NY Soc Serv L § 367-O (2021)
2021 New York Laws SOS - Social Services Article 5 - Assistance and Care Title 11 - Medical Assistance for Needy Persons 367-O - Health Insurance Demonstration Programs.

§  367-o.  Health insurance demonstration programs. 1. Notwithstanding any inconsistent  provision  of  law,  the  commissioner  of  health  is authorized  to  establish  one  or  more  demonstration programs for the purposes of providing additional knowledge and experience in  mechanisms to   provide,  maintain  or  subsidize  health  insurance  coverage  for unemployed and underemployed health care workers.   2. Health insurance continuation demonstration.  (a) The  commissioner of  health  is  hereby authorized to establish mechanisms to improve the process of authorizing medical assistance payment  of  health  insurance premiums,  pursuant to paragraph (c) of subdivision one of section three hundred sixty-seven-a of this title, on behalf of personal care and home health care workers who reside in any city  with  a  population  of  one million  or  more  and  any  county  with  a  population of nine hundred thousand  or  more  if  such  city  or  county  is  located  within  the metropolitan   commuter  transportation  district  created  pursuant  to section twelve hundred sixty-two of  the  public  authorities  law,  and whose  employment  is irregular, episodic, or cyclical, and whose health insurance coverage therefore is frequently disrupted.    Notwithstanding the  provisions  of  section three hundred sixty-five of this title, the commissioner of health shall exercise discretion  to  determine  whether medical  assistance  payment  of such premiums is cost effective. If the commissioner of health determines that the test of cost effectiveness of insurance premiums is based on  other  than  a  case-by-case  basis,  no medical  assistance  payment  for  such  premiums will be made until the commissioner of health obtains all necessary approvals under federal law and regulation to receive federal financial participation in  the  costs of such medical assistance.  (b)  The commissioner of health is authorized in consultation with the superintendent of financial services to require group  health  insurance plans  and employer-based group health plans to report to the department or its  designee,  insofar  as  such  reporting  does  not  violate  any provisions  of  the  federal  Employee Retirement Income Security Act of 1974 (ERISA), at such times and in such manner as  the  commissioner  of health   shall   decide,  any  information  needed  to  operate  such  a demonstration project, including, but not  limited  to,  the  number  of persons  in  such  plans  who  become  ineligible  each  month  for  the continuation coverage described in paragraph (a) of this subdivision. In addition, every health maintenance organization certified under  article forty-four  of  the  public health law and every insurer licensed by the superintendent  of  financial  services  shall  submit  reports  to  the superintendent  and  to  the  commissioner of health in such form and at such times as may be  required  to  implement  the  provisions  of  this subdivision.   3.  Rate  incentive  demonstration.    With respect to a demonstration program authorized by subdivision one of this section, the  commissioner of  health  may solicit and accept applications for participation in the demonstration program from any  employer,  or  group  of  employers,  of personal  care  workers  or home health workers, who are employed in any city with a population of one million or more  and  any  county  with  a population  of  nine  hundred thousand or more if such city or county is located within the metropolitan commuter transportation district created pursuant to section twelve hundred sixty-two of the  public  authorities law,   and   whose  employers  provide  services  primarily  to  medical assistance recipients, if the following conditions are met:  (a) at least fifty percent of the persons receiving services from such employers are recipients of medical assistance;  (b) the employer contributes to  a  group  health  insurance  plan  or employer based group health plan on behalf of such employees; and  (c)  no benefits are provided under the group health insurance plan or employer based group health plan in excess of the benefits  provided  to the  majority of hospital workers in the community in which the personal care and home health care workers  are  employed.  The  commissioner  of health  is  authorized to add up to fifty-eight million dollars per year for  the  period  January   first,   two   thousand   through   December thirty-first,  two  thousand  two,  and  up  to  one hundred sixty-three million dollars per year for the  period  January  first,  two  thousand three  through  June  thirtieth, two thousand seven, to rates of payment for  qualifying  personal  care  providers  and  certified  home  health agencies  who  are approved to participate in the demonstration program. The commissioner may modify the amounts made available for any  specific annual  period so long as the total amount made available for the period of the demonstration is not exceeded.   3-a. (a) Notwithstanding subdivision three  of  this  section  or  any other  contrary  provision  of  law  and  subject to the availability of federal financial participation, the commissioner of health  shall,  for periods  on  and  after  July  first,  two  thousand seven through March thirty-first, two  thousand  eight,  and  within  amounts  appropriated, adjust  rates  of  payments  for  certified  home  health  agencies  and providers of personal care services who, (i) are located in a city  with a  population  of  over  one  million  persons,  or  in  a county with a population of over nine hundred  thousand  persons  if  such  county  is located within the metropolitan commuter transportation district created pursuant  to  section twelve hundred sixty-two of the public authorities law; and (ii) provide more than fifty  percent  of  their  total  annual hours  of  home  care  services to recipients of medical assistance; and (iii) contribute, as of July first,  two  thousand  seven,  to  a  group health  insurance  plan or employer based group health plan on behalf of their employees.  (b) Payments made pursuant to this subdivision to  eligible  providers shall  be  made  proportionally  in  the  form  of an add-on to rates of payment, based on each  eligible  provider's  most  currently  available total annual hours of home care services, as reported to the department, provided to recipients of medical assistance.  (c)  Providers  which have their rates of payment adjusted pursuant to this subdivision  shall  use  such  funds  solely  for  the  purpose  of supporting  health  insurance  coverage  for  their  employees  and  are prohibited from using such funds for any other purpose. The commissioner of health is authorized to audit  such  providers  for  the  purpose  of ensuring  compliance  with  the  provisions  of this paragraph and shall recoup any funds determined to have been used for purposes other than as authorized by this subdivision.   4. Notwithstanding any other law, rule or regulation to the  contrary, any  subscriber contract issued by an organization certified pursuant to article forty-four of  the  public  health  law  may,  for  purposes  of implementation  of  the demonstration authorized by subdivision three of this section, be issued on an experience rated basis.   5. Between January first, two thousand and December thirty-first,  two thousand  two, the state share amount for all demonstrations pursuant to this section shall be no more  than  twenty-seven  million  dollars  per twelve  month period if averaged over the term of the demonstration; and between January first,  two  thousand  three  and  June  thirtieth,  two thousand  seven,  the state share amount for all demonstrations pursuant to this section shall be no more than  sixty-nine  million  dollars  per twelve  month  period if averaged over the term of the demonstration and between July first, two  thousand  seven  and  March  thirty-first,  two thousand   eight,   the  state  share  of  medical  assistance  payments  authorized in accordance with subdivision two of this section shall  not exceed two million eight hundred fifty thousand dollars.