BILL NUMBER: S355A
SPONSOR: RIVERA
 
TITLE OF BILL:
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
 
PURPOSE OF BILL:
To allow individuals who have comparable coverage to a Medicare Part D
plan to also be eligible for EPIC if they otherwise qualify.
 
SUMMARY OF PROVISIONS:
Section 1: Amends section 242 of the Elder Law to allow participants to
qualify for EPIC benefits if they are enrolled in Medicare Part D or
another public or private drug plan certified by the Centers for Medi-
care and Medicaid Services (CMS) as meeting or exceeding the Medicare
Part D standard.
Section 2: Adds a definition of "CMS" to section 241 of the Elder Law.
Section 3: Adds a new section 280-e to the Public Health Law to author-
ize the Department of Health to assess whether health plans meet or
exceed the Medicare Part D standard, permit insurers and individuals to
request such assessments, and require the Department to maintain and
publish a list of qualifying plans.
Section 4: Directs the Department of Health and the Department of Finan-
cial Services to notify insurers of the new provisions and EPIC eligi-
bility guidelines.
Section 5: Sets an effective date of April 1 following enactment, with
immediate authority for necessary rulemaking,
 
EXISTING LAW:
Currently, to be eligible for EPIC a participant must be enrolled in a
Medicare Part D Plan.
 
JUSTIFICATION:
New York State established and funded the Elderly Pharmaceutical Insur-
ance Coverage (EPIC) Program in 1986 to assist seniors based on annual
income with the costs of prescription medications. Today, over 327,000
income-eligible seniors aged 65 and older receive assistance with
co-payments, the costs of excluded drugs, and/or plan premiums depending
on one's income. As the price of pharmaceutical drugs continues to rise
at unprecedented rates, EPIC has become even more important for many New
York seniors.
Unfortunately, some retirees are ineligible because their employers
opt-in to a federal program, which incentivizes them to offer comparable
coverage instead of the Medicare Part D plan. While the employer
receives a 28% Retiree Drug Subsidy (RDS) for creating a comparable drug
plan, in New York, the retirees who receive these comparable drug plans
are ineligible for EPIC. This legislation removes the barrier that
requires all participants to have a Medicare Part D plan and allows
those who have comparable coverage to be eligible for EPIC if they
otherwise meet the qualifications.
 
LEGISLATIVE HISTORY:
2023-24: S966 / A6518 Tapia
2021-22: 2535-A / No same as
2019-20: S6695 / A8654 Bronson
 
FISCAL IMPLICATIONS:
To be determined, but minimal as the number of EPIC-eligible retirees
with comparable coverage is small.
 
EFFECTIVE DATE:
This act shall take effect on the first day of April next succeeding the
date on which it shall have become law.

Statutes affected:
S355A: 241 elder law