Creates the managed care for persons with developmental disabilities advocacy program.
TITLE OF BILL: An act to amend the mental hygiene law, in relation to the creation of the managed care for persons with developmental disabilities advocacy program
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to establish the Managed Case for Persons with Developmental Disabilities Advocacy Program for purposes of assisting persons receiving services from the Office of People with Developmental Disabilities (OPWDD) to navigate the managed care system.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill creates the Managed Case for Persons with Developmental Disabilities Advocacy Program. The advocacy program shall advise individuals of applicable rights and responsibilities, provide information, referrals and technical assistance to address the needs of the individual, and pursue legal, administrative and other appropriate remedies or approaches to ensure the protection of and advocacy for the rights of the enrollees.
Section 2. Clarifies that the bill does not intend to transfer to the advocacy program any current duties, including Medicaid Service Coordination, of state employees employed by OPWDD.
Section 3 of the bill is the effective date.
The 2013-14 state budget authorizes the State to enroll individuals receiving OPWDD services to risk bearing Medicaid managed care plans starting in 2014. This is a significant change to the OPWDD system which has historically been a fee for service system.
Currently, OPWDD recipients receive care coordination from an independent third party, known as the Medicaid Service Coordination (MSC) program. As OPWDD services transition to managed care, many functions of this program will be assumed by managed care companies. Managed care companies cannot reasonably assume certain advocacy functions of the MSC program because the managed care company will often have a financial interest in denying certain services. For this reason, many stakeholders have expressed the need for additional outside advocates to be available to assist enrollees.
This bill ensures that persons receiving OPWDD services continue to receive independent advocacy after being enrolled in a managed care plan by creating a Managed Care for Persons with Developmental Disabilities Advocacy Program. The program will advise individuals of applicable rights and responsibilities, including, but not limited to, the right to treatment, person centered care, care in the most integrated setting, and the right to contest decisions made by a managed care company; ' provide information, referrals and technical assistance to address the needs of individuals with disabilities; and pursue legal, administrative and other appropriate remedies or
approaches to ensure the protection of and advocacy for the rights of the enrollees. This program will help ensure that enrollees continue to receive adequate care and that they have adequate input in their plan of care.
PRIOR LEGISLATIVE HISTORY:
To be determined.
This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 4885--A 2013-2014 Regular Sessions IN SENATE April 30, 2013 ___________Introduced by Sens. CARLUCCI, GRISANTI -- read twice and ordered print- ed, and when printed to be committed to the Committee on Mental Health and Developmental Disabilities -- reported favorably from said commit- tee and committed to the Committee on Finance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the mental hygiene law, in relation to the creation of the managed care for persons with developmental disabilities advocacy program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 13.40 of the mental hygiene law is amended by adding a new subdivision (h) to read as follows: (H) THE COMMISSIONER AND THE COMMISSIONER OF HEALTH SHALL JOINTLY ESTABLISH THE MANAGED CARE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES ADVOCACY PROGRAM, HEREINAFTER REFERRED TO AS THE ADVOCACY PROGRAM. THE ADVOCACY PROGRAM SHALL BE INTEGRATED WITH AND PROVIDED IN ADDITION TO INDEPENDENT MEDICAID MANAGED CARE OMBUDS SERVICES PROVIDED TO PERSONS WITH DISABILITIES ENROLLING IN MEDICAID MANAGED CARE. THE ADVOCACY PROGRAM SHALL: ADVISE INDIVIDUALS OF APPLICABLE RIGHTS AND RESPONSIBIL- ITIES, INCLUDING, BUT NOT LIMITED TO, THE RIGHT TO TREATMENT, PERSON CENTERED CARE, CARE IN THE MOST INTEGRATED SETTING, AND THE RIGHT TO CONTEST DECISIONS MADE BY A MANAGED CARE COMPANY; PROVIDE INFORMATION, REFERRALS AND TECHNICAL ASSISTANCE TO ADDRESS THE NEEDS OF INDIVIDUALS WITH DISABILITIES; AND PURSUE LEGAL, ADMINISTRATIVE AND OTHER APPROPRI- ATE REMEDIES OR APPROACHES TO ENSURE THE PROTECTION OF AND ADVOCACY FOR THE RIGHTS OF THE ENROLLEES. THE ADVOCACY PROGRAM SHALL ALSO PROVIDE SUPPORT TO ELIGIBLE INDIVIDUALS ENROLLING IN DISCOS, HMOS PROVIDING SERVICES PURSUANT TO SUBDIVISION EIGHT OF SECTION FORTY-FOUR HUNDRED THREE OF THE PUBLIC HEALTH LAW, MANAGED LONG TERM CARE PLANS PROVIDING SERVICES UNDER SUBDIVISIONS TWELVE, THIRTEEN AND FOURTEEN OF SECTIONEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10533-06-3 S. 4885--A 2
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH LAW, FULLY INTEGRATED DUAL ADVANTAGE PROVIDING SERVICES UNDER SUBDIVISION TWENTY-SEVEN OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, AND ANY OTHER MANAGED CARE ENTITY; SUPPORT DURING THE PERSON-CENTERED PLANNING PROCESS AND RELATED PROCESSES INCLUDING UPDATES TO THE PERSON-CENTERED CARE PLAN; AND ASSISTANCE WITH SECURING HOUSING, EMPLOYMENT, AND COMMU- NITY-BASED SUPPORTS AND SERVICES THAT FALL OUTSIDE OF THE SCOPE OF DISCO SERVICES AND SUPPORTS. THE COMMISSIONERS SHALL JOINTLY DESIGNATE AN INDEPENDENT AGENCY OR ORGANIZATION TO ADMINISTER THE ADVOCACY PROGRAM. SUCH AGENCY SHALL BE THE AGENCY COORDINATING THE INDEPENDENT MEDICAID MANAGED CARE OMBUDS SERVICES, OR A SUB-CONTRACTOR OF THAT AGENCY. THE ADVOCACY PROGRAM SHALL BE ADVISED BY A BOARD, WHOSE MEMBERSHIP SHALL REFLECT REPRESENTATION OF THE DEVELOPMENTAL DISABILITY POPULATION. S 2. Nothing in this act is intended to transfer to the developmental disabilities advocacy program created by subdivision (h) of section 13.40 of the mental hygiene law any current duties, including Medicaid service coordination, of state employees who are employed by the office for people with developmental disabilities. S 3. This act shall take effect immediately.