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§ 88. Paragraph (b) of subdivision 3 of section 366-a of the social services law, as added by chapter 256 of the laws of 1966, is amended to read as follows:

(b) notify the applicant in writing of the decision, and where such applicant is found eligible, provide [an] a tamper resistant identification card containing a photo image of the applicant for use in securing medical assistance under this title provided, however, that an identification card need not contain a photo image of a person other than an adult nember of an eligible household

single-person eligible household. The department, is not required to provide, but shall seek practical methods for providing, a card with such picture to when such person is homebound or is a resident of a residential health care facility, or an in-patient psychiatric facility, or is expected to remain hospitalized for an extended period. The commissioner shall have the authority to define categories of recipients who are not required to have a photo identification card where such card would be limited, unnecessary or impracticable.

$ 89. (Intentionally omitted)

§ 90. Subparagraph 4 of paragraph ç of subdivision 5 of section 366 of the social services law, as amended by chapter 165 of the laws of 1991, is amended to read as follows:

(4) Any transfer made by a person or the person's spouse under subparagraph three of this paragraph shall cause the person to be ineligible for nursing facility services, for services at a level of care equivalent to that of nursing facility services for the lesser of (i) a period of thirty months from the date of transfer, or (ii) a period equal to the total uncompensated value of the resources so transferred, divided by the average cost of nursing facility services to a private patient for a given period of time at the time of application as determined by the commissioner. For purposes of this subparagraph the average cost of nursing facility services to a private patient for given period of time at the time of application shall be presumed to be one hundred twenty percent of the average medical assistance rate of payment as of the first day of January of each year for nursing facilities within the region as established pursuant to paragraph (b) of subdivision sixteen of section twenty-eight hundred seven-c of the public health law wherein the applicant resides.

§ 91. Paragraphs (a) and (b) of subdivision 6 of section 367-a of the social services law aré repealed and six new paragraphs, (a), (b), (d), (e), (f) and (8) are added and paragraph (c), as added by chapter 165 of the laws of 1991, is amended to read as follows:

(a) Notwithstanding any inconsistent provision of law, payment for claims for services as specified in paragraph (d) of this subdivision furnished to eligible persons under this title, subject to paragraph (b) of this subdivision shall be reduced in accordance with the provisions of paragraph (C) of this subdivision by an amount not to exceed the maximun amount authorized by federal law and regulations

co-payment amount, which co-payment amount the provider of such services may charge the recipient, provided, however, no provider may deny such services to an individual eligible for services based on the individual's inability to pay the co-payment amount.

(b) Co-payments shall apply to all eligible persons for the services defined in paragraph (d) of this subdivision with the exception of :

(1) individuals under twenty-one years of age; (ii) pregnant women;

(iii)' individuals who are inpatients in a medical facility who have been required to spend all of their income for medical care, except their personal needs allowance;

(iv) individuals enrolled in health maintenance organizations or other entities which provide comprehensive health services, or other managed care programs for services covered by such programs; and

(v) any other individuals required to be excluded by federal law or regulations.

(c) (1) Co-payments charged pursuant to this subdivision for noninstitutional services shall not exceed the following table, provided, however, that the department may establish standard co-payments for services based upon the average or' typical payment for that service: EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

to be omitted.

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State's payment

Maximum [copayment] co-payment for the services

chargeable to recipient $10 or less

$ .50 $10.01 to $25

$1.00 $25.01 to $50

$2.00 $50.01 or more

$3.00 (ii) co-payments charged pursuant to this subdivision for each discharge for inpatient care shall be twenty-five dollars.

(d) Co-payments shall apply to the following services, subject to such exceptions for subcategories of these services as recognized by the commissioner in regulations, provided in accordance with section three hundred sixty-five-a of this article and the regulations of the department, to the extent permitted by title XIX of the federal social security act:

(i) in-patient care in a general hospital, as defined in subdivision ten of section twenty-eight hundred one of the public health law;

(ii) out-patient hospital and clinic services except for mental health services, mental retardation and developmental disability services, alcohol and substance abuse services and methadone maintenance services;

(iii) home health services, including, services provided under the long term home health care program, provided however, home health providers shall not require employees providing services in the home to collect the co-payment amount;

(iv) sickroom supplies; (v) drugs, excepting psychotropic drugs specified by the department; (vi) clinical laboratory services; (vii) x-rays; (viii) emergency

services provided for non-urgent or emergency medical care, provided however, co-payments shall not be required for

emergency services or family planning services and supplies;

(e)' In the period from January first, nineteen hundred ninety-three to March thirty-first, nineteen hundred ninety-three no recipient shall be required to pay more than a total of fifty dollars in co-payments required by this subdivision for drugs, nor shall reductions in payments

a result of such co-payments exceed fifty dollars for any recipient. (f) In the year commencing April first, nineteen hundred ninety-three and for each year thereafter, no recipient shall be required to pay more than a total of one hundred dollars in co-payments required by this subdivision, nor shall reductions in payments

result of such COpayments exceed one hundred dollars for any recipient.

(8) The commissioner shall promptly:

(i) promulgate a regulation making it an unacceptable practice under the medical assistance program for a provider to deny services to an individual eligible for services based on the individual's inability to pay the co-pay amount required by this subdivision;

(ii) establish and maintain a toll-free hotline which may be used to report a violation of the regulation promulgated pursuant

subparai) of this paragraph; and

) provide notice to all recipients summarizing their rights and obligations under this subdivision.

§ 92. Paragraph (d) of subdivision 7 of section 367-a of the social services law, as added by chapter 165 of the laws of 1991, is amended to read as follows:

(d) Notwithstanding any inconsistent provision of law, if a manufacturer (as defined under section 1927 of the federal social security act) has entered into a rebate agreement with the department or with the federal secretary of health and human services on behalf of the department under section 1927 of the federal social security act, the department shall reimburse for covered outpatient drugs which are dispensed under the medical assistance program to all persons in receipt of medical as sistance benefits as a result of their being eligible for or in receipt of home relief, only pursuant to the terms of the rebate agreement between the department and such manufacturer; provided, however, that any agreement between the department and a manufacturer entered into before August first, nineteen hundred ninety-one, shall be deemed to have been entered into on April first, nineteen hundred ninety-one; and provided further, that a manufacturer has not entered into agreement with the department before August first, nineteen hundred ninety-one, such agreement shall not be effective until April first, nineteen hundred ninety-two, unless such agreement provides that rebates will be retroactively calculated as if the agreement had been in effect

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on April first, nineteen hundred ninety-one. The rebate agreement between such manufacturer and the department shall utilize for (covered outpatient] single source drugs and innovator multiple source drugs the identical formula used to determine the basic rebate for federal financial participation single source drugs and innovator multiple source drugs, pursuant to paragraph one of subdivision (c) of section 1927 of the federal social security act, to determine the amount of the rebate pursuant to this paragraph. The rebate agreement between such manufacturer and the department shall utilize for non-innovator multiple source drugs the identical formula used to determine the basic rebate for federal financial participation non-innovator multiple source drugs, pursuant to paragraphs three and four of subdivision (c) of section 1927 of the federal social security act, to determine the amount of the rebate pursuant to this paragraph. The terms and conditions of such rebate agreement with respect to periodic payment of the rebate, provision of information by the department, audits, manufacturer provision of information verification of surveys, penalties, confidentiality of information, and length of the agreement shall apply to drugs of the manufacturer 'dispensed under the medical assistance program to all persons in receipt of medical assistance benefits as a result of their being eligible for or in receipt of home relief. The department in providing utilization data to a manufacturer (as provided for under section 1927.4 (b)(1)(A) of the federal social security act) shall provide such data by zip code, if requested, for drugs covered under a rebate agreement. $ 93. Intentionally omitted) Š 94. Intentionally omitted)

§ 95. Section 2803-c of thé public health law is amended by adding a new subdivision 2-a to read as follows:

2-a. (a) Notwithstanding any inconsistent provision of this section or any other law to the contrary, rates of payment to general hospitals for seimbursement of inpatient hospital services provided to subscribers of health maintenance organizations operating in accordance with the provisions of article forty-four of this chapter or article forty-three of the insurance law for patients discharged or after July first, nineteen hundred ninety-two, excluding subscribers who are eligible for medical assistance pursuant to the social services law and participants in regional pilot projects established pursuant to chapter seven hundred three of the laws of nineteen hundred eighty-eight, shall be the case based payments per discharge as determined in accordance with subdivision one of this section or the per diem rates of payment determined in accordance with subdivision four of this section or the rate negotiated and approved pursuant to paragraph (b) of subdivision two of this section, whichever is applicable, increased by a factor of nine percent, subject to an elimination of or a reduction in such factor pursuant to paragraph (b) of this subdivision. The commissioner shall advise each health maintenance organization on or before June first for the nineteen hundred ninety-two rate period and on or before December first for each annual period thereafter commencing on January first whether it qualifies for an elimination of or a reduction in the factor; provided, however, that a health maintenance organization may appeal on or before May first for an elimination of or a reduction in pursuant to paragraph (b). of this subdivision, to be effective July first, the factor established for the rate year.

(b) (i) The nine percent increase shall be eliminated for a health zaintenance organization if on or before May first for the nineteen hundred ainety-two rate period and on or before October first preceding the nineteen hundred ninety-three rate year and April first, if the health maintenance organization has appealed therefor, for the six month period thereafter commencing on July first the health maintenance organization is determined by the commissioner of social services to be a managed care provider under section three hundred sixty-four-j, of the social services law in each social services district within its service area, and to have enrolled at least ninety percent of the sum of its target numbers of medical assistance eligibles who are not exempt from participating in the managed care program and are residing in social services districts in its service area.

(ii) The nine percent increase shall be reduced by four and one-half percentage points if on or before May first for the nineteen hundred ninety-two rate period and or before October first preceding the EXPLANATION-Matter in italics is new; matter in brackets [] is old law

to be omitted.

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nineteen hundred ninety-three rate year and April first, if the health maintenance organization has appealed therefor, for the six month period thereafter cominencing on July first the health maintenance organization is determined by the commissioner of social services to be a managed care provider under section three hundred sixty-four-j of the social services law in each social services district' within its service area, and to have enrolled for the nineteen hundred ninety-two rate period at leașt fifty percent and for the nineteen hundred ninety-three rate year, at least sixty-six percent of the sun of its target number of medical assistance eligibles who

not exempt from participating in the managed care program and are residing in social services districts in its service area.

(iii) A health maintenance organization may apply to the state commissioner of social services on or before May first for the nineteen hundred ninety-two rate period and on or before July first preceding the nineteen hundred ninety-three rate year for an exemption from participation in managed

programs 'in a social services district on such bases as demonstration of a good faith effort to enter into a managed care contract with the social services district, or such other criteria as the commissioner of social services may establish. For purposes of this paragraph, the health maintenance organization's service area shall be deemed not to include a social services district in which the health maintenance organization is exempted by the state commissioner of social services from participating in managed care programs., The target number for a social services district shall be determined by calculating the ratio of the health maintenance organization's subscribers in the social services district, excluding subscribers who are eligible for medical assistance pursuant to the social services law, subscribers who are beneficiaries of title XVIII of the federal

social security

act (medicare) and participants in regional pilot projects established

pursuant to chapter

hundred three of the laws of nineteen hundred eighty-eight, to the number of all health maintenance organization subscribers residing in the social services district, excluding, subscribers who are eligible for medical assistance pursuant to the social services law, subscribers who are beneficiaries of title XVIII of the federal social security act (medicare) and participants in

in regional pilot projects established pursuant to chapter seven hundred three of the laws of nineteen hundred eighty-eight, and applying that ratio to the medicaid managed care enrollment objective. The medicaid managed care enrollment objective for each social services district shall be the greater of; the number of medical assistance eligibles residing in the social services district who

not exempt from participating in managed care programs determined by the commissioner of social services to be the enrollment goal under approved medicaid managed care plans of July first in the year preceding the rate year as required by paragraph seven of section three hundred sixty-four-j of the social services law;

five percent of the medical assistance eligibles who are not exempt from participating in managed care programs who reside in social services districts in which the first full year of an approved medicaid managed care plan has not been completed; or the actual number of medical assistance eligibles residing in the social services district who are not exempt from participating in managed care programs who

in fact enrolled in managed

programs as of July first of the year preceding the rate year (except of May first, nineteen hundred ninety-two for, the rate period commencing July first, nineteen hundred ninety-two). The data used to determine the subscriber ratio shall be based the most recent subscriber statistics available. For purposes of this paragraph, managed care program enrollees in health maintenance organization shall be deemed to include persons eligible for medical assistance pursuant to the social services law enrolled by the health maintenance organization through an affiliation contract, approved by the commissioner in consultation with the commissioner

of social services, with a prepaid health services plan.

(c) (i) Each health maintenance organization shall pay into statewide health maintenance organization pool created by the commissioner the factor established pursuant to paragraph (a) of this subdivision, as ad justed in accordance with paragraph (b) of this subdivision, for each patient discharged in the previous calendar month commencing with patients discharged on or after July first, nineteen hundred ninety-two. Funds

accumulated in the pool, including, income from invested funds, shall be deposited by the commissioner and credited to the general fund.

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(ii) Payments by health maintenance organizations to the pool shall be made on a time schedule established by the council, subject to the

approval of the commissioner, by regulation; provided, however, that estimated payments shall be due on or before the fifteenth day following the end of each month unless payments of actual amounts due for such calendar months have been made within such fifteen day time period. Interest and penalties on arrearages shall be determined in accordance with subdivision twenty of this section in the same manner interest and penalties on arrearages payments to bad debt and charity care regional pools.

(iii) The commissioner is authorized to contract with a pool administrator designated in accordance with paragraph (c) of subdivision sixteen of this section, or if not available such other administrators as the commissioner shall designate, to receive and distribute health maintenance organization pool funds. In the event contracts are effectuated, the commissioner shall conduct or cause to be conducted annual audits of the receipt and distribution of the pool funds. The reasonable costs and expenses of an administrator as approved by the commissioner, not to exceed for personnel services on an annual basis two hundred thousand dollars, shall be paid from the pooled funds.

(d)..(i) Notwithstanding any inconsistent provision of this section or any other law to the contrary, for a corporation organized and operating in

accordance with article forty-three of the insurance law that offers a point of service type benefit and in addition is certified April first, nineteen hundred ninety-two to operate as a health maintenance organization for which the number of enrollees in the health maintenance organization is reduced on after April first, nineteen hundred ninety-two by more than twenty percent based on transfers to point of service indemnity type benefits offered by such corporations, the subscriber ratio for purposes of determining the target number of medical assistance recipient's calculated pursuant to paragraph (b) of this subdivision shall be based on subscriber ratio data for the period prior to April first, nineteen hundred ninety-two and the factor of nine percent established pursuant to paragraph (a) of this subdivision, ad justed in accordance with paragraph (b) of this subdivision, shall be applied further to sates of payment to general hospitals for reimbursement of inpatient hospital services provided to enrollees in the point of service indemnity type benefit. If a corporation can provide the commissioner with satisfactory evidence that the transfers from the health maintenance organization to the point of service contracts were due to reasons

circumstances beyond the control of the corporation, this paragraph will not apply.

(ii) Each article forty-three insurance law corporation shall pay into the statewide health maintenance organization pool created pursuant to paragraph (C) of this subdivision the factor as applied to point of service indemnity type benefit reimbursement pursuant to subparagraph (i) of this paragraph in such time and manner as established pursuant to paragraph (c) of this subdivision for purposes of payments by health maintenance organizations.

(e) Health maintenance organizations operating in accordance with artičie forty-four of this chapter or article forty-three of the insurance law and corporations organized and operating in accordance with article forty-three of the insurance law shall provide to the commissioner such information as the commissioner may require to effectuate the provisions of this subdivision, including by May first of each year data by county of total enrollment and separately identifying subscribers who are eligible for medical assistance pursuant to the social services law,

subscribers who are beneficiaries of title XVIII of the federal social security act (medicare) and participants in regional pilot projects tablished, pursuant

to chapter seven hundred three of the laws of nineteen hundred eighty-eight, reflecting enrollment no earlier than the prior year.

§ 96. (Intentionally omitted) § 97. (Intentionally omitted) $ 98. Intentionally omitted)

§ 99. (a) Notwithstanding any inconsistent provision of law to the contrary, the sum of twenty-nine million dollars shall be reallocated from funds otherwise to be distributed in accordance with subparagraphs (i) and (ii) of paragraph (f) of subdivision 19 of section 2807-c of the EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

to be omitted.

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