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(i) a managed care provider shall arrange for access to and enrollment
of primary care practitioners and other medical services providers;
PROVIDED, HOWEVER, THAT A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN
SHALL ARRANGE FOR ACCESS TO AND ENROLLMENT OF PRIMARY CARE PRACTITIONERS
IF SO AUTHORIZED. Each managed care provider shall possess the expertise
and sufficient resources to assure the delivery of quality medical care
to participants in an appropriate and timely manner and may include
physicians, nurse practitioners, county health departments, providers of
comprehensive health service plans licensed pursuant to article forty-
four of the public health law, and hospitals and diagnostic and treat-
ment centers licensed pursuant to article twenty-eight of the public
health law or otherwise authorized by law to offer comprehensive health
services or facilities licensed pursuant to articles sixteen, thirty-one
and thirty-two of the mental hygiene law.
S 4. Paragraph (b) of subdivision 4 of section 364-j of the social
services law, as amended by section 57 of part A of chapter 57 of the
laws of 2006, is amended to read as follows:
(b) Participants shall select a managed care provider from among those
designated under the managed care program, provided, however, a partic-
ipant shall be provided with a choice of no less than two managed care
providers. Notwithstanding the foregoing, a local social services
district designated a rural area as defined in 42 U.S.C. 1395ww may
limit a participant to one managed care provider, if the commissioner
and the local social services district find that only one managed care
provider is available, AND THE COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES MAY LIMIT A PARTICIPANT ELIGIBLE TO ENROLL IN
A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN TO ONE SUCH PLAN, IF
FEDERAL APPROVAL IS SECURED TO REQUIRE ENROLLMENT WHEN THERE ARE LESS
THAN TWO MANAGED CARE PLANS OPERATING IN THE PARTICIPANT'S COUNTY OF
RESIDENCE AUTHORIZED TO COORDINATE CARE OR PERSON WITH DEVELOPMENTAL
DISABILITIES PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW. A
managed care provider in a rural area shall offer a participant a choice
of at least three primary care practitioners and permit the individual
to obtain a service or seek a provider outside of the managed care
network where such service or provider is not available from within the
managed care provider network, PROVIDED, HOWEVER, THAT THIS REQUIREMENT
SHALL ONLY APPLY TO A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN TO
THE EXTENT IT IS AUTHORIZED TO COVER SUCH SERVICES.
S 5. Paragraph (c) of subdivision 4 of section 364-j of the social
services law, as amended by chapter 649 of the laws of 1996, is amended
to read as follows:
(c) Participants shall select a primary care practitioner from among
those designated by the managed care provider. In all districts, partic-
ipants shall be provided with a choice of no less than three primary
care practitioners. In the event that a participant does not select a
primary care practitioner, the participant's managed care provider shall
select a primary care practitioner for the participant, taking into
account geographic accessibility; PROVIDED, HOWEVER, THAT THIS PARAGRAPH
SHALL NOT APPLY IF A PARTICIPANT IS ENROLLED IN A DEVELOPMENTAL DISABIL-
ITIES MANAGED CARE PLAN THAT IS NOT AUTHORIZED TO ARRANGE FOR PRIMARY
CARE.
S 6. Subparagraphs (iv), (v), (vi) and (vii) of paragraph (e) of
subdivision 4 of section 364-j of the social services law, subparagraphs
(iv) and (vii) as amended by section 39 of part A of chapter 56 of the
laws of 2013, subparagraph (v) as amended by section 78 of part H of
chapter 59 of the laws of 2011, and subparagraph (vi) as amended by
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section 14 of part C of chapter 58 of the laws of 2004, are amended to
read as follows:
(iv) Local social services districts or enrollment organizations
through their enrollment counselors, OR IN THE CASE OF DEVELOPMENTAL
DISABILITIES MANAGED CARE PLANS, THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES OR ENROLLMENT ORGANIZATIONS THROUGH THEIR ENROLLMENT
COUNSELORS, shall provide participants with the opportunity for face to
face counseling including individual counseling upon request of the
participant. Local social services districts or enrollment organizations
through their enrollment counselors shall also provide participants with
information in a culturally and linguistically appropriate and under-
standable manner, in light of the participant's needs, circumstances and
language proficiency, sufficient to enable the participant to make an
informed selection of a managed care provider. Such information shall
include, but shall not be limited to: how to access care within the
program; a description of the medical assistance services that can be
obtained other than through a managed care provider; the available
managed care providers and the scope of services covered by each; a
listing of the medical services providers associated with each managed
care provider; the participants' rights within the managed care program;
and how to exercise such rights. Enrollment counselors shall inquire
into each participant's existing relationships with medical services
providers and explain whether and how such relationships may be main-
tained within the managed care program. For enrollments made during face
to face counseling, if the participant has a preference for particular
medical services providers, enrollment counselors shall verify with the
medical services providers that such medical services providers whom the
participant prefers participate in the managed care provider's network
and are available to serve the participant.
(v) Upon delivery of the pre-enrollment information, the local
district or the enrollment organization shall certify the participant's
receipt of such information. Upon verification that the participant has
received the pre-enrollment education information, a managed care
provider, a local district or the enrollment organization may enroll a
participant into a managed care provider. Managed care providers must
submit enrollment forms to the local department of social services. Upon
enrollment, participants will sign an attestation that they have been
informed that: participants have a choice of managed care providers;
participants have a choice of primary care practitioners; and, except as
otherwise provided in this section, including but not limited to the
exceptions listed in subparagraph (iii) of paragraph (a) of this subdi-
vision, participants must exclusively use their primary care practition-
ers and plan providers. The commissioner of health may suspend or
curtail enrollment or impose sanctions for failure to appropriately
notify clients as required in this subparagraph. ENROLLMENT IN A DEVEL-
OPMENTAL DISABILITIES MANAGED CARE PLAN SHALL NOT BE GOVERNED BY THIS
SUBPARAGRAPH.
(vi) Enrollment counselors or local social services districts, OR, AS
APPROPRIATE, ENROLLMENT COUNSELORS OR THE OFFICE FOR PEOPLE WITH DEVEL-
OPMENTAL DISABILITIES, shall further inquire into each participant's
health status in order to identify physical or behavioral conditions
that require immediate attention or continuity of care, and provide to
participants information regarding health care options available to
persons with HIV and other illnesses or conditions under the managed
care program. Any information disclosed to counselors shall be kept
A. 9920 4
confidential in accordance with applicable provisions of the public
health law, and as appropriate, the mental hygiene law.
(vii) Any marketing materials developed by a managed care provider
shall be approved by the department of health or the local social
services district, and the commissioner of mental health and the commis-
sioner of alcoholism and substance abuse services, OR THE COMMISSIONER
OF DEVELOPMENTAL DISABILITIES, where appropriate, within sixty days
prior to distribution to recipients of medical assistance. All marketing
materials shall be reviewed within sixty days of submission.
S 7. Paragraph (f) of subdivision 4 of section 364-j of the social
services law is amended by adding a new subparagraph (vi) to read as
follows:
(VI) THE PROVISIONS OF THIS PARAGRAPH SHALL NOT APPLY TO PARTICIPANTS
ELIGIBLE TO ENROLL IN A DEVELOPMENT DISABILITIES MANAGED CARE PLAN.
S 8. Paragraph (g) of subdivision 4 of section 364-j of the social
services law, as amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
(g) If another managed care provider is available, participants may
change such provider or plan without cause within thirty days of notifi-
cation of enrollment or the effective date of enrollment, whichever is
later with a managed care provider by making a request of the local
social services district except that such period shall be forty-five
days for participants who have been assigned to a provider by the
commissioner of health. However, after such thirty or forty-five day
period, whichever is applicable, a participant may be prohibited from
changing managed care providers more frequently than once every twelve
months, as permitted by federal law except for good cause as determined
by the commissioner of health through regulations. NOTWITHSTANDING ANY
PROVISION OF THIS PARAGRAPH, PARTICIPANTS MAY CHANGE A MANAGED CARE
PROVIDER TO ENROLL IN A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN AT
ANY TIME WITHOUT CAUSE AND MAY CHANGE DEVELOPMENTAL DISABILITIES MANAGED
CARE PLANS AT ANY TIME WITHOUT CAUSE.
S 9. Paragraph (h) of subdivision 4 of section 364-j of the social
services law, as amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
(h) If another medical services provider is available, a participant
may change his or her provider of medical services (including primary
care practitioners) without cause within thirty days of the partic-
ipant's first appointment with a medical services provider by making a
request of the managed care provider. However, after that thirty day
period, no participant shall be permitted to change his or her provider
of medical services other than once every six months except for good
cause as determined by the commissioner through regulations. THIS PARA-
GRAPH SHALL NOT APPLY TO PARTICIPANTS ENROLLED IN DEVELOPMENTAL DISABIL-
ITIES MANAGED CARE PLANS.
S 10. Paragraph (i) of subdivision 4 of section 364-j of the social
services law, as amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
(i) A managed care provider requesting a disenrollment shall not
disenroll a participant without the prior approval of the local social
services district in which the participant resides, OR, IN THE CASE OF A
DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN, WITHOUT THE PRIOR APPROVAL
OF THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES, provided that disen-
rollment from a special needs managed care plan must comply with the
standards of the commissioner of health, the commissioner of alcoholism
and substance abuse services, and the commissioner of mental health AND
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DISENROLLMENT FROM A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN MUST
COMPLY WITH THE STANDARDS OF THE COMMISSIONER OF HEALTH AND THE COMMIS-
SIONER OF DEVELOPMENTAL DISABILITIES. A managed care provider shall not
request disenrollment of a participant based on any diagnosis, condi-
tion, or perceived diagnosis or condition, or a participant's efforts to
exercise his or her rights under a grievance process, provided however,
that a managed care provider may, where medically appropriate, request
permission to refer participants to a managed care provider that is a
special needs managed care plan or a comprehensive HIV special needs
plan after consulting with such participant and upon obtaining his/her
consent to such referral, and provided further that a special needs
managed care plan may, where clinically appropriate, disenroll individ-
uals who no longer require the level of services provided by a special
needs managed care plan.
S 11. Paragraph (m) of subdivision 4 of section 364-j of the social
services law, as amended by chapter 649 of the laws of 1996, is amended
to read as follows:
(m) A managed care provider shall provide all early periodic screening
diagnosis and treatment services, as well as interperiodic screening and
referral, to each participant under the age of twenty-one, at regular
intervals, as medically appropriate, EXCEPT THAT A DEVELOPMENTAL DISA-
BILITIES MANAGED CARE PLAN SHALL ONLY BE REQUIRED TO PROVIDE SUCH
SERVICES IF SO AUTHORIZED.
S 12. Paragraph (n) of subdivision 4 of section 364-j of the social
services law, as amended by chapter 484 of the laws of 2009, is amended
to read as follows:
(n) A managed care provider shall provide or arrange, directly or
indirectly (including by referral) for the provision of comprehensive
prenatal care services to all pregnant participants in accordance with
standards adopted by the department of health, EXCEPT THAT A DEVELOP-
MENTAL DISABILITIES MANAGED CARE PLAN SHALL ONLY BE REQUIRED TO PROVIDE
OR ARRANGE FOR SUCH SERVICES IF SO AUTHORIZED.
S 13. Paragraph (v) of subdivision 4 of section 364-j of the social
services law, as added by section 39 of part A of chapter 56 of the laws
of 2013, is amended to read as follows:
(v) A managed care provider must allow enrollees to access chemical
dependence treatment services from facilities certified by the office of
alcoholism and substance abuse services, even if such services are
rendered by a practitioner who would not otherwise be separately reim-
bursed, including but not limited to a credentialed alcoholism and
substance abuse counselor (CASAC), EXCEPT THAT A DEVELOPMENTAL DISABILI-
TIES MANAGED CARE PLAN SHALL ONLY BE REQUIRED TO ALLOW ACCESS TO SUCH
SERVICES IF SO AUTHORIZED.
S 14. Paragraph (g) of subdivision 5 of section 364-j of the social
services law, as added by section 15 of part C of chapter 58 of the laws
of 2004, is amended to read as follows:
(g) The commissioner of health may delegate some or all of the tasks
identified in this section to the local districts, EXCEPT THAT THE
COMMISSIONER OF HEALTH MAY NOT MAKE ANY SUCH DELEGATION WITH RESPECT TO
DEVELOPMENTAL DISABILITIES MANAGED CARE PLANS.
S 15. Paragraph (b) of subdivision 6 of section 364-j of the social
services law, as added by chapter 649 of the laws of 1996, is amended to
read as follows:
(b) distribute marketing materials to recipients of medical assist-
ance, unless such materials are approved by the department of health
A. 9920 6
and, as appropriate, the office of mental health OR THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES.
S 16. Subparagraph (ii) of paragraph (f) of subdivision 8 of section
364-j of the social services law, as added by chapter 649 of the laws of
1996, is amended to read as follows:
(ii) there are opportunities to select from at least three primary
care providers, PROVIDED HOWEVER THAT THIS REQUIREMENT SHALL NOT APPLY
TO DEVELOPMENTAL DISABILITY MANAGED CARE PLANS THAT ARE NOT AUTHORIZED
TO OFFER OR ARRANGE FOR PRIMARY CARE; and
S 17. The opening paragraph of paragraph (f) of subdivision 27 of
section 364-j of the social services law, as added by section 72 of part
A of chapter 56 of the laws of 2013, is amended to read as follows:
Notwithstanding any inconsistent provisions of this section and
sections one hundred twelve and one hundred sixty-three of the state
finance law, or section one hundred forty-two of the economic develop-
ment law, or any other law to the contrary, the commissioner of health
and, in the case of FIDAs authorized exclusively to enroll persons with
developmental disabilities, the commissioner of health and the commis-
sioner of the office for people with developmental disabilities, may
contract with FIDAs approved under this section without a competitive
bid or request for proposal process, [are authorized to enter into a
contract or contracts under this section,] provided, however, that:
S 18. The opening paragraph of subdivision (g) of section 13.40 of the
mental hygiene law, as added by section 72-b of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
Notwithstanding any inconsistent provision of sections one hundred
twelve and one hundred sixty-three of the state finance law, or section
one hundred forty-two of the economic development law, or any other law
to the contrary, the commissioner and the commissioner of health are
authorized to enter into a contract or contracts under section forty-
four hundred three-g of the public health law, subdivision eight of
section forty-four hundred three of the public health law, and subdivi-
sion twelve of section forty-four hundred three-f of the public health
law, AND TO ENTER INTO CONTRACTS WITH APPLICANTS FOR A CERTIFICATE OF
AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-G OF THE PUBLIC
HEALTH LAW FOR COSTS ASSOCIATED WITH DEVELOPING INFORMATION TECHNOLOGY,
HUMAN RESOURCES AND CARE COORDINATION SYSTEMS NECESSARY TO OPERATE A
DISCO, provided, however, that:
S 19. Section 13.40 of the mental hygiene law is amended by adding a
new subdivision (h) to read as follows:
(H) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER LAW
TO THE CONTRARY, THE COMMISSIONER AND THE COMMISSIONER OF HEALTH ARE
AUTHORIZED TO ENTER INTO CONTRACTS FOR ANY OF THE FOLLOWING AS NECESSARY
TO OVERSEE AND DEVELOP, OPERATE AND OVERSEE A MANAGED CARE SYSTEM UNDER
THE PEOPLE FIRST WAIVER PROGRAM: QUALITY ASSESSMENT, QUALITY IMPROVE-
MENT, ASSESSMENTS OF ENROLLEES, ENROLLMENT COUNSELING AND ENROLLMENT
PROCESSING, OUTSIDE ADVOCACY AND INFORMATION TECHNOLOGY, PROVIDED,
HOWEVER, THAT:
1. THE OFFICE SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS THAN
THIRTY DAYS:
(1) A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
(2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;
A. 9920 7
(3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY SEEK
SELECTION, WHICH SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
(4) THE MANNER BY WHICH A PROSPECTIVE CONTRACTOR MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
2. ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT ARE RECEIVED FROM
PROSPECTIVE CONTRACTORS IN A TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONERS; AND
3. THE COMMISSIONER AND THE COMMISSIONER OF HEALTH MAY JOINTLY SELECT
SUCH CONTRACTOR OR CONTRACTORS THAT, IN THEIR DISCRETION, HAVE DEMON-
STRATED THE ABILITY TO PERFORM THE SERVICES REQUESTED IN A COST-EFFEC-
TIVE MANNER AND TO PERFORM SUCH SERVICES AND DELIVER WORK PRODUCTS THAT
WILL BE OF ADEQUATE QUALITY TO MEET THE NEEDS OF THE OFFICE AND THE
DEPARTMENT OF HEALTH AND THE INTERESTS OF INDIVIDUALS PARTICIPATING IN
THE PEOPLE FIRST WAIVER PROGRAM.
S 20. Subdivisions (a), (b), (c), (d), (e), (f), (g), (h), (i), (j),
(k), (l), (m) and (o) of section 41.36 of the mental hygiene law are
REPEALED.
S 21. Subdivision (n) of section 41.36 of the mental hygiene law, as
amended by chapter 525 of the laws of 1985, is amended to read as
follows:
(n) The commissioner OF DEVELOPMENTAL DISABILITIES shall establish a
procedure, subject to the approval of the state comptroller, whereby
payments in addition to the [client's] personal allowance OF AN INDIVID-
UAL LIVING IN A COMMUNITY RESIDENTIAL FACILITY may be made to providers
of services for one or more of the following needs of [clients] INDIVID-
UALS residing in such facilities, limited to two hundred fifty dollars
per [client] INDIVIDUAL per year and paid semi-annually in the manner
specified by such procedures:
1. Replacement of necessary clothing;
2. Personal requirements and incidental needs of [clients] INDIVIDUALS
RESIDING IN THE FACILITY;
3. Recreational and cultural activities of [clients] INDIVIDUALS
RESIDING IN THE FACILITY. Such payments may be made from monies appro-
priated to the office for this purpose. Such payments shall be audited
by the office pursuant to an audit plan approved by the comptroller.
S 22. Subdivision (a) of section 43.02 of the mental hygiene law, as
amended by chapter 168 of the laws of 2010, is amended to read as
follows:
(a) Notwithstanding any inconsistent provision of law, payment made by
government agencies pursuant to title eleven of article five of the
social services law for services provided by any facility licensed by
the office of mental health pursuant to article thirty-one of this chap-
ter or licensed or operated by the office for people with developmental
disabilities pursuant to article sixteen of this chapter or certified by
the office of alcoholism and substance abuse services pursuant to this
chapter to provide inpatient chemical dependence services, as defined in
section 1.03 of this chapter, shall be at rates or fees certified by the
commissioner of the respective office and approved by the director of
the division of the budget, provided, however, the commissioner of
mental health shall annually certify such rates or fees which may vary
for distinct geographical areas of the state and, provided, further,
that rates or fees for service for inpatient psychiatric services or
inpatient chemical dependence services, at hospitals otherwise licensed
pursuant to article twenty-eight of the public health law shall be
established in accordance with section two thousand eight hundred seven
A. 9920 8
of the public health law AND, PROVIDED, FURTHER, THAT RATES OR FEES FOR
SERVICES PROVIDED BY ANY FACILITY LICENSED OR OPERATED BY THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES PURSUANT TO ARTICLE SIXTEEN OF
THIS CHAPTER AND DEVELOPED PURSUANT TO REVISED METHODOLOGIES DEVELOPED
AS A CONDITION OF FEDERAL APPROVAL OF THE PEOPLE FIRST WAIVER PROGRAM
SHALL BE CERTIFIED BY THE COMMISSIONER OF HEALTH; PROVIDED, HOWEVER,
THAT SUCH METHODOLOGIES SHALL TAKE INTO ACCOUNT THE POLICIES AND GOALS
OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
S 23. Paragraph (ii) of subdivision (c) of section 43.02 of the mental
hygiene law, as amended by chapter 168 of the laws of 2010, is amended
to read as follows:
(ii) methodologies used in the establishment of the schedules of rates
or fees pursuant to this section, PROVIDED, HOWEVER THAT THE COMMISSION-
ER OF HEALTH SHALL ADOPT RULES AND REGULATIONS INCLUDING METHODOLOGIES
DEVELOPED BY HIM OR HER FOR SERVICES PROVIDED BY ANY FACILITY LICENSED
OR OPERATED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES
PURSUANT TO SUBDIVISION (A) OF THIS SECTION.
S 24. This act shall take effect immediately; provided, however, that
the amendments to section 364-j of the social services law made by
sections one, two, three, four, five, six, seven, eight, nine, ten,
eleven, twelve, thirteen, fourteen, fifteen, sixteen and seventeen of
this act shall not affect the repeal of such section and shall be deemed
repealed therewith.