New York Laws
Title 11 - Medical Assistance for Needy Persons
367-O - Health Insurance Demonstration Programs.

(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.

Structure New York Laws