Section 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 insurance 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 insurance 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.