Requires additional medicaid recipients throughout the state to participate in managed care plans; directs the commissioner of health to submit all appropriate waivers, state plan amendments, and federal applications to secure federal financial support.
TITLE OF BILL: An act to amend the social services law, in relation to mandatory managed care for certain recipients of medical assistance
PURPOSE OF THE BILL: This bill would require additional Medicaid recipients, throughout the State, to participate in managed care plans.
SUMMARY OF SPECIFIC PROVISIONS: § 1- Amends Paragraph (b) of subdivision 1 of § 364-j of the Social Services Law to include rural health networks and those providers who hold a comprehensive HIV special needs plan certificate of authority as managed care providers.
§ 2- Amends paragraph (e) of subdivision 3 of § 364-j of the Social. Services Law to expand the categories of individuals who are required to enroll with a managed care program. Specifically, this bill would require that the following categories of individuals be enrolled in managed care programs: persons who are dually eligible for Medicaid and Medicare and who are enrolled in a TEFRA plans; persons who are eligible for S.S.I.; persons who are HIV positive; or persons with serious mental illness and children and adolescents with serious emotional disturbances be enrolled in managed care programs.
§ 3- Amends § 364-j of the Social Services Law to authorize the Commissioner of Health to take all necessary measures to cause all social services districts in the state not already doing so to provide Medicaid services and implement the State's managed care program. In addition, this section authorizes the Commissioner of Health to submit all appropriate waivers to implement this Plan.
§ 4- Stipulates that § 2 of this act shall not take effect unless and until the Commissioner of Health receives all necessary approvals under federal law.
§ 5- Effective date.
JUSTIFICATION: While implementing cost containment measures, managed care programs incorporate comprehensive consumer protections to ensure that all recipients obtain enrollment assistance and quality care, and understand their rights and responsibilities under the managed care plan. This bill expands the definition of managed care providers, requires that all areas of the State provide Medicaid managed care programs, and expands the categories of individuals who are required to enroll in the programs.
PRIOR LEGISLATIVE HISTORY: 2011-2012 - S.4182/A.2338 - HEALTH/Health 2009-2010 - S.7264-A/A.6675-A -- HEALTH/Health 2007-2008 - S.3296/A.4673 2005-2006 - S.3541/A.5461
FISCAL IMPLICATIONS: Yet to be determined. Cost savings to both counties and the State are expected.
EFFECTIVE DATE: This act shall take effect immediately, with provisions.
STATE OF NEW YORK ________________________________________________________________________ 2737 2013-2014 Regular Sessions IN SENATE January 23, 2013 ___________Introduced by Sen. RANZENHOFER -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law, in relation to mandatory managed care for certain recipients of medical assistance THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (b) of subdivision 1 of section 364-j of the social services law, as amended by chapter 649 of the laws of 1996, subparagraphs (i) and (ii) as amended by chapter 433 of the laws of 1997, is amended to read as follows: (b) "Managed care provider". An entity that provides or arranges for the provision of medical assistance services and supplies to partic- ipants directly or indirectly (including by referral), including case management; and: (i) is authorized to operate under article forty-four of the public health law or article forty-three of the insurance law and provides or arranges, directly or indirectly (including by referral) for covered comprehensive health services on a full capitation basis;
[or](ii) is authorized as a partially capitated program pursuant to section three hundred sixty-four-f of this title or section forty-four hundred three-e of the public health law or section 1915b of the social security act; (III) IS A RURAL HEALTH NETWORK AS DEFINED IN SUBDIVISION TWO OF SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW; OR (IV) HOLDS A COMPREHENSIVE HIV SPECIAL NEEDS PLAN CERTIFICATE OF AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-C OF THE PUBLIC HEALTH LAW. S 2. Paragraph (e) of subdivision 3 of section 364-j of the social services law, as amended by section 77-a of part H of chapter 59 of the laws of 2011, is amended to read as follows:EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05160-01-3 S. 2737 2
(e) The following categories of individuals
[may]SHALL be required to enroll with a managed care program [when]FOLLOWING THE APPROVAL OF program features and reimbursement rates [are approved]by the commis- sioner of health and, as appropriate, the commissioners of the depart- ment of mental health, the office for persons with developmental disa- bilities, the office of children and family services, and the office of alcohol and substance abuse services: (i) an individual dually eligible for medical assistance and benefits under the federal Medicare program and enrolled in a Medicare managed care plan offered by an entity that is also a managed care provider; provided that (notwithstanding paragraph (g) of subdivision four of this section): (a) if the individual changes his or her Medicare managed care plan as authorized by title XVIII of the federal social security act, and enrolls in another Medicare managed care plan that is also a managed care provider, the individual shall be (if required by the commissioner under this paragraph) enrolled in that managed care provider; (b) if the individual changes his or her Medicare managed care plan as authorized by title XVIII of the federal social security act, but enrolls in another Medicare managed care plan that is not also a managed care provider, the individual shall be disenrolled from the managed care provider in which he or she was enrolled and withdraw from the managed care program; (c) if the individual disenrolls from his or her Medicare managed care plan as authorized by title XVIII of the federal social security act, and does not enroll in another Medicare managed care plan, the individ- ual shall be disenrolled from the managed care provider in which he or she was enrolled and withdraw from the managed care program; (d) nothing herein shall require an individual enrolled in a managed long term care plan, pursuant to section forty-four hundred three-f of the public health law, to disenroll from such program. (ii) an individual eligible for supplemental security income; (iii) HIV positive individuals; (iv) persons with serious mental illness and children and adolescents with serious emotional disturbances [, as defined in section forty-four hundred one of the public health law]; (v) a person receiving services provided by a residential alcohol or substance abuse program or facility for the mentally retarded; (vi) a person receiving services provided by an intermediate care facility for the mentally retarded or who has characteristics and needs similar to such persons; (vii) a person with a developmental or physical disability who receives home and community-based services or care-at-home services through existing waivers under section nineteen hundred fifteen (c) of the federal social security act or who has characteristics and needs similar to such persons; (viii) a person who is eligible for medical assistance pursuant to subparagraph twelve or subparagraph thirteen of paragraph (a) of subdi- vision one of section three hundred sixty-six of this title; (ix) a person receiving services provided by a long term home health care program, or a person receiving inpatient services in a state-oper- ated psychiatric facility or a residential treatment facility for chil- dren and youth; (x) certified blind or disabled children living or expected to be living separate and apart from the parent for thirty days or more; (xi) residents of nursing facilities;S. 2737 3
(xii) a foster child in the placement of a voluntary agency or in the direct care of the local social services district; (xiii) a person or family that is homeless; and (xiv) individuals for whom a managed care provider is not geograph- ically accessible so as to reasonably provide services to the person. A managed care provider is not geographically accessible if the person cannot access the provider's services in a timely fashion due to distance or travel time. S 3. Section 364-j of the social services law is amended by adding two new subdivisions 27 and 28 to read as follows: 27. THE COMMISSIONER OF HEALTH SHALL TAKE ALL MEASURES NECESSARY AND CONVENIENT TO CAUSE ALL SOCIAL SERVICES DISTRICTS IN THE STATE NOT ALREADY DOING SO TO PROVIDE MEDICAL ASSISTANCE AND IMPLEMENT THE STATE'S MANAGED CARE PROGRAM AND PARTICIPATE IN SUCH PROGRAM AUTHORIZED BY THIS SECTION. 28. THE COMMISSIONER OF HEALTH SHALL SUBMIT THE APPROPRIATE WAIVERS, STATE PLAN AMENDMENTS AND FEDERAL APPLICATIONS, INCLUDING BUT NOT LIMIT- ED TO, WAIVER REQUESTS AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT, OR SUCCESSOR PROVISIONS, AS THE COMMISSIONER OF HEALTH SHALL DEEM NECES- SARY TO SECURE APPROPRIATE FEDERAL FINANCIAL SUPPORT FOR THE COST OF A PROGRAM TO AUTHORIZE MANDATORY MANAGED CARE FOR MEDICAL ASSISTANCE RECIPIENTS RESIDING IN ALL AREAS OF THE STATE, INCLUDING RECIPIENTS OF SUPPLEMENTAL INCOME AND PERSONS ENROLLED OR ELIGIBLE TO BE ENROLLED IN A MEDICARE TEFRA PLAN. S 4. Section two of this act shall not take effect unless and until the commissioner of health receives all necessary approvals under feder- al law and regulation to implement its provisions, and provided that such provisions do not prevent the receipt of federal financial partic- ipation under the medical assistance program. The commissioner of health shall submit such waiver applications and/or state plan amendments as may be necessary to obtain such approvals and to ensure continued feder- al financial participation. S 5. 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 and three of this act shall not affect the repeal of such section pursuant to chapter 710 of the laws of 1988, as amended, and shall be deemed repealed therewith; provided that the commissioner of health shall notify the legislative bill drafting commission upon the occurrence of the enactment of the legislation provided for in section two of this act in order that the commission may maintain an accurate and timely effective data base of the official text of the laws of the state of New York in furtherance of effecting the provisions of section 44 of the legislative law and section 70-b of the public officers law.