A. 7227 2
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:
(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 DISCO SHALL ARRANGE FOR ACCESS TO AND ENROLL-
MENT 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, coun-
ty health departments, providers of comprehensive health service plans
licensed pursuant to article forty-four of the public health law, and
hospitals and diagnostic and treatment 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 pursu-
ant 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 DISCO TO ONE MANAGED CARE PLAN, IF FEDERAL APPROVAL IS SECURED TO
REQUIRE ENROLLMENT WHEN THERE ARE LESS THAN TWO MANAGED CARE PLANS OPER-
ATING IN THE PARTICIPANT'S COUNTY OF RESIDENCE AUTHORIZED TO COORDINATE
CARE FOR PERSONS 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 DISCO 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 DISCO 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
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(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
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 DISCOS, THE
OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES OR ENROLLMENT ORGAN-
IZATIONS 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 counse-
lors OR IN THE CASE OF DISCO, THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL
DISABILITIES OR ENROLLMENT ORGANIZATIONS THROUGH THEIR ENROLLMENT COUN-
SELORS, shall also provide participants with information in a culturally
and linguistically appropriate and understandable manner, in light of
the participant's needs, circumstances and language proficiency, suffi-
cient 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 maintained 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 DISCO
SHALL NOT BE GOVERNED BY THIS SUBPARAGRAPH.
(vi) Enrollment counselors or local social services districts, OR, AS
APPROPRIATE, THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES,
shall further inquire into each participant's health status in order to
identify physical or behavioral conditions that require immediate atten-
tion or continuity of care, and provide to participants information
A. 7227 4
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 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 DISCO.
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 DISCO AT ANY TIME WITHOUT CAUSE AND MAY CHANGE
DISCO OR DISCOS PLAN 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 DISCOS.
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
DISCO, WITHOUT THE PRIOR APPROVAL OF THE COMMISSIONER OF DEVELOPMENTAL
DISABILITIES, provided that disenrollment 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
A. 7227 5
commissioner of mental health AND DISENROLLMENT FROM A DISCO MUST COMPLY
WITH THE STANDARDS OF THE COMMISSIONER OF HEALTH AND THE COMMISSIONER OF
DEVELOPMENTAL DISABILITIES. A managed care provider shall not request
disenrollment of a participant based on any diagnosis, condition, 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 permis-
sion 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 individuals 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 DISCO 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 DISCO SHALL
ONLY BE REQUIRED TO PROVIDE OR ARRANGE FOR SUCH SERVICES IF SO AUTHOR-
IZED.
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 DISCO 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
DISCOS.
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
and, as appropriate, the office of mental health OR THE OFFICE FOR
PEOPLE WITH DEVELOPMENTAL DISABILITIES.
A. 7227 6
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 DISCOS 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. Paragraphs (a) and (b) of subdivision 2 of section 43.04 of the
mental hygiene law, as amended by chapter 41 of the laws of 1992,
subparagraph (ii) of paragraph (a) and subparagraph (ii) of paragraph
(b) as separately amended by chapters 194 and 309 of the laws of 1996
and subparagraph (iii) of paragraph (a) as added by section 1 and
subparagraph (iii) of paragraph (b) as added by section 2 of part D of
chapter 58 of the laws of 2007, are amended to read as follows:
(a) (i) For each provider of services in the categories of services
set forth in subdivision one of this section located in [Regions II and
III, as defined in the methodology established pursuant to paragraph
(ii) of subdivision (c) of section 43.02 of this article] ALL COUNTIES
EXCLUDING NEW YORK, BRONX, KINGS, QUEENS AND RICHMOND, the assessment
shall be six-tenths of one percent of each such provider of services'
gross receipts received for all services rendered within such service
categories on a cash basis beginning January first, nineteen hundred
ninety-one.
(ii) For each provider of services in the categories of services set
forth in subdivision one of this section, excluding, on and after April
first, nineteen hundred ninety-four, providers of day treatment
services, located in [Regions II and III, as defined in the methodology
established pursuant to paragraph (ii) of subdivision (c) of section
43.02 of this article] ALL COUNTIES EXCLUDING NEW YORK, BRONX, KINGS,
QUEENS AND RICHMOND, an additional assessment shall be two and four-
tenths percent of each such provider of services' gross receipts
received for all services rendered within such service categories on a
cash basis beginning April first, nineteen hundred ninety-two; provided,
however, such additional assessment shall be five and four-tenths
percent of each such provider of services' gross receipts received for
all services rendered within such service categories on a cash basis
beginning April first, nineteen hundred ninety-six and ending March
thirty-first, nineteen hundred ninety-seven.
(iii) For each provider of services in the categories of services set
forth in subdivision one of this section, excluding, on and after April
first, nineteen hundred ninety-four, providers of day treatment
services, located in [Regions II and III, as defined in the methodology
established pursuant to paragraph (ii) of subdivision (c) of section
A. 7227 7
43.02 of this article] ALL COUNTIES EXCLUDING NEW YORK, BRONX, KINGS,
QUEENS AND RICHMOND, notwithstanding any other provision of this para-
graph, the total assessment shall be six percent of each such provider's
gross receipts received on a cash basis for all services rendered,
beginning April first, nineteen hundred ninety-seven, and five and five-
tenths percent of each such provider's gross receipts received on a cash
basis for all services rendered, beginning January first, two thousand
eight.
(b) (i) For each provider of services in the categories of services
set forth in subdivision one of this section located in [Region I, as
defined in the methodology established pursuant to paragraph (ii) of
subdivision (c) of section 43.02 of this article] THE COUNTIES OF NEW
YORK, BRONX, KINGS, QUEENS AND RICHMOND, the assessment shall be six-
tenths of one percent of each such provider of services' gross receipts
received for all services rendered within such service categories on a
cash basis beginning July first, nineteen hundred ninety-one.
(ii) For each provider of services in the categories of services set
forth in subdivision one of this section, excluding, on and after April
first, nineteen hundred ninety-four, providers of day treatment
services, located in [Region I, as defined in the methodology estab-
lished pursuant to paragraph (ii) of subdivision (c) of section 43.02 of
this article] THE COUNTIES OF NEW YORK, BRONX, KINGS, QUEENS AND RICH-
MOND, an additional assessment shall be two and four-tenths percent of
each such provider of services' gross receipts received for all services
rendered within such service categories on a cash basis beginning April
first, nineteen hundred ninety-two; provided, however, such additional
assessment shall be five and four-tenths percent of each such provider
of services' gross receipts received for all services rendered within
such service categories on a cash basis beginning April first, nineteen
hundred ninety-six and ending March thirty-first, nineteen hundred nine-
ty-seven.
(iii) For each provider of services in the categories of services set
forth in subdivision one of this section, excluding, on and after April
first, nineteen hundred ninety-four, providers of day treatment
services, located in [Region I, as defined in the methodology estab-
lished pursuant to paragraph (ii) of subdivision (c) of section 43.02 of
this article] THE COUNTIES OF NEW YORK, BRONX, KINGS, QUEENS AND RICH-
MOND, notwithstanding any other provision of this paragraph, the total
assessment shall be six percent of each such provider's gross receipts
received on a cash basis for all services rendered, beginning April
first, nineteen hundred ninety-seven, and five and five-tenths percent
of each such provider's gross receipts received on a cash basis for all
services rendered, beginning January first, two thousand eight.
S 19. Subdivision 4 of section 43.04 of the mental hygiene law, as
amended by chapter 37 of the laws of 2011, is amended to read as
follows:
4. Gross receipts received from all services rendered within the
service categories set forth in subdivision one of this section shall
include, without limitation, all monies received on account of such
services pursuant to rates of reimbursement established by the office
for people with developmental disabilities OR THE DEPARTMENT OF HEALTH
and paid by the state, and shall not include, subject to the provisions
of subdivision twelve of this section, charitable contributions, grants,
donations, bequests and income from non-service related fund raising
activities and governmental deficit financing.
A. 7227 8
S 20. Paragraph 3 of subdivision (b) of section 5.07 of the mental
hygiene law, as amended by section 3 of part N of chapter 56 of the laws
of 2012, is amended to read as follows:
(3) The commissioners of each of the offices shall be responsible for
the development of such statewide five-year plan for services within the
jurisdiction of their respective offices and after giving due notice
shall conduct one or more public hearings on such plan. The behavioral
health services advisory council and the advisory council on develop-
mental disabilities shall review the statewide five year comprehensive
plan developed by such office or offices and report its recommendations
thereon to such commissioner or commissioners. Each commissioner shall
submit the plan, with appropriate modifications, to the governor no
later than the first day of November of each year in order that such
plan may be considered with the estimates of the offices for the prepa-
ration of the executive budget of the state of New York for the next
succeeding state fiscal year. Such comprehensive plan shall be submitted
to the legislature and also be posted to the website of each office.
Statewide plans shall ensure responsiveness to changing needs and goals
and shall reflect the development of new information and the completion
of program evaluations. [An interim report detailing the commissioner's
actions in fulfilling the requirements of this section in preparation of
the plan and modifications in the plan of services being considered by
the commissioner shall be submitted to the governor and the legislature
on or before the fifteenth day of March of each year. Such interim
report shall include, but need not be limited to:
(a) actions to include participation of consumers, consumer groups,
providers of services and departmental facilities, as required by this
subdivision; and
(b) any modifications in the plan of services being considered by the
commissioner, to include: (i) compelling budgetary, programmatic or
clinical justifications or other major appropriate reason for any
significant new statewide programs or policy changes from a prior
(approved) five year comprehensive plan; and (ii) procedures to involve
or inform local governmental units of such actions or plans.]
S 21. Subdivision (c) of section 5.07 of the mental hygiene law is
REPEALED.
S 22. Section 13.06 of the mental hygiene law is REPEALED.
S 23. Subdivision (a) of section 13.21 of the mental hygiene law, as
amended by section 3 of part J of chapter 56 of the laws of 2012, is
amended to read as follows:
(a) The directors of both the state operations offices and develop-
mental disabilities regional offices in the office for people with
developmental disabilities shall be appointed by the commissioner. Each
such director shall be in the non-competitive class and designated as
confidential as defined by subdivision two-a of section forty-two of the
civil service law and shall serve at the pleasure of the commissioner.
[He or she] THE COMMISSIONER shall in exercising his or her appointing
authority take, consistent with article twenty-three-A of the correction
law, all reasonable and necessary steps to insure that any such person
so appointed has not previously engaged in any act in violation of any
law which indicates a propensity to act in a manner that would compro-
mise the health and safety of patients in the facility [of which he or
she is director. He or she]. A DIRECTOR shall manage the state oper-
ations office or developmental disabilities regional office and adminis-
ter its personnel system subject to applicable law, the regulations of
the commissioner, and the rules of the state civil service commission.
A. 7227 9
The directors of the developmental disabilities regional offices and
state operations offices shall maintain effective supervision of all
parts of their respective offices. The directors of state operations
offices shall generally provide for the administration of supports and
services to individuals with developmental disabilities in state oper-
ated programs. Directors of regional offices shall generally oversee
the administration of supports and services to individuals with develop-
mental disabilities in settings outside the state operated programs.
S 24. Subdivision (a) of section 13.33 of the mental hygiene law, as
amended by section 4 of part J of chapter 56 of the laws of 2012, is
amended to read as follows:
(a) Each state operations office under the jurisdiction of the commis-
sioner shall have a minimum of one board of visitors consisting of at
least seven but not more than fourteen members. Members appointed or
reappointed after the effective date of this chapter shall be appointed
by the governor[, by and with the advice and consent of the senate].
Members shall be appointed for four year terms to expire on the thirty-
first day of December of the fourth year of the term of office provided
however, when more than three terms expire in any one year, members may
be appointed for terms of fewer years as designated by the governor so
that no more than three members' terms expire in any one year. All terms
of office shall expire on the thirty-first day of December of the desig-
nated year. A member whose term has expired shall, however, remain in
office until such member's successor has been appointed and has taken
office, or until such member shall have resigned or have been removed
from office in the manner hereinafter provided. Should any member
resign or be removed from office, the governor shall promptly submit[,
for senate consent,] a successor candidate to fill the remaining term of
the vacated office. A visitor may be removed by the governor for cause
after notice and an opportunity for a hearing on the charges. In making
appointments to boards of visitors, the governor shall endeavor to
ensure that the membership of each such board shall adequately reflect
the composition of the community or communities served by the state
operations office, that the membership of each such board includes at
least three individuals who are parents or relatives of patients or of
former patients and that the remainder includes only those persons,
including former patients, who shall have expressed an active interest
in, or shall have obtained professional knowledge in the care of persons
with developmental disabilities or in developmental disability endeavors
generally.
S 25. Section 33.17 of the mental hygiene law is REPEALED.
S 26. 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.