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. LBD08041-01-1S. 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, threeS. 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, duringS. 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.
