Bill Text: NY S02737 | 2013-2014 | General Assembly | Amended
Bill Title: Requires additional medicaid recipients throughout the state to participate in managed care plans; directs the commissioner of health to submit all appropriate waivers, state plan amendments, and federal applications to secure federal financial support.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2014-01-23 - PRINT NUMBER 2737A [S02737 Detail]
Download: New_York-2013-S02737-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2737--A
2013-2014 Regular Sessions
I N S E N A T E
January 23, 2013
___________
Introduced by Sen. RANZENHOFER -- read twice and ordered printed, and
when printed to be committed to the Committee on Health -- recommitted
to the Committee on Health in accordance with Senate Rule 6, sec. 8 --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee
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:
1 Section 1. Paragraph (b) of subdivision 1 of section 364-j of the
2 social services law, as amended by chapter 649 of the laws of 1996,
3 subparagraph (i) as amended by section 35-a and subparagraph (ii) as
4 amended and subparagraph (iii) as added by section 77 of part A of chap-
5 ter 56 of the laws of 2013, is amended to read as follows:
6 (b) "Managed care provider". An entity that provides or arranges for
7 the provision of medical assistance services and supplies to partic-
8 ipants directly or indirectly (including by referral), including case
9 management; and:
10 (i) is authorized to operate under article forty-four of the public
11 health law or article forty-three of the insurance law and provides or
12 arranges, directly or indirectly (including by referral) for covered
13 comprehensive health services on a full capitation basis, including a
14 special needs managed care plan or comprehensive HIV special needs plan
15 CERTIFICATE OF AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-C
16 OF THE PUBLIC HEALTH LAW; [or]
17 (ii) is authorized as a partially capitated program pursuant to
18 section three hundred sixty-four-f of this title or section forty-four
19 hundred three-e of the public health law or section 1915b of the social
20 security act; [or]
21 (iii) is authorized to operate under section forty-four hundred
22 three-g of the public health law[.]; OR
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05160-03-4
S. 2737--A 2
1 (IV) IS A RURAL HEALTH NETWORK AS DEFINED IN SUBDIVISION TWO OF
2 SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW.
3 S 2. Paragraph (e) of subdivision 3 of section 364-j of the social
4 services law, as amended by section 38 of part A of chapter 56 of the
5 laws of 2013, is amended to read as follows:
6 (e) The following categories of individuals [may] SHALL be required to
7 enroll with a managed care program [when] FOLLOWING THE APPROVAL OF
8 program features and reimbursement rates [are approved] by the commis-
9 sioner of health and, as appropriate, the commissioners of the office of
10 mental health, the office for people with developmental disabilities,
11 the office of children and family services, and the office of alcoholism
12 and substance abuse services:
13 (i) an individual dually eligible for medical assistance and benefits
14 under the federal Medicare program; provided, however, nothing herein
15 shall: (a) require an individual enrolled in a managed long term care
16 plan, pursuant to section forty-four hundred three-f of the public
17 health law, to disenroll from such program; or (b) make enrollment in a
18 Medicare managed care plan a condition of the individual's participation
19 in the managed care program pursuant to this section, or affect the
20 individual's entitlement to payment of applicable Medicare managed care
21 or fee for service coinsurance and deductibles by the individual's
22 managed care provider.
23 (ii) an individual eligible for supplemental security income;
24 (iii) HIV positive individuals;
25 (iv) persons with serious mental illness and children and adolescents
26 with serious emotional disturbances[, as defined in section forty-four
27 hundred one of the public health law];
28 (v) a person receiving services provided by a residential alcohol or
29 substance abuse program or facility for the developmentally disabled;
30 (vi) a person receiving services provided by an intermediate care
31 facility for the developmentally disabled or who has characteristics and
32 needs similar to such persons;
33 (vii) a person with a developmental or physical disability who
34 receives home and community-based services or care-at-home services
35 through existing waivers under section nineteen hundred fifteen (c) of
36 the federal social security act or who has characteristics and needs
37 similar to such persons;
38 (viii) a person who is eligible for medical assistance pursuant to
39 subparagraph twelve or subparagraph thirteen of paragraph (a) of subdi-
40 vision one of section three hundred sixty-six of this title;
41 (ix) a person receiving services provided by a long term home health
42 care program, or a person receiving inpatient services in a state-oper-
43 ated psychiatric facility or a residential treatment facility for chil-
44 dren and youth;
45 (x) certified blind or disabled children living or expected to be
46 living separate and apart from the parent for thirty days or more;
47 (xi) residents of nursing facilities;
48 (xii) a foster child in the placement of a voluntary agency or in the
49 direct care of the local social services district;
50 (xiii) a person or family that is homeless;
51 (xiv) individuals for whom a managed care provider is not geograph-
52 ically accessible so as to reasonably provide services to the person. A
53 managed care provider is not geographically accessible if the person
54 cannot access the provider's services in a timely fashion due to
55 distance or travel time;
S. 2737--A 3
1 (xv) a person eligible for Medicare participating in a capitated
2 demonstration program for long term care;
3 (xvi) an infant living with an incarcerated mother in a state or local
4 correctional facility as defined in section two of the correction law;
5 (xvii) a person who is expected to be eligible for medical assistance
6 for less than six months;
7 (xviii) a person who is eligible for medical assistance benefits only
8 with respect to tuberculosis-related services;
9 (xix) individuals receiving hospice services at time of enrollment;
10 provided, however, that this clause shall not be construed to require an
11 individual enrolled in a managed long term care plan or another care
12 coordination model, who subsequently elects hospice, to disenroll from
13 such program;
14 (xx) a person who has primary medical or health care coverage avail-
15 able from or under a third-party payor which may be maintained by
16 payment, or part payment, of the premium or cost sharing amounts, when
17 payment of such premium or cost sharing amounts would be cost-effective,
18 as determined by the local social services district;
19 (xxi) a person receiving family planning services pursuant to subpara-
20 graph six of paragraph (b) of subdivision one of section three hundred
21 sixty-six of this title;
22 (xxii) a person who is eligible for medical assistance pursuant to
23 paragraph (d) of subdivision four of section three hundred sixty-six of
24 this title;
25 (xxiii) individuals with a chronic medical condition who are being
26 treated by a specialist physician that is not associated with a managed
27 care provider in the individual's social services district; and
28 (xxiv) Native Americans.
29 S 3. Section 364-j of the social services law is amended by adding two
30 new subdivisions 29 and 30 to read as follows:
31 29. THE COMMISSIONER OF HEALTH SHALL TAKE ALL MEASURES NECESSARY AND
32 CONVENIENT TO CAUSE ALL SOCIAL SERVICES DISTRICTS IN THE STATE NOT
33 ALREADY DOING SO TO PROVIDE MEDICAL ASSISTANCE AND IMPLEMENT THE STATE'S
34 MANAGED CARE PROGRAM AND PARTICIPATE IN SUCH PROGRAM AUTHORIZED BY THIS
35 SECTION.
36 30. THE COMMISSIONER OF HEALTH SHALL SUBMIT THE APPROPRIATE WAIVERS,
37 STATE PLAN AMENDMENTS AND FEDERAL APPLICATIONS, INCLUDING BUT NOT LIMIT-
38 ED TO, WAIVER REQUESTS AUTHORIZED PURSUANT TO SECTIONS ELEVEN HUNDRED
39 FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT,
40 OR SUCCESSOR PROVISIONS, AS THE COMMISSIONER OF HEALTH SHALL DEEM NECES-
41 SARY TO SECURE APPROPRIATE FEDERAL FINANCIAL SUPPORT FOR THE COST OF A
42 PROGRAM TO AUTHORIZE MANDATORY MANAGED CARE FOR MEDICAL ASSISTANCE
43 RECIPIENTS RESIDING IN ALL AREAS OF THE STATE, INCLUDING RECIPIENTS OF
44 SUPPLEMENTAL INCOME AND PERSONS ENROLLED OR ELIGIBLE TO BE ENROLLED IN A
45 MEDICARE TEFRA PLAN.
46 S 4. Section two of this act shall not take effect unless and until
47 the commissioner of health receives all necessary approvals under feder-
48 al law and regulation to implement its provisions, and provided that
49 such provisions do not prevent the receipt of federal financial partic-
50 ipation under the medical assistance program. The commissioner of health
51 shall submit such waiver applications and/or state plan amendments as
52 may be necessary to obtain such approvals and to ensure continued feder-
53 al financial participation.
54 S 5. This act shall take effect immediately; provided, however, that:
S. 2737--A 4
1 (a) the amendments to section 364-j of the social services law made by
2 sections two and three of this act shall not affect the repeal of such
3 section and shall be deemed repealed therewith;
4 (b) the amendment to subparagraphs (ii) and (iii) of paragraph (b) of
5 section 364-j of the social services law shall not affect the expiration
6 or repeal of such subparagraphs and the repeal of such section;
7 (c) provided that the commissioner of health shall notify the legisla-
8 tive bill drafting commission upon the occurrence of the enactment of
9 the legislation provided for in section two of this act in order that
10 the commission may maintain an accurate and timely effective data base
11 of the official text of the laws of the state of New York in furtherance
12 of effecting the provisions of section 44 of the legislative law and
13 section 70-b of the public officers law.
