Directs the department of health to provide oversight of the transitioning of individuals to managed long term care plans operated by health maintenance organizations.
Ayes (61): Adams, Addabbo, Avella, Ball, Bonacic, Boyle, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Espaillat, Farley, Felder, Flanagan, Fuschillo, Gallivan, Gianaris, Gipson, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Hoylman, Kennedy, Klein, Krueger, Lanza, Larkin, Latimer, LaValle, Libous, Little, Marcellino, Marchione, Martins, Maziarz, Montgomery, Nozzolio, O'Brien, Peralta, Perkins, Ranzenhofer, Ritchie, Rivera, Robach, Sampson, Sanders, Savino, Serrano, Seward, Skelos, Smith, Squadron, Stavisky, Stewart-Cousin, Tkaczyk, Valesky, Young, Zeldin
Excused (2): O'Mara, Parker
TITLE OF BILL: An act to amend the public health law, in relation to managed long term care plans operated by health maintenance organizations
PURPOSE: This bill directs the Department of Health to provide over-sight of the transitioning of individuals to managed long term care.
SUMMARY OF PROVISIONS: Section one amends § 4403-f of the Public Health Law by adding a new subdivision 11-a to require the Department of Health to provide oversight in the transition of individuals to managed long term care by ensuring: access to quality care; adequate notice and enrollment assistance; accountability from providers; periodic assessments of plans and providers; mechanisms to prevent waste and abuse; and incentives for such indicators as appropriate enrollment and quality.
Section two provides that this act shall take effect immediately and shall expire and be deemed related with the remainder of the section
JUSTIFICATION: As part of New York's Medicaid reform, dually eligible individuals (those in receipt of Medicare and Medicaid) who are 21 years of age or older and are in need of community based long term care services for more than 120 days are or will soon have their care provided through managed long term care plans (MLTCPs) or care coordination models (CCMs). This is a major transformation for Medicaid recipients, service providers, health insurers and the state. This legislation will ensure the state provides oversight of the enrollment, quality, adequacy and cost of care as health plans take on many of the roles formerly held by the state under the traditional Medicaid fee for service system of care.
According to the Department of Health's February 2013 report on Managed Long Term Care Mandatory Enrollment, approximately 75,000 Medicaid recipients statewide were enrolled in a managed long term care plan (MLTCP) as of December 2012. This number has more than doubled in two years and is expected to continue to grow as the phase-in continues and ultimately nursing home residents are included. In addition to many more individuals being placed in MLTCPs, the number of plans approved by the department has also risen sharply.
While the Department's report indicates high customer satisfaction with MLTCPs, concerns have been raised about appropriate services and enrollment. It is imperative that the Department of Health continue to be vigilant in ensuring individuals transition smoothly into managed long term care and that appropriate oversight is in place as this legislation provides
PRIOR LEGISLATIVE HISTORY: Similar to S.7773 of 2012
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: Immediately and shall expire and be deemed related with the remainder of the section.
STATE OF NEW YORK ________________________________________________________________________ 3912--A 2013-2014 Regular Sessions IN SENATE February 26, 2013 ___________Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to managed long term care plans operated by health maintenance organizations THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 4403-f of the public health law is amended by adding a new subdivision 11-a to read as follows: 11-A. IN TRANSITIONING INDIVIDUALS TO MANAGED LONG TERM CARE, THE DEPARTMENT SHALL PROVIDE OVERSIGHT OF LONG TERM MANAGED CARE BY ENSUR- ING: (A) PARTICIPANTS ARE APPROPRIATELY NOTIFIED OF THE UPCOMING CHANGES TO THEIR HEALTH CARE, AND THEIR RIGHTS AND OPTIONS; (B) ACCESS TO APPROPRIATE ENROLLMENT ASSISTANCE, CONSUMER ASSISTANCE AND COMPLAINT MECHANISMS; (C) ACCESS TO QUALITY CARE BY REQUIRING NETWORK TRANSPARENCY AND CHOICE OF LONG TERM CARE PLANS, ALLOWING PATIENTS TO CHOOSE THE PLAN THAT BEST FITS THEIR NEEDS; (D) TRANSPARENCY AND ACCOUNTABILITY FROM PROVIDERS, WHICH SHALL INCLUDE A MECHANISM BY WHICH STAFF, PARTICIPANTS AND FAMILY MEMBERS CAN CONFIDENTIALLY REPORT CONCERNS RELATING TO QUALITY TO THE PLAN AND THE STATE; (E) PLANS AND PROVIDERS ARE ASSESSED PERIODICALLY AND DATA IS PUBLISHED REGARDING ENROLLMENT IN INTEGRATED CARE DESIGNS, NETWORK ADEQUACY, NEW SERVICE DESIGNS, OUTCOME MEASURES, INCLUDING THE EXTENT TO WHICH CARE PLANS ARE CONTINUED OR ALTERED BASED UPON NEW COMPREHENSIVE ASSESSMENTS, AND THE TYPES AND AMOUNTS OF SERVICES HEALTH PLANS HAVE AUTHORIZED;EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09297-03-3 S. 3912--A 2
(F) MECHANISMS ARE IN PLACE TO STATE OVERSIGHT OF ENROLLMENT AND SERVICES TO PREVENT WASTE AND ABUSE IN THE MANAGED LONG TERM CARE SYSTEM; AND (G) INCENTIVES ARE PROVIDED FOR A VARIETY OF INDICATORS, INCLUDING BUT NOT LIMITED TO, SMOOTH PATIENT TRANSITIONS, APPROPRIATE ENROLLMENT, QUALITY CARE, HIGH STAFF RETENTION AND POSITIVE HEALTH CARE OUTCOMES ACHIEVED AT A LOW COST. S 2. This act shall take effect immediately; provided that the amend- ments to section 4403-f of the public health law made by section one of this act shall not affect the expiration and repeal of such section, and shall expire and be deemed repealed therewith.