N.Y. Pub. Health Law § 2795
New York state adult cystic fibrosis assistance program
Redline — January 1, 2015 → current.View current text →
Current — January 1, 2026
As of January 1, 2015
§ 2795. Cystic fibrosis; health care for adults over twenty-one years\nold. 1. The commissioner shall establish a program to reimburse the\ncost of providing health care or health insurance to eligible\nindividuals who have cystic fibrosis.\n 2. To be a fully eligible individual for whom health care will be\nprovided under this section, such individual:\n (a) shall be at least twenty-one years old;\n (b) shall have been diagnosed as having cystic fibrosis;\n (c) shall have resided in the state for a minimum of twelve continuous\nmonths immediately prior to application for services under this section;\n (d) shall not be eligible for medical benefits under any group or\nindividual health insurance policy; and\n (e) shall not be eligible for medical assistance pursuant to title\neleven of article five of the social services law solely due to earned\nincome.\n 3. To be a partially eligible individual for whom health care will be\nprovided under this section, such individual shall meet all the criteria\nof a fully eligible individual except that a partially eligible\nindividual shall be an individual who is eligible for medical benefits\nunder any group or individual health insurance policy but which does not\ncover all services necessary for the care and treatment of cystic\nfibrosis.\n 4. The commissioner shall require each fully eligible individual, upon\ndetermination of eligibility, to make application to a private health\ninsurance provider as prescribed by the commissioner for an individual\nhealth insurance policy. If and when such policy is granted, the\ncommissioner shall approve payment for the associated premium.\n 5. The commissioner shall authorize payment for service related to the\ncare and treatment of cystic fibrosis not otherwise covered by a health\ninsurance policy. Providers of such services shall be reimbursed at the\nsame rate and claims for payment shall be made as if such individual\nwere eligible for benefits pursuant to title eleven of article five of\nthe social services law.\n 6. All eligible individuals shall be required to contribute seven\npercent of their net annual income toward the cost of care and/or the\ncost of the annual health insurance premium.\n 7. The commissioner shall, in consultation with the commissioner of\nsocial services, promulgate rules and regulations necessary to implement\nthe provisions of this act.\n
* § 2795. New York state adult cystic fibrosis assistance program. 1.\nSubject to available appropriation for the purpose outlined in this\narticle, the department shall establish an adult cystic fibrosis\nassistance program, which shall be known as the "New York State Adult\nCystic Fibrosis Assistance Program", and which shall consist of\nadministrative support services for the provision of financial\nassistance for services such as prescription drug costs, device costs,\nmedical care services, behavioral health services, and insurance\npremiums for the treatment of cystic fibrosis disease and its\nconditions.\n 2. The commissioner shall enter into a contract for the operation and\npromotion of the adult cystic fibrosis assistance program subject to\nsuch terms and conditions as may be contained within such contract with\nan organization that has experience and expertise improving access to\nhealthcare for patients who are underinsured by dispersing financial\nassistance grants to cover costs of essential treatments and\nmedications. The contractor may subcontract as needed for the effective\nperformance of the contract. All such subcontractors and the terms of\nsuch subcontracts shall be subject to approval by the commissioner.\n 3. The duties of the contractor shall include, but not be limited to,\nthe following:\n (a) verification of patient eligibility for financial assistance\ngrants allowable pursuant to paragraph (b) of this subdivision. To be\neligible for a financial assistance grant, a patient shall meet criteria\ndetermined by the department, which shall include but not be limited to,\nrequiring the patient:\n (i) be a New York state resident;\n (ii) be at least twenty-one years of age or older;\n (iii) have a diagnosis of cystic fibrosis; and\n (iv) have some form of primary private health insurance or Medicare\nand is not eligible for state Medicaid, and shall maintain health\ninsurance during the financial assistance award period;\n (b) review of financial assistance grant applications submitted by\neligible patients for approval, for services including but not limited\nto prescription drug costs, device costs, medical care services,\nbehavioral health services, and medical, vision and dental insurance\npremiums, for patient treatment of cystic fibrosis;\n (c) disbursement of grant funding for applications approved pursuant\nto paragraph (b) of this subdivision related to the care and treatment\nof cystic fibrosis not otherwise covered by a health insurance policy;\n (d) preparation and submission of a monthly report to the department.\nSuch report shall include but not be limited to:\n (i) new grants, which is the number of new grant recipients for\ninitial grant periods;\n (ii) renewal grants, which is the number of renewal grant recipients\nfor renewal grant periods;\n (iii) total active grant recipient count, which is the total number of\nactive grant recipients;\n (iv) grant recipients by insurance type, which is the number of active\ngrant recipients sorted by insurance type;\n (v) program expenses, which is the total amount spent sorted by\nassistance type but does not include administration fees;\n (vi) application outcomes report, which is the number of grant\nrecipients who have become inactive, sorted by reason; and\n (vii) allotment used, which is the total amount of copayment\nassistance provided to each grant recipient compared to what is\ncurrently used by the grant recipient.\n * NB Repealed March 31, 2027\n
Official source: NYS Open Legislation (New York State Senate). Reproduced from public-domain New York statutes; confirm against the official source for the current text. Not legal advice.