Relates to improving and expanding the pharmaceutical insurance coverage program for certain medicare enrollees; creates the expanded pharmaceutical insurance coverage panel, to be responsible for expanding pharmaceutical insurance coverage.
Establishes the New York Health program, a comprehensive system of access to health insurance for New York state residents; provides for administrative structure of the plan; provides for powers and duties of the board of trustees, the scope of benefits, payment methodologies and care coordination; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; enacts provisions relating to financing of New York Health, including a payroll assessment, similar to the Medicare tax; establishes a temporary commission on implementation of the plan; provides for collective negotiations by health care providers with New York Health.
Prohibits medical assistance providers from refusing to furnish care, services or supplies to any person who is entitled to receive such care, services or supplies under this title if such medical assistance provider furnishes the same care, services or supplies under the Medicare program pursuant to title XVIII of the federal social security act and the person is dually eligible under that program.
This bill increases payments to rural critical access hospitals (CAHs) by setting their reimbursement rates at 101% of reasonable costs for covered services like emergency care, inpatient care, and outpatient treatments. Starting April 1, 2027, these hospitals will receive payments calculated using the same method as Medicare uses for outpatient CAH services under federal law. The rate applies to services provided to patients eligible for state-funded payments under the public health law. Implementation depends on annual state funding appropriations.
This bill requires health insurance plans to reimburse providers for the full cost of administering recommended vaccines. It mandates coverage for both vaccine acquisition costs (using CDC private sector rates plus a 21% minimum for shipping/storage) and all administration expenses (including counseling, supplies, and routine nursing activities based on current Medicare rates). The law directly affects healthcare providers who administer vaccines, ensuring they are compensated for both the vaccine itself and the full process of delivery. It applies to all CDC-recommended vaccines for diseases like measles, polio, and hepatitis B, as determined by health authorities.
This bill creates a new "expanded pharmaceutical insurance coverage panel" within New York's executive department to manage expanded prescription drug coverage for residents. The panel, composed of agency leaders (including health and aging officials), will set program rules, determine patient cost-sharing amounts, and develop outreach to inform eligible people about benefits - particularly affecting seniors and low-income New Yorkers who rely on prescription drug coverage. Key mechanisms include annual reporting on enrollment, costs, and program effectiveness, as well as coordinating with federal programs like Medicare. The panel will operate without paid members, focusing on implementing expanded coverage under existing state law.
Prohibits public employers from diminishing health insurance benefits provided to Medicare-eligible retirees and their Medicare-eligible dependents or the contributions such employer makes for such health insurance coverage below the level of such benefits or contributions made on behalf of such retirees and dependents by the public employer as of December 31, 2021.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care when the patient has a long term relationship with a medical professional who is not a recurring provider under the managed care provider's network.
This bill requires health insurance plans to reimburse providers for all costs associated with administering recommended vaccinations, including both vaccine acquisition costs (based on CDC private sector rates plus 21% for shipping/storage) and full administration costs (like counseling, supplies, and nursing time, using current Medicare rates). It directly affects healthcare providers (such as clinics and doctors' offices) who administer vaccines, ensuring they are compensated for the full cost of delivery. The reimbursement applies specifically to vaccines recommended by the CDC's immunization practices committee, covering standard childhood and adult vaccines like measles, polio, and flu shots. This policy change aims to remove financial barriers for providers to offer routine vaccinations under insurance coverage.
