NY State Senate Bill 2013-S6976

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
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Delivered to Governor
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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 09, 2014	referred to health

2013-S6976 (ACTIVE) - Details

See Assembly Version of this Bill:: A9920
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L; amd §§13.40, 41.36, & 43.02, rpld §41.36 subs (a) - (m) & (o), Ment Hyg L
Versions Introduced in 2015-2016 Legislative Session:: A7227

2013-S6976 (ACTIVE) - Summary

Relates to developmental disabilities managed care plan as a managed care plan.

2013-S6976 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S6976

TITLE OF BILL:  An act to amend the social services law, in relation
to a developmental disabilities managed care plan; to amend the mental
hygiene law, in relation to the development of certain methodologies;
and to repeal certain provisions of the mental hygiene law relating
thereto

Purpose of the Bill:

This bill would: (1) amend the Social Services Law (SSL) to make
conforming programmatic changes for the Office for People With
Developmental Disabilities (OPWDD) implementation of a managed care
waiver; and (2) amend the Mental Hygiene Law (MHL) to authorize a
streamlined contracting process for implementation of certain portions
of the OPWDD managed care waiver.

Summary of Provisions:

Section 1 of the bill would add a new definition to SSL § 364-j (1) to
define a "developmental disabilities managed care plan" as a managed
care plan that has received a certificate of authority under Public
Health Law § 4403-g.

Section 2 of the bill would amend SSL § 364-j (3)(a) to modify the
requirement that everyone receiving or eligible for Medicaid who lives

in a social services district that implemented the state's managed
care program must participate in the managed care program ,authorized
by § 364-j, to provide that participation in a developmental
disabilities managed care plan is governed by the provisions of Public
Health Law § 4403-g and Mental Hygiene Law

§ 13.40. This clarifies that persons eligible to enroll in a
developmental disabilities managed care plan are only required to do
so if the conditions for mandatory enrollment in Public Health Law
4403-g are met.

Section 3 of the bill would amend SSL § 364-j(4)(a)(i) to clarify that
a developmental disabilities managed care plan is only required to
arrange for primary care if it is authorized to cover such services by
its certificate of authority.

Section 4 of the bill would amend SSL§ 364-j(4)(b) to clarify that:
(1) recipients eligible to enroll can be limited to one plan in a
county if there is federal approval; and (2) a developmental
disabilities managed care plan is only required to arrange for primary
care if it is authorized to cover such services by its certificate of
authority.

Section 5 of the bill would amend SSL§ 364-j(4)(c) to clarify that:
(1) the requirement that enrollees in managed care plans select a
primary care practitioner from those designated by the plan does not
apply to developmental disabilities managed care plans not authorized
to arrange for primary care; (2) the right of enrollees to at least
three primary care practitioners does not apply to developmental
disabilities managed care plans not authorized to arrange for primary
care; and (3) a developmental disabilities managed care plan not


authorized to arrange for primary care is not required to select a
primary care provider for an enrollee who does not make such a
selection.

Section 6 of the bill would: (1) amend SSL § 364-j(4)(e)(iv), (v) and
(vi) to reflect that OPWDD, rather than local social services
districts, will provide enrollment counseling for persons enrolling in
developmental disabilities managed care plans, and to clarify that
subsection (v) does not apply to enrollment in a developmental
disabilities managed care plan; and (2) amend SSL § 364-j(4)(e)(vii)
to allow OPWDD a role in approving marketing materials for
developmental disabilities managed care plans.

Section 7 of the bill would add a new subparagraph (vi) to paragraph
(f) of SSL § 364-j(4) to exempt persons enrolling in developmental
disabilities managed care plans from the provisions of such paragraph
(f).

Section 8 of the bill would amend SSL § 364-j(4)(g) to allow persons
to enroll in a developmental disabilities managed care plan at any
time and to change developmental disabilities managed care plans at
any time without cause.

Section 9 of the bill would amend SSL § 364-j(4)(h) to exempt
enrollees in developmental disabilities managed care plans from the
restrictions on changing providers of Medical services.

Section 10 of the bill would amend SSL § 364-j(4)(i) to prohibit
developmental disabilities managed care plans from involuntarily
disenrolling a person without prior approval of the commissioner of
developmental disabilities and without complying with standards of the
commissioners of health and developmental disabilities.

Sections 11, 12 and 13 of the bill would amend various subdivisions of
SSL § 364-j (4) to exempt developmental disabilities managed care
plans from the requirements to cover early periodic screening
diagnostic and treatment services, prenatal services and chemical
dependence treatment services if such plans are not authorized to
cover such services.

Section 14 of the bill would amend SSL § 364-j(5)(g) to prohibit the
commissioner of health from delegating tasks to the local districts
with respect to developmental disabilities managed care plans.

Section 15 of the bill would amend SSL § 364-j(6) to allow OPWDD to
approve marketing materials for developmental disabilities managed
care plans.

Section 16 of the bill would amend SSL § 364-j(8)(f)(ii) to exempt
developmental disabilities managed care plans not authorized to cover
primary care services from the requirement to allow enrollees to
select from at least three primary care providers.

Section 17 of the bill would amend SSL§ 364-j(27)(f) to correct a
grammatical error.


Section 18 of the will would amend MHL § 13.40(g) to authorize a
streamlined contracting process with appropriate notice for the award
of start up funds for developmental disabilities individual support
and care coordination care organizations.

Section 19 of the of the bill would amend MHL§ 13.40 to add a new
subdivision (h) allowing the commissioners of health and developmental
disabilities to use a streamlined contracting process for contracts
for services related to quality assessment, quality improvement,
assessments of enrollees, enrollment counseling and enrollment
processing, outside advocacy and information technology as needed to
oversee and develop, operate and oversee a managed care system under
the people first waiver program.

Section 20 of the bill would repeal MHL § 41.39 (a) through (m) and
41.36 (o), which are no longer necessary with the transfer of rate
setting responsibilities to the Department of Health.

Section 21 of the bill would amend MHL § 41.36(n) to provide for the
use of person-first language.

Section 22 of the bill would amend MHL § 43.02(a) to allow the
Department of Health to certify Medicaid rates or fees for services
where it revises methodologies as a condition of federal approval for
the People First Waiver Program, and to require that such
methodologies take into account the policies and goals of OPWDD.

Section 23 of the bill would amend MHL § 43.02(c) to require that
regulations including methodologies developed by the Department of
Health be adopted by the Department.

Section 24 of the bill would provide for an immediate effective date.

Existing Law:

SSL § 364-j generally sets standards for managed care programs for
medical assistance recipients. MI-1L § 13.40 governs the People First
Waiver Program, the managed care program for individuals with
developmental disabilities currently being negotiated by the State and
federal governments.

Prior Legislative History:

This is a new bill.

Statement in Support:

OPWDD and the federal Centers for Medicare & Medicaid Services (CMS)
continue negotiations to implement the People First Waiver, a managed
care program for individuals with developmental disabilities which
will be overseen by OPWDD. Last year, legislation was enacted
authorizing the People First Waiver and reflecting negotiations with
CMS to date. This bill represents additional programmatic
modifications based on ongoing federal requirements, and authorizes
OPWDD to add additional functions necessary for implementing the
Waiver to the streamlined contracting and notice processes enacted
last year.


Budget Implications:

This bill will facilitate the implementation of the People First
Waiver Program and will allow the savings associated with such program
to occur.

Local Impact:

This bill has no anticipated local impact.

Effective Date:

This bill would provide for an immediate effective date.

2013-S6976 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6976

                            I N  S E N A T E

                              April 9, 2014
                               ___________

Introduced  by  Sen. HANNON -- (at request of the Office for People with
  Developmental Disabilities) -- 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 a developmental
  disabilities managed care plan; to amend the mental  hygiene  law,  in
  relation  to  the  development of certain methodologies; and to repeal
  certain provisions of the mental hygiene law relating thereto

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subdivision 1 of section 364-j of the social services law
is amended by adding a new paragraph (aa) to read as follows:
  (AA) "DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN".   A MANAGED  CARE
PLAN  THAT HAS RECEIVED A CERTIFICATE OF AUTHORITY ISSUED BY THE COMMIS-
SIONER AND THE COMMISSIONER OF DEVELOPMENTAL  DISABILITIES  PURSUANT  TO
SECTION FORTY-FOUR HUNDRED THREE-G OF THE PUBLIC HEALTH LAW.
  S  2.  Paragraph  (a)  of subdivision 3 of section 364-j of the social
services law, as amended by section 38 of part A of chapter  56  of  the
laws of 2013, is amended to read as follows:
  (a)  Every  person  eligible for or receiving medical assistance under
this article, who  resides  in  a  social  services  district  providing
medical  assistance,  which  has  implemented  the  state's managed care
program shall participate in the program  authorized  by  this  section.
Provided,  however,  that  participation  in a comprehensive HIV special
needs plan also shall be in accordance with article  forty-four  of  the
public  health  law [and]; participation in a special needs managed care
plan shall also be in accordance with article forty-four of  the  public
health  law and article thirty-one of the mental hygiene law AND PARTIC-
IPATION AND ENROLLMENT IN A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN
SHALL BE IN ACCORDANCE WITH SECTION FORTY-FOUR HUNDRED  THREE-G  OF  THE
PUBLIC HEALTH LAW AND SECTION 13.40 OF THE MENTAL HYGIENE LAW.
  S  3.  Subparagraph  (i)  of paragraph (a) of subdivision 4 of section
364-j of the social services law, as amended by section 14 of part C  of
chapter 58 of the laws of 2004, is amended to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13923-02-4

S. 6976                             2

  (i) a managed care provider shall arrange for access to and enrollment
of  primary  care  practitioners  and  other medical services providers;
PROVIDED, HOWEVER, THAT A DEVELOPMENTAL DISABILITIES MANAGED  CARE  PLAN
SHALL ARRANGE FOR ACCESS TO AND ENROLLMENT OF PRIMARY CARE PRACTITIONERS
IF SO AUTHORIZED. Each managed care provider shall possess the expertise
and  sufficient resources to assure the delivery of quality medical care
to participants in an appropriate and  timely  manner  and  may  include
physicians, nurse practitioners, county health departments, providers of
comprehensive  health  service plans licensed pursuant to article forty-
four of the public health law, and hospitals and diagnostic  and  treat-
ment  centers  licensed  pursuant  to article twenty-eight of the public
health law or otherwise authorized by law to offer comprehensive  health
services or facilities licensed pursuant to articles sixteen, thirty-one
and thirty-two of the mental hygiene law.
  S  4.  Paragraph  (b)  of subdivision 4 of section 364-j of the social
services law, as amended by section 57 of part A of chapter  57  of  the
laws of 2006, is amended to read as follows:
  (b) Participants shall select a managed care provider from among those
designated  under the managed care program, provided, however, a partic-
ipant shall be provided with a choice of no less than two  managed  care
providers.  Notwithstanding  the  foregoing,  a  local  social  services
district designated a rural area as defined  in  42  U.S.C.  1395ww  may
limit  a  participant  to one managed care provider, if the commissioner
and the local social services district find that only one  managed  care
provider  is  available,  AND  THE  COMMISSIONER AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES MAY LIMIT A PARTICIPANT ELIGIBLE TO ENROLL IN
A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN  TO  ONE  SUCH  PLAN,  IF
FEDERAL  APPROVAL  IS  SECURED TO REQUIRE ENROLLMENT WHEN THERE ARE LESS
THAN TWO MANAGED CARE PLANS OPERATING IN  THE  PARTICIPANT'S  COUNTY  OF
RESIDENCE  AUTHORIZED  TO  COORDINATE  CARE OR PERSON WITH DEVELOPMENTAL
DISABILITIES PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW.  A
managed care provider in a rural area shall offer a participant a choice
of  at  least three primary care practitioners and permit the individual
to obtain a service or seek a  provider  outside  of  the  managed  care
network  where such service or provider is not available from within the
managed care provider network, PROVIDED, HOWEVER, THAT THIS  REQUIREMENT
SHALL  ONLY  APPLY  TO A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN TO
THE EXTENT IT IS AUTHORIZED TO COVER SUCH SERVICES.
  S 5. Paragraph (c) of subdivision 4 of section  364-j  of  the  social
services  law, as amended by chapter 649 of the laws of 1996, is amended
to read as follows:
  (c) Participants shall select a primary care practitioner  from  among
those designated by the managed care provider. In all districts, partic-
ipants  shall  be  provided  with a choice of no less than three primary
care practitioners. In the event that a participant does  not  select  a
primary care practitioner, the participant's managed care provider shall
select  a  primary  care  practitioner  for the participant, taking into
account geographic accessibility; PROVIDED, HOWEVER, THAT THIS PARAGRAPH
SHALL NOT APPLY IF A PARTICIPANT IS ENROLLED IN A DEVELOPMENTAL DISABIL-
ITIES MANAGED CARE PLAN THAT IS NOT AUTHORIZED TO  ARRANGE  FOR  PRIMARY
CARE.
  S  6.  Subparagraphs  (iv),  (v),  (vi)  and (vii) of paragraph (e) of
subdivision 4 of section 364-j of the social services law, subparagraphs
(iv) and (vii) as amended by section 39 of part A of chapter 56  of  the
laws  of  2013,  subparagraph  (v) as amended by section 78 of part H of
chapter 59 of the laws of 2011, and  subparagraph  (vi)  as  amended  by

S. 6976                             3

section  14  of part C of chapter 58 of the laws of 2004, are amended to
read as follows:
  (iv)  Local  social  services  districts  or  enrollment organizations
through their enrollment counselors, OR IN  THE  CASE  OF  DEVELOPMENTAL
DISABILITIES  MANAGED  CARE  PLANS,  THE OFFICE FOR PEOPLE WITH DEVELOP-
MENTAL DISABILITIES OR ENROLLMENT ORGANIZATIONS THROUGH THEIR ENROLLMENT
COUNSELORS, shall provide participants with the opportunity for face  to
face  counseling  including  individual  counseling  upon request of the
participant. Local social services districts or enrollment organizations
through their enrollment counselors shall also provide participants with
information in a culturally and linguistically  appropriate  and  under-
standable manner, in light of the participant's needs, circumstances and
language  proficiency,  sufficient  to enable the participant to make an
informed selection of a managed care provider.   Such information  shall
include,  but  shall  not  be  limited to: how to access care within the
program; a description of the medical assistance services  that  can  be
obtained  other  than  through  a  managed  care provider; the available
managed care providers and the scope of  services  covered  by  each;  a
listing  of  the medical services providers associated with each managed
care provider; the participants' rights within the managed care program;
and how to exercise such rights.  Enrollment  counselors  shall  inquire
into  each  participant's  existing  relationships with medical services
providers and explain whether and how such relationships  may  be  main-
tained within the managed care program. For enrollments made during face
to  face  counseling, if the participant has a preference for particular
medical services providers, enrollment counselors shall verify with  the
medical services providers that such medical services providers whom the
participant  prefers  participate in the managed care provider's network
and are available to serve the participant.
  (v)  Upon  delivery  of  the  pre-enrollment  information,  the  local
district  or the enrollment organization shall certify the participant's
receipt of such information. Upon verification that the participant  has
received  the  pre-enrollment  education  information,  a  managed  care
provider, a local district or the enrollment organization may  enroll  a
participant  into  a  managed care provider. Managed care providers must
submit enrollment forms to the local department of social services. Upon
enrollment, participants will sign an attestation that  they  have  been
informed  that:  participants  have  a choice of managed care providers;
participants have a choice of primary care practitioners; and, except as
otherwise provided in this section, including but  not  limited  to  the
exceptions  listed in subparagraph (iii) of paragraph (a) of this subdi-
vision, participants must exclusively use their primary care practition-
ers and plan providers.  The  commissioner  of  health  may  suspend  or
curtail  enrollment  or  impose  sanctions  for failure to appropriately
notify clients as required in this subparagraph.  ENROLLMENT IN A DEVEL-
OPMENTAL DISABILITIES MANAGED CARE PLAN SHALL NOT BE  GOVERNED  BY  THIS
SUBPARAGRAPH.
  (vi)  Enrollment counselors or local social services districts, OR, AS
APPROPRIATE, ENROLLMENT COUNSELORS OR THE OFFICE FOR PEOPLE WITH  DEVEL-
OPMENTAL  DISABILITIES,  shall  further  inquire into each participant's
health status in order to identify  physical  or  behavioral  conditions
that  require  immediate attention or continuity of care, and provide to
participants information regarding  health  care  options  available  to
persons  with  HIV  and  other illnesses or conditions under the managed
care program. Any information disclosed  to  counselors  shall  be  kept

S. 6976                             4

confidential  in  accordance  with  applicable  provisions of the public
health law, and as appropriate, the mental hygiene law.
  (vii)  Any  marketing  materials  developed by a managed care provider
shall be approved by the  department  of  health  or  the  local  social
services district, and the commissioner of mental health and the commis-
sioner  of  alcoholism and substance abuse services, OR THE COMMISSIONER
OF DEVELOPMENTAL DISABILITIES,  where  appropriate,  within  sixty  days
prior to distribution to recipients of medical assistance. All marketing
materials shall be reviewed within sixty days of submission.
  S  7.  Paragraph  (f)  of subdivision 4 of section 364-j of the social
services law is amended by adding a new subparagraph  (vi)  to  read  as
follows:
  (VI)  THE PROVISIONS OF THIS PARAGRAPH SHALL NOT APPLY TO PARTICIPANTS
ELIGIBLE TO ENROLL IN A DEVELOPMENT DISABILITIES MANAGED CARE PLAN.
  S 8. Paragraph (g) of subdivision 4 of section  364-j  of  the  social
services  law,  as  amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
  (g) If another managed care provider is  available,  participants  may
change such provider or plan without cause within thirty days of notifi-
cation  of  enrollment or the effective date of enrollment, whichever is
later with a managed care provider by making  a  request  of  the  local
social  services  district  except  that such period shall be forty-five
days for participants who have  been  assigned  to  a  provider  by  the
commissioner  of  health.  However,  after such thirty or forty-five day
period, whichever is applicable, a participant may  be  prohibited  from
changing  managed  care providers more frequently than once every twelve
months, as permitted by federal law except for good cause as  determined
by  the commissioner of health through regulations.  NOTWITHSTANDING ANY
PROVISION OF THIS PARAGRAPH, PARTICIPANTS  MAY  CHANGE  A  MANAGED  CARE
PROVIDER  TO ENROLL IN A DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN AT
ANY TIME WITHOUT CAUSE AND MAY CHANGE DEVELOPMENTAL DISABILITIES MANAGED
CARE PLANS AT ANY TIME WITHOUT CAUSE.
  S 9. Paragraph (h) of subdivision 4 of section  364-j  of  the  social
services  law,  as  amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
  (h) If another medical services provider is available,  a  participant
may  change  his  or her provider of medical services (including primary
care practitioners) without cause within  thirty  days  of  the  partic-
ipant's  first  appointment with a medical services provider by making a
request of the managed care provider. However,  after  that  thirty  day
period,  no participant shall be permitted to change his or her provider
of medical services other than once every six  months  except  for  good
cause  as determined by the commissioner through regulations. THIS PARA-
GRAPH SHALL NOT APPLY TO PARTICIPANTS ENROLLED IN DEVELOPMENTAL DISABIL-
ITIES MANAGED CARE PLANS.
  S 10. Paragraph (i) of subdivision 4 of section 364-j  of  the  social
services  law,  as  amended by section 39 of part A of chapter 56 of the
laws of 2013, is amended to read as follows:
  (i) A managed care  provider  requesting  a  disenrollment  shall  not
disenroll  a  participant without the prior approval of the local social
services district in which the participant resides, OR, IN THE CASE OF A
DEVELOPMENTAL DISABILITIES MANAGED CARE PLAN, WITHOUT THE PRIOR APPROVAL
OF THE COMMISSIONER OF DEVELOPMENTAL DISABILITIES, provided that  disen-
rollment  from  a  special  needs managed care plan must comply with the
standards of the commissioner of health, the commissioner of  alcoholism
and  substance abuse services, and the commissioner of mental health AND

S. 6976                             5

DISENROLLMENT FROM A DEVELOPMENTAL DISABILITIES MANAGED CARE  PLAN  MUST
COMPLY  WITH THE STANDARDS OF THE COMMISSIONER OF HEALTH AND THE COMMIS-
SIONER OF DEVELOPMENTAL DISABILITIES.  A managed care provider shall not
request  disenrollment  of  a participant based on any diagnosis, condi-
tion, or perceived diagnosis or condition, or a participant's efforts to
exercise his or her rights under a grievance process, provided  however,
that  a  managed care provider may, where medically appropriate, request
permission to refer participants to a managed care provider  that  is  a
special  needs  managed  care  plan or a comprehensive HIV special needs
plan after consulting with such participant and upon  obtaining  his/her
consent  to  such  referral,  and  provided further that a special needs
managed care plan may, where clinically appropriate, disenroll  individ-
uals  who  no longer require the level of services provided by a special
needs managed care plan.
  S 11. Paragraph (m) of subdivision 4 of section 364-j  of  the  social
services  law, as amended by chapter 649 of the laws of 1996, is amended
to read as follows:
  (m) A managed care provider shall provide all early periodic screening
diagnosis and treatment services, as well as interperiodic screening and
referral, to each participant under the age of  twenty-one,  at  regular
intervals,  as  medically appropriate, EXCEPT THAT A DEVELOPMENTAL DISA-
BILITIES MANAGED CARE PLAN  SHALL  ONLY  BE  REQUIRED  TO  PROVIDE  SUCH
SERVICES IF SO AUTHORIZED.
  S  12.  Paragraph  (n) of subdivision 4 of section 364-j of the social
services law, as amended by chapter 484 of the laws of 2009, is  amended
to read as follows:
  (n)  A  managed  care  provider  shall provide or arrange, directly or
indirectly (including by referral) for the  provision  of  comprehensive
prenatal  care  services to all pregnant participants in accordance with
standards adopted by the department of health, EXCEPT  THAT  A  DEVELOP-
MENTAL  DISABILITIES MANAGED CARE PLAN SHALL ONLY BE REQUIRED TO PROVIDE
OR ARRANGE FOR SUCH SERVICES IF SO AUTHORIZED.
  S 13. Paragraph (v) of subdivision 4 of section 364-j  of  the  social
services law, as added by section 39 of part A of chapter 56 of the laws
of 2013, is amended to read as follows:
  (v)  A  managed  care provider must allow enrollees to access chemical
dependence treatment services from facilities certified by the office of
alcoholism and substance abuse  services,  even  if  such  services  are
rendered  by  a practitioner who would not otherwise be separately reim-
bursed, including but not  limited  to  a  credentialed  alcoholism  and
substance abuse counselor (CASAC), EXCEPT THAT A DEVELOPMENTAL DISABILI-
TIES  MANAGED  CARE  PLAN SHALL ONLY BE REQUIRED TO ALLOW ACCESS TO SUCH
SERVICES IF SO AUTHORIZED.
  S 14. Paragraph (g) of subdivision 5 of section 364-j  of  the  social
services law, as added by section 15 of part C of chapter 58 of the laws
of 2004, is amended to read as follows:
  (g)  The  commissioner of health may delegate some or all of the tasks
identified in this section to  the  local  districts,  EXCEPT  THAT  THE
COMMISSIONER  OF HEALTH MAY NOT MAKE ANY SUCH DELEGATION WITH RESPECT TO
DEVELOPMENTAL DISABILITIES MANAGED CARE PLANS.
  S 15. Paragraph (b) of subdivision 6 of section 364-j  of  the  social
services law, as added by chapter 649 of the laws of 1996, is amended to
read as follows:
  (b)  distribute  marketing  materials to recipients of medical assist-
ance, unless such materials are approved by  the  department  of  health

S. 6976                             6

and,  as  appropriate,  the  office  of  mental health OR THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES.
  S  16.  Subparagraph (ii) of paragraph (f) of subdivision 8 of section
364-j of the social services law, as added by chapter 649 of the laws of
1996, is amended to read as follows:
  (ii) there are opportunities to select from  at  least  three  primary
care  providers,  PROVIDED HOWEVER THAT THIS REQUIREMENT SHALL NOT APPLY
TO DEVELOPMENTAL DISABILITY MANAGED CARE PLANS THAT ARE  NOT  AUTHORIZED
TO OFFER OR ARRANGE FOR PRIMARY CARE; and
  S  17.  The  opening  paragraph  of paragraph (f) of subdivision 27 of
section 364-j of the social services law, as added by section 72 of part
A of chapter 56 of the laws of 2013, is amended to read as follows:
  Notwithstanding  any  inconsistent  provisions  of  this  section  and
sections  one  hundred  twelve  and one hundred sixty-three of the state
finance law, or section one hundred forty-two of the  economic  develop-
ment  law,  or any other law to the contrary, the commissioner of health
and, in the case of FIDAs authorized exclusively to enroll persons  with
developmental  disabilities,  the commissioner of health and the commis-
sioner of the office for people  with  developmental  disabilities,  may
contract  with  FIDAs  approved under this section without a competitive
bid or request for proposal process, [are authorized  to  enter  into  a
contract or contracts under this section,] provided, however, that:
  S 18. The opening paragraph of subdivision (g) of section 13.40 of the
mental  hygiene law, as added by section 72-b of part A of chapter 56 of
the laws of 2013, is amended to read as follows:
  Notwithstanding any inconsistent provision  of  sections  one  hundred
twelve  and one hundred sixty-three of the state finance law, or section
one hundred forty-two of the economic development law, or any other  law
to  the  contrary,  the  commissioner and the commissioner of health are
authorized to enter into a contract or contracts  under  section  forty-
four  hundred  three-g  of  the  public health law, subdivision eight of
section forty-four hundred three of the public health law, and  subdivi-
sion  twelve  of section forty-four hundred three-f of the public health
law, AND TO ENTER INTO CONTRACTS WITH APPLICANTS FOR  A  CERTIFICATE  OF
AUTHORITY  PURSUANT  TO SECTION FORTY-FOUR HUNDRED THREE-G OF THE PUBLIC
HEALTH LAW FOR COSTS ASSOCIATED WITH DEVELOPING INFORMATION  TECHNOLOGY,
HUMAN  RESOURCES  AND  CARE  COORDINATION SYSTEMS NECESSARY TO OPERATE A
DISCO, provided, however, that:
  S 19. Section 13.40 of the mental hygiene law is amended by  adding  a
new subdivision (h) to read as follows:
  (H) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF SECTIONS ONE HUNDRED
TWELVE  AND ONE HUNDRED SIXTY-THREE OF THE STATE FINANCE LAW, OR SECTION
ONE HUNDRED FORTY-TWO OF THE ECONOMIC DEVELOPMENT LAW, OR ANY OTHER  LAW
TO  THE  CONTRARY,  THE  COMMISSIONER AND THE COMMISSIONER OF HEALTH ARE
AUTHORIZED TO ENTER INTO CONTRACTS FOR ANY OF THE FOLLOWING AS NECESSARY
TO OVERSEE AND DEVELOP, OPERATE AND OVERSEE A MANAGED CARE SYSTEM  UNDER
THE  PEOPLE  FIRST  WAIVER PROGRAM: QUALITY ASSESSMENT, QUALITY IMPROVE-
MENT, ASSESSMENTS OF ENROLLEES,  ENROLLMENT  COUNSELING  AND  ENROLLMENT
PROCESSING,  OUTSIDE  ADVOCACY  AND  INFORMATION  TECHNOLOGY,  PROVIDED,
HOWEVER, THAT:
  1. THE OFFICE SHALL POST ON ITS WEBSITE, FOR A PERIOD OF NO LESS  THAN
THIRTY DAYS:
  (1)  A DESCRIPTION OF THE PROPOSED SERVICES TO BE PROVIDED PURSUANT TO
THE CONTRACT OR CONTRACTS;
  (2) THE CRITERIA FOR SELECTION OF A CONTRACTOR OR CONTRACTORS;

S. 6976                             7

  (3) THE PERIOD OF TIME DURING WHICH A PROSPECTIVE CONTRACTOR MAY  SEEK
SELECTION,  WHICH  SHALL BE NO LESS THAN THIRTY DAYS AFTER SUCH INFORMA-
TION IS FIRST POSTED ON THE WEBSITE; AND
  (4)  THE  MANNER  BY  WHICH  A  PROSPECTIVE  CONTRACTOR  MAY SEEK SUCH
SELECTION, WHICH MAY INCLUDE SUBMISSION BY ELECTRONIC MEANS;
  2. ALL REASONABLE AND RESPONSIVE SUBMISSIONS THAT  ARE  RECEIVED  FROM
PROSPECTIVE  CONTRACTORS  IN  A  TIMELY FASHION SHALL BE REVIEWED BY THE
COMMISSIONERS; AND
  3. THE COMMISSIONER AND THE COMMISSIONER OF HEALTH MAY JOINTLY  SELECT
SUCH  CONTRACTOR  OR  CONTRACTORS THAT, IN THEIR DISCRETION, HAVE DEMON-
STRATED THE ABILITY TO PERFORM THE SERVICES REQUESTED IN  A  COST-EFFEC-
TIVE  MANNER AND TO PERFORM SUCH SERVICES AND DELIVER WORK PRODUCTS THAT
WILL BE OF ADEQUATE QUALITY TO MEET THE NEEDS  OF  THE  OFFICE  AND  THE
DEPARTMENT  OF  HEALTH AND THE INTERESTS OF INDIVIDUALS PARTICIPATING IN
THE PEOPLE FIRST WAIVER PROGRAM.
  S 20. Subdivisions (a), (b), (c), (d), (e), (f), (g), (h),  (i),  (j),
(k),  (l),  (m)  and  (o) of section 41.36 of the mental hygiene law are
REPEALED.
  S 21. Subdivision (n) of section 41.36 of the mental hygiene  law,  as
amended  by  chapter  525  of  the  laws  of 1985, is amended to read as
follows:
  (n) The commissioner OF DEVELOPMENTAL DISABILITIES shall  establish  a
procedure,  subject  to  the  approval of the state comptroller, whereby
payments in addition to the [client's] personal allowance OF AN INDIVID-
UAL LIVING IN A COMMUNITY RESIDENTIAL FACILITY may be made to  providers
of services for one or more of the following needs of [clients] INDIVID-
UALS  residing  in such facilities, limited to two hundred fifty dollars
per [client] INDIVIDUAL per year and paid semi-annually  in  the  manner
specified by such procedures:
  1. Replacement of necessary clothing;
  2. Personal requirements and incidental needs of [clients] INDIVIDUALS
RESIDING IN THE FACILITY;
  3.  Recreational  and  cultural  activities  of  [clients] INDIVIDUALS
RESIDING IN THE FACILITY.  Such payments may be made from monies  appro-
priated  to  the office for this purpose. Such payments shall be audited
by the office pursuant to an audit plan approved by the comptroller.
  S 22. Subdivision (a) of section 43.02 of the mental hygiene  law,  as
amended  by  chapter  168  of  the  laws  of 2010, is amended to read as
follows:
  (a) Notwithstanding any inconsistent provision of law, payment made by
government agencies pursuant to title eleven  of  article  five  of  the
social  services  law  for services provided by any facility licensed by
the office of mental health pursuant to article thirty-one of this chap-
ter or licensed or operated by the office for people with  developmental
disabilities pursuant to article sixteen of this chapter or certified by
the  office  of alcoholism and substance abuse services pursuant to this
chapter to provide inpatient chemical dependence services, as defined in
section 1.03 of this chapter, shall be at rates or fees certified by the
commissioner of the respective office and approved by  the  director  of
the  division  of  the  budget,  provided,  however, the commissioner of
mental health shall annually certify such rates or fees which  may  vary
for  distinct  geographical  areas  of the state and, provided, further,
that rates or fees for service for  inpatient  psychiatric  services  or
inpatient  chemical dependence services, at hospitals otherwise licensed
pursuant to article twenty-eight of  the  public  health  law  shall  be
established  in accordance with section two thousand eight hundred seven

S. 6976                             8

of the public health law AND, PROVIDED, FURTHER, THAT RATES OR FEES  FOR
SERVICES PROVIDED BY ANY FACILITY LICENSED OR OPERATED BY THE OFFICE FOR
PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES PURSUANT TO ARTICLE SIXTEEN OF
THIS  CHAPTER  AND DEVELOPED PURSUANT TO REVISED METHODOLOGIES DEVELOPED
AS A CONDITION OF FEDERAL APPROVAL OF THE PEOPLE  FIRST  WAIVER  PROGRAM
SHALL  BE  CERTIFIED  BY  THE COMMISSIONER OF HEALTH; PROVIDED, HOWEVER,
THAT SUCH METHODOLOGIES SHALL TAKE INTO ACCOUNT THE POLICIES  AND  GOALS
OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
  S 23. Paragraph (ii) of subdivision (c) of section 43.02 of the mental
hygiene  law,  as amended by chapter 168 of the laws of 2010, is amended
to read as follows:
  (ii) methodologies used in the establishment of the schedules of rates
or fees pursuant to this section, PROVIDED, HOWEVER THAT THE COMMISSION-
ER OF HEALTH SHALL ADOPT RULES AND REGULATIONS  INCLUDING  METHODOLOGIES
DEVELOPED  BY  HIM OR HER FOR SERVICES PROVIDED BY ANY FACILITY LICENSED
OR OPERATED BY THE OFFICE FOR  PEOPLE  WITH  DEVELOPMENTAL  DISABILITIES
PURSUANT TO SUBDIVISION (A) OF THIS SECTION.
  S  24. 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,  three,  four,  five, six, seven, eight, nine, ten,
eleven, twelve, thirteen, fourteen, fifteen, sixteen  and  seventeen  of
this act shall not affect the repeal of such section and shall be deemed
repealed therewith.

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Senate Bill S6976

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

2013-S6976 (ACTIVE) - Details

2013-S6976 (ACTIVE) - Summary

2013-S6976 (ACTIVE) - Sponsor Memo

2013-S6976 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S6976

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Sponsored By

Kemp Hannon

Archive: Last Bill Status - In Senate Committee Health Committee

2013-S6976 (ACTIVE) - Details

2013-S6976 (ACTIVE) - Summary

2013-S6976 (ACTIVE) - Sponsor Memo

2013-S6976 (ACTIVE) - Bill Text download pdf

Comments