Bill Text: NY S04603 | 2021-2022 | General Assembly | Introduced


Bill Title: Relates to improving and expanding the pharmaceutical insurance coverage program for certain medicare enrollees; creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2022-01-05 - REFERRED TO AGING [S04603 Detail]

Download: New_York-2021-S04603-Introduced.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                          4603

                               2021-2022 Regular Sessions

                    IN SENATE

                                    February 5, 2021
                                       ___________

        Introduced  by  Sen.  MAY  --  read  twice and ordered printed, and when
          printed to be committed to the Committee on Aging

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

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Section  240  of  the  elder  law,  is amended to read as
     2  follows:
     3    § 240. Short title. This title shall be known and may be cited as  the
     4  "program for [elderly] expanded pharmaceutical insurance coverage".
     5    § 2. Subdivisions 3 and 8 of section 241 of the elder law, subdivision
     6  8  as added by section 2 of part A of chapter 59 of the laws of 2011 and
     7  as renumbered by section 3 of part T of chapter 56 of the laws of  2012,
     8  are amended to read as follows:
     9    3. "Income" shall mean "household gross income" as defined in the real
    10  property  tax  circuit  breaker credit program, pursuant to subparagraph
    11  (C) of paragraph one of subsection (e) of section six hundred six of the
    12  tax law, but only shall include the income  of  program  applicants  and
    13  spouses  and shall exclude the income of other members of the household,
    14  but shall not include any increase in income derived from social securi-
    15  ty income or pension benefits that increase over the previous  year  due
    16  solely  to  a cost of living adjustment provided by the program adminis-
    17  trators.
    18    8. "Medicare part D excluded drug classes" shall  mean  any  drugs  or
    19  classes  of drugs, or their medical uses, which are described in section
    20  1927(d)(2) or 1927(d)(3) of the federal social security  act,  with  the
    21  exception of smoking cessation agents and medical marijuana dispensed in
    22  the state of New York.
    23    § 3. The elder law is amended by adding a new section 242-a to read as
    24  follows:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08041-01-1

        S. 4603                             2

     1    §  242-a.  Expanded pharmaceutical insurance coverage panel.  1. There
     2  is hereby established within the executive department,  a  panel  to  be
     3  known as the "expanded pharmaceutical insurance coverage panel". For the
     4  purposes  of  this section, the term "the panel" shall mean the expanded
     5  pharmaceutical insurance coverage panel.
     6    2.  The panel shall consist of the commissioners of the departments of
     7  education and health, the superintendent of the department of  financial
     8  services, and the directors of the office for the aging and the division
     9  of  the budget. Each panel member may designate an officer of his or her
    10  respective department, office, or division to represent and exercise all
    11  the powers of such panel member at any meeting of the panel  from  which
    12  such panel member may be absent.
    13    3.  The  director  of the office for the aging and the commissioner of
    14  health shall serve as co-chairs of the panel.
    15    4. The panel shall meet at such times  as  may  be  requested  by  the
    16  co-chairs, provided that the panel shall meet at least two times a year.
    17    5. The panel shall:
    18    (a)  subject to the approval of the director of the budget, promulgate
    19  program regulations pursuant to section two hundred  forty-six  of  this
    20  title;
    21    (b)  determine the annual schedule of cost-sharing responsibilities of
    22  eligible program participants pursuant to sections  two  hundred  forty-
    23  seven and two hundred forty-eight of this title;
    24    (c)  enter  into contracts pursuant to section two hundred forty-three
    25  of this title;
    26    (d) recommend and implement alternative program improvements  for  the
    27  efficient  and effective operation of the program in accordance with the
    28  provisions of this title with the advice of the  advisory  committee  as
    29  defined in subdivision seven of this section;
    30    (e)  develop  and  implement, in cooperation with area offices for the
    31  aging, an outreach program to inform  eligible  applicants  of  benefits
    32  they  may  be  entitled to pursuant to this title, and to make available
    33  information concerning the program for expanded pharmaceutical insurance
    34  coverage  and  benefits  to  which  they  may  be  entitled  through   a
    35  prescription drug coverage program funded by the federal government; and
    36    (f)  prepare  an annual report and submit such report to the governor,
    37  the temporary president of the senate, and the speaker of  the  assembly
    38  no  later  than  the  first day of January of each year. The panel shall
    39  include in such report, at a  minimum,  annual  statistical  information
    40  regarding  the  number  of  persons  enrolled  in the program by marital
    41  status and income level and age, an estimate of the per cent of eligible
    42  New York residents that are enrolled, the total number of enrollees that
    43  receive an income-related subsidy under section 1860D-14 of the  federal
    44  social  security  act,  and  the  number  that  so qualify through their
    45  enrollment in the Medicare Savings Program, the numbers of participating
    46  provider pharmacies, recipients and payments by county, a summary of the
    47  administrative cost containment initiatives completed during  the  year,
    48  projections  of program costs for the following two years, and an evalu-
    49  ation of the performance of the program contractor or contractors and of
    50  the cost effectiveness of all outreach efforts.
    51    6. The panel members shall receive no compensation for their  services
    52  as panel members.
    53    7.  There  shall  be  an  advisory committee to the panel comprised of
    54  twelve persons.  Four members shall be appointed by the governor,  three
    55  members shall be appointed by the temporary president of the senate, one
    56  member  shall  be  appointed by the minority leader of the senate, three

        S. 4603                             3

     1  members shall be appointed by the speaker of the assembly and one member
     2  shall be appointed by the minority leader of the assembly.  The  commit-
     3  tee  members shall be representatives of consumers, pharmacists, pharma-
     4  ceutical drug manufacturers and pharmaceutical wholesalers. No less than
     5  sixty  percent  of  the  committee membership shall represent consumers.
     6  Committee members shall receive no compensation for their  services  but
     7  shall  be  allowed  their  actual and necessary expenses incurred in the
     8  performance of their duties.
     9    § 4. Subdivisions 1 and 2 of section 242 of the elder law, subdivision
    10  1 as amended by section 4 of part T of chapter 56 of the laws  of  2012,
    11  and  subdivision  2  as amended by section 12 of part A of chapter 60 of
    12  the laws of 2014, are amended to read as follows:
    13    1. Persons eligible  for  comprehensive  coverage  under  section  two
    14  hundred forty-seven of this title shall include:
    15    (a)  any  unmarried  resident who is enrolled in medicare and at least
    16  sixty-five years of age in the year two thousand twenty, during the year
    17  two thousand twenty-one is at least sixty years of age, during the  year
    18  two  thousand twenty-two is at least fifty-five years of age, during the
    19  year two thousand twenty-three is at least fifty years  of  age,  during
    20  the  year  two thousand twenty-four is at least forty-five years of age,
    21  during the year two thousand twenty-five is at least forty years of age,
    22  during the year two thousand twenty-six is at least thirty-five years of
    23  age, during the year two thousand twenty-seven is at least thirty  years
    24  of  age,  during  the year two thousand twenty-eight is at least twenty-
    25  five years of age, or during the year two  thousand  twenty-nine  is  at
    26  least  eighteen  years  of  age;  and whose income for the calendar year
    27  immediately preceding the effective date of the annual  coverage  period
    28  beginning  on or after January first, two thousand five, is less than or
    29  equal to twenty thousand dollars.   After the initial  determination  of
    30  eligibility,  each  eligible individual must be redetermined eligible at
    31  least every twenty-four months; and
    32    (b) any married resident who is enrolled in medicare and is  at  least
    33  sixty-five years of age in the year two thousand twenty, during the year
    34  two  thousand twenty-one is at least sixty years of age, during the year
    35  two thousand twenty-two is at least fifty-five years of age, during  the
    36  year  two  thousand  twenty-three is at least fifty years of age, during
    37  the year two thousand twenty-four is at least forty-five years  of  age,
    38  during the year two thousand twenty-five is at least forty years of age,
    39  during the year two thousand twenty-six is at least thirty-five years of
    40  age,  during the year two thousand twenty-seven is at least thirty years
    41  of age, during the year two thousand twenty-eight is  at  least  twenty-
    42  five  years  of  age,  or during the year two thousand twenty-nine is at
    43  least eighteen years of age; and whose  income  for  the  calendar  year
    44  immediately  preceding  the effective date of the annual coverage period
    45  when combined with the income in the same calendar year of such  married
    46  person's  spouse  beginning on or after January first, two thousand one,
    47  is less than or equal to twenty-six thousand dollars. After the  initial
    48  determination  of eligibility, each eligible individual must be redeter-
    49  mined eligible at least every twenty-four months.
    50    2. Persons  eligible  for  catastrophic  coverage  under  section  two
    51  hundred forty-eight of this title shall include:
    52    (a)  any  unmarried  resident who is enrolled in medicare and at least
    53  sixty-five years of age in the year two thousand twenty, during the year
    54  two thousand twenty-one is at least sixty years of age, during the  year
    55  two  thousand twenty-two is at least fifty-five years of age, during the
    56  year two thousand twenty-three is at least fifty years  of  age,  during

        S. 4603                             4

     1  the  year  two thousand twenty-four is at least forty-five years of age,
     2  during the year two thousand twenty-five is at least forty years of age,
     3  during the year two thousand twenty-six is at least thirty-five years of
     4  age,  during the year two thousand twenty-seven is at least thirty years
     5  of age, during the year two thousand twenty-eight is  at  least  twenty-
     6  five  years  of  age,  or during the year two thousand twenty-nine is at
     7  least eighteen years of age; and whose  income  for  the  calendar  year
     8  immediately  preceding  the effective date of the annual coverage period
     9  beginning on or after January first, two  thousand  one,  is  more  than
    10  twenty thousand and less than or equal to seventy-five thousand dollars.
    11  After the initial determination of eligibility, each eligible individual
    12  must be redetermined eligible at least every twenty-four months; and
    13    (b)  any  married  resident  who  is enrolled in medicare and at least
    14  sixty-five years of age in the year two thousand twenty, during the year
    15  two thousand twenty-one is at least sixty years of age, during the  year
    16  two  thousand twenty-two is at least fifty-five years of age, during the
    17  year two thousand twenty-three is at least fifty years  of  age,  during
    18  the  year  two thousand twenty-four is at least forty-five years of age,
    19  during the year two thousand twenty-five is at least forty years of age,
    20  during the year two thousand twenty-six is at least thirty-five years of
    21  age, during the year two thousand twenty-seven is at least thirty  years
    22  of  age,  during  the year two thousand twenty-eight is at least twenty-
    23  five years of age, or during the year two  thousand  twenty-nine  is  at
    24  least  eighteen  years  of  age;  and whose income for the calendar year
    25  immediately preceding the effective date of the annual  coverage  period
    26  when  combined with the income in the same calendar year of such married
    27  person's spouse beginning on or after January first, two  thousand  one,
    28  is  more  than twenty-six thousand dollars and less than or equal to one
    29  hundred thousand dollars. After the initial determination  of  eligibil-
    30  ity,  each  eligible  individual  must be redetermined eligible at least
    31  every twenty-four months.
    32    § 5. Paragraphs (e) and (f) of subdivision 3 of  section  242  of  the
    33  elder  law, paragraph (e) as amended by section 3-d of part A of chapter
    34  59 of the laws of 2011, and paragraph (f) as amended  by  section  1  of
    35  part  T  of  chapter  56  of  the  laws  of 2012, are amended to read as
    36  follows:
    37    (e) As a condition of eligibility for benefits under this title, if  a
    38  program  participant's  income  indicates  that the participant could be
    39  eligible for an income-related subsidy under  section  1860D-14  of  the
    40  federal  social  security  act by either applying for such subsidy or by
    41  enrolling in a medicare savings program as a qualified medicare  benefi-
    42  ciary  (QMB),  a  specified low-income medicare beneficiary (SLMB), or a
    43  qualifying  individual  (QI),  a  program  participant  is  required  to
    44  provide,  and  to authorize the [elderly] expanded pharmaceutical insur-
    45  ance coverage  program  to  obtain,  any  information  or  documentation
    46  required  to  establish  the participant's eligibility for such subsidy,
    47  and to authorize the [elderly] expanded pharmaceutical insurance  cover-
    48  age program to apply on behalf of the participant for the subsidy or the
    49  medicare  savings  program.  [The elderly] Upon receipt of an enrollment
    50  application, or at any time after enrollment when the program has infor-
    51  mation that indicates an  enrollee  is  eligible  for  a  subsidy  under
    52  section  1860D-14  of  the  federal social security act or in a medicare
    53  savings program, the expanded pharmaceutical insurance coverage  program
    54  shall  make a reasonable effort to notify the program participant of his
    55  or her need to provide any of the above required  information.  After  a
    56  reasonable  effort  has  been made to contact the participant, a partic-

        S. 4603                             5

     1  ipant shall be notified in writing that he or  she  has  sixty  days  to
     2  provide  such  required information. If such information is not provided
     3  within the sixty day period, the participant's coverage  may  be  termi-
     4  nated.   A program participant who is eligible to enroll in the medicare
     5  savings program shall be assisted to do so, and their  expanded  pharma-
     6  ceutical  insurance  coverage  program  enrollment  shall  be  in  place
     7  throughout the medicare savings program application process.
     8    (f) As a condition of eligibility for benefits  under  this  title,  a
     9  program participant is required to be enrolled in Medicare part D and to
    10  maintain  such  enrollment.  For  unmarried participants with individual
    11  annual income less than or equal to twenty-three  thousand  dollars  and
    12  married  participants  with  joint  annual  income less than or equal to
    13  twenty-nine thousand  dollars,  the  [elderly]  expanded  pharmaceutical
    14  insurance  coverage  program  shall  pay  for  the portion of the part D
    15  monthly premium, and any late enrollment  penalty  that  may  have  been
    16  assessed,  that  is  the  responsibility  of the participant. Such total
    17  payment shall be limited to  the  low-income  benchmark  premium  amount
    18  established  by  the  federal centers for medicare and medicaid services
    19  and any other amount which such agency establishes under its de  minimus
    20  premium policy.
    21    §  6.  Subdivision  3  of  section  250 of the elder law is amended by
    22  adding a new paragraph (f) to read as follows:
    23    (f) The expanded pharmaceutical insurance coverage program shall  post
    24  to its website the names of manufacturers that have a rebate program and
    25  list  the drugs that are covered by such rebate program in a manner that
    26  provides enrollees with access to such information prior to  the  annual
    27  medicare open enrollment period.
    28    § 7. This act shall take effect immediately.
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