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Amendments to the

STATE OPERATIONS BUDGET BILL

(Senate 2800-A and Assembly 4000-A)

DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION

Page 70, Line 22, After “system” and

before “;”, insert

“and shall report such information to a taskforce established by executive order; and

provided further, the commissioner shall

close facilities as recommended by such task

force so long as such recommendations are in

accord with the terms of the executive

order”

Page 70, Line 22-26, Strike out

“that any such facilities shall be closed

after the commissioner considers the

recommendations of a task force established

by executive order, but”


“within the time period as prescribed by”

and insert

“in accord with the terms of”

Page 70, Line 32, Strike out “,”

and insert “. Any such closures

may be undertaken”

Page 70, Line 40, After “the”, insert “task force or the”



“and shall report such information to a task

force established by executive order; and





order”








2



and insert


Page 72, Line 43, Strike out “,”and insert “. Any such closures









force so long as such recommendations are inaccord with the terms of the executive

order”








and insert














order”



3






Pages 75-76, Line 45-1, Strike out


and insert






Page 77, Line 36, After “system” andbefore “;”, insert







order”



after the commissioner considers therecommendations of a task force established




and insert



and insert “. Any such closuresmay be undertaken”









4




order”



after the commissioner considers therecommendations of a task force established




and insert



and insert “. Any such closuresmay be undertaken”


DEPARTMENT OF HEALTH

Page 320, Line 49, After “Grant”, insert

“-- Notwithstanding sections 112 and 163 of the state

finance law, or any other inconsistent provision of law,

the commissioner of health is authorized to enter into a

contract without a request for proposal process or any

other competitive process to the Computer Services

Corporation, for the purposes set forth in the earlyinnovator federal grant awarded to the department of health

by the federal centers for medicare and medicaid services

pursuant to the Patient Protection and Affordable Care Act

(P.L. 111-148) and the Health Care and Education

Reconciliation Act of 2010 (P.L. 111-152), to the entity or

entities specified in such grant, up to the amount needed

for implementation of such grant”



5

Amendments to the

AID TO LOCALITIES BUDGET BILL

(Senate 2803-A and Assembly 4003-A)

PREAMBLE

Page 1, Line 9, After “2011” and

before “.”, insert

“except as otherwise noted”

Page 2, Line 16, After “2011” and


“except as otherwise noted”

STATE EDUCATION DEPARTMENT

Page 60, Line 4, Strike out “18,727,587,000”

and insert “35,618,422,000”

Page 60, Line 6, Strike out “6,240,479,000”and insert “9,335,479,000”


and insert “49,037,989,000”


and insert “45,330,071,000”

Page 62, Line 15, Strike out “For”

and insert

“Notwithstanding any inconsistent provision of law, for”

Page 62, Line 16, Before “provided”, insert

“for the 2011-12 and 2012-13 state fiscal years”

Page 62, Line 16, After “that” insert

“not more than 40.01 percent of this appropriation shall

be available for 2011-12 state fiscal year payments for

general support for public schools for the 2011-12 school

year, nor more than 18.42 percent of this appropriation

shall be available for remaining payments for the 2011-12

school year payable in the 2012-13 state fiscal year and

provided further that notwithstanding any inconsistent

provision of law, the remaining amounts available for the2012-13 school year shall be apportioned to school

districts pursuant to the education law and subject to the

limitations of this appropriation including the gap

elimination adjustment as provided for herein unless,

however: 1) a chapter of the laws of 2011 or 2012 enacted

hereafter establishes formulae for the apportionment of


year; and, 2) such formulae shall ensure that such amounts

calculated pursuant to such formulae shall not exceed the

product of the personal income growth index multiplied by

the statewide total of such apportionments, including the

gap elimination adjustment, due and owing during the base



6

school year to school districts and boards of cooperative

educational services from the general support for public

schools as computed based on an electronic data file used

to produce the school aid computer listing produced by the

commissioner in support of the enacted budget for the base

year, and the personal income growth index shall be the

average of the quotients for each year in the period

commencing with the 2005-06 state fiscal year and

finishing with the 2009-10 state fiscal year of the totalpersonal income of the state for each such year divided by

the total personal income of the state for the immediately

preceding state fiscal year, but not less than one, and

the total personal income of the state shall be the total

personal income of the state of New York as published by

the United States department of commerce based on the data

available most proximate and prior to February 1, 2011;

and, 3) provided further that, such chapter shall be

enacted into law prior to April 1, 2012.

Provided that, notwithstanding any inconsistent provision

of law,”

Page 62, Line 18, Strike out

“for the 2011-12 state fiscal year”

and insert

“for the 2011-12 school year”

Page 62, Line 22, After “district,” insert

“and shall also reduce payments due to each district for

the 2012-13 school year within the 2012-13 state fiscal

year pursuant to section 3609-a of the education law by an

amount based on the gap elimination adjustment for the

2012-13 school year computed for such district,”

Page 62, Line 25, Strike out “adjustment”

and insert “adjustments”

Page 62, Line 26, After “2011”, insert “or 2012”

Page 62, Line 28, After “2011-12”, insert “and 2012-13”

Page 62, Line 28, Strike out “year”

and insert “years”

Page 62, Line 32, Strike out “adjustment”

and insert “adjustments”

Page 62, Line 45, After “ment”, insert


Page 63, Line 35, After “adjustment” insert




7

Page 67, Between lines

11 and 12, Insert

“Provided further that, the gap elimination adjustment for

a district for the 2012-13 school year shall equal the

product of the gap elimination adjustment percentage for

such district and the excess growth amount, where the gap

elimination adjustment percentage shall be the quotient of

the gap elimination adjustment amount set forth for eachschool district as “GAP ELIMINATION ADJUSTMENT” under the

heading “2011-12 ESTIMATED AIDS” in the school aid

computer listing produced by the commissioner in support

of the executive budget proposal for the 2011-12 school

year and entitled “BT111-2”, divided by the statewide

total of all such gap elimination adjustment amounts set

forth for all districts in such school aid computer

listing, and the excess growth amount shall be the

positive difference, if any, of (1) the statewide total,

excluding the gap elimination adjustment for the 2012-13

school year, of the apportionments due and owing during

the current school year to school districts and boards of

cooperative educational services from the general supportfor public schools less (2) the product of the personal

income growth index multiplied by the statewide total of

such apportionments, including the gap elimination

adjustment for the 2011-12 school year, due and owing

during the base school year to school districts and boards

of cooperative educational services from the general

support for public schools as computed based on an

electronic data file used to produce the school aid

computer listing produced by the commissioner in support

of the enacted budget for the base year, and the personal

income growth index shall be the average of the quotients

for each year in the period commencing with the 2005-06

state fiscal year and finishing with the 2009-10 state

fiscal year of the total personal income of the state foreach such year divided by the total personal income of the

state for the immediately preceding state fiscal year, but

not less than one, and the total personal income of the

state shall be the total personal income of the state of

New York as published by the United States department of

commerce based on the data available most proximate and

prior to February 1, 2011.”








32 and 33, Insert

“Provided further that notwithstanding any provision of law

to the contrary, in determining the final payment for the

state fiscal year pursuant to section 3609-a of the

education law, the general support for public schools



8

appropriations for the state fiscal year ending March 31,

2012 shall be deemed to include the portion of this

appropriation made available for 2011-12 state fiscal year

payments for general support for public schools for the

2011-12 school year as provided for herein added to the

sum of other such designated appropriated amounts.”

Page 67, Line 38, After “law” and

before “,”, insert

“for the 2011-12 and 2012-13 school years”

Page 67, Line 44, Strike out “and entitled “BT111-2””

and insert

“submitted in the immediately preceding school year”

Page 68, Line 16, After “Notwithstanding”, insert

“section 40 of the state finance law or”

Page 68, Lines 17-18, Strike out

“funds appropriated herein shall be available for payment

of liabilities hereafter to accrue”

and insert

“this appropriation shall lapse on March 31, 2013”


and insert “26,462,319,000”

Page 69, Line 41, After “12” insert “and 2012-13”

Page 69, Line 41, Strike out “year”and insert “years”

Page 69, Line 51, After “budget” and


“provided that no more than $12,058,000 shall be available

for 2011-12 state fiscal year payments for general support

for public schools for the 2011-12 school year”

Page 69, Line 51, After “that”, insert

“in each state fiscal year”


14 and 15, Insert











9








And insert


Page 70, Line 27, Strike out “12,058,000”

and insert “29,283,000”


Page 70, Line 29, Strike out “year”and insert “years”

Page 70, Line 42, After “for”, insert “each”

Page 70, Line 43, After “year” and


“and provided further that no more than $8,750,000 shall be

available for 2011-12 state fiscal year payments for


year”

Page 71, Before line 1, Insert
















and insert




10


and insert “21,250,000”




Page 71, Line 25, After “$3,285,000”, insert

“for each such school year, and provided further that no

more than $2,300,000 shall be available for 2011-12 state

fiscal year payments for general support for public schools

for the 2011-12 school year, and”

Page 71, Line 26, After “provided”, insert “further”


35 and 36, Insert


to the contrary, in determining the final payment for thestate fiscal year pursuant to section 3609-a of the













and insert



and insert “5,585,000”


Page 72, Line 1, Strike out “year,”

and insert

“years, provided that no more than $1,911,000 shall be



year, and”



11


11 and 12, Insert






2012 shall be deemed to include the portion of thisappropriation made available for 2011-12 state fiscal year









and insert







Page 72, Line 40, After “program” andbefore “.”, insert

“, provided that no more than $3,500,000 shall be available




40 and 41, Insert




education law, the general support for public schoolsappropriations for the state fiscal year ending March 31,










12

Page 72-73, Lines 51-2, Strike out



and insert







Page 73, Line 8, After “law”, insert

“, provided that no more than $13,650,000 shall be


general support for public schools for the 2011-12 schoolyear, and”


17 and 18, Insert









2011-12 school year as provided for herein added to thesum of other such designated appropriated amounts.”






and insert



and insert “33,150,000”






13






year”

Page 74, Before lines 1, Insert
















and insert



and insert “129,200,000”




Page 74, Line 17, After “districts”, insert



for public schools for the 2011-12 school year, and”

Page 74, Between lines31 and 32, Insert













14






and insert







Page 74, Line 50, After “$400,000”, insert

“in each such year”

Page 75, Line 5, After “ation”, insert

“, provided that no more than $280,000 shall be available


for public schools for the 2011-12 school year, and”


14 and 15, Insert


to the contrary, in determining the final payment for thestate fiscal year pursuant to section 3609-a of the













and insert


Page 75, Line 27, Strike out “280,000”

and insert “680,000”



15

Page 75, Line 30, After “for”, insert “each of”


Page 75, Line 31, Strike out “year,”

and insert

“years, provided that no more than $1,400,000 shall be

available for 2011-12 state fiscal year payments forgeneral support for public schools for the 2011-12 school

year, and”


40 and 41, Insert







appropriation made available for 2011-12 state fiscal yearpayments for general support for public schools for the





Page 75-76, Lines 51-2, Strike out



and insert




Page 76, Line 6, After “year”, insert

“and for services and expenses of a $12,000,000 special

academic improvement grants program for the 2012-13 school

year”

Page 76, Line 8, After “law” andbefore “,”, insert





23 and 24, Insert






16













and insert


Page 76, Line 36, Strike out “4,200,000”and insert “14,400,000”

Page 76, Line 38, Strike out “2011-12”

and insert “2012-13”

Page 76, Line 38, After “years” and




general support for public schools for the 2011-12 or prior

school years”

Page 77, Between lines2 and 3, Insert











Page 77, Line 15, Strike out

“or hereafter to accrue”

and insert

“. Notwithstanding section 40 of the state finance law or

any provision of law to the contrary, this appropriation

shall lapse on March 31, 2013”



17


and insert “54,400,000”

Page 77, Line 17, After “$13,840,000”, insert

“in each school year”




Page 77, Line 27, After “year” and






33 and 34, Insert












“, and funds appropriated herein shall be available forpayment of aid hereafter to accrue”

and insert





and insert “23,528,000”




Page 78, Line 4, After “services,”, insert

“provided that no more than $518,409,000 shall be available


for public schools for the 2010-11 and prior school years

and no more than $180,194,000 shall be available for 2011-

12 state fiscal year payments for general support for

public schools for the 2011-12 school year, provided that,

notwithstanding any inconsistent provision of law in no



18

event shall such amounts paid in the 2011-12 state fiscal

year exceed 50.00 percent of the amount appropriated herein

and”

Page 78, Line 12, Strike out “and entitled “BT111-2””

and insert

“submitted in the immediately preceding school year”


31 and 32, Insert









2011-12 and prior school years as provided for herein

added to the sum of other such designated appropriatedamounts.”

Page 78, Lines 40-41, Strike out “or hereafter to accrue,”

Page 78, Line 47, After “program”, insert





and insert “1,397,329,000”




Page 78, Line 50, After “$25,000,000” and


“for each such school year”

Page 78, Line 52, After “amount”, insert

“in each such school year”

Page 79, Line 8, After “$500,000”, insert

“in each such school year”

Page 79, Line 14, After “icate” and


“, and provided that no more than $17,500,000 shall be



year”



19


24 and 25, Insert






2012 shall be deemed to include the portion of thisappropriation made available for 2011-12 state fiscal year




Page 79, Line 37, Strike out “or hereafter to accrue”

and insert












general support for public schools for the 2010-11 and

prior school years”


2 and 3, Insert









2011-12 and prior school years as provided for hereinadded to the sum of other such designated appropriated

amounts.”






and insert “192,000,000”



20


and insert “35,363,159,000”

Page 93, Line 13, After “schools”, insert

“for the 2011-12 and 2012-13 school years, provided that,

notwithstanding any other provision of law to the

contrary, in computing the additional lottery grant

pursuant to subparagraph (4) of paragraph (b) ofsubdivision 4 of section 92-c of the state finance law for

the 2011-12 school year, the base grant shall not exceed

$1,970,000,000.

Notwithstanding section 40 of the state finance law or any

provision of law to the contrary, this appropriation shall

lapse on March 31, 2013”


and insert “3,991,000,000”

Page 93, Line 15, After “2010-11”, insert

“and June 2011-12”

Page 93, Line 15, After “payment”, insert

“s, provided that no more than $240,000,000 shall be



year.


provision of law to the contrary, this appropriation shall

lapse on March 31, 2013”


and insert “480,000,000”








year.


provision of law to the contrary, this appropriation shalllapse on March 31, 2013”


And insert “1,516,000,000”


And insert “5,987,000,000”



21

DEPARTMENT OF HEALTH


and insert “29,713,714,290”


and insert “61,105,414,000”

Page 349, Line 5, Strike out “6,539,181,300”and insert “12,677,165,300”


and insert “103,496,293,590”


and insert “981,954,000”

Page 365, Line 21, After “act.”, insert

“Notwithstanding any inconsistent provision

of law, rule or regulation:

1. Effective October 1, 2011, co-paymentsshall be made to health care providers on

behalf of an eligible child enrolled in

the child health insurance plan pursuant

to title 1-A of article 25 of the public

health law for covered health care

services provided to such child in amounts

to be determined by the commissioner of

health consistent with federal standards

and specified in applicable contracts.

Aggregate co-payment amounts collected by

health care providers pursuant to this

paragraph shall not exceed $300 per year

per eligible child. The commissioner of

health shall reduce subsidy payments madeto approved organizations pursuant to

subdivision 8 of section 2511 of the

public health law to reflect estimated

collections of co-payment amounts imposed

pursuant to this paragraph and as

specified in applicable contracts based on

the number of covered health care service

visits reported by an approved

organization on the Medicaid Managed Care

Operating Report submitted to the

department of health for the calendar year

ending December 31, 2010 and adjusted

annually on July 1 to reflect the visitsreported for the preceding calendar year;

provided however, if this chapter

appropriates sufficient additional funds

to support subsidy payments made to

approved organizations pursuant to


public health law without imposing co-

payments pursuant to this paragraph, the

provisions of this paragraph shall not

apply and shall be considered null and

void as of March 31, 2011.



22

2. The commissioner of health shall adjust

subsidy payments made to approved

organizations pursuant to subdivision 8 of

section 2511 of the public health law on

and after April 1, 2011 through March 31,

2012, so that the amount of each such

payment is reduced by one and seven tenths

percent; provided however, if this chapter

appropriates sufficient additional fundsto support subsidy payments made to



public health law without this reduction,

the provisions of this paragraph shall not


void as of March 31, 2011.”


and insert “511,100,000”


and insert “511,100,000”


“Notwithstanding any inconsistent provision

of law, rule or regulation:

1. Effective October 1, 2011, co-payments

shall be made to health care providers on

behalf of an eligible child enrolled in

the child health insurance plan pursuant

to title 1-A of article 25 of the public

health law for covered health care

services provided to such child in amounts

to be determined by the commissioner of

health consistent with federal standardsand specified in applicable contracts.

Aggregate co-payment amounts collected by

health care providers pursuant to this

paragraph shall not exceed $300 per year

per eligible child. The commissioner of

health shall reduce subsidy payments made

to approved organizations pursuant to


public health law to reflect estimated

collections of co-payment amounts imposed

pursuant to this paragraph and as

specified in applicable contracts based on

the number of covered health care servicevisits reported by an approved

organization on the Medicaid Managed Care

Operating Report submitted to the

department of health for the calendar year

ending December 31, 2010 and adjusted

annually on July 1 to reflect the visits

reported for the preceding calendar year;

provided however, if this chapter







23

public health law without imposing co-

payments pursuant to this paragraph, the

provisions of this paragraph shall not


void as of March 31, 2011.

2. The commissioner of health shall adjust

subsidy payments made to approved

organizations pursuant to subdivision 8 of

section 2511 of the public health law onand after April 1, 2011 through March 31,

2012, so that the amount of each such

payment is reduced by one and seven tenths

percent; provided however, if this chapter





public health law without this reduction,

the provisions of this paragraph shall not


void as of March 31, 2011.”


and insert “470,854,000”


and insert “470,854,000”


and insert “510,776,000”


“. Provided, however, up to $57,000,000 may be utilized for

the purpose of supporting the New York State medical

indemnity fund established pursuant to a chapter of thelaws of 2011”


43 and 44, Insert

“For services and expenses related to the

Public Health Services Corps ............. 1,000,000

For suballocation to the department of

financial regulation for the purpose of

supporting the New York state medical

indemnity fund ........................... 43,000,000”




24

Page 374-393, Line 47 (page 374) through line 10 (page 393)

Strike Out

“MEDICAL ASSISTANCE ADMINISTRATION PROGRAM ............... 1,347,500,000

--------------

General Fund

Local Assistance Account

For state reimbursement of local administra-

tive expenses for medical assistance

programs notwithstanding section 153 of

the social services law.

The money hereby appropriated is available

for payment of aid heretofore accrued or

hereafter to accrue to municipalities, and

to providers of medical services pursuant

to section 367-b of the social services

law, and shall be available to the depart-

ment net of disallowances, refunds,

reimbursements, and credits.Notwithstanding any other provision of law,

the money hereby appropriated may be

increased or decreased by interchange,

with any appropriation of the department

of health, and may be increased or

decreased by transfer or suballocation

between these appropriated amounts and

appropriations of the office of mental

health, the office for people with devel-

opmental disabilities, the office of alco-

holism and substance abuse services, the

department of family assistance office of

temporary and disability assistance and

office of children and family serviceswith the approval of the director of the

budget, who shall file such approval with

the department of audit and control and

copies thereof with the chairman of the

senate finance committee and the chairman

of the assembly ways and means committee.

Notwithstanding any inconsistent provision

of law, in lieu of payments authorized by

the social services law, or payments of

federal funds otherwise due to the local

social services districts for programs

provided under the federal social security

act or the federal food stamp act, fundsherein appropriated, in amounts certified

by the state commissioner of temporary and

disability assistance or the state commis-

sioner of health as due from local social

services districts each month as their

share of payments made pursuant to section

367-b of the social services law may be

set aside by the state comptroller in an

interest-bearing account in order to

ensure the orderly and prompt payment of

providers under section 367-b of the

social services law pursuant to an esti-



25

mate provided by the commissioner of

health of each local social services

district's share of payments made pursuant


law ........................................ 545,050,000

For contractual services related to medical

necessity and quality of care reviews

related to medicaid patients. Subject to

the approval of the director of the budg-et, all or part of this appropriation may

be transferred to the health care stand-

ards and surveillance program, general

fund - local assistance account .............. 3,700,000

The amount appropriated herein, together

with any federal matching funds obtained,

may be available to the department,

subject to the approval of the director of

the budget, for contractual services

related to a third party entity responsi-

ble for education of persons eligible for

medical assistance regarding their options

for enrollment in managed care plans.Subject to the approval of the director of

the budget, all or a part of this appro-

priation may be transferred to the office

of managed care, general fund - state

purposes account. Notwithstanding any

other provision of law, the money hereby

appropriated may be increased or decreased

by interchange, with any appropriation of

the department of health, and may be

increased or decreased by transfer or

suballocation between these appropriated

amounts ..................................... 25,000,000

For state reimbursement of administrative

expenses for the medical assistanceprogram provided by the office of mental

health, office for people with develop-

mental disabilities and office of alcohol-

ism and substance abuse services.


for payment of aid heretofore accrued and

hereafter to accrue. Notwithstanding any



by interchange with any other appropri-

ation of the department of health with the

approval of the director of the budget ..... 100,000,000

--------------Program account subtotal ................. 673,750,000

--------------

Special Revenue Funds - Federal

Federal Health and Human Services Fund

Medicaid Administration Transfer Account

For reimbursement of local administrative

expenses of medical assistance programs

provided pursuant to title XIX of the

federal social security act or its succes-

sor program.



26

The moneys hereby appropriated are to be

available for payment of aid heretofore

accrued or hereafter to accrue to munici-

palities, and to providers of medical

services pursuant to section 367-b of the

social services law, shall be available to

the department net of disallowances,

refunds, reimbursements, and credits. The

amounts appropriated herein may be avail-able for costs associated with a common

benefit identification card, and subject

to the approval of the director of the

budget, these funds may be transferred to

the credit of the state operations account

medicaid management information systems

program.

Notwithstanding any other provision of law,




of health, and may be increased or

decreased by transfer or suballocationbetween these appropriated amounts and


health, the office for people with devel-

opmental disabilities, the office of alco-




office of children and family services

with the approval of the director of the

budget, who shall file such approval with

the department of audit and control and

copies thereof with the chairman of the

senate finance committee and the chairman

of the assembly ways and means committee.Notwithstanding any inconsistent provision






act or the federal food stamp act, funds

herein appropriated, in amounts certified





share of payments made pursuant to section367-b of the social services law may be










law ........................................ 573,750,000



27

For reimbursement of administrative expenses

of the medical assistance program provided

by the office of mental health, office for

people with developmental disabilities,

and office of alcoholism and substance

abuse services provided pursuant to title

XIX of the federal social security act.


for payment of aid heretofore accrued andhereafter to accrue. Notwithstanding any



by interchange with any other appropri-

ation of the department of health with the

approval of the director of budget ......... 100,000,000

--------------

Program account subtotal ................. 673,750,000

--------------

MEDICAL ASSISTANCE PROGRAM .............................. 48,751,877,000

--------------

General Fund

Local Assistance Account

For the medical assistance program, includ-

ing administrative expenses, for local

social services districts, and for medical

care rates for authorized child care agen-

cies.

The money hereby appropriated is to be





social services law, and for payment ofstate aid to municipalities and to provid-

ers of family care where payment systems

through the fiscal intermediaries are not

operational, and shall be available to the

department net of disallowances, refunds,

reimbursements, and credits.


of law to the contrary, funds may be used

by the department for outside legal

assistance on issues involving the federal

government, the conduct of preadmission

screening and annual resident reviews

required by the state's medicaid program,computer matching with insurance carriers

to insure that medicaid is the payer of

last resort and activities related to the

management of the pharmacy benefit avail-

able under the medicaid program.










28









interest-bearing account in order toensure the orderly and prompt payment of







law.





of health and the office of medicaidinspector general and may be increased or




health, office for people with develop-

mental disabilities, the office of alco-




office of children and family services,

the office of Medicaid Inspector General,

and state office for the aging with the

approval of the director of the budget,

who shall file such approval with thedepartment of audit and control and copies

thereof with the chairman of the senate

finance committee and the chairman of the

assembly ways and means committee.


of law to the contrary, the moneys hereby

appropriated may be used for payments to

the centers for medicaid and medicare

services for obligations incurred related

to the pharmaceutical costs of dually

eligible medicare/medicaid beneficiaries

participating in the medicare drug benefit

authorized by P.L. 108-173.Notwithstanding any inconsistent provision

of law, the moneys hereby appropriated

shall not be used for any existing rates,

fees, fee schedule, or procedures which

may affect the cost of care and services

provided by personal care providers, case

managers, health maintenance organiza-

tions, out of state medical facilities

which provide care and services to resi-

dents of the state, providers of transpor-

tation services, that are altered,

amended, adjusted or otherwise changed by



29

a local social services district unless

previously approved by the department of

health and the director of the budget.

For services and expenses of the medical

assistance program including hospital

inpatient services ....................... 1,231,436,000



outpatient and emergency room services ..... 422,696,000For services and expenses of the medical

assistance program including clinic

services ................................... 378,652,000


assistance program including nursing home

services ................................. 2,206,838,000


assistance program including other long

term care services ....................... 2,611,714,000


assistance program including managed care

services ................................. 4,093,988,000

For services and expenses of the medicalassistance program including pharmacy

services ................................... 310,421,000


assistance program including transporta-

tion services .............................. 111,102,000


assistance program including dental

services .................................... 85,045,000


assistance program including non-institu-

tional and other spending ................ 1,061,470,000


of law, subject to the approval of the

director of the budget, up to the amountappropriated herein, together with any

available federal matching funds, may be

transferred to the general fund - state

purposes account for services and expenses

related to pharmacy best practices initi-

atives including prior authorizations and

prior approvals .............................. 6,800,000



director of the budget, up to the amount

appropriated herein, together with any


transferred to the general fund - statepurposes account for services and expenses

related to utilization review activities

including but not limited to utilization

management for radiology and transporta-

tion management services .................... 10,500,000

Notwithstanding any inconsistent provisions









30

related to education of medicaid eligibles

and recipients regarding the medicare part

D program and recipient and provider

notification and other program information

as determined necessary by the commission-

er of health. Subject to the approval of

the director of the budget, a portion of

this appropriation may be suballocated to

other state agencies ......................... 2,500,000Notwithstanding any inconsistent provision

of law, subject to the approval of a plan

by the director of the budget, up to the

amount appropriated herein, together with

any available federal matching funds, may

be transferred to the general fund - state


related to making improvements in the

long-term care system including long-term

care restructuring, the nursing home tran-

sition and diversion waiver, and point-of-

entry initiatives for the purpose of

expanding and promoting a more coordinatedlevel of care for the delivery of quality

services in the community .................... 1,750,000








related to required criminal background

checks for non-licensed long-term care

employees including employees of nursing

homes, certified home health agencies,

long term home health care providers, AIDShome care providers, and licensed home

care service agencies ....................... 11,705,000


of section 112 or 163 of the state finance

law or any other contrary provision of the

state finance law or any other contrary

provision of law, the commissioner of

health may, without a competitive bid or

request for proposal process, enter into

contracts with one or more certified

public accounting firms for the purpose of

conducting audits of disproportionate

share hospital payments made by the stateof New York to general hospitals and for

the purpose of conducting audits of hospi-

tal cost reports as submitted to the state

of New York in accordance with article 28

of the public health law. Notwithstanding

any inconsistent provisions of law,


the budget, up to the amount appropriated

herein, together with any available feder-

al matching funds, may be transferred to

the general fund - state purposes account ...... 900,000



31


of law, subject to a plan developed by the

commissioner of health and approved by the



available federal matching funds, will be

available for demonstrations that develop

and evaluate interventions targeted at

medicaid beneficiaries who are otherwiseexempt or excluded from mandatory Medicaid

managed care and who have multiple comor-

bidities.

Notwithstanding section 112 and section 163

of the state finance law, for chronic

illness demonstration projects authorized

by section 364-l of the social services

law, the commissioner of health may allo-

cate up to $2,500,000 of the amount appro-

priated for contracts without a request

for proposal process or any other compet-

itive process ................................ 6,000,000

Notwithstanding any other provision of law,the money herein appropriated, together

with any available federal matching funds,

is available for transfer or suballocation

to the state university of New York and

its subsidiaries, or to contract without

competition for services with the state

university of New York research founda-

tion, to provide support for the adminis-

tration of the medical assistance program

including activities such as dental prior

approval, retrospective and prospective

drug utilization review, development of

evidence based utilization thresholds,

data analysis, clinical consultation andpeer review, clinical support for the

pharmacy and therapeutic committee, and

other activities related to utilization

management and for health information

technology support for the medicaid

program ...................................... 6,000,000

For grants to the civil service employees

association, Local 1000, AFSCME, AFL-CIO

to contribute to the union's cost of

purchasing health insurance coverage under

the family health plus (FHPlus) buy-in for

child care providers represented by the

union who do not otherwise qualify forcoverage under FHPlus ........................ 6,800,000

For grants to the United Federation of

Teachers, Local 2, AFT, AFL-CIO to

contribute to the union's cost of purchas-

ing health insurance coverage under the

family health plus (FHPlus) buy-in for

child care providers represented by the

union who do not otherwise qualify for

coverage under FHPlus ........................ 9,000,000



director of the budget, moneys appropri-



32

ated herein may be transferred to the

general fund, state purposes account for

services and expenses related to the inde-

pendent audit of the internal controls of

the school and preschool supportive health

services programs as required by the New

York state school supportive health

services program compliance agreement with

the centers for medicare and medicaidservices.



director of the budget, the amount appro-

priated herein may be increased or

decreased by interchange with any appro-

priation of the department of health ........... 400,000


assistance program including medical

services provided at state facilities

operated by the office of mental health,

the office for people with developmental

disabilities and the office of alcoholismand substance abuse services ............. 4,000,000,000

Less an amount that may be allocated

consistent, to the extent practicable,

with the findings and recommendations

contained in a report submitted by the

medicaid redesign team pursuant to execu-

tive order number five. Provided, however,

that if additional savings are necessary

to meet the reduction in the level of

medical assistance program state operating

funds spending assumed herein, the commis-

sioner of health and the New York state

medicaid director, in consultation with

the director of the budget, the commis-sioner of the office for people with

developmental disabilities, the commis-

sioner of the office of mental health and

the commissioner of the office of alcohol-

ism and substance abuse services, shall

develop a plan to achieve such savings

copies of which shall be provided to the

department of audit and control, the

chairperson of the senate finance commit-

tee and the chairperson of the assembly

ways and means committee.


of law, rule or regulation to the contra-ry, for the period April 1, 2011 through

March 31, 2012, the commissioner of health

may implement, to the extent practicable,

the findings and recommendations submitted

by the Medicaid redesign team or such plan

as may otherwise be developed hereunder

by, among other actions: modifying or

suspending reimbursement methods, includ-

ing but not limited to all fees, premium

levels and rates of payment, notwithstand-

ing any provision of law that sets a

specific amount or methodology for any



33

such payments or rates of payment; modify-

ing or discontinuing Medicaid program

benefits; seeking all necessary Federal

approvals, including, but not limited to

waivers and waiver amendments; and

suspending time frames for notice,

approval or certification of rate require-

ments, notwithstanding any provision of

law, rule or regulation to the contrary,including but not limited to sections 2807

and 3614 of the public health law, section

18 of chapter 2 of the laws of 1988, and

18 NYCRR 505.14(h) ..................... (2,850,000,000)

--------------

Program account subtotal .............. 13,725,717,000

--------------

Special Revenue Funds - Federal

Federal Health and Human Services Fund

Medicaid Direct Account

For services and expenses for the medicalassistance program, including administra-

tive expenses for local social services

districts, pursuant to title XIX of the


sor program.

The moneys hereby appropriated are to be





social services law, and for payment of

state aid to municipalities and to provid-

ers of family care where payment systems

through the fiscal intermediaries are notoperational, shall be available to the

department net of disallowances, refunds,

reimbursements, and credits.





of health and the office of medicaid

inspector general and may be increased or




health, office for people with develop-mental disabilities, the office of alco-



temporary and disability assistance,

office of children and family services,

and state office for the aging with the

approval of the director of the budget,

who shall file such approval with the

department of audit and control and copies






34









by the state commissioner of temporary anddisability assistance or the state commis-












district's share of payments made pursuantto section 367-b of the social services

law.



inpatient services ....................... 4,876,642,000



outpatient and emergency room services ... 1,162,281,000


assistance program including clinic

services ................................... 895,129,000


assistance program including nursing home

services ................................. 4,036,725,000For services and expenses of the medical

assistance program including other long

term care services ....................... 3,303,731,000


assistance program including managed care

services ................................. 5,584,020,000


assistance program including pharmacy

services ................................. 2,376,534,000


assistance program including transporta-

tion services .............................. 221,149,000

For services and expenses of the medicalassistance program including dental

services ................................... 176,107,000


assistance program including noninstitu-

tional and other spending ................ 4,828,516,000


assistance program including a series of

targeted chronic illness demonstration

projects.

Notwithstanding section 112 and section 163

of the state finance law, for chronic

illness demonstration projects authorized



35

by section 364-l of the social services

law, the commissioner of health may allo-

cate up to $2,500,000 of the amount appro-

priated for contracts without a request

for proposal process or any other compet-

itive process ................................ 6,000,000


the money herein appropriated, is avail-

able for transfer or suballocation to thestate university of New York and its

subsidiaries, or to contract without

competition for services with the state

university of New York research founda-

tion, to provide support for the adminis-

tration of the medical assistance program

including activities such as dental prior

approval, retrospective and prospective

drug utilization review, development of

evidence based utilization thresholds,

data analysis, clinical consultation and

peer review, clinical support for the

pharmacy and therapeutic committee, andother activities related to utilization

management and for health information

technology support for the medicaid

program ...................................... 6,000,000


of section 112 or 163 of the state finance

law or any other contrary provision of the

state finance law or any other contrary

provision of law, the commissioner of

health may, without a competitive bid or

request for proposal process, enter into

contracts with one or more certified

public accounting firms for the purpose of

conducting audits of disproportionateshare hospital payments made by the state

of New York to general hospitals and for

the purpose of conducting audits of hospi-

tal cost reports as submitted to the state

of New York in accordance with article 28

of the public health law. Notwithstanding

any inconsistent provisions of law,


the budget, up to the amount appropriated

herein ......................................... 900,000


assistance program including medical

services provided at state facilitiesoperated by the office of mental health,

the office for people with developmental

disabilities and the office of alcoholism

and substance abuse services ............. 4,000,000,000



inpatient, hospital outpatient and emer-

gency room, clinic, nursing home, other

long term care, managed care, pharmacy,

transportation, dental, non-institutional

and other spending, medical services

provided at state facilities operated by



36

the office of mental health, the office

for people with developmental disabilities

and the office of alcoholism and substance

abuse services and for any other medical

assistance services resulting from an

increase in the federal medical assistance

percentage pursuant to the American Recov-

ery and Reinvestment Act. Funds appropri-

ated herein shall be subject to all appli-cable reporting and accountability

requirements contained in such act ....... 1,204,000,000

Less an amount that may be allocated

consistent, to the extent practicable,

with the findings and recommendations

contained in a report submitted by the

medicaid redesign team pursuant to execu-

tive order number five. Provided, however,

that if additional savings are necessary

to meet the reduction in the level of

medical assistance program special revenue

funds - federal spending assumed herein,

the commissioner of health and the NewYork state medicaid director, in consulta-

tion with the director of the budget, the

commissioner of the office for people with

developmental disabilities, the commis-

sioner of the office of mental health and

the commissioner of the office of alcohol-

ism and substance abuse services, shall

develop a plan to achieve such savings

copies of which shall be provided to the

department of audit and control, the

chairperson of the senate finance commit-

tee and the chairperson of the assembly

ways and means committee. Notwithstanding

any inconsistent provision of law, rule orregulation to the contrary, for the period

April 1, 2011 through March 31, 2012, the

commissioner of health may implement, to

the extent practicable, the findings and

recommendations submitted by the Medicaid

redesign team or such plan as may other-

wise be developed hereunder by, among

other actions: modifying or suspending

reimbursement methods, including but not

limited to all fees, premium levels and

rates of payment, notwithstanding any

provision of law that sets a specific

amount or methodology for any suchpayments or rates of payment; modifying or

discontinuing Medicaid program benefits;

seeking all necessary Federal approvals,

including, but not limited to waivers and

waiver amendments; and suspending time

frames for notice, approval or certif-

ication of rate requirements, notwith-

standing any provision of law, rule or

regulation to the contrary, including but

not limited to sections 2807 and 3614 of



37

the public health law, section 18 of chap-

ter 2 of the laws of 1988, and 18 NYCRR

505.14(h) .............................. (2,582,000,000)

--------------

Program account subtotal .............. 30,095,734,000

--------------

Special Revenue Funds - Other

HCRA Resources FundIndigent Care Account

For the purpose of making payments to

providers of medical care pursuant to

section 367-b of the social services law,

and for payment of state aid to munici-

palities where payment systems through

fiscal intermediaries are not operational,

to reimburse such providers for costs

attributable to the provision of care to

patients eligible for medical assistance.

Payments from this appropriation to gener-

al hospitals related to indigent carepursuant to article 28 of the public

health law respectively, when combined

with federal funds for services and

expenses for the medical assistance

program pursuant to title XIX of the


sor program, shall equal the amount of the

funds received related to health care

reform act allowances and surcharges

pursuant to article 28 of the public

health law and deposited to this account

less any such amounts withheld pursuant to

subdivision 21 of section 2807-c of the

public health law. Notwithstanding anyinconsistent provision of law, the moneys

hereby appropriated may be increased or

decreased by interchange or transfer with

any appropriation of the department of

health with the approval of the director

of the budget, who shall file such

approval with the department of audit and

control and copies thereof with the chair-

man of the senate finance committee and

the chairman of the assembly ways and

means committee ............................ 791,500,000

--------------

Program account subtotal ................. 791,500,000--------------


HCRA Resources Fund

Medical Assistance Account

For the purpose of making payments, the

money hereby appropriated is available for

payment of aid heretofore accrued or here-

after accrued, to providers of medical

care pursuant to section 367-b of the

social services law, and for payment of



38

state aid to municipalities and the feder-

al government where payment systems

through fiscal intermediaries are not

operational, to reimburse such providers

for costs attributable to the provision of

care to patients eligible for medical

assistance. Notwithstanding any inconsist-

ent provision of law, the moneys hereby

appropriated may be increased or decreasedby interchange or transfer with any appro-

priation of the department of health with

the approval of the director of the budg-

et, who shall file such approval with the

department of audit and control and copies




For services and expenses related to the

medical assistance program ................. 146,400,000


assistance program related to the treat-

ment of breast and cervical cancer ........... 2,100,000For services and expenses of the medical

assistance program related to primary care

case management. All or a portion of this

appropriation may be transferred to state

operations appropriations .................... 2,000,000


assistance program related to disabled

persons ..................................... 23,500,000


assistance program related to physician

services .................................... 85,200,000


assistance program related, but not limit-

ed to, pharmacy, inpatient, and nursinghome services ............................ 1,786,626,000


assistance program related to the city of

New York ................................... 124,700,000


assistance program related to providing

distributions for supplemental medical

insurance for medicare part B premiums,

physician services, outpatient services,

medical equipment, supplies and other

health services ............................. 68,000,000


assistance program related to the familyhealth plus program ........................ 628,400,000


assistance program related to providing

financial assistance to residential health

care facilities ............................. 15,000,000


assistance program related to supporting

workforce recruitment and retention of

personal care services or any worker with

direct patient care responsibility for



39

local social service districts which

include a city with a population of over

one million persons ........................ 136,000,000



workforce recruitment and retention of

personal care services for local social

service districts that do not include a

city with a population of over one millionpersons ..................................... 11,200,000



rate increases for certified home health

agencies, long term home health care

programs, AIDS home care programs, hospice

programs, managed long term care plans and

approved managed long term care operating

demonstrations for recruitment and

retention of health care workers ............ 50,000,000

--------------

Program account subtotal ............... 3,079,126,000

--------------


Miscellaneous Special Revenue Fund

Medical Assistance Account

For the purpose of making payments to

providers of medical care pursuant to

section 367-b of the social services law,

and for payment of state aid to munici-

palities and the federal government where

payment systems through fiscal interme-

diaries are not operational, to reimburse

such providers for costs attributable to

the provision of care to patients eligiblefor medical assistance.


assistance program including nursing home,

personal care, certified home health agen-

cy, long term home health care program and

hospital services ........................ 1,059,800,000

--------------

Program account subtotal ............... 1,059,800,000

--------------”


10 and 11, Insert

“MEDICAL ASSISTANCE ADMINISTRATION PROGRAM ............... 2,741,000,000--------------

General FundLocal Assistance Account

For state reimbursement of local administra-tive expenses for medical assistanceprograms notwithstanding section 153 ofthe social services law.

Notwithstanding section 40 of state financelaw or any other law to the contrary, allmedical assistance appropriations made



40

from this account shall remain in fullforce and effect in accordance with thefollowing schedule: 49 percent for theperiod April 1, 2011 to March 31, 2012; 51percent for the period April 1, 2012 toMarch 31, 2013.

Notwithstanding section 40 of the statefinance law or any provision of law to the

contrary, subject to federal approval,department of health state funds medicaidspending, excluding payments for medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services and furtherexcluding any payments which are notappropriated within the department ofhealth, in the aggregate, for the periodApril 1, 2011 through March 31, 2012,shall not exceed $15,109,236,000 except asprovided below and state share medicaidspending, in the aggregate, for the period

April 1, 2012 through March 31, 2013,shall not exceed $15,710,743,000, but inno event shall department of health statefunds medicaid spending for the periodApril 1, 2011 through March 31, 2013exceed $30,819,979,000 provided, however,such aggregate limits may be adjusted bythe director of the budget to account forany changes in the New York state federalmedical assistance percentage amountestablished pursuant to the federal socialsecurity act, increases in providerrevenues, and beginning April 1, 2012 theoperational costs of the New York statemedical indemnity fund, pursuant to achapter establishing such fund. Thedirector of the budget, in consultationwith the commissioner of health, shallperiodically assess known and projectedmedicaid expenditures incurred both priorto and subsequent to such assessment foreach such period, and if the director ofthe budget determines that suchexpenditures are expected to causemedicaid spending for such period toexceed the aggregate limit specifiedherein for such period, the state medicaiddirector, in consultation with thedirector of the budget and the

commissioner of health, shall develop amedicaid savings allocation plan to limitsuch spending to the aggregate limitspecified herein for such period.

Such medicaid savings allocation plan shallbe designed, to reduce the expendituresauthorized by the appropriations herein incompliance with the following guidelines:(1) reductions shall be made in compliancewith applicable federal law, including theprovisions of the Patient Protection andAffordable Care Act, Public Law No. 111-148, and the Health Care and EducationReconciliation Act of 2010, Public Law No.



41

111-152 (collectively “Affordable CareAct”) and any subsequent amendmentsthereto or regulations promulgatedthereunder; (2) reductions shall be madein a manner that complies with the statemedicaid plan approved by the federalcenters for medicare and medicaidservices, provided, however, that the

commissioner of health is authorized tosubmit any state plan amendment or seekother federal approval, including waiverauthority, to implement the provisions ofthe medicaid savings allocation plan thatmeets the other criteria set forth herein;(3) reductions shall be made in a mannerthat maximizes federal financialparticipation, to the extent practicable,including any federal financialparticipation that is available or isreasonably expected to become available,in the discretion of the commissioner,under the Affordable Care Act; (4)reductions shall be made uniformly among

categories of services, to the extentpracticable, and shall be made uniformlywithin a category of service, to theextent practicable, except where thecommissioner determines that there aresufficient grounds for non-uniformity,including but not limited to: the extentto which specific categories of servicescontributed to department of healthmedicaid state funds spending in excess ofthe limits specified herein; the need tomaintain safety net services inunderserved communities; the need toencourage or discourage certain activitiesby providers of particular health careservices in order to improve quality ofand access to care; or the potentialbenefits of pursuing innovative paymentmodels contemplated by the Affordable CareAct, in which case such grounds shall beset forth in the medicaid savingsallocation plan; and (5) reductions shallbe made in a manner that does notunnecessarily create administrativeburdens to medicaid applicants andrecipients or providers.

In accordance with the medicaid savingsallocation plan, the commissioner of thedepartment of health shall reduce

department of health state funds medicaidspending by the amount of the projectedoverspending through, actions including,but not limited to modifying or suspendingreimbursement methods, including but notlimited to all fees, premium levels andrates of payment, notwithstanding anyprovision of law that sets a specificamount or methodology for any suchpayments or rates of payment; modifying ordiscontinuing medicaid program benefits;seeking all necessary federal approvals,including, but not limited to waivers,waiver amendments; and suspending time



42

frames for notice, approval orcertification of rate requirements,notwithstanding any provision of law, ruleor regulation to the contrary, includingbut not limited to sections 2807 and 3614of the public health law, section 18 ofchapter 2 of the laws of 1988, and 18NYCRR 505.14(h).

The money hereby appropriated is availablefor payment of aid heretofore accrued tomunicipalities, and to providers ofmedical services pursuant to section 367-bof the social services law, and shall beavailable to the department net ofdisallowances, refunds, reimbursements,and credits.

Notwithstanding any other provision of law,the money hereby appropriated may beincreased or decreased by interchange,with any appropriation of the departmentof health, and may be increased ordecreased by transfer or suballocationbetween these appropriated amounts and

appropriations of the office of mentalhealth, the office for people with devel-opmental disabilities, the office of alco-holism and substance abuse services, thedepartment of family assistance office oftemporary and disability assistance andoffice of children and family serviceswith the approval of the director of thebudget, who shall file such approval withthe department of audit and control andcopies thereof with the chairman of thesenate finance committee and the chairmanof the assembly ways and means committee.

Notwithstanding any inconsistent provisionof law, in lieu of payments authorized bythe social services law, or payments offederal funds otherwise due to the localsocial services districts for programsprovided under the federal social securityact or the federal food stamp act, fundsherein appropriated, in amounts certifiedby the state commissioner of temporary anddisability assistance or the state commis-sioner of health as due from local socialservices districts each month as theirshare of payments made pursuant to section367-b of the social services law may beset aside by the state comptroller in aninterest-bearing account in order to

ensure the orderly and prompt payment ofproviders under section 367-b of thesocial services law pursuant to an esti-mate provided by the commissioner ofhealth of each local social servicesdistrict's share of payments made pursuantto section 367-b of the social serviceslaw ...................................... 1,113,100,000

For contractual services related to medicalnecessity and quality of care reviewsrelated to medicaid patients. Subject tothe approval of the director of the budg-et, all or part of this appropriation may



43

be transferred to the health care stand-ards and surveillance program, generalfund - local assistance account .............. 7,400,000

The amount appropriated herein, togetherwith any federal matching funds obtained,may be available to the department,subject to the approval of the director ofthe budget, for contractual services

related to a third party entity responsi-ble for education of persons eligible formedical assistance regarding their optionsfor enrollment in managed care plans.Subject to the approval of the director ofthe budget, all or a part of this appro-priation may be transferred to the officeof managed care, general fund - statepurposes account. Notwithstanding anyother provision of law, the money herebyappropriated may be increased or decreasedby interchange, with any appropriation ofthe department of health, and may beincreased or decreased by transfer orsuballocation between these appropriated

amounts ..................................... 50,000,000For state reimbursement of administrativeexpenses for the medical assistanceprogram provided by the office of mentalhealth, office for people with develop-mental disabilities and office of alcohol-ism and substance abuse services.

The money hereby appropriated is availablefor payment of aid heretofore accrued .Notwithstanding any other provision oflaw, the money hereby appropriated may beincreased or decreased by interchange withany other appropriation of the departmentof health with the approval of thedirector of the budget ................... 200,000,000

--------------Program account subtotal ............... 1,370,500,000

-------------- Special Revenue Funds - FederalFederal Health and Human Services FundMedicaid Administration Transfer Account

For reimbursement of local administrativeexpenses of medical assistance programsprovided pursuant to title XIX of thefederal social security act or its succes-sor program.

Notwithstanding section 40 of state finance

law or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in fullforce and effect in accordance with thefollowing schedule: 49 percent for theperiod April 1, 2011 to March 31, 2012; 51percent for the period April 1, 2012 toMarch 31, 2013

The moneys hereby appropriated are to beavailable for payment of aid heretoforeaccrued to municipalities, and toproviders of medical services pursuant tosection 367-b of the social services law,shall be available to the department net



44

of disallowances, refunds, reimbursements,and credits. The amounts appropriatedherein may be available for costsassociated with a common benefitidentification card, and subject to theapproval of the director of the budget,these funds may be transferred to thecredit of the state operations account

medicaid management information systemsprogram.Notwithstanding any other provision of law,the money hereby appropriated may beincreased or decreased by interchange,with any appropriation of the departmentof health, and may be increased ordecreased by transfer or suballocationbetween these appropriated amounts andappropriations of the office of mentalhealth, the office for people with devel-opmental disabilities, the office of alco-holism and substance abuse services, thedepartment of family assistance office oftemporary and disability assistance and

office of children and family serviceswith the approval of the director of thebudget, who shall file such approval withthe department of audit and control andcopies thereof with the chairman of thesenate finance committee and the chairmanof the assembly ways and means committee.

Notwithstanding any inconsistent provisionof law, in lieu of payments authorized bythe social services law, or payments offederal funds otherwise due to the localsocial services districts for programsprovided under the federal social securityact or the federal food stamp act, fundsherein appropriated, in amounts certifiedby the state commissioner of temporary anddisability assistance or the state commis-sioner of health as due from local socialservices districts each month as theirshare of payments made pursuant to section367-b of the social services law may beset aside by the state comptroller in aninterest-bearing account in order toensure the orderly and prompt payment ofproviders under section 367-b of thesocial services law pursuant to an esti-mate provided by the commissioner ofhealth of each local social servicesdistrict's share of payments made pursuant

to section 367-b of the social serviceslaw ...................................... 1,170,500,000

For reimbursement of administrative expensesof the medical assistance program providedby the office of mental health, office forpeople with developmental disabilities,and office of alcoholism and substanceabuse services provided pursuant to titleXIX of the federal social security act.The money hereby appropriated is availablefor payment of aid heretofore accrued .Notwithstanding any other provision oflaw, the money hereby appropriated may beincreased or decreased by interchange with



45

any other appropriation of the departmentof health with the approval of thedirector of budget ....................... 200,000,000

--------------Program account subtotal ............... 1,370,500,000

-------------- MEDICAL ASSISTANCE PROGRAM .............................. 96,932,562,000

-------------- General FundLocal Assistance Account

For the medical assistance program, includ-ing administrative expenses, for localsocial services districts, and for medicalcare rates for authorized child care agen-cies.

Notwithstanding section 40 of state financelaw or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in fullforce and effect in accordance with the

following schedule: 49.50 percent for theperiod April 1, 2011 to March 31, 2012;50.50 percent for the period April 1, 2012to March 31, 2013.

Notwithstanding section 40 of the statefinance law or any provision of law to thecontrary, subject to federal approval,department of health state funds medicaidspending, excluding payments for medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services and furtherexcluding any payments which are notappropriated within the department ofhealth, in the aggregate, for the periodApril 1, 2011 through March 31, 2012,shall not exceed $15,109,236,000 except asprovided below and state share medicaidspending, in the aggregate, for the periodApril 1, 2012 through March 31, 2013,shall not exceed $15,710,743,000, but inno event shall department of health statefunds medicaid spending for the periodApril 1, 2011 through March 31, 2013exceed $30,819,979,000 provided, however,such aggregate limits may be adjusted bythe director of the budget to account for

any changes in the New York state federalmedical assistance percentage amountestablished pursuant to the federal socialsecurity act, increases in providerrevenues, and beginning April 1, 2012 theoperational costs of the New York statemedical indemnity fund, pursuant to achapter establishing such fund. Thedirector of the budget, in consultationwith the commissioner of health, shallperiodically assess known and projectedmedicaid expenditures incurred both priorto and subsequent to such assessment foreach such period, and if the director of



46

the budget determines that suchexpenditures are expected to causemedicaid spending for such period toexceed the aggregate limit specifiedherein for such period, the state medicaiddirector, in consultation with thedirector of the budget and thecommissioner of health, shall develop a

medicaid savings allocation plan to limitsuch spending to the aggregate limitspecified herein for such period.

Such medicaid savings allocation plan shallbe designed, to reduce the expendituresauthorized by the appropriations herein incompliance with the following guidelines:(1) reductions shall be made in compliancewith applicable federal law, including theprovisions of the Patient Protection andAffordable Care Act, Public Law No. 111-148, and the Health Care and EducationReconciliation Act of 2010, Public Law No.111-152 (collectively “Affordable CareAct”) and any subsequent amendments

thereto or regulations promulgatedthereunder; (2) reductions shall be madein a manner that complies with the statemedicaid plan approved by the federalcenters for medicare and medicaidservices, provided, however, that thecommissioner of health is authorized tosubmit any state plan amendment or seekother federal approval, including waiverauthority, to implement the provisions ofthe medicaid savings allocation plan thatmeets the other criteria set forth herein;(3) reductions shall be made in a mannerthat maximizes federal financialparticipation, to the extent practicable,including any federal financialparticipation that is available or isreasonably expected to become available,in the discretion of the commissioner,under the Affordable Care Act; (4)reductions shall be made uniformly amongcategories of services, to the extentpracticable, and shall be made uniformlywithin a category of service, to theextent practicable, except where thecommissioner determines that there aresufficient grounds for non-uniformity,including but not limited to: the extentto which specific categories of services

contributed to department of healthmedicaid state funds spending in excess ofthe limits specified herein; the need tomaintain safety net services inunderserved communities; the need toencourage or discourage certain activitiesby providers of particular health careservices in order to improve quality ofand access to care; or the potentialbenefits of pursuing innovative paymentmodels contemplated by the Affordable CareAct, in which case such grounds shall beset forth in the medicaid savingsallocation plan; and (5) reductions shall



47

be made in a manner that does notunnecessarily create administrativeburdens to medicaid applicants andrecipients or providers.

In accordance with the medicaid savingsallocation plan, the commissioner of thedepartment of health shall reducedepartment of health state funds medicaid

spending by the amount of the projectedoverspending through, actions including,but not limited to modifying or suspendingreimbursement methods, including but notlimited to all fees, premium levels andrates of payment, notwithstanding anyprovision of law that sets a specificamount or methodology for any suchpayments or rates of payment; modifying ordiscontinuing medicaid program benefits;seeking all necessary federal approvals,including, but not limited to waivers,waiver amendments; and suspending timeframes for notice, approval orcertification of rate requirements,

notwithstanding any provision of law, ruleor regulation to the contrary, includingbut not limited to sections 2807 and 3614of the public health law, section 18 ofchapter 2 of the laws of 1988, and 18NYCRR 505.14(h).

Provided, notwithstanding any other law orrule to the contrary, that in order tomake expenditures from theseappropriations and achieve savingsnecessary to meet the department of healthstate funds medicaid expenditure cap asreferenced above, a court shall issue anorder in every medical, dental orpodiatric malpractice action commencedduring state fiscal year 2011-12 and statefiscal year 2012-13 pending before it, onits own motion or on the motion of anydefendant in such action liable fordamages arising from pain and suffering,loss of services, loss of consortium, orother nonpecuniary damages suffered by aninjured plaintiff, limiting the recoveryof such damages from every defendantliable for malpractice in such action, tono more than $250,000, provided that suchsum may be adjusted in accordance withConsumer Price Index for all Consumers, aspublished annually by the United States

Department of Labor, Bureau of LaborStatistics, and further provided thereshall be established the New York StateMedical Indemnity Fund, to provide afunding source for certain costsassociated with birth related neurologicalinjuries pursuant to a chapter of the lawsof 2011 enacted as legislation submittedby the governor, which fund shall becontingent upon the enactment of a$250,000 cap on non economic damagespursuant to this appropriation or pursuantto such chapter.



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The money hereby appropriated is to beavailable for payment of aid heretoforeaccrued to municipalities, and toproviders of medical services pursuant tosection 367-b of the social services law,and for payment of state aid tomunicipalities and to providers of familycare where payment systems through the

fiscal intermediaries are not operational,and shall be available to the departmentnet of disallowances, refunds,reimbursements, and credits.

Notwithstanding any inconsistent provisionof law to the contrary, funds may be usedby the department for outside legalassistance on issues involving the federalgovernment, the conduct of preadmissionscreening and annual resident reviewsrequired by the state's medicaid program,computer matching with insurance carriersto insure that medicaid is the payer oflast resort and activities related to themanagement of the pharmacy benefit avail-

able under the medicaid program.Notwithstanding any inconsistent provisionof law, in lieu of payments authorized bythe social services law, or payments offederal funds otherwise due to the localsocial services districts for programsprovided under the federal social securityact or the federal food stamp act, fundsherein appropriated, in amounts certifiedby the state commissioner of temporary anddisability assistance or the state commis-sioner of health as due from local socialservices districts each month as theirshare of payments made pursuant to section367-b of the social services law may beset aside by the state comptroller in aninterest-bearing account in order toensure the orderly and prompt payment ofproviders under section 367-b of thesocial services law pursuant to an esti-mate provided by the commissioner ofhealth of each local social servicesdistrict's share of payments made pursuantto section 367-b of the social serviceslaw.

Notwithstanding any other provision of law,the money hereby appropriated may beincreased or decreased by interchange,with any appropriation of the department

of health and the office of medicaidinspector general and may be increased ordecreased by transfer or suballocationbetween these appropriated amounts andappropriations of the office of mentalhealth, office for people with develop-mental disabilities, the office of alco-holism and substance abuse services, thedepartment of family assistance office oftemporary and disability assistance andoffice of children and family services,the office of Medicaid Inspector General,and state office for the aging with theapproval of the director of the budget,



49

who shall file such approval with thedepartment of audit and control and copiesthereof with the chairman of the senatefinance committee and the chairman of theassembly ways and means committee.

Notwithstanding any inconsistent provisionof law to the contrary, the moneys herebyappropriated may be used for payments to

the centers for medicaid and medicareservices for obligations incurred relatedto the pharmaceutical costs of duallyeligible medicare/medicaid beneficiariesparticipating in the medicare drug benefitauthorized by P.L. 108-173.

Notwithstanding any inconsistent provisionof law, the moneys hereby appropriatedshall not be used for any existing rates,fees, fee schedule, or procedures whichmay affect the cost of care and servicesprovided by personal care providers, casemanagers, health maintenance organiza-tions, out of state medical facilitieswhich provide care and services to resi-

dents of the state, providers of transpor-tation services, that are altered,amended, adjusted or otherwise changed bya local social services district unlesspreviously approved by the department ofhealth and the director of the budget.

Notwithstanding any other provision of law,rule or regulation, to the contrary, forthe period April 1, 2011 through March 31,2013, all medicaid payments made forservices provided on and after April 1,2011, shall, except as hereinafterprovided, be subject to a uniform twopercent reduction and such reduction shallbe applied, to the extent practicable, inequal amounts during the fiscal year,provided, however, that an alternativemethod may be considered at the discretionof the commissioner of health and thedirector of the budget based uponconsultation with the health care industryincluding but not limited to, a uniformreduction in medicaid rates of payment orother reductions provided that any methodselected achieves no less than$702,000,000 in medicaid state sharesavings, except as hereinafter provided,for services provided on and after April1, 2011 through March 31, 2013.

The following shall be exempt fromreductions pursuant to this section:

(i) any reductions that would violatefederal law including, but not limitedto, payments required pursuant to thefederal medicare program;

(ii) any reductions related to paymentspursuant to article 32, article 31 andarticle 16 of the mental hygiene law;

(iii) payments the state is obligated tomake pursuant to court orders orjudgments;



50

(iv) payments for which the non-federalshare does not reflect any state funding;and

(v) at the discretion of the commissioner ofhealth and the director of the budget,payments with regard to which it isdetermined by the commissioner of healthand the director of the budget that

application of reductions pursuant to thissection would result, by operation offederal law, in a lower federal medicalassistance percentage applicable to suchpayments.

Reductions to medicaid payments or medicaidrates of payments made pursuant to thissection shall be subject to the receipt ofall necessary federal approvals.

Provided, however, if this chapterappropriates sufficient additional fundsto support medicaid payments or medicaidrates of payments, the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,

2011.Notwithstanding paragraph (c) of subdivision

10 of section 2807-c of the public healthlaw, section 21 of chapter 1 of the lawsof 1999, or any other contrary provisionof law, in determining rates of paymentsby state governmental agencies effectivefor services provided for the period April1, 2011 through March 31, 2013, forinpatient and outpatient services providedby general hospitals, for inpatientservices and adult day health careoutpatient services provided byresidential health care facilitiespursuant to article 28 of the publichealth law, for home health care servicesprovided pursuant to article 36 of thepublic health law by certified home healthagencies, long term home health careprograms and AIDS home care programs, forpersonal care services provided pursuantto section 365-a of the social serviceslaw, hospice services provided pursuant toarticle 40 of the public health law,foster care services provided pursuant toarticle 6 of the social services law, thecommissioner of health shall apply nogreater than zero trend factorsattributable to calendar years on and

after 2011 in accordance with paragraph(c) of subdivision 10 of section 2807-c ofthe public health law, provided, however,that such no greater than zero trendfactors for such calendar years shall alsobe applied to rates of payment forpersonal care services for such periodprovided in those local social servicedistricts, including New York city, whoserates of payment for such services areestablished by such local social servicedistricts pursuant to a rate-settingexemption issued by the commissioner ofhealth to such local social service



51

districts in accordance with applicableregulations, and provided further,however, that for rates of payment forassisted living program services providedfor the period April 1, 2011 through March31, 2013, trend factors attributable tosuch calendar years shall be establishedat no greater than zero percent, provided,

however, that if this chapter providessufficient additional funding to cover thecost of trend factor adjustments to therates enumerated in this section, thenprovisions of this section shall be deemednull and void as of March 31, 2011.

Notwithstanding any provision of law to thecontrary and subject to the availabilityof federal financial participation, forthe period April 1, 2011 through March 31,2013, clinics certified pursuant toarticles 16, 31 or 32 of the mentalhygiene law shall be subject to targetedmedicaid reimbursement rate reductions inaccordance with the provisions of this

section. Such reductions shall be based onutilization thresholds which may beestablished either as provider-specific orpatient-specific thresholds. Providerspecific thresholds shall be based onaverage patient utilization for a givenprovider in comparison to a peer basedstandard to be determined for eachservice. When applying a provider specificthreshold, rates will be reduced on aprospective basis based on the amount anyprovider is over the determined thresholdlevel. Patient-specific thresholds will bebased on annual thresholds determined foreach service over which the per visitpayment for each visit in excess of thestandard during a twelve month periodshall be reduced by a pre-determinedamount. The thresholds, peer basedstandards and the payment reductions shallbe determined by the department of health,with the approval of the division of thebudget, and in consultation with theoffice of mental health, the office forpeople with developmental disabilities andthe office of alcoholism and substanceabuse services, and any such resultingrates shall be subject to certification bythe appropriate commissioners pursuant to

subdivision (a) of section 43.02 of themental hygiene law. The base period usedto establish the thresholds shall be the2009 calendar year. The total annualizedreduction in payments shall be no lessthan $10,900,000 for Article 31 clinics,no less than $2,400,000 for Article 16clinics, and no less than $13,250,000 forArticle 32 clinics. Provided however ifthis chapter provides sufficientadditional funding to cover the cost oftargeted medicaid reimbursement rate



52

reductions enumerated in this section,then the provisions of this section shallbe deemed null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissioner

of health is authorized, in consultationwith the commissioners of the office ofmental health, office of alcoholism andsubstance abuse services, and office forpeople with developmental disabilities to:establish, in accordance with applicablefederal law and regulations, standards forthe provision of health home services toenrollees with chronic conditions in theprogram of medical assistance for needypersons; establish payment methodologiesfor health home services based on factorsincluding but not limited to thecomplexity of the conditions providerswill be managing, the anticipated amount

of patient contact needed to manage suchconditions, and the health care costsavings realized by provision of healthhome services; establish the criteriaunder which such an enrollee will bedesignated as being eligible to receivehealth home services; and assign anyenrollee designated as an eligibleindividual to a provider of health homeservices. Until such time as thecommissioner of health obtains necessarywaivers of the federal social securityact, enrollees assigned to providers ofhealth home services will be allowed toopt out of such services. In addition tosuch payments made for health homeservices, the commissioner of health isauthorized to pay additional amounts toproviders of health home services thatmeet process or outcome standardsspecified by the commissioner. Payment forsuch health home services and suchadditional payments will be made withstate funds only, to the extent that suchfunds are appropriated therefore, untilsuch time as federal financialparticipation in the costs of suchservices is available. The commissioner ofhealth is authorized to submit amendments

to the state plan for medical assistanceand/or submit one or more applications forwaivers of the federal social securityact, to obtain federal financialparticipation in the costs of health homeservices. Notwithstanding any limitationsimposed by section 364 - l of the socialservices law, the commissioner isauthorized to allow entities participatingin demonstration projects establishedpursuant to such section to provide healthhome services. Notwithstanding any law,rule, or regulation to the contrary, thecommissioners of the department of health,



53

the office of mental health, and theoffice of alcoholism and substance abuseservices are authorized to jointlyestablish a single set of operating andreporting requirements and a single set ofconstruction and survey requirements forentities that can demonstrate experiencein the delivery of health, and mental

health and/or alcohol and substance abuseservices and the capacity to offerintegrated delivery in each locationapproved by the commissioner, and meet thestandards for providing and receivingpayment for health home services. Inestablishing a single set of operating andreporting requirements and a single set ofconstruction and survey requirements forentities described in this subdivision,the commissioners of the department ofhealth, the office of mental health, andthe office of alcoholism and substanceabuse services are authorized to waive anyregulatory requirements as are necessary

to avoid duplication of requirements andto allow the integrated delivery ofservices in a rational and efficientmanner. Provided, however, if this chapterappropriates sufficient additional fundsto provide coverage for persons withchronic conditions under the program ofmedical assistance for needy personswithout the savings to be achieved throughthe provision of health home services,then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013: coverage under themedicaid program for enteral formulatherapy is limited to coverage only fornasogastric, jejunostomy, or gastrostomytube feeding or for treatment of an inbornerror of metabolism, and no othernutritional or dietary supplements arecovered; coverage under the medicaidprogram for prescription footwear andinserts is limited to coverage only whenused as an integral part of a lower limborthotic appliance, as part of a diabetictreatment plan, or to address growth and

development problems in children; coverageunder the medicaid program for compressionand support stockings is limited tocoverage only for pregnancy or treatmentof venous stasis ulcers; and thecommissioner of health is authorized torequire prior authorization forprescriptions of opioid analgesics inexcess of four prescriptions in a 30-dayperiod. Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid coverage of suchservices without imposing suchlimitations, then the provisions of this



54

paragraph shall not apply and shall beconsidered null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, when medicaideligible persons are also beneficiaries

under part B of title XVIII of the federalsocial security act and payment under partB would exceed the amount that would bepaid by medicaid if the person were noteligible under part B or a qualifiedmedicare beneficiary, the amount payablefor services covered under the medicaidprogram for hospital outpatient servicesor diagnostic and treatment centerservices pursuant to article 28 of thepublic health law shall be 20 percent ofthe amount of any coinsurance liability ofsuch eligible person pursuant to federallaw if they were not eligible for medicaidor were not a qualified medicare

beneficiary; provided however that in noevent shall the amount payable forservices covered under the medicaidprogram for such eligible person exceedthe approved medical assistance paymentlevel less the amount payable under partB. Provided, however, if this chapterappropriates sufficient additional fundsto provide medical assistance paymentsunder paragraph (d) of subdivision 1 ofsection 367-a of the social services lawfor hospital outpatient services ordiagnostic and treatment center servicesin situations where payment under part Bof title XVIII of the federal socialsecurity act would exceed the amount thatotherwise would be paid by medicaid ifthe person were not eligible under part Bor a qualified medicare beneficiary, thenthe provisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the maximum co-payment chargeable to a recipient ofmedicaid for non-institutional servicesshall be as follows: where the state’s

payment for the service is $10 or less,the maximum co-payment shall be $.60;where the state’s payment for the serviceis from $10.01 to $25, the maximum co-payment shall be $1.15; where the state’spayment for the service is from $25.01 to$50, the maximum co-payment shall be$2.30; where the state’s payment for theservice is $50.01 or more, the maximum co-payment shall be $3.40. The co-paymentchargeable to a medicaid recipient foreach discharge for inpatient care shall be$30. The co-payment charged for eachgeneric prescription drug dispensed shall



55

be $1.15 and for each brand nameprescription drug dispensed shall be$3.40; provided, however, that the co-payment charged for each brand nameprescription drug on the preferred druglist established pursuant to section 272of the public health law and the co-payment charged for each brand name

prescription drug reimbursed pursuant tosubparagraph (ii) of paragraph (a-1) ofsubdivision 4 of section 365-a of thesocial services law shall be $1.15. Co-payments shall apply to the followingservices in addition to those listed inparagraph (d) of subdivision 6 of section367-a of the social services law: visioncare; dental services; audiology services;physician services; nurse practitionerservices; and rehabilitation servicesincluding occupational therapy, physicaltherapy and speech therapy. In the yearcommencing April 1, 2011 and for each yearthereafter, no recipient shall be required

to pay more than a total of $300.00 in co-payments nor shall reductions in medicaidpayments as a result of such co-paymentsexceed $300.00 for any recipient. In boththe medicaid and family health plusprograms, the co-payment for emergencyroom services provided for non-urgent ornon-emergency medical care shall be $6.40;provided however that co-payments shallnot be required with respect to emergencyservices or family planning services andsupplies. The co-payment for nursepractitioner services in the family healthplus program shall be $5.00. Provided,however, if this chapter appropriatessufficient additional funds to allow themedicaid and family health plus programsto pay for services without the savings tobe achieved by increasing the amount orscope of required co-payments, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissionersof the office of mental health and theoffice of alcoholism and substance abuse

services, in consultation with thecommissioner of health and with theapproval of the division of budget, shallhave responsibility for jointlydesignating regional entities to provideadministrative and management services forthe purposes of prior approving andcoordinating the provision of behavioralhealth services, and integratingbehavioral health services with otherservices available under the medicalassistance program, for recipients ofmedical assistance who are not enrolled inmanaged care, and for approval,



56

coordination, and integration ofbehavioral health services that are notprovided through managed care programsunder the medical assistance program forindividuals regardless of whether or notsuch individuals are enrolled in managedcare programs. Such regional entitiesshall also be responsible for safeguarding

against unnecessary utilization of suchcare and services and assuring thatpayments are consistent with the efficientand economical delivery of quality care.In exercising this responsibility, thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services are authorized tocontract, after consultation with thecommissioner of health, with regionalbehavioral health organizations or otherentities. Such contracts may includeresponsibility for: receipt, review, anddetermination of prior authorizationrequests for behavioral health care and

services, consistent with criteriaestablished or approved by thecommissioners of mental health andalcoholism and substance abuse services,and authorization of appropriate care andservices based on documented patientmedical need.

Notwithstanding any inconsistent provisionof sections 112 and 163 of the statefinance law, or section 142 of theeconomic development law, or any otherlaw, commissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services are authorized toenter into such contract or contractswithout a competitive bid or request forproposal process; provided, however, thatthe office of mental health and the officeof alcoholism and substance abuse servicesshall post on their websites, for a periodof no less than thirty days: a descriptionof the proposed services to be providedpursuant to the contractor contracts; thecriteria for selection of a contractor orcontractors; the period of time duringwhich a prospective contractor may seekselection, which shall be no less thanthirty days after such information isfirst posted on the website; and the

manner by which a prospective contractormay seek such selection, which may includesubmission by electronic means. Allreasonable and responsive submissions thatare received from prospective contractorsin timely fashion shall be reviewed by thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services. Thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services, in consultationwith the commissioner of health, shallselect such contractor or contractors



57

that, in their discretion, are best suitedto provide the required services.

The commissioners of the office of mentalhealth, the office of alcoholism andsubstance abuse services and thedepartment of health, shall have theresponsibility for jointly designating ona regional basis, after consultation with

the city of New York’s local governmentalunit, as such term is defined in themental hygiene law, and its local socialservices district, and with the priorconsultation of other affected counties, alimited number of specialized managed careplans, special need managed care plans,and/or integrated physical and behavioralhealth provider systems capable ofmanaging the behavioral and physicalhealth needs of medical assistanceenrollees with significant behavioralhealth needs. Initial designations of suchplans or provider systems should be madeno later than April 1, 2013, provided,

however, such designations shall becontingent upon a determination by suchstate commissioners that the entities tobe designated have the capacity andfinancial ability to provide services insuch plans or provider systems, and thatthe region has a sufficient population andservice base to support such plans andsystems. Once designated, the commissionerof health shall make arrangements toenroll such enrollees in such plans orintegrated provider systems and to paysuch plans or provider systems on acapitated or other basis to manage,coordinate, and pay for behavioral andphysical health medical assistanceservices for such enrollees.

Notwithstanding any inconsistent provisionof section 112 and 163 of the statefinance law, and section 142 of theeconomic development law, or any other lawto the contrary, the designations of suchplans and provider systems, and anyresulting contracts with such plans,providers or provider systems areauthorized to be entered into by suchstate commissioners without a competitivebid or request for proposal process.Oversight of such contracts with such

plans, providers or provider systems shallbe the joint responsibility of such statecommissioners, and for contracts affectingthe city of New York, also with the city’slocal governmental unit, as such term isdefined in the mental hygiene law, and itslocal social services district.

Provided, however, if this chapterappropriates sufficient additional fundsto provide coverage for behavioral healthcare and services under the program ofmedical assistance for needy personswithout the savings to be achieved bycontracting for the prior authorization of



58

such services, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011.

For services and expenses of the medicalassistance program including hospitalinpatient services.

Notwithstanding any contrary provision of

law, in determining rates of payments forgeneral hospital inpatient services bystate governmental agencies effective forservices provided for the period April 1,2011 through March 31, 2013, thecommissioner of health shall make suchadjustments to such rates as are necessaryand not inconsistent with otherwisedirectly applicable regulations, to reducereimbursement with regard to servicesprovided to hospital inpatients as aresult, as determined by the commissionerof health, of potentially preventableconditions, hospital acquired conditions,injuries sustained while a hospital

inpatient and the inappropriate use ofcertain medical procedures, includingcesarean deliveries, coronary arterygrafts and percutaneous coronaryinterventions ............................ 1,608,837,000

For services and expenses of the medicalassistance program including hospitaloutpatient and emergency room services ..... 773,050,000

For services and expenses of the medicalassistance program including clinicservices ................................... 684,627,000

For services and expenses of the medicalassistance program including nursing homeservices.

Notwithstanding any contrary provision oflaw, for the period April 1, 2011 throughMarch 31, 2013, with regard to adjustmentsto inpatient rates of payment madepursuant to section 2808 of the publichealth law for inpatient services providedby residential health care facilities forthe period April 1, 2010 through March 31,2012 and the period April 1, 2012 throughMarch 31, 2013, the commissioner of healthand the director of the budget shall, upona determination by such commissioner andsuch director that such rate adjustmentsshall, prior to the application of anyapplicable adjustment for inflation,

result in an aggregate increase in totalmedicaid rates of payment for suchservices for either such state fiscalyear, including payments made pursuant tosubparagraph (i) of paragraph (d) ofsubdivision 2-c of section 2808 of thepublic health law, make such proportionaladjustments to such rates as are necessaryto reduce such total aggregate rateadjustments within each such year suchthat the aggregate total for each suchyear reflects no such increase ordecrease, and provided further, however,that adjustments made pursuant to this



59

paragraph shall not be subject tosubsequent correction or reconciliation,and provided further, however, that ifthis chapter provides sufficientadditional funding to cover the cost ofsuch rate adjustments to the ratesenumerated in this paragraph, thenprovisions of this paragraph shall be

deemed null and void as of March 31, 2011.Notwithstanding any contrary provision oflaw, rule or regulation, for the periodApril 1, 2011 through March 31, 2013, thecapital cost component of medicaid ratesof payment for services provided byresidential health care facilities shallnot include any payment factor for returnon or return of equity, and providedfurther, however, that for that period noadjustment to rates of payment shall bemade pursuant to paragraph (d) ofsubdivision 20 of section 2808 of thepublic health law as in effect on March31, 2011, provided, however, that if this

chapter provides sufficient additionalfunding to cover the cost of theadjustments to the rates enumerated inthis section, then provisions of thissection shall be deemed null and void asof March 31, 2011.

Notwithstanding any inconsistent provisionof law or regulation to the contrary, forthe period April 1, 2011 through March31, 2013, the commissioner of health shallnot be required to revise certified ratesof payment established pursuant to thepublic health law prior to April 1, 2013,based on consideration of rate appealsfiled by residential health carefacilities pursuant to section 2808 of thepublic health law or based uponadjustments to capital cost reimbursementas a result of approval by thecommissioner of health of an applicationfor construction under section 2802 of thepublic health law, in excess of aggregateamount of $80,000,000 per state fiscalyear, provided, however, that in revisingsuch rates within such fiscal limits thecommissioner of health may prioritize rateappeals for facilities which thecommissioner of health determines arefacing significant financial hardship and,

further, the commissioner of health isauthorized to enter into agreements withsuch facilities to resolve multiplepending rate appeals based upon anegotiated aggregate amount and may offsetsuch negotiated aggregate amounts againstany amounts owed by the facility to thedepartment of health, including, but notlimited to, amounts owed pursuant tosection 2807-d of the public health law,provided further, however, that such rateadjustment made pursuant to this section



60

remain fully subject to approval by thedirector of the budget in accordance withthe provisions of subdivision 2 of section2807 of the public health law.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, payments under the

medicaid program to reserve a bed in aresidential health care facility while amedicaid recipient is temporarilyhospitalized or on leave of absence fromthe facility shall be made as follows:payments for reserved bed days shall bemade at 95 percent of the medicaid rateotherwise payable to the facility forservices provided on behalf of suchrecipient; payment for reserved bed daysduring temporary hospitalizations may notexceed fourteen days in any twelve monthperiod; payment for reserved bed days fornon-hospitalization leaves of absence maynot exceed ten days in any twelve month

period; and payments for reserved bed daysfor temporary hospitalizations shall onlybe made to a residential health carefacility if at least 50 percent of thefacility’s residents eligible toparticipate in a medicare managed careplan are enrolled in such a plan.Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payments for reservedbed days without regard to the percentageof a residential health care facility’sresidents that are enrolled in a medicaremanaged care plan, then the provisions ofthis paragraph shall not apply and shallbe considered null and void as of March31, 2011 ................................. 2,393,048,000

For services and expenses of the medicalassistance program including other longterm care services.

Notwithstanding any inconsistent provisionof law or regulation to the contrary, forthe period April 1, 2011 through March 31,2013, for participating providers, meaningcertified home health agencies, long termhome health agencies and personal careproviders with total medicaidreimbursements exceeding $15,000,000 percalendar year, every service or item

within a claim submitted by aparticipating provider shall be reviewedand verified by a verificationorganization prior to submission of aclaim to the department of health providedthat the verification organization shalldeclare each service or item to beverified or unverified and provided thateach participating provider shall receiveand maintain reports for the verificationorganization which shall contain data onverified items or services includingwhether a service appeared on a conflictor exception report before verification



61

and how that conflict or exception wasresolved and items or services that werenot verified, including conflict andexception report data for these servicesand provided that every service or itemwithin a claim submitted by aparticipating provider shall be reviewedand verified by a verification

organization prior to submission of aclaim to the department of health providedthat the verification organization shalldeclare each service or item to beverified or unverified. Provided, however,if this chapter appropriates sufficientadditional funds to support participatingproviders of medical assistance programitems subject to preclaim review otherwiseprovided for in the public health law,than the provisions of this section shallbe deemed null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to the

contrary, for the period April 1, 2011through March 31, 2013:

1. The amount of personal care servicescovered by the medicaid program shall notexceed eight hours per week forindividuals whose needs are limited tonutritional and environmental supportfunctions.

2. The commissioner of health is authorizedto adopt standards for the provision andmanagement of personal care servicescovered by the medicaid program forindividuals whose need for such servicesexceeds a specified level to be determinedby the commissioner of health.

3. The commissioner of health is authorizedto provide assistance to persons receivingpersonal care services covered by themedicaid program who are transitioning toreceiving care from a managed long termcare plan certified pursuant to section4403-f of the public health law.

4. Provided, however, if this chapterappropriates sufficient additional fundsto allow for the payment of personal careservices at the level provided for inparagraph (e) of subdivision 2 of section365-a of the social services law, then theprovisions of this paragraph shall not

apply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law or regulation and subject to theavailability of federal financialparticipation,

(a) for the period April 1, 2011 throughMarch 31, 2013, rates of payment bygovernment agencies for services providedby certified home health agencies, exceptfor such services provided to childrenunder eighteen years of age and otherdiscrete groups as may be determined bythe commissioner, shall reflect ceiling



62

limitations determined in accordance withthis section, provided, however, that atthe discretion of the commissioner suchceilings may, as an alternative, beapplied to payments for services providedfor the period April 1, 2011 through March31, 2012, except for such servicesprovided to children and other discrete

groups as may be determined by thecommissioner. In determining such paymentsor rates of payment, agency ceilings shallbe established. Such ceilings shall beapplied to payments or rates of paymentfor certified home health agency servicesas established pursuant to this sectionand applicable regulations. Ceilings shallbe based on a blend of: (i) an agency’s2009 average per patient medicaid claims,weighted at a percentage as determined bythe commissioner; and (ii) the 2009statewide average per patient medicaidclaims adjusted by a regional wage indexfactor and an agency patient case mix

index, weighted at a percentage asdetermined by the commissioner. Suchceilings will be effective April 1, 2011through March 31, 2012. An interim paymentor rate of payment adjustment effectiveApril 1, 2011, shall be applied toagencies with projected average perpatient medicaid claims, as determined bythe commissioner, to be over theirceilings. Such agencies shall have theirpayments or rates of payment reduced toreflect the amount by which such claimsexceed their ceilings.

(b) Ceiling limitations determined pursuantto subdivision (a) of this section shallbe subject to reconciliation. Indetermining payment or rate of paymentadjustments based on such reconciliation,adjusted agency ceilings shall beestablished. Such adjusted ceilings shallbe based on a blend of: (i) an agency’s2009 average per patient medicaid claimsadjusted by the percentage of increase ordecrease in such agency’s patient case mixfrom the 2009 calendar year to the annualperiod April 1, 2011 through March 31,2012, weighted at a percentage asdetermined by the commissioner; and (ii)the 2009 statewide average per patient

medicaid claims adjusted by a regionalwage index factor and the agency’s patientcase mix index for the annual period April1, 2011 through March 31, 2012, weightedat a percentage as determined by thecommissioner. Such adjusted agency ceilingshall be compared to actual medicaid paidclaims for the period April 1, 2011through March 31, 2012. In those instanceswhen an agency’s actual per patientmedicaid claims are determined to exceedthe agency’s adjusted ceiling, the amountof such excess shall be due from each suchagency to the state and may be recouped by



63

the department in a lump sum amount orthrough reductions in the medicaidpayments due to the agency. In thoseinstances where an interim payment or rateof payment adjustment was applied to anagency in accordance with paragraph (a),and such agency’s actual per patientmedicaid claims are determined to be less

than the agency’s adjusted ceiling, theamount by which such medicaid claims areless than the agency’s adjusted ceilingshall be remitted to each such agency bythe department in a lump sum amount orthrough an increase in the medicaidpayments due to the agency.

(c) Interim payment or rate of paymentadjustments pursuant to this section shallbe based on medicaid paid claims, asdetermined by the commissioner, forservices provided by agencies in the baseyear 2009. Amounts due from reconcilingrate adjustments shall be based onmedicaid paid claims, as determined by the

commissioner, for services provided byagencies in the base year 2009 andmedicaid paid claims, as determined by thecommissioner, for services provided byagencies in the reconciliation periodApril 1, 2011 through March 31, 2012. Indetermining case mix, each patient shallbe classified using a system based onmeasures which may include, but not belimited to, clinical and functionalmeasures, as reported on the federalOutcome and Assessment Information Set(OASIS), as may be amended.

(d) The commissioner may require agencies tocollect and submit any data required toimplement the provisions of this section.

(e) Payments or rate of payment adjustmentsdetermined pursuant to this section shall,for the period April 1, 2011 through March31, 2012, be retroactively reconciledutilizing the methodology in paragraph (b)of this section and utilizing actual paidclaims from such period.

(f) Notwithstanding any inconsistentprovision of this section, payments orrate of payment adjustments made pursuantto this section shall not result in anaggregate annual decrease in medicaidpayments to providers subject to this

section that is in excess of $200,000,000,as determined by the commissioner and notsubject to subsequent adjustment, and thecommissioner shall make such adjustmentsto such payments or rates of payment asare necessary to ensure that suchaggregate limits on payment decreases arenot exceeded.

Notwithstanding any inconsistent provisionof law or regulation and subject to theavailability of federal financialparticipation, for the period April 1,2012 through March 31, 2013, payments bygovernment agencies for services provided



64

by certified home health agencies, exceptfor such services provided to childrenunder eighteen years of age and otherdiscreet groups as may be determined bythe commissioner, shall be based onepisodic payments. In establishing suchpayments, a statewide base price shall beestablished for each sixty day episode of

care and adjusted by a regional wage indexfactor and an individual patient case mixindex. Such episodic payments may befurther adjusted for low utilization casesand to reflect a percentage limitation ofthe cost for high-utilization cases thatexceed outlier thresholds of suchpayments. Episodic payments shall be basedon medicaid paid claims, as determined andadjusted by the commissioner to achievesavings comparable to the prior statefiscal year, for services provided by allcertified home health agencies in the baseyear 2009. The commissioner may requireagencies to collect and submit any data

required to implement this subdivision.Notwithstanding any inconsistent provision

of law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, benefits under themedical assistance program shall befurnished to applicants in cases where,although such applicant has a responsiblerelative with sufficient income andresources to provide medical assistance,the income and resources of theresponsible relative are not available tosuch applicant because of the absence ofsuch relative and the refusal or failureof such absent relative to provide thenecessary care and assistance. In suchcases, however, the furnishing of suchassistance shall create an impliedcontract with such relative, and the costthereof may be recovered from suchrelative in accordance with title 6 ofarticle 3 of the social services law andother applicable provisions of law.Provided, however, if this chapterappropriates sufficient additional fundsto allow medical assistance to befurnished in situations in which aresponsible relative who is not absentfrom the household fails or refuses to

provide necessary care and assistance,then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any contrary law, rule orregulation, for the period April 1, 2011through March 31, 2013 medicaid rates ofpayments for services provided bycertified home health agencies, by longterm home health care programs or by anAIDS home care program, to patientsdiagnosed with Acquired Immune DeficiencySyndrome (AIDS) shall reflect no separatepayment for home care nursing services.



65

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013:

1. The commissioner of health is authorizedto submit the appropriate waivers,including but not limited to thoseauthorized pursuant to sections 1115 and

1915 of the federal social security act orsuccessor provisions, and any otherwaivers necessary to require medicalassistance recipients who are twenty-oneyears of age or older and who requirecommunity-based long term care services,as specified by the commissioner, for morethan 120 days, to receive such servicesthrough a managed long term care plancertified pursuant to section 4403-f ofthe public health law or other carecoordination program specified by thecommissioner.

2. With respect to persons in receipt oflong term care services prior to

enrollment, the commissioner of healthshall require the managed long term careplan to contract with agencies currentlyproviding such services, in order topromote continuity of care.

The commissioner shall develop a workgroupto further evaluate and promote thetransition of persons in receipt of homeand community-based long term careservices in to managed long term careplans and other care coordination models.

3. An entity shall not need a designation bythe majority leader of the senate, thespeaker of the assembly, or thecommissioner of health in order to applyfor a certificate of authority as amanaged long term care plan.

4. Managed long term care plans may beauthorized by the department of health tocover primary care and acute care.

5. Managed long term care enrollmentapplications will be processed by thedepartment of health or its designee, andnot by local departments of socialservices.

6. Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payment for services ona fee-for-service basis without the

savings to be achieved by requiringenrollment of medicaid recipients inmanaged long term care plans or other carecoordination models, and by streamliningthe process for enrolling participants inmanaged long term care plans, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011 ................ 4,388,550,000

For services and expenses of the medicalassistance program including managed careservices.



66


1. The following medicaid recipients shallnot be required to participate in amanaged care program established pursuantto section 364-j of the social services

law: (i) individuals with a chronicmedical condition who are being treated bya specialist physician that is notassociated with a managed care provider inthe individual’s social services districtmay defer participation in the managedcare program for six months or until thecourse of treatment is complete, whicheveroccurs first; and Native Americans.

2. The following medicaid recipients shallnot be eligible to participate in amanaged care program established pursuantto section 364-j of the social serviceslaw: (i) a person eligible for medicareparticipating in a capitated demonstration

program for long term care; (ii) an infantliving with an incarcerated mother in astate or local correctional facility asdefined in section 2 of the correctionlaw; (iii) a person who is expected to beeligible for medical assistance for lessthan six months; (iv) a person who iseligible for medical assistance benefitsonly with respect to tuberculosis-relatedservices; (v) individuals receivinghospice services at time of enrollment;(vi) a person who has primary medical orhealth care coverage available from orunder a third-party payor which may bemaintained by payment, or part payment, ofthe premium or costs sharing amounts, whenpayment of such premium or cost sharingamounts would be cost-effective, asdetermined by the local social servicesdistrict; (vii) a person receiving familyplanning services pursuant to subparagraph11 of paragraph (a) of subdivision 1 ofsection 366 of the social services law;(viii) a person who is eligible formedical assistance pursuant to paragraph(v) of subdivision 4 of section 366 ofthe social services law; and (ix) a personwho is medicare/medicaid dually eligibleand who is not enrolled in a medicare

managed care plan.3. The following categories of medicaid

recipients may be required to enroll witha managed care program when programfeatures and reimbursement rates areapproved by the commissioner of healthand, as appropriate, the commissioner ofmental health: (i) an individual duallyeligible for medical assistance andbenefits under the federal medicareprogram and enrolled in a medicare managedcare plan offered by an entity that isalso a managed care provider; providedthat (notwithstanding paragraph (g) of





68

their social services district to enrollin the managed care program to select amanaged care provider, and as appropriate,a mental health special needs plan.

5. The department of health is authorized tocontract with an entity offering acomprehensive health services plan,including an entity that has received a

certificate of authority pursuant tosections 4403, 4403-a or 4408-a of thepublic health law (as added by chapter 639of the laws of 1996) or a healthmaintenance organization authorized underarticle 43 of the insurance law, toeligible individuals residing in thegeographic area served by such entity.Cities with a population of over 2,000,000shall not be authorized to enter intomedicaid managed care contracts withcomprehensive health services plans. Suchcontracts may provide for medicaidpayments on a capitated basis for nursingfacility, home care or other long term

care services of a duration and scopedetermined by the commissioner of health.

6. Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payment for services ona fee-for-service basis without thesavings to be achieved by expanding thepopulations allowed or required toparticipate in medicaid managed care, orby streamlining the process for enrollingparticipants in medicaid managed careplans, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011 ..................................... 7,126,729,000

For services and expenses of the medicalassistance program including pharmacyservices.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, payments for drugswhich may not be dispensed without aprescription as required by section 6810of the education law and for which paymentis authorized under the medical assistanceprogram pursuant to subdivision 2 ofsection 365-a of the social services lawor under the family health plus program

pursuant to subparagraph (v) of paragraph(e) of subdivision 1 of section 369-ee ofthe social services law may be included inthe capitation payment for services orsupplies provided to medical assistance orfamily health plus recipients by managedcare organizations or other entities whichare certified under article 44 of thepublic health law or licensed pursuant toarticle 43 of the insurance law orotherwise authorized by law to offercomprehensive health services plans tomedical assistance or family health plusrecipients. Provided, however, if this



69

chapter appropriates sufficient additionalfunds to allow such drugs to continue tobe excluded as a benefit available tomedical assistance and family health plusrecipients through such comprehensivehealth services plans, then the provisionsof this paragraph shall not apply andshall be considered null and void as of

March 31, 2011.Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissionerof health is authorized to designate someor all of the drugs manufactured ormarketed by a pharmaceutical manufactureras non-preferred drugs under the preferreddrug program established pursuant tosection 272 of the public health law if:the commissioner of health has previouslydesignated such pharmaceuticalmanufacturer as one with whom thecommissioner is negotiating a

manufacturer agreement, and included thedrugs it manufactures or markets on thepreferred drug list; and the commissionerhas not reached a manufacturer agreementwith such manufacturer. Provided, however,if this chapter appropriates sufficientadditional funds to require thecommissioner of health to designate asnon-preferred all of the drugsmanufactured or marketed by a manufacturerwith whom the commissioner has been unableto reach a manufacturer agreement, thenthe provisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, for those drugswhich may not be dispensed without aprescription as required by section 6810of the education law and for which paymentis authorized under the medical assistanceprogram pursuant to subdivision 2 ofsection 365-a of the social services law,payments for such drugs and dispensingfees shall be limited to amountsestablished by the commissioner of health.Provided, however, if this chapter

appropriates sufficient additional fundsto allow the medical assistance program tocontinue to pay for drugs and dispensingfees in the amounts described insubdivision 9 of section 367-a of thesocial services law, then the provisionsof this paragraph shall not apply andshall be considered null and void as ofMarch 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissionerof health may designate therapeutic



70

classes of drugs or individual drugs aspreferred drugs in the medicaid preferreddrug program established pursuant tosection 272 of the public health law priorto any review that may be conducted by thepharmacy and therapeutics committeecreated pursuant to section 271 of thepublic health law. In addition, if a non-

preferred drug is prescribed and does notmeet the criteria for approval of a non-preferred drug under subdivision 3 ofsection 273 of the public health law,after providing a reasonable opportunityfor the prescriber to reasonably presenthis or her justification for priorauthorization, prior authorization will bedenied if the preferred drug programdetermines that the use of the non-preferred is not warranted. Provided,however, if this chapter appropriatessufficient additional funds to allow themedicaid program to pay for non-preferreddrugs which have been prescribed but whose

use the preferred drug program hasdetermined to be unwarranted, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, for personseligible for medical assistance who arealso beneficiaries under part D of titleXVIII of the federal social security act,the following categories of drugs shallnot be exempt from the definition of“covered part D drugs” and shall besubject to the medical assistanceexclusion of coverage for “covered part Ddrugs”: atypical anti-psychotics, anti-depressants, anti-retrovirals used in thetreatment of HIV/AIDS, and anti-rejectiondrugs used for the treatment of organ andtissue transplants. Provided, however,that if this chapter appropriatessufficient additional funds to continue toexempt such drugs from the definition of“covered part D drugs”, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the followingdrugs shall not be exempt from inclusionin the preferred drug program establishedpursuant to section 272 of the publichealth law: atypical anti-psychotics;anti-depressants; anti-retrovirals used inthe treatment of HIV/AIDS; and anti-rejection drugs used for the treatment oforgan and tissue transplants. Provided,however, if this chapter appropriatessufficient additional funds to allow such



71

drugs to continue to be exempt from theprior authorization requirements of thepreferred drug program, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011 ............... 82,339,000

For services and expenses of the medicalassistance program including transporta-

tion services .............................. 137,733,000For services and expenses of the medicalassistance program including dentalservices .................................... 98,731,000

For services and expenses of the medicalassistance program including non-institu-tional and other spending.

Notwithstanding any inconsistent provisionof law, the money hereby appropriated maybe available for payments to schooldistricts, and to any city with apopulation of over 2,000,000 associatedwith additional claims for schoolsupportive health services.


of law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013:

1. The commissioner of health is authorizedto contract with one or more entities toconduct a study to determine actual directand indirect costs incurred by publicschool districts and state operated/statesupported schools which operate pursuantto article 85, 87 or 88 of the educationlaw for medical care, services andsupplies, including related specialeducation services and specialtransportation, furnished to children withhandicapping conditions. In addition, thecommissioner of health is authorized tocontract with one or more entities toconduct a study to determine actual directand indirect costs incurred by countiesfor medical care, services and supplies,including related special educationservices and special transportation,furnished to pre-school children withhandicapping conditions.

2. Notwithstanding any inconsistentprovision of sections 112 and 163 of thestate finance law, or section 142 of theeconomic development law, or any otherlaw, the commissioner of health is

authorized to enter into a contract orcontracts referenced in paragraph onewithout a competitive bid or request forproposal process; provided, however, thatthe department of health shall post on itswebsite, for a period of no less thanthirty days: a description of the proposedservices to be provided pursuant to thecontract or contracts; the criteria forselection of a contractor or contractors;the period of time during which aprospective contractor may seek selection,which shall be no less than thirty daysafter such information is first posted on



72

the website; and the manner by which aprospective contractor may seek suchselection, which may include submission byelectronic means. All reasonable andresponsive submissions that are receivedfrom prospective contractors in timelyfashion shall be reviewed by thecommissioner of health. The commissioner

of health shall select such contractor orcontractors that, in his or herdiscretion, are best suited to serve thepurposes of this section.

3. The commissioner of health shall evaluatethe results of the study or studiesreferenced in paragraph one to determine,after identification of actual direct andindirect costs incurred by public schooldistricts, state operated/state supportedschools, and counties, whether it isadvisable to claim federal reimbursementfor expenditures under sections 368-d and368-e of the social services law ascertified public expenditures. In the

event such claims are submitted, iffederal reimbursement received forcertified public expenditures on behalf ofmedical assistance recipients whoseassistance and care are the responsibilityof a social services district in a citywith a population of over 2,000,000,results in a decrease in the state shareof annual expenditures pursuant tosections 368-d and 368-e of the socialservices law for such recipients, then tothe extent that the amount of any suchdecrease exceeds $50,000,000, the excessamount shall be transferred to such city.Any such excess amount transferred shallnot be considered a revenue received bysuch social services district indetermining the district’s actual medicalassistance expenditures for purposes ofparagraph (b) of section 1 of part C ofchapter 58 of the laws of 2005.

4. Provided, however, if this chapterappropriates sufficient additional fundsto pay for costs incurred by public schooldistricts, state operated/state supportedschools, and counties without claiming theactual direct and indirect costs incurredby such entities as certified publicexpenditures, then the provisions of this

paragraph shall not apply and shall beconsidered null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the medicalassistance program shall provide coveragefor medically necessary speech therapy,and when provided at the direction of aphysician or nurse practitioner, physicaltherapy and related rehabilitativeservices, and occupational therapy.Provided, however, that speech therapy,



73

physical therapy, and occupational therapyeach shall be limited to coverage oftwenty visits per year, with suchlimitation not applying to persons withdevelopmental disabilities. Provided,however, if this chapter appropriatessufficient additional funds to allow themedical assistance program to cover such

medically necessary services without alimitation on the number of visits paidfor, then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the estate of amedical assistance recipient, for purposesof making any recoveries of the cost ofsuch assistance otherwise authorized bylaw, shall include any real and personalproperty in which the medical assistancerecipient had any legal title or interest

at the time of death, including jointlyheld property, retained life estates, andinterests in trusts, to the extent of suchinterests, provided, however, that a claimagainst a recipient of such property bydistribution or survival shall be limitedto the value of the property received orthe amount of medical assistance benefitsotherwise recoverable, whichever is less.Provided, however, if this chapterappropriates sufficient additional fundsto permit limiting recoveries to real andpersonal property and other assets passingunder the terms of a valid will or byintestacy, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011 ..................................... 1,661,670,000

Notwithstanding any inconsistent provisionof law, subject to the approval of thedirector of the budget, up to the amountappropriated herein, together with anyavailable federal matching funds, may betransferred to the general fund - statepurposes account for services and expensesrelated to pharmacy best practices initi-atives including prior authorizations andprior approvals ............................. 13,600,000


of law, subject to the approval of thedirector of the budget, up to the amountappropriated herein, together with anyavailable federal matching funds, may betransferred to the general fund - statepurposes account for services and expensesrelated to utilization review activitiesincluding but not limited to utilizationmanagement for radiology and transporta-tion management services .................... 21,000,000

Notwithstanding any inconsistent provisionsof law, subject to the approval of thedirector of the budget, up to the amountappropriated herein, together with any



74

available federal matching funds, may betransferred to the general fund - statepurposes account for services and expensesrelated to education of medicaid eligiblesand recipients regarding the medicare partD program and recipient and providernotification and other program informationas determined necessary by the commission-

er of health. Subject to the approval ofthe director of the budget, a portion ofthis appropriation may be suballocated toother state agencies ......................... 5,000,000

Notwithstanding any inconsistent provisionof law, subject to the approval of a planby the director of the budget, up to theamount appropriated herein, together withany available federal matching funds, maybe transferred to the general fund - statepurposes account for services and expensesrelated to making improvements in thelong-term care system including long-termcare restructuring, the nursing home tran-sition and diversion waiver, and point-of-

entry initiatives for the purpose ofexpanding and promoting a more coordinatedlevel of care for the delivery of qualityservices in the community .................... 3,500,000

Notwithstanding any inconsistent provisionof law, subject to the approval of thedirector of the budget, up to the amountappropriated herein, together with anyavailable federal matching funds, may betransferred to the general fund - statepurposes account for services and expensesrelated to required criminal backgroundchecks for non-licensed long-term careemployees including employees of nursinghomes, certified home health agencies,long term home health care providers, AIDShome care providers, and licensed homecare service agencies ....................... 23,410,000

Notwithstanding any inconsistent provisionof section 112 or 163 of the state financelaw or any other contrary provision of thestate finance law or any other contraryprovision of law, the commissioner ofhealth may, without a competitive bid orrequest for proposal process, enter intocontracts with one or more certifiedpublic accounting firms for the purpose ofconducting audits of disproportionateshare hospital payments made by the state

of New York to general hospitals and forthe purpose of conducting audits of hospi-tal cost reports as submitted to the stateof New York in accordance with article 28of the public health law. Notwithstandingany inconsistent provisions of law,subject to the approval of the director ofthe budget, up to the amount appropriatedherein, together with any available feder-al matching funds, may be transferred tothe general fund - state purposes account .... 4,600,000

Notwithstanding any inconsistent provisionof law, subject to a plan developed by thecommissioner of health and approved by the



75

director of the budget, up to the amountappropriated herein, together with anyavailable federal matching funds, will beavailable for demonstrations that developand evaluate interventions targeted atmedicaid beneficiaries who are otherwiseexempt or excluded from mandatory Medicaidmanaged care and who have multiple comor-

bidities.Notwithstanding section 112 and section 163of the state finance law, for chronicillness demonstration projects authorizedby section 364-l of the social serviceslaw, the commissioner of health may allo-cate up to $2,500,000 of the amount appro-priated for contracts without a requestfor proposal process or any other compet-itive process ............................... 12,000,000

Notwithstanding any other provision of law,the money herein appropriated, togetherwith any available federal matching funds,is available for transfer or suballocationto the state university of New York and

its subsidiaries, or to contract withoutcompetition for services with the stateuniversity of New York research founda-tion, to provide support for the adminis-tration of the medical assistance programincluding activities such as dental priorapproval, retrospective and prospectivedrug utilization review, development ofevidence based utilization thresholds,data analysis, clinical consultation andpeer review, clinical support for thepharmacy and therapeutic committee, andother activities related to utilizationmanagement and for health informationtechnology support for the medicaidprogram ..................................... 12,000,000

For grants to the civil service employeesassociation, Local 1000, AFSCME, AFL-CIOto contribute to the union's cost ofpurchasing health insurance coverage underthe family health plus (FHPlus) buy-in forchild care providers represented by theunion who do not otherwise qualify forcoverage under FHPlus ....................... 13,600,000

For grants to the United Federation ofTeachers, Local 2, AFT, AFL-CIO tocontribute to the union's cost of purchas-ing health insurance coverage under thefamily health plus (FHPlus) buy-in for

child care providers represented by theunion who do not otherwise qualify forcoverage under FHPlus ....................... 18,000,000

Notwithstanding any inconsistent provisionof law, subject to the approval of thedirector of the budget, moneys appropri-ated herein may be transferred to thegeneral fund, state purposes account forservices and expenses related to the inde-pendent audit of the internal controls ofthe school and preschool supportive healthservices programs as required by the New



76

York state school supportive healthservices program compliance agreement withthe centers for medicare and medicaidservices.

Notwithstanding any inconsistent provisionof law, subject to the approval of thedirector of the budget, the amount appro-priated herein may be increased or

decreased by interchange with any appro-priation of the department of health ........... 800,000For services and expenses of the medicalassistance program including medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services ............. 8,500,000,000

--------------Program account subtotal .............. 27,582,824,000

-------------- Special Revenue Funds - FederalFederal Health and Human Services Fund

Medicaid Direct Account For services and expenses for the medicalassistance program, including administra-tive expenses for local social servicesdistricts, pursuant to title XIX of thefederal social security act or its succes-sor program.

Notwithstanding section 40 of state financelaw or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in fullforce and effect in accordance with thefollowing schedule: 50.90 percent for theperiod April 1, 2011 to March 31, 2012;49.10 percent for the period April 1, 2012to March 31, 2013.

The moneys hereby appropriated are to beavailable for payment of aid heretoforeaccrued to municipalities, and toproviders of medical services pursuant tosection 367-b of the social services law,and for payment of state aid tomunicipalities and to providers of familycare where payment systems through thefiscal intermediaries are not operational,shall be available to the department netof disallowances, refunds, reimbursements,and credits.

Notwithstanding any other provision of law,the money hereby appropriated may beincreased or decreased by interchange,with any appropriation of the departmentof health and the office of medicaidinspector general and may be increased ordecreased by transfer or suballocationbetween these appropriated amounts andappropriations of the office of mentalhealth, office for people with develop-mental disabilities, the office of alco-holism and substance abuse services, thedepartment of family assistance office oftemporary and disability assistance,



77

office of children and family services,and state office for the aging with theapproval of the director of the budget,who shall file such approval with thedepartment of audit and control and copiesthereof with the chairman of the senatefinance committee and the chairman of theassembly ways and means committee.

Notwithstanding any inconsistent provisionof law, in lieu of payments authorized bythe social services law, or payments offederal funds otherwise due to the localsocial services districts for programsprovided under the federal social securityact or the federal food stamp act, fundsherein appropriated, in amounts certifiedby the state commissioner of temporary anddisability assistance or the state commis-sioner of health as due from local socialservices districts each month as theirshare of payments made pursuant to section367-b of the social services law may beset aside by the state comptroller in an

interest-bearing account in order toensure the orderly and prompt payment ofproviders under section 367-b of thesocial services law pursuant to an esti-mate provided by the commissioner ofhealth of each local social servicesdistrict's share of payments made pursuantto section 367-b of the social serviceslaw.

Notwithstanding any other provision of law,rule or regulation, to the contrary, forthe period April 1, 2011 through March 31,2013, all medicaid payments made forservices provided on and after April 1,2011, shall, except as hereinafterprovided, be subject to a uniform 2percent reduction and such reduction shallbe applied, to the extent practicable, inequal amounts during the fiscal year,provided, however, that an alternativemethod may be considered at the discretionof the commissioner of health and thedirector of the budget based uponconsultation with the health care industryincluding but not limited to, a uniformreduction in medicaid rates of payment orother reductions provided that any methodselected achieves no less than$702,000,000 in medicaid state share

savings, except as hereinafter provided,for services provided on and after April1, 2011 through March 31, 2013.

The following shall be exempt fromreductions pursuant to this section:

(i) any reductions that would violatefederal law including, but not limited to,payments required pursuant to the federalmedicare program;

(ii) any reductions related to paymentspursuant to article 32, article 31 andarticle 16 of the mental hygiene law;



78

(iii) payments the state is obligated tomake pursuant to court orders orjudgments;

(iv) payments for which the non-federalshare does not reflect any state funding;and

(v) at the discretion of the commissioner ofhealth and the director of the budget,

payments with regard to which it isdetermined by the commissioner of healthand the director of the budget thatapplication of reductions pursuant to thissection would result, by operation offederal law, in a lower federal medicalassistance percentage applicable to suchpayments.

Reductions to medicaid payments or medicaidrates of payments made pursuant to thissection shall be subject to the receipt ofall necessary federal approvals.

Provided, however, if this chapterappropriates sufficient additional fundsto support medicaid payments or medicaid

rates of payments, the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011.

Notwithstanding paragraph (c) of subdivision10 of section 2807-c of the public healthlaw, section 21 of chapter 1 of the lawsof 1999, or any other contrary provisionof law, in determining rates of paymentsby state governmental agencies effectivefor services provided for the period April1, 2011 through March 31, 2013, forinpatient and outpatient services providedby general hospitals, for inpatientservices and adult day health careoutpatient services provided byresidential health care facilitiespursuant to article 28 of the publichealth law, for home health care servicesprovided pursuant to article 36 of thepublic health law by certified home healthagencies, long term home health careprograms and AIDS home care programs, forpersonal care services provided pursuantto section 365-a of the social serviceslaw, hospice services provided pursuant toarticle 40 of the public health law,foster care services provided pursuant toarticle 6 of the social services law, the

commissioner of health shall apply nogreater than zero trend factorsattributable to calendar years on andafter 2011 in accordance with paragraph(c) of subdivision 10 of section 2807-c ofthe public health law, provided, however,that such no greater than zero trendfactors for such calendar years shall alsobe applied to rates of payment forpersonal care services for such periodprovided in those local social servicedistricts, including New York city, whoserates of payment for such services areestablished by such local social service



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districts pursuant to a rate-settingexemption issued by the commissioner ofhealth to such local social servicedistricts in accordance with applicableregulations, and provided further,however, that for rates of payment forassisted living program services providedfor the period April 1, 2011 through March

31, 2013, trend factors attributable tosuch calendar years shall be establishedat no greater than zero percent, provided,however, that if this chapter providessufficient additional funding to cover thecost of trend factor adjustments to therates enumerated in this section, thenprovisions of this section shall be deemednull and void as of March 31, 2011.

Notwithstanding any provision of law to thecontrary and subject to the availabilityof federal financial participation, forthe period April 1, 2011 through March 31,2013, clinics certified pursuant toarticles 16, 31 or 32 of the mental

hygiene law shall be subject to targetedmedicaid reimbursement rate reductions inaccordance with the provisions of thissection. Such reductions shall be based onutilization thresholds which may beestablished either as provider-specific orpatient-specific thresholds. Providerspecific thresholds shall be based onaverage patient utilization for a givenprovider in comparison to a peer basedstandard to be determined for eachservice. When applying a provider specificthreshold, rates will be reduced on aprospective basis based on the amount anyprovider is over the determined thresholdlevel. Patient-specific thresholds will bebased on annual thresholds determined foreach service over which the per visitpayment for each visit in excess of thestandard during a twelve month periodshall be reduced by a pre-determinedamount. The thresholds, peer basedstandards and the payment reductions shallbe determined by the department of health,with the approval of the division of thebudget, and in consultation with theoffice of mental health, the office forpeople with developmental disabilities andthe office of alcoholism and substance

abuse services, and any such resultingrates shall be subject to certification bythe appropriate commissioners pursuant tosubdivision (a) of section 43.02 of themental hygiene law. The base period usedto establish the thresholds shall be the2009 calendar year. The total annualizedreduction in payments shall be no lessthan $10,900,000 for Article 31 clinics,no less than $2,400,000 for Article 16clinics, and no less than $13,250,000 forArticle 32 clinics. Provided, however ifthis chapter provides sufficientadditional funding to cover the cost of



80

targeted medical reimbursement ratereductions enumerated in this section,then the provisions of this section shallbe deemed null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011

through March 31, 2013, the commissionerof health is authorized, in consultationwith the commissioners of the office ofmental health, office of alcoholism andsubstance abuse services, and office forpeople with developmental disabilities to:establish, in accordance with applicablefederal law and regulations, standards forthe provision of health home services toenrollees with chronic conditions in theprogram of medical assistance for needypersons; establish payment methodologiesfor health home services based on factorsincluding but not limited to thecomplexity of the conditions providers

will be managing, the anticipated amountof patient contact needed to manage suchconditions, and the health care costsavings realized by provision of healthhome services; establish the criteriaunder which such an enrollee will bedesignated as being eligible to receivehealth home services; and assign anyenrollee designated as an eligibleindividual to a provider of health homeservices. Until such time as thecommissioner of health obtains necessarywaivers of the federal social securityact, enrollees assigned to providers ofhealth home services will be allowed toopt out of such services. In addition tosuch payments made for health homeservices, the commissioner of health isauthorized to pay additional amounts toproviders of health home services thatmeet process or outcome standardsspecified by the commissioner. Payment forsuch health home services and suchadditional payments will be made withstate funds only, to the extent that suchfunds are appropriated therefore, untilsuch time as federal financialparticipation in the costs of suchservices is available. The commissioner of

health is authorized to submit amendmentsto the state plan for medical assistanceand/or submit one or more applications forwaivers of the federal social securityact, to obtain federal financialparticipation in the costs of health homeservices. Notwithstanding any limitationsimposed by section 364 - l of the socialservices law, the commissioner isauthorized to allow entities participatingin demonstration projects establishedpursuant to such section to provide healthhome services. Notwithstanding any law,rule, or regulation to the contrary, the



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commissioners of the department of health,the office of mental health, and theoffice of alcoholism and substance abuseservices are authorized to jointlyestablish a single set of operating andreporting requirements and a single set ofconstruction and survey requirements forentities that can demonstrate experience

in the delivery of health, and mentalhealth and/or alcohol and substance abuseservices and the capacity to offerintegrated delivery in each locationapproved by the commissioner, and meet thestandards for providing and receivingpayment for health home services. Inestablishing a single set of operating andreporting requirements and a single set ofconstruction and survey requirements forentities described in this subdivision,the commissioners of the department ofhealth, the office of mental health, andthe office of alcoholism and substanceabuse services are authorized to waive any

regulatory requirements as are necessaryto avoid duplication of requirements andto allow the integrated delivery ofservices in a rational and efficientmanner. Provided, however, if this chapterappropriates sufficient additional fundsto provide coverage for persons withchronic conditions under the program ofmedical assistance for needy personswithout the savings to be achieved throughthe provision of health home services,then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013: coverage under theMedicaid program for enteral formulatherapy is limited to coverage only fornasogastric, jejunostomy, or gastrostomytube feeding or for treatment of an inbornerror of metabolism, and no othernutritional or dietary supplements arecovered; coverage under the medicaidprogram for prescription footwear andinserts is limited to coverage only whenused as an integral part of a lower limborthotic appliance, as part of a diabetic

treatment plan, or to address growth anddevelopment problems in children; coverageunder the medicaid program for compressionand support stockings is limited tocoverage only for pregnancy or treatmentof venous stasis ulcers; and thecommissioner of health is authorized torequire prior authorization forprescriptions of opioid analgesics inexcess of four prescriptions in a thirty-day period. Provided, however, if thischapter appropriates sufficient additionalfunds to allow medicaid coverage of suchservices without imposing such



82

limitations, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, when medicaid

eligible persons are also beneficiariesunder part B of title XVIII of the federalsocial security act and payment under partB would exceed the amount that would bepaid by medicaid if the person were noteligible under part B or a qualifiedmedicare beneficiary, the amount payablefor services covered under the medicaidprogram for hospital outpatient servicesor diagnostic and treatment centerservices pursuant to article 28 of thepublic health law shall be 20 percent ofthe amount of any coinsurance liability ofsuch eligible person pursuant to federallaw if they were not eligible for medicaid

or were not a qualified medicarebeneficiary; provided however that in noevent shall the amount payable forservices covered under the medicaidprogram for such eligible person exceedthe approved medical assistance paymentlevel less the amount payable under partB.

Provided, however, if this chapterappropriates sufficient additional fundsto provide medical assistance paymentsunder paragraph (d) of subdivision 1 ofsection 367-a of the social services lawfor hospital outpatient services ordiagnostic and treatment center servicesin situations where payment under part Bof title XVIII of the federal socialsecurity act would exceed the amount thatotherwise would be paid by medicaid if theperson were not eligible under part B or aqualified medicare beneficiary, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the maximum co-payment chargeable to a recipient of

medicaid for non-institutional servicesshall be as follows: where the state’spayment for the service is $10 or less,the maximum co-payment shall be $.60;where the state’s payment for the serviceis from $10.01 to $25.00, the maximum co-payment shall be $1.15; where the state’spayment for the service is from $25.01 to$50.00, the maximum co-payment shall be$2.30; where the state’s payment for theservice is $50.01 or more, the maximum co-payment shall be $3.40. The co-paymentchargeable to a medicaid recipient foreach discharge for inpatient care shall be



83

$30.00. The co-payment charged for eachgeneric prescription drug dispensed shallbe $1.15 and for each brand nameprescription drug dispensed shall be$3.40; provided, however, that the co-payment charged for each brand nameprescription drug on the preferred druglist established pursuant to section 272

of the public health law and the co-payment charged for each brand nameprescription drug reimbursed pursuant tosubparagraph (ii) of paragraph (a-1) ofsubdivision 4 of section 365-a of thesocial services law shall be $1.15. Co-payments shall apply to the followingservices in addition to those listed inparagraph (d) of subdivision 6 of section367-a of the social services law: visioncare; dental services; audiology services;physician services; nurse practitionerservices; and rehabilitation servicesincluding occupational therapy, physicaltherapy and speech therapy. In the year

commencing April 1, 2011 and for each yearthereafter, no recipient shall be requiredto pay more than a total of $300.00 in co-payments nor shall reductions in Medicaidpayments as a result of such co-paymentsexceed $300.00 for any recipient. In boththe medicaid and family health plusprograms, the co-payment for emergencyroom services provided for non-urgent ornon-emergency medical care shall be $6.40;provided however that co-payments shallnot be required with respect to emergencyservices or family planning services andsupplies. The co-payment for nursepractitioner services in the family healthplus program shall be $5.00. Provided,however, if this chapter appropriatessufficient additional funds to allow themedicaid and family health plus programsto pay for services without the savings tobe achieved by increasing the amount orscope of required co-payments, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissioners

of the office of mental health and theoffice of alcoholism and substance abuseservices, in consultation with thecommissioner of health and with theapproval of the division of budget, shallhave responsibility for jointlydesignating regional entities to provideadministrative and management services forthe purposes of prior approving andcoordinating the provision of behavioralhealth services, and integratingbehavioral health services with otherservices available under the medicalassistance program, for recipients of



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medical assistance who are not enrolled inmanaged care, and for approval,coordination, and integration ofbehavioral health services that are notprovided through managed care programsunder the medical assistance program forindividuals regardless of whether or notsuch individuals are enrolled in managed

care programs. Such regional entitiesshall also be responsible for safeguardingagainst unnecessary utilization of suchcare and services and assuring thatpayments are consistent with the efficientand economical delivery of quality care.In exercising this responsibility, thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services are authorized tocontract, after consultation with thecommissioner of health, with regionalbehavioral health organizations or otherentities. Such contracts may includeresponsibility for: receipt, review, and

determination of prior authorizationrequests for behavioral health care andservices, consistent with criteriaestablished or approved by thecommissioners of mental health andalcoholism and substance abuse services,and authorization of appropriate care andservices based on documented patientmedical need.

Notwithstanding any inconsistent provisionof sections 112 and 163 of the statefinance law, or section 142 of theeconomic development law, or any otherlaw, commissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services are authorized toenter into such contract or contractswithout a competitive bid or request forproposal process; provided, however, thatthe office of mental health and the officeof alcoholism and substance abuse servicesshall post on their websites, for a periodof no less than thirty days: a descriptionof the proposed services to be providedpursuant to the contractor contracts; thecriteria for selection of a contractor orcontractors; the period of time duringwhich a prospective contractor may seekselection, which shall be no less than

thirty days after such information isfirst posted on the website; and themanner by which a prospective contractormay seek such selection, which may includesubmission by electronic means. Allreasonable and responsive submissions thatare received from prospective contractorsin timely fashion shall be reviewed by thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services. Thecommissioners of the office of mentalhealth and the office of alcoholism andsubstance abuse services, in consultation



85

with the commissioner of health, shallselect such contractor or contractorsthat, in their discretion, are best suitedto provide the required services.

The commissioners of the office of mentalhealth, the office of alcoholism andsubstance abuse services and thedepartment of health, shall have the

responsibility for jointly designating ona regional basis, after consultation withthe city of New York’s local governmentalunit, as such term is defined in themental hygiene law, and its local socialservices district, and with the priorconsultation of other affected counties, alimited number of specialized managed careplans, special need managed care plans,and/or integrated physical and behavioralhealth provider systems capable ofmanaging the behavioral and physicalhealth needs of medical assistanceenrollees with significant behavioralhealth needs. Initial designations of such

plans or provider systems should be madeno later than April 1, 2013, provided,however, such designations shall becontingent upon a determination by suchstate commissioners that the entities tobe designated have the capacity andfinancial ability to provide services insuch plans or provider systems, and thatthe region has a sufficient population andservice base to support such plans andsystems. Once designated, the commissionerof health shall make arrangements toenroll such enrollees in such plans orintegrated provider systems and to paysuch plans or provider systems on acapitated or other basis to manage,coordinate, and pay for behavioral andphysical health medical assistanceservices for such enrollees.

Notwithstanding any inconsistent provisionof section 112 and 163 of the statefinance law, and section 142 of theeconomic development law, or any other lawto the contrary, the designations of suchplans and provider systems, and anyresulting contracts with such plans,providers or provider systems areauthorized to be entered into by suchstate commissioners without a competitive

bid or request for proposal process.Oversight of such contracts with suchplans, providers or provider systems shallbe the joint responsibility of such statecommissioners, and for contracts affectingthe city of New York, also with the city’slocal governmental unit, as such term isdefined in the mental hygiene law, and itslocal social services district.

Provided, however, if this chapterappropriates sufficient additional fundsto provide coverage for behavioral healthcare and services under the program ofmedical assistance for needy persons



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without the savings to be achieved bycontracting for the prior authorization ofsuch services, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011.

For services and expenses of the medicalassistance program including hospital

inpatient services.Notwithstanding any contrary provision oflaw, in determining rates of payments forgeneral hospital inpatient services bystate governmental agencies effective forservices provided for the period April 1,2011 through March 31, 2013, thecommissioner of health shall make suchadjustments to such rates as are necessaryand not inconsistent with otherwisedirectly applicable regulations, to reducereimbursement with regard to servicesprovided to hospital inpatients as aresult, as determined by the commissionerof health, of potentially preventable

conditions, hospital acquired conditions,injuries sustained while a hospitalinpatient and the inappropriate use ofcertain medical procedures, includingcesarean deliveries, coronary arterygrafts and percutaneous coronaryinterventions ............................ 8,674,990,000

For services and expenses of the medicalassistance program including hospitaloutpatient and emergency room services ... 2,232,942,000

For services and expenses of the medicalassistance program including clinicservices .............................. 1,583,477,000

For services and expenses of the medicalassistance program including nursing homeservices.

Notwithstanding any contrary provision oflaw, for the period April 1, 2011 throughMarch 31, 2013, with regard to adjustmentsto inpatient rates of payment madepursuant to section 2808 of the publichealth law for inpatient services providedby residential health care facilities forthe period April 1, 2010 through March 31,2012 and the period April 1, 2012 throughMarch 31, 2013, the commissioner ofhealth and the director of the budgetshall, upon a determination by suchcommissioner and such director that such

rate adjustments shall, prior to theapplication of any applicable adjustmentfor inflation, result in an aggregateincrease in total medicaid rates ofpayment for such services for either suchstate fiscal year, including payments madepursuant to subparagraph (i) of paragraph(d) of subdivision 2-c of section 2808 ofthe public health law, make suchproportional adjustments to such rates asare necessary to reduce such totalaggregate rate adjustments within eachsuch year such that the aggregate totalfor each such year reflects no such



87

increase or decrease, and providedfurther, however, that adjustments madepursuant to this paragraph shall not besubject to subsequent correction orreconciliation, and provided further,however, that if this chapter providessufficient additional funding to cover thecost of such rate adjustments to the rates

enumerated in this paragraph, thenprovisions of this paragraph shall bedeemed null and void as of March 31, 2011.

Notwithstanding any contrary provision oflaw, rule or regulation, for the periodApril 1, 2011 through March 31, 2013, thecapital cost component of medicaid ratesof payment for services provided byresidential health care facilities shallnot include any payment factor for returnon or return of equity, and providedfurther, however, that for that period noadjustment to rates of payment shall bemade pursuant to paragraph (d) ofsubdivision 20 of section 2808 of the

public health law as in effect on March31, 2011, provided, however, that if thischapter provides sufficient additionalfunding to cover the cost of theadjustments to the rates enumerated inthis section, then provisions of thissection shall be deemed null and void asof March 31, 2011.

Notwithstanding any inconsistent provisionof law or regulation to the contrary, forthe period April 1, 2011 through March 31,2013, the commissioner of health shall notbe required to revise certified rates ofpayment established pursuant to the publichealth law prior to April 1, 2013, basedon consideration of rate appeals filed byresidential health care facilitiespursuant to section 2808 of the publichealth law or based upon adjustments tocapital cost reimbursement as a result ofapproval by the commissioner of health ofan application for construction undersection 2802 of the public health law, inexcess of aggregate amount of $80,000,000per state fiscal year, provided, however,that in revising such rates within suchfiscal limits the commissioner of healthmay prioritize rate appeals for facilitieswhich the commissioner of health

determines are facing significantfinancial hardship and, further, thecommissioner of health is authorized toenter into agreements with such facilitiesto resolve multiple pending rate appealsbased upon a negotiated aggregate amountand may offset such negotiated aggregateamounts against any amounts owed by thefacility to the department of health,including, but not limited to, amountsowed pursuant to section 2807-d of thepublic health law, provided further,however, that such rate adjustment madepursuant to this section remain fully



88

subject to approval by the director of thebudget in accordance with the provisionsof subdivision two of section 2807 of thepublic health law.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, payments under the

medicaid program to reserve a bed in aresidential health care facility while amedicaid recipient is temporarilyhospitalized or on leave of absence fromthe facility shall be made as follows:payments for reserved bed days shall bemade at 95 percent of the medicaid rateotherwise payable to the facility forservices provided on behalf of suchrecipient; payment for reserved bed daysduring temporary hospitalizations may notexceed fourteen days in any twelve monthperiod; payment for reserved bed days fornon-hospitalization leaves of absence maynot exceed ten days in any twelve month

period; and payments for reserved bed daysfor temporary hospitalizations shall onlybe made to a residential health carefacility if at least 50 percent of thefacility’s residents eligible toparticipate in a medicare managed careplan are enrolled in such a plan.Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payments for reservedbed days without regard to the percentageof a residential health care facility’sresidents that are enrolled in a medicaremanaged care plan, then the provisions ofthis paragraph shall not apply and shallbe considered null and void as of March31, 2011 ................................. 7,315,443,000

For services and expenses of the medicalassistance program including other longterm care services.

Notwithstanding any inconsistent provisionof law or regulation to the contrary, forthe period April 1, 2011 through March 31,2013, for participating providers, meaningcertified home health agencies, long termhome health agencies and personal careproviders with total medicaidreimbursements exceeding $50,000,000 percalendar year, every service or item

within a claim submitted by aparticipating provider shall be reviewedand verified by a verificationorganization prior to submission of aclaim to the department of health providedthat the verification organization shalldeclare each service or item to beverified or unverified and provided thateach participating provider shall receiveand maintain reports for the verificationorganization which shall contain data onverified items or services includingwhether a service appeared on a conflictor exception report before verification



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and how that conflict or exception wasresolved and items or services that werenot verified, including conflict andexception report data for these servicesand provided that every service or itemwithin a claim submitted by aparticipating provider shall be reviewedand verified by a verification

organization prior to submission of aclaim to the department of health providedthat the verification organization shalldeclare each service or item to beverified or unverified. Provided, however,if this chapter appropriates sufficientadditional funds to support participatingproviders of medical assistance programitems subject to preclaim review otherwiseprovided for in the public health law,than the provisions of this section shallbe deemed null and void as of March 31,2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to the

contrary, for the period April 1, 2011through March 31, 2013:

1. The amount of personal care servicescovered by the medicaid program shall notexceed eight hours per week forindividuals whose needs are limited tonutritional and environmental supportfunctions.

2. The commissioner of health is authorizedto adopt standards for the provision andmanagement of personal care servicescovered by the medicaid program forindividuals whose need for such servicesexceeds a specified level to be determinedby the commissioner of health.

3. The commissioner of health is authorizedto provide assistance to persons receivingpersonal care services covered by themedicaid program who are transitioning toreceiving care from a managed long termcare plan certified pursuant to section4403-f of the public health law.

4. Provided, however, if this chapterappropriates sufficient additional fundsto allow for the payment of personal careservices at the level provided for inparagraph (e) of subdivision 2 of section365-a of the social services law, then theprovisions of this paragraph shall not

apply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law or regulation and subject to theavailability of federal financialparticipation,

(a) for the period April 1, 2011 throughMarch 31, 2013, rates of payment bygovernment agencies for services providedby certified home health agencies, exceptfor such services provided to childrenunder eighteen years of age and otherdiscrete groups as may be determined bythe commissioner, shall reflect ceiling



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limitations determined in accordance withthis section, provided, however, that atthe discretion of the commissioner suchceilings may, as an alternative, beapplied to payments for services providedfor the period April 1, 2011 through March31, 2012, except for such servicesprovided to children and other discrete

groups as may be determined by thecommissioner. In determining such paymentsor rates of payment, agency ceilings shallbe established. Such ceilings shall beapplied to payments or rates of paymentfor certified home health agency servicesas established pursuant to this sectionand applicable regulations. Ceilings shallbe based on a blend of: (i) an agency’s2009 average per patient medicaid claims,weighted at a percentage as determined bythe commissioner, and; (ii) the 2009statewide average per patient medicaidclaims adjusted by a regional wage indexfactor and an agency patient case mix

index, weighted at a percentage asdetermined by the commissioner. Suchceilings will be effective April 1, 2011through March 31, 2012. An interim paymentor rate of payment adjustment effectiveApril 1, 2011, shall be applied toagencies with projected average perpatient medicaid claims, as determined bythe commissioner, to be over theirceilings. Such agencies shall have theirpayments or rates of payment reduced toreflect the amount by which such claimsexceed their ceilings.

(b) Ceiling limitations determined pursuantto subdivision (a) of this section shallbe subject to reconciliation. Indetermining payment or rate of paymentadjustments based on such reconciliation,adjusted agency ceilings shall beestablished. Such adjusted ceilings shallbe based on a blend of: (i) an agency’s2009 average per patient medicaid claimsadjusted by the percentage of increase ordecrease in such agency’s patient case mixfrom the 2009 calendar year to the annualperiod April 1, 2011 through March 31,2012, weighted at a percentage asdetermined by the commissioner; and (ii)the 2009 statewide average per patient

medicaid claims adjusted by a regionalwage index factor and the agency’s patientcase mix index for the annual period April1, 2011 through March 31, 2012, weightedat a percentage as determined by thecommissioner. Such adjusted agency ceilingshall be compared to actual medicaid paidclaims for the period April 1, 2011through March 31, 2012. In those instanceswhen an agency’s actual per patientmedicaid claims are determined to exceedthe agency’s adjusted ceiling, the amountof such excess shall be due from each suchagency to the state and may be recouped by



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the department in a lump sum amount orthrough reductions in the medicaidpayments due to the agency. In thoseinstances where an interim payment or rateof payment adjustment was applied to anagency in accordance with paragraph (a),and such agency’s actual per patientmedicaid claims are determined to be less

than the agency’s adjusted ceiling, theamount by which such medicaid claims areless than the agency’s adjusted ceilingshall be remitted to each such agency bythe department in a lump sum amount orthrough an increase in the medicaidpayments due to the agency.

(c) Interim payment or rate of paymentadjustments pursuant to this section shallbe based on medicaid paid claims, asdetermined by the commissioner, forservices provided by agencies in the baseyear 2009. Amounts due from reconcilingrate adjustments shall be based onmedicaid paid claims, as determined by the

commissioner, for services provided byagencies in the base year 2009 andmedicaid paid claims, as determined by thecommissioner, for services provided byagencies in the reconciliation periodApril 1, 2011 through March 31, 2012. Indetermining case mix, each patient shallbe classified using a system based onmeasures which may include, but not belimited to, clinical and functionalmeasures, as reported on the federalOutcome and Assessment Information Set(OASIS), as may be amended.

(d) The commissioner may require agencies tocollect and submit any data required toimplement the provisions of this section.

(e) Payments or rate of payment adjustmentsdetermined pursuant to this section shall,for the period April 1, 2011 through March31, 2012, be retroactively reconciledutilizing the methodology in paragraph (b)of this section and utilizing actual paidclaims from such period.

(f) Notwithstanding any inconsistentprovision of this section, payments orrate of payment adjustments made pursuantto this section shall not result in anaggregate annual decrease in medicaidpayments to providers subject to this

section that is in excess of $200,000,000,as determined by the commissioner and notsubject to subsequent adjustment, and thecommissioner shall make such adjustmentsto such payments or rates of payment asare necessary to ensure that suchaggregate limits on payment decreases arenot exceeded.

Notwithstanding any inconsistent provisionof law or regulation and subject to theavailability of federal financialparticipation, for the period April 1,2012 through March 31, 2013, payments bygovernment agencies for services provided



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by certified home health agencies, exceptfor such services provided to childrenunder eighteen years of age and otherdiscreet groups as may be determined bythe commissioner, shall be based onepisodic payments. In establishing suchpayments, a statewide base price shall beestablished for each sixty day episode of

care and adjusted by a regional wage indexfactor and an individual patient case mixindex. Such episodic payments may befurther adjusted for low utilization casesand to reflect a percentage limitation ofthe cost for high-utilization cases thatexceed outlier thresholds of suchpayments. Episodic payments shall be basedon medicaid paid claims, as determined andadjusted by the commissioner to achievesavings comparable to the prior statefiscal year, for services provided by allcertified home health agencies in the baseyear 2009. The commissioner may requireagencies to collect and submit any data

required to implement this subdivision.Notwithstanding any inconsistent provision

of law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, benefits under themedical assistance program shall befurnished to applicants in cases where,although such applicant has a responsiblerelative with sufficient income andresources to provide medical assistance,the income and resources of theresponsible relative are not available tosuch applicant because of the absence ofsuch relative and the refusal or failureof such absent relative to provide thenecessary care and assistance. In suchcases, however, the furnishing of suchassistance shall create an impliedcontract with such relative, and the costthereof may be recovered from suchrelative in accordance with title 6 ofarticle 3 of the social services law andother applicable provisions of law.Provided, however, if this chapterappropriates sufficient additional fundsto allow medical assistance to befurnished in situations in which aresponsible relative who is not absentfrom the household fails or refuses to

provide necessary care and assistance,then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any contrary law, rule orregulation, for the period April 1, 2011through March 31, 2013 medicaid rates ofpayments for services provided bycertified home health agencies, by longterm home health care programs or by anAIDS home care program, to patientsdiagnosed with Acquired Immune DeficiencySyndrome (AIDS) shall reflect no separatepayment for home care nursing services.



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1. The commissioner of health is authorizedto submit the appropriate waivers,including but not limited to thoseauthorized pursuant to sections 1115 and

1915 of the federal social security act orsuccessor provisions, and any otherwaivers necessary to require medicalassistance recipients who are twenty-oneyears of age or older and who requirecommunity-based long term care services,as specified by the commissioner, for morethan 120 days, to receive such servicesthrough a managed long term care plancertified pursuant to section 4403-f ofthe public health law or other carecoordination program specified by thecommissioner.

2. With respect to persons in receipt oflong term care services prior to

enrollment, the commissioner of healthshall require the managed long term careplan to contract with agencies currentlyproviding such services, in order topromote continuity of care.

The commissioner shall develop a workgroupto further evaluate and promote thetransition of persons in receipt of homeand community-based long term careservices in to managed long term careplans and other care coordination models.

3. An entity shall not need a designation bythe majority leader of the senate, thespeaker of the assembly, or thecommissioner of health in order to applyfor a certificate of authority as amanaged long term care plan.

4. Managed long term care plans may beauthorized by the department of health tocover primary care and acute care.

5. Managed long term care enrollmentapplications will be processed by thedepartment of health or its designee, andnot by local departments of socialservices.

6. Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payment for services ona fee-for-service basis without the

savings to be achieved by requiringenrollment of medicaid recipients inmanaged long term care plans or other carecoordination models, and by streamliningthe process for enrolling participants inmanaged long term care plans, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011 ................ 5,643,636,000

For services and expenses of the medicalassistance program including managed careservices.



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1. The following medicaid recipients shallnot be required to participate in amanaged care program established pursuantto section 364-j of the social services

law: (i) individuals with a chronicmedical condition who are being treated bya specialist physician that is notassociated with a managed care provider inthe individual’s social services districtmay defer participation in the managedcare program for six months or until thecourse of treatment is complete, whicheveroccurs first; and Native Americans.

2. The following medicaid recipients shallnot be eligible to participate in amanaged care program established pursuantto section 364-j of the social serviceslaw: (i) a person eligible for medicareparticipating in a capitated demonstration

program for long term care; (ii) an infantliving with an incarcerated mother in astate or local correctional facility asdefined in section 2 of the correctionlaw; (iii) a person who is expected to beeligible for medical assistance for lessthan six months; (iv) a person who iseligible for medical assistance benefitsonly with respect to tuberculosis-relatedservices; (v) individuals receivinghospice services at time of enrollment;(vi) a person who has primary medical orhealth care coverage available from orunder a third-party payor which may bemaintained by payment, or part payment, ofthe premium or costs sharing amounts, whenpayment of such premium or cost sharingamounts would be cost-effective, asdetermined by the local social servicesdistrict; (vii) a person receiving familyplanning services pursuant to subparagraph11 of paragraph (a) of subdivision 1 ofsection 366 of the social services law;(viii) a person who is eligible formedical assistance pursuant to paragraph(v) of subdivision 4 of section 366 of thesocial services law; and (ix) a person whois Medicare/Medicaid dually eligible andwho is not enrolled in a medicare managed

care plan.3. The following categories of medicaid

recipients may be required to enroll witha managed care program when programfeatures and reimbursement rates areapproved by the commissioner of healthand, as appropriate, the commissioner ofmental health: (i) an individual duallyeligible for medical assistance andbenefits under the federal medicareprogram and enrolled in a medicare managedcare plan offered by an entity that isalso a managed care provider; providedthat (notwithstanding paragraph (g) of



95

subdivision 4 of this section): (ii) anindividual eligible for supplementalsecurity income; (iii) HIV positiveindividuals; (iv) persons with seriousmental illness and children andadolescents with serious emotionaldisturbances, as defined in section 4401of the public health law; (v) a person

receiving services provided by aresidential alcohol or substance abuseprogram or facility for the mentallyretarded; (vi) a person receiving servicesprovided by an intermediate care facilityfor the mentally retarded or who hascharacteristics and needs similar to suchpersons; (vii) a person with adevelopmental or physical disability whoreceives home and community-based servicesor care-at-home services through existingwaivers under section 1915 (c) of thefederal social security act or who hascharacteristics and needs similar to suchpersons; (viii) a person who is eligible

for medical assistance pursuant tosubparagraph 12 or subparagraph 13 ofparagraph (a) of subdivision 1 of section366 of the social services law; (ix) aperson receiving services provided by along term home health care program, or aperson receiving inpatient services in astate-operated psychiatric facility or aresidential treatment facility forchildren and youth; (x) certified blind ordisabled children living or expected to beliving separate and apart from the parentfor thirty days or more; (xi) residents ofnursing facilities; (xii) a foster childin the placement of a voluntary agency orin the direct care of the local socialservices district; (xiii) a person orfamily that is homeless; and (xiv)individuals for whom a managed careprovider is not geographically accessibleso as to reasonably provide services tothe person. A managed care provider is notgeographically accessible if the personcannot access the provider’s services in atimely fashion due to distance or traveltime.

4. Applicants for medicaid and pregnantwomen applying for presumptive eligibilityunder the medicaid program shall be

required to choose a managed care providerat the time of application; if theparticipant does not choose such aprovider, the commissioner of health shallassign the applicant to a managed careprovider in accordance with subparagraphs(ii) through (v) of paragraph (f) ofsubdivision 4 of section 364-j of thesocial services law. Individuals alreadyin receipt of medicaid shall have no lessthan thirty days from the date selected by



96

their social services district to enrollin the managed care program to select amanaged care provider, and as appropriate,a mental health special needs plan.

5. The department of health is authorized tocontract with an entity offering acomprehensive health services plan,including an entity that has received a

certificate of authority pursuant tosections 4403, 4403-a or 4408-a of thepublic health law (as added by chapter 639of the laws of 1996) or a healthmaintenance organization authorized underarticle 43 of the insurance law, toeligible individuals residing in thegeographic area served by such entity.Cities with a population of over 2,000,000shall not be authorized to enter intomedicaid managed care contracts withcomprehensive health services plans. Suchcontracts may provide for medicaidpayments on a capitated basis for nursingfacility, home care or other long term

care services of a duration and scopedetermined by the commissioner of health.

6. Provided, however, if this chapterappropriates sufficient additional fundsto allow medicaid payment for services ona fee-for-service basis without thesavings to be achieved by expanding thepopulations allowed or required toparticipate in medicaid managed care, orby streamlining the process for enrollingparticipants in medicaid managed careplans, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011 ..................................... 10,023,265,000

For services and expenses of the medicalassistance program including pharmacyservices.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, payments for drugswhich may not be dispensed without aprescription as required by section 6810of the education law and for which paymentis authorized under the medical assistanceprogram pursuant to subdivision 2 ofsection 365-a of the social services lawor under the family health plus program

pursuant to subparagraph (v) of paragraph(e) of subdivision 1 of section 369-ee ofthe social services law may be included inthe capitation payment for services orsupplies provided to medical assistance orfamily health plus recipients by managedcare organizations or other entities whichare certified under article 44 of thepublic health law or licensed pursuant toarticle 43 of the insurance law orotherwise authorized by law to offercomprehensive health services plans tomedical assistance or family health plusrecipients. Provided, however, if this



97

chapter appropriates sufficient additionalfunds to allow such drugs to continue tobe excluded as a benefit available tomedical assistance and family health plusrecipients through such comprehensivehealth services plans, then the provisionsof this paragraph shall not apply andshall be considered null and void as of

March 31, 2011.Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissionerof health is authorized to designate someor all of the drugs manufactured ormarketed by a pharmaceutical manufactureras non-preferred drugs under the preferreddrug program established pursuant tosection 272 of the public health law if:the commissioner of health has previouslydesignated such pharmaceuticalmanufacturer as one with whom thecommissioner is negotiating a

manufacturer agreement, and included thedrugs it manufactures or markets on thepreferred drug list; and the commissionerhas not reached a manufacturer agreementwith such manufacturer. Provided, however,if this chapter appropriates sufficientadditional funds to require thecommissioner of health to designate asnon-preferred all of the drugsmanufactured or marketed by a manufacturerwith whom the commissioner has been unableto reach a manufacturer agreement, thenthe provisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, for those drugswhich may not be dispensed without aprescription as required by section 6810of the education law and for which paymentis authorized under the medical assistanceprogram pursuant to subdivision 2 ofsection 365-a of the social services law,payments for such drugs and dispensingfees shall be limited to amountsestablished by the commissioner of health.Provided, however, if this chapter

appropriates sufficient additional fundsto allow the medical assistance program tocontinue to pay for drugs and dispensingfees in the amounts described insubdivision 9 of section 367-a of thesocial services law, then the provisionsof this paragraph shall not apply andshall be considered null and void as ofMarch 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the commissionerof health may designate therapeutic



98

classes of drugs or individual drugs aspreferred drugs in the medicaid preferreddrug program established pursuant tosection 272 of the public health law priorto any review that may be conducted by thepharmacy and therapeutics committeecreated pursuant to section 271 of thepublic health law. In addition, if a non-

preferred drug is prescribed and does notmeet the criteria for approval of a non-preferred drug under subdivision 3 ofsection 273 of the public health law,after providing a reasonable opportunityfor the prescriber to reasonably presenthis or her justification for priorauthorization, prior authorization will bedenied if the preferred drug programdetermines that the use of the non-preferred is not warranted. Provided,however, if this chapter appropriatessufficient additional funds to allow themedicaid program to pay for non-preferreddrugs which have been prescribed but whose

use the preferred drug program hasdetermined to be unwarranted, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the followingdrugs shall not be exempt from inclusionin the preferred drug program establishedpursuant to section 272 of the publichealth law: atypical anti-psychotics;anti-depressants; anti-retrovirals used inthe treatment of HIV/AIDS; and anti-rejection drugs used for the treatment oforgan and tissue transplants. Provided,however, if this chapter appropriatessufficient additional funds to allow suchdrugs to continue to be exempt from theprior authorization requirements of thepreferred drug program, then theprovisions of this paragraph shall notapply and shall be considered null andvoid as of March 31, 2011 ................ 3,968,930,000

For services and expenses of the medicalassistance program including transporta-tion services .............................. 349,464,000


assistance program including dentalservices ................................... 280,432,000

For services and expenses of the medicalassistance program including noninstitu-tional and other spending.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the medicalassistance program shall provide coveragefor medically necessary speech therapy,and when provided at the direction of aphysician or nurse practitioner, physicaltherapy and related rehabilitative



99

services, and occupational therapy.Provided, however, that speech therapy,physical therapy, and occupational therapyeach shall be limited to coverage oftwenty visits per year, with suchlimitation not applying to persons withdevelopmental disabilities. Provided,however, if this chapter appropriates

sufficient additional funds to allow themedical assistance program to cover suchmedically necessary services without alimitation on the number of visits paidfor, then the provisions of this paragraphshall not apply and shall be considerednull and void as of March 31, 2011.

Notwithstanding any inconsistent provisionof law, rule or regulation to thecontrary, for the period April 1, 2011through March 31, 2013, the estate of amedical assistance recipient, for purposesof making any recoveries of the cost ofsuch assistance otherwise authorized bylaw, shall include any real and personal

property in which the medical assistancerecipient had any legal title or interestat the time of death, including jointlyheld property, retained life estates, andinterests in trusts, to the extent of suchinterests, provided, however, that a claimagainst a recipient of such property bydistribution or survival shall be limitedto the value of the property received orthe amount of medical assistance benefitsotherwise recoverable, whichever is less.Provided, however, if this chapterappropriates sufficient additional fundsto permit limiting recoveries to real andpersonal property and other assets passingunder the terms of a valid will or byintestacy, then the provisions of thisparagraph shall not apply and shall beconsidered null and void as of March 31,2011 ..................................... 8,417,449,000

For services and expenses of the medicalassistance program including a series oftargeted chronic illness demonstrationprojects.

Notwithstanding section 112 and section 163of the state finance law, for chronicillness demonstration projects authorizedby section 364-l of the social serviceslaw, the commissioner of health may allo-

cate up to $2,500,000 of the amount appro-priated for contracts without a requestfor proposal process or any other compet-itive process ............................... 12,000,000

Notwithstanding any other provision of law,the money herein appropriated, is avail-able for transfer or suballocation to thestate university of New York and itssubsidiaries, or to contract withoutcompetition for services with the stateuniversity of New York research founda-tion, to provide support for the adminis-tration of the medical assistance programincluding activities such as dental prior



100

approval, retrospective and prospectivedrug utilization review, development ofevidence based utilization thresholds,data analysis, clinical consultation andpeer review, clinical support for thepharmacy and therapeutic committee, andother activities related to utilizationmanagement and for health information

technology support for the medicaidprogram ..................................... 12,000,000Notwithstanding any inconsistent provisionof section 112 or 163 of the state financelaw or any other contrary provision of thestate finance law or any other contraryprovision of law, the commissioner ofhealth may, without a competitive bid orrequest for proposal process, enter intocontracts with one or more certifiedpublic accounting firms for the purpose ofconducting audits of disproportionateshare hospital payments made by the stateof New York to general hospitals and forthe purpose of conducting audits of hospi-

tal cost reports as submitted to the stateof New York in accordance with article 28of the public health law. Notwithstandingany inconsistent provisions of law,subject to the approval of the director ofthe budget, up to the amount appropriatedherein ....................................... 4,600,000

For services and expenses of the medicalassistance program including medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services ............. 8,500,000,000

For services and expenses of the medicalassistance program including hospitalinpatient, hospital outpatient and emer-gency room, clinic, nursing home, otherlong term care, managed care, pharmacy,transportation, dental, non-institutionaland other spending, medical servicesprovided at state facilities operated bythe office of mental health, the officefor people with developmental disabilitiesand the office of alcoholism and substanceabuse services and for any other medicalassistance services resulting from anincrease in the federal medical assistancepercentage pursuant to the American Recov-

ery and Reinvestment Act. Funds appropri-ated herein shall be subject to all appli-cable reporting and accountabilityrequirements contained in such act ....... 1,204,000,000

--------------Program account subtotal .............. 58,322,628,000

--------------



101

Special Revenue Funds - OtherHCRA Resources FundIndigent Care Account


law or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in full

force and effect in accordance with thefollowing schedule: 50 percent for theperiod April 1, 2011 to March 31, 2012; 50percent for the period April 1, 2012 toMarch 31, 2013.

Notwithstanding section 40 of the statefinance law or any provision of law to thecontrary, subject to federal approval,department of health state funds medicaidspending, excluding payments for medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services and further

excluding any payments which are notappropriated within the department ofhealth, in the aggregate, for the periodApril 1, 2011 through March 31, 2012,shall not exceed $15,109,236,000 except asprovided below and state share medicaidspending, in the aggregate, for the periodApril 1, 2012 through March 31, 2013,shall not exceed $15,710,743,000, but inno event shall department of health statefunds medicaid spending for the periodApril 1, 2011 through March 31, 2013exceed $30,819,979,000 provided, however,such aggregate limits may be adjusted bythe director of the budget to account forany changes in the New York state federalmedical assistance percentage amountestablished pursuant to the federal socialsecurity act, increases in providerrevenues, and beginning April 1, 2012 theoperational costs of the New York statemedical indemnity fund, pursuant to achapter establishing such fund. Thedirector of the budget, in consultationwith the commissioner of health, shallperiodically assess known and projectedmedicaid expenditures incurred both priorto and subsequent to such assessment foreach such period, and if the director of

the budget determines that suchexpenditures are expected to causemedicaid spending for such period toexceed the aggregate limit specifiedherein for such period, the state medicaiddirector, in consultation with thedirector of the budget and thecommissioner of health, shall develop amedicaid savings allocation plan to limitsuch spending to the aggregate limitspecified herein for such period.

Such medicaid savings allocation plan shallbe designed, to reduce the expendituresauthorized by the appropriations herein in



102

compliance with the following guidelines:(1) reductions shall be made in compliancewith applicable federal law, including theprovisions of the Patient Protection andAffordable Care Act, Public Law No. 111-148, and the Health Care and EducationReconciliation Act of 2010, Public Law No.111-152 (collectively “Affordable Care

Act”) and any subsequent amendmentsthereto or regulations promulgatedthereunder; (2) reductions shall be madein a manner that complies with the statemedicaid plan approved by the federalcenters for medicare and medicaidservices, provided, however, that thecommissioner of health is authorized tosubmit any state plan amendment or seekother federal approval, including waiverauthority, to implement the provisions ofthe medicaid savings allocation plan thatmeets the other criteria set forth herein;(3) reductions shall be made in a mannerthat maximizes federal financial

participation, to the extent practicable,including any federal financialparticipation that is available or isreasonably expected to become available,in the discretion of the commissioner,under the Affordable Care Act; (4)reductions shall be made uniformly amongcategories of services, to the extentpracticable, and shall be made uniformlywithin a category of service, to theextent practicable, except where thecommissioner determines that there aresufficient grounds for non-uniformity,including but not limited to: the extentto which specific categories of servicescontributed to department of healthmedicaid state funds spending in excess ofthe limits specified herein; the need tomaintain safety net services inunderserved communities; the need toencourage or discourage certain activitiesby providers of particular health careservices in order to improve quality ofand access to care; or the potentialbenefits of pursuing innovative paymentmodels contemplated by the Affordable CareAct, in which case such grounds shall beset forth in the medicaid savingsallocation plan; and (5) reductions shall

be made in a manner that does notunnecessarily create administrativeburdens to medicaid applicants andrecipients or providers.

In accordance with the medicaid savingsallocation plan, the commissioner of thedepartment of health shall reducedepartment of health state funds medicaidspending by the amount of the projectedoverspending through, actions including,but not limited to modifying or suspendingreimbursement methods, including but notlimited to all fees, premium levels andrates of payment, notwithstanding any



103

provision of law that sets a specificamount or methodology for any suchpayments or rates of payment; modifying ordiscontinuing medicaid program benefits;seeking all necessary federal approvals,including, but not limited to waivers,waiver amendments; and suspending timeframes for notice, approval or

certification of rate requirements,notwithstanding any provision of law, ruleor regulation to the contrary, includingbut not limited to sections 2807 and 3614of the public health law, section 18 ofchapter 2 of the laws of 1988, and 18NYCRR 505.14(h).

For the purpose of making payments toproviders of medical care pursuant tosection 367-b of the social services law,and for payment of state aid to munici-palities where payment systems throughfiscal intermediaries are not operational,to reimburse such providers for costsattributable to the provision of care to

patients eligible for medical assistance.Payments from this appropriation to gener-al hospitals related to indigent carepursuant to article 28 of the publichealth law respectively, when combinedwith federal funds for services andexpenses for the medical assistanceprogram pursuant to title XIX of thefederal social security act or its succes-sor program, shall equal the amount of thefunds received related to health carereform act allowances and surchargespursuant to article 28 of the publichealth law and deposited to this accountless any such amounts withheld pursuant tosubdivision 21 of section 2807-c of thepublic health law. Notwithstanding anyinconsistent provision of law, the moneyshereby appropriated may be increased ordecreased by interchange or transfer withany appropriation of the department ofhealth with the approval of the directorof the budget, who shall file suchapproval with the department of audit andcontrol and copies thereof with the chair-man of the senate finance committee andthe chairman of the assembly ways andmeans committ............................. 1,583,000,000

--------------

Program account subtotal ............... 1,583,000,000--------------

Special Revenue Funds - OtherHCRA Resources FundMedical Assistance Account


law or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in fullforce and effect in accordance with the



104

following schedule: 45.60 percent for theperiod April 1, 2011 to March 31, 2012;54.40 percent for the period April 1, 2012to March 31, 2013.

Notwithstanding section 40 of the statefinance law or any provision of law to thecontrary, subject to federal approval,department of health state funds medicaid

spending, excluding payments for medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services and furtherexcluding any payments which are notappropriated within the department ofhealth, in the aggregate, for the periodApril 1, 2011 through March 31, 2012,shall not exceed $15,109,236,000 except asprovided below and state share medicaidspending, in the aggregate, for the periodApril 1, 2012 through March 31, 2013,shall not exceed $15,710,743,000, but in

no event shall department of health statefunds medicaid spending for the periodApril 1, 2011 through March 31, 2013exceed $30,819,979,000 provided, however,such aggregate limits may be adjusted bythe director of the budget to account forany changes in the New York state federalmedical assistance percentage amountestablished pursuant to the federal socialsecurity act, increases in providerrevenues, and beginning April 1, 2012 theoperational costs of the New York statemedical indemnity fund, pursuant to achapter establishing such fund. Thedirector of the budget, in consultationwith the commissioner of health, shallperiodically assess known and projectedmedicaid expenditures incurred both priorto and subsequent to such assessment foreach such period, and if the director ofthe budget determines that suchexpenditures are expected to causemedicaid spending for such period toexceed the aggregate limit specifiedherein for such period, the state medicaiddirector, in consultation with thedirector of the budget and thecommissioner of health, shall develop amedicaid savings allocation plan to limit

such spending to the aggregate limitspecified herein for such period.

Such medicaid savings allocation plan shallbe designed, to reduce the expendituresauthorized by the appropriations herein incompliance with the following guidelines:(1) reductions shall be made in compliancewith applicable federal law, including theprovisions of the Patient Protection andAffordable Care Act, Public Law No. 111-148, and the Health Care and EducationReconciliation Act of 2010, Public Law No.111-152 (collectively “Affordable CareAct”) and any subsequent amendments



105

thereto or regulations promulgatedthereunder; (2) reductions shall be madein a manner that complies with the statemedicaid plan approved by the federalcenters for medicare and medicaidservices, provided, however, that thecommissioner of health is authorized tosubmit any state plan amendment or seek

other federal approval, including waiverauthority, to implement the provisions ofthe medicaid savings allocation plan thatmeets the other criteria set forth herein;(3) reductions shall be made in a mannerthat maximizes federal financialparticipation, to the extent practicable,including any federal financialparticipation that is available or isreasonably expected to become available,in the discretion of the commissioner,under the Affordable Care Act; (4)reductions shall be made uniformly amongcategories of services, to the extentpracticable, and shall be made uniformly

within a category of service, to theextent practicable, except where thecommissioner determines that there aresufficient grounds for non-uniformity,including but not limited to: the extentto which specific categories of servicescontributed to department of healthmedicaid state funds spending in excess ofthe limits specified herein; the need tomaintain safety net services inunderserved communities; the need toencourage or discourage certain activitiesby providers of particular health careservices in order to improve quality ofand access to care; or the potentialbenefits of pursuing innovative paymentmodels contemplated by the Affordable CareAct, in which case such grounds shall beset forth in the medicaid savingsallocation plan; and (5) reductions shallbe made in a manner that does notunnecessarily create administrativeburdens to medicaid applicants andrecipients or providers.

In accordance with the medicaid savingsallocation plan, the commissioner of thedepartment of health shall reducedepartment of health state funds medicaidspending by the amount of the projected

overspending through, actions including,but not limited to modifying or suspendingreimbursement methods, including but notlimited to all fees, premium levels andrates of payment, notwithstanding anyprovision of law that sets a specificamount or methodology for any suchpayments or rates of payment; modifying ordiscontinuing medicaid program benefits;seeking all necessary federal approvals,including, but not limited to waivers,waiver amendments; and suspending timeframes for notice, approval orcertification of rate requirements,



106

notwithstanding any provision of law, ruleor regulation to the contrary, includingbut not limited to sections 2807 and 3614of the public health law, section 18 ofchapter 2 of the laws of 1988, and 18NYCRR 505.14(h).

For the purpose of making payments, themoney hereby appropriated is available for

payment of aid heretofore accrued or here-after accrued, to providers of medicalcare pursuant to section 367-b of thesocial services law, and for payment ofstate aid to municipalities and the feder-al government where payment systemsthrough fiscal intermediaries are notoperational, to reimburse such providersfor costs attributable to the provision ofcare to patients eligible for medicalassistance. Notwithstanding any inconsist-ent provision of law, the moneys herebyappropriated may be increased or decreasedby interchange or transfer with any appro-priation of the department of health with

the approval of the director of the budg-et, who shall file such approval with thedepartment of audit and control and copiesthereof with the chairman of the senatefinance committee and the chairman of theassembly ways and means committee.

For services and expenses related to themedical assistance program ................. 292,800,000

For services and expenses of the medicalassistance program related to the treat-ment of breast and cervical cancer ........... 4,200,000

For services and expenses of the medicalassistance program related to primary carecase management. All or a portion of thisappropriation may be transferred to stateoperations appropriations .................... 4,000,000

For services and expenses of the medicalassistance program related to disabledpersons ..................................... 47,000,000

For services and expenses of the medicalassistance program related to physicianservices ................................... 170,400,000

For services and expenses of the medicalassistance program related, but not limit-ed to, pharmacy, inpatient, and nursinghome services ............................ 5,337,510,000

For services and expenses of the medicalassistance program related to the city ofNew York ................................... 249,400,000

For services and expenses of the medicalassistance program related to providingdistributions for supplemental medicalinsurance for medicare part B premiums,physician services, outpatient services,medical equipment, supplies and otherhealth services ............................ 136,000,000

For services and expenses of the medicalassistance program related to the familyhealth plus program ...................... 1,278,800,000

For services and expenses of the medicalassistance program related to providingfinancial assistance to residential healthcare facilities ............................. 30,000,000



107

For services and expenses of the medicalassistance program related to supportingworkforce recruitment and retention ofpersonal care services or any worker withdirect patient care responsibility forlocal social service districts whichinclude a city with a population of overone million persons ........................ 272,000,000

For services and expenses of the medicalassistance program related to supportingworkforce recruitment and retention ofpersonal care services for local socialservice districts that do not include acity with a population of over one millionpersons ..................................... 22,400,000

For services and expenses of the medicalassistance program related to supportingrate increases for certified home healthagencies, long term home health careprograms, AIDS home care programs, hospiceprograms, managed long term care plans andapproved managed long term care operatingdemonstrations for recruitment and

retention of health care workers ........... 100,000,000--------------

Program account subtotal ............... 7,944,510,000--------------

Special Revenue Funds - OtherMiscellaneous Special Revenue FundMedical Assistance Account


law or any other law to the contrary, allmedical assistance appropriations madefrom this account shall remain in fullforce and effect in accordance with thefollowing schedule: 50 percent for theperiod April 1, 2011 to March 31, 2012; 50percent for the period April 1, 2012 toMarch 31, 2013.

Notwithstanding section 40 of the statefinance law or any provision of law to thecontrary, subject to federal approval,department of health state funds medicaidspending, excluding payments for medicalservices provided at state facilitiesoperated by the office of mental health,the office for people with developmentaldisabilities and the office of alcoholismand substance abuse services and furtherexcluding any payments which are not

appropriated within the department ofhealth, in the aggregate, for the periodApril 1, 2011 through March 31, 2012,shall not exceed $15,109,236,000 except asprovided below and state share medicaidspending, in the aggregate, for the periodApril 1, 2012 through March 31, 2013,shall not exceed $15,710,743,000, but inno event shall department of health statefunds medicaid spending for the periodApril 1, 2011 through March 31, 2013exceed $30,819,979,000 provided, however,such aggregate limits may be adjusted bythe director of the budget to account for



108

any changes in the New York state federalmedical assistance percentage amountestablished pursuant to the federal socialsecurity act, increases in providerrevenues, and beginning April 1, 2012 theoperational costs of the New York statemedical indemnity fund, pursuant to achapter establishing such fund. The

director of the budget, in consultationwith the commissioner of health, shallperiodically assess known and projectedmedicaid expenditures incurred both priorto and subsequent to such assessment foreach such period, and if the director ofthe budget determines that suchexpenditures are expected to causemedicaid spending for such period toexceed the aggregate limit specifiedherein for such period, the state medicaiddirector, in consultation with thedirector of the budget and thecommissioner of health, shall develop amedicaid savings allocation plan to limit

such spending to the aggregate limitspecified herein for such period.

Such medicaid savings allocation plan shallbe designed, to reduce the expendituresauthorized by the appropriations herein incompliance with the following guidelines:(1) reductions shall be made in compliancewith applicable federal law, including theprovisions of the Patient Protection andAffordable Care Act, Public Law No. 111-148, and the Health Care and EducationReconciliation Act of 2010, Public Law No.111-152 (collectively “Affordable CareAct”) and any subsequent amendmentsthereto or regulations promulgatedthereunder; (2) reductions shall be madein a manner that complies with the statemedicaid plan approved by the federalcenters for medicare and medicaidservices, provided, however, that thecommissioner of health is authorized tosubmit any state plan amendment or seekother federal approval, including waiverauthority, to implement the provisions ofthe medicaid savings allocation plan thatmeets the other criteria set forth herein;(3) reductions shall be made in a mannerthat maximizes federal financialparticipation, to the extent practicable,

including any federal financialparticipation that is available or isreasonably expected to become available,in the discretion of the commissioner,under the Affordable Care Act; (4)reductions shall be made uniformly amongcategories of services, to the extentpracticable, and shall be made uniformlywithin a category of service, to theextent practicable, except where thecommissioner determines that there aresufficient grounds for non-uniformity,including but not limited to: the extentto which specific categories of services



109

contributed to department of healthmedicaid state funds spending in excess ofthe limits specified herein; the need tomaintain safety net services inunderserved communities; the need toencourage or discourage certain activitiesby providers of particular health careservices in order to improve quality of

and access to care; or the potentialbenefits of pursuing innovative paymentmodels contemplated by the Affordable CareAct, in which case such grounds shall beset forth in the medicaid savingsallocation plan; and (5) reductions shallbe made in a manner that does notunnecessarily create administrativeburdens to medicaid applicants andrecipients or providers.

In accordance with the medicaid savingsallocation plan, the commissioner of thedepartment of health shall reducedepartment of health state funds medicaidspending by the amount of the projected

overspending through, actions including,but not limited to modifying or suspendingreimbursement methods, including but notlimited to all fees, premium levels andrates of payment, notwithstanding anyprovision of law that sets a specificamount or methodology for any suchpayments or rates of payment; modifying ordiscontinuing medicaid program benefits;seeking all necessary federal approvals,including, but not limited to waivers,waiver amendments; and suspending timeframes for notice, approval orcertification of rate requirements,notwithstanding any provision of law, ruleor regulation to the contrary, includingbut not limited to sections 2807 and 3614of the public health law, section 18 ofchapter 2 of the laws of 1988, and 18NYCRR 505.14(h).

For the purpose of making payments toproviders of medical care pursuant to

2011-12AppropStrikeInsert30day-1

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