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

                                  2338

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            January 18, 2011
                               ___________

Introduced  by  M. of A. SCHIMMINGER, GABRYSZAK -- Multi-Sponsored by --
  M. of A. HOOPER, MAGEE, N. RIVERA -- read once  and  referred  to  the
  Committee on Health

AN  ACT  to  amend  the  social  services  law, in relation to mandatory
  managed care for certain recipients of medical assistance

  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 364-j of the
social services law, as amended by chapter 649  of  the  laws  of  1996,
subparagraphs  (i)  and  (ii)  as  amended by chapter 433 of the laws of
1997, is amended to read as follows:
  (b) "Managed care provider". An entity that provides or  arranges  for
the  provision  of  medical  assistance services and supplies to partic-
ipants directly or indirectly (including by  referral),  including  case
management; and:
  (i)  is  authorized  to operate under article forty-four of the public
health law or article forty-three of the insurance law and  provides  or
arranges,  directly  or  indirectly  (including by referral) for covered
comprehensive health services on a full capitation basis; [or]
  (ii) is authorized  as  a  partially  capitated  program  pursuant  to
section  three  hundred sixty-four-f of this title or section forty-four
hundred three-e of the public health law or section 1915b of the  social
security act;
  (III)  IS  A  RURAL  HEALTH  NETWORK  AS DEFINED IN SUBDIVISION TWO OF
SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW; OR
  (IV) HOLDS A COMPREHENSIVE  HIV  SPECIAL  NEEDS  PLAN  CERTIFICATE  OF
AUTHORITY  PURSUANT  TO SECTION FORTY-FOUR HUNDRED THREE-C OF THE PUBLIC
HEALTH LAW.
  S 2. Paragraph (g) of subdivision 3 of section  364-j  of  the  social
services  law,  as  amended by chapter 649 of the laws of 1996, subpara-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02425-01-1

              

A. 2338                             2

graph (i) as amended by section 30 of part C of chapter 58 of  the  laws
of 2008, is amended to read as follows:
  (g)  The following categories of individuals will [not] be required to
enroll with a managed care program [until]  FOLLOWING  THE  APPROVAL  OF
program  features  and reimbursement rates [are approved] by the commis-
sioner of health and, as appropriate, the commissioner of mental health:
  (i) an individual dually eligible for medical assistance and  benefits
under  the  federal  Medicare program and enrolled in a Medicare managed
care plan offered by an entity that is also  a  managed  care  provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):
  (a) if the individual changes his or her Medicare managed care plan as
authorized  by  title  XVIII  of  the  federal  social security act, and
enrolls in another Medicare managed care plan that  is  also  a  managed
care  provider, the individual shall be (if required by the commissioner
under this paragraph) enrolled in that managed care provider;
  (b) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII  of  the  federal  social  security  act,  but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider  in  which he or she was enrolled and withdraw from the managed
care program;
  (c) if the individual disenrolls from his or her Medicare managed care
plan as authorized by title XVIII of the federal  social  security  act,
and  does not enroll in another Medicare managed care plan, the individ-
ual shall be disenrolled from the managed care provider in which  he  or
she was enrolled and withdraw from the managed care program;
  (d)  nothing  herein shall require an individual enrolled in a managed
long term care plan, pursuant to section forty-four hundred  three-f  of
the public health law, to disenroll from such program.
  (ii) an individual eligible for supplemental security income;
  (iii) HIV positive individuals; and
  (iv)  persons with serious mental illness and children and adolescents
with serious emotional disturbances[, as defined in  section  forty-four
hundred one of the public health law].
  S 3. Section 364-j of the social services law is amended by adding two
new subdivisions 25 and 26 to read as follows:
  25.  THE  COMMISSIONER OF HEALTH SHALL TAKE ALL MEASURES NECESSARY AND
CONVENIENT TO CAUSE ALL SOCIAL  SERVICES  DISTRICTS  IN  THE  STATE  NOT
ALREADY DOING SO TO PROVIDE MEDICAL ASSISTANCE AND IMPLEMENT THE STATE'S
MANAGED  CARE PROGRAM AND PARTICIPATE IN SUCH PROGRAM AUTHORIZED BY THIS
SECTION.
  26. THE COMMISSIONER OF HEALTH SHALL SUBMIT THE  APPROPRIATE  WAIVERS,
STATE PLAN AMENDMENTS AND FEDERAL APPLICATIONS, INCLUDING BUT NOT LIMIT-
ED  TO,  WAIVER  REQUESTS AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED
FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT,
OR SUCCESSOR PROVISIONS, AS THE COMMISSIONER OF HEALTH SHALL DEEM NECES-
SARY TO SECURE APPROPRIATE FEDERAL FINANCIAL SUPPORT FOR THE COST  OF  A
PROGRAM  TO  AUTHORIZE  MANDATORY  MANAGED  CARE  FOR MEDICAL ASSISTANCE
RECIPIENTS RESIDING IN ALL AREAS OF THE STATE, INCLUDING  RECIPIENTS  OF
SUPPLEMENTAL INCOME AND PERSONS ENROLLED OR ELIGIBLE TO BE ENROLLED IN A
MEDICARE TEFRA PLAN.
  S  4.  Section  two of this act shall not take effect unless and until
the commissioner of health receives all necessary approvals under feder-
al law and regulation to implement its  provisions,  and  provided  that
such  provisions do not prevent the receipt of federal financial partic-

A. 2338                             3

ipation under the medical assistance program. The commissioner of health
shall submit such waiver applications and/or state  plan  amendments  as
may be necessary to obtain such approvals and to ensure continued feder-
al financial participation.
  S  5.  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 and three of this act shall not affect the repeal of
such section pursuant to chapter 710 of the laws of  1988,  as  amended,
and  shall  be deemed repealed therewith; provided that the commissioner
of health shall notify the legislative bill drafting commission upon the
occurrence of the enactment of the legislation provided for  in  section
two  of  this  act in order that the commission may maintain an accurate
and timely effective data base of the official text of the laws  of  the
state  of New York in furtherance of effecting the provisions of section
44 of the legislative law and section 70-b of the public officers law.