Relates to medicaid management; authorizes the commissioner of health and the department of health to report to the legislature and for the department to develop outcome results-based objectives for medicaid service and administrative contracts to promote efficiency and prevent waste and abuse.
TITLE OF BILL: An act to amend the social services law, in relation to providing for medicaid management
PURPOSE: The bill is aimed at gaining better management of the Medicaid System in New York State which is expected to spend over $44.5 billion in state, federal and local dollars in 2005. The bill directs the Department of Health to convene periodic meetings of the Commissioners of all state agencies receiving Medicaid funds and appropriate representation of local departments of social services to, among other things, contain the growth of Medicaid spending and improve the efficiency, effectiveness and quality of existing service delivery. It also directs the department to report annually on 1) the results of the multi-agency meetings and 2) Medicaid expenditures made to other state agencies in the preceding state fiscal year. It requires the department to develop an annual plan to conduct periodic audits, reviews and inspections of state agencies receiving Medicaid funds to, among other things, promote accountability, economy, effectiveness, and efficiency.
SUMMARY OF PROVISIONS: Section 1 creates a new section 363-c of the Social Services Law directing the Department of Health to:
*Convene meetings at least quarterly with all state agencies receiving Medicaid funds and appropriate representation of local departments of social services to identify: 1) methods to contain the growth of Medicaid spending; 2) methods to improve the quality of and recipient satisfaction with Medicaid state agency services; 3) opportunities for consolidation and methods to improve the efficiency and effectiveness of existing service delivery; 4) opportunities for education and prevention; 5) annually the number of persons on waiting lists to receive services for each list; and 6) the collective priority of critical needs for the Medicaid population.
*Report annually on 1) the results of the multi-agency meetings and 2) Medicaid expenditures made to other state agencies in the preceding state fiscal year.
*Develop outcome results-based objectives for Medicaid service and administrative contracts with other state agencies.
*Develop an annual plan to conduct periodic audits, reviews and inspections of state agencies receiving Medicaid funds to, among other things, promote accountability, economy, effectiveness and efficiency.
Section 2 provides an effective date of 120 days after it shall have become law.
One of the largest expenses in the New York State Budget is Medicaid with $45.7 billion spent in 2006. This bill, modeled after a proposal under consideration in South Carolina, is an attempt to more effectively manage Medicaid which is dispersed through many different programs and administered by many different agencies. These agencies, along with the representation of the local social services districts which determine eligibility at the front end, must come together more regularly with the goal of making a more effective, efficient, and accountable program.
LEGISLATIVE HISTORY: 2005 - S.5069/A.7972 -- PASSED SENATE/Health 2006 - S.5069/ A. 7972 -- RULES/Health 2007 - S.1304/A.5286 -- HEALTH/Health 2008 - S.1304/ A.5286 -- HEALTH/Health 2010 - S.2639/A.1212 -- HEALTH/Health
FISCAL IMPLICATIONS: Savings as Medicaid is managed more efficiently and effectively.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 3197 2011-2012 Regular Sessions IN SENATE February 11, 2011 ___________Introduced by Sens. RANZENHOFER, MAZIARZ, O'MARA -- 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 providing for medicaid management THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraphs (d) and (e) of subdivision 1 of section 363-c of the social services law, as amended by section 19 of part C of chapter 109 of the laws of 2006, are amended to read as follows: (d) opportunities for education and prevention;
[and](e) ANNUALLY THE NUMBER OF PERSONS ON WAITING LISTS TO RECEIVE SERVICES AND THE TYPE OF SERVICES FOR EACH LIST; AND (F) the collective priority of critical needs for the medicaid popu- lation. S 2. Section 363-c of the social services law is amended by adding nine new subdivisions 4, 5, 6, 7, 8, 9, 10, 11 and 12 to read as follows: 4. THE DEPARTMENT SHALL DEVELOP OUTCOME RESULTS-BASED OBJECTIVES FOR MEDICAID SERVICE AND ADMINISTRATIVE CONTRACTS WITH OTHER STATE AGENCIES. REIMBURSEMENT SHALL BE BASED ON THE COMPLETION OF OUTCOMES, AS APPROPRI- ATE. 5. THE DEPARTMENT SHALL IDENTIFY PAYMENT RATES FOR MEDICAID SERVICES PROVIDED BY OTHER STATE AGENCIES THAT EXCEED AVAILABLE COMPARABLE MARKET RATES AND DEVELOP METHODS TO ENSURE THAT, WHERE APPROPRIATE, RATES ARE THE LOWER OF COST OR MARKET. TO ENSURE THAT THE PROVISIONS OF THIS SECTION ARE MET AND THAT DUPLICATIVE SERVICES ARE NOT PROVIDED TO MEDI- CAID RECIPIENTS, THE DEPARTMENT MAY LIMIT MEDICAID SERVICES PROVIDED BY OTHER STATE AGENCIES.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01493-01-1 S. 3197 2
6. THE DEPARTMENT SHALL DEVELOP AN ANNUAL PLAN TO CONDUCT PERIODIC AUDITS, REVIEWS, AND INSPECTIONS OF STATE AGENCIES RECEIVING MEDICAID FUNDS FOR THE PURPOSE OF: (A) ENSURING COMPLIANCE WITH STATE AND FEDERAL REGULATIONS; (B) PROMOTING ACCOUNTABILITY, ECONOMY, EFFECTIVENESS, AND EFFICIENCY; AND (C) PREVENTING AND DETECTING WASTE, FRAUD, AND ABUSE. 7. AUDITS AND REVIEWS SHALL BE PERFORMED IN ACCORDANCE WITH GENERALLY ACCEPTED GOVERNMENT AUDITING STANDARDS. 8. REPORTS SHALL BE ISSUED IN ACCORDANCE WITH PROFESSIONAL STANDARDS AND SHALL INCLUDE A DESCRIPTION OF ANY SIGNIFICANT PROBLEMS, ABUSES, AND DEFICIENCIES ENCOUNTERED IN THE ADMINISTRATION AND OPERATION OF MEDICAID SERVICES ALONG WITH RECOMMENDATIONS FOR CORRECTIVE ACTION. REPORTS SHALL INCLUDE THE FINANCIAL VALUE OF ANY ITEMS REPORTED. 9. THE DEPARTMENT IS AUTHORIZED TO DIRECTLY ACCESS ALL SYSTEMS, RECORDS, REPORTS, REVIEWS, FILES, DOCUMENTS, PAPERS, AND SIMILAR INFOR- MATION RELATED TO MEDICAID PAYMENTS WITHIN STATE AGENCIES AND ENTITIES DOING BUSINESS WITH THESE AGENCIES. 10. THE DEPARTMENT MAY ENTER INTO EXTERNAL CONTRACTS AS NECESSARY IN FULFILLING THE REQUIREMENTS OF THIS SECTION. 11. THE DEPARTMENT SHALL WITHHOLD ANY AMOUNTS RELATED TO FRAUD, ABUSE, AND NON-COMPLIANCE. 12. THE DEPARTMENT SHALL MAKE ALL REPORTS AVAILABLE TO THE GOVERNOR, THE SENATE FINANCE COMMITTEE, THE ASSEMBLY WAYS AND MEANS COMMITTEE, THE SENATE HEALTH COMMITTEE, THE ASSEMBLY HEALTH COMMITTEE, THE SENATE SOCIAL SERVICES, CHILDREN AND FAMILIES COMMITTEE, AND THE ASSEMBLY SOCIAL SERVICES COMMITTEE. S 3. This act shall take effect immediately.