as follows: 4 (A) Every insurer delivering a group or school blanket policy or issu- 5 ing a group or school blanket policy for delivery, in this state, which 6 provides coverage for inpatient hospital care or coverage for physician 7 services shall provide [as part of such policy broad-based] coverage for 8 the diagnosis and treatment of mental[, nervous or emotional disorders9or ailments, however defined in such policy, at least equal to the10coverage provided for other] health conditions and: 11 (i) where the policy provides coverage for inpatient hospital care, 12 benefits for inpatient care in a hospital as defined by subdivision ten 13 of section 1.03 of the mental hygiene law[, which benefits may be limit-14ed to not less than thirty days of active treatment in any contract15year, plan year or calendar year,] and benefits for outpatient care 16 provided in a facility issued an operating certificate by the commis- 17 sioner of mental health pursuant to the provisions of article thirty-one 18 of the mental hygiene law, or in a facility operated by the office of 19 mental health[, which benefits may be limited to not less than twenty20visits in any contract year, plan year or calendar year. Benefits for21partial hospitalization program services shall be provided as an offset22to covered inpatient days at a ratio of two partial hospitalization23visits to one inpatient day of treatment.] or, for care provided in 24 other states, to similarly licensed or certified hospitals or facili- 25 ties; and 26 (ii) where the policy provides coverage for physician services, it 27 shall include benefits for outpatient care provided by a psychiatrist or 28 psychologist licensed to practice in this state, a licensed clinical 29 social worker who meets the requirements of subparagraph (D) of para- 30 graph four of this subsection, a nurse practitioner licensed to practice 31 in this state, or a professional corporation or university faculty prac- 32 tice corporation thereof. [Such benefits may be limited to not less than33twenty visits in any contract year, plan year, or calendar year.] 34 [(iii)] (B) Coverage required by this paragraph may be [provided on a35contract year, plan year or calendar year basis and shall be consistent36with the provision of other benefits under the policy. Such coverage may37be] subject to annual deductibles, co-pays and coinsurance as may be 38 deemed appropriate by the superintendent and shall be consistent with 39 those imposed on other benefits under the policy. [In the event that a40policy provides coverage for both inpatient hospital care and physician41services, the aggregate of the benefits for outpatient care obtained42under this paragraph may be limited to not less than twenty visits in43any contract year, plan year or calendar year.44(iv) In this paragraph, "active treatment" means treatment furnished45in conjunction with inpatient confinement for mental, nervous or46emotional disorders or ailments that meet standards prescribed pursuant47to the regulations of the commissioner of mental health.48(B) (i) Every insurer delivering a group or school blanket policy or49issuing a group or school blanket policy for delivery, in this state,50which provides coverage for inpatient hospital care or coverage for51physician services, shall provide comparable coverage for adults and52children with biologically based mental illness. Such group policies53issued or delivered in this state shall also provide such comparable54coverage for children with serious emotional disturbances. Such coverage55shall be provided under the terms and conditions otherwise applicable56under the policy, including network limitations or variations, exclu-S. 1507--A 129 A. 2007--A 1sions, co-pays, coinsurance, deductibles or other specific cost sharing2mechanisms. Provided further, where a policy provides both in-network3and out-of-network benefits, the out-of-network benefits may have4different coinsurance, co-pays, or deductibles, than the in-network5benefits, regardless of whether the policy is written under one license6or two licenses.7(ii) For purposes of this paragraph, the term "biologically based8mental illness" means a mental, nervous, or emotional condition that is9caused by a biological disorder of the brain and results in a clinically10significant, psychological syndrome or pattern that substantially limits11the functioning of the person with the illness. Such biologically based12mental illnesses are defined as schizophrenia/psychotic disorders, major13depression, bipolar disorder, delusional disorders, panic disorder,14obsessive compulsive disorders, bulimia, and anorexia.] Provided that no 15 copayment or coinsurance imposed for outpatient mental health services 16 provided in a facility licensed, certified or otherwise authorized by 17 the office of mental health shall exceed the copayments or coinsurance 18 imposed for a primary care office visit under the policy. 19 § 14. Subparagraphs (C), (D) and (E) of paragraph 5 of subsection (l) 20 of section 3221 of the insurance law are REPEALED and five new subpara- 21 graphs (C), (D), (E), (F) and (G) are added to read as follows: 22 (C) Coverage under this paragraph shall not apply financial require- 23 ments or treatment limitations to mental health benefits that are more 24 restrictive than the predominant financial requirements and treatment 25 limitations applied to substantially all medical and surgical benefits 26 covered by the policy. 27 (D) The criteria for medical necessity determinations under the policy 28 with respect to mental health benefits shall be made available by the 29 insurer to any insured, prospective insured, or in-network provider upon 30 request. 31 (E) For purposes of this paragraph: 32 (i) "financial requirement" means deductible, copayments, coinsurance 33 and out-of-pocket expenses; 34 (ii) "predominant" means that a financial requirement or treatment 35 limitation is the most common or frequent of such type of limit or 36 requirement; 37 (iii) "treatment limitation" means limits on the frequency of treat- 38 ment, number of visits, days of coverage, or other similar limits on the 39 scope or duration of treatment and includes nonquantitative treatment 40 limitations such as: medical management standards limiting or excluding 41 benefits based on medical necessity, or based on whether the treatment 42 is experimental or investigational; formulary design for prescription 43 drugs; network tier design; standards for provider admission to partic- 44 ipate in a network, including reimbursement rates; methods for determin- 45 ing usual, customary, and reasonable charges; fail-first or step therapy 46 protocols; exclusions based on failure to complete a course of treat- 47 ment; and restrictions based on geographic location, facility type, 48 provider specialty, and other criteria that limit the scope or duration 49 of benefits for services provided under the policy; and 50 (iv) "mental health condition" means any mental health disorder as 51 defined in the most recent edition of the diagnostic and statistical 52 manual of mental disorders or the most recent edition of another gener- 53 ally recognized independent standard of current medical practice such as 54 the international classification of diseases.S. 1507--A 130 A. 2007--A 1 (F) An insurer shall provide coverage under this paragraph, at a mini- 2 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 3 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 4 (G) This subparagraph shall apply to hospitals in this state that are 5 licensed by the office of mental health that are participating in the 6 insurer's provider network. Where the policy provides coverage for inpa- 7 tient hospital care, benefits for inpatient hospital care in a hospital 8 as defined by subdivision ten of section 1.03 of the mental hygiene law 9 provided to individuals who have not attained the age of eighteen shall 10 not be subject to preauthorization. Coverage provided under this para- 11 graph shall also not be subject to concurrent utilization review during 12 the first fourteen days of the inpatient admission, provided the facili- 13 ty notifies the insurer of both the admission and the initial treatment 14 plan within two business days of the admission, performs daily clinical 15 review of the patient, and participates in periodic consultation with 16 the insurer to ensure that the facility is using the evidence-based and 17 peer reviewed clinical review criteria utilized by the insurer which is 18 approved by the office of mental health and appropriate to the age of 19 the patient, to ensure that the inpatient care is medically necessary 20 for the patient. All treatment provided under this subparagraph may be 21 reviewed retrospectively. Where care is denied retrospectively, an 22 insured shall not have any financial obligation to the facility for any 23 treatment under this subparagraph other than any copayment, coinsurance, 24 or deductible otherwise required under the policy. 25 § 15. Subparagraphs (A), (B) and (D) of paragraph 6 of subsection (l) 26 of section 3221 of the insurance law, as amended by section 2 of part B 27 of chapter 71 of the laws of 2016, are amended and three new subpara- 28 graphs (E), (F) and (G) are added to read as follows: 29 (A) Every policy that provides hospital, major medical or similar 30 comprehensive coverage [must] shall provide inpatient coverage for the 31 diagnosis and treatment of substance use disorder, including detoxifica- 32 tion and rehabilitation services. Such inpatient coverage shall include 33 unlimited medically necessary treatment for substance use disorder 34 treatment services provided in residential settings [as required by the35Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §361185a)]. Further, such inpatient coverage shall not apply financial 37 requirements or treatment limitations, including utilization review 38 requirements, to inpatient substance use disorder benefits that are more 39 restrictive than the predominant financial requirements and treatment 40 limitations applied to substantially all medical and surgical benefits 41 covered by the policy. [Further, such coverage shall be provided42consistent with the federal Paul Wellstone and Pete Domenici Mental43Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).] 44 (B) Coverage provided under this paragraph may be limited to facili- 45 ties in New York state [which are certified] that are licensed, certi- 46 fied or otherwise authorized by the office of alcoholism and substance 47 abuse services and, in other states, to those which are accredited by 48 the joint commission as alcoholism, substance abuse or chemical depend- 49 ence treatment programs and are similarly licensed, certified, or other- 50 wise authorized in the state in which the facility is located. 51 (D) This subparagraph shall apply to facilities in this state that are 52 licensed, certified or otherwise authorized by the office of alcoholism 53 and substance abuse services that are participating in the insurer's 54 provider network. Coverage provided under this paragraph shall not be 55 subject to preauthorization. Coverage provided under this paragraph 56 shall also not be subject to concurrent utilization review during theS. 1507--A 131 A. 2007--A 1 first [fourteen] twenty-one days of the inpatient admission provided 2 that the facility notifies the insurer of both the admission and the 3 initial treatment plan within [forty-eight hours] two business days of 4 the admission. The facility shall perform daily clinical review of the 5 patient, including the periodic consultation with the insurer to ensure 6 that the facility is using the evidence-based and peer reviewed clinical 7 review tool utilized by the insurer which is designated by the office of 8 alcoholism and substance abuse services and appropriate to the age of 9 the patient, to ensure that the inpatient treatment is medically neces- 10 sary for the patient. Any utilization review of treatment provided under 11 this subparagraph may include a review of all services provided during 12 such inpatient treatment, including all services provided during the 13 first [fourteen] twenty-one days of such inpatient treatment. Provided, 14 however, the insurer shall only deny coverage for any portion of the 15 initial [fourteen] twenty-one day inpatient treatment on the basis that 16 such treatment was not medically necessary if such inpatient treatment 17 was contrary to the evidence-based and peer reviewed clinical review 18 tool utilized by the insurer which is designated by the office of alco- 19 holism and substance abuse services. An insured shall not have any 20 financial obligation to the facility for any treatment under this 21 subparagraph other than any copayment, coinsurance, or deductible other- 22 wise required under the policy. 23 (E) The criteria for medical necessity determinations under the policy 24 with respect to inpatient substance use disorder benefits shall be made 25 available by the insurer to any insured, prospective insured, or in-net- 26 work provider upon request. 27 (F) For purposes of this paragraph: 28 (i) "financial requirement" means deductible, copayments, coinsurance 29 and out-of-pocket expenses; 30 (ii) "predominant" means that a financial requirement or treatment 31 limitation is the most common or frequent of such type of limit or 32 requirement; 33 (iii) "treatment limitation" means limits on the frequency of treat- 34 ment, number of visits, days of coverage, or other similar limits on the 35 scope or duration of treatment and includes nonquantitative treatment 36 limitations such as: medical management standards limiting or excluding 37 benefits based on medical necessity, or based on whether the treatment 38 is experimental or investigational; formulary design for prescription 39 drugs; network tier design; standards for provider admission to partic- 40 ipate in a network, including reimbursement rates; methods for determin- 41 ing usual, customary, and reasonable charges; fail-first or step therapy 42 protocols; exclusions based on failure to complete a course of treat- 43 ment; and restrictions based on geographic location, facility type, 44 provider specialty, and other criteria that limit the scope or duration 45 of benefits for services provided under the policy; and 46 (iv) "substance use disorder" shall have the meaning set forth in the 47 most recent edition of the diagnostic and statistical manual of mental 48 disorders or the most recent edition of another generally recognized 49 independent standard of current medical practice such as the interna- 50 tional classification of diseases. 51 (G) An insurer shall provide coverage under this paragraph, at a mini- 52 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 53 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 54 § 16. Subparagraphs (A) and (B) of paragraph 7 of subsection (l) of 55 section 3221 of the insurance law, as amended by chapter 41 of the lawsS. 1507--A 132 A. 2007--A 1 of 2014, are amended and a new subparagraph (C-1) is added to read as 2 follows: 3 (A) Every policy that provides medical, major medical or similar 4 comprehensive-type coverage [must] shall provide outpatient coverage for 5 the diagnosis and treatment of substance use disorder, including detoxi- 6 fication and rehabilitation services. Such coverage shall not apply 7 financial requirements or treatment limitations to outpatient substance 8 use disorder benefits that are more restrictive than the predominant 9 financial requirements and treatment limitations applied to substantial- 10 ly all medical and surgical benefits covered by the policy. [Further,11such coverage shall be provided consistent with the federal Paul Well-12stone and Pete Domenici Mental Health Parity and Addiction Equity Act of132008 (29 U.S.C. § 1185a).] 14 (B) Coverage under this paragraph may be limited to facilities in New 15 York state that are licensed, certified or otherwise authorized by the 16 office of alcoholism and substance abuse services [or licensed by such17office as outpatient clinics or medically supervised ambulatory18substance abuse programs] to provide outpatient substance use disorder 19 services and, in other states, to those which are accredited by the 20 joint commission as alcoholism or chemical dependence treatment programs 21 and similarly licensed, certified or otherwise authorized in the state 22 in which the facility is located. 23 (C-1) A large group policy that provides coverage under this paragraph 24 may not impose copayments or coinsurance for outpatient substance use 25 disorder services that exceeds the copayment or coinsurance imposed for 26 a primary care office visit. Provided that only one such copayment may 27 be imposed for all services provided in a single day by a facility 28 licensed, certified or otherwise authorized by the office of alcoholism 29 and substance abuse services to provide outpatient substance use disor- 30 der services. 31 § 17. Subparagraph (E) of paragraph 7 of subsection (l) of section 32 3221 of the insurance law, as added by section 4 of part MM of chapter 33 57 of the laws of 2018, is amended and three new subparagraphs (F), (G) 34 and (H) are added to read as follows: 35 (E) This subparagraph shall apply to facilities in this state that are 36 licensed, certified or otherwise authorized by the office of alcoholism 37 and substance abuse services for the provision of outpatient, intensive 38 outpatient, outpatient rehabilitation and opioid treatment that are 39 participating in the insurer's provider network. Coverage provided under 40 this paragraph shall not be subject to preauthorization. Coverage 41 provided under this paragraph shall not be subject to concurrent review 42 for the first [two] three weeks of continuous treatment, not to exceed 43 [fourteen] twenty-one visits, provided the facility notifies the insurer 44 of both the start of treatment and the initial treatment plan within 45 [forty-eight hours] two business days. The facility shall perform clin- 46 ical assessment of the patient at each visit, including the periodic 47 consultation with the insurer to ensure that the facility is using the 48 evidence-based and peer reviewed clinical review tool utilized by the 49 insurer which is designated by the office of alcoholism and substance 50 abuse services and appropriate to the age of the patient, to ensure that 51 the outpatient treatment is medically necessary for the patient. Any 52 utilization review of the treatment provided under this subparagraph may 53 include a review of all services provided during such outpatient treat- 54 ment, including all services provided during the first [two] three weeks 55 of continuous treatment, not to exceed [fourteen] twenty-one visits, of 56 such outpatient treatment. Provided, however, the insurer shall onlyS. 1507--A 133 A. 2007--A 1 deny coverage for any portion of the initial [two] three weeks of 2 continuous treatment, not to exceed [fourteen] twenty-one visits, for 3 outpatient treatment on the basis that such treatment was not medically 4 necessary if such outpatient treatment was contrary to the evidence- 5 based and peer reviewed clinical review tool utilized by the insurer 6 which is designated by the office of alcoholism and substance abuse 7 services. An insured shall not have any financial obligation to the 8 facility for any treatment under this subparagraph other than any copay- 9 ment, coinsurance, or deductible otherwise required under the policy. 10 (F) The criteria for medical necessity determinations under the policy 11 with respect to outpatient substance use disorder benefits shall be made 12 available by the insurer to any insured, prospective insured, or in-net- 13 work provider upon request. 14 (G) For purposes of this paragraph: 15 (i) "financial requirement" means deductible, copayments, coinsurance 16 and out-of-pocket expenses; 17 (ii) "predominant" means that a financial requirement or treatment 18 limitation is the most common or frequent of such type of limit or 19 requirement; 20 (iii) "treatment limitation" means limits on the frequency of treat- 21 ment, number of visits, days of coverage, or other similar limits on the 22 scope or duration of treatment and includes nonquantitative treatment 23 limitations such as: medical management standards limiting or excluding 24 benefits based on medical necessity, or based on whether the treatment 25 is experimental or investigational; formulary design for prescription 26 drugs; network tier design; standards for provider admission to partic- 27 ipate in a network, including reimbursement rates; methods for determin- 28 ing usual, customary, and reasonable charges; fail-first or step therapy 29 protocols; exclusions based on failure to complete a course of treat- 30 ment; and restrictions based on geographic location, facility type, 31 provider specialty, and other criteria that limit the scope or duration 32 of benefits for services provided under the policy; and 33 (iv) "substance use disorder" shall have the meaning set forth in the 34 most recent edition of the diagnostic and statistical manual of mental 35 disorders or the most recent edition of another generally recognized 36 independent standard of current medical practice such as the interna- 37 tional classification of diseases. 38 (H) An insurer shall provide coverage under this paragraph, at a mini- 39 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 40 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). 41 § 18. Paragraph 7-b of subsection (l) of section 3221 of the insurance 42 law, as added by section 2 of part B of chapter 69 of the laws of 2016, 43 is amended to read as follows: 44 (7-b) [(A)] Every policy that provides medical, major medical or simi- 45 lar comprehensive-type coverage and provides coverage for prescription 46 drugs for medication for the treatment of a substance use disorder shall 47 include immediate access, without prior authorization, [to a five day48emergency supply] to the formulary forms of prescribed medications 49 covered under the policy for the treatment of substance use disorder 50 [where an emergency condition exists], including a prescribed drug or 51 medication associated with the management of opioid withdrawal and/or 52 stabilization, except where otherwise prohibited by law. Further, cover- 53 age [of an emergency supply] without prior authorization shall include 54 formulary forms medication for opioid overdose reversal otherwise 55 covered under the policy prescribed or dispensed to an individual 56 covered by the policy.S. 1507--A 134 A. 2007--A 1 [(B) For purposes of this paragraph, an "emergency condition" means a2substance use disorder condition that manifests itself by acute symptoms3of sufficient severity, including severe pain or the expectation of4severe pain, such that a prudent layperson, possessing an average know-5ledge of medicine and health, could reasonably expect the absence of6immediate medical attention to result in:7(i) placing the health of the person afflicted with such condition in8serious jeopardy, or in the case of a behavioral condition, placing the9health of such person or others in serious jeopardy;10(ii) serious impairment to such person's bodily functions;11(iii) serious dysfunction of any bodily organ or part of such person;12(iv) serious disfigurement of such person; or13(v) a condition described in clause (i), (ii), or (iii) of section141867(e)(1)(A) of the Social Security Act.15(C) Coverage provided under this paragraph may be subject to copay-16ments, coinsurance, and annual deductibles that are consistent with17those imposed on other benefits within the policy; provided, however, no18policy shall impose an additional copayment or coinsurance on an insured19who received an emergency supply of medication and then received up to a20thirty day supply of the same medication in the same thirty day period21in which the emergency supply of medication was dispensed. This subpara-22graph shall not preclude the imposition of a copayment or coinsurance on23the initial emergency supply of medication in an amount that is less24than the copayment or coinsurance otherwise applicable to a thirty day25supply of such medication, provided that the total sum of the copayments26or coinsurance for an entire thirty day supply of the medication does27not exceed the copayment or coinsurance otherwise applicable to a thirty28day supply of such medication.] 29 § 19. Subparagraph (B) of paragraph 17 of subsection (l) of section 30 3221 of the insurance law, as amended by section 39 of part D of chapter 31 56 of the laws of 2013, is amended to read as follows: 32 (B) Every group or blanket policy that provides physician services, 33 medical, major medical or similar comprehensive-type coverage shall 34 provide coverage for the screening, diagnosis and treatment of autism 35 spectrum disorder in accordance with this paragraph and shall not 36 exclude coverage for the screening, diagnosis or treatment of medical 37 conditions otherwise covered by the policy because the individual is 38 diagnosed with autism spectrum disorder. Such coverage may be subject to 39 annual deductibles, copayments and coinsurance as may be deemed appro- 40 priate by the superintendent and shall be consistent with those imposed 41 on other benefits under the group or blanket policy. [Coverage for42applied behavior analysis shall be subject to a maximum benefit of six43hundred eighty hours of treatment per policy or calendar year per44covered individual.] This paragraph shall not be construed as limiting 45 the benefits that are otherwise available to an individual under the 46 group or blanket policy, provided however that such policy shall not 47 contain any limitations on visits that are solely applied to the treat- 48 ment of autism spectrum disorder. No insurer shall terminate coverage or 49 refuse to deliver, execute, issue, amend, adjust, or renew coverage to 50 an individual solely because the individual is diagnosed with autism 51 spectrum disorder or has received treatment for autism spectrum disor- 52 der. Coverage shall be subject to utilization review and external 53 appeals of health care services pursuant to article forty-nine of this 54 chapter as well as[,] case management[,] and other managed care 55 provisions.S. 1507--A 135 A. 2007--A 1 § 20. Items (i) and (iii) of subparagraph (C) of paragraph 17 of 2 subsection (l) of section 3221 of the insurance law, as amended by chap- 3 ter 596 of the laws of 2011, are amended to read as follows: 4 (i) "autism spectrum disorder" means any pervasive developmental 5 disorder as defined in the most recent edition of the diagnostic and 6 statistical manual of mental disorders[, including autistic disorder,7Asperger's disorder, Rett's disorder, childhood disintegrative disorder,8or pervasive developmental disorder not otherwise specified (PDD-NOS)]. 9 (iii) "behavioral health treatment" means counseling and treatment 10 programs, when provided by a licensed provider, and applied behavior 11 analysis, when provided [or supervised] by a [behavior analyst] person 12 licensed, certified [pursuant to the behavior analyst certification13board,] or otherwise authorized to provide applied behavior analysis, 14 that are necessary to develop, maintain, or restore, to the maximum 15 extent practicable, the functioning of an individual. [Individuals that16provide behavioral health treatment under the supervision of a certified17behavior analyst pursuant to this paragraph shall be subject to stand-18ards of professionalism, supervision and relevant experience pursuant to19regulations promulgated by the superintendent in consultation with the20commissioners of health and education.] 21 § 21. Paragraph 17 of subsection (l) of section 3221 of the insurance 22 law is amended by adding four new subparagraphs (H), (I), (J) and (K) to 23 read as follows: 24 (H) Coverage under this paragraph shall not apply financial require- 25 ments or treatment limitations to autism spectrum disorder benefits that 26 are more restrictive than the predominant financial requirements and 27 treatment limitations applied to substantially all medical and surgical 28 benefits covered by the policy. 29 (I) The criteria for medical necessity determinations under the policy 30 with respect to autism spectrum disorder benefits shall be made avail- 31 able by the insurer to any insured, prospective insured, or in-network 32 provider upon request. 33 (J) For purposes of this paragraph: 34 (i) "financial requirement" means deductible, copayments, coinsurance 35 and out-of-pocket expenses; 36 (ii) "predominant" means that a financial requirement or treatment 37 limitation is the most common or frequent of such type of limit or 38 requirement; and 39 (iii) "treatment limitation" means limits on the frequency of treat- 40 ment, number of visits, days of coverage, or other similar limits on 41 the scope or duration of treatment and includes nonquantitative treat- 42 ment limitations such as: medical management standards limiting or 43 excluding benefits based on medical necessity, or based on whether the 44 treatment is experimental or investigational; formulary design for 45 prescription drugs; network tier design; standards for provider admis- 46 sion to participate in a network, including reimbursement rates; methods 47 for determining usual, customary, and reasonable charges; fail-first or 48 step therapy protocols; exclusions based on failure to complete a course 49 of treatment; and restrictions based on geographic location, facility 50 type, provider specialty, and other criteria that limit the scope or 51 duration of benefits for services provided under the policy. 52 (K) An insurer shall provide coverage under this paragraph, at a mini- 53 mum, consistent with the federal Paul Wellstone and Pete Domenici Mental 54 Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).S. 1507--A 136 A. 2007--A 1 § 22. Paragraphs 1, 2, and 3 of subsection (g) of section 4303 of the 2 insurance law, as amended by chapter 502 of the laws of 2007, are 3 amended to read as follows: 4 [(1)] A medical expense indemnity corporation, hospital service corpo- 5 ration or a health service corporation, [which] that provides group, 6 group remittance or school blanket coverage for inpatient hospital 7 care[,] or coverage for physician services shall provide as part of its 8 contract [broad-based] coverage for the diagnosis and treatment of 9 mental[, nervous or emotional disorders or ailments, however defined in10such contract, at least equal to the coverage provided for other] health 11 conditions and [shall include]: 12 [(A)] 13 (1) where the contract provides coverage for inpatient hospital care, 14 benefits for in-patient care in a hospital as defined by subdivision ten 15 of section 1.03 of the mental hygiene law[, which benefits may be limit-16ed to not less than thirty days of active treatment in any contract17year, plan year or calendar year.18(B)] or for inpatient care provided in other states, to similarly 19 licensed hospitals, and benefits for out-patient care provided in a 20 facility issued an operating certificate by the commissioner of mental 21 health pursuant to the provisions of article thirty-one of the mental 22 hygiene law or in a facility operated by the office of mental health[,23which benefits may be limited to not less than twenty visits in any24contract year, plan year or calendar year. Benefits for partial hospi-25talization program services shall be provided as an offset to covered26inpatient days at a ratio of two partial hospitalization visits to one27inpatient day of treatment.28(C) Such coverage may be provided on a contract year, plan year or29calendar year basis and shall be consistent with the provision of other30benefits under the contract.] or for out-patient care provided in other 31 states, to similarly certified facilities; and 32 (2) where the contract provides coverage for physician services bene- 33 fits for outpatient care provided by a psychiatrist or psychologist 34 licensed to practice in this state, a licensed clinical social worker 35 who meets the requirements of subsection (n) of this section, a nurse 36 practitioner licensed to practice on this state, or professional corpo- 37 ration or university faculty practice corporation thereof. 38 (3) Such coverage may be subject to annual deductibles, co-pays and 39 coinsurance as may be deemed appropriate by the superintendent and shall 40 be consistent with those imposed on other benefits under the contract. 41 Provided that no copayment or coinsurance imposed for outpatient mental 42 health services provided in a facility licensed, certified or otherwise 43 authorized by the office of mental health shall exceed the copayments or 44 coinsurance imposed for a primary care office visit under the contract. 45 [(D) For the purpose of this subsection, "active treatment" means46treatment furnished in conjunction with in-patient confinement for47mental, nervous or emotional disorders or ailments that meet such stand-48ards as shall be prescribed pursuant to the regulations of the commis-49sioner of mental health.50(E) In the event the group remittance group or contract holder is51provided coverage under this subsection and under paragraph one of52subsection (h) of this section from the same health service corporation,53or under a contract that is jointly underwritten by two health service54corporations or by a health service corporation and a medical expense55indemnity corporation, the aggregate of the benefits for outpatient care56obtained under subparagraph (B) of this paragraph and paragraph one ofS. 1507--A 137 A. 2007--A 1subsection (h) of this section may be limited to not less than twenty2visits in any contract year, plan year or calendar year.3(2) (A) A hospital service corporation or a health service corpo-4ration, which provides group, group remittance or school blanket cover-5age for inpatient hospital care, shall provide comparable coverage for6adults and children with biologically based mental illness. Such hospi-7tal service corporation or health service corporation shall also provide8such comparable coverage for children with serious emotional disturb-9ances. Such coverage shall be provided under the terms and conditions10otherwise applicable under the contract, including network limitations11or variations, exclusions, co-pays, coinsurance, deductibles or other12specific cost sharing mechanisms. Provided further, where a contract13provides both in-network and out-of-network benefits, the out-of-network14benefits may have different coinsurance, co-pays, or deductibles, than15the in-network benefits, regardless of whether the contract is written16under one license or two licenses.17(B) For purposes of this subsection, the term "biologically based18mental illness" means a mental, nervous, or emotional condition that is19caused by a biological disorder of the brain and results in a clinically20significant, psychological syndrome or pattern that substantially limits21the functioning of the person with the illness. Such biologically based22mental illnesses are defined as schizophrenia/psychotic disorders, major23depression, bipolar disorder, delusional disorders, panic disorder,24obsessive compulsive disorders, anorexia, and bulimia.25(3) For purposes of this subsection, the term "children with serious26emotional disturbances" means persons under the age of eighteen years27who have diagnoses of attention deficit disorders, disruptive behavior28disorders, or pervasive development disorders, and where there are one29or more of the following:30(A) serious suicidal symptoms or other life-threatening self-destruc-31tive behaviors;32(B) significant psychotic symptoms (hallucinations, delusion, bizarre33behaviors);34(C) behavior caused by emotional disturbances that placed the child at35risk of causing personal injury or significant property damage; or36(D) behavior caused by emotional disturbances that placed the child at37substantial risk of removal from the household.] 38 § 23. Paragraphs 4 and 5 of subsection (g) of section 4303 of the 39 insurance law are REPEALED and five new paragraphs 4, 5, 6, 7 and 8 are 40 added to read as follows: 41 (4) Coverage under this paragraph shall not apply financial require- 42 ments or treatment limitations to mental health benefits that are more 43 restrictive than the predominant financial requirements and treatment 44 limitations applied to substantially all medical and surgical benefits 45 covered by the contract. 46 (5) The criteria for medical necessity determinations under the 47 contract with respect to mental health benefits shall be made available 48 by the corporation to any insured, prospective insured, or in-network 49 provider upon request. 50 (6) For purposes of this subsection: 51 (A) "financial requirement" means deductible, copayments, coinsurance 52 and out-of-pocket expenses; 53 (B) "predominant" means that a financial requirement or treatment 54 limitation is the most common or frequent of such type of limit or 55 requirement;S. 1507--A 138 A. 2007--A 1 (C) "treatment limitation" means limits on the frequency of treatment, 2 number of visits, days of coverage, or other similar limits on the 3 scope or duration of treatment and includes nonquantitative treatment 4 limitations such as: medical management standards limiting or excluding 5 benefits based on medical necessity, or based on whether the treatment 6 is experimental or investigational; formulary design for prescription 7 drugs; network tier design; standards for provider admission to partic- 8 ipate in a network, including reimbursement rates; methods for deter- 9 mining usual, customary, and reasonable charges; fail-first or step 10 therapy protocols; exclusions based on failure to complete a course of 11 treatment; and restrictions based on geographic location, facility type, 12 provider specialty, and other criteria that limit the scope or duration 13 of benefits for services provided under the contract; and 14 (D) "mental health condition" means any mental health disorder as 15 defined in the most recent edition of the diagnostic and statistical 16 manual of mental disorders or the most recent edition of another gener- 17 ally recognized independent standard of current medical practice such as 18 the international classification of diseases. 19 (7) A corporation shall provide coverage under this paragraph, at a 20 minimum, consistent with the federal Paul Wellstone and Pete Domenici 21 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 22 1185a). 23 (8) This subparagraph shall apply to hospitals in this state that are 24 licensed by the office of mental health that are participating in the 25 corporation's provider network. Where the contract provides coverage for 26 inpatient hospital care, benefits for inpatient hospital care in a 27 hospital as defined by subdivision ten of section 1.03 of the mental 28 hygiene law provided to individuals who have not attained the age of 29 eighteen shall not be subject to preauthorization. Coverage provided 30 under this paragraph shall also not be subject to concurrent utiliza- 31 tion review during the first fourteen days of the inpatient admission, 32 provided the facility notifies the corporation of both the admission and 33 the initial treatment plan within two business days of the admission, 34 performs daily clinical review of the patient, and participates in peri- 35 odic consultation with the corporation to ensure that the facility is 36 using the evidence-based and peer reviewed clinical review criteria 37 utilized by the corporation which is approved by the office of mental 38 health and appropriate to the age of the patient, to ensure that the 39 inpatient care is medically necessary for the patient. All treatment 40 provided under this subparagraph may be reviewed retrospectively. Where 41 care is denied retrospectively, an insured shall not have any financial 42 obligation to the facility for any treatment under this subparagraph 43 other than any copayment, coinsurance, or deductible otherwise required 44 under the contract. 45 § 24. Subsection (h) of section 4303 of the insurance law is REPEALED. 46 § 25. Subsection (i) of section 4303 of the insurance law, as amended 47 by chapter 230 of the laws of 2004, is amended to read as follows: 48 (i) A medical expense indemnity corporation or health service corpo- 49 ration [which] that provides coverage for physicians, psychiatrists or 50 psychologists for psychiatric or psychological services or for the diag- 51 nosis and treatment of [mental, nervous or emotional disorders and52ailments] mental health conditions, however defined in such contract, 53 [must] shall make available and if requested by all persons holding 54 individual contracts in a group whose premiums are paid by a remitting 55 agent or by the contract holder in the case of a group contract issued 56 pursuant to section four thousand three hundred five of this article,S. 1507--A 139 A. 2007--A 1 provide the same coverage for such services when performed by a licensed 2 clinical social worker, within the lawful scope of his or her practice, 3 who is licensed pursuant to article one hundred fifty-four of the educa- 4 tion law. The state board for social work shall maintain a list of all 5 licensed clinical social workers qualified for reimbursement under this 6 subsection. Such coverage shall be made available at the inception of 7 all new contracts and, with respect to all other contracts, at any anni- 8 versary date subject to evidence of insurability. Written notice of the 9 availability of such coverage shall be delivered to the group remitting 10 agent or group contract holder prior to inception of such contract and 11 annually thereafter, except that this notice shall not be required where 12 a [policy] contract covers two hundred or more employees or where the 13 benefit structure was the subject of collective bargaining affecting 14 persons who are employed in more than one state. 15 § 26. Subsection (k) of section 4303 of the insurance law, as amended 16 by section 3 of part B of chapter 71 of the laws of 2016, is amended to 17 read as follows: 18 (k)(1) Every contract that provides hospital, major medical or similar 19 comprehensive coverage [must] shall provide inpatient coverage for the 20 diagnosis and treatment of substance use disorder, including detoxifica- 21 tion and rehabilitation services. Such inpatient coverage shall include 22 unlimited medically necessary treatment for substance use disorder 23 treatment services provided in residential settings [as required by the24Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. §251185a)]. Further, such inpatient coverage shall not apply financial 26 requirements or treatment limitations, including utilization review 27 requirements, to inpatient substance use disorder benefits that are more 28 restrictive than the predominant financial requirements and treatment 29 limitations applied to substantially all medical and surgical benefits 30 covered by the contract. [Further, such coverage shall be provided31consistent with the federal Paul Wellstone and Pete Domenici Mental32Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).] 33 (2) Coverage provided under this subsection may be limited to facili- 34 ties in New York state [which are certified] that are licensed, certi- 35 fied or otherwise authorized by the office of alcoholism and substance 36 abuse services and, in other states, to those which are accredited by 37 the joint commission as alcoholism, substance abuse, or chemical depend- 38 ence treatment programs and are similarly licensed, certified or other- 39 wise authorized in the state in which the facility is located. 40 (3) Coverage provided under this subsection may be subject to annual 41 deductibles and co-insurance as deemed appropriate by the superintendent 42 and that are consistent with those imposed on other benefits within a 43 given contract. 44 (4) This paragraph shall apply to facilities in this state [certified] 45 that are licensed, certified or otherwise authorized by the office of 46 alcoholism and substance abuse services that are participating in the 47 corporation's provider network. Coverage provided under this subsection 48 shall not be subject to preauthorization. Coverage provided under this 49 subsection shall also not be subject to concurrent utilization review 50 during the first [fourteen] twenty-one days of the inpatient admission 51 provided that the facility notifies the corporation of both the admis- 52 sion and the initial treatment plan within [forty-eight hours] two busi- 53 ness days of the admission. The facility shall perform daily clinical 54 review of the patient, including the periodic consultation with the 55 corporation to ensure that the facility is using the evidence-based and 56 peer reviewed clinical review tool utilized by the corporation which isS. 1507--A 140 A. 2007--A 1 designated by the office of alcoholism and substance abuse services and 2 appropriate to the age of the patient, to ensure that the inpatient 3 treatment is medically necessary for the patient. Any utilization review 4 of treatment provided under this paragraph may include a review of all 5 services provided during such inpatient treatment, including all 6 services provided during the first [fourteen] twenty-one days of such 7 inpatient treatment. Provided, however, the corporation shall only deny 8 coverage for any portion of the initial [fourteen] twenty-one day inpa- 9 tient treatment on the basis that such treatment was not medically 10 necessary if such inpatient treatment was contrary to the evidence-based 11 and peer reviewed clinical review tool utilized by the corporation which 12 is designated by the office of alcoholism and substance abuse services. 13 An insured shall not have any financial obligation to the facility for 14 any treatment under this paragraph other than any copayment, coinsu- 15 rance, or deductible otherwise required under the contract. 16 (5) The criteria for medical necessity determinations under the 17 contract with respect to inpatient substance use disorder benefits 18 shall be made available by the corporation to any insured, prospective 19 insured or in-network provider upon request. 20 (6) For purposes of this subsection: 21 (A) "financial requirement" means deductible, copayments, coinsurance 22 and out-of-pocket expenses; 23 (B) "predominant" means that a financial requirement or treatment 24 limitation is the most common or frequent of such type of limit or 25 requirement; 26 (C) "treatment limitation" means limits on the frequency of treatment, 27 number of visits, days of coverage, or other similar limits on the 28 scope or duration of treatment and includes nonquantitative treatment 29 limitations such as: medical management standards limiting or excluding 30 benefits based on medical necessity, or based on whether the treatment 31 is experimental or investigational; formulary design for prescription 32 drugs; network tier design; standards for provider admission to partic- 33 ipate in a network, including reimbursement rates; methods for deter- 34 mining usual, customary, and reasonable charges; fail-first or step 35 therapy protocols; exclusions based on failure to complete a course of 36 treatment; and restrictions based on geographic location, facility type, 37 provider specialty, and other criteria that limit the scope or duration 38 of benefits for services provided under the contract; and 39 (D) "substance use disorder" shall have the meaning set forth in the 40 most recent edition of the diagnostic and statistical manual of mental 41 disorders or the most recent edition of another generally recognized 42 independent standard of current medical practice such as the interna- 43 tional classification of diseases. 44 (7) A corporation shall provide coverage under this paragraph, at a 45 minimum, consistent with the federal Paul Wellstone and Pete Domenici 46 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 47 1185a). 48 § 27. Paragraphs 1 and 2 of subsection (l) of section 4303 of the 49 insurance law, as amended by chapter 41 of the laws of 2014, are amended 50 and a new paragraph 3-a is added to read as follows: 51 (1) Every contract that provides medical, major medical or similar 52 comprehensive-type coverage [must] shall provide outpatient coverage for 53 the diagnosis and treatment of substance use disorder, including detoxi- 54 fication and rehabilitation services. Such coverage shall not apply 55 financial requirements or treatment limitations to outpatient substance 56 use disorder benefits that are more restrictive than the predominantS. 1507--A 141 A. 2007--A 1 financial requirements and treatment limitations applied to substantial- 2 ly all medical and surgical benefits covered by the contract. [Further,3such coverage shall be provided consistent with the federal Paul Well-4stone and Pete Domenici Mental Health Parity and Addiction Equity Act of52008 (29 U.S.C. § 1185a).] 6 (2) Coverage under this subsection may be limited to facilities in New 7 York state that are licensed, certified or otherwise authorized by the 8 office of alcoholism and substance abuse services [or licensed by such9office as outpatient clinics or medically supervised ambulatory] to 10 provide outpatient substance [abuse programs] use disorder services and, 11 in other states, to those which are accredited by the joint commission 12 as alcoholism or chemical dependence substance abuse treatment programs 13 and are similarly licensed, certified or otherwise authorized in the 14 state in which the facility is located. 15 (3-a) A contract that provides large group coverage that provides 16 coverage for outpatient substance use disorder services under this 17 subsection may not impose copayments or coinsurance for outpatient 18 substance use disorder services that exceed the copayment or coinsurance 19 imposed for a primary care office visit. Provided that only one such 20 copayment may be imposed for all services provided in a single day by a 21 facility licensed, certified or otherwise authorized by the office of 22 alcoholism and substance abuse services to provide outpatient substance 23 use disorder services. 24 § 28. Paragraph 5 of subsection (l) of section 4303 of the insurance 25 law, as added by section 5 of part MM of chapter 57 of the laws of 2018, 26 is amended and three new paragraphs 6, 7 and 8 are added to read as 27 follows: 28 (5) This paragraph shall apply to facilities in this state [certified] 29 that are licensed, certified or otherwise authorized by the office of 30 alcoholism and substance abuse services for the provision of outpatient, 31 intensive outpatient, outpatient rehabilitation and opioid treatment 32 that are participating in the corporation's provider network. Coverage 33 provided under this subsection shall not be subject to preauthorization. 34 Coverage provided under this subsection shall not be subject to concur- 35 rent review for the first [two] three weeks of continuous treatment, not 36 to exceed [fourteen] twenty-one visits, provided the facility notifies 37 the corporation of both the start of treatment and the initial treatment 38 plan within [forty-eight hours] two business days. The facility shall 39 perform clinical assessment of the patient at each visit, including the 40 periodic consultation with the corporation to ensure that the facility 41 is using the evidence-based and peer reviewed clinical review tool 42 utilized by the corporation which is designated by the office of alco- 43 holism and substance abuse services and appropriate to the age of the 44 patient, to ensure that the outpatient treatment is medically necessary 45 for the patient. Any utilization review of the treatment provided under 46 this paragraph may include a review of all services provided during such 47 outpatient treatment, including all services provided during the first 48 [two] three weeks of continuous treatment, not to exceed [fourteen] 49 twenty-one visits, of such outpatient treatment. Provided, however, the 50 corporation shall only deny coverage for any portion of the initial 51 [two] three weeks of continuous treatment, not to exceed [fourteen] 52 twenty-one visits, for outpatient treatment on the basis that such 53 treatment was not medically necessary if such outpatient treatment was 54 contrary to the evidence-based and peer reviewed clinical review tool 55 utilized by the corporation which is designated by the office of alco- 56 holism and substance abuse services. A subscriber shall not have anyS. 1507--A 142 A. 2007--A 1 financial obligation to the facility for any treatment under this para- 2 graph other than any copayment, coinsurance, or deductible otherwise 3 required under the contract. 4 (6) The criteria for medical necessity determinations under the 5 contract with respect to outpatient substance use disorder benefits 6 shall be made available by the corporation to any insured, prospective 7 insured, or in-network provider upon request. 8 (7) For purposes of this subsection: 9 (A) "financial requirement" means deductible, copayments, coinsurance 10 and out-of-pocket expenses; 11 (B) "predominant" means that a financial requirement or treatment 12 limitation is the most common or frequent of such type of limit or 13 requirement. 14 (C) "treatment limitation" means limits on the frequency of treatment, 15 number of visits, days of coverage, or other similar limits on the scope 16 or duration of treatment and includes nonquantitative treatment limita- 17 tions such as: medical management standards limiting or excluding bene- 18 fits based on medical necessity, or based on whether the treatment is 19 experimental or investigational; formulary design for prescription 20 drugs; network tier design; standards for provider admission to partic- 21 ipate in a network, including reimbursement rates; methods for determin- 22 ing usual, customary, and reasonable charges; fail-first or step therapy 23 protocols; exclusions based on failure to complete a course of treat- 24 ment; and restrictions based on geographic location, facility type, 25 provider specialty, and other criteria that limit the scope or duration 26 of benefits for services provided under the contract; and 27 (D) "substance use disorder" shall have the meaning set forth in the 28 most recent edition of the diagnostic and statistical manual of mental 29 disorders or the most recent edition of another generally recognized 30 independent standard of current medical practice such as the interna- 31 tional classification of diseases. 32 (8) A corporation shall provide coverage under this paragraph, at a 33 minimum, consistent with the federal Paul Wellstone and Pete Domenici 34 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 35 1185a). 36 § 29. Subsection (l-2) of section 4303 of the insurance law, as added 37 by section 3 of part B of chapter 69 of the laws of 2016, is amended to 38 read as follows: 39 (l-2) [(1)] Every contract that provides medical, major medical or 40 similar comprehensive-type coverage and provides coverage for 41 prescription drugs for medication for the treatment of a substance use 42 disorder shall include immediate access, without prior authorization, to 43 [a five day emergency supply] the formulary forms of prescribed medica- 44 tions covered under the contract for the treatment of substance use 45 disorder [where an emergency condition exists], including a prescribed 46 drug or medication associated with the management of opioid withdrawal 47 and/or stabilization, except where otherwise prohibited by law. Further, 48 coverage [of an emergency supply] without prior authorization shall 49 include formulary forms of medication for opioid overdose reversal 50 otherwise covered under the contract prescribed or dispensed to an indi- 51 vidual covered by the contract. 52 [(2) For purposes of this paragraph, an "emergency condition" means a53substance use disorder condition that manifests itself by acute symptoms54of sufficient severity, including severe pain or the expectation of55severe pain, such that a prudent layperson, possessing an average know-S. 1507--A 143 A. 2007--A 1ledge of medicine and health, could reasonably expect the absence of2immediate medical attention to result in:3(i) placing the health of the person afflicted with such condition in4serious jeopardy, or in the case of a behavioral condition, placing the5health of such person or others in serious jeopardy;6(ii) serious impairment to such person's bodily functions;7(iii) serious dysfunction of any bodily organ or part of such person;8(iv) serious disfigurement of such person; or9(v) a condition described in clause (i), (ii) or (iii) of section101867(e)(1)(A) of the Social Security Act.11(3) Coverage provided under this subsection may be subject to copay-12ments, coinsurance, and annual deductibles that are consistent with13those imposed on other benefits within the contract; provided, however,14no contract shall impose an additional copayment or coinsurance on an15insured who received an emergency supply of medication and then received16up to a thirty day supply of the same medication in the same thirty day17period in which the emergency supply of medication was dispensed. This18paragraph shall not preclude the imposition of a copayment or coinsu-19rance on the initial limited supply of medication in an amount that is20less than the copayment or coinsurance otherwise applicable to a thirty21day supply of such medication, provided that the total sum of the copay-22ments or coinsurance for an entire thirty day supply of the medication23does not exceed the copayment or coinsurance otherwise applicable to a24thirty day supply of such medication.] 25 § 30. Subsection (n) of section 4303 of the insurance law, as amended 26 by chapter 230 of the laws of 2004, is amended to read as follows: 27 (n) In addition to the requirements of subsection (i) of this section, 28 every health service or medical expense indemnity corporation issuing a 29 group contract pursuant to this section or a group remittance contract 30 for delivery in this state which contract provides reimbursement to 31 subscribers or physicians, psychiatrists or psychologists for psychiat- 32 ric or psychological services or for the diagnosis and treatment of 33 [mental, nervous or emotional disorders and ailments,] mental health 34 conditions, however defined in such contract, must provide the same 35 coverage to persons covered under the group contract for such services 36 when performed by a licensed clinical social worker, within the lawful 37 scope of his or her practice, who is licensed pursuant to subdivision 38 two of section seven thousand seven hundred four of the education law 39 and in addition shall have either (i) three or more additional years 40 experience in psychotherapy, which for the purposes of this subsection 41 shall mean the use of verbal methods in interpersonal relationships with 42 the intent of assisting a person or persons to modify attitudes and 43 behavior which are intellectually, socially or emotionally maladaptive, 44 under supervision, satisfactory to the state board for social work, in a 45 facility, licensed or incorporated by an appropriate governmental 46 department, providing services for diagnosis or treatment of [mental,47nervous or emotional disorders or ailments,] mental health conditions, 48 or (ii) three or more additional years experience in psychotherapy under 49 the supervision, satisfactory to the state board for social work, of a 50 psychiatrist, a licensed and registered psychologist or a licensed clin- 51 ical social worker qualified for reimbursement pursuant to subsection 52 (i) of this section, or (iii) a combination of the experience specified 53 in paragraphs (i) and (ii) totaling three years, satisfactory to the 54 state board for social work. The state board for social work shall 55 maintain a list of all licensed clinical social workers qualified for 56 reimbursement under this subsection.S. 1507--A 144 A. 2007--A 1 § 31. Paragraph 2 of subsection (ee) of section 4303 of the insurance 2 law, as amended by section 40 of part D of chapter 56 of the laws of 3 2013, is amended to read as follows: 4 (2) Every contract that provides physician services, medical, major 5 medical or similar comprehensive-type coverage shall provide coverage 6 for the screening, diagnosis and treatment of autism spectrum disorder 7 in accordance with this paragraph and shall not exclude coverage for the 8 screening, diagnosis or treatment of medical conditions otherwise 9 covered by the contract because the individual is diagnosed with autism 10 spectrum disorder. Such coverage may be subject to annual deductibles, 11 copayments and coinsurance as may be deemed appropriate by the super- 12 intendent and shall be consistent with those imposed on other benefits 13 under the contract. [Coverage for applied behavior analysis shall be14subject to a maximum benefit of six hundred eighty hours of treatment15per contract or calendar year per covered individual.] This paragraph 16 shall not be construed as limiting the benefits that are otherwise 17 available to an individual under the contract, provided however that 18 such contract shall not contain any limitations on visits that are sole- 19 ly applied to the treatment of autism spectrum disorder. No insurer 20 shall terminate coverage or refuse to deliver, execute, issue, amend, 21 adjust, or renew coverage to an individual solely because the individual 22 is diagnosed with autism spectrum disorder or has received treatment for 23 autism spectrum disorder. Coverage shall be subject to utilization 24 review and external appeals of health care services pursuant to article 25 forty-nine of this chapter as well as[,] case management[,] and other 26 managed care provisions. 27 § 32. Subparagraphs (A) and (C) of paragraph 3 of subsection (ee) of 28 section 4303 of the insurance law, as amended by chapter 596 of the laws 29 of 2011, are amended to read as follows: 30 (A) "autism spectrum disorder" means any pervasive developmental 31 disorder as defined in the most recent edition of the diagnostic and 32 statistical manual of mental disorders[, including autistic disorder,33Asperger's disorder, Rett's disorder, childhood disintegrative disorder,34or pervasive developmental disorder not otherwise specified (PDD-NOS)]. 35 (C) "behavioral health treatment" means counseling and treatment 36 programs, when provided by a licensed provider, and applied behavior 37 analysis, when provided [or supervised] by a [behavior analyst certified38pursuant to the behavior analyst certification board] person that is 39 licensed, certified or otherwise authorized to provide applied behavior 40 analysis, that are necessary to develop, maintain, or restore, to the 41 maximum extent practicable, the functioning of an individual. [Individ-42uals that provide behavioral health treatment under the supervision of a43certified behavior analyst pursuant to this subsection shall be subject44to standards of professionalism, supervision and relevant experience45pursuant to regulations promulgated by the superintendent in consulta-46tion with the commissioners of health and education.] 47 § 33. Subsection (ee) of section 4303 of the insurance law is amended 48 by adding four new paragraphs 8, 9, 10, and 11 to read as follows: 49 (8) Coverage under this paragraph shall not apply financial require- 50 ments or treatment limitations to autism spectrum disorder benefits that 51 are more restrictive than the predominant financial requirements and 52 treatment limitations applied to substantially all medical and surgical 53 benefits covered by the policy. 54 (9) The criteria for medical necessity determinations under the 55 contract with respect to autism spectrum disorder benefits shall be madeS. 1507--A 145 A. 2007--A 1 available by the corporation to any insured, prospective insured, or 2 in-network provider upon request. 3 (10) For purposes of this subsection: 4 (A) "financial requirement" means deductible, copayments, coinsurance 5 and out-of-pocket expenses; 6 (B) "predominant" means that a financial requirement or treatment 7 limitation is the most common or frequent of such type of limit or 8 requirement; and 9 (C) "treatment limitation" means limits on the frequency of treatment, 10 number of visits, days of coverage, or other similar limits on the scope 11 or duration of treatment and includes nonquantitative treatment limita- 12 tions such as: medical management standards limiting or excluding bene- 13 fits based on medical necessity, or based on whether the treatment is 14 experimental or investigational; formulary design for prescription 15 drugs; network tier design; standards for provider admission to partic- 16 ipate in a network, including reimbursement rates; methods for determin- 17 ing usual, customary, and reasonable charges; fail-first or step therapy 18 protocols; exclusions based on failure to complete a course of treat- 19 ment; and restrictions based on geographic location, facility type, 20 provider specialty, and other criteria that limit the scope or duration 21 of benefits for services provided under the contract. 22 (11) A corporation shall provide coverage under this subsection, at a 23 minimum, consistent with the federal Paul Wellstone and Pete Domenici 24 Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 25 1185a). 26 § 34. Paragraphs 17, 20 and 21 of subsection (a) of section 4324 of 27 the insurance law, paragraph 17 as amended and paragraphs 20 and 21 as 28 added by section 8 of part H of chapter 60 of the laws of 2014, are 29 amended and a new paragraph 22 is added to read as follows: 30 (17) where applicable, a listing by specialty, which may be in a sepa- 31 rate document that is updated annually, of the name, address, and tele- 32 phone number of all participating providers, including facilities, [and33in addition,] and: (A) whether the provider is accepting new patients; 34 (B) in the case of mental health or substance use disorder services 35 providers, any affiliations with participating facilities certified or 36 authorized by the office of mental health or the office of alcoholism 37 and substance abuse services, and any restrictions regarding the avail- 38 ability of the individual provider's services; (C) in the case of physi- 39 cians, board certification, languages spoken and any affiliations with 40 participating hospitals. The listing shall also be posted on the corpo- 41 ration's website and the corporation shall update the website within 42 fifteen days of the addition or termination of a provider from the 43 corporation's network or a change in a physician's hospital affiliation; 44 (20) with respect to out-of-network coverage: 45 (A) a clear description of the methodology used by the corporation to 46 determine reimbursement for out-of-network health care services; 47 (B) a description of the amount that the corporation will reimburse 48 under the methodology for out-of-network health care services set forth 49 as a percentage of the usual and customary cost for out-of-network 50 health care services; and 51 (C) examples of anticipated out-of-pocket costs for frequently billed 52 out-of-network health care services; [and] 53 (21) information in writing and through an internet website that 54 reasonably permits a subscriber or prospective subscriber to estimate 55 the anticipated out-of-pocket cost for out-of-network health care 56 services in a geographical area or zip code based upon the differenceS. 1507--A 146 A. 2007--A 1 between what the corporation will reimburse for out-of-network health 2 care services and the usual and customary cost for out-of-network health 3 care services[.]; and 4 (22) the most recent comparative analysis performed by the corporation 5 to assess the provision of its covered services in accordance with the 6 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 7 Equity Act of 2008, 42 U.S.C. 18031 (j), and any amendments to, and 8 federal guidance or regulations issued under, those Acts. 9 § 35. Subsection (b) of section 4325 of the insurance law, as added by 10 chapter 705 of the laws of 1996, is amended to read as follows: 11 (b) No corporation organized under this article shall by contract, 12 written policy [or], written procedure or practice prohibit or restrict 13 any health care provider from filing a complaint, making a report or 14 commenting to an appropriate governmental body regarding the policies or 15 practices of such corporation which the provider believes may negatively 16 impact upon the quality of or access to patient care. Nor shall a corpo- 17 ration organized under this article take any adverse action, including 18 but not limited to refusing to renew or execute a contract or agreement 19 with a health care provider as retaliation against a health care provid- 20 er for filing a complaint, making a report or commenting to an appropri- 21 ate governmental body regarding policies or practices of such corpo- 22 ration which may violate this chapter including subsection (g), (k), 23 (1), (1-1) or (1-2) of section forty-three hundred three of this arti- 24 cle. 25 § 36. Subparagraph (C) of paragraph 1 of subsection (b) of section 26 4900 of the insurance law, as added by chapter 41 of the laws of 2014, 27 is amended and a new subparagraph (D) is added to read as follows: 28 (C) for purposes of a determination involving substance use disorder 29 treatment: 30 (i) a physician who possesses a current and valid non-restricted 31 license to practice medicine and who specializes in behavioral health 32 and has experience in the delivery of substance use disorder courses of 33 treatment; or 34 (ii) a health care professional other than a licensed physician who 35 specializes in behavioral health and has experience in the delivery of 36 substance use disorder courses of treatment and, where applicable, 37 possesses a current and valid non-restricted license, certificate or 38 registration or, where no provision for a license, certificate or regis- 39 tration exists, is credentialed by the national accrediting body appro- 40 priate to the profession; [and] or 41 (D) for purposes of a determination involving treatment for a mental 42 health condition: 43 (i) a physician who possesses a current and valid non-restricted 44 license to practice medicine and who specializes in behavioral health 45 and has experience in the delivery of mental health courses or treat- 46 ment; or 47 (ii) a health care professional other than a licensed physician who 48 specializes in behavioral health and has experience in the delivery of 49 mental health courses of treatment and, where applicable, possesses a 50 current and valid non-restricted license, certificate, or registration 51 or, where no provision for a license, certificate or registration 52 exists, is credentialed by the national accrediting body appropriate to 53 the profession; and 54 § 37. Paragraph 9 of subsection (a) of section 4902 of the insurance 55 law, as amended by section 1 of part A of chapter 69 of the laws of 56 2016, is amended to read as follows:S. 1507--A 147 A. 2007--A 1 (9) When conducting utilization review for purposes of determining 2 health care coverage for substance use disorder treatment, a utilization 3 review agent shall utilize an evidence-based and peer reviewed clinical 4 review [tools designated by the office of alcoholism and substance abuse5services that are appropriate to the age of the patient and consistent6with the treatment service levels within the office of alcoholism and7substance abuse services system] tool that is appropriate to the age of 8 the patient. When conducting such utilization review for treatment 9 provided in this state, a utilization review agent shall utilize an 10 evidence-based and peer reviewed clinical tool designated by the office 11 of alcoholism and substance abuse services that is consistent with the 12 treatment service levels within the office of alcoholism and substance 13 abuse services system. All approved tools shall have inter rater reli- 14 ability testing completed by December thirty-first, two thousand 15 sixteen. 16 § 38. Subsection (a) of section 4902 of the insurance law is amended 17 by adding a new paragraph 12 to read as follows: 18 (12) When conducting utilization review for purposes of determining 19 health care coverage for a mental health condition, a utilization review 20 agent shall utilize evidence-based and peer reviewed clinical review 21 criteria that is appropriate to the age of the patient. The utilization 22 review agent shall use clinical review criteria deemed appropriate and 23 approved for such use by the commissioner of the office of mental 24 health, in consultation with the commissioner of health and the super- 25 intendent. Approved clinical review criteria shall have inter rater 26 reliability testing completed by December thirty-first, two thousand 27 nineteen. 28 § 39. Paragraph (b) of subsection 5 of section 4403 of the public 29 health law, as added by chapter 705 of the laws of 1996, is amended to 30 read as follows: 31 (b) The following criteria shall be considered by the commissioner at 32 the time of a review: (i) the availability of appropriate and timely 33 care that is provided in compliance with the standards of the Federal 34 Americans with Disability Act to assure access to health care for the 35 enrollee population; (ii) the network's ability to provide culturally 36 and linguistically competent care to meet the needs of the enrollee 37 population; [and] (iii) the availability of appropriate and timely care 38 that is in compliance with the standards of the Paul Wellstone and Pete 39 Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 40 U.S.C. 18031(j), and any amendments to, and federal guidance and regu- 41 lations issued under those Acts, which shall include an analysis of the 42 rate of out-of-network utilization for covered mental health and 43 substance use disorder services as compared to the rate of out-of-net- 44 work utilization for the respective category of medical services; and 45 (iv) with the exception of initial licensure, the number of grievances 46 filed by enrollees relating to waiting times for appointments, appropri- 47 ateness of referrals and other indicators of plan capacity. 48 § 40. Subdivision 3 of section 4406-c of the public health law, as 49 added by chapter 705 of the laws of 1996, is amended to read as follows: 50 3. No health care plan shall by contract, written policy [or], written 51 procedure or practice prohibit or restrict any health care provider from 52 filing a complaint, making a report or commenting to an appropriate 53 governmental body regarding the policies or practices of such health 54 care plan which the provider believes may negatively impact upon the 55 quality of, or access to, patient care. Nor shall a health care plan 56 take any adverse action, including but not limited to refusing to renewS. 1507--A 148 A. 2007--A 1 or execute a contract or agreement with a health care provider as retal- 2 iation against a health care provider for filing a complaint, making a 3 report or commenting to an appropriate governmental body regarding poli- 4 cies or practices of such health care plan which may violate this chap- 5 ter or the insurance law including subsection (g), (k), (l), (l-1) or 6 (1-2) of section forty-three hundred three of the insurance law. 7 § 41. Paragraphs (r), (t) and (u) of subdivision 1 of section 4408 of 8 the public health law, paragraph (r) as amended and paragraphs (t) and 9 (u) as added by section 18 of part H of chapter 60 of the laws of 2014, 10 are amended and a new paragraph (v) is added to read as follows: 11 (r) a listing by specialty, which may be in a separate document that 12 is updated annually, of the name, address and telephone number of all 13 participating providers, including facilities, [and, in addition,] and: 14 (i) whether the provider is accepting new patients; (ii) in the case of 15 mental health or substance use disorder services providers, any affil- 16 iations with participating facilities certified or authorized by the 17 office of mental health or the office of alcoholism and substance abuse 18 services, and any restrictions regarding the availability of the indi- 19 vidual provider's services; and (iii) in the case of physicians, board 20 certification, languages spoken and any affiliations with participating 21 hospitals. The listing shall also be posted on the health maintenance 22 organization's website and the health maintenance organization shall 23 update the website within fifteen days of the addition or termination of 24 a provider from the health maintenance organization's network or a 25 change in a physician's hospital affiliation; 26 (t) with respect to out-of-network coverage: 27 (i) a clear description of the methodology used by the health mainte- 28 nance organization to determine reimbursement for out-of-network health 29 care services; 30 (ii) the amount that the health maintenance organization will reim- 31 burse under the methodology for out-of-network health care services set 32 forth as a percentage of the usual and customary cost for out-of-network 33 health care services; 34 (iii) examples of anticipated out-of-pocket costs for frequently 35 billed out-of-network health care services; [and] 36 (u) information in writing and through an internet website that 37 reasonably permits an enrollee or prospective enrollee to estimate the 38 anticipated out-of-pocket cost for out-of-network health care services 39 in a geographical area or zip code based upon the difference between 40 what the health maintenance organization will reimburse for out-of-net- 41 work health care services and the usual and customary cost for out-of- 42 network health care services[.]; and 43 (v) the most recent comparative analysis performed by the health main- 44 tenance organization to assess the provision of its covered services in 45 accordance with the Paul Wellstone and Pete Dominici Mental Health Pari- 46 ty and Addiction Equity Act of 2008, 42 U.S.C. 18031(j) and any amend- 47 ments to, and federal guidance and regulations issued under, those Acts. 48 § 42. Subparagraph (iii) of paragraph (a) of subdivision 2 of section 49 4900 of the public health law, as added by chapter 41 of the laws of 50 2014, is amended and a new subparagraph (iv) is added to read as 51 follows: 52 (iii) for purposes of a determination involving substance use disorder 53 treatment: 54 (A) a physician who possesses a current and valid non-restricted 55 license to practice medicine and who specializes in behavioral healthS. 1507--A 149 A. 2007--A 1 and has experience in the delivery of substance use disorder courses of 2 treatment; or 3 (B) a health care professional other than a licensed physician who 4 specializes in behavioral health and has experience in the delivery of 5 substance use disorder courses of treatment and, where applicable, 6 possesses a current and valid non-restricted license, certificate or 7 registration or, where no provision for a license, certificate or regis- 8 tration exists, is credentialed by the national accrediting body appro- 9 priate to the profession; [and] or 10 (iv) for purposes of a determination involving treatment for a mental 11 health condition: 12 (A) a physician who possesses a current and valid non-restricted 13 license to practice medicine and who specializes in behavioral health 14 and has experience in the delivery of mental health courses of treat- 15 ment; or 16 (B) a health care professional other than a licensed physician who 17 specializes in behavioral health and has experience in the delivery of a 18 mental health courses of treatment and, where applicable, possesses a 19 current and valid non-restricted license, certificate, or registration 20 or, where no provision for a license, certificate or registration 21 exists, is credentialed by the national accrediting body appropriate to 22 the profession; and 23 § 43. Paragraph (i) of subdivision 1 of section 4902 of the public 24 health law, as amended by section 2 of part A of chapter 69 of the laws 25 of 2016, is amended and a new paragraph (j) is added to read as follows: 26 (i) When conducting utilization review for purposes of determining 27 health care coverage for substance use disorder treatment, a utilization 28 review agent shall utilize an evidence-based and peer reviewed clinical 29 review [tools designated by the office of alcoholism and substance abuse30services that are appropriate to the age of the patient and consistent31with the treatment service levels within the office of alcoholism and32substance abuse services system] tool that is appropriate to the age of 33 the patient. When conducting such utilization review for treatment 34 provided in this state, a utilization review agent shall utilize an 35 evidence-based and peer reviewed clinical tool designated by the office 36 of alcoholism and substance abuse services that is consistent with the 37 treatment service levels within the office of alcoholism and substance 38 abuse services system. All approved tools shall have inter rater reli- 39 ability testing completed by December thirty-first, two thousand 40 sixteen. 41 (j) When conducting utilization review for purposes of determining 42 health care coverage for a mental health condition, a utilization review 43 agent shall utilize evidence-based and peer reviewed clinical review 44 criteria that is appropriate to the age of the patient. The utilization 45 review agent shall use clinical review criteria deemed appropriate and 46 approved for such use by the commissioner of the office of mental 47 health, in consultation with the commissioner and the superintendent of 48 financial services. Approved clinical review criteria shall have inter 49 rater reliability testing completed by December thirty-first, two thou- 50 sand nineteen. 51 § 44. This act shall take effect on the first of January next succeed- 52 ing the date on which it shall have become a law and shall apply to all 53 policies and contracts issued, renewed, modified, altered or amended on 54 or after such date; provided, however, notwithstanding any provision of 55 law to the contrary, nothing in this act shall limit the rights accruing 56 to employees pursuant to a collective bargaining agreement with anyS. 1507--A 150 A. 2007--A 1 state or local government employer for the unexpired term of such agree- 2 ment where such agreement is in effect on the effective date of this act 3 and so long as such agreement remains in effect thereafter or the eligi- 4 bility of any member of an employee organization to join a health insur- 5 ance plan open to him or her pursuant to such a collectively negotiated 6 agreement. 7 SUBPART B 8 Section 1. Subdivision 1 of section 2803-u of the public health law, 9 as added by section 1 of part C of chapter 70 of the laws of 2016, is 10 amended to read as follows: 11 1. The office of alcoholism and substance abuse services, in consulta- 12 tion with the department, shall develop or utilize existing educational 13 materials to be provided to general hospitals to disseminate to individ- 14 uals with a documented substance use disorder or who appear to have or 15 be at risk for a substance use disorder during discharge planning pursu- 16 ant to section twenty-eight hundred three-i of this [chapter] article. 17 Such materials shall include information regarding the various types of 18 treatment and recovery services, including but not limited to: inpa- 19 tient, outpatient, and medication-assisted treatment; how to recognize 20 the need for treatment services; information for individuals to deter- 21 mine what type and level of treatment is most appropriate and what 22 resources are available to them; and any other information the commis- 23 sioner deems appropriate. General hospitals shall include in their poli- 24 cies and procedures treatment protocols, consistent with medical stand- 25 ards, to be utilized by the emergency departments in general hospitals 26 for the appropriate use of medication-assisted treatment, including 27 buprenorphine, prior to discharge, or referral protocols for evaluation 28 of medication-assisted treatment when initiation in an emergency depart- 29 ment of a general hospital is not feasible. 30 § 2. This act shall take effect immediately. 31 SUBPART C 32 Section 1. Subparagraph (v) of paragraph (a) of subdivision 2 of 33 section 3343-a of the public health law is REPEALED and subparagraphs 34 (vi), (vii), (viii), (ix) and (x) are renumbered subparagraphs (v), 35 (vi), (vii), (viii) and (ix). 36 § 2. This act shall take effect immediately. 37 SUBPART D 38 Section 1. Paragraph (r) of subdivision 4 of section 364-j of the 39 social services law, as amended by section 39 of part A of chapter 56 of 40 the laws of 2013, is amended to read as follows: 41 (r) A managed care provider shall provide services to participants 42 pursuant to an order of a court of competent jurisdiction, provided 43 however, that such services shall be within such provider's or plan's 44 benefit package and are reimbursable under title xix of the federal 45 social security act, provided that services for a substance use disorder 46 shall be provided by a program licensed, certified or otherwise author- 47 ized by the office of alcoholism and substance abuse services. 48 § 2. This act shall take effect immediately; provided, however that 49 the amendments to paragraph (r) of subdivision 4 of section 364-j of theS. 1507--A 151 A. 2007--A 1 social services law made by section one of this act shall not affect the 2 repeal of such section and shall be deemed to be repealed therewith. 3 SUBPART E 4 Section 1. Subdivision (b) of schedule I of section 3306 of the public 5 health law is amended by adding nineteen new paragraphs 58, 59, 60, 61, 6 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 and 76 to read as 7 follows: 8 (58) N-(1-phenethylpiperidin-4-y1)-N-phenylbutyramide. Other name: 9 Butyryl Fentanyl. 10 (59) N-[1-[2-hydroxy-2-(thiophen-2-yl)ethyl]piperidin-4-y1]-N-phenylpro- 11 pionamide. Other name: Beta-Hydroxythiofentanyl. 12 (60) N-(1-phenethylpiperidin-4-y1)-N-phenylfuran-2-carboxamide. Other 13 name: Furanyl Fentanyl. 14 (61) 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide. 15 Other name: U-47700. 16 (62) N-(1-phenethylpiperidin-4-y1)-N-phenylacrylamide. Other names: 17 Acryl Fentanyl or Acryloylfentanyl. 18 (63) N-(4-fluoropheny1)-N-(1-phenethylpiperidin-4-yl)isobutyramide. 19 Other names: 4-fluoroisobutyryl fentanyl, para-fluoroisobutyryl fenta- 20 nyl. 21 (64) N-(2-fluoropheny1)-N-(1-phenethylpiperidin-4-yl)propionamide. 22 Other names: ortho-fluorofentanyl or 2-fluorofentanyl. 23 (65) N-(1-phenethylpiperidin-4-y1)-N-phenyltetrahydrofuran-2-carboxamide. 24 Other name: tetrahydrofuranyl fentanyl. 25 (66) 2-methoxy-N-(1-phenethylpiperidin-4-y1)-N-phenylacetamide. Other 26 name: methoxyacetyl fentanyl. 27 (67) N-(1-phenethylpiperidin-4-y1)-N-phenylcyclopropanecarboxamide. 28 Other name: cyclopropyl fentanyl. 29 (68) N-(1-phenethylpiperidin-4-y1)-N-phenylpentanamide. Other name: 30 Valeryl fentanyl. 31 (69) N-(4-fluoropheny1)-N-(1-phenethylpiperidin-4-yl)butyramide. Other 32 name: para-fluorobutyrylfentanyl. 33 (70) N-(4-methoxypheny1)-N-(1-phenethylpiperidin-4-yl)butyramide. 34 Other name: para-methoxybutyryl fentanyl. 35 (71) N-(4-chloropheny1)-N-(1-phenethylpiperidin-4-yl)isobutyramide. 36 Other name: para-chloroisobutyryl fentanyl. 37 (72) N-(1-phenethylpiperidin-4-y1)-N-phenylisobutyramide. Other name: 38 isobutyryl fentanyl. 39 (73) N-(1-phenethylpiperidin-4-y1)-N-phenylcyclopentanecarboxamide. 40 Other name: cyclopentyl fentanyl. 41 (74) N-(2-fluoropheny1)-2-methoxy-N-(1-phenethylpiperidin-4-yl) 42 acetamide. Other name: Ocfentanil. 43 (75) 1-cyclohexy1-4-(1,2-diphenylethyl)piperazine. Other name: MT-45. 44 (76) Fentanyl-related substances, their isomers, esters, ethers, salts 45 and salts of isomers, esters and ethers. 46 (i) Fentanyl-related substance means any substance not otherwise list- 47 ed in this section, that is structurally related to fentanyl by one or 48 more of the following modifications: 49 (A) Replacement of the phenyl portion of the phenethyl group by any 50 monocycle, whether or not further substituted in or on the monocycle; 51 (B) Substitution in or on the phenethyl group with alkyl, alkenyl, 52 alkoxyl, hydroxyl, halo, haloalkyl, amino or nitro groups; 53 (C) Substitution in or on the piperidine ring with alkyl, alkenyl, 54 alkoxyl, ester, ether, hydroxyl, halo, haloalkyl, amino or nitro groups;S. 1507--A 152 A. 2007--A 1 (D) Replacement of the aniline ring with any aromatic monocycle wheth- 2 er or not further substituted in or on the aromatic monocycle; and/or 3 (E) Replacement of the N-propionyl group by another acyl group. 4 § 2. Section 3308 of the public health law is amended by adding a new 5 subdivision 7 to read as follows: 6 7. The commissioner may, by regulation, classify as a Schedule I 7 controlled substance in section three thousand three hundred six of this 8 article any substance listed in Schedule I of the federal schedules of 9 controlled substances in 21 USC §812 or 21 CFR §1308.11. 10 § 3. This act shall take effect on the ninetieth day after it shall 11 have become a law. 12 § 2. Severability clause. If any clause, sentence, paragraph, subdivi- 13 sion, section or part of this act shall be adjudged by any court of 14 competent jurisdiction to be invalid, such judgment shall not affect, 15 impair, or invalidate the remainder thereof, but shall be confined in 16 its operation to the clause, sentence, paragraph, subdivision, section 17 or part thereof directly involved in the controversy in which such judg- 18 ment shall have been rendered. It has hereby declared to be the intent 19 of the legislature that this act would have been enacted even if such 20 invalid provisions had not been included herein. 21 § 3. This act shall take effect immediately provided, however, that 22 the applicable effective date of Subparts A through E of this act shall 23 be as specifically set forth in the last section of such Subparts. 24 PART CC 25 Section 1. The public health law is amended by adding a new section 26 280-d to read as follows: 27 § 280-d. Prescriber assistance. 1. Unlicensed assistants may be 28 employed in licensed pharmacies for purposes other than the practice of 29 pharmacy, including at least two unlicensed persons per pharmacist to 30 assist in the dispensing of drugs, provided, however, that a pharmacist 31 may obtain the assistance of up to four additional unlicensed persons 32 where such additional unlicensed persons are certified as pharmacy tech- 33 nicians by a nationally accredited pharmacy technician certification 34 program. Proof of certification for such individuals employed by a phar- 35 macy shall be maintained by the pharmacy and provided to state agencies 36 upon request. The department and state board of pharmacy shall consider 37 and may establish regulations permitting a pharmacist to obtain the 38 assistance of a greater number of unlicensed persons. 39 2. (a) The compounding, preparation, labeling, or dispensing of drugs, 40 in accordance with article one hundred thirty-seven of the education 41 law, in facilities licensed in accordance with article twenty-eight of 42 this chapter shall be performed by: (i) a licensed pharmacist, as 43 defined in article one hundred thirty-seven of the education law; (ii) a 44 pharmacy intern, under the direct supervision of a licensed pharmacist 45 as defined in article one hundred thirty-seven of the education law; or 46 (iii) under the direct supervision of a licensed pharmacist an individ- 47 ual who has received certification from a nationally accredited pharmacy 48 technician certification program may assist in the preparation and 49 dispensing of drugs including weighing, mixing, and measuring when prop- 50 erly trained. Proof of certification and training for such individuals 51 employed by a facility shall be maintained by the facility and provided 52 to state agencies upon request. 53 (b) A person employed in a facility licensed in accordance with arti- 54 cle twenty-eight of this chapter who directly assists licensed pharma-S. 1507--A 153 A. 2007--A 1 cists to dispense prescriptions in such facility on the effective date 2 of this section shall be exempt from the certification requirement in 3 paragraph (a) of this subdivision if he or she submits evidence to, and 4 verified by, his or her employer, of a minimum of five (5) years of 5 employment in good standing in a pharmacy within the previous eight (8) 6 years, including eighteen consecutive months with a single employer. 7 Such evidence and verification shall be documented and maintained by the 8 facility and provided to state agencies upon request. Such individual 9 shall not be permitted to assist in the compounding of medications. 10 § 2. This act shall take effect immediately. 11 PART DD 12 Section 1. (a) Notwithstanding any other provision of law to the 13 contrary, for the state fiscal years beginning April 1, 2019 and ending 14 on March 31, 2021, all Medicaid payments made for services provided on 15 and after April 1, 2019, shall, except as hereinafter provided, be 16 subject to a uniform reduction and such reduction shall be applied, to 17 the extent practicable, in equal amounts during the fiscal year, 18 provided, however, that an alternative method may be considered at the 19 discretion of the commissioner of health and the director of the budget 20 based upon consultation with the health care industry including but not 21 limited to, a uniform reduction in Medicaid rates of payments or other 22 reductions provided that any method selected achieves up to $190,200,000 23 in Medicaid state share savings in state fiscal year 2019-2020 and up to 24 $190,200,000 in state fiscal year 2020-2021, except as hereinafter 25 provided, for services provided on and after April 1, 2019 through March 26 31, 2021. Any alternative methods to achieve the reduction must be 27 provided in writing and shall be filed with the senate finance committee 28 and the assembly ways and means committee not less than thirty days 29 before the date on which implementation is expected to begin. Nothing in 30 this section shall be deemed to prevent all or part of such alternative 31 reduction plan from taking effect retroactively, to the extent permitted 32 by the federal centers for medicare and Medicaid services. 33 (b) The following types of appropriations shall be exempt from 34 reductions pursuant to this section: 35 (i) any reductions that would violate federal law including, but not 36 limited to, payments required pursuant to the federal medicare program; 37 (ii) any reductions related to direct payments pursuant to article 32, 38 article 31 and article 16 of the mental hygiene law; 39 (iii) payments the state is obligated to make pursuant to court orders 40 or judgments; 41 (iv) payments for which the non-federal share does not reflect any 42 state funding; and 43 (v) at the discretion of the commissioner of health and the director 44 of the budget, payments with regard to which it is determined by the 45 commissioner of health and the director of the budget that application 46 of reductions pursuant to this section would result, by operation of 47 federal law, in a lower federal medical assistance percentage applicable 48 to such payments. 49 (c) Reductions to Medicaid payments or Medicaid rates of payments made 50 pursuant to this section shall be subject to the receipt of all neces- 51 sary federal approvals. 52 § 2. This act shall take effect immediately. 53 § 2. Severability clause. If any clause, sentence, paragraph, subdivi- 54 sion, section or part of this act shall be adjudged by any court ofS. 1507--A 154 A. 2007--A 1 competent jurisdiction to be invalid, such judgment shall not affect, 2 impair, or invalidate the remainder thereof, but shall be confined in 3 its operation to the clause, sentence, paragraph, subdivision, section 4 or part thereof directly involved in the controversy in which such judg- 5 ment shall have been rendered. It is hereby declared to be the intent of 6 the legislature that this act would have been enacted even if such 7 invalid provisions had not been included herein. 8 § 3. This act shall take effect immediately provided, however, that 9 the applicable effective date of Parts A through DD of this act shall be 10 as specifically set forth in the last section of such Parts.
