Section 2795. Cystic fibrosis; health care for adults over twenty-one years old


Latest version.
  • 1. The commissioner shall establish a  program  to  reimburse  the
      cost   of   providing  health  care  or  health  insurance  to  eligible
      individuals who have cystic fibrosis.
        2. To be a fully eligible individual for  whom  health  care  will  be
      provided under this section, such individual:
        (a) shall be at least twenty-one years old;
        (b) shall have been diagnosed as having cystic fibrosis;
        (c) shall have resided in the state for a minimum of twelve continuous
      months immediately prior to application for services under this section;
        (d)  shall  not  be  eligible  for medical benefits under any group or
      individual health insurance policy; and
        (e) shall not be eligible for medical  assistance  pursuant  to  title
      eleven  of  article five of the social services law solely due to earned
      income.
        3. To be a partially eligible individual for whom health care will  be
      provided under this section, such individual shall meet all the criteria
      of  a  fully  eligible  individual  except  that  a  partially  eligible
      individual shall be an individual who is eligible for  medical  benefits
      under any group or individual health insurance policy but which does not
      cover  all  services  necessary  for  the  care  and treatment of cystic
      fibrosis.
        4. The commissioner shall require each fully eligible individual, upon
      determination of eligibility, to make application to  a  private  health
      insurance  provider  as prescribed by the commissioner for an individual
      health insurance policy.  If  and  when  such  policy  is  granted,  the
      commissioner shall approve payment for the associated premium.
        5. The commissioner shall authorize payment for service related to the
      care  and treatment of cystic fibrosis not otherwise covered by a health
      insurance policy. Providers of such services shall be reimbursed at  the
      same  rate  and  claims  for payment shall be made as if such individual
      were eligible for benefits pursuant to title eleven of article  five  of
      the social services law.
        6.  All  eligible  individuals  shall  be required to contribute seven
      percent of their net annual income toward the cost of  care  and/or  the
      cost of the annual health insurance premium.
        7.  The  commissioner  shall, in consultation with the commissioner of
      social services, promulgate rules and regulations necessary to implement
      the provisions of this act.