Relates to prohibiting ownership or control of managed long term care plans by health maintenance organizations or insurers.
TITLE OF BILL: An act to amend the public health law, in relation to managed long term care plans not being controlled or owned by for-profit health maintenance organizations or insurers
PURPOSE OR GENERAL IDEA OF BILL: To assure that managed long term care plans are primarily owned by not for profit providers or service entities, to promote best practices consistent with the interests of the recipient.
SUMMARY OF SPECIFIC PROVISIONS: Amends the definition of "eligible applicant" for certification as a managed long, term care (MLTC) plan to require eligible insurers and health maintenance organizations be not-for-profit. An exception would recognize entities already certified.
The bill clarifies that an MLTC, or other lawful combinations of long term care providers can participate in accountable care organizations.
JUSTIFICATION: Medicaid long term care (over 120 days) has been reformed to be delivered by care coordination entities, predominantly through risk-bearing managed long term care plans. Currently, this transition is applied to home and community-based services, with institutional (nursing home) care contemplated to be phased in.
MLTCs have, until now been almost exclusively entities owned by long term care providers, not by HMOs or insurance companies. When participation in an MLTC was voluntary, there was little concern that insurance carriers would enter the field. However, now participation in an MLTC is mandatory for many and will become mandatory for more long term care recipients. There is growing interest by for-profit HMOs and insurance companies in forming MLTCs. With their economic resources they could easily come to dominate the field. So there is growing concern that patients may ultimately have no choice but to enroll in for-profit insurance carrier-owned MLTCs.
The individuals affected by this transition are primarily those with chronic conditions, many who are elderly or otherwise affected with life-limiting illness. Care and service decisions for these individuals should not be measured against profit margins of shareholders. Other states' experience in this area has proven that provider-based MLTCs, which most all of New York MLTCs currently are, deliver both the quality and the savings expected.
PRIOR LEGISLATIVE HISTORY: New bill
FISCAL IMPLICATIONS: None
EFFECTIVE DATE: Immediately
STATE OF NEW YORK ________________________________________________________________________ 6583 IN SENATE February 10, 2014 ___________Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to managed long term care plans not being controlled or owned by for-profit health mainte- nance organizations or insurers 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 4403-f of the public health law, as added by chapter 659 of the laws of 1997, is amended to read as follows: (b) "Eligible applicant" means an entity controlled or wholly owned by one or more of the following: a hospital as defined in subdivision one of section twenty-eight hundred one of this chapter; a home care agency licensed or certified pursuant to article thirty-six of this chapter;
[an]A NOT-FOR-PROFIT entity that has received a certificate of authori- ty pursuant to sections forty-four hundred three, forty-four hundred three-a or AN INTEGRATED DELIVERY SYSTEM THAT HAS RECEIVED A CERTIFICATE OF AUTHORITY PURSUANT TO SECTION forty-four hundred eight-a of this article (as added by chapter six hundred thirty-nine of the laws of nineteen hundred ninety-six), or a NOT-FOR-PROFIT health maintenance organization authorized under article forty-three of the insurance law; or a not-for-profit organization which has a history of providing or coordinating health care services and long term care services to the elderly and disabled; PROVIDED, HOWEVER, THAT AN ENTITY OWNED OR CONTROLLED BY AN ENTITY THAT HAS RECEIVED A CERTIFICATE OF AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE OR FORTY-FOUR HUNDRED THREE-A OF THIS ARTICLE AND HAS RECEIVED A CERTIFICATE OF AUTHORITY UNDER THIS SECTION PRIOR TO THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO THOUSAND THIRTEEN WHICH ADDED THIS PROVISION SHALL BE DEEMED TO BE AN ELIGIBLE APPLICANT. S 2. Section 4403-f of the public health law is amended by adding a new subdivision 15 to read as follows: 15. A MANAGED LONG TERM CARE PLAN MAY BE A PARTICIPANT IN AN ACCOUNT- ABLE CARE ORGANIZATION UNDER ARTICLE TWENTY-NINE-E OF THIS CHAPTER.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04700-03-4 S. 6583 2
S 3. Subdivision 6 of section 2999-o of the public health law, as amended by chapter 461 of the laws of 2012, is amended to read as follows: 6. "Health care provider" includes but is not limited to an entity licensed or certified under article twenty-eight or thirty-six of this chapter; an entity licensed or certified under article sixteen, thirty- one or thirty-two of the mental hygiene law; OR ANY LAWFUL COMBINATION OF SUCH HEALTH CARE PROVIDERS, INCLUDING BUT NOT LIMITED TO A MANAGED LONG TERM CARE PLAN UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF THIS CHAPTER; or a health care practitioner licensed or certified under title eight of the education law or a lawful combination of such health care practitioners; and may also include, to the extent provided by regu- lation of the commissioner, other entities that provide technical assistance, information systems and services, care coordination and other services to health care providers and patients participating in an ACO. S 4. This act shall take effect immediately; provided, however, that the amendments to section 4403-f of the public health law made by sections one and two of this act shall not affect the repeal of such section and shall be deemed repealed therewith.