Resolutions: February 2005

WHEREAS, Community Board Five has received the following applications:

• Gramercy Park Neighborhood Assoc., street festival on Park Avenue South, bet. 17th and 23rd Streets, on Sunday, May 14

• 14th Street – Union Square LDC, street festival on Park Avenue South, bet. 17th & 23rd Streets, on Saturday, July 16

• Innovative Community Enterprises, Inc., street festival on Madison Avenue, bet. 42nd and 57th Streets, on Monday, May 30

• The Workmen's Circle, street festival on Madison Avenue, bet 42nd and 57th Streets, on Sunday, July 17

• National Ethnic Coalition of Organizations, street festival on Madison Avenue, bet. 42nd and 57th Streets, on Sunday, August 14

• Forum's Children Foundation, street festival on Avenue of the Americas, bet. 42nd and 56th Streets, on Saturday, May 21

• International Immigrants Foundation, Inc., street festival on Avenue of the Americas, bet. 34th and 56th Streets, on Sunday, June 19

• Church of St. John the Baptist, street festival on Sixth Avenue, bet. 23rd and 33rd Streets on Saturday, July 9

• USO of Metropolitan NY, street festival on Avenue of the Americas, bet. 42nd and 56th Streets, on Sunday, July 10

• Coalition of Italo-American Assoc., Inc., street festival on Seventh Avenue, bet. 47th and 59th Streets, on Sunday, May 29

• NY Young Republican Club, street festival on Seventh Avenue, bet. 47th and 59th Street, on Sunday, June 12

• St. George Assoc., Inc. (NYPD), street festival on 45th Street, bet. 6th and 7th Avenues on Sunday, July 31

• The West 47th -48th Streets Block Association, street festival on Eighth Avenue, bet. 47th and 57th Streets on Sunday, July 3

• Children's Leukemia Research Assoc., Inc. (52 Assoc for the Handicapped Inc.), street festival on 52nd Street, bet. Lexington and Seventh Avenues on Saturday, June 25

And

WHEREAS, These events are held every year without incident; and

WHEREAS, The applicants has agreed to abide by Community Board Five's Street Activity Guidelines; and

WHEREAS, Community Board Five requests that the sponsors and producers of the events screen for and do not allow vendors selling counterfeit goods; therefore be it

RESOLVED, That Community Board Five recommends approval of the above referenced applications.

WHEREAS, The Grand Central Partnership has filed an application for an outdoor urban park/outdoor café d/b/a Pershing Square Café from May 2nd thru October 28th, on Park Avenue (Southbound lanes only), between East 42nd Street and East 40th Street; and

WHEREAS, This activity has been held in prior years without incident; therefore be it

RESOLVED, That Community Board Five recommends approval of the application by the Grand Central Partnership for an outdoor urban park/outdoor café d/b/a Pershing Square Café on Park Avenue (Southbound lanes only).

The above resolution passed with a vote of 26 in favor, 0 opposed, 1 abstention.  

WHEREAS, The NYU College of Dentistry has applied for a permit to hold a public service event for oral cancer screening at 6 East 43rd Street, between Fifth and Madison Avenues on Thursday, April 7, 2005; and

WHEREAS, This event has been held for the last 3 years without incident; therefore be it

RESOLVED, That Community Board Five recommends approval of the application by NYU College of Dentistry for a public service event for an oral screen cancer screening at 6 East 43rd Street, between Fifth and Madison Avenues on Thursday, April 7, 2005.

The above resolution passed with a vote of 26 in favor, 0 opposed, 1 abstention.  

WHEREAS, PQ. Broadway, Inc. has filed an application for an unenclosed sidewalk café for 8 tables and 16 seats at 38 East 19th Street; and

WHEREAS, Community Board Five feels that the placement of a sidewalk café at this location will not impede pedestrian traffic; therefore be it

RESOLVED, That Community Board Five recommends approval of the application for an unenclosed sidewalk café at 38 East 19th Street for 8 tables/16 seats.

The above resolution passed with a vote of 19 in favor, 7 opposed, 1 abstention.   

WHEREAS, Union Square Hospitality Group has applied for:

• a special events permit for the use of Madison Square Park for a Big Apple Barbeque on Saturday, June 11th and Sunday, June 12th ; and

• a Street Activity permit for Saturday, June 11th and Sunday, June 12th on Madison Avenue, between East 23rd and East 26th Streets, and

WHEREAS, The applicant remains aware of the continuing concerns of the residential community about noise, litter, property damage, and security as they relate to the use of Madison Square Park for large-scale special events; and

WHEREAS, Community Board Five is aware of the problems caused by the unparalleled number of additional events of street activities in the Madison Square area; and

WHEREAS, Community Board Five recommends that the applicant continue to hold the event on 26th Street, to the 2 blocks, between 5th and Park Avenues on the north end of Madison Square Park; therefore be it

RESOLVED, That Community Board Five recommends denial of the application by Union Square Hospitality Group a Street Activity and Parks Special Event permit.

WHEREAS, The Sikh Cultural Society has applied for:

• a special events permit for the use of Madison Square Park for a post-parade cultural event on Saturday, April 30, 2005; and

• a Street Activity permit for Saturday,  April 30, 2005 on Madison Avenue, between East 23rd and East 27th Streets, and

WHEREAS, Set-up would begin after 10:00 a.m. and clean-up would end by 7:00 p.m., with the event itself running from noon to 6:00 p.m.; and

WHEREAS, There will be an expected 7,500 attendees at this event; and

WHEREAS, Food at the event is distributed free of charge; and

WHEREAS, The applicant remains aware of the continuing concerns of both the residential community and New York City Parks & Recreation employees about noise, litter, property damage, and security as they relate to the use of Madison Square Park for large-scale special events; and

WHEREAS, The applicant agreed to either move their stage from 23rd Street and Madison Avenue northward to 24th Street or to stage the speakers from 23rd Street to 24th Street with lower sound levels; and

WHEREAS, Community Board Five continues to encourage the police to monitor the sound level at events in and around Madison Square Park; and

WHEREAS, The applicant has agreed that the park will be left cleaner than they originally found it; and

WHEREAS, The applicant has agreed to hire additional security to prevent the crowd from entering unauthorized park areas; and

WHEREAS, Addressing numerous problems caused by the unparalleled number of street activities in its district, Community Board 5 has adopted guidelines for recommending approval of street activity permit applications; and

WHEREAS, The applicant has agreed to comply with those guidelines, including that participation in the events will not be denied to any group on the basis of age, race, ethnicity, sexual orientation, gender identity or expression or religion; therefore be it

RESOLVED, That Community Board Five recommends approval of both the Street Activity and Parks Special Event permit applications of the Sikh Cultural Society for their event on Saturday, April 30, 2005. 

WHEREAS, New York City Parks and Recreation has proposed to redesign the northern end of Union Square Park; and

WHEREAS, Union Square Park and the north plaza of Union Square are highly valued public spaces that serve many constituencies, including local residents, businesses, park visitors, playground users, the green market and many others; and

WHEREAS, Funding has been provided from public and private sources, including the Union Square Partnership, Councilmember Margarita Lopez and the City of New York; and

WHEREAS, Union Square has traditionally been a place for free speech and public assembly; and

WHEREAS, Any proposal for the redesign of the park and plaza must balance the many uses of the park's constituents; and

WHEREAS, Consultation took place between the Union Square Partnership and New York City Parks and Recreation regarding a potential redesign of the north end of the park, including the playground areas, pavilion and the north plaza; and

WHEREAS, As a result of these consultations, Union Square Partnership has contracted Michael Van Valkenberg Landscape Architects to develop potential design concepts for the north end of the park and the plaza; and

WHEREAS, As part of the design process, Community Board Five, NYC Parks and Recreation and the Union Square Partnership sponsored numerous meetings with local residents, businesses, park users and interested community organizations to solicit input into the design; and 

WHEREAS, A final design was presented to Community Board Five at a public meeting on Monday, January 31, 2005; and

WHEREAS, Elements of the final design include the following:

Playground

• Consolidate two existing play spaces into one continuous, enlarged playground (enlarged from 5,100 square feet to more than 10,000 square feet) with distinct age-specific play areas that encourage creativity through landforms, play equipment and open spaces with child sized hills, and a planted perimeter.  Sand, water and plants will be incorporated into the playground.

• The playground is designed to be accessible to wheelchairs as well as baby strollers.

• A unisex bathroom with changing table, accessible only from the playground for use by children and their guardians, will be located on the west side of the pavilion.

• Design was conceived with security and sight lines in mind.  Parks security, Parks employees as well as a playground associate will be available as added security.

Northern Gateway Plaza

• Addressing its history as an urban gathering space, the plaza will be repaved using materials able to withstand the greenmarket's requirements as it relates to truck usage as well as drainage. Asphalt blocks are proposed to create an integration of the plaza perimeter with the park as a continuation of the southwest corner renovation. 

• Along 17th street, 8 trees will be planted flush to the ground with improved drainage.  Space between the trees will be a minimum of 20 feet. 

• Addressing the requirement by Department of Transportation for a barrier along 17th street to inhibit mid-block crossing, temporary metal removable stanchions will be installed along the north end of the square.  Style to be similar to the fencing currently being used within the park.

• Additional shaded public seating as well as trees will be placed along the north façade of the pavilion.

• Construction will be phased (working with the greenmarket) to minimize impact with operations.

• Public bathrooms accessible from the north side will be built along the east side of the pavilion for use by all park patrons as well as the greenmarket.

• Increased and historically sensitive lighting to be installed.

• The design has been developed in consultation with the managers of the greenmarket without objection.

Concession

• Restoration of the pavilion with the main entrance on the south side, and seasonal terrace. The concessionaire will be responsible for a full restoration of the pavilion. 

• The seasonal terrace will occupy less area than what is occupied currently by the concession.  The area will be available to the public when the concession is closed.

• Additional public seating will be installed along the south side of the pavilion and in the vicinity of the Lincoln statue.

• Internal exhaust will go through an existing chimney.

• Waste bin storage has been positioned with little visual impact, minimal space requirements as well as keeping with park's aesthetics.

Parks and Recreation Office and Storage

• A smaller building will be added on to west side of the pavilion to increase storage for the Parks Department staff.

• A new basement of the building will be excavated of approximately 1,000 square feet to create locker rooms, showers, and increased office space, and;

WHEREAS, The renovation of Union Square North and full restoration of the pavilion is not contingent on a concessionaire; and

WHEREAS, The proposal calls for the use of the Pavilion as a year round concession, and Community Board Five, traditionally, has been concerned with commercial concessions and their accompanying signage in public parks; and

WHEREAS, Any concession would go through an RFP review process and the Parks Department has assured the Board an opportunity to opine on the draft RFP prior to its release, as was done in that case of the Madison Square Park Food Kiosk; and

WHEREAS, Many in the community have expressed concern regarding a year round food concession with high prices and limited access, Community Board Five recommends that the RFP should not be limited to restaurateurs, but should be open to other entities such as cultural and community groups; and

WHEREAS, The Parks Department has agreed to require any concessionaire to offer low cost items such as take-out food service in the case of a restaurant; and

WHEREAS, The Board is also concerned with the possible elimination of tables and chairs for public seating in the concession area; and

WHEREAS, The Parks department has agreed to look closely at all prudent options for increasing public seating both portable and fixed including opening up portions of the space south of Lincoln's statue to temporary tables and chairs; and

WHEREAS, The Parks Department has agreed to evaluate all options in either fast tracking the playground construction or phasing to minimize closure time and possibly open alternative space in the park for supervised play in the interim; therefore be it

RESOLVED, That Community Board Five supports the design of the north end of Union Square Park and the Plaza as described above; and be it further

RESOLVED, That Community Board Five requests that the Parks Department include opportunities for other organizations, such as cultural institutions, community groups, etc. to submit proposals for the pavilion in addition to restaurateurs, and that the Board be given full opportunity to opine on the RFP prior to its release. 

WHEREAS, Federation of Turkish American Associations, Inc. has applied for a special event permit to hold Folk Dance Performance in Bryant Park on Wednesday, May 18, 2005; and

WHEREAS, Set-up would begin at 9:00 am, the event itself will run from 11:30 a.m. to 2:30 p.m., and clean up will conclude by 3:30 p.m.; and

WHEREAS, The event would be held in the area near the fountain on the west side of the park; and

WHEREAS, The applicant has informed the Committee that no fees will be charged and no food or merchandise will be sold; and

WHEREAS, Approximately 400 spectators are anticipated throughout the day; and

WHEREAS, The applicant is using amplified sound, understands the concerns of the community regarding the use of amplified sound and has agreed to obtain and abide by the terms a sound permit from the New York Police Department; and

WHEREAS, the applicant has agreed to leave the park cleaner than it was found; therefore, be it

RESOLVED, Community Board Five recommends approval of a special events permit for Federation of Turkish American Associations, Inc. to hold a Folk Dance performance in Bryant Park. 

The above resolution passed with a vote of 22 in favor, 0 opposed, 1 abstention.  

WHEREAS, This application is for 1140 Broadway, a Neo-Classical store and loft building designed by Maynicke and Franke and built circa 1914-1916; and

WHEREAS, The applicant wishes to replace the second and third floor fenestration above the transoms over the storefronts to more closely echo the storefronts by installing painted aluminum windows that match in storefronts in section; and

WHEREAS, The bulkheads will be restored across the bottom of the storefronts, matching one remaining bulkhead on the building, and will be made of aluminum painted to match the original; and

WHEREAS, Terra-cotta spandrel panels to match the existing panels above will be placed above the storefronts, a glass marquee will be placed over the main entrance to the building in a design that mimics the original pediment still present over one doorway at the corner; and 

WHEREAS, The interior half-floor created during an earlier renovation and now visible with the storefront restorations, will be hidden behind interior opaque glass, and the exterior signage band for the storefronts will be placed over these transoms; and

WHEREAS, Roll-down gates now on the exterior will be removed and new gates will be installed inside the storefronts, and a temporary fence will be erected only during the time of the renovation and installation work on the storefronts; and

WHEREAS, The facade of the entire building has already been cleaned and restored; and

WHEREAS, The design, in effect, creates a master plan for the storefronts and the applicant plans to institute these changes as the current tenants agree to them or leave; therefore be it

RESOLVED, That Community Board Five recommends approval of the application for a Certificate of Appropriateness for 1140 Broadway

The above resolution passed with a vote of 21 in favor, 0 opposed, 2 abstentions.    

WHEREAS, The building is a Beaux Arts style loft building designed by Robert Maynicke and built in 1899-1900; and

WHEREAS, The applicant is proposing to replace the existing storefront and remove the existing exterior roll down security gate; and

WHEREAS, The applicant is proposing to replace the all glass lobby entrance doors with oil-rubbed bronze and glass entrance doors; and

WHEREAS, The applicant is proposing an applied signage to an opaqued transom and a new retractable fabric awning, which seems appropriate to the building and district; and

WHEREAS, The applicant’s proposal generally seems appropriate to the Madison Square North Historic District; therefore be it

RESOLVED, That Community Board Five recommends approval of the application to alter the building entrance and install new storefront infill and signage.

The above resolution passed with a vote of 21 in favor, 0 opposed, 2 abstentions.    

WHEREAS, The applicant has applied to make alterations to 44 W 22 St, a 5 story building originally built in 1851 and altered in 1893 by De Lemos & Cordes; and

WHEREAS, The alterations include a new elevator, stair enclosure and mechanical system as well as a one story mansard-roofed 6th story, all of which will not be visible from the street; and

WHEREAS, The alterations include a rear extension of masonry on the 3rd, 4th and 5th floors and roof with new aluminum windows, which is not visible from the back street, and does not interfere aesthetically or otherwise with the adjoining buildings; therefore be it

RESOLVED, that Community Board Five Landmarks Committee recommends approval of the application for alteration.

 The above resolution passed with a vote of 21 in favor, 0 opposed, 2 abstentions.    

WHEREAS, The applicant is proposing to build a new 15-story residential building on a parking lot site recently rezoned from M-6 to C6-4A, permitting such uses; and

WHEREAS, The building is massed in a fashion (tall building next to short building next to tall building) frequently found throughout the Ladies' Mile Historic District;  and

WHEREAS, The building materials (limestone base for three stories, glazed grey brick central shaft with matching mortar, light aluminum cornice of windows with articulated dentils) appear compatible with the Historic District;  and

WHEREAS, The project generally seems to be sensitively studied and detailed and thoughtfully integrated into its neighborhood; therefore be it

RESOLVED, That Community Board Five recommends approval of the application to construct a new 15-story building and to request that the Landmarks Preservation Commission issue a report to the City Planning Commission relating to an application for a Modification of Bulk pursuant to Section 74-711 of the Zoning Resolution.

The above resolution passed with a vote of 21 in favor, 0 opposed, 2 abstentions.     

WHEREAS, The property is a Greek Revival style rowhouse constructed in 1847-48, altered in 1850 and again in the 1920's and later converted to commercial use;  and

WHEREAS, According to their 74-711 application, the applicant would agree to restore the façade and maintain it in perpetuity in exchange for permission to build the rooftop addition and rear yard addition;  and

WHEREAS, The rooftop addition is very visible from the street and impacts severely on the historic quality of this small historic landmark; therefore be it

RESOLVED, That Community Board Five recommends denial of the application to construct rooftop and rear yard additions and does not approve the request that the Landmarks Preservation Commission issue a report to the City Planning Commission relating to an application for a Special Permit pursuant to Section 74-711 of the Zoning Resolution for a Modification of Use.

The above resolution passed with a vote of 22 in favor, 0 opposed, 2 abstentions.   

WHEREAS, The property is a Beaux-Arts style store and loft building, designed by Schwartz and Gross and built in 1909-10; and

WHEREAS, The applicant is attempting to get approval for windows illegally installed without Landmarks Preservation Commission approval or permits; and

WHEREAS, The windows installed would not be approved by Landmarks due to their unorthodox arrangement and construction (transom window over aluminum double-hung window over fixed glass); therefore be it

RESOLVED, That Community Board Five recommends denial of the application to legalize the installation of windows without Landmarks Preservation Commission permits.

The above resolution passed with a vote of 22 in favor, 0 opposed, 2 abstentions.   

WHEREAS, 15 West 20th Street is a 9-story vacant building located within the Ladies Mile Historic District and in the area recently rezoned to C6-4A permitting residential use as-of-right; and

WHEREAS, The Owner proposes to construct a two-story penthouse addition set back approximately 20' from the front of the building, 24' from the western lot line and 20' from the northern building line; and

WHEREAS, The second story of the proposed addition is above 125' from the sidewalk and, under the provisions of Z.R. §23-66, would have to be set back an additional 10' from the back of the building, thereby reducing the second story by 330 square feet; and

WHEREAS, The Owner, having agreed to substantial setbacks on three sides in order to make the addition invisible from the street, has applied for a Special Permit waiving the rear yard setback requirement; and

WHEREAS, the project received approval from the Landmarks Committee of Community Board Five in October 2003 and a Certificate of Appropriateness and a Certificate of No Effect from the Landmarks Preservation Commission in March 2004; and

WHEREAS, Pursuant to the requirements of §74-711, the Owner has recorded a Memorandum of Understanding regarding façade restoration work; and

WHEREAS, Although the Committee is concerned about the tendency of owners to maximize the value of their buildings by building penthouse additions, this addition will not block the light and air to any neighboring buildings, is not visible from the street and is the only deviation from the Zoning Code requested by the Owner; therefore be it

RESOLVED, that Community Board Five recommends approval of the issuance of a Special Permit.

The above resolution passed with a vote of 21 in favor, 1 opposed, 1 abstention.    

WHEREAS, Community Board Five supports the East Side Access project for the Long Island Railroad which would bring LIRR trains into Grand Central; and

WHEREAS, The MTA is proposing to build a new tunnel and platform 150 feet below ground through its preferred design of East Side Access; and

WHEREAS, The current cost of the East Side Access project is estimated to be $6.3 billion through federal and state funding; and

WHEREAS, It is unclear with New York State's fiscal crisis whether or not funding for transportation projects like the 2nd Avenue subway and East Side Access is going to be available; and

WHEREAS, The MTA wants to build a facility on East 50th Street between Park and Madison Avenues to ventilate the proposed tunnels and platform for Long Island Railroad service into Grand Central Terminal; and

WHEREAS, The MTA has performed an Environmental Impact Statement on the East Side Access project as a whole and an Environmental Assessment on the 50th Street facility; and

WHEREAS, The community on and around East 50th Street has raised serious concerns about the security and safety impact of the facility; and

WHEREAS, The MTA has been accessible during the process and has met with Community Board 5 to hear concerns; and

WHEREAS, There are legitimate security concerns for the facility as the MTA has a history of security problems and has recently left sensitive documents in public trash receptacles making them easy to find; and

WHEREAS, The MTA should investigate a variety of East Side Access alternatives including the Upper Loop alternative to determine if they can be constructed without the East 50th Street Facility and disruption of service on MetroNorth; therefore be it

RESOLVED, That Community Board Five opposes construction of the Ventilation Facility on East 50th Street as currently designed and encourages further study by the MTA of the issues raised by the community including:

• Safety concerns about having diesel fuel to power generators in case of a power failure;

• Concerns about a terrorist attack on the facility by either igniting the diesel fuel or pumping chemicals into the station and tunnels;

• The canyon impact with exhaust due to the high rise buildings surrounding the facility.

• Disruption of the community during construction that would occur during this 6 year project.

And be it further

RESOLVED, That Community Board Five encourages a full review of all alternatives including the Upper Loop Alternative that would permit construction of East Access without the East 50th Street facility and would permit the project to be constructed in a more cost effective and community friendly manner.

WHEREAS, The MTA wants to conduct a pilot program to change train operation on the L line from trains run by a train operator and conductor to Communications Based Train Control (CBTC) which is a radio wave based system that uses a computerized signal system computers to guide the train along its route; and

WHEREAS, Most trains within the subway system currently operate with 2 personnel – a train operator and conductor – running them; and

WHEREAS, Using the CBTC should not eliminate the need for 2 personnel on the each subway train; and

WHEREAS, The MTA plans to conduct the CBTC pilot with only one train operator and will remove the conductor from the L train starting in June 2005 when the pilot is initiated; and

WHEREAS, There are frequent problems in the subway system including blackouts, periodic power failures, fires, and sick passengers; and

WHEREAS, Having a train operator and a conductor on a subway train increase passenger safety and make dealing with emergencies easier; and

WHEREAS, The recent fire impact on the signals of the A and C lines show that the signal system needs to be upgraded; and

WHEREAS, The train operators and conductors do not object to pilot projects testing new signal systems including CBTC as long as they are done in a manner that respects the unique problems and operations of the NYC subway and are done with both a train operator and a conductor; therefore be it

RESOLVED, That Community Board Five supports this pilot only if it is conducted with both a train operator and conductor on each train and requests the MTA share its analysis of the CBTC pilot with the community before proceeding further with the project.

The above resolution then passed with a  vote of 20 in favor, 1 opposed, 1 abstention.    

WHEREAS, The Medicaid program currently provides healthcare to the neediest members of our community including working adults, children, seniors, the disabled and mentally ill; and

WHEREAS, The $1.13 Billion in cuts to the Medicaid program in the proposed 2005/6 State budget would most likely increase the number of uninsured in our community, decrease access to long term care services for our elderly and disabled, unduly restrict access to needed drug therapy, and eliminate some so-called "optional" services; and

WHEREAS, These cuts would have a long term impact to New York City by reducing funding to important health facilities and providers in the city and the Community Board  Five area, causing layoffs for healthcare workers; and

WHEREAS, These cuts significantly hurt hospitals and other health care institutions that are already in a financial crisis; and

WHEREAS, These cuts would impact on the quality of care all New Yorkers receive and cause those denied coverage to seek treatment for routine illnesses in emergency rooms instead of at primary care providers; and

WHEREAS, Community Board Five recognizes the financial strain placed upon both state and localities by increasing Medicaid costs; and

WHEREAS, The budget proposed by the Governor conditions the State assuming an increasing share of Medicaid costs on legislative acceptance of the $1.13 billion in cuts; and

WHEREAS, There are other alternatives to reduce city and state Medicaid expenditures, such as making health and LTC insurance more affordable, re-importing drugs, consolidating New York's pharmaceutical purchases, and revising the federal funding formula; therefore be it

RESOLVED, Community Board Five urges the Governor and legislature:

• to reduce to the greatest extent possible the proposed Medicaid cuts and to consider other options to control Medicaid spending; 

• to ensure that any Medicaid cutbacks do not disproportionately impact one sector of the population; and,

• in establishing a Medicaid drug formulary, to provide a consumer friendly appeal process and give final authority over a patient's medication to the prescribing physician; and

• to de-link decisions on services and eligibility from decisions on fiscal relief to localities; and

• to advocate aggressively for a revision of the federal funding formula that would reduce the burden on states like New York that are disadvantaged by the current formula; and

• to establish a state commission of health policy experts charged with examining the Medicaid program and developing recommendations for reforming it to provide comprehensive medically appropriate health services to the state's medically needy in the most efficient and cost-effective manner.