S T A T E   O F   N E W   Y O R K
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                                  7687

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              May 22, 2015
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
  Committee on Health

AN ACT to amend the social services law, in relation to  the  review  of
  reimbursement  methodologies under contracts or agreements with insur-
  ers under the medical assistance program for home and  community-based
  long term care services

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subdivision 18 of section 364-j of the social services law,
as amended by chapter 649 of the laws of 1996, paragraph (b) as  amended
by  chapter  433  of the laws of 1997, paragraph (c) as added by section
40-c of part B of chapter 57 of the laws of 2015, paragraphs (c) and (d)
as added by section 55 of part B of chapter 57 of the laws of  2015,  is
amended to read as follows:
  18.  (a) The department of health may, where not inconsistent with the
rate setting authority of other state agencies and subject  to  approval
of  the  director  of  the division of the budget, develop reimbursement
methodologies and fee schedules for determining the amount of payment to
be made to managed care providers under the managed care  program.  Such
reimbursement methodologies and fee schedules may include provisions for
payment of managed care fees and capitation arrangements.
  (b)  The  department  of  health  in  consultation  with organizations
representing managed care providers shall select an independent  actuary
to  review  any such reimbursement rates. Such independent actuary shall
review and make recommendations concerning appropriate actuarial assump-
tions relevant to the establishment of rates including but  not  limited
to  the adequacy of the rates in relation to the population to be served
adjusted for case mix, the scope of services the plans must provide, the
utilization of services and the network of providers necessary  to  meet
state  standards.  The independent actuary shall issue a report no later
than December thirty-first, nineteen hundred ninety-eight  and  annually

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11080-01-5
              

A. 7687                             2

thereafter. Such report shall be provided to the governor, the temporary
president  and the minority leader of the senate and the speaker and the
minority leader of the assembly. The department of health  shall  assess
managed  care providers under the managed care program on a per enrollee
basis to cover the cost of such report.
  (c) In setting such reimbursement methodologies, the department  shall
consider  costs  borne by the managed care program to ensure actuarially
sound and adequate rates of payment to ensure quality of care.
  [(c)] (D) The department of health shall require the independent actu-
ary selected pursuant to paragraph (b) of this subdivision to provide  a
complete actuarial memorandum, along with all actuarial assumptions made
and  all other data, materials and methodologies used in the development
of rates, to managed care providers thirty days prior to  submission  of
such  rates  to  the  centers  for  medicare  and  medicaid services for
approval. Managed care providers may request additional  review  of  the
actuarial soundness of the rate setting process and/or methodology.
  [(d)]  (E)(I)  THE DEPARTMENT OF HEALTH SHALL SELECT AND CONTRACT WITH
AN INDEPENDENT ACTUARY TO STUDY AND REVIEW ADEQUATE REIMBURSEMENT  METH-
ODOLOGIES  UNDER CONTRACTS OR AGREEMENTS WITH INSURERS UNDER THE MEDICAL
ASSISTANCE PROGRAM FOR HOME AND COMMUNITY-BASED LONG TERM CARE  SERVICES
PROVIDED UNDER THIS ARTICLE, BY FISCAL INTERMEDIARIES OPERATING PURSUANT
TO  SECTION THREE HUNDRED SIXTY-FIVE-F OF THIS TITLE OR RATES OF PAYMENT
FOR SUCH SERVICES UNDER THE MEDICAL ASSISTANCE PROGRAM  TO  ENSURE  SUCH
CONTRACTS OR RATES SHALL SUPPORT COMPENSATION FOR PERSONS PROVIDING SUCH
HOME  CARE  AIDE  SERVICES  AND  CONSUMER  DIRECTED  PERSONAL ASSISTANCE
SERVICES TO ENSURE THE RETENTION OF A  QUALIFIED  WORKFORCE  CAPABLE  OF
PROVIDING  HIGH QUALITY CARE TO RECIPIENTS OF SUCH SERVICES IN BOTH WAGE
PARITY AND NON-WAGE PARITY REGIONS. SUCH COMPENSATION SHALL AT A MINIMUM
INCLUDE WAGE PARITY COMPENSATION AS REQUIRED  UNDER  SECTION  THIRTY-SIX
HUNDRED  FOURTEEN-C  OF  THE  PUBLIC HEALTH LAW OR SUCH WAGE AS REQUIRED
UNDER ARTICLE NINETEEN OR  NINETEEN-A  OF  THE  LABOR  LAW  AS  REQUIRED
TOGETHER  WITH  THE FOLLOWING COSTS: RECRUITMENT, TRAINING AND RETENTION
OF DIRECT CARE PERSONNEL INCLUDING WAGE; SALARY; MANDATORY CONTRIBUTIONS
PURSUANT TO TITLE 26, SUBTITLE C, CHAPTER 21 OF THE UNITED  STATES  CODE
(FICA);  COSTS  ATTRIBUTED  TO  WORKERS COMPENSATION; COUNTY LIVING WAGE
LAWS AS APPROPRIATE; AND A SUPPLEMENTAL BENEFIT RATE.
  (II) THE DEPARTMENT OF HEALTH SHALL REPORT ON THE RESULTS OF THE INDE-
PENDENT ACTUARY FINDINGS UNDER  THIS  PARAGRAPH  TO  THE  GOVERNOR,  THE
TEMPORARY  PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE
CHAIRS OF THE SENATE HEALTH COMMITTEE AND ASSEMBLY HEALTH  COMMITTEE  ON
OR BEFORE JANUARY FIRST, TWO THOUSAND SIXTEEN.
  (F)  The  department of health shall annually provide to the temporary
president of the senate and the speaker of the assembly the annual Medi-
caid managed care operating reports submitted  to  the  department  from
managed  care  plans  that  contract  with  the state to manage services
provided under the Medicaid program.
  S 2. This act shall take effect immediately; provided that the  amend-
ments made to section 364-j of the social services law by section one of
this act shall not affect the repeal of such section and shall be deemed
repealed therewith.