New York A 8226: Provides for program eligibility for plans comparable to Medicare part D

Bill Text

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A08226 Summary:

BILL NOA08226 

&nbsp

SAME ASSAME AS S00355-A

&nbsp

SPONSORTapia

&nbsp

COSPNSRDe Los Santos, Hevesi, Lunsford, Levenberg, Santabarbara, Glick, Colton, Cruz, Davila, Shimsky,
 Rosenthal, Brown E, Raga, Reyes, Griffin

&nbsp

MLTSPNSR

&nbsp

Amd §§242 & 241, Eld L; add §280-e, Pub Health L

&nbsp

Relates to program eligibility for plans comparable to Medicare part D; provides for analysis of health plans by the department of health to determine whether such health plans meet or exceed the Medicare part D standard; requires the department of health, in consultation with the department of financial services, to notify prescription drug insurers of the provisions of this act.

Go to top A08226 Actions:

BILL NOA08226 

&nbsp

05/05/2025referred to aging

01/07/2026referred to aging

Go to topA08226 Committee&nbspVotes:

Go to topA08226 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA08226 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 8226

 2025-2026 Regular Sessions

 IN ASSEMBLY

 May 5, 2025
 ___________

 Introduced by M. of A. TAPIA, DE LOS SANTOS, HEVESI, LUNSFORD, LEVEN-
 BERG, SANTABARBARA, GLICK, COLTON, CRUZ, DAVILA, SHIMSKY, ROSENTHAL,
 E. BROWN, RAGA -- read once and referred to the Committee on Aging

 AN ACT to amend the elder law, in relation to program eligibility for
 health plans comparable to Medicare part D; and to amend the public
 health law, in relation to assessment of prescription drug coverage by
 health plans

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Paragraphs (f) and (h) of subdivision 3 and subdivision 4
 2 of section 242 of the elder law, paragraph (f) of subdivision 3 as
 3 amended by section 1 of part T of chapter 56 of the laws of 2012, para-
 4 graph (h) of subdivision 3 as amended by section 3-f of part A of chap-
 5 ter 59 of the laws of 2011, and subdivision 4 as added by section 12-a
 6 of part T of chapter 56 of the laws of 2012, are amended to read as
 7 follows:
 8 (f) As a condition of eligibility for benefits under this title, a
 9 program participant is required to be enrolled in Medicare part D, or
 10 any other public or private drug plan which has successfully demon-
 11 strated to CMS that the coverage meets or exceeds the actuarial value of
 12 the defined standard coverage under the Medicare part D prescription
 13 drug benefit, as determined by CMS, and to maintain such enrollment. For
 14 unmarried participants with individual annual income less than or equal
 15 to twenty-three thousand dollars and married participants with joint
 16 annual income less than or equal to twenty-nine thousand dollars, the
 17 elderly pharmaceutical insurance coverage program shall pay for the
 18 portion of the part D or comparable plan monthly premium that is the
 19 responsibility of the participant. Such payment shall be limited to the
 20 low-income benchmark premium amount established by the federal centers
 21 for medicare and medicaid services and any other amount which such agen-
 22 cy establishes under its de minimus premium policy.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD00618-04-5

 A. 8226 2

 1 (h) The elderly pharmaceutical insurance coverage program is author-
 2 ized to represent program participants under this title with respect to
 3 their Medicare part D or comparable coverage.
 4 4. As a condition of eligibility for benefits under this title,
 5 participants must be enrolled in [medicare] Medicare part D, or any
 6 other public or private drug plan which has successfully demonstrated to
 7 CMS that the coverage meets or exceeds the actuarial value of the
 8 defined standard coverage under the Medicare part D prescription drug
 9 benefit, as determined by CMS, and maintain such enrollment. For persons
 10 who meet the eligibility requirements to participate in the elderly
 11 pharmaceutical insurance coverage program, the program will pay for a
 12 drug covered by the person's [medicare] Medicare part D plan or compara-
 13 ble plan or a drug in a [medicare] Medicare part D excluded drug class,
 14 as defined in subdivision eight of sectio