N.Y. SOS Law § 365-A — New York Code / Act SOS / Article 5 / Title 11 / Section 365-A
Character and adequacy of assistance
Status: in_force

§ 365-a. Character and adequacy of assistance. The amount, nature and\nmanner of providing medical assistance for needy persons shall be\ndetermined by the public welfare official with the advice of a physician\nand in accordance with the local medical plan, this title, and the\nregulations of the department.\n  1. "Benchmark coverage" shall mean payment of part or all of the cost\nof medically necessary medical, dental, and remedial care, services, and\nsupplies described in subdivision two of this section, and to the extent\nnot included therein, any essential benefits as defined in 42 U.S.C.\n18022(b), with the exception of institutional long term care services;\nsuch care, services and supplies shall be provided consistent with the\nmanaged care program described in section three hundred sixty-four-j of\nthis title.\n  2. "Standard coverage" shall mean payment of part or all of the cost\nof medically necessary medical, dental and remedial care, services and\nsupplies, as authorized in this title or the regulations of the\ndepartment, which are necessary to prevent, diagnose, correct or cure\nconditions in the person that cause acute suffering, endanger life,\nresult in illness or infirmity, interfere with such person's capacity\nfor normal activity, or threaten some significant handicap and which are\nfurnished an eligible person in accordance with this title and the\nregulations of the department. Such care, services and supplies shall\ninclude the following medical care, services and supplies, together with\nsuch medical care, services and supplies provided for in subdivisions\nthree, four and five of this section, and such medical care, services\nand supplies as are authorized in the regulations of the department:\n  (a) services of qualified physicians, dentists, nurses, and private\nduty nursing services shall be further subject to the provisions of\nsection three hundred sixty-seven-o of this chapter, optometrists, and\nother related professional personnel;\n  (b) care, treatment, maintenance and nursing services in hospitals,\nnursing homes that qualify as providers in the medicare program pursuant\nto title XVIII of the federal social security act, infirmaries or other\neligible medical institutions, and health-related care and services in\nintermediate care facilities, while operated in compliance with\napplicable provisions of this chapter, the public health law, the mental\nhygiene law and other laws, including any provision thereof requiring an\noperating certificate or license, or where such facilities are not\nconveniently accessible, in hospitals located without the state;\nprovided, however, that care, treatment, maintenance and nursing\nservices in nursing homes or in intermediate care facilities, including\nthose operated by the state department of mental hygiene or any other\nstate department or agency, shall, for persons who are receiving or who\nare eligible for medical assistance under provisions of subparagraph\nfour of paragraph (a) of subdivision one of section three hundred\nsixty-six of this chapter, be limited to such periods of time as may be\ndetermined necessary in accordance with a utilization review procedure\nestablished by the state commissioner of health providing for a review\nof medical necessity, in the case of skilled nursing care, every thirty\ndays for the first ninety days and every ninety days thereafter, and in\nthe case of care in an intermediate care facility, at least every six\nmonths, or more frequently if indicated at the time of the last review,\nconsistent with federal utilization review requirements; provided,\nfurther, that in-patient care, services and supplies in a general\nhospital shall not exceed such standards as the commissioner of health\nshall promulgate but in no case greater than twenty days per spell of\nillness during which all or any part of the cost of such care, services\nand supplies are claimed as an item of medical assistance, unless it\nshall have been determined in accordance with procedures and criteria\nestablished by such commissioner that a further identifiable period of\nin-patient general hospital care is required for particular patients to\npreserve life or to prevent substantial risks of continuing disability;\nprovided further, that in-patient care, services and supplies in a\ngeneral hospital shall, in the case of a person admitted to such a\nfacility on a Friday or Saturday, be deemed to include only those\nin-patient days beginning with and following the Sunday after such date\nof admission, unless such care, services and supplies are furnished for\nan actual medical emergency or pre-operative care for surgery as\nprovided in paragraph (d) of subdivision five of this section, or are\nfurnished because of the necessity of emergency or urgent surgery for\nthe alleviation of severe pain or the necessity for immediate diagnosis\nor treatment of conditions which threaten disability or death if not\npromptly diagnosed or treated; provided, however, in-patient days of a\ngeneral hospital admission beginning on a Friday or a Saturday shall be\nincluded commencing with the day of admission in a general hospital\nwhich the commissioner or his designee has found to be rendering and\nwhich continues to render full service on a seven day a week basis which\ndetermination shall be made after taking into consideration such factors\nas the routine availability of operating room services, diagnostic\nservices and consultants, laboratory services, radiological services,\npharmacy services, staff patterns consistent with full services and such\nother factors as the commissioner or his designee deems necessary and\nappropriate; provided, further, that in-patient care, services and\nsupplies in a general hospital shall not include care, services and\nsupplies furnished to patients for certain uncomplicated procedures\nwhich may be performed on an out-patient basis in accordance with\nregulations of the commissioner of health, unless the person or body\ndesignated by such commissioner determines that the medical condition of\nthe individual patient requires that the procedure be performed on an\nin-patient basis;\n  (c) out-patient hospital or clinic services in facilities operated in\ncompliance with applicable provisions of this chapter, the public health\nlaw, the mental hygiene law and other laws, including any provisions\nthereof requiring an operating certificate or license, including\nfacilities authorized by the appropriate licensing authority to provide\nintegrated mental health services, and/or alcoholism and substance abuse\nservices, and/or physical health services, and/or services to persons\nwith developmental disabilities, when such services are provided at a\nsingle location or service site, or where such facilities are not\nconveniently accessible, in any hospital located within the state and\ncare and services in a day treatment program operated by the department\nof mental hygiene or by a voluntary agency under an agreement with such\ndepartment in that part of a public institution operated and approved\npursuant to law as an intermediate care facility for persons with\ndevelopmental disabilities; and provided, that the commissioners of\nhealth, mental health, alcoholism and substance abuse services and the\noffice for people with developmental disabilities may issue regulations,\nincluding emergency regulations promulgated prior to October first, two\nthousand fifteen that are required to facilitate the establishment of\nintegrated services clinics. Any such regulations promulgated under this\nparagraph shall be described in the annual report required pursuant to\nsection forty-five-c of part A of chapter fifty-six of the laws of two\nthousand thirteen;\n  (d) home health services provided in a recipient's home and prescribed\nby a physician including services of a nurse provided on a part-time or\nintermittent basis rendered by an approved home health agency or if no\nsuch agency is available, by a registered nurse, licensed to practice in\nthis state, acting under the written orders of a physician and home\nhealth aide service by an individual or shared aide provided by an\napproved home health agency when such services are determined to be cost\neffective and appropriate to meet the recipient's needs for assistance\nsubject to the provisions of section three hundred sixty-seven-j and\nsection three hundred sixty-seven-o of this title;\n  (e) (i) personal care services, including personal emergency response\nservices, shared aide and an individual aide, subject to the provisions\nof subparagraphs (ii), (iii), (iv), (v) and (vi) of this paragraph,\nfurnished to an individual who is not an inpatient or resident of a\nhospital, nursing facility, intermediate care facility for individuals\nwith intellectual disabilities, or institution for mental disease, as\ndetermined to meet the recipient's needs for assistance when cost\neffective and appropriate, and when prescribed by a qualified\nindependent physician selected or approved by the department of health,\nin accordance with the recipient's plan of treatment and provided by\nindividuals who are qualified to provide such services, who are\nsupervised by a registered nurse and who are not members of the\nrecipient's family, and furnished in the recipient's home or other\nlocation;\n  (ii) the commissioner is authorized to adopt standards, pursuant to\nemergency regulation, for the provision, management and assessment of\nservices available under this paragraph for individuals whose need for\nsuch services exceeds a specified level to be determined by the\ncommissioner, and who with the provision of such services is capable of\nsafely remaining in the community in accordance with the standards set\nforth in Olmstead v. LC by Zimring, 527 US 581 (1999) and consider\nwhether an individual is capable of safely remaining in the community;\n  (iii) the commissioner shall provide assistance to persons receiving\nservices under this paragraph who are transitioning to receiving care\nfrom a managed long term care plan certified pursuant to section\nforty-four hundred three-f of the public health law, consistent with\nsubdivision thirty-one of section three hundred sixty-four-j of this\ntitle;\n  (iv) personal care services available pursuant to this paragraph shall\nnot exceed eight hours per week for individuals whose needs are limited\nto nutritional and environmental support functions;\n  (v) subject to the availability of federal financial participation,\npersonal care services other than personal emergency response services\navailable pursuant to this paragraph shall be available only to\nindividuals assessed as needing at least limited assistance with\nphysical maneuvering with more than two activities of daily living, or\nfor individuals with a dementia or Alzheimer's diagnosis, assessed as\nneeding at least supervision with more than one activity of daily\nliving, as defined and determined by using an evidenced based validated\nassessment instrument approved by the commissioner and in accordance\nwith regulations of the department and any applicable state and federal\nlaws by an independent assessor. The provisions of this subparagraph\nshall only apply to individuals who receive an initial authorization for\nsuch services on or after October first, two thousand twenty;\n  (vi) In establishing any standards for the provision, management or\nassessment of personal care services the state shall meet the standards\nset forth in Olmstead v. LC by Zimring, 527 US 581 (1999) and consider\nwhether an individual is capable of safely remaining in the community;\n  (f) preventive, prophylactic and other routine dental care, services\nand supplies;\n  (g) sickroom supplies, eyeglasses, prosthetic appliances and dental\nprosthetic appliances furnished in accordance with the regulations of\nthe department; provided further that: (i) the commissioner of health is\nauthorized to implement a preferred diabetic supply program wherein the\ndepartment of health will receive enhanced rebates from preferred\nmanufacturers of glucometers and test strips, and may subject\nnon-preferred manufacturers' glucometers and test strips to prior\nauthorization under section two hundred seventy-three of the public\nhealth law; (ii) enteral formula therapy and nutritional supplements are\nlimited to coverage only for nasogastric, jejunostomy, or gastrostomy\ntube feeding, for treatment of an inborn metabolic disorder, or to\naddress growth and development problems in children, or, subject to\nstandards established by the commissioner, for persons with a diagnosis\nof HIV infection, AIDS or HIV-related illness or other diseases and\nconditions; (iii) prescription footwear and inserts are limited to\ncoverage only when used as an integral part of a lower limb orthotic\nappliance, as part of a diabetic treatment plan, or to address growth\nand development problems in children; (iv) compression and support\nstockings are limited to coverage only for pregnancy or treatment of\nvenous stasis ulcers; and (v) the commissioner of health is authorized\nto implement an incontinence supply utilization management program to\nreduce costs without limiting access through the existing provider\nnetwork, including but not limited to single or multiple source\ncontracts or, a preferred incontinence supply program wherein the\ndepartment of health will receive enhanced rebates from preferred\nmanufacturers of incontinence supplies, and may subject non-preferred\nmanufacturers' incontinence supplies to prior approval pursuant to\nregulations of the department, provided any necessary approvals under\nfederal law have been obtained to receive federal financial\nparticipation in the costs of incontinence supplies provided pursuant to\nthis subparagraph;\n  (g-1) drugs provided on an in-patient basis, those drugs contained on\nthe list established by regulation of the commissioner of health\npursuant to subdivision four of this section, and those drugs which may\nnot be dispensed without a prescription as required by section\nsixty-eight hundred ten of the education law and which the commissioner\nof health shall determine to be reimbursable based upon such factors as\nthe availability of such drugs or alternatives at low cost if purchased\nby a medicaid recipient, or the essential nature of such drugs as\ndescribed by such commissioner in regulations, provided, however, that\nsuch drugs, exclusive of long-term maintenance drugs, shall be dispensed\nin quantities no greater than a thirty day supply or one hundred doses,\nwhichever is greater; provided further that the commissioner of health\nis authorized to require prior authorization for any refill of a\nprescription when more than a ten day supply of the previously dispensed\namount should remain were the product used as normally indicated, or in\nthe case of a controlled substance, as defined in section thirty-three\nhundred two of the public health law, when more than a seven day supply\nof the previously dispensed amount should remain were the product used\nas normally indicated; provided further that the commissioner of health\nis authorized to require prior authorization of prescriptions of opioid\nanalgesics in excess of four prescriptions in a thirty-day period in\naccordance with section two hundred seventy-three of the public health\nlaw; medical assistance shall not include any drug provided on other\nthan an in-patient basis for which a recipient is charged or a claim is\nmade in the case of a prescription drug, in excess of the maximum\nreimbursable amounts to be established by department regulations in\naccordance with standards established by the secretary of the United\nStates department of health and human services, or, in the case of a\ndrug not requiring a prescription, in excess of the maximum reimbursable\namount established by the commissioner of health pursuant to paragraph\n(a) of subdivision four of this section;\n  (h) speech therapy, and when provided at the direction of a physician\nor nurse practitioner, physical therapy including related rehabilitative\nservices and occupational therapy;\n  (i) laboratory and x-ray services; and\n  (j) transportation when essential and appropriate to obtain medical\ncare, services and supplies otherwise available under the medical\nassistance program in accordance with this section, upon prior\nauthorization, except when required in order to obtain emergency care,\nand when not otherwise available to the recipient free of charge or\nthrough a transportation program implemented pursuant to section three\nhundred sixty-five-h of this title and approved by the commissioner of\nhealth for which federal financial participation is claimed as an\nadministrative cost;\n  * (k) care and services furnished by an entity offering a\ncomprehensive health services plan, including an entity that has\nreceived a certificate of authority pursuant to sections forty-four\nhundred three, forty-four hundred three-a or forty-four hundred eight-a\nof the public health law (as added by chapter six hundred thirty-nine of\nthe laws of nineteen hundred ninety-six) or a health maintenance\norganization authorized under article forty-three of the insurance law,\nto eligible individuals residing in the geographic area served by such\nentity, when such services are furnished in accordance with an agreement\napproved by the department which meets the requirements of federal law\nand regulations.\n  * NB Effective until December 31, 2029\n  * (k) care and services furnished by an entity offering a\ncomprehensive health services plan to eligible individuals residing in\nthe geographic area served by such entity, when such services are\nfurnished in accordance with an agreement approved by the department\nwhich meets the requirements of federal law and regulations.\n  * NB Effective December 31, 2029\n  (l) care and services of podiatrists which care and services shall\nonly be provided upon referral by a physician, nurse practitioner or\ncertified nurse midwife in accordance with the program of early and\nperiodic screening and diagnosis established pursuant to subdivision\nthree of this section or to persons eligible for benefits under title\nXVIII of the federal social security act as qualified medicare\nbeneficiaries in accordance with federal requirements therefor and\nprivate duty nurses which care and services shall only be provided in\naccordance with regulations of the department of health; provided,\nhowever, that private duty nursing services shall not be restricted when\nsuch services are more appropriate and cost-effective than nursing\nservices provided by a home health agency pursuant to section three\nhundred sixty-seven-l;\n  (m) hospice services provided by a hospice certified pursuant to\narticle forty of the public health law, to the extent that federal\nfinancial participation is available, and, notwithstanding federal\nfinancial participation and any provision of law or regulation to the\ncontrary, for hospice services provided pursuant to the hospice\nsupplemental financial assistance program for persons with special needs\nas provided for in article forty of the public health law.\n  * (n) care and services of audiologists provided in accordance with\nregulations of the department of health.\n  * NB There are two par (n)'s\n  * (n) care, treatment, maintenance and rehabilitation services that\nwould otherwise qualify for reimbursement pursuant to this chapter to\npersons suffering from alcoholism in alcoholism facilities or chemical\ndependence, as such term is defined in section 1.03 of the mental\nhygiene law, in inpatient chemical dependence facilities, services, or\nprograms operated in compliance with applicable provisions of this\nchapter and the mental hygiene law, and certified by the office of\nalcoholism and substance abuse services, provided however that such\nservices shall be limited to such periods of time as may be determined\nnecessary in accordance with a utilization review procedure established\nby the commissioner of the office of alcoholism and substance abuse\nservices and provided further, that this paragraph shall not apply to\nany hospital or part of a hospital as defined in section two thousand\neight hundred one of the public health law.\n  * NB There are two par (n)'s\n  * (o) care and services furnished by a managed long term care plan or\napproved managed long term care demonstration pursuant to the provisions\nof section forty-four hundred three-f of the public health law to\neligible individuals residing in the geographic area served by such\nentity, when such services are furnished in accordance with an agreement\nwith the department of health and meet the applicable requirements of\nfederal law and regulation.\n  * NB Repealed December 31, 2029\n  (p) targeted case management services provided to children who\n  (i) are eighteen years of age or under; and\n  (ii) either\n  (1) are physically disabled, according to the federal supplemental\nsecurity income program criteria, including but not limited to a person\nwho is multiply disabled; or\n  (2) have a developmental disability, as defined in subdivision\ntwenty-two of section 1.03 of the mental hygiene law and demonstrate\ncomplex health needs as defined in paragraph c of subdivision seven of\nsection three hundred sixty-six of this title; or\n  (3) have a mental illness, as defined in subdivision twenty of section\n1.03 of the mental hygiene law and demonstrate complex health or mental\nhealth care needs as defined in paragraph d of subdivision nine of\nsection three hundred sixty-six of this title; and\n  (iii) require the level of care provided by an intermediate care\nfacility for the developmentally disabled, a nursing facility, a\nhospital or any other institution; and\n  (iv) are capable of being cared for in the community if provided with\ncase management services and/or other services provided under this\ntitle; and\n  (v) are capable of being cared for in the community at less cost than\nin the appropriate institutional setting; and\n  (vi) are not receiving services under section three hundred\nsixty-seven-c of this title and for whom services provided under section\nthree hundred sixty-seven-a of this title are not available or\nsufficient to support the children's care in the community.\n  (q) diabetes self-management training services for persons diagnosed\nwith diabetes when such services are ordered by a physician, registered\nphysician assistant, registered nurse practitioner, or licensed midwife\nand provided by a licensed, registered, or certified health care\nprofessional, as determined by the commissioner of health, who is\ncertified as a diabetes educator by the National Certification Board for\nDiabetes Educators, or a successor national certification board, or\nprovided by such a professional who is affiliated with a program\ncertified by the American Diabetes Association, the American Association\nof Diabetes Educators, the Indian Health Services, or any other national\naccreditation organization approved by the federal centers for medicare\nand medicaid services; provided, however, that the provisions of this\nparagraph shall not take effect unless all necessary approvals under\nfederal law and regulation have been obtained to receive federal\nfinancial participation in the costs of health care services provided\npursuant to this paragraph. Nothing in this paragraph shall be construed\nto modify any licensure, certification or scope of practice provision\nunder title eight of the education law.\n  (r) asthma self-management training services for persons diagnosed\nwith asthma when such services are ordered by a physician, registered\nphysician's assistant, registered nurse practitioner, or licensed\nmidwife and provided by a licensed, registered, or certified health care\nprofessional, as determined by the commissioner of health, who is\ncertified as an asthma educator by the National Asthma Educator\nCertification Board, or a successor national certification board;\nprovided, however, that the provisions of this paragraph shall not take\neffect unless all necessary approvals under federal law and regulation\nhave been obtained to receive federal financial participation in the\ncosts of health care services provided pursuant to this paragraph.\nNothing in this paragraph shall be construed to modify any licensure,\ncertification or scope of practice provision under title eight of the\neducation law.\n  (s) smoking cessation counseling services; provided, however, that the\nprovisions of this paragraph shall not take effect unless all necessary\napprovals under federal law and regulation have been obtained to receive\nfederal financial participation in the costs of such services.\n  (t) cardiac rehabilitation services when ordered by the attending\nphysician and provided in a hospital-based or free-standing clinic in an\narea set aside for cardiac rehabilitation, or in a physician's office;\nprovided, however, that the provisions of this paragraph relating to\ncardiac rehabilitation services shall not take effect unless all\nnecessary approvals under federal law and regulation have been obtained\nto receive federal financial participation in the costs of such\nservices.\n  (u) screening, brief intervention, and referral to treatment of\nindividuals at risk for substance abuse including referral to the\nappropriate level of intervention and treatment in a community setting;\nprovided, however, that the provisions of this paragraph relating to\nscreening, brief intervention, and referral to treatment services shall\nnot take effect unless all necessary approvals under federal law and\nregulation have been obtained to receive federal financial participation\nin such costs.\n  (v) administration of vaccinations in a pharmacy by a certified\npharmacist within his or her scope of practice.\n  (w) podiatry services for individuals with a diagnosis of diabetes\nmellitus; provided, however, that the provisions of this paragraph shall\nnot take effect unless all necessary approvals under federal law and\nregulation have been obtained to receive federal financial participation\nin the costs of health care services provided pursuant to this\nparagraph.\n  (x)(i) lactation counseling services for pregnant and postpartum women\nwhen such services are ordered by a physician, physician assistant,\nnurse practitioner, or midwife and provided by a qualified lactation\ncare provider, as determined by the commissioner of health; provided,\nhowever, that the provisions of this paragraph shall not take effect\nunless all necessary approvals under federal law and regulation have\nbeen obtained to receive federal financial participation in the costs of\nhealth care services provided pursuant to this paragraph. Nothing in\nthis paragraph shall be construed to modify any licensure, certification\nor scope of practice provision under title eight of the education law.\n  (ii) for the purposes of this paragraph, the following terms shall\nhave the following meanings:\n  (1) "Qualified lactation care provider" shall mean a person who\npossesses current certification as a lactation care provider from a\ncertification program accredited by a nationally recognized accrediting\nagency.\n  (2) "Nationally recognized accrediting agency" shall mean a nationally\nrecognized accrediting agency designated by the commissioner; provided\nthat the commissioner shall designate more than one agency.\n  (y) harm reduction counseling and services to reduce or minimize the\nadverse health consequences associated with drug use, provided by a\nqualified drug treatment program or community-based organization, as\ndetermined by the commissioner of health; provided, however, that the\nprovisions of this paragraph shall not take effect unless all necessary\napprovals under federal law and regulation have been obtained to receive\nfederal financial participation in the costs of health care services\nprovided pursuant to this paragraph. Nothing in this paragraph shall be\nconstrued to modify any licensure, certification or scope of practice\nprovision under title eight of the education law.\n  (z) hepatitis C wrap-around services to promote care coordination and\nintegration when ordered by a physician, registered physician assistant,\nregistered nurse practitioner, or licensed midwife, and provided by a\nqualified professional, as determined by the commissioner of health.\nSuch services may include client outreach, identification and\nrecruitment, hepatitis C education and counseling, coordination of care\nand adherence to treatment, assistance in obtaining appropriate\nentitlement services, peer support and other supportive services;\nprovided, however, that the provisions of this paragraph shall not take\neffect unless all necessary approvals under federal law and regulation\nhave been obtained to receive federal financial participation in the\ncosts of health care services provided pursuant to this paragraph.\nNothing in this paragraph shall be construed to modify any licensure,\ncertification or scope of practice provision under title eight of the\neducation law.\n  ** (aa) care and services furnished by a developmental disability\nindividual support and care coordination organization (DISCO) that has\nreceived a certificate of authority pursuant to section forty-four\nhundred three-g of the public health law to eligible individuals\nresiding in the geographic area served by such entity, when such\nservices are furnished in accordance with an agreement approved by the\ndepartment of health which meets the requirements of federal law and\nregulations.\n  * NB Repealed December 31, 2027\n  (bb) Subject to the availability of federal financial participation,\nservices and supports authorized by the federal regulations governing\nthe Home and Community-Based Attendant Services and Supports State Plan\nOption (Community First Choice) pursuant to 42 U.S.C. § 1396n(k).\n  (cc) care and services for surgical first assistant services provided\nby a registered nurse first assistant provided that: (i) the registered\nnurse first assistant is certified in operating room nursing; (ii) the\nservices are within the scope of practice of a non-physician surgical\nfirst assistant; and (iii) the terms and conditions of the policy or\ncontract otherwise provide for the coverage of the services. Nothing in\nthis paragraph shall be construed to prevent the medical management or\nutilization review of the services; prevent a policy or contract from\nrequiring that services are to be provided through a network of\nparticipating providers who meet certain requirements for participation,\nincluding provider credentialing; or prohibit an insurer from providing\na global or capitated payment or electing to directly reimburse a\nnon-physician surgical first assistant for the services, as otherwise\npermitted by law.\n  (dd) pasteurized donor human milk (PDHM), which may include fortifiers\nas medically indicated, for inpatient use, for which a licensed medical\npractitioner has issued an order for an infant who is medically or\nphysically unable to receive maternal breast milk or participate in\nbreast feeding or whose mother is medically or physically unable to\nproduce maternal breast milk at all or in sufficient quantities or\nparticipate in breast feeding despite optimal lactation support. Such\ninfant shall: (i) have a documented birth weight of less than one\nthousand five hundred grams; or (ii) have a congenital or acquired\ncondition that places the infant at a high risk for development of\nnecrotizing enterocolitis; or (iii) have a congenital or acquired\ncondition that may benefit from the use of donor breast milk as\ndetermined by the commissioner of health or his or her designee.\n  (ee) Medical assistance shall include the coverage of a set of\nservices to ensure improved outcomes of women who are in the process of\novulation enhancing drugs, limited to the provision of such treatment,\noffice visits, hysterosalpingogram services, pelvic ultrasounds, and\nblood testing; services shall be limited to those necessary to monitor\nsuch treatment. In the event that ninety percent federal financial\nparticipation for such services is not available, the state share of\nappropriations related to these services shall be used for a grant\nprogram intended to accomplish the purpose of this section.\n  (ff) evidence-based prevention and support services recognized by the\nfederal Centers for Disease Control (CDC), provided by a community-based\norganization, and designed to prevent individuals at risk of developing\ndiabetes from developing Type 2 diabetes.\n  * (gg) addiction and mental health services and supports provided by\nfacilities licensed pursuant to article thirty-six of the mental hygiene\nlaw.\n  * NB There are 3 par (gg)'s\n  * (gg) all buprenorphine products, methadone or long acting injectable\nnaltrexone for detoxification or maintenance treatment of a substance\nuse disorder prescribed according to generally accepted national\nprofessional guidelines for the treatment of a substance use disorder.\nSuch medication assisted treatment shall not be subject to any prior\nauthorization mandate.\n  * NB There are 3 par (gg)'s\n  * (gg) care and services provided by mental health counselors and\nmarriage and family therapists licensed pursuant to article one hundred\nsixty-three of the education law acting within their scope of practice,\nwhere such services would otherwise be covered under this title. Nothing\nin this paragraph shall be construed to modify or expand the scope of\npractice of a mental health counselor or marriage and family therapist\nlicensed pursuant to article one hundred sixty-three of the education\nlaw.\n  * NB There are 3 par (gg)'s\n  (hh) The commissioner is authorized to establish one or more maternal\nhealth promotion pilot programs in one or more counties or regions of\nthe state, for the purpose of providing Medicaid reimbursement of the\nprenatal maternal childbirth education and preparation classes for\nenrollees, and transportation to and from such classes, for the purpose\nof improving maternal outcomes and reducing maternal-infant mortality.\nThe commissioner is authorized to establish fees for the reimbursement\nof such classes, subject to the approval of the state director of the\nbudget.\n  (ii) Care and services provided by clinical social workers licensed\npursuant to article one hundred fifty-four of the education law acting\nwithin their scope of practice, where such services would otherwise be\ncovered under this title.\n  * (jj) pre-natal and postpartum care and services for the purpose of\nimproving maternal health outcomes and reduction of maternal mortality\nwhen such services are recommended by a physician or other health care\npractitioner authorized under title eight of the education law, and\nprovided by qualified practitioners. Such services shall include but not\nbe limited to nutrition services provided by certified dietitians and\ncertified nutritionists; care coordination, case management, and peer\nsupport; patient navigation services; services by licensed clinical\nsocial workers; dyadic services; Bluetooth-enabled devices for remote\npatient monitoring; remote ultrasound scans; remote fetal non-stress\ntests and other services determined by the commissioner of health;\nprovided, however, that the provisions of this paragraph shall not take\neffect unless there is federal financial participation. Nothing in this\nparagraph shall be construed to modify any licensure, certification or\nscope of practice provision under title eight of the education law.\n  * NB There are 2 par (jj)'s\n  * (jj) applied behavior analysis, under article one hundred\nsixty-seven of the education law, provided by a person licensed,\ncertified, or otherwise authorized to provide applied behavior analysis\nunder that article.\n  * NB There are 2 par (jj)'s\n  * (kk) community health worker services which shall include, but not\nbe limited to, culturally appropriate patient education, health care\nnavigation, care coordination including the development of a care plan,\npatient advocacy, and support services for the management of chronic\nconditions for children under age twenty-one, and for adults with\nhealth-related social needs, when such services are recommended by a\nphysician or other health care practitioner authorized under title eight\nof the education law, and provided by qualified community health\nworkers, as determined by the commissioner of health; provided, however,\nthat the provisions of this paragraph shall not take effect unless all\nnecessary approvals under federal law and regulation have been obtained\nto receive federal financial participation in the costs of health care\nservices provided pursuant to this paragraph. Nothing in this paragraph\nshall be construed to modify any licensure, certification or scope of\npractice provision under title eight of the education law.\n  * NB There are 2 par (kk)'s\n  * (kk) care and services of nutritionists and dietitians certified\npursuant to article one hundred fifty-seven of the education law acting\nwithin their scope of practice.\n  * NB There are 2 par (kk)'s\n  (ll) Chronic Disease Self-Management Program for persons diagnosed\nwith arthritis when such services are ordered by a physician, registered\nphysician's assistant, registered nurse practitioner, or licensed\nmidwife and provided by qualified educators, as determined by the\ncommissioner of health, subject to federal financial participation.\nNothing in this paragraph shall be construed to modify any licensure,\ncertification or scope of practice provision under title eight of the\neducation law.\n  (mm) (i) biomarker precision medical testing for the purposes of\ndiagnosis, treatment, or appropriate management of, or ongoing\nmonitoring to guide treatment decisions for, a recipient's disease or\ncondition when one or more of the following recognizes the efficacy and\nappropriateness of biomarker precision medical testing for diagnosis,\ntreatment, appropriate management, or guiding treatment decisions for a\nrecipient's disease or condition:\n  (1) labeled indications for a test approved or cleared by the federal\nfood and drug administration or indicated tests for a food and drug\nadministration approved drug;\n  (2) centers for medicare and medicaid services national coverage\ndeterminations or medicare administrative contractor local coverage\ndeterminations; or\n  (3) nationally recognized clinical practice guidelines.\n  (ii) As used in this paragraph, the following terms shall have the\nfollowing meanings:\n  (1) "Biomarker" means a characteristic that is measured as an\nindicator of normal biological processes, pathogenic processes, or\nresponses to an exposure or intervention, including therapeutic\ninterventions.\n  (2) "Biomarker precision medical testing" means the analysis of a\npatient's tissue, blood, or other biospecimen for the presence of a\nbiomarker. Biomarker testing includes but is not limited to\nsingle-analyte tests and multi-plex panel tests performed at a\nparticipating in-network laboratory facility that is either CLIA\ncertified or CLIA waived by the federal food and drug administration.\n  (3) "Nationally recognized clinical practice guidelines" means\nevidence-based clinical practice guidelines informed by a systematic\nreview of evidence and an assessment of the benefits, and risks of\nalternative care options intended to optimize patient care developed by\nindependent organizations or medical professional societies utilizing a\ntransparent methodology and reporting structure and with a conflict of\ninterest policy.\n  (iii) Coverage of biomarker precision medical testing provided under\nthis paragraph shall not require a deviation from the review for\nstandard coverage or any existing process used to determine medical\nnecessity.\n  (nn) (i) Medical assistance shall include the coverage of the\nfollowing services for individuals when a medical treatment may directly\nor indirectly cause iatrogenic infertility, which is an impairment of\nfertility resulting from surgery, radiation, chemotherapy, sickle cell\ntreatment, or other medical treatment affecting reproductive organs or\nprocesses:\n  (1) standard fertility preservation services to prevent or treat\ninfertility, which shall include medically necessary collection,\nfreezing, preservation and storage of oocytes or sperm, and such other\nstandard services that are not experimental or investigational; together\nwith prescription drugs, which shall be limited to federal food and drug\nadministration approved medications and subject to medical assistance\nprogram coverage requirements. In vitro fertilization (IVF) shall not be\ncovered as a fertility preservation service; and\n  (2) coverage of the costs of storage of oocytes or sperm shall be\nsubject to continued medical assistance program eligibility for\nindividuals when a medical treatment may directly or indirectly cause\niatrogenic infertility, and shall terminate upon any discontinuance of\nmedical assistance eligibility.\n  (ii) In the event that federal financial participation for such\nfertility preservation services is not available, medical assistance\nshall not include coverage of these services.\n  3. Any inconsistent provisions of this section notwithstanding,\nmedical assistance shall include:\n  (a) early and periodic screening and diagnosis of eligible persons\nunder six years of age and, in accordance with federal law and\nregulations, early and periodic screening and diagnosis of eligible\npersons under twenty-one years of age to ascertain physical and mental\ndisabilities; and\n  (b) care and treatment of disabilities and conditions discovered by\nsuch screening and diagnosis including such care, services and supplies\nas the commissioner shall by regulation require to the extent necessary\nto conform to applicable federal law and regulations.\n  (c) screening, diagnosis, care and treatment of disabilities and\nconditions discovered by such screening and diagnosis of eligible\npersons ages three to twenty-one, inclusive, including such care,\nservices and supplies as the commissioner shall by regulation require to\nthe extent necessary to conform to applicable federal law and\nregulations, provided that such screening, diagnosis, care and treatment\nshall include the provision of evaluations and related services rendered\npursuant to article eighty-nine of the education law and regulations of\nthe commissioner of education by persons qualified to provide such\nservices thereunder.\n  (d) family planning services and twelve months of supplies for\neligible persons of childbearing age, including children under\ntwenty-one years of age who can be considered sexually active, who\ndesire such services and supplies, in accordance with the requirements\nof federal law and regulations and the regulations of the department.\nCoverage of prescription contraceptives shall include a twelve-month\nsupply that may be dispensed at one time or up to twelve times within\none year from the date of the prescription. No person shall be compelled\nor coerced to accept such services or supplies.\n  4. Any inconsistent provision of law notwithstanding, medical\nassistance shall not include, unless required by federal law and\nregulation as a condition of qualifying for federal financial\nparticipation in the medicaid program, the following items of care,\nservices and supplies:\n  (a) drugs which may be dispensed without a prescription as required by\nsection sixty-eight hundred ten of the education law; provided, however,\nthat the state commissioner of health may by regulation specify certain\nof such drugs which may be reimbursed as an item of medical assistance\nin accordance with the price schedule established by such commissioner.\nNotwithstanding any other provision of law, modifications to the list of\ndrugs reimbursable under this paragraph may be filed as regulations by\nthe commissioner of health without prior notice and comment; provided,\nhowever, that the department will notify enrollees of any eliminations\nto the list of drugs reimbursable under this paragraph at least sixty\ndays prior to the removal of such drug. Such eliminations shall be\nreferred to the drug utilization review board established pursuant to\nsection three hundred sixty-nine-bb of this article for recommendation\nprior to elimination from the list;\n  (a-1) (i) a brand name drug for which a multi-source therapeutically\nand generically equivalent drug, as determined by the federal food and\ndrug administration, is available, unless previously authorized by the\ndepartment of health. The commissioner of health is authorized to\nexempt, for good cause shown, any brand name drug from the restrictions\nimposed by this subparagraph;\n  (ii) notwithstanding the provisions of subparagraph (i) of this\nparagraph, the commissioner is authorized to deny reimbursement for a\ngeneric equivalent, including a generic equivalent that is on the\npreferred drug list or the clinical drug review program, when the net\ncost of the brand name drug, after consideration of all rebates, is less\nthan the cost of the generic equivalent, unless prior authorization is\nobtained under section two hundred seventy-three of the public health\nlaw;\n  (a-2) drugs which may not be dispensed without a prescription as\nrequired by section sixty-eight hundred ten of the education law, and\nwhich are non preferred drugs pursuant to section two hundred\nseventy-two of the public health law, or the clinical drug review\nprogram under section two hundred seventy-four of the public health law,\nunless prior authorization is granted or not required;\n  (b) care and services of chiropractors and supplies related to the\npractice of chiropractic, except as provided for by the commissioner\npursuant to a pilot program approved under federal law and regulation;\n  (c) care and services of an optometrist for using drugs in excess of\nthe maximum reimbursable amounts for optometric care and services\nestablished by the commissioner and approved by the director of the\nbudget;\n  (d) any medical care, services or supplies furnished outside the\nstate, except, when prior authorized in accordance with department\nregulations or for care, services and supplies furnished: as a result of\na medical emergency; because the recipient's health would have been\nendangered if he or she had been required to travel to the state;\nbecause the care, services or supplies were more readily available in\nthe other state; or because it is the general practice for persons\nresiding in the locality wherein the recipient resides to use medical\nproviders in the other state;\n  (e) drugs, procedures and supplies for the treatment of erectile\ndysfunction when provided to, or prescribed for use by, a person who is\nrequired to register as a sex offender pursuant to article six-C of the\ncorrection law, provided that any denial of coverage pursuant to this\nparagraph shall provide the patient with the means of obtaining\nadditional information concerning both the denial and the means of\nchallenging such denial; or\n  (f) drugs for the treatment of sexual or erectile dysfunction, unless\nsuch drugs are used to treat a condition, other than sexual or erectile\ndysfunction, for which the drugs have been approved by the federal food\nand drug administration.\n  (g) for eligible persons who are also beneficiaries under part D of\ntitle XVIII of the federal social security act, drugs which are\ndenominated as "covered part D drugs" under section 1860D-2(e) of such\nact.\n  (h) opioids prescribed in violation of the treatment plan standards of\nsubdivision eight of section thirty-three hundred thirty-one of the\npublic health law or treatment plan standards as otherwise required by\nthe commissioner.\n  5. (a) Medical assistance shall include surgical benefits for\nemergency or urgent surgery for the alleviation of severe pain, for\nimmediate diagnosis or treatment of conditions which threaten disability\nor death if not promptly diagnosed or treated.\n  (b) Medical assistance shall include surgical benefits for certain\nsurgical procedures which meet standards for surgical intervention, as\nestablished by the state commissioner of health on the basis of\nmedically indicated risk factors, and medically necessary surgery where\ndelay in surgical intervention would substantially increase the medical\nrisk associated with such surgical intervention.\n  (c) Medical assistance shall include surgical benefits for other\ndeferrable surgical procedures specified by the state commissioner of\nhealth, based on the likelihood that deferral of such procedures for six\nmonths or more may jeopardize life or essential function, or cause\nsevere pain; provided, however, such deferrable surgical procedures\nshall be included in the case of in-patient surgery only when a second\nwritten opinion is obtained from a physician, or as otherwise\nprescribed, in accordance with regulations established by the state\ncommissioner of health, that such surgery should not be deferred.\n  (d) Medical assistance shall include a maximum of one patient day of\npre-operative hospital care for surgery authorized by paragraphs (b) or\n(c) of this subdivision; provided, however, that with respect to\nspecific surgical procedures which the state commissioner of health has\nidentified as requiring more than one patient day of pre-operative care,\nmedical assistance shall include such longer maximum period of\npre-operative care as such commissioner has identified as necessary.\n  (e) Medical assistance shall not include any in-patient surgical\nprocedures or any care, services or supplies related to such surgery\nother than those authorized by this subdivision.\n  6. Any inconsistent provision of law notwithstanding, medical\nassistance shall also include payment for medical care, services or\nsupplies furnished to eligible pregnant persons pursuant to section\nthree hundred sixty-six and subdivision five of section three hundred\nsixty-four-i of this title, to the extent that and for so long as\nfederal financial participation is available therefor; provided,\nhowever, that nothing in this section shall be deemed to affect payment\nfor such medical care, services or supplies if federal financial\nparticipation is not available for such care, services and supplies\nsolely by reason of the immigration status of the otherwise eligible\npregnant person.\n  7. Medical assistance shall also include disproportionate share\npayments to general hospitals under the public health law.\n  8. When a non-governmental entity is authorized by the department\npursuant to contract or subcontract to make prior authorization or prior\napproval determinations that may be required for any item of medical\nassistance, a recipient may challenge any action taken or failure to act\nin connection with a prior authorization or prior approval determination\nas if such determination were made by a government entity, and shall be\nentitled to the same medical assistance benefits and standards and to\nthe same notice and procedural due process rights, including a right to\na fair hearing and aid continuing pursuant to section twenty-two of this\nchapter, as if the prior authorization or prior approval determination\nwere made by a government entity, without regard to expiration of the\nprior service authorization.\n  9. (a) Notwithstanding any inconsistent provision of law, any\nutilization controls on occupational therapy or physical therapy,\nincluding but not limited to, prior approval of services, utilization\nthresholds or other limitations imposed on such therapy services in\nrelation to a chronic condition in clinics certified under article\ntwenty-eight of the public health law or article sixteen of the mental\nhygiene law shall be: (i) developed by the department of health in\nconcurrence with the office for people with developmental disabilities;\nand (ii) in accord with nationally recognized professional standards. In\nthe event that nationally recognized professional standards do not\nexist, such thresholds shall be based upon the reasonably recognized\nprofessional standards of those with a specific expertise in treating\nindividuals served by clinics certified under article twenty-eight of\nthe public health law or article sixteen of the mental hygiene law.\n  (b) Prior approval by the department of health of a physical therapy\nevaluation or an occupational therapy evaluation by a qualified\npractitioner practicing within the scope of such practitioner's\nlicensure shall not be required. The department may require prior\napproval for treatment as recommended by such an evaluation. In the\nevent that prior approval is required, and the department fails to make\na determination within eight days of presentation of a treatment request\nfor physical or occupational therapy services, the department shall\nautomatically approve four therapy visits. In the case of any denial of\na prior approval request for physical therapy or occupational therapy,\nthe department shall provide a reasonable opportunity for the qualified\npractitioner to provide his or her assessment of the beneficiary's\nphysical and functional status as documented in a treatment plan with\nreasonable and obtainable goals. If, upon completion of such four\ntherapy visits, the department has not yet rendered a determination on\nthe request for physical or occupational therapy services, the\ndepartment shall automatically approve an additional four therapy\nvisits. Subsequent automatic approvals shall be issued in the same\nmanner until such time as the department issues a determination, but in\nno event shall such approvals exceed the number of services or the\nperiod of time recommended by the evaluation. If the qualified\npractitioner provides documentation that is in accord with reasonably\nrecognized professional standards, the recommended treatment plan shall\nbe final, and the prior approval request shall be approved.\n  10. The department of health shall establish or procure the services\nof an independent assessor or assessors no later than October 1, 2022,\nin a manner and schedule as determined by the commissioner of health, to\ntake over from local departments of social services, Medicaid Managed\nCare providers, and Medicaid managed long term care plans performance of\nassessments and reassessments required for determining individuals'\nneeds for personal care services, including as provided through the\nconsumer directed personal assistance program, and other services or\nprograms available pursuant to the state's medical assistance program as\ndetermined by such commissioner for the purpose of improving efficiency,\nquality, and reliability in assessment and to determine individuals'\neligibility for Medicaid managed long term care plans. Notwithstanding\nthe provisions of section one hundred sixty-three of the state finance\nlaw, or sections one hundred forty-two and one hundred forty-three of\nthe economic development law, or any contrary provision of law,\ncontracts may be entered or the commissioner may amend and extend the\nterms of a contract awarded prior to the effective date and entered into\nto conduct enrollment broker and conflict-free evaluation services for\nthe Medicaid program, if such contract or contract amendment is for the\npurpose of procuring such assessment services from an independent\nassessor. Contracts entered into, amended, or extended pursuant to this\nsubdivision shall not remain in force beyond September 30, 2028.\n
N.Y. SOS Law § 367-W — New York Code / Act SOS / Article 5 / Title 11 / Section 367-W
Health care and mental hygiene worker bonuses
Status: in_force

§ 367-w. Health care and mental hygiene worker bonuses. 1. Purpose and\nintent. New York's essential front line health care and mental hygiene\nworkers have seen us through a once-in-a-century public health crisis\nand turned our state into a model for battling and beating COVID-19. To\nattract talented people into the profession at a time of such\nsignificant strain while also retaining those who have been working so\ntirelessly these past two years, we must recognize the efforts of our\nhealth care and mental hygiene workforce and reward them financially for\ntheir service.\n  To do that, the commissioner of health is hereby directed to seek\nfederal approvals as applicable, and, subject to federal financial\nparticipation, to support with federal and state funding bonuses to be\nmade available during the state fiscal year of 2023 to recruit, retain,\nand reward health care and mental hygiene workers.\n  2. Definitions. As used in this section, the term:\n  (a) "Employee" means certain front line health care and mental hygiene\npractitioners, technicians, assistants and aides that provide hands on\nhealth or care services to individuals, without regard to whether the\nperson works full-time, part-time, on a salaried, hourly, or temporary\nbasis, or as an independent contractor, that received an annualized base\nsalary of one hundred twenty-five thousand dollars or less, to include:\n  (i) Physician assistants, dental hygienists, dental assistants,\npsychiatric aides, pharmacists, pharmacy technicians, physical\ntherapists, physical therapy assistants, physical therapy aides,\noccupational therapists, occupational therapy assistants, occupational\ntherapy aides, speech-language pathologists, respiratory therapists,\nexercise physiologists, recreational therapists, all other therapists,\northotists, prosthetists, clinical laboratory technologists and\ntechnicians, diagnostic medical sonographers, nuclear medicine\ntechnologists, radiologic technologists, magnetic resonance imaging\ntechnologists, ophthalmic medical technicians, radiation therapists,\ndietetic technicians, cardiovascular technologists and technicians,\ncertified first responders, emergency medical technicians, advanced\nemergency medical technicians, paramedics, surgical technologists, all\nother health technologists and technicians, orderlies, medical\nassistants, phlebotomists, all other health care support workers, nurse\nanesthetists, nurse midwives, nurse practitioners, registered nurses,\nnursing assistants, and licensed practical and licensed vocational\nnurses;\n  (ii) to the extent not already included in subparagraph (i) of this\nparagraph, staff who perform functions as described in the consolidated\nfiscal report (CFR) manual with respect to the following title codes:\n  Mental Hygiene Worker;\n  Residence/Site Worker;\n  Counselor (OMH);\n  Manager (OMH);\n  Senior Counselor (OMH);\n  Supervisor (OMH);\n  Developmental Disabilities Specialist QIDP - Direct Care (OPWDD);\n  Certified Recovery Peer Advocate;\n  Peer Professional - Non-CRPA (OASAS Only);\n  Job Coach/Employment Specialist (OMH and OPWDD);\n  Peer Specialist (OMH);\n  Counselor - Alcoholism and Substance Abuse (CASAC);\n  Counseling Aide/Assistant - Alcoholism and Substance Abuse;\n  Other Direct Care Staff;\n  Case Manager;\n  Counselor - Rehabilitation;\n  Developmental Disabilities Specialist/Habilitation Specialist QIDP -\nClinical (OPWDD);\n  Emergency Medical Technician;\n  Intensive Case Manager (OMH);\n  Intensive Case Manager/Coordinator (OMH);\n  Nurse - Licensed Practical;\n  Nurse - Registered;\n  Psychologist (Licensed);\n  Psychologist (Master's Level)/Behavioral Specialist;\n  Psychology Worker/Other Behavioral Worker;\n  Social Worker - Licensed (LMSW, LCSW);\n  Social Worker - Master's Level (MSW);\n  Licensed Mental Health Counselor (OASAS, OMH, OCFS);\n  Licensed Psychoanalyst (OMH);\n  Therapist - Recreation;\n  Therapist - Activity/Creative Arts;\n  Therapist - Occupational;\n  Dietician/Nutritionist;\n  Therapy Assistant/Activity Assistant;\n  Nurse's Aide/Medical Aide;\n  Behavior Intervention Specialist 1 (OPWDD);\n  Behavior Intervention Specialist 2 (OPWDD);\n  Clinical Coordinator;\n  Intake/Screening;\n  Pharmacist;\n  Marriage and Family Counselor/Therapist;\n  Residential Treatment Facility (RTF) Transition Coordinator (OMH);\n  Crisis Prevention Specialist (OMH);\n  Early Recognition Specialist (OMH);\n  Other Clinical Staff/Assistants;\n  Nurse Practitioner/Nursing Supervisor;\n  Therapist - Physical;\n  Therapist - Speech;\n  Program or Site Director; and\n  Assistant Program or Assistant Site Director; and\n  (iii) such titles as determined by the commissioner, or relevant\nagency commissioner as applicable, and approved by the director of the\nbudget.\n  (b) "Employer" means a provider enrolled in the medical assistance\nprogram under this title that employs at least one employee and that\nbills for services under the state plan or a home and community based\nservices waiver authorized pursuant to subdivision (c) of section\nnineteen hundred fifteen of the federal social security act, or that has\na provider agreement to bill for services provided or arranged through a\nmanaged care provider under section three hundred sixty-four-j of this\ntitle or a managed long term care plan under section forty-four hundred\nthree-f of the public health law, to include:\n  (i) providers and facilities licensed, certified or otherwise\nauthorized under articles twenty-eight, thirty, thirty-six or forty of\nthe public health law, articles sixteen, thirty-one, thirty-two or\nthirty-six of the mental hygiene law, article seven of this chapter,\nfiscal intermediaries under section three hundred sixty-five-f of this\ntitle, pharmacies registered under section six thousand eight hundred\neight of the education law, or school based health centers;\n  (ii) programs that participate in the medical assistance program and\nare funded by the office of mental health, the office of addiction\nservices and supports, or the office for people with developmental\ndisabilities; and\n  (iii) other provider types determined by the commissioner and approved\nby the director of the budget;\n  (iv) provided, however, that unless the provider is subject to a\ncertificate of need process as a condition of state licensure or\napproval, such provider shall not be an employer under this section\nunless at least twenty percent of the provider's patients or persons\nserved are eligible for services under this title and title XIX of the\nfederal social security act.\n  (c) Notwithstanding the definition of employer in paragraph (b) of\nthis subdivision, and without regard to the availability of federal\nfinancial participation, "employer" shall also include an institution of\nhigher education, a public or nonpublic school, a charter school, an\napproved preschool program for students with disabilities, a school\ndistrict or boards of cooperative educational services, programs funded\nby the office of mental health, programs funded by the office of\naddiction services and supports, programs funded by the office for\npeople with developmental disabilities, programs funded by the office\nfor the aging, a health district as defined in section two of the public\nhealth law, or a municipal corporation, where such program or entity\nemploys at least one employee. Such employers shall be required to\nenroll in the system designated by the commissioner, or relevant agency\ncommissioners, in consultation with the director of the budget, for the\npurpose of claiming bonus payments under this section. Such system or\nprocess for claiming bonus payments may be different from the system and\nprocess used under subdivision three of this section.\n  (d) "Vesting period" shall mean a series of six-month periods between\nthe dates of October first, two thousand twenty-one and March\nthirty-first, two thousand twenty-four for which employees that are\ncontinuously employed by an employer during such six-month periods, in\naccordance with a schedule issued by the commissioner or relevant agency\ncommissioner as applicable, may become eligible for a bonus pursuant to\nsubdivision four of this section.\n  (e) "Base salary" shall mean, for the purposes of this section, the\nemployee's gross wages with the employer during the vesting period,\nexcluding any bonuses or overtime pay.\n  (f) "Municipal corporation" means a county outside the city of New\nYork, a city, including the city of New York, a town, a village, or a\nschool district.\n  3. Tracking and submission of claims for bonuses. (a) The\ncommissioner, in consultation with the commissioner of labor and the\nMedicaid inspector general, and subject to any necessary approvals by\nthe federal centers for Medicare and Medicaid services, shall develop\nsuch forms and procedures as may be needed to identify the number of\nhours employees worked and to provide reimbursement to employers for the\npurposes of funding employee bonuses in accordance with hours worked\nduring the vesting period.\n  (b) Using the forms and processes developed by the commissioner under\nthis subdivision, employers shall, for a period of time specified by the\ncommissioner:\n  (i) track the number of hours that employees work during the vesting\nperiod and, as applicable, the number of patients served by the employer\nwho are eligible for services under this title; and\n  (ii) submit claims for reimbursement of employee bonus payments. In\nfilling out the information required to submit such claims, employers\nshall use information obtained from tracking required pursuant to\nparagraph (a) of this subdivision and provide such other information as\nmay be prescribed by the commissioner. In determining an employee's\nannualized base salary, the employer shall use information based on\npayroll records.\n  (c) Employers shall be responsible for determining whether an employee\nis eligible under this section and shall maintain and make available\nupon request all records, data and information the employer relied upon\nin making the determination that an employee was eligible, in accordance\nwith paragraph (d) of this subdivision.\n  (d) Employers shall maintain contemporaneous records for all tracking\nand claims related information and documents required to substantiate\nclaims submitted under this section for a period of no less than six\nyears. Employers shall furnish such records and information, upon\nrequest, to the commissioner, the Medicaid inspector general, the\ncommissioner of labor, the secretary of the United States Department of\nHealth and Human Services, and the deputy attorney general for Medicaid\nfraud control.\n  4. Payment of worker bonuses. (a) Upon issuance of a vesting schedule\nby the commissioner, or relevant agency commissioner as applicable,\nemployers shall be required to pay bonuses to employees pursuant to such\nschedule based on the number of hours worked during the vesting period.\nThe schedule shall provide for total payments not to exceed three\nthousand dollars per employee in accordance with the following:\n  (i) employees who have worked an average of at least twenty but less\nthan thirty hours per week over the course of a vesting period would\nreceive a five hundred dollar bonus for the vesting period;\n  (ii) employees who have worked an average of at least thirty but less\nthan thirty-five hours per week over the course of a vesting period\nwould receive a one thousand dollar bonus for such vesting period;\n  (iii) employees who have worked an average of at least thirty-five\nhours per week over the course of a vesting period would receive a one\nthousand five hundred dollar bonus for such vesting period.\n  (iv) full-time employees who are exempt from overtime compensation as\nestablished in the labor commissioner's minimum wage orders or otherwise\nprovided by New York state law or regulation over the course of a\nvesting period would receive a one thousand five hundred dollar bonus\nfor such vesting period.\n  (b) Notwithstanding paragraph (a) of this subdivision, the\ncommissioner may through regulation specify an alternative number of\nvesting periods, provided that total payments do not exceed three\nthousand dollars per employee.\n  (c) Employees shall be eligible for bonuses for no more than two\nvesting periods per employer, in an amount equal to but not greater than\nthree thousand dollars per employee across all employers.\n  (d) Upon completion of a vesting period with an employer, an employee\nshall be entitled to receive the bonus and the employer shall be\nrequired to pay the bonus no later than the date specified under this\nsubdivision, provided however that prior to such date the employee does\nnot terminate, through action or inaction, the employment relationship\nwith the employer, in accordance with any employment agreement,\nincluding a collectively bargained agreement, if any, between the\nemployee and employer.\n  (e) Any bonus due and payable to an employee under this section shall\nbe made by the employer no later than thirty days after the bonus is\npaid to the employer.\n  (f) an employer shall be required to submit a claim for a bonus to the\ndepartment no later than thirty days after an employee's eligibility for\na bonus vests, in accordance with and upon issuance of the schedule\nissued by the commissioner or relevant agency commissioner.\n  (g) No portion of any dollars received from claims under subparagraph\n(ii) of paragraph (b) of subdivision three of this section for employee\nbonuses shall be returned to any person other than the employee to whom\nthe bonus is due or used to reduce the total compensation an employer is\nobligated to pay to an employee under section thirty-six hundred\nfourteen-c of the public health law, section six hundred fifty-two of\nthe labor law, or any other provisions of law or regulations, or\npursuant to any collectively bargained agreement.\n  (h) No portion of any bonus available pursuant to this subdivision\nshall be payable to a person who has been suspended or excluded under\nthe medical assistance program during the vesting period and at the time\nan employer submits a claim under this section.\n  (i) The use of any accruals or other leave, including but not limited\nto sick, vacation, or time used under the family medical leave act,\nshall be credited towards and included in the calculation of the average\nnumber of hours worked per week over the course of the vesting period.\n  5. Audits, investigations and reviews. (a) The Medicaid inspector\ngeneral shall, in coordination with the commissioner, conduct audits,\ninvestigations and reviews of employers required to submit claims under\nthis section. Such claims, inappropriately paid, under this section\nshall constitute overpayments as that term is defined under the\nregulations governing the medical assistance program. The Medicaid\ninspector general may recover such overpayments to employers as it would\nan overpayment under the medical assistance program, impose sanctions up\nto and including exclusion from the medical assistance program, impose\npenalties, and take any other action authorized by law where:\n  (i) an employer claims a bonus not due to an employee or a bonus\namount in excess of the correct bonus amount due to an employee;\n  (ii) an employer claims, receives and fails to pay any part of the\nbonus due to a designated employee;\n  (iii) an employer fails to claim a bonus due to an employee.\n  (b) Any employer identified in paragraph (a) of this subdivision who\nfails to identify, claim and pay any bonus for more than ten percent of\nits employees eligible for the bonus shall also be subject to additional\npenalties under subdivision four of section one hundred forty-five-b of\nthis article.\n  (c) Any employer who fails to pay any part of the bonus payment to a\ndesignated employee shall remain liable to pay such bonus to that\nemployee, regardless of any recovery, sanction or penalty the Medicaid\ninspector general may impose.\n  (d) In all instances recovery of inappropriate bonus payments shall be\nrecovered from the employer. The employer shall not have the right to\nrecover any inappropriately paid bonus from the employee.\n  (e) Where the Medicaid inspector general sanctions an employer for\nviolations under this section, they may also sanction any affiliates as\ndefined under the regulations governing the medical assistance program.\n  6. Rules and regulations. The commissioner, in consultation with the\nMedicaid inspector general as it relates to subdivision five of this\nsection, may promulgate rules, to implement this section pursuant to\nemergency regulation; provided, however, that this provision shall not\nbe construed as requiring the commissioner to issue regulations to\nimplement this section.\n
N.Y. PBA Law § 1302 — New York Code / Act PBA / Article 5 / Title 11-C / Section 1302
Capital District transportation district
Status: in_force

§ 1302. Capital District transportation district. There is hereby\ncreated and established a transportation district to be known as the\nCapital District transportation district. This district shall embrace\nthe counties of Albany, Schenectady, Rensselaer, and Saratoga and such\nof the following counties as may elect to become members by action of\ntheir governing bodies as provided in subdivision ten of section\nthirteen hundred three: Greene, Columbia, Montgomery, Fulton, Warren and\nany other county included within the upper Hudson planning and\ndevelopment region as designated by the state. The transportation\ndistrict shall also include all lands and water and all lands under\nwater and all rivers, lakes, bays and harbors within any of the counties\nof said district.\n
N.Y. VAT Law § 2403 — New York Code / Act VAT / Title 11 / Article 48-C / Section 2403
Operation of ATVs; where permitted
Status: in_force

§ 2403. Operation of ATVs; where permitted. 1. Highways. No person\nshall operate an ATV on a highway except as provided herein.\n  (a) An ATV may make a direct crossing on a highway other than an\ninterstate highway or a controlled access highway, provided:\n  (i) the crossing is made at an angle of approximately ninety degrees\nto the direction of the highway and at a place where no obstruction\nprevents a quick and safe crossing;\n  (ii) the vehicle is brought to a complete stop before crossing the\nshoulder or main travelled way of the highway;\n  (iii) the driver yields the right-of-way to all oncoming traffic that\nconstitutes an immediate hazard;\n  (iv) in crossing a divided highway, the crossing is made only at an\nintersection of the highway with another public street or highway, and\n  (v) if the crossing is made between the hours of one-half hour after\nsunset to one-half hour before sunrise or in conditions of reduced\nvisibility, only if both front and rear lights are lighted.\n  (b) An ATV may be operated on any highway which has been designated\nand posted as open for travel by ATVs in accordance with the provisions\nof section twenty-four hundred five of this article.\n  2. Public lands other than highways. No person shall operate an ATV on\nany public lands, waters and property other than a highway, except that\nan ATV may be operated on any such lands which have been designated and\nposted for travel by ATVs in accordance with the provisions of section\ntwenty-four hundred five of this article.\n  3. Private property. No person shall operate an ATV on the private\nproperty of another without the consent of the owner or lessee thereof.\n  3-a. Real property of a farm operation. No person shall operate an ATV\non the real property of a farm operation, as defined in subdivision\neleven of section three hundred one of the agriculture and markets law,\nwithout the consent of the owner or lessee thereof, where such owner or\nlessee has erected or maintained any sign, structure, display, or device\nprohibiting the trespass thereon, and which shall include a sign\nstating: "No Trespassing". A violation of this subdivision shall be a\ntraffic infraction, and shall, upon a conviction of a first violation be\npunishable by a fine of not more than two hundred fifty dollars or by\nimprisonment for not more than fifteen days or by both such fine and\nimprisonment; upon a conviction of a second violation, both of which\nwere committed within a period of eighteen months, shall be punishable\nby a fine of not more than four hundred dollars or by imprisonment for\nnot more than forty-five days or by both such fine and imprisonment;\nupon a conviction of a third or subsequent violation, all of which were\ncommitted within a period of eighteen months, shall be punishable by a\nfine of not more than five hundred fifty dollars or by imprisonment for\nnot more than ninety days or by both such fine and imprisonment.\n  4. Emergency vehicle. The provisions of subdivisions one, two and\nthree of this section shall not apply to operation as emergency vehicle\nby any authorized emergency, police or civil defense all terrain\nvehicle.\n
N.Y. PBA Law § 1299-II — New York Code / Act PBA / Article 5 / Title 11-B / Section 1299-II
Acquisition and disposition of real property
Status: in_force

§ 1299-ii. Acquisition and disposition of real property. 1. In\naddition to the powers provided in section twelve hundred ninety-nine-gg\nof this title to acquire transportation facilities, equipment and real\nproperty, the authority may acquire, by condemnation pursuant to the\ncondemnation law and/or in accordance with the condemnation provisions\nof subdivision seven of this section, any real property it may deem\nnecessary, convenient, or desirable to effectuate the purpose of this\ntitle, provided, however, that any such condemnation proceedings shall\nbe brought only in the supreme court and the compensation to be paid\nshall be ascertained and determined by the court without a jury.\nNotwithstanding the foregoing provisions of this subdivision, no real\nproperty may be acquired by the authority by condemnation or by purchase\nfor purposes other than a transportation facility unless the governing\nbody of the city, village or town in which such real property is located\nshall first consent to such acquisition.\n  2. Nothing herein contained shall be construed to prevent the\nauthority from bringing any proceedings to remove a cloud on title or\nsuch other proceedings as it may, in its discretion, deem proper and\nnecessary or from acquiring any such property by negotiation or\npurchase.\n  3. Where a person entitled to an award in the proceedings to condemn\nany real property for any of the purposes of this title remains in\npossession of such property after the time of the vesting of title in\nthe condemnor, the reasonable value of his use and occupancy of such\nproperty subsequent to such time as fixed by agreement or by the court\nin such proceedings or by any court of competent jurisdiction shall be a\nlien against such award subject only to the liens of record at the time\nof vesting of title in the condemnor.\n  4. Title to all property acquired under this act shall vest in the\nauthority.\n  5. The authority may, whenever it determines that it is in the\ninterest of the authority, dispose of any real property or property\nother than real property, which it determines is not necessary,\nconvenient or desirable for its purposes.\n  6. The authority may, whenever it shall determine that it is in the\ninterest of the authority, rent, lease or grant easements or other\nrights in, any land or property of the authority.\n  7. The authority may adopt the following condemnation procedures.  A\ncertified copy of a resolution adopted by the authority authorizing the\nacquisition and identifying and describing the property and franchises,\nif any, sought to be acquired by condemnation shall be filed in the\noffice of the county clerk of the county in which such property is\nsituated, held or maintained. A petition for an order vesting title to\nsuch property and franchises, if any, sought to be acquired by\ncondemnation shall set forth a description of the said property and\nfranchises, if any, and a prayer that title be vested in the authority,\nshall be presented, upon notice of the application to condemn published\nin five successive issues of a publication of general circulation within\nthe county where such property and franchises, if any, are located, to a\nspecial term of the supreme court held at the time and place specified\nin such notice, within the judicial district in which the property being\nacquired or some part thereof is situated. Such proceedings shall have\nprecedence over all other cases on the calendar of such court, any other\nprovision of the law to the contrary notwithstanding. Upon due proof to\nthe satisfaction of the court of the filing of the resolution as\nhereinafter described, such court, not later than three days after the\npresentation of the petition, shall thereupon enter an order vesting\ntitle to such property and franchises, if any, in the authority. Upon\nsuch vesting of title the authority shall have the right to enter upon\nand take possession of such property. A notice of such acquisition shall\nbe directed to the owners of the property and franchises, if any, so\nacquired and to any other person or persons having an estate, interest\nor easement in such property or a lien, charge or encumbrance thereon by\npersonal service or by registered mail at the last known address within\nfifteen days after such vesting of title. Such notice shall set forth\nsuch resolution, the date of the submission to the court, the date of\nthe order vesting title in such authority and such other matters as the\nauthority may determine.\n  8. If funds are made available by the authority for the payment of the\ncost and expense of the acquisition thereof, the department of\ntransportation of the state of New York, when requested by the\nauthority, may acquire such real property in the name of the state as\nmay be determined from time to time by the authority as being necessary,\nconvenient or desirable to effectuate the purposes of this title, may\nremove the owner or occupant thereof where necessary, and obtain\npossession and, when requested by the authority, may dispose of any real\nproperty so acquired, all according to the procedure provided in section\nthirty of the highway law and pursuant to the procedure required under\nfederal law, when applicable. The authority shall have the right to\npossess and use for its corporate purposes all such real property so\nacquired. Claims for the value of the property appropriated and for\nlegal damages caused by any such appropriation shall be adjusted and\ndetermined by such department with the approval of the authority or by\nthe court of claims as provided in section thirty of the highway law and\nas required by federal law, when applicable. When a claim has been filed\nwith the court of claims, the claimant shall cause a copy of such claim\nto be served upon the authority and the authority shall have the right\nto be represented and heard before such court. All awards and judgments\narising from such claims shall be paid out of moneys of the authority.\nNo real property may be acquired pursuant to the provisions of this\nsection for purposes other than a transportation facility unless the\ngoverning body of the city, village or town in which such real property\nis located shall first consent to such acquisition.\n
N.Y. PBA Law § 1278 — New York Code / Act PBA / Article 5 / Title 11 / Section 1278
Title not affected if in part unconstitutional or ineffective
Status: in_force

§ 1278. Title not affected if in part unconstitutional or ineffective.\nIf any provision of any section of this title or the application thereof\nto any person or circumstance shall be adjudged invalid by a court of\ncompetent jurisdiction, such order or judgment shall be confined in its\noperation to the controversy in which it was rendered, and shall not\naffect or invalidate the remainder of any provision of any section of\nthis title or the application of any part thereof to any other person or\ncircumstance and to this end the provisions of each section of this\ntitle are hereby declared to be severable.\n
N.Y. ENV Law § 71-1107 — New York Code / Act ENV / Article 71 / Title 11 / Section 71-1107
Punishment for violations of title 5 of article 15
Status: in_force

§ 71-1107. Punishment for violations of title 5 of article 15.\n  1. A violation of section 15-0501, 15-0503 or 15-0505, shall\nconstitute a misdemeanor, punishable by a fine of not to exceed ten\nthousand dollars, or by imprisonment not to exceed one year or by both\nsuch fine and imprisonment and, in addition thereto, by a civil penalty\nof not more than five thousand dollars.\n  2. A subcontractor, employee or agent of such person or public\ncorporation, or of a state department who knowingly and intentionally\nacts, or a prime contractor of such person, public corporation or state\ndepartment who acts with or without an intention to violate the\nprovisions of title 5 of article 15, in disregard of specifications\nprovided in a construction contract protecting against stream damage,\nshall be guilty of a violation punishable by a fine of not less than\ntwenty-five dollars, nor more than two hundred fifty dollars, or by\nimprisonment for not more than fifteen days, or by both such fine and\nimprisonment, and, in addition, thereto, by a civil penalty of not more\nthan five thousand dollars.\n
N.Y. VAT Law § 2264 — New York Code / Act VAT / Title 11 / Article 48-A / Section 2264
Display of registration number plate or plates
Status: in_force

§ 2264. Display of registration number plate or plates. 1. The\nregistration number plate or plates assigned to a limited use vehicle\nshall be displayed on the vehicle at all times such vehicle is operated\non the public highways in such manner as the commissioner may, be\nregulation, prescribe. One registration number plate shall be issued by\nthe commissioner for a limited use motorcycle. One or two registration\nnumber plates, as determined by the commissioner, shall be issued by the\ncommissioner for a limited use automobile. No number other than the\nregistration number plate assigned to a limited use vehicle by the\ncommissioner, or the identification number of the registration issued by\nanother state shall be painted, attached or otherwise displayed on a\nlimited use vehicle when such vehicle is being operated on a public\nhighway. Nothing herein shall prohibit the display of a vehicle\nidentification number plate or number affixed by the manufacturer or his\nagent in accordance with section twenty-two hundred sixty-seven of this\nchapter.\n  2. Dealer demonstrator number plates shall conform to the requirements\nset forth in subdivision one of this section with the exception that\nsuch number plates may be temporarily but firmly affixed to the limited\nuse vehicle being demonstrated or tested.\n  3. The use of dealer demonstrator number plates shall be subject to\nthe provisions of sections four hundred fifteen and four hundred sixteen\nof this chapter.\n  4. No dealer shall permit a dealer demonstrator number plate to be\nused on any vehicle unless such vehicle would qualify for the issuance\nof such a number plate when registered.\n
N.Y. SOS Law § 364-D — New York Code / Act SOS / Article 5 / Title 11 / Section 364-D
Medical assistance research and demonstration projects
Status: in_force

* § 364-d. Medical assistance research and demonstration projects. 1.\nThe department is authorized to sponsor, conduct and participate in the\nfollowing research and demonstration projects: "Eldercare: A Social\nHealth Maintenance Organization", "New York State Alcoholism Services\nDemonstration", and "Physician Reimbursement and Continuing Care Under\nMedicaid", for the purpose of testing the use of innovative\nadministrative techniques, new reimbursement methods, and changes in the\nscope of benefits, so as to promote a more efficient utilization of\nhealth resources and the containment of medical assistance program\ncosts. Such demonstration projects may be conducted in one or more\nsocial services districts or portions of such districts.\n  2. (a) Social services districts shall be required to participate in\nthe operation of such research and demonstration projects as the\ndepartment may approve. Social services districts shall cooperate with\nthe department in the conduct of such projects whenever the department\nshall request or require such participation or cooperation.\n  (b) Notwithstanding any inconsistent provision of law to the contrary,\nexpenditures made in connection with any research demonstration project\nundertaken pursuant to the provisions of this section shall be subject\nto state reimbursement under section three hundred sixty-eight-a of this\ntitle.\n  3. The research and demonstration projects undertaken pursuant to the\nprovisions of this section shall limit the individuals participating\nthereunder to those persons with respect to whom the department has\ndetermined that there is a reasonable expectation that the total cost of\nbenefits under such project would be less than the total cost of\nbenefits for such individual if the research and demonstration program\nwere not in effect.\n  4. Notwithstanding any inconsistent provision of this chapter or any\nother law to the contrary, the commissioner may, subject to the approval\nof the director of the budget, approve any or all of the research and\ndemonstration projects specified in subdivision one of this section, and\napply for the appropriate waivers under federal law and regulation, and\nmay waive any of the provisions of this chapter, when such action would\nbe likely to assist in promoting the objectives of this title.\n  5. (a) For each project undertaken pursuant to the provisions of this\nsection, the department shall submit an interim report and final report\nto the governor and the legislature. The interim report shall be due\neighteen months after the date of approval of the project by the\ndepartment; the final report shall be due at the conclusion of the\nproject.\n  (b) Such reports shall include a listing of the accomplishments of the\nresearch and demonstration project, and shall evaluate the progress made\nin achieving the objectives of the project.\n  6. This section shall be effective with respect to each such project,\nother than the "New York State Alcoholism Services Demonstration\nProject", if and as long as, federal participation is available for\nexpenditures made for such research and demonstration project conducted\npursuant to the provisions of this section.\n  * NB Expired July 22, 1986 -- Eldercare: A Social Health Maintenance\nOrganization expired April 9, 2007 per chapter 58 of 2007 Part C § 6.\n
N.Y. SOS Law § 367-A — New York Code / Act SOS / Article 5 / Title 11 / Section 367-A
Payments; insurance
Status: in_force

§ 367-a. Payments; insurance. 1. (a) Any inconsistent provision of\nthis chapter or other law notwithstanding, no assignment of the claim of\nany supplier of medical assistance shall be valid and enforceable as\nagainst any social services district or the department, and any payment\nwith respect to any medical assistance shall be made to the person,\ninstitution, state department or agency or municipality supplying such\nmedical assistance at rates established by the appropriate social\nservices district and contained in its approved local medical plan,\nexcept as otherwise permitted or required by applicable federal and\nstate provisions, including the regulations of the department; provided,\nhowever, that for those districts for whom the department has assumed\npayment responsibilities pursuant to section three hundred sixty-seven-b\nof this chapter, rates shall be established by the department, except as\notherwise required by applicable provisions of federal or state law. A\nsocial services official may apply to the department for local\nvariations in rates to be applicable, upon approval by the department,\nto recipients for whom such district is responsible. Claims for payment\nshall be made in such form and manner as the department shall determine.\n  (b) Where an applicant for or recipient of public assistance or\nmedical assistance has health insurance in force, is enrolled in a group\nhealth insurance plan or group health plan covering care and other\nmedical benefits provided under this title, payment or part-payment of\nthe premium, co-insurance, any deductible amounts and other cost-sharing\nobligations for such insurance may also be made when deemed\ncost-effective pursuant to the regulations of the department.\n  (c) Any inconsistent provisions of this title or other law\nnotwithstanding and to the extent that federal financial participation\nis available therefor and in accordance with the regulations of the\ncommissioner, payment of the premium for coverage under a group health\ninsurance plan or group health plan may be made under the medical\nassistance program on behalf of a person not otherwise entitled to\npublic assistance or medical assistance if the social services official\ndetermines that the savings in expenditures to the program as a result\nof such coverage are likely to exceed the amount of the premiums paid\nand such person has:\n  (i) income (as determined in accordance with the methodology used to\ndetermine eligibility for benefits under the federal supplemental\nsecurity income program) in an amount less than or equal to one hundred\nper cent of the federal income official poverty line (as defined and\nannually revised by the federal office of management and budget)\napplicable to the person's family size;\n  (ii) resources (as determined in accordance with the methodology used\nto determine eligibility for benefits under the federal supplemental\nsecurity income program) less than or equal to twice the maximum amount\nan individual is permitted to have to obtain benefits under the federal\nsupplemental security income program; and\n  (iii) coverage available under a group health insurance plan or an\nemployer-based group health plan provided pursuant to title XXII of the\nfederal public health services act, section 4980B of the federal\ninternal revenue code of 1986, or title VI of the employee retirement\nincome security act of 1974.\n  (d) (i) Amounts payable under this title for medical assistance for\nitems and services provided to eligible persons who are also\nbeneficiaries under part A of title XVIII of the federal social security\nact and items and services provided to qualified medicare beneficiaries\nunder part A of title XVIII of the federal social security act shall not\nbe less than the amount of any deductible and co-insurance liability of\nsuch eligible persons or for which such eligible persons or such\nqualified medicare beneficiaries would be liable under federal law were\nthey not eligible for medical assistance or were they not qualified\nmedicare beneficiaries with respect to such benefits under such part A.\n  (ii) Amounts payable under this title for medical assistance for items\nand services provided to eligible persons who are also beneficiaries\nunder part B of title XVIII of the federal social security act and items\nand services provided to qualified medicare beneficiaries under part B\nof title XVIII of the federal social security act shall not be less than\nthe amount of any deductible liability of such eligible persons or for\nwhich such eligible persons or such qualified medicare beneficiaries\nwould be liable under federal law were they not eligible for medical\nassistance or were they not qualified medicare beneficiaries with\nrespect to such benefits under such part B.\n  * (iii) With respect to items and services provided to eligible\npersons who are also beneficiaries under part B of title XVIII of the\nfederal social security act and items and services provided to qualified\nmedicare beneficiaries under part B of title XVIII of the federal social\nsecurity act, the amount payable for services covered under this title\nshall be the amount of any co-insurance liability of such eligible\npersons pursuant to federal law were they not eligible for medical\nassistance or were they not qualified medicare beneficiaries with\nrespect to such benefits under such part B, but shall not exceed the\namount that otherwise would be made under this title if provided to an\neligible person other than a person who is also a beneficiary under part\nB or is a qualified medicare beneficiary minus the amount payable under\npart B; provided, however, amounts payable under this title for items\nand services provided to eligible persons who are also beneficiaries\nunder part B or to qualified medicare beneficiaries by an ambulance\nservice under the authority of an operating certificate issued pursuant\nto article thirty of the public health law, a psychologist licensed\nunder article one hundred fifty-three of the education law, or a\nfacility under the authority of an operating certificate issued pursuant\nto article sixteen, thirty-one or thirty-two of the mental hygiene law\nand with respect to outpatient hospital and clinic items and services\nprovided by a facility under the authority of an operating certificate\nissued pursuant to article twenty-eight of the public health law, shall\nnot be less than the amount of any co-insurance liability of such\neligible persons or such qualified medicare beneficiaries, or for which\nsuch eligible persons or such qualified medicare beneficiaries would be\nliable under federal law were they not eligible for medical assistance\nor were they not qualified medicare beneficiaries with respect to such\nbenefits under part B.\n  * NB Effective until April 1, 2027\n  * (iii) With respect to items and services provided to eligible\npersons who are also beneficiaries under part B of title XVIII of the\nfederal social security act and items and services provided to qualified\nmedicare beneficiaries under part B of title XVIII of the federal social\nsecurity act, the amount payable for services covered under this title\nshall be the amount of any co-insurance liability of such eligible\npersons pursuant to federal law were they not eligible for medical\nassistance or were they not qualified medicare beneficiaries with\nrespect to such benefits under such part B, but shall not exceed the\namount that otherwise would be made under this title if provided to an\neligible person other than a person who is also a beneficiary under part\nB or is a qualified medicare beneficiary minus the amount payable under\npart B; provided, however, amounts payable under this title for items\nand services provided to eligible persons who are also beneficiaries\nunder part B or to qualified medicare beneficiaries by an ambulance\nservice under the authority of an operating certificate issued pursuant\nto article thirty of the public health law, or a facility under the\nauthority of an operating certificate issued pursuant to article\nsixteen, thirty-one or thirty-two of the mental hygiene law and with\nrespect to outpatient hospital and clinic items and services provided by\na facility under the authority of an operating certificate issued\npursuant to article twenty-eight of the public health law, shall not be\nless than the amount of any co-insurance liability of such eligible\npersons or such qualified medicare beneficiaries, or for which such\neligible persons or such qualified medicare beneficiaries would be\nliable under federal law were they not eligible for medical assistance\nor were they not qualified medicare beneficiaries with respect to such\nbenefits under part B.\n  * NB Effective April 1, 2027\n  * (iv) If a health plan participating in part C of title XVIII of the\nfederal social security act pays for items and services provided to\neligible persons who are also beneficiaries under part B of title XVIII\nof the federal social security act or to qualified medicare\nbeneficiaries, the amount payable for services under this title shall be\neighty-five percent of the amount of any co-insurance liability of such\neligible persons pursuant to federal law if they were not eligible for\nmedical assistance or were not qualified medicare beneficiaries with\nrespect to such benefits under such part B; provided, however, amounts\npayable under this title for items and services provided to eligible\npersons who are also beneficiaries under part B or to qualified medicare\nbeneficiaries by an ambulance service under the authority of an\noperating certificate issued pursuant to article thirty of the public\nhealth law, or a psychologist licensed under article one hundred\nfifty-three of the education law, shall not be less than the amount of\nany co-insurance liability of such eligible persons or such qualified\nmedicare beneficiaries, or for which such eligible persons or such\nqualified medicare beneficiaries would be liable under federal law were\nthey not eligible for medical assistance or were they not qualified\nmedicare beneficiaries with respect to such benefits under part B.\n  * NB Effective until April 1, 2027\n  * (iv) If a health plan participating in part C of title XVIII of the\nfederal social security act pays for items and services provided to\neligible persons who are also beneficiaries under part B of title XVIII\nof the federal social security act or to qualified medicare\nbeneficiaries, the amount payable for services under this title shall be\nthe amount of any co-insurance liability of such eligible persons\npursuant to federal law if they were not eligible for medical assistance\nor were not qualified medicare beneficiaries with respect to such\nbenefits under such part B, but shall not exceed the amount that\notherwise would be made under this title if provided to an eligible\nperson other than a person who is also a beneficiary under part B or is\na qualified medicare beneficiary minus the amount payable under part B;\nprovided, however, amounts payable under this title for items and\nservices provided to eligible persons who are also beneficiaries under\npart B or to qualified medicare beneficiaries by an ambulance service\nunder the authority of an operating certificate issued pursuant to\narticle thirty of the public health law shall not be less than the\namount of any coinsurance liability of such eligible persons or such\nqualified medicare beneficiaries, or for which such eligible persons or\nsuch qualified medicare beneficiaries would be liable under federal law\nwere they not eligible for medical assistance or were they not qualified\nmedicare beneficiaries with respect to such benefits under part B.\n  * NB Effective April 1, 2027\n  (e) Amounts payable under this title for medical assistance in the\nform of clinic services pursuant to article twenty-eight of the public\nhealth law, article sixteen of the mental hygiene law and independent\npractitioner services for individuals with developmental disabilities\nprovided to eligible persons diagnosed with a developmental disability\nwho are also beneficiaries under part B of title XVIII of the federal\nsocial security act, or provided to persons diagnosed with a\ndevelopmental disability who are qualified medicare beneficiaries under\npart B of title XVIII of such act shall not be less than the approved\nmedical assistance payment level less the amount payable under part B.\n  (f) Amounts payable under this title for medical assistance in the\nform of outpatient mental health services under article thirty-one or\noutpatient chemical dependence services including opioid treatment\nservices under article thirty-two of the mental hygiene law provided to\neligible persons who are also beneficiaries under part B of title XVIII\nof the federal social security act or provided to qualified medicare\nbeneficiaries under part B of title XVIII of such act shall not be less\nthan the approved medical assistance payment level less the amount\npayable under part B.\n  (g) Notwithstanding any provision of this section to the contrary,\namounts payable under this title for medical assistance in the form of\nhospital outpatient services or diagnostic and treatment center services\npursuant to article twenty-eight of the public health law provided to\neligible persons who are also beneficiaries under part B of title XVIII\nof the federal social security act or provided to qualified medicare\nbeneficiaries under part B of title XVIII of such act shall not exceed\nthe approved medical assistance payment level less the amount payable\nunder part B.\n  (h) Amounts payable under this title for medical assistance in the\nform of freestanding clinic services pursuant to article twenty-eight of\nthe public health law provided to eligible persons participating in the\nNew York traumatic brain injury waiver program who are also\nbeneficiaries under part B of title XVIII of the federal social security\nact or who are qualified medicare beneficiaries under part B of title\nXVIII of such act shall not be less than the approved medical assistance\npayment level less the amount payable under part B.\n  2. (a) Any inconsistent provision of this chapter notwithstanding,\nprovision for medical care and other medical benefits available under\nthis title may be made, in whole or in part, either under this title or\nother appropriate provisions of this chapter, through insurance or other\nprepaid plans, in accordance with the regulations of the department.\n  (b) Any inconsistent provision of this chapter or other law\nnotwithstanding, upon furnishing assistance under this title to any\napplicant or recipient of medical assistance, the local social services\ndistrict or the department shall be subrogated, to the extent of the\nexpenditures by such district or department for medical care furnished,\nto any rights such person may have to medical support or reimbursement\nfrom liable third parties, including but not limited to health insurers,\nself-insured plans, group health plans, service benefit plans, managed\ncare organizations, pharmacy benefit managers, or other parties that\nare, by statute, contract, or agreement, legally responsible for payment\nof a claim for a health care item or service. For purposes of this\nsection, the term medical support shall mean the right to support\nspecified as support for the purpose of medical care by a court or\nadministrative order. The right of subrogation does not attach to\ninsurance benefits paid or provided under any health insurance policy\nprior to the receipt of written notice of the exercise of subrogation\nrights by the carrier issuing such insurance, nor shall such right of\nsubrogation attach to any benefits which may be claimed by a social\nservices official or the department, by agreement or other established\nprocedure, directly from an insurance carrier. No right of subrogation\nto insurance benefits available under any health insurance policy shall\nbe enforceable unless written notice of the exercise of such subrogation\nright is received by the carrier within three years from the date\nservices for which benefits are provided under the policy or contract\nare rendered. Liable third parties shall not deny a claim made by a\nsocial services official or the department in conformance with this\nparagraph solely on the basis of the date of submission of the claim,\nthe type or format of the claim form, a failure to obtain prior\nauthorization, or a failure to present proper documentation at the\npoint-of-sale that is the basis of the claim. Liable third parties shall\nrespond to a request for payment within sixty calendar days after\nreceipt of written proof of loss or claim for payment for health care\nservices provided to a recipient of Medicaid who is covered by the third\nparty and shall not charge a fee to process or adjudicate a claim. The\nlocal social services district or the department shall also notify the\ncarrier when the exercise of subrogation rights has terminated because a\nperson is no longer receiving assistance under this title. Such carrier\nshall establish mechanisms to maintain the confidentiality of all\nindividually identifiable information or records. Such carrier shall\nlimit the use of such information or record to the specific purpose for\nwhich such disclosure is made, and shall not further disclose such\ninformation or records.\n  (c) In accordance with regulations of the department and to the extent\nauthorized by federal law and regulation, the social services district\nis authorized to retain, in addition to amounts retained as repayment\nfor its share of the costs of medical assistance provided, a portion of\nthe federal share of the amount collected as medical support or third\nparty benefits assigned under paragraph (f) of subdivision four of\nsection three hundred sixty-six of this article, when such district, or\nother governmental agency pursuant to an agreement with such district,\nhas collected such medical support or third party benefits on behalf of\na person receiving medical assistance whose rights to medical support or\nthird party benefits have been assigned to the state or to the\nappropriate social services official. Where more than one district has\nbeen involved in enforcing or collecting such amounts, the federal\nincentive shall be apportioned among each such district in accordance\nwith the regulations of the department.\n  3. (a) As used in this subdivision, the following terms shall have the\nfollowing meanings:\n  (1) "Qualified medicare beneficiary" means a person who is entitled to\nhospital insurance benefits under part A of title XVIII of the federal\nsocial security act, whose income does not exceed one hundred\nthirty-eight percent of the official federal poverty line applicable to\nthe person's family size and whose resources do not exceed twice the\nmaximum amount of resources a person may have in order to qualify for\nbenefits under the federal supplemental security income program of title\nXVI of the federal social security act, as determined for purposes of\nsuch program. To the extent that federal financial participation is\navailable, a person whose resources are in excess of the amount\nspecified in this subparagraph but otherwise meets the requirements\nshall be considered a "qualified medicare beneficiary".\n  (2) "Qualified individual" means a person who is entitled to hospital\ninsurance benefits under part A of title XVIII of the federal social\nsecurity act and whose income is greater than one hundred thirty-eight\npercent, but less than or equal to one hundred eighty-six percent, of\nthe federal poverty line, for the applicable family size, and who is not\notherwise eligible for medical assistance under this article; referred\nto as a qualified individual.\n  (3) "Qualified disabled and working individual" means an individual\nwho is not otherwise eligible for medical assistance and:\n  (i) who is entitled to enroll for hospital insurance benefits under\nsection 1818A of part A of title XVIII of the federal social security\nact;\n  (ii) whose income does not exceed two hundred percent of the official\nfederal poverty line applicable to the person's family size; and\n  (iii) whose resources do not exceed twice the maximum amount of\nresources that an individual or a couple, in the case of a married\nindividual, may have and obtain federal supplemental security income\nbenefits under title XVI of the federal social security act, as\ndetermined for purposes of that program.\n  For purposes of this subparagraph, income and resources are determined\nby the same methodology as is used for determining eligibility under the\nfederal supplemental security income benefits under title XVI of the\nfederal social security act.\n  (b) Payment of premiums for enrolling qualified disabled and working\nindividuals and qualified medicare beneficiaries under Part A of title\nXVIII of the federal social security act and for enrolling such\nbeneficiaries and eligible recipients of public assistance under part B\nof title XVIII of the federal social security act, together with the\ncosts of the applicable co-insurance and deductible amounts on behalf of\nsuch beneficiaries, and recipients, and premiums under section 1839 of\nthe federal social security act shall be made and the cost thereof borne\nby the state or by the state and social services districts,\nrespectively, in accordance with the regulations of the department,\nprovided, however, that the share of the cost to be borne by a social\nservices district, if any, shall in no event exceed the proportionate\nshare borne by such district with respect to other expenditures under\nthis title. Moreover, if the director of the budget approves, payment of\npremiums for enrolling persons who have been determined to be eligible\nfor medical assistance only may be made and the cost thereof borne or\nshared pursuant to this subdivision.\n  (c) (1) Beginning April first, two thousand two and to the extent that\nfederal financial participation is available at a one hundred percent\nfederal Medical assistance percentage and subject to sections 1933 and\n1902(a)(10)(E)(iv) of the federal social security act, medical\nassistance shall be available for full payment of medicare part B\npremiums for qualified individuals.\n  (2) Premium payments for the individuals described in subparagraph one\nof this paragraph will be one hundred percent federally funded up to the\namount of the federal allotment. The department shall discontinue\nenrollment into the program when the part B premium payments made\npursuant to subparagraph one of this paragraph meet the yearly federal\nallotment.\n  (3) (i) The commissioner of health shall develop a simplified\napplication form, consistent with federal law, for payments pursuant to\nthis section. The commissioner of health, in cooperation with the office\nfor the aging, shall publicize the availability of such payments to\nmedicare beneficiaries.\n  (ii) Low-income subsidy data transmitted from the social security\nadministration to local departments of social services in accordance\nwith section 1144(c)(3) of the federal social security act shall be\ntreated as an application for the medicare savings program, without\nrequiring submission of another application. Any information verified by\nthe social security administration shall be accepted without further\nverification, if the information provided through low-income subsidy\ndata supports a determination of eligibility under this subdivision. The\ncommissioner of health shall report on an annual basis on the status of\nthe medicare savings program and the number of applications received by\nlocal social services districts under this article.\n  (d) (1) Payment of premiums for enrolling individuals in qualified\nhealth plans offered through a health insurance exchange established\npursuant to the federal Patient Protection and Affordable Care Act (P.L.\n111-148), as amended by the federal Health Care and Education\nReconciliation Act of 2010 (P.L. 111-152), shall be available to\nindividuals who:\n  (i) immediately prior to being enrolled in the qualified health plan,\nwere or would have been eligible under the family health plus program as\na parent or stepparent of a child under the age of twenty-one, and whose\nMAGI household income, as defined in subparagraph eight of paragraph (a)\nof subdivision one of section three hundred sixty-six of this title,\nexceeds one hundred thirty-three percent of the federal poverty line for\nthe applicable family size;\n  (ii) are not otherwise eligible for medical assistance under this\ntitle; and\n  (iii) are enrolled in a standard health plan in the silver level, as\ndefined in 42 U.S.C. 18022.\n  (2) Payment pursuant to this paragraph shall be for premium\nobligations of the individual under the qualified health plan and shall\ncontinue only if and for so long as the individual's MAGI household\nincome exceeds one hundred thirty-three percent, but does not exceed one\nhundred fifty percent, of the federal poverty line for the applicable\nfamily size, or, if earlier, until the individual is eligible for\nenrollment in a standard health plan pursuant to section three hundred\nsixty-nine-gg of this article.\n  (3) The commissioner of health shall submit amendments to the state\nplan for medical assistance and/or submit one or more applications for\nwaivers of the federal social security act as may be necessary to\nreceive federal financial participation in the costs of payments made\npursuant to this paragraph; provided further, however, that nothing in\nthis subparagraph shall be deemed to affect payments for premiums\npursuant to this paragraph if federal financial participation in the\ncosts of such payments is not available.\n  4. No social services district shall make final payments pursuant to\ntitle XIX of the federal social security act for benefits available\nunder title XVIII of such act without documentation that title XVIII\nclaims have been filed and denied.\n  5. (a) When medical care, services and supplies are furnished an\neligible person on behalf of a social services district under this\ntitle, such social services district is authorized to utilize any\nappropriate organization as a fiscal intermediary to audit and make\npayment for such district's share of the cost of such care, services and\nsupplies.\n  (b) To carry out the purposes of paragraph (a), the department, on\nbehalf of itself and any of the social services districts, may enter\ninto agreements with appropriate organizations to act as fiscal\nintermediaries.\n  6. (a) Notwithstanding any inconsistent provision of law, payment for\nclaims for services as specified in paragraph (d) of this subdivision\nfurnished to eligible persons under this title, subject to paragraph (b)\nof this subdivision shall be reduced in accordance with the provisions\nof paragraph (c) of this subdivision by an amount not to exceed the\nmaximum amount authorized by federal law and regulations as a co-payment\namount, which co-payment amount the provider of such services may charge\nthe recipient, provided, however, no provider may deny such services to\nan individual eligible for services based on the individual's inability\nto pay the co-payment amount.\n  (b) Co-payments shall apply to all eligible persons for the services\ndefined in paragraph (d) of this subdivision with the exception of:\n  (i) individuals under twenty-one years of age;\n  (ii) pregnant women;\n  (iii) individuals who are inpatients in a medical facility who have\nbeen required to spend all of their income for medical care, except\ntheir personal needs allowance or residents of community based\nresidential facilities licensed by the office of mental health or the\noffice for people with developmental disabilities who have been required\nto spend all of their income, except their personal needs allowance;\n  (iv) individuals enrolled in health maintenance organizations or other\nentities which provide comprehensive health services, or other managed\ncare programs for services covered by such programs, except that such\npersons, other than persons otherwise exempted from co-payments pursuant\nto subparagraphs (i), (ii), (iii) and (v) of this paragraph, and other\nthan those persons enrolled in a managed long term care program, shall\nbe subject to co-payments as described in subparagraph (v) of paragraph\n(d) of this subdivision;\n  (v) individuals whose family income is less than one hundred percent\nof the federal poverty line, as defined in subparagraph four of\nparagraph (a) of subdivision one of section three hundred sixty-six of\nthis title, for a family of the same size; and\n  (vi) any other individuals required to be excluded by federal law or\nregulations.\n  (b-1) The commissioner is authorized to submit any request or\napplication to the Centers for Medicare and Medicaid Services as may be\nnecessary to be granted a waiver of the requirement for the department\nof health to calculate its Medicaid payments to managed care\norganizations to include cost sharing established under the state plan\nfor medical assistance for enrollees who are not exempt from cost\nsharing. In the absence of such a waiver, the commissioner shall adjust\nMedicaid payments to managed care organizations beginning October first,\ntwo thousand fifteen or on the date the Centers for Medicare and\nMedicaid Services commences enforcement of such requirement, whichever\nis later.\n  * (c) (i) Co-payments charged pursuant to this subdivision for\nnon-institutional services shall not exceed the following table,\nprovided, however, that the department may establish standard\nco-payments for services based upon the average or typical payment for\nthat service:\n    State's payment                  Maximum co-payment\n    for the services               chargeable to recipient\n      $10 or less                           $.50\n      $10.01 to $25                        $1.00\n      $25.01 to $50                        $2.00\n      $50.01 or more                       $3.00\n  (ii) co-payments charged pursuant to this subdivision for each\ndischarge for inpatient care shall be twenty-five dollars.\n  (iii) Notwithstanding any other provision of this paragraph,\nco-payments charged for each generic prescription drug dispensed shall\nbe one dollar and for each brand name prescription drug dispensed shall\nbe two dollars and fifty cents; provided, however, that the co-payments\ncharged for each brand name prescription drug reimbursed pursuant to\nsubparagraph (ii) of paragraph (a-1) of subdivision four of section\nthree hundred sixty-five-a of this title shall be one dollar.\n  (iv) When an individual is initially dispensed or prescribed a seven\nor fewer days supply of an opioid pursuant to paragraph (b) of\nsubdivision five of section three thousand three hundred thirty-one of\nthe public health law, and is subsequently dispensed or prescribed an\nadditional supply of such opioid for the same underlying condition, the\ntotal co-payment that may be charged to such an individual for the\ninitial prescription plus all subsequent prescriptions for the same\nunderlying condition for up to a total of thirty-days supply of such\nopioid shall not exceed the amount set forth in subparagraph (iii) of\nthis paragraph.\n  * NB Repealed March 31, 2029\n  (d) Co-payments shall apply to the following services, subject to such\nexceptions for subcategories of these services as recognized by the\ncommissioner in regulations, provided in accordance with section three\nhundred sixty-five-a of this article and the regulations of the\ndepartment, to the extent permitted by title XIX of the federal social\nsecurity act:\n  (i) in-patient care in a general hospital, as defined in subdivision\nten of section twenty-eight hundred one of the public health law;\n  (ii) out-patient hospital and clinic services except for mental health\nservices, and developmental disability services, alcohol and substance\nabuse services and methadone maintenance services;\n  (iii) home health services, including services provided under the long\nterm home health care program, provided however, home health providers\nshall not require employees providing services in the home to collect\nthe co-payment amount;\n  (iv) sickroom supplies;\n  (v) drugs, excepting psychotropic drugs and drugs with FDA approved\nindications for the treatment of tuberculosis as specified by the\ndepartment and those drugs intended for use by residents of adult care\nfacilities licensed by the department of health who have been required\nto spend all of their income, except their personal needs allowance;\n  (vi) clinical laboratory services;\n  (vii) x-rays;\n  (viii) emergency room services provided for non-urgent or\nnon-emergency medical care, provided however, co-payments shall not be\nrequired for emergency services or family planning services and\nsupplies;\n  (e) In the period from January first, nineteen hundred ninety-three to\nMarch thirty-first, nineteen hundred ninety-three no recipient shall be\nrequired to pay more than a total of fifty dollars in co-payments\nrequired by this subdivision for drugs, nor shall reductions in payments\nas a result of such co-payments exceed fifty dollars for any recipient.\n  (f) (i) In the year commencing April first, nineteen hundred\nninety-three and for each year thereafter, and ending in the year\nconcluding on March thirty-first, two thousand five, no recipient shall\nbe required to pay more than a total of one hundred dollars in\nco-payments required by this subdivision, nor shall reductions in\npayments as a result of such co-payments exceed one hundred dollars for\nany recipient.\n  (ii) In the year commencing April first, two thousand five and for\neach year thereafter, no recipient shall be required to pay more than a\ntotal of two hundred dollars in co-payments required by this\nsubdivision, nor shall reductions in payments as a result of such\nco-payments exceed two hundred dollars for any recipient.\n  (g) The commissioner shall promptly:\n  (i) promulgate a regulation making it an unacceptable practice under\nthe medical assistance program for a provider to deny services to an\nindividual eligible for services based on the individual's inability to\npay the co-pay amount required by this subdivision;\n  (ii) establish and maintain a toll-free hotline which may be used to\nreport a violation of the regulation promulgated pursuant to\nsubparagraph (i) of this paragraph; and\n  (iii) provide notice to all recipients summarizing their rights and\nobligations under this subdivision.\n  7. (a) Every manufacturer or wholesaler of drugs, prescriptions or\npoisons registered under the provisions of section sixty-eight hundred\neight of the education law, shall, upon request of the department for\nany information pertaining to wholesale prices charged to pharmacists\nfor any drugs available under the medical assistance program, make the\nrequested information available to the department on a monthly basis, or\nsuch other periodic basis as the department shall request.\n  (b) The department shall provide for financial arrangements with any\nmanufacturer or wholesaler of drugs, prescriptions or poisons as may be\nnecessary to reimburse such manufacturer or wholesaler for its actual\nand necessary costs included in furnishing the requested information.\n  (c) Any information obtained pursuant to the provisions of this\nsubdivision shall not be made available for public inspection or copying\nunder the provisions of article six of the public officers law. The\ndepartment shall not disclose such information to any person, firm,\ndepartment or agency, except any state agency or department as may be\nnecessary for the administration of the medical assistance program under\nthe provisions of this chapter or any other law.\n  (d) Notwithstanding any inconsistent provision of law, if a\nmanufacturer (as defined under section 1927 of the federal social\nsecurity act) has entered into a rebate agreement with the department or\nwith the federal secretary of health and human services on behalf of the\ndepartment under section 1927 of the federal social security act, the\ndepartment shall reimburse for covered outpatient drugs which are\ndispensed under the medical assistance program to all persons in receipt\nof medical assistance benefits as a result of their eligibility having\nbeen established under subparagraph one or nine of paragraph (a) of\nsubdivision one of section three hundred sixty-six of this title, and\nwhich are dispensed to all persons eligible for health care services as\na result of their eligibility having been established under subdivision\ntwo of section three hundred sixty-nine-ee of this article, only\npursuant to the terms of the rebate agreement between the department and\nsuch manufacturer; provided, however, that any agreement between the\ndepartment and a manufacturer entered into before August first, nineteen\nhundred ninety-one, shall be deemed to have been entered into on April\nfirst, nineteen hundred ninety-one; and provided further, that if a\nmanufacturer has not entered into an agreement with the department\nbefore August first, nineteen hundred ninety-one, such agreement shall\nnot be effective until April first, nineteen hundred ninety-two, unless\nsuch agreement provides that rebates will be retroactively calculated as\nif the agreement had been in effect on April first, nineteen hundred\nninety-one. The rebate agreement between such manufacturer and the\ndepartment shall utilize for single source drugs and innovator multiple\nsource drugs the identical formula used to determine the basic rebate\nfor federal financial participation single source drugs and innovator\nmultiple source drugs, pursuant to paragraph one of subdivision (c) of\nsection 1927 of the federal social security act, to determine the amount\nof the rebate pursuant to this paragraph. The rebate agreement between\nsuch manufacturer and the department shall utilize for non-innovator\nmultiple source drugs the identical formula used to determine the basic\nrebate for federal financial participation non-innovator multiple source\ndrugs, pursuant to paragraphs three and four of subdivision (c) of\nsection 1927 of the federal social security act, to determine the amount\nof the rebate pursuant to this paragraph. The terms and conditions of\nsuch rebate agreement with respect to periodic payment of the rebate,\nprovision of information by the department, audits, manufacturer\nprovision of information verification of surveys, penalties,\nconfidentiality of information, and length of the agreement shall apply\nto drugs of the manufacturer dispensed under the medical assistance\nprogram to all persons in receipt of medical assistance benefits as a\nresult of their eligibility having been established under subparagraph\none or nine of paragraph (a) of subdivision one of section three hundred\nsixty-six of this title, and which are dispensed to all persons eligible\nfor health care services as a result of their eligibility having been\nestablished under subdivision two of section three hundred sixty-nine-ee\nof this article. The department in providing utilization data to a\nmanufacturer (as provided for under section 1927.4(b)(1)(A) of the\nfederal social security act) shall provide such data by zip code, if\nrequested, for drugs covered under a rebate agreement.\n  * (e) During the period from April first, two thousand fifteen through\nMarch thirty-first, two thousand twenty-nine, the commissioner may, in\nlieu of a managed care provider or pharmacy benefit manager, negotiate\ndirectly and enter into an arrangement with a pharmaceutical\nmanufacturer for the provision of supplemental rebates relating to\npharmaceutical utilization by enrollees of managed care providers\npursuant to section three hundred sixty-four-j of this title and may\nalso negotiate directly and enter into such an agreement relating to\npharmaceutical utilization by medical assistance recipients not so\nenrolled. Such rebate arrangements shall be limited to the following:\nantiretrovirals approved by the FDA for the treatment of HIV/AIDS,\naccelerated approval drugs established pursuant to this paragraph,\nopioid dependence agents and opioid antagonists listed in a statewide\nformulary established pursuant to subparagraph (vii) of this paragraph,\nhepatitis C agents, high cost drugs as provided for in subparagraph\n(viii) of this paragraph, gene therapies as provided for in subparagraph\n(ix) of this paragraph, and any other class or drug designated by the\ncommissioner for which the pharmaceutical manufacturer has in effect a\nrebate arrangement with the federal secretary of health and human\nservices pursuant to 42 U.S.C. § 1396r-8, and for which the state has\nestablished standard clinical criteria. No agreement entered into\npursuant to this paragraph shall have an initial term or be extended\nbeyond the expiration or repeal of this paragraph. For purposes of this\nparagraph, an "accelerated approval" is a drug or labeled indication of\na drug authorized by the Federal Food, Drug and Cosmetic Act for drugs\napproved under Subpart H of 21 CFR Part 314 and Subpart E of 21 CFR Part\n601 for serious conditions that fill an unmet medical need based on\nwhether the drug has an effect on a surrogate clinical endpoint, and is\npending verification of clinical benefit in confirmatory trials.\n  (i) The manufacturer shall not enter into any rebate arrangements with\na managed care provider, or any of a managed care provider's agents,\nincluding but not limited to any pharmacy benefit manager on the gene\ntherapy, drug, or drug classes subject to this paragraph when the state\nhas a rebate arrangement in place and standard clinical criteria are\nimposed on the managed care provider.\n  (ii) The commissioner shall establish adequate rates of reimbursement\nwhich shall take into account both the impact of the commissioner\nnegotiating such arrangements and any limitations imposed on the managed\ncare provider's ability to establish clinical criteria relating to the\nutilization of such drugs. In developing the managed care provider's\nreimbursement rate, the commissioner shall identify the amount of\nreimbursement for such drugs as a separate and distinct component from\nthe reimbursement otherwise made for prescription drugs as prescribed by\nthis section.\n  (iii) The commissioner shall submit a report to the temporary\npresident of the senate and the speaker of the assembly annually by\nDecember thirty-first. The report shall analyze the adequacy of rates to\nmanaged care providers for drug expenditures related to the classes\nunder this paragraph.\n  (iv) Nothing in this paragraph shall be construed to require a\npharmaceutical manufacturer to enter into a rebate arrangement\nsatisfactory to the commissioner relating to pharmaceutical utilization\nby enrollees of managed care providers pursuant to section three hundred\nsixty-four-j of this title or relating to pharmaceutical utilization by\nmedical assistance recipients not so enrolled.\n  (v) All clinical criteria, including requirements for prior approval,\nand all utilization review determinations established by the state as\ndescribed in this paragraph for the gene therapies, drugs, or drug\nclasses subject to this paragraph shall be developed using\nevidence-based and peer-reviewed clinical review criteria in accordance\nwith article two-A of the public health law, as applicable.\n  (vi) All prior authorization and utilization review determinations\nrelated to the coverage of any drug subject to this paragraph shall be\nsubject to article forty-nine of the public health law, section three\nhundred sixty-four-j of this title, and article forty-nine of the\ninsurance law, as applicable. Nothing in this paragraph shall diminish\nany rights relating to access, prior authorization, or appeal relating\nto any drug class or drug afforded to a recipient under any other\nprovision of law.\n  (vii) The department shall publish a statewide formulary of opioid\ndependence agents and opioid antagonists, which shall include as\n"preferred drugs" all drugs in such classes, which shall include all\nsubclasses of a given drug that have a different pharmacological route\nof administration, provided that:\n  (A) for all drugs that are included as of the date of the enactment of\nthis subparagraph on a formulary of a managed care provider, as defined\nin section three hundred sixty-four-j of this title, or in the Medicaid\nfee-for-service preferred drug program pursuant to section two hundred\nseventy-two of the public health law, the cost to the department for\nsuch drug is equal to or less than the lowest cost paid for the drug by\nany managed care provider or by the Medicaid fee-for-service program\nafter the application of any rebates, as of the date that the department\nimplements the statewide formulary established by this subparagraph.\nWhere there is a generic version of the drug approved by the Food and\nDrug Administration as bioequivalent to a brand name drug pursuant to 21\nU.S.C. § 355(j)(8)(B), the cost to the department for the brand and\ngeneric versions shall be equal to or less than the lower of the two\nmaximum costs determined pursuant to the previous sentence; and\n  (B) for all drugs that are not included as of the date of the\nenactment of this subparagraph on a formulary of a managed care\nprovider, as defined in section three hundred sixty-four-j of this\ntitle, or in the Medicaid fee-for-service preferred drug program\npursuant to section two hundred seventy-two of the public health law,\nthe department is able to obtain the drug at a cost that is equal to or\nless than the lowest cost to the department of other comparable drugs in\nthe class, after the application of any rebates. Where there is a\ngeneric version of the drug approved by the Food and Drug Administration\nas bioequivalent to a brand name drug pursuant to 21 U.S.C. §\n355(j)(8)(B), the cost to the department for the brand and generic\nversions shall be equal to or less than the lower of the two maximum\ncosts determined pursuant to the previous sentence.\n  (viii) The commissioner may identify and refer high cost drugs, as\ndefined in clause (D) of this subparagraph, that are not included as of\nthe date of the enactment of this subparagraph on a formulary of a\nmanaged care provider or covered by the Medicaid fee for service of\nprogram to the drug utilization review board established by section\nthree hundred sixty-nine-bb of this article for a recommendation as to\nwhether a target supplemental Medicaid rebate should be paid by the\nmanufacturer of the drug to the department and the target amount of the\nrebate.\n  (A) If the commissioner intends to refer a high cost drug to the drug\nutilization review board pursuant to this subparagraph, the commissioner\nshall notify the manufacturer of such drug and shall attempt to reach\nagreement with the manufacturer on a rebate arrangement satisfactory to\nthe commissioner for the drug prior to referring the drug to the drug\nutilization review board for review. Such arrangement may be based on\nevidence based research, including, but not limited to, such research\noperated or conducted by or for other state governments, the federal\ngovernment, the governments of other nations, and third party payers or\nmulti-state coalitions, provided however that the department shall\naccount for the effectiveness of the drug in treating the conditions for\nwhich it is prescribed or in improving a patient's health, quality of\nlife, or overall health outcomes, and the likelihood that use of the\ndrug will reduce the need for other medical care, including\nhospitalization.\n  (B) In the event that the commissioner and the manufacturer have\npreviously agreed to a rebate arrangement for a drug pursuant to this\nparagraph, the drug shall not be referred to the drug utilization review\nboard for any further rebate agreement for the duration of the previous\nrebate agreement, provided however, the commissioner may refer a drug to\nthe drug utilization review board if the commissioner determines there\nare significant and substantiated utilization or market changes, new\nevidence-based research, or statutory or federal regulatory changes that\nwarrant additional rebates. In such cases, the department shall notify\nthe manufacturer and provide evidence of the changes or research that\nwould warrant additional rebates, and shall attempt to reach agreement\nwith the manufacturer on a rebate for the drug prior to referring the\ndrug to the drug utilization review board for review.\n  (C) If the commissioner is unsuccessful in entering into a rebate\narrangement with the manufacturer of the drug satisfactory to the\ndepartment, the drug manufacturer shall in that event be required to\nprovide to the department, on a standard reporting form developed by the\ndepartment, the information as described in subdivision six of section\ntwo hundred eighty of the public health law. All information disclosed\npursuant to this clause shall be considered confidential and shall not\nbe disclosed by the department in a form that identifies a specific\nmanufacturer or prices charged for drugs by such manufacturer.\n  (D) For the purposes of this subparagraph, the term "high cost drug"\nshall mean a brand name drug or biologic that has a launch wholesale\nacquisition cost of thirty thousand dollars or more per year or course\nof treatment, or a biosimilar drug that has a launch wholesale\nacquisition cost that is not at least fifteen percent lower than the\nreferenced brand biologic at the time the biosimilar is launched, or a\ngeneric drug that has a wholesale acquisition cost of one hundred\ndollars or more for a thirty day supply or recommended dosage approved\nfor labeling by the federal Food and Drug Administration, or a brand\nname drug or biologic that has a wholesale acquisition cost increase of\nthree thousand dollars or more in any twelve-month period, or course of\ntreatment if less than twelve months.\n  (ix) For purposes of this paragraph, a "gene therapy" is a drug (A)\napproved under section 505 of the Federal Food, Drug and Cosmetics Act\nor licensed under subsection (a) or (k) of section 351 of the Public\nHealth Services Act; (B) that treats a rare disease or condition, as\ndefined in 21 USC § 360bb(a)(2), that is life-threatening, as defined in\n42 CFR 321.18; (C) is considered a gene therapy by the federal Food and\nDrug Administration for which a biologics license pursuant to 21 CFR\n600-680 is held; (D) if administered in accordance with the labeling of\nsuch drug, is expected to result in either the cure of such disease or\ncondition or a reduction in the symptoms of such disease or condition\nthat materially improves the patient's length or quality of life; and\n(E) is expected to achieve the result described in clause (D) of this\nsubparagraph after not more than three administrations.\n  * NB Repealed March 31, 2032\n  * 8. No government agency shall purchase, pay for, or make\nreimbursement or grants-in-aid for any service in a residential\ntreatment facility for children and youth or a comprehensive psychiatric\nemergency program unless at the time such service was provided, the\nresidential treatment facility for children and youth or comprehensive\npsychiatric emergency program possessed a valid operating certificate\nauthorizing such service. Notwithstanding any inconsistent provision of\nlaw, no government agency shall make payments pursuant to this title or\ntitle nineteen of the federal social security act to a residential\ntreatment facility for children and youth for service to a person whose\nneed for care and treatment in such a facility was not certified\npursuant to section 9.51 of the mental hygiene law.\n  * NB Effective until July 1, 2027\n  * 8. No government agency shall purchase, pay for, or make\nreimbursement or grants-in-aid for any service in a residential\ntreatment facility for children and youth unless at the time such\nservice was provided, the residential treatment facility for children\nand youth possessed a valid operating certificate authorizing such\nservice. Notwithstanding any inconsistent provision of law, no\ngovernment agency shall make payments pursuant to this title or title\nnineteen of the federal social security act to a residential treatment\nfacility for children and youth for service to a person whose need for\ncare and treatment in such a facility was not certified pursuant to\nsection 9.51 of the mental hygiene law.\n  * NB Effective July 1, 2027\n  * 9. Notwithstanding any inconsistent provision of law or regulation\nto the contrary, for those drugs which may not be dispensed without a\nprescription as required by section sixty-eight hundred ten of the\neducation law and for which payment is authorized pursuant to paragraph\n(g) of subdivision two of section three hundred sixty-five-a of this\ntitle, and for those drugs that are available without a prescription as\nrequired by section sixty-eight hundred ten of the education law but are\nreimbursed as items of medical assistance pursuant to paragraph (a) of\nsubdivision four of section three hundred sixty-five-a of this title,\npayments under this title shall be made at the following amounts:\n  (a) for drugs provided by medical practitioners and claimed separately\nby the practitioners the lower of:\n  (i) (1) an amount equal to the national average drug acquisition cost\nset by the federal centers for medicare and medicaid services for the\ndrug, if any, or if such amount is not available, the wholesale\nacquisition cost of the drug based on the package size dispensed from,\nas reported by the prescription drug pricing service used by the\ndepartment, (2) the federal upper limit, if any, established by the\nfederal centers for medicare and medicaid services; (3) the state\nmaximum acquisition cost, if any, established pursuant to paragraph (e)\nof this subdivision; or (4) the actual cost of the drug to the\npractitioner.\n  (ii) Notwithstanding subparagraph (i) of this paragraph and paragraph\n(e) of this subdivision, for the Medicaid fee-for-service program, if a\ndrug has been purchased from a manufacturer by a covered entity pursuant\nto section 340B of the federal public health service act (42 USCA §\n256b), the actual amount paid by such covered entity. For purposes of\nthis subparagraph, a "covered entity" is an entity that meets the\nrequirements of paragraph four of subdivision (a) of such section that\nelects to participate in the program established by such section, and\nthat causes claims for payment for drugs covered by this subparagraph to\nbe submitted to the medical assistance program, either directly or\nthrough an authorized contract pharmacy. No medical assistance payments\nmay be made to a covered entity or to an authorized contract pharmacy of\na covered entity for drugs that are eligible for purchase under the\nsection 340B program and are dispensed on an outpatient basis to\npatients of the covered entity, other than under the provisions of this\nsubparagraph. Medical practitioners submitting claims for reimbursement\nof drugs purchased pursuant to section 340B of the public health service\nact shall notify the department that the claim is eligible for purchase\nunder the 340B program, consistent with claiming instructions issued by\nthe department to identify such claims.\n  (iii) In no event shall a medical practitioner be reimbursed at an\namount that is lower than the state maximum acquisition cost, or for\ndrugs that do not have a state maximum acquisition cost, the wholesale\nacquisition cost of the drug based on the package size.\n  (b) for drugs dispensed by pharmacies:\n  (i) (A) if the drug dispensed is a generic prescription drug, the\nlower of: (1) an amount equal to the national average drug acquisition\ncost set by the federal centers for medicare and medicaid services for\nthe drug, if any, or if such amount if not available, the wholesale\nacquisition cost of the drug based on the package size dispensed from,\nas reported by the prescription drug pricing service used by the\ndepartment, less seventeen and one-half percent thereof; (2) the federal\nupper limit, if any, established by the federal centers for medicare and\nmedicaid services; (3) the state maximum acquisition cost, if any,\nestablished pursuant to paragraph (e) of this subdivision; or (4) the\ndispensing pharmacy's usual and customary price charged to the general\npublic; (B) if the drug dispensed is available without a prescription as\nrequired by section sixty-eight hundred ten of the education law but is\nreimbursed as an item of medical assistance pursuant to paragraph (a) of\nsubdivision four of section three hundred sixty-five-a of this title,\nthe lower of (1) an amount equal to the national average drug\nacquisition cost set by the federal centers for medicare and medicaid\nservices for the drug, if any, or if such amount is not available, the\nwholesale acquisition cost of the drug based on the package size\ndispensed from, as reported by the prescription drug pricing service\nused by the department, (2) the federal upper limit, if any, established\nby the federal centers for medicare and medicaid services; (3) the state\nmaximum acquisition cost if any, established pursuant to paragraph (e)\nof this subdivision; or (4) the dispensing pharmacy's usual and\ncustomary price charged to the general public;\n  (ii) if the drug dispensed is a brand-name prescription drug, the\nlower of:\n  (A) an amount equal to the national average drug acquisition cost set\nby the federal centers for medicare and medicaid services for the drug,\nif any, or if such amount is not available, the wholesale acquisition\ncost of the drug based on the package size dispensed from, as reported\nby the prescription drug pricing service used by the department; or (B)\nthe dispensing pharmacy's usual and customary price charged to the\ngeneral public; and\n  (iii) notwithstanding subparagraphs (i) and (ii) of this paragraph and\nparagraphs (d) and (e) of this subdivision, if the drug dispensed is a\ndrug that has been purchased from a manufacturer by a covered entity\npursuant to section 340B of the federal public health service act (42\nUSCA § 256b), the actual amount paid by such covered entity pursuant to\nsuch section, plus the reasonable administrative costs, as determined by\nthe commissioner, incurred by the covered entity or by an authorized\ncontract pharmacy in connection with the purchase and dispensing of such\ndrug and the tracking of such transactions. For purposes of this\nsubparagraph, a "covered entity" is an entity that meets the\nrequirements of paragraph four of subsection (a) of such section, that\nelects to participate in the program established by such section, and\nthat causes claims for payment for drugs covered by this subparagraph to\nbe submitted to the medical assistance program, either directly or\nthrough an authorized contract pharmacy. No medical assistance payments\nmay be made to a covered entity or to an authorized contract pharmacy of\na covered entity for drugs that are eligible for purchase under the\nsection 340B program and are dispensed on an outpatient basis to\npatients of the covered entity, other than under the provisions of this\nsubparagraph. Pharmacies submitting claims for reimbursement of drugs\npurchased pursuant to section 340B of the public health service act\nshall notify the department that the claim is eligible for purchase\nunder the 340B program, consistent with claiming instructions issued by\nthe department to identify such claims.\n  (c) Notwithstanding subparagraph (i) of paragraph (b) of this\nsubdivision, if a qualified prescriber certifies "brand medically\nnecessary" or "brand necessary" in his or her own handwriting directly\non the face of a prescription, or in the case of electronic\nprescriptions, inserts an electronic direction to clarify "brand\nmedically necessary" or "brand necessary", for a multiple source drug\nfor which a specific upper limit of reimbursement has been established\nby the federal agency, in addition to writing "d a w" in the box\nprovided for such purpose on the prescription form, payment under this\ntitle for such drug must be made under the provisions of subparagraph\n(ii) of such paragraph.\n  (d) In addition to the amounts paid pursuant to paragraph (b) of this\nsubdivision, the department shall pay a professional pharmacy dispensing\nfee for each such drug dispensed in the amount of ten dollars and eight\ncents per prescription or written order of a practitioner; provided,\nhowever that this professional dispensing fee will not apply to drugs\nthat are available without a prescription as required by section\nsixty-eight hundred ten of the education law but do not meet the\ndefinition of a covered outpatient drug pursuant to Section 1927K of the\nSocial Security Act.\n  (e) For a multiple source generic drug for which no specific upper\npayment limit has been established by the federal centers for medicare\nand medicaid services, the commissioner of health may establish a\nmaximum acquisition cost for such drug which shall be effective until\nsuch time as a specific federal upper payment limit has been established\nfor such drug. The department shall use a similar methodology in\nestablishing such an interim price as that utilized by the centers for\nmedicare and Medicaid services in establishing the federal upper payment\nlimit. For this purpose, the department is authorized to enter into a\ncontract with an entity to provide technical and administrative support\nto the commissioner of health.\n  (g) Notwithstanding any other provision of this subdivision to the\ncontrary, the department is authorized to implement a specialty pharmacy\nprogram for the purpose of procuring certain specialty drugs at reduced\ncost. The department is authorized to enter into contracts with one or\nmore contractors in order to obtain certain specialty drugs from a\nlimited number of sources at reduced prices. For purposes of this\nparagraph, specialty drugs include, but are not limited to, chemotherapy\nagents, hydration therapy agents, pain therapy agents, intravenous\nadministration of antibiotics or other drugs, and total parenteral\nnutrition. All contracts entered into by the department to effectuate\nthe provisions of this section shall require the contractors to take\nsteps to assure that drugs provided pursuant to such contracts will be\nreadily accessible to consumers in a fashion that is no more restrictive\nthan that which was in effect prior to the implementation of the\nspecialty pharmacy program. This paragraph shall be effective only to\nthe extent that federal financial participation is available in the cost\nof drugs obtained pursuant to this paragraph. The commissioner of health\nis authorized to submit amendments to the state plan for medical\nassistance and to submit applications for waivers under the social\nsecurity act to obtain the federal approvals necessary to implement this\nparagraph. However, any pharmacy owned and operated by a not-for-profit\norganization solely for the purpose of providing drugs to individuals\ndiagnosed with cystic fibrosis as part of a comprehensive clinical care\nprogram approved by the national organization that accredits cystic\nfibrosis care centers and maintains a national registry of cystic\nfibrosis clinical data shall be exempt from the specialty pharmacy\nprogram.\n  (h) The commissioner of health is authorized to establish a medication\ntherapy management pilot program in one or more counties or regions of\nthe state for the purpose of improving compliance with drug therapies\nand improving clinical outcomes. Payments under such program may be made\nto retail pharmacies for the provision of one-on-one medication regimen\ncounseling services for persons determined by the commissioner to be\neligible to receive such services. The commissioner is authorized to\nestablish fees for such counseling services, subject to the approval of\nthe director of the division of the budget. The provisions of this\nparagraph shall not take effect unless all necessary approvals under\nfederal law and regulation have been obtained to receive federal\nfinancial participation in the costs of services provided under this\nparagraph.\n  (i)(i) The department of health shall establish a program for\nsynchronization of medications. Under the synchronization program, a\nhealth care practitioner may prescribe a refill of one or more of the\npatient's medications for a shorter period than would ordinarily be\nprovided, for the purpose of synchronizing refill dates of one or more\nof the patient's medications subject to the synchronization when it is\nagreed among the recipient, the health care practitioner and a\npharmacist that synchronization of multiple prescriptions for the\ntreatment of a chronic illness is in the best interest of the patient\nfor the management or treatment of a chronic illness provided that the\nfollowing apply to such medications:\n  (A) are covered by the department of health pursuant to this title;\n  (B) are used for treatment and management of a chronic illness that\nare subject to refills;\n  (C) are not a schedule II controlled substance, nor a schedule III\ncontrolled substance that contains hydrocodone or other opioid\nmedication as scheduled in section thirty-three hundred six of the\npublic health law, or a controlled substance under the federal\nControlled Substances Act;\n  (D) meet all prior authorization criteria specific to the medications\nat the time of the synchronization request;\n  (E) are of a formulation that can be effectively and lawfully aligned\nover required short fill periods to achieve synchronization; and\n  (F) do not have quantity limits or dose optimization criteria or state\nor federal requirements that would be violated in fulfilling\nsynchronization.\n  (ii) The department of health shall not deny coverage for the\ndispensing of a medication by a pharmacy for a partial supply when it is\nfor the purpose of synchronizing the patient's medications. When\napplicable to permit synchronization, the department of health shall\nallow a pharmacy to override any denial codes indicating that a\nprescription is being refilled too soon for the purposes of medication\nsynchronization.\n  (iii) The dispensing fee paid to the pharmacy contracted to provide\nservices pursuant to this section for a partial supply associated with\nmedication synchronization shall be paid in accordance with the Medicaid\nstate plan as approved by the Centers for Medicare and Medicaid\nServices.\n  (iv) The requirement of this paragraph applies only once for each\nprescription drug subject to medication synchronization except when\neither of the following occurs:\n  (I) the prescriber changes the dosage or frequency of administration\nof the prescription drug subject to a medication synchronization; or\n  (II) the prescriber prescribes a different drug.\n  (v) Nothing in this paragraph shall be deemed to require health care\npractitioners and pharmacists to synchronize the refilling of multiple\nprescriptions for a recipient.\n  (vi) The provisions of this paragraph are subject to compliance with\nall applicable federal and state laws and regulations, including the\nCenters for Medicare and Medicaid Services approved Medicaid state plan.\nThe commissioner shall apply for waivers and submit state Medicaid plan\namendments as are necessary to implement the program for synchronization\nof medications.\n  * NB Effective until March 31, 2029\n  * 9. Notwithstanding any inconsistent provision of law or regulation\nto the contrary, for those drugs which may not be dispensed without a\nprescription as required by section sixty-eight hundred ten of the\neducation law and for which payment is authorized pursuant to paragraph\n(g) of subdivision two of section three hundred sixty-five-a of this\ntitle, payments under this title shall be made at the following amounts:\n  (a) for drugs provided by medical practitioners and claimed separately\nby the practitioners, the actual cost of the drugs to the practitioners;\nand\n  (b) for drugs dispensed by pharmacies:\n  (i) if the drug dispensed is a multiple source prescription drug for\nwhich an upper limit has been set by the federal health care financing\nadministration, an amount equal to the specific upper limit set by such\nfederal agency for the multiple source prescription drug, and\n  (ii) if the drug dispensed is a multiple source prescription drug or a\nbrand-name prescription drug for which no specific upper limit has been\nset by such federal agency, the lower of the estimated acquisition cost\nof such drug to pharmacies, or the dispensing pharmacy's usual and\ncustomary price charged to the general public. Estimated acquisition\ncost means the average wholesale price of a prescription drug based upon\nthe package size dispensed from, as reported by the prescription drug\npricing service used by the department, less ten percent thereof, and\nupdated monthly by the department.\n  (c) Notwithstanding subparagraph (i) of paragraph (b) of this\nsubdivision, if a qualified prescriber certifies "brand medically\nnecessary" or "brand necessary" in his or her own handwriting directly\non the face of a prescription for a multiple source drug for which a\nspecific upper limit of reimbursement has been established by the\nfederal agency, in addition to writing "d a w" in the box provided for\nsuch purpose on the prescription form, payment under this title for such\ndrug must be made under the provisions of subparagraph (ii) of such\nparagraph.\n  (d) In addition to the amounts paid pursuant to paragraph (b) of this\nsubdivision to pharmacies for those drugs which may not be dispensed\nwithout a prescription, as required by section sixty-eight hundred ten\nof the education law and for which payment is authorized pursuant to\nparagraph (g) of subdivision two of section three hundred sixty-five-a\nof this title, the department shall pay a pharmacy dispensing fee for\neach such prescription drug dispensed, which dispensing fee shall not be\nless than the following amounts:\n  (i) for prescription drugs categorized as generic by the prescription\ndrug pricing service used by the department, five dollars and fifty\ncents per prescription; and\n  (ii) for prescription drugs categorized as brand-name prescription\ndrug by the prescription drug pricing service used by the department,\nfour dollars and fifty cents per prescription.\n  * NB Effective March 31, 2029\n  10. Any provider except for those providers certified under article\ntwenty-eight of the public health law, of ordered services or supplies\nunder the medical assistance program may be required to provide\nfinancial security to assure that funds are available to repay any\noverpayments made to the provider under this title and to assure the\nfinancial security of the medical assistance program. For the purposes\nof this subdivision, "ordered services or supplies" shall mean those\nservices or supplies described in paragraphs (g), (i) and (j) of\nsubdivision two of section three hundred sixty-five-a of this title.\n  (a) Any financial security required by this subdivision must meet the\nrequirements of this paragraph. Financial security may be provided\nthrough a bond with a corporate surety, from a company authorized to do\nbusiness in this state, or an irrevocable letter of credit or\ncertificate of deposit from a New York state or federally chartered\nbank, trust company, savings bank or savings and loan association\nqualified to do business in New York state and insured by the federal\ndeposit insurance corporation.\n  (b) The bond, letter of credit or certificate of deposit shall be\npayable in favor of the people of the state of New York for the purpose\nof indemnifying the medical assistance program against any overpayments\nmade to the provider.\n  (c) The bond, letter of credit or certificate of deposit filed and\nmaintained pursuant to this section shall not be cancelled, revoked or\nterminated except after notice to, and with the consent of, the\ndepartment at least forty-five days in advance of such cancellation,\nrevocation or termination.\n  (d) The department may bring and maintain an action against the\nprovider and the surety or bank, trust company, savings bank or savings\nand loan association for any claimed overpayments made to the provider.\n  (e) Financial security shall not be required for providers which do\nnot submit claims for payment under the medical assistance program\nexceeding five hundred thousand dollars per annum or forty-two thousand\ndollars per month.\n  (f) Financial security shall be in an amount equal to the provider's\nestimated claims for payment for a one year period and may be adjusted\nbi-annually in accordance with the dollar amount of claims actually\nsubmitted. If the commissioner is satisfied from an investigation of the\nfinancial condition of a provider that the provider is solvent and\npossessed of sufficient assets to provide reasonable assurance of\nrecovery of any overpayments, the commissioner may modify the amount of\nfinancial security to be provided by such provider.\n  (g) Financial security must be submitted by a provider upon initial\napplication for enrollment as a provider of medical assistance and with\neach subsequent enrollment. A change in ownership of a provider shall\nnot release, cancel or terminate liability under this section under any\nbond, letter of credit or certificate of deposit filed for a provider\nwhile such bond, letter of credit or certificate of deposit is in effect\nunless the transferee, purchaser, successor or assignee of such provider\nobtains a bond, letter of credit or certificate of deposit under this\nsection for the benefit of such new owner. All providers enrolled in the\nmedical assistance program on the effective date of this subdivision\nwill be required to submit financial security within ninety days of\nnotice of such requirements by the department.\n  (h) The department may make the submission of the financial security\nrequired by this subdivision a condition of participation in the medical\nassistance program.\n  11. (a) Any inconsistent provisions of this title or other law\nnotwithstanding, no health insurer, self-insured plan, managed care\norganization, pharmacy benefit manager, or other party that is, by\nstatute, contract, or agreement, legally responsible for payment of a\nclaim for a health care item or service, employer or organization who\nhas a plan, including an employee retirement income security act or\nservice benefit plan, providing care and other medical benefits for\npersons, whether by insurance or otherwise, shall exclude a person from\neligibility, coverage or entitlement to medical benefits by reason of\nthe eligibility of such person for medical assistance under this title,\nor by reason of the fact that such person would, except for such plan,\nbe eligible for benefits under this title.\n  (b) Any inconsistent provisions of this title or other law\nnotwithstanding, no insurer may impose requirements on the department or\na social services district which has been assigned the rights of an\nindividual who is eligible for medical assistance under this title and\nwho is covered for health benefits from the insurer, that are different\nfrom requirements applicable to an agent or assignee of any other\nindividual so covered.\n  (c) Any inconsistent provisions of this title or other law\nnotwithstanding, the department may, to the extent necessary to\nreimburse the department and the social services districts for\nexpenditures under this title, certify to the commissioner of taxation\nand finance pursuant to section one hundred seventy-one-f of the tax law\namounts to be withheld from tax refunds otherwise due to any individual\nwho is required by court order to provide medical support in the form of\nhealth insurance benefits for a child who is eligible for medical\nassistance under this title and who has received payment from a\nthird-party for the cost of such services for such child but has not\nused such payments to reimburse either the other parent or guardian of\nsuch child or the provider of such services or the appropriate social\nservices district; provided however, that any claims for current or\npast-due child support shall take priority over any such claims for the\ncosts of such services and care. Such amounts shall be withheld pursuant\nto section one hundred seventy-one-f of the tax law, and shall be\ncredited to unreimbursed medical assistance incurred on behalf of such\nchild. The department shall by regulation establish procedures\nconsistent with paragraphs (a) and (b) of subdivision four of section\none hundred seventy-one-c of the tax law by which any individual who is\nthe subject of a certification may contest such certification.\n  12. Prior to receiving medical assistance under subparagraphs five and\nsix of paragraph (c) of subdivision one of section three hundred\nsixty-six of this title, a person whose net available income is at least\none hundred fifty percent of the applicable federal income official\npoverty line, as defined and updated by the United States department of\nhealth and human services, must pay a monthly premium, in accordance\nwith a procedure to be established by the commissioner. The amount of\nsuch premium shall be twenty-five dollars for an individual who is\notherwise eligible for medical assistance under such subparagraphs, and\nfifty dollars for a couple, both of whom are otherwise eligible for\nmedical assistance under such subparagraphs. No premium shall be\nrequired from a person whose net available income is less than one\nhundred fifty percent of the applicable federal income official poverty\nline, as defined and updated by the United States department of health\nand human services.\n
N.Y. SOS Law § 364-B — New York Code / Act SOS / Article 5 / Title 11 / Section 364-B
Residential and medical care placement demonstration projects
Status: in_force

* § 364-b. Residential and medical care placement demonstration\nprojects.  1.  Notwithstanding any inconsistent provisions of this\nchapter or any other law to the contrary, social services districts are\nhereby authorized to conduct or participate in time-limited\ndemonstration projects for the purpose of demonstrating the feasibility\nof reducing medical assistance expenditures for care in residential\nhealth facilities by utilizing medical assistance funds for:  (a)\nconducting initial assessments of, and performing case management\nfunctions, for (i) persons financially eligible for medical assistance\npursuant to this title who request long term care services, and (ii)\npersons whether or not otherwise financially eligible for medical\nassistance who seek care in or discharge from a residential health care\nfacility or a congregate care facility as described in section two\nhundred nine of this chapter, and (b) providing social services and\nmedical supplies determined to be necessary and appropriate as a result\nof assessments conducted pursuant to paragraph (a) hereof, to those\npersons participating in an approved project who are otherwise eligible\nto receive medical assistance, whether or not such services or supplies\nare authorized to be provided under this title; provided, however, that\nno such additional services or supplies provided hereunder shall be\nsubject to state reimbursement unless prior approval to provide such\nservices or supplies to persons eligible for medical assistance has been\ngranted by the department.  Such demonstration projects may be conducted\nor participated in by a social services district only in accordance with\na plan submitted to the department on or before the thirtieth day of\nJune, nineteen hundred seventy-seven, and only to the extent and period\nfor which such plan has been approved or from time to time extended by\nthe commissioner.\n  2.  Any plan submitted pursuant to this section shall provide that in\nany case in which it is determined by an assessment conducted in\naccordance with such a project that placement in a skilled nursing\nfacility or an intermediate care facility would be appropriate, such\nplacement shall be subject to review and approval by the department of\nhealth provided, however, that the commissioner of health may delegate\npreplacement assessment review function to such a project.  In addition,\nany plan submitted pursuant to this section shall include a description\nof any assessment methodology utilized in determining the\nappropriateness of placements in skilled nursing facilities or\nintermediate care facilities and any such plan may be approved by the\ncommissioner only after such methodology has been submitted to the\ndepartment of health for its review and comment.\n  3.  Notwithstanding any inconsistent provision of law to the contrary,\nexpenditures made in connection with an approved residential and medical\ncare placement demonstration project for assessments, case management\nand social services and medical supplies authorized to be provided by\nthis title or approved by the department, shall be subject to state\nreimbursement under section three hundred sixty-eight-a of the social\nservices law in accordance with a schedule of maximum reimbursable\namounts established by the department for such services and supplies.\n  4.  Notwithstanding any inconsistent provision of this chapter or any\nother law to the contrary, the commissioner may, subject to the approval\nof the director of the budget, approve such demonstration projects and\napply for the appropriate waivers under federal law and regulation and\nmay waive:  (a) any provision of this title or regulation of the\ndepartment as may be necessary to make medical assistance funds\navailable for initial assessment and performing case management\nfunctions for persons participating in such approved projects without\nregard to their eligibility to participate in the medical assistance\nprogram and when appropriate, providing additional approved social\nservices and medical supplies, not otherwise authorized under this\ntitle, to persons participating in such approved projects who are\notherwise eligible to participate in the medical assistance program; and\n(b) such department regulations relating thereto as may be necessary to\nenable a social services district to carry out such project.\n  5.  The commissioner shall require that a final independent evaluation\nbe made of any demonstration project approved and conducted hereunder in\na form mutually agreed upon by him and the state commissioner of health,\nand shall provide copies of such report to the governor and to the\nlegislature.  In addition the commissioner shall submit annual interim\nreports on the progress of each project to the governor and legislature\nby the first day of February of each year.\n  * NB Expired September 30, 1986\n
N.Y. SOS Law § 368-A — New York Code / Act SOS / Article 5 / Title 11 / Section 368-A
State reimbursement
Status: in_force

§ 368-a. State reimbursement. 1. The department shall review the\nexpenditures made by social services districts for medical assistance\nfor needy persons, and the administration thereof, before making\nreimbursement. Before approving such expenditures for reimbursement, the\ndepartment shall give due consideration to the results of the reviews\nand audits conducted by the department of health pursuant to subdivision\ntwo of section three hundred sixty-four. If approved by the department,\nsuch expenditures shall not be subject to reimbursement by the state\npursuant to section one hundred fifty-three or any provision of this\nchapter other than this section, but shall be subject to reimbursement\nby the state in accordance with this section and the regulations of the\ndepartment, as follows:\n  There shall be paid to each such district\n  (a) the amount of federal funds, if any, properly received or to be\nreceived on account of such expenditures;\n  (b) the full amount expended on behalf of the department for medical\nassistance furnished under this title to eligible patients in state\ninstitutions for the mentally disabled, in facilities or parts thereof\nfor the care and treatment of drug dependent persons operated pursuant\nto the mental hygiene law and in other hospitals while such patients are\non release from an institution in the state department of mental hygiene\nor from a drug abuse treatment facility or part thereof operated in\ncompliance with applicable provisions of law and supervised by the state\ndivision of substance abuse services, to eligible veterans and their\ndependents in that part of the New York state home for veterans and\ntheir dependents at Oxford that has been approved pursuant to law as a\nnursing home and in a hospital while on release from that home for the\npurpose of receiving care in such hospital, in that part of a public\ninstitution operated for the care of the mentally disabled that has been\napproved pursuant to law as an intermediate care facility, to eligible\nveterans and their dependents in that part of the New York state home\nfor veterans and their dependents at Oxford that has been approved\npursuant to law as an intermediate care facility and in a hospital while\non release from such intermediate care facilities for the purpose of\nreceiving care in such hospital, and for the administration thereof,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof;\n  (c) the full amount expended for medical assistance furnished under\nthis title to eligible Indians and members of their families residing on\nany Indian reservation in this state, and for the administration\nthereof, after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof;\n  (d) fifty per centum of the amount expended for medical assistance\nfurnished under this title to other eligible persons, and for the\nadministration thereof, after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n  (e) one hundred percentum of the amount expended for the development\nof medical assistance data systems, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof.\nSuch reimbursement shall be available only to the extent that such\nprojects have received federal approval and to the extent that claims\nfor ninety percent federal aid have been approved.\n  (f) The full amount expended on behalf of the department for medical\nassistance furnished to persons described in subdivision five of section\nthree hundred sixty-five of this article, including the administration\nthereof, after first deducting therefrom any federal funds properly\nreceived or to be received on account of such expenditures.\n  (g) Notwithstanding any other provision of law, reimbursement for the\nfollowing services: care, treatment, maintenance and nursing services in\nnursing homes and health related care and services in intermediate care\nfacilities provided in accordance with paragraph (b) of subdivision two\nof section three hundred sixty-five-a of this title; home health\nservices provided in accordance with paragraph (d) of subdivision two of\nsection three hundred sixty-five-a of this title; personal care services\nprovided in accordance with paragraph (e) of subdivision two of section\nthree hundred sixty-five-a of this title; long term home health care\nprograms services provided in accordance with section three hundred\nsixty-seven-c of this title; and nursing home transition and diversion\nservices provided in accordance with subdivision six-a of section three\nhundred sixty-six of this title shall be made as follows:\n  (i) for services provided on or after January first, nineteen hundred\neighty-four through December thirty-first, nineteen hundred eighty-four,\nseventy-two per centum after first deducting therefrom any federal funds\nproperly received or to be received on account thereof;\n  (ii) for services provided on or after January first, nineteen hundred\neighty-five through December thirty-first, nineteen hundred eighty-five,\nseventy-six per centum after first deducting therefrom any federal funds\nproperly received or to be received on account thereof; and\n  (iii) for services provided on or after January first, nineteen\nhundred eighty-six through March thirty-first, nineteen hundred\nninety-four, eighty per centum after first deducting therefrom any\nfederal funds properly received or to be received on account thereof;\n  (iv) for services provided on or after April first, nineteen hundred\nninety-four eighty-one and two hundred thirty-five thousandths per\ncentum after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof.\n  (h) (i) Beginning January first, nineteen hundred eighty-four, one\nhundred per centum of the amount expended for medical assistance for\nthose individuals who are eligible pursuant to section three hundred\nsixty-six of this article as a result of a mental disability as\ndetermined by the commissioner in consultation with the commissioner of\nthe office of mental health and the commissioner of the office for\npeople with developmental disabilities and with the approval of the\ndirector of the budget after first deducting therefrom any federal funds\nproperly received or to be received on account thereof.\n  (ii) Notwithstanding any other provision of law to the contrary, on\nand after the effective date of this subparagraph, the department of\nhealth shall make no further recovery or recoupment of monies that were\nadvanced to local social services districts, during the period from\nApril first, nineteen hundred ninety-two to the effective date of this\nsubparagraph, to cover the medical assistance costs pursuant to this\nparagraph for rehabilitative services for residents of community\nresidences licensed or operated by the office of mental health or for\nthe office for people with developmental disabilities home and community\nbased waiver services.\n  (i) The full amount expended on behalf of the department for medical\nassistance furnished to persons described in subdivision eight of\nsection three hundred sixty-five of this article, including the\nadministration thereof, after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n  (j) Notwithstanding any other provision of law, but in conjunction\nwith the provisions of paragraph (g) of subdivision one of this section,\nreimbursement for the care and services provided to those persons\neligible pursuant to subparagraph seven of paragraph (a) of subdivision\none of section three hundred sixty-six of this title shall be\nseventy-five per centum after first deducting therefrom any federal\nfunds properly received or to be received on account thereof.\n  (k) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a\nsupplementary bad debt and charity care adjustment component of rates of\npayment determined in accordance with subdivision fourteen-a of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be limited to the amount of federal funds properly\nreceived or to be received on account of such expenditures; provided,\nhowever, that reimbursement shall be made by the state for the full\namount expended for a supplementary bad debt and charity care adjustment\nfor a general hospital operated by the state of New York or by the state\nuniversity of New York, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n  (l) Effective January first, nineteen hundred ninety, one hundred per\ncentum of the amount expended for medical assistance for those\nindividuals who are eligible pursuant to paragraphs (n) and (o) of\nsubdivision four of section three hundred sixty-six of this article\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof.\n  (m) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a\nsupplementary low income patient adjustment component of rates of\npayment for a public general hospital determined in accordance with\nsubdivision fourteen-d of section twenty-eight hundred seven-c of the\npublic health law for general hospital inpatient hospital services\nprovided in accordance with paragraph (b) of subdivision two of section\nthree hundred sixty-five-a of this article shall be limited to the\namount of federal funds properly received or to be received on account\nof such expenditures; provided, however, that reimbursement shall be\nmade by the state for the full amount expended for a supplementary low\nincome patient adjustment for a general hospital operated by the state\nof New York or by the state university of New York, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account of such expenditure.\n  (n) Notwithstanding any inconsistent provision of law, reimbursement\nfor the amount expended for medical assistance furnished under this\ntitle to eligible persons pursuant to a statewide managed care plan or\nmanaged care demonstration program, or to eligible persons enrolled in\nany health maintenance organization or other entity authorized by law to\nfurnish comprehensive health services pursuant to a plan, shall be\nreimbursed, after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof, in accordance with the\nfollowing schedule: (i) for services provided for the period April\nfirst, nineteen hundred ninety-four to March thirty-first, nineteen\nhundred ninety-nine, fifty-three and eight hundred seventy-five\nten-thousandths percent thereof; and (ii) for services provided for the\nperiod April first, nineteen hundred ninety-nine to March thirty-first,\ntwo thousand three, fifty percent thereof.\n  (o) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for the\ncomponent of rates of payment for a general hospital determined in\naccordance with paragraph (s) of subdivision eleven of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be one hundred per centum of the amount expended\nfor medical assistance, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n  (p) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department on behalf of a social\nservices district pursuant to section three hundred sixty-seven-b of\nthis article or by a social services district directly, for a public\ngeneral hospital indigent care adjustment payment for a public general\nhospital determined in accordance with subdivision fourteen-f of section\ntwenty-eight hundred seven-c of the public health law for general\nhospital inpatient hospital services provided in accordance with\nparagraph (b) of subdivision two of section three hundred sixty-five-a\nof this article shall be limited to the amount of federal funds properly\nreceived or to be received on account of such expenditures; provided,\nhowever, that reimbursement shall be made by the state for the full\namount expended for a public general hospital indigent care adjustment\nfor a general hospital operated by the state of New York or by the state\nuniversity of New York, after first deducting therefrom any federal\nfunds properly received or to be received on account of such\nexpenditure.\n  * (q) Notwithstanding any inconsistent provision of this chapter or\nany other provision of law to the contrary, reimbursement for the amount\nexpended for medical assistance furnished under this title to eligible\npersons for services provided by a managed long term care plan, shall be\nbased upon a uniform average of expenditures reflecting a mix of\nprimary, acute and long term care services. Such uniform average, or\naverages, will be determined by the commissioner of health and shall\nreflect the mix of services as applied to the amounts calculated\npursuant to applicable paragraphs (g) and (n) of this subdivision, after\nfirst deducting therefrom any federal funds properly received or to be\nreceived on account of such expenditure.\n  * NB Repealed December 31, 2029\n  * (r) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department of health on behalf\nof a social services district pursuant to section three hundred\nsixty-seven-b of this title or by a social services district directly,\nfor medical assistance furnished pursuant to the provisions of\nsubparagraph one of paragraph (q) of subdivision four of section three\nhundred sixty-six of this title to children born on or before September\nthirtieth, nineteen hundred eighty-three, shall be made for the full\namount expended for such children, after first deducting therefrom any\nfederal funds properly received or to be received on account of such\nexpenditure.\n  * NB Expired April 1, 2005\n  * (s) Notwithstanding any other provision of law, reimbursement by the\nstate for payments made, whether by the department of health on behalf\nof a social services district pursuant to section three hundred\nsixty-seven-b of this title or by a social services district directly,\nfor medical assistance furnished pursuant to the provisions of\nsubparagraph one of paragraph (t) of subdivision four of section three\nhundred sixty-six of this title to children, shall be made for the full\namount expended for such children, after first deducting therefrom any\nfederal funds properly received or to be received on account of such\nexpenditure.\n  * NB Expired April 1, 2005\n  (t) (i) for services provided on or after January first, two thousand\nthree through December thirty-first, two thousand four, fifty percent of\nthe amount expended for health care services under section three hundred\nsixty-nine-ee of this article, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof;\n  (ii) for services provided on or after January first, two thousand\nfive, through September thirtieth, two thousand five, seventy-five\npercent of the amount expended for health care services under section\nthree hundred sixty-nine-ee of this article, after first deducting\ntherefrom any federal funds properly received or to be received on\naccount thereof;\n  (iii) for services provided on or after October first, two thousand\nfive, through December thirty-first, two thousand five, seventy-five\npercent of the amount expended by the social services district\nconsisting of the city of New York, and one hundred percent of the\namount expended by all other social services districts, for health care\nservices under section three hundred sixty-nine-ee of this article,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof; and\n  (iv) for services provided on or after January first, two thousand six\nthrough December thirty-first, two thousand six, and thereafter, one\nhundred percent of the amount expended for health care services under\nsection three hundred sixty-nine-ee of this article, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account thereof.\n  (u) Notwithstanding any other provision of law, the full amount\nexpended for family planning services provided to eligible persons\npursuant to subparagraph eleven of paragraph (a) of subdivision one of\nsection three hundred sixty-six of this title, after first deducting\ntherefrom federal funds properly received or to be received on account\nof such expenditures.\n  (v) One hundred per centum of the amount expended for the\nadministration of medical assistance furnished pursuant to subparagraphs\ntwelve and thirteen of paragraph (a) of subdivision one of section three\nhundred sixty-six of this title, after first deducting any federal funds\nproperly received or to be received on account of such expenditures.\n  (w) One hundred per centum of the amount expended for the\nadministration of medical assistance furnished pursuant to paragraph (v)\nof subdivision four of section three hundred sixty-six of this title,\nafter first deducting any federal funds properly received or to be\nreceived on account of such expenditures.\n  (x) One hundred percent of the amount expended for health care\nservices as determined in accordance with paragraph (c) of subdivision\nten of section twenty-eight hundred seven-d of the public health law,\nafter first deducting therefrom any federal funds properly received or\nto be received on account thereof.\n  (y) One hundred percent of the amount expended for health care\nservices as determined in accordance with paragraph (v-1) of subdivision\nfour of section three hundred sixty-six of this title, after first\ndeducting therefrom any federal funds properly received or to be\nreceived on account thereof.\n  (z) One hundred percent of the amount expended for health care\nservices described in sections three hundred sixty-eight-d and three\nhundred sixty-eight-e of this title, after first deducting therefrom any\nfederal funds properly received or to be received on account thereof.\n  2. (a) For the purpose of state reimbursement under this title,\nexpenditures for administration of medical assistance for needy persons\nshall include expenditures for salaries of employees of local welfare\ndepartments, except for those excluded under paragraph (b) of this\nsubdivision; operation, maintenance and service costs; and such other\nexpenditures, such as equipment costs, depreciation charges, and rental\nvalues, as may be approved by the department. It shall not include\nexpenditures for capital additions or improvements.\n  (b) State reimbursement shall not be made for any part of the salary\nof a social services official, or a chief executive officer of a social\nservices department, whose qualifications do not conform to those fixed\nby the department, or a city or town service officer; nor shall such\nreimbursement be made on the salary of a deputy commissioner, or deputy\ndirector or an employee, unless his employment is necessary for the\nadministration of medical assistance and his qualifications conform to\nthose fixed by the department.\n  (c) State reimbursement shall not be made for any part of the salary\nof a local medical director appointed after the effective date of this\nact whose qualifications do not conform to those established pursuant to\nsection three hundred sixty-four of this title.\n  (d) State reimbursement shall not be made for any part of the cost of\nthose items of care, services, supplies and equipment, and drugs which\nrepresent co-payment amounts for which a provider of medical assistance\nis authorized to charge a recipient in accordance with subdivision six\nof section three hundred sixty-seven-a of this article.\n  * 3. For the purpose of state reimbursement for personal care\nservices, such reimbursement to a social services district shall be\nlimited to expenditures for such district's allocation of the statewide\nneed for personal care services, pursuant to section three hundred\nsixty-seven-d of this chapter.\n  * NB Expired March 31, 1985\n  3. (a) Claims for state reimbursement shall be made in such form and\nmanner and at such times and for such periods as the department shall\ndetermine.\n  (b) When certified by the department, state reimbursement shall be\npaid from the state treasury upon the audit and warrant of the\ncomptroller out of funds made available therefor.\n  (c) When the moneys allotted to the state by the federal department of\nhealth, education and welfare or other authorized federal agency for any\nquarter shall have been received by the department of taxation and\nfinance, the department shall, as soon as possible, certify to the\ncomptroller the amount to which each public welfare district is entitled\nfor such quarter and such amount shall be paid out of the state treasury\nafter audit by the comptroller to the respective public welfare\ndistricts.\n  (d) The department is authorized in its discretion to make advances to\npublic welfare districts in anticipation of the state reimbursement\nprovided for in this section.\n  4. Payment of state reimbursement and advances shall be made to the\nfiscal officer of the public welfare district entitled thereto pursuant\nto the provisions of this chapter.\n
N.Y. PBA Law § 1299-EE — New York Code / Act PBA / Article 5 / Title 11-B / Section 1299-EE
Purposes of the authority
Status: in_force

§ 1299-ee. Purposes of the authority. 1. The purposes of the authority\nshall be the continuance, further development and improvement of\ntransportation and other services related thereto within the\nRochester-Genesee regional transportation district, by railroad,\nomnibus, marine and air, in accordance with the provisions of this\ntitle.\n  2. It is hereby found and declared that such purposes are in all\nrespects for the benefit of the people of the state of New York and the\nauthority shall be regarded as performing an essential governmental\nfunction in carrying out its purposes and in exercising the powers\ngranted by this title.\n