STATE OF NEW YORK
________________________________________________________________________
6450--A
2023-2024 Regular Sessions
IN ASSEMBLY
April 11, 2023
___________
Introduced by M. of A. KIM, DICKENS, GIBBS, McDONALD -- Multi-Sponsored
by -- M. of A. COOK -- read once and referred to the Committee on
Aging -- recommitted to the Committee on Aging in accordance with
Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the elder law, in relation to improving and expanding
the pharmaceutical insurance coverage program for certain medicare
enrollees
The People of the State of New York, represented in Senate and Assem-
bly, do enact as follows:
1 Section 1. Section 240 of the elder law is amended to read as follows:
2 § 240. Short title. This title shall be known and may be cited as the
3 "program for [elderly] expanded pharmaceutical insurance coverage".
4 § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
5 8 as added by section 2 of part A of chapter 59 of the laws of 2011 and
6 as renumbered by section 3 of part T of chapter 56 of the laws of 2012,
7 are amended to read as follows:
8 3. "Income" shall mean "household gross income" as defined in the real
9 property tax circuit breaker credit program, pursuant to subparagraph
10 (C) of paragraph one of subsection (e) of section six hundred six of the
11 tax law, but only shall include the income of program applicants and
12 spouses and shall exclude the income of other members of the household,
13 but shall not include any increase in income derived from social securi-
14 ty income or pension benefits that increase over the previous year due
15 solely to a cost-of-living adjustment provided by the program adminis-
16 trators.
17 8. "Medicare part D excluded drug classes" shall mean any drugs or
18 classes of drugs, or their medical uses, which are described in section
19 1927(d)(2) or 1927(d)(3) of the federal social security act, with the
20 exception of smoking cessation agents and medical marijuana dispensed in
21 the state of New York.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01416-03-4
A. 6450--A 2
1 § 3. The elder law is amended by adding a new section 242-a to read as
2 follows:
3 § 242-a. Expanded pharmaceutical insurance coverage panel. 1. There
4 is hereby established within the executive department, a panel to be
5 known as the "expanded pharmaceutical insurance coverage panel". For the
6 purposes of this section, the term "the panel" shall mean the expanded
7 pharmaceutical insurance coverage panel.
8 2. The panel shall consist of the commissioners of the departments of
9 education and health, the superintendent of the department of financial
10 services, and the directors of the office for the aging and the division
11 of the budget. Each panel member may designate an officer of his or her
12 respective department, office, or division to represent and exercise all
13 the powers of such panel member at any meeting of the panel from which
14 such panel member may be absent.
15 3. The director of the office for the aging and the commissioner of
16 health shall serve as co-chairs of the panel.
17 4. The panel shall meet at such times as may be requested by the
18 co-chairs, provided that the panel shall meet at least two times a year.
19 5. The panel shall:
20 (a) subject to the approval of the director of the budget, promulgate
21 program regulations pursuant to section two hundred forty-six of this
22 title;
23 (b) determine the annual schedule of cost-sharing responsibilities of
24 eligible program participants pursuant to sections two hundred forty-
25 seven and two hundred forty-eight of this title;
26 (c) enter into contracts pursuant to section two hundred forty-three
27 of this title;
28 (d) recommend and implement alternative program improvements for the
29 efficient and effective operation of the program in accordance with the
30 provisions of this title with the advice of the advisory committee as
31 defined in subdivision seven of this section;
32 (e) develop and implement, in cooperation with area offices for the
33 aging, an outreach program to inform eligible applicants of benefits
34 they may be entitled to pursuant to this title, and to make available
35 information concerning the program for expanded pharmaceutical insurance
36 coverage and benefits to which they may be entitled through a
37 prescription drug coverage program funded by the federal government; and
38 (f) prepare an annual report and submit such report to the governor,
39 the temporary president of the senate, and the speaker of the assembly
40 no later than the first day of January of each year. The panel shall
41 include in such report, at a minimum, annual statistical information
42 regarding the number of persons enrolled in the program by marital
43 status and income level and age, an estimate of the per cent of eligible
44 New York residents that are enrolled, the total number of enrollees that
45 receive an income-related subsidy under section 1860D-14 of the federal
46 social security act, and the number that so qualify through their
47 enrollment in the medicare savings program, the numbers of participating
48 provider pharmacies, recipients and payments by county, a summary of the
49 administrative cost containment initiatives completed during the year,
50 projections of program costs for the following two years, and an evalu-
51 ation of the performance of the program contractor or contractors and of
52 the cost effectiveness of all outreach efforts.
53 6. The panel members shall receive no compensation for their services
54 as panel members.
55 7. There shall be an advisory committee to the panel comprised of
56 twelve persons. Four members shall be appointed by the governor, three
A. 6450--A 3
1 members shall be appointed by the temporary president of the senate, one
2 member shall be appointed by the minority leader of the senate, three
3 members shall be appointed by the speaker of the assembly and one member
4 shall be appointed by the minority leader of the assembly. The commit-
5 tee members shall be representatives of consumers, pharmacists, pharma-
6 ceutical drug manufacturers and pharmaceutical wholesalers. No less than
7 sixty percent of the committee membership shall represent consumers.
8 Committee members shall receive no compensation for their services but
9 shall be allowed their actual and necessary expenses incurred in the
10 performance of their duties.
11 § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
12 1 as amended by section 4 of part T of chapter 56 of the laws of 2012,
13 and subdivision 2 as amended by section 12 of part A of chapter 60 of
14 the laws of 2014, are amended to read as follows:
15 1. Persons eligible for comprehensive coverage under section two
16 hundred forty-seven of this title shall include:
17 (a) any unmarried resident who is enrolled in medicare and at least
18 sixty-five years of age in the year two thousand twenty-three, during
19 the year two thousand twenty-four is at least sixty years of age, during
20 the year two thousand twenty-five is at least fifty-five years of age,
21 during the year two thousand twenty-six is at least fifty years of age,
22 during the year two thousand twenty-seven is at least forty-five years
23 of age, during the year two thousand twenty-eight is at least forty
24 years of age, during the year two thousand twenty-nine is at least thir-
25 ty-five years of age, during the year two thousand thirty is at least
26 thirty years of age, during the year two thousand thirty-one is at least
27 twenty-five years of age, or during the year two thousand thirty-two is
28 at least eighteen years of age; and whose income for the calendar year
29 immediately preceding the effective date of the annual coverage period
30 beginning on or after January first, two thousand five, is less than or
31 equal to twenty thousand dollars. After the initial determination of
32 eligibility, each eligible individual must be redetermined eligible at
33 least every twenty-four months; and
34 (b) any married resident who is enrolled in medicare and is at least
35 sixty-five years of age in the year two thousand twenty-three, during
36 the year two thousand twenty-four is at least sixty years of age, during
37 the year two thousand twenty-five is at least fifty-five years of age,
38 during the year two thousand twenty-six is at least fifty years of age,
39 during the year two thousand twenty-seven is at least forty-five years
40 of age, during the year two thousand twenty-eight is at least forty
41 years of age, during the year two thousand twenty-nine is at least thir-
42 ty-five years of age, during the year two thousand thirty is at least
43 thirty years of age, during the year two thousand thirty-one is at least
44 twenty-five years of age, or during the year two thousand thirty-two is
45 at least eighteen years of age; and whose income for the calendar year
46 immediately preceding the effective date of the annual coverage period
47 when combined with the income in the same calendar year of such married
48 person's spouse beginning on or after January first, two thousand one,
49 is less than or equal to twenty-six thousand dollars. After the initial
50 determination of eligibility, each eligible individual must be redeter-
51 mined eligible at least every twenty-four months.
52 2. Persons eligible for catastrophic coverage under section two
53 hundred forty-eight of this title shall include:
54 (a) any unmarried resident who is enrolled in medicare and at least
55 sixty-five years of age in the year two thousand twenty-three, during
56 the year two thousand twenty-four is at least sixty years of age, during
A. 6450--A 4
1 the year two thousand twenty-five is at least fifty-five years of age,
2 during the year two thousand twenty-six is at least fifty years of age,
3 during the year two thousand twenty-seven is at least forty-five years
4 of age, during the year two thousand twenty-eight is at least forty
5 years of age, during the year two thousand twenty-nine is at least thir-
6 ty-five years of age, during the year two thousand thirty is at least
7 thirty years of age, during the year two thousand thirty-one is at least
8 twenty-five years of age, or during the year two thousand thirty-two is
9 at least eighteen years of age; and whose income for the calendar year
10 immediately preceding the effective date of the annual coverage period
11 beginning on or after January first, two thousand one, is more than
12 twenty thousand and less than or equal to seventy-five thousand dollars.
13 After the initial determination of eligibility, each eligible individual
14 must be redetermined eligible at least every twenty-four months; and
15 (b) any married resident who is enrolled in medicare and at least
16 sixty-five years of age in the year two thousand twenty-three, during
17 the year two thousand twenty-four is at least sixty years of age, during
18 the year two thousand twenty-five is at least fifty-five years of age,
19 during the year two thousand twenty-six is at least fifty years of age,
20 during the year two thousand twenty-seven is at least forty-five years
21 of age, during the year two thousand twenty-eight is at least forty
22 years of age, during the year two thousand twenty-nine is at least thir-
23 ty-five years of age, during the year two thousand thirty is at least
24 thirty years of age, during the year two thousand thirty-one is at least
25 twenty-five years of age, or during the year two thousand thirty-two is
26 at least eighteen years of age; and whose income for the calendar year
27 immediately preceding the effective date of the annual coverage period
28 when combined with the income in the same calendar year of such married
29 person's spouse beginning on or after January first, two thousand one,
30 is more than twenty-six thousand dollars and less than or equal to one
31 hundred thousand dollars. After the initial determination of eligibil-
32 ity, each eligible individual must be redetermined eligible at least
33 every twenty-four months.
34 § 5. Paragraphs (e) and (f) of subdivision 3 of section 242 of the
35 elder law, paragraph (e) as amended by section 3-d of part A of chapter
36 59 of the laws of 2011, and paragraph (f) as amended by section 1 of
37 part T of chapter 56 of the laws of 2012, are amended to read as
38 follows:
39 (e) As a condition of eligibility for benefits under this title, if a
40 program participant's income indicates that the participant could be
41 eligible for an income-related subsidy under section 1860D-14 of the
42 federal social security act by either applying for such subsidy or by
43 enrolling in a medicare savings program as a qualified medicare benefi-
44 ciary (QMB), a specified low-income medicare beneficiary (SLMB), or a
45 qualifying individual (QI), a program participant is required to
46 provide, and to authorize the [elderly] expanded pharmaceutical insur-
47 ance coverage program to obtain, any information or documentation
48 required to establish the participant's eligibility for such subsidy,
49 and to authorize the [elderly] expanded pharmaceutical insurance cover-
50 age program to apply on behalf of the participant for the subsidy or the
51 medicare savings program. [The elderly] Upon receipt of an enrollment
52 application, or at any time after enrollment when the program has infor-
53 mation that indicates an enrollee is eligible for a subsidy under
54 section 1860D-14 of the federal social security act or in a medicare
55 savings program, the expanded pharmaceutical insurance coverage program
56 shall make a reasonable effort to notify the program participant of his
A. 6450--A 5
1 or her need to provide any of the above required information. After a
2 reasonable effort has been made to contact the participant, a partic-
3 ipant shall be notified in writing that he or she has sixty days to
4 provide such required information. If such information is not provided
5 within the sixty day period, the participant's coverage may be termi-
6 nated. A program participant who is eligible to enroll in the medicare
7 savings program shall be assisted to do so, and their expanded pharma-
8 ceutical insurance coverage program enrollment shall be in place
9 throughout the medicare savings program application process.
10 (f) As a condition of eligibility for benefits under this title, a
11 program participant is required to be enrolled in Medicare part D and to
12 maintain such enrollment. For unmarried participants with individual
13 annual income less than or equal to twenty-three thousand dollars and
14 married participants with joint annual income less than or equal to
15 twenty-nine thousand dollars, the [elderly] expanded pharmaceutical
16 insurance coverage program shall pay for the portion of the part D
17 monthly premium, and any late enrollment penalty that may have been
18 assessed, that is the responsibility of the participant. Such total
19 payment shall be limited to the low-income benchmark premium amount
20 established by the federal centers for medicare and medicaid services
21 and any other amount which such agency establishes under its de minimus
22 premium policy.
23 § 6. Subdivision 3 of section 250 of the elder law is amended by
24 adding a new paragraph (f) to read as follows:
25 (f) The expanded pharmaceutical insurance coverage program shall post
26 to its website the names of manufacturers that have a rebate program and
27 list the drugs that are covered by such rebate program in a manner that
28 provides enrollees with access to such information prior to the annual
29 medicare open enrollment period.
30 § 7. This act shall take effect immediately.