2023 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.